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.

Motions in amendment

[Murray Rankin, NDP, Victoria, BC]

Madam Speaker, it was a pleasure to be in the riding of my colleague and friend from Edmonton Strathcona to talk about this with hundreds of passionate Canadians who were, frankly, surprised there was no willingness on the part of the government to consider advance directives in Bill C-14.

Since I spoke in Edmonton, I ended up moving that there be amendments specifically to provide that kind of advance requests, as so many witnesses had proposed. However, every Liberal on the committee voted against that change.

I think Canadians are demanding it. I get more letters and calls about this issue than any other deficiency in the bill. I hope that the review that is proposed in the legislation will eventually take us there, because I know Canadians are demanding it.

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

Madam Speaker, there is one principle in which my colleague and I fundamentally disagree, and that is on the issue of safeguards for vulnerable people.

I have had the privilege of working on behalf of many vulnerable groups over the last 10 years, as I am sure my colleague has. However, for my colleague to suggest that other jurisdictions have not had a problem with vulnerable persons being at risk to the physician-assisted suicide regime is simply untrue.

The committee heard from witnesses from other jurisdictions and, in fact, from people who had been part of administrations where the physician-assisted suicide situation had been implemented. They clearly warned us about the slippery slope that would happen when this door was open.

I would like my colleague to confirm that many witnesses did warn the committee about the fact that other jurisdictions had faced a problem in this area.

[Murray Rankin, NDP, Victoria, BC]

Madam Speaker, that was exactly the evidence that the Supreme Court heard. The trial court heard voluminous testimony about that and concluded that safeguards were to be properly built-in within their judgment.

In addition to that, Bill C-14 lists many additional safeguards that are provided, and I am comfortable with the result that has been achieved. However, I am not comfortable that we are taking away the rights of so many Canadians, which were achieved at great expense and difficulty in the Supreme Court decision in Carter.

[Randy Boissonnault, Liberal, Edmonton Centre, AB]

Madam Speaker, I rise on a point of order. If you seek it, I hope you will find unanimous consent for the following motion: That Bill C-16, an act to amend the Canadian Human Rights Act and the Criminal Code, be deemed to have been read a second time, referred to a committee of the whole, reported to the House without amendment, concurred in at report stage, read a third time, and passed.

[The Assistant Deputy Speaker, Carol Hughes]

Does the hon. parliamentary secretary have the unanimous consent of the House to move the motion?

[Some hon. members]

No.

[The Assistant Deputy Speaker, Carol Hughes]

Since there is no consent, the motion is deemed negatived.

Resuming debate, the hon. member for Sherwood Park—Fort Saskatchewan.

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

Madam Speaker, it is a pleasure for me to rise on this very important subject.

In a fairly limited way but nonetheless to some extent, we have had the chance to debate the larger philosophical questions in the legislation. However, I want to be very surgical in my comments today, no pun intended.

We have some important amendments before us that reflect good-faith efforts by opposition members to try to improve legislation. Whether we agree with it, there are some important steps we can take to substantially improve the legislation to try to make it better.

We had amendments come forward at committee. I had the pleasure of getting three of my proposed amendments passed, but on relatively limited aspects of the legislation. Therefore, I am moving today what I think are four substantive and important amendments that would improve the legislation. They are amendments that members should be able to agree on, regardless—

[The Assistant Deputy Speaker, Carol Hughes]

I want to remind hon. members that pictures are not to be taken in the House. If the member took pictures, I will recommend that the member delete them immediately and abide by the rules of the House, which is that no photos are to be taken in the House of Commons.

The hon. member for Sherwood Park—Fort Saskatchewan.

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

Madam Speaker, it has been quite the day on the procedural front, but I appreciate the opportunity to get back to a subject that is too important to be waylaid by these sorts of things. I mentioned four substantive amendments that I proposed. These are amendments that I think all members should be able to take a serious look at, and hopefully many on the government side will even agree with them.

I will say very clearly the purpose of these amendments. These amendments would not restrict access to something which the Supreme Court has deemed that we must give access to. Indeed, these amendments would provide greater shape and substance to the value of autonomy, which is supposed to be the basis of this legislation. They would give meaning and effect to that. I will mention that three out of four of these amendments would not even change the eligibility criteria.

What do I mean when I say that they would give added substance to autonomy? For an individual to have autonomy and effectively express that autonomy, the individual needs to have information about the choices he or she is making. How can people make autonomous choices if they do not have information about which they are supposed to be making the choice? That needs to include information about the impacts of a choice, as well as the alternatives that are available. Autonomy also requires some opportunity or space for meaningful deliberation based on that information.

What I am asking for in three out of the four amendments would not even require a change to the eligibility criteria. It is simply protection of the value of autonomy, assurance that individuals get the information they need, assurance that people who do not consent do not get pushed into this, and assurance that people who do not meet the criteria will not have their lives taken. The court asked us to develop a system of safeguards that would ensure that people who are vulnerable are not put at risk, that people who do not consent do not lose their lives in a medical environment, that people still feel safe in a medical environment, that they do not have to worry about going to a hospital and losing their lives without consenting to it.

We need these safeguards in place, and these amendments would do the job that the court asked us to do. They would provide the safeguards and protect the autonomy of individuals involved. I hope that members will take a serious look at all four of these amendments.

The first one, Motion No. 3 on the Order Paper, says that prior to making the request, someone must have consulted a medical practitioner specifically regarding palliative care options and be informed of a full range of options. Now, this can be part of the pre-existing consultation with a physician. There is no need for this to require additional time. This consultation, as I mentioned in committee, could happen with someone over the phone. There is not even a need for a requirement for an in-person consultation.

I see this amendment as the minimum of the minimum, but it would require that people get information about palliative care options before they take part in euthanasia or assisted suicide, and that people who express interest in euthanasia or assisted suicide at least first have someone say, “There is an alternative. This is what the alternative looks like. This is what is available in your area. Now you can choose between that robust, well-explained alternative of palliative care or the option of physician-assisted suicide or euthanasia.”

I do not see why members would have any objection to this amendment. It would not add any hoops to jump through. It is simply an assurance that patients would receive information about their alternatives. Indeed, it cuts to the core of what autonomy is supposed to be about: people having the information to make meaningful, understood choices between different alternatives.

It is interesting to hear members talk about their personal experiences on this issue. People talk about pain having been totally unmanageable in a particular case. In fact, the pain may have actually been manageable, but the person did not get good information and did not have access to the palliative care or pain management they needed. It is always unfortunate when I hear that said, because this speaks to people not getting the information they need about palliative care and pain management.

Let us do the minimum with that amendment. Let us make sure that people get information about palliative care options. I do not think that is too much to ask, and it would show the goodwill of the House to look at an amendment like that in a serious way.

My second amendment, Motion No. 7 on the Order Paper, would add a requirement of imminent natural death. This is the only one of my four amendments that would inform the eligibility criteria, but it is an important change. The phrase “reasonably foreseeable” is, of course, very ambiguous language. The use of the word “terminal” provides some greater degree of clarity.

This is very much constitutional. We have the right as Parliament to define the contours of an exception to the Criminal Code. As the justice minister herself has said, identifying the purpose of the law can alter the charter interpretation, and courts have said they would show deference. There is a need to proceed conservatively at the outset on an issue like this, and there is always the opportunity to study going further.

Most Canadians, when they think about this issue, are thinking in terms of terminal. This is consistent with the Quebec experience. There were seven years of study and a great deal of deliberation in the Quebec context. The conclusion, after much debate there, was that “terminal” was the best way to go. We would be unwise in a few months to rush to a very different conclusion than Quebec made after years and years of deliberation, or at least to go in a further direction than it did, because it had much more time to think about it.

Describing this legislation in a clearly terminal context provides greater protection from the concerns that the member for Winnipeg Centre and others have raised about this leading to some degree of suicide contagion. If we clearly define the legislation as applying to a limited population in a limited situation, we would have to worry relatively less so about how this may lead to some degree of suicide contagion in the rest of society.

I hope members will take a good look at that amendment as well.

The third amendment I am proposing is on the Order Paper as No. 12. It is a requirement for self-administration in cases where an individual is able to self-administer. This means that assisted suicide would be the default, as opposed to euthanasia, in the event that an individual is able.

This does not limit anyone's access to euthanasia or assisted suicide. Everyone who had access before the amendment would have access after it. However it ensures contemporaneous consent. It means that an individual who is seeking this service is consenting at the moment that they do it, and that there is no better way of doing it. This, again, adds substance to the idea of autonomy. It makes for good individual rationality in terms of the individual making the decision and doing it to themselves right at that moment.

This is a good safeguard in terms of ensuring contemporaneous consent, but it also has other benefits. It has the potential to help address the access issue. Doctors, in some cases, may be more comfortable assisting than they would be in actually providing. That is a safeguard that provides some additional benefits as well. There are no negative access implications. There is no harm in that provision.

The final amendment that I proposed is around advance review. The bottom line is that the so-called safeguards in the legislation are no good unless someone is checking. We have a requirement for two doctors and two witnesses, but a person could shop around. These four people could be anyone. They could be the same four people approving it for different Canadians across the country.

Therefore, I have put forward a proposal for a relatively minimal advance review process. It would be up to the provinces to designate that process. They could simply say that a lawyer has to sign off that the legal criteria were met, or they could have a judge do it. There are provisions for the provinces to have a choice within that context. However, there has to be an advance review. There has to be someone checking. If no one is checking, what good are the safeguards? What is the point of having any requirement at all if we do not have someone with the legal competency to understand what those safeguards are and to compare those safeguards to a situation? This is a complex legal situation. It requires some kind of competent legal authority.

The four amendments are modest amendments. They are surgical. They protect the value of autonomy. I hope all members, including members of the government, will take a serious look at them and give their support to them.

[Colin Fraser, Liberal, West Nova, NS]

Madam Speaker, I appreciate the comments of my friend. I know that at the Standing Committee on Justice and Human Rights, of which I am a member, we heard the same arguments. Obviously in the debate we are having with the competing motions before the House to amend the bill, we know there are some who suggest that the bill goes too far and some who suggest it does not go far enough. We are hearing that over and over.

One of the things that I would like to ask the hon. member is with regard to his change in Motion No. 7, which would basically change the words to “imminent natural death” being required. He says it is clearly constitutional, that the wording would be acceptable by the court, because Parliament has the ability to do that. Of course, we have a Charter of Rights in our country, and Parliament is subject to the rights as enunciated by the court. What I am wondering about is the word “imminent”. Does he believe that the appellants, who were the subject of the appeal in Carter, Kay Carter and Gloria Taylor, would have been able to get medical assistance in dying using the word “imminent”?

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

Madam Speaker, let me address a number of the different comments that the member made. I appreciated his contribution at the justice committee, although I did not always agree with the things he said there.

With respect to some members wanting to go further, some members thinking that this would not go far enough, some wanting it to pull back, I will just say this. I think that there are some ways that we can improve the legislation that would add clarity, that would add safeguards, that should have a substantial degree of consensus. The amendments that I proposed are not in the main about limiting eligibility. They are about providing safeguards to ensure a more robust and protected concept of autonomy.

The amendment he referred to about “terminal” is an exception to that, and it is one that I think is still important. However, the other three are very much focused on providing safeguards to ensure that those who receive this service have properly consented and have understood exactly what their options are in the context of that.

Now, the question—

[The Assistant Deputy Speaker, Carol Hughes]

Questions and comments, the hon. member for Saint-Hyacinthe—Bagot.

[Brigitte Sansoucy, NDP, Saint-Hyacinthe—Bagot, QC]

Madam Speaker, I completely agree with my colleague about the importance of palliative care. Having spent much of my life working in social services and on behalf of people in difficulty, everything affecting vulnerable people is really important to me.

However, and my colleague knows this because we sat on the same committee, a number of witnesses told us that we should not consider all ill or disabled people as being vulnerable. I believe that by doing so we are treating them like children. Many of them can give free and informed consent.

I would like my colleague to explain his views to me because listening to him, I sometimes have the impression that all sick or disabled people are vulnerable.

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

Madam Speaker, I certainly have never said, or certainly did not mean to imply, that every individual who may have a disability is vulnerable, and certainly would not be vulnerable in the same sense. There could be different degrees of vulnerability that could affect us all.

However, what I am trying to do with these amendments is to simply protect autonomy, ensure that everybody has the information they need about the alternatives. Some people may have that information already, but some people may not. That is why we need these safeguards.

If I have time, I want to briefly go back to comment to the previous questions because I did not get to answer the second part of it.

The member argued that an imminent requirement might not be constitutional. I will just say this. The Quebec bill has a requirement of imminence, and the Supreme Court, in its extension, said that the new provisions they were putting in place with respect to the extension do not apply to Quebec because Quebec already has a law in place. I think that would strongly suggest that in the view of the court, the Quebec model, which has a requirement for imminence, is constitutional. It would allow us to follow that model.

What I am suggesting in this amendment is to simply to a greater extent align the federal legislation with the Quebec legislation, which we already have a sense is constitutional.

However, I think there are some other points that could be made in defence of that; namely, that the court said in its decision that it would show a substantial degree of deference toward Parliament.