Mandatory Medical Referral for MA – Ontario College of Physicians Consultation

We are sharing this call to action from the Physicians’ Alliance against Euthanasia:

The College of Physicians and Surgeons of Ontario (CPSO) is currently conducting another national public consultation on its policies on: MAiDProfessional Obligations and Human Rights and Planning for and Providing Quality End-of-Life Care, in anticipation of updating these policies following the passing of Bill C-7. The deadline for the consultation is May 14th, 2021.

One of the main concerns regarding the policies is the possibility of obliged referrals for MAiD, hence this urgent call to action for conscience protection. There are also concerns that the new CPSO policies will not clearly specify the expectation that ‘standard of care’ therapy should be applied first. Note: All doctors and/or citizens across Canada may respond to the CPSO’s physician and public consultations.

We ask that you kindly complete the surveys addressing the above mentioned policies. For each policy, there is dedicated consultation page (with a survey) and a discussion page (where we encourage you to write your commentsMAiD2Mad offers guidelines for the MAiD and Professional Obligations and Human Rights consultations.

Please click on the links below to access the web pages:



Professional Obligations and Human Rights (POHR)

Planning for and Providing Quality End-of-Life Care (EOL)


Below we’ve compiled a few resources to assist you in participating in the End-of-life consultation.

Although the deadline for the CPSO national public consultation is May 14th, 2021, the policy changes are already being discussed and it is important to positively influence the policy changes. Please take the time to complete the survey and comment on the discussion forum as soon as possible. 


Catherine Ferrier


Resources pertaining to the End-of-life consultation:


Physicians are required to sensitively engage patients in a discussion when they express a wish or request for their death to be hastened in order to seek to understand the motivation for their expression and to resolve any underlying issues that can be treated or otherwise addressed.

This stipulation is very important, now more than ever, since MAID is legal. It is essential that the stipulation be maintained.

The policy also states:

The Advance Care Planning section of the policy has been updated to include a clear statement that advance care plans are not a substitute for consent and that they are meant to guide substitute decision-making.

  • This will be important for future discussions of MAID by advance request.
  • In your comments, please make sure to state that:
    • Doctors should not be obliged to provide effective referrals for MAID.
    • Doctors only need to discuss MAiD if requested by the patient, and to “sensitively engage” about other options as per above.
    • Doctors must prioritize supporting all patients so that they have the basic requirements needed to live; not to facilitate their death as a response to their suffering.
    • Doctors who are unwilling to collaborate in MAID should be able to provide contact information of a neutral resource such as tele-health, and not be required to make a referral

      § For hospitalized patients, option of transferring the patient’s care to another professional.
    • Protection of the freedom of conscience and professional judgment of physicians is essential to maintaining the integrity of the profession.
    • Doctors should not be permitted to propose MAID to a patient who has not requested it.
    • MAiD must never be raised by anyone but the patient to avoid the risk of subtle coercion in the context of despair or suicidality
    • Before considering MAID, the medical standard of care should not only have been discussed, but also applied.
    • In responding to questions about conflict between patient wishes and physician judgment or standard of care, it is necessary to keep in mind that any policy that is developed would apply not only to treatment refusal or withdrawal, but to MAID.

      For example: Where there is disagreement between the medical standard of care and the patient’s values (often articulated through their substitute decision-maker) with respect to providing life-saving or life-sustaining treatments, how important is it for physicians to try and accommodate those values? If acceptance of patient values is absolute, this could lead to requiring participation in MAID (also in other acts the doctor considers unethical).
  • Note the difference between the current policy and the questionnaire about physicians being advised vs obliged to engage in advance care planning and other acts.