In Canada, as in many developed countries, healthcare conscientious objection is growing in visibility, if not in incidence. Yet the country's health professional policies on conscientious objection are in disarray. The article reports the results of a comprehensive review of policies relevant to conscientious objection for four Canadian health professions: medicine, nursing, pharmacy and dentistry. Where relevant policies exist in many Canadian provinces, there is much controversy and potential for confusion, due to policy inconsistencies and terminological vagueness. Meanwhile, in Canada's three most northerly territories with significant Aboriginal populations, whose already precarious health is influenced by funding and practitioner shortages, there are major policy gaps applicable to conscientious objection. In many parts of the country, as a result of health professionals' conscientious refusals, access to some legal health services - including but not limited to reproductive health services such as abortion - has been seriously impeded. Although policy reform on conscientious conflicts may be difficult, and may generate strenuous opposition from some professional groups, for the sake of both patients and providers, such policy change must become an urgent priority.
Canada's medical assistance in dying legislation contains the eligibility criterion "natural death has become reasonably foreseeable." The phrase "reasonably foreseeable" is unfamiliar and unclear. As a result of ongoing confusion about its meaning, there is reason to be concerned that under-or over-inclusive interpretations of the phrase are adversely affecting access to MAID. With critical interests at stake (eg access to MAiD and potential criminal liability), it is essential that the meaning of the phrase be clarified. Furthermore, the meaning of "reasonably foreseeable" will be at issue in the Charter challenges to the federal MAiD legislation currently before the courts in British Columbia and Quebec. In order to determine whether the s. 241.2(2) violates the Charter, the courts will first have to determine what "reasonably foreseeable" means because whether the limits on access to MAiD violate the Charter depends on the scope of the limits. This paper therefore brings the principles of statutory interpretation to bear and proposes an interpretation of "reasonably foreseeable" in an effort to contribute to the judicial consideration of the meaning of the phrase and to guide clinical practice until clarification is provided by the courts.La legislation canadienne en matiere d'aide medicale a mourir (AMM) prevoit le critere d'admissibilite selon lequel la mort naturelle est devenue raisonnablement previsible .,, L'expression raisonnablement previsible , est pas familiere et nest pas claire. En raison de la confusion persistante quant a sa signification, il y a lieu de s'inquieter du fait que des interpretations trop larges ou trop etroites de Iexpression nuisent a Iacces a IAMM. Compte tenu des inter~ts critiques en jeu (par exemple Iacces a IAMM et la responsabilite penale potentielle), il est essentiel que le sens de Iexpression soit clarifie. De plus, le sens de IVexpression raisonnablement previsible , sera en cause dans les contestations au titre de la Charte de la legislation federale sur IAMM actuellement devant les tribunaux en viole la Charte, les tribunaux devront d'abord determiner ce que Ion entend par raisonnablement previsible ,, car la question de savoir si les restrictions a Iacces a IAMM violent la Charte depend de I'etendue de ces restrictions. Le present document met donc a profit les principes de IPinterpretation des lois et propose une interpretation de Iexpression raisonnablement previsible > afin de contribuer a Iexamen judiciaire du sens de Iexpression et de guider la pratique clinique jusqua ce que les tribunaux apportent des precisions.
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