Bill C-14 (Medical Assistance in Dying)
Bill C-14, called An Act to amend the Criminal Code and to make related amendments to other Acts (or Medical Assistance in Dying) was tabled on Thursday April 14, 2016 in response to the Supreme Court of Canada Carter vs Canada decision of February 6, 2015. It allows for the following:
Criminal Code Changes:
The Criminal Code would be changed so that physicians, nurse practitioners – and those who help them – can provide assistance to die to eligible patients without the risk of being charged with assisted suicide or homicide.
Eligibility would require that a person:
- 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;
- be experiencing enduring and intolerable suffering as a result of their medical condition; and
- be on a course toward the end of life meaning 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.
Safeguards in the legislation include:
- patients having to make a written request for medical assistance in dying;
- having the request signed by two independent witnesses;
- two independent physicians or authorized nurse practitioners being required to evaluate the request;
- a mandatory period of at least 15 days of reflection, unless death or loss of capacity to consent is imminent; and
- the patient’s right to withdraw a request at any time.
Terminology used by the Federal Government:
Physician-assisted suicide: Where a physician or nurse practitioner gives or prescribes to a person a substance that they can self-administer to cause their own death.
Voluntary euthanasia: Where a physician or nurse practitioner directly administers a substance that causes the death of the person who has requested it.
Could health care providers opt out?
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. We expect that health care providers can opt out if they wish.
Would health care facilities like residential hospices be able to opt out?
The issue of site exemptions is being left to the provinces and territories and medical institutions to determine where medical assistance in dying services would be offered. Quebec has allowed residences (hospices) to opt out and most have decided to do so.
What to expect next
Both Houses of Parliament will debate Bill C-14; it will be studied by a committe, possibly amended, and then there will be a vote before it becomes law.
Here is an overview of the process:
The provinces and territories are working on parallel legislation and regulations to implement Medical Assistance in Dying.
We have been and continue to be engaged in the process. This year, CHPCA had two written submissions and I presented to the Parliamentary Joint Committee on Physician Assisted Death on February 3. I met with the Minister of Justice on March 15 and will be meeting with the Minister of Health later in April to shift the focus to universal access to hospice palliative care including “a palliative care approach to primary care” now that Bill C-14 has been tabled.
Hospice Palliative Care continues to be recognized as a parallel issue that is separate from Medical Assistance in Dying and the government has indicated that as a part of a multi-year health accord, it will commit to providing $3 billion over four years to improve home care, which will include palliative care.
The CHPCA will be working with the federal government to ensure this becomes a reality. Please stay tuned to CHPCA policy alert emails as more information becomes available.
Canadian Hospice Palliative Care Association
Friday April 15, 2016