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.

[Carole Morency, Director General and Senior General Counsel, Criminal Law Policy Section, Department of Justice]

The thing that I would draw to the committee's attention—and maybe the member who sponsored it could explain if there's a different rationale—is that it looks to me like it's similar to the process that the Supreme Court has stated as a result of the additional four-month extension on the suspension of the Carter decision, which is that individuals who wish to seek out medical assistance in dying can do it currently through an application to a superior court in the province in which they reside.

It's a different approach from what Bill C-14 as introduced has proposed. I'm not sure if some of the witnesses had spoken to the implications, but certainly, there are different access implications for individuals, such as time constraints, perhaps, and resource implications of going through that process. We haven't seen the motion to amend before, but those are some of the initial considerations.

[Ted Falk, Conservative, Provencher, MB]

I move that Bill 14, in clause 3, be amended by replacing line 6 on page 5 with the following:

dying only if a judge of the superior court in the province in which the person is ordinarily resident, on application by the person, makes an order stating that the court is satisfied that the person meets all of the following criteria:”

In essence, this is prior judicial approval. It will certainly take a lot of the onus off our health care providers, our nurse practitioners, and our physicians as well, because the judge will be the one who makes the final decision. I think what we've noticed in the time since the Carter decision until the present is that this system seems to have been working quite well. The application comes before a judge and the judge looks at it thoroughly to make sure the conditions are consistent with the Carter decision today, and going forward, once this bill receives royal assent, a judge will review each situation and will make sure that the situation is compliant with Bill C-14.

I think it's a very important check and balance, and it also creates protection for health care providers all the way down, because a judge would be doing the final sign-off and making sure that all the i's are dotted and the t's are crossed.

[Joanne Klineberg]

Well, there are a couple of things for the committee's consideration, again.

One, if we think about the exemptions that have been created for people who might aid the physician or the nurse practitioner, it was drafted to say “any person” because there might be other types of professionals. For instance, someone might actually consult a lawyer to determine how they might proceed to obtain medical assistance in dying. That wouldn't be captured.

Also, given the information I provided a few minutes ago, there is no legal possibility that the offence could be interpreted so as to.... Sorry, that was with respect to a slightly different point. But it's really not possible to interpret the criminal offences as though they would prohibit simply giving someone information about a lawful process, so for the committee's consideration for clauses like that we usually draft for greater certainty.

Finally, the definition of “medical assistance in dying”, in Bill C-14 is such that the definition itself doesn't include the eligibility criteria and the safeguards. The definition is merely a nurse practitioner or a medical practitioner who administers a substance to cause the death of a person. So the committee might wish to consider adding words like “obtaining information on the lawful provision of medical assistance in dying” so that you're not capturing other things that a physician might say that would not be within the lawful boundaries of medical assistance in dying.

[The Chair, Liberal, Anthony Housefather]

Ladies and gentlemen, sorry for the delay. I would like to call the Standing Committee on Justice and Human Rights to order. It's a great pleasure to have with us today from the Department of Justice Carole Morency, Joanne Klineberg, and Julie Besner. From the Department of Health, we have Helen McElroy and Sharon Harper. Thank you for coming.

Ladies, it's very nice to have you. We are going to be doing a clause-by-clause review of Bill C-14. This is the first clause-by-clause review this committee has undertaken. The parliamentary clerk has provided me with some instructions that I would like to give members of the committee so that you all know about clause-by-clause review and how it works, as some of us have not done this before. As the name indicates, this is an examination of all the clauses in the order in which they appear in the bill. I will call each clause successively, and each clause is subject to debate and a vote. If there are amendments to the clause in question, I will recognize the member proposing it, who may explain it. The amendment will then be open for debate. When no further members wish to intervene, the amendment will be voted on. Amendments will be considered in the order in which they appear in the package that each member received from the clerk. If there are amendments that are consequential to one another, they will be voted on together.

In addition to having to be properly drafted in the legal sense, amendments must also be procedurally admissible. The chair may be called upon to rule amendments inadmissible if they go against the principle of the bill or beyond the scope of the bill, both of which were adopted by the House when it agreed to the bill at second reading, or if they offend the financial prerogative of the crown. If you wish to eliminate a clause of the bill altogether, the proper course of action is to vote against that clause when the time comes, not to propose an amendment to delete it.

Since this is a first exercise for many new members, the chair will go slowly. I've been advised by some members that I seem to go fast, so I'm going to try to go slowly to allow all members to follow the proceedings properly. If during the process the committee decides not to vote on a clause, that clause can be put aside by the committee so that we can revisit it later in the process.

As indicated earlier, the committee will go through the package of amendments in the order in which they appear and vote on them one at a time unless some are consequential and dealt with together. Amendments have been given a number in the top right corner to indicate which party submitted them. There is no need for a seconder to move an amendment. Once moved, you will need unanimous consent to withdraw it. During debate on an amendment, members are permitted to move subamendments. These subamendments do not require the approval of the mover of the amendment. Only one subamendment may be considered at a time, and this subamendment cannot be amended. When a subamendment is moved to an amendment, it is voted on before another subamendment may be moved. The committee may consider the main amendment and vote on it, and that would be “as amended”. Once every clause has been voted on, the committee will vote on the title and the bill itself. If amendments are adopted, an order to reprint the bill will be required so that the House has a copy for use at report stage.

Finally, the committee will have to order the chair to report the bill to the House. That report contains the text of any adopted amendments as well as an indication of any deleted clauses.

I apologize for speaking only in English, but it would take too long to go over the text again. I hope that you have still all understood by listening to the simultaneous interpretation.

Budget Implementation Act, 2016, No. 1

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

Mr. Speaker, it is a privilege to rise in the House today on behalf of all the residents of my riding who have reached out to my office and spoken to me personally about their dissatisfaction with the first budget of the Liberal government.

Following the release of the budget, my office sent out surveys to every household and business in my riding, asking whether they supported the out-of-control spending of the Liberal government. Out of the responses I have received, over 90% of my constituents do not support these ballooning deficits and unnecessary spending.

Canadians know best, that we need to live within our means and take out loans or increase spending only in urgent situations. There will always be emergencies that require extraordinary measures such as major roof repairs, new pump in a rural water system or the replacement of a car that died without warning.

While most Canadians would agree that these might be good reasons to borrow, I doubt that many would consider it good money management to take out a new loan to pave the driveway or buy a new flat screen TV, especially if already paying down a hefty mortgage.

Along with many members on this side of the House, this is my first budget while sitting in opposition. I am not impressed that the government has already started to tear down the hard work that our Conservative government did to build a strong economy that Canada enjoyed. Nor are my constituents impressed.

The Liberals talk about slow growth in the past. They fail to recognize that Canada led the G7 in economic growth through some of the most challenging times the world has seen since the Great Depression. The current government will not even admit that we left it with a surplus of over $7 billion. The Department of Finance, the parliamentary budget officer, and experts across Canada repeatedly remind the Liberals that they are wrong, but they simply continue to ignore the facts.

This is important because the almost $30 billion the Liberals have decided to borrow is borrowed not out of necessity, but out of a desire to take the hard-earned money made by Canadians and spend it on pet projects for special interest groups. They have ensured that they can continue this out-of-control spending by including in their omnibus budget bill a clause that repeals our balanced budget legislation.

This balanced budget legislation, passed by the previous Parliament, would force future governments to restrict spending so we would not be borrowing on the backs of our future generations and we could incrementally pay down our national debt. However, the Liberals are now removing the hope we had of reducing our debt. Instead, they plan to increase it by another $119 billion.

Many of us in the House have been blessed with children and some of us even with grandchildren. I am blessed with nine grandchildren, but these out-of-control spending budgets accumulated over time will gravely affect them. I want to ensure that the Liberals know that there will be consequences to their poor decisions today.

If we consider just debt charges alone over the course of the government's mandate, interest charges alone increase by almost $10 billion. This is money that could be spent on more important infrastructure projects or increased health transfers. It could also be spent on funding a small business tax cut, or fulfilling the Liberal's promise to increase home care spending and invest in palliative care. Yet there is not one dollar earmarked in this budget for palliative care or increased home care.

Over the next five years, the interest costs alone rise from $25.7 billion to $35.5 billion. That is an increase of almost $10 billion just to pay interest on the increased national debt.

The three topics that have been brought to my attention most often by my constituents are: first, the Liberals' broken promise to lower small business tax rate; second, giving hard-working farmers a cold shoulder; and third, no money given toward increasing access to palliative care for Canadians.

First are the Liberals' broken promises to small businesses. Waterloo region is home to thousands of small businesses and they were all excited to hear that every party in the campaign was going to lower the small business tax rate to 9%. Unfortunately, this promise, like many other promises made by the Liberals, was completely broken in their very first budget.

On top of that, the Minister of Small Business and Tourism, from the Waterloo region herself, has been defending this broken promise throughout the region and across Canada for the past number of weeks. The finance department has estimated that this broken promise will cost the small business sector $2.2 billion over four years.

It is clear that when it really comes down to it, the Liberals fail to understand the crucial role that small business has to play in Canada. One has to wonder if the entire Liberal government agrees with the Prime Minister who stated publicly that small businesses were just “tax havens” for the wealthy.

The Prime Minister really is out of touch with Canadians. We know that roughly two-thirds of small and medium-sized business owners fall directly into the middle class. Employers are about four times more likely to be earning less than $40,000 than they are to be earning more than $250,000.

On top of the broken promise of lowering the tax rate for small business owners, small business owners know that we do not keep on spending money we do not have and are very worried about the direction the government is going.

Speaking on behalf of these small business owners, the president of the Canadian Federation of Independent Business, Dan Kelly, says:

Small business owners across the country are deeply troubled by the ballooning deficit. What was proposed to Canadians as a short-term $10-billion deficit plan to invest in critical infrastructure is now $29 billion with no plan to get back to balance...Small business owners know that today’s deficits are tomorrow’s taxes.

Second, the budget is a complete disaster for all the farmers in my riding.

Growing up on a farm myself, I have a pretty good idea of the amount of work that these men and women put in every day to feed their families and thousands of other families across Canada. We should be supporting these people. However, the budget completely forgets about them. In fact, the only support for the agriculture industry in Canada is extra funding for bureaucrats in Ottawa, none for moms and dads who are up before the sun rises and finish work well after the sun sets.

In my riding, where there are over 1,200 farms, approximately 1,400 in all of Waterloo region accounting for $473 million in gross receipts in 2010, farmers are professionals. They want to meet their social obligations in protecting the environment, in protecting the health of their animals, and in providing the best quality products for their families, for their communities, and for the world.

The Canadian agriculture and agri-food sectors account for more than $100 billion in economic activity every year and employ more than two million Canadians. The importance of agriculture to our national interests cannot be overstated. In fact, one in eight jobs in Canada depends upon agriculture, those in primary agriculture, food processing, horticulture, and farm markets.

Under the previous Conservative government, farming families saw their taxes drop to the lowest level in 50 years and farmers gained access to more international markets than ever. However, today, with this budget, Canadian farm families are being left behind. The Liberals are borrowing $30 billion to spend in other sectors. The Liberal government must make our farm families a priority.

Third is the government's failure to meet its commitment to increasing home care and palliative care.

As we in this chamber are considering Bill C-14, it is now more important than ever that the government make good on its promise to increase funding for home care and palliative care services. I have said it many times already during second reading of Bill C-14, but let me repeat it. Without proper palliative care options to give Canadians considering assisted suicide, they are not making a fully informed decision. We have all failed in protecting vulnerable Canadians.

Therefore, I would suggest that the Liberal government make four changes to the budget immediately, as it would be in the best interests of all Canadians.

First, the government needs to limit the size of its deficit and re-implement the balanced budget legislation that our government introduced. It needs to start realizing the money it is spending is not its money to spend without reserve, but is taxpayer money and belongs to taxpayers.

Second, the government should make good on its promise to lower the small business tax rate. This would be one of the single-best methods to help out the middle class and to grow our economy. These businesses would be able to expand, innovate and hire more workers, immediately helping our economy.

Third, the Liberals should rekindle their relationship with Canadian farmers and immediately include measures in the budget that would lower taxes for these hard-working Canadians who are the heart of our country.

Last, the Liberal government needs to provide funding for home and palliative care across Canada. Over 70% of Canadians who need this form of care do not have access to it. This is something that absolutely needs to be changed. Now, more than ever, we need to protect and care for the most vulnerable among us.

Physician-Assisted Death

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

Mr. Speaker, the second petition is very appropriate, as the committee moves tonight to examine the amendments to Bill C-14.

The petitioners from throughout my riding, as well as from as far away as Winnipeg, call for measures to ensure that through medically assisted death, Canadians can choose to pursue methods of death of their own choice with dignity.

Motions in Amendment

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

Mr. Speaker, I am pleased to address the House to speak to Bill C-7. Throughout the discussion I will take the opportunity to emphasize that, even though I am not my party's critic on the matter related to this bill, two aspects of it concern me in both form and substance.

Bill C-7 concerns the 28,000 officers of the RCMP, or the Royal Canadian Mounted Police.

This bill was introduced in response to the Supreme Court's January 2015 decision in Mounted Police Association of Ontario v. Canada concerning the right of association of RCMP members. In its ruling, the Court gave the government one year to introduce legislation on the right of RCMP members to associate. That deadline was extended to May 16, 2016.

That is the first thing that I wanted to mention, as it reminds us of what we are going through, in terms of form, with the study of Bill C-14 concerning medical assistance in dying, in which I was directly involved.

RCMP members were not unionized, but they were part of groups and could have discussions with the employer under the staff relations representative program, which was established in the 1970s. It worked quite well, but was challenged by some groups of RCMP officers in Ontario, which resulted in this decision.

For the benefit of the Quebeckers who are watching, I should explain that the RCMP is also the largest police force in eight out of 10 provinces. Ontario has the Ontario Provincial Police, Quebec has the Sûreté du Québec, and the other provinces have the RCMP, the Royal Canadian Mounted Police, which is the police force that enforces the laws and regulations and maintains order in Canada.

The Supreme Court ordered the government to pass legislation conferring on RCMP officers freedom of association and the right to collective bargaining. It was at that point that our government, which was in power at the time, began to clear the way for drafting this legislation, under the direction of the hon. member for Bellechasse—Les Etchemins—Lévis.

Negotiations concerning freedom of association, agreements governing salaries, and all such matters do not happen overnight. We need to take the time to do it right, and that is the point we have reached.

The current government introduced Bill C-7. We agree on the principle of the bill, but we had some serious problems with some of the clauses. Therefore, during the clause-by-clause study, my colleague, the hon. member for Durham, who was a minister and who is a lawyer and a member of the Royal Canadian Navy, proposed some very important amendments.

Clauses 40 and 42, which were deleted from Bill C-7, had to do with health care and insurance provided to RCMP members. We are very happy that the government listened to the Conservative member for Durham with respect to deleting these two major clauses.

However, we do not recognize freedom of association in the same way as the government. We have two opposing views. This is also the case with another bill, Bill C-4, which I am working on in my role as employment and social development critic.

What is the government proposing, and what would we have liked to see in this bill? We think that the right of association must be recognized, but that it should be subject to a secret vote that reflects the will of the members. This is a key element that we enshrined in Bill C-525, for example, which was passed by the House of Commons. This bill required that union certification, specifically when a group of workers is trying to unionize, be subject to a secret vote.

The Conservative member for Durham proposed that solution, but the government rejected it. We find that unfortunate. The sacred right of association must be enshrined in law so that, when it comes time to negotiate, that right is even more powerful, legitimate, influential, and authoritative. In our opinion, the best way to ensure and assert that authority and strength is establishing secret ballot voting.

We know what we are talking about here in the House of Commons. We were all elected by secret ballot. That way of doing things dates back to 1874. It is nothing new. Elected members of the House of Commons have been familiar with the principle of the secret ballot for a long time. The same is true for elected officials in the provincial legislatures across the country. Every elected representative is elected by secret ballot. The same is true at the municipal level. Our mayors and municipal councillors are elected by secret ballot. That is a given in our democratic system if we want those representatives to be powerful, strong, authoritative, and competent.

A solid foundation is needed when it comes time to negotiate and discuss and to ensure that people are properly represented. On this side of the House, we believe that the best way to give unions or union representatives more authority is to allow them to obtain that authority by secret ballot. We encountered exactly the same problem with Bill C-4, for which I am the official opposition critic.

Bill C-525, which was introduced by a Conservative member under the former government, enshrined in law regulations regarding unions and the creation of unions through secret ballot. All of us here, who have decision-making authority, obtained that authority because the people in our ridings voted for us. We think that, when people need to create a union or an association, their representatives, who will be given the authority to negotiate with their employer, should be chosen through the same approach.

That is fundamental, but unfortunately, the government members decided to do otherwise. That is the government's decision to make, but it is not what we would have done.

We believe that that element is fundamental and that the government should have acted accordingly. The Supreme Court specifically stated, in the ruling handed down in January of last year:

The flip side of...freedom of association under s. 2(d) is that the guarantee will not necessarily protect all associational activity.

From our perspective, the best way to give the newly formed group the necessary authority is a secret ballot.

I want to be clear. We support the fact that the 28,000 members of the RCMP, for whom we have a lot of respect, are doing a great job. It is the most honourable job in our country. They deserve a lot, and they deserve it for our citizens. We have a lot of respect for them. We agree with the fact that they should have the right to negotiate as a group. We recognize that. That is why our colleague, the hon. member for Durham, did a tremendous job at the parliamentary committee by pulling out two clauses, clauses 40 and 42, which were not as good as they should have been.

However, we are at a crossroads. The government prefers to have a way of recognizing the group that will represent the RCMP members. We believe the RCMP members would be better served if the election of those people as their representatives was done by a secret ballot vote in front of the government. That is why we agree with the principle of the bill, but unfortunately, we will not be supporting Bill C-4 because the government has failed to recognize that the secret ballot vote is the best way to ensure the strongest dignity of this group to be represented.

Health

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

Mr. Speaker, I will expect to see palliative care mentioned in Bill C-14.

The Minister of Health said her priority was palliative care for $3 billion. However, she is spending her time and government resources right now on legalizing marijuana.

Is marijuana a bigger priority for our aging population than palliative care? Is it worthy of her attention now, or is her palliative care initiative going to pot?

Budget Implementation Act, 2016, No. 1

[Peter Kent, Conservative, Thornhill, ON]

Mr. Speaker, I thank my hon. colleague for her thoughtful comments and constructive criticism of this budget. However, a day after the government abruptly shut down debate on Bill C-14 to comply with the Supreme Court order to provide Canadians with the constitutional right to a physician-assisted death, I wonder if she does not find a bit rich the finance minister's comments about avoiding half measures, in that there is not a mention of a penny of the $3 billion promised during the campaign by the Liberals for palliative care, among other things, which would ease Canadians' constitutional right to live a full and complete life. I wonder if my colleague shares my concern about this disappointing delay of priorities.

[Jennifer Gibson]

Some of my current concerns are about the way in which, in a sense, the shift from the Carter decision to Bill C-14 seems to have been motivated by a real concern about vulnerable populations. We've heard from Mr. Arvay this morning about this having led to certain exclusions of persons who have been labelled and classified as vulnerable.

I think that's a dangerous shift, actually, because as long as we label somebody as vulnerable, we are eroding their capacity. We are presuming that they are not capable, and in so doing we are treating them as unequal to the rest of us in society. I think that's a dangerous direction to be moving in.

At the same time, we are concerned about vulnerability. I think there are other mechanisms through which we can meet that concern. The current safeguards that are articulated here are definitely on the right track, but I start to become nervous when we move in the direction of thinking of prior review, of judicial oversight, which I think is motivated by a concern sometimes framed as enhanced transparency but more often as a way to address issues of vulnerability, while we have mechanisms within health care practice that would better serve that goal, and indeed, from a patient perspective, ensure a much more seamless experience for them at the end of life.

With regard to the judicial review process, we have had some experience over the last three months of cases going through the judicial review process to receive access to assisted death. One of the individuals who went through this process pleaded that this not be the mechanism by which they access assisted death because it is a burden, at the end of one's life, to be going through that particular process.

[Murray Rankin, NDP, Victoria, BC]

Thank you.

First of all, I'd like to say thank you to each of the panellists separately.

Dr. Chochinov, we had the benefit at the Senate/House committee of your colleague Maître Pelletier, who was very helpful. You weren't able to be there so it's good to meet you here. Thanks for your work on the expert panel.

Dr. Gibson, your leadership in the provincial and territorial task force is really quite remarkable, and thank you so much for all of the work that you have done respectively.

Of course, Mr. Paterson, than you for your dogged litigation in the Supreme Court as an intervener in Carter. We're very fortunate to have you here.

I want to start with you, Dr. Gibson, on the issue of vulnerability. I want to give you an opportunity, because you were going quickly at the end of your remarks on the issue of vulnerability.

Could you elaborate a little for us and put it in the framework of BillC-14 and explain how we can do much better in conclusion?

Protection of Freedom of Conscience Act

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

moved for leave to introduce Bill C-268, An Act to amend the Criminal Code (medical assistance in dying).

Mr. Speaker, I am honoured to present my private member's bill known as the protection of freedom of conscience act. With the introduction of Bill C-14, I have heard from many Canadians. I think all of us in this House have heard that Bill C-14 has a gaping hole: it does not protect the conscience rights of Canadians. The Carter decision required that conscience rights be protected for medical health care professionals. This is not included in Bill C-14. The government has said that it does not compel but it also does not protect conscience rights. Therefore, I am proud and thankful to represent all Canadians with respect to a pan-Canadian approach to protect the conscience rights of health care professionals with the passage of this bill, the protection of freedom of conscience act.

(Motions deemed adopted, bill read the first time and printed)

[Jennifer Gibson, Director and Sun Life Financial Chair in Bioethics, University of Toronto Joint Centre for Bioethics, As an Individual]

Thank you.

Good morning everyone, and thank you so much for the invitation to join you. As some of you may know, I co-chaired the provincial-territorial expert advisory group on physician-assisted deaths. Most recently I've been working with the Joint Centre for Bioethics task force on medical assistance in dying, in collaboration with health system stakeholders, to prepare for the implementation of medical assistance in dying in Ontario.

Today, though, I'm speaking as an individual. Although the chair has advised that we should not take a philosophical approach, I will be tapping into my disciplinary expertise in ethics and policy to provide an additional perspective to today's conversation.

Over the last few days I've had the opportunity to listen to the testimony of several panels. It has been fascinating and admittedly predictable to see convergence in some areas and continuing divergence in others. Bill C-14 is fundamentally an amendment of the Criminal Code within the parameters of the Charter of Rights and Freedoms and the charter ruling, and it has implications for the conduct of health care. But it is not the comprehensive regulatory regime envisioned in the Carter decision.

This week's discussions underscore how much of the work that we are collectively undertaking through this consultative process is not just legal, although it's about legislation and proper jurisdiction, nor political, although it is part of a parliamentary process. It is also fundamentally what I would call values work, by which I mean the pursuit of a right balance in C-14 of three ethical goals: recognizing and protecting individual autonomy, alleviating or minimizing suffering, and preventing harm. All three ethical goals have been articulated in witness testimonies over the course of the last three days.

As written, Bill C-14 proposes one way to balance these three ethical goals. Specifically, as noted in the preamble, it seeks to strike the most appropriate balance between

the autonomy of persons who seek medical assistance in dying, on one hand, and the interests of vulnerable persons in need of protection and those of society, on the other.

It proposes that this balance be achieved by limiting access to medical assistance in dying to competent adults whose natural deaths are reasonably foreseeable.

Is this the most appropriate balance? Testimony in the last three days suggests otherwise, and I would agree. Witnesses have rightly challenged the definition of “grievous and irremediable medical condition” and particularly proposed paragraph 241.2(2)(d), that is, the much-beleaguered “reasonably foreseeable” paragraph.

In my brief, I recommend removing that “grievous and irremediable” portion entirely and amending proposed paragraph 241.2(1)(c) to bring greater clarity, coherence, and consistency with the parameters already laid out by Carter.

Given its definition of “grievous and irremediable”, Bill C-14 denies medical assistance in dying for competent persons who have a “grievous and irremediable medical condition that causes...enduring and intolerable suffering” but who are not—quoting from the legislative backgrounder—“nearing the end of their lives” or “on a trajectory towards their natural death”, and whose medical condition is not itself fatal.

One might argue, as some witnesses have done, that to limit medical assistance in dying this way offers an important safeguard to protect vulnerable persons who might, as per the preamble, be “induced, in moments of weakness, to end their lives”. But if, as other witnesses have argued, persons like Kay Carter would not be eligible for medical assistance in dying, then many suffering Canadians are being left behind by Bill C-14.

To paraphrase Mr. Bauslaugh's testimony from yesterday evening, Bill C-14 rations compassion only for the suffering of those who are dying. For many, including me, the balance of autonomy, protection of the vulnerable, and minimizing of suffering have not yet been achieved with this definition of “grievous and irremediable”.

There is another area that puts into question whether Bill C-14 is successful in balancing these three key ethical goals. Several witnesses yesterday spoke about the exclusion of mature minors, competent persons who are enduring intolerable suffering from psychiatric illness, and competent persons seeking to make an advance request for medical assistance in dying.

These exclusions, possibly temporary pending further study, as per the non-legislative commitment articulated in the preamble, are explained in the legislative backgrounder as necessary to protect “vulnerable persons” in these “complex” situations. However, exclusion of competent persons on the presumption of vulnerability does not serve the end of balancing autonomy and preventing errors and abuse and may, I fear, actually have the opposite effect of marginalizing and further entrenching the social vulnerability of the very individuals we are seeking to protect.

The protection of vulnerable persons turns on safeguarding competence, voluntariness, and consent. Exclusion of otherwise competent persons may be justifiable to the extent that this is proportional and necessary to prevent another injustice. Failing this, though, these exclusions violate the autonomy of competent persons in these groups and unjustly force these individuals to remain in a state of enduring and intolerable suffering.

Waiting until the fifth year following royal assent to address the results of additional study would be neither reasonable nor just. Hence, echoing other witnesses, my brief recommends that Bill C-14 be amended to establish an expedited schedule for study of medically assisted dying involving mature minors, competent persons with primary psychiatric illness, and persons who have given advance consent while competent.

I will close my brief remarks with the final reflection on vulnerability as it relates to Bill C-14. The call to protect the vulnerable is one that we all share, and it's morally praiseworthy. However, we must ask ourselves who decides who is vulnerable. Is it the individual through his or her lived experience, or is it the rest of us in society who decide what type of vulnerability matters and to whom, and what the appropriate response to vulnerability is?

Witnesses have offered different responses to these questions. Some wish to set limits on which competent person should be eligible for medical assistance in dying, excluding those who are perceived to be in need of protection or susceptible to moments of weakness. Others wish to set up procedural safeguards to protect competence, voluntariness, and consent.

Bill C-14 offers an uncomfortable compromise among these different responses, tilting the balance of ethical goals precariously away from preserving individual autonomy and minimizing intolerable suffering of competent persons.

I know we can do much better for Canadians.

Thank you.

[Josh Paterson, Executive Director, British Columbia Civil Liberties Association]

Thank you very much.

I'm pleased to be here today. I just want to say that although I'm not addressing all of our concerns today, the B.C. Civil Liberties Association continues to stand by our previous submissions to the parliamentary committee that went before.

Today my focus is simply on making the bill Carter-compliant. Bill C-14, in our view, must be amended in order to ensure compliance with the Carter decision and with the Charter of Rights and Freedoms. I have to say we were shocked when we first saw this bill and we learned that not only did it ignore many of the core recommendations of the parliamentary committee, but it actually cut out part of the heart of the victory that our organization had won in Carter.

In our view, this bill forgets what the Carter case was about. This case wasn't just about helping people with terminal illnesses to have a dignified death of their choosing; it was equally about ensuring that people who are trapped in unimaginable suffering from non-terminal illnesses have the right to escape a lifetime of indefinite suffering. Both of these kinds of people were before the court, and importantly, our organization was granted public interest standing to argue this case as an institution, in respect of various kinds of patients. The ruling was not limited to terminal cases, as we know from the mouth of the Supreme Court itself in January. It did not limit the decision to terminal people or to people who were foreseen to die.

The government says, well, this restriction isn't a restriction to those who are terminal. We say that the effect is the same, that under this bill, someone needs to be dying in order to qualify. The court itself has said that this is wrong.

We won that victory after years of gathering evidence, of tireless work, of fighting a federal government that opposed the realization of this right tooth and nail. We systematically were able to beat each of those arguments that were mustered by the government over multiple years. We knew, in winning, that this would make a real difference for people who would otherwise suffer intolerable and terrible deaths. We knew it would make a difference for people who were suffering unimaginably from grievous and irremediable illnesses in life, and now we see this victory being hollowed out, being taken right out of the bill for half of those people.

In order to remedy this, we support the amendment that was referred to by Professor Downie in her remarks yesterday. We take the position that prohibiting patients whose deaths are not reasonably foreseeable from having the choice of medical assistance in dying violates the charter, and that the entire section referring to the definition of “grievous and irremediable” in the bill should be eliminated. In its place, we believe that proposed paragraph 241.2(1)(c) should be amended to state that a person must have 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. This, we believe, will bring the criteria in line with Carter.

If Bill C-14 is not amended to eliminate the requirement that a condition be “incurable” rather than “irremediable”, the requirement that there be an advanced state of irreversible decline, and the requirement that natural death be reasonably foreseeable, the result will be terrible suffering for those Canadians who are barred from accessing medical assistance in dying—and that's what this is about. It's not an academic exercise, or even an exercise, as is often done in this place, quite appropriately, in balancing political interests. It is about the intolerable and unimaginable suffering of real Canadians, and about their rights.

The “reasonably foreseeable” requirement is terribly vague. You've already heard from numerous witnesses who have said so, including The College of Family Physicians of Canada, representing the doctors who are most likely to be dealing with these issues. We believe this requirement, in particular, of reasonably foreseeable natural death, is unconstitutional because it violates the charter right to liberty. It deprives a patient of fundamental choice related to their body. The court concluded that the Criminal Code in its original form, through its blanket prohibition on the right to request a physician's assistance in dying, interfered with liberty by restricting the ability of qualifying patients to make decisions concerning their bodily integrity and their medical care.

It interferes with the charter right to security of the person because it causes a patient to continue to endure suffering, and it interferes with the charter right to life. Since individuals are deprived of the choice of an assisted death, there are some individuals who may take their own lives prematurely in order to avoid intolerable suffering, while they are still physically able to do so.

Now, the government suggests that restricting access to assistance in dying to people whose deaths are “reasonably foreseeable” is justified because it will protect the vulnerable. We've heard already from Mr. Arvay that this argument was used by Canada at court, and the court's decision was clear: Parliament cannot rely on a blanket exclusion of a whole class of people to protect the vulnerable when other less-interfering means are available to do the same thing, for example, to assess decisional capacity on an individual basis. Canada even conceded at the trial, in Carter, and I'm quoting from the Supreme Court reasons:

“It is recognised that not every person who wishes to commit suicide is vulnerable, and that there may be people with disabilities who have a considered, rational and persistent wish to end their own lives”.

There's a really easy way to understand this, and it's that these arguments were made already. As has been described, there is a circle, a class of people, who won a right, who were guaranteed a right. Canada tried to say they didn't have that right; they tried to justify it. Those arguments failed, and that right was recognized. Now the government is taking those same people and trying to pull them out of that protection and use some of the same justifications. This isn't a dialogue. This is the court saying, “This is the law” and the bill saying, “No, it's not the law. We say something else is the law. We say something else is constitutional”. That is just wrong, and frankly, we don't think it will withstand a constitutional challenge, and the result will be costly relitigation of the same point that's already been decided by the Supreme Court of Canada.

In the minute I have remaining, I don't want to spend too much time on it, but I do want to touch on this idea of prior judicial approval that continues to come up in committee. It is a complete departure from current end-of-life practices, and it's one that, of course, as many of you will know, Canada has tried before in respect of abortion, and it was rejected in the Morgentaler decision. The court there held that this procedural barrier of prior approval contributed to violating the charter rights of women by creating delay and, fundamentally, by directly interfering with women's autonomy to make choices about their own bodies by putting a state approval in place in front of their choice. Our experience as counsel with the exemptions right now is that prior approval is costly, time-consuming, prone to delay, and a significant barrier to access. It would be a real mistake for Parliament to reproduce a prior state-approval function for this kind of profoundly personal medical decision when it was soundly rejected nearly 30 years ago in relation to other profoundly personal medical decisions.

Thank you.

[Dr. Harvey Chochinov]

Honourable members of Parliament, my name is Harvey Max Chochinov. I hold the academic rank of distinguished professor of psychiatry at the University of Manitoba. I direct the Manitoba Palliative Care Research Unit, and I hold the only Canada research chair in palliative care. I've spent the entirety of my career working and conducting research in palliative end-of-life care. I'm also the former chair of the external panel on options for a legislative response to Carter v. Canada.

It is my privilege today to share some thoughts on Bill C-14 focusing on possible amendments for your consideration. My submission, which you've received, outlines these in more detail and also includes my rationale for why the current limitations described in the bill, including limiting access to patients whose death is reasonably foreseeable and not including provisions for mental illness, advance directives, and minors, are eminently justifiable and prudent.

The amendments I've put before you for your consideration include the following.

Number one, the government should consider an amendment stipulating that medically hastened death will take the form of assisted suicide, so long as patients are able to take lethal medication on their own. Euthanasia would be reserved for instances in which patients are no longer able to ingest lethal medication independently.

International experience reveals that euthanasia and assisted suicide are vastly different in terms of their uptake and lethality. In the jurisdictions that offer only physician-assisted suicide, the latter accounts for about 0.3% of all deaths. In jurisdictions that offer euthanasia, that form of death accounts for 3% to 4% of all deaths.

Extrapolating these figures to Canada and anticipating approximately 260,000 deaths per year, a regime offering physician-assisted suicide exclusively would expect about 800 to 1,000 of these deaths annually. On the other hand, a regime dominated by euthanasia could expect between 8,000 and 10,000 of these deaths annually.

According to experts appearing before the external panel, this vast difference is largely accounted for by ambivalence. Ambivalence is an important dynamic in considering a hastened death. While assisted suicide offers the possibility of changing one's mind—30% to 40% of patients in Oregon who receive a prescription never in fact use it—euthanasia dramatically reduces that possibility, once it has been scheduled and expectations are set for a specific time and place.

The data is clear. This will ensure that thousands of people each year who are ambivalent about an assisted death will not feel pressured by circumstances to proceed before they are ready to die.

Number two, the government should consider an amendment requiring that all patients obtaining medically hastened death should first be provided with a palliative care consultation. This would be over and above the duties of the two physicians described in the current bill and would be critical, so long as the bill limits access to patients whose natural death is reasonably foreseeable and who are in an advanced stage of irreversible decline in capacities.

The palliative consultants would not be in a decision-making role; rather, their role would be to identify all physical, psychosocial, existential, and spiritual sources of distress underlying the request to die; to ensure that patients are fully informed of all options that could be initiated on their behalf; and finally, to document their findings so that prospectively collected, anonymized information could be entered into a national database providing a detailed and objective basis for Parliament's five-year review of Bill C-14.

Number three, the government should consider an amendment requiring judicial oversight and approval for all medically hastened deaths. Judicial oversight would ensure a precedent-based, consistent, and clearly articulated set of benchmarks regarding when eligibility criteria have been met.

Judicial oversight would insulate health care institutions and professions from any perceived or real hazards associated with medically hastened death and would likely increase access, given the increase in number of health care professionals who would be prepared to engage with patients requesting medically hastened death. Oversight would demonstrate profound leadership, indicating that while Canada has made medically hastened death legal, our government does not yet know how this fits into our current system of health care.

Number four, in the most profound way possible, judicial oversight would ensure a commitment to transparency and objective evaluation of all factors, be they medical, emotional, psychosocial, financial, or environmental, that might underpin a request for medically hastened death.

In conclusion, I believe that the limitations and safeguards currently included in Bill C-14, together with these suggested amendments, would see Canada's approach to medically hastened death marked by integrity, transparency, and wisdom. Thank you.