“People often change their minds about medically assisted dying. In one year, 692 Canadians asked for it and then changed their minds. Advance requests are wrong because they allow doctors to end a person's life without checking if they still want it.”

“Mr. Speaker, I want to really thank my colleague for a profound and thoughtful speech, for sharing the story about his mother as an example of somebody who changed their mind, who thought they would want one thing and then, in a moment, wanted something else. I suspect that the love and care that the member and others in his family showed may have influenced her decision to change direction at that point. That story relates to a broader statistic. In the latest reports, 692 Canadians in one year made a request for MAID and then changed their minds. Where does that leave us with advance directives when a person signs a document that allows something to happen to them without them being asked at some future point when their circumstances have changed? Maybe they have adapted, maybe there are new aspects to their life, things they did not think they could deal with that they are dealing with, and they are happy in the midst of them. What should we say to those 692 Canadians in one year who made the choice, like his mother did, to change their minds?”

“We must not rush this bill. We need to take our time to protect vulnerable people, put safe rules in place, and answer questions from medical experts.”

“Mr. Speaker, I want to thank my hon. colleague for the kind comments. Our leader brought up our former colleague Lisa Raitt and her husband, who is living with dementia. She wonders what would have happened if he had made that advance directive early on. She knows full well that he is fully content. He would not have wanted to go forward with it. All we are asking is to make sure that we, as parliamentarians, do our job and make sure we are looking after the most vulnerable of Canadians, putting those safeguards in place, answering and addressing the questions that the medical community and the experts have. That is our job, not rushing something through in the 11th hour.”

“I do not want this bill to pass. It lets people agree to assisted dying in advance, instead of right before it happens. Canada already has far too many assisted deaths compared to other places. The government is being cynical by putting advance requests into the same bill that stops assisted dying for mental illness.”

“Mr. Speaker, it is an honour to rise to speak to the issue of medical assistance in dying, or as we call it more often in this country, government-assisted dying. Canada is a pariah on the international stage when it comes to the way we have implemented this. Here is an interesting story. California and Canada legalized assisted dying, or assisted suicide in the case of California, in the same year at about the exact same time. California has about the same population as Canada. California has a very similar political outlook on the world as Canada. The difference in the application of MAID is profound, just in the raw numbers of it. In Canada, we have over 15,000 people a year ending their lives through MAID. It sounds like it is going to be more this year. In California, there are about 300 people per year. That is a huge difference, and there are lots of reasons for that. We can speculate about all of those reasons, but I just wanted to put that out there. We are a distinct outlier in the world, in Canada, in terms of the MAID regime. I would point out that both Great Britain and Slovenia have looked at Canada, have had referendums on this issue and, because of the situation in Canada, have rejected the MAID regime entirely. They said they would not poison people to death and would demand that their health care systems promote the health care of their people, not the death of their people. I remember back in 2016-17 when the first MAID bill came in. I remember saying that it was a radical bill and that this was going to be a slippery slope. I was wrong about that. It has been a cliff, not a slippery slope. We are now on our sixth piece of legislation expanding MAID. We thought Justin Trudeau was a radical prime minister on this file. I remember being quite skeptical of Jody Wilson-Raybould and Jane Philpott. They kind of led the charge when it came to the Liberals bringing in the bill in the first place. I remember calling them radical and thinking they were radical. It turns out now that they were the voices of restraint when it came to this. I remember there were Liberals at the time who voted against the bill because they did not feel it went far enough. Here we are, once again, with an expansion of MAID in this country. There seems to be no concern or upper limit to the Liberals’ desire for Canadians to have the right to end their lives. Now, I would say that in Canada, the deaths of despair, whether they be drug overdose or whatever they are, continue to increase. We hear constantly, story after story, from family members of somebody who was offered MAID when they did not want it or took MAID when their family was unaware that they were even ill, and there is no recourse. There is no ability for the family to question what went on. They have no ability to get any information about it because the patient is dead, the patient is gone, and there was a discussion between the doctor and the patient. Now the government wants to expand MAID once again, with advance directives. I would point out that advance directives have been a part of the discussion all the way through, and since 2015-16, they have been rejected all the way through. They have not been studied in depth the same way that MAID for mental illness has, and I would suggest that Canadians have firmly rejected MAID for mental illness. The government has been supremely cynical by doing the thing that Canadians wanted it to do, by repealing MAID for mental illness, but putting advance directives for MAID in the same bill, pairing one off against the other. That is supremely cynical on behalf of the government. The Liberals had their opportunity to vote for Bill C-218, and they rejected it. I thought they just wanted to take credit for it, and they can take credit for it now that they are bringing the bill forward. The piece around advance directives is about contemporaneous consent. I remember moving motions and amendments to the original bill, trying to emphasize contemporaneous consent. The California model requires that in the moment that MAID is being administered, a nod must be given or the patient must press the button, essentially. Back in 2017, I felt the original MAID bill, I think it was Bill C-14 at the time, did not do enough to ensure contemporaneous consent, and here we are with advance directives being so far away from contemporaneous consent, because an advance directive could be signed decades before the situation ever arises. Maybe nobody has had a conversation for years about what advance directives even mean, but suddenly a number of different motivations have come into play. Suddenly, a bunch of people who are not the individual would be making a decision about whether this person should be euthanized or not, with no contemporaneous consent. We have examples from around the world, such as from the Netherlands, where this kind of thing happens. There is a particularly horrific story about a Dutch lady who had dementia. She was physically very healthy. She was not in pain in any way whatsoever. She was happy and she ate well. She was living in an extended care facility, and her advance directive said that when she could no longer recognize her children, she would like MAID. That was what her advance directive said. She still had her faculties and could still participate in conversation. She knew what was happening day by day, but she did not recognize her children most of the time. That is 100% the truth. On the day that she was going to be euthanized, she knew she was going to be euthanized, and she pleaded with everybody she came into contact with that day, telling them that she did not want to die. However, because there was an advance directive, her coffee was drugged and she was compelled. The horrific part about it and why it ended up being in the news is that her family had come and gathered around her, and they had to restrain her because the drugs from her coffee wore off. They had to restrain her while they euthanized her. That was a horrific experience for all involved, but it was what the advance directive said. Despite the fact that she repeatedly said to multiple people that day that she did not want to die, she was euthanized. She was euthanized because her advance directive said that when she could no longer recognize her children, she did not want to live anymore. She was perfectly healthy. There was nothing physically wrong with her. She was eating well and she had joy in her life, but she could not recognize her children any longer. That is not the case for every dementia patient. Some dementia patients live with a lot of angst, and we need to work to minimize the effects of dementia. Dementia is a horrific disease that I know about. I have experience with family members who had it, and it is a horrific disease. It is tragic to watch a loved one decline in that respect, but offering them MAID or having to compel somebody else to murder them is no solution to the problem.”

“Canada's system is government-assisted dying because someone else performs the procedure. The United Nations says our system is flawed and harms people with disabilities. The member should read that report.”

“Mr. Speaker, the reality is that, with the Canadian system, it is a choice to some degree, but somebody else is administering it. This is government-assisted. That is the reality of the system. Whether the member wants to acknowledge that or not does not change that reality. The world is watching. The United Nations has issued a directive to Canada saying that our MAID regime is not working appropriately and is a detriment to those living with disabilities. The member should read the report from the UN.”

“I do not oppose advance requests in general. Usually, they let a person refuse treatment. This bill is different because it forces doctors to kill someone instead of just refusing care.”

“Mr. Speaker, to the point on advance directives, I am not opposed to advance directives. I would just point out to the member that, in most cases, an advance directive is a refusal of treatment or not compelling somebody to treat a person. This is a completely new world of compelling a doctor to murder someone. That is what an advance directive is. When a given set of circumstances exists, laid out in an advance directive, we are compelling the health care system, a doctor or a health care practitioner, to kill a person. That is what this advance directive is. It is not a refusal of care.”

“Our laws only let people make advance requests to refuse medical care, not to demand someone end their life. We do not allow people to give advance consent for other major actions. A person must agree at the time it happens.”

“Mr. Speaker, just to pick up on that, I think that is a very important point about the way advance directives operate now and the proposal for an advance directive for MAID. Advance directives now are essentially negative, saying “Do not do this to me”, or “Do not intervene under certain circumstances”. It is necessary that such a framework exists for indicating non-intervention in certain cases. That is very different from a person saying, “In a certain set of hypothetical circumstances, I want this thing done to me.” There is no other instance in which we create an advance directive for a positive action against a person, nor would we allow advance consent in other such cases. We can think of many cases of lesser gravity than ending a life where we simply do not allow advance consent. We require contemporaneous consent as a necessary condition of autonomy. This is a radical departure from that in what consent means.”

“I agree with what was just said. Letting someone ask for assisted dying in advance is very serious. A person cannot come back from it, and someone else will make the final choice to end their life.”

“Mr. Speaker, I am not sure if there was a question. I think it was more of a statement. I agree wholeheartedly with that sentiment. That is the fundamental issue with this. This is an advance directive on MAID. Someone does not come back from that. It is the end of their life, and that decision will be made by somebody other than them.”

“I oppose this bill. It lets doctors end a person's life based on a paper signed years earlier, without asking the person for consent at the time. Other people should not get to decide if someone dies based on an old document. We should vote against this bill and pass its rules about mental health separately.”

“Mr. Speaker, tonight, I am addressing the House on Bill C-41, the latest attempt to further expand the cases in which a doctor or nurse practitioner is legally permitted to end the life of their patient, a practice which is generally, if euphemistically, called MAID in Canada. The bill proposes to allow the use of so-called advance directives for MAID. Bill C-41 would allow a patient to sign an advance directive permitting a doctor or nurse practitioner to kill them under certain future circumstances, perhaps years or decades in the future. Necessarily, other people would have to assess and determine whether the conditions in the signed document had been met. The patient would have delegated the power over life and death for themselves to another person. Bill C-41 would eliminate the legal requirement that a person consent to their death when they are dying. It would replace the requirement for contemporaneous consent with advance consent. Of course, advance consent is inevitably less clear in practice than contemporaneous consent. In the signing of an advance directive, a person would be making a prediction about how they think they would feel under certain future circumstances that they likely have not experienced before. They would be making a prediction about how their future self would feel and what their future self would want. They would be judging the situation from the outside without lived experience. In practice, people would likely be presented with pro forma advance directives based on a common template and told that typically people in such a situation sign something like this or want something like that, etc. We already know these kinds of proposals to people who are not asking for them are occurring. Perhaps these pro forma advance directives would be given to people right after a new diagnosis is given, when a person is understandably scared about the unknown and about what they would feel under new circumstances, and they would trust authority figures and sign these pro forma documents. This would then provide those same authority figures with options, but certainly not clarity. They would later look at a patient and compare that pro forma directive with their assessment of the patient’s current condition. Do they seem happy, content? Is their life worth living? How does what they wrote or signed on the page compare to what we guess might be going on in their head today? Certainly in so many cases there would be a variety of different interpretations. Perhaps the burnt-out spouse and caregiver would think the conditions of the advance directive are met, while the adult children would think otherwise. Importantly, the law as written would not require the patient to be asked or informed again once they have written the advance directive. One day the clinician changes the substance of what is in the patient’s IV, and the patient dies. “It was her wishes,” says the doctor. “No, it wasn’t”, say the grandchildren, but at the end of the day, she is dead, because someone killed her based on their interpretation of a piece of paper that she signed years ago. Welcome to Canada. Maybe grandmother was a bit of a people pleaser. Maybe she talked about her illness in slightly different ways to different people, depending on what she thought they wanted to hear. This is very normal, of course. All of us are people pleasers to some extent, but Bill C-41 would require other people to interpret her feelings, her sufferings and her wishes, and to turn them into their own judgments about whether she should be killed, again with no obligation to talk to her about it once the initial paper had been signed. Families would inevitably be deeply divided over who decided to kill Grandma and whether the conditions of the signed document were met. Confusion is inevitable. The ambiguities are legion, involved in assessing someone else’s suffering based on a directive made long ago by a person who at the time had no experience of the illness. This means in practice that someone else would decide when and whether someone dies, and they will not ask before they kill them. Underneath these practical problems is a deeper moral question about advance directives. Can I bind my future self in matters as weighty as life and death? Can I make a choice that would permit someone to kill my future self, especially when that self may not remember or be conscious of the previous decision? When we allow advance requests today, it is purely in the case of a negative, a person signing an order to not have something done to them. Signing an advance request to not have something done to me is very different from a directive that licenses someone to do something to me when I am not aware of what is happening and under nebulous, difficult-to-define circumstances. Not only do we not allow this type of definitive advance determination, generally speaking, but we have done painstaking work to correct a grave moral error of the past in this regard, the idea that consent, once given, is given forever. The most obvious context in which this applies is sexual consent. Recognizing the need for contemporaneous consent in every sexual encounter was a real and important moral development. Previous but clearly flawed legal doctrines of the past regarded consent to marriage as furnishing a definitive future consent to sexual relations, and thus did not prosecute the offence of marital rape. It was a critically important and clearly positive moral development to recognize the importance of contemporaneous consent in every sexual encounter, that receiving consent in the moment is necessary, regardless of a past commitment. Everyone in the House agrees, I am sure, that marital rape should be prosecuted. It is hard for me to understand, then, why some members would regard advance consent in matters of death as permissible, while rejecting it in matters of sexuality. Introducing the idea of violating a person’s autonomy on the basis of a piece of paper signed in the past would seem to be a step in undoing the moral progress that has been made in this regard. A person also cannot consent to slavery. Some, though certainly not all, systems of slavery are based on the idea that a person can sell themselves, an act through which the present self binds the future self. Today we would understand such systems as grossly immoral and as representing a denial of human dignity and of autonomy, yet death is more final than slavery. If the past self cannot bind the future self in the case of slavery, then why would it be so in the case of death? What began in the name of autonomy has lost the plot by now denying the autonomy of the present self to adapt to new circumstances and to make new choices. The practical and philosophical problems inherent in the operationalization of advance directives for MAID likely informed the decision of members of the Conservative Party of Canada to explicitly adopt a position opposing advance directives for MAID. I am proud to be part of a party that officially opposes this expansion in its member-driven policy document. These problems have led virtually every other country in the world to also reject going down this road. Most notably, I think the problems with such advance requests also informed the decision of the Justin Trudeau Liberal government to reject calls to implement a system of advance requests for MAID. In each past stage, there were those who argued for advance directives, yet the Trudeau Liberal government evidently decided, based on the moral and/or practical risks associated with them, that it was not going to go down this road. However, now we have the new Prime Minister, who is hell-bent on pushing Canada’s MAID regime further than Justin Trudeau by pursuing an expansion that even Justin Trudeau rejected. As a fellow Catholic, while not expecting that a shared religious identity would lead us to agree on every issue, I did expect better from the Prime Minister. I expected that he would at least have some sensitivity to the idea of universal human dignity, the need to prevent the devaluing of the lives of people with disabilities and the need to avoid further MAID expansion. It is difficult for me to reconcile his stated convictions with his decision to advance legislation that would allow a patient to be killed in their bed without even being asked for contemporaneous consent. Canada already has the most radical MAID regime in the world, and the Prime Minister, the Catholic Prime Minister, is now wilfully presiding over the further expansion of a MAID system that is already the most radical in the world. It is frankly hard to tell what the Prime Minister believes at all, even if his frequent reversals of conviction have brought him some measure of political success thus far. All of these events call to mind the alleged remark of Pope Urban VIII following the death of Cardinal Richelieu. He quipped, “If there is a God, the Cardinal de Richelieu will have much to answer for. If not...well, he had a successful life.” This is worth contrasting with the observation of St. Teresa of Calcutta, who said that we are not called to be successful, but faithful. The point is one of general application, regardless of fundamental beliefs or philosophical commitments; that is, to be a statesman is to stand for something. Our calling as members of Parliament is to faithfully defend the national interest of Canada and the common good, to defend it from the shame that it already faces as a global pariah and embarrassment when it comes to the fundamental rights of people with disabilities. On that basis, I will fiercely oppose this expansion, as it would turn my country into a place where patients are killed without even being asked, based on a document that they signed years ago. As a brief final coda, I note that Bill C-41 contains provisions around limiting the application of MAID in the cases of mental health. These provisions on mental health are supported by over 90% of MPs and could easily be proposed separately and adopted rapidly. That debate has thankfully already been won, but it is the height of cynicism for the government to tie those provisions to its radical new expansion of MAID. We must defeat this bad, cynical bill. Of course, I agree with the mental health provisions in the bill, but those could easily be passed in a separate bill in 48 hours. No one should fall for this devious legislative trick. That is why we must oppose the expansion in Bill C-41.”

“I want this bill stopped. It allows advance requests for assisted dying, which takes away a person's choice when their condition gets worse. People should have to give consent at the time their life is ended.”

“Mr. Speaker, my speech in the debate tonight was about advance requests for MAID, which are not about autonomy. Advance requests deny autonomy because they prevent a person whose condition has deteriorated from having a choice. They would involve the past self making predictions about the future self and binding the future self under conditions in this legislation where, incredibly, it would not be required that they be told what is happening to them when their life is being ended. That would be a denial of autonomy, a denial of the ability of a present individual to consent. The requirement of contemporaneous consent, as I discussed, is fundamental in law and in practice. This would be a denial of autonomy, of contemporaneous consent. On that basis, as well as others, the bill must be opposed.”

“I oppose this bill. It is dangerous to let someone else decide when another person's suffering is too great to bear, based on a request written years earlier. Only the person themselves can say how much they are suffering, and they should have to consent at the time.”

“Mr. Speaker, respectfully, what would be set up in this legislation is ridiculous and unreal. It says, on the one hand, that we must allow a person to live as long as they want, up to the point of intolerable suffering. At the same time, it is saying that somebody else, external to them, would decide, based on an advance directive written years before the suffering has even been experienced, comparing that document to what they perceive the person’s experiences are. The idea that somebody else is going to decide what is intolerable suffering for a person who does not have capacity to consent, and is not even being asked to consent, is ludicrous. It is nonsensical. The only basis on which the framework could plausibly work is with contemporaneous consent, where the person attests to their own suffering. How can a third party attest to the level of suffering a person is experiencing? Again, it is dangerous and nonsensical to have somebody else make decisions for them.”

“I do not trust the government's claim that this bill adds safeguards to medically assisted dying. They have ignored the safeguards in past laws and kept expanding who can get it. I want to know if my colleague shares these concerns.”

“Mr. Speaker, one of the reasons I am concerned about Bill C-41 is that the Liberals claim it to be the MAID safeguards act. They have had multiple opportunities to adhere to the safeguards they have allegedly put in place in previous MAID legislation, but it is very clear that they have blown by those safeguards. MAID has expanded since the very first bill in 2017. I wonder if my colleague shares those concerns. To say there are safeguards in place is just factually not the case.”

“I want the government to split this bill into two parts. We should quickly pass the part that stops medically assisted dying for mental illness. The rules for medically assisted dying have already failed, and caseworkers have even offered it to veterans looking for mental health help. The other part of the bill allows people to ask for medically assisted dying in advance, and that needs much more study before we vote on it.”

“Mr. Speaker, I am somewhat displeased to have to rise to speak to Bill C-41, as I have risen in the House on a number of occasions since 2017, when the Liberals brought forward the initial MAID bill. I want to go back to that initial MAID bill to show why I am raising some concerns with where we are today. I held a number of town halls throughout my riding of Foothills when the initial MAID legislation was brought forward. In fact, I brought some of my colleagues who were participants in the MAID committee established by the government to study the initial MAID legislation, because I wanted some experts at the town halls in my riding to discuss the possible implications of this legislation and what it actually meant. I will say that of all the town halls I have held in my riding over my 11-plus years as a member of Parliament, there was never the kind of attendance and engagement from my constituents as there was on the medical assistance and dying proposal. Hundreds of people attended every town hall of the several I held throughout my riding, and I have to admit that it was very split. Constituents were on both sides of this issue. Many were unclear on what it would mean. When the time came to stand up in the House and vote on that legislation, I voted against it. The main reason I voted against it is that there was no assurance or confidence from what I heard from the various speeches in the House. I even sat in on the MAID committee on a number of occasions just to learn more about what the implications of this legislation would be. In listening to those experts, to the testimony at the MAID committee and certainly to my constituents, I can say that two things really stood out for me. As I said, there was no confidence that the safeguards being proposed in that legislation would be adhered to. As my colleague before me mentioned, someone would have had to have two doctors sign off before MAID was implemented and anyone requesting MAID would have had to have a mental health assessment. MAID was only supposed to be available for those with a terminal, incurable disease with a foreseeable end. We have certainly seen over the years that that has not been the case. MAID has grown and expanded well beyond that despite the safeguards that were allegedly in place. The second thing that stood out for me, especially after participating in the MAID committee several years ago, was the real push, especially from members of the Senate at that time, to expand MAID well beyond those with just a terminal illness. There were discussions about having it for people with mental illness, people with disabilities and even minors at that time. I have to admit that I was stunned by how far some members of that committee wanted to push this legislation. As a decision of conscience, I voted against MAID at the time. I feel that my vote has been justified with how far MAID has expanded in Canada. We are now seeing exponential growth. In fact, we are leading the world on the issue, which I do not think is something we should be proud of. We have seen what I was concerned about, what I was worried about: MAID being expanded to those with mental health issues and those with disabilities. One story really stands out, which I want to raise in my speech tonight. I remember a call I received from a constituent who was an army veteran, a peacekeeper, with the Princess Patricia’s Canadian Light Infantry in Calgary and who lived in Okotoks. He called me to say that he was a counsellor for other veterans with PTSD. He certainly suffered from PTSD. Mark Meincke was his name. He said he needed to let me know that he was getting calls from veterans who, when they were making calls to Veterans Affairs Canada and talking to their caseworkers, were being offered MAID. I found this claim to be quite astonishing. A veteran, someone who has put their life on the line for the service of our country, when they were reaching out to their caseworker at Veterans Affairs Canada, asking for access to mental health services, to counselling or even to check the status of their disability claim, was being offered MAID instead of being offered mental health services. In fact, we found these claims to be quite true. He brought us recordings of phone calls with Veterans Affairs and a number of cases of calls he had had with other veterans, and it was astonishing. In fact, we asked Mr. Meincke to come to the veterans affairs committee to lay out his story, and the testimony that he gave at that committee was astonishing. I want to give a couple of quotes that Mr. Meincke raised at that time. As I said, he served in Croatia. He witnessed some of the most devastating horrors that one would ever want to see. He said he was devastated by the phone call from Veterans Affairs, saying, “It’s called ‘sanctuary trauma’, where the place you go for help steps on your neck. That’s what happened here.” He said the comment from the case worker at Veterans Affairs was that, if they have any suicidal thoughts down the road, MAID was an option, that “it’s better than blowing your brains out against the wall.” These were the pieces of advice that our veterans were getting from Veterans Affairs. Our fear right from the beginning was that MAID would be expanded far beyond what it is or what it was intended to be. This is our concern. The Liberals are talking out of both sides of their mouth on this piece of legislation. On one hand, they are saying that they are going to delay the decision to offer MAID to people with mental illness as the sole underlying factor, which we completely support. However, at the same time, they are offering advance directives, which requires much further study because the history of the Liberals getting this right is one of failure. Conservatives are united on splitting this bill. We would fast-track the portion about mental health as quickly as possible to ensure those with mental health concerns are protected, but the underlying factor of advance directives deserves much further scrutiny and debate. Canadians deserve this. I do not want the Liberals to play politics on this. This is a matter of life and death, which has clearly been shown with our veterans, and that is not right. Let the Liberals do the right thing and split the bill so Canadians can have their say.”

• Echo ×5

  A repeated line

  “This is a matter of life and death.”

  Said 5 times by 4 members since November 4.

  Every time it was said →