CCBI News – Psychiatrists and Euthanasia for Mental Illness; Effective Referral—CPSO—CCBI Response: Conflict with Conscience/Religious Beliefs

December 2, 2022

Dear Friends of CCBI,

Psychiatrists and Euthanasia for Mental Illness

An important piece of news this week is that senior psychiatrists have told the government that it should delay allowing euthanasia (MAiD) for people with mental illnesses. CCBI has been reporting on this move in 2021 amending the law passed in 2016 and extending euthanasia to cases of mental illness. That change was scheduled to be implemented in March 2023, allowing for study and hearings by a special committee formed to devise safeguards for the procedure. The committee heard from many groups and individuals both for and against the extension, either by mail (e.g., by CCBI) or at hearings, if fortunate enough to be scheduled. While it was important and necessary to register those views, nothing seemed to have had much public impact until the publication of a declaration by psychiatrists on December 1, 2022.

CTV News relates: “The Association of Chairs of Psychiatry in Canada, which includes heads of psychiatry departments at all 17 medical schools, issued a statement Thursday calling for a delay to the change set to be implemented in mid-March.”

Note that this powerful Association is not against euthanasia but is rightly pointing out further dangers inherent in the legislation permitting the procedure for people with certain forms of mental illness. The statement refers to public concern about suicide, in turn frequently associated with mental illness and self-harm, and to society’s efforts to prevent it. It is puzzling that, at the same time, society would condone assisted death for people suffering from similar mental illnesses. What is the distinction between suicide / assisted suicide? Why prevent one and allow the other? How will mental illnesses be assessed? What are the criteria? In fact, the Association raises the same points that many other groups have already raised (CCBI, among others) but in all likelihood a professional, medical body may have more power and influence. We shall see….

After all, psychiatrists will be responsible for assessment of applicants for the procedure, and we should pay attention when they warn society of foreseeable problems in their task.  For one thing, they question the concept of ‘irremediability.’ The medical profession knows only too well how difficult it is in many cases to be reasonably certain that a patient will never be able to recover. Deciding on an application for MAiD for a person with mental illness, even if the doctor agrees with euthanasia in principle, is fraught with danger, most obviously for the person about to end his or her life but also for doctors and psychiatrists who express doubts about cooperating in termination of life as an ‘answer’ to a psychiatric problem. Euthanasia is not treatment, which doctors are trained to give and where their professionalism truly lies.

This matter is far from being resolved and it will be interesting to see Parliament’s next steps. We hope they listen and prohibit euthanasia, if not completely, then in these types of cases. That would be a small step towards justice for the mentally ill.

Effective Referral / College of Physicians and Surgeons of Ontario

Over the years, the College of Physicians and Surgeons of Ontario (CSPO) has steadily extended its demands and broadened its definition of ‘effective referrals.’ A recent public consultation, if implemented, will cause further concern and distress for those who object to abortion and euthanasia and whose conscience does not allow them to refer a patient to another doctor who may be willing to perform such procedures.

“We, the people,” the general public, are often unaware of these manoeuvres, therefore we are including this lengthy section from the College’s “Advice to the Profession” to illustrate its approach and to inform people about impositions being made, or that will be made, on all physicians, including conscientious objectors:

Effective Referral: taking positive action to ensure the patient is connected to a non-objecting, available, and accessible physician, other health-care professional, or agency. For more information about an effective referral, see the companion Advice to Profession document.

What further action do I need to take if I learn that the patient was not connected?

If physicians learn that their patient was not connected, they are required to take further action to provide an effective referral. In doing so, physicians may need to take a more active step to connect their patient. For example, if the first action they took was to provide the patient with a contact number for a non-objecting, available, and accessible physician, the next action they may need to take is to directly contact another physician health-care professional, or agency on the patient’s behalf and arrange for them to be seen.

Does the expectation to provide patients with an effective referral apply in faith-based hospitals and hospices?

Yes. Physicians are required to comply with the expectations set out in the College’s policy. This means that physicians would be required to provide patients with access to information and care, including an effective referral, for the services, treatments, and procedures that are not provided in the faith-based hospital or hospice.

Can I end the physician-patient relationship because my patient wishes to explore a care option that conflicts with my conscience or religious beliefs?

No. The College’s Ending the Physician-Patient Relationship policy states that physicians must not end the physician-patient relationship solely because the patient wishes to explore a care option that conflicts with the physician’s conscience or religious beliefs.

I am a primary care provider and my patient is exploring a health service that conflicts with my conscience or religious beliefs. Do I have to continue managing the other elements of their care?

Yes. As noted above, you cannot end the physician-patient relationship solely because the patient is exploring a health service that conflicts with your conscience or religious beliefs. Physicians have an obligation to continue to offer comprehensive and continuous care to meet their patients’ other needs and are required to do so in a manner that does not impose their own religious beliefs on patients.

Can physicians practise in accordance with their conscience or religious beliefs?

Yes. However, physicians’ freedom of conscience and religion must be balanced against patients’ right to access health services. The Canadian Charter of Rights and Freedoms protects the right to freedom of conscience and religion, but this right is not absolute. The right to freedom of conscience and religion can be limited, as necessary, to protect public safety, order, health, morals, or the fundamental rights and freedoms of others. The balancing of rights must be done in context. In relation to freedom of religion specifically, courts will consider the degree to which the act in question interferes with a sincerely held religious belief and will seek to determine whether the act interferes with the religious belief in a manner that is more than trivial or insubstantial. The less direct the impact on a religious belief, the less likely courts are to find that freedom of religion is infringed. Conduct that would potentially cause harm to and interfere with the rights of others would not automatically be protected. The Court of Appeal for Ontario has confirmed that where an irreconcilable conflict arises between a physician’s interest and a patient’s interest, physicians’ professional obligations and fiduciary duty require that the interest of the patient prevails.

If any of these points strike you as unethical, then please take the time to email, write or call the College to express your thoughts. The College represents the public interest as well as being responsible for regulating its members, and please find its contact information below in the reference section. Meantime, please see CCBI’s comments.

CCBI’s Response, sent to the CPSO

On behalf of the Canadian Catholic Bioethics Institute and its followers, we wish to raise points of concern about effective referrals for physicians who, for reasons of moral principle, often confirmed by their faith, are opposed to MAiD procedures. They, therefore, for the same reasons, will not and should not make effective referrals within the parameters defined in the latest College consultations on ‘Human Rights in the Provision of Health Services and MAiD,’ which oblige them not only to make a referral but also to follow up with patients to check whether their applications for MAiD are proceeding, and if not, must help that to happen.

These are surely unreasonable demands to make on conscientious objectors, and, if adopted by the CPSO, might result in Charter challenges. Freedom of conscience, while not an absolute right in Canadian Law, is established as a Charter right to protect everyone’s right of conscience. The conscience rights of physicians and health care professionals, therefore, are every bit as important as those of individuals requesting procedures that deliberately hasten death, and it is unjust that preference should be given to the latter, as detailed in CSPO policies.

Adults are supposed to be capable of full consent in qualifying for these procedures and, therefore, capable of pursuing their wishes through other avenues. There is no need to seek help from those who object to the procedures and who have no desire to cooperate in any action involved in their performance. It could be found discriminatory to compel a body of people to aid others in such situations by limiting that body’s due exercise of freedom of conscience.

Sincerely,
Dr Moira McQueen, LLB, MDiv. PhD
Executive Director
Canadian Catholic Bioethics Institute

CTV News
Experts ask for delay in MAID for those with mental illness | CTV News

College of Physicians and Surgeons of Ontario
For Council (cpso.on.ca)
ADVICE TO THE PROFESSION: 2 HUMAN RIGHTS IN THE PROVISION OF HEALTH SERVICES
CPSO – CPSO’s Effective Referral Requirement Affirmed by Superior Court

Contacts:
College of Physicians and Surgeons of Ontario
80 College Street
Toronto, Ontario  M5G 2E2 

Patient/public general inquiries
416-967-2603
Toll Free: 1-800-268-7096 Ext. 603
Email: feedback@cpso.on.ca

Pope Francis’ Intentions for December

Volunteer Not-for-Profit Organizations
We pray that volunteer non-profit organizations committed to human development find people dedicated to the common good and ceaselessly seek out new paths to international cooperation.

Moira and Bambi