Canada
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Jurisdictional, organizational and regulatory framework for health care delivery in Canada
- Sean Murphy* | Canadian provinces have constitutional jurisdiction in the regulation of health care and health care professions and over labour and civil rights law within the scope of that jurisdiction. . . .
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Conscience Rights Matter
- Sohail Gandhi* | . .
To those physicians who are opposed to legal protection for Conscience Rights, let me ask you this. What would you do if a patient asked you for a referral to have only a blue eyed, blonde haired baby?
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- David Anderson* | Bill C-418 seeks to amend the Criminal Code to make it an offence to intimidate a medical practitioner, nurse practitioner, pharmacist or any other health care professional for the purpose of compelling them to take part, directly or indirectly, in the provision of physician-assisted suicide. . .
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Nurse diagnosed with PTSD after interacion with patient seeking euthanasia
Tribunal rules "her own convictions" caused her injury: Denies claim for compensation
- Administrative Labour Tribunal
| The worker is a nurse in the palliative care unit of the
Notre-Dame Pavilion at the University Hospital of Montreal. In December 2015, a patient for whom she was in charge decided to
avail himself of the new provisions of the
Act Concerning End-of-Life
Care, commonly known as medical assistance
in dying. This was a first: he was the first patient of this hospital to
express his desire to plan his death. The worker was informed that one of her patients had requested
medical intervention to end his life and developed a psychological
reaction following the death of the latter. . .
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Conscience Versus the Spirit of the Age
- Jason Kenney*
| . . . This evening I wish to share with you, distinguished members of the bar
gathered under the patronage of Saint Thomas More, some thoughts about the
importance of conscience in the life of legislators like myself and those
who, like yourselves, are charged with the administration and adjudication
of those laws. I seek to do so because history in general— and the history
of Thomas More in particular —teaches us that the recognition of the rights
of conscience is an essential limitation of State power. Put another way,
where the rights of conscience are violated, the prospect of a State that
unjustly limits liberty becomes all too real throughout history. . .
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"Autonomy",
"Justice" and the Legal Requirement to Accommodate
the
Conscience and Religious Beliefs of Professionals in Health Care
- Iain T. Benson*
| Frank M. Archer's critical review, though it might seem to
some people to be a legal and ethical view is, with respect,
neither of these things. While it is, in its way, critical,
it does not deal with the legal or ethical principles that
are necessary in order to make an informed decision
regarding law or ethics in relation to the practice of a
profession in general or the question of "emergency
contraceptives" in particular. . .
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Eternal Vigilance is the Price
of Conscience Protection:
The Freedom of Conscience in Relation to "Health"
- Iain T. Benson*
| . . .Apparently this
medical student has been threatened with loss of graduation
if, because of his stated religious reasons, he will not
offer abortion as an option to a patient. In terms of the
legal requirement, the issue is whether or not a physician
is required to refer a patient for an abortion. . . .
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"Do Not
Resuscitate":
Whose Choice?
Court Gives Course In Medical Ethics To The
Public Trustee
- Iain T. Benson*
Brad.
B. Miller* | . . .Can a
doctor or health care facility legally issue a "do not
resuscitate" order if the patient or the patient's guardian
refuses to consent to that order? What are the obligations
of the Public Trustee's office with respect to consenting or
opposing "do not resuscitate orders? . . .
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The Courts' Spectacles:
Some Reflections on the Relationship between Law and
Religion in Charter Analysis
- Mr. Justice David M.Brown*
| . . .The main point which I wish to make in this paper is
that when courts engage in this "managing" exercise they do
not operate as philosophically-neutral actors. Instead, the
case law reveals that they perform the "managing" exercise
through philosophical lenses that are not blank, but reflect
philosophical choices which inform their balancing task. .
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In Defence of the New Heretics: A Response to Frank Archer
Responding to Archer F.
Emergency Contraceptives and
Professional Ethics.
Canadian Pharmaceutical Journal, May 2000, Vol. 133, No. 4, p.
22-26
- Sean Murphy*
| Before taking action that they may later regret, those who would coerce or
discriminate against conscientious objectors, or drive them from the
practice of pharmacy, would do well to revisit Frank Archer's critical
review . . . Although many pharmacists have accepted the review as a
definitive ethical statement, it is insufficient warrant for repression of
freedom of conscience within the profession. . .
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(Ethical Commentary)
Postscript
for the Journal of Obstetrics and Gynaecology Canada:
Morgentaler
vs.
Professors Cook and Dickens
Responding to Cook RJ, Dickens BM, "In
Response". J.Obstet Gyanecol Can 2004; 26(2)112; Cook RJ,
Dickens BM, Access to emergency contraception [letter] J.Obstet
Gynaecol Can 2004; 26(8):706.
- Sean Murphy* | .
. . the arguments of Professors Cook and Dickens for
mandatory referral are unsupported and even contradicted by
their own legal and ethical references. Regulatory officials
with the power to enforce the views of Cook and Dickens are
unlikely to discover this in the pages of the Journal,
since, by editorial fiat, the discussion was terminated with
the publication of their 'final word' on the subject. Here,
then, is the postscript to the discussion, supplemented by
developments in the United Kingdom and Belgium that have a
bearing on the issue. . .
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Commentary
on Cecilia Moore's Case
- Sean Murphy* |
The following commentary concerns the case of Cecilia Moore,
a welfare worker who was fired for refusing to authorize
medical coverage for an abortion. . .
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Legalizing therapeutic homicide and assisted suicide:
A tour of
Carter v. Canada
- Sean Murphy* |
The trajectory of the trial was determined by the
unchallenged fundamental premise that suicide can be a
rational and moral act, and that the sole purpose of the law
against assisted suicide is to prevent suicides by
vulnerable people in moments of weakness, who might be
tempted to commit suicide that is not rational and moral.
The only issue was whether or not safeguards could be
designed to permit legitimate access to assisted suicide,
while preventing the vulnerable from accessing it in moments
of weakness. . .
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Project Backgrounder
Re: Joint intervention in
Carter v. Canada
Supreme Court of Canada, 15 October, 2014
- In June, 2012, a British Columbia Supreme Court
Justice ruled in favour of physician assisted suicide
and euthanasia. The plaintiffs
appealed to the Supreme Court of Canada.
- The Catholic Civil Rights League,
Faith and Freedom Alliance and the
Protection of Conscience Project were jointly granted intervener status
in Carter by the Supreme Court of Canada. The joint
factum voiced concern that legalization of physician assisted
suicide and euthanasia would likely adversely affect physicians and
health care workers who object to the procedures for reasons of
conscience. The factum was supplemented by a ten minute oral
presentation.
Factum |
Backgrounder
Supreme Court of Canada orders legalization of physician assisted
suicide - AND euthanasia
Physicians unwilling to kill
already face demands that they find someone who will
- Sean Murphy*
| In a 9-0 ruling released on 6 February, 2015, the Supreme Court of Canada
struck down two sections of Canada’s Criminal Code "insofar as they prohibit
physician-assisted death" in circumstances outlined by the Court.
It appears that most or all of the major media outlets understood this to
mean that the Court had legalized physician assisted suicide. . . the ruling
not only permits physician assisted suicide, but
physician administered euthanasia. . .
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Decriminalization of assisted suicide and the violation of our
rights
- Albertos Polizogopoulos* | In October, the Supreme Court of Canada heard the Carter
case, where parties are challenging Criminal Code
prohibitions on physician assisted suicide in the
hopes of decriminalizing it. If they're successful,
it will impact more than just physicians. . .
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Amir Attaran and the elves
A law professor makes much ado
- Sean Murphy*
| . . . University of Ottawa law professor
Amir Attaran asserts that the "corrosive hostility"
of the Canadian Medical Association to
"physician-assisted dying" is evident in its
"cowardly and stupid" position on the procedure. . . In his telling, ever since the Court ignored the threat and struck down
the law, the CMA has been acting like a "sore loser," trying to persuade
physicians not to participate. . . And he complains that the CMA won't
force physicians unwilling to kill patients or help
them commit suicide to find someone who will. . .
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A "uniquely Canadian approach" to freedom of conscience
Provincial-Territorial Experts recommend coercion to ensure delivery of
euthanasia and assisted suicide
Recommendations designed to broaden and maximize impact of Supreme Court
ruling
- Sean Murphy*
| The Experts' recommendations are intended to extend and maximize the
impact of the Carter ruling. They will effectively require all institutions,
facilities, associations, organizations and individuals providing either
health care or residential living for elderly, handicapped or disabled
persons to become enablers of euthanasia and assisted suicide. This will
entail suppression or significant restriction of fundamental freedoms. . .
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To kill — or not to kill? That is the question.
An answer for a Dying With Dignity clinical advisor
- Sean Murphy*
| . .>the DWD Clinical Advisor was exasperated by the description of euthanasia and assisted suicide as "killing." This, he/she exclaims, is a malicious lie that adds to the world's misery.
Such a cri de cœur calls for a thoughtful discussion of the question it raises.
Does providing euthanasia and assisted suicide entail killing — or does it not?
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Jewish physicians' freedom of
conscience and religion and the Carter Case
- Charles Wagner*,
Adam Hummel* | How does the decision in the Supreme Court of Canada (SCC) in Carter
v. Canada (Attorney General)1
("Carter") impact on the religious Jewish doctor? Will this landmark
decision bring into conflict these doctors' freedom of conscience and
religion with their professional obligations? The Carter case sets
aside federal criminal laws as they relate to physician assisted
suicide. It stands for the proposition that individuals who are
suffering unbearably have a constitutional right to a physician-assisted
suicide.
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Conscience, euthanasia and assisted suicide in Manitoba
The Medical Assistance in Dying (Protection for Health Professionals and Others) Act
- Sean Murphy*
| . .The MAiD Act is a procedure-specific law applying only to euthanasia and assisted suicide. It protects all regulated professionals who refuse to provide or "aid in the provision" of the procedures from professional disciplinary proceedings and adverse employment consequences because they have refused. They remain liable for other misconduct in relation to the refusal.
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Quebec’s Act Respecting End of Life Care
Reportable and non-reportable euthanasia
- Sean Murphy*
| . .Quebec's euthanasia law, the Act Regarding End of Life Care (ARELC), permits two kinds of euthanasia, distinguished here as reportable and non-reportable euthanasia. . .
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- In July, 2006, the Canadian Medical Association Journal
published a guest editorial by Sanda Rodgers of the Faculty of
Law, University of Ottawa, and Jocelyn Downie, of the Health Law
Institute, Dalhousie University, Halifax, Nova Scotia. The
editorial appears to have been an attempt to bully objecting
physicians who refuse to refer patients for abortion by menacing
assertions about legal and ethical obligations. The CMAJ
is a publication of the Canadian Medical Association, which,
however, asserts that its contents do not necessarily represent
the views of the Association.
Commentary (Ethics)
Yet
More Pharmacists Who Don't Understand Ethics: This Time Ontario
- Iain T. Benson*
| . . . For pharmacists and pharmacy technicians the
accommodation of religious belief and conscience guaranteed
by Section 2 of the Canadian Charter of Rights and
Freedoms will be suspended should this principle go
ahead as drafted. This is not the approach taken by doctors
and the Canadian Medical Association would not endorse this
blunt and unfair kind of principle. . .
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Letter to Minister of Health (Ontario)
- Protection of Conscience Project | . .
.I understand that the Ontario College of Pharmacists has
made a recommendation to the OHPRAC to the effect that
freedom of conscience ought to be denied to pharmacists and
pharmacy technicians. I am advised by concerned pharmacists
that those who would have objected to this were unaware that
the College was contemplating such a recommendation and were
not consulted about it. . .
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Ontario Human Rights Commission attempts to suppress
freedom of conscience
- Sean Murphy*
| The College of Physicians and Surgeons of Ontario is
the regulatory and licensing authority for physicians and surgeons
practising in Ontario, Canada. In February, 2008, the Ontario Human
Rights Commission recommended that the exercise of freedom of conscience by
physicians be restricted. The College then drafted a policy that
demanded that Ontario physicians sacrifice their freedom of conscience to
avoid prosecution by Ontario's human rights apparatus.
Commentary (Ethics)
Freedom of Conscience and Human Rights
- Michelle Davis*
| A series of Bioethics Matters will look at the Ontario
Human Rights Commission, the Ontario Human Rights Code, and
the Canadian Charter of Rights and Freedoms to explore the
issues of religious discrimination, the right to be free
from discrimination based on creed (religion), and the
freedom of conscience and religion. . .
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The
New Inquisitors
- Sean Murphy* | .
. . OHRC agents have broad
powers to enter private property without
warrant, and can, without warrant, search
premises, examine, measure, photograph the area and
and seize they think relevant to the investigation.
. . police can be called upon to assist, using force
if need be.
. .All of this for the purpose of
investigating, not unlawful conduct, but mere
"tension or conflict," or conditions that might lead
to either. In contrast, Canadian police have far
less power to investigate criminal offences -
including murder. . .
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Ontario court affirms right of state to compel participation in euthanasia
Doctors must refer patients for 'medical assistance in dying'
- Michael Cook* | Back in 2006, Oxford University's Professor Julian Savulescu published a frontal attack on the notion of conscientious objection in medicine in the BMJ, a popular medical journal. At the time it seemed odd rather than dangerous, the dream of an ideologue rather than sober policy. . . .
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With Ontario court's ruling on doctors, the revolution continues
There is a growing antipathy among Canadian elites against conscientious individuals who refuse to accept their views
- Barry W. Bussey* | How is it that such a simple decision could be made so complicated? Given the history of accommodating individual conscience in the medical profession and in Canadian law, the case before the Ontario Court of Appeal to accommodate doctors' consciences was a "no-brainer." The law, history, and basic human decency cried out: "Accommodate the physician!" Instead, the highest court in Ontario followed the worrying legal revolution against accommodation and stomped on conscience. . .
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Forced Referral and Freedom of Religion vs Freedom of Conscience
Without freedom of conscience our free democracy would not exist
- Shawn Whatley, MD* |
A recent court decision in Ontario missed the mark when it ignored the impact forced referral has on freedom of conscience.
On May 15, the Ontario appeals court ruled that doctors must give patients a referral for euthanasia, abortion, and other contentious issues, regardless of what an individual doctor thinks about them. . .
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Physicians in Canada should be moral actors, not robotic bureaucrats
Doctors should not be obliged to write referrals for procedures they find morally objectionable
- Brian Bird* | Earlier this week, Ontario's highest court heard a case that pits access to health care against the moral convictions of doctors. The case essentially tests the extent to which Canadians can follow their own moral compasses while operating in a professional capacity.
In Ontario, doctors can refuse to perform procedures or prescribe drugs that they consider immoral. However, the public body that regulates these doctors – the College of Physicians and Surgeons of Ontario (CPSO) – requires them to refer patients to doctors who are willing and able to provide the requested health care service. . .
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Understanding Freedom of Conscience
- Brian Bird*
| A court case dealing with freedom of conscience gives rise
to questions about what freedom of conscience protects and why
we protect it. . . . Balancing physicians' freedom of conscience with patients' access to
medical services is a delicate task. But that balance will certainly not be
struck if, when it comes to freedom of conscience, we do not know what we
are talking about or why it matters.
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Physicians,
conscience, and assisted dying:
By requiring that physicians make referrals for assisted
dying, Ontario is forcing them to leave medicine or abandon
their ethical framework.
- Deina Warren,* Derek Ross*
|
Of all the jurisdictions worldwide that permit some form
of assisted suicide, Ontario stands alone in mandating that
physicians participate in it. . . [C]ompelling physicians to
participate in MAID results in the state deciding
what everyone should believe; and second, it
undermines physicians' moral integrity, a
foundational component of medical ethics and
principled health care. . .
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Ontario must amend its assisted dying
legislation to recognize conscience rights
- John Milloy*
| Canadians ask a lot of our physicians – years
of education, long hours, complex cases and
demanding patients (full disclosure – I am
married to a doctor). Since June of last year, we have also been
asking them to help some of their patients take
their own lives. . . Should we not respect the fact that some
doctors and other health-care providers simply
don't want to be involved in assisted dying for
reasons of conscience?
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Re: Redefining the
Practice of Medicine
Euthanasia in Quebec
An Act Respecting End of Life Care
(June, 2014)
- Sean Murphy*
| Part 1: Overview - An Act Respecting End-of-Life Care
("ARELC")
is intended to legalize euthanasia by physicians in the province of
Quebec. It replaces the original Bill 52, the subject of a previous
commentary by the Project. The
original text of the Bill 52 did not define medical aid in
dying (MAD), but ARELC now makes it clear that Quebec
physicians may provide euthanasia under the MAD protocol.
. .
Part 1
- Part 2: ARELC in detail -
An Act Respecting End-of-Life Care ("ARELC")
is intended to legalize euthanasia by physicians in the province of
Quebec. It replaces the original Bill 52, the subject of a previous
commentary by the
Project. ARELC purports to establish a right to euthanasia
for a certain class of patients by including it under the
umbrella of "end-of-life care." . . .
Part 2
- Part 3: Evolution or Slippery Slope? - Euthanasia laws frequently include guidelines and safeguards intended
to prevent abuse. Eligibility criteria are the most basic guidelines or
safeguards. In considering their stability, it is important to
consider not only the elasticity of existing statutory provisions, but
recommendations for expansion that might ultimately result in changes to
the law. . .
Part 3
- Part 4: The Problem of Killing -
The original text of Bill 52 did not define "medical aid dying"
(MAD), but it was understood that, whatever the law actually said, it was
meant
to authorize physicians to kill patients who met MAD
guidelines. The Minister of Health admitted that it
qualifed as homicide, while others acknowledged that MAD
meant intentionally causing the death of a person, and that
its purpose was death. . .
Part 4
- Part 5: An Obligation to Kill - Statistics from jurisdictions where euthanasia and/or
assisted suicide are legal suggest that the majority of
physicians do not participate directly in the procedures.
Statistics in Oregon and Washington state indicate that the
proportion of licensed physicians directly involved in
assisted suicide is extremely small. . .
Part 5
- Part 6: Participation in Killing -
It appears that, even where euthanasia or assisted suicide is legal,
the majority of physicians do not actually provide the services. However, by establishing a purported legal "right" to euthanasia, ARELC generates
a demand that physicians kill their patients, despite the high probability that a majority of physicians will
not do so. . .
Part 6
- Part 7: Refusing to Kill - It is important identify problems that the
Act poses for those
who object to euthanasia for reasons of conscience, and to consider how objecting health care workers might
avoid or respond to coercion by the government and the state medical and legal establishments . .
.
Part 7
- Part 8: Hospitality and Lethal Injection -
Under the Act Respecting End of Life Care (ARELC) palliative
care hospices may permit euthanasia under the MAD protocol on their
premises, but they do not have to do so. Patients must be advised
of their policy before admission. The government included
another section of ARELC to provide the same exemption for La Michel
Sarrazin, a private hospital. The exemptions were provided for
purely pragmatic and political reasons. . .
Part 8
- Part 9: Codes of Ethics and Killing -
Refusing to participate, even indirectly, in conduct believed to involve
serious ethical violations or wrongdoing is the response expected of
physicians by professional bodies and regulators. It is not clear
that Quebec legislators or professional regulators understand this. .
.
Part 9
-
Quebec Euthanasia Guidelines: Practice guide issued by Quebec health care profession
regulators (August, 2015)