Concerns raised over assisted dying bill

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This article was published 07/11/2017 (2910 days ago), so information in it may no longer be current.

A Manitoba bill that seeks to spell out protections for health-care professionals who refuse to participate in a medically assisted death would make vulnerable patients more vulnerable, say opponents of Bill 34.

Not so, argued half a dozen Manitoban doctors who stood to speak in favour of the Medical Assistance in Dying (Protection for Health Professionals and Others) Act at the standing committee on legislative affairs Monday night.

“Bill 34 is the right thing to do,” said Dr. Randy Goossen, a family doctor and psychiatrist of Mennonite heritage. “It sends a message that we respect all people, those who choose MAID (medical assistance in dying) and those who follow their conscience.”

Central to Monday night’s discussion was the question of whether Health Minister Kelvin Goertzen’s bill would impede a person’s right to access medical assistance in dying.

That has to do in part with the wording of the bill, which in some respects reiterates federal law that already indicates no person is to be compelled to participate in a medically assisted death.

Under Bill 34, a health-care professional cannot be compelled to “provide or aid in the provision of medical assistance in dying.” Under the bill, professional regulatory bodies also cannot discipline a health-care provider for refusing to participate.

The bill is too ambiguous, argued Cory Ruf of Dying with Dignity Canada.

“If interpreted broadly, this provision could suggest that physicians have absolutely no obligation to ensure that patients in their care have access to the compassionate treatment that they seek, and to which they have a right,” he told the committee via telephone.

“In the most dramatic scenarios, this legislation could even communicate to objecting clinicians that they do not have to do the bare minimum that the College (of Physicians and Surgeons of Manitoba) expects of them.”

Dr. Alewyn Vorster, past-president of the college and chair of its working group on the provision of assisted dying in the province, agreed the wording of the bill is too broad.

“Our primary concern is health-care providers may misconstrue Bill 34 as giving those who conscientiously object the right to refuse to provide patients with timely access to a resource that will provide accurate information about MAID, or to abandon their patients who wish to explore MAID.”

Many of the doctors who spoke in favour of Bill 34 told the committee they agreed with the college’s approach to MAID so far, especially when compared with Ontario’s approach.

The College of Physicians and Surgeons of Ontario passed a policy requiring all of its doctors who conscientiously object to provide an “effective referral.” That means a doctor must refer their patient in a timely manner to “a non-objecting, available and accessible physician, nurse practitioner or agency.” Currently in Manitoba, health-care providers who do not wish to be involved in medically assisted deaths are only required to provide a phone number or similar point of contact to patients who want it.

“I think we’ve hit the right balance on the issue of referral,” Goertzen told the Free Press shortly before the committee hearings began. “I don’t think that (Bill 34) changes that balance… I don’t think it takes anything away from those who are seeking access.”

Goertzen said he’s received upwards of 14,000 letters from Manitobans in support of the bill. It’s not meant to circumvent the policies Vorster’s working group engineered, he said, but rather to guard against future college leaders possibly changing them.

“This bill, we believe, holds that balance for the future,” Goertzen told Vorster in response to his request in committee that the government amend it.

That balance would mean not requiring that health-care providers refer patients seeking information about assisted dying to someone who can provide it beyond offering up a phone number or similar point of contact.

That’s key, Larry Worthen of the Coalition for Healthcare and Conscience said, because his members see a referral as part of the process.

“Participation includes providing MAID, assisting in the provision of it or making arrangements for the patient to receive it as in a referral,” he said. “A referral is a recommendation that the patient under our care should access this procedure… it is a denial of our solemn responsibilities to God.”

Worthen rejected scenarios put forward by Ruf in which a person is too sick or impaired by illness to act when simply given a phone number or a point of contact. There are always family members or friends or other health-care providers or care co-ordinators who can assist, he said.

“We should not force a patient to prolong their life against their will,” Worthen said, “but it is also not right that we should be forced to participate in the death of a patient that goes against the very reason we became doctors and nurses in the first place.”

Bill 34 still needs to progress through the report stage, concurrence and third reading to become law. It has to do this before the end of this legislative session on Thursday. Health critic Andrew Swan said the bill has the support of the NDP caucus, despite earlier concerns that it makes no mention of patient rights.

jane.gerster@freepress.mb.ca