Alberta Resources
General References
- World Medical Association policy on euthanasia (2019). https://www.wma.net/policies-post/declaration-on-euthanasia-and-physician-assisted-suicide/
“…No physician should be forced to participate in euthanasia or assisted suicide, nor should any physician be obliged to make referral decisions to this end…”
- Section 1553 of the Affordable Care Act on euthanasia (enacted under the Obama administration) https://www.hhs.gov/civil-rights/for-individuals/refusal-provide-assisted-suicide-services/index.html
‘Section 1553 of the Affordable Care Act states that the Federal Government, and any state or local government or health care provider that receives federal financial assistance under this Act (or an amendment made by this Act) or any health plan created under this Act (or an amendment made by this Act), may not discriminate against an individual or institutional health care entity because the entity does not provide any health care item or service that causes, or assists in causing, the death of any individual, such as by assisted suicide, euthanasia, or mercy killing.’
- Section 1303(b)(4) of the Affordable Care Act on abortion (enacted under the Obama administration). https://www.hhs.gov/conscience/conscience-protections/index.html
‘No qualified health plan offered through an Exchange may discriminate against any individual health care provider or health care facility because of its unwillingness to provide, pay for, provide coverage of, or refer for abortions.” A recent Executive Order affirms that under the Affordable Care Act, longstanding federal health care provider conscience laws remain intact, and new protections prohibit discrimination against health care facilities and health care providers based on their unwillingness to provide, pay for, provide coverage of, or refer for abortions. Executive Order 13535, “Ensuring Enforcement and Implementation of Abortion Restrictions in the Patient Protection and Affordable Care Act” (March 24, 2010).
Jurisdictions elsewhere that protect conscience and do not require referrals
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California:
https://leginfo.legislature.
ca.gov/faces/billNavClient. xhtml?bill_id=201520162AB15 “443.14. (a) Notwithstanding any other law, a person shall not be subject to civil or criminal liability solely because the person was present when the qualified individual self-administers the prescribed aid-in-dying drug. A person who is present may, without civil or criminal liability, assist the qualified individual by preparing the aid-in-dying drug so long as the person does not assist the qualified person in ingesting the aid-in-dying drug.
(b) A health care provider or professional organization or association shall not subject an individual to censure, discipline, suspension, loss of license, loss of privileges, loss of membership, or other penalty for participating in good faith compliance with this part or for refusing to participate in accordance with subdivision (e).
(c) Notwithstanding any other law, a health care provider shall not be subject to civil, criminal, administrative, disciplinary, employment, credentialing, professional discipline, contractual liability, or medical staff action, sanction, or penalty or other liability for participating in this part, including, but not limited to, determining the diagnosis or prognosis of an individual, determining the capacity of an individual for purposes of qualifying for the act, providing information to an individual regarding this part, and providing a referral to a physician who participates in this part. Nothing in this subdivision shall be construed to limit the application of, or provide immunity from, Section 443.16 or 443.17.
(d) (1) A request by a qualified individual to an attending physician to provide an aid-in-dying drug in good faith compliance with the provisions of this part shall not provide the sole basis for the appointment of a guardian or conservator.
(2) No actions taken in compliance with the provisions of this part shall constitute or provide the basis for any claim of neglect or elder abuse for any purpose of law.
(e) (1) Participation in activities authorized pursuant to this part shall be voluntary. Notwithstanding Sections 442 to 442.7, inclusive, a person or entity that elects, for reasons of conscience, morality, or ethics, not to engage in activities authorized pursuant to this part is not required to take any action in support of an individual’s decision under this part.
(2) Notwithstanding any other law, a health care provider is not subject to civil, criminal, administrative, disciplinary, employment, credentialing, professional discipline, contractual liability, or medical staff action, sanction, or penalty or other liability for refusing to participate in activities authorized under this part, including, but not limited to, refusing to inform a patient regarding his or her rights under this part, and not referring an individual to a physician who participates in activities authorized under this part.
(3) If a health care provider is unable or unwilling to carry out a qualified individual’s request under this part and the qualified individual transfers care to a new health care provider, the individual may request a copy of his or her medical records pursuant to law.”
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Colorado:
https://www.sos.state.co.us/pubs/elections/Initiatives/titleBoard/filings/2015-2016/145Final.pdf
25-48-117. No duty to prescribe or dispense. (1) A HEALTH CARE PROVIDER MAY CHOOSE WHETHER TO PARTICIPATE EN PROVIDING MEDICAL AID-IN-DYING MEDICATION TO AN TNDIVIDUAL IN ACCORDANCE WITH THIS ARTICLE.
(2) IF A HEALTH CARE PROVIDER IS UNABLE OR UNWILLING TO CARRY OUT AN INDIVIDUAL’S REQUEST FOR MEDICAL AID-TN-DYING MEDICATION MADE EN ACCORDANCE WITH THIS ARTICLE, AND ThE INDIVIDUAL TRANSFERS HIS OR HER CARE TO A NEW HEALTH CARE PROVIDER, THE PRIOR HEALTH CARE PROVIDER SHALL TRANSFER, UPON REQUEST, A COPY OF THE INDIVIDUAL’S RELEVANT MEDICAL RECORDS TO ThE NEW HEALTH CARE PROVIDER
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District of Columbia:
Sec. 11. Health care provider participation; notification; permissible sanctions.
(a) No health care provider shall be obligated under this act, by contract, or otherwise, to participate in the provision of a covered medication to a qualified patient.
(b) If a health care provider is unable or unwilling to carry out a patient’s request for a covered medication under this act and the patient transfers his or her care to a new health care provider, the prior health care provider shall transfer, upon request of the patient, a copy of the patient’s relevant medical records to the new health care provider.
(c) A health care provider may prohibit any other health care provider that it employs or contracts with from providing a covered medication under this act on the prohibiting health care provider’s premises; provided, that the prohibiting health care provider has notified the health care provider of this policy before the employee or contractor has provided a covered medication.
(d) Notwithstanding section 12, if, before a covered medication has been provided, the prohibiting health care provider has notified the sanctioned health care provider that it prohibits providing a covered medication under this act, the prohibiting health care provider may impose the following sanctions:
(1) Loss of privileges, loss of membership, or other sanction pursuant to the prohibiting health care provider’s medical staff bylaws, policies, and procedures, if the sanctioned health care provider is a member of the prohibiting health care provider’s medical staff and participates under this act while on staff on the premises of the prohibiting health care provider’s health care facility;
(2) Termination of the lease or other property contract or other nonmonetary remedies provided under the lease or property contract, not including loss or restriction of medical staff privileges or exclusion from a provider panel, if the sanctioned health care provider participates under this act while on the premises of a prohibiting health care provider’s health care facility or on the property that is owned by or under the direct control of the prohibiting health care provider;
(3) Termination of an employment contract or other nonmonetary remedies provided by contract if the sanctioned health care provider participates under this act in the course and scope of the sanctioned health care provider’s duties as an employee or independent contractor of the prohibiting health care provider; or
(4) Any other sanctions and penalties in accordance with the prohibiting health care provider’s policies and practices; provided, that no sanctions or penalties shall be imposed under this paragraph without a procedure for contesting the sections and penalties.
(e) Nothing in this section shall be construed to prevent:
(1) A health care provider from participating under this act while acting outside the course and scope of the health care provider’s duties as an employee or independent contractor of the prohibiting health care provider;
(2) A patient from contracting with his or her attending physician and consulting physician to act outside the course and scope of the health care provider’s duties as an employee or independent contractor of the prohibiting health care provider;
(3) A health care provider from making an initial determination pursuant to the standard of care that a patient has a terminal disease and informing him or her of the medical prognosis;
(4) A health care provider from providing information about this act upon the request of the patient; or
(5) A health care provider from providing a patient, upon request, with a referral to another health care provider.
(f) Sanctions issued pursuant to subsection (d) of this section are not reportable under section 513(a)(4)(C) of the District of Columbia Health Occupations Revision Act of 1985, effective March 25, 1986 (D.C. Law 6-99; D.C. Official Code§ 3-1205.13(a)(4)(C)).
Sec. 12. Immunities, liabilities, and exceptions.
(a) Except as provided in section 11 , no person shall be subject to civil or criminal liability or professional disciplinary action for:
(1) Participating in good faith compliance with this act;
(2) Refusing to participate in providing a covered medication under this act;
or
(3) Being present when a qualified patient takes a covered medication.
(b) Nothing in this act shall be interpreted to lower the applicable standard of care for the attending physician, consulting physician, psychiatrist, psychologist, or other health care provider participating in this act.
(c) No request by a patient for a covered medication made in good-faith compliance with the provisions of this act shall provide the basis for the appointment of a guardian or conservator.
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Hawaii:
https://www.capitol.hawaii.gov/session2018/bills/HB2739_HD1_.htm
(4) No health care provider or health care facility shall be under any duty, whether by contract, statute, or any other legal requirement, to participate in the provision to a qualified patient of a prescription or of medication to end the qualified patient’s life pursuant to this chapter. If a health care provider is unable or unwilling to carry out a patient’s request under this chapter and the patient transfers the patient’s care to a new health care provider, the prior health care provider shall transfer, upon request, a copy of the patient’s relevant medical records to the new health care provider; and
(5) No health care facility shall be subject to civil or criminal liability for acting in good faith compliance with this chapter.
(b) Notwithstanding any other provision of law, a health care facility may prohibit a health care provider from participating in actions covered by this chapter on the premises of the health care facility if the health care facility has notified the health care provider of the health care facility’s policy regarding participation in actions covered by this chapter. Nothing in this subsection shall prevent a health care provider from providing health care services to a patient that do not constitute participation in actions covered by this chapter.
(c) Subsection (a) notwithstanding, if the health care facility has notified the health care provider prior to participation in actions covered by this chapter that the health care facility prohibits participation on its premises in actions covered by this chapter, the health care facility may subject the health care provider to the following sanctions:
(1) Loss of privileges, loss of membership, or other sanction provided pursuant to the medical staff bylaws, policies, and procedures of the health care facility if the health care provider is a member of the health care facility’s medical staff and participates in actions covered by this chapter while on the premises of the health care facility other than in the private medical office of the health care provider;
(2) Termination of lease or other property contract or other nonmonetary remedies provided by lease contract, not including loss or restriction of medical staff privileges or exclusion from a provider panel, if the health care provider participates in actions covered by this chapter while on the premises of the health care facility or on property that is owned by or under the direct control of the health care facility; or
(3) Termination of contract or other nonmonetary remedies provided by contract if the health care provider participates in actions covered by this chapter while acting in the course and scope of the health care provider’s capacity as an employee or independent contractor of the health care facility; provided that nothing in this paragraph shall be construed to prevent:
(A) A health care provider from participating in actions covered by this chapter while acting outside the course and scope of the health care provider’s capacity as an employee or independent contractor; or
(B) A patient from contracting with the patient’s attending provider, consulting provider, or counselor to act outside the course and scope of those providers’ capacity as an employee or independent contractor of the health care facility.
(d) A health care facility that imposes sanctions pursuant to subsection (c) shall follow all due process and other procedures the health care facility may have that are related to the imposition of sanctions on a health care provider.
(e) For the purposes of this section:
“Notify” means to deliver a separate statement in writing to a health care provider specifically informing the health care provider prior to the health care provider’s participation in actions covered by this chapter of the health care facility’s policy regarding participation in actions covered by this chapter.
“Participate in actions covered by this chapter” means to perform the duties of an attending provider pursuant to section -4, the consulting provider function pursuant to section -5, or the counseling referral function or counseling pursuant to section -6. The term does not include:
(1) Making an initial determination that a patient has a terminal disease and informing the patient of the medical prognosis;
(2) Providing information about this chapter to a patient upon the request of the patient;
(3) Providing a patient, upon the request of the patient, with a referral to another physician; or
(4) Entering into a contract with a patient as the patient’s attending provider, consulting provider, or counselor to act outside of the course and scope of the health care provider’s capacity as an employee or independent contractor of a health care facility.
(f) Action taken pursuant to sections -4 through -6 shall not be the sole basis for disciplinary action under sections 453-8, 465-13, or 467E-12.
- -20 Prohibited acts; penalties. (a) Any person who intentionally makes, completes, alters, or endorses a request for a prescription made pursuant to section -2, for another person, or conceals or destroys any documentation of a rescission of a request for a prescription completed by another person, shall be guilty of a class A felony.
(b) Any person who knowingly coerces or induces a patient by force, threat, fraud, or intimidation to request a prescription pursuant to section -2, shall be guilty of a class A felony.
(c) Nothing in this section shall limit any liability for civil damages resulting from any intentional or negligent conduct by any person in violation of this chapter.
(d) The penalties in this chapter are cumulative and shall not preclude criminal penalties pursuant to other applicable state law.
- -21 Claims by governmental entity for costs incurred. Any governmental entity that incurs costs resulting from a person terminating the person’s life pursuant to this chapter in a public place shall have a claim against the estate of the person to recover costs and reasonable attorneys’ fees related to enforcing the claim.
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Oregon:
The Oregon Death with Dignity Act : http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Documents/statute.pdf, c. 127.885
From Section 4, paragraph 4.01:
(4) No health care provider shall be under any duty, whether by contract, by statute or by any other legal requirement to participate in the provision to a qualified patient of medication to end his or her life in a humane and dignified manner. If a health care provider is unable or unwilling to carry out a patient’s request under ORS 127.800 to 127.897, and the patient transfers his or her care to a new health care provider, the prior health care provider shall transfer, upon request, a copy of the patient’s relevant medical records to the new health care provider.
See also FAQs at: http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Pages/faqs.aspx#ifa -
Vermont:
An Act relating to patient choice and control at end of life http://www.leg.state.vt.us/docs/2014/Acts/ACT039.pdf, c. 5283 and 5285
§ 5285. LIMITATIONS ON ACTIONS (a) A physician, nurse, pharmacist, or other person shall not be under any duty, by law or contract, to participate in the provision of a lethal dose of medication to a patient. (b) A health care facility or health care provider shall not subject a physician, nurse, pharmacist, or other person to discipline, suspension, loss of license, loss of privileges, or other penalty for actions taken in good faith reliance on the provisions of this chapter or refusals to act under this chapter.https://www.healthvermont.gov/sites/default/files/documents/pdf/Act39_faq.pdf
Do doctors have to tell patients about this option?
Under Act 39 and the Patient’s Bill of Rights, a patient has the right to be informed of all options for care and treatment in order to make a fully-informed choice. If a doctor is unwilling to inform a patient, he or she must make a referral or otherwise arrange for the patient to receive all relevant information.
Are all doctors, nurses and pharmacists required to participate in Act 39? No. Participation by any health care professional is completely voluntary. -
Washington:
The Washington Death with Dignity Act: http://app.leg.wa.gov/rcw/default.aspx?cite=70.245&full=true , c. 70.245.190
Section 190 of the Act subsection 1 states:
http://app.leg.wa.gov/rcw/default.aspx?cite=70.245.190
(d) Only willing health care providers shall participate in the provision to a qualified patient of medication to end his or her life in a humane and dignified manner. If a health care provider is unable or unwilling to carry out a patient’s request under this chapter, and the patient transfers his or her care to a new health care provider, the prior health care provider shall transfer, upon request, a copy of the patient’s relevant medical records to the new health care provider.
See also questions 4 and 8 from: Questions and Answers about Initiative 1000, the “Washington State Death with Dignity Act”
https://www.doh.wa.gov/YouandYourFamily/IllnessandDisease/DeathwithDignityAct/FrequentlyAskedQuestions -
Australia (Victoria):
Conscientious objection of registered health practitioners
A registered health practitioner who has a conscientious objection to voluntary assisted dying has the right to refuse to do any of the following—
(a) to provide information about voluntary assisted dying;
(b) to participate in the request and assessment process;
(c) to apply for a voluntary assisted dying permit;
(d) to supply, prescribe or administer a voluntary assisted dying substance;
(e) to be present at the time of administration of a voluntary assisted dying substance;
(f) to dispense a prescription for a voluntary assisted dying substance.
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Belgium:
Art. 14. La demande et la de´claration anticipe´e de volonte´ telles que pre´vues aux articles 3 et 4 de la pre´sente loi n’ont pas de valeur contraignante.
Aucun me´decin n’est tenu de pratiquer une euthanasie. Aucune autre personne n’est tenue de participer a` une euthanasie.
Si le me´decin consulte´ refuse de pratiquer une euthanasie, il est tenu d’en informer en temps utile le patient ou la personne de confiance e´ventuelle, en en pre´cisant les raisons. Dans le cas ou` son refus est justifie´ par une raison me´dicale, celle-ci est consigne´e dans le dossier me´dical du patient.
Le me´decin qui refuse de donner suite a` une requeˆte d’euthanasie est tenu, a` la demande du patient ou de la personne de confiance, de communiquer le dossier me´dical du patient au me´decin de´signe´ par ce dernier ou par la personne de confiance
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Colombia:
https://www.minsalud.gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/VS/PP/abc-muerte-anticipada.pdf
9 ¿Qué debe hacer el profesional médico que alegue objeción de conciencia y que fue delegado por el comité para realizar el procedimiento?
El médico deberá presentar por escrito y debidamente motivada la objeción al comité, el cual deberá designar a otro médico en un término no mayor a 24 horas.
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Holland:
https://www.worldrtd.net/
dutch-law-termination-life- request-and-assisted-suicide- complete-text (the English translation in a pro-euthanasia site) and this from the actual government site: https://www.government.nl/
topics/euthanasia/is- euthanasia-allowed (in English): “Physician not obliged to perform euthanasia
Physicians are not obliged to grant a request for euthanasia. A physician who does not want to perform the procedure himself should discuss this with the patient and may decide to refer him to another physician.”
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Luxembourg:
“21
What happens in the case where the conditions are met and the doctor raises his conscientious objection ?
When the doctor raises his conscientious objection, he is obliged to inform his patient and/or the person of trust of this within 24 hours and to submit the file to a colleague appointed by the patient or by the person of trust.”
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Switzerland:
Swiss Criminal Code:
http://www.admin.ch/opc/en/classified-compilation/19370083/index.html>, art. 115.
In Switzerland, despite the absence of legislation on physician-assisted suicide, the legality of this practice derives from an omission in Swiss penal law. Article 115 of the Swiss Criminal Code criminalizes the provision of assisted suicide services for “selfish motives.” Therefore, it would appear that under article 115, assisted suicide is permitted as long as the person providing this service does so for unselfish reasons. (Stephen J. Ziegler, “Collaborated Death: An Exploration of the Swiss Model of Assisted Suicide for its Potential to Enhance Oversight and Demedicalize the Dying Process,” Journal of Law, Medicine & Ethics, Summer 2009, page 322)