Criminal Code

Motion in Amendment Adopted

February 10, 2021


Hon. Pamela Wallin
[16:35]

Therefore, honourable senators, in amendment, I move:

That Bill C-7, as amended, be not now read a third time, but that it be further amended in clause 1,

(a) on page 3, by adding the following after line 18:

“(3.1) Subparagraph 241.2(3)(b)(ii) of the Act is replaced by the following:

(ii) signed and dated before or after the person was informed by a medical practitioner or nurse practitioner that the person has a grievous and irremediable medical condition;”;

(b) on page 4, by replacing line 13 with the following:

“(ii) signed and dated before or after the person was informed”;

(c) on page 5,

(i) by replacing line 30 with the following:

“(3.2) For the purposes of subsections (3) and (3.1), the medical”,

(ii) by replacing line 33 with the following:

“the requirement set out in paragraph (3)(h) or (3.1)(k), as the case may be, if”;

(iii) by replacing line 37 with the following:

“(1) and all other safeguards set out in subsection (3) or (3.1), as the case may be,”.

Thank you, colleagues.

The Hon. the Speaker pro tempore
[16:38]

On debate.

Hon. Paula Simons
[16:38]

Honourable senators, my mother was a brilliant, beautiful woman — a woman with a passion for great literature, high fashion and duplicate bridge. She was a woman who disliked sentimentality of any kind, so I hope somewhere she’ll forgive me if I say I’m still haunted by the memory of the day I took her for that fateful neurocognitive exam, the day the specialist delivered the bleak diagnosis: Alzheimer’s disease.

My mother’s response was straightforward. She asked for medical assistance in dying, but she was, of course, both too early and too late. Her death was not imminent. Her sufferings would eventually be grievous and irremediable, but they weren’t yet. And at the same time, she had already lost much of her capacity to be her own medical decision maker.

Her tragic story demonstrates why advance directives must be part of our understanding of medical aid in dying. We cannot properly exercise our autonomy or protect our dignity if we cannot choose for ourselves when and while we still have the capacity to do so. We must give Canadians the opportunity to exercise free and informed prior consent when it comes to end‑of-life decisions.

Such a concept is neither new nor radical. Advance directives, or personal directives as they’re known in Alberta, are well established in provincial health law. Back in 1991, the Ontario Court of Appeal in a case known as Fleming v. Reid stated:

A patient, in anticipation of circumstances wherein he or she may be unconscious or otherwise incapacitated and thus unable to contemporaneously express his or her wishes about a particular form of medical treatment, may specify in advance his or her refusal to consent to the proposed treatment. A doctor is not free to disregard such advance instructions, even in an emergency. The patient’s right to forgo treatment, in the absence of some overriding societal interest, is paramount to the doctor’s obligation to provide medical care.

The legal framework, then — the paradigm — is already in place. Expanding it to encompass degenerative dementias is both logical and humane and would give people facing dementia diagnoses, or the future prospect of dementia diagnoses, badly needed peace of mind. It would protect their charter rights, too, to equal treatment under the law regardless of physical or mental disability.

I can tell you that as the years ground on, it was terrible to see my proud, elegant mother lose her ability to read and write, her ability to dress herself and her ability to recognize her oldest, dearest friends.

Last July, after months of pandemic isolation where we could only visit with her at a distance, which confused her horribly, my mom suffered a broken hip. In the emergency room, the doctor was blunt. There was no way she would recover from her injury. The doctor therefore offered me two terrible choices. We could leave her shattered hip untreated, pump her full of morphine and send her to a palliative care centre to die. I asked if she would be given anything to ease her death. No, I was told. She was still ineligible for anything as humane as MAID.

Instead, the doctor told me their only option would be to withhold all food and fluids and leave her to die of dehydration and starvation. Oh, and because of COVID, I would not be allowed to be with her. I would need to say goodbye to her right there and then in the ER and send her off to die alone in pain and terror.

The alternative was little better: the physical stress and trauma of major surgery and the painful aftermath of a hip replacement with no real prospect she’d ever walk again. Still, in the moment it seemed the least bad choice. Was it the right decision? I just don’t know.

I do know that my mother suffered in hospital for more than a month in agony, fear and raging, violent fury, unable to understand why she was there and why I wouldn’t bring her home. Every long day, I bore witness to her torture and torment. I listened to her scream and scream. She was so utterly vulnerable.

It was my job to protect her. I failed.

Eventually, she stopped eating and drinking, and I can’t tell you whether that was out of instinct or some conscious choice. We chose not to have her force fed with a feeding tube. The hospital moved her to a quiet, private room and brought in a bed so I could sleep beside her.

My brother and I were both with her as she died, over the course of hours, her way finally, belatedly, smoothed by generous doses of hydromorphone.

My mother, she would have hated this speech. She would have found it sentimental, manipulative, mawkish and a grotesque invasion of her privacy. Still, if her story can, in any way, help you and help the government to see the wisdom of Senator Wallin’s compassionate, common sense idea, then I shan’t apologize, not even to her.

I failed my mother when she needed me most. We mustn’t fail Canadians now. For mercy’s sake, and in the name of mercy, can we not give Canadians better choices and the right to speak for themselves while and when they still can? Thank you. Hiy hiy.

[16:44]

Thank you very much to Senators Wallin and Simons, who have already spoken on what is a very emotional and passionate issue for people who are looking at the whole issue of dementia. Dementia is, indeed, a difficult and emotional disease that many families face every single day. To see a loved one not knowing those who care for and love them is heartbreaking. I think that many of us in this chamber or on Zoom today have watched as loved ones lose touch with reality.

Honourable senators, Bill C-7 deals with cases like the Audrey Parker case. Ms. Parker had advanced breast cancer with brain metastases. She was eligible for MAID. There was a good chance that the brain cancer would affect her cognitive capacity to consent before the date that she wanted for MAID.

So Audrey Parker had MAID months before she would have chosen it. Bill C-7 allows for an advance request when you already qualify for MAID. This is a change from Bill C-14.

However, honourable senators, what this amendment does is allow for advance directives after the diagnosis of an illness but before the person would be eligible for MAID — so the person would not be eligible for MAID at that point.

Honourable senators, Jennifer Gibson, a professor of bioethics at the University of Toronto, worries that most of the public debate about advance directives has been simplified and focused on Alzheimer’s dementia. Dementia forms are varied and have many stages that affect suffering and the ability to consent. Professor Gibson believes that there are significant differences in the issues, and there are uncertainties around dementia and consent that should be considered.

Honourable senators, I would ask: What are the significant issues that should be looked at? What are the significant uncertainties that should be considered? I don’t know the answer to those questions. Also, what criteria should be used to allow advance directives? What safeguards would have to be put in place if we allow advance directives?

Honourable senators, I don’t know the answers to those questions either.

Honourable senators, the Legal Committee did not study advance directives in their review of Bill C-7, nor did the committee evaluate advance directives in their study of the bill. There were no witnesses at the Legal Committee to talk about advance directives. There were no witnesses at the committee to answer questions or offer opinions on advance directives. Honourable senators, I cannot vote in favour of an amendment that changes Bill C-7 so drastically. I cannot vote in favour of an amendment that brings forward changes that have not been debated in the committee and for which the subject matter was not discussed before today in relation to this bill.

We as senators have a responsibility to hear all sides of an issue. It is a very emotional issue, but especially when this issue is a life-or-death issue, we have a responsibility to have witnesses at committee hearings who will agree or disagree on legislation such as Bill C-7.

The legalizing of advance directives is a complex issue and needs lengthy consideration at the committee level. We have not done that.

Honourable senators, we have not gathered evidence on this amendment to guide us, or at least to guide me. We have a responsibility for sober second thought when we study legislation and when we look at amendments. I will not be supporting this amendment. Thank you.

Hon. Kim Pate
[16:49]

Honourable senators, like Senators Wallin and Simons, and so many others in this chamber and elsewhere, I speak as a family member — a daughter and a granddaughter — of loved ones who died after years of living with dementia. I would personally like to be able to have access to an advance directive. I recognize that this is, in part, a function of the privilege which I currently enjoy.

A witness at the Legal Committee characterized Bill C-7 as legislation created for those who are “well, but worried, well off, and White.” The proposed amendment expands non-end-of-life medical assistance in dying in ways that will likely create more rights and more choices for those who are most privileged — those also most likely to have the financial and other resources necessary to put in place advance directives. I am concerned that it would do so at the expense of entrenching and reinforcing ableism, in particular for those who are most marginalized, including as a result of class and race.

Bill C-7 permits advance consent to medical assistance in dying as an alternative to a painful death in the event of a loss of capacity. This amendment would extend the bill to permit consent in advance to medical assistance in dying as an alternative to a painful life; a life with disabling health issues.

When Minister Qualtrough appeared at the Legal Committee last fall, she spoke not only about her ministerial responsibilities with respect to Bill C-7, but she also reminded us of her lived experience:

Daily, we — Canadians with disabilities — hear comments like, “I could never live like that.” “If I had to live like that, I would rather be dead.” “How can you live like that?” We face stigma, stereotypes and ignorance. This is the backdrop for these conversations.

Disability organizations have challenged us to reflect on how much of our understanding of others’ suffering is shaped by ableism, systemic discrimination and exclusion.

I have spent nearly four decades working with and on behalf of some of those most marginalized, victimized, criminalized and institutionalized. Today, one in four federal prisoners are seniors. Many are suffering from chronic health conditions, pose no risk to public safety, yet have been kept in prison instead of being allowed to receive the health care that they need in the community.

Many are living with dementia and live in conditions of isolation that amount to segregation and solitary confinement. Imagine for a moment the situation of someone facing the prospect of cognitive decline in prison, fearing that the rest of their life may be spent in conditions that amount to torture, alone and likely terrified.

Too often, visiting loved ones with dementia in long-term care homes, I found myself horrified by the parallels with the conditions of social and psychological isolation.

Surely, the COVID-19 pandemic has destroyed any possible illusion about the adequacy of the current long-term care system, and particularly for-profit homes, as a regime to be entrusted with our loved ones at the moments they are most vulnerable and most in need of care.

Given the current cost barriers and unavailability of home and community-based care for many considering non-end-of-life medical assistance in dying under Bill C-7, the alternative is life in this thoroughly inadequate system of long-term care institutions.

Canada continues to lag behind on long-term, health and social care, spending significantly less than the average among OECD countries as a percentage of GDP. Not surprisingly, the Netherlands, which leads the way in terms of spending, has also pioneered programs like dementia villages that have put in place more humane, community-driven options for those with dementia and other neurodegenerative conditions.

How can we justify prioritizing expanding rights to advance directives for some without a similarly clear focus on the need to ensure that health, social, housing and income support systems uphold standards of adequate and dignified care for all?

Yet another of my dilemmas, honourable colleagues. Meegwetch, thank you.

Hon. Chantal Petitclerc
[16:54]

Senator Wallin, thank you for the amendment that you presented today, which is an extension of your hope that people be allowed to make an advance request for medical assistance in dying before they have a grievous and irremediable medical condition. If I remember correctly, you have addressed the House on this essential issue twice already. Today, I would like to point out how consistent your work on this issue has been and how important it is.

I would like to take my time today to underline the significant complexity of this area as a matter of federal legislation.

We are talking about a situation where a person with decision-making capacity writes a document setting out that they would want to receive MAID in the future if they lose decision-making capacity, and if the specific circumstances arise that causes them unbearable suffering when they no longer have capacity.

This matter is complex and would require safeguards for at least two distinct periods. First, the time when the person prepares the document setting out their wishes to receive MAID in the future; and, second, the time when a practitioner would administer MAID to end the person’s life because the conditions specified in their document are fulfilled.

This amendment does not speak to any safeguards around the written consent provided before an eligible diagnosis.

This amendment is also silent on the complexities that may arise from harmonizing provincial and territorial laws to account for advance requests. For instance, advance requests require the participation of substitute decision makers, such as family members.

Since the person would no longer have the capacity to make health-related decisions for themselves, it would be up to others to determine when and how the advance request would be implemented and to contact the practitioner administering MAID. Provincial laws may also require that advance requests be kept in a registry so that practitioners can access them and make sure they are up to date. The practicalities are regulated by the provinces and territories. Of course, those are just a few examples of the complexities and details that I believe must be carefully considered before moving forward. As you know, the committee’s in-depth study and pre-study of Bill C-7 did not address advance requests because they are not part of the bill.

Yes, it is true, a few witnesses did comment on advance requests. Professor Raphael Cohen-Almagor, the University of Hull in the United Kingdom, said to the committee about advance directives:

They should be taken care of seriously and carefully. I’ve seen at least 60 different versions of advance directives, from fluid to general ones, like, “I would like to die when I don’t know my children,” to very detailed ones.

Professor Cohen-Almagor noted another practical problem:

 . . . we have to be cognizant of changes that happen in the minds of patients as they progress with the disease.

Because a patient who is diagnosed with dementia may say they want one thing at one stage of the disease but change their mind as they progress to another stage, should the practitioner abide by the advance directive if the patient wants something very different now? These are very important and legitimate questions.

The Council of Canadian Academies report on advance requests also noted many complexities with advance requests for MAID. The majority of experts, practitioners and stakeholders consulted on this specific issue during the government’s round table in February 2020 recommended that this type of advance request be studied further as part of the parliamentary review of the MAID regime that is required by former Bill C-14.

Honourable senators, like many of you, I look forward to this parliamentary review.

I believe policy decisions surrounding advance requests must be based on that kind of thorough, comprehensive study that takes into account the multitude of details that ensure Canadians are protected and well cared for. That is why, Senator Wallin, that while I sincerely support your intention, I cannot support the amendment.

Hon. Diane Bellemare
[17:00]

I have a question for Senator Petitclerc.

Hon. Lucie Moncion (The Hon. the Acting Speaker)
[17:00]

There’s no time left. We have to move on to Senator Gold.

Hon. Marc Gold (Government Representative in the Senate)
[17:01]

Honourable senators, I want to begin by expressing my admiration for Senator Wallin and for everything that she’s bringing to this debate. Senator, you’re passionate and reasoned. You’re reasonable in your advocacy on behalf of this issue. Your arguments and your presentations are deeply rooted in the core values that define us, define our Charter, our right to live, to control our own lives and our own passage through life, to be treated with equal respect and concern. So your story and many others touch me personally. Thank you. But I have to agree with Senator Petitclerc, and I’m not able to support this amendment.

As others have explained, this issue is very complex, and introducing such an amendment would require far more study, so that all the proper safeguards to protect those most vulnerable would be in place. Changes of this magnitude to medical assistance in dying require a cautious approach so that we might have confidence that legislation will ensure the protection of Canadians at the end of their lives.

But beyond the issues of policy that the amendment would introduce and attempts to introduce, I have serious reservations on process grounds, and not just as Government Representative but as a senator. At committee and during debate, we’ve heard time and time again that even minor modifications to MAID cannot and should not be rushed. That’s why we collectively insisted on doing our work responsibly, even in the face of the original December court deadline. That’s why I have spent months reminding government colleagues in the other place that the Senate will insist on studying Bill C-7 in an appropriately thorough fashion. That is our job. That’s what we’re doing, and we take it seriously.

In my view, adopting Senator Wallin’s amendment would simply be inconsistent with the attention to detail and seriousness that we, as a chamber, have given to the study of Bill C-7 thus far. We simply have not properly considered the ramifications and effect of this proposal. It would be — and I say this respectfully because I am touched and moved by it — it would be irresponsible to introduce this as an amendment to Bill C-7.

As an analogy, imagine for a moment a scenario where I, as Government Representative, introduced a government bill expanding access to medical assistance in dying on the issue of advance requests. I had not put into place a transparent process of consultation, discussion or information requests of experts. Neither had I referred the bill to committee for study. I was simply asking the Senate to pass these changes in one day, without any study, without any review or scrutiny.

Now, we all know what your answer would be — a hard no — and with good reason. The Senate would insist on conducting sober second thought. This amendment, the weight of its importance and the consequences of its passage surely are significant enough for the study and review that it deserves.

Honourable senators, our Standing Senate Committee on Legal and Constitutional Affairs spent countless hours on the language and content of Bill C-7, hearing from well over 100 witnesses. It did so because, when it comes to MAID, every word in the legislation matters. It’s a matter of life and death. There was no focus or attention given to advance requests during committee study because the subject is simply not addressed in the proposed legislation. In fact, the committee’s 36-page pre-study report does not even address the issue.

Senator Wallin’s proposal would introduce a new, major component to MAID on the fly — changes that have not been researched, scrutinized or studied by any parliamentary committee in either house. In that context, I submit to you that adopting this amendment would simply be — and again, respectfully — imprudent, and I ask you to vote against it.

Hon. Frances Lankin
[17:06]

Senator Wallin, may I thank you for your continued work on this. I do support your amendment. I’m struck by how many of us have family experiences that help shape our understanding or view of this. I am struck by how closely my family’s experience mirrors Senator Simons’, and I don’t have the courage of Senator Simons today to speak about this without bringing forward tears that I won’t be able to speak through.

What I do want to say about my family experience — but I want to speak mostly about the technical issues in this amendment — is that my mom suffered for nearly 30 years with dementia and with a serious progression of dementia which rendered her incapable, just a few years into the 30 years, of making any such request like this. She died long before MAID was a reality in Canada. She had a major stroke, and the diagnosis was that she could never recover from that and that she would only be able to be kept alive with a feeding tube.

The family had done everything right. I had worked with my mom when she still had capacity to consent to treatment; to provide an advance directive on a living will, for personal care; on being sure that my brother and I were well aware of her wishes; and ensuring that whenever she had an interaction with the health care system that her wishes were provided to the physician attending and the other health care professionals. That advance directive did not want heroic efforts to keep her alive should her condition — and there were a number of requirements — which she met, at the time that she did pass.

Every province and territory has legislative and regulatory regimes in place to allow for advance directives on personal care, to allow for living wills that set out the expectation. There is legislation for consent to treatment and how that is to be judged and treated, long before MAID came to our national dialogue, and for capacity to consent, adjudication where there is a dispute around that.

This amendment from Senator Wallin builds on top of all that exists in our country. This is a form of saying that those advance directives, which can say — and I will speak on behalf of my brother and I who, every time we talk, check in to see how our cognitive abilities are because we fear the genetic heritage — that I don’t want any intervention under these conditions. I want to die.

But the dilemma is, in MAID, to be able to appreciate using medical assistance in dying as opposed to my mom, who had the saline drip removed as per her own request, and whom I sat beside for 14 days while she died of hunger and thirst. No one would agree that’s appropriate, and we all would want to figure out how to get to a better place. But why is it that I can insist on the conditions that would lead to my death through pain and anguish but not through medical assistance in dying? This does not make sense to me.

Senator Wallin has brought this issue forward over and over, and we all have heard these debates. I am sorry that the committee didn’t explore these issues when some witnesses brought them forward. That’s true.

To Senator Cordy and Senator Gold, I understand the point that you are making, but the intransigence on the part of this government not to hold the reviews that we had requested — we discussed this thoroughly in Bill C-14 as well, as we did mental illness, as we did mature minors. Those studies, for all the reasons we’ve heard, have not taken place, and we are asking people to wait another two, three or four years, when the system to allow for advance directives that would lead to a person’s death already exists. Senator Wallin’s amendments simply provide safeguards around when this must be signed; before a diagnosis of lack of cognitive impairment or dementia comes about.

I appreciate that people would like to spend more time on this. We have had many opportunities to discuss this over the last five years, and it has been brought forward by Senator Wallin. There have been debates. Quite frankly, a lot of us have reached out and done research on this, because it’s of particular interest to us, to hear from professionals, regulators and various provincial jurisdictions —

The Hon. the Speaker pro tempore
[17:12]

Senator Lankin, I’m sorry. Your time has expired.

Hon. Pierre J. Dalphond
[17:12]

I agree with Senator Wallin that, and 80% of Canadians that using advance directives is the direction in which the law should go. My issue with the amendment is that to accomplish that, it adds two words, which are “before/or,” which I’m afraid are not enough to achieve that goal.

The three countries, so far, that have allowed advance directives — Belgium, the Netherlands and Luxembourg — highlight many different policy considerations and options that are at stake.

In the Netherlands, the system is currently before the courts, which are dealing with the issue of whether advance directives can be used to provide MAID to people with Alzheimer’s.

In Belgium, unlike in the Netherlands, an advance directive is valid only for persons who are unconscious at the time of the provision of MAID. This means that individuals with conditions affecting decision-making capacity, such as dementia, are not able to use an advance directive to request euthanasia for a future date, when they are no longer capable of making decisions. Also, the directive is valid for only five years, but it can be renewed.

In Luxembourg, the advance directive is only for unconscious persons. Unlike in Belgium, there is no time limit, but every five years, a central body of government verifies that the person who signed the advance directive still wants to keep it in the system.

Under Bill C-7, if this amendment is accepted and the other requirements of Bill C-7 are not changed, a person will need to be conscious to receive MAID. There are a few issues with this that I can think of now. Do we allow advance directives if a person is unconscious at the time MAID is provided? Is there a form to be used? Will that be the same form across the country, or would that decision be left up to the provinces? Will advance directives be time restricted, like in Belgium and Luxembourg? Should a national or provincial authority be in charge of confirming a person’s wishes every five years, like in Luxembourg?

We did not hear answers to these questions during the study of Bill C-7. Unlike the mental illness question, which arose in nearly every panel, advance directives were generally not addressed by witnesses.

Hon. Pierre-Hugues Boisvenu
[17:17]

Honourable senators, I support the amendment proposed by my colleague. Yesterday I presented a somewhat similar amendment, but it was defeated.

Bill C-7 has a rather hypocritical perspective when it comes to persons suffering from degenerative disease. They are told that they are eligible for medical assistance in dying, but that they cannot make advance requests. How can a person suffering from a degenerative disease make a request for medical assistance in dying and exercise their rights without making an advance request? That is like telling that person that they are being given a driver’s licence, but they do not have permission to board their vehicle. That pretty much sums up Bill C-7.

Dozens of people contacted me this morning, people who received a diagnosis. They get the impression that the Senate has forgotten about them, that it has turned a deaf ear to their plight and the pain they experience every day.

By making an advance request, these people would be able to live with peace of mind until they reached level 5 of their disease, the stage where they would lose full contact with reality and where the family or the physician, by virtue of the authority given by the patient in advance, would proceed to ending their days.

As I said yesterday, we have the key that will ensure those people are not imprisoned by their inevitable suffering. When we force these patients to continue to suffer, we do the same to their family. The patient’s pain and suffering also affect the people supporting them and the entire family.

We failed to help these people in 2016 and we are about to fail them again in 2021.

I do not believe that the government will complete its work on mental illness in two years, given that this matter is too complex. However, it is not that complex to those suffering from degenerative diseases, because the law states that they have this right. What the law does not mention is how this right will be exercised.

I believe that Senator Wallin’s amendment shows how this right will be exercised. I want to reiterate that we do not have the right to fail the people who want to exercise this right a second time in 2021. Thank you.

Hon. Claude Carignan
[17:20]

I’d like to begin by saying that I lean towards supporting advance medical directives. That is why yesterday I voted in favour of Senator Boisvenu’s amendment seeking to compel the government to study this issue quickly. I wanted to help nudge it that direction.

A number of senators have mentioned that when Bill C-14 was adopted, we called for a study on advance medical directives, emancipated minors and the issue of mental illness. However, the government failed to do its job. This was also recommended by a joint committee of the Senate and the House of Commons, which studied this issue and recommended a more in-depth study.

That unfortunately did not happen. It was also unfortunate that, when we studied Bill C-7, we didn’t look into how to proceed with advance medical directives. This topic wasn’t studied, aside from the testimony quoted by Senator Dalphond, perhaps. I think that’s the only mention specifically about advance medical directives, in addition to a few questions from my colleague, Senator Boisvenu, but we didn’t really address the issue.

That got me thinking about this issue. We all have our own personal story. Part of my story is that my mother has Alzheimer’s. I have often heard my mother pray for death to take her. Every time I visit her, I can tell the light in her eyes has grown a little dimmer. Last time, she barely recognized me. Even so, I have a hard time imagining what my always-smiling mother would think of a doctor showing up all of a sudden to administer MAID.

We really need to think about this issue because, when a person is unable to consent at the end of life, that raises some serious ethical issues. Even though I tend to be in favour of advance medical directives, I encourage people to vote against this amendment. We might have to push this government and practically beg it to keep its promise to put a process in place as soon as possible, in collaboration with the provinces.

Quebec is already fairly advanced in this area, so it could share its experience with the provinces and the federal government to help set up an advance directive system for those who have indicated when and how they want to leave this world. Thank you.

Senator Bellemare
[17:24]

The issue of advance directives is quite upsetting and makes me emotional too, because, like you and your friends of a certain age, I think it would be good to be able to make such requests.

However, Bill C-7 does not address that issue, and we were not given the mandate to study it. Even though I strongly support advance directives, I would prefer that we continue to consider this matter.

I have also had personal experiences that made me think about the issue of advance medical directives. My late father had dementia. When he began suffering a great deal in his long-term care facility, they gave him sedatives, such as morphine, and, in the end, he passed quickly and quietly.

At that time, when I went to visit him, I saw something disconcerting: two people with Alzheimer’s whose smiles lit up the whole care unit. While living in the care facility, they fell in love. Even though their respective spouses still came to visit, those two did not remember them at all. They seemed so happy in their little bubble. When one of them died, the other followed just two weeks later.

I know these individuals weren’t suffering, and perhaps that’s the key, but the fact remains that this is a complex issue that requires careful reflection. We could always argue that this is just an amendment to the Criminal Code and leave it up to the provinces to reflect on it. Nevertheless, it seems very clear to me that this aspect was left out of Bill C-7 and, because of this, the scope of the bill is greatly expanded.

For these reasons, I will not be supporting Senator Wallin’s amendment, even though I agree that it should be studied and I would be inclined to support it. Thank you.

Hon. Jim Munson
[17:27]

I wasn’t going to speak on this particular amendment, but sometimes debate does matter. Every once in a while, after being here for 17 years, sometimes I think the Senate has to take the initiative and has to force the debate.

I was thinking this afternoon, at the beginning of the debate, that I would abstain because of the arguments that are being made with this particular initiative of an advance directive. Everybody tells their own story, and I, too, have a story, but I don’t have to get into that story about my own mother and father today. I was moved by Senator Simons’ debate and how she spoke about this.

I know the issue is not in this particular bill, Bill C-7, but there has been enough discussion that has gone on here and on the other side that we sometimes have to be brave. If we pass this amendment it has to go back to the other side, and who knows what they will say in the other place? With that, and without getting into the complexities of it all, sometimes we use the words “I have empathy, but,” or “I really feel for you, but”; but in this case, I am rising to say that I will support this amendment. Thank you.

Hon. Renée Dupuis
[17:29]

I wanted to ask Senator Wallin a question, but since we’re running out of time, I will put it another way.

It seems to me that the discussions that took place during the deliberations on Bill C-7 focused on the clause providing for a waiver of final consent, subclause 3.2 of amending clause 1, which provides that the waiver of final consent is reserved for situations where death is reasonably foreseeable. This means that a deliberate decision was made to ensure that individuals whose death is not reasonably foreseeable would not be allowed to waive final consent if, prior to their losing their capacity to consent, they had signed an agreement with the doctor who would administer MAID. This was neither by chance nor by mistake.

The Standing Senate Committee on Legal and Constitutional Affairs discussed this proposed addition in Bill C-7. I believe that the dilemma we are in is related to the fact that . . . I also want to reference the more than 150-page 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, written by a group of experts in Quebec. That is why I insisted that Ms. Chalifoux appear before our committee. As Senator Dalphond alluded to earlier, she shared with us the recommendations made by the group of experts. This is an extremely complex issue, and Senator Wallin’s amendment, which we are debating now, addresses two things, in my opinion. The amendment could have addressed just the notion of giving individuals the opportunity to waive final consent, regardless of whether their death is foreseeable, in cases where the individual is experiencing serious, intolerable and irremediable suffering. Thank you.

The Hon. the Speaker pro tempore
[17:32]

Are honourable senators ready for the question?

The Hon. the Speaker pro tempore
[17:32]

Honourable senators, all those opposed to adopting the motion in amendment, please say “nay.”

The Hon. the Speaker pro tempore
[17:33]

All those in favour of the motion and who are in the Senate Chamber, please say “yea.”

The Hon. the Speaker pro tempore
[17:33]

All those opposed to the motion who are in the Senate Chamber, please say “nay.”

The Hon. the Speaker pro tempore
[17:33]

In my opinion, the “nays” have it. I see two senators rising.

The Hon. the Speaker pro tempore
[17:33]

We will have a 15‑minute bell. The vote will be at 5:48 p.m. Call in the senators.

Senator Pate
[18:06]

I would like to explain my abstention, Your Honour.

Honourable senators, I’ve abstained despite my personal view because I believe it is irresponsible to prioritize legislation to expand choices for those most privileged without first or also ensuring that measures are in place in the form of standards and funding of adequate health, social, housing and economic supports to ensure that all — in particular those who are poor, racialized and those with disabilities — also have access to meaningful choice.

The Hon. the Speaker pro tempore
[18:06]

Thank you, Senator Pate.

Hon. Colin Deacon
[18:06]

Honourable senators, I am in favour of advance directives, but I really believe that the need for greater study to manage risks and put up guardrails is essential. I look forward to supporting it in the future. Thank you.

Hon. Patricia Bovey
[18:07]

Honourable senators, I too want to explain my abstention, and it’s for exactly the same reason as Senator Deacon (Nova Scotia). Thank you.

Senator Dupuis
[18:07]

I abstained because I did not want to prevent the proposal from being adopted. I am in favour of advanced directives before a diagnosis is made, but I do not want to give the government the opportunity to reject the amendment on the mental illness exclusion in the response we will receive from the House of Commons. Thank you.

The Hon. the Speaker pro tempore
[18:08]

Honourable senators, pursuant to the order adopted on February 8, 2021, the sitting must now be suspended for an hour. We will resume at 7:08 p.m.