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.

Physician-Assisted Dying

[Justin Trudeau, Liberal, Prime Minister]

Mr. Speaker, on Bill C-14, Canadians understand that this is an important and big step in our nation's history as we move forward on a delicate issue under a time crunch by the Supreme Court.

One of the things Canadians expect is that we take this very seriously and responsibly, and that is exactly what we are doing before committee, and that is what we have been doing with these consultations.

The NDP has put forward amendments to enlarge the scope of the allowances. The Conservatives are putting forward amendments to further restrict it. We are listening to all proposals. We are working hard to ensure that Canadians have the right legal framework to help them with these incredibly personal and sensitive decisions.

[Thomas Mulcair, NDP, Outremont, QC]

Mr. Speaker, a number of experts and legal professionals have serious concerns about the constitutionality of Bill C-14. The legislation could be challenged in court, but in committee, the Liberals have rejected nearly all of the amendments that would have fixed the bill.

What is preventing the Prime Minister from seeking the Supreme Court's opinion on Bill C-14?

With so many raising concerns about the constitutionality of Bill C-14, why will the Prime Minister not simply refer the bill to the Supreme Court to avoid years of legal challenges.

Second Reading

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

Mr. Speaker, I thank my colleague from Saint-Hyacinthe—Bagot. I will not forget the name this time. I have had the great pleasure of working with her on Bill C-14.

Six months ago, Canadians had their say. We are democratic and we respect their choice. If we had been perfect, we would not be on this side of the House. Each government has its own experiences. The reality is that these people got elected by making promises, and now they are doing the complete opposite. That is the reality. These people got elected by promising that there would be a small $10-billion deficit. How big is the deficit now? It is $30 billion. They got elected by promising that they would make tax changes without any cost to the public, but those changes will cost $1.7 billion. These people were elected on a platform, but they are not following through on it.

This is insulting, and it only adds to Canadians' cynicism about politics.

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

Thank you. I appreciate the time to speak to this. Most people around this table—all the people around this table—are friends of mine, and this is both a parliamentary matter of principle and it's also intensely personal. This series of motions that are just being passed, I've been considering whether it will have an immediate effect on my health or merely take years off my life later, and I'm not saying this facetiously. I'm saying in all honesty that this is terrifying for me personally.

What we're facing here is a couple of fictions. The first fiction is that my friend Mark Gerretsen says this is his motion. I know he didn't write it. It was written under the PMO in the previous government. The second fiction is that parliamentary committees are the masters of their own proceedings. It stretches credulity to imagine that parliamentary committees, all of a sudden in the fall of 2013, all automatically adopted the same motion and that it has sprung into the mind of all parliamentary committees simultaneously in the spring of 2016 to do it again.

This is changing the way in which legislation goes through Parliament, changing parliamentary procedures without going through the trouble and the steps it takes to change Standing Orders and change rules. This is the last step required, if every parliamentary committee does this after every election in every session of Parliament. This is essentially taking report stage and making it an anachronistic redundancy, as opposed to being what it was historically, an opportunity for parliamentarians as a whole, not merely members of committees, to suggest amendments.

The brief history of this is that up until the year 2002, members of Parliament of all parties had the right to put forward amendments at report stage. As a result of a 1999 effort by the Alliance party at that time, more than 700 amendments to the Nisga'a treaty were put forward in an attempt to derail it at report stage. The party in power at that time, the former Liberal government of Jean Chrétien—Don Boudria as House leader—retreated to a long process. It took them a couple of years to actually change the parliamentary rules such that a member of Parliament who had an opportunity through their party to put forward amendments to a bill in committee had no such right to put forward further substantive amendments at report stage.

That created the unintended reality that the only members of Parliament with an opportunity to put forward substantive amendments at report stage were those who, again through an irregular process creating two tiers of members of Parliament, were in parties smaller than 12 or sitting as independents. We were the only ones who did have rights to put forward amendments at report stage.

The only remnant of what report stage has been historically, going back through Westminster parliamentary democratic history, was the ironic reality that only members in parties with fewer than 12 had rights to put forward amendments at report stage, because we'd had no opportunity in committee; hence the creation of a fake opportunity of running from committee to committee to put forward amendments, but having no right to move them—as you see in this motion, they're “deemed to have been moved”—having no right to vote on them, and having no right to do anything other than pursue a brief opportunity to make a representation in support of them.

The reality for me personally is that many times committees will be doing clause-by-clause consideration at the same time. I raced to the environment committee in the 41st Parliament with amendments to keep seismic testing out of Sable Island National Park and got there too late. My amendments had all been defeated because I was tied up in a different committee trying to put forward amendments on a different bill.

This creates a virtual impossibility for me personally. Now, I'm very well aware that you've all been told this has to be passed and has to be passed today. Earlier today, the national defence committee was told they had to pass it and had to pass it without giving me an opportunity to speak, because, to make my point, I was tied up with BillC-14, where I'd been summoned to the justice committee to do my amendments there.

[The Chair, Liberal, Larry Bagnell]

Good morning. This is meeting number 20 of the Standing Committee of Procedure and House Affairs for the first session of the 42nd Parliament. This meeting is in public and is being televised.

In our first 15 minutes today, we'll continue our inquiry into the question of privilege related to the matter of premature disclosure of the contents of Bill C-14. In the second hour, we will resume our study of initiatives towards a family-friendly House of Commons. The Clerk of the Ontario Legislative Assembly will appear by video conference.

What we're planning to do, because our time has been truncated, is to just have the opening statements by the Clerk and the Law Clerk.

You have lots of time, because we're not going to do the hour of questioning now. We'll postpone that to another time—so we don't infringe on anyone's privilege by not getting questions and start another case.

[Sean Casey, Liberal, Charlottetown, PE]

I want to put the government's position on the record.

This amendment is well intentioned, but because the amendment is drafted in the conditional, it's incompatible with acceptable language for Criminal Code provisions. You may want to get the view of the officials on this.

The criminal law sets minimal standards for acceptable behaviour in society. Conditional circumstances are typically better addressed by medical practice regulation.

Also, uncertainty would be created. It's unclear if it places an obligation on the medical or the nurse practitioner to determine whether the person has difficulty communicating or what degree of difficulty would trigger the provision. If there's a desire to require additional communication technologies or resources for certain classes of persons, it should be left as a matter of medical practices to be determined by the provinces and medical regulators.

Bill C-14 already requires medical and nurse practitioners to provide medical assistance in dying with reasonable care and skill, according to any applicable provincial standards. This is sufficient to address the concern raised by the amendment, which is unnecessary in the government's view. Existing informed consent procedures require that a person understands the medical options available to them.

[The Chair, Liberal, Anthony Housefather]

Ladies and gentlemen, good morning.

It's a pleasure to call this meeting of the Standing Committee on Justice and Human Rights to order as we resume our clause-by-clause consideration of Bill C-14.

It's a pleasure to have you all here this morning. I hope our discussion continues to be fruitful.

Yesterday was a long session, and I really appreciated everyone's openness and tone. It was an excellent session in terms of tone, and I hope that continues today. I'm sure it will.

We are starting from where we left off, with amendment PV-5.

I'm going to turn to Ms. May to explain PV-5.

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

I think especially now, knowing that Mr. Bittle's amendment is being withdrawn, this is the only chance to amend proposed paragraph 241.2(2)(b) to ensure that we are not insisting upon an additional condition.

It was not part of the Supreme Court of Canada rationale. There was no suggestion in the decision of the court in Carter that one must have an advanced state of irreversible decline and capability. Again, the Dying With Dignity group asked that this entire clause be struck.

I'm hoping that my compromised effort here will meet with support from Liberal members of this committee.

Please pass at least one opposition amendment to BillC-14. I think it will improve our sense of a healthy democracy.

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

Thank you, Mr. Chair.

As I suggested in the opening to my last amendment, in a series of amendments I'm attempting to restore proposed subsection 241.2(2) to a status of definition that's compliant with the Carter decision.

I note that some of the witnesses before the committee asked that this subclause be removed in its entirety. In this one, I haven't gone as far with my amendment as the Dying With Dignity witnesses asked you to do, but what I have done is remove the word “advanced,” so it would now read, “they are in a state of irreversible decline in capability” as opposed to “in an advanced state of irreversible decline”.

The position of Dying With Dignity was that this would force years of severe, unwanted suffering upon people who have a grievous and irremediable medical condition, but who have not yet reached the end stages of their medical condition.

The use of the word “advanced”, again speaking of terms that are imprecise, speaking of areas where we don't have clear medical guidance, in this context is unhelpful in meeting the guidance that we have from the Supreme Court of Canada, and imposes on people who otherwise meet the tests of BillC-14 unnecessary, additional suffering and grievous harm, denying them of their rights for longer than legislators should do.

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

I appreciate, Mr. Chair, the latitude to those of us who are pulled to committee by the motion you passed and don't have the opportunity to present it at the report stage.

I appreciate the chance to plead once again with the Liberal members of this committee to consider that passing Bill C-14 with the language that you find in subparagraph (a)—and then I'll come back to (b) and (d) on other amendments—will have the effect of passing legislation that is not charter-compliant. It will be one that does not meet the standards of section 7 of the Charter of Rights and Freedoms and will create more litigation and more uncertainty instead of doing what's required of lawmakers, regardless of personal opinion or lobby efforts by groups that failed at the Supreme Court of Canada. We have a unanimous Supreme Court of Canada decision, and it's our obligation to meet its terms.

[Sean Casey, Liberal, Charlottetown, PE]

Thank you, Mr. Chair.

I just want to give you the government's position with respect to this amendment. The government opposes this amendment. There is no certainty or clarity around what is meant by “grievous and irremediable medical condition”. The Canadian Medical Association has stated that there is no shared meaning of what constitutes “grievous condition”.

If practitioners interpret it broadly, for example to apply to persons with permanent physical disabilities who are otherwise in good health or persons who have just been diagnosed with a degenerative disease, it could increase the risks posed by medical assistance in dying to vulnerable persons, could contribute to the stigmatization of the quality of lives of persons with disabilities, and potentially undermine suicide prevention.

This amendment is also fundamentally contrary to the government's policy choices as reflected in Bill C-14. As introduced, Bill C-14 contains the clarity that is needed to give confidence to medical professionals to undertake what is otherwise a criminal act.

Thank you, Mr. Chair.

[Rob Oliphant, Liberal, Don Valley West, ON]

I'm speaking in favour of the amendment. I wanted the committee to be clear about a case that the Court of Queen's Bench of Manitoba ruled on last Friday. This is the case of a woman referred to as patient No. 2, the second case under the four-month interim regime from the Supreme Court of Canada, where each province defined its own system with a pre-authorization by a judge.

The judge heard the case of a woman in her fifties who has ALS and has an expectation of living three to five years. She has a disease that is irremediable. She has suffering that is intolerable to her. However, one would not be able to say her death will take place in the reasonably foreseeable future, nor is she necessarily in a decline.

One can argue that her status is very similar to Kay Carter's. However, she is about 30 years younger. I have heard it argued that Kay Carter was elderly. Therefore, her death was foreseeable in the future. This would not be the case of patient No. 2. The judge in this case was taking her leave from the Carter decision and applying it in this case.

If this amendment is not passed, would this patient be allowed a dignified death if Bill C-14 passes unamended? That would be my concern, and that is why I speak in favour of the amendment.

It's important for the committee to be clear that there are cases in which people may be seeking death right now, before this bill is passed, because they fear they would be ineligible to receive the right granted under the Carter case at this time.

That is a grave concern I have. I believe this case should be strongly considered by a judge who has read the law well and is concerned about the nature of this bill. That's all I have to say.

[Mark Warawa, Conservative, Langley—Aldergrove, BC]

The committee has said no to prior judicial oversight. The only form of oversight at this point...and the Carter decision...were that we had a regime with strict safeguards, including enforcement. To this point, Bill C-14 does not have that oversight, other than two physicians or two nurse practitioners. But there is no oversight—no judicial oversight, no oversight whatsoever. We're relying on two people of that competence to end a life, to assist in the ending of a life of an individual at the individual's request.

If we want to amend this, I'd be in favour of amending it, but you would need...and we heard this from testimony. I'm thinking of the special committee; I'm not sure if this committee heard that from the witnesses. There was an encouragement to make sure you do not have the physicians putting themselves in a very dangerous position where the government of the day says that in this case, if there was a charge or a complaint made against a physician or a nurse practitioner, they did this inappropriately. Maybe a family member would not be happy with how the situation was handled, and now we have these physicians in a very dicey situation where they could be charged with homicide.

The encouragement was to have some sort of oversight. I think this is an attempt to provide some oversight—if not judicial, because of concerns it would delay, then in another way.

In the spirit of what is being attempted here, if we don't want a minister of health, is there an appetite to have any oversight? I think it's needed. We've heard that it was needed. Without it, you're going to leave physicians vulnerable to possibly being charged. I appreciate the spirit of it. Maybe we need to find another way.

The other thing, Mr. Chair—and I think it's salient—is that we have one approved amendment to this point. It was a Liberal amendment—and that's good. It was a good amendment; it actually got unanimous support. But that was it. I think that when we, through the discussion, through the debate, highlight some needs for changes, we need to seriously consider them and amend them, if appropriate.

[Mark Warawa, Conservative, Langley—Aldergrove, BC]

I would suggest otherwise. We did hear from medical professionals who spoke to the committee, who said that physicians may not have that talent, that skill level, that expertise, to be able to determine whether or not the patient, the person requesting assistance in medical aid in dying.... That medical GP or nurse practitioner may not have that expertise, and in some cases will not have that. Yet, Bill C-14 will give them the authority to make that assessment without any expertise. We heard clearly from the CMA and other medical professionals on the importance of having a proper assessment.

We've also heard comments of the importance of being Carter-compliant. It was a competent, consenting adult. If somebody is not competent, who has an underlying medical or psychological or psychiatric condition, and you have somebody who is not an expert to determine whether or not they're competent, you'll end up putting at risk vulnerable Canadians.

I think the amendment is very appropriate. It's not redundant; it's necessary. For clarity of the legislation, it should be supported.

[Mark Warawa, Conservative, Langley—Aldergrove, BC]

Chair, I would agree with Mr. Fraser. I think he's captured it quite well. This is Carter-compliant and I think Bill C-14 as written is superior to what is being proposed in the amendment, so we will be voting against the amendment and supporting the language of Bill C-14.