Canada’s physician-assisted dying bill explained

[Health Minister Jane Philpott, right, speaks as Justice Minister Jody Wilson-Raybould looks on at a news conference in Ottawa on April 14, 2016. THE CANADIAN PRESS/Adrian Wyld]

Proposed legislation announced Thursday by the federal government will allow for physician-assisted death in Canada “for adults who are suffering intolerably and for whom death is reasonably foreseeable.”

Bill C-14 was tabled in Parliament less than two months ahead of the June 6 deadline set when the Supreme Court of Canada granted an exemption to its February 2015 ruling. In that ruling, the federal court struck down the country’s existing legislation banning physician-assisted dying.

At that time the government was given one year to either allow the court decision to come into effect or introduce legislation that would comply with the Charter of Rights and Freedoms. The top court later gave the Liberal government an extra four months, to June 6, to prepare for the ruling to come into effect.

The new bill announced by Justice Minister Jody Wilson-Raybould and Health Minister Jane Philpott was more restrictive than the Supreme Court ruling, or the recommendations of a parliamentary committee report, but left room open for further changes to the law.

Below are seven must-know things about the law.

Who does the bill apply to?

Under the bill, doctor-assisted dying will be available to Canadian adults 18 and over who are “mentally competent” and have a serious and incurable disease, disability or illness. The proposed legislation says that those applicable should be able to access medical assistance in dying “without adverse legal consequences for their families — including the loss of eligibility for benefits — that would result from their death.”

Who is excluded?

A few key groups of people are excluded from the legislation — some against the recommendations of the earlier parliamentary committee on physician-assisted death. The proposed legislation will only apply to adults, which means that “mature minors” are not included. It also excludes those who are suffering from illnesses that may cause suffering but are strictly psychological in nature, such as schizophrenia.

Perhaps most controversially, Bill C-14 excludes the possibility of advanced consent for physician-assisted death. Because of that, and because the bill applies to those who are “mentally competent,” it appears that it will not apply to Canadians with dementia or Alzheimer’s.

Who can legally assist with death?

The proposed legislation creates exceptions to the crimes of culpable homicide, assisting suicide and administering a noxious substance in order to allow “medical practitioners and nurse practitioners to provide medical assistance in dying and to permit pharmacists and other persons to assist in the process.”

This means that doctors, nurses and pharmacists who help a person receive a physician-assisted death won’t be subject to criminal charges, as long as they comply with federal regulations. At the same time, the bill creates new offences for failure to comply with the standards it sets out.

However, the bill does not compel any medical practitioner to assist with deaths, and conscience rights are still applicable. It merely removes the criminal penalty for doing so when the regulations are followed.

What safeguards are in place?

There are several attempts in the bill to introduce safeguards to some of the concerns around physician-assisted death. It includes a clear reaffirmation of the societal harms of suicide, as well as the importance of protecting the vulnerable and preventing them from seeking death in “moments of weakness.” Part of that is a mandatory 15-day “reflection period,” to prevent people from making a rash decision after a diagnosis. That period is waived if either death or loss of capacity to consent is imminent.

The bill also encourages a consistent approach to physician-assisted suicide across the country, and the government will work with the provinces and territories to co-ordinate care.

Can people travel to Canada to die?

No. The bill has included measures to avoid attracting people from other countries who may wish to come to Canada to access a physician-assisted death. In order to be eligible under the proposed legislation, a person must also be eligible for publicly funded healthcare in Canada — that is, a Canadian resident. This excludes anyone who wishes to travel from the United States or another country in order to access the service.

How does the bill differ from the parliamentary report?

A report, Medical Assistance in Dying: A Patient-Centred Approach, prepared by a parliamentary committee ahead of this bill made some recommendations that ultimately weren’t included. For example, the 70-page report said that patients should be able to make an “advance request” for physician-assisted death — something that could be relevant for those with conditions like dementia or Lou Gehrig’s disease (ALS). The report also said that Canadians suffering from psychiatric conditions shouldn’t be exempted from the option of physician-assisted death.

Bill C-14 doesn’t include either of those provisions. However, Wilson-Raybould said during a news conference Thursday that the law could change in the future to expand physician-assisted death to others.

What comes next?

Now that is has been tabled in Parliament, Bill C-14 will move to committee for further study before it comes up for a vote in the House of Commons. Liberal MPs (excluding ministers) will have a free vote on the bill. If the proposed legislation passes that vote, it then goes to the Senate for approval.

The government will also look into whether the bill’s restrictions should be loosened in the future, for example to allow advance consent for physician-assisted suicide. Wilson-Raybould said Thursday that she believes the bill would stand up to a Charter challenge, and that a document outlining its compliance with the Charter would be forthcoming at an unspecified date.