Tag: referral

Debate flies at CMA meeting over physician’s role in assisted dying

 Global News

Julia Wong

HALIFAX – Physicians from across the country spent hours at the Canadian Medical Association’s annual general meeting discussing what their role would entail if asked to assist a patient in dying.

Dozens of physicians took the floor to share their thoughts, concerns and worries over what was morally acceptable and what to do if they had a conscientious objection.

The Supreme Court of Canada struck down the ban on assisted dying in February and gave the federal government one year to create a new law. It will technically be legal for a physician to be involved in assisted dying next year.

Dr. Douglas Maynes, a Halifax psychiatrist who has been practicing for 43 years, said he has concerns about those with mental illness. . . (Full text)

 

Doctors’ Group urges Canadian Medical Association to defend conscience rights on assisted death

News Release

Christian Medical and Dental Society of Canada

HALIFAX, Aug. 24, 2015 /CNW/ – Larry Worthen, Executive Director of the Christian Medical and Dental Society of Canada (CMDS), urged the Canadian Medical Association (CMA), today, to support their members’ freedom of conscience when they meet on Tuesday, August 25th, to consider the CMA’s position on assisted death and conscience rights.

Said Larry Worthen, “Many physicians have moral convictions that will not allow them to participate in medical aid in dying. There should be no discrimination against a physician for her refusal to participate in medical aid in dying for moral or conscience reasons. That is why the Christian Medical and Dental Society of Canada urges the Canadian Medical Association to adopt the third option being presented to them by CMA staff: that physicians have a ‘duty to provide complete information on all options and advise on how to access a separate, central information, counselling and referral service.'”

The Canadian Medical Association will be discussing a policy framework called “Principled Based Approach to Assisted Dying in Canada” at their general council meeting in Halifax on August 25th. Section 5.2 of this document deals with physician conscience protection and assisted death. CMA staff will present four options for dealing with conscientious objection, and delegates will be polled on which option should be included in official CMA policy.

All options deal with the situation in which a physician is not able, for reasons of conscience, to participate in physician-assisted death. The four options are:

  1. Duty to refer directly to a non-objecting physician;
  2. Duty to refer to an independent third party;
  3. Duty to provide complete information on all options and advise on how to access a separate, central information, counselling, and referral service; or
  4. Patient self-referral to a separate central information, counseling, and referral service.

Options ‘1’ and ‘2’ require the objecting physician to refer. Many physicians will have moral convictions that assisted death is never in the best interests of the patient, while others may object to assisted death because of the particular circumstances of the patient. A referral is essentially a recommendation for the procedure, and facilitates its delivery. A requirement to refer means that physicians will be forced to act against their consciences.

Option ‘4’ allows the patient to directly access assisted death, but does not necessarily provide an opportunity for counseling by a physician who has a longer term relationship with the patient.

“Option ‘3’ allows the discussion of all options to occur with the patient and the physician who knows them. If, after considering all of the options, the patient still wants assisted death, the patient may access that directly. This option ensures that all reasonable alternatives are considered. It respects the autonomy of the patient to access all legal services while at the same time protecting physicians’ conscience rights,” added Mr. Worthen.

Option ‘3’ is a summary of a proposal submitted to the CMA by three organizations: the Christian Medical and Dental Society, the Canadian Federation of Catholic Physician Societies, and Canadian Physicians for Life. Taken together, they represent more than 3000 Canadian physicians.

CMDS (Christian Medical and Dental Society) represents some 1600 physicians and dentists across Canada.

See the complete CMDS-CFCPS-CPFL- proposal to the CMA 

 

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]

Canadian Medical Association plans for physician assisted suicide, euthanasia

Commentary on draft framework (August, 2015)

Sean Murphy*

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

II.    Overview

III.    Principles Based Approach to Assisted Dying in Canada

III.1    Highlights of the decision from a physician perspective

III.2    Strategic Questions

III.2.1    Strategic Question 3

III.2.2    Additional strategic questions

IV.    Schedule A: Draft Principles-Based Recommendations

IV.1    Foundational principles

IV.1.1    2.  Equity

IV.1.2    3.  Respect for physician values

IV.1.3    5.  Clarity

IV.1.4    9: Solidarity

IV.2    Recommendations –  1.  Patient qualifications for access to medical aid in dying

IV.2.1    1.2  Informed decision

IV.2.2    1.3  Capacity

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.4    Belgium – 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

VI.    Project Summary

VII.    Project Recommendations

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 freedomsFor 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.”