An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying)

This bill was last introduced in the 42nd Parliament, 1st Session, which ended in September 2019.

Sponsor

Status

This bill has received Royal Assent and is now law.

Summary

This is from the published bill. The Library of Parliament often publishes better independent summaries.

This enactment amends the Criminal Code to, among other things,
(a) create exemptions from the offences of culpable homicide, of aiding suicide and of administering a noxious thing, in order to permit medical practitioners and nurse practitioners to provide medical assistance in dying and to permit pharmacists and other persons to assist in the process;
(b) specify the eligibility criteria and the safeguards that must be respected before medical assistance in dying may be provided to a person;
(c) require that medical practitioners and nurse practitioners who receive requests for, and pharmacists who dispense substances in connection with the provision of, medical assist­ance in dying provide information for the purpose of permitting the monitoring of medical assistance in dying, and authorize the Minister of Health to make regulations respecting that information; and
(d) create new offences for failing to comply with the safeguards, for forging or destroying documents related to medical assistance in dying, for failing to provide the required information and for contravening the regulations.
This enactment also makes related amendments to other Acts to ensure that recourse to medical assistance in dying does not result in the loss of a pension under the Pension Act or benefits under the Canadian Forces Members and Veterans Re-establishment and Compensation Act. It amends the Corrections and Conditional Release Act to ensure that no investigation need be conducted under section 19 of that Act in the case of an inmate who receives medical assistance in dying.
This enactment provides for one or more independent reviews relating to requests by mature minors for medical assistance in dying, to advance requests and to requests where mental illness is the sole underlying medical condition.
Lastly, this enactment provides for a parliamentary review of its provisions and of the state of palliative care in Canada to commence at the start of the fifth year following the day on which it receives royal assent.

Elsewhere

All sorts of information on this bill is available at LEGISinfo, an excellent resource from the Library of Parliament. You can also read the full text of the bill.

Votes

June 16, 2016 Passed That a Message be sent to the Senate to acquaint their Honours that this House: agrees with the amendments numbered 1, 2(d), 2(e), 4, and 5 made by the Senate to Bill C-14, An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying); proposes that amendment 2(c)(i) be amended by replacing the text of the amendment with the following text “sistance in dying after having been informed of the means that are available to relieve their suffering, including palliative care.”; proposes that amendment 3 be amended in paragraph (b) by adding after the words “make regulations” the words “that he or she considers necessary”; respectfully disagrees with amendment 2(a) because requiring that a person who assists to be free from any material benefit arising from the patient's death would eliminate from participation the family members or friends most likely to be present at the patient's express wish, and this would violate patient autonomy in a fundamental and inacceptable manner; and respectfully disagrees with amendments 2(b), 2(c)(ii), and 2(c)(iii) because they would undermine objectives in Bill C-14 to recognize the significant and continuing public health issue of suicide, to guard against death being seen as a solution to all forms of suffering, and to counter negative perceptions about the quality of life of persons who are elderly, ill or disabled, and because the House is of the view that C-14 strikes the right balance for Canadians between protection of vulnerable individuals and choice for those whose medical circumstances cause enduring and intolerable suffering as they approach death.
June 16, 2016 Failed That the motion be amended by: ( a) deleting the paragraph commencing with the words “respectfully disagrees with amendments numbered 2(b), 2(c)(ii), and 2(c)(iii)”; and ( b) replacing the words “agrees with amendments numbered 1, 2(d), 2(e), 4, and 5” with the words “agrees with amendments numbered 1, 2(b), 2(c)(ii), 2(c)(iii), 2(d), 2(e), 4, and 5”.
May 31, 2016 Passed That the Bill be now read a third time and do pass.
May 31, 2016 Failed That the motion be amended by deleting all the words after the word “That” and substituting the following: “Bill C-14, An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying), be not now read a third time but be referred back to the Standing Committee on Justice and Human Rights for the purpose of reconsidering Clause 3 with a view to ensuring that the eligibility criteria contained therein are consistent with the constitutional parameters set out by the Supreme Court in its Carter v. Canada decision.”.
May 30, 2016 Passed That Bill C-14, An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying), {as amended}, be concurred in at report stage [with a further amendment/with further amendments] .
May 30, 2016 Failed “Health, no later than 45 days after the day”
May 30, 2016 Failed “(7.1) It is recognized that the medical practitioner, nurse practitioner, pharmacist or other health care institution care provider, or any such institution, is free to refuse to provide direct or indirect medical assistance in dying. (7.2) No medical practitioner, nurse practitioner, pharmacist or other healthcare institution care provider, or any such institution, shall be deprived of any benefit, or be subject to any obligation or sanction, under any law of the Parliament of Canada solely by reason of their exercise, in respect of medical assistance in dying, of the freedom of conscience and religion guaranteed under the Canadian Charter of Rights and Freedoms or the expression of their beliefs in respect of medical assistance in dying based on that guaranteed freedom.”
May 30, 2016 Failed “(3.1) The medical practitioner or nurse practitioner shall not provide a person with assistance in dying if the criteria in subsection (1) and the safeguards in subsection (3) have not been reviewed and verified in advance (a) by a competent legal authority designated by the province for that purpose; or (b) if no designation is made under paragraph (a), by a legal authority designated by the Minister of Health in conjunction with the Minister of Justice for that purpose. (3.2) The designation referred to in paragraph (3.1)(b) ceases to have effect if the province notifies the Minister of Justice that a designation has been made under paragraph (3.1)(a).”
May 30, 2016 Failed “(3.1) As it relates to medical assistance in dying, no medical practitioner or nurse practitioner may administer a substance to a person if they and the medical practitioner or nurse practitioner referred to in paragraph (3)(e) concur that the person is capable of self-administering the substance.”
May 30, 2016 Failed “(d) their imminent natural death has become foreseeable, taking into account all of their medical circumstances.”
May 30, 2016 Failed
May 30, 2016 Failed “(f) they have, if they suffer from an underlying mental health condition, undergone a psychiatric examination performed by a certified psychiatrist to confirm their capacity to give informed consent to receive medical assistance in dying.”
May 30, 2016 Failed “(f) prior to making the request, they consulted a medical practitioner regarding palliative care options and were informed of the full range of options.”
May 30, 2016 Failed
May 18, 2016 Passed That, in relation to Bill C-14, An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying), not more than one further sitting day shall be allotted to the consideration at report stage of the Bill and one sitting day shall be allotted to the consideration at third reading stage of the said Bill; and That, 15 minutes before the expiry of the time provided for Government Orders on the day allotted to the consideration at report stage and on the day allotted to the consideration at third reading stage of the said Bill, any proceedings before the House shall be interrupted, if required for the purpose of this Order, and in turn every question necessary for the disposal of the stage of the Bill then under consideration shall be put forthwith and successively without further debate or amendment.
May 4, 2016 Passed That the Bill be now read a second time and referred to the Standing Committee on Justice and Human Rights.
May 4, 2016 Passed That the question be now put.
May 4, 2016 Passed That, in relation to Bill C-14, An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying), not more than one further sitting day shall be allotted to the consideration at second reading stage of the Bill; and That, 15 minutes before the expiry of the time provided for Government Orders on the day allotted to the consideration at second reading stage of the said Bill, any proceedings before the House shall be interrupted, if required for the purpose of this Order, and, in turn, every question necessary for the disposal of the said stage of the Bill shall be put forthwith and successively, without further debate or amendment.

Criminal CodeGovernment Orders

April 22nd, 2016 / 10:05 a.m.
See context

Vancouver Granville B.C.

Liberal

Jody Wilson-Raybould LiberalMinister of Justice and Attorney General of Canada

moved that Bill C-14, An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying), be read the second time and referred to a committee.

Madam Speaker, I am pleased to rise in the House to address Bill C-14, which would, for the first time in our country's history, create a federal legislative framework to permit medical assistance in dying across Canada.

Before I begin my remarks today, I want to acknowledge that medical assistance in dying is a challenging issue for all Canadians. It is difficult. Death and dying are not things that we are comfortable talking about in our society. We all have stories of our families and those people close to us, which touch us and challenge us in this regard. Nonetheless, since the release of last year's decision in the Supreme Court of Canada in the Carter case, this government has not shied away from having difficult conversations with Canadians.

Equally, I want to recognize that we did not wrestle with these issues alone. I commend the dedicated efforts of all the individuals and organizations that have made tremendous contributions to the public debate and dialogue around how we implement medical assistance in dying in Canada.

I do not have time to include in my remarks today all the names of the people who have been involved, but I would first like to recognize the members of the special joint committee who exemplified dedication and service to Canadians in delivering a comprehensive report under extremely difficult and tight time constraints. Their task was not easy, but they rose to the challenge.

I also want to acknowledge the work of the federal external panel and the provincial expert advisory group, as well as the thousands of individual Canadians, experts, and organizations that participated in these consultations.

I would like to stress how invaluable all of this input and evidence was in the development of the bill, as explained and referenced in the Department of Justice legislative background on Bill C-14, which I will be tabling later this morning and which will be available on the Justice Canada website at the time. The bill that is before the House today is the culmination of all of these efforts.

From the start, we have known from the Supreme Court of Canada's unanimous Carter decision, that it is not about whether or not to have medical assistance in dying; it is about how we will do it. We are keenly aware of the diverse perspectives on this issue, and each of them raises worthy considerations. We have also looked carefully at the evidence from other jurisdictions that permit medical assistance in dying.

With all of this in mind, and in appreciating the limited time frame we have had to respond to the Carter decision, our government has chosen an approach that respects both the charter and the needs and values of Canadians.

First, it would permit physicians and nurse practitioners to provide medical assistance in dying, so that patients who are suffering intolerably from a serious medical condition, and whose death is reasonably foreseeable given all of their medical circumstances, can have a peaceful death and not be forced to endure slow and painful suffering.

Second, it would commit to study the other situations in which a request for medical assistance in dying might be made; situations that were not in evidence before the court in the Carter litigation and were beyond the scope of its ruling.

This evidenced-based approach will allow us to respect the autonomy and the charter rights of Canadians while ensuring robust protections for vulnerable persons. It is the right approach for our country.

Our government, under the leadership of my colleague, the Minister of Health, will be bringing forward non-legislative approaches to support the bill, including an end-of-life care coordination system for linking patients to willing providers, and in the context of a new health accord, we will promote the improvements to palliative care across the country.

To ensure public safety, the bill would re-enact section 14 and subsection 241(b) of the Criminal Code, but provide exemptions to permit medical assistance in dying for eligible persons. The bill would limit eligibility to persons 18 years and over who are capable of making decisions with respect to their health.

The bill would require that the person be competent at the time that the medical assistance in dying is provided, which practically means that advance directives would not be permitted. Requests must be fully informed and free from coercion, to ensure they reflect the person's true wishes.

The bill would also require that the person have a grievous and irremediable condition, which is defined in the bill. The definition is intended to be applied flexibly by physicians and nurse practitioners who can use their training, ethics, and good judgment to apply the criteria.

To be clear, the bill does not require that people be dying from a fatal illness or disease or be terminally ill. Rather, it uses more flexible wording; namely, that “their natural death has become reasonably foreseeable, taking into account all of their medical circumstances”. This language was deliberately chosen to ensure that people who are on a trajectory toward death in a wide range of circumstances can choose a peaceful death instead of having to endure a long or painful one.

As the Supreme Court of Canada noted, Gloria Taylor was dying from a terminal illness and would be eligible. So too would Kay Carter, who was 89 and according to the court suffered from spinal stenosis, which itself does not cause death but can become life-threatening in conjunction with other circumstances such as age and frailty.

This approach to eligibility responds directly to the Supreme Court's ruling, as it noted in paragraph 127:

The scope of this declaration is intended to respond to the factual circumstances in this case. We make no pronouncement on other situations where physician-assisted dying may be sought.

In our view the people captured by the court's ruling would be eligible under the proposed legislation. Moreover, the legislation proposes a workable standard. The Canadian Medical Association, in supporting the legislation, has stated that the proposed eligibility criteria are one of several “critical elements to support a consistent, national approach”.

Bearing in mind that medical assistance in dying can pose real risks and equally that we do not wish to promote premature death as a solution to all medical suffering, these criteria may not allow eligibility for some circumstances, such as a person with a major physical disability who is otherwise in good health, or a person who solely suffers from mental illness. These conditions, in absence of additional medical circumstances, may not be associated with a reasonably foreseeable death.

Our approach in no way denies the suffering experienced by persons who would not be eligible. In partnership with the provinces and territories, we will do what we can to improve the quality of health services and other supports that are needed to enable such individuals to live a better quality of life.

We have listened to those who say that permitting medical assistance in dying as a response to suffering in life, as opposed to suffering in the dying process, will put already vulnerable individuals at greater risk. We recognize that medical assistance in dying will in many respects fundamentally change our medical culture and our society. It is appropriate in this context to focus our attention on facilitating personal autonomy in the dying process where the risks to the vulnerable are manageable.

The bill recognizes that procedural safeguards are necessary and appropriate in medical assistance in dying. The bill would adopt the recommendations of the special joint committee regarding the appropriate safeguards. For example, eligibility must be assessed by at least two medical practitioners or authorized nurse practitioners.

The bill would also set out a legal framework for a compulsory monitoring regime to ensure that we have Canadian data to assess how medical assistance in dying is working in practice.

This is an issue that will require close co-operation with the provinces and territories, and the monitoring requirements would only become binding after the Minister of Health brings forward regulations, which she will develop in consultation with those governments.

Finally, the bill would commit Parliament to review its provisions after five years.

In addition to the parliamentary review mechanism included in the bill, we will also undertake independent studies into three key issues that the Supreme Court of Canada declined to address in the Carter ruling: eligibility for persons under the age of 18; advance requests; and requests for medical assistance in dying solely on the basis of mental illness.

To be clear, the ruling in Carter was expressly limited to a competent adult person who clearly consents to the termination of life. Further, the Supreme Court stated that assistance in dying for minors or persons with psychiatric disorders would not fall within the parameters suggested in these reasons. Simply put, the court in Carter did not hear evidence related to these sorts of cases, nor did the Supreme Court find that there was a right to medical assistance in dying in any of these circumstances.

Regarding persons under 18, we are mindful of the evidence heard at the special joint committee that more specific study and evidence are needed, given the irrevocable nature of the procedure and the fact that minors are vulnerable by virtue of their age.

In terms of advance requests, where a person makes a request in advance for a form of treatment that they would want if they lose their ability to express their wishes, the risks of error and abuse increase when a person is unable to confirm previously stated wishes. In effect, a person loses the ability to withdraw their consent to die. They would no longer clearly consent, in the language of Carter.

We are also mindful of evidence that people often err in making predictions about how they will respond to future medical suffering. In the very few jurisdictions where advance requests are allowed, physicians generally will not perform medical assistance in dying under ethically difficult circumstances where the person is conscious but mentally incompetent to express their wishes. More study of this complex issue is needed.

With regard to mental illness as the sole basis for a request for medical assistance in dying, further study is also needed. This is the delicate balance that the bill would strike. Circumstances beyond the scope of the Carter decision will be studied. However, at this moment, we will act responsibly as we take our first steps as a country on this challenging issue.

A question that many have about the bill is whether it is consistent with the Carter ruling. There will always be a diversity of opinions about what is required to respond to a particular judgment, but it falls to Parliament not only to respect the court's decision, but also to listen to diverse voices and decide what the public interest demands. It is never as simple as simply cutting and pasting the words from a court's judgment into a new law.

The bill before the House today respects Carter and complies with the Charter of Rights. The court ruled that the previous law, which involved a complete prohibition, went too far in restricting the rights of Canadians like Ms. Carter and Ms. Taylor, whose natural deaths had become reasonably foreseeable, to choose medical assistance in dying.

As I have already mentioned, the court expressly stated that it did not pronounce on anything beyond the factual circumstances of the case before it. The court did not define the term “grievous and irremediable condition”. It left the task of definition, as well as the elaboration of public policy and safeguards, to Parliament.

The eligibility criteria in the bill are consistent not only with the legal principles of Carter but with the circumstances of the plaintiffs in the Carter case, including Gloria Taylor, who was suffering from fatal ALS, and Kay Carter, who was also in a state of irreversible decline and nearing the end of her life.

In finding that an absolute prohibition was unconstitutional, the court did not require Parliament to enact a specific medical assistance in dying regime. Rather, it directed us to address the deficiencies of the previous law. The court said:

...physician-assisted death involves complex issues of social policy and a number of competing societal values. Parliament faces a difficult task in addressing this issue; it must weigh and balance the perspective of those who might be at risk in a permissive regime against that of those who seek assistance in dying.

This is precisely what Bill C-14 does. It respects personal autonomy, protects the vulnerable, and affirms the inherent value in every human life.

The bill would create a consistent national floor in terms of eligibility and procedural safeguards under the federal criminal law power, which is there to ensure the safety of all Canadians.

The requirements we see in the bill would have to be respected across the country. However, provinces and professional regulatory bodies may also choose under their jurisdiction to add additional safeguards or requirements, such as how to respect the conscience rights of their medical professionals and health care institutions while ensuring access for patients. To this end, as I have already mentioned, my colleague, the Minister of Health, will be working with her counterparts to bring forward a coordinated system for linking patients to willing providers.

I want to say a few words about how the bill will give Canadians confidence that the risks associated with medical assistance in dying will be carefully addressed.

Ultimately, we want medical assistance in dying to reflect the true autonomous choice of Canadians who request it. However, we know how autonomy can be compromised in both overt and subtle ways. At points in our life, all of us are vulnerable. However, vulnerability is experienced disproportionately by those Canadians who are alone or lack social supports, who live in poverty, who face discrimination or a multitude of other reasons. Some people may feel that they are a burden to others or struggle to find joy and purpose in their life. The availability of medical assistance in dying must not inadvertently tempt persons who are experiencing these or other sorts of vulnerabilities to choose a premature death, nor should it suggest that dying is an appropriate response to a life with disability.

It makes sense to limit medical assistance in dying to situations where death is reasonably foreseeable, where our physicians, nurse practitioners, and others, can draw on their existing ethical and practical knowledge, training, and expertise in addressing these challenging circumstances.

Coupled with robust procedural safeguards, the bill would effectively respond to the risks and ensure that requests for medical assistance in dying are made freely, autonomously, and with the benefit of full information.

More fundamentally, our government wants medical assistance in dying to be there for Canadians, so they can have a choice of a peaceful death that accords with how they have lived their life, over a painful and prolonged one that does not.

Our government believes in the equality of all Canadians' lives and sees the inherent value in each of them.

Before eligibility for medical assistance in dying is extended beyond persons who are suffering intolerably and in a state of decline toward death, which is what the Carter decision was about, we need to be absolutely confident that we would not be putting vulnerable people at risk. We need to be confident that we are not undermining important policy goals and/or societal values, such as supporting Canadians with physical or mental disabilities to live out healthy lives and fully participate in our society.

I look forward to working with all members of these chambers on this incredibly difficult and complex issue, to ensure that before June 6, 2016, our country will have a law that respects autonomy and provides choice to Canadians, while also protecting those in our society who we too often lose sight of. Together, let us take this opportunity to build a consensus of which Canadians can be proud.

Finally, I am tabling a document, in both official languages, entitled “Legislative Background: Medical Assistance in Dying (Bill C-14)”.

Criminal CodeGovernment Orders

April 22nd, 2016 / 10:25 a.m.
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Conservative

Scott Reid Conservative Lanark—Frontenac—Kingston, ON

Madam Speaker, the minister tells us correctly that the court left the task of defining certain terms to Parliament. Therefore, it is regrettable that the key term “reasonably foreseeable death” in this legislation is not defined. This is problematic, because in her speech, in which she expresses the intent of the government on the subject, she is ambiguous as to what the meaning could be.

She said that it is not necessary to be “terminally ill”. Therefore, “reasonably foreseeable” does not mean that we have a projected end date to that person's life, unless she has some definition of terminally ill that is different from the one normally used. On the other hand, she said that we do not promote premature death. Again, these two are directly in contradiction, unless she has some definition for the term premature death that has not yet been shared with us.

Therefore, I will ask this question to the minister. Would she object to an amendment to this legislation in the committee process that would give a definition to the term “reasonably foreseeable”, so that it is not left up to other individuals who may apply different standards, and so that Canadians are not faced with what I think is an unreasonable amount of uncertainty as to what this bill will do once it is put into practice?

Criminal CodeGovernment Orders

April 22nd, 2016 / 10:25 a.m.
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Liberal

Jody Wilson-Raybould Liberal Vancouver Granville, BC

Madam Speaker, first let me say that I am looking forward to the substantive discussion that we have in this House around this particular issue. I am certainly looking forward to the discussion that will ensue in both Houses in terms of the committee work. I expect that the robust discussion will lead to many suggestions for potential improvements of the bill. I believe fundamentally in the democratic process, and look forward to the discussions at committee, at which I will be participating.

The question was specifically around reasonable foreseeability. In terms of the legislation, reasonable foreseeability and the elements of eligibility in terms of being able to seek medical assistance in dying, all must be read together. We purposefully provided flexibility to medical practitioners to use their expertise, to take into account all of the circumstances of a person's medical condition and what they deem most appropriate or define as reasonably foreseeable.

Criminal CodeGovernment Orders

April 22nd, 2016 / 10:25 a.m.
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NDP

Murray Rankin NDP Victoria, BC

Madam Speaker, I would like to begin by congratulating the minister on a very thoughtful presentation. I am grateful for that.

The minister, in her remarks, did refer to the need for a delicate balance and believes that she has that balance right in the bill before us. She then talked about the need for parliamentarians to listen to Canadians, but also, of course, to listen—fundamentally, I thought she said—to the court.

The question I have is with respect to the rule of law. Had we listened to other Canadians in the context of other delicate issues, such as abortion or same-sex marriage rights or the like, that might have undercut what the court said in those judgements. My question for the minister is this. If she is persuaded by evidence she hears that we do not have that delicate balance right: (a), would she agree to amendments, and, (b), would she agree to perhaps refer this to the Supreme Court of Canada in an official reference to ensure we have the delicate balance, to which she referred, right?

Criminal CodeGovernment Orders

April 22nd, 2016 / 10:30 a.m.
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Liberal

Jody Wilson-Raybould Liberal Vancouver Granville, BC

Madam Speaker, I am confident in the proposed legislation that we put forward in terms that it meets and answers the Supreme Court of Canada decision in Carter. As well, it is compliant with the Charter of Rights and Freedoms. The Supreme Court was very clear on two things: one, an absolute ban on medical assistance in dying is contrary to the charter; and, two, it is up to Parliament and provincial legislatures to design the complex regulatory regime around it.

With respect to the question on putting a reference to the Supreme Court of Canada, we as legislators have a responsibility to ensure that we are putting forward the right balance. It is our job to do that. It would certainly be premature to consider any reference to the Supreme Court of Canada in advance of Parliament having a law in place.

Criminal CodeGovernment Orders

April 22nd, 2016 / 10:30 a.m.
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Charlottetown P.E.I.

Liberal

Sean Casey LiberalParliamentary Secretary to the Minister of Justice and Attorney General of Canada

Madam Speaker, I would like to thank and congratulate the minister on her speech and on her incredible leadership on a question that is so important in our country at this time.

I have a couple of questions. In her speech, the minister talked about the fact that there were many influences on the decision that the government ultimately decided to take. I would invite her to perhaps talk about the influence of the special joint committee on Bill C-14, and also on the Quebec legislation on Bill C-14.

The other question I would ask the minister to address arises out of the question from the Conservative member opposite and his expressed concern over the lack of clarity in the words “reasonable foreseeability”.

Could the minister comment on how the terms have been recognized and interpreted by the courts, and the guidance that it should be able to provide us in understanding the purpose of the legislation?

Criminal CodeGovernment Orders

April 22nd, 2016 / 10:30 a.m.
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Liberal

Jody Wilson-Raybould Liberal Vancouver Granville, BC

Madam Speaker, in terms of influences, it is welcomed as well as supported. I thank the special joint committee for its substantive recommendations, all of which have propelled forward a national discussion on this really important issue.

I had the opportunity to work closely with and be in communication with the province of Quebec, hearing and learning from it regarding the years it invested to come up with its own medical aid and dying legislation, which was enacted last year.

On reasonable foreseeability, this is a commonly used term in many areas of the law, including criminal law. It is applied depending on the nature of the circumstances of a particular piece of legislation.

Criminal CodeGovernment Orders

April 22nd, 2016 / 10:30 a.m.
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Conservative

Karen Vecchio Conservative Elgin—Middlesex—London, ON

Madam Speaker, the minister's excellent speech gives Canadians a good idea of what this legislation is about, and I applaud her on that.

When I look at this legislation, I need to find a balance. I am taking this back to my constituents and we are talking about it. I have a specific question on this. I have a friend who has been suffering from ALS, so this might be too much of a timeline and I might not be able to actually get the answer. Would we be looking at foreseeable death as the time of diagnosis? He has been suffering for about 12 years. Are we saying that the day after he was diagnosed, he could then say that he believed this was best way for him to finish his life and proceed with assisted dying now, or would he have to wait until he became more ill?

Criminal CodeGovernment Orders

April 22nd, 2016 / 10:35 a.m.
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Liberal

Jody Wilson-Raybould Liberal Vancouver Granville, BC

Madam Speaker, I certainly support all members going back to their ridings and having this discussion with their constituents.

On reasonable foreseeability and diagnosis, as I said, we leave the determination, taking into account all of the elements, up to medical practitioners. The requirement of reasonable foreseeability must be in conjunction with an irreversible state of decline or a trajectory toward death. That would be determined on a case-by-case basis, recognizing the many views that we were provided on individual circumstances of patients being quite different.

Criminal CodeGovernment Orders

April 22nd, 2016 / 10:35 a.m.
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Conservative

Michael Cooper Conservative St. Albert—Edmonton, AB

Madam Speaker, I would like to thank the Minister of Justice and Attorney General of Canada for her thoughtful presentation this morning.

The issue of physician-assisted dying is one of the most important social issues that Canada has faced in some time. There is no question that physician-assisted dying will be one of the most important issues this Parliament must address.

I had the unique opportunity to give special attention to the issue of physician-assisted dying as a vice-chair of the Special Joint Committee on Physician-Assisted Dying. The special joint committee had a very short time period to deal with a highly sensitive and complex issue. While I, along with my Conservative MP colleagues on the committee, the hon. member for Louis-Saint-Laurent, the member for Langley—Aldergrove and the member for Kitchener—Conestoga, were not able to agree with all the recommendations in the main committee report, all members from all parties and in both Houses worked respectfully and in good faith to do what they believed was best for Canada and respectful of the law arising from the Carter decision.

I would particularly like to a acknowledge the hon. member for Don Valley West, who served ably as chair of the special joint committee.

The issue of physician-assisted dying raises many deep legal, moral and ethical questions. It is an issue that Canadians get very emotional about, and that is understandable. When we are talking about physician-assisted dying, we are talking about something that is probably the most important thing to any human being, living and dying, the right to live and the right to die.

It is not a new issue to Parliament. Indeed, over the last 25 or so years, this issue has come before Parliament 14 or 15 times. Each time Parliament was asked the question whether to legalize physician-assisted dying or not, Parliament chose not to. However, the issue of whether we should legalize physician-assisted dying or not is over, because the Supreme Court of Canada in Carter determined that physician-assisted dying was a charter right for certain Canadians.

While the Supreme Court recognized that physician-assisted dying was a charter right for certain Canadians, it is important to emphasize that the Supreme Court said that it was a charter right for certain Canadians. The Supreme Court did not say that physician-assisted dying was a charter right to anyone, any time, anywhere, under any circumstances in Canada. Rather, the court set out a clear set of parameters. More specifically, what the court determined was that competent adult persons who were suffering intolerably from a grievous and irremediable condition and who gave their clear consent, had a right under section 7 of the charter to physician-assisted dying.

In so deciding, the Supreme Court sought to strike a balance between respecting individual autonomy with the need to protect vulnerable persons. The Supreme Court was satisfied that balance could be achieved with what the court characterized at paragraph 105 of its decision as a system of carefully designed and monitored safeguards.

The test before Parliament is to find that balance in the way of a legislative response. As a starting point for a legislative response, it is important to look to the Carter decision. Does the legislation satisfy the parameters of Carter?

I am satisfied that the legislation does satisfy the general parameters of Carter in limiting physician-assisted dying to competent adult persons who are suffering from an incurable disease or illness, in an irreversible state of decline, and whose death is foreseeable.

That being said, I believe the legislation falls short in at least two regards at this present time. First, I am not satisfied that the legislation sufficiently protects vulnerable persons, persons particularly with underlying mental health challenges. Second, I am disappointed that the legislation does not contain provisions to protect the conscience rights of physicians and allied health professionals.

With respect to safeguards, it is true that the legislation limits physician-assisted dying to persons who are suffering from a physical illness, and make no mistake, that is a very important safeguard. That safeguard, by the way, is consistent with what the Supreme Court pronounced in holding that one had a right to physician-assisted dying in the context of an irremediable condition.

However, where the legislation falls short is that it does not take into account persons who have a physical illness on the one hand, but on the other hand, suffer from an underlying mental health challenge. Make no mistake about it; if people have underlying mental health challenges, are suffering from physical illnesses, and they meet all the criteria of Carter, they have a right to physician-assisted dying as does every other Canadian who meets that criteria. The issue is ensuring their capacity to consent.

In that regard, it is important to remember that the Supreme Court, as one of the key criterion in the parameters that it set out, said that individuals must give their clear consent. Now the evidence before the special joint committee is that physicians generally have the training and skill to diagnose someone with an underlying mental health challenge, to identify the underlying mental health challenge. However, to take the next step, to undertake the kind of complex analysis of determining capacity and consent, a significant amount of evidence said that any physician was not able to do it. Rather, someone with more specialized training such as a psychiatrist would be able to undertake that type of assessment.

I would respectfully submit that it would be an important improvement in the legislation to contain a safeguard to require a psychiatrist to undertake an evaluation of the patient who is determined to have an underlying mental health challenge to determine capacity to consent on a decision that is ultimately irreversible.

With respect to conscience protections, I am disappointed that there is no provision for conscience protections in the legislation. Rather, this has been passed on to the provinces, to colleges, and to professional regulating bodies. The Government of Canada has a duty to protect the conscience rights of physicians and allied health professionals.

The conscience rights of physicians are charter rights and those charter rights are as important as the charter rights of patients to access physician-assisted dying. The charter rights of physicians with respect to the protection of their conscience and right to conscientious objection is not only any charter right, it is a charter right under section 2 of the charter. Section 2 charter rights are considered to be fundamental freedoms.

It is important that the legislation sufficiently respect everyone's charter rights, the charter rights of patients and the charter rights of physicians.

Last, I want to emphasize the importance for the government to respond quickly in the area of palliative care. This is very critical. It is something that Parliament has talked about for a long time. There have been somewhere in the neighbourhood of four or five Senate committee reports. There was at least one report out of the House of Commons. I know that the hon. member for Kitchener—Conestoga chaired a committee that looked at the issue of palliative care.

Now that physician-assisted dying has become a reality, it is time to end the discussion. It is time to act when it comes to providing access to palliative care. It is widely recognized that palliative care is an essential part of end-of-life decision-making. One thing that I heard over and over again as a member of the special joint committee was that a person cannot truly consent to physician-assisted dying unless the person has all options available to them. One of those options is palliative care, but the fact is that only 15% to 30% of Canadians have access to palliative care. Let me say that the option of palliative care without access to palliative care is no option at all.

I want to acknowledge that the Minister of Health did announce $3 billion in funding for palliative care. This is a very important step in the right direction, but it is also noteworthy that there is no mention of palliative care in the budget. There is not one new cent for funding towards palliative care. It begs the question, where is this funding going to come from and when, and where is it going to go? It is absolutely important that the government take decisive action on palliative care.

With that, I would say that this legislation is a significant step in the right direction, having regard for some of the recommendations in the special joint committee main report that I believe went beyond the scope of Carter. I want to thank the government for listening, for considering the dissenting report that was authored by me, as well as my three Conservative MP colleagues on the committee.

However, it is imperfect legislation. There are some of what I would consider to be significant flaws. I am hopeful that the government will be amenable as the legislation moves forward to accepting amendments so that everyone's charter rights can be respected, the charter rights of patients, the charter rights of physicians and allied health professionals, and the charter rights of vulnerable persons.

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April 22nd, 2016 / 10:50 a.m.
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Liberal

Doug Eyolfson Liberal Charleswood—St. James—Assiniboia—Headingley, MB

Madam Speaker, the speech by the hon. member for St. Albert—Edmonton was impassioned and very principled.

Just from my perspective, the question was brought up as to whether or not medical practitioners should have the right to exercise their conscience in either performing or referring with respect to this. I have practised medicine for 20 years. I know the importance of keeping to one's conscience in the medical practice.

Another controversial issue in our society is abortion. There is no legislative protection for physicians that says they have the right to refuse to perform abortions or refuse to refer for them. However, no physician in Canada, to my knowledge, has ever been forced to perform against one's conscience.

I do not know that such legislation is therefore required for the same objection in this issue.

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April 22nd, 2016 / 10:50 a.m.
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Conservative

Michael Cooper Conservative St. Albert—Edmonton, AB

Madam Speaker, that is an important question.

I am concerned that there will be inconsistencies. There already seem to be some inconsistencies with some of the guidelines that have come out of the colleges.

I think there is a simple way to address this to ensure that physicians' charter rights are respected, and I think the federal government can play a role in that with a fairly simple amendment to the legislation.

I would note that there is a precedent for this type of legislation. It is section 3 of the Civil Marriage Act, which simply provides that no religious officials may be penalized if they decide not to partake in a civil marriage.

I think that something similar to section 3 of the Civil Marriage Act could be included in this legislation and would go a long way to ensuring that everyone's charter rights, including those of physicians, are protected.

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April 22nd, 2016 / 10:50 a.m.
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NDP

The Assistant Deputy Speaker NDP Carol Hughes

I would remind members that, as opposed to shouting out things, if they want to contribute, please stand to be recognized.

Questions and comments. The hon. member for Victoria.

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April 22nd, 2016 / 10:50 a.m.
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NDP

Murray Rankin NDP Victoria, BC

Madam Speaker, I would like to congratulate my colleague, the member for St. Albert—Edmonton, for his very useful contribution in the same spirit with which he contributed so much during the work of the Special Joint Committee on Physician-Assisted Dying, which I had the honour of being part of. I would like to echo his thanks to the member for Don Valley West and also Senator Ogilvie, who co-chaired that important committee. I just hope that during this debate we can sustain that same tone of respectful dialogue.

He indicated that he was satisfied that Bill C-14 is consistent with the Carter case. On that point, as I will elaborate I hope later today, I respectfully disagree but hope we can work together in the justice committee to get it right for all Canadians.

I was taken with his comments on conscience protection in the legislation, something which just came up as well in the comment from my colleague across the way.

In pointing out it is a charter right for those who have conscience reasons not to participate in medical aid in dying, I think he made an excellent reference to section 3.1 of the Civil Marriage Act which gives a recognition for that conscience protection in that legislation.

I am wondering whether or not it should be appropriate to leave this to the provinces. Some have said this is a matter, and I think the minister made that point as well, of provincial jurisdiction working with the colleges. On the other hand, the member points out that it involves the charter, and therefore, those individuals who wish to support those rights are going to have to work with 13 other jurisdictions.

I would like the member's comments on whether he thinks that is appropriate.

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April 22nd, 2016 / 10:50 a.m.
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Conservative

Michael Cooper Conservative St. Albert—Edmonton, AB

Madam Speaker, I want to thank my friend, the hon. member for Victoria, and also acknowledge the important contribution that he made to the special joint committee. His contribution was very valuable.

I would just reiterate the point that I previously made, that I do see a need for consistency, and that could be done in the way of a simple amendment to the legislation.

On the issue of jurisdiction, I would note that in the Carter decision, the Supreme Court expressly recognized that health care is an area of concurrent jurisdiction, so I believe there is ample room jurisdictionally for the government to act in this regard.