Hundreds of doctors from across Canada spent Tuesday morning in Halifax debating all aspects of assisted death and end of life.
At the Canadian Medical Association's annual meeting, a number of doctors said they aren't comfortable offering assisted death and they don't want to refer a patient to another physician.
But the CMA struck a balance on the issue, agreeing not to support assisted death, but saying doctors have a duty to provide complete information on all options and advise patients on access.
'Don't be a doctor if you don't want to provide the range of services to patients.' - Chris Milburn
The association gathered input from hundreds of members leading up to this week's conference.
A "significant minority" of doctors, 29 per cent, who responded to the association's poll said they will offer the service.
Dr. Chris Milburn, who has a family practice in Sydney, N.S., is one of them.
'Doctors are public servants'
"My feeling is that doctors are public servants. We are paid by the public to provide services that are, not only the Supreme Court of Canada, but the people of Canada and Parliament of Canada have decided are reasonable," he said.
"Certainly some of us may have moral objections to some of those services, abortion or assisted dying. I was jokingly saying that in a world of 7.3 billion human beings, the fact that doctors are expected to provide fertility services to produce more babies may be morally objectionable to some of us."
He said doctors should not judge patients and their decisions about medical care, "if those decisions are reasonable and legal and they are requesting a reasonable and legal service."
"The other issue is if we refuse to provide services such as birth control, abortion or assisted dying, it puts our patients in a position where they are often not able to get those services from another provider and they are being denied medical care. And I don't think we have the right to do that."
Don't ask physicians to be killers
Milburn said he has been involved in palliative care in some form since graduating from medical school.
"We always have a choice here in Canada. It is a free country. Don't be a doctor if you don't want to provide the range of services to patients," he said.
The CMA survey, offered online in June and July, had 1,407 responses. Sixty-three per cent of respondents said they would not help a patient to die and eight per cent said they were unsure.
The respondents were also asked if they agreed with the Supreme Court decision to strike down the current Criminal Code section that prohibits doctors from helping patients to die, with 59 per cent agreeing and 27 per cent disagreeing, the other 13 per cent did not want to comment.
Saskatoon hematologist Shelia Harding strongly opposes doctor-assisted deaths.
"I feel strongly that hastening death is not part of medicine. I think it eviscerates what medicine is intended to be. I think that asking physicians to be killers is contrary to the very core of medicine," she said.
Even indirectly quickening patients' deaths should be as tightly controlled as possible, Harding said.
February 2016 deadline for new law
"I think it is essential for the moral character of medicine that for physicians to be able to practise according to conscience. To ask physicians to park that at the door in some circumstances is to disable them. Our patients benefit when we are people of integrity. If we are required to squelch that, it does our patients harm in the long term," she said.
Also, 29 per cent of doctors surveyed said that if they refused to help a patient die, they should not be required to refer them to another doctor, while 42 per cent were in favour of some type of referral procedure.
The majority of physicians polled who agreed with assisted death, 43 per cent, said they did not know if they would offer medical aid in dying to someone whose suffering was purely psychological. Thirty-eight per cent said no and 19 per cent said they would.
The Supreme Court of Canada ruled earlier this year that the federal and provincial governments have until February to come up with laws to regulate assisted death.
The Canadian Medical Association will provide input to federal and provincial panels struck to examine the issue.