Conscientious objection to effective referral for medical assistance in dying: an analysis in terms of Rawlsian liberal political theory

Abstract

The recent legalization of medical assistance in dying (MAID) and the contentious mandatory effective referral policy implemented by the College of Physicians and Surgeons of Ontario (CPSO) have spurred robust legal and academic debate around the following question: to what extent should the CPSO limit physicians’ ability to conscientiously object to referrals for healthcare services? Rawlsian political liberalism ranks conscience freedoms as fundamental liberties central to justice in a liberal democracy, whereas equality of access to goods or services rank secondarily. Mandatory effective referrals make unjust demands on some physicians by requiring them to take positive action against their consciences. Patients should have direct access to assenting physicians for services where fundamental moral disagreements are common, as is the case with abortion, for example. In order to protect patient autonomy, conscientious objections should be public so that patients can make informed choices about their primary healthcare providers prior to coming under their care.