Collège des Médecins du Québec (Canada)
Freedom of conscience and religion
Annotated Extracts and Links
Code of Ethics of Physicians (R.S.Q., c. C-26, s.
24. A physician must, where his personal convictions prevent him from
prescribing or providing professional services that may be appropriate,
acquaint his patient with such convictions; he must also advise him of the
possible consequences of not receiving such professional services.
physician must then offer to help the patient find another physician.
Legal, Ethical and Organizational Aspects of Medical Practice in Québec
Personal Convictions: Conscientious Objection
While physicians must honor their obligation to come to the rescue and
assistance of all patients who consult them, they are nonetheless citizens
themselves with rights, notably the right to their own beliefs. When their
convictions could influence the nature or quality of care provided to a
patient, physicians must make sure that they fulfill their ethical
obligations. In this regard, section 24 of the Code of Ethics is
A physician must, where his personal convictions
prevent him from prescribing or providing professional services that may
be appropriate, acquaint his patient with such convictions; he must also
advise him of the possible consequences of not receiving such
professional services. The physician must then offer to help the patient
find another physician.
For example, a physician who is opposed to abortion or contraception is
free to limit these interventions in a manner that takes into account his or
her religious or moral convictions. However, the physician must inform
patients of such when they consult for these kinds of professional services
and assist them in finding the services requested.
While the Code of Ethics requires an objecting physician to
help a patient find another physician, it does not explicitly require
that the objector find someone willing to provide a morally contested
However, the gloss on the Code of Ethics provided by ALDO
Quebec, an authoritative document, indicates that what is intended by
the Code is an "effective referral."
Requiring "effective referral" is unacceptable to many conscientious
objectors because they believe that it makes them unacceptably complicit
in immoral acts.
31. A physician practising in a centre
operated by an institution who refuses a request for medical aid in dying
for a reason not based on section 29 must, as soon as possible, notify the
executive director of the institution or
any other person designated by the executive director and forward the
request form given to the physician, if that
is the case, to the executive director
or designated person. The executive director of
the institution or designated person must then take the necessary
steps to find, as soon as possible, another
physician willing to deal with the request in accordance with section 29.
If the physician who receives the request practises in a private health
facility and does not provide medical aid in dying,
the physician must, as soon as possible, notify the
executive director of the local authority referred
to in section 99.4 of the Act respecting health services and social services
that serves the territory in which the patient making the request resides,
or notify the person designated by the executive director. The physician
forwards the request form received, if that is the case, to the executive
director or designated person and the steps mentioned in the first
paragraph must be taken.
If no local authority serves the territory in which the patient resides,
the notice referred to in the second paragraph is forwarded to the executive
director of the institution operating a local community service centre in
the territory or the person designated by the executive director.
50. A physician may refuse to administer
medical aid in dying because of personal convictions, and a health
professional may refuse to take part in administering it for the same
reason. In such a case, the physician or health professional must
nevertheless ensure that continuity of care is provided to the patient, in
accordance with their code of ethics and the patient's wishes. In addition,
the physician must comply with the procedure established in section 31.
The Act Respecting End of Life Care is Quebec's euthanasia
Section 31 applies to physicians who refuse to provide euthanasia for
reasons other than the patient not fitting the criteria for MAD service,
including conscientious objection. They must notify an
administrator of their refusal with respect to a particular patient, and
the administrator assumes responsiblity for finding someone willing to
provide the service.
A number of objecting physicians find this unacceptable because it
requires them to put the euthanasia delivery system into motion with
respect to a particular patient (as distinct from giving notice to an
administrator of their unwillingness to provide euthanasia for reasons
Section 50 specifically concerns refusal to provide euthanasia for
reasons of conscience. It imposes two requirements on objecting
physicians. First: they must notify an administrator as required
by Section 31. Second: they must ensure "contintuity of care . . .
in accordance with their code of ethics."
As noted above, the postion of the Collège des Médecins du Québec is
that the Code of Ethics for Physicians requires effective
referral. Requiring "effective referral" is unacceptable to many
conscientious objectors because they believe that it makes them
unacceptably complicit in immoral acts.
This was succinctly explained to Quebec legislators by Dr. Charles
Bernard, President and Director General of Quebec's Collège des
[I]f you have a conscientious objection and it is
you who must undertake to find someone who will do it, at this time,
your conscientious objection is [nullified]. It is as if you did it
anyway. / [Original French] Parce que, si on a une objection de
conscience puis c'est nous qui doive faire la démarche pour trouver la
personne qui va le faire, à ce moment-là, notre objection de conscience
ne s'applique plus. C'est comme si on le faisait quand même.
[Consultations: Tuesday 17 September 2013 -
Vol. 43 no. 34:
Collège des médecins du Québec, (Dr. Charles Bernard, Dr. Yves Robert,
Dr. Michelle Marchand), T#154]