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Third Reading of Bill C-14, An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying), as amended

 

Honourable senators, I'll begin by speaking about safeguards.

Bill C-14 outlines numerous safeguards which are essential to prevent errors and abuse in the provision of medical assistance in dying. For example, "safeguards" are defined on pages 6 and 7, and they have been debated at length in this chamber.

We all recognize that the safeguards must be respected when medical assistance in dying is provided to another human being. Under clause 4 of the act, medical practitioners and nurse practitioners who receive requests for medical assistance in dying, as well as the pharmacists who dispense the substances, must provide certain information so that medical assistance in dying can be monitored, thereby ensuring that the safeguards have been met. After all, what good are safeguards if they only exist on paper?

Clause 4 also authorizes the Minister of Health to make regulations respecting the information to be provided by medical practitioners, nurse practitioners and pharmacists, and all that information is to be used to ensure medical assistance in dying complies with the requirements of the bill, including the safeguards.

Unfortunately, clause 4 of the bill will not come into force at the same time as the rest of the bill. As a result, medical assistance in dying will not be monitored to ensure the safeguards are actually being followed.

Paragraph 27 of the decision of the Supreme Court states:

The trial judge then considered the risks of a permissive regime and the feasibility of implementing safeguards to address these risks.

Ultimately, the trial judge concluded:

. . . the risks of physician-assisted death "can be identified and very substantially minimized through a carefully- designed system" that imposes strict limits that are scrupulously monitored and enforced.

Paragraph 105 of the Supreme Court decision again refers to "a carefully-designed system" that is "scrupulously monitored and enforced." Paragraph 29 of the decision further states that a "stringently limited, carefully monitored system of exceptions" would achieve Parliament's objective in the bill.

Honourable senators, the Supreme Court recognized that there must be safeguards to protect the vulnerable and that a carefully designed system must have stringent limits that are scrupulously monitored and enforced.

What we have before us is a system which does impose stringent limits, but without clause 4 and the accompanying regulations, the system will not be scrupulously monitored and enforced. In fact, will it be monitored at all?

Departmental officials have indicated that it may take 18 months before this section of the act comes into force. Honourable senators, it is not acceptable to wait 18 months before medical assistance in dying can be monitored. Accordingly, I will be proposing that the act be amended so that clause 4 will come into force 12 months after the rest of the bill comes into force, or on any earlier day that may be fixed by order of the Governor-in-Council.

Even though I'm recommending 12 months, I must say that I do have some concerns that the bill, if enacted, will actually operate without proposed section 4 for a 12-month period, and I do question whether the monitoring will be appropriate.

In addition, clause 4, page 10, line 11, states that "The Minister of Health may make regulations" regarding the information needed to monitor medical assistance in dying to ensure the legislation is being complied with and to ensure those provided with assistance in dying actually requested it. Also, page 10, line 32, states that:

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 . . . .

I am recommending that the word "must" replace "may" in both of these instances so that regulations and guidelines are consistent among provinces and territories. Accordingly, line 11 would then read: "The Minister of Health must make regulations . . ."

Lines 32, 33 and 34 would read: "The Minister of Health, after consultation with representatives of the provincial governments responsible for health, must establish guidelines . . . ."

Honourable senators, my amendment will also clarify a third issue. The bill currently states that the information referenced in the regulations must be provided to the recipient designated in the regulations, which is, in my opinion, appropriate. However, the bill also states that if no recipient has been designated, then the information must be provided to the Minister of Health.

My amendment would require that a recipient be designated so that all information goes to one designated person. This would ensure that medical assistance in dying would be properly monitored by a designated recipient and would assure that those receiving medical assistance in dying received it in compliance with the act.

Therefore, honourable senators, I move:

That Bill C-14, as amended, be not now read a third time, but that it be amended

(a) in clause 4, on page 10,

(i) by replacing lines 2 and 3 with the following:

"ulations.",

(ii) by replacing lines 9 to 11 with the following:

"the recipient designated in those regulations.

(3) The Minister of Health must make regulations",

(iii) by replacing line 32 with the following:

"(3.1) The Minister of Health, after consultation with repre-", and

(iv) by replacing line 34 with the following:

"health, must establish guidelines on the information to be"; and

(b) in clause 11, on page 14, by replacing lines 12 and 13 with the following:

"11 Sections 4 and 5 come into force 12 months after the day on which this Act receives royal assent or on any earlier day that may be fixed by order of the Governor in Council.".