Doctors who morally object to treatments must refer patients elsewhere

CTV News

Paolo Lorrigio, The Canadian Press

Ontario doctors who have a moral or religious objection to treatments such as assisted dying, contraception or abortions must refer patients to another doctor who can provide the service, after a court found it is necessary to guarantee that vulnerable patients can access the care they need.

A group of five doctors and three professional organizations had launched a legal challenge against a policy issued by the province’s medical regulator, arguing it infringed on their right to freedom of religion and conscience under the Charter of Rights and Freedoms.

The group — which includes the Christian Medical and Dental Society of Canada, the Canadian Federation of Catholic Physicians’ Societies and Canadian Physicians for Life — said the requirement for a referral amounted to being forced to take part in the treatment. . . [Full Text]

Changes to abortion provision means NHS staff need more legal protection

The Herald

Dr. Mary Neal

FREEDOM of conscience is an important fundamental freedom recognised in international treaties but current protection for conscientious objection by health professionals in UK domestic law is inadequate.

Some professionals have statutory ‘protection’ that is so narrow. This was exposed by the UK Supreme Court’s judgment in the Glasgow midwives’ case. The court held that ‘hands off’ involvement in terminations was not covered by the statutory conscience right in the Abortion Act 1967, so that individuals had no right to refuse to enable and support the process in indirect ways. . . [Full Text]

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

Why would my terminally ill father be denied a medically assisted death?

The Globe and Mail

Paul Taylor

The question: My father was in the advanced stages of prostate cancer and wanted a medically assisted death. He was told he needed the approval of two health-care providers. One said yes, but the other said no because he “was not in any distress.” But that decision was so wrong. My father was a very stoic man, and was not one to complain. Did the doctor want him to break down in tears and beg to be put to death? My father died two weeks later in a hospice – instead of his home, the place where he wanted to die.

The answer: It has been over a year and a half since Parliament passed a law that makes medical assistance in dying – called MAID for short – legal across Canada. The story you tell reflects one of the many challenges in creating a standardized system to handle these requests and to ensure that patients and their families are properly informed.

One key failing in your father’s case is that he was not apparently told he could have asked for another assessment after the second MAID assessor turned him down. If another assessor had agreed that he was eligible, he could have proceeded with an assisted death.

It’s impossible to say whether his assessors were unaware he had this option or simply failed to mention it.

Whatever the case, “we need to do a better job educating health-care providers about what they must be disclosing to patients,” says Jocelyn Downie, a professor in the faculties of law and medicine at Dalhousie University in Halifax.

In the meantime, it’s certainly worthwhile reviewing how the process is supposed to work. . . [Full Text]

‘Pro-life medics must have conscientious objection rights’

The Christian Institute

A Bill designed to afford better protections for medical professionals who conscientiously object to abortion has passed its second reading in the House of Lords.

The Conscientious Objection (Medical Activities) Bill has been described as “important and timely”.

It seeks to ensure conscience objection rights for all medics and has now moved on to Committee Stage in the House of Lords. However, since it is a Private Member’s Bill, the Bill is not expected to pass. . . [Full Text]

Conscientious Objection: A Quick(ish) Answer

Journal of Medical Ethics

Mary Neal

The Conscientious Objection (Medical Activities) [HL] Bill, introduced by the crossbench peer Baroness O’Loan, received its second reading in the House of Lords on Friday 26th January and successfully proceeded to the committee stage.  In a post on this blog the following day, Iain posed a very reasonable question about clause 1(1)(a) of the Bill.  That clause would allow health professionals to refuse to be involved in “the withdrawal of life-sustaining treatment”, and Iain asks how this can be compatible with existing civil and criminal law, under which it is unlawful to fail to withdraw treatment (including life-sustaining treatment) from a competent patient who no longer consents to it, or from a patient who lacks capacity if treatment is no longer in her best interests.

Before responding, I should declare an interest: I’m a spokesperson for the Free Conscience campaign, which supports the Bill.  I endorse the Bill’s premise that healthcare professionals should, in key areas of practice, benefit from statutory conscience rights that are both meaningful and effective. . . [Full Text]

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.

Suicidal women struggle to get second opinion when seeking an abortion

Expert teams are not always available when assessment needed

Irish Independent

Eilish O’Regan

Concerns have emerged at senior HSE levels about the failure to always secure a psychiatrist to give a second opinion in cases where a pregnant woman is seeking an abortion on the grounds she is suicidal.

An internal document said in some cases it has meant the two psychiatrists and obstetrician, who are required under law to make an assessment in such cases, cannot be found.

Abortion is allowed in cases of suicide risk under the Protection of Life During Pregnancy Act of 2013, which came into effect in 2014.

The abortion can only be allowed if the doctors agree she is suicidal. If she is turned down, the woman then can apply for a review before another panel.

However, in an internal report authorised by Dr Philip Crowley, HSE national director for quality improvement, the lack of availability of a “second opinion” psychiatrist at the initial assessment means that in some cases the woman’s application is going straight to review. . . [Full text]