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

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

Mr. Speaker, the Supreme Court has been clear. It has set for us a deadline of June 6 to pass legislation. This is not a matter of whether medical assistance in dying is to be legal; it is to establish a framework.

I am concerned that should we go forward there will be a vacuum in which there is no regulation. We must act. The Supreme Court has given us an extension of time. We have the time in which to do it. I know it may seem that we are a bit rushed, but we are willing to work extra hard on the justice committee to ensure it gets back to this place in the appropriate amount of time. However, it is imperative that we get this work completed, and get it to the other place so that vacuum does not exist.

[Marjolaine Boutin-Sweet, NDP, Hochelaga, QC]

Mr. Speaker, earlier an hon. member talked about respecting provincial jurisdictions.

Does the government know how it is going to ensure that the practice will not be too different from one end of the country to the other? In other words, how will it prevent fragmentation while respecting provincial jurisdiction?

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

Mr. Speaker, I believe the bill is set up in an appropriate way that it would allow for the provinces to set up with their own colleges and with their own regulations on how medical assistance would be provided. As the hon. member knows, the provision of health care services in the country is the jurisdiction of the province. We respect that and the bill makes provisions for that. The minister has stated that she looks forward to working with the provinces to assist in a framework across the country.

[Sylvie Boucher, Conservative, Beauport—Côte-de-Beaupré—Île d’Orléans—Charlevoix, QC]

Mr. Speaker, every one of us has their own story, experiences, destiny, and perspective on life and death.

However, no one, and I mean no one, can be indifferent to the bill we will soon be voting on. It is important to respect the personal and private opinions of all our colleagues on both sides of the House.

Just 15 years ago, we might never have had this discussion or this debate. Quebec paved the way with its end-of-life legislation. After more than six years of countless meetings and many discussions, and not without much debate involving all of society, members of Quebec's National Assembly passed the bill, which became a reality for Quebec.

One of my former colleagues in the House, the hon. Steven Fletcher, introduced two bills on this issue in 2014, thus laying the groundwork for national reflection. In 2015, the Supreme Court also struck down the Criminal Code section that prohibits a doctor from assisting someone to end their life in very specific circumstances.

There is little time left before the Government of Canada puts in place a Canadian law to provide a framework for medical assistance in dying.

A special joint committee was struck, and six weeks of meetings, discussions, and testimony followed. The committee then tabled a report in the House of Commons. In response, a bill was drafted. Now we need to work together to make the bill law.

We must take Canadians' opinions into account. This is not a partisan issue. This is a social issue that should bring people together. First and foremost, we must protect the most vulnerable members of society. It is the Government of Canada's duty to legislate on this very difficult matter. This bill touches our core values. We will never achieve unanimity.

Even so, we have to address concerns that have been raised about a subject that is still sensitive and emotional for all of us. It is our duty to have a frank and open discussion to move the debate forward in response to the Supreme Court of Canada's request.

I think we need to set aside any emotions we might be feeling in connection with such a personal and sensitive subject. We must ensure that the legislation includes guarantees to protect the most vulnerable members of our society as well as the conscience rights of doctors and other health professionals.

As legislators, we must have an open discussion that respects who we are, and we must be free to vote in accordance with what we believe deep down.

We must also make some amendments to ensure that there is an excellent framework for this legislation.

We must respect the rights of the ill, but we must also respect the right of doctors to say no. There is currently a grey area that leaves room for interpretation by the provinces. We must be united as a country on protecting doctors, pharmacists, and institutions. I am talking about all health care personnel.

The Government of Canada must ensure that the people who make use of this legislation are making a clear and informed choice and have all of the information they need to make an informed decision.

There are some concerns, especially in the details of the bill, with respect to the fact that nurses have the same decision-making power as doctors in providing medical assistance in dying.

I remind members that Bill C-14 on medical assistance in dying is the government's response to the Carter decision. In this decision, the court ruled that people have a right to medical assistance in dying if they are adults, if they are suffering from a grievous and irremediable medical condition, and if they have given informed consent.

It is important to consider what “informed consent” means. It must be clearly defined, to ensure that the Canadian public is fully aware of what is involved.

We must also consider and propose solutions for people who want to live, in spite of their illness, and for those who want to be with their loved ones even though they realize they are at the end of their life. I think it is very important that we invest much more in palliative care.

We are talking a lot about medical assistance in dying, but I get the impression that in this debate members are forgetting about the most important thing, and that is the ill person. There is little or no reference to those who will never make use of this legislation.

On a more personal note, I too have had to think carefully about this issue. I carefully weighed the pros and cons. I looked to my own experiences for answers to my questions. I searched my past. I looked at myself in the mirror and thought about my views on life and death. I saw the face of my father, who was stuck in a wheelchair for over six years. Not a day went by when he did not shed some tears. How many times did he tell me that he would rather die than be there, paralyzed, unable to walk or be completely autonomous?

However, I also thought about the time when, of necessity, I ended up supporting my friend Rachel through the terminal stage of her illness. She had AIDS, but she wanted to live at all costs, despite the illness that was consuming her.

Then there is me, both a legislator and a human being, who must, in all honesty, reflect logically on what I myself would do if I were at the end of my life and had to make a choice. There is no obvious answer. However, I dislike aggressive therapy, and everything is already there in black and white.

This debate has forced me to think beyond death itself to accepting it and to the grieving process that is necessary either for the person involved or the loved ones.

The medical assistance in dying legislation is not perfect. There are some things that need to be redefined and a few amendments to incorporate, but we have to keep in mind that the Supreme Court is pressing us to pass legislation by June 6. That is why I am voting in favour of this motion, in order for the bill to go back to committee and for the committee, which is duly appointed, to study the provisions and ensure that all Canadians are protected. They are what matter most here.

[Celina Caesar-Chavannes, Liberal, Parliamentary Secretary to the Prime Minister]

Mr. Speaker, I want to thank my colleague for her impassioned speech on this topic, and especially the examples of her father and friend. I thank her for sharing that with us.

I would ask my colleague to comment further on the importance of this legislation, in particular for other members of communities who are contemplating this important decision in their lives.

[Sylvie Boucher, Conservative, Beauport—Côte-de-Beaupré—Île d’Orléans—Charlevoix, QC]

Mr. Speaker, I think that this is a social bill. As I said, we must leave partisanship aside and listen to what Canadians want us to do as legislators. A lot of people have concerns about this bill because they do not believe it is sufficiently well framed. That is why if we are required to do this, I want it to be drafted in such a way that it respects all Canadians. This bill must include safeguards for those who are going to use it. Those safeguards are just as important for us, the legislators, but they are especially important for Canadians.

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

Mr. Speaker, I thank the member for personalizing the conversation in relation to family members. It is appreciated.

Coming back to the issue of palliative care, I want to thank the Conservative members of the special committee who put a focus in their dissenting report on the importance of palliative care and the failure of successive governments to implement that.

I want to flag again the work that my colleague from Timmins—James Bay is doing on the palliative care issue and the fact that he was able to get the House to agree. It was a rare moment of close agreement a couple of years ago.

I am hoping that the member can talk a bit more about what steps the House and the government might take to bring some of those recommendations around palliative care to fruition.

[Sylvie Boucher, Conservative, Beauport—Côte-de-Beaupré—Île d’Orléans—Charlevoix, QC]

Mr. Speaker, I would like to thank my colleague for her question.

We are talking at length about medical assistance in dying, but the need for palliative care is also great. I used to provide support for people who were dying and suffering. We need palliative care so that people who wish to continue living despite the illness consuming them can live in a supportive environment where they are properly cared for and find relief from their illnesses.

Some of them want to live more than anything, whereas others want to die. We have to look at both sides of the coin. We should have this debate because it is not a partisan debate but rather a societal debate.

[Gérard Deltell, Conservative, Louis-Saint-Laurent, QC]

Mr. Speaker, we were very pleased and moved to hear our newly elected colleague, who has also served in other sessions. It is clear that she is experienced.

Are people in my colleague's riding talking about this issue? What are they telling her?

[Sylvie Boucher, Conservative, Beauport—Côte-de-Beaupré—Île d’Orléans—Charlevoix, QC]

Mr. Speaker, I would like to thank my colleague for his question.

Yes, they are obviously talking to me about this issue. I see both sides of the issue, and they are very well defined. When I visit the urban part of my community, people tell me that they are in favour of this bill. When I visit the rural part, people are starting to ask some good questions that make me think about the importance of representing both parties in this bill: the people who are at the end of their lives and the people who want to live. That is what is missing in this bill. Quite frankly, palliative care has been forgotten. Therefore, I am hearing one thing from the urban population and another from the rural population.

As legislators, we want a law that benefits all Canadians, whether they have the right to die or not.

[Larry Bagnell, Liberal, Yukon, YT]

Mr. Speaker, I am happy to rise on this very important debate. It affects all of us, including my wife Melissa, my seven-year-old daughter Aurora, my four-year-old son Dawson, me, and everyone. Not all bills affect every Canadian, but this does. It is a very critical debate.

When this first came up in the House, I voted against it, because sadly there is much elder abuse in Canada, people who take advantage of those with less capacity. I encourage all legislatures, all four levels of government in Canada, all government workers, and all journalists to do everything in their power to work to eliminate elder abuse. That includes the protections needed in this particular bill.

I was also not comforted by what happens in some European countries with legislation. Many people are assisted in dying without their consent.

I have now been convinced by six items. First is the great care that was put into the protection provisions of this bill. There are two doctors or nurse practitioners, totally independent from each other, who are needed to approve the consent.

Informed consent is needed, and again at the time that the act will be carried out. The person must be suffering from intolerable pain. They must provide written consent. They must be in the process of dying, and there must be a 15-day waiting period.

There must be a five-year review of this bill, with the additions that many people might be suggesting during this debate.

Also, I have been convinced by the overwhelming support of my constituents who have contacted me, saying that people should have assistance in choosing the time to end their intolerable suffering.

I have also been convinced by the government's strong conviction, ensuring that there is good palliative care, so that the lack thereof is not what forces the choice of this other decision under this law.

I am also convinced by the cautious approach the government has taken to ensure that such a major life-and-death decision is done right.

Finally, I am convinced that there will be no sanction against health care workers who do not want to participate. I talked to a very experienced medical administrator who suggested that it could be up to 90% of doctors who would choose not to participate. For the provincial and territorial governments, that will provide an administrative challenge for those very small communities that may only have one practitioner.

I have asked my constituents, through the newspaper, to give me feedback. I received very heartfelt thanks and heartfelt views on all sides of this legislation, similar to what I am sure the other 338 members of Parliament have from many of their constituents. Of course, they were not all the same.

I have not had any bad experiences, as a number of MPs have had. However, I was moved by the sad stories of those who did, primarily with family members.

I remember a call from a mayor who told the story of the terrible suffering of a family member. It had gone on far longer than was ever needed. There was no benefit to the person. They did not want to be there.

I remember a call from another friend in a very similar situation. They exposed the myth that it was important not to do this in order to have family gathering together for a peaceful end. They outlined how that is a myth because at the end, in that particular case, the person was in so much pain and it was so distracting, the person did not want to or have the ability to see or gather with anyone.

I had feedback from another constituent whose father and other relatives had Alzheimer's disease. It was a terrible end that they did not want to have, and it could have been ended earlier.

Other constituents gave a large number of different views. One person said that if we allowed such suffering to go on in an animal, we would be charged. Another person talked about their husband who had a rapidly deteriorating disease. He wanted to die at home with family and could not. The doctor explained how that was not possible. They had a terrible painful experience in the hospital for their last few days.

On the other side of the issue, I had a nurse contact me who is totally against the bill and did not think we should proceed with it.

Then there were two views related to the people who are left behind in these situations. There were a number of people who, when in this terrible pain and suffering, did not want the suffering of their relatives and friends to go on. They wanted to terminate their lives so there would be no suffering left for their family and friends. On the other side of the coin, a person suggested we did not want to deny family and friends the wonderful ability to care for that person to the end.

Another person suggested that we have to make sure that all publicly funded health care facilities must allow this.

I also had a suggestion from someone who works with seniors, wanting an advance directive, similar to what is in the Yukon Care Consent Act for end of life that exists right now.

In summary, a majority of my constituents were in favour of assisted dying. Some were against it, like a woman from the small community of Haines Junction. Of those in favour, a number of them want some of the suggestions that people have talked about here today. Many were in favour of having advance directives. I would say that is the biggest amendment they would like to occur at second reading.

I want to close with a couple of suggestions for the committee to wrestle with. First is the advance directives. If people have a debilitating disease, they have to give informed consent at the very last minute, but they may not be able to, as they might not be in condition to do so, so it defeats the whole purpose. Perhaps it should be allowed only for those who are not capable at the last minute so that, as has occurred in the past, people with advance directives who in the end did not want them carried out are not taken advantage of.

The second biggest suggestion was related to the description of foreseeable future. On one side it may provide the flexibility that people want to make the right decision at the right time. On the other hand, it may not be enough definition. Medical workers want more definition, so they are not caught on the wrong side of a criminal law suit.

I had a student ask me an interesting question: what if a person suffering from an insufferable physical disease also has a mental illness and therefore could not give the informed consent? I am glad the committee will further study mental illness. I had a number of people suggest that mental health, Alzheimer's, and even mature youth need to be dealt with.

I want to thank my constituents and members of the House for this very non-partisan, thoughtful debate on this life-and-death situation for all of us. Hopefully, in the end we will find the combination that gives the most peace to the most Canadians.

[Bernard Généreux, Conservative, Montmagny—L'Islet—Kamouraska—Rivière-du-Loup, QC]

Mr. Speaker, my colleague gave an excellent speech. He described his riding, which is very big like mine. Actually, I think his riding is even bigger than mine.

Rural regions often have difficulty obtaining services. In my opinion, offering palliative care would be one way to make up for the lack of services available to people who need help at the end of their lives. I would like my colleague to talk about how increasing services and care at centres designed for that purpose fits in with this bill.

[Larry Bagnell, Liberal, Yukon, YT]

Mr. Speaker, I definitely agree with the member. I am very happy that the minister is so committed to palliative care, which is an important part of this whole process, so that a person does not have to make a decision on assisted death just because good palliative care is not available.

My mother had wonderful palliative care in B.C., and I would hope that is available to all Canadians.

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

Mr. Speaker, I would like to discuss further with the member the comments he has heard from his constituents around conscientious objection from health care providers and practitioners.

New Democrats in the all-party committee made a clear recommendation that no health care worker should ever be compelled to participate in assisted dying and that they should be legally shielded from unfair consequences resulting from that personal decision.

Despite my intention to support the bill at second reading and send it to committee, there is still concern that there are no legislative measures to enshrine that recommendation, although we are hearing from the government that it may be interested in non-legislative options.

I would be interested to hear whether the member has further ideas about which side of the regulation that issue might fall and whether he shares my concern that it would be better, for the sake of health care providers, to lock in those protections and guarantees.

[Larry Bagnell, Liberal, Yukon, YT]

Mr. Speaker, none of the health care people I talked with were concerned that their protection was not in the bill, but I certainly hope the committee does look at it.