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.
Bryan May Liberal Cambridge, ON
Mr. Speaker, I want to thank the member for Brampton South for her speech and her contribution to this debate.
The core principle that this debate is about, which is balance, cannot be emphasized enough. This has been mentioned by all sides. I am wondering if the hon. member can speak a bit more about the government's investment in palliative care, as well as possibly elaborating a bit on the work that has been done in each of the ridings to consult.
Sonia Sidhu Liberal Brampton South, ON
Mr. Speaker, the Minister of Health has been very clear. She committed in this House, in response to the question I asked on May 2, to invest in palliative care. As part of a multi-year health accord, the federal government has committed to providing $3 billion over the next four years to improve home care, including palliative care. The minister is working with the provinces and territories. Palliative care is more about dignity while dying from natural causes. That is the right plan. Our health minister is very keen to implement that, and that is what we are doing.
Bob Nault Liberal Kenora, ON
Mr. Speaker, it is an honour to have this opportunity to speak to this legislation and enter this debate. First, I want to thank the leadership of all the parties for making this a free vote. This is such an emotional, difficult, and personal debate. Having had the opportunity to sit in the House since the eighties, I have had the opportunity to be involved in many debates. From my experience, this is one of the most difficult debates that as a parliamentarian I have entered into.
I want to be clear, as we start this discussion, that I support the legislation, and I will lay out to some extent the reason why I feel this way. This decision has to be based on our own personal life experiences and some would say, our own values. However, the reality is that all members in this place come from different parts of Canada, come from different experiences, and have different understandings in some respects of what we are entering into.
We all have to keep this in mind. This is fundamental societal change. This is fundamental because we are moving to allow individual Canadians, people we love, people we are close to, people who are our neighbours, our friends, the ability to have medical assistance in dying. It should be one of those debates that should not be taken lightly. Nor should it be a debate where we talk specifically about what the lawyers or the courts are saying. Yes, we have a court case to deal with and the Supreme Court has told us what its sense is, that in fact people have a right to assisted dying. However, we should not diminish the importance of what that may do to our country over the long term.
I want to use my experience as a member of Parliament to explain the rationale for being extremely careful and diligent in our decisions as we move forward over the next number of years.
I represent a riding that probably has the most suicides of anywhere in Canada. Over the last decade, I have watched hundreds of young people take their lives, people who I know their families, their moms and dads, and have watched with some horror as they have made that kind of decision. Yes, it is a little different than what we are debating today, but it defines how we feel about the objective of allowing people to make that ultimate decision of taking their own life with the medical assistance of others.
We should in some regard be careful not to assume what is being said by others in the House, for example, that the legislation does not go far enough, or that it may be not charter compliant because it is too restrictive, or that it goes too far for some people who have made equally compassionate arguments in the House. This decision has to be based on where we think we want our society to go. It is not up to the courts to define and to suggest, as some have suggested even today, that we have not gone far enough so therefore we have to go all the way to a particular place because it may not potentially be compliant with the charter.
I sat in cabinet for a number of years and I have seen many legal arguments put to cabinet on different issues by legal counsel and on many occasions. On many occasions I have had the opportunity to see the decision made right or the decision made wrong, or the advice to be given not exactly as we had anticipated. Therefore, we cannot stand in this place and assure Canadians that this legislation is absolutely perfect one way or the other.
That is why I like the approach the government has taken. It has taken an approach that it is very restrictive. It gives society time to look at the other areas that we may consider, as parliamentarians, to allow people to take their own life, for example, minors.
As I said, I have had the experience of watching many young children take their lives. To talk about minors who are willing to take their lives and make it legal and easier, if I could put it in those terms, is not something I totally support. I am very concerned about that.
I am worried about the whole issue of advance requests. It is hard to predict the situation a person will find themselves in, so we need to have more study of the whole issue of advance requests, and minors and mental illness.
I support the legislation, not because the leadership told me to do it. I do not tend to work that way and never have. I think it is the best approach for something that would fundamentally change our society forever.
We have to remind ourselves as we stand here, and when we vote tonight, that someone close to us very soon will use this legislation. It may not be as comfortable and as simple as some people have made it sound. We have had this discussion today.
The legal framework is important. It is important for the Senate not to get into this discussion about whether or not it goes far enough. The reality of it is that if it is a framework that allows us to get the compliance we need through the charter, we should move forward on it. I want to make this clear. I do not care which legislation we would pass, the one the NDP seems to favour or the one the Conservatives seem to want to have, and I am not sure exactly which way that would go. That legislation will go to the Supreme Court to be tested as we move forward. It does not matter which legislation we pass because this is such a fundamental change to our society, there is no doubt people will go to the Supreme Court to test the reality of the legislation.
Here is the reality we face. Under the legislation, we allow mentally competent adults who are in an advanced state of irreversible decline in capability, have a serious and incurable illness, disease or disability and are experiencing enduring and intolerable suffering caused by their medical condition, and whose death has become reasonably foreseeable, taking into account all of their medical circumstances, to seek assisted dying. That is a pretty large amount to start with.
I know this will change our health care system for the next generations. I strongly recommend to members of Parliament not to be too quick to judge what other generations will want to have 50, 100 years from now. We should be very careful about that.
I believe, as most Liberals do, in individual rights. I am not suggesting we restrict those, but the right to choose for people who are competent is fair. Having control and obviously the dignity in dying are very important concepts for me as a member of Parliament.
Today I am pleased to have this opportunity to make these comments. This is not a partisan issue. This will not get any member of Parliament more votes, one way or the other. This is a profound fundamental change in how I will deal with individuals every day with whom I am close. I want to ensure we get it right. If we did restrict it too much this time, I would rather do that than go too far.
Kevin Sorenson Conservative Battle River—Crowfoot, AB
Madam Speaker, when I first polled my constituents, I found that most of them were opposed to doctor-assisted suicide because they had heard stories about Belgium and the Netherlands, and had seen how it was a slippery slope. However, most of them believe that if these are fairly restricted, there are cases where it may be implemented. How do we stop the slippery slope? That is my question for the member.
Most Canadians want to be assured that doctor-assisted dying is limited to competent adult individuals, and the member spoke about that. They would not want those under the age of 18, who might feel depressed or have mental issues, to access assisted dying. As far as vulnerable people, how we confirm their capacity to consent is another concern.
In the last part of the member's speech, he said that he was a Liberal and that he believed in individual rights. Why do we not have in the legislation conscience rights protections for physicians and other medical practitioners who oppose physician-assisted dying? Right now, in Ontario, it is a requirement—
The Assistant Deputy Speaker Carol Hughes
Order, please. Other people will want to ask questions as well, and it is only five minutes. Therefore, I will give some time for a response.
The hon. member for Kenora.
Bob Nault Liberal Kenora, ON
Madam Speaker, my colleague has asked a good question. It goes back to my original discussion that we should go slowly and take our time. We should not just let the Supreme Court, or courts, decide what Parliament should decide. We have to make decisions in this place based on what is good for Canadians, in accordance with their beliefs and values. They will be interpreted in the courts, as will this legislation. If in fact, as the member has suggested, we do not allow for conscience rights for members of the medical profession to not participate and if this is considered to be unacceptable to the courts, we will hear that, and we will have further debates.
I have been in this place for 17 years, and my colleague has been here quite a long time himself. We will continue to have this debate, because it is a fundamental change for us as a society. We cannot compare ourselves to other countries, and we should be very careful how we approach that.
Robert Aubin NDP Trois-Rivières, QC
Madam Speaker, I listened carefully to my colleague's comments.
Two things really caught my attention. The first was at the beginning of his speech, when he commended the leadership of all the parties for allowing a free vote on this bill. Obviously, I also commend that. It seems to me, however, that in addition to a free vote, we should be making a more concerted effort to seek the broadest possible consensus in the House. I think that is where our views diverge somewhat.
Furthermore, at the end of his speech, the other point that struck me is when he said that, no matter which legislation we pass, whether it is an NDP, Conservative, or Liberal bill, it will face a court challenge.
My question is very simple: why did the Liberals refuse to refer the bill to the Supreme Court, which would have ensured that it was acceptable?
Bob Nault Liberal Kenora, ON
Madam Speaker, the use of sending references to the Supreme Court should be used sparingly. I know the opposition tends to like the idea of sending this to the Supreme Court. I am sure it will go to the Supreme Court, but it will go on specific matters, not based on whether we think the overall bill is charter compliant or not.
I firmly believe the bill is charter compliant. I agree with the minister that it does meet the test, and that it will not be the bill we are dealing with specifically, Bill C-14. It will be matters like whether we did not go far enough, and others will challenge that.
I know you are trying to hurry me up, Madam Speaker. I was going to answer the other question. Maybe I will get it in the next go-around.
The Assistant Deputy Speaker Carol Hughes
I want to remind members that there are five minutes of questions and answers, which is not a lot of time. If members can keep their questions as short as possible, we can get as many in as possible.
The hon. member for Provencher.
Ted Falk Conservative Provencher, MB
Madam Speaker, I want to start by saying that I will be splitting my time with the member for Selkirk—Interlake.
I want to say right from the outset that I am conceptually opposed to Bill C-14. I believe in the sanctity of life, and I believe that all life, from conception right through to natural death, has value, has worth, and has purpose.
As a sitting member of the committee for justice and human rights, I spent several weeks together with the committee in significant and lengthy meetings examining Bill C-14. We spent long days listening to witness testimony from experts and organizations from all over the country, and then doing a clause-by-clause analysis of the bill. Despite the many concerns voiced again and again by witnesses, there were no meaningful amendments made to the bill.
Bill C-14 is called medical assistance in dying, but make no mistake, Bill C-14 is physician-assisted suicide. It is important that we make this distinction. The gravity of the bill should not be undermined by the colourful wording. The bill would change Canada forever, and it would be naive to think that Canada's most vulnerable people would not be at risk under the bill in its present state. This is the most significant social re-engineering bill in the past 25 years, because it changes how we view the sanctity of life.
The Supreme Court was very clear that physician-assisted suicide is not a charter right, but it is an exemption that could be provided on an exception basis providing individuals meet certain criteria. The person must be a competent adult who clearly consents to the termination of life, who 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.
Bill C-14 clearly goes beyond the Supreme Court decision with a mandate to study making physician-assisted suicide available to mature minors, exploring the concept of advance directives, and providing physician-assisted suicide to mentally disabled individuals. This is just not acceptable.
The committee heard testimony from approximately 42 individuals and/or groups who all have a vested interest in this issue. Over 100 amendments were presented to committee based on evidence from witness testimony provided to committee. Sadly, the Liberals did not present any substantive amendments, and in fact, voted against any meaningful amendments presented by any of the opposition parties. The Conservatives presented many thoughtful amendments that would have strengthened the bill and added important safeguards, as they did last night at report stage. This is a missed opportunity.
Let me highlight just a few of these missed amendments, these missed opportunities.
These amendments included things like assuring that only trained and qualified medical practitioners, in other words physicians, would assess the individual and administer the lethal cocktail that would eventually procure death. The way the legislation is presently drafted, it would allow a person to obtain the lethal drug from pharmacists, take it home, self-administer, and procure their own death. This worries me, and it should worry every Canadian. Witnesses presented testimony that in other jurisdictions that permit this practice, 30% to 40% of prescriptions for death go unused.
What happens to these unused drugs? What if the drugs fall into the wrong hands? What if the drugs were not administered properly? What if they did not take all of it and complications set in as a result? How can we be sure that the individuals were not at some point pressured into it? There are just way too many unanswered questions in the bill.
The bill would also make it near impossible for medical practitioners to monitor and report on subsequent events. Did the patient self-administer the drug or did the patient die from an illness? How do we ensure that we have the correct data to track euthanasia in Canada? These are valid concerns being voiced by Canadians, and it could have been addressed in the amendments that we proposed at committee.
The Liberals are unwilling to consider an amendment to ensure physician supervision during the procedure.
In addition, Bill C-14 allows for nurse practitioners to provide medical assistance in dying. There are substantial differences between a medical practitioner and a nurse practitioner, including the length of time spent training and the ability to prescribe various narcotics, yet suddenly, in this bill, we are affording them the ability to assess an individual's eligibility for physician-assisted suicide and prescribe life-ending cocktails, which is in stark contrast to the typical expectations we have of nurse practitioners.
This goes too far and is another issue we sought to address in the bill. Again, this is a missed opportunity.
We also provided an amendment that would have removed psychological suffering as an eligibility consideration for physician-assisted suicide. This, quite simply, leaves too much room for interpretation. Allowing for psychological suffering as an eligibility consideration is the start of a very slippery slope in terms of who can receive physician-assisted suicide and for what purpose.
We also suggested that “reasonably foreseeable death”, as defined in the bill, would be replaced with imminent death or at least death expected within 30 days. We heard testimony from witnesses on either end of the spectrum raising various concerns about this wording. “Reasonably foreseeable” in one physician's eyes could be completely different in the eyes of another. This will certainly open the door to uncertainty among patients and practitioners, and will definitely lead to subsequent lawsuits.
To further strengthen safeguards, we proposed an amendment requiring that prior judicial review had occurred to ensure that all criteria for physician-assisted suicide eligibility had been met.
Dr. Will Johnston, chair of the Euthanasia Prevention Coalition of British Columbia, came to testify before committee. He said the following:
...although it might be assumed, nowhere specifies that doctors must actually examine the patient, the extent to which they must do so, or the extent that doctors must inquire into the internal and external factors that create vulnerability for the patient.
Dr. Johnston brings forward a valuable consideration. Bill C-14 does not stipulate to what degree a patient should be examined nor does it require examination of the factors creating vulnerability for the patient.
In addition, we know that this is a complicated matter and difficult to address in legislation. Every individual and every disease presents a different set of challenges. Judicial oversight would ensure that individuals meet all the criteria given their unique set of circumstances and would further protect Canada's most vulnerable people. Again, this very reasonable amendment was rejected.
We also put forward a request that palliative care consultation be included as a criterion for seeking physician-assisted death. Patients would be made aware of all options available to them and ensure palliative care options were understood, offered, and available.
We heard time and again in committee that access to palliative care is a problem in this country. We also heard that palliative care, especially chronic pain treatment and counselling services, is very successful at alleviating the suffering, depression, and anxiety, things that lead people to wish to hasten their death.
The minister spoke on palliative care, and insisted that palliative care and physician-assisted suicide go hand in hand, yet the committee refused to adopt palliative care consultations as a prerequisite component in the bill.
The Canadian Society of Palliative Care Physicians outlined the issue well before committee. They wrote:
In order to ensure that medically assisted death is not our first or only response to human suffering, we need to build in an explicit legal requirement to identify, explore and record the sources of a person’s suffering and attempt to address the motivations of his/her request for death. This should not be undertaken as a screening or determination process, but rather an opportunity to ensure that a person who requests an assisted death is fully informed of available options for treatment.... The Bill should be amended to incorporate a meaningful right for patients to be informed of the full range of available treatments, technologies and supports that could ease their suffering, whatever its source.
Palliative care consultations would protect patients and ensure that physician-assisted death does not become the first response to human suffering. I cannot understand why the government would not want to ensure patients have sought out all other alternatives before requesting physician-assisted death.
One of the things we were very clear about, which the evidence produced over and over again in committee, was the whole need for conscience rights protection, not only for individuals but institutions. This came across as a large concern. We presented several amendments to committee that would have met the concern of many institutions and individuals that may be forced or required to offer this service. These amendments were all rejected, not only at committee but they were rejected here last night at report stage as well. We find that unacceptable.
Anthony Housefather Liberal Mount Royal, QC
Madam Speaker, I want to congratulate my hon. colleague on the excellent work he is doing as deputy chair of the Standing Committee on Justice and Human Rights. While we disagree about the ramifications or the outcome of the committee hearings, I want to thank him for his part in the process. It is always a pleasure working with him.
I disagree that there were no meaningful amendments made at committee. There were 16 amendments made, including issues of conscience and palliative care. What is problematic is that we talk about the Liberals rejecting them, but the Liberals did not reject amendments that were proposed by the opposition and vote against them. I do not know of any occasion when the NDP, Bloc, and the Green Party agreed with the Conservatives. There were always differences and the Liberals were sort of in the middle, agreeing with some and not agreeing with others. Therefore, I do not think it is fair to say the government or the Liberals rejected the amendments.
I will give one example and ask my hon. friend if he can respond to it. My hon. friend spoke of an amendment that came up at committee related to—
The Assistant Deputy Speaker Carol Hughes
As I have mentioned, members have to try to keep their questions short so that others have the opportunity to ask questions as well. I will now ask the member to respond.
The hon. member for Provencher.
Ted Falk Conservative Provencher, MB
Madam Speaker, I am not sure what I am responding to, but I also want to make reference to my colleague from Mount Royal. He chairs the Standing Committee on Justice and Human Rights and he does a very admirable job. He serves us and this country well. He seeks to maintain a neutral and unbiased position, and gives us all an opportunity to present our concerns.
However, he is not completely accurate when he states that amendments were considered, because the consideration Conservatives asked for regarding conscience rights, in particular, was to have the bill amended, not merely to amend the preamble. The preamble states that no one shall be compelled by this legislation to perform physician-assisted suicide, but it does not provide specific and implicit conscience rights protection for health care individuals.
Cheryl Hardcastle NDP Windsor—Tecumseh, ON
Madam Speaker, I want to ask my hon. colleague to expand on the issue of amendments being addressed. Would he agree that no opposition amendments were accepted that were to the core provisions of the bill and that they were mostly minor or technical clarifications in nature?
Ted Falk Conservative Provencher, MB
Madam Speaker, I want to thank my colleague for that question because she is absolutely correct. There were no meaningful amendments directed toward the core of the bill that were accepted. The amendments that were accepted were minor in nature, or technical. The only substantive amendment of any sort, which is weak, is that there will be a palliative care review conducted every five years, along with a review of physician-assisted suicide legislation. Other than that, there were no amendments accepted by the Liberal government from the NDP, the Bloc, the Green Party, or the Conservative Party that were of any consequence.