Honourable senators, this is a difficult topic for many of us. I want to state at the outset that I promote the sanctity of human life, and I am opposed to assisted suicide; however, we have been put into a situation by the Supreme Court of Canada and we have to make a decision.

We can work toward passing piece of legislation that has stringent safeguards and, where safeguards are absent, make amendments to ensure they are in place, or we will have a gaping hole as we have had with other controversial bills in the past.

This is a life-and-death situation, and for that reason we need to have proper safeguards in place. Parliament needs to respond to the Supreme Court's decision and pass legislation in one form or another.

While I am opposed to euthanasia and assisted suicide, that is not to suggest in any way that I do not have profound sympathy for those who are suffering intolerable pain, whether that stems from physical or mental illness.

For example, I recently met a woman from Manitoba who, since moving to Winnipeg at the age of 10, suffered severe bullying to the point of trauma and as a result struggled with a mental illness and depression. She began self-harming, taking pills to the extent that she was on life-support. At the age of 18, she attempted suicide for the first time. In 2007, at the age of 23, she jumped off of a bridge in Winnipeg in another suicide attempt. She broke her back, feet, and spent six months in the hospital. Her medical team did not believe she would ever walk again. While she may or may not have been able to qualify for the criteria set out in Bill C-14, she told me that if assisted suicide had been an option, she certainly would have taken it. This lady just finished a two-year college program, working in child and youth care, and is taking on a new responsibility as a community housing support mentor. Colleagues, she lives a full and healthy life.

We know that in the Netherlands, studies show that patients are four times more likely to request assisted suicide if they are depressed. There is nothing in this legislation that prevents a severely depressed or mentally ill individual from accessing suicide. In light of the situation we are in, we should be ensuring that assisted suicide is used in narrow circumstances after psychological assessments have been conducted and truly as a last resort.

Legalizing assisted suicide crosses more ethical and legal divides than any legislation most or maybe all of us will ever work with. It is certainly the largest shift in medicine that has happened in our country's history. As Andrew Coyne put it, the legalization of assisted suicide, and I quote:

. . . embraced the idea of suicide, not as a tragedy we should seek to prevent, but a right we are obliged to uphold . . . .

The ministers responsible had an extraordinarily difficult task in crafting the legislation. However, they responded to the Supreme Court's decision in a reasonably responsible way. There are some stringent safeguards in the legislation, and provisions in the bill, in my opinion, are significantly more acceptable than the recommendations of the joint committee.

With that said, there are some safeguards absent from this legislation that are absolutely crucial to ensure that the vulnerable are protected in a situation where the chance of abuse of power to inflict death is too great.

The government asked the Senate to conduct a pre-study, where we made a number of recommendations so that in an attempt to pass an acceptable bill in a timely manner, they could consider the recommendations before it was ever sent to the Senate. Our committee did an outstanding job in its deliberation of such a passionately divisive issue, and in a respectful manner. In our committee, the chairman, Senator Runciman, commended the committee on the conciliatory manner with which we approached this great task.

After hearing from 66 witnesses, and sitting through over 20 hours of meetings, we worked hard to arrive at rational, reasonable amendments, many of which were adopted by the committee unanimously. Again, as Senator Batters pointed out to the minister earlier this week, recommendations were passed unanimously by a committee made up of Liberals, independents and Conservatives.

However, unfortunately, the House of Commons did not accept even a single one of the committee's recommendations.

While I supported many of the recommendations proposed by members of the committee, I will largely focus on the recommended amendments that I proposed, specifically, the recommendations that were adopted by the committee, and I'll allow other senators to elaborate on their recommendations.

Colleagues, Bill C-14 includes a safeguard which stipulates that a medical practitioner must reaffirm a patient's consent, which includes assessing competency to consent immediately prior to administering the drug.

There is no such safeguard when the drug is given as a prescription. After the prescription is given, the patient can take the substance years down the road, potentially with a mental illness progressing. There is no safeguard in place to ensure that the individual has the capacity to consent at the time of taking the prescription or that the individual is not being coerced.

When the physician administers the drug, it is stipulated that a witness who is not the beneficiary of the patient must be present. However, virtually any individual can administer the drug to the patient after it is given as a prescription. What is most concerning is that there is no provision barring the person from being a direct beneficiary.

We put in a recommendation for an amendment to this effect which was adopted unanimously by our committee. No jurisdiction in the world, colleagues, has a legalized assisted suicide for any person other than the patient or the physician to administer the drug, yet this legislation allows anyone to administer the drug.

At the very least, the government should make a reasonable compromise to exclude beneficiaries to reduce the potential for abuse. The minister told me that patients want their loved ones around at this very difficult and emotional time. Nothing about this amendment would preclude family members from surrounding the patient. This is simply a necessary safeguard in a problematic situation. The fact that the government has excluded beneficiaries in the witness provision means they acknowledge a problem with a beneficiary being directly involved in the decision to administer death to the respective patient. We need to remain consistent in our approach in acknowledging this risk.

Another recommendation I made — and perhaps the one I am the most passionate about — is with respect to conscientious objection. Colleagues, it is absolutely imperative that medical practitioners are protected every step of the way when it comes to declining to participate in assisted suicide.

This is not a standard medical procedure and should not be regarded as such. Keep in mind, colleagues, many physicians feel that this major paradigm shift has been imposed upon them.

Members in the other place worked hard in an attempt to get an amendment passed to protect the conscientious rights of physicians. The government, instead, put in an amendment that does not have any practical significance.

The government has repeatedly stated that such regulations regarding the extent to which practitioners will be protected will be left up to the provincial college of physicians and surgeons. The Ontario College of Physicians and Surgeons appeared at our committee and made it adamantly clear that they will not support conscientious objection when it comes to providing what they call "effective referral."

We heard from physicians at the committee that it is imperative that a person must be able to conscientiously object to providing a referral for a number of reasons.

Dr. Dawn Davies, the Chair of Bioethics Committee at the Canadian Paediatric Society, when asked by Senator Lankin about why conscience protection should be enshrined in the Criminal Code exemption rather than left up to the provinces, she stated:

I'm responding as a clinician. You've been speaking to lots of heads of colleges of physicians who represent their membership to a large degree. Unlike almost anything else I can think of in medicine, this has been imposed on us. I know it's about the patients, but I completely reject the language along the lines of we just need to suck it up. It's not why most of us went into medicine.

Dr. Davies continues:

I would argue that in almost every other case there is a duty to refer or a duty to transfer care. I think that at a provincial level they're collecting lists of physicians willing to perform this procedure and that patients will navigate their own way.

To say there is a duty to refer makes people that may not be comfortable with this in any way, shape or form feel complicit in part of it. There's enough of a groundswell of change that people will be able to navigate themselves.

Dr. Blackmer, President of the Canadian Medical Association, when responding to a similar question stated:

There's a very complex question around the referral issue, though. For physicians, that has a special importance because it's a legislated act. A referral from one physician to another means that I'm sending you a patient because I think you can provide a specialized service that I cannot, and I'm endorsing that service to the patient. You can see how in the context of assisted dying that would be extremely morally problematic, because essentially if I'm forced to refer a patient for you for assisted dying, for a lot of physicians that would be morally equivalent.

Dr. Blackmer later spoke for the Canadian Medical Association when he said: "For those members who choose not to participate in assisted dying, we have been vehement about their rights to conscientious objection."

Yet, colleagues, several provinces have indicated they will contradict the CMA's position on this.

The most compelling testimony we heard on conscientious objection was from Dr. Sephora Tang, a psychiatrist who works daily with patients who have either tried to commit suicide or are chronically suicidal, some of whom have physical conditions that would likely qualify for assisted dying under this legislation. Dr. Tang said that these patients come to her in a safe place. She has seen time and time again patients come out of a suicidal state. She told our committee that if she was forced to refer her depressed or suicidal patient to a willing practitioner upon a patient's request, she would be completely stripped of her professional judgment.

She said at committee:

How do I feel about sending my patient, somebody I know that I could work with if they would be willing to work with me, to somebody that I know may be also the person that would cause the death of this patient?

She continued:

I wish to be able to do my work, which I honestly love. It is the most rewarding thing to be able to work with my patients and journey with them and to see them come out of a very dark place. I need time to be able to do that with my patients.

If we do not have legislation that allows me to practise according to my conscience, this time that I have with my patients to work with them will be truncated . . . to their detriment and to the detriment of the families and friends . . . that are left behind . . . .

Colleagues, some opposing a conscientious objection protection have claimed there will be issues in terms of access. However, Carolyn Pullen, of the Canadian Nurses Association, said at committee:

In both the case of abortion and in medical assistance in dying, these are not emergency situations. There is time, even in remote or rural circumstances, where if a provider needs to recuse themselves from the process, there would be policies and practices in place to bring in a substitute provider to provide that care.

Another claim that the government has made against enshrining this protection is that we would be infringing on provincial jurisdiction.

The Hon. the Speaker: Senator Plett, your time is expired. Are you asking for five more minutes?

Senator Plett: Please.

The Hon. the Speaker: Granted, colleagues?

Hon. Senators: Agreed.

Senator Plett: Thank you, colleagues.

Another claim that the government has made against enshrining this protection is that we would be infringing on provincial jurisdiction. We, as the federal Parliament, are setting out exemptions to the Criminal Code. We are stating that in "these" circumstances, or within "these" parameters, assisting a person in death is legal. The provinces have absolutely no legal say in such parameters.

Colleagues, this protection is imperative if we are going to pass this legislation. It is a protection that needs to be consistent across the country and that is guaranteed to any medical practitioner who feels that their professional judgment is being stripped from them or that they have to choose between career and conscience.

Colleagues, we will have more time to debate individual amendments when they are introduced. I know that some honourable senators, in good conscience, cannot bring themselves to vote in favour of this bill. However, I am of the opinion that we must find a way of strengthening and passing this legislation.

Colleagues, I would encourage you, when I bring these amendments forward, that you support them. If this bill does pass, these safeguards will be crucial for both consistency and for protection of the vulnerable, and I hope I can count on your support.