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

Service, not Servitude


College of Physicians and Surgeons of Nova Scotia

Freedom of conscience and religion

Annotated Extracts and Links

Transfer of Care (27 May, 2016)
[Full Text]

In the complex world of medicine, it is imperative that a single physician be identified at all times as the most responsible physician (MRP) for any patient. . .

. . . A transfer of care occurs whenever there is a change in the most responsible physician for a particular patient.  This can take place with movement of patients between health care locations, providers or different levels of care within the same location as their conditions and care needs change.

Physicians have the primary responsibility to ensure effective transfers of care.  Physicians are encouraged to be involved in the design of transitions within the health care system to ensure coordination and continuity of care for the benefit of their patients.

This document applies whenever there is a change in the MRP of the patient. . .

Professional Standards


2.  When transferring a patient, the MRP must ensure:

a)  the accepting physician has the necessary clinical information to assume care, including asummary of active medical problems and the treatment plan for the patient at the time oftransfer; and

b)  the accepting physician, who will become the MRP upon transfer, is clearly identified in thepatient’s medical record and has agreed to accept the transfer of care.

3.  In either situation, when discharging or transferring a patient:

a)  professional judgement is required to determine the extent and timeliness of information provided to the accepting physician, and the balance between verbal and written communications;

b)  the physician must inform the patient that a transfer of care is to take place and identify who is to become the most responsible physician for that patient.


Project Annotations

The policy describes physician-initiated transfers of care.

Medical Assistance in Dying (14 December, 2018)
[Full Text]


2.  Interpretation

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;


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 participate 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 Standard;

4.3.3  provide all relevant patient medical records to the physician providing services related to medical assistance in dying;

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.    Definitions

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 Annotations

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 find this requirement unacceptable.