Protection of Conscience Project
Protection of Conscience Project
www.consciencelaws.org
Service, not Servitude

Service, not Servitude

Canada

College of Physicians and Surgeons of British Columbia

Freedom of conscience and religion

Annotated Extracts and Links

Access to Medical Care
Effective 2012 Nov | Revised 2019 Jun [Full Text]

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Conscientious Objection to Providing Care

Physicians are not obliged to provide treatments or procedures to patients which are medically unnecessary or deemed inappropriate based on scientific evidence and their own clinical expertise.

While physicians may make a personal choice not to provide a treatment or procedure based on their values and beliefs, the College expects them to provide patients with enough information and assistance to allow them to make informed choices for themselves. This includes advising patients that other physicians may be available to see them, or suggesting that the patient visit an alternate health-care provider. Where needed, physicians must offer assistance and must not abandon the patient.

Physicians in these situations should not discuss in detail their personal beliefs if not directly relevant and should not pressure patients to disclose or justify their own beliefs.

In all cases, physicians must practise within the confines of the legal system, and provide compassionate, non-judgmental care according to the CMA Code of Ethics and Professionalism.

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Project Annotations

"Assistance" should not be understood to imply providing or facilitating a morally contested service, since that interpretation would render the policy self-contradictory.  In responding to questions from the Project in 2013, the College provided the following answers:

  • Q)  Is Access to Medical Care to be understood to require physicians to do what they believe to be immoral or unethical?
    • A)  No.
  • Q)  Does the College propose to take disciplinary action against physicians who refuse to do what they believe to be immoral or unethical?
    • A)  No, unless the College considers that in those specific circumstances the physician abandoned the patient without providing an appropriate level of medical care.

Medical Assistance in Dying
Effective 2016 Sep | Revised 2019  Jun [Full Text]
Conscientious Objection

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Physicians may make a personal choice not to assess patients for and/or perform MAID, based on their values and beliefs. The College expects the physician to provide patients with enough information and assistance to allow them to make informed choices for themselves. This includes consulting with other experts on relevant medical facts and, when needed, competency assessments.

Physicians who object to PAD on the basis of their values and beliefs are required to provide an effective transfer of care for their patients by advising patients that other physicians may be available to see them, suggesting the patient visit an alternate physician or service and, if authorized by the patient, transferring the medical records as required.

Where needed, physicians must offer assistance to the patient and must not abandon the patient. While a physician is not required to make a formal referral on behalf of their patient, they do have a duty of care that must be continuous and non-discriminatory. Physicians should not discuss in detail their personal beliefs and should not pressure patients to disclose or justify their own beliefs. In all cases, physicians must practise within the confines of the legal system, and provide compassionate, non-judgemental care according to the CMA Code of Ethics and Professionalism.

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Project Annotations

The policy recognizes an important distinction between providing information and providing or facilitating a morally contested service or procedure.

"An effective transfer of care" is defined as "advising patients that other physicians may be available to see them, suggesting the patient visit an alternate physician or service, and if authorized by the patient, transferring the medical records as required."

In other words, with respect to a transfer of care, the College does not require objecting physicians to initiate a transfer, but only that they cooperate in a patient-initiated transfer if asked to forward the patient's medical record.  This is the usual requirement in foreign jurisdictions where euthanasia and assisted suicide are permitted