Mark Sandercock, PhD

While patient rights may be important, it is not the only consideration because both patient and doctor are independent moral agents who must act together to bring about the patient’s death, even if the only involvement from the primary care physician is to refer to patient to a doctor willing to prescribe MAiD. The right to self-determination—to end his life by his own choice —that is claimed by the patient goes beyond what he does to his own body. The assertion of his right not only involves many other people, including doctors, nurses, other hospital staff, relatives, friends and others in the wider community, but also his singular action negatively affects many other people. In granting the right to MAiD, society as a whole allows one person to exert control over and supersede the acts and consciences of other autonomous individuals, and dissenting physicians in particular. Therefore, even if a society places a high value on personal rights, it must still balance the patient’s right to determine how he will die with the physician’s equal right to not assist in the patient’s death in any way and so reject the patient’s request for a referral because the physician has an equal right to refuse to be involved in the act. Within the context of the Conscientious Objection standard put forward by the CPSA, participation through an “effective referral” must directly involve physicians in MAiD, even if the physician objects because the doctor truly believes that euthanasia is not in the patient’s best interests. It would be far better to allow the physician to provide the patient with the online resources that would allow the patient to select a physician whose values align with his/her own and so pursue MAiD and thereby entirely remove the physician who conscientiously objects from involvement in a referral. Finally, from a legal standpoint, it has been argued that the right to conscience must be upheld in all situations. Violation of a person’s conscience is irreversible; once violated, a conscience cannot simply be restored. As law professor Lynne Wardle (2010: 7) writes, there is a “big difference whether the protection of rights of conscience is a matter of toleration, to be suspended or superseded when political or other circumstances warrant, or whether it is a fundamental, inalienable human right.” It is crucial to understand this difference because the implications are enormous: “if you demand that a man betray his conscience, you have eliminated the only moral basis for his fidelity to the rule of law, and have destroyed the moral foundation for democracy” (Wardle, 2010: 8). Violating a physician's conscience through enforcement of an "effective referral" standard will erode public trust in the health care system. Thus, the right to conscience should be firmly established and upheld for all people in general, and in the case of MAiD, for physicians and other health care workers in particular. Reference: Wardle, L. Protection of health-care providers’ rights of conscience in American law: present, past, and future. Ave Maria Law Review, 2010; 9 (1): 1–46.

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