OTTAWA — Doug Eyolfson did not love the physician-assisted dying bill at first, but he ended up supporting it.
The Winnipeg emergency room doctor and Liberal MP was concerned the Trudeau government's proposed legislation would not allow patients to decide in advance they would like to end their lives with the help of a physician once they reached a certain point.
"It's something that I would personally want for myself and something I would like to see, at some point, provided to patients as an option," Eyolfson said.
Chief Government Whip Andrew Leslie scrums with media in Ottawa on Wednesday, May 18, 2016. (Photo: Matthew Usherwood/CP)
The deeply personal played a major role in the decisions of individual Liberals when it came to their votes on Bill C-14, the federal government's response to the Supreme Court ruling that did away with the ban on physician-assisted suicide.
Prime Minister Justin Trudeau kept his promise to give his caucus a free vote on this matter of conscience, while ensuring his Liberal government avoided embarrassment on a major piece of legislation which could, for better or worse, end up being an important part of its legacy.
The political victory could be short-lived, as C-14 is getting a serious grilling in the far-less-predictable Senate, but the moves to quell opposition debate in the House of Commons and the lengthy discussions with caucus offer a glimpse at how the government will handle other thorny issues it will face during its mandate.
Well-time phone calls, late-night information sessions
A senior government source acknowledged that the key was to help those in caucus who felt the bill did not go far enough to understand that the cabinet took a cautious approach, because it would be easier to expand a program later, if necessary, than to restrict one that was later seen to have gone too far.
There were late-night information sessions, one-on-one conversations with Justice Minister Jody Wilson-Raybould or Health Minister Jane Philpott and well-timed telephone calls to those sitting on the fence or showing signs of shifting from one side to the other.
Eyolfson said it was Philpott who personally made the case to him why the government chose to keep the question of advance requests out of the bill, even though it meant ignoring a major recommendation from the special joint committee the Liberals struck to provide input.
He said she explained to him that the Netherlands is the only jurisdiction that allows advance requests for patients who are not comatose and research has shown families and doctors are hesitant to actually comply with them.
"Once that part was explained to me, it made sense as a prudent measure," said Eyolfson.
Rookie Grit felt no pressure to change vote
Winnipeg MP Robert-Falcon Ouellette voted against the bill from the outset out of concern for the impact it could have on indigenous communities, where an alarmingly high number of youth are turning to suicide. He said he felt no pressure to change his mind, but understood that more than personal convictions could come into play.
"I think some people are nervous, but they are really good team players and they want to play on the same team and play nice," said Ouellette.
Andrew Leslie, the chief government whip, said getting the numbers right on C-14 involved more than his usual role.
Not only did he have to keep track of whether Liberal MPs were close enough to make it to the House of Commons for a vote on short notice, Leslie also had to gauge how they were feeling and thinking on any given day, never certain until each MP voted.
"You cannot guarantee the will of Parliament," he said.
"This is the time to stand and be counted, one way or the other."
— Andrew Leslie, chief government whip
Right from the beginning, Leslie said, a handful of MPs had deeply personal stories that set them on one path or another, some telling him they were absolutely determined they could not support the government position.
There was little anyone could do about them, but there was another, much larger group of Liberals who either felt the government's position had not gone far enough in meeting the ruling from the Supreme Court — including some with concerns about the constitutionality of the bill — or had gone too far.
Leslie said he referred those MPs to Philpott, Wilson-Raybould or others who could provide them with more information and arguments.
He said he also had to fulfil his basic job of tracking the numbers and that sometimes involved calling cabinet ministers back from overseas trips — especially after an embarrassing near-miss when the New Democrats and Conservatives caught him off guard with a snap vote on an Air Canada bill. The ended in a 139-to-139 tie that Speaker Geoff Regan broke in favour of the government.
"We had to win," Leslie said, but added that on such a personal issue, another factor came into play.
MP missed chance to vote against bill
"This is the time to stand and be counted, one way or the other," Leslie said.
Montreal-area Liberal MP Alexandra Mendes had planned on doing just that.
She was one of those who told Leslie right away that she could not support C-14 unless it was amended to include advance directives, an opinion she held to firmly after watching both her grandmothers slip away slowly due to Alzheimer's.
But when the final vote came Wednesday night, Mendes said she got a few minutes behind in a seminar she was giving a couple of blocks south of Parliament Hill and then could not run fast enough in her heels to reach the Commons on time.
She missed the deadline by seven minutes and was so disappointed and angry with herself that she hid in Leslie's office for half an hour until she calmed down.
"So, for the most prosaic of reasons, I ended up missing a vote that was so significant for me on a personal level," Mendes wrote in an email.
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A look at some jurisdictions where right-to-die laws are in place. (Information courtesy of The Canadian Press)
A right-to-die bill was adopted last year, the first legislation of its kind in Canada. The law, scheduled to go into effect in December, stipulates that patients would have to repeatedly ask a doctor to end their lives on the basis of unbearable physical or psychological suffering. They would have to be deemed mentally sound at the time of the requests. The law, however, is being challenged in court by two Quebec-based groups on the grounds that it undercuts sections of the Criminal Code that outlaw assisted suicide and euthanasia. The federal government has expressed its opposition to the legislation but is named as a defendant in the court challenge because it is responsible for the Criminal Code.
The results of a referendum made Oregon the first U.S. state to make it legal for a doctor to prescribe a life-ending drug to a terminally ill patient of sound mind who makes the request. However, doctors cannot administer the life-ending drugs and the patient must swallow them without help. Patients must state three times -- once in writing -- that they wish to die, and those statements must be made at least 15 days apart. They must also obtain a concurring opinion from a second doctor that they have less than six months to live and are of sound mind. The law took effect in late 1997, and through June, 2014, just over 800 people had used the law.
The state became the first in the U.S. to allow a person's right to die through legislation rather than through a court decision or a referendum result. Vermont's law, which took effect in May 2013, is closely modelled on the system in Oregon and uses the same safeguards. Patients must state three times, including once in writing -- that they wish to die. They must also obtain a concurring opinion from a second doctor that they have less than six months to live and are of sound mind.
In January 2014, a judge ruled that competent, terminally ill patients have the right to seek their doctors' help in getting prescription medication if they want to end their lives on their own terms. The state's attorney general is appealing the ruling, and a decision on whether it will be upheld is expected later this year.
A referendum saw the state enact right to die legislation in 2008. As in Oregon, patients with less than six months to live must administer the doctor-prescribed lethal medication on their own. According to a government report, 549 people applied for the right to die between 2009 and 2013. Of those, 525 actually took their own lives.
In 2009, the state's Supreme Court ruled that Montana's public policy supports mentally competent, terminally ill patients being able to choose aid in dying. Physicians are allowed to prescribe medication that patients must administer themselves. More detailed legislative bills have been introduced in the state but have not passed. The court ruling still stands today, but data about its usage is not available.
A law passed in 1942 forbade anyone from helping someone kill themselves for selfish reasons. As a result, people arguing that they are assisting with a suicide for unselfish motives are not considered to be committing a crime. Suicides can be assisted by people other than doctors and no medical condition needs to be established. Switzerland is the only country that allows foreigners to travel there for the purpose of ending their own lives.
In the Netherlands, euthanasia is legal under specific circumstances and for children over the age of 12 with parental consent. In Europe, patients don't have to prove that they have a terminal illness -- establishing unbearable suffering is usually sufficient. Dutch doctors are allowed to perform euthanasia if a patient whose unbearable suffering has no hope of improvement asks to die with a full understanding of the situation. A second doctor must agree with the decision to help the patient die.