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Protection of Conscience Project

www.consciencelaws.org

Service, not Servitude

Policy Positions

Collège des Médecins du Québec (Canada)

Freedom of conscience and religion

Annotated Extracts and Links


Code of Ethics of Physicians (R.S.Q., c. C-26, s. 87)
[Full Text]

24. A physician must, where his personal convictions prevent him from prescribing or providing professional services that may be appropriate, acquaint his patient with such convictions; he must also advise him of the possible consequences of not receiving such professional services.
The physician must then offer to help the patient find another physician.

Legal, Ethical and Organizational Aspects of Medical Practice in Québec (ALDO Quebec)
Personal Convictions: Conscientious Objection
[Full Text]

While physicians must honor their obligation to come to the rescue and assistance of all patients who consult them, they are nonetheless citizens themselves with rights, notably the right to their own beliefs. When their convictions could influence the nature or quality of care provided to a patient, physicians must make sure that they fulfill their ethical obligations. In this regard, section 24 of the Code of Ethics is clear:

A physician must, where his personal convictions prevent him from prescribing or providing professional services that may be appropriate, acquaint his patient with such convictions; he must also advise him of the possible consequences of not receiving such professional services. The physician must then offer to help the patient find another physician.

For example, a physician who is opposed to abortion or contraception is free to limit these interventions in a manner that takes into account his or her religious or moral convictions. However, the physician must inform patients of such when they consult for these kinds of professional services and assist them in finding the services requested.

Project Annotations

While the Code of Ethics requires an objecting physician to help a patient find another physician, it does not explicitly require that the objector find someone willing to provide a morally contested procedure.

However, the gloss on the Code of Ethics provided by ALDO Quebec, an authoritative document, indicates that what is intended by the Code is an "effective referral."

Requiring "effective referral" is unacceptable to many conscientious objectors because they believe that it makes them unacceptably complicit in immoral acts.  


An Act Respecting End-of-Life Care
[Full Text]

31. A physician practising in a centre operated by an institution who refuses a request for medical aid in dying for a reason not based on section 29 must, as soon as possible, notify the executive director of the institution or any other person designated by the executive director and forward the request form given to the physician, if that is the case, to the executive director or designated person. The executive director of the institution or designated person must then take the necessary steps to find, as soon as possible, another physician willing to deal with the request in accordance with section 29.

If the physician who receives the request practises in a private health facility and does not provide medical aid in dying, the physician must, as soon as possible, notify the executive director of the local authority referred to in section 99.4 of the Act respecting health services and social services that serves the territory in which the patient making the request resides, or notify the person designated by the executive director. The physician forwards the request form received, if that is the case, to the executive director or designated person and the steps mentioned in the first paragraph must be taken.

If no local authority serves the territory in which the patient resides, the notice referred to in the second paragraph is forwarded to the executive director of the institution operating a local community service centre in the territory or the person designated by the executive director.

50. A physician may refuse to administer medical aid in dying because of personal convictions, and a health professional may refuse to take part in administering it for the same reason. In such a case, the physician or health professional must nevertheless ensure that continuity of care is provided to the patient, in accordance with their code of ethics and the patient's wishes. In addition, the physician must comply with the procedure established in section 31.

Project Annotations

The Act Respecting End of Life Care is Quebec's euthanasia law.

Section 31 applies to physicians who refuse to provide euthanasia for reasons other than the patient not fitting the criteria for MAD service, including conscientious objection.  They must notify an administrator of their refusal with respect to a particular patient, and the administrator assumes responsiblity for finding someone willing to provide the service.

A number of objecting physicians find this unacceptable because it requires them to put the euthanasia delivery system into motion with respect to a particular patient (as distinct from giving notice to an administrator of their unwillingness to provide euthanasia for reasons of conscience).

Section 50 specifically concerns refusal to provide euthanasia for reasons of conscience.  It imposes two requirements on objecting physicians.  First: they must notify an administrator as required by Section 31.  Second: they must ensure "contintuity of care . . . in accordance with their code of ethics."

As noted above, the postion of the Collège des Médecins du Québec is that the Code of Ethics for Physicians requires effective referral.  Requiring "effective referral" is unacceptable to many conscientious objectors because they believe that it makes them unacceptably complicit in immoral acts.

This was succinctly explained to Quebec legislators by Dr. Charles Bernard, President and Director General of Quebec's Collège des médecins:

[I]f you have a conscientious objection and it is you who must undertake to find someone who will do it, at this time, your conscientious objection is [nullified]. It is as if you did it anyway. / [Original French] Parce que, si on a une objection de conscience puis c'est nous qui doive faire la démarche pour trouver la personne qui va le faire, à ce moment-là, notre objection de conscience ne s'applique plus.  C'est comme si on le faisait quand même.
[Consultations: Tuesday 17 September 2013 - Vol. 43 no. 34: Collège des médecins du Québec, (Dr. Charles Bernard, Dr. Yves Robert, Dr. Michelle Marchand), T#154]

 

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