College of Physicians and Surgeons of Nova Scotia
Policies & statements relevant to freedom of conscience
Medical Assistance in Dying
(13 October, 2017)
2.1 This standard is to be interpreted in a manner that . . .
2.1.4 recognizes and appropriate balance between the physician's freedom of conscience and
religion and the patients'
right to life, liberty and security of the person;Project Annotation (i)
4. Responsibility of physicians unable or unwilling to
participate in physician assisted death
4.1 Physicians may be unable to participate in medical assistance
in dying for various practical reasons such as lack of availability or lack
of expertise. Some physicians may be unwilling to participate for
reasons of conscience. No physician can be compelled to prescribe or
administer medication for the purpose of medical assistance in dying.
4.2 The physician unwilling or unable to participateProject Annotation (ii)
must complete an effective transfer of
care for any patient requesting medical assistance in dying.
[See definition of "effective transfer of care" in Article 9.] (Emphasis in original).
4.3 In addition to completing an effective transfer of care, a
physician unable or unwilling to provide medical assistance in dying must,
at the earliest opportunity:
4.3.1 advise the patient that he or she is
not able or willing to provide medical assistance in dying;
4.3.2 provide the patient with a copy of this
4.3.3 provide all relevant patient medical
records to the physician providing services related to medical assistance in
4.3.4 continue to provide medical services
unrelated to medical assistance in dying unless the patient requests
otherwise or until alternative care is in place. . .
9.1 For the purposes of this standard:
9.2 "effective transfer of care" means a transfer made by one
practitioner ["practitioner" includes both medical practitioners and nurse
practitioners] in good faith to another physician who is available to accept the
transfer, who is accessible to the patient, and willing to provide medical
assistance in dying if the eligibility criteria are met.Project Annotation (iii)
(i) The statement is disingenuous, inasmuch as the policy requires active collaboration in euthanaisia or assisted suicide by objecting physicians, and compulsory collabortion in homicide and suicide cannot reasonably be construed as a 'balanced' or 'appropriate' recognition of physician freedom of conscience.
(ii) The presumption here is that "participation" does not include collaboration in the form of the required "effective transfer of care." This is contestable.
(iii) Read in conjunction with Professional Standards Regarding Transfer of Care,
the policy appears to use the term "effective transfer of care" as a synonym for "effective referral." That is: the policy demands that a physician unwilling to kill a patient or help the patient commit suicide must find a physician who will do so and arrange for that physician to take over the care of the patient for that purpose. Many physicians who object to euthanasia or assisted suicide for reasons of conscience would consider this morally/ethically unacceptable collaboration.