Mr. Speaker, I am pleased to participate in the third reading debate on Bill C-14, which would provide a federal framework on medically assisted dying. As acknowledged by many in the House in the last number of weeks, medical assistance in dying is a complex, challenging, and deeply personal issue for us all.
Since the Supreme Court of Canada rendered its unanimous decision in Carter last year, it has been discussed by many Canadians in different settings from coast to coast to coast. The issues continue to be debated and thoughtfully discussed worldwide, from the United States to Europe to Australia and New Zealand. Almost everywhere in the world, the act of ending one's life deliberately and the act of helping someone to end their life are serious crimes punishable by severe sentences.
Nevertheless, Canada is not alone in creating a legislative regime to permit medical assistance in dying. There are four American states, Oregon, Washington, Vermont, and California, the country of Colombia, and the three European countries of Belgium, the Netherlands, and Luxembourg that currently have legislative regimes that allow some form of medical assistance in dying.
These different international regimes share similarities, especially with regard to safeguards, oversight, and reporting, most of which are included in Bill C-14. These similarities are as follows: requests for medical assistance in dying must be in writing, made voluntarily by the patient, and in many cases witnessed by independent witnesses; a second opinion from an independent physician must be sought; and a delay or reflection period between the request and the actual provision of medical assistance in dying is required.
Colombia has a unique approval process for medical assistance in dying. It involves interdisciplinary committees within each hospital that assess requests and support patients and their families throughout the process.
In addition, almost all international regimes have mandatory oversight systems involving independent national or regional committees and government agencies or departments, which collect and process data in order to properly monitor medical assistance in dying. They make annual or biannual reports on medical assistance public in their respective jurisdictions. This evidence was critical to the Supreme Court of Canada's analysis in the Carter litigation.
Unlike the fairly consistent approaches, the safeguard and oversight that we see in other countries, the various laws take two different approaches with regard to both: one, the form of medical assistance in dying that is permitted; and, two, the medical circumstances under which it can legally be provided.
One could describe the different approaches with regard to eligibility and the form as being a spectrum. At one end of the spectrum stands the four American states that enacted the legislation, starting with Oregon in 1997, Washington in 2008, Vermont in 2013, and most recently California, just last year.
In these states, a mentally competent adult aged 18 years or older can obtain the assistance of a physician to die, only if their request is voluntary, and if they suffer from a terminal disease, which is defined as an incurable and irreversible disease that has been medically confirmed and will, within reasonable medical judgment, produce death within six months.
In the U.S. states, the physician is only permitted to provide the patient with a prescription for a substance that the patient must self-administer at a time of their choosing. This is commonly known as physician-assisted suicide.
What is commonly called euthanasia, where the physician administers an injection to the patient, is expressly prohibited in these states. Advance requests are also not allowed.
While these legislative measures in the U.S. accommodate individuals suffering from diseases that cause a steady, rapid, and predictable decline toward death, such as some forms of cancer, they do not accommodate other conditions, including some degenerative diseases that are enduring and predictable, nor do they enable patients who are physically unable to self-administer a substance to access a medically assisted death.
The Colombian regime, which was developed in response to two rulings from its Constitutional Court, has eligibility criteria similar to that of the U.S. states. It limits eligibility to adults who have a terminal illness, defined as a progressive and irreversible serious condition or pathology that will cause death within a relatively short time frame. It does not require the person to have a prognosis of six months, but it does require that death is expected in the short term. Unlike the American states, Colombia only permits a physician to administer a substance that causes a person's death. However, Colombia's regime does permit a patient to prepare an advance request for medically assisted death, which is not permitted in the U.S.
At the other end of the spectrum, there is Belgium, the Netherlands, and Luxembourg, known as the “Benelux” countries. In these three northern European countries, patients are eligible for medical assistance in dying if they have “intolerable” or “unbearable” physical or psychological suffering resulting from a serious and incurable medical condition where there is no prospect for improvement. Eligible individuals do not need to be dying or suffering from life-threatening conditions. Both physician-assisted suicide and what is commonly called voluntary euthanasia are permitted in these countries.
While advance requests are permitted, there are some differences between the Benelux states. In Belgium and Luxembourg, advance requests can only be carried out where the patient is in a state of irreversible unconsciousness, while in the Netherlands, advance requests are also permitted where patients are unable to express their wishes but are conscious, such as for persons with dementia or Alzheimer's.
While medical assistance in dying is only available to adults in Luxembourg, children as young as 12 years of age can request medical assistance in dying with their parents' consent in the Netherlands. In Belgium, adults and emancipated minors can request medical assistance in dying for the same kinds of conditions. In 2014, Belgium extended eligibility to minors of any age, but only where they are likely to die in the short term and where their suffering is physical. Additional safeguards must also be met.
The experience and lessons from the Benelux countries have been closely examined. For example, in the Netherlands, while the legislation permits advance requests for patients who have lost their ability to express their wishes, Dutch research suggests that physicians are generally unwilling to provide medical assistance in dying, due to the inability of these patients to comprehend their medical condition and their inability to express informed consent.
The government has sought to learn from the experiences of other jurisdictions. The proposed legislation is broader than the U.S. state approach, which only permits those with a fatal disease to access assistance. Instead, Bill C-14 provides the option of a peaceful death to everyone who is in decline toward the natural end of their life, not just those who suffer from fatal diseases or terminal illnesses. At the same time, it avoids some of the risks that the Benelux-style regimes might present, although such broader questions, and the experience of other regimes around the world, will continue to be studied.
I urge all members to support this incredibly important bill to answer the call of our Supreme Court to legislate in this area.
