Bruce Stanton Responds to Bill C-14, Legislation on Medical Assistance In Dying
Following the introduction of the government’s proposed legislation on medical-assistance in dying, Bill C-14, I have reviewed the bill and the feedback I received on this issue and concluded that I will be supporting it, at second reading. I’d like to explain how I reached this decision. At the bottom of the page are links to Bill C-14, a backgrounder on the bill from the Department of Justice, the Supreme Court’s Carter decision, the Special Joint Committee on Physician-Assisted Dying, and my submission to the Minister of Justice on this subject. I have included a link to the Provincial-Territorial Expert Panel on this issue, and the federal government’s own expert panel process that reported to the Justice Minister in December 2015.
It is first instructive to briefly recap how we got here, and what the government has proposed. As you know, in February 2015 the Supreme Court made its ruling in Carter v. Canada (Attorney General), which involved a number of Canadians suffering from illnesses such as degenerative spinal stenosis (Kay Carter) and amyotrophic lateral sclerosis (ALS) (Gloria Taylor) who challenged the Criminal Code provisions banning medical professionals from assisting them in ending their lives. In their ruling, the Court struck down those provisions on the basis that they were a violation of the right to life, liberty and security of the person (Section 7 of the Canadians Charter of Rights and Freedoms) for people who meet three conditions:
- They are competent adults
- They consent to ending their life
- They have a grievous and irremediable medical condition (including an illness, disease or disability) that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition
The Court gave the federal government one year to bring forward new legislation that would be compliant with this ruling. With the change in government following the 2015 federal election, the new government was given an additional four months to pass this legislation, and created a Special Joint Committee on Physician-Assisted Dying (PDAM) to study this issue. The Committee released its recommendations on February 25th. A link to this study report is listed below
I also conducted my own consultations on this issue in January and February 2016, speaking with experts and stakeholders familiar with end-of-life issues, and have received hundreds of mailed and emailed comments and opinions, in response to my invitation to hear from constituents. These inputs were summarized in my submission to the Minister of Justice, Jody Wilson-Raybould, on March 8th (see link below)
On April 14th, the government introduced its proposed legislation, Bill C-14 (An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying)). It would allow Canadians who satisfy the following conditions to access medical-assistance in dying:
- Be a mentally competent adult (18 years or older)
- Make a voluntary request and give informed consent to receive medical assistance in dying
- Have a serious and incurable illness, disease or disability
- Be in an advanced state of irreversible decline in capability
- Experience enduring and intolerable suffering as a result of their medical condition
- Be on a course toward the end of life. Death would have to be reasonably foreseeable in all of the circumstances of a person’s health, but there would not have to be a specific prognosis or prospected time period before death.
The government also identified three areas that it wants to take more time to examine before addressing through legislation: requests by mature minors, the use of advance directives (allowing people to provide consent for medical-assistance in dying while competent to do so, but in advance of their illness or condition reaching a state of enduring and intolerable suffering to the point they would not be capable of giving voluntary, informed consent as the law would require), and requests where mental illness is the sole underlying condition. This recaps how we arrived at this point.
Turning to my reasoning for supporting this bill, at least at this stage, as you would undoubtedly have concluded, this is an issue that resonates at a personal level with most people. There was no consensus among what I heard. Compelling arguments were provided on both sides of the question. For some, the sanctity of life is of paramount concern, and hastening the end of a life is simply not acceptable under any circumstances. On the other side, people have recounted the experience of family members or friends who underwent a painful, undignified, end-of-life, complete with the burden of guilt that loved ones were providing strenuous, heroic care, sometimes at a considerable detriment to their own health and well-being. They wished to end their physical and emotional turmoil knowing the end was near. We heard of cases where patients were left with self-starvation as a means of hastening their own death, but concluded it would be for not, since they would be fed intravenously. This is a regrettable and sad state of being for the last days of anyone, let alone, someone you cherish and love. The latter experience underlines the necessity of access to quality, palliative, end-of-life care for all Canadians.
Accordingly, medical-assistance in dying is something that Canadians should be able to access in the certain circumstances, such as those outlined by the Supreme Court in their Carter ruling. Even among supporters of medical assistance in dying, many expressed concern about ensuring there are adequate safeguards to protect vulnerable Canadians from being coerced into ending their lives, as well as for respecting the conscience rights of health care workers who hold moral, ethical or religious objections to medical-assistance in dying.
I had previously expressed support for allowing access to medical-assistance in dying provided it was limited to those identified in the Supreme Court’s Carter ruling – competent adults who consent to ending their lives, and are suffering from a grievous and irremediable medical condition. Bill C-14 is consistent with that ruling.
The three primary concerns that I identified during my consultations related to (i) protecting conscience rights of healthcare workers, (ii) protections for vulnerable Canadians, particularly if the legislation included the ability to have a third-party consent to medical-assistance in dying in the event the person was not competent to provide it themselves, and (iii) access to quality palliative care.
On protecting conscience rights, the government has indicated the following:
Would health care providers be able to decline to provide medical assistance in dying?
There is nothing in the proposed legislation that would compel a health care provider to provide medical assistance in dying or refer a patient to another medical practitioner. Balancing the rights of medical providers and those of patients is generally a matter of provincial and territorial responsibility. However, the federal government has committed to work with provinces and territories to support access to medical assistance in dying, while respecting the personal convictions of health care providers.
On protecting vulnerable Canadians, given the narrow scope of who qualifies for medical-assistance in dying, which precludes third-party consent, I’m satisfied the following safeguards that have been proposed, would prevent a person from being assisted in dying against their wishes.
- A request for medical assistance in dying would need to be in writing by the patient or another adult on the patient’s behalf, if the patient cannot write, and witnessed by two independent witnesses;
- A physician or nurse practitioner would need to be of the opinion that the patient is eligible to receive medical assistance in dying;
- A second physician or nurse practitioner would need to provide a written opinion confirming the patient is eligible to receive medical assistance in dying;
- The physician or nurse practitioner providing medical assistance in dying and the physician or nurse practitioner giving the second opinion would need to be independent of each other and of the patient;
- Following the request for medical assistance in dying, a mandatory reflection period of at least 15 days would need to occur between the day the written request was signed and the day medical assistance in dying was provided, unless death or the patient’s loss of capacity were imminent;
- A patient requesting medical assistance in dying could rescind their request at any time; and
- Immediately before providing medical assistance in dying, the physician or nurse practitioner would need to give the patient the opportunity to withdraw their request and ensure that the patient gives express consent to receive medical assistance in dying.
With respect to access to palliative care, I was looking for assurances that the availability of medical assistance in dying would not erode funding for palliative care but that, indeed, it should be expanded. A lack of access to high-quality, palliative care should never lead someone to seek medical-assistance in dying. When the government introduced C-14, they committed to working with the provinces and territories to improve palliative and end-of-life care when they negotiate a new Health Accord.
While I support this bill at Second Reading, my support will be withdrawn if the bill is returned with amendments that broaden access beyond the current limitations, limitations I believe are just and necessary to protect the vulnerable.
I will continue to press the government to fulfill its commitment to supporting and ensuring palliative care is accessible to all Canadians, and that healthcare professionals will not be required to participate, and be saved any recrimination in so choosing, in any administering of medical assistance in dying.
As I indicated earlier, the government has signaled that further examination of the three issues surrounding broader access to medical-assistance in dying;, as it concerns mature minors, advance directives, and requests when mental illness is the sole underlying condition, will be taken up at some point in the future. I will follow these developments closely but I believe society’s interest in protecting vulnerable (mentally ill, infirmed and aged, with cognitive or developmental disabilities, among others) Canadians against abuses should outweigh the prerogative of individuals to claim access to medical assistance in dying, beyond this limited and compassionate approach the government has defined.
I hope you find my explanations helpful and informative. Please contact me if you have further questions of comments. Again, thank you for taking the time to convey your concerns and comments on this issue.
Bruce Stanton, M.P.