John Sikkema and Derek Ross
The Alberta government is directing Albertans seeking information about “medical assistance in dying” (MAID) to contact Alberta Health Service’s “central care coordination service” or to initiate a discussion about medical assistance in dying with their family physician or specialist.
As for physicians in Alberta, a Ministerial Order requires that those who receive a request for MAID, but who decline “for reasons of conscience or religion to provide or to aid in providing [MAID]”, must ensure the patient has timely access to Alberta Health Service’s coordination service.
Thankfully, the government has decided against requiring physicians who conscientiously object to participating in MAID to provide “effective referrals” – that is, to find a physician who is known to be a willing MAID provider and to refer his or her patient to that other physician. Alberta’s system allows physicians who object to MAID to keep their patients. The initiative to find a MAID provider remains with the patient. As for the way the “coordination service” will operate, Alberta Health Services says its teams are available to discuss all end of life options, including MAID, and can connect patients with palliative care providers. We hope the goal is always to encourage “alternatives” to assisted suicide and euthanasia and we intend to look further into how the coordination service actually operates.
It is our view, however, as expressed in our submission to the Alberta government, that the provinces are not obligated to fund or facilitate medically assisted suicide or euthanasia, or to require anyone else to do so. The Carter decision simply rendered the complete criminal prohibition on such practices invalid.
Alberta’s adoption of the “central care coordination service” follows its public consultations on the issue of medically assisted suicide and euthanasia in March of this year, in which CLF participated. On May 27, Alberta Health released a report on these consultations entitled “What We Heard: Medical Assistance in Dying”.
“What We Heard” reports that 55% of people who completed its survey said physicians who do not wish to provide medical assistance in dying should refer to a physician who does, while 27% said the physician should refer to a resource that would provide information and the remainder either had no opinion or said the physician should not be required to provide any kind of referral.
CLF’s opposition to requiring effective referral for MAID is specifically cited in Alberta Health’s report. “On the matter of physician referral, opinions varied,” the report notes. It continues (page 10):
Some felt that physicians with moral or religious objections should not be compelled to make a referral to another physician or a third party.
“Provincial legislation should not require, and should preclude the College of Physicians and Surgeons of Alberta from requiring, physicians to provide effective referrals for PAD. The requirement to provide a referral would clearly and unjustifiably interfere with freedom of conscience because it forces physicians to participate in an act to which they are conscientiously opposed.” – Submission from Christian Legal Fellowship
The report is organized according the following subjects: eligibility for MAID, protections for vulnerable persons, administration of MAID, conscientious objection, reporting and monitoring, and palliative care.
Of course, federal law (Bill C-14) sets out the basic requirements for eligibility, safeguards, and reporting, but provincial law and policy play an important role in how MAID is provided in practice. Since the federal law does not contain any concrete protections for physicians or others against being required to provide or participate in MAID – though it says that “nothing in this Act affects the guarantee of freedom of religion” – provincial law and policy are especially important when it comes to freedom of conscience and religion.
CLF has urged provincial governments and medical regulatory bodies not to place the burden of ensuring that patients who want MAID get it on individual health care workers or even health care facilities. Alberta has avoided this by establishing a central information and coordination service. By contrast, the policies of the physicians’ colleges of Ontario (CPSO), Nova Scotia (CPSNS) and Saskatchewan (CPSS) currently require a physician to provide “effective referral” if he or she objects to providing what the patient requests.
CPSO’s effective referral policy is currently the subject of a constitutional challenge, which CLF is monitoring closely. Alberta’s policy is an encouraging development and provides an important illustration of how freedom of conscience and religion can be accommodated.