January 13, 2016

RE: CPSO Interim Guidance on Physician-Assisted Death

The Catholic Civil Rights League (CCRL) is pleased to provide this submission to the College of Physicians and Surgeons of Ontario (CPSO) regarding the draft CPSO Interim Guidance on Physician-Assisted Death document.

The CCRL has strongly opposed all forms of assisted suicide and euthanasia. We agree with the Joint Statement of the Canadian Conference of Catholic Bishops (CCCB) and the Evangelical Fellowship of Canada (EFC) and other religious leaders (October 28, 2015):

The sanctity of human life is a foundational principle of Canadian society. It has both individual and communal import: it undergirds the recognition of the equal dignity of each individual regardless of their abilities or disabilities and shapes and guides our common life together, including our legal, health care and social welfare systems. It engenders the collective promotion of life and the protection of the vulnerable.

While Canadian society continues to affirm the importance of human dignity, there is a worrisome tendency to define this subjectively and emotionally. For us, human dignity is most properly understood as the value of a person’s life before her or his Creator and within a social network of familial and societal relationships. We are convinced the only ways to help people live and die with dignity are: to ensure they are supported by love and care; to provide holistic care which includes pain control as well as psychological, spiritual and emotional support; and, to improve and increase resources in support of palliative and home care.

On the basis of our respective traditions and beliefs, we insist that any action intended to end human life is morally and ethically wrong. Together, we are determined to work to alleviate human suffering in every form but never by intentionally eliminating those who suffer.

Whereas euthanasia and assisted suicide in itself is morally and ethically wrong, compelling another person to be involved in this morally and ethically depraved act is no less wrong.  As interveners in Carter, the CCRL focussed on the impact to health care in general and to the conscience rights of health care workers specifically.  We strongly advocated for a robust understanding and protection of the Charter right of freedom of conscience and religion.

The right to avoid moral complicity in assisted suicide and euthanasia is an essential part of one’s religious and conscientious freedom.

The CPSO’s insistence on compelling Ontario physicians to complete an “effective referral” does nothing to honour the Charter right of freedom of conscience and religion, rather it is a breach of a physician’s rights and a serious incursion into the professional standing of a physician. The League strongly rejected the CPSO’s mandate for an effective referral in January 2015 and earlier in August of 2014, and we maintain our opposition now as it pertains to assisted suicide and euthanasia.

Doctors and other health care professionals, indeed all Canadians, enjoy the Charter right of freedom of conscience and religion.  A proper balancing of the rights of physicians with the concept of patient autonomy must not result in the trumping of the rights of physicians in their medical practices.  Such rights extend not only to refusing to perform assisted suicide and euthanasia, but the right not to be obliged to refer to other practitioners who may be willing to provide such services. This clearly constitutes participation in wrong.  The mandate for an effective referral must be rejected.

Lines 184-189 are wholly unacceptable to the CCRL:

 Where a physician declines to provide physician-assisted death for reasons of conscience or religion, the physician must not abandon the patient. An effective referral to another health-care provider must be provided. An effective referral means a referral made in good faith, to a non-objecting, available, and accessible physician or agency. The referral must be made in a timely manner to allow patients to access care. Patients must not be exposed to adverse clinical outcomes due to a delayed referral.

The CCRL appeals to the CPSO to strike from the interim guidance document the necessity to “provide an effective referral.” The compulsion to make an effective referral is morally unacceptable. Compelling a physician to provide an effective referral to another physician, health-care provider, or third party agency in order to carry out assisted death or euthanasia, procedures to which he or she objects on the grounds of conscience or religion also compels that physician to violate his or her own conscience by being a participant in the very act, the very procedure to which he or she objects in the first place.

Lines 49-50 refer to the CPSO’s “Guiding Principles of Professionalism”:

Communicating sensitively and effectively with patients in a manner that supports their autonomy in decision-making, and ensures they are informed about their medical care.

Echoed in this cited principle is the notion of patient autonomy, which is referred to throughout the document. The CCRL submits that a patient’s autonomy is in no way violated if it is the patient seeking assisted suicide or euthanasia who makes a self-referral to another physician, healthcare professional or third party. There are no grounds for a physician having to do anything other than transferring medical records and releasing the patient. The patient must make the self referral, the physician must not be compelled to make an effective referral and in so doing, severely and irreparably inflicting self-harm through coercion into a grave violation of conscience.

The CCRL submits that physicians must have the right to carry out their duties in line with their consciences. The compulsion to effectively refer violates this right of freedom of conscience and religion and there is no reason to institute the need to provide an effective referral, whether it is on the grounds of patient autonomy, access to care, or on any other grounds.

With this submission, we at the CCRL call upon the CPSO to reject the mandate for effective referrals. The medical profession, as with any grouping of individuals, is not truly free to live and free to grow if its members are not able to govern their actions in accordance with their individual consciences, whether informed by moral and religious beliefs or otherwise.

Canada is a pluralist society, and an authentic pluralism recognizes that there will be differences in the public sphere, and that we live with such differences in a civil society.  The draft CPSO guiding document engages in a trumping exercise, mandating that a patient’s autonomy trumps recognized conscientious and religious rights of physicians.  The demand for acceptance of a regime of effective referral of morally objectionable practices would lead to patients losing trust in the professional status of doctors.

As with any regulatory entity, the CPSO has no business second-guessing the validity of sincerely held religious beliefs, exercised in the course of one’s professional judgment.

There is also the likelihood of numerous physicians opposing the draft guidance document and their refusal to comply, generating unwarranted complaints and possible exits from the jurisdiction.  The extent of potential disruption is unknown, but greater instability would certainly follow in the provision of medical services. Ontario can ill afford such a tearing of the social fabric of our society.

The better alternative is to accept that we are respectful of differences, especially when they concern aspects of one’s moral or religious beliefs, in no way trivial, but rather as the basis of a well-developed civil society.

An example of the exercise of one’s conscience may be found in the history of St. Thomas More, whose example is recognized and promoted by the Roman Catholic Church.  More, the former Lord Chancellor of England, ultimately met his death for failing to sign on to the Oath of Supremacy, which he understood would sever his allegiance with his Church.  Was his objection merely a refusal to sign a piece of paper, or to speak mere words?  St. Thomas More accepted martyrdom.

The prospect of added professional discipline by the CPSO does not make an effective referral more palatable.  We assert that a conscientious doctor, in the exercise of his/her conscience, by refusing to refer for physician assisted suicide or euthanasia, would be acting completely within his/her rights of conscience and religious freedom, in avoiding complicity in the premature, and until this year, illegal death of a patient.

We assert that the moral risk to one’s conscience in an effective referral for objectionable procedures by a physician remains the same.  The fact that the procedure here involves the death of the patient only serves to heighten the moral choice that a doctor will make.

It is worth noting that several provisions of the Criminal Code remain in place, following the decision in Carter, notably counselling suicide (s. 241a) and administration of a noxious substance (s. 245).  We have submitted that those provisions have important impacts on public safety, and should be retained.  The ruling in Carter may provide an argument for relief from prosecution of physicians, but it cannot by its terms be extended to nurses, pharmacists, psychologists, or others not specifically named.

It is unacceptable for the CPSO to provide “guidance” to physicians on how to comply with professional obligations, while exposing other health professionals to possible criminal prosecutions under the Criminal Code.

The current discussion of the Interim Guidance proposal from the CPSO discloses the failure of the quick passage by the CPSO of its previous landmark change in directive on the requirement for “effective referral” from objectionable procedures, as promulgated in March, 2015, in which the Executive Council ignored the majority of the many thousands of objections filed in good faith on this issue.

The CCRL is aware that the CPSO directive from March, 2015 is already the subject of a court challenge. The passage of a further extension of such “guidance” to physician assisted death cannot be sustained in its current form.

Christian Domenic Elia, PhD

Executive Director

Catholic Civil Rights League (CCRL)



Philip Horgan


Catholic Civil Rights League (CCRL)



For more information, please contact:

Christian Domenic Elia, PhD
Executive Director
Catholic Civil Rights League (CCRL)