This bill was last introduced in the 42nd Parliament, 1st Session, which ended in September 2019.
Jody Wilson-Raybould Liberal
This bill has received Royal Assent and is now law.
This is from the published bill.
This enactment amends the Criminal Code to, among other things,
(a) create exemptions from the offences of culpable homicide, of aiding suicide and of administering a noxious thing, in order to permit medical practitioners and nurse practitioners to provide medical assistance in dying and to permit pharmacists and other persons to assist in the process;
(b) specify the eligibility criteria and the safeguards that must be respected before medical assistance in dying may be provided to a person;
(c) require that medical practitioners and nurse practitioners who receive requests for, and pharmacists who dispense substances in connection with the provision of, medical assistance in dying provide information for the purpose of permitting the monitoring of medical assistance in dying, and authorize the Minister of Health to make regulations respecting that information; and
(d) create new offences for failing to comply with the safeguards, for forging or destroying documents related to medical assistance in dying, for failing to provide the required information and for contravening the regulations.
This enactment also makes related amendments to other Acts to ensure that recourse to medical assistance in dying does not result in the loss of a pension under the Pension Act or benefits under the Canadian Forces Members and Veterans Re-establishment and Compensation Act. It amends the Corrections and Conditional Release Act to ensure that no investigation need be conducted under section 19 of that Act in the case of an inmate who receives medical assistance in dying.
This enactment provides for one or more independent reviews relating to requests by mature minors for medical assistance in dying, to advance requests and to requests where mental illness is the sole underlying medical condition.
Lastly, this enactment provides for a parliamentary review of its provisions and of the state of palliative care in Canada to commence at the start of the fifth year following the day on which it receives royal assent.
All sorts of information on this bill is available at LEGISinfo, an excellent resource from the Library of Parliament. You can also read the full text of the bill.
The House resumed consideration of Bill C-14, An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying), as reported (with amendment) from the committee, and of the motions in Group No. 1.
Bill C-14—Notice of time allocation motionCriminal CodeGovernment Orders
Beauséjour New Brunswick
Liberal
Dominic LeBlanc LiberalLeader of the Government in the House of Commons
Madam Speaker, I would like to advise that an agreement could not be reached under the provisions of Standing Order 78(1) or 78(2) with respect to the report stage and third reading stage of Bill C-14, an act to amend the Criminal Code and to make related amendments to other acts (medical assistance in dying).
Therefore, under the provisions of Standing Order 78(3), I give notice that a minister of the crown will propose at the next sitting a motion to allot a specific number of days or hours for the consideration and disposal of the proceedings at those stages.
Dominic LeBlanc Liberal Beauséjour, NB
Madam Speaker, I hope you will find unanimous consent for the following motion, which I will read slowly so that colleagues understand exactly what I am proposing, that notwithstanding any standing order or usual practice of the House, the House shall continue to sit beyond the hour of daily adjournment for the purpose of considering Bill C-14, an act to amend the Criminal Code and to make related amendments to other acts (medical assistance in dying), at report stage, and when no member rises to speak or at midnight on that sitting day, whichever is earlier, the debate shall be deemed adjourned and the House deemed adjourned until the next sitting day.
John Oliver Liberal Oakville, ON
Madam Speaker, I am thankful for the opportunity to join the debate today on Bill C-14, which addresses medical assistance in dying. I would like to acknowledge the incredible respect and thoughtfulness expressed by members in this very delicate debate.
Before I begin, I would like to acknowledge the advice and insights I received from a former colleague, Dr. Lorne Martin, chief of staff at Halton Healthcare, on the medical ethics and physician perspectives that would be created by the legislation.
The bill has generated significant debate and feedback from my riding of Oakville, both from people who wrote or contacted me on their own initiative, as well as those who responded to the forums that were created to solicit feedback through local media and my interactive website, johnoliver.mp. I have read and carefully considered the many views and concerns that came from residents of Oakville and I would like to address those that are relevant to the act and the amendments proposed.
The community responses can be grouped into five categories. The first is from those who are opposed to any form of medically assisted death and want the law to respect and protect every human life from conception to natural death. These are individuals who put forward the principle that we must not take another's life. There were many submissions of this nature.
For people who hold these values, I believe it is important, once again, at this stage, to understand that the Supreme Court of Canada's unanimous decision in the Carter case was a declaration that the Criminal Code prohibitions on assisted dying were not in accordance with the Charter of Rights and Freedoms. Effective June 6, 2016, medically assisted death is legal in Canada whether the bill is passed or not.
Therefore, the issue before this legislature is not whether medically assisted death will be allowed. Rather, the issue is whether medically assisted death will be permitted in accordance with the parameters set out by the Carter ruling or under a legislative framework established by elected representatives. Accordingly, our decisions are how to safely implement this new practice, who should be eligible, what safeguards are needed to protect vulnerable individuals, what are the roles and responsibilities of medical professionals, and how do we create a monitoring regime to ensure accountability, transparency, and improvement in this area as we go forward.
The second category of responses from my community were in reaction to the special joint committee recommendations. Many Oakville residents wrote to me expressing their concern that the rights of vulnerable Canadians may be infringed upon as we protect the rights of those seeking autonomy in their end-of-life decisions. Specific concerns were raised in relation to including Canadians with psychiatric conditions, psychological suffering, and minors.
Bill C-14 and the proposed amendments are more restrictive than both the Carter decision and the committee recommendations, in part, for the reasons raised by these constituents. To protect the rights of the more vulnerable, the bill has not included these broader situations or circumstances in the eligibility criteria, thereby addressing the concerns raised by these residents.
The third category of responses were diametrically opposed to those previously stated. These residents spoke in favour of the Supreme Court decision and about their belief that the Charter of Rights and Freedoms should allow autonomy to the individual in end-of-life decisions. Several accompanied their statements with personal stories of difficult end-of-life experiences for loved ones or worries about their own unique circumstances.
They also expressed concerns that Bill C-14 is too restrictive and does not address all the circumstances that should be considered eligible under the act. In particular, the clause requiring that natural death be reasonably foreseeable was felt to exclude many Canadians that they felt should be allowed.
In addition, there were concerns raised about denying advance directives. Denying advance directives puts people who suffer from degenerative illnesses that will eventually affect their competency in the position of having to exercise their right to an end-of-life decision in advance of losing competency.
The fourth category of concerns surrounded the rights of medical practitioners and institutions to ensure that they would be able to have freedom of conscience and religion to decide whether to participate in a medically assisted death. Bill C-14 would not compel participation by health care providers and I feel it is sufficient.
The final category of responses were fewer in number, but supported the position put forward by Bill C-14 as a reasonable starting point to address the complex and competing values and rights created by the Carter decision.
Having now spent considerable time in understanding and researching the issues raised by my constituents, and after careful consideration and personal reflection, I will be supporting Bill C-14 as reported by the committee for the following reasons.
I committed upon entering the past election and during my campaign to uphold the Canadian Charter of Rights and Freedoms. The Supreme Court ruling clearly found that the existing laws were not compliant with charter rights and freedoms and denied autonomy to a person seeking to end his or her life who clearly consents to the termination of life, and has a grievous and irremediable medical condition that causes enduring suffering that is intolerable to the individual. It is therefore morally incumbent, I believe, on this legislature to put legislation in place to protect this right and freedom, and I support that direction as carried out in the act.
We face, as a legislative body, the difficult task of balancing the competing social and moral values and interests surrounding this direction. For me, the protection of the vulnerable who may be individually or collectively disrespected or coerced to choose a premature death in the face of a too-permissive regime of assistance in dying must be balanced against those suffering from grievous and irremediable conditions.
As a first step in understanding the competing social and moral issues and the charter rights and freedoms of different groups, I believe Bill C-14, while not perfect, is an acceptable starting position for Canadians.
I would have preferred that Bill C-14 was more permissive for those where death is not reasonably foreseeable, and instead, built in protections for those who are vulnerable to the too-permissive language. While the bill's language is open to reasonable interpretation of foreseeable death, it does leave complex legal and ethical decisions with families and medical practitioners that will be open to court challenges and future charter appeals. This will add further stress and suffering to already untenable situations for many.
I do take some comfort from provisions within Bill C-14 to conduct further reviews after five years of eligibility criteria, and from the amendments coming back from the committee to review, after 180 days, other initiatives such as advance directives.
Another factor in my decision to support Bill C-14 is my belief that with properly offered health services, such as palliative care, most Canadians will not opt to use its provisions. Research from other countries suggests that most people prefer to enter into a palliative care program and experience natural death. While palliative care is not always a substitute for medically assisted death, it would be unacceptable to have people choosing medically assisted death as a result of inadequate palliative care services. I believe we can do more to ensure that palliative care programs are available and accessible across Canada, as proposed in some of the amendments.
The work of the Minister of Health in negotiating a new health accord agreement with the provinces and territories is fundamental to achieving these services, and I fully support her diligent efforts to achieve a new accord and ensure that all Canadians have access to high-quality sustainable care.
In discussion with doctors and other health care workers, there is general support and agreement with the bill, particularly the freedom given to caregivers to choose to participate in assisted death based on their own conscience and religious beliefs. I support the freedom that is put forward in the bill and do not feel an amendment is required.
Physicians today are already involved in substantive decisions regarding end of life, working with families or in accordance with advance directives. They often provide key clinical advice in the decision to end life support or to apply do not resuscitate orders. However, asking physicians to interpret and execute advance directives to end a life is ethically more challenging and places significant onus on them as individuals, particularly in hospital environments where they do not know the person or where there is not a family to consult.
Finally, my decision to support the bill arises from personal experiences and the loss of a loved family member who, as she requested, passed away at home in the presence of family. The final days of her life were marked with pain and suffering, which we were able to somewhat alleviate through oral morphine.
However it is allowed, appropriate care at the end of life needs to be available to people when required. I want my family members, fellow Oakvillians, and fellow Canadians to have autonomy in making end-of-life decisions as they have enjoyed autonomy in all of the major decisions in their lives.
I will be supporting Bill C-14 , and I urge all members of the House to support this important bill.
Sean Casey Liberal Charlottetown, PE
Madam Speaker, there is no question that not all individual members in the Canadian Medical Association are of one voice. The voice of the medical profession has spoken clearly and loudly in support of the legislation. Indeed, there are individual members and groups of doctors who do not feel the same way, one of whom was referred to by the hon. member.
The other point that I would add is this. If we are left without legislation on June 6, it is doctors like the one the hon. member quoted who will be left without a law, without eligibility criteria, and without the present system of applying to a court for an exemption, something that will only exist until June 6. There will be a great deal of uncertainty if no law is passed. That I think will leave doctors in a situation where they will be extremely reluctant to accede to a patient's request for medical assistance in dying without the certainty that is provided in Bill C-14, as flawed as it may be.
Sean Casey LiberalParliamentary Secretary to the Minister of Justice and Attorney General of Canada
Madam Speaker, I am pleased to voice my support for Bill C-14, significant legislation that would become Canada's first national medical assistance in dying regime, and would provide a thoughtful and well-considered response to the Supreme Court of Canada's decision in Carter.
I would first like to acknowledge the remarkable work of the members of the House of Commons Standing Committee on Justice and Human Rights who studied Bill C-14 under some very tight time constraints and who nonetheless were able to significantly enrich our reflection and debate on this highly complex and personal issue. This is certainly a matter on which everyone's point of view deserves the utmost respect and consideration. All justice committee members have unquestionably demonstrated these qualities in the course of their work.
Allow me to highlight some areas where the work of the justice committee has been particularly helpful.
Many stakeholders who appeared before the committee, in particular organizations representing medical professionals, expressed a great deal of concern about conscience protections for medical providers. Bill C-14, as a criminal law measure, would create exemptions from conduct that would otherwise be criminal and therefore would not compel anyone to provide medical assistance in dying in any way. However, some stakeholders urged the committee to add a specific clause that would clearly reflect, for greater certainty, their conscience rights as protected under the charter.
On the other hand, other stakeholders such as the Barreau du Québec and Quebec health lawyer Jean-Pierre Ménard affirmed the position previously expressed by the Minister of Justice that the conscience rights of health care providers were matters that fall under the purview of the provinces and territories as well as under the responsibility of medical regulatory bodies, which themselves are provincially regulated.
I am pleased to say that the justice committee carefully listened to submissions from all sides of the debate and that a motion was tabled to address this significant concern within the limits of our constitutional framework. Bill C-14 was amended in order to give a greater sense of comfort to medical professionals that nothing in Bill C-14 would compel individuals to act against their deeply held beliefs.
The justice committee should also be commended for working in a non-partisan way to make improvements to the proposed legislation. For instance, the committee amended the bill to clarify that where persons signed a written request on behalf of a patient who cannot write, they could only do so at the patient's express direction. The committee members also amended the bill to clarify that for the sake of professionals who provided counselling services, giving someone information about medical assistance in dying would not be criminally prohibited.
Although these amendments and several others do not fundamentally change the scope of Bill C-14, they should increase the level of comfort for Canadians, including health care providers and other professionals who may be involved. I applaud the committee for all of its efforts.
We have heard countless times how challenging the issue of medical assistance in dying is and how Canadians and organizations hold divergent views that are informed by strongly held beliefs. I think we can all agree that this tension was most apparent during the debate over who should be eligible for medical assistance in dying in our country.
Just as it was the case before the Special Joint Committee on Physician-Assisted Dying, the justice committee also heard a wide range of views on eligibility and on what was required to respond to the Carter ruling.
At one end of the spectrum, some stakeholders continue to oppose legalization of any form of medical assistance in dying, as is still the case in most countries around the world, or they propose that it be significantly narrowed.
At the other end of the spectrum, some argue that Bill C-14 does not go far enough and urge Parliament to adopt one of the broadest regimes in the world, similar to ones that exist in only three European countries. They maintain that the eligibility criteria in Bill C-14 are too narrow and they should also include mature minors, people suffering solely from a mental illness, and those who have lost their capacity to consent to die, but who have made an advance request for medical assistance in dying.
Somewhere in the middle of that spectrum, though, lies a group of stakeholders who have expressed strong support for Bill C-14 and who recognize that the bill's cautious and balanced approach is imminently justifiable, including the commitment to explore broader eligibility issues in the near future.
Among that group is the Canadian Medical Association, which speaks on behalf of 83,000 physicians across Canada and which supports the adoption of Bill C-14 as it was drafted, and without amendments.
In contrast with those who argue that the Supreme Court's language of grievous and irremediable medical condition is clear and preferable, the Canadian Medical Association takes quite a different position. It says that the criteria in Bill C-14, including the requirement that death be reasonably foreseeable, provides sufficient direction to physicians and is a great improvement from the court's language, which it considers to be vague and unworkable from a medical standpoint.
Similarly, the Canadian Nurses Association, a federation of 11 provincial and territorial nursing associations and colleges, representing nearly 139,000 registered nurses across Canada, has said publicly that its priority is having the bill passed before the June 6 deadline expires. Further, its CEO, Anne Sutherland Boal, stated just yesterday that the successful passing of the bill would be both compassionate and protective to patients, families, and care providers, while emphasizing that the legislative safeguards in the bill would work to protect the most vulnerable Canadians.
Although lawyers and legal academics continue to argue with each other over whether or not the court's language, or the language in Bill C-14, provides sufficient clarity, how can we as parliamentarians discount the views of medical practitioners? The Supreme Court expressed confidence in Canada's physicians to respond to Canadians who wished to access medical assistance in dying, and that confidence is well-placed.
We as parliamentarians must also have confidence in medical practitioners. They will be the ones facing these difficult life and death decisions with their patients and assessing their eligibility. For them, it is not a philosophical or theoretical exercise. They will be applying the very measures in Bill C-14 in their daily practice. Their views must be given significant weight.
National disability rights organizations and others have also supported the approach to eligibility proposed by Bill C-14 as a meaningful safeguard to protect individuals who might be vulnerable in the framework of a medical assistance in dying regime, as a result of societal discrimination, loneliness, or lack of social supports, for example.
On the question of safeguards, the same dynamic has been at play. Some stakeholders expressed support for the measures proposed in Bill C-14, while at the same time seeking to put in place additional safeguards to protect the vulnerable, such as prior judicial authorization. Others, wanting to facilitate broader access, have sought to remove some safeguards, such as the reflection period.
While we respect those who feel that the proposed safeguards are either inadequate or overly burdensome, I believe the safeguards in Bill C-14, taken together, are consistent with many of those found in regimes around the world. Just as the court in Carter was persuaded that the risks to vulnerable Canadians could be adequately managed under a regime with robust safeguards, I am confident the safeguards in Bill C-14 would guard against abuse and error.
Last, I would like to remind all members that Bill C-14, or the provision of medically assisted dying, is not intended to be, or to become, the response to all forms of intolerable suffering. The bill is a thoughtful response to Carter, which recognized the autonomy of those suffering on a path toward death to die peacefully at the time of their choosing and therefore to avoid a prolonged, painful, and undignified death, or one that is inconsistent with their values. Bill C-14 acknowledges the autonomy of such persons to make important end-of-life health care decisions, while also balancing the equally important societal objectives of affirming the value of the lives of all Canadians, preventing suicide, and protecting the most vulnerable in our society.
I believe this legislation respects all interests at stake, and is one of which Canadians can be proud. For all these reasons, I urge all members of the House to support Bill C-14.
Elizabeth May Green Saanich—Gulf Islands, BC
Madam Speaker, my friend, the hon. member for Kitchener—Conestoga, and I have had occasion to speak outside the chamber about this matter. I have met with a very impressive doctor of palliative medicine who raised the issue that there could be an interference, which I had not understood.
I am comfortable to support Bill C-14, with the amendments, so I need to bracket my comment this way. I do think it is important that no patient fear going to a doctor, for a misplaced fear. It is not something that the bill brings forward, but the palliative care doctor said that, from his point of view, he did not want his facility to provide this service for fear that those who went through those doors might have any concern that they might be medically assisted in something to which they did not consent.
I see, under this law and under our society, no prospect of that ever happening, because the sanctions would be severe. However, I do understand the issue, now, which I had not when he first put the question to me.
Elizabeth May Green Saanich—Gulf Islands, BC
Madam Speaker, if I were standing alone, saying that I thought it was unconstitutional, I would be arrogant, at the least. However, Joe Arvay, who was the counsel for Kay Carter, the British Columbia Civil Liberties Association, the co-plaintiff in the case with Kay Carter, and so many of those who have studied this might rely on section 1, but I think that is a faint hope.
The Supreme Court, in making the decision it made, that there was a violation of Kay Carter's charter rights, took into account her entire condition.
There will be a challenge to Bill C-14. It will very likely be found to not be charter-compliant, and it falls far short of the expectations of Canadians.
I did not have time in my 10-minute speech to speak to something I spoke to at second reading, which is another disappointment that I have with the bill; that is, the failure to allow for advance directives.
Patients across Canada, people who are suffering, have a right to expect that this Parliament will, at least, reflect what the Supreme Court did in its decision.
Elizabeth May Green Saanich—Gulf Islands, BC
Madam Speaker, it is an honour to be able to rise at report stage. I appreciate the decision of the Speaker to recognize that, if there was ever a time for exceptional circumstances and exceptions under our Standing Order 76.1(5), this is such an occasion.
The use of the exceptional circumstances here is to allow a real opportunity at report stage to improve the bill. This is not a fake debate about amendments that have no hope. It is my profound hope that the amendments before the House now as we debate this at report stage, with a free vote, with every member allowed to weigh in, can yet improve this legislation to the point where the vast majority of us will be comfortable voting for it with amendments. As it is right now, I do not know if this bill could pass this House in its current state.
Let me just go back for a moment, for context. I do think context and empathy are important on all sides of the House. Bill C-14 is the direct result of the Supreme Court of Canada's unanimous decision in February 2015 to accept that certain provisions of the Criminal Code violate the Charter of Rights and Freedoms insofar as they affect people who are suffering from grievous and irremediable medical conditions, and wish to have the right to choose their own time and way of dying. As the court wrote at the time, “an individual's choice about the end of her life is entitled to respect”.
In my time in Parliament, there has not been a bill that is more difficult to talk about, that touches more on aspects of our own personal principles, faith, beliefs, rights, and politics, all wrapped up in a charter decision. It has been difficult to talk about, but I think it has been approached on all sides with appropriate respect. As my colleague just mentioned, the chair of the justice committee, the hon. member for Mount Royal, did an exceptional job in steering through the many amendments that were reviewed in committee. However, not enough of those amendments were accepted to make the bill acceptable.
Let me go through why I do not think I can vote for the bill without amendments. It is not about what I think; it is not about whether I think the bill is satisfactory. I think everyone on all sides of the House, including government members, admit that it is flawed. It is not quite what one would want, compared to, for instance, the exceptional report of the committee that guided the government, the joint committee report of the House and Senate on how to respond to the Carter decision. This bill falls short.
That is not the basis on which I cannot vote for it now. It is not my opinions. Our challenge as parliamentarians is to ensure that whatever we pass meets the standard set out for us by the Supreme Court of Canada in assessing what it was about the status quo that made the situation for Kay Carter one that was not merely unfair but a violation of her charter rights.
That is the key question here. There is a level of provision for medically assisted dying below which government legislation cannot sink. That bar, that line, is charter rights, as set out by the Supreme Court of Canada.
I wanted to comment and focus a bit on this question, as set by the court, of an individual's choice about the end of her life being entitled to respect. I suppose we could wish that the court now used the female pronoun and intended it generically, as we have heard the male pronoun used generically throughout our lives.
However, I think it can be inferred that the Supreme Court of Canada, using the female pronoun, is talking about the plaintiff before them. It is talking about Kay Carter. Would Kay Carter have access, under Bill C-14, to medically assisted dying? Most observers whom I have heard at this point, knowledgeable observers, do not believe she would.
That, to me, is the crux of the debate, which means that her charter rights would still be infringed, even after we passed Bill C-14 as it is currently written.
This is why. Kay Carter was not about to die from her illness. She had a spinal stenosis that would not kill her. I want to refer to specifically the way Jocelyn Downie, professor of both law and medicine at Dalhousie University, described it that in her view Bill C-14 is unconstitutional. I want to read an excerpt from Professor Downie:
There was no evidence on the record before the court that Kay Carter's death was reasonably foreseeable in any temporally proximate way. In fact, it was just the opposite.
To pick one of many possible examples from the evidence before the court, as Kay Carter wrote in her letter to the Dignitas clinic in Forch, Switzerland:
The neurologist, Dr. Cameron of North Vancouver, assessed me and I had a CAT scan and MRI done. From these tests he told me that I had an ongoing, slow deterioration of the nerves that would never kill me but eventually would reduce me to lie flat in a bed and never move.
In other words, Kay Carter would not fit the definition within the bill that the requirement to be grievous and irremediably affected in a condition that would allow medically assisted death would be a death that was reasonably foreseeable. That clearly suggests, although the language is somewhat vague, that Bill C-14 requires that a person, to be grievous and irremediable within the meaning of the act to access medically assisted dying, has to be in a terminal state.
The court in its unanimous decision may have left some ambiguity for those who were hoping to find a loophole, but I do not think it is there, with the facts of the case right in front of them, Kay Carter, who was not in a terminal state. Beyond that—and this is where I have sympathies for the current government—the Supreme Court gave a year from the day of the decision in February 2015, but the Minister of Justice was not sworn in until November 4. The Prime Minister was not sworn in until November 4. The time limits imposed on the new Liberal government are not of its making, and I am clearly sympathetic.
I opposed at the time going to the court to ask for an extension because deadlines such as this, given the effect of the court's decision rendering those Criminal Code sections unconstitutional, will not create chaos or a situation that cannot be managed.
However, to go back to that moment when the Government of Canada went to the Supreme Court to obtain an extension, in this excerpt Madam Justice Karakatsanis says clearly in questioning one of the counsel: “I'm thinking particularly about somebody has to be a la fin de vie whereas in Carter we rejected terminally ill”.
Let me put it again clearly. A Supreme Court of Canada justice says that in Carter we rejected terminally ill. That is clearly the standard for ensuring that rights are protected: that we must not ensure that in order to access medically assisted death the person be on the verge of death, that their death be reasonably foreseeable, even if we take reasonably foreseeable back to a year or two years. Kay Carter did not have that circumstance.
Another medical expert who has written about Bill C-14 since it came forward, Professor Jesse Pewarchuk, who is a clinical assistant professor of medicine at the University of British Columbia, wrote:
Worse, the wording of the proposed law introduces significant doubt as to whether an Alzheimer’s patient who has yet to lose capacity (yet is certain to) would even be eligible, since death can take years, even from the point of entering long-term nursing care.
“Foreseeable death” and “advanced state of decline in capability” are loaded, ambiguous clauses that seem to eliminate the Charter rights of dementia patients...and to put any physician carrying out their wishes in considerable legal peril.
Without these amendments passing at report stage, I cannot vote for Bill C-14. In an ideal world, I would rather there were a framework of laws for doctors to follow, for nurse practitioners to follow—a framework, consent, reforms, and the witnesses and the independence and the elements of law. However, if these amendments are not passed, I cannot vote for a law that falls below the bar of what the Supreme Court says constitutes protection of charter rights.
Harold Albrecht Conservative Kitchener—Conestoga, ON
Madam Speaker, earlier today the House voted on a motion regarding physicians' freedom of conscience, and I did not take notice as to how my colleague voted, so I would ask him this question.
In the context of Bill C-14 at report stage, Motion No. 14 calls for clear definitions of freedom of conscience. Would my colleague support those?
Michael Cooper Conservative St. Albert—Edmonton, AB
Madam Speaker, it is a privilege to speak to Bill C-14 at report stage.
I have brought forward three amendments, two of which are related. Motions Nos. 4 and 9 on the Order Paper relate to requiring someone with an underlying mental health condition to undertake a psychiatric assessment to determine capacity to consent. Motion No. 14 on the Order Paper deals with conscience protections, ensuring that the conscience rights of health professionals and health care institutions are respected. I will get into a little more detail momentarily with regard to those amendments.
Let me just say at the outset that however short or long my parliamentary tenure proves to be, Bill C-14, I have little doubt, will be one of the most important votes that I cast. I believe that is true for all hon. members in this House, because we are talking about a bill that will impact the lives of Canadians not just for years to come, but likely decades to come.
Having regard for the gravity of the decision before us, I have spent a lot of time reflecting on what is the right thing to do. At the present time, I am still reflecting.
One of the shortcomings of Bill C-14 at second reading was the absence of conscience protections. I am pleased that now that the legislation has gone through committee, there has been movement in the right direction when it comes to protecting conscience rights of health care professionals. More specifically, Bill C-14 provides that no individual is obliged to provide, or assist in providing, physician-assisted dying. In addition to that, the preamble has been amended to expressly recognize section 2, freedom of religion and freedom of conscience under the charter.
I want to thank the hon. member for Victoria for his leadership in moving those amendments at committee in close co-operation with me, as well as the hon. member for West Nova. I would be remiss if I did not acknowledge the hon. member for Mount Royal for his hard work and the collaborative approach he took as chair of the justice committee, which resulted in an important improvement in the legislation.
With respect, I believe there is still work to do when it comes to conscience protections. I believe it is important that not only health care professionals but also health care institutions have their charter rights and appropriate conscience protections in place. That is what my amendment would seek to do to ensure that everyone's charter rights are respected.
I would note that Madam Justice McLachlin and Mr. Justice Moldaver at paragraph 94 of the Loyola decision recognized that the individual and collective aspects of section 2 charter rights are intertwined.
With respect to the other two amendments I have brought forward, one of the concerns I have is the fact that in the legislation any two physicians or any two nurse practitioners can determine whether or not a patient satisfies the criteria for physician-assisted dying.
The problem with that is that not every physician and not every nurse practitioner has the training and experience to determine capacity to consent when an underlying mental health challenge is present in a patient.
The clear evidence before the special joint committee of which I was a vice-chair, as well as the justice committee of which I am a member, was that someone with more specialized training, namely a psychiatrist, is required to undertake what is, quite frankly, a complex analysis in many cases.
My amendment would simply provide that anyone who has an underlying mental health challenge be referred to a psychiatrist for a psychiatric assessment to determine his or her capacity to consent. It is a simple amendment. It is a straightforward amendment. It is a much-needed amendment. We simply cannot allow people with mental illness to fall through the cracks. We cannot allow that to happen as parliamentarians. One way we can mitigate that from happening is to pass this very important amendment.
When I look at Bill C-14 in its totality, I see a bill that contains many important safeguards. Those safeguards ought not to be minimized or dismissed. They are there; they are real, and they are serious. At the same time, the bill falls short when it comes to protecting the most vulnerable of the vulnerable, namely, people with mental illness. I see a bill that moves in the right direction when it comes to protecting conscience rights of health professionals, but still falls short when it comes to health care institutions.
Bill C-14 is an imperfect bill. It is not a bad bill, but it is a bill that I believe can be improved upon. As I reflect, I must ask myself whether I support an imperfect bill or do I vote against an imperfect bill having regard for the consequences that would follow in the absence of legislation being cast when the expiration of the declaration on the stay of constitutional invalidity is June 6.
In closing, I will continue to reflect. I am hopeful that some of the gaps in Bill C-14 can be closed. I am hopeful that all hon. members on all sides of the House can work together collaboratively and in a spirit of good faith to try to do the best we can to make this bill the best that it can possibly be in the circumstances. We owe it to patients. We owe it to physicians and health professionals. We owe it to the vulnerable. Most importantly, we owe it to Canadians.
Murray Rankin NDP Victoria, BC
Madam Speaker, that was exactly the evidence that the Supreme Court heard. The trial court heard voluminous testimony about that and concluded that safeguards were to be properly built-in within their judgment.
In addition to that, Bill C-14 lists many additional safeguards that are provided, and I am comfortable with the result that has been achieved. However, I am not comfortable that we are taking away the rights of so many Canadians, which were achieved at great expense and difficulty in the Supreme Court decision in Carter.
Murray Rankin NDP Victoria, BC
Madam Speaker, it was a pleasure to be in the riding of my colleague and friend from Edmonton Strathcona to talk about this with hundreds of passionate Canadians who were, frankly, surprised there was no willingness on the part of the government to consider advance directives in Bill C-14.
Since I spoke in Edmonton, I ended up moving that there be amendments specifically to provide that kind of advance requests, as so many witnesses had proposed. However, every Liberal on the committee voted against that change.
I think Canadians are demanding it. I get more letters and calls about this issue than any other deficiency in the bill. I hope that the review that is proposed in the legislation will eventually take us there, because I know Canadians are demanding it.
Murray Rankin NDP Victoria, BC
Mr. Speaker, I appreciate your thoughtful ruling and your recognition that this is indeed a historic event and, as you said, a generational issue. In Motion No. 1, I have suggested that we delete clause 3 of the bill, which is one of the central features of it.
The Supreme Court's ruling in the Carter case was a watershed moment for many Canadians, especially those who had fought so long to have their suffering recognized and their autonomy respected. I was proud to support the principle of Bill C-14 during second reading. I did so thinking of Sue Rodriguez of Victoria, Gloria Taylor, and Kay Carter, and of all of the others who paved the way for the rights of other suffering Canadians to be recognized by the Supreme Court and by Parliament.
While I was proud to support the bill in principle, at the time I raised serious concerns about particular provisions in it. Still, I was optimistic that these concerns would be resolved and the bill improved by hearing from experts and making the necessary amendments in committee. Sadly, that was not to be done.
The first day of consideration in the justice committee ended without a single opposition amendment accepted by the Liberal majority. By the end of the week, after more than 100 amendments were proposed, just 16 were accepted. Of course, I am pleased that my amendment was accepted to strengthen the government's commitment to providing more Canadians with palliative care, mental health supports, better services for patients with Alzheimer's and dementia, and culturally appropriate services for indigenous patients. I thank my colleagues from all parties for supporting my amendments to that end. However, many of the handful of changes at committee were simply minor technical changes.
Along with members from several parties, I offered a solution to the glaring flaw in the bill, the elephant in the room, namely the fact that it simply did not square with the Supreme Court's ruling. I proposed using the exact words of the Supreme Court to determine eligibility. That was of course one of the main recommendations of the special House Senate joint committee that addressed this bill. Sadly, all of these proposals were rejected. It became clear that the government had no interest in changing the central feature of this bill. Therefore, does the Liberals' bill square with the Supreme Court decision in Carter? The answer is clearly no.
The Supreme Court declared the two laws that prevented medical assistance in dying:
...void insofar as they prohibit physician-assisted death for a competent adult person who (1) clearly consents to the termination of life; and (2) 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.
That language defined the circumference set out by our highest court as to who had the right to physician-assisted dying. Outside of that circle, there remains a total ban on assistance in dying. Mature minors, those who have lost or never had the capacity to give legal informed consent, those with solely psychiatric conditions, and those with merely minor medical conditions were never eligible in the Supreme Court decision. However, within the circle are all consenting competent adults with a grievous and irremediable illness, disease, or disability that causes enduring and intolerable suffering.
This bill would erase the circle set by the Supreme Court and draws a much smaller circle within it, covering only those nearing the end of life and facing what is called reasonably foreseeable natural death, a phrase which just recently the Collège des médecins du Québec called incomprehensible from a medical perspective.
A lawyer representing the British Columbia Civil Liberties Association at the court hearings said this to the justice committee, “Bill C-14 cuts the heart out of our victory in the Carter case”. By adding an end-of-life requirement onto the court's ruling, Bill C-14 would revoke the right to choose from an entire class of competent adult Canadians. That group is everyone suffering intolerably from an irremediable but non-fatal condition.
I have constituents in my riding who fall into that outer ring beyond the circle of rights recognized by the government, people who are suffering, who saw their suffering recognized by the Supreme Court and who cannot, for the life of them, understand why the government now insists on removing their right to choose this option.
What justification has the government offered for this disturbing decision? At the House and Senate committee, and again at the justice committee, some argued we could not afford to expand the circle of compassion, that the Supreme Court ruling could not be obeyed in full, that not all those who were granted rights in Carter could see those rights upheld because to do so would pose an unacceptable risk to vulnerable persons.
These are important arguments, but they are not new. In fact, they were advanced ably and in great detail before the Supreme Court of Canada. Here is what the court wrote.
At trial [the Crown] went into some detail about the risks associated with the legalization of physician-assisted dying. In its view, there are many possible sources of error... Essentially...there is no reliable way to identify those who are vulnerable and those who are not. As a result, it says, a blanket prohibition is necessary.
I emphasize this:
The evidence accepted by the trial judge does not support Canada’s argument...The trial judge found that it was feasible for properly qualified and experienced physicians to reliably assess patient competence and voluntariness, and that coercion, undue influence, and ambivalence could all be reliably assessed as part of that process....As to the risk to vulnerable populations (such as the elderly and disabled), the trial judge found that there was no evidence from permissive jurisdictions that people with disabilities are at heightened risk of accessing physician-assisted dying....no evidence of inordinate impact on socially vulnerable populations in the permissive jurisdictions...no compelling evidence that a permissive regime in Canada would result in a “practical slippery slope”. accepted by the trial judge does not support [this] argument.
That was the conclusion of the Supreme Court after considering the evidence and arguments raised in Carter, the very same evidence and arguments that were advanced at the joint House and Senate committee, which I was honoured to serve on, and at the justice committee just last week. After considering that evidence and those arguments, the court issued its ruling in Carter, establishing the right to choose medical assistance in dying for everyone inside a carefully measured circle of eligibility.
Quite simply, there was a large circle of eligibility. The government has chosen within that circle to define a smaller class. It simply cannot do that if we believe in the rule of law, if we believe in the fact that the Supreme Court should be listened to in this case.
In conclusion, I simply cannot support moving any further with a bill that would revoke from an entire class of competent adult Canadians rights granted to it by the Supreme Court of Canada.
The Speaker Geoff Regan
There are 16 motions in amendment standing on the Notice Paper for the report stage of Bill C-14.
Motion No. 5, submitted by the hon. member for Victoria, and Motion No. 10, submitted by the hon. member for Montcalm, propose additional amendments to provisions of the bill that were previously amended in committee. Both motions seek to amend what is meant by “a grievous and irremediable medical condition”.
It should be noted that very similar definitions were proposed and defeated in committee, although they were proposed in reference to a different clause. In the view of the Chair, the objective of these motions is essentially identical to that of the amendments defeated in committee, and these motions will therefore not be selected for consideration at report stage.
The Chair has received letters sent by the hon. member for Sherwood Park—Fort Saskatchewan, the hon. member for Regina—Qu'Appelle, the hon. member for St. Albert—Edmonton, the hon. member for Saanich—Gulf Islands, and the hon. member for Kitchener—Conestoga arguing that certain motions, though previously defeated in committee, should be selected at report stage as they are of such exceptional significance as to warrant a further consideration, in accordance with the notice to Standing Order 76.1(5).
Motions Nos. 2, 11 and 15, submitted by both the hon. member for Barrie—Springwater—Oro-Medonte and the hon. member for Kitchener—Conestoga, as well as Motion No. 8, submitted only by the hon. member for Kitchener—Conestoga, will not be selected by the Chair as they could have been presented in committee. The Chair has difficulty accepting that they should now be accepted at report stage when no attempt was made by either member to present them in committee.
Motions Nos. 4 and 9, submitted by the hon. member for St. Albert—Edmonton and the hon. member for Regina—Qu'Appelle, seek to ensure that a person who suffers from an underlying mental health condition has undergone a psychiatric evaluation to confirm that they are capable of giving informed consent in relation to a request for medical assistance in dying. Motion No. 14, submitted by the same two members, seeks to ensure that people are free to refuse to provide medical assistance in dying. All three motions are identical to amendments defeated in committee.
The same is true for Motion No. 6, submitted by both the hon. member for Montcalm and the hon. member for Saanich—Gulf Islands. This motion seeks to delete paragraph 241.2(2)(d), which states that an individual's natural death must become reasonably foreseeable in order for the individual to be considered to have a grievous and irremediable medical condition.
In the case of the motions submitted by the hon. member for Sherwood Park—Fort Saskatchewan, Motions Nos. 7, 12 and 13 are also identical to amendments defeated in committee. Motion No. 7 seeks to amend paragraph 241.2(2)(d) to reference instead that the person's natural death must be imminent. Motion No. 12 seeks to add a paragraph providing that no substance is to be administered to a person who is capable of self-administering. Motion No. 13 provides for a review of the safeguards in relation to a request by a competent legal authority. Motion No. 3, which provides that a person must have consulted a medical practitioner regarding palliative care options prior to making a request for medical assistance in dying, is very similar to an amendment defeated in committee. The only distinction between the two is that the latter provided that such consultation had to have taken place within the 15 days prior to making the request.
The Chair appreciates the arguments put forward by hon. members as to why they consider these amendments to be of such significance as to warrant further consideration at report stage. I recognize that this is an important issue on which many members have strong and varied opinions. The Chair notes that the bill before us is unique, in its far-reaching social, moral and constitutional implications. The Chair also notes that, given the variety of opinions expressed by various members in all parties in relation to the provisions of this once-in-a-generation bill, the Chair is open to the argument of exceptional significance as contemplated in our Standing Orders. For these reasons, the Chair is prepared, on this occasion, to give members the benefit of the doubt and to select Motions Nos. 3, 4, 6, 7, 9, 12, 13 and 14, even though they were previously defeated in committee or are similar to motions previously defeated in committee.
All of the other motions, Motions Nos. 1 and 16, were examined, and the Chair is satisfied that they meet the guidelines expressed in the note to Standing Order 76.1(5), which deals with the selection of motions in amendment at report stage.
Therefore, Motions Nos. 1, 3, 4, 6, 7, 9, 12, 13, 14, and 16 will be grouped for debate and voted upon according to the voting pattern available at the table.
I shall now propose these motions to the House.