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.

Motions in amendment

[Michael Cooper, Conservative, St. Albert—Edmonton, AB]

Madam Speaker, it is a privilege to speak to Bill C-14 at report stage.

I have brought forward three amendments, two of which are related. Motions Nos. 4 and 9 on the Order Paper relate to requiring someone with an underlying mental health condition to undertake a psychiatric assessment to determine capacity to consent. Motion No. 14 on the Order Paper deals with conscience protections, ensuring that the conscience rights of health professionals and health care institutions are respected. I will get into a little more detail momentarily with regard to those amendments.

Let me just say at the outset that however short or long my parliamentary tenure proves to be, Bill C-14, I have little doubt, will be one of the most important votes that I cast. I believe that is true for all hon. members in this House, because we are talking about a bill that will impact the lives of Canadians not just for years to come, but likely decades to come.

Having regard for the gravity of the decision before us, I have spent a lot of time reflecting on what is the right thing to do. At the present time, I am still reflecting.

One of the shortcomings of Bill C-14 at second reading was the absence of conscience protections. I am pleased that now that the legislation has gone through committee, there has been movement in the right direction when it comes to protecting conscience rights of health care professionals. More specifically, Bill C-14 provides that no individual is obliged to provide, or assist in providing, physician-assisted dying. In addition to that, the preamble has been amended to expressly recognize section 2, freedom of religion and freedom of conscience under the charter.

I want to thank the hon. member for Victoria for his leadership in moving those amendments at committee in close co-operation with me, as well as the hon. member for West Nova. I would be remiss if I did not acknowledge the hon. member for Mount Royal for his hard work and the collaborative approach he took as chair of the justice committee, which resulted in an important improvement in the legislation.

With respect, I believe there is still work to do when it comes to conscience protections. I believe it is important that not only health care professionals but also health care institutions have their charter rights and appropriate conscience protections in place. That is what my amendment would seek to do to ensure that everyone's charter rights are respected.

I would note that Madam Justice McLachlin and Mr. Justice Moldaver at paragraph 94 of the Loyola decision recognized that the individual and collective aspects of section 2 charter rights are intertwined.

With respect to the other two amendments I have brought forward, one of the concerns I have is the fact that in the legislation any two physicians or any two nurse practitioners can determine whether or not a patient satisfies the criteria for physician-assisted dying.

The problem with that is that not every physician and not every nurse practitioner has the training and experience to determine capacity to consent when an underlying mental health challenge is present in a patient.

The clear evidence before the special joint committee of which I was a vice-chair, as well as the justice committee of which I am a member, was that someone with more specialized training, namely a psychiatrist, is required to undertake what is, quite frankly, a complex analysis in many cases.

My amendment would simply provide that anyone who has an underlying mental health challenge be referred to a psychiatrist for a psychiatric assessment to determine his or her capacity to consent. It is a simple amendment. It is a straightforward amendment. It is a much-needed amendment. We simply cannot allow people with mental illness to fall through the cracks. We cannot allow that to happen as parliamentarians. One way we can mitigate that from happening is to pass this very important amendment.

When I look at Bill C-14 in its totality, I see a bill that contains many important safeguards. Those safeguards ought not to be minimized or dismissed. They are there; they are real, and they are serious. At the same time, the bill falls short when it comes to protecting the most vulnerable of the vulnerable, namely, people with mental illness. I see a bill that moves in the right direction when it comes to protecting conscience rights of health professionals, but still falls short when it comes to health care institutions.

Bill C-14 is an imperfect bill. It is not a bad bill, but it is a bill that I believe can be improved upon. As I reflect, I must ask myself whether I support an imperfect bill or do I vote against an imperfect bill having regard for the consequences that would follow in the absence of legislation being cast when the expiration of the declaration on the stay of constitutional invalidity is June 6.

In closing, I will continue to reflect. I am hopeful that some of the gaps in Bill C-14 can be closed. I am hopeful that all hon. members on all sides of the House can work together collaboratively and in a spirit of good faith to try to do the best we can to make this bill the best that it can possibly be in the circumstances. We owe it to patients. We owe it to physicians and health professionals. We owe it to the vulnerable. Most importantly, we owe it to Canadians.

[Tom Kmiec, Conservative, Calgary Shepard, AB]

Madam Speaker, on a point of order, I would like to get assurance from my colleague from Halifax that he has erased the photo that he had taken in the House. As we all know, taking photos in the chamber is not allowed unless authorized and any unauthorized photography amounts to a breach of members' privilege. If he cannot assure you, Madam Speaker, that he has erased the photo, I will be prepared to return to the House with further comments on the matter.

[Kevin Lamoureux, Liberal, Winnipeg North, MB]

Madam Speaker, on the same point of order, it was a number of months ago when I stood on a similar point of order when a picture was taken of the opposition from the government benches. At the time, it was advised that the member did not take pictures and it was taken at that person's word.

The member in question indicated that he was going to delete the picture in question. Out of respect for the member's integrity, I think we accept that as being done and we leave it at that. Members, especially new members, might not necessarily be familiar with the rule and by your raising it, Madam Speaker, and it being talked about earlier, it should be put to rest at that.

[The Assistant Deputy Speaker, Carol Hughes]

I really appreciate the input that has been provided to me. Follow-up is being done. As I have indicated, and as the parliamentary secretary indicated, I did ask the member to delete the photos. No pictures are to be taken in the House of Commons while the House is sitting. We generally take members at their word to act on the direction that has been provided to them.

On that note, as I said, other follow-up is being done with the member from Halifax, and should it be required, I will get back to the member for Calgary Shepard with a further response.

Questions and comments, the hon. member for Charlottetown.

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

Madam Speaker, I would like to thank the member for St. Albert—Edmonton for his thoughtful contribution to the debate and also for the substantial work that he has done both on the special joint committee and on the justice committee. He is a standing example that while we may disagree, we need not be disagreeable.

The member finished his speech with an indication that he is reflecting and struggling a bit with how he is going to vote on this. He is struggling with the possibility of there being no law if those who are like him are wavering as to whether or not to pass what they see as an imperfect law.

Given the member's substantial experience in the debate here on the floor and before both committees, I would invite him to elaborate on the consequences of this law being defeated and our having no law on June 6.

[Michael Cooper, Conservative, St. Albert—Edmonton, AB]

Madam Speaker, I believe it is important that Parliament respond legislatively by the June 6 deadline. If legislation is not passed, there will be a vacuum. As a result of that vacuum, there will be no certainty for patients, no certainty for physicians, and no protections for the vulnerable. What we would likely have would be the colleges, for example, stepping in, but we would have a patchwork across Canada. What we need is consistency.

If the legislation cannot be passed before June 6, I think it also is incumbent upon the Minister of Justice, if necessary, to take the step of applying to the Supreme Court and asking for a further extension so that we can get a law passed. It is absolutely essential, absolutely imperative, that there not be a legislative vacuum.

[Murray Rankin, NDP, Victoria, BC]

Madam Speaker, I would like to thank the member for St. Albert—Edmonton for a very thoughtful presentation, and for the spirit of good faith and collaboration that he spoke about. He demonstrated that in the committees, on which I had the pleasure to serve with him, and he demonstrated that in his speech today.

My question is about the amendment dealing with conscience protection.

The member spoke of the need for institutional conscience protection. We differ on whether bricks and mortar really do have a conscience. However, the question is on the changes that were made in committee, namely, the clarification that nothing in this law would compel an individual to provide or assist in providing medical assistance in dying, and the reference in the preamble to the protection under the charter of conscience and religious rights. Would the member be satisfied with the conscience protections regime that we have crafted, subject of course to that one issue of institutional protection?

[Michael Cooper, Conservative, St. Albert—Edmonton, AB]

Madam Speaker, I believe that the amendments that were passed at committee go a long way in the right direction toward protecting the conscience rights of health care professionals. At the same time, I believe that the amendment that I am proposing in some respects tightens that up a little and then extends, of course, to protecting health care institutions. I think that it adds to the amendment that was passed at committee.

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

Madam Speaker, I thank my colleague for his hard work on both the joint committee and on the justice committee. There is no question that he has a grasp of this topic, which is probably beyond most of us in the House.

I would ask the member again to comment on the issue of standing up for specific protection for those who might have underlying psychiatric issues.

[Michael Cooper, Conservative, St. Albert—Edmonton, AB]

Madam Speaker, I would reiterate that perhaps there is no one group that is more vulnerable than people with mental illness. We need to be certain that those who have mental illness who may seek physician-assisted dying because they have an underlying physical condition that is grievous and irremediable have the capacity to consent. One of the clear parameters set out by the Supreme Court is that an individual must clearly give his or her consent.

We need to make sure that we have the appropriate safeguards for those people who are particularly vulnerable, and I think that my amendment does just that.

[The Assistant Deputy Speaker, Carol Hughes]

It is my duty, pursuant to Standing Order 38, to inform the House that the questions to be raised tonight at the time of adjournment are as follows: the hon. member for Saskatoon West, housing; the hon. member for Saint-Hyacinthe—Bagot, Canada Border Services Agency; and the hon. member for Burnaby South, Statistics Canada.

Resuming debate, the hon. member for Montcalm.

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, first of all, as I have done in the past, I would like to thank everyone taking part in this debate, as they are clearly demonstrating great compassion for persons with disabilities, diseases, or grievous and irremediable medical conditions.

However, as I have already said, just because we are compassionate does not mean that we are helpful. We are not being helpful when we affect a person's autonomy and thus the principle of self-determination. That is the basis for the amendments we are moving.

By deleting paragraph 241.2(2)(d), after all the discussions we have had about the “reasonably foreseeable natural death” criterion, we are complying with the ruling in Carter. As soon as a person has a grievous and irremediable disease or disability that causes them enduring suffering that is intolerable and that cannot be relieved under conditions that they consider acceptable, which is the purpose of our second amendment, we cannot claim that we are not affecting their self-determination.

Earlier I heard my Conservative Party colleagues talking about harmonizing this bill with Quebec's legislation. What they failed to mention is that the Quebec law was not intended to cover something made necessary by the Carter decision, namely assisted suicide.

It is important to distinguish terminal illness from the end-of-life stage, which Quebec's legislation placed within a continuum of palliative care. A person may very well be receiving good palliative care, yet still request death. They are at the end-of-life stage, when the dying process has already begun and is irreversible.

The question in the Carter decision is the following: What do we do with people who are terminally ill but not yet at the end-of-life stage? That is the question we needed to answer. By insisting on keeping the “reasonably foreseeable natural death” criterion in its bill, the government is going against the Carter decision.

I am not the only one to say so. The Barreau du Québec said so. The lawyer who argued the case before the Supreme Court said so. They won. The Carter family's lawyer said so. Kay Carter would not have had access to medical assistance in dying under the “reasonably foreseeable natural death” criterion unless, as some have been forced to do recently, she had gone on a hunger strike. In that case, natural death is reasonably foreseeable. That is totally inhumane.

Her other option would have been to argue her case right up to the Supreme Court. That is the road the government is currently going down. It says it is going to leave those who are suffering from a grievous irremediable illness with the burden of going to the Supreme Court to win their case. It is perfectly clear that this bill, as worded, flies in the face of what the Supreme Court said in its decision.

According to the Supreme Court, section 7 of the charter includes three rights, the right to life, liberty, and security of the person, and these three rights are affected by the total prohibition and the “reasonably foreseeable natural death” criterion. The Supreme Court indicated that the right to life is being undermined because some individuals are being forced to take their own lives prematurely rather than wait until their suffering and their lives have become intolerable. This bill does not address that issue.

That is why this bill will be ruled out of order and unconstitutional by the Supreme Court. Many people are certain of that. Why then is the government insisting on making this compromise?

That is what legislators did with regard to abortion in the 1970s. What the Supreme Court said in 1988 in the Morgentaler case is exactly what is happening with this bill.

When a law sets out exceptional and exculpatory measures in an attempt to respect rights and fundamental values, those measures have to be real. People have to be able to access them. We cannot take away a person's ability to decide for themselves. No one can make that decision for them. No one here should compare one life to another. It is not about that. No one here should get to decide for a patient what his or her quality of life is.

However, this bill attempts to do so because, to a certain extent, it attempts to qualify a person's death based on a foreseeability criterion. Unless her age was a factor, Kay Carter was not facing a natural, reasonably foreseeable death. That is the danger with this bill. The danger is that someone will either have to go on a hunger strike, which is inhumane, or else we will have to take their age into account. However, spinal stenosis, for example, can be just as intolerable at 42, 62, or 52 years of age.

What does this bill do about all the people who have degenerative diseases and do not want to die? People are not living with a disease that makes them suicidal. They are living with the disease. What they do not want is for someone to decide what is right for them.

Throughout our lives, we have the right to self-determination, meaning that no one can undermine our integrity. In the case of an emergency at the hospital, patients have to give their free and informed consent before they receive any treatment.

Why, then, at the most intimate moment of a human being's life, that person's own death, would anyone presume to do such a thing? On what basis would it be done? On the basis of the common good? Would a neighbour agree to die in that person's stead?

Some would presume to tell a person what to do and take away the right to self-determination when that person is most fragile and vulnerable. That is what the Liberal Party is condoning because it lacks the political courage to do what the Carter ruling asked it to do. It lacks the political courage to make a decision.

We may soon end up with a judicial democracy, but it is not up to the Supreme Court to legislate. That is a job for legislators, and each one of my colleagues opposite is responsible for shaping laws in accordance with the principles of fundamental justice.

I repeat, according to the principle of fundamental justice, found in section 7 of the law, exculpatory measures must be real; they must be genuinely available.

Anyone who wants to vote against these two amendments needs to prove to me that the bill, as currently written, will fulfill the requirements I just discussed.

[Anthony Housefather, Liberal, Mount Royal, QC]

Madam Speaker, I would like to thank my colleague for his remarks at the Standing Committee on Justice and Human Rights. Even though he is not a member of the committee, I appreciated his presence and his contribution.

The hon. member said on several occasions that the proposed bill does not meet the requirements set out in the Carter ruling. However, he was often at committee meetings when many witnesses, including medical and legal experts, said the opposite. We understand that any law could be found unconstitutional by a court. However, I believe that this legislation is constitutional and complies with the charter and the Carter ruling.

Will my hon. colleague acknowledge that many legal experts appeared before the committee, including the Canadian Medical Association representative, who said that he was in favour of the condition of reasonably foreseeable natural death?

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, when witnesses appeared before the committee, I heard people who were confusing the Quebec law with what the Supreme Court asked us to do. My Conservative colleagues, with their notion of imminent death, are creating this confusion. I mentioned this earlier.

That is also the case for the Canadian Medical Association. Everyone thinks that the Quebec law has struck the proper balance. In terms of end-of-life care, it is good legislation and there has been a consensus about that for almost six years. However, that legislation does not resolve the problem of assisted suicide.

This bill and this law do not currently apply to Kay Carter's situation. We must comply with the Supreme Court ruling, which contains criteria that differ from those found in the bill. It is too restrictive.

[Brigitte Sansoucy, NDP, Saint-Hyacinthe—Bagot, QC]

Madam Speaker, I would like to thank my colleague for his speech. It is clear that he has a lot of expertise on this complex and sensitive issue.

When the Standing Committee on Justice and Human Rights was examining this bill, a Liberal government representative said that the clause on natural death was deliberately vague so that more members would vote to pass this bill. However, the argument has often been raised that there is a legal void.

Does the member think that it is better to have a vague law or no law at all? I would also like him to talk about what the Collège des médecins du Québec had to say about this clause.