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.

Reference to Standing Committee on Procedure and House Affairs

[Kevin Lamoureux, Liberal, Winnipeg North, MB]

Mr. Speaker, I sat very patiently listening to other members address a very serious issue. I would ask that they respond in kind and listen to what I have to say on this very important issue.

We need to put things into perspective, much as I did back in the 1990s when we had members leaving their seats, suggesting all sorts of behavioural issues, much as I saw today, which included the Prime Minister and others.

I do believe that the government House leader, in a responsible fashion, has made the suggestion that we allow the matter to go before the Standing Committee on Procedure and House Affairs where in fact we will have a good healthy discussion, and where we can take into consideration many aspects of what we witnessed here today. That is indeed the responsible thing for us to do.

I continue to understand the perception of what has taken place over the last couple of days—and I know first-hand because I participated in it—as many members have in the very emotional debate with respect to Bill C-14, as the government has attempted, on numerous occasions, to allow that debate to go on so that all members would be able to speak. However, on the other side, we have seen the opposition try to—

Bill C-14—Time Allocation Motion

[Jane Philpott, Liberal, Markham—Stouffville, ON]

Mr. Speaker, I hope my hon. colleague will find that I will always treat him with the utmost respect, as he always treats me. I thank him for all of his outstanding work as the critic for health for his party. I look forward to many further conversations with him.

As my hon. colleague knows, I am not a lawyer. However, my understanding of the Carter decision, as I have read it and discussed it with legal colleagues, is that it is based on two specific cases. It uses the term “grievous and irremediable”. It very specifically makes the point that it does not presume to make a decision on behalf of all Canadians. Rather, it presumes to make a decision on behalf of those specific cases. I understand that within the House, and across Canada, there are various interpretations about what the implications of that are for terminal conditions.

I am aware of the decision that was made in Alberta yesterday. That decision specifically said that it was not a commentary about the charter or Bill C-14. Rather, it was a commentary about a specific case and whether it met the criteria for exemption that had been set out in this interim period. It is because of that case and the fact that we have not developed safeguards for terminality in medical assistance in dying that enforces for us why it is important we get this in place. There is very clear solid evidence that the number of physicians who are prepared to provide medical assistance in dying drops considerably with respect to non-terminal cases, and where mental illness is involved, it is even more unlikely physicians will be willing to participate.

It is a very serious matter. I look forward to further discussion and debate on this. We fundamentally believe the legislation is the right legislation for Canada.

[Matthew Dubé, NDP, Beloeil—Chambly, QC]

Mr. Speaker, I would like to use Quebec as an example. In the years ahead, the Quebec National Assembly will serve as an example of what a Parliament can accomplish when it sets partisanship aside.

I understand that the members of the National Assembly had more time to deal with this. Nevertheless, considering all the parties involved in the debate in Quebec, they set an example for us to follow. This absence of partisanship is a real legacy for all Quebeckers, and it shows the kind of results that can be achieved together.

Here, the only legacy that our consideration of Bill C-14 will leave for Canadians is a reminder of a dark day for democracy, when the government's sunny ways were tossed out the window.

The only thing that is remarkable about our current debate on Bill C-14 is the abuse on the part of this government. During the election campaign, the Liberals promised over and over again to be different. The only way this government is any different than the last government is that it is even worse.

Now that Quebec has become a model to be emulated in the future, does the minister really want our handling of such an important bill to become an example of what not to do?

Is this really the legacy we want to leave for our children? I think that we would not want to be remembered as a Parliament that did not work because of a government that kept imposing gag orders.

[John Brassard, Conservative, Barrie—Innisfil, ON]

Mr. Speaker, as a new member of the House I am extremely disappointed with respect to the government's actions. Like all new members in the House, the expectation among my residents in supporting me to come to this great place was that I was going to be able to extend my voice in the debates. As we have seen by the actions of the government, what amounts to effectively a basic dictatorship, debates have been stifled in the House.

I want to remind Canadians and I want to remind the government exactly what it said, what it handed to the Governor General in the throne speech. It is proving not to be worth the paper it was written on now. The throne speech said:

Canada succeeds in large part because here, diverse perspectives and different opinions are celebrated, not silenced. Parliament shall be no exception. In this Parliament, all members will be honoured, respected and heard, wherever they sit. For here, in these chambers, the voices of all Canadians matter.

Further on in the throne speech, it says:

And to give Canadians a stronger voice in the House of Commons, the Government will promote more open debate and free votes, and reform and strengthen committees.

Four times now, with Bills C-6, C-10, C-15 and now C-14, we are seeing debate thwarted. Why the hypocrisy on the part of the government? All Canadians deserve to know.

[Karen Vecchio, Conservative, Elgin—Middlesex—London, ON]

Mr. Speaker, I stand here today as a member of Parliament who takes this job and this decision for Bill C-14 extremely seriously.

I ask both the Minister of Health and the Minister of Justice, recognizing that we have had time allocations, because this is such an important bill to so many Canadians, why could they not voice their opinions when we were debating Bill C-6 and Bill C-11, so that members on this side of the House, including members from their own side, could debate something that is so sensitive?

I, myself, hosted town halls, took letters out to constituents, and spoke to a variety of different physicians and stakeholders throughout this country. Our voices, I feel, are not being heard, regardless of whether we are for or against the bill.

Similar to our member down the aisle, I, too, voted for this to go to committee. I am proud of that because I believe we need to have this open discussion. However, the opportunity for this open discussion has been closed in our faces and I find that extremely frustrating, especially when I am trying to honour my constituents' wants and needs.

Why have the members on the other side not stepped forward to the fact that Bill C-14 is important to Canadians? They should have fought for Canadians when discussing the bill.

[Murray Rankin, NDP, Victoria, BC]

Mr. Speaker, I am deeply disappointed that I must rise to debate time allocation on medical assistance in dying, Bill C-14. I voted for this bill at second reading and I believe the record will show I worked collaboratively with colleagues on the Conservative and Liberal sides of the House to improve the bill.

The elephant in the room is that the central feature of this bill, who is eligible for medical assistance in dying, is patently unconstitutional. It limits who is eligible to a narrower class of suffering people than the class that won a unanimous decision in the Supreme Court of Canada in Carter.

Yesterday, the Alberta Court of Appeal unanimously said that the Supreme Court decision cannot be limited to terminally ill people or people who are at the end of life. Virtually all credible constitutional experts agree this is unconstitutional.

For the Liberal Party, that claims it is the party of the charter, I find this so perplexing. It does not comply with the Carter case and it does not comply with the charter. The government is threatening us with untrue stories of legislative chaos if we do not pass its version of the bill.

In the name of all patients who are suffering with enduring pain but are not at end of life, who are watching the government take away their victory in the Supreme Court, how can the government justify ramming through a bill on such a sensitive issue? Why can the government not let us work together to get it right for all Canadians?

[Dominic LeBlanc, Liberal, Leader of the Government in the House of Commons]

Mr. Speaker, I move:

That in relation to Bill C-14, An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying), not more than one further sitting day shall be allotted to the consideration of the report stage and one sitting day shall be allotted to the third reading stage of the said bill; and

That fifteen minutes before the expiry of the time provided for Government Orders on the day allotted to the consideration of the report stage and on the day allotted to the third reading stage of the said bill—

Government Business Motion No. 6

[Andrew Scheer, Conservative, Regina—Qu'Appelle, SK]

Mr. Speaker, I would like to add some of my comments here as well and perhaps provide a little bit more for the government House leader to consider as he goes and prepares his remarks.

I will keep my remarks very short, because I think what most members of the House would like to do is debate Bill C-14, which is a bill that could have been called on Monday, on Tuesday morning, or earlier today before the dilatory motions. As the government House leader said during question period, in essence, the Liberals just pulled the fire alarm.

Simply put, Motion No. 6 is a disgrace and not worthy of a democracy such as ours. It is an affront to the dignity of the House and its members.

Motion No. 6 is a complete quashing of the opposition's ability to hold the government to account. It is the total disempowerment of certain members of Parliament, who were sent here by 60.5% of Canadian voters. Motion No. 6 is indirectly disenfranchising every one of those voters through the draconian measures set out.

Beauchesne's, sixth edition, outlines some elements of the Constitution Act and our system of government, which I believe is relevant to this very point. It states:

Canada thus was ensured a responsible Cabinet system with the assumption that there will always be a recognizable government with a legislative programme. If the electorate so wishes, the system also presupposes an Opposition ready and willing to attack the Government in an attempt to have its legislation altered or rejected.... More tentative are such traditional features, as respect for the rights of the minority, which precludes a Government from using to excess the extensive powers that it has to limit debate or to proceed in what the public and the Opposition might interpret as unorthodox ways.

On May 2, 2000, during a discussion of the rule of time allocation at the Standing Committee on Procedure and House Affairs, the former clerk of the House of Commons, Robert Marleau, responded to a question regarding the Speaker's authority to protect the minority in the manner described earlier. The former clerk said, “it exists...intrinsically in the role of the speakership”, and continued, “all the time, where there can be tyranny on either side. It could be the tyranny of the majority or the tyranny of the minority.”

My interpretation of what the clerk said is that there exists a limit to what a majority government can do.

In an earlier point of order, I described how Speaker Fraser ruled on the government tactic of skipping over Routine Proceedings in order to get to a point where time allocation could be moved. On one occasion in 1986, he disallowed it, whereas on other occasions he allowed it.

If there was ever a point when a Speaker should intervene to protect the minority from the tyranny of the majority, Motion No. 6 is it.

Parliament is fundamentally about debate. It is also about the right to dissent in a civilized manner. Genuine political opposition is a necessary attribute of democracy, tolerance, and trust, and the ability of citizens to resolve differences by a peaceful means. The existence and tolerance of an opposing view is essential to the functioning of government.

I have more to say on this, but I would like to reserve the right to come back at a later time when the House is not up against the clock on such an important bill as Bill C-14.

However, Mr. Speaker, I do ask you to consider that Motion No. 6 is a completely unprovoked response to a situation that simply did not exist. I would invite the government to show me one example of a dilatory motion being moved by either opposition party when it came to the legislative agenda that the government is currently putting forward.

The Liberals are unilaterally withdrawing every single tool that the opposition has to propose alternate subjects of debate, they are ignoring the good work of committees, they are preventing members of Parliament from debating such things as motions to instruct a committee, and they are completely changing the rules around the clock and the calendar.

Therefore, I would like to come back to the House at a later time, but being cognizant of what little time left the House has to debate Bill C-14, because of the tactics of the government, I will yield the floor at this time.

Physician-Assisted Dying

[Elizabeth May, Green, Saanich—Gulf Islands, BC]

Mr. Speaker, my question is for the Prime Minister, and I want to start by quoting this from yesterday's unanimous decision by the Alberta Court of Appeal:

...the declaration of invalidity on Carter does not require that the applicant be terminally ill.... The decision itself is clear. No words in it suggest otherwise.... The interpretation urged on us by [the Government of] Canada is not sustainable.

In light of this, would the government be willing to entertain the amendments now before this place at report stage to ensure that Bill C-14 is compliant with the charter?

National Maternity Assistance Program Strategy Act

[Gérard Deltell, Conservative, Louis-Saint-Laurent, QC]

Mr. Speaker, I want to say from the outset that we support this private member's bill. We think this bill is important. We certainly would not describe this bill as coming in by the back door. This bill was introduced by a member of Parliament who was duly elected by his constituents. He came in here through the front door. We are pleased to welcome this bill through the front door, even though it is a private member's bill. To us there is no distinction to be made, contrary to what other colleagues may have said in the past. Private members' bills are important, and I like to reiterate that every chance I get.

On those fine words, we are in favour of this bill. I want to acknowledge the very positive way in which it was introduced. We have here a newly elected member of Parliament, much like myself, who took over from his predecessor in Kingston and the Islands and was privy to a situation that a person shared with him in his riding office.

People watching us on television think that parliamentarians argue all day long. That is simply not true. What we do here in the House is just one part of our work as MPs, because we work a lot in our ridings. In fact we spend more than half our time there. When we meet with Canadians, talk to them, and listen to them, we grasp the essence of our work. That is exactly what happened to the member for Kingston and the Islands. He met in his office with a constituent who had a concern, then he presented the concern here in the House by the front door and not the back door, and that is a good thing.

What is the bill about? The bill would let a woman take preventive leave and receive maternity benefits if her job could have a negative impact on her pregnancy. We must understand that this type of situation is becoming increasingly common. When I say that, I am not being negative, but constructive. That is today's reality.

A few decades ago we could not imagine there would be female welders, such as our colleague's constituent, but today we know that there are no gender-specific jobs. Every job is open to everyone. Men and women alike can do any job there is. However, this leads to situations, in welding for example, where workers are exposed to chemicals or have to do physically demanding work where they have to stand up, bend, stoop, and do other things that might have an impact on a pregnancy. We do not need to be doctors to know that. It is obvious that this is a cause for concern. That is why we are in favour of this bill.

It should be noted that this type of approach, preventive withdrawal, has been around in Quebec for years. I know what I am talking about because my riding is in Quebec.

I would like to share our concerns in that regard. We agree with the principle. I cannot emphasize that enough. We are going to vote in favour of the bill. I just want to reassure everyone of that. However, this bill clearly opens a door that could have significant financial implications. Similar legislation in Quebec has had such implications. I tried to determine exactly how much it costs. That is very difficult because it changes a lot over time. In Quebec, we know that 20% of pregnant women take preventive leave. They may include women who work in hair salons with certain chemicals or nurses who come into contact with sick people, obviously, or chemicals or medical products. They may also include teachers who use chalkboards and other products. We need to be aware that this measure could cost a lot of money. We need to be aware of that. We are talking about 20%, which means that one in five pregnant women in Quebec takes this sort of leave.

Recently, we have been talking a lot about Bill C-14, which, as members know, follows on similar legislation in Quebec. I have been reminded of the Quebec model many times in the past few hours.

To get back to the topic at hand, if the government were to model this system after Quebec's and one out of every five women were to take medical leave, that means 75,000 women would have access to this type of leave. We are not opposed to that. We need to be aware of this reality. However, this could end up costing an additional $245 million. We need to be aware of this. We need to take this into consideration. Either we believe in it or we do not. If we do, we need to do what is necessary.

Since this is a private member's bill that came through the front door, we need to recognize that it cannot have any financial implications. However, this bill could ultimately have some financial implications. We need to keep that in mind.

We completely agree with the other part of the bill, which proposes striking a committee and holding consultations with Canadians. Consultations seems to be a popular word these days. Consultations will help us get to the bottom of this issue, assess the situation, take a look at the Quebec experience, identify what works and what does not work, and learn from what is going on in Quebec, so that we can improve the approach.

I would remind members that we completely agree with the principle. We are cautious about the potential financial implications, and we are open to the discussions and conversations that we, as parliamentarians, need to have with all Canadians on this issue.

We believe in families and we believe that the government should assist families. We support that, but it needs to be done in a positive, constructive manner. We fully recognize that these days, there is no longer such a thing as men's work and women's work. All professions are open to everyone. This is what leads to improvements and enhancements to our laws, regulations and approaches regarding the maternity rights of all Canadian women.

Naturally, we want millions of children to be born here in this big, beautiful country.

Report Stage

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

Mr. Speaker, that certainly raises a good possibility. To invoke the notwithstanding clause would in fact give Parliament the kind of time that we need to study this important issue.

The rush with which the government has moved forward on an issue of such intense, immense significance is really inappropriate. We saw in the joint committee a lack of ability to get many witnesses in. We saw the same thing in the justice committee. Today we have seen a number of examples where we wasted hours on quickly moving other bills forward on the agenda when we, as members, were informed that today, beginning at 10 o'clock this morning, we would begin to discuss Bill C-14.

We have not had enough time to discuss this issue and it is of too great a significance for us to allow this to proceed in its current form.

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

Mr. Speaker, it is a great honour to rise to speak at report stage of Bill C-14.

As I stated earlier in this House, it is unfortunate that the Supreme Court of Canada has taken it upon itself to force legislation to be written, which overturns thousands of years of our understanding of the intrinsic value and dignity of every human life.

The Supreme Court has done this, completely rejecting the fact that elected members of this House have rejected initiatives to legalize physician-assisted suicide on at least 15 occasions since 1991. Most recently, a bill to allow physician-assisted suicide was rejected in 2010 by a vote of 59 to 226.

It is not only that nine unelected judges have inserted themselves into a national conversation that should be initiated in this House of Commons, they have even lamented the fact that an extension was sought to give parliamentarians more time to properly study, discuss, and debate this issue of exceptional importance.

In their judgment of January 15, 2016, in granting an extension, the Supreme Court stated, “That the legislative process needs more time is regrettable, but it does not undermine the point that it is the best way to address this issue.”

Really? It is regrettable? It is regrettable to take more time to think soberly through this complex issue, to implement such momentous change, to destroy the very foundations of medicine, to turn upside down the time-honoured belief that it is fundamentally wrong to kill another human being, and all in the name of compassion?

In regard to the impatience on the part of the Supreme Court, Warren Perley wrote, in Beststory:

Common sense dictates that such momentous changes to the law governing assisted suicide should be based on the compass rather than the clock. Until this point, Canadians have never had access to legally assisted suicide. Instead they have relied on doctors and nurses to administer palliative care, which must include adequate pain management and, in rare cases, palliative sedation. Pro-euthanasia advocates argue this is euthanasia, but they are in error.

Changing laws in matters of such substantive and exceptional significance as assisted suicide should be made by the compass. I could not agree more. Unfortunately, we have thrown away our compass. We no longer need a compass. We now just pool our collective ignorance and decide on the basis of popular opinion to sail off in any direction that suits the winds of the day, rudderless.

One of Canada's indigenous leaders, Mr. Francois Paulette, a Dene leader and chair of Yellowknife's Stanton Territorial Health Authority states that indigenous people are bound by spiritual law, not man-made law. He goes on to state, “We don't play God.... God is responsible for bringing us into this world, and taking our life. It is pretty straightforward.”

Whether as a member of the indigenous community or not, for all Canadians, the crux of the issue before us today, and the source of the conflict and confusion, is the fact that the preamble of our Charter of Rights and Freedoms on one hand, and Bill C-14 on the other, are built on two opposite pillars: one made of gold, and the other of styrofoam.

The preamble of the charter states, “recognize the supremacy of God and the rule of law”. Yes, there is a compass. Yes, there is a North Star. Even our Canadian charter states that in Canada we do recognize this North Star, the supremacy of God.

Yet if we look at the very first paragraph of Bill C-14, we see a totally opposite starting point. Rather than the “supremacy of God”, we see “autonomy of persons”.

My contention is that these two opposite philosophies cannot coexist at the same time, if we are to continue to have true freedom and trust in our society. We may deny God, and man as his image bearer. We can try to kill both God, and man as man. We may press forward in a suicidal course, but it always ends in pure vanity, for we are surrounded inside and out by the reality of God and his order in every sphere of life.

We all know that there are necessary limits placed on the autonomy of humans. Yet on an issue as monumental as the issue of life and death, we are considering extending autonomy without stopping to think what such autonomy might do to our understanding of the value of human life.

Does this autonomy serve well those among us who, for dozens of reasons, find themselves vulnerable, voiceless, and open to abuse in the most extreme and final way possible, an unwanted hastened death?

The very fact that I can drive from my riding of Kitchener—Conestoga to Ottawa each Sunday evening is because the autonomy of all drivers is limited. Drivers heading to Kitchener occupy the north side of the 401 highway as they travel west, so I am free to travel unimpeded on my easterly journey in the southern lanes.

To allow autonomy in many situations in life is foolhardy, to say the least. Our freedom and trust is enhanced by strict limits on personal autonomy for the greater good of community. We could list many such restrictions on personal autonomy: quarantines for highly infectious diseases, such as ebola; prohibition of using highly toxic chemicals and pesticides on private property; the limitation on raising farm animals in the residential area of a city. In these cases and dozens of others, we recognize that the greater community good supersedes individual autonomy.

To retain limits on personal autonomy in the case of physician-assisted suicide is for the greater good of society. To remove the restriction on personal autonomy could very well lead to the crumbling boundaries that our Liberal colleague, the member for Winnipeg Centre, referenced a few weeks ago in the Chamber when he said, “We are in a sorry state. We have truly entered a new age, one of the throwaway culture where all boundaries are starting to crumble”.

I fear for the kind of Canada I will leave for my children and grandchildren if we rush blindly ahead with an endorsement of physician-assisted suicide. The risk to society is too great. The dangers are far too real.

There is no doubt that in spite of our best efforts to place so-called safeguards to protect the vulnerable among us, there will be situations where innocent Canadians will be killed without their expressed consent. There is no doubt in my mind that in spite of our best efforts to spin the difference between suicide and what we are now calling medical assistance in dying, there would be a correlating increase in suicide rates in Canada.

Aaron Kheriaty, associate professor of psychiatry, and director of the medical ethics program at the University of California at Irvine School of Medicine states:

The debate over doctor-assisted suicide is often framed as a personal issue of autonomy and privacy. Proponents argue that assisted suicide should be legalized because it affects only those individuals who--assuming they are of sound mind--are making a rational and deliberate choice to end their lives. But presenting the issue in this way ignores the wider social consequences.

What if it turns out that individuals who make this choice in fact are influencing the actions of those who follow?

He goes on to report that in states where physician-assisted suicide has been legalized, there has been an increase in suicide of 6.3% overall, but among those over 65, an increase of 14.5%.

He continues:

The results should not surprise anyone familiar with the literature on the social contagion effects of suicidal behavior. You don't discourage suicide by assisting suicide.

Aside from publicized cases, there is evidence that suicidal behavior tends to spread person to person through social networks, up to three “degrees of separation” away. So my decision to take my own life would affect not just my friends' risk of doing the same, but even my friends' friends' friends. No person is an island.

Finally, it is widely acknowledged that the law is a teacher. Laws shape the ethos of a culture by affecting cultural attitudes toward certain behaviors and influencing moral norms. Laws permitting physician-assisted suicide send a message that, under especially difficult circumstances, some lives are not worth living – and that suicide is a reasonable or appropriate way out. This is a message that will be heard not just by those with a terminal illness but also by anyone tempted to think he or she cannot go on any longer.

Debates about physician-assisted suicide raise broad questions about societal attitudes toward suicide. Recent research findings on suicide rates press the question: What sort of society do we want to become? Suicide is already a public health crisis. Do we want to legalize a practice that will worsen this crisis?

I believe that life is always to be chosen over what some would call death with dignity. There is nothing dignified about deciding to end someone's life that is not worth living. If the patient has a need, let us address the need. Our goal should be to eliminate the problem, not the patient.

We need to be doing far more to address the needs of vulnerable Canadians. To that end, I have five proposed changes that need to be included in Bill C-14. Four of these have been accepted as amendments by others in the House.

First, the preamble should contain a statement indicating that suicide prevention is an important public policy goal, recognizing the sanctity of life as a societal principle.

Mr. Speaker, I see that I am out of time, so I will try to get my other points in when responding to questions.

[John Oliver, Liberal, Oakville, ON]

Mr. Speaker, I never once suggested that it would be reflective of a failure of the palliative care system. In meeting the needs of Canadians at the end of life, an array of services and professional support are required. Palliative care is part of that, as are the provisions of Bill C-14, in an act of end of life if required.

With respect to natural death and palliative care, people are supported through it. Generally, pain is well managed, and many people opt for natural death, particularly when properly supported with palliative care. However, there will be circumstances where pain cannot be managed or where the loss of autonomy is so dramatic that the palliative care model is insufficient. We need to have the provisions of Bill C-14 available to assist people who wish to end their life as they approach the end of their life.

[Wayne Stetski, NDP, Kootenay—Columbia, BC]

Mr. Speaker, I, too, really appreciate the depth of the discussion that we have had around Bill C-14.

The recommendations that came from the original interparliamentary committee, I thought, were excellent, and I was very supportive of the potential bill at that point. However, I have some real issues with the way the bill currently sits, and I want to focus on two.

Do advance directives not give people more choice in that they at least have the opportunity to do an advance directive rather than wait until they are no longer in a state where they could make a decision at all? Does it not provide more choice to have advance directives?

Secondly, intolerable pain and suffering was a really important part of the Carter decision, and I think should be an important part of the bill. Again, I know personally that if I had a choice later on in life, if I was struggling with intolerable pain and suffering, I would really like to go with a needle in my hand in the arms of somebody who loves me rather than just put it to chance.

Those two provisions are missing from the bill and I would appreciate the member's perspective on why.

[John Oliver, Liberal, Oakville, ON]

Mr. Speaker, I think it is very important to state again that palliative care is not a substitute in all cases for end-of-life decisions as contemplated by Bill C-14. However, it is important that there is an effective health accord that is negotiated with the provinces and territories by the Minister of Health, which will take some time to ensure that there is consistent and uniform high-quality services available across Canada. I think those are the first initiatives that need to take place. However, monitoring and evaluating the effectiveness of the palliative care programs can come as we begin to get them in place.