Medical Assistance in Dying Safeguards Act

Bill C-41, Medical Assistance in Dying Safeguards Act · Second reading · now at second reading in the House Where it stands

What Bill C-41 would do

The bill would permit doctors and nurse practitioners to provide medical assistance in dying to people who have lost the capacity to consent, if they made an advance request while still able to do so. To qualify, the person must have been diagnosed with a serious and incurable condition expected to cause that loss of capacity, and their province must have a system to store and track those requests. The bill would also permanently exclude people from receiving assisted dying solely on the basis of a mental illness.

Official text (opens in a new tab)

10 statements

Leslyn Lewis, Haldimand—Norfolk

Conservative
“I want the minister to tell me who decides if a person lives or dies when they cannot make decisions for themselves and did not leave clear instructions.”
Official Hansard

Mr. Speaker, I thank the minister for his speech and the tone of his speech. There are so many people in Canada who are very interested in this subject. When I was a lawyer, I often had to take people’s directives, when doing a will, of what they wanted if they ended up in a situation where there was no prospect of recovery, they were on life support and their life was completely diminished. They set those standards, and it was very clear to a practitioner what those standards were. My question for the minister is, what happens when those standards are not there? Who is the arbiter of a person’s life? Who makes those decisions, whether a person can live or die at that particular time, when they do not have the capacity to do that?

Ziad Aboultaif, Edmonton Manning

Conservative
“I want the minister to explain how this bill will protect vulnerable people with mental illness, including veterans.”
Official Hansard

Mr. Speaker, today I remember a friend of mine, Alex Tsang, who accessed the system three years ago, and it was a very difficult moment for him and his family. I visited with him at his place hours before he went to take the procedure. The question remains in the mind of all Canadians, and that is about justice, when it comes to this important bill that we have been visiting over and over since 2016. I have been here for 11 years. The question to the minister is this: How can we ensure for vulnerable Canadians, veterans and others with mental illness, that this new legislation would provide that justice that they are looking for?

Costas Menegakis, Aurora—Oak Ridges—Richmond Hill

Conservative
“I do not want this bill to pass without much stronger rules. Letting people ask for medically assisted dying years in advance is dangerous because feelings change and people who cannot speak for themselves cannot give consent. It risks wrongful death. We need stronger national rules, independent oversight, and better care and housing so people do not choose death just because they lack support.”
Official Hansard

Mr. Speaker, I rise today to speak to Bill C-41, the medical assistance in dying safeguards act, undoubtedly a matter of profound moral weight and a subject that touches on the core of our humanity, our duty of care and our responsibilities as legislators. Few issues before this House demand as much solemn reflection, unyielding principle and careful constitutional stewardship as medical assistance in dying. Our core priority as Conservatives has been clear from day one and will continue to be about protecting vulnerable Canadians and ensuring that robust, clear and uncompromised safeguards are in place surrounding consent and patient safety. Canadians must be able to trust that any decision regarding MAID is strictly voluntary, fully informed and completely free of pressure, subtle coercion or undue influence from any outside source. However, as we examine the current trajectory of MAID expansion and the legislative proposals before us surrounding advance requests, serious legal, ethical and practical questions arise. These are questions that we, as elected representatives of the people, cannot afford to sweep aside or ignore for the sake of political convenience. Allowing individual provinces and territories to decide independently on whether to permit advance requests risks creating a deeply confusing, fractured patchwork of systems across Canada. I do not want to digress, but we can point to many examples that speak to exactly that, where we have mayhem when too many people and too many jurisdictions have control over similar things. Quite often, it is not in the national interest and not in the interest of Canadians. Back to this legislation, such fragmentation would only serve to increase inequity in MAID access, while simultaneously weakening standardized oversight. Canadians deserve the same baseline protections and safety guarantees, regardless of the province or territory in which they reside. Leaving essential aspects of advance requests to a mosaic of provincial legislation raises deeply concerning prospects of inconsistent safeguards across our country. Furthermore, the proposed decriminalization of advance requests introduces deeply contested legal and ethical considerations that our legal framework is ill prepared to manage. Advance euthanasia requests would introduce heightened and unprecedented risks for both patients and health care providers, including the irreversible and devastating risk of wrongful death. Consider the fundamental, irreconcilable challenge of consent. How can consent be truly protected when a person can no longer communicate their current living wishes? A decision taken and recorded years or even decades earlier in a legal document may not reflect how that same individual feels today. Human circumstances change, perspectives shift, and human resilience in the face of hardship often surprises us. Advance MAID requests must not be allowed to remain valid indefinitely without mandatory regular review, renewal and re-evaluation. Equally dangerous is the reality that under this proposed advance request model, health care practitioners would effectively be forced to substitute their own subjective judgment to determine whether a patient’s suffering has become intolerable at a time when the patient can no longer express how they actually feel. No Canadian should ever receive MAID because someone else, whether a doctor, a family member, a bureaucrat, a politician or anyone else, believes their suffering has become unbearable. Disability, dependence or declining health should never be treated as proof or justification that a person’s life is no longer worth living. Our legal safeguards must explicitly protect vulnerable Canadians from ageist or discriminatory assumptions about their quality of life. If there is ever any doubt about whether someone is actively refusing MAID, their life must come first if they express reluctance in any way. A simple 30-day waiting period is no substitute for a thorough independent assessment when genuine uncertainty exists. Parliament must be fully satisfied that safeguards can reliably protect people who are no longer able to speak up or advocate for themselves. We must also directly confront the broader scope of MAID’s expansion into health care domains where safety cannot be guaranteed. Canadian legal and health care systems are simply not equipped to respond safely to the expansion of MAID where mental illness is the sole underlying medical condition. For years, Conservatives have stood firm on this critical point, advocating for caution and medical responsibility. I am pleased that the Special Joint Committee on Medical Assistance in Dying finally aligned itself with Conservative leadership in recognizing that mental illness as the sole underlying condition should be indefinitely paused. Maintaining that exclusion explicitly recognizes the significant unresolved safety concerns surrounding these complex clinical cases. My colleague the Conservative member of Parliament for Cloverdale—Langley City took concrete legislative action on this issue by introducing a private member’s bill, Bill C-218. Her bill would have amended the Criminal Code to permanently repeal the scheduled expansion of the MAID program for mental illness as the sole underlying condition. Unfortunately, and for reasons very difficult to defend, the Liberals voted against it. We must ensure that our national laws offer treatment, comprehensive psychiatric support, compassion and hope to those facing severe mental health struggles instead of an administrative avenue to simply end their lives. To restore trust and ensure strict accountability across the entire medical system, Conservatives have consistently advocated for stronger federal monitoring and comprehensive public reporting. We need minimum national standards for MAID oversight, updated clinical guidance, training for practitioners and an urgent, thorough review of the effectiveness and real-world enforceability of current safeguards. To that end, Canada should establish an independent national MAID oversight commission modelled after Quebec’s framework to review individual cases, monitor strict compliance with legal standards and publish detailed annual reports for the Canadian public. At the absolute heart of the debate is a basic moral promise that no Canadian should ever feel that MAID is their only available option because they cannot access proper medical care, affordable housing or adequate social support. Vulnerable Canadians deserve real care, robust protection and genuine hope. They should never be offered MAID as a tragic substitute for basic social and medical support that their governments have failed to provide. Governments must prioritize and ensure meaningful, universal access to high-quality palliative care, disability supports, specialized housing and mental health services in every community across this country. Our laws reflect our core social values. When citizens are at their most vulnerable, such as when they are sick, aging, living with disabilities or facing severe personal hardship, they need to know that their country values their existence and that we stand by them. Let us ensure that our national legislation upholds human dignity, strengthens national safeguards and unequivocally puts the protection of human life first.

Costas Menegakis, Aurora—Oak Ridges—Richmond Hill

Conservative
“I support keeping mental illness out of medical assistance in dying, but I still have serious concerns. The government should focus on providing proper healthcare, housing, and social services instead of offering medically assisted dying as an easy way out.”
Official Hansard

Mr. Speaker, the hon. member’s question was very thoughtful. We welcome the exclusion of mental illness as the sole underlying condition, but serious questions still remain. That addresses the first part of the member’s question. On the second part, I think it is incumbent upon the government, and upon all of us as legislators, to ensure the proper health professionals, social services and housing, all of the issues that are important to fundamental dignity and life for all Canadians, are available to them. We need to focus on improving those services rather than having an easy out where someone can opt for MAID. We are playing with a very deep moral, ethical and, in some cases, religious issue here. It is much more important that we focus on providing adequate services to people rather than legislation such as this.

Costas Menegakis, Aurora—Oak Ridges—Richmond Hill

Conservative
“The federal government should keep control over assisted dying rules. Giving this power to the provinces has not worked well in the past. This issue is too important to all Canadians to leave to the provinces without strong federal oversight.”
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Official Hansard

Mr. Speaker, it is a slippery slope when we start passing on our responsibility as federal legislators and including more and more legislative bodies across the country to have the provinces to weigh in and have jurisdiction over something as important as this, especially the specific details of this particular legislation. We have seen other matters of jurisdiction across the country that have been disseminated down to the provinces, and we have seen how that has not worked effectively. This is something of profound moral interest to all Canadians, and I do not believe in including provinces, giving them additional responsibilities and having them weigh in on this without clear federal oversight. The things that need to be addressed in this particular legislation should be passed on to the provinces.

Ziad Aboultaif, Edmonton Manning

Conservative
“I want my colleague to say more about how we can protect people with mental illness from this law.”
Official Hansard

Mr. Speaker, my colleague mentioned Bill C-218, which sought justice and protection for people with mental illness from the expansion of this bill. If he does not mind, I wonder if he could elaborate on what he meant by that and why the bill was necessary to protect vulnerable Canadians.

Costas Menegakis, Aurora—Oak Ridges—Richmond Hill

Conservative
“We should not allow assisted dying for people with mental illness. Offering it to people at their lowest point makes no sense. We needed my colleague's bill to stop this, but the government voted against it.”
Official Hansard

Mr. Speaker, I want to thank the hon. member for sharing a very personal and passionate story about his personal experience with a close friend of his who he had to unfortunately say goodbye to. It is something that touched him profoundly and he shared it with us here in the House. Mental illness is a big subject. It encompasses a whole bunch of different people who have mental illness for a whole variety of reasons, and there is a process to get through that. To give them the option of MAID at a time when they are at the lowest in their lives, when they feel there is no future for them, whether it is health-related or otherwise, makes absolutely no sense. Excluding it from the legislation through the legislation my colleague put forward in the House was mandatory and needed. Unfortunately, the government voted against it.

Costas Menegakis, Aurora—Oak Ridges—Richmond Hill

Conservative
“We need to study this assisted dying bill very carefully. We must listen to doctors, lawyers, families, veterans, and people with disabilities. We should send the bill to committee and propose changes to improve it. The government needs to listen to other parties and the public, because this bill is about human life.”
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Official Hansard

Mr. Speaker, Bill C-41 is before us. I think it is incumbent upon us to discuss it in full detail in the context of what it means for people who are at the end of their life or who are very close to people who are at the end of their lives. I think we need to carefully examine this piece of legislation. We need to consult medical professionals, legal experts, families, veterans and people living with disabilities and listen to them. We need to bring it to committee, discuss it, discuss it here in the House and propose amendments. The government has not been forthcoming in welcoming amendments from other parties in the House. With legislation like this, I think it is important that the government listens to not only what its members think, but also what other people think as well. We are the voice of the people in the House. We should listen to the experts who give us advice and make this legislation as strong and as foolproof as possible, because we are talking about the most important thing for all of us, which is life.

Branden Leslie, Portage—Lisgar

Conservative
“I worry that the safeguards in this bill will not be enough. How can we make sure the government listens to experts so these rules actually protect people?”
Official Hansard

Mr. Speaker, I appreciate that this is a difficult subject. Many of us, if not all of us, have had a loved one who has struggled with mental illness or aging challenges such as dementia. My concern is trying to understand whether or not these safeguards are going to be enough in this law. My colleague just pointed out the importance of life. I am curious about his thoughts on how best we go about ensuring that the government is willing to listen to those experts and help us understand what the necessary safeguards are to make sure the rules in place are actually achieving their intended results.

Costas Menegakis, Aurora—Oak Ridges—Richmond Hill

Conservative
“I want stronger federal rules and oversight for assisted dying. People must have a choice right up to the last second. This bill lets someone ask for assisted dying decades before it happens, but they might change their mind later.”
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Official Hansard

Mr. Speaker, our party, the Conservative Party, has advocated for stronger federal monitoring and public reporting. I want to thank the member for his question because it gives me an opportunity to say that I think we should all believe that there should be minimum national standards for MAID oversight. We should have updated guidance and training and a review of effectiveness and enforceability of current MAID safeguards. This needs to be ongoing. It needs to be serious. We need to look at it and ensure that oversight is there, and that we absolutely, at all times, ensure that the person has their choice up to the very last second. This legislation, for example, would allow someone to make a decision decades earlier, but decades later, they may have changed their mind. We cannot go by that. Safeguards are very important in ensuring that we preserve the will of the person whose life is at stake.

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