downloaded July 2016 from:

http://www.parl.gc.ca/content/hoc/Bills/421/Government/C-14/C-14_4/C-14_4.PDF
Canada's right-to-die law

    The right-to-die came to the whole country of Canada in June 2016.
A new law was added to the Criminal Code,
which created a new exemption for doctors and nurse-practitioners
in the law against 'assisting suicide',
which was otherwise not changed.

    This new law allows "medical assistance in dying" (MAiD),
which is carefully defined as giving the dying patient
either a lethal injection
or a lethal drug that can be taken by the dying patient.

    The MAiD law sets forth eligibility requirements
for patients-and-families to fulfill
to see if this patient will qualify for medical assistance in dying.

    Because the text of the law is not very user-friendly,
it will be explained first before the text is presented.
These comments in violet are not part of the law.

    The Canadian right-to-die law includes 12 safeguards,
which are the operational methods
by which doctors, patients, & their families
are empowered to examine their end-of-life options.
These safeguards are presented here in the order of importance,
beginning with the most important procedures.

    Each safeguards is linked to a more complete explanation
of how to apply that safeguard found on the Internet.
These explanations are not included in Canada's right-to-die law.

Requests for Death from the Patient

Physician's Statement of Condition and Prognosis

Independent Physician Reviews the Condition and Prognosis

Certification of Terminal Illness or Incurable Condition

Informed Consent from the Patient

Unbearable Suffering

Unbearable Psychological Suffering

Psychological Consultant Evaluates the Patient's Ability to Make Medical Decisions

Information about Palliative Care and other Alternatives to Death

The Patient Must be an Adult Resident of the State
(This residency requirement is implicit in the requirement
that the patient be covered by
any government health-insurance program in Canada.)

Waiting Periods For Reflection

Opportunities for the Patient to Rescind or Postpone the Life-Ending Decision

When each of these safeguards appears in the text of the law,
a hyperlink is provided to the explanation on the Internet.

    HealthCanada has provided a useful summary of this law,
with hundreds of relevant links for more information:
http://healthycanadians.gc.ca/health-system-systeme-sante/services/palliative-pallatifs/medical-assistance-dying-aide-medicale-mourir-eng.php


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First Session, Forty-second Parliament,
64-65 Elizabeth II, 2015-2016 
STATUTES OF CANADA 2016 
CHAPTER 3 
An Act to amend the Criminal Code
and to make related amendments to other Acts
(medical assistance in dying)

ASSENTED TO JUNE 17, 2016
BILL C-14

SUMMARY

This enactment amends the Criminal Code to, among other things,

(a) create exemptions from the offences of culpable homicide,
of aiding suicide and of administering a noxious thing,
in order to permit medical practitioners and nurse practitioners
to provide medical assistance in dying
and to permit pharmacists and other persons to assist in the process;

(b) specify the eligibility criteria and the safeguards that must be respected
before medical assistance in dying may be provided to a person;

(c) require that medical practitioners and nurse practitioners
who receive requests for, and pharmacists who dispense substances
in connection with the provision of, medical assistance in dying
provide information for the purpose of permitting the monitoring
of medical assistance in dying,
and authorize the Minister of Health to make regulations respecting that information;
and

(d) create new offences for failing to comply with the safeguards,
for forging or destroying documents related to medical assistance in dying,
for failing to provide the required information and for contravening the regulations.

This enactment also makes related amendments
to other Acts to ensure that recourse to medical assistance in dying
does not result in the loss of a pension under the Pension Act
or benefits under the Canadian Forces Members
and Veterans Re-establishment and Compensation Act.
It amends the Corrections and Conditional Release Act
to ensure that no investigation need be conducted under section 19 of that Act
in the case of an inmate who receives medical assistance in dying.

This enactment provides for one or more independent reviews
relating to requests by mature minors for medical assistance in dying,
to advance requests
and to requests where mental illness is the sole underlying medical condition.

Lastly, this enactment provides for a parliamentary review
of its provisions and of the state of palliative care in Canada
to commence at the start of the fifth year
following the day on which it receives royal assent.

64-65 ELIZABETH II
CHAPTER 3

An Act to amend the Criminal Code
and to make related amendments to other Acts
(medical assistance in dying)
[Assented to 17th June, 2016]

Preamble

Whereas the Parliament of Canada recognizes the autonomy of persons
who have a grievous and irremediable medical condition
that causes them enduring and intolerable suffering
and who wish to seek medical assistance in dying;

Whereas robust safeguards,
reflecting the irrevocable nature of ending a life,
are essential to prevent errors and abuse
in the provision of medical assistance in dying;

Whereas it is important to affirm the inherent and equal value of every person’s life
and to avoid encouraging negative perceptions of the quality of life
of persons who are elderly, ill or disabled;

Whereas vulnerable persons must be protected from being induced,
in moments of weakness, to end their lives;

Whereas suicide is a significant public health issue
that can have lasting and harmful effects
on individuals, families and communities;

Whereas, in light of the above considerations,
permitting access to medical assistance in dying
for competent adults whose deaths are reasonably foreseeable
strikes the most appropriate balance between
the autonomy of persons who seek medical assistance in dying, on one hand,
and the interests of vulnerable persons
in need of protection and those of society, on the other;

Whereas it is desirable to have a consistent approach
to medical assistance in dying across Canada,
while recognizing the provinces’ jurisdiction
over various matters related to medical assistance in dying,
including the delivery of health care services
and the regulation of health care professionals,
as well as insurance contracts and coroners and medical examiners;

Whereas persons who avail themselves of medical assistance in dying
should be able to do so without adverse legal consequences for their families
— including the loss of eligibility for benefits —
that would result from their death;

Whereas the Government of Canada has committed to uphold
the principles set out in the Canada Health Act
— public administration, comprehensiveness, universality, portability and accessibility —
with respect to medical assistance in dying;

Whereas everyone has freedom of conscience and religion
under section 2 of the Canadian Charter of Rights and Freedoms;

Whereas nothing in this Act affects the guarantee of freedom of conscience and religion;

Whereas the Government of Canada recognizes that in the living conditions of Canadians,
there are diverse circumstances and that different groups have unique needs,
and it commits to working with provinces, territories and civil society
to facilitate access to palliative and end-of-life care,
care and services for individuals living with Alzheimer’s and dementia,
appropriate mental health supports and services
and culturally and spiritually appropriate end-of-life care for Indigenous patients;

And whereas the Government of Canada
has committed to develop non-legislative measures
that would support the improvement of a full range of options for end-of-life care,
respect the personal convictions of health care providers and explore other situations
— each having unique implications —
in which a person may seek access to medical assistance in dying,
namely situations giving rise to requests by mature minors,
advance requests
and requests where mental illness is the sole underlying medical condition;

Now, therefore, Her Majesty,
by and with the advice and consent
of the Senate and House of Commons of Canada,
enacts as follows:

R.S., c. C-46

Criminal Code

1 Section 14 of the Criminal Code is replaced by the following:

Consent to death

14 No person is entitled to consent to have death inflicted on them,
and such consent does not affect the criminal responsibility
of any person who inflicts death on the person who gave consent.

2 The Act is amended by adding the following after section 226:

Exemption for medical assistance in dying

227 (1) No medical practitioner or nurse practitioner
commits culpable homicide
if they provide a person with medical assistance in dying
in accordance with section 241.2

Exemption for person aiding practitioner

(2) No person is a party to culpable homicide
if they do anything for the purpose of
aiding a medical practitioner or nurse practitioner
to provide a person with medical assistance in dying
in accordance with section 241.2.

Reasonable but mistaken belief

(3) For greater certainty, the exemption set out in subsection (1) or (2)
applies even if the person invoking it
has a reasonable but mistaken belief
about any fact that is an element of the exemption.

Non-application of section 14

(4) Section 14 does not apply with respect to a person
who consents to have death inflicted on them
by means of medical assistance in dying
provided in accordance with section 241.2.

Definitions

(5) In this section, medical assistance in dying,
medical practitioner and nurse practitioner
have the same meanings as in section 241.1.

R.S., c. 27 (1st Supp.), s. 7(3)

3 Section 241 of the Act is replaced by the following:

Counselling or aiding suicide

241 (1) Everyone is guilty of an indictable offence
and liable to imprisonment for a term of not more than 14 years
who, whether suicide ensues or not,

(a) counsels a person to die by suicide or abets a person in dying by suicide; or

(b) aids a person to die by suicide.

Exemption for medical assistance in dying

(2) No medical practitioner or nurse practitioner
commits an offence under paragraph (1)(b)
if they provide a person with medical assistance in dying
in accordance with section 241.2.

Exemption for person aiding practitioner

(3) No person is a party to an offence under paragraph (1)(b)
if they do anything for the purpose
of aiding a medical practitioner or nurse practitioner
to provide a person with medical assistance in dying
in accordance with section 241.2.

Exemption for pharmacist

(4) No pharmacist who dispenses a substance
to a person other than a medical practitioner or nurse practitioner
commits an offence under paragraph (1)(b)
if the pharmacist dispenses the substance
further to a prescription that is written by such a practitioner
in providing medical assistance in dying
in accordance with section 241.2.

Exemption for person aiding patient

(5) No person commits an offence under paragraph (1)(b)
if they do anything, at another person’s explicit request,
for the purpose of aiding that other person
to self-administer a substance
that has been prescribed for that other person
as part of the provision of medical assistance in dying
in accordance with section 241.2.

Clarification

(5.1) For greater certainty, no social worker,
psychologist, psychiatrist, therapist, medical practitioner,
nurse practitioner or other health care professional
commits an offence if they provide information to a person
on the lawful provision of medical assistance in dying.

Reasonable but mistaken belief

(6) For greater certainty, the exemption set out in any of subsections (2) to (5)
applies even if the person invoking the exemption
has a reasonable but mistaken belief
about any fact that is an element of the exemption.

Definitions

(7) In this section, medical assistance in dying,
medical practitioner, nurse practitioner and pharmacist
have the same meanings as in section 241.1.

Medical Assistance in Dying

Definitions

241.1 The following definitions apply in this section and in sections 241.2 to 241.4.

medical assistance in dying means

(a) the administering by a medical practitioner or nurse practitioner
of a substance to a person, at their request, that causes their death; or

(b) the prescribing or providing by a medical practitioner or nurse practitioner
of a substance to a person, at their request,
so that they may self-administer the substance
and in doing so cause their own death. (aide médicale à mourir)

medical practitioner means a person who is entitled
to practise medicine under the laws of a province. (médecin)

nurse practitioner means a registered nurse who,
under the laws of a province, is entitled to practise as a nurse practitioner
 — or under an equivalent designation —
and to autonomously make diagnoses,
order and interpret diagnostic tests,
prescribe substances and treat patients. (infirmier praticien)

pharmacist means a person who is entitled to practise pharmacy
under the laws of a province. (pharmacien)

Eligibility for medical assistance in dying

241.2 (1) A person may receive medical assistance in dying
only if they meet all of the following criteria:

(a) they are eligible
— or, but for any applicable minimum period
of residence or waiting period, would be eligible —
for health services funded by a government in Canada;

(b) they are at least 18 years of age
and capable of making decisions with respect to their health;

(c) they have a grievous and irremediable medical condition;

(d) they have made a voluntary request for medical assistance in dying
that, in particular, was not made as a result of external pressure; and

(e) they give informed consent to receive medical assistance in dying
after having been informed of the means that are available
to relieve their suffering, including palliative care.

Grievous and irremediable medical condition

(2) A person has a grievous and irremediable medical condition
only if they meet all of the following criteria:

(a) they have a serious and incurable illness, disease or disability;

(b) they are in an advanced state of irreversible decline in capability;

(c) that illness, disease or disability or that state of decline
causes them enduring physical or psychological suffering
that is intolerable to them
and that cannot be relieved under conditions
that they consider acceptable; and

(d) their natural death has become reasonably foreseeable,
taking into account all of their medical circumstances,
without a prognosis necessarily having been made
as to the specific length of time that they have remaining.

Safeguards

(3) Before a medical practitioner or nurse practitioner
provides a person with medical assistance in dying,
the medical practitioner or nurse practitioner must

(a) be of the opinion that the person
meets all of the criteria set out in subsection (1);

(b) ensure that the person’s request for medical assistance in dying was
(i) made in writing and signed and dated by the person
or by another person under subsection (4), and
(ii) signed and dated after the person was informed
by a medical practitioner or nurse practitioner
that the person has a grievous and irremediable medical condition;

(c) be satisfied that the request was signed and dated by the person
— or by another person under subsection (4) —
before two independent witnesses
who then also signed and dated the request;

(d) ensure that the person has been informed
that they may, at any time and in any manner, withdraw their request;

(e) ensure that another medical practitioner or nurse practitioner
has provided a written opinion confirming
that the person meets all of the criteria set out in subsection (1);

(f) be satisfied that they and the other medical practitioner
or nurse practitioner referred to in paragraph (e) are independent;

(g) ensure that there are at least 10 clear days
between the day on which the request was signed by or on behalf of the person
and the day on which the medical assistance in dying is provided or
— if they and the other medical practitioner
or nurse practitioner referred to in paragraph (e)
are both of the opinion that the person’s death,
or the loss of their capacity to provide informed consent, is imminent —
any shorter period that the first medical practitioner
or nurse practitioner considers appropriate in the circumstances;

(h) immediately before providing the medical assistance in dying,
give the person an opportunity to withdraw their request
and ensure that the person gives express consent
to receive medical assistance in dying; and

(i) if the person has difficulty communicating,
take all necessary measures to provide a reliable means
by which the person may understand the information
that is provided to them and communicate their decision.

Unable to sign

(4) If the person requesting medical assistance in dying
is unable to sign and date the request, another person
— who is at least 18 years of age,
who understands the nature of the request for medical assistance in dying
and who does not know or believe that they are a beneficiary
under the will of the person making the request,
or a recipient, in any other way, of a financial
or other material benefit resulting from that person’s death —
may do so in the person’s presence,
on the person’s behalf and under the person’s express direction.

Independent witness

(5) Any person who is at least 18 years of age
and who understands the nature of the request
for medical assistance in dying
may act as an independent witness, except if they

(a) know or believe that they are a beneficiary under the will
of the person making the request, or a recipient, in any other way,
of a financial or other material benefit resulting from that person’s death;

(b) are an owner or operator of any health care facility
at which the person making the request is being treated
or any facility in which that person resides;

(c) are directly involved in providing health care services
to the person making the request; or

(d) directly provide personal care to the person making the request.

Independence — medical practitioners and nurse practitioners

6) The medical practitioner or nurse practitioner
providing medical assistance in dying
and the medical practitioner or nurse practitioner
who provides the opinion referred to in paragraph (3)(e)
are independent if they

(a) are not a mentor to the other practitioner
or responsible for supervising their work;

(b) do not know or believe that they are a beneficiary
under the will of the person making the request,
or a recipient, in any other way, of a financial or other material benefit
resulting from that person’s death,
other than standard compensation
for their services relating to the request; or

(c) do not know or believe that they are
connected to the other practitioner
or to the person making the request
in any other way that would affect their objectivity.

Reasonable knowledge, care and skill

(7) Medical assistance in dying must be provided
with reasonable knowledge, care and skill
and in accordance with any applicable
provincial laws, rules or standards.

Informing pharmacist

(8) The medical practitioner or nurse practitioner who,
in providing medical assistance in dying,
prescribes or obtains a substance for that purpose
must, before any pharmacist dispenses the substance,
inform the pharmacist that the substance is intended for that purpose.

Clarification

(9) For greater certainty, nothing in this section
compels an individual to provide or assist in providing
medical assistance in dying.

Failure to comply with safeguards

241.3 A medical practitioner or nurse practitioner who,
in providing medical assistance in dying,
knowingly fails to comply with all of the requirements
set out in paragraphs 241.2(3)(b) to (i) and subsection 241.2(8)
is guilty of an offence and is liable

(a) on conviction on indictment,
to a term of imprisonment of not more than five years; or

(b) on summary conviction,
to a term of imprisonment of not more than 18 months.

Forgery

241.4 (1) Everyone commits an offence
who commits forgery in relation to
a request for medical assistance in dying.

Destruction of documents

(2) Everyone commits an offence
who destroys a document that relates
to a request for medical assistance in dying
with intent to interfere with

(a) another person’s access to medical assistance in dying;

(b) the lawful assessment of a request for medical assistance in dying; or

(c) another person invoking an exemption
under any of subsections 227(1) or (2), 241(2) to (5) or 245(2).

Punishment

(3) Everyone who commits an offence under subsection (1) or (2) is liable

(a) on conviction on indictment,
to a term of imprisonment of not more than five years; or

(b) on summary conviction,
to a term of imprisonment of not more than 18 months.

Definition of document

(4) In subsection (2), document has the same meaning as in section 321.

4 The Act is amended by adding the following after section 241.3:

Filing information — medical practitioner or nurse practitioner

241.31 (1) Unless they are exempted
under regulations made under subsection (3),
a medical practitioner or nurse practitioner
who receives a written request for medical assistance in dying must,
in accordance with those regulations,
provide the information required by those regulations
to the recipient designated in those regulations.

Filing information — pharmacist

(2) Unless they are exempted
under regulations made under subsection (3),
a pharmacist who dispenses a substance
in connection with the provision of medical assistance in dying must,
in accordance with those regulations,
provide the information required by those regulations
to the recipient designated in those regulations.

Regulations

(3) The Minister of Health must make regulations
that he or she considers necessary

(a) respecting the provision and collection,
for the purpose of monitoring medical assistance in dying,
of information relating to requests for, and the provision of,
medical assistance in dying, including

(i) the information to be provided, at various stages,
by medical practitioners or nurse practitioners and by pharmacists,
or by a class of any of them,

(ii) the form, manner and time
in which the information must be provided,

(iii) the designation of a person
as the recipient of the information, and

(iv) the collection of information
from coroners and medical examiners;

(b) respecting the use of that information,
including its analysis and interpretation,
its protection and its publication and other disclosure;

(c) respecting the disposal of that information; and

(d) exempting, on any terms that may be specified,
a class of persons from the requirement
set out in subsection (1) or (2).

Guidelines — information on death certificates

(3.1) The Minister of Health,
after consultation with representatives
of the provincial governments responsible for health,
must establish guidelines on the information
to be included on death certificates
in cases where medical assistance in dying has been provided,
which may include the way in which
to clearly identify medical assistance in dying as the manner of death,
as well as the illness, disease or disability
that prompted the request for medical assistance in dying.

Offence and punishment

(4) A medical practitioner or nurse practitioner
who knowingly fails to comply with subsection (1),
or a pharmacist who knowingly fails to comply with subsection (2),

(a) is guilty of an indictable offence
and liable to a term of imprisonment of not more than two years; or

(b) is guilty of an offence punishable on summary conviction.

Offence and punishment

(5) Everyone who knowingly contravenes
the regulations made under subsection (3)

(a) is guilty of an indictable offence
and liable to a term of imprisonment of not more than two years; or

(b) is guilty of an offence punishable on summary conviction.

5 Subsection 241.4(2) of the Act is amended
by striking out “or” at the end of paragraph (b),
by adding “or” at the end of paragraph (c)
and by adding the following after that paragraph:

(d) the provision by a person of information under section 241.31.

6 Section 245 of the Act is renumbered as subsection 245(1)
and is amended by adding the following after that subsection:

Exemption

(2) Subsection (1) does not apply to

(a) a medical practitioner or nurse practitioner
who provides medical assistance in dying
in accordance with section 241.2; and

(b) a person who does anything for the purpose of aiding
a medical practitioner or nurse practitioner
to provide medical assistance in dying
in accordance with section 241.2.

Definitions

(3) In subsection (2), medical assistance in dying,
medical practitioner and nurse practitioner
have the same meanings as in section 241.1.

Related Amendments

R.S., c. P-6
Pension Act

7 (1) The definition improper conduct in subsection 3(1)
of the Pension Act is replaced by the following:

improper conduct includes wilful disobedience of orders,
vicious or criminal conduct and wilful self-inflicted wounding
— except if the wound results from
the receipt of medical assistance in dying
and the requirement set out in paragraph 241.2(3)(a)
of the Criminal Code has been met; (mauvaise conduite)

(2) Subsection 3(1) of the Act is amended
by adding the following in alphabetical order:

has the same meaning
as in section 241.1 of the Criminal Code;
(aide médicale à mourir)

(3) Section 3 of the Act is amended
by adding the following after subsection (3):

Deeming — medical assistance in dying

(4) For the purposes of this Act,
if a member of the forces receives medical assistance in dying,
that member is deemed to have died
as a result of the illness, disease or disability
for which they were determined to be eligible
to receive that assistance,
in accordance with paragraph 241.2(3)(a) of the Criminal Code.

1992, c. 20

Corrections and Conditional Release Act

8 Section 19 of the Corrections and Conditional Release Act
is amended by adding the following after subsection (1):

Medical assistance in dying

(1.1) Subsection (1) does not apply to a death that results
from an inmate receiving medical assistance in dying,
as defined in section 241.1 of the Criminal Code,
in accordance with section 241.2 of that Act.

2005, c. 21

Canadian Forces Members and
Veterans Re-establishment and Compensation Act

9 (1) Subsection 2(1) of the Canadian Forces Members
and Veterans Re-establishment and Compensation Act
is amended by adding the following in alphabetical order:

medical assistance in dying has the same meaning
as in section 241.1 of the Criminal Code.
(aide médicale à mourir)

(2) Section 2 of the Act is amended
by adding the following after subsection (5):

Interpretation — medical assistance in dying

(6) For the purposes of this Act,
a member or veteran has neither inflicted wilful self-injury
nor engaged in improper conduct
by reason only that they receive medical assistance in dying,
if the requirement set out in paragraph 241.2(3)(a)
of the Criminal Code has been met.

Deeming — medical assistance in dying

(7) For the purposes of this Act,
if a member or a veteran receives medical assistance in dying,
that member or veteran is deemed to have died
as a result of the illness, disease or disability
for which they were determined to be eligible
to receive that assistance,
in accordance with paragraph 241.2(3)(a) of the Criminal Code.

Independent Review

Mature minors, advance requests and mental illness

9.1 (1) The Minister of Justice and the Minister of Health must,
no later than 180 days after the day on which this Act receives royal assent,
initiate one or more independent reviews
of issues relating to requests by mature minors
for medical assistance in dying, to advance requests
and to requests where mental illness
is the sole underlying medical condition.

(2) The Minister of Justice and the Minister of Health must,
no later than two years after the day on which a review is initiated,
cause one or more reports on the review,
including any findings or recommendations resulting from it,
to be laid before each House of Parliament.

Review of Act

Review by committee

10 (1) At the start of the fifth year
after the day on which this Act receives royal assent,
the provisions enacted by this Act
are to be referred to the committee of the Senate,
of the House of Commons or of both Houses of Parliament
that may be designated or established
for the purpose of reviewing the provisions.

Report

(2) The committee to which the provisions are referred is to review them
and the state of palliative care in Canada
and submit a report to the House or Houses of Parliament
of which it is a committee,
including a statement setting out any changes
to the provisions that the committee recommends.

Coming into Force

Order in council

11 Sections 4 and 5 come into force
12 months after the day on which this Act receives royal assent
or on any earlier day
that may be fixed by order of the Governor in Council.

++++++++++++++++++++++++++++++++++++++++

PROVINCES AND TERRITORIES OF CANADA
MAY ENACT THEIR OWN END-OF-LIFE MEDICAL CARE LAWS

    Each of the provinces and territories of Canada
is also permitted to create its own regulations
concerning end-of-life medical care
because these governmental bodies
are responsible for health-care in Canada.

    The province of Quebec has created such a law:
https://s3.amazonaws.com/aws-website-jamesleonardpark---freelibrary-3puxk/SG-QUEB2.html.

    When other provinces and territories
modify their health-care laws
to allow more choices at the end of life,
they will also be linked from here.

    If you are a legislator from another province of Canada,
here are some explicit suggestions for improving
Quebec's law concerning end-of-life medical care:
https://s3.amazonaws.com/aws-website-jamesleonardpark---freelibrary-3puxk/SG-CAN.html.
These ways to make a better law include
putting all of the safeguards into one section of the law
and naming all five medical methods of managing dying.



THE ROLE OF NURSE PRACTITIONERS
IN MEDICAL ASSISTANCE IN DYING

    The law above gives registered nurse practitioners
that same rights and responsibilities as physicians
in the practice of granting medical assistance in dying.
Here is a comprehensive explanation of how to apply the national law
from the College of Nurses of Ontario:
http://cno.org/globalassets/4-learnaboutstandardsandguidelines/maid/maid-june-23-final.pdf



Go to a listing of safeguards used in other places:
Safeguards as Found in Various Laws and Proposed Laws.
Created July 2, 2016; Revised 7-6-2016; 7-7-2016; 7-8-2016; 1-4-2019;

Go to the beginning of this website
James Leonard Park—Free Library