Bill C-14 does not allow “medically assisted dying” for minors or for those with mental illness, nor does it allow advanced directives for those diagnosed with dementia. Instead, the federal government has committed those matters to further study. Justice Minister Jody Wilson-Raybould said this study does not presuppose any decision on these matters one way or the other. The bill also includes a mandatory review after five years.

Though the bill mentions conscience rights of health care professionals in its preamble, it does not protect them. Health Minister Jane Philpott said the provinces and territories as well as health professionals’ regulatory bodies would determine whether health care professionals will be required to refer patients if they refuse to participate.
She also said the provinces and territories will determine whether publicly funded, religiously based health care facilities will be forced to provide medically assisted death on their premises.

Philpott also highlighted the government’s commitment to palliative care, so that not only can people have a “good death” through medically assisted dying, but through palliative care can be ensured “a good life to the very end.”

Philpott said debate on medically assisted death “forced us to confront the reality palliative care is very patchy across Canada.” She noted the government has committed $3 billion over the next five years for home care, that includes palliative care.

Those eligible for either voluntary euthanasia or assisted suicide must be 18 years old or over, have a “grievous and irremediable medical condition” that makes “natural death reasonably foreseeable” and must make a voluntary request with informed consent and be eligible for publicly funded health care services in Canada. 

“Medical aid in dying” will be considered health care so it will be subject to the rules of the Canada Health Act to ensure universality and accessibility, so Canadians can have “autonomy” in their end-of-life decisions, said Philpott. 

Health care workers who follow the criteria for a medically assisted death “no longer need to fear criminal prosecution,” she said. The bill will restore the sections of the Criminal Code prohibiting assisted suicide and counselling and abetting suicide, but carves out exemptions for physicians, nurse-practitioners, pharmacists and others who help carry out a medically assisted death according to specified rules. For example, that means a family member could help put a lethal drug cocktail to the lips of a person who has had the drug prescribed by a physician without risking being charged. 

The safeguards include a requirement of two independent medical opinions from a physician or a nurse practitioner indicating the person meets the eligibility criteria, a request in writing or by a proxy if the person cannot write, the right to withdraw the request at any time, a 15-day waiting period “unless death or loss of capacity is imminent” and a confirmation of informed consent immediately before the assisted death is provided.

Government House Leader Dominic LeBlanc said Liberal MPs will be able to debate and vote freely on the bill, though cabinet will, as is usual, vote the government line.

LeBlanc warned of the consequences of defeating the bill, which will leave a legal vacuum once the Supreme Court of Canada’s Carter decision comes into effect.

Conservative MPs Michael Cooper and Gerard Deltell, who were members of the joint-Parliamentary Committee on Physician-Assisted Dying and who dissented from its recommendations, said they were glad the government did not follow the committee’s recommendations to include minors, the mentally ill and advanced directives.

But Cooper said it is essential to pass legislation or the resulting legal vacuum will leave “no certainty for patients or doctors and that is an unacceptable situation.”