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

[Cheryl Hardcastle, NDP, Windsor—Tecumseh, ON]

Mr. Speaker, as members are aware, Bill C-14 now goes to third reading, which gives the Senate two days to consider it before the June 6 deadline.

While I acknowledge the government's expressed desire to get the bill passed before the Supreme Court's June 6 deadline, I think most people agree that this is too important a piece of legislation to rush, especially considering that in its present form it is not likely to pass constitutional muster. On this, I second NDP justice critic, the member for Victoria, when he said, “I cannot accept passing a bill that I know to be unconstitutional”.

The key flaw of Bill C-14 is the end-of-life requirement of a reasonably foreseeable natural death. This is the part that conflicts with the Supreme Court, which did not require terminality or end of life, and therefore, according to the Carter decision, infringes on the charter rights of all those who have a grievous and irremediable condition that causes them intolerable suffering but who are not dying as a result.

The Canadian and Quebec bar associations, various other legal experts, and now the Alberta Court of Appeal, have said that this requirement conflicts with the Supreme Court. Medical groups do not like it either. The body that represents every provincial medical regulator has come out against the bill as being too vague for doctors to follow.

The NDP put forward a number of amendments that would have improved the bill tremendously. Had they not been rejected, the bill would likely have had a better shot at making it through the Senate.

We suggested removing the controversial end-of-life requirement, which is almost certainly unconstitutional, and replacing it with the exact words that the Supreme Court used in its decision. However, the Liberals rejected that.

Of more than 100 amendments moved, just 16 were accepted, and they were mostly minor technical clarifications. However, the NDP did manage to secure agreement on two amendments that were introduced and adopted unanimously, and that was clarifying conscience objection rights and adding a stronger commitment to palliative care.

As criticism grows against the bill, the government increasingly falls back on the excuse of a deadline imposed on us by the Supreme Court, which is not exactly true. The court said that it would give federal and provincial governments a year to put in place more complex regulatory regimes should they choose. On June 6, an exemption is opened in two Criminal Code offences for patients and physicians acting within the guidelines that the court set out in the Carter decision.

There is not a vacuum, and to be blunt, murder will not become legal, nor will medical aid in dying return to being illegal without a federal law in place.

Over the past year, every provincial medical regulator has developed guidelines for medical aid in dying that physicians must follow. These safeguards are very close to the safeguards proposed in Bill C-14. Federal leadership is necessary to ensure that access is equitable across Canada and to prevent a patchwork, but it is not strictly necessary to ensure basic access right now. Therefore, this final push to get the bill through the House is most unfortunate, and it is not the outcome we had hoped for.

The NDP worked long days in good faith with other parties, but it is better than passing a flawed bill, defying the Supreme Court, and infringing on the charter rights of suffering Canadians, which prompted this legislative response in the first place. For us, this is not a partisan issue. We have collaborated with all parties from the start on this and will continue that constructive approach, especially when it comes to championing the causes for our health care and palliative care.

We had a chance to get this bill right, but the government does not seem interested in listening at this point. It is important here to step back and reflect on how we got to where we are now.

In February 2015, a unanimous Supreme Court ruling established the charter-protected right of competent adult Canadians experiencing enduring and intolerable suffering as a result of grievous and irremediable medical conditions, including a disease, disability, or illness, to access medical assistance in dying. In February 2015, the Supreme Court unanimously decided in Carter v. Canada that Canadians who are suffering intolerably because of a grievous and irremediable medical condition have a charter-protected right to access medical assistance in dying.

The effect of the ruling was suspended until June 6, 2016. The reports of an interprovincial task force and a federal expert panel, as well as a wide array of witness testimony, were considered by a joint special committee of Parliament, resulting in 21 recommendations on a legislative response to Carter.

We succeeded in adding major actionable recommendations on palliative care to that report. This issue of palliative care is what, for myself, goes directly to what I object to most about Bill C-14 in its current state.

Should the government rush into a bill like Bill C-14 without also having a plan to shore up and extend palliative care? The answer is, of course, most emphatically no, it should not.

As noted in the recent report by the Canadian Cancer Society, “Right to Care: Palliative care for all Canadians”, there are gaps in palliative care across the country. As my colleague mentioned in her speech, it is very heart-wrenching to know some of the stats and facts about what is actually available right now in palliative care for Canadians.

It is an epic fail for the government to be putting forward a bill while at the same time ignoring the real tangible details that we need to give us confidence as we move forward in a future with medical-assisted dying. That was so insensitive.

About 45% of cancer patients die in acute care hospitals, even though most Canadians prefer to die at home. Not only are acute care settings more costly than dedicated palliative care, they are also not equipped to provide the most appropriate care to palliative care patients and their families.

Palliative care can increase the efficient use of our public health care dollars, but increased care outside of a hospital setting can place undue financial hardship on family caregivers. Health care costs tend to increase substantially in the months and weeks before death, due to increasing frailty and dependence on health care services.

We believe that the government should take a lead in providing appropriate funding for palliative care. Improving palliative care in all settings, including outside the hospital, should result in a more efficient use of health care dollars.

However, there will be upfront costs to facilitate change. Federal, provincial, and territorial governments should work together to establish a financing plan, and create a national palliative care transition fund to ensure the changes needed to improve palliative care in Canada can take place.

When I look at the latest version of Bill C-14, it states that:

...it commits to working with provinces, territories and civil society to facilitate access to palliative and end-of-life care, care and services for individuals living with Alzheimer’s and dementia, appropriate mental health supports and services and culturally and spiritually appropriate end-of-life care for Indigenous patients.

Now, it is all well and good, but precise commitments need to be made, and this bill is quite vague.

The only other time palliative care is mentioned in the bill is:

....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.

On the fifth year? To me, this seems to be way too far in the future. Canadians of all political persuasions and faiths, indeed, Canadians of goodwill everywhere deserve something more definite and concrete than a promise to review palliative care within five years.

This is all the more disappointing, given that the government could have addressed this issue in its recent first budget as it knew that we would soon be debating Bill C-14. However, as we know, not a single dollar was earmarked for palliative care measures. We should have fortified health care, palliative care, home care before we crafted Bill C-14. It would have alleviated our anxiety on what the future holds.

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

Mr. Speaker, just to pick up on the member's last point, there are many things I could talk about but we recognize within the Government of Canada, the Liberal Party, how important palliative care is. I used to be a health care critic in the Province of Manitoba. I am very much familiar with the needs of palliative care. It is important that we recognize that the best way to deliver palliative care is in co-operation with the province and the many different stakeholders. It goes even beyond government.

One of the initiatives that this government has taken responsibility for in terms of providing good strong leadership is the idea of working with the different provincial and territorial ministers of health in order to achieve a new health care accord. By doing that, we are that much more able to provide the type of palliative care that Canadians want to see in the future.

My question for the member is this. Does she not believe that it is important for the federal government not only to make the financial commitment that it has made, which is billions of dollars, but that it is equally important that we work with the stakeholders so that Canadians will get the best possible palliative care system in the world; and that can only be achieved if the federal government is prepared to show leadership, which it has done, and we work with the provinces that are delivering our health care services?

[Cheryl Hardcastle, NDP, Windsor—Tecumseh, ON]

Mr. Speaker, I appreciate the hon. member's comments because I am one of those people who does champion not just palliative care but recommitting this country to universal health care access. We have all heard through assisted dying many stories from our constituents, who are very disconcerted. It is really scary for ordinary Canadians to read the text of a bill that could be passed tonight, and then to have almost platitudes, very ambiguous comforts about palliative care. That is where the problem is.

I do agree that it is very important, and I think maybe the hon. member misses my point that it should have been front-loaded. Those details should have come first, and then present the text for Bill C-14. That makes it that much easier for people to be able to accept. I know as recently as last week, I heard people who are heartbroken saying, “My father was in the hospital hallway for nine days before he passed away. What are you going to do about that? I don't want to hear any more about Bill C-14. What are you going to do about that?” My heart breaks.

It is not just that my heart breaks. I know now I have to show some federal leadership like all of us here. That needs to come first. It would be very easy for the current governing party to stand up with some real hard-core statements, not these ambiguous things that are meant to placate us and just sort of distract us from the issue.

Where is this money? Recommit to the Canada health accord. Enforce the Canada Health Act when it comes to home care. You could make three bold statements right now that would change the whole atmosphere of this. That has been missed and that is what is highly frustrating. When it comes to working with other jurisdictions, yes you have to take federal leadership that is strong and true, and strong—

[The Assistant Deputy Speaker, Anthony Rota]

Questions and comments.

I want to remind the hon. member that she is talking through the chair and not directly to the other speaker.

We have time for a brief question. That one went on for a bit longer than anticipated.

The hon. member for Kitchener—Conestoga.

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

Mr. Speaker, I want to thank my colleague from Windsor—Tecumseh for her statement. Earlier today her colleague from Saint-Hyacinthe—Bagot indicated that doctors who do not wish to participate in physician-assisted suicide must at least make an effective referral.

I want to point out that, “...forcing a physician to refer for assisted-suicide would infringe the physician’s freedom of conscience and religion. From the physician’s perspective, referring is a form of participation because, by acting as a step in the process, the physician is directly helping the patient obtain the service”. That is from a National Post review.

Would my colleague not agree that there needs to be more clear, unequivocal protection for conscience rights for medical doctors and for institutions that do not wish to participate in any form in physician-assisted suicide?

[Cheryl Hardcastle, NDP, Windsor—Tecumseh, ON]

Mr. Speaker, that is a very intriguing question. I believe these comprehensive conversations need to take place in that provincial jurisdiction, that provincial arena. However, up until now we have not been able to have those meaningful discussions because this was something in the Criminal Code. The Supreme Court has addressed that.

Now no one is vilified when they talk about it at a provincial level. They can actually make some comprehensive arrangements and people can be acknowledged in a safe environment professionally as they address this complex issue.

[Ramesh Sangha, Liberal, Brampton Centre, ON]

Mr. Speaker, it is a great pleasure for me to have this opportunity to share my ideas and opinions regarding Bill C-14 to amend the Criminal Code.

In a unanimous decision on February 6, 2015, the Supreme Court of Canada turned down the provision in the Criminal Code, giving Canadian adults who were mentally competent and suffering intolerably and enduringly the right to a doctor's help in dying.

The court suspended its ruling for 12 months, with a decision taking effect in 2016, giving the government enough time to amend its laws. In January 2016, the court granted an additional four-month extension to its ruling suspension.

Until now, it is a crime in Canada to assist another person in ending their own life. As a result, people who are grievously and irremediably ill cannot seek a physician's assistance in dying and may be condemned to a life of severe and intolerable suffering. A person facing this prospect has two options: they can take their own life prematurely, often by violent or dangerous means, or they can suffer until they die from natural causes. The choices are cruel.

This enactment would amend 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 criteria for eligibility, 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 further to, medical assistance in dying; provide information for the purpose of monitoring medical assistance in dying; 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 statues being affected.

We have reached to the final stage of debate in the House regarding the process, with hours of debate on Bill C-14.

The biggest thing during these debates was the sense of compassion with which the House heard from members debating for their individual constituents. That is the reason the bill touched the hearts of not only the members of the House, but also the hearts of Canadian from coast to coast to coast. Now, when the bill has reached to its final stage, I appreciate and congratulate every member for actively participating in building the most important and valuable laws on assisted dying and also the government for affording full opportunity to all members to be part and parcel of this delicate and important legislation.

I also appreciate the extensive hard work done by both the Minister of Health and the Minister of Justice and by the members of the Joint Standing Committee of the Senate and the House.

Being new to this legislative process, I was thrilled to watch yesterday's voting by the House on numerous motions. I saw members were in favour of few motions and were against on other motions. I realized the importance of these motions on assisted dying for the members of the House. That is the way of members use their choices out of their own conscience and the will their constituents. I realized the real sense of democracy and a true parliamentary decision process being adopted.

This enactment to amend the existing Criminal Code is an important step and is auxiliary to new enactment regarding medical assistance in dying. Being legislators, it is our duty to see that medical service providers and other persons who provide assistance in medically assisted dying are legally safe.

As we all know, this is a first major revolutionary enactment. Going forward, there may be many ancillary issues cropping up. I and my Liberal caucus colleagues as well as many other members of the House are keen to see that bill should pass. I urge all members of the House to vote in favour of Bill C-14, an act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying).

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

Mr. Speaker, repeatedly throughout the day today, and even last night in the vote, we saw a reticence on the part of primarily the Liberal Party to accept the recommendation and the amendment that would guarantee conscience rights for medical professionals and institutions. Repeatedly they have indicated that we can count on provincial regulatory bodies, which will care for this and conscience protection will be guaranteed. However, as we have seen, the Royal College of Physicians and Surgeons of Ontario and Saskatchewan have both indicated that there is an expectation on the part of their medical professionals to at least refer for the practice of physician-assisted suicide.

Would my colleague on the other side not agree that at the very least, if we are to have a bill that goes down the path of allowing physician-assisted suicide and voluntary euthanasia, we should guarantee in law, in the bill, that physicians and health care institutions will not be obligated to act against their moral conscience?

[Ramesh Sangha, Liberal, Brampton Centre, ON]

Mr. Speaker, we are going through this enactment, which is useful for the persons who are really in need of medical assistance in dying. People who are working for the purpose of execution of the act are required to be exempted from the offence of culpable homicide. The Supreme Court has already given instructions to pass a law to develop procedures easy for them to perform their duty. It is a duty of the physician or the duty of the persons who are medically authorized to perform these acts and we are here to ensure they are provided the necessary safeguards.

[Don Davies, NDP, Vancouver Kingsway, BC]

Mr. Speaker, we have all struggled with this very delicate and sensitive issue in light of the Supreme Court direction, which has left parliamentarians with the task of constructing a law that conforms with the Supreme Court case decision in the Carter case. Of course, the Carter case laid down very specific criteria in allowing Kay Carter, the litigant in that case, getting the court's approval for her to access physician-assisted death.

Ms. Carter did not have a terminal illness. She specifically did not have a condition that would lead to her foreseeable death. Yet the court found that her rights under the charter were violated.

When the court laid down the clear criteria required in a grievous and irremediable condition, could the member explain why the Liberal government added the extra criteria of requiring that death be reasonably foreseeable when the lawyer that argued the case and every serious constitutional expert in the land, the Court of Appeal in Alberta and in Ontario, all indicated that it would be unconstitutional?

[Ramesh Sangha, Liberal, Brampton Centre, ON]

Mr. Speaker, my colleague is especially concerned about people dying when they are not critically ill. However, the Supreme Court has given direction to the government to take care of those who are critically ill and need assistance in dying, and to follow the procedures, which we have to now include in the bill, to ensure those procedures are followed by doctors, nurse practitioners, and those who execute the law.

We talk about assisted dying and about the laws being properly executed. Doctors and others who are involved in providing these procedures, maybe the prescription provider as well, all have the right to provide their duties freely without fear of being penalized later.

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

Mr. Speaker, could the member elaborate on the importance of establishing the legal framework by June 6? We believe this is very important. At the beginning of his comments, the member talked about the Supreme Court of Canada decision. That decision means we need to have legislation passed by June 6. Perhaps he would like to provide further comment on this importance of this as we will be voting on this shortly. We all have a responsibility to address the Supreme Court of Canada's decision.

[Ramesh Sangha, Liberal, Brampton Centre, ON]

Mr. Speaker, we are facing a timeline. The instructions given from the Supreme Court gave a June 6 deadline. That limitation period is looming over our heads. We should respect the Supreme Court order.

However, at the same time, we are trying our best to meet those limitations. As I already said in my submission, the House has tried its best to meet those requirements. Every member has their own part and parcel to play in the debate. Now, at the final stage, when we are prepared to make it law, we should work together to ensure the bill comes into force, as per the requirement of the Supreme Court.

[Ziad Aboultaif, Conservative, Edmonton Manning, AB]

Mr. Speaker, the hon. member urged us at the end of his speech to vote for Bill C-14. I would like to ask him if he could outline three good reasons why we should.

[Ramesh Sangha, Liberal, Brampton Centre, ON]

Mr. Speaker, first, the important thing is to have legislation in place to give safety to those who assist a person in dying. They should have clear safety in that they are not committing culpable homicide. The Supreme Court has already said we should do that.

Second, there is a requirement that there be maximum information obtained so more and more improvements can be done on these regulations by the health minister from time to time.

Third, as we know, if there is a failure to comply with the legislation, we should have the best provisions so we can make amendments to punish those who do not comply properly with the law.