The CPSO is the regulatory body for all medical professionals in Ontario. Physicians are required to register with the CPSO, who will then monitor quality of care and investigate and discipline any doctors who do not follow professional conduct as described in the various policies. Regarding Medical Assistance in Dying, the CPSO has no authority over the existing legislation or changes to it – this would fall to Federal and Provincial legislatures, or to the courts. However, the CPSO does have jurisdiction over the policies given to doctors regarding how they can practice in accordance with the current laws.

One of the major concerns with the existing CPSO policy is the requirement for physicians to provide an effective referral if they have a conscientious objection to providing a specific service, such as Medical Assistance in Dying. The relevant policy regarding conscientious objections is as follows:

“While the federal legislation does not address the conscientious objections of health care providers, the College has outlined expectations, set out below, for physicians who have a conscientious or religious objection to MAID. These expectations accommodate the rights of objecting physicians to the greatest extent possible, while ensuring that patients’ access to healthcare is not impeded.

1. Consistent with the expectations set out in the College’s Professional Obligations and Human Rights policy, physicians who decline to provide MAID due to a conscientious objection:
   1. must do so in a manner that respects patient dignity and must not impede access to MAID.
   2. must communicate their objection to the patient directly and with sensitivity, informing the patient that the objection is due to personal and not clinical reasons.
   3. must not express personal moral judgments about the beliefs, lifestyle, identity or characteristics of the patient.
   4. must provide the patient with information about all options for care that may be available or appropriate to meet their clinical needs, concerns, and/or wishes and must not withhold information about the existence of any procedure or treatment because it conflicts with their conscience or religious beliefs.
   5. must not abandon the patient and must provide the patient with an effective referral.
      1. Physicians must make the effective referral in a timely manner and must not expose patients to adverse clinical outcomes due to a delay in making the effective referral.”

To provide further clarity, the CPSO defines ‘effective referral’ as, “taking positive action to ensure the patient is connected to a non-objecting, available, and accessible physician, other health-care professional, or agency.”

Many doctors and medical groups in Ontario believe that it would violate their conscience to administer MAiD, but also to participate in the process through an effective referral. The CPSO states that through their current policy, they are seeking to balance the right to freedom of conscience and religion against the rights of patient access to care, but the existing policy does not do that. You can use a number of the points below to respond to the consultation:

• Freedom of conscience and religion are fundamental freedoms under the Charter of Rights and Freedoms.
  • Doctors should be permitted to pursue their profession without violating their conscience.
  • While there is no requirement in Ontario for physicians to administer MAiD, many doctors object to participating in the process through an effective referral as well.
• Most of the Provincial medical regulatory bodies do not require effective referrals for issues of conscience.
• Doctors’ conscience rights also matter for patients.
  • Limiting conscience rights will limit the number of conscientious objectors who enter or remain in the medical field, and reduces access to health care.
  • Patients should be able to choose a doctor who they can trust to make ethical decisions and will seek to promote their patients’ health.

• The medical field is strengthened through diversity of thought and diversity of doctors.

• • Doctors should be able to provide the best possible medical advice, whether or not the patient disagrees with that advice.
  • In other medical situations, such as requests for dramatic liposuction or a tongue splitting, doctors are permitted to deny the patient’s request without fear of discipline from the CPSO.
• Doctors are not vending machines where you ask for something, and it gets spit out.
  • There should be dialogue about what is best for the patient.
  • Forcing a doctor to do something that they believe is not in the best interest of the patient muzzles a doctor from giving an honest medical opinion.
• Conscience protection does not exclude patients from accessing care. Rather, it protects physicians from participating in certain procedures.

 

The Medical Assistance in Dying consultation can be found here:  http://policyconsult.cpso.on.ca/?page_id=13129 Simply click on ‘online survey,’ and you can begin the survey. Alternatively, you can click on ‘email us your thoughts,’ or email the CPSO directly at [email protected]. We encourage you to use the ideas in this guide, expand on them, and present them in your own words. Please allow your concerns to be heard through this unique opportunity.