Canada continues to struggle with doctor shortages. RBC analysts that Canada will be short around 44,000 physicians by 2028. Family doctors will account for 72 per cent of the shortage. Today, over six million Canadians are without a family doctor.
Some provinces have tried to solve this problem by helping more students become doctors and fast-tracking licensing for interprovincial and international doctors. But at the same time, doctors are leaving because of bad policies.
Health Canada recently urged all medical regulators in Canada to require doctors to give “effective referrals” for medical assistance in dying (MAiD), also known as euthanasia. That means the doctor must facilitate the process that will lead to their patient’s death by connecting the patient to a doctor who will provide euthanasia.
The College of Physicians and Surgeons of Ontario already mandates effective referral. This policy, along with the ongoing expansion of euthanasia, has meant some doctors are being forced out of the profession by policies which do not permit freedom of conscience for medical professionals. Instead of being able to dialogue with their patients about what is best for their health care, there is little room for professional, moral, or ethical judgment about euthanasia.
Some doctors believe providing an effective referral makes them complicit in something that is harmful to their patients. An analogy may help demonstrate this. Let’s say a patient asks their doctor for a particular prescription drug. The doctor believes this drug would harm the patient more than it would help them. Instead of having a conversation with the patient about what is best given the circumstances and making a professional, ethical decision, the doctor must not only tell the patient where to get the drug and how, but also refer the patient to a drug provider.
Of course, that is not how it works with prescription drugs or, more generally, in medicine. You might think that medical regulators should give doctors greater discretion to not provide or facilitate access to services that are ethically controversial. But effective referral policies target exactly such services. A compromise policy would be to forbid doctors from misleading patients or actively interfering with patient access to a controversial service but not to require them to proactively inform the patient that another doctor can end their life or facilitate such a “service”.
Health Canada’s preferred policy also has negative implications for patients. Patients may want the security of knowing their doctor will never recommend or facilitate euthanasia. Others may desire a doctor with an ethical stance that permits euthanasia. Some patients may prefer a doctor who will provide their honest opinion, whether or not they agree with that opinion.
A single approach to new and highly controversial medical and ethical issues is not helpful for either doctors or patients. It can cause specific groups of people to feel isolated, marginalized, and suspicious of the system in which they work, or which is supposed to help them navigate difficult medical choices. Penalizing physicians with conscientious objections to euthanasia may not only exacerbate the doctor shortage but prevent patients from finding a family physician who is ethically aligned with them.
Canada’s doctor shortage will only get worse if health-care professionals are increasingly forced to leave or discouraged from entering the field in the first place. If we do not prioritize freedom of conscience, access to medical care will be further reduced as medical professionals are removed, move to another jurisdiction, retire early, or change careers.
A common objection to protecting conscience for medical professionals is that patients may have difficulty accessing euthanasia as a result of some physicians’ refusal to participate. There is little evidence to support this claim. Although euthanasia was a serious crime until 2016, there are many willing providers in Canada. Canada is rapidly catching up to the Netherlands, where euthanasia has been legal for decades, in terms of euthanasia deaths as a percentage of total deaths.
For some physicians, the consequence of a nationwide policy requiring them to violate their conscience will be that they avoid certain practice areas – such as psychiatric care, particularly with euthanasia set to expand to those with mental illness in 2024 – or avoid medicine altogether.
Canada cannot afford to lose more doctors. Canadian jurisdictions need to think seriously about the implications of existing or proposed policies and pass legislation that will protect the conscience of medical professionals.
Daniel Zekveld is a Policy Analyst with the Association for Reformed Political Action (ARPA) Canada.
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