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.

[Luc Thériault, Bloc, Montcalm, QC]

Thank you, Madam Chair.

I would like to thank the witnesses for their valuable contributions. I will address Dr. Naud, Judge Rochon and Mr. Roberge.

Mr. Roberge, do you believe that Bill C-7 would lead to as clear a challenge as with Bill C-14? Are there provisions in Bill C-7 that could infringe on the rights guaranteed under section 7 of the Canadian Charter of Rights and Freedoms and therefore be challenged in court? I am not asking for a thesis in response, just your quick impressions.

[André Rochon, Retired Justice of the Québec Court of Appeal, As an Individual]

Ladies and gentlemen, thank you for your invitation and for this opportunity to share with you our committee's thoughts on advance requests for medical assistance in dying.

In the name of a strong consensus in the country and in order to protect the autonomy and dignity of the person, I propose that the bill before you be amended immediately to give any person suffering from a major neurocognitive disorder such as Alzheimer's the right to MAID. The urgency of the matter is clear to me. In this regard, allow me to provide a brief reminder of the elements that led us here.

In 2015, the Carter decision set out the cardinal rule that, in exercising an individual's right to life, liberty and security of the person, every person must be free to make his or her own fundamental decisions without interference by the state.

Bill C-14 was passed in 2016. It provides for the formation of an expert panel to study three situations, including that of advance requests for MAID.

In 2018, this expert panel stated the following regarding advance requests:

Having some assurance that their request for MAID would be honoured could provide comfort and relieve anxiety and distress at end of life for those who make this choice.

…

Allowing ARs for MAID might have an impact on the way society values people with capacity loss, increasing stigma and signalling that it is acceptable to consider a life with capacity loss as one not worth living.

In the face of the suffering and distress of all those who receive such a diagnosis, the question is no longer whether the compassion of Canadian society should grant us MAID. The time has come to define the parameters for the granting of this assistance and to put in place guidelines both to ensure the protection of potentially vulnerable people and to respect the clearly expressed will of the person affected.

So when a person receives such a diagnosis, which is likely to progress to severe dementia, they must be allowed to give an advance directive to request MAID when their situation has reached a serious and irreversible stage, provided that the person meets the following criteria: a) they are eligible for government health care; b) they are at least 18 years of age; c) they must be able to express their will freely, without external coercion or undue influence, and must not suffer from a mental condition that affects their judgment; d) a physician must certify that the person meets the above criteria when signing the advance directive.

To be valid, this directive must be renewed in writing after a six-month waiting period from the signature of the initial directive, ensuring that the four previous conditions are still met. This period is an important guideline, which provides a sufficient period of reflection for the person affected and ensures that the decision was not made impulsively or without sufficient reflection.

It goes without saying that this directive may be revoked at any time in writing, as long as the person is capable of doing so. The representative may ask the multidisciplinary team to begin the evaluation process as soon as it has reason to believe that the advanced stage of the disease is reached.

As an added precaution, the directive should be written in a prescribed form. I have appended to my presentation synopsis a template of this directive.

What you are being asked to do today is to provide a choice for anyone diagnosed with an Alzheimer's-type neurocognitive disorder. It isn't a matter of imposing a course of action, but rather of putting in place the necessary guidelines for exercising this choice.

Inspired by our values, this citizen is asking the government to come to their aid and provide them with the necessary care to relieve their suffering, preserve their dignity and respect their decision.

Thank you.

[Dr. Jennifer Gibson, Director and Sun Life Financial Chair in Bioethics, University of Toronto Joint Centre for Bioethics, As an Individual]

Thank you so much for the invitation to join you today. As noted, I'm affiliated with the University of Toronto, but in 2015 I co-chaired the provincial-territorial expert advisory group on physician-assisted dying. In 2017-18, I was co-chair of the Council of Canadian Academies' expert panel on medical assistance in dying, and chaired the working group on advance requests for MAID. Today I am speaking as an individual drawing from these experiences and my disciplinary background in ethics and health policy.

I had the privilege to meet with this committee in spring 2016 in relation to Bill C-14. Over the last few weeks, I've been reflecting on how much has changed in four and a half years and how better prepared we are to contemplate amendments to the legislative framework for MAID in Canada with some confidence. In 2016, we did not have any Canadian experience to draw from, and relied on experience from other jurisdictions. We did not yet have systems and care processes in place to offer MAID to eligible persons and needed to build these. We did not know what actual effect the introduction of MAID would have on Canadians. Would it displace palliative care? Would it make people more vulnerable and not less?

Today, with the benefit of almost five years' experience, we have learned that MAID can be provided safely and compassionately to Canadians. We have Canadian evidence to draw from. We have the lived experience of Canadian families, caregivers and clinicians to shed light on its practice. We have heard from community groups and individual citizens about how, and to what extent, MAID fits within a continuum of supports for persons who are suffering.

Bill C-14 sought to outline a legislative framework, including eligibility criteria and procedural safeguards, but sought ultimately, to the greatest extent possible, to respond to Canadians' suffering whilst balancing the autonomy of persons seeking MAID on the one hand and the interests of vulnerable persons in need of protection and those of society on the other. The project of striking the right balance of these values-based commitments continues today.

Many of the comments from witnesses and organizations who have appeared before this committee have drawn attention to the suitability and appropriateness of key safeguards, both those that are in the current legislative framework and those that are being contemplated in Bill C-7. Such current safeguards, such as the 10-day reflection period and the requirement of final consent, were introduced in order to ensure that only those Canadians who wished MAID actually received it and to protect and promote their autonomy.

Experience of the last four and a half years has shown that the effect of the safeguard may not have been what was originally intended. On the one hand, we have heard from clinicians about some patients who have forgone pain medication and endured preventable suffering in order to sustain their capacity to provide final consent. On the other hand, we have also learned from clinicians, families and caregivers that persons seeking MAID are most often not ambivalent about their choice. In the words of a member of the public who emailed me in December 2015 and who was facing a life-limiting illness, “no patient is going to reach such a decision and request lightly”. Hence, the removal of the 10 clear days and final consent seemed to be a good step forward toward striking a new, appropriate balance in safeguarding Canadians who have already been found eligible for MAID.

There is little doubt about the importance of safeguards to protect vulnerable persons who might, as per the original preamble to Bill C-14, be induced in moments of weakness to end their lives. A lesson we may draw from our experience of the last four and half years is that in developing safeguards, we must be especially attentive to the potential impact of the safeguards, notwithstanding their intent to protect. We must be especially wary of a safeguard if it may reasonably have the effect of rendering some persons more vulnerable. The protection of vulnerable persons turns on safeguarding competence, voluntariness and consent. Exclusion of otherwise competent persons may be justifiable in limited circumstances if there is a strong case to be made from the perspective of justice. Failing this, though, these exclusions violate the autonomy of competent persons of such groups and unjustly force these individuals to remain in a state of enduring and intolerable suffering.

For these reasons, we may wish to consider whether the 90-day reflection period will, in fact, be protective or may instead contribute toward enduring suffering of persons who are already found to be eligible for medical assistance in dying.

[Michael Cooper, Conservative, St. Albert—Edmonton, AB]

Thank you very much, Madam Chair.

Let me just say, as the Conservative who was at the subcommittee meeting, that at no time was it my position that four meetings followed by two meetings of clause-by-clause was adequate. I think, based upon the testimony that we heard today, it's become clearer that it is insufficient and that more time is required.

I know, having served on the Special Joint Committee on Physician-Assisted Dying and then on the justice committee with you, Madam Chair, during the study of Bill C-14, that there was a very thorough process. It not only resulted in more meetings, but longer panels.

This is a very condensed process. It's one of the most complex areas that Parliament could possibly legislate. I think Mr. Moore's motion to simply require an additional two meetings would provide an opportunity for this committee to do its due diligence without, in any significant way, running up against the clock that the government is concerned about.

Again, with respect to that clock, the government wouldn't be in this situation had it chosen not to prorogue Parliament. Thank you.

[Dr. Catherine Frazee]

Absolutely. There was a delicate balance between autonomy and equality struck in Bill C-14. If Bill C-7 proceeds, that delicate balance will simply no longer exist. It is a nightmare scenario, both in terms of the message it will send and in its immediate consequences.

Sorry.

[Rob Moore, Conservative, Fundy Royal, NB]

Dr. Frazee, we heard prior testimony today from Krista Carr from Inclusion Canada. She described this situation now as the “worst nightmare”. That's pretty strong language for those persons with disabilities. What is the government missing here in what I think is an overreach in this response?

Our position was that this should have been appealed. It was a lower court decision in Quebec and it should have been appealed. When you have a brand new bill, as Bill C-14 was, it's the government's responsibility to defend its legislation and at the first instance, it gave up on its own legislation and the safeguards that were in it.

I'd ask you to speak to why this would be described as the worst nightmare for those persons with disabilities.

[Rob Moore, Conservative, Fundy Royal, NB]

Thank you, Madam Chair.

Thank you again to all of the witnesses. There has been very informed and relevant testimony today. It raises grave concerns with me about the sufficiency of the amount of time the government has put forward to deal with this legislation. I feel that we should be having more meetings of this committee because we're hearing new perspectives now that we haven't heard in previous testimony.

It's been put out there that there's been some kind of unanimity and great support among the medical community, but, Dr. Frazee, we've seen a letter signed by almost 800 doctors who have expressed serious concerns about how Bill C-7 opens up the medical assistance in dying regime in Canada. I want you to comment specifically on something.

Bill C-14 had a number of safeguards in it. After the Truchon decision, the government responded with Bill C-7, but in doing so, it has stripped out a number of safeguards that it didn't have to: the 10-day reflection period, the requirement that there be two witnesses—things that could provide an element of safeguard for those who are engaged in this process. I'd like your comments on that, because I think it's greatly troubling when we see safeguards that were put in place very recently and then, at the first instance, we're stripping them away.

[Luc Thériault, Bloc, Montcalm, QC]

Thank you, Madam Chair.

I will be quick, as I have only six minutes.

I first want to say to all the witnesses that I am very sensitive to their plea for better care. It is essential to continue calling for this. As I have already said several times, deficiency, whatever kind it may be, does not have to lead to a disability. A disability is a social issue, but a deficiency is not. So I am very sensitive to this fight and to what you have told us today.

However, the terms must be defined. Mr. Racicot, I really like the name of your network, Living With Dignity. It seems to me that living with dignity is above all about having the ability to exercise at any time our freedom of choice, our free will, our capacity for self-determination, especially in medical decisions. The idea is to be able to give free and enlightened consent without anyone affecting it.

That said, I have seen two issues in your brief's conclusion, and I will read to you the penultimate paragraph:

This legislative project, like those that paved the way for euthanasia in this country, gives the false impression that a person's dignity is essentially dependent on his or her autonomy. By administering medical assistance in dying to the person who requests it, one would supposedly respect his or her dignity (a dignity, however, that is inherent in every person, irrespective of their degree of autonomy). In such a discourse, it is implied that in order to die with dignity one must necessarily die earlier, from a death that is administered, chosen and above all anticipated. What a sad state of affairs.

It is indeed a sad state of affairs. However, the issue is that the Quebec Superior Court itself struck down legislation currently in force that stems from former Bill C-14 and evoked the same reasons—that it was forcing the individual to commit suicide, to put an end to their life before they had even reached their own tolerance threshold, which was violating the individual's right to life.

It should be pointed out that the autonomy discussed here is not physical in nature. I hope that is not what you are referring to. In fact, physical autonomy is only a condition fostering moral autonomy. Psychological autonomy is a necessary condition. When an individual loses their cognitive abilities, they can make no moral, practical or adequate judgment, so they cannot provide their free and enlightened consent.

You will agree with me that physical deficiency has nothing to do with autonomy, as defended here, in this bill. I hope you will not confuse all this.

[Michel Racicot]

Thank you, Madam Chair.

As a lawyer and former president of the Living With Dignity network, I thank you for giving us this opportunity to share some observations. I will be very brief, as everything else is provided in our brief.

The Living With Dignity network was founded in 2010. This is a citizen network of over 5,000 allies that is closely following the evolution of end-of-life care in Quebec and in Canada. We have been there for all the stages, including the latest cases such as Lamb and Truchon.

Unfortunately, since the provisions on medical assistance in dying came into force in 2015 in Quebec, and in 2016 in the rest of Canada, we have been seeing increased relaxing of the safeguard measures, be it stemming from court rulings or the interpretation of those who implement medical assistance in dying.

We understand that the Government of Canada must now amend its legislation, but Bill C-7 goes much further by making numerous changes to safeguards that had, however, been deemed necessary in June 2016. I feel it is really dangerous and rushed to do this right now, during a pandemic, when the consequences of the current safeguards have not been analyzed in the review of current legislative provisions, which should begin soon. So we are asking that those safeguards be kept for everyone who is at the end of their life.

Concerning provisions that affect those who are not at the end of their life, we have heard the message from the entire community of persons with disabilities and their advocacy groups. They raised the same issue on Bill C-14 when the Senate proposed removing the end-of-life criterion. They are mostly ignored now, given the proposed amendments.

It is hard to understand how the federal Parliament can adopt the proposed measures, which would make Canada the most permissive country in that area, while making fine statements of principle in the preamble of Bill C-7, as it had done in the preamble of Bill C-14.

Finally, given certain court rulings that have undermined caregivers' conscientious objection, especially in Ontario, it would be desirable for the current legislative provisions to be strengthened to clearly stipulate that nothing in this bill can force anyone not only to practise medical assistance in dying or to assist someone in that practice, but also to refer an individual who is asking for medical assistance in dying to a colleague who does provide that service.

[Dr. Heidi Janz]

Justice committee, I appear before you as the chair of the Ending-of-Life Ethics Committee of the Council of Canadians with Disabilities, a national organization with a mandate to preserve and promote the human rights of people with disabilities.

I feel compelled to spend a few precious moments of my allotted time to register my concern, indeed my alarm, at the breakneck speed at which this committee is operating. This committee has been convened to study the potential impacts of expanding eligibility for medical aid in dying to include ill and disabled people who are not dying. Those in charge of this committee are very aggressively rushing the important and complex work of the committee. All of this is happening in the middle of a global pandemic, when our focus as a country has been on taking measures to protect the lives of our most vulnerable citizens. At best, this is extremely ironic; at worst, it is hypocritical, irresponsible and extremely unethical.

As someone who relies on assisted and augmentative communication, I had to request additional time beyond the two and a half minutes allotted for my testimony. This incident illustrates the reality of systemic ableism within a society designed by, and for, typically functioning people. Ableism causes the support needs of people with disabilities to be viewed as excessive and unsustainable. This has enormous and very dangerous implications for the expansion of MAID.

Disability scholar Veronica Chouinard defines ableism as “ideas, practices, institutions, and social relations that presume able-bodiedness, and by so doing, construct persons with disabilities as marginalized...and largely invisible 'others'.” Like racism and sexism, ableism classifies entire groups of people as “less than”, and perpetuates harmful stereotypes, misconceptions and generalizations about people with disabilities. Unlike racism or sexism, however, ableism remains, in the words of Canadian disability scholar Gregor Wolbring, “one of the most societally entrenched and accepted isms.”

People with disabilities are at a higher risk of suicide due to systemic and internalized ableism, yet they face substantial barriers when trying to access suicide prevention services. Medical professionals overlook typical sources of stress. Problems arising from relationship breakdowns, depression and isolation are wrongly attributed to disability. The removal of “reasonably foreseeable” natural death as a limiting eligibility criterion for the provision of MAID will result in people with disabilities seeking MAID as an ultimate capitulation to a lifetime of ableist oppression. In a truly just and progressive society, suicide prevention measures should be applied equally to all people.

More and more Canadians with disabilities find themselves in extreme financial distress as the pandemic drives up costs while already meagre provincial income supports remain stagnant. What’s more, some provinces have recently been publicly musing about reducing, or altogether scrapping, their income support programs for people with disabilities. Recent news reports indicate that some people with disabilities living in poverty are being driven to end their lives through MAID because they lack the means to survive. Physicians report that patients with disabilities are requesting MAID upon learning that the wait time for accessible housing with the supports they require is 10 years or more.

Given the demonstrated ongoing prevalence of ableism in Canada, the Council of Canadians with Disabilities is recommending the following amendments to Bill C-7 in hopes of limiting the bill’s capacity to weaponize ableism in this country.

One, the receipt of adequate housing, income support, palliative care and home-based services should be prerequisite eligibility requirement for MAID. The onus for providing these supports at the level required must fall on governments. A person with disabilities should never bear the burden of trying to lobby for adequate supports.

Two, refer to the Supreme Court of Canada, by way of constitutional reference, Bill C-14’s existing protections limiting MAID to cases where a person’s natural death is reasonably foreseeable.

Three, any changes to Canada’s MAID law must meaningfully respond to last year’s end of mission statement by the United Nations special rapporteur on the rights of persons with disabilities, wherein Ms. Catalina Devandas-Aguilar communicated her serious concerns about “significant shortcomings in the way [all levels of Canadian government] respect, protect and fulfill the rights of persons with disabilities”. Specifically, she noted that there was a lack of “protocol...to demonstrate that persons with disabilities have been provided with viable alternatives when eligible for assistive dying”, and that she had received “worrisome claims about persons with disabilities in institutions being pressured to seek medical assistance in dying, and practitioners not formally reporting cases involving persons with disabilities”.

Four, Canada's amended medical assistance in dying law should follow the judicial directive of the SCC in the Carter decision, which required a “carefully-designed system” that imposes stringent limits that are “scrupulously monitored and enforced.”

Five, remove Bill C-7's provision allowing a disabled person's health care or personal care provider to be an eligible witness to that person's request for MAID.

Six, retain Bill C-14's mandatory 10-day waiting period requirement, as it currently stands, and the requirement for independent verification of all MAID requests by two witnesses.

Seven, in response to the prevalence of medical ableism, add language to Bill C-7 that will ensure that all discussions surrounding MAID are patient-led and not prematurely initiated by the physician.

Eight, remove Bill C-7's provisions waiving Bill C-14's important and necessary final consent requirements.

Bill C-7 would enshrine a legal form of ableism into Canadian law by making medical assistance in dying a legally sanctioned substitute for the provision of community-based supports to assist people with disabilities to live. The Council of Canadians with Disabilities, along with the entire disability rights community in Canada, is therefore pleading with policy-makers to rethink and revise Bill C-7 in light of the reality of systemic ableism. You must ensure that MAID does not weaponize systemic ableism in Canada.

Thank you.

[Dr. Ewan Goligher, Assistant Professor, Interdepartmental Division of Critical Care Medicine, University of Toronto, As an Individual]

Madam Chair and honourable members of the committee, I speak to you as an academic physician-scientist, a critical care specialist who frequently provides end-of-life care, as the father of a child with physical disabilities, and as a very concerned Canadian citizen. I wish to address you specifically on the ethics of moral objection to euthanasia.

The first patient I was ever asked to examine in medical school was a young man with profound disability from primary progressive multiple sclerosis. I will call him Nathan, though that was not his real name. Nathan was paralyzed from the neck down, bed-bound, and blind. As I interviewed him, he began to speak of his experience as a person living with serious disability. He spoke especially of the deep loneliness that he felt, the isolation from the rest of the world, the absence of meaningful friendship. His pain was primarily not that of physical suffering but of deep despair of ever enjoying meaningful human contact or relational intimacy.

All these years later, I wonder if Nathan would have considered seeking a doctor’s help to commit suicide. I invite each of you to imagine that you are the one to fulfill that wish for someone like him. You place the intravenous line. You inject the sedation to put him to sleep. You inject the paralytic agent to halt his breathing. Within minutes his heart stops and he is gone. His loneliness and hopelessness are ended, and so is he.

We must all agree that this patient’s loneliness and despair are tragic. We all agree that he deserves the very highest level of care and compassion, that we must work to uphold his dignity and his quality of life. Yet with respect to the ethics of causing his death, many, like me, find a variety of important reasons to object to participating in such an act. First, we argue that euthanasia devalues the patient by treating them as a means to an end. In order to make Nathan’s suffering go away, we would make him go away. We intentionally target and end his person in order to resolve his loneliness and despair. In doing so, we are treating him—his person—as a means to an end, rather than as an end in himself. True respect for the intrinsic and incalculable worth of persons requires that they always be treated as ends in themselves. We do not destroy that which we regard as profoundly and intrinsically valuable.

Second, since respect for persons is the moral foundation of the duty to respect autonomy, by treating persons as means to ends we undermine the very basis for respecting their autonomy. If persons can intentionally be rendered non-persons, then what makes their autonomy inviolable?

Third, in participating in the patient’s act of suicide and causing his death, we are implicitly declaring that we agree that his life is not worth living. We are affirming his perception that his existence is no longer desirable, that we are supportive of his non-existence. Nathan’s loneliness and despair highlight the way that even while we may be autonomous, we are also deeply dependent on others for affirmation and value.

Bill C-7 declares that an entire class of people—those with physical disabilities—are potentially appropriate for suicide, that their lives are potentially not worth living. Indeed, were it not for their disability, we would not be willing to end them. I cannot imagine a more degrading and discriminatory message for our society to communicate to our fellow citizens living with disabilities.

Now, reasonable people may disagree over the ethics of euthanasia. Given the concerns raised here, it is understandable and eminently reasonable that many physicians and nurses object to participating in the provision of euthanasia in general, and to those with disabilities in particular. Contrary to the claims of some, objecting to euthanasia is not motivated by selfish concern for personal moral sensibilities, but rather by a profound moral concern to uphold the value of the patient and to maintain high-quality medical care.

Moreover, the Canadian experience has shown that protecting conscience presents no obstruction to patient access. Bill C-7 should be modified to clearly ensure that Canadians’ fundamental freedoms of conscience are upheld and supported in ways that Bill C-14 failed to accomplish.

Finally, I implore you to ensure that if this law is passed, it requires that the physical, social, psychological, existential and spiritual needs of patients like Nathan have been thoroughly and systematically addressed before they are considered to be eligible for euthanasia. He and others like him deserve the best opportunity for living before they conclude that their existence is pointless and should be ended.

Thank you for your consideration.

[Roger Foley]

The current safeguards are already failing under Bill C-14. Taking away those safeguards, there's absolutely no way to protect vulnerable and disabled persons from a wrongful assisted death. I'm disabled, and I know that if you pass Bill C-7, I won't survive and there'll be thousands of wrongful deaths. You'll see the numbers pile up. So I urge you to please not allow this regime to continue to slide.

[Michael Cooper, Conservative, St. Albert—Edmonton, AB]

Thank you very much, Madam Chair, and thank you, witnesses, for your very helpful testimony.

I want to direct my first question to Mr. Sikkema and Mr. Schutten, as well as Mr. Berger.

In the Supreme Court's Carter decision, the court adopted the pronouncement of the trial judge, wherein the trial judge stated that risks associated with physician-assisted death “can be identified and very substantially minimized through a carefully-designed system” that imposes strict limits.

We have heard some fairly compelling testimony about how vulnerable persons could be put at risk as a result of the removal of important safeguards passed in Bill C-14. Can you speak to any charter issues that you see in that context, Mr. Sikkema, Mr. Schutten or Mr. Berger?

[John Sikkema]

My apologies to the translators.

Our current law, as amended by Bill C-14, is already interpreted to allow doctors to euthanize patients who have a decade or more of life ahead. Our current law already fails to prevent doctors from suggesting MAID without being asked, or at least listing it as an option, which can send a powerful message to the sick and disabled that someone thinks their life isn't worth living.

Bill C-7 not only fails to address those problems, as identified by the United Nations special rapporteur, among others, but it makes them worse. If Bill C-7 passes, it will be possible for a person with a serious illness to go to their doctor's office, have their doctor suggest MAID as an option for them, have the doctor's secretary pop in to witness a written request and then be killed as soon as the second opinion is acquired. Of course the doctor would have to mention other options, but that's just the basic rule of informed consent.

That's the fast and easy track. The slow track isn't much better. For those in the ambiguous category of not reasonably foreseeable death, Bill C-7 says that other options should be discussed and consultations offered, which isn't much, and one would think that such basic steps should already be there for the fast-track cases.

As for the 90-day waiting period, palliative care physicians have already pointed out that it's inadequate because it often takes longer to help people manage their symptoms and to find satisfactory treatments, and so on. We share that concern. We would also point out that the 90-day waiting period is itself ambiguous given that it begins, not on the day a written request is signed and dated, as with the 10-day waiting period that would be cut, but on the day the doctor begins to assess a patient's eligibility, which could be months earlier.

Many people seem to think further expansion of euthanasia is inevitable. This is not true. The Carter decision was very limited in scope, as the court stated at the beginning and end of its decision. This is about Ms. Taylor and persons in her position. She was near death with a known fatal illness and the court said, “We make no pronouncement on other situations where physician-assisted dying may be sought”, at the end of its judgment. It bookended its judgment with those things.

The lone judge who decided Truchon failed to appreciate this and failed to recognize Parliament's objectives in limiting MAID to the end-of-life context. It is the responsibility of Parliament and this committee to listen to the concerns of all parties, including disability rights advocates, palliative care physicians and others; to be clear about its objectives; to defend them against a particular judge; and to enact more responsible policies.

Thank you very much.

[Dr. Leonie Herx, Palliative Medicine Consultant, As an Individual]

Thank you, Madame Chair, and thank you to the committee for having me today.

Good afternoon. My name is Dr. Leonie Herx. I'm a palliative medicine specialist, associate professor and head of palliative care at Queen's University. I'm the immediate past president of the Canadian Society of Palliative Care Physicians and I've been on their board of directors for the past eight years. I'm also an adviser to the Vulnerable Persons Standard, an internationally recognized evidence-based framework that outlines the safeguards necessary to protect vulnerable persons who may be subject to coercion and abuse in a system for medically administered death.

I come before you today to share concerns that are not mine alone, concerns that are shared by many physicians across Canada, as evidenced by the 959, and counting, physicians from all medical specialties who have signed our MAID to MAD petition that was submitted to this committee. In the Carter v. Canada ruling, the Supreme Court stated that a carefully designed and monitored system of safeguards would limit risk to vulnerable persons. In our recent publication in the World Medical Journal in April 2020, my palliative medicine colleagues and I documented concerns and reviewed evidence of errors and harm occurring under the current Bill C-14 MAID regime. A copy of our paper has been submitted to you as well.

Bill C-7 proposes to further reduce these safeguards and put more Canadians at risk of wrongful death. Year after year, there have been documented cases of non-compliance and misapplication of the law and policy with respect to MAID in Canada. The chief coroner of Ontario, the end-of-life care commission in Quebec and, very recently, the correctional investigator of Canada have all reported on these issues.

We also see instances of vulnerable patients being told by their health care team that they should consider a medically administered death because the cost of their care is too great. Roger Foley, from London, Ontario, required 24-hour care that was not able to be provided in his home. While living at the hospital, an administrator suggested that he get MAID, not out of compassion for his circumstances but out of concern for the cost of his care on the system. This conversation was recorded and, of course, has been widely shared.

MAID has also been suggested when the health care team perceives an individual as not having value. While receiving emergency treatment in hospital, Candice Lewis, a 25-year-old woman with a developmental disability and chronic medical problems, had a doctor approach her mother and suggest that she consider MAID for her daughter. Her mother said they were not interested in MAID, and the doctor told her she was being selfish. The doctor then tried to convince Candice herself that she should get MAID. Because Candice felt scared, she asked to go home. The family complied and took her home, feeling that it was unsafe to stay in the hospital.

The UN special rapporteur on the rights of persons with disabilities issued a concern after a recent trip to Canada in 2019. She stated that she was “extremely concerned about the implementation of the legislation on medical assistance in dying from a disability perspective” and that there was a lack of protocol “to demonstrate that persons with disabilities have been provided with viable alternatives when eligible for assisted dying.”

We have seen countless patients whose hope and resilience were restored when their basic care needs were met. We know that many people request medically administered death out of fear of being a burden to others. This demoralization and sense of being a burden is amplified when real options to support living do not exist.

If we are trying to make a medically administered death regime safer for Canadians, then we should look to the Victoria, Australia, legislation, which employs stringent safeguards to address important issues such as the risks of coercion. I've included sections of the legislation in my written brief for your reference. In the Victoria legislation, doctors must not bring up assisted death to a patient unless they ask about it. This is especially important for persons who already feel they are a burden and less valued in society as a result of systemic discrimination.

Bill C-7 is written in such a way that a patient could choose to die before they have actually received therapies that we know in medicine have a high likelihood for recovery or relief of suffering. In other countries where MAID is legalized, it is most often only available for those who are dying. Regardless, all other jurisdictions require that physicians determine that there are no other options of care left to pursue. It is a last resort only.

Physicians who know that there are reasonable treatment options for their patients have a professional duty to instill hope and support resilience and not to stimulate a desire to die. My professional integrity as a physician compels me to offer recommendations to promote the health and well-being of my patients. If I am required to present death as an option alongside evidence-based standards of medical care, this compromises my ability to provide good care to my patients. Doctors need to be able to work with integrity and have our consciences' rights respected.

For the sake of vulnerable Canadians and the practice of medicine, I urge this committee to make significant amendments to this proposed legislation.

Thank you.