Commentary on draft framework (August, 2015)
Abstract
The Canadian Medical Association (CMA) draft framework, Principles Based Approach to Assisted Dying in Canada presumes that physicians have an obligation to kill patients or help them commit suicide in the circumstances described by the Supreme Court of Canada in Carter v. Canada. It claims that objecting physicians are obliged to support physicians who do so, and to facilitate their work. By presuming these contested obligations as normative, the framework imposes a structure for response and discussion that is prejudicial to objecting physicians.
CMA officials define “participation” in the draft framework to mean only providing a lethal injection or writing a lethal prescription, although this is not stated in the document. Referral is not counted as “participation,” and the draft framework appears to reflect the view that referral is the preferred method for reconciling conflicts between patients seeking euthanasia or assisted suicide and physicians unwilling to be involved with homicide or suicide. This introduces a fundamental structural bias in framing the CMA approach to accommodating freedom of conscience and religion.
The bias in favour of mandatory referral becomes particularly evident in Schedule B, which considers only compulsory referral as a means of reconciling freedom of conscience and access to services. Further, the structural bias is reflected and reinforced by numerous erroneous and substantially misleading statements.
What support might be offered to physicians unwilling to provide or facilitate euthanasia and assisted suicide is conditional upon their referring the patient to a third party, but the formulation in the draft framework is insufficiently clear and has been compromised by revisions to fundamental principles. An acceptable policy will not require objecting physicians to become part of a chain of causation culminating in a morally contested procedure.
Despite the bias apparent in the draft framework, it should be possible to reconcile respect for the fundamental freedoms of physicians and demands for access to morally contested services. This can be done within the framework proposed by the CMA in the manner suggested in this commentary..
Table of Contents
I. Introduction
III. Principles Based Approach to Assisted Dying in Canada
III.1 Highlights of the decision from a physician perspective
III.2.2 Additional strategic questions
IV. Schedule A: Draft Principles-Based Recommendations
IV.1.2 3. Respect for physician values
IV.2 Recommendations – 1. Patient qualifications for access to medical aid in dying
IV.3 Recommendations- 2. Process map for decision-making in medical aid in dying
IV.3.1 Stages 1& 2: Requesting/Before undertaking medical aid in dying
IV.3.2 Stage 3: After undertaking medical aid in dying
IV.4 5. Moral opposition to medical aid in dying
IV.4.1 5.2 Conscientious objection by a physician
V. Schedule B: Legislative Criteria Across Jurisdictions
V.1 Q3: Reconcile refusal and equitable access? (Table of comparisons)
V.2 Netherlands – misleading and biased
V.3 Luxembourg – incomplete and confusing
V.5 Oregon -erroneous, misleading, confusing and biased
V.6 Washington -erroneous, misleading, confusing and biased
V.7 Vermont – misleading and biased
V.8 Senate Bill 225 – misleading and biased
V.9 Carter trial decision- seriously misleading and biased
V.10 Carter SCC decision – misleading and biased