College of Physicians and Surgeons of Prince Edward Island
Polices relevant to freedom of conscience
Links and annotations
CMA Code of Ethics and Professionalism
Conscientious Objection to Provision of Service
(4 November, 2019)
The policy recognizes a key distinction
between providing information and providing or
facilitating a morally contested service or
The point is to balance the desire of a physician to avoid
complicity in a wrongful act with the importance of informed
decision-making by the patient, which requires that the patient have all
of the information relevant for the purpose of choosing a course of
treatment. It is necessary to respect both the freedom of conscience of
the physician and the freedom and right of the patient to make a fully
Physicians are expected to provide information
necessary to satisfy the requirements of informed
medical decision making, such as prognosis, the
treatments or procedures available, benefits and
burdens of treatment, risks, etc. Only if a
physician is unwilling to provide this information
is an offer of "timely access" to another physician
or resource required. The purpose of arranging
timely access in this situation is to ensure that
the patient has information needed for
decision-making. Offering timely access
may be achieved in various ways.
The offer of "assistance" in certain circumstances should not be understood to imply facilitating a morally contested service by referral or other means, since some physicians refuse to do so because they believe that makes them complicit in the act that follows.
Medical Assistance in Dying (4 November, 2019)
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 Amir Attaran, The Limits of Conscientious and Religious Objection to Physician-Assisted Dying after the Supreme Court’s Decision in Carter v Canada (2016 ) 36:3 Health L Can 86.
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 will 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.