In response to Carter v. Canada (Attorney General), the case which struck down the provisions in the Criminal Code that prohibited physician-assisted death, Minister of Justice, Jody Wilson-Raybould tabled Bill C-14 in the House of Commons for First Reading on April 14, 2016.
As set out in the Preamble, Bill C-14 was drafted so that there would be "a consistent approach to medical assistance in dying across Canada, while recognizing the provinces' jurisdiction over various matters…including the delivery of health care services and the regulation of health care professionals."
The following is a summary of Bill C-14:
Criminal Code Amendments
The framework for the Bill is the Criminal Code; therefore amendments have been made exempting medical and nurse practitioners from being charged with culpable homicide and counselling or aiding suicide, in certain circumstances. There are also similarCriminal Code exemptions for persons aiding medical or nurse practitioners, including pharmacists and persons aiding patients making a request for assisted dying.
Medical Assistance in Dying - Defined
The Act provides that medical assistance in dying means:
- the administering by a medical practitioner or nurse practitioner of a substance to a person, at their request that causes their death; or
- the prescribing or providing by a medical practitioner or nurse practitioner of a substance to a person, at their request, so that they may self-administer the substance and in doing so cause their own death.
This provision seems to suggests that a person can self-administer the lethal dose at home.
Eligibility for Medical Assistance in Dying
Persons are eligible to receive medical assistance in dying if they meet all of the following criteria:
- they are eligible for health services funded by a government in Canada;
- they are at least 18 years old and capable of making health decisions;
- they have a grievous and irremediable medical condition;
- they have made a voluntary request; and
- they have given informed consent.
People are deemed to have a grievous and irremediable medical condition if:
- they have a serious and incurable illness, disease or disability;
- they are in an advanced state of irreversible decline in capability;
- that illness, disease or disability or state of decline causes them enduring physical or psychological suffering that is intolerable to them and cannot be relieved under conditions they consider acceptable; and
- their natural death has become reasonably foreseeable, without a prognosis having been made as to the specific length of time they have remaining.
The definition for grievous and irremediable does not require a patient to have received a prognosis that death is likely to occur within a specific time frame, in contrast to the Death with Dignity Act in Oregon, the End of Life Option Act in California, the Patient Choice and Control at End of Life Act in Vermont, the Death with Dignity Act in Washington - all of which require the patient to have an illness that will produce death within six months. The definition is more similar to Quebec's An Act Respecting End-of-Life Care, which requires the patient to "be at the end of life" and in an "advanced state of irreversible decline in capability."
'Informed consent' will be defined based on provincial statues and provincial common law.
In order to preserve the safety of patients and their families, there are a many safeguards set out in Bill C-14. They oblige medical practitioners and nurse practitioners who provide medical aid in dying to:
- be of the opinion that the person meets all criteria for eligibility;
- ensure that request was:
- made in writing and signed and dated by that person or if unable to sign, another person who is at least 18 years old and who understands the nature of the request; and
- signed and dated after the person was informed that the person's natural death has become reasonably foreseeable
- be satisfied that the request is signed and dated before two independent witnesses who also sign and date the request;
- ensure that the person is informed that they can withdraw their request at any time;
- ensure that another medical practitioner or nurse practitioner has provided a written opinion confirming the person meets the eligibility criteria;
- be satisfied that he or she and the other medical practitioner or nurse practitioner are independent;
- ensure that there at least 15 clear days between the signed request and the application of the request for medical assistance in dying or fewer days if both the medical and nurse practitioners opine that the person's death or loss of capacity to provide informed consent is imminent; and
- give the person an opportunity to withdraw their request and ensure that the person gives express consent before receiving the lethal dose.
If the person making the request is unable to sign and date the request, another person who is at least 18 years old and who understands the nature of the request can do so in the person's presence on their behalf.
Witnesses must be independent. Bill C-14 sets out a specific definition for 'independent'. The definition excludes: beneficiaries under the will of the person making the request or recipients of financial or other material benefit resulting from the death; owners or operators of any health care facility where person is being treated or resides; persons directly involved in providing health care services to the person; and persons directly providing personal care to the person.
Medical practitioners and nurse practitioners providing medical assistance in dying must be independent of the other practitioner providing the opinion set out in the 'Safeguards', and this includes for example, not being in a business, mentoring or supervising relationship.
The safeguards set out in Bill C-14 are similar to the safeguards applicable in the United States and to those applicable in Luxembourg (Law of 16 March 2009 on Euthanasia and Assisted Suicide) and Belgium (28 May 2002 Act on Euthanasia). They are also quite similar to those set out in Quebec's An Act Respecting End-of-Life Care.
Education and Training
Due to the high degree of sensitivity associated with providing medical assistance in dying, Bill C-14 sets out explicitly that the application of the request must be provided with reasonable knowledge, care and skills.
This section suggests that education and training for providing medical assistance in dying is necessary.
Failure to Comply with Safeguards: Offences and Punishments
As mentioned above, Bill C-14 is rooted in the Criminal Code and therefore, there are strict provisions included for offences such as failing to comply with safeguards, forgery, destruction of documents, and misfiling of information. Punishment includes imprisonment.
Future of Bill C-14
The Bill does not set out provisions relating to conscientious objection for physicians or facilities. This issue will be left to the provincial governments and the regulatory colleges, although it is hoped that there is accordance between the provinces to ensure consistency. At present, Bill C-14 does not include provisions related to advanced directives or mature minors. The Minister of Justice has indicated that objective, evidence-based data should be gathered from this initial phase before moving forward in such a direction.
The Bill proposes an incremental adoption of medical assistance in dying for a country where this type of request is new and the gravity of the request is, great. Should the Bill pass through the House of Commons and the Senate it will become law on June 6, 2016. If Bill C-14 is defeated there will not be a consistent law across the country to guide medical assistance in dying when the current criminal code provisions are eliminated.