Official Hansard
Mr. Speaker, I rise to speak to Bill C-41, the medical assistance in dying safeguards act. This is one of the most profound questions Parliament can consider. It touches on life, death, dignity, autonomy, compassion, equality and our responsibilities to one another. It is deeply personal, affecting individuals confronting serious illness, their families, caregivers and medical professionals. There are deeply held differences of opinion on this issue shaped by personal experience, ethical traditions, religious beliefs and understandings of human dignity. For that reason, this is a matter of conscience and a free vote for the New Democratic caucus. At the heart of this debate is a fundamental human rights question: How do we respect individual dignity, autonomy and rights while protecting those who may be vulnerable? Every person deserves to live and die with dignity. That means respecting the right to make deeply personal decisions about one’s body, health and end-of-life care. It also means ensuring that people are not abandoned by the systems and institutions meant to support them. Canada’s debate about assisted dying has been shaped by decades of advocacy, legal challenges and difficult ethical questions. We all remember the case of Sue Rodriguez in 1993. Former NDP MP Svend Robinson stood by her. It was a difficult moral issue then, and it remains difficult today. Living with ALS, Rodriguez challenged Canada’s prohibition on assisted dying. She argued that she should have the right to seek assistance in ending her life before her illness took away her ability to do so. The Supreme Court rejected her challenge in a narrow 5-4 decision, but her struggle brought questions about autonomy, equality, security of the person and dignity into the national conversation. More than two decades later, the Supreme Court revisited those questions in Carter v. Canada. In February 2015, the court unanimously found that the Criminal Code prohibitions on physician-assisted dying violated the charter rights of certain competent adults experiencing grievous and irremediable medical conditions causing enduring and intolerable suffering. That decision was a landmark moment in Canadian human rights law. Parliament responded with Bill C-14 in 2016, establishing Canada’s first federal framework for medical assistance in dying. In 2021, Bill C-7 expanded eligibility for certain individuals whose natural death was not reasonably foreseeable, while introducing different safeguards. Subsequent legislation, including Bill C-39 and Bill C-62, delayed the proposed expansion to people whose sole underlying medical condition is a mental illness. Now Bill C-41 is before us to respond to the courts, and Parliament is addressing two critical questions: one, the issue of advance requests and, two, those whose sole underlying medical condition is mental illness. On the first question, what Bill C-41 would do is establish a framework for advance requests for MAID, and it would only be permitted in provinces and territories that have the required legislative regime in force. Because Bill C-41 stipulates that an advance request is permitted only in provinces or territories that have the required legislative regime in force, it raises serious concerns about unequal access. Canadians should not have different rights depending on where they live, yet this is where we are at with Bill C-41. I will have more to say about that. On the second point, the bill would maintain the exclusion of people whose sole underlying medical condition is a mental illness. There are different human rights perspectives on that question. Excluding people solely because of a mental illness raises serious charter equality concerns. There is an argument that people should not be denied access to a legal medical procedure simply because of their diagnosis and that eligibility should be considered through appropriate individualized assessments and safeguards. At the same time, mental health experts and disability rights organizations have raised concerns about the ability to determine when a mental illness is irremediable, the availability of appropriate treatment, and profound disparities in access to care. There is no question that these concerns deserve serious consideration. For example, end-of-life advocacy groups view the exclusion of mental illness as discriminatory and unconstitutional, emphasizing bodily autonomy and equity under the law. Dying With Dignity Canada expressed deep disappointment over legislative barriers, stating that preventing a group of people from having access to a legal medical procedure simply because of their diagnosis violates charter rights. The organization maintains that individuals should have equal rights to apply based on rigorous individualized assessments. On the flip side, Inclusion Canada, a leading disability rights group, argued that expanded eligibility perpetuates dangerous ableist assumptions that life with a disability is not worth living. Meanwhile, the Centre for Addiction and Mental Health notes that there is a lack of established criteria and consensus among psychiatrists for if and when a mental illness should be considered irremediable, alongside stark disparities in access to care. To that end, there is another dimension to this debate that we cannot ignore. The right to make a choice is meaningful only when people have real choices available to them. Experts, disability advocates and health care organizations have raised concerns about whether people experiencing profound suffering always have access to the care and support they need. Some warn that assisted dying risks becoming an answer to suffering that could be alleviated through better access to health care, affordable housing, disability supports and community services. The government’s own report has identified inadequate funding for mental health services. A person living with a disability should not have to fight for basic services, appropriate housing or the resources required to live independently. A person experiencing mental health challenges should not face inaccessible treatment, long wait-lists or a shortage of community-based supports. Someone approaching the end of life should not be denied quality palliative care because of where they live or their financial circumstances. Telling someone that a service exists is not the same as ensuring they can access it. Palliative care, counselling, disability services and mental health treatment must be timely, affordable and appropriate. This is not an argument against individual autonomy. It is an argument that autonomy must be supported by the social and economic conditions that allow people to exercise it meaningfully. The federal government has a responsibility to work with the provinces and territories to address these gaps. Dignity cannot be separated from the material conditions in which people live. In June, the Special Joint Committee on Medical Assistance in Dying recommended that the federal government indefinitely exclude people whose sole underlying medical condition is a mental illness. The committee also identified a pressing need for increased and more equitable access to adequate mental health services. People deserve timely access to treatment, counselling, psychiatrists, psychologists and community-based services. The committee’s call for more equitable mental health services must not be lost in this debate. Maintaining an exclusion in the Criminal Code cannot substitute for the government’s responsibility to invest in mental health care. We must also consider how this legislation would affect people differently. People living in poverty, experiencing homelessness, living with disabilities or living in remote communities can face significant barriers to accessing health care. First nations, Inuit and Métis communities have experienced generations of inequities in health care, including inadequate access to culturally safe services and palliative care. The government must engage indigenous governments and organizations meaningfully in implementation, respecting indigenous self-determination and the diversity of perspectives within indigenous communities. We must ask whether every person can make an informed and voluntary decision without pressure, discrimination or the absence of meaningful alternatives. This is a fundamental human rights question. I began by noting that Canada’s debate about assisted dying has been shaped by decades of advocacy, legal challenges and difficult ethical questions. I suspect that this is not the end to legal challenges on this question. There are people who believe that the right to die with dignity is inseparable from the right to make decisions about one’s own body and the circumstances of their death. There are others who approach this question through concerns for the sanctity of life, the protection of the vulnerable, disability rights and the responsibilities of society. We must make room for these differences and chart a path forward. Regardless of which party one belongs to in the House, we can all agree that every person deserves dignity, compassion and access to appropriate health care and support. No one should be made to feel that their life is less valuable because they live with a disability, an illness, poverty or circumstances that make life more difficult. The right to make decisions about one’s own life and death cannot become an excuse for the government’s own withdrawal from its responsibility to provide care. There is the important work of the parliamentary committee. People with lived experiences, families, disability advocates, indigenous organizations, medical professionals and other experts must have the opportunity to contribute and be heard. We must not rush the bill through committee. We owe Canadians a process that is thoughtful, transparent and grounded in human rights, and we must respect the dignity of people at the end of life, protect those who may be vulnerable to coercion or who have inadequate support, and build a health care system that gives everyone the opportunity to live and die with dignity.
