Court challenge raises issue of “reasonable apprehension of bias”

Sean Murphy*

Documents filed in an important Canadian court case bring into question the value and purpose of “public consultations” held by medical regulators, at least in the province of Ontario.

In March, 2015, the College of Physicians and Surgeons of Ontario (CPSO) approved a highly controversial policy, Professional Obligations and Human Rights.  The policy requires physicians  to facilitate services or procedures to which they object for reasons of conscience by making an “effective referral” to a colleague or agency willing to provide the service.  A constitutional challenge to the policy was dismissed by  the Ontario Divisonal Court in 2018.[1] An appeal of that ruling will be heard by the Ontario Court of Appeal on January 21-22, 2019.

Among the thousands of pages filed with the trial court are a number dealing with the public consultation conducted by the CPSO from 10 December, 2014 to 20 February, 2015.  In response to its invitation to stakeholders and the public, the CPSO received 9,262 submissions about the proposal, the great majority of which opposed it.[2]

College officials  finalized the wording of the policy on 19 January, 2015,[3]   a month before the consultation ended; only about 565 submissions would have been received by then.[4]  727 submissions had been received  by the time the policy was sent to the Executive Committee on 28 January,[5]  which promptly endorsed it and forwarded it to the College Council for final approval.[6]

According to the briefing note supplied to the Council, by 11 February, 2015 the College had received 3,105 submissions.[7]  Thus, the final version of the policy was written and approved by the College Executive before about  90% of the submissions in the second consultation had been received.

Submissions received by CPSO from 10 Dec 2014 to 20 Feb 2015

During the first 40 days ending 11 February, the College received an average of about 18 submissions per day.  Assuming someone spent eight full hours every working day reading the submissions, about 22 minutes could have been devoted to each.  Three staff members dedicated to the task could have inceased this average to about an hour, so the first 700 submissions could conceivably have received appropriate attention.

Time available for analysis of submissions

However, this seems unlikely in the case of more than 8,000 submissions received later.

By 11 February about 183 submissions were arriving at the College every day, increasing to about 684 daily in the last ten days of the consultation – one every two minutes.   A College staffer working eight hours daily without a break could have spent no more than about two minutes on each submission, and only about one minute on each of those received in the last ten days  – over 65% of the total.

A minute or two was likely sufficient if College officials deemed consultation results irrelevant because they had already decided the outcome.  This conclusion is consistent with the finalization and approval of the policy  by the six member College Executive (which included the Chair of the  working group that wrote it [8]).  To do this weeks before the consultation closed was contrary to normal practice.  CPSO policy manager Andréa Foti stated that working groups submit revised drafts to the Executive Committee  after public consultations close[9] – not before.

One would expect government agencies that invite submissions on important legal and public policy issues would allow sufficient time to review and analyse all of the feedback received before making decisions. The CPSO’s failure to do so does not reflect institutional respect for thousands of individuals and groups who responded in good faith to its invitation to comment on the draft policy.  Rather, such conduct invites a reasonable apprehension of bias that is unacceptable in the administration of public institutions.

1. The Christian Medical and Dental Society of Canada v. College of Physicians and Surgeons of Ontario, 2018 ONSC 579 (Can LII)  [CMDS v CPSO].

2. CMDS v CPSO, supra note 1  (Respondent’s Application Record, Volume 1, Tab 1, Affidavit of Andréa Foti [Foti] at para 121.

3.    Foti, supra note 2 at para 133.

4. Estimated daily average based on the total received by 28 January (727).

5. CMDS v CPSO, supra note 1  (Respondent’s Application Record, Volume 4, Tab WW, Exhibit “WW” attached to the Affidavit of Andréa Foti: Executive Committee Briefing Note (February, 2015) (CPSO Exhibit WW) at 1724.

6. CMDS v CPSO, supra note 1  (Respondent’s Application Record, Volume 4, Tab XX, Exhibit “XX” attached to the Affidavit of Andréa Foti: Proceedings of the Executive Committee – Minutes – 3 February, 2015) (CPSO Exhibit XX) at 1746-1748.

7. “Council Briefing Note: Professional Obligations and Human Rights – Consultation Report & Revised Draft Policy (For Decision)” [CPSO Briefing Note 2015].  In College of Physicians and Surgeons of Ontario, “Annual Meeting of Council, March 6, 2015” at 61.

8. Dr. Marc Gabel. See CPSO Exhibit WW, supra note 4 at 1722 (note 1), and CPSO Exhibit XX, supra note 5 at 1746.

9. Foti, supra note 2 at para 36.

Hawaii legalizes assisted suicide: Refusing to refer for suicide may incur legal liability

Sean Murphy*

Assisted suicide will become legal in Hawaii on 1 January, 2019, as a result of the passage of the Our Care, Our Choice Act. Introduced in the state House of Representatives only in January, it passed both the House and Senate and was approved by Governor David Ige on 5 April. Beginning next year, physicians will be able to write prescriptions for lethal medications for Hawaiian residents who are capable of informed consent, who are at least 18 years old, and who have been diagnosed with a terminal, incurable disease expected to result in death within six months.1

And beginning next year, Hawaiian physicians who refuse to facilitate assisted suicide by referring patients to a willing colleague may face discipline — including expulsion from the medical profession — or other legal liabilities. Hawaii could become one of only two jurisdictions in the world where willingness to refer patients for suicide is a condition for practising medicine.2 . . . [Full text]

Professor David Oderberg joins Protection of Conscience Project Advisory Board

News Release   

For immediate release

Protection of Conscience Project

The Protection of Conscience Project welcomes David S. Oderberg, Professor of Philosophy at the University of Reading, UK to the Project Advisory Board. Professor Oderberg joined the university after completing his doctorate at Oxford in the early 1990s. He is the author of many articles in metaphysics, ethics, philosophy of religion, philosophy of science, and other areas. He is also the author of several books including Moral Theory and Applied Ethics (Blackwell, 2000) as well as co-editor of collections in ethics such as Human Values: New Essays on Ethics and Natural Law (Palgrave, 2004) and Human Lives: New Essays on Non-Consequentialist Bioethics (Palgrave, 1997).

Prof. Oderberg has been working on freedom of conscience in health care over the last few years, with a recent article in the Journal of Medical Ethics on co-operation, and a forthcoming policy monograph to be published by the Institute of Economic Affairs. He is Editor of Ratio, an international journal of analytic philosophy, and Senior Fellow of the Higher Education Academy. In 2013 he delivered the Hourani Lectures in Ethics at SUNY Buffalo, and has a book forthcoming based on those lectures, to be called The Metaphysics of Good and Evil. [Faculty Profile] [Website]

Contact:
Sean Murphy, Administrator
Protection of Conscience Project
protection@consciencelaws.org


The Protection of Conscience Project is a non-profit, non-denominational initiative that advocates for freedom of conscience in health care. The Project does not take a position on the morality or acceptability of morally contested procedures. Since 1999, the Project has been supporting health care workers who want to provide the best care  for their patients without violating their own personal and professional integrity. 

 

 

Protection of Conscience Project welcomes new advisor from Scotland

News Release
For immediate release

Protection of Conscience Project

The Protection of Conscience Project welcomes Dr. Mary Neal, PhD, LLB Honours, LLM to the Project Advisory Board. Dr. Neal is Senior Lecturer in Law, University of Strathclyde, Glasgow.  She researches, writes, and teaches in the fields of Healthcare Law and Bioethics, focusing on beginning and end-of-life issues.  In 2014-15, she was Adviser to the Scottish Parliamentary Committee scrutinising the Assisted Suicide (Scotland) Bill, and she is a current member [2018] of the British Medical Association’s Medical Ethics Committee. She has published a wide range of academic articles and blogs on a range of topics including, most recently, conscientious objection by healthcare professionals; the nature of ‘proper medical treatment’; the role of the emotions in end-of-life decision-making; and the conceptual structure and content of human dignity.

Dr. Neal was a co-editor of and contributor to the recent volume Ethical Judgments: Re-writing Medical Law (Hart, 2017). Her works-in-progress include articles and book chapters on conscientious objection; the idea of ‘vulnerability’ in healthcare; physician-assisted suicide; and the role of dignity in human rights discourse. Among other research activities, Dr. Neal is currently leading two funded projects relevant to the issue of conscientious objection in healthcare. One is a British Academy/Leverhulme-funded project exploring conflicts between personal values and professional expectations in pharmacy practice. The other is a multi-disciplinary network of academics and healthcare professionals (the ‘Accommodating Conscience Research Network’, or ‘ACoRN’), funded by the Royal Society of Edinburgh, and beginning with a series of roundtables exploring various aspects of conscientious objection in healthcare. Dr Neal is also a spokesperson for the Free Conscience campaign supporting the Conscientious Objection (Medical Activities) Bill currently before the UK Parliament.[Faculty Profile]

Contact:
Sean Murphy, Administrator
Protection of Conscience Project
protection@consciencelaws.org


The Protection of Conscience Project is a non-profit, non-denominational initiative that advocates for freedom of conscience in health care. The Project does not take a position on the morality or acceptability of morally contested procedures. Since 1999, the Project has been supporting health care workers who want to provide the best care  for their patients without violating their own personal and professional integrity. 

International constitutional and human rights lawyer joins Protection of Conscience Project Advisory Board

News release 

For immediate release

Protection of Conscience Project

The Protection of Conscience Project welcomes Dr. Iain Benson, Professor of Law, University of Notre Dame Australia, Sydney and Extraordinary Professor of Law, University of the Free State, Bloemfontein South Africa to the Project Advisory Board.

Born in Edinburgh, Scotland, the father of seven children, Professor Benson is an academic, lecturer and practising lawyer specialising in pluralism and human rights.  His particular focus is on freedoms of association, conscience and religion, the nature of pluralism, multi-culturalism and relationships between law, religion and culture. He has been involved in many of the leading cases on rights of association, conscience and religion in Canada and abroad for two decades.  As a barrister he has appeared before all levels of court and his work has been cited by the Supreme Court of Canada and the Constitutional Court of South Africa.

He was one of the drafters of the South African Charter of Religious Rights and Freedoms (signed by all major religions in that country in September 2010) and remains closely involved in advancing the Charter in that country and similar projects elsewhere.

Author of over 40 academic articles and book chapters, he is co-editor with Barry W. Bussey, of Religion Liberty and the Jurisdictional Limits of Law (Toronto: Lexis Nexis, 2017) and authored Living Together with Disagreement: Pluralism, the Secular and the Fair Treatment of Beliefs by Law (Ballan Australia: Connor Court, 2012). His scholarly work is referred to in many books and articles.

He teaches Legal Philosophy, Legal History, Public International Law, Human Rights and Contemporary Legal Issues. He works in English and French, dividing his time between Australia (where he now lives) and France, South Africa and Canada (in the latter two of which he has appointments).[Faculty profile]

Contact:
Sean Murphy, Administrator
Protection of Conscience Project
protection@consciencelaws.org


The Protection of Conscience Project is a non-profit, non-denominational initiative that advocates for freedom of conscience in health care. The Project does not take a position on the morality or acceptability of morally contested procedures. Since 1999, the Project has been supporting health care workers who want to provide the best care  for their patients without violating their own personal and professional integrity. 

Canadian court rules that state can compel participation in homicide and suicide

News Release

For immediate release

Protection of Conscience Project

Three judges of the Ontario Superior Court of Justice Divisional Court have unanimously ruled that, notwithstanding religious convictions to the contrary, Ontario  physicians can be forced to help patients access any and all services and procedures, including euthanasia and assisted suicide.

“In the end,” observed Project Administrator Sean Murphy,  “the ruling effectively gives the state the power to compel citizens to be parties to homicide and suicide, even if they believe it is wrong to kill people or help them kill themselves.”

The Protection of Conscience Project jointly intervened in the case with the Catholic Civil Rights League and Faith and Freedom Alliance on the issue of freedom of conscience.  The court acknowledged the submission, but explicitly limited its ruling to the exercise of freedom of religion.  It did not address freedom of conscience.

The court approved the reasoning of the College of Physicians and Surgeons of Ontario, the state medical regulator.  The College argued that “physicians must be prepared to take positive steps to facilitate patient access” to euthanasia and assisted suicide, and that there is “no qualitative difference” between euthanasia and “other health services.”

With respect to options of objecting physicians, the court observed that they are free to change their field of practice in order to avoid moral conflicts.  The judges added that those who fail to do so are to blame for any psychological distress they might experience if compelled to violate their convictions.  It appears that they were unconcerned that this might further reduce the number of family and palliative care physicians, noting that there was “no evidence” that coercive policies would adversely affect physicians “in any meaningful numbers.”

Dr. Shimon Glick, advisor to the Project and Professor Emeritus of the Faculty of Health Sciences at Ben Gurion University of the Negev in Israel, described the ruling as “sad.”  Commenting on the decision, Project Advisor Professor Roger Trigg of Oxford said, “once the perceived interests of the State override the moral conscience of individuals  – and indeed of professionals- particularly in matters of life and death, then we are treading a slippery slope to totalitarianism.”

“Even the first steps- that may not seem important to some,” he warned, “are taking us in that direction.”

Professor Trigg’s warning was echoed by Professor Abdulaziz Sachedina, a leading Islamic scholar and philosopher who also serves on the Project Advisory Board.  Professor Sachedina asked, “Are we  going to submit to “totalitarian ethics” reflected in such court decisions, making suicide a tempting option without any regard to conscientious objection?”

The decision concluded legal proceedings launched jointly by five Ontario physicians, the Christian Medical and Dental Society of Canada, Canadian Physicians for Life, and the Canadian Federation of Catholic Physicians’ Societies.  They are considering the possibility of appeal.

Contact:
Sean Murphy, Administrator
Protection of Conscience Project
E-mail: protection@consciencelaws.org


The Protection of Conscience Project is a non-profit, non-denominational initiative that advocates for freedom of conscience in health care. The Project does not take a position on the morality or acceptability of morally contested procedures. Since 1999, the Project has been supporting health care workers who want to provide the best care  for their patients without violating their own personal and professional integrity. 

 

 

Physician, expert in Jewish medical ethics joins Protection of Conscience Project Advisory Board

News Release

For immediate release

Protection of Conscience Project

Professor Shimon Glick, MD,  of the Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel, has joined the Protection of Conscience Project Advisory Board.

Professor Glick was born in Brooklyn in 1932 and received his medical training in the United States, specializing in internal medicine and endocrinology. He immigrated to Israel in 1974 to become a founding member of the Faculty of Health Sciences (FOHS) at Ben Gurion University of the Negev and head of the Internal Medicine Department at Soroka Medical Center. He and his colleagues instituted the practice of “early clinical exposure,” insisting that students meet patients in their first week at medical school, even before beginning traditional academic studies. “The students don’t just treat patients. They talk to them and learn what it’s like to be sick,” he explains. Students also take their medical or Hippocratic oath when they begin their studies, rather than taking the oath when they finish.

Professor Glick became chair of Israel’s first Internal Medicine Division and served as Dean of the FOHS between 1986 and 1990. During his tenure, he played a key role in formulating the admissions process for medical students – a process based not only on achievements but also the candidates’ character. Professor Glick headed the Prywes Center for Medical Education and the Jakobovits Center for Jewish Medical Ethics, two domains that were assigned a central role in the professional education of students in the Faculty. He was also instrumental in the instruction on doctor-patient communications for first year medical students. In addition, Professor Glick has served as ombudsman for Israel’s Ministry of Health. He is widely recognized as an expert in medical ethics, with a particular focus on Jewish medical ethics, and is at the forefront of the efforts to bring a Jewish perspective to bear on the most important issues of modern bioethics.

In 2014, in recognition of his contributions to medical education and practice, Professor Glick received a Lifetime Achievement Award as part of the Nefesh B’Nefesh Bonei Zion Awards. The award recognizes outstanding Anglo Olim – veteran and recent – who encapsulate the spirit of modern-day Zionism by contributing in a significant way towards the State of Israel.

Professor Glick is blessed with 46 grandchildren and (at last count) 77 great grandchildren.  He continues to teach at the Joyce and Irving Goldman Medical School and the Medical School for International Health (MSIH).  [Faculty Profile]

 

Project comment on Quebec euthanasia statistics

News Release

For immediate release

Protection of Conscience Project

LifeSite News has published an article concerning Quebec euthanasia statistics collated by the Project.

During the interview that led to the publication of the article, the Project Administrator expressed concern that a significant increase in the volume of cases in the last half of 2016 could increase pressure on physicians and other health care workers who do not wish to participate in the procedure.  Such pressure was generated across Canada by the exponential increase in the number of abortions following liberalization of the abortion law in 1969, from under 300 in eleven years[1] to over 11,000 in the first year after the change in the law.[2]  The number of euthanasia and assisted suicide cases in the first year of legalization seems unlikely to exceed 20%  of that number, but this is still sufficient to warrant concern about pressure on objecting health care workers.

The statistical returns disclose some wide differences between different regions or reporting agencies, and sometimes between reporting agencies in the same administrative region.  For example: the number of euthanasia requests per 100,000 population is reported to be much higher in the Quebec City area than in the rest of the province, while the number of euthanasia requests per 100,000 palliative patients reported in Lanaudiere and Laval is much higher than in the Montreal Region.  Euthanasia is reported to be provided per 100,000 population in the Quebec City area at a rate three times that of Montreal.

The Administrator explained that the statistics were primarily useful in raising important questions about the reasons for such variations or trends, such as differences in the quality or accessibility of palliative care or the nature of patient illnesses.

Note

1. Waring G. “Report from Ottawa.” CMAJ Nov. 11, 1967, vol. 97, 1233 (Accessed 2016-06-15).

2. In 1970, the first year under the new rules, there were more than 11,000. In 1971 there were almost 39,000. “Therapeutic abortion: government figures show big increase in ‘71.” CMAJ May 20, 1972, Vol. 106, 1131 (Accessed 2016-06-15)

[Release revised 2017-03-14]

Pharmacist freedom of conscience recognized in British Columbia

LifeSite News

Steve Weatherbe

VANCOUVER, British Columbia, March 9, 2017 (LifeSiteNews) – Christian pharmacists in British Columbia can now practice with a clear conscience.

Under the B.C. College of Pharmacy’s new ethics code, they cannot be forced to prescribe for abortions, euthanasia, or artificial contraception.

Cristina Alarcon, a Vancouver-area community pharmacist who was a driving force behind the new code, says it “covers everything.” For the first time, pharmacists can refuse to dispense any prescription that violates their conscience. [Full text]

 

Quebec euthanasia rate almost doubled in last half of 2016

Quebec euthanasia rate after one year passes Belgian rate at five year mark

Sean Murphy*

Since 10 December, 2015, euthanasia has provided by physicians in Quebec under the terms of An Act Respecting End of Life Care (ARELC).  Health and social services agencies established by the government throughout the province are state agencies responsible for the delivery and coordination of health care in the province administrative regions. These are called Centres intégrés de santé et de services sociaux (CISSS) and Centres intégrés universitaires de santé et de services sociaux [CIUSSS).  Some administrative regions (like Montreal and the Quebec City region) have more than one CISSS or CIUSSS.

These agencies are responsible for the delivery of euthanasia and are required to make reports to a commission established by the law (the Commission sur les soins de fin de vie) to monitor the administration of euthanasia.  According to the Commission, they are also required to post these reports on their websites.

As of 6 March, 2016, one of these agencies (Outaouais) had not posted the reports on its website.  Two (Outaouais and Abitibi-Temiscamingue) had neither posted the most recent report nor sent the report to the Commission, and did not respond to a request for it.

The Project has compiled the statistics provided by the other agencies in tables and charts.  Note that, in some cases, the number of patients lethally infused is higher than the number of requests because euthanasia was provided in response to a request made in the previous reporting period.

Quebec’s euthanasia rate almost doubled in the last half of 2016.  One year after legalization, Quebec has passed the euthanasia rate reached by Belgium after five years.  If Quebec’s rate continues without escalation throughout 2017, it will exceed that achieved by Belgium after nine years.