Submission to the College of Physicians and Surgeons of Ontario Re: Medical Assistance in Dying

Abstract

The focus of this submission is confined to the exercise of freedom of conscience by practitioners who refuse to do what they believe to be unethical or immoral in relation to euthanasia and assisted suicide (“medical assistance in dying”: EAS, MAiD).

Unanticipated changes in a patient’s condition may trigger an urgent request for immediate provision of EAS that has already been approved. This can be problematic if the responsible EAS practitioner is unavailable to respond. EAS practitioners should be required to be available to respond to urgent requests once EAS has been approved.

Falsification of EAS death certificates is contrary to accepted international standards and can be considered deceptive, unethical or professionally ill-advised. EAS practitioners unwilling to falsify death certificates should be accommodated by the College and Office of the Chief Coroner.

Current policy does not give sufficient attention to criminal responsibility. Practitioners incur grave criminal liability if they facilitate EAS for patients they believe are ineligible. Persons in authority incur criminal liability if they attempt to compel them to facilitate EAS for such patients. Practitioner-patient discussion must be informed by the fact that counselling suicide remains a criminal offence. The policy fails to recommend reflection and caution in presenting euthanasia and assisted suicide as treatment options.

Confirmation that objecting practitioners are not required to personally kill their patients is welcome, but this should not be seen as a concession. The Project also welcomes the statement that objecting practitioners are not obliged to assess EAS eligibility. However, the claim that they have a fiduciary duty to collaborate in killing their patients should be given no weight because it is not supported by the judicial decisions the College cites to that effect.

Practitioners may have clinical reasons for refusing an EAS request; the policy statement to the contrary should be deleted. Overbroad expressions open to abuse for ideological reasons should be replaced (e.g., replace “impede access” with “interfere with access”).

With respect to “effective referral,” the policy erroneously implies that refusal to make an effective referral for EAS amounts to patient abandonment. It demonstrates either confusion or hypocrisy and moral partisanship in relation to the moral/ethical significance of referral.

College policy that practitioners unwilling to collaborate in killing their patients should take up hair restoration or leave medical practice may adversely affect access to health care and patient safety. To require unwilling citizens to collaborate in killing other people and punish or disadvantage them if they refuse is a dangerous and especially repugnant idea. It stands in violent contradiction to the solicitude for human life, dignity and freedom that ought to characterize a democratic society. This issue was not argued or even considered by the trial court or Ontario Court of Appeal in rulings on CPSO policy.

Keywords: conscience, referral