Protection of Conscience Project
Protection of Conscience Project
www.consciencelaws.org
Service, not Servitude

Service, not Servitude

Canada

College of Physicians and Surgeons of Prince Edward Island

Polices relevant to freedom of conscience

Links and annotations

Full TextCMA Code of Ethics and Professionalism
 
Full TextConscientious Objection to Provision of Service
(4 November, 2019)
Project Annotations

The policy recognizes a key distinction between providing information and providing or facilitating a morally contested service or procedure. 

 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 informed choice.

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.


Full TextMedical Assistance in Dying (4 November, 2019)
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 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.  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 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.