The case for self-referrals on medically-assisted dying
Is it really such a bad thing that Hippocratic doctors will not participate in the killing of their patients?
Ontario Superior Court Judges WiltonSiegel, Lococo and Matheson seem to think so. This year they affirmed the College of Physicians and Surgeons of Ontario requirement for medical doctors to provide an ‘effective referral’ for a patient requesting Medical Assistance in Dying (MAID).
Ontario is the only jurisdiction in Canada which mandates physicians to refer for Medical Assistance in Dying. Alberta, for example, has an effective self-referral route which involves just one phone-call. In the day of cellphones, WiFi and VOIP, making or delegating this call is an easy task partly confirming the patient’s personal autonomy and ability to manage their own affairs.
Advocates for assisted death present the Hippocratic doctor’s inability to refer as some egregious ‘abandonment’ — patently a Straw-Man argument in this highly charged polemic.
Hippocratic principles are often an unstated foundation of trust between doctor and patient. Humanist Dr. Donald Boudreau of McGill University said it well: Euthanasia “… alters the mission of medicine. It strikes at the very core of our beings as healers.” The physicians publicly opposing MAID are quickly ‘de-platformed’ because they are visibly white male Christians. Hippocrates guided every physician: Atheist, Humanist, Muslim, Jew, Buddhist, Sikh, Hindu and Christian alike.
The most commonly used protocol for MAID in Canada is Voluntary Euthanasia: the direct killing of a consenting human being by another. This IS huge. The only people in Canada who may legally kill other citizens routinely are the doctors and Nurse Practitioners providing MAID (not even the police may use deadly force routinely — only when responding to violent crime.) This task was imposed onto the caregiving professions despite long traditions of the exact opposite.
This presents many health-care professionals with a serious predicament: just because something is legal does not make it moral or ethical. A patient’s ability to self-refer allows Hippocratic doctors and nurses to avoid what they perceive to be complicity in a homicide.
Moreover, Judge Wilton-Siegel stated that the CPSO requirement to refer for MAID does indeed “infringe the rights of religious freedom of the Individual Applicants as guaranteed under the Charter”! Wilton-Siegel added the dubious suggestion that affected doctors ‘may require an accommodation on their part’ to avoid requests for MAID. Any such ‘accommodation’ would have to be to an area of medicine with little or no direct patient care. In reality this means that Hippocratic doctors in Ontario get to choose one of four bad options — compromise your fundamental principles; face disciplinary action; change jobs completely or do not work in the province!
One can paraphrase this lack of compromise from both the CPSO and the Ontario Superior Court of Justice as: ‘Hippocratic doctors need not apply’.
Ontario needs family physicians and the province will recruit enough docs — but be careful what sort of docs you wish for!
Ontario needs family physicians and the province will recruit enough docs — but be careful what sort of docs you wish for! DR. KEVIN HAY
London resident Roger Foley wants to live despite his serious neurodegenerative disease.
He is in hospital after finding the stateprovided home-care to be inadequate and is suing for self-directed home-care. Roger claims he was threatened with a forced discharge or he would be faced with an $1,800 per day charge!
He claims he was offered euthanasia as an alternative. Cold logic says this is a very efficient solution though most find it offensive to offer death to someone wishing to live. Only the living tell such tales…
A self-referral route for patients seeking assistance in dying is a good thing.