Canada
College of Physicians and Surgeons of Alberta
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)
[Full Text]
(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 [Emphasis in original].i, Project Annotation (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 [Emphasis in original].Project Annotation (ii)
(3) A regulated member must
not promote his/her own moral or
religious beliefs when interacting with patients [Emphasis in original].
(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,
Project Annotation (iii) the regulated member
must
ensure that the patient who seeks such advice or medical
care is offered timely access to
[Emphasis in original]:
- a regulated member who is willing to provide the
medical treatment, service or information;Project Annotation (iv) or
- a resource that will provide accurate
information about all available medical options.Project Annotation (v)
Conscientious Objection Notes
i. Canadian Charter of Rights and Freedoms, Part I of The Constitution Act, 1982.
Project Annotations
The policy recognizes a key distinction
between providing timely access to information and providing or
facilitating a morally contested service or
procedure. Offering timely access to information may be achieved in various ways.
i. Giving timely notice should help to avoid conflicts between physicians and patients.
ii. 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. The point 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.
iii. Consistent with section (2), section (4) is concerned only with "providing or offering access to information," not providing a morally contested procedure. Only if a physician is unwilling to provide the information described in annotation (ii) is an offer of "timely access" to another physician or resource required.
iv. An objecting physician may offer timely access to someone willing to provide the morally contested service OR to someone willing to provide information about it. This does not oblige an objecting physician to connect a patient with someone who provides the contested service, though some may be willing to do so.
v. That is, to someone willing to "provide accurate information," which need not be someone who provides a morally contested service.
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 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 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 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
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 the College standard partly reproduced above.
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.
Alberta MAID Care Coordination Service (AMCCS)
The nature of the AMCCS is important because some
objecting physicians are unwilling to facilitate contact with a
service primarily designed to deliver euthanasia and assisted suicide. There is usually no objection to facilitating contact with a general end-of-life
care co-ordinating service even if euthanasia and assisted suicide are
among the options.
The
Alberta MAID Care Coordination Service appears to have been primarily designed to deliver euthanasia and assisted suicide (EAS). All of the information in the 2016 AMCCS web pages concerned EAS services. None led to other end of life options like palliative care. All but one of 31 FAQ's concerned euthanasia and assisted suicide. While the AMCCS web pages now include some links to other end-of-life options, current AMCCS web pages (2020 Jan 28) demonstrate that it remains a euthanasia and assisted suicide service.
This is a barrier to compliance
Order respecting Medical Assistance in Dying Standards of Practice by physicians unwilling to connect patients directly with an EAS agency. On the other hand, Alberta's system continues to be cited by organizations representing objecting physicians as a model for other Canadian jurisdictions. Further, there do not appear to have been complaints about non-compliance with the Order. How can one account for this?
Four factors are likely relevant. First, the number of physicians who refuse to connect patients directly with EAS services is probably small. Second, patients who have not been given direct contact information for the AMCCS may have been satisfied with the information they have received. Third(related to the second), physicians who do not comply with the Order may supply patients with other information (such as contact information for Alberta Health Link) that is sufficient for their purposes. Finally, providing AMCCS is required only in the case of an enquiry, but requests for EAS can be managed under section 4.
Note that the
MyHealth.Alberta.ca website, also maintained by the provincial
government and Alberta Health Services, includes resources for palliative and end of life care that do not reference euthanasia and 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. This may be because the Carter case was launched and decided so as to ensure access to euthanasia and assisted suicide, not palliative care.