This bill was last introduced in the 42nd Parliament, 1st Session, which ended in September 2019.
Jody Wilson-Raybould Liberal
This bill has received Royal Assent and is now law.
This is from the published bill. The Library of Parliament often publishes better independent summaries.
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.
All sorts of information on this bill is available at LEGISinfo, an excellent resource from the Library of Parliament. You can also read the full text of the bill.
Pierre-Luc Dusseault NDP Sherbrooke, QC
Mr. Speaker, I would like to thank my colleague for her work on this issue.
Could she talk about access to medical assistance in dying for all Canadians, no matter where they live in Canada, as it is now a right protected by the charter as a result of the ruling?
Brigitte Sansoucy NDP Saint-Hyacinthe—Bagot, QC
Mr. Speaker, the issue of access to medical assistance in dying is indeed crucial. Since it is a right, of course it must be accessible. That is why it is important to extend this capacity to other health care professionals.
When it comes to assessing eligibility for medical assistance in dying, physicians take care of that. The riding I represent is 50 kilometres from the nearest urban centre, and some of my constituents do not have access to a doctor. It is therefore important to allow other health care professionals to help people exercise their right.
Wayne Stetski NDP Kootenay—Columbia, BC
Mr. Speaker, I rise today to speak to Bill C-14, an act to amend the Criminal Code and to make related amendments to other acts related to medical assistance in dying.
I support the bill at second reading. However, it does need to be amended.
I will start today with a story. Some years ago, my wife Audrey and I adopted a beautiful sable sheltie dog by the name of Princess Diana of Cornwall. She was named at a time when we lived on Cornwall Drive in Port Coquitlam, and the world was abuzz with a royal wedding involving two people named Charles and Diana.
Princess was a great dog. Unfortunately, when she was about 11 years old, she developed cancer. We were already living in our current home city of Cranbrook, located in the Rocky Mountains area of British Columbia. As the cancer progressed, Princess was living with more pain and discomfort. We consulted our local vet regularly. One day he told us that she was terminal and in a lot of pain and he thought the best thing we could do for her was to end her suffering. He asked us to bring her back the next day. We took her home to say our goodbyes, and the next day I brought Princess back to the veterinarian. He asked me if I would like to leave her with him or whether I would like to stay. I said I would stay. I held her in my arms and watched the needle go into her paw. She lay down and died in my arms. As I stood there with tears in my eyes, I thought that if I were ever in intolerable pain from an incurable disease, this is how I would want to leave this world, with a needle in my paw, lying in the arms of someone I love. I personally became a believer in physician-assisted suicide right there 20 years ago.
I am not suggesting that the death of a pet and that of a human are equivalent, though they certainly can feel much the same, as many who have loved a beloved pet will know. We need to take even more care that we have it right when we are talking about euthanasia through a human lens.
As members know, in February 2015, a unanimous Supreme Court ruling established the charter-protected right of competent adult Canadians who are experiencing enduring and intolerable suffering as a result of a grievous and irremediable medical condition, including a disease, disability, or illness, to access medical assistance in dying. We in the NDP are committed to implementing the Supreme Court order decision with balance and sensitivity, respecting the autonomy of patients, the rights of health care practitioners and vulnerable individuals, and the fundamentally personal nature of this issue to every Canadian; in other words, we need to get this legislation right.
Last week, when I was back in my riding of Kootenay—Columbia, I met with Bendina Miller, the past president of the Canadian Association for Community Living. The CACL was one of the main supporters of the vulnerable persons standard, the purpose of which is to protect the vulnerable in Canada, as Bill C-14, medical assistance in dying, moves forward. While the CACL believes that the bill in its current form takes appropriate steps toward addressing the vulnerability of people living with a disability, it believes some improvements are required to meet the Supreme Court's intent that the legislation must provide fair access to assisted death and also protect vulnerable persons who may be influenced or induced to use the system to die.
The Canadian Association for Community Living recommends five areas of substantive amendment to this draft bill. I will summarize them here.
First, Bill C-14 should be amended to extend the current requirement for judicial oversight until such time as a study of the merits and implications of the bill allows them to be clearly understood.
Second, included in the bill should be an explicit legal requirement to identify, explore, and record the sources of a person's suffering, and an attempt to address the motivations of his or her request for death.
Third, Bill C-14 should be amended to meet the requirements of the Carter decision and should specify that a voluntary request for medical assistance in dying cannot be made as a result of external pressure or any form of inducement.
Fourth, Bill C-14 should be amended to specify that the minister “will” make, not “may” make, regulations regarding the mandatory reporting of information about requests and the provision of assisted dying.
Fifth, it should mandate a palliative care or other professional evaluation to ensure patients' rights to informed consent by having information about the full range of available treatments and supports that could ease their suffering.
The bill should not proceed without an enhanced national palliative care strategy, which is clearly missing in the Liberal government's 2016-17 budget.
Back in November, I had the pleasure of meeting new members of Parliament from all of the parties represented here in the House, except the Green Party. I was struck by how consistent the words were from all of my colleagues. They said they were here to work collaboratively to build a better Canada. It was very encouraging for me as a new MP, because that is also why I am here.
When I am back home in my riding sharing with my constituents what we are doing here in the House, I tell them that we are working on three bills in particular that would fundamentally change Canada, going forward: first of all, proportional representation voting; second, legalizing marijuana; and third, physician-assisted suicide.
This is the first of those three bills to come to the House for debate and further study, and we need to work together collaboratively to build a better future for Canadians. The bill would do three things: maximize one's willingness to live through expanded palliative care, ensure that our vulnerable citizens are protected, and give our citizens the Supreme Court assured right to choose to die in the arms of someone who loves them, if they are experiencing enduring and intolerable suffering as a result of a grievous and irremediable medical condition.
Let us amend the bill collaboratively and give Canadians the best possible outcome on this very important and emotional issue.
Criminal CodeGovernment Orders
May 2nd, 2016 / 4:35 p.m.
See
context
Spadina—Fort York Ontario
Liberal
Adam Vaughan LiberalParliamentary Secretary to the Prime Minister (Intergovernmental Affairs)
Mr. Speaker, I thank the member for his considered remarks to the House, but I did not hear a reference to the notion or the concept of advance consent. I am curious as to whether he has thoughts on that issue and how those concerns may be addressed in the parliamentary process as this bill moves through committee.
Clearly, some of the other areas we understand as areas that need to be questioned and explored by committee. We accept that and think it is a good legislative process. However, I did not hear those remarks, and I am interested to hear the member's thoughts on that.
Wayne Stetski NDP Kootenay—Columbia, BC
Mr. Speaker, absolutely, I think that is missing from the current version of the bill. I think it is really important to give Canadians the opportunity for an advance declaration of what their wishes are, particularly if they know their disease is leading to a condition where they will not have the ability to make that decision themselves later on. Therefore, I do think that should be in the bill.
Garnett Genuis Conservative Sherwood Park—Fort Saskatchewan, AB
Mr. Speaker, I want to pick up on the question of advance consent, because it has come up a number of times today.
What we heard from the special committee, at least from those who are involved in health care or represent those who are involved in health care, is that it is very difficult to have an advance directive about a very hypothetical situation in which a people do not actually know how they will experience what they will be going through. With an advance consent provision, one may end up with a situation where someone, who at the present time does not want to die, still has their life taken because of something they wrote down earlier, and they may be experiencing those events differently from how they expected.
I want to ask the member specifically with regard to sexual consent. We have a very clear understanding that a person cannot consent in advance. There has to be contemporaneous consent in the context of sexual consent. Therefore, why would we have a different and lower standard for someone consenting to die than for someone consenting to engage in sexual relations?
Wayne Stetski NDP Kootenay—Columbia, BC
Mr. Speaker, I really do not think it is a lower standard. If we have the opportunity to declare our intent ahead of time and put it in writing, that at least gives us some opportunity to have some say over our future. If we reach the point where we cannot consent and we cannot not consent, and then we have no options at all. Therefore, at least having an opportunity to declare our wishes ahead of time is an improvement over not having any choice at all.
Harold Albrecht Conservative Kitchener—Conestoga, ON
Mr. Speaker, I really hesitated getting up to ask this question, but my colleague, and I respect him and his work, inferred some similarity between the loss of a pet and the loss of a loved one, a human. I have lost lots of pets over the last 60 years, and yes, I have shed some tears, and I have had this kind of experience. However, to infer that there is even a 1% similarity between losing a pet and losing a family member I think misses the point.
I watched my mother and dad approach death. I watched a brother, who lay unconscious for a month in hospital on life support approach death and die. Five years ago today, my wife suffered an intracranial hemorrhage and two days later passed away. However, not in one of those situations, not in one of them, would I have wanted to end their lives one day earlier.
We need to realize what suffering can teach us as we walk alongside those who are suffering and enter into their suffering. That is what it means to be human. My concern is that if we lose the drive to walk with those who are suffering and lose the commitment to actually do something about palliative care and provide good care for those who are suffering, we are really missing the boat.
I would like my colleague to comment on the lack in the budget of actual hard commitment to really get on with palliative care.
Wayne Stetski NDP Kootenay—Columbia, BC
Mr. Speaker, let me repeat what I said during my speech. I am not suggesting that the death of a pet and the death of a human are equivalent.
We need to take even more care that we get it right when we are talking about euthanasia using a human lens. I absolutely agree that palliative care is critical. We need to make sure that we have a national palliative care strategy to go along with this, but they need to go hand in hand if they are to move forward at all.
The story I told was what convinced me that if I had a choice, I would choose to die with dignity.
Sean Casey LiberalParliamentary Secretary to the Minister of Justice and Attorney General of Canada
Mr. Speaker, it is my honour to stand to speak in support of Bill C-14, a significant piece of legislation that would allow for the first time in Canadian history the provision of medical assistance in dying across the country.
I believe Bill C-14 directly and thoughtfully responds to the Supreme Court of Canada decision in Carter. This legislation would strike a careful balance between the autonomy of competent adults whose deaths are reasonably foreseeable to seek medical assistance in dying and the protection of vulnerable people through careful tailoring of the eligibility criteria and robust safeguards that are essential to prevent error and abuse.
As recognized by the Canadian Medical Association before the Special Joint Committee on Physician-Assisted Dying, one cannot underscore enough the significance of this sea change in Canadian medical practice and Canadian society as a whole.
At present, there are eight jurisdictions in the world, in addition to Quebec, that have adopted precise legal rules on medical assistance in dying: four U.S. states, Colombia, and the European countries of Belgium, the Netherlands, and Luxembourg.
The international community is is looking at Canada's leadership on this issue right now, and I commend all hon. members on both sides of this House for their invaluable contributions to this complex and sensitive debate.
Bill C-14 would establish the criminal law rules regarding medical assistance in dying that address issues including eligibility, procedural safeguards, and the framework for a pan-Canadian monitoring system. In addition to the comprehensive legislative response proposed in Bill C-14, the government would undertake independent studies into three key issues that the Supreme Court declined to address in Carter: eligibility for persons under 18, advance requests, and requests for medical assistance in dying solely on the basis of a mental illness.
Allow me today to provide all members with further clarifications on the eligibility criteria included in Bill C-14 and how they respond to the Carter ruling, a question that has been asked numerous times since the bill was introduced.
Under Bill C-14, medical assistance in dying would only be available to mentally competent adults: one, who have a serious and incurable illness, disease or disability; two, who are in an advanced state of irreversible decline in capability; three, who experience enduring and intolerable physical or psychological suffering as a result of their medical situation; and four, whose natural death has become reasonably foreseeable taking into account all of their medical circumstances and without requiring any specific prognosis as to the length of time that they have remaining.
I would emphasize that those are the exact words of the legislation, because there has been some incorrect reporting on what is actually required. It is also important to remember that the criteria must not be read in isolation. Each element mutually informs the meaning and scope of the others. They work together to create a clear picture.
Some people wonder what reasonable foreseeability of death means given that everyone's death is reasonably foreseeable in the sense that death, like taxes, is inevitable for all of us. Bill C-14 expressly states that the person's natural death has become reasonably foreseeable, which clearly indicates that a change in the patient's medical circumstances is required. The patient is now on a path toward death, but previously he or she was not. A healthy person's death is not reasonably foreseeable unless the person experiences a change in his or her medical circumstances.
Mr. Speaker, at the outset of my remarks, I neglected to inform you, but I do now, that I will be sharing my time with the esteemed member for Fredericton.
The concept of reasonable foreseeability is also well known in law, and assessment depends on the context. In the context of medical assistance in dying, it would require a real possibility of the patient's death within a period of time that is not too remote from circumstances that can be predicted within a range of reasonable possibilities. Again, the legislation expressly states that a specific prognosis as to the time the patient has remaining would not be required. Because everyone's trajectory toward the end of life would be unique, this criterion was carefully crafted to provide maximum flexibility to medical practitioners so that they may assess the overall medical circumstances of a patient on a case-by-case basis. The overall medical circumstances, as opposed to any particular type of condition, are what matters when the objective is to give Canadians the option of a peaceful medically assisted death instead of having to endure a prolonged or painful one.
As recognized by medical standards and guidelines on prognostic indicators, there are many factors that may contribute to a patient's being assessed as approaching the end of life, including the presence of an advanced, progressive, and incurable disease, but also completely different factors, such as age, the general frailty of the patient, and risks of death from complications of other conditions that may not be fatal on their own, but which can jeopardize the life of someone who is otherwise weakened.
As recently recognized by the Canadian Medical Association, the requirement that natural death has become reasonably foreseeable would provide clearer guidance than the court's use of “grievous and irremediable” in that it would indicate , and I quote the CMA representative, that the condition should be “towards the end of the spectrum”, but does not mean “terminal or that death is immediately on the horizon”.
If we consider the Carter ruling itself, the Supreme Court expressly stated that the scope of its declaration was intended to respond to the factual circumstances of the case, and that it made no pronouncement on other situations where physician-assisted dying may be sought. Bill C-14 would directly respond to the factual circumstances of both Kay Carter and Gloria Taylor, who were both in decline and suffering while on a trajectory toward the end of their lives without it being certain when exactly they would die.
The Supreme Court did not define the term “grievous and irremediable medical condition”. It rather acknowledged that it was Parliament's task to weigh and balance the perspective of those who might be at risk in a permissive regime against those who seek assistance in dying. This is exactly what Bill C-14 does. It defines eligibility in a manner that is consistent with the Carter ruling read in its entirety, and provides necessary clarity on the assessment of eligibility.
Some have expressed concern over the lack of express protection for conscience rights of health care providers. The legislative objectives of Bill C-14, which are clearly stated in its preamble, include respecting the personal convictions of health care providers while also recognizing the provinces' jurisdiction over various matters related to medical assistance in dying. Balancing the interests of medical practitioners and those of patients is such a matter. Importantly, nothing in Bill C-14 would compel health care providers to provide any assistance that may be contrary to their conscience rights. More important than legal protections in a statute book are the concrete and practical actions that are directly aimed at supporting conscience rights of practitioners. In this regard, the Minister of Health has offered to work in collaboration with the provinces and territories on the development of an end-of-life care coordination system to help respect the providers' conscience rights while facilitating patients' access to care including assistance in dying.
Some have expressed concern that the safeguards in the bill are not sufficient. The proposed safeguards are generally consistent with and perhaps even a little stronger than the safeguards found in other medical assistance in dying regimes around the world.
The trial judge in Carter considered voluminous evidence on the efficacy of these regimes, and the evidence persuaded her that the risks to vulnerable people could be adequately managed under such systems. We are equally confident that these safeguards would guard against abuse and error.
I believe the proposed legislation is the right way forward on medical assistance in dying for Canada at this time and is a principled response to the Carter decision. I would urge all members to support second reading of Bill C-14.
Martin Shields Conservative Bow River, AB
Mr. Speaker, I appreciate the presentation on the debate today. One of the areas I am concerned about with the bill is that in rural Canada it can be a challenge to identify two physicians or two nurse practitioners. Outside the large urban areas there are a smaller number of doctors and often not even a nurse practitioner. Even if we had those four, it would quickly become identifiable who those people were, and that could be a severe challenge in rural communities. The only other alternative then is referrals. Again, those are the people who become the referral that people go to.
That is a question I have with this legislation. I am very concerned about the limited number of medical people who would have to be involved in this process outside the major urban centres.
Sean Casey Liberal Charlottetown, PE
Mr. Speaker, it is that very concern that was borne in mind when the decision was made to extend the exemption with respect to medical aid in dying to nurse practitioners. We see more and more in the country, with doctors being abundant in major centres and not so much outside of major centres, that much of the load has now fallen to nurse practitioners. That is the very reason why they are included.
Access is important with respect to any charter right. The member raises a very valid concern and the specific attempt to address it is with respect to the inclusion of nurse practitioners.
Georgina Jolibois NDP Desnethé—Missinippi—Churchill River, SK
Mr. Speaker, I have a question about access to adequate medical services and access to nurse practitioners or doctors. Where I come from, in my riding, most reserves and communities do not have that privilege when we talk about the national palliative care strategy. I am very concerned because where I come from we do not even have access to a nurse. How can the government ensure that we can have this meaningful discussion in a broader context to help people die with dignity?
Sean Casey Liberal Charlottetown, PE
Mr. Speaker, clearly, the last two questions point out the unevenness of access to medical services right across the country.
Today in Parliament we are debating an act to amend the Criminal Code. The government's response to the Carter decision was both legislative and non-legislative. The legislative measures are the ones we are debating now, but in terms of non-legislative measures, there is a commitment of $3 billion in home care, a significant part of which would be palliative care.
This legislation alone would not resolve the inequality in access to medical services across the country. We acknowledge that. It cannot do that. That is something the government has to continue to strive to accomplish through the negotiation of the health accord and through working with provinces for a palliative care strategy and for medical coverage in rural and remote areas.
Nick Whalen Liberal St. John's East, NL
Mr. Speaker, I would like to thank the member for his comments and reasoned commentary on this.
I had the good opportunity of having a round table last week with the Newfoundland and Labrador coalition of pensioners and seniors associations. To a person, they were favourable of the approach we have taken with this legislation. There was one issue that really hit to the crux of what they felt might be far enough or not far enough in the legislation. That was with respect to advance care directives. They also had a concern with respect to determining in advance whether or not one's condition would become intolerable. They were also concerned about the ability of provinces to have appropriate registries in place to handle that type of medical care.
I would ask the member if he agrees that this integrative approach of going incrementally toward medical assistance in dying is the proper way to go, or if he feels we should go even further at this stage.