What Health Industry Clients Need to Know in Relation to Bill C-14 on Medical Assistance in Dying

April 14, 2016 | Lisa Spiegel, Kathryn M. Frelick

Bill C-14, An Act to amend the Criminal Code of Canada and to make related amendments to other Acts (medical assistance in dying) (“Bill C-14”), was released today by the Parliament of Canada.

Bill C-14 follows the landmark February 6, 2015 Supreme Court of Canada decision in Carter v. Canada (Attorney General) declaring the Criminal Code of Canada provisions prohibiting a health professional’s assistance in dying to be void where medical-assisted dying was being sought by competent, consenting adults with grievous and irremediable medical conditions. The Supreme Court asked the federal government to enact, by February 6, 2016, a new law recognizing the right of consenting individuals to seek medical assistance in dying. This deadline was later extended to June 6, 2016.

Miller Thomson’s earlier communiques on this issue can be found here:

What Health Industry Clients Need to Know about Bill-C14

The preamble to Bill C-14 sets out the Canadian Parliament’s recognition of the autonomy of persons who have grievous and irremediable medical conditions that cause them enduring and intolerable suffering and who wish to seek medical assistance in dying. It also recognizes that robust safeguards preventing errors and abuse to medical assistance in dying must be in place. Bill C-14 also notes that vulnerable persons must be protected from being induced, in moments of weakness, to end their lives. Finally, the preamble acknowledges that while it is desirable to have a consistent approach to medical assistance in dying across Canada, it is the provinces that have jurisdiction in relation to the delivery of health care services, the regulation of health care professionals, as well as insurance contracts, coroners and medical examiners.

Bill C-14 defines medical assistance in dying as follows:

  • the administering by a medical practitioner or nurse practitioner of a substance to a person, at their request, that causes their death; or
  • the prescribing or providing by a medical practitioner or nurse practitioner of a substance to a person, at their request, so that they may self-administer the substance and in doing so cause their own death.

To receive medical assistance in dying, Bill C-14 requires a person to meet all of the following criteria:

  • be eligible for publically funded health services in Canada;
  • be at least 18 years of age and capable of making decisions with respect to their health;
  • have a grievous and irremediable medical condition, meaning:
    • a serious and incurable illness, disease or disability;
    • an advanced state of irreversible decline in capability;
    • enduring physical or psychological suffering, caused by the medical condition, that is intolerable to them and that cannot be relieved under conditions that they consider acceptable; and
    • natural death has become reasonably foreseeable, taking in account all of their medical circumstances, without a prognosis necessarily having been made as to the specific length of time that they have remaining;
  • have voluntarily requested medical assistance in dying, which request was not made as a result of external pressure; and
  • provide informed consent to receive medical assistance in dying.

Bill C-14 sets out multiple prescribed safeguards before medical or nurse practitioners can provide medical assistance in dying. These safeguards require, among other things, that these health care providers be of the opinion that the person meets the above criteria, that the voluntary request be documented in a specific manner and within a specific timeframe, that the informed consent includes the right to withdraw the requested assistance (including immediately before providing the medical assistance) and that another independent medical or nurse practitioner has provided a written opinion confirming the person meets all of the above criteria. Details in relation to these safeguards will be set out in subsequent communications.

Bill C-14 requires that medical and nurse practitioners who receive requests for, and pharmacists who dispense substances in connection with, the provision of medical assistance in dying provide information for the purposes of monitoring the medical assistance.

Bill C-14 does not compel health facilities, physicians or other health practitioners to provide end-of-life assistance. Rather, Bill C-14 creates exemptions from various criminal offences, including aiding suicide, in order to permit medical and nurse practitioners to provide medical assistance in dying and permit pharmacists and other persons to assist in the process. Failures to comply with the legislation could result in criminal findings punishable by imprisonment. Expectations and obligations around end-of-life assistance will also be set by provincial regulatory bodies.

The Bill contemplates a review of the above provisions in five years.

What Facilities Need to Do

Bill C-14 has clear and numerous implications for our health industry clients. We expect that provincial health authorities and regulators will provide further requirements and guidance following this Bill. We strongly suggest that effective policies, procedures and guidelines be implemented to ensure compliance and protection from liability.

Miller Thomson’s National Health Industry Group has extensive experience advising clients on end-of-life issues, has assisted health care facilities in developing and updating end-of-life policies, procedures and tools and has provided education to Boards, organizational leadership and health care providers.  We would be pleased to provide our assistance in positioning your organization to appropriately address physician-assisted dying and related issues.

View Bill C-14.


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