Standing Committee on Justice and Human Rights, Briefs & Oral Submissions: 151-239

Malcho, Xuanyun [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. . .

Maloney, Barbara [Full Text]

4. No one should be compelled to participate in any way with AS/E ("MAID") against their
conscience. This means they should not have to make any referral, directly or indirectly, and
should not be disqualified from entering the health care professions because of their
conscientious objection to "MAID." Criminal law falls within federal jurisdiction and so Bill-14
needs provisions to make it a criminal offence to compel/coerce/intimidate anyone to participate in AS/E ("MAID") or to discriminate against them in any way (for example, not admitting them to medical school) for their conscientious beliefs. Parliament does not have to legalize "MAID" - it could invoke the Charter’s "notwithstanding clause" but the Government is
choosing not to. If Parliament refused to legalize AS/E, physicians’ and other health care
workers’ consciences would not be in danger of being violated. So in choosing to legalize it,
Parliament now has a duty to use the criminal law to protect the consciences and rights of those who are morally opposed to being involved in killing; otherwise provincial Colleges (like the College of Physicians and Surgeons of Ontario) will require "effective referrals" and punish
conscientious objectors.

Maloney, Patricia [Full Text]

4) Doctor's conscience rights must be upheld, along with their right to not be forced to refer for assisted suicide

5) Doctors who refuse to assist in a suicide or refer a patient for assisted suicide, must be explicitly protected under the law, the same way those involved in the assisted suicide are protected.

Marcelino, Sheilah [Full Text]

I write to ask you to amend Bill C-14 in the following ways:

3. Respect the conscience rights of all institutions, pharmacists and health care workers who choose not to participate in or refer patients for assisted suicide. 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.

Mark, Dr. Kevin J. [Full Text]

1. Currently the act does not provide federal legal protection for those practitioners and other healthcare workers who are compelled by their consciences to withhold their own participation in "medical assistance in dying". Those who are unable or unwilling to participate in "medical assistance in dying" must be legally protected, so that they are not legally compelled into acting against their consciences; this must include legal protection even from having to refer a patient to someone else who will potentially carry out a lethal injection or prescription for suicide, as a medical practitioner only refers patients for those procedures that he/she feels are worthy of a referral since a referral caries with it a legal and moral responsibility and obligation that has some degree of recommendation of exploring further the potentiality of the particular procedure in question. For those practitioners who conscientiously object to participation in any form of "medical assistance in dying", even a referral is unconscionable and would violate not only a doctor's autonomy, but also certain rights and freedoms in the Charter of Rights and Freedoms.

McGee, Helen [Full Text]

. . . Third, legislated protection for individuals and institutions that cannot participate directly or indirectly in assisted death needs to be a priority at the federal level to standardize conscience protection across Canada. I recommend that this legislation make it clear that conscientious objectors may continue to provide health care unrelated to the person’s request for assisted death until other care can be arranged. However, it must also be clear that a conscientious objector is not required to make a referral to another care provider to facilitate death. . .

McGill, Linda [Full Text]

Bill C-14 does not provide federal legal protection for the medical practitioner, nurse practitioner, or other health care worker who by their conscience do not want to participate in any way in providing "medical assistance in dying". Those who are unable or unwilling to participate in "medical assistance in dying" MUST be legally protected, so that they are not legally forced to act against their conscience.

Many of these people disagree with the deliberate taking of a human life, and view euthanasia and assisted suicide as murder. This legal protection MUST also include legal protection from having to refer a patient to someone who would provide euthanasia and assisted suicide, as this too would be viewed as assisting, and again would be against their conscience to indirectly be involved in this fatal act.

For those practitioners and health care workers who conscientiously object to participation in any form of "medical assistance in dying", even a referral is unconscionable and would violate not only their autonomy, but also their rights and freedoms in the Charter of Rights and Freedoms. Health care institutions, hospices and long term care facilities whose mission, vision and values commit them to heal and care MUST be able to be legally protected from providing euthanasia and assisted suicide as well.

Meglarejo, Marie [Full Text]

. . . Finally another very important issue: the law should respect freedom of conscience which is enshrined in our Charter of Rights, and protects it. The new law, if it passes, should not only respect but protect those who will refuse to participate in assisted suicide and euthanasia and who will not refer their patients to someone else who is willing to kill them either. To respect and protect those persons and institutions who because of their conscience or religious beliefs refuse to participate in assisted suicide and euthanasia, is very important, they should never suffer for that fact and should not be punished in anyway whatsoever.

If ever Canada were to impose on people a unique way of thinking and acting without respect for the beliefs and consciences of its citizens, Canada would stop being a democracy to become a tyranny.

I am sure that those of you who are members of the Standing Committee on Justice and Human Rights do not intend to destroy Canada as a democracy and I trust in your good judgement to find solutions that do not punish institutions, doctors, nurses, pharmacists, etc. who will refuse to collaborate with assisted suicide and euthanasia.

National Association of Pharmacy Regulatory Authorities [Full Text]

. . . With the public interest in mind, it is important that a federal framework be in place to ensure that healthcare professionals such as pharmacists and pharmacy technicians are enable to participate in the process, while not being prevented from exercising "conscientious objection" to participate in line with their code of ethics. . .

Nicholas, Graydon [Full Text]

Freedom of Conscience

The Charter states that:

2. Everyone has the following fundamental freedoms:

(a) freedom of conscience and religion;

Bill C-14 does not respect the freedom of conscience of those who will be forced to participate in the medically assisted in dying. Section 241.3 makes it an offence if medical and nurse practitioners and pharmacists do not cooperate following their consciences.

Freedom of Conscience is protected by the UN which Canada has endorsed. Parliament, composed of the House of Commons and the Senate, is being asked to ignore this human right. It is imperative that the Freedom of Conscience be protected for all medical personnel and health institutions that do not want to participate. The Coalition of HealthCare and Conscience has stated: No other foreign jurisdiction in the world that has legalized euthanasia/assisted suicide forces health care workers, hospitals, nursing homes or hospices to act against their conscience or mission and values.

What has become of our country that has fought for freedom of other people in the world from oppression, genocide, violence and danger to lives? Surely, Canada must continue to respect human rights of its own citizens. Canada will lack moral authority when it tries to criticize repressive governments from other nations of the world who trample on the human rights of their citizens.

Oral Submission [Edited Audio]

. . . I filed my submission, and the three areas I addressed are the sanctity of life, palliative care, and freedom of conscience. . .

The other area I will concentrate on is freedom of conscience. Of course we know that's a fundamental right within our Charter.

But that fundamental right that appears in our Charter, because I remember 1980's, when this was being debated. Mind you, I was on the other side; I was advocating for indigenous and aboriginal rights back then throughout our country, making sure that the document would in fact protect our people.

But in looking at the Declaration of Human Rights, of course, he was, one of the writers of that was an individual from New Brunswick, Professor Humphreys. And in Article 18 it says "Everybody has the right to freedom of thought, conscience and religion". And this same phrase, of course, is also repeated in the International Covenant on Civil and Political Rights, again, article 18.

And Canada not only acknowledged the existence of these particular declarations, but Canada as a country also signed what's called the optional protocol, which allows a citizen of this particular country then, to question the decision-making power of Parliament and are they, in fact, fulfilling the obligations under international instruments.

My cousin Sandra Lovelace of course was the first one who took the optional protocol to the United Nations, and she's a senator now. But it was about dealing with her identity as an indigenous woman who had lost her rights through marriage to a non-native. Ultimately, Canada was sanctioned by the United Nations, and ultimately Canada changed the law in 1985.

I put that on record maybe, I think as I look at this legislation, I'm not sure if the advisers of the Department of Justice examined this legislation in terms of conscience rights, because there's an absence of there. Does it, in fact, comply with international law? Does it comply with the instruments at the United Nations level? And of course, the Department of Justice has all kinds of experts. And, so, maybe, I just raise that with the committee, Mr. Chairman, because I think it's an important, it's something that shouldn't be overlooked. Sometimes legislation is passed, I remember the 80s, when they say, "Okay, hold your nose and let it pass, even if you don't agree with it."

But conscience is so important, so critical. If you force somebody to do something against their will and they have firm beliefs, well, what's going to happen to the medical profession? What's going to happen to those institutions that exist who do not wish to participate in this particular arrangement that's going to be enacted by Parliament? . . .

Hon. Rob Nicholson: . . . How much do you think Parliament can actually do at this particular time? Parliament was clear on its position, but now the courts have indicated very clearly that the present law, the law that's been on the books and maintained by Parliament is unconstitutional. How much can parliamentarians do, in your opinion?

Mr. Graydon Nicholas: . . . The law is the law. The Supreme Court has made its decision, but the judges also know that the ultimate judge is Parliament. Parliament is the one who enacts legislation, and if one of our fundamental rights is the freedom of conscience, then Parliament, I think, has to protect that right as well so that it's not left to the particular provinces to say can these agencies then force the medical people to do this. Mr. Arvay has indicated that the chief justice said don't force.

And I think the weakness of this current legislation is there's nothing in there which respects that fundamental right, and if it's not in there under criminal law, it will be brought up as a defence, and it will be litigated from provincial court all the way to the Supreme Court of Canada, which will probably involve a five-to-seven-year span, and there will be a lot of litigation on this as well.

But I don't see why Parliament cannot insert in that bill freedom of conscience for those that don't want to participate, and also, furthermore, the fact that as also institutions, because there are institutions. For example, back in Fredericton the hospice that's been created and the hospice in Saint John both said there's no way we're going to comply with this law if we're forced to participate in it.

Hon. Rob Nicholson: There certainly has been precedent for that even at the federal level with the Civil Marriages Act. There is provisions in there that someone can't be forced to do something against their conscience.

Mr. Graydon Nicholas: And I think I'll just refer to, because you know, in my little brief, I've got here, now, probably, I imagine the Coalition for HealthCARE and Conscience is going to appear here, I assume. Anyway, here's what they said:

No other foreign jurisdiction in the world that has legalized euthanasia/assisted suicide forces health care workers, hospitals, nursing homes or hospices to act against their conscience or mission [or] values.

Mr. Colin Fraser: . . . With regard to freedom of conscience, again, I don't know that anyone would disagree that there should be, obviously, a right for people to be able to not perform these, if it goes against their conscience.

Now, you talk about no other foreign jurisdiction that forces medical practitioners to carry this out. But you'd agree with me that this is the only, there's no other federal government or national government in a federation which has dealt with this situation. All of the other ones are not federal governments.

Mr. Graydon Nicholas: You're thinking of, in terms of the type of government we have in this country as opposed to other countries.

Mr. Colin Fraser: Right.

Mr. Graydon Nicholas: Okay. Well, I mean, irrespective of what form of government there is, the fact of the matter, I think, in my opinion, is.... He [referring to Mr. Arvay] is a counsel, and I used to be a counsel, you can't, you cannot foreclose a defence argument in the future on any legislation under Criminal Code, because it's subject to the Charter. All sections are like that. And so, if you don't specifically put in legislation protection of right to conscience, it's going to be brought up anyway.

And, so, if you're silent as a Parliament on this issue, there probably won't be enough courtrooms in Canada to handle all the litigation and defences that's going to occur because of this, because you're dealing with thousands and thousands and thousands of people involved in the medical profession.

Mr. Colin Fraser: That's referenced, obviously, in the preamble. There's suggestions to that effect.

And with regard to the law itself, what we're doing is amending the Criminal Code, and it lies in the jurisdiction of the provinces and the medical profession itself to regulate and to pronounce on these conscience rights.

Would you not agree with that?

Mr. Graydon Nicholas: Well, with the greatest respect, if you look at the preamble of the Charter of Rights and find out how the courts have used those words in the opening comments, you'll find that it's a nice statement, flowery statement, but in terms of effect, it doesn't have that much, in the actual interpretation of a particular right or a particular section that's being considered.

That's all I'm saying, and I'm not saying anything new. If you talk to litigators, people who defend people in criminal processes every day, they'll tell you that as well. But that does not relieve Canada, however, of its obligations under these two instruments.

Canada can't go to another country and say, you know, "Hey, you're a terrible government; look, you're infringing on the rights of your people, which are human rights that the United Nations recognize", and then all of a sudden Parliament says, you don't have the right to freedom of conscience. What's that going to do?

Mr. Colin Fraser: Well, okay, so you'd would agree with me, though, that this is an amendment to the Criminal Code and that nothing in here compels any medical practitioner or nurse practitioner to have to carry out what's against their conscience.

Mr. Graydon Nicholas: Well, the way it's open-ended now, if you look at those provisions under this Bill C-14, and if you look at the offences that are created because of this, if you don't notice, if you don't do that, well, you're subject to a criminal charge, and then of course when you're subject to a criminal charge, you have a right to defend yourself.

Mr. Colin Fraser: But, where in here does it compel anybody to do it? It's a criminal exemption. Where does it compel?

Mr. Graydon Nicholas: Well, I mean, just look at the offences you've created under this bill. I'm not going to go into the debate of - There's offences created under this legislation. And if you look, for example, at section 241.3 is one which is an offence because you're creating a hybrid offence. In other words, it could be an indictable offence or it could be a summary conviction offence, and then of course the prosecutors will determine as to which category a particular circumstance.... Whenever you have an offence created by legislation.... Here's another one on 241.3 . . .

Mr. Colin Fraser: Sir, with great respect, I understand there's offences in here, but it has nothing to do with compelling a medical practitioner. That's about failure to comply with safeguards. That's not saying somebody has to do it. You'd agree with that at least.

Mr. Graydon Nicholas: Look at the section under what you're contemplating as regulations, 241.31(4). If there is a regulatory scheme that's going to be set up, and whatever this is going to look like, if you don't refer a patient to somebody else, or you don't even want to do that, what's the licensing body in each province going to do?

Mr. Colin Fraser: Okay. Well, I'll leave it there.

Ninan, Dr. Abraham [Full Text]

2. Every provision must be made to ensure that doctors are not asked to work against their sacred and firmly held convictions regarding the sanctity of life and their calling to preserve life and promote healing. They should under no circumstances be asked to refer patients to another physician or facility that will do the killing. By doing so they will be complicit in the act of killing. It may send some of our experienced physicians into early retirement or voluntary exile into another country. It may deter prospective ethical and moral young people from taking up the profession. It may attract people into the practice of medicine who are amoral or God forbid, possessing undesirable qualities. All this can lead to a deterioration in our health care system - a system that needs all the help it can get at this point. . .

I write as a physician who has been in the active practice of medicine for 49 years, 42 of which has been in Canada. I am a neonatologist and am acutely aware of the challenges involved in end of life care. . .

Oudshoorn, Chris and Fran [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. . .

Phillips, Jo-Anne [Full Text]

. . . I am concerned that the protection of conscience for medical and nurse practitioners and pharmacists is not clearly stated in this bill. How could you protect the nurse practitioner who does not have the same power and influence as doctors? I imagine that they would have great difficulty and little support defending their right to not assist in the death of their patient. How will you protect them and the fallout if they are forced to do what is unimaginable to them and which goes against their training? . . .

Philpott, Jane (Minister of Health)

Oral Submission [Edited Video]

Jane Philpott: . . . In closing, we believe this proposed legislation values the personal autonomy of Canadians, in line with the Supreme Court's decision in Carter, while ensuring the protection of vulnerable Canadians and the conscience rights of health care providers.

Mr. Michael Cooper: I'm going to move on then to another area of concern, which is the need to balance on the one hand the charter rights of patients, but also the charter rights of physicians and allied health professionals. That balance, the need for that balance was expressly recognized by the Supreme Court in paragraph 132 of the Carter decision.

And I guess I'm a little bit concerned that the legislation doesn't contain conscience protections. Instead, this has been left to the provinces, to colleges, to professional regulating bodies. And I was wondering if you might be able to comment on why you've chosen to effectively pass the buck on to the provinces on something as important as protecting what are fundamental freedoms under the Charter, section 2 Charter rights.

Hon. Jody Wilson-Raybould: . . . I know that the question of conscience rights of medical practitioners has been one that has been raised in many forums, in terms of discussions. Certainly it was raised at the special joint committee.

We have, in terms of the legislation, and there nothing in our legislation that would compel a medical practitioner to perform medical assistance in dying. As you point out, the jurisdiction in terms of regulations falls to the provinces and territories. Having said that, I know that my colleague, Minister Philpott, will continue to work extremely collaboratively, as she has been, with the provinces and territories to assist them in, where possible, in ensuring that there is that comprehensive regulatory framework that is, to put it in place.

Hon. Jane Philpott: And I would just underline- this is not within the legislation, but you've probably heard us talking about this around the topic of conscience rights - that recognizing both the fact that we will, are committed to upholding the conscience rights of health care providers and at the same time making sure that Canadians will have access to options for care, we have made it clear to the provinces and territories, and are in fact already working with them on developing a care coordination system for end-of-life care, that will ensure that if a person is in a situation where their particular provider does not feel, for reasons of conscience, that they want to participate, that we would put a mechanism in place. This has been greeted with great enthusiasm by medical associations and by provinces and territories, and I look forward to giving you more details as that develops.

Mr. Ahmed Hussen: . . .Very quickly, under the framework established by Bill C-14, a provincial health care facility could choose not to provide medical assistance in dying. I'd just like to know what your views are on that, how you feel about that.

Hon. Jane Philpott: For a province?

Mr. Ahmed Hussen: Yes, a provincial health care facility could choose not to provide medical assistance in dying.

Hon. Jane Philott: So as you know, the delivery of health care is in the domain of the provinces and territories. However, in introducing this bill, we've made it clear that the federal government acknowledges that medical assistance in dying is to be considered a medically necessary service. Like any other medically necessary service, we expect provinces to act within the Canada Health Act and to be sure that all Canadians have access to these particular options for care. We will certainly work with the provinces and territories to make sure Canadians do have the access they require.

Mr. Ted Falk: Minister Philpott, you indicated that the bill provides protection for health care professionals, and I'm thinking you're suggesting it does from a liability perspective, but how about health care professionals' protection for conscience rights? Why not inlcude that right away? Why is liability so important? Actually, really, I want to know why conscience rights aren't in there, and what area they could be put?

Hon. Jane Philpott: So, this, as you know, this is a piece of legislation that is an amendment to the Criminal Code. It's not a piece of legislation that describes the working medical practice, for instance. It's not a health bill. It's a piece of amendment to the Criminal Code, and therefore it was deemed not to be appropriate to specify that. We have made that very clear that we, there nothing in here that compels a medical practitioner to participate in medical assistance in dying. The actual oversight of medical practitioners is done at the provincial and territorial level. We have indicated to them that it is our expectation that the conscience rights of providers would be protected.

(To Minister Wilson Raybould) I don't know whether you want to elaborate more on why it wasn't included, but . . .

Ms. Iqra Khalid: With respect to the rights of conscience for medical practitioners, now it's my understanding, and what you have indicated today as well, and based on the questions of our colleagues here.... Is there no way to codify the rights of conscience, for example, saying that somebody cannot be forced to administer medical assistance in dying as part of the Criminal Code, or to make it a penalty to coerce somebody into administering death under this legislation? Or would that not be in the federal jurisdiction at all? Would that be something that would be dealt at the provincial level?

Hon. Jody Wilson-Raybould: Thank you for the question. There is nothing in Bill C-14, our proposed legislation, that would compel a medical practitioner to engage in medical assistance in dying. As you quite rightly point out, this is within the jurisdiction of the provinces and territories, and Minister Philpott will be, will continue to work with her counterparts to assist in putting together the regulatory framework, to assist the provinces.

Mr. Michael Cooper: I just have one question for Minister Wilson-Raybould. Just to follow up on the question posed by Ms. Khalid, wherein, if I heard you correctly, Minister, you had said that with respect to conscience protections that was an area that fell within provincial jurisdiction. Now, we, of course, are legislating in part under Parliament's criminal law power. At paragraph 53 of the Carter decision, the Supreme Court expressly said that "Health care is an area of concurrent jurisdiction".

So having regard for those facts as well as section 3.1 of the Civil Marriage Act, which, you know, said that religious officials don't have to perform civil marriages, again in an area that has both provincial and federal jurisdiction overlap, perhaps, I just want to be clear, are you saying that Parliament cannot legislate on conscience protections in the face of the foregoing?

Hon. Jody Wilson-Raybould: Well, we, ah, first of all with respect to the Civil Marriage Act. I know that that has been brought up a number of times. And what was provided within that was that religious officials would not have to serve a specific community in terms of marriages. But we're talking about doctors serving the public at large. And we believe, that it is, well I don't believe, it is the jurisdiction of the provinces and territories to ensure the regulation of the conscience rights of medical practitioners. We, there's nothing in our legislation as you know that would compel a medical practitioner to perform medical assistance in dying.

The Chair: Can I wrap up by asking a wrap-up question? Sorry to intervene, but on Mr. Cooper's question, Ms. Khalid had made a different suggestion. She had suggested that the Criminal Code could be amended in order to prohibit anyone from coercing a medical professional to perform physician-assisted suicide. I presume that you would agree that that would be within the, a prohibition that could exist in the Criminal Code, could it not? I mean regulations may be provincial and territorial, but could that theoretically exist?

Hon. Jody Wilson-Raybould: Well, I um, I mean, renovation of the Criminal Code is something that we are undertaking in a comprehensive way. I'm not sure that the question is raising a particular issue that we could address that couldn't be already addressed in terms of the discussions that we're having with the provinces and territories. But, certainly, we, at the questions that have been raised here, we'll take a look.

Physicians' Alliance Against Euthanasia [Full Text]

. . . While some Canadian doctors and health care institutions are willing to cause patients' deaths, most are not5, not out of selfish concerns, as some have suggested, but out of concern for our patients. There is no justification for imposing any duty to implement this political decision, which is foreign to our profession, on medicine as a whole or on any individual practitioner or institution. Attempts to do so are already being seen, both in Quebec6 and in Ontario7.

Quebec was a pioneer in bringing palliative care to North America. Since euthanasia was legalized in Quebec four months ago, one excellent palliative care physician has compared her daily life to "living in a war zone". Another retired early, the day the law came into effect. Highly skilled doctors and nurses, who have given years and decades to the care of dying patients, are suffering burn-out, taking sick leave and being driven from the field by confrontations over a supposed "right" to be killed.8 By threats of losing funding if they insist on caring for people rather than killing them.9 Patients are refusing treatment for their symptoms because of their fear of receiving "the injection" without having asked for it.10

In summary, our recommendations to render Bill C-14 safer for patients, for health care environments (safe spaces for patients) and for the integrity of our profession, are:

7. Include in the law a prohibition against requiring any health professional to cause the death of a patient or to refer a patient to another person to obtain their death, even through a third party, and against requiring any health care institution to euthanize patients under their care or to assist in their suicide.

Oral Submission [Edited Video]

Dr. Catherine Ferrier: . . . My second point is about what is often called freedom of conscience, but is also about protecting health care services from becoming death-promoting environments and thereby protecting patients from those environments. I suggest you include in the law a prohibition against requiring any health professional to cause the death of a patient, or to refer a patient to another person to obtain their death - even through a third party, as is the case in Quebec - and against requiring any health care institution to euthanize patients under its care or to assist in their suicide.

There's no justification for imposing any duty to implement this political decision, which is foreign to the medical profession, on medicine as a whole, or on any individual practitioner or institution. Attempts to do so are already being seen, both in Quebec and in Ontario, through requirements to refer. The federal law cannot just leave this question to the provinces. In Quebec, since December, doctors who are unwilling to euthanize patients must refer them to an administrative body that will ensure the death occurs. This does not protect the patient or the professional integrity of the physician. If I were a surgeon and a patient asked me for a procedure I thought was either not going to help them or would be too risky, I would refuse to do it, and I would also refuse to send the patient to someone else who would do it. They would, of course, be free to go and find a doctor of their choosing if they wanted to.

In palliative care in Quebec, one excellent palliative care physician has compared her daily life under this law to living in a war zone. You never know when a death request is going to land on you. You can't be giving hope to dying patients in one room and euthanizing them in the next.

Another doctor retired early the day the law came into effect for this reason. Highly skilled doctors and nurses who have given years and decades to the care of dying patients are suffering burnout, taking sick leave, and being driven from the field by confrontations over a supposed right to be killed, and by threats of losing funding if they insist on caring for people rather than killing them. . .

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.

Pickup, Mark Davis [Full Text]

Recommendation #1: Amendment to C-14 to recognize and fortify Charter guarantees of freedom of conscience and religion and expression. Physicians, nurses and pharmacists who have profound conscientious or religious objections to participating, in any way, with euthanasia or assisted suicide must not be forced into it or required to refer patients to doctors who are willing to kill. This must be unequivocal in the legislation! Such emphatic recognition of religious freedom is a hallmark of a pluralistic society.

There are forces at play to force this on them.1 Imbed in the legislation recognition of the supremacy of Charter guarantees of freedom of conscience and religion, and its expression (CANADIAN CHARTER OF RIGHTS AND FREEDOMS, Section 2, (a,b)).

From a Christian point of view, the Canadian Supreme Court decision on assisted suicide legitimized something that is intrinsically evil. Many Christian medical professionals can not comply; recognize this by exempting those with conscientious objections and curtail provincial or professional associations from imposing participation in assisted suicide or forcing them to refer for assisted suicide. Mitigate the extent of this moral evil by endorsing conscience rights for doctors, nurses and pharmacists who have deep moral objections to participating in any way with medically assisted suicide.

Pilon, Dr. Liette [Full Text]

. . . Doctors and health care workers will be torn between their usual role of caring and the new role of putting to death, and are without protection for their right to refuse to participate for reason of conscience. . .

-Add a protection for the right of conscientious objection: Nothing is said about this in C-14

Given the very fundamental nature of the values involved here, the risks of the failure of the controls, and that health care workers have always had the task to cure, treat, improve, relieve and not to kill, (a complete reversal) it is imperative to protect the rights of conscientious objectors, for whom even to refer is the equivalent of being an accomplice of a serious and criminal act, like telling a suicidal person where to find a weapon. Provincial health departments have their own agenda and will try to get health care workers to participate even against their conscience and beliefs. The federal government must prevent coercion or intimidation and the risk of penalties for conscientious objectors. We must protect the freedoms and choices of health workers also.

One could say: Although there is a permission and an exemption to the Criminal Code for cases mentioned in regard to medical assistance in dying, no professional or health care worker or institution shall be obliged to participate in any way in the process of bringing a patient to receive the said medical assistance to die. It would be to provincial health departments to establish references procedures that do not require the participation of the objectors, such requests could come directly from patients to designated authorities. There could also have care units or parts of units of certain institutions reserved for such purposes. Not all specialties are in all hospitals, why should this be considered a more essential service?

Pitzel, Bert (Roman Catholic Archdicoese of Regina) [Full Text]

. . . In light of the recent decision of the Supreme Court of Canada, we urge federal, provincial and territorial legislators to enact and uphold laws that enhance human solidarity by promoting the rights to life and security for all people; to make good-quality home care and palliative care accessible in all jurisdictions; and to implement regulations and policies that ensure respect for the freedom of conscience of all health-care workers and administrators who will not and cannot accept suicide or euthanasia as a medical solution to pain and suffering. . .

Pothier, Dianne

Oral Submission [Edited Video]

Mr. Colin Fraser: With regard to conscience rights, we've heard in some testimony that conscience rights should actually be explicitly stated in this law. What I'm wondering, of course, this is an amendment to the Criminal Code, and I'd like your views on whether you feel that would be appropriate to insert in the Criminal Code itself. It's in the preamble now.

What are your thoughts on that?

Ms. Dianne Pothier: I think suggestions have been made about saying, well, nobody shall be coerced to perform medically assisted dying or participate in it. I think you could put that in the criminal law, but my sense is that's not the real concern. The real concern isn't coercion in the sense of, you know, a gun to your head. The real concern is professional repercussions if you don't participate.

And if that's the real concern, I think there are limits as to how far the feds can go. It's not a Criminal Code provision, I don't think, but, I mean, in federal jurisdiction you've got military hospitals in terms of professional consequences. That's not a very big part of the picture. If you're talking about essentially discrimination against people for exercising their conscience rights, the Canadian Human Rights Act has a very limited application, generally and specifically, in a way that could implicate people conscientiously objecting to medical assistance in dying. So I think there are some things that could be done. But mostly it would be difficult for the feds to go very far with this.

But, I mean, you know, the ministers have been saying nothing in this act requires anybody to do anything. And that's true. The question is do you have more robust statements of that. I think you may be able to go some distance, but if you're looking for the strongest protections, it's provincial jurisdiction.

Powell, Dr. Barbara [Full Text]

. . . Another worry is that protection for conscience rights of conscientious health care practitioners and their facilities is excluded from the legislation. Still worse, the soft prohibition on having death inflicted is so poorly worded; it is open to interpretations (as in provinces) of providing enforceable entitlement to unnatural and premature death being inflicted by another. This goes beyond the call of Carter, and if not amended to more closely correspond to the ruling that called C-14 into being, the law may be taken as obligating a physician, nurse, pharmacist to precipitate or inflict death, contrary to conscience rights.

Some read the lack of conscience protection as the government intending to leave decisions about conscience up to each province. But if C-14 carries as worded, it may be possible to interpret the bill as providing enforceable entitlement to have death inflicted, as does Michael Cooper, sitting member of the joint special committee, who stated that he thought the Supreme Court had established "that physician-assisted dying was a charter right for certain Canadians". If, as many have been saying, that is indeed what bill C-14 does, then the provinces have much room to shirk their responsibility to uphold conscience rights of anyone in the causal chain of a demanded death, and they are provided strong motive where the entitlements mean the federal government has to transfer funds for procedures in a whole new category, really making C-14 a money bill.

By fundamental justice in a free country, there can be no "right to have death inflicted"; even if there might be limited permission (as in decriminalized suicide). But by contriving to introduce an entitlement to be killed, bill C-14 adopts the astonishing premise that the state can require people to become parties to inflicted death and suicide and allow provinces or colleges to punish them if they refuse. It is contrary to liberal democracy, a first duty of which is to serve and protect life and conscience.

I am not sure I would want to rescue a Bill that should die, but Bill C-14, as awful as it is, and as likely to be rammed through can at least be corrected of the false entitlement language by an amendment to s. 14 and ss. 227 (4) of the Criminal Code as introduced by the bill.

The gist of the amendment would look like this:

"s. 14(1) No person is entitled to have death inflicted on them.

(2) Consent or request by a person to have death inflicted on them does not affect the criminal responsibility of any other person who precipitates or inflicts death on the person who requested or consented to have death inflicted on them." And ..

" s. 227(4) Subsection 14(2) does not apply to persons who precipitate or inflict death on a person in accordance with s. 241." .

Quebec Association for the Right to Die with Dignity [Full Text]

Oral Submission [Edited Video]

Mr.Murray Rankin: My next question is for you, Dr. L'Espérance. I want to ask you about the protection of medical practitioners in Quebec on grounds of conscience. We've heard a lot about that here. Some have suggested that we need to clarify it in this federal law.

Maître Ménard told us that was in provincial competence from a matter of legal perspective, but of course your perspective is medical. I want to ask,if there have been any problems with conscience, number one, in the protection of doctors. And number two, you made a distinction between an individu and an organisation. And so I presume you're saying that institutions should not be allowed to have conscience protections, but individuals. Do I understand you correctly?

Dr. Georges L'Espérance: Absolutely.

On the first question, no, there's no problem in Quebec with- conscientious objection. No matter what the reasons for the objection based on conscience, it's normal.

The obligation of Quebec is this, a doctor, a medical practitioner who refuses medical assistance in dying has to refer the patient to his association so that they can find a doctor who will do so for the patient. It's exactly the same problem as was the case with abortion, as is the case, as well, with abortion. Now, the institution cannot have a conscience nor a conscientious objection. If you're looking at a private hospital, a Catholic hospital, Muslim hospital, anything, that would be totally private, in imposing the rules, certain rules, but if it is a public institute they would have to bend to the will of the person. But our goal is to provide care for persons and medical assistance in dying is the ultimately last compassionate act of care.

Dr. Nacia Faure: What has upset me and concerned me from the very beginning of this discussion is very often the patient is forgotten. The dignity of the individual is important, the state of their mind, their soul, so this is what we must seek to do, is to help this individual. Ultimately, the core issue is the dignity of the patient, of the individual. It's all well and good to talk about other issues from a medical standpoint, but we think of the patient.

Mr. Murray Rankin: . . . because the Supreme Court said in Carter that individual medical practitioners, on rights of conscience, need not perform the service, and we're trying to clarify whether the bill needs that protection.

But I just want to say, Dr. L'Espérance, I agree entirely with you. Institutions are different than individuals, and taking money at the same time as denying people constitutional rights is really quite unthinkable.

Dr. Georges L'Espérance: I'll let the legal experts decide whether or not there should be an amendment to the Criminal Code or not. But, to my mind, I'm not a lawyer, I don't think it's part of the Criminal Code. I think that this is part of the overall legal framework.

Raes, Gerard [Full Text]

7. The bill provides no conscience protection for medical or nurse practitioners. Further to that, the bill requires medical or nurse practitioners to provide the "designated recipient" or the Minister of Health with every request for euthanasia or assisted suicide.

Riendeau, Mary [Full Text]

. . .There needs to be above all conscience protection for Health Care Professionals - they should be able without penalty to not be involved in the act of killing or refer to someone who will. . .

REAL Women of Canada [Full Text]

2. Protection for Conscience Rights

The Supreme Court of Canada, in the Carter case stated, that "Nothing in this declaration would compel physicians to provide assistance in dying." Conscience rights have not been provided in Bill C-14. The recent decisions of the medical associations of Saskatchewan and Ontario require physicians to refer patients for assisted suicide, thereby making them complicit to the act. The requirement of the Supreme Court of Canada on the issue, therefore, has not been complied with. There is nothing to guarantee that the provinces will provide the required protection for the physicians, nurses, pharmacists and religious institutions who oppose assisted dying for conscience reasons. An Angus Reid Poll in March 2016 found that 69% of Canadians agree that those with moral objections to assisted suicide should be permitted to refuse to participate in it.

Conscience rights of religious institutions, physicians, nurses and pharmacists must be specifically protected in the legislation.

Reggler, Dr. Jonathon [Full Text]

. . . My intention to provide Medical Assistance In Dying (MAID) has been reported in local and national news media. Many elderly patients have commented and I always respond that I hope my patient was not upset. The reply is inevitably a variation on "I agree with your position". This is not surprising. 84% of Canadians and 87% of British Columbians supported MAID in an Ipsos-Reid poll in 2014. 80% of people support advance directives for MAID. Many senior nurses at our Catholic hospital and the attached hospice have thanked me for my support for MAID. . .

3. All publicly funded hospitals and hospitals should be required to allow MAID on site

It is the duty of the Federal government to ensure fairness in the provision of Charter rights. Our local hospital is Catholic. The next nearest hospital is an hour's drive away. Our hospital has a draft policy ready which, if not required to allow MAID on site, will prohibit MAID and force physicians to send patients home for MAID, however sick, or to transfer them to another facility in a community where their own physician will not have admitting privileges and their family does not live. Only 12% of our community of 60,000 is Catholic and most Catholics support MAID. However, the Catholic Church's over-powerful hierarchy does not. It is wrong for the owners of the bricks and mortar of publicly funded facilities to restrict access to MAID for patients who qualify for this Charter right, or to make it necessary for them to endure additional suffering by being moved. The Bill already makes eligibility for publicly funded care a qualifying criterion. Bill C-14 should require MAID to be available in all publicly funded hospitals and hospices. . .

Reimer, Lorraine [Full Text]

. . . Bill C-14 fails to protect the conscience rights of health care workers and health care institutions, hospices and long term care facilities whose mission, vision and values commit them to heal and care, to reject providing measures of death to patients entrusted to their care. The wording must be changed to protect the conscience rights of health care workers and those institutions who conscientiously object to both providing medical assistance in dying and referring their patients to those who will assist in dying. . .

Right to Die Society of Canada [Full Text]

2) Do not follow the Court in speaking of consent. In the context of a law about death, this term will alarm many. It is also dated – it harks back to the days when all the plans were made by the doctor and the patient's role was just to say "Oh, all right".

Instead present the doctor's role as explaining to the patient what the various options are (one of them being MAID), then accepting the patient's choice (pointing to a referral database if necessary). . .

Roman Catholic Archdiocese of Vancouver [Full Text]

On behalf of the Roman Catholic Archdiocese of Vancouver, I would like to establish that we firmly oppose euthanasia and assisted suicide in principle. In the interest of mitigating the harm and anything that will erode the sacredness of human life, we would like to support the submission of the Protection of Conscience Project’s brief, summarized below and more fully set out in its submission to the parliamentary Special Joint Committee. . .

Saba, Dr. Paul [Full Text]

. . . Quebec's provincial medical board has mandated physicians not to write on the death certificate that their patients have been euthanized. Indeed, there is a threat – express and implied -- of sanctions and possible loss of physicians' licenses if they fail to comply.

Montreal is where I live and practice as a medical physician. . . As a physician, I refuse to inject a lethal substance into a patient [or refer any patient to be so injected] since the intention is to prematurely end a person's life. Accordingly, I have launched court challenges to disallow the governing euthanasia law in Quebec. Nevertheless, I realize that disobeying this law risks the possible loss of my medical license. . .

Salvation Army [Full Text]

Consistency of conscience protection across the country

7. We recognize how difficult it is to balance the rights of Canadians in drafting the proposed legislation. We note, however, that the proposed legislation does not provide protection for the rights of those who do not wish to participate in medical assistance in dying.

8. Bill C-14 leaves the protection of conscience and religious beliefs to be interpreted by provincial and territorial governments and regulating bodies. We encourage an amendment be made to Bill C-14 so as to include protection of conscience for healthcare and social service providers and facilities1 so as to ensure that a basic level of conscience protection is consistent across the country. Section 3 of the Civil Marriages Act provides an example of the type of protections that may be included in this legislation.2

Conclusion

10. The Salvation Army strongly supports an amendment to Bill C-14 to include protection of conscience rights of healthcare and social service providers and facilities. . .

Saskatchewan Pro-Life Association [Full Text]

. . . We respectfully recommend the following . . .

4. Supporting and protecting the Charter rights of physicians, nurses, pharmacists and institutions which object o euthanasia and assisted suicide and may face criminal prosecution for refusing to administer or prescribe a lethal dose to a patient or offer a referral to others who may prescribe a lethal dose to a patient.

We strongly urge Government to implement conscience protection for all who should in no way be pressured, coerced or discriminated against for taking a conscientious stand against assisted suicide or euthanasia.

Schratz, Paul [Full Text]

. . .The main weaknesses of this legislation are:

3. Inadequate conscience protection for staff, medical personnel, and institutions that do not want to have any role whatsoever in assisted suicide. . .

Schuck, Lena [Full Text]

. . . We need to protect the rights of dissenting Canadians, especially doctors and nurses, from being forced to perform euthanasia. . .

Shariff, Mary J. [Full Text]

NO "RIGHT" TO DIE AND FREEDOM OF CONSCIENCE

Carter did not establish a "right to die". It used the Charter (Section 7) to "crack open" the Criminal Code so physicians who "choose to provide"6 could do so without criminal liability provided certain criteria are met.

RECOMMENDATION 2: Include in Preamble that exemption does not establish a right to die; only a right to request.

Additionally, in all other permissive jurisdictions, given that this act is an exemption to homicide, no health care provider can be compelled to participate or provide MAID – all guarantee physicians freedom of conscience.

RECOMMENDATION 3: Include in Preamble that no health care provider is under a duty, whether by contract, statute or by any other legal requirement to participate in or provide MAID.7

Snell, Jennifer [Full Text]

. . .I am appalled that the government would even consider compelling a doctor or any other health care professional to intentionally kill a human being. The rights of Doctor's and health care professional are just that RIGHTS and nobody should have the right to take their rights away in order to apply the rights of another. This statement includes forcing doctors to refer patients to someone else who would do the killing. . .

Somerville, Margaret [Full Text]

1.5 Recognizing PAD as an exception, as Bill C-14 does, also helps to establish that access is not a right - but rather under certain conditions, an immunity form prosectuion for a criminal offence - which carries an important anti-suicide public health message. As well, this immunity characterization of the legal nature of claims to access PAD and its provision, will assist in protecting the freedom of conscience Charter rights of healthcare professionals, who refuse involvement in PAD for reasons of conscience or religion. . .

Soubolsky, Amy [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. . .

Spencer, Richard [Full Text]

. . . I have no wish to force those who have different views, or conscientious objections, to do what I want to do, or help me do it. By the same token, their views and beliefs should not prevent my wishes, which affect me and my family but do not affect them, from being carried out. . .

Spiess, Gary W. [Full Text]

. . . Ihave purposely not focused this message on conscience protection for health care workers, as though I also see this is also of vital importance, I wish to keep the focus on the clients, as they must be our first priority as health care workers.

My hope is that your committee and all parliamentarians will strongly consider the experience of Belgium and other countries, who state that many of the safeguards they thoughtfully included in their legislation are either downplayed, or out rightly ignored altogether. . .

Squires, Collette [Full Text]

. . . To strengthen safeguards within the legislation, please also consider:

8. Protection of conscience for medical practitioners and pharmacists (similar to the balance provided in the legislation permitting same sex civil unions, which also provides conscience rights to those who do not want to provide the service). . .

St. Catherine's Right to Life [Full Text]

. . . We are glad that the Government is committed to "respect the personal convictions of health care providers." . . .

1. C-14 should be amended to declare the Charter rights of medical practitioners – physicians, nurses and nurse -- practitioners, and pharmacists whose conscientious beliefs oppose assisting another in suicide to decline furnishing such assistance. To compel "conscientious objectors" to perform this service– or refer to someone who will perform it– in violation of their own understanding of their ethical and professional obligations to their patients would be a violation of that "freedom of conscience and religion" declared "Fundamental" in The Canadian Charter of Rights and Freedoms. To claim that allowing assisted suicide in some instances implies an ethical obligation binding on all medical practitioners to participate directly or indirectly in the practice contradicts the very idea of the Charter itself. This would depart from the practice of other jurisdictions that permit assisted suicide. And it would undermine the welfare of patients so far as their care-givers might be understood by their patients to have suppressed their own conscientious and ethical beliefs. We note that one leading advocate of "Effective Referral" has said that "conscientious objectors" should consider a change in profession, and we hope that members of the Justice and Human Rights Committee find that remark as repugnant as we do. We note that the Court itself said Anothing in [its] decision would compel physicians to provide assistance in dying. And, further, we would observe that the same principle that justified the Government in allowing members of Parliament to obey their conscience in voting as they choose on Bill C-14 entails the importance of recognizing the role of conscience for medical practitioners under our law. We would add, finally, that it seems appropriate that our federal Parliament should affirm the Charter rights of medical practitioners rather than leave the "rights of conscience" to be affirmed or ignored, as may be, by professional associations.

Taylor, Elaine [Full Text]

. . . and while many of us know it has been going on already for many years in Canada, the pressure on medical staff to kill against their conscience or better judgment, and on patients to submit to being killed instead of being helped, has already caused an observable slippery-slope in those countries that see themselves as so "progressive". When people are forced to shut down their consciences just to keep a decent job, you will find Canadians committing unimaginable abuses and crimes. When people ignore their conscience long enough, no laws or safety clauses will substitute. It will be open season on the weak, elderly, handicapped, disabled, and any unwanted person, just as it is now on the unborn, and there will be no justice or protection from the system that legislates to allow doctors to play God. . .

The Wilberforce Project [Full Text]

3. Conscience Protection: Medically Aided Death has been founded in the beliefs of autonomy and respect for one’s choices. This value must be extended to all medical professionals, not just the patient! It is unconstitutional that medical staff’s freedom of choice and conscience is not rigorously protected. A fundamental right such as this should not be left for the provinces or medical communities to uphold.

Thorpe, Kim [Full Text]

. . . Freedom of conscience for pharmacists and health care workers must be respected and include the right to refuse to participate in or to refer a patient for assisted suicide. Likewise, no institution should be penalized in any way for refusing to participate in or refer a patient for assisted suicide.

Tokaruk, Carole [Full Text]

I am very much against forcing people to go against their religious beliefs and be a part of the killing of another human being. How can anyone feel safe anymore if one is expected to perform an act that goes against the very fiber of their being. . .

Toronto Board of Rabbis [Full Text]

. . . Finally, the final legislation must respect the sincerely held religious and philosophical beliefs of individual and institutional health-care providers that it is never acceptable to assist actively in another's death. The legislation must include provisions for individuals and institutions to report requests for physical assisted death to a third-party, which will then be responsible for follow-up consultations and, if appropriate, facilitating physician assisted death. Judaism does not allow for individuals or Jewish institutions to participate actively in the death of another human being. The legislation must respect this stance.

Toth, Kathleen & Mark [Full Text]

. . . We are concerned that hospitals may be ordered to provide this procedure if they are publicly funded. Those which are faith-based would necessarily have to close rather than comply with a law which contradicts the belief system on which they operate.

Doctors, nurses, pharmacists and other health-care providers who could not in good conscience obey a law which required them to participate in a procedure which they morally oppose, may be forced to retire rather than comply with such a law, or risk prosecution if they refuse. . .

Towler, Christi [Full Text]

. . .Doctors, health care professionals and health care institutions NEED CLEAR CONSCIENCE PROTECTION !!!!!!

- a lack of conscience protection will push good, experienced doctors out of the so much needed palliative care. . .

van Brugge, Melanie [Full Text]

. . . I desire to see that healthcare professionals are not forced to participate in euthanasia and that loved ones are allowed to decide to advocate for life. This right needs to be protected above the decision of what healthcare individuals may predetermine concerning the patient if the patients wished are to live. . .

Vanderhorst, Hendrik [Full Text]

3. Add conscience protection language in order to protect those in medicine who feel strongly that assisted suicide is wrong

a. Rationale: We must protect our doctors who feel that practicing assisted suicide is committing murder. Never should anyone be forced to commit and act that they feel is murder. If we do not include conscience protection language in the law we will only force doctors out of Canada or out of the medical profession entirely. We will prevent many students from taking up this profession in Canada and will prevent foreign doctors who desire to practice medicine in Canada from coming here. . .

van Staveren, Winston [Full Text ]

. . .Health care workers should not be forced against their conscience to assist in killing their patients. . .

Walji, Wendy [Full Text]

. . . I request that a conscience protection clause be included to protect people and Religious Institutions from discrimination, if they refuse to act in any way to intentionally cause death. . .

Wili, Sigrid [Full Text]

. . . Doctors are opposed to assisted dying should of course not be forced to provide it. However, I do think the patient's needs and right to care cannot be ignored. Doctors should be required to provide effective transfer of care to a provider, or at least refer the patient to a third-party referral agency if one is available. I also believe any publicly funded institution should be obligated to provide a full range of services, as some locations have very limited facilities. Effective referral procedures and assurance that assisted dying be allowed in all publicly funded healthcare facilities need to be developed. . .

Wilson-Raybould, Jody (Minister of Justice and Attorney General of Canada)