Mr. Speaker, it is my honour to stand to speak in support of Bill C-14, a significant piece of legislation that would allow for the first time in Canadian history the provision of medical assistance in dying across the country.
I believe Bill C-14 directly and thoughtfully responds to the Supreme Court of Canada decision in Carter. This legislation would strike a careful balance between the autonomy of competent adults whose deaths are reasonably foreseeable to seek medical assistance in dying and the protection of vulnerable people through careful tailoring of the eligibility criteria and robust safeguards that are essential to prevent error and abuse.
As recognized by the Canadian Medical Association before the Special Joint Committee on Physician-Assisted Dying, one cannot underscore enough the significance of this sea change in Canadian medical practice and Canadian society as a whole.
At present, there are eight jurisdictions in the world, in addition to Quebec, that have adopted precise legal rules on medical assistance in dying: four U.S. states, Colombia, and the European countries of Belgium, the Netherlands, and Luxembourg.
The international community is looking at Canada's leadership on this issue right now, and I commend all hon. members on both sides of this House for their invaluable contributions to this complex and sensitive debate.
Bill C-14 would establish the criminal law rules regarding medical assistance in dying that address issues including eligibility, procedural safeguards, and the framework for a pan-Canadian monitoring system. In addition to the comprehensive legislative response proposed in Bill C-14, the government would undertake independent studies into three key issues that the Supreme Court declined to address in Carter: eligibility for persons under 18, advance requests, and requests for medical assistance in dying solely on the basis of a mental illness.
Allow me today to provide all members with further clarifications on the eligibility criteria included in Bill C-14 and how they respond to the Carter ruling, a question that has been asked numerous times since the bill was introduced.
Under Bill C-14, medical assistance in dying would only be available to mentally competent adults: one, who have a serious and incurable illness, disease or disability; two, who are in an advanced state of irreversible decline in capability; three, who experience enduring and intolerable physical or psychological suffering as a result of their medical situation; and four, whose natural death has become reasonably foreseeable taking into account all of their medical circumstances and without requiring any specific prognosis as to the length of time that they have remaining.
I would emphasize that those are the exact words of the legislation, because there has been some incorrect reporting on what is actually required. It is also important to remember that the criteria must not be read in isolation. Each element mutually informs the meaning and scope of the others. They work together to create a clear picture.
Some people wonder what reasonable foreseeability of death means given that everyone's death is reasonably foreseeable in the sense that death, like taxes, is inevitable for all of us. Bill C-14 expressly states that the person's natural death has become reasonably foreseeable, which clearly indicates that a change in the patient's medical circumstances is required. The patient is now on a path toward death, but previously he or she was not. A healthy person's death is not reasonably foreseeable unless the person experiences a change in his or her medical circumstances.
Mr. Speaker, at the outset of my remarks, I neglected to inform you, but I do now, that I will be sharing my time with the esteemed member for Fredericton.
The concept of reasonable foreseeability is also well known in law, and assessment depends on the context. In the context of medical assistance in dying, it would require a real possibility of the patient's death within a period of time that is not too remote from circumstances that can be predicted within a range of reasonable possibilities. Again, the legislation expressly states that a specific prognosis as to the time the patient has remaining would not be required. Because everyone's trajectory toward the end of life would be unique, this criterion was carefully crafted to provide maximum flexibility to medical practitioners so that they may assess the overall medical circumstances of a patient on a case-by-case basis. The overall medical circumstances, as opposed to any particular type of condition, are what matters when the objective is to give Canadians the option of a peaceful medically assisted death instead of having to endure a prolonged or painful one.
As recognized by medical standards and guidelines on prognostic indicators, there are many factors that may contribute to a patient's being assessed as approaching the end of life, including the presence of an advanced, progressive, and incurable disease, but also completely different factors, such as age, the general frailty of the patient, and risks of death from complications of other conditions that may not be fatal on their own, but which can jeopardize the life of someone who is otherwise weakened.
As recently recognized by the Canadian Medical Association, the requirement that natural death has become reasonably foreseeable would provide clearer guidance than the court's use of “grievous and irremediable” in that it would indicate , and I quote the CMA representative, that the condition should be “towards the end of the spectrum”, but does not mean “terminal or that death is immediately on the horizon”.
If we consider the Carter ruling itself, the Supreme Court expressly stated that the scope of its declaration was intended to respond to the factual circumstances of the case, and that it made no pronouncement on other situations where physician-assisted dying may be sought. Bill C-14 would directly respond to the factual circumstances of both Kay Carter and Gloria Taylor, who were both in decline and suffering while on a trajectory toward the end of their lives without it being certain when exactly they would die.
The Supreme Court did not define the term “grievous and irremediable medical condition”. It rather acknowledged that it was Parliament's task to weigh and balance the perspective of those who might be at risk in a permissive regime against those who seek assistance in dying. This is exactly what Bill C-14 does. It defines eligibility in a manner that is consistent with the Carter ruling read in its entirety, and provides necessary clarity on the assessment of eligibility.
Some have expressed concern over the lack of express protection for conscience rights of health care providers. The legislative objectives of Bill C-14, which are clearly stated in its preamble, include respecting the personal convictions of health care providers while also recognizing the provinces' jurisdiction over various matters related to medical assistance in dying. Balancing the interests of medical practitioners and those of patients is such a matter. Importantly, nothing in Bill C-14 would compel health care providers to provide any assistance that may be contrary to their conscience rights. More important than legal protections in a statute book are the concrete and practical actions that are directly aimed at supporting conscience rights of practitioners. In this regard, the Minister of Health has offered to work in collaboration with the provinces and territories on the development of an end-of-life care coordination system to help respect the providers' conscience rights while facilitating patients' access to care including assistance in dying.
Some have expressed concern that the safeguards in the bill are not sufficient. The proposed safeguards are generally consistent with and perhaps even a little stronger than the safeguards found in other medical assistance in dying regimes around the world.
The trial judge in Carter considered voluminous evidence on the efficacy of these regimes, and the evidence persuaded her that the risks to vulnerable people could be adequately managed under such systems. We are equally confident that these safeguards would guard against abuse and error.
I believe the proposed legislation is the right way forward on medical assistance in dying for Canada at this time and is a principled response to the Carter decision. I would urge all members to support second reading of Bill C-14.
