I appreciate the CPSA Council’s work in guiding our profession, and have read the proposed changes to the Conscientious Objection Standard of Practice. The introduction of an “effective referral” is not acceptable to many physicians. For many an “effective referral” is seen as contrary to their conscience, cultural beliefs and/or religious traditions. I worry that the suggested change may cause many physicians to experience moral distress if they are trying to practice according to their personal convictions, yet are being compelled to do otherwise by CPSA Standards. I suspect that if the proposed change is approved, it will cause some physicians to retire early, change their scope of practice, or move to another jurisdiction to work. Given the current crisis in our healthcare system, I don’t think the proposed change is prudent. In addition I think our current system and standards does an excellent job in finding the balance between providing patient access to particular services and allowing a physician to practice according to their beliefs. It is also hard to interpret how the proposed changes of “effective referral” would apply in cases of MAiD. The MAiD Standards of practice already specify what is required of a physician when a patient requests MAiD, and I have difficulty reconciling the proposed changes in this document with the MAiD standards of practice. I would suggest that Section 1.f. be reworded to remove the term “effective referral”. Thank you for your time in reviewing this feedback, and I appreciate your thoughtful reflection moving forward.