As I scrolled through all the social media posts about Friday’s March for Life in Washington, D.C., I couldn’t help but think about our neighbors to the north, Canada, where their unspeakably nihilist euthanasia program rolls on. I won’t sugarcoat it by using the Trudeau government’s favored term, “MAiD,” or “Medical-Aid-in-Dying,” which is not what euthanasia is at all; medical-aid-in-dying is palliative care, and it is done wonderfully by thousands of hospice programs around the world without involving doctors injecting patients with needles full of life-ending drugs. No, Canada’s euthanasia program isn’t MAiD; it’s killing fragile people, and unless Parliament hits the brakes, starting at the end of March, Canada will add the mentally ill to the list of people eligible for euthanasia.
Alberta, lauded in many US conservative circles and eye-rolled in many Canadian liberal circles, was the one province where I assumed that another nefarious euphemism, “effective referral,” which requires an objecting practitioner to make an “effective referral” for euthanasia evaluation and provision to another practitioner in a timely manner, thereby stripping the objecting medical provider of her conscience rights, would ever rear its ugly head. Sorry to say, I was wrong; in January the Alberta College of Physicians and Surgeons proposed adding an “effective referral” requirement to their Conscientious Objector Standards applying to physicians in Alberta.
Although this is far from a Catholic-physicians-only issue, since conscientious objector physicians to Canada’s euthanasia regime span the spectrum from atheist to religiously fundamentalist, insofar as Catholic physicians are concerned, the Catechism of the Catholic Church could not be more clear: “Whatever its motives and means, direct euthanasia consists in putin an end to the lives of handicapped, sick, or dying persons. It is morally unacceptable.” (CCC 2277). Furthermore, the Catechism, citing the encyclical Dignitatis Humanae, states that regarding conscience: “Man must not be forced to act contrary to his conscience.” (CCC 1782). That formulation of conscience protection is far from unique to Catholicism; it’s been a bedrock right in Western Civilization for centuries.
So what does “effective referral” do to destroy conscience rights? In short, effective referral requires a conscientious objector physician to formally cooperate with evil, as the objecting physician is required to take the position that “I won’t kill you, but I’ll refer you to another doctor because I know that doctor is willing to kill.” In practice, this often takes the form of an effective referral hotline, wherein the objecting doctor provides the person seeking euthanasia a phone number where they can receive referrals to amenable doctors. While that psychologically distances the objecting doctor, it does not morally distance her; the referral is still made with the intent of finding someone to countenance killing the patient. Yes, in some places you call Dominos for a pizza, in Canada you call the euthanasia hotline for assistance in suicide.
The longer answer regarding effective referral is that it provides a cover for the government to strip a doctor of the right NOT to be involved in a morally objectionable course. Ontario, Nova Scotia, and British Columbia have made it mandatory for objecting physicians to provide an effective referral, and Canada’s federal Parliament has voiced a preference for effective referral in every province. Objecting physicians in Ontario brought this mandate to provincial court, where the court found that yes, of course, effective referral substantially violates their right freedom of religion and conscience but, in effect, said “so what?” (If you want to journey through the complexities of getting to “so what,” my legalese article can be found here: Conscience Rights and “Effective Referral” in Ontario - Carter Anne McGowan - The National Catholic Bioethics Quarterly (Philosophy Documentation Center) (pdcnet.org)”. So Ontario is truly in the upside down, where a doctor’s religious freedom and conscientious objection to killing may be substantially infringed so that a patient, his family, or friends doesn’t need to…google the hotline number or call in a different medical practitioner.
Silence in provincial law and in physician’s college guidelines also provide little protection, as they leave open the possibility of a malpractice claim for an objecting doctor failing to meet the applicable standard of care if that doctor will not provide or refer to euthanasia when the patient meets the legal conditions for it when the majority of physicians will. As of now, only Manitoba has passed a law precluding mandatory effective referrals.
Given the lack of Alberta law on effective referral, the College of Physicians and Surgeons of Alberta jumped in to try to require it. The colleges have been some of the prime movers of the euthanasia rollout and the insistence that doctors provide it in Canada, with the College of Physicians and Surgeons of Ontario being the most egregious euthanasia-pusher.
Thankfully, Alberta doctors responded with a vociferous negative to the proposal, and the College of Physicians and Surgeons of Alberta backed down. But Alberta remains without a conscience protection law, a circumstance that will hopefully be remedied in its provincial legislature, because all of this takes place against the backdrop of euthanasia – already available to those certified as terminally ill or chronically ill – currently set to become available on March 17 to the mentally ill, provided they wait ninety days after receiving certification from two doctors that their condition is irremediable (which, if the physicians asked to certify euthanasia for mentally ill are honest, they will not be able to guarantee, as the waxing and waning of mental illness is devilishly tricky to predict). And, in an irony of ironies, the mentally ill persons seeking to die at a doctor’s hand must be certified as non-suicidal.
So the arrival of an “effective referral” attempt in Alberta at this time seems more than a little convenient for all the forces in Canada trying to spread euthanasia access far and wide, but its rebuff at the hands of physicians provides a small reason for hope that medical practictioner conscience can be enshrined in law in Alberta.
For the tide to turn on the larger issue – Canada’s love affair with expanding euthanasia availability – well, that’s going to take more than an act of a legislature. It’s going to require a renewed appreciation for the value of every human life, even when fragile, and even when it’s nearing its end.