Letter on conscience to CPS Nova Scotia

08 March 2024

Dr. Gus Grant, Registrar
College of Physicians & Surgeons of Nova Scotia
400-175 Western Parkway
Bedford, NS B4B 0V1

Dear Dr. Grant,

As Nova Scotia continues to develop policies and professional standards, we urge you to ensure robust conscience protection for physicians.

The Evangelical Fellowship of Canada (EFC) is the national association of evangelical Christians in Canada. Established in 1964, the EFC provides a national forum for Canada’s four million Evangelicals and a constructive voice for biblical principles in life and society.

The EFC has affiliated denominations, churches and organizations in Nova Scotia whose members include both physicians and patients in the NS healthcare system.

Charter-protected freedoms of conscience and religion are fundamental freedoms that should be recognized and supported in College policies. These freedoms can be balanced with patients’ right to access care and, in fact, may allow for better patient care as patients have a greater degree of trust in physicians whose values align with their own.

Conscience is rooted in the convictions and judgment of the individual physician. It is not the same for all physicians, even among those whose convictions are religiously informed.

For example, there are evangelical and other physicians who are conscientious objectors to participating in the intentional ending of a patient’s life through medical assistance in dying (MAiD). Some medical professionals may not object to MAiD in principle but cannot end the life of a patient who still has decades to live. Others may not participate in ending the life of a patient who is eligible for MAiD but whose request is motivated by inadequate living conditions or lack of support.

If MAiD continues to expand, such as on the basis of mental illness or to mature minors, there will be more medical professionals who will be unable to participate in MAiD.

Health Canada’s Model Practice Standard for MAiD proposes use of the term “effective referral” in provincial regulators’ professional standards and policies related to MAiD.

We urge you to respect and protect physicians deeply held beliefs and not compel direct or indirect participation in MAiD. Policies that require an effective referral for MAiD require physicians to actively facilitate procedures that may be against a physician’s conscience. This is unnecessary and problematic in many ways.

An effective referral is understood as formal cooperation in the procedure. It acts as a professional recommendation that euthanasia should be considered and may take place.

Participation in MAiD against their conscientious objection has a significant impact on a healthcare professional, including moral injury or moral distress. Objecting physicians may face burnout, early retirement or feel they need to leave their practice. This ultimately reduces the level of care available to patients.

Protecting physicians’ conscience benefits patients as well. It fosters trust and open, honest communication.

There are alternative ways for patients to access MAiD that do not violate a physician’s conscience or cause moral injury. Upon request, physicians could provide contact information or information on access routes to MAiD without being forced to participate in the delivery of the procedure.

Many other provinces do not use the term “effective referral” in their policies, including BC, AB, SK, MB and NL. The Ontario College has revised its policy so that physicians may simply provide contact information in certain circumstances.

Ensuring patient access does not need to violate physicians’ conscience.

The Council of Canadians with Disabilities (CCD) has clearly advocated for robust conscience protection for healthcare professionals so that people with disabilities are able to find doctors they can trust as allies. As the CCD Ending of Life Ethics Committee wrote to Ontario Health Minister Elliott and PC MPPs on April 12, 2021:

Given the ubiquity of medical ableism, it is of utmost importance that physicians and other healthcare providers whose views of the quality and worth of lives lived with disability differ from the majority be afforded robust protection of their conscience rights. People with disabilities need to be able to find doctors and other healthcare providers who they know will fight for their lives when necessary. Without legal protection of the conscience rights of healthcare professionals, this will not be possible. A failure to enact legislation to protect the conscience rights of healthcare professionals would thus leave thousands of Ontarians with disabilities without recourse to healthcare professionals who they can trust to serve as allies against the ubiquity of medical ableism that devalues and endangers their lives.

All Nova Scotians would benefit from the ability to find physicians whose philosophy of care and convictions align with their own.

We urge you to set a high standard of conscience protection as you develop and amend your policies and professional standards related to conscientious objection in Nova Scotia.


Julia Beazley, Director of Public Policy