Ontario must amend its assisted dying
legislation to recognize conscience rights
Originally published in the
online publication QP
4 April, 2017
Reproduced with permission
Canadians ask a lot of our physicians – years
of education, long hours, complex cases and
demanding patients (full disclosure – I am
married to a doctor).
Since June of last year, we have also been
asking them to help some of their patients take
their own lives.
No matter how you feel about assisted dying,
you have to admit that having a role in the act
is a burden that few of us would ever welcome.
And yet as a society we seem to forget that
doctors are no different. As Dr. Jeff Blackmer,
a vice-president of the Canadian Medical
Association, recently told the National
Post: "The act is performed out of care and
compassion … But for most [doctors], it doesn't
make the psychological impact of that final,
very definitive act, any less than it would be
for anybody …"
Should we not respect the fact that some
doctors and other health-care providers simply
don't want to be involved in assisted dying for
reasons of conscience?
In fairness, the current system does not
force any medical professional actually to
administer the procedure. But what happens when
a patient under his or her care wants to access
According to guidelines issued by the College
of Physicians and Surgeons of Ontario, a doctor
who objects must take steps to refer the patient
to a physician or healthcare provider who is
open to performing the procedure – what is
technically known as an effective referral.
To some physicians this is tantamount to
indirect participation. They have no interest in
abandoning their patient and are prepared to
work with them to try to address their concerns,
including pain management, counselling and other
measures. They do not, however, want potentially
to be the starting point of the process that
leads them to euthanasia or assisted dying and
they refuse to be in involved in an effective
The college has refused to recognize their
concerns, resulting in a legal challenge from a
number of physician groups.
The Ontario government recently
introduced Bill 84, designed to bring provincial
laws in line with the new federal law. Here was
a perfect opportunity to clarify the rules
around effective referrals and allow physicians
to opt out fully due to reasons of conscience.
Yet the bill is silent on the matter.
This is not an impossible circle to square.
Objecting physicians have asked the province to
create a care co-ordination system that could be
accessed by patients wishing to be assessed for
medical assistance in dying, relieving their
physician of the need to refer
It's a system that has been established in
Alberta. There, an objecting physician can
simply provide patients with the contact
information of a care co-ordination service that
will provide them with assistance.
The irony of the situation is that the
Ontario government recently announced its
intention to establish a similar co-ordination
service in Ontario, making it simple to adopt
conscience protections mirroring those that
exist in Alberta.
And it's not just Alberta: A number of other
provinces have adopted similar pathways for
objecting physicians. In fact, experts in the
field note that outside of Canada there is no
jurisdiction allowing physician-assisted dying
in the world that doesn't allow doctors to opt
out of any form of involvement.
It is unclear why the Ontario Liberals are
refusing to take this step. The Progressive
Conservatives have taken up the cause and are
promising to introduce amendments to the bill at
committee stage. Among the most vocal
Conservative MPPs have been prominent social
conservatives like Monte McNaughton. Many see
this group as being on the "wrong side" of
numerous hot button issues like abortion, LGBTQ
rights and the new sex-ed curriculum.
Let's not turn conscience rights into a "hot
button" issue and dismiss the legitimate
concerns of physicians.
Yes it is true that many physicians object to
physician-assisted dying due to their religious
faith – a faith whose tenets concerning care for
the most vulnerable may have attracted them to
the profession in the first place. Why should
these beliefs be dismissed? What message is
Ontario sending when we tell doctors that their
religious faith or other deeply held values
can't be accommodated the same way it is in
I remember the outrage at Queen's Park over
the proposed Quebec charter of values. Aimed at
further secularizing the government, the charter
would have, among other things, banned those in
the Quebec public sector, including doctors,
from wearing religious symbols, such as
turbans or hijabs.
Ontario's Minister of Citizenship and
Immigration at the time, Michael Coteau, put out
a statement criticizing the legislation and
confirming the Ontario government's commitment
to "freedom of expression and religion." I
remember that many of my colleagues cheered when
an Ontario hospital blatantly tried to recruit
Quebec doctors by highlighting Ontario's respect
for their beliefs.
Why did we try to persuade doctors that our
province respects their freedoms back then and
yet can't take their freedom of conscience
seriously now? What has changed?