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.

Notice of time allocation motion

[Some hon. members]

Agreed.

[The Deputy Speaker, Bruce Stanton]

The House has heard the terms of the motion. Is it the pleasure of the House to adopt the motion?

[Some hon. members]

Agreed.

[The Deputy Speaker, Bruce Stanton]

(Motion agreed to)

[The Deputy Speaker, Bruce Stanton]

It being 5:37 p.m., the House will now proceed to the consideration of private members' business as listed on today's Order Paper.

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 second time and referred to a committee, and of the motion that this question be now put.

Criminal Code

[Dean Allison, Conservative, Niagara West, ON]

Mr. Speaker, before I get started, I want to congratulate my colleagues who sat on the Special Joint Committee on Physician-Assisted Dying. When legislation like this comes before us, we always sit long hours. I certainly want to thank the members of the Conservative Party for the dissenting report. It was great to see that at least some of those ideas were worked upon in the legislation.

This House finds itself in a position where we must pass an effective regulatory framework to make way for medically assisted suicide. I am rising today to help ensure that this new framework respects the charter rights of physicians and patients alike.

It is my fear that the proposals put forward by the government in an attempt to bring our laws in line with the charter may in fact do the opposite. I believe there is a potential to break with the charter by not effectively protecting the rights of physicians to practise according to their freedom of religion and conscience.

Additionally, I fear that the government's promise to revisit this legislation in a few years simply gives it an opportunity to further expand it.

As a member of the opposition party, I feel compelled to warn the House of what I fear might happen if the bill is passed in its current form. I believe that decisions such as this can inevitably lead down a slippery slope.

While the government has chosen to forego many of the more contentious recommendations made by the joint special committee, Liberal and NDP members of that committee clearly felt confident in the recommendations. This leads me to believe that, in time, this law will be expanded even further to include those measures.

The Supreme Court was quite clear in its ruling. Access to assisted suicide was to be limited to a “competent adult” person who “clearly consents to the termination of life” and has “a grievous and irremediable medical condition (including an illness, disease or disability) that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition.”

I am happy to see that the government has listened to some of the recommendations made by my hon. colleagues in their dissenting report. In that report, they referenced a system currently used in Quebec, where only patients aged 18 and older with severe incurable physical illnesses, and whose medical condition is characterized by an advanced and irreversible decline, can request medical help to die.

Furthermore, in Quebec, the attending physician must ensure that his or her patient has clearly consented to physician-assisted suicide, ensuring, among other things, that it was not the result of external pressure, while also providing the patient with a full prognosis on the condition and possible treatment options along with the likely consequences.

Quebec physicians are free to act according to their conscience. If they do not want to proceed, they must refer the patient to an independent body which will contact another physician. Two independent physicians must confirm that the patient meets all of the criteria prescribed by the legislation.

Keeping in mind the Quebec system and considering the irreversibility of assisted suicide, we must acknowledge that the realities of this practice as a form of treatment permanently ends a human life. As such, we must exercise great caution to ensure that there are effective safeguards against any abuse of the system.

I understand that the Minister of Health has said that physicians cannot be prosecuted under the bill for failing to comply with a patient's desire to end their life. The absence of any specific mention of this in the legislation that was brought forward is troubling. Without a specific reference to the rights of physicians to act according to their conscience, I believe it will not be long before doctors are facing lawsuits for failure to comply with a patient who wishes to die.

Again, while I am glad to see the government has decided not to include certain recommendations that the committee made, I feel it is necessary that I voice my objections to them before the government decides to add them at a future date.

I am doing this because my constituents are very concerned about this issue. I have received dozens of letters and calls from people in my riding, and they all want me to warn of the consequences that opening this door may bring.

I will touch on some of the most at-risk parts of society as far as assisted suicide is concerned, namely the young, the elderly, and those who suffer from mental illness.

In the preamble to the bill, the government said that it would leave the door open for non-legislative measures involving requests for assisted suicide from “mature minors, advance requests and requests where mental illness is the sole underlying medical condition”. This is where I take the most issue with this bill.

What the Liberals call “mature minors” are people who are not allowed to buy alcohol or vote, and people who are subject to a different set of criminal standards than adults.

The Government of Canada, for many decades, has been of the opinion that while all citizens are entitled to their constitutional rights, there are what we call reasonable limits on certain rights. What I mean by this is that the rights of an individual stop when they directly conflict with the rights of another individual. Therefore, there is no primacy of one constitutional right over another.

Now that the right to assisted suicide has been added to that list, I believe it should not now or in the future be made available to minors. When setting the voting age or creating the Youth Criminal Justice Act, governments create a different system for people who are not yet adults. The rationale for these differences comes from the medically accepted fact that the human brain is not fully developed until around the age of 18.

With respect to the possibility of providing assisted suicide to requests where mental illness is the sole underlying medical condition, I have two points. First, the Supreme Court did not mention mental illness in its ruling. Second, the court said that individuals seeking assisted suicide must be fully competent.

To that point, I would ask the government this. When a predisposition toward suicide is often a side effect of mental illness, how are doctors supposed to decide when the decision to die is the true wish of the patient or merely the effect of their condition? Is this a decision that we really want to force upon our doctors?

Another group of individuals that I fear may be exploited as part of this system are the elderly. Elder abuse is already a well-known problem in Canada and, no matter what actions the government takes, it is difficult to stop it entirely. The inevitable consequences of access to assisted suicide is that the elderly are put at risk of being exploited.

In jurisdictions where assisted suicide is legal, there have been cases of elderly people seeking the service because they feel they have become a burden to their family or to society. There have been even worse examples, such as situations where the elderly person's own family has pressured him or her into seeking assisted suicide. We cannot allow this to become a feature of the system.

What we do need to do is to help our elderly folks, providing them with a better system of palliative care.

During last year's election, the Liberals promised to invest $3 billion on new palliative care. However, when the budget was released, there was nothing. I know that a number of my colleagues have raised this in other speeches, so I will not get into it in any greater detail. However, this is part of a broad theme of the Liberals breaking campaign promises during their high-spending agenda in many other areas.

Earlier, I spoke of my fears that the rights of doctors to operate according to their own conscience and religious convictions may be supplanted with this new right that the Supreme Court has granted.

I have seen arguments from people who say that doctors should have no right to deny such treatment, especially if they are working in isolated areas. To those people, I would say that we all have constitutionally protected rights, and one of those rights is that of the individual to practise their religion unhindered by the government. Each major religion in Canada disapproves of suicide in one way or another. Many of our doctors subscribe to and conduct themselves according to these religious beliefs. We cannot allow the rights of assisted suicide to replace the rights to practise one's religion or to follow one's conscience.

I want to add that I have had a number of religious nursing homes in my riding, Grimsby, Vineland, United Mennonite, saying, “What happens if the doctors refuse? Does it now fall on us, as an institution, to try to carry out their wills?”

These are some of the things that I think need further discussion.

We, as parliamentarians, must ensure that the proper safeguards are in place to prevent exploitation of the system. That is why I join with my colleagues on this side of the aisle in cautioning against moving too fast and too far on this issue.

Our goal, first and foremost, should not be to extend assisted suicide to patients, but to protect patients from it. By this, I mean a strong regulatory regime is required, one that would ensure that only those with incurable diseases and unconscionable suffering are granted access to this treatment.

We cannot make this a common form of treatment. It must be the absolute last resort.

This is by far the number one reason that my constituents have written to my office in recent days. I tell them what I am saying right now.

We cannot allow this system to become the norm. We must ensure that the first priority of this legislation is to protect human life. We cannot allow minors, whether mature or not, access to a system that ensures they have no future. We need to partner with the provinces and tackle mental illness rather than making suicide a more valid alternative. We also need to further the partnership to support palliative care.

I know that I am very fortunate. In Grimsby, we have the McNally House Hospice, which is well sponsored and well looked after in the community. I know in the greater region of Niagara that we have a number of facilities that people support in a big way. They give access to late-in-life care to more elderly members of society, therefore reducing the risk of elder abuse. I believe that is very important, and I realize that is not what every community has in this country.

We must, above all else, treat this issue with the same care that we would expect our doctors to provide to us.

[Nathan Cullen, NDP, Skeena—Bulkley Valley, BC]

Mr. Speaker, this process did not start well. The work was done in Quebec for many months and years in advancing this conversation forward. There seems to be some reluctance in the country to talk about end of life. It is not a comfortable conversation for many Canadians. It is not one that often happens even within families to a proper level before that time comes. We all wrestle and grapple with these issues.

Once the Supreme Court decision came down, we joined with the then Liberals in opposition to suggest that a special committee be struck. The then government voted against that and wasted many precious months in hearing from an even broader spectrum of Canadians than we were able to since the last federal election. However, that all happened and now we are here.

The member mentioned something about the conscientious objectors. This is my question. We note that it is in the preamble of the bill, but not in the structure of the bill itself. There are those in the medical profession who, for whatever reasons, be they religious or personal beliefs, do not wish to practise physician-assisted death. Yet it does not appear in the text of the bill itself. For those who have been around Parliament a bit, they know there is a difference between those two things in terms of its strength.

Having read both the committee's report and the dissenting report, could my friend comment as to why the government did not include such an important measure within the very heart of this legislation that would affect so many?

[Dean Allison, Conservative, Niagara West, ON]

Mr. Speaker, that was one of the concerns I heard the most in my office. I mentioned earlier in my speech that caregivers approached me in my office from various religious nursing homes and nursing facilities, which obviously have a very conscientious view of life and how important it is to them. One concern they had was that in smaller communities, there may not be many doctors or people may not have as many options, maybe not even palliative care, for that matter. If a doctor did not want to perform that service, what would happen? Would it mean that the responsibility would go back to the nursing home or care facility? That is a concern.

To maybe echo the question back to the member, that is one of the things we need to strengthen. We need to ensure it is not just in the preamble but in the actual legislation, so there can be protection for those with conscience and want to act according to their faiths.

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

Mr. Speaker, I thank my colleague for his good work on this and also for his partnership with institutions in his riding that provide excellent care for many vulnerable Canadians, especially those facing end-of-life situations in hospices and nursing homes.

My question is related to the protection of the vulnerable groups among us, for example, those people who may have some underlying psychological issues and may not have the capacity to make decisions. The legislation has in it the need for two independent witnesses and two independent doctors. That is a big improvement over what we thought might come from the committee report. Yet there is no regime in place to ensure that those two supposed independent witnesses and doctors are actually independent.

Would my colleague support an amendment that would include some type of prior review, which would mandate either a judicial or a tribunal review to ensure that the assertions being made were actually factual?

[Dean Allison, Conservative, Niagara West, ON]

Mr. Speaker, I want to again thank the member for Kitchener—Conestoga for his excellent work on the committee.

I would certainly support that. One thing that concerns me is how far the report actually went. While I appreciate where the government legislation landed and that it is not perfect, my concern is what will happen in the future as we look to review these kinds of things. What happens then? Do we push it further?

We have seen before that if we do not clearly articulate the legislation, it becomes very easy to push the limit, to move around the edges, and then say we thought it meant something else or maybe we could go in a direction that was not originally intended by the people who were there at the time.

I, by all means, would support a notion like that.

[Nathan Cullen, NDP, Skeena—Bulkley Valley, BC]

Mr. Speaker, I often say it is a pleasure for me to rise, because it is such an incredible honour to even stand in the House of Commons and attempt, in our own ways, to try to represent the great group of Canadians from our territories. Yet, as I approached Parliament this evening, thinking about this particular debate, I found myself struggling to use the word “pleasure”. It is simply because this debate strikes at the very heart of some of the most difficult questions we face as legislators, that we face as Canadians, that we face as friends and family of those who have faced the incredible difficulty of end of life.

There has been a certain amount of trepidation and perhaps fear from many of us in this place to talk about end of life, end-of-life care, the palliative care question, and to talk about end of life and the issue of medical assistance in dying, physician-assisted suicide.

I suppose there are some things required of us all in this debate. One is to fully appreciate and understand that great sense of responsibility and to bring to this conversation as much humility as we can muster. For some of us in elected office, humility is not always at the ready and available. It is also perhaps to bring the best wisdom we can from those who know a great deal more about this subject than we might.

Oftentimes we say that we have to separate the personal from the political, that we as legislators have to act purely in the best means and understanding that we have about the law and how we wish to craft the law in a way that is defensible at the Supreme Court and representative of our constituents. Yet, this debate brings those two things together for many of us.

This is incredibly personal for any who have stood in the House and spoken to this bill, or who will, if one reflects back on any experiences we have had with family members facing those challenges at end of life.

The Supreme Court of Canada ruled unanimously and gave Parliament a timeline to work toward creating legislation. It struck down the laws in Canada as it saw them. Many of those judges were appointed by the previous Conservative government.

What concerns me in what we see before us today is the government, as we often hear, has attempted to strike a balance. It has attempted to seek a perfect middle ground on such a contentious issue. While I admit that is a very difficult thing to do on legislation on an issue like this, we raised a number of concerns at the special committee.

We continue to raise those concerns, even though the New Democrats support getting this bill to the committee stage so we can hear from those witnesses who now have seen the final legislation. We need to understand whether it is constitutional, whether it is helpful, and whether it will actually achieve what the Supreme Court and Canadians have asked us to do.

I mentioned in the past that it was with regret that after the Supreme Court came down with a very clear directive to Parliament to form a new law, to create new rules for our country, the previous government was unwilling or unable, for whatever reasons, to begin that work at all. We sought to pass a motion in the House of Commons to start the committee process, to bring the witnesses in so we could hear from them, but we were also six to seven months out from an election. The government seemed to not want to really talk about it.

The government struck some process that has since not borne any fruit, and now we are under the proverbial legislative gun. We are sitting late. The committee has worked incredibly hard. I want to thank all members, Conservative, Liberal, and New Democrats alike, who worked tirelessly to bring us incredibly important recommendations, some which made it into this bill, some which did not.

I know the Liberal co-chair of the committee has expressed his disappointment on some of these important issues. Yet, we face this time crunch, somewhat of Parliament's own manufacturing, unfortunately. While the process has been hard worked at, it perhaps will need some revising as the bill moves forward.

Let me take some specific moments and some concerns that we raised. The protection of medical practitioners, while it appears in what is called the preamble of the bill, in the aspirations of the bill, it does not appear in the actual heart of the legislation, it does not appear in the law. For those in the medical services community who have sincere religious, heartfelt beliefs that prevent them from assisting someone with end-of-life procedures, we need to have the most complete protection for those health care professionals.

I come from northern British Columbia. This is an absolutely contentious issue. Faith leaders from a broad set of denominations and those working within the medical profession, who are incredibly dedicated and gifted medical service providers, have come forward with serious concerns. I am not able to allay their concerns with what I see in this legislation.

We helped unanimously pass a motion from the member for Timmins—James Bay to finally have a national palliative care strategy. It is the other side of this coin. While there is the incredibly important issue of what happens at that moment of end of life, for all the moments leading up to that, what kind of care do we offer those who are passing from this life? What kind of honour, respect and love do we offer them through our medical system, through this great Canadian public medical system?

For so many years, governments have spoken the words. They have said that palliative care is important. They have said that they care for our seniors, for our elders, and for our sick, yet we see nothing for this in budget after budget. We do not see the ability to lift up that burden together and provide that palliative care. In some senses, Bill C-14 would be an opportunity to enshrine at least into law the requirement for the country to finally have a national palliative care strategy. It is disappointing that it is only referenced as opposed to being brought in with full weight and structure.

I was also disappointed because the committee worked so hard. As a New Democrat, it is difficult for me to credit a joint Senate House of Commons committee. However, I know those good senators came to this process with an open mind. They worked very diligently and came up with a series of recommendations for the government over a number of the issues, and they were simply ignored.

That brings me to another concern. Legal and medical experts told us that even Ms. Carter would not actually qualify for assistance under this bill. She brought this case to the Supreme Court. She suffered so much. Her family went through hell trying to achieve the services they desired and had to go all the way to the Supreme Court. It finally won that arduous process.

Rather than get that perfect place where the government has sought to balance the competing interests over such a sensitive topic, my concern is that the government has muddled it entirely and invited future challenges in court. We have also heard from some of the lawyers who presented in front of the court. They said that this legislation would be challenged almost immediately. Therefore, what have we just gone through?

The committee met many hours and heard from dozens of witnesses. We looked at the very clear ruling from the Supreme Court. Then we came out the other end with something in the middle that offered neither side any great solace, if there are just two sides in this debate. We have heard from a number of the groups that have worked tirelessly on this issue, for decades in some cases, of their disappointment and dissatisfaction. Happily, the way the process works in our Parliament, the bill can go and be remedied.

This is the true test for the new government. This is its first constitutional legislation. This is the first time it must meet the challenge of the charter in legislation. Will it meet that challenge with the humility, courage, and intelligence that is required to do the right thing, not just the right thing by the courts, but the right thing by Canadians who are desperately seeking the ability to end their life on their terms when they are suffering so greatly? For us, to stand in judgment of them and their families, for us to say we will decree, under more and more narrow definitions, who can actually access this service seems dangerous to me. It seems hubris and unintelligent. This is simply because we invite years more of litigation in the courts and years more of uncertainty and suffering by those very families that are already suffering with a family member whose life is coming to an end in such terrible conditions.

I want to congratulate again the members who served, particularly the member for Victoria, who brought his legal wisdom and his compassion to this conversation, as well as the member for Timmins—James Bay, who first and most importantly raised this issue of palliative care and the need for that strategy. To all members of the House, we must find our convictions, find our courage, do the right thing, and do what is necessary both legally and morally.

[Pierre-Luc Dusseault, NDP, Sherbrooke, QC]

Mr. Speaker, I would like to commend my colleague on his speech.

In it, he referred to palliative care. If hospitals and health care facilities offered quality palliative care, that would also affect the quality of life of people who are dying. What does he think about that? Would palliative care not also be an appropriate way to ensure that everyone can die with dignity? How important is palliative care in the health care system?

[Nathan Cullen, NDP, Skeena—Bulkley Valley, BC]

Mr. Speaker, I would like to thank my dear colleague for his question.

When it comes to palliative care, studies all show the same thing. Quebec is setting an example for the entire country, not only with regard to the end-of-life issue, but also with regard to palliative care.

We asked the Liberal government what its plan was and where the money was. It is difficult to provide high-quality care without money.

The questions refer to a void that exists. They look at only one side, not both sides. What are we going to do for Canadians? What is the government going to do for people who want palliative care for themselves or a family member?

I find that sad, but it is also an opportunity to build something that is strong, direct, and clear, to develop a national strategy that will give us a strong and ethical palliative care system.

[Dianne Lynn Watts, Conservative, South Surrey—White Rock, BC]

Mr. Speaker, I appreciated my colleague bringing forward a number of the issues he outlined. I am wondering if he feels that had there been more time given by the courts, some of these issues could have been addressed and the legislation could have been more robust.