5.3.1 Conscientious Objection to Medical Assistance in Dying (MAiD)
Angel Petropanagos, Ph.D.
- Describe the Canadian laws and professional guidelines regarding refusals to participate in the provision of medical assistance in dying (MAiD)
- Describe the rights and obligations of physicians who conscientiously object to MAiD
- Describe the nature of conscience and of a refusal grounded on conscience
- Consider personal, professional, and social values that may inform beliefs surrounding MAiD
Sam, a 62-year-old man, was diagnosed with Amyotrophic Lateral Sclerosis (ALS) three and half years ago. He is wheelchair bound and receives four hours of homecare support. He recently relinquished his driver’s license after he began having difficulties breathing and performing some of the basic activities of daily living, including dressing, toileting, and showering. He was prescribed medication for pain management. Sam lives in a rural community and has no family and few friends. He has asked his neurologist, Dr. H. (who has been the only physician involved in his care since his family doctor retired) about whether he can access MAiD. Sam knows that as his illness progresses he will eventually lose the ability to speak and communicate. The thought of this terrifies Sam. He tells Dr. H. that he is ready to die. Dr. H. tells Sam that he does not believe that he has reached the stage where MAiD is a reasonable option and that in addition, he cannot participate in a process leading to ‘premature death’ as a matter of personal conscience. He claims that causing a patient’s ‘premature death’ is morally wrong. Further, Dr. H. tells Sam that he also works at a hospital that objects to MAiD on religious grounds and will not provide this service to patients. He tells Sam that he will continue to provide him with more pain medication, additional home care, or other supportive care options Dr. H. tells Sam that he is willing to send him to a different physician if he wants to be assessed for MAiD, but Sam declines because he feels ashamed for having asked Dr. H. about MAiD. Sam worries that this conversation may have damaged his relationship with his neurologist and Sam is unsure if he will continue to receive good medical care. Sam does not speak to any other healthcare professionals about his wish to die, although his desire to access MAiD persists. Four months after speaking with Dr. H., Sam lost the ability to speak, his breathing became much more difficult, and he experienced frequent aspiration. He no longer has the ability to communicate. He was recently admitted to a palliative care unit, where he continues to reside.
- How might we understand Dr. H.’s refusal to participate in MAiD?
- What are the ethical considerations that support conscientious objection in healthcare?
- What are the ethical concerns about conscientious objection in healthcare?
- Which Canadian laws and guidelines are relevant to conscientious objection to medical assistance in dying?
- Did Dr. H. fulfil his legal or professional obligations towards Sam?
- How should Dr. H. have managed his conscientious objection to medical assistance in dying?
- An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying) (formerly Bill C-14), 1st Sess, 42nd Leg, Canada, 2016 (assented to June 17, 2016).
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- Canadian Charter of Rights and Freedoms, Part I of the Constitution Act, 1982, being Schedule B to the Canada Act 1982 (UK), 1982, c 11.
- Canadian Medical Association, (October 2015) Principles-based Recommendations for a Canadian Approach to Assisted Dying.
- Carter v. Canada (Attorney General). 2012 BCSC 886 (CanLII).
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