College of Physicians and Surgeons of Newfoundland and Labrador(Canada)
Freedom of conscience and religion
Annotated Extracts and Links
5. Responsibilities of Physicians who Decline to Participate
5.1 No physician can be compelled to prescribe or administer
medication for the purpose of ending a patient’s life.
5.2 Physicians unwilling to participate in physician-assisted death
for personal, moral, religious, or ethical reasons are expected to freely
offer accurate information to patients. No physician may provide false,
misleading, intentionally confusing, coercive, or materially incomplete
information to patients.
5.3 The College recommends that a physician who declines to
participate in physician assisted death offer the patient who seeks such
advice or medical care timely access to another physician (or appropriate
information resource, clinic or facility, care provider, health
authority, or organization) who is:
(a) available to assist the patient;
(b) accessible to the patient; and
(c) willing to provide physician-assisted death to a
patient who meets the eligibility criteria.
5.4 A physician who declines to provide physician-assisted death to
a patient may not terminate the doctor-patient relationship on that basis
alone. At all times, the physician must abide by other relevant College
guidelines and policies.
5.5 The objecting physician should:
(a) Provide access to all relevant medical records to
any other physician who is providing services related to
physician-assisted death; and
(b) Continue to provide medical services unrelated to
physician-assisted death, unless the patient requests otherwise, or until
another suitable physician has assumed responsibility for the person’s
6. Responsibilities of All Physicians
6.1 Any physician who is approached by a patient for information on
physician-assisted death has an obligation to discuss the subject with
the patient, the first time it is raised by the patient, regardless of
whether the physician objects to providing this service.
6.2 During the first visit where the patient requests or mentions
physician-assisted death, all physicians have an obligation to:
(a) engage in a fulsome discussion as to the reasons
behind the patient’s request, and answer any questions the patient may
pose to the best of the physician’s knowledge and ability;
(b) ensure that the patient has information about
(and, if appropriate, a referral to) any other service or clinician that
may be of benefit to the patient, including but not limited to palliative
care, pain specialist, psychiatry, or non-physician services such as
physiotherapy, occupational therapy, counseling, and so on; and
(c) advise the patient whether the physician is
willing to personally participate in physician-assisted death;
(d) provide the patient with access to further
information, including a copy of this Policy (or information on how it
can be readily accessed via www.cpsnl.ca).
Physicians are expected to provide information
necessary to satisfy the requirements of informed
medical decision making.
With respect to 5.3(c), the policy appears to
employ an unacceptably narrow definition of
"participation." It fails to acknowledge that
objecting physicians may consider it unacceptable to
direct a patient to a physician willing to provide
euthanasia or assisted suicide, on the grounds that
doing so would constitute unacceptable participation
in the act. However, the policy recommends but
does not require such referrals.