Questions and Answers
Bill C-14, legislation on medical assistance in dying, received royal assent on June 17, 2016. For more information, visit canada.ca/health
The following is a list of questions and answers related to the proposed medical assistance in dying legislation. Content has been grouped by subject.
For definitions of specific terms, see the Glossary.
Background on the proposed legislation
- Why has the government introduced legislation on medical assistance in dying?
Since the SCC’s decision in Carter meant that medical assistance in dying would become legal in Canada, it was the responsibility of the government to put forward clear rules around who is eligible to obtain medical assistance in dying, what safeguards must be followed to ensure that vulnerable individuals are protected, and to create a monitoring regime to ensure accountability, transparency, and public trust in the system. Federal legislation also ensures a consistent approach to medical assistance in dying across Canada.
Additionally, the Government has committed to working with provinces and territories to explore options to support access for patients who want access to medical assistance in dying in a manner that supports the personal convictions of health care providers. The Government has also, committed to working with the provinces and territories to improve palliative care during discussions on a new health accord.
- Why are we calling this regime “medical assistance in dying”?
- The term “medical assistance in dying” is meant to clarify several important points. First, assistance in dying would only be legally permitted in a medical context. Second, using the word “medical” as opposed to the more commonly used term “physician” indicates that medical professionals other than physicians could provide medical assistance in dying, specifically nurse practitioners. Third, the words “in dying” suggest that eligibility would be limited to patients who are dying, i.e., nearing a natural death, without requiring a specific life expectancy.
- Were consultations held on the development of the regime? Who was consulted and how?
There have been many consultations over the past year on the issue of medical assistance in dying, and the results of all those activities have been taken into account in developing the legislation.
On December 11, 2015, the Special Joint Committee (SJC) on Physician-Assisted Dying was established to review recent consultation activities, including those of the External Panel on Options for a Legislative Response to Carter v. Canada and the Provincial-Territorial Expert Advisory Group on Physician-Assisted Dying. The Committee also consulted with Canadians and stakeholders, and made recommendations on the framework of a federal response to Carter. The SJC held 16 meetings, heard from 61 witnesses, received over 100 briefs, and tabled its final report in Parliament on February 25, 2016, which included 21 recommendations on eligibility, procedural safeguards, oversight and monitoring, and other health sector implementation issues and responses.
- Is medical assistance in dying available elsewhere in the world?
Some form of medical assistance in dying is regulated under legislation in four US states (Oregon, Washington, Vermont and California), in Colombia, and in three European countries (Belgium, the Netherlands, and Luxembourg, i.e., “Benelux”). There are similarities and differences between which form of medical assistance in dying is allowed, who is eligible, and the procedures to be followed.
In Switzerland, assisted suicide is not a crime if the person providing assistance does not do so for a selfish motive. The practice is not specifically regulated; it is carried out by several distinct “right to die” organizations, each with its own protocols. Generally, eligibility is similar to that under the laws of the Benelux countries. Voluntary euthanasia is prohibited.
- Does this legislation comply with Carter?
Yes. This legislation would ensure that individuals whose circumstances were considered by the court in Carter could obtain access to medical assistance in dying. See question specific to Kay Carter.
While the Supreme Court of Canada did not explicitly say that its ruling was “limited to individuals who are nearing death, it expressly stated that: ”[t]he scope of this declaration is intended to respond to the factual circumstances in this case. We make no pronouncement on other situations in which physician-assisted dying may be sought.” (para. 127) In legal terms, the effect of these words is that the declaration is limited to persons like Ms. Taylor, a person who was nearing death.
Gloria Taylor was suffering from the fatal disease of ALS and was in an advanced state of irreversible decline in capability. When she joined the litigation, she had a prognosis of one year to live, in other words, her natural death had become reasonably foreseeable. Under Bill C-14, people like Ms. Taylor would be eligible for medical assistance in dying. But Bill C-14 goes farther than the circumstances of Ms. Taylor in two ways: the legislation expressly states that a specific prognosis of time remaining left to live is not required, and that that reasonable foreseeability of death is a function of “all” of a person’s medical circumstances, meaning that they do not have to be dying from a fatal or “terminal” disease.
The SCC did not define “grievous and irremediable medical condition”; rather, it acknowledged that it was Parliament’s task to “weigh and balance the perspective of those who might be at risk in a permissive regime against that of those who seek assistance in dying”. This is what Bill C-14 does: it defines eligibility in a manner that is consistent with Carter in its entirety, thus bringing certainty and clarity to the assessment of eligibility.
- How is Bill C-14 compliant with the Canadian Charter of Rights and Freedoms?
- The proposed legislation was carefully reviewed for consistency with the Charter. The Minister of Justice and Attorney General of Canada tabled and made publicly available the Legislative Background for Bill C-14 at Second Reading in the House of Commons. This document describes the legislative considerations and the potential Charter impacts of the Bill.
Coming into force and interim measures
- When exactly did the Supreme Court of Canada’s decision in Carter take effect?
- The effects of the decision in Carter, which ended the prohibition on medical assistance in dying, took effect on Tuesday, June 7th.
- When would the proposed legislation come into force?
- The law would come into force when it is passed and receives Royal Assent (typically within a few days of being passed by Parliament).
- What happens now that the June 6, 2016 deadline has passed, and the legislation has not passed in Parliament?
- The Supreme Court of Canada’s ruling in Carter takes effect on June 7, 2016, meaning that medical assistance in dying is lawful where it is in accordance with the parameters set by the Carter ruling. The interim court approval process established by the Supreme Court in January 2016 is no longer available or required for medical assistance in dying.
- What effect does the proposed legislation have on cases before the courts now where patients are seeking medical assistance in dying?
- This is proposed legislation that is currently before Parliament and therefore it is not in force. It has no effect on cases that are currently before the courts.
Types of medical assistance in dying and eligibility for it
- What form or forms of medical assistance in dying would be permitted?
The amendments would allow two types of medical assistance in dying:
- where a physician or nurse practitioner directly administers a substance that causes the death of the person who has requested it - commonly called voluntary euthanasia; and
- where a physician or nurse practitioner gives or prescribes to a person a substance that they can self-administer to cause their own death - commonly known as physician-(or medically-) assisted suicide.
- Would all patients be able to choose which type of medical assistance in dying they want?
- The criminal law would permit physicians and nurse practitioners to provide both types of medical assistance in dying. Provinces and territories could decide, under their health jurisdiction, to make additional rules about one or both practices.
- Does the person have to be dying from a fatal or terminal disease to be eligible?
No. Any mentally competent adult who has a serious and incurable illness, disease or disability, who is in an advanced state of irreversible decline in capability, who is suffering intolerably, and whose death has become reasonably foreseeable, should have access to medical assistance in dying, by making a voluntary request giving informed consent.
It is not required that the person be suffering from a fatal disease that will cause their death. Rather, the legislation expressly states that death must be “reasonably foreseeable, taking into account all of their medical circumstances,” which could include considerations of age or frailty, and the interaction of several different medical conditions which may cause the person to be in a life-threatening condition. This language was deliberately chosen to avoid limiting assistance to those suffering from fatal or “terminal” conditions, and to allow everyone who is in suffering while in decline toward the end of life to have the option of choosing a medically-assisted death.
- Would psychological suffering meet the test for eligibility?
- Yes. A person would need to be suffering unbearably as a result of their medical circumstances, and both physical pain and psychological suffering can justify a request for medical assistance in dying. However, a patient would still need to meet all of the other eligibility criteria.
- Why is the proposed law only available to adults?
- At this time, not enough is known about the risks and benefits of medical assistance in dying for minors. The trial judge in Carter found that, to the degree that there was a societal consensus on eligibility for medical assistance in dying, it was limited to mentally competent or capable adults. This approach responds directly to the Supreme Court’s ruling in Carter: “The appropriate remedy is therefore a declaration that p. 241 (b) and s. 14 of the Criminal Code are void insofar as they prohibit physician-assisted death for a competent adult person who (1) clearly consents to the termination of life; and (2) has a grievous and irremediable medical condition (including an illness, disease or disability) that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition. “Irremediable”, it should be added, does not require the patient to undertake treatments that are not acceptable to the individual. The scope of this declaration is intended to respond to the factual circumstances in this case. We make no pronouncement on other situations where physician-assisted dying may be sought.” However, the Government would also initiate an independent review of the special considerations related to requests for medical assistance in dying by mature minors within 180 days of the legislation receiving Royal Assent.
- Why not offer medical assistance in dying for mature minors?
The Carter ruling was limited to adults (see paragraph 127 of the decision). There was no evidence before the Court about assessing a minor’s ability to make a decision involving terminating their life, nor about how medical practitioners might respond to such cases. The Supreme Court of Canada expressly acknowledged that the issue of medical assistance in dying for minors was not part of the factual circumstances being considered by the Court (paragraph 111 of the decision).
However, if Bill C-14 passes in Parliament, the government would initiate an independent review to study the legal, medical and ethical issues related to medical assistance in dying for mature minors and in other contexts within 180 days of the legislation receiving Royal Assent. This will enable the development of the approach to this study, and the study itself, to be informed by the considerations and perspectives that will be expressed during the Parliamentary study of the Bill.
- When will the federal government mandate the independent studies of other issues, such as requests by mature minors, advance requests and requests when mental illness is the sole underlying medical condition?
- The federal government would initiate these reviews within 180 days of the legislation receiving Royal Assent. This would allow Parliamentary and other perspectives expressed during the study of the Bill to inform the approach to these studies, and the studies themselves.
- Would patients have to be mentally competent or capable at the time that medical assistance in dying would be provided?
- Yes. Just before the physician or nurse practitioner could provide medical assistance in dying — whether in the form of administering, providing or prescribing a lethal substance — they would need to confirm with the patient that they are still sure that this is what they want. It is very important that the patient be able to withdraw their consent for medical assistance in dying at any time.
- Why is it important to ensure that requests are voluntary?
- The requirement that the request be “voluntary” is another way of saying that the person who would receive medical assistance in dying must decide to request it for themselves, without any pressure from any other person. The Supreme Court of Canada found that the right to choose medical assistance in dying belongs only to the competent adult who would receive it. This requirement is also necessary to protect vulnerable people.
- Would Kay Carter have been eligible under the Bill C-14 criteria?
As noted in the Supreme Court’s decision in Carter, “Kay was diagnosed in 2008 with spinal stenosis, a condition that results in the progressive compression of the spinal cord. By mid-2009, her physical condition had deteriorated to the point that she required assistance with virtually all of her daily activities. She had extremely limited mobility and suffered from chronic pain.” (para 17). Kay Carter was 89 years old when she went to Switzerland to obtain assisted dying.
Under the proposed legislation, two independent health care professionals would need to evaluate the circumstances of a patient’s health. The circumstances of Kay Carter could have been found to meet the following four eligibility criteria to receive medical assistance in dying:
- Having a serious and incurable illness, disease or disability;
- Being in an advanced state of irreversible decline;
- Enduring physical or psychological suffering that was intolerable to her; and,
- Her natural death had become reasonably foreseeable, taking into account all of her medical circumstances, without a prognosis necessarily having been made as to the specific length of time left to live. (it is not required that death be caused by any particular disease or condition - it can include considerations of age or frailty, and all other relevant health considerations).
- Why not offer medical assistance in dying for those suffering solely from a mental illness?
People with a mental illness would be eligible for medical assistance in dying, as long as they met all of the eligibility criteria.
Where death is not reasonably foreseeable in all of the circumstances of the person’s medical condition or where their mental illness renders them incompetent to make medical decisions, people with psychiatric conditions would not be able to access medical assistance in dying, because they would not meet all of the eligibility criteria.
In terms of the Carter ruling there was no evidence before the Court about the specific considerations and complexities regarding medical assistance in dying for people suffering solely from amental illness, and no witnesses or parties to the case were in such circumstances. In fact, the Court said at paragraph 111, in regards to evidence from Belgium: “a number of recent, controversial and high-profile cases of assistance in dying in Belgium ... would not fall within the parameters suggested in these reasons, such as euthanasia for minors or persons with psychiatric disorders...”.
Medical assistance in dying for people suffering solely from a mental illness involves a unique range of considerations and concerns, and more study is needed to determine the relative benefits and risks associated with permitting assistance in dying in this context in Canada.
If Bill C-14 passes in Parliament, the government is proposing an independent study be conducted of the legal, medical and ethical issues related to medical assistance in dying for those suffering from a mental illness alone. This would enable the development of the approach to this study, and the study itself, to be informed by the considerations and perspectives that will be expressed during the Parliamentary study of the Bill.
- Why not allow advance directives for medical assistance in dying?
Advance directives, by their nature, are made before they are needed and are only actioned when a person can no longer communicate. People who cannot communicate cannot confirm whether or not they still consent to the procedure requested in the advance directive. The ability to withdraw consent is a key safeguard in the Bill to protect vulnerable individuals.
Furthermore, the Carter ruling was limited to mentally competent adults who clearly consent at the time that medical assistance in dying would be provided. There was no evidence before the Court regarding the unique considerations of advance directives.
However, in recognition of these difficult circumstances, the legislation does permit the reflection period of 10 days to be shortened to any shorter period of time if it appears to both medical practitioners that the person’s loss of capacity to consent is imminent.
In testimony before the Special Joint Committee on Physician-Assisted Dying, the Alzheimer’s Society of Canada warned that the “risks are just too great” to allow medical assistance in dying when a person is no longer competent to express their wishes.
If Bill C-14 passes in Parliament, the government is proposing an independent study of the legal, medical and ethical issues related to advanced requests for medical assistance in dying. This would enable the development of the approach to this study, and the study itself, to be informed by the considerations and perspectives that will be expressed during the Parliamentary study of the Bill.
Protective measures and safeguards in the proposed legislation
- Why would it be required that the request be in writing?
- Requiring a written request serves several purposes, just as it does for other important decisions that must be put in writing. It underscores the seriousness of the decision, it helps avoid confusion and uncertainty, and it provides evidence that could help protect those who participate from any allegations that they behaved improperly. The legislation would also ensure that where the patient could not write or sign, someone could do so on their behalf.
- Why would it be required that the request be witnessed by two independent witnesses?
- The proposed requirement for independent witnesses is a safeguard intended to ensure that requests for medical assistance in dying are truly voluntary, reflect the wishes of the patient, and are not made as a result of external pressure or coercion. It also serves to reinforce the serious nature of the decision being made, as many other important documents must be witnessed by independent persons. Without such a safeguard, it would be possible for a person to receive medical assistance in dying with the only witnesses being the medical practitioners who carried out the procedure. In such a situation, it would be very difficult to verify whether the person’s request for medical assistance in dying was truly their own decision. The involvement of independent witnesses who have nothing to gain from the person’s death and who have not been involved in the person’s treatment also provides an important element of transparency to the process.
- Why would a second medical opinion be required?
- The proposed legislation requires that individuals seeking medical assistance in dying obtain a second medical opinion. A second medical opinion is intended to corroborate the assessment made by the first physician or nurse practitioner concerning the eligibility for medical assistance in dying. This second opinion would also help reassure the practitioner who would provide medical assistance in dying that he or she is acting within the scope of the law and consistent with reasonable medical knowledge and skill. Finally, it would give Canadians confidence that checks and balances are in place, and would minimize the chance of abuse.
Providers of medical assistance in dying
- Which type of medical professional would be able to provide patients with medical assistance in dying?
- Both physicians and nurse practitioners would be able to provide medical assistance in dying without facing criminal consequences, so long as they comply with the rules set out in the Criminal Code, and all applicable provincial and territorial laws, rules and policies.
- Why would nurse practitioners be eligible to provide medical assistance in dying?
Any nurse practitioner whose provincial and territorial laws and professional rules and standards allow them to provide medical assistance in dying would be able to do so without fear of criminal sanction.
Nurse practitioners have the authority to deliver many of the same medical services as family physicians; they can assess, diagnose, prescribe and treat patients. They can act independently in every jurisdiction except Quebec, where they practice under the authority of a physician.
Exempting nurse practitioners from criminal liability would provide provinces and territories with an additional option to facilitate access to medical assistance in dying.
- What would medical professionals need to do to ensure they are acting within the law when they provide medical assistance in dying?
- Physicians and authorized nurse practitioners would not face criminal liability if they provided medical assistance in dying to an eligible patient and in compliance with the safeguards set out in the Criminal Code. They would also need to ensure that they comply with any applicable provincial or territorial laws, rules and policies.
- Would other health providers who could be part of the process of assessing a medical assistance in dying request also be protected from liability?
- Yes. Everyone who acts for the purpose of helping a physician or authorized nurse practitioner provide medical assistance in dying, in accordance with the applicable criminal rules, and any applicable provincial or territorial laws, standards or rules, would be protected from criminal liability. This could include social workers who are asked to assist in evaluating the voluntariness of a patient request, hospital lawyers who are asked to verify compliance with the medical assistance in dying safeguards, nurses aiding providers in delivering the procedure, and pharmacists who fill the prescriptions.
- Could a physician or nurse practitioner or other health care provider who provides information about medical assistance in dying to a patient be charged with a criminal offence?
It would not be a crime for a physician or nurse practitioner, or other health care professional (such as a social worker, psychologist, psychiatrist or therapist), to provide information about how to request medical assistance in dying in a lawful manner. However, it would remain a crime to provide a person with information that would enable them to take direct action to end their life in an unlawful manner, such as where to find certain deadly chemicals that could be ingested to cause death.
It would also remain a crime for anyone, including physicians and nurse practitioners, to encourage, counsel, advise, recommend, or in any way try to influence a person to seek to end their life. Physicians and nurse practitioners - and others in a caregiving relationship with a patient, or those in a relationship of authority or responsibility over a patient - should take care to avoid inadvertently encouraging someone to choose medical assistance in dying.
- Would all physicians and nurse practitioners who act in “good faith” be protected from criminal liability?
- Physicians and nurse practitioners who act in “good faith” or with a reasonable but mistaken belief would be protected from criminal liability. For example, if a physician honestly believed that a patient was 18 years old or that their state of decline was irreversible, and other reasonable practitioners would have formed the same belief, they would still be entitled to the medical assistance in dying exemption, even if they later learned that they were mistaken.
- Would there be a specific exemption for pharmacists?
- Yes. There would be a specific exemption for pharmacists that would apply where the patient had obtained a prescription that the pharmacist must fill. In this situation, the pharmacist delivers the drugs directly to the patient (or someone on their behalf) and so would be closely connected to the patient receiving a substance that they could use to end their life. A specific exemption has been proposed for pharmacists to provide certainty and clarity as to what they are permitted to do.
- Would institutions be able to decline to provide medical assistance in dying?
- Under our constitution, it would be up to individual provinces and territories to determine whether some medical institutions would be allowed to decline to provide medical assistance in dying. Nothing in Bill C-14 addresses this issue.
Supporting the personal convictions of health care providers
- Would health care providers be able to decline to provide medical assistance in dying?
- 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. Balancing the rights of medical providers and those of patients is generally a matter of provincial and territorial responsibility. However, 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.
- How will patients access medical assistance in dying, if their physician or nurse practitioner will not provide it due to personal convictions?
- The Supreme Court of Canada was clear that nothing in its reasons would compel physicians to provide medical assistance in dying and there is nothing that compels physicians to provide medical assistance in dying in the proposed legislation. However, physicians and nurse practitioners exercising their conscience rights may constitute a barrier to access for those who are seeking medical assistance in dying. The government will work with provinces and territories to explore options to facilitate access and care coordination, while recognizing the personal convictions of health care providers.
- Are there drugs available in Canada for medical assistance in dying?
Many of the drugs commonly used for this procedure are already marketed in Canada, and are prescribed for common purposes, such as pain control, anaesthesia, and nausea.
Decisions by physicians and nurse practitioners to use specific drugs for specific patients are considered within the practice of medicine and guided by clinical practice guidelines and protocols.
Health Canada, as the regulator of drug products, works with partners as appropriate to enable access for Canadians to safe and effective health products through scientific reviews.
- Would medical assistance in dying be part of palliative care?
- The principle of palliative care is that dying people and their families are made to be as comfortable as possible, and to feel as dignified as possible, while dying from natural causes. Most palliative care specialists consider medical assistance in dying to be something different from palliative care. It would be up to the provinces and territories and medical institutions to determine where medical assistance in dying services would be offered.
- What will be done to improve palliative care?
Canadians have clearly indicated that they want to maintain their independence and receive care at home, including at the end of their lives.
As part of a multi-year health accord, the federal government has committed to providing $3 billion over the next four years to improve home care, including palliative care.
Recently, federal, provincial and territorial ministers of health agreed to work individually and collectively on improving home care to better meet the needs of patients closer to home, including those who need palliative care.
Monitoring and reporting
- How would medical assistance in dying be monitored?
Monitoring would be critical for transparency and public accountability of medical assistance in dying, as well as to evaluate whether the law is achieving its goals of respecting autonomy for eligible persons to choose medical assistance in dying, while protecting vulnerable persons and the conscience rights of health care practitioners. Monitoring would ensure that high-quality, comparable Canadian data is generated so that any future discussions about changes to the medical assistance in dying system could be made based on the best possible evidence. Monitoring would help Canadians understand, for example, the number of requests for medical assistance in dying (approved and not approved), demographic information about the persons who request medical assistance in dying, whether there are regional differences in how medical assistance in dying is being carried out across Canada, the types of medical conditions that motivate requests, and whether the procedural safeguards in the law are working as intended.
Nearly all jurisdictions that permit a form of medical assistance in dying have established monitoring systems for these purposes. The proposed legislation empowers the Minister of Health to make regulations about the information to be collected and the processes for collecting it and reporting on it.
The Government would work with provinces and territories in developing these regulations and in establishing an interim system until a permanent process is in place.
- What kind of system would there be for monitoring medical assistance in dying?
- The Minister of Health would develop regulations with the cooperation of the provinces and territories and other experts. These regulations could address the kinds of information to be provided, the body that would analyze the information, and how often reports would be published, for example.
- Would there be monitoring of medical assistance in dying in the interim before regulations are put in place?
- Health Canada would work collaboratively with the provinces and territories on a protocol for the collection of medical assistance in dying data in the interim while the permanent system is developed.
- Would Parliament study this legislation further?
- Yes. The legislation contains a requirement for a parliamentary review, by one or more committees, in five years’ time. This will allow for any necessary amendments including, for example, to address the results of studies on mature minors, advance directives, and persons suffering solely from a psychiatric illnesses.
Federal providers of health services
- What are the proposed changes to the other Acts in the Bill?
The Bill would amend definitions of various terms in the Pension Act and the Canadian Forces members and Veterans Re-establishment and Compensation Act to ensure a Canadian Forces member or veteran who dies after receiving medical assistance in dying would not have their survivors’ entitlement to pensions or other benefits affected. The amendments to these two acts would also deem that a member or veteran’s death in these circumstances would be considered as resulting from their underlying medical condition, not medical assistance in dying itself.
The Bill would also amend section 19 of the Corrections and Conditional Release Act to clarify that if a federal inmate were to receive medical assistance in dying, there would not be a requirement for the Correctional Service of Canada to conduct a separate investigation into such a death.
- A number of departments provide health services to specific federal populations. Would the proposed legislation impact these health services?
The federal government provides some direct and indirect health services to federal populations, such as First Nations and Inuit, immigration detainees, refugee claimants, federal inmates, veterans, members of the Armed Forces and the Royal Canadian Mounted Police.
These departments would determine how best to serve their client populations, although it is likely they would align with provincial and territorial approaches for implementation, with consideration for the particular challenges of their populations.
- Would there be specific considerations for First Nations and Inuit?
The legislation will apply to all Canadians, including First Nations. However, the provision of medical assistance in dying raises some specific issues and implications for First Nations and Inuit communities in Canada, particularly with respect to their unique geographical and cultural characteristics.
Federal, provincial and territorial ministers of health agreed to work together and with Indigenous leaders to improve the coordination, continuity and appropriateness of health services for Indigenous peoples.
- How will medical assistance in dying impact veterans and their families?
The eligibility criteria for some Veterans Affairs Canada benefits available to eligible survivor(s) currently require that the Canadian Armed Forces member’s or Veteran’s death was as a result of a service-related injury or disease, or a non-service related injury or disease that was aggravated by service.
Veterans Affairs Canada will be making changes to its legislation to be able to provide benefits to eligible survivors in cases where the underlying cause of a Canadian Armed Forces member’s or Veteran’s death was a service-related medical condition, and the manner of death was medical assistance in dying. As a result of these changes, medical assistance in dying, is not “willful self-inflicted wounding” for the purposes of benefit eligibility.
- How will medical assistance in dying affect federal inmates?
Inmates in federal institutions who meet all of the eligibility criteria in the proposed legislation would be able to have access to medical assistance in dying while in federal custody.
Impact on provinces and territories
- How is the proposed legislation similar to or different from Quebec’s law?
- Under the proposed criminal law, practitioners would be able to provide both assisted suicide and voluntary euthanasia, whereas Quebec’s health law only permits voluntary euthanasia. The proposed eligibility criteria are similar to those of Quebec, but there are some small differences. For instance, under the criminal law, the intolerable suffering must be caused by the person’s medical condition, which is not a strict requirement under Quebec’s law. Also, in Quebec the law requires the patient to be "at the end of life," whereas under the proposed legislation, this would be expressed as death having become "reasonably foreseeable".
- How would the regime interact with provincial legislation and jurisdiction?
Parliament has exclusive jurisdiction over the criminal law, including exemptions from otherwise applicable offences. In the case of medical assistance in dying, the proposed legislation sets out who is eligible to receive medical assistance in dying, and what safeguards must be applied, for medical practitioners to be protected from criminal responsibility.
Provinces and territories cannot modify the Criminal Code requirements through their own legislation in such a manner as to make lawful something that is not permitted under the criminal law. However, they can legislate with respect to other aspects of medical assistance in dying under their jurisdiction over health. They could create laws that address other aspects of medical assistance in dying, such as whether any special training is needed to provide medical assistance in dying, whether specific forms should be used, and how the cause of death should be recorded on the death certificate in the case of medical assistance in dying. At the moment, only Quebec has specific legislation in place.
Provinces and territories could add restrictions on access through legislation. Depending on what any such law might do, it could be challenged as violating rights under the Charter of Rights and Freedom. Whether or not provinces or territories pass medical assistance in dying-related laws or regulations, the criminal law would no longer prevent eligible patients from accessing medical assistance in dying.
Legislative Background Paper
- Why did the Government of Canada produce the Legislative Background Paper?
- The issue of medical assistance in dying is a difficult and deeply personal issue. The Government of Canada produced and publicly released this Legislative Background Paper (Paper) to help explain to Canadians in more detail the content of the legislation, and to share with Canadians the considerations and information that was taken into account while developing the proposed legislation.
- Is this a Legal Opinion?
- This is not a Legal Opinion. There is no solicitor-client privileged material in the paper. The Paper includes details about the legislation, considerations that were taken into account in developing it, and an overview of possible impacts on Charter rights as well as a general description of the Government of Canada’s rationale as to C-14’s consistency with the Canadian Charter of Rights and Freedoms (Charter) and the Carter judgment. The Paper also includes highlights from the decision in the Carter, health considerations, and practices of other countries that were used to inform the development of Bill C-14.
- Is the Government of Canada expecting litigation and/or a Charter challenge?
- Medical assistance in dying is a divisive issue, and criminal law reform, by its very nature, may involve Charter challenges. With C-14, the Government of Canada is confident that it has responded to the Carter decision in an appropriate way that complies with the Charter.
- Why is this Paper so technical?
- This Paper is technical in nature as it sets out the policy, legal and legislative considerations on a highly complex and sensitive issue that cuts across many different fields. It helps to guide Canadians, in an open and transparent way, through the impacts of the proposed legislation, and considerations that were taken into account during the creation of C-14.
- What happens if the Senate amends the legislation?
- For more information about the legislative process, including the process if the Senate makes amendments, please visit the Parliament of Canada web site to read about how a bill becomes law: http://www.parl.gc.ca/LEGISinfo/Faq.aspx?Language=E&Mode=1#ID0E6
- Has the Senate amended legislation in the past?
- Yes. The Library of Parliament has compiled a list of Bills introduced in the House of Commons and amended by the Senate since 1960: http://www.lop.parl.gc.ca/ParlInfo/compilations/HouseOfCommons/legislation/HOCBillsAmandedBySenate.aspx
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