The Christian Medical and Dental Association is made up of over 1,600 Christian doctors from across Canada. We have almost 300 members in Alberta. For the past eight years, our members have been very concerned about their ability to continue to practice due to the introduction of Medical Assistance in Dying (MAiD) in Canada. The introduction of the term “effective referral”, first in Ontario and now in the Model Practice Standard, has been very problematic for physicians. For Catholics, Orthodox Jews, and Evangelicals, the provision of a formal referral is morally equivalent to actually performing the act of euthanasia itself. This concern has been shared by doctors of other faiths, those with no particular faith who practice Hippocratic medicine, or simply oppose MAiD from a humanist perspective. It has led to early retirements, changes in practice focus, and moves to other provinces. As you can well imagine our doctors have concerns about reconciling MAiD with their ethical and moral responsibilities to their patients. The problems with MAiD have become apparent over time – including the controversial rapid expansion to include patients with disabilities who are not in danger of death and the planned expansion to patients whose only presenting illness is mental health related. There have been documented cases across Canada where patients have chosen MAiD because of lack of services and support. Our members want to be able to counsel patients who are suffering and advocate for them to receive the best care to relieve that suffering. We are very concerned about vulnerable patients who may “fall through the cracks” in our current system and end up choosing MAiD because they feel they have no other options. While our members cannot in good conscience provide an “effective referral”, they can direct patients to a resource with accurate information about all available medical options in response to a patient request. We do so based on the obligations required by the College. We do this reluctantly, but objectively as a professional requirement. We are asking the Alberta College not to use the term “effective referral” in your revisions of your policy on Conscientious Objection, for the following reasons: 1. Ontario’s position has been further developed and elaborated upon. While we are still disappointed by the use of “effective referral” in their policy, we were pleased when the Ontario College revised its Advice to the Profession: Human Rights in the Provision of Health Services earlier this year to allow members to simply provide the patient with contact information for a non-objecting, available, and accessible physician, other health-care professional, or agency in certain circumstances. 2. Other key provinces are not using the term “effective referral”, including BC, SK, MB, and NL. We are waiting for updated policies from NB, PEI, and NS. By not using the term “effective referral”, these policies open the door to the patient gaining access without it causing moral distress or moral injury to the physician. 3. The term “effective referral” will be misunderstood in medical education and in medicine generally as a formal referral. This will result in a lack of respect for human rights and diversity when physicians are judged to be shirking their responsibility by colleagues when they do not provide a formal referral. It will also serve to deter people who could be accepted to medical school from ever applying because they feel they will be forced to act against their moral and ethical compass. 4. The ethics of MAiD have not been decided. Justice Lynn Smith in the very first Carter decision said that there was no medical consensus on the ethics of MAiD in Canada. While it is legal, there is no consensus whether it is ethical across the board or in particular cases. How can the regulator require a referral to a service that many members consider unethical? Concerning the obligation to provide information as detailed in the policy at 1.b., we are seeking clarification as to whether there is an expectation that information be proactively provided about controversial procedures prior to a patient request. We are concerned that providing information to a patient regarding abortion or MAiD without a precipitating patient concern or inquiry may alarm the patient or unduly influence their decision-making. This is of particular concern if the proposed expansion of MAiD for patients whose primary condition is mental illness is implemented, as the obligation to provide information will interfere with the normal practice of psychiatry for patients experiencing suicidal ideation. We have provided a more detailed submission via email.