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Bill C-14

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SUMMARY
Criminal Code
Related Amendments
Pension Act
Corrections and Conditional Release Act
Canadian Forces Members and Veterans Re-establishment and Compensation Act
Review of Act
Coming into Force
EXPLANATORY NOTES

First Session, Forty-second Parliament,

64-65 Elizabeth II, 2015-2016

HOUSE OF COMMONS OF CANADA

BILL C-14
An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying)

FIRST READING, April 14, 2016

MINISTER OF JUSTICE

90795

SUMMARY

This enactment amends the Criminal Code to, among other things,

(a) create exemptions from the offences of culpable homicide, of aiding suicide and of administering a noxious thing, in order to permit medical practitioners and nurse practitioners to provide medical assistance in dying and to permit pharmacists and other persons to assist in the process;

(b) specify the eligibility criteria and the safeguards that must be respected before medical assistance in dying may be provided to a person;

(c) require that medical practitioners and nurse practitioners who receive requests for, and pharmacists who dispense substances in connection with the provision of, medical assistance in dying provide information for the purpose of permitting the monitoring of medical assistance in dying, and authorize the Minister of Health to make regulations respecting that information; and

(d) create new offences for failing to comply with the safeguards, for forging or destroying documents related to medical assistance in dying, for failing to provide the required information and for contravening the regulations.

This enactment also makes related amendments to other Acts to ensure that recourse to medical assistance in dying does not result in the loss of a pension under the Pension Act or benefits under the Canadian Forces Members and Veterans Re-establishment and Compensation Act. It amends the Corrections and Conditional Release Act to ensure that no investigation need be conducted under section 19 of that Act in the case of an inmate who receives medical assistance in dying.

Lastly, this enactment provides for a parliamentary review of its provisions, to commence at the start of the fifth year following the day on which it receives royal assent.

Available on the House of Commons website at the following address:

www.ourcommons.ca

1st Session, 42nd Parliament,

64-65 Elizabeth II, 2015-2016

HOUSE OF COMMONS OF CANADA

BILL C-14

An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying)

Preamble

Whereas the Parliament of Canada 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;

Whereas robust safeguards, reflecting the irrevocable nature of ending a life, are essential to prevent errors and abuse in the provision of medical assistance in dying;

Whereas it is important to affirm the inherent and equal value of every person’s life and to avoid encouraging negative perceptions of the quality of life of persons who are elderly, ill or disabled;

Whereas vulnerable persons must be protected from being induced, in moments of weakness, to end their lives;

Whereas suicide is a significant public health issue that can have lasting and harmful effects on individuals, families and communities;

Whereas, in light of the above considerations, permitting access to medical assistance in dying for competent adults whose deaths are reasonably foreseeable strikes the most appropriate balance between the autonomy of persons who seek medical assistance in dying, on one hand, and the interests of vulnerable persons in need of protection and those of society, on the other;

Whereas it is desirable to have a consistent approach to medical assistance in dying across Canada, while recognizing the provinces’ jurisdiction over various matters related to medical assistance in dying, including the delivery of health care services and the regulation of health care professionals, as well as insurance contracts and coroners and medical examiners;

Whereas persons who avail themselves of medical assistance in dying should be able to do so without adverse legal consequences for their families — including the loss of eligibility for benefits — that would result from their death;

Whereas the Government of Canada has commit-ted to uphold the principles set out in the Canada Health Act — public administration, comprehensiveness, universality, portability and accessibility — with respect to medical assistance in dying;

And whereas the Government of Canada has committed to develop non-legislative measures that would support the improvement of a full range of options for end-of-life care, respect the personal convictions of health care providers and explore other situations — each having unique implications — in which a person may seek access to medical assistance in dying, namely situations giving rise to requests by mature minors, advance requests and requests where mental illness is the sole underlying medical condition;

Now, therefore, Her Majesty, by and with the advice and consent of the Senate and House of Commons of Canada, enacts as follows:

R.‍S.‍, c. C-46

Criminal Code

1 Section 14 of the Criminal Code is replaced by the following:

Consent to death

14 No person is entitled to consent to have death inflicted on Insertion start them Insertion end , and such consent does not affect the criminal responsibility of any person Insertion start who inflicts Insertion end death on the person Insertion start who gave Insertion end consent.

2 The Act is amended by adding the following after section 226:

Exemption for medical assistance in dying

227 (1) No medical practitioner or nurse practitioner commits culpable homicide if they provide a person with medical assistance in dying in accordance with section 241.‍2.

Exemption for person aiding practitioner

(2) No person is a party to culpable homicide if they do anything for the purpose of aiding a medical practitioner or nurse practitioner to provide a person with medical assistance in dying in accordance with section 241.‍2.

Reasonable but mistaken belief

(3) For greater certainty, the exemption set out in subsection (1) or (2) applies even if the person invoking it has a reasonable but mistaken belief about any fact that is an element of the exemption.

Non-application of section 14

(4) Section 14 does not apply with respect to a person who consents to have death inflicted on them by means of medical assistance in dying provided in accordance with section 241.‍2.

Definitions

(5) In this section, medical assistance in dying, medical practitioner and nurse practitioner have the same meanings as in section 241.‍1.

R.‍S.‍, c. 27 (1st Supp.‍), s. 7(3)

3 Section 241 of the Act is replaced by the following:

Counselling or aiding suicide

241 Insertion start (1) Insertion end Everyone is guilty of an indictable offence and liable to imprisonment for a term Insertion start of Insertion end not Insertion start more than Insertion end 14 years who, whether suicide ensues or not,

(a) counsels a person to Insertion start die by Insertion end suicide or abets Insertion start a person in dying by suicide Insertion end ; or
(b) aids a person to Insertion start die by Insertion end suicide.

Exemption for medical assistance in dying

(2) No medical practitioner or nurse practitioner commits an offence under paragraph (1)‍(b) if they provide a person with medical assistance in dying in accordance with section 241.‍2.

Exemption for person aiding practitioner

(3) No person is a party to an offence under paragraph (1)‍(b) if they do anything for the purpose of aiding a medical practitioner or nurse practitioner to provide a person with medical assistance in dying in accordance with section 241.‍2.

Exemption for pharmacist

(4) No pharmacist who dispenses a substance to a person other than a medical practitioner or nurse practitioner commits an offence under paragraph (1)‍(b) if the pharmacist dispenses the substance further to a prescription that is written by such a practitioner in providing medical assistance in dying in accordance with section 241.‍2.

Exemption for person aiding patient

(5) No person commits an offence under paragraph (1)‍(b) if they do anything, at another person’s explicit request, for the purpose of aiding that other person to self-administer a substance that has been prescribed for that other person as part of the provision of medical assistance in dying in accordance with section 241.‍2.

Reasonable but mistaken belief

(6) For greater certainty, the exemption set out in any of subsections (2) to (5) applies even if the person invoking the exemption has a reasonable but mistaken belief about any fact that is an element of the exemption.

Definitions

(7) In this section, medical assistance in dying, medical practitioner, nurse practitioner and pharmacist have the same meanings as in section 241.‍1.

Medical Assistance in Dying

Definitions

241.‍1 The following definitions apply in this section and in sections 241.‍2 to 241.‍4.

medical assistance in dying means

(a) the administering by a medical practitioner or nurse practitioner of a substance to a person, at their request, that causes their death; or
(b) 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. (aide médicale à mourir)

medical practitioner means a person who is entitled to practise medicine under the laws of a province. (médecin)

nurse practitioner means a registered nurse who, under the laws of a province, is entitled to practise as a nurse practitioner – or under an equivalent designation – and to autonomously make diagnoses, order and interpret diagnostic tests, prescribe substances and treat patients.‍ (infirmier praticien)

pharmacist means a person who is entitled to practise pharmacy under the laws of a province.‍ (pharmacien)

Eligibility for medical assistance in dying

241.‍2 (1) A person may receive medical assistance in dying only if they meet all of the following criteria:

(a) they are eligible — or, but for any applicable minimum period of residence or waiting period, would be eligible — for health services funded by a government in Canada;
(b) they are at least 18 years of age and capable of making decisions with respect to their health;
(c) they have a grievous and irremediable medical condition;
(d) they have made a voluntary request for medical assistance in dying that, in particular, was not made as a result of external pressure; and
(e) they give informed consent to receive medical assistance in dying.
End of inserted block

Grievous and irremediable medical condition

(2) A person has a grievous and irremediable medical condition if

(a) they have a serious and incurable illness, disease or disability;
(b) they are in an advanced state of irreversible decline in capability;
(c) that illness, disease or disability or that state of decline causes them enduring physical or psychological suffering that is intolerable to them and that cannot be relieved under conditions that they consider acceptable; and
(d) their natural death has become reasonably foreseeable, taking into account all of their medical circumstances, without a prognosis necessarily having been made as to the specific length of time that they have remaining.
End of inserted block

Safeguards

(3) Before a medical practitioner or nurse practitioner provides a person with medical assistance in dying, the medical practitioner or nurse practitioner must

(a) be of the opinion that the person meets all of the criteria set out in subsection (1);
(b) ensure that the person’s request for medical assistance in dying was
- (i) made in writing and signed and dated by the person or by another person under subsection (4), and
- (ii) signed and dated after the person was informed by a medical practitioner or nurse practitioner that the person’s natural death has become reasonably foreseeable, taking into account all of their medical circumstances;
(c) be satisfied that the request was signed and dated by the person — or by another person under subsection (4) — before two independent witnesses who then also signed and dated the request;
(d) ensure that the person has been informed that they may, at any time and in any manner, withdraw their request;
(e) ensure that another medical practitioner or nurse practitioner has provided a written opinion confirming that the person meets all of the criteria set out in subsection (1);
(f) be satisfied that they and the other medical practitioner or nurse practitioner referred to in paragraph (e) are independent;
(g) ensure that there are at least 15 clear days between the day on which the request was signed by the person and the day on which the medical assistance in dying is provided or — if they and the other medical practitioner or nurse practitioner referred to in paragraph (e) are both of the opinion that the person’s death, or the loss of their capacity to provide informed consent, is imminent — any shorter period that the first medical practitioner or nurse practitioner considers appropriate in the circumstances; and
(h) immediately before providing the medical assistance in dying, give the person an opportunity to withdraw their request and ensure that the person gives express consent to receive medical assistance in dying.
End of inserted block

Unable to sign

(4) If the person requesting medical assistance in dying is unable to sign and date the request, another person — who is at least 18 years of age and who understands the nature of the request for medical assistance in dying — may do so in the person’s presence on their behalf.

Independent witness

(5) Any person who is at least 18 years of age and who understands the nature of the request for medical assistance in dying may act as an independent witness, except if they

(a) know or believe that they are a beneficiary under the will of the person making the request, or a recipient, in any other way, of a financial or other material benefit resulting from that person’s death;
(b) are an owner or operator of any health care facility at which the person making the request is being treated or any facility in which that person resides;
(c) are directly involved in providing health care services to the person making the request; or
(d) directly provide personal care to the person making the request.
End of inserted block

Independence — medical practitioners and nurse practitioners

(6) The medical practitioner or nurse practitioner providing medical assistance in dying and the medical practitioner or nurse practitioner who provides the opinion referred to in paragraph (3)‍(e) are independent if they

(a) are not in a business relationship with the other practitioner, a mentor to them or responsible for supervising their work;
(b) do not know or believe that they are a beneficiary under the will of the person making the request, or a recipient, in any other way, of a financial or other material benefit resulting from that person’s death, other than standard compensation for their services relating to the request; or
(c) do not know or believe that they are connected to the other practitioner or to the person making the request in any other way that would affect their objectivity.
End of inserted block

Reasonable knowledge, care and skill

(7) Medical assistance in dying must be provided with reasonable knowledge, care and skill and in accordance with any applicable provincial laws, rules or standards.

Informing pharmacist

(8) The medical practitioner or nurse practitioner who, in providing medical assistance in dying, prescribes or obtains a substance for that purpose must, before any pharmacist dispenses the substance, inform the pharmacist that the substance is intended for that purpose.

Failure to comply with safeguards

241.‍3 A medical practitioner or nurse practitioner who, in providing medical assistance in dying, knowingly fails to comply with all of the requirements set out in paragraphs 241.‍2(3)‍(b) to (h) and subsection 241.‍2(8) is guilty of an offence and is liable

(a) on conviction on indictment, to a term of imprisonment of not more than five years; or
(b) on summary conviction, to a term of imprisonment of not more than 18 months.
End of inserted block

Forgery

241.‍4 (1) Everyone commits an offence who commits forgery in relation to a request for medical assistance in dying.

Destruction of documents

(2) Everyone commits an offence who destroys a document that relates to a request for medical assistance in dying with intent to interfere with

(a) another person’s access to medical assistance in dying;
(b) the lawful assessment of a request for medical assistance in dying; or
(c) another person invoking an exemption under any of subsections 227(1) or (2), 241(2) to (5) or 245(2).
End of inserted block

Punishment

(3) Everyone who commits an offence under subsection (1) or (2) is liable

(a) on conviction on indictment, to a term of imprisonment of not more than five years; or
(b) on summary conviction, to a term of imprisonment of not more than 18 months.
End of inserted block

Definition of document

(4) In subsection (2), document has the same meaning as in section 321.

4 The Act is amended by adding the following after section 241.‍3:

Filing information — medical practitioner or nurse practitioner

241.‍31 (1) Unless they are exempted under regulations made under subsection (3), a medical practitioner or nurse practitioner who receives a written request for medical assistance in dying must, in accordance with those regulations, provide the information required by those regulations to the recipient designated in those regulations or, if no recipient has been designated, to the Minister of Health.

Filing information — pharmacist

(2) Unless they are exempted under regulations made under subsection (3), a pharmacist who dispenses a substance in connection with the provision of medical assistance in dying must, in accordance with those regulations, provide the information required by those regulations to the recipient designated in those regulations or, if no recipient has been designated, to the Minister of Health.

Regulations

(3) The Minister of Health may make regulations

(a) respecting the provision and collection, for the purpose of monitoring medical assistance in dying, of information relating to requests for, and the provision of, medical assistance in dying, including
- (i) the information to be provided, at various stages, by medical practitioners or nurse practitioners and by pharmacists, or by a class of any of them,
- (ii) the form, manner and time in which the information must be provided, and
- (iii) the designation of a person as the recipient of the information;
(b) respecting the use of that information, including its analysis and interpretation, its protection and its publication and other disclosure;
(c) respecting the disposal of that information; and
(d) exempting, on any terms that may be specified, a class of persons from the requirement set out in subsection (1) or (2).
End of inserted block

Offence and punishment

(4) A medical practitioner or nurse practitioner who knowingly fails to comply with subsection (1), or a pharmacist who knowingly fails to comply with subsection (2),

(a) is guilty of an indictable offence and liable to a term of imprisonment of not more than two years; or
(b) is guilty of an offence punishable on summary conviction.
End of inserted block

Offence and punishment

(5) Everyone who knowingly contravenes the regulations made under subsection (3)

(a) is guilty of an indictable offence and liable to a term of imprisonment of not more than two years; or
(b) is guilty of an offence punishable on summary conviction.
End of inserted block

5 Subsection 241.‍4(2) of the Act is amended by striking out “or” at the end of paragraph (b), by adding “or” at the end of paragraph (c) and by adding the following after that paragraph:

Start of inserted block
(d) the provision by a person of information under section 241.‍31.
End of inserted block

6 Section 245 of the Act is renumbered as subsection 245(1) and is amended by adding the following after that subsection:

Exemption

(2) Subsection (1) does not apply to

(a) a medical practitioner or nurse practitioner who provides medical assistance in dying in accordance with section 241.‍2; and
(b) a person who does anything for the purpose of aiding a medical practitioner or nurse practitioner to provide medical assistance in dying in accordance with section 241.‍2.
End of inserted block

Definitions

(3) In subsection (2), medical assistance in dying, medical practitioner and nurse practitioner have the same meanings as in section 241.‍1.

Related Amendments

R.‍S.‍, c. P-6

Pension Act

7 (1) The definition improper conduct in subsection 3(1) of the Pension Act is replaced by the following:

improper conduct includes wilful disobedience of orders, vicious or criminal conduct and wilful self-inflicted wounding Insertion start — except if the wound results from the receipt of medical assistance in dying and the requirement set out in paragraph 241.‍2(3)‍(a) of the Criminal Code has been met Insertion end ; (mauvaise conduite)

(2) Subsection 3(1) of the Act is amended by adding the following in alphabetical order:

medical assistance in dying has the same meaning as in section 241.‍1 of the Criminal Code; (aide médicale à mourir)

(3) Section 3 of the Act is amended by adding the following after subsection (3):

Deeming — medical assistance in dying

(4) For the purposes of this Act, if a member of the forces receives medical assistance in dying, that member is deemed to have died as a result of the illness, disease or disability for which they were determined to be entitled to receive that assistance, in accordance with paragraph 241.‍2(3)‍(a) of the Criminal Code.

1992, c. 20

Corrections and Conditional Release Act

8 Section 19 of the Corrections and Conditional Release Act is amended by adding the following after subsection (1):

Medical assistance in dying

(1.‍1) Subsection (1) does not apply to a death that results from an inmate receiving medical assistance in dying, as defined in section 241.‍1 of the Criminal Code, in accordance with section 241.‍2 of that Act.

2005, c. 21

Canadian Forces Members and Veterans Re-establishment and Compensation Act

9 (1) Subsection 2(1) of the Canadian Forces Members and Veterans Re-establishment and Compensation Act is amended by adding the following in alphabetical order:

medical assistance in dying has the same meaning as in section 241.‍1 of the Criminal Code. (aide médicale à mourir)

(2) Section 2 of the Act is amended by adding the following after subsection (5):

Interpretation — medical assistance in dying

(6) For the purposes of this Act, a member or veteran has neither inflicted wilful self-injury nor engaged in improper conduct by reason only that they receive medical assistance in dying, if the requirement set out in paragraph 241.‍2(3)‍(a) of the Criminal Code has been met.

Deeming — medical assistance in dying

(7) For the purposes of this Act, if a member or a veteran receives medical assistance in dying, that member or veteran is deemed to have died as a result of the illness, disease or disability for which they were determined to be entitled to receive that assistance, in accordance with paragraph 241.‍2(3)‍(a) of the Criminal Code.

Review of Act

Review by committee

10 (1) At the start of the fifth year after the day on which this Act receives royal assent, the provisions enacted by this Act are to be referred to the committee of the Senate, of the House of Commons or of both Houses of Parliament that may be designated or established for the purpose of reviewing the provisions.

Report

(2) The committee to which the provisions are referred is to review them and submit a report to the House or Houses of Parliament of which it is a committee, including a statement setting out any changes to the provisions that the committee recommends.

Coming into Force

Order in council

11 Sections 4 and 5 come into force on a day to be fixed by order of the Governor in Council.

Published under authority of the Speaker of the House of Commons

EXPLANATORY NOTES

Criminal Code

Clause 1: Existing text of section 14:

14 No person is entitled to consent to have death inflicted on him, and such consent does not affect the criminal responsibility of any person by whom death may be inflicted on the person by whom consent is given.

Clause 2: New.

Clause 3: Existing text of section 241:

241 Every one who

(a) counsels a person to commit suicide, or
(b) aids or abets a person to commit suicide,

whether suicide ensues or not, is guilty of an indictable offence and liable to imprisonment for a term not exceeding fourteen years.

Clause 4: New.

Clause 5: New.

Clause 6: New.

Pension Act

Clause 7: (1) Existing text of the definition:

improper conduct includes wilful disobedience of orders, wilful self-inflicted wounding and vicious or criminal conduct; (mauvaise conduite)

(2) and (3) New.

Corrections and Conditional Release Act

Clause 8: New.

Canadian Forces Members and Veterans Re-establishment and Compensation Act

Clause 9: New.