Bill C-230

Protection of Freedom of Conscience Act

An Act to amend the Criminal Code (intimidation of health care professionals)

This enactment amends the Criminal Code to make it an offence to intimidate a medical practitioner, nurse practitioner, pharmacist or 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 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.

Medical Assistance in Dying

[Arnold Viersen, Conservative, Peace River—Westlock, AB]

Mr. Speaker, I have a petition in support of Bill C-230.

The petitioners, who come from across Canada, are concerned about doctors and health care professionals who might be coerced into engaging or supporting euthanasia against their conscience. They want these conscience rights and second options to be protected. The petitioners note that doctors deserve freedom of conscience and that the Canadian Medical Association has confirmed that conscience protection would not be a limit to their use. The petitioners also describe how, during the Special Joint Committee on Physician-Assisted Dying, witnesses stated that conscience rights should be protected by the government in the response to the Carter decision.

The petitioners are calling on Parliament to enshrine in the Criminal Code protection of conscience rights for physicians and health care workers from coercion or intimidation, so that they would not have to provide or refer for assisted suicide or euthanasia.

[Len Webber, Conservative, Calgary Confederation, AB]

Mr. Speaker, I have a petition today from many Canadians who are concerned about the lack of conscience rights for medical professionals. They strongly support the aim of Bill C-230, so it is truly disappointing that the Liberal government does not respect the rights of many.

As I said in my speech on this matter last week, I truly believe that as a society we must find a way to give Canadians something without taking something away from others. The protection of conscience rights does just this by ensuring lawmakers can, in good conscience, give access to certain medical procedures without unjustly compromising the existing freedoms exercised by others.

Protection of Freedom of Conscience Act

[The Speaker, Liberal, Anthony Rota]

Pursuant to order made Thursday, June 23, the House will now proceed to the taking of the deferred recorded division on the motion at second reading stage of Bill C-230 under Private Members' Business.

The House resumed from September 29 consideration of the motion that Bill C-230, An Act to amend the Criminal Code (intimidation of health care professionals), be read the second time and referred to a committee.

[Kelly Block, Conservative, Carlton Trail—Eagle Creek, SK]

Madam Speaker, I am thankful for the opportunity to close the debate on my bill, the protection of freedom of conscience act.

I believe this is a straightforward piece of legislation. It would make it an offence to intimidate a medical professional to participate in medically assisted suicide, directly or indirectly, or to dismiss from employment or refuse to hire a medical professional simply because they refuse to take part in medically assisted dying.

With the removal of safeguards, the slippery slope that many predicted when medically assisted suicide was decriminalized has come to fruition. Additionally, the courts and government legislation have expanded medically assisted suicide far beyond what was conceived in the Carter decision of 2015. Now, those who promote euthanasia support medically assisted suicide for the mentally ill, with some even believing that children should be eligible. This is creating turbulent and stressful times for many in the medical field.

Given this expansion of medical assistance in dying, there is the growing concern or objection among many medical professionals, whether they support MAID or disagree with it, that they may be forced to participate, even if they do not believe that it is in a particular patient's best interest based on their expertise and knowledge of the patient's history. More and more are becoming aware of the erosion of respect for their professional judgment and the precious relationship between the health care provider and their patient.

Unlike what some are trying to portray, this bill does not relitigate the legality of MAID, nor does it seek to impede a patient's access to MAID. Rather, it seeks to protect a medical professional's charter right not to participate in medically assisted suicide when they cannot in good conscience do so.

Section 2 of the Canadian Charter of Rights and Freedoms specifically says:

Everyone has the following fundamental freedoms:

(a) freedom of conscience and religion;

During the first hour of debate, my colleague, the member for St. Albert—Edmonton, reminded us that the Supreme Court's ruling in the Carter decision was predicated on two things: “a willing patient and, as importantly, a willing physician.” He went on to note that in the decision, the Supreme Court stated the following: “we note...that a physician’s decision to participate in assisted dying is a matter of conscience and, in some cases, of religious belief”.

Protecting individuals from coercion of this nature is not foreign to the Criminal Code of Canada, as found in section 425. If Parliament can enshrine criminal penalties for employers for coercing employees not to form a union, then surely we can provide similar protection for medical professionals when dealing with conscience protections.

Throughout the pandemic, we saw just how important every doctor, nurse and medical support worker is to our system. I do not want even one of these amazing men and women to leave Canada or leave the profession because they are faced with a situation of having one of their most precious rights violated.

With Bill C-230, I have put forward comprehensive yet simple legislation that is important to medical professionals from coast to coast. I would welcome a committee's examination of it, as well as any recommendations to improve it.

In closing, it is an honour to have introduced a private member's bill of substance and consequence in this place and to have members debate it. I humbly ask all members to vote in favour of it at second reading so that it can be sent to committee for further study.

[Melissa Lantsman, Conservative, Thornhill, ON]

Madam Speaker, I rise in support of Bill C-230, presented in this House by my friend and my colleague, the member for Carlton Trail—Eagle Creek. The bill we are debating today is worth more than a casual dismissal, as I have heard done in this debate by so many.

The bill, if supported, would provide the protections for charter rights of medical professionals who object to providing or participating in medical assistance in dying, which is something that many Canadians are concerned are not there. This is not a debate about medically assisted dying, on which my own convictions are based on a deeply held personal experience and one I would not wish on anyone in this House.

It is also insulting to hear that some members in this House think that it is exercise in politics. This is a debate that is often used in the simplification of applying a litmus test to carelessly sift people into buckets based on how they see a very complex societal issue, to which some so easily assign a check mark or an X. I also support a woman's right to choose. I always have. I always will. I support the LGBT community and its rights, and not as a check mark but as someone who is a proud member of it.

Canadians have varied opinions on MAID based on deeply held personal circumstances, beliefs and experience. One member in this House said, before opposing these important provisions in the bill, which aims to codify them in law, that he did not see the need for them.

However, I do want to reiterate and emphasize some points that are important to this conversation and should be important to members of this House and Canadians alike. Medical assistance in dying is a deeply held moral and conscientious issue that has legal and ethical questions beyond a simple difference of opinion. We know that from the debates in this House. The medical professionals have a duty to do what is in the best interests of their patients and provide them with the best advice on how to move forward with their care. I will say that this is personal and I will say that I went through it. In this case of medical assistance in dying, there are professional and ethical considerations that should be weighed with the highest degree of importance and a caution that touches on the deep moral convictions that I do not believe have been adequately addressed in the current context of our laws.

That said, this bill aims to add two new offences to the Criminal Code. It does not pronounce on whether conscience-rights protections are somehow up for debate. They are not, despite some members' suggesting that this bill would aim to do things that it would not do.

I do believe that it is important to state, for my colleague and those before her who brought this to the House in a piece of legislation, what it actually says and not fall into an issue that we are not debating today. One, the bill would make it an offence to intimidate a medical practitioner for the purpose of compelling them to take part directly or indirectly in the provision of medical assistance in dying. Two, it also would make it an offence to dismiss or refuse to employ the medical practitioner on that same basis. The debate suggests that the provisions in the Criminal Code already do this, and that is simply not the case.

While the Criminal Code does not compel a medical professional to provide MAID, there is nothing in the Criminal Code that specifically protects medical professionals when they are pressured or coerced into participating in or advising on medical assistance in dying.

Not wanting to discuss this does not make the conversation go away. The bill is a direct response to disability rights groups and groups who are calling for these provisions and who understand first-hand that it is a problem. This bill is a direct response to the first nations groups who have called for this and understand that it is a problem. This bill is a direct response to legal experts. It is a response to mental health professionals who understand that this is a problem. Therefore, saying that it is not a problem does not make it not a problem.

This bill would make certain that medical professionals who choose not to take part in or to refer a patient for assisted suicide or medical assistance in dying would never be forced or coerced to violate their charter rights.

The Ontario Medical Association specifically called for an amendment like this in the bill passed by the government, to provide greater conscience protections for medical professionals, acknowledging that although the current clause in the government's bill, “for greater certainty”, exists, it does not actually do the thing it is supposed to do, which is protect freedom. It cannot be enforced. That is the problem that this bill, which was brought to this floor for debate by my colleague, would correct.

This bill addresses the gap and would close it by establishing two spelled-out and very targeted offences. Stakeholders are calling on those additional safeguards, and any discussion of answering this call should not be callously dismissed. It should be thoughtfully considered on behalf of all Canadians, and certainly those who have asked for provisions like this.

Members opposite have stated throughout the debate a jurisdictional argument, and that it somehow infringes on provincial jurisdiction. It is hard to see it as anything but political when one argues that conscience rights legislation somehow interferes with jurisdiction while simultaneously believing that the legalization of medical assistance in dying does not do the same thing.

To go back to the code for a second and the notion that existing provisions in the Criminal Code already produce satisfactory protections, if that were the case, this bill would not be necessary. However, I believe that notion ought to be challenged, because it is simply not the case. The evidence from those affected should trump the dismissal of evidence from politicians claiming it to be trivial, or worse, not even acknowledged.

This bill would do just as much to protect patients as it does medical professionals, which is something that has not been talked about, by protecting the fundamentally important relationship between a physician and a patient. It would do so by ensuring the advice their physician is providing is free and clear of coercion. That should be a priority, not a land mine we cannot discuss. We should have these discussions here, because they are important and the provisions do not exist as they currently talk about in the code.

There have been laws that created unintended consequences of doctors being forced to participate in providing a patient's death, regardless of whether they believed it was in the patient's best interest or not. The current provisions cannot possibly claim that the Criminal Code already protects the conscience rights of medical professionals, not if one reads the code. The clause I mention confirms only that the Criminal Code is not the source of obligation to participate. It does not state it as an offence. It must actually articulate it as an offence in order for people to effectively deal with it as an offence and in order to enforce it. That is what we are talking about.

Without conscience rights, doctors are constrained to provide medical assistance in dying, regardless of whether it is their professional opinion or is in the best interest of the patient, regardless of their moral, ethical and personal convictions and regardless of their own beliefs. Without the necessary protections, they may be coerced and they may be intimidated, and those rights would have no value as a result.

Many of us today might be or might have been in a situation where a loved one has a difficult choice to make about their health. Why would we not want our loved ones to receive the best possible care, the most options and the best options from good doctors, based on advice that has not been coloured by possible intimidation?

Over the past years, we have seen just how much Canadians depend on our health care system and how crucial doctors and medical professionals who work in that system have been. Every Canadian has, or at least a number of Canadians have experienced or are experiencing now how important the system is, and making sure that system works is even more important.

We need to create a work environment for medical professionals that protects them, supports them, encourages them and attracts the most qualified people possible to the profession. I encourage members in this House to support the passage of this protection of freedom of conscience act. I hope those with deeply held conviction will understand what my hon. colleague is trying to achieve for patients, doctors and those wanting to see them protected.

[Len Webber, Conservative, Calgary Confederation, AB]

Madam Speaker, it is my pleasure to rise today to speak to Bill C-230, the protection of freedom of conscience act. My colleague from Carlton Trail—Eagle Creek has worked hard to bring this legislation forward, and I applaud her for doing so. Right off the bat, though, I do want to say that my hon. colleague and I come at these issues from opposite ends, but I thank her for encouraging me to share a different perspective on the matter.

I support a woman's right to seek an abortion, and I always will. I support Canadians having access to medical assistance in dying, and I always will. In fact, I proudly supported the legislation that made access to medical assistance in dying possible several years ago. However, I also respect that a medically assisted death is not acceptable for a large number of Canadians, especially those who hold strong religious convictions where their teachings prohibit such acts. Today I find myself standing strongly to defend those who disagree with my fundamental beliefs. If we want others to defend our rights and freedoms, we have to be willing to defend theirs.

Rights and freedoms are a two-way street. As I said in 2016, while debating MAID, this is a complex issue for which there are strong opinions on both sides. Trying to solve and encapsulate such complex emotional issues into legislation is always a challenge and it will never be perfect. As such, I strongly supported the original legislation's requirement that there be a review at the five-year mark to re-evaluate the legislation. I feel that this thorough re-evaluation has never taken place and breaks faith with the spirit of the original legislation, so I would strongly urge the Liberal government to undertake a deep review of the MAID legislation and address its shortcomings. The trust of Canadians is being put to the test and it does not have to be this way.

I have also been a very strong advocate for palliative care and will continue to be. My dear friend, Lou Winthers, who worked for me in my constituency office for many, many years, was the executive director of Rosedale Hospice in Calgary. My family and I volunteered there and saw directly the importance of palliative care. Also, my late father-in-law, David Macdonald, was the executive chef at the Rosedale Hospice in Calgary. He spent much of his long career as an executive chef in many of the prime hotels throughout the country. He spent his final years cooking for the dying in the hospice.

As many members know, I was widowed when my wife passed away from breast cancer. That journey, more than any other, showed me that palliative care is necessary and timely access to it is critical. In fact, one of the conditions on which I supported MAID was that we simultaneously and strongly support palliative care. One cannot replace the other. They are both needed. The fact is that palliative care remains grossly underfunded and access is hit-or-miss depending on where one lives and when one needs it.

Both MAID and palliative care rely on medical professionals. These professionals are people, real people, with personal beliefs, personal convictions and personal experiences. I can understand that not all medical professionals support abortion or MAID, and I support their belief that they should not be forced to perform certain procedures that put them at odds with their conscience, their beliefs and their community. Quite frankly, I would not want to have a procedure performed on me by anyone who did not believe in what they were doing. Would it not be better to know if one's doctor or nurse was willing to put 100% effort into their work before the procedure started?

Protecting conscience rights ensures that both the patient and the medical staff are fully informed and aware of issues when giving consent. I do not need to go into detail to explain the importance of informed consent in the medical process, but I believe protections of conscience rights are an important aspect of the whole informed consent process.

The whole process of dying is deeply personal and individually unique. Sometimes, a person will have experiences with the dying that leave lasting impressions, and I feel compelled to share one here tonight.

On a Thursday in August 2020, a constituent, Sophia Lang, wrote to me to tell me she had been approved for MAID. She said:

You have no idea how much peace of mind that gives me: that there is a merciful way out of needless pain and suffering. I thank the Lord each day that I have that option for when life is no longer worth living.

She went on to say:

However there is a problem. One needs to have mental faculties to be able to consent at the very end. That is a reason that many people—and I may be one of them—choose to activate MAID early: for fear of being unable to consent at the end. I wish you, as my representative in parliament, to help improve the law so that advance directives are made legal. Many people would be able to live longer and at peace.

Imagine my shock when I later learned that we were having these exchanges in her last days. She died just four days after our last exchange, as I learned through the Calgary Herald obituaries. She never mentioned how close she was to leaving this world in any of our emails. I found it so powerful that when she had so little time left on this earth, she spent precious moments advocating for those who would follow in her footsteps.

Sophia has been gone for two years now, but her voice is not silent. I will continue to support access to MAID, advocate for proper advance directives and strongly call for a better palliative care system in Canada. At the same time, I will defend and speak for those who have conscience objections to these procedures.

I truly believe that as a society we must find a way to give Canadians something without taking something away from others. Protection of conscience rights does just this by ensuring lawmakers can, in good conscience, give access to certain medical procedures without unjustly compromising the existing freedoms exercised by others.

As Democrat politician and American lawyer Joe Andrew famously said, the hardest decisions in life are not between good and bad or right and wrong, but between two goods or two rights. I believe we can find a common ground on these issues, and we must. We need to find a way to make rights compatible and find a way to give something to some without taking away from others.

I call on all members of the House to support getting the bill to committee. I think this is an important conversation we need to have as a Parliament. Again, I understand that my colleague and I have fundamental disagreements on issues like MAID and abortion, but I hope we have demonstrated to our colleagues that when members do share common ground on an issue, like conscience rights, we owe it to Canadians to work together.

I would also like to say that the National Day for Truth and Reconciliation is an opportunity to make Canada better. It is a moment to reflect on our failures of the past, the impact they continue to have today and how we can bring about the healing that is required. We are a nation of nations, a people of peoples, and we have an opportunity to use this occasion to better ourselves and our country.

I hope all Canadians reflect on their individual and our collective responsibilities to bring about changes that are needed. True truth and reconciliation is our shared path to a better Canada.

[Nathalie Sinclair-Desgagné, Bloc, Terrebonne, QC]

Madam Speaker, we are here to discuss Bill C-230, which would amend the Criminal Code to make it an offence to intimidate health care personnel—a medical practitioner, nurse practitioner or anyone who could provide medical assistance in dying. It seeks to create a Criminal Code offence to “protect” health care personnel. These health care professionals, now and in the future, may take part in the provision of medical assistance in dying.

Excuse me, Madam Speaker, but there is a lot of commotion. I would like to give my speech in peace.

[Mark Gerretsen, Liberal, Parliamentary Secretary to the Leader of the Government in the House of Commons (Senate)]

Madam Speaker, I am pleased to participate in the debate on Bill C-230, the protection of freedom of conscience act. I appreciate the contributions of the member for Carlton Trail-Eagle Creek to medical assistance in dying, or MAID, which is a complex and deeply personal issue to many Canadians.

First, I want to acknowledge that the aim of the bill, which is to support the conscience rights of health care professionals, is indeed laudable. The government has always supported conscience rights, which is why, since the very beginning of Canada's MAID framework in a former bill, Bill C-14, these rights have been specifically recognized and acknowledged. However, at the same time, the criminal law is a blunt instrument that should be reserved for the most serious situations.

In my remarks today, I want to raise some questions about whether new offences are an appropriate solution to the legitimate concerns raised by the bill's sponsor. In this regard, it bears recalling the primary reason the criminal law is concerned with MAID in the first place, which is to provide the necessary exemptions to ensure that persons who choose to provide or assist in providing MAID do not face criminal consequences for doing so. The MAID provisions found in the Criminal Code were carefully crafted to respect the autonomy of Canadians, respond to the evolving issues and protect vulnerable persons. In other words, the involvement of criminal law is necessary to permit MAID while ensuring it is carried out in a safe, responsible manner.

However, Bill C-230 seeks to involve the criminal law in two very different ways: first, to create a new MAID-specific intimidation offence, and second, to create an employment sanctions offence. With respect to the former, the intimidation offence, it is worth reiterating that the Criminal Code already provides provisions for several offences that would be available to respond to situations where a health care professional is a victim of coercive or threatening behaviour, including the intimidation offence in section 423 and the extortion offence in section 346.

To me, it is not evident that an additional specific offence is required to protect conscience rights. I should also say that I am not aware of any evidence of health care professionals facing threatening circumstances in the context of refusing to provide MAID or that there is a specific gap that needs to be filled in our law.

I have taken note of the fact that the proposed intimidation offence in Bill C-230 would be a summary conviction offence, which, if enacted, would stand out from other intimidation offences in the Criminal Code. The existing offences are either straight indictable or hybrid offences. In addition to being duplicative of existing offences, the fact that the proposed intimidation offence would only be prosecutable by summary conviction may suggest that intimidating conduct is less serious in a MAID context, which seems counterintuitive.

To further highlight why I have concerns about creating a specific intimidation offence as proposed by Bill C-230, I would like to draw members' attention to a recent example that offers a clear contrast. Last year, as members will recall, unfortunately in some parts of our country there was a threatening atmosphere of intimidation present for many health care professionals who were simply trying to go to work and care for members of their communities during the pandemic. That is why the government responded with Bill C-3, an act to amend the Criminal Code and the Canada Labour Code, which provided new criminal law tools to protect all health care workers and all Canadians who are seeking their care.

I believe Bill C-3 was an appropriate criminal law response to the credible threats to the safety and security of health care professionals and Canadians, but I am not convinced that a similar response is necessary when it comes to the situation of conscience rights and the provision of MAID. It seems to me that the charter and existing criminal law offences already provide the necessary protections for those rights, alongside the specific provision in the current MAID framework that expressly states that nothing in the federal law compels an individual to provide or assist in providing MAID. There is simply no obvious need to supplement what already exists.

Turning to the employment sanctions offence, I am struggling with Bill C-230's proposal to create a new offence that would exclusively target employers who dismiss or refuse to employ health care professionals who choose not to provide MAID. Moreover, in my view, Bill C-230's employment sanctions offence would not address the concerns described in the bill's preamble regarding conscience rights and certain requirements for professionals to make effective referrals for MAID.

As members are aware, in some jurisdictions, the professional orders that regulate health care professions have established requirements that their members provide effective referrals for MAID. While there have been cases where these requirements were challenged, the courts, including the Court of Appeal for Ontario, have upheld them, noting that this is a difficult issue that involves taking into consideration the conscience rights of professionals and the needs of their patients.

I do not believe it would be constructive for Parliament to intervene by creating a new criminal offence such as the one proposed by the bill. Rather, a more productive approach is for the government to continue its efforts to work closely with the provinces and territories on the implementation of MAID in a manner that supports persons who may be considering it and the health care professionals who provide exceptional care to their patients.

For the reasons I have mentioned, I have significant concerns with Bill C-230. While I agree wholeheartedly with protecting the conscience rights of all health care professionals, including those who choose to participate or refuse to participate in MAID, I am not persuaded that the two offences proposed in the bill are necessary or desirable.

The House resumed from March 28 consideration of the motion that Bill C-230, An Act to amend the Criminal Code (intimidation of health care professionals), be read the second time and referred to a committee.

Medical Assistance in Dying

[Glen Motz, Conservative, Medicine Hat—Cardston—Warner, AB]

Madam Speaker, the second petition has to do with conscience rights. Yesterday, my colleague from Carlton Trail—Eagle Creek spoke on her bill, Bill C-230, the protection of freedom of conscience act, and I am presenting a petition today that supports this legislation. The petitioners are concerned about doctors and health professionals who might be coerced into engaging and supporting euthanasia or MAID, and they want conscience rights and second opinions to be protected.

The petitioners ask that protection of conscience rights be enshrined into law, protecting physicians and health care workers from coercion or intimidation regarding providing or referring someone for MAID or euthanasia.

Protection of Freedom of Conscience Act

[Michael Cooper, Conservative, St. Albert—Edmonton, AB]

Madam Speaker, I rise in strong support of Bill C-230, the protection of freedom of conscience act, introduced by my friend, the member for Carlton Trail—Eagle Creek.

The bill before us is much-needed legislation to protect the charter rights of medical professionals who conscientiously object to providing or otherwise participating in medical assistance in dying. I want to commend the member for her steadfast leadership in championing conscience rights and for bringing this bill back to the House, as she introduced a similar bill that died on the Order Paper in the last Parliament.

Medical assistance in dying raises profound legal, moral and ethical questions. The trial judge in the Carter decision, which struck down the Criminal Code prohibition against physician-assisted death, stated, “The evidence shows that thoughtful and well-motivated people can and have come to different conclusions about whether physician-assisted death can be ethically justifiable.” This is true of patients, and it is true of medical professionals.

Medical professionals have a duty to do what is in the best interest of their patients and to provide the best possible advice based upon their judgment and experience, all of which are grounded on moral and professional convictions. In the case of medical assistance in dying, there are professional, moral and ethical considerations of the highest weight.

In the Carter decision, the Supreme Court predicated its decision on two things: a willing patient and, as importantly, a willing physician. At paragraph 132 of the Carter decision, the court said that nothing in its pronouncement would compel medical professionals to participate in MAID. The court went further in stating that, “However, we note...in addressing the topic of physician participation...that a physician’s decision to participate in assisted dying is a matter of conscience and, in some cases, of religious belief.” In other words, again, it requires a willing patient and a willing physician.

Now, there are those who would say that this legislation is redundant, that it is not needed, and that in terms of medical assistance in dying, conscience rights of medical professionals are already protected. They would point to the pronouncement in Carter. They might also cite Bill C-14, which includes a preamble that expressly recognizes conscience rights as well as a “for greater certainty” clause in the Criminal Code, which simply provides that “for greater certainty, nothing in this section compels an individual” to provide MAID.

While the intention of Parliament was to protect the conscience rights of medical professionals when Bill C-14 was debated and passed—and I was there for, and actively participated in, that debate and the study of that bill at committee—in practice, conscience protections and the rights of medical professionals are not being respected across Canada. There is a gap, and that is why, when Bill C-7 was studied at the justice committee, we heard from medical professionals who expressed serious concerns about pressure and coercion in providing MAID.

Indeed, the Ontario Medical Association wrote to our committee and specifically called on the committee to amend Bill C-7 to provide greater conscience protections for medical professionals, given that the “for greater certainty” clause, although better than nothing, simply does not have teeth. It is not enforceable. In that context, while the Criminal Code does not compel a medical professional to provide MAID, there is nothing in the Criminal Code that specifically protects medical professionals when they are pressured or coerced to provide MAID. This bill addresses that gap and would close it by establishing two targeted offences; namely, it would make it an offence to intimidate or coerce a medical professional with regard to providing or participating in MAID, and secondly, it would make it an offence to dismiss or refuse to hire a medical professional solely on the grounds that they object to participating in MAID.

While this legislation would protect the rights of medical professionals, it must also be emphasized that this bill would just as much protect the rights of patients. The bill would protect the rights of patients by protecting the physician-patient relationship. It would do so by safeguarding the ability of medical professionals to provide their best advice and judgment, free of pressure and free of coercion, to a patient who is considering medical assistance in dying. It would protect patients by protecting their right to a second opinion. There can be no second opinion, or at least a guarantee of a second opinion, in the face of coercion or pressure to provide medical assistance in dying. There can be no second opinion when the only choice offered to a patient is medical assistance in dying as a result of pressure and coercion.

The need to safeguard the patient-physican relationship, which this bill works toward achieving, is all the more needed in the face of the radical expansion of medical assistance in dying in Canada with the passage of Bill C-7, which removes critical safeguards, including the criterion that death be reasonably foreseeable and opens the door to medical assistance in dying for persons who are suffering solely from a mental illness, even though it is never possible to predict when someone who is suffering from mental illness can get better. It is never possible to predict irremediability in the case of a solely mental illness. As a result of the removal of those critical safeguards, vulnerable patients are put at greater risk.

When the conscience rights of medical professionals to exercise their best judgment are protected free of intimidation and coercion, the rights of patients are equally protected. This is a timely, targeted and necessary piece of legislation that would protect the rights of medical professionals and their charter rights and the rights of patients. I urge its passage.

[Randall Garrison, NDP, Esquimalt—Saanich—Sooke, BC]

Madam Speaker, I am pleased though a bit surprised to be speaking on Bill C-230. Less than a year ago, on May 27, 2021, we were in the House debating Bill C-268, the very same bill from the very same member for Carlton Trail—Eagle Creek. While I am a bit in awe of the member's ability to place so highly in the random draw for Private Members' Business in two successive Parliaments, I am also at a bit of a loss to explain why the member would squander her luck on this bill.

There are two reasons I say this. As MPs we get limited opportunities to place bills directly before the House. I had that opportunity in 2013, and I used it to put forward Bill C-279, which sought to add gender identity and gender expression to the list of prohibited grounds for discrimination in the Canadian human rights code and in the hate crime section of the Criminal Code. Though many thought it unlikely, the bill did pass the House with support from MPs from all parties. It took a lot of work to put together that coalition of MPs. While my bill followed a somewhat torturous path, there was always a path forward and it became law.

I wonder why it is that having heard so clearly, in speeches less than a year ago, that there was limited, if any, support for this bill outside her own party, the member for Carlton Trail—Eagle Creek has brought it back again. Since there is nothing to indicate any change of circumstances or any change of heart, this bill will go nowhere this time as well. Failing to bring forth a bill that might have some prospect for passing or reintroducing this bill instead of bringing forward a new bill presenting ideas not already debated here in the House leads me to call reintroducing this bill, at best, a missed opportunity.

The second reason I have for declaring the reintroduction of this bill a lost opportunity has to do with the bill itself. This bill picks up a tiny portion of the extensive and important debates on medical assistance in dying that took place on Bill C-14 in Parliament in 2016 and again on C-7 in the last Parliament. It seeks to take one small and very debatable point and turn it into a wedge issue in the House.

We are waiting for the Special Joint Committee on Medical Assistance in Dying to get down to work on outstanding important and critical issues around medical assistance in dying, but as that committee has yet to get under way, I want to take this opportunity today to restate the principle that has guided New Democrats through these debates.

We believe that medical assistance in dying is an important tool for helping to end unnecessary suffering for patients facing end-of-life issues and for avoiding the unnecessary suffering of their families, who have to accompany them on this journey. This is the reason New Democrats will always defend the right of access to information about MAID and access to the service for all those who qualify for assistance in dying and choose to proceed.

In the debate on Bill C-7, many issues arose concerning the challenges Canadians face at the end of life, some of which Bill C-7 addressed directly and some which have not yet been addressed. Two important concerns were front and centre, and these, for me, were the most important. The first was to help alleviate unnecessary suffering by eliminating the waiting period, which was a cause of great concern for patients who feared loss of capacity before they could complete the waiting period and thus make them ineligible for medical assistance in dying and forced to consider suffering.

The second was a change allowing a waiver of final consent. This is a provision I know quite well, personally, as a friend of mine chose to go earlier than she would have liked because of a brain tumour and her fear that she would lose capacity to consent at the last moment and, in doing so, have to continue making her family suffer.

A second challenge was also debated in Bill C-7. How do we preserve as much autonomy as possible for Canadians who are dying? Most of the issues related to this still have to be dealt with at the special joint committee. This includes questions of advance directives, the question of access to MAID for those with mental illness and for mature minors, and whether protections for people with disabilities from being pressured to seek MAID are adequate. I remain frustrated with the delays in dealing with these very important issues. The bill before us is not one of those.

A third challenge that came up in the debate on Bill C-7 was access to services at the end of life. We learned there are a great many gaps in services in our Canadian health care system for those who are facing death. There are gaps in diagnostic and treatment services depending on where one lives, whether it is a major city with excellent facilities or a rural and remote area. We learned of important gaps in palliative care.

However, instead of addressing these challenges, the challenges of autonomy and the challenges of access to services, Bill C-230 is about something else altogether. What this bill would do is override a patient's right to access information about and to have access to legally provided medical services, based on the personal beliefs of a service provider.

Let me put that in plain language. Let us suppose there are a variety of treatments available to a patient. It does not really matter in this case what they are. If a medical professional believes that one of them should not be available, this bill says there is no obligation on that professional to make sure patients find out all the options available to them. Professional organizations, like colleges of physicians and surgeons, and colleges of nurses, have found this to be unethical behaviour, so they require doctors, to varying degrees, to refer patients to someone who is supportive of those services and who is available to provide those services.

This requirement to refer exists in its strictest form in Ontario as the right of patients to an effective referral, meaning a referral to a health care professional who is available, capable and willing to provide that service. This has been upheld by the courts as a reasonable compromise between the rights of patients' access to medical issues and the conscience rights of service providers. That is the main reason I cannot support this bill. If passed, it would result, on a very real and practical basis, in the denial of access to necessary health services for many Canadians.

Many communities have a very limited number of doctors and if one of those doctors, or even more than one of those doctors, is unwilling to let their patients find out about medical assistance in dying, then we are condemning those Canadians to suffer at the end of life in ways that other Canadians would not have to suffer. No health care professionals are in fact required by law to participate, and that is why I find titling this bill “intimidation of health care professionals” disingenuous at best. Is requiring a referral actually participation in medical assistance in dying? Clearly it is not, and trying to torque a requirement to provide information into participation helps no one understand the real issues of conscience involved in medical assistance in dying.

An equally important reason for opposing this bill is the dangerous precedent that this bill would set. Its role as a potentially precedent-setting bill has already been noted by anti-choice advocates who have been vocal in their support for this bill. They recognize that it would provide a precedent for denying referrals for access to contraception and abortion services, and I want to point out that denials of service and denials of information are very real in our existing Canadian medical care system.

This bill would also be a very bad precedent for current attempts to deny transgender minors the counselling and medical services they need to affirm who they are. Without access to services that others may think are inappropriate, this will leave families with trans minors struggling to find the information and support that their kids really need. If this kind of precedent is allowed, medical professionals would not have to provide a referral to someone who would be providing a medically necessary service.

As I approach the end of my comments today, I cannot end without mentioning yet another unfortunate precedent set in this bill, and that is its use of inflammatory language. I have no doubt, as I said in my question to the sponsor of this bill, of her personal convictions and their strength. However, as sincere as they may be, the language used in this bill conjures up a spectre of the use of violence to intimidate medical professionals, something of which there is absolutely no evidence of happening in Canada. Invoking the spectre of violent intimidation is certainly not conducive to an informed debate on the real issues that are in question here.

I will close my comments today by restating that, on principle, New Democrats are opposed to any legislation that would limit access to Canadians seeking information about or the service of medical assistance in dying. No matter how strong the beliefs others may hold, this right exists to access medically necessary services. There is no doubt that the end of life is a difficult moment for all families, and medical assistance in dying, I still believe, is an important way of ending unnecessary suffering both for patients and families at the end of life. I would not like to see anyone denied access to information they need to make a choice that protects their own autonomy of how their lives end. At this point, let me salute the health care professionals who assist patients and their families through this very difficult process.

Once again, I lament the tendency of not just this member but, indeed, many Conservative members of the House to use private member's bills for scoring political points and sharpening divisions in the House—

[Gary Anandasangaree, Liberal, Parliamentary Secretary to the Minister of Justice and Attorney General of Canada]

Madam Speaker, I am very pleased to speak this morning with respect to Bill C-230, an act to amend the Criminal Code, intimidation of health care professionals, which was introduced by the member for Carlton Trail—Eagle Creek. I want to acknowledge that I am speaking today on the traditional unceded lands of the Algonquin people.

The stated goal of Bill C-230 is to protect an important right: the right to freedom of conscience and religion, which is guaranteed by section 2 of the Canadian Charter of Rights and Freedoms. It is a laudable goal, but one that I do not think the bill achieves. The bill proposes to create two new criminal offences that seek to protect the right of health care professionals, including medical practitioners, nurse practitioners and pharmacists, to object to taking part in the provision of medical assistance in dying to provide services according to their conscience.

First, it proposes the creation of a new intimidation offence that would prohibit the use of coercion or any intimidating behaviour to compel a health care professional to participate, directly or indirectly, in the provision of MAID. Second, it proposes the creation of an employment sanctions offence that would prohibit employers from refusing to employ, or to dismiss, health care professionals solely because they refused to participate directly or indirectly in the provision of MAID.

We certainly all agree that it is imperative that the right to freedom of conscience and religion be protected, not only for health professionals in the context of medical assistance in dying, but for everyone in Canada.

This is central to ensuring that we are able to live our lives, both personally and professionally, with equal rights and dignity. However, I do not believe that the proposed Criminal Code amendments are necessary to protect this central right, so I must oppose the bill.

The proposed intimidation offence, which would prohibit the use of coercion or intimidation to compel a health care professional to participate in MAID, largely duplicates existing Criminal Code offences. For instance, in section 423, the Criminal Code already prohibits the use of violence, threats of violence, intimidation or attempts at intimidation to compel any person to abstain from doing anything that they have a lawful right to do, or to do anything that they have a lawful right to abstain from doing. Criminal Code section 346 also makes it an offence to extort someone, which is to use threats, accusations, menaces or violence to induce, or attempt to induce, that person to do anything or to cause anything to be done. These are both indictable offences and are punishable by maximums of 14 years imprisonment and life imprisonment, respectively.

The existing offences of intimidation and extortion apply in all circumstances, including in the context of the provision of MAID by health care professionals. I believe that these offences provide sufficient protection for health care professionals who do not wish to participate in the provision of MAID.

The proposed employment sanctions offence would prohibit employers from refusing to employ, or to dismiss, health care professionals simply because they refuse to participate in the provision of MAID. This is a valid and important objective, but I urge us to reflect on how such a provision may encroach on provincial and territorial jurisdiction.

As all members of the House are aware, MAID falls under the shared jurisdiction of the federal government, which has jurisdiction over criminal law, and of provincial governments, which are responsible for the provision of health care. However, with the exception of federally regulated sectors, employment-related matters generally fall within the responsibility of the provinces and territories. As such, employment concerns may be more appropriately addressed by the regulation of employers at the provincial and territorial level. Irrespective of jurisdictional issues, I also wonder whether criminal law is the right tool to use to address employment issues.

I am also mindful that, even though the preamble of Bill C-230 suggests that it seeks to respond to circumstances in which practitioners are required to make effective referrals for MAID, the bill would not address that issue because the professional orders that establish those policies would not be captured by the proposed employment sanctions offence.

We must remember that the MAID legislation simply permits the provision of MAID. It does not compel anyone to provide it, whether directly or indirectly. In fact, it contains a provision explicitly clarifying that “nothing in this section compels an individual to provide or assist in providing medical assistance in dying.” This can be found in subsection 241.2(9).

I am not aware of any evidence that suggests that health care professionals are being coerced or intimidated to provide MAID. I wholeheartedly believe that the criminal law already offers protection to anyone who may be coerced to participate in MAID. I would also like to remind members that the criminal law should be used sparingly.

I would also like to note that the proposed offences would offer protection only to health care professionals who object to taking part in the provision of MAID. They would not apply in circumstances where a health care professional may wish to provide MAID but is coerced or intimidated to abstain from providing it. I have to question why we would resort to creating a new criminal offence to protect one health care professional's freedom of conscience but not another's.

Canadians have varied opinions on MAID, depending on their personal circumstances, beliefs and experiences. Despite these diverse views, public opinion research consistently demonstrates strong support for MAID. Our MAID laws recognize the importance of permitting access to MAID as a means of relieving intolerable suffering for competent adults. The laws recognize that those who wish to access MAID should be able to do so, and available statistics show that many Canadians choose to receive MAID.

Since the first legislation in 2016 up until the most recent data released by Health Canada covering 2020, there have been 21,589 medically assisted deaths in Canada. The vast majority of persons who have received MAID had cancer as their main underlying condition, followed by persons who had cardiovascular conditions, chronic respiratory conditions and neurological conditions. This trend is consistent with the leading causes of death in Canada, which list cancer and heart disease as the number one and number two causes of death, respectively. These can be found in the Second Annual Report on Medical Assistance in Dying in Canada 2020.

MAID is a complex and deeply personal issue that engages fundamental rights and interests, both for persons contemplating MAID and for the health care professionals who choose or choose not to participate in the provision of MAID. MAID is anything but straightforward, and we must continue to work together to find appropriate and effective solutions to balance the rights of persons to access MAID with the rights of health care professionals to provide quality care and service in accordance with their conscience. I appreciate the spirit of this bill, but I continue to have real concerns that it would appear to be an improper use of the Criminal Code. I must therefore oppose it.

[Kelly Block, Conservative, Carlton Trail—Eagle Creek, SK]

moved that Bill C-230, An Act to amend the Criminal Code (intimidation of health care professionals), be read the second time and referred to a committee.

Mr. Speaker, it is a privilege to rise today to begin the debate on my private member's bill, Bill C-230, the protection of freedom of conscience act. This bill revives my private member's bill, which died on the Order Paper, from the last Parliament, with some slight modifications.

I would be remiss if I did not once again acknowledge that this bill is built on the hard work and determination of former members of Parliament. The first bill proposed to address this issue was introduced by the late Mark Warawa in 2016. His bill did not proceed because of the government's introduction of Bill C-14. After Bill C-14 was passed into law, my former colleague David Anderson introduced his private member's bill, Bill C-418, during the 42nd Parliament. However, that bill also died on the Order Paper when the general election was called in 2019.

I would like to thank all those who have been championing this issue for many years and their willingness to work with me. Experts throughout Canada have provided information and advice, while thousands of grassroots Canadians voiced their support for protecting our fundamental freedoms. I would also like to thank the Library of Parliament for its timely, diligent and expert research, which helped inform this proposed legislation.

For the purposes of this debate, I think it is important to understand conscience. There are numerous definitions of conscience, but they are consistent in defining it as an individual’s inner sense of knowing the difference between what is right and wrong and allowing that knowledge to guide their behaviour. The Canadian Charter of Rights and Freedoms, under the heading of “Fundamental Freedoms”, in subsection 2(a) states that everyone has the fundamental freedom of conscience. In this way, Bill C-230 is straightforward. It seeks to add two new offences to the Criminal Code of Canada. I will read the summary so members will know what they are:

This enactment amends the Criminal Code to make it an offence to intimidate a medical practitioner, nurse practitioner, pharmacist or 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 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.

This bill is a response to calls from disability rights groups, first nations, the Ontario Medical Association, legal experts and many medical and mental health professionals to protect conscience rights. It ensures that medical professionals who choose not to take part in or refer a patient for assisted suicide or medical assistance in dying will never be forced or coerced to violate their freedoms as stated in the charter.

Previous Parliaments have passed laws that created the unintended consequence of doctors and medical professionals being forced to participate in providing a patient's death, regardless of whether they believe it is in their best interest. Bill C-14 and Bill C-7 created a federal standard for medical assistance in dying and assisted suicide but not for conscience protections.

By way of background, sections 241.1 to 241.4 of the Criminal Code of Canada deal with the provision of medical assistance in dying. These sections are in part VIII of the code. It deals with offences against the person and reputation, which include offences such as homicide, kidnapping, assault and many more. Subsection 241(1) of the Criminal Code still makes it a criminal offence to counsel or aid in a suicide. It reads:

Everyone is guilty of an indictable offence and liable to imprisonment for a term of not more than 14 years who, whether suicide ensues or not,

(a) counsels a person to die by suicide or abets a person in dying by suicide; or

(b) aids a person to die by suicide.

When creating the exemption allowing for MAID, the government had to create an exemption to this prohibition on counselling or aiding in suicide. This then leads to the untenable claim that the Criminal Code already protects the conscience rights of medical professionals.

Some claim that the clarification clause, section 241.2 (9) of the Criminal Code, somehow protects conscience rights. It states:

For greater certainty, nothing in this section compels an individual to provide or assist in providing medical assistance in dying.

While I understand why some would want to think it protects conscience rights, I believe they are sadly mistaken. While I appreciate and support this inclusion in the Criminal Code, it only addresses one side of the coin. This clause only confirms that the Criminal Code is not the source of compulsion to participate in medical assistance in dying.

For the Criminal Code to have any teeth on this issue, it should articulate that it is an offence to compel someone to provide, or assist in providing, medical assistance in dying against their will. Compelling someone to participate in MAID can and does happen, which is why I have brought forward this legislation and why it needs to pass.

Regarding jurisdictional questions about this bill, as I mentioned earlier, this bill proposes that two new offences be added to the Criminal Code of Canada to address intimidation, dismissal from employment or refusal to employ a medical professional. This is similar to section 425 of the Criminal Code, which addresses the same actions taken by an employer to compel employees with respect to belonging to or organizing a union. I would suggest that if it is appropriate to have section 425 in the Criminal Code, it is reasonable to include the amendments I am proposing.

I would also submit that it is inaccurate to argue that conscience rights legislation somehow interferes with the role of the provinces while, at the same time, believing that the legalization of medical assistance in dying does not. Ensuring that conscience rights are protected is the responsibility of Parliament and of the Government of Canada, which is why I introduced this bill and why it should be passed.

Additionally, provinces can introduce their own conscience rights legislation for medical professionals. For example, Manitoba has passed simple and clear legislation in this regard, and I would encourage all provincial legislatures and parliaments to follow Manitoba’s example.

While the text of this bill focuses on the conscience rights of medical professionals, this legislation also serves to protect the right of patients to receive a second opinion. What do I mean by this? If all doctors are forced to propose MAID as a treatment option to their patients, this one-size-fits-all approach would give Canadian patients less choice, not more.

Additionally, individuals who object to MAID would be deterred from entering the medical profession altogether. Patients would no longer be able to seek a second opinion for their end-of-life care. In this way, conscience rights for medical professionals not only protect medical professionals and their patients, but they also protect our health care system.

Without conscience rights, doctors are constrained to provide, or refer their patients to receive, medical assistance in dying, regardless of whether it is their professional opinion that it is in the best interest of the patient. This concern for the patient’s best interest does not mean that a medical professional objects to medical assistance in dying in all cases, just that in his or her opinion it is not an option that should have to be offered in every case. This became especially pertinent to the medical community with the passage of Bill C-7.

To highlight the impact of the removal of the safeguard that death be reasonably foreseeable, I would like to quote from a recent column published online in Policy Options magazine which states the following:

Many injuries and physical illnesses are indeed accompanied by temporary depression and suicidal thinking. For example, research demonstrates increased risk of suicide for two years after a spinal cord injury. This suicidality overwhelmingly ends with adaptation and recovery support. Offering death to anyone during a period of transient increased suicidality is, in our view, unethical and violates the standard of medical care by which physicians must abide.

The fact that the newly expanded law may facilitate death in those circumstances of increased suicidal thinking is, in and of itself, problematic.

Some have tried to frame conscience rights as the rights of the patient versus the rights of the doctor. Nothing could be further from the truth.

Health care is fundamentally about the doctor-patient relationship. For example, take the psychiatrist who supports MAID in certain circumstances, but in a certain case has spent 15 years counselling a patient who suffers from bouts of depression and suicidality. For 15 years, they have built understanding and trust. What would happen if that patient, suffering from a bout of suicidality, should demand assisted suicide? Under current law, that psychiatrist would be forced to refer that patient to someone else so he or she could die. They must do this, despite knowing that the suicidal thoughts are temporary and that otherwise the patient is joyful and loves his or her life. Ending that patient's life would be wrong, but the psychiatrist’s hands are tied. This should not be what passes for medical care in Canada.

Some might claim that there are safeguards in place to prevent such tragedies, but I would ask them if they are absolutely sure. With the passage of Bill C-7, many safeguards for medical professionals were removed. We are talking about ending a human life. There is no room for uncertainty when a life hangs in the balance.

Additionally, should the first line of safeguards not be the expertise of the medical professionals who know their patients best? If those medical professionals do not believe death is the answer, should we not at least consider if they are right? However, this then leads to the concern some raise that protecting the conscience rights of medical professionals will block access to those who truly want it. I would suggest this is both misleading and nothing but baseless fearmongering. Medical assistance in dying and assisted suicide are readily available throughout all of Canada. There are information phone lines, hospitals staffed with willing medical professionals, even email addresses to help set up appointments. In a word, MAID has become the status quo. It is available.

The Canadian Medical Association also stated clearly that conscience protections would not affect access because there were more than enough physicians willing to offer MAID. Therefore, common sense should tell us that the charter rights of medical professionals are breached when they are forced to either offer or refer assisted suicide or medical assistance in dying. Surely, we have the capacity to both ensure access to MAID while still protecting the fundamental charter right to freedom of conscience.

Finally, some have suggested that medical professionals should leave their morality at the door. I do not believe we want this to happen. For example, we would all want and expect doctors to be bound by their morals if they were offered a bribe to move someone up on a waiting list. If we hold our medical professionals to a higher standard, we cannot then tell them to ignore their personal moral standards. Further, while discussing the issue of conscience rights with a doctor, she told me that, in the absence of conscience protection, the group with the most to lose are the patients, and they are the ones we are trying to help. This bill protects the doctor-patient relationship by ensuring that doctors and other medical professionals are always able to recommend and provide the care they believe is best for their patients. Patients need this bill to pass. Canada’s medical professionals need this bill to pass.

Over the past two years, we have seen just how important our health care system is and how critical the medical professionals who work in that system are to Canadians and our way of life. We need to create a work environment for medical professionals that protects them, supports them, and encourages them to continue in the critical work they do.

In closing, I encourage all members to support passage of the protection of freedom of conscience act.