Bill C-7, An Act to amend the Criminal Code (medical assistance in dying)

UPDATE: On February 17 the Senate passed Bill C-7 and sent a message to the House of Commons with the amendments it adopted, as summarized below.

Senate amendments expand MAID

As our regular readers will know, Bill C-7 proposes to significantly expand euthanasia. By euthanasia we mean the purposeful act of causing someone’s death. In Canada, euthanasia is known as “medical assistance in dying,” or MAID.

For a full summary of how we got here, you can see Horizons, How Legislative Developments Impact Your Ministry: A Case Study of MAID and Charity Bylaws in CCCC Bulletin 2021:1 (February).

Right now, the Bill is being debated in the Senate. This week, a number of amendments were proposed, some of which expand MAID even more than the original Bill contemplated. Below is a summary of the amendments, whether they passed, and the record of votes for and against.

In brief, the Senate has

• rejected conscience protection
• rejected a default of patient-initiated conversations about MAID
• rejected a two-witnesses requirement for MAID requests
• rejected an amendment to make it possible for involuntary words, sounds or gestures to be understood as demonstrating refusal or resistance to MAID, requiring a final opportunity to withdraw MAID request
• adopted extending MAID to people without diagnoses
• adopted waiving final consent requirements in some circumstances
• adopted extending MAID where mental illness is the sole underlying medical condition (in effect 18 months after Royal Assent)
• adopted collecting information about patients’ race
• adopted requiring a comprehensive review committee be formed.

The Bill has not yet been passed by the Senate. Debate on Bill C-7 is ongoing and will resume Tuesday, February 16 so there may yet be more changes. When the Senate is done proposing changes, the revised Bill will be sent back to the House of Commons. An exchange will follow to determine whether the amendments will be accepted, or whether further changes will be made. Both the House of Commons and Senate have to pass the Bill in identical form before it can become law.

In its costing note, the Office of the Parliamentary Budget Officer (PBO) points out that under the current MAID regime, the net reduction in health care costs is $86.9 million. The PBO estimates that the net reduction from Bill C-7 will be $62 million. It notes the challenge in estimating the financial impact for a number of reasons:

• Only Quebec records the expected time remaining before natural death would occur
• It does not account for private, out-of-pocket costs for (i.e.) palliative care at home
• it does not take into account the impact of COVID-19, including
  • the likelihood of increased cancer deaths as a result (relying on UK study showing 70-89% reduction in urgent referrals for early cancer diagnosis)
  • the use of Stats Can projected deaths in 2021 that were calculated prior to the pandemic
  • the COVID-19 deaths of patients with underlying medical conditions who may have requested MAID

The PBO estimates that MAID will represent 2.2% of all deaths in 2021. In 2019, MAID represented 2.0% of all deaths. For comparison, Stats Can reports that in 2019 Alzheimer’s disease accounted for 2.2% of deaths, and Influenza and Pneumonia accounted for 2.4% of deaths across Canada.

Thankfully, the report clearly notes that it should “in no way be interpreted as suggesting that MAID be used to reduce health care costs.”

If your ministry cares for the elderly or those living with mental illness, supports the disability community or provides hospice/end of life care, these developments have the potential to significantly impact your organization and mission.

What can or should we do in the face of such proposals?

Since the Senate will almost certainly pass a version of Bill C7 that will be different than what the House of Commons passed, it may still be worthwhile to reach our to your MP to express your concern.

This type of development should exhort us to fervent prayer!

It shows that now, more than ever, our communities need to hear messages of hope and meaning in suffering. And it should encourage Christian ministries to persevere in the significant and important work of affirming the God-given value of all life.

Conscience protection – Rejected

• Would make it an offence to compel another person to provide or facilitate the provision of MAID
• A person would still be required to provide information about MAID to a patient who requested that information
• Record of votes: Yeas 12, Nays 63, Abstentions 3

Patient-initiated conversations – Rejected

• Would require that conversations about MAID between a medical practitioner and patient be patient-initiated
• Record of votes: Yeas 18, Nays 66, Abstentions 1

 Two independent witnesses requirement – Rejected

• Would restore a requirement that two independent witnesses – rather than one – sign and date a request for MAID
• If a person’s death is reasonably foreseeable, would restore a mandatory 10-day waiting period between when the request is signed and the day of death/MAID
• Record of votes: Yeas 23, Nays 52, Abstentions 2

Involuntary words, sounds or gestures can require final opportunity to withdraw request – Rejected

• Would delete language in the bill that says involuntary words, sounds or gestures made in response to the administration of the [lethal] substance do not constitute a demonstration of refusal or resistance that would require a medical or nurse practitioner to give the patient one final opportunity to withdraw their request for MAID
• Record of votes: Yeas 15, Nays 61, Abstentions 1s

MAID requests prior to diagnosis; waive requirement for final consent – Adopted

• Allows a person to request MAID prior to being diagnosed with a grievous and irremediable medical condition
• Under certain conditions, waives the requirement for a person whose death is not reasonably foreseeable to give final consent immediately before being euthanized
• Record of votes: Yeas 47, Nays 28, Abstentions 8

MAID for reasons solely of mental illness – Adopted

• Removes language in the bill that prohibits MAID for reasons solely of mental illness, if other requirements are met
• Takes effect 18 months after bill receives Royal Assent
• Record of votes: Yeas 57, Nays 21, Abstentions 6

Collect information about race of patients – Adopted

• Requires federal health minister to make regulations for the collection of information about the race of a person who requests or receives MAID, if that person consents
• Requires minister to make regulations to permit that information be used to identify race-based inequities and how race intersects with other forms of systemic inequality in MAID
• Record of votes: voice vote

Committee for comprehensive review – Adopted

• Requires a committee to be formed within 30 days of the bill receiving Royal Assent to undertake a comprehensive review of the MAID provisions in the Criminal Code
• Committee will be senators, MPs and must submit its report within 180 days
• Record of votes: voice vote