This bill was last introduced in the 42nd Parliament, 1st Session, which ended in September 2019.
Jody Wilson-Raybould Liberal
This bill has received Royal Assent and is now law.
This is from the published bill.
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.
All sorts of information on this bill is available at LEGISinfo, an excellent resource from the Library of Parliament. You can also read the full text of the bill.
The House resumed consideration of the motion that Bill C-14, An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying), be read the third time and passed, and of the amendment.
Majid Jowhari Liberal Richmond Hill, ON
Mr. Speaker, I will be splitting my time with the hon. member for Montcalm.
I am humbled by the opportunity to stand in the House 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), at third reading. It is an important issue facing all Canadians.
Every time I come to the House, I come I wearing three hats. The first is the hat entrusted to me as a member of Parliament representing my constituents of Richmond Hill; the second is the hat of a legislator working hard to make the best decisions for all Canadians; and the third is the hat of an individual with his own convictions and beliefs.
Today, I will open my heart and share my thoughts, hoping to reach the hearts of all Canadians.
Let me start by acknowledging how challenging an issue this is. It is difficult for a person to engage in a conversation about death, yet our government has honourably taken on this responsibility.
On April 30, I participated in a York Region town hall, where a sizeable portion of the attendees were from Richmond Hill. They passionately spoke to this matter from all sides. I am inspired by the passion found within my constituency, and I would like to assure them, and all Canadians, that we are in this together.
I am sharing my story with the House, a story that complements the perspective of my constituents, and the work that we do in the House.
This is the story of my father's journey dealing with the inner turmoil caused by cancer. It is the exact reason why I am so passionate about the bill. I wrestled with this issue because each one of my hats had a strong stake in this debate and the final decision to be made.
The difficulty of beating cancer is well known to many. However, despite the odds, my father fought this disease. He fought it with all his power and he succeeded. Unfortunately, his success was short-lived and he relapsed in no time.
As a loving and supportive family, we did everything for my father to keep him happy and comfortable during the end of his days. However, no matter what we did, it was not good enough to relieve his pain. No amount of moral and social support was stronger than his inner suffering. We provided him with palliative care, but it was not enough. It broke my heart to watch my father slowly lose himself through the process. At the end, he was more concerned about the impact of his suffering on us than on him. After all, his pain was alleviated with heavy doses of morphine. However, there was no remedy for his mental pain and the hit to his pride.
I have heard the concern that providing medical assistance in dying would negatively impact vulnerable people. However, as I stated before, what made my father vulnerable was not having the option to put an end to his journey.
Eventually, my father suffered from two illnesses, one physical and the other mental. The amount of pain he was going through physically began affecting him psychologically as well. He began isolating himself from us, and in the end was suffering alone.
I agree with the government's commitment to support quality end-of-life services and to continue working with the provinces and territories to improve palliative care. Canadians and the Richmond Hill community have made it clear that is what they want. To that end, the government has committed to a long-term investment into palliative care of $3 billion over four years. However, no amount of investment into palliative care would have relieved my father's agony.
My father's experience is not a unique one. I am sure that others in the House know of someone who has endured similar distress.
We have a big responsibility to Canadians. Our responsibility is to make Canada great, to provide Canadians with the means for a better life, to facilitate their realization of their vision, and to help them achieve their dreams and aspirations. We were elected to represent their wishes, to provide services, and to make legislation to achieve those ends.
Let us look at the data that speaks to what Canadians want. Polls show that a majority of Canadians accept the idea and would even request medical assistance in dying if it were available to them. Those polls also show that over the years the acceptance level of medical assistance in dying has been increasing. As Canadians became more aware of the matter, they began to empathize with those who suffer. In Richmond Hill alone, the local parliament project has shown that over 70% of my riding agrees that individuals who are terminally ill should be allowed to end their lives with the assistance of a medical professional.
In February of 2016, a Statistics Canada demographic analysis showed that persons aged 65 and over make up a record proportion of our population. It also showed that the proportion of seniors in our population has been increasing over the past 50 years, and the trend is continuing. What does this mean for us as legislators and representatives? It means that we must be forward thinking in our legislation and we must ensure there are mechanisms in place to deal with future problems.
The Carter case has shown us already that our current legislation is outdated, and the Supreme Court has asked us to update it. We are faced with a June 6 deadline. Let us ensure that we are prepared for this demographic shift and potential needs, such as the one on the table today. In order to ensure that we are prepared for this shift, we must ensure that we address key issues in our current system.
According to a research article published by the journal Palliative Medicine, in Canada, we need to streamline our legislative, financial, and regulatory affairs in terms of delivery of palliative care services. This means that once the legislation is passed we must continue to conduct studies and address lagging areas of hospice and palliative care services delivery.
I was fortunate enough to hear points of view from my neighbours in Richmond Hill during the town hall. They opened up their hearts and shared with me. The most powerful story came from people suffering with terminal illnesses, similar to the one my father had. They spoke of the importance of making advance requests, addressing the issue of mental illness, and access to mature minors. I am happy to hear that the government will appoint independent bodies to study these issues. I have seen members of the relevant committees work hard to ensure that they provide a reasonable approach to the legislation.
It is after carefully thinking through all these issues that I have decided to support Bill C-14.
I realize our government has genuinely worked hard on the bill. As it stands, Canadians do not have a choice on how to say goodbye to this world. My father died in my arms. He died in an attempt to say something to me, something I will never know. He did not choose when to leave me. He did not choose how to leave.
Through my declaration of Bill C-14, I am sending four messages. To my conscience, I can say rest assured that with this decision I have balanced the three hats and their responsibilities to the best of my ability. To my dad, I would say, “It took 10 years to understand what you wanted to say to me before you left me. Dad, in supporting this bill, I am happy to carry your wishes forward”. To my constituents and the Richmond Hill community, I want to assure them they were consulted, they were heard, and they are well represented.
To all Canadians, it has been a long and hard journey, but the journey of a thousand miles begins with the first step. However, in order for the journey to begin, the bill needs to pass. Let us work together to take that first step.
Kelly Block Conservative Carlton Trail—Eagle Creek, SK
Mr. Speaker, it is a privilege to rise in my place today and add the voices of my constituents to the debate on Bill C-14, an act to amend the Criminal Code and to make related amendments to other acts, regarding medical assistance in dying.
I want to begin by telling this House that, in the almost nine years that I have been a member of this place, I have not been asked about or received as much correspondence as I have on the matter of physician-assisted suicide. It is clear that Canadians and members of this House have varied and deeply held beliefs and convictions on this issue, which have been informed by our life experiences. We members also have a responsibility to balance our personal beliefs with those of our constituents and the incredible wealth of knowledge they share with us. The widespread reaction to this short debate in Parliament confirms my belief and, I believe, the belief of my colleagues that physician-assisted suicide represents the defining issue of this Parliament.
Bill C-14 would have the most lasting impact on Canadians and the social fabric of our society because each one of us could at some point see someone we know struggle with such a decision. My constituents' opinions on this issue have been genuine, considered, and informative, with a clear majority opposing physician-assisted suicide. I am pleased to inform them that I share their views. I believe in the inviolable dignity of all human life, and that it is to be protected by law from conception to natural death. Therefore, I have opposed and will continue to oppose any attempt to legalize euthanasia or physician-assisted suicide.
I have grave concerns with the process surrounding the introduction and passage of this bill. I am cognizant that Bill C-14 is now at third reading and that many members are still grappling with how they will vote later today. I hope all members will be able to vote freely, as Conservative members will be able to do.
This legislation was first introduced in this place on April 14, less than two months ago. Passing a bill in a month and a half is a challenge under any circumstances, but passing a bill of this magnitude and in this amount of time is reckless and demonstrates a complete disregard for the significance of this issue to all Canadians. As my colleague from Lethbridge noted in her earlier remarks, the Supreme Court of Canada has sent Parliament into an unending abyss of grey, and each day parliamentarians are being tested on the future limits of this legislation as one what-if leads to another. I do not believe that all the impacts of this bill can be assessed in such a tight timeline, as this truly is a new moral space for Canadians to contemplate.
Like many of us here, I am concerned that minors may eventually be able to obtain medical assistance in dying. I am concerned for the well-being of those struggling through mental illness because, quite frankly, we as a country are only now beginning to recognize and understand its reach and impacts on so many. As well, I am concerned with the notion that doctors who for legitimate reasons of faith or conscience oppose medical assistance in dying would be forced to participate in this process contrary to their personal ethics.
While the government has presented us with a bill that is much narrower in scope than the recommendations made by the special committee, stakeholders on both sides of this issue have raised many what-is-next questions. These have not been answered, and I am therefore disappointed that consultations and debate on Bill C-14 are ending prematurely.
Many of my constituents have suggested that the government should consider using section 33 of the Charter of Rights and Freedoms, the notwithstanding clause, to prevent physician-assisted suicide rather than rushing a bill through Parliament that appears to fully satisfy no one. I want the government and my constituents to know that I would support using the notwithstanding clause to prevent the Supreme Court's decision in Carter v. Canada from having any effect. While I am not a constitutional expert, I assume that section 33 was included in the charter because the prime minister and the premiers of the day wanted to affirm that a democratically elected federal Parliament and provincial legislatures, and not the judicial branch, would have the responsibility to pass laws on matters of public policy.
By refusing to invoke the notwithstanding clause, the government is prematurely ending our deliberations on this bill, and consequently removing many voices from the discussion.
Parliament should be passing laws that the courts then interpret within the charter. Courts should not be telling Parliament what laws it needs to pass and by when they must be passed.
I do not believe that former premier of Saskatchewan Allan Blakeney would have signed the charter without the presence of the notwithstanding clause, as it protected the rights of Saskatchewan's legislature to override a court decision with which it might not agree.
Then prime minister Pierre Elliott Trudeau agreed when he said:
...it is a way that the legislatures, federal and provincial, have of ensuring that the last word is held by the elected representatives of the people rather than by the courts.
Former prime minister Jean Chrétien, who was at the time Canada's justice minister, made a similar comment:
The purpose of an override clause is to provide the flexibility that is required to ensure that legislatures rather than judges have the final say on important matters of public policy.
If physician-assisted suicide is not an issue for the Parliament of Canada to invoke section 33, what is?
Liberal members have continuously used the June 6 deadline as justification to pass the bill quickly, yet I would posit that the notwithstanding clause exists precisely so that Parliament, and not the courts, can set the timeline on important matters of public policy. At the very least, the government could have used this clause to give itself more time to consult Canadians and draft legislation that conforms to the court's decision and protects life.
Quebec's National Assembly took six years to develop its legislation on physician-assisted suicide, yet the Supreme Court only gave the federal government a total of 16 months to put in place new legislation. Unfortunately, it is clear that using the notwithstanding clause is not an approach that the current government would even consider.
I will use my remaining time to address the issue of conscience rights for medical professionals.
I believe that opening the door to physician-assisted suicide is a slippery slope for our society. However, I believe that it is even more reckless if we fail to protect conscience rights in this legislation.
Without adequate protection for the conscience rights of medical professionals, Parliament, and more specifically the current governing party, is inserting the thinnest edge of the wedge when it comes to legislative disregard for conscience rights. If the current Parliament fails to respect these rights, we are setting a most dangerous precedent.
Precedents matter. Members might not be in the House or even alive to see the effects that the precedents set by passing Bill C-14 may have, which is why the protection of conscience rights today is so important.
I would have expected that most in this place would support conscience rights for medical professionals. I took at face value that the government included a mention of conscience rights in the preamble of the bill as an indication of its support for the principle, but the results of last night's vote demonstrated that this was not the case.
No one is a permanent or an eternal member of this place. Just like legislators in past parliaments, the only lasting effect we can have on the future is to be clear in our intentions through the laws we pass today. Therefore, it behooves us as members of the 42nd Parliament to be very specific in what is allowed and what is being protected with this piece of legislation.
In conclusion, our only legacy as a Parliament is what we pass into law. We have a responsibility to get this legislation right and ensure that all the issues that have been raised are addressed.
Gérard Deltell Conservative Louis-Saint-Laurent, QC
Mr. Speaker, I will share my time with my colleague the member for Carlton Trail—Eagle Creek.
This is a very difficult time in my short political career, because it is a sensitive subject that should be free of partisanship. All opinions are right, and no one is wrong. We are all good Canadians of good conscience, and we are looking for the best solution on such a sensitive subject.
When it comes to this subject, we are not here to try to convince anyone; we are here to explain our point of view. According to the Supreme Court’s decision in the Carter case, it is not a matter of determining whether we are for or against medical assistance in dying, but of determining how we will apply it.
Here we are at the final reading of Bill C-14. At my leader’s invitation, I had the privilege of participating in the parliamentary committee that studied the matter and produced a main report and a dissenting report. My official opposition colleagues and I signed the dissenting report, while my Conservative colleagues in the Senate signed the main report. This shows that there was no partisanship in our approach.
In our dissenting report, we raised five major concerns. Most of them were noted by the government and are reflected in Bill C-14. We were against the medical assistance in dying bill applying to minors; the government listened to us. We were against the bill applying in the case of mental illness; the government listened to us. We wanted complete openness concerning conscience protections for physicians and institutions; the government listened to us in part. We also wanted a clear commitment from the government concerning palliative care; the government listened to us in part.
On another note, I salute my colleague from Sarnia—Lambton, who introduced Bill C-277 in the House almost exactly 24 hours ago. The aim of this private member’s bill is to force the government to make a firm commitment to provide the necessary palliative care to as many Canadians as possible. As we know, only one-third of Canadians have access to that type of care. With Bill C-277, we want that to be enforced.
Those are the elements of Bill C-14 that we consider positive or semi-positive. Now here are the things that are of great concern to us.
First, there is the famous definition of reasonably foreseeable death. For us, this makes absolutely no sense. “Reasonably foreseeable” means both everything and nothing. I am going to die some day. That is reasonably foreseeable, of course, but it means absolutely nothing. From sage experience, Quebec used the expression “end of life”. That is at least clearer.
There is also the matter of nurse practitioners, who have the same decision-making powers as physicians under the bill. I have tremendous respect for nurses, and I know what I am talking about, since they are often the first people, and sometimes the only people, who see us when we are in hospital. However, when it is a matter of life or death, and that is literally the issue here, I would prefer that physicians have the ultimate responsibility rather than the wonderful nurses.
The points I have just mentioned are based on Quebec’s experience. I know what I am talking about, because I was a member of the National Assembly of Quebec. We worked on and gave serious consideration to the issues surrounding medical assistance in dying for six years, whereas here in the House we had only a few months to do the same work.
Later, I will talk about an unfortunate statement we heard during question period.
Based on Quebec’s experience, we built our case for the dissenting report. The current bill includes some elements in full, others to some extent, and still others not at all. It is a fairly even balance of the positive and negative elements.
Then there remains the famous issue of constitutionality. Every bill that is put forward can be challenged. In fact, whatever bill was introduced, it would have been challenged by one group or another. For weeks, some people have been saying that it is constitutional, and others have been saying that it is not. Most of the people we heard from said that it did not make sense and that it did not comply with the Constitution or the Carter decision. However, this morning, in La Presse, if I remember correctly, three constitutional experts from three different universities, namely Laval University, the University of Montreal, and UQAM, said it was constitutional.
If we table a bill, we will hear a bunch of lawyers say that it is good and a bunch of lawyers say it is not good. This is the point, and we have to live with that. It is democracy. This is how it works in our judiciary system.
I say this with great respect for legal eagles. I know that there are some here, some prestigious ones in fact, and I salute them, including the member for Mont-Royal.
The charter issue is another interesting point. Some people say it complies with the charter, while others say it does not.
Let us try not to be too partisan. If we cannot rely on the Liberal government to draft a bill that complies with the charter, whom can we rely on? Do I need to remind anyone that it was the Liberal Party, under the leadership of the Right Hon. Pierre Elliott Trudeau, father of the current Prime Minister, who enshrined the Canadian Charter of Rights and Freedoms in the 1982 Constitution, signed some 300 feet from here by Her Majesty the Queen on April 17, 1982? We all remember that. The sky was overcast, and at the very moment the signing took place, there was a rumble of thunder. Just a brief history lesson.
Seriously, I am not the greatest fan of the charter, much less of the Liberal Party, especially not the Liberal Party, but good Lord, if we cannot rely on the Liberal government to draft a bill that complies with the charter, I wonder whom we can rely on.
The events are balanced. This bill has good points and bad points. Over the past 24 hours, three events occurred that are worth thinking about. First, yesterday we voted on 10 possible amendments and they were all defeated by the Liberal majority. I commend the government members who voted against their party's position for their courage, honour, and dignity. Well done.
However, I believe that two of those amendments, both of them introduced by the member for St. Albert—Edmonton, were essential.
The first amendment protected the most vulnerable members of our society by proposing that people undergo a psychiatric assessment before giving their consent. We think that is extremely important because protecting the most vulnerable members of our society is essential. Nevertheless, the government voted against that amendment.
The second amendment had to do with conscience protections for institutions. I speak on behalf on my friends from Quebec when I say that, in Quebec, institutions such as hospitals are secular. However, outside Quebec, some institutions are religious and act according to the dictates of their conscience. We need to protect their conscience rights, but this bill does not do that. We proposed that amendment, but the government voted against it. That is unfortunate. The government refused to accept amendments.
Moreover, this morning, Quebec's health and social services minister, Gaétan Barrette, made a statement. I know the guy. He is honest, hard-working, conscientious, and a man of integrity. He is also a medical specialist who was once an administrator and is now a minister. Speaking on behalf of the government of Quebec, he said:
I myself am disinclined, for governmental and professional reasons, to support C-14 because of its worst feature: reasonably foreseeable natural death. That makes no sense. It cannot be enforced. I would be very hesitant to get on board C-14 as it stands...
He added that the bill is very off-putting, that this is a bad clause, and that it is [too much] of a minefield for him.
The third element applies to the Prime Minister's statements in question period today. He said he is working with the provinces on this, but that has no basis in fact. Worse still, he said, “we drew a great deal of inspiration from the reflections of the Quebec National Assembly”.
I can tell you one thing. I sat in the National Assembly. I was there for the six years that this was being studied. What we have seen here in the past six months does not resemble in the least what took place in the National Assembly.
I will not revisit the unfortunate events that took place two weeks ago when there was to be a vote to restrict our right to speak. I will look at the overall process. Unfortunately, the government did not follow the example set by the National Assembly in terms of either substance or form.
Consequently, bearing in mind the positive and negative elements of the bill and the three events that have taken place over the course of the past 24 hours, that is, the vote against the amendments, which were all rejected, the statement by the Quebec minister of health and social services, and the misleading statement by the Prime Minister of Canada, I will be voting against this bill.
Randeep Sarai Liberal Surrey Centre, BC
Mr. Speaker, I am pleased to participate in the third reading debate on Bill C-14, which would provide a federal framework on medically assisted dying. As acknowledged by many in the House in the last number of weeks, medical assistance in dying is a complex, challenging, and deeply personal issue for us all.
Since the Supreme Court of Canada rendered its unanimous decision in Carter last year, it has been discussed by many Canadians in different settings from coast to coast to coast. The issues continue to be debated and thoughtfully discussed worldwide, from the United States to Europe to Australia and New Zealand. Almost everywhere in the world, the act of ending one's life deliberately and the act of helping someone to end their life are serious crimes punishable by severe sentences.
Nevertheless, Canada is not alone in creating a legislative regime to permit medical assistance in dying. There are four American states, Oregon, Washington, Vermont, and California, the country of Colombia, and the three European countries of Belgium, the Netherlands, and Luxembourg that currently have legislative regimes that allow some form of medical assistance in dying.
These different international regimes share similarities, especially with regard to safeguards, oversight, and reporting, most of which are included in Bill C-14. These similarities are as follows: requests for medical assistance in dying must be in writing, made voluntarily by the patient, and in many cases witnessed by independent witnesses; a second opinion from an independent physician must be sought; and a delay or reflection period between the request and the actual provision of medical assistance in dying is required.
Colombia has a unique approval process for medical assistance in dying. It involves interdisciplinary committees within each hospital that assess requests and support patients and their families throughout the process.
In addition, almost all international regimes have mandatory oversight systems involving independent national or regional committees and government agencies or departments, which collect and process data in order to properly monitor medical assistance in dying. They make annual or biannual reports on medical assistance public in their respective jurisdictions. This evidence was critical to the Supreme Court of Canada's analysis in the Carter litigation.
Unlike the fairly consistent approaches, the safeguard and oversight that we see in other countries, the various laws take two different approaches with regard to both: one, the form of medical assistance in dying that is permitted; and, two, the medical circumstances under which it can legally be provided.
One could describe the different approaches with regard to eligibility and the form as being a spectrum. At one end of the spectrum stands the four American states that enacted the legislation, starting with Oregon in 1997, Washington in 2008, Vermont in 2013, and most recently California, just last year.
In these states, a mentally competent adult aged 18 years or older can obtain the assistance of a physician to die, only if their request is voluntary, and if they suffer from a terminal disease, which is defined as an incurable and irreversible disease that has been medically confirmed and will, within reasonable medical judgment, produce death within six months.
In the U.S. states, the physician is only permitted to provide the patient with a prescription for a substance that the patient must self-administer at a time of their choosing. This is commonly known as physician-assisted suicide.
What is commonly called euthanasia, where the physician administers an injection to the patient, is expressly prohibited in these states. Advance requests are also not allowed.
While these legislative measures in the U.S. accommodate individuals suffering from diseases that cause a steady, rapid, and predictable decline toward death, such as some forms of cancer, they do not accommodate other conditions, including some degenerative diseases that are enduring and predictable, nor do they enable patients who are physically unable to self-administer a substance to access a medically assisted death.
The Colombian regime, which was developed in response to two rulings from its Constitutional Court, has eligibility criteria similar to that of the U.S. states. It limits eligibility to adults who have a terminal illness, defined as a progressive and irreversible serious condition or pathology that will cause death within a relatively short time frame. It does not require the person to have a prognosis of six months, but it does require that death is expected in the short term. Unlike the American states, Colombia only permits a physician to administer a substance that causes a person's death. However, Colombia's regime does permit a patient to prepare an advance request for medically assisted death, which is not permitted in the U.S.
At the other end of the spectrum, there is Belgium, the Netherlands, and Luxembourg, known as the “Benelux” countries. In these three northern European countries, patients are eligible for medical assistance in dying if they have “intolerable” or “unbearable” physical or psychological suffering resulting from a serious and incurable medical condition where there is no prospect for improvement. Eligible individuals do not need to be dying or suffering from life-threatening conditions. Both physician-assisted suicide and what is commonly called voluntary euthanasia are permitted in these countries.
While advance requests are permitted, there are some differences between the Benelux states. In Belgium and Luxembourg, advance requests can only be carried out where the patient is in a state of irreversible unconsciousness, while in the Netherlands, advance requests are also permitted where patients are unable to express their wishes but are conscious, such as for persons with dementia or Alzheimer's.
While medical assistance in dying is only available to adults in Luxembourg, children as young as 12 years of age can request medical assistance in dying with their parents' consent in the Netherlands. In Belgium, adults and emancipated minors can request medical assistance in dying for the same kinds of conditions. In 2014, Belgium extended eligibility to minors of any age, but only where they are likely to die in the short term and where their suffering is physical. Additional safeguards must also be met.
The experience and lessons from the Benelux countries have been closely examined. For example, in the Netherlands, while the legislation permits advance requests for patients who have lost their ability to express their wishes, Dutch research suggests that physicians are generally unwilling to provide medical assistance in dying, due to the inability of these patients to comprehend their medical condition and their inability to express informed consent.
The government has sought to learn from the experiences of other jurisdictions. The proposed legislation is broader than the U.S. state approach, which only permits those with a fatal disease to access assistance. Instead, Bill C-14 provides the option of a peaceful death to everyone who is in decline toward the natural end of their life, not just those who suffer from fatal diseases or terminal illnesses. At the same time, it avoids some of the risks that the Benelux-style regimes might present, although such broader questions, and the experience of other regimes around the world, will continue to be studied.
I urge all members to support this incredibly important bill to answer the call of our Supreme Court to legislate in this area.
The House resumed consideration of the motion that Bill C-14, An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying), be read the third time and passed, and of the amendment.
Justin Trudeau LiberalPrime Minister
Mr. Speaker, Canadians understand that this is a big step in our society. It is one that must be taken responsibly and with full awareness of both the concerns around vulnerability and the need to defend Canadians' rights, freedoms, and choices. That is exactly what we put forward.
We understand that this is the beginning of a conversation that will go on for the coming years, as court cases, evidence, concerns, and doctors evolve in their thinking as we approach this.
However, this is a big step. It needs to be taken right, and that is exactly what Bill C-14 does.
Thomas Mulcair NDP Outremont, QC
Mr. Speaker, they waited until April before introducing their bill. We all agree on that.
After the Liberals refused calls from the NDP to refer Bill C-14 to the Supreme Court, the Alberta Court of Appeal called out the Liberals for pushing a bill that flies in the face of the Carter decision. Now the Ontario courts are raising concerns about whether the bill respects the Charter of Rights and Freedoms.
How many court decisions will it take before the Liberals finally admit they have made mistakes? Why would the Prime Minister prefer that suffering Canadians spend years in court fighting for their rights instead of getting his new law right the first time?
Justin Trudeau LiberalPrime Minister
Mr. Speaker, first, Bill C-14 does comply with the Charter of Rights and the Supreme Court's rulings. That is exactly what we have been maintaining for a long time now.
Second, as of June 6, Canadians will not have the framework provided by the Supreme Court while we work on this bill. That is why it is so important to ensure that we have a framework on June 6 that will protect the vulnerable, while safeguarding Canadians' rights and freedoms.
Thomas Mulcair NDP Outremont, QC
Mr. Speaker, once again, the government is refusing to work with the opposition to make Bill C-14 consistent with the Supreme Court decision and the Canadian Charter of Rights. The reality is that medical assistance in dying is currently possible under the Supreme Court's criteria.
Yesterday, a court granted a woman in Manitoba the right to seek medical assistance in dying. In the meantime, the government is insisting on limiting access to it.
Why is the government insisting on moving forward with this bill, knowing that it does not comply with the Charter of Rights?
Elizabeth May Green Saanich—Gulf Islands, BC
Madam Speaker, for both the Minister of Health and the Minister of Justice, with real sincerity, I know how difficult this has been. I think all Canadians are grateful for the care in the approach. However, that does not change the result right now, today, as I do not feel I can vote for Bill C-14.
It grieves me to say so, but I do not believe Bill C-14 is compliant with the Carter decision. I see this as a strange conflict in a sense between two professions in Canada: the legal community and the doctors. I know what the doctors want from Parliament, and I know what the legal community is telling us. As a trained lawyer, I do not see how Bill C-14 is compliant with Carter.
Because future judges will read these debates for guidance, how on earth could Kay Carter access medically assisted dying under Bill C-14?
Jane Philpott LiberalMinister of Health
Madam Speaker, I am going to be splitting my time with the member for Surrey Centre.
The topic we are addressing today is a solemn one. As a result, the past few weeks have been emotional for all parliamentarians, myself included, as we have wrestled with the matter of assisted dying.
The government had the responsibility to respond to the Supreme Court decision that was made in February 2015. I joined my colleagues in addressing that responsibility after we formed government in November 2015. Thus, in the very short time since forming government, there has been an incredible amount of work by officials and parliamentarians, with input from Canadians with a diverse range of views.
Before us today is a legislative framework that we believe is the right approach for Canada. It is transformative. It would forever change the range of options that Canadians would have as they approach the end of their life. I would like to reflect on the principles that make up the foundation of our government's legislative approach in developing the legislation that is before the House today.
First, it is about the principle of personal autonomy, in helping people to write their own story, in a sense, in providing Canadians with access to medical assistance in dying, for the Supreme Court made it clear to us that Canadians must have that access.
We have the responsibility to abide by the Charter of Rights and Freedoms, and we have the responsibility to put forth legislation that respects the decisions of the Supreme Court of Canada. This legislation before the House today, if passed, would do just that.
The legislation also respects the principle of the inherent value of life. It is written, therefore, with appropriate safeguards that would protect vulnerable individuals. It would also firmly uphold the conscience rights of health care providers.
Over the past several weeks and months, I have had conversations with members in this chamber from all sides of the House. The Minister of Justice and I have appeared at committees in the House and the Senate. I have personally had numerous meetings and phone calls with many interested advocates, in addition to the witnesses whom committees have heard on this particular legislation.
It is worth noting today that the professional bodies that represent health care providers are supportive of this legislative approach. These include the Canadian Medical Association, Canadian Nurses Association, Canadian Pharmacists Association, and HealthCareCan, which represents our nation's hospitals and academic health sciences centres.
Just today, parliamentarians received an open letter from 36 organizations representing the vulnerable, including the Canadian Association for Community Living, which has come out in support of this bill. Each organization may have continued areas of interest in which they wish to seek clarifications or undertake work with my department or with provinces and territories so that they can properly work with their members on implementing assistance in dying.
As I have said in the past, this is an iterative process. It is why not only would we study further potential areas of assisted dying within a short period of time, if the legislation passes, but there would also be a parliamentary review of this important legislation.
Let us discuss the matter of timing. The Supreme Court of Canada gave our government an extension to put a legislative framework in place by June 6. Before going further, allow me to say that I respect the roles and responsibilities everyone has here as parliamentarians, as well as the responsibilities that senators hold in the upper chamber.
There is a good reason for all of us to want to reflect upon and investigate this legislation in a thoughtful manner on behalf of Canadians. The reality is that we are facing a finite amount of time before there is a legal void, an absence of legislation to address the matter.
Despite what some may say, there are real and very serious challenges if there is no legislative framework in place. As I said yesterday, there is a real risk that there could be no law in place by June 6. It is important to underscore what is at stake.
First, organizations like the Canadian Medical Association and the Canadian Medical Protective Association have made it clear that they believe there is a vast majority of doctors who would not participate in assistance in dying without a legislative framework, despite the protections that some say the Carter decision provides.
Doctors are being advised by the appropriate associations to seek legal counsel before proceeding with any form of assisted dying, including consulting patients, and this would pose significant access issues and result in a situation where the Supreme Court's decision is not being realized.
Second, it would be illegal for any other health care providers to offer assistance in dying. That means that nurses, pharmacists, social workers, and other providers recognized by amendments passed at committee would face no legal protection. In particular, pharmacists who are needed to dispense medications required for medical assistance in dying require clarification.
Finally, there is the possibility that some could receive assistance in dying without a legislative framework in place, who would not otherwise have been eligible under the government's approach. This means, for example, the risk that someone facing severe depression could seek assistance in dying and that the safeguards to protect that individual would be inadequate or nonexistent.
I also want to remind members that medical assistance in dying is unlikely to be the choice for the vast majority of individuals at the end of life, and at its core our health care system is there to keep Canadians healthy. Canadians should have access to high-quality palliative care. This is something to which I have been, and will continue to be, committed to addressing with our provincial and territorial colleagues, along with the delivery of our government's platform commitment of $3 billion for home care.
Our government put forth this legislation that would transform end-of-life care options for Canadians. It is an approach that respects their rights under the charter, protects our most vulnerable, and considers the needs of health care providers.
I want to thank my fellow parliamentarians for their attention to the bill. Many of us are new to this role, and this is no small matter that we have been asked to address on behalf of the 36 million Canadians whom we represent. I thank them for engaging in the conversation with respect and dignity. I thank them for doing their utmost to consider the perspective of others, even if it differs greatly from their own. I thank them for the serious discourse we have undertaken in a situation where it is likely impossible to write legislation that would entirely satisfy every diverse view.
Recognizing our responsibility to implement legislation, I urge members to support Bill C-14 for today's final vote. I look forward to working with the Senate, if the House wishes to proceed to the next stage of our legislative process.
Frank Baylis Liberal Pierrefonds—Dollard, QC
Madam Speaker, there is a poem by the great Welsh poet, Dylan Thomas, entitled, Do Not Go Gentle Into That Good Night. It is a poem of a son calling out to his dying father to fight his imminent death, and it ends as follows:
And you, my father, there on the sad height,
Curse, bless, me now with your fierce tears, I pray.
Do not go gentle into that good night.
Rage, rage against the dying of the light.
He is imploring his father to fight to the very end, to rage against the dying of the light. I believe this stanza describes the very essence of western philosophy when it comes to dying. Simply put, do not accept death.
However, life is terminal. The very definition of life is to die. A rock does not live, because a rock does not die. A tree lives, because a tree dies. A person lives, because he or she dies. So, am I going to die?
This is the subject of an excellent Ted Talks by a first responder. It is about a paramedic who would often arrive at the scene of an accident only to find a victim whose injuries were so severe that he or she was not going to survive. These victims would inevitably look up to this paramedic and ask: “Am I going to die?” In those moments, he would always lie and say no. He did so because he thought that was the kind, caring thing to do. Then a few years ago, he arrived at the scene of a severe motorcycle accident to find a victim who again asked the same question. For some reason, he told the truth and said yes. The reaction was not what he expected. The victim showed calm, inner peace, wisdom, and acceptance. From that time forward, he always told the truth.
Dylan Thomas in his poem tells us “wise men at their end know dark is right”. Therefore, am I going to die? Yes. We are all going to die.
Now we find ourselves discussing an issue that is foreign to many of us. With Bill C-14, we are trying to determine when it is acceptable to accept to die. That is to say, when it is acceptable to go gentle into that good night. This is essentially what we are debating with this bill.
Some argue that the bill should follow the Supreme Court's ruling to the letter. Some argue that the bill should be broad to encompass all possible scenarios. Some argue that the bill should be narrow and restricted so as to protect the vulnerable. Some argue that there should be no bill at all, and we should not be on this path regardless of what the Supreme Court says.
Here in the House we have had great debate on this matter. It has been passionate, intelligent, and respectful. It has been the House of Parliament at its best. For example, the member for St. Albert—Edmonton, who was on the special joint committee that prepared the guiding report for this legislation, has spoken eloquently on why he believes this bill is missing certain key protections. On the other hand, the member for Victoria, who was also on the special joint committee, has expressed, in a thoughtful, intelligent manner, his strong belief that the bill is too restrictive in certain areas.
I have received numerous personal letters from many sides of this argument, letters from people who are suffering now and fear not being able to access this gentle path when their time comes. Other letters are from caregivers who look after the grievously sick, the aged, and the mentally incapacitated. They are deeply concerned that these vulnerable people will not be protected. My own father has written on this bill.
I was out meeting constituents a few weeks ago and a lady came up to me. She said that she really liked what my father had written in the newspaper. Now, people get confused at times, and I did not know about this, so I just thanked her. When I got home, I called my father and asked if he wrote something in the paper. He said, “Yes”. I asked to see it, if he could email it me. He said, “No, I've erased it”, because he does not like to keep clutter on his computer.
I asked him to explain the gist of what he said, and he went on to explain that the term “reasonably foreseeable natural death” was a difficult one, even for a physician. My father had suffered severe heart attacks 25 years ago and was told to put his affairs in order by his physician.
Here he was, using the example of his own life to say, “I am alive 25 years later.” He is alive because on a dark night 25 years ago, he chose to “rage against the dying of the light.”
None of these people are wrong. Everyone has an opinion, and everyone's opinion is valid. For each person, that destination, that moment in time when it is acceptable to accept death is different, and rightfully so.
If the destination is uncertain, how do we arrive at it? Cautiously. There is a concept in engineering called “overshoot”. Simply put, the faster one arrives at the destination, the more likely one is to overshoot it. For example, if someone is driving in a car toward a stop sign and if he or she is going very fast and slams on the brakes, the individual will shoot past the stop sign. On the other hand, if someone goes very slowly, it will take that individual a very long time to get to the stop sign and he or she may even stop short.
We have an uncertain destination that is different for each person. How do we get there? Cautiously. We go toward that destination slowly. This is precisely the approach that the Minister of Health and the Minister of Justice have decided to take.
With Bill C-14, we are moving forward to this destination slowly, and we accept that we may even stop short. The bill acknowledges this. It is explicitly written into the law that it will be re-examined in a few years' time, precisely to allow for adjustments.
This is a very wise approach, and I commend the Minister of Health and the Minister of Justice for the work they have done to bring us here.
In summary, we will all face our death. At that time, some of us will choose to fight death to bitter end. As a society, we already support that decision and we use the full weight of our medical system to help those people who choose to "rage against the dying of the light".
On the other hand, some of us will choose to accept death with inner peace and calm. As a society, we must now accept their decision and allow our medical system to help them. With this bill, we will help some of those people to "go gentle into that good night."
Luc Thériault Bloc Montcalm, QC
Madam Speaker, my Liberal colleagues are lavish in their praise of the minister. They think that the bill is perfect and will easily pass the test of the charter and the courts.
My question is simple. How does Bill C-14 guarantee a reasonable expectation of the right to life; liberty, by which I mean freedom of conscience in the sense of respecting autonomy; and security of the person, in the case of a person suffering from a grievous and irremediable illness, if the person has to go on a hunger strike to be eligible for medical assistance in dying and meet the reasonably foreseeable natural death criterion?
Francis Scarpaleggia Liberal Lac-Saint-Louis, QC
Madam Speaker, I will be sharing my time with my hon. colleague from Pierrefonds—Dollard.
In this postmodern world of ours, with its tendency at times toward a certain kind of what some might call libertarian relativism, we must continue to believe and affirm that there exist values that we can all agree are objectively good and worth protecting and promoting, values that should inform, motivate, and guide us both individually and collectively. Namely, we must subscribe to the imperative that we as human beings have a duty to support each other in our struggle in this fight for life, as some colleagues have put it, this struggle against the undeniable reality of our finite existence, our mortality. Every moment of life has value. This truth is to be asserted and upheld. This is the prevailing consensus, one that has become deeply rooted and entrenched in society over the course of history. It is also our best instinct. Many of my constituents fear that Bill C-14 would undermine this consensus, this instinct. I understand this fear.
We cannot allow ourselves to fall into indifference, to be quietly seduced by the facile notion found in the well-worn phrase “to each his own”, whereby we agree on everyone's right to choose, but beyond that we do not think it our business to provide reinforcement for the desirable and good choice. When I hear anyone appear to frame the debate on medical assistance in dying as one of pure libertarian choice, I must admit that a little part of me shudders.
After much reflection, I do not believe that Bill C-14 would necessarily lead us down a path to an increasingly permissive and contagious attitude toward self-directed death.
I would like to quote bioethicist Margaret Somerville, someone generally identified as a philosophical conservative on bioethical matters, someone who has written on the dangers of legalized doctor-assisted death:
The bill would legislate these actions as an "exemption" from—an exception to—prosecution for the Criminal Code offences of culpable homicide and assisted suicide that would otherwise be committed. Treating medically assisted dying as an exception will help to ensure, as is essential, that it does not become part of the norm for how Canadians die;
In other words, Bill C-14 would not normalize medically assisted dying as perhaps has occurred in Belgium and the Netherlands, the two most often cited examples of the slippery slope.
Dr. Sommerville goes on to say that:
Recognizing medically assisted dying as an exception also helps to establish that access to it is not a right but rather, under certain conditions, an immunity from prosecution for a criminal offence....
This approach, she further states, “carries an important anti-suicide public health message.”
I would add that the government has taken care to emphasize this message in the bill's preamble, which acknowledges that “suicide is a significant public health issue that can have lasting and harmful effects on individuals, families and communities”.
I am not a doctor who deals with life and death on a daily basis and I have never been at death's door.
Like every one of us here, I am an elected member trying to make the best possible decision in the context of the undeniable reality that the Supreme Court made a unanimous decision in the heart-rending Carter case.
The court's decision requires Parliament to create a new legal framework to regulate a specific aspect of end of life. If we fail to do our jobs now, the result will be a partial legal and regulatory vacuum. To quote the Ontario Hospital Association, if the bill is not passed by June 6, “Assisted dying would be lawful where it is provided in accordance with the parameters established by the Court and provincial regulatory bodies.”
The parameters set out by the court are fairly general. The court did not offer precise prescriptions for what an operative medical assistance in dying framework should look like. It is not the role of the courts to be so prescriptive.
This is not to say that I do not have concerns in voting for this legislation. Absent a Supreme Court ruling, and had the issue been raised once again through a private member's bill, I would very likely not have voted for medical assistance in dying. I have already, in the past, voted against a private member's bill on doctor-assisted suicide.
However, we do have a Supreme Court decision that creates a requirement to act. The Prime Minister and the Minister of Justice and the Minister of Health have, in my view, acted wisely in taking a cautious approach to the issue, notwithstanding the excellent work of the special joint committee under the capable and intelligent stewardship of my friend and colleague the member for Don Valley West.
The bill may not be perfect, but I believe it would be a mistake to suggest that it leaves a wide-open field in medically assisted dying, a fear expressed to me by many thoughtful constituents committed in the highest degree to the protection of human life.
Bill C-14 would establish numerous criteria to be met before access to medically assisted dying could be granted. In addition to being 18 years of age, the person must have a grievous and irremediable medical condition that meets four distinct criteria: the illness, disease, or disability must be serious and incurable; the individual must be in an advanced state of irreversible decline; moreover, the illness must be causing enduring physical or psychological suffering that is intolerable; and natural death must be said to be reasonably foreseeable. In addition, the person must make a voluntary request that is free from external pressure and that is the result of informed consent.
The bill also includes a number of safeguards, and the individual must make a request in writing or through another reliable means. If the request is being signed by a proxy, that proxy must be at least 18 years of age and understand the nature of the request. The request must be made after the person has been informed that his or her natural death has become reasonably foreseeable.
The request must be signed and dated before two independent witnesses, and in turn, these witnesses must not consciously be beneficiaries, financial or in any other material way, of the individual making the request, and they must not be directly involved in providing personal care to the person making the request.
Two medical practitioners must provide a written opinion confirming that the person meets the eligibility criteria, and these medical practitioners must be independent. For example, one cannot be a supervisor of the other or a mentor of the other.
Crucially, the person must be informed that he or she has an opportunity to withdraw the request at any time.
All of this said, I am not at all convinced that medical assistance in dying is a serene and dignified phenomenon, even if often depicted in this way. I suspect that complications may arise. This is why it is crucial and to the government's credit that the bill allows for monitoring of medical assistance in dying through detailed reporting.
A few years ago, a handful of parliamentarians, including the members for Kitchener—Conestoga and Carlton Trail—Eagle Creek, the former members for Newmarket—Aurora, Guelph, and Windsor—Tecumseh, and myself, wondered about enhancing and improving palliative care in Canada.
We founded the committee on compassionate and palliative care and produced a report. The silver lining in this debate is that palliative care is receiving a degree of attention never before seen in this chamber or in national discourse at large.
It is my sincere hope that, once quality palliative care of the kind provided by the West Island Palliative Care Residence is available through appropriate federal and provincial funding to all Canadians approaching death, this legislation will become somewhat of a relic, and medical assistance in dying will no longer be considered the default option in relieving end of life pain and suffering.
In this regard, I am heartened that, in addition to the government's existing commitment to do more to fund palliative care, the bill makes specific reference to this commitment. The advent of universally available quality palliative care will hopefully one day be seen as the high-water mark in the measure of a truly just society.