My statement on Medical Assistance in Dying (Bill C-14)
I rise in the House today in support of Bill C-14, An Act to amend the Criminal Code and to make related amendements to other Acts, also known as Medical Assistance in Dying or MAID. In January, I was appointed to the Special Joint Committee on Physician-Assisted Dying and I was excited for the opportunity to be a part of the change that many Canadians have been waiting for.
Over the span of a couple of months, my fellow committee members and I spent a lot of time working to understand the complex issue of Medical Assistance in Dying. We discussed, we debated, and we even disagreed on a few issues, but in the end, we drafted a report that I felt was the best possible solution for this complex social and legal issue.
Drafting any legislation can be difficult, but it becomes especially difficult when the title includes “death or dying”. It is a topic that most of us are sensitive towards, and many have difficulty confronting.
Within the Special Joint Committee, we dealt head on with a number of difficult issues, and were immersed in them for 6 weeks. We reviewed reports by the Provincial-Territorial Expert Advisory Group on Physician-Assisted Dying, Healthcare regulatory bodies throughout Canada, and the federal External Panel on Options for a Legislative Response to Carter v. Canada, to name a few.
We had the challenging task of grappling with a few major issues touched on by Bill C-14, which included the availability of Medical Assistance in Dying for mature minors, patients with mental illness, advance consent, conscientious objection and inevitably, ensuring that adequate safeguards were in place to protect the vulnerable.
On February 25th, the Special Joint Committee reported back to Parliament, where the Ministers of Justice and Health took the report into consideration, and began drafting Bill C-14, which is what I am here to discuss today.
Bill C-14 reflects a number of recommendations made by the Special Joint Committee, which include:
allowing both Euthanasia and Assisted Suicide
being permanent residents of Canada, so as not to encourage, what some have coined as, “suicide or death tourism”
requiring a written request for medical assistance in dying
requiring 2 witnesses during the time of request
requiring confirmation from 2 doctors or nurse practitioners that the person making the request meets all of the criteria for MAID; and
requiring a mandatory statutory review
The key message I have taken from this very difficult discussion that I was part of, and that Canadians are now joining, is that this has to be a patient-centered discussion. I encourage all parliamentarians to set aside personal values and beliefs and focus on what is in the best interest of patients. Medical assistance in dying is, and should only be, about the patient.
Upon reflection of our committee work, I now realize that the committee managed to develop a higher level of comfort with this difficult topic than is held by most Canadians at this point in the public discourse on MAID. So I am glad to see that the Government took the overarching perspective of Canadians into consideration and is willing to use this legislation as a stepping stone for further studies and future re-visitation.
In the past few months I have hosted and co-hosted medical assistance in dying townhalls. I have spoken directly to my constituents. I have listened to the concerns of my constituents and of many Canadians around the country, and just last week, there was a demonstration for Bill C-14 held at my Constituency Office. I’ve heard the positive, the negative, the concerns, and the support, and although I fully support this legislation, I believe there are a few voids that have yet to be filled.
Firstly, during the demonstration last week, an important criteria, or better yet lack of criteria, of the bill was brought into question. How does one maintain safeguards when dealing with non-medical personnel? Bill C-14 ensures protections are met for non-medical personnel who participate in Medical Assistance in Dying, including those who aid a person, at that person’s explicit request, to self-administer a substance prescribed as part of the provision of MAID, by amending sections 241 of the Criminal Code, and introducing section 227 to allow MAID if the appropriate conditions are met.
But, what is being done to ensure that non-medical personnel are in fact following the guidelines required by MAID? For instance, right before the time of administering the lethal prescription, a patient must be asked whether they would like to continue with MAID, but how do we know that these independent individuals are in fact asking this question, among others? How do we know that the individual will not take advantage of the situation or the vulnerable position that the patient is in? These are questions my constituents would like to see addressed.
Secondly, I recently spoke to someone who was heavily involved in the Carter V. Canada case, who was wondering whether Kay Carter herself would have qualified for Medical Assistance in Dying given the legislation being discussed today. I’ve read articles stating that she would have been, because she met the criteria for eligibility. But would health-care practitioners consistently agree that Kay Carter would indeed have qualified under this legislation?
The part that I am finding difficult to grasp, for Kay Carter, and many others, is the ambiguity of the criterion for imminent death. How do we know that individuals will not be turned away from the service of MAID, because of the vague nature of this criterion. Who is responsible for deciding the criteria for imminent death? Will there be inconsistencies in the definition of imminent death? How will we, as society, address these?
Lastly, the hard timeline between the date of request and the day on which medical assistance in dying would be provided was yet another point of concern. Many constituents have expressed concerns that this may lead to the hastening of death, because the timeline was simply too short. The Special Joint Committee had recommended a flexible waiting period, which would depend on the nature of the illness, as opposed to just an “imminent death.” It would be suggested that imminence and competence not be the only factors in determining the timeline, but much rather “the rapidity of progression and nature of the patient’s medical condition” be used when determining the reflection period.
These are a few pieces of the proposed legislation that my constituents and I feel need to be clarified and tightened before the final legislation is created for June 6, 2016.
However, I also want to acknowledge that the legislation has done a great job of addressing a number of concerns that have been conveyed by my constituents and many others. For instance, the first misconception that I would like to clear up is that Bill C-14 does not address the conscientious objections of medical personnel. It does.
There is nothing in the proposed legislation that would compel a healthcare 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 and we need to respect that. However, that being said, 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.”
Bill C-14 also “recognizes the autonomy of persons who have a grievous and irremediable medical condition that causes them enduring and intolerable suffering and who wish to seek medical assistance in dying,” while recognizing the importance of protecting the vulnerable and ensuring adequate safeguards are in place.
In addition to the Government’s commitment on medical assistance in dying, as suggested in Bill C-14, the government is committed to improving end of life-care services; “The Government of Canada has made a commitment to develop non-legislative measures that would support the improvement of a full range of options for end-of-life care.” It has also committed to providing $3 billion over the next 4 years to improve home care, which includes palliative care. While this may not be enough to cover the deficiencies across the country, it is definitely the beginning of a long-term approach to ensuring access to palliative care for increased numbers of Canadians.
Over the past 4 months I have encountered a wide variety of perspectives about this complex and difficult issue. Some have been extremely restrictive, while others have been extremely permissive. Some believe that the legislation goes too far, while others believe it does not go far enough.
I believe that Bill C-14 is an important first step in Canada. It is a cautious, even conservative piece of legislation but it provides a necessary first response to the Carter decision, along with a commitment to continue studying the effects and revisiting important issues of MAID in the future.
A local paper - The Langley Times did a piece on the demonstration that took place at my Cloverdale-Langley City riding office last week and stated that “Despite the contentious nature of the issue, discussions appear to have been largely respectful and constructive leading up to new federal legislation on [Medical Assistance in Dying].” So to all of my constituents who have emailed, called, attended townhalls, and everyone who has voiced their opinion on Medical Assistance in Dying in a respectful manner, thank you. I appreciate and encourage the feedback. Our government will continue to ask for your input on this and other issues.
Dr. Cindy Forbes, of the Canadian Medical Association has indicated support for Bill C-14, which she made evident in her statement on April 14th, when she said that the “…commitment to exploring mechanisms to support patient access and respect the personal convictions of health care providers will be critical to the pan-Canadian framework on medical assistance in dying. We applaud the federal government for making this commitment.”
Ultimately, when it comes to Bill C-14, I would like to see the voids found within the legislation to be addressed prior to June 6th and I intend on supporting Bill C-14. Like Dr. Forbes, I encourage my colleagues, on both sides of the House, to support the rights of Canadians, and to put patients first, by supporting Bill C-14.
Thank you Mr. Speaker."