Category: Canada

Unacceptable to force doctors to participate in assisted dying against their conscience: CMA head

National Post

Sharon Kirkey

No physician in the country should be forced to play a role in any aspect of assisted dying against their moral or religious beliefs — including referring patients to another doctor willing to help them die, the Canadian Medical Association says.

Legalized physician-assisted death will usher in such a fundamental change in practice “we simply cannot accept a system that compels physicians to go against their conscience as individuals on something so profound as this,” CMA president Chris Simpson said in an exclusive interview.

The unanimous Supreme Court of Canada ruling legalizing assisted dying would not compel doctors to help patients end their lives when the historic decision takes effect next year.

But the justices were more guarded on the issue of mandatory referral, saying the Charter rights of both patients and doctors will need to be reconciled.

Dr. Simpson said that many doctors who conscientiously object to assisted dying feel the very act of referral “is contrary to their personal ethics or moral or religious beliefs.” . . . [Full text]

Giving doctors a choice on assisted suicide

National Post

The following is an open letter written by medical professionals to the College of Physicians and Surgeons of Ontario.

Should Ontario’s doctors be forced to violate their consciences? On Feb. 6, the Supreme Court of Canada struck down the Criminal Code provisions against euthanasia and physician-assisted suicide. Concurrently, the College of Physicians and Surgeons of Ontario (CPSO) is proposing to oblige physicians, at the risk of professional discipline, to refer patients for procedures that a physician has refused for reasons of conscience, to a willing physician or agency established for such referrals.

This is a major shift in policy for the CPSO. Aside from Quebec, this position is not held by any other medical regulatory college in Canada and is inconsistent with the position of the Canadian Medical Association, the American Medical Association and similar bodies in Commonwealth countries. . . [Full Text]

How far should a doctor go? MDs say they ‘need clarity’ on Supreme Court’s assisted suicide ruling

National Post

Sharon Kirkey

Canada’s doctors are seeking clarity from the federal government on what the Supreme Court of Canada intended in its landmark ruling on assisted dying, including the question of how far a doctor is permitted to go in contributing to a patient’s death.

“We’ve got a few key questions that we think need clarity and this is one of them: Is it euthanasia or is it assisted dying?” said the Canadian Medical Association’s director of ethics and professional affairs, Dr. Jeff Blackmer.

The powerful doctors’ lobby said it is not clear whether the high court has opened the door not just to assisted suicide  –  where a doctor writes a prescription for a lethal overdose of drugs the patient takes herself  –  but also to something many physicians find profoundly more uneasy: pushing the syringe themselves. . . [Full text]

 

Protect doctors’ right to choose

QMI AGENCY

It’s all about choice. The Supreme Court of Canada has ruled that suffering Canadians have the right to choose to end their life through assisted suicide.

But doctors must also have the right to choose  –  to choose whether they are a part of this process or not.

A recent article in the Canadian Medical Association Journal showcases several points worth repeating. They report that a majority of palliative care physicians actually don’t envision assisted suicide as part of their work. . . [Full text]

 

American Medical Association provides details of new freedom of conscience policy

AMA submission to Ontario College of Physicians an improvement on quality of briefing by College working group

Sean Murphy*

The American Medical Association has made a submission to the public consultation on physician freedom of conscience being conducted by the College of Physicians and Surgeons of Ontario (CPSO).  The AMA letter provides important details about a policy on physician freedom of conscience adopted by the AMA House of Delegates in November, 2014, but not due to be formally published until June of this year.

The current consultation on a controversial draft policy, Professional Obligations and Human Rights (POHR), was approved by College Council in December, 2014.  Briefing materials provided to Council members by the College working group at that time included the American Medical Association as one of the organizations selected for international comparison of policies.

However, the single sentence offered by the working group as representative of AMA policy was taken from an on-line source of short essays about medical ethics, not an authoritative source of information about AMA policy. In fact, the article was about conscientious objection among pharmacists, not about the policies of the American Medical Association concerning freedom of conscience in health care.

The letter from the AMA is a substantial improvement upon what the Protection of Conscience Project submission characterizes as the “deficient and superficial” briefing materials concerning the United States supplied to College Council in December.

. . .In the Council’s view, an account of the nature and scope of a physician’s duty to inform or to refer when a patient seeks treatment that is in tension with the physician’s deeply held personal beliefs must address in a nuanced way the question of moral complicity. The Council concurs that physicians must provide information a patient needs to make a well-considered decision about care, including informing the patient about options the physician sincerely believes are morally objectionable. However, the Council sought to clarify that requirement, holding that before initiating a patient-physician relationship the physician should “make clear any specific interventions or services the physician cannot in good conscience provide because they are contrary to the physician’s deeply held personal beliefs, focusing on interventions or services that a patient might otherwise reasonably expect the practice to offer.”

The Council also reached a somewhat different conclusion than the College with respect to a duty to refer.

The College’s draft policy provides that, when a physician is “unwilling to provide certain elements of care on moral or religious grounds,” the physician must provide “an effective referral” to “a nonobjecting, available, and accessible physician or other health care provider.”

This seems to us to overstate a duty to refer, risk making the physician morally complicit in violation of deeply held personal beliefs, and falls short of according appropriate respect to the physician as a moral agent. On our view, a somewhat less stringent formulation of a duty to refer better serves the goals of non-abandonment, continuity of care, and respect for physicians’ moral agency. The council concluded that:

In general, physicians should refer a patient to another physician or institution to provide treatment the physician declines to offer. When a deeply held, well-considered personal belief leads a physician also to decline to refer, the physician should offer impartial guidance to patients about how to inform themselves regarding access to desired services.

On the Council’s analysis, the degree or depth of moral complicity is defined in part by ones “‘moral distance’ from the wrongdoer or the act, including the degree to which one shares the wrongful intent.”

Other factors also influence complicity, including “the severity of the immoral act, whether one was  under duress in participating in the immoral act, the likelihood that one’s conduct will induce others to act immorally, and the extent to which one’s participation is needed to facilitate the wrongdoing.” . . .