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

This bill was last introduced in the 43rd Parliament, 2nd Session, which ended in August 2021.

This bill was previously introduced in the 43rd Parliament, 1st Session.

Sponsor

David Lametti  Liberal

Status

This bill has received Royal Assent and is now law.

Summary

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) repeal the provision that requires a person’s natural death be reasonably foreseeable in order for them to be eligible for medical assistance in dying;
(b) specify that persons whose sole underlying medical condition is a mental illness are not eligible for medical assistance in dying;
(c) create two sets of safeguards that must be respected before medical assistance in dying may be provided to a person, the application of which depends on whether the person’s natural death is reasonably foreseeable;
(d) permit medical assistance in dying to be provided to a person who has been found eligible to receive it, whose natural death is reasonably foreseeable and who has lost the capacity to consent before medical assistance in dying is provided, on the basis of a prior agreement they entered into with the medical practitioner or nurse practitioner; and
(e) permit medical assistance in dying to be provided to a person who has lost the capacity to consent to it as a result of the self-administration of a substance that was provided to them under the provisions governing medical assistance in dying in order to cause their own death.

Elsewhere

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.

Votes

March 11, 2021 Passed Motion respecting Senate amendments to Bill C-7, An Act to amend the Criminal Code (medical assistance in dying)
March 11, 2021 Failed Motion respecting Senate amendments to Bill C-7, An Act to amend the Criminal Code (medical assistance in dying) (amendment)
March 11, 2021 Passed Motion for closure
Dec. 10, 2020 Passed 3rd reading and adoption of Bill C-7, An Act to amend the Criminal Code (medical assistance in dying)
Dec. 3, 2020 Passed Concurrence at report stage of Bill C-7, An Act to amend the Criminal Code (medical assistance in dying)
Dec. 3, 2020 Failed Bill C-7, An Act to amend the Criminal Code (medical assistance in dying) (report stage amendment)
Oct. 29, 2020 Passed 2nd reading of Bill C-7, An Act to amend the Criminal Code (medical assistance in dying)

Criminal CodeGovernment Orders

February 27th, 2020 / 5:50 p.m.
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Parkdale—High Park Ontario

Liberal

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

Madam Speaker, I want to thank the hon. member for Saanich—Gulf Islands for her contributions today and every day in this chamber for so many years.

The member led us through a very eloquent chronological history of the status of the jurisprudence, from Sue Rodriguez to the Carter decision to the Truchon decision, as well as the idea of Parliament keeping up with and responding to the law.

There has been debate, and it is fair debate, in this chamber over the last two days about how we are attempting to exceed the Truchon decision in some respects by wading into the area of advance directives and addressing what is now becoming known as the Audrey Parker amendment.

I would like to have the member's sense and thoughts about trying to get in front of the courts, at least on this occasion, and whether that is a prudent step in terms of empowering and respecting the dignity of people who are in such precarious positions and want to maintain some control over their final days.

Criminal CodeGovernment Orders

February 27th, 2020 / 5:50 p.m.
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Green

Elizabeth May Green Saanich—Gulf Islands, BC

Madam Speaker, I do not think we are getting ahead of the law. I think the advance consent, the Audrey Parker amendment, within this legislation is exactly within the four corners of the decision in Carter. The question of when one's rights as a human being, under the Charter of Rights and Freedoms, are impinged was directly related, in Carter, to having to foreshorten one's own life because one knew one might not be able to consent later.

I would say we may be slightly ahead of a court decision striking the current law down, but we are not getting ahead of the law. We are finally meeting it.

Criminal CodeGovernment Orders

February 27th, 2020 / 5:50 p.m.
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Conservative

Tamara Jansen Conservative Cloverdale—Langley City, BC

Madam Speaker, the hon. member asked what the trajectory is of the issue of euthanasia in this country, and I thank her for asking. It is really important that we make a concise assessment of where we are going with this legislation.

It is clear that this bill is ensuring that our country will prioritize euthanasia access, while allowing palliative care to take a back seat. As we know, a request for physician-assisted death cannot be truly voluntary if the option of proper palliative care is not available.

Is the hon. member willing to admit that palliative care in this country is abysmal, and dwindling more and more every day, due to the government's desire to push euthanasia as the preferred treatment option?

Criminal CodeGovernment Orders

February 27th, 2020 / 5:50 p.m.
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Green

Elizabeth May Green Saanich—Gulf Islands, BC

Madam Speaker, to the hon. member for Cloverdale—Langley City, not only am I not willing to admit it, I think the assertion is absurd. I think the assertion is offensive. Nobody in this place, regardless of party, would place euthanasia as a desired outcome over a full range of choices.

It does not require admitting anything. I asked the Minister of Health earlier in this place whether she would agree that services are not adequate for the provision of counselling, mental health services and, of course, assistance in having access to the facilities that make palliative care so much desired and so much preferred for patients and families across Canada.

I would urge the hon. member to rethink this. One cannot allege that the lack of services in palliative care is due to anyone's desire to push death over adequate care. I think the very notion is outrageous.

Criminal CodeGovernment Orders

February 27th, 2020 / 5:55 p.m.
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NDP

Alexandre Boulerice NDP Rosemont—La Petite-Patrie, QC

Madam Speaker, I find it quite incredible that the official opposition is suggesting that the government wants to favour euthanasia over palliative care. I find that quite shocking.

There is one issue that concerns me in relation to people with Alzheimer's disease. Unlike physically degenerative diseases, Alzheimer's disease can last for years. How does my colleague view the possibility of advance consent?

Criminal CodeGovernment Orders

February 27th, 2020 / 5:55 p.m.
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Green

Elizabeth May Green Saanich—Gulf Islands, BC

Madam Speaker, I hope my answer will be brief. I thank my colleague from Rosemont—La Petite-Patrie.

These are such complex issues that I would prefer to wait for the review that is scheduled to take place soon, five years after the current act came into force. My own father died of Alzheimer's, and I am not sure what he would have done if he had this option. I want to take the time to think about it.

Criminal CodeGovernment Orders

February 27th, 2020 / 5:55 p.m.
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Conservative

Kelly Block Conservative Carlton Trail—Eagle Creek, SK

Madam Speaker, I appreciate the opportunity to speak on Bill C-7, an act to amend the Criminal Code regarding medical assistance in dying, which was introduced earlier this week and dramatically expands the existing euthanasia regime in Canada.

This bill was introduced in response to a ruling made September 11, 2019, where the Superior Court of Quebec found, in Truchon versus the Attorney General of Canada, that it was unconstitutional to limit access to medical assistance in dying to people nearing the end of life.

I believe it is completely unacceptable that the government did not appeal the Truchon decision to the Supreme Court. Truchon struck down vital protections for vulnerable Canadians that the Liberal government put in place less than five years ago. Appealing this decision would have allowed us to get certainty on the framework within which Parliament can legislate.

The summary of the bill states that it amends the Criminal Code to:

among other things,

(a) repeal the provision that requires a person's natural death to be reasonably foreseeable in order for them to be eligible for medical assistance in dying...

It excludes mental health as an eligible reason to receive assisted suicide. It creates two sets of safeguards that must be respected before medical assistance in dying may be provided, which differ in application depending on whether death is reasonably foreseeable. It also creates an advance directive wherein a medical practitioner can proceed with assisted suicide without consent immediately before administering it, assuming all other criteria are met and the patient enters into an arrangement in writing with a medical practitioner or a nurse practitioner to cause death on a specified day.

While these changes are significant, it is the other things where I will focus most of my attention. In responding to Bill C-14 in the last Parliament and now to this bill, it has always been our priority, on this side of the House, to ensure that legislation permitting euthanasia and assisted suicide includes safeguards for the most vulnerable in our society, as well as for the conscience rights of physicians and allied health professionals.

Of all the proposed changes, I am most concerned about the removal of the 10-day waiting period. This was not a change mandated by Truchon. Rather, it is a deliberate choice by the Liberal government to strike down one of the most important safeguards for vulnerable people facing uncertain medical prognoses.

Nearly every one of us can think of someone in their lives, perhaps a friend, a grandparent or even a spouse, who has received a serious diagnosis. The emotional impact of hearing that news can be overwhelming for both the patients and their families. It can cause depression, anxiety and a great fear of the unknown.

I am sure many of us can also think of people we know who have received terminal diagnoses and went on to beat their illness and live for years afterwards. However, with the safeguard of a 10-day waiting period gone, such stories may be fewer and farther between.

Without having to take the time to come to terms with their situation, to speak to their families and to learn about treatment options from their doctors, many people will make emotional decisions based on fear.

Another amendment removes the need for two independent witnesses and allows health care workers to act as witnesses. People may not even hear another voice offering a different solution.

By making these changes, we diminish the extremely important role legislators play in contemplating all of the unintended outcomes and consequences and then protecting against them. We know very well that the current euthanasia regime has serious problems, that it has been abused and that it has been used as a tool of desperation after the failures of government.

Sean Tagert suffered from an advanced case of ALS that left him completely paralyzed, unable to speak and reliant on a ventilator. Despite these challenges, Tagert fought to stay alive so he could watch his son, whom he spoke of in lengthy Facebook posts, grow up.

Sean required 24-hour in-home medical assistance to stay alive. Initially the health care system provided him only 15 hours, leaving Sean to somehow pay hundreds of dollars each day. Eventually, even that was too much for the health authority. Health care authorities told Sean that he would no longer receive funding for home care, leaving as his only option institutional care at a facility hours away, separated from family and removed from the son he called his reason for living.

Sean appealed, but to no avail. He was going to lose his home care. Mr. Tagert fought long and hard for the rights of persons with disabilities and their families but in the end, he was driven by his desperate circumstances to believe that assisted suicide was his only option. He was “worn out”, in his own words. On August 6, 2019, he ended his life.

I am going to read from the statement his family posted at that time:

We would ask, on Sean's behalf, that the government recognize the serious problems in its treatment of ALS patients and their families, and find real solutions for those already suffering unimaginably.

“Real solutions” does not mean removing the safeguards for those who are the most vulnerable. It means providing true alternatives, be that palliative care, in-home care or the unique care needed.

It is not enough to simply put in legislation as we find here in proposed paragraph 241.2(3.1)(g), under Safeguards:

...[to] ensure that the person has been informed of the means available to relieve their suffering, including, where appropriate, counselling services, mental health and disability support services, community services and palliative care and has been offered consultations with relevant professionals who provide those services or...care.

If we have no intention of ensuring that those services are being funded or are even available, we have failed.

I note that the current federal government broke a key election commitment to invest $3 billion in long-term care, including palliative care. Access to palliative care is an essential part of end-of-life decision making. That point has been made over and over during this debate.

People should never be put in a position where they believe death is the only solution available to them. We are, and we must be, better than that. We must protect every human life with a jealousy born of the knowledge that each person is unique, and has an innate dignity that nothing, not time, not illness nor disability, can ever take away.

Criminal CodeGovernment Orders

February 27th, 2020 / 6:05 p.m.
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Parkdale—High Park Ontario

Liberal

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

Madam Speaker, I have one point of clarification and then one question for the hon. member.

I thank her for her comments today. The point of clarification is that the contribution, actually two budgets ago by the government, to palliative care and long-term care was $6 billion, not $3 billion.

I have a question. There are safeguards. The member opposite mentioned a catastrophic event or a diagnosis that could be shocking to an individual. That is exactly what we have contemplated by creating a second track for people whose death is not imminent and people whose death is not reasonably foreseeable.

The legislation entrenches a 90-day assessment period, a period of time when the person must be informed of counselling, mental health supports, disability supports, community services and palliative care, and then an acknowledgement from the medical practitioner that the person has appropriately considered those options.

Is that the exact type of response that the member opposite feels is required to ensure people are not making this decision, which is a permanent decision, with undue haste?

Criminal CodeGovernment Orders

February 27th, 2020 / 6:05 p.m.
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Conservative

Kelly Block Conservative Carlton Trail—Eagle Creek, SK

Madam Speaker, I would suggest that one of the safeguards that I feel should have been left in the legislation was the 10-day period of reflection. I think that was very important to leave in this legislation, as I mentioned in my remarks.

The observations have already been made that this could be waived, and I recognize that. However, I think any time we can keep a safeguard in place that allows individuals that sober second thought, we should do that.

Criminal CodeGovernment Orders

February 27th, 2020 / 6:05 p.m.
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Bloc

Andréanne Larouche Bloc Shefford, QC

Madam Speaker, I thank my colleague for her speech.

I would like to remind her that medical assistance in dying is an intervention allowed only in exceptional cases, under very strict conditions. Access to this intervention is strictly regulated by law.

Bill C-7 will not bring about an unreasonable increase in MAID cases. According to a report of Quebec's commission on end-of-life care, from December 10, 2015, to March 31, 2018, a total of 830 requests for MAID were denied for various reasons, including the death of the person before the procedure, the withdrawal of the request by the sick person or a death that was not reasonably expected.

In short, there is nothing in Bill C-7 that will cause a substantial increase in requests for medical assistance in dying.

Criminal CodeGovernment Orders

February 27th, 2020 / 6:05 p.m.
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Conservative

Kelly Block Conservative Carlton Trail—Eagle Creek, SK

Madam Speaker, I do not think there was a question there. However, my hon. colleague made some observations about whether access to MAID has increased in her province.

I will state again something I said in the remarks I made. I believe it is incumbent upon legislators, who have been given the very important role of putting legislation in place, to always look at legislation to understand and try to address any unintended consequences and then protect against them. Leaving safeguards in place that do not unduly create duress should be the route we choose to take.

Criminal CodeGovernment Orders

February 27th, 2020 / 6:10 p.m.
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NDP

Randall Garrison NDP Esquimalt—Saanich—Sooke, BC

Madam Speaker, I want to ask the member about what I think is an unintended consequence of Bill C-14. It is the situation where people are forced to choose to go early because they are afraid of losing competence at the last minute, something the new bill addresses.

There are many examples of it across the country, I have one example that is very close to me. I have friend who wanted to see family and relatives and spend some time doing last things because she had a very serious brain tumour. She chose to go earlier because she feared losing competence.

That is an unintended consequence of the current legislation. People should be able to make that choice and have an orderly and dignified end to their lives. Does the member not see that as an unintended consequence?

Criminal CodeGovernment Orders

February 27th, 2020 / 6:10 p.m.
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Conservative

Kelly Block Conservative Carlton Trail—Eagle Creek, SK

Madam Speaker, when Bill C-14 was introduced in the previous Parliament, the decision was made to not include advance directives. I think that was purposeful. Had we been allowed to deal with the issues that the Truchon case identified and keep all of these other issues in mind for the statutory review that is being contemplated, it would have allowed us far more time to look at the legislation, see what was and was not working and have a timely and comprehensive study of Bill C-14.

Criminal CodeGovernment Orders

February 27th, 2020 / 6:10 p.m.
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Dartmouth—Cole Harbour Nova Scotia

Liberal

Darren Fisher LiberalParliamentary Secretary to the Minister of Health

Madam Speaker, medical assistance in dying, or MAID, is complex. It is a deeply personal and difficult topic, yet this past January alone, more than 300,000 Canadians took part in the online public consultation to have their say. Many others, including experts and family members of loved ones who received MAID, took part in round-table discussions.

We also heard how the legislation is working from many of the conscientious health care providers involved in delivering this service. Canadians are engaged and aware of the importance of bringing the compassionate, sensible measures contained within Bill C-7, an act to amend the Criminal Code (medical assistance in dying).

This bill builds on the foundation laid by the current legislation on MAID, passed by Parliament in June 2016, and extends eligibility for MAID to persons who, while suffering intolerably, may not be at the end of life. This bill respects the Truchon decision and supports the autonomy of Canadians wanting to make an informed choice to end the suffering they face as a result of serious illness, regardless of whether their condition is life-threatening in the near term.

Respecting the autonomy of Canadians while protecting the safety of vulnerable people remains our central objective. That is why Bill C-7 proposes a two-track approach to safeguards, based on whether or not a person's death is reasonably foreseeable.

We have proposed to ease certain safeguards that had the unintended consequence of creating a barrier for someone accessing MAID whose death is deemed reasonably foreseeable, and we will introduce new and modified safeguards for eligible persons whose death is not reasonably foreseeable.

Bill C-7 would permit the waiving of final consent for persons at the end of life who have been already assessed and approved to receive MAID, but who are at risk of losing their decision-making capacity before it can be provided. There was very strong support for this type of amendment from Canadians, experts, health care providers and their professional regulating bodies.

Our government recognizes the importance of data and science-based evidence in the decision-making process. That is why this bill proposes that we expand data collection through the federal monitoring regime to provide a more complete picture of MAID in Canada.

I would like to note that following the Truchon decision there has been widespread speculation about the potential for persons solely with mental illness to be eligible for MAID. However, many stakeholders in the mental health community have expressed deep concern about this possibility. They feel this option directly conflicts with important treatment principles, which are that there is always hope for recovery and that people can live fulfilling lives with a mental illness.

From the perspective of many health care providers and many health care specialists, assessing eligibility for such individuals poses numerous challenges. Mental illnesses are not generally considered to be incurable, which is a requirement under the current law. In addition, the trajectory of such conditions can be more difficult to predict.

In light of the multiple challenges we heard and the lack of support from the practitioner community who would bear the responsibility for conducting eligibility assessments, this bill does not permit MAID for persons whose sole medical condition is a mental illness.

This decision was not taken lightly. It in no way implies that suffering associated with mental illness is any less severe or more tolerable than that associated with another medical condition, such as one arising from a physical condition. Rather, this decision reflects the many uncertainties underlying this question and a concern that allowing MAID in these circumstances could place Canadians at risk.

We recognize that there are proponents who support MAID eligibility for persons solely with a mental illness. However, in light of the Quebec court decision and the compressed time frame for legislative amendments, there is insufficient time to fully address this topic and determine whether a regime that allows access to MAID for persons whose sole underlying condition is a mental illness is viable.

For these reasons, we are adopting an incremental and cautious approach. It is our view that this issue should be explored as part of the parliamentary review process, which is expected to begin later this year.

It is easy as parliamentarians and as legislators to lose the human element of what we do and to focus on talking points and politics, but these compassionate and sensible measures have come from extensive consultation with Canadians, experts and folks who have lived with the unintended consequences of the original legislation.

These are folks like the late Audrey Parker, a Nova Scotian who wanted to spend just one last Christmas with her family but ended her life through MAID two months prior, while she could still give consent.

I want to take this time to read some of Audrey Parker's final posts into the record so they will be preserved in Hansard, because this legislation includes her amendment. As my colleagues in the House debate, discuss and study the bill, I want them to remember that there are many folks like Audrey across Canada who deserve this autonomy and this compassion.

She said:

“This is my last note to you. I can tell you I loved my life so much and I have no regrets. I feel like I’m leaving as my best self and I’m ready to see what happens when I die today. I’m hoping for something exciting to happen but I guess I won’t know until the time is here.

“The one thing I’m happiest about, is that I finally found ‘my people’ during my lifetime. I’ve even met new people that I already adore near the end of my journey so it’s never too late for anything in life.

“In the spirit of teaching and sharing, I’d like to leave you with some words that explain my position with MAID.

“When the MP’s debated MAID federally, someone decided to add late stage consent as a fail-safe to ensure no one dies at the hand of another.

“There are four categories of MAID candidates.... Of the four categories, the only one that is cut and dried is my category of Assessed and Approved. We are terminal, suffering outrageous pain and there is no time frame with using MAID. The kicker that makes it difficult is the late stage consent.

“As I near my death today, it is even more evident than ever before, that late stage consent has got to be amended and removed from MAID in Canada for my category of end users.”

“Dying is a messy business. I can’t predict when cancer will move into my brain matter or when something else big happens to make me more unwell. I and only I can make that decision for myself. It’s about living out every extra day that I can. No one including my doctor knows what the right day to die will be. Only I can know that as I wake each day. I’m not going to wait until I lose myself.... I wanted to make it to Christmas and New Year’s Eve... my favorite time of the year but I lost that opportunity because of a poorly thought out federal law.

“Had late stage consent been abolished, I simply would have taken my life one day at a time. If I noticed I was losing capacity, I would have taken control myself....and called my doctor to come assist me with my death. All I have to give is 24 hours notice so she can pick up the drugs from the drug store in my neighborhood. We were totally organized but the law tied our hands.

“This decision has to come from the patient. No one else. That’s why we the dying should be living day to day until we have to leave by invoking MAID.

“Be happy everyone and be kind to others.... Audrey.”

I ask that all members in the House support Bill C-7.

Criminal CodeGovernment Orders

February 27th, 2020 / 6:20 p.m.
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Conservative

Gérard Deltell Conservative Louis-Saint-Laurent, QC

Madam Speaker, obviously everyone is very touched by the testimony of our colleague.

The member talked about his support for the bill. I too support it. However, I have concerns with the timeline.

I was part of the National Assembly of Quebec when it became the first legislator in Canada to adopt a bill about this issue. It took us six full years. I was part of the committee that worked on the bill that the House of Commons adopted four years ago. It took us six full months.

As far as I am concerned, there is obviously a rush for some people, but does the member think we should take all the time necessary and do all the consultation necessary to achieve the best bill possible?