A new peer-reviewed book, Medical Assistance in Dying (MAID) in Canada: Key Multidisciplinary Perspectives has just been released. The book, published by Springer Academic and edited by Jaro Kotalik and David W. Shannon, features 31 chapters by experts from multiple disciplines, to offer a “comprehensive discussion of the Canadian Medical Assistance in Dying (MAID) program.”

Deina Warren, Director of Legal Affairs at CCCC and Derek Ross, Executive Director and General Counsel for Christian Legal Fellowship, contributed a chapter on “The Importance of Conscience as an Independent Protection.”

Their article emphasizes how freedom of conscience needs greater attention, particularly in the context of MAID expansion and the debate about whether and to what extent physicians should participate in MAID.

Freedom of Conscience is Distinct from Freedom of Religion

To date, courts have primarily focused on the role of freedom of religion in resolving such questions, but the Canadian Charter of Rights and Freedoms also guarantees freedom of conscience. This is important because, as Deina and Derek explain:

MAID—the act of intentionally ending another person’s life via the administration or provision of a lethal substance—engages human rights considerations, as well as health, medical, clinical, social, and cultural factors. All of these considerations are relevant for professional ethics (and, therefore, professional conscience), yet they are largely absent from the current [freedom of religion] framework, which focuses on religious matters, such as one’s “system of faith and worship” and practices “which allow individuals to foster a connection with the divine or with the subject or object of that spiritual faith”. Thus, a more specific, extensive, and discrete analysis of conscience is merited… [references omitted]

Deina and Derek make the case that freedom of conscience should be interpreted generously and as “an independent right with independent content” – principles of Charter interpretation require no less. Their article proposes “some ideas on how freedom of conscience can be more robustly understood, calling for (1) a clearer articulation of the purpose for and necessity of protecting conscience; and (2) an analytical framework that recognizes the complexity of conscientious convictions, and the severe social, public, and individual harms of violating conscience.”

You can read more about their chapter here.

Euthanasia Expansion

Euthanasia in Canada has undergone a massive shift since the Carter decision in 2015. What was once a criminal act for “inflicting death” on another person became a legalized process: first to hasten a “reasonably foreseeable” death, then to purposefully end the life of a person who was not dying but who determined their suffering was intolerable, and, as of next year, to include those whose sole underlying condition is a mental illness. In addition, a Parliamentary committee has proposed expanding MAID eligibility to children. In the meantime, health care facilities are facing growing pressure to either provide MAID on-site or risk being shut down (see discussion in Brian Bird and Derek Ross, Faith-based health care offers vital access to medical assistance in living).

In this landslide of change, it is important to ensure that conscience protection is not washed away. As Deina and Derek note in their article:

[L]egal, medical, and ethical views vary widely on these subjects. Therefore, not only will conscientious concerns about participating in these procedures become more complex, the diversity of viewpoints and positions will also likely increase. Perhaps a place where theses varied views can meet is in the concept of conscience, the basis for our shared “essential humanity”. … In the case of the most basic of human instincts—to not end another person’s life— it is essential to guard against eliminating cognitive dissonance on the ethics of these matters. These are, after all, questions of life and death. If freedom of conscience has no role to play here, where does it? [references omitted]

Enriching the Discussion

The collection also features articles on the Supreme Court of Canada’s decision in Carter v Canada, the expansion of assisted death in Canada, and its implications for palliative care, suicide prevention, mental illness, disability rights, and freedom of conscience, among other topics. You can read more about these chapters here.

Thoughtful consideration and protection of conscience, among other things in the MAID debates, is more important than ever. This collection of articles is an important contribution to that conversation.

Related CCCC Blogs

Parliamentary Committee Recommends MAID Expansion; Expert Witnesses Respond with Concern and Criticism (12 April 2023)

Bill C-7, An Act to amend the Criminal Code (medical assistance in dying) (12 February 2021)

Related CLF Blogs/Resources

Parliamentary Committee recommends expanding assisted death (22 Feb 2023)

World Medical Association updates ethical code upholding conscience + reaffirms opposition to euthanasia (2 Dec 2022)

Advocating for palliative care (1 Nov 2022)

CLF brief to the Special Joint Committee on Medical Assistance in Dying (31 May 2022)

Ontario Court of Appeal upholds ‘effective referral’ requirement for euthanasia (15 May 2019)

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