Comment: MDs should not be able to block assisted dying

Allowing doctors who object to physician-assisted dying not to refer or transfer care of their patients to another physician is worrying.

Speaking at the joint parliamentary and Senate committee hearings on physician-assisted dying, Dr. Jeff Blackmer of the Canadian Medical Association said doctors who don’t want to participate in providing assisted dying on grounds of conscience should not be obliged to refer a patient to another willing practitioner.

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He also claimed that 70 per cent of physicians in Canada would not participate in assisting in the provision of assisted dying.

It wasn’t clear from his testimony what should happen to patients at the end of life who find that available doctors will not honour their request for assisted dying. But to require that suffering patients must, on their own, find another doctor is cruel and unsupportable. It will make accessing assisted dying far more difficult for aboriginal Canadians, or anyone living in northern or rural areas where doctors and other medical professionals are scarce.

I require complex care — many things are going wrong now and this will only degenerate further. Such is the prognosis for many who suffer from neurological disorders such as ALS or mine, Friedreich’s ataxia, or diseases such as HIV/AIDS, late-stage cancer or dementia.

I need a general practitioner with access to specialists. Does it now fall to me to screen my GP about his or her attitude to physician-assisted dying should I want to consider this option?

What if he or she says: “No, I don’t endorse physician-assisted dying on grounds of conscience. I abhor the very idea of such a practice.” Would you risk damaging the relationship with your GP on whom your complex care and the quality of your life now depend? Can a patient blacklist be far behind?

Fanciful, you think? Since grounds of conscience would now count as grounds for denial of service, doctors could invoke it without evidence other than saying so.

During their testimony, the representatives of the CMA were silent regarding how abuses of conscience would be policed or disciplined.

The point of the Supreme Court of Canada ruling was that under certain narrowly defined circumstances, the charter trumps conscience. We are ruled by law and not by conscience, no matter how pure it is alleged to be.

Besides, who is this legislation for? It is not for medical professionals, professional associations, lawyers, judges of a superior court or the SCC. It is for two types of people who qualify for physician-assisted dying under the criteria spelled out in the Carter decision: those competent adults who choose assisted dying and those who choose some other end-of-life option.

Any legislation that compromises the rights of either group is wrong and unsupportable.

If anyone objects to assisted dying on grounds of conscience, such people should not be involved at any stage in the assessment of my capacity and voluntariness of my request for assisted dying or its provision later.

Nor can we rely on doctors to excuse themselves. Why? If conscience is the serious impediment the CMA claims it is, then the conflict of interest is obvious. Not only must it be eliminated, it must be seen to be eliminated. Otherwise, how can anyone in good conscience be expected to participate in it? I see no reason to risk the result by participating in so suspect a process, riddled as it is with unrecognized and unacknowledged conflicts of interest. Competent adults ought to consider now whether they need to make other arrangements.

Thanks to the CMA, we know it is up to each of us to do our own due diligence when it comes to end-of-life choices. This will require some basic information.

For example, how many doctors in B.C. will refuse on grounds of conscience to be involved in providing assisted dying? Will the lists of conscientious-objecting doctors be made public provincially and for each local health authority?

If the CMA’s position is adopted, it will leave many truly bereft — those who lack the financial, social, legal and educational wherewithal to navigate our complicated health system, and the health sufficient to explore and act on their preferred alternative.

Dr. Douglas Grant, CEO of Nova Scotia’s College of Physicians and Surgeons, noted: “We have to at least consider the possibility that physicians who conscientiously object to providing this service might consciously obfuscate or block a patient from accessing the service.

“It is naïve to think that access to physician-assisted death will not be an issue, whether for reasons of conscience or geography.”

By insisting on a broad, unwarranted and unregulated appeal to conscience at the expense of the violation of the charter rights of all those eligible for physician-assisted dying, the CMA risks doing irreparable harm to the relationship of trust that should obtain between doctor and patient.

 

John Priddle is a member of the Victoria chapter of Dying with Dignity.

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