An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying)

This bill was last introduced in the 42nd Parliament, 1st Session, which ended in September 2019.

Sponsor

Status

This bill has received Royal Assent and is now law.

Summary

This is from the published bill.

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.

Elsewhere

All sorts of information on this bill is available at LEGISinfo, an excellent resource from the Library of Parliament. You can also read the full text of the bill.

Votes

June 16, 2016 Passed That a Message be sent to the Senate to acquaint their Honours that this House: agrees with the amendments numbered 1, 2(d), 2(e), 4, and 5 made by the Senate to Bill C-14, An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying); proposes that amendment 2(c)(i) be amended by replacing the text of the amendment with the following text “sistance in dying after having been informed of the means that are available to relieve their suffering, including palliative care.”; proposes that amendment 3 be amended in paragraph (b) by adding after the words “make regulations” the words “that he or she considers necessary”; respectfully disagrees with amendment 2(a) because requiring that a person who assists to be free from any material benefit arising from the patient's death would eliminate from participation the family members or friends most likely to be present at the patient's express wish, and this would violate patient autonomy in a fundamental and inacceptable manner; and respectfully disagrees with amendments 2(b), 2(c)(ii), and 2(c)(iii) because they would undermine objectives in Bill C-14 to recognize the significant and continuing public health issue of suicide, to guard against death being seen as a solution to all forms of suffering, and to counter negative perceptions about the quality of life of persons who are elderly, ill or disabled, and because the House is of the view that C-14 strikes the right balance for Canadians between protection of vulnerable individuals and choice for those whose medical circumstances cause enduring and intolerable suffering as they approach death.
June 16, 2016 Failed That the motion be amended by: ( a) deleting the paragraph commencing with the words “respectfully disagrees with amendments numbered 2(b), 2(c)(ii), and 2(c)(iii)”; and ( b) replacing the words “agrees with amendments numbered 1, 2(d), 2(e), 4, and 5” with the words “agrees with amendments numbered 1, 2(b), 2(c)(ii), 2(c)(iii), 2(d), 2(e), 4, and 5”.
May 31, 2016 Passed That the Bill be now read a third time and do pass.
May 31, 2016 Failed That the motion be amended by deleting all the words after the word “That” and substituting the following: “Bill C-14, An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying), be not now read a third time but be referred back to the Standing Committee on Justice and Human Rights for the purpose of reconsidering Clause 3 with a view to ensuring that the eligibility criteria contained therein are consistent with the constitutional parameters set out by the Supreme Court in its Carter v. Canada decision.”.
May 30, 2016 Passed That Bill C-14, An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying), {as amended}, be concurred in at report stage [with a further amendment/with further amendments] .
May 30, 2016 Failed “Health, no later than 45 days after the day”
May 30, 2016 Failed “(7.1) It is recognized that the medical practitioner, nurse practitioner, pharmacist or other health care institution care provider, or any such institution, is free to refuse to provide direct or indirect medical assistance in dying. (7.2) No medical practitioner, nurse practitioner, pharmacist or other healthcare institution care provider, or any such institution, shall be deprived of any benefit, or be subject to any obligation or sanction, under any law of the Parliament of Canada solely by reason of their exercise, in respect of medical assistance in dying, of the freedom of conscience and religion guaranteed under the Canadian Charter of Rights and Freedoms or the expression of their beliefs in respect of medical assistance in dying based on that guaranteed freedom.”
May 30, 2016 Failed “(3.1) The medical practitioner or nurse practitioner shall not provide a person with assistance in dying if the criteria in subsection (1) and the safeguards in subsection (3) have not been reviewed and verified in advance (a) by a competent legal authority designated by the province for that purpose; or (b) if no designation is made under paragraph (a), by a legal authority designated by the Minister of Health in conjunction with the Minister of Justice for that purpose. (3.2) The designation referred to in paragraph (3.1)(b) ceases to have effect if the province notifies the Minister of Justice that a designation has been made under paragraph (3.1)(a).”
May 30, 2016 Failed “(3.1) As it relates to medical assistance in dying, no medical practitioner or nurse practitioner may administer a substance to a person if they and the medical practitioner or nurse practitioner referred to in paragraph (3)(e) concur that the person is capable of self-administering the substance.”
May 30, 2016 Failed “(d) their imminent natural death has become foreseeable, taking into account all of their medical circumstances.”
May 30, 2016 Failed
May 30, 2016 Failed “(f) they have, if they suffer from an underlying mental health condition, undergone a psychiatric examination performed by a certified psychiatrist to confirm their capacity to give informed consent to receive medical assistance in dying.”
May 30, 2016 Failed “(f) prior to making the request, they consulted a medical practitioner regarding palliative care options and were informed of the full range of options.”
May 30, 2016 Failed
May 18, 2016 Passed 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 report stage of the Bill and one sitting day shall be allotted to the consideration at third reading stage of the said Bill; and That, 15 minutes before the expiry of the time provided for Government Orders on the day allotted to the consideration at report stage and on the day allotted to the consideration at third 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 stage of the Bill then under consideration shall be put forthwith and successively without further debate or amendment.
May 4, 2016 Passed That the Bill be now read a second time and referred to the Standing Committee on Justice and Human Rights.
May 4, 2016 Passed That the question be now put.
May 4, 2016 Passed 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.

Arif Virani Liberal Parkdale—High Park, ON

Mr. Chen has offered me some of his time.

In respect to this issue, it's critical to understand this committee is the master of its own process. Apropos of what Mr. Chen has indicated, the matters the committee wishes to study can be determined by the subcommittee on procedure here at this committee earlier than a five-year period or later than a five-year period.

In terms of the point made by Ms. Rempel, as to whether there's an inconsistency by not implementing a mandatory review in this legislation with what is transpiring with the Bill C-14 issue, there is absolutely no inconsistency. That undermines the notion that somehow what is applied for with one piece of legislation under a different minister, and under their mandate, must therefore be applied to every single piece of government legislation that is being enacted by the Government of Canada.

That is clearly not the way this government operates, nor is that the way that any government has operated. Decisions made with respect to whether mandatory reviews are required are made in consultation with ministerial or departmental officials relevant to that ministry, relevant to that minister's own decision-making, and also germane to the issues that are at issue within that specific legislative context.

The position being articulated by Mr. Chen is that in the context of this legislation it does not meet that threshold requiring a mandatory review, particularly when you have a standing committee populated by members of all three parties that can initiate such a review on their own volition.

Michelle Rempel Conservative Calgary Nose Hill, AB

Mr. Chair, by that logic my colleague opposite has negated the Minister of Health in saying that Bill C-14 requires a five-year review, which is part of the bill we're debating in the Commons today, so there's a bit of a dichotomy there, or a lapse in logic.

I would direct a question to the department officials, and perhaps if they can inform the committee of the commonality of five-year reviews in terms of legislation, as well elaborate on whether a parliamentary review would constitute a sunset clause of this particular piece of legislation.

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May 3rd, 2016 / 1:15 p.m.


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NDP

Christine Moore NDP Abitibi—Témiscamingue, QC

Mr. Speaker, as I said in my speech, the government chose to leave people who are not at the end of their lives out of Bill C-14.

In some cases, individuals might want medical assistance in dying. One example that comes to mind is people on hemodialysis, an onerous and time-consuming treatment. After 10, 15, or 20 years of such demanding treatments, people might be worn out and might want to stop. All patients have the right to refuse treatment. A patient who refuses this treatment will die in the short term, but continuing to receive the treatment will not cause death. That means that the patient's end of life is not reasonably foreseeable, and he or she may therefore not be covered under this bill. People may want medical assistance in dying, but some of them are not covered under this bill as written. That must be fixed.

I think we should concentrate on palliative care first and foremost. Allowing medical assistance in dying makes no sense unless we have optimal palliative care in place.

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May 3rd, 2016 / 1:05 p.m.


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NDP

Christine Moore NDP Abitibi—Témiscamingue, QC

Mr. Speaker, I think it is very important to rise to speak to Bill C-14, today and on other days of debate.

As my colleagues probably know, I am a health care professional. I still work at the hospital a few times a month, mainly in emergency and intensive care. This is important to me. End-of-life care is very important, which is why I supported a motion that my colleague from Timmins—James Bay moved during the previous Parliament. That motion dealt with a national palliative care strategy.

To begin, I would like to highlight two or three points from the Supreme Court decision that I think are particularly important to this discussion. The decision states:

...the prohibition [of medical assistance in dying] deprives some individuals of life, as it has the effect of forcing some individuals to take their own lives prematurely, for fear that they would be incapable of doing so when they reached the point where suffering was intolerable.

And by leaving them to endure intolerable suffering, it impinges on their security of the person.

It is important to mention that the Supreme Court decision underscores the government's responsibility to address the suffering that people experience. It is also important to understand the difference between suffering and pain. Pain is a physiological reaction to stress, such as an injury. Suffering has to do with an emotional experience.

Take, for example, a very painful event such as childbirth. That pain is associated with a positive emotional experience, the birth of a child. That event does not necessarily cause suffering, but it does cause significant pain.

A person might also have a minor injury that can cause extreme suffering because of the emotional experience associated with it. I think it is important to make that distinction.

These days, we have excellent therapeutic ways to alleviate pain. Opiates were long used, but now we also have patient-controlled analgesic pumps. We can even offer continuous palliative sedation, similar to what intensive care patients receive when they are intubated to ensure that they do not feel any pain. There are a number of extremely effective ways of alleviating pain, in addition to non-pharmacological methods. We have a good range of treatments to offer patients who are in pain.

It is possible to alleviate the suffering that comes with an emotional experience such as the end of life or an end-of-life diagnosis without resorting to medical assistance in dying. In that case, palliative care is an option. The bill applies to adults with a serious and incurable illness, disease, or disability who are in an advanced state of irreversible decline in capability and whose natural death has become reasonably foreseeable.

Obviously, we are talking here about people who are at the end of their lives, people who need palliative care. The purpose of palliative care is to ease the suffering of both the patient and the family. Palliative care helps ensure that people are cared for properly, and that they have the help they need to get through the grieving process and the hardship associated with illness.

We want to take away all the pain, but we also want to provide support for the family.

Optimal palliative care helps not only the patient but also the whole family, so that the patient's death can be as peaceful as possible for everyone involved. We are going about things the wrong way by providing medical assistance in dying when the palliative care offered in Canada is not yet optimal.

When palliative care facilities are underfunded and need to try to drum up donations every year, they are unable to offer optimal palliative care. Most of these facilities can only take patients who are expected to die in less than three months. However, people can often live much longer than that with a terminal illness and they need a lot more support.

Moreover, in many rural areas, palliative care beds are reserved through surgical units. That means that nurses who are taking care of palliative care patients also have to take care of seven or eight other patients. Nurses are therefore unable to respond quickly or spend as much time as they should with the families, and the patient's death does not go the way he or she would like.

For people who do not have the means or who do not want to die at home, unfortunately the hospital is often the only other option when palliative care beds are not available. This is not an easy experience, and it can create suffering because patients do not always have all the support they deserve.

There has been a lot of effort in recent years to remove some natural processes from hospitals. One example would be the birthing centres that have been set up. The thinking is that it would be better for mothers to go through pregnancy and childbirth a little more naturally in a setting other than a hospital, as long as there are no medical complications.

The same thing is being done with death, which is a natural process. It is being taken out of hospitals to make the experience much more positive, in a place other than the medical setting of a hospital.

Hospices try to remove all traces of hospitals. They have hospital beds, but they try to use the patients' own bedding, have large windows, and help patients forget that they are not at home.

Unfortunately, no matter how hard the palliative care facilities work, they are often underfunded. For example, the Maison du bouleau blanc, in my riding, has four beds, only two of which are subsidized. It therefore relies on donations to maintain its other two beds. It has a large room with big windows and a shower, but this is the only room that the facility has been able to convert to an ideal palliative care room.

These people cannot afford nurses. The people who work there are extremely dedicated practical nurses. However, they have some legal limits. For that reason, all the protocols regarding doctors working with palliative care facilities had to be updated, in order to ensure proper care for the patients.

We could address a number of shortcomings and avoid making the patients suffer. If someone who receives a terminal diagnosis knows that they will receive good palliative care as their condition worsens, they may not choose to take their own life prematurely. This would therefore help protect the right to life.

However, as long as do nothing on palliative care, we are working backwards. We cannot reverse the life-based medical model to allow for medical assistance in dying if our palliative care services are not as good as possible or accessible to all Canadians, regardless of where they live, even if they live in a remote region.

Since I am out of time, I would be happy to take questions from my colleagues.

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May 3rd, 2016 / 1 p.m.


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Liberal

Kate Young Liberal London West, ON

Mr. Speaker, the minister went on to say that her experiences as a family physician reinforced her sense that we must “uphold the principles of palliative care, as well as respecting the rights of patients to make their own decisions about their care as they approach the end of life”.

Earlier this year, the minister met with provincial and territorial health ministers in Vancouver to launch discussions on a new multi-year health accord. Through the health accord process, our government will be making significant investments totalling $3 billion dollars to help deliver more and better quality home care services for Canadians. We expect that support for palliative care in a variety of settings, where patients can receive the ongoing care they need and deserve at the end of life, will be one of the priorities going forward. I agree that there is no doubt that care at the end of life should be there when people need it. We want all Canadians to have access to the best care possible.

The issues in this area are complex. However, I strongly believe that Bill C-14 has struck the right balance between competing rights and policy objectives.

I call on members of this House to support it.

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May 3rd, 2016 / 12:50 p.m.


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London West Ontario

Liberal

Kate Young LiberalParliamentary Secretary to the Minister of Transport

Mr. Speaker, I am pleased to speak to Bill C-14, which would enact a federal legislative framework to permit medical assistance in dying across Canada.

Medical assistance in dying is a deeply personal issue for all Canadians, as we have witnessed. As parliamentarians, we must consider a diverse range of views on this complex issue. I know that we all take this responsibility very seriously.

The starting point is, of course, the February 6, 2015 decision of the Supreme Court of Canada in Carter v. Canada. The court unanimously held that the criminal laws prohibiting physician-assisted dying interfere with liberty and security of the person by denying grievously and irremediably ill individuals the ability to make decisions concerning their bodily integrity and medical care, and leaving them to endure intolerable suffering.

The court also held that the laws deprive some people of life by forcing them to end their lives prematurely for fear that they would be incapable of doing so when they reached a point where their suffering was intolerable. The court accepted that the criminal prohibition on assistance in dying furthers a pressing and substantial legislative objective, that of preventing vulnerable individuals from being induced to die by suicide against their will in a moment of weakness.

However, the court concluded that a permissive regime with properly designed and administered safeguards was capable of protecting vulnerable people from abuse and error, and that the absolute prohibition went farther than necessary to achieve its objective. The court appropriately left the task of designing this new regime to Parliament.

The proposed legislation responds to the Carter ruling by enacting a new legal framework for access to medical assistance in dying, including the safeguards that the court called for in order to minimize the potential for errors and abuse.

The court did not define the term "grievously and irremediably ill", but the proposed legislation does define it in a manner that is consistent with these circumstances. Specifically, the person must be in an advanced state of irreversible decline in capability. The person must have a serious and incurable medical condition. The person must be suffering intolerably. The person's death must have become reasonably foreseeable, taking into account all of the person's unique medical circumstances.

Canadians would have the comfort of knowing that they would be able to get the assistance they need if they are suffering intolerably when their capacity declines as they approach the end of their lives.

Like so many honourable members who have stood in this house to debate this difficult legislation, I have my own personal story that makes this issue all the more relevant. My mother, Eleanor Anderson, spent over 10 years in a wheelchair after suffering a massive stroke at the age of 69. She had to learn to walk, talk, eat, everything right from scratch. Then it happened again, another stroke five years later. She fought back again, but with each stroke a little more of her was taken away.

She never wanted to feel helpless. During those years in a wheelchair, my mother would try her best to do everything on her own, whether it was dressing, loading the dishwasher, or simply wiping down the kitchen counter. During those years, she never wanted our sympathy.

Despite her tenacity, she knew the day would come when she could not fight any longer. She made it very clear to my father, to me, and my brother that if the time came and she was not able to do much more than lie in a bed, she wanted to drift away peacefully. As expected, what we all feared eventually happened.

She continued to have small strokes, losing mobility and function with each one, to the point that she could no longer sit up in her wheelchair, talk, or even eat. We were not even sure if she knew any of us anymore. She pulled out the feeding tube that kept her alive, to the point where the doctors said they wanted to insert a tube in her stomach. That was not the life my mother wanted, and so we said no. We had to let her go. Doctors agreed it was best, and said she would only last a few days.

We asked that she be moved to palliative care at another hospital. Ironically, they said they could not move her because she would not make it, that she would die en route, and so she lay in that hospital bed, and we watched her slowly starve to death.

She would last 12 days, and her death was anything but peaceful. It was the most excruciating experience I have ever been through, and nothing prepared me or my family for her death. I know my mother would have agreed that this legislation is a step in the right direction. She would have wanted to be able to communicate her desire to die with dignity. However, she would have also wanted her family to follow through on her wishes.

Twelve years later, my dad said to me, after catching an infection, “I just want to close my eyes and not wake up”. That is exactly what happened. He was gone two days later. He got his wish. However, I know that many people are not as fortunate, and it is for those people that we must be prepared to lend our voice.

Health Minister Jane Philpott said this in her speech to the House:

...every person, every story, is unique. However, much is shared in common: the hope to die in peace; the desire to be respected; and to have personal autonomy and dignity honoured by family and health care providers alike.

Minister Philpott went on to say that her experience as a family physician reinforced her sense that we must—

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May 3rd, 2016 / 12:35 p.m.


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Conservative

Alice Wong Conservative Richmond Centre, BC

Mr. Speaker, today I rise to discuss Bill C-14.

As we well know, Bill C-14 is the government's response to the Supreme Court ruling in the Carter decision last February. The court gave the government a total of 16 months to form legislation, so here we are in the House today, debating the bill.

I was pleased to see that the bill included many recommendations provided by my Conservative colleagues in their dissenting report from the special joint committee report on this issue. However, I do not believe the bill in its current form is good enough.

I have benefited from listening to my colleagues' speeches, and appreciate the passion each has shown as they discuss Bill C-14 in the House. Indeed, I have made my own consultations with various interested parties in my riding of Richmond Centre, and look forward to sharing them with you.

We have received many suggestions and comments on the legislation, both from parties that believe the bill is too restrictive and those who believe it is not restrictive enough. Indeed, I am rather impressed that there was significant public interest on this bill, and I would like to continue to encourage people in Richmond Centre who have not given their thoughts on this matter to write to myself or my office.

My voting position on second reading will be carefully considered from a balance of available information, including from the consultations I have held with interested stakeholders in my riding.

To begin, I would like to share some of my personal experiences. During my time as the Minister of State for Seniors, I had the opportunity to work with many groups who are devoted to protecting our most vulnerable and ensuring quality palliative care. The unfortunate reality is that there are many seniors who are not provided with effective end-of-life care. Instead, they are subject to elder abuse and are often pressured into making decisions to avoid becoming a burden to their families. This is tragic. It is absolutely imperative that we ensure that there are safeguards to protect seniors against such elder abuse.

A potential safeguard to protect financial abuse of elders, which is a very common and unfortunate form of elder abuse, is to simply prohibit any independent witnesses from financially profiting at all from the will or the estate of those who requested physician-assisted suicide. This was actually a recommendation from a group of constituents I met with recently. They pointed out that in the bill, the independent witnesses that have to sign the documentation to enable the physician-assisted suicide only have to know or believe they are not a beneficiary under the will of the person making such a request. Again, this is simply not enough.

Back in my riding of Richmond Centre, I have been an active member of the Richmond Rotary Club. This club was instrumental in building the first hospice in Richmond. It was there that I and my fellow Rotarians witnessed first-hand the benefits quality palliative care can bring people. Life is valuable at every stage. One of my primary concerns with physician-assisted suicide is that it will only complicate end-of-life decisions. Individuals who are sick or need additional care will see themselves as a burden, and choose death to avoid placing further expectations on family members.

Instead, we need to be supporting family caregivers and demonstrating that every life is valuable.

As others have noted, there was no allocation in the budget for palliative care services. This is totally and absolutely unacceptable. This issue is quickly becoming more about access to death than access to life. It is absolutely essential that the government make a commitment to strengthen palliative care and encourage citizens to seek such care first. Palliative care provides death with true dignity and not a forced death, which is what physician-assisted suicide is.

Last year, I had the opportunity to meet with organizations such as the Council for Canadians with Disabilities, the CCD. I met with its representatives to discuss their concerns and the importance of protecting individuals with disabilities. More recently, they were able to appear as witnesses at the special joint committee to discuss their views on possible legislation. The CCD was very concerned with the recommendations provided by the committee and commented, “The permissive approach would put vulnerable people at risk”.

We cannot ignore the needs of our most vulnerable. It is crucial that the legislation reflect the concerns of groups such as the Council for Canadians with Disabilities to ensure all Canadians are protected.

I would like to share a few of the comments I have heard from my constituents over the past several months. I will emphasize that my repeating these comments in the House today does not mean that I endorse all of them, but rather, this is a reflection of the variety of comments received. I know as an elected figure this may be hazardous as I may be quoted out of context; however, it is my duty to ensure that these voices are heard.

A primary theme as a result of my consultations is that Bill C-14 would only decriminalize the act of physician-assisted suicide as performed by medical practitioners.

I will add that there would be no effects or changes to the Canada Health Act, nor would it instruct our provinces to provide this procedure as something to be covered under provincial medical insurance plans. In my home province of British Columbia, this is the medical services plan, the MSP.

In general, there seemed to be a considerable amount of confusion about whether the provincial governments would actually provide this procedure and whether they would indeed pay for it.

One stakeholder group mentioned it wished to invoke the notwithstanding clause to maintain the previous provisions of the Criminal Code. This group found the terminology of what constituted a terminal illness to be a slippery slope and that unendurable pain could be mitigated with quality palliative care. As it realized that this was generally not a realistic approach with the existing government, it also mentioned that it was hoping for a robust protection for health care providers and facilities to act according to their conscience.

There were many other comments, but I have only 10 minutes for this speech, so I will state again that I have been pleased with the amount of interest we have received from engaged citizens and stakeholder groups on Bill C-14. I will be making my voting decision after giving the people of Richmond Centre the maximum period of time to send their feedback.

I would like to end my speech with a short story. Many members of my family are health professionals. Even among those who are young, many desire to grow up to be doctors or nurses. When I ask my young nieces and nephews why they want to be a doctor, I always receive the same simple answer, “I want to save lives.”

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May 3rd, 2016 / 12:25 p.m.


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Liberal

Joël Lightbound Liberal Louis-Hébert, QC

Mr. Speaker, rarely in this parliamentary life are we called upon to debate such an important subject, an issue that requires such seriousness, rigour, sensitivity, and compassion.

With that in mind, I want to begin by commending the professionalism of all my colleagues in the House, who, from the beginning of our study of Bill C-14, have set partisanship aside and have made this debate more of a discussion, rather than a debate per se.

The subject that we are being asked to deal with today is one that invariably raises sincere emotions and touches a nerve with all of us, not only here in Ottawa, but all across the country. Developing a framework for medical assistance in dying means striking a balance between implementing a right with such irrevocable consequences on the one hand, and protecting vulnerable people with regard to that right on the other hand.

What right are we talking about? It is the right of a competent adult, who freely consents and suffers from a grievous and irremediable illness causing intolerable suffering, to die at the time of their choosing and with the necessary assistance and medical support. This is a right guaranteed by section 7 of the Canadian Charter of Rights and Freedoms, which states that everyone has the right to life, liberty, and security of the person. This right was unanimously recognized by the Supreme Court of Canada on February 6, 2015, in the Carter case. This right protects life, because the absolute prohibition in section 14 and paragraph 241(b) of the Criminal Code on aiding or counselling another person to commit suicide made individuals suffering from grievous and irremediable illness feel that they were forced to take their own lives prematurely out of fear that the progression of their illness would make it impossible for them to do so and that their suffering would become intolerable.

The absolute nature of the blanket prohibition on medical assistance in dying deprived people of a portion of their life that they could otherwise have enjoyed. This right also protects the liberty and security of the person.

As the Supreme Court explained in paragraph 66 of its decision in Carter, by denying people the right to request a physician’s assistance in dying, the Criminal Code is interfering with “their ability to make decisions concerning their bodily integrity and medical care”. The Criminal Code thus trenches on liberty. Since that option was not available to Canadians, they had to endure intolerable suffering, which also impinged on their right to security of the person.

Although the Supreme Court recognized that medical assistance in dying is one of the rights guaranteed under section 7 of the charter, those rights are not absolute. Limitations and restrictions can be placed on those rights, according to the principle set out in Oakes, which is based on section 1 of the charter. The principles in question are those of minimal impairment and an important government objective.

Bill C-14 must be examined through that lens. Although people with grievous and irremediable medical conditions should be given the right and means to die with dignity, that is not an absolute right. We also need to protect vulnerable people, people who are unable to provide informed consent, and people who could be subject to undue pressure.

My position could evolve, as I continue to listen to my colleagues and constituents and as I continue to reflect on this topic.

However, I think that it is a good idea to exclude minors and people with mental illness from this bill. Like many members in the House, and like the Quebec National Assembly when their work was complete, I think that including minors would have created some virtually insurmountable problems with respect to consent, as my Conservative colleague from Louis-Saint-Laurent pointed out.

With respect to people with mental illness, I think that in the absence of full and informed consent, the sanctity of life must prevail. Since such consent is nearly impossible to obtain under the circumstances, it is prudent to exclude people with mental illness from the bill.

Conversely, I think that some aspects of the bill raise some questions. One aspect is the notion of a death that is reasonably foreseeable, which the government wants to introduce, even though this notion was not in the Carter decision.

The court recognized that not having access to medical assistance in dying could cause intolerable suffering and, therefore, impinges on the individual's right to security of the person.

I also think that individuals who are suffering from a grievous and irremediable medical condition but who are not at the end of their life, which unfortunately is the case for many people in Canada, are therefore being deprived of the right to security and integrity of the person.

I am afraid that with this addition, one of the appellants in Carter would not have had access to medical assistance in dying. I am not certain either that such a restriction minimally impairs a charter right, as seen in Oakes.

Second, although I am aware that there is a need for robust protections and that the bill includes many, which is a good thing most certainly, I have doubts about the protection provided by the provision in paragraph 241.2(3)(h), which stipulates that immediately before medical assistance in dying is provided, a patient must reiterate his or her free, informed, and full consent.

Doctors would have to stop administering medication, such as morphine, which eases the patient's pain, in order to obtain this full consent. I fear that this provision will create excessive suffering for individuals at a moment when they want to gently leave behind their overwhelming suffering.

Third, I was not convinced that advance consent was a good idea, but I was enlightened by my colleagues. Although I am still not convinced, I welcome the government's willingness to study the issue further.

Lastly, like many of my constituents, I think medical assistance in dying must be brought into the broader context of end-of-life care. To that end, I also welcome the promise to invest $3 billion over four years in home care.

I believe that, like the bill, this is a step in the right direction, but it is not the final destination. I will vote in favour of this bill at second reading, and I encourage my colleagues to do the same.

Criminal CodeGovernment Orders

May 3rd, 2016 / 12:10 p.m.


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Liberal

Dan Vandal Liberal Saint Boniface—Saint Vital, MB

Mr. Speaker, I am privileged to rise in this chamber in support of Bill C-14, medical assistance in dying.

I am in favour of the bill, not only because it was mandated by the Supreme Court of Canada, but for very personal reasons. I believe it is a bill, a policy, that respects the rights of individual Canadians who are suffering unbearable pain. It respects their right to die a peaceful death.

I rise today to speak in favour of this bill on medical assistance in dying, not because of the Supreme Court's decision to strike down the criminal law banning medical assistance in dying, but rather for very personal reasons.

To begin with, the bill refers to medically assisted dying. It is not referred to as medically assisted suicide. My common definition of suicide, and I believe it is society's definition, is intentionally taking one's own life when death is not imminent. In the case of Bill C-14, there are clear conditions that would qualify an individual for medical help in dying. This would include, of course, the reality that death is imminent for that individual.

Henceforth, I believe we should stop calling it suicide because it is clearly not suicide in the common form of our understanding. I also believe that there is no parallel with the very sad and tragic suicide epidemic that is occurring in indigenous communities across our great country. In my mind, one is an apple and one is an avocado. They should not be compared.

The whole debate around medically assisted death is deeply personal and has led to some very emotional discussions. For me, it has led to much personal reflection. Like many Canadians, like many people in these chambers, I have seen too many family members and friends suffer excruciating pain needlessly when death was imminent.

Very personal for me was an experience last August 2, the same day that the federal election was called, when my mother passed away. She was 96 years old and she had been living alone for the last 20 years. She had been living bedridden and in pain in a care home for the last five years.

My mother was a religious person and had a special relationship with her god. She prayed every day. She scolded me for not attending church as often as I should. Over the last 20 years her body deteriorated, but her mind and hearing stayed sharp. Over the last 10 years, my mother shared with me her desire to have her life end. Medical advances had helped her to live longer, but her quality of life had severely deteriorated. She had become completely bedridden in the last five years and, in the last four years, malignant masses and tumours had developed throughout her lower body. Constant pain set in, and pain protocol was established. My mother, tough as nails, continued to breathe, pray, and hope that God would come and take her away. The praying and hoping continued for years and years.

My mother was of sound mind. She was a religious person who was at peace with her god. Families, nuns, and a priest would visit her faithfully. They gave her comfort, but she continued to express to me that she wanted to die peacefully and comfortably. She wished that there was a way to end the unbearable physical pain that could no longer be managed regardless of the care she received. I wish she could have had that choice, and she should have had that choice.

My personal feeling is that the legislation does not go far enough. I would have preferred that those who are experiencing enduring and intolerable suffering, with no chance of ever improving during their lifetime, be allowed the opportunity to access medically assisted dying, under the strict conditions that we have imposed in the bill.

However, I also understand that the legislation shifts the paradigm in such a profound way that in the future we will be making reviews. The law will be improved, and evidence will be collected. I hope that myths will be dispelled, and individual human dignity, self-determination, and choice will be nurtured further.

This choice is the basis of our discussions today. We hope to offer this choice to individuals who, in their last moments on earth, are experiencing intolerable physical suffering as a result of a grievous and irremediable medical condition. The debate is not about suicide. It is about trying to ensure the dignity of the dying person. We make choices about the care we receive throughout our life, and it is unfortunate that this choice is taken away from us at the end of our life.

It is true that the Supreme Court's decision in Carter v. Canada made physician-assisted death legislation necessary. I believe many of us have spoken to the fact that the timelines are anything but ideal. Would I have preferred to have another six months of debate, consultation, and discussion in order to make this reality? Of course, I would have preferred that. I believe every member in these chambers would have preferred that.

However, it is also true that there are people who feel that this legislation does not go far enough. There are also people who are opposed to physician-assisted death entirely. I have had many discussions with constituents on this issue.

I represent Saint-Boniface—Saint Vital, a riding with many Catholic constituents, and they have all made their views very clear.

Everyone, regardless of their position in this debate, wants to ensure the protection and dignity of individuals. The notion of dignity, which has come up several times in these chambers, is highly individual. Personal history, personal beliefs, and personal health situations all define what dignity means to the individual, and I might also add the right to self-determine.

Dying with dignity is a personal choice that needs to be respected. This bill is necessary. As a society, we must make sure that the best care possible is available to all our fellow Canadians.

This is an important moment in our history, where consultation has not only played an important role in the past but will play an important role into the future. I applaud the government for undertaking vast consultations across Canada and abroad to ensure that this legislation defends people's choices and freedoms in a way that protects the most vulnerable. It also supports personal convictions of health care providers.

I further congratulate the government on taking the time to continue the very important consultations and discussion surrounding mature minors, people who suffer from mental illness, and people who would like to arrange advance directives.

I would like to add that I fully support the government's commitment to a full range of options for quality end-of-life care, including palliative care, an area in which the St. Boniface Hospital, in my riding, is a leader. This bill establishes responsible measures to promote a standard approach to medical assistance in dying across Canada. It recognizes the inherent value and the equality of every human life.

The proposed legislation sets the framework for medically assisted dying across the country. It also provides a review in five years. It is balanced, responsible, and a very compassionate response to a very difficult, very personal issue.

Criminal CodeGovernment Orders

May 3rd, 2016 / 11:55 a.m.


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Conservative

David Anderson Conservative Cypress Hills—Grasslands, SK

Madam Speaker, it is good to be here today to speak to Bill C-14. One of the principles we have in the House is that legislation is best built on a very solid foundation, and this bill does not have that.

What the Supreme Court ruled years ago on the Rodriguez case was very clear. However, just over a year ago, as with so many other decisions and so many other directions, the Supreme Court reversed itself. If it had really good underlying reasons for doing that, it would have been fine, but the justification for it was very interesting. It was a mistake in perception as set forward by the Supreme Court. The justices called it a changing matrix of social and legal facts which brought them to their conclusion. I and others are concerned that this makes our laws, including the interpretation of charter rights, dependent upon the opinions of a very small group of people. I will talk a bit more about the matrix of social and legal facts in a few minutes.

From my perspective, this is not an improvement. Many of my colleagues on both sides of the House have shared their concerns about Bill C-14, with some supporting it and others opposing it. However, a number of things are missing in the bill, and we need to have further discussion about. I heard a few comments earlier about the timeline, how pressured it was, how we needed to get this done and that this basically was prohibiting us from taking the time needed to discuss these things a bit further and with a bit more depth.

There is no clear definition of what irremediable means. The bill talks about that being the requirement for someone to qualify for physician-assisted dying.

I am concerned about the expansion of this process to nurse practitioners, so it would not just include physicians. People have asked why medical personnel are even involved with this. They have asked whether there is not some other place this can be done so people do not have to be concerned that when they go into the hospital for medical care, rather than receiving a positive side of medical care, they receive a very negative side of it.

There is a criminal exemption for those who perform euthanasia, but there is no protection for those who do not want to participate. A number of people are very concerned about what is called conscience rights and the lack of protection for that in the legislation.

There is a lack of clarity around psychological conditions and how that may come into play with this issue. One of the things that really concerns a lot of people is the lack of a vulnerability assessment, taking the time to find out if people are being pressured or whether there is some vulnerability that is bringing them to the point where they have made a decision that may be wrong for them.

Some people have called for a prior judicial review. There is no mention of that in the legislation.

Also, there is a lack of clarity on data collection. This has been an issue in a number of areas. Will we see good data collection? Will someone keep a good set of records on what goes on with this process?

We often have heard the concern that there is no clear commitment to palliative care. We just heard a member from the government talk about this. The Liberals made this commitment during the election campaign. They felt it was within their jurisdiction to promise $3 billion toward palliative care, but now, in the House, we hear them talk about how other jurisdictions are responsible for this. It sounds as if the Liberals are trying to avoid their responsibilities for this.

I would like to go back to the Supreme Court decision. It turned back the former position. It reversed it and it left us with an open field when it came to the issue of assisted suicide or assisted dying. The only thing the Supreme Court said in its ruling on Carter was that the person needed to consent and that the person needed to have a grievous and irremediable medical condition causing enduring and intolerable suffering. If we look at that, we see it leaves that whole area very open.

As I said earlier, good legislation should have a good foundation. I do not believe this does because of the Supreme Court decision. The foundation is the Carter decision and it hardly qualifies as a stable base on which to create good legislation.

I do not suppose we will get this done today, but we will come back at another stage on this bill. However. I would like to take a few minutes to talk a bit about the Supreme Court's recent decision in Carter v. Canada. It obviously is a very controversial decision and touches on a sensitive issue for many Canadians because there are very deeply held beliefs on both sides of this issue.

The Supreme Court acknowledged that the prohibition on assisted suicide was in general a valid exercise of federal criminal law. It also decided that the law went too far and it did not apply in cases where a competent adult with a grievous medical condition could consent to the termination of his or her life. I believe this decision is disturbing for a number of reasons.

The first is that the court ignored parliamentary consensus. In its decision, it claimed that the reversal from its earlier position in Rodriguez v. B.C. was necessary because of a different matrix of legislative and social facts. Yet, the purported differing matrix ignores the clear and unchanged parliamentary consensus opposing assisted suicide.

Between 1991 and 2012, nine private members' bills were introduced in the House of Commons, all seeking to amend the Criminal Code to decriminalize assisted suicide or euthanasia. Six were voted on and all of them failed to pass. When considering the matrix of legislative facts, the court gave weight to legislative developments in Belgium, Switzerland, Oregon, Washington, and the Netherlands, but it completely ignored the legislative record of Canada's Parliament.

Second, the court found no societal consensus in Canada on this issue. In her decision at the trial level of Carter v. Canada in the Supreme Court of B.C., Justice Smith wrote, “As to physician-assisted death, weighing all of the evidence, I do not find that there is a clear societal consensus either way”. Clearly whatever the change in that matrix of legal and social facts entails, it did not include a clear consensus from the people of Canada”.

This lack of consensus remains unchanged in the 22 years since the Rodriguez case in which the court stated, “No consensus can be found in favour of the decriminalization of assisted suicide. To the extent that there is a consensus, it is that human life must be respected”.

Clearly, the court found no consensus among western countries. While insisting again this matrix of legislative and social facts had changed since the last Supreme Court ruling on the issue, it acknowledged that physician-assisted dying remained a criminal offence in most western countries. Regardless, it chose to align itself with the minority of jurisdictions that allowed it.

I believe the court misinterpreted Parliament's objective in prohibiting assisted suicide. In its ruling, it put significant weight on the parliamentary objective of two sections, section 241(b) and 14 of the Criminal Code, which prohibit assisted suicide. The court asserted that these sections were put in place only to fulfill the state interest in protecting the vulnerable. However, in the earlier court case with Rodriguez, the court had said the objective of this section was not simply “protecting the vulnerable”, but also “preserving life”.

It had written, “In this case, it is not disputed that in general s.241(b) is valid and desirable legislation which fulfils the government's objectives of preserving life and protecting the vulnerable”. This position was reaffirmed several times.

By insisting that in Carter the purpose of section 241 was only to protect the vulnerable, the Supreme Court was able to conclude that this prohibition put people outside this class and that there were people who did not need to be protected by it. The court's conclusion was that the current law was over broad and grossly disproportionate to its objectives. That allowed it to say that Parliament needed to establish safeguards to ensure that those who truly wanted to be euthanized would be able to do that.

That interpretation tramples on the intention of Parliament to preserve life. Had it considered the full purpose of these sections of the Criminal Code rather than just that one objective of protecting the vulnerable, I think the outcome would have been very different.

I would make one final point before my time runs out. The court really leaves the definition of irremediable open to patient interpretation. The court decided that irremediable did not require the patient to undertake treatments that were not acceptable to them. In other words, although treatment may be available, the condition still qualifies as irremediable if the treatment is not acceptable to the patient.

I wanted to express my concerns. However, I think we will come back to some of the things the Supreme Court touched on as well in terms of the right to die being conflated with the right to life and some of the other issues.

Criminal CodeGovernment Orders

May 3rd, 2016 / 11:40 a.m.


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Bloc

Luc Thériault Bloc Montcalm, QC

Madam Speaker, I listened closely to all of my colleagues.

Yesterday, I participated in the committee's hearings. This is my first opportunity to speak in the House.

I have just 10 minutes, but I would like to start by saying that everyone here is caring. Everyone is concerned about the well-being of people who are at the end of their lives, and everyone wants the best for them. However, just because we want to care, that does not necessarily mean that we do what is best for people. We are not necessarily doing what is best for someone if we infringe on a person's autonomy and self-determination.

In the moral sense of the term, human dignity is connected to respect for self-determination. That should be the basis of our debate. Yesterday, in committee, I heard people say that we should consider a person's dignity in relation to their illness. They were talking about whether the person is wearing diapers, which is just frightening. Only that individual can make judgments about their own quality of life, and we cannot compare one life to another.

By way of introduction, since Bill C-14 is quite similar to part of the Quebec law, I would like to provide some context regarding the basis of that law. At the request of medical specialists and other civil society groups in Quebec, in the fall of 2009, the Quebec National Assembly created a deliberative space in order to give people the opportunity to express their views on an issue that could not be more personal: their own end of life.

From that moment on, the status quo was no longer an option for Quebec parliamentarians. Five years later, on June 5, 2014, the National Assembly passed Bill 52, The Act Respecting End-of-Life Care. One aspect of that act is medical assistance in dying.

This work was guided by two premises. First, my death, like my life, is my own. Second, the autonomy bestowed on a person by law through the principle of self-determination and its corollary rule of free and informed consent, which applies in biomedical contexts, is never questioned throughout that person's life, even in times of weakness or extreme emergency. Why then would things be any different at the end of a person's life?

Why would a person's right to self-determination be taken away because he or she is terminally ill? On what grounds would that be done? Is there any more personal and unique time in a person's life than the moment of death? What more could we wish than for a person to be able to calmly and peacefully pass on into death without any fear of suffering or any actual suffering? Is that not what we all hope for and what we would wish for any human being?

The consensus that was reached in Quebec was to make these premises part of a continuum of care, so that palliative care and euthanasia, two realities in the history of this issue, would no longer be set in opposition to each other. Why pit palliative care and euthanasia against each other? This question has been implicit in many of my Conservative colleague's speeches, because unlike in Quebec, we did not hold a debate on the right to die, which used to be associated with passive euthanasia.

People had to fight for the right to die. At the time, paternalistic doctors tended to focus on the curative aspect, and people were dying from the chemotherapy, not the cancer. Over the years, there has been a shift from passive euthanasia to palliative care. Human beings have thus acquired the right to die.

Palliative care is about taking a holistic approach to end-of-life care. This concept was developed by Cicely Saunders, in England, and dates back to 1967. Why should a request for assisted dying arising out of a positive experience of care near the end of one's life be considered a failure? The dying process has started and is irreversible.

A person might wake up one morning and decide that he or she is ready to give up. A person might also decide that that is not the case and that he or she wants to go on living, and die a slow death. The Quebec legislation in no way precludes one or the other, because it places end-of-life care in a continuum of care.

For more than 30 years, palliative care was considered the only way to die with dignity at the end of one's life. It became apparent that such care did not meet every need. Most requests for medical assistance in dying are made as part of the process of palliative care. Very rarely does a person who receives a terminal diagnosis from a doctor immediately request an injection. If so, it all depends on the stage of the cancer. The patient might be put on anti-depressants and told to get his or her affairs in order. There are things that a person needs to do before dying.

One of the difficulties with Bill C-14 is that it groups together two realities under medical assistance in dying. One is covered by Quebec, namely euthanasia and end-of-life care, which includes palliative care; the other is assisted suicide. This choice is causing the conceptual confusion that leads to the impasse in our debates.

Assisted suicide is not euthanasia. The difference is that a person can be at the terminal phase of a degenerative disease without being near death. A person can suffer tremendously without being in a situation of reasonably foreseeable natural death.

The Supreme Court has asked legislators to provide a framework for assisted suicide. This is what the Supreme Court told us in section 7:

Insofar as they prohibit physician-assisted dying for competent adults who seek such assistance as a result of a grievous and irremediable medical condition that causes enduring and intolerable suffering, ss. 241 (b) and 14 of the Criminal Code deprive these adults of their right to life, liberty and security of the person under s. 7 of the Charter. The right to life is engaged where the law or state action imposes death or an increased risk of death on a person, either directly or indirectly. Here, the prohibition deprives some individuals of life, as it has the effect of forcing some individuals to take their own lives prematurely, for fear that they would be incapable of doing so when they reached the point where suffering was intolerable.

That is what we have been asked to do, and that is what we need to figure out.

Arnold Chan Liberal Scarborough—Agincourt, ON

I want to thank my colleagues on the other side for their interventions.

The reason I suggested at the last committee meeting that we bring the law clerk in—and I thank the analyst for his report to give us some background—is that I wanted to delve a bit more carefully, notwithstanding the finding by the Speaker of a prima facie case of a breach of members' privilege.

I'm not yet convinced that we in fact do have a breach of members' privilege. I've tried to look at The Globe and Mail article carefully, and I don't necessarily see evidence—at least in the article—that the reporter in question actually had a copy of the bill, which would be a breach of our privileges. Maybe someone did do something, and brief somebody out of turn in terms of the content of the bill, but it mostly talks about things that are not found in the bill as opposed to what was actually in the bill.

I go back, for example, to the reference in the paper by the analyst, looking at similar questions of privileges referred to committee, specifically about the example he cited from the member from Provencher from March of.... Sorry, I have the wrong one. I mean the Speaker's ruling of 2010 dealing with the member from Regina—Lumsden—Lake Centre about the premature disclosure of a private member's bill, where that had been disclosed on the member's website, which was then, of course, determined to be a breach of members' privileges.

I wanted to probe that a little bit more. Let's say I'm bringing in something under the Criminal Code dealing with the current private member's bill that's dealing with impaired driving. I say that I'm bringing in a private member's bill on the Criminal Code, but I'm not dealing with murder and I'm not dealing with consecutive sentencing. Would that be a breach of members' privileges when I don't disclose the actual contents of the bill that is before the House?

That's really my point here. In fact, was there actual significant...? Was the person actually reporting details of the substantive matters that were actually in Bill C-14 when it was introduced into the House on April 14?

Criminal CodeGovernment Orders

May 3rd, 2016 / 11:10 a.m.


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Liberal

Julie Dzerowicz Liberal Davenport, ON

Madam Speaker, I rise today to speak to Bill C-14, the medical assistance in dying bill.

To me, it is legislation that reflects where society is today. It is the right one for where the majority of Canadians are, and provides a strong foundation on which to build. It recognizes the inherent and equal value of every life, and honours the dignity and autonomy of an eligible person to choose medical assistance in dying under well-defined rules and conditions.

The introduction of this bill is big and represents a fundamental change in how we as Canadians view the right to life, liberty, and security of the person in Canada.

I confess that this is not an easy issue for me to talk about, but it is an important one to the residents of Davenport, the riding I am honoured and proud to represent. We as a society do not talk very much about death. It makes us nervous, and so this bill, which creates a framework to enable access to medical assistance in dying in Canada to those who are eligible, is a particularly sensitive topic.

I want to acknowledge that I have a large Catholic community in my riding, and many who believe that only God can decide when one dies, that death should be left in God's hands. On the other side, I have a number of groups within Davenport that think the proposed legislation does not go nearly far enough. Recognizing the blessed diversity of opinion, I invited community leaders to meet with me to discuss Bill C-14, to hear from them their specific concerns.

What I found was that I had to remind many of them that in February 2015 the Supreme Court of Canada unanimously, all nine members, voted to strike down the sections of the Criminal Code that made it illegal for anyone, including a doctor, to cause the death of another person who consents to die, or to assist a person to end his or her own life. I reminded them that the Supreme Court proclaimed that the prohibition on physician-assisted dying infringes on the right to life, liberty, and security of the person in a manner that is not in accordance with the principles of fundamental justice.

The Supreme Court gave the government a certain amount of time to introduce legislation. That date is currently June 6, which is why we are here today. Just as an aside, I was curious to see how many times the Supreme Court actually voted unanimously, and it has done so only 35 times since 1979.

There was no question that medical assistance in dying would become legal in Canada. What had to be determined is what kind of legislation we were going to introduce.

The Supreme Court's decision meant an important shift in our society's perception of personal autonomy. It signalled that a person's sense of dignity is intricately tied to how one perceives his or her quality of life. The decision to allow Canadians the choice of medical assistance in dying sheds light on the evolving role of our health care system and the role of patients in decision-making.

Canadians are looking to their doctors and nurses to provide health care, and to help them maintain their quality of life. However, when that quality is no longer attainable, Canadians want to know that their health care providers will also help them when their choice is a dignified end to their lives.

In addition to the consultation, I have received many letters from residents in Davenport. There are those who believe there should be no legislation at all, others who think that the proposed bill is not strong enough in protecting the conscience rights of doctors or in protecting the most vulnerable, and a further group who worry that the legislation does not go far enough, that we as a government have been too narrow in our interpretation of the Supreme Court decision. I will address all these concerns in the next few minutes.

Let me first address those who do not believe there should be any legislation. What many may not understand is that if the Liberal government does not create a new law by June 6 of this year, it means medical assistance in dying is legal if it is conducted in a way that adheres to the considerations outlined by the Supreme Court in its Carter ruling. Canadians would then not have any national framework and no law, which in my opinion would lead to a wild west, where it would be up to any one person's interpretation of the Carter decision and a situation that I believe would be open to abuse.

In introducing Bill C-14, the Liberal government purposely created legislation which as narrowly as possible adhered to the Supreme Court decision. It is narrow because this bill is meant to be a first step. It is meant to ground the legislation properly.

The legislation would do three things. It would allow physicians, nurses, and those who help them provide assistance in dying to eligible patients without the risk of being charged. It would also provide safeguards to make sure that those who receive medical assistance in dying are eligible, can give informed consent, and voluntarily request it. Finally, it would lay the foundation for the Minister of Health to make regulations to establish a process for monitoring and reporting on the use of medical assistance in dying.

I will pause for a second to reiterate the first point, because as mentioned, many have written to me to express their concern that the legislation as drafted does not protect the conscience rights of doctors. I want to be clear that there is nothing in the legislation that compels any medical practitioner or authorized nurse practitioner to provide medical assistance in dying or to refer a patient to another medical practitioner. The legislation is meant to balance access to medical assistance in dying while respecting the personal convictions of health care providers.

The legislation is also clear on who is eligible. A person has to be mentally competent, 18 years of age or over, make a voluntary request, and give informed consent to receive medical assistance in dying. They have to have a serious and incurable illness, disease or disability, be in an advanced state of irreversible decline in capability, experiencing and enduring intolerable suffering as a result of their medical condition, and be on a course toward the end of life. Death would have to be reasonably foreseeable in all of the circumstances of the person's health.

Protective measures are also a key part of the legislation to ensure that patients eligible have given informed consent. Patients have to make a written request for medical assistance in dying and have it signed by two independent witnesses. Also, two independent medical opinions have to confirm that the patient meets all the criteria. These first two criteria are intended to ensure that requests for medical assistance in dying are truly voluntary, that they reflect the wishes of the patient and are not made as a result of external pressure or coercion.

Too many of my constituents have said to me, “My dad was in the hospital. We kind of felt forced that maybe we would want to sort of end things.” I said that this legislation does not help with that. The patient has to make a written request. It has to be signed by two independent witnesses, and there has to be two independent medical opinions.

In addition, the second criterion also helps to reassure the medical practitioner who would provide medical assistance in dying that he or she is acting within the scope of the law and consistent with reasonable medical knowledge and skill.

The other criteria for patients to be eligible are that there is a mandatory 15-day waiting period; the patient has the right to withdraw a request at any time; and consent must be confirmed immediately before medical assistance in dying is provided. It is a very thoughtful protocol with very strong safeguards.

As part of this legislation, the foundation is also laid for the Minister of Health to establish a process for monitoring and reporting on the use of medical assistance in dying. We need to know, and Canadians need to be satisfied, that the system is operating as planned to respect the autonomy for eligible individuals while protecting vulnerable people.

Public trust and transparency in the implementation of medical assistance in dying are essential. This monitoring and reporting system will also be able to signal any issues or unexpected consequences.

Monitoring would also ensure that high-quality comparable Canadian data are generated so that any future discussions about changes to the medical assistance in dying system could be made based on the best possible evidence. Indeed, there will be a review of the legislation in five years, which could bring about changes that reflect the data gathered in this period.

For those who believe that this legislation has not gone far enough, there is a commitment to independent studies into three key issues that the Supreme Court of Canada in Carter declined to address. The first was the eligibility for persons under the age of 18. The second is the advance request. The third is requests for medical assistance in dying solely on the basis of mental illness.

It is also important to mention that palliative care, ensuring that all Canadians live as well as possible until their death, is equally important to this government. Just yesterday the Minister of Health stood in this House to reaffirm our commitment to $3 billion over four years for home care.

The minister is working hard with her counterparts across Canada on the next version of our health care accord, and high-quality palliative care for all Canadians is a key part of their deliberations.

I also should mention that one of the great positive side effects of introducing this legislation is that we are having a wide discussion on a national level. We need to be discussing this issue fully and we need to be understanding it.

In closing, I want to quickly thank and commend the great work that was done by the Special Joint Committee on Medical Assistance in Dying under the great leadership of my colleague, the MP for Don Valley West. I also thank the Minister of Justice and the Minister of Health for their excellent work in introducing this legislation.

Bill C-14 is meant to be a legislative foundation on which we will build moving forward . It recognizes the inherent and equal value of every life, and it honours the dignity and the autonomy of an eligible person to choose medical assistance in dying under well-defined rules and conditions. It is the right legislation for Canadian society today, and I will be supporting this legislation.

Criminal CodeGovernment Orders

May 3rd, 2016 / 11:05 a.m.


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Liberal

René Arseneault Liberal Madawaska—Restigouche, NB

Madam Speaker, I would like to first thank my colleague for his comments, which will make us carefully reflect on Bill C-14.

We should reflect on what is at the very heart of the debate on the Carter case and the Supreme Court decision. In one passage of the Supreme Court ruling in Carter, the justices state that the current Criminal Code provisions at the very core of the Carter case protect the vulnerable to such an extent that they constitute almost an absolute protection, which is prejudicial to some Canadians who are not vulnerable and would like to have access to medical assistance in dying.

I would like to hear what my colleague thinks of the Supreme Court's view as it relates to the current bill.

What are his thoughts on people who are not vulnerable as defined by the Supreme Court and how this is reflected in the bill?

The Clerk of the Committee Ms. Joann Garbig

Thank you, Chair.

If the committee would like, we can begin with a short chronology of the events in the House that gave rise to the order of reference to the committee, go on to a brief explanation of the specific privilege in question, do a brief summary of two similar cases that came before the committee some years ago, and then perhaps give members a sense of options going forward.

When a public bill is going to be introduced in the House, it has to be put on notice. On April 12 notice was given for the introduction of Bill C-14, the assisted-dying legislation. That same day The Globe and Mail published an article containing specific elements about the bill, and referenced a source familiar with the legislation, a person who was not authorized to speak publicly about it.

The next night, April 13, The National on CBC TV had similar details about the bill, and the source again was not identified. On April 14 the bill was introduced in the House, given first reading, and became a public document at that point.

On that same day, April 14, the official opposition House leader rose on a question of privilege regarding the premature disclosure of the contents of Bill C-14. In his intervention, he stated that the details about the bill that had been disclosed in The Globe and Mail article went beyond journalistic speculation, and that they matched the contents of the bill.

Following his intervention, the chief government whip rose and stated that the government takes any breach of privilege very seriously, and that no person had been authorized to discuss the contents of the bill prior to its introduction. He gave an unreserved apology, and committed to ensuring that no further such incidents would occur in the future.

The Speaker ruled on the question of privilege on April 19, and decided that the question raised by the opposition House leader constituted a prima facie, or at first sight, breach of privilege.

As per the standard practice, the member who had raised the question of privilege was then invited to move a motion to send the matter to this committee for further study and consideration.

The House adopted the motion on April 19, and this then became the order of reference before the committee today.