The debate around medically assisted dying continues in Ontario as healthcare organizations work to address the concerns of all relevant parties. Recently, several Ontario physicians’ groups told a court that the current rules that force doctors to offer medically assisted dying or a timely referral, infringes on their constitutional right to object on conscientious or religious grounds.

The group has requested a judicial review of the College of Physicians and Surgeons of Ontario’s (CPSO) recent assisted dying policy.

Constitutional Questions

The physicians’ groups in question include the Christian Medical and Dental Society of Canada, the Canadian Federation of Catholic Physicians’ Societies, and Canadian Physicians for Life. Five individual physicians have also joined the case. They argue that the CPSO rules requiring doctors to provide an “effective referral” for medical assistance in dying is the moral equivalent of those doctors offering the procedure themselves.

An Ottawa psychiatrist, who was one of 168 doctors who signed a letter notifying the CPSO that they will not adhere to the policy, told CBC News:

Doctors should have the right to exercise their freedom of conscience in deciding what treatment would be best for that patient.

The psychiatrist further argued that the goal of doctors who object to medically assisted dying is not to impede a patient’s access to the procedure, they simply do not want to be forced to provide it.

In response, the President of the CPSO said that the College’s policy considers medically assisted dying from the patient’s perspective, and noted:

…from the point of view of the patient, if they seek a service from a doctor, they shouldn’t have to figure out where a doctor stands on this issue or that issue, they should just be able to ask for a service.

Other Jurisdictions

The President of the Canadian Federation of Catholic Physicians’ Societies has questioned why Ontario is currently the only jurisdiction, both in Canada and worldwide, which insists on a referral process.

He notes that while Canada is not the only jurisdiction globally that has approved assisted suicide or euthanasia, none of the other jurisdictions have forced doctors to perform these procedures or to refer patients to other doctors who would perform these procedures, against their conscience. Other jurisdictions have found ways to permit doctors who object to opt out of performing or referring, without jeopardizing care for patients.

Suggestions for Alternative Policies

The Canadian Federation of Catholic Physicians’ Societies is urging the province to create a “coordination centre” that would refer patients seeking medical assistance in dying, as is the arrangement in Alberta. Such a centre would remove the onus from individual physicians, and could avoid the moral dilemma that doctors opposed to referring cases currently face.

However, CPSO’s President argues that while there are many patients who may be able to help themselves through the process of medical assistance in dying, the CPSO policy is specifically aimed at providing help to the most vulnerable patients, especially those who have reached the palliative stage. He points out:

A patient may need help navigating the system…[i]n the case of medical assistance in dying it may be a frail, elderly, bedridden patient, perhaps in an institution, and there’s no way that person is going to be able to navigate the system. And if the first doctor they ask turns them away, they may not be able to get access.

The President also disputes the allegation that Ontario is the only jurisdiction with a referral policy, and points to other Canadian jurisdictions with policies similar to Ontario’s. For instance, the College of Physicians and Surgeons of Nova Scotia requires an “effective transfer of care” in such situations, which, in the President’s mind “sounds like a referral”.

Referrals for Other Historically Controversial Procedures Unnecessary

A family doctor in Trenton, Ontario, who is one of the five individual doctors participating in the case, and also signed the letter notifying the CPSO that he will not adhere to the policy, notes that the policy could potentially “open a can of worms” in terms of abortion in Ontario by potentially forcing doctors who object to abortion for moral or religious reasons to have to refer patients or risk discipline from the College. He notes that there has never been an issue with access to abortion for women who wish to terminate their pregnancy despite the fact that referrals were not needed. The CPSO policy with respect to medical assistance in dying represents a “deviation from that tradition”.

The Divisional Court was scheduled to finish hearing the case earlier this month. We will continue to follow developments in this matter, and other developments related to medical assistance in dying and will provide updates as they become available.

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