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

[Gérard Deltell, Conservative, Louis-Saint-Laurent, QC]

Mr. Speaker, unfortunately, no legislation could have prevented that type of situation. We have to realize that.

There is not much we can do about people who are in utter despair. It would be nice to pass legislation asking them not to starve themselves in order to access this care. That goes without saying, but it will not stop those who are in the darkest days of their lives and feeling so vulnerable that they would go to such lengths. Should we pass such legislation? It is too hard.

It is on all of us as parliamentarians. We have certain responsibilities, but we must also work within certain boundaries, including our conscience, which is part of being human. That is why we must protect the most vulnerable among us. That is why this will not apply to minors and especially not to those suffering from mental illness. Those people are far too fragile.

If I said that this could prevent unintended consequences, I would be lying, unfortunately, because we cannot control human nature. We can try to limit them, but preventing them completely is wishful thinking.

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

Mr. Speaker, I want to follow up on the question from the member for Mount Royal about jurisdiction and conscience, because it is a very important question. In fact, the Carter decision recognizes health care as a joint area of jurisdiction, so it is very clear that there is involvement of the federal jurisdiction. Also, it is important to acknowledge the parallels to the same-sex marriage debate and what the then Liberal government did in the Civil Marriage Act with respect to protecting the conscience of religious officials who did not want to perform same-sex marriages. It was important at the time, as part of that debate, to ensure that nobody would be forced to perform that union, a religious official who did not want to. It was put in that legislation, even though the solemnization of marriage is done at the provincial level.

We see a clear parallel, and if it was doable then by a Liberal government, there is no reason not to include conscience protection in this legislation as well. Very similar language could in fact be used in the development of the amendment. That is important. It is something worth considering when we have a major social change like this. Some people will want to be part of that change, but others will not want to be part of that change, and we should respect those who do not want to be part of that change.

I wonder if the member sees a parallel between these two debates and would support including a similar provision in this law, as the previous Liberal government did in the Civil Marriage Act.

[Gérard Deltell, Conservative, Louis-Saint-Laurent, QC]

Mr. Speaker, I will speak to what I know. I am very familiar with the issue of medial assistance in dying and end-of-life care, as I took part in drafting the two applicable statutes. I can say that in extremely sensitive and fragile cases, we have to respect the doctor. I personally received calls from Quebec doctors about this. They told me that they were there to save lives and what they were being asked to do goes against their long-held beliefs. They agreed to do it, but we have to realize that doctors are ultimately there to save lives.

[Lloyd Longfield, Liberal, Guelph, ON]

Mr. Speaker, the hon. member has an excellent approach to the subject. It is definitely something very personal for each of us. I know myself, with my mother's passing, we had some very difficult conversations at that time.

This goes beyond what we do in the House here. However, one of our responsibilities is to provide guidelines for the conversations.

Let us look at the role the provinces play in this conversation. I was personally struggling with recommendation 11 from the committee, as a member of a Catholic community within my riding and having a lot of Catholics reporting to me that they were very concerned about Catholic institutions being mandated to perform services against their conscience.

The current legislation is leaving some very important details up to regulations with the provinces and those who are reporting to the provinces. We have a tight timeline. We have to provide some guidelines that may be seen by some as not restrictive enough and by others as too restrictive.

Could the hon. member comment on the need to have some flexibility in terms of getting this to the provinces for further discussion?

[Gérard Deltell, Conservative, Louis-Saint-Laurent, QC]

Mr. Speaker, based on the Quebec experience, we have to have conversations with each other. We need to have good conversations with the provinces. We had that in Quebec.

The member talked about his personal experience, as did his colleague a few minutes ago. I want to say that everyone has the right to act on behalf of their own conscience.

In Quebec, I voted for the law. I voted for the bill. However, 22 members of the National Assembly voted against it, all members of the Liberal Party, the governing party. Among them, 11 cabinet ministers, nearly half of the cabinet ministers, voted against that bill.

I do not want to interfere with everyone.

However, every member has to know that he or she is entitled to vote their conscience and that every vote is important, every vote is good because it is the vote of each individual member.

[Julie Dabrusin, Liberal, Toronto—Danforth, ON]

Mr. Speaker, I rise today to speak to Bill C-14 regarding medical assistance in dying. This is not the first time I have had the honour to participate in the discussion of this matter as a member of Parliament. I also was a member of the Special Joint Committee on Physician Assisted Dying. As a member of that committee, I was able to hear the thoughts of many people, both in my riding of Toronto-Danforth and across the country, on this very important issue that affects us all, and that is our end-of-life care.

My preference would have been for a bill that would have allowed for a broader scope of application. However, I support this legislation because it is a first step in the right direction, and it was a commitment to study the important issues of age, mental health, and advance directives, as will become apparent as I speak further. We need to take this first step, because this file has been left to languish for too long. My step would have been a bit bigger, but I am ready to start here on this path of incremental change.

Mr. Speaker, I intend to share my time with the member for Hamilton West—Ancaster—Dundas.

To date, we have struggled with the question of whether to allow, or not, medical assistance in dying. However, now we are faced with a different question, specifically, how we are going to legislate that assistance. This is an important change for us to consider, because following the Supreme Court of Canada decision in Carter, medical assistance in dying will be legal as of June 6. This bill is important because it gives us the opportunity to create a federal framework to govern medical assistance in dying.

In 1983, the Law Reform Commission of Canada reported on “Euthanasia, Aiding Suicide and Cessation of Treatment”. It found three basic principles reflected in our law, and I find that these principles set a good basis for our debate. The first is that the protection of human life is a fundamental value. The second is that patients have the right to autonomy and self-determination in making decisions about their medical care. The third is that human life needs to be considered from a quantitative and qualitative perspective.

I find it particularly instructive that the second principle creates a basis for a patient-centred approach to medical assistance in dying. This was the approach adopted by the Special Joint Committee on Physician-Assisted Dying on which I served.

Looking at the history of this issue, I have traced a long path of private members' bills, Senate bills, and private motions in the House. The issue has been before us approximately 11 times since 1991. The list of past attempts on this issue is incredible and demonstrates that efforts that have been made to grapple, unsuccessfully, with this issue have continued for too long. It is why I find it so important for the House to cross over this impasse and to take the first step toward legislating a framework.

The issue has not only been before us here. The other place has also considered the matter in committees, subcommittees, and bills. Just over 20 years ago, the Special Senate Committee on Euthanasia and Assisted Suicide released its report “Of Life and Death”.

The goal of that committee was to set the stage for the national debate that would take place in the years to come. The majority of senators on the committee were not ready to support medical assistance in dying. The minority on that committee made some recommendations to support medical assistance in dying for an individual who was competent and suffering from an irreversible illness that had reached an intolerable stage, as certified by medical practitioners.

Over the weekend, I finished reading the Hon. Steven Fletcher's book, Master of My Fate, which outlines his experience as a parliamentarian, generally, but focuses upon private members' bills that he brought on the issue of medical assistance in dying. The book brought special insight into his journey on this question. He shared his story of the massive accident that rendered him quadriplegic and his election to the House, including the time he served as a cabinet minister.

Our most recent initiative in the House on the issue of medical assistance in dying was two connected private members' bills put forth by the Hon. Mr. Fletcher. The first, Bill C-581, proposed to amend the Criminal Code to permit a doctor to assist a person in taking his or her own life. The eligibility criteria proposed in the bill would track the language in Carter very closely. I will read the most salient eligibility criterion for the sake of the House:

...a person must...have been diagnosed by a physician as having an illness, a disease or a disability (including disability arising from traumatic injury) that causes physical or psychological suffering that is intolerable to that person and that cannot be alleviated by any medical treatment acceptable to that person, or the person must be in a state of weakening capacities with no chance of improvement...

His other initiative, Bill C-582, proposed to establish a Canadian commission on physician-assisted death, which would have collected data from physicians who performed physician-assisted death. It recognized the possibility for incremental steps.

The bills were read a first time and left to languish on the Order Paper. However, on December 2, 2014, similar legislation was introduced in the other place and was debated on seven occasions, as late as June 2, 2015.

As we all know, during that time frame of December 2, 2014, to June 2, 2015, the Carter decision was released.

It is also worth noting that there have been active discussions in our provinces and territories about a framework for medical assistance in dying. The most notable example is Quebec, which struck a committee in 2009 to develop legislation on medical assistance in dying. The legislation came into effect in December of 2015. Much has been said regarding that law, and I will not repeat it, but it is notable that they too have a terminality provision.

I found it interesting that in testimony before our committee, Jean-Pierre Ménard of the Barreau du Québec stated that he believed the terminality clause of the Quebec legislation would have to be removed in light of the Carter decision. It underscores the point that such legislation will develop through incremental changes.

Working on the joint committee was an amazing experience. It was the first special joint committee in 20 years, and I see a strong value to this form of collaboration on major issues. The witness testimony and the thoughtful written submissions gave us a strong base upon which to form our recommendations. I stand behind the recommendations that we made. We did not come to our decisions easily. We lost sleep, debated a lot, and worked together to formulate our recommendations.

How then does my background on this file inform my views of the legislation we are debating today. I would have preferred that it would be broader. Most of what I have heard from my own constituents favours a broader approach. However, the bill is the first step into a complicated matter.

We need to empower individuals to choose how to manage the end of their lives and give value to the law reform commission's idea of a patient centred approach. Also, we need to consider not only the quantity of life but the quality. We need to respect people's autonomy and their right to be free from suffering, without putting vulnerable Canadians at risk. Bill C-14 gets us much closer to that goal than we currently find ourselves.

I would have preferred that we remove the clause of a reasonable and natural death, which refers to the foreseeability of a natural death. It is a terminality clause of sorts. The clause is vague and could place an overly broad restriction on a sick person's right to be free from pain and suffering. The concern about this terminology is that it tends to devalue the lives of the oldest among us. They are the most likely to be given permission to seek medical assistance in death with the legislation.

The young and sick suffer as much as the elderly. To quote Steven Fletcher “If the person is a cognitive adult, why on earth would we impose our views on what their quality of life is on them?”

The lack of advanced directives in the legislation is also too restrictive. A fundamental point of the Carter decision was that the Supreme Court of Canada had found a violation of “Life, Liberty, and Security of the Person” if individuals would feel they would have to cut their lives short because they did not have an expectation that they could end it later when the time would come. It is a tricky issue, but I am happy to see a commitment to study the issue further.

In my opinion, the positives of the bill outnumber the negatives, so I will be supporting the bill. However, I do see it as a first step on the journey.

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

Mr. Speaker, I want to thank my colleague for her service on the joint parliamentary committee that studied physician-assisted dying.

My colleague referred many times to my former colleague, Steven Fletcher, who appeared before the committee. I have had many conversations with him, and I understand his position. However, my concern is that had Mr. Fletcher had access to physician assisted suicide years ago when his accident first occurred, he very well may have followed through. That would have been a huge loss for Canada and for his family.

My concern is that when we implement these kinds of decisions, there is always the risk of one person inadvertently terminating his or her life, which would be a huge loss. We no longer practice capital punishment in Canada. One of the reasons is that it is too great a risk that one innocent person might die.

How would my colleague ensure that someone like Mr. Fletcher, who in a time of deep depression and deep physical suffering, may have taken the choice that would have hurt him and all of Canada because of the loss of his life and his contribution to our country?

[Julie Dabrusin, Liberal, Toronto—Danforth, ON]

Mr. Speaker, I would rather not speak about an individual specifically when I respond to my friend, because I cannot predict what his decisions may or may not have been if this legislation had been in place.

To speak more generally, I understand the point the member is raising. It was a question that was a concern to me and the committee as well when we examined the issue of a person who suffered a traumatic injury and was faced with a change of circumstances. How would that person handle these types of decisions? We did hear evidence before the committee on this issue, especially from Professor Jocelyn Downie, which stands out in my mind.

When we talk about irremediable as part of the determination and the assessment of competence, a person right after a traumatic injury may not, in a medical opinion, be found to be in an irremediable state and able to make the competence test because he or she would be in a state of flux at that moment.

We need to look at that further. That is just something we heard in our evidence. It was one position. That is why I am so happy we are committed to looking at the issues and discussing them further, because it is an important question.

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

Mr. Speaker, this issue affects all of us and we respect the very personal views that are brought forward.

What concerns me in the legislation that has been put before us is that we are not talking about an overall balance in end-of-life choices. We are talking about the very specific responses to the Carter decision. Eighty per cent of Canadians do not have access to quality palliative care. Therefore, 80% of Canadians facing end of life and their families do not have choices about good quality end-of-life care. In this vacuum, there must be a commitment by the federal government, but we have not seen that. We saw zero dollars in the budget for palliative care.

The New Democrats have Motion No. 46 before the House about moving forward not only on a palliative care strategy, but also taking responsibility for areas under federal jurisdiction. The federal government plays a huge role in the delivery of health services and it denies palliative care services often. There are also issues of changing EI provisions to help families.

Where is the government's commitment to the larger discussion on end of life in which Canadians need to be engaged?

[Julie Dabrusin, Liberal, Toronto—Danforth, ON]

Mr. Speaker, palliative care is an important part of the discussion about end-of-life care. There is no question that it has come up several times in this place and it is important.

I am a little wary of throwing around percentages and numbers. At committee, we heard a lot of different percentages. Perhaps it is that we do not have a fulsome understanding at this moment about what access to palliative care truly is. This needs further examination as well. On the numbers, I am a little concerned about percentages.

From what we heard and read at committee, the jurisdictions that have introduced medical assistance in dying have increased their access to palliative care at the same time as quality of that care.

[Filomena Tassi, Liberal, Hamilton West—Ancaster—Dundas, ON]

Mr. Speaker, I am honoured to rise in the House today to address Bill C-14. This bill is a response to the Supreme Court of Canada's unanimous ruling in the case of Carter v. Canada. The Supreme Court mandated that the Government of Canada create a framework for the provision of medical assistance in dying within a year of the ruling. That time lapsed on February 6, 2016, and an extension was granted until June 6, 2016.

The Supreme Court gave our government a short time in which to study this challenging and historic issue. I have listened to constituents who have argued passionately on both sides of this debate. I have struggled with the moral and ethical implications of this legislation. I understand that this is an emotionally charged and challenging topic.

Civilized societies have always recognized the sanctity of life. Countries around the world have legislated against the taking of another person's life. Historically, the taking of life has been considered to be the worst of crimes. The issue of medical assistance in dying poses a complex challenge to all Canadians because it brings together several different and difficult issues. There are questions of charter rights and personal freedoms. There are questions of protecting the vulnerable and responding to those who are enduring intolerable pain. There are theological, moral, and ethical considerations.

As well, this issue is an emotional one, fraught with the feelings of those who take strong positions on either side of the debate, and leavened by the feelings of those people who are experiencing such grievous suffering that they no longer wish to continue living.

Another element is purely economic, whether it is the pressures of inheritance or financial instability or the overwhelming cost of health care during the end of life. While we do not like to cite these utilitarian perspectives, their existence cannot be denied.

As well, this debate touches upon one's vision of a just society, whether one feels that ultimate justice involves complete choice or whether one feels that justice is best served by sometimes limiting the avenues available to a person so as to keep open the possibility of a happier tomorrow, a more desirable future, one that can be looked forward to rather than dreaded. I feel that this legislation finds a balance between these two perspectives, allowing choice to those who wish to end their grievous suffering and are already far along the path to dying and protecting those who may be vulnerable.

The ruling in Carter v. Canada was expressly limited to a competent adult person who clearly consents to the termination of his or her life. Furthermore, the Supreme Court of Canada did not find that there was a right to medical assistance in dying for minors or persons with psychiatric disorders. I was greatly relieved that these provisions were not included in this legislation.

To ensure that the path to the end is as fair and secure as possible, it is imperative that we accompany any legislation for medical assistance with enhanced support for palliative care. All parliamentarians have stories to share with respect to their engagement with people. We have interactions that have a profound impact upon us and never leave us.

On the campaign trail, I had the opportunity to visit a number of long-term care facilities. On one of these occasions, after the candidates gave speeches, there was an opportunity to mingle. I approached a man, who handed me a piece of paper. It was a petition for more personal support workers. He had tears in his eyes as he asked me to sign the petition. I sat with him and he explained his situation. He was there caring for his wife, who was beside him in a wheelchair. She had endured a serious stroke. This man was not advocating for his wife, as he was there every waking hour to take care of her, but he was advocating for others whom he witnessed daily not getting the care they needed. This was just not fair, not right, and clearly not just.

We have serious work to do in palliative care, which is connected to home care. Our government has pledged $3 billion to home care, and I am strongly encouraged by the health minister's commitment to see that high-quality home care is accessible to all Canadians. I look forward to engaging my colleagues in these debates and fighting for greatly enhanced palliative care for Canadians.

I have spent the last 20 years working with youth as a chaplain in high schools in Hamilton and Ancaster, Ontario. During this time, I have walked with thousands of students as they have negotiated the difficult terrain of adolescence and early adulthood. Their struggles are real, and the burdens they carry through family difficulty, personal struggles with identity, emotional pain, loneliness, rejection, or alienation are all real.

Young people face a complex and often overwhelming world in their physical neighbourhoods, in the relationships they inhabit, and in the virtual worlds in which they are thrown head first, often not ready. One only has to look at the terrible cases of online bullying that have removed the joy from the lives of young people and replaced it with sadness, depression, and in some cases suicide. I believe in our youth. I have spent my life believing for them and in them when they have sometimes stopped believing in themselves. I have made it my life's work. Amazingly, although their worlds sometimes sombred into darkest night and they feared that any light might have been extinguished forever, together we found a glimmer, a flicker that with love, inclusion, acceptance, and safety grew into a flame and then a roaring fire, not only of hope but of a desire to change the world, to bring healing to others who suffer and are rejected. These same teenagers have now stepped up and become leaders with a conviction to change the world. If assisted dying had been available to them when they were in the depths of their depression, they might not be with us today.

I am pleased that this legislation does not include mature minors, and I call for a renewed focus on creating a better, happier, more secure, and stabler world for our young people, online and in the physical world.

I have debated the morality of the question of medical assistance in dying. There are many who believe that in good conscience they cannot support assisted dying. For those who feel this way, I wish to address the issue of conscience.

People often equate conscience with values and beliefs. While conscience most certainly includes these, it also is much more complex. Conscience is at the very core of who we are as people. Conscience deals with reality. It appreciates the facts that are before us. The facts here are that the Supreme Court of Canada has ruled that medical assistance in dying is a charter right. We are not faced with the question of whether we allow medical assistance in dying; rather, we are faced with the question of in what conditions we will allow medical assistance in dying.

In my view, the bill before us is narrow in scope and respects the charter as interpreted in Carter v. Canada. Bill C-14 fulfills the legislative mandate delivered by the Supreme Court in a way that meets the charter but attempts to protect the vulnerable and the powerless. Although we can never fully protect the vulnerable, we can do our best. This is what Bill C-14 does.

Finally, I wish to affirm my support for respecting the personal values and beliefs of doctors and nurses and the mission statements upon which some institutions were created.

As the Minister of Justice has said, and I quote:

To this end, as I have already mentioned, my colleague, the Minister of Health, will be working with her counterparts to bring forward a coordinated system for linking patients to willing providers.

As is outlined in the government preamble to this bill, the Government of Canada has committed to developing non-legislative measures that will “respect the personal convictions of health care providers”. As the Minister of Health has indicated, “Practitioners will have the right to choose as their conscience dictates”.

I will continue to fight for the protection of the rights of morally objecting physicians and institutions while ensuring access for patients to their charter rights.

In light of all of these arguments, I stand in this House today in support of this fair and thoughtful legislation.

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

Mr. Speaker, this bill makes it possible for a person to ask a doctor for help committing suicide. If the doctor refuses because the person does not meet the criteria, that person can go to plenty of other doctors to get help.

Does the member agree that we need some rules around that practice of going from doctor to doctor?

[Filomena Tassi, Liberal, Hamilton West—Ancaster—Dundas, ON]

Mr. Speaker, as I have indicated, I will always respect the conscience rights of doctors. As the Minister of Health and the Minister of Justice have both confirmed, what we are speaking about here is the issue of accessibility. It has been made clear in this legislation and in the comments of both ministers that accessibility is an important issue. We will ensure that our consultations with provincial and territorial partners will provide accessibility that will be open to all Canadians who wish to pursue medical assistance in dying.

In Canada, we have approximately 77,000 physicians and more than 360,000 registered nurses. For me, it is not going to be a matter of having to go from physician to physician. I think that, with the brilliant work of our Minister of Health, accessibility will be available to people, and there is no question of conscience rights becoming an issue because of the accessibility point.

[Pierre-Luc Dusseault, NDP, Sherbrooke, QC]

Mr. Speaker, I would like to thank my colleague for her speech.

I was wondering whether, like her colleague, she thinks that the bill does not go far enough. Does she have concerns about compliance with the Supreme Court decision that this bill responds to? Does she think that the bill goes far enough? Does she share the same concerns as her colleague who spoke earlier? Perhaps the bill is not enough. Perhaps it is too limited in scope. Perhaps it does not fully comply with the Supreme Court's decision.

[Filomena Tassi, Liberal, Hamilton West—Ancaster—Dundas, ON]

Mr. Speaker, as I made clear in my speech, I think that this bill does go far enough with respect to the Carter v. Canada decision.

I expressed concern with respect to one area, which is minors and psychiatric care, and I am glad to see that the legislation does not include minors and psychiatric disorders. This stems from my work with youth.

I have worked with youth over the past 20 years, and I have seen them struggle through very difficult times. I have been with them in their darkest days. I have taken those same youth to the Dominican Republic on mission trips, and I have seen how the experience of working with the poor has turned their lives around.

My focus would be on ensuring that youth receive the support they want and that those who are at the end of their life, through palliative care, also receive the support they need and deserve.