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

[Arnold Viersen, Conservative, Peace River—Westlock, AB]

Madam Speaker, the member failed to recognize that the point I was trying to make is that language matters and the specific terms we use matter. She suggested that there are two different aspects to this law that we are addressing, and I will admit, I only went after the one, assisted suicide. The other term that is referenced in the law is euthanasia. I did not bring that up nearly as often. Those are the two terms she referenced. Even in the definition within the law, neither of those terms come up. It was either self-administered or a dosage administered by a health care professional.

The point of my speech was to ask, in 20 years, where has the discussion gone? We have moved along and the language has changed.

I address schools in my riding. I have been participating in a group called CIVIX. They set up something that they call meet your local elected official. When I address schools, I say that in the past when a person got up on a bridge, we told the person to come down because the individual's life had value, and now we are saying we can give them a push.

[Earl Dreeshen, Conservative, Red Deer—Mountain View, AB]

Madam Speaker, I have heard Liberals talk about some of the money that they may put into palliative care and that it is a commitment. When I spoke earlier, that was a concern I had. When one looks at the budget, one recognizes the fact that beyond the 6% escalator established by the Conservative government, the increases under the 3% for 2016-17 is 2.8%.

Therefore, when it comes to a commitment of dollars going to the provinces in order to ensure our health care system can handle things, what kind of faith does the member have in the government being able to put together a palliative care regime that would benefit Canadians?

[Arnold Viersen, Conservative, Peace River—Westlock, AB]

Madam Speaker, my colleague has asked me what my confidence is in the government addressing palliative care. I can look at the bill and see the lack of confidence that I have, because it has not been addressed in the budget and this bill was also an opportunity to perhaps showcase that one balances out the other. Palliative care has not been addressed in this bill or in the budget.

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

Madam Speaker, I am very pleased to be taking part in tonight's debate, and I would like to thank everyone for participating. The debate we are having today and will continue to have in the coming days and weeks is an important one. We need to find a solution before the deadline that the Supreme Court of Canada gave us. We got an extension so that we could get the job done in a limited period of time.

I would like to review the reasons why we are debating this issue. I think it is important to put the debate in context. We are having this debate tonight because of a Supreme Court of Canada ruling that directed Parliament to consider the matter and propose a legislative solution.

In its decision, the Supreme Court of Canada clearly struck down two Criminal Code provisions. Now it is up to us, as responsible parliamentarians, to fill the legal void that will take effect on June 6, 2016. This discussion predates the Supreme Court of Canada's decision. Rulings by lower courts led to the Supreme Court of Canada's final ruling. That is why we are here to talk about this.

It started when Ms. Carter, who is familiar to us all, and a number of other people went to the B.C. Supreme Court because they wanted the Criminal Code provisions that, until now, prevented people from aiding someone to take their own life struck down. That is what started the debate, and it ended with the Supreme Court of Canada ruling.

I would like to read a few excerpts from the ruling that indicate what our mandate as parliamentarians is. The Carter decision is historic. The first aspect that makes this decision historic is that the Supreme Court of Canada recognized that the B.C. court had the right to rule against the jurisprudence from the Rodriguez case. The trial judge decided to change the jurisprudence, because her ruling contradicted the ruling from a previous case. The trial judge's ruling also contradicted a Supreme Court of Canada ruling. Frankly, that was one of the important topics of discussion that came from this court case. Did the judge have the right to reverse the jurisprudence that had been valid until that point? It is a contentious issue. The fact that the Supreme Court of Canada validated the interpretation of the trial judge was historic. The changes that have taken place in the social context, in our society, are what allowed her to change the jurisprudence. The Supreme Court of Canada upheld the decision. It was also historic because it recognized that the right to life also includes the right to end one's life. It was the first time we had such an interpretation.

I will now quote an excerpt from the Supreme Court of Canada decision:

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

Later it states:

The prohibition on physician-assisted dying infringes the right to life, liberty and security of the person in a manner that is not in accordance with the principles of fundamental justice.

When I read these excerpts from the summary, I was surprised by the interpretation. I agreed with this interpretation, but I have to admit that, reading it for the first time, it was a surprise. That is why my colleague spoke about irony. Nevertheless, it is quite true that the right to life also includes the right to dispose of it.

I remember very well the moment when the decision was handed down on February 6, 2015. It was a Friday afternoon and I was in my riding office. The first thing I did was read the document. I was very interested in constitutional law, but also in this timely topic and the societal debate.

Quebec had a similar debate over the course of several years. I was curious to see what the Supreme Court would say. I was especially intrigued by the mandate given to us in its decision, namely to draft new legislation so that the right recognized by the Supreme Court would be granted to Canadians.

However, I was disappointed that the discussion did not get underway in the ensuing days. I was expecting it to happen quickly, but there were delays. I do not understand why, because it was a historic and unanimous Supreme Court decision. This decision directly involved parliamentarians, but it took a long time before things were put in place. We spoke out against that.

True, some work was done by experts. However, once again, it took too long. It is important to point out this foot-dragging. As a parliamentarian, I was disappointed that it was not the first item on the government's agenda when we returned to this place. The government quite simply did not want to talk about it. Yes, it did appoint a panel, but it quite simply refused to talk about the issue. I found that deplorable.

Now we are faced with a fait accompli, if I can put it that way. The Supreme Court decision requires us to make this service accessible because it is a constitutional right. As responsible parliamentarians, we cannot stand idly by. The Supreme Court gave us the mandate to ensure that this new constitutional right is accessible and given to Canadians.

As parliamentarians, we cannot just say that this is a constitutional right that every Canadian is entitled to and then turn around and restrict access to this service as much as possible. We should do the opposite.

It is important to understand the essence of the Supreme Court decision, that the right to medical assistance in dying is a constitutional right protected under the charter. As parliamentarians, we have no reason not to make this service accessible to everyone. I urge all my colleagues to support this bill in order to send it to committee and possibly improve it, so as to ensure that it respects the Supreme Court decision.

The last thing we want is to have more legal cases or more delays for those who might want to access this service quickly.

[Todd Doherty, Conservative, Cariboo—Prince George, BC]

Madam Speaker, I would say that my hon. colleague from Sherbrooke absolutely got it right. Over a year ago the Supreme Court rendered a decision and our Conservative government felt it was necessary that we took the time to get it right for Canadians. The gravity of the bill is such that we need to make sure we get it right.

The Liberal government has vacillated since October 20. The Liberals said that they want to get it right. They put great emphasis on this, yet this has only come to the House in the last two days. They have limited discussion. They have limited the witnesses.

This bill will be going to committee. Does the member believe there will be fair and open consultations when we have already seen, with the government's closure motion earlier today, that they are limiting debate and muzzling witnesses? Does he think we will get that fair and honest consultation at committee?

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

Madam Speaker, I thank my colleague for the question.

I agree that we have to do this right. One thing we can do is invite witnesses and experts to come talk to us about this bill. Preliminary work was done by an all-party committee that discussed the issue in general and the possible avenues we might consider.

Now we are talking about very different committee work because we have a bill and its clauses. It is tangible. This is extremely important work and experts should have a say on it. In committee we have already started hearing from experts who raised significant concerns about the bill. They fear that it is not consistent with the Supreme Court decision.

This is dangerous, because if we want to craft this bill properly, as I mentioned earlier, the last thing we want is to be tangled in legal challenges for years. If we want to do things properly, we need to listen to the experts, the people who are testifying in committee, and invite as many experts as possible to testify. If we do our job properly, people will be satisfied and there will not be any legal challenges in the coming years.

[Robert Aubin, NDP, Trois-Rivières, QC]

Mr. Speaker, I thank my colleague from Sherbrooke for his participation in this discussion. I know that he reads bills clause by clause, in great detail.

My question has to do with the eligibility criteria. The wording in the first three criteria of the bill seems to address all of the elements set out in the Carter decision.

However, the Liberal Party felt that it was necessary, for unknown reasons, to add a fourth criterion regarding a reasonably foreseeable natural death. I must admit that I find this very nebulous. I wonder if my colleague has managed to understand the meaning of this fourth criterion.

No one will have access to medical assistance in dying if they do not meet the four criteria. The first three are relatively objective and easy to understand. However, the fourth criterion is a monumental disaster.

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

Mr. Speaker, I thank my colleague from Trois-Rivières, who is absolutely right in saying that we have to wonder about the definition used in the bill.

I have a hard time understanding why the people at the Department of Justice who drafted this bill decided on this and where they got their definition of “enduring and intolerable suffering because of a grievous and irremediable medical condition”. That was in the Supreme Court ruling, but the bill uses a different definition. It talks about reasonably foreseeable natural death.

I have a hard time understanding how the Minister of Justice can defend her bill and say that she will have no problem testing it against the Supreme Court and the Carter decision when she is not using the same terms.

At the very least, she should have used terms similar to those in Carter. That would have prevented yet more cases seeking to overturn the law.

[Daniel Blaikie, NDP, Elmwood—Transcona, MB]

Mr. Speaker, I want to start by saying I have had occasion to listen to much of the debate that has been going on and I want to note that for the most part it has been very civil and the tenor of the debate has been very good. It has lent itself to thoughtful consideration of what is a very challenging bill because it is a challenging issue. I have found listening to the debate helpful in terms of coming to some conclusions about this bill and about the wider issue.

We have heard a number of members refer to their personal experience, which is natural to do with issues like this. My own is somewhat inconclusive. I have had several people whom I have been close to go through longer dying processes where it was clear for a while that they were in decline and were not going to get better and were suffering severely. I would say that for me, the lessons coming out of some of those different experiences mitigate in different directions on this.

In some cases, I have seen situations that really exposed the value of making medical assistance in dying possible because of the great suffering of people who know that death is coming and would rather die with dignity and choose the circumstances of their death and be able to die surrounded by their family, and having said their good-byes. I have also seen situations that really emphasize the vulnerability of people who are in hospital and unable to advocate for themselves, and how important it is in those situations to have family members who can do that for them. As well, I have seen how important it is to have rules, especially in the case where medical assistance in dying is available, to ensure that people are not taken advantage of in that vulnerable state.

I have also seen in those cases, and in one in particular, the fact that even prior to the Supreme Court decision, decisions about death and dying were already being made in Canadian hospitals and there were conversations already being had by families. Right now or prior to the Supreme Court decision, those conversations were about when to stop providing treatment or when to begin starving someone, frankly, who is in hospital. It is important to note that the conversation was already happening prior to the decision. Now that the decision has been made, this conversation is going to happen in new ways regardless of the decision that is taken here, because the Supreme Court has said that medical assistance in dying is something that is going to be available to Canadians. What we are here to decide is the framework under which that is provided and the rules according to which that is provided. We really cannot stress that enough.

There are two distinct sets of considerations, as far as I am concerned, that would lend themselves to making a decision on this bill.

One set is what we could call the substantive considerations about what exactly those rules should be. When we try to set those, it is helpful to have an expression of the ultimate values that we want to see manifest in the legislation. I was searching for the words and, as it turns out, quite fittingly, in a submission to the Special Joint Committee on Physician-Assisted Dying by the moderator of the United Church, which is my church, I found that language. The submission incidentally was not a position statement by the United Church. There was at that time and, as far as I know, there is still no official position by the United Church. However, the moderator made the submission and quoted a former moderator of the United Church who said:

For Christians, life is a sacred gift from God and needs to be valued and protected. But we also know that both life and death are part of the whole created order. Life itself isn’t absolute. Nor certainly is death. To speak of the sanctity of life is to affirm God’s desire for abundance of life for all of creation. God is love, and the Christian affirmation is that God’s love is the only absolute. “In life, in death, in life beyond death, God is with us,” says our creed.

So the United Church’s theological tradition is not to suggest that believing in the sanctity of life means that any attempt to end life must be prevented. Instead, what we are called to do is first listen to the struggles of those who are facing hard decisions and to make sure that they are not alone in those decisions, and second, to trust people with difficult choices about their own lives.

I cannot help but agree that the best decision we can make and the best policy we can implement is one that empowers people to make those decisions in their own lives and to ensure they are not alone in doing that, that it is not something they cannot consult their family or their medical professionals about and have a conversation about the right way to go about making the kind of decision that they may well be inclined to make anyway. We have heard some of the stories of terrible suffering and incidents that occur when people are denied the right to do what they intend to do with their own life.

It should not be a policy that causes people to make those decisions because other services were inadequately available or because they were under undue pressure from family or medical professionals. The safeguards in the bill actually do a fairly good job of ensuring that people will not be subject to that kind of coercion.

I worry that the lack of provision for any kind of advance directive may put people in difficult situations where they are not able to have that conversation and where it may possibly lead either to premature death because they choose to do it while they still can or to prolong a needless suffering. I would support a cautious movement toward a limited form of advance directive, because I recognize that it is a thorny issue, and it is not obvious the best way to do that, and I think it opens up a can of worms.

I agree with the cautious spirit of the bill with respect to extending this decision to minors.

I share the concern expressed by others in this House that there is no protection for the right of conscientious objection for health professionals who do not want to engage in this practice. I would hope to see amendments to this bill at committee to bring that in.

The second set of considerations that I think are very important for us in this place as legislators is to recognize that no matter what Parliament does here, medical assistance in dying will be available. That is not a decision we are making here. That is a decision that has been made in the Supreme Court. We are here to talk about the conditions under which that service will be provided. It is crucial that the rules be the same across the country, that we have a federal framework that applies across the board, and that it does not become a hodgepodge of various regulations from province to province to province.

It is important that we give certainty to medical professionals who will inevitably be called upon to assist in certain deaths, that they know that their career will not be on the line or they will not be risking going to jail if they go ahead and engage in this. That is why it is important to make amendments to the Criminal Code to give them that certainty, and this is the place to do that.

It is important as legislators that we also strive to honour the spirit of the Supreme Court decision, and that we head off needless legal challenges. We heard in this place that whatever happens, there will be challenges. However, I think there are some obvious ones. Adding language that was not in the Supreme Court decision, like the language of a “natural foreseeable death”, would preclude one of the very same women who pursued the right to medical assistance in dying in the Supreme Court. I think it is an obvious basis for challenge. It would be a mistake to send this bill out of this place if the service could not be provided to the person who the Supreme Court determined had a right to it.

In the last few moments that I have for debate, I want to say that those are the considerations that bear on this bill. However, this is happening in Canada no matter what, and we need to make sure that palliative care and other long-term care solutions are available to Canadians so that this is not a first option, a second option, or a third option, but it really is an option that comes after all other reasonable options have been explored, and that people have the support and the resources to access all of those options.

With that said, I will put on the record that I will be voting for this bill at second reading, and those are my reasons why.

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

Mr. Speaker, I think the member for Elmwood—Transcona recognizes the value of what the Supreme Court of Canada has said. The nine judges came in with a unanimous decision, indicating that we needed to come up with legislation. We look forward to it heading to the committee stage.

I want to provide a brief comment, because we hear a lot about palliative care. This government, the Prime Minister, is deeply committed to this.

For those who come from the province of Manitoba, as I do, we talk about Riverview and some of the fabulous work that many of those health care professionals provide for us in palliative care.

We recognize the importance of Ottawa working with the provinces, demonstrating leadership, and taking the initiative in ensuring that we have palliative care going forward. However, we need to get the provinces and territories engaged in the discussion. I know the member's father both as a federal MP and as a Manitoba MLA. I am sure he would agree that we need to get a higher sense of co-operation between the different levels of government in order to provide the type of palliative care that Canadians want and deserve.

Would the member not agree that Ottawa does need to continue to develop those relationships to provide quality palliative care into the future?

[Daniel Blaikie, NDP, Elmwood—Transcona, MB]

Mr. Speaker, obviously it is the case that if we are to deliver better palliative care in Canada, it will have to done in collaboration with the provincial governments and the federal government. However, what I would say matters greatly, what matters in this place is if we are going to do that, we need to see federal leadership. That has been the problem with health care in Canada for decades now. There has been a total absence of leadership from the federal government.

We have heard members talk about introducing palliative care into the Canada Health Act. That is fine, except we cannot enforce the Canada Health Act unless we have a federal government that is actually funding health care in Canada.

We have seen the contribution of the federal government over the decades go from 50¢ on the dollar down to 17¢ in health care. It was projected to go lower under the Conservative plan. We have yet to see in the Liberal budget anything that would stop that reduction in the federal share of health care funding.

It is great for us to talk about the need for that, and I am proud to do that as a New Democrat who believes in federal leadership on the health file by putting money on the table. However, until we have a government that does that, we will not get the kinds of improvements I think we would all like to see on palliative care. As a New Democrat, I would like to see that in all aspects of the public health care system.

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

Mr. Speaker, I enjoyed the member's speech. I do not know if we will agree quite as much on this issue as we did on the Air Canada Participation Act, but I always appreciate his contribution.

The member talked about the issue of autonomy. I would like to raise the issue in the context of the social architecture of choice, the factors that are around individuals that may shape a choice such that the choices they end up making are not the ones they would want to make under ideal circumstances.

Specifically, if we are going to genuinely protect autonomy in this case, I believe we need to have a strong system of palliative care. We need to have an advanced legal review to ensure the criteria are actually met, that a person is not being pushed into this, and someone is checking that the criteria are met. We also need some clarity that prevents people from shopping doctor to doctor with ambiguous criteria where there are vastly different interpretations.

Would the member agree with me that these proposals are not things that limit individual choice, but rather they are things that protect an individual's choice to get what they want and not be forced into something that is not really what they are seeking at the end of the day?

[Daniel Blaikie, NDP, Elmwood—Transcona, MB]

Mr. Speaker, I would agree that people who do not have adequate resources can end up making choices they would not otherwise make. That is not a true expression of autonomy, and it is important to provide that. Providing more and better palliative care and other health care options, whether it is home care or long-term care, to people is part of ensuring they are making an actual choice and not feeling forced into that choice.

I would agree that improvements can be made to the bill. For instance, the fact that data collection on assisted deaths is left to regulation is problematic. It is important to try to get a proper reporting of this so we can have a meaningful review of the legislation after some time. There are definitely details in the bill, and I named one, that could be improved at committee.

[Bev Shipley, Conservative, Lambton—Kent—Middlesex, ON]

Mr. Speaker, it is an honour to talk to this issue. In my 10 years here, this has likely been one of the most sensitive, most compassionate and emotional discussions I have had with my constituents in Lambton—Kent—Middlesex.

Let me start with a little background. Bill C-14 is act to amend the Criminal Code to allow assisted dying, so we can allow someone under the law to kill someone else. It sort of catches me in the pit of my stomach, quite honestly. Section 241 of the Criminal Code talks about counselling or aiding suicide. It says:

Everyone who

a. counsels a person to commit suicide, or

b. aids or abets a person to commit suicide,

whether suicide ensues or not, is guilty of an indictable offence and liable to imprisonment for a term not exceeding fourteen years.

That is what Canada has been built upon in terms of the desire to not have people help people kill themselves.

In February of last year, the Supreme Court of Canada gave all the exemptions to this Criminal Code. The Criminal Code now gives an exemption for medical assistance in dying, so no medical practitioner or nurse practitioner can be charged. There is an exemption for people aiding the practitioner. If the doctor is doing it, and a nurse practitioner is helping, they are exempt from any charges.

The pharmacist who provides the cocktail, whether injected by the doctor or prepared so the patient injects it on his or her own, is exempt from any criminal charge.

There is an exemption now for a person aiding a patient. No person commits an offence if he or she does anything at another person's explicit request.

The coverall is that if there is a mistake made, no charges can come forward.

I find it quite extraordinary that with the stroke of a pen, nine judges made a decision to take a criminal law in the country and turn it 180 degrees, now make something that was criminal a health remedy. We now have to encourage people to take someone else's life.

I find it quite hypocritical that we are talking about assisted suicide, assisted death at this time. We like to use comforting words so it does not really mean we are actually giving someone the authority to kill someone else, but that is what we are doing. That is what the Supreme Court told us we have to do. At the same time, we have a national strategy on suicide prevention.

I am not sure where the government is on that discussion at this time, but I find the two of them are running in opposite directions. When my colleagues talked about first nations, we have all read about the issues. We are all up in arms and disturbed when we see not only individuals but groups coming together to commit suicide.

One of the key things in any the long term care is palliative care. We have heard this from just about everyone. Many of us have talked about our experiences or someone we know. I can also speak of that.

My parents died of cancer. Anyone who knows someone who has had bone cancer knows of the pain that comes with it. Maybe back then though, when my parents were suffering and succumbed to cancer, there was true palliative care. In their cases it never crossed their minds to ask for some sort of assistance to terminate their lives, let alone ask to have their doctor either provide or give them the solution to take their lives.

We talk a lot about palliative care, where it is and how it will be funded. We have the governing party saying that it is in the budget. The member from Winnipeg said it was in the budget. It has not been produced. We know it is not in the budget. If we read the preamble, we might read between the lines, if one has a visionary mind that there might be money for it. There just is not. It is not in the legislation. It is not in the budget. I am afraid it is a lone wolf out in the desert saying it.

We need to take some lessons from other countries, like Belgium and the Netherlands. Belgium started this 15 years ago. It was very secure so patients did not get on a slippery slope. However, now it is estimated that 32% of those patients never gave their consent for their euthanasia. We are told it now increases by about 47% per year.

As palliative care dollars drop, the desire to have something to take the pain away, which palliative care could look after, goes to assisted suicide.

I have some serious concerns about this. I talked about palliative care. I also do not see where there is any protection for doctors, nurses, nurse practitioners. Nor is there protection for institutions that have a moral conscience, an ethical bar that will not allow them. I have talked to doctors and nurses. A nurse had asked me if this was true. I said we would have to wait for the legislation. She said that if it were true. she would be out of it. She could not kill someone or be part of the euthanization of someone. A doctor who took an oath to protect lives said that he never took any oath to take away life.

Does the government have a vision in the future? This raises a huge issue, because on page 2 of the bill, it says:

...the Government of Canada has committed to develop non-legislative measures that would support the improvement of a full range of options for end-of-life care—

...giving rise to requests by mature minors, advance requests and requests where mental illness is the sole underlying medical condition.

[Nicola Di Iorio, Liberal, Saint-Léonard—Saint-Michel, QC]

Mr. Speaker, I thank my colleague for the sincerity and candour of his remarks in this honourable House.

I would like my colleague to explain, as concisely as possible, what steps he would have taken after reading the Supreme Court ruling to comply with the decision and take action on it.