Conscientious Objection to Provision of Service (4 November, 2019)
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The “Policy on Conscientious Objection to Provision of Service” has been developed by the College of Physicians and Surgeons of Prince Edward Island(the College)as a guidance document for physicians as to how to balance the ethical dilemmas that occur when one’s beliefs and ethics as a practicing physician conflict with the ethical beliefs of one’s patients. Communication is clearly vital in this situation.

**[Relevant Excerpts from the CMA Code of Ethics and Professionalism (2018)]**

Moral or Religious Beliefs Affecting Medical Care

1. A physician must communicate clearly and promptly about any treatments or procedures the physician chooses not to provide because of his or her moral or religious beliefs.

2. A physician must not withhold information about the existence of a procedure or treatment because providing that procedure or giving advice about it conflicts with their moral or religious beliefs.

3. A physician must not promote their own moral or religious beliefs when interacting with patients.

4. When moral or religious beliefs prevent a physician from providing or offering access to information about a legally available medical or surgical treatment or service, that physician should ensure that the patient who seeks such advice or medical care is offered timely access to another physician or resource that will provide accurate information about all available medical options.

While physicians may make a personal choice not to provide a treatment or procedure based on their values and beliefs, the College expects them to provide patients with enough information and assistance to allow them to make informed choices for themselves. This includes advising patients that other physicians may be available to see them, or suggesting that the patient visit an alternate health-care provider. Where needed, physicians must offer assistance and must not abandon the patient.

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Medical Assistance in Dying (4 November, 2019)
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**[Relevant Excerpts from the CMA Code of Ethics and Professionalism (2018)]**

Foundational principles used in developing this document:

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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.

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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.

Standards:

Communication:

A physician who for conscientious reasons declines to provide medical assistance in dying must

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.

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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.

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 . . .