Protection of Conscience Project
Protection of Conscience Project
Service, not Servitude

Service, not Servitude

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


Links to the full briefs are provided below. 

Bold face identifies groups or individuals who appeared as witnesses.

For statements specific to freedom of conscience and religion for healthcare providers:

  • click on (Brief Extract) to see statements extracted from a brief,
  • click on [Edited Video Transcript]  for transcripts of edited videos.
Parliament Hill

Page 2 of 3

Back to Page 1 of  3

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.

  1. Dembo, Dr. Justine
  2. Department of Health (Edited Video Transcript)
  3. Department of Justice (Edited Video Transcript)
  4. »De Silva, Melanie  (Brief Extract)
  5. »Desjardins, Susan
  6. De Veber, Barrie and Zeni, Paul (Brief Extract)
  7. De Verber Institute for Bioethics and Social Research (Brief Extract)
  8. DisAbled Women's Network of Canada
  9. »Donauer, Andrew  (Brief Extract)
  10. »Downar, James
  11. »Downie, Jocelyn (Edited Video Transcript)
  12. »Dubland, Ed
  13. Dumont, Onil and Gagnon, Jocelyne
  14. Dying With Dignity Canada
  15. Dying with Dignity Canada's Disability Advisory Council (Brief Extract)
  16. »Dying With Dignity Canada, Nova Scotia Chapter
  17. Echlin, Jean and Pritchard, Dr. Jane (Brief Extract)
  18. »End of Life Planning Canada
  19. »Euthanasia Prevention Coalition
  20. Evangelical Fellowship of Canada (Brief Extract) (Edited Video Transcript)
  21. Federation of Medical Regulatory Authorities of Canada (Brief Extract)
  22. Fenton, Dr. W. James (Brief Extract)
  23. »Ferrier, Catherine
  24. »Fetherston, Ann
  25. Field, Jane
  26. Findlay, John and Margaret McCarthy (Brief Extract)
  27. »Fine, Adrian
  28. Fletcher, Steven (Edited Video Transcript)
  29. Ford, Jill (Brief Extract)
  30. »Forsey, Helen
  31. Frazee, Catherine
  32. »Friesen, Gordon (Brief Extract)
  33. »Gagnon, Glen
  34. Gauthier, Stephanie (Brief Extract)
  35. »Gibson, Jennifer
  36. Goldfinger, Eva (Brief Extract)
  37. »Goligher, Dr. Ewan C. (Brief Extract)
  38. »Gugliotta, Donato (Brief Extract)
  39. Guichon, Juliet
  40. Guzik, Pauline (Brief Extract)
  41. »Hammond, Katherine
  42. Hansen, Nancy
  43. »Harding, Dr. Sheila (Brief Extract)
  44. »HealthCareCAN (Brief Extract)
  45. Hein, Rebecca (Brief Extract)
  46. Hein, Sarah (Brief Extract)
  47. Hein, Stephanie (Brief Extract)
  48. Heineman, Rachel (Brief Extract)
  49. »Hilts, Cecile (Brief+)
  50. »Hogan, Marcia (Brief Extract)
  51. Hudson, Felicity and Keith (Brief Extract)
  52. »Hughson, Sue (Brief Extract)
  53. Jarrett, Linda
  54. »Johnston, Dr. Will (Edited Video Transcript)
  55. »Justice Centre for Constitutional Freedoms (Brief Extract) (Edited Video Transcript)
  56. Justice for Children and Youth
  57. Keyes, Chris (Brief Extract)
  58. »Knight, Gary D.
  59. Koch, Tom
  60. Krawczynski, Joanna (Brief Extract)
  61. »Laferrier, Audrey Jane
  62. »Lagman, Minette (Brief Extract)
  63. »Lansing, Dr. Davina (Brief Extract)
  64. Lee, Peter (Brief Extract)
  65. Legree, Janice (Brief Extract)
  66. »Leiva, Dr. Rene (Brief Extract)
  67. »Lemmens,Trudo
  68. Lepp, Joanne and Richard (Brief Extract)
  69. Levy, Karen (Brief Extract)
  70. »Leworthy, James G.
  71. »LifeCanada (Brief Extract)
  72. Living With Dignity (Edited Video Transcript)
  73. »Longworth, Isaac (Brief Extract)
  74. MacDonald, Deanna
  75. Mahoney, James (Brief Extract)
Go to Page 3 of 3

Department of Health and Department of Justice
Oral Submission [Edited Video]

Mr. Ted Falk:  . . . Mr. Pentney, I'm going to start with you, because you were here for the presentations, and I think I want to follow up a little bit more on the whole issue of conscience rights protection.     

And if you could, I think it's an issue that's important to a lot of folks right across Canada, it's an important issue to this committee, and we want to see if we somehow we can address that. And I'd like your comments and feedback a little bit on what is possible, from a legal perspective to draft something like that into the bill, what would it look like? Where would it belong? How can we do it?

William F. Pentney, Deputy Minister of Justice and Deputy Attorney General of Canada:   . . . First, I would say, as the two ministers indicated, the government very much acknowledged, has acknowledged that protection of conscience rights is an important consideration in moving forward with this. And also the Supreme Court of Canada obviously acknowledged that there are among the various rights and interests to be balanced, the conscience rights of physicians and medical practitioners is an important consideration. As the two ministers indicated previously, nothing in the bill compels or in that sense coerces a medical practitioner to be involved in this. The government has announced, and Minister Philpott confirmed today, the intention to continue discussions with provinces and territories about a continuing ca- and Mr. Kennedy and others can speak to this if you wish - a discussion about ways in which access to care can be facilitated and information can be provided, and that will be one element of a discussion around the ways in which conscience rights can be protected.

But although the Supreme Court has acknowledged that health care is a concurrent jurisdiction, this is an exercise of the criminal law power by the federal Parliament that's under discussion. This is not a medical regulatory or regulatory of health professionals or health institutions bill. This is an exemption which is being created in the criminal law, and that's been the focus of the attention in response to the way the case was framed in Carter and the way that the case has been brought before Canadians, going back to the Rodriguez case.  So in all of that, the consideration was what the focus of the bill about. The way in which the bill is constructed, is designed not to require or compel any medical practitioner, doctor, or nurse practitioner to be involved in this, and as Minister Philpott indicated previously, the government's commitment is to continue those discussions with provinces and territories to try to - I think the expression is, to "find pathways to care."

So I hope that that responds to the question.

Mr. Ted Falk:  Well, it responds but it wasn't really the answer I was looking for. I was hoping to hear you say that, well, we should draft something into the legislation that would provide protection for health care individuals, that they're not coerced into doing it, and that there's a protection for them as well, because there's a fear among health care professionals that they're not going to have a choice. Not just at the physician level, but downwards from there as well, that individuals that are currently tremendous and wonderful individuals who are providing excellent health and palliative care are going to be forced to participate in a physician-assisted suicide procedure.

Mr. William F. Pentney:  Thank you for the question. I fully understand, and we have observed the debate as it has unfolded and continues to unfold in provinces and territories with medical regulators, with physicians, and others across the country.

The bill does not compel or require anyone to provide the assistance. It opens an exemption in the criminal law to protect those who fit within the, who are providing medical assistance to individuals who fit within the criteria as established in the bill from what would otherwise be criminal liability. That's the nature and scope of the bill and the intention of the government.

There are a variety of other regulatory, medical professionalism and other issues, associated with this. We know from discussions on our side and certainly from the Health Canada discussions with provinces and territories, we know that medical regulators, provinces, and territories are actively engaged in looking at their dimensions of this issue, and we've no doubt that examination will continue.

Mr. Ted Falk:  Okay, I'm going to keep on that. I don't want to let it go just yet, because I think we could be preemptive. While we've got the debate going, and while the discussion is open, I think we could be preemptive. Rather than leaving it to the territories and the provinces to come up with their own regulations and maybe create a problem for health care officials, why don't we address that issue right now, up front, with the legislation that we're looking at?

Mr. William F. Pentney:   I think in respect of the exercise of the criminal law power in defining the nature and scope of eligibility and safeguards, the law is clear. I think the government's commitment to complementary and additional measures and discussions is also clear. And I think from the perspective of the way in which the law is constructed, it is not, it is constructed explicitly not to compel or require anyone to provide assistance in dying. . .

Mr. Mark Warawa: Thank you, Chair.

On conscience protection, you've said that the bill does not compel or require. You've said that the Supreme Court said that we're to create a complex regulatory system. There has been a major focus, rightly so, on vulnerable Canadians, but on conscience protection is probably the number one issue that we hear from as parliamentarians, make sure that the conscience protect, are being protected. So it's silent.  The legislation is silent on it. It does not compel or require, but it also does not protect.

It is possible, then, as we amend the Criminal Code of Canada to permit this, that we could also make it a criminal offence to coerce, intimidate, or force a physician against their will to participate. Is that not correct?

Mr. William F. Pentney: I, I guess we would have to look at it. I'm not aware of the circumstances in which that is a concern. I guess we'd have to look at it. And I would say that in respect of the scope of federal jurisdiction under the criminal law, we would also be focusing on the extent to which provisions that are inserted would have practical legal effect, given the division of powers.

Mr. Mark Warawa: But the provincial regulators, you said, their examination will continue, but we're talking about exemptions to the Criminal Code of Canada . . .

Mr. William F. Pentney: Yeah.

Mr. Mark Warawa: . . . that permit this, under certain strict criteria.  You cannot, before, you and not even presently, it's legal to take your own life, but you cannot, a person walking down the street cannot assist somebody to kill themselves. That's illegal. We're creating this strict regime, but you should also, then, not force somebody by intimidation, coercion, or any way to participate into the death of that individual against that person's will. And so that could be included in the Criminal Code, is my understanding, and still be, otherwise  we would hand it over to the provincial colleges of physicians, and it could be , it would not be pan-Canadian. It could be a total different approach if we allow it to each province to protect the conscience rights.

But we do, I believe, that power, that  authority to put that within the Criminal Code that you cannot coerce, force anybody to participate in the death of another person, to assisted suicide, against their will.

Mr. William F. Pentney: We, if it's the committee's wish, in terms of the completion of the study, we can certainly look at that.

The Chair:  Thank you very much.  We appreciate that.

I think that conscience rights have been raised by a number of people. And I think that Mr. Falk's original question, was trying to ask you, if protection of conscience rights are important to the committee, what solution you propose to make it fall within the law in the best possible way. One way that was suggested by Ms. Khalid is making a criminal prohibition, and if there are others, we'd be delighted to hear before we move to our clause-by-clause deliberation. . .

De Silva, Melanie [Full Text]

I am writing you to express my concerns about the protection of the vulnerable as well as conscience rights for Canadian physicians who refuse to participate in controversial procedures like assisted suicide/euthanasia. . .

I am deeply concerned that the recommendations of the Commons-Senate Committee on Physician Assisted Death do not include adequate protection for physicians' conscience rights. I consider referral, even to a third party to be a type of participation. I am also troubled by the committee's recommendation that facilities should not be allowed to opt-out of providing physician assisted death in their facilities. . .

I believe that the Canadian Charter of Rights and Freedoms protects Canadian citizens against being forced by the state to act against their moral or religious convictions. There are undoubtedly other ways to ensure that the request of the patients who choose these procedures is respected. It is not necessary to make dedicated physicians put their careers on the line and open themselves to professional disciplinary action simply because they wish to follow their conscience or to force the closure of facilities that cannot provide physician assisted death. If these physicians are forced to leave the practice of medicine because of short-sighted policies, then patients like me will be unable to find the kind of doctor that I would like to have. I am also concerned that facilities which cannot morally provide physician assisted death will be forced to close should these recommendations be included in future legislation.

. . . I request that whatever legislation is developed respects and protects the vulnerable as well as the conscience rights of Canadian physicians, other health care providers and objecting facilities.

De Veber, Barrie and Zeni, Paul [Full Text]

. . . The act of assisting a suicide or euthanizing a person conflicts with the conscience and convictions of many healthcare workers including physicians, nurse practitioners, nurses and pharmacists. Bill C-144 focuses on the right of the person with intolerable suffering to have medically assisted death. The bill also needs to offer the health professionals and institutions the right to follow their conscience about ending the life of a person or being complicit in the act by referring for assisted dying or euthanasia. Canadians should have the option to choose health professionals or hospitals where they feel safe.

We suggest that the Bill C‑14 be amended as follows:. . .

241.31 (1) allow the physician or nurse practitioner to inform the patient that due to reasons of conscience that they will not participate in the act of medical aid in dying nor refer for it.

De Verber Institute for Bioethics and Social Research [Full Text]

Freedom of Conscience

There are still major concerns with Bill C 14: it fails to guarantee freedom of conscience to medical professionals and hospitals; it fails to give adequate protection to the large number of people who fear assisted dying and want to be protected from it. Last, it does nothing to remedy the desperate shortage of high-quality palliative care in this country, or to ensure the right of Canadians to palliative care.

Freedom of conscience has to include not just the right not to prescribe the lethal pill or give the lethal injection, but also the right not to refer a patient to a doctor who will do those things. The right to "medical-aid-in-dying" will be accessible to those who choose this method. Thus doctors and nurses should have their right to say: "Morally and ethically I cannot give you a lethal injection nor can I give you a lethal prescription to cause your death; nor be complicit by enacting a referral for the same." We must all be equally protected under the Canadian Charter of Rights and Freedoms.

To remedy this we propose the following changes:

Filing information   -  medical practitioner or nurse practitioner

Suggested change:

241.31 (1) Unless they are exempted under regulations made under subsection (3), a medical practitioner or nurse practitioner 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 or inform the individual that so requests that they are for reasons of conscience unable to comply with the request. Institutions will not be required to participate in MAID. The person requesting medical assistance in dying or their representative shall have the opportunity to be referred to the Ministry of Health of the Province or Territory.

Filing information   -  pharmacist

Suggested change:

(2) Unless they are exempted under regulations made under subsection (3), a pharmacist who dispenses a sub-stance in connection with the provision of medical assistance in dying must, in accordance with those regulations, provide the information required by those regulations to the recipient or inform the individual that so requests that they are for reasons of conscience unable to comply with the request. Institutions will not be required to participate in MAID. The person requesting medical assistance in dying or their representative shall have the opportunity to be referred to the Ministry of Health of the Province or Territory.

Donauer, Andrew [Full Text]

. . . I am very concerned about the protection of conscience rights for health care workers and healthcare facilities who cannot participate because of their moral or ethical convictions. Provincial legislation must have conscience protections for health care workers and facilities like hospitals, nursing homes, or hospices. This legislation must protect health care workers from being forced to perform or refer for these procedures or being discriminated against because of their conscientious objection. In the same way, facilities must not be required to provide euthanasia on their premises.

No foreign jurisdiction that allows euthanasia requires physicians to refer or facilities to provide it. For example, California's law says that participation in any activities related to assisted suicide is voluntary.

Objecting health care workers and facilities are not able to participate in euthanasia for reasons of conscience, ethics, organizational values, religious convictions or the Hippocratic Oath. Many are members of religious traditions that consider referral of any kind, or allowing assisted death on facility premises, as forms of participation in euthanasia.

The Canadian Charter of Rights and Freedoms protects Canadian citizens against being forced by the state to do things against their conscience or religious convictions. There are ways to respect patient decision making while also respecting the rights of caregivers and facilities not to be involved.

Objecting caregivers and facilities are motivated by their concern for the well being of the patient. I would like to go to one of these doctors or be cared for in one of these facilities. If they are forced out of Canadian healthcare, I will not have this option. This restricts my freedom of choice. . .

Downie, Jocelyn
Oral Submission [Edited Video]

Ms. Iqra Khalid:  We understand that at the federal level, and specifically Bill C-14, that it is an amendment to the Criminal Code, which is what we have jurisdiction over. Now the actual administration of MAID would be something that would be implemented by the provinces.

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?

Prof. Jocelyn Downie:   I think this is one of the spots where the federal government actually  deserves a lot of credit, because they recognize that this is one of those issues that is absolutely federal and provincial. How do we do this? And they've taken it as an opportunity to exercise co-operative federalism. It's a muscle we haven't been exercising a lot recently, but this is one of those moments, and they've taken it. Which is to say, they've said, "We're going to facilitate the development together with the provinces and territories". So they're putting their money, literally their money where their mouth is on the facilitation of development with the provinces and territories. A pan-Canadian care pathway.

And what that is about is protecting conscience of providers, ensuring access for patients, and protecting the privacy of willing providers. So they've recognized the need for conscience protection, but they're dealing with it in the way that makes a lot of sense in terms of our division of powers, in terms of our history with respect to where conscience is actually regulated, and with respect to this sense of co-operative federalism. Where we have shared jurisdiction, let's talk, let's do it together, let's figure it out,  not let's torture something into a federal act. That isn't the way to do it.

So I think that that is very promising for having some harmonization. I think that that group, I would hope,  would bring the federation of colleges of physicians and surgeons, and the nurses to the table and say, "We're all sitting down here, and we're not leaving until we figure this out together", because the colleges of physicians, they splintered within, you know,  a week of getting together on this, and that's really problematic. The nurses, not so. Fascinating.

So I think that it gets, let's say that this is the kind of thing that we solve together, and bring those different levels of regulation together to solve it, because everybody shares the same goals. I want to protect conscience, you want to protect patient access as well, I'm sure, and so, and we all want to protect privacy. So that's how, I think that's how we have to do it.

Dying with Dignity Canada's Disability Advisory Council [Full Text ]

. . . Include a statutory mandate requiring the government to work with the provinces and territories and their medical regulatory bodies to ensure that medical practitioners who oppose assisted dying are required to provide an effective referral for patients who request it.

  • Patients who are suffering intolerably are weak and vulnerable. The responsibility for finding a willing provider should not be left to them. Such a situation is tantamount to patient abandonment. No physician or nurse practitioner will be required to provide assistance in dying, but any person choosing to practice medicine has obligations to their patients. A medical practitioner's right to conscience must be balanced with the patient's right to access assistance in dying.

Echlin, Jean and Pritchard, Jane [Full Text]

Our concerns include the following:

  • Lack of accessibility and availability of hospice palliative care that would ensure excellence in quality end-of-life-care for all Canadians.
  • Lack of conscience rights for health care professionals fails to support our rights under the Canadian Charter of Rights and Freedoms.
  • The obligation for all health care institutions to provide medical-aid-in-dying, again ignores Charter Rights.


2. Ensure that conscience rights for health care professionals are guarded and protected.

4. The conscience issue could be resolved by removing MAID from our health care system and establishing a separate funded system implemented by an interprofessional team of doctors and nurse practitioners with special training, licensure and regulations who actually choose to provide MAID.

Evangelical Fellowship of Canada [Full Text]


Freedom of Conscience and Religion

4. Insert the following clauses:

"Whereas everyone has the freedom of conscience and religion under section 2 of the Canadian Charter of Rights and Freedoms; Whereas freedom of religion under the Charter accounts for the socially embedded nature of religious belief, and the deep linkages between this belief and its manifestation through communal institutions and traditions;[Loyola decision, para 60.]

 Whereas nothing in this Act affects the guarantee of freedom of conscience and religion and, in particular, the freedom of all persons and health care institutions to decline to participate directly or indirectly in the provision of medical assistance in dying if doing so is against such person's religious beliefs or conscience, or contrary to an institution's purposes. Whereas it is not against the public interest to hold and publicly express diverse views on medical assistance in dying;"

Freedom of Conscience and Religion

7. We support the creation of a self-referring central agency to facilitate conscience protection for health care providers; however, conscience protection for individuals and institutions in the legislation is crucial. We recommend the following be inserted as a standalone provision of C-14, in a new section before Related Amendments, or as an amendment to the Canada Health Act:

Freedom of Conscience

For greater certainty, no person or organization is required to participate directly or indirectly in the provision of medical assistance in dying, and 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 medical assistance in dying, of the freedom of conscience and religion guaranteed under the Charter of Rights and Freedoms. 8. Create a Criminal Code offence that prohibits the coercion of any person to apply for, seek or receive MAID, and prohibits coercion of health care providers and institutions to counsel in relation to, or to participate directly or indirectly in MAID.

Oral Submission [Edited Video]

Mr. Bruce Clemenger:  . . . as the government is proceeding with legislation, we are calling for protection of conscience and religious freedom, for the strictest possible safeguards in order to minimize harm and risk to vulnerable persons, to ensure that occurrences are rare, and to protect our society's commitment to the respect for life.    

On the matter of freedom of conscience and religion, the minister, when she appeared on Monday, said that this legislation does not compel medical professionals to participate in MAID. While that is technically correct, the minister also said that MAID is now considered "medically necessary" treatment. This places conscientious-objecting persons and institutions at risk of coercion.

Actually, in looking at it today, someone pointed out to me that proposed subsection 227(4) creates an exemption to section 14, which appears to, at least, delete the caveat of "no person is entitled to". That seems to create an entitlement "for".  

Our concern is that creating a right establishes a corresponding obligation. If you accept the premise that medical aid in dying is a right, you have an obligation to protect, we submit, the freedoms and rights of doctors and other medical professionals.

The College of Physicians and Surgeons of Ontario, as you've heard, has already decided that all doctors must make effective referrals regardless of conscientious objection. What will this government do to protect medical professionals from being coerced to participate in the killing of another? Even in times of war, conscientious objectors were exempted. Medical practitioners must have the right to refuse to participate in physician-hastened death, either directly or indirectly, for reasons of conscience or deeply held beliefs, including the right not to make a referral.    

Also, there has been no commitment made to exempt objecting institutions, protecting their staff and the communities that provide care, which we feel is equally important. We recommend that protections be included by express statements in the preamble of the bill. We also strongly recommend that conscience protection be included in the legislation as a stand-alone provision in Bill C-14, or as an amendment to the Canada Health Act, or by creating a Criminal Code offence that prohibits coercion of patients, medical care providers, and institutions in relation to medically assisted dying.    

Did you know that the Banking Act forbids a bank from coercing someone to obtain a product or service as a condition of receiving another service, or that it is an offence to coerce someone either to belong or to refuse to belong to an artistic group? We are talking about hastening the death of another in this context. How much more important is it to protect the conscience of medical professionals and institutions?

Mr. Mark Warawa:  . . . There was a comment, I believe it was Mr. Clemenger that made a comment of the importance of conscience protection. C-14, as we've heard from the minister, does not compel or require a physician, a medical practitioner, a nurse practitioner,  pharmacist, to be participating in assisted suicide against their will. So they're not compelled. Yet there is hints that it would be the college of physicians and surgeons within each province that would determine whether a person is required to have an effective referral or not, which some physicians would find objectionable. . .

So there is problems in the regime being proposed, but I want to focus on conscience protection. The Canadian Medical Association said that 70% of physicians in Canada do not want to participate or refer. The other 30%, or 23,000 physicians represented by 30%, would be adequate to provide access. So why do you believe there's a push that the 70% are not protected - not compelled or required, but they're not protected? Why is it so important to have conscience protection included in C-14, or should C-14 be amended at a future date? . . .

Mr. Bruce Clemenger:  We believe it needs to be amended now, before it is passed, to make clear protection of conscience of both doctors and medical personnel, and also institutions that provide extended care on which premises someone may request assisted death, should a law pass.    

Again, as I said in my comments, the minister did clarify that nothing in the bill says the doctor will be obliged to. However, you look at the "whereas" statements, and it's clear that they're creating a regime around Bill C-14 that will deem medically assisted death as medically necessary. And once you create that paradigm, then, you're in a sense, what I don't think Carter established a right to -  access. It was an exemption from the application of the Criminal Code. But if you begin interpreting and framing it as a right to access, then there's an obligation to provide.    

And I guess the clear example would be the College of Physicians and Surgeons of Ontario, which already require an effective referral under the current regime while the bill is being suspended for the next four months.

So we think it needs to be in place. We think there needs to be a statement in the "whereas" section, clarifying that no one will be compelled contrary to their conscience or beliefs to participate. We think there could be a parallel - you've heard this before - a parallel paragraph inserted in Bill 14 along the lines of the 3.1 in the Marriage Act to protect it. But also, there have been some proposals - and I know they've been submitted to this committee - that actually clarify and define Criminal Code provisions against coercion.

Mr. Murray Rankin:   Mr. Clemenger, I'm not sure if I understood this, but when you talked about the conscience protection, have you looked at the legality, the constitutionality, of our putting that in federal laws? We've been struggling to address your concern. Many, including the leading practitioner in the province of Quebec, says it's clearly and utterly provincial jurisdiction, and even if we wanted to, we couldn't do it in federal law. Have you got an opinion on that point?

Mr. Bruce Clemenger:  We've talked to a number of constitutional lawyers ourselves, and they believe it is possible.

Again, it would be coercion. As I gave a couple of simple examples, but again the idea would be that we'd make it a criminal offence to coerce someone to undertake a certain action that is deeply contrary to their moral or religious beliefs.

So it's a reaffirmation of the freedom of Secion 2(a).

Mr. Murray Rankin:  Is there anything in the bill requiring a doctor to provide this service?

Mr. Bruce Clemenger:  As I said, it's the context of the bill, it's what the justice minister and the health minister have said in terms of making it a medically essential service. We already have the example of the Ontario College of Physicians and Surgeons, which is requiring -

Mr. Murray Rankin:  Essential service in the bill, I don't see where that is.

Mr. Bruce Clemenger:  She said it in-

Mr. Murray Rankin: We're talking about the law. Is there anything in the bill you can point to?

Mr. Bruce Clemenger:  Well, I guess, the only, I was referring to the "whereas" and then the broader context of what the regime the government is planning to set up in the context of C-14. And that's what gives us a concern.    

But also, we have a live example of the College of Physicians and Surgeons of Ontario, which is right now requiring effective referral, which is deeply contrary to the religious conscience and beliefs of many doctors. So they need protection.

Federation of Medical Regulatory Authorities of Canada [Full Text]

FMRAC's members regulate medical acts on behalf of patients. Importantly, we believe we can speak on behalf of the medical and professional interest.

Bill C-14 outlines an approach to medical assistance in dying that our members will regulate. They already regulate professional duties touched on in Bill C-14, specifically duty of care, duty not to abandon, informed consent and others.

FMRAC particularly feels positioned to speak on behalf of patients to the question of access. It will be our members who will regulate the balance sought by Bill C-14 between a patient's right of access and a physician's freedom of conscience.

Fenton, Dr. W. James [Full Text]

I write to request that freedom of conscience for individuals and institutions be included in the legislation concerning assisted death.

This is consistent with the direction given by the Supreme Court. It is also consistent with our Canadian value of freedom of religion.

No one should be required to do something that violates their honestly and deeply held moral values. To insist that they do so would be very destructive to the individual and ultimately to our Canadian culture.

Findlay, John and Margaret McCarthy [Full Text]

6. Bill C-14 has NO conscience clause for freedom of thought and action: Our Prime Minister Justin Trudeau often says that "PEOPLE MUST HAVE A CHOICE" yet he promotes a Bill which dictates that there be NO CHOICE for doctors / nurses who do not want to kill patients - a perfectly reasonable position for health professionals historically involved in health "care" not killing. JUSTIN TRUDEAU often talks of "STRENGTH THROUGH DIVERSITY". If true, then WHY NOT "diversity of belief" for those who do not want to euthanize people. Angus Ried says 68% of Canadians are OPPOSED to forcing religious health facilities to participate in suicide. A conscience clause would foster safe 'kill-free zones' for patients wanting health "care" not killing, in their vulnerable years.

The total absence of a conscience clause is a serious infringement on the Charter rights of doctors, nurses and pharmacists who should in no way be coerced, pressured or discriminated against for taking a conscientious stand against any involvement in assisted suicide. There is no jurisdiction in the world that forces physicians and other medical practitioners to act against their conscience. We strongly urge the Federal Government to implement rigorous conscience protection for objecting physicians and health care workers.

Fletcher, Steven
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?

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. 

Ford, Jill [Full Text]

3. Add explicit wording for conscience protection of medical practitioners and institutions (doctors, nurse practitioners, nurses, pharmacists, and anyone else who might be asked to participate in this act.) E.g. "Nothing in this bill shall compel or require any medical practitioner (doctor, nurse practitioner, nurse, pharmacist, care aide etc.) to counsel a patient to participate in MAID. Medical practitioners shall not be required to administer MAID nor shall they be required to refer patients for MAID."

Doctors, other healthcare professionals and institutions should NOT be required to perform this procedure OR to refer patients for euthanasia, which ethically is THE SAME THING. Most doctors and healthcare professionals go to school to be healers, not killers, and part of the Hippocratic Oath that they take is to do no harm. The Supreme Court’s decision clearly stated in Carter, "[i]n our view, nothing in the declaration of invalidity which we propose to issue would compel physicians to provide assistance in dying."

Freedom of conscience is enshrined in our Charter of Rights and Freedoms and needs to be respected and explicitly protected.

Friesen, Gordon [Full Text]

. . . In this case, I believe that we have not sufficiently weighed the seriousness of authorizing individuals to pass beyond the universal prohibition against homicide. The simple interdiction, "Thou shalt not kill", is not an arbitrary religious artifact. It is, rather, a deep social and evolutionary response to our collective human experience. Accordingly, I believe it is obvious that --should we wish to tinker with this fundamental social rule--, we must expect serious and perfectly foreseeable consequences which we have an equally serious duty to minimize through a lucid structural plan of implementation. . .

. . . First, at the personal level, we must consider the negative effects which will, or may, be inflicted upon the psychological well-being of those individuals chosen to pass beyond the interdiction to kill; we must honestly evaluate the psychological consequences for those doctors and nurses who will be required to participate in making the fatal decisions that will lead to the planned decease of qualified patients, and particularly, the psychological effects upon those doctors, nurses, and auxiliaries, which must result from performing the homicidal acts contemplated. In other words: we do not have the right, I believe, from the comfort of our theoretical perspective –and regardless of what benefits we hope to achieve--, to pretend that these doctors, these nurses, these auxiliaries, can simply pass over thousands of years of ancestrally ingrained taboos, without being subjected to extreme psychological stress. . .

In the principal exceptions for "assistance in dying" (227.1) and "aiding practitioner" (227.2), as well as in all similar formulations throughout the Bill, let the words "No medical practitioner or nurse practitioner (commits culpable homicide)" (227.1) and "No person (is a party to culpable homicide)" (227.2) be replaced with the following:

"No specially licenced medical practitioner or nurse practitioner"


"No specially licenced person"

The intent, of course, is to recognize that the authorization to pass beyond the legal prohibition against homicide, is a serious and extraordinary exception which should be accorded only to specific individuals who have:

1. Expressed an informed and fully voluntary desire to act in this capacity, and

2. Passed whatever training and psychological screening shall be developed to ensure fully informed participation and, hopefully, to protect through elimination, the more vulnerable.

It is the current view that allowing entire professional bodies, all nurses, and all doctors ----that is approximately half a million persons--, to participate legally in homicidal actions, is to invite personal and social disaster, be it only as regards the resultant increase of Post Traumatic Stress Disorder. Moreover, to expect that future generations of doctors and nurses will be recruited only among those psychologically adapted to kill would probably involve the loss of most of those people traditionally inclined towards such service. As a practical matter, no doctor should ever be required to justify a desire not to kill. Not to kill is our normal social default. And even more emphatically: no nurse or auxiliary should ever be accidentally exposed to a request for assistance in terminating a life.

Again, this is not a question of "conscientious objection" based in some religious dogma, this is simply a reflection of normal behavior. To pass beyond normality should require a specific and personal exemption.

Gauthier, Stephanie [Full Text]


While there is nothing in the proposed legislation that explicitly compels health care providers to provide direct or indirect medically assisted death; it does allow for individual provinces to do so. In fact, "it would be up to individual provinces and territories to determine whether some medical institutions would be allowed to decline to provide medical assistance in dying. Nothing in Bill C-14 addresses this issue."[iii]

Why does the Federal government not consider it just as much of a priority to protect the moral conscience rights medical personnel, as it is protecting in protecting from all criminal liability medical practitioners who end up killing a patient in error? If medical staff, opposed to participation in medically assisted death, is mandated by their province to participate; there will be indirect negative repercussions for all patients. One such repercussion, is that some doctors will choose to leave their practices, in order to practice in a location where they can freely exercise their conscience. Some will undoubtedly stay put despite their objections. However, what benefit are there to Canadians to be served by medical professionals who are willing to violate their conscience, in what they believe to be a form of murder, simply in order to keep their jobs. Explicit protection for the freedom for all medical practitioners to refuse involvement in medically assisted death of patients is essential. 

Goldfinger, Eva [Full Text]

. . .  Those, including medical practitioners, who for religious or other reasons do not believe in or are opposed to Physician or Medical Assistance in Dying, should absolutely not avail themselves of this assistance or be required to provide it. Neither should they have any right to impose their views on me or our governmental institutions to deny my right to choose this assistance. . .

. . . An up-to-date list of medical practitioners willing to provide P/MAD should also be made readily available for urban and rural areas of Canada both by the Government and by all medical and legal practitioners.

Goligher, Dr. Ewan C. [ Full Text]

I am writing as a concerned physician who conscientiously objects to physician-assisted death to request that you include provisions in Bill C-14 to protect the conscience rights of Canadian citizens who work as healthcare professionals. Some have argued that patients' legal entitlement to accessing assisted death trumps the ethical concerns of some doctors and nurses. As an academic physician specializing in internal medicine and intensive care medicine I frequently care for patients at the end of life, and having carefully considered the relevant ethical and philosophical issues, I conclude that conscientious objection to assisted death merits robust legal protection. Given that some physician regulatory bodies have already indicated that effective referrals for assisted death will be mandatory, parliamentary intervention is required to uphold freedom of conscience as guaranteed in the Charter of Rights and Freedoms.

Conscientious objection is reasonable and merits respect given the following considerations.

1. Doctors should provide PAD only if it is both legal and ethical

The Supreme Court has ruled that PAD ought not to be legally prohibited, but it cannot define whether it is ethical for doctors to intentionally cause death. In their decision on the legality of PAD, the Supreme Court Justices stated that "nothing in this decision would compel physicians to provide assistance in dying." The Justices recognize that we need not automatically accept that PAD is ethical in the wake of this sweeping change in law.

2. Assisted death is ethical only if certain insupportable philosophical assumptions are accepted.

First, in contending that death is better than life for some patients, advocates for PAD assume some notion of what it is like to be dead. Yet the medical profession has no idea what it is like to be  dead. All beliefs about the afterlife (including the belief that there is no afterlife) are metaphysical (quasi-religious) beliefs which cannot be confirmed or refuted by scientific medical evidence. Medical care must be based on evidence and observation, and doctors should not be forced to practice medicine based on untestable quasi-religious assumptions.

Second, PAD advocates assume that respect for the patient's wishes, rather than respect for the patient as a whole, is the foundational value of medical ethics. Respect for the patient's wishes is unquestionably part of respecting the patient, but valuing these wishes above the patient herself would prevent doctors from ever refusing any patient request, even if it would clearly harm her health. The long-accepted firm foundation for medical ethics (including the duty to respect the patient's wishes) is the incalculable intrinsic objective worth of the patient. Intentionally causing death would require us to render valueless that which is of essential value: the patient.  In sum, given the tenuous assumptions underpinning the case for PAD, doctors need not accept  that PAD is ethical.

3. Providing an effective referral makes physicians complicit in another physician's actions

If a father were to request that his daughter undergo circumcision (i.e. genital mutilation), and I deliberately provided an effective referral to a willing physician, I would be complicit in an extremely grievous breach of medical ethics. This scenario is not ethically identical to PAD but it effectively illustrates the moral and ethical responsibility attached to an effective referral. This moral responsibility is recognized in law: doctors are legally liable for referring a patient for a procedure that is forbidden by law, even if requested by the patient (as was the case for PAD until now).  Knowingly referring a patient to a physician willing to cause the patient's death makes doctors complicit in that death. Therefore, reason and conscience prevent us from accepting the claim that PAD is ethical, we ought not to provide referrals for PAD.

4. The Charter right of Freedom of Conscience applies to healthcare professionals

Some argue that doctors cannot claim the Charter right of Freedom of Conscience because we willingly accept responsibilities and duties that limit our freedom when we commit to care for the patient. Accordingly, doctors are duty-bound to deliberately cause death upon the patient's voluntary request. This argument is successful only if PAD is ethical: the commitment to care does not extend to providing unethical care. Doctors are duty-bound to ensure that their patient's suffering is relieved by all effective means available. Whether this commitment entails a duty to cause death is a controversial moral question contingent upon certain philosophical assumptions.  Those who insist upon a duty to refer for PAD impose their personal ethical beliefs and assumptions upon others. The freedom of individuals to decide this issue and to act in accordance with one's deeply held moral beliefs is precisely what the Charter right of Freedom of Conscience protects.

5. Respect for conscientious objection promotes good medical care

Even given the assumption that PAD is ethical, robust respect for conscientious objection is still ultimately good for patients. Patients entrust themselves to their doctors, and doctors must be worthy of this trust. The doctor's moral integrity  - a commitment to acting in accordance with moral norms  - is foundational to his/her trustworthiness. Suppressing conscientious objection prizes moral conformity over moral integrity and systematically teaches physicians to suppress their basic moral intuitions in favour of constantly evolving social conventions. It also teaches the profession to be less sympathetic of and tolerant toward patients' diverse moral beliefs. Thus, robust respect for conscientious objection should be viewed as an important public good that upholds the quality of medical care. [This claim has been convincingly argued in one of the world's most influential medical journals, see White and Brody, JAMA 2011:305(17):1804-1805].

6. Respect for conscientious objection will not meaningfully obstruct access to physician assisted death?

Making referrals mandatory does not immediately guarantee access as PAD will not be routinely provided by any particular medical specialty and many in the medical community do not know physicians willing to accept such referrals. Conscientious objectors have proposed simple solutions allowing patients to refer themselves for PAD. As an objector, I plan to transfer my hospitalized patients to a different attending physician (an act qualitatively different than an effective referral) to avoid unduly obstructing access. Carefully considered policy frameworks for providing PAD can show robust respect for conscientious objection while enabling universal patient access.

These considerations support our claim that it is reasonable to object to providing either assisted death or an effective referral for the same. Given this reasonable position and the evidence that regulatory bodies are not universally prepared to respect conscientious objection in this matter, I urge you to enact protections in law for the substantial minority of Canadian doctors and nurses who, for the sake of our unswerving commitment to the value of our patients, cannot participate in deliberately taking a life.

Gugliotta, Dr. Donato [Full Text]

. . . Let me preface my comments by saying I am a General Medical Practitioner, having practiced anesthesia, in-patient hospital work and community family practice, including palliative care, since 1987. I have practiced in the same small Ontario town since in 1991.

As a health care practitioner, I have a conscientious objection to participation in Medical Aid in Dying (MAD) both to performing the act and also to referral to have the act performed. . .

"Consistent approach to medical assistance in dying across Canada". I agree. Although one could argue that C-14 needs to respect Provincial responsibilities for health care, more needs to be done to ensure uniformity. Provincial Ministries of health and more importantly Governing Professional Colleges have already shown a significant disparity of approaches to the implementation of MAD especially in regards to conscience protection. The interim policy of the College of Physicians and Surgeons of Ontario (CPSO) would mandate an effective referral from a conscientious objecting doctor on June 7. This goes against the Charter right of conscience and would not satisfy C-14's goal of uniform approach. C-14 needs to support conscience rights of objecting health care providers and those of faith-based health care facilities. . .

. . . "Respect the personal convictions of health care providers." Yes, but this statement is too weak! Consider changing "respect" to "protect" for a more appropriate balance. . .

Guzik, Pauline [Full Text]

3. Protection for Conscience Rights: Section 241.31 (1): This states that a medical or nurse practitioner must respond to a request for euthanasia by providing the information required to the recipient or to the Minister of Health. It must be explicitly stated that a practitioner who has conscientious objection against euthanasia not be discriminated against for refusing any involvement. This protection should NOT be left to the provinces. The Charter of Rights applies to all Canadians. The Bill should also explicitly state religious institutions be protected by the Charter of Rights, from engaging in this legal killing which is against their consciences and values.

Harding, Dr. Sheila [Full Text]

I am a physician, in my 35th year of practice. I am a hematologist, with considerable experience in providing care to patients who are dying. I have recently completed 12 years as an Associate Dean of Medical Education. . .

. . . The legislation must provide explicit protection of those health care professionals who choose not to participate directly or through so-called effective referral in MAID. In addition to being protected from the requirement to participate, they must be protected from negative repercussions of that choice throughout their professional lives, be it in the initial selection processes for admission to a health care profession, during education and training, and in employment and advancement throughout their careers. Every other jurisdiction with some form of MAID has found a way to implement it without any coercion of health care professionals. Surely we can do the same.

Similarly, the legislation must ensure that institutions and facilities providing medical care, including long-term care, have the freedom to recuse themselves from any participation in MAID. . .

HealthCareCAN [Full Text]

Conscientious Objection

. . . HealthCareCAN is supportive of the language in the Preamble of Bill C-14, stating that the Government of Canada has committed to, "respect the personal convictions of health care providers" and the assurance by the Federal Health Minister, the Honourable Jane Philpott that, "under this bill, no health care provider will be required to provide medical assistance in dying." As outlined in the federal Department of Justice's analysis of Bill C-14, "freedom of conscience and religion are protected from government interference by paragraph 2(a) of the Charter." Respect for conscientious objection will be relevant for the range of health providers that will be involved in medical assistance in dying.

Background materials provided by the Government state that, "[b]alancing the rights of medical providers and those of patients is generally a matter of provincial and territorial responsibility." HealthCareCAN supports the government's commitment, "to work with provinces and territories to support access to medical assistance in dying, while respecting the personal convictions of health care providers."

Bill C-14 is silent on the role of hospitals and healthcare organizations in assisted death. Many healthcare institutions across Canada operate under a specific mission, vision, set of values and/or ethical framework. Our members across the country are seeking clarity, either federally or provincially, of their ability to honour their missions and ethical frameworks while ensuring that patient care remains a top priority.

Access to Medically-Assisted Dying

HealthCareCAN commends the federal government for its commitment (as outlined in Bill C-14 background materials) to:

"…work with provinces and territories on the development of mechanisms to coordinate end-of-life care for patients who want access to medical assistance in dying. This system would help connect patients with a physician or nurse practitioner willing to provide medical assistance in dying, and support the personal convictions of health care providers who choose not to participate. It would also respect the privacy of those who are willing to provide this assistance. This system could also offer other end-of-life care options to both patients and providers."

. . . HealthCareCAN supports the establishment of centralized bodies and information systems to facilitate access and a patient-centred response, and to ensure high quality information and continuity of care, while also respecting the right of a healthcare provider to conscientiously object. We support centralized systems that can be directly accessed by patients, families, health care professionals and institutions.

Hein, Rebecca [Full Text]

. . . Bill C-14 must provide conscience protection to physicians, all medical professionals, and institutions who are opposed to assisted suicide and euthanasia and therefore refuse to participate in euthanasia or assisted suicide in any way. Freedom of conscience is a constitutional right to all Canadian and must therefore be fully protected. This includes protection for Canadian taxpayers from being forced to participate in assisted suicide against their will through their tax dollars. . . . 

Hein, Sarah [Full Text]

. . . It is concerning to me that Bill C-14 does not protect right of conscience for medical practitioners, so I am asking that you protect chartered rights by clearly stating that no doctor or institution will be forced to participate in assisted suicide or euthanasia against their own conscience. . .

Hein, Stephanie [Full Text]

7) Provide conscience protection for medical practitioners who believe it is morally wrong to kill another human being. . . 

Heineman, Rachel [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. I 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.

Hilts, Cecile [Full Text]

. . . I am writing you today to express my deep concerns with the legislation of Bill C-14 your government tabled on Thurs, Apr 14. It is imperative that clear conscience protections for health care workers and facilities be set in place. Many people, including myself, are opposed to this legislation. It is unconstitutional that people should be forced to participate against their deeply held convictions, either through referral or by doing the procedure. Further to this, I would then question if you would respect my decision and those who would choose palliative care to die a natural death.

If this bill is passed without amendments, Canada will be the only country in the world that does not provide legal protections for those who cannot participate in medical assistance in dying because of their moral convictions. There is no guarantee that the provinces will even pass legislation on this topic. Legislation must clearly spell out the protections provided by the Charter of Rights and Freedoms, ensuring caregivers and their organizations will be protected from coercion and discrimination.

Why should physicians and health care workers be forced to put their careers on the line and open themselves to professional disciplinary action simply because they wish to follow their conscience? Why should the closure of facilities be allowed because they cannot provide medical assistance in dying? We need dedicated and caring health professionals we can put our trust in.

Hogan, Marcia [Full Text]

. . . I respectfully request the following amendments:

b) create a referral process to ensure patients who have requested MAID do not have to find a willing provider on their own

c) ensure all publicly funded hospitals, hospices and long-term care facilities allow MAID on the premises.

. . .Should the dying patient have to search for Medical Assistance from a hospital bed because the legislation protects the medical professional but fails the patient? Should patients have to be moved to another institution to access MAID? Legislation is meant to protect these vulnerable people, to support their charter right to choice, and to provide humane, universal access to MAID throughout our country. Legislation must mandate a referral process. . .

Hudson, Felicity and Keith [Full Text]

. . . we would like to see:

  • that doctors and health professionals will be protected by the chartered rights, stating that they will not be forced to participate in any way.

Hughson, Sue [Full Text]

. . . Page 2: Lines 13-23 I am concerned about "non legislated" processes to address conscientious objection, advance consent, mature minors and mental illness. These aspects of MAID should not be left to the provinces and territories concerning conscientious objection. Individuals may opt out of providing MAID, but publicly funded institutions across the country must find a way to allow access to MAID in their facilities, if not – remote areas and small communities may not have access to this necessary medical service. This directive should come from a federal level. . .

 . . . There are many medical individuals who will never want to participate in MAID. While their desire to opt out must be honoured, it is important to recognize that these individuals will continue to place obstacles in the path of implementation of MAID, and this must not be allowed. . .The choice to not participate in MAID has never been in peril.

Johnston, Dr. Will [Full Text]
Oral Submission [Edited Video]

Dr. Will Johnston:  . . .We have heard four times, I think, from Minister Wilson-Raybould that nothing in this act compels anyone to become involved in assisted suicide and euthanasia. That, I think, suggests that the time may be right that those words to actually appear in this bill: "nothing in this act compels". That could appear in the preamble. That could appear in another section. But I think this would go a long way toward giving that central direction to conscience protection and the protection of professional judgment which is so desirable. . .

Mr. Mark Warawa: . . . Dr. Johnston, regarding  "nothing compels a physician to" in the preamble, preambles are not usually seen by the court as the guiding principles as it would be if they were actually in the bill. I think all of us have heard from witnesses, the number one issue that we're hearing over and over again is protect the conscience rights of physicians, nurses, pharmacists, medical practitioners. And we we need to get it right when we protect vulnerable Canadians and we need to protect the conscience rights. The Supreme Court in the Carter decision highlighted that.

So it is at this point in the legislation that's proposed in Bill C-14, it's, it's a silent on that. And it's been explained by the minister and the department that it does not say anyone is forced to participate in this, but it is silent on this. Would it help, instead of having it in a preamble,  actually having it in the bill that it would be a criminal offence to force, intimidate, coerce a physician or health care practitioner, nurse practitioner, pharmacist to make it a criminal offence to actually force somebody to participate against their will?

Now, what we have in the Carter decision is it was a, it was legal to commit suicide, but it was illegal to assist somebody. Carter has said you can, under certain criteria, you can assist somebody. But, the pendulum has swung to where the special committee said well you must refer, but I think Canadians are,  that I'm hearing, is they want the conscience protected.     So my question to you is if C-14 was amended to make it a criminal offence to coerce, intimidate, force a physician, do you think that would deal with the issue as far as conscience protection?

Dr. Will Johnston:  . . .  it is true that the strongest possible statement of conscience rights would be contained in a section of the Criminal Code which actually provided not just a ringing endorsement of the section 2 Charter right to conscience - which has never been properly supported in jurisprudence that I'm aware of - but that would also provide actual penalties for discrimination against a person who was contemplating entering a health care profession, was in a health care profession, was in any way involved in the care of a patient, and where that person was being coerced to either renounce their determination not to participate in assisted suicide and euthanasia or to in any other way disadvantage that person. And so I would, of course, heartily endorse such a thing. And I think that it would be appropriate as a balance against this amazing innovation in Canadian law, that a statement of exemption from criminal prosecution, which is as groundbreaking as the rewrite of section 241, be accompanied by an equally groundbreaking assertion of conscience rights.

And I would challenge the committee to take this up as a special issue, because this is not the last contentious thing that's going to come before us. Medical science and genetics will deliver so many more contentious questions to us in the future. And are the conscience rights of the relevant professionals or involved practitioners to be thrown under the bus every time a new access right is declared by a court or by Parliament? It is, the time has come to decouple conscience rights from access rights. And this could most effectively be begun by a ringing endorsement of conscience rights and the protection of them in the Criminal Code.

Justice Centre for Constitutional Freedoms [Full Text]

Recommendation: In order to comply with Carter, Bill C-14 should codify protections for the conscience rights of physicians, nurses, pharmacists, and other health care workers, as well as health care organizations and institutions, to refuse to participate in, and refuse to refer for MAID.

The Supreme Court of Canada decision in Carter in no way compels doctors or other healthcare workers to cooperate unwillingly in providing MAID. Carter was predicated on two key factual conditions: a willing patient and a willing doctor. The applicants in Carter neither sought nor received a Charter right to compel doctors and other healthcare practitioners to provide, or refer for, MAID.

Despite the foregoing, provincial Colleges of Physicians, as well as Nurses' Associations have instituted requirements that their respective members participate in MAID, in disregard of conscience rights, on pain of professional sanction and reprisal. Parliaments' opportunity is manifest: the offending professional requirements violate both the law in Carter and the Canadian Charter of Rights and Freedoms (the "Charter") protections under s. 2(a), and s. 7.4 Parliament can and should bring uniformity and clarity to the issue of conscience rights and MAID. Doctors, educators, medical students5 and the various Colleges would all benefit from the inclusion in Bill C-14 of the protections for conscience and religious rights, as Carter mandates.

In addition to legal reasons, there are also strong pragmatic reasons for protecting conscience rights. Tens of thousands of Canadians trust and rely daily on the premise that their doctors and nurses will act in an ethical and conscientious manner in the provision of service. Provincial Colleges of Physicians have ethical requirements for doctors, and expect physicians to be governed by a strong sense of moral and ethical responsibility in daily practice.6 Yet many of the same Colleges of Physicians permit no room for abstention on the basis of conscience or religion.7 Parliament must consider the somber repercussions of mandating the overriding of a physician's conscience in one aspect of service (such as MAID) and the necessary implications this could have in other circumstances where a physician's ethics and conscience is expected to govern.

It is also of importance for Parliament to recognize that, while there is a right to die under the requirements set forth in Carter, those who avail themselves of MAID will be gone, while those who are tasked with implementing it will remain. It is in the best interests of all Canadians that those practitioners who care for patients on a daily basis be able to perform their duties with a clear conscience, and the knowledge that they have been true to both themselves and their perception of their medical and ethical mandate.8

We consequently continue to recommend the inclusion in Bill C-14 of codified protections for conscience as anticipated in Carter, similar to the recognition and protection of conscience and religious rights in the Civil Marriage Act.9

Oral Submission  [Edited Video]

Mr. Jay Cameron:  . . . While I'm here tonight to talk about conscience rights specifically, I think it's important, given what I've heard here so far tonight, to mention that we believe that Bill C-14 gets a number of things right. . .

. . . It was in the context of noting the need for legislative reform to allow for medical assistance in dying that the court discussed and reiterated the conscience and religious rights of medical practitioners, stating that "nothing in the declaration of invalidity which we propose to issue would compel physicians to provide assistance in dying." That's at paragraph 132. Instead the court underlined that "The Charter rights of patients and physicians will need to be reconciled...". It was within the rubric of reconciling those rights that the court in Carter suggested statutory balancing, statutory address. Unfortunately, Bill C-14 fails to do that.

It's our continued recommendation that, in order to comply with Carter, Bill C-14 should codify the protections for the conscience rights of physicians, nurses, pharmacists, and other health care workers, as well as health care organizations and institutions, to refuse to participate in and refuse to refer for MAID.

The applicants in Carter neither sought nor received a charter right to compel doctors or health care workers to provide or refer for MAID. Despite that fact, the colleges of physicians as well as nurses' associations have instituted requirements that their respective members participate in MAID in disregard of members' conscience rights, on pain of professional sanction and reprisal in some cases. This is Parliament's opportunity to bring uniformity and clarity to the issue of conscience rights, and was made for that reason.

I have two pragmatic reasons in addition to the reasons that were set forward before the subcommittee. First of all, tens of thousands of Canadians trust and rely daily on medical practitioners to perform their duties in an ethical and conscientious manner in the provision of service. The provincial colleges of physicians have ethical requirements for doctors, and they expect physicians to be governed by a strong sense of moral and ethical responsibility.

We say that this committee has to consider the ramifications of overriding a physician's conscience in one aspect of service and then expecting that same physician to act in a conscientious or ethical manner in all of these other service requirements.

We also say it's important for Parliament to recognize that what Carter was talking about was a balancing of rights. There is a right to die recognized in Carter, but there are also rights for medical practitioners. It's important not to lose sight of the forest for the trees. The people who under this current Bill C-14 will be implementing MAID are the people who will wake up tomorrow morning, look themselves in the eye, continue on with their daily business, and know that they performed their duties in an ethical and conscientious manner. The people who have availed themselves of MAID will be gone, but the medical practitioners will still be here.

In my respectful submission - I don't mean to be trite - is it a proper balancing, looking at somebody's life on the verge of expiring, weighed against the decades of medical practitioners who still, on a day-to-day basis, must act in a conscientious and ethical manner? Is it not disproportionate to focus solely, or almost exclusively, on the rights of patients as opposed to those who are tasked with implementing MAID?

We say it is. We say a proper balancing would never oblige an individual to participate in MAID. There have been lots of discussions about whether or not it's legal or constitutional to include a protection in Bill C-14 for conscience rights. We say it is.

First of all, it is clear that right now Bill C-14 is dictating how MAID can be implemented and who can implement it. It is making regulations. It is making laws, or it purports to make laws, with respect to how MAID is to be carried out in the province. If the province is the sole entity that can make laws with respect to MAID, then this legislation would be offside. It's clear that this is not the case. We say it's apparent that conscience rights can be protected.

I would direct your attention to the circumstances in this example, one out of a number that we've thought of. Of course, the general rule with respect to culpable homicide is that there's no killing. It's sort of similar to the general rule that if you are a Canadian individual or organization, you have to pay taxes, because federal taxes are the purview of Parliament. Charities are controlled by the provinces, under section 92 of the Constitution Act, 1867, and yet charitable organizations have to make application to the federal government to both obtain charitable status and continue it. The reason that's the case is that otherwise they would not be allowed to do what they are allowed to do, which is accept tax-exempt donations.

In summation, I'll say that there are other analogous circumstances, such as in the Civil Marriage Act, where there are enumerated protections for conscience rights. We say it would be a mistake not to codify the same in this legislation.

Mr. Michael Cooper:  . . . . Mr. Cameron, you stated that it was your opinion that Parliament has flexibility constitutionally to enact conscience rights protections. And you cited some examples of where Parliament has enacted laws or regulations in other contexts, but perhaps you could elaborate a little bit on what powers Parliament has to enact conscience rights protections.

Mr.Jay Cameron:  We say this is an unusual situation. It's important not to miss that what's happening here is the carving out of an exemption for culpable homicide. And because Parliament is carving out that exemption, we say that Parliament can set the parameters with respect to who is instituting MAID, how it's being instituted.

And we say the 15-day waiting period, for example, would be constitutional, because that is within the boundary of that exemption that's being carved out. We say it doesn't trench on the provincial powers. We say it's necessarily incidental for the exemption that's being carved out.

And we know that the Supreme Court of Canada has given that mandate to Parliament. So the expectation, when I read Carter, is that the court expects Bill C-14 to balance those rights, and that is what is conspicuously missing. We say that there's nothing wrong with putting that protection in the Criminal Code power, under the Criminal Code power in section 91 of the 1867 Constitution Act.

Mr. Michael Cooper:  Right.  And also on the area of health care.  I agree with you,. Parliament would have ample room in terms of criminal law power to legislate in this area but also the Supreme Court at paragraph 53 in Carter specifically said that the area of health care is an area of concurrent jurisdiction, in which both the federal and provincial governments can legislate. So I think it even allows greater flexibility in which to legislate.

But certainly Parliament does have the ability to legislate, but I guess then the question becomes how far Parliament does Parliament have in the way of legislating. A similar question was posed to a witness earlier this evening, Professor Pothier. And she seemed to suggest that Parliament could enact conscience protection legislation along the lines, for example, of section 3.1 of the Civil Marriage Act, but she then seemed to say that that would be about all that Parliament could do in the way of conscience protection legislation.

So could you perhaps elaborate on how far Parliament can go to protect conscience rights?

Mr. Jay Cameron: Without a reference to the Supreme Court of Canada, it's impossible to say entirely 100% for sure. I can't say. I feel like, I would be delving into the realm of speculation to say.

Suffice to say, I think this bill can enact protections with respect to conscience rights. I think that under both the criminal power and the health power, that Parliament has that jurisdiction. I also think the Supreme Court of Canada has sort of tipped its hand that it intends to be deferential with respect to this legislation.

So that's my response.

Mr. Michael Cooper:   . . . and I would simply note that if Parliament did not act, it would be left to the provinces, and that would create a patchwork of inconsistencies. Indeed, it could leave a situation in which there would be no conscience protections anywhere, or at least in certain provinces. And that would make Canada unique compared to every other jurisdiction that has some form of physician-assisted dying. In every other jurisdiction there are some forms of conscience protections enacted. Canada would have a vacuum in that regard, and that obviously would be very concerning.

 I don't know if you have anything further to elaborate, Mr. Cameron.

Mr. Jay Cameron:  I would say this, that Justice Dickson in Edwards Books at paragraph 143  counselled the avoidance of inquiries into people's religious beliefs. And from our perspective, this doesn't have to be made to be about religious beliefs. There are long-standing, thousands of years old beliefs, with respect to the killing of your patient, that were originally enshrined in the Hippocratic Oath, the Nightingale Pledge, which is the nurses' version of the Hippocratic Oath. They've been in existence for centuries in various forms, and many, many physicians today - you heard the statistics, 70% - don't want any part of this. Right.  And you don't erase centuries of conscience protections that aringrained in the medical profession with the slash of a pen. They're there, and whether they're ethical or they're conscience or they're religious-based, or it's just, "We feel uncomfortable about it, awe don't want to participate", they have the right not to do that under the Charter. That's our position.

Mr. Chris Bittle:  Mr. Cameron, I'd like to turn to you. Is there, leaving aside medical assistance in dying, is there another medical procedure out there in which a physician has been coerced against their will or against their own conscience or beliefs that you're aware of?

Mr. Jay Cameron:  I think that the answer to your question lies in the history of the medical profession.

Mr. Chris Bittle:  Let's not go back to the history of the medical profession. Today in Canada, let's look at what can you answer based on today in Canada, what other medical procedures you're concerned about, where physicians are struggling with conscience?

Mr. Jay Cameron: I don't know of, I don't know of an analogous situation where the consequence of the act of a physician is the intended death of the patient, so there's nothing analogous that I can think of.

Physicians and nurses were trained and raised up to care for patients and provide health care. I share the concern that another panellist mentioned tonight that killing a patient isn't consistent with the idea of health care that-

Mr. Chris Bittle:  But again, Mr. Cameron, you're venturing off. In terms of the specific individual, there's no other case you that can point to, I guess is the simple answer, that there is a concern with conscience rights in the medical profession.

And my next question goes to the colleges of physicians across the country that are self-regulating in terms of ethics, as are the bars of the various provinces.

Why are you advocating for regulating the professions, which clearly isn't within the jurisdiction of the federal government?

Mr. Jay Cameron: I'm not advocating for regulating professions, but I would note that every single month there are lawyers who are disbarred for malpractice and for improprieties.

And it's clear from the study that was released today that, whether it's intentional or accidental, the medical profession makes a lot of mistakes and kills a lot of the patients that it's supposed to be helping.

Mr. Chris Bittle:  The medical profession, like the legal profession, gets to determine what is unethical.

Mr. Jay Cameron:  Only so far, sir. Parliament decides what's criminal, and there are limits to what the purview is of both the law societies as well as the medical professions. They have a limited mandate, whereas Parliament's mandate is much larger and broader.

Mr. Chris Bittle:  Okay. In terms of conscience rights for institutions, can you point me to any Supreme Court decision that guaranteed conscience rights to a publicly funded institution?

Mr. Jay Cameron: I can point you to the freedom of association under section 2(d) of the Charter, which is not just a right for individuals, but it's also a collective right. And collectives form around the notion of doing what they can do collectively, what they can do individually.  And in -

Mr. Chris Bittle:  The answer's no.

Mr. Jay Cameron:   In this case.... Well, I don't know.  If you want to tell me what my answer is....

Mr. Chris Bittle:  Well, I'm asking you, is there a Supreme Court case that points to that? You're dancing around the subject, but is there a Supreme Court case, yes or no?

Mr. Jay Cameron: I'd refer you to the case of the Mounted Police Association.

Mr. Chris Bittle:  I'm sorry.

Mr. Jay Cameron:  The Mounted Police Association with respect to the associational rights of the collective.

Mr. Chris Bittle: So it's a union case.   So you can't point to a publicly funded institution.  That being said, doesn't that lead to a slippery slope, that if we grant conscience rights to institutions in this one exemption, we're opening up the Charter to issues of employment or access to a publicly funded institution for members of that particular religious group only? And how can we limit those Charter rights to your very narrow request?

Mr. Jay Cameron:  With respect, sir, I think that you're blurring the issue. The issue is whether or not a group of individuals who have formed around a common creed can decide whether or not they're going to participate in MAID - that's the question. We say they can-that's the answer.

Keyes, Chris [Full Text ]

. . . For those doctors who object to such measures, there is little mention in the Bill of conscience protection. According to the Coalition of Health Care and Conscience, a coalition of over 5000 objecting physicians, this is a signal from the government that this issue will be left up to provincial jurisdictions. . . 

Krawczynski, Joanna [Full Text]

Summary of concerns with the text of Bill C-14

B. As tabled, Bill C-14 does not protect the rights of medical professionals and students.

B. Upholding the rights of medical students and professionals

B1. Medical students and professionals have the right to act according to conscience and to fundamental medical principles. However, there are already cases of students being discriminated against in undergraduate programs as well as medical schools because of their beliefs. We need the federal government to protect the rights of medical students and professionals to decline to participate in assisted suicide as well as not be required to provide effective referrals.


i. Rather than S 241.31(3) of Bill C-14, insert a clause that provides federal guarantee of the rights of medical students and professionals, explicitly ensuring that no one is required to provide assisted suicide and/or an effective referral for assisted suicide, even to the Ministry of Health.

Lagman, Minette [Full Text]

I urge you to please:

1. ensure protection for frontline workers, myself alike, who truly value life in its entirety. Should we encounter requests from someone to assist to die, may we be protected, in all aspects of our being (ie. legally, emotionally, and physically), to be able to simply say "no", that is: to respect the conscience rights of all institutions and all health care workers who choose not to participate in or refer patients for assisted suicide. To acknowledge the plurality of views on the subject by providing clear safeguards so that no institution or health care provider will suffer discrimination, penalties or loss of employment for refusing to participate in or refer patients for assisted suicide.

As saying "yes" would be contrary to my conscience, and ultimately to my professional and ethical duty as an NP. Without this specific safeguard, Bill C-14 will bring moral distress and anxiety, which may wrongfully force us to succumb to actions we are strongly opposed to. . .

Lansing, Dr. Davina [Full Text]

241.31 (1) states that, unless otherwise exempted, health care practitioners who received requests for medical assistance in dying "must [...] provide the information required by those regulations to the recipient designated in those regulations or [...] the Minister of Health." (241.31 states similarly for pharmacists.) Section (3) seems to suggest that this is exclusively for statistical and information purposes. However, it could potentially be interpreted as a duty to refer for objecting health care professionals. This section would benefit from a clear statement either confirming or refuting whether it is intended to create a duty to refer. . .

Lee, Peter [Full Text]

. . . Respect the conscience rights of all medical professionals involved in assisted suicide and euthanasia. This includes not forcing them to make "Effective Referrals" or any referrals. It is not reasonable to respect one's medical opinion and then force them to effectively refer to carry out the contrary opinion. For instance, if in one's medical opinion removing a kidney is grave mistake for treatment, he would not be forced to refer to a surgeon who would carry out that procedure. There should not be any penalties for exercising your medical expertise. . .

Legree, Janice [Full Text]

. . .I write today asking you to protect the vulnerable and to respect the conscience rights of health care workers, hospitals, and other care facilities. I ask the government to provide legislative protection for health care workers and facilities that object to euthanasia/assisted suicide because of their moral convictions and/or institutional mission and values. Those who oppose euthanasia/assisted suicide should never be forced to perform the procedure or arrange for it to take place (referral). No foreign jurisdiction in the world that has legalized euthanasia/assisted suicide has forced health care workers or facilities to act against their conscience.

The Government of Canada has stated that it wishes to have this legislation implemented consistently across the country. If that is the case, legislative protection of conscience rights at the federal level would provide such consistency. . .

Leiva, Dr. Rene [Full Text]

1) While the proposed law is explicit in protecting health care providers who engage in euthanasia and assisted suicide, there no similar clause for the right of refusal for clinicians or organizations despite that legislations elsewhere make this clear. This includes the right to refuse to become complicit in what we believe is doing harm by referring for physician hastened death.

Lepp, Joanne and Richard [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.

Levy, Karen [Full Text]

. . . medical practitioners who do not wish to provide Medical Aid in Dying should not be compelled to do so, but they should be required to refer a patient requesting it to a colleague who will. . .

LifeCanada [Full Text]

1. Conscience Protection

Bill C-14 has omitted to include any protections for objecting physicians. We see this as a serious infringement on the Charter rights of doctors, nurses and pharmacists who should in no way be coerced, pressured or discriminated against for taking a conscientious stand against any involvement in assisted suicide or euthanasia.

Where is the right to choose for those millions of Canadians who do not want to be served by physicians who have been involved in or accomplices in the deaths of their patients?

We strongly urge the Government to implement rigorous conscience protection for objecting physicians. There is no jurisdiction in the world that forces physicians and other medical practitioners to act against their conscience. This should not be left to the Provinces to decide.

Living with Dignity
 Oral Submission [Edited Video]

Mr. Ahmend Hussen:  Secondly, you also spoke about,on the next page of your submission, you spoke about there being no justification for imposing any duty to implement this political decision on Canadian doctors and institutions.

Do you feel that Canadian doctors would be forced to conduct medical assistance in dying?

Dr. Catherine Ferrier:  Well, in Quebec right now, doctors who are not willing to conduct it themselves are obliged to send the patient along a path that will ensure that it will be done. So that, to me, is similar to what Dr. Blackmer mentioned about Ontario, which requires referral directly to someone who will do it. Most people who object to euthanizing patients would also object to sending them to their death, not because of our own needs but because we think it is contrary to the needs of our patients.

Mr. Ahmend Hussen:   Mr. Racicot, have you any opinion on that?

Mr. Michel Racicot:  Well, you see, the doctors also have a right to freedom of conscience, and a doctor who feels that it should not do that for its own conviction and for the good of the patient should not be obliged to do it and should not be obliged, either, to refer to someone who will do it, as is the case in Quebec.     

It is very important, if we have to have this law apply equally and similarly across the country, that this committee recommend that the objection of conscience, both for individuals and institutions, be implemented. And I personally think that you have the jurisdiction, because it's, in theory, within your jurisdiction over criminal law.     

In Quebec at the moment, certain hospitals do not perform abortions, and they are not forced to perform abortions, but they are forced to perform medical aid in dying. This is why we need the institutions to be protected as well.

Longworth, Isaac [Full Text]

. . . While I do not agree with any form of mercy-killing or assisted suicide, I do ask that you would consider these preliminary restrictions on euthanasia before it sweeps across our country putting vulnerable patients at risk. . .

- 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.

Mahoney, James [Full Text]

Problem: Protection of 'Conscience Rights'

Bill C-14 offers no statutory protection for conscience rights of healthcare professionals, whether doctors, nurses or pharmacists, who object on principle to being involved in assisted suicide or to playing any role in the chain of causation that results in assisted suicide.

Proposed Amendment:

All members of the healthcare professions have the right to "opt out" of assisted suicide, and they have no obligation, legal or otherwise, to refer any patient seeking assisted suicide to other practitioners for that purpose. No healthcare professional should face professional, disciplinary or other sanctions for refusing to facilitate an assisted suicide.


Many doctors decline to make assisted suicide referrals because they would feel morally complicit in any ensuing suicide. They believe they are enabling suicide as much by referring patients as by assisting suicides directly.