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)

AS PASSED BY THE HOUSE OF COMMONS May 31, 2016

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

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.

This enactment provides for one or more independent reviews relating to requests by mature minors for medical assistance in dying, to advance requests and to requests where mental illness is the sole underlying medical condition.

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

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;

Whereas everyone has freedom of conscience and religion under section 2 of the Canadian Charter of Rights and Freedoms;

Whereas nothing in this Act affects the guarantee of freedom of conscience and religion;

Whereas the Government of Canada recognizes that in the living conditions of Canadians, there are diverse circumstances and that different groups have unique needs, it commits to working with provinces, territories and civil society to facilitate access to palliative and end-of-life care, care and services for individuals living with Alzheimer’s and dementia, appropriate mental health supports and services and culturally and spiritually appropriate end-of-life care for Indigenous patients;

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:

Consent to death

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

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.

Counselling or aiding suicide

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

• (a) counsels a person to die by suicide or abets a person in dying by suicide; or

• (b) aids a person to die by 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.

Clarification

(5.‍1) For greater certainty, no social worker, psychologist, psychiatrist, therapist, medical practitioner, nurse practitioner or other health care professional commits an offence if they provide information to a person on the lawful provision of medical assistance in dying.

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.

Grievous and irremediable medical condition

(2) A person has a grievous and irremediable medical condition only if they meet all of the following criteria:

• (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.

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 has a grievous and irremediable medical condition;

• (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 10 clear days between the day on which the request was signed by or on behalf of 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;

• (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; and

• (i) if the person has difficulty communicating, take all necessary measures to provide a reliable means by which the person may understand the information that is provided to them and communicate their decision.

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 the person’s behalf and under the person’s express direction.

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.

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 a mentor to the other practitioner 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.

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.

Clarification

(9) For greater certainty, nothing in this section compels an individual to provide or assist in providing medical assistance in dying.

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.

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).

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.

Definition of document

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

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,

  • (iii) the designation of a person as the recipient of the information, and

  • (iv) the collection of information from coroners and medical examiners;

• (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).

Guidelines — information on death certificates

(3.‍1) The Minister of Health, in cooperation with representatives of the provincial governments responsible for health, may establish guidelines on the information to be included on death certificates in cases where medical assistance in dying has been provided, which may include the way in which to clearly identify medical assistance in dying as the manner of death, as well as the illness, disease or disability that prompted the request for medical assistance in dying.

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.

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.

• (d) the provision by a person of information under section 241.‍31.

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.

Definitions

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

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

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

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 eligible to receive that assistance, in accordance with paragraph 241.‍2(3)‍(a) of the Criminal Code.

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.

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

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 eligible to receive that assistance, in accordance with paragraph 241.‍2(3)‍(a) of the Criminal Code.