Hon. Mohamed-Iqbal Ravalia: Honourable senators, I rise today to speak in support of Bill S-248, An Act to amend the Criminal Code (medical assistance in dying), introduced by Senator Wallin. I would like to thank Senator Wallin, whose continued advocacy for expanding eligibility for advance requests for medical assistance in dying, or MAID, is grounded in evidence-based research, compassion and a patient-centred approach.

This bill contains two main objectives, the first being that it would amend the Criminal Code to permit an individual whose death is not reasonably foreseeable to enter into a written agreement to receive MAID on a specified day if they lose capacity to consent prior to that day. The second objective is to permit an individual who has been diagnosed with a serious and incurable illness, disease or disability to make a written declaration to waive the requirement for final consent when receiving MAID if they lose capacity to consent, are suffering from symptoms outlined in their written declaration and have met all other relevant safeguards outlined in the Criminal Code.

In effect, this bill would allow competent persons to make advance requests for medical assistance in dying. In the most practical sense, it would broaden the range of options for patients who are faced with difficult circumstances and, at times, agonizing decisions.

Honourable senators, we have heard from Senators Wallin, Seidman and Kutcher, who delivered well-researched and articulate arguments as to why this bill needs to be further studied at committee. Senator Wallin’s proposal for expanding the right to advanced requests for MAID isn’t new. As Senator Seidman highlighted, it was a recommendation made more than six years ago to the Special Joint Committee on Medical Assistance in Dying, which she was a member of, by many witnesses with knowledge and expertise in the areas of law, health and ethics. Senator Wallin also proposed this amendment last year during our study of Bill C-7, which passed in this chamber but was later rejected by the government of the day, who handed it over to the Special Joint Committee on Medical Assistance in Dying for further study and consideration.

I would like to commend the work of the Special Joint Committee on Medical Assistance in Dying, which, as we are all aware, has conducted a parliamentary review on some of the key issues in Bill C-7, including advanced requests. The committee, co-chaired by our honourable colleague Senator Martin, recently tabled their second report, Medical Assistance in Dying in Canada: Choices for Canadians. This work is supported by our honourable colleagues including Vice-Chair Senator Mégie and members Senators Dalphond, Kutcher and Wallin. I’d like to highlight that in this report, the committee recommends that the Government of Canada amend the Criminal Code to allow for advance requests following a diagnosis of a serious and incurable medical condition, disease or disorder leading to incapacity.

Honourable senators, legislation can often seem theoretical, distant and cold. However, Bill S-248 involves real people, real families and agonizingly real choices made in a context that cannot possibly be understood by those who have not lived or experienced it.

I recognize that this is a deeply emotional and polarizing issue, and I respect the deeply held moral and spiritual beliefs of many in this chamber that we should not be in the business of making it easier to end a human life.

My perspective on this issue comes from over 35 years as a practising physician and having the gut-wrenching experience of witnessing incurable medical conditions slowly and steadily destroy everything that resembles life and living. I have witnessed the harsh toll that these conditions take on both patients and their loved ones. And so, the polarity of emotions in my own head and mind seem to be at constant odds. This is indeed a sensitive subject with a strong emotional and spiritual foundation, and based on my lived experiences in caring for individuals with cognitive impairment, neurodegenerative disorders, brain tumours and other neurological diseases that slowly and steadily strip away so much of what makes us who we are.

Honourable senators, I have always marvelled at the complexity of the human brain. Weighing a mere 1.4 kg, it shapes so much of what it means to be human, and its degeneration leaves behind sequelae that are heart-rending. Medical advances mean that we live longer and have a plethora of diagnostic and therapeutic options. The progress and understanding of medical science is indeed a marvel to behold. And yet, when it comes to understanding the brain, we remain somewhat in the dark.

Many of us have witnessed the effects of loss of cognition in our loved ones, friends and communities. The process is hardly ever linear. Plateaus and systematic decline are interwoven until all that remains is a shadow of what was a productive life.

In medical school, I had the opportunity to study dementia and neurocognitive disorders. During an elective in Edinburgh, Scotland, I had my first experience of working and studying in a “dementia unit,” as it was called. It was here that I first witnessed the impact of the loss of higher function on loved ones and caregivers. I felt so helpless and forlorn, and this memory would come back to haunt and remind me of how very cruel this malady is as I took charge of caring for my own unit and individuals in various stages of cognitive decline in my beloved Twillingate.

Honourable senators, let me categorically state that I would never canvass, suggest, coerce or advise MAID. It is a decision that must and should always be left to the individual and their determination as to why, how or when they might seek such an option. If asked, I will offer all options for individuals and families to consider and include the key members of my team in that complex and emotionally charged process. I’ve often turned to clergy and psychologists myself for personal reflection, and perhaps redemption, when facing these questions.

My time in practice has taught me that even when every treatment option is offered to those in cognitive decline, there is a progressive point in some individuals that does cause irremediable pain and suffering, physical and emotional pain, searing dissociation that is caught in the eyes of the victim — haunting, cruel and unremitting.

Does life’s moral compass always bend towards justice? I don’t know the answer to that. But watching people that I’ve loved so dearly go through this agony has left me wounded and scarred. I have witnessed countless tragic and painful experiences: the angst of confusion, agitation, delirium, combativeness, personality changes, loss of bodily function, infections and often helplessness.

A dear friend once said to me, “Ravs, all I can remember is the pain and confusion in mum’s eyes. All my other wonderful memories have been drowned out by this one image. What could we have done differently?” My answer is that I’m not sure. I’m hurting too. She knit me a pair of woollen socks, she baked me pies and she loved inviting me in for pea soup on Saturdays. She was so wise. I miss her, too.

We, as the providers of care, often feel the most helpless, trying our best to provide evidence-based care for our community members — people we know and love so dearly.

So yes, I’ve seen a lot of suffering and pain, and I do not have all the answers. But the memories linger and surface. There are the blood-curdling screams, aggression and agitation and cruel verbal assaults on loved ones. Even when you know why it is happening, you live with it, day in and day out, in a state of disbelief and despondency.

So the difficult question arises repeatedly from patients: “What if I did not have to go through this? What if it did not have to be this way? Can I make this decision? What if I change my mind? Will I still go to heaven? I’m afraid. I can’t bear to watch my family agonize over me if I lose it altogether.”

Honourable colleagues, Bill S-248 offers competent patients options. It is our duty to assess whether those options are feasible in allowing Canadians the choice of how they wish to plan their lives when faced with such unbearable situations. This is an important piece of legislation. It requires all of our careful thought, consideration and study at the next legislative step at committee. Thank you, wela’lin.

(On motion of Senator Martin, debate adjourned.)

On the Order:

Resuming debate on the motion of the Honourable Senator Ravalia, seconded by the Honourable Senator Duncan, for the second reading of Bill S-253, An Act respecting a national framework for fetal alcohol spectrum disorder.