Monday, February 8, 2021

The Standing Senate Committee on Legal and Constitutional Affairs has the honour to present its

FOURTH REPORT

Your committee, to which was referred Bill C-7, An Act to amend the Criminal Code (medical assistance in dying), has, in obedience to the order of reference of Thursday, December 17, 2020, examined the said bill and now reports the same without amendment but with certain observations, which are appended to this report.

Respectfully submitted,

Oberservations to the fourth report of the Standing Senate Committee on Legal and Constitutional Affairs (Bill C-7)

For this study, your committee held numerous meetings over the course of three full days, with more than 19 hours of hearings. In total, the committee heard from 66 witnesses, including the Minister of Justice; regulatory authorities; professional organizations; advocacy groups; persons living with disabilities; academics, legal and medical practitioners, and experts; Indigenous representatives; caregivers; and other stakeholders. The committee has also received numerous written submissions. This is in addition to the 81 witnesses heard in more than 35 hours of meetings during the subject-matter study of the bill in November 2020.

The committee heard from numerous witnesses with many years of direct experience in the provision of Medical Assistance in Dying (MAiD) in Quebec and elsewhere in Canada. These witnesses provided specific information to committee members about the framework governing MAiD: regulations, procedures, guides and instructions, and rules of practice. They also related their professional and personal experiences with patient assessment and administration and their knowledge of the way patients and their families experience MAiD.

The committee makes the following observations:

Patient-Initiated MAiD Requests

Requests for MAiD should be strictly patient-initiated. The committee heard from many witnesses that the inherent power imbalance between patients and their medical practitioners constitutes a big challenge for ensuring that patients are making free and informed choices and are not inappropriately coerced into seeking access to MAiD.

Oversight Mechanism

The Government of Canada should create an oversight body or mechanism to ensure compliance with MAiD regulations and to oversee that appropriate accountability and medical care have been provided to all patients, including, but not limited to, ensuring that no forms of abuse or coercion are detected prior to MAiD being administered.

Equality Rights

Bill C-7 expands rights to MAiD for some, while increasing inequality for those most marginalized. It fails to address existing barriers not only to MAiD but to alternative means of relieving suffering, such as health and personal care, social, housing and economic supports, and thereby to meaningful choice, in particular for those marginalized as a result of ableism, racism, classism and sexism.

Meaningful Choice and Access to Support

The Government of Canada has failed to provide clear details or timelines for measures to uphold the right to meaningful choice for all, including standards regarding long-term care, palliative care, community healthcare as well as housing and income supports necessary to ensure that alternative means for relieving suffering under s. 241.2(3.1)(g) of the bill are accessible, in practice, to all.

Access to Data

Existing data collected by Health Canada does not monitor many important factors concerning individuals requesting access to or receiving MAiD. Adequate disaggregated data will help to strengthen future reviews and reports and to monitor the effects of systemic inequality and the social determinants of health with respect to access to MAiD. The Government of Canada should ensure that Health Canada collects adequate disaggregated data concerning persons who have requested MAiD, including such factors as race, housing status, income, institutionalization, education level, ethnicity, area of residence, gender identity or expression, illness or condition, and access to alternatives to MAiD.

Indigenous Consultation

During the drafting of Bill C-7, the Department of Justice undertook public consultations with Indigenous leaders and experts; however, the committee underscores that these consultations were not comprehensive. The department failed to include Métis- or Inuit-specific representation in their Indigenous roundtable. Bill C-7 does not address the concerns that were raised at the Indigenous roundtable during the consultation process regarding the limited access to culturally appropriate healthcare options for Indigenous Peoples and systemic racism in the healthcare system.

Parliamentary Review

The preamble to Bill C-7 states that a committee of Parliament will begin a review of the legislative provisions relating to MAiD and the state of palliative care in Canada in June 2020. It does not specify that the parliamentary review look at Indigenous Peoples’ access to MAiD or access to culturally appropriate palliative care. Parliamentary review of MAiD legislation should include research and analysis on Indigenous Peoples’ access to and use of MAiD, and on culturally appropriate palliative care in Indigenous communities.

Support services

Several witnesses stated that improved disability supports, palliative care and mental health services are needed in conjunction with or instead of access to MAiD and that additional investments in these support services are essential. Indigenous Peoples, especially those living in remote areas, face additional barriers to accessing culturally appropriate support services which may be alternatives to MAiD. Future parliamentary reviews of the legislation should pay particular attention to the accessibility of culturally appropriate support services for Indigenous Peoples.

International Human Rights Obligations

It is important to note the importance of monitoring Canada’s adherence to international human rights obligations by independent human rights experts and of standards regarding quality of long-term care, palliative care, home care, housing and income in accordance with social determinants of health, as these will be central to future reviews of Bill C-7 and Canada’s MAiD legislation.