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- Page navigation anchor for Protecting Conscientious Objection Protects Patients and the Medical ProfessionProtecting Conscientious Objection Protects Patients and the Medical Profession
I am writing to respond to Dr. Eric Brown's letter "RE: Doctors don't need to refer for MAiD". It is true, as Dr. Brown states, that "The religious rights of all Canadians are protected, but the right to a particular occupation is not". The intended implication, it seems, is that any conscientious objectors should simply leave the practice of medicine. This is a common argument leveled against conscientious objectors. However, there are several problems with this argument, and I would like to highlight two.
Firstly, it is worth keeping at the forefront of our minds that, as Dr. Kelsall pointed out in her article, any kind of participation in MAiD would have been judged as culpable homicide until 2015. If Dr. Brown's argument is taken to its logical conclusion, what would it mean for the many doctors who entered practice before that time with both a legal and a personal moral responsibility not to intentionally end the lives of their patients? It's certainly not the case that they "knew what they were getting into", and therefore have no excuse for refusing to perform a service that's "part of the job". Instead, it seems as though this line of reasoning would force many competent, compassionate, and well-intentioned physicians out of a profession that they entered in good faith. This is a loss for both patients and the medical profession.
Secondly, I would like to point out that Dr. Brown's...
Show MoreCompeting Interests: None declared. - Page navigation anchor for RE: Physicians are not solely responsible for ensuring access to medical assistance in dyingRE: Physicians are not solely responsible for ensuring access to medical assistance in dying
I am very grateful for the clear thinking of Dr. Kelsall's plain language commentary.
It was only a very short time ago that medical assistance in dying was deemed homicide, for which no one could make a referral!Competing Interests: None declared. - Page navigation anchor for RE: An effective referral is still a referralRE: An effective referral is still a referral
We are writing to respond to Dr. Steven Bodley’s letter: “Just the Facts on Effective Referral.” Since beginning our medical training, we have encountered a variety of viewpoints on the subject of medical assistance in dying (MAiD). While some physicians strongly advocate for increased access to MAiD, many others are not comfortable with the thought of being implicated in, much less performing, this procedure. In our classes, we have been encouraged to make space for the multiple perspectives that exist in our diverse society. We are deeply saddened to see that this inclusivity does not extend to practicing physicians, specifically with respect to the protection of their consciences. The College of Physicians and Surgeons of Ontario’s (CPSO’s) effective referral policy for MAiD does not go far enough in protecting the religious freedom of physicians.
According to the CPSO’s policy (no.4-16) on MAiD, an effective referral is required to be made in “good faith to a non-objecting, available, and accessible physician, nurse practitioner or agency.” While Dr. Bodley insists that “an effective referral is not synonymous with a direct referral,” this does not change the fact that, regardless of the healthcare practitioner or agency to whom a physician is sending a referral, he or she is still doing exactly that. It is unfortunate that the CPSO does not acknowledge that the provision of an “indirect” referral still renders the referring physician complicit. Most, if not a...
Show MoreCompeting Interests: None declared. - Page navigation anchor for RE: Just the Facts on Effective ReferralRE: Just the Facts on Effective Referral
We are writing to respond to the CMAJ editorial Physicians are not solely responsible for ensuring access to medical assistance in dying, by Dr. Diane Kelsall.
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The College of Physicians and Surgeons of Ontario (CPSO) was at the forefront of policy development as the MAiD legislation was coming into force, providing much needed guidance to the profession on this important issue after consulting broadly with the public and the profession.
Dr. Kelsall has mischaracterized various aspects of the MAiD discussion, especially as it pertains to the effective referral provision of our Medical Assistance in Dying (MAiD) policy for doctors who object to MAiD on religious or other grounds, and the issue of what constitutes “complicity” when objecting doctors encounter grievously ill patients seeking help to end their lives. (Our effective referral provision is also captured, as the editorial notes, in our Professional Obligations and Human Rights policy.)
An effective referral is not synonymous with a direct referral, and there are a number of ways that objecting physicians could discharge their effective referral obligations without relying on a direct referral, as we have made quite clear in our MAiD policy’s accompanying fact sheet. Examples of these include (but are not limited to): objecting physicians can make the referral themselves or delegate the task to a staff member or colleague; the physician or a designate can connect the patient with an agency charged...Competing Interests: None declared. - Page navigation anchor for Semantics and medical assistance in dyingSemantics and medical assistance in dying
This is an article by the chief editor of the CMAJ. The language used, even if it is prefaced by "to be blunt," is out of place. To say: "This is not mere semantics — to be blunt, the physician must ask another health care provider to consider killing their patient," is inflammatory language and should not be coming out of the pen of a chief editor of any responsible publication. We all know what is happening, but spare us the crude language. The conscientious objectors are the ones using semantics if they try to say that referral to “Dr. MAiD assessor at such a phone number” is different from referral to “a care coordinating centre at such a phone number.”
Competing Interests: None declared. - Page navigation anchor for The buck must stop somewhereThe buck must stop somewhere
Dr. Kelsall's commentary on the recent Ontario court decision upholding the requirement for "effective referral" seems to mischaracterize the specifics of what the College of Physicians and Surgeons of Ontario (CPSO) requires of its members with regard to ensuring access to MAID and other contentious medical treatments. Specifically, she mentions the requirement to "refer patients requesting MAiD directly" to a non-objecting party. The CPSO has explicitly and repeatedly made clear that there is no requirement for an objecting physician to make a "direct referral" or a "formal referral." Instead, the College states that "a physician makes an effective referral when he or she takes positive action
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to ensure the patient is connected in a timely manner to another physician, health care provider, or agency who is non-objecting, accessible and available to the patient." (https://www.cpso.on.ca/CPSO/media/documents/Policies/Policy-Items/PAD-Ef...) This could include providing contact information for the patient to self-refer to the provincial Care Coordination Service or a non-objecting physician. Alternatively, a physician can designate someone else to provide the patient with this information, or ask a colleague to take over care of the patient. This is a far cry from requiring that "the physician...Competing Interests: I am a member of the Physicians' Advisory Council of Dying with Dignity Canada, and a member of the Canadian Association of MAID Assessors and Providers. - Page navigation anchor for RE: Maid referralRE: Maid referral
Excellent article. It seems to me that the Ontario College is trying to bully and force physicians to endorse an ideology with the threat of job loss, and masquerading it as a patient access issue.
There is no evidence in Ontario (or any other province without this restrictive policy) that access to MAID would or has been curtailed without an effective referral policy. It is simply unnecessary. There are many other ways that access to MAID can be ensured without forcing physicians to choose between their calling and their conscience.
Dr Paul GalessiereCompeting Interests: None declared. - Page navigation anchor for RE: Doctors don't need to refer for MAiDRE: Doctors don't need to refer for MAiD
The title given in the email list of contents for this issue is misleading. Doctors, at least in Ontario, do need to refer for MAiD, so, as the article notes, says the Superior Court.
The religious rights of all Canadians are protected, but the right to a particular occupation is not. If one's religious beliefs are incompatible with facilitating patients accessing any legal service that is compatible with their beliefs, than one has the option of choosing a different occupation.
I cannot imagine why one would find giving the patient information about MAiD and the phone number of the coordination service acceptable when providing a referral is not. I disagree with you, this is semantics.Competing Interests: None declared.