Bill C-14 (Historical)

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

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.

Criminal Code

[Erin O'Toole, Conservative, Durham, ON]

Madam Speaker, even his framing of this, that mistakes can be made, sort of shows that it is very difficult for Parliament or any sort of regulatory regime, or the professions themselves, to set certainty. In fact, one of my main concerns with Bill C-14 is that it essentially kicks the issue back to the courts by using a reasonable foreseeable standard, which is kind of the linchpin of our common law.

When it comes to the case of a veteran with PTSD, there is no reasonable foreseeable end to that person's life at all, provided there is proper intervention. I have talked to military members, lower ranks and higher ranks. When the black dog, as Winston Churchill described it, hits people, they do think their own only option is to end their lives. However, I have met veterans who are now helping dozens of other veterans because they have found a path to wellness through a whole variety of programs and have made the decision to err on the side of help and not on the side of tragedy.

The very fact that the special committee put mental injuries, many of which can be treated, in the framework for euthanasia shows how difficult it will be to find the right balance.

[Garnett Genuis, Conservative, Sherwood Park—Fort Saskatchewan, AB]

Madam Speaker, I want to underline that there has been some discussion here about psychological suffering. The legislation very clearly includes psychological suffering as a criterion and subsection 241.2(2) talks about physical or psychological suffering being a criterion. The member, quite rightly, illustrates how having these provisions could create a more permissive environment for suicide more generally. We have heard his concerns about veterans. The member for Winnipeg Centre has spoken quite eloquently about the effect of some of this in the aboriginal community.

Would the member agree with me that we should simply remove the reference to psychological suffering from the legislation? It would be cleaner and clearer if we were to talk specifically about physical suffering and would not create some of these problems that he and others have raised.

[Erin O'Toole, Conservative, Durham, ON]

Madam Speaker, I would like to thank my friend and learned colleague who has provided a lot of perspective on this. That one issue needs to be addressed at committee or immediately with respect to Bill C-14, because it shows that already the legislation and the framework is flawed.

Going back to my earlier comments, this is a difficult circumstance, where, as parliamentarians, we are faced with compassion on both sides of the issue. Provided we have shared time between the member for Thornhill and myself, who may disagree on the final elements of what we see missing in Bill C-14, it shows the gravity of this decision, why we should have this debate, and why more members should be here to share their personal views with respect to concerns on either side.

[The Assistant Deputy Speaker, NDP, Carol Hughes]

We are now at the five-hour mark for this part of the debate. Now we are going to the 10-minute debate and 5 minutes of questions and answers.

Resuming debate, the hon. parliamentary secretary to the Minister of National Defence.

[John McKay, Liberal, Parliamentary Secretary to the Minister of National Defence]

Madam Speaker, I was quite encouraged by the previous two speakers and their internal discussion on this issue. It does show that within parties, and I know within our party, there is considerable debate about this issue.

I found trying to assemble my thoughts to be quite difficult as it does go to the heart of our beliefs, our values, and our experiences. Sometimes, frankly, they are not reconcilable beliefs or values.

First, I take the opportunity to compliment the government on allowing a free vote. That is particularly important on this side of the chamber. In a debate such as this, it is very important that members feel complete freedom to speak freely, to vote freely, and to, as much as possible, minimize the partisan jabs that go on in this place. Because this is a free debate and a free vote, it actually strengthens this vote. It is, after all, important that we reflect the consensus of Canadians. They put us here, and they are the ones who we are to reflect.

In this perpetual dialogue between Parliament and the court, it is important that we establish a standard of deference for both institutions, both of which are critical to our freedoms and our democracy. Because this is a free vote, I believe it will therefore strengthen Parliament's expression on Bill C-14.

Some have said today that this decision flows from the Carter decision, and indeed Bill C-14 before us is a response to that decision. However, I would argue that the debate predates Carter by at least several decades as Canada unwinds itself from its Judeo-Christian heritage.

The sixth biblical commandment says simply “thou shalt not kill”. One way or another, it has formed the basis for our legislation and our jurisprudence for the last 4,000 years. In religious and secular terms, it is the doctrine of the sanctity of life.

The last time the Supreme Court dealt with this issue was, as has been mentioned many times, in the Rodriguez decision. At that time, Mr. Justice Sopinka spoke for the majority when he said, “This argument focuses on the generally held and deeply rooted belief in our society that human life is sacred or inviolable.”

He then goes on to reference section 7 of the charter and states that it is rooted in “the profound respect for the value of human life”, which is the right to life and the right not to be deprived therefore except in accordance with the principles of justice.

My own views, frankly, parallel Mr. Justice Sopinka, and in part explain why I do not support capital punishment. The reason I do not support capital punishment is that so often we get it wrong. Similarly, my views are pro-life, which I know is a minority view. I try to be, in my own philosophical way, as consistent as I can be.

What has happened for the justices to do what is an about-face, and disavow their own decision? I know that some will say that the charter is a living tree, but still this is a very significant change of position and even a disavowal of their previous decision in a space of less than 25 years.

In my view, it is the rapidity with which Canadians have disavowed their Judeo-Christian heritage on the sanctity of life and have substituted a test of the functionality of life. Life has to be functional in order to have meaning. Life for its own sake, let alone being created in the image of God, does not meet the test of functionality.

I appreciate that images of people in great suffering are felt deeply by us all and, as the previous speaker said, there is compassion on both sides of this argument.

I do hope the government means what it says in the preamble:

And whereas the Government of Canada has committed to develop non-legislative measures that would support the improvement of a full range of options for end-of-life care, respect the personal convictions of health care providers and explore other situations?—?each having unique implications...

I would be distressed if this were mere lip service, but I have some confidence that the money set aside will in fact start to address some of the situations where people find themselves in end-of-life situations with very few, if no, alternatives. I think as we as a society age, this is going to become more and more of a critical issue.

However, concerns have also been raised by those who represent vulnerable communities and their concerns are legitimate.

Jurisdictions that have gone down the route of assisted suicide have, frankly, a bit of a spotty record. Once institutionalized, there seems to be upward pressure on the numbers and expansion of categories and cases which seem to fall outside of even the most generous interpretation of the law. It is perfectly understandable that there will be expansionary pressure. Indeed, it is a certainty that those who want individual autonomy as the value that is above all other values will challenge this legislation. That is a guaranteed certainty.

However, for those who cannot speak for themselves or for whom consent is problematic at the best of times, there is a worry that the categories of “assistance” would be expanded. I know this sounds like a slippery slope argument, and that is only because it is.

There is an absolute certainty of judicial challenge, regardless what the Government of Canada puts forward, how this Parliament votes and possibly explains the reluctance of the previous government to engage.

While I support Bill C-14 as the best that could be offered up under these circumstances and therefore will vote for it, I would have liked to have seen a couple of other measures included.

First, I would have liked to have seen a panel approach, rather than the one that is offered up. In Ontario, we have declarations of medical competency. It is based upon a panel of one doctor, one lawyer, and one other.

It makes sense to me that leaving the process exclusively in the hands of health care professionals will inevitably create a bias to the questions doctors ask about health concerns rather than procedural concerns, consent concerns, and ethical concerns which lawyers, ethicists, and others focus upon.

It seems to me that if a panel of mixed professionals is required for mental health competency, which is after all a reversible decision, then a panel of three mixed professionals should be the norm in a decision that is not reversible. It also may go a long way to alleviate the concerns of “doctor shopping”. It would lead also to a consistency of approach across the country.

The second measure is conscientious objections. I have heard the argument that no health care professional can be compelled to participate, and it might even be true. I think we can solve that quite easily by simply stating that explicitly in the legislation.

Finally, there has been a lot of negative commentary about the right of religious groups to comment on this bill. It might be pointed out that rabbis, imams, pastors, priests, nuns, and so on, have literally sat at bedsides millions of times as people have passed. They have every right to give their opinion and they bring with them literally thousands of years of experience.

I would like to finish with a quote from Jean Vanier, which I obviously will not get to, but I know you will want to hear in the response to questions, Madam Speaker.

[Harold Albrecht, Conservative, Kitchener—Conestoga, ON]

Madam Speaker, the member made some very insightful remarks. I certainly agree with him on many of the points he made in terms of how Bill C-14 needs to be improved, the panel oversight, some protections for conscience rights, and those kinds of things.

My question relates to the legal profession. I am not a lawyer, so I will ask my colleague who is a lawyer. He commented that in the Rodriguez decision in 1993, the Supreme Court decided that the social good was of higher importance than relieving the suffering of one individual. That ruling was affirmed again in the Latimer case in 1997.

I wonder if my colleague would comment on what he thinks changed in terms of the law that created a situation where the Supreme Court would reverse itself on a fundamental issue when from my perspective, I do not see that any laws have changed.

If he has time, I would love the hon. member to give the Vanier quote.

[John McKay, Liberal, Scarborough—Guildwood, ON]

Madam Speaker, I am not sure the law has changed all that much. I do think societal conditions have changed, and I think there is a value shift that is going on from a communitarian view of life to a personal autonomy view of life. I think that actually is expressed by Jean Vanier, a philosopher, a theologian, a humanitarian, the founder of L'Arche, and a former Royal Canadian Navy officer, who said:

A society which discards those who are weak and non-productive risks exaggerating the development of reason, organisation, aggression and the desire to dominate. It becomes a society without a heart, without kindness—a rational and sad society, lacking celebration, divided within itself and given to competition, rivalry and, finally, violence.

I do not think we are there, but frankly, those are concerns that have been expressed and I think they are concerns that bear being listened to.

[Charlie Angus, NDP, Timmins—James Bay, ON]

Madam Speaker, one of the concerns we have as New Democrats is the issue of finding a balance on this legislation.

It was put forward and put upon the House by the Supreme Court. It has laid down a set of rules that we have to respond to, but if we are to move in that direction, the obvious question is, where are the standards for palliative care across this country?

There are many areas under provincial jurisdiction, but the federal government plays an important role in the delivery of health care and the federal government also has a major responsibility in areas of its own jurisdiction, and we have seen a lack of action.

We moved through the last Parliament a national palliative care strategy, but we saw no movement from the government in the budget. We are now hearing on this day that we are discussing medically assisted death that they will come forward at some point with all kinds of money, but there is nothing there now.

We have Motion No. 46 that will be coming before the House about establishing a coherent national palliative care strategy, working also to improve the EI benefits for caregivers so that families are given support, and also calling on the federal government to establish standards under federal jurisdiction.

I ask my hon. colleague what he believes the role of this Parliament is on moving forward with palliative care at this important time.

[John McKay, Liberal, Scarborough—Guildwood, ON]

Madam Speaker, I thank my hon. colleague for his work in the last few months with the people in Attawapiskat.

He puts the question in a very pointed way. We are in a bit of jam. We have a limited time frame in which to actually pass legislation which affects the Criminal Code.

When the Minister of Health answered a similar question in question period earlier today, she said that she is absolutely committed to putting forward a palliative care strategy. I am prepared to accept her at her word. Knowing her personally, knowing her personal background, knowing her integrity, I am perfectly at ease with accepting her word on this and her seeking out funds in order to put money behind that strategy.

I think the hon. member has raised a pretty legitimate issue, and we would all be a lot more comforted if we were doing this legislation in the context of a tabled palliative care strategy.

[Michelle Rempel, Conservative, Calgary Nose Hill, AB]

Madam Speaker, Canada is a secular state, but we are not, however, an amoral state. Our morality is defined in the shared set of values that sustain our pluralism, and our freedom of speech enables civil society to explore and frame what we define as right and what we define as wrong.

The law and policy that parliamentarians set also have the effect of shaping social norms. In this, I ask my colleagues in considering this bill to consider our responsibility as parliamentarians in defining the morality of our country. This is a sacred connection between us and the Canadians we represent.

The introduction of the Canadian Charter of Rights and Freedoms guarantees certain political rights to Canadian citizens and civil rights of everyone in Canada from the policies and actions of all areas and levels of government. It also greatly expands the scope of judicial review in Canada.

The Supreme Court of Canada ruling on physician-assisted dying, or the Carter ruling, touches the core of our nation's morality in that it discusses the sanctity of human life and how we should, as a nation, best respect it. It places the onus on Parliament to respond with a new legislative framework to address the issue of physician-assisted dying per the scope of the ruling. It also places an onus on Canadians to actively participate in one of the most transformative debates that Canada has had in a generation.

The Minister of Justice, in her speech on this bill, stated:

From the start, we have known from the Supreme Court of Canada's unanimous Carter decision, that it is not about whether or not to have medical assistance in dying; it is about how we will do it.

I disagree.

The debate in this place that the Carter ruling has spurred is about how we respond to the ruling, not simply how to allow physician-assisted dying to occur. This is material because the Carter ruling does not allow us to abdicate our responsibility to decide whether physician-assisted dying should occur or in what context it should be allowed.

To be clear, with this bill the government has chosen to respond to the Carter ruling by allowing physician-assisted dying to occur in the context defined therein. It could have responded to it in many ways, including the invocation of the notwithstanding clause of the charter.

My concern with the government's approach to the Carter ruling is multi-faceted, but particularly troubling to me is that much of its rationale for its response seems to be that the Supreme Court has forced Parliament to allow a framework for physician-assisted dying.

In this matter of deep concern and sensitivity to all Canadians with all viewpoints on this issue, this is not a sufficient enough explanation to show the government's intent over time as to how approaching broader questions related to physician-assisted dying should be addressed.

I say this not simply as an indictment of the government, but as a cause for reflection for us all. While the Carter ruling came out over a year ago, all of our political platforms and national debates were largely silent on approaches to this issue during the last federal election campaign.

While parliamentary panels and committees did a remarkable amount of work in a short period of time, similar legislation in Quebec took nearly six years of public engagement to draft and pass, and even then, Quebec's National Assembly was divided.

There are issues the government has touched upon in relation to the Carter ruling which I do not believe Canadians have given us a clear mandate to legislate upon.

I also believe that the bill in its current state would leave provincial legislatures and medical associations with unresolved legislative issues leading to a balkanized patchwork of legislation and processes related to this issue.

While I appreciate that the government must respond to the Carter ruling in a shortly defined period, I am concerned that the government has not clearly specified its preliminary positions on many issues raised in the joint committee report and in tone has resigned itself to the inevitability of future charter challenges on this legislation.

In this context, I respectfully urge my colleagues here and the government to deeply focus upon our responsibility as parliamentarians to respond to the Carter ruling with firmness and clarity and to do the following.

First, change the timing of the parliamentary review of this legislation to two years after coming into force as opposed to five years, and to develop a strategy to actively engage a wide range of Canadians in this discussion.

This would promote us as legislators and our electorate to embark upon a fully informed discussion on how to best provide end-of-life care and ease of suffering to Canadians, with the hope of engaging more Canadians on issues that arose in the joint committee report, which I do not believe we have a clear mandate to legislate upon and are beyond the scope of Carter. This early review would also allow Parliament to assess the efficacy of the government's proposed safeguards. The review of this legislation should also be held on a regular, as opposed to a one-time, basis. The requirement of an annual report to Parliament regarding the government's response to the Carter ruling would also be helpful.

Second, the government has signalled the need to study issues of use of advance directives in physician-assisted dying, availability of physician-assisted dying to mature minors, and the definition of conditions beyond the scope of the Carter ruling under which physician-assisted dying would be available in the future.

To date, the government has not described the framework, the timing, nor the scope under which these studies would occur. This needs to be rectified immediately, hopefully with the input of members from a broad range of the community. Further, the government should commit to taking policy responses to these issues to the electorate before allowing them to come to pass.

Third, the bill is silent on direction regarding conscience rights of medical practitioners and faith-based care facilities in being required to provide physician-assisted dying to patients. In this, we are forcing the issue to be decided by provincial legislatures and by medical associations. This silence is an abdication of our responsibility to the electorate, as the Carter ruling clearly outlines the need for Parliament to respect the charter rights of both patients seeking physician-assisted death and the conscience rights of health care providers. I also have concerns regarding the selection of a panel approach to approval, as opposed to the way the bill currently outlines the selection.

Fourth, I am concerned the government's response to the Carter ruling to date is simply this bill. This fails a significant component of the Carter ruling. The ruling in its conclusion relies upon the assumption that a legislative framework allowing physician-assisted death would ensure that physicians properly inform patients of their diagnosis and prognosis and the range of available options for medical care, including palliative care interventions aimed at reducing pain and avoiding the loss of personal dignity, prior to allowing physician-assisted death to occur. In this, I believe Canadians have the responsibility to ensure that the range of options available to patients in this situation is robust and in every situation enables people to lessen their suffering while living.

In saying this, I in no way diminish the legitimate right for patients to choose the path of their end-of-life care. However, our country will have failed them if our response to the Carter ruling simply focuses on legislative mechanisms to allow physician-assisted death to occur rather than also placing a significant new emphasis on increasing and improving the range of available options for patients facing grievous and irremediable medical conditions.

Our response should also be clear about the limitations we would place on further expansions to the scope of access to physician-assisted dying. This includes a formal response from all levels of government, civil society, non-governmental organizations, Canada's faith community, and individuals to talk about and address the following: the mental anguish those facing grievous and irremediable medical conditions experience; how to support those who provide care to those who are suffering; reducing barriers to access to end-of-life care, including isolation, availability, and cost; reducing the stigma of mental health issues in Canada, and providing care and compassion to those facing this issue; ensuring a culture in which suicide is normalized does not arise, and ensuring strategies for suicide prevention are prioritized; ensuring that medical professionals have robust and comprehensive training on end-of-life care; developing and funding a comprehensive palliative care strategy to be implemented at the same time the bill comes into force; ensuring that physician-assisted dying does not evolve in our society as a promoted response to a diagnosis of a grievous and irremediable medical condition; and engaging research institutions and granting councils in a discussion on how to fund and manage research related to end-of-life care, and ensuring that what we have learned is effectively translated into public policy and clinical practice.

This discussion should not be treated as static, and a mechanism to address the success of programs and initiatives, in coordination with provinces and territories, health care providers, civil society, and the public at large, to address these issues on a regular basis should be immediately implemented.

Our collective response must first and foremost come from a place of compassion for those who are suffering. Our response must recognize the spirit of the Carter ruling in that Canadians ultimately have the right to choose their path of care.

However, we cannot abdicate our responsibility to respond to these issues to the courts or to other levels of government, nor should we see a legal framework in which physician-assisted dying occurs as a comprehensive response to the Carter ruling. Instead, we should ensure that our response is comprehensive, is clear and thoughtful, and is backed by a mandate from Canadians. Our covenant with our electors and the respect for the sanctity of life demand nothing less

[Kevin Lamoureux, Liberal, Parliamentary Secretary to the Leader of the Government in the House of Commons]

Madam Speaker, I listened attentively to many of the comments the member made. There were several ideas which ultimately have a lot of validity. I have listened to the debate today, and she and other members have been very willing to share their many opinions on the legislation and justifiably so.

We have been fairly clear about wanting to get the legislation to committee. We are all very much aware of the Supreme Court of Canada deadline which is looming.

I would ask if the member would at the very least recognize the importance of getting the legislation to committee, where members like herself and others could share their thoughts on how they might improve the legislation. At the same time, they could provide Canadians from different parts of our great nation the opportunity to provide direct input to our standing committee.

Would she not support getting the bill to committee as soon as possible so we could actually get that feedback, especially given the deadline from the Supreme Court of Canada and the fact that we also have to get the bill through the Senate of Canada?

[Michelle Rempel, Conservative, Calgary Nose Hill, AB]

Madam Speaker, while I appreciate that the government does have a timeline in which to respond to the Carter ruling, I also find its response to be lacking for the reasons that I have outlined in my speech.

[Pierre-Luc Dusseault, NDP, Sherbrooke, QC]

Madam Speaker, I thank my colleague for her speech.

However, how can she tell the House that it is not our duty to abide by this ruling and to grant this right? The court stipulated that medical assistance in dying is now a right guaranteed by the Canadian Charter of Rights and Freedoms.

As legislators, how can we refuse to grant a right that was confirmed in the Supreme Court decision?

What does she want us to do if she does not want us to abide by the court's decision and understand that this is now a charter right that must be granted to all Canadians?

[Michelle Rempel, Conservative, Calgary Nose Hill, AB]

Madam Speaker, as I outlined in my speech, the options afforded to us as parliamentarians with regard to a Supreme Court ruling are many. The government has chosen to respond with this bill and I do not feel that the government has responded adequately in terms of providing a concurrent framework on palliative care outlining how. For example, the Liberals talked about studying an expansion of the Carter ruling in terms of situations in which physician-assisted dying would occur.

I believe it is incumbent upon the government to clearly communicate this prior to a vote happening in the House of Commons. I do not think it has done that to date. I certainly think there is a little more work to do on this before it is an adequate response to the Carter ruling.

[Harold Albrecht, Conservative, Kitchener—Conestoga, ON]

Madam Speaker, my colleague has outlined many of the concerns that many of us in the House have. Throughout debate today we have heard government members assure us that conscience protection is included in Bill C-14. I do not share that optimism because it do not see it here, other than in the preamble, and it is actually along with the intention to expand physician-assisted dying to minors and people with psychological issues. That is a pretty weak commitment.

My bigger concern is that the bill is totally silent on protection for health institutions. We know that many hospices in Canada have been started with the express purpose of improving the quality of life for those approaching end of life and many of them are supported by very generous donors. If we are to insist that those institutions now need to participate in physician-assisted dying, I have concerns that we will end up losing a lot of health care facilities in our country. I am wondering if my colleague would share any comments on her views on protection for institutions.