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.

Criminal Code

[Cathy McLeod, Conservative, Kamloops—Thompson—Cariboo, BC]

Madam Speaker, I am going to use an example again. The Liberals promised $3 billion for palliative care. They say they cannot put it in the budget because they have to negotiate with the provinces. I notice that they certainly have not completed their negotiations with the provinces in terms of how the infrastructure money is going to be spent.

The Liberals made a promise on something as critical as palliative care. I would ask my colleague if their excuse of still having to come to some sort of conclusion with the provinces actually holds any sway, because I have not received a good answer on that issue from any of the Liberals.

[Ted Falk, Conservative, Provencher, MB]

Madam Speaker, that is a great question, because the Liberals did make a commitment to provide funding for palliative care. The doctors and nurses I have spoken to have said that when proper palliative care is available, the need for physician-assisted suicide just about falls down to nil. Had the money been in the budget that was promised by the Liberal government during the campaign, it would have helped to address that concern.

If we could provide proper palliative care for individuals, it would address the two basic fears that people told me they have at end of life. Number one is whether the pain can be controlled and number two is whether they can be helped with their fear, and both of those things can be addressed through proper palliative care.

[James Bezan, Conservative, Selkirk—Interlake—Eastman, MB]

Madam Speaker, I rise somewhat concerned today that I am finally, for the first time, able to speak to Bill C-14. We are at third reading. This bill has been rammed through the House. The Liberals have brought in closure time and again with this bill. Every time it was debated, whether at second reading or report stage, I was not available, or the time was so constrained and the list of speakers of the members of Parliament was so long, that I could not get on the list. Finally, I am able to speak today to Bill C-14 to reflect my concerns and those of my constituents on this bill.

When closure is used in dealing with issues of conscience like we are dealing with today with respect to physician-assisted death or doctor-assisted suicide, whatever we want to call it, we need to take the time to have the debate. We need to have the discussion among parliamentarians and talk to the appropriate experts to ensure that we get this right. If the Liberals rush this bill through the legislative process in the House and if they try to do it in the Senate, I can guarantee that mistakes will be made and this bill will be facing court challenges in a relatively short period of time.

I also have to reflect what my friend from the riding of Provencher said today. It is extremely disappointing that so many reasonable amendments were presented by members of the opposition parties, and not one of them found their way into this bill at report stage last night. That truly is disappointing.

In my riding of Selkirk—Interlake—Eastman, the topic of physician-assisted suicide is divisive, as it is right across the country. The majority of constituents who have contacted my office have been opposed to this policy, on two fronts: first, many people have deeply held moral, ethical, and religious beliefs that are strongly against assisted suicide; and, second, many believe that the policy will be used prematurely to end the lives of those who have become a burden to their families, society, or the medical system.

It is important to note that the Liberals broke a key election promise to invest $3 billion into-long term care, including palliative care. Access to palliative care is an essential part of end-of-life decision-making. There was unanimous agreement on the Special Joint Committee on Physician-Assisted Dying and among stakeholders, including the Canadian Medical Association, on the need for a pan-Canadian strategy on palliative care, with dedicated funding. This would be an important step forward for Canada. It is something that the Liberals have glossed over in favour of introducing this legislation in a very careless and expeditious manner.

Many medical doctors, nurses, and health care professionals are conflicted with the ethical and moral conundrum that assisted suicide presents, as it runs counter to the modern adaptation of the Hippocratic oath. The University of Ottawa captures the challenge of this principle. It states:

Given the complexity of medicine in the 21st century, an ancient oath cannot possibly encompass current values. Therefore, the significance of the Hippocratic Oath does not reside in its specific guidelines, but rather, in its symbolism of an ideal: the selfless dedication to the preservation of human life.

I would stress “the preservation of human life”.

Although the Canadian Medical Association in the last year has turned its back on its previous position on physician-assisted suicide, the Supreme Court of Canada went to great lengths and grasped at straws to change its position from its previous rulings as to whether there should be exemptions offered for physician-assisted suicide.

The Canadian Medical Association is a member of the World Medical Assembly, which adopted a resolution back in 1992 on this. It revised it slightly in 2005, but reaffirmed it in April of 2015 in Oslo. It states:

Physician-assisted suicide, like euthanasia, is unethical and must be condemned by the medical profession. Where the assistance of the physician is intentionally and deliberately directed at enabling an individual to end his or her own life, the physician acts unethically. However the right to decline medical treatment is a basic right of the patient and the physician does not act unethically even if respecting such a wish results in the death of the patient.

Quite clearly, the World Medical Association, doctors and physicians from right around the globe, is saying that this is unethical.

As has been pointed out, we are quite concerned from our side, and I am in particular, about the charter rights under sections on the freedom of conscience. As has been noted, there was a minor amendment made to Bill C-14 in the preamble to allow for the protection of individuals but not of institutions. Is it strong enough to be considered legal in a case that goes before the courts, the Canadian Human Rights Commission, or one of the provincial human rights commissions, if section 2 is defined in the preamble but is not actually in the clauses of the legislation itself?

Institutions would be exempt, and I know that some members have had conversations with people at some institutions who are very concerned about this. I looked to the St. Boniface General Hospital in Winnipeg, a Catholic-run hospital. They are quite concerned that they, as an institution, will have to violate their own religious and moral beliefs to provide assisted suicide. They believe in the sanctity of life, as many of us on our side do also.

Like most Canadians, I have watched loved ones succumb to lengthy and chronic debilitating illnesses. Dying with dignity is desired by all Canadians. Unfortunately, only a handful of us will die in our sleep with minimal discomfort or pain. I do not believe that we should institute a policy that will provide physician-assisted suicide to every Canadian when they are near their end of life. Dying with dignity does not apply only to physician-assisted suicide. Expanding and improving palliative care services is by far the better public policy, and should be a priority of all health care providers across this country. I am recommitting to working with like-minded Canadians and policy-makers, and parliamentarians right here, who want to enhance palliative care in Manitoba and across the country. My wife Kelly works as a nurse in a personal care home and provides palliative care services all the time. She agrees that strengthening palliative care services will allow more Canadians to die with dignity.

I have met with the Manitoba League of Persons with Disabilities and talked to Carlos Sosa, who is the Manitoba representative on the Council of Canadians with Disabilities. They are very concerned with the way that Bill C-14 is laid out right now because it would do little to address the concerns of the vulnerable and how the law would deal with people in the disabled community. In particular, the bill would not provide for an assessment of vulnerabilities that may induce a person to assist and seek an assisted suicide. It does not have an expedited prior review and authorization by a judge or independent body with expertise in fields of health care, ethics, and law. This was one of the amendments we brought forward last night, and it was defeated.

Rhonda Wiebe, who is the co-chair of the Canadian Council of Disabilities end of life ethics committee, said:

In the Carter decision, the Supreme Court of Canada gave the Government of Canada two assignments (1) develop a regime to provide dying people access to assisted suicide and (2) protect vulnerable Canadians who at a time of weakness may be influenced to accept medical aid in dying. Unfortunately, [Bill] C-14 has some serious gaps when it comes to protecting the vulnerable..... Canada must do enough to protect people like [her] and other Canadians with disabilities who can be made vulnerable by both [their] health conditions and [their] social and economic circumstances.

I am privileged to belong to a political party that allows for free votes on issues of moral and religious beliefs. On policies such as physician-assisted suicide, Conservative members are free to either reflect the will of their constituents or to vote according to their personal beliefs. As someone with very strong Christian values, I cannot support Bill C-14. Bill C-14 needs better protection in place for youth under the age of 18, and safeguards for those who are vulnerable, including those who are dealing with mental health challenges.

[Anthony Housefather, Liberal, Mount Royal, QC]

Madam Speaker, I am sure that my hon. colleague inadvertently stated something that is not correct, which is that conscience amendments were not added to the bill. We did have a conscience amendment that was drafted in conjunction with the member for St. Albert—Edmonton, the member for Victoria, the member for Central Nova, and I, which is in the bill. The preamble was amended and the bill itself was amended. I just want to correct him on that point.

There was a judgment by the Alberta court yesterday, saying that a non-Canadian citizen, not eligible for medicare, was eligible for physician-assisted dying. We have had a judgment from the Court of Appeal of Alberta that stated that a psychiatric patient of 58 years old who was not dying—death was not only not imminent but not even foreseeable—was eligible.

Does the hon. member not agree that without this law being adopted by June 6, and without safeguards in place, such as two opinions, a waiting period, and all of the other safeguards in the bill, that we will be going down a very slippery slope?

[James Bezan, Conservative, Selkirk—Interlake—Eastman, MB]

I do agree, Madam Speaker, that we do not want the slippery slope. We do not want judges, without any background at all in the ethics or medical field, making rulings on individuals in cases like the member for Mount Royal just outlined.

We also know that the amendment that was accepted was rather watered down. Again, it is in the preamble and not in the body of the bill.

We have some options here. The government has options. It can request an extension from the Supreme Court of Canada so we do not have to go for the June 6 deadline. We can work with the opposition members and make this right and accept some of these amendments that we brought forward and are very reasonable, or we could use the notwithstanding clause. There are options out there, but ultimately I ask people to defeat the bill.

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

Madam Speaker, we are dealing with a closure motion today that allows very few members of Parliament to speak. We saw a couple of weeks ago that the government pulled Bill C-14 from the Order Paper a number of times when members of Parliament wanted to speak on it.

We saw, as well, a government refusing even the ability yesterday, under closure, knowing that we had a vote on Monday evening, to allow members of Parliament to speak during the day. It defies logic that a non-partisan bill of this nature would be treated so reprehensibly by the government.

Given all of the concerns raised by legal and medical professionals, their communities, the concerns about the lack of constitutionality of the bill, which has now been pointed out in two court decisions, why does the member think the government is trying to ram through this bill in such a partisan and inappropriate way?

[James Bezan, Conservative, Selkirk—Interlake—Eastman, MB]

Madam Speaker, there is no question that this is an issue that deserves to have the proper time for debate in Parliament. The government, for whatever reason, other than the June 6 deadline, rather than doing the right thing and asking for another extension so we can get this right, is using closure, very autocratic measures to limit debate, and not allowing us, as parliamentarians, to express the will of our constituents or our own personal beliefs.

We know we should have the time to get it right. Whenever we see these types of motions, especially on legislation that will affect the long-term history of Canada—this is something that will go on into the future with little chance for amendment or change—we have to get it right. The way we do that is not through using closure and draconian measure that the Liberals have forced upon us.

[Kevin Sorenson, Conservative, Battle River—Crowfoot, AB]

Madam Speaker, with all due respect, the member who gave his speech talked a bit about why the government would have done it. In some ways it may be competence or incompetence. The Liberals pushed this off as long as they could, expecting that they would be able to ramrod it through, and now they are saying they will not make the June 6 deadline. What will they do? That very well may be it.

I thank the hon. member for speaking on palliative care. Why does my colleague who gave the speech believe that the government would not have addressed palliative care initially in the budget, saying that it recognized what was coming and offering its commitment to palliative care?

Through all this debate—

[The Assistant Deputy Speaker, Carol Hughes]

I want to give the member a chance to respond, so I will ask for a brief answer from the member for Selkirk—Interlake—Eastman.

[James Bezan, Conservative, Selkirk—Interlake—Eastman, MB]

Madam Speaker, I agree with my friend from Battle River—Crowfoot. There is no question that this legislation is being ramrodded through without proper consideration. There is no question that the issue of palliative care is not even addressed in the budget or in this policy development that we are working on right now. If we are going to deal with end-of-life issues properly, we need to have palliative care.

All the Liberals want to do is talk about those issues without committing the dollars that they promised they were going to commit.

[Francis Scarpaleggia, Liberal, Lac-Saint-Louis, QC]

Madam Speaker, I will be sharing my time with my hon. colleague from Pierrefonds—Dollard.

In this postmodern world of ours, with its tendency at times toward a certain kind of what some might call libertarian relativism, we must continue to believe and affirm that there exist values that we can all agree are objectively good and worth protecting and promoting, values that should inform, motivate, and guide us both individually and collectively. Namely, we must subscribe to the imperative that we as human beings have a duty to support each other in our struggle in this fight for life, as some colleagues have put it, this struggle against the undeniable reality of our finite existence, our mortality. Every moment of life has value. This truth is to be asserted and upheld. This is the prevailing consensus, one that has become deeply rooted and entrenched in society over the course of history. It is also our best instinct. Many of my constituents fear that Bill C-14 would undermine this consensus, this instinct. I understand this fear.

We cannot allow ourselves to fall into indifference, to be quietly seduced by the facile notion found in the well-worn phrase “to each his own”, whereby we agree on everyone's right to choose, but beyond that we do not think it our business to provide reinforcement for the desirable and good choice. When I hear anyone appear to frame the debate on medical assistance in dying as one of pure libertarian choice, I must admit that a little part of me shudders.

After much reflection, I do not believe that Bill C-14 would necessarily lead us down a path to an increasingly permissive and contagious attitude toward self-directed death.

I would like to quote bioethicist Margaret Somerville, someone generally identified as a philosophical conservative on bioethical matters, someone who has written on the dangers of legalized doctor-assisted death:

The bill would legislate these actions as an "exemption" from—an exception to—prosecution for the Criminal Code offences of culpable homicide and assisted suicide that would otherwise be committed. Treating medically assisted dying as an exception will help to ensure, as is essential, that it does not become part of the norm for how Canadians die;

In other words, Bill C-14 would not normalize medically assisted dying as perhaps has occurred in Belgium and the Netherlands, the two most often cited examples of the slippery slope.

Dr. Sommerville goes on to say that:

Recognizing medically assisted dying as an exception also helps to establish that access to it is not a right but rather, under certain conditions, an immunity from prosecution for a criminal offence....

This approach, she further states, “carries an important anti-suicide public health message.”

I would add that the government has taken care to emphasize this message in the bill's preamble, which acknowledges that “suicide is a significant public health issue that can have lasting and harmful effects on individuals, families and communities”.

I am not a doctor who deals with life and death on a daily basis and I have never been at death's door.

Like every one of us here, I am an elected member trying to make the best possible decision in the context of the undeniable reality that the Supreme Court made a unanimous decision in the heart-rending Carter case.

The court's decision requires Parliament to create a new legal framework to regulate a specific aspect of end of life. If we fail to do our jobs now, the result will be a partial legal and regulatory vacuum. To quote the Ontario Hospital Association, if the bill is not passed by June 6, “Assisted dying would be lawful where it is provided in accordance with the parameters established by the Court and provincial regulatory bodies.”

The parameters set out by the court are fairly general. The court did not offer precise prescriptions for what an operative medical assistance in dying framework should look like. It is not the role of the courts to be so prescriptive.

This is not to say that I do not have concerns in voting for this legislation. Absent a Supreme Court ruling, and had the issue been raised once again through a private member's bill, I would very likely not have voted for medical assistance in dying. I have already, in the past, voted against a private member's bill on doctor-assisted suicide.

However, we do have a Supreme Court decision that creates a requirement to act. The Prime Minister and the Minister of Justice and the Minister of Health have, in my view, acted wisely in taking a cautious approach to the issue, notwithstanding the excellent work of the special joint committee under the capable and intelligent stewardship of my friend and colleague the member for Don Valley West.

The bill may not be perfect, but I believe it would be a mistake to suggest that it leaves a wide-open field in medically assisted dying, a fear expressed to me by many thoughtful constituents committed in the highest degree to the protection of human life.

Bill C-14 would establish numerous criteria to be met before access to medically assisted dying could be granted. In addition to being 18 years of age, the person must have a grievous and irremediable medical condition that meets four distinct criteria: the illness, disease, or disability must be serious and incurable; the individual must be in an advanced state of irreversible decline; moreover, the illness must be causing enduring physical or psychological suffering that is intolerable; and natural death must be said to be reasonably foreseeable. In addition, the person must make a voluntary request that is free from external pressure and that is the result of informed consent.

The bill also includes a number of safeguards, and the individual must make a request in writing or through another reliable means. If the request is being signed by a proxy, that proxy must be at least 18 years of age and understand the nature of the request. The request must be made after the person has been informed that his or her natural death has become reasonably foreseeable.

The request must be signed and dated before two independent witnesses, and in turn, these witnesses must not consciously be beneficiaries, financial or in any other material way, of the individual making the request, and they must not be directly involved in providing personal care to the person making the request.

Two medical practitioners must provide a written opinion confirming that the person meets the eligibility criteria, and these medical practitioners must be independent. For example, one cannot be a supervisor of the other or a mentor of the other.

Crucially, the person must be informed that he or she has an opportunity to withdraw the request at any time.

All of this said, I am not at all convinced that medical assistance in dying is a serene and dignified phenomenon, even if often depicted in this way. I suspect that complications may arise. This is why it is crucial and to the government's credit that the bill allows for monitoring of medical assistance in dying through detailed reporting.

A few years ago, a handful of parliamentarians, including the members for Kitchener—Conestoga and Carlton Trail—Eagle Creek, the former members for Newmarket—Aurora, Guelph, and Windsor—Tecumseh, and myself, wondered about enhancing and improving palliative care in Canada.

We founded the committee on compassionate and palliative care and produced a report. The silver lining in this debate is that palliative care is receiving a degree of attention never before seen in this chamber or in national discourse at large.

It is my sincere hope that, once quality palliative care of the kind provided by the West Island Palliative Care Residence is available through appropriate federal and provincial funding to all Canadians approaching death, this legislation will become somewhat of a relic, and medical assistance in dying will no longer be considered the default option in relieving end of life pain and suffering.

In this regard, I am heartened that, in addition to the government's existing commitment to do more to fund palliative care, the bill makes specific reference to this commitment. The advent of universally available quality palliative care will hopefully one day be seen as the high-water mark in the measure of a truly just society.

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, my Liberal colleagues are lavish in their praise of the minister. They think that the bill is perfect and will easily pass the test of the charter and the courts.

My question is simple. How does Bill C-14 guarantee a reasonable expectation of the right to life; liberty, by which I mean freedom of conscience in the sense of respecting autonomy; and security of the person, in the case of a person suffering from a grievous and irremediable illness, if the person has to go on a hunger strike to be eligible for medical assistance in dying and meet the reasonably foreseeable natural death criterion?

[Francis Scarpaleggia, Liberal, Lac-Saint-Louis, QC]

Madam Speaker, I am unaware of the specific case mentioned by my colleague.

[Luc Thériault, Bloc, Montcalm, QC]

Carter.

[Francis Scarpaleggia, Liberal, Lac-Saint-Louis, QC]

I am told that it is the Carter case. We believe, as the Minister of Justice has mentioned on many occasions, that Ms. Carter would have been eligible under the criteria established by the bill. I concur with that opinion and I respect it.

Naturally, there will be differences of opinion about this legislation. I am certain that we have not seen the end of litigation.