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

Sponsor

Status

This bill has received Royal Assent and is, or will soon become, 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, provided by 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 CodeRoutine Proceedings

June 16th, 2016 / 10:15 a.m.
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Beauséjour New Brunswick

Liberal

Dominic LeBlanc LiberalLeader of the Government in the House of Commons

Mr. Speaker, I wish to state that the completion of Bill C-14 is an urgent matter because a legislative framework is needed to protect our most vulnerable in society and establish clear and consistent practices for medical professionals, while providing access to assisted dying pursuant to the Supreme Court of Canada ruling.

Therefore, pursuant to Standing Order 53, I move:

That, notwithstanding any Standing or special Order or usual practice of the House, when Orders of the Day are called later this day, a Minister of the Crown be authorized to move, without notice, a motion relating to Senate amendments to Bill C-14, An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying).

Criminal CodeRoutine Proceedings

June 16th, 2016 / 10:15 a.m.
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Conservative

Garnett Genuis Conservative Sherwood Park—Fort Saskatchewan, AB

Mr. Speaker, I appreciate the member's arguments with respect to the urgency of this issue. However, he may be aware, and I think should be, that provincial guidelines have already been proposed with respect to this, and provinces are bringing in a framework to deal with this at the provincial level.

That does not negate the possible arguments for or against having a federal framework, but I think it is important to acknowledge, in the context of a claim to the alleged urgency of this issue, what the reality is at the provincial level, because if we look at the various guidelines, it actually seems fairly clear to me that a number of provinces have done a much better job of protecting the vulnerable than the framework the federal government has put in place.

I have raised concerns repeatedly in this House about the lack of protection for the vulnerable in this legislation. It is important that we separate out two different issues. There is the issue of the eligibility criteria, which has been fairly contentious in terms of whether it should be terminal, whether it should simply repeat the language of the Supreme Court, and whether it should use other types of language, as the government does in the somewhat ambiguous term of death being “reasonably foreseeable”, but then there is the separate question with respect to safeguards.

I think, especially in this legislation, whatever Canadians and members of this House think of the provisions in terms of eligibility criteria, that there is an absence of safeguards. If we look at what the provinces have put in place, they have, in many cases, done a much better job of providing important safeguards.

One of the models I would like to draw to the attention of members of the House is the law in place in Manitoba. The law put in place there has actually been praised. It was welcomed as a welcome development, even by someone involved in assisting people accessing assistance in dying, with an understanding of the real benefits of this law.

The system that was set up in Manitoba was that it allowed individuals seeking assistance in dying, euthanasia, or physician-assisted suicide, whatever we want to call it, to have their cases reviewed by government lawyers. It did not require judicial review, which has many advantages but is something that some members have claimed is unduly onerous. It instead created a procedure by which government lawyers would review the eligibility criteria and would be able to, in the context of their legal expertise and knowledge, rule on whether the person in fact met the criteria.

The government's legislation contains absolutely no mechanism for advance legal review by competent authority, and we proposed an amendment to that effect in hopes of seeing the government bring it in. Unfortunately, it would not agree to that.

I think the Manitoba law strikes a good compromise. It does not require judicial review, but it does have some kind of apparatus whereby we have review by competent legal authority. Certainly in the case of Manitoba, the vulnerable in Manitoba are better off under the provisions of the existing standards in Manitoba than they would be under federal legislation.

Let us talk about some of the other provinces. In general, the provinces I was able to look at use language around attending physicians. They have protections in terms of conscience, but they are rooted in this idea of an attending physician being in some way involved in the process.

The federal legislation, Bill C-14, makes no reference to attending physicians. It does not require the involvement of the attending physician at all. It simply says that any two physicians can sign off. We could have two physicians in the country that see a particular case one way and every other physician in the country seeing the case a completely different way. That person would still be able to access euthanasia or assisted suicide.

The guidelines, which in their wisdom most of the provinces, at least most of the ones I have had a chance to look at deal with, have a specifically carved out role for an attending physician. I would argue that involving, in the guidelines, specifically the attending physician provides significantly greater safeguards than we would have otherwise.

This speaks very much to the motion the government House leader put forward, because he is claiming that there is some urgency to passing this legislation on the basis of the protection of the vulnerable. However, if we look at the rules that are in place in the various provinces, it is very clear that they may, so far, in terms of the interim guidelines they have put in place since June 6, have a somewhat more liberal interpretation of the eligibility criteria, but on the issue of safeguards, on the issue of the protection of the vulnerable, they are actually doing a much better job.

I have stated before concerns about The College of Physicians and Surgeons of Ontario's policy with respect to conscience. It is evident in its interim policies that it has introduced, as well, a requirement for effective referral, requiring someone to be complicit or to refer for euthanasia, which is gravely concerning to physicians as well as to many other people within the province of Ontario. However, that would not change with the federal legislation, because the legislation would not provide the necessary protections for conscience.

In other provinces, though, we see a better job in terms of understanding processes that can be put in place which protect the vulnerable and also protect conscience. Therefore, generally speaking, they make reference to this issue of having the attending physician involved, but they do not specifically require the participation or an effective referral. In my home province of Alberta, there has been a system constructed whereby there is a sort of central hub where people would go directly, or where someone might be pointed, in order to have their situation addressed or adjudicated in some way.

These systems prevent what I think is one of the very pernicious aspects of Bill C-14, which is the possibility of doctor shopping. It is where a person, or even a member of their family, could shop the case around, and 10 or 20 different doctors could say absolutely not because the person does not meet the ambiguous criteria. It is somewhat ambiguous under Carter, but no less ambiguous under the provisions of the new government legislation.

What is important in this debate is that people have raised the spectre of a legislative vacuum, in that there will be no legislation, no rules in place whatsoever. Well, June 6 has come and gone, and provinces were ready to respond in a way and to an extent that the federal government simply was not. The government proposed the legislation fairly late. It did not seek to get our buy-in on the substance of the legislation. Instead, the government pushed this forward at a late stage and said that we have to pass it now because it is urgent.

Well, provinces have done a much better job here. Now June 6 has come and gone, and we are not in a vacuum. Provinces have developed standards, policies, and procedures, some of which may be better than others; some of which I may agree with more or less. However, if we look at the substance of these, I think we see that there is not at all a legislative vacuum. In fact, the provinces have in some cases been more effective.

The central issue of doctor shopping, the issue of whether or not someone meets the criteria, needs to be adjudicated. It needs to be adjudicated, hopefully once, and may be subject to appeal or review by someone else. However, there needs to be one person or a group of people who have the expertise, legally and medically, who make the assessment, and then that decision is made.

This fearmongering from the government about the absence of a law or a vacuum, I think really misses the point. We have these bodies, colleges of physicians and surgeons at the provincial level, that have the competency and have come up with guidelines, that have recognized, unlike the government, the concerns about doctor shopping that we have raised repeatedly in the House. They have recognized the problems with conscience and said they could try to construct, using their expertise and authority at the provincial level, a system that works better and that provides real protections for the vulnerable.

Whenever we think about the eligibility criteria, and in some cases the interpretation of the eligibility criteria is different at the provincial level, let us provide the safeguards.

One thing I want to briefly mention is that the federal legislation provides immunity from prosecution for someone who has a “reasonable but mistaken belief” that the standards have been met. Therefore, someone could take the life of a person who did not meet the criteria and still avoid prosecution. That is not a protection for the vulnerable. However, in the absence of the legislation, we do not have that exemption. The vulnerable are better protected because there is not an exemption for those who take life without the consent of the patient and without the proper criteria being met.

In looking at the reality of what is in place at the provincial level, it is not correct at all to talk about a legislative vacuum. Therefore, the motion does not have the urgency that is claimed.

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

June 16th, 2016 / 10:40 a.m.
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Vancouver Granville B.C.

Liberal

Jody Wilson-Raybould LiberalMinister of Justice

She said: Mr. Speaker, I would like to begin my comments by acknowledging the depth and quality of the thoughtful work that the other place has undertaken in its review of Bill C-14.

The number of amendments that were presented and thoroughly debated speaks volumes, not only about the complexity of the issue at hand but also about the dedication with which members of the other place sought to improve the legislation.

Bill C-14, as passed by the House of Commons, expressed our policy choice to address medical assistance in dying in a principled and cautious manner. This policy choice was deliberately and carefully crafted. The bill achieves the most appropriate balance between individuals' autonomy in deciding how their death will occur and protection of vulnerable individuals, as well as broader societal interests. These interests include suicide prevention, equal valuation of every person's life, and preventing the normalization of death in response to suffering. Several amendments were made to Bill C-14 in the other place.

The most significant amendment was the deletion of the definition of “grievous and irremediable medical condition”. The effect of this amendment essentially removes the eligibility requirement that “natural death has become reasonably foreseeable”. This amendment appears to have been motivated by a concern that this criterion is unconstitutional because it does not explicitly appear in the Supreme Court Carter decision.

Many legal experts have testified before the Standing Committee on Legal and Constitutional Affairs in the other place. Some expressed their views that Bill C-14, as initially passed in the House of Commons, would be found unconstitutional if challenged in the courts.

However, other legal experts and professors took the opposite view, that Bill C-14, as adopted in the House of Commons, with the requirement that natural death be reasonably foreseeable, is constitutional. In Carter, the Supreme Court was clear that it is the role of Parliament to craft a complex, regulatory regime with respect to medical assistance in dying and that such a regime would be given a high degree of deference by the courts.

Hon. colleagues, as Minister of Justice and the Attorney General of Canada, I am confident that Bill C-14, as originally drafted and presented in this place, is constitutional. As outlined in an addendum to the legislative background paper that I distributed to all parliamentarians earlier this week, and which I am pleased to table in the House today, the question is whether the complex, regulatory regime found in Bill C-14 is consistent with the charter, not whether it exactly replicates the wording of the Supreme Court in Carter. In the dialogue that this Parliament has with the judiciary, Bill C-14 is our principled, cautious, and deliberate response.

This is a transformational discussion, and a significant first step for our country. It is important to note that Bill C-14 is very different from the former law that was before the court in Carter. Our proposed legislation permits medical assistance in dying for the overwhelming majority of those Canadians who would seek to access it, and it is motivated by broader, new legislative objectives that do not animate the former law.

Bill C-14 is a new law with new features, and an analysis of its constitutionality must reflect this. The Carter ruling alone is not the end of the story, nor is it the end of our national discussion. The conclusion to draw here is that there are diametrically opposed but reasonable points of view about the constitutionality of Bill C-14.

The situation is not unique. It is normal and part of a healthy debate for legal experts to differ on the merits of a particular piece of legislation that has not yet been examined by the courts. However, I would caution that fundamentally altering the delicate balance purposefully struck in Bill C-14 solely because of the existence of these differing views is ill-advised.

As the Supreme Court of Canada stated in Carter, “the risks associated with physician-assisted death can be limited through a carefully designed and monitored system of safeguards”. The government's policy choices, as reflected in Bill C-14, were specifically crafted to protect vulnerable Canadians from these different types of risks.

First is the protection of those who will ask for medical assistance in dying. Bill C-14, as passed by this chamber, would limit eligibility to those whose death has become reasonably foreseeable and for whom the risks can be adequately addressed by the robust safeguards found in Bill C-14. However, if eligibility is drastically expanded to all Canadians who are suffering unbearably, regardless of whether or not their death is reasonably foreseeable, as in the amendments the other place proposes, there are more risks of different types that are much harder to detect.

These risks include the very real possibility that individuals may be motivated to request medical assistance in dying for a whole host of reasons, psychosocial, emotional, or systemic, which are separate from their medical condition but that exacerbate their suffering. People may die unnecessarily or prematurely, when other options for improving their quality of life are available. Cases from other jurisdictions that permit medical assistance in dying support these concerns. We do not believe that this is what Canadians want.

Importantly, while the other place expanded eligibility in the bill, it did not introduce new safeguards for the very circumstances where the most caution is required. The result is that any serious medical condition, whether it be a soldier with post-traumatic stress disorder, a young person who suffered a spinal cord injury in an accident, or a survivor whose mind is haunted by memories of sexual abuse, could result in eligibility for medical assistance in dying. I raise these examples from other jurisdictions not to be sensational, but to highlight the real risks at play.

However, beyond the risks for those who make a request for medical assistance in dying, making it available to all Canadians who are suffering would also have repercussions at a much broader level. It would alter our societal values and send the wrong message to our most vulnerable Canadians who may never even request assistance. These are risks for which there are no obvious safeguards.

Broadening eligibility for medical assistance in dying to situations where death is not reasonably foreseeable would contribute to negative perceptions about the quality and dignity of life of people with disabilities. Organizations like the Canadian Association for Community Living and the Council of Canadians with Disabilities, among other disability rights organizations, have cautioned us about the potential devaluation of the lives of Canadians with disabilities that broader eligibility criteria would attract. They tell us that such devaluation happens when the law presumes that life with a disability could be so unbearable that death should be a state-sanctioned option.

Broad eligibility criteria could also send the wrong message that society feels it is appropriate to address suffering in life by choosing death. This message may encourage some who are in crisis and already considering suicide to act, even privately and without assistance. Procedural safeguards would not help these individuals. The relationship between medical assistance in dying and suicide has not been sufficiently studied and we must have more information about this complex situation before we can decide what is right for Canada. I want to acknowledge the thorough and emotional discussion in the other place on this incredibly important issue.

We recognize the important amendments to Bill C-14 adopted by the other place, namely that a person signing on behalf of the patient requesting assistance cannot know or believe that they will benefit from the patient's death. This is indeed a thoughtful amendment that improves the bill and a valuable safeguard that we are pleased to support. Ensuring that a patient is aware of all means available to relieve their suffering, including palliative care, is of course important.

A further amendment concerning the monitoring system introduces mandatory language requiring the Minister of Health to make regulations and guidelines. The government appreciates the other place's concern that regulations to support the monitoring regime be put in place. Canadians want to know that this system will be well monitored and we support this well-crafted amendment from the other place.

Further, there was an amendment requiring that the issues to be studied in the bill, which are mature minors, advance directives, and requests where the sole underlying condition is mental illness, be completed in two years. This amendment from the other place reflects the concern that Canadians have for these incredibly complex issues, and the desire for this government to be held to account on each of them, and for that reason it is supported.

I would also like to acknowledge the substantive work of the Standing Committee on Justice and Human Rights, whose thoughtful study of the bill resulted in 16 amendments from all parties being adopted.

I would urge all members of the House to consider the pressing need for a federal legislative framework governing medical assistance in dying. With no such regime in place at this time, with the force and clarity of the criminal law, all Canadians face significant uncertainty.

It is crucial to keep in mind that Bill C-14 was carefully and deliberately crafted as a cohesive and balanced regime. The balance sought in Bill C-14 would be upset by the broadening of eligibility criteria to individuals who are not approaching death without the corresponding safeguards for these specific cases.

Since forming government, we have spent countless hours consulting with Canadians and stakeholders, carefully considering all of the evidence and diverse perspectives on this incredibly challenging issue. We are confident in the policy choices expressed in Bill C-14. The legislation represents the right approach for Canada at this important time in our country's history. I encourage all members of the House to support the government's motion, which respects the other place's contribution to this important debate and maintains the most appropriate balance for all Canadians.

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

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

June 16th, 2016 / 10:55 a.m.
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Liberal

Jody Wilson-Raybould Liberal Vancouver Granville, BC

Mr. Speaker, I would like to acknowledge the hon. colleague's comments on the crucial nature of Bill C-14 and pursuing a national regime for medical assistance in dying in this country, necessarily so in response to the Supreme Court of Canada's direction. I recognize, as stated in my comments, the importance of ensuring that we proceed with caution with respect to medical assistance in dying, recognizing that there is a link, as articulated by my friend, and that we do everything we can to study this particular issue and proceed with caution on the next steps of this debate in this country.

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

June 16th, 2016 / 10:55 a.m.
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NDP

Murray Rankin NDP Victoria, BC

Mr. Speaker, the Minister of Justice said, in introducing the motion, that she respectfully disagrees with amendments 2(b) and 2(c) because they would remove the criterion of reasonably foreseeable death and undermine the objectives of Bill C-14. As the House knows, the amendments would make sure that the legislation would be consistent with the constitutional parameters of the Carter case, in the words of the Supreme Court. Professor Hogg said that if the bill was amended in this way it would be consistent with the parameters set out in the Carter case, and if it were not the bill would be unconstitutional.

I would like the minister's reaction to the comments of Dr. Douglas Grant, the chair of the Federation of Medical Regulatory Authorities of Canada, who said that the criteria in the unamended Bill C-14, in other words, the “reasonably foreseeable” language the minister would propose to retain would involve language that is “too vague to be understood or applied by the medical profession and too ambiguous to be regulated effectively.”

I would like the minister's comments on that quote.

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

June 16th, 2016 / 10:55 a.m.
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Liberal

Jody Wilson-Raybould Liberal Vancouver Granville, BC

Mr. Speaker, I certainly acknowledge my friend across the way for the work and the commitment he has made with respect to Bill C-14 and this discussion.

While I acknowledge the quote that he conveyed from Douglas Grant from the regulators, I would like to counter that discussion with a comprehensive response that we have received from the Canadian Medical Association and physicians across the country who look at the language of reasonable foreseeability and the further definition that we provided in terms of eligibility around “grievous and irremediable” as providing clarity, as providing medical practitioners across the country with the ability, based on their direct relationships with their patients, to determine whether or not a patient is eligible for medical assistance in dying.

We believe that flexibility is the most appropriate response and the medical practitioners have confirmed that with us.

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

June 16th, 2016 / 10:55 a.m.
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Bloc

Luc Thériault Bloc Montcalm, QC

Mr. Speaker, I listened carefully to the minister. I would say that this was not her best argument in defence of Bill C-14.

She seems to be confusing the concepts of being suicidal and assisted suicide. She also claims that adopting the definition in Senator Joyal's amendment and the terms in the Carter decision would put us on a slippery slope, giving people who are suddenly suffering access to medical assistance in dying.

We are talking about medical assistance in dying. Does she think that health care professionals would consent to assist someone who is suicidal? Since they would not give their consent, does she think that a suicidal person under the care of our health care system would not find the help they need to reverse their suicidal state? How does she distinguish between being suicidal and medically assisted suicide, other than by citing the fact that the latter is medically assisted? Does she trust the health care system?

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

June 16th, 2016 / 10:55 a.m.
See context

Liberal

Jody Wilson-Raybould Liberal Vancouver Granville, BC

Mr. Speaker, certainly I acknowledge my colleague across the way for his ongoing commitment and discussion on this important issue.

My words today were in speaking to a motion to the other place in terms of their thoughtful considerations with respect to Bill C-14.

The member opposite speaks to the risks, speaks to the broadening of the criteria in terms of one of the amendments that was sent back. What I was expressing in my comments were the serious concerns that we have. If we were to broaden the eligibility criteria, there would not be the necessary safeguards in place to account for that broadening of the criteria.

What I sought to articulate in my comments were examples highlighted from other jurisdictions, factual examples where a broad criteria has resulted in patients accessing medical assistance in dying in the cases that my colleague across the way speaks to, in terms of individuals who are suffering from mental illness alone. Recognizing that there are other remedies, certainly, we trust medical practitioners to perform their duties responsibly in servicing their patients in the best and most appropriate manner.

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

June 16th, 2016 / 11:10 a.m.
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Winnipeg North Manitoba

Liberal

Kevin Lamoureux LiberalParliamentary Secretary to the Leader of the Government in the House of Commons

Mr. Speaker, I appreciate the comments from the member across the way.

Could the member provide some thoughts on the number of individuals who were involved? We can talk about the decision of the Supreme Court of Canada, and the preliminary work that was done last summer on the issue of assisted dying? We had a joint committee of the House, including the other place. We have had ample opportunity through consultation, even at committee stage with individual members of Parliament. This is a very emotional issue for all of us as we try to deal with the passage of Bill C-14.

Could the member provide any personal insights on the legislation, or about the issue at hand, or provide comment in regard to the amount of individuals who have had, directly or indirectly, an opportunity to participate?

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

June 16th, 2016 / 11:30 a.m.
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NDP

Murray Rankin NDP Victoria, BC

Mr. Speaker, I am very pleased to rise to address the government's motion on a response to the Senate regarding the amendments it has made to Bill C-14. My personal involvement in this process began in January when I had the honour to serve on a special all-party and Senate committee. My colleague, the member for Saint-Hyacinthe—Bagot, was a very important member of that committee as well. Our mandate was to advise the government on a response that would respect the Supreme Court of Canada decision in Carter, respect the Charter of Rights and Freedoms, and respect the priorities of Canadians.

I have told the House before how very proud I was of the work that we accomplished together, and the spirit as well with which we worked in that place. We knew that the government would not accept all of our recommendations, but each was based on the evidence and faithfully respected the testimony that we heard, testimony of experts who came to us from across this country and reached out to others in the process.

Since Bill C-14 was introduced in the House, I, like many others, have focused great attention on its most surprising feature. That feature was the decision of the government to narrow the declaration of the Supreme Court of Canada to a much smaller circle of eligibility, and it could have proved to be a fatal flaw.

That was the testimony, after all, of the Canadian Bar Association, the Quebec Bar Association, Jean-Pierre Ménard, Joseph Arvay, and later the testimony of Canada's foremost constitutional scholar, Professor Peter Hogg. That was the conclusion, as well, of the courts in Ontario and Alberta. That flaw was important, not only because it fatally weakened the bill against the charter challenge, but also because it would force suffering Canadians to launch a court battle. That flaw was so important and so glaring that it overshadowed much of what was good about Bill C-14. Colleagues who have grown tired of hearing me warn about charter challenges and infringed rights will be pleased to hear little of that from me today, because that fatal flaw has been erased from the bill that is now before the House.

The bill as amended now combines a clear and faithful implementation of the Supreme Court ruling with a system of stringent medical safeguards to individually screen every request for assistance in dying. Those safeguards are based on the evidence received by the all-party committee. They reflect the best practices of other jurisdictions as well as made-in-Canada provisions, which members of all parties have helped shape over the course of this debate.

Without the amendment that came to us from the other place, as Peter Hogg has testified, the bill would not be consistent with the decision in Carter. That was his clear testimony. It also would remove a victory that would be taken from those individuals in Canada who could not comply with the very narrow, and frankly inexplicable restriction, of reasonably foreseeable death. Those individuals have that right as of today until Bill C-14 is enacted. Those rights will be taken away should the motion by the government be passed.

However, I am happy to say that the bill before us today, which contains the language of the Supreme Court decision, would of course be compliant with that decision and with the Charter of Rights and Freedoms. As Professor Hogg has said in the clearest possible terms, if it is not fixed as per the amendment that comes to us today, it will be struck down in the Supreme Court of Canada.

When I speak of Mr. Hogg and I hear the government saying we have different experts in different places, I suppose it is important to remind the House of the accomplishments of that individual. His decisions and his book have been cited over 200 times in the Supreme Court of Canada. By my reckoning, it has been cited 1,627 times in the courts of Canada. To suggest that this professor is just another person with an opinion is really quite disturbing, because the government itself, the Department of Justice, has retained that individual on countless occasions.

For him to say, as he did in the other place, that the bill, without the amendment before us today that would fix the problem, is somehow unconstitutional, that it is just another expert, that lawyers differ, economists differ, whatever, is simply misleading.

Canada's leading constitutional scholar has said in the clearest possible terms that without the amendment that happily is now in the bill before us for debate, it has to be fixed. I termed that testimony a game-changer, because I wondered how on earth a government that has retained this gentleman dozens of times could now turn around and say, as the minister did this morning in her speech, that constitutional scholars just differ and that is how it works.

Happily we have in front of us a bill as amended in the other place that we can support, and that is the good news for Canadians. Some amendments come before us to deal with things like palliative care, an amendment that would require all patients considering medical assistance in dying to get a full briefing on palliative care options.

Another amendment would deal with restricting people who help a person in assisted dying, tightening the rules around what role a person who could materially benefit from the death could do.

Another amendment that comes from the other place would compel the Minister of Health to draft regulations around death certificates and provide greater clarity on what information is collected by medical practitioners.

Another amendment calls for a report to be issued to Parliament within two years on issues that have arisen from the provision of physician-assisted dying. Finally, there are some minor language amendments.

The safeguards in the bill reflect many things. They provide the high degree of care, caution, and scrutiny that is necessary to match a court ruling that was broad in its compassion for the right of suffering Canadians to choose. They reflect the confidence that Canadians have in the skill and judgment of our health care professionals, and they reflect the realities of our vast and diverse country, and the principles of equity that undergird our public health care system, of which Canadians should be so proud.

Much has been said in this chamber about the need to balance respect for the autonomy and protection for the individual. We have heard that so often. The Supreme Court of Canada was unanimous in its analysis of our charter, and it ruled definitively on the question of whose autonomy must be respected on this deeply personal matter of choice.

It was for us, as legislators, then to choose what combination of safeguards might be necessary to screen out from that group those who, by virtue of diminished capacity or external pressure, must be denied this option for their own safety. We consider this question carefully, knowing that excessive caution would have its costs. Excessive barriers would not protect the vulnerable. Rather, they would condemn competent, autonomous, adult Canadians to intolerable suffering by wrongly denying their right to choose.

Neither could the solution be to presumptively deny the autonomy of a whole class of persons granted their right to choose by the Supreme Court of Canada. No matter the rhetoric, to presumptively deny people's autonomy, to assess them not as unique individuals, but to dismiss them blindly as a group, to me, is as deeply patronizing and offensive as it is unnecessary.

The Supreme Court expressed faith in us as legislators that we could devise what they called “a carefully designed and monitored system of safeguards” to address the risks associated with offering the compassionate choice of medical assistance in dying. I, for one, believe the court's faith was not misplaced.

We remember what the Supreme Court of Canada said in Carter:

We have concluded that the laws prohibiting a physician's assistance in terminating life...infringe Ms. Taylor's s. 7 rights to life, liberty and security of the person that is not in accordance with the principles of fundamental justice, and that the infringement is not justified under s. 1 of the Charter. To the extent that the impugned laws deny the s. 7 rights of people like Ms. Taylor they are void by operation of s. 52 of the Constitution Act, 1982.

Here is what the court went on to add:

it is for Parliament and the provincial legislatures...should they so choose, by enacting legislation consistent with the constitutional parameters set out in these reasons.

There are two key points that came out of the Supreme Court's pronouncement. The first is that we did not have to do this at all. The court decision could have stood on its own, as in fact it is doing now, along with the safeguards that the provincial and territorial regulators have put in place. We did not need to do what we have done, but we did, in the words of the court, choose to do so.

The second point, though, is equally important: that we could only do so if what we enacted as legislation was “consistent with the constitutional parameters set out in [our] reasons”.

Here is what Professor Hogg testified in the other place. He said, “In my opinion, [the bill] is not consistent with the constitutional parameters set out in [the Carter reasons].”

The amended bill before us would fix it and be possible for all of us to work in the spirit of collaboration, as we did so effectively in the Special Joint Committee on Physician-Assisted Dying and the Standing Committee on Justice and Human Rights. We wrapped our hands around something that would make Canadians proud, wrapped our arms something that would show the compassion that the Supreme Court of Canada showed in the Carter decision, rather than dividing us on party lines or other lines.

All that the amendment the government announced today it wishes not to follow would do is to ensure that it is consistent with the Supreme Court of Canada and the charter. Much has been said about the fact that we need not follow and put into legislation the precise words of a court judgment. Of course, that is right. The simple path was to put the actual language of the decision into the legislation because that was clear and obvious, and certainly no one could say it would be unconstitutional to do so. Rather, the government wishes to use the words “reasonably foreseeable” natural death, which people on all sides of this place have demonstrated is ludicrous language.

Dr. Douglas Grant, head of the regulatory body for all medical regulatory authorities across the country, has pointed out that the language is vague and unworkable from a medical point of view. The government proposed to take the words of the Supreme Court of Canada, though it did not need to, but at least no one can say they are bad, and substitute words that are incomprehensible to the people, physicians and health care providers, who are being required to implement them.

I cannot understand that. I particularly cannot understand it when to do so would be to take away the rights of Canadians that were hard fought for and won in the Supreme Court of Canada. Why? What do I tell those people who call me and say they have to decide whether to take their own life now, because after this bill comes into force that may not be an option available to them? They won that right in the Supreme Court of Canada. In no way do they feel they are near end of life. They may have 30 more years of excruciating pain and suffering, and how dare we say that they do not have that autonomy as a Canadian individual? However, now the government purports to take away that right.

Please understand that as of June 6, the Supreme Court decision stands alone, carefully governed by rules that apply to health care practitioners from coast to coast to coast. It is not the wild west, as colleagues have already pointed out. We have rules in place that are being enacted and carefully followed. If this motion passes, the moment the current government takes away those rights by saying that people have to have a reasonably foreseeable natural death, they will lose that right.

How can the Liberals possibly argue that this somehow would not deprive Canadians of rights that they won in the court? These are real people. This is real suffering. The government says no, that it has this delicate balance right, and it calls it a public policy choice. Some Canadians think that the government goes too far and some Canadians say it does not go far enough, so it will come right down the middle. That frame is wrong. We are here because we chose to implement a unanimous Supreme Court of Canada decision.

We are not here to say we will pick and choose what we like about this issue.

Can we add additional safeguards? Absolutely, and I am proud of what we did. Can we deal with palliative care? Yes. Can we deal with conscience rights? Of course, and we did, and I am proud of what we achieved.

The elephant in the room is that an entire class of successful litigants have had those rights deprived in this place.

The good news is that we can fix that. We have a path to do that, which comes from the other place. It is language we tried to get through the House before. I do not care where it comes from. I am on the side of suffering Canadians who want the rights that they had before.

It is worth reminding ourselves of a very simple fact. We are not called upon to legalize medical assistance in dying. That was already done by the Supreme Court of Canada and is now the law of the land. Instead, we were invited, if the government chose to do so, to offer the broader framework necessary to give clarity and comfort to all Canadians.

I believe that balance has been achieved in the bill that we have before us, as amended. The words of the Supreme Court are there to speak to whose autonomy must be respected, and the work of all parliamentarians is reflected in the system of safeguards before us. The onus must now be on the government to explain why it proposes to cut the words of the Supreme Court judgment out of the bill we have received from the other chamber.

I know that many of us share a common belief that no one can ever make this difficult choice of medical assistance in dying for another. but by rejecting the ruling of the Supreme Court and removing its words from the bill, that is exactly what the government suggests that we do. I cannot accept that, and on a free vote, it is up to all members to decide whether they can accept that.

I would ask all members in this place to consider the alternative; that is, to accept that what we now have is a balanced bill that bears the marks of the Supreme Court, of Parliament, and of thousands of Canadians who participated in consultations and town halls along the way.

I feel we have in our hands, now, what the special all-party committee set out, in January, to produce; that is, a bill that respects the Supreme Court ruling, respects the Charter of Rights and Freedoms, and respects the priority of Canadians.

We do not need to reopen the debate and cut out the words of the Supreme Court. We do not need to reject the charter fix, which was proposed in this chamber, adopted by the other chamber, and confirmed as constitutional by a most respected scholar on the charter.

I move:

That the motion be amended by:

a) Deleting the paragraph commencing with the words “respectfully disagrees with amendments 2b, 2c(ii) and 2c(iii)”; and

b) Replacing the words “agrees with amendments numbered 1, 2d, 2e, 4 and 5” with “agrees with amendments 1, 2b, 2c(ii), 2c(iii), 2d, 2e, 4 and 5”;

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

June 16th, 2016 / 11:55 a.m.
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NDP

Murray Rankin NDP Victoria, BC

Mr. Speaker, I want to acknowledge the contribution the member for Sherwood Park—Fort Saskatchewan has made throughout this process in both committees.

The idea that the Manitoba regulators have of interposing a prior judicial restraint, if you will, or the process that the member described, could constitute an effective barrier to access. Canadians accept that their doctors look after them in life, and I believe, with the safeguards that are in place to deal with conflict of interest, a reflection period, and the like, we can trust the same physicians to look after us in death.

I worry about barriers that would impose, particularly in non-urban areas, the notion of finding a lawyer and the like. In Nunavut or northern Manitoba for that matter, it is somewhat troubling. Therefore, I think that would be an effective barrier. I do not think it is required.

I think we have it right in Bill C-14. I just wish the test of eligibility would embrace all Canadians and allow those who won the victory in Carter to not have to march back to the Supreme Court in a few months to be told that.

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

June 16th, 2016 / noon
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NDP

Murray Rankin NDP Victoria, BC

Madam Speaker, I thank the hon. member for Mount Royal for his superb leadership as chair of the justice committee, which I have the honour to work with him on.

I understand that the Canadian Medical Association agrees with the bill. I have heard from so many doctors in my office who call constantly saying that they do not understand it. Frankly, the CMA is a trade organization for doctors. It is not the regulatory body that has to decide what to do when doctors run afoul of the professional standards being implemented in each of the territories.

I think that the constitutional constraints on us, under a criminal law power, to do some of the things that provinces can better properly do will address some of the very concerns that the member raises, such as whether we have an adequate reflection period, and the like. I am proud to see that, although these rules are not unanimous from from coast to coast to coast, they are fairly consistent. I think taken with Bill C-14, they will provide the kinds of safeguards that Canadians expect.

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

June 16th, 2016 / noon
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Markham—Stouffville Ontario

Liberal

Jane Philpott LiberalMinister of Health

Madam Speaker, I want to say before I begin that I will be splitting my time with the hon. member for Montcalm.

I am pleased to be here today to continue our important discussion on Bill C-14 concerning medical assistance in dying.

We have seen the serious thought and deliberation that hon. senators have put into this bill over the past few weeks. It is now up to us to carefully examine the amendments that the Senate has presented.

Medical assistance in dying is only available in a very small number of jurisdictions around the world and it is brand new to Canada. What we are talking about with this bill is a fundamental change to social policy in this country. We are pursuing transformative change at the same time as we are facing incredible time pressure to put federal legislation in place. It is, therefore, critically important that we move forward with great care.

There are a number of paths that we could choose to follow with respect to medical assistance in dying in this country. I believe that the choice we have made with Bill C-14 represents the approach that is most appropriate and responsible for Canada, and here is why. It strikes a careful balance between respecting the autonomy of patients seeking assistance in dying and protecting vulnerable people. It would protect the conscience rights of providers and support those who choose to participate. It would put measures in place to study the legislation over time as we understand and gather further data to deal with the issues.

I would first like to bring to the attention of hon. members the ways in which the bill respects the autonomy of patients. Under this legislation, eligible patients approaching the end of their lives would be able to choose a peaceful medically assisted death. This represents a significant shift in the way we approach suffering at the end of life in this country. It provides patients with greater autonomy over their decisions.

The bill also improves access for patients. By allowing nurse practitioners to administer medical assistance in dying, the bill recognizes Canada's unique geographic and demographic realities. Nurse practitioners often work alone to provide vital health care services in underserved regions.

In addition to supporting access and autonomy, Bill C-14 also takes care to protect patients who may be vulnerable. When changing social policy, we must proceed with great caution if there is a chance that those who are most vulnerable among us may be negatively affected. Without appropriate safeguards, the availability of medical assistance in dying could pose threats to marginalized people and those who may lack access to adequate familial, social, or economic supports. This bill would establish robust safeguards and procedures to protect vulnerable persons from being encouraged or coerced into seeking medical assistance in dying.

It is important to recognize that there has been significant support in this piece of legislation from the health care sector, including the Canadian Association for Community Living, which includes 40 individual advocates and 50 organizations. It includes various medical associations, both provincially and federally, the Canadian Nurses Association, the Canadian Association of Advanced Practice Nurses, the Canadian Pharmacists Association, the Canadian Psychiatric Association, the Canadian Association of Social Workers, and many more.

This legislation also complies with the vulnerable persons standard, which I believe sends a strong message to all Canadians about our support for those among us who need most protection.

The bill recognizes that medical professionals have the right to follow their conscience and choose whether or not they want to participate in medical assistance in dying. For those who do choose to participate, the bill ensures that the doctors and nurse practitioners who administer this assistance will not be prosecuted. It also exonerates those who may assist, such as pharmacists and authorized nurses.

Finally, it outlines criteria to help support providers in assessing patients. It is important to keep in mind that health care providers are required to assess the condition of their patients on a regular, if not daily, basis. Assessing the level and type of suffering is already part of medical practice and it is very common in all end-of-life care. It is, for example, a crucial element in determining the best approaches to alleviate suffering in palliative care.

Our eligibility criteria and safeguards offer providers direction and flexibility within their field of expertise and scope of practice to make an assessment about the condition and circumstances of a patient seeking medical assistance in dying on a case by case basis.

Given the complexity and often personal nature of this issue, there is significant debate in terms of the correct approach from many different perspectives. What we have with Bill C-14 is an approach that would put a cautious assisted-dying framework in place while leaving the door open to adjust as we better understand more challenging issues. In the legislation, there is a commitment to independent studies on challenging issues that need to be investigated further before determining what policy considerations the government should make.

One thing is certain, these are issues that present real risks to people in vulnerable circumstances and highlight the complicated nature of balancing autonomy against the protection of vulnerable patients. There is also, of course, a mandatory parliamentary review of this legislation after five years.

I would be remiss if I did not reaffirm here today the importance of improving access to high quality palliative care for all Canadians. Our government has committed to investing in this area. I continue to work with provinces and territories to help support access to all options for care at the end of life.

The motion today has given thoughtful consideration to the work of the upper chamber. I thoroughly appreciated the opportunity to take questions for a two-hour period at the committee of the whole, in addition to the time that I appeared before the committee's pre-study.

There are two amendments made by the upper chamber where we respectfully disagree. As captured in the motion today, we as a government reviewed and sought a path forward that encompasses the Senate's amendments where possible, resulting in our agreement with the five remaining amendments. There is alternative text proposed to reflect the upper chamber's desire to recognize the vital importance of palliative care options for patients. As I have said repeatedly, this is a positive outcome if the result of this legislation allows tangible improvement to access palliative care in Canada.

We also have a responsibility to provide language in the legislation that health care professionals can understand in order to provide access to assisted dying. As is stated in the proposed message to the Senate, removing the criterion of the reasonable foreseeability of natural death would undermine the objectives of 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. Bill 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.

In conclusion, I would like to underline to my fellow parliamentarians that the approach set out in Bill C-14 is the result of tremendous thought and deliberation over the course of many months. There have been extensive consultations over this past year on the issue of medical assistance in dying with Canadians, stakeholders, and relevant experts. The findings have been reviewed carefully to inform the legislation.

I hope both the House and the Senate are able to support the motion. I would like to thank, from the bottom of my heart, all the parliamentarians from both the upper and the lower chamber who have professionally and thoroughly debated this issue. It is a transformative social policy that governments debate once in a generation, and this piece of legislation is one of those remarkable debates. Make no mistake, this will be a dramatic change for Canada.

In the Carter decision, the Supreme Court acknowledged that it was up to Parliament to craft an appropriate regime. I believe we arrived at the best approach for our country.

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

June 16th, 2016 / 12:10 p.m.
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Liberal

Jane Philpott Liberal Markham—Stouffville, ON

Madam Speaker, my colleague's question gives me an opportunity to reiterate again, as my colleague the Minister of Justice and I have said on numerous occasions, that we are absolutely clear on the fact that the two cases that were reviewed in the matter of Carter v. Canada are cases of people who would absolutely have been eligible under the legislation that is before the House today.

If the Carter decision is read carefully one will understand that it was clearly speaking to people who were facing end-of-life decisions. We are fundamentally affirming today that the people in question in that case would have met the criteria of Bill C-14 for medical assistance in dying.

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

June 16th, 2016 / 12:40 p.m.
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Conservative

Garnett Genuis Conservative Sherwood Park—Fort Saskatchewan, AB

Madam Speaker, I am pleased to speak to the NDP amendment, as well as to the underlying issues raised by Bill C-14, and to address some outstanding issues.

The first thing I want to do is pick up on a question that my colleague from the NDP just asked with respect to choice. Many of the arguments in favour of this legislation have been framed around this idea of choice. However, at the same time we have to acknowledge that this bill is designed to impose significant limitations on choice as well. It does not legalize suicide in every case. Clearly, I think it suggests that there still ought to be limits on choice. That is a good thing. However, those limitations do not at all protect the vulnerable. They do not go nearly far enough. We would understand the limits of choice in that choice is shaped by values and social norms, and my colleague touched on this as well. The stigma and social acceptability around something shapes the kinds of choices that are made.

In light of the Supreme Court decision and the fact that we have to respond to it, I am very concerned, and I think many of my colleagues at least on this side of the House but perhaps in other corners of the House are concerned, that suicide remains a socially unacceptable choice, and that maybe it should be allowed in certain narrow circumstances as required, but that we do not allow ourselves to shift in a direction where we remove the fundamental stigma around taking human life, and that we maintain a fundamental respect for the intrinsic value and dignity of all human life. It is my belief that going down that road only a little bit is very difficult and perhaps even impossible. In the debate around this issue, we have already seen that, as soon as the can of worms is opened a little bit, there is a major push for expansion to all kinds of other different situations.

The language used, and the language that some members and the NDP amendment want to limit this to, is “grievous and irremediable”. It seems to me that people who take their life do so because they consider themselves to be facing grievous and irremediable suffering. Clearly, there is no one who takes his or her life who does not think that. Therefore, it is not at all a simple matter, as some members have suggested, to clearly demarcate suicide; and then, on the other hand, what is covered by this issue? Choice always has limits. It must have limits, especially when choices may impact the broader social architecture of choice under which other people operate. I think that is an important point that is underlined here, that we need to try, as much as possible, to preserve that underlying concept of the value of human life. I do not think that Bill C-14 has nearly the safeguards to do that. What we could have had, and what we should have at the very least, is some kind of clear legal criteria.

It has been interesting in the discussion today that we have the minister really highlighting the importance of the reasonably foreseeable criterion. I do not support the NDP amendment. All things being equal, I would still like “reasonably foreseeable” to remain in the bill, although I agree with the NDP that it is not at all clear what that means. Then the minister talks about the importance of this criterion and how the entire bill, the system of safeguards, was developed with that criterion in mind. She said that, clearly, if we did not have that aspect in the criteria, we would need additional safeguards. Therefore, she is putting a very large amount of weight on those two undefined words. She said that the Liberals would not want “reasonably foreseeable” to apply to a young person who had some kind of an accident and became permanently disabled. They would not want “reasonably foreseeable” to apply to somebody with just a mental health challenge. However, without meaning to those words, without some kind of clarity, it is not at all clear that those cases that the minister has identified are even excluded by this legislation. Therefore, in a sense, she defeats her own argument by saying that this legislation has limited safeguards because of the narrowing of the criteria, such as only a 10-day waiting period, but given that there was no meaningful, well-defined, narrowing of the criteria, then she acknowledges effectively that the safeguards in this bill are inadequate.

If this legislation were written with a tighter narrowing of criteria in mind, then perhaps we should have actually had some definition of what constituted the new criteria. We should have had some kind of definition of what this means. Of course, Conservatives proposed an amendment to add the word “imminent”. We can say that death is reasonably foreseeable for all of us, but death is not imminent for all of us. That would have at least provided some metric for establishing a distinction between some cases and other cases. The lack of criteria is a huge problem.

It is important, in recognizing the absence of clear criteria, that we again investigate putting review criteria in place. We have seen what the provinces have already done. The reason I say we are not in a legal vacuum is that there is no federal legislation but there are provincial rules in place, so we are not in a legal vacuum, as such, strictly speaking. There are policies and procedures in place at the provincial level. The provinces have introduced many very good safeguards that are not in this federal legislation, and it is important to say that those safeguards, in many cases, would not apply after the federal legislation passes.

Provincial guidelines, in most cases that I have seen, refer to the involvement of the attending physician. They do not just say any two physicians. They say there is some role for an attending physician and a consulting physician, implying that the person involved in adjudicating the case should be, in some ways, involved in the care of the patient and not be some doctor somewhere else who has agreed to sign all the forms for almost anyone. The involvement of the attending physician is important. It could have been included in the federal legislation, but if the federal legislation passes saying any two doctors, then the requirement for an attending physician being involved would no longer apply, because it would be prescribed a certain way in the Criminal Code.

I would encourage the government to take the experience and wisdom of the provinces seriously on this, recognizing that there are no effective legal criteria up front, there are only undefined legal criteria, and we should add in some of the more effective review mechanisms to ensure that, however ambiguous the criteria are, the legal criteria are being met, in fact, such as they are.

I have advocated for the Manitoba model, or some element of it, to be incorporated into the federal model, which involves government lawyers looking at each case. I asked my friend from Victoria about this, and he said that could pose an unnecessary barrier, such as if there are no lawyers available. The model that the Government of Manitoba has put in place includes government lawyers available to review each case. It is not as if one has to go out and find someone, and it is not a process of needing to make an application to the court, although there are, frankly, plenty of cases in the world where someone might need to make an urgent application to a court and there are provisions to allow that to happen.

Therefore, it is not at all true that this is sort of an impossibly onerous barrier, but the Government of Manitoba has done something much less than requiring judicial review. It has simply put in place a system where there is advanced legal review by government lawyers. Recognizing the value of that model, that review process, the government should think about incorporating that into federal legislation or, at the very least, ensure it is not proceeding in a way that interferes with or overturns that provincial set-up.

In conclusion, I want to speak briefly to the issue of protecting the vulnerable. There has been some discussion here about what constitutes vulnerability and who is vulnerable. We can understand “vulnerable” as referring to people who probably, in ideal circumstances, would not choose death, but are in some way in not ideal circumstances, which limits them and propels them toward a choice they would not otherwise make. This can happen often, whether it is a person who does not have perspective because of his or her situation, or whether someone is sort of the victim of suicide contagion and is responding to other things and situations happening in his or her life. It could be someone who is influenced more by social than physical circumstances. We need to be attentive to these things, and that speaks to the importance of robust safeguards.

I hope we can, as a House, still at this last stage, try to bring in some meaningful definitions and safeguards that would protect the vulnerable and protect Canadian society.