Mr. Speaker, I appreciate this opportunity to outline the proposed amendments to the federal legislation on assisted dying. This bill responds to the Superior Court of Québec's ruling last year in Truchon by removing the requirement that a person's natural death be reasonably foreseeable in order to be eligible for medical assistance in dying. The proposed amendments were developed with the goal of supporting autonomy and choice for those Canadians with non-terminal conditions who are suffering intolerably, while addressing the potential risks of expanded eligibility for medically assisted death.

Our government consulted widely on this issue. We examined the evidence submitted before the court. We looked at domestic and international research. We compared our experience to other assisted dying regimes from around the world. We consulted with constituents, including 300,000 individuals who took part in our online public consultation, and we asked health care professionals about their practical experience with MAID over the past few years.

The bill reflects some important changes based on what we heard. In light of the need to respect the autonomy of Canadians seeking MAID, while providing protections for vulnerable people, the bill proposes the application of a two-track system of safeguards. While the bill no longer uses a reasonably foreseeable natural death as a basis for determining eligibility, it does use it as a basis for determining whether to apply a more rigorous set of safeguards. If a person's death is reasonably foreseeable, a set of safeguards akin to the existing regime would apply. However, some of the original safeguards have been eased in light of the feedback we received.

For example, there was overwhelming support for changing the witness requirement from two witnesses to one. Providers consistently reported that finding two independent witnesses posed a barrier to those seeking MAID, especially for anyone living in a care home with a limited social network. The sole purpose of the witness is to confirm that a person seeking MAID has signed the request themselves. To be clear, the witness has no role in confirming whether the request was made voluntarily, nor does the witness have any role in assessing whether the person's condition makes them eligible for MAID. Rather, it is the MAID provider who undertakes the eligibility assessment and ensures that the person requesting MAID is making the request freely and not in response to external pressures.

The proposed bill responds to these concerns and eases this requirement to one witness. It also allows for a witness to be someone who is paid to provide personal support or health care services. Anyone who is in a position to benefit in any way from the person's death, as a beneficiary to a will or in any other material way, would not qualify as an independent witness.

Health care providers and the families of people who receive MAID also told us that the mandatory 10-day wait period often results in prolonged suffering for individuals who had already put careful and extensive thought into their decision. As a result, the proposed bill would remove this requirement.

I would like to address how the bill would protect Canadians, while satisfying the requirement from the Truchon ruling to eliminate the reasonable foreseeability of natural death clause. On this issue, we received feedback from practitioners and stakeholders who expressed concerns that people who are suffering but not at the end of life could make decisions about MAID that are not fully informed with respect to all available treatments and supports.

On this very sensitive subject, I consulted with my own constituents in Mississauga—Streetsville. I found one of the strongest proponents of these MAID reforms in Mr. Paul Irwin, who suffers from Parkinson's disease. Although this horrible affliction is slowly robbing Mr. Irwin of his neurological functions, I can assure the House that his mind remains razor sharp. Mr. Irwin has explored all available treatments and supports, and he has consulted a wide range of medical professionals. There is no doubt in Mr. Irwin's mind that he would like to control when and how he passes as a recipient of MAID. It is not a decision that individuals in Mr. Irwin's circumstances take lightly or without having weighed all alternatives. I applaud Mr. Irwin's courage.

In order to afford individuals like Mr. Irwin the dignity they deserve, we have added safeguards in lieu of foreseeable natural death that would apply only to requests where a person's death is not reasonably foreseeable. These strengthened safeguards are designed to support informed decision-making and the consistent application of good medical practice. For example, the bill proposes a 90-day minimum assessment period to offer an exploration of all relevant aspects of the person's situation.

We heard very clearly through the consultation process that Canadians are concerned about implementing a requirement for specialist consultations in assessments of MAID. We know that in some parts of the country, such as rural and remote communities, a consultation with a specialist can be harder to arrange. We do not want to create unnecessary barriers. This is why the bill proposes that, for people whose death is not reasonably foreseeable, one of the assessments will be done by a provider with expertise in the person's medical condition but not necessarily a specialist. We recognize that many health care providers have special training and certifications that qualify them to assess a person's particular medical circumstances, even if they are not specialists.

The bill also proposes that the practitioners and the patient would need to agree that reasonable options to relieve the patient's suffering had been seriously considered. This safeguard respects an individual's autonomy, while at the same time underscoring the importance of a fully informed, decision-making process.

In addition, following the Truchon decision, some have expressed concerns that individuals suffering solely from a mental illness could receive MAID. For example, many clinicians argue that the trajectory of mental illness is harder to predict than that of physical diseases, rendering it impossible to determine when or if a mental illness can be considered irremediable as required by MAID legislation. Another concern is the challenge of conducting capacity assessments, given that the symptoms of mental illnesses can affect a person's ability to understand and appreciate the nature and consequences of treatment decisions.

In light of these important concerns, the wording of the bill would preclude individuals suffering solely from a mental illness from accessing MAID. The decision to include this wording reflects the complexity of this problem and the need to fully consider the potential consequences of permitting MAID for individuals with a mental illness to make sure that vulnerable persons are not put at risk. We anticipate that this issue will be further explored as part of the parliamentary review.

I would now like to turn my attention to the waiver of final consent.

The current law includes a procedural safeguard that requires the practitioner to ensure that the person gives their express consent immediately before providing MAID. This is often referred to as “final consent” and is significant for health care providers as it provides a final confirmation of the person's desire to proceed with MAID. This safeguard also prohibits MAID for individuals who have lost the capacity to provide final consent, regardless of how definitive they were about their intention when they had capacity, made the request and were deemed eligible.

Unfortunately, the requirement for final consent had the unintended consequence of encouraging some individuals to receive MAID earlier than they would have liked out of fear of losing capacity to consent prior to their preferred date. This was the situation faced by Audrey Parker. Ms. Parker was very clear about her desire to share one last Christmas with her family, but felt compelled to receive MAID almost two months earlier than anticipated in order to ensure that she was still capable of providing final consent for the procedure.

In a similar example that is a bit closer to home, my friend and legislative assistant recently lost his father. A MAID recipient, Wah-Lit “Edward” Lui passed away peacefully at home on September 23, 2020. Once doctors had diagnosed Edward with a rare complication of terminal cancer, he had little choice but to immediately initiate the MAID process, which had long been his expressed desire, for fear of losing the ability to final consent over the next few days. Thus, Andrew and his family had a mere 24 hours to say their final goodbyes.

Under the proposed amendments, individuals who have been found eligible to receive MAID and whose death is reasonably foreseeable, but who may be at risk of losing decision-making capacity, could waive the requirement to provide final consent before the procedure. For families like the Parkers and the Luis all across Canada, allowing MAID to proceed in the absence of the ability to provide final consent is simply the right thing to do.

As a further safeguard, in order to waive this requirement, an individual would need to have been assessed and approved for MAID, and be at or very close to the end of life. As proposed in the bill, the individual would provide written consent for the practitioner to administer MAID on a specified date.

In conclusion, the proposed amendments in the bill take into account the lessons we have learned through consultations and respond to the immediate task of following up on the Truchon decision. With this revised legislative package, our government has gone a very long way to respect and support the autonomy of Canadians who wish to consider a medically assisted death, while taking seriously our responsibility to protect vulnerable people.

Gagan Sikand