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

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

Mr. Speaker, I appreciate the respectful tone and the way in which all members in this place are approaching an issue which I know could divide us. It touches on the sanctity of life, on issues of great importance to all of us, and on the question of human suffering that so distresses all of us. It interprets a Supreme Court decision. Bill C-14 is a bill that requires a sobriety, a sensitivity and a respectful dialogue as we approach it.

Other members have reflected on what they have learned from their constituents. I need to share the story of what happened to me when I became the member of Parliament for Saanich—Gulf Islands. I was someone who would not have been comfortable with this bill. My constituents may be the most active group of people working for Dying With Dignity.

There are two Dying With Dignity chapters in Saanich—Gulf Islands. I was visited by members from the Salt Spring Island chapter. I was visited by members from the Victoria chapter. Over time, I realized that perhaps my riding had been sensitized to this issue, because Sue Rodriguez lived in my riding.

Her death in 1994 touched all Canadians, as we realized that she tried so hard to get relief from the courts, permission to have a medically assisted death. In the end, it was not possible through the legal system. We all remember her quite courageous and tragic death.

At the time of the court telling Sue Rodriguez that she could not find access to legal medically assisted death, she said, “If I cannot give consent to my own death, whose body is this? Who owns my life?”

These are profound questions that hang in the air still. Some of us might answer that none of us own our own life, that our lives belong to the creator. Some of us may say whatever one believes, each of us has the right to make our own decisions. Those people who might believe one aspect through faith have no right to deny some one else the decision that he or she wants to take, to plan for a death with dignity.

In the course of listening to my constituents, particularly through a series of town hall meetings over the last five years, and through questions and comments that have come to me through the mail, I became persuaded that my job as their member of Parliament was to support access to medically assisted death.

Then my life experience as a lawyer kicked in, and I was very relieved when the Carter decision came down. I thought that at long last we now had legal clarity on this matter, and that Parliament could begin to resolve the issue through the work in Parliament. The issue has been through the courts so often that I felt that we were now in a position as lawmakers and legislators to deal with the decision in Carter.

Just to remind members, the Supreme Court said that the Criminal Code sections that prohibited physician-assisted death violated section 7 of the Charter, and therefore:

....are void insofar as they prohibit physician-assisted death for a competent adult person who (1) clearly consents to the termination of life; and (2) has a grievous and irremediable medical condition (including an illness, disease or disability) that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition.

The court was clear in this decision that we were not speaking of any possibility that one person could make a decision for medical assistance in dying for anyone else. This is a personal decision. The Supreme Court has said that a competent adult person can make this determination. What the court set out as the conditions that would justify medically assisted death was a grievous and irremediable medical condition.

I was disappointed in Bill C-14. I felt, after looking at the report of the special committee, that the legislation would likely anticipate where the court would go in future rulings, and avoid protracted court cases as Canada figured out how we would accommodate medical assistance in dying.

The bill, in not fulfilling even the conditions set out in the decision of the Supreme Court in Carter, would lead to more litigation and more suffering for people who now see that the Supreme Court of Canada has said that to suffer in situations like this violates their charter rights. If we pass Bill C-14 as it is currently drafted, Parliament would be denying them their charter rights going forward.

Other members of Parliament have mentioned this. We know that the legislation is attempting to balance very difficult issues to ensure that there are robust safeguards—and we have had conversations about whether they are sufficiently robust—the sanctity of life, and the protection of vulnerable persons.

This bill is close to getting it right, but where I am really baffled is in the decision not just to say “irremediable” but to insist, as others have noted, that one of the conditions in section 241.2(2)(d), is that their natural death has become “reasonably foreseeable”. I am afraid that is quite baffling, given what the Supreme Court told us we must do. The “irremediable” situation was not described as incurable or terminal. That is a deficiency in the legislation and one that will not just disappoint people who are suffering, but also calls into question the wisdom of this place in interpreting the Supreme Court of Canada's decision to protect charter rights.

Many have spoken about this second area as well. As I read it I thought that this cannot be right, that this must just to be bad drafting, that they cannot mean this. In going through all the conditions, yes, there are safeguards there. There are independent medical practitioners, more than one, and there is not undue influence of any kind. Not to go through every element of it, but as we have to go through quite a protracted process to make a legal declaration, and it would be fulfilled by independent witnesses, one has to go through all of this and then, after all that, at 241.2(3)(h) we find that immediately before providing the medical assistance in dying, the person would be given the opportunity to withdraw the request. and ensure that the person gives express consent to receive medical assistance in dying.

This is gravely disappointing. Those who take the decision that they want medical assistance in dying are now denied that, if their situation is one where we cannot reasonably foresee their natural death and where at the moment they have planned for and gone through this protracted process to ensure that they would have medical assistance in their death, now must be of sound mind to reassert and have the capacity to reassert that they have confirmed this is what they wish. This would surely deny many groups of people who would look to the court decision in Carter as their way of knowing that they would have the right to choose to die with dignity with the assistance of a medical professional.

Many have mentioned these deficiencies in Bill C-14. There are others that have been raised by the British Columbia Civil Liberties Association, as a co-litigant in the Carter case. I am not out of sympathy with those, but perhaps those could wait for another time.

I do not see how Parliament could decide to wait for another time in ensuring that the legislation we pass now is in conformity with the instructions we received from the Supreme Court of Canada.

Calling on my background as a lawyer, as well as my commitment to my constituents, I look at Bill C-14 and ask how we could pass something that would once again be found by a court to violate section 7 charter rights for those Canadians who have met the test in Carter, but would fail the test in Bill C-14. It is an enormously difficult question.

I have enormous respect for all the voices I have heard in the House in this debate at second reading. I will vote for the bill at second reading, but I hope we are prepared to fix its deficiencies in committee.

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

Mr. Speaker, I always appreciate the thoughtful remarks from the member for Saanich—Gulf Islands.

However, I want to push back a little on her suggestion that this is bound for unsuccessful litigation and ask her these three questions. Would she agree that the court in its decision did not define “grievous and irremediable”? Would she agree that it was open to Parliament to provide such a definition? Would she agree that at page 98 of the decision, the Supreme Court said it would give a great degree of deference to any complex regulatory scheme that is put in place by Parliament to respond to the decision?

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

Mr. Speaker, I return the compliment to my friend, the member for Charlottetown and parliamentary secretary. I enjoy working with him as well.

However, in answering his question, while the court did not define “grievous and irremediable”, it is a logical leap, which I will not take, to imagine that the court was not considering the specific case in front of it. In other words, the case of Kay Carter dealt with someone who was in a grievous and irremediable situation, but her natural death was not foreseeable at that moment. The facts set before the court that led it to make this ruling was that there was a violation of charter rights, not in the abstract, but for the plaintiff, the litigant, before them. It described her condition as “grievous and irremediable”. In that, it did not insist that we know or that her doctors know that her natural death was foreseeable. In other words, the facts set in this case did not require a terminal illness.

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

Mr. Speaker, I want to thank my colleague for her thoughtful remarks, although I may disagree with her on some of her conclusions.

Would she agree that there needs to be better protection within the legislation to ensure that should their conscience not allow medical or health care practitioners who are providing end-of-life care to go down that path, that they should have the freedom not to participate?

Second, in terms of the potential future of this regime, in whatever form it ends up taking, is she concerned at all about the impact on the potential lack of trust between patient and doctor? What would this do to the patient-doctor relationship in terms of trust, especially for those who are elderly, who may be facing end-of-life decisions?

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

Mr. Speaker, I do not think there is any dispute—well, I should not say there is no dispute—between the hon. member and myself. It is only right that a health care professional would have the ability to say that they would not want to assist in a situation like this.

As for whether I think this would call into question the relationship between a patient and their doctor, I do not see that it would. I believe that doctors who are not prepared to assist in this way will make a recommendation to the patient that they find somebody who is prepared to do it. They know they need to get independent medical advice from more than one medical professional.

I have great respect for the medical profession. I cannot imagine the medical profession urging someone to consider an option such as medical-assisted dying if that is not something the individual, on their own, has chosen because they are in a situation of grievous suffering and they wish that for themselves. I do not see it contaminating the doctor-patient relationship.

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

Mr. Speaker, before I begin, I would like to acknowledge the Minister of Justice, the Minister of Health, and the parliamentary secretaries and their teams for their work on this important legislation, and to thank them for their efforts. I would also like to thank the chair and members of the Special Joint Committee on Physician-Assisted Dying, the witnesses they heard from, and the countless Canadians who took part in consultations right across the country. This is not an easy topic for discussion, and I commend all involved for their thoughtful, compassionate, and thorough work.

The Carter decision set out a clear objective for parliamentarians to come up with a legislative framework that allows Canadians who are suffering intolerably the right to request assistance to end their suffering. Bill C-14 is the government's answer to this critical objective, and I stand here today, proud to support this important legislation.

I have heard from constituents on both sides of the issue, some who flatly oppose allowing any access to medical assistance in death, and others who believe the legislation does not go far enough. I have also heard from people who applaud the thoughtful work on this bill and have reached out to me to express their gratitude.

In this regard, it is important to note and to reiterate what has been mentioned many times in this chamber. With this legislation, our task was not to determine if physician-assisted dying was necessary, but to determine how best to move it forward. This is an important consideration and one that is worth repeating.

Of paramount importance to me in reviewing this bill was to determine if it properly considers different interests, including balancing the right to personal autonomy at the end of life with the need to ensure robust protection for the most vulnerable in our society. I believe that this legislation achieves this balance and that it rightly takes the necessary steps to ensure that the rights of all are respected.

With respect to personal autonomy, this legislation responds to the objective mentioned earlier that was provided to us by the Supreme Court of Canada, that Canadians who are suffering intolerably have the right to request assistance to end their suffering.

I am not a lawyer, and as such will not speak to the legal ramifications of this bill. As well, I cannot speak with authority on the constitutional nuances of this bill. However, as a person of faith, it was critically important to me that subsection 2(a) of the Charter of Rights and Freedoms, which grants Canadians the freedom of conscience and religion, was considered and protected.

A couple of weeks ago, I had a meeting in my office with members from the St. John the Evangelist Catholic Church in Whitby. While they understood that the objective for us in this chamber was to come up with a legislative framework for medical assistance in dying, they were gravely concerned about protecting the conscience of medical professionals. They wanted some assurance that the conscience of the health care provider was protected.

Balancing the rights of medical providers and those of the patient is generally a matter of provincial and territorial concern. However, our government is committed to working with the provinces and territories to explore options to facilitate access and care coordination while recognizing the personal convictions of health care providers.

Having worked in health care based research for the bulk of my professional life, I have had the opportunity to work closely with health care professionals in a variety of capacities. It is very important to me that any legislation put forward respected the rights and personal convictions of care providers. I am very pleased to see that this legislation makes mention of this while acknowledging that safeguarding those convictions requires an ongoing conversation with the provinces and territories.

The robust considerations and protections for the most vulnerable in our society inherent in this legislation are also of particular importance. This legislation sets out the criteria for the determination by medical professionals as to whether or not a patient suffers from a grievous or irremediable medical condition. These criteria include that they have a serious and incurable illness, disease or disability; are in an advanced state of irreversible decline in capability; the state of decline causes them enduring physical or psychological suffering that is intolerable to them and that cannot be relieved under conditions that they consider acceptable; and that their natural death has become reasonably foreseeable.

As a mother of three children and MP for the bedroom communities in my riding of Whitby, I was pleased that the legislation also includes strict eligibility requirements that protect minors. Careful thought and consideration are required to understand and assess a minor's ability to make a decision involving the termination of his or her life. I applaud the decision to further study this aspect of the legislation and look forward to being actively involved at that time.

Additionally, this legislation would ensure that those who make a request for assisted dying do so without coercion, having provided informed consent, and given the opportunity to, at any time and in any manner, withdraw their consent. These safeguards are fundamental to Bill C-14. The bill provides safeguards to ensure that individuals can remove consent. The requirements that the request be voluntary and that the person must decide for himself or herself that he or she wants medical assistance in dying is as equally important as the requirement to have the ability to remove consent.

I am proud that this government has listened to stakeholders from across the country and has committed to ensuring that all Canadians have access to quality end-of-life care, including palliative care. Our $3-billion commitment to improving and expanding access to home care is another critically important step and I look forward to seeing continued progress on this vital portfolio in the months ahead.

Finally, I would like to thank and acknowledge my colleagues in the chamber for the thoughtful, measured, and respectful tone struck during this debate. This is not an easy topic of discussion. It is one that challenges us to examine our fundamental beliefs about life and death. I commend all for their work on this file.

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

Mr. Speaker, it is good to hear the member talk about how she sees the protection of conscience as very important, but I would simply ask, why not protect it in the legislation? There is, of course, a precedent for this. We have talked about the Civil Marriage Act including protection for conscience at the federal level. A similar model could be used.

Essentially, what we are being told by the government is that we are talking about it, so why not just take the government's word for it. Taking the government's word for it just is not good enough. We want to see conscience protection included in the legislation.

Also, does the member clearly understand that the protection of conscience includes the right to choose not to refer? There has been some confusion about that by some other members. Respecting an individual's conscience includes the right to not only not provide a service but to not be complicit in providing the service by using a formal referral. Physicians do not have an objection to providing information, of course, and facilitating the orderly transfer of records, but there is a big difference between that and a formal referral. I would appreciate the member's comments on that as well.

[Celina Caesar-Chavannes, Liberal, Whitby, ON]

Mr. Speaker, with respect to the right of a physician not to refer, as I said in my comments, this is for the provinces and territories to determine, with the help of the government, to respect the conscience rights of physicians.

The question about referrals did come up in my riding. Many were concerned about that. I hope that consideration is part of an ongoing conversation with the provinces and territories and medical professionals.

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

Mr. Speaker, given that the member is the Parliamentary Secretary to the Prime Minister, does she have any more information she can give us regarding the funding that will be allocated to palliative care?

As she knows, no funding was allocated for that purpose in the latest budget, nor are there any new commitments set out in Bill C-14. Can she give us a little more information in that regard?

[Celina Caesar-Chavannes, Liberal, Whitby, ON]

Mr. Speaker, as the Minister of Health has stated many times in this House, she is in constant dialogue with the provinces and territories to renew the health accord. There is a commitment of $3 billion in the budget to look at end-of-life care, including home care and palliative care.

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

Mr. Speaker, as a follow-up to my previous question, to put a finer point on it, the current policy of the College of Physicians and Surgeons of Ontario is to require referral if something falls within the standard of care, or in an emergency or urgent situation, to actually require the provision of that service. This is not something that can wait for further consultation, because if this legislation passes, then right after June 6, or whenever this would take effect, it would be required in Ontario for physicians to either refer or potentially to provide this service.

If the member accepts the value of protecting conscience, recognizing that this could be the reality and the outcome in her riding once this legislation passes, would she not support immediate changes to this legislation which formally and directly would ensure the protection of conscience in that legislation?

[Celina Caesar-Chavannes, Liberal, Whitby, ON]

Mr. Speaker, I do respect the fact that there are jurisdictional boundaries with respect to what we can and cannot legislate. The provinces and territories have jurisdiction over this particular aspect and the government will continue to work with the provinces and territories to ensure that the conscience rights of our medical professionals are taken into consideration with respect to this bill.

[Luc Berthold, Conservative, Mégantic—L'Érable, QC]

Mr. Speaker, this evening, I have the pleasure of being here with my colleagues to speak about the bill on medical assistance in dying.

This is a major issue and I must admit that it gave me a greater understanding of my new role here as the member representing the people of my riding, the new role that I am playing in the House of Commons for our country.

From the beginning, there has been a lot of talk about the budget, transportation, deficits, terrorism, and all sorts of other topics that are all equally important to our country. However, rarely does a bill generate as much uneasiness and discomfort among our constituents as the bill we have before us today.

Not a day has gone by since January that I have not spoken about medical assistance in dying with the people of my riding of Mégantic—L'Érable. Quite honestly, I expected people to give me strong, clear answers. However, it has been quite the opposite. After speaking with people even for just two or three minutes, I have seen that they know how important this issue is, but they hesitate to voice their opinions on it.

I think that, as a member of Parliament, my role is to take a position in accordance with my values and beliefs, all the while representing the will of those who did me the honour of electing me to Parliament.

I must say that I have not yet made up my mind about this issue. Every time I find myself leaning to one side, I hear arguments that make me once again question my views.

This is a complex issue that touches people's hearts and strikes at the very core of their values. A bill about medical assistance in dying is not like any other bill. This is a bill that makes us take a look at ourselves and our lives. We immediately think about our parents, our grandparents, our brothers, our sisters, our friends, and ourselves. Suddenly, a bill that is being discussed in Ottawa, far from my riding, becomes something very personal to the people I talk to.

Allow me to give an example. How would we react if one of our loved ones was suffering at the end of their life and their last moments were unbearable? Most of us have had experience with this. We have been in this type of situation, supporting a loved one at the end of their life. Most often, these people we care about are suffering from a cancer that can cause horrible suffering. No one, absolutely no one, wants to see a loved one suffer.

I want to share my own experience. My father died of throat cancer after a difficult eight-month battle against this terrible disease. He was not even 50 years old. Those were difficult months. I think that we all went through something similar in our own lives, when we had to support someone we loved dearly through a very difficult time.

When that stage begins, we do not realize that it is the final stage of that person's life. When doctors set out to treat that person, we do not expect it to be the beginning of the end, so we begin a healing process with our loved one, and we work hard with that person because we love them and we want to fight and win the war on cancer.

At the end of that war, when my father knew that medicine could do nothing more for him, how would I have reacted if someone had suggested ending his life? I do not know because I was one of the last people in my family to tell him he could let go and give up the fight. I did not want him to go even though I knew deep down that it was the only way out for him.

Fortunately, my father received palliative care that minimized his suffering in his final moments. My mother and my brother showed great courage. They were by his side in his final moments because they lived in the same city. I was farther away and saw him on weekends. All of those people and his family members were by his side until the end.

I am certain that he is looking down on me today and that he is very proud to see me here in the House of Commons. My story is that of thousands of Canadians. It is the story of our will to live, and it is the story of our relationship with death.

Soon, I will have to vote on Bill C-14. I will have to decide how our country will respond to the Supreme Court decision that gives some Canadians the right to choose medical assistance in dying. I will repeat that I have not yet made my decision.

I recognize that people who are dying must be able to die with dignity. Dying with dignity does not necessarily mean obtaining medical assistance in dying. Dying with dignity means being able to die surrounded by your loved ones whenever possible, receiving medical treatment that is respectful of one's last moments and, above all, not suffering too much.

I was shocked to learn in the course of the legislative process that not all Canadians have access to palliative care. More than 60% of Canadians who are dying will not have the support required to take this last step in dignity. Even before I take a stand on medical assistance in dying, I believe that we have a duty to change this.

I hope that the goal of members of the House is not to do everything they can so that as many Canadians as possible choose to make use of medical assistance in dying. In fact, I am convinced that it is not. The Supreme Court has ordered us to quickly regulate the use of medical assistance in dying and to set parameters for the entire process. Which Canadians will be given access to medical assistance in dying? How will the most vulnerable members of our society be protected? Who will help the sick people and authorize the use of medical assistance in dying? How will the people who are involved in the dying person's choice be protected?

Over the coming weeks, I am going to show Bill C-14 to my constituents. In a few days, I am going to set up a meeting with a community organization in my riding called Le Havre, which is an aid and support group for people with mental health problems. We are going to hold a round table to talk about medical assistance in dying, the end of life, and people's decision-making abilities. I hope that these discussions will give me a better idea of the choice that I should make in a few weeks.

Fortunately, although it was definitely short on time, the Special Joint Committee on Physician-Assisted Dying managed to ensure that we heard from many groups and citizens to gather their views. I did not attend all the meetings, in fact I attended only one, but it made an impression on me. I will come back to that later.

I want to thank all of my colleagues in the House and the Senate who contributed to the work of the committee. There is no single response to the Carter ruling, because no two situations are identical. The good will of everyone allowed parliamentarians to consider two reports, including a dissenting report tabled by our colleagues, the members for Louis-Saint-Laurent, Langley—Aldergrove, Kitchener—Conestoga, and St. Albert—Edmonton. I am pleased that Bill C-14 takes a lot of inspiration from my colleagues' report, because it more closely reflects my concerns at this stage in my own personal thinking.

As I already mentioned, this is not about a race to allow medical assistance in dying. We need to make sure we protect Canadians' charter rights, whether that involves seeking medical assistance in dying or protecting those who will have to face that difficult choice, whether they want to or not, in the coming years. In the current situation, I think Bill C-14 should have been based more on the dissenting report, because the bill does not go far enough to protect vulnerable individuals, their families, and health professionals. What are its main principles? As my colleague from Louis-Saint-Laurent mentioned earlier today, it is about the protection of minors, people with mental illness, and the conscience of doctors and other health professionals.

The bill should apply only to people who are at the end of their lives. The option to receive palliative care is also important to Canadians. Steven Fletcher mentioned something to the joint committee. He said, “The further you move away from the Carter decision, the more likely it is that you're going to step into provincial jurisdiction. When you make that step, I predict you'll go into constitutional darkness, never to be found again.” We have to make the right decision, an informed decision. I think that the dissenting report shows us the way. Soon I will have to take a stand, and I hope that my constituents will help me with that.

[Bob Bratina, Liberal, Hamilton East—Stoney Creek, ON]

Mr. Speaker, I appreciate the comments by my friend across the way, but I am confused about the emphasis on palliative care with the deadline that is presented to us, which is June 6.

If we were going to venture into palliative care and incorporate it into the legislation, we would have to have talks with the provinces that would actually be delivering the palliative care. The first thing we would have to do is define what proper palliative care would be, and that would become confusing because in some cases there would be family members available and in other cases there would not. I had a case in my own family with two grandmothers over 100 years of age whose children were in their eighties. I am not sure whether a definition could incorporate them into that.

Given the deadline we have and the involvement with the provinces, how would my colleague suggest that we possibly approach the palliative care question?

[Luc Berthold, Conservative, Mégantic—L'Érable, QC]

Mr. Speaker, in an ideal world, we would have the time to do things in order. Unfortunately, the Supreme Court imposed a deadline. I think that the choices when it comes to end of life are comprehensive choices. We cannot just offer people medical assistance in dying without also offering them the possibility of dying gently, with dignity, and with palliative care. We must offer both options to Canadians.

As to how to do that, it is a judge who decided to force our hand and make us proceed more quickly. We must do everything in our power to make palliative care available. It is our duty as members of Parliament.