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

[Tom Kmiec, Conservative, Calgary Shepard, AB]

Madam Speaker, I was worried that the member had almost become mute after the Manitoba election results.

The previous government called national consultations and started the process of hearing from Canadians on what they wanted to see in the bill. It is an excuse to say that the timetable is so short. A few months have gone by since October 19. The current government could have tabled a bill and we could have considered it. We would have had much more time for a fulsome debate.

The answer is simple. The government should have simply tabled a bill back in December or January to get the process started. The Liberals knew the deadline and they knew when would be too late. Instead, they have chosen to table a bill so far along the process that requires us to have shortened debate and a shorter review time.

[Sheila Malcolmson, NDP, Nanaimo—Ladysmith, BC]

Mr. Speaker, I heard a lot of agreement, but I want to reflect on the correspondence I am getting from people in my riding of Nanaimo—Ladysmith.

One writer said, “I want to have the choice how and when I am ready to die. It is not simply a matter of providing palliative care facilities, but we should definitely have more and better hospice care in people's homes as well as residential hospice within the community. I consider it a basic human right and though it is of essential importance to me in my senior years, I believe that people of all ages should be supported in facing their own end.”

This is an issue that has gone on for a long time and my sense is this Parliament and people are ready to decide. However, following up on my colleague's comment across the aisle, the Conservatives had opportunities to consult, but slowed and slowed.

I think all parties recognize that the Quebec leadership on this issue, so far as thorough and complete consultation, is to be admired. After the Carter decision and while they were still in power, why did the Conservatives not take the initiative and do the consultation we needed?

[Tom Kmiec, Conservative, Calgary Shepard, AB]

Mr. Speaker, obviously I was not a member of the government in the previous Parliament, but the Conservatives called for national consultations, appointed a panel and heard from Canadians on what they wanted to see in the bill. Again, the current government could have tabled a bill in December or January and kicked off the process in the House to ensure we would have enough time to get it to committee, have a fulsome consideration of section by section and leave enough time for the Senate to also contribute to the debate.

We can debate whether the timelines were good or not, but they are what they are. We have until June 6 to report back and have a bill that is passed by both Houses of Parliament. The most important thing is the content of the bill. That is what we are debating. We are not debating whether the timelines are appropriate. It is the content, the safeguards and conformity with the Carter decision that are important.

[Raj Grewal, Liberal, Brampton East, ON]

Mr. Speaker, I rise today to speak to Bill C-14, an act to amend the Criminal Code and to make related amendments to other acts regarding medical assistance in dying.

I would like to start by saying that I value and recognize the deeply personal and difficult nature of this topic for many across our great nation. We all know at least one person who has passed, or may pass, in intolerable pain. It is difficult for families to witness their loved ones suffering, but more so for the patient who has no control over his or her situation and believe he or she should have a choice for a peaceful death. This, my friends, is the reason we need to have this discussion and pass this legislation.

Many of our colleagues on both sides of the House and in both chambers have worked diligently over the last few months on the Special Joint Committee on Physician-Assisted Dying in order to help create a comprehensive framework that upholds the essence of the Supreme Court's decision as a result of the Carter case. This decision balances different interests and protects vulnerable persons. I would like to thank all of our colleagues on the joint committee, their staff, library analysts, the clerk, and all of the witnesses who appeared and sent briefs to the committee.

This is not an easy topic on which to give, hear, or read testimony day in and day out, and for many it can take an emotional toll. At the same time, witnesses who contributed to the consultations should be commended for being a valuable part of Canada's history, as we shape this nation's law to allow our citizens to die with dignity.

Just last year, a provincial and territorial advisory group on medical assistance in dying was established, with most provinces and territories participating, led by Ontario. This shows the need for and interest in adapting our laws to allow for death with dignity.

Included in this report is the unequivocal call for amendments to the code to allow for assisted dying by regulated health professionals and to protect these professionals while they do it. We look forward to working with these territorial and provincial partners. It is also why, as part of our budget, we have put a multi-year health accord forward, with the federal government's commitment to providing $3 billion over the next four years to improve home care and palliative care.

On February 6, 2015, the Supreme Court of Canada unanimously declared that the Criminal Code prohibitions against physician-assisted dying were unconstitutional when considering competent adults who clearly consented to die, who were suffering, and where death was reasonably foreseeable. I would like to quote a vital part of that SCC ruling. It states:

It is a crime in Canada to assist another person in ending her 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: she can take her own life prematurely, often by violent or dangerous means, or she can suffer until she dies from natural causes. The choice is cruel.

This highlights the core of this issue, and the special joint committee showed it understood the Supreme Court's points. The report of the committee illustrates this, and I will quote from it. It states, "Our response to the Carter ruling must be focused on the needs and wishes of patients. The Committee was unanimous in recognizing the overarching need to have safeguards to protect the vulnerable.”

Therefore, the objectives of this legislation are comprehensive and adequately balance all the core elements of the discussion on this topic, some of which are: recognizing personal autonomy and dignity; recognizing inherent and equal value of every life; setting out eligibility for competent adults where death is reasonably foreseeable and who are suffering intolerably; balancing different interests, including personal autonomy toward the end of life and the protection of vulnerable persons; and encouraging a consistent approach across Canada.

Bill C-14 incorporates the points made by various stakeholders, including doctors and nurse practitioners, patients and families, civil rights groups, leading experts, faith-based groups, provincial and territorial governments, and more.

To enable access to medical assistance in dying, the Criminal Code will be changed so physicians, nurse practitioners, and those who help them can provide eligible patients assistance in dying without the risk of being charged with assisted suicide or homicide. There will be safeguards to ensure those who receive medical assistance in dying are eligible, can give informed consent and can voluntarily request it. The foundation will be laid for the Minister of Health to make regulations to establish a process for monitoring and reporting on the use of medical assistance in dying. It is crucial that the ability to provide assistance in dying is not limited to physicians.

Nurse practitioners are an important part of this framework if we are to provide all Canadians with equitable access to a peaceful death. Nurse practitioners have the authority to deliver many of the same medical services as family physicians. They can assess, diagnose, prescribe and treat patients. They can act independently in every jurisdiction, except Quebec, where they practice under the authority of a physician. That is why they are covered under Bill C-14.

In order to ensure the safety of all vulnerable persons, we have included the following safeguards that must be respected: a medical opinion to ensure the patient meets all of the established criteria; a second independent medical opinion; a request in writing or by proxy before two independent witnesses; the right to withdraw the request at any time; a 15-day waiting period, unless death or loss of capacity is imminent; and, consent must be confirmed immediately before medical assistance in dying is provided.

As a government that values the power of evidence-based decision making, the provisions regarding monitoring will be critical for transparency and public accountability of medical assistance in dying, as well as to evaluate whether the law is achieving its goals of respecting the autonomy of eligible persons to choose medical assistance in dying while protecting vulnerable persons and the conscience rights of health care professionals.

Nearly all jurisdictions that permit a form of medical assistance in dying have established monitoring systems for these purposes. The government would work with the provinces and territories in developing these regulations and in establishing an interim system until a permanent process is in place. As the legislation stipulates that there must be a parliamentary review in five years, the data collected from monitoring will be essential to improving the law.

There are those who say this legislation does not go far enough. We have listened carefully and appreciate their input and passion for a thorough framework for medical assistance in dying. It is their tireless advocacy which will ensure that we have the best possible legislation regarding this very sensitive issue.

With that being said, at this time not enough is known about the risks or benefits of medical assistance in dying for minors. We could certainly use more time to study this, as well as advance requests when mental illness is the sole underlying medical condition for requests.

These are important parts of the issue that cannot be written in hastily. They will be studied independently once this bill is passed so we meet our responsibility as a government to protect all vulnerable persons from any potential abuses or error.

To conclude, we do not have an easy task ahead of us. However, most things worth doing are not easy. We each have been elected to make difficult decisions and work hard to do what is best for our constituents and all Canadians. Canadians have spoken loudly on this issue, and we know that a majority of them support medical assistance in dying. We owe it to them to vibrantly debate and pass this legislation in order to allow Canadians a choice in how they end their lives.

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

Mr. Speaker, the member wrapped up by referencing opinion polls. Of course, we know Canadians support strong safeguards, including conscience protection. There will be some form of assisted suicide in this country going forward, but Canadians want to see us do the hard work of putting in safeguards.

The member talked specifically about the court decision. He would know that when the court granted the four-month extension, it put in place a system by which people could still, in the interim, seek euthanasia or assisted suicide, but they needed to go before a judge to do that. The court in its wisdom understood the need for some kind of system of legal review.

With ambiguous criteria, the absence of advanced legal review, and allowances for people to go from doctor to doctor until they get the right outcome or the outcome they want, this is not a system for ensuring that any kind of meaningful check occurs at all.

Would the member agree with me, and agree, frankly, with the direction the court seems to have given us when they granted the extension, that we should have some kind of system of advanced legal review by competent authority, and it would not have to be onerous, to ensure that whatever criteria are in this legislation are actually met in every case?

[Raj Grewal, Liberal, Brampton East, ON]

Mr. Speaker, the government has laid out a clear framework to ensure that the most vulnerable people in our society are protected. For mentally competent adults who are in an advanced state of irreversible decline and capability, have a serious and incurable disease, and for whom death is reasonably foreseeable, there will be not one but two medical opinions by independent witnesses.

We have also stipulated that we will be working with the provinces and territories to ensure that we have regulations that are in the best interests of all Canadians.

[Sheila Malcolmson, NDP, Nanaimo—Ladysmith, BC]

Mr. Speaker, we want the bill to move forward. We want this medical service to be accessible to all. We also want to get the details right.

During the election campaign, the leader of the Liberal Party issued a statement that told us that he believed the Supreme Court made the right decision and that Canada's laws must be consistent with the court's ruling, because that is the right thing to do.

If experts who testified in the Carter case find that in fact the outline of the bill is not consistent with the court's direction and ruling, will the Prime Minister and his party still support the direction of this legislation, or will they bring forward amendments at committee in order to bring it in line with the Supreme Court ruling? Will they seek a reference to the Supreme Court to ensure that their proposal is completely charter compliant?

[Raj Grewal, Liberal, Brampton East, ON]

Mr. Speaker, Bill C-14 represents a direct response to the Carter ruling. It sets out a framework to ensure that we have assisted dying in this country within a framework that ensures we protect the most vulnerable people from abuse.

On second reading, the Attorney General said the government will be putting forward, publicly, the documents that examine the charter impact of the bill for all Canadians and this House to look at as well.

We will be working with the provinces and territories to ensure that we have regulations to protect this framework, because this is a very sensitive issue for all Canadians. This bill is a great response to the Carter ruling, and the parliamentary review after five years will ensure that this issue keeps building forward.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

Mr. Speaker, I heard the member talk about the details for the physicians and nurse practitioners making decisions.

I am wondering if the member would agree that the legislation puts the onus on the provinces, and in particular, the regulatory bodies. By doing so, it opens the doors for different regulatory decisions across Canada and these will not be uniform and consistent across the country.

[Raj Grewal, Liberal, Brampton East, ON]

Mr. Speaker, my hon. colleague is well aware that health care is a joint federal and provincial jurisdiction, and as a federal government, we have to work with our partners, the provinces and territories, to pass this legislation and set a framework.

We clearly stated that we are willing to work with our partners to ensure that in Canada our confederation works best for all Canadians, especially on issues such as physician-assisted dying, and that we have the best interests of Canadians at heart.

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

Mr. Speaker, I am very proud to take part in this debate as the representative for the people of Timmins—James Bay.

This is a historic debate for our country. The issue of medical assistance in dying is very complex and very personal. As parliamentarians, we have a duty to work together, strike a balance, respect the Supreme Court ruling in Carter, put in place the necessary protections for vulnerable individuals and seniors, and, lastly, introduce a national plan in order to guarantee access to palliative care.

At the beginning of this discussion, I think it is very important to put on the record that none of us come into this discussion with any level of moral superiority. This issue affects every single one of us. It affects our families. We cannot discuss this issue without putting it through the prism of our own personal lives and the lives of the people we know.

During this very time that the discussion has been going on, I was in the hospital with someone very close to me. The doctors said that there was nothing more to be done, they would have to go to hospice, and there were only days left. This person who is very close to me said that if they only had days, they were getting their hair done and were going to buy some nice shoes, $600 shoes. Being from a Scottish family, that was quite shocking. They said if they only had days, they were going to go out and have a nice dinner. Those days have turned into weeks.

Every day is a miracle. That is something we need to recognize. The power and the will to live is so incredible. We have to support it. We also have to recognize those who are living with intolerable pain, and be respectful of those whose hopes for the future are so crushed by debilitating illness. It puts us in a very special position, to be careful.

I want to say at the outset that I respect the importance and supremacy of the Supreme Court in our country, but I think it made a fundamental error and mistake in its treatment of the Canadian people. I think it was responding to what it felt was the last government's refusal to respond on a number of court decisions, so it put a firm timeline on Parliament to act.

It would have been fair for the Supreme Court to recognize that in October there was an election, a new mandate, and a new government. That government should have been given the opportunity to take this discussion across the country. This discussion should not be dealt with simply within this Parliament. This discussion should be a mandate that every Canadian is able to participate in. It is very unfortunate, and nobody will ever accuse me of giving the government a free pass, but the government's hands have been tied in a very unfortunate manner, in that we have to have this legislation passed by June.

For those who are very concerned about this legislation and in listening to some of my Conservative colleagues, I would warn that if Parliament does not act and if Parliament does not set the parameters for this legislation, we will then see a legal vacuum. The decisions on medically assisted death are already being made by the courts across this country. They are stepping into the vacuum that exists now.

It is incumbent upon us to respond. It is not good enough to say that we will fight this, that it is not the Supreme Court's job, and that Parliament should take back control. People can say whatever they want, but at the end of the day if we do not act by June, there will be a legal vacuum in this country. I would tell any of my colleagues who are very concerned about this legislation to just watch what happens in a legal vacuum, where others go back to the Supreme Court saying that they want to expand the rules much further.

Where does that bring us? One of my concerns is that if we are going to talk about the right that people have, the constitutional right, wherever they are in this country, to end their life if they are in medically difficult circumstances, how can we have that discussion without saying that people also have the right to quality palliative end-of-life care?

Across this country, only 16% to 30% of Canadians are able to access quality palliative care. Only six provinces have palliative care definitions under their framework. In fact, only four provinces actually even have a palliative care framework. There is a patchwork across this country.

We respect, within the House, that much of the health care services are delivered through the provinces, but the federal government has a fundamental role to play in working with the provinces. This is why the New Democratic Party pushed in the last Parliament for a national palliative care strategy, respecting the provincial and territorial jurisdictions but working to find ways of establishing proper palliative services. Pretty much every parliamentarian voted for that, yet we have seen no action. We have seen no action from the present government, which is a fundamental mistake if we are talking about having this legislation in by June.

Today is the first day I have ever heard someone from the government talk about their election promise that was supposed to be $3 billion. Well, that $3 billion is not happening now. Again, we are putting that to some time in the future. That is not acceptable. I have heard people talk about cruel limited choices and compassion, but it happens all the time. If someone is living in a rural area in Northern Ontario and are sick, and their children are living in Alberta or B.C., they are having to make some pretty tough decisions on their own. I have dealt with them in my office, and that lack of access to quality palliative care is heartbreaking.

The New Democratic Party has pushed Motion No. 46 in this new Parliament, which calls for the establishment of a pan-Canadian palliative end-of-life strategy. It has already been supported by Parliament, but we have not seen any action on it. We are asking for that to be moved now, to re-establish the secretariat on palliative and end-of-life care, with dedicated funding. That could have been done in this budget and it could still be done now to implement a national awareness campaign on end-of-life care so that people can have this discussion. I have been hearing lots of talk about how important it is to have this discussion in the House, but the federal government can play a role in furthering the discussion.

The other area is EI benefits for compassionate care so that people are able to look after their loved ones. Finally, there is a huge area of jurisdiction under the federal government, where it delivers health services to indigenous people, people in the military, and people in prisons.

Section 12.1 under the federal health act says that under no circumstances whatsoever, when someone is dying on a reserve and is being flown out for their final hours, will their spouse be allowed on the plane with them. They are to die alone. Under section 12.1 of these standards, it says it cannot be appealed. The first rule in the health standards says under no circumstances will compassion be accepted. That could be changed tomorrow. The health minister could stand up and say it is an unacceptable, cruel standard that the federal government would allow an elderly person to die alone without their life partner there, and that they would have written into the legislation that under no circumstances would compassion be considered a reason for letting someone be with them when they die. What kind of nation are we, if we think that is a perfect bureaucratic standard? It is not.

Therefore, if we are going to have this discussion about allowing people with incurable suffering to make that choice, and if we are going to make it available nationally, then it is incumbent upon the House to say that every family that has a loved one who is suffering will have the support they need, because how we come through death as a family is how we find ourselves. We either come out through these deaths stronger and closer together, or sometimes we see families breaking apart because of the strain that is put on them by a system that has failed them again and again, and when they needed it in the most vulnerable moment in their lives.

I am asking my colleagues. We could rise to a higher level in the House. We could rise to what we are called to do, which is to establish a vision for our nation. This is an opportunity, but it is going to have to move beyond simply this legislation. It is going to have to be done in conjunction with a plan for palliative care across the country.

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

Mr. Speaker, I appreciate many of the comments on the issue of palliative care. As a former health critic in the Province of Manitoba, I spent a good number of hours meeting and talking with individuals who were very much concerned about the need for expanding palliative care. This is an issue that all provinces, as they try to deal with their provincial budgets, have to come to grips with. It is not an easy issue.

The Minister of Health and the Prime Minister have made the commitment, and we want to demonstrate strong leadership on this file. We are talking about $3 billion. We are talking about the issue of a health care accord renewal. The last time that took place was back in 2004.

There is an opportunity for us as parliamentarians to recognize that we need to invest in palliative care, but at the same time would the member not agree that it is absolutely critical that in demonstrating this leadership we also need to work with our provincial stakeholders and others to ensure that we are providing a service, so that it does not matter what region in the country, there is some level of basic palliative care for all Canadians?

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

Mr. Speaker, certainly the reason we passed the palliative care strategy in the last Parliament was that one of the key first lines was to work in conjunction with the provinces and territories, but we have not seen that action. There was no action on the call for establishing the palliative care strategy. We can talk about it, but unless we establish a palliative care strategy or unless we put in the secretariat, this is just talk.

Yes, it is $3 billion, but there was nothing in the budget. There were zero dollars in the budget to deal with the shortfalls in health care.

My colleague can shake his head all he wants, but an election promise does not make palliative care. Palliative care is made by political will, and political will needs someone to stand up and say in a budget or a throne speech that we will establish that secretariat and we will make this happen.

So far, today has been the first time the Liberals have announced it. Lo and behold, guess what we are discussing. We are talking about medically assisted death and suddenly there is all this will on the other side. However, that will is the power of the government.

I would ask the Liberals, where were the dollars for health care for first nations under their jurisdiction when we got zero dollars to augment the huge shortfall? On palliative care, the Liberals can talk all they want, but they are going to have to put the structures in place and they have not done it yet.

[Jim Eglinski, Conservative, Yellowhead, AB]

Mr. Speaker, the hon. member mentioned quite a bit about the vacuum that may come about if this does not happen. I would like his opinion on what would happen if this House votes the bill down.

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

Mr. Speaker, I think it would be incredibly irresponsible if we told the Supreme Court that we have taken our opportunity to respond to it and we are not going to do it. Is the Supreme Court going to sit around and say that is perfectly reasonable? The Supreme Court will say that we had an opportunity to draft legislation with clear rules and clear limits, and in that vacuum other decisions will be made.

There will be groups that will come forward and will challenge the Supreme Court and say that they saw the Carter decision and they do not think it goes far enough and they want to establish further rights. Those rights would be established because Parliament has made it known under the mandate. I believe that we should have had more time, but we do not have more time. If we are telling the Supreme Court that we are not going to take our responsibility here in the House to draft legislation, in that vacuum, a lot of steps are going to be taken and members of Parliament are not going to be able to do anything except get up and make their Standing Order 31 statements to rail at the Supreme Court once again.

It is our responsibility; we have that duty, and we can do it now. I would say we all work together, because we are all in this together. We have to come out with legislation. Otherwise, that vacuum is going to be, potentially, very socially difficult and maybe destructive.