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

[Karina Gould, Liberal, Parliamentary Secretary to the Minister of International Development]

Mr. Speaker, I would like to begin my comment with something that the previous speaker mentioned. He said that he appreciated the tone and the level of respect that this debate has taken.

My hon. colleague began by saying that she was not going to offend anyone, or that she hoped not to. However, it is incredibly important to recognize that this issue is deeply personal. It is something that affects many different people. Therefore, to put medical assistance in dying in the way that it was painted, I think is deeply offensive to many of my constituents and people across this country. There is a certain level of respect that needs to be offered to those individuals who are seeking this assistance. They are at a point where they are suffering so immeasurably and so severely that we need to respect that decision and ensure their voices are being heard. That is what this bill addresses. It is important to remember that there are many safeguards within this bill that protect vulnerable individuals.

Because she talked about choices and rights, I am wondering what my colleague would say to someone who is suffering so immeasurably that this is the choice that he or she would make.

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

Mr. Speaker, I would repeat that there are different opinions on this issue. While we want to protect the views of those who would choose this way, there are many who are offended by that choice. We need to recognize that. That was my intent in bringing the message.

[Bev Shipley, Conservative, Lambton—Kent—Middlesex, ON]

Mr. Speaker, one thing I can say about my colleague from Sarnia—Lambton is that we always know where she stands. Quite honestly, this debate is about just that. She certainly would not offend anyone, because we either live or we die. Let us be frank about it. The Supreme Court has given medical people the right to kill people. That is what has happened.

I did not see anything in this bill with respect to the following. Let us say that there are people who are terminally ill and are dying of severe cases of cancer. They might not die of the cancer; rather, they could die because of the poison that is given to them. I am wondering what the death certificates would say in terms of the cause of death. If we are to track any of the statistics, if we do not have some indication of what they actually died from, then we lose track of what this bill would accomplish.

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

Mr. Speaker, my understanding of the way it is intended to work is that if someone does request assisted dying, the cause of death would be listed as the pre-existing condition as opposed to assisted suicide. Therefore, I agree that this will cover up the tracks of how often this is happening. All of the countries that have implemented legislation like this began with good intent and good process. However, people were not following the rigour, so the data tracking was difficult. Eventually, they opened it very wide, which is my concern with this legislation.

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

Mr. Speaker, I wonder if the member could provide some comment. She was a part of the government for a number of years. The Canada health care accord that was signed back in 2004 was allowed to expire. Year after year, we in the opposition argued that the Conservative government of the day should have done something with respect to the renewal of that health care accord. It is a bit much to listen to the Conservatives saying that we are not doing enough in terms of palliative care, because palliative care no doubt would have played a very important role in any future health care accord. If we think of the future of health care delivery, would she not agree that palliative care has to be a major component of that?

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

Mr. Speaker, I absolutely do agree that palliative care has to be a fundamental part of health care as we go forward.

I heard questions earlier tonight that asked when end of life starts. Palliative care experts will tell us that even up to a year before death, in some cases two years, there is an advantage to good palliative care, the kind that does not just occur in the hospitals but in hospices and in home care. Therefore, I encourage the current government to do what it can to implement the promise it made in the budget.

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

Mr. Speaker, I can assure the member that the Liberal government will do what it can in terms of administering a palliative health care policy from coast to coast to coast. It is something we have believed in for many years and ultimately have been advocating for. Therefore, it is with pride when I look to the current Prime Minister and the Minister of Health when we talk about how we are going to see an investment in palliative care.

Before I talk more about palliative care, I want to talk about why we are here today.

It was a Supreme Court decision, a unanimous decision, which needs to be highlighted, where all of the judges came to the conclusion that Canadians suffering intolerably have the right to request assistance to end their suffering. We respect that decision. The issue before us today is, if Canada should have medical assistance in dying, how do we make it available? In essence, that is the issue before us today.

It is important that we recognize that this decision was made in February 2015. The government of the day sat back and did virtually nothing. It took a change in government, when Canadians spoke on October 19, and then a number of weeks that followed. We had the first Liberal-appointed cabinet in the last decade, and part of the mandate letter was to deal with this issue.

We do not have a choice. The Supreme Court has made this decision. We have a responsibility as parliamentarians to act on that court decision.

We have seen an incredible amount of effort put in by members of the Special Joint Committee on Physician-Assisted Dying, who worked virtually around the clock, seven days a week, with Senate colleagues. They did a phenomenal job in terms of getting us into the position of where we are today, which is debating the bill at second reading.

Hopefully, sometime this week, we will see the bill pass second reading. Parliamentarians, many of whom have talked about all sorts of ideas, will be able to make their presentation or express their thoughts at the committee stage, and at the same time allow stakeholders and individuals to share their incredible experience. At the end of the day, if we can improve this legislation, I can assure members that the Government of Canada is open to doing that. We are not fearful of accepting amendments, if in fact it can improve the quality of the legislation.

Within the legislation, members will find that there is an automatic review mechanism. After four years from this legislation becoming law, it will be reviewed by Parliament. I believe that is the responsible thing to do.

As parliamentarians, I would suggest we all have a role to play in terms of looking at how we are going to get this legislation through in a timely fashion. Not only does it have to pass the House and go to committee, it also has to get through the Senate, and it is important that it be done by June 6. We need to do this, because it is one of the ways we ensure that there are standards across the country so that void can be been filled.

We can look at what the legislation would actually do.

Access to medical assistance in dying would only be available to those who meet certain conditions. One, they must be mentally competent adults who are in an advance state of irreversible decline and capability. Two, they must have a serious and incurable illness, disease, or disability, and are experiencing enduring and intolerable suffering caused by their medical condition. Three, it must be those whose death has become reasonably foreseeable, taking into account their medical circumstances. We believe this meets what the Supreme Court of Canada has asked of us.

Obviously, it is a very emotional issue. We all have stories that we can reflect on. In 1999, I was at my father's deathbed. Thanks to good palliative care, I was able to be there at his time of passing. I appreciate the importance of pain management. He was in what I would classify as a fantastic facility. It allowed my father to end his life in a very positive fashion. Having a wonderful relationship with those he truly cared about and loved was very important, not only to me but to my family.

Prior to his going into Riverview Health Centre, I remember that we could barely communicate with him because of the intense pain that he endured. Once he was in the loving and caring hands of our health care professionals in a palliative care unit, with proper medications and painkillers, the difference was night and day. I remember saying to the doctor that we were going to have to look at having him come out, believing that he was getting so much better.

Our health care workers do an incredible service to Canadians. We need to recognize that. We should not be fearful that the legislation is going to obligate a doctor, a nurse, or a nurse practitioner to do something that goes against who they are, or that they are going to be penalized for that.

We have had those assurances, whether it is a charter of rights assurance or assurances from the ministers directly when they brought this bill forward and addressed it. The assurances are there. We are going to provide a service that is necessary. It is the right thing to do.

This is not something that is coming from one political party or one faction of society. It has gone through the court process. Nine Supreme Court judges ruled unanimously. We believe in Canada, and we believe in the rule of law. We recognize that this legislation is necessary.

As I indicated, there is always the opportunity to look for ways to improve the legislation. I am anxious to see it get to the committee stage, and to see if there is anything that could come out of the committee that would make it a better piece of legislation.

I have had the opportunity to listen to a good portion of this debate. I want to emphasize how important it is that we continue to look at palliative care and the potential that the Government of Canada has to show leadership on this issue, much like the current Prime Minister demonstrated leadership by getting in this legislation in its current format and getting the Special Joint Committee on Physician-Assisted Dying working together to bring us to where we are today.

We want to see the same sort of leadership, and I believe it is there, on the issue of palliative care. We do need to see strong national leadership on that issue. That is why I was very glad when the Minister of Health made a $3-billion commitment to palliative care.

Let us not kid ourselves; it will not be easy. I was a health care critic at the provincial level. If we are going to try to implement a program that is going to be universal so that it does not matter what region of the country people are living in, it will require a great deal of sitting down with our provincial counterparts and other stakeholders, in particular our first nations, aboriginal communities, to come up with how we can shape a world-class palliative care system.

Let us not kid ourselves; it is not going to be an easy challenge. That is why I am very grateful for the sense of commitment, whether it is coming from the PMO's office or from the Minister of Health in regard to making sure that, number one, there are financial resources to follow the commitment; and number two, that there is a feeling that in order to achieve it, we have to get people sitting around the table. That is something that is truly different this time around from what it was under the previous administration.

This government believes in working with other levels of government and believes in working with people. I believe that ultimately that is going to make the difference.

Today we debate this very important issue that all Canadians are very much concerned about. All Canadians have an opinion on it. It is such a privilege to express what I believe is what a majority of my constituents would want me to do on this issue and I feel very proud in terms of what this government has been able to accomplish in a relatively short period of time.

[Martin Shields, Conservative, Bow River, AB]

Mr. Speaker, I appreciate the member and the speaker before him for thanking us for the tone of this debate and the non-partisan and impersonal debate it was, although it got a little more personal with our colleague there.

A question I asked earlier was answered in a different way and I will try again. One of the things I see in the document deals with two doctors and two nurse practitioners that will be put in the role of signing or agreeing with the documents. In the rural areas I am familiar with having that many doctors and nurse practitioners can be a challenge. The answer I got was, “That is why there are a lot of nurse practitioners.” In the rural areas I am familiar with there are more doctors than nurse practitioners. There are not many nurse practitioners.

We come down to the challenge in rural areas of those people being known. It is very tough in a smaller community for medical staff to be labelled with that kind of a role. How would my colleague deal with this in rural areas, realizing that nurse practitioners in some areas are not as plentiful as they are in other areas?

[Kevin Lamoureux, Liberal, Winnipeg North, MB]

Mr. Speaker, I note that nurse practitioners for all intents and purposes, even though they have been around for many years, it is only in the recent decade or so that we have seen provinces looking at how we could potentially expand the roles of nurse practitioners.

I realize there are a lot of sensitive issues in regard to health care and the delivery of health care services, which include doctors in many rural communities. The more remote, the more difficult it can be, but there are also many rural communities that have a fairly healthy situation with doctors.

The answer to the question likely lies in working with our health care professionals and different stakeholders like our provinces to see if the concerns the member has raised could possibly be dealt with. I do not have the short answer, but hopefully that will assist him in getting a better understanding of where I am coming from on that issue.

[Alistair MacGregor, NDP, Cowichan—Malahat—Langford, BC]

Mr. Speaker, I appreciated the parliamentary secretary's speech. In the Carter ruling of the Supreme Court of Canada when it held up the appeal, it defined a competent adult person as one who clearly consents to the termination of life and has a grievous and irremediable medical condition that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition.

In Bill C-14 under proposed paragraph 241.2(2)(d), the legislation specifically mentions that a natural death has to be reasonably foreseeable. I want to know the member's opinion on that specific section of the bill. Does he believe that complies with the Carter ruling and is the government prepared to refer this legislation at some point down the road to the Supreme Court to make sure that we do not have future charter challenges?

[Kevin Lamoureux, Liberal, Winnipeg North, MB]

Mr. Speaker, as the legislation stands currently, I am fairly confident that it meets the requirements of the Supreme Court of Canada's decision. Having said that, I would remind the member, as I indicated during my remarks, that once we get to the committee stage there will be the opportunity to hear expert witnesses and the individuals who have written the legislation. Many of these questions could be put right to the table.

A lot will depend on how the ebb and flow of the committee goes. It is not to say that I do not know the specific answer, but I would feel far more comfortable given the makeup of the committee and I know the types of effort that people have gone to in looking at the actual wording. A little change in a word could have a fairly profound impact in terms of how the legislation is actually interpreted.

It is best that we understand what is being said in our intent and then we have to rely on the professionals and the individuals who are drafting the legislation and working with the different stakeholders to make sure that we get it right. I am confident that at the end of the day we will get it right.

[Adam Vaughan, Liberal, Parliamentary Secretary to the Prime Minister (Intergovernmental Affairs)]

Mr. Speaker, I thank members for pursuing this issue not just from some excellent legal scholarship, and we heard that tonight with presentations from my colleagues, but also talking about the impact their lives have had on how they assess the legislation before us.

I too will reflect on my time on this planet, dealing with the challenges of watching a loved one pass away. In this case it was my mother. It was 20 years ago this past January. After a very determined 15-year battle with cancer, she succumbed. Part of the process involved palliative care at the end, which was excellent. However, it was too much for her at one point and she called her three children around, my two sisters and myself. She said, “Kids, I've had enough.” She pulled her oxygen mask off and said, “Don't revive me. I love you. Goodbye.”

We had been dealing with three or four months, it is almost impossible to measure the time, of watching my mother struggle on to make sure that all the kids were there to say goodbye, and saying goodbye to loved friends and family. Clearly, after 15 years, she had had enough.

We sat there by the bedside and watched as life started to leave my mother's body. For myself, who had been in the city and was taking care of her at the end, most persistently on a daily basis, it was too much for me. I could not take it anymore. I left the hospital room knowing that I had said my goodbyes and this was the end. When I came in the next morning, there was my mother sitting up in bed saying, “Well, that didn't work.” Palliative care continued for weeks afterward. It was a palliative care that got more fragile, more painful, and a greater hardship for her and for us to deal with, but in the end she passed away.

She had a do not revive order. As we talk about this issue, we have found ways in the country before to assist people in making decisions, even when they are not in a place to make those decisions.

That is what we are struggling with today. How do we find a more proactive and more informed way of doing this when different dimensions and different diagnostic tools come into play, and different eventualities are being considered?

What we are trying to figure out here is how to extend the do not resuscitate orders into a new sphere of medical assistance. That is the essence of what we are trying to do. It strays into other areas. I have heard it in these debates that the legislation is fine but it does not do X or it does not do Y, which are really topics for other pieces of legislation. We are not focusing on what we are trying to get done right here.

The bill responds to the Supreme Court, as we are compelled to do constitutionally. I do not resent it. It is an extraordinary responsibility to respond to the Supreme Court when it assesses our laws to be lacking or the needs of our population not being met. What we are trying to do is to get a perfect letter through a defined letter box and making sure it clears that letter box.

People in our country are suffering and families are suffering as we debate this. I appreciate the sentiment from many people in the debate to try to get the legislation perfect. It deserves to be perfect. We all strive to make it perfect. However, we cannot let perfection get in the way of what is needed and what is good. There is goodness in the bill, because it does limit people's suffering. Have we done enough on palliative care? Of course not. Have we done enough on the quality of life? Of course not. Have we done enough on medical research? Of course not.

Death is still a very difficult subject for far too many of us. However, Bill C-14 responds to the court's challenge in a very particular way, and the committee will try to make it better. I trust it will come back to the House with a better bill. I hope we can get the bill to committee as soon as possible so it has the space to work on that perfection, rather than us pursuing our task of trying to perfect the criticism of the bill. We need to get the bill to committee so it can be studied, some of the language refined, some of the opportunities better understood, and some of the restrictions better defined. We need to get it to committee quickly.

However, we have to resist being afraid of this bill because it would start to do things that we have not contemplated, such as the slippery-slope comments we had, where we are worried about what happens with person X and person Y in five and ten years' time if these conditions change. We have to look at the legislation that is in front of us, we have to deliver it to committee with criticisms attached, and then we have to trust ourselves as colleagues, as parliamentarians engaged in this issue, to try to and hope to deliver a better bill for the next reading and then on to the Senate for its work and for its resolution.

Let us not kid ourselves. There will be no bill passed in this Parliament that will not be challenged at some future date at the Supreme Court. There will be no new thinking or new idea or new circumstance that does not demand of us to revisit this bill in one, two, three, five, or ten years from now. We have lived on this planet for thousands of years and never perfected the art of dying. It is a tough issue. It is a hard issue. If we lose sight of the fact that our inability to come to terms with that promotes and prolongs the suffering of individuals, we will have truly failed as parliamentarians. We are being asked to make a tough call. This legislation would define what we think is a good judgment and would define what we think is a good approach to this.

I can hear good ideas emerging. However, the debate being called for by many quarters about improving palliative care did not need this bill for that call to be made. We should have been perfecting palliative care years ago. The call to ensure that vulnerable people are better protected and their quality of life is better protected did not need this bill for that debate to happen. Vulnerable people should have been spoken to and their needs addressed long before this bill was ever presented.

However, to use those as roadblocks to end suffering is unconscionable in my perspective, and we have to respond to the deadline that has been imposed upon us by a court that has already been asked to extend that deadline once and already has referenced the suffering as a reason not to extend it again. We have a duty, and we have a duty tonight and over the next few days to get this bill to committee as quickly as possible, and then to listen to what we have said to one another in these last few hours. I do not think anybody has presented a concern that is not of value and does not inform our ability to talk about this bill in more pronounced ways and more reflective ways, and that is good.

Let us amend. Let us lean into the parliamentary committees that we have here. Let us trust one another to fix good ideas and make them better ideas. That is what the committee process is supposed to be about, and that is something that I trust will happen. Let us measure the impact of this debate through that process and ensure that our voices and the voices of our constituents are heard in this debate and also heard in the legislation as it moves forward. At the end of the day, let us be honest with ourselves. We will be revisiting this issue the minute it gets royal assent. We will revisit it because life brings us these challenges as surely as it brings us death. We have to be, on these sorts of issues, smart enough to trust one another, compassionate enough to learn from one another, and at the end of the day, disciplined enough to ensure that this Parliament works for those who are suffering, those who are vulnerable, and those who want to live out their last few days with dignity.

My mum taught me a lot about life by the way she died, and I am sure it is a story that all of us have learned from loved ones as we have watched them move through very difficult times. However, I also remember my mum saying, as she was sitting there, that she loved us and it was not just her suffering she was trying to manage, it was ours. Therefore, it is not just our difficult decision we are trying to manage here today; it is the country's difficult decision.

I trust all members to take that seriously, but I also trust them to support us as we pursue palliative-care improvement, as we pursue the opportunity to improve the lives of vulnerable people in this country, and as we seek to deliver choice to people about how they move forward, with support when they make mistakes but understanding when they get it right.

I hope we can get it right with this legislation. I hope the committee gets it right, and I hope the next debate about this finds even more consensus.

[Todd Doherty, Conservative, Cariboo—Prince George, BC]

Mr. Speaker, I want to thank the hon. member for Spadina—Fort York for his comments and for sharing his experiences with the House.

The hon. member mentioned trust a number of times, about getting it right. With a decision and legislation that bears the gravity that this does, I again go back to the time that we are spending discussing this—this is not a debate; it is a discussion—trying to make sure we get it as close to right as possible. The balance of power rests on that side of the House, and I would think that the public and perhaps those down the street in the Supreme Court can see that we are having those discussions and that, at this point, if the government went across the street and said it needs more time, I would hazard a guess that it would allow that.

Whether it is a notwithstanding clause or just asking for another extension, would my hon. colleague across the way at least say that true leadership would be asking for a bit more time for us to have this great discussion?

[Adam Vaughan, Liberal, Spadina—Fort York, ON]

Mr. Speaker, I was in the House last session when Liberals were in opposition and we moved a motion to speed this debate up to give us that time, and it was defeated. I do not think it is our privilege now, having already gone to the Supreme Court and asked for an extension, to prolong other people's suffering. We have a responsibility to act.

This issue has been in front of us for a lot longer than the bill has been in front of us; the committee spent time on it and did extraordinary work exploring this issue and laying the groundwork for the legislation; and there was work done in the previous Parliament, although not nearly fast enough.

The issue is that we have to accept, as parliamentarians, that we do not produce perfect legislation. We never will. We are just people giving it our best effort. On this bill, where a free vote has been offered to all parliamentarians on this side of the House, and I assume on the other side, we are in the position of trying to make this work. The deadline we have been given by the Supreme Court is the right decision.

It is time to act. It is time to end the suffering for some and provide clarity for others, so I do not think the responsible thing to do is to ask for a delay. We must make a decision, and then we must revisit this issue when problems arise again, because, as surely as we stand here today, they will.

[Daniel Blaikie, NDP, Elmwood—Transcona, MB]

Mr. Speaker, I want to thank the hon. member for his compelling speech. The one piece that stood out to me is more of a process issue.

He talked about the need to get this bill to committee so that it can be improved. That is something I would like to see. I could go on about some of the things that I do not think the government got right in this bill, but given that a special committee did a lot of great work on this and issued a report, and the government legislation does not really reflect much of anything that came out of that report, why should we have confidence that the government is going to respond appropriately to the next committee that looks at this bill?