Kelly Block MP speech supporting Bill C-230 - The Protection of Freedom of Conscience Act.

The speech by Kelly Block MP from March 28 supporting Bill C-230 - The Protection of Freedom of Conscience Act. 

Link to the video of Kelly Block's speech in parliament.

Sign the online Petition in support of Bill C-230 (Link)

Order MP postcards (at no cost) supporting Bill C-230 to send to your Member of Parliament by contacting EPC at: 1-877-439-3348 or  office@epcc.ca 

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Mr. Speaker, it is a privilege to rise today to begin the debate on my private member's bill, Bill C-230, the protection of freedom of conscience act. This bill revives my private member's bill, which died on the Order Paper, from the last Parliament, with some slight modifications.

I would be remiss if I did not once again acknowledge that this bill is built on the hard work and determination of former members of Parliament. The first bill proposed to address this issue was introduced by the late Mark Warawa in 2016. His bill did not proceed because of the government's introduction of Bill C-14. After Bill C-14 was passed into law, my former colleague David Anderson introduced his private member's bill, Bill C-418, during the 42nd Parliament. However, that bill also died on the Order Paper when the general election was called in 2019.

I would like to thank all those who have been championing this issue for many years and their willingness to work with me. Experts throughout Canada have provided information and advice, while thousands of grassroots Canadians voiced their support for protecting our fundamental freedoms. I would also like to thank the Library of Parliament for its timely, diligent and expert research, which helped inform this proposed legislation.

For the purposes of this debate, I think it is important to understand conscience. There are numerous definitions of conscience, but they are consistent in defining it as an individual’s inner sense of knowing the difference between what is right and wrong and allowing that knowledge to guide their behaviour. The Canadian Charter of Rights and Freedoms, under the heading of “Fundamental Freedoms”, in subsection 2(a) states that everyone has the fundamental freedom of conscience. In this way, Bill C-230 is straightforward. It seeks to add two new offences to the Criminal Code of Canada. I will read the summary so members will know what they are:

This enactment amends the Criminal Code to make it an offence to intimidate a medical practitioner, nurse practitioner, pharmacist or other health care professional for the purpose of compelling them to take part, directly or indirectly, in the provision of medical assistance in dying.

It also makes it an offence to dismiss from employment or to refuse to employ a medical practitioner, nurse practitioner, pharmacist or other health care professional for the reason only that they refuse to take part, directly or indirectly, in the provision of medical assistance in dying.

This bill is a response to calls from disability rights groups, first nations, the Ontario Medical Association, legal experts and many medical and mental health professionals to protect conscience rights. It ensures that medical professionals who choose not to take part in or refer a patient for assisted suicide or medical assistance in dying will never be forced or coerced to violate their freedoms as stated in the charter.

Previous Parliaments have passed laws that created the unintended consequence of doctors and medical professionals being forced to participate in providing a patient's death, regardless of whether they believe it is in their best interest. Bill C-14 and Bill C-7 created a federal standard for medical assistance in dying and assisted suicide but not for conscience protections.

By way of background, sections 241.1 to 241.4 of the Criminal Code of Canada deal with the provision of medical assistance in dying. These sections are in part VIII of the code. It deals with offences against the person and reputation, which include offences such as homicide, kidnapping, assault and many more. Subsection 241(1) of the Criminal Code still makes it a criminal offence to counsel or aid in a suicide. It reads:

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.

When creating the exemption allowing for MAID, the government had to create an exemption to this prohibition on counselling or aiding in suicide. This then leads to the untenable claim that the Criminal Code already protects the conscience rights of medical professionals.

Some claim that the clarification clause, section 241.2 (9) of the Criminal Code, somehow protects conscience rights. It states:

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

While I understand why some would want to think it protects conscience rights, I believe they are sadly mistaken. While I appreciate and support this inclusion in the Criminal Code, it only addresses one side of the coin. This clause only confirms that the Criminal Code is not the source of compulsion to participate in medical assistance in dying.

For the Criminal Code to have any teeth on this issue, it should articulate that it is an offence to compel someone to provide, or assist in providing, medical assistance in dying against their will. Compelling someone to participate in MAID can and does happen, which is why I have brought forward this legislation and why it needs to pass.

Regarding jurisdictional questions about this bill, as I mentioned earlier, this bill proposes that two new offences be added to the Criminal Code of Canada to address intimidation, dismissal from employment or refusal to employ a medical professional. This is similar to section 425 of the Criminal Code, which addresses the same actions taken by an employer to compel employees with respect to belonging to or organizing a union. I would suggest that if it is appropriate to have section 425 in the Criminal Code, it is reasonable to include the amendments I am proposing.

I would also submit that it is inaccurate to argue that conscience rights legislation somehow interferes with the role of the provinces while, at the same time, believing that the legalization of medical assistance in dying does not. Ensuring that conscience rights are protected is the responsibility of Parliament and of the Government of Canada, which is why I introduced this bill and why it should be passed.

Additionally, provinces can introduce their own conscience rights legislation for medical professionals. For example, Manitoba has passed simple and clear legislation in this regard, and I would encourage all provincial legislatures and parliaments to follow Manitoba’s example.

While the text of this bill focuses on the conscience rights of medical professionals, this legislation also serves to protect the right of patients to receive a second opinion. What do I mean by this? If all doctors are forced to propose MAID as a treatment option to their patients, this one-size-fits-all approach would give Canadian patients less choice, not more.

Additionally, individuals who object to MAID would be deterred from entering the medical profession altogether. Patients would no longer be able to seek a second opinion for their end-of-life care. In this way, conscience rights for medical professionals not only protect medical professionals and their patients, but they also protect our health care system.

Without conscience rights, doctors are constrained to provide, or refer their patients to receive, medical assistance in dying, regardless of whether it is their professional opinion that it is in the best interest of the patient. This concern for the patient’s best interest does not mean that a medical professional objects to medical assistance in dying in all cases, just that in his or her opinion it is not an option that should have to be offered in every case. This became especially pertinent to the medical community with the passage of Bill C-7.

To highlight the impact of the removal of the safeguard that death be reasonably foreseeable, I would like to quote from a recent column published online in Policy Options magazine which states the following:

Many injuries and physical illnesses are indeed accompanied by temporary depression and suicidal thinking. For example, research demonstrates increased risk of suicide for two years after a spinal cord injury. This suicidality overwhelmingly ends with adaptation and recovery support. Offering death to anyone during a period of transient increased suicidality is, in our view, unethical and violates the standard of medical care by which physicians must abide.

The fact that the newly expanded law may facilitate death in those circumstances of increased suicidal thinking is, in and of itself, problematic.

Some have tried to frame conscience rights as the rights of the patient versus the rights of the doctor. Nothing could be further from the truth.

Health care is fundamentally about the doctor-patient relationship. For example, take the psychiatrist who supports MAID in certain circumstances, but in a certain case has spent 15 years counselling a patient who suffers from bouts of depression and suicidality. For 15 years, they have built understanding and trust. What would happen if that patient, suffering from a bout of suicidality, should demand assisted suicide? Under current law, that psychiatrist would be forced to refer that patient to someone else so he or she could die. They must do this, despite knowing that the suicidal thoughts are temporary and that otherwise the patient is joyful and loves his or her life. Ending that patient's life would be wrong, but the psychiatrist’s hands are tied. This should not be what passes for medical care in Canada.

Some might claim that there are safeguards in place to prevent such tragedies, but I would ask them if they are absolutely sure. With the passage of Bill C-7, many safeguards for medical professionals were removed. We are talking about ending a human life. There is no room for uncertainty when a life hangs in the balance.

Additionally, should the first line of safeguards not be the expertise of the medical professionals who know their patients best? If those medical professionals do not believe death is the answer, should we not at least consider if they are right? However, this then leads to the concern some raise that protecting the conscience rights of medical professionals will block access to those who truly want it. I would suggest this is both misleading and nothing but baseless fearmongering. Medical assistance in dying and assisted suicide are readily available throughout all of Canada. There are information phone lines, hospitals staffed with willing medical professionals, even email addresses to help set up appointments. In a word, MAID has become the status quo. It is available. 

The Canadian Medical Association also stated clearly that conscience protections would not affect access because there were more than enough physicians willing to offer MAID. Therefore, common sense should tell us that the charter rights of medical professionals are breached when they are forced to either offer or refer assisted suicide or medical assistance in dying. Surely, we have the capacity to both ensure access to MAID while still protecting the fundamental charter right to freedom of conscience. 

Finally, some have suggested that medical professionals should leave their morality at the door. I do not believe we want this to happen. For example, we would all want and expect doctors to be bound by their morals if they were offered a bribe to move someone up on a waiting list. If we hold our medical professionals to a higher standard, we cannot then tell them to ignore their personal moral standards. Further, while discussing the issue of conscience rights with a doctor, she told me that, in the absence of conscience protection, the group with the most to lose are the patients, and they are the ones we are trying to help. This bill protects the doctor-patient relationship by ensuring that doctors and other medical professionals are always able to recommend and provide the care they believe is best for their patients. Patients need this bill to pass. Canada’s medical professionals need this bill to pass.

Over the past two years, we have seen just how important our health care system is and how critical the medical professionals who work in that system are to Canadians and our way of life. We need to create a work environment for medical professionals that protects them, supports them, and encourages them to continue in the critical work they do. 

In closing, I encourage all members to support passage of the protection of freedom of conscience act.

Kelly Block (MP) sponsors Bill C-268 - Protection of Freedom of Conscience Act

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Kelly Block, a Member of Parliament from Saskatchewan has sponsored Private Members Bill C-268: An Act to amend the Criminal Code (intimidation of health care professionals) cited as the Protection of Freedom of Conscience Act. Bill C-268 is scheduled for its first hour of debate on May 27, 2021.

Sign the EPC petition supporting Bill C-268 (Link).

Bill C-268 is similar to Bill C-418 that was sponsored by David Anderson MP in the previous parliament.

Bill C-268 protects conscience rights for medical professionals by preventing coercion and intimidation to participate in acts and protects their employment for medical professionals who conscientiously object to certain acts. 

Bill C-268 amends Section 241.5 (1) of the criminal code to state:

Every person who, for the purpose of compelling a medical practitioner, nurse practitioner, pharmacist or other health care professional to take part, directly or indirectly, in the provision of medical assistance in dying, uses violence or threats of violence, coercion or any other form of intimidation, is guilty

Bill C-268 also amends Section 241.5 (2) of the criminal code to state:

Every person who refuses to employ, or dismisses from their employment, a medical practitioner, nurse practitioner, pharmacist or other health care professional for the reason only that they refuse to take part, directly or indirectly, in the provision of medical assist­ance in dying is guilty

Sign the EPC petition supporting Bill C-268 (Link).  

The Euthanasia Prevention Coalition supports Bill C-268 and we will keep you up-to-date with the progress of the bill.

More information on this topic:

1. Assisted suicide and conscience rights must be reconciled (Link).  
2. Physicians should not be forced to make referrals for MAiD (Link). 
3. Dr Leonie Herx: Without my conscience rights I cannot be a good physician for my patients (Link).
4. A growing number of Canadian physicians are being bullied to participate in MAiD (Link).
   

Attacks on Conscience Rights are also an American concern.

By Mark Hodges (EPC researcher)

The Canadian Parliament is debating whether doctors may follow their vow and conviction to “do no harm,” or if government can force them to violate their most sacred and deeply held belief against euthanasia (lethal injection).

On the crucial conscience rights issue, the United States is only a step behind Canada, and may be closing in fast.

• Video: Conscience rights are essential (Link).

Saskatchewan MP David Anderson sponsored the Conscience Rights protection bill (C-418) that will determine whether conscientious objecting physicians will leave their profession, or forced to be complicit with killing.

Over the past decade, a debate has arisen over “competing rights,” namely, the fundamental right of physicians and other citizens to practice with integrity and conscience, versus a new “right” of patients to be euthanized upon request, regardless of their doctor’s convictions.

Assisted suicide advocates in both Canada and the U.S. say doctors’ rights must be overridden or compromised in favor of the "right to die". In 2016, the Canadian Medical Association voted against physicians’ conscience rights by a margin of 71 percent.

Conscience supporters say assisted suicide is not healthcare, and it is a doctor’s right to refuse to kill his/her patients, or refuse to prescribe lethal medication, and refuse to refer or be complicit with the act.

After Canada’s Supreme Court decriminalized euthanasia in 2015, the College of Physicians and Surgeons of Ontario promoted what they called a “compromise” which did not require doctors to lethally inject patients but it required doctors who objected to refer their patients to a death doctor.

This stripping of individual conscience rights is spreading to the United States. Proposed assisted suicide bills in Massachusetts, Minnesota, New Mexico, and Wisconsin included clauses to force objecting physicians to refer for suicide.

Belgium is following Ontario by pressuring all physicians regardless of conviction to refer for death by euthanasia.

Last year, the Ontario Court of Appeal upheld the College’s coercion, admitting that physicians’ rights were indeed “infringed” by the policy, but the infringement is reasonable in a democratic society. In an unprecedented ruling against Charter rights, the court institutionalized a “limit” on fundamental freedoms in the name of “ensuring access” to death “care.” 

Alex Schadenberg

The Euthanasia Prevention Coalition criticized the decision as no “compromise” at all. Alex Schadenberg stated that facilitating suicide makes one complicit in the act. He said:

“If it’s wrong to do the act, then it’s also wrong to send a patient to somebody else who will do the act,”

Ethicist Dr. Edmund Pelligrino explained that referring is participation. He reasoned.

“Formal cooperation is absolutely and always, forbidden. ...This is the case when the physician shares the evil intent, partakes directly and freely, or in any way facilitates an intrinsically evil act like…assisted suicide.”

Pro-assisted suicide politicians and doctors in the U.S. have begun to accuse physicians who refuse to practice assisted suicide of “abandoning patients.” Ironically, even ethicists in professional journal articles have called refusal to refer for death “a toxic form of patient abandonment.”

Alex Schadenberg disagree's, in life-or-death terms.

“People ask for euthanasia because they have lost hope. They may be in depression or experiencing distress, darkened by their reality, and feel that life has lost its purpose or value. In the past, doctors took this request to die as a cry for help, and they tried to find out what their patient needs to weather his or her overwhelming difficulty. The conscientious physician isn’t abandoning his or her patient, they’re caring for that person.”

Conscience advocates add that this is as much an issue of patients’ rights as it is of physicians’ rights.

“Physician conscience rights are important for physicians, but they are more important for protecting patients,”

Schadenberg pointed out, saying that conscience rights are central to protecting patients when they are most vulnerable. 

“I want a physician who will protect my life when I’m going through my deepest darkest times. When I’m going through that physical, psychological, emotional, or existential distress and I’m so darkened that I can’t see beyond my own difficulty, I need a physician who will say ‘no’ to me and will care for me, not kill me.”

Schadenberg concludes that denying conscience rights to physicians actually denies patients their right to live.

Conscience rights are not just for the religious; there are clear secular reasons to object to assisted suicide. First of all, suicide devalues human life.

The American College of Physicians stated in 2001.

“Both society in general and the medical profession in particular have important duties to safeguard the value of human life,” 

“This duty applies especially to the most vulnerable members of society.”

A second conviction against assisted suicide is that, with modern medicine and advances in palliative care, pain can be managed.

The Canadian Society of Palliative Care Physicians issued a statement against assisted euthanasia that emphasized palliative care’s mission is 

“to help patients live as fully as possible until their natural death. Palliative care strives to reduce suffering, not to intentionally end life... The Canadian public must be able to continue to trust that the principles of palliative care remain focused on effective symptom management and psychological, social, and spiritual interventions to help people live as well as they can until their natural death.”

Janice Strukoff of the Delta hospice spoke out against a 2018 edict by the Fraser Health Authority in British Columbia ordering healthcare facilities --including hospices-- to participate in Medical Aid in Dying (euthanasia). 

“Hospice palliative care is not about hastening death, and we object to the bullying currently taking place in B.C.”

Dr Neil Hilliard

The medical director of Fraser Health Palliative Care, Dr Neil Hilliard, resigned over the edict. He stated. 

“Providing euthanasia or physician-assisted suicide is not in accordance with palliative care, (which) ‘affirms life and regards dying as a normal process,’”

A third argument against assisted suicide is that physician-complicit killing destroys the doctor-patient trust to heal and do no harm.

“Legalizing euthanasia or physician-assisted suicide would have a profound and detrimental effect on the doctor–patient relationship,” 

The British Medical Association stated just sixteen years ago (2003). 

“It would be unacceptable to put vulnerable people in the position of feeling they had to consider precipitating the end of their lives.”

A fourth argument comes from the experience of states and countries where assisted suicide and euthanasia are legal. History proves that once euthanasia is accepted, limitations on candidates diminish and authorized applications expand.

Examples of the limits on euthanasia eroding are happening now. Since legalizing assisted suicide, the Oregon Health Authority changed the definition of “terminal illness” from its universally-understood meaning of “incurable and irreversible fatal disease” to include treatable medical conditions if a patient refuses to take his or her medicine.

Another example of expansion is the several assisted suicide bills debated in the Oregon legislature. One redefines “self-administer” so that the suicidal patient can legally be killed (commit “suicide”) by someone else. Another bill lengthens the necessary prognosis of six months to live. Another enables a pro-suicide doctor to wave the 15 day waiting period. Another widens “terminal” to include any medical condition that ultimately could “substantially contribute to a patient’s death.”

Some euthanasia activists go so far as to elevate the “right to die” to a “duty to die” for patients whose care “costs” too much for their families or for society at large.

In a speech to the Health Lawyers Association, then-Colorado Governor Richard Lamm stated in 1984 that the terminal elderly have “a duty to die and get out of the way,” because giving them health care would turn the U.S. into a “second-rate economic nation.” Time, the Washington Post, and the New York Times reported his remarks favorably.

It must be noted that this callous, purely economic reasoning is precisely the attitude that led pre-Nazi Germany to “dispose” of human “life devoid of value.” 

Dr. Leo Alexander, a Boston psychologist and the American psychiatric representative to the Nuremberg trials, explained that the foundations of genocide lie in euthanasia. Dr. Alexander wrote in the New England Journal of Medicine in 1949:

“The beginnings were at first merely a subtle shift of emphasis in the basic attitudes of physicians in the 1920s. It started with the acceptance of the attitude, basic in the euthanasia movement, that there is such a thing as a life not worthy to be lived,”

“This attitude in its early stages concerned itself merely with the severely and chronically sick, (then)...the socially unproductive, the ideologically unwanted, the racially unwanted, and finally all non-Germans. But it is important to realize the infinitely small wedged-in lever from which the entire mindset received its impetus was the attitude toward the non-rehabilitable sick.”

Summarizing reasons to oppose euthanasia, a 2012 statement from the Ethics, Professionalism and Human Rights Committee of the American College of Physicians read, 

“Making physician-assisted suicide legal raised serious ethical, clinical and social concerns and that the practice might undermine patient trust; distract from reform in end-of-life care; and be used in vulnerable patients, including those who are poor, are disabled, or are unable to speak for themselves or minority groups who have experienced discrimination.”

These reasons show that physicians’ right to refuse to prescribe death is not necessarily based on faith, but grounded in foundational understandings about humanity and healthcare.

David Anderson MP

Physicians leaving medicine is just what is happening in Canada. MP David Anderson testified. 

“I have spoken to doctors who feel overt pressure to leave family medicine because of their conscientious beliefs,”

“I have heard of palliative care doctors in Ontario who have stopped practicing altogether. Nurses who feel increasingly bullied are choosing to shift their focus or retire early. I have had personal conversations with people who work in old folks’ homes who explain they do not want to participate in this but are increasingly feeling pressured to do so.”

The effect of Canada’s euthanasia law is to force euthanasia objectors out of their chosen practice, or out of healthcare altogether. In May of this year, the Court of Appeal for Ontario brazenly exposed that effect as intended, actually advising conscientious medical workers to find a job where assisting suicide would not be required.

Anderson lashed out against the court’s insulting advice, calling it 

“incredibly demeaning to those men and women who have gone through years of training.”

“They are being punished for holding that level of dignity, respect and honor for their patients.”

Anderson continued:

“We have such a shortage of physicians and medical services,” 

“Particularly in rural areas, there is an increasing lack of physicians in an increasingly challenged medical system... The answer does not have to be to do it, find someone else to do it or get out of medicine.”

Fortunately, a flickering spark of common sense has been ignited in various places, and we must fan that into a flame.

The U.S. State Department report on international freedoms singled out a growing trend of prospective healthcare professionals whose potential is destroyed by a lack of conscience rights. 

“Medical and nursing students...expressed their reluctance to enter the health care field as a whole, and particularly specialties...where their objections to…euthanasia might not be respected.”

The Trump administration has officially noted Canada’s trashing of doctors’ conscience rights. Last year, U.S. Secretary of State Mike Pompeo released a report pointing out that Canada’s “regulations requiring doctors to refer patients seeking assisted death...constituted facilitation and violated constitutional guarantees of freedom of conscience and religion.”

Earlier this year, the Trump Department of Health and Human Services (HHS) reversed Obama rules and mandated conscience protections 

“for physicians, pharmacists, nurses, teachers, students, and faith-based charities,” exempting them from “having to provide, participate in, pay for, provide coverage of, or refer for, services such as...assisted suicide.”

HHS regulations now protect healthcare entities that object to 

“assisted suicide, euthanasia, or mercy killing” from “being required to perform, participate in, pay for, provide coverage for, counsel or refer for...euthanasia.”

Freedom of conscience “is the bedrock of American life,” President Donald Trump proclaimed.

The new HHS rules specifically include as unlawful discrimination:

“being steered away from a career in obstetrics, family medicine, or geriatric medicine, when one has a religious or moral objection to...physician-assisted suicide or euthanasia.”

Roger Severino, director of HHS’s Office for Civil Rights, elaborated, 

“This rule ensures that healthcare entities and professionals won’t be bullied out of the healthcare field because they decline to participate in actions that violate their conscience, including the taking of human life.”

Besides the current U.S. administration, there are other glimmers of hope. Last year the Norwegian Supreme Court handed down a landmark conscience rights ruling supporting a Polish physician who was fired for following her conscience not to kill.

In Canada, the province of Manitoba passed conscience rights legislation in 2017 allowing doctors to opt out of killing. MP David Anderson told Parliament.

“The example of the province of Manitoba...shows there does not need to be compulsion in the medical system when it comes to this issue,” 

“Why would one try to force people into doing what they believe to be wrong?”

David Anderson’s bill (C-418) has enabled debate in the Canadian Parliament. He told Parliament Bill C-418 would:

“provides the teeth” that the current law lacks. “make it an offence to intimidate” a healthcare worker “to take part, directly or indirectly, in the provision of physician-assisted suicide.” It would also stop hospitals and employers from firing healthcare workers who opt out of assisting in a patient’s suicide.

It is said, “Where the battle rages, loyalty is proved.” The fight for conscience rights is immediate and intense, and the outcome is in question not only for Canada, but the U.S. and the rest of the civilized world.

Canada's Parliament debates Conscience Rights Bill C-418

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

Petition supporting Bill C-418 to protect conscience rights (Link).

Bill C-418 is sponsored by David Anderson MP to protect conscience rights for healthcare professionals who oppose Medical Aid in Dying (euthanasia and assisted suicide).

The debate began at: 5:30 pm on May 29, 2019 (Link to the Hansard of the debate). The video of David Anderson's speech is above.

The Liberals clarified the euthanasia law while the NDP came out against conscience rights Bill C-418.

Mr. David Anderson (Cypress Hills—Grasslands, CPC) moved that Bill C-418, An Act to amend the Criminal Code (medical assistance in dying), be read the second time and referred to a committee.

David Anderson MP

Madam Speaker, the first thing I would like to do is to thank the many people across Canada who have shown up to work on this bill. It has caught on across the country. It has restored my faith in the good judgment of Canadians and, hopefully, we will see that same good sense shown in the House and we can have some restored faith here as well.

I am here today to speak to Bill C-418, which is the protection of freedom of conscience act. I need to point out again that I am surprised at the way this has caught on and caught the attention of the Canadian public. We should thank many Canadians and groups for whom this is an important issue for their work on publicizing and advancing conscience rights in Canada.

To begin to understand Bill C-418, we need to back up a bit. The Charter of Rights and Freedoms has a number of sections in it. Section 1, of course, guarantees our rights and freedoms. However, immediately following that is section 2, which declares the most fundamental rights, and that begins with freedom of conscience and religion. In 2015, the Carter decision in the Supreme Court said that although section 7 of the charter provides for the right to die, it also explicitly said that no one is required to participate in or be part of it.

We then came to Bill C-14, the government's assisted suicide bill. It is a bill that attracted much attention and controversy and laid out the groundwork for the first round of assisted suicide legislation in Canada. Whether they call it euthanasia, medically assisted dying or assisted suicide, they are all different names for the same thing. Medical practitioners were divided on the issue of participating in ending the lives of Canadians. Whether we supported Bill C-14 or not, it was clear that many within the medical community were very concerned. They did not and still do not want to participate in this activity.

When Bill C-14 was passed, it included subsection 241.2(9) which did say, “For greater certainty, nothing in this section compels an individual to provide or assist in providing medical assistance in dying.” That was not adequate because it did not lay out an offence, there was no framework for it and there was no penalty in Bill C-14 if someone violated that. It ended up being nothing more than a statement in Bill C-14.

While the Liberal talking points have repeated this, and the Liberals also claim that everyone has freedom of conscience and religion under section 2 of the charter, this is not the reality that medical personnel are facing across Canada. In spite of the fact that on the surface the charter, Carter and Bill C-14 supposedly agree, the reality is that physicians and medical personnel in this country are being pressured to participate in something with which they fundamentally disagree and there is no protection provided to them.

Conscience forms the basis of medical professionals' motivation to pursue their particular field. Doctors practise every day with the knowledge that it is their conscience that motivates them to test the limits of their knowledge and skill. Medical professionals know that patient care will suffer if they are deprived of the ability to live with integrity and to follow their consciences. They know the importance of these beliefs to them and their patients better than anyone else.

For a great many Canadian doctors, the core of their conscience prohibits their participation in taking a life. Indeed, many doctors remain devoted to the black and white of the ancient Hippocratic oath, a pledge that prohibits the administration of a poison to anyone. Through the availability of assisted suicide on demand across Canada, threats to conscience are no longer confined to the theoretical or to the rhetoric of the courtrooms. They are increasingly present in the examination room as well.

That is why I believe it is time to take action in defence of conscience rights that have stood the test of time for generations. Therefore, Bill C-418 seeks to amend the Criminal Code to do two things.

The first is to make it an offence to intimidate a medical practitioner, nurse practitioner, pharmacist or any other health care professional for the purpose of compelling them to take part, directly or indirectly, in the provision of physician-assisted suicide.

The second provision makes it an offence to dismiss from employment or to refuse to employ a medical practitioner, nurse practitioner, pharmacist or any other health care professional for the reason only that they refuse to take part, directly or indirectly, in the provision of physician-assisted suicide.

My bill would provide the teeth that Bill C-14 acutely lacks. The Liberals' attempt to provide protection for doctors consisted solely of a rudimentary clause, which stated, as I said earlier, that nothing compels someone to provide or assist. However, the provision lacked the teeth needed for its effective enforcement, as evidenced by the ongoing pressure that is being exerted on physicians, particularly by their regulating bodies.

I guess the question is whether these protections are really necessary, and I would say that they are. Throughout the legislative process, I have spoken to doctors who feel overt pressure to leave family medicine because of their conscientious beliefs. I have heard of palliative care doctors in Ontario who have stopped practising altogether. Nurses who feel increasingly bullied are choosing to shift their focus or retire early. I have had personal conversations with people who work in old folks' homes who explain they do not want to participate in this but are increasingly feeling pressured to do so. The pressure on these professionals exists and they are looking for relief.

What is more, regional associations such as the College of Physicians and Surgeons of Ontario have introduced regulations compelling conscientiously objecting physicians to participate by providing what they call “effective referrals” for physician-assisted suicide. A recent court decision has upheld this directive, contravening the assurances provided in Carter v. Canada and creating an even more urgent need among physicians for protection. This is in spite of the fact that in this situation in Ontario I am told that the majority of physicians support an allowance for conscientious objections, but the college has not taken that position.

As strange as it sounds, the recent court decision refers to the college's suggestion that if physicians do not like to participate then they can find other areas of medicine to take up. This is unusual, particularly in a situation where we have such a shortage of physicians and medical services. The college suggests that if they do not like participating they can take up things like sleep medicine, hair restoration, sport and exercise medicine, skin disorders, obesity medicine, aviation examinations, travel medicine or perhaps become a medical health officer.

For many of us across this country, particularly those of us in rural areas, we know there is an increasing lack of physicians in an increasingly challenged medical system. I find it passing strange that the college would be the one suggesting such a thing for its physicians. The answer does not have to be to do it, find someone else to do it or get out of medicine. Medical personnel and resources are scarce. Why would one try to force people into doing what they believe to be wrong? The example of the province of Manitoba and its conscientious objection legislation shows there does not need to be compulsion in the medical system when it comes to this issue.

My bill does not address the social acceptability of euthanasia and assisted suicide; that is not the point of it. Protecting physicians' conscience rights is not at all a physicians versus patients scenario. By protecting physicians' conscience rights, patients' rights are enhanced. Bill C-418 is about protecting the fundamental freedom of conscience and religion guaranteed to all Canadians in the Charter of Rights and Freedoms.

Parliamentarians from all parties cannot ignore the groundswell of support this bill has received from average Canadians who believe it is time to stand up for doctors and health care providers who are not willing to leave their core ethics behind when they are at a patient's bedside. This is not theoretical. I have had photos sent to me of the revolving TV screens that we see in hospital wards, with pictures of what seems to be a physician's hand gently resting on the arm of a senior citizen, touting assisted suicide as a medical service whereby physicians or nurse practitioners help patients fulfill their wish to end their suffering and a phone number is provided. Interestingly, it makes no mention of palliative care or other ways to reduce pain and suffering. It makes no mention of access to counselling.

With government, the courts and health care facilities promoting access as a right, should not those who object be allowed to have that fundamental freedom of conscience that is so important?

I want to close with a quote from “The Imperative of Conscience Rights” by the CRFI. They write:

The outcomes of the current controversies that engage freedom of conscience will not only signal the extent to which Canadians can conscientiously participate in public life—in other words, whether they can live in alignment with who they are and what they stand for in matters of morality. These outcomes will also speak volumes about who we are and what we stand for—as a society. Suppressing beliefs with which we disagree or that we find offensive in the name of tolerance and liberalism is a contradiction in terms. The fact that the state has deemed something legal does not remove a person’s freedom to express her moral opposition to it. This freedom is not absolute, but its roots—integrity, identity, and dignity—are necessary for human flourishing. These roots must therefore be top of mind whenever limitations on freedom of conscience are proposed. We believe that governments should only limit this human right if there is a compelling justification.

Scott Sims MP (Lib)

Scott Sims MP (Lib) Asked Mr Anderson - what is the response of the Canadian Medical Association to this issue.

David Anderson (MP) (CPC) responded that the Ontario Medical Association supported conscience rights but that the policy requiring physicians to do an "effective referral" was from the College of Physicians and Surgeons of Ontario (CPSO). Mr Anderson then explained that the province of Manitoba has legislated conscience rights for healthcare professionals.

Murray Rankin MP

Murray Rankin MP (NDP) Asked Mr Anderson - Can Bill C-418 be squared with the Ontario Court of Appeal decision that required physicians to provide an "effective referral" when asked for euthanasia.

David Anderson MP (CPC) responded: I believe that we can. It has been done in other places across the country, but there are numerous ways that people can come to information about assisted suicide or medical assistance in dying. There are certainly a number of options open as to how they might access that information. The question is whether physicians are obligated to refer that, to provide that, or if they can opt out and give them another way to find that information. We believe that is very possible.

John Nater MP

John Nater MP (CPC) asked Mr Anderson to highlight some of the correspondence he has received on the bill.

Mr Anderson MP (CPC) responded:

Madam Speaker, the interest in this bill has been surprising to me... It has been surprising to me how people have taken this on. There is an onslaught of petitions coming into my office every day and I am passing them on to my colleagues as well so that they can understand the interest that people in their ridings have in this issue.

People generally want to be fair to other people and allow them to have the capacity to operate off of the things they believe in. Every single one of us has a set of beliefs. We have a right to operate under our set of beliefs ... In this situation, we should be giving medical professionals, who operate every day from a sense of conscience in what they do, the opportunity to do that.

Rob Oliphant MP

Rob Oliphant MP (Lib) asked Mr Anderson: If it comes down to a patient's right or a physician's right, which would the member choose?

Mr Anderson MP (CPC) responded:
Madam Speaker, as I mentioned earlier, there are a number of options for people to find the information they need. There are many doctors and facilities that will provide this service if they want it, but there are other doctors and medical personnel who do not feel that assisting in someone's premature death is a part of the mandate of what they have been called to as physicians or medical personnel.

There are enough choices out there that people can have and we can allow those who disagree with this procedure to have their freedom of conscience and be able to live their professional lives in that fashion.

Arif Virani MP

Arif Virani (Parliamentary Secretary to the Minister of Justice and Attorney General of Canada (Lib) delivered the speech on behalf of the government. He essentially stated:

Madam Speaker, it is a pleasure to speak today to Bill C-418, the protection of freedom of conscience act. The bill proposes to create two new Criminal Code offences, an “intimidation offence” as well as an “employment sanctions offence”. Those offences would seek to protect health care professionals' freedom of conscience by prohibiting the use of intimidation to compel practitioners to provide medical assistance in dying and by prohibiting employers from dismissing practitioners for refusing to take part in medical assistance in dying.

...Providing medical assistance in dying is a gesture with the most serious of consequences. Some health care practitioners view it as an important part of their practice that relieves a patient’s intolerable suffering when approaching death. Others view it as contrary to their conscience, religious beliefs or their professional role. Other health care practitioners might support the availability of medical assistance in dying in principle but simply not wish to be involved in the practice themselves. Our government supports and respects all of these different viewpoints.

...With the utmost clarity in this regard, the House of Commons Standing Committee on Justice and Human Rights adopted an amendment to what was then Bill C-14, adding a new subsection 241.2(9) to the Criminal Code of Canada that clearly states that nothing in the medical assistance in dying provisions compels health care professionals or practitioners to participate in medical assistance in dying.

It is also critically important, since we are debating constitutional law, to keep in mind that paragraph 2(a) of the charter protects freedom of conscience and religion and guards against unjustified government interference in one's religious beliefs and freedom of conscience. We know that. The law reflects that. The Carter decision of the Supreme Court of Canada incorporated that. I will read part of paragraph 132 of the majority decision in Carter, which says that “nothing in the declaration of invalidity which we propose to issue would compel physicians to provide assistance in dying”. Those words entered Bill C-14 and were further strengthened by the amendment proposed by the justice committee and voted on in Parliament.
(Bill C-418 recognizes that C-14 stated that nothing compels health care professionals or practitioners to participate in medical assistance in dying, the question at hand is what constitutes participation.)

Arif Virani MP (LIB) then referred to the regulations that were instituted by the Minister of Health on November 1, 2018 and the five year review of the euthanasia law that will begin in June 2020.

Murray Rankin MP

Murray Rankin MP (NDP) delivered the speech on behalf of the NDP.

Rankin explained that the NDP oppose Bill C-418. He stated:

We must oppose this bill. We are concerned that it creates a loophole whereby health professionals could deny a referral to a patient seeking medical assistance in dying

...However, what is equally important is that there be the ability, always, for the patient to exercise his or her constitutional right to avail themself of medical assistance in dying. In a contest between a physician and that patient, the law is crystal clear. It is the patient's right that must prevail. I will come back to that in a moment

...In a recent Ontario Court of Appeal decision in 2019, a judge found that the rights of the patient must prevail over the rights of the physician. There must be what the Ontario court terms an “effective referral”

...We believe that coercion and intimidation are always wrong. However, it is important we keep the balance that was carefully struck in this Parliament when we took the step of creating a regime for Canadians to avail themselves of their constitutional right to medical assistance in dying in certain circumstances. We should keep that balance and not destroy it.
(In other words, the NDP believe that coercion and intimidation are always wrong except when it comes to forcing doctors to participate in euthanasia.)

Rachel Harder MP

Rachel Harder (MP) (CPC) then spoke in support of Bill C-418

While Bill C-14, the bill that makes medical assistance in dying legal within our country, advocates for those wishing to participate in the practice, it neglects or altogether fails to protect the medical practitioners whose conscience would be violated if they had to participate. This is a big problem as the professional judgment of many doctors still affirms that good medical care does not include hastening death.

...the current government outright refused to put conscience protections within the federal legislation. This was despite the fact that many witnesses came forward to committee during this time and asked for conscience protections to be explicitly placed within Bill C-14.

I sat there during those committee meetings and listened to that testimony. I was one of the individuals who advocated for those conscience protections. There is absolutely no reason why they should not have been a part of the legislation. However, they are not, so it requires this private member's bill, Bill C-418, in order to adequately protect the conscience of our medical practitioners in the Canadian system.

...Canadians should never be put in a situation where they feel they are forced to choose between their careers or beliefs. We live in Canada. We have a Charter of Rights and Freedoms. We should be able to engage in the career of our choice and have our ethical and moral values respected. We should be able to function according to our conscience. Currently, that is not the case. Those protections are not granted to medical practitioners the way they should be. Therefore, I call on the House to make a change, as is the member who sponsored this private member's bill.

..Bill C-418 would restore such freedom of religion and conscience. It acts to defend medical professionals who act in good conscience and within their constitutional rights to not participate in medical assistance in dying. It should be argued that this bill addresses a legislative gap that was left by the current government. It completes the work the Supreme Court asked this place to do.

...In 2016, the College of Physicians and Surgeons of Ontario adopted a medical assistance in dying policy requiring medical professionals, who would not provide medical assistance in dying themselves, to provide an effective referral. This policy was challenged by religious groups.

A group of more 1,500 Canadians came together and challenged this regulatory decision. They said that it violated their constitutional rights, their rights to freedom of religion and conscience. Unfortunately, on May 15, the Court of Appeal for Ontario ruled that religious physicians and medical professionals must provide effective referrals if they themselves would not be involved with medical assistance in dying. It went on to say that those medical practitioners who believed this violated their conscience could go and find a job within the medical profession where medical assistance in dying would not be required of them.

That is incredibly demeaning to those individuals who have gone through years of training and who, with great dedication and commitment to their patients, have served. These are the women and men who have been trained as medical professionals and it is their conscience that motivates them and compels them to function with dignity, respect and honour and to provide the utmost level of care to their patients. Now they are being punished for holding those beliefs, for holding that level of dignity, respect and honour for their patients.

Again, I would plead that it does not have to be this way, that a change can be made to the Criminal Code that would in fact protect the conscience rights of these medical practitioners who, because of their deeply-seeded beliefs, are not able to participate in any way in medical assistance in dying.

I ask that the House rightly respond to the Supreme Court's decision in the Carter v. Canada case and put this change within the Criminal Code to rightly respond to that decision.

Darrell Samson MP

Darrell Samson MP (Lib) spoke next to the bill. He re-iterated the points from the official Liberal speech, but he did say:

There has also been some independent research conducted in Canada. One study, which is entitled “Exploring Canadian Physicians' Experiences Providing Medical Assistance in Dying: A Qualitative Study”, found that, in some cases, providers who participate in medical assistance in dying reported that it negatively affected their working relationships with colleagues. This finding is just as alarming as the prospect that practitioners would be physically threatened in order to coerce them into participating.

I ask members of this chamber, and all Canadians, to be respectful of the beliefs, values and perspectives held by others, even when they differ vastly from their own opinions. There is no single right answer when values collide. Our way forward must be a journey in which we engage, listen and try to accommodate, not threaten or provoke conflict.

I am pleased that Bill C-418 again gives us an opportunity to discuss medical assistance in dying and also focus on the vital importance of respecting differences and diversity. I urge all members to approach this bill and ongoing public and policy debates on medical assistance in dying with open minds.

Keith Lamoureux MP

The final speaker was Keith Lamoureux (Lib) whose time was ended soon after he began. He essentially stated:

I was listening to the parliamentary secretary responsible for the legislation providing comment on the government's official position on the issue. I believe that the concerns the member opposite has, in good part, are addressed by the legislation we passed not that long ago.

May 29 was the first hour of debate on Bill C-418. A second hour of debate will be scheduled before Bill C-418 can do to a vote.