PDAM Committee Report

Supplementary Opinion

Submitted to the Special Joint Committee on Physician-Assisted Dying
by New Democrat MPs Brigitte Sansoucy (Saint-Hyacinthe-Bagot) and Murray Rankin (Victoria)

The committee has worked diligently––in spite of its short timeline and deeply sensitive subject––to deliver a report that honours the diversity of evidence it heard and makes important recommendations for the government to consider in its legislative response. It is a report in which we invested much time and care in shaping and are proud to support. We thank each of the 61 witnesses who made themselves available to the committee as well as the staff whose support was essential for the committee to deliver on its mandate in due time.  

We offer this supplementary opinion to provide Canadians with additional information, beyond what could be included in the main report, that we believe they will find helpful in understanding the context in which the committee worked and the options now facing the government. As the government moves forward, it must continue to engage with Canadians.

A principles-based approach to legislating on medical aid in dying

In making health policy, New Democrats believe in putting the patient first. In the case of medical aid in dying, that approach is the only way to be respectful of the complex and sensitive issues facing patients and their families, as well as responsive to the urgency of their suffering. And yet for five months following the Supreme Court’s unanimous decision in Carter, the previous government chose to neither take action in Parliament nor consult with Canadians. Their failure to act was an affront to this patient-centred approach and a derogation of their duty to govern for all Canadians, particularly those whose suffering was the concern of the Court and this committee. Those five wasted months created additional challenges which the committee worked admirably to overcome. Having now received the committee’s report, the government must move efficiently to introduce legislation that protects the Charter rights of these patients.

This legislation must consider not only the specific recommendations found in the committee’s main report, but the principles that drove our deliberations. It must ensure that every eligible patient’s right to access medical aid in dying is upheld, and protect any healthcare professional who objects for reasons of conscience from disciplinary action. It must honour patients’ autonomy and self-determination––ensuring that their privacy is not violated or their rights undermined by arbitrary bureaucracy––while still maintaining effective safeguards to protect vulnerable individuals. Recognizing the initiatives by provinces and territories since Carter, as well as the exemplary consultation process adopted by Quebec with respect to Bill 52, the federal government must adopt an approach of collaborative federalism, respecting provincial jurisdiction while providing the leadership necessary to avoid a regional patchwork.

As parliamentarians, New Democrats approach the question of medical aid in dying with the understanding that, however our views may differ, every parliamentarian is guided by deeply held values and the best interests of their constituents, and that the views of each Canadian must be respected as we seek to protect the Charter rights of all. We were pleased that the committee shared this desire to work in a non-partisan and respectful manner. This is the approach Canadians expect of Parliament, and we are hopeful that it can be maintained in the coming months as Parliament considers legislation relating to the committee’s report.

Respecting the priorities of Canadians: expanding palliative care, supporting caregivers

In its mandate from Parliament, the committee was tasked with providing recommendations on a federal response that “respects the Constitution, the Charter of Rights and Freedom, and the priorities of Canadians.”

The fact that palliative care can and must be improved was emphasized by every witness who testified on the subject before our committee, was repeatedly affirmed by representatives of all parties and both chambers of Parliament, and was recently the subject of a motion tabled by NDP MP Charlie Angus (Timmins – James Bay) and passed with near-unanimous support in the House of Commons in 2014. We can imagine no more conclusive proof that palliative care is truly a priority for Canadians and inextricably linked to the issue of medical aid in dying.

It is our view that making recommendations on the improvement of palliative care fell squarely within the committee’s mandate and remains essential to any balanced response to medical aid in dying. To that end, we introduced a package of concrete measures to improve palliative care.

Several motions introduced by Mr. Rankin on February 4, 2016, were adopted as recommendations in the final report, including:

• Re-establishing a secretariat on palliative care
• Creating a properly funded Pan-Canadian Strategy on Palliative and End-of-Life Care
• Providing culturally and spiritually appropriate services to Indigenous communities

At the same time, New Democrats believe the report could have gone further, to include steps that were within the committee’s mandate to recommend and are necessary for the government to take. These omissions are an opportunity missed but not yet lost. Alongside the recommendations in the main report, the government can now:

1. 1.   Demonstrate leadership by providing palliative care within federal jurisdiction.
2. Palliative care can and must be improved, and the government has significant scope to do so. The federal government is the fifth largest healthcare provider in Canada, providing direct health services to specific populations such as First Nations and Inuit peoples, veterans and active members of the Canadian Forces. Providing palliative care for those within direct federal health responsibility would help a significant number of Canadians and demonstrate leadership to provinces and territories.
3. 2.   Help every Canadian family by improving Compassionate Care benefits.
4. Family members can experience chronic financial, physical, and emotional stress when caring for a loved one. Helping caregivers provides significant benefits, both for the individual families and the health care system.
5. Under pressure, the last government adopted the NDP’s proposal to extend EI Compassionate Care benefits from 6 weeks to 6 months. Unfortunately, they failed to address the narrowness of eligibility criteria so too many families caring for loved ones will still be left out.
6. We believe that families should be able to access these supports not just when a loved one faces a terminal illness, but also when other serious family health events require time away from work.

Recognizing the broader health context

The committee report touched on several issues it described as “ancillary considerations,” including the needs for meaningful consultation with Aboriginal peoples, better support for mental health, improved palliative care, and a national dementia strategy.

We wish to recognize initiatives by several parliamentarians who have worked hard to address these priorities for Canadians, including former MP Libby Davies’ Continuing Care Act, former MP Claude Gravelle’s bill to create a National Dementia Strategy, and MP Charlie Angus’ motion to establish a Pan-Canadian Palliative and End-of-Life Care strategy.

New Democrats see these issues as not only intrinsically linked to the issue of medical aid in dying, but fundamental to a successful model of public healthcare in Canada for the 21st century. Canadians want better access to primary care, as a well as a stronger continuum of care, including home care, long term care and palliative care. They want greater equality of access and outcomes, regardless of their postal code. They want a government that not only strongly supports the Canada Health Act, but that is committed to ensuring its full implementation from coast to coast to coast. And they want to see the shameful deficiencies in on-reserve healthcare addressed and Aboriginal peoples respected as full partners in the development and implementation of health programs.

We therefore urge the government not to address medical aid in dying in a vacuum, but to consider its connections to other aspects of health policy, including social determinants of health. New Democrats recognize that social determinants—such as income and social status, education, employment conditions, social environments and support networks, gender, and healthy child development—play a role in health outcomes. These must be considered in relation to medical aid in dying to determine how they may affect health outcomes, access to care, and potential vulnerability. The government must take action to fight poverty, tackle rising food insecurity and address the affordable housing crisis so that Canadians are on more equal footing as they make end-of-life decisions.

In conclusion, we are proud to support the committee’s main report and wish to recognize the hard work of all our colleagues who worked alongside us throughout its development. Having taken a broader viewer of the committee’s mandate, we urge the government to take note of the additional issues and recommendations put forward in this supplementary opinion and to seize this opportunity to respond to the priorities of all Canadians.