Response to the College of Physicians and Surgeons of Ontario Consultation on Interim Guidance on Physician-Assisted Death

13 January 2016

The Evangelical Fellowship of Canada (EFC) was an intervener before the Supreme Court in Carter v. Canada. The EFC has been involved in discussions on euthanasia and assisted suicide for decades. We are a national association of evangelical Christians, with affiliates including 42 denominations, 65 ministry organizations, 38 educational institutions and more than 700 individual congregations.

The CPSO Interim Guidance on Physician-Assisted Death specifies that physicians who decline to participate in physician-assisted death for reasons of conscience or religion must provide a referral. However, this requirement to refer violates the Charter right of freedom of conscience and religion of conscientiously-objecting physicians.

In the Carter decision, the Supreme Court did not establish a positive right to assisted suicide. The Court found that a patient who fits the circumstances has a “right” to be free of the state prohibition against assisted suicide and request assistance. The focus of the Court was on patient autonomy and the freedom to request, and not on the provision of assisted suicide. The implication of the ruling is that a willing physician who freely assists them in their suicide would also be free from the prohibition. The Court did envision a “carefully designed and monitored system of safeguards” (par. 117). However, the Court was explicit that its ruling is confined to the right (freedom) of someone to seek assistance, and not to those who might provide assistance (par. 69).

In the headnote to the Carter decision, the Court said, “Nothing in this declaration would compel physicians to provide assistance in dying.” A person in certain circumstances has the freedom to request assisted suicide. The Court did not rule that the patient has a right to access state assistance or compel anyone to assist them in their suicide. In this regard, there is no “right” to assistance, and no one, neither physicians nor institutions, should be required to participate. The State is also therefore not required to provide or fund access to assisted suicide.

Physicians must have the right to refuse to participate in physician-assisted suicide for reasons of conscience, either directly or indirectly, including the right not to have to provide a referral. Providing a referral facilitates the treatment that follows. It is in effect a professional recommendation for a course of treatment. In the case of physician-assisted suicide or euthanasia, it is a form of participation in an action that is destructive to the patient. It is recommending, and participating, in an action that is contrary to the physician’s conscience. Most physicians who attend churches affiliated with the EFC consider participation in assisted suicide or euthanasia an offence against God’s commandments. If this policy is passed they will face the grim choice between following deeply-held religious beliefs or being disciplined by their professional body. It will mean that evangelical physicians may have to alter their practices or leave direct patient care. If this were to happen it would amount to a prima facie case of discrimination against a class of persons because of their religious beliefs and moral convictions.

The Court’s statement, “The Charter rights of patients and physicians will need to be reconciled in any legislative and regulatory response to this judgment” immediately follows the assertion, quoted above, that “Nothing in this declaration would compel physicians to provide assistance in dying.” These statements taken together indicate a need to reconcile the rights of patients and physicians without compelling objecting physicians to provide assistance, direct or indirect.

We urge the CPSO to remove the requirement to refer from its Interim Guidance, and to seek a  policy that would respect the conscience rights of its members.

Bruce J. Clemenger, President,
The Evangelical Fellowship of Canada