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

[Dan Vandal, Liberal, Saint Boniface—Saint Vital, MB]

Mr. Speaker, I am privileged to rise in this chamber in support of Bill C-14, medical assistance in dying.

I am in favour of the bill, not only because it was mandated by the Supreme Court of Canada, but for very personal reasons. I believe it is bill, a policy, that respects the rights of individual Canadians who are suffering unbearable pain. It respects their right to die a peaceful death.

I rise today to speak in favour of this bill on medical assistance in dying, not because of the Supreme Court's decision to strike down the criminal law banning medical assistance in dying, but rather for very personal reasons.

To begin with, the bill refers to medically assisted dying. It is not referred to as medically assisted suicide. My common definition of suicide, and I believe it is society's definition, is intentionally taking one's own life when death is not imminent. In the case of Bill C-14, there are clear conditions that would qualify an individual for medical help in dying. This would include, of course, the reality that death is imminent for that individual.

Henceforth, I believe we should stop calling it suicide because it is clearly not suicide in the common form of our understanding. I also believe that there is no parallel with the very sad and tragic suicide epidemic that is occurring in indigenous communities across our great country. In my mind, one is an apple and one is an avocado. They should not be compared.

The whole debate around medically assisted death is deeply personal and has led to some very emotional discussions. For me, it has led to much personal reflection. Like many Canadians, like many people in these chambers, I have seen too many family members and friends suffer excruciating pain needlessly when death was imminent.

Very personal for me was an experience last August 2, the same day that the federal election was called, when my mother passed away. She was 96 years old and she had been living alone for the last 20 years. She had been living bedridden and in pain in a care home for the last five years.

My mother was a religious person and had a special relationship with her god. She prayed every day. She scolded me for not attending church as often as I should. Over the last 20 years her body deteriorated, but her mind and hearing stayed sharp. Over the last 10 years, my mother shared with me her desire to have her life end. Medical advances had helped her to live longer, but her quality of life had severely deteriorated. She had become completely bedridden in the last five years and, in the last four years, malignant masses and tumours had developed throughout her lower body. Constant pain set in, and pain protocol was established. My mother, tough as nails, continued to breathe, pray, and hope that God would come and take her away. The praying and hoping continued for years and years.

My mother was of sound mind. She was a religious person who was at peace with her god. Families, nuns, and a priest would visit her faithfully. They gave her comfort, but she continued to express to me that she wanted to die peacefully and comfortably. She wished that there was a way to end the unbearable physical pain that could no longer be managed regardless of the care she received. I wish she could have had that choice, and she should have had that choice.

My personal feeling is that the legislation does not go far enough. I would have preferred that those who are experiencing enduring and intolerable suffering, with no chance of ever improving during their lifetime, be allowed the opportunity to access medically assisted dying, under the strict conditions that we have imposed in the bill.

However, I also understand that the legislation shifts the paradigm in such a profound way that in the future we will be making reviews. The law will be improved, and evidence will be collected. I hope that myths will be dispelled, and individual human dignity, self-determination, and choice will be nurtured further.

This choice is the basis of our discussions today. We hope to offer this choice to individuals who, in their last moments on earth, are experiencing intolerable physical suffering as a result of a grievous and irremediable medical condition. The debate is not about suicide. It is about trying to ensure the dignity of the dying person. We make choices about the care we receive throughout our life, and it is unfortunate that this choice is taken away from us at the end of our life.

It is true that the Supreme Court's decision in Carter v. Canada made physician-assisted death legislation necessary. I believe many of us have spoken to the fact that the timelines are anything but ideal. Would I have preferred to have another six months of debate, consultation, and discussion in order to make this reality? Of course, I would have preferred that. I believe every member in these chambers would have preferred that.

However, it is also true that there are people who feel that this legislation does not go far enough. There are also people who are opposed to physician-assisted death entirely. I have had many discussions with constituents on this issue.

I represent Saint-Boniface—Saint Vital, a riding with many Catholic constituents, and they have all made their views very clear.

Everyone, regardless of their position in this debate, wants to ensure the protection and dignity of individuals. The notion of dignity, which has come up several times in these chambers, is highly individual. Personal history, personal beliefs, and personal health situations all define what dignity means to the individual, and I might also add the right to self-determine.

Dying with dignity is a personal choice that needs to be respected. This bill is necessary. As a society, we must make sure that the best care possible is available to all our fellow Canadians.

This is an important moment in our history, where consultation has not only played an important role in the past but will play an important role into the future. I applaud the government for undertaking vast consultations across Canada and abroad to ensure that this legislation defends people's choices and freedoms in a way that protects the most vulnerable. It also supports personal convictions of health care providers.

I further congratulate the government on taking the time to continue the very important consultations and discussion surrounding mature minors, people who suffer from mental illness, and people who would like to arrange advance directives.

I would like to add that I fully support the government's commitment to a full range of options for quality end-of-life care, including palliative care, an area in which the St. Boniface Hospital, in my riding, is a leader. This bill establishes responsible measures to promote a standard approach to medical assistance in dying across Canada. It recognizes the inherent value and the equality of every human life.

The proposed legislation sets the framework for medically assisted dying across the country. It also provides a review in five years. It is balanced, responsible, and a very compassionate response to a very difficult, very personal issue.

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

Mr. Speaker, I thank the member for his speech, and particularly for having the courage to share some of his personal story and interactions with dying. These personal stories help us to add context.

Unfortunately, because of the lack of palliative care that we have in this country, there are many cases where a person may think or be told that their pain is not manageable when in fact their pain is manageable. This is why I think we need a greater emphasis on palliative care and pain management.

I want to ask specifically about dealing with palliative care in the context of the legislation before us. We have heard that there is a commitment, not in this budget but at some point in the future, to make investments in palliative care. Most of us think that is a good thing. The problem is that individuals do not have access to quality palliative care, and yet there is no allowance in the legislation requiring that they be offered palliative care before pursuing the option of assisted suicide or euthanasia.

I wonder if the member would support an amendment, as was recommended this morning in committee by an association representing palliative care doctors, to ensure that people would be offered palliative care, and that people would not opt for euthanasia simply because they do not have access to palliative care.

[Dan Vandal, Liberal, Saint Boniface—Saint Vital, MB]

Mr. Speaker, I met extensively with the St. Boniface Hospital in my ward, and with the Archbishop of Saint Boniface. There is certainly no argument from me that palliative care is extremely important in this whole topic.

We committed, post-election, $3 billion over the course of four years for improved home care, which is tightly connected to palliative care. We also have to take the health minister at her word when she says that palliative care is an absolute priority in her term as health minister. A lot of it is about partnerships with the governments across Canada.

I agree that palliative care needs to be improved. We need to improve the budgets on palliative care, and I support that notion.

[Don Davies, NDP, Vancouver Kingsway, BC]

Mr. Speaker, I would like to congratulate my hon. colleague on a thoughtful and sensitive speech. I also share his distinction between suicide and assisted death. That is an important distinction that all parliamentarians would do well to keep in mind.

I have two quick questions for him. First, he mentioned palliative care. I am the health critic for the New Democrats. I have pored over the budget of the government, and we know that the $3 billion promised during the election campaign by the Liberal government for home care is simply non-existent in the budget. I would like his comments on that and how he feels we can build a world-class palliative care system without a government that is prepared to put money behind it.

Second, in terms of the Supreme Court decision, it clearly said that assisted death should be available to anybody who suffers from a grievous and irremediable condition. This legislation includes additional criteria beyond the Supreme Court's instructions, including requiring that death be easily foreseeable. That has led to the perverse situation where Ms. Carter, the litigant in that case, likely would not be able to avail herself of assisted death, even though she successfully won the case. I wonder if he has any comment on the legislation in that regard.

[Dan Vandal, Liberal, Saint Boniface—Saint Vital, MB]

Mr. Speaker, I think the hon. member would agree that the bill being introduced, and that will be adopted, is profoundly shifting the paradigm on this issue. There are people who think it goes too far. There are people who think it does not go far enough. However, the reality is that it profoundly shifts the paradigm on the issue of medically assisted dying. It will be reviewed in five years, and I think there will be ample opportunity to improve it. I am confident that will happen.

On the palliative care commitment, it is quite clear that there is $3 billion over four years. I was sitting in this seat when the health minister made a commitment to improve palliative care service over the next four years.

[Joël Lightbound, Liberal, Louis-Hébert, QC]

Mr. Speaker, rarely in this parliamentary life are we called upon to debate such an important subject, an issue that requires such seriousness, rigour, sensitivity, and compassion.

With that in mind, I want to begin by commending the professionalism of all my colleagues in the House, who, from the beginning of our study of Bill C-14, have set partisanship aside and have made this debate more of a discussion, rather than a debate per se.

The subject that we are being asked to deal with today is one that invariably raises sincere emotions and touches a nerve with all of us, not only here in Ottawa, but all across the country. Developing a framework for medical assistance in dying means striking a balance between implementing a right with such irrevocable consequences on the one hand, and protecting vulnerable people with regard to that right on the other hand.

What right are we talking about? It is the right of a competent adult, who freely consents and suffers from a grievous and irremediable illness causing intolerable suffering, to die at the time of their choosing and with the necessary assistance and medical support. This is a right guaranteed by section 7 of the Canadian Charter of Rights and Freedoms, which states that everyone has the right to life, liberty, and security of the person. This right was unanimously recognized by the Supreme Court of Canada on February 6, 2015, in the Carter case. This right protects life, because the absolute prohibition in section 14 and paragraph 241(b) of the Criminal Code on aiding or counselling another person to commit suicide made individuals suffering from grievous and irremediable illness feel that they were forced to take their own lives prematurely out of fear that the progression of their illness would make it impossible for them to do so and that their suffering would become intolerable.

The absolute nature of the blanket prohibition on medical assistance in dying deprived people of a portion of their life that they could otherwise have enjoyed. This right also protects the liberty and security of the person.

As the Supreme Court explained in paragraph 66 of its decision in Carter, by denying people the right to request a physician’s assistance in dying, the Criminal Code is interfering with “their ability to make decisions concerning their bodily integrity and medical care”. The Criminal Code thus trenches on liberty. Since that option was not available to Canadians, they had to endure intolerable suffering, which also impinged on their right to security of the person.

Although the Supreme Court recognized that medical assistance in dying is one of the rights guaranteed under section 7 of the charter, those rights are not absolute. Limitations and restrictions can be placed on those rights, according to the principle set out in Oakes, which is based on section 1 of the charter. The principles in question are those of minimal impairment and an important government objective.

Bill C-14 must be examined through that lens. Although people with grievous and irremediable medical conditions should be given the right and means to die with dignity, that is not an absolute right. We also need to protect vulnerable people, people who are unable to provide informed consent, and people who could be subject to undue pressure.

My position could evolve, as I continue to listen to my colleagues and constituents and as I continue to reflect on this topic.

However, I think that it is a good idea to exclude minors and people with mental illness from this bill. Like many members in the House, and like the Quebec National Assembly when their work was complete, I think that including minors would have created some virtually insurmountable problems with respect to consent, as my Conservative colleague from Louis-Saint-Laurent pointed out.

With respect to people with mental illness, I think that in the absence of full and informed consent, the sanctity of life must prevail. Since such consent is nearly impossible to obtain under the circumstances, it is prudent to exclude people with mental illness from the bill.

Conversely, I think that some aspects of the bill raise some questions. One aspect is the notion of a death that is reasonably foreseeable, which the government wants to introduce, even though this notion was not in the Carter decision.

The court recognized that not having access to medical assistance in dying could cause intolerable suffering and, therefore, impinges on the individual's right to security of the person.

I also think that individuals who are suffering from a grievous and irremediable medical condition but who are not at the end of their life, which unfortunately is the case for many people in Canada, are therefore being deprived of the right to security and integrity of the person.

I am afraid that with this addition, one of the appellants in Carter would not have had access to medical assistance in dying. I am not certain either that such a restriction minimally impairs a charter right, as seen in Oakes.

Second, although I am aware that there is a need for robust protections and that the bill includes many, which is a good thing most certainly, I have doubts about the protection provided by the provision in paragraph 241.2(3)(h), which stipulates that immediately before medical assistance in dying is provided, a patient must reiterate his or her free, informed, and full consent.

Doctors would have to stop administering medication, such as morphine, which eases the patient's pain, in order to obtain this full consent. I fear that this provision will create excessive suffering for individuals at a moment when they want to gently leave behind their overwhelming suffering.

Third, I was not convinced that advance consent was a good idea, but I was enlightened by my colleagues. Although I am still not convinced, I welcome the government's willingness to study the issue further.

Lastly, like many of my constituents, I think medical assistance in dying must be brought into the broader context of end-of-life care. To that end, I also welcome the promise to invest $3 billion over four years in home care.

I believe that, like the bill, this is a step in the right direction, but it is not the final destination. I will vote in favour of this bill at second reading, and I encourage my colleagues to do the same.

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

Mr. Speaker, I have two specific follow-up questions. The member alluded to the government's commitment on home care, but we need to be clear that there is a big difference between palliative care and home care. Home care is the care that someone receives in their home to support their ongoing independence—it could be at varying stages—and palliative care is specifically the care for those who are dying.

I wonder if the member could clarify what kinds of investments we will see in palliative care, especially since neither of these things were in the budget.

Second, I want to ask him about contemporaneous consent, because the concern I have is that if we were to move down the road of having advance directives in this legislation, we would have a very different consent there than for sexual consent. In the context of sexual consent, of course, we require contemporaneous consent.

Why would we have a lower bar for consent when someone is choosing to die than for someone who is choosing to engage in sexual activity?

[Joël Lightbound, Liberal, Louis-Hébert, QC]

Mr. Speaker, I would like to begin by answering my colleague's question about money for home care and palliative care. I heard the minister say several times that palliative care is a priority for the government, a crucial priority that the government plans to invest in.

The government's pledge to invest $3 billion in home care over four years comes at a time when most of the people receiving home care are at the end of their lives. I completely agree with the member: palliative care should be and is a priority for this government.

With regard to his question concerning consent, my mind is not made up on advance directives, but I think there is a difference between consent in terms of sexual relations and consent when people know they have a debilitating illness that will prevent them from consenting further down the road. I think the distinction is clear.

However, my mind is not made up on that subject. I wish to hear more about advance directives and I am glad that the government has decided to study that question further.

[Luc Thériault, Bloc, Montcalm, QC]

Mr. Speaker, I appreciated my colleague's remarks.

Yesterday, the Barreau du Québec stated that the reasonably foreseeable natural death provision in the bill is not consistent with the Carter decision or the right to life in section 7. Ms. Carter would not have had access to medical assistance in dying unless reasonably foreseeable natural death were interpreted as having to do with age, which is an absolutely unnecessary distinction here.

I would like to hear my colleague's thoughts on that.

[Joël Lightbound, Liberal, Louis-Hébert, QC]

Mr. Speaker, I thank my colleague for his excellent question.

As I mentioned in my speech, I agree with the Barreau du Québec on that. I think the notion of reasonably foreseeable adds a criterion that did not exist in the Carter decision. Unfortunately, it places people who are suffering from a serious and incurable illness and experiencing suffering that is intolerable in situations where, if they are not terminally ill, they cannot receive medical assistance in dying.

That is one aspect of the bill that I personally have a problem with. Still, I think it is a step in the right direction, which is why I urge all members of the House to support this bill at second reading so it can go to committee.

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

Mr. Speaker, I thank my colleague from Louis-Hébert for his very clear speech on an issue that is so personal for many of us.

Almost everyone here in the House who is participating in this debate has similar stories from their own lives.

In my case, my grandmother was no longer able to teach downhill skiing at the end of her life. After teaching it for nearly 70 years, she started falling, until her injuries were too serious for her to survive them.

I do not think this came under the canopy of medical assistance in dying or assisted suicide. I find that circumstance unacceptable. We need to fix this lack of dignity.

Is my colleague worried about the legal vacuum that would exist if this bill is not passed within the prescribed time frame?

[Joël Lightbound, Liberal, Louis-Hébert, QC]

Mr. Speaker, I would like to thank my colleague for his question. In fact, we must avoid this legislative vacuum for Canadians.

That is why I believe voting for this prudent bill is the right thing to do. It is a step in the right direction, and it could go further.

This issue was debated in Quebec for years. Canada is just beginning to debate it, and I believe that the debate will have to continue for the next few years. The bill provides for a review of the act in the first five years.

We must have this debate, and we absolutely must present Canadians with a law before June 6, 2016.

[Alice Wong, Conservative, Richmond Centre, BC]

Mr. Speaker, today I rise to discuss Bill C-14.

As we well know, Bill C-14 is the government's response to the Supreme Court ruling in the Carter decision last February. The court gave the government a total of 16 months to form legislation, so here we are in the House today, debating the bill.

I was pleased to see that the bill included many recommendations provided by my Conservative colleagues in their dissenting report from the special joint committee report on this issue. However, I do not believe the bill in its current form is good enough.

I have benefited from listening to my colleagues' speeches, and appreciate the passion each has shown as they discuss Bill C-14 in the House. Indeed, I have made my own consultations with various interested parties in my riding of Richmond Centre, and look forward to sharing them with you.

We have received many suggestions and comments on the legislation, both from parties that believe the bill is too restrictive and those who believe it is not restrictive enough. Indeed, I am rather impressed that there was significant public interest on this bill, and I would like to continue to encourage people in Richmond Centre who have not given their thoughts on this matter to write to myself or my office.

My voting position on second reading will be carefully considered from a balance of available information, including from the consultations I have held with interested stakeholders in my riding.

To begin, I would like to share some of my personal experiences. During my time as the Minister of State for Seniors, I had the opportunity to work with many groups who are devoted to protecting our most vulnerable and ensuring quality palliative care. The unfortunate reality is that there are many seniors who are not provided with effective end-of-life care. Instead, they are subject to elder abuse and are often pressured into making decisions to avoid becoming a burden to their families. This is tragic. It is absolutely imperative that we ensure that there are safeguards to protect seniors against such elder abuse.

A potential safeguard to protect financial abuse of elders, which is a very common and unfortunate form of elder abuse, is to simply prohibit any independent witnesses from financially profiting at all from the will or the estate of those who requested physician-assisted suicide This was actually a recommendation from a group of constituents I met with recently. They pointed out that in the bill, the independent witnesses that have to sign the documentation to enable the physician-assisted suicide only have to know or believe they are not a beneficiary under the will of the person making such a request. Again, this is simply not enough.

Back in my riding of Richmond Centre, I have been an active member of the Richmond Rotary Club. This club was instrumental in building the first hospice in Richmond. It was there that I and my fellow Rotarians witnessed first-hand the benefits quality palliative care can bring people. Life is valuable at every stage. One of my primary concerns with physician-assisted suicide is that it will only complicate end-of-life decisions. Individuals who are sick or need additional care will see themselves as a burden, and choose death to avoid placing further expectations on family members.

Instead, we need to be supporting family caregivers and demonstrating that every life is valuable.

As others have noted, there was no allocation in the budget for palliative care services. This is totally and absolutely unacceptable. This issue is quickly becoming more about access to death than access to life. It is absolutely essential that the government make a commitment to strengthen palliative care and encourage citizens to seek such care first. Palliative care provides death with true dignity and not a forced death, which is what physician-assisted suicide is.

Last year, I had the opportunity to meet with organizations such as the Council for Canadians with Disabilities, the CCD. I met with its representatives to discuss their concerns and the importance of protecting individuals with disabilities. More recently, they were able to appear as witnesses at the special joint committee to discuss their views on possible legislation. The CCD was very concerned with the recommendations provided by the committee and commented, “The permissive approach would put vulnerable people at risk”.

We cannot ignore the needs of our most vulnerable. It is crucial that the legislation reflect the concerns of groups such as the Council for Canadians with Disabilities to ensure all Canadians are protected.

I would like to share a few of the comments I have heard from my constituents over the past several months. I will emphasize that my repeating these comments in the House today does not mean that I endorse all of them, but rather, this is a reflection of the variety of comments received. I know as an elected figure this may be hazardous as I may be quoted out of context; however, it is my duty to ensure that these voices are heard.

A primary theme as a result of my consultations is that Bill C-14 would only decriminalize the act of physician-assisted suicide as performed by medical practitioners.

I will add that there would be no effects or changes to the Canada Health Act, nor would it instruct our provinces to provide this procedure as something to be covered under provincial medical insurance plans. In my home province of British Columbia, this is the medical services plan, the MSP.

In general, there seemed to be a considerable amount of confusion about whether the provincial governments would actually provide this procedure and whether they would indeed pay for it.

One stakeholder group mentioned it wished to invoke the notwithstanding clause to maintain the previous provisions of the Criminal Code. This group found the terminology of what constituted a terminal illness to be a slippery slope and that unendurable pain could be mitigated with quality palliative care. As it realized that this was generally not a realistic approach with the existing government, it also mentioned that it was hoping for a robust protection for health care providers and facilities to act according to their conscience.

There were many other comments, but I have only 10 minutes for this speech, so I will state again that I have been pleased with the amount of interest we have received from engaged citizens and stakeholder groups on Bill C-14. I will be making my voting decision after giving the people of Richmond Centre the maximum period of time to send their feedback.

I would like to end my speech with a short story. Many members of my family are health professionals. Even among those who are young, many desire to grow up to be doctors or nurses. When I ask my young nieces and nephews why they want to be a doctor, I always receive the same simple answer, “I want to save lives.”

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

Mr. Speaker, the member is concerned about access to death versus access to life. On the timeline we are working with, imposed by the Carter ruling, is precisely access to death that we are addressing here. I do not believe there is anyone here who is opposed to looking at palliative care.

For me, freedom to life is very much like, and as important as, freedom of religion. Freedom of religion includes the freedom to be religious in any manner we choose, just as it includes the freedom from religion. Freedom of life includes the freedom to live, but it includes the fundamental right not to live. The latter is not a right that should be exercised lightly, and it is extremely important to have processes in place, as this bill proposes to do in line with the Carter decision.

I believe we should make every effort as a society and as a Parliament to make every person's life as good as possible. Indeed, that is a principal obligation of government. I believe that the decision of when to end one's life is a decision that belongs to the person whose life is ending, and only that person.

Does my colleague agree that the best defence of life we can provide is by getting this law through on deadline, avoiding a legal vacuum, even if it means revisiting the issue later?

[Alice Wong, Conservative, Richmond Centre, BC]

Mr. Speaker, I know I am not alone in stating that the time frame set out by the Supreme Court was not sufficient. Sixteen months is not nearly enough time to adequately examine evidence, consult with Canadians, and prepare well-drafted, careful, and sound legislation. I do not think it is appropriate to approve legislation simply because it is good enough or we are on a time crunch. It is never our responsibility to rush legislation. We represent our constituents to ensure a better and safer Canada.