Groups representing more than 4,700 Christian doctors across the country have launched a court challenge to Ontario regulations that require them to refer patients to physicians willing to provide an assisted death, arguing the referrals are morally equivalent to participating in the procedure.
The College of Physicians and Surgeons of Ontario, however, takes issue with the faith groups' position. "An effective referral does not foreshadow or guarantee an outcome," college spokeswoman Tracey Sobers said in an e-mail.
Ewan Goligher, a doctor who works in the intensive care unit at Mount Sinai Hospital in Toronto, said he considers himself a conscientious objector to doctor-assisted dying and supports the court challenge. "I think the patient is of greater value than their preference, and I cannot lift my hand to destroy that which is of fundamental value," he said in an interview.
The new federal law legalizing assisted death says in its preamble that doctors have a right to freedom of conscience, and notes that they are not required to perform or assist in the provision of an assisted death.
But Ontario's regulations spell out that doctors must perform an "effective referral."
"A physician makes an effective referral when he or she takes positive action to ensure the patient is connected in a timely manner to another physician, health-care provider, or agency who is non-objecting, accessible and available to the patient," a fact sheet on the college's website explains.
Several faith groups say the referral policy violates the freedom of conscience and religion protected in Section 2 of Canada's Charter of Rights and Freedoms. They are seeking a judicial review in Ontario Divisional Court, a process that is faster than a typical court challenge and could mean a court date by next February. They may ask for an even faster process, by requesting that one judge rather than three hear the case – which could mean a hearing as early as the fall, according to their lawyer, Albertos Polizogopoulos of Ottawa.
The faith groups are the Christian Medical and Dental Society of Canada, the Canadian Federation of Catholic Physicians' Societies, Canadian Physicians for Life and several individual physicians.
"Our position is doctors who opposed assisted suicide or physician-assisted death are put in a position now where they either need to violate their conscience and their religious and moral belief or face being disciplined by the college – and that's not a good place to be," Mr. Polizogopoulos said.
Similar concerns have been raised in Saskatchewan and Quebec.
He said other provinces are not requiring doctors to refer patients to willing doctors, citing Alberta, which has set up a centre to co-ordinate requests and referrals. The faith groups do not object to referring patients to the centre.
From a constitutional standpoint, Ontario needs to show that its policy is a minimal limit on conscience rights, Mr. Polizogopoulos said, adding that it won't be able to do that because other provinces found less restrictive ways to achieve the same goal of patient access.
The college, however, says that its policy seeks to reconcile conscience rights and patient access to care, while also taking into account physicians' professional obligations to their patients. "Physicians must not abandon their patients or impede access to care," Ms. Sobers said. "It is uncertain which physicians may be willing to provide physician-assisted death, and that therefore patients wishing to pursue this option will need assistance to find a physician who is prepared to be involved."
Dr. Goligher said if someone asks him about an assisted death, which has already occurred twice this month, "that indicates someone is suffering profoundly, and the underlying issues need to be explored and treated."
He said when assisted death was illegal, if he had knowingly referred a patient to someone willing to help an individual die, he could have been held legally accountable. "That's not just true about euthanasia. It's true about any issue in medicine. If I knowingly refer my patient to anyone who does things that are unethical, I need to be held to account."
Bruce Ryder, a constitutional specialist at Osgoode Hall Law School in Toronto, said the best way to protect patients' and physicians' rights is for governments or medical associations to maintain an online registry of physicians willing to provide medical assistance in dying. "Requiring objecting physicians to inform patients of the existence of such a registry would be a minimal impairment of their conscience rights and would ensure patients receive timely access," he said.