LEGISinfo Policy Paper (2)

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1 LEGISinfo Policy Paper: Bill C-7 An Act to amend the Criminal Code (medical assistance in dying) (2021) Carlo Martinez Department of Political Science, University of Guelph POLS 3300 Governing Criminal Justice Dr. Meghan Wrathall October 6, 2023

1 Identifying Information Bill C-7: An Act to amend the Criminal Code (medical assistance in dying) 43 rd Parliament, 2 nd session Minister of Justice, Hon. David Lametti, Liberal February 24, 2020 March 17, 2021 Summary of Bill The introduction of Bill C-7 by the Minister of Justice in February 2020 adheres to the Superior Court of Québec's decision in Truchon v. Attorney General of Canada, where the court declared section 241.2(2)(d) of the criminal code contravenes with the plaintiff's rights to section 7 "life, liberty and security of the person" and section 15 "equality" under the Canadian Charter. Therefore, Bill C-7 appeals to expand the eligibility criterion of patients receiving MAID (medical assistance in dying). Notably abolishing section 241.2(2)(d), where an individual's natural death no longer mandates it to be "reasonably foreseeable." Additionally, Bill C-7 seeks to complete various modifications to the procedural safeguards required for MAID. For instance, eradicate the 10-day waiting duration between the request and the procedure for MAID for patients with foreseeable natural death while presenting a 90-day waiting duration for patients with no foreseeable death. Opposition and Support for the Bill

1 Throughout the discourse of the second reading of Bill C-7, most of the major political parties involved seemed to have established their avid support for amending the criminal code. Luc Thériault, a constituent of the Bloc Québécois party, was in complete endorsement of embracing the principle of Bill C-7. Thériault asserts that every member of the parliament means only the best to those impacted and suffering from the outcome of their debate and is optimistic that the opposition will advocate for a statute that has a sense of compassion for the welfare of patients (Thériault, 2020). Thériault and his party affiliates find that the value of autonomy is crucial regarding debates on MAID. Consequently, Thériault argues that the members can't contend to be empathetic if they are interfering with an "individual's autonomy and self-determination, and if [they] refuse to respect their wishes on something as personal as their own death" (Thériault, 2020). It's important to note that in the initial proposal of MAID into the parliamentary system under Bill C-14, the New Democratic Party (NDP) voted against MAID due to its restrictive elements (Garrison, 2020). However, Randall Garrison, a constituent of the NDP, expresses that "New Democrats will support the bill... in order to bring an end to unnecessary suffering and to meet the deadline imposed by the Quebec court in the Truchon decision" (Garrison, 2020). While the Liberal Party has the Bloc Québécois' and NDP's reliance on revising Bill C-7, the Conservatives, being the official opposition against the criminal code, reach from a perspective that excluding the "subjective" component of reasonably foreseeable death, the code becomes even more subjective and has the potential to position vulnerable patients at even more risk (Cooper, 2020). Cooper also ensured to highlight the Liberals' lack of assurance concerning this bill and how the Liberal Party emphasized in 2016 how critical the reasonably foreseeable criterion is in protecting vulnerable patients, where four years later, they are now proceeding against their original stance (Cooper, 2020).

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1 Interest Group and Individual Witness Participation During the parliamentary committee hearings, numerous medical professionals in the industry were able to come forward and express their opinions and experiences with MAID. Dr. Ramona Coelho, an Ontario Family Physician, voiced her concerns about the priority of suicide prevention. Working with vulnerable and older patients, Dr. Coelho discerns she won't be able to protect her patients from "transient suicidal ideation" if this bill is granted royal assent (Dr. Coelho, 2020). Hence, Dr. Coelho advises a "conscience amendment" to the criminal bill and pushes for good quality medical care rather than focusing on MAID as a solution to resolve harmful ideations from patients Coelho, 2020). In contrast, some spoke in favour of MAID and demonstrated gratitude for it. Ms. Helen Long, the Chief Executive Officer of Dying with Dignity Canada, was one of them and has been dedicated to improving the standard of dying in Canada. Ms. Long was satisfied with the positive reactions from Canadians who have gone through MAID procedures and the federal government's recent consultation in regard to the criminal code, which invariably aligns with the vast research their organization has completed in the past (Long, 2020). Lastly, Dr. Georges L'Espérance, the President of the Quebec Association for the Right to Die with Dignity, shared his absolute and unwavering support for the need for MAID, supported by his years of educational experience as a retired surgeon. While Dr. L'Espérance is impressed by the legislative measures that are being accomplished for this bill, he thoroughly dissected the criminal code and proposed some relevant adjustments. For instance, adding further safeguards for the opt-out alternative such as "manifestations through words, sounds or actions of refusal for the substance to be administered" (L'Espérance, 2020). However,

1 apart from his minute suggestions, He thanked Minister Lametti for listening to practitioners and patients in the evolution of the recent bill. Assessment and Analysis As someone who's had the privilege of taking a university-level course on the psychology of death and dying, I feel fortunate to engage in exchanges where I can express opinions that are on the basis of educational and pragmatic background rather than claiming harmful sentiments that are unsubstantiated, especially in regards to such an intricate concept that garners ethical debates and controversies all around. It's essential to state that MAID is a medical procedure that is highly sensitive and personal due to its involvement with one's contemplation of life and mortality. Accordingly, I highly acknowledge that any legislation that concerns an individual's autonomy and end-of-life discretion, such as Bill C-7, should cater to protecting the patients who are heavily affected by its current regulation. However, if that is through the amendment of Bill C-7 and augmenting the criterion to include natural deaths that are not reasonably foreseeable, then I would completely advocate for this bill. The most common criticism against legalizing medical assistance in dying to a broader demographic whose deaths are not reasonably foreseeable in the near future is that it allows for too much permissiveness to accessibility to MAID. Sequentially, people tend to equate that to placing vulnerable Canadians (i.e., individuals with disabilities, psychological issues, and chronic illnesses) at a more heightened chance of premature death. However, that's not the case. MAID is not as convenient or unrestricted as anyone might think. Bill C-7 mandates MAID to go through a comprehensive and rigorous process, where patients must satisfy several strict criteria

1 to be eligible for the procedure (Dying with Dignity Canada). For instance, section 241.2(3.1) (h)) of Bill C-7 demands that "patients must be informed of the means available to relieve their suffering... and agree that the person has given serious consideration to those means." There needs to be a shift from favouring misconceptions on MAID because it easily aligns more with our ethical and moral compass and our comfort level. However, MAID is an essential resource that allows terminally ill patients who are in distress from bearing pain and exhaust all further restorative options (Vargo, 2022). Most patients with fatal illnesses prefer MAID with the purpose of desiring a peaceful process of dying. The pleasures of life tend to dissipate when the symptoms and trauma from their illnesses persist and get worse, so for some, that can be isolating and agonizing. Also, patients can't regulate what symptoms they can and can't feel. Therefore, with the benefit of MAID, patients maintain bodily autonomy and are able to oversee at least one aspect of their circumstances, and that's their end-of-life journey. Lastly, another main apprehension that opposers have with the current criminal code is the amended section 241.2(3)(g), "The 10-day waiting period that is currently required between the signing of a request for MAID and the day that MAID is provided is eliminated." Alex Schadenberg, the Executive Director of Euthanasia Prevention Coalition, claims that by overlooking this waiting period, "a person could request MAID on a "bad day" and die the same day," while emphasizing that "studies prove that the "will to live" fluctuates (). However, as Dr. L'Espérance referred to the waiting period as a "period of reflection" during the committee meeting, he finds it "insulting" to his patients' intelligence and agony to doubt that they might need that time to think about their decisions further (as if they might regret it) and extend their suffering (2020). Patients who have considered MAID are not arrogant about the outcome it produces. Navigating through this process is not an easy feat that anyone takes

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1 lightly. We can't perceive people's decision to receive MAID as a "selfish act" that is a "call for desperation." Patients ultimately just want to alleviate their suffering and use this moment to be around their loved ones, cherishing each other's presence before it's too late for those moments. As a closing remark, I believe in the vast capabilities of MAID in further advancing our perception of how humans should deal with death and dying, protecting individual's end-of-life rights, and helping with people's suffering. and As Dr. Green states, "a physician's duty is not to solely save and keep a patient alive, but the primary objective is to help them" (CTV, 2022). Works Cited Bill C-7: An Act to Amend the Criminal Code (Medical Assistance in Dying). (2020). 2nd Reading Feb. 24, 2020, 43rd Parliament, 2nd session. Retrieved from the Parliament of Canada website: https://www.parl.ca/LegisInfo/en/bill/43-2/C-7?view=details#bill- profile-tabs Myths and facts – medical assistance in dying (maid) in Canada . Dying With Dignity Canada. (2023, August 29). https://www.dyingwithdignity.ca/advocacy/myths-and-facts/ Schadenberg, A. (n.d.). Analysis of Bill C-7: An act to amend the Criminal Code (medical ... https://www.ourcommons.ca/Content/Committee/432/JUST/Brief/BR10971560/br- external/EuthanasiaPreventionCoalition-e.pdf

1 Vargo, A. (2022, May 28). Death with dignity in Canada: No longer limited to only the terminally-ill . Voices in Bioethics. https://journals.library.columbia.edu/index.php/bioethics/article/view/9473#:~:text=If%20a %20terminally%20ill%20individual,can%20mercifully%20respect%20bodily%20integrity W5 extended: Dr. Stefanie Green on end-of-life care in Canada . YouTube. (2022, April 9). https://youtu.be/5y-FkzsRhXY?si=7HlsFSZTj1F3YZI9