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Project Submission to the Canadian Provincial/Territorial Expert Advisory Group on Physician-Assisted Dying

Re: Implementation of Supreme Court of Canada ruling in Carter v. Canada

I. Introduction

I.1 The Protection of Conscience Project is a non-profit, non-denominational initiative that advocates for freedom of conscience among health care workers. It does not take a position on the acceptability of morally contested procedures. For this reason, almost half of the questions in the Written Stakeholder Submission Form are outside the scope of the Project’s interests.

I.2 The completed Written Stakeholder Submission Form is in Appendix “A” of this submission. The responses are numbered for reference purposes.

II. Scope of this submission

II.1 The responses in the Written Stakeholder Submission Form (Appendix “A”) are supplemented, in some cases, by additional comments in Part III. A protection of conscience policy is suggested in Appendix “B.”

III. Additional comments on numbered responses

III.1 Role of Physicians (Response 11)

III.1.1 While the Quebec euthanasia kits are to include two courses of medication in case the first does not work,1 insufficient attention has been paid to the fact that euthanasia and assisted suicide drugs do not always cause death as expected.2

III.1.2 Physicians willing to perform euthanasia as well as to assist in suicide should disclose and discuss options available in the event that a lethal injection or prescribed drug does not kill the patient.

III.1.3 Physicians willing to prescribe lethal drugs but unwilling to provide euthanasia by lethal injection should consider what they may be expected to do if a prescribed drug incapacitates but does not kill a patient.

III.1.4 The possibility of this complication provides another reason for insisting that the physician who approves assisted suicide or euthanasia should be the one to administer the lethal medication or to be present when it is ingested. Expecting other health care workers to deal with this complication is likely to increase the likelihood of conflict in what will be an already emotionally charged situation. . . . [Full Text]

Ontario physicians unwilling to kill patients must help find someone who will

College of Physicians and Surgeons demands “effective referral” for euthanasia, assisted suicide

For immediate release

Protection of Conscience Project

The College of Physicians and Surgeons of Ontario has quietly issued a directive that physicians who, for reasons of conscience or religion, are unwilling to kill patients or help them commit suicide, must help them find someone willing to do so.

The requirement appears in the policy Planning for and Providing Quality End-of-Life Care, approved in September by College Council:

8.3 Conscientious Objection

Physicians who limit their practice on the basis of moral and/or religious grounds must comply with the College’s Professional Obligations and Human Rights policy.

A note explains that limiting practice includes refusals to “provide care” (i.e., kill patients or assist with suicide.)

The College’s policy, Professional Obligations and Human Rights , demands that physicians who are unwilling to provide procedures for reasons of conscience or religion must make “an effective referral to another health-care provider,” which is defined as “a referral made in good faith, to a non-objecting, available, and accessible physician, other health-care professional, or agency.”

As a result of the demand for “effective referral,” Professional Obligations and Human Rights is the subject of a legal challenge filed by the Christian Medical and Dental Society and the Canadian Federation of Catholic Physicians’ Societies. Among other things, the suit alleges actual bias or a reasonable apprehension of bias on the part of the working group that developed the policy.

Professional Obligations and Human Rights was approved by College Council in March, 2015, despite overwhelming opposition to the demand for “effective referral” that was evident in the returns during the public consultation. The College issued a statement with the policy to the effect that it did not apply to euthanasia or assisted suicide. It promised to revisit the issue after Parliament or the provincial legislature enacted laws in response to the Supreme Court of Canada decision in Carter v. Canada.

“It was obvious at the time that this was an ingenuous tactic that they hoped would defuse opposition to the policy, at least among Council members” said Protection of Conscience Project Administrator, Sean Murphy. “This development simply confirms the obvious.”

Turning physicians into executioners

National Post

Sean Murphy*

When the Canadian Medical Association (CMA) convenes in Halifax this month for its Annual General Council, delegates will confront what the CMA’s Dr. Jeff Blackmer has called the biggest change in the medical profession in Canada, maybe in centuries: the legalization of physician-assisted suicide and euthanasia ordered by the Supreme Court of Canada.

Last year, when announcing the intention of the CMA to intervene in the Carter case at the Supreme Court, Dr. Blackmer and CMA President Dr. Louis Hugo Francescutti reflected on what was at stake.

One person’s right is another person’s obligation, and sometimes great burden, they wrote. And in this case, a patient’s right to assisted dying becomes the physician’s obligation to take that patient’s life. . . [Full text]

Project to Saskatchewan regulator: no evidence to support limitation of fundamental freedoms

Draft policy attacks character, competence of physicians

News Release

Protection of Conscience Project

Project to Saskatchewan regulator: no evidence to support limitation of fundamental freedoms For the third time this year, the Protection of Conscience Project has criticized a draft policy proposed by officials of the College of Physicians and Surgeons of Saskatchewan who want to control the exercise of freedom of conscience and religion by physicians. The draft policy, Conscientious Objection, was approved in principle by the College Council on 19 June and released for a public consultation that ended on 7 August.

Citing Section 1 of the Canadian Charter of Rights and Freedoms, the Project states that “the limits proposed in Conscientious Objection are neither reasonable nor demonstrably justified” because the College had no evidence that conscientious objection by Saskatchewan physicians has ever deprived anyone of access medical services or adversely affected anyone’s health.

The Project submission calls Conscientious Objection unacceptable “because it attacks the character and competence of objecting physicians, and it nullifies their freedom of conscience by compelling them to arrange for patients to obtain services to which they object.”

This has become of particular concern because physician assisted suicide and physician administered euthanasia will be legal in Canada in February of next year. The draft policy states that it does not apply to those services, but the Project submission rejects that disclaimer, calling it “ill-advised and misleading.”

Among other things, the Project points out that, even after the Supreme Court of Canada ordered the legalization of physician assisted suicide and euthanasia, the College’s Associate Registrar “defended the proposition that physicians should be disciplined or fired if they refuse to at least help to find someone willing to kill patients or help them commit suicide.”

The disclaimer was added only after it became clear that the policy faced overwhelming opposition, either as a tactic to secure the approval of the policy, or because some of its supporters began to realize the policy’s implications.

The submission warns the College that a policy on conscientious objection should be flexible enough to apply to requests for assisted suicide and euthanasia.

” If Council is uncertain how this can be done, it should postpone policy development concerning Conscientious Objection until after the Carter decision comes into force in 2016.”

The Project also strongly criticizes the policy because it suggests that physicians who refuse to do what they believe to be wrong cannot be trusted.

“Solely on the basis of their beliefs,” the submission notes, “it implies that they are unacceptably biased and effectively prohibits objecting physicians from communicating with their patients about morally contested procedures.”

Instead, the policy demands that they refer their patients to someone who can provide “full and balanced health information,” apparently assuming that physicians who have moral viewpoints are incapable of properly communicating with patients.

“But all physicians have moral viewpoints,” the Project reminds the College. “Conscientious Objection simply exchanges one kind of ‘bias’ for another.”

The Project submission includes an alternative policy that protects physician freedom of conscience and religion but does not obstruct patient access to services, including euthanasia and assisted suicide. The alternative draws on the CPSS draft policy, the Canadian Medical Association Code of Ethics, and a joint statement by the Canadian Medical Association, Canadian Healthcare Association, Canadian Nurses’ Association, and Catholic Health Association of Canada.

The proposed CPSS policy has also been criticized by the Christian Medical and Dental Societies, the Federation of Catholic Physicians Societies of Canada and Canadian Physicians for Life. Their joint submission states that Conscientious Objection “does not adequately deal with physicians’ human rights” and “does not accurately reflect the law.”

Project Submission to the College of Physicians and Surgeons of Saskatchewan

Re: Conscientious Objection

Abstract

Conscientious Objection is unacceptable because it attacks the character and competence of objecting physicians, and it nullifies their freedom of conscience by compelling them to arrange for patients to obtain services to which they object.

Council has been given no evidence that anyone in Saskatchewan has ever been unable to access medical services or that the health of anyone in Saskatchewan has ever been adversely affected because a physician has declined to provide or refer for a procedure for reasons of conscience. In the absence of such evidence, the limits proposed in Conscientious Objection are neither reasonable nor demonstrably justified.

Conscientious Objection is not justified by the principles included in the policy because there is no necessary connection between the principles and a policy requiring physicians to do what they believe to be wrong. The principles can be applied to force physicians to facilitate morally contested procedures only if they are ideologically interpreted in order to impose one world view at the expense of others. The Supreme Court of Canada has unanimously affirmed that such an approach is unacceptable.

It is unrealistic to believe that the approach taken in Conscientious Objection will not be taken with respect to physician administered euthanasia and physician assisted suicide. The disclaimer to the contrary is ill-advised and misleading. A policy on Conscientious Objection should be sufficiently flexible to apply to direct or indirect participation in killing patients or helping them commit suicide. If Council is uncertain how this can be done, it should postpone policy development concerning Conscientious Objection until after the Carter decision comes into force in 2016.

Alternatively, if the College believes that some kind of guidance should be provided with respect to this contentious issue, the Project offers an alternative that protects physician freedom of conscience and religion but does not obstruct patient access to services, including euthanasia and assisted suicide.

I. Introduction

II. Overview of this submission

III. Limitation of fundamental freedoms

IV. “Purpose” and “Principles”

V. Scope of Conscientious Objection

V.1 The disclaimer

V.2 Dissecting the disclaimer

V.3 Summary

V.4 Recommendations

VI. Physician obligations

5.1 Taking on new patients (Comment)