College of Physicians and Surgeons of Prince Edward Island
Polices relevant to freedom of conscience
Medical Assistance in Dying (4 November, 2019)
Foundational principles used in developing this document:
2) Access: Individuals who seek information about medical assistance in dying should have access to unbiased and accurate information. To the extent possible, all those who meetthe criteria for medical assistance in dying and request it should have access to medical assistance in dying.[Emphasis in original.]
3) Respect for physician values: Within the bounds of existing standards of practice and subject to the expectations in this document and the obligation to practice without discrimination as required by the CMA Code of Ethics and Professionalism (2018) and human rights legislation, physicians can follow their conscience when deciding whether or not to provide medical assistance in dying.
8) Duty to Provide Care: Physicians have an obligation to provide ongoing care to patients unless their services are no longer required or wanted or until another suitable physician has assumed responsibility for the patient. Physicians should continue to provide appropriate and compassionate care to patients throughout the dying process regardless of the decisions they make with respect to medical assistance in dying.
A physician who for conscientious reasons declines to
provide medical assistance in dying must [emphasis in original]
a. Disclose that fact to the
b. Continue to treat the patient
with dignity and respect, and provide medical care until
no longer required or wanted, or until another physician
has assumed responsibility for the patient, and
c. Provide, or arrange to be
provided, the patient's chart and sufficient medical
information, with the patient's consent, to the patient
or to other physicians or nurse practitioners involved
in the process
i) To enable the patient to make
his/her own informed choice and access all options for
care, including palliative care
ii) To enable access to another
physician, nurse practitioner or service
A physician, or delegate, must be respectful, must
provide sufficient, timely medical information, and must
not be confusing, coercive, or provide incomplete
A physician may delegate the responsibility for communication of information regarding medical assistance in dying to another person (who is competent to do so and for whom the physician is responsible), or to another agency.
A Physician's Obligation
This section must be read in the context of relevant
evolving federal and provincial legislation, which
supersedes this Policy. . .
Medical assistance in dying has been declared a right
under the amended Criminal Code.
Therefore it is important that each physician consider
the pros and cons and decide in advance whether or not
the physician would participate if ever called upon to
Each physician may find him/her self in one of the 3
1. The physician decides either for
conscientious or religious reasons not to participate.
The physician should advise all his/her patients of that
fact, perhaps by posting a notice in the office.
If a request is received anyway, the physician must not act as a barrier to the patient requesting the services, solely on the basis of the physician's beliefs. The physician, or delegate, must provide a copy of the patient's chart and sufficient medical information, with the patient's consent, to the patient or to other physicians or nurse practitioners involved in the process. The provision of information on medical assistance in dying may be delegated to another person (who is competent to do so and for whom the physician is responsible), or to another agency. A recommended course of action might be to
transfer the care of the patient to another physician,
nurse practitioner or service [emphasis in original].
Federal reporting is required by this physician only if the patient was referred or their care transferred to another physician/nurse practitioner or service for the purpose of requesting MAID.
2. The physician decides to participate, but
only to the degree of providing information, assessing
eligibility for medical assistance in dying and
referring to another physician, nurse practitioner or
agency who will carry out the procedure . . .
3. The physician plans to participate: to assess eligibility and to carry out the
procedure . . .
Under Foundational Principles the reference to human rights legislation is especially significant for physicians who decide to participate in euthanasia and assisted suicide. It has been argued that physicians who provide the services for one class of patients (the terminally ill, for example) but who refuse to provide the services for others (those not terminally ill) violates human rights legislation by discrimination on the basis of disability, and cannot avoid being found guilty of discrimination even if they arrange for the patient to see a willing colleague. See Attaran A. The Limits of Conscientious and Religious Objection to Physician-Assisted Dying after the Supreme Court’s Decision in Carter v Canada. Health L Can. 2016 Feb; 36(3):86-98.
The policy requires that an objecting physician
provide the patient with the medical chart and
information sufficient to allow informed medical
decision making and access treatment options.
that a transfer of care might be appropriate, but it is not required. These expectations
should not be problematic. Patient-initiated
transfers of care are the norm for objecting physicians in jurisdictions
outside Canada where euthanasia and/or assisted suicide are legal.
Under A Physician's Obligations the policy erroneously states that "medical assistance in dying"
(euthanasia and assisted suicide) have been declared to be a right under
the Criminal Code.
Section 241.1 of the Criminal Code provides definitions and
sets out the circumstances under which a physician or nurse practitioner
may provide euthanasia or assisted suicide without being prosecuted.
It does not establish a "right" to either.
Providing notice to patients in advance should prevent conflicts between patients seeking the services and physicians unwilling to provide them. In practice, many objecting physicians prefer to talk personally with patients who raise the issue.
In the first of the three situations described under A Physician's Obligation, a physician who refuses to participate is not required to refer a patient to an EAS provider or other person for the purpose of requesting EAS, but only to provide the patient or a patient's delegate or agent with medical records. This is clear because (a) the policy on
Conscientious Objection to Provision of Service does not require referral, (b) the policy states that federal reporting is not required unless a patient is referred for EAS, and (c) referral for EAS is addressed in the second situation.
Canadian Medical Association and Referral for Morally Contested Procedures