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.

[Ron McKinnon, Liberal, Coquitlam—Port Coquitlam, BC]

Thank you, Chair. There are many questions to ask and a lot of excellent witnesses.

I'm going to focus on Barreau du Québec because you are the first legal organization we've spoken with outside of the justice department.

The Department of Justice and the ministers are quite certain and quite confident that Bill C-14 is charter compliant and fully fulfills Carter. I take it that you are not in agreement with either of those assertions.

You talked about some of this already, so I'll focus on one small aspect in particular.

The definition of a grievous and irremediable condition includes a requirement for the patient to be in an advanced state of irreversible decline. Do you think that this is mandated by Carter and do you think it's an appropriate condition?

Criminal Code

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

Mr. Speaker, I fully agree with what the member opposite said about the need for palliative care as an option. Therefore, could he comment on why it is not part of Bill C-14 and why the word does not even appear in budget 2016?

[Jean-Pierre Ménard]

There may actually be all sorts of reasons, moral or other, to think otherwise, but from a strictly legal standpoint, the bill as it is worded creates a very real problem. I am a practising lawyer and I have clients, including groups of disabled individuals. Some of those groups have asked us to consider this scenario. In such a fundamental bill, it is important to generate some legal certainty for Canadians. The standards and the rules of the game must be clear for everyone.

This bill proposes a standard to enable access to medical assistance in dying, but the issue, with all due respect, is that this is not the standard from section 7 of the Canadian Charter of Rights and Freedoms as set out by the Supreme Court in the Carter decision. When a more narrow standard is adopted to cover end of life and similar issues, the problem lies in the fact that a void is being created. In fact, those individuals who do not meet the end-of-life conditions included in Bill C-14, but who do meet the conditions related to grievous and irremediable illness from the Carter decision, want to have the right to access medical assistance in dying. The Supreme Court decision truly applied to those individuals.

The Supreme Court did base its decision on end-of-life criteria. It did not wonder whether the individuals were really at the end of their life. That is not a factor the court considered. It talks about people suffering from grievous and irremediable conditions, some of which may lead to a sooner end of life. When the court gave section 7 all its scope, it did so consciously, I believe, in order to ensure a broader reach than that ensured by the bill.

The problem is that, by setting limits as has been done in this case, there is a risk of overlooking some of the people who have the constitutional right to access medical assistance in dying. This bill will take away that right or force those who want to exercise it to start from scratch again before the courts, so that the Supreme Court would once again fill that void. Two, three or four years down the road, the House of Commons—Parliament—will have to amend its legislation again.

The Barreau du Québec does not feel that this is desirable, especially when it comes to individuals with a grievous and irremediable medical condition who would have to engage in a legal battle again. That is not what we should aim for as a society.

We can agree or disagree. The Supreme Court may have gone too far, but we are talking about the Supreme Court and the law of the land. We cannot ignore this for the sake of other principles.

As for the criterion whereby death must be reasonably foreseeable, we have a similar problem in Quebec, as well. In fact, the criterion whereby the individual must be at the end of their life is also being debated. We are in the process of applying the legislation, and there are issues with this. As the criterion can sometimes be too nebulous, the position may vary from one physician to the next. Some are saying that, to be considered at the end of life, people have to be dying, terminally ill, while others are talking about three or six months. It is clear that reasonably foreseeable death is an excessively vague criterion. For Canadians, it is important that legal standards be clear, applicable and easy to understand for everyone.

We have held a long debate in Quebec to decide whether it was desirable to establish a time frame—such as six months or three months. The issue is that medical science is unable to predict whether the time frame will be three months or six months, depending on the individual. Therefore, we have decided that it would be preferable to give physicians an opportunity to use their discretion.

However, the problem is that, with nebulous criteria, Canadians' rights become more or less elastic, and that leads to problems. Taking into account those problems, as well as the scope of the Carter decision, we have recommended that this criterion simply be removed from the legislation.

[Murray Rankin, NDP, Victoria, BC]

Thank you, Chair.

I want to start with the Barreau du Québec, and particularly with Mr. Ménard, and to thank you very much, sir, for the very helpful testimony that you provided to the Senate-House committee, where you were one of our first witnesses. You were very valuable in explaining the Quebec experience and you've helped a great deal today.

I listened, I confess, in English to your remarks, and I took a few notes that I want to get your comments on.

You spoke about Bill C-14 being too restrictive. You said that the law is not based on the Carter principles, that it can be constitutionally challenged, that it's more restrictive than section 7, and you alluded again to a constitutional challenge. Then you spoke about “reasonably foreseeable” death, the expression in proposed paragraph 241.2(2)(d) that you said should be eliminated from the list of criteria. You indicated that it was too nebulous and that clarity needed to be provided in a definition that was so unclear.

What you've done is given us the same testimony we've heard from Professor Downie, from the east coast, and we'll be hearing on Thursday from the lawyer, Mr. Arvay, who argued the case from the west coast. You've talked to us from French Canada and English Canada.

There seems to be, among a lot of legal experts such as yourself, an acknowledgement that this is simply inconsistent with Carter. I'd like you to elaborate.

[Nathaniel Erskine-Smith, Liberal, Beaches—East York, ON]

Mr. Speaker, “Everyone has the right to life, liberty and security of the person and the right not to be deprived thereof except in accordance with the principles of fundamental justice”, so says section 7 of the Canadian Charter of Rights and Freedoms.

In February of last year, the Supreme Court applied those words to strike down the criminal prohibition against assisted dying.

As a matter of policy, this was a welcome decision. Blanket bans are an ill-advised form of regulating conduct that is not inherently wrongful. The criminal law is a blunt instrument, often imposing costs beyond the benefits it seeks to achieve and it should be resorted to sparingly.

An optimal policy involves nuanced legislation that protects those at risk without preventing others from making their own choices and directing their own lives as they see fit.

In response to the Supreme Court's decision in Carter, the government has drafted Bill C-14. The government states correctly that it is no longer a question of whether to legalize assisted dying but how we should do so. In other words, relitigating Carter is a futile exercise when the Supreme Court has already spoken, unanimously no less.

Still, it remains useful to understand how we got to where we are. If we are to adequately address the court's concerns, we should have a complete understanding of those concerns. Having studied section 7 of the charter in depth, I would like to first briefly explain what the Supreme Court requires of us on this issue.

Section 7 of the charter provides the right to life, liberty, and security of the person qualified by the principles of fundamental justice. A violation of life, liberty, and security of the person is only unconstitutional if there is also an infringement of a principle of fundamental justice.

The court has stated that those principles are to be found in the basic tenets and principles of the legal system. The key principle to understand on this issue is over-breadth, or what we refer to as “minimal impairment” under the classic Oakes test under section 1. If a law infringes life, liberty, and security of the person, over-breadth requires the law to be reasonably necessary to achieve an important government objective.

In Carter, the court first determined that the blanket criminal prohibition against assisted dying engages life, liberty, and security of the person. In the court's words:

Liberty protects “the right to make fundamental personal choices free from state interference”.... Security of the person encompasses “a notion of personal autonomy involving control ...over one's bodily integrity...”.

Second, the court determined that the blanket prohibition was over broad. The purpose of the legislation, as defined by former Justice Sopinka in the earlier Rodriguez decision, was “...the protection of the vulnerable who might be induced in moments of weakness to commit suicide ...”. In the court's view, the absolute prohibition on assisted dying went too far. While protecting vulnerable people is the law's object, it caught people outside of this class: those who are competent, fully informed, free from coercion or duress, yet choosing to end their lives.

We are now faced with new legislation, Bill C-14.

Our first job is to assess whether this legislation meets the criteria set by the Supreme Court. To answer this, we must first assess the government's objective, now a dual objective: one, to provide a means by which those subject to grievous and irremediable suffering can die with dignity; and, two, to protect those who wish to continue to live from coercion or undue influence.

Is this legislation reasonably necessary to effect these twin purposes? The answer is, unfortunately, not a resounding yes. It is a resounding almost.

I have real concerns, for example, that limiting access to those for whom death is “reasonably foreseeable”, however one seeks to define that term, would have precluded one of the applicants in the very Carter decision from accessing the new regime.

There is no evidence presented by the government that limiting access to terminal illness is necessary to protect the vulnerable, provided other safeguards are put in place, and it is an open question whether this provision is constitutional.

As one constituent aptly put it, “What Bill C-14 says is: I can express a desire to die when I'm terminally ill, but if I'm not considered competent, it won't count; I can express a desire to die when I'm competent, but if I'm not considered terminally ill, it won't count.” This should be remedied before we pass this legislation.

The remainder of the law may well fall within a range of reasonable options and therefore be charter-compliant, but that cannot possibly be what we aspire to in the House. We may have been tasked by the court to address the constitutionality of the current laws, but we are tasked by Canadians to go beyond that. The law we put forward should not simply fall within a range of reasonable options. It should be the best possible law we are capable of drafting.

I have met with many constituents over the last number of weeks and months to discuss this issue. In early April, for example, we hosted a town hall on the topic. It is, rightly, a sensitive topic for many.

My constituents' views and opinions have informed the following thoughts, all of which revolve around the importance of choice.

First, my constituents overwhelming favour advance directives. I appreciate that this is a complex area. It is one thing to assess an advance directive regarding a permanent coma and another thing to assess an advance directive regarding differing degrees of dementia. However, simply because a matter is complex or difficult does not mean we should not attempt to address it. I believe we need to look at advance directives more seriously and that many of the worries regarding stale decision-making can be resolved by sunset clause provisions.

As former Chief Justice Lamer said in Rodriguez, the legal system should not deny consent but should seek to ensure that such consent “is as independent and informed as is reasonably possible”. With appropriate safeguards in place, witness requirements, competency assessments, informed consent through advance directives should be respected.

Second, my constituents overwhelmingly favour placing assisted dying within the context of end-of-life health care overall. Under our charter, access to assisted dying cannot depend upon the availability of palliative care, but, as a matter of policy, for there to be a real choice, we should invest significantly in palliative care options. The $3 billion promise for home care investments is a good start, but it is only a start.

Third, choice depends upon competency and capacity. A competent adult should not be defined by age, but by capacity to understand and to choose.

Fourth, a small but vocal group of constituents have asked for choice for doctors, the right to conscientiously object. It is important for the government to acknowledge the deeply held beliefs of some doctors and we must do our best to reconcile those beliefs with the importance of providing access to assisted dying across our country. It is reasonable to respect doctors' choices, at the outset a cautious approach, providing patients with a public list of participating health professionals across the country.

Fifth, and finally, a similarly cautious approach regarding mental health is also warranted. The foundation of the court's decision was autonomy and dignity, and mental illness, including depression, can impinge upon fully informed and free choice. The law does not require anyone to choose life or death, but allows Canadians to make that deeply personal choice for themselves. For some, the right to life precludes assisted dying, but for others, including former Justice Cory, the right to life includes the right to death.

I will support this legislation at second reading and I hope it will be improved at committee.

[René Arseneault, Liberal, Madawaska—Restigouche, NB]

Mr. Speaker, I thank you for giving me the opportunity to share my thoughts on Bill C-14.

I had the privilege of sitting on the Special Joint Committee on Physician-Assisted Dying. Along with the members of the committee, made up of 11 of our colleagues and five senators, I believe I can say that I was right in the thick of things, when it came to testimonies and opinions from the various stakeholder groups, experts, and everyday citizens.

The debate on medical assistance in dying is an emotional one. That is because it deals with the last of the taboos of any society, namely to plan one's own death and, in a way, to get help organizing it.

Whether you are religious, secular, atheist, philosophically liberal, or ideologically conservative, every opinion on medical assistance in dying matters. In the wake of the Carter decision, the diverging opinions and our deepest moral values now seem to torment us. Either side of the argument on medical assistance in dying is a source both for concern and for hope. This issue leaves no one indifferent, but above all stirs the most sincere and honest emotions.

That is where we run the risk of losing sight of the purpose of the debate. In fact, medical assistance in dying, regardless of our personal values, is not something that any of us must impose on or deny anyone else. I urge all my colleagues to keep in mind that medical assistance in dying is now an individual right recognized by the Supreme Court of Canada, a right that is no one's business but the individual's and, at the same time, a right that does not force anyone to compromise their deepest individual moral convictions.

Morality, taboos, planned death and the emotions this stirs must not cloud the rationale of the Carter decision. If we eliminate our individual morality from the analysis of the Carter decision, then it is rather simple.

First of all, two sections of the Criminal Code are affected, namely section 14 and paragraph 241(b). These provisions prohibit a person from counselling or aiding another person to commit suicide.

Second, as a result of these Criminal Code provisions, a person suffering from a grievous and irremediable illness could prematurely end their life, knowing that no one could help them die when they are no longer able to commit suicide because of the progression of the illness. In short, the prohibition in the Criminal Code provisions I mentioned could lead a person with an irremediable illness to take their own life early, even though they are still enjoying a certain quality of life, because they foresee that they will no longer be able to do so themselves at a later date.

Third, section 7 of the Canadian Charter of Rights and Freedoms states that everyone has the right to life. In Carter, the Supreme Court cited this principle in stating that a person suffering from a terminal illness cannot be deprived of this right. In other words, medical assistance in dying will maximize the time the person has left to live. That is the objective of Bill C-14, which amends the Criminal Code of Canada in order to allow medical assistance in dying.

In its wisdom and with a unanimous decision, the Supreme Court of Canada is showing us the way so that we can amend section 14 and paragraph 241(b) of the Criminal Code, which currently violate the right to life, liberty and security of the person guaranteed by section 7 of our charter.

The principles in Carter that must guide us in developing Bill C-14 are found in paragraph 127 of the decision, a paragraph that I invite my colleagues to read carefully because it will require our attention when we debate this matter.

The Supreme Court of Canada stated:

[These sections] 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.

Also in paragraph 127, the Supreme Court of Canada stated:

The scope of this declaration is intended to respond to the factual circumstances in this case. We make no pronouncement on other situations where physician-assisted dying may be sought.

I will support this bill at second reading, but I must confess that I hope the committee can re-examine the bill and try to fine-tune it, because I have some concerns.

For example, this bill may suggest a rather restrictive approach with respect to Carter, especially since the bill contains words that are not in this decision. For example, subsection 241.2(2) states: “A person...[has] a serious and incurable illness, disease or disability”. The word “incurable” never appears in the Carter decision, and that may seem a bit too restrictive.

The bill also refers to an “advanced state of irreversible decline in capability”. The words “advanced” and “decline” do not appear in the Carter decision and could be interpreted as rather restrictive language.

Another one of my concerns has to do with the fact that, right now, this bill seems to disregard any advance requests for medical assistance in dying. Since the Carter decision suggests that there may be other requests in other exceptional circumstances, I believe that it is quite likely that people with a grievous and irremediable medical condition may also experience a deterioration of their cognitive and intellectual faculties.

I think that perhaps the committee should re-examine the possibility of an advance request so that someone with Alzheimer's or brain cancer, for example, is not prevented from giving informed consent to medical assistance in dying the second time because of the deterioration of his or her mental and cognitive abilities.

On page 6 of the bill, in paragraph 241.2(3)(h), it reads:

immediately before providing the medical assistance in dying, give the person an opportunity to withdraw their request and ensure that the person gives express consent to receive medical assistance in dying.

It seems that this paragraph is rather strict, given that people who are terminally ill could lose consciousness or that their intellectual faculties could be impaired because they are being heavily medicated. They therefore might not be able to consent to the medical assistance in dying the second time.

Those are some of my thoughts on the bill. I hope that the committee responsible for studying it will reflect on these comments.

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

Thank you, Chair.

Thank you to the witnesses for being here.

I'm sure most of us in this room have experienced saying goodbye to a loved one or a friend. In my 66 years, I've said goodbye to my parents and my in-laws. Whether it's at a young age like my mother, at 47, suddenly in her sleep, or most recently my mother-in-law, it hurts.

My mother-in-law had dementia. She was never in a pitiful state. She lived a very wonderful life of love. We loved her. She was dignified. She was dignified because we gave her that dignity. She was never in a pitiful state. I heard in testimony today that it could be defined as a pitiful state, and in special committee I heard that it's not sensible for somebody to be in an adult diaper in the last year of their life in bed with dementia, but we loved her and we miss her.

We went to say goodbye to her. We were told by her family physician that she had two to five days to live. We asked what sense there was in giving her her meds, her glaucoma drops, her dementia medicine, and whatnot. As a family we said to just stop the medicine and let her go. After three days of staying with her—she was in California—my wife said goodbye. It was a wonderful experience. When we came back, we phoned the rest home: Is she gone? No. The next day: Is she gone? No. When we called the third day, they said somebody wanted to talk to us.

She came back. We had another wonderful year. It was one of the best years we had.

I tell you, we don't know what we're playing with here. We don't know if somebody's going. She missed Dad and she wanted to go. She would have qualified. But she came back, and we had that wonderful year.

Dr. Johnston, regarding putting “nothing compels a physician to” in the preamble, preambles are not usually seen by the court as the guiding principles as they would be if they were actually in the bill. I think all of us have heard from witnesses that the number one issue—and we're hearing it over and over again—is to protect the conscience rights of physicians, nurses, pharmacists, medical practitioners. We need to get it right when we protect vulnerable Canadians and we need to protect conscience rights. The Supreme Court in the Carter decision highlighted that.

The legislation that's proposed in Bill C-14 at this point is silent on that. It's been explained by the minister and the department that it does not say that anyone is forced to participate in this, but it is silent on it. Would it help, instead of having it in a preamble, to actually state in the bill that it would be a criminal offence to force, intimidate, or coerce a physician or health care practitioner, nurse practitioner, or pharmacist to participate against their will?

What we have in the Carter decision is that it was legal to commit suicide, but it was illegal to assist somebody. Carter has said that under certain criteria, you can assist somebody. The pendulum has swung to where the special committee has said you must refer, but the Canadians that I'm hearing from want conscience protected.

My question to you is this: if Bill C-14 were amended to make it a criminal offence to coerce, intimidate, or force a physician, do you think that would deal with the issue as far as conscience protection is concerned?

[Dr. Will Johnston, Chair, Euthanasia Prevention Coalition of British Columbia, As an Individual]

Thank you very much, Chair and members of the committee. It's an honour to be here today.

I am a family physician with 35 years of experience. I deliver babies. I look after people who are at the palliative end of life. I look after people with disabilities who are nowhere near dying. I am perhaps the only person at this table who has conducted capability assessments—about a hundred of them, in fact—with a lot riding on a legal medical assessment of whether the person was capable.

It was with some great relief that I saw that Bill C-14 at first reading, as drafted, took a very careful approach. Far from trying to be groundbreaking or in the van of the entire world in its daring nature, it took a very responsible approach to the many issues in front of us.

I'd like to take a minute to tell you a story about Uncle Matt.

Uncle Matt was a strong older man who was on a hunting trip in northern B.C. He spent two weeks traipsing through the bush, but on the way home, near Chilliwack, he began to suffer weakness on one side of his body. He was having a stroke. He eventually was transferred to Surrey Memorial Hospital and came to my attention 10 days after a feeding tube had been pulled out. His niece contacted me because she was able to discern that he wanted to live. He was able to say “hungry“, “thirsty“, and the niece asked Uncle Matt's daughter, “Why are you not putting that tube back down? We think he wants to live.” Her reply, in part, was “I've been tallying things up, and he wasn't a very nice man.”

The niece and another nephew kidnapped him from Surrey Memorial Hospital and took him to Vancouver General Hospital. The nurse there, although he was able to croak out the word “thirsty“, was aware they did not hold powers of attorney and put him in an ambulance and sent him back to Surrey Memorial. He died.

He died during an emergency hearing that I helped arrange, during which a judge actually issued an order that the feeding tube be put back down, that he be rehydrated, and that his true wishes discerned.

Now, this is not to say that the people who've come to Nino or who have come in front of Françoise are like Uncle Matt, because the people who have self-selected to approach people who are involved with end-of-life planning and that organization have already self-selected to be highly motivated. This is to simply demonstrate that the medical system, as it now stands, consisted for Uncle Matt of doctors who would not listen to the possibility that he wanted to live and was being intentionally dehydrated to death—he had several million dollars' worth of real estate—and that the hospital risk management, such as it was, was more concerned about the hospital not being sued than it was about Uncle Matt's wishes being respected.

This takes me to the point that this bill, although it might be assumed, nowhere specifies that doctors must actually examine the patient, the extent to which they must do so, or the extent that doctors must inquire into the internal and external factors that create vulnerability for the patient. I refer you here to the vulnerable person standard, which is being published now and which contains four key elements that should be reflected in this legislation.

This lack of requirement for the two doctors—and I use doctors to mean doctors and nurse practitioners—to deeply engage with the patient begins with the acceptance by the doctors of a written request, which can be created before two witnesses by someone representing the patient who purports to understand the nature of the request. The doctors do not have to meet, nor do they have to assess the motives of the representative. The patient representative and two witnesses must be physically together at some point in time, but a doctor does not have to be present at that time.

The two witnesses are not required to have any understanding of the situation, other than that a request is being signed and dated. The witnesses are not expected to have any knowledge of the patient's decision-making capability or the representatives' motives. Under the draft act, any number of physicians may be canvassed by anyone to find two who approve of death in any given situation.

The factors that are enumerated in the safeguard section of the bill in proposed section 241.2 are in many ways moot. Therefore, I would propose the first amendment of four that I'm interested in proposing, and it is that there needs to be some form of prior review by a third party, such as an independent, objective judge, or some sort of process in which the facts that brought this person to the point of being proposed for assisted suicide or euthanasia could be reviewed.

I can tell you that it is extremely difficult to make these determinations, and I have done it many times. I think that to expect that any two doctors in the medical system could do that is to invite wrongful death. I am sure that in 20 years, as the members of this committee must understand, many deaths will have occurred under the auspices of Bill C-14. I'm sure the members of the committee will want to think that if there are wrongful deaths emanating from this legislation, you did your best to plug the gaps, to fill in the holes, and to make sure that vulnerable people were truly protected. As it stands, the two-doctor standard for assessing consent and capacity, I would suggest, is insufficient, and I think I've been echoed in that concern by others.

My second point is that it seems that Mr. Rankin has the deepest understanding of the fact that a long period of time may happen between the dispensing of the medication and the death of the patient. In that period of time, there is room for abuse, sadly. In Oregon, once the dose is dispensed from a pharmacy, it goes out into the wild blue yonder and is never accounted for again. If the patient struggled and was actually given the dose by someone else, one would never know.

Although Mr. Rankin's insistent questioning on this matter may be designed to lay the groundwork for advance consent to be put in place, I think there's another interpretation that could be taken from his acute observation, and that is on the wording of proposed paragraph 241.2(3)(h), under safeguards, that the physician must

immediately before providing the medical assistance in dying, give the person an opportunity to withdraw their request

I would suggest that this wording really should be “at the time of”. Furthermore, why is it not possible for the lethal dose to be dispensed not from a pharmacist to the patient but from a pharmacist to the doctor, so that the doctor could ensure that at the time the lethal dose was used, the elements of consent were there and the capacity was there? This would address the concerns of Mr. Emberley from the pharmaceutical association as well as some of Francine Lemire's concerns.

We have heard four times, I think, from Minister Wilson-Raybould that nothing in this act compels anyone to become involved in assisted suicide and euthanasia. That, I think, suggests that the time may be right for those words to actually appear in this bill: “nothing in this act compels”. That could appear in the preamble. That could appear in another section. I think it would go a long way toward giving that central direction to conscience protection and the protection of professional judgment that is so desirable.

There is another question, of course, and that is the issue of whether we could actually make a simple wording change in the eligibility section of this bill, which would in some ways answer three of the four areas that I've talked about so far. We could actually.... I'm sorry. It's in proposed section 227, a proposed new section of the Criminal Code that deals with exemptions from criminal prosecution for doctors and others who provide assistance in dying to someone who qualifies under the eligibility criteria.

Under proposed subsection 241(2), it is stated that:

No medical practitioner or nurse practitioner commits an offence

There, we could easily say “no specially licensed medical practitioner or nurse practitioner”. This would address several concerns at once. One is that in the eligibility criteria, it is nowhere specified that the person has to have received the services or an offer of services of a multidisciplinary team that could try to address the symptoms that gave rise to the request for death. A specially licensed physician or specially licensed nurse practitioner could be charged with making sure that this had happened.

I think that's worth commenting on further. I've heard it said several times that it was unconscionable that this be left to two physicians who are not charged with making sure that alternatives have been offered, and that could easily be fitted into the eligibility criteria.

I look forward to your questions.

[Françoise Hébert]

I want to step in now and address the second point in our brief, which is advance requests for medical aid to die.

Bill C-14 ignores recommendation 7 of the special joint committee, which would permit advance requests for someone diagnosed with a condition likely to cause loss of competence—for example, Alzheimer's disease. The government is proposing instead an independent study of advance requests, and it may revisit the issue in five years when the bill is reviewed.

Here is our view.

Dementing diseases such as Alzheimer's are terminal. They kill vital brain cells slowly and cruelly. The course of the disease can last up to 20 years after a diagnosis. In the late stages of dementing diseases, the body is alive but the brain is compromised beyond repair. The person has become a shell, living in an advanced state of irreversible decline in capability. It is a pitiable state to be in.

The idea of being demented deeply scares me. I would rather be dead than live the final stages of dementia. We've all heard someone say “Just shoot me” as they imagine themselves severely demented. We foresee the loss of quality in their future life. They foresee the quality of life in their future life, and they beg to be allowed to receive assistance to die if they have by then lost the capacity to make the request. We believe that a valid advance request that includes a specific, independently verifiable description of a future state so devoid of quality that life itself would be intolerable to the individual should survive its author's loss of capacity to request assistance to die.

Some will say this can't work because that person might change their mind, but we posit that when you lose the capacity to make an informed choice about your own body, then you also lose the capacity to change your mind, and your advance request should stand as the last expressed wishes of your competent self.

If my validly written and witnessed advance request describes a state of being so lacking in quality that it would be intolerable to me, and if my description of that state is sufficiently clear that my legal substitute decision-maker and two independent medical professionals can verify that my debilitation has reached the point that I so clearly described, then my advance request should satisfy legal requirements to allow me to receive assistance to die.

Our overall view comes down to this. Bill C-14 must put forward clear rules about who is eligible for assistance to die, but it must do this in a way that respects the autonomy of the individual, in consultation with medical professionals, to decide when suffering has become so intolerable that death is preferable. This can be done in real time, or it can be done in advance through a clear and valid advance request. We beg you not to abandon to a pitiable fate those Canadians who would take the time to draft an advance request for assistance to die should they at some point in the future lose the capacity to make an advance contemporaneous request.

Trust the people who elected you to represent them, and trust the medical profession.

Thank you.

[Mark Strahl, Conservative, Chilliwack—Hope, BC]

Mr. Speaker, it is always an honour to stand in this place and participate in the debate, no matter what the subject matter. There are some debates that are more important than others, and I would venture to say that parliamentary historians will not be poring over the Hansard of the latest budget implementation act in five, 10, or 50 years from now. However, the debate we are taking part in today is not just any debate. It matters. How we as a Parliament, as a group of elected representatives, respond to it will have a profound impact on our society and on the value we place on life in the months and years ahead.

We are here to debate Bill C-14. The short title of the bill is the medical assistance in dying act. I would suggest that this title downplays the decision that we as parliamentarians are being asked to make. Bill C-14 would remove the criminal prohibitions for killing a person, or helping that person kill himself or herself, in certain situations. That is the harsh, stark reality of what we are dealing with in this bill. It is not just another medical procedure that we can sterilize with antiseptic and non-offensive language. This is a serious matter. It will result in a fundamental shift in Canadian society, and making the language more palatable and less jarring does not change that.

We are here because of the Supreme Court of Canada's Carter decision. While the court had previously ruled that the Criminal Code provisions on euthanasia and assisted suicide were constitutional and did not violate the charter, last February it reversed itself and struck down sections of the Criminal Code. It gave Parliament until June to come up with a law that respects its ruling and places restrictions on when and where euthanasia and assisted suicide can take place without criminal penalty.

The Council of Canadians with Disabilities and the Canadian Association for Community Living have produced an excellent commentary on the court's decision, warning that persons with disabilities, including people with serious mental and emotional disabilities, have been put at serious risk. They have also provided these sobering statistics:

...in Belgium, the number of Assisted Suicide deaths has increased an average of 47.77% annually since 2003, and in the Netherlands it has increased 64.13% since 1995, with no end in sight to this increase.

They have called upon Parliament to “place crucial safeguards on the Court’s judgment to limit access to assisted suicide”.

Unfortunately, the joint parliamentary committee report on assisted suicide went the other way, suggesting that doctor-assisted suicide should even be made available to minor children and those struggling with mental illnesses. As a result, Conservative MPs on the committee filed a dissenting report recommending stronger protections for the vulnerable. Thankfully, most of their recommendations have made their way into Bill C-14.

I have heard from hundreds of my constituents who oppose assisted suicide and euthanasia. They fundamentally believe that the Supreme Court's ruling and this bill will lead us down a slippery slope. Some oppose it on religious grounds, believing in the sanctity of life at all stages. Others oppose it for a variety of logical or ethical reasons.

I have also been contacted by some constituents who support the concept of euthanasia in principle and in certain circumstances. Having myself watched a number of family members and friends ranging in age from 13 to 85 die from cancer over the last few years, I understand the desire to ease the suffering of those we love as much as possible at the end of their lives. I believe that, instead of considering euthanasia and assisted suicide as a desired way to provide relief to dying patients, the federal government should be doing more, in concert with the provinces, to promote and expand comprehensive palliative care services right across the country.

Indeed, we voted nearly unanimously for expanded palliative care services and a plan in the last Parliament. During the election campaign, the government promised to inject $3 billion into palliative care. However, its budget did not include a dollar of funding or a mention of it coming anytime soon. The Minister of Health referenced her commitment to palliative care again today in question period. However, words are not enough. We need action, and it should have been a companion to this legislation, not an afterthought.

I want to talk about my main concern with assisted suicide as it relates to this bill and the ruling by the Supreme Court.

We need to continue the national conversation about improving our mental health system of care, which is currently failing too many Canadians. Mental Health Week starts today. The Canadian Mental Health Association is encouraging us to get loud on ending the stigma around mental illness.

Many of us have participated in, and will participate in, events this week to do just that. We put on green ribbons. We have attended champions of mental health dinners. We celebrate those who have spoken out and shared their stories of overcoming the darkness in which they have often lived for years. We beg people struggling with mental illness to reach out. We tell them that help is available, and it is. We grieve whenever individuals take their own life as a result of their mental illness.

Indeed, we have had many debates in the House, with heartfelt speeches by members on all sides, trying to figure out how we can best support those struggling with mental illness. Why did we do that? It is because we believe we must provide hope for those who are suffering. We believe that every life is worth saving and that those with mental illness can be treated, helped, and hopefully made well again.

We are told we should, as parliamentarians, separate assisted suicide from suicide brought on by mental illness. We should not be under the impression that we get to choose whether these two issues will be conflated or not. If assisted suicide becomes normalized, we should not be surprised if societal attitudes on other types of suicide change as well.

I recognize that mental illness is currently excluded from permissible cases for assisted suicide or euthanasia, but the government has said it will be embarking on further studies to look at the unique implications of situations where mental illness is the sole underlying medical condition. Indeed, Liberals mentioned their intention to move forward on this study at the technical briefing on Bill C-14.

Why would the government want to study this matter further if not to bring it forward as a future amendment to the bill? We cannot allow the door to be opened even a crack to allow for those suffering from mental illness to be able to access physician-assisted suicide.

I recently spoke to someone who was diagnosed with bipolar II disorder about the bill. This person attempted to be well with every tool available, and shared the following with me:

My disease is a challenge every single day of my life. Sometimes I work to keep the symptoms at bay from minute to minute. Suffering is a given. And yet, I have much joy and hope, so much to live for. But what if I get really sick, what if I can not manage for an extended period and fall into a deep unbearable depression? Do I need to write an advanced directive to my doctor, asking them explicitly not to allow me access to euthanasia? To ask them to help me fight for my life, even if I can't do that in my moment of total despair?

We need to say it loud and clear that suicide is not the answer for mental illness, whether it is medically assisted or not.

I know that my time is short, so I will move on to another concern I have, and that is the possibility of having two nurse practitioners to sign off on assisted suicide or euthanasia requests for a patient. Nurse practitioners play a vital role in many remote, rural, and northern communities, but when we are dealing with a matter this serious, this permanent, with these types of consequences, I believe that not only should two doctors be required to sign off but that there should be a requirement for a psychological examination or independent oversight from a social worker to be done on patients before they can access assisted suicide or euthanasia.

This would provide an additional level of protection to ensure that patients are truly capable of making decisions with respect to their health and that the request to end their life was not made as a result of external pressure as is mentioned in section 241.2 of the bill.

Finally, Bill C-14 does not enshrine the legal rights of medical professionals such as doctors, nurses, pharmacists, and caregivers to opt out of providing assisted suicide services or referrals if their personal conscience, beliefs, or ethics do not permit them to do so. This is a critical flaw.

As the bill does not adequately protect vulnerable people and does not adequately protect the conscience rights of medical professions, unfortunately, I cannot support it.

[Nino Sekopet, Client Services Manager, End of Life Planning Canada]

Thank you, Françoise.

Thank you for having me here. My name is Nino Sekopet, and I am a psychotherapist retained by End of Life Planning Canada to support people who want a safe place to talk about dying. For four years before this, I played the same role with Dying With Dignity Canada.

I deal every day with the complex and profound topic of the end of life. I see it as a continuum that, unfortunately, consists of two emotionally charged and polarized extremes. We have people who support physician-assisted dying and we have people who oppose it. There is also a vast space in between. Looking through a purely psychological lens, I believe that when we as individuals or as a society stand in either one of those polarizing extremes, deserting the vast in-between space, we miss something very important. We miss the very thing that gives the charge to those polarizing extremes. We fail to recognize the impact on the end of life. We fail to recognize the impact of the fear and insecurity that drives the emotional charge at both extremes.

I believe that if we are able to correctly address the impact of fear and insecurity, and if we do it to the degree that is necessary, those polarizing extremes will lose some of their charge. We will become less polarized. As individuals and as a society, we will become healthier and more willing to consider and accept our differences. We will become more inclusive rather than exclusive. We will become more tolerant.

What I've learned through my work with people approaching death is that clarity is the best way to contain fear and create a space where these patients can feel more secure. Clarity provides a psychological frame within which individuals can rest safely, knowing that they are secure, recognized, and validated. This applies to everyone at the end of life, to all of us. It applies equally to health care professionals, to patients, and to their families.

In my professional opinion, the reasonably foreseeable natural death criterion proposed in Bill C-14 provides little security, little frame of reference. Because of its openness to interpretation, it encourages fear and insecurity, rather than creating space for safety. Removing that criterion from the proposed legislation will restore clarity in line with the Supreme Court's Carter decision. It will benefit everyone engaged in the end-of-life territory, patients as well as health care professionals. It will ultimately benefit all of us as individuals and as a society.

I would like to invite you to step into the vast in-between space and contain the fear of all individuals engaged in end-of-life territory by removing the reasonably foreseeable natural death criterion from the proposed legislation. I invite you to trust the individual who is suffering terribly, and that person's physician, to know when their time has come. By doing that, you will make us all feel safer, regardless of our place on the end-of-life spectrum.

Thank you.

[Françoise Hébert, Chair, End of Life Planning Canada]

Thank you very much.

Thank you, Mr. Chair, for the privilege of appearing before the committee this evening.

I'm Françoise Hébert, chair of End of Life Planning Canada. Before retiring four years ago to become a full-time volunteer, I was the CEO of the Alzheimer Society of Toronto. We actually trained Chief Blair's staff on how to find the poor lost souls who got lost all the time.

My colleague, Nino Sekopet, is a psychotherapist. He is our client services manager. You may recognize him from the current issue of Maclean's magazine, which profiles him as Canada's leading assisted-death counsellor. Nino is the one to call if you want a safe and confidential place to talk about how to achieve a good death, and he is being swarmed by the media these days—his 15 minutes of fame.

End of Life Planning Canada regrets that Bill C-14 is creating certain limitations and conditions that will shut the door to the option of assisted dying for many Canadians who might otherwise meet the criteria set out in the Carter decision.

The Special Joint Committee on Physician-Assisted Dying got it largely right, in our view, and we hope that this committee will agree that strength and gumption are called for when regulating a Charter of Rights and Freedoms issue, even if this means going further than other jurisdictions have in dealing with such a fraught and deeply personal decision as to request assistance to die. Therefore, we beg each of you around this table, as the Supreme Court justices did so well, to imagine yourself with a grievous and irremediable medical condition that's causing you enduring suffering that is intolerable to you. That is the perspective that you need to legislate from.

I'm going to turn it over for three minutes to my colleague, the famous Nino Sekopet.

[Jean-Pierre Ménard, Member, Working Group on the End-of-Life Care, Barreau du Québec]

Ladies and gentlemen, members of the committee, good evening.

The Barreau du Québec is the first intervenor from a province where legislation already exists on medical assistance in dying. The law has been in effect since December 10, 2015. There have already been dozens of cases, and certain issues have begun to arise in applying the law in some situations. To contribute to your debate, we are going to share some of the difficulties we have observed here and there, so that you may avoid encountering the same issues with the federal act. They are not major ones, but we have to be aware of them.

As Mr. Battista said, our first comment concerns the issue of assisting someone to commit suicide. The Quebec legislation does not provide for assisting suicide. We must not forget that the Quebec law is very comprehensive. It covers all of the medical assistance in dying practices that are under provincial jurisdiction. We decided not to include assisting suicide because at the time it was seen as an aspect that was essentially criminal, and the province had no jurisdiction in the matter. The provincial act is an act on care, it is not criminal legislation. Consequently, assisting suicide was not included. However, this will now be made accessible through medical assistance in dying.

We think it is important to think about measures to regulate this that are not contained in the Quebec legislation or any other provincial law. As Mr. Battista pointed out, one of the difficulties comes from the fact that the physician has no control over what happens once he has provided the medication to the patient. He cannot even certify that the patient really did pass away because of that process, nor can he determine when the death occurred. To the extent that the federal law permits assisting suicide, we think it should contain more obligations, such as requiring from those who assist the person that they immediately notify authorities, either the physician or a public authority, that the person has passed away in this manner, so that the proper management of the process may be monitored.

As Mr. Battista pointed out, there is an issue regarding physicians' ethical obligations. There is, for instance, the obligation of following one's patient and not abandoning him. For some physicians, giving a patient a pill and allowing him or her to take it himself is seen as a kind of abandonment. It can also be difficult for a physician to get involved in such a process.

Let's talk about compatibility with the Carter ruling. We should be aware that the impact of the law will in future be measured in light of section 7 of the Canadian Charter of Rights and Freedoms, which is broader in scope than what the bill is proposing. If we adopt more restrictive criteria than what is now allowed under section 7 of the Canadian Charter of Rights and Freedoms, clearly we will be opening the door to legal challenges. The Barreau du Québec feels that it is not desirable that people who could have access to medical assistance in dying under the criteria in the Carter decision, no longer have this access because of Bill C-14. We have seen what happens in Quebec when a more restrictive standard is applied. For instance, some people have stopped eating in order to become eligible under the law. This type of situation, which occurs because of a more restrictive criterion, is not a desirable development. This is important and that is why we made that recommendation.

Moreover, we think that the criterion of reasonably foreseeable death is too vague, too uncertain. It is important for the Barreau du Québec that citizens be able to count on a legal standard that is as clear as possible. The fact that this is highly subject to interpretation, because of the wording, may deprive certain Canadians of the constitutional right to obtain assistance in dying. If we want such a criterion to be present, it is important to develop it more. However, since this criterion does not exist in the Carter ruling, we think that leaving it in the bill will open the door to legal debates. That is why we recommend the pure and simple elimination of paragraph 241.2(2)(d) proposed in the bill.

I'd like to discuss a few more technical situations regarding the safeguards, among others the characteristics of the witnesses. The standards being imposed are so strict that it will be difficult even for the person concerned to find a witness to sign the form. Members of the family and many other people are excluded. We should remember that the witness only attests the signature, nothing more. In any case, the physician is going to have to verify that the patient gave his or her consent freely. I think that too much is being imposed on the witnesses. These criteria would be more appropriate if we were asking for consent on behalf of someone else. But in the case of a simple witness, we think that these measures are far too rigid.

Let's move on to the declaration. Our brief was written from the perspective that a very detailed provincial law exists, and we are adding a federal law. In order to avoid a multiplication of forms and reports, I think it would be important that there be an exception in the bill; when the government is satisfied with the provincial declarations that are required, there should be an exemption in the bill so that physicians do not have to make a host of declarations. An overabundance of paperwork will also discourage a certain number of physicians from doing these things.

In Quebec, the reporting process is already very elaborate. Why should there be an additional report? I think that this will only make the process more cumbersome, unnecessarily. However, nothing prevents federal authorities from requiring that the province provide the information collected through its own monitoring measures. In Quebec, the province monitors medical assistance in dying. We have created an organization specifically for that purpose, the Commission sur les soins de fin de vie, the end of life care board, in addition to the monitoring done by the Collège des médecins and the Conseil des médecins, dentistes et pharmaciens. And so the creation of a new level of monitoring seems superfluous to us. We think you should consider less onerous monitoring measures in the provinces where a law already exists.

Thank you.

[Denis Lemieux, Liberal, Chicoutimi—Le Fjord, QC]

Mr. Speaker, it is a great pleasure to take part in this second reading debate of Bill C-14 on medical assistance in dying in Canada.

I had the privilege of being a member of the Special Joint Committee on Physician-Assisted Dying, and I supported all of the report's recommendations.

However, as many members have acknowledged today, medical assistance in dying is a complex, sensitive, and extremely personal issue.

Ever since the Supreme Court handed down its ruling in Carter last year, Canadians all across the country have been contributing to the discussion. The issue continues to be the subject of serious debate and deliberations all around the world, everywhere from the United States to Europe, Australia, and New Zealand.

In virtually all parts of the world, deliberately ending someone's life and helping someone end his or her own life are serious crimes that carry harsh penalties.

However, as many people know, Canada is not the only jurisdiction to legislate and authorize medical assistance in dying. Four U.S. states, specifically Oregon, Washington, Vermont, and California, along with Colombia, and three European countries, specifically Belgium, the Netherlands, and Luxembourg, have a legislative framework that allows some form of medical assistance in dying.

I listened to more than 60 expert witnesses during the meetings of the Special Joint Committee on Physician-Assisted Dying, and I was deeply moved by the testimony of the Hon. Steven Fletcher; Benoît Pelletier; Jean-Pierre Ménard from Quebec; Dr. Cindy Forbes, president of the Canadian Medical Association; and Dr. Monica Branigan of the Canadian Society of Palliative Care Physicians.

Last week, though, I got a call at my constituency office from Bibianne Gauthier, the mother of Jean Truchon. After our conversation, I was able to put a face to a real request for medical assistance in dying.

After meeting Ms. Gauthier and her son Jean, I decided to share this real case with my colleagues in the House and read the letter that Jean Truchon wrote to his health care team on January 20.

I would like the House to know that I personally got permission from Jean Truchon to read this letter in Canada's Parliament. I am also doing this at the request of Mr. Truchon's parents:

“I am 48 years old and I have had cerebral palsy since birth. I spent 22 wonderful years living in an apartment.

On March 11, 2012, my life was turned completely upside down when the medical team at the Centre hospitalier universitaire de Montréal diagnosed me with inoperable degenerative cervical disc disease. That day, I reluctantly put one foot in the grave and I have every intention of putting the rest of my body there on September 1, 2016. I had to resign myself to living in a home and despite the good care I am receiving and my efforts to adjust to the situation, I simply cannot imagine living much longer under these conditions.

My question is this. Since I believe that I do not meet the eligibility criteria for medical assistance in dying [in January of this year], I intend to refuse to allow the staff to feed me or give me water, as I am unable to feed myself. I am asking that my doctor at the centre be authorized to administer a drug to at least relieve the pain.

I look in the mirror and I no longer recognize the man I once was. That is when I say, ‘What is the use in living like this’. Sometimes I think you do not have be at the end of your life to experience the intolerable suffering that I am currently experiencing. Doctors have told me that eventually I will become incontinent. The thought of it is too much to bear. I still have too much dignity to live like that.

At one point, I was in bed and no one responded when I pressed the call bell. I had to relieve myself in bed. It was then that I understood that life in an institution was not for me. I know that other people living a similar life in similar circumstances make different choices. However, in my case, I made the carefully considered decision that 2016 would be my last year.

I realize that dying before my parents is not the best way to go because it defies logic. However, I cannot take it anymore. My family and my friends are aware of and respect my decision even though they do not agree with it, because they are going to lose me. They understand all my struggles, and I thank them for their understanding.

I have considered a more dramatic form of suicide, but the fear of surviving and being in an even worse condition prevents me from doing it. Furthermore, to ease my family's pain, I am choosing to leave in a more honest manner by having them at my side. The antidepressants I have been offered, together with an explanation of their potential benefits, will never give me back the use of my arms or change the prognosis of physical decline. In good conscience and of my own free will, I have refused the medication, which will not give me back the will to live what would seem like an artificial life.

If this letter results in a more objective awareness of those who are suffering and are not at the end of their lives, I will have achieved one of my objectives.

Since I have no expectations that my case will be eligible for medical assistance in dying, I am also appealing to the CIUSSS bioethics committee to allow my treatment team to respect my choice and to allow me to receive the comfort care and the medication required to alleviate my suffering when I stop my feeding.

Thank you for taking the time to read this letter.”

The letter was signed by Jean Truchon.

This extraordinary 48-year-old man is just one of the faces of medical assistance in dying in Canada, but as I read about Jean's courageous decision, I felt that the committee had made good recommendations in its report.

The Minister of Justice consulted all of the existing legislation around the world to draft the government's legislative response to the Carter decision.

The bill sets three eligibility criteria: individuals must be competent adults who are in an advanced state of irreversible decline; they must have a grievous and irremediable illness or disability, and their medical condition must cause them enduring and intolerable suffering; and their deaths must have become reasonably foreseeable, taking into account all of their medical circumstances.

The bill also has a non-legislative component. It provides for further study of three specific topics: mature minors, advance requests, and mental illness.

I am also pleased to see that Bill C-14 includes solid safeguards to prevent mistakes and abuses. I would like to reiterate them: the patient must get an opinion from two independent doctors and the request must be made in writing; the patient has the right to withdraw the request; there is a 15-day waiting period; and consent must be confirmed immediately prior to the administration of the medical assistance in dying.

In closing, I would like to encourage all members to read the document entitled “Legislative Summary of Bill C-14: An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying)”, which was tabled in the House by the Minister of Justice. It contains important information on the international laws and regimes that influenced the government's approach to medical assistance in dying in Canada.

The government wanted to learn from the experiences of other jurisdictions. The approach it plans to take is broader in scope than that of the United States, which gives access to medical assistance in dying only to people with an incurable disease. The approach the government is considering gives the option of a peaceful death to everyone approaching the end of his or her life, not just those suffering from incurable diseases. At the same time, it eliminates some of the risks that may be associated with a broader regime. The government has also committed to continue examining these more general issues and will continue to observe what is being done elsewhere in the world in terms of medical assistance in dying.

I urge all members to support this bill and send it to committee, thereby responding to our Supreme Court's request to legislate in this area.

[Raj Grewal, Liberal, Brampton East, ON]

Mr. Speaker, Bill C-14 represents a direct response to the Carter ruling. It sets out a framework to ensure that we have assisted dying in this country within a framework that ensures we protect the most vulnerable people from abuse.

On second reading, the Attorney General said the government will be putting forward, publicly, the documents that examine the charter impact of the bill for all Canadians and this House to look at as well.

We will be working with the provinces and territories to ensure that we have regulations to protect this framework, because this is a very sensitive issue for all Canadians. This bill is a great response to the Carter ruling, and the parliamentary review after five years will ensure that this issue keeps building forward.