The College of Physicians and Surgeons of Nova Scotia recently passed a new “effective referral” policy for medical professionals in the province. Such a policy violates physicians’ freedom of conscience and fails to allow differing opinions on controversial procedures. ARPA Canada highlighted this new policy earlier, alongside other polices across the country that fail to protect conscience. As controversial procedures become more accepted in our society, freedom for doctors to choose not to participate in those procedures often takes a back seat. If you live in Nova Scotia, you can reach out to your local candidates during the current election period and ask them to take action on this issue.

The Policy

Nova Scotia’s new policy was passed by the College of Physicians and Surgeons of Nova Scotia in May 2024. It requires doctors to make an effective referral if they conscientiously object to providing a medical procedure. Effective referral is defined by the College as “a referral made in good faith to a non-objecting, available, and accessible physician, healthcare professional, or agency or service that oversees the delivery of the care being sought.” In other words, while a doctor does not need to perform a procedure he objects to, he must facilitate the procedure by ensuring his patient is connected to another doctor who will provide it.

The conversation around conscientious objection often centres around euthanasia, but the College makes clear that it also requires effective referrals for abortion, medical transitioning, and anything else doctors might object to providing.

Another element of Nova Scotia’s new policy is a requirement to discuss all available treatment options with a patient, even if providing such information conflicts with the physician’s conscience. While many doctors are fine with giving information about where a patient can find out more about a procedure the doctor objects to, some fear that they may also be required to advise patients on procedures such as euthanasia, even if the topic has not been raised by the patient.

In Practice

Recently, a woman in Nova Scotia was being asked a series of pre-operative questions before undergoing surgery. The doctor inquired if she was aware of euthanasia (MAiD). The registrar of the College of Physicians and Surgeons of Nova Scotia noted that it was “clearly inappropriate and insensitive” for the doctor to raise MAiD at that time, but still defended the general expectation that doctors raise the option of euthanasia with patients who seem eligible for it.

Health Canada recommends implementing effective referral for MAiD across the country. They also recommend that medical professionals raise the option of euthanasia with patients in certain circumstances. The Canadian Association of MAiD Assessors and Providers also provides guidance on raising the option of euthanasia with patients. That said, only Ontario and Nova Scotia require effective referral, and no province explicitly requires doctors to raise the option of controversial procedures. No province forbids suggesting MAiD, either.

Impact

Doctors must not be coerced to participate in something they believe is wrong. Such coercion inflicts real harm on the doctor’s moral and professional integrity. A patient goes to their doctor for professional advice. That advice is based on the physician’s education, experience, and best judgment, all of which are grounded in their moral and professional convictions. Not only is protecting conscience good for doctors, but it is also good for patients. In fact, many patients want a doctor who they know will never offer or provide them with certain procedures.

Further, policies that fail to respect the conscience of medical professionals impact a healthcare system that is already struggling. In response to Nova Scotia’s new policy, at least 41 doctors in the province signed a letter stating that they cannot follow the policy. There may be more who share those beliefs but have not signed the letter. Forty-one doctors may not seem like a lot, but this is happening in a province with a population of just over one million, and where, as of June of this year, over 160,000 (16%) Nova Scotians were on a waitlist for a family doctor.

What Can You Do?

Nova Scotia’s policy around conscientious objection is the most restrictive in the country, and will result in doctors leaving the profession, moving to another jurisdiction, retiring early, or potentially receiving disciplinary action from the College when they fail to follow this policy.

As Nova Scotia nears its provincial election on November 26, ask candidates in your area what they think about this issue. We’ve included a sample email below that you can copy and paste or use as a starting point. Ask candidates to commit to protecting freedom of conscience if they are elected.

Following the election, reach out to your MLA and ask them to protect doctors’ consciences in the province. You can do so using our simple EasyMail system, which automatically looks up your MLA based on your postal code. This is also fully editable to make it your own. 

Together, we can let Nova Scotia’s provincial leaders know that we care about protecting the right of doctors not to participate in procedures they do not support.

Sample Email:

Dear (MLA or candidate name),

Thank you for your willingness to represent our community in the legislature. I am writing today regarding freedom of conscience for medical professionals, hoping it is an issue you will take a stand on if elected.

It is concerning to me that the College of Physicians and Surgeons of Nova Scotia requires physicians to provide an effective referral for patients requesting MAiD, abortion, and other controversial procedures. Doctors may be uncomfortable referring for these procedures if recommending them goes against their conscience, yet they are subject to professional disciplinary action if they refuse.

Freedom of conscience is protected under the Charter of Rights and Freedoms, and Canada’s laws should reflect that. It is critical that the government protect the conscience of healthcare professionals. The province should protect freedom of conscience by clarifying that health care professionals must not be pressured to participate in medical procedures that go against their conscience.

Protecting conscience is good for both doctors and patients. Many patients, including me, want a doctor who shares their values and will never offer them a procedure they object to. Additionally, with doctor shortages in the province, we cannot afford to lose more doctors because of bad policies.

I ask that you work to protect the conscience rights of medical professionals, so that they can continue to practice in the province while providing the best possible care based on their convictions.

I look forward to hearing back from you on your stance on this issue, and I hope to see better freedom for doctors to practice in line with their conscience in our province.

Sincerely,