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

[Vance Badawey, Liberal, Niagara Centre, ON]

Madam Speaker, first, in fact there is money allocated in our budget for home care. Within the home care line item, there would be consultations continuing with palliative care and those who administer palliative care throughout the country, as well as mental health care services. In fact, I came from a meeting this morning with the Minister of Health and the Minister of Justice which confirmed those discussions were continuing to happen throughout the nation.

With respect to the second question about palliative care, the simple answer is yes. Although we are reacting to the Supreme Court ruling and putting in place legislation that is based on giving choice to Canadians, we are not going to end there. We will continue to discuss this issue with Canadians across the country and with that, strengthen those programs before individuals make those decisions.

[Don Davies, NDP, Vancouver Kingsway, BC]

Madam Speaker, I listened with interest to the speech from my hon. colleague. He very clearly said that he believed this legislation would conform with the Supreme Court decision in Carter.

I have read a very spirited and well-reasoned letter recently from Joe Arvay, the lawyer who argued the Carter decision. He very vociferously disagrees with that comment. Specifically, he focuses on the fact that the Supreme Court decision very clearly has said that physician-assisted death should be available to those who suffer purely from a grievous and irremediable condition. Yet, this legislation would go further than that and would add the additional requirement that the death be reasonably foreseeable. Mr. Arvay argued that was an unwarranted and illegitimate extension of the Supreme Court decision. In fact, he argued that the test of reasonably foreseeable death was specifically raised through the court process and rejected at all levels of the courts through this process.

Could my hon. colleague tell us how he thinks the legislation would conform with the Supreme Court decision when it so clearly contradicts the Supreme Court's statement of the criteria required for access to physician-assisted death?

[Vance Badawey, Liberal, Niagara Centre, ON]

Madam Speaker, I did not make a comment with respect to this conforming with the Supreme Court decision. My comment was specific to this legislation giving some substance to an issue in which the Supreme Court left a void.

We have listened to Canadians. We have heard loud and clear that Canadians want a choice to ensure they make a proper decision after discussing these issues with their physicians, their family, and their friends. With that, as I said in my statement, end of life would have to be foreseeable and would have to be imminent, and those decisions would be concluded then by those discussions between physicians and individuals. The legislation would then support those choices for every Canadian.

[Don Davies, NDP, Vancouver Kingsway, BC]

Madam Speaker, I want to begin my remarks by acknowledging the delicacy, sensitivity, and grace that the subject before us requires. The subject matter of this debate, assisted dying, raises issues of the most profound importance, indeed of life and death.

They engage our deepest sentiments not only as parliamentarians but as humans. They involve our conscience, our morality, our ethics, our values, our philosophies, our spirituality, our individuality, and our dignity. I believe we must approach these issues with the utmost care, compassion, and respect, because Canadians have diverse and deeply held views on this matter, all worthy of consideration and deference.

The context of the debate is clear: death is feared, suffering is feared, loss of control is feared. With the advances in modern medicine, people today can, and indeed must, contemplate living without an acceptable quality of life, of being alive but not living, of possessing basic bodily functions without agency, without dignity, without hope.

At the same time, we fear the diminution of the sanctity of life, of the possibility of abuse of the vulnerable among us, embarking on a slippery slope that challenges long-standing foundational tenets of respect for the preservation of human life. This debate is about a fundamental collision of values, one which is based on the instinct to live and to preserve life in all instances, and the other premised on the right to control our inevitable passing as an inherent aspect of our individualism and personal liberty.

I hope that we treat the issues involved in this debate with the compassion and respect that they deserve, because we must simultaneously balance the notions of death with dignity with life with dignity. There will be no right or wrong here. There is only the possibility of compromise, understanding, and moving forward with as much wisdom and sensitivity as possible.

In many ways, we have taken an unfortunate path to the present. We are here by virtue of the legal process. It was based on a rights-based analysis and decision engendered by the mandate of a court, quite legitimately, because of a charter-based argument that challenged criminal provisions as violating individual constitutional rights.

We are not here because of a discussion based on faith, or conscience, or ethics. This has left many Canadians feeling rushed and robbed of the kind of full debate that perhaps ought to have been conducted on a matter of such social depth. As such, we are here debating not if, but how assisted death might best be implemented.

However, I do take comfort in the fact that the Supreme Court of Canada arrived at its decision unanimously, something that does not commonly occur. This gives me confidence that the most learned jurists in our nation were certain that we, as parliamentarians, can and must construct a system that allows Canadians to seek and obtain the assistance of their medical providers in ending their lives in tightly defined circumstances.

I would like to address my comments and thoughts on two areas: palliative care, and key aspects of this legislation. I am the health critic for the New Democratic Party and, as such, I approach this issue not only from a values or ethical or moral perspective, but from a health care point of view. I believe one of the most central aspects of the debate before us must revolve around palliative care. If we are honest, we will acknowledge that we as a nation have failed to construct the range and quality of end-of-life care that is essential to provide Canadians with the confidence they need to live their lives to the fullest extent.

We as a society have been remiss, slow to develop a system of palliative care that is so essential when we contemplate end-of-life issues. If we are to do our best to create the conditions where Canadians avail themselves of assisted death only in the rarest of circumstances, we must focus on achieving a number of things.

We must create pain-management programs to ensure that we have the widest possible resources to make everyone comfortable, regardless of their medical condition or proximity to end of life. We must develop home care resources to ensure that folks, especially seniors, can live their remaining days in the comfort of their personal surroundings, communities, memories, friends, and families.

We must construct palliative units across our country that allow people who are approaching their end to have environments that are comfortable, enriching, graceful, and interesting, and where spouses, children, families, and friends can be together in respectful private settings. They should have the very best medical care a developed country like Canada can muster. If we were to invest in world-class palliative care, we would likely see relatively few Canadians seeking assisted death.

Regardless of where one is placed on this debate, I think we all agree that we should be trying our best to encourage all Canadians to choose to live their lives to the fullest. This bill, the government, and its recent budget have thus far failed to identify and provide the resources needed to make a world-class palliative care system a reality in this country. Talk is not enough, and this must change. As New Democrats, we will work ceaselessly to press the government to allocate the resources necessary to build a world-class palliative care system across Canada. We will press the governments of every province and territory to work together to ensure that this system is available to all Canadians, regardless of where they live.

I have some key observations.

I personally believe that competent adults have the right to determine the conditions of their passing in the circumstances identified by the Supreme Court, namely where they face a grievous and irremediable medical condition that they find intolerable, and with a carefully designed and secure process that ensures their wishes can be ascertained with certainty. To the extent that this legislation deviates from that decision, it must be amended.

If it is truly the case that the prime successful litigant in the Supreme Court case, Ms. Kay Carter, would not be permitted a physician-assisted passing under this legislation, that is patently wrong. I believe we must tread extremely cautiously in this area and move very deliberately.

While I have listened carefully to those who favour a broad expansion of assisted death beyond the Supreme Court's careful parameters, I do not agree. In my view, care and caution are required in such delicate matters. Very difficult considerations accompany the issues of mature minors, psychological suffering, and advance consent. I believe it is the wisest course to engage fully with Canadians prior to legislating in these areas. We are moving from a society that has observed criminal sanctions for suicide and assisted death for centuries, to one which is constructing a system in response to the circumstances presented to the Supreme Court in the Carter case. In my view, this is sufficient for the moment, and we ought to focus our efforts on ensuring that the Carter principles are properly enshrined in law.

As the father of a child with special needs, I want to ensure that every vulnerable Canadian is fully protected with respect to all circumstances in this area. I am sympathetic to those who fear a slide down a slippery slope that puts vulnerable Canadians at risk, and I agree that we must ensure tight parameters are in place to prevent this. I believe that we can and must explicitly ensure that medical personnel and institutions have their rights of faith and conscience fully protected. Just as I believe that Canadians who wish to exercise their charter rights to access assisted dying must be respected, so too must those who choose not to be involved in such matters because of their faith or values not be compelled to do so. The constitutional rights of some Canadians must not be enforced at the cost and by the diminution of the constitutional rights of other Canadians.

I further believe that faith-based health institutions are direct extensions of the faith communities and groups that sponsor them and, as such, constitute expressions of values that are eminently worthy of protection. I believe we can ensure that all Canadians have access to their Carter rights while also protecting the equally important rights of those who may have conscientious objections to participating in any way in them.

In the end, it is my fundamental conviction that we as parliamentarians can and must craft legislation that reflects the best of who we are as Canadians: people who cherish individual rights and liberties, people who care deeply about each other, people who are compassionate and concerned with justice, and people who are dedicated to making our society one that is ruled by law, by wisdom, and by respect for all.

I will do my very best to reflect these values as we craft this important legislation for Canadians.

[René Arseneault, Liberal, Madawaska—Restigouche, NB]

Madam Speaker, I would like to first thank my colleague for his comments, which will make us carefully reflect on Bill C-14.

We should reflect on what is at the very heart of the debate on the Carter case and the Supreme Court decision. In one passage of the Supreme Court ruling in Carter, the justices state that the current Criminal Code provisions at the very core of the Carter case protect the vulnerable to such an extent that they constitute almost an absolute protection, which is prejudicial to some Canadians who are not vulnerable and would like to have access to medical assistance in dying.

I would like to hear what my colleague thinks of the Supreme Court's view as it relates to the current bill.

What are his thoughts on people who are not vulnerable as defined by the Supreme Court and how this is reflected in the bill?

[Don Davies, NDP, Vancouver Kingsway, BC]

Madam Speaker, in many ways, that question gets to the very heart of the matter before us, which is that the Supreme Court has clearly and carefully ruled that competent adults in Canada who are suffering from grievous and irremediable conditions ought to be allowed the ability to choose their end of life and get assistance from their medical professionals to do so.

Where this issue gets very difficult is when we consider the extensions of that decision, when we talk about whether mature minors ought to be able to access those same conditions, even if they are not vulnerable. It is about people suffering from a psychological or mental health condition, and whether those conditions are in and of themselves sufficient to warrant access to physician-assisted death, even if they are not vulnerable. Finally, there is the issue of advance consent, which I think many Canadians agree with in principle, but I believe raises very difficult issues of implementation.

I am one who agrees with the government in terms of moving very carefully in this legislation. I am mindful of the fact that many civil liberties groups feel that the legislation could have been more broad and extended physician-assisted death to groups beyond the Carter decision, but I believe we must move and tread carefully in this area. The issues are so important, and Canadians are so engaged in this, that it is better that we move correctly than that we move quickly.

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

Madam Speaker, I want to thank my colleague for his speech, and I want to especially thank him for his commitment to protecting the conscience rights of health care workers and institutions. I am wondering if he would agree to an amendment that would actually guarantee those rights in the legislation. It is clear that the legislation wants to take a pan-Canadian approach for the availability of physician-assisted suicide. I think it is equally important that we have a pan-Canadian approach in terms of protecting the conscience rights of health care workers and institutions.

Second, I was pleased to hear his commitment to protecting the vulnerable. There are some safeguards listed in the bill as it relates to independent witnesses, independent doctors, and so on. I am wondering if my colleague would also agree to an amendment that would include within the regime a pre-judicial or some type of prior review that would ensure that the independent witnesses who claim to be independent, and the doctors, are actually facing up to that fact.

[Don Davies, NDP, Vancouver Kingsway, BC]

Madam Speaker, I would like to thank my hon. colleague for those thoughtful points. They also raise fundamental issues that will be discussed at committee. I could not be clearer than I was in my speech in saying that I believe the conscience rights of those who do not want to participate in assisted death, medical practitioners and institutions, ought to be explicitly protected. I am certain amendable to the form it takes, whether that is in the legislation or otherwise, but what is important is that the principle is respected.

With respect to the member's second question about additional safeguards to ensure that the vulnerable are protected, again, I agree with him fully that the principle of protecting the vulnerable has to be a core foundational aspect of this legislation. I would be willing to look at any other procedures that may work, whether it is by amendment to the bill or otherwise, to accomplish that.

[Julie Dzerowicz, Liberal, Davenport, ON]

Madam Speaker, I rise today to speak to Bill C-14, the medical assistance in dying bill.

To me, it is legislation that reflects where society is today. It is the right one for where the majority of Canadians are, and provides a strong foundation on which to build. It recognizes the inherent and equal value of every life, and honours the dignity and autonomy of an eligible person to choose medical assistance in dying under well-defined rules and conditions.

The introduction of this bill is big and represents a fundamental change in how we as Canadians view the right to life, liberty, and security of the person in Canada.

I confess that this is not an easy issue for me to talk about, but it is an important one to the residents of Davenport, the riding I am honoured and proud to represent. We as a society do not talk very much about death. It makes us nervous, and so this bill, which creates a framework to enable access to medical assistance in dying in Canada to those who are eligible, is a particularly sensitive topic.

I want to acknowledge that I have a large Catholic community in my riding, and many who believe that only God can decide when one dies, that death should be left in God's hands. On the other side, I have a number of groups within Davenport that think the proposed legislation does not go nearly far enough. Recognizing the blessed diversity of opinion, I invited community leaders to meet with me to discuss Bill C-14, to hear from them their specific concerns.

What I found was that I had to remind many of them that in February 2015 the Supreme Court of Canada unanimously, all nine members, voted to strike down the sections of the Criminal Code that made it illegal for anyone, including a doctor, to cause the death of another person who consents to die, or to assist a person to end his or her own life. I reminded them that the Supreme Court proclaimed that the prohibition on physician-assisted dying infringes 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.

The Supreme Court gave the government a certain amount of time to introduce legislation. That date is currently June 6, which is why we are here today. Just as an aside, I was curious to see how many times the Supreme Court actually voted unanimously, and it has done so only 35 times since 1979.

There was no question that medical assistance in dying would become legal in Canada. What had to be determined is what kind of legislation we were going to introduce.

The Supreme Court's decision meant an important shift in our society's perception of personal autonomy. It signalled that a person's sense of dignity is intricately tied to how one perceives his or her quality of life. The decision to allow Canadians the choice of medical assistance in dying sheds light on the evolving role of our health care system and the role of patients in decision-making.

Canadians are looking to their doctors and nurses to provide health care, and to help them maintain their quality of life. However, when that quality is no longer attainable, Canadians want to know that their health care providers will also help them when their choice is a dignified end to their lives.

In addition to the consultation, I have received many letters from residents in Davenport. There are those who believe there should be no legislation at all, others who think that the proposed bill is not strong enough in protecting the conscience rights of doctors or in protecting the most vulnerable, and a further group who worry that the legislation does not go far enough, that we as a government have been too narrow in our interpretation of the Supreme Court decision. I will address all these concerns in the next few minutes.

Let me first address those who do not believe there should be any legislation. What many may not understand is that if the Liberal government does not create a new law by June 6 of this year, it means medical assistance in dying is legal if it is conducted in a way that adheres to the considerations outlined by the Supreme Court in its Carter ruling. Canadians would then not have any national framework and no law, which in my opinion would lead to a wild west, where it would be up to any one person's interpretation of the Carter decision and a situation that I believe would be open to abuse.

In introducing Bill C-14, the Liberal government purposely created legislation which as narrowly as possible adhered to the Supreme Court decision. It is narrow because this bill is meant to be a first step. It is meant to ground the legislation properly.

The legislation would do three things. It would allow physicians, nurses, and those who help them provide assistance in dying to eligible patients without the risk of being charged. It would also provide safeguards to make sure that those who receive medical assistance in dying are eligible, can give informed consent, and voluntarily request it. Finally, it would lay the foundation for the Minister of Health to make regulations to establish a process for monitoring and reporting on the use of medical assistance in dying.

I will pause for a second to reiterate the first point, because as mentioned, many have written to me to express their concern that the legislation as drafted does not protect the conscience rights of doctors. I want to be clear that there is nothing in the legislation that compels any medical practitioner or authorized nurse practitioner to provide medical assistance in dying or to refer a patient to another medical practitioner. The legislation is meant to balance access to medical assistance in dying while respecting the personal convictions of health care providers.

The legislation is also clear on who is eligible. A person has to be mentally competent, 18 years of age or over, make a voluntary request, and give informed consent to receive medical assistance in dying. They have to have a serious and incurable illness, disease or disability, be in an advanced state of irreversible decline in capability, experiencing and enduring intolerable suffering as a result of their medical condition, and be on a course toward the end of life. Death would have to be reasonably foreseeable in all of the circumstances of the person's health.

Protective measures are also a key part of the legislation to ensure that patients eligible have given informed consent. Patients have to make a written request for medical assistance in dying and have it signed by two independent witnesses. Also, two independent medical opinions have to confirm that the patient meets all the criteria. These first two criteria are intended to ensure that requests for medical assistance in dying are truly voluntary, that they reflect the wishes of the patient and are not made as a result of external pressure or coercion.

Too many of my constituents have said to me, “My dad was in the hospital. We kind of felt forced that maybe we would want to sort of end things.” I said that this legislation does not help with that. The patient has to make a written request. It has to be signed by two independent witnesses, and there has to be two independent medical opinions.

In addition, the second criterion also helps to reassure the medical practitioner who would provide medical assistance in dying that he or she is acting within the scope of the law and consistent with reasonable medical knowledge and skill.

The other criteria for patients to be eligible are that there is a mandatory 15-day waiting period; the patient has the right to withdraw a request at any time; and consent must be confirmed immediately before medical assistance in dying is provided. It is a very thoughtful protocol with very strong safeguards.

As part of this legislation, the foundation is also laid for the Minister of Health to establish a process for monitoring and reporting on the use of medical assistance in dying. We need to know, and Canadians need to be satisfied, that the system is operating as planned to respect the autonomy for eligible individuals while protecting vulnerable people.

Public trust and transparency in the implementation of medical assistance in dying are essential. This monitoring and reporting system will also be able to signal any issues or unexpected consequences.

Monitoring would also ensure that high-quality comparable Canadian data are generated so that any future discussions about changes to the medical assistance in dying system could be made based on the best possible evidence. Indeed, there will be a review of the legislation in five years, which could bring about changes that reflect the data gathered in this period.

For those who believe that this legislation has not gone far enough, there is a commitment to independent studies into three key issues that the Supreme Court of Canada in Carter declined to address. The first was the eligibility for persons under the age of 18. The second is the advance request. The third is requests for medical assistance in dying solely on the basis of mental illness.

It is also important to mention that palliative care, ensuring that all Canadians live as well as possible until their death, is equally important to this government. Just yesterday the Minister of Health stood in this House to reaffirm our commitment to $3 billion over four years for home care.

The minister is working hard with her counterparts across Canada on the next version of our health care accord, and high-quality palliative care for all Canadians is a key part of their deliberations.

I also should mention that one of the great positive side effects of introducing this legislation is that we are having a wide discussion on a national level. We need to be discussing this issue fully and we need to be understanding it.

In closing, I want to quickly thank and commend the great work that was done by the Special Joint Committee on Medical Assistance in Dying under the great leadership of my colleague, the MP for Don Valley West. I also thank the Minister of Justice and the Minister of Health for their excellent work in introducing this legislation.

Bill C-14 is meant to be a legislative foundation on which we will build moving forward . It recognizes the inherent and equal value of every life, and it honours the dignity and the autonomy of an eligible person to choose medical assistance in dying under well-defined rules and conditions. It is the right legislation for Canadian society today, and I will be supporting this legislation.

[Dianne Lynn Watts, Conservative, South Surrey—White Rock, BC]

Madam Speaker, again we hear about the $3 billion for palliative care. We have yet to find it in the budget. There is some language around home care, but there is no identification of palliative care. Could the member please clarify that?

[Julie Dzerowicz, Liberal, Davenport, ON]

Madam Speaker, I can understand why there is some confusion. We have reaffirmed our commitment. We made a promise and we continue to be committed to $3 billion over four years for home care. It has not been introduced in the 2016 budget, but we have reconfirmed our commitment to $3 billion over four years.

Also, the minister has been very clear that high-quality palliative care for all Canadians is a key part of her current deliberations with her counterparts, the provincial ministers of health right across the country. I have great faith and hope that something will be brought forward in due time.

[Anne Minh-Thu Quach, NDP, Salaberry—Suroît, QC]

Madam Speaker, the debate on medical assistance in dying is certainly very important.

Although the bill is being brought forward very quickly, some amendments are needed, especially for some of the definitions that are a little vague. From the beginning we have heard that a natural death must be reasonably foreseeable. Doctors cannot even agree on what this means. The government has not been able to define what is a reasonably foreseeable death.

Can the member shed some light on this? Will there be clarifications at the committee stage to fix this? The greater the uncertainty, the more difficult it will be for professionals to make clear decisions and ensure that there are no abuses.

[Julie Dzerowicz, Liberal, Davenport, ON]

Madam Speaker, there is a very clear list. It is a very thoughtful list of criteria of who would be eligible for medical assistance in dying. We have put a safeguard in place where two independent medical practitioners would have to give the same opinion. We have done that to help reassure each of those medical practitioners who want to provide the medical assistance in dying that he or she is acting within the scope of the law and consistent with reasonable medical knowledge and skill. They act as a bit of a check and balance on each other in terms of interpreting the list of criteria of who would be eligible for medical assistance in dying.

[Judy Sgro, Liberal, Humber River—Black Creek, ON]

Madam Speaker, I want to begin by congratulating my colleague on her excellent presentation on a very difficult issue that is clearly troubling for all of us here in the House.

One of the things I continue to hear from many people in Humber River—Black Creek is about elderly people feeling that their families are not interested in seeing them just wither away, and how do they know they are protected. We know all of the answers are here, but the challenge is to communicate and give that level of confidence to Canadians.

I would be interested to hear how my colleague plans to ensure the people in her constituency understand what is required before any kind of action could be taken to end someone's life.

[Julie Dzerowicz, Liberal, Davenport, ON]

Madam Speaker, this is something that very much weighs on me. I want to do a huge communication effort. I felt that there was not an understanding that there was a Supreme Court decision and a law had to be enacted.

My objective is to do a series of interviews with a number of local newspapers and radio stations to make sure people are as educated as possible on this issue.