Special Joint Committee on Physician Assisted Dying
Parliament of Canada (January-February, 2016)
Extracts of Briefs and Oral Submissions
Links to the full briefs are provided below.
For statements specific to freedom of conscience and religion for
healthcare providers, click on
to see statements extracted from a brief, and on [EV
Transcript] for transcripts of edited videos.
Groups/individuals who appeared as witnesses, but who neither
contributed briefs nor make comments clearly relevant to freedom of
conscience in health care are marked with an asterisk.
Bold face identifies groups or individuals who
appeared as witnesses.
Page 3 of 3 (Martin to Wilson)
Mental Health Commission of Canada
Mount, Balfour MD
Nurses Association of New Brunswick
Physicians' Alliance Against Euthanasia
Protection of Conscience Project
Provincial Territorial Expert Advisory Group
REAL Women of Canada
Registered Nurses Association of the Northwest Territories and
Saba, Paul MD
Secular Connexion Séculière
Shapray, Howard QC
Society of Rural Physicians of Canada
Sullivan, William MD
Surgeon General, Canadian Forces Health Services Group
Svec, Katherine Meaney
United Church of Canada
Toujours Vivant - Not Dead Yet
von Fuchs, Ruth (Right to Die Society of Canada)
Walker, Ken MD (W. Gifford-Jones MD)
McPhee, Margaret [Full
. . . Physicians who object to carrying out PAD should be obliged to
refer the patient to someone who is willing to carry it out, or at least
provide the patient with the name of such a physician, if the patient is
capable of referring him/herself. . .
5. I understand not all physicians may want this responsibility so
agree that they should have the right ofconscientious objection. They then
however, must provide timely information and effective referrals (or
transfers of care) to an institution, independent agency or other provider.
6. It is imperative that publicly funded healthcare institutions,
including hospitals, hospices and long-termcare facilities are allowed and
even required to provide physician-assisted dying on their premises. All
publicly funded healthcare institutions must allow PAD on their premises, no
matter their belief systems. If no doctors on staff are willing to provide,
an external doctor must be permitted into the hospital to provide the
service. This policy is especially relevant for small communities where
healthcare options may be limited.
. . . It is also acceptable that a doctor or practitioner who does not
wish to provide PAD must refer the patient to someone who will.
All publicly funded healthcare institutions must allow PAD on their
premises. If no doctors on staff are willing to provide it, an external
doctor must be permitted into the facility to provide the service. This is
especially important in small communities where facilities may be limited or
restricted by religious affiliations. . .
Peterson, Heather [Full
. . . Some physicians may be opposed to assisted dying which is their
right. But they must not be allowed to stop the patient from gaining access
to their own right to die. Please ensure that dissenting doctors be required
to refer the patient to doctors who are accepting of the law. . .
Physicians' Alliance Against Euthanasia
4. No doctor or other health professional should ever be required to
participate in "physician-assisted dying", even by referring a patient to
another professional or an administrative body who will facilitate it. There
should be no discrimination against health professionals or trainees in the
health professions who are unwilling to collaborate in this act. No
jurisdiction in the world requires such collaboration.
5. Similarly, all health care institutions should be free to prohibit the
practice of euthanasia within their walls, in order to create a safe space
for patients who are afraid of being euthanized without having requested it.
Protection of Conscience Project
IV. Coerced complicity in homicide
IV.1 The position of the Provincial-Territorial Expert Advisory Group and
some influential or powerful individuals or groups is that a learned or
privileged class, a profession or state institutions can legitimately compel
people to be parties to homicide or suicide - and punish them if they
IV.2 Nothing of the kind is stated or implied in
Carter. This is
not a reasonable limitation of fundamental freedoms, but a reprehensible
attack on them and a serious violation of human dignity. From an ethical
perspective, it is incoherent, because it posits the existence of a moral or
ethical duty to do what one believes to be wrong. From a legal and civil
liberties perspective, it is profoundly dangerous. If the state can demand
that citizens must be parties to killing other people, and threaten to
punish them or discriminate against them if they refuse, what can it not
demand? Yet the Group appears to experience resistance to coerced
participation in homicide and suicide as a "uniquely Canadian" mountain to
IV.3 Other countries have demonstrated that it is possible to
provide euthanasia and physician assisted suicide without suppressing
fundamental freedoms. None of them require "effective referral,"
transfer" or otherwise conscript objecting physicians into
euthanasia/assisted suicide service (Appendix "A"). It
appears that they recognize a point made by Dr. Monica Branigan when she
appeared before the Committee: that one "cannot build a sustainable system
on moral distress."
V. Federal and provincial
V.1 Provincial governments have primary jurisdiction over human rights
law, subject to the Canadian Charter of Rights and Freedoms. By virtue of
the subject matter in this particular case (homicide and suicide), the
federal government has jurisdiction in criminal law.
V.2 Criminal law is
not used to enforce or defend fundamental rights and freedoms per se. For
that, Canada relies upon human rights statutes. But Canada does use the
criminal law to prevent and to punish particularly egregious violations of
fundamental freedoms that also present a serious threat to society: unlawful
electronic surveillance, unlawful confinement and torture, for example.
V.3 Coercion, intimidation or other forms of pressure intended to force
citizens to become parties to homicide or suicide is both an egregious
violation of fundamental freedoms and a serious threat to society that
justifies the use of criminal law.
V.4 For this reason, whatever might be
decided about laws regulating euthanasia and assisted suicide, the Project
proposes that the federal government make it a matter of law and national
public policy that no one can be compelled to become a party to homicide or
suicide, or punished or disadvantaged for refusing to do so, even if the
homicide or suicide is not a criminal offence.
offers an amendment to the Criminal Code designed to achieve that
Hon. James S. Cowan: The business of conscientious
objection. Nobody is trying to force anybody to participate in this process.
But, the corollary of that, that protects the practitioner, whether its a
physician or another medical professional. But looking at it from the point
of view of the patient, how do we ensure that there is what I would call an
effective referral. Something more than simply saying, “I'm not, I can't be
involved in this. You're on your own. Go and look it up on the Internet. Go
call the medical society, and they may be able to help you”. Don't you agree
that we need to have, design a regime that ensures there is a more effective
referral than that?
Dr. Jennifer Gibson: Yes
Hon. James S. Cowan: What would that look like?
Dr. Jennifer Gibson: This became clear to us
through the consultation. We heard from many physicians who initially felt
like this was weighing down a burden and it was falling only on physicians'
But, on the issue of access, very clearly, there are multiple actors that
need to be operating together in order to be able to make this, to ensure
access. What we've recommended, is that, in here, we've defined roles for
different levels and institutions, institutional roles, including regional
health authorities, to facilitate access.
Quite apart from the issue of conscientious objection, access - period -
is going be a challenge for many in Canada. And so, there is going to need
to be system coordination, and that will be at the provincial and at the
regional level within provinces indeed.
Hon. James S. Cowan: That's the role of the regulatory
authorities, the colleges of physicians . . .
Dr. Jennifer Gibson: The regulatory authorities,
indeed. And I think this is where the Supreme Court of Canada invited us to
And so, we do acknowledge in clinical practice - and not just physicians
but other health professionals as well - that they have a right of
conscience. And, in fact, one of our members, Sister Nuala Kenny, Dr. Sister
Nuala Kenny, who was a member of our expert advisory group, reminded us that
conscience also applies to those who are proponents and are willing to
practise physician-assisted death. Their conscience tells them that this is
the right thing to do.
And unless we want, we need to be able to ensure that we have a regime
that calls on physicians and clinicians to stay closely anchored to what
they're called to do in terms of public service. So, this is, you know,
Colleges do have a key role in making very clear what the expectations are
of their members in terms of facilitating access.
It's been very clear in our recommendations, and also we're hearing
this from some of the, especially from the physicians in palliative care,
that an effective transfer of care would be important, but that all
physicians, all clinicians ought to be able to provide all information about
all options. That doesn't mean that the physician needs to participate in
the act of physician-assisted death, but they must be able to provide
information on the options and, if necessary, on the basis of conscience,
facilitate an effective transfer. And to do that well, they're going to need
others in the system facilitating it.
Hon. James S. Cowan: Exactly. Can I just make sure that
your comments would also apply to institutions?
Dr. Jennifer Gibson: Yes. . .
Mr. John Aldag: . . . In your report, you talk
about physicians refraining from - this is in recommendation 36 - and I'm
just really curious, in your discussions about how big of an issue it was on
physicians refraining from participating in physician assisted dying, and if
you see that it's a large issue that we need to pay a lot of attention to on
the conscientious objection?
Or, just any quick thoughts on that?
Ms. Maureen Taylor: Yeah. I'm not a legal
expert, but I have a feeling that this is going to be seen as something that
the provinces will say they have jurisdiction over. That's what we were told
by the Attorney General.
But I will say that I love that you're thinking along those lines,
because, again, we want, we don't want a patchwork approach to this. As we
know, right now in Prince Edward Island, women cannot get an abortion. We do
not want that to happen with physician-assisted dying. Anything your group
can do to ensure in the absence of provinces - This is one worry -
I'll be blunt - is that some provinces will do nothing after next June.
They won't bring in legislation. And I think you were talking about that
So if you can have something in place where those Canadians who live in a
province that wants to bury its head in the sand won't be left without this
option. I don't know what those things are, I'm not the expert, but I
love that you're thinking about it.
This is an issue that seems fairly uniquely Canadian. Of course, there
are physicians who conscientiously object in the other jurisdictions, but as
far as we knew from our research, it has never been such a mountain to climb
as it seems to be in Canada, and I have no insight as to why that is.
Conscience Rights of Physicians Ignored
The Supreme Court of Canada in its decision also made the statement,
without supporting evidence, that “Nothing in this declaration would compel
physicians to provide assistance in dying.” The court has quickly been
proven wrong on this point. The Colleges of Physicians and Surgeons of the
provinces of Saskatchewan and Ontario have declared that any physician who,
for conscience or religious reasons, may not wish to participate in assisted
suicide, must refer a patient to another physician to carry out this
To coerce physicians to provide services that go against their religion
or consciences is not acceptable. It is contrary to the Charter's right of
freedom of conscience and religion. It is also a serious incursion into the
professional standing of the physician. A proper balancing of the rights of
physicians with the concept of patient autonomy, must not result in the
trumping of the rights of a physician in his/her medical practice. Such
rights extend not only to refusing to perform assisted suicide and
euthanasia, but the right not to be obliged to refer to other practitioners
or third parties, who may be willing to provide such services. The reality
is that the requirement to refer for assisted suicide or euthanasia
procedures, to which the physician objects on the grounds of conscience or
religion, compels that physician to violate his or her conscience by being a
participant in the very act, the very procedure to which he or she objects
in the first place.
. . . In Quebec at this time, where the provisions of euthanasia of the
Quebec law were being challenged (32), there is the clear infringement on
the constitutional rights and freedoms of physicians. It obliges physicians,
who refuse to administer euthanasia by reason of their medical code of
conduct and medical conscience of best medical practice and best interest of
their patients, to nevertheless participate by way of referral. Physicians
are compelled to report to the medical director of the establishment that
they have received a request of medical aid in dying even if they consider
this not the best medical scientifically proven way to provide medical care
and least harmful way to provide care. (32) . . .
The Salvation Army calls on the Government of Canada to:
2. protect the conscience of individuals as well as facilities and the
organizations that operate them with respect to the provision of
Protection of Conscience of Individuals and Health-Care
The development of a system that permits access to physician-assisted
death while simultaneously protecting the right of conscience and the right
to life of vulnerable people will require careful balancing. The Salvation
Army submits that the right of conscience exists not only for physicians but
for health-care facilities and the organizations that operate them.
Recognizing a right of conscience for institutions would not result in the
denial of a patient's Charter right; rather it would be the same as for a
health practitioner exercising their right of conscience. The institution
would do everything necessary to ensure the patient receives the desired
care and would ensure the transfer of care in an expedient and compassionate
manner should physician assisted death be desired.
One of the objectives of Carter was to balance the right of access to
physician-assisted death with the right of conscience for those who do not
wish to participate. Permitting some facilities to be exempt from providing
physician-assisted death will not limit access in a meaningful way. Rather,
allowing for institutions to be exempt will offer protection to the
conscience, morality and beliefs of patients, health-care providers and
organizations who do not wish to engage with physician-assisted death. We
note that several other jurisdictions such as Washington and Oregon offer
health facilities or health care providers the option to decline from
participating in physician-assisted death.
We recognize there are many other practical considerations, as
physician-assisted death becomes a reality in Canada. The Salvation Army in
Canada therefore calls on Government to:
2. Ensure the protection of the conscience of individuals as well as
facilities with respect to the provision of physician-assisted death so that
individuals who choose not to participate may do so in a trustworthy and
safe environment where physician-assisted death is not present
. . . Carter requires Parliament to specifically legislate protections
for individuals and groups in the healthcare field who object on matters
Recommendation 1: It is proposed that Parliament provide explicitly that
health care workers and/or institutions cannot be subject to obligation or
sanction, including professional sanction, as a result of their failure to
participate in physician assisted suicide or euthanasia.
I. PARLIAMENT MUST ENACT CONSCIENCE PROTECTIONS:
The Carter decision in no way compels doctors or other healthcare workers
to unwillingly cooperate in a suicide. Carter was based on two important
factual conditions: a willing patient and a willing doctor. The
applicants in Carter all had willing doctors. Had there been no willing
doctor, the Supreme Court may have still held the applicants had a right to
assisted suicide, but not necessarily by a physician. The finding of the
Court in the specific case of Carter does not positively obligate
physicians to add assisted suicide or euthanasia to their medical practices.
Many doctors and other healthcare workers object to assisted suicide and
euthanasia on the grounds of moral conscience; others object as a matter
of professional ethics, which is no less an objection of conscience. In
paras. 130-132 of the Carter decision, the Supreme Court held "a
physician's decision to participate in assisted dying is a matter of
conscience and, in some cases, of religious belief." The Court then
invited Parliament, along with provincial legislatures and physician's
colleges, to implement a scheme which protects these rights.
Parliament should explicitly affirm that physicians and all other health
care workers are not obligated in any way to participate in physician
assisted suicide or voluntary euthanasia, either in the act of killing
itself, or in the process which might lead to such a killing. Parliament
should affirm that the failure to so participate does not infringe the
rights of patients, and is not a reason for discipline or other sanction,
either criminal or professional.
It is established law in Canada that doctors are not government actors,
and therefore cannot violate the Charter rights of other individuals
(see: Stoffman v. Vancouver General Hospital,  3 S.C.R. 483). Only
government can violate the constitution, and under the constitution,
doctors are private actors. The facts that doctors are regulated by a public
body, that they are largely paid by public dollars, and that Canada has a
system of socialized medicine, do not render doctors public actors whose
conduct is measured against the Charter. Like lawyers, engineers, and
other professionals, doctors are private actors. Carter does not and cannot
place any obligation on individual physicians to assist in a suicide or
euthanasia, especially where to do so would violate their fundamental
freedoms of conscience and religion. This reasoning applies equally to
protect other healthcare workers such as nurses and pharmacists, who are
similarly private actors.
Some assume that the government has a positive obligation to facilitate
assisted suicide or voluntary euthanasia for those who qualify per
Carter. Firstly, it must be noted that this argument is made in the
absence of any evidence establishing that access to assisted suicide and
euthanasia will be a problem. However, even assuming this to be the case, a
government obligation to facilitate a Charter right does not require
individual non-government actors (i.e. healthcare workers) to be
compelled to cooperate in an action to which they object as a matter of
fundamental moral conscience. To the extent that government sets forward a
scheme to facilitate access to assisted suicide and euthanasia, such a
scheme cannot place obligations on or sanction individuals who object to
assisted suicide or euthanasia as a matter of conscience. Individual
physicians who object as a matter of conscience to assisted suicide or
euthanasia cannot be compelled to refer patients to another physician who
will provide these, if this referral would also violate their
Parliament should also recognize the rights of patients who may wish to
seek care in institutions where physician assisted suicide and euthanasia
are not offered. This is an important matter of patient choice,
especially for those patients who are not comfortable with physician
assisted death, and for whom its existence undermines their trust in
their physicians and damages the therapeutic relationship. Some patients
have concerns that they will be coerced into physician assisted death,
and that there will conflicts of interest (including possibly financial
conflicts) regarding their care. The existence of institutions which do
not provide physician assisted death will greatly assist such patients in
maintaining confidence in the medical system. . .
ii. The PTG's failure to properly balance conscience rights against
patient interests Respecting conscience rights, the PTG rightly
recognizes that physicians with moral reservations must be exempt from
being forced to participate in assisted suicide. However, this does not
adequately protect the conscientious objector from being complicit in what
they regard to be a most serious offence against life. As such, the
exemption should extend to all health care workers (e.g. nurses and
pharmacists and others) who might be requested to assist in a suicide. It
must also exempt physicians from being required to refer a patient for
assisted suicide, as referring a patient for suicide is considered by
many conscientious objectors as an unacceptable form of cooperation in
the killing of a human being. Rather than requiring mandatory discussions
and referrals, there could be made publically available a registry of
participating physicians and institutions for self-referral by patients.
Secular Connexion Séculière
Public Funding & Doctor Participation: Both medically assisted suicide
and voluntary euthanasia should be a part of public medical funding so that
there is no issue of differing availability because of financial reasons.
Doctors and other medical care providers must have the right to exercise
their own personal philosophy in these matters, but must not have the right
to inhibit the right of individuals to choose their own path to completing
life with dignity.
Dr. John Soles (President, Society of Rural Physicians of Canada):
. . . As you know, Canada is 90% rural by geography, and has slightly less
than 20% of the population being rural. And roughly 10% of Canadian doctors
work in rural areas. Canada's rural population is poorer; it's less healthy,
and it has a significantly higher proportion of indigenous peoples,
particularly in the north. Rural Canadians have less access to health care
and may have to travel very significant distances, particularly in the
north, to get such care. Canada's rural physicians are older, they are much
more likely to be international medical graduates - I'm an exception in that
instance. The health care in very small rural communities may be provided by
nurses and other health care workers rather than physicians. Access to
specialists is limited, and most rural physicians work as generalists and
include palliative care within their skill set. . .
. . .the question of who does what. I believe that whatever the personal
beliefs of a physician may be, they must be willing to discuss all legal
options with their patients and make appropriate referrals if they
themselves are unable to take part in that service. I think here the way
abortion works in Canada, is a reasonable, has some similarities. Physicians
should not be obligated to be involved with a service that they have moral
difficulties with, however they should be able to have such a discussion
with their patients and to refer when necessary.
One of the questions that has arisen in the past, or in discussions about
this is death certificates and how they're filled out. I think death
certificates should have physician-assisted dying as the immediate cause of
death with the diagnosis that led to this as an underlying cause.
And now the concerns in rural areas. The challenge in rural areas is
often, as in the community I live, that there is a group of physicians
who work together, and how is it possible to arrange a second opinion about
someone's suitability for this, or their competence? I think it's
inappropriate to do that within a group of physicians who work together. How
is it possible to arrange and expedite a psychiatric consultation, if that's
required? If all physicians in a group are conscientious objectors to this
process, how do patients obtain a service, which is considered legal in a
small community, where the physicians are not able morally to provide that
service? This is a little different than the abortion discussion in that
these patients are much less likely to be able to travel safely.
Where and how in a rural community where everyone knows everyone is it
possible to carry out this process? What would the effect be on other
members of the community? What would the effect be on the staff of a rural
hospital? What would the effect be if there was radically different
viewpoints within a small group of physicians?
Those are the important points . . .
Dr. John Soles: . . . I'm not sure I have the answers for
I think the role of telemedicine was mentioned. If we're looking at a
patient that has requested physician-assisted death and is in one of these
communities in which there is only one physician group, it would be most
appropriate that this patient be assessed by a second physician. And if that
can't be done in person, then it needs to be done in some other fashion; and
that would presumably be via video or telephone link, preferably video.
If you had a small community where there was no physician who was willing
to participate in this process, other than informing a patient about, if the
patient requests it, informing them about what the process was, it creates a
great challenge, because I really don't think that it's appropriate for
these decisions to be solely made without actually sitting in the room with
the patient. . .
Hon. Nancy Ruth: . . . how can nurse practitioners
or other people in rural areas deal with this, if there is a legitimate
request, maybe assessed through telehealth, for physician-assisted death for
someone who wants to stay in their home, be they living in Grise Fiord in
the high Arctic or anywhere else in Canada. And a cocktail of drugs could be
flown in by mail, like other drugs are sent by mail. Do you ever, can you
imagine that happening? And what kinds of problems would there be?
Dr. John Soles: Certainly I can imagine, as any
physician who's provided palliative care, I prescribe lethal doses of drugs
to patients all the time without the expectation that they take them.
Just to clarify that for the committee, if I have a patient who has
terminal cancer, for instance, they will go home perhaps with a dose of
medication that, if you or I had it, it would be terminal. And the striking
thing to me is that I cannot recall, in my personal experience, any patient
that has chosen to take their medication in that fashion.
I think the real challenge, if you're prescribing medications at a
distance and you're sending them, you know, through the mail and they're
being administered by the patient's family or a nurse, what happens when
things go wrong? I don't really want to make this comparison, but there's
been cases where death by lethal injection in the States has gone badly
wrong, and those are cocktails delivered by physicians. I would hate to
think of some nurse in Grise Fiord who has that kind of experience.
3. Roles and regulation of healthcare pracitioners
For nearly 2,500 years, physicians and the profession of medicine have
recognized that assisted suicide and euthanasia are not medical treatment
and this position should be maintained and these interventions- should be
kept out of medicine. (See J. Donald Boudreau and Margaret A. Somerville,
"Euthanasia is not medical treatment", British Medical Bulletin 2013;
106: 45--66, 001:10.1093/bmb/ldtOlO explaining this stance.)
Consequently, a new profession should be established to carry out
euthanasia. The practitioners should not be healthcare professionals or,
if so, only ones who have permanently retired from practice.
Practitioners should be specially trained, licensed and have travel money
provided to give people across Canada equal access to euthanasia.
If this approach is not adopted, two publicly available lists of
physicians and institutions should be established, those who will provide
euthanasia and those who will not. This is a reasonable compromise
between Canadians who agree with euthanasia and those who oppose or fear it.
The Supreme Court emphasized that the Charter right to "security of the
person" includes freedom from fear about what could happen to us when we are
dying, which often seems to be forgotten or ignored with respec to this
right of those fearul of euthanasia.
This approach will also solve most freedom of conscience issues.
Healthcare professionals must not be forced to provide or refer for
euthanasia when they have ethical or conscience objections to doing so. It
must be kept in mind that respect for physicians' patients and can be the
last such protection against doing them serious harm or other serious
wrongdoing. . .
Freedom of Conscience
Physician-assisted death runs contrary to the
ethical practice of doctors who want to promote health and life where they
can, and who prefer to provide excellent end-of-life care within a
palliative framework. Our Charter of Rights guarantees freedom of
conscience; this needs to be protected for our doctors.
may feel comfortable with ending a patient's life. This creates an inherent
conflict. Who will train these doctors? What will be the ethical principles
guiding their work? How will you keep the process free from the potential
for monetary gain? Should this become a money-maker for certain health
professionals, as private abortion clinics have become?
How will you
guarantee "safe places" for patients and medical staff where no one will
feel compelled or coerced?
PAD is a controversial matter. Some physicians will have no religious or
ethical objection to providing this service for their patients, while for
others it will violate the dictates of their conscience. A policy must
include a 'conscience clause' which enables providers to decline to offer
the service on grounds of personal conviction. However, it must also require
that they not abandon patients who request PAD; they must then be obliged
to provide patients with an effective and timely referral to a provider
willing to help them. On the other hand, publicly funded health care
institutions should be required to permit PAD on their premises if a
physician is willing to provide it. Otherwise, patients in many
communities with religiously affiliated hospitals will be denied timely
access to the service.
Svec, Katherine Meaney
3. Non-compliant health care providers, hospitals, and care facilities
must not impede an eligible patient's right to obtain Physician-Assisted
3. Non-compliance: Many physicians have responded to surveys stating they
will not agree to hasten a patient's death, nor will they refer. Other than
simply abandoning their patient to self-help, I have as yet seen no
alternative offered by these non-compliant physicians. This crucial gap in
the process must be addressed and a solution found which balances the rights
of such physicians and the rights of suffering patients. Hospitals and
care facilities with a religious component must not be allowed to dictate
terms. Patients who meet the criteria and who request Physician-Assisted
Dying must have timely access to a cooperating physician.
4. Physicians need clarity and firm guidelines e.g. How are Ontario
physicians to comply with the CMA Policy of no duty to refer which is at
odds with the CPSO policy on this issue?
4. Clear Guidelines: If the CMA insists there is no duty to refer, one is
left to wonder how Ontario physicians are to comply, in light of the CPSO's
policy on Professional Obligations and Human Rights which clearly states:
"Where physicians are unwilling to provide certain elements of care for
reasons of conscience or religion, an effective referral to another
health-care provider must be provided to the patient. An effective referral
means a referral made in good faith, to a non-objecting, available, and
accessible physician, other health-care professional, or agency. The
referral must be made in a timely manner to allow patients to access care.
Patients must not be exposed to adverse clinical outcomes due to a delayed
referral. Physicians must not impede access to care for existing patients,
or those seeking to become patients." (Limiting Health Services for
Legitimate Reasons: Policy Number:#2-15 Reviewed and Updated March 2015)
Of particular note is the fact that this policy was confirmed after the SCC
ruling on the Carter case, yet there is no mention of any exclusions (such
as physician- assisted dying) to be applied to the duty to refer.
United Church of Canada [Full
. . . The emphasis on physician-assisted dying being a decision
between an individual and their doctor implies that the doctor must also be
allowed the right not to participate if they believe it inappropriate to do
so. Support for physician-assisted dying must take into account the
difficulties faced by medical staff both in contributing to the ending of an
individual's life, and in the emotional implications that might result. . .
Where an individual who qualifies for physician-assisted death
under the new legislation requests their doctor's assistance to end their
life, but the doctor has objections to participating, the doctor ought to be
obliged to refer the individual to another doctor. This is
consistent with other legislation, such as the abortion laws, which allow
freedom of conscience for medical professionals without jeopardizing equal
access to medical care for individuals. . .
von Fuchs, Ruth (Right to Die Society of Canada)
. . . Ultimately there will be a situation of patient's orders and
doctor compliance (or doctor refusal and patient referral, if assisted dying
is chosen and the doctor is unwilling to provide it). . .
3. Referral - Physicians who oppose PAD must be required to refer
patients to another doctor or a third-party referral agency.
3. Conscientious Objection The whole idea of the Right To Die movement
is to provide choice at the end of life. Proponents, like me, want control
over our own bodies and we respect that right for others. I totally support
the right of physicians and other healthcare providers to refuse to provide
Physician Assisted Death to a patient who requests it but the patient's
right to it must also be protected. Physicians who oppose assisted dying
must be required to refer patients who request it to another doctor or a
third-party referral agency. Sick and dying patients should not be
responsible for finding an alternate doctor on their own.
4. Institutions - All publicly funded healthcare institutions must allow
PAD on their premises.
4.Publicly Funded Healthcare Institutions The protection of every
patient must be a paramount consideration of the Bill and no patient can be
denied access to PAD because of the beliefs or policies of religious
institutions. All publicly funded healthcare institutions must allow PAD
on their premises. If no doctors on staff are willing to provide it, an
external doctor must be permitted into the hospital to provide the service.
This policy is especially relevant for small communities where healthcare
options may be limited. For example, some communities may only have
Catholic-affiliated hospitals or hospices nearby. If those institutions
refuse to provide PAD on their premises, then access to PAD will be heavily
restricted in the communities they serve. Even in larger centres, a patient
may be rushed to an emergency department at a Catholic hospital. Moving the
patient to a non-denominational institution would cause unnecessary
stress and may not be possible depending on the patient's condition.
b) Any tax payer supported facility, must provide the facility for
the patient to have their pain end in a kind and compassionate manner.
e) All medical parties must adhere to the document, not using their
own personal bias to ignore the documented / witnessed wishes of the
patient, this includes the “family doctor”.