An appeal court decision to uphold the College of Physicians and Surgeons of Ontario’s (CPSO) policy on effective referral for assisted dying is a victory for patients’ rights in the province, Dying With Dignity Canada (DWDC) says.
On Wednesday, the Court of Appeal for Ontario announced its ruling in a constitutional challenge to the CPSO’s effective referral rule, which requires doctors who oppose assisted dying to connect patients who request it with a non-objecting provider or agency. The appellants, led by the Christian Medical and Dental Society of Canada, have argued that the policy infringes upon Charter rights of doctors who oppose medical assistance in dying (MAID).
- Download and read the Court of Appeal for Ontario's decision
- Learn more about effective referrals for assisted dying
In a 74-page decision, Chief Justice George R. Strathy, writing for the court, explained that the effective referral policy is justifiable under the Constitution and functions to protect patients. “In the case of a conflict, the interests of patients come first, and physicians have a duty not to abandon their patients,” wrote Chief Justice Strathy in the unanimous decision.
The leading charity defending Canadians’ end-of-life rights, DWDC is cheering the court’s decision to uphold the CPSO’s policy on effective referral. “This decision sends a strong message to Ontarians and to the country as a whole: clinicians who oppose assisted dying have no right to impede access of patients who request it,” said DWDC CEO Shanaaz Gokool. “We are pleased that the court reached a just outcome, and we thank the CPSO for its commitment to upholding human rights in the province of Ontario.”
As an official intervener in the appeal, DWDC made a written submission to the court and delivered oral arguments when the case was heard in January. Represented pro bono by lawyers Kelly Doctor and Mary-Elizabeth Dill from Goldblatt Partners LLP, DWDC argued that the effective referral rule is critical to upholding Ontarians’ right to equitable and dignified access to medical assistance in dying, as well as their rights to privacy in healthcare.
The appellants in the case had argued that it was sufficient for objecting clinicians to provide vulnerable patients with general information in the form of brochures and websites. However, as Doctor emphasized in court in January, expecting sick and frail patients to navigate the healthcare system by themselves is both unrealistic and potentially harmful. Any additional delays because of a lack of an effective referral may result in losing the right to an assisted death altogether should the patient lose capacity to consent.
“It’s wrong for a clinician to simply hand their patient the link to a website or a telephone number, and essentially tell them they’re on their own,” Gokool said. “We’ve heard time and time again how painful, stigmatizing, and sometimes impossible, it can be for suffering people to overcome the hurdles imposed by their clinicians’ refusal to provide a timely referral. The CPSO’s policy is absolutely essential to upholding the patient rights of the most vulnerable, most socially isolated people in our healthcare system.”