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.

[Jody Wilson-Raybould, Liberal, Vancouver Granville, BC]

Again, I would look around the table and thank all members of this committee for the substantive discussions that have been had around Bill C-14 on medical assistance in dying.

To your question, the June 6 deadline of the Supreme Court of Canada is incredibly important, and our government is committed to doing everything we can to meet that deadline, recognizing where the proposed legislation is within the House of Commons, acknowledging the substantive work that senators have done in their pre-study phase, and recognizing the work that they will continue to do in considering Bill C-14. I would stress, again, the importance of meeting the June 6 deadline. We are doing everything we can to ensure that is the case. Not meeting the June 6 deadline, as you rightfully point out, would leave a vacuum in terms of the law, in terms of the application of medical assistance in dying in this country, with regard to eligibility. The court application process for exemptions would no longer exist. There would be no safeguards in place. Medical practitioners would have uncertainty around how the Carter ruling would be applied, and I think, further to that, in terms of patients who want to access medical assistance in dying, they would be limited in doing so, given the uncertainty that would exist. As you know, in this country, the only jurisdiction that has a law around assistance in dying is Quebec, so I am very committed to ensuring that we do everything we can to meet that June 6 deadline.

[Michael Cooper, Conservative, St. Albert—Edmonton, AB]

Thank you, Minister. It certainly seems that it has become quite urgent when we see, for example, in Alberta a serious fraud case thrown out. It looks as if this week perhaps two sexual assault cases may be thrown out for delay, so I would reiterate that the appointments are urgently needed now, but I appreciate the answer.

Turning to a different topic with the remaining time I have, the June 6 deadline that the Supreme Court issued to the stay on the declaration of constitutional invalidity is coming up. Obviously, Bill C-14 is moving forward in the House of Commons, but in conversations I have had with Senate colleagues, there seems to be a general consensus that the legislation may not get through the Senate by the June 6 deadline.

In that scenario, what steps is the federal government going to take? What are you going to do as minister? Would you, for example, consider bringing forward an application to the Supreme Court for a short-term extension to allow sufficient time to make sure that legislation can get passed before we end up in a situation where there could be a vacuum with no law and no certainty for physicians, for patients, and no safeguards for the vulnerable?

Third Reading

[Adam Vaughan, Liberal, Parliamentary Secretary to the Prime Minister (Intergovernmental Affairs)]

Mr. Speaker, it is interesting to listen to my colleague across the way, on two fronts: one, the very strong arguments he made that legislation can in fact protect good-paying jobs; two, that government interaction can generate growth in the employment sector.

However, what I would like him to comment or reflect upon is that the previous Conservative government had carriage of this file. It came to the conclusion—I think I am paraphrasing it correctly—that effectively it agreed with Air Canada that there was no provision to legislate there. It concluded that the legislation was weak and that it was not going to intervene. Effectively, it decided to do nothing.

Was doing nothing on this file preferable to securing the jobs that would be secured through Bill C-14? Was the previous government's position of doing nothing on this file but agreeing with Air Canada on it having no obligation to do any work in any one of these major cities in fact the responsible direction to go, or is this position an advancement, by the fact that it protects real jobs in real cities?

Citizenship and Immigration

[Dominic LeBlanc, Liberal, Beauséjour, NB]

Mr. Speaker, there have been discussions with the parties and I am hoping that if you seek it, you would find unanimous consent for the following motion. I move that, notwithstanding any Standing Order or usual practice of the House, on Tuesday, May 17, 2016, and on Wednesday, May 18, 2016, the House continue to sit beyond the ordinary hour of daily adjournment for the purposes of considering Bill C-14, an act to amend the Criminal Code and to make related amendments to other acts (medical assistance in dying).

Democratic Reform

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

Mr. Speaker, in his answer, the government House leader tried to reference the thinly veiled attempt to bring in closure last week through Standing Order 56.1. Therefore, I have a motion that I was wondering if I could get unanimous consent on. It is that, notwithstanding any standing order or usual practice of the House, on Tuesday, May 17, 2016, and on Wednesday, May 18, 2016, the House continue to sit beyond the ordinary hour of daily adjournment until midnight for the purposes of considering Bill C-14, an act to amend the Criminal Code and to make related amendments to other acts, and at midnight or when no member rises to speak, the House shall adjourn until the next sitting day.

Physician-Assisted Dying

[Jody Wilson-Raybould, Liberal, Minister of Justice and Attorney General of Canada]

Mr. Speaker, this a deeply personal and complex issue, which I have been working on with the Minister of Health and with every member in the House. We are committed to ensuring that we move forward with Bill C-14, to hear robust dialogue and debate, and to ensure that we strike the right balance between ensuring personal autonomy and doing as much as we can to protect the vulnerable.

This is what this piece of legislation does. I am hopeful that we will continue to have discussion, because this is not going to be the end of this discussion. We will consider this as a country—

Physician-Assisted Death

[Dan Ruimy, Liberal, Pitt Meadows—Maple Ridge, BC]

Mr. Speaker, unlike the previous government, we believe in the importance of parliamentary debate, all the while keeping in mind issues such as Supreme Court deadlines.

I believe we have a responsibility to ensure that all members of Parliament who want to participate in debate on legislation such as Bill C-14 should be able to do so.

Could the Leader of the Government in the House of Commons inform the House as to the intention of the government in regard to the debate on Bill C-14 at report stage and third reading?

Opposition Motion—Freedom of Conscience

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

Madam Speaker, I am very pleased to participate in this important debate about conscience rights. It is an honour to follow my friend, the member for Cypress Hills—Grasslands. I want to, particularly, salute the great work done on this motion by the member for Peace River—Westlock, someone who is making a great contribution here, not just with his clever S.O. 31 rhymes but also with his substantive contributions at other times.

I think we have had a good debate today, but at the same time, as much as our conventions are to take a liberal view of topicality, there has been a lot of discussion about aspects of Bill C-14 that do not directly relate to conscience. Maybe that underlines the fact that there actually should have been more discussion of Bill C-14 at second reading. I hope there will not be closure on it at third reading.

I want to focus my comments today on this specific opposition day motion on the issues of conscience.

First of all, right off the bat, I want to underline what we are talking about here. The government has talked about an amendment that was brought in at committee to the legislation that discussed conscience rights. I say, “discussed conscience rights”, but it did not protect conscience rights.

I want to read that amendment so members know exactly what we are talking about. It is on page 8 of the reprinted bill, lines 32 to 34:

For greater certainty, nothing in this section compels an individual to provide or assist in providing medical assistance in dying.

Let us be clear about what that section says, “nothing in this section compels an individual”, etc. The concern was never that this section compelled individuals, but rather, that the interaction of this legislation and policies at the provincial level, which are pre-existing, which we know exist, without the protections in this legislation will have the effect of a violation of conscience protection.

It is sleight of hand for the government to say there is nothing in the legislation by itself. It is precisely the interaction of the legislation with existing policies that causes the problem.

The government has quite correctly pointed out that Conservative members supported this amendment, because it was a very small step in the right direction. However, on the many substantive problems to the legislation, which we proposed amendments about, we did not see any support from government members. We proposed robust, serious conscience protection, things that would not just reference conscience but would actually protect conscience. We proposed those amendments. The member for St. Albert—Edmonton and others did an excellent job of presenting and advocating those, but unfortunately, to no avail.

That is what we are talking about, whether or not the legislation should contain robust, meaningful protection of conscience.

For all those members who have, today, paid lip service to the idea of conscience, I ask, “Why, then, did the members in the committee not support things that would take the necessary action to protect conscience?”

We have heard a number of different arguments about this issue. We have heard that conscience rights are already protected in the charter, so we do not have to worry about them because they are already part of our underlying laws. Yes, it is correct to say that conscience rights are in the charter, but it is not at all sufficient to say that we do not need policies and legislation that ensure those charter principles are actually implemented.

Why is this important?

First, courts are going to show some degree of deference to the legislature when they are interpreting the exact application of these rights. It is important for the legislature to be clear about the importance of conscience rights to us and how we would like to see it operationalized in particular situations.

It also provides certainty. Without the certainty of guaranteeing positive conscience protection in the legislation, people will have their conscience rights violated, at least in the interim, and will be forced to go to the court to seek a remedy.

I am of the view that the current College of Physicians and Surgeons' policy in Ontario does violate section 2 provisions around conscience in the charter, but this now requires what is happening now, which is a legal challenge. For the time being, it creates a great deal of problems and uncertainty. It prevents many medical practitioners from participating effectively in serving their patients.

It is not enough to just say we have these guarantees in the charter so we do not need to think about them. No. We need to ensure that the rights of conscience are protected in policies and in legislation. That is why we want to see positive conscience rights protection here.

There has been some discussion, as well, about this jurisdictional question. It is curious that the government says, on the one hand, “We've provided conscience protection in the legislation”, and then it says, on the other hand, “Conscience protection is not something we can provide; it's at the provincial level”.

Which is it? Its arguments against the motion are in fact mutually exclusive.

Let us be very clear. This legislation does not provide positive conscience protection, but given that the legislation, Bill C-14, is describing the contours of an exception to the Criminal Code, it is very much within our rights, as the legislature, to say that the exception we are creating in the Criminal Code has conditions and exceptions within it.

There is no principle problem with doing that. Again, as has been discussed, this is something that has been done before when the federal government is involved in areas describing the contours of those exceptions and ensuring conscience protection.

We often talk here about the importance of pluralism, about the value of Canadian multiculturalism. Protection of conscience is an essential part of our fabric as a multicultural nation. People come here from other places, people who have lived here for a long time. They have different kinds of traditions, different kinds of values. Multiculturalism is not just that we look different and eat different food but that we can have substantive different perspectives on what constitutes the good life, and that we can live out those conceptions in our lives and that we can have respectful discussions with each other about those different conceptions of the good life.

However, it is important to have that meaningful robust concept of multiculturalism, of pluralism existing, and that we do protect rights of conscience and religion. It is not enough to just pay lip service to these concepts, like pluralism, they need to be protected. Conscience rights provide the foundation on which a well-functioning pluralistic and multicultural society is built.

I want to underline as well that conscience rights are a right of non-interference. They are not a demand to interfere in someone else's life. An expectation of the protection of a conscience right is simply the expression of someone saying, “Just leave me alone. Just let me do my own thing with my own medical practice. I am not going to interfere with someone else, but just let me do what I wish to do within my own sphere.” That is all those who are seeking conscience protection are asking for.

Therefore, why will the government not ensure that the doctors who want to provide good service to their patients, who want to provide palliative care and other necessary services, and who may have a different conception of the good life or of some of these moral questions than others do are left alone? They are not asking for anything special. They are asking to be left alone so that they can continue to do the good work that they want to do.

One of the counter-arguments we hear is that health care is public, so given that there is some degree of public involvement the state should somehow be able to dictate the terms of health care up to the point of taking away individual conscience rights. Is it not curious that as soon as the state is partially involved in something there is this automatic assertion that conscience rights and the rights of the individuals involved go out the window?

Given that health care is, in practice, provided as a partnership between state funding and individuals who are acting within that system who are motivated not just by the funding that comes from the state but by values, compassion, and a desire to serve their patients, and given that health care is a partnership between community groups, volunteer donors, those who fundraise for local hospitals, as well as the state, why not protect the conscience rights of individuals and of institutions so that they can continue to provide services that reflect their values?

We have talked a lot here about law, theory, and principles of rights. Let us bring this back to something very concrete and practical.

I have mentioned Dr. Nancy Naylor before, who is a palliative care physician in Strathroy, Ontario. I have not spent a lot of time in Strathroy, but I do not suspect that there are a very large number of palliative care physicians there. She is leaving the practice of palliative care because she is concerned that her conscience rights will be infringed as a palliative care physician.

We can talk back and forth about the theory of the rights that are at play here, but never mind the doctor and her career, what is the cost to this doctor's patients, the many people who do not want to die and who just want access to good quality palliative care? What about them? Every time a doctor is forced to leave a jurisdiction because of an infringement on their conscience rights that affects those patients who lose access to that family doctor or palliative care physician. That affects far more patients than the doctor or the doctor's family.

Whatever members think about this arguably important theory of conscience rights, they should think about the impact on patients and about the impact on our already woefully inadequate system of palliative care.

I ask members to support this important motion.

[David Anderson, Conservative, Cypress Hills—Grasslands, SK]

Madam Speaker, we have a motion before us today with a few basic points, and it seems to me that conscience rights for health care professionals are a fundamental freedom, and I argue that they are guarded and protected under the Charter of Rights and Freedoms. However, the failure to protect those conscience rights within our health care system cannot do anything but damage our health care system.

We have a private member's bill, Bill C-268, that addresses these issues and specifically talks about giving people the opportunity to be able to exercise their freedom. I appreciate the minister's attention to this bill. Earlier today, though, she said that this does not create a duty that was not there before. I would argue that actually it does, because this is new ground. This is completely new ground that we are going into. There has never been an expectation in the medical community before that health care providers need to participate in causing death. There are new duties being created here that are not being addressed by Bill C-14 that need to be. We need to stop, take a look at it, and then try to reapply some of those things that are important in terms of conscience rights.

[René Arseneault, Liberal, Madawaska—Restigouche, NB]

Madam Speaker, I listened closely to our colleague's comments and concerns. I attended public hearings during which the Canadian Medical Association said that freedom of conscience for doctors who would be responsible for providing care related to medical assistance in dying would not be a problem because so many doctors are okay with making that kind of assistance available.

I would like my colleague to tell us more about why he thinks it is important, essential even, for Bill C-14 to include a specific provision on freedom of conscience for doctors and people who will provide care related to medical assistance in dying.

How can we square what he thinks is so important with the Supreme Court's requirement in Carter, which does not mention that issue but says instead that we have to help non-vulnerable people get that assistance?

[David Anderson, Conservative, Cypress Hills—Grasslands, SK]

Madam Speaker, I am splitting my time with the member for Sherwood Park—Fort Saskatchewan.

I am a little confused as are some people here with the back and forth. Conservatives take Bill C-14 very seriously and we want to debate it. I was surprised a little earlier when it seemed the Liberals wanted us to go all night, through the night. I assume that means they would like to speak during the day and then leave the opposition to speak at night when supposedly no one is listening. I think a reasonable compromise was suggested a couple of minutes ago, which is that we extend the hours to midnight, during which time we would have serious debate on this issue.

That is why we are here today. It is interesting that the notion of freedom of conscience seems to be coming up more and more in our society. In the last couple of weeks, I have crossed paths with it in discussions separate from discussions around Bill C-14.

Yesterday, at the Subcommittee on International Human Rights, someone spoke about working with persecuted minorities and the question came up about what role freedom of conscience plays.

Last week, there was a forum in town about making the world safer for diversity. Dr. Os Guinness talked about how freedom of conscience has always been properly understood as the very first right. We can talk about life, liberty, and happiness, but without freedom of conscience, none of those other things actually exist in reality.

Everybody has beliefs that are important to them. I guess it is a common misconception we have that others have beliefs and I am the one who is unbiased. Each of us brings valid perceptions to these discussions and in our culture, until recently, it seemed that we were generally of the opinion that no one has the right to force anyone to work against their own beliefs.

It seems as we focus more and more on rights and less and less on responsibilities, we find ourselves pressured and I think we have to admit that we often find ourselves pressuring others on their values of conscience and the core values that people hold. It is beginning to affect every area of our culture. With the Carter decision, this has come to the forefront, because it is no longer just perceived discrimination that it is impacting, but it comes right down to the court's decision that having the right to kill oneself is a charter right.

I will take a bit of time to look at the Carter decision. It was a reversal of a previous decision, the Rodriguez decision. The court ruled that we now have, as Canadian citizens, a charter right to kill ourselves and we have the right to have others help us. There are very few guidelines that the court put on that decision. It talked about how the condition had to be irremediable and a grievous condition, basically beyond the person's decision to suffer through it. I could go into the criteria for that, which perhaps I will do a little later.

While the court decided one decision, it created a whole host of other complications. One of them, of course, is the call to reconcile physicians' and patients' rights. The question we are dealing with today is what role others have to play or do they play in that decision to prematurely end life.

Bill C-14 does not solve that. I was glad to hear the minister acknowledge that earlier. Conscience issues are becoming the biggest issues around Bill C-14. In this case, I would argue that the government has failed Canadians.

There is a legitimate question to be asked and I am surprised that it has not even been discussed—it is not discussed in other countries either—as to why medical personnel are expected to be involved at all. However, they are, and even though they are, most of them do not want to participate. The medical personnel whom I have talked to are not accepting of or enthusiastic about this. I have spoken with a number of doctors who say that if they are forced to participate in this, they are willing to leave the country, that they are not going to participate. For those of us who live in rural areas and have a very small supply of medical care, it is a frightening thing to hear one's doctor say he or she is prepared to leave if this is forced on him or her.

I want to talk about the protection of conscience in Bill C-14. The preamble states:

Whereas everyone has freedom of conscience and religion under section 2 of the Canadian Charter of Rights and Freedoms;

Whereas nothing in this Act affects the guarantee of freedom of conscience and religion;...

That is the preamble, which has no legal impact. There is no content within Bill C-14 that provides this balance.

The Senate committee heard some great testimony. The Justice Centre for Constitutional Freedoms said:

...the Court discussed and reiterated the conscience and religious rights of medical practitioners, stating that, “nothing in the declaration of invalidity which we propose to issue would compel physicians to provide assistance in dying.”

However, then it went on to say, “the Charter rights of patients and physicians will need to be reconciled. Thus, it is apparent that the Court intended Parliament’s legislative response to address the issue of medical practitioners’ conscience rights. Bill C-14 fails to do so.”

It is interesting to me that Bill C-14 actually provides protection for participants, but it does not provide protection for those who do not want to participate. There is an exemption for medical assistance in dying where it says that no medical practitioner commits homicide if they provide a person with medical assistance. It says that no person is a party to homicide if they do anything for the purpose of aiding in that. Then it says that for greater certainty, if the person has any reasonable, even mistaken, belief about any fact that is an element of the exemption, they have no legal responsibility for that.

I just point out that protection for participants has been included for those people who choose to participate, even if they are mistaken in what they have done. I can find no similar parallel protection for those who conscientiously object.

Some have said to pass it on to the provinces. We just heard that a minute ago from my colleague from the NDP. I would argue this is not a provincial issue. If it is, there will be a dozen different scenarios in this country and then the courts will get even more involved than they have been. It is a Criminal Code issue. Why would we give legislative protection in a bill to those who want to participate and then argue that Parliament has no right to legislate protection for those who do not want to take part?

The executive director of the Christian Medical and Dental Society said at the Senate committee:

...what our members cannot do is perform or participate in what is referred to as medical assistance in dying. To be clear, by participation, I also mean playing a role in causing death by arranging for the procedure to be carried out by someone else through referral.

He went on to say that the current preamble respects the personal conviction of health care providers, but it does not have any legal weight, and that no foreign jurisdiction in the world has legalized assisted suicide and euthanasia and then forced their health care workers in hospitals, nursing homes, and hospices to act against their conscience, their mission, or their values. He said that to force providers to act in this way in Canada would actually be to violate section 2 of the Charter of Rights and Freedoms.

It is necessary that the federal government legislate protection of conscience rights for health care professionals in order to respect the charter and to protect our existing health care system. Federal legislation would send a clear signal to provinces, organizations, and the courts that the right of conscience must be protected.

I argue that because medical personnel and supervisory groups cannot and will not agree, Parliament should set those guidelines, and they should be set in the Criminal Code.

A minister said a little earlier today that the protection is in the charter, not in the Criminal Code, but I think that is exactly the concern that Canadians have. The charter interpretation has gone 180° on the issue of assisted suicide, and there is nothing keeping that from happening as well on section 2 of the charter.

We need conscience rights. What are they? They are the right not to participate, the right not to be forced to refer. They are a fundamental freedom guaranteed by section 2 of the charter.

We need to protect the health care system. As I mentioned earlier, I have been told by physicians that they are prepared to leave if they are going to be forced into this, and they are not prepared to go against their own conscience. The Ontario college is making a big mistake in thinking that it can force doctors to do this against their conscience. I am not sure why it thinks it needs to control others who are just trying to do the right thing.

There were other suggestions that we heard a little earlier. For example, what is wrong with allowing patients to transfer their medical care to a doctor of choice? How about a directory of doctors so people can identify doctors who provide such services? We live in an electronic age, that should not be difficult. It would give Canadians confidence they could find medical personnel who would not be acting contrary to their care.

We need to protect the charter right of health care professionals. We need to make it a criminal offence to intimidate or coerce the health care professional to take part directly or indirectly in assisted suicide or euthanasia and to make it a criminal offence to dismiss anyone from employment for taking that position.

As I wrap up, I just want to come back to the point that no person should be put in a position where his or her private rights, which are guaranteed by the charter, are removed by force. Nothing is more fundamental than being able to live out that which we believe, especially if that belief is aimed at supporting and preserving life.

[Kevin Lamoureux, Liberal, Winnipeg North, MB]

Madam Speaker, I was actually going to address the point of order raised, but if it is necessary to bring up a separate point of order, I will do it as a separate point of order.

I just want to say that I am very much aware and sensitive to the many negotiations that are taking place surrounding Bill C-14. Having said that, the government's will has always been to try to allow members to address the bill. That is the reason we brought forward the motion earlier today—

[Irene Mathyssen, NDP, London—Fanshawe, ON]

Madam Speaker, on a point of order, I would like to say that we are very disappointed in what is going on in the House regarding Bill C-14. It is very serious legislation. Currently, there are sensitive, ongoing negotiations being conducted in regard to it, and those negotiations should be respected.

[Anne Minh-Thu Quach, NDP, Salaberry—Suroît, QC]

Madam Speaker, I would like to know if the member can find an obligation anywhere in Bill C-14 for professionals to refer patients. I cannot.

The whole issue of referral rests with professional associations, so it is under provincial jurisdiction. As federal MPs, we are obligated to respect provincial jurisdiction and every individual's basic right to equal access to medical assistance in dying.

[Anne Minh-Thu Quach, NDP, Salaberry—Suroît, QC]

Madam Speaker, I think we all agree that it is important to protect professionals' freedom of conscience.

The reason I oppose the Conservatives' motion is that they are eliminating the possibility of referring patients to other professionals. If we adopt the Conservatives' motion, patients will no longer have the right to request medical assistance in dying as they do now thanks to the Supreme Court's ruling.

We have to respect patients' rights and freedoms. Bill C-14 does not force health care professionals to refer patients elsewhere if they conscientiously object.