Dr. Frank Ewert wants protection from having to help a patient die — but Dying with Dignity Canada doesn't want that to happen at the cost of patients receiving full access to end-of-life options.
"When I started back a number of years ago and vowed to follow the Hippocratic oath, I meant it. It was very profound to me, it resonated with my core beliefs, that I would always respect life, that I would do nothing to harm a patient," Ewert told a legislative committee on Monday evening.
Bill 34, which would protect medical professionals from disciplinary action for refusing to provide or aid in providing medical assistance in dying services, went to hearings before a standing committee Monday evening.
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The bill was introduced to the legislature in May and underwent a second reading last week. The committee process allows the public to voice concerns or show support for the proposed bill, and ask for other considerations to be made.
The committee, comprised of members of all three provincial parties, heard the concerns of 18 various groups and private citizens on Monday evening.
Bill 34 is meant to protect doctors like Ewert, who was among the people who addressed the committee. Ewert has been practising medicine for decades and said he would never want to be asked to assist in helping a patient die.
But the bill faced criticism from Dying With Dignity Canada, a group that advocates for patients' rights to end-of-life options, because it does not clearly define what a health-care provider's obligations are to a patient.
The bill states a conscientious objector can refuse to provide assistance in dying, but also can refuse to aid in the process.
"If interpreted broadly, this provision could suggest that physicians have absolutely no obligation to ensure that patients in their care have access to compassionate treatment that they seek and to which they have a right," said Cory Ruf, who represented Dying With Dignity Canada by conference call.
"If passed in its current form, Bill 34 would communicate that it would be okay to tell desperately ill Manitobans that they are on their own," said Ruf.
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Ruf also took issue with the bill's lack of protections for medical professionals who wish to help their patients access medical assistance in dying, or MAID, if they work in a facility where the service isn't offered, such as faith-based hospitals and care homes.
"It offers employment protections for health-care professionals who refuse to participate in MAID, without extending those same protections to clinicians, who as a matter of conscience, feel a duty to provide this essential service," said Ruf.
Regulatory body wants amendments that would protect patients
The College of Physicians and Surgeons of Manitoba said they support protecting the rights of conscientious objectors, but asked for amendments to be made to the bill that would ensure that vulnerable patients still have access to MAID.
"[Doctors who object] still have to provide the patient with a resource in a timely fashion," said Alewyn Vorster, past president of the college.
"It's a telephone number, it's a website," he said.
Vorster said in a situation where a patient could not access MAID on their own, a medical professional would be obligated to ensure the request was made known to others who could help the patient access MAID.
"But it has to happen, and it has to be documented, and it has to happen in a timely fashion," said Vorster.
"We would like an amendment as well, to not allow that physician or provider to be able to abandon the patient's medical care, and this refers to the other medical issues that the patient has," he said.
Group that represents conscientious objectors says they have been 'misunderstood'
Coalition for Healthcare and Conscience was also at the committee meeting. They say protecting a person's right to refuse assisted dying needs to be put into law, because other jurisdictions have seen conscience rights being eroded.
"We've found, particularly in Ontario, where conscience rights are just not being protected, for instance, we have two Ontario medical schools who have asked questions about conscientious objection in their admission process," said Larry Worthen, spokesperson for the coalition.
The College of Physicians and Surgeons of Ontario's policy on MAID requires that conscientious objectors provide an 'effective referral', something Worthen's group takes issue with.
"We would differentiate in providing information to patients about MAID and how to access it, and actually being involved directly in connecting the patient through a referral to the person who would provide medical assistance in dying. For us, the referral is the same as actually doing it," said Worthen.
Manitoba's college does not require a referral, only that information be passed to the patient and Worthen said the coalition doesn't have a problem with that.
Worthen said the idea that a doctor who objects to MAID would prevent a patient's access to the service isn't true.
"No doctor wants to impede or impair a patient in getting access to something that they have a legal right to," said Worthen.
"We're just simply saying, please don't ask us to be an integral cog in the wheel, in terms of connecting the patient to the person that is going to do the [MAID]."
"We've been completely misunderstood on many quarters, people think that because we can't do a referral, we don't care about our patients, and that couldn't be further from the truth," he said.
Ewert said he agrees with the college's stance on providing information to patients and is open to amending the bill to clarify what those obligations are.
He says it's important to protect the rights of objectors now, because future regulatory bodies may not always have the same views.
"Colleges come and go, they're elected, they're appointed, and there is no guarantee that a future college would think the same way," he said.
The opposition NDP have declared their support for the bill, but said they would like to see more done in regards to palliative care improvements, mental health supports, and ensuring patients have access to MAID if they desire.
The standing committee can make recommendations in their report to the house before the bill moves forward.