Category: Project Essays

Conscience, euthanasia and assisted suicide in Manitoba

The Medical Assistance in Dying (Protection for Health Professionals and Others) Act

Sean Murphy*

Manitoba is the only Canadian province with a stand-alone statute that protects health care professionals who refuse to provide services: the Medical Assistance in Dying (Protection for Health Professionals and Others) Act (MAiD Act).1

The MAiD Act is a procedure-specific law applying only to euthanasia and assisted suicide. It protects all regulated professionals who refuse to provide or “aid in the provision” of the procedures from professional disciplinary proceedings and adverse employment consequences because they have refused. They remain liable for other misconduct in relation to the refusal.

The Act protects those who refuse for any reason; refusal need not be based on any specific ground. Hence, it equally protects refusal for reasons of personal discomfort, distaste or fear and refusal based on moral or ethical objections.

“Aid in the provision” is not defined. A narrow reading could limit protection against coercion to acts closely associated with the administration of a lethal substance, like inserting an IV line or dispensing lethal drugs. A broad reading could extend it to include facilitation by referral or other means. However, based on the Janaway2 and Doogan3 cases in the United Kingdom (in which the key term, “participate,” was restricted to “hands on” activity), a narrow reading of “aid in the provision” is possible.

Professional obligations in relation to refusal are untouched by the law. Regulators remain free to specify obligations that do not prevent or conflict with refusal to provide or aid in the provision of euthanasia and assisted suicide. Based on a narrow interpretation of “aid,” this could include facilitation by referral to an EAS practitioner. This would be unacceptable to objecting professionals who consider that to entail complicity in killing patients.

Notes:

1.  Medical Assistance in Dying (Protection for Health Professionals and Others) Act , CCSM c M92.

2.  R v Salford Health Authority, Ex p Janaway [1989] AC 537.

3.  Greater Glasgow Health Board (Appellant) v Doogan and another (Respondents) (Scotland) [2014] UKSC 68 at para 37—38.

Freedom of conscience and nursing in Manitoba

Sean Murphy*

Abstract

For the most part, the codes of ethics and standards of Manitoba’s nurse regulators provide little insight into the regulators’ approach to freedom of conscience for nurses, and frequent failure to distinguish between “care” and “treatment” often impairs discussion of conscientious objection. The College of Licensed Practical Nurses of Manitoba code and standards appear inclined to separate personal and professional integrity, giving priority to the latter at the expense of the former. This encourages the view that nurses must leave their personal integrity in the parking lot when they report for work.

The regulators’ views about freedom of conscience for nurses are most clearly demonstrated in the joint publication Duty to Provide Care (2019). They recognize conscientious objection only to providing a service. They fail to recognize (or are unwilling to admit) that one can legitimately refuse to encourage or facilitate a service for reasons of conscience. Consistent with this, they demand that objecting nurses provide effective referral for all morally contested procedures, including euthanasia and accepted suicide. This would be unacceptable to anyone who believes that it is immoral to facilitate what one believes to be immoral.

Unlike earlier guidelines for euthanasia and assisted suicide, Duty to Provide Care (2019) fails to clearly distinguish between “care” and procedures or interventions, and it does not acknowledge the duty of employers (and regulators) to accommodate nurses in the exercise of freedom of conscience. . . [Full text]

Freedom of conscience and nursing in Alberta

Sean Murphy*

Introduction

Nursing has often been described as a “caring profession.” For historical reasons associated with the development of nursing, it appears that most nursing guidance documents use the terms “care” or “nursing care” with respect to all nurse-patient interactions, including interventions or treatments ordered by attending physicians.

This puts objecting nurses at a rhetorical disadvantage. Objections are made to treatments or interventions, not to caring. However, in a nursing context this is more readily perceived or characterized as “refusing to care.”

The failure to distinguish between “care” and “treatment” can introduce uncertainty into guidance about conscientious objection, which, for example, may insist that an objecting nurse continue to provide “care” for a patient until relieved, without specifying that the care does not include the treatment or intervention to which the nurse objects…[Full text]

Physician freedom of conscience in Alberta

Sean Murphy*

Alberta has been identified by freedom of conscience advocates as providing a satisfactory model of accommodation that should be imitated across the country. In late 2019 the head of the Alberta Medical Association and sponsor of a controversial protection of conscience bill in the Alberta legislature agreed that existing protections were “appropriate and effective.” On the other hand, it has been reported that Alberta physicians are obliged to refer for morally contested services, including assisted suicide, which would be unacceptable to many objecting practitioners. The dissonant evaluations reflect differences between actual practice and two College policies that take different approaches to freedom of conscience…[Full text]

Physician freedom of conscience in Manitoba

Sean Murphy*

The MAiD Act

Manitoba is the only Canadian province with a stand-alone statute that protects health care professionals who refuse to provide services: the Medical Assistance in Dying (Protection for Health Professionals and Others) Act (MAiD Act).1

The MAiD Act is a procedure-specific law applying only to euthanasia and assisted suicide (EAS). It protects all regulated professionals who refuse to provide or “aid in the provision” of the procedures from professional disciplinary proceedings and adverse employment consequences because they have refused. They remain liable for other misconduct in relation to the refusal.

The Act protects those who refuse for any reason; refusal need not be based on any specific ground. Hence, it equally protects refusal for reasons of personal discomfort, distaste or fear and refusal based on moral or ethical objections. . . [Full text].