Canada
Collège des Médecins du Québec
Policies & statements relevant to freedom of conscience
An Act Respecting End-of-Life Care
(Updated to 2022 Jun 01)
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
(chapter S-4.2)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.
L'Aide Médicale à Mourir, Mise à jour 11/2019: Guide d'exercice et lignes directrices pharmacogiques
(Medical Aid in Dying, Updated 11/2019: Practice and pharmacological guidelines)
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It is certainly understandable that some physicians would be reluctant to give an opinion that might confirm that one or other of the legal criteria authorizing MAID has been met, for fear that all the criteria would be met and that two colleagues would consider MAID acceptable. However, doing these assessments before deciding what the most appropriate care for the patient is (MAID and/or other types of care) means not participating in the recommendation or the administration of this care. Not doing so, just in case, would discriminate against people whose suffering is such that they request assistance in dying and who might then be deprived of the best possible care.
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Il est certes compréhensible que certains médecins aient des réticences à donner un avis qui pourrait confirmer le respect de l'un ou l'autre des critères légaux autorisant une AMM, par crainte qu'éventuellement l'ensemble des critères soit présent et que deux confrères jugent que l'AMM serait acceptable. En revanche, effectuer de tels examens en amont de la décision de prodiguer les soins les plus appropriés au patient concerné (AMM et/ou autres) n'est participer ni à la recommandation ni à l'administration de tels soins. Ne pas le faire, au cas où, serait discriminatoire envers les personnes qui souffrent au point de demander de l'aide pour mourir et qui pourraient ainsi être privées des meilleurs soins.
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Project Annotations
Quebec is unique among Canadian provinces in having a provincial euthanasia law, the Act Regarding End of Life Care (ARELC).
ARELC does not permit practitioner assisted suicide, but allows two kinds of euthanasia, distinguished here as reportable and non-reportable euthanasia.
Reportable euthanasia is identified as "medical aid in dying" in ARELC. Only physicians may administer a lethal substance and must conform to procedural guidelines and reporting requirements.
ARELC's protection of conscience provision (Section 50)applies only to reportable euthanasia.
Section 50 distinguishes physicians (who alone can provide lethal injections) from other health professionals, ironically providing less protection for physicians than for others. Physicians may refuse only "to administer" the substance - a very specific action. The law does not prevent them from being forced to participate in other ways, and College guidelines now demand objecting physicians provide "clinical assessments of capacity to consent" and provide opinions about the prognosis of patients seeking euthanasia (see Medical Aid in Dying: Practice and pharmacological guidelines (2019)).
Non-reportable euthanasia is not explicitly identified in the law, but is permitted for legally incompetent patients (including those under 14 years old) who are not dying. Substitute decision makers acting under the authority of Quebec's Civil Code can order them to be starved and dehydrated to death. There are no procedural guidelines, no reporting requirements, and it appears that the order can be carried out by anyone responsible for patient care.
Related:
Quebec law and freedom of conscience for health care professionals
Quebec's Act Respecting End of Life Care: Reportable and non-reportable euthanasia