- Member of Parliament
- Member of Parliament
- Bloc Québécois
- Montcalm
- Quebec
- Voting Attendance: 64%
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- Government Page
Madam Speaker, as we begin the debate and this study, and since we are dealing with principles here, I would say from the outset that just because a person has an impairment does not mean that they have a disability. That is a basic principle, as far as I am concerned. Disability is a social construct.
A person living with disabilities achieves autonomy when they have social and economic autonomy. If the bill and especially the regulations, which do not exist yet, are drafted with that in mind, then they will certainly have our attention and support.
For a person living with disabilities to have dignity, to live in dignity, how much basic income should they receive annually?
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Madam Speaker, I heard the member for Abbotsford say right out of the gate that his bill seeks to reaffirm the dignity and worth of each and every human life. Who could be against that?
The dignity of every human life, as I was trying to say to him earlier, depends on autonomy and respect for a person's self-determination. We may have good intentions, but if we claim to know what is good for a so-called vulnerable person because we think we know better than they do about what is good for them, because we mistake sympathy for compassion, if we decide through some sort of state or medical paternalism what is supposedly good for them, without considering the person's suffering at all, if we take away a person's self-determination, then we undermine their dignity. That is what I wanted to say, but my colleague did not understand.
That is the very foundation of our position. It is called ethical and political philosophy, not theology or any sort of religious ideology.
The preamble to the bill sets out its intentions: “Whereas Parliament considers it a priority to ensure that adequate supports are in place for the mental health of Canadians”. Who could be against that?
I see no problem with that, but it has nothing to do with the purpose of the bill. This can be done without saying that the mental disorder considered as a serious and irremediable medical condition is excluded. I will come back to that.
The second paragraph of the preamble states, “Whereas Parliament considers that vulnerable Canadians should receive suicide prevention counselling rather than access medical assistance in dying”. This really shows a lack of rigour.
All the experts spoke about this and we can even read it in the literature. It is a little twisted to associate suicide with medical assistance in dying. I heard the leader of the opposition make that link a few times during oral question period, but conceptually that is false. Medical assistance in dying is initiated when an individual expresses that that is what they want. It is not imposed. Above all, it is for situations where the person's condition is irreversible. As far as I know, no witness at committee told us that a suicidal state is not reversible. Furthermore, witnesses also told us that we should not conflate the two. This is not getting off to a good start.
When a request for medical assistance in dying cites a mental disorder as the reason, the first step is to establish whether the person suffering has been struggling with the mental disorder for 10, 20 or 30 years of their life. In the experts' report, which I hope my colleague has read, it says that a person exhibiting suicidal ideation would not be eligible. It is one thing to want or to request medical assistance in dying, and another to meet the eligibility criteria. This is essential.
A person who is depressed or in crisis will not necessarily receive medical assistance in dying. Moreover, the experts say that an assessor would never consider a request for medical assistance in dying from a person in a state of crisis. The patient would have to first exhaust all available treatments for alleviating their suffering, without refusing a single treatment capable of restoring their health.
As Dr. Black said, “One study estimated suicidal thinking as an 8% lifetime risk for adults in the Netherlands, yet 65 or 0.0004% of adults in the Netherlands have died of MAID in any given year due to psychiatric reasons.”
Now we have members talking about a potential slippery slope, citing Bill C-14 and ignoring the obligation given to us by the courts to proceed with passing Bill C-7. Bill C‑14 was a bad bill that confused the public. Is it respectful of human dignity to force people to go on a hunger strike to reach the standard of likely and reasonably foreseeable natural death? I think there is something a bit inhumane about that.
In order to reach a criterion that was unworkable for some, people had to actually go on a hunger strike. Others, like Ms. Gladu and Mr. Truchon, had to assert their rights in court. Members say they want to protect the vulnerable. They should start by not treating these people like children and not exploiting them for any purpose. They should instead think about their well-being.
Who is more vulnerable than someone who is suffering intolerably and is close to their tolerance threshold? Who are we to decide for them what their tolerance threshold should be? That is essentially what this is all about.
People want to live as long as possible. The court determined that these individuals' right to life was being infringed upon. I am sure the Conservatives have a lot to say about the right to life. The court found that by denying these individuals the right to medical assistance in dying, their ability to live as long as possible is being taken away. This prevents them from living until they reach their tolerance threshold. That is when we could provide care to them and proceed.
Without this assurance, what do many of these individuals do? They commit suicide prematurely, and this infringes on their right to life. This is indisputable, and it could not be considered reasonable in a free and democratic society, even if it went to the Supreme Court.
Some people always want to go to court. However, right now, people are suffering. While we are procrastinating, people are suffering. We have to put things into perspective.
The committee that considered the issue of mental illness as the sole underlying medical condition made a recommendation. That is why I think that Bill C-314 is premature, at the very least, if not irrelevant at this time.
I will read the committee's recommendation. It states, and I quote: “That, five months prior to the coming into force of eligibility for MAID where a mental disorder is the sole underlying medical condition, a Special Joint Committee on Medical Assistance in Dying be re-established by the House of Commons and the Senate in order to verify the degree of preparedness attained for a safe and adequate application of MAID (in MD-SUMC situations). Following this assessment, the Special Joint Committee will make its final recommendation to the House of Commons and the Senate.”
At the very least, I would have expected a debate to take place following the work of that committee. That is the least that could have been done. I invite my colleague from Abbotsford to read the report of the Special Joint Committee on Medical Assistance in Dying and especially the expert panel's report. The recommendations set out in the expert panel's report include criteria and guidelines that do not exist for other forms of MAID practice. He should feel reassured after reading those recommendations, and I am sure he will never talk about a slippery slope again.
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Mr. Speaker, all the data we have shows that people who are at the end of life have received palliative care. However, there are palliative care units that refuse to take someone into that unit because they allegedly requested medical assistance in dying. I find that unacceptable.
I feel that palliative care is a stepping stone to dying with dignity. As part of the process, someone may request medical assistance in dying. That must be respected. Not everyone can manage to endure their pain and live an existence that makes them suffer to the end.
I do not think the choice is ours; it belongs to the person. There is no reason why the government should not accept a patient's decision, their free choice. They must make an informed decision that is not subject to change, as we heard from some witnesses in committee. We were told that when some physicians had a patient before them requesting medical assistance in dying, they would force them to change their mind so that they would not ask for it and receive only palliative care.
Imagine the opposite scenario. That would make the news everywhere for months.
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- May/2/22 5:13:46 p.m.
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Madam Speaker, how can someone claim to be able to call witnesses and have them submit briefs of no more than 1,000 words and talk to us for five scant minutes, when in Quebec we called experts who were given an hour for questions and answers and 15 minutes to explain their research? How can someone believe that the process would be credible with such a short deadline and a 10-page report? It is appalling.
Let us take a brief look at the main reports produced on medical assistance in dying to show why October 17 was an entirely appropriate and realistic deadline.
In 2012, in the National Assembly, the report of the Select Committee on Dying with Dignity entitled “Dying with Dignity” was 178 pages long.
In 2016, the report of the Special Joint Committee on Physician-Assisted Dying entitled “Medical Assistance in Dying: A Patient-Centred Approach,” was 60 pages long.
In December 2018, the first report of the Council of Canadian Academies’ Expert Panel on Medical Assistance in Dying entitled “The State of Knowledge on Medical Assistance in Dying for Mature Minors” was 193 pages long. The second report, entitled “The State of Knowledge on Advance Requests for Medical Assistance in Dying” was 219 pages long. The third report, entitled “The State of Knowledge on Medical Assistance in Dying Where Mental Disorder is the Sole Underlying Medical Condition”, was 247 pages long.
In 2019, Filion and Maclure’s report entitled “L’aide médicale à mourir pour les personnes en situation d’inaptitude: le juste équilibre entre le droit à l’autodétermination, la compassion et la prudence”, or medical assistance in dying for incapacitated persons: balancing the right to self-determination, compassion and prudence, was 157 pages long. This report was prepared following 17 eight-hour sessions.
In December 2021, the report of the Select Committee on the Evolution of the Act respecting end-of-life care, submitted to the Quebec National Assembly, was 90 pages long. This report was prepared following 39 meetings with witnesses and 46 steering committee meetings.
However, on our side, we would have to do the same thing in eight weeks, at a pace of one meeting a week, with witnesses who are not allowed to submit reports over 1,000 words long, so we could produce a report of no more than 10 pages. That is ridiculous. They put that in a closure motion and they think we are going to be happy about it.
I have no problem with the Conservatives completely disagreeing with what I stand for on this file, but I will not go along with the work being done poorly or in a partisan manner or with a debate as important as this one being reduced to legal quibbling at the end of the session. That is how this government is behaving.
The motion we are debating today is a prime example of how the Liberals have decided to act a like an arrogant majority government with support from the NDP. The message Canadians and Quebeckers sent during the election in September has gone by the wayside once again. This minority government, emphasis on minority, can go back to strongarming and cutting debate short when it feels like it. It is deplorable.
The main purpose of today's motion, although meant to extend debate until midnight from Monday to Friday, is to muzzle the opposition parties, and I will prove it. I would like to add another consideration, which stems from a certain deference to House of Commons employees. We need to think about the repercussions that extending sittings until midnight will have on the interpreters' ability to do their work safely, both in the House of Commons and in committee.
During the pandemic, we saw that virtual meetings created extra work for interpreters. In light of that, the Liberals should have shown greater consideration for them. Should we be surprised that they did not? We are concerned that, with all the extra work required of the interpreters, there will be fewer time slots available for committee meetings.
Let us look at the first part of this motion, paragraph (a). It begins by stating that “on the day of the adoption of this order, the ordinary hour of daily adjournment shall be 12:00 a.m.”. That is not a problem because the Bloc Québécois wants to sit, debate and work. On the issue of medical assistance in dying, we wanted to work on it before last April 8.
Paragraph (a) continues, “that until Thursday, June 23, 2022, a minister of the Crown may, with the agreement of the House leader of another recognized party, rise from his or her seat at any time during a sitting, but no later than 6:30 p.m., and request that the ordinary hour of daily adjournment for the current sitting or a subsequent sitting be 12:00 a.m., provided that it be 10:00 p.m. on a day when a debate pursuant to Standing Order 52 or 53.1 is to take place, and that such a request shall be deemed adopted”.
To me, the words “with the agreement of the House leader of another recognized party” are clearly referring to the NDP. The government is talking about the NDP, but this is completely out of character for that party. This is not the first time a government has moved a motion like this one.
Let us think back to the period from 2015 to 2019 and the democratic position of the so-called democratic party. At that time, the Liberals had a majoirity government. Earlier I spoke about how the Conservatives and the Liberals pass the buck back and forth, normalizing what is happening and accusing one another of the very thing that they themselves are doing. Then, they are shocked when people no longer have faith in democracy and go protest in the streets.
On May 30, 2017, the opposition, including 34 NDP members, voted against Motion No. 14 on the extension of sitting hours and conduct of extended proceedings. On May 29, 2018, the opposition, including 30 NDP members, voted against Motion No. 22 on the extension of sitting hours and conduct of extended proceedings. On May 28, 2019, the opposition, including 30 NDP members, voted against Motion No. 30 on the extension of sitting hours and conduct of extended proceedings.
Between 2011 and 2015, the Conservatives had a majority government.
On June 11, 2012, 96 NDP members voted against Motion No. 15 on the extension of sitting hours from June 11 to 22, except on Fridays, pursuant to Standing Order 27. On May 22, 2013, the opposition, including 82 NDP members, voted against Motion No. 17 on the extension of sitting hours and the conduct of extended proceedings. On May 29, 2014, 28 NDP members voted against Motion No. 10 on the extension of sitting hours and the conduct of extended proceedings.
The last time a minority government tabled such a motion, in 2009, it was defeated by the opposition. If a minority government tries to take away parliamentarians' privileges and their ability to debate, the opposition usually votes against it, as long as the opposition members are willing to stand up and respect the people who voted for them to oppose an arrogant majority government that governs like an absolute monarch.
On June 9, 2009, the minority government was Conservative.
On June 9, 2002, 138 opposition MPs, including 27 NDP members, voted against Motion No. 5 on extending the hours in June, and 134 members voted for the motion.
We know that the Liberals and New Democrats have an agreement on Motion No. 11. The NDP always opposed such a move over the years, but this time, it decided to give in.
This means that debate hours will be extended to midnight, Monday to Friday, provided that the government leader obtains the agreement of the NDP leader and makes the announcement before 6:30 p.m. If an emergency or take‑note debate is scheduled, the debate will be extended until 10:00 p.m.
The minority government has complete control over the evening program without allowing the opposition to have any say on what happens in the House. That is the first problem.
It is paragraph (c) that really limits the opposition's powers. The House leader of the official opposition spoke at length about this and did a brilliant job illustrating it, citing all the examples where the rights of the opposition could be flouted, so I do not need to repeat all of them.
The most abhorrent part of this motion is paragraph (e), which extends the deadline for the final report on medical assistance in dying. As I said earlier, even though the Bloc agrees, it nevertheless took an appeal to the Chair to have the vote split, which, fortunately, we obtained.
In closing, I implore all parties to take an approach that crosses partisan divides on this issue. I hope the Leader of the Government in the House of Commons, who said at one point that he did not agree with the October 17 date, can convince his colleagues to vote in favour of that part of the motion.
That said, I would like to table an amendment to the amendment:
That the amendment be amended, in subparagraph (a)(ii), by replacing the words “two sitting days’ notice” with the words “one sitting day’s notice”.
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Madam Speaker, the bill we are debating today has to do with protecting the freedom of conscience of health care professionals and practitioners when it comes to medical assistance in dying.
I think we should base our debate on the approach that Quebec took on this matter back in 2010. Quebec studied this issue from 2010 to 2014. The debates were non-partisan. The process allowed for all points of view to be heard and compiled. The focus of the debate was human dignity.
When talking about end-of-life care, we must not forget that the way to protect human dignity lies in freedom of choice. No one can claim to be acting in a patient's best interests if that patient is not allowed to make their own decisions. What is interesting about the Conservatives' bill is that they want the state to be less involved in the economy but more involved in our lives, especially when it comes to death, which is one of the intimate decisions a human being will make.
It is not the state or Conservative members who are going to die in place of the individual, the person who is dying, the patient, so why are they trying to interfere in this decision?
This bill is pointless, and I say this because subsection 241.2(9) already stipulates that no one can be compelled or forced to provide medical assistance in dying against their will.
As I just mentioned, the Quebec legislation should guide us in our debate here today. Section 31 of the Quebec legislation stipulates that medical practitioners cannot be forced to participate directly or indirectly in MAID, and I quote:
A physician practising in a centre operated by an institution who refuses a request for medical aid in dying for a reason not based on section 29 [which sets out all the conditions that a doctor must meet before deciding whether to provide medical assistance in dying] must, as soon as possible, notify the executive director of the institution or any other person designated by the executive director and forward the request form given to the physician, if that is the case, to the executive director or designated person. The executive director of the institution or designated person must then take the necessary steps to find, as soon as possible, another physician willing to deal with the request in accordance with section 29.
This means that a patient who is dying and highly vulnerable should not be burdened with having to take the steps I just mentioned. The bill the Conservatives are introducing today would do just that. It would force these individuals to take those steps at the most vulnerable time of their lives, when they are dying or about to die. However, medical practitioners can refuse to participate directly or indirectly in MAID.
As we heard during the Standing Committee on Justice and Human Rights' study of Bill C-7, some practitioners, citing freedom of conscience, are currently refusing to abide by the Collège des médecins du Québec's code of ethics and forward the request. In other words, they are ignoring the request, which they are not allowed to do.
In Quebec, conscientious objection is defined as follows: “Health professionals must not ignore a request for medical aid in dying. However, a doctor may refuse to administer medical aid in dying because of his or her personal values. The doctor must notify, as soon as possible, the executive director of the institution”.
That is the issue. The Conservatives have introduced a bill to add a provision to the Criminal Code that would make what they call intimidation in health care facilities an offence.
This would be a situation where a health care professional dealing with a family supporting a dying patient—a father, a mother, a brother, a sister—offers end-of-life options without ever mentioning medical assistance in dying. That is the kind of scenario we are talking about.
Quebec was a leader in this area and contributed to advancing the legislation, but there is still a lot of resistance on the ground when a patient requests medical assistance in dying. That can manifest in various ways. The surprising thing is that this resistance stands in stark contrast to what I consider the essence of Quebec's legislation, which was to integrate end-of-life care into the palliative care continuum.
In the current debate, there is one side advocating for palliative care and another advocating for medical assistance in dying. Quebec's legislation did not fall into the trap of such unnecessary division. Palliative care should be accessible, and the continuum of palliative care can give rise to a request for medical assistance in dying. A request for MAID emerges when a patient is given the opportunity to make a free and informed choice.
A person's dignity must not be defined by how they die, and it cannot be compromised because death is considered to be distasteful. To respect a human being is to respect their dignity, and that means respecting their independence and capacity for self-determination until their last breath.
The law enshrines the principle of self-determination throughout our lives, especially when it comes to medical decisions. No one can interfere with my person without my free and informed consent. Why then, at the most intimate moment in my life, would the state interfere in my life and take away my right to self-determination? I can only make a free choice if the practitioner is able to offer me all the choices, including access to palliative care, palliative sedation, and medical assistance in dying. This is a decision that only a dying person can make.
These types of bills and debates take us away from far nobler objectives. There is nothing new here to crow about; it was already set out in the legislation.
I would like members to understand why the Bloc Québécois will oppose this bill. We oppose this bill because at present, in Quebec, some people requesting MAID in a hospital are not being admitted to a palliative care unit. It is shameful that people at the end of their lives must live their last moments in a place that is far from peaceful and far from what is recommended as appropriate for dying with dignity. Why oppose that?
We must focus our efforts on having a continuum of care, working to ensure that palliative care is as available and accessible as possible in all forms, whether at home, in hospices, or elsewhere. A request for assisted death must be viewed not as a failure, but as a success in accompanying an individual towards death.
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