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.

Second Reading

[Ali Ehsassi, Liberal, Willowdale, ON]

Mr. Speaker, I am grateful for the opportunity to rise today to join many other colleagues in addressing the significant national debate surrounding Bill C-14, and our government's prompt and appropriate response to the Supreme Court's Carter decision. I believe this was a duty the previous government neglected, and I am proud of our government's response to this complex issue.

Bill C-14 represents a mandated response to the Supreme Court's Carter decision by providing a national framework to ensure, subject to necessary safeguards, access to a fundamental and inviolable right enshrined under section 7 of the Canadian charter. After all, the Carter decision transformed the question before the government from one focused on whether the government should legislate and legalized medical assistance in dying to the very different question of how fast to legislate and legalize medical assistance in dying.

Despite the clear contours delineated by the Supreme Court, I would like to acknowledge the hard work of all members of the House over the course of the past several months to contribute to this important national debate by recognizing the crucial role of the Special Joint Committee on Medical Assistance in Dying, and acknowledging the leadership demonstrated by the Minister of Justice and the Minister of Health for introducing this transformative legislation.

I would also like to thank all Canadians who have, in one way or another, participated in nation-wide consultations with their provincial and federal governments. I am very proud that many constituents in my riding of Willowdale took the time to approach me regarding various aspects of this bill, and having listened to them, I realize full well that this is a deeply important issue for many Canadians.

At the centre of the profound and solemn debate that has ensued in the House and elsewhere, have been discussions focused on such foundational principles, such as the need to respect individual rights, equity, consent and capacity, clarity, dignity, and accountability. Yet, given the extensive debate that has occurred in the House, I would like to specifically focus my remarks on two specific aspects of this bill which I believe need to be further highlighted and emphasized.

The first issue I will focus on is that Bill C-14 represents a significant first step that now requires further co-operation with our provincial and territorial partners. Second, it is important to recognize the significant safeguards embedded in Bill C-14.

One of the primary characteristics of charter rights, of course, is equal access. If charter rights are by definition universal, they must, within reason, be equally accessible to all Canadians. This is where I believe Bill C-14 comes into play by establishing a national framework for medical assistance in dying that can ensure equitable access across provinces and territories. I feel that Bill C-14 fulfills an expressed desire by our provincial and territorial governments for a national framework to address this timely issue.

I strongly believe that this legislation provides an opportunity for the federal government to facilitate a collaborative approach, which includes provincial and territorial consultation. Specifically, the bill's own preamble clearly states that the law must apply consistently across all of Canada. As such, this bill advocates for a national framework in order to avoid variations from province to province.

As we all know, the Quebec government has in many ways laid the groundwork for medical assistance in dying with their own provincial legislation. However, while provinces will continue to act as key legislative and administrative partners in medical assistance in dying, I think we can all agree that establishing a pan-Canadian, national approach was crucial.

We should continue to work with the provinces and territories to explore mechanisms to coordinate end-of-life care for patients who want access to medical assistance in dying, thus avoiding crucial gaps in access and delivery.

Furthermore, in keeping with our government's commitment to evidence-based decision-making, we will engage with the provinces and territories to support the development of a pan-Canadian monitoring system to collect and analyze data, monitor trends, and publicly report on medical assistance in dying.

This two-way relationship is important. In other words, Bill C-14 represents the beginning of a partnership on medical assistance in dying. Our provincial colleagues, informed by the framework we have provided, can now begin the process of implementing their own medical assistance in dying regimes. Quebec, of course, has already done so, while Ontario and most other provinces have begun the process through the creation of a PT advisory groups on physician-assisted dying.

Allow me now to shift to the second element I would like to address today, the topic of the safeguards included within Bill C-14.

Bill C-14 makes Canada the ninth jurisdiction in the world to legalize medical assistance in dying, not including Quebec. Fortunately, we have been able to learn from their experiences to implement safeguards that will protect the most vulnerable while also allowing suffering Canadians access to their charter rights. Bill C-14 is, therefore, a carefully and deliberately crafted piece of legislation, which learns from the best practices of other governments to legalize medical assistance in dying.

As the Supreme Court made clear in paragraph 117 of the Carter decision, the risks associated with physician-assisted death can be limited through a carefully designed and monitored system of safeguards. Our government is committed to addressing the task put forth by the Supreme Court. We understand that this is a complex and emotional issue for many Canadians. As a result, we want to ensure that protecting the charter rights of some Canadians does not infringe upon the charter rights of others.

Bill C-14 provides strict criteria outlining precisely who is eligible for medical assistance in dying. Relatively strict guidelines are required when dealing with such a significant issue and eligibility is limited to three prescribed sets of conditions contained in Bill C-14.

Bill C-14 also includes safeguards protecting the personal convictions of health care providers. This is a fact that bears repeating as there seems to be some misunderstanding and confusion surrounding this issue. There is nothing in Bill C-14 that compels any medical practitioner to perform medical assistance in dying against their will.

As the Minister of Justice recently confirmed in her appearance before the Standing Committee on Justice and Human Rights on May 2, 2016, she said:

There is nothing in our legislation that would compel a medical practitioner to perform medical assistance in dying as you point out. The jurisdiction in terms of regulations falls to the provinces and territories.

The Minister of Health also addressed this issue in her remarks before the same committee and apart from reiterating that the issue of the conscience rights of health providers falls within the jurisdiction of the provinces, she confirmed that the federal government is already working with the provinces to develop a care coordination system for end-of-life care.

Finally, I believe the inclusion in Bill C-14 of a five-year review clause is another important safeguard. While I have the utmost confidence that the bill would address the issues presented to the government via the Carter decision, this mechanism would allow for future improvements and modifications, if need be.

Before concluding, allow me to also emphasize that Bill C-14 is part of a larger discussion around end-of-life health care. In that spirit, I am proud of the commitments our government has made toward palliative care, through a much-needed $3-billion investment over four years for home and palliative care.

I am confident that the vast majority of my constituents support medical assistance in dying and support Bill C-14. I urge my colleagues in the House to support the bill as well. By boldly, yet responsibility, reacting to the Carter decision, our government has created a workable and pragmatic national framework that would allow us to closely collaborate with the provinces and territories.

Bill C-14 marks the beginning of a new era. By addressing the expanded charter rights laid out by the Carter decision, this legislation would provide Canadians access to a long-overdue right.

The House resumed from May 3 consideration of the motion that Bill C-14, An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying), be read the second time and referred to a committee, and of the motion that this question be now put.

[Michel Racicot, Vice-President, Living With Dignity]

Thank you, Mr. Chairman.

As you know, I'm a lawyer with over 40 years' experience in computer and telecom law, so you might be wondering what I'm doing here. I'm here because I've assisted many terminally ill persons, beginning with my wife, who died of cancer at age 37 in 1985 after we had adopted three children.

I am here also because I've seen, on a daily basis and sometimes for several weeks and years, the day-to-day reality of palliative care workers attending to the needs of patients in their last weeks, days, and sometimes hours of life. I'm also vice-president of Living with Dignity/Vivre dans la Dignité, an organization representing over 5,000 citizens who are concerned about the future of our health care system and indeed about our nation.

Governments in this country take great strides with public media campaigns to try to prevent suicide—suicide of young people, of aboriginals, of Inuit—and unfortunately politicians make the headlines when a wave of suicides hits a reserve. But now we're about to authorize doctors to take their patients' lives or to help those patients commit suicide. Are we are no longer going to send emergency squads to try to persuade a person not to jump from a bridge, or are we going to send doctors to push them to their death? This is a dire reality that we are now facing.

Many have claimed that medical aid in dying is now a new charter right. Carter did not create a new constitutional right to death; the court only concluded that the prohibitions of the Criminal Code infringe on the existing rights to life, liberty, and security as guaranteed by the charter. Since the charter is part of our Constitution, the creation of a new charter right to death would have required the Constitution to be amended, which requires the involvement of Parliament and of all the provincial legislatures. This could not have been done by the Supreme Court, and the court did not create a new charter right to death, only an exemption from criminal law.

Before turning to the amendments, let me try to set our perception of what the power of Parliament is. Many have claimed that Parliament is bound to adopt a law within the confines set forth in Carter. Parliament is not held captive by the Supreme Court decision. It need not adopt a law that fits within the parameters set forth in Carter. Carter is based on the premise that the prohibition on assisted suicide and euthanasia is intended to protect only vulnerable people, not to protect all Canadians. Parliament now has the power to set the record straight and to confirm in no uncertain terms in a new bill that the prohibition against assisted suicide and euthanasia is indeed to protect all Canadians. It also has the power to re-enact those prohibitions, despite the Supreme Court decision.

As the Supreme Court itself recognized, between 1991 and 2010 this House and its committees debated no less than six private members' bills that were seeking to decriminalize assisted suicide, and none was passed. I'm calling on you. Should you ignore completely the wisdom of the hundreds of members of the House of Commons who decided not to decriminalize assisted suicide in the past? Or, should you not remind your colleagues that indeed your predecessors acted responsibly and with wisdom in rejecting this approach? You have the power and you have the responsibility to make history for our population, our children, our grandchildren, and their descendants.

Re-enacting the provisions struck in part by Carter requires political courage. It also requires all members of Parliament to be able to exercise their right to freedom of conscience protected by the charter and without being forced to vote according to a party line. This is our call to action.

Of course, if this Parliament does not re-enact these prohibitions, it can still set safeguards. Contrary to what CMA has said, our experience teaches us that these safeguards may not be sufficient to help protect all Canadians. This House has the power to prescribe, as it is said in the charter, “such reasonable limits...as can be demonstrably justified in a free and democratic society”. These limits can be more stringent that those specified in Carter.

The court recognized itself in Carter:

Parliament must be given the opportunity to craft an appropriate remedy. [....] ...issuing [a constitutional] exemption would create uncertainty, undermine the rule of law, and usurp Parliament’s role. Complex regulatory regimes are better created by Parliament than by the courts.

Let me now turn to certain amendments we're proposing.

In the order that the Supreme Court made last January 15, to prolong the extension of the suspension of their decision, the court said the persons who wanted to avail themselves of medical assistance in dying, as permitted in Carter, could apply to the superior court of their jurisdiction. And the court even said:

Requiring judicial authorization during [the] interim period ensures compliance with the rule of law and provides an effective safeguard against potential risks to vulnerable people.

We think that this reasoning is not only valid until June 6, but this process should continue beyond June 6, when Bill C-14 comes into effect. Abuses and errors are possible. We know medical errors exist, and as it concerns medical assistance in dying, an abuse or an error will be fatal. We therefore submit that Bill C-14 be amended to provide that medical assistance in dying can only be obtained with the prior authorization of a superior court.

Turning to transparency in data collection and reporting, Quebec has been now experiencing euthanasia for over four months. Several aspects have now become clearer, some of which are frankly very troubling.

One of them concerns the transparency and data collection and the reporting. Under practice guidelines issued by our Collège des médecins du Québec, a physician filling out the certificate of death, prescribed under the Public Health Act of Quebec, must enter the disease or morbid condition that warranted medical aid in dying and led to death as the immediate cause of death. This is not the manner of death—cardiac arrest—but the disease, injury, or complication that caused death.

The college goes on by stating that the term “medical aid in dying” should not appear on the certificate of death. Indeed, if this information were disclosed to family members who had not been informed, it could on one hand go against a patient's wishes to keep the information confidential, and on the other hand cause them harm.

Well, this guideline is forcing doctors to falsify the cause of death in a public document, and this is contrary to the applicable regulation that specified that the physician must indicate the cause of death in the most precise manner possible. Thus, if a doctor follows the guideline of the Quebec Collège des médecins, he might be prosecuted and be subject to a penal offence.

To address this risk, Bill C-14, proposes to add to the Criminal Code the offence of committing forgery in relation to a request for medical assistance in dying. However, the term “forgery” is not defined, and we have to look at section 366 of the Criminal Code for its definition.

In light of the Quebec experience, and of the need to monitor compliance with all required conditions to provide medical assistance in dying in the future, we strongly recommend that proposed subsection 241.4(1) be modified to include the offence of making any false declaration, by any means, to the effect that the cause of death was not medical assistance in dying, but was the underlying medical condition that justified a recourse to it.

Lastly, I'd like to talk briefly about the danger of good faith defences. Bill C-14 proposes that any person who has reasonable but mistaken belief about any fact that is an element of the exemption for medical assistance in dying should nevertheless be able to invoke the exemption from the crime of culpable homicide or the crime of assisted suicide.

Although these provisions are well intended, they do not unfortunately pass any serious examination in light of the experience that abuse of the elderly and sick persons is rampant in our society, as Dr. Ferrier, and other physicians dealing on a daily basis with these types of patients can attest. This is inviting a floodgate of abuse.

For such reasons, we recommend that these provisions of good faith defences be struck from Bill C-14.

I thank you for your attention.

[Dr. Jeff Blackmer, Vice-President, Medical Professionalism, Canadian Medical Association]

Thank you, Dr. Forbes, and committee members.

As mentioned, I will speak to the CMA's response on the core elements of this legislation. We certainly welcome questions from the committee today and at any time over the course of your important study.

First, the CMA's position is that the safeguards proposed in Bill C-14 are robust and are aligned with our recommendations. These safeguards include considerations such as patient eligibility criteria, process requirements to request medical assistance in dying, as well as monitoring and reporting requirements.

Second, the CMA supports the legislative objective to recognize that a consistent framework for medical assistance in dying across Canada is extremely desirable.

In addition to these robust safeguards, the enactment of definitions for medical assistance in dying, as well as what constitutes a grievous and irremediable medical condition in federal legislation, is essential to the achievement of a consistent, pan-Canadian framework.

Our principles-based recommendations reflect on the subjective nature of what constitutes enduring and intolerable suffering, as well as a grievous and irremediable condition, as well as the physician's role in helping make an eligibility determination.

We also support the objective to support the provision of a full range of options for end-of-life care and to respect always the personal convictions of health care providers. To this end, we encourage the federal government to very rapidly advance its commitment to develop a pan-Canadian end-of-life coordinating system. Ideally, this should be in place by June 6.

The CMA is aware that one jurisdiction has made such a system available to support connecting patients who qualify for assisted dying with willing providers. Until this system is available across the country, there may be a disparity of support for patients and practitioners from province to province.

Finally, it is our position that Bill C-14, to the extent constitutionally possible, must respect the personal convictions of health care providers by protecting the rights of those who do not wish to participate in assisted dying or to directly refer a patient to someone who does wish to participate.

We would be very pleased to speak further on this critical issue, one that is also essential for a consistent pan-Canadian framework.

Thank you for your attention.

[Dr. Cindy Forbes, President, Canadian Medical Association]

Thank you, Mr. Chair.

As you mentioned, I'm Dr. Cindy Forbes, president of the Canadian Medical Association. I'm also a family physician from Nova Scotia. I'm joined today by Dr. Jeff Blackmer, vice-president of medical professionalism. Dr. Blackmer has led the CMA's work on medical assistance in dying.

As the national organization representing over 83,000 Canadian physicians, the CMA has played an instrumental role in the public dialogue on what should be the framework to govern assisted dying. Let me recap our role. It was the CMA's position that making medical assistance in dying legal was for society to decide. We did not take a position on that question.

Following the Supreme Court's landmark decision last year, the CMA has focused its considerable efforts, consulting with physicians and the public on what the framework should be. In the course of our work, CMA has consulted directly with tens of thousands of members. Our position and remarks today are informed by these extensive consultations. Today, we are here on behalf of Canada's doctors to convey one overarching message: the CMA recommends that parliamentarians support the enactment of Bill C-14 as proposed and without amendment.

As the national professional association representing Canada's physicians, the CMA has played an important role in leading the public dialogue on end-of-life care. This in-depth consultation was instrumental to the development of the CMA's “Principles-based Recommendations for a Canadian Approach to Assisted Dying”. The CMA's core recommendations address four areas: patient eligibility, procedural safeguards, the roles and responsibilities of physicians, and ensuring effective patient access. The CMA's recommendations on these issues form our position on the overall framework to govern medical assistance in dying in Canada.

Before turning the floor over to my colleague, Dr. Blackmer, who will review CMA's response on the core elements of the legislation, I will provide our response on the overall approach.

Put simply, the CMA strongly supports the government's overall response to the Carter decision. This includes legislative and non-legislative measures. Of particular importance are the commitments to develop a pan-Canadian end-of-life care coordinating system and to support the full range of end-of-life care options, including expanding palliative care.

Finally, the CMA recognizes that there's been significant public discussion regarding the approach for the “Carter plus” issues. These include eligibility for mature minors, advance care directives, and mental health as a sole condition.

The CMA supports the approach proposed by the federal government not to include these issues in Bill C-14 and to study them in greater detail prior to advancing legislative proposals. This approach aligns with the approach taken by other jurisdictions, for example, Belgium.

I'll now turn the microphone over to my colleague, Dr. Blackmer.

Bill C-14—Time Allocation Motion

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

Mr. Speaker, it is incredibly important that we meet the June 6 deadline of the Supreme Court of Canada.

The object of this piece of legislation is to ensure that we balance personal autonomy and provide protection to the vulnerable. If we do not have legislation in place as of June 6, there will be no safeguards in place, and the medical practitioners will have uncertainty with respect to the eligibility criteria around somebody who wants to access medical assistance in dying.

The Supreme Court of Canada said two things. It said that an absolute prohibition on medical assistance in dying is unconstitutional, and it put it to Parliament to do our job, to put in place a substantive piece of legislation that reflects the diversity of views that exist in this country. That is what Bill C-14 does.

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

Mr. Speaker, this is a difficult debate because it is not about Bill C-14. It is about democracy in this place. The reason it is not democracy is that for the last four years under the majority Conservative government, we saw the illegitimate use of closure more than 100 times in this place. We looked to the new government and we believed in the mandate that there would be greater respect for opposition parties.

My faith in that was crushed by the decision of the hon. House leader to insist that Liberals at committee pass a motion that deprived me of my rights at report stage. Now we have closure on this matter.

I have the utmost respect for the Minister of Justice. I hold her in high esteem, so I ask her this question. In balancing the harms, the harm to democracy in this place versus the risk that taking the time to do Bill C-14 right might take us beyond June 6, would there be harm done? That is my key point as a lawyer. The Supreme Court of Canada decision could take effect. We could be late having royal assent and there could be a—

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

Mr. Speaker, I agree with my colleague across the aisle about the sensitive nature, the deeply emotional, and complex realities in our consideration of Bill C-14. Putting in place a medical assistance in dying regime in our country is transformative. It is a paradigm shift.

There has been substantive debate. There have been submissions made by 84 members in the House. There was ample opportunity to debate this.

Ten members from the member opposite's party had the opportunity to speak, and members from his party stopped speaking last night at 11:00 o'clock.

We need to fundamentally ensure that we meet the Supreme Court of Canada's deadline of June 6. We are endeavouring to do so to ensure we can get this substantive piece of legislation through the parliamentary process to comply with the Supreme Court's deadline.

[Peter Julian, NDP, New Westminster—Burnaby, BC]

Mr. Speaker, that is absolute rubbish, and it is shameful. The opposition parties were very clear that we wanted to debate the issue throughout the week. That was the initial government offer. Now we are seeing a shameful backtracking from the government.

The Liberals promised sunny ways. They promised that they would respect opposition parties in the House. I remember them promising as well that they would respect parliamentary debate in this place. They had no better opportunity to prove they would actually walk the talk than on Bill C-14, which is a non-partisan issue to which I think all members of Parliament want to give voice.

However, now we are seeing, shamefully, the use of closure to shut down what should have been a non-partisan debate through the course of this week.

What is even more appalling is that in the previous government, it would allow five days of debate. The Liberals are shutting this down after two-and-a-half days of debate, only. Why are sunny ways turning to dark ways, and why are Liberals shutting down debate on the bill after only two-and-a-half days?

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

Mr. Speaker, I am pleased to stand to speak about this. We recognize that the Supreme Court of Canada has put in place a deadline of June 6. We respect the Supreme Court of Canada in terms of responding to the Carter decision and have put forward Bill C-14 to do just that.

There has been substantive debate in the House. We have had over 21 hours of debate. Eighty-four members of Parliament, from every party in the House, have had the opportunity to speak.

We need to ensure we meet the court's deadline. We need to get this into committee so if amendments are proposed, they can be proposed at the committee stage.

I would further respectfully submit that yesterday we tried to extend the sitting hours as late as necessary to ensure that all MPs who wanted to speak had the opportunity to do so. Unfortunately, the opposition decided to limit the hours of debate.

[Dominic LeBlanc, Liberal, Leader of the Government in the House of Commons]

moved:

That, in relation to Bill C-14, An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying), not more than one further sitting day shall be allotted to the consideration at second reading stage of the Bill;

and

That, 15 minutes before the expiry of the time provided for Government Orders on the day allotted to the consideration at second reading stage of the said Bill, any proceedings before the House shall be interrupted, if required for the purpose of this Order, and, in turn, every question necessary for the disposal of the said stage of the Bill shall be put forthwith and successively, without further debate or amendment.

Physician-Assisted Dying

[Rhéal Fortin, Bloc, Rivière-du-Nord, QC]

Mr. Speaker, this week the Barreau du Québec submitted a brief to the Standing Committee on Justice and Human Rights that confirms that Bill C-14 on medical assistance in dying does not meet the requirements set out by the Supreme Court in the Carter decision.

I happen to know that there are a few government MPs who are also members of the Barreau du Québec, and I am sure they could confirm the credibility of the representatives from the Barreau for the minister, if necessary.

Will the government, which includes 40 MPs from Quebec, nine of which are members of the Barreau du Québec, amend Bill C-14 to address the gaps outlined by the Barreau du Québec?

Criminal Code

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

Mr. Speaker, we have heard many extremely poignant statements over the past few days in this chamber. Here are a few of them, not necessarily word for word, but the essence is there: This is by far the most crucial question we have faced in this chamber in the past 10 years. We are experiencing a fundamental shift in society. Centuries of thought are being overturned. Thousands of years of the understanding of the sacred gift of human life are being discarded.

The Liberal member of Parliament for Winnipeg Centre stated:

Perhaps this is just another step on the road of moral relativism that we are in nowadays, but even our judiciary cannot serve as a balance between the different societies making up Canada. We are in a sorry state. We have truly entered a new age, one of the throwaway culture where all boundaries are starting to crumble.

He goes on to say:

From an indigenous perspective, I look at this bill and I cannot support it, because it leads to a place where I do not believe we are looking out for the interests of all people within our society. It is not allowing us to fully comprehend the needs of everyone who makes up Canadian societies, but really, it is taking us down a path that is very dangerous, and we do not know where it ends.

This comment is true not only for our indigenous communities, but also for the overwhelming majority of all Canadians who are informed by their faith, whether that be Jewish, Muslim, Sikh, or Christian.

I want to read from a very insightful blog that I came across today.

...from its very first sentence the bill sounds the final death-knell, for all public purposes, of Abrahamic faith. The Carter/C-14 doctrine of autonomy is a clear repudiation of that kind of faith and the establishment of a new faith in man as utterly independent of God. One does not need to be Abrahamic to understand this. If the Parliament of Canada recognizes personal autonomy as extending a moral right to determine the manner and timing of one’s own death, and to take one’s own life or another’s life, it necessarily recognizes the person—and [Parliament] itself as a deliberative body of persons—as lying outside of all putative divine authority in such matters. In short, the C-14 preamble is the final repudiation of the Charter preamble. “The principles of fundamental justice”...now operate independently of any reference whatsoever to the supremacy of God. The link between “the supremacy of God and the rule of law” is decisively severed.

He then goes on to quote Nietzsche:

What were we doing when we unchained this earth from its sun? Whither is it moving now? Whither are we moving? Away from all suns? Are we not plunging continually? Backward, sideward, forward, in all directions? Is there still any up or down? Are we not straying, as through an infinite nothing? Do we not feel the breath of empty space? Has it not become colder? Is not night continually closing in on us? Do we not need to light lanterns in the morning? Do we hear nothing as yet of the noise of the gravediggers who are burying God? Do we smell nothing as yet of the divine decomposition? Gods, too, decompose. God is dead. God remains dead. And we have killed him.

Over the past few days in the House, we have heard from many members with a wide variety of positions. Let me first say that I am very thankful that the government decided not to follow through with all of the recommendations made in the Liberal-dominated special joint committee report and decided rather to incorporate many of the comments of the dissenting report created by me and other members of the Conservative Party.

While Bill C-14 is a huge improvement from the very permissive, wide-open regime recommended by the joint committee, the legislation falls far short in protecting some of our most vulnerable Canadians, and as a result, I cannot support it.

First, there is no firm commitment to conscience protection for doctors and other health care workers who for a variety of reasons may not want to participate in any fashion in physician-assisted suicide. This includes the need to make a referral to a participating doctor.

While the preamble states boldly that it is “desirable to have a consistent approach to medical assistance in dying across Canada”, and later refers to “respect the personal convictions of health care providers”, there is no section in the actual clauses of Bill C-14, no clear, unequivocal statement that no doctor or health care worker would be under any obligation to participate.

Just as important, what about health care institutions and hospices which, because of the core values they embrace, may not want to have physician-assisted suicide available in their institutions? What about a hospice which raises upward of 50% of its own revenue from private donations and which relies largely on armies of volunteers and donors who believe in the inherent and intrinsic dignity of human life? My fear is that if any of these institutions are forced into situations in which they are obligated to engage in physician-assisted suicide, the community may face the very real possibility of losing those volunteers and donors, and ultimately, may in fact lose the very institution itself. This would be a tragic unintended consequence of not guaranteeing conscience rights to doctors, health care workers, and institutions.

These changes must be included in Bill C-14 if we are to respect the professionals and institutions that provide excellent quality of health care every day.

There also needs to be a clear commitment to providing palliative care as a real and viable option. To offer physician-assisted suicide without a meaningful offer of available and palliative care is to provide no option.

Let me quote Dr. David Baker:

Without a right to palliative care, Canadians will soon be receiving publicly funded physician assistance to die because it [palliative care] is not available. This will infringe their s. 7 Charter right to life, liberty and the security of their persons and their section 15 equality rights as Canadians with disabilities and seniors.

Another important amendment that is needed is to have a system of prior review. There needs to be a legal system in place to ensure that no coercion occurs and to ensure that the two independent witnesses are in fact independent and that the two independent doctors are in fact independent.

Dr. Trudo Lemmens, the chair on health law and policy at the faculty of law at the University of Toronto stated:

...some eligibility criteria are inevitably quite open to interpretation, which makes it all the more problematic that an assessment of competency and informed consent by two physicians is seen as sufficient to ensure compliance. I continue to support a prior review system as reflected in the Vulnerable Person Standard, which is supported by a wide and inclusive coalition of patient and disability advocacy groups, health professional organizations, health care institutions and individuals with a wide variety of ideological and religious affiliations.

While I am fundamentally opposed to the taking of human life at any point, if we are to adopt legislation as a House of Commons, if we are going to go down this road, we need to be sure that we have far more stringent safeguards included in the bill.

[Kelly McCauley, Conservative, Edmonton West, AB]

Mr. Speaker, before I start, I would like to thank my friend from Yellowhead for his kind words on Fort McMurray. The devastation there is overwhelming. I would like the people there to know they have my prayers, and I am sure the thoughts and prayers of everyone in the House today.

I used to work in Fort McMurray. In fact, the very first hotel I managed just burned down. I know the people there will be counting on our support, and the people there know everyone in the House will be supporting them.

I rise today to discuss Bill C-14. This is obviously a very difficult issue for many people in the House, and I appreciate the views expressed here today and in yesterday's debate. Members oppose the bill on faith-based grounds, legal grounds, ethical grounds, and for other reasons. Others praise and support the bill.

I truly respect each member's personal contribution to the parliamentary debate. I would like to express my gratitude to the members of the Special Joint Committee on Physician-Assisted Dying. It is probably one of the most difficult, if not the most difficult, issues we are going to face in this Parliament.

We all know someone who has died in pain, a loved one, a child, a colleague. We have all seen the ravages of disease on the body of people we once saw only as the embodiment of life and hope. I have lost two of my most beloved uncles to cancer. One of these uncles was a lifer in the Royal Canadian Navy, who finished his career in service to Canada as base commander at CFB Esquimalt.

Commander Larry Dzioba, as any commander would be, was ready for his battle that would come. He fought cancer to the end and was still living independently, in relatively good health, up until the final two days before he passed away. I credit his strong Ukrainian stock for his strength and always think that he viewed pain as something to be tolerated.

Another uncle of mine, Michael McCauley, passed away after years of chemotherapy and radiation. In the end, he passed away at home in his bed surrounded by his family. He maintained his dignity until the very end.

Another very close friend of mine, my dear friend Peter, died of lung cancer a few years back. Peter and I worked together at the famed Deerhurst Resort in Muskoka, pre-gazebo days, and later together in Edmonton. Peter went from diagnosis to death in just three months, but his family and friends will forever be grateful to the wonderful staff at the Cross Cancer Institute in Edmonton, who ensured that Peter lived his final days as comfortably as possible and with dignity.

Unfortunately, however, far too many Canadians suffer due to inadequate palliative care. A 2015 study shows that anywhere from 15% to 30% of Canadians have access to adequate palliative care, and even at the highest levels of the spectrum, it is nowhere near enough.

This is where my concerns with Bill C-14 begin. From the bill's preamble, I quote the following:

Whereas it is desirable to have a consistent approach to medical assistance in dying across Canada

The government wishes to have a universal approach to assisted suicide in Canada, but does not state the need for universal access to palliative care across Canada. Members of the House have repeatedly commented on access to broadband Internet as a human right, yet there is nothing about a human right to palliative care. The government commits to broadband expansion in its 2016 budget, but if we search “palliative” in budget 2016, we get the message ''no matches were found''. It is disgraceful and shameful.

The health minister has said that $3 billion will be committed over four years for palliative care across the country, but there are no details on this. It is not listed once in the budget. There is no information on how it will be rolled out or how it will be paid for.

In fact, the $3 billion is probably the same $3 billion that the Liberals promised in their election campaign for increased home care services. It is not specifically for palliative care, which they are stating now, but for home care services.

Alarmingly, the health minister said in January, just before meeting with provincial health ministers, that "more money isn't necessarily the only solution”. The $3 billion is promised, yet it does not seem to exist anywhere in the budget and, according to the government, may not be necessary. I would argue that virtually every doctor who treats terminally ill patients would disagree.

It is paramount that the government states immediately how it will ensure equal access to proper palliative care across this country. It is unfathomable that the government would introduce assisted dying legislation without announcing a detailed strategy to prevent terminally ill Canadians from believing doctor-assisted suicide is their only option.

The government has a moral obligation to outline such a strategy and provide adequate funding immediately. It is not enough to simply spout off a few talking points, get in a few good sound bites, and then hope it is later forgotten.

The government has not done nearly enough to think through this bill in its haste to meet the Supreme Court's deadline. It has not begun to consult with the provinces on many of the responsibilities that will be downloaded onto them. For example, Alberta has been working on this for five months with no apparent consultation with the government.

I believe assisted suicide is not the answer to the complex problem of human suffering, whether it be physical, emotional, or even spiritual suffering. Medical advances specifically in pain management drugs have gone a long way in helping the suffering bear pain and keep their dignity. What is really needed above and beyond the medical advances and improvements in palliative care is a willingness to be involved in the lives of those who suffer. The reasonable answer to suffering is love, companionship, and hope for the better, hope for tomorrow, for hope allows us to continue on.

In addition to the philosophical objections that I have to this bill, there are many practical concerns. One is the lack of education on the matter of alternative methods for care of the terminally ill. For example, a survey of pre-licensure pain curricula in the health science faculties of 10 different Canadian universities showed that many would-be doctors receive less training in pain management than their counterparts in veterinary medicine. Meanwhile, a survey of over 1,100 doctors and nurses showed that those who treat fewer terminally ill patients, therefore knowing the least about symptom management, are most likely the ones in favour of assisted suicide, whereas those with the most experience with symptom management and end-of-life care tend to oppose it.

Dr. Max Chochinov, a noted specialist on palliative care, explains that the will to live is directly inverse to the amount of pain and that loss of dignity drives wanting to die and treatment of pain can improve sense of dignity.

I realize that we will have doctor-assisted suicide in Canada. The courts have decreed it, and society appears to demand it, but we in this House must ensure that we are doing everything to ensure we protect the vulnerable and enshrine the belief that all life is precious before we introduce a new law.

There are holes that must be addressed before Bill C-14 becomes law. Like many others in the House, I am disappointed that there are no provisions to protect the rights of doctors, nurses, and other medical practitioners who object to participating in assisted dying or referring on conscience grounds. We must protect their rights regarding referrals as well.

My own doctor stated on the issue, “not selling you a drug but sending you to a street corner for drugs where you are murdered makes me just as complicit in your death.” I enjoy the bluntness of my doctor.

It is not enough to simply leave it to the provinces or to say that there is no problem because so far no health professional has been forced against his or her conscience to perform certain acts. The rights of health care professionals must be respected and must be enshrined in federal law. It has always been our society's custom to assist the suffering, to be by their side, and not to kill them. This practice must be reaffirmed, and a respectful approach to human life must be upheld, one that recognizes that the intrinsic worth with which every human being is endowed is not eradicated by suffering.

Life is precious and I believe that our nation's laws must reflect this fact. In the Gospel of Life, Pope John Paul II wrote very eloquently about the issue of assisted suicide. He stated that assisted suicide is a crime which no human law can claim to legitimize. However, he further stated that elected officials “could licitly support proposals aimed at limiting the harm done by such a law and at lessening its negative consequences at the level of general opinion and public morality. This does not in fact represent an illicit cooperation with an unjust law, but rather a legitimate and proper attempt to limit its evil aspects.”

Doctor-assisted suicide is already a reality in Canada. While I acknowledge that Bill C-14 reflects many of the safeguards of the dissenting report put forward by my Conservative colleagues on the special committee, it is still a flawed piece of legislation. It does not include an obligation to provide all possible palliative and pain management options to terminally ill patients. It does not mandate that funding be given and then maintained for end-of-life care. It does not guard the conscience rights of medical professionals. Beyond this, Bill C-14 does not offer a legitimate and proper attempt to limit the evil aspects of suicide. It is for these reasons that I will not be supporting this bill.

[Scott Reid, Conservative, Lanark—Frontenac—Kingston, ON]

Mr. Speaker, I thought that rather than giving my rationale and telling people how I will vote at the end, I would do the opposite.

I want to say, first of all, that I will be voting yes at second reading to this bill, so that it can be sent to committee where it can be discussed in principle, and perhaps be amended to make it better than it currently is.

At third reading, I will be guided in my voting by the instructions of my constituents. I am mailing out what I call a constituency referendum. It is effectively a survey designed to ask them in as impartial a way as possible how they would have their member of Parliament vote. The reason I am doing this is that I believe, when it comes to a profound issue of conscience like this, the consciences of my constituents are every bit as good as my own conscience, that of the other members of Parliament, or the people on the Supreme Court of Canada. They will guide me at third reading.

My comments today are, therefore, about the underlying issue that I think is at stake here as we, meaning Parliament, the courts, the policy-makers here in Canada and frankly in every country in the world, must face as we deal with the realities of life and death at this particular moment in time.

Right now, and this is not something that has always been true in our history, life is expensive, maintaining life is expensive, and death is cheap. This is something that has not been true throughout our history.

Anybody who reads the novels of the Brontë sisters is aware of the fact that in the mid-19th century, and in every century before that, life was relatively inexpensive to maintain, in part because the ability of medical technology to keep people alive was so limited. The doctor would arrive, perhaps bleed someone if they had a simple fever, and then, at least this is how it happens in the novels, advise the relatives to prepare themselves. The financial difference between life and death was very limited.

That is no longer true. I want to make this point in the context of a health issue that has nothing to do with euthanasia or the assisted suicide or assisted dying debate, but it really illustrates just how expensive life is in a world of improved technology and pharmaceuticals.

This month, May is cystic fibrosis month. I know somebody who has cystic fibrosis, and I have become very passionately involved in this. Every year, I encourage members of Parliament to wear a rose, and we will all be doing this next Wednesday, in honour of those who have cystic fibrosis. I wear the cystic fibrosis pin today.

Now there was a drug introduced in 2012, called ivacaftor, trade name Kalydeco, which, for the 4% to 5% of cystic fibrosis patients who have the delta-F508 mutation of the gene with the CFTR protein, for that small segment of cystic fibrosis sufferers, this drug effectively turns what would otherwise be a terminal disease into a manageable illness that is problematic but not fatal.

It is available at a very high cost to them, their families, or the public health care system, depending on where the patient lives. The cost to get access to Kalydeco is approximately $300,000 American per year. The patents on drugs are typically about 20 years long. Presumably at the end of that 20-year period, the cost will drop dramatically, but right now it is $300,000 per year. Members can do the math, $300,000 times 20 means that it is $6 million to keep one individual alive.

It is well worthwhile, but the fact is that life is expensive, whereas denying them this care, and some provinces do not give public funding for the drug, is cheap. That costs very little. I do not mean to suggest that the drug company is charging unreasonably, or any of these other subsidiary questions. It cost $458 million for Vertex, the company that developed this drug, to bring it to market. My observation is simply that life is very expensive and maintaining life is expensive. Death is cheap.

Now, turning to palliative care, of course it costs a great deal less than this to keep people alive on palliative care at the end of their lives. However, the fact is that denying care is less expensive. This is exclusive of the Supreme Court ruling. It is exclusive of whatever is in Bill C-14 or should, or should not, be in Bill C-14. This creates a dynamic in which there is a strong financial incentive for policy-makers to promote the less expensive option, as there is in everything.

In this case, it means that the incentive to do what is necessary to allow the life option as opposed to the death option is reversed or weakened. This means the incentive to not provide palliative care is going to be very strong.

In this situation, the Supreme Court of Canada ruling in Carter v. Canada is likely to have tilted the dynamic in favour of death as a solution to the high-cost problem of maintaining lives that are deemed to be not worth living.

To make the point about how this is relevant, I want to quote from what the health minister said on the Friday before the break, in her speech on the issue. I had the good fortune to be able to question her afterwards about this. She said:

Today, Canadians are aware, and have a general understanding, of palliative care. However, some studies have [shown] that the overwhelming majority, perhaps 70% or more of us, do not have access to it, particularly in rural and remote areas. Many providers are not well trained to provide palliative care services.

I think she was just presenting what she regards correctly, as a fact. However, read this a different way and a more sinister meaning becomes evident. We lack the funds, or the provinces lack the funds, for palliative care, but death is the less expensive way to ensure that no one lives an unbearable life.

Again, I do not think she meant this in a sinister way. The implication was simply there to be found, and taking her words and reading them a little differently, we see that implication.

Faced with this problem, the problem brought upon us by the fact that we can extend life in a way that never could before but with limited funds and, inevitably, there are not enough funds to deal with all the life needs that are out there, the wrong move taken for a reason that seems noble but is poorly thought through could have disastrous consequences.

To make this point, I want to turn to one of the best books on public policy I have ever read, Lectures on the Relation between Law and Public Opinion in England during the Nineteenth Century, by the great Albert Venn Dicey.

Writing about Lord Shaftesbury, the well-meaningful philanthropist and statesman, he writes something that I think could well be applied to the Supreme Court's ruling in Carter v. Canada:

...the natural desire of an ardent philanthropist to save from immediate suffering any class of persons who are unable completely to protect themselves against oppression, and to do this by the means which lie nearest to hand, without deeply considering whether action which gives immediate relief to [these] sufferers...may not possibly in the end produce evils of untold magnitude.

In response to this, the danger is that we will do what Dicey warned about Parliament reacting. He was talking about the British Parliament. He was writing of a different century, but this is a warning that is well taken by any Parliament dealing with this kind of situation.

He said:

...laws passed to meet a particular emergency, or to satisfy a particular demand...produce, in the long run, more effect on legislative opinion than a law which openly embodies a wide principle. Laws of emergency often surreptitiously introduce or reintroduce into legislation, ideas which would not be accepted if brought before the attention of Parliament or of the nation.

This legislation is being introduced in haste in response to an artificial deadline, and it is an artificial deadline, set up by a Supreme Court which has a noble goal in mind but which has not, in my view, looked at all the implications of what it is trying to do. In dealing with a highly atypical set of cases, all of our jurisprudence in Canada at the Supreme Court level is based upon suffers of ALS who, on that bell curve of different ways in which people can die, either fully in charge as ALS sufferers are of their wills and their minds but not of their bodies or, at the other extreme, like Alzheimer's sufferers perhaps in reasonable physical health but not in possession of their faculties, and everybody in between. We have used that set of cases that have come before us because that is the way the court system works. Only the mentally capable can get their cases to the court and the court has generalized in a way that leads, potentially, into a hasty reaction that could lead to a principle being introduced into our law which may have, as Dicey says, unfathomable consequences.

I ask us all to move very cautiously and to seriously consider the possibility of amendments to this legislation in the coming weeks, as we go into committee.