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

[Christine Moore, NDP, Abitibi—Témiscamingue, QC]

Mr. Speaker, I think it is very important to rise to speak to Bill C-14, today and on other days of debate.

As my colleagues probably know, I am a health care professional. I still work at the hospital a few times a month, mainly in emergency and intensive care. This is important to me. End-of-life care is very important, which is why I supported a motion that my colleague from Timmins—James Bay moved during the previous Parliament. That motion dealt with with a national palliative care strategy.

To begin, I would like to highlight two or three points form the Supreme Court decision that I think are particularly important to this discussion. The decision states:

...the prohibition [of medical assistance in dying] deprives some individuals of life, as it has the effect of forcing some individuals to take their own lives prematurely, for fear that they would be incapable of doing so when they reached the point where suffering was intolerable.

And by leaving them to endure intolerable suffering, it impinges on their security of the person.

It is important to mention that the Supreme Court decision underscores the government's responsibility to address the suffering that people experience. It is also important to understand the difference between suffering and pain. Pain is a physiological reaction to stress, such as an injury. Suffering has to do with an emotional experience.

Take, for example, a very painful event such as childbirth. That pain is associated with a positive emotional experience, the birth of a child. That event does not necessarily cause suffering, but it does cause significant pain.

A person might also have a minor injury that can cause extreme suffering because of the emotional experience associated with it. I think it is important to make that distinction.

These days, we have excellent therapeutic ways to alleviate pain. Opiates were long used, but now we also have patient-controlled analgesic pumps. We can even offer continuous palliative sedation, similar to what intensive care patients receive when they are intubated to ensure that they do not feel any pain. There are a number of extremely effective ways of alleviating pain, in addition to non-pharmacological methods. We have a good range of treatments to offer patients who are in pain.

It is possible to alleviate the suffering that comes with an emotional experience such as the end of life or an end-of-life diagnosis without resorting to medical assistance in dying. In that case, palliative care is an option. The bill applies to adults with a serious and incurable illness, disease, or disability who are in an advanced state of irreversible decline in capability and whose natural death has become reasonably foreseeable.

Obviously, we are talking here about people who are at the end of their lives, people who need palliative care. The purpose of palliative care is to ease the suffering of both the patient and the family. Palliative care helps ensure that people are cared for properly, and that they have the help they need to get through the grieving process and the hardship associated with illness.

We want to take away all the pain, but we also want to provide support for the family.

Optimal palliative care helps not only the patient but also the whole family, so that the patient's death can be as peaceful as possible for everyone involved. We are going about things the wrong way by providing medical assistance in dying when the palliative care offered in Canada is not yet optimal.

When palliative care facilities are underfunded and need to try to drum up donations every year, they are unable to offer optimal palliative care. Most of these facilities can only take patients who are expected to die in less than three months. However, people can often live much longer than that with a terminal illness and they need a lot more support.

Moreover, in many rural areas, palliative care beds are reserved through surgical units. That means that nurses who are taking care of palliative care patients also have to take care of seven or eight other patients. Nurses are therefore unable to respond quickly or spend as much time as they should with the families, and the patient's death does not go the way he or she would like.

For people who do not have the means or who do not want to die at home, unfortunately the hospital is often the only other option when palliative care beds are not available. This is not an easy experience, and it can create suffering because patients do not always have all the support they deserve.

There has been a lot of effort in recent years to remove some natural processes from hospitals. One example would be the birthing centres that have been set up. The thinking is that it would be better for mothers to go through pregnancy and childbirth a little more naturally in a setting other than a hospital, as long as there are no medical complications.

The same thing is being done with death, which is a natural process. It is being taken out of hospitals to make the experience much more positive, in a place other than the medical setting of a hospital.

Hospices try to remove all traces of hospitals. They have hospital beds, but they try to use the patients' own bedding, have large windows, and help patients forget that they are not at home.

Unfortunately, no matter how hard the palliative care facilities work, they are often underfunded. For example, the Maison du bouleau blanc, in my riding, has four beds, only two of which are subsidized. It therefore relies on donations to maintain its other two beds. It has a large room with big windows and a shower, but this is the only room that the facility has been able to convert to an ideal palliative care room.

These people cannot afford nurses. The people who work there are extremely dedicated practical nurses. However, they have some legal limits. For that reason, all the protocols regarding doctors working with palliative care facilities had to be updated, in order to ensure proper care for the patients.

We could address a number of shortcomings and avoid making the patients suffer. If someone who receives a terminal diagnosis knows that they will receive good palliative care as their condition worsens, they may not choose to take their own life prematurely. This would therefore help protect the right to life.

However, as long as do nothing on palliative care, we are working backwards. We cannot reverse the life-based medical model to allow for medical assistance in dying if our palliative care services are not as good as possible or accessible to all Canadians, regardless of where they live, even if they live in a remote region.

Since I am out of time, I would be happy to take questions from my colleagues.

[Julie Dabrusin, Liberal, Toronto—Danforth, ON]

Mr. Speaker, I thank the member for Abitibi—Témiscamingue for her extensive remarks on palliative care.

As she may know, I was a member of the Special Joint Committee on Physician-Assisted Dying, and we talked a lot about palliative care. We also talked about how, for some people, that is not enough. Even though they have access to palliative care, they want the right to medical assistance in dying.

Can the member help me think of some ideas for people who want medical assistance in dying? They do not want palliative care; they want medical assistance in dying.

What safeguards does she think we should put in place for them so we can give them that right?

[Christine Moore, NDP, Abitibi—Témiscamingue, QC]

Mr. Speaker, as I said in my speech, the government chose to leave people who are not at the end of their lives out of Bill C-14.

In some cases, individuals might want medical assistance in dying. One example that comes to mind is people on hemodialysis, an onerous and time-consuming treatment. After 10, 15, or 20 years of such demanding treatments, people might be worn out and might want to stop. All patients have the right to refuse treatment. A patient who refuses this treatment will die in the short term, but continuing to receive the treatment will not cause death. That means that the patient's end of life is not reasonably foreseeable, and he or she may therefore not be covered under this bill. People may want medical assistance in dying, but some of them are not covered under this bill as written. That must be fixed.

I think we should concentrate on palliative care first and foremost. Allowing medical assistance in dying makes no sense unless we have optimal palliative care in place.

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

Mr. Speaker, I thank the member for her eloquent remarks, specifically around the importance of palliative care. We have heard from the NDP some agreement with what we have been saying, which is on the importance of palliative care as well as conscience protection. We have actually heard the Liberals in some instances, and in different ways, saying that these things are important as well.

My view would be that we need to make sure that these things are included in this legislation, that we have protection for a right for someone to access palliative care, and a right of conscience. We hear reassurances from the government that it cares about these things as well, so let us get this into legislation so that Canadians and those of us who are voting on the bill can have certainty that those rights will be protected.

Would the member agree that we need amendments specifically in this legislation, not just separate funding commitments, but amendments in this legislation, to ensure that people will be offered palliative care and that there will be protection of conscience?

[Christine Moore, NDP, Abitibi—Témiscamingue, QC]

Mr. Speaker, I agree that it makes no sense to guarantee the right to medical assistance in dying without guaranteeing the right to receive optimal, high quality palliative care. Both options have to be on the table.

For example, someone who is diagnosed with advanced cancer could be offered medical assistance in dying. They know that option is on the table. However, palliative care might not be available in their region. They would have to relocate and spend their dying moments far from their family. They are not being offered a full choice. If we really want to be consistent in terms of what we are putting on the table, then both rights have to be guaranteed to end-of-life patients.

[Bob Zimmer, Conservative, Prince George—Peace River—Northern Rockies, BC]

Mr. Speaker, indeed this is a heavy subject for most Canadians. Physician-assisted suicide is definitely weighty. There were laws that we thought were sufficient, but it is as a result of the Supreme Court deciding the law is not sufficient that we are in this predicament today of having to find some alternatives.

I will be speaking to some different issues. I would not say they are of the highest importance to me. I will speak about those issues a little later. However, I want to talk about a few of the issues that are not talked about as much. One of them is on page 11 of the bill, called “Deeming”. I will read from the act itself. It states:

For the purposes of this Act, if a member of the forces receives medical assistance in dying, that member is deemed to have died as a result of the illness, disease or disability for which they were determined to be entitled to receive that assistance

I will go to the next page, where it again says “Deeming”. This time it states:

For the purposes of this Act, if a member or a veteran receives medical assistance in dying, that member or veteran is deemed to have died as a result of the illness, disease or disability for which they were determined to be entitled to receive that assistance

I mention that today as a former member of the veterans affairs committee, which dealt with PTSD, with veterans who have experienced trauma as a result of war, as well as relatives who have suffered trauma and PTSD as a result of war. I am concerned about this clause in a dramatic way, due to the potential for it to be used as a way out for families. It could be a means of financial assurance, if the member decides it is a way out, that could provide sustenance for his or her family.

I feel it would open a door that was previously closed to members. We certainly respect the ones who have passed as a result of suicide, but I am concerned that this opens the door wider, to making it a somewhat legitimate exercise and to potentially doing it for families to receive benefit. We should be looking at more ways to help members of the forces and veterans with PTSD rather than giving them a doorway out.

The second issue I would say is a more significant argument for me, and that is the issue of compelling. Compelling has different forms. Compelling, as we heard from physicians who are friends of mine, and nurses, could be a doctor compelling a nurse to deliver a life-ending drug. Can a patient compel a doctor to end that patient's life? Does a senior feel compelled to end his or her life to lessen the financial burden to the family? Does a senior feel compelled to end his or her life to make room for others in hospital rooms and beds in our country?

I feel that there are a lot of arguments. I will first talk about the argument of a physician compelling a nurse. Certainly there is discussion within the bill to allow physicians to have the freedom to do what they wish to do based on their religious beliefs, or the basic belief that life is sacred and not wanting to take part in assisted dying. Most of us fully understand the way that the Supreme Court can be used as a tool. A citizen could use the Supreme Court as a tool if a doctor refused service.

If a doctor refused to assist a person to end his or her life, it would likely end up in a court, which I am sure will happen if this bill passes the way that it is. Doctors could be held to account, if a law is enacted that they have a responsibility to perform that duty for Canadian citizens. Likewise, if doctors feel compelled to perform that service, which is what we heard in testimony from doctors directly, doctors do not actually give the injection or do the duty of ending the life. It is passed on to another member of the medical staff, usually a nurse, and that person will be compelled by a doctor's order to deliver the life-ending treatment or drug. Those are huge issues, and any one of those breaks in the chain could potentially end up in a court. A particular member of medical staff would be ordered to enforce that care.

I will move on to the more general compelling of seniors and people who are ill in our society. I have two senior parents. May dad is 82 and my mom is 72. The last thing I would want would be for them to feel like they are a burden on our system. They have contributed all their lives. To this day, my dad still works as a carpenter out in the shop. He pays his taxes. A senior should not feel like he or she needs to end his or her life based on a health care system that needs more space or is just too expensive.

I love my parents, but that is not always the case across Canada. Different families do not agree as much as I do with my parents and there are frictions within families. Would some of these frictions within families be used to compel seniors to possibly end their lives because they have been made to feel they are a burden on our system? Certainly these are the what-if cases, but with 30 million people, these cases will arise, if they have not arisen already. It is deeply concerning to me that this is even an option.

Much has been said of late about the suicides in Attawapiskat and suicide in general and what the feelings are about suicide. I do not think we can sugar coat it. We call it end of life and some other groups have call it different names, but it is suicide. It is the ending of someone's life.

What concerns me is an example of what could potentially happen. A group of individuals who feel they do not want to be on Earth anymore go into a physician's office and based on a psychiatrist's exam and review, they are warranted to end their lives. I am concerned this opens the door wide to an acceptance of suicide as a somewhat acceptable form of living in this world or ending one's life in this world. It is a huge concern for me.

Lastly, I will speak about why I do not think we need to be in this situation. It goes back to the notwithstanding clause. I had a conversation with a judge on a plane ride home to Vancouver. My comment to the judge was that as members of Parliament we were checked every four years during an election. Often we would see many different faces in this place. The people of Canada have checked us. Some have made it back and some have not. We see some new faces. They made it here because the people spoke.

What check is on the judiciary of our country? The response from this Supreme Court justice was that there was a check, the notwithstanding clause.

I know it is yeoman's work to even try to get this kind of law into some kind of acceptable form because of so many diversities, but we already have a law. It is the job of 338 members of the House of Commons to enact laws. It is the job of the Supreme Court to uphold those laws. My concern is that there seems to be a usurping of our particular body by the Supreme Court. I would challenge the government to look into that. It should look into whether we already have a law. A lot of us still accept the law for what it is. Rather than having a discussion about reforming and rewriting what is already there, we need to go back and really think seriously about it.

I certainly agree with most people here that palliative care needs to be better in Canada. We have all had passionate arguments about the sanctity of life. I believe all were created equal in this place.

However, we need to seriously think about either rewriting the law as it was, as Canadians have sent us here to do, or upholding the laws that are already in place by previous bodies of elected people to the House. We need to honour this place. This is the place where we make laws. It is not just we 338 individuals. We have been sent here to represent over 30 million people, and their voices need to be heard loud and clear.

It is a tough argument to have in this place. There are many issues on both sides that we all feel very passionate about, in whatever form that is, but we need to consider seriously upholding the laws currently in place.

[Kevin Lamoureux, Liberal, Parliamentary Secretary to the Leader of the Government in the House of Commons]

Mr. Speaker, we need to emphasize the fact that the Supreme Court decision was made unanimously by all the sitting Supreme Court judges, which says a lot. Therefore, when the member makes reference to using the notwithstanding clause, I would caution him.

So that people understand this, because the member seemed to give this a lot of attention, access to medical assistance in dying would only be available to those who would meet certain conditions: they must be mentally competent adults who are in an advance state of irreversible decline and capability; have a serious and incurable illness, disease, or disability, and experience enduring and intolerable suffering caused by their medical condition; and whose deaths have become reasonably foreseeable, taking into account all of their medical circumstances.

This law is better than the alterative, which is no law. The member has specifically expressed his concerns with the legislation. I would strongly suggest he share those concerns with the standing committee to see if there are ways in which we can deal with some of those.

[Bob Zimmer, Conservative, Prince George—Peace River—Northern Rockies, BC]

Mr. Speaker, the fact the member has spoken to me, means he is exercising that right of the citizens who sent him here. He likely represents about 100,000 people, based on riding size. I represent 107,000 people. If seven or nine individuals supersede an elected body that represents 30 million, then we disagree on numbers.

The member talked about certain definitions. Correct me if I am wrong, but we are all in certain phases of decline. We all are going to meet our end someday. My concern is that such an open definition would apply to any individual on this planet. Again, once we open it up that wide, we open it wide up for abuse.

[Kennedy Stewart, NDP, Burnaby South, BC]

Mr. Speaker, I am very confused by the Conservatives who keep raising the use of the notwithstanding clause. Could the member perhaps flesh out how he would see this going forward?

If we are going to at least discuss this, I would like to hear some idea about how the member thinks we could start this process of using a notwithstanding clause to override the Supreme Court decision.

[Bob Zimmer, Conservative, Prince George—Peace River—Northern Rockies, BC]

Mr. Speaker, on the notwithstanding clause, I do not know if it has been used. Somebody can correct me if I am wrong on whether it has been used or not. However, it should be used very carefully.

My point is that we need to ensure that the governing body that represents the citizens of Canada in creating laws for this place and for the country is supreme in its ability. That is what we are sent here to do. Because a body of judges has said otherwise, I do not think changes our responsibility to our country and to our citizens. This is why I support it.

I was not aware of anybody else suggesting the notwithstanding clause. This is a personal opinion. However, we need to ensure this place remains sacred and we represent what Canadians say to us.

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

Mr. Speaker, my colleague has talked about the notwithstanding clause and, realistically, that would be anathema to the current government. The Liberals' attitude seems to be that one cannot even disagree or hold a different point of view than that of the Supreme Court.

However, at the same time, the government needs to accept responsibility for, in fact, in some ways, going much further than the court decision. We have things like the reasonable but mistaken clause, which would allow someone to escape prosecution for taking someone's life who maybe did not consent if that person had a reasonable but mistaken belief that the criteria were met. The court referred to that there is nothing in its decision that should infringe on conscience, but yet we see the legislation has no protection on conscience.

Could the member comment on the fact that the government is not just implementing what the Supreme Court directed, but is actually going much further, and it needs to take responsibility for that?

[Bob Zimmer, Conservative, Prince George—Peace River—Northern Rockies, BC]

Mr. Speaker, I think the member is referring to the Carter decision. What we have seen are problematic issues with the current bill. It has gone far past what the Carter decision said it would wish to see.

Again, I implore the government to consider rethinking this bill, maybe splitting it into different issues, so it addresses conscience rights and compelling somebody to do something they do not want to do.

Canadians care deeply about this issue. I hope the government takes our discussions back to committee, and approves some amendments at the very least.

[Ginette Petitpas Taylor, Liberal, Moncton—Riverview—Dieppe, NB]

Mr. Speaker, I move:

That this question be now put.

[Phil McColeman, Conservative, Brantford—Brant, ON]

Mr. Speaker, I would ask for clarification as to exactly what the intent of the question being put is. I am unclear on the intention. Does this mean closure on debate on the issue? Perhaps you, Mr. Speaker, could answer that.

[The Deputy Speaker, Conservative, Bruce Stanton]

I realize this might be a new procedure for some. Certainly, it has been a while since we have had something like this before the House.

I invite members, if they have questions on the procedural side of this, to speak with the Table. Essentially the motion that this question be put does not in any way prohibit the continuation of debate. We are still in debate, now on the motion.

The member for Moncton—Riverview—Dieppe used her 10-minute time to put the motion before the House. She still has five minutes for questions and comments, after which we will proceed with regular debate and whoever is next in order.

That was the hon. member for Brantford—Brant's question. We will now go to the hon. member for Moncton—Riverview—Dieppe for her response.