Bill C-7, passed by the House of Commons and now in front of a Senate committee, raises even more ethical challenges than the original legislation. Doctors who object should not be compelled to support it.
Bill C-7 is changing the landscape of Canadian medicine. With this legislation, the federal government is expanding medically administered death (MAiD) to individuals not at end of life and with no requirement for MAiD to be a last resort in patient care. Under Bill C-7, a patient with a chronic illness or disability could receive MAiD when therapeutic options for care that could alleviate suffering have not been provided.
While some physicians may decide to aid in ending the life of their patient who is not dying, what will become of physicians who do not believe that administering death is good medicine?
Professional medical opinions are rooted in extensive medical knowledge, years of training and practice, and an individual practitioner’s conscience. It is our conscience that navigates us through the ethics necessary for providing each patient with the best medical advice for a given situation.
Medicine is not a department store. Our role is not to check the storeroom to see if we have the display item you like in the size and colour you desire. Much like a lawyer representing a client is obligated to provide them with the best legal advice, it is our responsibility to use our education, training and expertise for the health and safety of our patients. People come to us seeking help and advice and our duty is to provide the best advice and care we can. Physicians sometimes refuse patient requests, such as antibiotics when they have a viral infection. Or we may cancel a driver’s licence against a patient’s will for their safety and the common good.
Many physicians cannot participate in or facilitate MAiD through a referral without betraying their professional medical opinion or moral obligations to the value and good of the patient. Referrals are not simply a means to provide access to something a doctor does not have expertise in or services they do not offer. Rather, with a referral, physicians endorse a treatment that is in the best interests of the patient. Referral for an act that goes against a physician’s moral obligation to the good of the patient is unconscionable.
Several of the Canadian provincial colleges have created policies with positive obligations that force physician participation in MAiD. This ignores the diverse backgrounds and communities of health care professionals who have committed themselves to the practice of medicine as a life-preserving profession. This approach supposes that conscientious objectors are acting selfishly rather than out of their professional medical and moral obligations and assumes, without argument, that the weighty ethical concerns of objectors are unfounded.
Effective patient access to elective services such as MAiD need not rest on physician participation through referral. The Canadian Medical Association stated, “a forced referral policy creates a false dichotomy, pitting patient access against physicians’ conscience when no other jurisdiction has done that, and yet patient access doesn’t seem to be a problem in the rest of the world.“ In a pluralistic society with diverse beliefs, systems can be set up for ethically controversial procedures that allow direct access for those who want it without forcing anyone’s participation. There are many models within Canada and around the world that strike such a balance.
MAiD for disabled and chronically ill people who are not dying is only one of the controversial legislative changes that will alter how medicine is practised and health care is delivered in Canada. The expected expansion of MAiD to mature minors, individuals with mental health as a sole diagnosis, and advance directives will significantly impact the future practice of medicine in Canada. It is imperative that governments set up the necessary systems now to allow direct patient access and put in place robust and meaningful legislated protections for physicians to practise medicine according to their consciences and with integrity.
Dr. Thomas Bouchard is a family physician who cares for frail elderly persons in long-term care centres in Calgary. Dr. Ramona Coelho is a family doctor who cares for persons with disabilities and chronic illnesses in London, Ont. Dr. Leonie Herx is the head of Palliative Medicine at Queen’s University and immediate past-president of the Canadian Society of Palliative Care Physicians.