College of Physicians and Surgeons of British Columbia (Canada)
Access to Medical Care (November, 2012)
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Conscientious Objection to Providing Care
Physicians are not obliged to provide treatments or procedures to
patients which are medically unnecessary or deemed inappropriate based on
scientific evidence and their own clinical expertise.
While physicians may make a personal choice not to provide a treatment or
procedure based on their values and beliefs, the College expects them to
provide patients with enough information and assistance to allow them to
make informed choices for themselves. This includes advising patients that
other physicians may be available to see them, or suggesting that the
patient visit an alternate health-care provider. Where needed, physicians
must offer assistance and must not abandon the patient.
Physicians in these situations should not discuss in detail their
personal beliefs if not directly relevant and should not pressure patients
to disclose or justify their own beliefs.
In all cases, physicians must
practise within the confines of the legal system, and provide compassionate,
non-judgmental care according to the CMA Code of Ethics.
Project Annotations
"Assistance" should not be understood to imply providing or facilitating a
morally contested service, since that interpretation
would render the policy self-contradictory. In
responding to questions from the Project in 2013,
the College provided the following answers:
- Q) Is Access to Medical Care to be understood to
require physicians to do what they believe to be immoral or
unethical?
- Q) Does the College propose to take disciplinary action
against physicians who refuse to do what they believe to be immoral
or unethical?
- A) No, unless the College considers that in those
specific circumstances the physician abandoned the patient
without providing an appropriate level of medical care.
Medical Assistance in Dying (9 September, 2016)
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Conscientious Objection
Physicians may make a personal choice not to assess patients for and/or
perform MAID, based on their values and beliefs. The College expects the
physician to provide patients with enough information and assistance to
allow them to make informed choices for themselves. This includes consulting
with other experts on relevant medical facts and, when needed, competency
assessments.
Physicians who object to PAD on the basis of their values and beliefs are
required to provide an effective transfer of care for their patients by
advising patients that other physicians may be available to see them,
suggesting the patient visit an alternate physician or service and, if
authorized by the patient, transferring the medical records as required.
Where needed, physicians must offer assistance to the patient and must
not abandon the patient. While a physician is not required to make a formal
referral on behalf of their patient, they do have a duty of care that must
be continuous and non-discriminatory.
Physicians should not discuss in
detail their personal beliefs and should not pressure patients to disclose
or justify their own beliefs. In all cases, physicians must practise within
the confines of the legal system, and provide compassionate, non-judgemental
care according to the CMA Code of Ethics.
Project Annotations
The policy recognizes an important distinction
between providing information and providing or
facilitating a morally contested service or
procedure.
The transfer of care envisaged by the policy is
patient-initiated, not physician-initiated.
Once a patient has found a willing physician, the
objecting physician is expected to co-operate in the
transfer of records, etc. in the normal way.
This is the practice in jurisdictions outside Canada
that have legalized assisted suicide and/or
euthanasia.