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Speaking to Senator Plett's Amendment to Bill C-7

Hon. Rosemary Moodie

Honourable senators, I rise to speak to this amendment on Bill C-7. I intend to vote against this amendment because I believe that clinicians do have well-recognized conscience rights in place in provincial regulations across this country, and that this amendment seeks to accomplish what has already been decided against by the courts.

The medical profession has sought to balance the rights of patients against the moral conscience of clinicians for decades. We see this in the expansive body of research and writing in the medical literature. We see this in the training received by clinicians, training that I’ve been a part of as a clinical teacher for the past 25 years.

The training provides nurturing, the development of skills such as compassion, listening, empathy and sensitivity to the non-medical factors that affect patients. We see this in the bodies that regulate the clinicians across Canada, bodies that have established clear guidelines that address the need for this balance between the rights of patients and the moral or religious conscience of clinicians — regulatory bodies such as the College of Registered Nurses of Manitoba; the College of Physicians and Surgeons of Ontario; and the Quebec college, the Collège des médecins du Québec.

In Manitoba, guidelines have been established which match the three regulatory nursing bodies there that mirror similar policies across the country where clinicians who exercise their conscience right to opt out from providing MAID have to inform the patient that they will not be participating in this process, must provide the patient information or provide access through deferring and referring to someone else to provide that information, and must continue to provide ongoing care. This speaks to the expectation that physicians should not abandon their patients. The College of Physicians and Surgeons of Ontario, in its ethics rules:

 . . . recognizes that physicians have the right to limit the health services they provide for reasons of conscience or religion.

. . . physicians’ freedom of conscience and religion must be balanced against the right of existing and potential patients to access care.

These regulations and standards align completely with the code of ethics elaborated by the Canadian Medical Association.

The Government of Quebec has embedded conscience rights and the need for effective referral in their law in sections 31 and 50 of An Act respecting end-of-life care.

Colleagues, clinicians do not solely practise according to their moral compass but according to rules backed by evidence and experience, rules that ensure best practices, that respect patients’ rights and autonomy as well. This amendment seeks to make the rights of patients subordinate to the conscience of clinicians. In a world with this amendment, patients’ access to MAID would depend on whether or not fortune provided them with the right clinician. Dying patients or those suffering intolerably would have to undertake their own investigations into MAID, according to Senator Plett, without the guidance or support of clinicians. This would be cruel, a lack of compassion and caring. This is not how we ensure constitutionally protected rights.

It is my interpretation that this amendment would criminalize the colleges, health authorities and other organizations throughout the country, including in Manitoba, and would conflict with Quebec law.

Furthermore, the standards established by these regulatory bodies have been tested in court. The 2019 decision of the Ontario Court of Appeal has addressed the careful balance that needs to occur, considering the rights of patients against the moral conscience of practitioners. Where irreconcilable conflict arises between a physician’s moral and religious beliefs and a patient’s rights to information and autonomy, physicians’ professional obligations and fiduciary duty require that the interests of the patient prevail. That’s the world I want to live in.

Colleagues, clinicians involved in providing MAID have told us they seek clarity in the law. They want clear definitions. They want to know that they’re practising within the law. This amendment would only add a layer of confusion. “Compel to facilitate” is a phrase that is both vague and has potentially dire consequences for nurses, physicians, colleges, regulators and employers, who could be seen as compelling clinicians under this amendment simply because they issue and enforce rules that require effective referrals.

The requirement of good clinical practice — transfer of care, it’s called — with formal exchange of relevant patient information could be construed to be facilitation of MAID and would be subject to summary offence for a clinician. I refer you to Senator Dupuis’ concerns raised during yesterday’s debate on the perils of vague language in regards to the second clause. If this amendment becomes law, there is a risk that immediate legal action would be taken against regulators.

Honourable senators, while I respect the intention of Senator Plett’s amendment, I believe that we have sufficient conscience rights embedded in existing regulations that respect the moral and religious beliefs of clinicians. If this amendment were to pass, patients would lose significant access to MAID and therefore access to constitutionally protected rights. Thank you.