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

[David Graham, Liberal, Laurentides—Labelle, QC]

Madam Speaker, I would like to thank my colleague from Lac-Saint-Louis for his good speech.

Is he satisfied with the process that took place and is he pleased with the result?

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

Madam Speaker, I am pleased with the outcome of the debate. I believe that we have had a very comprehensive debate on the issue. I have been here until midnight at least once to listen to the excellent speeches of members from all parties in the House on the issue.

We must not forget that, unlike some legislation debated in the House, this matter is also currently being debated by society at large. This debate is not being held in a vacuum. Not only do members have the opportunity to express their opinions, and as far as I know most have done so, but this debate is also being held in the media, in people's kitchens and in community centres.

[Robert Aubin, NDP, Trois-Rivières, QC]

Madam Speaker, I would like to thank my colleague for his comments.

I would like to go back to the criterion of reasonably foreseeable natural death because in Quebec there have been people who starved themselves in an attempt to meet this criterion.

Does the member not believe that this criterion runs completely counter to the guidelines established by the Carter ruling?

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

Madam Speaker, we put a lot of faith in the Supreme Court's opinion, as we should.

Right now, we cannot predict how the Supreme Court will rule if this bill ends up before it. Chances are good that the court will respect the will of the House that is expressed this evening at third reading.

We believe that the bill is consistent with the parameters set out by the court in Carter. We also believe that the court will, to a large extent, respect the will of the House, which is sincerely trying to act in accordance with the court's decision in Carter.

[Frank Baylis, Liberal, Pierrefonds—Dollard, QC]

Madam Speaker, there is a poem by the great Welsh poet, Dylan Thomas, entitled, Do Not Go Gentle Into That Good Night. It is a poem of a son calling out to his dying father to fight his imminent death, and it ends as follows:

And you, my father, there on the sad height,
Curse, bless, me now with your fierce tears, I pray.
Do not go gentle into that good night.
Rage, rage against the dying of the light.

He is imploring his father to fight to the very end, to rage against the dying of the light. I believe this stanza describes the very essence of western philosophy when it comes to dying. Simply put, do not accept death.

However, life is terminal. The very definition of life is to die. A rock does not live, because a rock does not die. A tree lives, because a tree dies. A person lives, because he or she dies. So, am I going to die?

This is the subject of an excellent Ted Talks by a first responder. It is about a paramedic who would often arrive at the scene of an accident only to find a victim whose injuries were so severe that he or she was not going to survive. These victims would inevitably look up to this paramedic and ask: “Am I going to die?” In those moments, he would always lie and say no. He did so because he thought that was the kind, caring thing to do. Then a few years ago, he arrived at the scene of a severe motorcycle accident to find a victim who again asked the same question. For some reason, he told the truth and said yes. The reaction was not what he expected. The victim showed calm, inner peace, wisdom, and acceptance. From that time forward, he always told the truth.

Dylan Thomas in his poem tells us “wise men at their end know dark is right”. Therefore, am I going to die? Yes. We are all going to die.

Now we find ourselves discussing an issue that is foreign to many of us. With Bill C-14, we are trying to determine when it is acceptable to accept to die. That is to say, when it is acceptable to go gentle into that good night. This is essentially what we are debating with this bill.

Some argue that the bill should follow the Supreme Court's ruling to the letter. Some argue that the bill should be broad to encompass all possible scenarios. Some argue that the bill should be narrow and restricted so as to protect the vulnerable. Some argue that there should be no bill at all, and we should not be on this path regardless of what the Supreme Court says.

Here in the House we have had great debate on this matter. It has been passionate, intelligent, and respectful. It has been the House of Parliament at its best. For example, the member for St. Albert—Edmonton, who was on the special joint committee that prepared the guiding report for this legislation, has spoken eloquently on why he believes this bill is missing certain key protections. On the other hand, the member for Victoria, who was also on the special joint committee, has expressed, in a thoughtful, intelligent manner, his strong belief that the bill is too restrictive in certain areas.

I have received numerous personal letters from many sides of this argument, letters from people who are suffering now and fear not being able to access this gentle path when their time comes. Other letters are from caregivers who look after the grievously sick, the aged, and the mentally incapacitated. They are deeply concerned that these vulnerable people will not be protected. My own father has written on this bill.

I was out meeting constituents a few weeks ago and a lady came up to me. She said that she really liked what my father had written in the newspaper. Now, people get confused at times, and I did not know about this, so I just thanked her. When I got home, I called my father and asked if he wrote something in the paper. He said, “Yes”. I asked to see it, if he could email it me. He said, “No, I've erased it”, because he does not like to keep clutter on his computer.

I asked him to explain the gist of what he said, and he went on to explain that the term “reasonably foreseeable natural death” was a difficult one, even for a physician. My father had suffered severe heart attacks 25 years ago and was told to put his affairs in order by his physician.

Here he was, using the example of his own life to say, “I am alive 25 years later.” He is alive because on a dark night 25 years ago, he chose to “rage against the dying of the light.”

None of these people are wrong. Everyone has an opinion, and everyone's opinion is valid. For each person, that destination, that moment in time when it is acceptable to accept death is different, and rightfully so.

If the destination is uncertain, how do we arrive at it? Cautiously. There is a concept in engineering called “overshoot”. Simply put, the faster one arrives at the destination, the more likely one is to overshoot it. For example, if someone is driving in a car toward a stop sign and if he or she is going very fast and slams on the brakes, the individual will shoot past the stop sign. On the other hand, if someone goes very slowly, it will take that individual a very long time to get to the stop sign and he or she may even stop short.

We have an uncertain destination that is different for each person. How do we get there? Cautiously. We go toward that destination slowly. This is precisely the approach that the Minister of Health and the Minister of Justice have decided to take.

With Bill C-14, we are moving forward to this destination slowly, and we accept that we may even stop short. The bill acknowledges this. It is explicitly written into the law that it will be re-examined in a few years' time, precisely to allow for adjustments.

This is a very wise approach, and I commend the Minister of Health and the Minister of Justice for the work they have done to bring us here.

In summary, we will all face our death. At that time, some of us will choose to fight death to bitter end. As a society, we already support that decision and we use the full weight of our medical system to help those people who choose to "rage against the dying of the light".

On the other hand, some of us will choose to accept death with inner peace and calm. As a society, we must now accept their decision and allow our medical system to help them. With this bill, we will help some of those people to "go gentle into that good night."

[François Choquette, NDP, Drummond, QC]

Madam Speaker, I am pleased to participate in this debate. This discussion is really important for everyone in the Drummond region. In my region, people are very concerned about palliative care. We have people who are working very hard in the field of palliative care in the greater Drummond region. For example, there is Maison René-Verrier, which provides wonderful palliative care. I know that palliative care is important to the Liberals, but unfortunately, there was nothing in the most recent budget in that regard. There is also nothing in this bill to indicate that the government is really going to focus on palliative care. I would like to hear my colleague's thoughts on that.

[Frank Baylis, Liberal, Pierrefonds—Dollard, QC]

Madam Speaker, that is an excellent question. Palliative care plays a key role in a person's decision about whether or not to choose medical assistance in dying. On the West Island of Montreal, we are lucky to have the West Island Palliative Care Residence, which is known throughout Canada for its expertise in palliative care. I know that we have already taken steps to talk to the people who work there to find out more about their excellent model so that it can be expanded upon and applied across the country.

[Anthony Housefather, Liberal, Mount Royal, QC]

Madam Speaker, the member for Drummond mentioned palliative care. Perhaps he is not aware that at committee we inserted palliative care in the bill twice, in the preamble and in the bill. In the preamble we stated that palliative care, and the Minister of Health's requirement to work with her provincial and territorial counterparts on palliative care, was an essential issue that needed to be done. In the bill we stated that, after five years, the committee reporting on medically assisted dying also needed to report on palliative care, because nobody in the country should exercise medical assistance in dying because of a lack of good palliative care.

Was the member for Pierrefonds—Dollard aware of these amendments, and could he talk more about the government's commitment to palliative care?

[Frank Baylis, Liberal, Pierrefonds—Dollard, QC]

Madam Speaker, again, palliative care is a critically important aspect of the decision that one day all of us will face. Hopefully, it will be there for all of us.

As the member mentioned, this is part of the preamble and an essential part of the process we are going through. Some people are frustrated that everything is not done at once, that everything has not fallen into place overnight. It does not work like that in the real world. This is why I believe the right approach is to go slow, learn from our experiences, and, at the same time, work to bring about palliative care, which will have a critical impact on people who are forced to make such challenging decisions.

[Anthony Housefather, Liberal, Mount Royal, QC]

Madam Speaker, my friend from Pierrefonds—Dollard talked about a balanced approach. I am sure he is aware of the court decision yesterday that stated that a non-Canadian citizen had the right to exercise medical assistance in dying in the absence of legislation that clearly set out what Parliament intended for medical assistance in dying.

Could the member talk a little about his concerns if the deadline of June 6 is not met by Parliament?

[Frank Baylis, Liberal, Pierrefonds—Dollard, QC]

Madam Speaker, I think the country as a whole is concerned about this issue and it is incumbent upon us as legislators to put something in place. I disagree with people who say that no law is better than this law. I would tell them that no law is perfect, and no law will not be amended and no law will not be subject to changes as we learn, experience, and go forward.

I strongly encourage those who oppose it and say the will vote for nothing to do their job as legislators, put something in place and then work to make it better.

[Cheryl Gallant, Conservative, Renfrew—Nipissing—Pembroke, ON]

Madam Speaker, I will be sharing my time with the member for Bruce—Grey—Owen Sound.

It is with great humility that I stand in my place today as the member of Parliament for Renfrew—Nipissing—Pembroke to represent the good people of my riding on such a weighty issue as the one before Parliament today, medical assistance in dying.

The debate strikes right at the heart of who we are as a nation, and I pray we get this right, as is humanly possible.

I thank all those constituents who answered my call to contact me regarding their thoughts on the legislation. I am pleased to confirm I have sought out the views from as many constituents as possible to guide, when the time comes, to support or oppose the government, or the Supreme Court, who are driving this issue today.

I have listened carefully to my fellow MPs on this topic. They have expressed various points of view eloquently. In keeping with my principles, and those for which my voters have elected and continue to re-elect me, I believe it is important to give a voice to those individuals who have not been given the opportunity to speak in this place, but should be heard.

I am pleased to add to the debate on medical assistance in dying with a sampling of letters and comments that have been received by my office to guide me in the debate. While time does not permit me to read all the correspondence I received onto the official record, I want to assure them that all points of view are important and will be considered.

This is a letter from Carmel in Pembroke. It reads, “Dear honourable member, I understand that the government plans to introduce a law regarding medical aid in dying. I totally disagree with many of the recommendations of the special joint committee on physician-assisted dying. Once euthanasia and assisted suicide are legalized we have embarked on a slippery slope. The boundaries will continue to be challenged. I urge you to write a law as restrictive as possible, and to respect and include the rights of many Canadians, who see any legalization of euthanasia and assisted suicide as murder. As a former health care worker for many years, I urge the government to invest more money in palliative care. I know from experience, pain can be controlled. They will receive passionate loving care and death will come naturally. Trusting that common sense will prevail in your good judgment.”

This email was received from David in Arnprior:

“Hello Member of Parliament. I do not support this legislation, not because I do not firmly believe in a competent citizen's right to commit suicide at the end of life as determined solely and completely by that individual, but because C-14 does not go far enough. This bill certainly needs to be passed federally so a provincial regulatory ragtag patchwork does not evolve. As well, C-14 needs expansion in at least four areas: Enshrine my right to predetermine through a pre-arranged power of attorney for personal care that suicide is my wish if I become incapable of making that choice later on; in other words, similar to my legal right now to refuse treatment before treatment is ever needed. Enshrine my right to commit suicide on my own, without a doctor's direct assistance. This change will allow “medical practitioners” to merely prescribe requested and appropriate meds for this most personal action, not to have to do it themselves in an environment perhaps not of my own choosing. Following from number 2, ensure that a broad array of competently trained, caring “medical practitioners” beyond merely MDs are available to assist as I may desire; the so called “death doula” model. Ensure that the so-called mentally ill can benefit from the legislation if they are deemed competent to do so by due process, since by virtue of being labelled mentally ill, a person should not also be deemed mentally irrational or incompetent in all areas or aspects of life. This is very unlike children under 18 or the developmentally delayed however, who must be closely protected, at least by benefit of clear due process. At the same time, there is a clear need for those ethically opposed in both caring professions and institutions to be able to opt out because of their beliefs, but only insofar as they must also be compelled to refer me to those who are non-opposed. This should also hold true by the way, for abortion, legalized marijuana, and like matters. There is also a clear case for broadly based, publicly funded “palliative care” services for those who want this kind of assistance. At the end of one's life it must always be about informed and competent personal freedom of choice, whatever that choice may be. This is in fact the basis of all quality of life and death, as entrenched in our Canadian charter, as decided by our Supreme Court. A national referendum on the matter is unwise and not needed. Similarly, I refer you back to Conservative P.M. Mulroney's 1980s second election, which was a referendum/vote writ large on free trade. He won then, as did NAFTA. Therefore, I largely agree with the previous Pierre Trudeau's 1960s statement when he was Liberal justice minister: “The state has no right in the bedrooms of the nation”. I think that goes a bit too far. The state does have a "limited" right, but only to ensure vulnerable persons, as well as persons who may become vulnerable, are not exploited, and are always treated with dignity and respect. In this, the Dutch, Swiss and Oregon models serve well. Thank you; please do acknowledge this email and feel free to share your thoughts.”

This note was received from David in Combermere. It states, “Our local newspaper here in Barry's Bay featured your request for input on Bill C-14. Thank-you for doing that. I personally view the bill as a Pandora's box and with so much language that leaves it ambiguous enough for the Liberal government to permit almost anything for the killing of Canadians. I don't know if you follow the studied newsletters of the Euthanasia Prevention Coalition and its editor, Alex Schadenberg, but I am enclosing their latest issue on Bill C-14. It's a whopper. EPC clearly presents the issues I endorse and in a more studied way than I could present to you. Please consider it my opinion on this vital life and death issue that you are wanting to present to Parliament. Thank you for all that you can do in this matter. God bless you.”

This letter was received from Betty from Killaloe. It reads, “Dear Member of Parliament, I strongly oppose physician-assisted suicide. I believe that life is given to us by God and should be taken away by Him as well. We don't know what his plan is for us and we need to trust Him with our lives. Even for non-believers, once that door is open to taking the life of a patient who is terminally ill, how long will it be until a needle will be given to those who are in long-term care, who are costing the health care system a lot of money to keep them there? How about the disabled whom a lot of people believe are a burden to our society, the mentally ill, etc. Let us put money into our palliative care and hospices where people can die naturally. History has shown us that where people interfere with the natural order and God's plan, evil and disaster follow. God's law states "thou shalt not kill" which should be above all the laws of the land. Thank you for giving me a chance to express my views.”

This email came from a couple in Arnprior. It says, “Dear Member of Parliament, Both my wife and I are advocates for doctor-assisted dying. We not only would like to see assisted dying for those people who are in need of this procedure and who have their full faculties but even more so for the thousands of poor souls suffering from Alzheimer's and who cannot make an informed decision. What we suggest is that it be made legal for people to choose this option during the preparation of their will with family and/or doctor as witness to this wish. We have a mother in long-term care in Almonte and the number of people suffering from Alzheimer's disease far outnumber the people who are lucid. I am sure if these people had a choice it would be to end their lives rather than sit in wheelchairs all day and to be treated, through no fault of their own, like babies. Our total hearts and admiration go out to the nurses and aides who care for those in need. We cannot thank them enough.”

Nancy from Deep River wrote, “Dear Member of Parliament, I'm answering your request for feedback on the specific euthanasia bill. First, a few generalities. I see the entire dynamics against a background where there is a movement for a culture of death, COD, and a movement for a culture of life. The culture of death tends to be hidden and manipulative. The well researched documentary CD called ‘Agenda’ provides evidence of this. There are elitists who want to reduce the world population by almost any means. Some of them want to make a shambles of the capitalist system so that their socialist ideal swoops down as the saver of the world. It is ironic that these elitists are socialist. I have read that the CIA supported the radical feminist movement, which has been instrumental in tearing down family structures and consequently economic stability. Hilary Clinton said, quite clearly even if not in these exact words, because I don't remember exactly how she expressed it, that in our society there are Judeo-Christian values that ‘we’ have to get rid of.”

“Specific examples show this. ‘They rope in well-intentioned liberals, like fools conned into their service. Now to the specifics. The most dangerous thing about the bill is that there is nothing in the law to protect the conscience rights of medical personnel. This means we would have legislated immorality if the bill passes in its current form. Such a law would corrupt an important sector of the citizenry. Corrupt citizens are antithetical to a healthy democracy. If conscience protection is not in the law, it is almost certain that somehow the “inconvenience” of non-participating physicians will be swept aside by a bureaucracy, just as it is now in Quebec. The bill does have some restrictions. I can believe that it was drafted in order to satisfy the Supreme Court's mandate in a careful manner. There are two facts against an optimistic view of these restrictions. Note the language we hear on the news, about beginning gently with euthanasia. Such language indicates that the plan is over time to include more situations where euthanasia would be permissible. Make no mistake about these restrictions. Like dew on roses, they will evaporate. This has been the experience in Europe.”

[Kevin Lamoureux, Liberal, Parliamentary Secretary to the Leader of the Government in the House of Commons]

Madam Speaker, my question for the member is related to the whole need that we have before us today. This legislation will provide the legal framework to ensure that vulnerable people across Canada are at least being considered and taken care of.

At the committee stage, we saw members from all political parties were able to advance amendments and ultimately get some accepted which is a wonderful thing. Does the member believe it is better to have some legislation or a law in place than no law in place? Because if it is the latter, there are going to be many Canadians who will be very vulnerable to this situation.

[Cheryl Gallant, Conservative, Renfrew—Nipissing—Pembroke, ON]

Madam Speaker, what I am doing is providing the thoughts of my constituents who feel that this has not had proper debate and would like to see longer debate. As Nancy from Deep River was saying. “Now in the Netherlands a significant percentage of deaths are reported as executed by physicians without any request by the patient or family. The actual number would have to be greater than those where the physician has the temerity to admit this, which is murder and is illegal.

From a practical standpoint, it is almost impossible to make restrictions robust over time. The Council of Canadians with Disabilities says the bill does not provide protections it asked for in its vulnerable persons standard. Those protections, which are not in the bill, have to do with the assessment of vulnerabilities that may be inducing a person to seek assisted suicide as well as a review with the authorities with relevant expertise. In sum, the bill has three major drawbacks.”

[Robert Aubin, NDP, Trois-Rivières, QC]

Madam Speaker, I paid close attention to my colleague's remarks, and I admire her choice to use her time to serve as her constituents' mouthpiece.

We have all heard from people in our ridings who are in favour of medical assistance in dying and people who are not. Their views are polar opposites. However, there is one theme most people agree on: palliative care.

My question is simple: is there a way to reconcile the perspectives of those who are in favour and those who are not? We know that increasing pain medicine dosage in palliative care often results in death. In many cases, patients lose consciousness. With medical assistance in dying, patients consciously choose to leave their loved ones for the same reason and use the same medication to do so.