Bill C-7 amends Canada’s law on euthanasia, which is euphemistically referred to as medical assistance in dying, in the bill. The federal government proposed Bill C-7 as its response to the September 2019 Quebec Superior Court decision striking down the requirement in Bill C-14 that natural death be reasonably foreseeable in order to qualify for euthanasia. The government could have exercised its option to appeal the decision but chose not to. While Bill C-7 removes the clause that natural death be reasonably foreseeable, it goes much further than the Quebec Superior Court decision mandated.

elderly man hospital bed

This bill greatly expands access to euthanasia. It allows physicians and nurse practitioners to euthanize a patient even if the patient is no longer able to consent as long as the patient has previously indicated consent. In Bill C-14 which was passed in 2016, the ability to consent prior to receiving a lethal injection was presented as a safeguard to protect vulnerable persons from involuntary euthanasia:

“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.”

Consider in addition that the 2015 Supreme Court decision in Carter explicitly stated that euthanasia would be allowed “for a competent adult person who clearly consents to the termination of life.”

The Summary of Bill C-7 states that “this enactment amends the Criminal Code, to among other things”:  permit medical assistance in dying to be provided to a person who has been found eligible to receive it, whose natural death is reasonably foreseeable and who has lost the capacity to consent before medical assistance in dying is provided, on the basis of a prior agreement they entered into with the medical practitioner or nurse practitioner: and permit medical assistance in dying to be provided to a person who has lost the capacity to consent to it as a result of the self-administration of a substance that was provided to them under the provisions governing medical assistance in dying in order to cause their own death.

Page 2 of the bill says:  “while recognizing the inherent risks and complexity of permitting medical assistance in dying for persons who are unable to provide consent at the time of the procedure, Parliament considers it appropriate to permit dying persons who have been found eligible to receive medical assistance in dying and are awaiting its provision to obtain medical assistance in dying even if they lose the capacity to provide final consent, except if they demonstrate signs of refusal of the procedure.”

Section 3.2 of Bill C-7 now permits euthanasia of a patient who is no longer competent if the patient has previously given consent as long as “the person does not demonstrate by words, sounds or gestures, refusal to have the substance administered or resistance to its administration.”
However, section 3.3 which follows says: “For greater certainty, involuntary words, sounds or gestures, made in response to contact do not constitute a demonstration of refusal or resistance for the purpose of paragraph 3.2c.” According to these two sections of the bill, it seems that the decision depends entirely on how the physician interprets the words, sounds or gestures of the incompetent patient. Clause (3.3) provides protection to the physician not the patient.

Consider the following report from Holland. An elderly woman with dementia had given her consent to euthanasia in an advance directive. A physician at the facility where she lived decided later that the time had come for euthanasia. Prior to administering the lethal injection, the physician had placed a sedative in the elderly woman’s coffee. The patient struggled when the physician began the injection at which point, the physician asked the woman’s family to hold her down so she could finish the injection. The family agreed to do so.

Changing the law to allow euthanasia by advance consent was not required by the Truchon decision of the Quebec Superior Court. In such cases, there is always a risk that a person may receive euthanasia against their wishes. Secondly, Bill C-14 required two independent witnesses to a patient’s request for euthanasia. Bill C-7 requires only one witness and that person can be a paid caregiver or a medical professional responsible for your care. It cannot be however, the physician or nurse practitioner who will deliver the lethal injection.

It also eliminates the 10 day waiting period between the time of the request and the provision of the lethal injection for those whose natural death is reasonably foreseeable. It means that it would be possible for someone to request and receive euthanasia on the same day. For those whose natural death is not reasonably foreseeable but meet other criteria, a 90 day reflection period is required.

Persons with chronic illnesses or disabilities are at risk with this change in the law. Adequate support services are still lacking for them. Under Bill C-14, cases of coercion towards euthanasia were reported in Canadian media. CTV featured the story of Roger Foley and CBC, the story of Candice Lewis. Persons with disabilities are now eligible for euthanasia and in two years, persons with mental illness will be as well.

Finally this bill lacks specific conscience rights protection for health care professionals and institutions who object to participation in euthanasia. Prior to the 2015 Supreme Court decision in Carter, euthanasia was considered homicide. Now, we are told that giving lethal injections is health care. Patients need care not killing.

In December 2020, Justice Minister Lametti asked and obtained from the Quebec Superior Court, an extension to give more time for the federal government to pass Bill C-7. The government was given until February 26, 2021. Bill C-7 became law on March 17th, 2021.