Standing Committee on Justice and Human Rights, Briefs & Oral Submissions: 1-75

Links to the full briefs are provided below. Click on (Brief Extract) to see extracts of briefs relevant to freedom of conscience. Click on (Edited Video Transcript) to see what was said relevant to freedom of conscience during oral submissions.

Bold face identifies groups or individuals who appeared as witnesses. Note that some witnesses may not have provided written briefs.

»identifies briefs circulated to Committee members before the Committee began clause-by-clause review and amendment of the Bill on 9 May.

»identifies briefs circulated to Committee members after the Committee began clause-by-clause review and amendment of the Bill on 9 May.

Other briefs were not circulated before the Committee concluded its deliberations.

(Brief Extract)

(Edited Video Transcript)

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Alsmo, Lola [Full Text]

. . . I would like to see the following concerns addressed within this piece of legislation.

e) It be explicitly stated that healthcare providers be allowed to refuse to perform and refer for physician-assisted suicide on the grounds of conscientious objection. Conscience rights are a protected freedom under Section 2 of the Canadian Charter of Rights and Freedoms and should not be violated. . .

Armour-Godbolt, Shelagh [Full Text]

3.) Access to legislated services. Having lived and worked in northern BC, I am very aware that there are many smaller communities in Canada with only one physician, one pharmacist and a limited number of nurses. Where there are personal objections to offering this service once the legislation is passed, health professionals may decline. In that case, petitioners need to be able to be referred for assistance elsewhere than their home community. Some health professionals who decline to participate may also feel they cannot refer – adding to the distress, anxiety and length of an individual's search for assisted death within the legislation. I urge the Committee to address this issue fully in your study of the Bill. Possibly a central office will be needed where petitioners can receive appropriate referrals once the legislation is passed. . .

Arvay, Joseph

Oral Submission [Edited Audio]

Hon. Rob Nicholson: . . . If there had been provisions in here, I'd like to have your opinion on the provisions within this law protecting people on matters of conscience as to whether they would participate in this. Do you think that would stand constitutional scrutiny if that had been...? Of course, it depends on how it's drafted. I appreciate that, but what are your thoughts on that area in general?

Mr. Joseph Arvay: Mr. Nicholson, I appreciate the question, and quite frankly, those portions of the bill are not something I've put my mind to. I've come here to deal with the definition of "grievous and irremediable". Um, obviously. . .

Hon. Rob Nicholson: Free legal advice on this

Mr. Joseph Arvay: Yes, I appreciate that.

Hon. Rob Nicholson: Thank you very much.

Mr. Joseph Arvay: I can say this, though, that certainly when we argued the Carter case, it was our position that no doctor should be forced to provide physician-assisted dying, and the Supreme Court of Canada accepted that.

Beyond that I'm not prepared to answer that question. I'm sorry I can't be more helpful.

Association for Reformed Political Action [Full Text]

5. Add conscience protection language akin to the Civil Marriage Act to C-14 in order to protect the best practices of medicine. We recommend adding to the body of C-14 the following:

Conscientious Protection

Physicians and other health practitioners are free to refuse to participate in or refer for assisted suicide and euthanasia in accordance with their professional medical opinions or sincerely held religious beliefs.

For greater certainty, no person or organization shall be deprived of any benefit, or be subject to any obligation or sanction, under any law of the Parliament of Canada solely by reason of their exercise, in respect of refusal to participate in or refer for an assisted suicide or euthanasia, of the freedom of conscience and religion guaranteed under the Canadian Charter of Rights and Freedoms.

Azevedo, James & Tracy [Full Text]

. . . Please also ensure the protection of Canadian health care workers (doctors, nurses, pharmacists, other), who have dedicated themselves to saving lives and improving quality of life – not ending them – so that their freedoms of conscience and religion are fully protected under the law. Please fight to protect these freedoms even to the extent of giving them the right to refuse referral of services, and in doing so dismissing them from being forced to participate in the process. . .

Barreau du Québec [Full Text]

. . . To prevent problems in application regarding the obligations placed on health professionals, we believe that where a province has validly enacted medical assistance in dying legislation, in compliance with Carter, the health professional following the procedural requirements of this legislation should be deemed to have met the requirements of the federal legislation in subsections (3) and the following subsections of section 241.2 and thereby obtain the exemption. . .

Oral Submission [Edited Video]

Mr. Murray Rankin: . . . I'd like to ask you another question that didn't come up in your remarks, but which my colleagues have asked about, namely the conscience rights of physicians. And I believe that when you were on television in Quebec - and I believe I heard this second-hand, so I may have it wrong - you indicated that that would be a purely provincial jurisdiction. Would you elaborate on that if I've got it right?

Mr. Jean-Pierre Ménard: That's a very relevant question. Okay, in terms of conscience rights, this doesn't fall under criminal law. It falls under the medical code of ethics, so it's really the medical profession that determines how physicians are supposed to behave. And I think that this issue of conscience rights should not be dealt with under criminal law. They should be dealt with through the provincial law and the code of ethics and medical practice.

And I think it's, well, in Quebec, end-of-life care includes clauses about conscience rights which are very clear. And there are similar things in other provinces as well. The problem with having a federal provision about conscience rights is that then they could come into conflict with the provincial rules. So I think it's better to leave it up to the provincial colleges of physicians to determine that. They understand the context, they understand the standards, the professional standards, and I don't think we should deal with that under federal law.

We already made some comments about this, but we were simply saying that I think we should let the provincial colleges of physicians, let them regulate it, and let the provinces deal with it. I think we already have enough to deal with here with the criminal law.

Basnett, Richard and Wendy [Full Text]

. . . Please also ensure the protection of Canadian health care workers (doctors, nurses, pharmacists, other), who have dedicated themselves to saving lives and improving quality of life – not ending them – so that their freedoms of conscience and religion are fully protected under the law. Please fight to protect these freedoms even to the extent of giving them the right to refuse referral of services, and in doing so dismissing them from being forced to participate in the process. . .

Beddoe, Mark and Nancy [Full Text]

. . . The bill does not provide conscience protection for medical practitioners or nurse practitioners. They are required to send requests for euthanasia or assisted suicide to a "designated recipient" or the Minister of Health. This makes them participate in the act. This would often result in a very serious denial of religious freedom. . .

Bergen, Theresa [Full Text]

. . . there is no conscience protection for healthcare professionals.

Section 241.31, requires medical and nurse practitioners to be involved in the act by requiring them to "send requests" for euthanasia or assisted suicide to a "designated recipient" or the Minister of Health. Our Canadian Charter of Rights and Freedoms, specifically gives freedom of conscience and religion to Canadians. So how can healthcare workers be forced to participate in an act that is against their conscience? This is wrong. . . .

Berger, Dr. Philip et al [Full Text]

3. Equity and Charter Rights to Liberty and Security:

For any law to be just, it cannot further the marginalization of particular groups of its citizens. There are groups of vulnerable patients who have trouble trusting institutions and seeking care. These very patients may be fearful of seeking medical help should MAID be mandated in every institution and by every provider. It is critical for the Committee to create safe spaces for these patients by providing exemptions to objecting institutions and providers.

Similarly, legislation should prevent systematic discrimination of an entire group of clinicians who espouse the established purpose of medicine: to heal and to avoid inflicting the ultimate negative outcome - death. . .

Birenbaum, Shelley [Full Text]

. . . I am fully aware of the religious belief of Catholics, highly orthodox Jews and some other religions, that only God may take life. However, Canada is not a theocracy; it is a democracy. The Supreme Court of Canada clearly provided that physicians who have religious or moral objections to physician assisted dying do not have to provide such services. Professional regulatory bodies and associations have already begun to articulate that those health care professionals must transfer care appropriately so that the professional obligation to provide patients with all possible options is complied with. . .

Boer, Theo

Oral submission [Edited video]

. . . In an article in a journal of the Royal Dutch Medical Association, two ethicists and a doctor suggest 10 rules for patients who want to have euthanasia; for example, be verbally gifted but be humble; do not make a depressed impression on your doctor; if you still enjoy your hobbies, don't mention them; stress the seriousness of your physical suffering; etc.

According to an RDMA survey published last year, 70% of physicians in the Netherlands experienced pressure to perform euthanasia, and 64% are of the opinion that the pressure has increased. . .

. . . Now, in normal life, any person has the right to do anything that is not unlawful. Consequently, doctors will have a right to perform euthanasia under the given conditions. This right to kill is among the most peculiar elements of the bill. To kill means the intentional, direct, and irreversible act removes a person from the community of the living. Even on request, such a decision should always remain the exception. . .

. . . given the intrinsically problematic, ethical character of killing, I think it is desirable that Bill C-14 contains unambiguous conscience protection for health care professionals. . .

Hon. Rob Nicholson: Let me start at the end with you, Professor Boer. You said that there was considerable pressure, that doctors feel in the Netherlands to perform this. Are there any conscientious objection provisions in the Dutch law?

Prof. Theo Boer: That is not needed because euthanasia in principle is a punishable act. So nobody can ever be obliged to perform something that is an extreme emergency.

Hon. Rob Nicholson: But you said in your testimony that there's an increasing percentage of doctors who feel the pressure to perform this. Why is that?

Prof. Theo Boer: . . . The former health minister, Els Borst, was a liberal and who introduced the law. She has insisted from the very beginning that all health care professionals are free in doing or not doing euthanasia. And she also resented -she was killed tragically a year ago - she resents the development that people are, doctors are held morally obligated to perform euthanasia.

So I would say that it is in despite of the law that we have, that there is a strong societal pressure....

Prof. Theo Boer: . . . Let me just add that we have had the conscientious objection in the Netherlands also from institutions. I can, for example, from my research I know that from all the cases of euthanasia there was not one Muslim, on 41,000 cases. So why would we oblige a Muslim nursing home to provide that kind of care? I don't see it, and I think it's a matter of a tolerating society that you know that this house will not provide this kind of help, and that you will have to make your arrangements and go to another one. I think we have autonomous citizens, and they know what institution to choose.

Mr. Chris Bittle: Going back to, and just to clarify for my point an item that Mr. Nicholson was talking about, in terms of pressure doctors are feeling. Is that pressure from societal pressure and pressure from patients? Is that the pressure of which you're speaking?

Prof. Theo Boer: . . . It's both, basically. I think there's a general pressure from society, which, so to speak, sees euthanasia, sees death as the best solution to very severe suffering. So what I see is that there is the pressure on doctors, in the way that I've read in many dossiers, where patients say, "Doctor, I have seen the documentary on television. Euthanasia for my kind of patients is now allowed, so you'd better do it." So that's direct pressure from patients.

Then there's a second pressure, and that's of course the pressure from relatives. And I do understand that. Because for relatives, the suffering of someone who is a beloved, to see his or her suffering may be just as traumatizing for them as the suffering that the patient has to undergo himself. So, for example, the end-of-life clinic that has been established in the Netherlands that now has about 450 euthanasia cases a year. In my research, it has become clear that in 60% of the cases it was the family members who bring the patient to the clinic in order to be helped. So yes, there's a strong pressure, I think.

And then there is maybe a third sort of pressure, and that is the internalized pressure of a patient. I have seen one in about 10 cases where the patient motivates his euthanasia request on the basis that he wants to save his relatives from having to see his suffering. What you see is that the relatives in that case, they do not put up opposition to that observation of the patient. They rather say, "Well, that is very friendly of you, and we may find a way to have you have euthanasia." Where if I would say that the natural reaction of family members to such a motivation would be, "No, please, Mother, don't ask euthanasia because it's too much for us. Because it's your life, and we will do whatever." You see...?

Bradshaw, Edith [Full Text]

. . . From a Christian point of view, the Canadian Supreme Court decision on assisted suicide legitimized something intrinsically evil. Any Christian medical professionals cannot comply. Recognize this by exempting medical professionals with conscientiouis objections and curtail provincial or professional associations from imposing participation in assisted suicide or forcing them to refer for assisted suicide. Mitigate the extent of this moral evil by endorsing conscience rights for doctors, nurses and pharmacists who have deep moral objections to participating in any way with medically assisted suicide. . .

Recommendation 2: Include an amendment to C-14 to recognize and fortify Charter guarantees of freedom of conscience and religion and their expression. Physicians, nurses and pharmacists who have profound conscientious or religioius objections to participating, in any way, with euthanasia or assisted suicide must not be forced into it or required to refer patients to doctors who are willing to kill. This must be unequivocal in leglisation. Such emphatic recognition of religious freedom is the hallmark of a pluralistic society. . .

British Columbia Humanist Association [Full Text]

Add paragraph:

Whereas the Government of Canada commits to working with the provinces and territories to ensure the principles of universality and accessibility apply to medical assistance in dying by requiring that health care institutions that receive public funds must provide medical assistance in dying and that health care professionals are equipped to provide medical assistance in dying;

Rationale: While the bill references the principles of the Canada Health Act (CHA), there s no guarantee that the principles of universality will be upheld based on our reading of the bill. Lacking such commitment, we believe, as occurred following Morgentaler, large disparties in access will inevitably developed [sic] across the country. Spelling out in legislation a commitment to work to ensure no publicly funded health care institution turns away a patient requesting MAID and that medical professionals are empowered to provide MAID would demonstrate such an effort to uphold the principles of the CHA.

Brooks, Jeffrey [Full Text]

. . . Patients meeting the criteria should be provided access to MAID in the institution they find themselves in at that time of their life. They must not be transferred to another institution or be denied MAID if they meet the criteria simply because they find themselves in a specific institution or a part of an institution that does not want to offer MAID. The Bill should be amended to protect patient rights to access. . .

Burrell, Althea; Santoro, Daniel [Full Text]

. . . However, Bill C-14 does not contain any protection of conscience rights. Many doctors and other healthcare workers object to assisted suicide and euthanasia on the grounds of moral conscience; others object as a matter of professional ethics, which is no less an objection of conscience. In paras. 130-132 of the Carter decision, the Supreme Court held "a physician's decision to participate in assisted dying is a matter of conscience and, in some cases, of religious belief." The Court then invited Parliament, along with provincial legislatures and physician's colleges, to implement a scheme which protects these rights.

Parliament is free to craft an exception to a criminal prohibition on what terms it sees fit, even while the regulation of professionals is not within the scope of Parliament's constitutional jurisdiction. There is a necessary interplay between, and overlap of, federal and provincial jurisdiction on many matters related to assisted suicide.

By legislating that any participant in an assisted suicide be a willing participant, Parliament would ensure that those who object as a matter of conscience cannot be compelled to participate in an assisted suicide or euthanasia.

The preamble to the legislation should also express support and recognition of the rights of healthcare workers who object to participation in assisted suicide and euthanasia. . .

We make the following recommendations to amend Bill C-14:

1. The exceptions to the laws against culpable homicide, aiding a suicide, and administering a noxious thing should only apply to physicians and health care workers who are willing to participate in these acts. . .

4. The preamble to the legislation should be amended to specifically recognize the rights of healthcare workers who object to participation in assisted suicide and euthanasia.

Canadian Association for Community Living

Oral Submission [Edited Video]

Ms. Iqra Khalid: This has come up in the committee a lot from different organizations as well as colleagues around this table: with respect to protecting the conscience rights of medical personnel, physicians and nurses, etc. Now, what is your opinion - I would ask this for all three of you to commet - what is your opinion on having a criminal prohibition creating an offence in the Criminal Code to, to make it an offence to coerce a physician into administering death under this bill?

Mr. Michael Bach: I think you solve the problem by going with advance review, because then physicians aren't actually authorizing this. They're doing their job as physicians, which is, and that's our proposal to address that concern. And it also means that you can have many more physicians in Canada, beyond the only one-third that are saying they would do this at this point, that would be willing to step up, because they're not actually authorizing it. They're just examining causes of suffering and putting options on the table to address it, which is what we should be hoping and expecting of physicians in this country.

Canadian Conference of Catholic Bishops [Full Text]

While the legislation is itself intrinsically and gravely immoral for the reasons stated above, there are particular characteristics of the current draft of Bill C-14 which make it even more damaging and dangerous to Canadian society. For example, it contains no protections for health care workers who refuse to cooperate in so-called "medical assistance in dying" or to give an effective referral, nor to institutions that refuse to provide the service for religious or conscientious reasons.

Leaving such protections to provincial legislators or professional organizations (such as provincial colleges of physicians, pharmacists, or nurses) would result in a chaotic situation with conflicting rules between provinces and would effectively prompt the resignation or removal of many health care professionals. It could also potentially force the closure of hospitals operated under religious auspices, most of which are Catholic. These institutions employ thousands of physicians and tens of thousands of staff. At a time when our health care system requires more resources, not less, the federal government should not allow lower jurisdictions to drive conscientious health care practitioners from their professions.

Canadian Council of Christian Charities [Full Text]

. . . There are a number of religious charitable organizations, sucha a palliative care hospitals, who refuse, based on deeply held moral and religious reasons, to be involved or associated with physician assisted dying. . . . Our country has long respected religious conscience that refuses to intentionally take the life of another human being. . .

. . . Government's fiscal support of religious charities does not give government license to violate their religious scruples. Government funding stems from the government acting in the public interest. It has no right to violate the conscience of religious corporations. We take the position that no religious organization ought to be forced to take the life of another human being no matter how moral or right, in the opinion of government, it may seem to be.

We suggest the Canadian public would be best served with a policy that respects and encourages religious institutions to be true to their convictions on the matter of physician assisted suicide as they compassionatrely serve the needs of their patients and clientele. The conscience is the very pith and substance that sustains these instruments of mercy and worthy of respect.

Therefore, we support the recommendation made by Christian Legal Fellowship that calls for an amendment to the Income Tax Act that would protect the charitable status of registered charities that refuse to provide euthansia or assisted suicide on their premises; or who engage in suicide prevention intitatives and/or publicly express views that suicide is harmful, ought to be prevented, and/or publicly express views that suicide is harmful, ought to be prevented, and/or that the participation by individual in the death of another is intrinscally morally and legally wrong.. . .

Canadian Council of Imams

Oral Submission [Edited Video]

Mr. Sikander Hashmi: . . . In the Islamic faith tradition, neither euthanasia nor assisted suicide is supported or encouraged. However, since that matter has already been decided by the Supreme Court, our concerns and recommendations regarding Bill C-14 centre around three things: safeguarding the interests of patients in distress, minimizing errors, and conscience protection for health care providers and faith-based facilities. . .

. . . We are also very concerned about the protection of conscience rights of health care providers and faith-based facilities. Conscience rights should be given the same level of importance as the patient's right to seek assistance in dying. In our view, the level of disengagement from assisted death should be at the discretion of individual health care providers and faith-based care facilities and should be publicly disclosed to would-be patients. This should be specified in the bill. . .

Ms. Iqra Khalid: . . . And then you had talked about conscience rights for the physicians or medical practitioners who are administering.

I want to talk specifically with respect to conscience rights to begin with. Now, we have heard testimony from other witnesses who have indicated that there is a coroner's report. And they've asked that the coroner's reports be something that becomes mandatory. The cause of death that is outlined in the coroner's report it's not always, as it is right now, it's not mandated to be listed as, you know medical assistance in dying. Do you think - I just want the religious perspective on it. Do you think that the cause of death as suicide, in essence, is something that faith-based families, would that would be something they would be comfortable with?

Mr. Sikander Hashmi: It could certainly be something that perhaps could be troubling for some. Of course, you know, there's different views and different levels of comfort that people of different faiths have with regard to suicide. So if a family finds out that the autopsy or the coroner's report shows that the death was by suicide, it could certainly put them in a situation that they may find to be uncomfortable.

Ms. Iqra Khalid: Would it be hurtful to families, then, dealing with not only with the loss of a loved one but then also to deal with the negative connotations in society as a whole, perhaps?

Mr. Sikander Hashmi: Certainly, I believe so. Again different communities and different groups will, I think, see suicide in different ways. And if that becomes something which is known in public and the family finds out, or friends, or relatives, or other members of the community find out, then it could certainly be hurtful to the family.

Ms. Iqra Khalid: . . .Now, do you see - this is open to all three witnesses to comment on. Do you see that the provinces would be able to come up with a consistent approach, specifically, self-regulation of doctors, would they be able to ensure that those physicians or medical practitioners that do not want to partake in the administration of death, would the self-regulated bodies be able to take ownership of that piece and make sure that everybody's conscience rights are protected?

Mr. Sikander Hashmi: . . . I think what's making health practitioners and medical professionals of faith quite nervous is this uncertainty of not knowing how it's going to actually play out. As far as the patient's rights are concerned with regard to assisted dying, yes, the bill is there and everything seems to be quite clear, but when it comes to the rights of conscience, it's not very clear.

We're already hearing complaints from doctors in Quebec, talking about how they're feeling pressured. We heard of one case where there was talk of sanctions against a doctor who was not willing to give an effective referral. So I that's really troubling to the point where there's actually doctors who are even considering leaving the profession, or the fact that they might have to leave if it doesn't play out to their satisfaction.

So I appreciate the efforts that the government may be planning to make, but I think there should be a lot more clarity at this point with regard to this matter.

Canadian Federation of Catholic Physicians' Societies [Full Text]

1. The Supreme Court has stated that physicians should not be forced to participate in Physician-Assisted Death (PAD). As you are no doubt aware, Quebec's legislation, Bill 52, mandates a referral for assisted dying if requested. The College of Physicians and Surgeons of Ontario passed a policy mandating that physicians refer patients for procedures to which they object on moral or religious grounds. Other Provincial Colleges have and are contemplating similar policies. Such policies are intended to "balance" the conscience rights of doctors with the right of patients to access legal procedures. A forced referral for PAD would require us to participate in a procedure which gravely contradicts our most firmly held convictions informed by faith and reason, as well as the Hippocratic Oath.1 The current form of Bill C-14 does not acknowledge the conscience rights of physicians or healthcare workers with similar convictions. The freedom of conscience and religion is a Charter right and should be protected by federal laws. If the protection of conscience and religion is not explicitly protected in Bill C-14, we are fearful that it will lead to a patchwork of policies across the country with varying degrees of protections for conscientious objectors. We believe this will lead to physicians and other health care professionals whose Charter rights are being violated to respond by defending his or her Charter right in court or by ceasing to practice in health care. We do not believe that either of these avenues are what is best for Canadians or our medical system. There are other ways for patients to access legal procedures that do not require violating the fundamental freedoms of conscientious objectors.

Recommendation 1: Amend Bill C-14 to clearly protect the conscience rights of health care professionals from being coerced to perform or refer to another physician or third party who would carry out the procedure. They also must be protected from discrimination from current or potential employers based on these conscientious objections. . .

3. Many patients already express concerns about the ability to trust physicians or hospitals. Many, especially those most vulnerable are reluctant to seek care from health care providers or institutions as they are already fearful that they will be killed or harmed. These beliefs were pervasive even when euthanasia and physician assisted suicide was considered a criminal act. We believe the legalization of euthanasia and assisted suicide will make patients even more reluctant to seek the health care they require and as a result the overall burden of suffering in our country may in fact be increased.

Recommendation 3: Amend Bill C-14 to include protection of health care institutions opposed to PAD so that they can continue to provide care consistent with their values and so that patients and families will have the option of choosing these "safe-havens" for their care, places where they will not have to be fearful that they will be killed when they seek medical care and compassion towards a dignified natural death. . .

Canadian Medical Association [Full Text]

iv) Respect Personal Convictions

Finally, it is the CMA's position that Bill C-14, to the extent constitutionally possible, must respect the personal convictions of health care providers. In the Carter decision, the Supreme Court of Canada emphasized that any regulatory or legislative response must seek to reconcile the Charter rights of patients wanting to access assisted dying and physicians who choose not to participate in medical assistance in dying on grounds of conscientious objection.

The CMA's Principles-based Recommendations achieves an appropriate balance between physicians' freedom of conscience and the assurance of effective and timely patient access to a medical service. From the CMA's significant consultation with our membership, it is clear that physicians who are comfortable providing referrals strongly believe it is necessary to ensure the system protects the conscience rights of physicians who are not.

While the federal government has achieved this balance with Bill C-14, there is the potential for other regulatory bodies to implement approaches that may result in a patchwork system. The CMA's position is that the federal government effectively mitigate this outcome by rapidly advancing the establishment of the pan-Canadian end-of-life care coordinating system. . .

Oral Submission [Edited Video]

Dr. Cindy Forbes: . . . Today, we are here on behalf of Canada's doctors to convey one overarching message: the CMA recommends that parliamentarians support the enactment of Bill C-14 as proposed and without amendment. . . . Put simply, the CMA strongly supports the government's overall response to the Carter decision. This includes legislative and non-legislative measures. . .

Dr. Jeff Blackmer: . . . We also support the objective to support the provision of a full range of options for end-of-life care and to respect always the personal convictions of health care providers. To this end, we encourage the federal government to very rapidly advance its commitment to develop a pan-Canadian end-of-life coordinating system. Ideally, this should be in place by June 6.

The CMA is aware that one jurisdiction has made such a system available to support connecting patients who qualify for assisted dying with willing providers. Until this system is available across the country, there may be a disparity of support for patients and practitioners from province to province.

Finally, it is our position that Bill C-14, to the extent constitutionally possible, must respect the personal convictions of health care providers by protecting the rights of those who do not wish to participate in assisted dying or to directly refer a patient to someone who does wish to participate.

We would be very pleased to speak further on this critical issue, one that is also essential for a consistent pan-Canadian framework. . .

Mr. Ted Falk: Thank you to all of our witnesses. I too apologize for the inconvenience you suffered because of our votes and procedure in this House.

I'd like to begin my questions with the CMA.

This is just for clarification, because I wasn't sure how many doctors you said you represented. You indicated that you like the bill and you would like to see it adopted without amendment. Is that correct?

Mr. Jeff Blackmer: That is correct. We represent over 83,000 physicians in Canada.

Mr. Ted Falk: Okay.

Dr. Jeff Blackmer: If I may, we've consulted with tens of thousands of physicians over the past two to three years in the course of various national town halls we've conducted across the country. We've done extensive polling, and we've had numerous debates at our national annual meeting.

So we do represent those physicians.

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Mr. Chris Bittle: My initial questions I'd like to direct to the CMA. There is concern about conscience rights and we've heard that from a number of groups. But, are there any other procedures that you know about, apart from medical assistance in dying, in which there is a concern that doctors are forced to or coerced to perform a procedure, a medical procedure against their will?

Dr. Jeff Blackmer: I would say probably the best analogy is therapeutic abortion. This is one where the medical profession has certainly struggled collectively and individually. And there's often a question around conscience rights and a right to objection and whether or not physicians may have an obligation to refer to another practitioner there. So that's probably the closest analogous situation.

Mr. Chris Bittle: But physicians aren't required to conduct a therapeutic abortion.

Dr. Jeff Blackmer: No. That's correct. There's no requirement for them to do that, and there's only one province that currently has a requirement that they refer to a colleague, which is Ontario. Ontario is actually the only jurisdiction in the entire world with that requirement.

Mr. Chris Bittle: And do the colleges across the country, the colleges of physicians of various provinces, they fiercely safeguard the conscience rights of physicians through their own professional regulations?

Dr. Jeff Blackmer: That's correct. And I would say that particularly on the point of assistance in dying, we've seen the nine provinces, outside of Quebec, come forward with regulations. All of them, save Ontario, have wording that very clearly protects the conscience rights of physicians, but we have certainly seen some discrepancies in terms of the exact wording. And as I say, Ontario is an outlier in terms of their regulations in that regard.

Mr. Chris Bittle: And perhaps you could speak for a moment about the importance of self-regulation in terms of your membership.

Dr. Jeff Blackmer: Self-regulation is very much a privilege and not a right of the medical profession. It is something we constantly must strive to uphold through our actions, collectively and individually, again.

As you know, there are members of the public now on these regulatory bodies, and we look to them for guidance as well. This is critical to what it means to be a medical professional-the ability to self-regulate and to hold our members to a high standard.

On issues such as conscientious objection, we do often look to the colleges for guidance. This has been a difficult issue, again, because of some of the inconsistencies in the guidance that has come forward. . .

Mr. Murray Rankin: I noticed you carefully said, We're struggling with conscience protection in the committee and how to do it, and you said, "to the extent constitutionally possible".

Do you have a legal opinion on whether we can do it in this federal law?

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Dr. Jeff Blackmer: I'm not a lawyer, but having spoken to a lot of lawyers about this, the interpretation that I've had is that this would not be possible. Now we, if the committee feels otherwise and there is a possibility otherwise, we would support that possibility, certainly. . .

Mr. Ahmend Hussen: This is for the Canadian Medical Association, either one of the representatives.

I'd like to know if you have any concerns with respect to Bill C-14 and whether patients will have difficulty accessing medical assistance in dying as it moves forward.

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Dr. Jeff Blackmer: That's a very important question. I would point out that when we've done surveys of the membership in the CMA, somewhere around 30% of physicians have said that if this becomes legal they would be willing to participate. That may sound, on the face of it, low; it's actually not. That equates to tens of thousands of physicians. In Oregon, it's less than 0.6% of physicians who participate in assisted dying. So in terms of just the numbers, access won't be a problem. The problem is connecting patients who qualify with willing practitioners.

You can imagine that most physicians aren't willing to put their name out there to advertise that they're going to be participating in this; there are security and safety concerns. So what we need, and what the CMA has been calling for, is a system to help connect patients who qualify for assisted dying with practitioners who are willing to provide the service. At the same time this means that physicians who don't want to participate, or don't want to refer, can have their conscience rights protected. So it's a way to satisfy both situations.

Mr. Ahmend Hussen: How would that system look like?

Dr. Jeff Blackmer: There's actually a system in Alberta, at the current point in time, that the Alberta government has been working on where physicians can register with a central registry and say, "I'm willing to participate." And patients, or a health care provider, can call that number and find out more information about the legislation and about the service, but also be connected, where appropriate, with a willing provider. They put that in place because of the situation that they had where a patient in Calgary was not able to find a willing provider and had to travel outside of the province, even though there were many physicians in Calgary who could have assisted. So we desperately need this type of a system to make sure that we connect patients and providers.

Dr. Cindy Forbes: I want to also echo those comments. I can honestly say the most common question I get from my colleagues who know that I've been involved at this level is, are asking me, do you know who's going to provide the service? So they may be willing to refer, but they, at this point in time have no idea, and as Dr. Blackmer pointed out, it's unlikely we're going to have a directory or a list published somewhere. So this concept of a central referral, coordinating system would be essential when June 6 arrives, that physicians would know there's a system; that patients would know there is a system. There would be no confusion and that it will pave the way to access for the people who really should be accessing the service.

Canadian Medical Protective Association [Full Text]

. . . The CMPA recommends that the brief reference to right of conscience in the preamble be expanded given the importance to practitioners that their personal convictions be respected in this area. Consideration might be given to inlcuding in the preamble of Bill C-14 language similar to the language of the Civil Marriage Act or the Bill C-14 Legislative Background document, such as "nothing in this Act compels healthcare providers to provide MAID or to otherwise impact their rights under paragraph 2(a) of the Charter of Rights and Freedoms". . .

Oral submission [Edited video]

Mr. Ahmed Hussen: My last question is with respect to Mr. Stern. In your opinion, does Bill C-14 respect the conscience rights of health care practitioners who do not want to participate in medical assistance in dying?

Dr. Hartley Stern: I think it does so, but perhaps not as strongly as we would like it to.

And I made suggestions about adding some wording in the preamble. As I understand it - again, I'm not a lawyer, I'm a physician - that adding it in the preamble sets the context and sets the tone of the law. And we feel that by adding those words in the preamble, will help strengthen that protection. So, and again, the protection on, I'll just leave it at that.

The Chair: Ms. Branigan, did you want to get in on that?

Dr. Monica Branigan: I think sometimes when we're talking about conscience protection, we tend to focus on whether people want to be involved in the act of hastening death itself. And there's a very important concern about conscience for making an effective referral that isn't alluded to. And again, the solution is to - and I understand that the Canadian Medical Association will speak to you on this matter - but is to have an effective coordinating system that will take care of that.

And I think that is going to be a significant issue, to force physicians to make a referral that they feel complicit in the act. And so, what I'm saying is, I'm not sure that needs to be put into the Criminal Code. I think in terms of implementation, to have a separate coordinating system will absolutely ensure access to patients and will give the conscience protection that physicians need and deserve.

Dr. Hartley Stern: Could I make a a supplement, just a small comment on that?

Chair: Yes, sure.

Dr. Hartley Stern: In our submission to the joint parliamentary committee, we recommended that the wording and the way it was drafted in Quebec, I think, would be a very useful addendum for this parliamentary committee. That would ease the concerns of those people that my colleague is concerned about, those who have even a difficulty referring. That the legislation in Quebec is very thoughtful on this matter.

***

Mr. Michael Cooper: Dr. Stern, you alluded to the need for conscience protections for physicians. What about for health care institutions? What are your comments on that? I know that in the Loyola decision, Chief Justice McLachlin recognized that under section 2 of the charter, that the conscience rights of physicians and institutions are intertwined.

Dr. Hartley Stern: I run an organization that protects physicians. This is a most complicated area. I don't feel that I'm the right person to tell you what to do, or to give you advice on institutions. I used to run an institution. I no longer do that. I can't help you on that one.

Dr. Monica Branigan: And again, sorry, I would like to jump in here and talk about how that's where the coordination system comes in, so that if you are a religious institution and you opt out, you have a built-in way of having an easily accessible access plan for the patients in your institution. So if you set it up in that way, then you can accommodate a lot more people and beliefs.

Canadian Nurses Association

Oral Submission [Edited Video]

Dr. Caroyn Pullen: . . . CNA welcomes the federal government's moderate approach to this challenging legislation, and we support the expeditious passing of this bill. CNA strongly endorses the stated intention to work with the provinces and territories on a pan-Canadian care pathway for end-of-life care, which has the potential to reconcile issues related to access and conscience. . .

Canadian Pharmacists Association

Oral submission [Edited video]

Mr. Philip Emberley: . . . On the issue of conscience, we strongly believe that pharmacists and other health care professionals should not be compelled to participate in assisted dying if it is counter to their personal beliefs. The legislation does not set out whether or how health care professionals can refuse a request. This leaves protection of conscience for health care professionals, including pharmacists, up to the provinces and to provincial regulators - professional regulators. In addition to this, and to ensure that freedom of conscience is respected, pharmacists should not be compelled to refer the patient directly to another pharmacist who will fulfill the patient's request. This is an important consideration for pharmacists who view referral as morally equivalent to personally assisting a patient to die.

To provide equal protection of pharmacists' right to conscientious objection and patients' right to access, CPhA recommends the creation of an independent information body with the capacity to refer to a participating pharmacist, and we urge the federal government to work with the provinces and the territories to create and implement such a system. . .

Mr. Michael Cooper: I have one final question to Mr. Emberley.

On the issue of conscience protections for pharmacists, you spoke about an independent body that could be set up. I just to make sure I understand what you're recommending.

Are you suggesting that, for example, if a pharmacist had a conscientious objection to physician-assisted dying, they would then get in touch with that independent body. The independent body would then get in touch with the patient and get the patient to a pharmacist who could provide the services that the patient needs? Such a body, I believe, exists in the province of Quebec in terms of what they had provided as an alternative to an effective referral regime in Bill 52.

Mr. Philip Emberley: Yes, that is, that's the kind of structure that we had anticipated in this. That it would be an independent third party agency that could be engaged in such a way. Exactly. . .

Ms. Iqura Khalid: . . . When you were referring to the third party body or independent body with respect to pharmacists providing the drug, do you see there being a bit of a problem in remote geographic locations where there is only one pharmacy say, servicing a whole rural community, for example? What do you think of, how do you think such a body would affect those instances?

Mr. Philip Emberley: Yes, it's a very important question, and we feel that the provincial regulatory bodies are right now in the process of drafting guidelines for their members, and I think this is a very important consideration that they will have to, they really have to drill down on some of the specifics, because they need to take into consideration the needs of their populations. So, I definitely think this is an area that they will need to hone in on quickly to ensure that accessibility is optimized.

Canadian Society of Palliative Care Physicians [Full Text]

Oral submission [Edited video]

Mr. Ahmed Hussen: My last question is for Mr. Stern. In your opinion, does Bill C-14 respect the conscience rights of health care practitioners who do not want to participate in medical assistance in dying?

Dr. Hartley Stern: I think it does so, but perhaps not as strongly as we would like it to.

And I made suggestions about adding some wording in the preamble. As I understand it - again, I'm not a lawyer, I'm a physician - that adding it in the preamble sets the context and sets the tone of the law. And we feel that by adding those words in the preamble, will help strengthen that protection. So, and again, the protection on, I'll just leave it at that.

The Chair: Ms. Branigan, did you want to get in on that?

Dr. Monica Branigan: I think sometimes when we're talking about conscience protection, we tend to focus on whether people want to be involved in the act of hastening death itself. And there's a very important concern about conscience for making an effective referral that isn't alluded to. And again, the solution is to - and I understand that the Canadian Medical Association will speak to you on this matter - but is to have an effective coordinating system. That will take care of that.

And I think that is going to be a significant issue, to force physicians to make a referral that they feel complicit in the act. And so, what I'm saying is, I'm not sure that needs to be put into the Criminal Code. I think in terms of implementation, to have a separate coordinating system will absolutely ensure access to patients and will give the conscience protection that physicians need and deserve.

Dr. Hartley Stern: Could I make a a supplement, just a small comment on that?

Chair: Yes, sure.

Dr. Hartley Stern: In our submission to the joint parliamentary committee, we recommended that the wording and the way it was drafted in Quebec, I think, would be a very useful addendum for this parliamentary committee. That would ease the concerns of those people that my colleague is concerned about, those who have even a difficulty referring. That the legislation in Quebec is very thoughtful on this matter.

***

Mr. Michael Cooper: Dr. Stern, you alluded to the need for conscience protections for physicians. What about for health care institutions? What are your comments on that? I know that in the Loyola decision, Chief Justice McLachlin recognized that under section 2 of the charter, that the conscience rights of physicians and institutions are intertwined.

Dr. Hartley Stern: I run an organization that protects physicians. This is a most complicated area. I don't feel that I'm the right person to tell you what to do, or to give you advice on institutions. I used to run an institution. I no longer do that. I can't help you on that one.

Dr. Monica Branigan: And again, sorry, I would like to jump in here and talk about how that's where the coordination system comes in, so that if you are a religious institution and you opt out, you have a built-in way of having an easily accessible access plan for the patients in your institution. So if you set it up in that way, then you can accommodate a lot more people and beliefs.

Castagna, Dr. Luigi A. [Full Text]

I would like the Committee to give serious consideration to amend Bill C-14, to allow physicians and health-care institutions committed to healing, to opt out from direct or indirect involvement in physician assisted suicide (PAS) and euthanasia.

Individual patients and communities would greatly benefit from this provision in a number of ways:

• Patients would have access to physicians whom they can trust to act in a principled way, according to the best of their judgment, in light of the inherent value of life.

• To know that a physician and allied professional are part of an institution where PAS and euthanasia are not practiced, promotes a positive, therapeutic relationship between doctor and patient, helps allaying the fears and anxieties experienced during a serious illness, and encourages the patient to engage fully in his current circumstances.

• Opted-out Physicians and allied professionals would work in an environment that values and rewards their commitment, effort and creativity in providing care in difficult, challenging situations.

• Vulnerable patients would be free from subtle or explicit pressures, to consent to life-ending measures. They would be spared the distressing ambivalence of perceiving their care givers also as potential killers.

• Patients who chose to be cared for in an institution opted out from PAS and euthanasia would not have to fear becoming victims of the abuses and errors that any practice is inherently prone to. In the case of PAS and euthanasia, the consequences of abuse or error are irreversible.

• In absence of opted-out institutions and physicians, patient might seek care in jurisdictions where PAS and euthanasia are illegal. This is the case in Holland and Belgium, where elderly patients often seek care in neighboring Germany. In Canada, such option would only be possible for individuals with sufficient financial means. Access to medical care as healing practice, free from PAS and euthanasia should be a choice available to every Canadian.

• Large communities within Canada who uphold the sanctity of life, including practicing followers of the historic religions (e.g.: Judaism, Christianity and Islam) would find support in opted-out institutions as they try to maintain, in accordance with their beliefs, a sense of meaning and purpose in the face of disabilities, chronic disease or approaching death.

• Talented and principled young people, with an aptitude to the practice medicine as a healing art, and members of minority groups who understand PAS and euthanasia as unethical, would not be discouraged or barred from pursuing medicine as a profession, if opting-out were possible. This would ensure diversity within the medical profession.

• Allowing physicians and institutions to opt out, would prevent a shift of power and resources away from Canadians who wish to live, in favor of those who wish to die. It would be a step forward to extend access to palliative care to all citizens, rather than the currently estimated 30%.

• Opted-out physicians and institutions will help preventing erosion of the understanding that all human beings are of equal value, regardless of their age, socioeconomic status, abilities, and general health.

Catholic Civil Rights League [Full Text]

Inadequate Protection of Conscience Rights of Healthcare Professionals

A provision in the preamble to Bill C-14 provides a reference to conscience rights of healthcare workers, but such protections need greater clarification from the federal level, with a secure process for enforcement, whether by a provision of the Criminal Code to oppose any infraction. Such protections should not be left merely to provincial mandates.

Health Minister Dr. Jane Philpott asserted that "no healthcare provider will be required to provide medical assistance in dying", yet without addressing issues of mandatory referrals, or institutional protections for religious institutions. . .

Recommendations

3. Rights and freedoms of medical practitioners, medical institutions, and the many citizens who desire traditional (Hippocratic) medical care must not be obviated in any fashion, including loss or diminishment of funding. Islands of refuge for religious hospitals and hospice care facilities must be established as a matter of law, and no prejudice should be suffered. Provincial transfers under the Canada Health Act should accommodate such institutions, as a matter of best practice.

Centre for Israel and Jewish Affairs [Full Text]

. . . Despite divergent opinions on whether MAID should be permitted, there is a strong consensus that, following the Supreme Court's decision, substantial measures are needed to protect healthcare providers who object to MAID for reasons of conscience and to ensure that eligibility for MAID is sufficiently regulated.

Conscience

Many healthcare practitioners object to MAID on the basis of deeply held professional, moral and religious convictions. Unfortunately, Bill C-14 is currently silent on the conscience rights of physicians, nurses and pharmacists who may be called upon to participate in MAID.

The Carter v. Canada decision explicitly noted: "nothing in the declaration of invalidity which we propose to issue would compel physicians to provide assistance in dying." Instead, the Court noted that "the Charter rights of patients and physicians will need to be reconciled in any legislative and regulatory response." C-14 should be amended to explicitly ensure that physicians, nurses and pharmacists who object to MAID for reasons of conscience cannot be compelled to provide it, nor be subject to discriminatory employment practices in any area of federal jurisdiction.

For some healthcare providers, even making a referral for MAID would be an unconscionable act. We are encouraged that Bill C-14 does not compel physicians to provide a direct referral.

Had this been the case, Canada would be the only jurisdiction with such a requirement, which would likely fail to satisfy the Supreme Court's mandate to balance the rights of patients and physicians.

Accommodation for physicians with regard to referral must not degrade patient access to MAID.

Several models have been proposed to balance these competing rights. For example, the Canadian Medical Association has proposed a "separate central information, counselling and referral service" to which objecting physicians could direct patients seeking physician-hastened death.

Dr. Hershl Berman, a specialist in internal medicine and palliative medicine at the Temmy Latner Centre for Palliative Care and an associate professor in the faculty of medicine at the University of Toronto, recently proposed another model in the Hill Times. He wrote: "Rather than actively referring patients, all physicians should be required to report any request for assisted death to the provincial Ministry of Health or a regulatory body. Physicians would be required to register if they are willing and qualified to provide MAID, and indicate how many additional patients they are able to take on per year. If the report is from a doctor willing to provide the service, he or she would receive confirmation. If not, the registry would connect the patient with a nearby practitioner."

Dr. Berman also noted that, "in addition to respecting the beliefs and values of physicians who object to MAID, this process has an additional benefit. Many physicians, especially specialists, have a limited network of colleagues to whom they are accustomed to referring. In isolation, particularly in underserviced areas, any doctor may have difficulty finding a colleague willing to accept the patient. If the process is managed centrally, a registry can ensure more effective and timely access for patients who wish to hasten their own death."

Oral Submission [Edited Video]

Mr. Richard Marceau: . . . Despite diverging opinions, there is a broad consensus that exists on the matter within further to the Supreme Court's decision in Carter, many measures must be taken to protect those who deliver health care, and those who object to medically assisted dying because of reasons of conscience. We want to ensure that there would be availability to medically assisted dying, also to palliative care.

First of all, allow me to begin with the issue of the of conscientious objection. Many health professionals are opposed to medically assisted dying, by basing their position on their profound moral, religious and ethical convictions.

Unfortunately, Bill C-14 presently is silent on the issue, and for many of them, this is an act, that is to say, medically assisted dying, is something that is unacceptable.

We are very encouraged by the fact that Bill C-14 doesn't force doctors to directly refer their patients. Had thatbeen the case, Canada would have been the only country to impose such a requirement, and it probably would have not met the mandate of the Supreme Court.

I stress the fact that accommodations concerning the views of these professionals have to be taken into account.

[the Canadian Medical] Association has proposed a separate central information, counselling, and referral service to which objecting physicians could direct patients seeking physician-hastened death.

Dr. Hershl Berman, a specialist in internal medicine and palliative medicine at the Temmy Latner Centre for Palliative Care in Toronto and an associate professor in the Faculty of Medicine at the University of Toronto, recently proposed another model in The Hill Times. He wrote:

Rather than actively referring patients, all physicians should be required to report any request for assisted death to the provincial Ministry of Health or a regulatory body. Physicians would be required to register if they are willing and qualified to provide MAID, and indicate how many additional patients they are able to take on per year. If the report is from a doctor willing to provide the service, he or she would receive confirmation. If not, the registry would connect the patient with a nearby practitioner.

. . . Dr. Berman also noted that, and I quote:

In addition to respecting the beliefs and values of physicians who object to MAID, this process has an additional benefit. Many physicians, especially specialists, have a limited network of colleagues to whom they are accustomed to referring. In isolation, particularly in under-serviced areas, any doctor may have difficulty finding a colleague willing to accept the patient. If the process is managed centrally, a registry can ensure more effective and timely access for patients who wish to hasten their own death.

Ms. Iqra Khalid: This has come up in the committee a lot from different organizations as well as colleagues around this table: with respect to protecting the conscience rights of medical personnel, physicians and nurses, etc. Now, what is your opinion - I would ask this for all three of you to comment - what is your opinion on having a criminal prohibition creating an offence in the Criminal Code to, to make it an offence to coerce a physician into administering death under this bill?

Mr. Richard Marceau: To make it a criminal offence...to coerce a physician to.

We're going to the balance of competing rights here. And those two rights were recognized by the Supreme Court in Carter. I'm not sure we need to go that far as I do believe, as per Carter and as we suggest, that there is a way to make sure the the conscience and religious rights of medical practitioners be respected in that process. Otherwise, it wouldn't make it more legal. If those rights are not respected, this process is not legal per se, and we could go back into the whole, going back to the court and take years and years and years. And I think you have the possibility in front of you. You can craft the right balance between those two rights that a lot of Canadians are looking for.

People are for medical assisted dying by the way, and people are opposed to it. If there's one place where I believe there's consensus between those two competing visions, it is this.

Mr. Michael Bach: I think you solve the problem by going with advance review, because then physicians aren't actually authorizing this. They're doing their job as physicians, which is, and that's our proposal to address that concern. And it also means that you can have many more physicians in Canada, beyond the only one-third that are saying they would do this at this point, that would be willing to step up, because they're not actually authorizing it. They're just examining causes of suffering and putting options on the table to address it, which is what we should be hoping and expecting of physicians in this country.

Ms. Iqra Khalid: And Mr. Fletcher, if you have some remarks on that?

Honourable Steven Fletcher: Yes. In Canada you cannot force a physician to do anything. I am aware of a physician who refused to see people who smoke. There was nothing the college could do. It was his choice. What we have to make sure is that people are not denied their Charter rights, and that is the concern I raised earlier about section 141(1)(b). It's not clear that people are made aware of all the options available to them. In fact, it seems that it would be against the law if they were to raise the prospect of death. And that is, essentially, a denial of Charter rights. But nobody will force anybody in the medical profession to do anything they don't want to do. They don't have to do it now and they will never be able to force someone to do it. The Supreme Court was very clear.

The Chair: . . . Can I just clarify something that was just said? Cause I'm a bit confused. So there's been a lot of people from all sides of the debate, as Monsieur Marceau had said, that have come forward and said that conscience rights should be protected in a way that is more clear than is currently the case, in which only the preamble references somewhat to a conscience right. Ms. Khalid suggested one way that could be done, through a criminal prohibition. There are other ways.

You, Mr. Bach, seemed to suggest that was unnecessary provided there was the review process, but the review process would only ascertain that the person was competent and willing and that all of the requirements of the law were met. There would still be a physician that in the end would be there -

Mr. Michael Bach: - to administer the act.

The Chair: So in order to prevent a physician, a nurse, a pharmacist, or anybody who didn't want to do that from being fired or from being coerced into doing it, the thought was to find a way to still add conscience rights. I don't understand how having that added process would stop, would change that there would be people of conscience who wouldn't want to do this.

Mr. Michael Bach: I wasn't suggesting that conscience rights shouldn't be protected.

Christian Legal Fellowship [Full Text]

Recommendation #2:

For greater certainty, Parliament should affirm that suicide prevention remains a charitable purpose and that no charitable institution will lose its registered status solely by reason of their:

lawful efforts or initiatives to reduce levels of suicide, including deaths caused by MAID
in the case of health care facilities and their associated foundations, lawfully declining to provide MAID at their facilities, and
in the case of religious charities, any of its members, officials, supporters or adherents exercising, in relation to assisted suicide, the freedom of conscience and religion guaranteed under the Canadian Charter of Rights and Freedoms.

. . . It is also imperative that C-14 contain positive affirmation of and explicit protection for the conscience rights of those who object to participating, directly or indirectly, in assisted suicide or euthanasia. Legislative silence on such matters will not afford adequate protection.

Participating in the deliberate inducement of death on another person remains an affront to medical ethics and to the longstanding legal principle of the inviolability of life. It is, as Justice Sopinka put in in 1993, "intrinsically morally and legally wrong". Carter did not challenge or overturn this conclusion. The fact that it created a narrow exception to the legal prohibition in very limited circumstances means only that the state can allow individuals and institutions to participate in MAID – it cannot require them to do so. To the contrary, the government would be wrong and unjustified if it were to require participation, as it would (among other problems) violate the dignity and freedom of such individuals.

The SCC in Carter specifically contemplated a role for Parliament to play in protecting conscience rights. Parliament should make it an offence to pressure any person to participate in assisted suicide or euthanasia, pursuant to its criminal law power. Such a provision would be a practical means of upholding the Charter's guarantees of freedom of religion and conscience. It would also not conflict with a MAID-seeker's Charter rights, which do not create a positive claim against an individual (such as a health care provider) or institution that is unwilling to participate in providing MAID.

Recommendation #3:

Pursuant to its criminal law power, Parliament should make it an offence to pressure any person to obtain or to participate in providing, directly or indirectly, assisted suicide or euthanasia. (See Appendix for draft amendment.)

Appendix A: Amendments to Bill C-14

Freedom of conscience and religion and expression of beliefs

1. For greater certainty, no person or organization shall be deprived of any benefit, or be subject to any obligation or sanction, under any law of the Parliament of Canada solely by reason of their exercise, in respect of assisted suicide or euthanasia, of the freedom of conscience and religion guaranteed under the Canadian Charter of Rights and Freedoms or the expression of their belief that participation by one individual in the death of another is intrinsically morally and legally wrong. . .

. . . (The following provisions are adapted from a similar proposal by The Protection of Conscience Project)

Compulsion to participate in homicide or suicide

241.3(1) Every one commits an offence who, by an exercise of authority or intimidation, compels another person to be a party to homicide or suicide.

Punishing refusals to participate in homicide or suicide

241.3(2) Every one commits an offence who

a) refuses to employ a person or to admit a person to a trade union, professional association, school or educational program because that person refuses or fails to agree to be a party to homicide or suicide; or

Intimidation to participate in homicide or suicide

241.3(3) Every one commits an offence who, for the purpose of causing another person to be a party to homicide or suicide

(a) suggests that being a party to homicide or suicide is a condition of employment, contract, membership or full participation in a trade union or professional association, or of admission to a school or educational programme; or

(b) makes threats or suggestions that refusal to be a party to homicide or suicide will adversely affect

(i) contracts, employment, advancement, benefits, pay, or

(ii) membership, fellowship or full participation in a trade union or professional association.

Definitions

241.3(5) (a) For the purpose of this section, "person" includes an unincorporated organization, collective or business.

(b) For greater certainty, for the purpose of this section, "suicide" includes death by medical aid in dying as defined in s. 241.1(b) and "homicide" includes medical aid in dying as defined in s. 241.1(a).

(c) For the purpose of subsection (1),"homicide" and "suicide" include attempted homicide and suicide.

Punishment

241.3(6) (a) Every one who commits an offence under subsection (1) is guilty of an indictable offence and liable to imprisonment for life.

(b) Every one who commits an offence under subsection (2) is guilty of an indictable offence and liable to imprisonment for ten years.

(c) Every one who commits an offence under subsection (3) is guilty of an indictable offence and liable to imprisonment for five years.

Oral Submission [[Edited Video]

Mr. Derek Ross: . . . In addition, the preamble should state that sanctity of life remains one of Canada's most fundamental societal principles; that it is not contrary to the public interest to express the view that participating in causing a person's death is intrinsically, morally, and legally wrong . . .

. . . This also means that Parliament should protect the charitable status of organizations devoted to preventing suicide as well as religious organizations and health care facilities that decline to provide MAID at their facilities, and should do so through clear amendments to the Income Tax Act, which we set out in our brief.

These amendments will serve to promote freedom of religion, conscience, and expression, but just as importantly, respect and preserve a medical and societal culture in which treatment is promoted as a solution to suffering, not suicide. . .

. . . We also urge Parliament to explicitly protect the rights of those who object to participating in MAID, such as health care providers. And I know others will be speaking to that matter this afternoon.

Christian Reformed Centre for Public Dialogue [Full Text]

Conscience Protection: Conscience protection of medical care providers is a matter of deep significance in any MAID regime. We note that Bill C-14 makes a single reference to conscience protection in the nonlegislative measures referred to in the last paragraph of the Preamble. We expect that conscience protection is a matter for policy development at the level of provincial governments and medical regulatory bodies. Therefore, there will be a troubling lag in the development of conscience protection for medical care providers following the passage of Bill C-14. Addressing this lag is a matter of urgency.

Recommendation 5: That the Standing Committee on Justice and Human Rights encourage the Minister of Health to, as a matter of urgency, engage with her provincial counterparts and appropriate regulatory bodies, for the development of a pan-Canadian solution to conscience protection for medical care providers and institutions with respect to MAID. Conscience protection of practitioners and institutions must be balanced with patient autonomy and reasonable provision for access to MAID services.

Chun, Hye Jung [Full Text]

I am writing to ask you to amend the Bill C-14 to consider the following:

- Respect and protect the conscience of all institutions, hospitals and health care workers including physicians and pharmacists who do not want to participate in the assisted suicide or who do not want to refer patients to physicians who participate in it.

- Provide safeguards for health care workers in order that they are not discriminated or penalized for refusing to participate or refusing to refer patients. . .

Cleary, Beatrice [Full Text]

. . . The issue of doctors having to carry out assisted death is another concern. If a doctor says it is against my conscience, morals, religion or whatever their reason is, he or she should not be forced to, nor should he or she have to refer the patient to someone who will, as that is like assisting the person to end their life anyway. . .

Coalition for HealthCARE and Conscience [Full Text]

. . . We will continue to provide the highest standards of care for all patients regardless of their views on this issue. We will not obstruct patient access or abandon our patients. We simply ask that our moral convictions be respected, and that approaches like transfer of care, and direct access to assessments be implemented so that patient decisions can be respected without sacrificing conscience rights.

We are concerned that Bill C-14, as proposed, doesn't protect the conscience rights of health care workers and facilities with moral objections to helping take the lives of Canadians.

Members of our Coalition should not be forced to perform actions that go against their conscience, or to refer the action to others, since that is the moral equivalent of participating in the act itself. It is simply not right or just to say: you do not have to do what is against your conscience, but you must make sure it happens. We do not believe that there is a necessary conflict between conscience rights and patient decision making. It is possible for both to coexist and organizations like the Canadian Medical Association have proposed ways to make that happen.

This may be the reason why no other foreign jurisdiction in the world that has legalized assisted suicide forces health care workers, hospitals, nursing homes or hospices to act against their conscience or mission and values.

It appears that the federal government is leaving this issue to the provinces and territories for consideration. The provinces may opt not to legislate which will create a legal vacuum leaving each health authority or each facility to create their own policy. Health care workers will be required to vindicate their own constitutional rights at their own expense all over the country.

This will undoubtedly result in a patchwork of different approaches. This could cause serious injustice to some very conscientious, committed and capable health care practitioners.

All of this while Canadian popular opinion support conscience protection for health care workers and institutions.

Provide Conscience Protection in Bill C-14

Parliament has the power, authority and precedent to legislate on this matter.

The 2005 Civil Marriage Act contains language in its preamble and a specific clause recognizing that officials of religious groups are free to refuse to perform marriages that are not in accordance with their religious beliefs, even though marriage is within provincial jurisdiction.

Our coalition recommends that Parliament use the same legislative approach in Bill C-14, including language both in the preamble to the bill and in a specific clause that confirms that individuals or faith-based healthcare institutions who oppose assisted suicide are not to be compelled to engage in it and are not to be discriminated against as a result of their opposition.

This would allow the federal government to make certain that medically assisted dying is regulated equitably across Canada and that the Charter rights of healthcare practitioners and faith-based healthcare institutions are respected.

Proposed Amendments

Preamble:

WHEREAS Parliament respects and affirms freedom of conscience and religion for healthcare practitioners and faith-based institutions;

WHEREAS nothing in this Act affects the guarantee of freedom of conscience and religion and, in particular, the freedom of healthcare practitioners and faith-based institutions to refuse to provide or participate in the provision of medical assistance in dying;

WHEREAS the refusal of a healthcare practitioner or faith-based institution to provide or participate in the provision of medical assistance in dying is not against the public interest;

WHEREAS the refusal of a healthcare practitioner or faith-based institution to perform or participate in the provision of medical assistance in dying ought not result in them being deprived of any benefit and ought not subject them to any obligation;

WHEREAS this Act seeks to exempt people from prosecution for providing medical assistance in dying and not to create a positive obligation on individuals to provide or participate in the provision of medical assistance in dying;

Body of Act:

Healthcare practitioners

1. It is recognized that healthcare practitioners are free to refuse to participate in medical assistance in dying either directly or indirectly if doing so is not in accordance with their conscience and/or religious beliefs.

Freedom of conscience and religion

1.1 For greater certainty, no person or organization shall be deprived of any benefit, or be subject to any obligation or sanction, under any law of the Parliament of Canada solely by reason of their exercise or refusal to exercise, in respect of medical assistance in dying, of the freedom of conscience and religion guaranteed under the Canadian Charter of Rights and Freedoms.

Oral Submission [Edited Video]

Archbishop Thomas Cardinal Collins: . . . I appear today on behalf of the Coalition for HealthCARE and Conscience. Joining me is my colleague Larry Worthen, the executive director of the Christian Medical and Dental Society of Canada, which is a member of our coalition. We represent more than 5,000 physicians across Canada and more than 110 health care facilities and almost 18,000 care beds and 60,000 staff. . .

. . .Today we will address the need for amendments to Bill C-14 to protect conscience rights for physicians and health care facilities. Our members are committed to caring for their patients at every stage of life. We know what it is to journey with those who are facing great suffering in mind and body. We are committed to serving those who suffer with a compassionate love that is rooted in faith and expressed through the best medical care available.

What our members cannot do is perform or participate in what is being referred to as medically assisted death. To be clear, by participation I also mean playing a role in causing death by arranging for the procedure to be carried out by someone else through a referral.

We acknowledge that the draft legislation tabled on April 14 set aside, at least for the moment, some of the most disturbing recommendations from the parliamentary joint committee. We remain concerned, however, that the bill does not protect the conscience rights of health care workers and facilities with moral objections to euthanasia and assisted suicide.

We see no reference to conscience rights in Bill C-14. The preamble to the legislation notes that the government respects "the personal convictions of health care providers." While that respect is appreciated, it does not carry the same legal weight as legislative protection. No foreign jurisdiction in the world that has legalized euthanasia/assisted suicide forces health care workers, hospitals, nursing homes, or hospices to act against their conscience or mission and values.

It appears that the federal government is leaving this issue to the provinces and territories for consideration, but if the federal government enacts a law that establishes euthanasia/assisted suicide across Canada, it needs to provide robust protection of conscience rights across Canada.

It is essential that the government ensure that effective conscience protection is given to health care providers, both institutions and individuals. It is simply not right or just to say to an individual, "You do not have to do what is against your conscience, but you must make sure it happens." It is equally unjust to require a health care facility to repudiate its institutional conscience or mission. We would note that no health care facility in Canada makes every procedure available to its patients.

We will continue to journey lovingly with our patients every day. We ask that you protect all health care workers and the institutions that are successors to the pioneers of health care in our country to ensure that they may continue their mission of care and healing. . .

Mr. Laurence Worthen: . . .We wish to make it clear that should Parliament legalize medical aid in dying, we will not in any way obstruct patients who decide to seek that procedure, and we will never abandon our patients.

We know there are many ways to respect patient decisions that do not violate the conscience of health care workers or institutions. The Canadian Medical Association and other experts have said there is no necessity for there to be a conflict between these two values.

Our own proposal recommends the use of transfer of care and direct patient access, so patients have the choice of staying with their physician for care or transferring care to another physician.

Facilities that cannot provide the procedure on their premises are prepared to help transfer patients to the facility of their choice if the patient so desires.

To force providers to act against their moral convictions is to breach section 2 of the Charter of Rights and Freedoms. We know hospitals and regulators all across the country are right now developing policies on this subject. For example, the College of Physicians and Surgeons of Ontario has already provided a provisional policy that will force doctors to provide a referral for euthanasia and assisted suicide. While at the same time at least seven other provincial colleges have not taken that approach.

Legislation from Parliament would send a clear signal that the charter rights of caregivers all across Canada can be protected. Canadians should not have to deal with a patchwork approach.

Parliament has legislated matters that overlap into provincial or territorial jurisdiction in the past. Consider, for example, the Civil Marriage Act passed by Parliament in 2005 to legalize and regulate same-sex marriage. While marriage falls under provincial jurisdiction, this is federal legislation that governs marriage. The act contains language in its preamble and a specific clause recognizing that officials of religious groups are free to refuse to perform marriages that are not in accordance with their religious beliefs.

Our coalition recommends Parliament use the same legislative approach in Bill C-14, including language both in the preamble to the bill and in a specific clause that confirms that individuals or faith-based health care institutions that oppose euthanasia or assisted suicide are not to be compelled to engage in it and are not to be discriminated against as a result of their opposition. . .

It is not in the public interest to discriminate against the category of people based solely on their moral convictions and religious beliefs. This does not create the kind of tolerant, inclusive, or pluralistic society that Canadians deserve. . .

Mr. Michael Cooper: . . . Cardinal, you spoke about the need for conscience protections. And I'd like to ask you about conscience protections for health care institutions, faith-based institutions. There are some who are not supportive of conscience protections for faith-based institutions. They seem to distinguish between, on the one hand, health care providers as individuals and institutions, and in so doing they characterize institutions as bricks and mortar. This view seems to be inconsistent for example with the pronouncement of the Supreme Court in the Loyola decision wherein Justice McLachlin recognized that under section 2 health practitioners and institutions are intertwined when it comes to freedom of religion and freedom of conscience. I was wondering what your comments might be on those who would say health care institutions are merely bricks and mortar, and therefore are not worthy of conscience protections.

Thomas Cardinal Collins: I think with health care institutions, what we call their conscience we called "mission". And, from the earliest days of our country, the religious sisters who founded health care in our country were driven by their mission of serving other people. That is the heart of who they were, and it is to this very day.

Like, I live right next to a Catholic hospital, where it presents itself as the Urban Angel protecting the people, and it does do that. That spirit, that mission of that hospital, is something profound. It is what I would call an institutional conscience. It is something very precious.

Institutions like Catholic hospitals and others of other faiths are not bricks and mortar; they are the spirit of the people there who are helping. And so I think that's a very narrow and misguided view of groups of people who give their life to help others and without whom this country would be a colder, harsher, rougher place, without the love and care of people serving a mission, as a hospital. It's not just bricks and mortar at all.

Mr. Michale Cooper: In the absence of conscience protections, could you comment on what you're hearing in terms of what impact that may have on health institutions, many of whom have been providing quality health services for decades? I know that, you know, in the province of Alberta, Covenant Health, for example is one such example, where, you know, in the absence of conscience protections this is, becomes a major problem.

Would you be able to comment on the impact, it will have if Parliament doesn't act with conscience protection legislation?

Thomas Cardinal Collins: Well, I think it would be a very serious impact. I noticed when we got together to make a statement in the parliamentary press room a while ago the Salvation Army also was standing...we were side by side, because they also have hospitals which are very much, they're very concerned about that.

So I think it's the institutions, which are these health care facilities that are there to serve.... If they are not allowed to do that, that would be a very serious problem. And, of course, the individuals as well. Individual health care providers are the doctors, nurses, pharmacists. These are people who also need to be protected, and also not just about their conscience rights not to perform these procedures but also to effect a referral to make them happen.

Mr. Michael Cooper: And last question and it is directed to Mr. Worthen. You had read a proposed conscience protection clause. I haven't seen the text of it. You may have submitted a brief, but I haven't had an opportunity to review it. Based on what I heard, is it modelled after section 3.1 of the Civil Marriage Act? Is that effectively the structure of that specific proposed amendment? It sounds awfully similar.

Mr. Laurence Worthen: It is very similar. It was based upon that legislation. . .

Mr. Murray Rankin: . . . There was talk of an institutional conscience. There was talk of mission and that institutions ought to be provided conscience protection in the bill. I wasn't sure if you could speak to the requirement, if any, of a transfer to another facility if a particular institution is not willing to provide this constitutionally guaranteed service.

I'd like your position on whether that institution or that practitioner with conscience objections should be required to make a transfer or referral of a patient.

Mr. Laurence Worthen: If I could just respond to that.

Part of the problem in this debate is the definition of referral. When we talk about referral, we're talking about a formal referral, which essentially is a recommendation.

If patients are in a facility that is not able to provide assisted death on the premises, then our moral beliefs allow us, allow physicians within that facility to facilitate a transfer of the patient to the facility of their choice where they can get access to that procedure.

Similarly if a patient comes into a doctor's office and wants assisted death, and the doctor is a conscientious objector, there are number of ways to deal with that. One of them is transfer to another physician. Another is if the provincial government were to develop a process of direct access for this, then the patient could actually keep their physician.

There are many, many ways we can ensure patient requests are respected, while at the same time protecting conscience.

Cochien, Dr. Eileen [Full Text]

I am a family physician working for the last sixteen years in Vancouver, British Columbia. I am writing you today to express my concerns with the legislation your government tabled on Thursday, April 14, 2016. There should be clear conscience protection for physicians such as myself, health care workers, and medical facilities in the legislation. Many physicians, like me, are opposed to legalization. It is not right that we should be forced to participate against ourdeeply held moral convictions, either by referral or by actually assisting in a patient's death.

If this bill is passed without amendments, Canada will be the only country in the world that does not provide legal protection for physicians who cannot participate in medical assistance in dying because of their moral convictions. It is not good enough to say that the provinces will look after this, because there is no guarantee that they will even pass legislation on this topic. Legislation must clearly spell out the protection provided by the Charter of Rights and Freedoms, so that caregivers and their organizations will be protected from coercion and discrimination.

It is not necessary to force dedicated physicians and healthcare workers to put their careers on the line and open themselves to professional disciplinary action simply because they wish to follow their conscience. It is not necessary to force the closure of facilities that cannot provide medical assistance in dying. If physicians such as myself are forced to leave the practice of medicine because of these short-sighted policies, then all of my patients will be left without care. In addition, my patients will not be able to find the kind of doctor that they would like to have. I am also concerned that facilities which cannot morally provide medical assistance in dying (such as St. Paul's Hospital in Vancouver - my Family Medicine residency alma mater) will be forced to close should the provincial government stop funding them.

The government could provide the medical professional community with a database – which could be as simple as a toll-free number – that would connect patients with willing providers and information, thus protecting morally-opposed physicians from participating in or endorsing their patients' suicide.

Please carefully consider my concerns as these deliberations are conducted. I request that whatever amendments to this legislation are developed respect the conscience rights of Canadian physicians, other health care providers, and objecting facilities, in addition to protecting the vulnerable. . .

Coffey, Kyle [Full Text]

Concerns and Recommendations for Bill C-14:

Conscience Rights: There are no protections in the legislation for healthcare professionals' right to conscientious objection (which is a Charter right i.e. "freedom of conscience" in S.2 of the Charter of Rights and Freedoms):
- As the legislation currently specifies in S241.31(1) that medical and nurse practitioners must give an effective referral unless exempted by regulations to be made by health minister. This section states "unless they are exempted under regulations made under subsection (3)…… (doctors and nurses) who receives a written request for medical assistance in dying must, in accordance with those regulations, provide the information required by those regulations to the recipient designated by those regulations or, if no recipient has been designated, to the Minister of Health.
- S241.31(3) the "subsection 3" mentioned above, states: The Minister of Health may make (those mentioned above) regulations.
  - The problems with these provisions:
    - As noted above, there are no explicit protections for conscience rights of medical professionals and instead these people are subject to the regulations to be made by the Minister of Health and the various provincial bodies. The federal government has a duty to strongly protect the conscience rights of medical professionals who may object to performing or even effectively referring for DAS and euthanasia as these are Charter rights. Being forced to pass the written consent of a patient to a designated recipient or even the Minister of Health (who will then arrange for the procedure to be carried out) could be considered an "effective referral" by some conscientiously objecting medical professionals (most certainly for Catholics and probably many other Christians, but also for those non-Christians who have values opposed to this practice). This is because giving an effective referral is an indirect participation in the same morally objectionable act. It is analogous (to those who morally object) to showing a potential murderer where their target lives or to providing transportation for bank robbers etc. The whole reason for a Charter is that it provides universal and equitable recognition of human rights across the country. If the federal legislation doesn't protect conscience rights then that national standard for human rights and dignity is then compromised.
  - To fix these provisions:
    - The bill should provide explicit protection for those who conscientiously object to directly or indirectly participating in DAS or euthanasia. These peoples' Charter recognized human rights should not be subject to regulations made by provinces or Health Ministers. The Federal government has the duty to put in place legislation that will not leave medical professionals rights vulnerable.

College of Family Physicians of Canada

Oral Submission [Edited Video]

Dr. Francine Lemire: . . . Complex health issues such as physician-assisted dying and abortion require a level of protection for the privacy of not only the patient but also the health professionals providing these procedures. To ensure a level of security for the provider, names or information of those assisting in the procedures should not be released to the public or the media. Physicians and other care providers, such as nurse practitioners, should feel safe and secure when they care for patients.

In providing medical aid in dying to a patient with a long-standing relationship, a provider should not feel under pressure to do so for other patients under the same or other circumstances. Every case should be considered on its own merits. . .

. . . There needs to be assurances that a physician's conscientious objection will be considered and balanced with both the rights of the provider and ensuring that patients are not abandoned when most vulnerable.

Regardless of any legislation created, physicians must be cognizant of the scope of their responsibility in providing care to a patient. The CFPC maintains that family physicians should, above all, remain committed to their relationships with patients and their patients' loved ones during this last chapter of their lives. Recognizing that those who have serious illness or disabilities and those who are dying are among their most vulnerable patients, family doctors are health advocates on behalf of such patients.

Mr. Ahmed Hussen: . . . Do you have any concerns with respect to whether patients will have any difficulties accessing medical assistance in dying as it is provided under Bill C-14?

Dr. Francine Lemire: So I think the concerns would relate to geographic limitations, rural environments, remote environments where such an access could be more of an issue. And I think that, at the same time, we need to accept the reality that there is support that currently is available to providers and patients in remote environments through Telehealth, through other mechanisms of this nature, but there is no doubt that access in rural and remote areas of our country is a concern for us.

College of Physicians and Surgeons of Ontario [Full Text]

. . .the College is developing a more comprehensive submission and plans to raise additional concerns regarding the definition of 'grievous and irremediable condition' and to seek clarification of the government's proposed non-legislative measures regarding access. With respect to the latter, the College believes it is essential that health care providers with conscientious objections to MAID be required to facilitate patient referrals to ensure and support patient access to MAID. . .

Congress of Union Retirees of Canada - Hamilton, Burlington and Oakville Chapter [Full Text]

Conscientious Objection to Participating in Medical Assistance in Dying

Bill C-14 is silent on the issue of conscientious objection by medical practitioners to provide and participate in medical assisted dying services. The Bill is also silent as to the role of publicly funded health care institutions will play in providing medical assistance dying services.

Bill C-14 and other appropriate Acts should be amended to ensure that medical practitioners who have objections to providing medical-assisted dying services be required by law to refer patients requesting medical-assisted dying to medical practitioners who are willing to provide that service.

Bill C-14 and other appropriate Acts should be amended to ensure that all publicly funded health care institutions provide medical assistance in dying services.

Recommendations

2. Preamble

That an additional paragraph be added to the Preamble to read:

Whereas the Government of Canada will work with the provinces and territories and their medical regulatory bodies to establish a clear process that respects a health care practitioner's freedom of conscience while at the same time respecting the needs of a patient who seeks medical assistance in dying. The objecting medical practitioner shall at a minimum provide an effective referral for the patient.

3. Preamble

That an additional paragraph be added to the Preamble to read:

Whereas the Government of Canada will work with the provinces and territories to ensure that all publicly funded health care institutions provide medical assistance in dying.

Cottle, Dr. Margaret M. [Full Text]

Proposed Amendments:

1) Any request for Physician Hastened Death (PHD) should be evaluated by a centralized, multi-disciplinary team of highly trained professionals before PHD is undertaken.

2) No health care professional or institution should be compelled to participate in any aspect of PHD. Criminal sanctions should be written into Bill C-14 that would apply to those coercing participation either directly or by imposing sanctions or withholding employment or education from those who refuse to participate in PHD.

One of the pillars of the VPS is an effective evaluation process before the PHD occurs. The first amendment above would work toward that goal. Palliative care is never practiced by physicians alone; a team is essential to proper care. Requests for hastened death are extremely complex and should be evaluated by a team of trained professionals as well. Their mandate would be to explore these requests and to identify any aspects of the request that would be amenable to treatments acceptable to the patient but not yet implemented, or that stem from a lack of proper social supports. This need not be onerous or complicated. PHD is a serious, irreversible procedure and it is important that it is not undertaken without proper oversight. A centralized evaluation team would have additional benefits. Patients could self-refer to such a service and this would not only provide direct access to PHD, but would avoid difficulties involved when health care professionals choose not to participate in PHD due to clinical judgment or conscientious objection. A centralized system could also provide a better opportunity to monitor and to study all aspects of PHD and to modify regulations and procedures if problems are identified. This central system could be available by teleconference for remote areas, or teams could travel to remote communities as needed.

There has been an almost fanatical emphasis on "access" to PHD for anyone who wants it, almost for any reason, and too little attention paid to the real harm that will result from patients' and families' legitimate fears and subsequent avoidance of care. . .

. . . An additional safeguard that could assuage some of these fears would be to require that PHD be carried out only in separate facilities that are regulated by the federal government and are not associated with the regular health care system. These separate spaces would not overly inconvenience anyone seeking PHD and could include the patient's home or mobile units, such as British Columbia's mobile mammography vans. In addition, both institutions and health care professionals must be allowed to opt out completely from any participation in PHD without fear of repercussions or sanctions of any kind. (See amendment 2 above.) This would provide "euthanasia-free zones" or safe spaces that are every bit as much a right for patients who want to be safe from possible non-consensual PHD as "access" is for those who wish to have PHD. It is interesting that there are many, many services for which patients have to travel some distance, such as radiotherapy, dialysis, specialized surgeries, and even some forms of medical imaging such as MRIs and there is no equivalent outrage at the thought of limiting access to those important services for patients. Access to even basic palliative care is not yet mandated, and it seems ludicrous to mandate access to PHD without first mandating and funding proper access to palliative care for all Canadians. In addition, patients should have the opportunity to choose to be treated by physicians and other health care professionals who have made principled, firm commitments to avoid all participation in PHD. This is the Hippocratic ethic that has informed medicine for over 2,400 years and reassures patients, instilling hope and generating trust. It is disingenuous to assert that an "effective referral" does not make a physician complicit in PHD when referrals for unacceptable practices, such as female genital mutilation, are considered to be complicit. Even in non-medical law referral is culpable - referring someone to a "hit man" when asked to suggest an assassin is considered being an accessory to murder. Also, Canada as a country does not "refer" for capital punishment since we will not extradite a criminal accused of a capital offense to a jurisdiction that has the death penalty without written assurance that the death penalty will not be applied. Physicians with individual patients who are being asked to refer to specific physicians who will carry out the PHD are obviously more complicit than either of those scenarios. It is also noteworthy that in those jurisdictions where PHD is legal there has been no need for coercion of either institutions or individuals to participate and access has not been impeded.

De Koninck, Angela [Full Text]

. . . Bill C-14 fails to protect the conscience rights of health care workers and health care institutions, hospices and long term care facilities whose mission, vision and values commit them to heal and care, to reject providing measures of death to patients entrusted to their care. The wording must be changed to protect the conscience rights of health care workers and those institutions who conscientiously object to both providing medical assistance in dying and referring their patients to those who will assist in dying. . .

Standing Committee on Justice and Human Rights House of Commons, Parliament of Canada (May, 2016)

Re: Bill C-14

Extracts of Briefs and Oral Submissions

Note:

Page 1 of 3

Go to Page 2 of 3

Alsmo, Lola [Full Text]

Armour-Godbolt, Shelagh [Full Text]

Arvay, Joseph

Oral Submission [Edited Audio]

Association for Reformed Political Action [Full Text]

Azevedo, James & Tracy [Full Text]

Barreau du Québec [Full Text]

Oral Submission [Edited Video]

Basnett, Richard and Wendy [Full Text]

Beddoe, Mark and Nancy [Full Text]

Bergen, Theresa [Full Text]

Berger, Dr. Philip et al [Full Text]

Birenbaum, Shelley [Full Text]

Boer, Theo

Oral submission [Edited video]

Bradshaw, Edith [Full Text]

British Columbia Humanist Association [Full Text]

Brooks, Jeffrey [Full Text]

Burrell, Althea; Santoro, Daniel [Full Text]

Canadian Association for Community Living

Oral Submission [Edited Video]

Canadian Conference of Catholic Bishops [Full Text]

Canadian Council of Christian Charities [Full Text]

Canadian Council of Imams

Oral Submission [Edited Video]

Canadian Federation of Catholic Physicians' Societies [Full Text]

Canadian Medical Association [Full Text]

Oral Submission [Edited Video]

Canadian Medical Protective Association [Full Text]

Oral submission [Edited video]

Canadian Nurses Association

Oral Submission [Edited Video]

Canadian Pharmacists Association

Oral submission [Edited video]

Canadian Society of Palliative Care Physicians [Full Text]

Oral submission [Edited video]

Castagna, Dr. Luigi A. [Full Text]

Catholic Civil Rights League [Full Text]

Centre for Israel and Jewish Affairs [Full Text]

Oral Submission [Edited Video]

Christian Legal Fellowship [Full Text]

Oral Submission [[Edited Video]

Christian Reformed Centre for Public Dialogue [Full Text]

Chun, Hye Jung [Full Text]

Cleary, Beatrice [Full Text]

Coalition for HealthCARE and Conscience [Full Text]

Oral Submission [Edited Video]

Cochien, Dr. Eileen [Full Text]

Coffey, Kyle [Full Text]

College of Family Physicians of Canada

Oral Submission [Edited Video]

College of Physicians and Surgeons of Ontario [Full Text]

Congress of Union Retirees of Canada - Hamilton, Burlington and Oakville Chapter [Full Text]

Cottle, Dr. Margaret M. [Full Text]

De Koninck, Angela [Full Text]

Standing Committee on Justice and Human Rights
House of Commons, Parliament of Canada (May, 2016)