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

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

Mr. Speaker, I am tempted to quote one of my favourite movies and say, “You have to have a little faith”.

The committee that laid the groundwork for this legislation, the bill that is in front of us, explored a lot of issues; and at the end of the day, the justice minister presented a bill, which in the opinion of the government, gets the issue fundamentally right as it relates to the Supreme Court. It takes away some of the other issues, says that this is core of what we need to do, and leaves it to Parliament to improve upon it. We need to seize that, as parliamentarians, as an opportunity to show how Parliament can work collaboratively around, in particular, difficult issues.

The challenge we have is to find ways to address some of the ideas we want pursued, not just through this specific piece of legislation. Advance consent is an issue for me, or the different names that it is given, like advance care directives. It is a fundamental part of what is missing in this bill, and I want to see that really seized upon by the committee. The palliative care component, the duty of care to people with vulnerabilities, all of those issues are other issues we need to bring to the House, and we need to bring the same level of creativity and compassion to those issues.

We get locked into this notion that governments must present perfect legislation or, otherwise, it is thumbs up or thumbs down. Parliament is not supposed to work that way. We come here representing parties and our constituents, and we have to bring all of that to bear on legislation each and every day, not just simply vote party colours all the time. That is part of the freedom we need to explore in Parliament and one that our leader has put on the table and is trying pursue, and we need members' support to make it happen.

[The Deputy Speaker, Conservative, Bruce Stanton]

Before we resume debate, I want to make a brief comment to all hon. members. First, I want to compliment members, as we have heard earlier today, on some very heartfelt interventions from all sides of the House on this particular issue, a very human and emotional issue that is before the House.

The chair occupants are doing their best to accommodate members and are trying not to cut them off. We are down to 10-minute speeches and five-minute periods for questions and comments, which generally only leaves us enough time for two interventions during that five minute period.

We will do our best, but if members happen to notice that there are a good number of members rising on questions and comments and wish to keep their interventions concise, that would allow more members to participate in that five-minute question and comment period.

We will be as judicious and fair as we can in making sure that all members have the opportunity to finish their points, and so on.

Resuming debate, the hon. member for North Island—Powell River.

[Rachel Blaney, NDP, North Island—Powell River, BC]

Mr. Speaker, today this House stands to discuss Bill C-14. As we do so, we must seriously consider this important responsibility. The Supreme Court decision has been made. The job in this House is to create legislation that would provide clear boundaries moving forward.

In February 2015, the Supreme Court of Canada concluded that the absolute prohibition on assisted suicide violated the charter rights of Canadians suffering intolerably with grievous and irremediable medical conditions who, being adults and assessed as competent decision-makers, would otherwise seek medical assistance in dying on their own terms.

In response, the joint special committee of Parliament was tasked to consult with experts and Canadians who reflect the diverse perspectives on this issue. It reviewed the Supreme Court's decision in the Carter case and the 400-page judgment of the B.C. Supreme Court that preceded it. It studied Quebec's new assisted dying law, as well as the reports of two major panels on medical aid in dying, which together heard from 13,000 Canadians and more than 100 organizations. The committee then held 11 hearings, called 61 expert witnesses, and received more than 100 written briefs from groups across Canada.

I have read the report and want to thank the committee for the great work it has done, resulting in 21 recommendations on a legislative response. These recommendations demonstrate balance and sensitivity, respecting the autonomy of patients, the rights of health care practitioners and vulnerable individuals, and the fundamentally personal nature of this issue to every Canadian.

I have also been listening to the constituents in my riding of North Island—Powell River, where people are very concerned. Many from my riding are worried that there is not enough support for palliative and end-of-life care. They want to know that the vulnerable will be protected and they want to know that those who suffer greatly can decide to die with dignity. I have had many letters from my constituents, and I know there will be many more. This is a subject that deserves much discussion in each riding across Canada.

Bill C-14 is also a very personal one for me. Years ago, I was a volunteer for a hospice and watched many people die. I remember being present for people who were in so much pain and who wanted the release of death so badly that starving themselves became their only solution. I remember the agony of the people and their families who just wanted a safe release from this pain.

I also sat with people who fought every day for one more. Their desire to continue in the face of such pain was tremendous.

After volunteering there for years, I left knowing that death is an intensely personal process and that honouring people and their families through it is so important.

Today, I want to talk to Bill C-14, the Liberal government's legislative response to the Carter case.

The Liberal bill has raised new concerns and leaves many questions, for me, unanswered.

There is consensus among academics, health professionals, faith communities, and the public that Canadians deserve better end-of-life and palliative care treatment.

The federal government has a role to play in working with the provinces and the territories, as well as first nations, Inuit, and Métis communities, on finding strategies that work.

We have a critically important opportunity to enhance the services across the country, yet the government was missing in action in the budget on palliative care—even after promising $3 million for home care during the campaign. Holding the government to account on the promise of that motion remains one of our top priorities as we assist in the legislative response to the Carter decision.

This bill refers to palliative care in its preamble; yet while introducing this bill, the government made no new commitments to palliative care. The people of my riding want to see this investment happen.

The NDP took a significant step forward in the last Parliament when a motion brought by the member for Timmins—James Bay to establish a pan-Canadian palliative and end-of-life care strategy earned nearly unanimous support of the House of Commons.

Palliative care is about patient- and family-centred physical, psychological, and spiritual care.

Everyone dies, every family has to deal with the loss of a loved one, and these traumatic moments are made more difficult and more expensive when there is no access to quality palliative care. With an aging population, it is crucial that the federal government provide leadership now.

The government backgrounder refers to the following system to ensure equal access:

The government is proposing to work with provinces and territories on the development of mechanisms to coordinate end-of-life care for patients who want access to medical assistance in dying. This system would help connect patients with a physician or nurse practitioner willing to provide medical assistance in dying, and support the personal convictions of health care providers who choose not to participate. It would also respect the privacy of those who are willing to provide this assistance. This system could also offer other end-of-life care options to both patients and providers.

However, this is not mentioned at all in the bill. This leaves a lack of clarity and room for poor decisions. It is important to respect the health care practitioners' freedom of conscience while at the same time respecting the needs of the patient.

Having seen the previous government's agenda being held up in the courts time and time again, Canadians expect a government to be thorough. Now is the time to strengthen the bill against charter challenges by resolving contradictions with the Supreme Court ruling in Carter. Canadians have waited long enough. Let us get it right the first time.

It is not a partisan criticism either. The co-chair, Conservative Senator Ogilvie, told the Hill Times that the law as it has been introduced will be challenged in courts, and he is disappointed that the government did not take more of the committee's recommendations.

This is not a case where good enough legislation is good enough. This is a life and death issue, so let us get the right legislation.

The people in my riding are concerned about safeguards. They know the value of life and want to make sure that some lives are not considered less valued than others. I could not agree more. I have members of my family who have severe mental illness and who are differently abled. They are precious to me, and I would not wish them gone from my life.

Right now, Bill C-14 would legalize medical assistance in dying for competent adults 18 years of age or older who meet the following criteria: serious and incurable illness, disease or disability; in an advanced state of irreversible decline in capability; experiencing enduring physical or psychological suffering that is intolerable to them and that cannot be relieved under conditions that they consider acceptable; their natural death has become reasonably foreseeable, taking into account all of their medical circumstances, without a prognosis necessarily having been made as to the specific length of time that they have remaining.

There are also requirements for two independent medical practitioners or nurse practitioners to confirm each criterion. The request must be in writing where possible and witnessed by an independent adult, and a 15-day reflection period must be observed. To help protect people in vulnerable situations, the witness to the request cannot be a beneficiary under the will of the patient, someone who may benefit from the patient's death, or directly involved in providing care to the patient. The two physicians or nurse practitioners must also be independent from one another. Safeguards must be there to provide the support that patients and their families need during this painful time.

We know that this is a difficult issue that touches many in a personal way. There are many issues to discuss, and we hope to see them discussed. Therefore, I will be voting in support of the bill, but I know that it is going to a special committee, and when it returns to the House I hope to see many more changes made.

Many speakers today are expressing their profound disbelief that Bill C-14 would deny Kay Carter, one of the two women on whose behalf this case was brought to the Supreme Court, suffering from serious and incurable but non-fatal conditions, the right to choose medical assistance in dying.

According to many experts, their only remaining recourse to meet the bill's final criterion would be to starve themselves to near death, as we have seen people do in Quebec, in order to meet the province's eligibility criteria. I have seen this in action, and it is a dreadful way to die.

Going forward, New Democrats will consult with experts and people affected as we study this legislation very carefully. As Amy Engel wrote, “I want to be someone strong and brave enough to make hard choices. But I want to be fair and loving enough to make the right ones”.

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

Mr. Speaker, the member referred to page 7, numbers (5) and (6), which talk about independent witnesses, and the independence of medical and nurse practitioners, ensuring that there is no business relationship, and there is no potential financial benefit from having someone have their death hastened.

Certainly, I agree with these principles that are here, but my concern is that, while they are here, a person could say that, yes, they are independent and all of those things, but there is no method of verifying whether or not that is in fact the case.

I wonder if my colleague would support the idea of a prior review, either a tribunal or judicial review, or some panel which would oversee and verify the facts that are stated.

[Rachel Blaney, NDP, North Island—Powell River, BC]

Mr. Speaker, this is part of the realities we are facing.

We know that some of these decisions have to be done in partnership with the provinces which will have certain authority and responsibility in this process.

I think it goes back to that bigger question of making sure there is the support, so that we do not have a patchwork framework across the country. We want to make sure that the services make sense, and we want to make sure that we ask these hard questions.

I am hopeful that the work done in committee will answer some of these questions for us in a good way, and that we will see that process unfold in our relationship with the provincial and territorial governments.

[David Graham, Liberal, Laurentides—Labelle, QC]

Mr. Speaker, palliative care is, indeed, a very important issue.

There are many people here who believe the bill goes too far. There are many others who do not believe it goes far enough, and I fall generally in that camp. I think we could do a lot more, but I appreciate the compromise presented in this bill.

The member for Spadina—Fort York who spoke earlier is correct in that anything we do will face further challenges. For better or for worse, I do not believe this file is ever going to be completely closed. It is too close to the hearts of too many people. I think all members can agree with that.

The member wants to resolve a number of conflicts she sees between the bill and the Supreme Court ruling. I am wondering if the member plans to submit amendments to achieve that very thing at committee, and if she agrees that the committee process is the best way to address these issues within the tight timelines we face.

[Rachel Blaney, NDP, North Island—Powell River, BC]

Mr. Speaker, I hope that the committee will continue the work when the bill gets there.

One of my frustrations is that many of the thoughtful recommendations that were brought forth by the last committee were not put into this bill.

I would like to see a review of the wonderful recommendations that were already made, and to make sure that we do not repeat the work that was already done.

[Elizabeth May, Green, Saanich—Gulf Islands, BC]

Mr. Speaker, this is a difficult topic, and I am generally in agreement with what the member has put forward.

We heard earlier from the parliamentary secretary to the Prime Minister that there would be a possibility for amendments. I am wondering whether the hon. member for North Island—Powell River has considered amendments from her party, and whether we have any indication that the Liberal government will in fact entertain amendments that come from opposition members of Parliament.

[Rachel Blaney, NDP, North Island—Powell River, BC]

Mr. Speaker, it is very important that all voices be heard strongly in this process.

For me in the work that I am doing, speaking with my riding has been very powerful. People are concerned. People are very supportive. Some people are very unsupportive of this process.

It is important that the government continue to do its work, to make sure that the voices are heard, so that the voices of the ridings across this country are heard.

[François Choquette, NDP, Drummond, QC]

Mr. Speaker, I want to congratulate my hon. colleague on his excellent speech. It was very well delivered and very well explained. Truly, I could not have done better.

I also want to thank my hon. colleagues from Saint-Hyacinthe—Bagot and Victoria for their excellent work on this special committee to arrive at the findings we have here.

What struck me most in my colleague's speech was the issue of palliative care. The NDP worked very hard to put in place a palliative care strategy. In my riding, we have Maison René-Verrier, which does excellent work for people who, sadly, are at the end of their life. It is very important to support those people, to be very close to them, and to help them get through this stage we must all go through.

I would like my hon. colleague to say a bit more about the importance of providing palliative care. Unfortunately, the Liberal government still has not delivered on its promises on palliative care.

[Rachel Blaney, NDP, North Island—Powell River, BC]

Mr. Speaker, that is an excellent question.

Palliative care is so important. We do have an aging population, and as people get to that part of their life, they want to know the services are there for them. I represent a vast riding with many rural communities. We face many challenges in helping people stay in their communities for a period of time as they age.

Having a Canadian strategy that really engages the provinces and territories to work collaboratively to meet the needs of constituents across this country is imperative. We have already had a vote on a motion that the member for Timmins—James Bay presented and that was nearly unanimous.

In this House, we know palliative care is important. I hope we continue our work to make sure that service is delivered.

[Chris Bittle, Liberal, St. Catharines, ON]

Mr. Speaker, I am pleased to have an opportunity to participate in the second reading debate on Bill C-14, the proposed legislative approach to medical assistance in dying in our country.

This is a historic bill, and it tackles an issue that is of great interest and importance to many Canadians. It is also one that raises divergent and deeply held personal views, which is why broad consultations with a variety of groups and organizations were essential before reforms could be developed and considered by Parliament.

Members are aware that a special joint committee of the House of Commons and the Senate recently studied this issue, in January and February of this year, and in the context of that study, had the opportunity to hear from 61 witnesses and consider over 100 written briefs.

Other recent consultation initiatives were undertaken by the federal external panel on options for a legislative response to Carter in Canada, from July to December 2015, and the provincial and territorial experts advisory group on physician-assisted dying, from August to December 2015. Each panel met with representatives of dozens of stakeholder groups and received numerous written submissions from key organizations, including the medical sector, disability rights groups, legal and civil liberty organizations, and faith groups. Furthermore, many of the organizations that were consulted held extensive consultations with their own membership, some over the span of years, and shared the benefit of those with these panels.

Of course, we are also indebted to the years of consultations undertaken by the provincial government in Quebec leading up to its own legislation in this area. The extensive work that those in Quebec undertook was carefully considered, and I thank them for their leadership on this issue. It informs this proposed legislation as well.

The broad and in-depth consultations that have occurred over the past year across this country have undoubtedly enriched the policy development process that has led to the introduction of Bill C-14. I am pleased to see in the document entitled “Legislative Background: Medical Assistance in Dying (Bill C-14)” which accompanied the bill and was tabled in this place by the Minister of Justice, that the development of the proposed legislation was informed by the evidence before all levels of court in the Carter case by available Canadian and international research, social science evidence, governmental reports, and parliamentary studies.

That document also tells us that it was informed by the experience of existing international medical assistance in dying regimes around the world, as well as by numerous recent consultation activities on medical assistance in dying, including the work of the special joint committee, the federal external panel, the provincial-territorial expert advisory group, the work of the Canadian Medical Association and the College of Family Physicians of Canada, as well as the work of the provincial colleges of physicians and surgeons.

The consultation process has been robust and comprehensive. This has provided an opportunity for a variety of stakeholders from diverse perspectives to share their views and to reflect the views of other stakeholders who may not necessarily share their point of view.

I would like to briefly outline the considerations that some of the key stakeholders have raised with respect to this issue. One of the key stakeholder groups on this issue, given the active role they will be playing in response to requests for medical assistance in dying, is the medical profession, and by that I mean the various types of health care providers, such as doctors, nurses, pharmacists, nurse practitioners as well as their regulatory bodies.

The importance of this issue for the medical profession was underscored by a representative of the Canadian Medical Association who appeared before the special joint committee and testified that medical assistance in dying is a difficult and controversial issue for the medical profession, that it represents a sea change for physicians in Canada.

Many of the people who spoke from the perspective of the medical profession emphasized the need for clarity in the law so that health care providers are crystal clear about what is permissible and what is not permissible in providing medical assistance in dying, and that federal legislation is needed to ensure national consistency.

I am pleased that the proposed legislation responds to that request for clarity and consistency. Bill C-14 comprehensively sets out who can do what and to whom, and which safeguards are to be complied with. Moreover, as it is a proposed amendment to the Criminal Code, it would apply equally across Canada.

The unanimous decision of the Supreme Court of Canada in Carter focused on the role physicians could play in medical assistance in dying. I am pleased to see that in Bill C-14 explicit exemptions are also included for other types of health care providers, such as nurse practitioners, pharmacists, or other persons who would assist a medical practitioner or nurse practitioner with a request for medical assistance in dying.

This is responsive to the wealth of information received from representatives of nursing to pharmacist organizations in the course of various consultations.

Another important request that was raised by the medical profession was the need to respect the conscience rights of health care professionals who may object to providing medical assistance in dying. I would highlight that the bill makes explicit reference in the preamble to respecting the personal convictions of health care providers.

I will also note that the government has committed to working with the provinces and territories to support access to medical assistance in dying by connecting willing health care providers with patients. To me, this strikes an appropriate balance between supporting patient access or respecting the conscience rights of health care providers, as well as the jurisdiction of the provinces and territories.

Lastly, the medical profession, among other stakeholders, expressed a strong desire for a national monitoring system for medical assistance in dying. I am very pleased to see that Bill C-14 would empower the Minister of Health to make regulations to establish a federal monitoring system, with the associated requirements for health care providers who would be responsible for handling requests for medical assistance in dying to provide information for the purpose of that monitoring.

Several key stakeholders, and in particular disability rights groups, raised the necessity of robust safeguards to protect the right to life of every person in our country. This of course includes people who are ill, elderly, or disabled. Some national disability rights groups also indicated that stringent safeguards were needed to ensure the voluntary nature of a request for medical assistance in dying, free from any pressure or coercion, and based on informed consent, the heart of which was ensuring the patient had the capacity to make the decision in question.

The consultations that have occurred thus far, and the ones that will continue over the coming week, are crucial to ensuring we get this bill right. I am very much looking forward to the testimony that will be presented before the Standing Committee on Justice and Human Rights this coming week, a committee of which I am a member. I am eager to gage the opinions of all sides of the medical assistance in dying debate. I look forward to working with my committee colleagues to bring this bill back to Parliament and have a sound framework in place by the June 6 Supreme Court of Canada deadline.

Parliament has debated the issue of medical assistance in dying on several occasions over the past two decades. Each time, it was not able to support amendments to the Criminal Code to make this a reality for Canadians. The time has come to make this change. I believe this proposed legislation should be passed. I agree with the legislative background paper the Minister of Justice has tabled, and its statements that this proposed legislation strikes an appropriate balance between the autonomy of those seeking access to medical assistance and the interests of vulnerable persons in our society. I would urge all members of the House to support the second reading of Bill C-14.

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

Mr. Speaker, I want to thank my colleague for pointing out that a few times tonight reference has been made to “when this bill gets to committee”. It in fact is in committee right now, and the committee has started its work. I understand it has had four hours of study already, and it will continue that tomorrow.

My colleague referred to broad consultation a number of times. He referenced the expert panel. We have the expert panel report. Unfortunately, the Liberal government chose not to accept any recommendations from the expert panel. Therefore, we are somewhat limited with respect to broad consultation.

Also, in terms of broad consultation, a number of groups requested to appear before the joint committee that were not allowed to be present simply because of the time pressure. Therefore, to use the term “broad consultation” is a bit of a stretch. However, I certainly hope that in the next week of study at the justice committee there will be broader consultation.

My colleague referred to the fact that this should apply equally across Canada. I wonder if he would agree that if we can apply the access to physician-assisted dying across Canada, we could also at least ensure conscience right protection for physicians and other medical health practitioners, as well as institutions that offer health care, be applied equally across Canada.

[Chris Bittle, Liberal, St. Catharines, ON]

Mr. Speaker, the consultations have been broad. The joint committee heard from over 60 witnesses and received over 100 different briefs. Over the next week, my colleagues and I will hear from 42 witnesses. We have yet to determine the number of briefs that we will receive, but I expect it will exceed the number of witnesses who we are hearing. We are getting a broad variety of opinions from faith groups, medical associations, individuals, and bar associations.

The other issue that my hon. friend brought up was conscience rights, and whether they can be enshrined. This is a Criminal Code amendment at its core. This law would not compel physicians to do anything. We have to respect the jurisdiction of the provinces and the provinces regulate medical professions and so do the independent colleges of physicians and surgeons and colleges of nurses, and so on and so forth. We have to respect the rights of the provinces to legislate in that regard.

[David Graham, Liberal, Laurentides—Labelle, QC]

Mr. Speaker, the member for St. Catharines is right, that the process is not over. There are more people to hear from, more studies to be done, more details to be hashed out.

Would the member like to remind our colleagues what the results of not passing Bill C-14 would be? The Carter decision does not provide us a deadline after which the status quo remains. There are real world results for this being defeated. Would the member like to address the real world effects of this bill not passing?