College of Physicians and Surgeons of Nova Scotia (Canada)
Freedom of conscience and religion
Annotated Extracts and Links
Professional Standards Regarding Transfer of Care
(27 May, 2016)
In the complex world of medicine, it is imperative that a single
physician be identified at all times as the most responsible physician (MRP)
for any patient. . .
. . . A transfer of care occurs whenever there is a change in the most
responsible physician for a particular patient. This can take place
with movement of patients between health care locations, providers or
different levels of care within the same location as their conditions and
care needs change.
Physicians have the primary responsibility to ensure effective transfers
of care. Physicians are encouraged to be involved in the design of
transitions within the health care system to ensure coordination and
continuity of care for the benefit of their patients.
This document applies whenever there is a change in the MRP of the
patient. . .
2. When transferring a patient, the MRP must ensure:
a) the accepting physician has the necessary
clinical information to assume care, including a summary of active medical
problems and the treatment plan for the patient at the time of the
b) the accepting physician, who will become the
MRP upon transfer, is clearly identified in the patient's medical record and
has agreed to accept the transfer of care.
3. In either situation, when discharging or transferring a patient:
a) professional judgement is required to
determine the extent and timeliness of information provided to the accepting
physician, and the balance between verbal and written communications;
b) the physician must inform the patient that a
transfer of care is to take place and identify who is to become the most
responsible physician for that patient.
The policy describes physician-initiated transfers of care.
Professional Standard Regarding Medical Assistance in Dying (22 June,
2.1 This standard is to be interpreted in a manner that . . .
2.1.4 recognizes and appropriate balance betweenthe physician's freedom of conscience and
religion and the patients'
right to life, liberty and security of the person;
2.1.5 is consistent with the Criminal Code of Canada
4. Responsibility of physicians unable or unwilling to
participate in physician assisted death
4.1 Physicians may be unable to participate in medical assistance
in dying for various practical reasons such as lack of availability or lack
of expertise. Some physicians may be unwilling to participate for
reasons of conscience. No physician can be compelled to prescribe or
administer medication for the purpose of medical assistance in dying.
4.2 The physician unwilling or unable to participate
must complete an effective transfer of
care for any patient requesting medical assistance in dying.
[See definition of "effective transfer of care" in Article 9.]
4.3 In addition to completing an effective transfer of care, a
physician unable or unwilling to provide medical assistance in dying must,
at the earliest opportunity:
4.3.1 advise the patient that he or she is
not able or willing to provide medical assistance in dying;
4.3.2 provide the patient with a copy of this
4.3.3 provide all relevant patient medical
records to the physician providing services related to medical assistance in
4.3.4 continue to provide medical services
unrelated to medical assistance in dying unless the patient requests
otherwise or until alternative care is in place. . .
9.1 For the purposes of this standard:
9.2 "effective transfer of care" means a transfer made by one
practitioner ["practitioner" includes both medical practitioners and nurse
practitioners] in good faith to another physician who is available to accept the
transfer, who is accessible to the patient, and willing to provide medical
assistance in dying if the eligibility criteria are met.
Read in conjunction with Professional Standards Regarding Transfer of Care,
the policy appears to use the term "effective transfer of care" as a
synonym for "effective referral." That is: the policy
appears to demand that a physician unwilling to kill a patient or help
the patient commit suicide must find a physician who will do so and
arrange for that physician to take over the care of the patient for that
purpose. Many physicians who object to euthanasia or assisted
suicide for reasons of conscience would find this requirement