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

Service, not Servitude


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 patient,

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 information.

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 do so.

Each physician may find him/her self in one of the 3 following situations:

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 . . .

Project Annotations

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.  It suggests 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