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

• Now that Bill C-7 has received Royal Assent, what is the Government going to do to ensure safe implementation of the law?

KEY MESSAGES
• The new law introduces significant changes in Canada’s framework for MAID. These changes arise from a Court decision and the views of Canadians expressed through public consultations and debated fully in the House of Commons and the Senate.
• We recognize that the changes to the MAID regime present new challenges for provincial and territorial governments and practitioners as they work to ensure safe, sensitive and consistent interpretation and application of the law in health systems across the country.
• The Government will be working closely with provincial and territorial governments, medical experts and other stakeholders over the next year and beyond to support the safe implementation of Bill C-7.

IF PRESSED ON THE INCREASE IN MAID DEATHS IN 2020……
• In 2020, 7,595 cases of MAID were reported, accounting for 2.5% of all deaths in Canada.
• The number of MAID deaths in Canada is comparable to that of other permissive regimes, where MAID deaths account for 0.3% - 4.1% of all deaths.
• The steady increase in MAID deaths over the last four years is expected as people become more aware of assisted dying as a legal option and it gains greater acceptance by Canadians.
• The Second Annual Report on MAID that provides aggregated information on the delivery of MAID in Canada in 2020 is anticipated to be released in July 2021.
• Recent changes to the MAID legislation authorize expanded data collection under the federal monitoring regime. Following the passage of these regulations, annual reports will include even more information on individuals requesting and receiving MAID, including information on race, Indigenous identity and disability (as defined in the Accessible Canada Act) – as long as the individual consents to providing this information.

IF PRESSED ON THE PARLIAMENTARY REVIEW PROCESS …
• The Government of Canada recognizes that other important issues related to MAID remain to be explored.

• As set out in the legislation, a parliamentary review of the MAID legislation will consider areas such as the eligibility of mature minors, advance requests, mental illness, palliative care and the protection of Canadians living with disabilities.
• The Government will do whatever is required to support this work.

IF PRESSED ON THE TOPIC OF MAID FOR PERSONS WITH A MENTAL ILLNESS…
• The Government of Canada recognizes the concerns and the challenges associated with allowing MAID for individuals suffering solely from mental illness.
• That is why the new legislation includes a 24-month sunset clause on the exclusion of MAID requests where mental illness is the sole condition. This is accompanied by a requirement to initiate an independent review to consider protocols, guidance and safeguards that would be applied to MAID requests by persons who have a mental illness.
• Minister Lametti and I are working together to set up the expert panel that will undertake this work. A final report containing the panel’s conclusions and recommendations will be completed within the year.
• Parliamentarians will then have another year to consider whether additional safeguards should be legislated, and it will provide professional regulatory bodies and associations with the information they need to develop appropriate guidance and resources.

IF PRESSED ON PRIVATE MEMBERS BILL C-268: PROTECTION OF FREEDOM OF CONSCIENCE ACT…
• The Criminal Code already provides significant protection for health care professionals in relation to MAID.
• The current legislation explicitly states that nothing in the MAID legislation compels a health care provider to provide or assist in the provision of medical assistance in dying.
• This is not changed in the new legislation.

BACKGROUND
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. The Bill was terminated with the prorogation of Parliament but was re-introduced on October 5, 2020 (its content was unchanged). It received Royal Assent on March 17, 2021.
The new law responds to feedback from over 300,000 Canadians, experts, practitioners, stakeholders, provinces and territories, provided during the January and February 2020 consultations. It is also informed by the testimony of over 120 expert witnesses heard throughout Bill C-7’s study by the House of Commons and the Senate.

During the period of suspension of the Truchon ruling (September 11, 2019 to March 17, 2021), Quebec residents meeting all eligibility requirements (other than a reasonably foreseeable natural death) were able to make an application to a court for an individual exemption to have their request for MAID considered. A total of 19 Quebec residents received exemptions during this period (in addition to the two plaintiffs Jean Truchon and Nicole Gladu).
The new MAID legislation:
• removes the requirement for a person’s natural death to be reasonably foreseeable in order to be eligible for MAID
• introduces a two-track approach to procedural safeguards based on whether or not a person’s natural death is reasonably foreseeable
o existing safeguards are maintained and, in some cases, eased for eligible persons whose natural death is reasonably foreseeable
o new and strengthened safeguards are introduced for eligible persons whose natural death is not reasonably foreseeable
• temporarily excludes eligibility for individuals suffering solely from mental illness for 24 months, and requires the Ministers of Justice and Health to initiate an expert review tasked with making recommendations within the next year on protocols, guidance and safeguards for MAID for persons suffering from mental illness
• allows eligible persons whose natural death is reasonably foreseeable, and who have a set date to receive MAID, to waive final consent if they are at risk of losing capacity in the interim
• requires expanded data collection and analysis through the federal monitoring regime to provide a more complete and inclusive picture of MAID in Canada

PARLIAMENTARY REVIEW OF MAID LEGISLATION
As outlined in the previous legislation, the 2016 law was to be referred to one or more Parliamentary Committees by June 2020, but this did not take place as a result of the pandemic. The new legislation requires that a Parliamentary Review be initiated within 30 days following Royal Assent. The first meeting of the Special Joint Committee on Medical Assistance in Dying was held on Monday May 17, 2021. The Committee will meet every Monday until the House rises on June 23, 2021 (to resume in the Fall).
The joint Chairs will be Dr. Hedy Fry (Lib) and Senator Martin (CPC). A workplan has not yet been agreed upon, but the review is expected to address (but not necessarily be limited to) the topics of mature minors, advance requests, mental illness, the state of palliative care in Canada, and the protection of Canadians with disabilities. The Committee must submit its report to Parliament no later than one year after the start of the review.
MENTAL ILLNESS: SUNSET CLAUSE AND INDEPENDENT REVIEW
The new legislation includes a 24-month sunset clause on the exclusion of MAID requests where mental illness is the sole condition. The sunset clause is accompanied by a legislative requirement that an independent review be initiated to consider protocols, guidance and safeguards to apply to MAID requests by persons who have a mental illness. Individuals with a mental illness would be required to meet all other eligibility criteria including those that define a grievous and irremediable medical condition. A report containing the conclusions and recommendations of the independent review must be provided no later than 12 months after the day Bill C-7 comes into force (i.e., by March 17, 2022), and made public very shortly thereafter.
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 was released in July 2020. The second annual report is anticipated to be released in July 2021 and will cover data collected for the 2020 calendar year.
The second annual report indicates that, in 2020, there were 7,595 reported cases of MAID, accounting for 2.5% of all deaths (this percentage is in the median relative to other permissive jurisdictions). This represents an increase of 34.2% over 2019 when there were 5,631 reported cases of MAID. All provinces have experienced a steady year over year growth in the number of MAID cases since 2016. When all data sources are considered, the total number of medically assisted deaths reported in Canada from the enactment of federal legislation to December 31, 2020 was 21,589.
A slightly greater proportion of men (51.9%) than women (48.1%) received MAID. The average age at the time of MAID being provided was 75.3 years. Cancer (69.1%) remains the most commonly cited underlying medical condition.
Importantly, it also found that the majority of individuals receiving MAID (82.8%) were reported to have received palliative care services. Of those MAID recipients who did not access palliative care services before receiving MAID, the majority (88.5%) would have had access to these services according to the reporting practitioner. Similarly, 90.0% of persons receiving MAID who were deemed to require disability support services had received them.
Federal reporting regulations setting out requirements for physicians, nurse practitioners and pharmacists came into force in November 2018. Under that reporting regime, data is collected on all written requests for MAID and its provision.
Changes to the MAID regulations following the passage of Bill C-7 will expand the collection of data to include information on on race, Indigenous identity and disability (as defined in the Accessible Canada Act) – as long as the individual consents to providing this information. However, regulatory changes will take time (i.e., up between 18 to 24 months), in order to adequately consult on what data should be collected under the expanded regime.

CHANGES TO DATA COLLECTION
Now that Bill C-7 has received Royal Assent, Health Canada will be amending the regulations to align with the revised eligibility criteria and safeguards as well as other data collection requirements set out in the new legislation. Bill C-7 requires that data be collected with respect to race or Indigenous identity and disability. Expanding the MAID monitoring regime in this way will help demonstrate the presence of any inequalities or disadvantages based on these or other characteristics in the provision of MAID. In amending the MAID monitoring regulations, the Government will consult with a broad range of stakeholders, including groups representing persons experiencing inequalities, to help identify the appropriate information that needs to be collected and how collection can be undertaken in a way that is respectful, inclusive and does not impose an unreasonable burden on clinicians who are legally obligated to provide the data.
BILL C-268 PROTECTION OF FREEDOM OF CONSCIENCE ACT
Bill C-268, the Protection of Freedom of Conscience Act, proposes to amend the Criminal Code to create two hybrid offences to protect the conscience rights of healthcare providers in relation to MAID: (1) an offence prohibiting the use of violence or threats of violence, coercion or intimidation to compel a healthcare professional to participate, directly or indirectly, in the provision of MAID; and an offence prohibiting firing or refusing to employ healthcare professionals because they refuse to take part in providing MAID.

None