Physician (including retired)
[May 27, 2021 4:50 PM]
As advised by the Physician Advisory Service, I submit by email my input about the CPSO’s MAID policy as the online survey is no longer available. Yes clearly a physician should respond with respect to patients’ dignity and autonomy. Hence, I disagree that a physician should be required to communicate their objection to the patient; indeed, if they communicate their objection at all, it needs to be with professional and personal discretion and with very cautious sensitivity. I think I should usually spare my patients expression of my personal and religious convictions and objections. I find shocking that College policy appears to say I must do otherwise. Information on all options for care should be and are available to patients. I do not agree that needs to or should come from the physician, and I strongly disagree that physicians should be required to propose medically assisted death as an option; indeed I question whether and when a physician should make, let alone volunteer, such a potentially insensitive suggestion. I strongly disagree that a physician should be required to provide an “effective referral” as defined in the CPSO Guideline. The prompt set-up of a central phone number to access the Central Referral Agency by a 1-800 phone number was well aligned with patient autonomy. Indeed, that public domain information is and should be accessible without any potential influence or interference by the physician. I think it is more respectful of the patient and of their autonomy that a physician provide, in response to patient enquiry rather than as a physician-proposed suggestion, contact information for a central coordination service or a group “point person” for the patient to act upon if they choose. I think this is almost invariably best done without any disclosure of the physician’s beliefs or objections. I think that should be sufficient to satisfy the College’s policy requirements.
Member of the public
[May 17, 2021 3:55 PM]
Dear Sir / Madam, I am writing as a very concerned Canadian citizen about the risk to those with mental illness and disabilities posed by the proposals suggested under the current parliamentary review of Bill C-14 on ‘medical assistance in dying’ (MAID). I am deeply worried that the proposed changes to Bill C-14 may not protect such vulnerable persons and will deter them or their carers from seeking other solutions such as pain management or mental and physical therapy. I strongly urge the College of Physicians and Surgeons of Ontario, true to the Hippocratic Oath, to ensure that any proposed changes to Bill C-14 protect the vulnerable, including minors, who may be tempted to end their lives early due to pain or mental distress, and to advocate instead for adequate social support, pain management, or other care for vulnerable patients whose lives deserve safe-guarding. Thank you for your attention to this urgent and very grave matter,
Physician (including retired)
[May 14, 2021 10:43 PM]
Note: Some content has been edited in accordance with our posting guidelines. You are absolutely right, and as you can see in the comments, an overwhelmingly majority of physicians agree with you. Politicians, and lawyers in courts have neither the medical knowledge nor the right to govern what physicians can and should, or not, do. The addition of lay members of Council, politically appointed is similar. Originally professional Guilds were created to ensure the skills and ethics of the members who created them, whether barber-surgeons or silversmiths. This is what "protected the public". As predicted by George Orwell, the first order of business of the rampant extreme socialism of today is to reverse the meaning of words. "Special interest group" is meant to imply some small faction attacking the "consensus" of medical knowledge. MAID is easier to spell and say than the intrinsically abhorrent "euthanasia" and emotionally sugar-coats it. As noted by many, this is inevitably intertwined with the demand for effective referral in this and other forms of mis-represented "health care". Each unique conceived human being, whether sick or disabled, at all stages of life until natural death, deserves physical and emotional support, not murder. The Bible consists of historical and allegorical stories about the natural biological "laws" affecting the herd of mankind, along with much good advice about compassion and organizational justice. Sin or not, unfortunately, citing it as a reference makes it easy to belittle statements based on scientific evidence from thousands or more years of plant and animal life necessarily propagated by two sexes alone. This is not a "social construct". Changing "sex" to "gender" and proposing other ideas is the real social construct. Typically the CPSO has fallen for that, evidenced by the introductory questions. Arising from that, demanding the right to [redacted] is called "affirmation". This should be extreme malpractice, rather than supported by public funds. In contrast to castration, counselling (supportive listening) is wrongfully called "conversion" therapy, using the letter "c" and sounding enough like "aversion" therapy, which is already illegal. Drawn into the fad of social media, the CPSO has announced by "Twitter" that physicians discussing the harm and ineffectiveness of masking and social distancing, and of imprisonment of families, children, the lonely old in contradiction of the supposed consensus, will be treated as "misinformation" and subject to discipline. Dozens of Twitter replies by patients indicated that they could no longer trust their physicians to tell their objectively held truth. Outrageous. [redacted].
Organization
[May 14, 2021 4:03 PM]
Action Life Ottawa
Good Morning: Action Life Ottawa is an educational pro-life organization counting more than 4,000 supporters in the Ottawa region. Our goal is to foster respect for every human life from conception to natural death. We welcome the opportunity to participate in this consultation on the College's policy on Professional Obligations and Human Rights and Medical Assistance in Dying. We respectfully recommend that the CPSO policy as presently mandated be amended to protect the fundamental freedoms of physicians who hold a religious or conscientious objection to particular services. The objecting physician should not be required to make an effective referral, give contact information of a willing non-objecting physician, nor direct the patient to an agency or point person who will provide coordination for the procedure. Conscientious objectors are not impeding access as patients have other options such as Telehealth Ontario, local clinics and hospitals. A triage system identifying patient queries and matching patients to a non-objecting physician is an acceptable option. In cases of euthanasia, an objecting physician may request a transfer of care and the new physician will make the necessary arrangements for the service. Naturally, physicians will assure the patient of continued care until the transfer is in place. While physicians willingly discuss euthanasia or abortion when raised or requested by the patient, they should not be obliged to present all services as an option or refer in spite of their objections. They would also inform the patient of their refusal to facilitate certain services when the patient enquires about them. Conscientious objectors care about their patients and want to address their concerns and fears. It is most unreasonable to force physician involvement in morally controversial services. Objecting physicians are not abandoning patients, they simply refuse any participation in intentionally causing their death. Conscientious objectors should suffer no discrimination, harassment or punishment for refusing to do what they believe to be wrong, injurious and detrimental. There should be no duty to inform about all clinical options or services available when they are deemed inappropriate, harmful to the patient, against the physician’s professional judgement, conscience or religious beliefs. The Physicians Alliance Against Euthanasia - Collectif des medecins contre l’euthanasie stated regarding the College of Physicians and Surgeons of Ontario’s policy: “The violence of the obligation to “inform” goes even beyond that of “effective referral” itself. Every patient who fits the criteria for euthanasia must be subjected to the terrible stress and doubt of learning that he or she belongs to that select group of people for whom medically-inflicted death has become an option. And no objection of judgement or of conscience can free the doctor from delivering that terrible message and its implicit suggestion.” (1) Discussion about euthanasia should be initiated by the patient not the physician. The risk of undue influence on vulnerable patients is real and the offer or suggestion of euthanasia made by the physician may be perceived by patients as euthanasia being the response to their medical condition. Consider that media reports have brought to light accounts of hospital staff exerting pressure in the direction of euthanasia on patients with disabilities. CTV News reported on the case of Roger Foley, a then 42-year-old man living with cerebellar ataxia, having been offered euthanasia when he was seeking assisted living services: According to Foley’s statement of claim, the only two options offered to him have been a “forced discharge” from the hospital “to work with contracted agencies that have failed him” or medically assisted death. Refusing to leave the hospital and unwilling to die by a doctor’s hand, Foley claims he has been threatened with a $1,800 per day hospital bill, which is roughly the non-OHIP daily rate for a hospital stay... According to Trudo Lemmens, a professor and Scholl Chair in Health Law and Policy at the University of Toronto’s Faculty of Law, Foley’s allegations -- if true -- are “very troubling.” “If true, we would have here an instance of a patient receiving an offer for MAID (medical assistance in dying) while the patient precisely complains about receiving substandard levels of care,” Lemmens said in an email to CTV News. “MAID should not be introduced as an option to someone who complains about sub-standard care and, clearly not to someone who is suicidal.” (2) Additionally, Catalina Devandas Aguilar, United Nations Rapporteur on the Rights of Persons with Disabilities expressed in her report following a visit to Canada: I am extremely concerned about the implementation of the legislation on medical assistance in dying from a disability perspective. I have been informed that there is no protocol in place to demonstrate that persons with disabilities have been provided with viable alternatives when eligible for assistive dying. I have further received worrisome claims about persons with disabilities in institutions being pressured to seek medical assistance in dying, and practitioners not formally reporting cases involving persons with disabilities. I urge the federal government to investigate these complaints and put into place adequate safeguards to ensure that persons with disabilities do not request assistive dying simply because of the absence of community-based alternatives and palliative care. (3) Hospices have also been subjected to coercion because they will not allow euthanasia on site. Serenity Hospice in North Bay was pressured by four euthanasia practitioners because the hospice would not permit euthanasia (MAID) on its premises. The North Bay Nugget reported: It is “unconscionable” that medical assistance in dying (MAiD) is not allowed at the Nipissing Serenity Hospice, the four doctors who perform the procedure say in a letter to the hospice’s board of directors...The four medical providers of MAiD say they “absolutely disagree” with the hospice’s position that MAiD “is not one of the tools in the palliative care basket.”...The doctors “suggest that the community be engaged and see what its position is on a publicly funded facility that denies MAiD to patients in hospice care. (4) The Delta Hospice Society had its assets seized and staff fired by the government of British Columbia due to its refusal to offer euthanasia in its facility. Both hospices followed the longstanding practice of palliative care endorsed by the Canadian Hospice Palliative Care Association and the Canadian Society of Palliative Care Physicians which seeks to help patients live as fully as possible, relieve pain and suffering until natural death. Euthanasia advocates are pushing for the inclusion of euthanasia within palliative care in spite of it being in direct opposition to the philosophy of palliative care. The Physicians Alliance Against Euthanasia reports that objecting physicians are being targeted: The Physicians Alliance against Euthanasia has received reports that unwilling physicians are being pressured and bullied to participate in Medical Assistance in Dying (MAiD): euphemism for euthanasia and assisted suicide. Fearing reprisals, physicians have asked that no information that could identify them be disclosed. The pressure has been intense for many physicians, especially amongst palliative specialists, some leaving even before this latest development. Descriptions were made of toxic practice environments and fear of discipline by medical regulators... The reports we are hearing from distressed physicians describe deliberate disruption of arrangements that were previously working satisfactorily and that had permitted patients to have access to MAiD while still allowing for conscience objectors to not be involved in facilitating the patient’s death. This bullying and betrayal of collegial relationships can poison practice environments and compromise patient care. Such behavior should not be tolerated by health care administrators in Canada. (5) Action Life believes the public interest can best be served by offering robust conscience rights protection for physicians. Patients have an equal right to receive care in a euthanasia free zone from a physician who will not suggest or introduce the topic of euthanasia. Some patients fear being treated by physicians who are euthanasia practitioners or being hospitalized in an institution where euthanasia is permitted. These situations may result in distress for the patient and a lack of trust between patient and physician. Concerning the medical assistance in dying policy, it is astonishing that physicians who euthanize patients are required to falsify death certificates by listing the underlying illness as cause of death rather than the actual cause, euthanasia. The World Medical Association (WMA) retains its opposition to euthanasia stating: The WMA reiterates its strong commitment to the principles of medical ethics and that utmost respect has to be maintained for human life. Therefore, the WMA is firmly opposed to euthanasia and physician-assisted suicide. Concerning referrals for euthanasia, the WMA says: “No physician should be forced to participate in euthanasia or assisted suicide, nor should any physician be obliged to make referral decisions to this end.” (6) The Canadian Medical Association in its 2016 submission to the College wrote: The argument that only mandatory referral puts patients' interests first or respects patient autonomy − and that not making a referral does not − is fundamentally erroneous. Action Life recognises that referrals present the objecting physician with a sense of complicity and cooperation with the procedure. We remain strongly opposed to effective referrals as they violate the most basic freedoms, the right to be free from coercion and to live and work fully in accordance with your conscience or religious beliefs. They are equally detrimental to the dignity and professional integrity of physicians who are not mere automatons forced to acquiesce to patient demands. Objecting physicians wish to practice medicine in accordance to the Hippocratic tradition which enjoins physicians to never participate in the intentional death of a patient. The Ontario Medical Association and the Canadian Medical Association both support conscience rights protection. We encourage the College to provide this protection in its policy. 1- https://collectifmedecins.org/en/conscience-and-canadian-doctors/ 2- https://www.ctvnews.ca/health/the-solution-is-assisted-life-offered-death-terminally-ill-ont-man-files-lawsuit-1.3845190 3- https://www.ohchr.org/EN/NewsEvents/Pages/DisplayNews.aspx?NewsID=24481 4- https://www.nugget.ca/news/local-news/controversy-emerges-at-new-hospice. 5- https://collectifmedecins.org/en/press-release-2/ 6- https://www.wma.net/policies-post/declaration-on-euthanasia-and-physician-assisted-suicide/&LangID=E (World medical Association Declaration ON EUTHANASIA AND PHYSICIAN-ASSISTED SUICIDE, Adopted by the 70th WMA General Assembly, Tbilisi, Georgia, October 2019
Organization
[May 14, 2021 3:02 PM]
Christian Legal Fellowship
Response in PDF format.
Member of the public
[May 14, 2021 2:53 PM]
Response in PDF format.
Organization
[May 14, 2021 12:27 PM]
Evangelical Fellowship of Canada
Response in PDF format.
Physician (including retired)
[May 14, 2021 12:20 PM]
Response in PDF format.
Organization
[May 14, 2021 12:15 PM]
Canadian Psychiatric Association
Response in PDF format.
Organization
[May 14, 2021 12:09 PM]
Christian Medical and Dental Association of Canada (CMDA)
Response in PDF format.
Organization
[May 14, 2021 10:51 AM]
Canadian Centre for Christian Charities
Response in PDF format.
Organization
[May 13, 2021 11:38 AM]
Ontario Medical Association (OMA)
Response in PDF format.
Organization
[May 13, 2021 8:30 AM]
Ontario Association for ACT and FACT (OAAF)
Response in PDF format.
Member of the public
[May 12, 2021 7:57 PM]
I object in the strongest possible terms to the CPSO requiring conscientiously or religiously objecting physicians to provide an effective referral. To my view, this is not in the public interest. A subset of my reasons is provided, in brief, below: 1. The effective referral clause – while expedient - is fundamentally unnecessary. Other jurisdictions have implemented ways to respect conscientiously objecting physicians and patients without requiring this. Other approaches could be used to achieve the goal of providing access for those who wish to pursue MAID while still respecting conscientiously objecting physicians. 2. This policy will effectively bar or dissuade individuals who would or might conscientiously object on this matter from practicing medicine in our province in many medical disciplines over the long term. As such, it risks barring or dissuading many talented individuals from serving in medicine. Both those who object on philosophical and those who do so on religious grounds will be barred/dissuaded – especially those that find providing an effective referral for MAID morally problematic (a position I happen to agree with). This an unconscionable form of discrimination and is unnecessary, regardless of what may or may not have been ruled in previous cases. 3. This will create a barrier to medical treatment for patients such as myself, and as such does not respect our needs. I am not comfortable entrusting my long-term care – especially (but not limited to) my end-of-life care – to a physician who would be willing to refer me for MAID or, quite frankly, any physician who would be willing to participate in, refer, or take positive steps to connect someone to a procedure that violates the physician’s conscience (regardless of the topic). I doubt I am the only person with this concern. I also request that the CPSO consider adding to the policy something that bars physicians from discussing MAID as an option if the patient clearly indicates that the patient does not want it discussed.
Member of the public
[May 12, 2021 12:30 AM]
Someone who identifies as Jehovah's Witness refuses blood transfusions out of respect for the blood, not because he supposes the transfusion will harm his body. A patient who FEELS that the greater harm is continuing to live is emotionally disturbed. His despair is understandable, but his pain may have affected his ability to reason. However, there are indeed those who look ahead and specify a wish to die in possible future conditions they deem unbearable. Such a wish may only be a prayer or it is wrong; only the truly autonomous God can grant such a wish. The doctor who helps realize it is harming the patient. Does a patient with body identity integrity disorder cause harm when he intentionally amputates, say, a healthy arm?
Member of the public
[May 11, 2021 9:28 PM]
Suicide and euthanasia of people is wrong for the same reason that euthanasia of animals is good. God had made people a little like Himself, and one shared resemblance is headship. God rules everything that He has made, but He has entrusted that government to people. Even after the Fall into sin, people continue to rule, eating now meat as well as plants. Their sinful impulse is also to kill each other, but after the violence for which God sent the Flood, He made clear again that they were only to kill the animals, and any man who killed another was himself to be killed (the death penalty). His reason for the prohibition against murder was people's original resemblance to Himself. My father, who with his siblings continued to visit my grandmother with Alzheimer's--even though she would forget the visit five minutes later--shot my sister's dog after she had become too busy to walk it regularly. We prayed for God to take my confused grandmother to Himself soon but made sure the nurses were taking good care of her until her natural death. It hurt my father to shoot the dog, but the dog died instantly and was spared the suffering of endless days of boredom chained to a zipline. The first of our ancestors, Adam and Eve, were human beings made by God. They were not animals. Their children have found out much of the marvellous order in God's design and care of the world even while they experience the curse of decay and death evident, for example, in the law of entropy. This discovering and exploring of the world is part of their role as stewards. As Western people became proud of their progress and rejected God, they became foolish and attributed the world to chance development. Most contemporary scientists are evolutionists, but historically they were mostly creationists. There is plenty of evidence for the Creation. If the Creator has told people not to kill each other, who am I as one of them to disobey Him and assist my neighbour's suicide? I understand that some people do not believe in God, but nevertheless He does exist. There can be no such thing as religious neutrality; it just doesn't work that way. Even the Canadian Charter of Rights and Freedoms, though it undermines the Christian inheritance, admits in its preamble that "Canada is founded upon principles that recognize the supremacy of God and the rule of law." One of the Bible verses on the Peace Tower, a Parliament building in Ottawa, is Psalm 72:8, "He [Christ] shall have dominion also from sea to sea." Yes, He shall!
Physician (including retired)
[May 11, 2021 8:07 AM]
Note: the attached response was signed by First Nations representatives, Indigenous physicians, other health care workers, and members of the public. Response in PDF format.
Member of the public
[May 10, 2021 8:45 AM]
Hi I am a member of the public, and a bio-medical/mechatronics engineer. My friend whom works in the medical field recently told me about this and this is my take on it: The problem with C7 and C14 and the new introduction of physician based rules is that the doctor's idea of harm is not always the same as the patient's. And let's face it- doctors do harm every day. Every surgery causes harm with incisions, and risk of harm through infection and possibly anaesthesia, etc. It's just that this harm is believed to be less serious than the alternative. Furthermore, in most cases (exceptions include children or unconscious patients), the patient must agree to the procedure. If I have an infection in my leg, and the doctor believes I'll die if it's not amputated, he/she/they doesn't have the right to just lop it off without my okay, and if I specifically refuse consent, he/she/they certainly doesn't have that right, even if I lose consciousness. All of this is because we deem that the patient, in all but the most exceptional cases, has this right to decide which is the greater harm. A Jehovah's Witness might believe that receiving a blood transfusion is a greater harm than dying. I don't agree, but it's not my decision. Likewise, a patient may feel that the greater harm is continuing to live, so a doctor who refuses their remedy, whatever their reason, is doing the greater harm.
Prefer not to say
[May 09, 2021 6:08 PM]
Interesting perspective. Then what do you think about the euthanization of animals? In particular home animals, like dogs and cats? Would love to get your perspective on it. I apologize, but I am an atheist, and I like to believe in science-backed evidence. My perspective on this is, that technically we are animals too... More evolved, yes... But technically still animals. We evolved from Ape like creatures, to what we are now. And probably in the near future will continue to evolve, to adapt to changing climate. If we are okay to euthanize animals and apes (our ancestors) in a humane way. Who are we to judge when someone would like MAID in the end of care life? I understand some individuals believe in god, but not everyone does, unfortunately, and some people believe in other things. We can't just put one's personal beliefs and thinking on the table and ignore others, it just doesn't work that way.
Member of the public
[May 05, 2021 9:49 PM]
I might request MAiD! God helping me, I hope I would not--suicide is murder--but there's no doubt I would be extremely vulnerable to temptation--as in Nazi Germany, where some Jews saved themselves by agreeing to betray their fellows. My forty-something crippled cousin has lived most or all of her life in great pain because of the deformities she was born with. She had many operations as a child, and as an adult she has probably never been without pain relievers. You would tempt her with MAiD? Do you realize that instead of the end, MAiD may be the beginning of unending pain in everlasting fire? MAiD is not the response of faith in God but of doubt and unbelief. Your pain scenario is used to kill 100,000 Canadians every year. Put them out of their misery! We are told that it is better to kill the child in utero than to have him experience all the pain that would be his lot because of his dysfunctional family, low socioeconomic status, or congenital disease (or developmental disease like my cousin's). Murder is justified as sympathetic caring. No, the truth is the opposite: human dignity means that every human being has the right to life and should choose life, and we are all in this together--to choose life.
Organization
[May 05, 2021 8:55 AM]
Canadian Medical Protective Association (CMPA)
Response in PDF format.
Physician (including retired)
[May 04, 2021 8:18 AM]
Participation in MAID must remain voluntary. The Charter for Rights and Freedoms protects conscience rights but the current CPSO policy regarding conscience objection and MAiD requires practitioners to create a pathway for death via effective referral. In order to maintain patient and physician wellness, the policy must be amended to protect and respect conscience and patient safety in all patient settings. Most other provinces in Canada have systems that respect an individual’s conscience while maintaining patient access to controversial services. Ontario actually has systems to facilitate patient access and therefore these policies place an undue burden on practitioners without increasing patient access. The policy around effective referral must be removed for the health and safety of patients and physicians in Ontario.
Member of the public
[May 03, 2021 9:27 PM]
I wish I could remain confident that your comment was intended as satire like Jonathan Swift's "Modest Proposal," but I now realize you sincerely mean it. Your thoughts are far more forceful and consistent when written from a pro-life perspective because they actually were originally written from a pro-life perspective, http://policyconsult.cpso.on.ca/?page_id=13152#comment-12114 Since that rebuttal already exists, I make only this addition, restating your final thoughts: I am perturbed that vulnerable patients' LIVES will be ENDED by SOCIAL PRESSURE and by UNSCRUPULOUS ATHEISTS DECIDING THEIR DEATHS. Requiring doctors to facilitate the killing of patients fosters DISTRUST in the physician-patient relationship. The physician is compelled to do something ABHORRENT to keep his employment rather than work and pray for healing or, at least, a mitigation of suffering until natural death. I am PLEASED that you are contemplating protection of conscience so that doctors and nurses can speak freely and truthfully against MAiD as a corruption of their standard of care. Such evil as MAiD should not even come into the mind of a medical professional.
Other health care professional (including retired)
[May 03, 2021 8:26 PM]
Let me pose the question to you. Let's say you get severely burned in a fire and are in severe pain and because of injures to your body you will eventually succumb to them. And no type of pain relievers are helping, not even the strongest of nerve blockers? Would you fight the extreme amounts of pain till the end or commit sucide? Or would you request MAID, and would you think it's like Nazi Germany then?
Member of the public
[April 30, 2021 9:39 PM]
If you prize individual liberty, then why would you require a doctor to facilitate the killing of a patient or (since you imply approval of abortion) a dependant of the patient? The requirement of effective referral is actually a LOSS of freedom: an effective referral means that for a career the sincere Christian cannot be a family doctor and as a patient he may not have a sincere Christian family doctor. Contrary to your caricature, the effective referral actually DOES force doctors to "disobey their own spiritual path." Not suffering but PATIENT suffering is noble. The spiritual problem of sin in general is the origin of all suffering in the world. As an act of defiance--since suicide rejects the supremacy of God--MAiD is more likely to result in everlasting suffering in the afterlife. God is the judge, but He has made clear that only He may decide the end of a human life. His minister of justice is the civil government, and so it may kill foreign aggressors in war and criminals for capital crimes. Because of sinful human nature, civil government must be limited or it becomes totalitarian (communism made the government rich and everybody else poor). For the same reason of the corrupting influence of power, doctors should never have to kill people. MAiD is evil.
Physician (including retired)
[April 30, 2021 8:28 PM]
Note: Some content has been edited in accordance with our posting guidelines. Dear College of Physicians and Surgeons of Ontario, I am no longer in clinical practice but did spend 40 years in Children's orthopaedics and 27 of those years was medical director of [redacted], a rehabilitation centre and school for multi-handicapped children. The surviving members of that cohort are now adults living with a multitude of disabilities. I also have a grandchild who is severely handicapped. If you did not hear the "White coat, black art" broadcast recently by Dr Brian Golding on CBC you should look it up and listen to the interview he had with a handicapped adult who strongly opposed this euthanasia move to eliminate people who do not have a terminal illness. Much as the seniors in long term care have suffered the consequences of inadequate care during Covid, this person expressed similar concern for the handicapped, who might seek this way out because they are not being adequately supported in life. He did interview another person who had what he said was abdominal migraine who can go for months without symptoms and then have severe abdominal pain. and he wanted the ability to be able to have one of the designated "Maids" end his life, if he so chose. It was possibly understandable how someone who has a terminal illness, and wants to go sooner might have a procedure that could be interpreted as Medical Assistance In Dying. This new proposed law is to end the life of a person who is not dying. This should not have the name Medical attached to it at all. A more realistic name would be LAS (Legally Assisted Suicide), or LAM (Legally Assisted Murder), and should not be conducted by the medical profession who are trained to treat people to get better or help them cope with sometimes trying afflictions. Putting this under the MAID banner is painting the whole profession with this brush. If the legal minds think this is a good idea then they should take ownership of this LAS and conduct the orchestra that ends up carrying out the lethal injection. It doesn't have to be a physician to become known as the executioner. Any person could be trained to start an IV and they could be informed what the lethal dose should be of any number of drugs. If the politicians, many of them in the legal profession, are keen to go ahead with this, then let the legal profession take ownership of carrying it out. The College of physicians should help defend the doctors from being implicated in carrying out these LAS procedures rather than facilitating them being carried out by physicians, presumably in a medical facility. Doctors have been and continue to be heavily involved in COVID care and prevention, trying to save lives, and have in many cases been too busy to get involved in criticizing this LAS procedure. I believe I am in the quiet majority, in the medical profession, in expressing the above opinions. If LAS is handled outside of the Medical Profession this would put a damper on how frequently it is sought. If it is mandated to function in the medical profession then you will be creating more than vaccine hesitancy among the population. When they have to be anesthetized for some operative procedure, they will be wondering whether they will be wakened up. [redacted]. I would predict that the college would be involved in a multitude of parallel cases if doctors are labelled as the executioners of these people who are not dying. I would appeal to you to do the right thing and help keep the medical profession out of this Legally Assisted Suicide.
Physician (including retired)
[April 30, 2021 7:22 PM]
Note: Some content has been edited in accordance with our posting guidelines. Dear Colleagues, We are two Ontario doctors for whom it has been distressing to see the expansion of MAiD criteria. This past winter one of us assessed an elderly gentleman who had attempted to end his own life while in hospital. There was an interval of about 45 minutes from the time of the call to come assess him and my [redacted] arrival at his bedside, and in that time he had had warm encouragement from the nurses. By the time I assessed him he was feeling a tiny bit of hope and commented that the way he had been treated had made him look at dying differently. He would have qualified for MAiD if he had still wished to die. Because he no longer did, we were able to put extra supports in place and he was able to have some rich family time. I was not involved in his care over the long term, so I don't know what eventually happened. But imagine how different things might have been if the nursing staff who attended him right after his suicide attempt had whole-heartedly endorsed his desire to end his life, and treated it as the natural next step! Would that have been the best thing for him? I [redacted] have also encountered a patient who wished to end his life because he was isolated and lonely. He qualified for MAiD, but it was clear that a significant factor contributing to his decision was social isolation. Options were discussed but he was adamant that MAiD was what he wanted and it was eventually carried out. It is hard to see this as anything except a failure of our society and health care system. Instead of meeting this gentleman's needs, our society agreed that he should end his life, and helped him do it. Did we act in his best interests? We could not sincerely support MAiD for either of these gentlemen as the best medical option. And their situations were relatively uncomplicated and they were not members of particularly vulnerable populations. We all know how, despite our best efforts, patients are sometimes open to suggestion, or even unwanted pressure, when they feel fragile, and are dealing with distressing and challenging medical and psychiatric diagnoses. By obligating physicians to offer MAiD before it has even been considered, CPSO policy would require physicians to send a powerful, and possibly unwanted, message to vulnerable patients: we think your life is not worth living. And how much worse this would be for marginalized populations! As MAiD becomes more mainstream in our health care system, it becomes even more important that vulnerable patients be protected. By forcing effective referral, the CPSO policy has the potential to damage the patient-physician relationship and encourage doctors to overlook viable alternatives. This is problematic for anyone, but even moreso for the vulnerable. As it becomes normal for people to die by MAiD, those who do not desire it are likely to feel subtle pressure to cooperate. And this is a cash-strapped health care system, for which the ideal economic choice will often be MAiD rather than expensive ongoing hospitalization, adding an extra layer of unspoken coercion. Surely we can all acknowledge that, despite our best efforts as health care professionals, these factors do sometimes play into patient care decisions. Allowing doctors to practice according to conscience would create a safe space for vulnerable patients who don't want MAiD. And it would allow us to not betray our oath to act in the best interests of our patients.
Organization
[April 30, 2021 1:44 PM]
Ontario College of Family Physicians (OCFP)
Response in PDF format.
Member of the public
[April 29, 2021 9:21 PM]
Until Bill C-7 this year, assisted suicide was what we were talking about, and the "recent extension of the categories of people who can access MAiD" means that we are now also discussing euthanasia, killing psychologically disturbed people unable to provide meaningful consent. A better acronym for this violence is MAD (Murder Arranged by Doctors). It has not even a shadow of a place in the "full range of health care options." Imagine including an active rapist in the "full range" of suitors seeking my daughter's hand in marriage. It doesn't help me to have somebody else introduce him to her. In the same way, the caring physician cannot refer a suicidal patient to a hitman (another physician with no scruples about MAD). In your support for conscience rights of doctors, please realize that even referral to CPSO-authorized killers is out of the question.  Effective referral is "participation in the process" of MAiD.  Thank you for your support for conscience rights!
Physician (including retired)
[April 29, 2021 8:02 PM]
The institutional loss of control over the manner of a persons death, and the placing of that control closer to an individual making their own autonomous decision as to how much suffering they must endure is a meaningful advance to individual liberty. Society has moved on from institutional and religious control of birth and of marriage to the last of the triad of control, death. Suffering is not noble for most of us. If the choice is to suffer, no law stops someone from doing so, in my experience almost all who ask about MAID have considered or are under expert palliative care which has provided them with the best it has to offer. It has for these patients no longer to satisfy their needs, physically, psychologically or spiritually. The various tenets of various religions are not held by all, and no one is forcing anyone to disobey their own spiritual path. Institutional killing is present in war, executions, and poverty. More efforts in saying no to these institutional issues would be more appropriate.
Member of the public
[April 29, 2021 2:02 PM]
Dear College of Physicians and Surgeons of Ontario, As a resident of Ontario since birth, I would like to add my voice to the many who are asking for conscience rights for those medical practitioners who are against MAiD. No one, for fear of losing their practice, should be forced to advocate for MAiD. This is not a question of "fake" news or old wives tales like "reading by flashlight will cause eventual blindness." Reasonable people can agree that this is not factual. However, there is no such consensus with MAiD. There is a great deal of controversy about this law and a great deal of unease as we all know that it will gradually keep expanding. Doctors should have the basic right to choose not to advocate this to their patients and especially before anyone is critically ill. We have come to a sad juncture in this country when people can face censure because they believe in life rather than hastening death. It will not cause any undue hardship to patients to allow conscience rights for our doctors. I ask you to please do so.
Member of the public
[April 29, 2021 12:47 AM]
If a society permits assisted suicide, then the same underlying attitude will infect palliative care. For evidence, I refer to a comment in a concurrent CPSO discussion in which a commenter endorses an article in a medical journal, one that suggests changes to CPSO policy on palliative care, http://policyconsult.cpso.on.ca/?page_id=13100#comment-11371 . "A treatment should not be provided simply because an individual or their SDM demands it and it can be implemented. Rather, it should only be provided if there is some reasonable probability of benefit [as measured by the physician], if it is desired [by the patient], and if it can be defended on grounds of distributive justice." With respect to DISTRIBUTIVE JUSTICE, the commenter means that "withholding or withdrawing potentially life prolonging medical treatment [is justified if] the expected utility is too low to warrant the public resources necessary to provide it." Both this consideration and the evaluation of reasonable probability of benefit are pragmatic. Now the patient's wishes are no longer controlling; instead the doctor and health-care budget dictate. Expensive gender transition become a right, but palliative treatment is either too costly or doubtful of success. Unfortunately, MAiD goes hand-in-hand with subpar palliative care.
Member of the public
[April 28, 2021 9:35 PM]
Guilt, not merely discomfort, is the problem. An effective referral makes the referring doctor or nurse complicit in the potential murder. Referring for abortion or MAiD is similar to reporting a Jew in Nazi Germany: you aren't killing the Jew yourself, but you are still partly responsible for his death, even if all you did was say a few words or point.
Other health care professional (including retired)
[April 28, 2021 4:43 PM]
I am against MAiD, which is a euphemism for Physician Assisted suicide. Physicians and other health care providers should not be forced to carry out an effective referral. MAiD is not health care; the goal is death of the patient. It seems ironic that section 12 e of the CPSO Medical Assistance in Dying guidelines speak about the lack of a timely effective referral leading to adverse outcomes. I wonder what is a more adverse outcome than death. In my years of nursing, my goal was to help people find hope, comfort, a way forward with life. No one should be obliged to participate in killing or be complicit by offering a referral. It is wrong.
Member of the public
[April 28, 2021 1:46 PM]
Response in PDF format.
Member of the public
[April 28, 2021 10:45 AM]
Dear College of Physicians and Surgeons of Ontario, I'll make this short, as I am sure you are getting lots of input about the amendments to the MAiD policies. Re: Allowing people to choose their own deaths and to implicate others in doing so: It's wrong. It goes against the Commandments that have guided civil law for centuries. You shall not kill. It's wrong to coerce HEALTH care professionals, under threat, to take ANY part in such an un-healthy act, going against the oath, "Do No Harm". It tells suffering patients that they are dispensable. If there is no way--provided by law--for health care professionals to abstain from this act--or from referral--then our Government becomes a Totalitarian one, and freedom is destroyed. (We are a family of six adults that feel exactly the same way.)
Member of the public
[April 28, 2021 8:20 AM]
Reading through these comments above, a lot of individuals have mixed feelings about this policy/issue. It makes me think, now that other larger densely populated countries like India and Japan and parts of Europe are in talks of legalizing Maid, it will become a more widely accepted end-of-life option around the world. Everyone, regardless of a doctor, nurse, Physician Assistant, etC, will, unfortunately, have to be more accepting and come to terms with the idea of MAID. But from reading the rest of the comments above, a lot of individuals feel uncomfortable making the recommendation when MAID is requested. Knowing, that the law is now in effect and there is no turning back and hiding from the issue of Maid, perhaps we can make the process simpler? Perhaps, by automating the referral process through computer software and systems, so uncomfortable doctors have to put the least amount of effort into referrals for the request of MAID by a patient. On the top of my head, something like a simple button on a PC, saying that the patient is requesting a maid, could be blindly toggled on some sort of physician software. From there, in the background, the request could be made to another clinic/physician without much effort involved. Another thing that comes to mind is now that End of Life care is becoming a bigger topic, perhaps, create a course in Schools that helps students become more accepting of Maid and how to deal with situations like it? Also, having specialized clinics, that could be run by either doctors or nurses, volunteers that can assist with MAID or Palliative care (whatever the patient chooses or has on their legal binding will), could perhaps work too? I know I'm throwing random thoughts out of my head. But thinking long term, how medicine is practiced, and what we believed and performed years ago, will be significantly changed in the next 5-10 years, with new and exciting advancements in bio and engineering fields. And we will either have to be accepting of these changes or make accommodations to make more progression into a more futuristic society.
Organization
[April 27, 2021 9:32 PM]
Protection of Conscience Project
Response in PDF format.
Member of the public
[April 27, 2021 9:24 AM]
Dear College of Physicians and Surgeons of Ontario, I understand that the federal government has recently extended the categories of people who can access MAiD and that the CPSO is now reviewing the requirements of doctors in these situations. MAiD is still controversial, and while I accept that some patients have been awarded the right to ask for it, I would ask that you please protect the conscience rights of doctors by not requiring them to participate in this process if they disagree morally with the practice (or truly do not believe it is in the best interests of their patient). Doing so could: 1) Cause a moral injury to the physician 2) Discourage future physicians from joining the profession, if they know they may be forced to do something that is against their conscience In the same way that we respect the diversity of values and beliefs among patients, I would ask that you create space in your processes for physicians to be able to hold their own convictions. I know that the medical community deals with ethical matters on a regular basis, and I trust that you would be able to structure this process in such a way that patients would still be able to access their full range of health care options.
Member of the public
[April 27, 2021 8:57 AM]
Response in PDF format.
Member of the public
[April 26, 2021 9:07 PM]
Even if the patient has mentioned MAiD, the physician should not have to refer the patient to someone willing to arrange the potential suicide.
Member of the public
[April 26, 2021 8:46 PM]
If the intent for using morphine in the scenario is to relieve pain and not to cause death, and accepted dosing guidelines are followed, then the treatment is considered ethical, the risk of a potentially dangerous adverse secondary effects particularly hastening death is minimal, and the risk of respiratory depression is vastly over-estimated (https://www.mypcnow.org/fast-fact/morphine-and-hastened-death/ ). If the intent for using morphine is to cause death, then the use is abuse. It is a form of assisted suicide or euthanasia.
Organization
[April 26, 2021 2:39 PM]
Catholic Health Association of Ontario
Response in PDF format.
Member of the public
[April 25, 2021 1:28 PM]
Dear College of Physicians and Surgeons of Ontario, As a resident of Ontario, I write to you regarding your Medical Assistance in Dying (MAiD) policy, which has recently widened the availability of MAiD to the disabled and mentally ill. It is important to safeguard the rights of those doctors who prefer to assist their patients in living with their difficulties and who are morally against the MAiD policy. Do not compel doctors to refer their patients to MAiD services, or to offer MAiD as an alternative to living even if their patients do not inquire about it.
Member of the public
[April 24, 2021 9:04 PM]
What else are doctors lying about? What other blatant lying is required by the CPSO? Some doctors took the Hippocratic oath, but the CPSO is now forcing them to facilitate abortions and, through the policy that is the subject of this consultation, assisted suicides. They are being told to break their vow or lose their license.
Member of the public
[April 24, 2021 8:43 PM]
There must be no policy requiring effective referral. The CPSO should not discriminate against me as a patient by ending my access to trustworthy physicians who, like me, are horrified by the recognition of assisted suicide as a health care service and will never participate in any way. An effective referral requirement for physicians and other health care professionals is unjust to patients because it denies some of them access to appropriate health care. In fact, the CPSO should influence all physicians to be trustworthy and never grant them--despite their limited role in a system with documentation, witnesses, and other safeguards--the power to dispense lethal poison. Technology may have changed radically since the first Hippocratic oath was taken, but human nature remains the same. The irony is that not only is MAiD not beneficent, and not only is MAiD maleficent, but also MAiD offends the autonomy of patients by influencing the whole of society toward death as an ideal after useful existence. There will be patients--ever more, in fact, after the recent expansion of MAiD--who will be killed, not really because they want to die, but because they have come to understand--or did once indicate that they seemed to understood--ironically again, that that's life. C'est la vie! Others will never have even given this assurance, but they will be the mistakes in a system where to err is human. If capital punishment been abolished for fear of mistakes by which an actually innocent convict dies, then why is not the same reasoning applied to the health care system? Others will be casualties outside the system, analogous to born babies abandoned because of societal indifference to the humanity of the human fetus. For example, there will be increased incidence of nursing home attendants intentionally overdosing feeble residents whom nobody visits. The fatalistic and pragmatic philosophy that undergirds MAiD is not glorious and free. It is survival of the fittest, and it is brutish and cruel, completely opposed to the monastic origin of health care. Shame on Canada! Do not require effective referral.
Member of the public
[April 24, 2021 3:51 PM]
So does putting them on a morphine drip as they slowly fade away....
Member of the public
[April 24, 2021 11:28 AM]
Dear College of Physicians and Surgeons of Ontario, As a consumer of health care in the province of Ontario, I ask that you respect and protect . the conscience rights of all doctors. They should not be forced to make arrangements for MAID for a patient if it is against their conscience. Also doctors should not be told that they have to suggest to a patient that MAID is available to them if they have not already asked for or about it. Having your doctor discuss MAID with you as a patient is just a form of promotion and will be seen by the patient as "I guess that I need to do this". It would certainly lower moral and end up increasing the number of patients who request MAID. Is that what we want in this province - doctors with a conscience need not apply? I prefer to know that I can still find a doctor who will care for me until natural death.
Member of the public
[April 24, 2021 5:05 AM]
Dear College of Physicians and Surgeons of Ontario, We need our doctors, nurses, and medical professionals more than ever. They are a diverse and talented group who want to serve and help others, and their consciences should be respected. Please protect our caring doctors, nurses and pharmacists from being forced to participate in causing the death of their patients. No one should be forced to provide or aid in providing euthanasia, including making a referral. People are resourceful and will find ways to get what they want without forcing all doctors to prescribe death.
Member of the public
[April 23, 2021 9:04 PM]
MAiD inevitably degrades palliative care. Palliative care is expensive; MAiD is relatively cheap. Long ago, when there was not enough food to go around, the Inuit practiced senilicide, simply abandoning the elderly. Modern MAiD is more sophisticated but amounts to the same economics: you're getting old, you're a drain on resources, there is MAiD, you know. These suggestions might never be verbalized: the existence of MAiD as an option is enough to make the argument. Forget prompt access to MAiD--ANY access to MAiD will in the long run hurt palliative care.
Member of the public
[April 23, 2021 10:35 AM]
Dear College of Physicians and Surgeons of Ontario, Doctors are so important! We need them, we appreciate them and we couldn't live without them. Literally. Please insure that their profession does not force them to end someone's life if it is against their conscience. A doctor should not be expected to perform euthanasia or an abortion if it is against their personnal values. Also, it should not be part of their job to inform a patient that MAID is an option, if that patient has not mentionned it himself. That is just so sad and cruel. I hope that doctors will continue tu have a profession that enables them to have a free conscience and act upon it, helping their patience in every healthy way possible.
Member of the public
[April 23, 2021 10:34 AM]
The College of Physicians and Surgeons of Ontario, Dear Doctors, These are trying times we are living in. Each day on the news we see exhausted Doctors and medical staff in hospitals doing their best to save the lives of patients due to COVID. Recently in Ontario our emergency rooms are so full that doctors are in tears or are very emotional over the life and death decisions they may be forced to make re who should get a ventilator and who will be left to die. My heart breaks for doctors that they are being put into this position. Interestingly enough, this is what is proposed for all doctors regarding euthanasia. How can a doctor who has made it their lives practice to save lives now be forced to assist someone to die? This should never happen. We are asking that you amend the current policy so that doctors will not be forced to make arrangements for euthanasia assessment if it is against their conscience. We are also asking that you do not add anything to the policy that would force doctors to inform patients of their potential eligibility for euthanasia before the patient makes a request. This change, supported by euthanasian advocates, would have the effect of lowering patient morale and promoting euthanasia. Please protect the conscience protections for doctors.
Member of the public
[April 23, 2021 8:52 AM]
Response in PDF format. [MESSAGE FROM ADMINISTRATOR: DURING THE CONSULTATION PERIOD, WE RECEIVED 14 RESPONSES FROM INDIVIDUAL RESPONDENTS, CONTAINING THE CONTENT PUBLISHED ABOVE, WITH VARYING LEVELS OF PERSONAL CONTENT OR INFORMATION INCLUDED. WHILE EACH INDIVIDUAL RESPONSE IS NOT BEING PUBLISHED HERE IN FULL, THESE RESPONSES ARE ALL BEING READ AND CONSIDERED AS PART OF THE PUBLIC CONSULTATION.]
Member of the public
[April 22, 2021 9:13 PM]
Killing or mutilating the patient or a dependant of the patient is always wrong. Forcing a doctor to be complicit in the killing or mutilation of the patient or a dependant of the patient is even more wrong. First in medical ethics, according to the ancient Hippocratic oath, is to do no harm. That the CPSO is training students and forcing doctors to help kill patients and their dependants is not just unprofessional and unethical; it is downright evil. To say the least, the CPSO should force out of the profession any doctor or nurse who intentionally kills people.
Member of the public
[April 22, 2021 7:24 PM]
Note: Some content has been edited in accordance with our posting guidelines. Dear College of Physicians and Surgeons of Ontario, As a person living in Ontario, I would like to give voice to my thoughts about your Medical Assistance in Dying (MAiD) policy. I have had many great Doctors in my 80 years and have been quite greatful for their skills and compassion. Right nowI have a wonderful Nurse Practitioner and think the world of her. She is very thorough and compassionate.She has treated my wife, [redacted], through 2 cancers and other problems as we expect our professionals to do. I cannot fathom that she would be required to kill a patient and not continue treatment for a good outcome. We have so many wonderful doctors/healers on Canada and our Province of Ontario and regardless what the ones in Ottawa say, we cannot in good faith, to them or the citizens, turn them into executioners.
Member of the public
[April 22, 2021 7:12 PM]
Note: Some content has been edited in accordance with our posting guidelines. Dear College of Physicians and Surgeons of Ontario, I've been a resident in Ontario for several years, where I am currently doing my PhD in Medical Biophysics at [redacted]. May lab is part of the [redacted]. Prior to moving to [Ontario] I lived in [redacted] and volunteered in [redacted]'s Palliative Care ward, as well as several hospices in [redacted]. I am very disappointed in the direction my health care system is taking here in Ontario, and would like to formally express my opposition to expanding medical assistance in dying to the disabled and those struggling with mental health. Many of my colleagues, some I closely work with, have suffered from depression and anxiety, especially during the pandemic. They are vulnerable, and deserve care and support to get through the rough patches they are facing. In all honesty, from the anecdotes that I hear from practicing doctors in Ontario, and family who has accompanied people with complicated medical issues in the health care system, I no longer have much trust of my own health care system to have the best interests of the patient. Furthermore, I strongly disagree with the professional pressure and disciplinary action and regulation/legislation that would prevent doctors from following their well informed conscience, and force them to make effective referrals to other doctors who would do things like provide lethal injections or poisonous cocktails that end the life of a patient. My health care system is in your hands. Please do what you can to make it about caring for the vulnerable, and accompanying patients, instead of sending the message that their life is not worth living.
Member of the public
[April 22, 2021 5:45 PM]
Dear College of Physicians and Surgeons of Ontario, Is there anyone reading or hearing this who hasn’t experienced difficult moments at one time or another in one’s life? Hopelessness can present itself in many ways; it can cause us to choose death at a time when all of our defences are down and vulnerability at an all time high. Who of us, has not encountered a family member or friend who thought they would never get through their crises? Yet with the help and support of friends, family and medical professionals we did. Life teaches us many things as we get older. Think of your own son’s and daughters who may experience a crisis in their life, only to be offered at a vulnerable moment, a way to end it all. I appeal to you, consider those you love as it will be too late when they are gone, if this bill goes through. Even if you have no belief in God, what gives us the right to introduce to the vulnerable, the idea that it is okay to end one’s life? Do you really want to lead them on that path. Many will choose to die when life appears hopeless simply because they are at their lowest. The increase of categories will create an endless path of people justifying why they should end their lives and thinking it is okay because it’s legal. Just because it’s legal doesn’t mean it’s right. Please consider what doors you are opening when you offer people a means of ending their life; an individual mentally challenged who cannot at that time see that there will be better times than this moment or this day; the lonely, broken hearted, the elderly etc.
Member of the public
[April 22, 2021 5:29 PM]
Ontario Health and Death Insurance Plan would be a more apt name for our present and future system than OHIP. College of physicians and surgeons and executioners would be a better name than CPSO if the new MAID laws are to be enacted as they stand now. Going to the doctor for medical help and admittsnce to a hospital may become a worrying act if putting to death is the new recommended treatment for the old, infirm, depressed and worthless. Worthless indeed because one does not typically dispose of the worthwhile. I came from Holland and my aunts and uncles and cousins feared to go to the hospital as aged folks when they became sick. Canada is going the same route. Better economically to be sure! And that has to be the big factor in this issue apparently. Human life is disposable. Please, as caring doctors and surgeons, voice YOUR objections to keeping the injunctions in this bill!
Member of the public
[April 22, 2021 2:59 PM]
Dear CPSO, As a life-long resident of Ontario, I am concerned about the quality of our health care system and of our doctors. I believe we need our doctors to uphold the highest possible standards of medical ethics in their practice. This means that they must NOT be pressured into referring patients for MAID. To do so would be out of harmony with the Hippocratic Oath and the policy of the World Medical Association. Personally, I would not feel comfortable having a doctor who resorts to MAID for his patients. This scares me to death. I want to know that my doctor will do everything possible to save my life and encourage me to fight to live if I were to ever experience a terminal illness, disability, or debilitating accident. To even suggest MAID as an option is defeatist, disrespectful, and it implies that my life might me considered "unworthy" in some way - which it is not. Please ensure your policies affirm patients' lives and doctors' conscience rights to uphold universal ethics. Thank you.
Member of the public
[April 22, 2021 2:45 PM]
Dear College of Physicians and Surgeons of Ontario, Please don't FORCE doctors to help kill people. Many people are perceived by others as burdens and many of those are vulnerable. There will be cases where the doctor is forced to be party to what is described as suicide but is in fact closer to murder. Conscious is the only protection for the patient.
Member of the public
[April 22, 2021 1:09 PM]
Dear Minister Elliot, I am writing to ask you to support legislation for conscience protection and regulation of Medical Assistance in Dying (MAiD), so that no physician--or other regulated healthcare professional, such as a nurse practitioner, registered nurse or social worker--is obliged to raise MAiD as a treatment option or to refer a patient directly to another health professional for the purpose of receiving MAiD. My reasons for this request are numerous and as follows: -Bill C-7 will place persons at risk for wrongful deaths. Patients should have their suffering addressed by good medicine and support. -Medically administered death for life-suffering, instead of resources and medical care to live, is unconscionable. That amounts to abandoning patients at their lowest point, when they need help the most to find ways and reasons to go on living when things get difficult. Difficulties, and learning to overcome them, are an integral part of life, and various healthcare professionals have been well-trained to help patients with coping, to improve their resilience and their quality of life physically, mentally, emotionally and spiritually. -The College of Physicians and Surgeons of Ontario currently requires physicians to create a pathway for MAiD. -To have a policy that forces some health care professionals to violate their conscience is discriminatory against members of the profession who do not believe that death is a good treatment option for people with disabilities, chronic illness and mental illness. -Patients receive better care when their doctors are free to act with integrity. A patient should know that they are being offered what the doctor truly believes to be appropriate and the best clinical care, not what the doctors have been coerced into doing via threat of disciplinary action. I have worked on the front lines of healthcare for the past 30 years. I have worked in a setting that has regularly provided euthanasia aka MAiD ever since it became legal in 2016. So I speak from extensive experience. Requests for MAiD and deaths by MAiD have increased over time; at least in my work setting i.e. palliative care, MAiD is far from a rare occurrence these days. It will no doubt continue to increase as long as legislation keeps expanding MAiD to include more groups of people e.g. the disabled, mentally ill, seniors who feel they've lived long enough, mature minors, and younger minors whose parents choose death on their behalf. This is especially likely to be the default choice of too many Canadians as long as there is no significant improvement to the availability of services that enhance the health and quality of life of Canadians with terminal illness, disabilities or mental illness, frail elderly people, people in long-term care, etc. Especially those who are marginalized in one or more ways. Since euthanasia was decriminalized in 2016, I have witnessed highly skilled and experienced palliative care professionals, including physicians--who are in short supply at the best of times--leave their area of specialty so as not to have to deal with MAiD, given their philosophical and/or moral objection to it and the pressures placed on them legally and professionally. Some have left their profession entirely. Others, including myself, have "retired" earlier than we planned to or wanted to, because of undue pressure to act against our conscience when it comes to MAiD in the course of our practice. Still others have moved on to other professions, or from front line clinical work to research work, in order to "get away from" the pressures unduly imposed upon them by current legislation re:MAiD. It is unjust and oppressive to expect healthcare professionals with conscience objections to MAiD to have anything to do with it, including discussing it at length with a patient or making "an effective referral." This can result in serious moral distress for practitioners and cast a pall on the good work they do to help patients live with the best possible quality of life, whatever circumstances in which they find themselves. There are enough healthcare professionals who are supportive of MAiD that they should be the only ones to have to address it in any way with patients. This will respect and protect the conscience rights of physicians and other healthcare professionals, who do not wish to feel complicit in what they perceive to be wrongdoing i.e. helping to end a patient's life unnaturally--a practice that is highly controversial, including in ethics circles and among healthcare professionals of all disciplines, regardless of what their official governing body may say to the contrary. Conscience rights are supposed to be protected under Canada's Charter of Rights and, in my province of Ontario, the Human Rights Code. This has yet to be allowed in practice. Please support full protection of the conscience rights of physicians and other healthcare professionals to not be involved in assisting a patient in any way, to any degree, to access MAiD. That is the right and fair thing to do.
Member of the public
[April 22, 2021 12:58 PM]
Here is what the Australian province called Victoria, does for their “conscientious objectors”: “There is strong protection in the legislation for health practitioners with a conscientious objection to voluntary assisted dying. Section 7 of the Act states that “[A] registered health practitioner who has a conscientious objection to voluntary assisted dying has the right to refuse to do any of the following (a) to provide information about voluntary assisted dying; (b) to participate in the request and assessment process; (c) to apply for a voluntary assisted dying permit; (d) to supply, prescribe or administer a voluntary assisted dying substance; (e) to be present at the time of administration of a voluntary assisted dying substance; (f) to dispense a prescription for a voluntary assisted dying substance”. There is no requirement for health professionals with a conscientious objection to voluntary assisted dying to refer patients on to a willing practitioner.” Parliament of Victoria: Voluntary assisted dying act (2017). https://www2.health.vic.gov.au/hospitals-and-health-services/patient-care/end-of-life-care/voluntary-assisted-dying/vad-overview.2Accessed 21 Nov 2018.
Member of the public
[April 22, 2021 12:44 PM]
Dear College of Physicians and Surgeons by violating the rights of conscience of those physicians who deem these action to be murder you are an accessory to their crime. Do no harm, either to the conscience of your colleges or the patients in their charge or if you insist otherwise, do your own killing.
Member of the public
[April 22, 2021 12:20 PM]
• Bill C-7 will place persons at risk for wrongful deaths. Patients should have their suffering addressed by good medicine and support. • Medically administered death for life-suffering instead of resources and medical care to live is unconscionable. • The College of Physicians and Surgeons of Ontario currently requires physicians to create a pathway for MAiD. See Fletcher, J. CMAJ2015 editorial. • To have a policy that forces some health care professionals to violate their conscience is discriminatory against members of the profession who do not believe that death is a good treatment option for people with disabilities, chronic illness and mental illness. • Patients receive better care when their doctors are free to act with integrity. A patient should know that they are being offered what the doctor truly believes to be appropriate and the best clinical care, not what the doctors have been coerced into doing via threat of disciplinary action. • Canada is a diverse democracy. Manitoba followed Dr. Fletcher’s plan. Liberal democracies are meant to understand that we are not all alike, and accommodations should be made when possible.
Physician (including retired)
[April 22, 2021 9:42 AM]
Good Morning! The issue of MAiD has been a matter of controversy for quite some time. I have put a lot of thought into the matter and submitted a document as below to discuss the principles that relate to the respect of physician conscience in a pluralistic society. Included are suggestions how the CPSO could balance the disparate societal pressures in an equitable and ethical way. Please take time to read this—I know there is a lot to process!
Other health care professional (including retired)
[April 22, 2021 9:35 AM]
Note: Some content has been edited in accordance with our posting guidelines. To the College of Physicians and Surgeons of Ontario (CPSO), My name is [redacted] and I am an advocate and admirer of medical professionals who dedicate their livelihood, and sometimes their lives, to promote and sustain the health of Canadian citizens. Two of my children are in health care professions (RN and RD) and I too worked in a hospital (RRT). We have seen a lot of suffering and death, and understand the ethical challenges medical professionals face, especially when a patient is suffering physically, mentally and/or emotionally and is feeling hopeless. We have also thankfully seen a lot of hope and recovery. With the expansion of MAID, however, I am unsure my advocacy and admiration are well placed, especially if medical professionals are restricted from having the freedom of conscience in practice. It is my understanding that the CPSO is currently considering that doctors be required to arrange for euthanasia assessments, even if it defies their consciences. It seems to me that, in your considerations, Section 2: Fundamental Freedoms of the Charter of Rights and Freedoms stated below is not being applied. Fundamental freedoms – section 2 2. Everyone has the following fundamental freedoms: freedom of conscience and religion; If it is, then doctors and all medical professionals have the freedom to advise or not advise patients on euthanasia and the freedom to inform or not inform them about euthanasia. What other interpretation and application are there of this protection of freedom of conscience? Canadians believe that physicians are committed and obligated to inform and prescribe to patients treatments that promote health, prevent illness and improve one’s quality of life. Some, however, believe that euthanasia is sometimes the only solution to improve a patient’s quality of life by enabling them to die. Not everyone believes that death is the solution for suffering. Therefore, not everyone, not every medical professional, not every doctor should be required to inform, advise and advocate for euthanasia. As I see it, requiring doctors to arrange for arrange for euthanasia assessments is a violation of their freedom of conscience. It is my hope that the CPSO honour and protect our freedoms and allow all medical professionals to act according to conscience without fear of reprisal. Thank you for considering my perspective.
Member of the public
[April 22, 2021 8:07 AM]
I know you are in the process of updating your policies on conscience rights for doctors and I earnestly ask you to word your statement so no medical staff should ever be asked to go against their conscience. This means proscribing any medication, providing MAID, being obliged to provide information about procuring MAID. This does not mean that a person who wants death cannot have it, but they cannot oblige another person whose conscience does not permit them to kill a person intentionally be obliged to do so. If, as the advocates are so vocal about the right to have it, let the medical staff who are willing to perform this deed advertise. In this day and age when it has become clear that the drug cocktail used to kill the person has been banned from executions in the US for being inhumane, and now a similar method is used for MAID, then it should stop being used until at least a fool proof way of non-suffering death is found. People have taken up to 36 hours of excruciating pain to die in some cases, as your studies show. How can medical staff tolerate this abuse of people in the name of "dying with dignity"? Please protect doctors who wish to follow their conscience. Let those who are willing advertise.
Member of the public
[April 22, 2021 12:04 AM]
The sober observer cannot help but notice that the West is using Orwellian tactics to achieve change and call it progress.  In Canada the biggest risk of sex, unwanted children, was eliminated by Section 223 of the Criminal Code:  "a child becomes a human being within the meaning of this Act when it has completely proceeded, in a living state, from the body of its mother."  Redefine the human child so that abortion is not murder!  More recently overburdened health care systems were enlightened with the help of the MAiD.  Redefine medical care so that assisted suicide and euthanasia are not murder! Put aside for a moment consideration of the obviously atheist origin.  What makes quality of life any better a criterion for societal acceptance than Aryan ancestry?  In all societies, whether they be rich Dutch city dwellers or poor Chinese farmers, the right to die degrades into the duty to die.  The Groningen protocol is just as barbaric as the two-child policy.  Swallowing toxin from one's doctor or caregiver may be no more voluntary--indeed, often less so--than gulping fertilizer to avoid becoming a burden to one's children.  Killing is caring?  Really?
Member of the public
[April 21, 2021 11:10 PM]
MAiD is not the practice of medicine, and all patients need to know that physicians will first do no harm. Should patients fear hospitals because they intentionally kill patients? Perverse beliefs should not impact the patient's right to receive life-sustaining care. Dying should be entirely patiently waited, with palliative care to make the suffering more tolerable.  Medicine and killing don't mix.
Member of the public
[April 21, 2021 10:30 PM]
From a medical perspective, killing the patient harms him.
Member of the public
[April 21, 2021 10:07 PM]
I don't know whether your comment is well written French, but Google's translator shows me that it is good sense. Indeed, true compassion journeys along with the sufferer, suffering with him. Job's wife urged him to curse God and die, but his three friends, when they arrived, sat with him for seven days and seven nights without speaking a word, for they saw that his pain was very great. Yet even they erred greatly by afterward speaking too easily and confidently about that which they did not understand, Job's suffering and its cause.
Member of the public
[April 21, 2021 9:46 PM]
It is murder. Read Genesis 6-9 in the Bible.
Member of the public
[April 21, 2021 9:37 PM]
You misrepresent me as a potential and probably eventual patient. Promoting the inherent dignity of the human being--the sanctity of human life--is beneficial to every human being and, therefore, in the general interest. Really you are the one representing special interest groups. Abortion, assisted suicide, and euthanasia cheapen human life in general and unnaturally end it specifically for the very young, very old, very sick, and very confused. Why may I not have a doctor whom I may trust to never even consider offering me in my darkest moments the final solution? Suicide is a sin! You probably care about the patient's consent. Doctors annually kill 100,000 young Canadians without having asked their consent, and the recent expansion of assisted suicide to those who are psychologically vulnerable will increase the numbers of older Canadians killed without meaningful consent. The human being is an odd assortment of beliefs, moods, trends, and contradictions that defy a mechanical process of consent. The grim MAiD may be currently legal in Canada, but she is not good. She is, in fact, evil. Canada is no longer glorious and free. Kill the MAiD!
Member of the public
[April 21, 2021 8:34 PM]
And you could add that not everyone believes in the pre-born child, either. Where does that leave him? Is it reasonable for his mother to kill him just because she does not believe he exists? He's only a clump of cells, she says. Note, then, that there is no such a thing as religious neutrality. Without presuppositions there can be no reasoning. Canada was founded upon principles that recognize the supremacy of God and the rule of law. One of those main principles--if not the main principle--is the sanctity of human life, also called human dignity. Because God had made the human being a little bit like Himself, He has reserved to Himself the right to decide the time of that being's ending. I may not even kill myself; suicide is murder.
Member of the public
[April 21, 2021 1:05 PM]
Maybe because to do so is career suicide? So doctors with conscience issues just try to avoid situations where they are asked for it?
Member of the public
[April 21, 2021 12:41 PM]
Dear College of Physicians and Surgeons of Ontario, Since the government has allowed more people to access MAID, I have become very uneasy for doctors as well as patients. Please amend your current policy so that doctors will NOT be forced to make arrangements for euthanasia assessments if it goes against their conscience. It must be very difficult for people who entered a profession to help save lives to discuss MAID as an option for the "care" of their patients. Please do NOT add anything to the current policy that would obligate doctors to inform patients of their potential eligibility for euthanasia before the patients inquire about it. I fear this information would prompt many patients to request MAID at a time when they are mentally vulnerable. This is morally wrong. It is not in the best interest of those patients and it should go against the principles of most doctors. If my doctor ever suggested MAID when I did not broach the subject, I would not care to hear the reasons she was compelled to tell me of my eligibility to receive help in dying. I would believe that she gave up on me, that she thinks I wasn't worth her time and medical resources and I would feel that she made a judgment on my outcome and the value of my life. How utterly demoralizing! It would contraindicate the very reason I would seek medical help in the first place. Unfortunately, if your current policy stays in place, I won't have the choice to look for another doctor.
Physician (including retired)
[April 21, 2021 10:26 AM]
Note: Some content has been edited in accordance with our posting guidelines. Response in PDF format.
Member of the public
[April 21, 2021 9:26 AM]
Dear College of Physicians and Surgeons of Ontario, As a resident in Ontario, I'm deeply concerned for not only the safety of my elderly loved ones, but for the ability of friends in the medical field in Ontario who do not wish to participate in the killing of their patients. MAiD already undermines the dignity of patients and now it threatens the conscience rights of the most dedicated and humane doctors in the province. Why would you threaten the best, brightest, and most compassionate doctors in the CPSO by violating their consciences? Furthermore, you would be putting up roadblocks for excellent candidates to enter the medical field because they do not wish to do harm. Please refrain from imposing any more burdens on conscientious doctors in Ontario.
Member of the public
[April 21, 2021 8:37 AM]
Dear College of Physicians and Surgeons of Ontario, I am an Ontario citizen with responsibility for others in my family who deal with mental health challenges. Given the incredibly long wait times to access psychiatric and other mental health services in Ontario, and the load that places on vulnerable individuals, I am alarmed by the federal government expansion of doctor-initiated death. How this plays out in practice for vulnerable people looks like it is going to depend on doctors. Specifically, it will be necessary to find doctors for my family that are committed to care, and who don't see killing as a suitable substitute for actual treatment - even if that treatment is woefully underfunded and in short supply. I need to be able to take my family to their doctors with absolute confidence that not only will they will not be encouraged to consider life-ending alternatives as a way out, but that instead they will be actively supported in finding life-giving and life-enhancing options. If you force doctors to make an 'effective referral', you are preventing me from ever accessing the very doctors I need - those who don't see killing as a fair or suitable alternative for patients with disabilities. You would be destroying the trust that is absolutely fundamental to the doctor-patient relationship. Even countries that have long permitted assisted suicide - such as Switzerland - do not even permit the Canadian level of killing, and certainly do not force their doctors to participate in even assisted suicide, never mind direct killing. There is certainly no international medical consensus on the desirability or even ethics practice, Canada being very much an outlier, and Ontario even moreso. The record from the rare countries who have been enthusiastic about killing patients, the Netherlands and Belgium in particular, show a continuing erosion of patient and family rights. Given the current pressures on health care spending - pressure that is going to get much worse with huge COVID budget deficits - there is also going to be pressure from governments to encourage more economical treatments. When killing patients is the fastest and most economical treatment of all, the government will undoubtedly pressure the CPSO to oblige doctors to 'inform' or 'advise' their patients of this cost-saving alternative. This would be perhaps the most dangerous of all: An Ontario where doctors must, even in a small way, encourage people to kill themselves that had not otherwise thought of it. Those seeking death have many alternatives already. Please protect me and my family. Please enable us to access the fear-free medical care that we too deserve.
Member of the public
[April 21, 2021 7:57 AM]
Note: Some content has been edited in accordance with our posting guidelines. Dear College of Physicians and Surgeons of Ontario, As a citizen of Ontario, I would like to share my opinion about your Medical Assistance in Dying (MAiD) policy. Recently, the federal government increased the quantity of people who can access MAiD to include people living with disabilities and those coping with mental health challenges. I am relieved that these patients will have more access to medically assisted dying. Quality life is IMPORTANT, duration of life is much less so. Reduce the suffering! We need healthcare professionals in our healthcare system who understand suffering, and have the courage to end it when deemed appropriate by the patient. These professionals need to be protected from litigation in performing these euthanasias. [redacted] MAiD is UNFORTUNATELY still illegal in most countries. Medical ethics is divided on the issue. The World Medical Association MIGHT BE against the practice, BUT HOPEFULLY WILL COME ON BOARD. Yet you are necessitating all healthcare professionals in Ontario to aid. I need a healthcare professional who will confirm to me that she or he will care for MY WISHES, when depression or a urgent diagnosis make it burdensome to keep going. This is IMPORTANT for loved ones or friends whose health concerns may make them vulnerable to contemplating ending their lives. Please authorize healthcare professionals to CONSIDER THE WISHES OF THE PATIENT. DO NOT TRAMPLE UPON THE WISHES OF THE PATIENT! ALLOWING doctors to engage in making arrangements for MAiD ADDS TO the trust in the physician patient relationship. The physician is compelled to do something based on protecting their employment, rather than their understanding that it is the correct treatment for the patient. I am also PLEASED that you may be contemplating a requirement that doctors apprise patients that there is a chance they might be approved for MAiD even before they request it. This seems very THOUGHTFUL– in essence it means informing a patient who is depressed or a person with a disability that they can access MAiD when the idea had not come to their mind. I am perturbed that vulnerable patients'S WISHES may be THWARTED by RELIGIOUS ORGANIZATIONS INTERFERING WITH OUR LIVES, and
Member of the public
[April 21, 2021 7:47 AM]
Note: Some content has been edited in accordance with our posting guidelines. Dear College of Physicians and Surgeons of Ontario, As a pastor in Ontario, I am concerned about your Medical Assistance in Dying (MAiD) policy. As a pastor in [Ontario], we have several physicians and nurses who are members of our congregation. Our commitments to our faith beliefs makes it immoral to promote any form of suicide. Please develop a policy that protects the religious rights of all physicians without compelling them to make an "effective referral". Your actions will force some of our countries best doctors and nurses to move to other countries where they can serve without violating their conscience. Also, as a patient nearing retirement, I want the confidence to know that if my health deteriorates, that I have a doctor that values life enough to not support suicide.
Member of the public
[April 20, 2021 10:23 PM]
Dear College of Physicians and Surgeons of Ontario, Physicians should uphold life, not end it, regardless of the patient's mental condition. Doctors and other health professionals should be free to follow their conscience and not be forced to participate in any form that would lead to euthanasia. Patients should be safe that on those moments when life seems unbearable, there are doctors or health professionals who will look after their best interest to live life instead of ending it. Sincerely asking you do not make doctors and other health professionals peddlers of euthanasia.
Member of the public
[April 20, 2021 9:25 PM]
Dear College of Physicians and Surgeons of Ontario, Do NOT take away conscience protections under MAiD or any program, for the doctors you regulate.
Member of the public
[April 20, 2021 9:15 PM]
Dear College of Physicians and Surgeons Do you not think that enough people have died from Covid that you feel obliged to help kill even more. People suffering from depression need loving and caring help from health professionals, not someone to point them towards an execution. Dealing with isolation because of Covid contributes to more and more depression. This new law is like taking advantage of our predicament with Covid to rid the world of even more people. Wrong is wrong. To compound all of this by making medical professionals go against their conscience, their moral beliefs and/or their religious beliefs is wrong. Just because some of you may lack these qualities does not justify, in the end, the killing of another human being.
Member of the public
[April 20, 2021 9:11 PM]
Is it too much to ask the CPSO to leave the killing of people to rapists, executioners, and terrorists? My tone is abrasive because I remember the outcome of their 2014 "consultation" forcing doctors to kill pre-born babies and provide "contraceptives" and contraceptives. Although the majority of the comments opposed the new policy, the CPSO went ahead with it, anyway. They also buried the consultation, I remember, and it simply disappeared after the feedback deadline instead of receiving the analysis I seem to remember seeing given to other consultations. Doctors and nurses are supposed to help heal, and the CPSO are supposed to train them to do their job of healing. Referring to abortion and suicide assistance as services and requiring medical students to tacitly approve of them and professionals to offer them or else refer patients to others is making them complicit in murder. As a patient, I want a medical system I can trust, NOT practitioners and observers who--whether out of cynicism, pragmatism, idealistic atheism, or weak-minded sympathy--would advise killing me or recommending that I go MAD (Murder Arranged by Doctors).
Physician (including retired)
[April 20, 2021 8:57 PM]
Note: Some content has been edited in accordance with our posting guidelines. Dear College of Physicians and Surgeons of Ontario, As a specialist in General Internal Medicine in [Ontario], I would like to make known my position about your Medical Assistance in Dying (MAiD) policy. With the sweeping MAiD expansion enacted in parliament, I have no doubt - stemming from my front-line experience - that vulnerable patients will be seeking euthanasia as they start to feel like a burden to others, and people with disabilities will have increasing pressures associated with external perceptions of their quality of life from others in a position of "privilege". Please hear my plea. While I naturally respect the autonomy of my patients and the rule of law -- it is crucial to me to remain outside of the cogwheels of euthanasia and not to be forced to sign an "effective referral". I ask this, not because it is "below me" or I scrupulously refuse to dirty my hands with such an act, but because I personally am convinced that it would not be acting in my patient's best interest. Conversely, I do not ask for the right to dissuade my patient from a position of authoriy -- simply the right to respectfully explore the alternatives to MAiD which may occasionally come to mind first as a simple, clean-cut (and admittedly definitive) solution. Conscientious objection is in no way about shaming a patient who seeks euthanasia: every patient is to be treated with the utmost respect, in particular in times of suffering. It is about offering alternative strategies within medicine to address this suffering, both in the physical dimension and in the psychological dimension.
Physician (including retired)
[April 20, 2021 8:52 PM]
Dear College of Physicians and Surgeons of Ontario, I would like to tell you, very simply, that I am completely opposed to the idea and the enforcement of Medical Assistance in Dying (MAID). This is not a form letter. I am expressing my long-held views that expecting physicians, of which I am one, to be their patients' "executioner" is not what I signed up for when I became a doctor over 50 years ago. The advancement of Palliative Care has been such that there is no longer any reason for patients to die in pain or worse. The recent addition of mental illness to the list of reasons for MAID is preposterous. The expectation that all physicians, irrespective of their personal beliefs, would be forced to comply with a patient's request for MAID is unconscionable! The fact that patients can request MAID despite not having a terminal illness beggars belief. Please do all you can (and more) to get this legislation off the record.
Member of the public
[April 20, 2021 8:02 PM]
Dear College of Physicians and Surgeons of Ontario, I would like to give voice to my feedback about your Medical Assistance in Dying (MAiD) policy. Recently, the federal government extended the quantity of people who can access MAiD to include people living with disabilities and those coping with mental health challenges. Bill C-7 which is open to terrible abuse. Life is sacred and should not be dispensed with because someone is mentally unstable; perhaps temporarily, and is not in a position to give meaningful consent. Frankly, the bill is totally immoral by permitting a doctor to take the word of even a housekeeper or an estate beneficiary to extinguish a human life and even on the very same day! It is what the philosopher Nietze would have wanted and his philosophy was the foundation of Nazism. Remember that the Nazis too started by executing the mentally ill because they were not useful to society, and then it was just small step to decide that Jewish life should be extinguished and Communists. With no respect for the sanctity of life, there is nothing to stop Canada from becoming a Nazi state G-d forbid. Is this what we want for Canada?
Member of the public
[April 20, 2021 7:36 PM]
Dear College of Physicians and Surgeons of Ontario, I line in Ontario, I would like you to know that I do not approve of any Medical Assistance in Dying (MAiD) policy. Recently, the federal government increased the quantity of people who can access MAiD to include people living with disabilities and those fearful of mental health challenges. I do not want this to be a normalization of any kind. I do not want this applied to me or to anyone I associate with. People are people no matter what their condition, physical or mental. We are more than expendable entities. Many have disabilities and require more effort and it is a challenge to see people through this. Having them basically make a commitment to suicide is unjust to the human spirit. We should be doing our upmost to be sure they get the compassionate care they need. We should not be forcing doctors at any level to advise them towards MAID. It is my firm belief that nobody should be forced against their conscience to make even a referral. It is often said that you can tell the state of a country by the way the animals are treated in that country. And here we are having less concern for our doctors and others not capable in some case to make decisions being treated no better than animals. Please let doctors who have a conscience obey their desires to help others not just force them to make referrals to mal aligned practice. I need a healthcare professional who will reassure me that she or he will help me even when depression or a significant diagnosis make it challenging to keep going. This is also the case for loved ones or friends whose health issues may make them vulnerable to contemplating ending their lives. I had a sister commit suicide and I can tell you that although she may have thought at the moment it was the best solution that it was not and that if she had enough time to think about it that it would not have happened. It helped nobody.
Member of the public
[April 20, 2021 7:09 PM]
Dear College of Physicians and Surgeons of Ontario, As an Ontarian please hear me out. Recently, the federal government modified access for MAiD to include people living with disabilities and those coping with mental health challenges. I am troubled about forcing doctors with conscience who differ in a free country on personal moral grounds on euthanasia to be legally compelled to participate or perform the procedure. The right to abstain or recuse oneself should be enshrined in law. Please authorize healthcare professionals to keep caring for their patients in their own way with their right to object. Forcing doctors to cooperate in making arrangements for MAiD obstruct basic freedoms. Other physicians can be referred from a pool who do not object and are willing to assist those who seek MAiD. Forcing all physicians to do something based on protecting their career, rather than their conviction and freedom is wrong.
Member of the public
[April 20, 2021 6:06 PM]
Dear College of Physicians and Surgeons of Ontario, Doctors should not have to refer someone or perform doctor assisted suicide. People's beliefs and values matter!
Physician (including retired)
[April 20, 2021 5:33 PM]
Dear College of Physicians and Surgeons of Ontario, As a retired Family Physician in Ontario, I am not opposed to euthanasia, nor am I opposed to doctors assisting patients who wish to die with dignity. On the other hand, I would be opposed to any regulation that would obligate a physician to carry out or to facilitate this act. The issue of mental illness is a particularly difficult one and this diagnosis should be ruled out by a request for consultation and possible treatment.. The CMPA should be consulted to protect physicians from legal action relating to euthanasia, for example action taken by relatives of the patient. Another obligation that participating physicians will need to address are the legal issues of the patient's will and life insurance considerations. Finally, I don't think that Ontario should adopt a policy that is not shared by the rest of Canada.
Physician (including retired)
[April 20, 2021 4:50 PM]
Note: Some content has been edited in accordance with our posting guidelines. Dear College of Physicians and Surgeons of Ontario, I am a [redacted] year-old family doctor in a mid-sized town in [redacted]. I work in a clinic for the marginalized and those with psychiatric diagnoses. Each week, I am being asked to apply for MAiD. I have a 48 year-old survivor of human trafficking with severe PTSD and chronic pelvic pain who begs to be euthanized. I have a palliative 59 year-old with metastatic lung cancer waiting to hear from his estranged daughter. The home care nurses are asking that I discuss MAiD with him as he is so grief-stricken that his daughter hasn’t called that it is better he be euthanized. I have a 74 year-old with endstage myeloproliferative disorder asking about MAiD because he is scared that he won’t be able to afford hospice. Despite being a conscientious objector, I am duty-bound to refer them to the MAiD clinic. Although I have indicated I will not do the assessment for MAiD, the MAiD clinic sends me the assessment paperwork and I am forced to look through it. The value of these human lives is distilled down to a tick box, a yay or nay. It haunts me, makes me to go the back where I can weep privately. My hands are bloody even though I did not pull the trigger. One day, it will be my turn to die. After having journeyed with patients for the past 17 years, I have no doubt that there will be an accounting of sorts at the end. I will be asked if I had a hand in the euthanasia of those patients. While I will not actively push the medications that will cause them to die, there is the sin of collusion that weighs on me and I will have to answer for this. I cannot abandon patients. Yet, I am asked to do something that traumatizes me. With regret, at the height of my medical career, I find that there is no choice but to vote with my feet. I never thought MAiD would end my career. I thought I could hide behind a private family practice or in palliative care or in senior assessments or in a mental health clinic. I was wrong. It is everywhere. Pain is everywhere and instead of dealing with the pain, we have been given a gun to end it all. Yes, MAiD kills. It killed this family doctor.
Member of the public
[April 20, 2021 4:47 PM]
Dear College of Physicians and Surgeons of Ontario, As a person living in Ontario, I would like to make known my position about your Medical Assistance in Dying (MAiD) policy. Recently, the federal government extended the categories of people who can access MAiD to include people living with disabilities and those fearful of mental health challenges. I have worked with disabled youth and have supported a brother who is bi-polar for many years. What both groups need to hear more of is that they matter, rather than maybe they are a burden. If we open our minds and hearts, we have a lot to learn from them. As I age, how can I place trust in any doctor who treats me if that doctor does not practice according to the oath he took to preserve lives. I learned more life lessons caring for a mother and mother-in-law as they battled terminal cancer than any book or scholar could have taught me. They wanted to live because they knew we valued them. My doctor inspires me to take responsibility for my health and encourages me. How could I trust him if I knew that if I become seen as “a burden on the system”, he will pressure me to terminate my life. This feels like a way to save money in the health system and to think the Bill was pushed through during a pandemic when people were not aware of it is DISGUSTING and GUTLESS. If you want to make euthanasia available, have a unique branch of medicine (just like we have mid-wives for birthing) and that new branch can offer assisted dying. DOCTORS MUST NOT BE INVOLVED IN THIS!! This allows those who want assisted death to proceed, but then there is no conflict for doctors and their patients who want to live.. That is many doctors. MAiD is still illegal in most countries. Medical ethics is divided on the dilemma. The World Medical Association is against the practice. Yet you are demanding all healthcare professionals in Ontario to cooperate. I need a healthcare professional who will affirm to me that she or he will support me even when depression or a significant diagnosis make it challenging to keep going. This is also the case for loved ones or friends whose health issues may make them vulnerable to contemplating ending their lives. Please permit healthcare professionals to keep caring for their patients. Forcing doctors to cooperate in making arrangements for MAiD obstructs the trust in the physician patient relationship. The physician is compelled to do something based on preserving their career, rather than their recognition that it is the optimal treatment for the patient. I am also troubled that you may be contemplating a requirement that doctors apprise patients that there is a chance they might meet the requirements for MAiD even before they request it. This seems very tactless – basically it means apprising a patient who is depressed or a person with a disability that they can access MAiD when the idea had not come to their mind. MAiD should never be normalized to be like any other medical procedure. Otherwise, it will develop into an easy out for governments attempting to save money and for practitioners who want to cut corners. Your regulatory energies should be directed to the protection of vulnerable patients instead of eliminating healthcare professionals whose sole failing is that they do not want to end the lives of those commended to their care.
Member of the public
[April 20, 2021 3:54 PM]
Dear College of Physicians and Surgeons of Ontario, Never, in a civilized, democratic, free society, should anyone be forced to perform or refer for procedures which violate their conscience rights. Once this happens, good, moral, caring, thinking people will stop applying for med school and nursing school. Is this really what we want?
Member of the public
[April 20, 2021 2:48 PM]
Dear College of Physicians and Surgeons of Ontario, As a citizen of Ontario, I would like to make known my feedback about your Medical Assistance in Dying (MAiD) policy. Recently I read volume 1 of Alexandr Solszhenitsyn's The Gulag Archipelago. His study of prison life and the terrorism utilized by the Soviet Stae apparatus to suppress peiople for a host of different reasons, made me cringe but also made me more sensitive to the changes that have come to our society. I am wondering whether Canada with its changes in the law regarding human beings, sickness, death and suicide isn’t in fact becoming its own form of Gulag. People in the health field are supposed to be there to help people in need of health care whether doctor, nurse, or pharmacist. Perhaps these professions, like those of judges and elected public officials, have become intoxicated by power, and admittedly anyone under the right circumstances can become amoral, merely automatons willing to carry out the latest orders by those in authority. Still, I know that there are doctors and nurses who have a conscience that trembles in the face of euthanasia and assisted suicide. That is what MaiD is, regardless of the fine sounding euphemism. For those physicians and nurses that do not accept the morality of that action their conscience must be respected. Period. As Solszhenitsyn wrote about being recruited into the NKVD secret police: ”it was not our minds that resisted but something inside our breasts…..inside your breast there is a sense of revulsion, repudiation. I don’t want to. It makes me sick….. We were ransomed by the small change in copper that was left from the golden coins our great grand-father had expended, at a time when morality was not considered relative and when the distinction between good and evil was simply perceived by the heart.” If a man can write that and survive 14 years of hard labour in a gulag, why can’t a free, highly educated man or woman recognize that in our Ontario? The members of CPSO ought to reflect as did Solszhenitsyn and not sink down into the gutter of today’s Gulag being imposed on a free society by mindless judges and cowardly politicians. Respect life. Listen to that voice of a properly informed conscience and do not crush it with an unjust law.
Member of the public
[April 20, 2021 12:39 PM]
Response in PDF format. [MESSAGE FROM ADMINISTRATOR: DURING THE CONSULTATION PERIOD, WE RECEIVED 3,988 RESPONSES FROM INDIVIDUAL RESPONDENTS, CONTAINING THE CONTENT PUBLISHED ABOVE, WITH VARYING LEVELS OF PERSONAL CONTENT OR INFORMATION INCLUDED. WHILE EACH INDIVIDUAL RESPONSE IS NOT BEING PUBLISHED HERE IN FULL, THESE RESPONSES ARE ALL BEING READ AND CONSIDERED AS PART OF THE PUBLIC CONSULTATION.]
Physician (including retired)
[April 18, 2021 12:56 PM]
The Care Coordination Service was established specifically and exclusively to deal with MAID and currently any referral to CCS is for assisted suicide only. Therefore, the CCS does not provide any information to any other medical service. Such center should provide the information on all available medical services in Ontario to the patients and physicians. The physicians objecting MAID have moral dilemma of actual participation in the process of killing of the patient with current definitions of an "effective referral". The definition of effective referral should be broadened to the information to the patient that such services could be accessed through the hospital with giving to the patient the general info line number, on the internet with entering the topic into the search engine or if this institution broadens the information on access to all medical services in Ontario to the Care Coordinated Service.
Medical student
[April 17, 2021 6:29 PM]
Reading all the responses of people disagreeing above makes me uncomfortable for the near future (5-10 years from now) when we have new unimaginable medical advancements come out from the discovery of CRISPR. Will people find it morally uncomfortable that bioengineers/hackers are playing the hand of 'god' with evolution and the Hippocratic oath then? Only time will tell...However, I am okay with the guidelines that cpso has put in place for MAID. As the majority of the population ages in the next few years, having the option of MAID may help in the upcoming overburdened health care system. We will also, however, still need to put more funding into the health care system so that we can take care of the young and old population alike as the health care system starts to become more stressed.
Physician (including retired)
[April 16, 2021 9:26 PM]
Given the new changes to the MAiD legislation, it would be invaluable to incorporate means for self- referral or a third party referral system that allows physicians to avoid participation in MAiD. The ability to practice medicine in accord with one's own conscience is a necessity to a long and fulfilling career in medicine. Many voices on this forum have asked for them; representation for these physicians matter.
Physician (including retired)
[April 16, 2021 2:03 PM]
At this time, we truly do not understand the pathophysiology of most psychiatric illness, including depression. For this reason, no one can say at this time that a psychiatric illness is truly irremediable. We simply don't have the knowledge at this time. For this reason, I don't believe any psychiatric illness thus qualifies for MAID. I understand that by 2023 mental illness alone may be eligible for MAID if nothing else is done by the government. This is truly a concerning problem, for the reason mentioned above.
Member of the public
[April 15, 2021 10:35 AM]
A term that was coined a few short years ago in the world of technology is "disruption" of a certain industry/field. The medical field rarely ever has any "disruption". So when something does come along, it becomes hard to come to terms to accept it into our daily lives. But as we learn to use it and navigate it, we learn to accept it and we often question how we were able to live a life without it. I feel this is very similar to the issue around MAID. MAID is a "disruption" of the Medical industry, which we need to learn to navigate and learn how to use. Over the years, rules will be changed and modified to adapt to the ever-changing and fast-moving society we live in and I believe it will take time to come to terms with the changes and ever so changing needs of society. A good example of this would be the cell phone. When it was first released, people were against it for many reasons(i.e Security, Privacy, and Health Reasons due to radio waves). But now as the years have progressed, a vast majority of us cannot think of a world without it. I think MAID will be a similar example to this. It will take time, but we will come to terms with it and learn to become a more modern and futuristic society that isn't stuck on rules/judgment that was created in the past for situations that we don't face in our current society.
Physician (including retired)
[April 15, 2021 7:44 AM]
I had a few points to share: 1. for the record, I am a conscientious objector to MAiD 2. i have been troubled by the effective referral issue 3. however, after reading your recent documents, I was quite impressed by not only the safeguards put in to the C7 implementation but also the extensive discussion of conscientious objection and effective referral, including options to refer to agencies that provide more information as an option for physicians like me rater than directly to a potential provider of MAiD. that's really it. I was pleasantly surprised by the documents.
Physician (including retired)
[April 14, 2021 12:25 PM]
The context in which physicians might end patients’ lives has changed. Hippocrates never had a patient on a ventilator. As recently as about thirty years ago no physician had a patient with recurrence of leukemia after bone marrow transplantation. Modern medicine has changed the context in which patients now die, from one natural death with relative impotence of physicians to change the course of dying, to medical prolongation of life resulting in different and unnatural forms of dying. The injunction against lethal drugs in the old context of dying remains valid, but we rightly should reassess it in the context of modern forms of dying. …The physician who prolongs her patient’s life, but who then aids in the patient’s request to die, has not violated the Hippocratic injunction, and in fact has fulfilled the physician’s duty to heal so far as is reasonable without producing harm
Physician (including retired)
[April 14, 2021 12:19 PM]
Over time the Hippocratic Oath has been modified on a number of occasions as some of its tenets became less and less acceptable. References to women not studying medicine and doctors not breaking the skin have been deleted. The much-quoted reference to ‘do no harm’ is also in need of explanation. Does not doing harm mean that we should prolong a life that the patient sees as a painful burden? Surely, the ‘harm’ in this instance is done when we prolong the life, and ‘doing no harm’ means that we should help the patient die. Killing the patient–technically, yes. Is it a good thing–sometimes, yes. Is it consistent with good medical end-of-life care: absolutely yes
Physician (including retired)
[April 13, 2021 8:19 PM]
This is not a legitimate rebuttal. Demanding that a colleague remain silent simply because "the courts have ruled" concerns me. We need debate on this issue. The courts, and politicians, do not have the right to impose fundamental changes on the profession of medicine.
Organization
[April 13, 2021 1:07 PM]
Council of Canadians with Disabilities
Response in PDF format.
Physician (including retired)
[April 11, 2021 7:16 PM]
The effective referral requirement has already been dealt with by the courts, and the promised exodus of physicians who believe their rights supersede those of their patients has yet to appear.
Physician (including retired)
[April 11, 2021 7:13 PM]
It's a medical act, and some patients need a physician's assistance to seek medical care. Should your patients also self-refer for cancer surgery? The courts have already told you that your personal beliefs are no more important than your patient's right to receive care.
Physician (including retired)
[April 11, 2021 7:08 PM]
It's not murder. Read the legislation.
Physician (including retired)
[April 11, 2021 4:56 PM]
Special interest groups have already gone to court in an attempt to value their perceived rights over those of their patients, and the courts have already ruled. If you're not current on the issue, please don't clog this page with old objections.
Member of the public
[April 11, 2021 11:47 AM]
Please hear my heart. It is a moral evil to kill people whether in the womb before birth or due to illness. It is a moral evil to force physicians into the position mandating them to kill their own patients. This is the Hippocratic oath: I swear by Apollo Healer, by Asclepius, by Hygieia, by Panacea, and by all the gods and goddesses, making them my witnesses, that I will carry out, according to my ability and judgment, this oath and this indenture. To hold my teacher in this art equal to my own parents; to make him partner in my livelihood; when he is in need of money to share mine with him; to consider his family as my own brothers, and to teach them this art, if they want to learn it, without fee or indenture; to impart precept, oral instruction, and all other instruction to my own sons, the sons of my teacher, and to indentured pupils who have taken the Healer’s oath, but to nobody else. I will use those dietary regimens which will benefit my patients according to my greatest ability and judgment, and I will do no harm or injustice to them.[7] Neither will I administer a poison to anybody when asked to do so, nor will I suggest such a course. Similarly I will not give to a woman a pessary to cause abortion. But I will keep pure and holy both my life and my art. I will not use the knife, not even, verily, on sufferers from stone, but I will give place to such as are craftsmen therein. Into whatsoever houses I enter, I will enter to help the sick, and I will abstain from all intentional wrong-doing and harm, especially from abusing the bodies of man or woman, bond or free. And whatsoever I shall see or hear in the course of my profession, as well as outside my profession in my intercourse with men, if it be what should not be published abroad, I will never divulge, holding such things to be holy secrets. Now if I carry out this oath, and break it not, may I gain for ever reputation among all men for my life and for my art; but if I break it and forswear myself, may the opposite befall me.[6] – Translation by W.H.S. Jones. I hope you will stand against what is coming down the line for physicians and for vulnerable people who think being killed or killing their preborn child solves their problems. You are in a position to say something and I hope and pray that you do. The pressure is now on doctors in Ontario to kill their own clients. It is insanity to want to kill oneself. It is further insanity to mandate laws in which the doctor is forced to kill people. https://www.justice.gc.ca/eng/cj-jp/ad-am/bk-di.html. In the future, children will be killed too with parental assent, of course. This is all insanity. It is morally evil. Just as bad as systemic racism. Everybody bleeds red and deserves to live. The Hippocratic oath has been changed and doctors are being trained to kill people. The doctors who are not in favour of killing one’s own patients are in danger of being pushed out of the medical system. I beg you to stand against it. And, to stand against MAID. It needs to be eliminated completely. https://policyoptions.irpp.org/magazines/may-2017/mandating-physicians-to-participate-in-assisted-suicide/ http://www.epcc.ca/resources/do-you-call-this-a-life/
Physician (including retired)
[April 11, 2021 11:43 AM]
Note: Some content has been edited in accordance with our posting guidelines. This policy on MAID continues to be a violation of the supreme court ruling which stated that conscience right must be respected. An effective referral does not respect conscience rights. To say a person has a "right" to MAID is vastly different than saying a person has a "right" to force their physician to participate in their MAID. This is not a reasonable balance of patient rights and physicians' conscience. It is very possible to have an effective provision of MAID without requiring physician participation through effective referral as other provinces have proven. Ontario was the first place in the world to strip physicians of their conscience rights. Does that cause you to have any pause? I am appalled at the posture of the CPSO. Likewise, I am appalled that the Royal College would offer a "forum" which had an objective to "contrast key points regarding the evolving debate around Bill C7" (2nd of 3 objectives outline in the invitational email send Feb 4, 2021) and then had a panel where every member was enthused about and promoting changes that were not yet law eg. including people with only a mental health diagnosis to have a "right" to MAID. This was so insulting to many of the 1000 physicians listening that the moderator had to ask people to stop commenting on the bias as she was getting so many comments on it! Interesting that the chat was closed so that no attendee could see what others were chatting. A colleague emailed the college about this and the response from [the Royal College] was a denial of [their] own stated objectives. In the email response to my colleague [they] stated, "Importantly, the intent of the forum was not to debate the proposed changes, but rather to educate our fellows as to the current status of the changes." ([Their] second stated objective for the forum was to "contrast key points regarding the evolving debate around Bill C7.") The disingenuousness of the CPSO and the Royal College - speaking in terms of "balancing" needs of patients and physicians - is not very covert. It is transparent and a very sad state of affairs. In addition, it is imperative that physicians not bring up MAID - the protocol should stipulate that the conversation must be initiated by the patient. The risk of overt or covert coercion cannot be constrained otherwise.
Member of the public
[April 11, 2021 11:03 AM]
Note: Some content has been edited in accordance with our posting guidelines. Good Morning, As an interested mature member of the public, I continue to receive and read the invitations to either provide comments on an existing policy before revision or a new policy under draft. This invitation started around 2014-2015 when I completed a survey conducted by a market research group inquiring about interest in the proposed medical assistance dying, from the federal government. My participation led to inquiring about my interest in participating in the Ontario provincial CPSO planning for the early provincial draft policy. As I receive new invitations to provide comments, I chose which I might have a contribution to offer as the CPSO deadline approaches. Having read the policies and discussions for those of interest, I might reply to ad a comment closer to each deadline. For two of the policies approaching deadlines, Professional Obligations and Human Rights, and Planning & Providing Quality End Of Life Care, I have nothing further to add. MAID is especially of interest to me. My earliest comment had been about the name, “Doctor Assisted End Of Life”, however MAID is certainly acceptable. Unlike Maureen Taylor and Dr. Donald Low’s end of life experience and her investment in bringing this important policy forward, my husbands brain tumour was diagnosed in [redacted] and he lived (with medical care in [Ontario] for surgery, radiation, chemotherapy - then long term care) for four years less two months, [redacted], in a state of moderate then advanced dementia associated with his loss of frontal temporal brain and in part due to his cancer treatments. He wanted all treatments available and his request was respected by his medical teams. That experience as well as that of others, including a sibling I was power of attorney for (complicated cardiovascular history) again prolonged over four years almost in parallel timeline [redacted], to my husband's medical diagnosis and care, confirmed for me what I already knew my personal end of life preferences would be. My thoughts now as we are living in year two of this very prolonged pandemic and having learned how unprepared the Public Health Agency of Canada (PHAC) has been along with the disappointing federal government oversight of our basic safety and security and as we know how overextended the health care services are - Nurses, Doctors, Respiratory Staff, Personal Support Workers, others - as well as hospital capacities and lack of adequate number of nursing home beds - I would not want to live with very rationed care options that I expect will be what we might be living with during several years ahead. Even the current COVID-19 vaccines especially Pfizer BIONTECH and Moderna have been rationed and scarce with federal politics with respect to delayed dosing overruling Dr. Mona Nemer, Chief Science Advisor, Ottawa as well as both Pfizer and Moderna. Regretfully the doctors in Ontario seem to have been very limited - almost disregarded as being able to contribute from the early weeks of 2020. With respect to vaccines, I have an excellent family doctor in [Ontario] and will hope for one of the mRNA vaccines and with his consultation and intending the second dose at the medically advised interval of 21-28 days. The most important choices are those made between patient and doctor, not the Prime Minister. Not knowing when or what our quality of life might be post pandemic, we can expect scarce and rationed health care and government budgets and diminished or compromised daily living. This may add to the interest by more people in considering and requesting MAID. However this might be used as the policy is under review as the pandemic experience should be acknowledged to some extent as the policy proceeds to edit. I am a member of the public, former Registered Nurse, with Clinical Drug Research experience most in oncology among other areas of research, retired.
Physician (including retired)
[April 10, 2021 6:57 PM]
I am sorry but I am not in favor of MAID
Member of the public
[April 10, 2021 5:09 PM]
As a person in my 8th decade, I'm now in good health... BUT I will die within the next 6 to 20 years. The question of when and how I die is what I wish to determine and control for myself: ... and my preferred option would be for a "good" death, quick, pain-free (to the degree possible), and at minimal cost to our public healthcare system... at the time and place of my own choosing ... with my family & friends supporting me... and "of sound mind". (But when/if I start to lose my mental "competency", I want to trigger my "good" death before it is fully lost.) --IOW, I don't want to occupy an acute care bed, nor consume days/weeks/months/years of costly life-sustaining (or palliative) pharmaceuticals... while simultaneously preventing qualified medical personnel from attending to other patients with a longer more productive life expectancy. This would be my absolute worst case scenario!! I have studied the different options now legally available to me -- but none of those provided by the public healthcare system (MAiD, Palliative, Long-Term Care) meet ALL my qualifications for a "good" death. That said, MAiD comes closest --IF I can qualify by contracting a Life-Ending condition! BUT as a well-informed person, I won't choose to get myself infected or otherwise 'damaged' just so I can maybe qualify for MAiD under the present legislated and regulatory restrictions -- NOR should I (or anyone) have to do that just to access a "good" death via MAiD. NOR would I want any provider who bends/ignores the overly restrictive legal requirements be held liable for honouring my request as her or his patient and providing/administering me with the necessary MAiD drugs to accomplish my preferred assisted suicide. I have written my detailed Advance Care Directive -- which includes having MAiD -- AND I've included specific measures and trigger symptomologies that I hope will be honoured/obeyed if I am compromised by accident/illness/mental loss/etc.. AND if perchance an attending publicly-paid MD (or other provider) would choose (for whatever reason) to not honour my choice for MAiD, then I would expect that CSPO (and all future legal/regulatory revisions) would require them to refer me immediately to a provider that would rapidly administer MAiD in full accordance with my ACD. Thank you for considering my submission... on behalf of the many Canadians “of sound mind” who feel similarly about their own "good" deaths. PS. If MAiD is denied me at the time and place of my choosing, and if I am physically capable to do so, I will find an alternate method of terminating my life... which will probably be much more traumatic -- to onlookers, bus/truck/train drivers, to attending first responders, and to my own family and friends who later learn of my having been forced to make that choice because the system or MD refused my treatment decision and/or refused to refer me to a provider who could administer MAiD to me.
Organization
[April 08, 2021 3:51 PM]
Association for Reformed Political Action (ARPA) Canada
Response in PDF format.
Physician (including retired)
[April 08, 2021 11:14 AM]
I feel there needs to be more specific information regarding mental health. As a psychiatrist I am already being asked about MAID. I myself do not do MAID. However happy to refer but I cannot find anyone to refer to around mental health, what do we do in that situation? I understand the mental health is included as of 2023.
Physician (including retired)
[April 08, 2021 10:42 AM]
I am completely familiar with MAID. My Christian conviction and conscience cannot accept MAID. MAID is euthanasia and killing of patients. I will not be able to participate in MAID directly or even indirectly through referral. I have made it known to my patients of this position and have previously made this position known to the CPSO. I seek to provide excellent compassionate care for all my patients including end of life care with excellent palliative care referral if required. Thank you
Physician (including retired)
[April 07, 2021 10:51 PM]
Many persons who have pro-life views cannot in good conscience refer patients for death, even for compassionate reasons. They should have the right to act according to their conscience, and refer such a patient to palliative care, or give them the option of changing doctors. No physician should be compelled to act against their conscience. Otherwise any such physician would be compelled to leave general practice and specialise in another field; and is there not already a shortage of family practitioners? This would limit the numbers even more.
Medical student
[April 07, 2021 9:59 PM]
The idea that MAiD results in a positive outcome is based on the assumption that we know what it is like to be dead, and that--for some people--being dead is better than being alive. However, this is a highly questionable. What evidance do we have to suggest that this is true? How can this hypothesis be tested with objective science? If we don't know what it's like to be dead, how can we possibly determine who would be better dead (should be eligible for MAiD) and who would be better alive (should receive suicide prevention)? Who are we to decide what lives have enough value to continue living and what lives should be terminated? Just because MAiD is legal, is it moral? As a future physician, why should I be coerced into doing something (directly or through another) that kills my patient and does not allow me to monitor or follow up with them to ensure that the treatment had the desired outcome? This seems like an incredibly risky business that no champion of evidance based medicine could ever consider doing. Physicians must be given the freedom to follow their consciences and professional judgement when it comes to MAiD, and should never be forced to perform procedures that violate their deepest beliefs, values, and personal integrity.
Organization
[April 07, 2021 9:31 PM]
Physicians Together With Vulnerable Canadians
Response in PDF format.
Organization
[April 07, 2021 9:20 AM]
Orthodox Rabbis of Ontario
As community rabbis, we write on behalf of ourselves and our Jewish communities to express our very grave concerns about Bill C-7 and the expansion of “medical assistance in dying” (MAiD). One of Judaism’s fundamental precepts is the value of human life. Indeed the current COVID-19 pandemic has shown us the great lengths the world has gone to protect the most vulnerable amongst us. Yet, Bill C-7 endangers the lives of some of these very same vulnerable Canadians. The impending enactment of Bill C-7, along with the CPSO’s policy on requiring participation or facilitation of MAiD poses grave religious and moral issues to members of the Jewish faith. As it now stands Bill C-7 would mean observant Jews who are health care workers will either no longer be welcome in the medical field or will be forced to abandon their deeply held beliefs. Therefore, we are reaching out to ask for the following: 1. We ask that only patients initiate MAiD discussions, and the doctor should never bring it up as a treatment option (to avoid subtle patient coercion in the context of despair or suicidality). 2. We ask for stronger conscience rights for medical professionals to refrain from participating directly and indirectly in MAiD if they so choose. Canada has always been a compassionate nation where all of its citizens are welcome and protected. We ask that you continue to respect and protect the plurality and diversity of all Canadians.
Member of the public
[April 05, 2021 7:55 PM]
The current CPSO policy on MAID is guided by the right of the individual to receive a service superseding the right of the provider. If a right is truly a Human Right, it must be self-fulfilling, not relying on others. Otherwise, it is slavery. I have reviewed the submission by the Toronto Board of Rabbis and find it to be comprehensive and reasonable. I urge that this submission be required reading by all Council Members who will be voting to approve the new policy. Further, the CPSO must allow conscientious objection in this new MAID policy
Organization
[March 31, 2021 7:37 AM]
Canadian Society of Palliative Care Physicians
Response in PDF format.
Other health care professional (including retired)
[March 30, 2021 5:57 PM]
I agree that if a patient seeks a particular treatment for a condition and the healthcare provider using his/her clinical judgement believes the particular treatment the patient seeks is not medically indicated, the patient is free to seek a second opinion, but must do so on his/her own. If we really believe that MAiD is a treatment for a medical condition, the same rules must apply.
Member of the public
[March 30, 2021 3:23 PM]
Dear College of Physicians and Surgeons of Ontario (CPSO), Thanks for giving the Canadian public an opportunity to provide you with feedback about Medical Assistance in Dying (MAiD). Here is my feedback. In my personal and professional opinion (note: I am a retired philosophy professor who has studied and taught ethics) I recommend the following: (a) medical personnel who conscientiously object to MAiD and “effective” referrals for MAiD should not be required to participate in or facilitate MAiD; and (b) they should be provided workplace protection from harassment and discrimination because of their conscientious objection. Here are my reasons for the above recommendations. MAiD is a euphemism for physician-assisted suicide. But, according to the World Medical Association (https://www.wma.net/policies-post/declaration-on-euthanasia-and-physician-assisted-suicide/), good medical practice should neither ask nor require any doctor or nurse to help patients with suicide. After all, suicide is wrong and tragic (that is why Canadians work hard at suicide prevention). Moreover, turning physician-assisted suicide into “health care” is seriously problematic in other ways. History teaches us that medically administered death is dangerous for the vulnerable as well as all of us. This can be seen in recent years in the abuses of MAiD in Belgium and The Netherlands (for evidence see, for starters, the documentaries Euthanasia Deception and Fatal Flaws; both available online). In not-as-recent history, we should note Dr. Leo Alexander’s observation at the Nuremberg Trials (1945-1946). Dr. Alexander attributed the beginnings of the horrors of the Holocaust to the attitude of physicians, i.e., that they accepted “life not worthy of life” as a justification of killing patients (for evidence, see Dr. Alexander’s essay in New England Journal of Medicine, 1949; available online). The notion of “life not worthy of life”—German: lebensunwertes leben—was at the heart of the Holocaust and is at the heart of MAiD. Yes, in Canada there are patients who choose physician-assisted suicide as their best option. But this “choice” is often due to a lack of real options, especially a lack of top-notch palliative and hospice care. In fact, top-notch palliative and hospice care is not available for the vast majority of Canadians. A basic understanding of ethics requires that assistance in living should be provided for all BEFORE medical assistance in suicide is offered at all. Also, I am troubled that if the CPSO does not provide protections to physicians who object to performing MAiD or making effective referrals to MAiD, then, as time passes, the medical profession will be staffed primarily by doctors who are morally callous. I fear that in the future those doctors who object to MAiD will not or will not be allowed to practice medicine, and I fear that most or all doctors who do practice medicine will have no moral qualm about killing patients as a regular part of “health care.” What is worse, I suspect they also will have no moral qualm about falsely reporting any misdeeds they commit. The fact is that doctors in Ontario who are now practicing MAiD are falsely reporting cause of death on death certificates. Indeed, blatant lying is promoted—required—by the CPSO. My evidence: According to CPSO on MAiD: “When completing the death certificate physicians: a. must list the illness, disease, or disability leading to the request for MAID as the cause of death; and b. must not make any reference to MAID or the drugs administered on the death certificate.” (Bold in original. Reference: See #22 of CPSO on MAiD here: https://www.cpso.on.ca/Physicians/Policies-Guidance/Policies/Medical-Assistance-in-Dying.) Again: Blatant lying is promoted—required—by the CPSO. Alarmingly, when it comes to MAiD, lying has become a norm of practice for the CPSO. A reasonable question for Canadians to ask is this: What else are doctors lying about? If my studies (and personal experience) in ethics have taught me anything, it’s this: little ethical lapses pave the way to big ethical lapses. It seems that with regards to MAiD, the CPSO—with its institutionalized lying—is well on its way to engaging in big ethical lapses. For the sake of moral integrity (and for the sake of regaining public trust), the CPSO needs its conscientious objectors. Therefore, I recommend the following to the College of Physicians and Surgeons of Ontario: (a) medical personnel who conscientiously object to MAiD and “effective” referrals for MAiD should not be required to participate in or facilitate MAiD; and (b) they should be provided workplace protection from harassment and discrimination because of their conscientious objection. Thanks again for the opportunity to provide you with feedback. I hope my feedback is helpful.
Other health care professional (including retired)
[March 30, 2021 2:18 AM]
Thank you for speaking up. I agree.
Member of the public
[March 29, 2021 8:29 PM]
Note: Some content has been edited in accordance with our posting guidelines. I [redacted] declare that at no time must any physician or other health care professional be obliged to participate with Medical Assistance in Dying (MAID) in any way, including bu referral, in the mighty name of Jesus.
Organization
[March 22, 2021 8:32 PM]
Toronto Board of Rabbis
Note: Some content has been edited in accordance with our posting guidelines. Response in PDF format.
Physician (including retired)
[March 21, 2021 8:13 PM]
As physicians we knew that all this consultation was irrelevant and a depressing waste of time. The decisions were already a foregone conclusion and the last CPSO consultation on this subject made no difference. The reality is that there is no special medical knowledge or training required to take someones life. The "safeguards" and "referral process" the CPSO and government have set up are irrelevant when death on demand is any individual's right with upcoming legislation. Why sugar coat it? Set up technicians who can perform this in a nice quiet family setting. Save hospital bed costs if this was originally to be done in hospital. Funeral directors have the facilities to offer one stop shopping in a dignified environment. Why not allow morticians who are all licenced by the province do this. The physician can stop by to fill in the death certificate and no cost to transport a body. No physician would be a conscientious objector to completing a death certificate. Are we as physicians being self serving in keeping this charade up by even calling it "Medical" assistance in "dying - or the not yet dying" so we can keep control of another consumer commodity?
Physician (including retired)
[March 19, 2021 3:09 PM]
For most family doctors, fully understanding the reality of the difficulties in the daily lives of our disabled patients is virtually impossible. What will be the effect of awareness of the existence of MAID on a group already under assault? Pressures and hints, subtle and not so subtle, by family and caregivers could undermine the self worth of vulnerable people, who may feel forced to take this path. Disabled rights groups are already sounding the alarm about this law. The 90 day waiting period is too short for many depressed patients, including those with reactive depression following a major life loss. Perhaps the OMA could provide an education program on the adverse consequences of C-7.
Organization
[March 18, 2021 2:44 PM]
Canadian Medical Protective Association (CMPA)
Response in PDF format.
Other health care professional (including retired)
[March 15, 2021 4:09 PM]
There should be no circumstances in which any physician or other health care professional is obliged or even pressured to participate in MAID in any way, including referral to initiate the steps involved in the process. Those professionals who don't object, especially those who are enthusiastic supporters of MAID, are the only ones who should have anything to do with it. That way everyone gets conscience protection & no one experiences moral distress or soul injury from being compelled to do things that go against their moral code. MAID is the most significant issue of our time & also the most polarizing. Let's treat it with the consideration it deserves and, in the process, respect & support all healthcare professionals' perspectives equally. If this doesn't happen, there may well be an exodus of members from the medical profession. What a shame that would be, and so unnecessary.
Medical student
[March 15, 2021 3:26 PM]
When it comes to MAiD/euthanasia/assisted suicide, I see a lot of talk about conscience/religious rights. But not everybody who refuses to cause somebody's death does so for religious reasons! Physicians should have the right to refuse MAID for professional reasons as well. After all, practicing medicine is all about saving, prolonging, or enhancing life. In every other area of medicine, death is the most single most serious 'complication' or 'adverse health outcome' (for example, we go to great lengths to minimize the mortality rates of our many medical treatments/procedures). Ever since Hippocrates, medical students have been taught "First, do no harm". However, with MAID, death is the intended outcome. MAID involves the administration of poison without ANY therapeutic benefit. This is the only 'treatment' that seeks to kill the patient. I don't have to be religious to find this practice deeply concerning, reprehensible, and diametrically opposed to everything else I have promised to perform or been taught to value. MAID is not medicine. Added to this, when a physician makes a referral, they are making a statement that the service they are asking for is medically necessary, but outside of their clinical competence. Thus, effective referrals are an inherently complicit act. Forcing physicians to refer is no different than forcing physicians with conscientious/philosophical objections to perform the act itself. This is deeply concerning. I cannot make a referral for something that I do not believe is medically necessary or warranted without compromising my professional integrity, and my College should not be forcing me to do so.
Other health care professional (including retired)
[March 15, 2021 2:00 PM]
Bonjour! Pour travailler avec des personnes qui ont ou ont eu des pensées suicidaires, je sais qu'il suffit de peu souvent pour que la personne retrouve du courage et la force de vivre dans des situations imparfaites et même très difficiles. Rendons possible la compassion en suscitant des lieux et des ouvriers de compassion. Ouvriers formés à promouvoir la vie et non la mort.
Physician (including retired)
[March 14, 2021 11:45 PM]
Slippery slope indeed. So far, I have had 3 patients request MAID. In my opinion (as their family doctor), none met the legislated criteria. They were duly assessed (not by me) and two were approved and their lives ended. I believe that instead of further expanding MAID eligibility as suggested by Bill C-7, we should be working to identify ways of providing better health care.
Physician (including retired)
[March 14, 2021 6:44 PM]
As a psychiatrist, I am extremely concerned that medical assistance in dying be extended to mental illnesses. There is always hope and something to do for our mentally sick patients, whether it is through psychopharmacology and/or any kind of psychotherapy. My mission is to prevent suicide and I will keep doing so. Offering a wider range of services with an easier (and cheaper) access in the community would definitely be a better option than being part of a programmed death.
Physician (including retired)
[March 14, 2021 5:42 PM]
Requests for hastened death in palliative care patients have been studied since long before MAiD became legal in Canada. When I was a trainee,we were taught to thoroughly explore these requests and their underlying causes and to address all these causes as best as humanly possible. This requires a nuanced, thoughtful, and ongoing discussion between doctor and patient. This policy makes no mention of this important part of an approach to requests for hastened death. It makes what should be a searching exploration of suffering and existential distress sound abrupt and business-like. It also seems to imply that the only role for a conscientious objector in responding to such requests is prompt facilitation of MAiD by referral. All physicians, regardless of whether or not they think MAiD is a good idea, should be able to have a sensitive and compassionate discussion with a patient who is contemplating MAiD about why they are thinking this and whether any other options might be helpful. Being a conscientious objector need not preclude a physician from having this discussion with patients in a compassionate way, or from conitnuing to provide for non-MAiD aspects of patient care until the day the patient dies. Also, I agree with those who have stated that physicians should not be forced to make referrals for MAiD. There are many examples of jurisdictions where referral is not mandated which we can look to for other solutions. Working under the constant threat of being asked to deeply violate one's integrity, especially while in an already emotionally-taxing job, is distressing and leads to burnout. I fear this will become more common now that Bill C-7 has greatly expanded eligibility for MAiD.
Organization
[March 11, 2021 1:32 PM]
Office of the Information and Privacy Commissioner of Ontario (IPC)
Response in PDF format.
Physician (including retired)
[March 08, 2021 10:42 AM]
MAID should be entirely self-referred. Objecting physicians should not be forced to refer to services if it's against their conscience. Having a self-referral system would avoid this whole mess.
Member of the public
[March 07, 2021 9:22 AM]
Superb palliative care goes hand-in-hand with MAID, it does not replace it. Access to both needs to be made as straightforward as possible including in the case of MAID retaining the requirement for an effective referral in the situation where a practitioner does not wish to themselves provide MAID. The updates to the legislation, when they come and depending on what is finally included, do mean that the existing policy should be revisited and revised as appropriate to ensure prompt access to MAID continues to be available for those who need and wish to have it.
Member of the public
[March 01, 2021 3:31 PM]
I am against medical assistance in dying. Our cultural need for happiness is blind to the fact that the living lack to courage to participate with the suffering. Finally, the so called strong and wise let the other do the act. If we are totally ‘ free and enlightened ‘ put your other in the garage and close the door and carry out the body. Finally the human body is deeply only a scientific object in the the arena of medical assisted death from conception to death. Science then is the only God , a problem. The problem is the public opinion does not like complex discussions on dignity and the soul.
Member of the public
[March 01, 2021 10:37 AM]
Not everyone believes in god. Where does that leave atheists? Is it reasonable that a terminally ill atheist cannot determine his/her own fate because of doctors imposing their religious beliefs?
Other health care professional (including retired)
[February 27, 2021 1:22 PM]
Everyone including physicians should have the basic human right to act according to conscience. Moreover this forced referral can lead to murder of the most vulnerable group without consent from either patient or physician since the physician has no choice and the patient may merely be coerced by misled.
Physician (including retired)
[February 27, 2021 1:22 AM]
Life is a gift from God. we cannot take life away before its natural end. Otherwise it will be murder. There is no "Dignity" when murder is performed.
Member of the public
[February 24, 2021 11:58 AM]
People with chronic and serious illness should have to right to assisted death, step should be taken to ensure the patient fully understand their decisions but should be allowed. Quality of life is important once you have lost it and there is not solution we should allow and stop the suffering. Because that is all it is suffering.
Other health care professional (including retired)
[February 23, 2021 3:43 PM]
I am firmly against any attempts to take the life of another individual. Medical Assistance in Dying should be replaced with Superb Palliative Care. No physician or Nurse should be compelled to administer MAID. Honor the Oath taken by physicians to do no harm.
Physician (including retired)
[February 18, 2021 10:39 AM]
In the past, it was legal and ethically acceptable to administer and to increase to dangerous levels, doses of analgesics to terminally ill patients with intolerable pain, because if death would occur as a consequence it would be a non-intentional side effect rather than an intention to kill the patient. Euthanasia and assisted suicide are not necessary to solve the problem of terminally ill patients with intolerable suffering . The lack of adequate and effective palliative care discriminates against a sector of the population and expose them to subtle pressures to resort to Medically Assisted Suicide or to Euthanasia. Patients with psychoses or with deep depression may understand intellectually their problem but are not emotionally free to make adequate decisions, therefore they can not choose freely what is good for them. If treatment of their conditions have failed, they can be given a combination of analgesics with tranquilizers and antidepressants and be put to sleep for indefinite time. Since they have a very short time to live, there is no danger of developing addictions to medications.
Organization
[February 17, 2021 2:05 PM]
Professional Association of Residents of Ontario (PARO)
Response in PDF format.
Physician (including retired)
[February 17, 2021 12:03 AM]
I completely agree with this comment - physicians should not be forced to provide a referral for MAID. As a physician I believe there are better treatment options available than MAID. If I believe a treatment is not medically indicated, there are no other conditions in which a referral is mandated. Given lack of access to allied health, social services, palliative care, specialists in rehabilitation (PM&R), it seems unreasonable to mandate effective referral for MAID without mandating all other treatment options before pursuing MAID.
Physician (including retired)
[February 14, 2021 4:29 PM]
I don't think doctors should be required to refer for MAID. There already is a mechanism to allow a patient to access the procedure in Ontario without the doctor referring the patient. Given the genetic revolution that is coming and changing attitudes of the public one can envision many other procedures doctors could soon be required to refer for that will violate their consciences. If an artificial conception for instance introduces certain traits certain segments of the population want that advantage some members over others. We were told when the original MAID legislation was introduced that there would be no slippery slope. Yet here we are only a few years later removing waiting periods that were to prevent impulsive requests and the requirement for only one provider to access the patient. For people with disabilities they will be granted to access MAID with no reasonably foreseeable death something so called able bodied Canadians will not have access to. The message is that some lives are more worth living than others. The waiting times for therapy for many disabling conditions is more than 90 days. Recovery from some conditions is much longer than 90 days as well. Recovery from a spinal cord injury usually only starts after 90 days. We are creating a situation where dying is made easier than living and will now be requiring doctors to facilitate that. In many places in Ontario palliative care access is inadequate. Many of the doctors who got into providing palliative care are the same ones who don't want to to be involved with MAID. Given palliative care is a context in which MAID will likely occur we may lose a good number of palliative care doctors. Nursing home doctors are also in short supply. A setting in which MAID requests are sure to occur.
Organization
[February 12, 2021 4:09 PM]
Resurrection Lutheran Church – CALC, LCMC
Response in PDF format.
Member of the public
[February 10, 2021 10:27 AM]
Response in PDF format.
Other health care professional (including retired)
[February 08, 2021 4:08 PM]
I agree with comments about the timing of this important consultation given that Bill C-7 may require changes that we cannot address in this consultation. For example the process map could be changed. Also the wider range of people potentially eligible for MAiD could create more need to address conscientious objection as some MDs/NPs may be OK with MAiD for a limited range of cases but not for other cases. I would like to see change to the effective referral to make it easier to not have to do a direct referral to an agreeing MD/NP. This could be done through a point person as in the policy.
Physician (including retired)
[January 14, 2021 2:38 PM]
The changes expected under Bill C-7 make it even more important that the policy be revised. It should allow giving patients information, such as the number for Care Coordination Service (CCS), to be considered as positive action, sufficient to meet their obligation.
Physician (including retired)
[December 22, 2020 9:30 AM]
In the advice document it would be helpful to advise physicians regarding a non judgmental way to explore why someone maybe requesting MAID, what burden they are carrying. It may be financial, it may be loneliness, lack of access to available support systems etc. It is important to seek to offer assistance to alleviate that burden so that the patient decision is truly informed. We need to offer support more than just traditional medical support as the reasons may be broader.
Member of the public
[December 17, 2020 8:31 PM]
Any professional, regardless of what that profession is, has an ethical obligation to do what is in the best interest of their client/patient. The client/patient may well be in a better position than the professional to determine what their best interests are. Difficult decisions are made by professionals of every stripe every day. If a professional, for reasons of conscience, cannot help a client/patient, that professional has an ethical obligation to refer to someone who can. It is reasonable to allow a professional to step away from participating in matters that compromise his/her religious beliefs, however, it is unethical to impose those beliefs on someone else, just as it is unethical for the state to impose beliefs on that professional. Any professional who cannot abide by this should consider changing professions.
Physician (including retired)
[December 11, 2020 4:50 PM]
I agree that with Bill C-7 before the senate the CPSO should ensure that any changes to the law are addressed in the policy. It seems it will likely result in the simple deletion of the requirement for death to be reasonably forseeable, but I have not reviewed the legislation directly.
Physician (including retired)
[December 10, 2020 4:50 PM]
At no time must any physician or other health care professional be obliged to participate in any way , including referral , in MAID !
Physician (including retired)
[December 10, 2020 4:30 PM]
Given either the Dec 18/20 deadline or the passing of C7 is just a week away would it not make sense to wait and adjust this once that outcome is known, as much of what is written around MAID assessment and provision will change at that time. Otherwise, the policies re: effective referral, conscientious objection and other details seem fine.