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

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

Mr. Speaker, I must say that I am disappointed that the member has chosen to move yet another amendment. It has become very clear that there are many members of the House who would rather not have legislation in place, the legal framework. I would suggest that, if we were to follow the will of those individuals, there would be a legal vacuum in Canada, where the most vulnerable individuals would be put into compromised positions. It would be unfortunate.

I listened very closely to what the member was talking about, and I disagree. With the Supreme Court decision, there is a role for Ottawa and the provinces.

My question is this. Why does the member choose to believe it is better to have a legal vacuum than to have a legal framework? Would he not agree that there are going to be more people in vulnerable positions because of that vacuum?

[Murray Rankin, NDP, Victoria, BC]

Mr. Speaker, I thank the parliamentary secretary for his perspective on this, and I am sorry he is disappointed. We are trying to do our best for Canadians to get a bill in place that will not find suffering Canadians lined up at the Supreme Court doorstep as soon as we pass it. That is why we are doing this, and we hope people will support that initiative.

To talk about a legal vacuum is misleading, with great respect. We already have every college of physicians and surgeons across the land involved in having safeguards in place. Yes, having Bill C-14 on June 6 would be preferable to not having Bill C-14 on June 6, but having knowingly passed a law that is unconstitutional would be even worse. Let us take the time, I say, to get it right, not to get it done right now.

[Peter Julian, NDP, New Westminster—Burnaby, BC]

Mr. Speaker, I would really like to thank the member for Victoria for what was a very substantive speech. It is rare in the House, although we all like to speak out, that we hear a member basically pull apart the government's arguments on assisted dying and put forward, as the member for Victoria has, the real reasons the government has so badly botched what should have been a non-partisan approach to the bill, which should have involved all members of Parliament. Instead, the government has been so clearly partisan that it has risked the actual objective of the bill to accomplish some sort of legislative framework and risked having it put in place.

I would like to ask the member for Victoria a question. He spoke very eloquently to the uncertainty that is created by this bill being rammed through the House of Commons. Could he speak to what uncertainty we and Canadians are going to see as a result of having a bill rammed through the House of Commons that does not meet the constitutional obligations or the obligations set out in the Supreme Court decision?

[Murray Rankin, NDP, Victoria, BC]

Mr. Speaker, I thank my colleague and friend from Burnaby—New Westminster for his remarks as well.

This is the quintessential non-partisan issue in the House. It was not a Liberal, Conservative, or NDP initiative. It came forth because the Supreme Court said that, if we chose, we could enact legislation to address the Carter ruling. We chose to do so. It was not a partisan issue. I have tried—and I think the record will show—to be as constructive and non-partisan as possible, working with Conservative and Liberal colleagues to make amendments to the bill at committee, for example.

For a party that claims to be the party of the Charter of Rights and Freedoms to do what it is about to do is really quite shocking to me. I do not understand. The medical and legal uncertainty that I tried to address during my speech is so obviously going to happen now. Do not take my word for it; it is medical and legal regulators who are saying that, so we have to do a better job.

[Kevin Lamoureux, Liberal, Winnipeg North, MB]

Mr. Speaker, when we hear arguments from the other side saying that there is this legal opinion here or there is this thought over there, it is somewhat concerning.

I am sure the opposition is very aware that there is extensive legal opinion from many different lawyers who have clearly indicated that what we are debating today is in fact in compliance with Canada's constitution and our charter, and that it will stand the test.

Will the member not at the very least acknowledge that there is in fact a significant legal community that is endorsing this legislation?

[Murray Rankin, NDP, Victoria, BC]

Mr. Speaker, I will not acknowledge that there is a significant body of legal opinion to that effect.

I will acknowledge that the Department of Justice, which lost at trial and lost unanimously in the Supreme Court of Canada, is of that view. I will acknowledge that it lost its case in the Alberta Court of Appeal. I will acknowledge that a week or so ago Justice Perell in the Ontario Superior Court also rejected the Department of Justice's view.

I will say that the Canadian Bar Association, the Barreau du Québec, Monsieur Ménard, Joseph Arvay, and eminent constitutional scholars from coast to coast have taken this position.

I cannot predict with certainty what a Supreme Court will say, but I am confident I would rather be in their shoes than on the side of the government with its position that does not appear to even have an independent legal opinion behind it.

[Ziad Aboultaif, Conservative, Edmonton Manning, AB]

Mr. Speaker, I would like to congratulate my colleague from Victoria for his usual thoughtful speeches and analysis and his approach to many topics here in the House.

What happened yesterday with the voting against some of the thoughtful amendments presented was that the government has voted them down. I would like to hear the member's opinion on why this has happened. I can only see it as for political reasons, and nothing more.

Could the member give us his views on that?

[Murray Rankin, NDP, Victoria, BC]

Mr. Speaker, I am not clear to this moment on why the government is so bent on passing a law that so many believe to be unconstitutional.

I frankly do not understand why the very thoughtful amendments were rejected yesterday. This was purported to be a free vote, but I did not see more than a few Liberal members stand against this bill.

Tonight, I understand we will be voting at third reading. This is the opportunity for members, particularly those concerned about rule of law, to come forward and vote against a bill that is patently unconstitutional, to get it right for Canadians, and protect those individuals who had their rights given to them, clearly, in the Carter case and would now see those rights taken away by Bill C-14.

[Brian Masse, NDP, Windsor West, ON]

Mr. Speaker, could the member give a little perspective on how we are dealing with hospice and palliative care in this matter?

These are very important issues raised in this chamber by the previous member for Windsor—Tecumseh, Mr. Joe Comartin, and being carried on by the current member for Windsor—Tecumseh.

The potential path of this bill will lead to every senator having an opportunity to speak to this bill, but not members of Parliament. Could my colleague tell us what he feels about that, which I think is a real shame and an affront to democracy?

[Murray Rankin, NDP, Victoria, BC]

Mr. Speaker, palliative care is something that the former and present members for Windsor—Tecumseh have been pushing passionately in the House, in the justice committee, and in the Senate-House mixed committee.

It is something we wished to see enshrined in this bill. We were disappointed there was not a dollar of money in the federal budget for palliative care, despite promises during the campaign. We were, however, able to get an amendment through in the preamble to Bill C-14 that at least addresses the urgent requirement for palliative care.

The Minister of Health, herself, has pointed out that less than 30% have access to palliative care in Canada. That is connected—it must be so connected—with this bill that we need to do much better on that score.

I just hope the government actually puts its money where its mouth is and comes up, in the health accords, with meaningful help for palliative care and hospice care from coast to coast to coast. It is so urgently needed.

[Sonia Sidhu, Liberal, Brampton South, ON]

Mr. Speaker, I am humbled to stand in this place and take this opportunity to speak to Bill C-14, an act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying).

I will be splitting my time with the member for Kenora.

I know that this issue is very personal to Canadians. It is about quality of life and dignity. It is about autonomy. Most of all, it is about compassion.

I listened to many people in the constituency of Brampton South on this issue. I heard support from most people in my riding. I also heard sincere and heartfelt concerns, particularly from our Orthodox-based communities. I appreciate their conviction, and that they have raised their voices with respect to this important issue.

I will use my time today to explain why I will be voting for this important legislation.

My heart goes out to all of those suffering and their family members, who are facing circumstances I cannot imagine. I think we can agree that it is those who are suffering, and their families, who this debate should be about. I hope that hon. members will not forget that fact. We must lean toward a compassionate approach for those who are affected. This is a serious matter and a complex issue. Therefore, we must find the right balance.

Our government must address this now. The Supreme Court made a unanimous decision, and soon there will be a legislative vacuum.

I think we can agree that a patchwork approach by the provinces would be the wrong approach. We would be ignoring our responsibility to show national leadership on this matter.

The framework laid out in Bill C-14 provides a solid, focused and detailed plan, which will meet the June 6 deadline set out by the court. Let me explain why.

Permitting medical assistance in dying will extend more control to eligible terminally ill patients on how to live out their last days. This legislation also provides important safeguards and limitations. It requires the Minister of Health and the Minister of Justice, in consultation with the provinces, to create regulations that will protect all of those involved.

By permitting medical assistance in dying for competent adults, whose deaths are reasonably foreseeable, I believe we are striking the right balance between the patients' autonomy who seek this medical assistance and the interests of patients in need of protection.

It is important to note that this bill does not stand alone. I would point out the critical work of improving palliative care in this country. The ideas of medical assistance in dying and a strong palliative care system are not in conflict. Rather, the two are complementary and are both important issues to address. That is why I am proud that the Minister of Health has recommitted to home care and palliative care improvements in response to a question that I asked during question period on May 2. In her reply to my question, the minister quoted Dr. Atul Gawande, who talked about how people want not only a good death but a good life to the very end. The minister reiterated her commitment to palliative care and providing dignity when Canadians are suffering. She announced how she will work with the provinces to ensure the high quality care of all Canadians. She also brought up how the Government of Canada is committed to an investment of $3 billion over four years to support that goal of palliative care and home care improvements. I commend this step forward.

We cannot view assisted dying legislation separate from investments in our health care system. Quality palliative care is a critical priority of this government. Indeed, as our government renegotiates the health accord with the provinces, I look forward to seeing palliative care discussed. The work with the provinces, territories, and stakeholders is essential to providing options to end-of-life care.

My background is as a research coordinator and diabetes educator. I know how the roles and views of physicians and nurse practitioners are vital to this issue. As a member of the health committee, and someone who worked in the health care field for almost 20 years, I understand the importance of consulting the people on the front lines. Physicians and nurse practitioners are central to the end-of-life process. Their conscience rights will be respected in this legislation. We are working on the best way to ensure their views are always taken into account.

The rules in this legislation are clear and eligibility has been carefully defined. I want to be clear. There is nothing in the legislation that would compel any medical practitioner or authorized nurse practitioner to provide medical assistance in dying. The legislation is meant to balance access to medical assistance in dying while respecting the personal convictions of health care providers. This is about finding the right balance.

Canadians are looking to their doctors and nurses to provide health care and to help them maintain their quality of life. However, when the 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.

We have struck the right balance in my view by having proper procedural safeguards. Access to medical assistance in dying would only be available to those who meet the following conditions: be a mentally competent adult who is at an advanced state of irreversible decline in capability; have a serious and incurable illness, disease, or disability; experience enduring and intolerable suffering; and whose death is reasonably foreseeable.

It will also remain a crime to assist a person either in dying or in causing a person's death in a situation other than lawful medical assistance in dying. Protective measures are a key part of the legislation to ensure that eligible patients have given informed consent. Patients have to make a written request for medical assistance in dying and have it signed by two independent witnesses. 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.

Our evidence-based approach will include regulating, monitoring, and reporting. This monitoring and reporting system will also be able to signal any issues or unexpected consequences. We want Canadians to see a system that is functioning and preventing abuses or errors. This will build up confidence and allow Canadians to make informed decisions about how the system should operate.

I appreciate how other members have spoken about how we will look to international models in terms of ways to work with the provinces and territories. This end-of-life coordination system will respect the role of the provinces, while providing access and respecting people's rights.

I want to recognize the work of the committees and the senators who have studied this matter and made recommendations around this debate. These recommendations and testimony from those on all sides of this issue should be taken into account. There have been a number of informative and heartfelt speeches by fellow members who I also want to take a moment to applaud. I also thank the Minister of Justice and the Minister of Health for their work in introducing the legislation.

Bill C-14 strikes a proper balance in view of the Supreme Court of Canada's decision and provides a needed legal framework. As parliamentarians we have the final say on behalf of the people we serve who elected us to be their voice. This is a debate that engages our morality, our sense of justice, and our compassion. It asks tough questions of our legal and medical systems.

We have talked to one another and heard some touching stories. We have reflected on how this issue affects all of us. It has called on us to hear the stories coming from the prospective Canadians who are suffering. It is often all too easy to forget what we would do if we were in their shoes. We often fail to truly appreciate the perspective and experience of those diagnosed with a terminal illness. Their dignity is challenged more and more as they reach their end.

We need to pass this legislation at the soonest possible opportunity. I hope all members will support the bill with me.

[Cathy McLeod, Conservative, Kamloops—Thompson—Cariboo, BC]

Mr. Speaker, there is one part of the argument that the Liberals have put forward that makes absolutely no sense to me and that is the firm commitment they have given for $3 billion toward palliative care. They say they have to negotiate the health accord and we have to do this and we have to do that. This matter is too important.

The Liberals thought that education for aboriginals was important and they put it in the budget. Now they are looking at the negotiation process. With respect to the $3 billion for palliative care I do not know if they are trying to keep their deficit somewhere below that $30 billion that they extended it to. It makes no sense that the money for palliative care is not in this budget while they are negotiating with the provinces in terms of how it be spent.

[Sonia Sidhu, Liberal, Brampton South, ON]

Mr. Speaker, I respect that we have heard a diversity of opinions for this bill. Palliative care is about dignity while dying from natural causes. Canadians have clearly indicated that they want to maintain their independence and receive care at home, including at the end of their lives. Recently, federal, provincial, and territorial ministers of health agreed to work individually and collectively to improve home care to better meet the needs of patients closer to home, including those who need palliative care. This is the right plan that provides more options.

[Cheryl Hardcastle, NDP, Windsor—Tecumseh, ON]

Mr. Speaker, I would like to ask my hon. colleague a bit more about some of the concepts. I am very concerned with the idea of this being a balanced approach, that in this case balance is a logical fallacy here because an evidence-based approach has been ignored so far. I do not understand how that can be compromised in this kind of a profound situation with a bill dealing with something as serious as medically assisted dying.

Is the member at all concerned that there has been no independent legal analysis sought with regard to adherence to the charter? There has not been any. Is that a concern at all in this so-called balanced approach?

[Sonia Sidhu, Liberal, Brampton South, ON]

Mr. Speaker, I thank my hon. colleague for that great question. Yes, the committee did great work. Without federal legislation in place, Canadians would face an uncertain situation. I respect the views, but the job is about representing our Constitution and Canadians' views in this place. It is also about passing evidence-based policies that benefit Canadians. The people of Brampton South elected me to be their voice here, to bring a different approach, and to implement our government's better plan. Bill C-14 is the right bill at the right time. It is the best approach. We need checks and balances. That is why the committee did a great job. Even the CMA said that. The Canadian Medical Association has pointed out that in the Carter decision, the “...parameters are vague in the extreme, and contain absolutely no clinical direction whatsoever”.

The term “grievous and irremediable” which is used by the court is not a medical term, so we need more clarification for that. That is why the committee did great work. We listened to all the consultations and this is the right bill. We have listened to all Canadians, and this is the right bill that we have to bring.