Justice Committee on May 2nd, 2016

[The Chair, Liberal, Anthony Housefather]

Okay. Thank you very much.

We'll now go to Ms. Khalid.

[Iqra Khalid, Liberal, Mississauga—Erin Mills, ON]

Ministers, thank you for coming in and giving us this presentation. It's very much appreciated.

I have a couple of questions. First, it's my understanding that it was the Department of Justice that was on the opposite side against Kay Carter in the Supreme Court. It's also my understanding that it is the same Department of Justice that has helped with the drafting of the bill. Have we sought outside counsel to ensure charter compliance of this bill?

[Jody Wilson-Raybould, Liberal, Vancouver Granville, BC]

I'm happy to speak to that question.

In terms of the legislation, what was put forward was the result of, as we talked about, substantive discussions with stakeholders, reports, special committees. This was a decision of our government that we put forward. I'm incredibly honoured to be the Minister of Justice, and as the Minister of Justice I provide direction to my departmental officials. That direction was, as I said, provided by me and the direction of our government. I have confidence, as the minister, that our legislation is compliant with the charter.

[Iqra Khalid, Liberal, Mississauga—Erin Mills, ON]

Another area that a number of people have raised concerns about relates to physician-assisted or the medical assistance in dying part that is self-administered by the patient.

Minister Philpott, could you please walk us though how that would work? What safeguards are proposed in the legislation that would prevent abuse, specifically with regard to the self-administration of death?

[Jane Philpott, Liberal, Markham—Stouffville, ON]

You'll see that there are a number of safeguards that need to be met whether a medical practitioner actually provides the medication, or whether it's self-ingested, for example. All of those safeguards need to be met along the way.

You'll see that proposed subsection 241.2(8) talks about the fact that there needs to be a final opportunity given to a person to reaffirm before any prescription, for instance, is given to a person, that it is what the person wants to do if that medication is handed over. That would be the time of the final opportunity for the patient to say yes or no. This is essentially providing an opportunity for people who may, for instance, want to die at home. They may want to die in the privacy of their own bedroom surrounded by their family and not want a medical practitioner to be there.

I could go through the whole list. I can give you the entire list of safeguards, but I think they're laid out quite nicely in the legislation. Whether or not the doctor is actually giving the person the pills in the same room, or whether the person is taking those pills or that injectable home to be administered by someone else, they would have to meet all of the same safeguards.

[Iqra Khalid, Liberal, Mississauga—Erin Mills, ON]

What if the person, after having received the prescription, decides not to take the medication? Would that medication then just sit in their medicine cabinet?

[Jane Philpott, Liberal, Markham—Stouffville, ON]

That's an excellent question and one that I've asked myself. It's something that we will work very closely on with pharmacists, for instance, and with appropriate regulatory bodies.

That said, every single day in every single city in this country, people walk home with a bottle of pills, and if they were to take that whole bottle of pills they could potentially kill themselves, so it's not a territory with which we're unfamiliar. A tremendous amount of education of patients, providers, and pharmacists needs to be undertaken to make sure these pills are adequately cared for and that they in fact would have probably far better oversight than many other bottles of medications that are sitting in people's cupboards at home.

[Iqra Khalid, Liberal, Mississauga—Erin Mills, ON]

With respect to the rights of conscience for medical practitioners, it's my understanding, and what you have indicated today as well, and based on the questions of our colleagues here.... Is there no way to codify the rights of conscience, as in, for example, saying that somebody cannot be forced to administer medical assistance in dying as part of the Criminal Code, or making it a penalty to coerce somebody into administering death under this legislation? Or would that not be in the federal jurisdiction at all? Would that be dealt with at the provincial level?

[Jody Wilson-Raybould, Liberal, Vancouver Granville, BC]

Thank you for the question.

There is nothing in Bill C-14, our proposed legislation, that would compel a medical practitioner to engage in medical assistance in dying. As you quite rightly point out, this is within the jurisdiction of the provinces and territories, and Minister Philpott will continue to work with her counterparts to assist in putting together the regulatory framework, to assist the provinces.

[The Chair, Liberal, Anthony Housefather]

Although Mr. Nicholson couldn't attend today, we're delighted that we have Mr. Brassard here replacing him.

Welcome to our committee, Mr. Brassard, and over to you.

[John Brassard, Conservative, Barrie—Innisfil, ON]

Thank you, Mr. Chair.

By way of comment, I want to say that this issue has obviously been very difficult for many people to deal with. I think the government has put forward legislation that is somewhat reasonable at this point. I want to commend the members of the joint committee for the work they've done and commend this committee for the work that you are doing to get a better handle on the legislation.

I have only one question and it's for both ministers. You've mentioned that there have been ongoing discussions with the territories and the provinces with respect to Bill C-14.

Mr. Chair, through you, have any of the provinces or territories raised any concerns whatsoever about this bill and, if so, could the ministers please explain some of those concerns to the committee?

[Jody Wilson-Raybould, Liberal, Vancouver Granville, BC]

Perhaps I'll just speak to my ongoing discussions and relationships with my provincial and territorial counterparts, the attorneys general from across the country.

I had the opportunity to meet face-to-face with the attorneys general in Quebec City. I had spoken with them before the legislation was introduced and with many of them after the legislation was introduced. It's fair to say in my view that the provinces and territories were looking for federal leadership with respect to medical assistance in dying. They were looking to us to put parameters around medical assistance in dying, while respecting the complex regulatory framework that would be put in place with the provinces and territories, and that we would continue to work in a collaborative manner with them and ensure that we can share best practices coming from, for example, the Province of Quebec, which has engaged in this discussion and this debate for over six years. That relationship will continue.

[Jane Philpott, Liberal, Markham—Stouffville, ON]

The overwhelming response from the provinces and territories has been positive. They have been thankful for a framework that will allow some of them to proceed by simply using this framework and working with their local regulatory bodies. We have had conversations with Quebec with respect to the fact that there are some distinctions between this legislation and their own. It was not an expression that was negative in any way, but it was simply an acknowledgement of the fact that they will be going back to look at whether or not they will choose to make any adjustments to their own legislation to address these inconsistencies.

[John Brassard, Conservative, Barrie—Innisfil, ON]

Thank you, Mr. Chair. That's the only question I had.

[The Chair, Liberal, Anthony Housefather]

Thank you very much, Mr. Brassard.

Mr. Rankin.

[Murray Rankin, NDP, Victoria, BC]

I'll go to your last safeguard that is listed, that a patient reconfirm his or her expressed consent immediately before medical assistance in dying is provided. I want to ask you about two or three situations.

First, isn't it likely that many people will be incapacitated at that point because of a morphine drip? If they're not on a morphine drip, they may have very excruciating pain at the end of life that might vitiate their ability to provide consent at that time.

What if you're at home? How do you do that if you are taking the pills all by yourself or surrounded by family? How, in practical terms, can that safeguard be implemented?

[Jody Wilson-Raybould, Liberal, Vancouver Granville, BC]

I guess on both counts, I'm going to look to Minister Philpott to speak as well.

In terms of reconfirming consent, whether a patient is on a morphine drip or passing into sedation, this is where we would leave it up to the medical practitioners to determine, based on the conditions of the patient, whether or not the 15 days are required, or if there's a shorter period of time that is necessary, given all the circumstances of the patient's condition, whether that be on a morphine drip, or whether that be organ failure, for example. In situations like that, potentially, it depends on the circumstances of each case where the physician would determine that a shorter period of time would be required to confirm the consent.

In terms of the handing over of the medication, in the case of self-administration, the consent would be confirmed upon the handing over of the medication.

[Murray Rankin, NDP, Victoria, BC]

If I'm alone or I'm surrounded by family, and there's no medical practitioner for miles around, would it be when I receive the medication from the pharmacist?

Is that how it would be done? How can that possibly be immediately before providing medical assistance?

[Jane Philpott, Liberal, Markham—Stouffville, ON]

The interpretation is that before providing medical assistance in dying, the moment the prescription is handed over is the provision of the medical assistance—

[Murray Rankin, NDP, Victoria, BC]

Which could be weeks.

[Jane Philpott, Liberal, Markham—Stouffville, ON]

Again, as with any other prescription that a health care provider gives to a person, they have a responsibility to be sure that it is fully explained, that the person understands how it's to be used. The pharmacist has the same professional obligation and an obligation to follow-up to be sure that it's used appropriately.

[Murray Rankin, NDP, Victoria, BC]

We spent a lot of time in committee—the Senate special committee that I was proud to be part of—talking about palliative care. I heard you say, Minister, that you heard more about that than probably any other topic.

Yet, there's nothing but a word in the preamble here, and nothing accompanying the bill with any specific money. There's no commitment to a palliative care strategy or end-of-life secretariat, or anything.

Can you speak a little bit more about what your concrete commitment is to palliative care?

[Jane Philpott, Liberal, Markham—Stouffville, ON]

Thank you for bringing that up and for your continued advocacy around palliative care.

I think you'll hear me talk about it repeatedly because I feel extremely strongly about it. As a society, apart from the fact that I think this is ground-breaking legislation that we should be proud of as Canadians, we've taken this mature step in this matter. If the other phenomenal result of this conversation can be that for the first time we are determined as a country to say that the status quo is completely unacceptable, that only 15% to 30% of Canadians have access to high-quality palliative care, we are determined to make that right. We are in negotiation with the provinces and territories.

I fundamentally believe that every Canadian should have access to high-quality palliative care at the end of life, recognizing maybe 5% or 6% of Canadians don't want it. You'll hear Senator Carstairs talk about the 94%. She's obviously done some amazing work on this. We will be working with her and others. This will very much be a part of the health accord. You know that we've made a commitment to that. I would ask you to continue to ask for it. Please ask me every single day in the House of Commons if you can, so we can raise the bar on palliative care. It makes sense. It's what people need and what they want. It's financially far better. People actually live longer if they have good palliative care than if it's not offered to them. It's absolutely the right thing to do. I can offer you $3 billion now as part of my firm commitment and part of our health accord, which will include home care and palliative care. Stay tuned for more details on that.

[The Chair, Liberal, Anthony Housefather]

Thanks, I'm really glad we got to talk a little about palliative care.

Mr. Rankin, I hope you'll get time during question period every day to ask Minister Philpott about it.

The Conservatives had not exhausted all their time in the previous rounds, so Mr. Cooper is going to take the remaining time if that's okay, ministers.

Mr. Cooper.

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

I just have one question for Minister Wilson-Raybould. Just to follow up on the question posed by Ms. Khalid, if I heard you correctly, Minister, you had said that conscience protections fell within provincial jurisdiction. We are legislating in part under Parliament's criminal law power. In paragraph 53 of the Carter decision, the Supreme Court expressly said that “Health care is an area of concurrent jurisdiction”.

Having regard for those facts as well as section 3.1 of the Civil Marriage Act, which states that religious officials don't have to perform civil marriages in an area where provincial and federal jurisdiction overlap, I just want to be clear, are you saying that Parliament cannot legislate on conscience protections in the face of the foregoing?