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)

35 statements

Luc Thériault, Montcalm

Bloc Québécois
“The member would not answer my question because he thinks I do not belong here as someone who is not a federalist.”
Official Hansard

Mr. Speaker, he would not answer my question because my presence here is not legitimate, since I am not a federalist.

Luc Thériault, Montcalm

Bloc Québécois
“People across the country should have fair access to advance requests for medically assisted dying. Provinces manage health care, but a total ban would likely face a challenge at the Supreme Court. Also, studies show that poverty and poor services are not the main reasons people ask for this help. We should improve living conditions, but we cannot just tell people with untreatable mental illness to keep suffering.”
Official Hansard

Mr. Speaker, my colleague is right to point out that Svend Robinson and Sue Rodriguez advanced the discussion on MAID in 1993 in British Columbia. I would like to say something about the constitutional nature of equitable access to advance requests throughout the country whether or not a parliament passes legislation. I would say that this could be a reasonable infringement, according to the Supreme Court, given that the provinces are responsible for providing end-of-life care. A debate could take place in provincial legislatures that do not have a law. It could even become an election issue, in which case there would surely be an appeal to the Supreme Court if a government ever opted for a total prohibition. As for structural vulnerabilities, I agree that it is absolutely essential to improve people’s living conditions, whatever those living conditions may be. If we are talking about structural vulnerabilities in relation to mental illness, a scientific study conducted by Downar and Quinn says that structural marginalization is not a key factor in requests for MAID. Here is a quote: ...according to all available indicators....they clearly refute the notion that medical assistance in dying is driven by marginalization or inadequate service delivery on a significant scale in Canada. While there may be exceptions, the anecdotal cases cited to support this claim rarely stand up to scrutiny. We are therefore in favour of better living conditions, but in the case of someone who has been suffering from mental illness for decades and who does not respond to treatment, I have a problem with someone like that being told to simply carry on suffering.

Andréanne Larouche, Shefford

Bloc Québécois
“Doctors support patients and make sure they still want medical assistance in dying right up to the end. Quebec is ready to handle advance requests.”
Official Hansard

Mr. Speaker, I am hearing some interesting things this evening. There is a problem here. I wonder whether my colleague fully appreciates the clinical approach that underpins all of this. Right up until the very end, physicians support patients and ask whether this is still what they want. Quebec is prepared when it comes to advance requests. I have two—

Marie-Hélène Gaudreau, Laurentides—Labelle

Bloc Québécois
“We have the right to different beliefs, but we do not have the right to ignore human dignity. People should be allowed to make their own end-of-life choices with dignity.”
Official Hansard

Mr. Speaker, I am outraged this evening. We have the right to have different opinions. We have the right to hold certain beliefs and to disregard general statements or science. However, what we do not have the right to do is to disregard human dignity. I am hearing so much oversimplification right now. I am not saying that what I went through with my father, who had ALS, is right for everyone. That is not the case. We are asking if we can let people make their own end-of-life choices with dignity.

Luc Thériault, Montcalm

Bloc Québécois
“The government should not block people from choosing medical assistance in dying just because their only condition is a mental illness. Doctors can already tell if a person can make their own choices. Banning everyone with a mental illness is unfair and discriminatory.”
Official Hansard

Mr. Speaker, the member believes, as I do, that the role of the state is to ensure that the conditions are in place for a person to make a free and informed choice, not to impose what it thinks is best on a person who is suffering. However, when it comes to mental illness, on what grounds should the state restrict or undermine the right to self-determination of a person with a mental disorder who has been resistant to treatment for decades, as long as their decision-making capacity is not affected? Decision-making capacity can be assessed. Psychiatrists are already able to assess it when a mental illness exists alongside another condition, such as cancer. Why is it more complicated when the person just has a mental disorder? On what grounds should suffering that has become intolerable be considered reasonable under section 1 of the charter? On what basis, then, can discrimination be considered reasonable, when all of the experts told us that a blanket prohibition is discriminatory?

Luc Thériault, Montcalm

Bloc Québécois
“I know the member wants to split this bill into two bills. If that does not happen, I want to know if he will agree to vote on the parts separately instead.”
Official Hansard

Mr. Speaker, I understand that my colleague would prefer to see this bill split and for there to be two votes. If the bill is not split, would he at least agree to a split vote at second reading stage?

Luc Thériault, Montcalm

Bloc Québécois
“The Supreme Court ruled that medically assisted dying is not just for people who are dying soon. Forcing people to suffer until they are terminally ill violates their right to life. I want my colleague to explain why he is supporting a bill that goes against the Constitution.”
Official Hansard

Mr. Speaker, in his speech, my colleague said that he thought it was immoral for a person who is not terminally ill to have access to MAID. However, Bill C-14 was inconsistent with the Carter decision. Ms. Carter and Ms. Taylor were not terminally ill. They were approaching the terminal phase of their illness. Being terminally ill does not mean that death is imminent or that a person is not already experiencing intolerable and irremediable suffering. The Supreme Court is of the opinion that creating a blanket exclusion for people who are not terminally ill but who are suffering infringes on the right to life because it forces them to cut their life short rather than allowing them to determine when their suffering has become intolerable. What people want is to live as long as possible, up to the limit of what they can tolerate. That is what MAID allows for in cases that are not related to a reasonably foreseeable natural death. As a legislator, how can my colleague promote a bill that is unconstitutional?

Marie-Hélène Gaudreau, Laurentides—Labelle

Bloc Québécois
“I want the House to pass this bill and let Quebec use its own end-of-life rules. Quebec has already studied this for years and is ready to allow advance requests for medical assistance in dying. Individuals have the right to decide how they want to die before they lose the ability to speak for themselves. Holding more debates only delays people's right to make their own choices.”
Official Hansard

Mr. Speaker, it is late, but it is never too late to talk about what life is all about. In fact, death is a fact of life. That is what we are discussing tonight. Let me begin with my conclusion. We have heard our colleagues repeatedly point out that Quebec was ahead of the curve, that it conducted multiparty consultations and that it even took the time to examine each step of the process. Today, we are saying that Quebec is not only ready, but that it also needs the latitude, insofar as the Criminal Code is concerned, to fully implement its legislation. Here, we began studying medical assistance in dying five years ago, looking in particular at what took place in Quebec. That work yielded a wealth of findings that now allow us to clearly distinguish between two situations: advance requests and individuals who have been suffering from unbearable mental illnesses for decades. What I am beginning to realize is that we are not going to make it happen. Some people want to divide the bill, others want to have two votes. Basically, I cannot even keep up. There is one thing I do understand, though. Can we take action together and agree that if certain provinces and territories are not ready, that is their business? If we in Quebec are ready, because we have been talking about it for years, then please let us implement what we believe is right for us. This would illustrate that such a sensitive bill was drafted through a collaborative process. I do not think we will achieve that here in the House. We have perfectly legitimate differences of opinion, but when it comes to end-of-life care, human dignity is being set aside when the individual should come first regarding decisions about their own life. When someone is making a decision for themselves, I would feel very uncomfortable doing or saying anything that might influence that person. It is not up to me to tell them, no, they cannot die, or yes, they can die. It is up to the individual. I am saying this because I have been through it myself. I am talking about it, but I am certainly not trying to oversimplify things and suggest that the law should be based on my experience. I want that to be clear. I have lived experience. In 2017, my father was diagnosed with ALS. People who were here more than a decade ago knew the MP Mauril Bélanger. ALS is a devastating disease. It causes tremendous suffering. It can reach a point where a person is no longer able to endure that suffering, which in this case is both physical and psychological because the person is trapped in their own body. In 2017, my father participated in several research studies. At the time, even I, as his young daughter, would tell him that he could not possibly be thinking about death. He told me that death is just part of life. However, after discussing his case with researchers and scientists, he chose to die with his illness rather than from it. In the final stages of ALS, swallowing and breathing become increasingly difficult. The heart does not stop, but people generally end up suffocating. Because my father was eligible for MAID, he chose to die without having to endure that suffering. No one wants their parents to leave them, but he made me understand something. It was only afterwards that I realized how understandable it is not to want to lose a loved one. It is out of love. What I am hearing in these discussions is, above all, a fear that the person might miss out on something, that there could still be moments of happiness. I could have a colleague tell me that a person with dementia has experienced 24 hours of complete lucidity over the course of three months. Ultimately, it is up to the person who is caring for their loved one. We are unable to come to an agreement about the role of loved ones this evening. I am thinking back to when my father told me he was going to die from his illness. Of course, there was the possibility of intervention, but no one was ever able to intervene. I experienced it myself. How many times did we have to reaffirm the legitimacy of my father’s right to refuse treatment, to ask that he not be allowed to suffer, and to have his end-of-life wishes respected? He had been trapped in his body for 20 years. He told me one day that he had been using a ventilator, a BiPAP, for eight years, that he never took it off and wore it 24 hours a day, seven days a week. He could not take it anymore. The ventilator had replaced his lungs. I told him it was a natural reaction. That is what this is all about. Let nature take its course and let us not try to save lives. If we are sick, let us die. That is what I hear, and it troubles me. In my father’s case, he lived for eight years with a device that prolonged his life, but on the day he could no longer bear having that machine on his face all the time, we respected his wishes. It may have been that way from the start, eight years earlier, but he would have missed my wedding, he would not have seen my children grow up. Is it not selfish to want more time with our loved one? Essentially, today we are debating and talking about other people. When we are talking about others, perhaps we should ask the person who is making the choice what they want, particularly in the case of advance requests. That is also what worries me. Some say that people can live a whole other life. Earlier, I shared an analogy, or rather a story, about a colleague. I asked him what an advance request was. Simply put, sometimes we know somebody for 50, 60 or 90 years, and then they are diagnosed with Alzheimer’s. This person gets to say what they will and will not endure. They may not want their personality to change completely. They may not want to have to be fed. They may not want to be confined to a chair because they tend to wander around the building. I suggested a scenario where a person who has been in politics his entire life undergoes a 180-degree personality change, causing him to strip off his clothes and flirt with everyone he encounters. If this person acted happy, people would see it in a positive light. They would think he had certain wishes that he expressed when he still had the capacity to choose. Now that he no longer has the capacity to say that this is not the end of life he wanted, however, his wishes are no longer valid. That is what I am having a hard time understanding. As long as our discussions do not focus strictly on ethics and the protection of each individual’s right to choose, simply saying that we are going to hold more meetings and conduct more analyses will only prolong the debate. We will never see the end of it in the House. What I want is for every individual to be able to make their own decisions about how their life ends.

Marie-Hélène Gaudreau, Laurentides—Labelle

Bloc Québécois
“We need to focus our efforts on mental health care and prevention to save lives. When someone with mental illness asks for medically assisted dying, it is a cry for help. They will not be allowed to receive it, so asking gives us a chance to care for them instead of losing them to suicide.”
Official Hansard

Mr. Speaker, I did not have time to expand on prevention and the potential to save lives. Many of my colleagues have said that, when it comes to mental health in particular, we should start by putting all our efforts and energy into the service delivery networks. Yes, there are shortcomings. Imagine a loved one saying that they are going through an unbearable situation and they are going to request MAID. That person is sending a cry for help in the face of suffering. I am very sensitive to the issue of suicide. It may sound crazy to say, but if the person makes that request, rather than committing an irreversible act, that is, killing themselves, they have a better chance of getting through the crisis. That person will be cared for, because they will obviously not be eligible for MAID, and they will not fall through the cracks.

Marie-Hélène Gaudreau, Laurentides—Labelle

Bloc Québécois
“This bill does not force anyone to receive medically assisted dying, and people can change their minds. We should split the bill so we can allow advance requests now and study the mental health part more.”
Official Hansard

Mr. Speaker, I would like to clear something up. If I am diagnosed with Alzheimer’s disease, I will not directly receive MAID. If I do not want it and never will, I will never receive it. I am under no obligation. If I decide today that I want MAID, but I change my mind tomorrow, my most recent decision takes precedence. What is there to be afraid of? Does my colleague agree that this bill could be split? We could move ahead on advance requests, and the committee could take some time to explore the mental health component a little more.

Andréanne Larouche, Shefford

Bloc Québécois
“People claim we lack the data on this issue. Can my colleague share the facts from Quebec's committee report on dying with dignity?”
Official Hansard

Mr. Speaker, my question is simple. We heard that there was a lack of data and that there was no basis for it. Can my colleague, a member from Quebec, give us more details about the data and the serious approach undertaken by the Select Committee on Dying with Dignity? A report was published on this issue in Quebec.

Marie-Hélène Gaudreau, Laurentides—Labelle

Bloc Québécois
“Canada should copy Quebec's plan for medically assisted dying. If that is too hard, Canada should leave Quebec alone or let us separate so we can run our own affairs.”
Official Hansard

Mr. Speaker, I am so proud of that. Canada should take inspiration from the approach taken by the Quebec National Assembly. If that is too complicated, Canada should either let us be or let us leave, in which case we will take care of our own affairs.

Luc Thériault, Montcalm

Bloc Québécois
“People who are suicidal will not be allowed to get medical assistance in dying. Suicidal feelings can be treated and reversed, and patients are only eligible if their condition cannot be reversed. I want the member to read the guidelines written by the experts and doctors.”
Official Hansard

Mr. Speaker, I served on the Standing Committee on Health with my colleague. I am very familiar with, and deeply appreciative of, his personal commitment and all the efforts he makes to support suicide prevention. I think it is very generous of him to share these personal stories during tonight’s debate. I wanted to reassure him. As for eligibility and MAID for mental illness, I do not know what makes him say that he would have been eligible. I do not think he would have been. The proof is that he is here and that suicidality is reversible. It is only in a situation of irreversibility that we begin to assess the issue. Suicidality is reversible and is not inevitable. The experts’ report helped establish guidelines, as did the standards of practice established by the Canadian association of providers. I urge my colleague to review these guidelines. He will see that we are not allowing people who are suicidal to access MAID.

Luc Thériault, Montcalm

Bloc Québécois
“People should be allowed to make advance requests for medical assistance in dying. The Conservatives oppose this, even when someone is suffering from declining health. I want to know what other solution the Conservatives have to help these people.”
Official Hansard

Mr. Speaker, I would briefly like to mention a minor concern. I have sat on clinical ethics committees before. The last thing we would be allowed to do is make a decision based on reported cases without full and comprehensive knowledge of the situation in question. That said, I have been listening to the Conservatives since the debate started. They tell us that advance requests are not possible, even if a person is suffering, because that person could have other illnesses. It seems that they even object to advance directives. In a long-term care facility, there are different levels of care. If I have Alzheimer’s and I have a heart attack, and I am not resuscitated, I suppose they would object to that. What I want to know is what solution they have for people in declining health who are suffering, because suffering is part of it. What is the solution?

Luc Thériault, Montcalm

Bloc Québécois
“I want people to be able to make advance requests for medically assisted dying. The Conservatives would force people with cognitive decline to suffer until the very end. The Supreme Court said blocking this option forces people to end their lives sooner than they want to. People want to live as long as they can, but they should be allowed to choose when their suffering becomes too much.”
Official Hansard

Mr. Speaker, if I understand correctly, the Conservatives’ position on advance requests is that people who become incapacitated and will suffer due to cognitive decline should die after suffering to the very end. That is the Conservatives’ solution. I would invite my colleague to meet with Sandra from Montigny and tell her that. They care about suicide prevention. The Supreme Court said that this infringes on the right to life because people will be forced to shorten their lives. What people do is set a threshold for what they consider tolerable. They want to live for as long as possible, but when they reach that threshold, they are asking us to compassionately prevent them from continuing to suffer through their decline. The Conservatives’ solution is to tell them to keep suffering until the very end. I do not know if my colleague has ever seen someone dying of Alzheimer’s disease suffer to the very end. If he wants to see that, I can invite him over.

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