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

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

Mr. Speaker, with respect to palliative care, one of the proposals we have heard is to have a right to palliative care put into this legislation. We could not fully operationalize it today, but we could introduce a right that people could expect to have. That would fit really well with this.

This bill provides no conscience protection for doctors and nurses. If Parliament supports this bill, doctors in Ontario will not be able to opt out of performing euthanasia, and it is possible that some doctors will leave the profession. I urge the government to include conscience protection for doctors in this bill.

Does the hon. member agree with that?

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

Mr. Speaker, obviously, we cannot ask anyone to go against their values. We cannot force a health care professional to participate. As stated in the dissenting report, the act must protect the freedom of conscience of doctors, health care professionals, and all those who will be called upon to participate in this process.

That is an excellent question, and the answer should be obvious. I do not see how the opposite could happen, unless there was a new case before the Supreme Court because we would have unfortunately failed in this exercise.

[John Aldag, Liberal, Cloverdale—Langley City, BC]

Mr. Speaker, I rise in the House today in support of Bill C-14, an act to amend the Criminal Code and to make related amendments to other acts, also known as medical assistance in dying. In January, I was appointed to the Special Joint Committee on Physician-Assisted Dying and I was honoured for the opportunity to be part of this important discussion in Canadian society.

Over the span of a couple of months, my fellow committee members and I spent a lot of time working to understand the complex issue of medical assistance in dying. We discussed, we debated, and we even disagreed on a few issues, but in the end we drafted a report that I thought was the best possible solution for this complex social and legal issue.

Drafting any legislation can be difficult, but it becomes especially difficult when its title includes death or dying. It is a topic that most of us are sensitive toward and many have difficulty confronting.

Within the special joint committee we dealt head-on with a number of difficult issues and were immersed in them for six weeks. We reviewed reports by the provincial and territorial expert advisory panel on physician-assisted dying. We heard from health care regulatory bodies throughout Canada and the federal external panel on options for a legislative response to Carter v. Canada, to name a few.

We had the challenging task of grappling with the major issues touched on by Bill C-14, which include the availability of medical assistance in dying for mature minors or for patients with mental illness, advance consent, conscientious objection, and inevitably ensuring that adequate safeguards were in place to protect the vulnerable.

On February 25, the special joint committee reported back to Parliament where the Minister of Justice and the Minister of Health took the report into consideration and began drafting Bill C-14, which is what I am here to discuss today.

Bill C-14 reflects a number of recommendations made by the special joint committee and these include six main points: allowing both euthanasia and assisted suicide; making it available to permanent residents of Canada, so as not to encourage what some have coined as “suicide or death tourism”; requiring a written request for medical assistance in dying; requiring two witnesses during the time of request; requiring confirmation from two doctors or nurse practitioners that the person making the request meets all of the criteria for medical assistance in dying; and requiring a mandatory statutory review.

The key message I have taken from this very difficult discussion that I was part of and that Canadians are now joining, is that this has to be a patient-centred discussion. I encourage all parliamentarians to set aside personal values and beliefs and focus on what is in the best interests of patients. Medical assistance in dying is, and should only be, about the patient.

Upon reflection on our committee work, I now realize that the committee managed to develop a higher level of comfort with this difficult topic than is held by most Canadians at this point in the public discourse on medical assistance in dying. I am glad to see that the government took the overarching perspective of Canadians into consideration and is willing to use this legislation as a stepping stone for further studies and future revisitation.

In the past few months I have hosted and co-hosted medical assistance in dying town halls. I have spoken directly to my constituents. I have listened to the concerns of my constituents and of many Canadians around the country, and just last week, there was a demonstration for Bill C-14 held at my constituency office. I have heard the positive, the negative, the concerns, and the support, and although I fully support this legislation, I believe there are a few voids that have yet to be filled.

First, during the demonstration last week, important criteria, or better yet lack of criteria, of the bill were brought into question. How does one maintain safeguards when dealing with non-medical personnel? Bill C-14 ensures protections are met for non-medical personnel who participate in medical assistance in dying, including those who aid a person at that person's explicit request to self-administer a substance prescribed as part of the provision of medical assistance in dying, by amending section 241 of the Criminal Code, and introducing proposed section 227 to allow medical assistance in dying if the appropriate conditions are met.

However, what is being done to ensure that non-medical personnel are in fact following the guidelines required by medical assistance in dying? For instance, right before the time of administering the lethal prescription, a patient must be asked whether they would like to continue with medical assistance in dying, but how do we know that these independent individuals are in fact asking this question, among others? How do we know that the individual will not take advantage of the situation or the vulnerable position that the patient is in? These are questions my constituents would like to see addressed.

Second, I recently spoke to someone who was heavily involved in the Carter v. Canada case, who was wondering whether Kay Carter herself would have qualified for medical assistance in dying given the legislation being discussed today. I have read articles stating that she would have been, because she met the criteria for eligibility. However, would health care practitioners consistently agree that Kay Carter would indeed have qualified under this legislation?

The part that I am finding difficult to grasp, for Kay Carter and many others, is the ambiguity of the criterion for imminent death. How do we know that individuals would not be turned away from the service of medical assistance in dying because of the vague nature of this criterion? Who would be responsible for deciding the criteria for imminent death? Will there be inconsistencies in the definition of imminent death? How will we, as a society, address these?

Last, the hard timeline between the date of request and the day on which medical assistance in dying would be provided was yet another point of concern. Many constituents have expressed concerns that this may lead to the hastening of death because the timeline is simply too short. The special joint committee had recommended a flexible waiting period, which would depend on the nature of the illness as opposed to just an imminent death. It was suggested that imminence and competence not be the only factors in determining the timeline, but much rather the rapidity of progression and nature of the patient's medical condition be used when determining the reflection period.

These are a few pieces of the proposed legislation that my constituents and I feel need to be clarified and tightened before the final legislation is created for June 6.

However, I also want to acknowledge that the legislation has done a great job in addressing a number of concerns that have been conveyed by my constituents and many others. For instance, the first misconception I would like to clear up is that Bill C-14 does not address the conscientious objections of medical personnel. It does. There is nothing in the proposed legislation that would compel a health care provider to provide medical assistance in dying or refer a patient to another medical practitioner. Balancing the rights of medical providers and those of patients is generally a matter of provincial and territorial responsibility, and we need to respect that. However, that being said, the federal government has committed to work with the provinces and territories to support access to medical assistance in dying while respecting the personal convictions of health care providers.

Bill C-14 also recognizes the autonomy of persons who have a grievous and irremediable medical condition that causes them enduring and intolerable suffering and who wish to seek medical assistance in dying, while recognizing the importance of protecting the vulnerable and ensuring adequate safeguards are in place.

Over the past four months, I have encountered a wide variety of perspectives about this complex and difficult issue. Some have been extremely restrictive, while others have been extremely permissive. Some believe the legislation would go too far, while others believe it would not go far enough.

I believe Bill C-14 is an important first step in Canada. It is cautious, even conservative legislation, but it will provide a necessary first response to the Carter decision along with a commitment to continue studying the effects and revisiting important issues of medical assistance in dying in the future.

Ultimately, when it comes to Bill C-14, I would like to see the voids found within the legislation addressed prior to June 6, and I intend to support Bill C-14. I encourage my colleagues on both sides of the House to support the rights of Canadians, and to put patients first by supporting this bill.

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

Mr. Speaker, I think the hon. member respectfully engaged in some obvious sleight of hand with respect to the conscience provisions that are not in this legislation. He has said that it is a misconception to say that this legislation does not address conscience, but then he says there is nothing in the legislation that would directly infringe conscience. The fact is that the legislation does not contain conscience protection.

The member is right that it would not require the infringement of conscience, but it does not contain conscience protection. The effect of the absence of conscience protection is that in the province of Ontario at least, and perhaps other provinces, as soon as this legislation takes effect and euthanasia will enter the standard of care, physicians will be required to either refer or even, in certain situations, will be required to provide. The member should know that this would be the clear effect of this legislation. He should acknowledge that.

Again, if the member thinks conscience is important, why does the government not put forward amendments which would actually ensure the protection of conscience? Let us stop this slippery game about the language. If we all agree that conscience is important, why do we not firmly protect it in the legislation?

[John Aldag, Liberal, Cloverdale—Langley City, BC]

Mr. Speaker, as was stated by one of my colleagues earlier, the comment is that the provinces and territories will end up dealing with this issue of conscientious objection. The colleges will need to deal with referral. I have spoken to people within my home province of British Columbia, and the sense is that the provincial and territorial jurisdictions will need to be involved, and that is the appropriate place to address conscientious objection within this topic of medical assistance in dying.

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

Mr. Speaker, I want to thank my hon. colleague for Cloverdale—Langley City. Again, it is a marked departure from previous debates in this place to hear so many members of the governing party speaking clearly of their own concerns about government legislation.

I would ask my hon. colleague if he has a sense of whether the government, the minister, the committee, will have the right and expectation of being able to accept amendments, if that becomes the decision of the committee operating independent of control by the Prime Minister's Office or the minister.

[John Aldag, Liberal, Cloverdale—Langley City, BC]

Mr. Speaker, I believe very much that we have a good piece of legislation. As I said in my comments, it is a starting piece for a very difficult subject.

Our government has been very clear that we have legislation that has been put forward. We are in the consultation stage right now. We are having this debate. I believe that if compelling arguments are brought forward, they will at least be considered as the final legislation comes forward. I will be watching, along with my constituents, on what the final bill looks like.

[Michael Levitt, Liberal, York Centre, ON]

Mr. Speaker, I want to thank the hon. member for his speech, and I also want to add my voice in congratulating the members of this House for the tone of the debate this evening on what has been a rather late night.

Like all members of this House, I spent the last week in my riding of York Centre, where I had the opportunity to hear from a number of my constituents on this issue and on this bill. What I heard most was that it strikes a balance. I heard from people across the spectrum, who phoned or came into the office, that it is striking a balance, that there is work to be done, but that they feel this is a solid place to start as we head to the committee phase.

From my point of view, the advance directive provisions, dealing with individuals with mental illness, and many other things still need to be looked at.

I would ask the member what he feels are some of the things that the committee can be examining in this next phase, because I believe that the House should pass the bill and send it to committee.

[John Aldag, Liberal, Cloverdale—Langley City, BC]

Mr. Speaker, I would encourage the committee to listen to the comments that are being put forward, both the questions and concerns, and attempt to have witnesses who can address those, as the special joint committee had done. Then we will be able to weigh through the evidence, as we are about evidence-based policy, and see how the recommendations can be made to perhaps strengthen Bill C-14.

[Joël Godin, Conservative, Portneuf—Jacques-Cartier, QC]

Mr. Speaker, I am probably one of the last to speak today, since it is almost midnight.

Since this is my first long speech, I would like to take this opportunity to thank the 105,000 voters I represent. Not all 105,000 of my constituents voted for me, but more than 44% of the people of Portneuf—Jacques-Cartier did. I thank them.

Members win election campaigns, but we never do so alone. It is a family affair. Family is important to me. I would like to take this opportunity to thank my wife, Isabelle, who happens to be here this week. She is not in the gallery because it is late, but I appreciate her being here in Ottawa. I also want to thank my children, who are currently asleep. Charles-Antoine and Ann-Frédérique participated in my election campaign and sacrificed quality time with their father during the campaign. I want to thank them.

Last year, 2015, was a very difficult year for me. Talking about it is very emotional for me. There was an election. The 338 MPs here campaigned, but unfortunately, as fate would have it, my father passed away right in the middle of the campaign, on August 19. Unfortunately, he will never see me here in the House. He would probably have been very proud. My mother died in May. Both of my parents died in the same year, in 2015. I had two loyal volunteers up there watching over me. Sadly, my mother died of cancer like so many Canadians. We all have our story. I am sharing mine today. My father and mother died in 2015, but the year ended on a high note because I was elected.

My mother was diagnosed with cancer two years before she died. That is why I am taking part in this evening's debate, because I supported my mother through her illness. She passed away on May 1, 2015. She lived through that agony, and I would call it agony, but she was serene. She had some good times in those two years. She enjoyed the gatherings we had during those last two years. I saw her smile. I saw her stay positive. I saw her become a fighter. Unfortunately, on May 1, at 6:50 p.m., I had the unfortunate experience of finding her in her hospital bed after she had died. She had just begun palliative care. Unfortunately, it happened just a few minutes before I entered the room. That is why this debate is so important to me. I supported her. She did not really have the opportunity to improve her condition, which deteriorated really quickly.

The principle behind Bill C-14 is to allow Canadians to die with dignity. What is the definition of “dignity”? Dignity can be described as the respect, consideration, or regard that someone or something deserves. Human dignity is the principle whereby no person should ever be treated as an object or as a means, but rather as an intrinsic entity.

Out of respect, I can say that my mother was treated with dignity. She was treated with respect throughout her agony. She was respected until the very end. The law did not exist. Is this law really necessary? The Supreme Court requires us to make a decision, pass a law, accept a law and enact it. However, what worries me about this law are the parameters. It is important to understand that we must allow people to have access to medical assistance in dying.

However, human nature being what it is, it is difficult to take rights away from people after implementing a law that is too broad in scope. I therefore invite parliamentarians and the committee that will be examining the bill to be thorough and restrictive.

Let us begin by talking about the definition of “reasonably foreseeable”. I would like to inform the House that according to my life expectancy, I will die in 2044 at the age of 79. That is reasonable and foreseeable. That means we have a problem. This term is not defined clearly enough. It is not specific enough. The definition is too broad.

The Supreme Court of Canada gave us the mandate to determine the criteria for defining grievous and irremediable medical conditions. Why are we afraid of using science to define these criteria? Science can determine whether someone is at the end of his or her life. We are afraid to use words like “terminal”. A word like that does not really leave room for interpretation. If science tells a person that his or her condition is terminal, then it means that it is terminal and that that person should expect to die in the near future.

I would encourage the people who will be assessing the legislation to be very specific. We need to restrict access to this procedure. In my opinion, the first criterion should be that access is limited to people who are, unfortunately, terminally ill. I want to emphasize that safeguards should be put in place to restrict access to medical assistance in dying. We need to set very strict and restrictive parameters.

Doctors are there to save lives. They need to abide by the Hippocratic oath. Nurse practitioners are also being added to the mix. When they went to school, they did not expect to have to take any action that would result in death. We are talking about professionals who want to treat people to help improve their health. Why are we asking them to do the opposite? Are we going to ask other groups who work in hospitals to engage in this type of intervention? The nursing associations that I consulted were very surprised to be given this new responsibility and be part of this debate.

Some argue that there are regions that do not have access to doctors. If there are no nurse practitioners, who are we going to ask? The bill provides for a 15-day waiting period. To my knowledge, in this very beautiful country of Canada, the second-largest in the world, we are never 15 days away from treatment by doctors. We must not hand over the responsibility of carrying this out to a professional body other than the medical profession.

Do my colleagues know that a person other than nurse practitioners and doctors can go around with the famous drug that ends life? Clause 4 of the bill clearly stipulates:

No pharmacist who dispenses a substance to a person other than a medical practitioner or nurse practitioner commits an offence under paragraph (1)(b) if the pharmacist dispenses the substance further to a prescription that is written by such a practitioner in providing medical assistance in dying in accordance with section 241.2.

That is dangerous. People will be able to walk the streets with a drug that kills. We must also protect our seniors. They are vulnerable people. Heirs, insurance policies, caregivers, and families can take advantage of seniors. Let us protect our seniors. Let us be restrictive and put safeguards in place to impose as many limits as possible.

There is a centre called Cité Joie in my riding. I can understand that people reach the point of exhaustion. The centre offers respite. I can tell you that I have seen people there with extraordinary smiles.

I cannot bear to no longer see such happiness. We have to support these people. We cannot give them that possibility. I have much to say. However, in closing, I would like to inform the House that I have not made up my mind about the final bill. I am asking the committee that will study it to put more restrictive provisions in the bill so that we can believe in life and we resort to the legislation only at the end of life.

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

Mr. Speaker, I appreciate the personal story and the comments by my colleague from Portneuf—Jacques-Cartier. This is a very personal, emotional and important debate. Like me, he is a new MP, and he was not here when the Carter decision was handed down.

However, I am somewhat frustrated by the fact that nothing was done in the four months that passed between the time that the Supreme Court ruling was handed down and the end of the 41st parliament.

Since we were given such a short deadline, does my colleague believe that passing the bill at second reading would improve the situation, even if he is not satisfied with the conditions, or would he be happy with the void created by the failure to pass the bill at third reading, in the event that the changes he wants were not accepted?

[Joël Godin, Conservative, Portneuf—Jacques-Cartier, QC]

Mr. Speaker, we cannot change the past, but we can change the future.

We, the members of the opposition, are here to work with the government members. I do not want partisanship to enter into this debate, because this issue is too important for that.

Now, can we move forward on this bill? I very much appreciate my colleague's question, and I am not here to obstruct this bill. I respect my colleague. I am here to work with all parliamentarians so that all Canadians, whether in my riding or my colleagues' ridings, will be satisfied with our work and how we are representing them on this non-partisan file.

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

Mr. Speaker, facts are facts.

A year ago, when the Supreme Court directed Parliament to legislate, we did not really have a choice. The Supreme Court knew it was an election year. Parliament therefore had just three months before the fall election was called.

During that time, the government, under the leadership of the right hon. member for Calgary Heritage, struck a committee of three independent Canadian experts to study the situation. It is a lie to say that the former government did nothing. The committee produced a lengthy report with several recommendations. It was a great help to the parliamentary committee that produced the main report and the dissenting report. Those are the facts.

We talked about this for six years in Quebec. Here in the House of Commons, we have limited time. Nevertheless, is the member listening to his constituents, and are his constituents talking to him about this very sensitive subject?

[Joël Godin, Conservative, Portneuf—Jacques-Cartier, QC]

Mr. Speaker, I thank my colleague from Louis-Saint-Laurent, who has a lot of experience, especially on this issue. He had the privilege of working in the Quebec National Assembly, and he participated in the debate over six years. As he said, it is rather odd that we are taking six months, while Quebec took six years. It is no wonder we are here so late this evening. As parliamentarians, we are working extra hard.

I obviously meet with many constituents in my riding. They all want to discuss this very sensitive topic. There is no standard opinion on this issue, and no one blindly agrees. It is important to listen. As I mentioned in my speech, everyone has had a different experience with death, whether it is the death of a friend, family member, or child.

This is therefore a very emotional issue, and my constituents talk to me about it. I listen to them and ask questions to ensure that I am representing them well. When we vote on this bill in the House, I will make a decision that I think best reflects the beliefs of the people of Portneuf—Jacques-Cartier.

[The Assistant Deputy Speaker, Liberal, Anthony Rota]

There being no further members rising for debate, pursuant to order made earlier today, the debate is deemed adjourned and the House stands adjourned until tomorrow at 10 a.m., pursuant to Standing Order 24(1).

(The House adjourned at 11:55 p.m.)