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Bill C-7

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First Session, Forty-third Parliament,
68-69 Elizabeth II, 2019-2020
HOUSE OF COMMONS OF CANADA
BILL C-7
An Act to amend the Criminal Code (medical assistance in dying)
FIRST READING, February 24, 2020
MINISTER OF JUSTICE
90913


SUMMARY

This enactment amends the Criminal Code to, among other things,
(a)repeal the provision that requires a person’s natural death be reasonably foreseeable in order for them to be eligible for medical assistance in dying;
(b)specify that persons whose sole underlying medical condition is a mental illness are not eligible for medical assistance in dying;
(c)create two sets of safeguards that must be respected before medical assistance in dying may be provided to a person, the application of which depends on whether the person’s natural death is reasonably foreseeable;
(d)permit medical assistance in dying to be provided to a person who has been found eligible to receive it, whose natural death is reasonably foreseeable and who has lost the capacity to consent before medical assistance in dying is provided, on the basis of a prior agreement they entered into with the medical practitioner or nurse practitioner; and
(e)permit medical assistance in dying to be provided to a person who has lost the capacity to consent to it as a result of the self-administration of a substance that was provided to them under the provisions governing medical assistance in dying in order to cause their own death.
Available on the House of Commons website at the following address:
www.ourcommons.ca


1st Session, 43rd Parliament,
68-69 Elizabeth II, 2019-2020
HOUSE OF COMMONS OF CANADA
BILL C-7
An Act to amend the Criminal Code (medical assistance in dying)

Preamble
Whereas the Government of Canada has committed to responding to the Superior Court of Québec decision in Truchon v. Attorney General of Canada;

Whereas Parliament considers that it is appropriate to no longer limit eligibility for medical assistance in dying to persons whose natural death is reasonably foreseeable and to provide additional safeguards for those persons whose natural death is not reasonably foreseeable;
Whereas under the Canadian Charter of Rights and Freedoms every individual has the right to life, liberty and security of the person without being deprived of them except in accordance with the principles of fundamental justice and has the right to the equal protection and equal benefit of the law without discrimination;
Whereas Canada is a State Party to the United Nations Convention on the Rights of Persons with Disabilities and recognizes its obligations under it, including in respect of the right to life;
Whereas Parliament affirms the inherent and equal value of every person’s life and the importance of taking a human rights-based approach to disability inclusion;
Whereas Parliament recognizes the need to balance several interests and societal values, including the autonomy of persons who are eligible to receive medical assistance in dying, the protection of vulnerable persons from being induced to end their lives and the important public health issue that suicide represents;
Whereas it is desirable to have a consistent approach to medical assistance in dying across Canada, while recognizing the provinces’ jurisdiction over various matters related to medical assistance in dying, including the delivery of health care services and the regulation of health care professionals, as well as insurance contracts and coroners and medical examiners;
Whereas the Government of Canada is committed to having a federal monitoring regime that provides a reliable national dataset and that promotes accountability under the law governing medical assistance in dying and improve the transparency of its implementation;
Whereas, while recognizing the inherent risks and complexity of permitting medical assistance in dying for persons who are unable to provide consent at the time of the procedure, Parliament considers it appropriate to permit dying persons who have been found eligible to receive medical assistance in dying and are awaiting its provision to obtain medical assistance in dying even if they lose the capacity to provide final consent, except if they demonstrate signs of resistance to or refusal of the procedure;
Whereas further consultation and deliberation are required to determine whether it is appropriate and, if so, how to provide medical assistance in dying to persons whose sole underlying medical condition is a mental illness in light of the inherent risks and complexity of the provision of medical assistance in dying in those circumstances;
And whereas the law provides that a committee of Parliament will begin a review of the legislative provisions relating to medical assistance in dying and the state of palliative care in Canada in June 2020, which review may include issues of advance requests and requests where mental illness is the sole underlying medical condition;
Now, therefore, Her Majesty, by and with the advice and consent of the Senate and House of Commons of Canada, enacts as follows:
R.‍S.‍, c. 46

Criminal Code

2016, c. 3, s. 3
1(1)Subsection 241.‍2(2) of the Criminal Code is amended by adding “and” at the end of paragraph (b), by striking out “and” at the end of paragraph (c) and by repealing paragraph (d).
(2)Section 241.‍2 of the Act is amended by adding the following after subsection (2):
Exclusion
(2.‍1)For the purposes of paragraph (2)‍(a), a mental illness is not considered to be an illness, disease or disability.
2016, c. 3, s. 3
(3)The portion of subsection 241.‍2(3) of the Act before paragraph (a) is replaced by the following:
Safeguards — natural death foreseeable
(3)Subject to subsection (3.‍2), before a medical practitioner or nurse practitioner provides medical assistance in dying to a person whose natural death is reasonably foreseeable, taking into account all of their medical circumstances, without a prognosis necessarily having been made as to the specific length of time that they have remaining, the medical practitioner or nurse practitioner must
2016, c. 3, s. 3
(4)Paragraph 241.‍2(3)‍(c) of the Act is replaced by the following:
(c)be satisfied that the request was signed and dated by the person — or by another person under subsection (4) — before an independent witness who then also signed and dated the request;
2016, c. 3, s. 3
(5)Paragraph 241.‍2(3)‍(g) of the Act is replaced by the following:
(g)if the person has difficulty communicating, take all necessary measures to provide a reliable means by which the person may understand the information that is provided to them and communicate their decision; and
2016, c. 3, s. 3
(6)Subsection 241.‍2(3) of the Act is amended by striking out “and” at the end of paragraph (h) and by repealing paragraph (i).
(7)Section 241.‍2 of the Act is amended by adding the following after subsection (3):
Safeguards — natural death not foreseeable
(3.‍1)Before a medical practitioner or nurse practitioner provides medical assistance in dying to a person whose natural death is not reasonably foreseeable, taking into account all of their medical circumstances, the medical practitioner or nurse practitioner must
(a)be of the opinion that the person meets all of the criteria set out in subsection (1);
(b)ensure that the person’s request for medical assistance in dying was
(i)made in writing and signed and dated by the person or by another person under subsection (4), and
(ii)signed and dated after the person was informed by a medical practitioner or nurse practitioner that the person has a grievous and irremediable medical condition;
(c)be satisfied that the request was signed and dated by the person — or by another person under subsection (4) — before an independent witness who then also signed and dated the request;
(d)ensure that the person has been informed that the person may, at any time and in any manner, withdraw their request;
(e)ensure that a written opinion confirming that the person meets all of the criteria set out in subsection (1) has been provided by
(i)if they do not have expertise in the condition that is causing the person’s suffering, a medical practitioner or nurse practitioner with that expertise, or
(ii)if they have that expertise, another medical practitioner or nurse practitioner;
(f)be satisfied that they and the medical practitioner or nurse practitioner referred to in paragraph (e) are independent;
(g)ensure that the person has been informed of the means available to relieve their suffering, including, where appropriate, counselling services, mental health and disability support services, community services and palliative care and has been offered consultations with relevant professionals who provide those services or that care;
(h)ensure that they and the medical practitioner or nurse practitioner referred to in paragraph (e) have discussed with the person the reasonable and available means to relieve the person’s suffering and they and the medical practitioner or nurse practitioner referred to in paragraph (e) agree with the person that the person has given serious consideration to those means;
(i)ensure that there are at least 90 clear days between the day on which the first assessment under this subsection of whether the person meets the criteria set out in subsection (1) begins and the day on which medical assistance in dying is provided to them or — if the assessments have been completed and they and the medical practitioner or nurse practitioner referred to in paragraph (e) are both of the opinion that the loss of the person’s capacity to provide consent to receive medical assistance in dying is imminent — any shorter period that the first medical practitioner or nurse practitioner considers appropriate in the circumstances;
(j)if the person has difficulty communicating, take all necessary measures to provide a reliable means by which the person may understand the information that is provided to them and communicate their decision; and
(k)immediately before providing the medical assistance in dying, give the person an opportunity to withdraw their request and ensure that the person gives express consent to receive medical assistance in dying.
Final consent — waiver
(3.‍2)For the purposes of subsection (3), the medical practitioner or nurse practitioner may administer a substance to a person to cause their death without meeting the requirement set out in paragraph (3)‍(h) if
(a)before the person loses the capacity to consent to receiving medical assistance in dying,
(i)they met all of the criteria set out in subsection (1) and all other safeguards set out in subsection (3) were met,
(ii)they entered into an arrangement in writing with the medical practitioner or nurse practitioner that the medical practitioner or nurse practitioner would administer a substance to cause their death on a specified day,
(iii)they were informed by the medical practitioner or nurse practitioner of the risk of losing the capacity to consent to receiving medical assistance in dying prior to the day specified in the arrangement, and
(iv)in the written arrangement, they consented to the administration by the medical practitioner or nurse practitioner of a substance to cause their death on or before the day specified in the arrangement if they lost their capacity to consent to receiving medical assistance in dying prior to that day;
(b)the person has lost the capacity to consent to receiving medical assistance in dying;
(c)the person does not demonstrate, by words, sounds or gestures, refusal to have the substance administered or resistance to its administration; and
(d)the substance is administered to the person in accordance with the terms of the arrangement.
For greater certainty
(3.‍3)For greater certainty, involuntary words, sounds or gestures made in response to contact do not constitute a demonstration of refusal or resistance for the purposes of paragraph (3.‍2)‍(c).
Advance consent invalidated
(3.‍4)Once a person demonstrates, by words, sounds or gestures, in accordance with subsection (3.‍2), refusal to have the substance administered or resistance to its administration, medical assistance in dying can no longer be provided to them on the basis of the consent given by them under subparagraph (3.‍2)‍(a)‍(iv).
Advance consent — self-administration
(3.‍5)In the case of a person who loses the capacity to consent to receiving medical assistance in dying after self-administering a substance, provided to them under this section, so as to cause their own death, a medical practitioner or nurse practitioner may administer a substance to cause the death of that person if
(a)before the person loses the capacity to consent to receiving medical assistance in dying, they and the medical practitioner or nurse practitioner entered into an arrangement in writing providing that the medical practitioner or nurse practitioner would
(i)be present at the time the person self-administered the first substance, and
(ii)administer a second substance to cause the person’s death if, after self-administering the first substance, the person lost the capacity to consent to receiving medical assistance in dying and did not die within a specified period;
(b)the person self-administers the first substance, does not die within the period specified in the arrangement and loses the capacity to consent to receiving medical assistance in dying; and
(c)the second substance is administered to the person in accordance with the terms of the arrangement.
(8)Section 241.‍2 of the Act is amended by adding the following after subsection (5):
Exception
(5.‍1)Despite paragraphs (5)‍(c) and (d), a person who provides health care services or personal care as their primary occupation and who is paid to provide that care to the person requesting medical assistance in dying is permitted to act as an independent witness, except for
(a)the medical practitioner or nurse practitioner who will provide medical assistance in dying to the person; and
(b)the medical practitioner or nurse practitioner who provided an opinion under paragraph (3)‍(e) or (3.‍1)‍(e), as the case may be, in respect of the person.
2016, c. 3, s. 3
(9)The portion of subsection 241.‍2(6) of the Act before paragraph (a) is replaced by the following:
Independence — medical practitioners and nurse practitioners
(6)The medical practitioner or nurse practitioner providing medical assistance in dying and the medical practitioner or nurse practitioner who provides the opinion referred to in paragraph (3)‍(e) or (3.‍1)‍(e) are independent if they
(10)Paragraph 241.‍2(6)‍(b) of the English version of the Act is amended by replacing “or” with “and” at the end of that paragraph.
2019, c. 25, s. 80
2The portion of section 241.‍3 of the Act before paragraph (a) is replaced by the following:
Failure to comply with safeguards
241.‍3A medical practitioner or nurse practitioner who, in providing medical assistance in dying, knowingly fails to comply, subject to subsection 241.‍2(3.‍2), with all of the requirements set out in paragraphs 241.‍2(3)‍(b) to (h) or paragraphs 241.‍2(3.‍1)‍(b) to (k), as the case may be, and with subsection 241.‍2(8) is guilty of
2016, c. 3, s. 4
3(1)Subsections 241.‍31(1) and (2) of the Act are replaced by the following:
Filing information — practitioners
241.‍31(1)Unless they are exempted under regulations made under subsection (3), a medical practitioner or nurse practitioner who carries out an assessment of whether a person meets the criteria set out in subsection 241.‍2(1) or who receives a written request for medical assistance in dying must, in accordance with those regulations, provide the information required by those regulations to the recipient designated in those regulations.
Filing information — responsible for preliminary assessments
(1.‍1)Unless they are exempted under regulations made under subsection (3), any person who has the responsibility to carry out preliminary assessments of whether a person meets the criteria set out in subsection 241.‍2(1) must, in accordance with those regulations, provide the information required by those regulations to the recipient designated in those regulations.
Filing information — pharmacist and pharmacy technicians
(2)Unless they are exempted under regulations made under subsection (3), a pharmacist who dispenses a substance in connection with the provision of medical assistance in dying, or the person permitted to act as a pharmacy technician under the laws of a province who dispenses a substance to aid a medical practitioner or nurse practitioner in providing a person with medical assistance in dying, must, in accordance with those regulations, provide the information required by those regulations to the recipient designated in those regulations.
2016, c. 3, s. 4
(2)Subparagraph 241.‍31(3)‍(a)‍(i) of the Act is replaced by the following:
(i)the information to be provided, at various stages, by medical practitioners, nurse practitioners, persons referred to in subsection (1.‍1) who have the responsibility to carry out preliminary assessments, pharmacists and pharmacy technicians, or by a class of any of them, including the elements considered in the course of the assessments — preliminary or otherwise — of whether a person meets the criteria set out in subsection 241.‍2(1),
(3)Paragraph 241.‍31(3)‍(d) of the Act is replaced by the following:
(d)exempting, on any terms that may be specified, a class of persons from the requirements set out in subsections (1) to (2).
2016, c. 3, s. 4
(4)The portion of subsection 241.‍31(4) of the Act before paragraph (a) is replaced by the following:
Offence and punishment
(4)A medical practitioner or nurse practitioner who knowingly fails to comply with subsection (1), a person having the responsibility to carry out preliminary assessments who knowingly fails to comply with subsection (1.‍1) or a pharmacist or pharmacy technician who knowingly fails to comply with subsection (2),

Transitional Provision

Request made prior to assent
4A medical practitioner or nurse practitioner who provides medical assistance in dying to a person who, before the day on which this Act receives royal assent, had signed and dated a written request for medical assistance in dying must provide it in accordance with section 241.‍2 of the Criminal Code as it read immediately before that day, other than paragraph 241.‍2(3)‍(g), and with subsections 241.‍2(3.‍2) to (3.‍5) of that Act, as enacted by this Act.
Published under authority of the Speaker of the House of Commons



explanatory notes

Criminal Code
Clause 1: (1)Relevant portion of subsection 241.‍2(2):
(2)A person has a grievous and irremediable medical condition only if they meet all of the following criteria:
.‍.‍. 
(d)their natural death has become reasonably foreseeable, taking into account all of their medical circumstances, without a prognosis necessarily having been made as to the specific length of time that they have remaining.
(2)New.
(3) to (6)Relevant portion of subsection 241.‍2(3):
(3)Before a medical practitioner or nurse practitioner provides a person with medical assistance in dying, the medical practitioner or nurse practitioner must
.‍.‍.
(c)be satisfied that the request was signed and dated by the person — or by another person under subsection (4) — before two independent witnesses who then also signed and dated the request;
.‍.‍.
(g)ensure that there are at least 10 clear days between the day on which the request was signed by or on behalf of the person and the day on which the medical assistance in dying is provided or — if they and the other medical practitioner or nurse practitioner referred to in paragraph (e) are both of the opinion that the person’s death, or the loss of their capacity to provide informed consent, is imminent — any shorter period that the first medical practitioner or nurse practitioner considers appropriate in the circumstances;
.‍.‍.
(i)if the person has difficulty communicating, take all necessary measures to provide a reliable means by which the person may understand the information that is provided to them and communicate their decision.
(7)New.
(8)New.
(9)Relevant portion of subsection 241.‍2(6):
(6)The medical practitioner or nurse practitioner providing medical assistance in dying and the medical practitioner or nurse practitioner who provides the opinion referred to in paragraph (3)‍(e) are independent if they
Clause 2:Relevant portion of section 241.‍3:
241.‍3A medical practitioner or nurse practitioner who, in providing medical assistance in dying, knowingly fails to comply with all of the requirements set out in paragraphs 241.‍2(3)‍(b) to (i) and subsection 241.‍2(8) is guilty of
Clause 3: (1)Existing text of subsections 241.‍31(1) and (2):
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 designated in those regulations.
(2)Unless they are exempted under regulations made under subsection (3), a pharmacist who dispenses a substance 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 designated in those regulations.
(2) and (3)Relevant portion of subsection 241.‍31(3):
(3)The Minister of Health must make regulations that he or she considers necessary
(a)respecting the provision and collection, for the purpose of monitoring medical assistance in dying, of information relating to requests for, and the provision of, medical assistance in dying, including
(i)the information to be provided, at various stages, by medical practitioners or nurse practitioners and by pharmacists, or by a class of any of them,
.‍.‍.
(d)exempting, on any terms that may be specified, a class of persons from the requirement set out in subsection (1) or (2).
(4)Relevant portion of subsection 241.‍31(4):
(4)A medical practitioner or nurse practitioner who knowingly fails to comply with subsection (1), or a pharmacist who knowingly fails to comply with subsection (2),

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