Senator Wetston, I struggle with this every day. If I looked you in the eye and told you that I don’t believe that some people will be pressured, I would be lying. I think some will be. That’s where we come into play, and we have to make sure that there are enough safeguards so that people are not pressured. But it will also give those who have been waiting for such a long time the ability to die with dignity. So we are providing a pathway for people to die with dignity, but we also have to make sure that there are sufficient resources, like palliative care and access to proper medical care, so that people are not forced. That is also our duty. Senator Wetston, that’s something I struggle with every day.

Yes, I will.

Senator Cordy, I was your seatmate in 2016, and both of us struggled. You remember the terrible struggles we had, and we still have them. That’s the question people are asking, the one you are putting across. Those were not my words. They were Penny Mills’ words: “What’s the difference?” That’s the challenge, that we accept one, do not resuscitate, and MAID. That’s what people who want the choice are asking: What’s the difference? And that’s something we as parliamentarians have to look in the eye and say, “What are we doing? Are we going to provide MAID —”

May I ask for another five minutes, please?

Thank you, senators. That’s the challenge, Senator Cordy. You and I both struggled with this before. I believe that if we as parliamentarians are going to provide death with dignity, we also have to face those questions you asked.

I see it as a progression. As we learn more, Canadians are saying, “Yes, you brought in MAID, but then you put all these things in place that cause us a lot of pain and suffering.” We are revisiting those issues. That’s what we are doing. Plus, Senator Cordy, you remember the struggles we had and that we wanted foreseeable death not to be the only option. That’s what is in place now, what we struggled with in 2016, so I believe it is a progression.

Yes. Absolutely.

Senator, that’s such a difficult question, because we are a large country, and what has become very obvious with our pre-study is the terrible situation for Indigenous peoples and the terrible situation in rural areas. That’s why I believe what I heard in the most profound speech given by Senator Mégie on palliative care. And I believe that with this, hand in hand, we have to say to the government, “We have to put observations in place that this doesn’t go by itself.” With this you have to put proper palliative care. We have to make it possible that we have the same sort of service across Canada.

I think that’s something that has been raised time and again in the pre-study and before. And I think that this goes hand in hand when we tell the government — if we do — that we accept this; we have to say, “This is only part of it. We hold you liable for the other things that people were saying.”

Honourable senators, I rise today to speak to Bill C-7, An Act to amend the Criminal Code (medical assistance in dying), at second reading.

I want to start by acknowledging the hard work of my colleagues on the Standing Senate Committee on Legal and Constitutional Affairs during the week-long pre-study of Bill C-7. The committee members were open, actively listened and came to conclusions as a group.

I want to express my support to those affected by this bill who are suffering from serious and incurable physical or mental illnesses and who struggle every day with challenges that few of us can truly understand.

My thoughts go out to the families of those who are ineligible for MAID under Bill C-14, or who were ineligible, and who had to take drastic action to put an end to their loved one’s life and therefore their suffering, even though these individuals had the right to a dignified and humane end of life.

I thought it was a shame that none of the witnesses invited to the committee’s pre-study were patients with a personal stake in MAID and that no families were able to participate, share their perspectives and contribute to this debate, which is, after all, about them first and foremost. That was my biggest disappointment and one of the weaknesses of our pre-study, considering that it was the one opportunity for committee members to better understand the day-to-day suffering of these human beings and their loved ones.

The same applies to victims of crime. So often, when people are suffering because life has unfairly done them wrong, we lawmakers pay more attention to the testimony of experts, scientists, legal experts and religious figures without considering what the people who are directly affected feel and can contribute.

In my view, I think the victims of Bill C-14 are the ones we should have listened to, and should listen to, as we examine Bill C-7 in the coming months, and who should be at the heart of our reflection, rather than the experts. I see those individuals as the real experts on what a law imposes on their quality of life and especially on how they choose to end their lives. Very few of the stakeholders we consulted can truly understand their suffering, and I’m convinced that if we had heard from witnesses affected by MAID, we wouldn’t be so divided and torn in this debate.

Medical assistance in dying is a very emotional subject for many of us. It stirs up a lot of emotions and can even make us question our own perceptions of life and death. Basically, it is an opportunity for us to reflect on our human values as we are confronted with the cruel and unacceptable situations some human beings are unjustly condemned to live with.

Honourable colleagues, one of the first things I want to address in this chamber is the attitude that the federal government has taken in its management of medical assistance in dying since 2016. I get the impression that the federal government is just trying to rush Bill C-7 through both chambers without giving us, the legislators, the time we need to do our job properly and analyze the content of this bill within a reasonable time frame.

After all, it was the government that didn’t do its homework. We would not be in this situation if Justin Trudeau’s team had listened to the Senate when it made significant recommendations regarding Bill C-14 in 2016.

Since the government was bound by the deadline set by the Quebec Superior Court for reviewing the legislation, it was the government’s responsibility to allow enough time for the study of its new bill on MAID. It had the time, but chose not to take it, even though we all know that MAID is a sensitive topic and that the study of Bill C-14 was long and difficult. This time, we all know that the government decided to create a sense of artificial urgency because its own representatives are behind on their own homework.

I also remind you that the first iteration of Bill C-7 was introduced in February 2020 and died on the Order Paper with the prorogation of Parliament on August 18, when the Prime Minister was grappling with the WE Charity scandal. He chose to waste six precious weeks of work in the midst of the pandemic instead of taking responsibility and answering questions before the House of Commons Standing Committee on Finance. He also prorogued Parliament in order to avoid shedding light on the murder of Marylène Levesque, who was killed by a violent repeat offender who had already killed before. Let’s be clear: The government alone is responsible for the suffering of those who wish to receive medical assistance in dying.

The problem that we are still dealing with today has to do with Bill C-14, which was very flawed when it was passed. On February 6, 2015, in Carter, the Supreme Court of Canada struck down some provisions of the Criminal Code that banned certain people from accessing medical assistance in dying. The Supreme Court of Canada found those provisions to be unconstitutional because they were not consistent with section 7 of the Canadian Charter of Human Rights and Freedoms, namely the principle of liberty, which guarantees a person’s right to make fundamental personal choices without interference from the state, and the principle of security, which guarantees the right to control one’s bodily integrity without interference from the state. The Supreme Court of Canada did not focus the debate on people whose death is reasonably foreseeable or people suffering from degenerative illnesses.

Following the Supreme Court of Canada’s decision, the Special Joint Committee on Physician-Assisted Dying, which was made up of MPs and senators, made some rather clear recommendations in its February 25, 2016, report entitled Medical Assistance in Dying: A Patient-Centred Approach. It includes the following recommendations, and I quote:

RECOMMENDATION 2

That medical assistance in dying be available to individuals with terminal and non-terminal grievous and irremediable medical conditions that cause enduring suffering that is intolerable to the individual in the circumstances of his or her condition.

RECOMMENDATION 3

That individuals not be excluded from eligibility for medical assistance in dying based on the fact that they have a psychiatric condition.

These recommendations were made five years ago, and Justin Trudeau’s government has yet to follow them. I’m afraid that the argument of the Minister of Justice, who is criticizing the opposition by claiming to want to reduce people’s suffering, is coming back to haunt him.

In 2016, we already knew that the eligibility criterion defined as “naturally foreseeable death” in Bill C-14 would be found unconstitutional by our courts. The government disregarded the committee’s recommendations by sadly choosing to prolong extreme suffering for people with severe disabilities, in obvious violation of section 7 of the Canadian Charter of Rights and Freedoms.

We senators, however, did our homework. Our former colleague, Senator Joyal, proposed an amendment to Bill C-14 that would eliminate the naturally foreseeable death criterion. This amendment was rejected by the other place. I still remember the then justice minister, the Honourable Jody Wilson-Raybould, who at the time said she believed that Bill C-14 was constitutional, as her successor is now claiming about Bill C-7. They both made the same statement, and we will no doubt end up with the same outcome.

However, three years later, two people with severe disabilities, Nicole Gladu and Jean Truchon, had to take their fight to court to make the government do its homework even though Justin Trudeau’s team already knew the measure was unconstitutional. As senators, we did our job by warning the government about the constitutional problem, but the government chose to ignore that warning.

Just as I said upon leaving the Senate chamber in June 2016, here we are five years later in the same situation as when the same government decided not to appeal a superior court decision. Instead, it decided to introduce another bill that includes yet another unconstitutional and discriminatory provision: the exclusion of people suffering from serious mental illness. That was the elephant in the room that we weren’t afraid to talk about during the Legal and Constitutional Affairs Committee’s Bill C-7 pre-study meetings.

Honourable senators, I predict that Bill C-7 will suffer the same sad fate as Bill C-14.

Even more surprising are the arguments for justifying the exclusion of mental illness from the bill. It seems that the government did not have enough time to make a decision on this important aspect of the bill. We do know that there is no consensus within the scientific community. If this is the case, why doesn’t the government take more time to study the issue over the next few months? Study of Bill C-14 will begin in a few weeks, which leaves us a few months to decide on the issue and gives the government enough time to introduce a properly drafted bill on MAID that will be constitutional and will not exclude any individual wanting to access this right.

I question the introduction of this bill because we will be simultaneously working on reviewing Bill C-14 and its new version, Bill C-7, to come to the same conclusions. This seems like an inefficient and unnecessary exercise to me, because we already know from our experience with Bill C-14 that Bill C-7 will be challenged before the courts and that the government will have to come back with a new response. It is unfortunate that ever since Carter in 2015, five years ago now, we have failed to faithfully respond to the Supreme Court directive on MAID. Why then should the Senate adopt the principle of a bill that will go down the same road as the previous bill, involve lengthy parliamentary work and make us waste valuable time?

It is not hard to imagine that people living with mental health issues will have to fight in court to challenge this exclusion in the legislation on MAID. This could force some people to turn to suicide to end their suffering, since they will not be able to use the legislation to die with dignity.

That was actually one of the arguments raised by the Supreme Court of Canada, which found in Carter that if the government were to deny access to medical assistance in dying, it could cause patients to commit suicide, violating the right to life in section 7 of the Canadian Charter of Rights and Freedoms. Sadly, we already know that many people have since chosen to commit suicide.

I’d now like to return to an important point raised by Stéphane Beaulac, professor and legal expert, in his testimony during the pre-study by the Legal and Constitutional Affairs Committee.

Mr. Beaulac presented an institutional argument, namely, respectful dialogue between the legislative power and the judiciary. According to Mr. Beaulac, the ruling by Justice Baudouin of the Quebec Superior Court in Truchon should not have led the federal government to respond as hastily as it did with Bill C-7. I support that argument, because I think the government also could have appealed that ruling. If it had taken the matter to the Supreme Court of Canada, the highest court in the land could have ruled on this issue and the government could have then come back with a more in-depth analysis.

Mr. Beaulac also pointed out that legal vacuums have always existed in Canadian law and these voids are not a significant issue. On the contrary, they make it possible to have a more pertinent legal discussion among the provinces.

I fully concur with him. By applying pressure to pass the bill, the government has raised fears among all professional bodies that are directly or indirectly concerned with medical assistance in dying. During our week of pre-study on this issue, I listened carefully to the witnesses and I felt that most stakeholders were opposed to or had misgivings about this new law. After hearing from many witnesses, we did not arrive at a consensus and we are more divided than ever on the issue.

Apart from the constitutional argument, the bill has other flaws that my colleagues have already spoken about in the week of pre‑study and in different speeches.

Three minutes, please.

Thank you.

For example, a number of concerns were raised about the new category of safeguards that apply to people whose natural death is not foreseeable. There is no consensus around the government’s 90-day waiting period. The same goes for people who cannot provide final consent because they are unconscious. The government has provided no real answers to these questions.

Two other issues arose during the committee’s pre-study. First, there is no clear definition of how a patient and a practitioner should discuss the MAID option. Second, access to palliative care is problematic in some parts of Canada. Government ministers did not seem to be in agreement on these issues and were unable to provide detailed explanations relating to these issues. The Minister of Health said that her government transferred huge sums of money to the provinces for these services, but if not for the pandemic and the billion-dollar dance, we would still be where we were in 2016.

The last point I want to make has to do with people with disabilities. Many concerns were raised about expanding access to medical assistance in dying to these people. What is really striking is that most of the testimony supported the finding that not enough consultations were held with disability advocacy organizations.

In summary, I think that Bill C-7 is flawed, imperfect and unconstitutional. It raises serious concerns and contains a discriminatory clause. As with Bill C-14, it is clear that, when Bill C-7 passes, it will be challenged in court. Unfortunately, once again, many people stand to suffer because of this new bill.

Honourable senators, if this bill is passed as it now stands, the government is going to have to redo its homework in the coming years. In the meantime, we already know that far too many people will continue to suffer and will suffer even more given the consequences of Bill C-7, including people with degenerative mental illnesses. Let’s not forget that people who are mentally ill and whose death is naturally foreseeable currently have access to medical assistance in dying.

Honourable senators, since 2016, I have been working with families whose loved ones starved themselves to death because Bill C-14 ignored their pleas.

Honourable senators, I spoke with a mother who resigned herself to accompanying her 34-year-old son to Switzerland, paying more than $40,000, so he could follow through with his decision to put an end to his suffering with dignity, since Bill C-14 ignored people who are suffering.

Honourable senators, Bill C-7 will leave these people to fend for themselves, sacrificing them to political correctness and partisan stubbornness. The last thing I want is to hear more of the kind of poignant and painful testimony that we have been hearing for the past four years. I would like people who are suffering to be allowed to die with dignity, surrounded by their families, because that right is recognized by the Supreme Court of Canada.

In conclusion, I want to thank all those who shared their often difficult stories. They deserved to be listened to and to be treated with the utmost respect.

Thank you very much.

Would Senator MacDonald entertain a question from Senator Lankin?

Thank you very much, Senator Cotter. I want to ask a brief question about the Alberta E.F. case that you referenced.

When we were dealing with Bill C-14 in 2016, there was the E.F. case, which was an assisted suicide that had been carried out prior to Bill C-14 passing. I asked a question about it at Legal Committee because it was an extremely rare situation. The patient had a solely psychological and non-terminal illness, and it was an extremely rare psychiatric disorder.

Senator Cotter, did you know that in that particular case there were three doctors that approved this particular assisted suicide but only one of those doctors actually ever even saw that patient — the general practitioner, the GP? The psychiatrist who approved the assisted suicide only reviewed the file. The assisting doctor who was willing to do the assisted suicide never met the patient and did a consultation by FaceTime. This was pre-COVID, when FaceTime was a lot rarer. Did you know those particular facts?

Would the honourable senator take a question?

Senator Cotter, thank you for your speech — very eloquently delivered and very difficult to follow.

I am the final speaker of the evening, and I think there is enough time for me to complete my statement, so I will proceed.

It’s a very important debate and, as others have said, I want to acknowledge the effort and the passion and the commitment to the very thoughtful speeches already by our sponsor, our critic, our leaders, everyone in this chamber, and Senator Cotter most recently.

This is an extremely important one, so I wish to add my voice to this complex, sensitive and difficult debate that weighs heavily on all of us. As parliamentarians, we know that the final words imprinted on this piece of legislation, Bill C-7, will literally determine who has the right to bring their life to an end, when, by whom and how it will be done. I know that we did previously pass Bill C-14. I wish I could turn back time in some respects, but instead, I will do a flashback to 2016 just to remind ourselves as to where we were then and what has happened since.

The previous MAID bill, Bill C-14, was one of the most difficult pieces of legislation for me personally and for our chamber to deal with, as it was enacting an assisted dying bill for the very first time in our nation’s history, one that many other countries had not yet explored. We had robust debate at each stage, much longer than now, and our chamber was extremely divided throughout the process.

As I recall, it still felt as though we didn’t have enough time to make a monumental decision for our country. As a chamber we sought opinions, research and knowledge from experts, patients, families, Indigenous leaders, nurses and caregivers. At the end of the day, we came to a final vote on Bill C-14 as the Supreme Court imposed a deadline to pass federal legislation to allow medical assisted dying in Canada.

From the onset, I was extremely opposed to the bill and had every intention of voting against it, to the very end, but there was a ruling in the Alberta Court of Appeal, which was mentioned by Senator Batters, at that time that was opening up the doors alarmingly wide for MAID. I was advised then that passing federal legislation with safeguards we had managed to include through amendments and the inclusion of the foreseeable death provision was better than not having a federal regime in place.

I recall being advised that provinces have the responsibility of administering MAID and that they would be able to tighten the federal regime’s framework by adding further safeguards where needed. However, in my province of British Columbia, the opposite happened with the election of a different government. Rather than a strengthening and tightening of the MAID regime, there have been several concerning developments.

In fact, last July, Alan Nichols from Chilliwack, B.C., who struggled with depression with no signs of imminent foreseeable death, was given approval for MAID by health professionals despite pleas from his family who believed he did not fit the government criteria for MAID eligibility based on Bill C-14. Knowing I had voted for Bill C-14 with the hope of addressing outstanding issues like palliative care and greater safeguards, I find myself on heightened alert as we debate Bill C-7.

Honourable senators, what I wish to raise today is the concern I feel and share with many constituents across Canada who have contacted my office, as I’m sure they have yours. Should Bill C-7 pass unamended, it will bring unintended consequences on vulnerable individuals in our country during their time of deepest need and care. During the pre-study of Bill C-7 at the Standing Senate Committee on Legal and Constitutional Affairs, I had the opportunity to participate on several of those days as an ex officio member. The committee sat for five days straight and heard from a wide range of witnesses who shared their personal stories, expertise and recommendations to improve Bill C-7.

The information and differing opinions were overwhelming and made it absolutely clear to me that there are significant issues with this bill and gaps that need to be closed, and that we cannot rush this legislation. Colleagues, many have stated this and we know that there is no reversal of death. The end of life means the end, full stop.

Unlike Bill C-14, Bill C-7 expands the eligibility for medically assisted dying to those not facing near death but are living with a disability. However, it does not include those living with mental health issues. This opens up a consequential debate on whether this legislation implies that some lives are not worth living and covers up a deeper societal issue by providing an end-of-life solution to a greater social problem of neglect rather than fixing the gaps in our health care system across Canada.

In the words of Assistant Professor Jonas-Sébastien Beaudry, who so clearly articulated in Policy Options magazine, it’s not a matter of legal or ethical issue on whether people cannot judge for themselves when they feel their lives are not worth living. The issue is rather a political and social one because:

Bill C-7 opens a normative space in which various social actors, including medical experts and the state itself, can discuss the topic of “lives not worth living.”

Another concern I have with the current monitoring and reporting system is that it is not properly constructed and relies on self-reporting by MAID providers, leaving families with no way to penetrate doctor-patient privilege if they suspect wrongdoing. Our colleagues in the House of Commons raised the need for robust and standardized federal monitoring and data collection on MAID, and to receive reliable national datasets to understand who is accessing MAID and why.

Dr. Leonie Herx added there’s no oversight system separate from what is being done at Health Canada, where cases of MAID administration and compliance issues can be reviewed at a provincial level along with more thorough reporting from provinces. Currently only Quebec and Ontario have such an oversight system in place.

I was quite impressed with what some of the Quebec witnesses were able to tell us about how the regime is being monitored and administered in that province. I wish that one of the things we could do concurrently with what we are doing is to just begin the consultation and the sharing of best practices so that we can have what Quebecers have in terms of more consensus and sharing of information so that we can have availability of the best practices across Canada and more assurances for safeguarding the lives of the most vulnerable people.

Not only are we lacking clear and specific data, but witnesses expressed their concern that there is no proper standard in the delivery of MAID nor enough training for physicians and MAID providers. Dr. Mona Gupta, in response to a question, stated that:

The clinical community has been crying out for more training in MAID, end-of-life care and a variety of domains . . .

While I heard that the 10-day reflection period between the day the patient signed the written request and the day MAID is provided has not served the purpose of its original intent and only prolonged pain for patients set to receive MAID, I believe this safeguard is important to ensure certainty about the decision to receive MAID.

According to Health Canada’s report on MAID in 2019, 263 people withdrew their request for MAID because they had changed their minds. Of those people who changed their minds about MAID, one in five withdrew their request immediately before MAID was to be carried out. The current law allows for the reflection period to be reduced if death or loss of capacity to provide informed consent is imminent. As such, the removal of the 10-day period is dangerous in cases of patients who sign a request in the morning and can receive MAID the same day without reflection.

In fact, what unnerves me gravely is the wording of the greater certainty clause with regard to advance consent for MAID, which reads:

. . . involuntary words, sounds or gestures made in response to contact do not constitute a demonstration of refusal or resistance . . . .

— and can receive MAID.

Currently, if any patient resists at any time, practitioners would not be allowed to provide MAID. How can we, as legislators, be asked to accept such a provision of what constitutes a real sign of involuntary resistance?

As an example, my mother is in long-term care with advanced dementia, doesn’t recognize me or any member of the family, and was sound asleep when I was supposed to have a scheduled FaceTime call. The health professional on the other end took the camera into the room just to show me that she was sound asleep. And we were talking quite quietly and my mother stirred and just looked over as if recognizing my voice.

When I think about my own mother and envisioning a time if we were to ignore an involuntary movement or sound and continue a process, I would not want to be the family member put in such a position. So this is one of the provisions that really unnerved me because of my current situation with my own mother.

Dr. Trudo Lemmens, Professor and Scholl Chair in Health Law and Policy, Faculty of Law, University of Toronto, has done extensive work on the study of international and Canadian MAID practices and law. In his testimony to the Legal Committee, he said that this clause:

. . . violates the Convention on the Rights of Persons with Disabilities, which says loss of capacity doesn’t mean you lose your rights, including your potential right to express, in one way or another, your resistance to something, or your change of mind.

Dr. Harvey Max Chochinov, Distinguished Professor, University of Manitoba, shared data with the committee that the desire for death is fluctuant. One study done in Belgium by a psychiatrist looked at 100 patients requesting euthanasia on the grounds of mental conditions alone. Of those 100 patients, 38 patients eventually withdrew their requests, 11 of them after they had been approved. In Oregon, 20% to 40% of the people who request lethal medication, in fact, never take that medication. Dr. Chochinov argued that, according to data, the idea of someone who makes up their mind today and holds fast to it is simply not true.

When Minister Patty Hajdu came to testify at the Senate committee, I had the opportunity to ask her about stop mechanisms in place once MAID is triggered. She didn’t answer with any specific explanation and assurances of stop mechanisms, but what I have heard from witnesses and health professionals is that until the day of final consent, there are no mandatory checks about whether the patient has changed his or her mind.

According to an article written by Dr. Leonie Herx, Dr. Margaret Cottle and Dr. John Scott in the World Medical Journal, there is no direct oversight or mechanism to stop the administration of MAID in real time, even if red flags are raised. They state that “monitoring requirements include only basic demographic information and are reviewed in retrospect.” This means that there’s no mechanism that halts the MAID process, where someone can pause and review whether an individual has first received adequate care before continuing with MAID. Only through retrospective review of the reports after a person has already passed will we see that a certain percentage of people did not have access to palliative care, for example. Without adequate collection of information, how can MAID be delivered accurately and within compliance of all the regulations?

Professor Jaro Kotalik identified in his article in the Canadian Journal of Bioethics that it took two years and four months after the delivery of MAID had begun for federal monitoring regulations by the federal ministry of health to take effect. One of the most concerning facts he presented is that by the end of December 2019, over 13,000 Canadians died with medical assistance. For almost 10,000 of those MAID cases, we have no publicly accessible evidence that the eligibility criteria and safeguards prescribed by law were respected. Our provinces, territories and health institutions must work together to share information so that more information on who was receiving MAID, as well as any known vulnerabilities in socio-economic status, is collected and properly analyzed.

And what about palliative care? We’ve talked a lot about that in this chamber. Many honourable senators have spoken about the need for better and more accessible palliative care across the country. When I stood to make the difficult vote on Bill C-14, we were told by the government that palliative care would be reviewed. However, due to COVID, this review has not yet happened, but we are being asked to vote on a bill that expands eligibility criteria to MAID.

As many witnesses and honourable senators have stated, palliative care must be part of the spectrum of care and must be offered and made available before initiating conversations about MAID, not as an option along with MAID. I believe that MAID must be at the end of life, after all other services and support have been properly offered and made available.

Finally, Bill C-7 in its current form does not adequately protect conscience rights against forcing a physician to refer a patient for assisted suicide when it is against their conscience to do so. We have heard that Bill C-14 outlines conscience rights. However, the MAID regime is still relatively new, and forcing an individual to refer a person for MAID has not been tested in the Supreme Court of Canada.

Dr. Leonie Herx stated that the expectation of physician participation of MAID in Canada far exceeds that of any other permissive jurisdiction in the world. I have heard from doctors that they wish to see Bill C-7 strengthened and clarify the conscience clause in Bill C-14. Dr. Ewan Goligher, Assistant Professor of Medicine, University of Toronto, stated that even a referral makes a physician morally culpable.

In 2018, Dr. Diane Kelso highlighted that the Ontario Ministry of Health established a care coordination service where patients and caregivers can request directly to be connected to a doctor or nurse practitioner who provides MAID. However, the provincial college still required physicians to provide a direct referral. This is also the same in Nova Scotia, where physicians and nurse practitioners are required to make an effective referral for MAID.

At committee, several witnesses recommended to us further clarification in the Criminal Code would provide better clarity on whether or not referrals would be participating in the act of providing MAID. This is a very difficult aspect of our debate and one that I neither fully understand, nor comprehend. But listening to some of the medical professionals plead to the committee really did leave an impression with me.

Honourable senators, I will do my very best to conclude. I have several pages remaining. Thank you, colleagues. I will then, if I may, Your Honour, adjourn for the balance of my time.