21 in Saskatchewan choose death with medical assistance

‘We all want to die with dignity,’ says palliative care director

CBC News

Danny Kerslake

For about a year, it has been legal to die with medical assistance in Canada. Almost two dozen people in this province have chosen that option and ended their lives.

“We all want to die with dignity,” said Carmen Johnson, medical director of Palliative Care at Pasqua Hospital in Regina.

According to numbers obtained by CBC, as of the end of March, 21 people in Saskatchewan have died with medical assistance since the federal government’s assisted-dying law passed last June. . . [Full text]

 

Saskatchewan religious leaders call for freedom of conscience on assisted death

Regina Leader Post

D.C. Fraser

Religious leaders from around Saskatchewan are coming together to let the province know they want freedom of conscience to be respected throughout the assisted dying process.

The federal government passed assisted-dying legislation last week, at the insistence of the Supreme Court after it struck down laws preventing doctors from helping the incurable die.

It took a national debate, and a law ping-ponging between the Senate and House of Commons, but federal government officials say the law strikes the right balance between personal autonomy for those wanting to die and protecting the vulnerable.

Reverends, bishops, pastors,rabbis, imams and the like from around the province met with provincial officials on Tuesday and signed a letter calling for freedom of conscience, whether or not something lines up with their personal moral sense, when it comes to doctor-assisted deaths. . . [Full text]

Project to Saskatchewan regulator: no evidence to support limitation of fundamental freedoms

Draft policy attacks character, competence of physicians

News Release

Protection of Conscience Project

For the third time this year, the Protection of Conscience Project has criticized a draft policy proposed by officials of the College of Physicians and Surgeons of Saskatchewan who want to control the exercise of freedom of conscience and religion by physicians.  The draft policy, Conscientious Objection, was approved in principle by the College Council on 19 June and released for a public consultation that ended on 7 August.

Citing Section 1 of the Canadian Charter of Rights and Freedoms, the Project states that “the limits proposed in Conscientious Objection are neither reasonable nor demonstrably justified” because the College had no evidence that conscientious objection by Saskatchewan physicians has ever deprived anyone of access medical services or adversely affected anyone’s health.

The Project submission calls Conscientious Objection 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.”

This has become of particular concern because physician assisted suicide and physician administered euthanasia will be legal in Canada in February of next year.  The draft policy states that it does not apply to those services, but the Project submission rejects that disclaimer, calling it “ill-advised and misleading.”

Among other things, the Project points out that, even after the Supreme Court of Canada ordered the legalization of physician assisted suicide and euthanasia, the College’s Associate Registrar “defended the proposition that physicians should be disciplined or fired if they refuse to at least help to find someone willing to kill patients or help them commit suicide.”

The disclaimer was added only after it became clear that the policy faced overwhelming opposition, either as a tactic to secure the approval of the policy, or because some of its supporters began to realize the policy’s implications.

The submission warns the College that a policy on conscientious objection should be flexible enough to apply to requests for assisted suicide and euthanasia.

” 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.”

The Project also strongly criticizes the policy because it suggests that physicians who refuse to do what they believe to be wrong cannot be trusted.

“Solely on the basis of their beliefs,” the submission notes, “it implies that they are unacceptably biased and effectively prohibits objecting physicians from communicating with their patients about morally contested procedures.”

Instead, the policy demands that they refer their patients to someone who can provide “full and balanced health information,” apparently assuming that physicians who have moral viewpoints are incapable of properly communicating with patients.

“But all physicians have moral viewpoints,” the Project reminds the College. “Conscientious Objection simply exchanges one kind of ‘bias’ for another.”

The Project submission includes an alternative policy that protects physician freedom of conscience and religion but does not obstruct patient access to services, including euthanasia and assisted suicide.  The alternative draws on the CPSS draft policy, the Canadian Medical Association Code of Ethics, and a joint statement by the Canadian Medical Association, Canadian Healthcare Association, Canadian Nurses’ Association, and Catholic Health Association of Canada.

The proposed CPSS policy has also been criticized by the Christian Medical and Dental Societies, the Federation of Catholic Physicians Societies of Canada and Canadian Physicians for Life.   Their joint submission states that Conscientious Objection “does not adequately deal with physicians’ human rights” and “does not accurately reflect the law.”

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.

Sask MDs, doctors’ groups ask for a hearing by College of Physicians and Surgeons

News Release

Christian Medical and Dental Society of Canada

SASKATOON, June 17, 2015 /CNW/ – Larry Worthen, Executive Director of the Christian Medical and Dental Society of Canada (CMDS), urged the College of Physicians and Surgeons of Saskatchewan (CPSS), today, to support freedom of conscience when they meet on Friday, June 19th, to consider a policy on conscientious objection. CMDS and other doctors’ groups are asking for a meeting with the College’s drafting committee to express their concerns.

Said Larry Worthen, “To ask physicians to act against deeply held moral convictions would be a clear infringement on physicians’ rights to the Section 2 fundamental freedoms of conscience and religion guaranteed by the Canadian Charter of Rights and Freedoms. The College’s Associate Registrar Brian Salte has ties to the Conscience Research Project led by one of Canada’s leading proponents of abortion, assisted suicide and euthanasia, and Mr. Salte has attended briefings of that group. We ask that the College would give us equal time to present our side of the argument and hear concerns about how this policy will affect patient care in Saskatchewan.”

Previous CPSS policy drafts required that physicians refer patients for procedures even when performing such procedures went against the moral convictions of the physician. Under the drafts, physicians would even be forced to actually perform procedures even though to do so would go against strongly held moral and religious convictions. Physicians who refused to comply would be vulnerable to sanctions up to and including losing their licences.

“No one’s interests are served by effectively disqualifying certain Saskatchewan physicians from the practice of medicine,” said Worthen.

Roman Catholic and evangelical Protestant physicians hold grave concerns about the negative effects when they are forced to act against their consciences.

“Going against one’s conscience can cause moral distress which has been shown to affect patient care adversely. We need to have physicians who are free to bring their whole selves to their patients, including their compassion and their ethics,” said Mary Deutscher, member of the Roman Catholic Diocese of Saskatoon Justice and Peace Commission. “For Catholic physicians, participation in a formal referral makes them an accomplice in the procedure. This position is supported by many evangelical Protestant experts and other groups as well.”

This is also reflected in the positions of CMDS, Canadian Physicians for Life (CPL) and the Canadian Federation of Catholic Physicians’ Societies (CFCPS).

“Should the College choose to adopt this policy, it would assume the role of judge and jury deciding who could or could not exercise their constitutionally protected rights,” said Faye Sonier, CPL’s General Legal Counsel. “Physicians who cannot perform certain procedures due to their beliefs would become a class of citizens who fall outside the protection of the Canadian Charter of Rights and Freedoms.”

“Physicians who hold conscientious objections do so with profound respect for both the well-being and the autonomy of their patients. Their conscientious objections also stem from a deep commitment to the Hippocratic Oath,” said Dr. Thomas Bouchard, M.D., of the CFCPS. “In debates about conscience rights, the debate is often framed as a competition between the rights of a patient to access services versus the conscience of a physician. But physicians in these circumstances do not care solely about their conscience rights. These physicians also care deeply about the good of their patients.”

Self-referral is already a commonly exercised option among patients, including in respect of abortion services, across most of Saskatchewan. Self-referral allows the doctor to avoid being involved in facilitating the provision of the service, and the patient gets prompt access to the service.

A public opinion survey conducted May 20th-27th by Abingdon Research indicated that when a patient and doctor have different views on best treatment because of the doctor’s moral convictions, 47.5% of the Saskatchewan public felt that a patient could seek further advice or help from a different doctor without a formal referral, compared with 44.1% who felt the doctor should provide a formal referral. More than 53% of Saskatchewan residents felt that “nothing should happen to the doctor” who was unwilling to provide a treatment or a referral for reasons of moral conviction.

“Doctors represented by our groups are willing to discuss all procedures with their patients in a caring and objective way. We simply ask that when the patient makes a decision that the doctor cannot support for moral reasons that the patient access another service provider directly,” added Dr. Sheila Harding, M.D., a Saskatoon haematologist. “I have heard of many cases where doctor and patient agree to disagree and the patient returns to the physician’s practice after the procedure. If anything, the physician-patient relationship was enhanced.”

CMDS (Christian Medical and Dental Society) represents some 1600 physicians and dentists across Canada (cmdscanada.org). The Canadian Federation of Catholic Physicians’ Societies (canadiancatholicphysicians.com) represents groups from across Canada. Canadian Physicians for Life (physiciansforlife.ca is the national association of pro-life physicians and provides resources and educational opportunities to thousands of physicians and medical students each year.

SOURCE Christian Medical and Dental Society of Canada

For further information: Larry Worthen at 902-880-2495. Larry is available for interviews in Saskatoon after 10:00 a.m., Wednesday, June 17th, until Noon, Saturday, June 20th.

Conscientious objection policy rasies thorny issues for Sask. doctors

Saskatoon Star Phoenix

Jonathon Charlton

A draft policy under review by the College of Physicians and Surgeons of Saskatchewan does not require doctors who refuse to perform an abortion to refer patients to one who will.

Associate registrar Bryan Salte declined to comment on specifics in the draft, noting they could change. The CPSS committee working on the policy was set to review it further Friday, and it will go to the full CPSS council for formal approval in principle June 19. . . [Full text]

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Project Submission to the College of Physicians and Surgeons of Saskatchewan

Re: Conscientious Refusal (as revised)

5 June, 2015

Abstract

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.

The conclusion that objecting physicians “should not be obligated to provide a referral to a physician who will ultimately potentially provide the service” is entirely satisfactory. It is a tacit admission that such a policy would be an unacceptable assault on freedom of conscience.

Conscientious Refusal as revised attempts to nullify the alleged ‘bias’ of physicians who object to a procedure for reasons of conscience by requiring them to refer patients to a non-objecting colleague. This proposal is not sound, since, if it is to be applied fairly and consistently, the ‘bias’ of physicians who do not object to a procedure should be nullified in the same way. This would simply exchange one kind of alleged ‘bias’ for another, inconvenience patients and provide them with no better care.

The more sensible course is to require all physicians to provide patients with sufficient information to satisfy the requirements of informed medical decision making.  Physicians must advise patients at the earliest reasonable opportunity of services or procedures they decline to recommend or provide for reasons of conscience, advise affected patients that they may seek the services elsewhere, and ensure that they have sufficient information to approach other physicians, heath care workers or community organizations.  They must not promote their own moral or religious beliefs when interacting with a patient.

Physicians unwilling to abide by these requirements must promptly arrange for a patient to be seen by another physician or health care worker who is able to do so.

If the College is determined to enact a policy on conscientious refusal, it should ensure that the policy adopted is sufficiently flexible to accommodate physicians with respect to all procedures or services. Otherwise, Council should reject Conscientious Refusal as revised and postpone policy development until after the Carter decision comes into force in 2016.


Contents

I.    Revision of draft policy – Conscientious Refusal

II.    Focus of this submission

III.    Section 5.3

IV.    Section 5.3: Suggested modification

V.    Section 2: Scope

VI.    Summary

Appendix “A” – Ontario College briefing materials

Appendix “B” – Providing Information

Appendix “C” – Conscientious Refusal and assisted suicide/euthanasia

Saskatchewan policy forcing doctors to violate conscience fails to win enough support: final decision delayed

LifeSiteNews

Steve Weatherbe

A move to force Christian doctors in Saskatchewan to do abortions, assist at suicides, or refer patients to other willing doctors failed to win sufficient support at a meeting of the College of Physicians and Surgeons’ ruling council Thursday.

Faced with 4,400 hostile letters, many instigated by the Catholic Diocese of Saskatoon, the council decided to continue discussion at an emergency meeting on Saturday, and likely to put off a final vote until June, after a full public consultation.

“They weren’t all on the same page at all,” said Colette Stang, the head of Saskatchewan Pro-Life Association. “So it was a bit of a relief. I was pleased the decision wasn’t made.”. . . [Full text]

Project Submission to the College of Physicians and Surgeons of Saskatchewan

Re: Conscientious Refusal

Abstract

The policy Conscientious Refusal requires all physicians who object to a procedure for reasons of conscience to facilitate the procedure by referring patients to a colleague who will provide it, even if it is homicide or suicide.  No evidence was provided to justify the policy.  None of the arguments provided to Council justify the policy, nor do the principles included in the text.

Conscientious Refusal fails to recognize that the practice of medicine is a moral enterprise, that morality is a human enterprise, and that physicians, no less than patients, are moral agents.

The original text virtually copied by Conscientious Refusal was written by believers: by people who believe that whatever is “legally permissible and publicly-funded” is morally acceptable- including euthanasia, assisted suicide and abortion. It is an assertion of those beliefs and an authoritarian attempt to compel others to conform to them. It is a partisan document that is profoundly disrespectful of the moral agency of physicians, not a compromise.

Conscientious Refusal advances the dangerous idea that a learned or privileged class, a profession or state institutions can legitimately compel people to do what they believe to be wrong and punish them if they refuse. This is not a limitation of fundamental freedoms, but a serious violation of human dignity. It is also incoherent, because it posits the existence of a moral or ethical duty to do what one believes to be wrong.

The Associate Registrar has made it clear that those who refuse to do what the policy demands will be disciplined by the College or forced out of the medical profession. This clashes seriously with the approach taken by the Supreme Court of Canada, which has affirmed that public policy must make room for physicians whose “concept of the good life” precludes their participation in abortion, euthanasia, assisted suicide or other morally contested procedures.

The burden of proof was on the Associate Registrar and the appointed committee to prove beyond doubt that Conscientious Refusal is justified and that no less authoritarian alternatives are available.  They failed to discharge that burden; neither has College Council discharged it. The policy should be withdrawn.


Contents

I.    Origin of the draft policy, Conscientious Refusal

II.    Content of the proposed policy

III.    Focus of this submission

IV.    Justification for the proposed policy

V.    The issues

VI.    Response to the issues

VII.    Discussion

VIII.    Conclusions

Appendix “A”: Origin of the CPSS Draft Policy

Appendix “B”:  Development of the CPSS Draft Policy

Appendix “C”: Interview of CPSS Associate Registrar

Appendix “D”:  Ontario, Alberta, Manitoba and Saskatchewan College Policies

Appendix “E”:  College of Physicians and Surgeons of Saskatchewan Re: Guideline: Unplanned Pregnancy

Appendix “F”:  Morally Significant Participation

Appendix “G”:  Notes on Referral, Abandonment and Fiduciary Duty

What is plagiarism? Saskatchewan College of Physicians provides “teachable moment” for students, teachers

Sean Murphy*

High school and post-secondary teachers plagued by the problem of plagiarism can thank the College of Physicians and Surgeons of Saskatchewan for providing them with a “teachable moment.”

Saskatchewan’s College of Physicians has published a draft policy intended to force objecting physicians to do what they believe to be wrong, including participation in euthanasia, assisted suicide, and abortion.  The policy is virtually a word-for-word copy of the Model Conscientious Objection Policy proposed by euthanasia and abortion activists – without attribution.

Bryan Salte, speaking for the College, denied that the College document was taken from the Model Conscientious Objection Policy, though he did admit that it was a “significant source.”

Now Saskatchewan students have a comeback for teachers who award a “0” for plagiarism because they have copied most of a paper from a “significant source” on the internet.  They can quote Mr. Salte.

On the other hand, Saskatchewan teachers might take this as a “teachable moment”  to explain that it is unethical to pass off someone else’s work as one’s own – even if one likes it and agrees with it entirely and the real authors are pleased with the results.

It might even be a good topic for a class on ethics in medical research.