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Medical association vows to protect conscience rights

  • August 27, 2014

The Canadian Medical Association has passed a new policy on conscience rights that supports a doctor’s right to choose whether or not to help patients commit suicide in jurisdictions where it may become legal.

“If the law were to change, then we would support the right of physicians to follow their conscience. It (the new policy) doesn’t say we favour a change in the law,” said Dr. Jeff Blackmer, the CMA’s executive director of ethics.

The CMA stance opposing euthanasia remains in place.

“Our position is still that Canadian physicians should not participate in euthanasia or assisted suicide,” Blackmer said.

The CMA will come to the defence of doctors who refuse to participate in euthanasia and physician-assisted suicide if the law changes to make those practices legal.

The national doctors’ association is among the parties arguing against a change in the criminal code in the Carter case coming before the Supreme Court of Canada in October. The B.C. Supreme Court struck down the law against assisted suicide in 2012, giving Parliament one year to come up with new legislation. That ruling has been stayed until after the Supreme Court of Canada rules on the appeal.

The CMA position on conscience makes no difference to the Catholic Health Alliance of Canada, said CHAC president Michael Shea.

“It’s certainly still the view of Catholic health care that palliative care is the appropriate approach to end-of-life questions and issues. It certainly doesn’t change things for us,” Shea said. “If assisted suicide becomes legal, we’re in the process of looking at what implications that has for us in terms of policy making, but it certainly doesn’t change for us our values and our principles. That can’t change.”

Defending the conscience rights of doctors does not settle the contentious issue, Shea said.

“This thing has two edges and the knife cuts both ways,” said Shea. “It’s an important issue for our society to determine.”

Doctors at St. Michael’s Hospital in Toronto are required to sign a declaration stating they have received a copy of the CHAC’s Health Ethics Guide from the hospital and will abide by it.

Public opinion on euthanasia has remained fairly constant, while doctor opinion is divided. Regular polling by the Environics Focus Canada research program shows public approval for assisted suicide has increased, moving from 64 per cent in 2000 to 71 per cent in 2013.

A dwindling minority of people believe assisted suicide should result in criminal charges, according to the Environics poll. Between 2000 and 2013 Canadians who believed physician-assisted suicide should be a crime dropped from 26 per cent to 19 per cent. The national telephone poll is considered accurate within plus or minus 2.2 per cent, said Environics.

Doctors are more or less evenly split on legalizing euthanasia. A poll showed 44.8 per cent would favour making it legal, compared to 41.7 per cent opposed and 13.5 per cent undecided. A much smaller group of 26.7 said they would agree to a patient’s request for assisted suicide while more than half, 55.7 per cent, said they would likely not take on that role.

The CMA now has clear conscience rights policies for two areas of medical practice — physician-assisted suicide and therapeutic abortion. In both cases the CMA protects the rights of doctors to refuse to perform or refer patients for either procedure.

In other areas — contraception, in vitro fertilization, morning after pills — it is difficult for the CMA to have a policy which will cover all situations, Blackmer said.

Much depends on the medical outcome of refusal to provide a service such as con-traceptive prescriptions.

“What we have said consistently is that in those situations where health outcomes will not be affected and where there is no discrimination or human rights violation, we have consistently protected the rights to conscientious objection,” said Blackmer. 

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