Protection of Freedom of Conscience Act

An Act to amend the Criminal Code (medical assistance in dying)

Sponsor

David Anderson  Conservative

Introduced as a private member’s bill. (These don’t often become law.)

Status

Second reading (House), as of May 29, 2019

Subscribe to a feed (what's a feed?) of speeches and votes in the House related to Bill C-418.

Summary

This is from the published bill. The Library of Parliament often publishes better independent summaries.

This enactment amends the Criminal Code to make it an offence to intimidate a medical practitioner, nurse practitioner, pharmacist or any other health care professional for the purpose of compelling them to take part, directly or indirectly, in the provision of medical assistance in dying.

It also makes it an offence to dismiss from employment or to refuse to employ a medical practitioner, nurse practitioner, pharmacist or any other health care professional for the reason only that they refuse to take part, directly or indirectly, in the provision of medical assistance in dying.

Elsewhere

All sorts of information on this bill is available at LEGISinfo, provided by the Library of Parliament. You can also read the full text of the bill.

Protection of Freedom of Conscience ActPrivate Members' Business

May 29th, 2019 / 5:30 p.m.
See context

Conservative

David Anderson Conservative Cypress Hills—Grasslands, SK

moved that Bill C-418, An Act to amend the Criminal Code (medical assistance in dying), be read the second time and referred to a committee.

Madam Speaker, the first thing I would like to do is to thank the many people across Canada who have shown up to work on this bill. It has caught on across the country. It has restored my faith in the good judgment of Canadians and, hopefully, we will see that same good sense shown in the House and we can have some restored faith here as well.

I am here today to speak to Bill C-418, which is the protection of freedom of conscience act. I need to point out again that I am surprised at the way this has caught on and caught the attention of the Canadian public. We should thank many Canadians and groups for whom this is an important issue for their work on publicizing and advancing conscience rights in Canada.

To begin to understand Bill C-418, we need to back up a bit. The Charter of Rights and Freedoms has a number of sections in it. Section 1, of course, guarantees our rights and freedoms. However, immediately following that is section 2, which declares the most fundamental rights, and that begins with freedom of conscience and religion. In 2015, the Carter decision in the Supreme Court said that although section 7 of the charter provides for the right to die, it also explicitly said that no one is required to participate in or be part of it.

We then came to Bill C-14, the government's assisted suicide bill. It is a bill that attracted much attention and controversy and laid out the groundwork for the first round of assisted suicide legislation in Canada. Whether they call it euthanasia, medically assisted dying or assisted suicide, they are all different names for the same thing. Medical practitioners were divided on the issue of participating in ending the lives of Canadians. Whether we supported Bill C-14 or not, it was clear that many within the medical community were very concerned. They did not and still do not want to participate in this activity.

When Bill C-14 was passed, it included subsection 241.2(9) which did say, “For greater certainty, nothing in this section compels an individual to provide or assist in providing medical assistance in dying.” That was not adequate because it did not lay out an offence, there was no framework for it and there was no penalty in Bill C-14 if someone violated that. It ended up being nothing more than a statement in Bill C-14.

While the Liberal talking points have repeated this, and the Liberals also claim that everyone has freedom of conscience and religion under section 2 of the charter, this is not the reality that medical personnel are facing across Canada. In spite of the fact that on the surface the charter, Carter and Bill C-14 supposedly agree, the reality is that physicians and medical personnel in this country are being pressured to participate in something with which they fundamentally disagree and there is no protection provided to them.

Conscience forms the basis of medical professionals' motivation to pursue their particular field. Doctors practise every day with the knowledge that it is their conscience that motivates them to test the limits of their knowledge and skill. Medical professionals know that patient care will suffer if they are deprived of the ability to live with integrity and to follow their consciences. They know the importance of these beliefs to them and their patients better than anyone else.

For a great many Canadian doctors, the core of their conscience prohibits their participation in taking a life. Indeed, many doctors remain devoted to the black and white of the ancient Hippocratic oath, a pledge that prohibits the administration of a poison to anyone. Through the availability of assisted suicide on demand across Canada, threats to conscience are no longer confined to the theoretical or to the rhetoric of the courtrooms. They are increasingly present in the examination room as well.

That is why I believe it is time to take action in defence of conscience rights that have stood the test of time for generations. Therefore, Bill C-418 seeks to amend the Criminal Code to do two things.

The first is to make it an offence to intimidate a medical practitioner, nurse practitioner, pharmacist or any other health care professional for the purpose of compelling them to take part, directly or indirectly, in the provision of physician-assisted suicide.

The second provision makes it an offence to dismiss from employment or to refuse to employ a medical practitioner, nurse practitioner, pharmacist or any other health care professional for the reason only that they refuse to take part, directly or indirectly, in the provision of physician-assisted suicide.

My bill would provide the teeth that Bill C-14 acutely lacks. The Liberals' attempt to provide protection for doctors consisted solely of a rudimentary clause, which stated, as I said earlier, that nothing compels someone to provide or assist. However, the provision lacked the teeth needed for its effective enforcement, as evidenced by the ongoing pressure that is being exerted on physicians, particularly by their regulating bodies.

I guess the question is whether these protections are really necessary, and I would say that they are. Throughout the legislative process, I have spoken to doctors who feel overt pressure to leave family medicine because of their conscientious beliefs. I have heard of palliative care doctors in Ontario who have stopped practising altogether. Nurses who feel increasingly bullied are choosing to shift their focus or retire early. I have had personal conversations with people who work in old folks' homes who explain they do not want to participate in this but are increasingly feeling pressured to do so. The pressure on these professionals exists and they are looking for relief.

What is more, regional associations such as the College of Physicians and Surgeons of Ontario have introduced regulations compelling conscientiously objecting physicians to participate by providing what they call “effective referrals” for physician-assisted suicide. A recent court decision has upheld this directive, contravening the assurances provided in Carter v. Canada and creating an even more urgent need among physicians for protection. This is in spite of the fact that in this situation in Ontario I am told that the majority of physicians support an allowance for conscientious objections, but the college has not taken that position.

As strange as it sounds, the recent court decision refers to the college's suggestion that if physicians do not like to participate then they can find other areas of medicine to take up. This is unusual, particularly in a situation where we have such a shortage of physicians and medical services. The college suggests that if they do not like participating they can take up things like sleep medicine, hair restoration, sport and exercise medicine, skin disorders, obesity medicine, aviation examinations, travel medicine or perhaps become a medical health officer.

For many of us across this country, particularly those of us in rural areas, we know there is an increasing lack of physicians in an increasingly challenged medical system. I find it passing strange that the college would be the one suggesting such a thing for its physicians. The answer does not have to be to do it, find someone else to do it or get out of medicine. Medical personnel and resources are scarce. Why would one try to force people into doing what they believe to be wrong? The example of the province of Manitoba and its conscientious objection legislation shows there does not need to be compulsion in the medical system when it comes to this issue.

My bill does not address the social acceptability of euthanasia and assisted suicide; that is not the point of it. Protecting physicians' conscience rights is not at all a physicians versus patients scenario. By protecting physicians' conscience rights, patients' rights are enhanced. Bill C-418 is about protecting the fundamental freedom of conscience and religion guaranteed to all Canadians in the Charter of Rights and Freedoms.

Parliamentarians from all parties cannot ignore the groundswell of support this bill has received from average Canadians who believe it is time to stand up for doctors and health care providers who are not willing to leave their core ethics behind when they are at a patient's bedside. This is not theoretical. I have had photos sent to me of the revolving TV screens that we see in hospital wards, with pictures of what seems to be a physician's hand gently resting on the arm of a senior citizen, touting assisted suicide as a medical service whereby physicians or nurse practitioners help patients fulfill their wish to end their suffering and a phone number is provided. Interestingly, it makes no mention of palliative care or other ways to reduce pain and suffering. It makes no mention of access to counselling.

With government, the courts and health care facilities promoting access as a right, should not those who object be allowed to have that fundamental freedom of conscience that is so important?

I want to close with a quote from “The Imperative of Conscience Rights” by the CRFI. They write:

The outcomes of the current controversies that engage freedom of conscience will not only signal the extent to which Canadians can conscientiously participate in public life—in other words, whether they can live in alignment with who they are and what they stand for in matters of morality. These outcomes will also speak volumes about who we are and what we stand for—as a society. Suppressing beliefs with which we disagree or that we find offensive in the name of tolerance and liberalism is a contradiction in terms. The fact that the state has deemed something legal does not remove a person’s freedom to express her moral opposition to it. This freedom is not absolute, but its roots—integrity, identity, and dignity—are necessary for human flourishing. These roots must therefore be top of mind whenever limitations on freedom of conscience are proposed. We believe that governments should only limit this human right if there is a compelling justification.

Protection of Freedom of Conscience ActPrivate Members' Business

May 29th, 2019 / 5:40 p.m.
See context

Liberal

Scott Simms Liberal Coast of Bays—Central—Notre Dame, NL

Madam Speaker, I am wondering if my colleague has done his research about the Canadian Medical Association and if he has its opinion of it. I know he mentioned the college of physicians and surgeons and I find its response on that somewhat alarming. How does the CMA feel about that, as well as about a remedy for people who feel that they are ruled against in their profession when they feel that they have conscientiously objected to something that is important to them?

Protection of Freedom of Conscience ActPrivate Members' Business

May 29th, 2019 / 5:45 p.m.
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Conservative

David Anderson Conservative Cypress Hills—Grasslands, SK

Madam Speaker, I can tell my colleague opposite that the OMA, as far as I know, has come out in favour of protecting the conscience rights for the doctors who are part of its association, so the college and the OMA are not on the same page on this one.

The college in Ontario has brought in a much stricter set of guidelines, if we want to call it that, than virtually anywhere else across Canada. Manitoba has brought in a conscientious objection law, which would allow physicians to opt out of this and make it much simpler for them to do that. In Ontario, the requirement is that they “must effectively refer”, which are the words that are used. Many people feel that they just do not want to participate at that level and in this day and age of electronics, there are many other ways that people can access the information. There are a number of other suggestions out there about how that might be done.

The point of this bill is, first of all, to give the conscience protection that people need if they want to be able to continue to do their work.

Protection of Freedom of Conscience ActPrivate Members' Business

May 29th, 2019 / 5:45 p.m.
See context

NDP

Murray Rankin NDP Victoria, BC

Madam Speaker, I am in substantial agreement with the thrust of the question from the member for Coast of Bays—Central—Notre Dame.

The Court of Appeal for Ontario dealt with this question at least insofar as it said that in a dispute between a patient and a physician, “the interests of patients come first, and physicians have a duty not to abandon their patients.” Can the member square his initiative with that requirement in law?

Protection of Freedom of Conscience ActPrivate Members' Business

May 29th, 2019 / 5:45 p.m.
See context

Conservative

David Anderson Conservative Cypress Hills—Grasslands, SK

Madam Speaker, I actually believe that we can. It has been done in other places across the country, but there are numerous ways that people can come to information about assisted suicide or medical assistance in dying. There are certainly a number of options open as to how they might access that information. The question is whether physicians are obligated to refer that, to provide that, or if they can opt out and give them another way to find that information. We believe that is very possible.

Protection of Freedom of Conscience ActPrivate Members' Business

May 29th, 2019 / 5:45 p.m.
See context

Conservative

John Nater Conservative Perth—Wellington, ON

Madam Speaker, in my riding of Perth—Wellington, I have received a fair bit of correspondence on this matter in support of the member's bill. I was wondering if he could highlight some of the support he has had for his bill from constituents in his riding and Canadians across the country.

Protection of Freedom of Conscience ActPrivate Members' Business

May 29th, 2019 / 5:45 p.m.
See context

Conservative

David Anderson Conservative Cypress Hills—Grasslands, SK

Madam Speaker, the interest in this bill has been surprising to me. There are some bills that really catch people's imaginations across the country. There are other ones that we really have to work hard to try to get people to pay attention to. It has been surprising to me how people have taken this on. There is an onslaught of petitions coming into my office every day and I am passing them on to my colleagues as well so that they can understand the interest that people in their ridings have in this issue.

People generally want to be fair to other people and allow them to have the capacity to operate off of the things they believe in. Every single one of us has a set of beliefs. We have a right to operate under our set of beliefs as long as we are not destroying somebody else's life or are in other people's faces. In this situation, we should be giving medical professionals, who operate every day from a sense of conscience in what they do, the opportunity to do that.

Protection of Freedom of Conscience ActPrivate Members' Business

May 29th, 2019 / 5:45 p.m.
See context

Don Valley West Ontario

Liberal

Rob Oliphant LiberalParliamentary Secretary to the Minister of Foreign Affairs

Madam Speaker, I want to refer the mover of this piece of legislation to the report that was done by the special committee on medical assistance in dying. There was a strong concern in that report that, indeed, we do honour the conscientious objection of medical practitioners, while at the same respect the right of patients to get absolute medical attention. If it comes down to a patient's right or a physician's right, which would the member choose?

Protection of Freedom of Conscience ActPrivate Members' Business

May 29th, 2019 / 5:45 p.m.
See context

Conservative

David Anderson Conservative Cypress Hills—Grasslands, SK

Madam Speaker, as I mentioned earlier, there are a number of options for people to find the information they need. There are many doctors and facilities that will provide this service if they want it, but there are other doctors and medical personnel who do not feel that assisting in someone's premature death is a part of the mandate of what they have been called to as physicians or medical personnel.

There are enough choices out there that people can have and we can allow those who disagree with this procedure to have their freedom of conscience and be able to live their professional lives in that fashion.

Protection of Freedom of Conscience ActPrivate Members' Business

May 29th, 2019 / 5:45 p.m.
See context

Parkdale—High Park Ontario

Liberal

Arif Virani LiberalParliamentary Secretary to the Minister of Justice and Attorney General of Canada and to the Minister of Democratic Institutions

Madam Speaker, it is a pleasure to speak today to Bill C-418, the protection of freedom of conscience act. The bill proposes to create two new Criminal Code offences, an “intimidation offence” as well as an “employment sanctions offence”. Those offences would seek to protect health care professionals' freedom of conscience by prohibiting the use of intimidation to compel practitioners to provide medical assistance in dying and by prohibiting employers from dismissing practitioners for refusing to take part in medical assistance in dying.

Canada's medical assistance in dying legislation came into force almost three years ago, in June 2016. It allows adults who are suffering unbearably while on a trajectory towards death to seek the help of a medical practitioner or nurse practitioner in choosing a more peaceful death. Recently released data from Health Canada's fourth interim report reveals that as of October 31, 2018, more than 6,700 Canadians have received medical assistance in dying.

Addressing this issue and any matter of constitutional law in the House is always a pleasure for any lawyer in the House, and particularly for me who practised in this area for 15 years prior to entering the chamber.

Medical assistance in dying has been and continues to be a complicated and contentious issue. That is a given. It raises questions in relation to fundamental values about how we want to live and die as autonomous individuals, how vulnerable individuals must be afforded protection under the law and also about how we relate to each other as members of Canadian society.

The complexity of this issue warrants thorough reflection on the many points of view that inform it. Even within this place, different sets of values inform different positions taken when we debated former Bill C-14 at length.

For instance, as a result of the rich debate that took place, the legislation included a requirement that three independent studies be completed on topics that were particularly complex and beyond the scope of the former Bill C-14, namely, medical assistance in dying for mature minors, advance requests and requests where the sole underlying medical condition is a mental disorder.

The Council of Canadian Academies undertook the monumental task of canvassing the available evidence on these questions and produced three in-depth reports that will continue to inform the dialogue between the public and policy makers. Importantly, the reports themselves set out a variety of points of view among experts on these three issues.

Many members would also know there is ongoing charter litigation right now in the courts in Canada involving the eligibility criteria set out in the medical assistance and dying amendments to the Criminal Code that were passed three years before. These are ongoing matters.

It would be inappropriate to comment on them specifically, but I mention their existence to highlight the different fundamental values that medical assistance in dying implicates and that the legislation seeks to reconcile: supporting individual autonomy, protecting society's most vulnerable individuals and protecting broader societal values that go beyond an individual's desire to control their own death, such as the equality of all lives and the prevention of suicide.

We have seen in the opening comments of this debate the issue of the reconciliation of the charter rights held by the practitioners whose rights are being espoused by the member opposite from Cypress Hills—Grasslands, and also by the patients in the medical system, as was raised in the question by the member for Don Valley West and the member for Victoria.

As these complementary values underpin the particular Criminal Code exemptions that Parliament enacted to permit medical assistance in dying, they also play out on the ground. Indeed, just as Canadians in general may have different points of view about what medical assistance in dying should look like in Canada, so do the persons who are directly involved in this new practice, namely, our health care professionals, and in particular, the medical and nurse practitioners who are permitted to provide medical assistance in dying.

It is to be expected, and indeed Parliament heard, that this diverse group of professionals holds equally diverse views on medical assistance in dying. Our government firmly believes that medical and nurse practitioners, as well as other health care professionals involved in a patient’s care team, should not be forced to participate in the provision of medical assistance in dying.

Providing medical assistance in dying is a gesture with the most serious of consequences. Some health care practitioners view it as an important part of their practice that relieves a patient’s intolerable suffering when approaching death. Others view it as contrary to their conscience, religious beliefs or their professional role. Other health care practitioners might support the availability of medical assistance in dying in principle but simply not wish to be involved in the practice themselves. Our government supports and respects all of these different viewpoints.

It is crucial to note that in Canada the legal framework for medical assistance in dying is primarily one of criminal law. Parliament enacted careful exemptions to the offences of homicide and aiding suicide. This means that medical assistance in dying is permitted, but no one is compelled by the criminal law to provide it.

With the utmost clarity in this regard, the House of Commons Standing Committee on Justice and Human Rights adopted an amendment to what was then Bill C-14, adding a new subsection 241.2(9) to the Criminal Code of Canada that clearly states that nothing in the medical assistance in dying provisions compels health care professionals or practitioners to participate in medical assistance in dying.

It is also critically important, since we are debating constitutional law, to keep in mind that paragraph 2(a) of the charter protects freedom of conscience and religion and guards against unjustified government interference in one's religious beliefs and freedom of conscience. We know that. The law reflects that. The Carter decision of the Supreme Court of Canada incorporated that. I will read part of paragraph 132 of the majority decision in Carter, which says that “nothing in the declaration of invalidity which we propose to issue would compel physicians to provide assistance in dying”. Those words entered Bill C-14 and were further strengthened by the amendment proposed by the justice committee and voted on in Parliament.

Our government is mindful that the availability of medical assistance in dying in Canada may cause tensions in professional settings among medical and nurse practitioners who hold different views on this very topic. Strained relationships with colleagues were noted by the physicians who participated in a 2018 study published in the Journal of Pain Symptom Management, including physicians who are willing providers of medical assistance in dying but who work in environments that are predominantly opposed to medical assistance in dying. This example highlights the unique challenges that medical and nurse practitioners might face when they work in an environment with a majority or institutional view of medical assistance in dying that is different from their own.

In addition, eligible patient access to medical assistance in dying has to be reconciled with practitioners' conscience rights. This is the reconciliation that was raised in the context of this debate and in the Carter decision, and that has been reconciled within the framework of Bill C-14 as passed.

Importantly, provinces and territories have responsibility over the provision of health care and the regulation of professionals within their jurisdiction, and they face this complex task. In a context where we are debating constitutional law, it is important not just to look at the charter but also at the division of powers in the Constitution Act of 1867. When we are talking about regulating aspects of physicians in this country, that is germane to the jurisdiction of the various provinces mentioned in some of the responses by the member for Cypress Hills—Grasslands.

At the federal level, the Minister of Health has recently put in place regulations establishing a permanent monitoring regime for medical assistance in dying. The regime came into effect on November 1st, 2018. It will gather valuable data about written requests for medical assistance in dying and the patient making this request, but also about the reasons why a medical practitioner who received a written request referred the patient or transferred their care to another practitioner, including whether it was because providing medical assistance in dying or assessing someone for eligibility would be contrary to their conscience or religious beliefs.

National, consistent data about the number of requests for medical assistance in dying that are transferred because of a practitioner’s beliefs will inform Canadians about the breadth of this issue.

In addition, the medical assistance in dying legislation itself provided for a five-year parliamentary review of all of its provisions and the state of palliative care in this country. This review could begin as of June 2020. It will no doubt be informed by the comprehensive reports produced by the Council of Canadian Academies and any other available evidence about the Canadian experience, including that of health care practitioners involved in or affected by medical assistance in dying.

I wish to reiterate our government's respect for health care professionals' diverse points of view and beliefs about medical assistance in dying. We know that they hold their patients—

Protection of Freedom of Conscience ActPrivate Members' Business

May 29th, 2019 / 6 p.m.
See context

NDP

Murray Rankin NDP Victoria, BC

Madam Speaker, I wish to rise today to speak on behalf of the NDP in respect of Bill C-418, the initiative of the hon. member for Cypress Hills—Grasslands.

We must oppose this bill. We are concerned that it creates a loophole whereby health professionals could deny a referral to a patient seeking medical assistance in dying. I want to be very clear at the outset. I had the honour of representing our party, both on the special joint committee that dealt with medical assistance in dying and the justice committee.

At that time, I put an amendment before the justice committee to ensure that the rights of health care professionals would be respected, that no health care worker should ever be compelled to provide medical assistance in dying. I am proud of that contribution. I am proud that it became part of the law.

However, what is equally important is that there be the ability, always, for the patient to exercise his or her constitutional right to avail themself of medical assistance in dying. In a contest between a physician and that patient, the law is crystal clear. It is the patient's right that must prevail. I will come back to that in a moment.

Therefore, this no doubt well-intentioned bill before us uses very vague language that talks about directly or indirectly doing certain things. That, of course, is the problem with this bill. We in the NDP have always championed the rights of health care professionals, but we must address this critical balance.

Part of ensuring there is what is called an “effective referral” is that the doctors, the health care professionals, are able to find another route, but that, nonetheless, the patient always has, at the end of the day, the final ability to avail themself of that service. It is not enough to say they can self-refer themselves, that they can look in a phone book or go to a website. As I will illustrate in a moment, it just does not work that way.

In a recent Ontario Court of Appeal decision in 2019, a judge found that the rights of the patient must prevail over the rights of the physician. There must be what the Ontario court terms an “effective referral”. That term was defined as follows:

A referral made in good faith, to a non-objecting, available, and accessible physician, other health-care professional, or agency.

The quote that I find the most important in the entire decision is as follows:

The interests of patients come first, and physicians have a duty not to abandon their patients.

That is the Court of Appeal speaking.

It is an unimaginably difficult situation for a person who is by definition in severe pain and interminable suffering to be challenged to find a particular doctor in circumstances where they have less resources than would normally be available to them. They have a relationship with their physician. Let us say that physician does not accept the legitimacy of the law of Canada and has a conscientious reason for opposing it, which is, as I said at the outset, certainly their right. There are issues of confidentiality. Not everyone can simply go to their family and say, “Can you assist?” or has the wherewithal at the end of life to go to a website or to a telephone book to try to find that.

That is why the court of appeal, in its wisdom, made the statement that I just read. A doctor, in other words, cannot effectively cut their patient adrift.

It also must be said that this particular bill, and that case to which I referred, have significant implications for a woman's right to choose. That, as well, is something for which an effective referral is required at law. The Women's Legal Education and Action Fund intervened in that case, and after speaking about effective referral in the terms I just raised, said the following:

The Court agreed with LEAF that “due to historic inequalities in accessing the medical system, many women are dependent on physician approval to access reproductive services.” Since physicians act as gatekeepers to the system, an effective referral may be the only channel through which these women can access the care they need.

Therefore, there are implications of the bill that need to be understood as broader than the way it might be considered on its face.

We want to ensure what we did in those difficult debates about medical assistance in dying becomes a reality for people at end of life. No matter where they live in Canada, these services should be available.

Where I live on Vancouver Island, we have the highest uptake of this service in the country by a considerable amount, because the medical system has responded. Many physicians are providing this service. However, from talking to colleagues in places such as Atlantic Canada, I know it is an entirely different world elsewhere. As Canadians, we all have the same constitutional rights. The disparity is unacceptable, but that is the world in which we live. We have to do better.

Reasonable access, if that is what the law requires, is simply not a reality in many rural and remote parts of our country. It cannot be that a doctor can thwart the ability of patients ability to avail themselves of that service.

Some people may not want to talk to anyone other than their family doctor or a particular physician because of confidentiality issues. They may not even want their parents or children to know that they are considering this.

It is my belief that the bill, as it exists today, will disrupt the very careful balance that was achieved in this Parliament regarding physician assisted in dying.

I would like to share with the House an anecdote that was provided to me by a woman named Shanaaz Gokool, who is the chief executive officer of Dying With Dignity Canada. She tells a story about a gentleman who is only identified by his initials, R.A.

In 2018, R.A.'s mother was dying of terminal cancer. R.A. was her primary caregiver. He was an educated, loving son who was financially secure and able to take a leave of absence from work to provide daily care for his mother. The family was from another country and English was not their first language. His mother requested help with physician assisted dying, but her doctor did not think that was appropriate and declined to provide a referral.

R.A. did an Internet search and found somebody in a hospital nearby. The hospital sent him an email with more information about how to use the service, but he was overwhelmed in caring for his mother and missed the email. Some three weeks later, he finally got more information and called Dying With Dignity to witness his mother's MAID request. She was found eligible and a number of months after she first asked her primary care physician to help, the service was made available to her.

Unfortunately, days before she was to receive medical assistance in dying, she died a terrible death, essentially choking on and drowning in her own vomit, when her son looked away briefly.

When he was to testify to this before the Ontario Court of Appeal, he went back to check the email that was sent to him by the hospital care coordinator. It was a heart-breaking moment when he realized the email had the email address and phone number for the Ontario medical assistance in dying care coordination service. He had the information all along, but he was so busy caring for his mother he did not see the details in the original email.

The point of the story is that sometimes people need a physician or a health care professional to provide them with an effective service. This story is a tragic example of where that was not done. Sometimes a phone number or web address is simply not enough.

We believe that coercion and intimidation are always wrong. However, it is important we keep the balance that was carefully struck in this Parliament when we took the step of creating a regime for Canadians to avail themselves of their constitutional right to medical assistance in dying in certain circumstances. We should keep that balance and not destroy it.

Protection of Freedom of Conscience ActPrivate Members' Business

May 29th, 2019 / 6:10 p.m.
See context

Conservative

Rachael Harder Conservative Lethbridge, AB

Madam Speaker, right now many medical practitioners face the real threat of being discriminated against because of their deeply held ethical or moral beliefs.

Bill C-418 proposes to amend the Criminal Code to extend protection to those who choose not to provide or effectively provide medical assistance in dying by making it a punishable offence to use violence, threats of violence, coercion or any other form of intimidation to force a health care professional to participate in euthanasia.

The bill was brought forward by my colleague, the member for Cypress Hills—Grasslands. I wish to commend him for his noble efforts.

Two years ago, it was against the law for a doctor to take the life of a patient. In fact, one would think it unimaginable due to the oath a doctor takes. Medical assistance in dying was considered murder and any doctor who carried it out was deemed responsible for manslaughter.

It is now two years later. Medical assistance in dying is now permitted under Canadian law. However, medical professionals and Canadians from many backgrounds do not wish to participate in any form as it goes against their conscience.

While Bill C-14, the bill that makes medical assistance in dying legal within our country, advocates for those wishing to participate in the practice, it neglects or altogether fails to protect the medical practitioners whose conscience would be violated if they had to participate. This is a big problem as the professional judgment of many doctors still affirms that good medical care does not include hastening death.

Under section 2 of the Canadian Charter of Rights and Freedoms, Canadians are free to follow the religion of their choice. They are guaranteed the freedom of thought, freedom of belief and freedom of expression. These are considered fundamental freedoms in Canada. Nevertheless, Bill C-14 leaves physicians and Canadians of faith completely unprotected.

In Carter, the Supreme Court of Canada explicitly stated that the legalization of euthanasia did not entail a duty of physicians to provide it. It was not supposed to be forced upon them. To pay lip service to this ruling, this place, the House of Commons, put within Bill C-14 subsection section 241.2, which states, “nothing in this section compels an individual to provide or assist in providing medical assistance in dying.”

Despite these words, which is exactly what they are, simply words, the current government outright refused to put conscience protections within the federal legislation. This was despite the fact that many witnesses came forward to committee during this time and asked for conscience protections to be explicitly placed within Bill C-14.

I sat there during those committee meetings and listened to that testimony. I was one of the individuals who advocated for those conscience protections. There is absolutely no reason why they should not have been a part of the legislation. However, they are not, so it requires this private member's bill, Bill C-418, in order to adequately protect the conscience of our medical practitioners in the Canadian system.

Canadians should never be put in a situation where they feel they are forced to choose between their careers or beliefs. We live in Canada. We have a Charter of Rights and Freedoms. We should be able to engage in the career of our choice and have our ethical and moral values respected. We should be able to function according to our conscience. Currently, that is not the case. Those protections are not granted to medical practitioners the way they should be. Therefore, I call on the House to make a change, as is the member who sponsored this private member's bill.

Canada is a religiously plural and multicultural society. It allows its citizens to live out their lives according to their conscience, beliefs and values. In this country, freedom is our strength. I know the Prime Minister likes to talk a lot about how diversity is our strength. Sure, it contributes to it, but only when our freedom is intact and respects that diversity that exists. As soon as that freedom is attacked, diversity fails; diversity is no more.

Bill C-418 would restore such freedom of religion and conscience. It acts to defend medical professionals who act in good conscience and within their constitutional rights to not participate in medical assistance in dying. It should be argued that this bill addresses a legislative gap that was left by the current government. It completes the work the Supreme Court asked this place to do.

This bill is about protecting the very foundation of our country, Canada's religiously, plural and multicultural society, one that we are so proud of, happy to belong to and defend in this place as elected officials.

In 2016, medical assistance in dying became legal under law in Canada. As stated, that was Bill C-14. Just prior to that, in 2014, the Supreme Court ruled that to prohibit medical assistance in dying was actually a violation of section 7 within the Charter of Rights and Freedoms, the right to life, liberty and security of the person who wished to die. As a result, the Criminal Code was amended by the current government, which again is Bill C-14.

This has created a significant problem for many Canadians within the medical field, but it was not supposed to be this way.

When the Supreme Court of Canada ruled that the prohibition of medical assistance in dying was unconstitutional and needed to be fixed, it was stated that the legalization of medical assistance in dying did not compel or entail a duty for a physician to provide it. However, nothing was done to protect religious medical professionals from being forced to carry out this practice.

As a result, many practitioners across the country are calling on this place to make a further amendment to the Criminal Code in order to ensure their rights are respected. Their right to freedom and to act according to their conscience must be respected.

The argument often used is that medical practitioners can just refer their patients to another medical doctor, who will then provide the service. However, it should be noted that for some it is against their conscience even to refer someone to another medical practitioner. Those beliefs must also be respected.

Regional associations and regulatory bodies across the country have introduced regulations that strong-arm medical practitioners whose religious beliefs do not allow them to practise euthanasia in any capacity whatsoever.

In 2016, the College of Physicians and Surgeons of Ontario adopted a medical assistance in dying policy requiring medical professionals, who would not provide medical assistance in dying themselves, to provide an effective referral. This policy was challenged by religious groups.

A group of more 1,500 Canadians came together and challenged this regulatory decision. They said that it violated their constitutional rights, their rights to freedom of religion and conscience. Unfortunately, on May 15, the Court of Appeal for Ontario ruled that religious physicians and medical professionals must provide effective referrals if they themselves would not be involved with medical assistance in dying. It went on to say that those medical practitioners who believed this violated their conscience could go and find a job within the medical profession where medical assistance in dying would not be required of them.

That is incredibly demeaning to those individuals who have gone through years of training and who, with great dedication and commitment to their patients, have served. These are the women and men who have been trained as medical professionals and it is their conscience that motivates them and compels them to function with dignity, respect and honour and to provide the utmost level of care to their patients. Now they are being punished for holding those beliefs, for holding that level of dignity, respect and honour for their patients.

Again, I would plead that it does not have to be this way, that a change can be made to the Criminal Code that would in fact protect the conscience rights of these medical practitioners who, because of their deeply-seeded beliefs, are not able to participate in any way in medical assistance in dying.

I ask that the House rightly respond to the Supreme Court's decision in the Carter v. Canada case and put this change within the Criminal Code to rightly respond to that decision.

Protection of Freedom of Conscience ActPrivate Members' Business

May 29th, 2019 / 6:20 p.m.
See context

Liberal

Darrell Samson Liberal Sackville—Preston—Chezzetcook, NS

Mr. Speaker, I am extremely pleased to speak today to Bill C-418 tabled by the member for Cypress Hills—Grasslands in 2018.

Bill C-418, an act to amend the Criminal Code (medical assistance in dying), would amend the Criminal Code to create two new offences aimed at protecting the freedom and conscience of health care professionals who object to participating in or providing medical assistance in dying.

One proposed offence would focus on intimidating or threatening behaviour aimed at forcing a health care professional to participate in the provision of medical assistance in dying against their wishes.

The other proposed offence would prohibit an employer from punishing a health care professional because he or she objects to participating in the provision of medical assistance in dying, either by firing the individual or refusing to hire them.

This legislation proposes to build on Bill C-14 that Parliament adopted nearly three years ago. Bill C-14 amended the Criminal Code to legalize medical assistance in dying in response to the Supreme Court decision in Carter v. Canada, 2015.

These Criminal Code amendments created new exceptions for the offence of culpable homicide and aiding a person to die by suicide. The exceptions permit medical professionals to bring about a peaceful death for patients who can no longer endure the physical pain or psychological suffering they experience toward the end of their life.

We must keep in mind the seriousness of this behaviour. Health care providers are being asked to end life. This was not just prohibited by the criminal law until very recently, but also expressly prohibited by medical ethics.

These are just some of the reasons why medical assistance in dying is a deeply personal and difficult issue, implicating many values of the highest order of importance in our society. I am speaking of fundamental societal values, such as equality, individual autonomy, respect for life, protection of vulnerable persons, dignity and compassion.

Medical assistance in dying also implicates the conscience rights of medical professionals. This is the fundamental value that I understand motivates Bill C-418.

In its reports on certain types of requests for medical assistance in dying, which were tabled in the House only a few months ago by the Minister of Justice and the Minister of Health, the Council of Canadian Academies said that a person’s individual life experience, values and beliefs inform their perceptions about the question of medical assistance in dying.

While we all share certain experiences and values, each of us also has our our own unique experiences. This diversity of life experience, as the Council of Canadian Academies alludes to, gives each of us our own unique way of ordering the importance of the values in circumstances when they come into conflict.

Members of the chamber have no doubt seen firsthand this diversity of views in the letters they have received from constituents, or through conversations they have heard from coast to coast to coast. Many may have read the testimonies or written submissions that Canadians and organizations made to our justice and human rights committee while it was studying former Bill C-14.

Canadians have expressed a wide spectrum of perspectives and views on the issue. Some may resonate with our own personal beliefs and some may differ with them greatly. Many consider the question of health care providers' conscience rights and how they might be balanced against the rights of patients who are suffering unbearably and who choose medical assistance in dying.

While former Bill C-14 amended the criminal law to enable health care providers to respond to the wishes of patients who seek assistance in dying, it also made clear that it did not compel providers to provide or participate in the activity. This is stated in both the preamble of the bill and the relevant Criminal Code provisions.

Before this, the question of conscience protections was directly raised before the Supreme Court in the Carter case. In paragraph 132 of its ruling, the Supreme Court addressed several aspects of this question.

First, it explained that nothing in its ruling would compel physicians to provide assistance in dying, because its ruling simply rendered the old criminal prohibition invalid. This is consistent with the approach Parliament adopted in former Bill C-14, namely that in permitting medical and nurse practitioners to participate in medical assistance in dying, the criminal law does not compel them to do so.

The court did acknowledge that a physician's decision to participate in assisted dying is a matter of conscience and, in some cases, of religious belief. It concluded by underlining that the charter rights of patients and physicians would need to be reconciled.

Members of Parliament should not forget that medical assistance in dying is a complex issue with many facets and for which there are complementary spheres of responsibility. While Parliament is responsible for criminal law, provincial legislatures are responsible for the delivery of health care services and medical colleges and similar bodies are responsible for the regulation of health care professionals.

Medical assistance in dying is very new in Canada. On the ground, our health care systems and institutions are still adapting to the change. Some new laws and policies in the provincial domain have been developed, while others may still be under development.

ln terms of data, former Bill C-14 required the Minister of Health to put in place regulations for monitoring medical assistance in dying based on mandatory reports from health care providers. After a period of development and public consultation, this regime came into force on November 1, 2018. The first report is expected in 2020. lt may shed light on the quantity and quality of cases where practitioners who are asked to provide assistance in dying transfer care of the patient for reasons of conscientious objection.

In the meantime, Health Canada has released interim reports based on information voluntarily shared by the provinces.

According to the most recent report, released on April 25, 2019, over 6,700 Canadians have obtained an assisted death. That is a rather amazing figure.

There has also been some independent research conducted in Canada. One study, which is entitled “Exploring Canadian Physicians' Experiences Providing Medical Assistance in Dying: A Qualitative Study”, found that, in some cases, providers who participate in medical assistance in dying reported that it negatively affected their working relationships with colleagues. This finding is just as alarming as the prospect that practitioners would be physically threatened in order to coerce them into participating.

I ask members of this chamber, and all Canadians, to be respectful of the beliefs, values and perspectives held by others, even when they differ vastly from their own opinions. There is no single right answer when values collide. Our way forward must be a journey in which we engage, listen and try to accommodate, not threaten or provoke conflict.

I am pleased that Bill C-418 again gives us an opportunity to discuss medical assistance in dying and also focus on the vital importance of respecting differences and diversity. I urge all members to approach this bill and ongoing public and policy debates on medical assistance in dying with open minds.

Protection of Freedom of Conscience ActPrivate Members' Business

May 29th, 2019 / 6:30 p.m.
See context

Winnipeg North Manitoba

Liberal

Kevin Lamoureux LiberalParliamentary Secretary to the Leader of the Government in the House of Commons

Mr. Speaker, it is interesting that we would be debating the member opposite's bill today. We had a fairly passionate debate just a couple of years back. The debates I really enjoy and become engaged with are when members share stories of their own. When we talked about the assisted dying legislation, with the phenomenal amount of work done both in the House and outside the House through committees, we saw a great effort from Canadians and stakeholders from all regions of the country who provided direct input to the House. That went over and above what we did as parliamentarians. I am sure members can relate. We had constituents who were very passionate on this particular issue.

I was listening to the parliamentary secretary responsible for the legislation providing comment on the government's official position on the issue. I believe that the concerns the member opposite has, in good part, are addressed by the legislation we passed not that long ago.

I recall vividly many of the debates we had when it came to the issue of palliative care. Every member can relate to the issue of palliative care. It is an area this government has talked extensively about in terms of how, through health care, we can ensure that there are more palliative care facilities in all regions of our country. There is so much more we can do on that file to improve the conditions for providing this service to our constituents. It is a service that is provided to our constituents through our provincial administrations.

I used to be the health care critic many years ago in the province of Manitoba. One of the areas that would often surface was the issue of how many individuals we had in hospitals who would have been better off in a home care facility and how many times they were looking for palliative care beds. Many years later, after the time when I was the health care critic, we finally have a Prime Minister and a Minister of Health who have said that we need to see more palliative care units in Canada.

I see that my time has expired. I hope I will have another opportunity to continue my thoughts on this very important issue.

Protection of Freedom of Conscience ActRoutine Proceedings

October 30th, 2018 / 10:05 a.m.
See context

Conservative

David Anderson Conservative Cypress Hills—Grasslands, SK

moved for leave to introduce Bill C-418, an act to amend the Criminal Code (medical assistance in dying).

Mr. Speaker, it is my honour today to table the protection of freedom of conscience act. The purpose of this is to protect the rights of health care professionals who conscientiously object to participation in medical assistance in dying, making it an offence to intimidate or try to force a health care professional to be involved in this activity. It also makes it an offence to fire or refuse to employ a health care professional for refusing to take part, either directly or indirectly, in the provision of medical assistance in dying.

I believe it is time to stand up for the doctors and health care providers who are not willing to leave their core ethics behind when they are at a patient's bedside. Access to medical assistance in dying and the right to conscientious objection are not mutually exclusive.

(Motions deemed adopted, bill read the first time and printed)