Protection of Conscience Project
Protection of Conscience Project
Service, not Servitude

Service, not Servitude


College of Physicians and Surgeons of Newfoundland and Labrador

Freedom of conscience and religion

Annotated Extracts and Links

Medical  Assistance in Dying (March, 2017)
[Full Text]
Standard of Practice

1.    Foundational Principles

1.1    This Standard should be interpreted in a manner that

(a) respects the autonomy of patients, such that capable adults are free to make decisions about medical assistance in dying within the criteria established in this Standard;

(b)  simultaneously respects the right of physicians to refuse to provide this intervention in instances where a patient does not meet the legislative criteria, or the physician declines on personal grounds;

(c)  maintains the dignity of patients and treats patients, their family members, and others involved in end-of-life decisions with respect;

(d)  encourages equitable access to medical assistance in dying;

(e)  recognizes an appropriate balance between freedom of conscience of the physician and the patient’s right to life, liberty and security of the person


6.    Responsibilities of Physicians who Decline to Participate

6.1    No physician can be compelled to prescribe or administer medication for the purpose of ending a patient’s life.

6.2    Physicians unwilling to participate in medical assistance in dying for personal, moral, religious, or ethical reasons are expected to freely offer accurate information to patients. No physician may provide false, misleading, intentionally confusing, coercive, or materially incomplete information to patients.

6.3    The College recommends that a physician who declines to participate in medical assistance in dying offer the patient timely access to another medical professional (or appropriate information resource, clinic or facility, care provider, health authority, or organization) who is:

(a) available to assist the patient;

(b) accessible to the patient; and

(c)  willing to provide medical assistance in dying to a patient who meets the eligibility criteria.

 6.4    A physician who declines to provide medical assistance in dying to a patient may not terminate the doctor-patient relationship on that basis alone. At all times, the physician must abide by other relevant College standards of practice.

6.5    The objecting physician should:

(a)  Provide access to all relevant medical records to any Clinician who is providing services to the patient related to medical assistance in dying; and

(b)  Continue to provide medical services unrelated to medical assistance in dying, unless the patient requests otherwise, or until another suitable physician has assumed responsibility for the person’s ongoing care.

7.    Responsibilities of All Physicians

7.1    Any physician who is approached by a patient for information on medical assistance in dying has an obligation to discuss the subject with the patient, the first time it is raised by the patient, regardless of whether he or she objects to personally providing this service.

7.2    During the first visit where the patient requests or mentions medical assistance in dying, all physicians have an obligation to:

(a)  engage in a fulsome discussion as to the reasons behind the patient’s request, and answer any questions the patient may pose to the best of the physician’s knowledge and ability;

 (b) ensure that the patient has information about (and, if appropriate, a referral to) any other service that may be of benefit to the patient, including a referral to palliative care, pain specialist, or psychiatry; or non-physician services such as physiotherapy, occupational therapy, counseling, and so on; and advise the patient whether the physician is willing to personally participate in medical assistance in dying;  and

(c)  provide the patient with access to further information as appropriate.

Project Annotations

Physicians are expected to provide information necessary to satisfy the requirements of informed medical decision making.

The standard explicitly states that physicians are not required to "provide" (1.1b) euthanasia or assisted suicide  or "prescribe or administer" lethal medication (6.1). It also acknowledges that physicians may refuse to "participate," a broader term.

Objecting physicians may consider it unacceptable to direct a patient to a physician willing to provide euthanasia or assisted suicide, on the grounds that doing so would constitute morally unacceptable participation in the act.  However, the policy recommends but does not require such referrals.