Bill C-384 (Historical)

An Act to amend the Criminal Code (right to die with dignity)

This enactment amends the Criminal Code to allow a medical practitioner, subject to certain conditions, to aid a person who is experiencing severe physical or mental pain without any prospect of relief or is suffering from a terminal illness to die with dignity once the person has expressed his or her free and informed consent to die.

Criminal Code

[Michael Savage, Liberal, Dartmouth—Cole Harbour, NS]

Mr. Speaker, I have the pleasure today to present a petition on behalf of a large number of people in my own constituency, many of them parishioners at Saint Vincent de Paul Parish, who are very concerned about and opposed to Bill C-384 for a number of reasons, one of which is that it does not define terminal illness.

The undersigned are very concerned that this bill, if passed, would endanger Canadians and that it would open the door to deadly abuse. They feel that there are better ways to deal with those who are ill, even terminally ill, and they urge this House to vote against Bill C-384.

I am pleased to present this petition on their behalf. I want to thank, in particular, Kitty Wiley for the work that she did in putting this together.

[Tim Uppal, Conservative, Edmonton—Sherwood Park, AB]

Madam Speaker, it is my privilege to present a petition signed by hundreds of my constituents opposing Bill C-384, an act to amend the Criminal Code.

I would also like to thank the Catholic Women's League of Sherwood Park for its hard work on this.

[Marlene Jennings, Liberal, Notre-Dame-de-Grâce—Lachine, QC]

Mr. Speaker, please remind me when I have two minutes left.

I would like to announce to my colleagues in the House of Commons that the Liberal critic will not be voting in favour of this private member's bill by the hon. member for La Pointe-de-l'Île. I would like to thank her for raising this important issue. I personally think it is such an important and complex matter that a private member's bill is not the right vehicle to engage the public debate that this issue deserves. I would like to read a letter that the Canadian Medical Association addressed to my colleague, the hon. member for La Pointe-de-l'Île. A copy of this letter was sent to all hon. members. It sums up my concerns about this issue. The letter reads,

Madame,

The Canadian Medical Association (CMA) has been very interested in and concerned about the progress of Bill C-384 in the House of Commons. The House is at third reading of a bill that would, in some circumstances, allow a physician to aid a person to die with dignity if that person has provided free and informed consent. The CMA's policy is clear. “Canadian physicians should not participate in euthanasia or assisted suicide.”

As the attached policy notes, euthanasia and assisted suicide must be distinguished from the withholding or withdrawal of inappropriate, futile or unwanted medical treatment or the provision of compassionate palliative care, even when these practices shorten life. The CMA does not support euthanasia or assisted suicide and urges its members to uphold the principles of palliative care. Euthanasia and assisted suicide are opposed by almost every national medical association and prohibited by the law codes of almost all countries.

Our policies also clearly state that “the CMA recognizes that it is the prerogative of society to decide whether the laws dealing with euthanasia and assisted suicide should be changed”, but that there are some concerns that must be addressed before any changes are made. These include:

1. Adequate palliative-care services must be made available to all Canadians. In 1994, our members approved a motion that Canadian physicians should uphold the principles of palliative care. The public has clearly demonstrated its concern with our care of the dying. The provision of palliative care for all who are in need is a mandatory precondition to the contemplation of permissive legislative change. Efforts to broaden the availability of palliative care in Canada should be intensified.

2. Suicide-prevention programs should be maintained and strengthened where necessary. Although attempted suicide is not illegal, it is often the result of temporary depression or unhappiness. Society rightly supports efforts to prevent suicide, and physicians are expected to provide life-support measures to people who have attempted suicide. In any debate about providing assistance in suicide to relieve the suffering of persons with incurable diseases, the interests of those at risk of attempting suicide for other reasons must be safeguarded.

3. A Canadian study of medical decision-making during dying should be undertaken. We know relatively little about the frequency of various medical decisions made near the end of life, how these decisions are made and the satisfaction of patients, families, physicians and other caregivers with the decision-making process and outcomes.

Hence, a study of medical decision making during dying is needed to evaluate the current state of Canadian practice. This evaluation would help determine the possible need for change and identify what those changes should be. If physicians participating in such a study were offered immunity from prosecution based on information collected, as was done during the Remmelink commission in the Netherlands, the study could substantiate or refute the repeated allegations that euthanasia and assisted suicide take place.

4. Consideration should be given to whether any proposed legislation can restrict euthanasia and assisted suicide to the indications intended. Research from the Netherlands and Oregon demonstrate that a large percentage of patients who request aid in dying do so in order to maintain their dignity and autonomy.

If euthanasia or assisted suicide or both are permitted for competent, suffering, terminally ill patients, there may be legal challenges, based on the Canadian Charter of Rights and Freedoms, to extend these practices to others who are not competent, suffering or terminally ill. Such extension is the “slippery slope” that many fear.

This statement has been developed to help physicians, the public and politicians participate in any re-examination of the current legal prohibition of euthanasia and assisted suicide and arrive at a solution in the best interests of Canadians. The CMA is in favour of improving access to palliative care and suicide prevention programs, undertaking a study on how medical decisions are made near the end of life and having a comprehensive public debate on the matter, but we cannot support Bill C-384.

Sincerely,

Anne Doig, MD, CCFP, FCFP,

President

As I indicated at the beginning of my speech, I understand and deeply respect the desire of the hon. member for La Pointe-de-l'Île to bring this matter forth in the House of Commons, and I sympathize with her. I think this is a debate that we should have, but it should be initiated by the government.

I am critical, however, of this government and previous governments of my political stripe for not having had the moral fortitude to take the necessary steps to allow such a debate to take place and not undertaking such a study, as suggested and recommended by the Canadian Medical Association.

I truly believe that it is an issue that many Canadians, many families are grappling with and an idea that they are finding very painful to think about. Government has a responsibility to help Canadians deal with this issue, to see what the actual state is and whether or not this issue can be dealt with in a way that provides dignity and serenity, and also to provide a sense of security that there will not be mistakes made if legislative measures are in fact taken.

As I have said, I blame the government but I also blame my own political party, which formed government for several terms, for not having had the moral courage to deal with this.

[Jacques Gourde, Conservative, Lotbinière—Chutes-de-la-Chaudière, QC]

Therefore, when I articulated earlier that Bill C-384 is too broad in its scope, this concern applies to both the fact that it would permit physician-assisted suicide and euthanasia, and to the fact that it would allow a vast array of persons to make a request to a doctor for assisted death.

The second important concern I wish to raise with respect to this bill is how it does not encompass sufficient safeguards.

The subject of safeguards, like the subject of the scope, also has two aspects in the context of this bill.

The first deals with ensuring that the eligibility requirements and the terms used are properly circumscribed. In this respect, Bill C-384 contains a number of vague and undefined terms that could lead to interpretation problems and, therefore, potentially to misunderstandings or abuses.

For example, terms such as “while appearing to be lucid”, “appropriate treatment”, “severe physical or mental pain”, “without any prospect of relief” have the potential to be interpreted very subjectively.

Also, the 10-day “cooling off” period, if you will, is too short to ensure that a person’s wish to die was settled.

The other element of ensuring appropriate safeguards deals with putting in place an effective oversight mechanism. In this respect, it is my view that Bill C-384 contains a woefully insufficient oversight mechanism.

Under Bill C-384, the doctor who would assist in a suicide or terminate someone’s life would only have to provide a copy of the diagnosis to the coroner after the fact. This bill would give a doctor the authority to terminate life on the apparent consent of the patient.

Under the terms of C-384, people as young as 18, diagnosed with depression and not wanting treatment, could ask to have their life terminated by a doctor.

Parliament should not consider such profound changes to the law without prior input from Canadians. Many different stakeholder groups should be consulted in advance of specific reforms being considered. These amendments would have serious implications for the medical profession in particular.

Surely, the medical profession should be consulted in advance of such significant changes being made to current medical ethics and practice.

I know that other countries have struggled with this difficult issue over the years, both in their legislatures and in the courts. While some countries have amended their laws to permit physician-assisted suicide and/or euthanasia, others have not supported such changes. In any event, regardless of what other countries have done, we have to consider what is right for our society. It is not clear to me that the legal regime proposed in this bill is right for Canada.

In closing, I would like to reiterate that I do not support this bill. Bill C-384 would represent a substantial change to the current policy on the criminalization of euthanasia and assisted suicide. It raises a number of significant legal and policy concerns and, in my view, would not adequately protect human life. Bill C-384 would also have a major impact on current medical ethics and practice. Such substantial changes to the law should not be considered without extensive advance consultations.

[Jacques Gourde, Conservative, Parliamentary Secretary to the Minister of Public Works and Government Services and to the Minister of National Revenue]

Mr. Speaker, I am pleased to rise today to speak to BillC-384 that was introduced on May 13, 2009, by the member from La Pointe-de-l'Île. Two previous bills on this subject were introduced by the same member in past sessions of Parliament. One of them was debated in 2005, but did not come to a vote.

Mr. Speaker, I would like to state at the outset that I do not support Bill C-384 which proposes the legalization of physician-assisted suicide and euthanasia under specified conditions. This bill raises a number of serious concerns and I propose to outline the ones I consider to be most important.

First, Bill C-384 is too broad in terms of its scope. Mr. Speaker, Bill C-384 proposes to amend the Criminal Code to provide an exemption not only to the offence of assisted suicide, but also to the offence of murder. These amendments would represent a substantial change to the current state of the law on a matter that touches on life and death.

The proposed legalization of medical euthanasia and assisted suicide would not only apply to terminally-ill patients, but also to persons who suffer from severe physical or mental pain without any prospect of relief. Therefore, under this bill, persons who suffer from depression could request that a doctor help them to commit suicide. They could also request that the doctor carry out the act itself that would cause their death.

[Francine Lalonde, Bloc, La Pointe-de-l'Île, QC]

moved that Bill C-384, An Act to amend the Criminal Code (right to die with dignity) be read the second time and referred to a committee.

Mr. Speaker, I first introduced a private member's bill on the right to die with dignity in June 2005, because I felt confident that Quebeckers and Canadians needed Parliament to amend the Criminal Code to recognize that every person, subject to certain specific conditions, had the right to an end of life that is consistent with the values of dignity and freedom they have always espoused and so that an individual's wish regarding his or her death would be respected. In fact, I introduced this bill so that people would have a choice, the same right to choose that people in other countries have.

My conviction has grown stronger, and that is why I am introducing an amended bill on the right to die with dignity, Bill C-384. Briefly, it amends the Criminal code so that a medical practitioner does not commit homicide just by helping a person to die with dignity if—I am coming to the conditions—the person is at least 18 years of age, continues to experience severe physical or mental pain without any prospect of relief or suffers from a terminal illness. The person must have provided a medical practitioner with two written requests more than 10 days apart expressly stating the person's free and informed consent to opt to die.

The medical practitioner must have requested and received written confirmation of the diagnosis from another medical practitioner. The other practitioner must be independent and have no personal interest in the death of the person. The medical practitioner must have no reasonable grounds—this is important—to believe that the person's written requests were made under duress or while the person was not lucid. The practitioner must have informed the person of the consequences of his or her requests and of the alternatives available to him or her and must act in the manner indicated by the person, it being understood that the person may, at any time, revoke the requests made under subparagraph (a)(iii) of clause 2 of the bill.

The patient is free to change his mind. The doctor must constantly remind him of that. If he does not change his mind, the doctor must submit a copy of the confirmation referred to in subparagraph (i) to the coroner.

Mr. Speaker, would you please let me know when I have two minutes left?

As we all know, the right to receive medical assistance to die exists in other countries. The Netherlands was the first to make it a right. In that country, before the law existed, doctors who helped patients die were tolerated by the legal system, as long as they complied with medical directives from the country's equivalent of a college of physicians and surgeons. Then the law was changed to reflect what people had been thinking about and doing for all that time.

In the Netherlands, euthanasia is when a doctor, acting on behalf of a patient and in accordance with the patient's strict instructions, deliberately puts an end to the patient's life. I want to emphasize that, in the Netherlands, palliative care is excellent and euthanasia is one of the care options.

Belgium also passed a law after senators from different parties worked together to hold nationwide consultations and agree on a piece of legislation in which euthanasia is defined as an action by a party intentionally ending the life of a person at that person's request. The law has been in place for six years, and there is oversight in place as well. This year, there was a report on the application of the law. For those who fear that permitting people at the end of their lives to choose how they wish to die might result in a huge number of people seeking help to die, the incidence over the past six years in Belgium has been 4 per 1,000. I repeat: 4 per 1,000 deaths.

In Quebec, the debate is ongoing. The Collège des médecins has asked its ethics committee to consider the matter of euthanasia. After three years of study, the committee should soon be making recommendations. As Dr. Yves Robert, the college's secretary, told L'Actualité médicale,

Doctors do not want to abdicate their responsibilities when it comes to euthanasia, but we must determine the scope of those responsibilities and how they are to be carried out.

At its annual meeting on April 16 and 17, 2009, the Association des soins palliatifs broached the topic with a presentation by Dr. Yvon Beauchamp, who began his introduction with the following:

I have found that over the years in Canada, palliative care has been championed as the anti-euthanasia and the universal alternative to an act punishable under the laws of God, the laws of man and the laws of the college of physicians.

He added:

There are people who believe that “increased development of palliative care means there is no longer a need for suicide, assisted suicide and euthanasia.”

I could go on. On August 11, 2009, an Angus Reid survey of 804 adults in Quebec was published with the title, Strong Support in Quebec for Legalizing Euthanasia. The subtitle read, “Most Quebecers believe that laws governing euthanasia should be provincial responsibility.” The survey showed the following figures: 77% of Quebeckers believe euthanasia should be allowed, and 75% think it is a good idea to re-open the debate on euthanasia. On August 22, the Association féminine d'éducation et d'affaires sociales, the AFEAS, well-known in all ridings of Quebec, voted in favour of euthanasia at its convention. Members of the AFEAS took the position that Quebeckers should be allowed to die with dignity.

Palliative care and assisted suicide are not mutually exclusive; they complement each other. I am saying this right off the bat, because I know that I will hear that argument. How many times have I heard, “As long as some people do not have access to palliative care, we cannot consider medical assistance in dying”? Why? That has nothing to do with the issue. Everyone needs access to quality palliative care.

It should also be known that palliative care does not relieve all pain and especially not all the suffering that comes with the end of life, aging and the difficulty of a lengthy hospital stay.

I will read from a text by Dr. Boisvert, a long-time palliative care doctor at the Royal Victoria Hospital:

Caregivers, whose own health is relative, are not equipped to experience the throes of progressive decline (a teaspoon at a time, wrote one patient); the indignity of urinary or fecal (rectal, or worse, vaginal) incontinence—we do not often hear that in Parliament; of constant breathlessness; the throbbing acute pain caused by a collapsing cancerous vertebra, causing the patient to cry out at the slightest movement; the gauntness and extreme weakness that result in total dependence, even for the simplest things such as turning over in bed just slightly or lifting half a glass of water to one's parched lips.

Dr. Boisvert continued:

That is why I do not subscribe to the idea that people should find the strength to suffer to the end or the idea that people should be so compassionate as to suffer with their loved one, when it is the loved one that is truly suffering.

I would add that I do not understand why people prefer to wash their hands of this suffering that cannot be relieved, that can only be relieved by death, because the time that passes is a kind of torture. Do we here have the right not to hear or think about it? Again, palliative care cannot end all pain and suffering.

My colleagues may have received the document from five doctors who oppose my bill. They may have the support of a hundred or so others. What do they have to say? I read this document carefully and it acknowledges that palliative care cannot relieve all pain and suffering and certainly not the suffering described by Dr. Boisvert. Then why are they against my bill?

They say, “These people have to be heard and helped as much as possible, but their request remains absolutely unacceptable to us”.

Why? To me there is a disconnect here. Their position is unacceptable, especially when they admit:

The line between palliation and euthanasia may seem tenuous to some, since the distinction between them lies in the intention of the act and not in what it involves.

They wrote that because palliative care also uses what is known as terminal sedation, which plunges patients into a coma when their suffering cannot otherwise be eased. In such a coma, they cannot eat or drink, but they are still alive and, in the end, they die of lethal complications. This can take a short while or a very long time, and this terminal sedation basically amounts to an act of euthanasia. They claim it is not the same thing. Even the Catholic church says that when any action is taken that has a double effect, such as the positive effect of easing the suffering, and the negative effect, which leads to death, one is not responsible for the negative effect, because it was the positive effect that was sought. This was one of the teachings of Saint Thomas Aquinas.

When we consider that, not as followers of any religion, but as people who are responsible for the well being of our citizens, do we have the right to refuse to look at all the possibilities?

I would like to see the broadest possible committee hear from as many citizens as possible in order to be able to provide end of life medical assistance to people who are suffering greatly, who can no longer endure the suffering and want to end their lives. We should help them die with dignity.

I await your comments and hope to have your support, not for me, but for the people we may one day become. The lottery of death offers no guarantees.

Euthanasia and Assisted Suicide

[Pierre Lemieux, Conservative, Glengarry—Prescott—Russell, ON]

Mr. Speaker, I would like to table a 20-page petition signed by the residents of my riding who are opposed to Bill C-384, which proposes to legalize euthanasia and assisted suicide.

The petition states that Bill C-384 contradicts fundamental Canadian values and threatens all Canadians by undermining the inherent and inviolable value of each human life and its dignity. It is a real and growing threat to the sick, the depressed, seniors and the handicapped.

The petition urges us to vote against Bill C-384. I would also like to mention that this call for positive measures was highlighted by the presence of 2,000 people who participated in the March for Life this past spring.

Criminal Code

[Francine Lalonde, Bloc, La Pointe-de-l'Île, QC]

moved for leave to introduce Bill C-384, An Act to amend the Criminal Code (right to die with dignity).

Mr. Speaker, the time has come for this Parliament to find a way to decriminalize medical assistance in dying, which is of such vital importance to those whose suffering can no longer be relieved except by this ultimate compassion.

In recent years, the parliaments of three countries in the European Union, as well as two states in the U.S., have enacted legislation which allows physicians under certain circumstances—the express request of terminally ill patients being one of them—to help certain persons die.

Serious research into the application of this legislation and their very specific criteria clearly shows that the greatest fear expressed in this Parliament some years ago, abuses and the hypothetical slippery slope, has not in any way become reality. A remarkable progression has taken place in public opinion concerning the need for such a law. Increasingly, people believe that they should have the right to choose, when the time comes.

(Motions deemed adopted, bill read the first time and printed)