TORONTO - A parliamentary committee's recommendation that doctors who object to assisted dying be required to at least refer patients to a willing colleague is not only disappointing, but has also led some physicians to consider leaving their practices, says the Canadian Medical Association.

The all-party committee, which released a set of recommendations Thursday aimed at helping the federal government draft legislation governing medically aided death, said Ottawa should work with the provinces and territories to establish a process that respects a doctor's freedom of conscience, while respecting the needs of patients.

"At a minimum, the objecting practitioner must provide an effective referral for the patient," the committee said.

The CMA, which represents about 80,000 physicians across the country, had argued during hearings to the committee that doctors who oppose assisted dying on grounds of conscience should not be required to refer patients to a colleague willing to provide or administer drugs that would end their lives.

"We were very disappointed to see it not incorporated into the recommendations," said Dr. Jeff Blackmer, the CMA's vice-president of medical professionalism.

Referral has been a hot-button issue among members of the physicians group, with many arguing that doctors should not be coerced into providing the service, nor should they be required to ease the path to assisted death when it runs counter to their religious, moral or ethical beliefs.

Blackmer said the CMA had proposed an alternative -- the creation of a central mechanism to facilitate access to medically aided dying, which conscientious objectors could advise patients about.

"I in no way mean to sound alarmist, but I have heard from some colleagues that are near retirement age that if this does become enshrined in legislation, they will retire," he said. "I know some colleagues who have said they'll move to a U.S. state.

"I don't think those numbers are going to be huge, but certainly there is a subset of physicians who feel strongly enough about this that they would absolutely make changes in their practice, based on what the legislation might look like."