Manitoba has 'embarrassingly weak' stance on doctor-assisted death, says ethics professor

A Manitoba ethics professor says doctors vehemently opposed to physician-assisted death should consider changing careers.

Arthur Schafer, founding director of the Centre for Professional and Applied Ethics at the University of Manitoba, also says Manitoba isn't doing enough to protect the dignity and rights of patients to have access to an assisted death.

Recently, the Christian Medical and Dental Association met with Manitoba Health Minister Kelvin Goertzen to discuss conscience protection for doctors opposed to physician-assisted death.

The association is also asking Ontario's top court to reverse a policy requiring doctors to refer patients who want an assisted death to another doctor.

• Christian doctors' meeting with minister raises flags for assisted dying advocates
• Manitoba introduces doctor-assisted death policy
• Two more Winnipeg doctors speak out against assisted suicide

In Manitoba, doctors are only required to direct patients to a website that has information about assisted dying.

In an interview Friday with CBC's Information Radio, Schafer had the following to say on the topic:

Q: What are your concerns about the College of Physicians and Surgeons of Manitoba's position on this?

Manitoba's position is embarrassingly weak, I think, compared to the position taken by other colleges and especially the Ontario College of Physicians and Surgeons, which has been much more robust in protecting the dignity and rights of patients to have access to needed health care and at the same time, to protect physicians who have conscientious objections.

I don't think we have the balance right in Manitoba.

Q: What about doctors who have deeply held religious beliefs and say that referral to a website still gives patients the information they need but allows them to not be part of facilitating the process?

Let's take one step back. No college of physicians and surgeons is going to compel any doctor who has religious or ethical objections to perform a medical service. And we're not just talking about medical aid in dying, we're talking about prescriptions for abortion or contraception and so on.

One of the fundamental principles that every college, except perhaps Manitoba, is respecting is that doctors shouldn't abandon their patients.- Arthur Schafer

But just to focus on medical assistance in death, what every province says is that, except in an emergency, doctors' conscientious objections should be respected. In an emergency, patients have a right of access and the life and health of my patient will be my first consideration — that's the fundamental principle of the Hippocratic oath and if a doctor can't respect that, even in an emergency, then the physician should be either not practicing medicine or should be in a different branch of medicine — sports medicine or pathology, whatever. No one's going to force anyone to act against their conscience but patients have a right to full information. 

What the Manitoba college has said is that doctors don't even have to provide patients with access to information. That is, they don't have to inform the patients about all of their alternatives at the end of life, they can say, "Well, here's a website."

Remember, we're dealing with patients, some of whom may have real difficulty accessing information. One of the fundamental principles that every college, except perhaps Manitoba, is respecting is that doctors shouldn't abandon their patients. So if you, as a physician can't perform a service, you should transfer the patient to a doctor who will. And there has to be a doctor who is accessible, it can't be someone at the other end of the country. Remember, we're talking about people who may be suffering intolerably, who may be at the end of life, who may have locked-in syndrome.

Referring someone to a website, crikey, not everyone has a computer, not everyone is computer literate, not everyone has family to support them. Doctors shouldn't be forced to provide the service to which they object, except in an emergency, but they should be required professionally — and they are in Ontario and not in Manitoba — to inform their patients about all the alternatives and then to transfer the patient's care to someone who'll provide the service.

Q: What did the Supreme Court say about doctors' and patients' rights on this?

Yeah, that's an interesting question. In the Carter case, decided a little more than a year ago, what the Supreme Court said is that the rules and laws respecting physician-assisted death should respect the patient's right of access and the physician's right to conscientious objection. The two have to be reconciled [but] the Supreme Court didn't say how.

Into this breach, into this gap that the Supreme Court has left, either for legislation or for the professional bodies — the colleges of physicians and surgeons in each province — each provincial college has adapted legislation and Manitoba's is on the weaker end. I would hope that our medical colleagues would [raise] up their courage, respect patients' rights and dignities and at the same time, of course, not compel their colleague, except in an emergency, to provide a service to which they conscientiously object.

Q: What would you say about doctors who hold religious beliefs like this and feel that if they have to go through the options about how to die — that even that conversation goes against their fundamental beliefs?

What I would say is perhaps you should be practicing in a different branch of medicine or perhaps you shouldn't be practicing as a doctor. Patients are entitled to know what their options are. If doctors can't provide patients with adequate information about all of the relevant options for that patient, then the doctor is letting the patient down.

I would say that along with the version of the Hippocratic oath that our medical students all swear in Manitoba on their first day of medical school — the life and health of my patient will be my first consideration. 

Manitoba Health Minister Kelvin Goertzen was not available for an interview or to respond to Schafer's remarks.

In a written statement to CBC, the provincial government said there is an email address and phone number on the government's website which allows people to connect with a medical team if they want information about how to obtain an assisted death.