In 2015, the Supreme Court of Canada struck down the provisions of the Criminal Code of Canada, which prohibited physician assisted dying (Carter v Canada, 2015 SCC 5, 1 SCR 331 [Carter]). The ruling gave decision-makers until February 2016 to respond. However, there was a 4 month extension to June 6, 2016.
Summary of Bill C-14
Bill C-14 was drafted in response to the Carter decision. Bill C-14 creates an exemption to the laws prohibiting the counseling, aiding or abetting of another person’s suicide for individuals who qualify and consent to medically assisted dying.
Who can provide medically assisted dying?
Individuals who are lawfully entitled to practice medicine in the province, and registered nurses who are lawfully entitled to practice as nurse practitioners in the province may provide medically assisted dying. Alternatively, the consenting individual may self-administer the noxious substance. In this case, any other person may provide assistance to the individual in self-administering the substance as long as the following conditions are met.
- The assistance must be at the individual’s explicit request;
- The assistance must be for the purpose of aiding the individual in self-administering the substance; and
- The noxious substance must have been prescribed by a nurse practitioner or medical practitioner.
Who qualifies for medically assisted dying under Bill C-14
To qualify for medically assisted dying under Bill C-14, 5 conditions must be met.
- The individual must be eligible for health care funded by the Government of Canada (or would be eligible but for any applicable waiting period);
- The individual must be at least 18 years old and capable of making decisions with respect to their health;
- The individual must be suffering from a grievous and irremediable medical condition. Bill C-14 defines a grievous, irremediable medical condition as (a) a serious, incurable disease or disability that, (b) has led to an advanced state of irreversible decline in capacity and, (c) causes enduring physical or psychological suffering which is intolerable to the individual and cannot be relieved by conditions the individual considers acceptable and (d) the individual’s natural death is reasonably foreseeable, taking into account all medical circumstances;
- The request for medically assisted dying must be voluntary with no external pressures; and
- The individual must give informed consent. One notable difference between the decision in Carter and Bill C-14 is the condition under the latter that the individual’s natural death must be reasonably foreseeable.
What safeguards does Bill C-14 implement?
Bill C-14 imposes multiple safeguards on providers of medically assisted dying.
First, the individual who requests medical assistance in dying must have 2 independent witnesses sign and date the request. Those witnesses cannot know or believe they are a beneficiary under the individuals’ will or stand to receive any material benefit from the individual’s death. Furthermore, neither witness can be an owner or operator of any health care facility where the individual is treated or where the individual lives. Nor can they be directly involved in providing personal or health care to the individual.
Second, the Bill also requires another medical or nurse practitioner to provide a written opinion confirming all criteria described in the paragraph above are met. This other medical or nurse practitioner must be independent, meaning.
- they do not stand to receive any material benefit (other than fee for service) from the person’s death;
- they do not know or believe they are connected to the individual requesting in any way that could affect their objectivity;
- they are not in a business relationship with the other practitioner; and
- they are not a supervisor or mentor of the other practitioner.
The Bill also requires that there be 10 clear days between the individuals request and the day of death, unless all medical or nurse practitioners involved are of the opinion that death is imminent.
Current status
Bill C-14 has passed third reading and is currently at the Senate stage. However, the deadline of June 6th, 2016 imposed by the Supreme Court of Canada has now passed, leaving the Supreme Court’s ruling in Carter as the law of the land until federal legislation is passed.
More Information
For more information, read the full text of the bill, or see the open letter from the CEO of the Canadian Bar Association to the Special Joint Committee on Physician-Assisted Dying.
