Ontario and I believe Nova Scotia are the only jurisdictions in the world that require an effective referral. In every other jurisdiction in Canada and around the world, patients are able to obtain access without the requirement for an effective referral. There are already mechanisms in Ontario, where I practice, whereby patients can seek access to medical aid in dying without an effective referral.
It's quite clear that systems can be constructed, as Monsieur Racicot already suggested, through telehealth, etc., and organizations representing health care conscientious objectors have made very reasonable and constructive proposals in this regard, so if there were a will on the the part of the federal government, there is undoubtedly a way this could be done so that we would not be required to aid and abet the euthanasia of our patients.