College of Physicians and Surgeons of Alberta (Canada)
Freedom of conscience and religion
Annotated Extracts and Links
Conscientious Objection (June, 2016)
Formerly Moral or Religious Beliefs
Affecting Medical Care (In
force January, 2010 - June, 2016)
(1) A regulated member must communicate promptly
and respectfully about any treatments or procedures the regulated member
declines to provide based on his/her Charter freedom of conscience and
religion.i
(2) A regulated member must not
withhold information about the existence of a procedure
or treatment because providing that procedure or giving
advice about it conflicts with his/her Charter freedom
of conscience and religion.
(3) A regulated member must
not promote his/her own moral or
religious beliefs when interacting with patients.
(4) When
Charter freedom of
conscience and religion prevent a regulated member from
providing or offering access to information about a
legally available medical or surgical treatment or
service, the regulated member
must
ensure that the patient who seeks such advice or medical
care is offered timely access to:
- a regulated member who is willing to provide the
medical treatment, service or information; or
- a resource that will provide accurate
information about all available medical options.
Project Annotations
The policy recognizes a key distinction
between providing information and providing or
facilitating a morally contested service or
procedure.
With respect to providing information, it
presumes either that the mere giving of information
or advice has no moral significance, or, if it does,
that it is inconsequential. This is not necessarily
the case. The difficulty here is to balance the
desire of a physician to avoid complicity in a
wrongful act with the importance of informed
decision-making by the patient, which requires that
the patient have all of the information relevant for
the purpose of choosing a course of treatment. It is
necessary to respect both the freedom of conscience
of the physician and the freedom and right of the
patient to make a fully informed choice.
Physicians are expected to provide information
necessary to satisfy the requirements of informed
medical decision making, such as prognosis, the
treatments or procedures available, benefits and
burdens of treatment, risks, etc. Only if a
physician is unwilling to provide this information
is an offer of "timely access" to another physician
or resource required. The purpose of arranging
timely access in this situation is to ensure that
the patient has information needed for
decision-making. Offering timely access
may be achieved in various ways.
Medical Assistance In Dying
(June, 2016)
[Full
Text]
1. A regulated member who receives,
considers or fulfils a written request for medical
assistance in dying must do so in
accordance with legislation. . . (Emphasis in the
original)
3. A regulated member who receives an
inquiry from a patient with respect to medical
assistance in dying must ensure
that contact information for the Alberta Health
Services medical assistance in dying care
coordination service is provided to the patient, or
to another person identified by the patient, without
delay. (Emphasis in the original)
4. A regulated member who receives an oral
or written request from a patient for medical
assistance in dying and who declines for reasons of
conscience or religion to provide or to aid in
providing medical assistance in dying must
ensure that reasonable access to the Alberta Health
Services medical assistance in dying care
coordination service is provided to the patient
without delay. . . (Emphasis in the original)
8. In these standards, "medical assistance
in dying" means:
a) the administering by a regulated member of a
substance to a person, at their request, that
causes their death; or
b) the prescribing or providing by a regulated
member of a substance to a person, at their
request, so that they may self-administer the
substance and in doing so cause their own death.
Project Annotations (2016-11-02)
The current legislation directly applicable is
Section 241.1 of the Criminal Code and Alberta Order in
Council 142/216 (10 June, 2016),
Order respecting Medical Assistance in Dying Standards of Practice.
The latter is binding only in Alberta. Sections 3 and 4 of the
Order are reproduced as Sections 3 and 4 of this standard.
Section 3
Section 3 is limited to an inquiry from a patient, though
the response may be directed to someone delegated by the patient.
"Inquiry" presumably means a question concerning euthanasia or assisted
suicide that does not amount to a request. This provision does not
prevent a physician from responding to the question, but requires, in
addition, that the patient (or delegate) be given the contact
information for the
Alberta Health Services medical assistance in dying care coordination
service.
Section 4
Section 4 is limited to a request from a patient, and the response is
to be provided to the patient. It does not prevent an objecting
physician from discussing options with the patient, including euthanasia
and assisted suicide. Although the section does not specify that
the response may be provided to someone delegated by the patient, that
would presumably be allowed as a matter of custom.
This provision does not require that the objecting physician provide
specific contact information for the
Alberta Health Services medical assistance in dying care coordination
service, but "reasonable access" must be provided, which,
presumably, includes sufficient information for the patient to be able
to contact the service.
The patient - not the objecting physician - is responsible for
contacting the service. This is an important point, since
objecting physicians frequently object to doing something that may
facilitate what they perceive to be a wrongful act.
The nature of the service itself may be of some importance to some
objecting physicians, who may be unwilling to facilitate contact with a
service primarily designed to deliver euthanasia and assisted suicide,
but would be willing to facilitate contact with a general end-of-life
care co-ordinating service even if euthanasia and assisted suicide are
among the options.
Alberta MAID Care Coordination Service
As the name suggests, the
Alberta MAID Care Coordination Service appears to be primarily
designed to deliver euthanasia and assisted suicide. No comparable web pages appear to exist in the Alberta Health Services
website to provide direction to such services.
The entry page provides three main options: one for patients/families, one for health
professionals and volunteers, and one for general enquiries. No links lead
to palliative care or other end of life options. (Click image to enlarge.)
The
general enquiries link leads to a page with links to
information about euthanasia and assisted suicide. No links lead to
palliative care or other end of life options. (Click image to enlarge.)
The
professionals/volunteers link leads to a page with links to information
about euthanasia and assisted suicide. No links lead to palliative
care or other end of life options.(Click image to enlarge.)
The
patient/family link leads to a page with four headings:
- Care Coordination
Services
- Support (links to grief/bereavement and dying process
resources)
- How do I access medical aid in dying? (application for
euthanasia/suicide)
- Your questions answered (FAQ's) (All but one of
31 questions concern euthanasia/assisted suicide. Question 8
concerns options and includes a link to a palliative care resource.)
Patients
who go to the Care Coordination Services page are offered information
about two teams established in the province "available
to generally discuss all end of life options available, including
medical assistance in dying." The contact link returns the patient to
the entry page. No links lead to palliative care or other end of life
options. (Click image to enlarge.)
The
MyHealth.Alberta.ca website is also maintained by the provincial
government and Alberta Health Services. It includes resources for
palliative and end
of life care that do not reference euthanasia or assisted suicide.
There is no requirement in the Order in Council or College policy on
euthanasia/assisted suicide to provide patients with contact information
for this website or to ensure reasonable access to it, though physicians
would be free to do so.