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View Carol Hughes Profile
NDP (ON)
The hon. Parliamentary Secretary to the Minister of Natural Resources has eight and a half minutes remaining in her speech.
View Kim Rudd Profile
Lib. (ON)
Madam Speaker, as I was saying the other day about Bill C-14, it is evident that governments, national associations, and members of the public recognize the moral and ethical struggle that health care providers could experience regarding medical assistance in dying.
Most provincial and medical regulatory bodies have already provided professional guidance around safeguarding the conscience rights of physicians. Provinces like Alberta and New Brunswick say their physicians are under no obligation to participate in assistance in dying. However, they recognize that continuity of care, especially at this most critical time in a person's life, also cannot be neglected. Patients cannot be abandoned.
The Canadian Medical Association's submission to the Special Joint Committee on Physician-Assisted Dying recommended that physician freedom of conscience be recognized as a key component of the federal legislative response to the Carter decision. Participants at a public town hall meeting in Mississauga, Ontario, raised concerns about the ethical dilemmas facing physicians if they chose to be involved in medical assistance in dying.
On May 10, proposed new section 241.2 was carried. In effect, this amendment clarifies that there is nothing in the legislation that would compel a person to provide or assist in providing medical assistance in dying. This amendment would contribute to public awareness that the bill recognizes both the rights of health care providers for freedom of conscience and the needs of Canadians who wish to have access to medical assistance in dying.
It is clear that no health care provider would be required to provide medical assistance in dying. However, we must also respect the rights of people seeking this procedure to have reasonable access. We know that there are many physicians who would provide medical assistance in dying to an eligible patient under their care. We heard from them throughout the consultations leading up to Bill C-14.
In a poll of 372 physicians, the College of Family Physicians of Canada found that 65% would help a competent, consenting, dying patient end his or her life, if requested. However, as was presented to the Standing Committee on Justice and Human Rights by Dr. Jeff Blackmer of the Canadian Medical Association, having health care practitioners willing to provide medical assistance in dying is only one part of the equation. The other very important factor is the ability to connect eligible patients with these willing practitioners.
People seeking medical assistance in dying will have already encountered many challenges. Once they have made this difficult personal choice, they do not need additional barriers, such as the lack of a provider. The government has committed to develop measures that will support access to medical assistance in dying and to work with provinces and territories toward a common approach to referrals or transfer of patient care.
Provinces and territories have also indicated that they feel that a third-party referral function would be a viable option. This would respond to the access needs of patients and protect the conscience rights of health care providers who do not wish to refer patients for medical assistance in dying. To this end, we will be working with provinces and territories to develop an end-of-life care coordination system.
In its simplest form, this system would provide a registry of authorized providers willing to accept patients whose providers consciously object to this practice. It could also provide a system through which patients could self-refer to an authorized provider to seek an assessment of their eligibility. The end-of-life care coordination system could also be a source of information and resources to both patients and providers on all aspects of medical assistance in dying—eligibility criteria, safeguards, and so on—as well as information about other end-of-life options, including palliative care.
Similar systems are used in several other countries. For example, both Belgium and the Netherlands offer specialized services that provide physicians with access to a registry of trained, independent, and impartial physicians who offer consultations on end-of-life options, including euthanasia requests.
Collaborative federal, provincial, and territorial work could consider such international examples in establishing a made-in-Canada model to provide providers and patients with access to a system that could transfer care to a physician willing to assess and administer requests for medical assistance in dying.
Additionally, the system could service medical and nurse practitioners in need of an independent consulting practitioner, for example, in rural ridings, such as the one where I live, in remote areas, and where access to a second provider is challenging.
We trust our health care providers to work hand in hand with us in helping to maintain and improve our health. When our needs change, and we look for ways to relieve suffering and avoid a long and painful end, Canadians want to be confident that these providers will not abandon them but will help them choose their own paths.
I look forward to working with my federal, provincial, and territorial colleagues to ensure that, when the time comes, compassionate care and support at the end of life will be available to Canadians without undue burden or delay.
Physicians are key to the end-of-life process. They are a critical thread that not only binds but frames this whole discussion. They are imperative to move this important debate forward. I have shared my very personal experiences on palliative care and on how critical it is.
I met this past weekend with a physician in my riding who spent years working with palliative patients. This is a man who is passionate about end-of-life care, and he expressed unequivocally to me how important this legislation is. He felt that there is a strong desire on behalf of the medical community to find the right path to ensure that we have the best care options. This legislation is a major step forward on that very important path.
This legislation has created a national conversation around end-of-life care, palliative care, and home care and how we want to be treated at the end of our lives. This has to be the most important conversation we can ever have.
This is a true legacy piece. I believe the decisions we make around this bill will reverberate positively for years to come. As I said before, I am confident the proposed legislation provides us with a balanced solution that reconciles diverse interests in medical assistance in dying and is appropriate for Canada.
View Colin Carrie Profile
CPC (ON)
View Colin Carrie Profile
2016-05-20 10:12 [p.3634]
Madam Speaker, one of the things the member mentioned was choice in end-of-life care.
My concern is that, when Canadians were voting last fall, they knew this bill was in the pipe. Members are aware that the Liberals, when they campaigned, promised they would put $3 billion towards palliative care and home care. Sadly, in this past budget, as members are aware, there are absolutely zero new dollars for palliative care.
We know that the Liberals are rushing this bill forward. We have seen the antics this week. People watching today should probably know that the antics this week were about shutting down debate on this very issue.
If the Liberals are truly offering a choice to Canadians, there is still enough time. Could the member talk to the health minister and the finance minister, and please have that $3 billion put into palliative care, as the Liberals promised in their election campaign?
View Kim Rudd Profile
Lib. (ON)
Madam Speaker, in budget 2016, there is indeed $3 billion for health care. Part of that discussion with the provinces and territories is clearly around home care and palliative care.
We have made that commitment. We certainly heard it from the Minister of Health a number of times.
As we know, the provinces and territories have jurisdiction over health care. Our role is to have the conversation with our partners to make sure we have all of those supports for assistance in dying, and to make sure we are reflecting Canadians' rights to assistance in their very difficult time at the end of their life and also the rights of physicians to support Canadians.
View Daniel Blaikie Profile
NDP (MB)
View Daniel Blaikie Profile
2016-05-20 10:14 [p.3634]
Madam Speaker, I am concerned that the death of the bill is becoming reasonably foreseeable because it is in a grievous condition, but the good news is that it is not yet irremediable.
We heard from the Alberta Court of Appeal this week that the bill already does not meet the requirements of the Supreme Court decision and that it will not be deemed constitutional. We still have time to change the bill to make that happen. Unfortunately, debate on it is going to close today after only 2.5 hours because of a time allocation motion by the government, so we need to get this debate right today. We need to try to form a consensus that we want a bill that is constitutional.
Does the member think it makes sense to charge ahead to vote on a bill that we already know is not constitutional, or ought we not make amendments to the bill to make sure it is in fact constitutional?
View Kim Rudd Profile
Lib. (ON)
Madam Speaker, I am not a constitutional lawyer, so I will not speak to the constitutionality. There are a lot of lawyers who have looked at the bill and believe it will pass the test, but that is not the point.
The point is that we have a framework for Canadians for now. This is historic in terms of putting the bill forward, of having this very difficult conversation with Canadians, and we as a government have committed very clearly to the next steps, whether it be advance directives or other elements on which we have made a commitment to have a discussion with Canadians. I look forward to working with the members opposite to have that very important discussion.
View Yasmin Ratansi Profile
Lib. (ON)
View Yasmin Ratansi Profile
2016-05-20 10:16 [p.3635]
Madam Speaker, I thank my hon. colleague for her very thoughtful speech, and I know this is a very emotional matter. I have had town hall meetings on it, and there is some confusion as to the right of conscience for doctors or nurse practitioners, etc., who may not want to do it. I would like the member to shed light on this.
View Kim Rudd Profile
Lib. (ON)
Madam Speaker, as I said in my remarks and have said previously, in the bill there is protection for those medical practitioners who do not want to participate in this. I believe that the idea of having a registry or a place for patients and for physicians and other medical practitioners to go to be able to exchange those ideas and support each other is a very important step.
View Colin Carrie Profile
CPC (ON)
View Colin Carrie Profile
2016-05-20 10:17 [p.3635]
Madam Speaker, I would like to say how happy I am to finally be able to exercise my rights as a member of Parliament to speak to Bill C-14. Over the last few weeks, I have been in line to speak, but have not been able to do so because of the shutting down of debate and the antics put forth by the Liberals. I am really pleased to be able to talk today for my constituents.
I think it is important, when Canadians watch the debate, that they remember the debacle this week and that this was all about a vote on Wednesday to shut down debate on Bill C-14.
As my NDP colleague just said, we only have one more day, just a little over two hours, to debate 16 amendments. I think what is really important is for Canadians listening to this debate to get in touch with their MPs. They only have one week. I want them to look at the amendments and get in touch with their MPs, especially their Liberal MPs. As members sadly know, many of the backbench Liberal MPs will not be able to speak to the bill. The reason is that their front bench does not want them to speak on it. For me, for every member in the House, and for all Canadians, this is a very personal and very important bill, and has strong views on many sides of the debate. It will change the social structure of our country .
If we look at the foundation and the founding principles of our country and the great democracies around the world, they are based upon rights for life, liberty, and the pursuit of happiness. Today, we are actually debating some of the opposites of that: the opposite of life being death, the opposite of liberty being enclosure, and the opposite of pursuit of happiness basically being sadness.
I have been able to speak with, but also to listen to many of my constituents who have very diversified opinions. I think it is essential for all of us here in the House to respect these many points of view. At the extreme of one end, some were very much against the bill. Others were very much in favour of it. However, for most of the people I was able to listen to, they are somewhere in the middle.
The one thing that most of the people in Oshawa I have talked with agree on is that the act of assisted suicide should be an exception and not the rule. In other words, assisted suicide should only be made available on the rarest of occasions, and, of course, have the greatest of safeguards.
My concern, as we heard from my colleague here in the House, is that this is a flawed bill. In the rush to pass the assisted suicide bill before the deadline of June 6, the Liberal government has created confusion and despair. What have the Liberals chosen to do? They have chosen to break their promise to Canadians. I want to bring up and emphasize my question to my colleague across the way. When the Liberals were campaigning, they promised Canadians that they would put $3 billion into a palliative care system. I do not know where my colleague was reading it, but when I read the budget, there is absolutely no new money for health in the budget. In the first year, when the government is rushing to hit this date, there is no new money to support the other side of the equation. There is nothing. There is zero.
As far as health is concerned, this is a horrible message. It means that health care is not a priority for the Prime Minister. Canadians expect a choice between quality palliative care and this legislation. Instead, the Liberal government has chosen to support just one-half of that choice. It has put all its time and resources into assisted suicide and has not provided the promised $3 billion to palliative care, supportive care, for Canada's most vulnerable.
That is why I called on my colleague across the way to call on the Liberal government to immediately keep its promise. It is not too late to invest in palliative care. According to the Supreme Court, and from what we have heard, Canadians have the right to choose, to choose between assisted death, or hopefully the government can give them a choice to live comfortably near the end of their lives.
That is where this is really important and why I am glad I am able to speak today. The constituents I have talked to feel that the Liberal government needs to be held to account. Making the choice between assisted death and good palliative care has to be made available by June 6.
This is the first time in Canadian history that our government in Canada is drafting a law that would make it legal for one person to take the life of another. The Supreme Court has said that it is not just a required service, but has determined that it is a matter of individual rights. What precedent does that set? What do the experts in palliative care say?
Madam Speaker, I would like to share with you, but also with Canadians watching this debate and with my colleagues in the House, some of the thoughts of a very special constituent of mine in Oshawa. Her name is Dr. Gillian Gilchrist.
Dr. Gilchrist is a leading expert in the field of palliative care and she has practised medicine for over 50 years. She started the palliative care system in Oshawa in 1981, which was 35 years ago. I do not know anyone in the country with more experience, more respect, and more knowledge. Recently, through an initiative with Lakeridge Health in Oshawa, and Queen's University, a research chair has been named in her honour, dedicated to palliative care. It is the first fully funded academic research chair in palliative care at a community hospital in Canada. Dr. Gilchrist said that proper palliative care cannot be done without a team, and there is a lot that palliative care can do. There needs to be more volunteers and training. Patients deserve support, and the families need support as well.
One of the things Dr. Gilchrist said to me very strongly is that euthanasia is wrong, that doctors should not do it, and that it is not what they were trained to do. Dr. Gilchrist has treated more than 5,000 patients, and not one of those patients asked for euthanasia. She went on to say that palliative care cannot stretch across every corner in Canada, but with the assistance of the Internet, patients can obtain assistance to treatment as well as the support they need. Those individuals, at the end of their lives, can actually have a true choice. We know that experts have said that given the choice of good palliative care, 95% of patients will choose life over assisted suicide.
This affirms one of the most obvious weaknesses in the Liberal approach to this most personal and sensitive subject. How can the government rush forward so blindly toward an artificial deadline of June 6 without even providing the funds to improve palliative care options for Canadians? Have the Liberals even asked the Supreme Court for an extension?
Choice also belongs to doctors, whom the Supreme Court has said will have to perform this final irreversible act of assisted suicide. Doctors and institutions deserve the right of protection of conscience. We know that doctors have taken a Hippocratic oath that calls for them to first do no harm. The question is, why has the current Liberal government failed to adapt the legislation to provide positive protection for those doctors and institutions who cannot participate in suicide due to conscientious objections?
The legislation being presented today simply references conscience, but there is no guarantee of protection. There is a mishmash across the country. Conservatives have proposed explicit provisions for conscience protection. However, the Liberal government chose watered-down protection.
For me, it is beyond understanding how a group of nine unelected lawyers from the Supreme Court can tell physicians how they must practise medicine. We do not see medical doctors telling lawyers how to practise law, especially without guaranteeing their rights to abstain from a practice that all of them swore to reject. As Dr. Gilchrist told me, this is not why they became doctors.
I want to repeat that I have been prepared multiple times to speak to Bill C-14, and I have been able to listen to my constituents. What I think is really important for Canadians to understand is that this is not a debate about money, about technicalities, and this is not a debate about regulations. This is an unprecedented debate about the subject of one individual taking the life of another. It is a national debate. All Canadians deserve to have their voices heard.
I want to thank you, Madam Speaker, and I want to thank the House leaders for all they have done. This is probably one of the most important issues that I have faced as a parliamentarian in the 12 years that I have been here.
View Anthony Housefather Profile
Lib. (QC)
View Anthony Housefather Profile
2016-05-20 10:27 [p.3636]
Madam Speaker, I want to thank the hon. member for his passionate defence of palliative care.
I want to ensure that the hon. member is aware that at the Standing Committee on Justice and Human Rights, we added two amendments to the bill related to palliative care. We added an amendment to the bill and to the preamble, not only authorizing but mandating the Minister of Health to work with her provincial and territorial counterparts to ensure that we improve palliative care within Canada, improve care for dementia patients, and establish proper end-of-life care for aboriginal peoples that is culturally sensitive.
Also, with respect to the report that has to come back within five years that analyzes the law, we agreed, bipartisanly, to ask that there also be a report on palliative care. I completely understand and agree that the last thing anyone wants is someone to decide that they need medical assistance in dying because he or she is in too much pain. Does the member not agree that with the dangers of not having a bill or any safeguards in place as of June 6, it should at least make him consider voting in favour of the bill, flawed as he may believe it to be?
View Colin Carrie Profile
CPC (ON)
View Colin Carrie Profile
2016-05-20 10:28 [p.3636]
Madam Speaker, I appreciate my colleague's question because it shows that there is actually a lot of agreement between many people across the way and on different sides of the debate.
As he is a new member, I would like to point this out. He said that the Liberal health minister is mandated to work with the provinces and territories. Working with them is not the same as delivering an immediate $3 billion into palliative care.
As the bill sits today, it is extremely flawed. As was brought up by my NDP colleague, why are the Liberals taking this approach? During my speech today, I asked whether the Liberals had asked for an extension from the Supreme Court. I have heard about many decisions coming from the Supreme Court, and I believe that we can ask for that. It realizes the work that we are doing.
This is not something that needs to be rushed. I think we have to do the best we can to get things right.
View Pierre Nantel Profile
NDP (QC)
View Pierre Nantel Profile
2016-05-20 10:29 [p.3636]
Madam Speaker, I am pleased with the tenor of this morning's conversation on such an important subject. We seem to be embracing the propriety, elegance, and nobility of our role.
I cannot understand why the government is trying to rush this when it is such a sensitive matter. Barging around with such a sensitive issue like a bull in a china shop is a bad idea.
People are waiting for a clear decision. Ideas have changed. It has been suggested that the government request an extension from the Supreme Court. Why not do that? That is what should be done. We need time to think this through.
As a Quebecker, I find it so sad that we are fighting about this and looking after our own interests on an issue that should inspire the utmost respect. My provincial government counterparts and the people of Quebec made their decision after giving the matter a lot of thought.
My colleague says that it is about this or that, but ultimately, is this not about the suffering of the sick?
View Colin Carrie Profile
CPC (ON)
View Colin Carrie Profile
2016-05-20 10:31 [p.3637]
Madam Speaker, my NDP colleague who is from Quebec rightfully said that this issue was thought out through different governments, and all members in the House had time to listen to their constituents. I believe that they had six years of debate in Quebec.
This truly is a matter of life and death. It would change the social structure of our country.
The member is correct. The Supreme Court gave an artificial deadline. It came up with a date. However, the date can change.
We are doing our work in the House. Why does the government insist on rushing forward so that the voices of my constituents, my colleagues' constituents, and those of the backbench Liberal MPs, cannot be heard? Canadians deserve that their members of Parliament be heard in this House.
View Anthony Housefather Profile
Lib. (QC)
View Anthony Housefather Profile
2016-05-20 10:32 [p.3637]
Madam Speaker, I am honoured to participate in today's debate on such a core issue.
I would like to start by acknowledging the incredibly hard work and the non-partisan spirit of all of the member of the Standing Committee on Justice and Human Rights. I want to thank the deputy chairs, the hon. member for Provencher and the hon. member for Victoria, as well as the members of the committee, the hon. members for St. Albert—Edmonton, Niagara Falls, West Nova, St. Catharines, York South—Weston,Mississauga—Erin Mills, and Coquitlam—Port Coquitlam for their ability to work together in harmony. Even when we had an area where many people fundamentally disagreed and held true to very solid convictions, views and beliefs, we were able to work together in a non-partisan way and agree on 16 amendments to the bill before us.
It is true that not every member of our committee got everything they wanted. In fact, most of us did not get most of what we wanted, but what we did have was harmonious and agreeable debate, which should be an example to all of us in the House as to how parliamentarians should conduct themselves.
I now will talk about the bill itself, why I strongly support the adoption of the bill, and I want to put this in context. We are at a point where the Supreme Court delay is June 6. I will not attribute fault to anyone as to how we got here, but we only have a very short time to pass the bill. The hon. member previously asked why we would not ask the court for another delay. The court made it very clear, when we got our last four months delay of their original deadline, that it expected us to move forward and adopt legislation by June 6.
It does not mean that we could not ask again, but all of us should know that where the court ever grants a delay a second time, which is extremely unusual, it relates to an absolute inability of Parliament to get a law through. Therefore, I would ask everyone to consider what situation will we be in if we have no law on June 6? We will have no safeguards in place.
The current court decision that requires judicial review of an application for medically-assisted dying will expire on June 6. This will mean that no waiting period will be required. There will be no requirement for independent witnesses to somebody requesting medically-assisted death. There will be no requirement of a second opinion by a physician or a nurse practitioner that somebody meets the qualification of grievous and/or irremediable illness.
I would ask all of my colleagues on that side of the House, certainly within the Conservative Party, to consider the situation we will be in if we have no bill. It will not be a pretty situation. We will have absolutely no safeguards to ensure that those requesting medical assistance in dying truly have a grievous and/or irremediable medical condition. It is very serious.
I also want to talk about why we are here. My NDP colleague referred to the Alberta Court of Appeal. That explains to me all the more why we need safeguards and a law in place by June 6. We had a decision where a psychological patient who was not terminally ill, who had a short consultation with a psychiatrist lasting less than five minutes to evaluate her competence, was able to request medical assistance in dying and had it affirmed by the Court of Appeal. It is not true to say, as my colleague did, that it said the law was invalid. It was not looking at the current proposed law. It was looking at, and trying to interpret, the Carter decision by the Supreme Court the same way we all are.
My view is, as parliamentarians, we need to tell the court what principles we want to put forward, what safeguards we want to put forward so courts will look at the will of Parliament as opposed to doing what all of us are now trying to do and guess what the Supreme Court meant in the Carter decision.
I also want to point out that we should act cautiously here. Canada will only be the ninth jurisdiction in the world to allow medical assistance in dying. In the vast majority of these jurisdictions, the only people who can avail themselves of medical assistance in dying are people who are near the end of life, people in the U.S. who have six months to live, or people in Colombia who are near death. Only three jurisdictions in the world, the Netherlands, Belgium and Luxembourg, allow people to ask for their lives to be taken when they are not terminal.
The Supreme Court in Carter clearly contemplated a situation where we could not quite match section 7 and have section 7 compliance if we put in an end date. As a safeguard, we said that it had to be “reasonably foreseeable”. It is not perfect, but it is far better than having no requirement whatsoever that death be reasonably foreseeable.
In committee, we considered the things that were missing from the bill that we would have liked to have seen in it. By consensus, we added conscience rights for physicians, nurse practitioners, and pharmacists. We stated that under the bill nobody would be obliged to provide physician assistance in dying. In the preamble, we referred back to section 2 of the Charter of Rights and Freedoms, which guarantees the freedom of religion and the freedom of conscience, to make it clear that we did not intend for anyone to be coerced into doing this.
We also added palliative care to the bill, which is important. I referred to this in my previous question.
We also inserted protections for people who might also be associated with the act, for example, social workers and therapists.
We required that death certificates include medical assistance in dying as being the reason for death as well as the primary cause of the disease that lead to that.
While everybody did not receive exactly what they wanted, we have a far better solution than what we otherwise might have had in this situation where we would have no legislation and no guidance to the courts on what Parliament truly wanted.
My NDP colleague talked about what happened in Quebec. I am a Quebec MP too. What happened in Quebec is completely different from what we are dealing with as federal legislators.
It took Quebec six years to reach a consensus on the medical side. However, our situation is different because a Supreme Court ruling tells us that a certain percentage of people have a constitutional right to suicide without state interference if they are in a particular physical condition. The federal government would be irresponsible if it did not meet the Supreme Court's deadline.
We do not have six years to craft this consensus. To be honest, I wish we had more time at the Standing Committee on Justice and Human Rights. We tried our best. We listened to over 40 witnesses. They told us many different things, because there are so many different views in Canadian society on this bill. We spent many hours on clause-by-clause. We considered over 100 amendments. We had three full days and nights of meetings. Had we had more time to work together as colleagues of all three parties to draft legislation like we were trying to do on the fly, we possibly could have done better. That does not mean, however, that after June 6 we cannot improve the bill.
One of the things we inserted in the bill was a requirement that the Minister of Health work on these studies, especially on advance directives, and this should start within six months.
We need to be cautious with respect to advance directives. There are only three countries that allow advance directives and two of them only allow them for somebody who is in an irreversible coma. The idea that we should suddenly allow medical directives in advance for dementia patients, without any proper review or safeguards or understanding of the issue, to me is faulty. We have the opportunity in the future to correct any flaws that we see now in the bill.
I will use my last 30 seconds to try to prevail upon my colleagues in the House. I am sure many of my colleagues wished the Supreme Court had never rendered the Carter decision, which would have left the House with more latitude, but we are where we are. There is going to be medically assisted dying in Canada after June 6. The only question is whether it will be with no safeguards, with doctors and nurse practitioners trying to interpret Carter, or will it be with the clear safeguards that we have in Bill C-14. For me, the clear safeguards in Bill C-14 are the far better choice.
View Todd Doherty Profile
CPC (BC)
View Todd Doherty Profile
2016-05-20 10:41 [p.3638]
Madam Speaker, I find it interesting that our hon. colleague across the way has used words “on the fly” and “we have had three full days” of discussions. The House has debated the issue of pipelines longer than we are debating one of the most fundamental and important pieces of legislation of this Parliament, or those before us, and of those moving forward. We are dealing with life and death.
I am sure my hon. hon. colleague did not mean to say that good enough was good enough. When we are dealing with life and death, the government has done everything in its power to stall the debate, earlier this week and throughout the whole process. It is unacceptable.
Is good enough good enough when we are dealing with life and death?
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