Webcast archive: Conscience rights in Ontario

This week, we’re looking at Ontario doctors’ fight to act according to their conscience and avoid providing euthanasia.

In this episode of Euthanasia & Disability, Amy Hasbrouck and Christian Debray discuss:

  • Ontario doctors fight for conscience rights
  • FAQ: Safeguards Fail – Assisted suicide must be prescribed by a physician

Please note that this text is only a script and that our webcast contains additional commentary.


  • Doctors in Ontario are battling a policy of the College of Physicians and Surgeons of Ontario (CPSO) that requires them to make an “effective referral” for medical assistance in dying (MAID).
  • The policy, issued last June, states that doctors must comply with the “expectations” of the college, including:
    • In order to uphold patient autonomy and facilitate the decision-making process, physicians must provide the patient with information about all options for care that may be available or appropriate to meet the patient’s clinical needs, concerns, and/or wishes.  Physicians must not withhold information about the existence of any procedure or treatment because it conflicts with their conscience or religious beliefs.
    • Where a physician declines to provide medical assistance in dying for reasons of conscience or religion, the physician must not abandon the patient. An effective referral must be provided. 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.
  • This would seem to contradict the section of the federal law that states: “nothing in this section compels an individual to provide or assist in providing medical assistance in dying.”
  • The policy of the CPSO argues that referrals do not count as “assisting.” It states “For clarity, the College does not consider providing the patient with an ‘effective referral’ as ‘assisting’ in providing medical assistance in dying.”
  • The Ontario Medical Association has gone on record in support of doctors’ conscience rights, thus pitting them against their usual allies in the CPSO.
  • Five individual doctors and several religious groups have filed a lawsuit against the CPSO.  The Attorney General of Ontario joined the suit on the side of the College of physicians.
  • In the meantime, advocacy groups such as the Coalition for Conscience in HealthCARE have been pushing to amend Ontario’s bill 84, that was introduced in December to bring the province’s laws in line with the federal assisted dying legislation.  Their campaign resulted in 22,000 emails being sent to legislators in support of an amendment that would overrule the CPSO policy.
  • Several doctors testified at a hearing of the Ontario legislature’s Finance and Economic Affairs Committee on March 23 asking the committee to amend the bill.  They emphasized that providing referrals for MAID was tantamount to “recommending” the procedure, or “hiring a hit man.”  One doctor spoke of intimidation and bullying in the hospital where she worked, and many spoke of the coercive effect of the CPSO policy.
  • Many who testified suggested a third-party care coordination system, such as the Alberta Health Service’s Medical Assistance in Dying Care and Coordination Service.  This is an online resource that answers questions and provides information about assisted suicide and euthanasia, and directs people to palliative care and end-of-life services.
  • Though the Ontario Health Minister, Dr. Eric Hoskins, has promised that Ontario will set up a similar service in the province, he has not agreed to rescind the CPSO policy.


  • There’s no requirement that the person have a long-term relationship with the doctor.  Many people don’t have family doctors.
  • If one doctor says ‘no,’ to a request for euthanasia or assisted suicide, the person or their family can look for another doctor until they find one who will say ‘yes.’  This is called “doctor shopping.”
  • Family doctors are not trained to detect mental illness or cognitive problems that could interfere with a free and informed choice.
  • Most doctors have little if any training in pain management or palliative care, nor are they aware of support services that can enable someone to live in the community.
  • Doctors may not know enough about the person’s relationships or living situation to detect coercion or abuse.
  • Doctors face pressure to cut costs.  Assisted suicide is generally cheaper than continued care.
  • Studies show that a large majority of medical professionals under-estimate the quality of life of people with disabilities.  With such biases and pressures, how could a doctor make an appropriate judgment?