Justice Committee on May 10th, 2016

[Ted Falk, Conservative, Provencher, MB]

Yes.

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

On this admittedly relatively small point, we are trying to bring sunny ways back.

The version I'm going to move is an altered version, and it has been provided to the clerk. Maybe I should just read it out for the benefit of those who may not have it in front of them: “The Minister of Health, in cooperation with representatives of the provincial governments responsible for health, may establish guidelines on the information to be included on death certificates in cases where medical assistance in dying has been provided, which may include the manner in which to clearly identify medical assistance in dying as the primary cause of death, as well as the illness, disease or disability that prompted the request for medical assistance in dying.”

By replacing the “must” with the “may” and the “are to” with “may” later on, it addresses the jurisdictional concern. It doesn't create an obligation on the minister, but I think the minister would be wise to bring in these guidelines, especially based on the evidence we heard about some very serious concerns from the perspective of those who fill these documents out in the various provinces about conflicting guidelines from their professional bodies, and potentially from the legislation.

I think there's consensus here, and there we are.

[The Chair, Liberal, Anthony Housefather]

Ms. Khalid, do you want to speak to that?

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

Thank you very much, Mr. Chair, and thank you Mr. Genuis for the opportunity to collaborate with the other side.

I had proposed Lib-10 which speaks to that. I think that the reasons for it are to have sound data that informs our decisions going forward with respect to what this bill will entail and how it will affect Canadians. I think it's a great step forward. I completely agree with Mr. Genuis's amendment CPC-27 and I will be supporting it.

[The Chair, Liberal, Anthony Housefather]

Excellent. Is there any further debate?

Mr. Bittle.

[Chris Bittle, Liberal, St. Catharines, ON]

I was wondering if we could hear from the department on this language.

[Joanne Klineberg]

Again, I'm passing on information from some of my colleagues who are more expert in these areas. The Minister of Health already has the ability without this amendment to sit down and work with the provinces to establish guidelines on a co-operative basis, and of course, there is nothing that Parliament could do to compel the provinces to make these changes, which are in their area of jurisdiction.

[The Chair, Liberal, Anthony Housefather]

Mr. Fraser.

[Colin Fraser, Liberal, West Nova, NS]

Thank you. I appreciate the amendment and will be supporting it.

I think it responds to a very important matter that was brought forward by witnesses to our committee. We heard that there are definitely issues with regard to the cause of death as stated on death certificates. I believe this adequately responds to that. While it is permissive and will result in collaboration between the provinces and territories and the federal government, I believe it gives some direction in that regard. Ultimately, it responds to the issue that we heard about, and therefore I think that it's a reasonable amendment.

[The Chair, Liberal, Anthony Housefather]

Mr. Rankin.

[Murray Rankin, NDP, Victoria, BC]

Mr. Chair, I'm concerned about the amendment for reasons that may be semantic, but the end of it reads: “identify medical assistance in dying as the primary cause of death, as well as the illness, disease or disability that prompted the request for medical assistance in dying."

As I see it, the cancer, let's say, is the condition that causes it, and the medical assistance in dying is the manner in which it occurred. Otherwise, I'm concerned that we'll witness a sudden drop in deaths caused by cancer, ALS, and so on. That specification, if I'm understanding it properly, causes me great concern. Unless that's clarified I won't be able to support this.

[The Chair, Liberal, Anthony Housefather]

I think we may be able to clarify it.

Mr. Genuis, Ms Khalid, do you have a proposal? Perhaps we could say, “clearly identify medical assistance in dying as the manner of death”, as opposed to “the primary cause”. That way, I think Mr. Rankin might be able to support it.

[Murray Rankin, NDP, Victoria, BC]

That is correct.

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

In assisted dying, it's hard to dispute that if someone takes pills or receives the injection, that is the cause of death. The objective of this amendment is to seek to ensure that there is alignment between the professional obligations of those who are filling out these death certificates and the legislative framework around medical assistance in dying, as so called.

The possibility of a sudden drop in reported deaths around cancer or ALS is why I think it's very important to identify as well, in some manner, the illness that prompted the person to seek euthanasia or assisted suicide.

I'm comfortable with the language as it is, and hopefully Mr. Rankin will consider those arguments.

[Murray Rankin, NDP, Victoria, BC]

One other point that I didn't raise is whether or not there could be implications for people seeking life insurance coverage as a consequence of this. We were told very clearly in committee—and there have been newspaper articles and other media to this effect—that the life insurance companies will cover people if the underlying cause, the primary cause, is cancer, ALS, and so on. But if medical aid in dying is provided, will they still cover the individual? I fear that this could have an unintended consequence, in the way it's worded.

[The Chair, Liberal, Anthony Housefather]

I again suggest that somebody may want to subamend to use the word “manner”.

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

I'll just say that the insurance provisions and how they apply are a separate issue.

[The Chair, Liberal, Anthony Housefather]

I understand and I appreciate that, but you have an opportunity, I think, to have relatively unanimous consent to your motion if you make a wording change.

Otherwise you're going to have constant debate and not have unanimous consent. In the collaborative process that I think we've been working on, my suggestion is somebody subamend it to put the word manner there, and if you're not going to change the wording, we'll have a debate on that.

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

I'm comfortable with the language as is, but of course Mr. Rankin is welcome to propose a subamendment, and then the committee can move forward in that way.

[The Chair, Liberal, Anthony Housefather]

Ms. Khalid.

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

I am happy to propose that subamendment, changing “primary cause of death” to “manner of death, as well as the illness, disease, or disability that prompted the request for medical assistance in dying.”

I think that Mr. Rankin raises a good point, and I'm happy to work in collaboration.

[The Chair, Liberal, Anthony Housefather]

Now that there's a subamendment, the debate is on the subamendment to change the words “primary cause of death” to “manner of death”.

Is there any debate?

Monsieur Fraser.

[Colin Fraser, Liberal, West Nova, NS]

On the subamendment, I don't believe that has any effect on what we were trying to accomplish with this amendment as it was presented. It would address the concern of the witnesses we heard from who had a concern regarding what is placed on the death certificate.

I have no difficulty at all in supporting the subamendment to change the wording to “manner”. I think that's appropriate.

[The Chair, Liberal, Anthony Housefather]

Is there any further discussion?

(Subamendment agreed to [See Minutes of Proceedings])

Is there any further debate on the principle amendment?

Mr. McKinnon.

[Ron McKinnon, Liberal, Coquitlam—Port Coquitlam, BC]

Now that we have this subamendment, I think we have kind of convoluted language. “The manner in which to clearly identify the manner of death” seems a little circular, I guess.

I wonder if we could have another subamendment to get rid of “the manner in which”. We could say, “in cases where medical assistance”. Sorry, I mean, “which may specify, or may identify, medical assistance in dying as the manner of death”.