A parliamentary committee's recommendation that doctors who object to assisted dying be required to at least refer patients to a willing colleague is not only disappointing, but has also led some physicians to consider leaving their practices, says the Canadian Medical Association.
The all-party committee, which released a set of recommendations Thursday aimed at helping the federal government draft new right-to-die legislation, said Ottawa should work with the provinces and territories to establish a process that respects a doctor's freedom of conscience, while honouring the needs of patients who seek medical aid in dying.
"At a minimum, the objecting practitioner must provide an effective referral for the patient," the committee said.
The CMA, which represents about 80,000 physicians across the country, had argued during hearings to the committee that doctors who oppose assisted dying on grounds of conscience should not be required to refer patients to a colleague willing to provide or administer drugs that would end their lives.
"We were very disappointed to see it not incorporated into the recommendations," said Dr. Jeff Blackmer, the CMA's vice-president of medical professionalism.
Referral has been a hot-button issue among members of the physicians group, with many arguing that doctors should not be coerced into providing the service, nor should they be required to ease the path to assisted death when it runs counter to their religious, moral or ethical beliefs.
"There are physicians who see making a referral as morally analogous to doing the act itself," Blackmer said Friday from Ottawa.
"It means you know what will result from that referral. So for physicians who feel very strongly opposed to assisted dying, a number of them say: 'If I refer to another physician and I know that they will themselves undertake the act of assisted dying, I'm automatically morally complicit because I facilitated the process."'
Blackmer said the CMA had proposed an alternative: the creation of a central information hub to facilitate access to doctor-aided death, which conscientious objectors could point out to patients who desired to terminate their lives.
Objecting physicians would be required to provide detailed information to a patient and their family "so they could access that central service readily and in a very timely fashion, with no barriers whatsoever," he said. Physicians would also have to transfer the patient's records on request.
But Blackmer said the proposal was not even mentioned in the committee's report, despite having the backing of Dying With Dignity Canada and the B.C. Civil Liberties Association, two of the groups that spearheaded the legal battle to overturn the long-standing ban on assisted death.
"I in no way mean to sound alarmist, but I have heard from some colleagues that are near retirement age that if this does become enshrined in legislation, they will retire," he said of the proposed requirement to directly refer patients. "I know some colleagues who have said they'll move to a U.S. state.
"I don't think those numbers are going to be huge, but certainly there is a subset of physicians who feel strongly enough about this that they would absolutely make changes in their practice, based on what the legislation might look like."
The Supreme Court of Canada ruled a year ago that individuals with unbearable suffering from a grievous and irremediable condition could seek a doctor's help to die. Ottawa has until June 6 to pass new legislation reflecting the court's landmark decision.
In the meantime, the CMA hopes to meet with federal justice and health department officials to go through the recommendations and look for common ground on contentious issues such as obligatory referrals.
"We're more than convinced that common ground exists," said Blackmer. "If the rationale for requiring mandatory referral is to ensure access, that's very much a false dichotomy. There's no need to require mandatory referral to ensure access.
"And you don't need to look any further than other jurisdictions that have legalized assisted dying," he said of such countries as Belgium and the Netherlands. "None of them has a requirement for referral and none of them has an issue with access."