Opposition weighs in against physician college’s MAiD policy

The Catholic Civil Rights League and some Ontario doctors are advocating for the right to freedom of conscience and religion as the College of Physicians and Surgeons of Ontario (CPSO) opened the floor for consultation on its Medical Assistance in Dying draft policy.

Freedom of conscience rights for medical professionals are addressed in the draft document Human Rights in the Provision of Health Services. The policy essentially affirms that physicians would have to continue to make an effective referral to a medical professional who would carry out the controversial procedure.

“The CCRL believes that the continuance of historically recognized allowances, or work arounds that facilitate religious objection, should be maintained as part of our social fabric, and in recognition of the authentic pluralism of a free and democratic society,” wrote executive director Christian Domenic Elia in the league’s submission to the college. “A forced compulsion over such rights is the negation of a truly authentic pluralist society.”

Specifically, CCRL zeroed in on lines 333 and 339 of the document. The former asks, “does the expectation to provide patients with an effective referral apply in faith-based hospitals and hospices?” The latter asks, “can I end the physician-patient relationship because my patient wishes to explore a care option that conflicts with my conscience or religious beliefs?” In both cases, the CCRL declared that a patient’s concern cannot “trump the freedom of religion of the physician, or the institutional freedom of religion of a religious hospital.”

Ottawa-based psychiatrist Dr. Sephora Tang drew attention to lines 89-91 of the guidelines, which reads, “Physicians must provide patients with enough information about all available or appropriate clinical options to meet their clinical needs or concerns so that patients are able to make an informed decision about exploring a particular option.”

Tang specifically challenged how CPSO alluded to physicians who decline to assess or provide MAiD for “reasons of conscience.” Tang wrote there is a lack of clarity in how CPSO defines conscience.

“It is unclear whether the CPSO policy referring to conscientious objectors would include physicians who are not opposed to MAiD in principle but do have objections to its use for solely mental illness,” wrote Tang. “It is not in the public’s best interest to explicitly direct physicians to suppress their conscience in order to facilitate and be complicit in actions that they believe to be wrong, as the CPSO is currently intending to do by requiring an effective referral for the procedure.”

Tang recommended the CPSO follow the example of the World Medical Association, an organization that “explicitly refrained from recommending that physicians holding conscientious objections to morally contentious services be required to make an effective referral.”

A couple technical objections were also offered by Tang. She wrote that the human rights policy “forbids expression of the physician’s moral beliefs about a particular service.” She countered by writing “it is not possible to explain conscientious objection without expressing one’s belief about a service.”

The recommendation for effective referrals drew questions from Tang too. 

“In the context of mental illness, the provision of sufficient time in therapy may be sufficient to reverse requests for death. Requesting a timely referral for MAiD in the context of non-end of life scenarios pertaining to mental illness as a sole underlying eligibility criteria is counter-therapeutic for the vast majority of mental illnesses the CPSO may not have considered in drafting this policy.”

Tang also alluded to the proposed updates in the MAiD: Advice to the Profession document which deals with when and how MAiD should be discussed with patients. It heavily borrows material from Canadian Association of MAID Assessors and Providers (CAMAP) guidance sheet Bringing up Medical Assistance in Dying as a clinical care option.

It is apparent to Tang that there is an intention to direct physicians “to raise the option of MAiD unsolicited by patients.”

“While the CAMAP document referenced above strongly suggests to physicians that they should not be aiming to induce, persuade or convince the patient to request MAiD, in practice, especially within the dynamics of the power differential inherent within a doctor-patient relationship, this distinction may be difficult to separate, and may be experienced as the same by patients.”