The legislation regarding medical aid in dying (Bill C-14) was introduced by the federal government this week and to no one’s surprise has caused outrage from both those who support and those who oppose physician-assisted dying. One particular article from the Ottawa Citizen about the Catholic Health Alliance of Canada’s concern that the legislation didn’t do enough to specifically protect conscientious objectors is particularly galling. This group reiterates their belief that “referring someone who would assist in death would make them complicit” and argues that doctors should in no way be forced to refer patients on. I have stated my beliefs before that doctors refusing to even make a referral is a selfish act placing physicians own beliefs ahead of the real needs of sick and vulnerable patients. But this article got me to thinking about how a conversation would go between a dying patient and a physician that the Catholic Health Alliance is trying to protect.
Patient: Doctor, you have taken care of me for the last six years; I’m suffering from intractable pain and you just told me I only have a few weeks left to live. I would like to talk about medical aid in dying that I heard was just legalized.
Doctor: Sorry I can’t help you.
Patient: But it is legal now, right? I meet all the criteria for getting a prescription to allow myself to peacefully pass away and end my suffering.
Doctor: You do, but I’m sorry I disagree with the whole concept of a physician assisted death.
Patient: Ok then, can you help me find another doctor who could discuss it with me?
Doctor: No I can’t do that either.
Patient: Why not?
Doctor: Referring you to someone else would be just as bad as me writing the prescription myself. And my conscience won’t allow me to do that.
Patient: But you get paid in essence by the government don’t you? And the government made this a legal medical treatment?
Doctor: Yes, but I have the right to refuse to help you based on my own beliefs.
Patient: Can I please talk to another doctor about this?
Doctor: Go ahead.
Patient: Who would that be?
Doctor: I am not at liberty to say.
Patient: Is there an agency or service you can point me to?
Doctor: Sorry, I can’t.
Luckily, it sounds like a centralized database of physicians willing to provide medical aid in dying will be created in Canada to connect patients who are abandoned by their physicians. I would hope all doctors would be reasonable enough to at the least provide a phone number or website where patients could achieve timely access to a willing provider. The medical community is moving more and more towards patient-centered care; legislation that specifically allows doctors to refuse to refer patients for any medical intervention including medical aid in dying would be an unfortunate setback.