Question Period Note: Bill C-7 Medical assistance in dying

Media report press conference at which representatives of the Indigenous community express concerns over measures in Bill C-7 that would broaden eligibility for medical assistance in dying (MAID).

• We know that there are concerns in some communities about Bill C-7, which would broaden access to MAID. Concerns include that it could undermine suicide prevention efforts, or that persons will have access to MAID without having access to other resources that could improve the quality of their lives.
• I am confident that the safeguards in the existing law and those proposed in Bill C-7 for persons whose death is not foreseeable, will protect vulnerable persons while respecing the autonomy of suffering Canadians to choose a medically assisted death when they cannot go on any longer.
• No person can receive MAID unless they make a voluntary request and give informed consent. They must also be informed of all available services that could potentially relieve their suffering, discuss these with two independent MAID assessors, and there must be input of a practitioner with expertise in their condition. A minimum of 90 days must be taken to assess their eligibility; the assessments can be extended for as long as is necessary in each individual case.
• Bill C-7 was informed by a series of roundtables with experts and stakeholders, including a roundtable with Indigenous practitioners and community leaders. They emphasized the need for appropriate and culturally safe medical care, health services and mental health care as the most important protection for Indigenous persons in the context of an expanded MAID regime. Our Government hears these concerns and is committed to improving access to healthcare in Indigenous communities.

MAID LEGISLATION
Bill C-14, An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying), which has been in force since June 17, 2016, created exemptions from otherwise applicable criminal offences (aiding a person to die by suicide and culpable homicide), permitting practitioners to provide medical assistance in dying (MAID) in certain circumstances. The legislation requires a parliamentary review of its provisions, which was expected to begin in the summer of 2020 but has been delayed due to the COVID-19 pandemic.
On September 11, 2019, in the Truchon and Gladu case (Truchon), the Québec Superior Court struck down the eligibility criterion requiring that a person’s natural death be reasonably foreseeable.

On October 5, 2020, the Minister of Justice re-introduced Bill C-7, An Act to Amend the Criminal Code (medical assistance in dying), in response to the Québec Superior Court decision in Truchon. The Bill would: repeal the “reasonably foreseeable natural death” (RFND) criterion; exclude persons whose sole underlying medical condition is a mental illness; create two sets of safeguards that apply depending on whether natural death is reasonably foreseeable; allow the provision of MAID on the basis of consent given in advance if the person’s death is reasonably foreseeable, they are eligible for MAID, and they risk losing capacity before their scheduled date to receive MAID; and, expand data collection under the federal monitoring regime. RFND continues to function, however, as a means of assessing which procedural safeguards will apply in MAID requests with stronger safeguards in place where death is not foreseeable. Bill C-7 is identical to former Bill C-7 (introduced on February 24, 2020), which died on the Order Paper following the prorogation of Parliament in August 2020.

CONSULTATIONS
Bill C-7 was also informed by concerns and issues raised during the January and February 2020 consultations with Canadians, and roundtables held across the country with experts and stakeholders, including a separate roundtable focused on receiving specific feedback from Indigenous practitioners and community leaders.

Indigenous individuals and practitioners spoke to unique challenges for MAID in Indigenous communities as a result of historical and intergenerational trauma. Many mentioned the harmful experiences that Indigenous peoples face within the healthcare system, and ongoing challenges of discriminatory and limited access to culturally safe care. In the context of a broader MAID regime not limited to the end-of-life context, some were concerned that Indigenous patients may choose MAID due to lack of access to adequate healthcare services or as a result of external pressures (e.g., lack of housing).

Some Indigenous participants indicated that the best safeguard for Indigenous peoples would be to ensure that appropriate medical care, health services and mental health care are available to them. Many mentioned the importance of cultural safety as a key safeguard for Indigenous people in the MAID context, and the importance of training healthcare providers to deliver culturally safe care. Some Indigenous participants highlighted the variation in how Indigenous peoples view death and dying and the need for guidance from Elders and spiritual leaders to be able to perform MAID in a way that is culturally safe and appropriate. Some stakeholders noted the difficulties of talking about MAID in the North, where many patients speak a different language in which certain MAID-related terms and concepts do not exist.

SUICIDE PREVENTION
The Government of Canada supports provincial and territorial efforts on suicide prevention through targeted investments: $21 million over five years to implement and sustain a fully operational pan-Canadian suicide prevention service.
Populations at higher risk of suicide include Indigenous populations, veterans, LGBTQ2S+ groups, men and boys, and persons living with chronic physical illnesses. Evidence about the impact of non-end of life MAID regimes on suicide rates remains inconclusive.

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