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Debate on Senator Carignan’s amendment to Bill C-14, medical assistance in dying

Debate on Senator Carignan’s amendment to Bill C-14, medical assistance in dying

Debate on Senator Carignan’s amendment to Bill C-14, medical assistance in dying

Debate on Senator Carignan’s amendment to Bill C-14, medical assistance in dying

Published on 9 June 2016
Hansard and Statements by Senator James Cowan (retired), Joan Fraser (retired), Joseph Day, Mobina Jaffer, Serge Joyal

Hon. James S. Cowan (Leader of the Senate Liberals):

First, I want to reassure Senator Batters that those of us who are in the Senate Liberal caucus have, since February 2014, been completely independent of our former colleagues in the House of Commons. We have never whipped a vote in all that time. We discuss together; we work together. However, we don’t necessarily vote together, as you saw on the amendment last evening.

It would be inappropriate for Senator Carignan to seek from me anything more than my personal opinion on an amendment which he has proposed. As I will indicate shortly, we have done that. I don’t speak for my caucus on this. I’m presenting my personal views, as I did last evening. As you can see, my views were shared by some of my colleagues, but not by others. I respect their right to their view, and I know that they respect my right to do the same.

Colleagues, I want to thank Senator Carignan for presenting his amendment today and for the explanation that he has given as to the balance he has tried to strike on this issue.

As we’re considering this very serious issue, all of us have a responsibility to ensure that there are appropriate safeguards in place to meet the concerns of not only those who are vulnerable and those who would seek to access medical assistance in dying, but also those who care about those who are seeking or might seek medical assistance in dying, whether they are family members or organizations representing various groups in our society.

As senators, we are always conscious of our responsibility to look out for minorities and for those who don’t have powerful voices to speak on their behalf. That’s part of the responsibility and the concern that all of us share.

We have a responsibility here with respect to this issue to make sure that the framework of safeguards is as robust and as complete as we can make it. Obviously — and this has been mentioned before — there are always unforeseen, unintended consequences. That’s why legislation evolves, and that’s why it’s necessary to meet changing circumstances and to deal with things that could not have been anticipated at the time that the legislation or a regulation might have been put in place.

Personally, I believe that the protections which are already contained in C-14 are sufficiently robust to protect against abuse. However, I do understand that many feel they are not robust enough and need to be enhanced. I respect those views. I don’t necessarily agree with them, but we have all been inundated with concerns that people have expressed — some legitimate, some not so legitimate, but all I think honestly and firmly held and respected. So I think we have a responsibility to understand their concern and to respect the reasons behind it.

For that reason, I do support Senator Carignan’s amendment. I think it is an appropriate addition to the suite of protections contained in the bill at the moment, and I endorse what Senator Lankin said a few moments ago about her own experience and the concerns that she has about this.

But I want to caution, as other senators have, that while we want to make sure we have safeguards in place, we all know that safeguards, in certain instances, can become roadblocks. If we put in place something that we believe is a safeguard, with the intention of making it a safeguard, and it becomes a roadblock to access, then that may raise an issue under the Charter.

Senator Lang and others have raised the issue — and I know in my own province of Nova Scotia — how difficult it is to get access to physicians, specialists and, perhaps particularly, psychiatrists if you are in remote areas.

But I have confidence. I have talked to colleagues in the medical profession and medical regulatory agencies in my own province, and I’m confident that the medical profession, the medical regulatory agencies and the provincial authorities are up to this challenge, and will respond to this. While some of us might see that it is not necessary, or don’t feel that it is necessary, I’m persuaded that, on balance, it will meet the firmly and deeply held concerns of so many Canadians about protection of the vulnerable. For that reason, I am pleased to support the amendment.

One final cautionary note: There are always concerns about cost. Anytime courts are mentioned — lawyers, judges and availability — cost is always a big factor. That is something that needs to be borne in mind. As the federal government proceeds to negotiate and consult with the provincial governments and regulatory authorities, this is a factor. The accessibility and cost of accessibility of this type of service need to be considered.

With those few remarks, colleagues, I’m pleased to endorse my friend’s amendment.


Hon. Joseph A. Day:

Honourable senators, I’ll speak briefly on this particular amendment, and I do intend to speak generally about the bill at the conclusion of our debate.

Generally, with respect to this amendment, I have concerns. I don’t agree with my honourable colleague, Senator Andreychuk. I know a lot of people who are quite intimated by the very mention of having to do something with respect to a judge; and to add a psychiatrist to that mix would be hugely intimidating for a very large segment of the society that I know well. I’m speaking as a lawyer who has represented many people in applications in court situations, and this would be a barrier. I’m wondering if it’s really necessary.

I look at the safeguards, and what I have been trying to do is read this amendment against the bill and the changes that we, and I, agreed to yesterday and voted for. I felt they were reasonable amendments. But then this particular amendment is a bit of an adjustment to what was agreed to yesterday, trying to add more safeguards for a particular group we felt should be added that were excluded by the bill, and that’s those who are not at the end of life or terminally ill but still fit the other criteria.

There is a requirement for a medical practitioner or nurse practitioner to help sign the form being signed by the individual. There is a requirement for an independent medical practitioner or nurse practitioner; there is a requirement for two independent witnesses to witness the application. So we’ve got four independent people that are going to be involved in terms of being assured that what is taking place is reasonable. Now we have an amendment that comes along and adds a judge, a psychiatrist and two independent medical practitioners. There are five added on, honourable senators. Is this more than we need in order to be assured of the protection of this class of society and these individuals?

I believe that it’s more than we need, in particular because of the involvement of judges and psychiatrists, and knowing the situation in a lot of rural Canada, where nurse practitioners are like doctors. They deliver babies; they help people to die with dignity; they remove teeth for people. They do everything in the community relating to medical health, and that is why nurse practitioners are added in Bill C-14. You’ll see that everywhere: It is a medical practitioner or a nurse practitioner. I agree with that.

But then I look at the amendment, and I ask you to follow me on this: 1.2(b), about halfway down the page, “two independent medical practitioners.” So the nurse practitioners were left off with respect to this amendment; and if they are left off, they are obviously left off for a specific reason. There is an indication there is a lack of trust in the qualifications of nurse practitioners in relation to this second safeguard that we wish to incorporate for those who are not at the end of life.

I regret that that decision was made. I note as well that in 1.2(b) (ii) and (iii) there is a suggestion that the judge must provide — and then there’s a list that the judge is satisfied that, and in (iii) the independent medical practitioner confirms that the person was informed that palliative care could relieve their suffering.

Palliative care could relieve their suffering, and these people are not at the end of their life. Palliative care is an area we need to do a lot of work on. But I can tell you that palliative care, in virtually all instances where it is available in my province of New Brunswick, is for people who are in end-of-life situations. Now we’re putting in here palliative care for non-end-of-life situations and saying, “Gee, if you qualified for that, you might be able to be relieved from your suffering.”

I’m wondering about that particular clause as well.

Someone else mentioned earlier the risks associated with medical assistance in dying. That is another one of those items that the person must have been informed about. What are the risks associated with medical assistance in dying that are contemplated by this?

I am ill at ease to start with by putting judges into the process, as opposed to leaving judges for a review in the event that there is some perception of a problem. Judicial intervention as part of the process is something that I would prefer not to see. For that reason, along with the other points I have made about clauses in here that leave me ill at ease in terms of understanding and recognizing and believing that they are needed, I will not be able to support this particular proposed amendment.


Hon. Joan Fraser:

I am going to support this amendment. I can’t say I like it, but that has nothing to do with its purpose. It has to do with the tools available to us to provide safeguards for the class of people to whom, last night, we extended the services offered by this bill.

There is not a whole lot of international experience with medically assisted dying at all. There is even less experience from which we can learn in the case of people who seek medical assistance in dying even though they would otherwise not be at the end-of-life stage.

I don’t think any of us needs to think very hard to realize that in making what I profoundly believe was the right decision last night to accept the Supreme Court’s extension of that assistance to persons who are not relatively imminently otherwise doomed to die, in doing so we did raise, I suspect in many of our minds, concerns about safeguards.

Senator Carignan talked about some of the pressures of many kinds that can be exerted on people. We all, I’m sure, believe strongly that people have the right to die with dignity, but they also have the right to have their interests safeguarded as they face that choice.

Judicial oversight, judicial authorization, is essentially the strongest tool we have to try to ensure that their interests will be safeguarded, and that is why I support the amendment. It is designed to use the strongest tool we have, short of an outright ban, which would not protect their interests, to protect their interests. But it is, at the same time, a comparatively burdensome tool.

Senator Andreychuk, a long-time colleague for whom I have infinite respect, is shaking her head. Those of us who are not lawyers do see the judicial system as complex, arcane, burdensome, mysterious, unknown, not to mention costly. We may be right or we may be wrong, but that is our perception.

My concern there, in particular, is not for people like members of the Senate of Canada who have good links and networks that they can turn to for advice on how to get inside this arcane world of the judicial system, it’s for people who are not poor enough to qualify for legal aid and not really rich enough to face, without considerable trepidation, the prospect of hiring a lawyer.

I believe very strongly that as we go forward here, it will be very important for medical and legal authorities to provide the kind of guidance that Senator Lankin was talking about earlier with the medical system, registries, single points of contact where you can go to be guided to someone who says, “Here is a lawyer who understands the system and who can work with you.”

Senator Carignan, in his speech earlier today, went some of the way to persuade me that in implementing this system, we need not face the really terrifying legal costs that would exist in a trial situation. That’s comforting, and it’s comforting to be reminded that applications of this nature can go to the top of the judge’s list and not have to wait endlessly for resolution, because that would be a terrible thing. Still, I look for the day when experience will have helped us to find a system that need not involve the judicial system.

Senator Andreychuk expressed understandable caution about the medical system. One way or another, we are going to be dealing with systems here. This amendment will, as we move forward now, justifiably layer one system on top of another system. If we could resolve that back down to a single system, I would be more comforted that the interests of the applicants were really being served.

Let me also address the matter of psychiatrists. As I read this amendment, the work required of the independent psychiatrist referred to in 1.2(c) is not that complicated. It consists, as I read the text, solely of saying this person is competent to give informed consent.

Senator Mercer, I’m not a psychiatrist, but in my view, it would not necessarily have to take very long because it doesn’t need a diagnosis about many emotional conditions. It simply requires an assessment as to whether this person, whatever their other difficulties may be, can make an informed decision. That, I suspect, is a comparatively simple matter. However, as has been pointed out, psychiatrists are not easy to get, and they are also not inexpensive.

Without venturing into the undesirable terrain of provincial jurisdiction where we have, of course, no authority whatsoever, I would like to make a small suggestion that it would be very helpful if provinces, as part of their exercise of jurisdiction over health care matters, put psychiatrists on retainer; maybe one psychiatrist for small provinces, maybe a few psychiatrists in different regions for big provinces. That would mean that the psychiatrist would be available when needed, that the applicant would not have to go, find a psychiatrist and then wait for who knows how long to get an appointment.

Lawyers can be been on retainer. When the client calls, they have to answer. The same could be true for psychiatrists. Of course, I’m assuming that the service would be covered by medicare.

I wish we didn’t have to do this, but I believe we do. I do believe that Senator Carignan has responded to a significant degree of uncertainty as we go forward. As I said, I hope that over time and over not too many years, we will find a different way to meet the needs of these safeguards, but now, I do believe, for practice and also for the purpose of reassuring the public, this is an appropriate way to go, and I shall support the amendment.


Hon. Serge Joyal:

Honourable senators, I want to come back to the question of judicial authorization, the definition of what judicial authorization means. I won’t speak for the lawyers — my colleagues Senator Andreychuk, Senator Carignan, Senator Cowan, Senator Baker — or others in the room, but I think it is important to understand what we are requesting as a safeguard. In other words, what is the scope of judicial authorization? What does it mean for a layperson?

The second issue I would approach on debate is the cost, because like any of you, when you push the button for lawyers, you see the wheel machine begin to turn. You make a call and it costs $500. You call for 10 seconds, it’s another $500, and we know the problems. The Chief Justice of the Supreme Court has embarked on a crusade against the expensive cost of justice, and it will have an immediate effect. So how much will it cost? Who will pay for it?

The third element is how will it work in practice? I have listened to you individually and realize that each of you is wrestling with this. As our colleague Senator Mercer said, psychiatrists are not in Flin Flon, Manitoba, or they are not available in Caraquet, and we can identify thousands of small cities across Canada where there is no psychiatrist on Main Street. How will this be managed?

Back to the first question: What does judicial authorization mean? Judicial authorization, honourable senators, was defined by the Supreme Court in relation to Carter. I want to give the definition from two decisions in the last four months that have looked into those 29 cases where citizens went to court to receive the authorization and what the court decided judicial authorization means. I am quoting the Court of Appeal of Alberta, the unanimous decision, at paragraph 71. Here is what the Court of Appeal of Alberta said about what is implied with the judicial authorization.

Ultimately, however, the Supreme Court of Canada did not intend this to be an adversarial process.

It’s not an adversarial process. That’s important.

It is the role of the motions judge to carefully review the evidence before her and determine, on a balance of probabilities, whether the criteria in Carter 2015 have been met.

What does it mean? There is a decision in the Court of Queen’s Bench of Alberta dated June 1, the last decision I have been able to review. I reviewed all of them to be sure there is consistency between how the various courts have interpreted their role. Last week in Alberta, the decision dated June 1, here is what the learned justice stated at paragraph 31:

This Court is not called upon to conduct a full blown inquiry as to whether a claimant has established an individual case for personal constitutional exemption . . . .

Rather, the job of the motions judge is simply to determine whether a particular claimant meets the criteria articulated in Carter 2015. The question that the Supreme Court has directed the superior courts to answer is whether the applicant falls within that group. Therefore the inquiry is individual and fact specific, though, as indicated in the HS (Re) decision, the motions judge must be mindful of the legal framework and overall constitutional context of the inquiry.

So what does it mean? It means, as Senator Andreychuk mentioned, that the judge who has to give his authorization doesn’t sit in the court with his robe, with the parties for and against, or the Crown attorney and the accused and they fight in front of him and at the end of it he decides, “You’re right, you’re wrong; or you owe to this gentlemen that amount of money or that lady these damages.” That’s not at all the process. It’s essentially an administrative process. The judge has to be satisfied that the written information that she — Senator Andreychuk, because she was former justice — or he has in front of him according to his role.

Honourable senators, there have been many instances whereby justices are called upon in what we call le juge en chambre, that is the justice in his office, to give approval to a request that according to the law he is charged to give. This is a procedure that is part of the function of a judge. A judge sits in the court and a judge also sits in his office, and his decisions are as binding in his office as in the court. Remove from your mind the fact that we must see the judge in court. That is not at all what we mean here.

I have quoted two decisions to you. The most recent one is pretty clear about this. To illustrate my point, I have a decision here from the Ontario Superior Court of Justice of May 24. It’s about two and a half pages long. So it’s not like the judgment relating to Senator Duffy, 301 pages that the judge wrote. We’re not at all in that kind of context. I apologize to you, Senator Duffy. I just wanted to rely on your experience to testify how costly and delayed the justice system can be. We are all mindful of that.

That’s not at all what it is. It’s a short procedure. I’m reading from the judgment, the first sentence a couple of paragraphs down in this decision. I.J. is the name of the party, due to privacy.

I.J. has, on multiple occasions since March 2016, expressed a strong desire for physician-assisted death.

Paragraph 8 reads as follows:

I.J.’s family physician attests to the fact that I.J.’s pain and suffering has increased significantly over time. . . .

Paragraph 9:

Psychiatrist #1 attests that I.J. has tried many treatments to alleviate his pain but that none have been effective. . . .

Paragraph 10:

Psychiatrist #2 states that it is her opinion that I.J. has grievous irremediable medical conditions . . . .

It’s not complex piles of documents. It’s factual. It’s based on the information that has been given to the judge. So it’s not at all the case where a person is in a bed in hospital, with tubes and all kinds of connections so that you have to bring the bed in front of the judge in the court to say: “Well, are you consenting?” I mean, we have seen the movie. That’s not at all the process. Let’s be clear about that.

The second point I want to touch on is who pays. Well, honourable senators, unless you have forgotten, we have a health care system that is free in Canada. We’re talking here about medical assistance in dying. The word “medical” refers to health care, and health care is free. Each province has determined the list of services that are paid for by the health insurance plan. There are some that are not accepted. If you go for plastic surgery, the health care system won’t reimburse you or the doctors. For a certain kind of dentistry work, they won’t pay, either. Each province has determined the health care acts that are taken charge of by the public purse. That’s part of the health care system. We are talking here about a health care procedure. In other words, it’s a right that, according to the Supreme Court, a group of citizens have the benefit of enjoying at their own decision. It is like Bill 52, the end-of-life care act of Quebec. This is totally assumed by the Quebec government. It’s not something where you say: “Oh, my God, I’ve decided that I’m going to request medical assistance in dying, and who is going to pay for the drugs? Who is going to pay for the doctors who will come to examine me? Who will pay for the nurse practitioner? Who is going to pay for the paperwork for all this?” This is totally assumed by the health care system of the province in question.

We are now legislating the right of a person to access medical assistance in dying, totally within the provincial framework. So how will it be managed? It will be managed essentially, honourable senators, the way that the bill in Quebec provides. I refer you to section 2 of Bill 52 entitled, “Fonctions particulières des agences de la santé et des services sociaux”— in other words, the responsibility of the provincial health agencies and social services. It establishes here what they have to do with the hospital, the palliative care centre and the social services, whereby a person requests the service. The request is sent to the agencies, and it is the agencies that have the responsibility after that to treat the request on the basis of what the person has identified as being the condition that meets the requirement.

It is certainly the provinces who will decide — if we agree that the psychiatrist has to be involved — to which services it will be directed. That’s part of their responsibility. So we are not talking here of, as I understand the concerns of Senator Mercer, Senator Wallace, Senator Dyck and some other senators who have asked where the services are available. Those agencies exist because we live under the benefit of the public health care system.

That is centralized, with the responsibility of provincial agencies to get in the judicial district where that agency functions, where the patient is located, to be sent to the justice because it will be an administrative aspect of judicial authorization, just as in some procedures you seek to get the authorization of a justice in his office for all kinds of legal initiatives.

I humbly say to you get the lawyer out of this and make sure that the agencies have the proper administrative support to deal with this. I won’t be liked by my fellow lawyers in Quebec, who will say that you have removed us from something we could seek to be paid for. This is essentially a health care service. That’s why it is under the responsibility of provincial colleges of physicians and surgeons.

It will be up to the provinces to come forward with the kind of regime within their structure of delivery of services to include that need of a judicial authorization in the context that was provided by the Supreme Court, when it said that judicial authorization, as Senator Carignan stated, will be requested to be sure to protect the vulnerable.

I think we should not try to micromanage this at this stage. It is up to the health care ministers to come forward within their structure to make sure that the various steps included here are made accessible to their fellow citizens in their province to be sure that the system is functional. It will be functional the way it is described in Bill C-14. We should not fool ourselves. If Bill C-14 will remain as it is, they will have to do exactly the same — but not the judicial authorization.

That’s why I think this proposal, as Senator Andreychuk has mentioned, is workable. At this stage of our understanding of the implication, I think it’s worthwhile to have additional safeguards. If we would have been on the sailing cruise of multiple years of practice, maybe we would want to readjust on the basis of the conclusion of the experience.

May I have two more minutes, please, Your Honour?

The Hon. the Speaker pro tempore: Is that agreeable, honourable senators?

Hon. Senators: Agreed.

Senator Joyal: Maybe being from the province of Quebec and having read Bill 52 that they adopted in May 2014, I’m more familiar with how it’s being delivered. I think it is possible to deliver this in a responsible way and with the minimum efficiency to be sure that patients will have access to it within the context of Carter, and with the safeguards that are needed to be sure that people feel protected.

I mean, politicians are not trusted by people. I won’t quote statistics, as our friend Senator Bellemare likes to do, but the justices are the ones on top and then the doctors. People trust doctors, and people trust justices. If you say to Canadians, “You will have to trust your doctors on the evaluation of your competency and your health conditions, and you will trust a justice that will review this,” I think people will have confidence in the system. This is part of what we are trying to establish here, which, no doubt, is a change in the system. But I think what Senator Carignan proposes is helpful to give Canadians the conviction that what we are doing is responsible.

So, honourable senators, that’s how I understand the implications of what our colleague Senator Carignan is proposing, and why I think I should support it.

The Hon. the Speaker pro tempore: Senator Baker.

Hon. George Baker: Would the honourable senator take a question?

Senator Joyal: Yes.

Senator Baker: Could the honourable senator verify that the judicial authorizations that were sought by the provinces with the decision of the Supreme Court of Canada were mostly involved? When you looked at the original decisions, you had 20 pages. As you went on, it got smaller and smaller. Most of the print that you would read would be about the coroner’s conflict in the province and about sealing orders and non-disclosure of people’s names. The actual decision was very short, just a couple of short paragraphs based on affidavit evidence or letters. In the Quebec legislation it is based on forms, whereas in the other provinces where they didn’t have a system, it was short affidavit evidence — as you say, just to fit within and there were no adjudications other than that required.

The Hon. the Speaker pro tempore: Was there a question in that? I didn’t really understand the question.

Senator Baker: Yes. He has to answer the question, Your Honour.

Senator Joyal: I have the bunch of them here. I have reviewed them. It’s quite true what you say, Senator Baker. The first ones were very lengthy because the judges were in unchartered territory but you know very well what happens. When the law provides a function that will be attributed to a judge, what happens? The chief justice of that court decides to locate one judge; that is the administrative function of the court. It is to that judge that all the information is sent. He looks at it and develops the competence, experience and the basis of capacity to look into it quickly. That’s why I say don’t try to micromanage the system. This is how it works.

You are totally right. If you don’t know what to read before you go bed tonight, read those decisions and you will realize how efficient the court is in this situation.

Senator Mercer: Perhaps another question for Senator Joyal.

The Hon. the Speaker pro tempore: We are running out of time.

Senator Mercer: The issue is really the burden that you’re putting on the provincial health system. For example, in Nova Scotia, 75.5 per cent of all the psychiatrists are located in Halifax.

The Hon. the Speaker pro tempore: Honourable senators, is it agreed to give Senator Joyal a few more moments? Senator Ogilvie wants to ask questions as well.

Hon. Senators: Agreed.

Senator Mercer: Seventy-five per cent of the psychiatrists in Nova Scotia are in Halifax which means even if there is a psychiatrist in one town, he or she is probably burdened with a number of patients and will have to tell them, “Excuse me, but I’ve got to go out and see a patient and approve a patient’s application for assisted dying.” Meanwhile, he has patients that are in desperate need to help them get better and recover from whatever malady they suffer from. Then you talked about forms. I don’t know any really good doctor who will sign a form without doing one thing first: examine the patient. If you are a lawyer and I come in and ask you to sign a form, you will not sign that form without reading it and finding out the details of why I need the form signed, et cetera — and also if I can pay the bill.

The issue here really is you’re putting extra burden on the provincial health care system and this system does not give access or service people in rural Canada. That’s certainly not the case in rural Nova Scotia.

Senator Joyal: The case in the Alberta Court of Appeal raised the issue of a psychiatrist that was involved in the case to evaluate the psychiatric condition of the person. The psychiatrist came after two doctors. He was the third “evaluator” of the person. The psychiatrist developed a procedure among doctors to exchange information. They know those things. They know which questions to ask. If some doctors try to diagnose you of a certain disease, of course they will want to see you. But here we aren’t in the process of checking, checking, checking; it’s check, check and check and then the approval. I’m trying to simplify it.

The system has the capacity to do that. If we approve this proposal, I think the Ministers of Health have the capacity, as they did in Quebec, to determine that in the smallest village of Quebec of Saint-Léon-de-Maskinongé — as I said where there are 300 people in the Main Street — if there is a person who lives there and needs the service, the capacity of the system the way that Quebec’s Bill 52 has been established will be functional. I don’t doubt that there is a capacity in the system to respond.


Hon. Mobina S. B. Jaffer:

Thank you very much. I want to thank Senator Carignan for the great work you have done on this bill and on all the work you do here. It has been amazing working with you in all the work you do here, but especially on this bill.

Honourable senators, I stand with great difficulty today in front of you. I don’t want to speak. If my mother were alive, she would say, “Well, don’t speak, then.” My dad would say, “But if you believe in it, speak.” So I’m going to speak. I’m listening to my dad.

God bless you, dad.

Honourable senators, the process we are talking about is a court process. We are saying, “Go to a judge.” If you go to a judge, there will be lawyers involved. We are not talking about health tribunals. We are talking about going in front of a judge.

If we were talking about health tribunals, I would be in a different place than I am now. I want to say to you that everything that happened yesterday, when I read it today, I am absolutely troubled. I said to people who care about me in this institution, “After I’ve spoken, don’t you dare leave me; you still have to be my friends.”

Let me tell you what the B.C. Civil Liberties Association is saying will happen if we bring this amendment. Court applications will cost the critically ill $20,000 to $50,000. Canadians with rare diseases, those in rural and remote areas, will face the greatest cost barriers to access. Added cost barriers disproportionately impact seniors, women and racialized minorities who are more likely to be poor. Legal aid will not be available for low-income Canadians who are critically ill, and judicial pre-authorization could be a constitutional barrier to access.

I have their whole paper here. If anybody wants to read it, they are welcome. I will not read through it because I want to speak on this.

Honourable senators, I’m not the chief justice of my province, but as a lawyer who practises there a lot, this will be a chamber application. A judge will not go to a hospital. What will he do when he goes to the hospital? Look at the patient? He is not a doctor. He is not an expert. This will be a case that will probably go to the chambers. No, people will not be dressed as lawyers. They will not wear their black gowns, but they will still go to court.

If it was going to a health tribunal, I would not be speaking to you in this manner. I am finding it distasteful to speak because I don’t want — I’m finding it difficult, let’s put it that way.

Honourable senators, I am the first one who wants safeguards. I know they are needed, so I’m not against them. I also want this bill, so I’m not against this bill. But I want the bill for the immigrant woman, who is sleeping in a hospital, who has no access to funds and cannot get legal aid in my province. You can’t get legal aid in my province if you have a child that’s being abused. You can’t get legal aid in my province in custody cases. Do you think that an immigrant woman sitting in the hospital is going to be looked at by legal aid? Forget it. It’s not going to happen. Not in my province. I can’t talk about anybody else. Legal aid is not available. All the legal aid is being used for criminal cases. You can ask anybody. There is no legal aid. Legal aid will not come into this.

Let me tell you, if I can do this calmly. I agree, it will not be an adversarial process, but you still have to put evidence in front of the judge. You still have to convince the judge as to the person’s health.

So let’s look at it. What kind of evidence will the judge have? Let’s go through these amendments. Two medical doctors. I would respectfully suggest that we amend it and add “nurse practitioner” because the bill covers nurse practitioners as well. Two medical practitioners.

Senators, I practise in my province. To get even a one-page letter from a doctor costs between $500 and $1,000. This is not a one-page letter. This is setting out the medical health history of a person. A doctor would be making a very serious decision on somebody’s life; they are going to be very careful as to how they draft it. We are telling them to include the medical condition, the prognosis, whether palliative care is available. I could write a book about palliative care from what I have gone through with my father. In a place that is very well-to-do, West Vancouver in British Columbia, palliative care does not exist. So the doctor, judge or lawyer will have to inquire as to what palliative care exists in the area.

Then there are all the risks associated with assisted dying. That’s another thing a doctor has to put on the paper. That’s more work.

I don’t know about you, but in my province it’s very difficult to get a psychiatrist. And the minimum you would have to pay a psychiatrist is $10,000. I’m not kidding you. I deal with this all the time, if I can find a psychiatrist.

We have heard a lot about the Alberta case — two doctors. The case is from Red Deer. There was one doctor from Red Deer. They couldn’t find another doctor in all of Alberta. They went to Vancouver. The second doctor talked to and examined this person via Skype. He was from Vancouver; he never saw this patient. This is the Alberta case that we are all very proud of. So there are not two doctors in some areas.

Senators, I ask you to look at this amendment very carefully. I want to support this amendment, but my conscience tells me that given everything we worked on, we are creating terrible barriers.

Senators, we can only do so much and have only so many resources in such a short time. I humbly ask you to look at this very carefully, because for an immigrant woman who desperately needs a doctor to look after and who has no resources, this bill is not going to help her. I don’t even think it’s funny to say bring in more immigrants if we have more and more assisted dying, because this will affect everybody.

Honourable senators, this is probably the toughest thing I have ever done in my life, besides fleeing from the army. I’m going against everything I have worked for in the last few days. But I have to be true to myself. If we pass this amendment, everything we worked for is gone.

Thank you.


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