Project Submission to the College of Physicians and Surgeons of Saskatchewan

Re: Conscientious Objection

Abstract

Conscientious Objection is unacceptable because it attacks the character and competence of objecting physicians, and it nullifies their freedom of conscience by compelling them to arrange for patients to obtain services to which they object.

Council has been given no evidence that anyone in Saskatchewan has ever been unable to access medical services or that the health of anyone in Saskatchewan has ever been adversely affected because a physician has declined to provide or refer for a procedure for reasons of conscience. In the absence of such evidence, the limits proposed in Conscientious Objection are neither reasonable nor demonstrably justified.

Conscientious Objection is not justified by the principles included in the policy because there is no necessary connection between the principles and a policy requiring physicians to do what they believe to be wrong. The principles can be applied to force physicians to facilitate morally contested procedures only if they are ideologically interpreted in order to impose one world view at the expense of others. The Supreme Court of Canada has unanimously affirmed that such an approach is unacceptable.

It is unrealistic to believe that the approach taken in Conscientious Objection will not be taken with respect to physician administered euthanasia and physician assisted suicide. The disclaimer to the contrary is ill-advised and misleading. A policy on Conscientious Objection should be sufficiently flexible to apply to direct or indirect participation in killing patients or helping them commit suicide. If Council is uncertain how this can be done, it should postpone policy development concerning Conscientious Objection until after the Carter decision comes into force in 2016.

Alternatively, if the College believes that some kind of guidance should be provided with respect to this contentious issue, the Project offers an alternative that protects physician freedom of conscience and religion but does not obstruct patient access to services, including euthanasia and assisted suicide.


Contents

I.    Introduction

II.    Overview of this submission

III.    Limitation of fundamental freedoms

IV.    “Purpose” and “Principles”

V.    Scope of Conscientious Objection

V.1    The disclaimer

V.2    Dissecting the disclaimer

V.3    Summary

V.4    Recommendations

VI.    Physician obligations

5.1    Taking on new patients (Comment)

5.2    Providing information to patients

5.3    Exercise of freedom of conscience and religion

5.4    Necessary treatments to prevent harm to patients

Appendix “A” – Conscientious Objection– “Purpose” and “Principles”: Comment and critique

A1.    Introduction

A2.    “The fiduciary relationship between a physician and a patient.”

A3.    “Patient autonomy.”

A4.    “A patient’s right to continuity of care.”
“Patients should not be disadvantaged or left without appropriate care due to the personal beliefs of their physicians.”
“Physicians have an obligation not to abandon their patients.”

A5.    “A patient’s right to information about their care.”
“Physicians have an obligation to provide full and balanced health information, referrals and health services to their patients in a non-discriminatory fashion.”

A6.    “Physicians should not intentionally or unintentionally create barriers to patient care.”
“Physicians have an obligation not to interfere with or obstruct a patient’s right to access legally permissible and publicly-funded health services.”

A7.    “The College has a responsibility to impose reasonable limits on a physician’s ability to refuse to provide care where those limits are appropriate.”

A8.    “Medical care should be equitably available to patients whatever the patient’s situation, to the extent that can be achieved.”

A9.    “The College of Physicians and Surgeons has an obligation to serve and protect the public interest.”

A10.    “The Canadian medical profession as a whole has an obligation to ensure that people have access to the provision of legally permissible and publicly-funded health services.”

A11.    “Physicians’ freedom of conscience should be respected.”

A12.    “Physicians’ exercise of freedom of conscience to limit the health services that they provide should not impede, either directly or indirectly, access to legally permissible and publicly-funded health services.”

A13.    “Physicians’ exercise of freedom of conscience to limit the services that they provide to patients should be done in a manner that respects patient dignity, facilitates access to care and protects patient safety.”

A14.    Summary

Appendix “B” – Scope of Conscientious Objection
Purported non-applicability of policy to assisted suicide, euthanasia

B1.    Disclaimer

B2.    Disclaimer inconsistent with opinion of the CMPA

B3.    Disclaimer inconsistent with policy origin, previous statements

B4.    Disclaimer inconsistent with links between abortion and euthanasia

B5.    Principles support coercion of physicians to facilitate euthanasia

B5.3    “The fiduciary relationship between a physician and a patient.”

B5.4    “Patient autonomy.”

B5.5   “A patient’s right to continuity of care.”
“Patients should not be disadvantaged or left without appropriate care due to the personal beliefs of their physicians.”
“Physicians have an obligation not to abandon their patients.”

B5.6    “Physicians should not intentionally or unintentionally create barriers to patient care.”
“Physicians have an obligation not to interfere with or obstruct a patient’s right to access legally permissible and publicly funded health services.”
“Physicians’ exercise of freedom of conscience to limit the health services that they provide should not impede, either directly or indirectly, access to legally permissible and publicly-funded health services.”

B5.7    “Medical care should be equitably available to patients whatever the patient’s situation, to the extent that can be achieved.”

B5.8    “The College has a responsibility to impose reasonable limits on a physician’s ability to refuse to provide care where those limits are appropriate.”

B5.9    “The College of Physicians and Surgeons has an obligation to serve and protect the public interest. The Canadian Medical Profession as a whole has an obligation to ensure that people have access to the provision of legally permissible and publicly-funded health services.”

B6.    Unsatisfactory reasons offered to support the disclaimer

B6.1    Questioning the reasons

B6.2    Answering the questions

Appendix “C” – Conscientious Objection – 5.  Physician Obligations
Comment and Critque

C1.    5. Obligations (Project alternative)

5.1    Taking on new patients

5.2    Providing information to patients

5.3    Exercise of freedom of conscience and religion

5.4    Necessary treatments to prevent harm to patients

C2.    Conscientious Objection and Project alternative compared

Table A. Taking on new patients

Table B.  Providing information to patients

Table C.  Exercise of freedom of conscience and religion

Table D.  Necessary treatments to prevent harm to patients

C3.    Commentary corresponding to the tables in C2

Table A  5.1 Taking on new patients

Table B  5.2 Providing information to patients

Table C  5.3 Exercise of freedom of conscience and religion

Table D  5.4 Necessary treatments to prevent harm to patients.

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