Doctors' duty is to their patients, not their own interests: Ontario Court of Appeal

The Ontario Court of Appeal has unanimously upheld a policy that requires doctors provide an effective referral if they refuse to provide a medically assisted death. The decision builds upon a lower court ruling.

The ruling clearly sets out that religious beliefs cannot be used to deny patients healthcare.

Chief Justice Strathy wrote in his decision that individuals "have no common law, proprietary or constitutional right to practice medicine." Their responsibility is therefore to "the public interest, rather than their interests."

Following the legalization of assisted dying in Canada, the College of Physicians and Surgeons of Ontario adopted a policy requiring all doctors provide an "effective referral" to medical assistance in dying if their conscience or religious beliefs prevent them from providing the service. The policy states that: “An effective referral means a referral made in good faith, to a non-objecting, available, and accessible physician, nurse practitioner or agency. The referral must be made in a timely manner to allow the patient to access medical assistance in dying. Patients must not be exposed to adverse clinical outcomes due to delayed referrals.”

Dying With Dignity Canada intervened in the case and Chief Justice Strathy cited their factum in his reasons:

In resolving the balancing exercise, I find much assistance in the submissions of the intervener, Dying with Dignity Canada, which observes that in balancing the salutary effects of the Policies against the deleterious effects on objecting physicians, it was appropriate for the College and the Divisional Court to conclude that patients should not bear the burden of managing the consequences of physicians’ religious objections. It bears noting that the “compromise” arrived at by the College is not optimal for patients, who must accept being referred for MAiD if their physician objects to the procedure. As Dying with Dignity Canada notes, the burden imposed by the Policies is minimal and is acceptable for some of the appellants and for many other physicians. But, as it said:

"If a doctor is unwilling to take the less onerous step of structuring their practice in a manner that ensures that their personal views do not stand in the way of their patients’ rights to dignity, autonomy, privacy and security of the person, then the more onerous requirement of a transfer into a new specialty is a reasonable burden for that doctor to bear."

Ian Bushfield, Executive Director, BC Humanist Association:

The Ontario College's effective referral rules are among the most patient-centred in Canada. Now that they've been upheld by Ontario's highest court, these should serve as the floor for what Colleges in other provinces, including here in BC, ought to strive for.

The College of Physicians and Surgeons of British Columbia's Practice Standard on Medical Assistance in Dying merely requires that a doctor who objects to MAiD provide information to patients that "other physicians may be available to see them." There is no requirement for positive action, no requirement to connect the patient with a non-objecting physician and no assurance that the patient will not suffer because of a delay.

Read the ruling

Read Dying With Dignity Canada's press release

Photo credit: flickr/Kevin P Siu

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