Protection of Conscience Project
Protection of Conscience Project
www.consciencelaws.org
Service, not Servitude

Service, not Servitude

Canada

Collège des Médecins du Québec

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) (February, 2019)
Personal Convictions: Conscientious Objection

[Full Text]

Caution: machine-assisted translation

Le médecin doit également informer son patient de ses convictions personnelles, de nature morale ou religieuse, qui peuvent l’empêcher de lui recommander ou de lui fournir des services professionnels qui pourraient être appropriés, et l’aviser des conséquences possibles de l’absence de tels services professionnels. Il doit alors offrir au patient de l’aider dans la recherche d’un autre médecin (art. 24).

The physician must also inform his patient of his personal convictions, of a moral or religious nature, which may prevent him from recommending or providing him with professional services which might be appropriate, and advise him of the possible consequences of the absence of such professional services. He must then offer to help the patient to find another doctor (art.24).

Project Annotations

The Code of Ethics and the gloss on the Code by ALDO Quebec, an authoritative document, requires an objecting physician to help a patient find another physician, but do not require the objector find someone willing to provide a morally contested procedure. That requirement, stated in the previous version of ALDO, has been deleted.


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."

Previously, the postion of the Collège des Médecins du Québec was that the Code of Ethics for Physicians requires effective referral, but that is no longer the case. It is possible that a 2013 statement by the President and Director of the Collège  reflects the the reason for the change. Speaking to Quebec legislators about the pending euthanasia law, he said:

[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]