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

[Lloyd Longfield, Liberal, Guelph, ON]

Madam Speaker, we have had many comments in the House that the government has not gone far enough with Bill C-14 in being prescriptive about how it would be applied to the different types of medical institutes that are provincially regulated. They are similar to comments about how we would apply climate change legislation provincially, when provincial governments have already started the work on this.

In light of what Quebec has done already in terms of applying this, could we have a comment on the role between the federal and provincial governments in applying this legislation?

The House resumed from May 2 consideration of the motion that Bill C-14, An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying), be read the second time and referred to a committee.

[Juliet Guichon, Assistant Professor, University of Calgary Cumming School of Medicine, As an Individual]

Thank you very much for your invitation to address a section of Bill C-14. We are both from the University of Calgary medical school. Whereas I am trained in law with a doctoral degree and called to the bar of Ontario, my colleague Ian Mitchell is, as you have heard, a pediatrician who is a specialist in pediatric respirology and in ethics.

Proposed subsection 241.31(3) concerns regulations about creating, collecting, using, publishing, storing, and disposing of information about requests for and provision of medical assistance in dying generally. We respectfully make two recommendations concerning this subsection, but before we do that we respectfully recommend that this subsection of the Criminal Code should be based on the following two principles. First, all deaths that occur in Canada must be recorded accurately, and second, medical assistance in dying must be monitored scrupulously.

The proper implementation of these principles would foster protection, prevention, health promotion, health planning, and in rare cases, prosecution. Because the field of death reporting and death monitoring is not well known, we presume very briefly to describe it.

First is accurate reporting of death. Vital statistics are valuable only if the reports are accurate. An accurate report of how a person died is required to be contained in the medical certificate of death in common-law Canada, and in the bulletin de décès in Quebec.

Stating how someone dies entails identifying and stating truthfully the cause and the manner or circumstances of death. These two terms are terms of art, which are best understood by experts. It is not unusual for physicians without forensic training to have difficulty distinguishing between cause of death and manner of death, or to have difficulty naming the immediate antecedent and underlying cause of death. Consequently, in many provinces, medical certificates of death, which were originally completed by physicians, even in natural deaths, are routinely reviewed and corrected by forensic pathologists, medical examiners, or coroners, who have sub-specialty training in accurate death reporting.

Coroners exist in all provinces and territories except four. Those four are Alberta, Manitoba, Nova Scotia, and Newfoundland and Labrador. These four provinces have adopted the medical examiner system of death reporting. For our purposes, however, coroners and medical examiners perform the same functions. Sometimes, only these experts are permitted to establish cause and manner of death, and to complete the medical certificate of death.

For example, in Alberta, Manitoba, Prince Edward Island, and Nova Scotia, when a death occurs within 10 days of surgery, only the medical examiner or coroner may complete the medical certificate of death. Such requirements ensure that death is reported accurately.

Dr. Mitchell will discuss scrupulous monitoring.

[Dr. Hartley Stern, Executive Director and Chief Executive Officer, Canadian Medical Protective Association]

Hello, everyone. I am Dr. Hartley Stern and I am the executive director and chief executive officer of the Canadian Medical Protective Association.

Honourable members, thank you for giving me the opportunity to take part in this consultation process.

In providing medical legal advice and evidence-based education, the Canadian Medical Protective Association, the CMPA, sits at the intersection of the Canadian health care and legal systems. As such, we are already and will continue to be on the front lines in guiding physicians called upon by patients in individual cases for direction on medical assistance in dying, or MAID.

It is through this lens that we propose recommendations for amendments to Bill C-14 to ensure the legislation provides clear eligibility criteria and safeguards for patients, while ensuring health care professionals are not exposed to criminal sanctions for good faith participation in MAID.

The CMPA is generally supportive of Bill C-14. Given the complexity of the issue, we believe the bill strikes a reasonable balance between access and safeguards and leaves room for adaptation and change over time as we in Canada continue to gain experience with MAID.

As I said before the joint parliamentary committee, it is very important to focus operationally on the issues of eligibility, criteria, and safeguards. These are challenging issues. The Criminal Code amendments are crucial to confirming that physicians providing a patient with medical aid in dying are not in violation of the general prohibition on assisted suicide. This is a fundamental requirement to permit physicians to enter into that trusting and empathetic relationship with the patient that is so essential to the implementation of this policy.

We are pleased that the preamble of the legislation recognizes the need to adopt a consistent approach across Canada to medical assistance in dying, while recognizing the provinces' jurisdictions over various related matters, including the delivery of health care services, the regulation of health care professionals, and the role of medical examiners and coroners.

We do believe that the proposed legislation can be improved and submit the following recommendations to enhance operational clarity. I will touch on a few key points and encourage you to refer to our written submission for more substantive remarks.

On clarity, eligibility criteria, and safeguard requirements, the CMPA is pleased that Bill C-14 has provided clarity regarding the age requirement and the issue of advance requests for MAID. We believe, however, that Bill C-14 should state unequivocally whether or not a patient must be at the end of his or her life to be eligible to receive MAID. Uncertainty exists currently about the intended meaning of the requirement that

their natural death has become reasonably foreseeable, taking into account all of their medical circumstances, without a prognosis necessarily having been made as to the specific length of time that they have remaining.

If it is intended that the patient does not need to be at the end of life, then the committee should consider amending the paragraph to state that natural death has become reasonably foreseeable whether or not death is imminent. Conversely, if it is intended that patients need to be at the end of life, then the provision should specify that natural death has become reasonably foreseeable and is expected to be imminent. Patients and their physicians must be provided with a clear understanding of who is eligible and when.

Turning to the provision requiring compliance with provincial laws and standards, we agree that MAID must be provided in accordance with any applicable provincial laws, rules, or standards, as contemplated in proposed subsection 241.2(7). However, we believe that this proposed subsection should be deleted from Bill C-14, since it does not belong in criminal legislation. Health care professionals have to deliver care to patients in accordance with professional standards regardless of such a provision. Those health care providers that are negligent in the delivery of care may face regulatory or civil proceedings, but should not face criminal sanctions for breaching the standard of care or for failing to follow a policy created by the regulatory authority.

Furthermore, as currently worded, the good faith provisions in proposed subsections 227(1) and 241(6) are not available to health care professionals who may fall below the standard of care. Ensuring that well-intended health care professionals are not subject to criminal sanctions for breaching the standard of care is important to ensure access for patients by encouraging the participation of practitioners in MAID.

Turning in respect to protection for counselling a person to die by suicide, we believe that Bill C-14 should be amended to expressly state that no practitioner is guilty of a criminal offence for counselling a person to die by suicide under paragraph 241(1)(a) when a practitioner provides a patient with information about MAID in the course of considering possible medical options.

It is important that practitioners not fear criminal prosecution for raising MAID with their patients, where medically appropriate. Without such a provision, health care professionals may be reluctant to even discuss MAID with their patients.

Regarding the good faith protections, the bill provides for some degree of protection for good faith compliance but only does so with regard to criminal sanctions. The CMPA believes that the protection in proposed subsection 241.(6) should be extended to include civil and disciplinary proceedings for practitioners acting in good faith. Such protection exists legislatively elsewhere.

Reassuring practitioners acting in good faith that they are protected from criminal sanction, civil liability, and regulatory sanction is an important provision that will again help ensure access for patients.

On the issue of disproportionate sanctions, we believe that some of the sanctions provided in Bill C-14 are disproportionate to the relatively minor nature of the offences. Imprisonment for up to five years for failing to inform a pharmacist that the substance prescribed is intended for MAID, and imprisonment for up to two years for failing to comply with reporting obligations, is excessive and unnecessary. It seems to us that a maximum penalty consisting of a fine would be a sufficient deterrent in those circumstances.

On a final note, the CMPA recommends that the brief reference to right of conscience in the preamble of the legislation be expanded, given the importance to practitioners that their personal convictions are to be respected in this area. Consideration might be given to including in the preamble to Bill C-14 language to the effect that nothing in the act compels health care providers to provide MAID.

In conclusion, honourable members of Parliament, it is undeniable that this bill bears great importance to Canadians. We support your efforts in working to ensure that this most complex social issue is dealt with in a manner that respects the importance of the relationship between the patient and health care professionals, and the necessity to ensure that both are protected along this journey.

On behalf of the CMPA, I would like to thank the committee for inviting me to speak. We will be very pleased to provide any further information or data you may need.

Thank you very much.

[Prof. Theo Boer]

Ladies and gentlemen, I would like to thank the committee for inviting me today. I will make some remarks, but then I'll also go over to the bill itself.

In 2001 the Dutch Parliament adopted a law that is largely similar to Bill C-14.

For 10 years I was a member of a euthanasia review committee, a committee that decides after the fact whether a case of assisted dying was in accordance with the law. In those years I personally reviewed 4,000 euthanasia cases.

A 2012 government study, based on data collected as early as 2010, concluded that the Dutch law was solid. Until this day, the study is quoted to attest to the robustness of the law.

Admittedly, the Dutch euthanasia law does provide relief to many very ill patients. It provides doctors the necessary legal protection, and in doing so, it also provides transparency.

However, since 2010 the landscape has changed. Last week the euthanasia review committees presented their annual report, which I can show you here. It was presented just a week ago. It says that the numbers have gone up considerably, meaning that since 2010 the numbers went up from 3,000 to 5,500. Today one in 25 patients dies as a result of euthanasia, and we have seen a significant expansion in the pathology behind the euthanasia requests. The number of patients, for example, with dementia went up from 25 to 110 in five years. The number of psychiatric patients went up from two to 56 last year. Likewise, the numbers for euthanasia for people suffering from age-related diseases went up from a handful to 200. Contrary to what one might expect, the suicide numbers also went up, by 36% in the same period.

Before the end of this week, a person who is very dear to me will die through euthanasia. He is a man in his thirties suffering from the consequences of a sex-change operation, which he now sees as a crucial mistake. We have corresponded extensively, and I begged him not to make another decision that is irrevocable. However, the possibility of euthanasia has made him unwilling to seriously consider any other solution. In the words of your own bill, under proposed paragraph 241.2(2)(c), he says that this treatment is no longer acceptable to him.

In today's Canada, my friend would still be alive. My friend did not need pressure from outside, because what sufficed was loneliness, despair, self-contempt, and the societal climate in which euthanasia features as a remedy to serious suffering. I honestly think that the law has contributed to this climate. That's why I think Bill C-14 may need some adjustments. I do not doubt that Bill C-14 has good, noble, and important medical intentions, but I question the effectiveness of its criteria, which in its preamble, are referred to as “robust”.

In the Netherlands, we use exactly the same wording about our own criteria. Fifteen years later, however, I can tell you that even the most robust criteria may become like wax. Once new categories of patients start exploring the limits of the law, the criterion of intolerable suffering, for example, has become largely identical to what a patient wishes. After all, when a person insists on having euthanasia, who are we to question the intolerability of his suffering? Or when a person refuses palliative care, who are we to insist there are still ways that his suffering can be eased in a less radical way?

The developments in the Netherlands are even more remarkable given the increase in the quality of palliative care since the 1990s, the so-called pioneering years of the euthanasia law.

In an article in a journal of the Royal Dutch Medical Association, two ethicists and a doctor suggest 10 rules for patients who want to have euthanasia; for example, be verbally gifted but be humble; do not make a depressed impression on your doctor; if you still enjoy your hobbies, don't mention them; stress the seriousness of your physical suffering; etc.

According to an RDMA survey published last year, 70% of physicians in the Netherlands experienced pressure to perform euthanasia, and 64% are of the opinion that the pressure has increased.

Ladies and gentlemen, the decision you are about to take belongs to the most far reaching that Parliament can ever make. The outcome will influence the way that Canadians will die 30 years or 40 years from now. On a more fundamental level, it will impact the way people define suffering and cope with it. Please, therefore, allow me three remarks.

One, Bill C-14 exempts euthanasia from the Criminal Code. In normal life, any person has the right to do anything that is not unlawful. Consequently, doctors will have the right to perform euthanasia under the given conditions. This right to kill is among the most peculiar elements of the bill. To kill means that an intentional, direct, and irreversible act removes a person from the community of the living. Even on request, such a decision should always remain the exception. The society that legalizes euthanasia is bound to have an ambiguous relationship with the same society's resolve to prevent suicide. I do not think that the exemption from the Criminal Code is the right signal. I would suggest the Dutch system, in which physicians are punishable—hard as that may be—until they have provided proof that they have acted in accordance with the exceptions described in the law, in that order.

Two, given the intrinsically problematic, ethical character of killing, I think it is desirable that Bill C-14 contains unambiguous conscience protection for health care professionals.

Finally, I am probably not the only one who is puzzled by the fact that the requirement that a natural death should be reasonably foreseeable contains no specification. In hindsight wisdom, I think the biggest mistake of the Dutch is their failure to include a requirement of life expectation. This has made possible—and I have done research on this—that the average time between a euthanasia and the natural death that was expected has expanded from days or weeks to months, and in certain cases even years or decades.

Of course, any term has an element of randomness. However, not being specific about the term has even bigger disadvantages, because it gives away the only element that is left in the law that has an objective character. I would strongly suggest, even aware of the [Inaudible--Editor] advantages of it, to include a clear and unnegotiable term, such as a three-month or six-month requirement; and to initiate consultations, always, to alleviate the suffering; and to see to the needs of the people who have a longer life expectancy. Had the Dutch done so, we would not have seen much of the slippery slope that we find ourselves on now.

Thank you very much.

[Sally Guy, Social Worker and Policy Analyst, Canadian Association of Social Workers]

Thank you and good morning.

On behalf of the board of the Canadian Association of Social Workers and our provincial and territorial partner organizations, I'd like to thank this committee for choosing to hear the perspective of social work on Bill C-14.

Our organization was founded in 1926. We're the national association voice for the social work profession. We have a dual mandate to promote the profession as well as to advance issues of social justice.

I will get right to the point on Bill C-14. Although social workers will not be administering or providing a substance to cause death, it's reasonable that they would be involved in the lead-up or the consultative process leading to the decision to undergo medical assistance in dying. Social workers may also be among the care providers to whom a client would bring their end of life concerns, and may actually be the first point of contact in this regard.

As key members of interdisciplinary teams, and quite often as the only health, mental health, or helping professional in certain rural, remote, or northern contexts, social workers must be able to provide therapeutic counselling services; support to clients, their families, and even their networks; and referrals to service on the subject of medical assistance in dying. They must be able to do all of that without fear of criminal consequence.

It is very important that clients who are considering medical assistance in dying are able to bring these end of life concerns to their preferred care provider. It's equally important that care providers who are entering into these end of life discussions, or even consultations, can do so without worrying that they are going to be party to an offence.

To this end, CASW is concerned about the lack of clarity around the exemption for persons aiding a practitioner and persons aiding a patient under paragraph 241(b) of the Criminal Code, specifically as this might apply to social workers. Furthermore, Bill C-14 focuses very much on the provision—the actual act of providing or administering the substance to cause death in medical assistance in dying—with little emphasis on the process beforehand, that consultative process, the lead-up.

We're seeking further clarity on paragraph 241(a), specifically as to whether social workers who will be participating in client care leading to a decision to undergo medical assistance in dying could potentially be seen as counselling or abetting a person to die by suicide. Of course we want to avoid that.

To address this, we would recommend that C-14 be amended to clarify the meaning of “counsel”. Mental health providers like social workers provide therapeutic counselling services and engage in therapeutic conversations with their clients all the time. In this sense, “counsel” has a very different meaning from the one that's intended by paragraph 241(a). We think that this could be easily addressed by simply revising the word “counsel” in 241(a) to “persuades or encourages”, so it would read, “persuades or encourages a person to die by suicide”.

On top of that, we would also recommend creating or amending some language to provide an exemption for social workers who would be engaging with clients on the subject of medical assistance in dying, whereas “engage” could be defined as the provision of therapeutic counselling, the referral to information, supports to clients, their families, and even their broader networks, and of course, referrals to service.

This would just ensure that no social worker who engages with a person or a client on the topic of MAID, or medical assistance in dying, whether preceding or following that person's decision to undergo it, would be party to an offence under paragraphs 241(a) and (b), and equally that no social worker who aids a practitioner or patient by engaging with the person on the topic of MAID would be party to an offence.

I hope I kept that brief.

With that being said, I want to thank you again for hearing from social workers and I look forward to any questions that you might have.

[Dr. Georges L'Espérance]

Finally, I have one more thought on assisted suicide.

The Association is concerned about section 241.1b) of BillC-14, which in our opinion opens the door to a type of assisted suicide. In our view, it must be very clear that medical assistance in dying is and must remain a strictly medical act, administered by a physician, nurse clinician or pharmacist, according to the legislative provisions of each province.

There are four reasons for this.

First, current medical science makes it possible for persons with serious and grave medical conditions to live very comfortably for a period of time. It is incumbent on medicine to help patients until the end and to respect their independence and dignity when they can endure no more, either physically and psychologically.

Second, the immediate and compassionate presence of a physician or nurse clinician is necessary to address any problem that might arise during the administration of medical assistance in dying.

Third, a very strict framework must be established as regards professional, ethical and moral conduct and responsibility.

Fourth, any confusion must be prevented between medical assistance in dying and an unexpected suicide, which is always a terrible tragedy.

We understand the objective of not making it a crime for someone to help another person choose assisted suicide, whether in Switzerland or elsewhere. Yet the possibility of obtaining medical assistance in dying in Canada should eliminate this alternative, and fairly, regardless of the physical, financial or psychosocial capacities of the person with the terminal condition.

Thank you for your attention.

[The Chair, Liberal, Anthony Housefather]

I hereby convene the meeting.

Thank you for coming to this meeting of the Standing Committee on Justice and Human Rights. It's a great pleasure to have everyone here as we continue our discussions of Bill C-14.

We have four witnesses today, Dr. Georges L'Espérance, President of the Quebec Association for the Right to Die with Dignity, who is accompanied by Dr. Nacia Faure.

We also have with us Sally Guy, who is with the Canadian Association of Social Workers. Thank you very much for being here.

As an individual, we have with us Dr. Theo Boer, who is a professor of ethics and has experience with this in Holland. Welcome, Dr. Boer.

[Joël Godin, Conservative, Portneuf—Jacques-Cartier, QC]

Mr. Speaker, I am probably one of the last to speak today, since it is almost midnight.

Since this is my first long speech, I would like to take this opportunity to thank the 105,000 voters I represent. Not all 105,000 of my constituents voted for me, but more than 44% of the people of Portneuf—Jacques-Cartier did. I thank them.

Members win election campaigns, but we never do so alone. It is a family affair. Family is important to me. I would like to take this opportunity to thank my wife, Isabelle, who happens to be here this week. She is not in the gallery because it is late, but I appreciate her being here in Ottawa. I also want to thank my children, who are currently asleep. Charles-Antoine and Ann-Frédérique participated in my election campaign and sacrificed quality time with their father during the campaign. I want to thank them.

Last year, 2015, was a very difficult year for me. Talking about it is very emotional for me. There was an election. The 338 MPs here campaigned, but unfortunately, as fate would have it, my father passed away right in the middle of the campaign, on August 19. Unfortunately, he will never see me here in the House. He would probably have been very proud. My mother died in May. Both of my parents died in the same year, in 2015. I had two loyal volunteers up there watching over me. Sadly, my mother died of cancer like so many Canadians. We all have our story. I am sharing mine today. My father and mother died in 2015, but the year ended on a high note because I was elected.

My mother was diagnosed with cancer two years before she died. That is why I am taking part in this evening's debate, because I supported my mother through her illness. She passed away on May 1, 2015. She lived through that agony, and I would call it agony, but she was serene. She had some good times in those two years. She enjoyed the gatherings we had during those last two years. I saw her smile. I saw her stay positive. I saw her become a fighter. Unfortunately, on May 1, at 6:50 p.m., I had the unfortunate experience of finding her in her hospital bed after she had died. She had just begun palliative care. Unfortunately, it happened just a few minutes before I entered the room. That is why this debate is so important to me. I supported her. She did not really have the opportunity to improve her condition, which deteriorated really quickly.

The principle behind Bill C-14 is to allow Canadians to die with dignity. What is the definition of “dignity”? Dignity can be described as the respect, consideration, or regard that someone or something deserves. Human dignity is the principle whereby no person should ever be treated as an object or as a means, but rather as an intrinsic entity.

Out of respect, I can say that my mother was treated with dignity. She was treated with respect throughout her agony. She was respected until the very end. The law did not exist. Is this law really necessary? The Supreme Court requires us to make a decision, pass a law, accept a law and enact it. However, what worries me about this law are the parameters. It is important to understand that we must allow people to have access to medical assistance in dying.

However, human nature being what it is, it is difficult to take rights away from people after implementing a law that is too broad in scope. I therefore invite parliamentarians and the committee that will be examining the bill to be thorough and restrictive.

Let us begin by talking about the definition of “reasonably foreseeable”. I would like to inform the House that according to my life expectancy, I will die in 2044 at the age of 79. That is reasonable and foreseeable. That means we have a problem. This term is not defined clearly enough. It is not specific enough. The definition is too broad.

The Supreme Court of Canada gave us the mandate to determine the criteria for defining grievous and irremediable medical conditions. Why are we afraid of using science to define these criteria? Science can determine whether someone is at the end of his or her life. We are afraid to use words like “terminal”. A word like that does not really leave room for interpretation. If science tells a person that his or her condition is terminal, then it means that it is terminal and that that person should expect to die in the near future.

I would encourage the people who will be assessing the legislation to be very specific. We need to restrict access to this procedure. In my opinion, the first criterion should be that access is limited to people who are, unfortunately, terminally ill. I want to emphasize that safeguards should be put in place to restrict access to medical assistance in dying. We need to set very strict and restrictive parameters.

Doctors are there to save lives. They need to abide by the Hippocratic oath. Nurse practitioners are also being added to the mix. When they went to school, they did not expect to have to take any action that would result in death. We are talking about professionals who want to treat people to help improve their health. Why are we asking them to do the opposite? Are we going to ask other groups who work in hospitals to engage in this type of intervention? The nursing associations that I consulted were very surprised to be given this new responsibility and be part of this debate.

Some argue that there are regions that do not have access to doctors. If there are no nurse practitioners, who are we going to ask? The bill provides for a 15-day waiting period. To my knowledge, in this very beautiful country of Canada, the second-largest in the world, we are never 15 days away from treatment by doctors. We must not hand over the responsibility of carrying this out to a professional body other than the medical profession.

Do my colleagues know that a person other than nurse practitioners and doctors can go around with the famous drug that ends life? Clause 4 of the bill clearly stipulates:

No pharmacist who dispenses a substance to a person other than a medical practitioner or nurse practitioner commits an offence under paragraph (1)(b) if the pharmacist dispenses the substance further to a prescription that is written by such a practitioner in providing medical assistance in dying in accordance with section 241.2.

That is dangerous. People will be able to walk the streets with a drug that kills. We must also protect our seniors. They are vulnerable people. Heirs, insurance policies, caregivers, and families can take advantage of seniors. Let us protect our seniors. Let us be restrictive and put safeguards in place to impose as many limits as possible.

There is a centre called Cité Joie in my riding. I can understand that people reach the point of exhaustion. The centre offers respite. I can tell you that I have seen people there with extraordinary smiles.

I cannot bear to no longer see such happiness. We have to support these people. We cannot give them that possibility. I have much to say. However, in closing, I would like to inform the House that I have not made up my mind about the final bill. I am asking the committee that will study it to put more restrictive provisions in the bill so that we can believe in life and we resort to the legislation only at the end of life.

[John Aldag, Liberal, Cloverdale—Langley City, BC]

Mr. Speaker, I would encourage the committee to listen to the comments that are being put forward, both the questions and concerns, and attempt to have witnesses who can address those, as the special joint committee had done. Then we will be able to weigh through the evidence, as we are about evidence-based policy, and see how the recommendations can be made to perhaps strengthen Bill C-14.

[John Aldag, Liberal, Cloverdale—Langley City, BC]

Mr. Speaker, I rise in the House today in support of Bill C-14, an act to amend the Criminal Code and to make related amendments to other acts, also known as medical assistance in dying. In January, I was appointed to the Special Joint Committee on Physician-Assisted Dying and I was honoured for the opportunity to be part of this important discussion in Canadian society.

Over the span of a couple of months, my fellow committee members and I spent a lot of time working to understand the complex issue of medical assistance in dying. We discussed, we debated, and we even disagreed on a few issues, but in the end we drafted a report that I thought was the best possible solution for this complex social and legal issue.

Drafting any legislation can be difficult, but it becomes especially difficult when its title includes death or dying. It is a topic that most of us are sensitive toward and many have difficulty confronting.

Within the special joint committee we dealt head-on with a number of difficult issues and were immersed in them for six weeks. We reviewed reports by the provincial and territorial expert advisory panel on physician-assisted dying. We heard from health care regulatory bodies throughout Canada and the federal external panel on options for a legislative response to Carter v. Canada, to name a few.

We had the challenging task of grappling with the major issues touched on by Bill C-14, which include the availability of medical assistance in dying for mature minors or for patients with mental illness, advance consent, conscientious objection, and inevitably ensuring that adequate safeguards were in place to protect the vulnerable.

On February 25, the special joint committee reported back to Parliament where the Minister of Justice and the Minister of Health took the report into consideration and began drafting Bill C-14, which is what I am here to discuss today.

Bill C-14 reflects a number of recommendations made by the special joint committee and these include six main points: allowing both euthanasia and assisted suicide; making it available to permanent residents of Canada, so as not to encourage what some have coined as “suicide or death tourism”; requiring a written request for medical assistance in dying; requiring two witnesses during the time of request; requiring confirmation from two doctors or nurse practitioners that the person making the request meets all of the criteria for medical assistance in dying; and requiring a mandatory statutory review.

The key message I have taken from this very difficult discussion that I was part of and that Canadians are now joining, is that this has to be a patient-centred discussion. I encourage all parliamentarians to set aside personal values and beliefs and focus on what is in the best interests of patients. Medical assistance in dying is, and should only be, about the patient.

Upon reflection on our committee work, I now realize that the committee managed to develop a higher level of comfort with this difficult topic than is held by most Canadians at this point in the public discourse on medical assistance in dying. I am glad to see that the government took the overarching perspective of Canadians into consideration and is willing to use this legislation as a stepping stone for further studies and future revisitation.

In the past few months I have hosted and co-hosted medical assistance in dying town halls. I have spoken directly to my constituents. I have listened to the concerns of my constituents and of many Canadians around the country, and just last week, there was a demonstration for Bill C-14 held at my constituency office. I have heard the positive, the negative, the concerns, and the support, and although I fully support this legislation, I believe there are a few voids that have yet to be filled.

First, during the demonstration last week, important criteria, or better yet lack of criteria, of the bill were brought into question. How does one maintain safeguards when dealing with non-medical personnel? Bill C-14 ensures protections are met for non-medical personnel who participate in medical assistance in dying, including those who aid a person at that person's explicit request to self-administer a substance prescribed as part of the provision of medical assistance in dying, by amending section 241 of the Criminal Code, and introducing proposed section 227 to allow medical assistance in dying if the appropriate conditions are met.

However, what is being done to ensure that non-medical personnel are in fact following the guidelines required by medical assistance in dying? For instance, right before the time of administering the lethal prescription, a patient must be asked whether they would like to continue with medical assistance in dying, but how do we know that these independent individuals are in fact asking this question, among others? How do we know that the individual will not take advantage of the situation or the vulnerable position that the patient is in? These are questions my constituents would like to see addressed.

Second, I recently spoke to someone who was heavily involved in the Carter v. Canada case, who was wondering whether Kay Carter herself would have qualified for medical assistance in dying given the legislation being discussed today. I have read articles stating that she would have been, because she met the criteria for eligibility. However, would health care practitioners consistently agree that Kay Carter would indeed have qualified under this legislation?

The part that I am finding difficult to grasp, for Kay Carter and many others, is the ambiguity of the criterion for imminent death. How do we know that individuals would not be turned away from the service of medical assistance in dying because of the vague nature of this criterion? Who would be responsible for deciding the criteria for imminent death? Will there be inconsistencies in the definition of imminent death? How will we, as a society, address these?

Last, the hard timeline between the date of request and the day on which medical assistance in dying would be provided was yet another point of concern. Many constituents have expressed concerns that this may lead to the hastening of death because the timeline is simply too short. The special joint committee had recommended a flexible waiting period, which would depend on the nature of the illness as opposed to just an imminent death. It was suggested that imminence and competence not be the only factors in determining the timeline, but much rather the rapidity of progression and nature of the patient's medical condition be used when determining the reflection period.

These are a few pieces of the proposed legislation that my constituents and I feel need to be clarified and tightened before the final legislation is created for June 6.

However, I also want to acknowledge that the legislation has done a great job in addressing a number of concerns that have been conveyed by my constituents and many others. For instance, the first misconception I would like to clear up is that Bill C-14 does not address the conscientious objections of medical personnel. It does. There is nothing in the proposed legislation that would compel a health care provider to provide medical assistance in dying or refer a patient to another medical practitioner. Balancing the rights of medical providers and those of patients is generally a matter of provincial and territorial responsibility, and we need to respect that. However, that being said, the federal government has committed to work with the provinces and territories to support access to medical assistance in dying while respecting the personal convictions of health care providers.

Bill C-14 also recognizes the autonomy of persons who have a grievous and irremediable medical condition that causes them enduring and intolerable suffering and who wish to seek medical assistance in dying, while recognizing the importance of protecting the vulnerable and ensuring adequate safeguards are in place.

Over the past four months, I have encountered a wide variety of perspectives about this complex and difficult issue. Some have been extremely restrictive, while others have been extremely permissive. Some believe the legislation would go too far, while others believe it would not go far enough.

I believe Bill C-14 is an important first step in Canada. It is cautious, even conservative legislation, but it will provide a necessary first response to the Carter decision along with a commitment to continue studying the effects and revisiting important issues of medical assistance in dying in the future.

Ultimately, when it comes to Bill C-14, I would like to see the voids found within the legislation addressed prior to June 6, and I intend to support Bill C-14. I encourage my colleagues on both sides of the House to support the rights of Canadians, and to put patients first by supporting this bill.

[Luc Berthold, Conservative, Mégantic—L'Érable, QC]

Mr. Speaker, this evening, I have the pleasure of being here with my colleagues to speak about the bill on medical assistance in dying.

This is a major issue and I must admit that it gave me a greater understanding of my new role here as the member representing the people of my riding, the new role that I am playing in the House of Commons for our country.

From the beginning, there has been a lot of talk about the budget, transportation, deficits, terrorism, and all sorts of other topics that are all equally important to our country. However, rarely does a bill generate as much uneasiness and discomfort among our constituents as the bill we have before us today.

Not a day has gone by since January that I have not spoken about medical assistance in dying with the people of my riding of Mégantic—L'Érable. Quite honestly, I expected people to give me strong, clear answers. However, it has been quite the opposite. After speaking with people even for just two or three minutes, I have seen that they know how important this issue is, but they hesitate to voice their opinions on it.

I think that, as a member of Parliament, my role is to take a position in accordance with my values and beliefs, all the while representing the will of those who did me the honour of electing me to Parliament.

I must say that I have not yet made up my mind about this issue. Every time I find myself leaning to one side, I hear arguments that make me once again question my views.

This is a complex issue that touches people's hearts and strikes at the very core of their values. A bill about medical assistance in dying is not like any other bill. This is a bill that makes us take a look at ourselves and our lives. We immediately think about our parents, our grandparents, our brothers, our sisters, our friends, and ourselves. Suddenly, a bill that is being discussed in Ottawa, far from my riding, becomes something very personal to the people I talk to.

Allow me to give an example. How would we react if one of our loved ones was suffering at the end of their life and their last moments were unbearable? Most of us have had experience with this. We have been in this type of situation, supporting a loved one at the end of their life. Most often, these people we care about are suffering from a cancer that can cause horrible suffering. No one, absolutely no one, wants to see a loved one suffer.

I want to share my own experience. My father died of throat cancer after a difficult eight-month battle against this terrible disease. He was not even 50 years old. Those were difficult months. I think that we all went through something similar in our own lives, when we had to support someone we loved dearly through a very difficult time.

When that stage begins, we do not realize that it is the final stage of that person's life. When doctors set out to treat that person, we do not expect it to be the beginning of the end, so we begin a healing process with our loved one, and we work hard with that person because we love them and we want to fight and win the war on cancer.

At the end of that war, when my father knew that medicine could do nothing more for him, how would I have reacted if someone had suggested ending his life? I do not know because I was one of the last people in my family to tell him he could let go and give up the fight. I did not want him to go even though I knew deep down that it was the only way out for him.

Fortunately, my father received palliative care that minimized his suffering in his final moments. My mother and my brother showed great courage. They were by his side in his final moments because they lived in the same city. I was farther away and saw him on weekends. All of those people and his family members were by his side until the end.

I am certain that he is looking down on me today and that he is very proud to see me here in the House of Commons. My story is that of thousands of Canadians. It is the story of our will to live, and it is the story of our relationship with death.

Soon, I will have to vote on Bill C-14. I will have to decide how our country will respond to the Supreme Court decision that gives some Canadians the right to choose medical assistance in dying. I will repeat that I have not yet made my decision.

I recognize that people who are dying must be able to die with dignity. Dying with dignity does not necessarily mean obtaining medical assistance in dying. Dying with dignity means being able to die surrounded by your loved ones whenever possible, receiving medical treatment that is respectful of one's last moments and, above all, not suffering too much.

I was shocked to learn in the course of the legislative process that not all Canadians have access to palliative care. More than 60% of Canadians who are dying will not have the support required to take this last step in dignity. Even before I take a stand on medical assistance in dying, I believe that we have a duty to change this.

I hope that the goal of members of the House is not to do everything they can so that as many Canadians as possible choose to make use of medical assistance in dying. In fact, I am convinced that it is not. The Supreme Court has ordered us to quickly regulate the use of medical assistance in dying and to set parameters for the entire process. Which Canadians will be given access to medical assistance in dying? How will the most vulnerable members of our society be protected? Who will help the sick people and authorize the use of medical assistance in dying? How will the people who are involved in the dying person's choice be protected?

Over the coming weeks, I am going to show Bill C-14 to my constituents. In a few days, I am going to set up a meeting with a community organization in my riding called Le Havre, which is an aid and support group for people with mental health problems. We are going to hold a round table to talk about medical assistance in dying, the end of life, and people's decision-making abilities. I hope that these discussions will give me a better idea of the choice that I should make in a few weeks.

Fortunately, although it was definitely short on time, the Special Joint Committee on Physician-Assisted Dying managed to ensure that we heard from many groups and citizens to gather their views. I did not attend all the meetings, in fact I attended only one, but it made an impression on me. I will come back to that later.

I want to thank all of my colleagues in the House and the Senate who contributed to the work of the committee. There is no single response to the Carter ruling, because no two situations are identical. The goodwill of everyone allowed parliamentarians to consider two reports, including a dissenting report tabled by our colleagues, the members for Louis-Saint-Laurent, Langley—Aldergrove, Kitchener—Conestoga, and St. Albert—Edmonton. I am pleased that Bill C-14 takes a lot of inspiration from my colleagues' report, because it more closely reflects my concerns at this stage in my own personal thinking.

As I already mentioned, this is not about a race to allow medical assistance in dying. We need to make sure we protect Canadians' charter rights, whether that involves seeking medical assistance in dying or protecting those who will have to face that difficult choice, whether they want to or not, in the coming years. In the current situation, I think Bill C-14 should have been based more on the dissenting report, because the bill does not go far enough to protect vulnerable individuals, their families, and health professionals. What are its main principles? As my colleague from Louis-Saint-Laurent mentioned earlier today, it is about the protection of minors, people with mental illness, and the conscience of doctors and other health professionals.

The bill should apply only to people who are at the end of their lives. The option to receive palliative care is also important to Canadians. Steven Fletcher mentioned something to the joint committee. He said, “The further you move away from the Carter decision, the more likely it is that you're going to step into provincial jurisdiction. When you make that step, I predict you'll go into constitutional darkness, never to be found again.” We have to make the right decision, an informed decision. I think that the dissenting report shows us the way. Soon I will have to take a stand, and I hope that my constituents will help me with that.

[Marjolaine Boutin-Sweet, NDP, Hochelaga, QC]

Mr. Speaker, given that the member is the Parliamentary Secretary to the Prime Minister, does she have any more information she can give us regarding the funding that will be allocated to palliative care?

As she knows, no funding was allocated for that purpose in the latest budget, nor are there any new commitments set out in Bill C-14. Can she give us a little more information in that regard?

[Celina Caesar-Chavannes, Liberal, Parliamentary Secretary to the Prime Minister]

Mr. Speaker, before I begin, I would like to acknowledge the Minister of Justice, the Minister of Health, and the parliamentary secretaries and their teams for their work on this important legislation, and to thank them for their efforts. I would also like to thank the chair and members of the Special Joint Committee on Physician-Assisted Dying, the witnesses they heard from, and the countless Canadians who took part in consultations right across the country. This is not an easy topic for discussion, and I commend all involved for their thoughtful, compassionate, and thorough work.

The Carter decision set out a clear objective for parliamentarians to come up with a legislative framework that allows Canadians who are suffering intolerably the right to request assistance to end their suffering. Bill C-14 is the government's answer to this critical objective, and I stand here today, proud to support this important legislation.

I have heard from constituents on both sides of the issue, some who flatly oppose allowing any access to medical assistance in death, and others who believe the legislation does not go far enough. I have also heard from people who applaud the thoughtful work on this bill and have reached out to me to express their gratitude.

In this regard, it is important to note and to reiterate what has been mentioned many times in this chamber. With this legislation, our task was not to determine if physician-assisted dying was necessary, but to determine how best to move it forward. This is an important consideration and one that is worth repeating.

Of paramount importance to me in reviewing this bill was to determine if it properly considers different interests, including balancing the right to personal autonomy at the end of life with the need to ensure robust protection for the most vulnerable in our society. I believe that this legislation achieves this balance and that it rightly takes the necessary steps to ensure that the rights of all are respected.

With respect to personal autonomy, this legislation responds to the objective mentioned earlier that was provided to us by the Supreme Court of Canada, that Canadians who are suffering intolerably have the right to request assistance to end their suffering.

I am not a lawyer, and as such will not speak to the legal ramifications of this bill. As well, I cannot speak with authority on the constitutional nuances of this bill. However, as a person of faith, it was critically important to me that subsection 2(a) of the Charter of Rights and Freedoms, which grants Canadians the freedom of conscience and religion, was considered and protected.

A couple of weeks ago, I had a meeting in my office with members from the St. John the Evangelist Catholic Church in Whitby. While they understood that the objective for us in this chamber was to come up with a legislative framework for medical assistance in dying, they were gravely concerned about protecting the conscience of medical professionals. They wanted some assurance that the conscience of the health care provider was protected.

Balancing the rights of medical providers and those of the patient is generally a matter of provincial and territorial concern. However, our government is committed to working with the provinces and territories to explore options to facilitate access and care coordination while recognizing the personal convictions of health care providers.

Having worked in health care based research for the bulk of my professional life, I have had the opportunity to work closely with health care professionals in a variety of capacities. It is very important to me that any legislation put forward respected the rights and personal convictions of care providers. I am very pleased to see that this legislation makes mention of this while acknowledging that safeguarding those convictions requires an ongoing conversation with the provinces and territories.

The robust considerations and protections for the most vulnerable in our society inherent in this legislation are also of particular importance. This legislation sets out the criteria for the determination by medical professionals as to whether or not a patient suffers from a grievous or irremediable medical condition. These criteria include that they have a serious and incurable illness, disease or disability; are in an advanced state of irreversible decline in capability; the state of decline causes them enduring physical or psychological suffering that is intolerable to them and that cannot be relieved under conditions that they consider acceptable; and that their natural death has become reasonably foreseeable.

As a mother of three children and MP for the bedroom communities in my riding of Whitby, I was pleased that the legislation also includes strict eligibility requirements that protect minors. Careful thought and consideration are required to understand and assess a minor's ability to make a decision involving the termination of his or her life. I applaud the decision to further study this aspect of the legislation and look forward to being actively involved at that time.

Additionally, this legislation would ensure that those who make a request for assisted dying do so without coercion, having provided informed consent, and given the opportunity to, at any time and in any manner, withdraw their consent. These safeguards are fundamental to Bill C-14. The bill provides safeguards to ensure that individuals can remove consent. The requirements that the request be voluntary and that the person must decide for himself or herself that he or she wants medical assistance in dying is as equally important as the requirement to have the ability to remove consent.

I am proud that this government has listened to stakeholders from across the country and has committed to ensuring that all Canadians have access to quality end-of-life care, including palliative care. Our $3-billion commitment to improving and expanding access to home care is another critically important step and I look forward to seeing continued progress on this vital portfolio in the months ahead.

Finally, I would like to thank and acknowledge my colleagues in the chamber for the thoughtful, measured, and respectful tone struck during this debate. This is not an easy topic of discussion. It is one that challenges us to examine our fundamental beliefs about life and death. I commend all for their work on this file.

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

Mr. Speaker, I appreciate the respectful tone and the way in which all members in this place are approaching an issue which I know could divide us. It touches on the sanctity of life, on issues of great importance to all of us, and on the question of human suffering that so distresses all of us. It interprets a Supreme Court decision. Bill C-14 is a bill that requires a sobriety, a sensitivity and a respectful dialogue as we approach it.

Other members have reflected on what they have learned from their constituents. I need to share the story of what happened to me when I became the member of Parliament for Saanich—Gulf Islands. I was someone who would not have been comfortable with this bill. My constituents may be the most active group of people working for Dying With Dignity.

There are two Dying With Dignity chapters in Saanich—Gulf Islands. I was visited by members from the Salt Spring Island chapter. I was visited by members from the Victoria chapter. Over time, I realized that perhaps my riding had been sensitized to this issue, because Sue Rodriguez lived in my riding.

Her death in 1994 touched all Canadians, as we realized that she tried so hard to get relief from the courts, permission to have a medically assisted death. In the end, it was not possible through the legal system. We all remember her quite courageous and tragic death.

At the time of the court telling Sue Rodriguez that she could not find access to legal medically assisted death, she said, “If I cannot give consent to my own death, whose body is this? Who owns my life?”

These are profound questions that hang in the air still. Some of us might answer that none of us own our own life, that our lives belong to the creator. Some of us may say whatever one believes, each of us has the right to make our own decisions. Those people who might believe one aspect through faith have no right to deny someone else the decision that he or she wants to take, to plan for a death with dignity.

In the course of listening to my constituents, particularly through a series of town hall meetings over the last five years, and through questions and comments that have come to me through the mail, I became persuaded that my job as their member of Parliament was to support access to medically assisted death.

Then my life experience as a lawyer kicked in, and I was very relieved when the Carter decision came down. I thought that at long last we now had legal clarity on this matter, and that Parliament could begin to resolve the issue through the work in Parliament. The issue has been through the courts so often that I felt that we were now in a position as lawmakers and legislators to deal with the decision in Carter.

Just to remind members, the Supreme Court said that the Criminal Code sections that prohibited physician-assisted death violated section 7 of the Charter, and therefore:

....are void insofar as they prohibit physician-assisted death for a competent adult person who (1) clearly consents to the termination of life; and (2) has a grievous and irremediable medical condition (including an illness, disease or disability) that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition.

The court was clear in this decision that we were not speaking of any possibility that one person could make a decision for medical assistance in dying for anyone else. This is a personal decision. The Supreme Court has said that a competent adult person can make this determination. What the court set out as the conditions that would justify medically assisted death was a grievous and irremediable medical condition.

I was disappointed in Bill C-14. I felt, after looking at the report of the special committee, that the legislation would likely anticipate where the court would go in future rulings, and avoid protracted court cases as Canada figured out how we would accommodate medical assistance in dying.

The bill, in not fulfilling even the conditions set out in the decision of the Supreme Court in Carter, would lead to more litigation and more suffering for people who now see that the Supreme Court of Canada has said that to suffer in situations like this violates their charter rights. If we pass Bill C-14 as it is currently drafted, Parliament would be denying them their charter rights going forward.

Other members of Parliament have mentioned this. We know that the legislation is attempting to balance very difficult issues to ensure that there are robust safeguards—and we have had conversations about whether they are sufficiently robust—the sanctity of life, and the protection of vulnerable persons.

This bill is close to getting it right, but where I am really baffled is in the decision not just to say “irremediable” but to insist, as others have noted, that one of the conditions in section 241.2(2)(d), is that their natural death has become “reasonably foreseeable”. I am afraid that is quite baffling, given what the Supreme Court told us we must do. The “irremediable” situation was not described as incurable or terminal. That is a deficiency in the legislation and one that will not just disappoint people who are suffering, but also calls into question the wisdom of this place in interpreting the Supreme Court of Canada's decision to protect charter rights.

Many have spoken about this second area as well. As I read it I thought that this cannot be right, that this must just to be bad drafting, that they cannot mean this. In going through all the conditions, yes, there are safeguards there. There are independent medical practitioners, more than one, and there is not undue influence of any kind. Not to go through every element of it, but as we have to go through quite a protracted process to make a legal declaration, and it would be fulfilled by independent witnesses, one has to go through all of this and then, after all that, at 241.2(3)(h) we find that immediately before providing the medical assistance in dying, the person would be given the opportunity to withdraw the request, ensuring that the person gives express consent to receive medical assistance in dying.

This is gravely disappointing. Those who take the decision that they want medical assistance in dying are now denied that, if their situation is one where we cannot reasonably foresee their natural death and where at the moment they have planned for and gone through this protracted process to ensure that they would have medical assistance in their death, now must be of sound mind to reassert and have the capacity to reassert that they have confirmed this is what they wish. This would surely deny many groups of people who would look to the court decision in Carter as their way of knowing that they would have the right to choose to die with dignity with the assistance of a medical professional.

Many have mentioned these deficiencies in Bill C-14. There are others that have been raised by the British Columbia Civil Liberties Association, as a co-litigant in the Carter case. I am not out of sympathy with those, but perhaps those could wait for another time.

I do not see how Parliament could decide to wait for another time in ensuring that the legislation we pass now is in conformity with the instructions we received from the Supreme Court of Canada.

Calling on my background as a lawyer, as well as my commitment to my constituents, I look at Bill C-14 and ask how we could pass something that would once again be found by a court to violate section 7 charter rights for those Canadians who have met the test in Carter, but would fail the test in Bill C-14. It is an enormously difficult question.

I have enormous respect for all the voices I have heard in the House in this debate at second reading. I will vote for the bill at second reading, but I hope we are prepared to fix its deficiencies in committee.