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February 6  to March 31, 2017

We need your help now to change policies in many provinces, most urgently in Ontario, where Bill 84 (Medical Assistance in Dying Statute Law Amendment Act) was introduced on December 7, 2016.

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Ontario adds wording to legislation recognizing conscience rights of hospitals

Toronto Sun

Liz Payne

The Ontario government has quietly amended its proposed Patients First Act with wording that appears to strengthen the rights of faith-based hospitals to opt out of assisted death.

The proposed amendment, which was not originally in the act, appeared when it was re-tabled last month after the legislature was prorogued. The act, according to the province, is aimed at improving health care for patients and their families. . . [Full text]

Windsor doctor keeps Michigan license in face of legal assisted suicide in Ontario

Michigan Radio

WUOM FM: All Things Considered

Stateside Staff

Physicians in Ontario are facing a dilemma: What can you do when asked to perform an action that is legal, but violates your moral code or religious beliefs?

In 2015, the Supreme Court of Canada struck down the federal law that prohibited medically-assisted suicide.

In Ontario, the service is now covered by the Ontario Health Insurance Plan, and any drugs required to help a patient die will be available at no cost.

Dr. Brad Burke is a physician in Windsor who says assisted dying goes against his conscience. He’s making plans for the day when a patient asks him for help in dying.

He joined us today. Listen to our conversation with him . . . [Full audio interview]

 

Ontario hospitals allowed to opt out of assisted dying, raising conscientious accommodation concerns

National Post

Sharon Kirkey

Ontario will allow hospitals to opt out of providing assisted death within their walls, provoking charges from ethicists that conscientious accommodation has gone too far.

Elsewhere in the country, a divide is already shaping up, with half of voluntary euthanasia cases in Quebec reportedly occurring in Quebec City hospitals — and few in Montreal.

The situation highlights the messy state of the emotionally charged debate as the provinces wrestle with the new reality of doctor-assisted death, and as the Senate takes a proposed new law further than the governing Liberals are prepared to go. . . [Full Text]

 

A watchdog in need of a leash

Ontario College of Physicians manipulates consultation process

Protection of Conscience Project News Release

It appears that the College of Physicians and Surgeons of Ontario is manipulating its consultation process to support a controversial draft policy intended to force doctors to do what they believe to be wrong.

The College is intervening in a Discussion Forum about Professional Obligations and Human Rights (POHR), apparently to discredit critics and defend the policy. The Forum is supposed to be used by the public to provide feedback on the policy, and to post emails and written submissions the College receives from the public.

But on 29 January the College posted a comment accusing Professor Margaret Somerville of misrepresenting its policy in a National Post column. The comment included a link to a letter to the National Post from College President, Dr. Carol Leet.

Not content with interfering in the consultation by posting its own statement, the College impersonated anonymous forum participants and used its statement to reply to comments supporting Professor Somerville’s “modest proposal.”

Someone at the College seems to have had second thoughts about impersonating participants, because the replies were revised a couple of days later to identify the College as the author. But the purported correction of participant responses still violates College policy.

Sean Murphy, Administrator of the Protection of Conscience Project, thinks College officials are interfering in the consultation because they are afraid that more people will begin to realize what the draft policy really means.

“In her National Post column, Professor Somerville succinctly critiqued the draft policy, and offered a reasonable alternative,” he said. “If Dr. Leet disagreed, she was within her rights to write a letter to the editor.”

“But,” he added, “interfering in the consultation process is unacceptable.”

Murphy observed that the College is supposed to be the watchdog protecting the public and profession from unethical conduct.

“It seems this watchdog needs a leash.”

For details, see A watchdog in need of a leash: Ontario College of Physicians manipulates consultation process

Results of the first consultation on Physicians and the Human Rights Code

Sean Murphy*

In February, 2008, the  Ontario Human Rights Commission responded to a draft policy of the College of Physicians and Surgeons of Ontario with a submission recommending that physicians “must essentially ‘check their personal views at the door’ in providing medical care.”1

The College, in response, released a draft policy, Physicians and the Ontario Human Rights Code, stating, “there will be times when it may be necessary for physicians to set aside their personal beliefs in order to ensure that patients or potential patients are provided with the medical treatment and services they require.”2

As a result of the subsequent controversy and public pressure the demand that physicians abandon their moral or religious beliefs was dropped before Physicians and the Ontario Human Rights Code was adopted. The policy was slated for review by September, 2013, but a public announcement of the review was not made until June, 2014.  The first stage of a public consultation about the policy closed on 5 August, 2014.

In December, 2014, a working group at the College released a new policy draft called Professional Obligations and Human Rights (POHR)  for a second stage of consultation ending on 20 February, 2015. The most contentious element in POHR is a requirement that physicians who object to a procedure for reasons of conscience must help the patient find a colleague who will provide it.3

According to the College, POHR takes into account feedback received during the first consultation. When the new draft policy was released in December, Dr. Marc Gabel, then President of the College, stated that “public polling” by the College had demonstrated that “the vast majority of Ontarians believe that [objecting physicians] should be required to identify another physician who will provide the treatment, and make and/or coordinate a referral.”4

The “public polling” to which Dr. Gabel referred appears to be an on-line random survey of 800 Ontario residents conducted by the College in May, 2014. The participants were randomly selected “using a Voice Response system,” and College Council was told that the results can be generalized to the online population of the province (80% of adults), with an accuracy of +3.5% and a 95% level of confidence.5 Beyond that, the College has not disclosed details of the poll that would permit an independent assessment of its validity. Particularly on such an important question, this seems inconsistent with its commitment to greater transparency.6

An analysis of consultation feedback posted on the College website produces quite a different result.

College Council was told that the consultation produced 6,710 responses7 – an “unprecedented volume.”8 However, an unknown number of respondents contributed both to the On-line Survey and Discussion Forum, so the number of unduplicated consultation responses actually available for analysis may have been far less than 6,700. Less than half that number responded to a question about the extremely contentious issue of mandatory referral, and only 50% of that group supported it.9

In any case, an overwhelming majority of responses in a Discussion Forum supported freedom of conscience for physicians, but only about 2% advocated a policy of mandatory referral. Nor were On-line Survey responses supportive of a policy of mandatory referral, suggesting, instead, that such a policy is controversial.

A detailed analysis of the results of the consultation is available here.

Notes

1.  Submission of the Ontario Human Rights Commission to the College of Physicians and Surgeons of Ontario regarding the draft policies relating to establishing and ending physician-patient relationships. 14 February, 2008. (Accessed 2015-02-02)

2.  College of Physicians and Surgeons of Ontario, Physicians and the Ontario Human Rights Code, p. 4

3.  College of Physicians and Surgeons of Ontario, Professional Obligations and Human Rights (Draft, December, 2014)

4.  Gabel, M. “Dear Colleagues.” College of Physicians and Surgeons of Ontario, Dialogue, Vol. 10, Issue 4, 2014, p. 6. (Accessed 2015-02-02)

5.  College of Physicians and Surgeons of Ontario, Annual Meeting of Council, December 4-5, 2014, p. 330 (Accessed 2015-02-03)

6. Transparency Principles (Accessed 2015-02-02).

7.  College of Physicians and Surgeons of Ontario, Annual Meeting of Council, December 4-5, 2014, p. 328 (Accessed 2015-02-03)

8.  “Balancing MD and patient rights: Human rights draft policy open for consultation.”  Dialogue, Vol. 10, Issue 4, 2014, p. 49.  (Accessed 2015-01-30)

9.  3,104 responses. College of Physicians and Surgeons of Ontario, Physicians and the Ontario Human Rights Code Consultation: Online Survey Report and Analysis, Figure 4 (Accessed 2015-02-02)

Ottawa archbishop among religious urging CPSO not to violate physicians’ conscience rights

Catholic Register

Deborah Gyapong, Canadian Catholic News

OTTAWA – Ottawa Archbishop Terrence Prendergast, along with an imam and a rabbi, have written a joint-intervention in favour of physicians’ conscience rights.

“No Canadian citizen, including any physician, should ever be disciplined or risk losing their professional standing for conducting their work in conformity with their most deeply held ethical or religious convictions,” wrote Prendergast, Rabbi Reuven Bulka and Imam Samy Metwally in a July 31 letter to the College of Physicians and Surgeons of Ontario.

The College had been seeking input until Aug. 5 on its policy review entitled “Physicians and the Ontario Human Rights Code.” [Full Text]

Submission to the College of Physicians and Surgeons of Ontario

Cardinal Thomas Collins

Re: College of Physicians and Surgeons of Ontario consultation on the policy “Physicians and the Ontario Human Rights Code”

I welcome the opportunity to participate in the consultation concerning the College of Physicians and Surgeons policy “Physicians and the Ontario Human Rights Code,” approved in September of 2008. I will specifically be referring to the subsection ii “Moral or Religious Beliefs” in Providing medical services without discrimination.”

The first part of subsection ii surveys the legal context in Ontario, and specifically the Ontario Human Rights Code, and offers observations on how that affects the practice of medicine. It offers physicians “an indication of what principles may inform the decisions of Courts and Tribunals”, and so is largely informative, and does not take a position on issues.

The “College Expectations” section, however, establishes guidelines for physicians to follow.

I am glad that in the first of the “College Expectations” (“Communicate clearly and promptly about any treatments or procedures the physician chooses not to provide because of his or her moral beliefs.” ) the policy recognizes that there may well be some treatments or procedures that a physician cannot, in good conscience, offer. It is vital that our society respect freedom of conscience. For the common good of any society it is essential that the state, or professional associations with power over their members, not intrude into the sanctuary of conscience. The protection of freedom of conscience is a basic human right of all people, whatever their  faith or lack of faith. Many people with clear religious beliefs selflessly serve others as a result of those beliefs, in medicine and in other areas, and their service is of inestimable benefit to all of us. Our society would be poorer without that service, and from that perspective alone it is important that freedom of conscience be respected. In my September, 2008, submission, the last time there was a consultation on this policy, I wrote:

“Profound moral and religious convictions motivate and guide individual physicians, as well as nurses, pharmacists, and others. When I refer to physicians I also have in mind the others who use their skills and knowledge in the work of healing. In our province, and around the world, individuals and health care institutions motivated and guided by moral and religious convictions serve the sick and the suffering, and do so with respect and compassion. The benefits to society have been, and are, immense. For those who so generously devote their lives to the noble vocation of healing, ethical and religious convictions are not something optional or disconnected from the good they do.”

The third expectation, in the paragraph “Treat patients or individuals .. . ” is admirable. All patients should be treated with respect, and the physician-patient relationship should not be used as a forum for seeking to convert someone to one’s religious beliefs, or for criticizing other people, or entering into a debate with them. Those who have given their lives to the sacred vocation of medicine, and whose service is motivated by religious belief, treat the patient with special reverence, for he or she is seen as a child of God. Speaking only of my own religious tradition, physicians and hospitals whose mission is modeled on that of”Christ the Healer” are now, and have always been, agents of profound healing, and that is most appreciated by those who experience it, whatever their faith or lack of faith. If a physician, operating out of that richly beneficial medical tradition, politely declines to become involved with things such as contraception, abortion or (as may happen, eventually) euthanasia, then it would be a grave injustice to the physician, but also a loss to society, to seek to suppress his or her freedom of conscience.

The second expectation “Provide information about all clinical options . . . ” and the fourth “Advise patients or individuals . .. ” could have the potential for an infringement upon the rights of conscience of a physician, depending on the extent to which he or she is required to become actively involved in facilitating actions which go against his or her conscience. A lot depends on what is involved in “help the patient or individual make arrangements to do so.”

I will end with a quote from my submission to the previous consultation, in 2008:

“I urge the College of Physicians and Surgeons to support a physician who seeks to follow his or her conscience, and to take this opportunity of the preparation of a policy, to provide helpful and practical guidance to physicians on how to deal with the sometimes difficult situations they face, in a way that will allow them to maintain their moral integrity.”

Cardinal Thomas Collins,
Archbishop of Toronto
President of the Assembly of Catholic Bishops of Ontario

Submission to the Ontario College of Physicians and Surgeons

Catholic Civil Rights League

The Catholic Civil Rights League (CCRL) is pleased to provide this submission to the College of Physicians and Surgeons of Ontario (CPSO) regarding the review of the current policy Physicians and the Ontario Human Rights Code. The CCRL made a previous submission in 2008 prior to the adoption of the current policy. We make this submission on behalf of our membership nationally, particularly for those in Ontario.
Our concern today is similar to that of 6 years ago. We strongly advocate for the protection of the Charter right of freedom of conscience and religion for all Canadians, including physicians in the daily routine of their care to patients and in the overall forming of their individual medical practices. We believe this is key to the maintenance and growth of our social fabric in the province of Ontario and all of Canada. Your policy should reflect a true pluralistic society so as to avoid a climate for discrimination of any kind, including discrimination based on religious and moral beliefs and the exercise of one’s conscience.

The CCRL acknowledges the assertion in the current policy which states that, “There is no hierarchy of rights in the Charter; freedom of religion and conscience, and equality rights are of equal importance.” We also acknowledge that many citizens in Ontario subscribe to a belief in secular humanism, which often demands the relegating of issues informed by religion as private matters, which ought not be expressed or acted on in the public square. We would like to remind the CPSO that the Charter itself does not mention “freedom of religion” independent of “freedom of conscience and religion”, so that the right of one’s freedom of conscience informed by a religion, a philosophical system or otherwise is crucial regardless of society’s current views regarding religion.
The current CPSO policy also states that:

The balancing of rights must be done in context. In relation to freedom of religion specifically, Courts will consider how directly the act in question interferes with a core religious belief. Courts will seek to determine whether the act interferes with the religious belief in a ‘manner that is more than trivial or insubstantial.’ The more indirect the impact on a religious belief, the more likely Courts are to find that the freedom of religion should be limited.

The CCRL submits that issues pertaining to the sanctity of life from conception until natural death are at the core of Catholic beliefs. Such beliefs are also based in reason and medical science. To the Catholic physician, this would impact the providing of prescriptions of birth control pills and abortifacients and the performing of an abortion or its procural unless the mother’s life is in imminent threat. But such understandings go beyond these areas, and touch upon all aspects of medical care, whether for the disabled, the elderly, or those with mental afflictions. We assure the CPSO that under no circumstances would any of the aforementioned practices be considered ‘trivial or insubstantial’.

Secondly, we submit that the College must ensure that a physician’s conscience rights must be observed at first instance, especially given that there are numerous procedures which may cause such physicians, religious or otherwise, difficulty, regardless of their availability under the publicly funded system. In keeping with our mandate to educate the public and defend and promote the Catholic perspective, we at the CCRL submit that a physician must have the right to carry out their duties in line with their respective consciences.

We submit that it would be offensive and a fundamental injustice to human dignity to require people to support, facilitate or participate in what they perceive to be wrongful acts. The more serious the wrongdoing, the graver the injustice and offence that would occur. We urge the College to resist any policy revision to establish the principle that people can be compelled to do what they believe to be wrong – or face the risk of sanction if they refuse. The College should avoid any suggestion that physicians be required to observe a ‘duty to do what is wrong’ in medical practice.

In referring to the ‘balancing of rights’ referred to in the above excerpt from the 2008 policy, the CCRL submits that the current policy attempts to maintain this balance outlined in the Charter rights of conscience and religion and the Ontario Human Rights Code. Using the previous listed examples of practices that would be morally objectionable to a serious Catholic physician, the number of said physicians is minute in comparison to those who would have no objection whatsoever. If a lack of balance exists, it is surely found in the vast difference between physicians who choose to conscientiously dissent versus those who do not. A member of the public in Ontario has ample resources and options available for recourse to a physician to perform publicly funded services, without violating the conscience rights of a physician who may object.

With this submission, we at the CCRL sincerely hope that the September 2008 CPSO policy regarding Physicians and the Ontario Human Rights Code is not altered in a manner that would diminish a physician’s right to freedom of conscious and religion in carrying out his or her duties according to the professional standards and guidelines of the CPSO. The medical profession, as with any grouping of individuals is not truly free to live and free to grow if its members are not able to govern their actions in accordance with their individual consciences whether informed by moral and religious beliefs or otherwise. In no way is this subtractive to the social fabric of our society, rather it greatly contributes to a true pluralist and diverse population. We should be allowed to agree or to disagree at times, always respectful of differences especially when they concern aspects of one’s moral or religious core, in no way trivial, but rather at the basis of a well-developed, civil society.

Submission to the Ontario College of Physicians and Surgeons

Action Life Ottawa

Action Life Ottawa is a non-denominational, non-profit organization dedicated to the defence of human life through education. We believe that all human beings have an equal right to life before and after birth and that society has the duty to uphold and protect that right. Our organization counts 4,000 supporters.

Concerning the consultation on freedom of conscience, Action Life holds that physicians should not be expected to refer or provide services to which the physician is opposed on conscientious or religious grounds. To force physicians to act against their conscience or religious beliefs would constitute coercion and reduces the role of the physician to that of a technician who must fulfill every patient demand. The physician is not merely a technician providing services to patients. He/she cannot be expected to leave his/her moral integrity at the door. A physician’s ethics are informed as well by medical and scientific knowledge. It is vital that a physician not be forced to refer for abortion or other procedures which the physician finds morally or ethically objectionable. Some of these procedures or services, the physician might find harmful to a patient’s health.

Consider the practice of euthanasia recently legalized in Québec, what does the future hold for physicians in Ontario regarding this practice? Many physicians would be opposed to referring or performing euthanasia if it were legalized. Freedom of conscience and religion must be respected.

Provisions in the Code should protect physicians in Ontario from coercion and discrimination. The Constitution of Canada recognizes freedom of religion and conscience and these rights are protected by the Charter of Rights and Freedoms. The policy of the Canadian Medical Association (CMA) allows physicians to opt out of referrals for abortion. The present policy of the Canadian Medical Association is clear; physicians are under no obligation to provide or refer for abortion. In fact, the CMA’s policy on induced abortion states:

“A physician whose moral or religious beliefs prevent him or her from recommending or performing an abortion should inform the patient of this so that she may consult another physician. No discrimination should be directed against doctors who do not perform or assist at induced abortions. Respect for the right of personal decision in this area must be stressed, particularly for doctors training in obstetrics and gynecology and anesthesia.”

Attacks are mounting on the conscience rights of physicians. In 2007, a letter requesting a change to the CMA referral policy on abortion was sent by The National Abortion Federation an organization representing abortion providers in the U.S. and Canada. The National Abortion Federation was seeking a policy which would force physicians to refer for abortion. It received the following response from Dr. Colin McMillan, then President of the CMA who wrote “The CMA’s policy on induced abortion does not violate our Code of Ethics…Nor does it treat women unfairly or impede their access to critical health care.”

A controversy arose in 2006 when a guest editorial by two professors, published in the Canadian Medical Association Journal of July 4, stated in relation to induced abortion that “Health care professionals who …fail to provide appropriate referrals…are committing malpractice and risk lawsuits and disciplinary proceedings.” In response, the Journal published a letter from the CMA’s Director of Ethics clarifying that the CMA policy on abortion did not require physicians to refer for abortions if doing so would be a violation of their conscience.

The Ontario Medical Association, in response to the College of Physicians and Surgeons of Ontario‘s draft policy in 2008 stated:

“It is the OMA’s position that physicians maintain a right to exercise their own moral judgment and freedom of choice in making decisions regarding medical care and that the CPSO not insert itself into the interpretation of human rights statutes.”

We would agree with the Ontario Medical Association that “…it should never be professional misconduct for an Ontario physician to act in accordance with his or her religious or moral beliefs.” Action Life calls on the College of Physicians and Surgeons to strengthen measures to ensure the right of physicians to practice medicine in accordance with their conscience or religious beliefs.

Thank you for the opportunity to comment on this issue.

Action Life Ottawa