Submission to the Standing Committee on Finance and Economic
Affairs regarding Bill 84, Medical Assistance in Dying Statute Law
Amendment Act, 2017.
College of Physicians and Surgeons of Ontario
March 30, 2017
March 30, 2017
Mr. Eric Rennie
Clerk of the Standing Committee on Finance and Economic Affairs
99 Wellesley Street West, Room 1405
Whitney Block, Queen’s Park
M7A 1A2
To the Members of the Standing Committee on Finance and Economic Affairs:
We write in response to Bill 84: Medical Assistance in Dying Statute Law Amendment Act, 2017.
The College of Physicians and Surgeons of Ontario (the College) appreciates the opportunity to offer written
comments on Bill 84.
The College regulates the province’s medical profession and has a legal mandate to serve and protect the
public interest. All of our work, including that on medical assistance in dying (MAID), is undertaken with a
view toward fulfilling our mandate. In keeping with our mandate, the College supports patient access to care
and respect for patient autonomy.
The College issues certificates of registration to allow doctors to practise medicine; monitors and maintains
standards of practice through assessment; investigates complaints against doctors on behalf of the public;
and disciplines doctors who have committed an act of professional misconduct or who are incompetent. The
College articulates expectations for physician conduct on professionalism, medico-legal and other issues that
are relevant to the practice of medicine through the Practice Guide and over fifty College policies including
Consent to Treatment, Prescribing Drugs, Professional Obligations and Human Rights, and Medical Assistance
in Dying.
The College strongly supports Bill 84. The Bill aligns with federal legislation on MAID and also provides
important clarity and protections on a range of issues that fall under provincial legislation. It demonstrates
respect for patient autonomy and access to care, two goals which have underpinned the College’s work on
MAID, and indeed underpin all of the College’s activities as a regulatory authority.
We note in particular, and with support that the Bill ensures that patients’ benefits and claims are not
withheld should they proceed with MAID. Doing so ensures respect for patient autonomy and prevents
patients from being placed in the position of having to choose between accessing a legally available care
option, such as MAID and obtaining the benefits and claims to which they are entitled.
We further note with support the fact that the Bill clarifies the Coroner’s role and involvement in relation to
MAID. This is an important aspect of Bill 84. It provides important clarifications for patients who may
consider exploring MAID and for clinicians in terms of the role and involvement of the Coroner.
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Since the Supreme Court of Canada’s decision in the case Carter vs. Canada, the College has been actively
engaged in the issue of MAID. The College has provided guidance to physicians and support to patients
through the development of a Medical Assistance in Dying policy, Frequently Asked Questions, a Fact Sheet:
Ensuring Access to Care: Effective Referral, and a document developed specifically for the public: Medical
Assistance in Dying Policy: 10 Things The Patient Should Know.
The College’s Medical Assistance in Dying policy sets out the legal and professional obligations that
physicians have with respect to MAID. The policy includes a Process Map that sets out the steps involved in
managing a request for MAID and is consistent with the federal law, specifically the safeguards set out in
federal law. It also includes direction on record keeping, informed consent and conscientious objection.
With respect to conscientious objections, the policy indicates that objecting physicians are not required to
provide medical assistance in dying. As indicated in Step 1 of the Process Map contained in the Policy,
objecting physicians are also not required to assess whether a patient is eligible for medical assistance in
dying.
Where a physician declines to provide medical assistance in dying for reasons of conscience or religion, the
Policy requires that an effective referral must be provided to the patient in a timely manner. An effective
referral means a referral made in good faith, to a non-objecting, available, and accessible physician, nurse
practitioner or agency.
An effective referral does not guarantee a patient will receive a treatment, or signal that the objecting
physician endorses or supports the treatment. It ensures access to care and demonstrates respect for patient
autonomy. Physicians can make the referral themselves or they can assign the task to a designate.
In its public communications to the public and the profession, the College has provided examples of a variety
of scenarios that would satisfy the requirement for an effective referral. For example:
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The physician or designate contacts a non-objecting physician or non-objecting healthcare
professional and arranges for the patient to see that physician/professional.
The physician or designate connects the patient with an agency charged with facilitating referrals for
the healthcare service, and arranges for the patient to be seen at that agency.
A practice group in a hospital, clinic or family practice model identifies a point person who will
facilitate referrals or who will provide the healthcare to the patient. The objecting physician or their
designate connects the patient with that point person.
More information on what constitutes an effective referral can be found in the College Fact Sheet.
This Committee has heard testimony that in requiring an ‘effective referral’, the College stands alone,
and that its expectations of physicians are out of line with those of other jurisdictions. This is inaccurate.
Many health regulators in Ontario and in other provinces have the same or similar requirements. For
instance:
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In Quebec objecting physicians are required by legislation and regulation, as well as by the
Collège des médecins du Québec, to help patients find another physician; in the case of MAID
they may do so by connecting patients with a referral agency;
The Nova Scotia College of Physicians and Surgeons requires physicians who are unable or
unwilling to participate in MAID to complete an “effective transfer of care” for MAID, while
continuing to provide care unrelated to MAID;
The Colleges of Pharmacists in Ontario, Saskatchewan and Nova Scotia require their members
who have conscientious objections to participating in MAID to make an ‘effective referral’;
The College of Nurses of Ontario requires nurses with conscientious objections to transfer the
care of a client to another nurse or health care provider who can address the client’s needs;
The Saskatchewan Registered Nurses Association, the regulatory body for nurses in
Saskatchewan, requires nurse practitioners who are unable to provide or assist with a medicallyassisted death to provide a referral to a medical or nurse practitioner or a designated contact
person.
The College strongly supports the passage of Bill 84: Medical Assistance in Dying Statute Law Amendment,
2017. We appreciate the opportunity to share with the Committee, our views on Bill 84 and further
information about the College’s expectations in regards to medical assistance in dying.
Yours truly,
David Rouselle MD FRCSC
President
Rocco Gerace MD
Registrar
Attachments:
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Medical Assistance in Dying Policy
Frequently Asked Questions
Fact Sheet: Ensuring Access to Care: Effective Referral
Medical Assistance in Dying: 10 Things The Patient Should Know
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