Right of refusal
CMA says MDs should not be forced to refer an assisted death
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 Dr. 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.
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.”
He said resources could be provided to allow patients to “selfrefer” for assisted death — for example, a website listing the names of doctors willing to provide it.
“Then the patient themselves can take that initiative rather than have the physician who they are normally attached to, who conscientiously objects, make the call,” Simpson said.
Hospital administrators, an ombudsman or local health authorities could also be legislated to act on the behalf of patients, he said.
“I can’t emphasize enough that in us taking this position about conscientious objection we feel equally strong that we need to have other mechanisms to make sure that patients who need the service get it,” Simpson said.
A prominent Canadian bioethicist, however, says a doctor’s “ideological private convictions” should not trump a patient’s legal right to access assisted death.
Udo Schuklenk, of Queen’s University in Kingston, Ont., said he’s skeptical the CMA would be able to guarantee that patients eligible for assisted dying would have access where and when they need it.
“That forces us to ask why doctors should be permitted to opt out in this manner in the first place,” Schuklenk said.