The College of Physicians and Surgeons of Ontario is updating its policies on end-of-life care following a recent Supreme Court of Canada decision that found doctors can't unilaterally end life support.
The decision clarified the interpretation of Ontario's consent law in ruling that withdrawing life support constitutes a form of treatment, and thus requires consent.
But it only applies to Ontario cases, and while other provinces have consent legislation, how doctors there decide to discontinue treatment remains murky, said Bernard Dickens, a medical law expert at the University of Toronto's Joint Centre for Bioethics.
"In other provinces, it's not certain and the Supreme Court left that open," Dickens said, noting that disputes over end-of-life care decisions must go to independent tribunals or courts for resolution.
Under the new draft policies that are now under public consultation, doctors would also need consent before issuing "do not resuscitate" orders.
The college's president, Dr. Carol Leet, said the changes "put far more emphasis on planning for end-of-life care."
Disagreements often erupt over what a patient would have wanted, and if people discussed their wishes with their doctor and their family earlier, then maybe those clashes could be avoided, she said.
The proposed guidelines also tackle another contentious issue now being weighed by the Supreme Court.
While assisted suicide remains prohibited in Canada, doctors should do more than just say it's illegal when patients express a desire to speed up death, Leet said.
Doctors must respond "in a sensitive manner," the proposed guidelines say.
"A patient’s wish or request to hasten death may be a genuine expression of a desire to hasten their death, but it may also be motivated by an underlying and treatable condition such as depression, psychological suffering, unbearable pain or other unmet care needs," the document reads.
"Because these expressions may be motivated by an issue that can be treated or addressed, physicians must be prepared to engage patients in a discussion to seek to understand the motivation for their expression and to resolve any underlying issues that can be treated or otherwise addressed."
The regulator, which oversees, licenses and regulates some 28,000 physicians, is also updating its guidelines on how to balance the charter rights of doctors and patients.
The proposed changes mean doctors who refuse to perform certain procedures — such as abortions — on moral grounds would have to refer patients to another doctor.
Physicians were previously allowed to withhold treatment that clashed with their religious and moral beliefs but had no obligation to provide a referral, said Dr. Marc Gabel, the regulator's former president.
Doctors would now also have to set aside their convictions when urgent medical care is needed, he said.
"The issue is there's people out there who say doctors should pack their beliefs at the door," he said. "Then there are others who say 'My moral and religious beliefs trump everything.'"
The new draft policy — which reflects what's being done in other provinces and the United Kingdom — marks a reasonable compromise based on doctors' professional duties, he said.
Note to readers: This is a corrected story. Earlier versions incorrectly said the College of Physicians and Surgeons of Ontario 'represents' doctors and gave an incorrect figure for the number of doctors it oversees and licenses.