Hon. Ratna Omidvar: My question is for the Leader of the Government. Senator Gold, this is Pride Month. I want to take a minute to congratulate Senator Cormier on his leadership in creating and launching the Canadian Pride Caucus.

I want to shift your attention to what is happening to the LGBTQ2 community in Uganda where they passed a draconian law, calling into question the safety and security of members of this community. The law includes the death penalty for crimes of aggravated homosexuality, and significant penalties for anyone who is seemingly promoting homosexuality.

I’m, of course, encouraged by the statements put out by our government, the Prime Minister, the Minister of Foreign Affairs, the Canadian Pride Caucus and other parliamentarians. But, beyond the statements, I would like to know what the government is doing proactively to work with our regional partners, possibly the U.S., in trying to build a campaign to protect the LGBTQ2 people in Uganda.

Hon. Marc Gold (Government Representative in the Senate): Indeed, the government has been steadfast in its support of Canadian researchers and scientists since 2015. In particular, the government recognizes the central role that graduate students, doctoral students and post-doctoral students play within our research ecosystem.

Colleagues, previous budgets have provided $40.9 million to support targeted scholarships and fellowships for promising Black student researchers; and $38.3 million for the federal granting councils to add new Canada Excellence Research Chairs in the fields of science, technology, engineering and mathematics. The recent $1.4 billion announcement — through the Canada First Research Excellence Fund, or CFREF — demonstrates the government’s ongoing commitment to continue supporting the scientific and research community.

Colleagues, I’ve been advised that since this government was elected, more than $17 billion has been directly dedicated to science funding.

Hon. Stan Kutcher: My question is for Senator Gold. Graduate, trainee and post-doctoral programs are the apprenticeship positions in higher education that build the innovators and scientists of our future research and development and economic systems. Merit-based government-funded grants and scholarships level the playing field to allow access to those programs for everyone — and not only the privileged few.

Senator Gold, does the government realize the importance of these programs for the Canadian research ecosystem and the thriving of the future economy?

The Hon. the Speaker: Order.

Hon. Marc Gold (Government Representative in the Senate): Thank you for the question. I stand with the Prime Minister in his recent remarks regarding this issue when he stated, “This law is appalling and abhorrent, and we strongly condemn it.” He went on to say that Canada will continue to stand with the 2SLGBTQI+ people, and stand up for their rights at home and abroad.

It’s my understanding, senator, that the Minister of Foreign Affairs is working with partners in the region to support communities impacted by this law, and will continue to do so. As we know, not only Canada, but also the United States, the United Kingdom and the European Union have condemned this gross violation of human rights. The community in Uganda is not alone, and Canada is part of that effort to assist them. Canada stands with that community here and around the world in this fight against the rising crackdown on their fundamental rights.

Hon. Marc Gold (Government Representative in the Senate): Thank you for the question and for raising awareness of the challenges posed by the many wildfires burning across Quebec, Alberta, Nova Scotia and the rest of the country.

It is my understanding that a large number of the firefighters in Canada are volunteer firefighters, and one of the challenges facing communities is how hard it is to recruit enough firefighters to meet their increased needs. That being said, and with all due respect, it simply isn’t true that the government isn’t doing anything. On the contrary, following a request by the Province of Quebec, the government approved the deployment of the Canadian Armed Forces to help them deal with the situation.

I’m told that the government is also assessing whether additional federal resources are available to meet the province’s needs. The government knows that the current forest fire situation is and will continue to be difficult across the country for a number of reasons, including the climate, of course, but also a lack of volunteer firefighters. Your suggestion is important, and I will bring it to the minister’s attention.

Hon. Jean-Guy Dagenais: Every year, during the July 14 festivities in France, I am always impressed to see the thousands of firefighters in uniform marching in the Champs-Élysées parade. France has more than 252,000 firefighters, including 197,000 volunteer firefighters, who the country can call upon in the case of wildfires or other natural disasters. Many of these volunteers are retired members of the military.

Yesterday, I was shocked to see that the Prime Minister seemed unable to tell us what was going to be done to get the wildfires under control. We are talking about 2,200 wildfires so far this year, and it is not even summer yet. Unfortunately, wildfires, flooding and tornadoes all seem to be on the agenda for the coming years.

Will Canada stand idly by or will it do like France and set up a mobile volunteer fire brigade to intervene when major disasters strike? Believe me, we are going to need it.

Hon. Wanda Thomas Bernard: My question is for the Government Representative in the Senate. Senator Gold, Minister Marci Ien announced that $1.5 million is being allocated to Canada Pride to be used for safety precautions during Pride parades and festivals this year. This money is being allocated in a reactive manner in response to the very real rise in violence and threats of violence to the 2SLGBTQ+ community. 2SLGBTQ+ people also experience everyday violence year-round here in this country in the form of workplace discrimination, systemic discrimination in the medical system and harassment.

Senator Gold, given the acknowledgement of this increased violence towards this community during Pride Month, what kind of support does the government plan to offer after Pride Month is over, and what other strategies are the government planning to put in place to protect 2SLGBTQ+ people year-round?

Hon. Marc Gold (Government Representative in the Senate): Thank you for your question, senator, and for underlining this important issue and the vulnerability of the LGBTQ community to forms of discrimination that regrettably, and often tragically, continue apace.

This government is proud of the measures that it has taken to strengthen our laws against discrimination. We, in this chamber, had occasion just a few short years ago to debate amendments to the Canadian Human Rights Act to broaden the protection for members of that community. The funding that you announced and other measures are designed to increase and enhance support provisions to bring back the court challenges program as another mechanism whereby the infringement of legal rights, which is too often the case, can be challenged by those who would not otherwise have the means to do so.

The work will never be finished, and more will always need to be done until all Canadians can live with the full respect and dignity we are all entitled to regardless of our sexual orientation, our gender orientation and how we choose to live. This government is proud of its commitment to support those in that community. Actions speak louder than words, and actions will continue to be taken to support the community.

Hon. Marc Gold (Government Representative in the Senate): Thank you for your question. Former Governor General David Johnston was given a task by this government to inquire into the serious issue of foreign interference. He has been subjected to the most odious character assassination and has had his integrity impugned time and time again. In my 72 years on this earth, I have never seen such an attack orchestrated and sustained by a political party, by an opposition that has taken rhetoric to such depths. In that regard, I think that if the former governor general felt the need to defend his integrity and to make sure that the job he was doing could be done in an appropriate way for the benefit of Canadians, then his decision is something the government is prepared to support.

Hon. Rosa Galvez: Honourable senators, I rise to speak to the message from the other place on Bill S-5, strengthening environmental protection for a healthier Canada act.

A year after our comprehensive study of the bill to reform the Canadian Environmental Protection Act, known as CEPA, we are finally close to modernizing Canada’s legislative framework on toxic substances. I need not remind you that CEPA was adopted in 1999 and had not been updated since. Twenty-four long years is an outrageous amount of time to leave untouched the most important tool for protecting the environment and our health while science has progressed at an unprecedented rate and has warned us.

As we see the omnipresence of plastic pollution, microplastics in human organs, uncontrolled toxic spills, terrifying wildfires, floods and other extreme weather events caused by polluting gases warming the atmosphere, I can’t help but wonder: If we had revised CEPA 15 years ago, would we be at this dreadful cul-de-sac?

[Translation]

Bill S-5 is coming back to the Senate with a set of amendments modifying 38 clauses. We are grateful to the House of Commons, whose amendments are generally based on the work of the Senate. The House of Commons made no changes to 21 of our amendments, which validates the good work we did in committee. I sincerely thank every member of the Standing Committee on Energy, the Environment and Natural Resources.

The other Senate amendments were for the most part clarified or reformulated, and only a few were rejected by the Commons.

In my speech, I will address a few specific amendments, which, I believe, were improved by the House, and also a few remaining gaps and weaknesses.

[English]

One of the main features of Bill S-5 is the inclusion of the concept of a right to a healthy environment. During our study, most witnesses applauded the concept but criticized the bill for simply instructing the Minister of Environment and Climate Change to develop and implement a plan rather than enshrining the actual right.

The House made a few modifications, but the intent remains the same. It added a definition of a healthy environment, describing it as “an environment that is clean, healthy and sustainable.” It restructured the Senate amendment that required the implementation framework to elaborate on the reasonable limits to which that right is subject but maintained the Senate’s intent.

It also further clarified the principle of intergenerational equity by stating that:

. . . it is important to meet the needs of the present generation without compromising the ability of future generations to meet their own needs;

Under CEPA, the government is tasked with assessing substances and categorizing them depending on their toxicity. The government assesses approximately 600 substances new to the Canadian market each year. However, it does not give itself enough resources to assess all the substances currently in the Canadian market. For that reason, I had attempted to amend the bill by imposing a set timeline for the minister to finalize an assessment and publish its results. At the time, the committee had opted not to impose a deadline, as the timeline of an assessment would depend on the amount of government resources dedicated to that matter.

To address this issue, the House proposed what I think is a reasonable compromise. If the assessment of a substance has not been completed after two years, the minister must publish a statement indicating the reasons for the delay and an estimated time frame within which the final decision is to be published.

This is a question of ministerial responsibility. Therefore, it is incumbent on the minister to justify any delay that could harm our health.

The next point I would like to address is confidentiality. Currently, when a corporation provides information on a substance requested by the minister, they can request confidentiality by written request. Under the current CEPA regime, confidentiality appears to be granted automatically with no need for approval by the minister. This demonstrates a lack of transparency. Of course, there may be many valid reasons for the need for confidentiality, including trade secrets, integrity of contracts or protection against financial loss. However, the requester should have to demonstrate why confidentiality is needed, and the responsibility should fall on the minister to grant or deny it. This is something that both Senator Miville-Dechêne and I had argued in our committee study. Unfortunately, the committee opted to defeat our proposal.

Thankfully, the House of Commons picked up on this important issue of transparency and found a compromise. Their amendment would require the minister to review a statistically valid representative sample of confidentiality requests granted and determine whether the request is justified under a set of four possible justifications. The requests that don’t qualify are then deemed non-confidential and the minister shall report annually on these confidentiality requests.

I believe this strikes a good balance. When information does not need to be confidential, Canadians have the right to access that information, especially when it concerns their health and the protection of the environment.

Overall, I feel the other place has reinforced the Senate’s work on this bill. That is not to say, however, that there aren’t any remaining gaps or unaddressed issues with CEPA.

Environmental policy experts are not satisfied with the removal of the title of Schedule 1. This list exists because these substances have been found to be toxic in certain contexts, amounts or paths of exposure. The industry complained, saying that some of these substances can be found in everyday products. Whether or not the title of this list includes the words “toxic substances” does not change any legal requirements on these corporations — it is merely a labelling issue. Out of transparency, and for the benefit of the average Canadian, nomenclature is important. Hiding the fact that these substances were scientifically found to be toxic in certain contexts is not being transparent with Canadians.

Another major issue remains with the government’s capacity to assess substances. The government is over-reliant on industry to provide the scientific basis for assessments and often merely does a literature review rather than scientifically testing the substances themselves. This is problematic as we rely on industry for decisions that are the minister’s responsibility. For example, just last week, we learned through an article published by the CBC that industry knew for decades about the risks of per- and polyfluoroalkyl substances, also known as PFAS or forever chemicals, and kept it hidden. Major industry players knew these substances were toxic, yet they are present in everything from cookware to makeup. These chemicals are known to cause liver problems, pregnancy issues and cancer. Worse yet, the industry used tactics reminiscent of the tobacco and fossil-fuel industries to muddy the water around the toxicity of forever chemicals and to prevent more research to study the matter.

This is completely unacceptable, and it is our job as legislators to adopt a legislative framework that better regulates the industry. We cannot play with the health and safety of Canadians. We cannot rely on experiments that are overwhelmingly designed, performed, analyzed and disclosed by industry for the purpose of sales and profit rather than for the best interest of Canadians. We must equip our government with the adequate resources to make its own rigorous and transparent scientific assessments.

[Translation]

Colleagues, Bill S-5 makes essential updates to the Canadian Environmental Protection Act. It’s not perfect, and we still have a lot of work to do to ensure that our environmental protection act really focuses on preventing pollution, not managing and monitoring it.

The current Minister of Environment and Climate Change promised that more revisions are to come, and I eagerly await those proposals. Never again should we wait 24 years to modernize legislation that is so crucial to protecting our health and the environment.

I encourage you to support the bill while continuing to advocate for other improvements in the near future.

Thank you. Meegwetch.

(On motion of Senator Patterson (Nunavut), debate adjourned.)

Hon. Marc Gold (Government Representative in the Senate): I certainly care, as I think all senators care about the hardships that Canadians are facing due to worldwide supply chain problems, worldwide inflation and worldwide climate change, which have significantly affected our supply of food. That is why this government has made serious efforts to assist Canadians most in need, as I have outlined on many occasions.

With regard to the food banks, I do not know how the situation will continue to unfold. I have been involved in food banks in my hometown. Thank goodness for the volunteers and organizations that do provide this assistance and the governments that support them.

In that regard, the Government of Canada has made significant investments and funding available to local food banks to help them meet the needs of their residents and will continue to do so.

The Hon. the Speaker: Do you have a question?

The Hon. the Speaker: Could you ask your question, Senator Plett?

Hon. Donald Neil Plett (Leader of the Opposition): Senator Gold, if you answered a question once, you would be able to stop rolling your eyes every time we ask a question.

For us to ask questions about forest fires, which we all agree are devastating — no one is suggesting that we shouldn’t spend money on fighting forest fires. For you to try to get away from the Beijing interference is shameful.

You referenced your 72 years of your life. I can’t remember all 73 of mine, but never have I seen a government as corrupt as this Liberal government or as afraid of answering questions as this Liberal government.

You know, Senator Gold, if you would answer a question once, we would be able to get along much better in this chamber.

Thank you, Senator Dean. You can help me, talking about echo chambers.

Hon. Patti LaBoucane-Benson (Legislative Deputy to the Government Representative in the Senate), pursuant to notice of June 1, 2023, moved:

That the Certificate of Nomination for the proposed reappointment of Heather Powell Lank as Parliamentary Librarian, tabled in the Senate on June 1, 2023, be referred to the Standing Joint Committee on the Library of Parliament for consideration and report; and

That a Message be sent to the House of Commons to acquaint that House accordingly.

The Hon. the Speaker pro tempore: Is it your pleasure, honourable senators, to adopt the motion?

Hon. Donald Neil Plett (Leader of the Opposition): Honourable senators, I rise today to speak to Bill S-248, an initiative brought forward by a passionate and diligent advocate for patient autonomy and dignity, Senator Wallin. I know this legislation, like her amendment to the previous government bill, is based on a very personal and painful experience and is presented with sincere intentions.

In the previous speeches I have made on assisted suicide, I have stressed my concern with the speed and the magnitude of the expansions the government has made to what was initially a careful, cautious response to a decision made by the Supreme Court of Canada.

While we were keenly aware at the time of the paradigm-shifting nature of legalizing assisted suicide, most of us were also aware of the need for clarity, certainty and stringency in the law so that we could ensure no life would end prematurely without careful evaluation and the express consent of the individual.

For many of us, the safeguards at the time fell short, yet, as I have said before, I could never have imagined that a few short years after our “slippery slope” arguments were dismissed, we would be legalizing assisted suicide for people suffering from mental illness and tabling committee reports recommending the expansion of assisted suicide to children. These are proposals I find indefensible.

However, I would not put Bill S-248 in that category. I am sympathetic to the rationale for advance requests, particularly for patients diagnosed with Alzheimer’s and dementia, who fear living in an unfathomable state as their illness progresses.

That said, in practice, this legislation would eliminate one of the most fundamental safeguards in Canada’s assisted suicide regime: the need for unequivocal, unquestionable and clear final consent before ending the life of a person.

Advance requests eliminate the ability of a physician to ascertain the person’s present desire, leaving a very real possibility that a person’s life could be ended against his or her wishes.

The Supreme Court of Canada in Carter emphasized numerous times that a person requesting assisted suicide must provide clear consent. If the consent must be clear and unequivocal, it must also be contemporaneous. According to the experts, there are data highlighting the risk of providing assisted death to a patient against his or her wishes.

In discussing advance requests, or ARs, the report of the Council of Canadian Academies on advance requests for MAID prepared for the Government of Canada stated that:

The primary risk involved in ARs for MAID is the risk that a person will receive an assisted death against their wishes.

This risk is supported by Health Canada data. Health Canada’s first, second and third annual reports on assistance in dying in Canada demonstrate that, on average, approximately 20% of people who withdrew their requests for assisted suicide did so immediately before the provision of the assisted suicide.

That is a striking statistic, and one that should give us all pause.

I was not a member of the Special Joint Committee on Medical Assistance in Dying, but I did read the testimony and the final report with great interest. While some witnesses certainly agreed with what Senator Wallin is proposing, others raised serious legal, ethical and practical charges with advance requests.

There were three overarching concerns raised by witnesses. The first was the inability of an individual to predict with accuracy what their quality of their life would be in the future, particularly if they are living with a chronic medical condition. The second concern was the inability of a person to withdraw consent, and the third was that the advance requests present the possibility of abuse, coercion and undue influence of vulnerable patients.

On the first point, several witnesses provided examples of the limitations of our ability to assess our future quality of life. Dr. Romayne Gallagher, Clinical Professor of Palliative Medicine at the University of British Columbia testified on behalf of the Canadian Society of Palliative Care Physicians, stating that:

 . . . . medical and social science literature reminds us that people are poor at anticipating what life would be like with a life-changing illness or disability. People adapt to illness and disability and adjust their needs for a decent quality of life. Many medical conditions have long and unpredictable courses. . . .

Dr. Jonas-Sébastien Beaudry similarly noted that patients making advance requests may have experiences and desires that are different from those that they had in the past. They have never experienced what it is to live a life with fewer cognitive capacities.

He gave the illustration of a 75-year-old man named John who has lost the capacity to make his own health care decisions. It is widely accepted that when health care decisions are made on someone else’s behalf, they should only be made for the benefit of that patient. Dr. Beaudry noted that one would assume that John, without dementia, when he was, say, 50 years old, would know his future self better than anyone and that he would instinctively know what is best for John at the age of 75.

However, that is not so obvious. For one thing, John may be making decisions to, first and foremost, ease the burden on members of his family. He might also imagine his future self bedridden and highly dependent and feel shame at the thought of being seen this way. These assumptions may be based on widely held discriminatory beliefs about the quality of life of people with illnesses and disabilities and about whether their lives are worth living at all.

Dr. Beaudry noted that many people live happy lives with various significant medical conditions or a high level of dependency. However, if John or anyone in his family or health care team does not agree or is unaware of that because of ableist generalizations, John at 75 years old would become the victim of these ableist or ageist stereotypes.

Dr. Beaudry’s overarching point was that when it comes to health care, we should care for the patient before us even when that patient has advanced dementia. It does not mean that John’s past experiences are irrelevant. The holistic assessment of what is in his best interests may include his past wishes and preferences.

The bottom line is we do not give the last word to the former self of a patient, particularly a cognitively and experientially distant self.

The committee also heard from Dr. Alice Maria Chung, a geriatrician who has worked with elderly patients for 30-plus years and teaches capacity assessments to medical students, residents and practising physicians so that they will be able to identify whether a patient is capable of making a medical decision.

Dr. Chung posed this question:

What right does the 60- or 70-year-old you have to judge the quality of life of the 80- or 90-year-old you? Patients with chronic illnesses can often adapt to their altered circumstances and develop a new equilibrium and sense of self, and feel that their quality of life is actually quite good.

There is a body of medical literature demonstrating this point. She noted that she had seen it in her practice as well.

In response to this concern, Senator Wallin said that we do this all the time within the law. We write wills and we leave them with lawyers, we have “do not resuscitate” orders, et cetera. That is all true. However, we all know that actively ending a person’s life without certainty of their present consent is entirely different. In this case, I would argue, if there is any risk of getting it wrong, we cannot ethically proceed.

The second issue is that an individual would be unable to withdraw consent, which is an essential component to informed consent. Consent is a concept that has permeated public discourse over the past several years, and we have come to a societal understanding that, on the most serious of matters, consent must be current, explicit and unambiguous. I cannot imagine a more serious circumstance in which consent must be ascertained.

Are we really suggesting that a lack of refusal constitutes consent? We know that it does not and it cannot.

We can all agree that a person’s autonomy must be respected, and if an individual is capable of decision making and able to clearly communicate that decision, it is reasonable to hold a view that those wishes should be honoured. However, we have decided as a society that there are necessary limits to freedom of autonomy.

Dr. Félix Pageau, geriatrician and researcher, told the committee:

The government must protect vulnerable people and protect people from themselves. Which is why it has established a legal age for alcohol consumption and requires people to wear seat belts in cars and helmets on motorcycles. Freedom of autonomy is therefore not absolute in Canada; it is regulated.

Similarly, our current law places necessary limits on the ability of a person to make future decisions without the ability to change their minds on the most serious medical decision one can make. It is well-documented that when it comes to assisted death, requests and minds are being changed immediately prior to administration. Requests are being withdrawn. This option to withdraw consent at the last minute must remain.

Finally, there is the risk that allowing advance directives for people with dementia and Alzheimer’s could lead to abuse. People already face undue influence to avoid being a burden to their loved ones. As Dr. Chung stated:

I have had multiple patients who have been heartbroken at having been coerced into selling their home and moving into a facility because of family pressures to not be a burden. I cannot currently protect vulnerable elderly from financial abuse with the current safeguards. I do not believe safeguards could be crafted to adequately protect them from undue influence to accept or request MAID.

Trudo Lemmens is an expert in health and law policy. In the submission to a joint committee on this topic, he provided international context to the discussion, highlighting the requirements of other countries that have implemented advance requests for assisted suicide. He noted that:

Belgium only allows MAID based on AR when persons are permanently unconscious, to avoid euthanizing people who still enjoy life and may resist. The Netherlands originally had difficulty with MAID based on AR, since it was considered impossible to defend this practice on the basis that persons ’suffer unbearably’, when they were no longer able to confirm this. It now has permitted it for persons even when they appear to resist.

Neither regime involves explicit contemporary consent, which is arguably constitutionally required in Canada given the Supreme Court’s emphasis on clear consent in Carter.

Lemmens notes that our current medical assistance in dying, or MAID, regime already goes well beyond the Belgium law, while our social and health care support is below the Organisation for Economic Co-operation and Development, or OECD, average. Finally, he pointed out that perhaps, not surprisingly, the Dutch experience with advance requests has led to insurmountable ethical and legal challenges.

Colleagues, while I have tremendous compassion for people who have received a troubling neurocognitive diagnosis in which the future is unknowable and the fear of a poor quality of life sets in, as the experts have stated, there is no way to predict with certainty how one will feel as the illness progresses.

Giving the final sign-off or the last word to the past version of a person is wrong. We cannot give prior wishes of people who cannot fully appreciate their future lived experience priority over current interests. The stakes, colleagues, are too high.

Given that Health Canada’s own data states that 20% of those who withdraw their requests for MAID do so immediately before the procedure, if this bill passes, there will undoubtedly be people who fall through the cracks, patients whose lives are ended against their present wishes — the involuntary ending of a life.

The cost of getting it wrong far outweighs the cost of not acting. For that reason, I cannot support this bill. Thank you, colleagues.

Hon. Yonah Martin (Deputy Leader of the Opposition): Honourable senators, I rise to speak today as the critic of Bill S-248, An Act to amend the Criminal Code (medical assistance in dying).

I would like to acknowledge Senator Wallin, the sponsor of this bill, for her hard work and advocacy on the issue of advance requests.

As I’ve stated before, medical assistance in dying has been — and remains — one of the most complex and deeply personal issues for individuals and families across the country. There is a wide range of valid opinions in this chamber on what the appropriate parameters and safeguards should be as we continue to grapple with these questions in the development of our MAID regime.

As the critic of Bill S-248, a bill that will permit advance requests for MAID if an individual loses the capacity to consent, I would like to outline a few concerns regarding this bill and talk about important safeguards that need to be put in place. We have heard in detail from colleagues on what this bill does and doesn’t do. We have heard colleagues raise important points on the need for clearly defined safeguards, such as the length for which an advance request is valid, the role of independent witnesses and what constitutes voluntary and informed consent.

Bill S-248 amends the Criminal Code to:

(a) permit an individual whose death is not reasonably foreseeable to enter into a written arrangement to receive medical assistance in dying on a specified day if they lose the capacity to consent to receiving medical assistance in dying prior to that day; and

(b) permit an individual who has been diagnosed with a serious and incurable illness, disease or disability to make a written declaration to waive the requirement for final consent when receiving medical assistance in dying if they lose the capacity to consent to receive medical assistance in dying, are suffering from symptoms outlined in the written declaration and have met all other relevant safeguards outlined in the Criminal Code.

The content of Bill S-248 was originally proposed as an amendment to Bill C-7, which passed in the Senate but was rejected by the government. If passed, this bill will give Canadians who have been diagnosed with a grievous and irremediable medical condition the ability, before they lose the capacity to give consent, to make an advance request for MAID.

As co-chair of the Special Joint Committee on Medical Assistance in Dying, I worked with committee members as we reviewed medical assistance in dying with respect to palliative care, mature minors, protection for persons with disabilities, mental illnesses and advance requests. As a committee, we heard from various witnesses who supported and advocated for advance requests.

Dr. Helen Long, Chief Executive Officer of Dying With Dignity Canada, said:

Canadians tell us that they are concerned about their capacity to provide informed consent to MAID due to a family history of neurocognitive conditions, such as dementia or Parkinson’s, or that an accident or other medical problem could result in diminished mental capacity. Advance requests for MAID would allow those who so choose to avoid a life of grievous and irremediable pain and suffering if loss of capacity occurs.

Dr. Serge Gauthier, emeritus professor and neurologist, described how many of his patients want the choice to make advance requests, with some of his patients advising that they would contemplate suicide without having advance requests as an option.

Sandra Demontigny, who is 43 years old and has early-onset Alzheimer’s, shared what an advance request would mean for her:

However, I don’t want to experience the final phase of the disease, completely dependent and unable to express myself very much, if at all. I’ve seen it and I don’t want to live through it. That’s what I would specify in an advance request. It would definitely give me more time.

Without wishing to put pressure on you, if advance requests were not approved by Parliament, then unfortunately, I would have to decide to leave before entering that phase, in order to avoid becoming trapped.

We also heard from witnesses who cautioned that important safeguards must be put in place to be sure when dealing with advance requests.

Mr. Pierre Deschamps, lawyer and ethicist, said:

. . . the challenge for legislators is to design robust safeguards that will protect persons who have made advance requests for medical assistance in dying — such requests are generally made many years before the condition that may potentially give rise to their activation appears — from abuses such as medical assistance in dying that is provided too early or in haste under pressure from family members or medical staff who sympathize with the state of mental deterioration of the person, who will thus be put in a highly vulnerable position.

Dr. Alice Maria Chung, as quoted earlier by our leader, said:

The issues with advance directives for MAID are several-fold. First, we are not able to predict with accuracy what our own quality of life will be in the future, let alone if we are also living with a chronic medical illness. . . .

Second, with end-stage dementia, there would be absolutely no chance to withdraw consent, which is also essential to informed consent. Someone else, a health care worker who may not know the patient, or a caregiver, would have to decide when it’s time for MAID to proceed. . . .

Finally, there is the risk that allowing advance directives for patients with dementia could lead to abuse. . . . I do not believe safeguards could be crafted to adequately protect them from undue influence to accept or request MAID.

In the 2018 report from the Council of Canadian Academies, entitled The State of Knowledge on Advance Requests for Medical Assistance in Dying, the expert panel cited a number of knowledge gaps regarding advance requests.

McGill University physician Catherine Ferrier appeared before the Joint Committee on Medical Assistance in Dying and raised this concern, stating that the utility of advance directives in general is being seriously questioned by many experts. She noted that there is growing evidence that people tend to poorly predict their quality of life in hypothetical situations due to cognitive biases, such as projection bias — projecting current preferences onto future situations — focalism — focusing on what gets worse, not what remains positive — and immune neglect — underestimating one’s adaptive capacity.

Another knowledge gap noted in The State of Knowledge on Advance Requests for Medical Assistance in Dying dealt with the broader impacts of allowing advance requests for MAID in Canada. This would include the impacts experienced not only by those requesting MAID but also by those responsible for deciding if and when to follow through with the requests and by society as a whole.

Honourable senators, medical assistance in dying is indeed a complex and deeply personal issue. As the eldest daughter and primary caregiver of my late mother, who lived with advanced dementia for over a decade, it would have been impossible to follow an advance request had the law allowed her to put one in place before the disease had advanced. Neither she nor I could have anticipated the joy she exuded and spread to everyone on her floor as a person whose advanced dementia made her angelic and happy about everything.

I cannot imagine how I could have followed my mother’s wishes for an advance request for MAID at any point in her care.

MAID and the issue of advance requests are matters that are challenging for every parliamentarian. As legislators, we want to know we are making the right decision. We want clear evidence that our efforts are helping people and not harming them. Yet, on these highly emotional social issues, the path forward is not always clear. It is my hope that through the witness testimony at committee, we will be able to find that path, to hear from those experts in the field about advance requests for MAID and what safeguards we can put in place to ensure Canadians are protected and to ensure that their wishes are heard. Thank you.

(On motion of Senator Clement, debate adjourned.)

[Translation]

On the Order:

Resuming debate on the motion of the Honourable Senator Dalphond, seconded by the Honourable Senator Cordy, for the second reading of Bill S-256, An Act to amend the Canada Post Corporation Act (seizure) and to make related amendments to other Acts.