Ontario court rules doctors who oppose assisted death must refer patients

The Globe and Mail

Sean Fine

In the first Canadian test of conscience rights for doctors who oppose assisted death, an Ontario court has upheld regulations requiring the objectors to refer their patients to physicians willing to perform the procedure.

Groups representing 4,700 Christian doctors had challenged Ontario’s regulations requiring the referrals, saying that making such a referral was morally equivalent to participating in an assisted death.

But Ontario’s Divisional Court said the referral rule was a reasonable limit on doctors’ freedom of religion because it protects vulnerable patients from harm. And those patients, it said, have a constitutional right to equitable access to publicly funded health care.

Without the policy of “effective referral,” equitable access would be “compromised or sacrificed, in a variety of circumstances, more often than not involving vulnerable members of our society at the time of requesting services,” Justice Herman Wilton-Siegel wrote in the 3-0 ruling on Wednesday. . . [Full text]

Ontario court ruling “a significant loss for the entire health care system”

News Release

FOR IMMEDIATE RELEASE

CMDS, CFCPS, CPFL

Toronto, Ontario – From June 13-15, 2017, the legal application of three physicians’ organizations – the Christian Medical and Dental Society of Canada (“CMDS Canada”), the Canadian Federation of Catholic Physicians’ Societies (“CFCPS”) and the Canadian Physicians for Life – and five physicians – was heard in the Ontario Divisional Court. The respondent in the case is the College of Physicians and Surgeons of Ontario (CPSO).

An application was filed asking the Court to declare that portions of the CPSO’s Professional Obligations and Human Rights policy violate the Canadian Charter of Rights and Freedoms. An application for judicial review was simultaneously filed asking the Court to declare the same of the CPSO’s Medical Assistance in Dying policy.

Today, January 31, 2018, the Court declared that these CPSO policies violate freedom of religion by requiring physicians and surgeons to make referrals when their consciences will not allow them to perform a procedure or treatment. The Court stated, (at para. 87): “I am of the opinion that the Policies infringe the rights of religious freedom of the Individual Applicants as guaranteed under the Charter …”

However, the Court found that the violations were justified because of the importance of providing access to these services.

“The Court held that other jurisdictions had chosen less restrictive means of ensuring access. The Court also held that there was no evidence that conscientious objection ever results in a failure of access. The Court also held that the implications for physicians were serious and more than trivial or insubstantial. We are left wondering why an effective referral is necessary,” Larry Worthen, Executive Director of the Christian Medical and Dental Society of Canada said.

“Canada represents itself on the world stage as being a cultural mosaic. This is evidence that we are losing sight of that reality. To say we respect all cultures and beliefs, we need to respect their strongly held moral convictions. We heard from our members and other doctors with conscientious objections over and over again that they felt referral made them complicit and that they wouldn’t be able to live with themselves or stay in the profession if effective referral is still required. We are currently reviewing our options regarding an appeal.”

“This is a disappointing decision and puts our doctors – doctors who entered the field of medicine to provide quality, compassionate, and patient-centered care – in an impossible position,” states Dr. Ryan Wilson, President of Canadian Physicians for Life. “They don’t believe ending a patient’s life is medicine, and they don’t believe they can offer hope and healing in one room while assisting in killing a patient in another. Ultimately it is patient care that suffers, as our doctors will retire early, relocate, or change fields. For many, their religious and conscience rights are being violated and they won’t be able to practice medicine in Ontario. This is a significant loss for the entire health care system in the province and will have a direct impact on patient care.”

The CFCPS is very disappointed with this decision from this Ontario Court that denies conscience rights to many Ontario physicians. “The Canadian Charter of Rights and Freedoms guarantees freedom of religion for all Canadians,” stated Dr. Jim Lane, President of the CFCPS. “This decision forces many Ontario doctors to be unable to care for their patients. This decision also raises alarm bells to all health care workers and Ontario residents that their freedom of religion and conscience could also be jeopardized.”

CMDS Canada is a national association of Christian doctors and dentists who strive to integrate their Christian faith with medical or dental practice. CMDS Canada represents approximately 1600 medical doctors, dentists and medical and dental students, over 500 of which are located in Ontario.

The CFCPS is a national association of Catholic physicians’ guilds, associations and societies from eleven cities across Canada, four of which are in Ontario.

The physicians represented by CMDS Canada and CFCPS hold sincere religious and moral beliefs that form the basis of their moral or religious objection to physician-assisted death.

The Canadian Physicians for Life (“CPL”) is a national association of pro-life physicians, retired physicians, medical residents and students. CPL’s members are dedicated to building a culture of care, compassion and life. CPL was founded in 1975 and is a non-religious charitable organization. CPL’s members believe that every human life, regardless of age or infirmity, is valuable and worth protecting.

For more information and media requests contact:

Larry Worthen, Executive Director
Christian Medical and Dental Society of Canada
902-880-2495 (cell)
office@cmdscanada.org

Divisional Court Accepts Religious and Conscientious Infringement on Ontario Doctors

News Release

Catholic Civil Rights League

TORONTO, ON January 31, 2018 – The Catholic Civil Rights League (CCRL) is gravely disappointed in the ruling released today by the Ontario Divisional Court in the case CMDS et al v. CPSO.

The application was brought by several religious physicians and groups to challenge the mandate of the College of Physicians and Surgeons of Ontario (CPSO), that requires doctors who object to certain procedures on religious or conscientious grounds, such as assisted suicide, to provide nevertheless, an “effective referral” to another physician or caregiver who would perform the service.

The court upheld the policy that requires life affirming physicians to act against their religion and conscience.

It is an alarming development which places Ontario doctors at the risk of professional complaints for refusing to make such referrals.

While finding that the CPSO policies were in breach of the constitutional right to freedom of religion (the court declined to make a ruling on freedom of conscience given its assessment), it found that the policy choice of the CPSO engaged a “reasonable limit” on the exercise of such freedoms.  Speaking on behalf of the three-member panel, Mr. Justice Wilton-Siegel asserted that the CPSO limit on such rights, while not trivial, did not create a substantial infringement, even if it meant forcing a physician to violate one’s conscience, to accommodate his or her practice choices, even to the extent of stepping aside from certain practice areas.

The CCRL has maintained that the CPSO’s insistence on obligating Ontario physicians to perform an “effective referral” for objectionable procedures does nothing to honour the Charter right of freedom of conscience and religion. Rather it is a breach of a physician’s rights and a serious incursion into the professional standing of a physician.

A proper balancing of the rights of physicians with the concept of patient autonomy must not result in the trumping of the rights of physicians in their medical practices.  Such rights extend not only to refusing to perform assisted suicide and euthanasia, but the right not to be obliged to refer to other practitioners who may be willing to provide such services. This clearly constitutes participation in wrong.

According to a recent statement from the John Paul II Academy for Human Life and the Family:

“Seeking to impose on a doctor the duty to perform abortions or euthanasia (or, alternatively, to leave the medical profession or a given hospital), or to impose on him the duty to refer a woman to an abortionist, is gravely sinful and a direct violation of his inalienable human dignity and freedom of conscience.”

“The same also applies to the case where a prolife physician is claimed to be obliged to refer a patient (who requests physician-assisted suicide or euthanasia) to a colleague who would perform such acts.  Not only is the prolife physician not obliged to refer a patient to a colleague who would perform intrinsically wrong acts, he is also absolutely morally forbidden to do so,” they continue.

Speaking to the fallacy of the imposition of personal autonomy on others, “One can hardly imagine a worse perversion of moral truth and natural right than the idea that a person has a right to demand that other persons commit the crime to murder him. Nobody has any right whatsoever to demand from society to assist him to commit a crime against himself, or to oblige others to commit the crime of murdering him.”

“Quite the contrary, the others and the State, in virtue of their true moral autonomy, a moral autonomy subjected to the truth, have the absolute moral duty to reject such a request.”

The CCRL asserted in our legal argument, and relying upon previous authorities, that in a free and democratic society, the state should respect choices made by individuals and, to the greatest extent possible, will avoid subordinating these choices to any one conception of the good life.

Demanding that someone participate in perceived wrongdoing demands the submission of intellect, will and conscience, reducing the person to the status of a thing, to a tool to be used by others, to servitude that cannot be reconciled with principles of equality. It is an assault on human dignity that deprives physicians of their essential humanity.

The court missed an opportunity to require the CPSO to create a policy that would recognize that doctors have different views of what proper accompaniment of vulnerable patients entails.  Many patients not only share the views of the appellants, but also desire to be served by physicians who hold such views. Such doctors care deeply about their patients, and do not wish to be engaged in “referring” patients to their unnatural deaths.

The court instead accepted the arguments of the CPSO and has given its approval to a policy that serves to infringe upon the rights of such physicians.  Such an infringement is by no means insubstantial.

An appeal is required.


About the CCRL

The Catholic Civil Rights League (CCRL)) assists in creating conditions within which Catholic teachings can be better understood, cooperates with other organizations in defending civil rights in Canada, and opposes defamation and discrimination against Catholics on the basis of their beliefs. The CCRL was founded in 1985 as an independent lay organization with a large nationwide membership base. The CCRL is a Canadian non-profit organization entirely supported by the generosity of its members.

For further information: Christian Domenic Elia, PhD CCRL Executive Director 416-466-8244 @CCRLtweets

The Alarming Trend Of Bullying Hospitals And Hospices Into Assisted Suicide

Huffington Post

Reproduced with permission

Dr. Will Johnston

Canadians who are sick and suicidal can now be put to death under various medicalized and government-approved protocols, following court and legislative victories by euthanasia activists. These activists are now turning their considerable talents to a coercive makeover of the palliative hospice movement by demanding that hospices founded on a promise to never deliberately hasten death should provide a death

Before they got their way in the Canadian Supreme Court, the public posture of euthanasia advocates was one of caution, reassurance and limitation of objectives. After their victory, partisans of the medical killing movement have become impatient with individuals or institutions who want no part in suicide and euthanasia. Activists recommend expanding access to include all the people who were strategically excluded from the plan that had been sold to the public: children, people with chronic nonfatal conditions, the physically disabled, the cognitively disabled, psychiatric patients.

Now, even changing the location of a patient requesting suicide — from a euthanasia-free hospital or hospice, to one that does offer it — is being protested as a cruel imposition. In doing so, the death-seeking person is set up as a victim, and the hospital or hospice is portrayed as a victimizer. Never mind that hospital wards routinely transport people in complete comfort to procedures like X-rays or scopes, or to another location to continue care.

The implications of this are dire. Many hospices serve patients who want nothing to do with assisted suicide, and there will be much harm done by forcing it into their midst. Every community in this country has the resources to provide a distinct euthanasia-free space. That distinct space and its staff could be specialized and uncoerced into death-hastening.

The unpleasant alternative was demonstrated by the recent “sneak attack” on Louis Brier Hospital, a Jewish retirement home in Vancouver. This was the work of euthanasia activist Ellen Wiebe, idolized by like-minded columnists for her aggressive death-providing practice. Rather than arrange a simple transfer — perhaps to the home of one of the suicidal father’s daughters — the patient was killed by Dr. Wiebe against the firm policy of a facility with an understandable aversion to euthanasia.

As Louis Brier’s director protested, “We have a lot of Holocaust survivors. To have a doctor sneak in and kill someone without telling anyone. They’re going to feel like they’re at risk when you learn someone was sneaking in and killing someone.”

What Dr. Wiebe was doing by giving the finger to Louis Brier is a form of ethical bullying, masquerading as an altruistic claim that her client should come first and trump other people’s rights about the kind of place they want to live in.

Wanting Dr. Wiebe to kill you is a tragedy, not an emergency. It is a personal preference, sadly now provided by the Canadian health-care system, but without any judicial or parliamentary authorization to force others to accept involuntary proximity to your actions. It is also, increasingly, about people who are not dying, except in Dr. Wiebe’s elastic interpretation, but about those who have lost meaning and hope. What they get from the euthanasia provider amounts to a heartless endorsement of the hopelessness of their situation, cloaked in the language of autonomy.

Rather than look for a win-win compromise over this issue, the board of Fraser Health Authority, a large B.C. hospital system, has imposed euthanasia provision in all its palliative hospices. This edict, totally uncalled for by provincial or federal guidelines, caused the high-profile resignation of Palliative Care Medical Director Dr. Neil Hilliard.

Meanwhile, our governments are, in Dr. Hilliard’s words, “guilty by neglect” of a “palliative care access gap,” and your sick family member who seeks care, not death, may not find it “equitable or timely.”

Forcing hospices to betray their no-kill founding principles will not close that gap, it will just torpedo the 40-year struggle to convince often-fearful patients that palliative hospices are not about hastening death.

Fraser Health and any other misled health bureaucracies across Canada should back down. Don’t bully hospices as though there are no fair alternatives. Don’t bully Catholic hospitals, founded on a reverence for life long before the public purse got involved.

HHS Announces New Conscience and Religious Freedom Division

News Release

For immediate release

U.S. Department of Health and Human Services

Today, the U.S. Department of Health and Human Services (HHS) is pleased to announce the formation of a new Conscience and Religious Freedom Division in the HHS Office for Civil Rights (OCR).  The announcement will take place at an event at HHS headquarters from 10:30 a.m. to noon.  It will be livestreamed here. Speakers will include Acting Secretary Eric D. Hargan, House Majority Leader Kevin McCarthy, Representative Vicky Hartzler, Senator James Lankford, OCR Director Roger Severino, and special guests.

The Conscience and Religious Freedom Division has been established to restore federal enforcement of our nation’s laws that protect the fundamental and unalienable rights of conscience and religious freedom.  OCR is the law enforcement agency within HHS that enforces federal laws protecting civil rights and conscience in health and human services, and the security and privacy of people’s health information.  The creation of the new division will provide HHS with the focus it needs to more vigorously and effectively enforce existing laws protecting the rights of conscience and religious freedom, the first freedom protected in the Bill of Rights.

OCR already has enforcement authority over federal conscience protection statutes, such as the Church, Coats-Snowe, and Weldon Amendments; Section 1553 of the Affordable Care Act (on assisted suicide); and certain federal nondiscrimination laws that prohibit discrimination on the basis of religion in a variety of HHS programs.

OCR Director Severino said, “Laws protecting religious freedom and conscience rights are just empty words on paper if they aren’t enforced. No one should be forced to choose between helping sick people and living by one’s deepest moral or religious convictions, and the new division will help guarantee that victims of unlawful discrimination find justice. For too long, governments big and small have treated conscience claims with hostility instead of protection, but change is coming and it begins here and now.”

Acting HHS Secretary Hargan said, “President Trump promised the American people that his administration would vigorously uphold the rights of conscience and religious freedom.  That promise is being kept today. The Founding Fathers knew that a nation that respects conscience rights is more diverse and more free, and OCR’s new division will help make that vision a reality.”

Contact: Office for Civil Rights
202-774-3009

arina.grossu@hhs.gov

To learn more about the new Conscience and Religious Freedom Division, visit us at www.hhs.gov/conscience.

To file a complaint with OCR based on a violation of civil rights, conscience or religious freedom, or health information privacy, visit us at https://www.hhs.gov/ocr/complaints.

British conscience protection bill: second reading set for 26 January, 2018

The Conscientious Objection (Medical Activities) Bill [HL] 2017-19, introduced by Baroness Nuala O’Loan, will be debated during second reading in the British House of Lords on 26 January, 2018.  The proposal is a procedure-specific bill limited to activities associated with abortion, artificial reproduction and withdrawing life sustaining treatment.

No, Politico, Conscience Protections Are Neither ‘So-Called’ Nor ‘Controversial’

There is simply no historical ground upon which Politico can claim that protecting the right of medical professionals not to participate in abortion has been ‘controversial’ since Roe v. Wade.

The Federalist
Reproduced with permission

Casey Mattox

Government shouldn’t force people to violate their consciences. Until recently, that opinion hasn’t been particularly controversial, even where actual controversial issues like abortion were involved. One can support abortion and still think government shouldn’t discriminate against medical professionals who don’t perform abortions.

But if you want to gin up opposition to something, it presumably helps to pretend that it’s your opponent who is the extremist. You can’t very well admit that it’s your own opinion that is historically extreme and your opponent who has history on his side. That’s a much harder sell.

Perhaps this is why, in a story yesterday about the new U.S. Department of Health and Human Services office to address conscience and religious freedom for medical professionals and institutions, Politico casually dropped this nugget: “So-called conscience protections have been politically controversial since shortly after Roe v. Wade legalized abortion in 1973.”

This claim may be politically useful, but it is demonstrably false. At the risk of appearing to repeatedly bludgeon this false narrative to death, it’s important to understand just how inexcusably wrong this instance of fake news is, and how these sorts of so-called “mistakes” drive narratives that create today’s politics.

Shortly after Roe v. Wade

Weeks after the Supreme Court released its decision in Roe v. Wade, Congress enacted the first of the federal laws aimed at protecting conscience in light of this newly minted “right” to abortion. The Church Amendment, named for its sponsor, Idaho’s longtime Democratic Senator Frank Church, ensured that Catholic hospitals could continue to provide health care to millions of Medicaid patients without being forced to also perform abortions.

That provision passed 372-1 in the House and 92-1 in the Senate. Noted right-winger Sen. Ted Kennedy spoke in favor of the law on the floor of the Senate, calling it necessary “to give full protection to the religious freedom of physicians and others.”

A Democrat-controlled Congress added additional “so-called conscience protections” to the Church Amendment for these individual medical professionals and in federally funded programs over the next few years. The idea that these laws were controversial would have been a surprise to the bipartisan coalitions in Congress voting for them.

In 1992, Nadine Strossen, president of the American Civil Liberties Union, testified in favor of the Religious Freedom Restoration Act (yep, you read that correctly), saying RFRA would protect “such familiar practices as . . . permitting religiously sponsored hospitals to decline to provide abortion or contraception services.” The ACLU didn’t think conscience was either “so-called” or “controversial” in 1992.

In 1996, a bipartisan Congress again defended conscience rights, enacting the Coats-Snowe Amendment to the Public Health Services Act with President Bill Clinton’s signature. This law prohibits the federal government and any state or local government receiving federal funds (i.e., all of them) from discriminating against physicians or health-training programs or their participants on the basis that they don’t provide or undergo abortion training or perform or refer for abortions.

Forty-seven states have enacted laws protecting medical professionals from being discriminated against because of their objection to participating in abortion, most of those becoming law in the years immediately following Roe.

But everything above is just icing on the cake. Politico could have confirmed its narrative was false just by reading Roe. Addressing the concern that this new right to an abortion might result in attempts to force medical professionals to perform them, the Supreme Court explained this wouldn’t happen because the American Medical Association’s House of Delegates had already broadly defended the exercise of religious and moral conscience in the abortion context, quoting it in Roe:

Be it … resolved that no physician or other professional personnel shall be compelled to perform any act which violates his good medical judgment. Neither physician, hospital, nor hospital personnel shall be required to perform any act violative of personally held moral principles. In these circumstances good medical practice requires only that the physician or other professional personnel withdraw from the case so long as the withdrawal is consistent with good medical practice.

In the companion case Doe v. Bolton, the Supreme Court called a state law allowing hospitals not to admit patients for abortions and prohibiting them from requiring medical professionals to assist in them an “appropriate protection to the individual and to the denominational hospital.”

There is simply no historical ground upon which Politico can claim that protecting the right of medical professionals not to participate in abortion was “controversial” at the time of Roe or in the decades thereafter. It has only become “controversial” to defend the right of people to think differently and to live according to their own moral compass when the political left recently abandoned this classically liberal principle in favor of government compulsion.

The whole article reads like a horror movie in search of a villain. Its writers and interviewees know that HHS committing resources to safeguard the conscience of medical professionals and institutions that deliver health services to Americans is an evil plot. They just don’t know how. So the authors introduce the reader to none of these laws (available on the HHS Office of Civil Rights website with handy links), vaguely assert that all of this is really about LGBT issues (it’s not), and try to make boogey-men of those in this new office.

What Politico doesn’t do is inform readers that those advocating for government to compel medical professionals to perform abortions are actually the ones advocating for a departure from our historical common ground of respecting one another’s conscience. That, apparently, would complicate the narrative.

Casey Mattox is senior counsel with Alliance Defending Freedom. You can follow him on Twitter at @CaseyMattox_.

 

Ontario: make a call for conscience

Ontario Call for Conscience 2018

Coalition for HealthCARE and Conscience

The Problem

Assisted suicide has been legal in Canada since June 2016. Discussions are already taking place to  expand the criteria to minors, people with psychiatric illness and those with dementia. This puts people  who are lonely and isolated at risk of choosing euthanasia simply because they don’t have anyone  who cares and can give them hope.

Today in Ontario:

  • Physicians and other caregivers are forced to  participate in euthanasia against their will, by referring their patients.
  • Pro-euthanasia groups are threatening to sue faith based hospitals unless they allow  euthanasia on the premises.
  • Only a third of the population has access to adequate palliative care, so they are being  denied real choice on end of life issues.

This places physicians, nurses and other health  professionals in an impossible situation – assist in  the killing of their patients or lose the ability to care for patients at all.

This is happening despite constitutional protections for freedom of conscience and religion in the Charter  of Rights and Freedoms (s.2).

The Coalition for HealthCARE and Conscience  represents more than 110 healthcare facilities (with  almost 18,000 care beds and 60,000 staff) and more than 5,000 physicians across Canada. Our members are unable to participate in taking a patient’s life due to moral or ethical convictions.

The Solution

The Ontario legislature has the power to protect conscience rights for individuals and facilities and to provide adequate palliative care and mental health services so that people will not see assisted suicide as their only option. Our efforts in Manitoba helped to ensure the province passed conscience protection legislation in November 2017.

In advance of the June 2018 provincial election in Ontario, we have the opportunity to ask candidates from all parties three important questions:

  1. Will you support legislation to protect doctors, nurses and other health care providers who are being forced to participate in assisted suicide/euthanasia through making a referral?
  2. How will you protect facilities from being forced to offer euthanasia/assisted suicide on their premises?
  3. How does your party plan to address the lack of quality palliative care in our province?

To get involved, please participate in your Church’s Sign Up Sunday. We will be collecting contact information to help mobilize a large database of people to contact candidates for the 2018 Ontario provincial election.

[Leaflet]

For more information, visit www.canadiansforconscience.ca