Official Hansard
moved that Bill C-41, An Act to amend the Criminal Code and An Act to amend the Criminal Code (medical assistance in dying) and to make related amendments to other Acts, be read the second time and referred to a committee. He said: Mr. Speaker, today I have the extraordinary privilege of commencing debate on the medical assistance in dying safeguards act. Medical assistance in dying is a deeply personal and highly complex issue for many Canadians. Many of us have experiences with the issue that have helped inform our perspectives. In some cases, we will hear the most heart-wrenching experiences a family can live through, dealing with the extraordinary loss of the ones they hold closest. In other circumstances, through the pain, we will hear some of the most heartwarming stories of how medical assistance in dying minimized the suffering of someone a family cares about and how it provided an element of closure through a time of great uncertainty and pain. This is not an easy topic. Many families are contributing to this important national discussion by sharing their perspectives. There are some heart-rending examples, such as when someone loses a loved one. There are also other stories that show how important it is to protect families’ ability to exercise some control in very difficult circumstances. I recognize, as we go through this debate, that unanimity does not exist on an issue as sensitive as medical assistance in dying. There are different people who will agree or disagree with my point of view, but they hold those views reasonably and often for profound personal reasons. Although there is a range of opinions on a given issue, it is incumbent, in my view, on the Government of Canada to advance this agenda on the basis of what we believe is right and what we believe will best protect people who are vulnerable and who are living with irreversible illnesses, and, at the same time, to give agency to those who are suffering by providing them with some choice in how they transition away from this mortal world. Over the course of my remarks, I want to have a conversation about the history of this important issue in Canada and address squarely the two central issues that are the theme of the legislation we are debating, namely circumstances where medical assistance in dying is sought on the basis of mental illness as the sole underlying medical condition and the separate issue of advance requests for people who are diagnosed with an irreversible illness and may lose the capacity to provide consent. The changes we are debating today have been the subject of extensive study, debate in Parliament and legal challenges before the courts, and we have confidence that through the process of engagement, we have established the position we believe will best serve the interests of Canadians. I will begin by providing some background on this very important issue. It has been a little more than a decade since medical assistance in dying was first the subject of, initially, a legal challenge that spurred legislative change. This created a framework in Canada that provided for the possibility of medical assistance in dying where a person’s death was reasonably foreseeable and where they were living with intolerable suffering as a result of a serious and incurable disease. After the legislation was adopted in the chamber in 2016, we saw subsequent challenges that made their way through the legal system in the country. That changed the limitations that existed in the legislation at the time to expand medical assistance in dying to people who did not have the imminent threat of death but nevertheless were living with an intolerable level of suffering and whose condition was irreversible. The House took action to respond to those legal challenges, which has created today’s framework, a framework where someone may have access to medical assistance in dying when, in the opinion of medical professionals, they are living with an irreversible illness that is causing them to suffer intolerably. There are two issues that have been injected into the debates in Parliament over the course of this trend and that continue to be the subject of significant legal disagreement. Those issues relate to mental illness and advance requests. I would like to start with a discussion on the issue of mental illness when it comes to medical assistance in dying. I want to recognize the extraordinary challenges that people living with mental illness experience every day. We do not wish to diminish those experiences one iota as we have this important conversation. We wanted to ensure that we had a full and robust process to understand the different considerations that Parliament ought to consider as we make a decision on the future of medical assistance in dying when it comes to mental illness as the sole underlying medical condition. As a result of the last debate in Parliament about five years ago, there was an exclusion of medical assistance in dying for cases involving solely mental illness. It was subject to a timeline that is set to expire in March of next year. Without action, this timeline will elapse, and the protections that are currently in place will evaporate. In order to fully understand the consequences of such a decision and the considerations that should inform the next steps, Parliament struck a joint committee between the House of Commons and the Senate to study specifically this issue. I want to thank members of that committee for the work they have done. They did not necessarily share identical points of view, but they nevertheless contributed to an important conversation. In a parallel way, my office engaged with experts, organizations and advocates to understand the perspectives of those who are living with irreversible conditions, and also to understand the perspectives of those who want to protect against people making a decision because the condition they are living with, though it may not be irreversible, is incredibly difficult. Through these conversations, we have determined that the best path forward is to maintain the exclusion for medical assistance in dying where mental illness is the sole underlying medical condition that would justify access to this health service. This is not a decision we take lightly, but we believe it is the right one. This process of debate will continue over the course of the coming weeks in Parliament and will hopefully provide some certainty in this conversation going forward. The reasons cited in the report, which were reflected in our engagement over the course of the summer in particular, include some real concerns from the medical profession about a lack of consensus when it comes to the irremediable nature of mental illness. We have also heard clearly from Canadians the serious discomfort they hold in circumstances where they have inadequate access to mental health services at a community level, as we engage in a conversation about medical assistance in dying for people who would benefit from those services. I want to recognize this profound suffering and demonstrate our willingness to work with provinces and territories to help improve the quality of services that are offered at a ground level, but at this point in time, we believe the correct approach is to maintain the exclusion that exists in the Criminal Code on an indefinite basis. This is a really important conversation. People who are living with mental illness need support from their community and from the government, whether it be federal or provincial. However, after examining this issue, the government has decided to change the rule to avoid the circumstances that would come into effect next year. Again, we are confident, from the process of engagement, that the right thing to do in the circumstance is maintain the exclusion indefinitely. There is a separate key issue that has been central to debates in Parliament, academic study and public advocacy. This involves a conversation about the issue of advance requests. They concern a circumstance where a person is diagnosed with an irreversible illness that will cause extraordinary suffering and sadly will, at a certain point in time, predictably diminish the person’s capacity to provide informed consent about something as important as life and death. We have talked to patients who have been diagnosed early with one such condition. I am thinking in particular of the people I have discussed this issue with who have been diagnosed with Alzheimer’s. The pain that they experience personally is one part of the equation on their mind. They fear that they will lose themselves, cease to know their families or potentially become violent toward the ones they love or the ones who provide them care, consequences that they do not wish to live with. They want to recognize who they are at the time of their passing. This is a choice that we wish to provide to Canadians who wish to make that decision for themselves. We will be taking steps to allow for safeguards that would create the ability for people to provide consent while they still have the capacity to do so upon certain conditions that will develop as they approach the end of their life. This is a difficult conversation, but it is a difficult conversation for people who receive this diagnosis with or without the presence of medical assistance in dying. What we aim to do is reduce pain and suffering and reduce the difficulty that people experience by providing some agency to a person who feels like they have lost it as a result of their health concerns. In order to protect those who are diagnosed with such illnesses and are considering access to medical assistance in dying, I want to reassure this House that the conditions that are required for medical assistance in dying more broadly will continue to apply and that we will introduce new safeguards in this legislation and by working with provinces. Specifically, we will maintain the requirement that the condition of intolerable suffering, the irremediable nature of a disease and the advanced state of decline are all present in the opinion of medical professionals. I want to take a moment to address some pieces of misinformation that I have seen online and in public conversations since we made the announcement of the direction in which we would be moving. There is some concern that a person who is content or happy, despite the fact they may be living with a serious illness, would somehow be subjected to MAID. In some instances, this misinformation would suggest they are subjected to MAID without their consent. Nothing could be further from the truth. By maintaining the requirement that there be intolerable suffering agreed upon by multiple medical professionals, there is no possibility that a person who is living peacefully or happily and is not suffering intolerably would somehow have access to medical assistance in dying. In addition to these conditions, we would introduce new safeguards in the Criminal Code to help offer protections to Canadians. They would include the requirement that there be two medical assessors who independently arrive at the conclusion that the conditions outlined in an advance request are met, as well as the conditions required by the Criminal Code. We would also require that the process be the subject of provincial legislation that governs how services are actually administered in provincial health care systems. We would specifically require in this legislation that the provincial legislation create a repository to store and maintain the advance requests that are made, allow people to make changes to the conditions included in those advance requests and, importantly, provide the ability for an individual to revoke their consent at any point in time, which would end the efficacy of the advance request that was previously put in place. In addition, we would create new rules that would add additional safeguards, including specifically where there may be ambiguity from a person who may be approaching the end of their life as to whether they continue to provide consent to medical assistance in dying. Where there is any doubt in the view of either of the medical professionals who are mandated to take part in the process, a mandatory waiting period of 30 days would be put in place to ensure the opportunity to revisit this important conversation. There is a major concern with regard to advance requests in the case of people who are living with a mental illness that not only causes them suffering but also impairs their capacity to give consent when they are unwell. We need to create a new rule to ensure that people who want to make a choice to avoid the consequences of their illness can do so. This is a choice based on their values. These people want to be able to end their lives to spare themselves and their families the consequences of the illness. The existing conditions for MAID will be maintained. However, we are adding other safeguards to protect people who are more vulnerable, because such protection is sometimes necessary. It is important to understand that we would not be creating today a new system of health policy decisions or new rules that consider the administration of medical assistance in dying as much as we shifting the criminal liability that will attach to medical service providers who participate in medical assistance in dying. With these protections we would be putting in place, we would ensure that the doctors who are seeking to respect the wishes of their patients at the end of their lives are no longer considered criminals under Canada’s criminal law. I should say that this exercise has been one that has created a great deal of respect for Canadian democracy in myself, my office and many of the parliamentarians who I have spoken to. We have, over the course of more than a decade, been able to engage with the legal system, the House of Commons and the Senate through parliamentary debates and joint studies between the two houses of Parliament, and with the ability of ordinary citizens to have access to the courts where they feel their rights have been infringed. This is a sign that democracy may work well as we sort through an issue in which there may not be unanimity or consensus but nevertheless allows us to arrive at decisions based on reasons, science, facts and evidence. We have made this decision to move forward, but it will inevitably create an opportunity for the provinces to continue this conversation as they determine whether they will create a new framework for the provision of medical assistance in dying, in particular on the issue of advance requests. I am confident that we have taken the time to understand these issues and the reasons as to why we have put forward these new proposals. I look forward to seeing a new regime put in place that will help protect against some of the worst consequences of illnesses that people are living with in this country. I would like to draw the House’s attention, as I conclude, to certain comments I have seen in the public since the introduction of this legislation, including those from the family of Andrew Reid, who at 56 was diagnosed with a rare form of young-onset Alzheimer’s called posterior cortical atrophy. Patients with this condition will lose their sight and their ability to walk. Andrew’s wife Karina has become his caregiver. She said that grief is the ultimate form of love. Two years ago, Andrew sought MAID and was approved. She said that to be able to control his life, especially in what was coming up next, was extremely important, which is why they are supportive of this new legislation. Andrew said that he went into tears when he heard about the legislation and described it as a gift. I would like to conclude with this. This is not the only circumstance where this request has been put to me. There are friends of mine who have been through this process. There was one who I spoke to a few weeks ago who lost her husband under similar circumstances who himself experienced what it was like to have a parent cease to remember that he was her family. By creating agency for people to make decisions about how they will transition from this world when they live with incurable illnesses, we can do right by families who are going through the most difficult period of their lives. It was a pleasure to take part in today’s debate.
