Question Period Note: MEDICAL ASSISTANCE IN DYING (MAID) – DEBATE ON BILL C-7

• What is the status of the government’s amendments to the MAID legislation and the parliamentary review as required in the original MAID legislation?

● Bill C-7 was reintroduced in Parliament on October 5, 2020. It responds to the Truchon decision, while also addressing areas where there is strong provider and public support for improvement in the medical assistance in dying law.

● We are working with Parliamentarians to meet the deadline of December 18, 2020 set by the Quebec Court in order to provide a consistent legal framework for MAID for all Canadians.

● Our Government recognizes the importance of the Parliamentary Review which will provide an opportunity to address complex issues not addressed in Bill C-7. It is up to Parliament to determine the scope and timing of this review.

BILL C-7, AN ACT TO AMEND THE CRIMINAL CODE (MEDICAL ASSISTANCE IN DYING)
On September 11, 2019, the Superior Court of Quebec ruled in favour of two plaintiffs (Jean Truchon and Nicole Gladu) who had challenged the Criminal Code eligibility requirement that an individual’s natural death be reasonably foreseeable and the more stringent provincial requirement for a person to be at the end of life. The governments of Canada and Quebec did not appeal the decision.

On February 24, 2020, the federal government tabled proposed amendments to the 2016 Criminal Code provisions on MAID (Bill C-7) in response to Truchon. These proposed amendments were:
● remove the RFND eligibility requirement (those suffering solely from mental illness would not be eligible);
● introduce two-tracks of safeguards (RFND and non-RFND);
● allow “waiving of final consent” for eligible persons in the RFND category who may lose capacity to consent before MAID is provided; and
● expand data collection to provide a more complete picture of MAID in Canada

The original Bill was terminated with the prorogation of Parliament. Bill C-7 was re-introduced on October 5, 2020; its content was unchanged.

The Quebec court originally suspended its judgement until March 11, 2020. At the request of the Government of Canada, the date of invalidity was extended to July 11, 2020, and then again to December 18, 2020 in light of disruptions to parliamentary business during the pandemic. During the period of suspension, Quebec residents who meet all eligibility requirements (other than RFND) are able to make an application to a court for an individual exemption to have their request for MAID considered.

As of late November, 2020, 14 Quebec residents have applied for exemptions. Eleven of these requests have been approved, with three requests still pending. Two people have received MAID through an individual exemption, including Jean Truchon.

MAID DELIVERY DURING THE PANDEMIC
While MAID delivery continues, provinces and territories have experienced challenges during the pandemic. Key concerns include:
● Obtaining individuals to act as witnesses to a MAID request and practitioner access to the individual requesting MAID, either due to institutional policies limiting visitors or limited supply of personal protective equipment (PPE) available to facilitate a safe encounter.
● Residents of faith-based institutions with restrictive MAID policies unable to move to another location to receive MAID due to cancelled or limited transfers.
● Availability of drug supply used in MAID provision because the same drugs are also used as sedatives for the ventilation of COVID-19 patients.

The provisions in the Criminal Code are silent on the use of electronic tools to facilitate assessing or witnessing a MAID request. Many provincial governments and health professional regulatory bodies have released pandemic-adapted guidelines/policies such as supporting the use of virtual witnessing/assessments and preserving back-up MAID kits to prevent disposal of unused drugs.

Some practitioners have reported increased MAID inquiries from individuals concerned about their options in the context of COVID. The authors of an April 2020 Canadian Medical Association Journal article state that palliative sedation is preferable for COVID positive patients with a poor prognosis, given the procedural requirements for MAID. This view has been reiterated by Dying With Dignity Canada.

MAID STATISTICS AND MONITORING REGIME
The Regulations for the Monitoring of MAID require the federal Minister of Health to produce an annual report of MAID data. The first report, released on July 24, 2020, covers data collected under the new reporting regime for the 2019 calendar year.

This report found that, in 2019, there were 5,631 reported cases of MAID, accounting for 2.0% of all deaths (this percentage is in line with that of other permissive jurisdictions). This represents an increase of 26.1% over 2018 numbers, with all provinces experiencing a steady year over year growth in the number of MAID cases since 2016. When all data sources are considered, the total of number of medically assisted deaths reported in Canada since the enactment of federal legislation is 13,946.

Importantly, it also found that the majority of individuals receiving MAID (82.1%) were reported to have received palliative care services. Of those MAID recipients who did not access palliative care services before receiving MAID, the majority (89.6%) would have had access to these services according to the reporting practitioner. Similarly, 89.9% of persons receiving MAID deemed to require disability support services received them.

The regulations came into force in November 2018 and set out reporting requirements for participating physicians, nurse practitioners and pharmacists. Under this new reporting regime, data is now being collected on all written requests for MAID and its provision. The regulations will need to be updated to reflect the changes to the legislation proposed in the amendments.

PARLIAMENTARY REVIEW OF MAID LEGISLATION
As outlined in the current legislation, the 2016 law was to be referred to one or more Parliamentary Committees by June 2020. The parliamentary review will provide an opportunity to undertake a comprehensive review of the MAID legislation as well as the state of palliative care in Canada. The timing and scope of the review will be determined by Parliamentarians.

SYNOPSIS

Bill C-7 was reintroduced on October 5, 2020 and responds to the Superior Court of Quebec decision in Truchon, which struck down the eligibility requirement of a reasonably foreseeable natural death (RFND). Bill C-7 was originally tabled on February 24, 2020 and was terminated with the prorogation of Parliament.

The Quebec court originally suspended its judgment until March 11, 2020. In light of COVID-19, the deadline was extended to December 18, 2020. If legislative changes are not passed prior to this date, there will be a difference in eligibility for MAID between Quebec and the rest of Canada.

The original MAID legislation required a Parliamentary Review of its provisions and of the state of palliative care in Canada. It was originally anticipated that this review would be initiated in June 2020 but this was delayed due to the pandemic.