Dr. David Amies: Patients, not doctors, must be at the centre of assisted dying

Every doctor and nurse practitioner in Canada has the right to refuse a request for medical aid in dying (MAID) if it goes against their personal convictions. But what happens when medical professionals flat out refuse to refer suffering patients to willing physicians, effectively abandoning the individuals in their care? In response to Christian doctors challenging Ontario's assisted death referral requirement, Dr. David Amies writes about how there is no room for narrowly doctor-centred thinking or religious hypocrisy in assisted dying.

I felt my gorge rising when I read some of the statements put out by various medical religious groups after the MAID legislation was enacted. It appears that these groups are incensed by proposed regulations in Ontario requiring conscientiously objecting health professionals to provide referrals to willing physicians.

For example: “Our position is doctors who opposed assisted suicide or physician-assisted death are put in a position now where they either need to violate their conscience and their religious and moral belief or face being disciplined by the college — and that’s not a good place to be.” That statement came from lawyer Albertos Polizogopoulos who represents several faith groups and individual physicians, including the Christian Medical and Dental Society of Canada, the Canadian Federation of Catholic Physicians’ Societies and Canadian Physicians for Life.

Similarly, Evan Goligher from the intensive care unit at Mount Sinai Hospital in Toronto said, “I think the patient is of greater value than their preference, and I cannot lift my hand to destroy that which is of fundamental value.”

The new federal law does not require any healthcare professional who has a conscientious objection to taking part in performing MAID to do so. However, the proposed regulations in Ontario require all physicians, who cannot or will not provide assisted death, to refer an applicant to a doctor who will. The dissenting religious groups hold that such referrals are the moral equivalent of participating in the procedure. They argue that these regulations violate their freedom of conscience and religion, which is protected in section two of Canada's Charter of Rights and Freedoms.

Putting the patient first

What appears to be forgotten in all this self-righteous piety is the plight of a poor wretch suffering from a condition causing grief, pain and anguish for which there is no acceptable remedy. Such patients may well have been under the care of a physician for months or years. They may well have discussed possible ways out of their dilemma. Consequently, they may also have decided that their time has come and that they wish to die at a time and in a place of their own choosing. Such decisions are hardly made whimsically. Imagine then, how greatly their level of suffering would increase when they discover that their doctors are not only unwilling to help them but are not even prepared to refer them to others who could.

Medical aid in dying is all about patients. It is not about doctors.

No one is suggesting that all healthcare professionals be legally obliged to take part in MAID. It is perfectly understandable that many will regard such actions with distaste. However, when patients make a plea to have their lives prematurely ended because of their distressful circumstances, they are thinking about themselves. In my opinion, they are well within their rights to expect concern, continuing care and empathy from their doctors. Of course, doctors have rights as well, which must be respected. It would seem to me that providing the name of a willing physician or details of a centre that can coordinate such requests, as has been set up in Alberta, represents the tiniest imaginable brush with conscience, smaller by far than a blank refusal to help.

As far as I am aware, all religions have mechanisms whereby adherents can square their consciences with the Almighty. Most well-known is the Roman Catholic procedure of confession and penance. It is easy to understand the dilemma faced by conscientiously objecting physicians when asked by a dying patient for an assisted death. But a practitioner who flat out refuses to take the matter any further might find a greater weight on his or her conscience than that occasioned by providing the necessary information.  The term “whited sepulchre” comes to mind. 

Dr. David Amies is a retired doctor in Lethbridge, Alta., and a member of DWD Canada's Physicians Advisory Council.

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