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

[Joyce Murray, Liberal, Vancouver Quadra, BC]

Mr. Speaker, I want to thank the member for those thoughtful proposals.

There will be a committee process in which these kinds of ideas can be put forward and the committee can hear from expert witnesses. What we do not want to do is put unnecessary barriers in the way of people who are qualified to have this kind of end-of-life assistance.

I do want to say that it would have been helpful if the Conservative Party had done the work on how to follow through on the Supreme Court of Canada's requirement for medical assistance in dying when that Supreme Court ruling came out. There could have been much more discussion in Parliament a year ago, which is what our party called for and the Conservatives refused to do.

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

Mr. Speaker, I thank my colleague for her speech.

I want to begin by saying how much I appreciate the tone of our exchanges today. It is inspiring and a change from our debates.

My question is quite simple and is on the example my colleague gave in her speech about one of her friends who stopped eating and drinking for six days in order to end his life. Although the Supreme Court's criteria are relatively clear in the legislation, the fourth element is rather vague in my opinion.

We are talking about natural death becoming reasonably foreseeable. Could my colleague provide some clarification on this fourth criterion? If someone meets the first three criteria, would he not be forced, once again, to stop drinking and eating in order to meet the four criteria to get the service he is seeking?

[Joyce Murray, Liberal, Vancouver Quadra, BC]

Mr. Speaker, I thank the member for the question.

I can guarantee that my friend's condition was consistent with the criteria of our bill.

As I said in my remarks, with such a short time to deliver on the Supreme Court's mandate in the timeframe available, it is important to be cautious on how this is framed. That is what the proposed law would do. It finds the correct balance between safeguards for the vulnerable, the rights of physicians and nurses, and the personal rights of those who wish to have assistance in dying.

We have time moving forward to continue considering situations such as the member has brought forward to confirm that we have the balance right, or make adjustments in the future when the bill is reviewed in five years.

[Arif Virani, Liberal, Parliamentary Secretary to the Minister of Immigration]

Mr. Speaker, I rise today to speak to Bill C-14. I start with reference to the Supreme Court of Canada's Carter decision, about which we have heard much.

In the opening paragraph of that ruling, the unanimous court said:

It is a crime in Canada to assist another person in ending her own life. As a result, people who are grievously and irremediably ill cannot seek a physician’s assistance in dying and may be condemned to a life of severe and intolerable suffering. A person facing this prospect has two options: she can take her own life prematurely, often by violent or dangerous means, or she can suffer until she dies from natural causes. The choice is cruel.

I agree with the Supreme Court. The choice is cruel.

The Supreme Court concluded that the criminal law as it currently stands was not only cruel, it was also unconstitutional. The court found that section 7 of the charter required access to medical assistance in dying, subject to certain safeguards. That is where the House finds itself today.

Let us be clear. The question facing parliamentarians is not whether we can permit Canadians access to medical assistance in dying. That access must be permitted to comply with the charter. The actual question facing us is how to design the access. In terms of design, I believe Bill C-14 strikes the right balance. The balance is between the right, on the one hand, of a competent person who seeks an assisted death in response to a grievous and irremediable condition, as compared to the need to protect the vulnerable from being induced to commit suicide at a time of weakness.

Striking this balance is not simple. Nor is it permanent, and this is an important point. The balance must be calibrated and re-calibrated according to changing evidence and the evolution of societal values. Indeed, the Supreme Court's 2015 decision, which reversed the court's earlier ruling in 1993 in Rodriguez, is evidence of this very evolution. However, for now, in terms of where we are in 2016, I am firmly of the view that the bill would strike the right balance.

There is another reason why I rise before members today to speak in favour of the bill. That is because I have spent my career as a constitutional litigator fighting for people's rights, their human rights, their charter rights, their right to equality. Treating people equally means treating people with respect, according them dignity and according them autonomy. The bill would do that. It would give people control over their own lives, including the conclusion of their lives. It would allow those nearing death to pass in a manner of their choosing with less suffering.

In empowering choice, the bill would empower Canadians. It would strengthen us as a people because it is informed by a desire to give Canadians more autonomy and, as a result, greater dignity.

For the rest of my speaking time I would like to address two major categories of concern that this bill raises: the criticism that Bill C-14 does not go far enough to make medical assistance in dying available; and the opposite criticism that the bill goes too far and makes medical assistance in dying too accessible.

In this first category, the concerns are that Bill C-14 is not broad enough. They centre on three main components, and we have heard some of them this afternoon and in previous days of debate. For now, it is proposed that medical assistance in dying only be permitted for adults and for those who suffer from more than a mental illness alone. In addition, for now Bill C-14 would not provide for advanced directives regarding medical assistance in dying.

The words “for now” are important. The government has committed to an independent study of legal, ethical, and medical issues that are raised by each of these three different categories. This is important. If medical assistance in dying is to be expanded into any of these three areas, it must be done only after a comprehensive study of the benefits and the risks associated with permitting medical assistance in dying in such circumstances.

I was determined to hear from my constituents directly on this important legislation. Therefore, in early April I hosted a town hall in my riding of Parkdale—High Park on the issue of medical assistance in dying. The engaged constituents of my community came prepared with thoughtful and personal reflections, with concerns, and with questions, many of which related to these very three items I just raised.

While the residents and community, like me, are keen to protect and promote the autonomy and dignity of all Canadians, including youth and the mentally ill, the residents of my community also cautioned about moving too quickly in an area where the consequences of a decision were final and irreversible. They noted, for example, that in Belgium medical assistance in dying had been legalized and studied for a period of 12 years prior to medical assistance in dying being made available to minors. The mentally ill, it was noted, would be able to avail themselves of medical assistance in dying under this legislation provided the mental illness was part of the patient's overall medical circumstances and that the applicant was still able to meet all of the general eligibility criteria.

As one who has championed the rights of mental health consumer/survivors in my community, I know it is critical that before embarking on the path of increased access to medical assistance in dying for those whose condition is mental illness alone, we get this right.

As we have said repeatedly, our government believes in enacting legislation that is well reasoned, carefully analyzed, and based, above all, on sound evidence. The proposed independent studies into things like access for minors will help inform this analysis and critical evidence-building process. Importantly, Bill C-14 also contains a provision which calls for a mandatory review of the entire legislation every five years.

As I said at the outset, finding the right balance in legislation of this nature is not permanent; it is fluid. It is a dynamic process which can and must adapt to changing evidence and societal norms.

Bill C-14 is not an extensive enough category. We also find an argument relating to reasonable foreseeability. We heard questions about it this afternoon. Some assert that the requirement to Bill C-14 that a person's death must be reasonably foreseeable is an unnecessary barrier. Such concerns are unfounded. Bill C-14 is actually more permissive than any assisted-dying legislation in North America. In Quebec, an applicant must have a terminal disease. Bill C-14 is more accessible. It would allow medical assistance in dying where death is reasonably foreseeable, looking at the totality of the medical circumstances.

In addition, in each of the four American states that have legislated medical assistance in dying, one is required to have a specific prognosis that an individual has less than six months to live. There is no such temporal restriction in Bill C-14.

Finally, in the category of Bill C-14 not being quite broad enough, some contend that the bill should stipulate, and again we heard it this afternoon, that medical practitioners are professionally bound to provide such service. This criticism misunderstands the nature of Bill C-14. It is an amendment to the federal Criminal Code. It is also misguided jurisdictionally.

Wearing my constitutional hat, it is clear that the federal government has an important role to play in maintaining universal access to insured health services, but the ultimate delivery of medical services is primarily a matter of provincial jurisdiction. Our government, as was mentioned by my colleague, has committed to work going forward with provinces and territories to support access for medical assistance in dying, while simultaneously respecting the personal convictions of health care providers. This approach reflects the balancing that must occur when addressing competing charter claims.

On the one hand, the section 7 claims of those who seek access to medical assistance in dying must be balanced with the freedom of conscience rights that are entrenched in subsection 2(a) of the charter. Those are the freedom of conscience rights of health care providers. The Supreme Court recognized this in the Carter decision, in paragraph 132, and this bill recognizes it in the preamble.

The second broad category is that the bill is too permissive.

In fact, those who maintain that Bill C-14 is too permissive are the ones who are failing in the fundamental responsibility to protect people who might commit suicide in a moment of weakness.

Requesting medical assistance in dying is not simple. Nor should it be. Requests must be made in writing. This has a meaningful impact. All such requests must be witnessed by two independent individuals. They cannot be a beneficiary in a will or a person charged with the care of the ill individual. A request must then be approved in writing by not one, but two different medical practitioners. Finally, the bill calls for a mandatory waiting period of 15 days in order to allow individuals to reflect on the seriousness of this choice.

The bill goes further. It requires an extensive regime of monitoring, so data and trends respecting medical assistance in dying can be obtained and analyzed by government. This kind of monitoring will ensure transparency, but more important, it will facilitate strengthening safeguards where required.

Finally, I am encouraged by the fact that Bill C-14 not only reflects the significance of choosing medical assistance in dying, but that every choice ought to be an informed one. By this, I am referring to the pressing need to enhance palliative care in Canada, a need expressed to me time and again by residents in my riding of Parkdale—High Park. If we are to ensure that the significant choice of requesting medical assistance in dying is fully informed, it is critical that we work collectively, in a non-partisan manner, to ensure that improved palliative care is readily available.

In conclusion, I reiterate that this proposed legislation is neither too restrictive nor too permissive. It strikes the correct balance, while simultaneously recognizing that with further study and mandatory review, the balance will continue to be re-calibrated to reflect new evidence and evolving societal values respecting medical assistance in dying.

Most important, the bill would eliminate the cruel choice that the Supreme Court described in the opening paragraph of the Carter decision. No longer will grievously ill Canadians be faced with either taking their own life prematurely or prolonged suffering until they die. Bill C-14 would give such Canadians what the charter requires, autonomy. It would give them control over their passing in a manner that ensures their dignity. For this reason, I will be supporting this legislation.

[Harold Albrecht, Conservative, Kitchener—Conestoga, ON]

Mr. Speaker, there is a couple of things I would like to clarify. The member and his colleague who spoke earlier said, pretty unequivocally, that no doctor would be required to participate in this regime. I do not see any protection in Bill C-14 that would assure doctors they would not be required to participate, other than a very vague comment in the preamble talking about that possibility. It certainly does not put iron-clad protection in the bill.

The other issue I would like to raise with all my colleagues on the other side is palliative care. We continue to hear their commitment to palliative care. I applaud that. We need better palliative care. I have been working on that years. We can talk about it, but I do not see any evidence in the budget of the $3 billion that was promised to be immediately invested. I am very concerned. We need to get working on this. I want to see an actual firm commitment within the budget so we have something we can take to Canadians that says help is on the way.

Barring that, to offer physician-assisted death without—

[The Deputy Speaker, Conservative, Bruce Stanton]

The hon. parliamentary secretary to the Minister of Immigration, Refugees and Citizenship.

[Arif Virani, Liberal, Parkdale—High Park, ON]

Mr. Speaker, my hon. colleague has raised two points. One is the issue of doctor participation, and it is broader than just doctors; it is also nurse practitioners. Clearly, in the Carter decision, paragraph 132, the court went beyond the call to specify that nothing in its decision would compel a health care practitioner from being required or compelled to provide medical assistance in dying.

The preamble, as my colleague noted, reflects that same sort of rhetoric. I would put it to him that our party and this government firmly believe in complying with the charter, including all aspects of the charter, including section 2(a), which protects those conscience rights.

On the issue of palliative care, the member is correct. It would be inappropriate for palliative care to be entered into this bill, which deals with a discreet amendment to the Criminal Code. An announcement was made today in question period, and my friend was here to hear it. The minister indicated the amount of monies being allocated for palliative care. I would ask him to put faith in the minister. She is a family physician and has been on the ground providing these services. She recognizes the important need for palliative care to be provided in a robust way so people have an informed choice when they make this significant decision.

[Charlie Angus, NDP, Timmins—James Bay, ON]

Mr. Speaker, I listened with great interest to my hon. colleague.

My concern with the lack of action on palliative care is that there was zero dollars in the budget. We have a promise now, but that is another year lost. I find it extraordinary to be talking about the right to die, but not the right to quality palliative care and the role the federal government has to play.

The other area that concerns me is the federal government has major health responsibilities in the delivery of health services to the military, the federal penitentiaries, and indigenous people. Yet, under section 12.1 of the first nations non-insured health benefits, when people are dying and have to be taken out of a reserve for palliative treatment, their loved ones are not allowed to go with them.

It says in federal regulations that the first reason to deny loved ones to be with their spouse at the end of life is compassion. Compassion is the number one rule for denying loved ones a chance to have palliative care. If the Liberals are serious about ending these cruel choices, they will tell that health minister to change the wording in the health guidelines now, so loved ones are never separated at the time of death.

[Arif Virani, Liberal, Parkdale—High Park, ON]

Mr. Speaker, as we have indicated, the palliative care financial allotments do not appear in this discreet legislation. The member has raised an issue about whether they should have appeared in the budget. I can assure the member that we are working to renew a lapsed agreement called the Canada health accord, with which the member for Timmins—James Bay will be very familiar.

The previous government simply allowed that to lapse. We do not believe in governing in that manner. We believe in engaging with provinces and meeting with them to understand their needs, and to address them going forward in a robust manner that is consensual, two-way, and that provides the financial supports that are needed by the provinces and territories.

With respect to first nations palliative care in particular, and the very particular issue that the member for Timmins—James Bay has raised, I think it is an important issue. Obviously more important than the issue we are dealing with discreetly here is repairing a woeful and shameful record in respect of first nations peoples, which has existed for generations.

We see that reflected in every mandate letter provided to every cabinet minister by the Prime Minister. That is something on which we are actively working. We have had robust debates about mental health in particular communities, including the community the member represents. However, that is only one part of a broader piece that needs to be addressed.

I look forward to working closely with the member going forward about how to address compassionate care and palliative care, in particular for first nations people, as part of our duty of care to first nations.

[The Deputy Speaker, Conservative, Bruce Stanton]

Before we resume debate, I get the sense, especially given the nature of the debate today, of the need for time for members to explain points in questions that they might pose to a speaker who has just presented. We are doing our best. In the five-minute period, it is very difficult to pose much more than two questions and receive their responses. If members make their interventions more concise, obviously more members can participate, but in all honesty and as the presiding officer, the last thing we want to do is cut people off.

We will be as judicious as we possibly can, but if members are able to be concise in their interventions, it would help their colleagues to have more opportunities to pose questions in the five-minute period.

Resuming debate, the hon. member for Saint-Hyacinthe—Bagot.

[Brigitte Sansoucy, NDP, Saint-Hyacinthe—Bagot, QC]

Mr. Speaker, first of all I would like to say that I will be sharing my time with my colleague from Kootenay—Columbia.

Medical assistance in dying is definitely one of the most important social issues our country and our Parliament will face and have faced in a long time. There is no doubt in my mind that this is the most delicate issue that our Parliament will have to deal with.

I would like to say that I will be supporting this bill at second reading stage even though I feel that we need to amend it.

We have known from the beginning that the NDP will have a free vote on this personal and delicate issue. Therefore, we are not seeking a consensus, but rather we want to continue consulting our constituents and the many experts studying this issue in order to determine what would be the best bill to reflect Canadians' rights.

It is important that we clarify the bill we are studying because it leaves room for interpretation and, above all, it contradicts the Supreme Court's ruling in the Carter case.

We will debate the necessary amendments in a non-partisan manner, but it is important for everyone here in the House to remember why we are voting on this issue. The issue at hand is not whether we are for or against medical assistance in dying. The Supreme Court of Canada was very clear that medical assistance in dying is a charter right. We are here to debate the bill and ensure that it reflects the Carter decision and does not leave anything open to interpretation.

As I just said, the Supreme Court unanimously ruled that competent Canadian adults who are suffering intolerably as a result of a grievous and irremediable medical condition have the right, under the charter, to medical assistance in dying.

The Supreme Court mandated our Parliament, and also the provincial legislatures, to pass legislation that is compatible with the Supreme Court's decision. This decision sent a strong message to update our laws, which are meant to protect vulnerable people and also the health care professionals who help them.

It is important not to politicize this issue or deal with it in a partisan manner. It is also important not to reduce this major issue to a pro-life and pro-choice debate since we know that debates like that can be never-ending.

I am very proud to have been a member of the Special Joint Committee on Physician-Assisted Dying. I worked on that committee with my colleague from Victoria, and I would like to sincerely thank him for his expertise, experience, and wealth of knowledge on this issue. This was my first experience with committee work. I would therefore like to thank him again, along with all of the committee members and the staff who assisted us. It was a privilege for me to be part of that committee because it gave me the opportunity to carefully study the Supreme Court's decision in this regard, and the provincial court decision that preceded it. We also carefully considered the laws in Quebec. I am very proud of the role that Quebec has played in leading the way on this sensitive issue. We also considered legislation from countries around the world.

Our committee reviewed two major studies, which together heard from over 13,000 people and more than 100 organizations. We held 11 hearings.

Sixty-one expert witnesses shared their work with us. Since February 6, 2015, the day of the Supreme Court ruling, every medical organization in the country and every organization that represents people with illnesses or health care professionals has given this sensitive issue very careful consideration. Those speaking on behalf of doctors told us how they were trained up until February 6, 2015. Their careers were based on the duty to heal. Since February 6, 2015, they have become aware that their role is now also to help people avail themselves of their right to seek medical assistance in dying.

During the committee's work, I made a point of meeting with all of the organizations in Saint-Hyacinthe—Bagot with an interest in this issue. I met with representatives of organizations for people with disabilities, user committees, institutions, medical institution representatives, and an organization that works with bereaved families and supports people at the end of their lives. I shared the committee's thoughts with them. I also had a meeting with all of these stakeholders to discuss our committee's report. Everyone who is directly involved in this issue and deals with it on a daily basis was very comfortable with our recommendations.

The role of the committee was to take advantage of this unique opportunity to reflect on all of the aspects of physician-assisted dying. Of course, we know that the government will not take all of our 21 recommendations into account in its bill. As the parliamentary secretary was saying, we do not have a lot of time. However, we should be considering all aspects of this issue. We made one recommendation that generated a lot of questions, our recommendation on mature minors.

Some witnesses told us that, for years, they have been helping young people around 16 or 17 years of age who have lived with incurable diseases for a long time and that those young people achieved a degree of maturity that very few adults achieve over the course of their lives.

Of course, after hearing this sort of testimony, we cannot close the door on that aspect of the issue. We cannot move forward with it now, because studies need to be done. One of our recommendations was that the necessary studies be conducted according to a certain timeline. We should not wait for these young people to end up before the Supreme Court.

As I said, the legislation leaves too much room for interpretation. I believe that, as parliamentarians, we have the duty to ensure that people who are sick do not have to continue to go before the courts to defend their right to physician-assisted dying.

Lawyers told us that we could consider the Carter ruling as a floor. That is what we, as MPs, chose to do. The Conservatives are saying that the Carter ruling should be considered a ceiling. The Liberals decided to go below the Carter ruling and down into the basement with their provision on reasonably foreseeable natural death, and that needs to change.

The Liberals keep telling us that $3 billion has been promised for palliative care. That is only a promise. There was nothing about it in the budget. However, all of the witnesses spoke about palliative care. Everyone in my riding has talked to me about it too. The important thing is to work for the best interests of all Canadians and to allow them to die with dignity.

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

Mr. Speaker, with respect to the importance of palliative care, the member referenced that we heard from the government, not only in recent weeks, but for a number of months, in terms of its commitment to palliative care. It is a very important part of the debate, no doubt, and as we continue to debate, a very emotional piece of legislation about which we are all very opinionated. However, one of the things that is very important for us to recognize, when we talk about palliative care, is that there are many different stakeholders—in particular, provinces, first nations, and so forth—that need to play a critical role in the development of palliative care policy.

I wonder if the member might want to provide some comment, from her perspective, as to how important it is that Ottawa work with the different stakeholders to ensure that we do provide the type of palliative care that Canadians from coast to coast want to see?

[Brigitte Sansoucy, NDP, Saint-Hyacinthe—Bagot, QC]

Mr. Speaker, we must go much further. The federal government must provide leadership on palliative care. It is all very well to promise $3 billion and to promise to talk about it, but there was no money in the last budget to initiate discussions with the provinces and carry out the necessary studies.

I held consultations in my riding, which has one of the largest long-term care facilities in Quebec. For hundreds of seniors, there are only 12 palliative care beds in that institution. That is clearly inadequate. It is not enough to promise $3 billion. There has to be money in the budget, and the government has to get to work on this right now.

[Garnett Genuis, Conservative, Sherwood Park—Fort Saskatchewan, AB]

Mr. Speaker, I thank the member for her remarks.

The member for Parkdale—High Park, I believe it was, is quite correct to say that this legislation would create one of the most permissive euthanasia regimes in the world. That is certainly what I understood him to say, and I think that would be quite correct.

We are limited to some extent, obviously, by the legal environment we are in. However, my concern is that this does not contain the safeguards we need to ensure that there are precautions in place so that someone who took someone's life without consent would be effectively prosecuted.

I want to ask the member if she would support my proposal to remove the reasonable, but mistaken, provision within this bill. I think that would be a substantial improvement.

The bill right now says that people could avoid prosecution if they have a reasonable, but mistaken, belief that someone consented. This would allow people to take the life of a person who did not consent and, yet, escape prosecution if they could at least show, beyond a reasonable doubt, that they had a reasonable, but mistaken, belief.

Would the member support removing that very concerning section, in order to ensure that vulnerable people are protected?

[Brigitte Sansoucy, NDP, Saint-Hyacinthe—Bagot, QC]

Mr. Speaker, the clause on natural death that is reasonably foreseeable is the most contentious clause in this bill.

Yesterday, Quebec's health minister, Gaétan Barrette, said that the courts would quickly strike down this clause. He even called on doctors to rely on Quebec's law rather than the federal law as drafted. We have a duty to ensure that the law is clear.

In recent weeks, some Quebeckers have starved themselves to death while trying to become eligible for medical assistance in dying. That has to stop. People have to be able to decide to die with dignity. Our law must allow it.