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

[Sean Casey, Liberal, Parliamentary Secretary to the Minister of Justice and Attorney General of Canada]

Mr. Speaker, I thank my colleague, the member for Yukon, for his remarks. Clearly, he has consulted widely through his community and through his riding.

There are a couple of points arising, one is with respect to medical directives.

There has been a lot of discussion around medical directives, but the international experience, certainly in the Netherlands, is that even where they are allowed, most of the time medical practitioners are reluctant to rely upon them; and so, we would be very much forging new ground in that regard in a very compressed timeframe. Perhaps the member would like to give us some reflections in that regard.

The second point, I think, relates more to his riding; that is, in this legislation, there is something that is fairly unique to Canada, which is an enhanced role for nurse practitioners. The goal of the government certainly was, by allowing an enhanced role for nurse practitioners, to ensure access or to provide greater access for rural and remote communities. Perhaps the member would like to comment on whether that is important in an area like Yukon.

[The Assistant Deputy Speaker, Liberal, Anthony Rota]

In 30 seconds or less, the hon. member for Yukon.

[Larry Bagnell, Liberal, Yukon, YT]

Mr. Speaker, in 30 seconds I cannot deal with the advance directives other than to say it is very important that the committee deal with this in depth. That is why I am glad that, failing that, it will be taken up in the five-year review of the bill.

With respect to nurse practitioners, yes, in places like rural areas, there are huge, vast areas, larger probably than any country in Europe, that do not have a single doctor. So, nurse practitioners are increasingly playing a very important role. I think that is why the government included them in this legislation.

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

Mr. Speaker, it is an honour to rise in the House today to continue the debate on Bill C-14.

I truly believe that this debate we are having, and the quality of the debate I have heard throughout the day, is going to be a watershed moment for our country. It is certainly going to be one for the history books, because through a charter challenge, the Supreme Court is forcing us as a legislative body, as a country, to fundamentally examine the meaning of life, the meaning of death, and how we as a society treat those two very difficult concepts.

Death is a hard subject to talk about. Humans have, for thousands of years, struggled with the concept and how we deal with it. Many of us turn to spirituality to find answers, and others are more matter of fact. In any case, the debate concerning life and end of life has reached Parliament's doorstep, and it is up to us as parliamentarians to carry the torch and do that subject the honour and justice it deserves.

As a rookie member of Parliament for the great riding of Cowichan—Malahat—Langford, I have been receiving correspondence from my constituents. I must say to the constituents who are watching the debate today that I have never been prouder to be an MP for their area. The tone in which they have written me, whether they disagreed with the legislation or supported it, has been incredibly respectful.

Of the concerns that I have seen from constituents, some want to see more protection for health care workers. They are concerned that freedom of conscience and freedom of religion are not respected enough in the legislation. However, others do not think that the bill goes far enough. They have looked at the ruling from the Carter decision and compared the provisions of Bill C-14 with it and have found it lacking.

I have heard other hon. members in the House say that, no matter what bill comes out at royal assent, they do see challenges in the future, but it is up to us as parliamentarians to do the best we can with the time we have.

Speaking of the bill, I am going to support this legislation at second reading, because I think we have something to work with. To do honour and justice to it, we must send it to committee so that we can have a more fulsome look at its provisions, and we can hear from witnesses. Furthermore, we must take the recommendations from the special joint committee and see if some of those recommendations can be adequately applied.

I support this legislation, because I believe in a patient-centred approach. I realize that my support of this legislation will cause some of my constituents distress. It is one of the challenges of being an MP. It is balancing the views of one's constituents with one's own personal values. This is the eternal struggle that each and every one of us finds in the House every single day.

However, I believe that, if we are talking about values, one important concept to look at is to not impose one's values on someone else, but to respect a person's values. If a person's values means that he or she is choosing a way out to end suffering that we as healthy people can only imagine, well then we must respect that choice. I fundamentally believe in that.

Looking at the Carter decision, the Supreme Court ruled that it had to be a competent adult person who clearly consents to the termination of life and has a grievous and irremediable medical condition, including illness, disease, or disability, which causes enduring suffering and is intolerable to the individual in the circumstances of his or her condition.

Section 7 of the charter says:

Everyone has the right to life, liberty and security of the person and the right not to be deprived thereof except in accordance with the principles of fundamental justice.

The court found that the prohibition on physician-assisted dying infringed on the right to life, liberty, and security of the person in a manner that is not in accordance with the principles of fundamental justice, and that is why we are here today.

Of the recommendations of the special joint committee, there are three in particular that I want to look at. In a 10-minute speech, to look at all 21 is rather impossible, so I will start with recommendation 7, which dealt with advance directives.

There was a recommendation that advance directives be allowed, but unfortunately, Bill C-14 only makes mention of advance directives in the preamble. The preamble committed to exploring it, but there was no firm commitment in the legislation.

The other recommendation I want to look at is number 10 regarding freedom of conscience. The preamble, again, committed to non-legislative measures in this particular area. There is a template that the government could have followed. There is precedent in protecting freedom of conscience and freedom of religion. It goes all the way back to 2005 when Parliament passed the Civil Marriage Act.

For the reference of all MPs in the House, I will note that section 3 of the Civil Marriage Act states, “It is recognized that officials of religious groups are free to refuse to perform marriages that are not in accordance with their religious beliefs.” Section 3.1 says, “For greater certainty, no person or organization shall be deprived of any benefit, or be subject to any obligation or sanction, under any law of the Parliament of Canada solely by reason of their exercise”. There was a template and hopefully this is one area that the committee can examine further.

The other recommendation I want to look at is number 2. That was basically following the Carter decision. It states, “That medical assistance in dying be available to individuals with terminal and non-terminal grievous and irremediable medical conditions”. Unfortunately, the text of the bill, referring specifically to proposed paragraph 241.2(2)(d), reads, “their natural death has become reasonably foreseeable”.

This is one section where I do not know why the government wrote it in, because it goes against what the Carter decision specified and it goes against what the special joint committee recommended, yet it is here. I see nothing but problems with this. I see future charter challenges.

We owe it to Canadians to get this bill right the first time and not force people to go through the courts for several more years, only to have this legislation dumped back in our laps again. It is the same with advance directives. There will be people who get a diagnosis of dementia. We all know the end result of having Alzheimer's and they will ask why they are being excluded and why their advance directives are not being respected.

I would like to talk a bit about palliative care. I know it is a subject that has been talked about a lot in the House. The reason is that when this bill receives royal assent in June, it is going to be the law of the land. Palliative care is in such a sorry state in so many jurisdictions in Canada right now that I do not want Canadians to be living in a hospital bed somewhere with substandard care and thinking their only way out is to end their lives. That is why we talk about palliative care with such urgency, because once this bill becomes the law of the land, that is what some Canadians may think is their only option. We have to treat it with the urgency that it deserves.

I would now like to talk a bit about the great work that the member for Timmins—James Bay has done. It is very important to recognize that a previous motion in the House of Commons was passed with all-party support in 2014, yet here we are in 2016 still talking about it. I would love to have seen some firm dollar commitments in the budget. Until we see that, all we have is talk. We need an absolute pan-Canadian palliative care strategy. I was honoured to walk in the Hike for Hospice on the weekend in my riding. A great bunch of people in the community came out for it.

I would like to end on the concept of empathy versus sympathy. Up until this point, our country has had a sympathetic viewpoint on this whole issue and true empathy means that people step outside of just feeling sorry for people and actually perceive the world through their eyes. That is what this legislation aims to do, to see the world through the eyes of someone who is suffering from a condition. We have no idea what it is like and that is what everyone needs to be doing in this country, being more empathetic and trying to provide true support.

I will end there. I am thankful for this opportunity.

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

Mr. Speaker, the member has added one more to a long list of excellent speeches here today from all parties. Congratulations on that.

There are many conflicting emotions and opinions for so many people on this issue. I want to congratulate the government for taking those different viewpoints, balancing them with one another and with the requirement of the court ruling, and coming up with this excellent piece of legislation.

Would I like it to go further? Yes, I would. Personally, I would like to see the right to assisted death by a living will—that is advance approval—included as the member referenced. I also know that not everyone agrees with that for a variety of completely valid reasons. Indeed, many of our colleagues would like this bill to be more restrictive on certain points.

I congratulate also the special committee on such tremendous work and on producing such a comprehensive report that looks at these substantial and substantive nuances and conflicts. In the context of all the circumstances before us, the government has done the best possible job of balancing all of these different perspectives to get this bill in within the imposed and very rapid deadline.

I wonder if the member agrees that even on the points where he may disagree, the government has achieved a real working compromise that moves us forward as a country on this extremely important issue, and that the risk of doing too much and then having it fail outweighs the benefits of having a bill that would do everything the more progressive among us would like.

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

Mr. Speaker, I will agree with the member that the timeline is not ideal. Here we are on May 2, and June is next month and that is the deadline. This bill still has to make it through committee, come back for report and third reading, and go through the Senate before the Governor General signs off. In that time, we have not had much time to do the proper work, but we have to deal with what we have.

As for the certain clauses that the member was talking about, I just wish that the government had listened a bit more and followed the special joint committee's recommendations. Specifically with proposed paragraph 241.2(2)(d), that was a glaring oversight. However, again I do welcome its going to committee and I hope we have amendments that do it justice.

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

Mr. Speaker, based on what the member and others have said, it seems there is a consensus emerging, at least from the different opposition parties, about the need to have clearer and better protection of conscience. The Liberals say this is important to them. Why not put it in the legislation, exactly as the member talked about, using the model of the Civil Marriage Act?

I would caution the member on putting too much stock in the special joint committee. I know the member was not part of that process, but my big concern was that there was a real bias in terms of the witnesses who were able to present and the witnesses who were not able to present. Just one example is that we had three separate panels from the organization Dying with Dignity. However, many intervenors on the other side of the issue, people who actually intervened in the Carter decision and presented to the federal expert panel, were not able to participate in the special joint committee. I understand, from what I have heard so far, that the justice committee is looking at a more balanced group of witnesses and I really appreciate that. However, I would caution the member to consider the process that led to that result, and hopefully we will see a more balanced group of witnesses from the justice committee.

On the issue of advance directives, the big problem with advance directives is that those are used in very specific situations where the outcomes and all the elements can be predicted in advance. The problem is that it is very difficult to predict what exactly will happen to someone undergoing one of these illnesses or how the individual will respond to it. I wonder if the member can talk about the problems of using advance directives when there is not certainty at all about the kind of process that a person is going to go through or how that person is going to experience that at that time.

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

Mr. Speaker, I recognize that everyone in the House to some extent has had personal experience with the loss of a loved one. For me, it was my wife's grandmother, who was suffering from dementia. Had we stepped back a few years with her when she was present and cognizant and if she had been able to peek into the future and look at what her life would end up being, she might have wanted a different path. It is very hard to witness someone going through that who has lost the mental faculty to make a decision on his or her own.

I agree with the member. It is a very thorny subject, but I believe it is one that absolutely deserves a closer look. Someone who has a diagnosis of dementia is going to look at section 7 of the charter and is going to say, “This is failing me.” He or she is then going to take it to the Supreme Court and I am pretty sure that the Supreme Court will rule in that person's favour. It is up to us to grapple with this issue now.

[Kyle Peterson, Liberal, Newmarket—Aurora, ON]

Mr. Speaker, I rise tonight to comment on Bill C-14. Before beginning, I want to commend all members of the House for so far treating this debate with the sensitivity it warrants. This is without doubt an issue that evokes much passion on both sides of the issue. This debate at its essence pits the sanctity of life against the inherent autonomy of the individual. I think it may be a worthwhile exercise to go back in time, not just a little but back a few decades so we can attempt to put the current debate into some legal context.

The common law crimes of attempting suicide and assisting suicide were codified in Canada when Parliament enacted the Criminal Code in 1892. Eighty years later, in 1972, the House repealed the offence of attempting suicide from the Criminal Code based in part on the argument that a legal deterrent was unnecessary in those circumstances. However, the prohibition on assisting suicide remained. This prohibition is found currently in section 241 of the Criminal Code. This in my opinion is the fundamental shortcoming of our current law.

Currently, able-bodied Canadians can take their own lives without any legal consequences. Those who physically cannot are currently discriminated against from doing so. This brings us to Carter, a unanimous decision of the Supreme Court of Canada that overturned the 1993 case of Rodriguez. Carter holds that, among other things, the Criminal Code prohibition against assistance in dying found in section 241 is unconstitutional on the grounds that denying disabled people the right to assisted suicide is contrary to the Charter of Rights and Freedoms.

The current legislative prohibition found in the Criminal Code was held to be over broad in that it prohibited physician-assisted death for a competent adult person who, first, clearly consents to the termination of life, and second, has a grievous and irremediable medical condition including an illness, disease, or disability that causes enduring suffering that is intolerable to the individual and the circumstances of his or her condition.

This leads us to where we are today. The court decision requires strict limits that are scrupulously monitored. This government is proposing a framework that considers different interests, including personal autonomy toward the end of one's life, the protection of vulnerable persons, and conscience rights, all values that are deeply important to Canadians across this country.

The debate regarding medical assistance in dying is important to each and every one of us for different and for deeply personal reasons in many cases. For all Canadians this is a difficult and profoundly sensitive issue tied to their life experiences and personal beliefs.

I have heard many of my constituents share with me their opinions on the bill, some of whom face difficult and sometimes unimaginable health challenges. Just today, I received an email from a woman in my riding suffering from a slow-moving form of ALS. Gradually this horrible disease has taken her voluntary muscle control, making it difficult for her to sign her own name, to speak, and to even form the most basic sentences.

In her own words to me she describes the situation as thus, “Our hearts continue to pump. We are aware of everything happening to us and around us, but become unable to do the simplest things for ourselves. We cannot predict our lifespan”. She urged the House, through me, to reconsider the issue of advance directives. This is one Canadian who will be directly impacted by Bill C-14, one Canadian of many.

Members may ask why I relay this story. It is because Bill C-14 clearly states that a requirement for assisted dying must be that natural death is within the reasonably foreseeable future. For many Canadians, suffering and looking toward the future of only further pain and suffering, there is no clear, distinguishable path to death, but this should not diminish their choices. For some, without this choice in the future, it can feel like a loss of comfort, a loss of safety and a loss of autonomy.

Additionally, this past weekend I had the opportunity to sit with a few of my fellow members of Parliament from York region to listen to important concerns and questions relating to Bill C-14. With an open mic, this event not only provided the opportunity for the participants to express their views and opinions on medically assisted dying, but also allowed me a great opportunity to meet and discuss on a more personal level with the people in my community who would be directly affected by the results of this debate.

While these discussions are important, it is equally important that a person does not come to end-of-life decisions lightly. Oftentimes the decision follows years of personal deliberation and what I can only imagine would be the most difficult conversations of a family member and those closest to them.

For these reasons and many others, Bill C-14 cannot and should not be taken lightly. While there will always be those who believe the bill does not go far enough, others believe it goes too far.

The Supreme Court of Canada unanimously decided that Canadians suffering intolerably had the right to request assistance to end their suffering. The bill respects that decision. However, I would encourage all members to engage with their constituents on this important matter and bring that informed advice to committee.

Medical assistance in dying represents a significant change in the Canadian medical landscape, and this government has conducted consultations with many experts. Physicians have indicated that they would be most comfortable providing this option to patients approaching death as another option alongside palliative care, withdrawal of treatment or palliative sedation. These options are all individually important and are woven into the bill to ensure that patients are served and equally protected, as well to limit any risks to the physician.

As this government engages with the provinces and territories to support the development of a pan-Canadian monitoring system to collect and analyze data, monitor trends and publicly report on medical assistance in dying, I ask that we all take time to consult with our constituents.

While I am open to the government's Bill C-14 and will support it to move it to committee, I do feel some amendments may be necessary. We, as legislators, are not doing our jobs if we are not open to continually hearing from Canadians and engaging in meaningful consultations and dialogue, especially on an issue as important and fundamental as this one.

I urge all members to also support the bill. I thank the Speaker for allowing me to rise to speak on such an important topic and share my perspective.

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

Mr. Speaker, the member talked about the possibility of amendments. I would like to suggest one amendment and hear his comments on it.

We have these criteria in the bill, but the criteria only mean something if there is some kind of assessment in advance. If the only assessment of each case is retrospective, then there is very little way of adjudicating if someone is actually meeting the criteria. There is no way of protecting the vulnerable, because even if there is some suspicion of a problem, the person is already dead.

Our first priority should be to protect people who do not consent, who do not want this, from being pushed into it.

Would the member agree with me that a simple system of advanced, legal review by some kind of cognizant authority is necessary to ensure that people who do not consent do not have their lives taken inadvertently? It could be a judge, or a consent and capacity board, and the model could vary from province to province.

[Kyle Peterson, Liberal, Newmarket—Aurora, ON]

Mr. Speaker, we have a rare opportunity to hear from the member for Sherwood Park—Fort Saskatchewan, and I appreciate his question in this House. It is an important question.

I think everyone here agrees that we would all be very disappointed if we enacted a law that resulted in people having their lives terminated without their consent. I agree with the member that, as long as the mechanism in place could still be processed quickly without further suffering to the patient, it is a safeguard that should be in the system. We want to ensure that we are aligned with the Supreme Court that the patient consents to the termination of his or her life. I am happy to support whatever we need to do to ensure that is in the legislation.

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

Mr. Speaker, although the hon. member for Newmarket—Aurora is not in the position of being a parliamentary secretary or a minister, as a member of the majority Liberal government my question to him is this. Does he have any sense of whether the committee will be open to amendments and whether the governing party will allow amendments?

I have had the very depressing experience today of watching Liberal members being forced to vote for a motion that I pleaded them not to vote for. It is the first time I have had a very strong sense that perhaps the respect for individual members of Parliament and the ability to bring amendments at committee, reflecting the will of the committee, may be more circumscribed than I would have hoped.

[Kyle Peterson, Liberal, Newmarket—Aurora, ON]

Mr. Speaker, the member is correct that, like her, I am not a minister of the crown or a parliamentary secretary. However, like her, I am a Dalhousie law graduate and have a complete respect for the legal process. I think, for the legal and law-making processes to work well, committees must have the ability, the power, and the capacity to make amendments when that is the will of the committee or the House. I trust and I have faith in the justice committee that it will be not only willing but able to do so at the committee stage.

[Martin Shields, Conservative, Bow River, AB]

Mr. Speaker, I appreciate the member's contribution to the discussion this evening. One of the challenges I find with this legislation is from my past experience when I was on a board that was attempting to design do-not-resuscitate orders with doctors. It took us a couple of years before they finally agreed to it, and it turned into four levels, not one, of do-not-resuscitate orders. What we then found was that the doctors still found a way to not implement them. They said that we as a board had decided on the policy but that they did not want to implement it.

My question to my colleague is this. We have 10 different provinces and territories. How will we deal with a profession that really does not want to implement this particular process?

[Kyle Peterson, Liberal, Newmarket—Aurora, ON]

Mr. Speaker, I do not necessarily share my colleague's pessimism with respect to the ability of our provinces to implement processes that may or may not be derived at the federal level. I also do not necessarily agree that they may not want to implement them. If there is a robust consultation system in place with the provinces, the medical associations, and the health professionals in all of the provinces, by working in consultation, knowing full well that whatever process is in place has to be in line with the Supreme Court of Canada, I am convinced and optimistic that we will be able to come up with a reasonable process that ensures that doctors and health professionals are protected, and that the rights of the patients are protected at the same time.