The Carter Bill is tabled, but is it ready?

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Our government’s long awaited response to the Carter decision has finally arrived. Bill C-14, An Act to mend the Criminal Code of Canada and to make related amendments to other Acts (medical assistance in dying), was released on April 14, 2016.

The Act would amend the Criminal Code to allow medical or nurse practitioners and pharmacists the ability to assist in someone’s suicide without criminal prosecution. Currently, section 241 of the Criminal Code requires that “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 offense and liable to imprisonment for a term not exceeding fourteen years.”

In the Preamble of the Act, Parliament recognizes the autonomy of individuals with grievous and irremediable medical conditions who seek assistance in dying while still declaring the protection of vulnerable persons by ensuring that abuse of process safeguards are firmly in place. The most significant outcome of this Act are the conditions precedent to receiving medical assistance in dying. The Act would add to the Criminal Code:

Section 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.
  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.

Many safeguards have been put in place including that the patient’s request is in writing and signed with two witnesses, there is written confirmation from a second practitioner that the patient meets the criteria, the patient has at least fifteen days before the procedure to withdraw their request, and that the practitioners are completely independent from the patient.

The Bill does not include provisions for mature minors who, for all other purposes, meet the criteria to receive medical assistance in dying are precluded solely by virture of their age. Moreover, the Bill does not address the use of advance directives and whether or not practitioners could lawfully follow a previously made request to die with their assistance. The Bill also does not address those suffering severe mental conditions or provide for the freedom of conscientious objection by practitioners.

HLCJ previously reported a blog about the Special Joint Committee of Physician-Assisted Dying which made recommendations to the Government regarding what should and should not be included in the Bill. The recommendations included psychiatric conditions as qualifying under the criteria, would have allowed practitioners to act on advance directives made when the patient was capable, and included a provision for practitioners to conscientiously object to being involved. These recommendations seem to have been rejected by the government at this point in time.

There are still many details that the new Liberal government will have to iron out prior to the June 6, 2016 deadline. It is also important to note that these amendments to the Criminal Code are only that; the provision of health care is a provincial responsibility, so it is up to the provinces to develop further provisions in line with the Code.

Leane Lardner
Managing Editor – Media and Public Relations Liaison