“Canada has been debating medically assisted dying for decades, starting with court cases in the 1990s. Parliament needs to keep dealing with this issue directly so we can make progress. What does the member think about the role of the courts and public opinion on this?”

“Madam Speaker, I want to address the issue of courts and of public discussion and debates that have taken place over the years. I remember, from the early 1990s, the late Sue Rodriguez and what she ultimately had to go through. Her case went all the way to the Supreme Court. I believe it was a split decision, 5-4 or something of that nature, and she lost. The point is that we have been debating this issue for decades now. When I reflect back, I think it is important that Parliament address the issue head-on, which is what I see Parliament continuing to do, and hopefully there will be progress. I wonder if the member could provide her thoughts on the importance of public opinion, courts and so forth?”

“Deciding on medical assistance in dying is a deeply personal choice. Individual Canadians should be allowed to make this decision for themselves with proper information. The Supreme Court has ruled that this choice is protected by the Charter.”

“Madam Speaker, as I said, the split decision in Rodriguez actually exemplifies how complex the debate is, because it is a very personal choice. It is a very personal decision. Each of us brings value lenses to this discussion. In fact, that is precisely why we need to let individual Canadians make these decisions for themselves. They have to be properly informed, and they can be in consultation with whomever they choose, such as their family, but it is a choice we give to Canadians. In fact, the Supreme Court has told us that it is enshrined in the charter under Canadians’ section 7 rights of liberty and security of the person.”

“We need an open mind as we debate this bill. I want Canadians to have the right to make choices about their own bodies, including how they die.”

“Madam Speaker, in the House and around the committee table, we had the great benefit of hearing from so many people from a variety of backgrounds and with differing perspectives. In fact, it was a journey for me, too, to listen, because I came to the table with my own perspectives as well. Opening up one’s mind, as we are doing here today in debating this bill, is so crucially important. What I am envisioning for Canadians is what I have been talking about all along: the right to determine their own decisions with respect to their bodily autonomy and how they want to, if they choose to, leave this life in the way they choose is best for them.”

“I did not hear the whole question. But no doctor or nurse would help someone die without telling them first.”

“Madam Speaker, I am without the benefit of hearing the entire question. However, no medical practitioner is going to want to put themselves in a position where they have administered MAID without informing the person ahead of time.”

“I do not think the Conservatives speaking against this bill reflect what most Canadians think. I want the member to tell me if he believes his party's position matches the majority of Canadians.”

“Madam Speaker, I am going to go back to a question I have asked some of the member’s colleagues. I think it is an important question. What I am hearing from the Conservatives, I believe, is not necessarily a fair reflection of the overall opinions of Canadians as a whole. Does the member have any sense, in terms of the positioning by the Conservative members who have spoken so far, of whether it is truly reflective of what he believes a majority of Canadians might feel about the issue?”

“This bill only decriminalizes advance requests for medical assistance in dying, leaving the rules to the provinces. I want to know if the Leader of the Opposition would support that decriminalization if his concerns about the rules were addressed.”

“Madam Speaker, I respect a number of the things the Leader of the Opposition raised. I know it is a very difficult topic for many Canadians. I can remember my father, in the final stages of his cancer battle, struggling with what he wanted to do in terms of his directions. As we know, the bill would decriminalize advance directives. It would not set the framework. It would put forward the conversation, of course, that would take place between the provinces, but really, in this chamber it is about decriminalization. Does the Leader of the Opposition see a path in which, if he were satisfied with a framework that alleviated the concerns he raised in his speech, he would accept the decriminalized element of the process that this bill tries to achieve?”

“I want the House to pass this bill on medical assistance in dying to committee before Christmas. We have debated this issue for decades, and most Canadians support it. The Conservatives are asking for more debate and trying to split the bill just to stop it.”

“Madam Speaker, there are mixed emotions when approaching this particular debate because it is very much an emotional type of debate. I have had the opportunity to witness it first-hand for many years. In fact, when I look at its origins, I go back to just prior to the 2015 election, when a Supreme Court of Canada decision was made that ultimately put it on the agenda after Justin Trudeau was elected as Prime Minister. Under a new government, we had to deal with the issue. There was time for the Conservatives, even back in 2015, to attempt to bring forward legislation, but they did not do that. If I reflect on the number of comments I have heard thus far, a lot of those comments are related to members wanting more debate. They want to have more discussion. It is not that often that I agree with a member from the Bloc, but I can tell members that I believe there has been a great deal of discussion and debate for decades now. One only needs to turn to the province of Quebec, where we see strong leadership on this debate. It is a highly personal debate. What could be more intimate than discussions with family? I know this from my limited first-hand experience with the passing of my grandmother, when I was sitting at the St. Boniface Hospital, talking with my uncle and my father at her deathbed and listening to what the professionals had to say. Then a number of years later, and unfortunately the gap was not that great, came the passing of my father at the Riverview Health Centre. It is a bit better environment than St. Boniface Hospital, but the same questions were being asked, in particular with my father, who was scared of dying. Who blames an individual when that bridge comes? There is a point in time in most lives where for an extended period of time, they reflect on that. When that time comes, I believe it is critically important for family, friends and health care professionals, who play a critical role, along with spiritual leadership quite often, to get engaged in a very real and tangible way. I think we often underestimate the important role that our health care providers and those who support them play when it comes to end-of-life care. I think of my father’s passing. When we got him into the Riverview Health Centre, it did not look very promising. There were some medications that ultimately made him feel a whole lot better. I remember him saying to me, “I’m feeling better today than I was three weeks ago.” I talked to the doctor about it, who said that a lot depended on the medications and that while they had been very successful, we should not build our hopes up because it would be very short term. The doctor was right. It did take place relatively quickly. My father, in the discussions he was having with me, was talking about the cemetery and where he wanted to be buried. He wanted us to understand that he did not want something prolonged like what he had witnessed, to a certain degree, with his mother, my grandmother, at the St. Boniface Hospital. We really never know until we are put into that position, but I do believe, at my core, that it is the person who should have the ability to make that decision. When we take a look at what has taken place over the last few decades, I go to Sue Rodriguez who, during the early 1990s, had Lou Gehrig’s disease. She raised the discussion, not only on a national level, but back then it was taken into consideration around the world. When it came to MAID back in 1993, our Supreme Court of Canada made the decision, 5-4, not to move ahead, no doubt for all sorts of reasons. However, the debate has evolved significantly since then. I would like to read what Sue, apparently sometime in December 1992, stated. She said, “I want to be in charge of my life and my death.” I was a parliamentarian back then and I followed the news quite closely. I can tell members that it ignited a fierce discussion, and it was not just in Manitoba. I believe that discussion has never ended. When we take a look at the Carter decision, which was made prior to the 2015 election, maybe it was at the end of 2014 or 2015, but if we take a look at the arguments, I suspect that the world had changed, because even when the decision was made about Carter by the Supreme Court, there were actually a number of countries that had already put MAID into place, or some form of MAID. Public opinion has changed on the issue of MAID, even in the last decade since we passed the original legislation, which is why I was posing the question to members opposite. I was not trying to be mischievous. I believe that opinions have changed. If we canvassed Canadians as a whole, we would find that a majority of Canadians want us to move in this direction. When I think of the individuals who show up at my discussions at McDonald’s or in other environments, it seems to reinforce the public opinion that we need to look at moving in the direction that this legislation is bringing us. It is why I highlighted that it is important when we look at legislation, in good part, that we reflect on what a majority of Canadians would want us to be saying. We can still have our strong personal beliefs, and that is why I asked one member what they felt their constituents would have to say. Is there not a responsibility at least to have more of a balanced approach in debating the legislation? I have not seen that balance coming from the Conservative members thus far in the debate. That even includes the leader of the Conservative Party. I do believe we need to have a perspective that deals outside our personal opinions. This is why I think it was important for me to talk about a bit of the history and how it has been evolving. As I said, with the Carter decision, there were countries that had MAID. Since that decision, we have seen many other countries explore MAID and I suspect some of those countries are even looking at what Canada has been doing with MAID, because Canada does matter, not only on economic issues, but on social issues also. We talk about establishing a framework that would allow provinces to put into place a process that protects the integrity of the system. I can appreciate that there are examples that are going to be brought forward during this debate and even previously where there might have been very strong allegations, some of them no doubt proven to be true, which cause a great deal of concern to every member of the House, no matter what side of the debate they are on. For example, when I hear about a veteran who has been instructed, that concerns me greatly, as it would for any Canadian who has been hoodwinked or made to believe they do not have any other options. That does disgust me, but it does not mean we get rid of the opportunity for the thousands of people who have accessed MAID because they believed it was important for them. This is why I say that this has been evolving. When we talk about establishing the framework with strong guardrails, the debate does not end here. The debate will continue on in provincial and territorial regimes in Canada. Members across the way will say they want one standard practice across the nation. It does not work that way. We have provincial jurisdiction. They are constitutionally given jurisdictions that we have to be sensitive to and respect. This means we have to work with provincial and territorial governments in hopes that the provinces that want to continue to provide MAID are in a position to do so. I would expect those provinces and territories to add to the very basic guardrails we would be putting into place, and I believe they will. I believe that just as I believe that every member in the House of Commons is genuinely concerned about the subject matter. After all, we are talking about life. I believe the provinces and territories will also take the issue as seriously as members of Parliament do. As we, the Supreme Court and other courts have recognized, it is time that we see the charter, understand what a right is and bring forward laws that would enable MAID not only to exist, but to be supported and, at the same time, protect the individual. That is something that is within this legislation. There is no need to divide the legislation, as the Conservatives are arguing for. In my opinion, we cannot justify it. If someone says that they want more debate time, what they are really saying is that they do not want it to pass, because we have had decades of commentary and debate, inside the House and outside the House. The public has weighed in. Our courts have weighed in. Parliament has weighed in. I was here through the many debates that we have had inside the chamber over the last decade since we actually decriminalized it in 2016. I witnessed members of all political entities cry, share their stories and talk about what had taken place in the committees, which was gut-wrenching, no doubt, at times. We have had the opportunity, and we are going to have still more debate and more committee meetings on the issue. However, let us say, for the sake of argument, that we were able to pass the legislation with the its principles still intact. I do not want to preclude what could happen at the committee stage. We should be able to pass this, hopefully before Christmas. I believe that is a reasonable request, but one of the ways we can ensure that, and have time at the committee stage, would be for the House leadership teams to work on a way that we could actually pass this legislation to committee stage. Why oppose its going to the committee stage? At committee stage, there would be ample opportunities for stakeholders and parliamentarians to continue adding comments, issues, concerns and so much more. The opportunity is there, but I believe that we need to move forward with the principles of the legislation, as I would ask of those individuals who want to continue debate. I unfortunately do not have enough time. I would have loved to talk about the issue of hospice care. I would have loved to talk about the issue of palliative care. It is not just money. It is an important aspect, but the greatest threat to health care is not just financial resources, but it is how we manage the changes that are necessary so that we can have the type of quality health care that Canadians want and expect. There needs to be more financial accountability in that area. We need to look at personal care facilities, hospice care facilities and how our hospital institutions administer and provide palliative care, as an example. I look forward to seeing provinces and territories enter into the debate and discussions, and to taking a look at what the province of Quebec already has on the table. There are already things in place that other jurisdictions can look at. I suspect, over the coming weeks and months as the bill leaves Parliament, that we are going to see more debates on it at the provincial and territorial level, where they will no doubt be expanding on the issue of safeguards and protecting the rights of the individual. I see my time has expired. I appreciate the opportunity to share a few words.”

“We need to listen to all sides of this issue, not just the people who complain to their MP. People's views on medically assisted dying have changed over time. This bill matches what Canadians believe today, and provinces will still help run it. We need to move forward with it.”

“Madam Speaker, I would not suggest that Parliament has to follow polls. I would suggest that it is imperative, when we talk about an issue like this, that we ensure that we represent the different sides. It should not be all one-sided. For example, I posed a question to one of his colleagues and the remark was that the majority of all the people who contacted that member do not like it, or something of that nature. That is the essence of it. I think we have seen an evolution. I say “evolution” because it really has not been all that fast. We are going back to the nineties. The legislation that the government has put forward is, ultimately, a reflection of today’s times. We do need to move forward, and there is still the opportunity for the provinces and territories to administer it.”

“The member knows a lot about this issue and how Quebec handles it. I hope he joins the committee on this bill, and I encourage him to share his ideas with the minister.”

“Madam Speaker, I know the member has been a very strong leader on the whole debate around MAID for a number of years, and I have appreciated his contributions, as the minister expressed to me his appreciation of the member’s comments. I know he gives a lot of thought to it. I would encourage the member to take advantage of what he brings to this Parliament on the issue. The depth of his knowledge of what is happening in Quebec could be of great benefit to Parliament. I trust and hope he will be one of the committee members, but he might want to consider bringing some of his thoughts and ideas, even before bringing them to committee, to the minister.”

“I voted the way I did because the government was already working on this law. We had to follow a court order to avoid serious problems. Over the last ten years, this issue has changed because of court rulings, people's real experiences, and public input. More countries now have medically assisted dying laws, and people understand it better today.”

“Madam Speaker, for one of the private members’ bills that the member referenced, there was already discussions of the government bringing in legislation. The member knows that. After all, there is a court order, and if we do not respect that court order, it will cause a great deal of problems. We need to be able to make changes. At the end of the day, I would suggest to the member, as I tried to do in my comments, that as we have seen the debate evolve, we have seen significant changes. Some of those changes are brought upon us through courts and others were through lived experiences. We have had more people provide their thoughts on it since we have now had it over a decade. One thing I made reference to earlier, which the member would no doubt be aware of, is there are many more countries today that have MAID legislation. I think it is becoming better understood, not only here in Canada, but abroad as well.”

“How will the government work with doctors, nurses, and the provinces to make sure advance requests are done safely and smoothly?”

“Madam Speaker, how does the government plan to work with the medical community and the provinces to make sure that advance requests are implemented smoothly and surely?”

“Provinces and territories have a key role here, and Quebec is in the best position to handle it. The federal government wants to work with them and support their rules. I trust the provinces and territories to make the laws and rules needed to keep everyone safe.”

“Madam Speaker, I really appreciate the member’s question because it amplifies the importance of recognizing that the provinces and territories play an absolutely critical role. The province of Quebec is the one in the best position. The minister and the Government of Canada are very open to working with provinces and territories if there are ways we can be supportive in those guardrails. We are obviously very concerned in that regard. I have faith and confidence in our provinces and territories to bring in the legislation and the regulations necessary to provide that high sense of comfort for all.”

“People can change their minds and say no right up until the end. Last year, over 600 people asked for medically assisted dying and then changed their minds. That shows the system worked for them. I will look more into this issue.”

“Madam Speaker, the short answer to that is yes, they would be able to say no up until the very end. I will look a bit more into the issue. At the end of the day, as the member himself pointed out, there are 600 and some people who said yes at one point, but changed their minds. To me, that says the system worked for those individuals because they changed their minds, unless I am missing—”

“Some people strongly want the right to choose medically assisted dying in advance, and they can always change their minds. Why does the member think they should not have that right?”

“Mr. Speaker, if we take the other side, what about individuals who feel very passionate about the fact that they want to be able to make that decision? Does the member feel any sense of obligation to those individuals? After all, they know they can always reverse the decision. Why does the member feel that person should not have the right to make the decision?”

“This bill says that a doctor cannot help someone die if that person says no, resists, or shows they do not want it. Conservative members are saying the opposite. We must read the actual bill and not spread false information.”

“Mr. Speaker, I am going to start off by giving a quote directly from the legislation. Under clause 5, it states: A medical practitioner or nurse practitioner must not administer a substance to a person to cause their death on the basis of an advance request if the person demonstrates, by words, sounds or gestures, refusal or resistance to have the substance administered to them. Once the person demonstrates such refusal or resistance, medical assistance in dying can no longer be provided to them on the basis of that request. We need to think about what the legislation says. A number of members of the Conservative Party have stood in their place and said something completely opposite to that. I suggest that that is what we have to guard against: misinformation on such a serious debate.”

“Diseases like Alzheimer's take away a person's ability to choose to die with dignity. I want my colleague to explain why we should listen to people with these illnesses and let them make this choice in advance, while they still can.”

“Mr. Speaker, as my colleague said, tonight’s debate deals with fundamental issues of dignity and autonomy regarding the options available to people suffering from incurable illnesses. We have heard various accounts from people suffering from diseases such as Alzheimer’s, a condition that robs them of the choice to die with dignity. I would like to ask my colleague why it is important to listen to the experiences of these individuals and to establish a framework that will allow them to make a free and informed choice while they are still able to do so.”

“The federal government makes the criminal laws for medically assisted dying, but the provinces run health care. I want to know if the provinces are ready to handle advance requests. Are they ready to watch over doctors and nurses to make sure it is done safely?”

“Mr. Speaker, medical assistance in dying and health care are matters of shared jurisdiction. Criminal law is defined at the federal level, while the provinces are responsible for delivering health care. I would like to hear my colleague’s thoughts on how the provinces are prepared to manage the transition to advance requests. Are they adequately equipped to supervise health care professionals to ensure that it is carried out safely?”

“This bill lets people with illnesses like Alzheimer's choose their end-of-life care while they can still make that decision. People living with these illnesses told us they want that choice. What does the member say to them?”

“Mr. Speaker, through Bill C-41, we are establishing a framework that would allow people living with conditions such as Alzheimer’s to make a free and informed decision about their end-of-life care while they are still capable of doing so. This decision was not taken lightly. We heard deeply moving testimony from many individuals living with these conditions, and they expressed a desire to be able to make that choice while they still have capacity. I would like to ask my colleague this: What does he say to those individuals who came forward to give testimony and who are asking for the right to make that choice?”

“We should not allow assisted dying for people with chronic mental illness. We need to give them hope and care instead. People should also stop speaking badly about the doctors and nurses who provide palliative care and assisted dying. Allowing people to make an assisted dying request in advance is just like respecting a do-not-resuscitate order.”

“Mr. Speaker, I want to thank the Homewood Research Institute, which is based in Guelph and is a global leader in mental health research, for the really incredible webinar it did outlining why it was important not to proceed with permitting medical assistance in dying for folks who have a chronic mental illness. Part of that is to continue to give them hope and to make sure that nationally we provide access to care. What I am concerned about when listening to the debate tonight is that I feel like there is some level of disparagement toward the palliative care practitioners in this country and the people who administer MAID, who absolutely seek the consent of people and accompany them with dignity in their final moments. I just want to make sure that we are not straying into that space. I would also point out that if we sign a “do not resuscitate” order, that order is respected should it come to that in a hospital. An advance directive is essentially the same thing.”

“I support this bill. It lets people diagnosed with diseases like Alzheimer's make an advance request for medically assisted dying while they can still make their own choices. It also keeps assisted dying closed to people whose only medical condition is a mental illness.”

“Mr. Speaker, tonight, we have gathered to discuss a particularly sensitive issue that raises legal, ethical and social questions affecting patients suffering from an incurable disease, their families and health care professionals. I believe this is a topic we all take very seriously. Let us take a step back. The law on medical assistance in dying came into effect in Canada in 2016. That marked a significant change in Canadian society’s approach to end-of-life care. MAID provides eligible individuals with an additional choice regarding their care by allowing them to end their suffering with dignity. There are certainly strict guidelines in place. Medical assistance in dying is reserved for adults who meet strict eligibility criteria. We are talking, for example, about people living with an incurable illness who are approaching the end of life, such as cancer patients, or individuals with an incurable condition that causes irreversible physical decline and significant suffering, such as certain neurodegenerative disorders. There are guidelines that must be followed. The consent must be informed. The person has the right to withdraw consent at any point in the process. The passage of the bill in 2016 was not the end of the debate. I would say that it was the beginning and the continuation of an ongoing societal discussion on the subject of MAID. Over the past decade alone, we have pondered substantive questions about MAID, such as whether a person has a right to set the conditions for their end of life. This led to questions about dignity and suffering. As we know, the law was expanded in 2021. Initially, it was for naturally foreseeable death. The law was amended in 2021 to include people suffering from an irreversible illness that causes significant suffering. At the time, as a citizen, I heard very touching testimony from people who asked that their situation be taken into consideration so that they could have the right to make this choice for themselves. This also raises questions about the protection of vulnerable individuals, consent, and the ability to make a free and informed decision, as well as what to do when an illness deprives a person of that ability. With Bill C-41, we aim to update Canada’s legislative framework on medical assistance in dying, particularly with regard to people with mental illness and advance requests. We are therefore clarifying matters with respect to these two elements. I would say that this is another step in a collective reflection that began more than a decade ago. One key component of Bill C-41 seeks to allow for advance MAID requests. Under the current legislation, a person must be able to give informed consent to receive this care. They must understand their medical condition, their options, and the consequences of their decision. As a general rule, they must also confirm their consent immediately before MAID is administered. Very strict guidelines are in place. However, some diseases, such as Alzheimer’s disease and other forms of dementia, can lead to a gradual loss of decision-making capacity. As the disease progresses, a person may lose the ability to make an informed choice at the time they wish to receive MAID. Under the current rules, they cannot access this option, even if they had clearly expressed their wishes earlier in life when they were still capable of making that decision. Our government believes that Canadians with terminal illnesses should be able to make informed decisions about their future care while they still have the capacity to do so. That is why, with this bill, we intend to allow eligible adults who receive an early diagnosis of a terminal illness that is likely to cause them to lose their decision-making capacity to make an advance request for MAID. For example, an adult diagnosed with early-stage Alzheimer’s disease could specify in advance the conditions and circumstances under which they would want to receive MAID at a more advanced stage of their illness, when they would no longer be able to make that decision for themselves. The underlying objective is to respect the person’s wishes and their individual end-of-life choices, which I believe are based on deep and careful reflection. We heard some very moving testimony. Loved ones of people with Alzheimer’s said that MAID should be expanded to allow people in these situations to make informed choices while they still can. An advance request does not necessarily mean that MAID will automatically be administered at a later time. The eligibility criteria must be met and the strict guidelines must be followed. For example, two independent assessments will always be required for advance requests to ensure that the conditions described in the request are met. There must be confirmation that the person is in an advanced and irreversible state of decline and experiencing profound suffering, so the independent assessments still need to be carried out. The person may also signify, through sounds or gestures, that they withdraw their consent when MAID is about to be administered. If the person does not appear to consent to MAID, the procedure will be stopped. Obviously, a family member cannot submit an advance request on behalf of someone else. The aim is really to respect the choice of the person who made the request while they still had the capacity to do so. In our discussions tonight, it is important to understand the key role that the provinces and territories will play in this matter. At the federal level, we can amend the criminal framework, including the Criminal Code, since this falls under our jurisdiction. However, the delivery of health care services is a provincial responsibility. The federal government alone cannot oversee the implementation of advance requests for MAID. Even if Parliament were to amend the Criminal Code for this, the provinces would also have to take steps to ensure that advance requests would be available in their health care systems. As I mentioned, the provinces are responsible for the organization and delivery of health care in their jurisdictions, and it will be up to them to decide whether they want to implement this option and how it will be carried out. What I mean is that, even if the federal law changes, it does not become automatic across Canada. The provinces will have to decide whether to implement the framework within their borders. Co‑operation with the provinces and territories will therefore be critical so that everyone who is eligible can have access. As the federal government, we will continue to work with the provinces as we make progress on this matter. I will now discuss the second part. Through Bill C-41, we will maintain the exclusion for cases when mental illness is the sole underlying health condition. After careful consideration, following committee deliberations, and after hearing from numerous experts, we came to an agreement that MAID should not be expanded to cover individuals for whom mental illness is the sole underlying health condition. That said, we recognize that mental illness can cause profound suffering, even when it is not necessarily as visible as in the case of other physical health conditions. Canadians living with mental health issues deserve to have their suffering taken seriously. In the context of MAID, however, serious concerns remain regarding the ability to assess these situations safely and consistently. For these reasons, we decided not to expand MAID eligibility to individuals whose sole underlying medical condition is a mental illness. As I mentioned, this decision was not taken lightly. A parliamentary committee made up of senators and MPs from the various political parties examined the issue. Health experts and stakeholders also gave evidence. Finally, following all these consultations, the Special Joint Committee on Medical Assistance in Dying recommended against expanding medical assistance in dying. At the same time, other consultations took place. The conclusion was that uncertainty remains as to whether these situations can be assessed reliably and consistently. In light of that, our government believes that the current exclusion is the most appropriate approach. In closing, we are debating substantive issues tonight, issues that affect the choices people make when they are considering their end of life. I think it is important that legislators put a framework in place, particularly for people suffering from conditions such as dementia or Alzheimer’s. It is important to give these individuals the opportunity to make a free and informed choice about their end-of-life care.”