Submission to the Alberta College of Pharmacists
Re: Draft Code of Ethics

---

Notes

1. Alberta College of Pharmacists, New Code of Ethics: 60-day consultation. Accessed 2009-02-22

2. In Canada, consider the collision between medical ethics the demands of the Ontario Human Rights Commission that occurred in Ontario in 2008.

3. "The physician, the pharmacist, the nurse should have a right to take part or not in assisting a person once he or she has reached a decision to put an end to his or her life. Should they elect not to participate, their duty to their patient requires that they refer them to health professionals who will assist them." Canadian Pharmacists Association, Living and Dying with Dignity - Studying Euthanasia and Assisted Suicide. (16 November, 1994) Accessed 2009-02-21

4. Canadian Pharmacists Association brief, Review of Issues Surrounding Euthanasia and Physician-Assisted Suicide. 22 February, 2000.  Accessed 2009-02-22

5. National Association of Pharmacy Regulatory Authorities (NAPRA), Model Statement Regarding Pharmacists' Refusal to Provide Products or Services for Moral or Religious Reasons.(November, 1999)Accessed 2009-02-21

6. New Brunswick Pharmaceutical Society, Model Statement Regarding Pharmacists' Refusal to Provide Products or Services for Moral or Religious Reasons (November, 1999). Accessed 2009-02-21

7. Prince Edward Island Pharmacy Board, Policy Statement: Statement Regarding Pharmacists' Refusal to Provide Products or Services for Moral or Religious Reasons (June, 2000). Accessed 2009-02-21

8. " Individual pharmacists may experience conscience problems when requested to provide services to which they have a moral objection. . . . In future these services might expand to include preparation of drugs to assist voluntary or involuntary suicide, cloning, genetic manipulation, or even execution." College of Pharmacists of British Columbia, "Ethics in Practice: Moral Conflicts in Pharmacy Practice." Bulletin, March/April 2000, Vol. 25, No. 2. In subsequent correspondence with the Project, the College Registrar continued the thought in correspondence, observing, however, that "there are strong ethical arguments that could be made against participating in . . .involuntary suicide . . ." Letter from the Registrar of the College of Pharmacists of British Columbia to the Project Administrator, 19 April, 2000. This was, the Registrar later explained, a slip of the pen. What was really meant was "involuntary euthanasia". Letter from the Registrar of the College of Pharmacists of British Columbia to the Project Administrator, 9 May, 2000.

9. "[Objecting] pharmacists must refer patients to colleagues who will provide such services, and in the end deliver these services themselves if it is impractical or impossible for patients to otherwise received them." College of Pharmacists of British Columbia, "Ethics in Practice: Moral Conflicts in Pharmacy Practice." Bulletin, March/April 2000, Vol. 25, No. 2. "[T]here is a professional obligation to refer the patient to a pharmacist who is willing to provide the service. The pharmacist shall provide the requested pharmacy care if there is no other pharmacist within a reasonable distance or available within a reasonable time willing to provide the service." College of Pharmacists of British Columbia, Code of Ethics , Value 8 - Obligations, (2. ) Accessed 2009-02-20

10. Cooper J, Osmond B, Rantucci M. "Emergency Contraceptive Pills- Questions and Answers". Canadian Pharmaceutical Journal 133:5, June 2000. The finding is similar to expected pregnancy rates following 'unprotected' intercourse in studies by the Population Council and World Health Organisation (6.2% and 7.4% respectively). Cited in Trussell J, Ellertson C, von Hertzen H, Bigrigg A, Webb A, Evans M, et al. Estimating the effectiveness of emergency contraceptive pills (Abstract). Contraception 2003 Apr; 67(4):259-65. Accessed on 29 November, 2004. A website maintained by Princeton University puts the figure at 8%. See NOT-2-LATE.com - The Emergency Contraception Website. Accessed 29 November, 2004.

11. "Free the Doctor", Globe and Mail, 18 May, 1965. Quoted in de Valk, Alphonse, Morality and Law in Canadian Politics: The Abortion Controversy. Dorval, Quebec: Palm Publishers, 1974, p. 18]. Two years later the Globe argued that, in the case of abortion, "where religious moralities conflict, the State should support none, but leave the choice to individual conscience."["Now the job is to be done, let it be done right", Globe and Mail, 21 December, 1967. Quoted in de Valk, Alphonse, Morality and Law in Canadian Politics: The Abortion Controversy. Dorval, Quebec: Palm Publishers, 1974, p. 56]

12. The assurance given by a Canadian M.P. to a parliamentary committee studying her private member's bill to legalize abortion. [Quoted in de Valk, Alphonse, Morality and Law in Canadian Politics: The Abortion Controversy. Dorval, Quebec: Palm Publishers, 1974, p. 44-45]Similar assurances came from the Canadian Welfare Council: "At the risk of labouring the obvious, no woman will be required to undergo an abortion, no hospital will be required to provide the facilities for abortion, no doctor or nurse will be required to participate in abortion."[Standing Committee on Health and Welfare, Minutes of Proceedings and Evidence, Appendix "SS": Canadian Welfare Council Statement on Abortion to the House of Commons Standing Committee on Health and Welfare. February, 1968, p. 707].

Nor was the Catholic Hospital Association concerned: "We note that there is no question of [our hospitals] being obliged to change their present norms of conduct. On the contrary, proponents of a 'liberalized' abortion law admit that it should exempt those who object to being involved in procuring abortions." [Standing Committee on Health and Welfare, Minutes of Proceedings and Evidence, Appendix "QQ": Brief submitted by the Catholic Hospital Association of Canada . . . on the Matter of Abortion. February, 1968, p. 8058-8059]

Canadian Justice Minister John Turner rejected a protection of conscience amendment to the government bill legalizing abortion because, he said, the proposed law imposed no duty on hospitals to set up committees, imposed no duty on doctors to perform abortions, and did not even impose a duty on doctors to initiate an application for an abortion. [Hansard- Commons Debates, 28 April, 1969, p. 8069]

13. CRR documents obtained by the Catholic Family and Human Rights Institute (CFAM) were entered in the United States Congressional Record (p. E2535 to E2547) on 8 December, 2003, to forestall efforts by the Center to suppress dissemination of the documents through litigation. They are available on the Project website.

The documents cited herein are:

International Legal Program Summary of Strategic Planning: Through October 31, 2003 (E2535) ILPS Memo # 1- International Reproductive Rights Norms: Current Assessment (E2535-E2538); ILPS Memo #2- Establishing International Reproductive Rights Norms: Theory of Change (E2538-E2539).

Domestic Legal Progam Summary of Strategic Planning Through October 31, 2004 (E2539) DLPS Memo #1- Future of Traditional Abortion Litigation (E2539-2540); DLPS Memo #2- Report to Strategic Planning Participants From Systematic Approach Subgroup (E2540-E2541).DLPS Memo #3- Report to Strategic Planning Participants From "Other Litigation" Subgroup (E2541-E2542).

Program Strategies and Accomplishments (E2543)The Center for Reproductive Rights: Summary and Synthesis of Interviews (E2543-2546)The Center for Reproductive Rights Board of Directors - Primary Affiliation Information (E2547)

14. Which the "Other Litigation Subgroup" believed undermined the credibility of the CRR with respect to the interests of "women of colour." DLPS Memo #3, E2541) One of the Center's trustees also expressed concern that much of the funding from individuals was coming from donors over 60 years old ( The Center for Reproductive Rights: Summary and Synthesis of Interviews, E2546)

15. ". . .both the ICPD Programme of Action and the Beijing PFA reflect an international consensus recognizing the inalienable nature of sexual rights." ILPS Memo # 1, 2537

16. "Legally binding or ''hard'' norms are norms codified in binding treaties such as the International Covenant on Civil and Political Rights (ICCPR) or the Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW)" ILPS Memo # 1, E2535

17. The Center acknowledges that there is no binding international legal instrument that recognizes a right to abortion. [ILPS Memo # 1, E2536]

18. "The ILP's overarching goal is to ensure that governments worldwide guarantee reproductive rights out of an understanding that they are legally bound to do so." International Legal Program Summary of Strategic Planning: Through October 31, 2003 (E2535) "Our goal is to see governments worldwide guarantee women's reproductive rights out of recognition that they are bound to do so." ILPS Memo #1, E2537; ILPS Memo # 2, E2538. "The Center needs to continue its advocacy to ensure that women's ability to choose to terminate a pregnancy is recognized as a human right." ILPS Memo # 2, E2539"Advocates use of enforcement mechanisms can help cultivate a "culture" of enforcement . . ." ILPS Memo #2, E2539Pursuing the notion that abortion is part of "the fundamental rights strand of equal protection" is one of the suggestions in the report of the "Other Litigation" Subgroup, DLPS Memo #3, E2540. To establish abortion as a "fundamental" right would give it precedence over less "fundamental" rights in cases of conflict.

19. The norms offer "a firm basis for the government's duties, including its own compliance and its enforcement against third parties." ILPS Memo #2, E2538

20. "Supplementing . . .binding treaty-based standards and often contributing to the development of future hard norms are a variety of 'soft norms.' These norms result from interpretations of human rights treaty committees, rulings of international tribunals, resolutions of inter-governmental political bodies, agreed conclusions in international conferences and reports of special rapporteurs. (Sources of soft norms include: the European Court of Human Rights, the CEDAW Committee, provisions from the Platform for Action of the Beijing Fourth World Conference on Women, and reports from the Special Rapporteur on the Right to Health.)." ILPS Memo # 1, E2535

21. ILPS Memo # 2, E2538.

22. Whether or not the effect would be absolute would depend upon the relative value assigned to freedom of conscience vis a vis a 'right' to abortion. If both were considered equally fundamental, some tradeoffs might be permitted

23. The Center also recognizes the importance of public opinion and public education. "Public education and awareness building" is identified as one form of advocacy (ILPS Memo # 2, E2539; DLPS Memo #2, E2540-E2541). The CRR recognizes that it is important to use arguments that are "appealing and understandable to the public" (DLPS Memo #2, E2540), and, similarly, the limited appeal of highly technical or legalistic approaches (DLPS Memo #2, E2541). It is foreseen that enforcement of new rights might require "sustained public awareness-raising campaigns" in addition to support from the medical community and others. One concern raised in the documents is the possibility that to try to formally establish "reproductive rights" in a new international instrument might, "as a matter of public perception," undermine CRR's claims that such rights already exist (ILPS Memo # 1, E2538). It also encourages and takes advantage of favourable domestic political developments: ". . . the national political moment may be ripe for change, with or without the influence of international standards. Such changes. . . particularly in key countries in a region, may have a catlytic effect on neighbouring countries." (IPLS Memo #2, E2539).

24. ILPS Memo #2, E2538)

25. The Center seeks ways to bring its agenda "into the mainstream of legal academia and the human rights establishment" (ILPS Memo #2, E2539), seeing the media as a way to bring it "to the attention of relevant international, regional and national normative bodies, including legislators, other government officials, local and international judicial bodies, as well as medical bodies that can influence law and policy" (ILPS Memo #2, E2539).

26. DLPS Memo #1, E2539. Answers suggested in different parts of the documents include identifying "allies in government and civil society" (ILPS Memo #2, E2539) "fostering alliances with members of civil society who may become influential on their national delegations to the UN," (ILPS Memo #2, E2539), "collaboration with NGO's engaged in establishing legal norms at the national level" (ILPS Memo #2, E2539), and "providing input to civil society or government actors" (ILPS Memo #2, E2539). Consistent with a focus on elites rather than the public, references to "workshops around the world" are made within the context of getting input from "key players" and reinforcing the interest of "allies"(ILPS Memo #1, E2538), not public education.

27. ILPS Memo #1, E2538

28. For example, when the Center seeks sexual autonomy and access to abortion for children and adolescents, it proposes to work with "major medical groups" to achieve this end, not organizations representing parents. (DLPS Memo #2, E2540)

29. Center for Reproductive Rights, Memo #1 - International Reproductive Rights Norms: Current Assessment, E2538

30. ". . . there is no binding hard norm that recognizes women's right to terminate a pregnancy. To argue that such a right exists, we have focused on interpretations of three categories of hard norms: the rights to life and health; the right to be free from discrimination; those rights that protect individual decision-making on private matters." ILPS Memo #1, E2536

31. ILPS Memo #1, E2537 - E2538

32. "Arguments based on the decisions of one body can be brought as persuasive authority to decisions made in other bodies. . . As interpretations of norms acknowledging reproductive rights are repeated in international bodies, the legitimacy of these rights is reinforced." ILPS Memo #1, E2538

33. ISLP Memo #1, E2535, E2538.

34. "These lower profile victories will gradually put us in a strong position to assert a broad consensus around our assertions." ISLP Memo #1, E2538

35. Romalis, Garson, "Current Abortion Management." British Columbia Medical Journal, Dec. 1999, Vol. 41, No. 11, p. 554; "Morgentaler calls decision to halt abortions 'disgusting.'" New Brunswick/St. John Telegraph Journal, 9 November, 2002

36. Kretzul, E., "Ethical responsibilities in dealing with women requesting abortion services." The Messenger, No. 73, September, 1999. Accessed 2008-09-27.An instruction published in 2000 by the Ethics Advisory Committee of the College of Pharmacists of British Columbia included statements that impugned the integrity of conscientious objectors within the profession by implying that they were dishonest in dealing with patients. The Registrar of the College later acknowledged there was no evidence to support the statements, but refused to retract them and apologize. Project Report 2001-01. RE: College of Pharmacists of British Columbia- Conduct of the Ethics Advisory Committee (Revised 24 May, 2001) The President of the American College of Obstetricians and Gynecologists made the bald assertion that objectors "should be required to refer patients to other physicians who will provide the appropriate care." Mennuti, Michael T., Letter to American Senators from the President of the ACOG, 30 August, 2005. American College of Obstetricians and Gynecologists Demands Compulsory Referral

37. Submission of the Ontario Human Rights Commission to the College of Physicians and Surgeons of Ontario Regarding the draft policy, "Physicians and the Ontario Human Rights Code." 15 August, 2008. Accessed 3008-08-31

38. British Columbia pharmacist Frank Arche, for example, has claimed that pharmacists are obliged to provide services "despite personal religious or moral objections." Canadian Pharmaceutical Journal, May 2000, Vol. 133, No. 4, p. 22-26.

39. "Dr. James Robert Brown, a professor of science and religion at the University of Toronto, said he agrees with prosecuting a doctor with that sort of conflict. "Suppose someone (doctor) said, 'I'm uncomfortable with (treating) a minority,' I'd say, 'So long scum'," said Brown." "Brown believes performing abortions and offering other forms of contraception are necessary and if Dawson won't perform them, then, Brown added, 'Fine - just resign from medicine and find another job." "Religious beliefs are highly emotional - as is any belief that is effecting your behaviour in society. You have no right letting your private beliefs effect your public behaviour." Canning, Cheryl, "Doctor's faith under scrutiny: Barrie physician won't offer the pill, could lose his licence." The Barrie Examiner, February 21, 2002

40. Asoka ascended his father's throne in 269 BC. Time-Life Books, TimeFrame 400 BC - AD 200: Empires Ascendant, p. 107-109

41. More than 900 out of 5,000 Canadian soldiers were killed; nearly 2000 were captured. An example of the carnage: of the Royal Regiment of Canada, half were killed, just 65 of 554 made it back to England, and only 22 of them were unwounded. Readers Digest, The Canadians at War 1939/45. Vol. 1, p. 181, 192.

42. "Upon landing on the beach under heavy fire he attached himself to the Regimental Aid Post . . . During the subsequent period of approximately eight hours, while the action continued, this officer not only assisted the Regimental Medical Officer in ministering to the wounded . . . but time and again left this shelter to inject morphine, give first-aid and carry wounded personnel from the open beach . . . . On these occasions, with utter disregard for his personal safety, Honorary Captain Foote exposed himself to an inferno of fire and saved many lives by his gallant efforts . . . Honorary Captain Foote continued tirelessly and courageously to carry wounded men from the exposed beach to the cover of the landing craft. He also removed wounded from inside the landing craft when ammunition had been set on fire by enemy shells. When landing craft appeared he carried wounded from the Regimental Aid Post to the landing craft through heavy fire. On several occasions this officer had the opportunity to embark but returned to the beach as his chief concern was the care and evacuation of the wounded. He refused a final opportunity to leave the shore, choosing to suffer the fate of the men he had ministered to for over three years." Citation, as reported in The London Gazette, 14 February, 1946. Reproduced on the website of the Royal Hamilton Light Infantry: Hon LCol John Weir Foote, VC, CD. Accessed 2008-09-05

43. "Realizing the dangerous situation, Scrimger organized the evacuation of the wounded to the rear, but one of his patients, Captain H. F. McDonald, had a serious head wound. Any movement before he was stabilized would likely kill him. Scrimger chose to stay behind. The shells fell around them and then began to land on the farm. The slight, 5-foot-7-inch doctor, who weighed only 148 pounds, shielded McDonald's prone body while he worked over him. During the bombardment, the building was demolished and set on fire, but both Scrimger and McDonald survived the whirling shrapnel and exploding ammunition. Blinded by the smoke and heat of the fire, Scrimger pulled the larger, unconscious infantry officer onto his back and staggered out of the building. German infantry were advancing on the farm and the only escape was to cross the moat to the rear. Lurching to safety with McDonald on his back, Scrimger passed through the barrage, moving from shell hole to shell hole for cover. Hiding in a nearby ditch throughout the rest of the day, they avoided the enemy infantry. Captain McDonald later testified that each time the shells exploded around them, "Captain Scrimger curled himself round my wounded head and shoulder to protect me from the heavy shell fire, at obvious peril to his life. He stayed with me all that time and by good luck was not hit." Canadian War Museum, Backgrounder:"Francis Scrimger, V.C. Accessed 2008-09-11

44. Kingsmill, Suzanne, Francis Scrimger: Beyond the Call of Duty. Hannah Institute for the History of Medicine, Dundurn Press Ltd., 1991, p. 25. See also "The greatest devotion to duty": Dr. Francis Scrimger and his Victoria Cross. McCulloch, I. CMAJ. 1994 February 1; 150(3): 414-416. () Accessed 2008-09-04

45. Benson, Iain T., "There are No Secular 'Unbelievers.'" Centrepoints 7, Vol. 4, No. 1, Spring 2000, P. 3.(https://www.consciencelaws.org/Examining-Conscience-Issues/Ethical/Ethical10.html)

46. American College of Obstetrics and Gynecology, Committee on Ethics Opinion No. 385 , The Limits of Conscientious Refusal in Reproductive Medicine, p. 3. Accessed 2008-09-24.

47. For example: "The moral position of an individual pharmacist, if it differs from the ethics of the profession, cannot take precedence over that of the profession as a whole." College of Pharmacists of British Columbia Bulletin, Ethics in Practice: Moral Conflicts in Pharmacy Practice. March/April 2000, Vol. 25, No. 2, P. 5. For further information about the bulletin and related issues, see Project Report 2001-01, College of Pharmacists of British Columbia: Conduct of the Ethics Advisory Committee, 26 March, 2001.

48. One critic outlines the extent of the penetration of bioethics principlism, as defined in the American Belmont Report: "Many colleges and universities already require a course in bioethics in order to graduate, and most medical and nursing schools have incorporated it in their curricula. Bioethics is even being taught now in the high schools. And what is being taught as bioethics are the Belmont principles, or renditions of one or more of these principles as defined in Belmont terms. Nods may be given to 'alternative' propositions here and there, but in the end it is the language of principlism which sets the standards." Irving, Dianne N., What is "Bioethics"? (Quid est "Bioethics"?). Tenth Annual Conference: Life and Learning X (in press) University Faculty For Life, Georgetown University,Washington, D.C. Accessed 2008-09-11

49. "Medical professionalism includes both the relationship between a physician and a patient and a social contract between physicians and society." CMA Policy: Medical Professionalism. (Update 2005) P. 1 (Accessed 2008-09-06)"Professionalism is also the moral understanding among medical practitioners that gives reality to the social contract between medicine and society. This contract in return grants the medical profession a monopoly over the use of its knowledge base, the right to considerable autonomy in practice and the privilege of self-regulation." Canadian Stakeholders Coalition on Medical Professionalism, quoted in CMA Policy: Medical Professionalism. Accessed 2008-09-06 "Professionalism is the basis of medicine's contract with society." "Medical Professionalism in the New Millennium: A Physician Charter." Annals of Internal Medicine, 5 February 2002 | Volume 136 Issue 3 | Pages 243-246. Accessed 2008-09-06 "In Canada and the United States the social basis of the extraordinary grant of occupational authority and independence to professionalized occupations such as medicine and law has been a social contract between the profession and the public. Professionalism is the moral understanding among professionals that gives concrete reality to this social contract." Sullivan, William M., Medicine under threat: professionalism and professional identity. CMAJ, March 7, 2000; 162 (5). Accessed 2008-09-06. Similarly, Cruess, Sylvia R. and Cruess, Richard L., Professionalism: a contract between medicine and society. CMAJ 7 March 2000; 162 (5). Accessed 2008-09-06

50. "We also exchanged, or rather subsumed, social contract and morality into a single term, moral contract. It seemed to us that the idea of a moral dimension to medicine was important. It indicated something right and good in relation to the behaviours and actions of a doctor. The ultimate expression of those behaviours and actions is perhaps best summed up in the idea of a contract between the public and the profession - a moral contract. A social contract, while a correct description of the mutual agreement that exists between the public and profession, seemed too neutral a term. We wanted to emphasise an ethical edge to that mutual agreement." Doctors in Society: Medical Professionalism in a Changing World. Royal College of Physicians Report of a Working Party (December, 2005), para. 2.15. Accessed 2008-09-06

51. Latimer, Elizabeth J., Accidental patient. A doctor takes a different view. Can Fam Physician. 2002 August; 48: 1295-1296. Accessed 2008-09-06. James T.C, The Patient-Physician Relationship: Covenant or Contract? Mayo Clin Proc. 1996;71:917-918. Accessed 2008-09-07

52. College of Pharmacists of British Columbia, Bulletin. March/April, 2000, Vol. 25, No. 2

53. Stueck, Gordon, "Here we go again." Letter to the editor, Pharmacy Practice, May, 2000.Accessed 2009-02-25

54. Honderich, Ted (Ed.) The Oxford Companion to Philosophy (2nd Ed.) Oxford: Oxford University Press, 2005. p. 174

55. Laidlaw, Stuart, "College of physicians debates doctors' rights to refuse treatments."Toronto Star, 18 September, 2008. Accessed 2008-09-21

56. Canadian M.P. Grace MacInnis told a parliamentary committee studying her private member's bill to legalize abortion that "nobody would be forcing abortion procedures on anyone else."[Quoted in de Valk, Alphonse, Morality and Law in Canadian Politics: The Abortion Controversy. Dorval, Quebec: Palm Publishers, 1974, p. 44-45] Similar assurances came from the Canadian Welfare Council: "At the risk of labouring the obvious, no woman will be required to undergo an abortion, no hospital will be required to provide the facilities for abortion, no doctor or nurse will be required to participate in abortion."[Standing Committee on Health and Welfare, Minutes of Proceedings and Evidence, Appendix "SS": Canadian Welfare Council Statement on Abortion to the House of Commons Standing Committee on Health and Welfare. February, 1968, p. 707]. Nor was the Catholic Hospital Association concerned: "We note that there is no question of [our hospitals] being obliged to change their present norms of conduct. On the contrary, proponents of a 'liberalized' abortion law admit that it should exempt those who object to being involved in procuring abortions." [Standing Committee on Health and Welfare, Minutes of Proceedings and Evidence, Appendix "QQ": Brief submitted by the Catholic Hospital Association of Canada . . . on the Matter of Abortion. February, 1968, p. 8058-8059]

57. Canadian Justice Minister John Turner rejected a protection of conscience amendment to the government bill legalizing abortion because, he said, the proposed law imposed no duty on hospitals to set up committees, imposed no duty on doctors to perform abortions, and did not even impose a duty on doctors to initiate an application for an abortion. [Hansard- Commons Debates, 28 April, 1969, p. 8069]

58. Ontario Human Rights Commission, The Duty to Accommodate. Accessed 2008-09-07

59. Cook RJ, Dickens BM, "In Response". J.Obstet Gyanecol Can, February, 2004; 26(2)112.

60. McInerney v. MacDonald (1992), 93 Dominion Law Reports (4th) 415 (Supreme Court of Canada)

61. Recalling an earlier case (Canson Enterprises Ltd. v. Boughton & Co. [1991] 3 S.C.R. 534),

62. Quoting LeBel, J. in Henderson v. Johnston, [1956] O.R. 789 at p. 799.

63. Cook RJ, Dickens BM, Access to emergency contraception [letter] J.Obstet Gynaecol Can 2004; 26(8):706.

64. Dickens, Bernard M. "Informed Consent": Chapter 5 in Downie, Joceyln, Caulfield, Timothy and Flood, Colleen (Eds.) Canadian Health Law and Policy (2nd Ed.). Butterworths, p. 149.

65. Riebl v. Hughes (1980), 114 DLR (3rd) 1, (1980) 2 SCR 880, 14 CCLT 1, 33 NR, 361; Hopp v. Lepp (1980), 112 DLR (3d) 67, (1980) 2 SCR 192, (1980) 4 WWR 645, 22 AR 361, 13 CCLT 66, 32 NR 145, followed; Trogun v. Fruchtman (1973), 207 NW 2d 297; Downer v. Veilleux (1974), 322 A. 2d 82, referred to.

66. Zimmer v. Ringrose (1981), 124 DLR (3d) 225-226 (Alberta Court of Appeal); Zimmer v. Ringrose (1978), 89 Dominion Law Reports (3d) 657 (Alberta Supreme Court)

67. Zimmer v. Ringrose (1981), 124 DLR (3d) 219 (Alberta Court of Appeal); Zimmer v. Ringrose (1978), 89 DLR (3d) 649 (Alberta Supreme Court)

68. Zimmer v. Ringrose (1981), 124 DLR (3d) 219 (Alberta Court of Appeal); Zimmer v. Ringrose (1978), 89 DLR (3d) 649 (Alberta Supreme Court)

69. Zimmer v. Ringrose (1981), 124 DLR (3d) 226 (Alberta Court of Appeal)

70. Zimmer v. Ringrose (1978), 89 DLR (3d) 657-658 (Alberta Supreme Court)

71. Zimmer v. Ringrose (1981), 124 DLR (3d) 226 (Alberta Court of Appeal); Zimmer v. Ringrose (1978), 89 DLR (3d) 657 (Alberta Supreme Court)

72. Lee, Jenny, "Official slams 'sex selection' blood test: Gender of fetus can be seen five weeks into pregnancy." Vancouver Sun, 13 August, 2005. Accessed 2005-10-10

73. Ramsay, Sarah, "Controversy over UK surgeon who amputated healthy limbs." The Lancet, Volume 355, Number 9202, 05 February 2000. Dr. Smith waived his fee and the patients paid for the surgery. Accessed 2001-10-04

74. Gawande, Atul, When law and ethics collide - Why physicians participate in executions. N Engl J Med 354;12 23 March, 2006, 1221-1229. Accessed 2008-09-08

75. American Medical Association Policy E-2.06: Capital Punishment (June, 1998). Accessed 2008-09-06

76. Gawande, Atul, When law and ethics collide - Why physicians participate in executions. N Engl J Med 354;12 23 March, 2006, 1221-1229. Accessed 2008-09-08

77. Curfman, Gregory D., Morrissey, Stephen, and Drazen, Jeffrey M., Physicians and Execution. N Engl J Med 358;4. Accessed 2008-09-08

78. General Medical Council (United Kingdom) Personal Beliefs and Medical Practice. Accessed 2008-09-10

79. General Medical Council (United Kingdom) Good Medical Practice (2006). Accessed 2008-09-10

80. Royal Pharmaceutical Society of Great Britain, Code of Ethics for Pharmacists and Pharmacist Technicians, 1 August, 2007. Accessed 2009-02-20

81. Joint Statement on Preventing and Resolving Ethical Conflicts Involving Health Care Providers and Persons Receiving Care (1998)

82. United Kingdom Parliament, House of Lords Select Committee on Assisted Dying for the Terminally Ill Bill: Selections from the First Report

83. Joint Committee On Human Rights Twelfth Report: Assisted Dying for the Terminally Ill Bill, Para. 3.11 to 3.16. Accessed 2005-11-01

84. United Kingdom Parliament, House of Lords Select Committee on Assisted Dying for the Terminally Ill Bill: Examination of Witnesses (Questions 70 - 79) , Thursday, 16 September, 2004, Q70. Accessed 2005-11-01

85. Arco, Anna, "Catholic doctor wins victory for conscience." The Catholic Herald, 12 September 2008. Accessed 2009-02-27

86. Trinity Western University v. College of Teachers, [2001] 1 S.C.R. 772, 2001 SCC 31

87. Cromwell, Oliver, "Declaration of the Lord Lieutenant of Ireland." (January, 1649) Carlyle, Thomas, Oliver Cromwell's Letters and Speeches, with elucidations. Boston: Estes and Lauriat, 1886, Vol. I, Part 5, p. 18.

88. Cromwell, Oliver, "Declaration of the Lord Lieutenant of Ireland." (January, 1649) Carlyle, Thomas, Oliver Cromwell's Letters and Speeches, with elucidations. Boston: Estes and Lauriat, 1886, Vol. I, Part 5, p. 18.

89. "The physician, the pharmacist, the nurse should have a right to take part or not in assisting a person once he or she has reached a decision to put an end to his or her life. Should they elect not to participate, their duty to their patient requires that they refer them to health professionals who will assist them." Canadian Pharmacists Association, Living and Dying with Dignity - Studying Euthanasia and Assisted Suicide. (16 November, 1994). Accessed 2009-02-21

90. American College of Obstetrics and Gynecology, Committee on Ethics Opinion No. 385, The Limits of Conscientious Refusal in Reproductive Medicine. Accessed 2008-09-11

91. Alter, Jonathon, "Time to Think About Torture." Newsweek, 5 November, 2001, p. 45.

92. Maher's Story. Accessed 2008-09-08

93. Commission of Inquiry into the Actions of Canadian Officials in Relation to Maher Arar, Report of the Events Relating to Maher Arar: Analysis and Recommendations. (hereinafter, "Arar Inquiry: Analysis and Recommendations") p. 9. Accessed 2008-09-08

94. Arar Inquiry: Analysis and Recommendations, p. 35-36. Accessed 2008-09-08

95. Deputy Prime Minister Issues Terms of Reference for the Public Inquiry into the Maher Arar Affair. Accessed 2008-09-08

96. Re: briefing note for RCMP Commissioner Zaccardelli: "Assistant Commissioner Proulx states [in the note] that the RCMP can be considered complicit in Mr. El Maati's detention in Syria. However, Mr. Proulx testified that it was the media and public who would consider the RCMP's actions to be complicit. He did not personally believe that the RCMP was complicit, nor was he referring to complicity in the criminal sense." Commission of Inquiry into the Actions of Canadian Officials in Relation to Maher Arar, Report of the Events Relating to Maher Arar: Factual Background Vol. I, (hereinafter "Arar Inquiry: Vol. I") p. 64. Accessed 2008-09-08.

97. "The Ambassador did not consider that seeking the fruits of the Syrian interrogation made Canada complicit in obtaining information that might have been the product of torture. He reasoned that he did not ask the Syrians to continue interrogating Mr. Arar so that Canada could obtain information. Furthermore, the Ambassador did not have any evidence that Mr. Arar was being tortured or held incommunicado. Arar Inquiry: Vol. I, p. 271. Accessed 2008-09-08.

98. "Superintendent Killam was aware that Secretary Powell had given Minister Graham the clear impression that the RCMP was complicit in Mr. Arar's deportation. However, Superintendent Killam testified that, even without making further inquiries in response to the media reports, he was able to exclude the possibility that the allegation of complicity might be true, because the allegation was inconsistent with the RCMP position." Arar Inquiry: Vol. I, p. 299. Accessed 2008-09-08.

99. "Mr. Solomon prepared a draft memorandum for the Minister . . .which dealt with the upcoming CSIS trip to Syria and stated . . . "there are concerns as to whether a visit to Arar by Canadian intelligence officials may make Canada appear complicit in his detention and possible poor treatment by Syrian authorities." Arar Inquiry: Vol. I, p. 309. Accessed 2008-09-08.

"Mr. Livermore testified that the original statement about the reliability of the confession and the possible complicity by Canada if CSIS was to meet with Mr. Arar was "very much on the speculative side" and "it was anticipating something that we later ironed out with CSIS, namely that they would not seek access to Mr. Arar." Arar Inquiry: Vol. I, p. 310. Accessed 2008-09-08

100. ". . . the intervenors suggest that the circumstances under which these individuals ended up in Syrian detention raise troubling questions about whether Canadian officials were complicit in their detention. The evidence of what happened to them could possibly show a pattern of misconduct by Canadian officials." 770 Commission of Inquiry into the Actions of Canadian Officials in Relation to Maher Arar, Report of the Events Relating to Maher Arar: Factual Background, Vol. II, p. 770. Accessed 2008-09-08

101. "Canadian officials did not participate or acquiesce in the American decisions to detain Mr. Arar and remove him to Syria. I have thoroughly reviewed all of the evidence relating to events both before and during Mr. Arar's detention in New York, and there is no evidence that any Canadian authorities - the RCMP, CSIS or others - were complicit in those decisions." Arar Inquiry: Analysis and Recommendations, p. 29. Accessed 2008-09-08

"Although decisions to interact must be made on a case-by-case basis, they should be made in a way that is politically accountable, and interactions should be strictly controlled to guard against Canadian complicity in human rights abuses or a perception that Canada condones such abuses." Arar Inquiry: Analysis and Recommendations, p. 35. Accessed 2008-09-08

"If it is determined that there is a credible risk that the Canadian interactions would render Canada complicit in torture or create the perception that Canada condones the use of torture, then a decision should be made that no interaction is to take place." Arar Inquiry: Analysis and Recommendations, p. 199. Accessed 2008-09-08

"Even if one were to accept that Canadian officials were somehow complicit in those arrests, that would not change my conclusion, based on the evidence at the Inquiry, that Canadian officials did not participate or acquiesce in the American decision to send Mr. Arar to Syria from the United States." Arar Inquiry: Analysis and Recommendations, p. 271. Accessed 2008-09-08

"Information should never be provided to a foreign country where there is a credible risk that it will cause or contribute to the use of torture. Policies should include specific directions aimed at eliminating any possible Canadian complicity in torture, avoiding the risk of other human rights abuses and ensuring accountability." Arar Inquiry: Analysis and Recommendations, p. 345. Accessed 2008-09-08

"Clearly, the prohibition against torture in the Convention against Torture is absolute. Canada should not inflict torture, nor should it be complicit in the infliction of torture by others." Arar Inquiry: Analysis and Recommendations, p. 346. Accessed 2008-09-08

102. Smith, Graeme, "From Canadian custody into cruel hands." Globe and Mail, 23 April, 2007. Accessed 2008-09-07

103. Editorial, "The truth Canada did not wish to see." Globe and Mail, 2 April, 2007. Accessed 2008-09-08

104. "We will have to repent in this generation, not merely for the hateful words and actions of the bad people, but for the appalling silence of the good people."King, Martin Luther, Letter from Birmingham Jail, 16 April, 1963. Accessed 2005-08-02"Non-cooperation with evil is as much a duty as is cooperation with good."Gandhi, Mahatma, Statement before Mr. C. N. Broomfield, I. C. S., District and Sessions Judge. Ahmedabad, 18 March, 1922. Accessed 2005-08-02

105. Editorial, "How complicit are doctors in the abuse of detainees?" The Lancet, Vol 364, August 21, 2004, p. 725-729

106. Miles, Steven H., "Abu Ghraib: its legacy for military medicine." The Lancet, Vol 364, August 21, 2004, p. 725-729; Lifton, Robert Jay, Doctors and Torture. N Engl J Med 351;5

107. American Medical Association Policy E-2.06: Capital Punishment. Accessed 2008-09-08

108. American Medical Association Policy E.2.067: Torture. Accessed 2008-09-08

109. Canadian Medical Association Policy resolution BD80-03-99 - Treatment of prisoners. Status: Approved, 1979-Dec-08. Last Reviewed, 2004-Feb-28: Still relevant.

110. See American College of Obstetrics and Gynecology, Committee on Ethics Opinion No. 385, The Limits of Conscientious Refusal in Reproductive Medicine, p. 5, recommendation 4. Accessed 2008-09-11

111. "Referrals to Non-regulated Health Care Providers." In College of Physicians and Surgeons of Alberta, The Messenger, No. 93 (April, 2002) p. 6. Accessed 2008-10-05

112. Elahi, Maryam and Kushner, Adam "Doctors With 'Dirty Hands.'" Physicians for Human Rights Library. Accessed 2008-09-09. Originally published in the Washington Post, 8 June, 2003

113. Hartle, Anthony E.,"Atrocities in war: dirty hands and noncombatants - International Justice, War Crimes, and Terrorism: The U.S. Record." Social Research, Winter, 2002. Accessed 2008-09-08

114. A practical observation is that ethical advice "falls squarely into the most contested domain of social and public policy. Rawlsians and feminists; casuists and communitarians: all have their divergent visions of what individuals should find life worth living for, or be willing to live with. And these visions will not always coincide with the wishes of the patient, much less the consensus of society." Shalit, Ruth, "When we Were Philosopher Kings." The New Republic, April 28, 1997. Smith, Wesley J., "Is Bioethics Ethical?" The Weekly Standard, 28 May, 2000.

115. Richard G. Frey, "The ethics of the search for benefits: Animal experimentation in medicine," in Raanan Gillon (ed.), Principles of Health Care Ethics (New York: John Wiley & Sons, 1994), pp. 1067-1075; cited in Irving, Dianne N., "Scientific and Philosophical Expertise: An Evaluation of the Arguments on 'Personhood'". Linacre Quarterly February 1993, 60:1:18-46 [Updated and extensively revised, September 20, 1996]

116. Bleich, Dr. J. David, "Euthanasia", in Judaism and Healing: Halakhic Perspectives (1st Ed.), Ktav Publishing House, 1981, p. 139. Essay reprinted in A Matter of Choice: Responsibility to Live, Right to Die - Five Discussion Papers from the Jewish Perspective on Euthanasia. 13 April, 1994, Lubavitch Centre, Vancouver, B.C. (Ethics and Torah forum series)

117. Maritain, Jacques (John J. Fitzgerald, trans.) The Person and the Common Good. Notre Dame, Indiana: University of Notre Dame Press, 2002, p. 36, 43, 46

118. King, Martin Luther, Sermon: The Three Dimensions of a Complete Life. New Covenant Baptist Church, Chicago, Illinois, 9 April 1967. Accessed 2005-08-02

119. King, Martin Luther, Sermon: Rediscovering Lost Values. 2nd Baptist Church, Detroit 28 February, 1954. Accessed 2005-08-02

120. Charo, R. Alta, The Celestial Fire of Conscience- Refusing to Deliver Medical Care. N Eng J Med 352:24, June 16, 2005. Accessed 2008-09-13

121. Lewis, C.S., "Learning in War Time." In The Weight of Glory and Other Addresses. Grand Rapids, Mich.: William B. Eerdmans, 1975, p. 47

122. Maritain, Jacques (John J. Fitzgerald, trans.) The Person and the Common Good. Notre Dame, Indiana: University of Notre Dame Press, 2002, p. 59; Maritain, Jacques (Doris C. Anson, trans.) The Rights of Man and Natural Law. New York: Gordian Press, 1971, p. 3, 9

123. Maritain, Jacques (Doris C. Anson, trans.) The Rights of Man and Natural Law. New York: Gordian Press, 1971, p. 3-4

124. Somerville, Margaret, Death Talk: The Case Against Euthanasia and Assisted Suicide. Montreal & Kingston: McGill-Queens University Press, 2001, p. 191-192.

125. Maritain, Jacques (Doris C. Anson, trans.) The Rights of Man and Natural Law. New York: Gordian Press, 1971, p. 3

126. Maritain, Jacques (Doris C. Anson, trans.) The Rights of Man and Natural Law. New York: Gordian Press, 1971, p. 18

127. Maritain, Jacques (John J. Fitzgerald, trans.) The Person and the Common Good. Notre Dame, Indiana: University of Notre Dame Press, 2002, p. 71; Maritain, Jacques (Doris C. Anson, trans.) The Rights of Man and Natural Law. New York: Gordian Press, 1971, p. 14

128. Maritain, Jacques (John J. Fitzgerald, trans.) The Person and the Common Good. Notre Dame, Indiana: University of Notre Dame Press, 2002, p. 73; Maritain, Jacques (Doris C. Anson, trans.) The Rights of Man and Natural Law. New York: Gordian Press, 1971, p. 15-17, 76

129. Maritain, Jacques (Doris C. Anson, trans.) The Rights of Man and Natural Law. New York: Gordian Press, 1971, p. 11

130. Maritain, Jacques (John J. Fitzgerald, trans.) The Person and the Common Good. Notre Dame, Indiana: University of Notre Dame Press, 2002, p. 58

131. Maritain, Jacques (Doris C. Anson, trans.) The Rights of Man and Natural Law. New York: Gordian Press, 1971, p. 65

132. Maritain, Jacques (Doris C. Anson, trans.) The Rights of Man and Natural Law. New York: Gordian Press, 1971, p. 45

133. Joad, C.E.M., Guide to the Philosophy of Morals and Politics. London: Gollancz Ltd., (1938), p. 803. Quoted in R. v. Morgentaler (1988)1 S.C.R 30 at p. 178 (http://scc.lexum.umontreal.ca/en/1988/1988rcs1-30/1988rcs1-30.html) Accessed 2008-09-10

134. Joad, C.E.M., Guide to the Philosophy of Morals and Politics. London: Gollancz Ltd., (1938), p. 805. Cited in R. v. Morgentaler (1988) 1 S.C.R 30 at p. 178. Accessed 2008-09-10. See Maritain, Jacques, Man and the State. Chicago: University of Chicago Press, 1951, p. 13

135. Lewis, C.S., "The Humanitarian Theory of Punishment." In Hooper, Walter (Ed.) C.S. Lewis: First and Second Things. Glasgow: William Collins & Sons, 1985, p. 101

136. King, Martin Luther, Letter from Birmingham Jail, 16 April, 1963. Accessed 2005-08-02

137. Wojtyla, Karol, Love and Responsibility. San Francisco: Ignatius Press, 1993, p. 27

138. Kant, Immanuel, Fundamental Principles of the Metaphysic of Morals. Accessed 2008-09-10. Quoted in The Internet Encyclopedia of Philosophy, "Immanuel Kant (1724-1804) Metaphysics" . Accessed 2008-09-10

139. R. v. Morgentaler (1988)1 S.C.R 30 (Supreme Court of Canada) Accessed 2008-09-10.

140. R. v. Morgentaler (1988)1 S.C.R 30 (Supreme Court of Canada) Accessed 2008-09-10.

141. R. v. Morgentaler (1988)1 S.C.R 30 (Supreme Court of Canada) Accessed 2008-09-10

142. R. v. Morgentaler (1988)1 S.C.R 30 (Supreme Court of Canada) Accessed 2008-09-10.

143. "Pro-life pharmacy debuts in Virginia, touts freedom of conscience." Catholic News Agency, 21 October, 2008. Accessed 2009-02-26; Duin, Julia, "Va. pharmacy caters to pro-life customers: Will stock no birth control." Washington Times, 21 October, 2008. Accessed 2009-02-26.

144. "Legally binding or ''hard'' norms are norms codified in binding treaties such as the International Covenant on Civil and Political Rights (ICCPR) or the Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW)" ILPS Memo # 1, E2535

145. ". . . there is no binding hard norm that recognizes women's right to terminate a pregnancy. To argue that such a right exists, we have focused on interpretations of three categories of hard norms: the rights to life and health; the right to be free from discrimination; those rights that protect individual decision-making on private matters." ILPS Memo #1, E2536

146. "The ILP's overarching goal is to ensure that governments worldwide guarantee reproductive rights out of an understanding that they are legally bound to do so." International Legal Program Summary of Strategic Planning: Through October 31, 2003 (E2535) "Our goal is to see governments worldwide guarantee women's reproductive rights out of recognition that they are bound to do so." ILPS Memo #1, E2537; ILPS Memo # 2, E2538. "The Center needs to continue its advocacy to ensure that women's ability to choose to terminate a pregnancy is recognized as a human right." ILPS Memo # 2, E2539"Advocates use of enforcement mechanisms can help cultivate a "culture" of enforcement . . ." ILPS Memo #2, E2539Pursuing the notion that abortion is part of "the fundamental rights strand of equal protection" is one of the suggestions in the report of the "Other Litigation" Subgroup, DLPS Memo #3, E2540. To establish abortion as a "fundamental" right would give it precedence over less "fundamental" rights in cases of conflict.

147. The norms offer "a firm basis for the government's duties, including its own compliance and its enforcement against third parties." ILPS Memo #2, E2538

148. "Supplementing . . .binding treaty-based standards and often contributing to the development of future hard norms are a variety of 'soft norms.' These norms result from interpretations of human rights treaty committees, rulings of international tribunals, resolutions of inter-governmental political bodies, agreed conclusions in international conferences and reports of special rapporteurs. (Sources of soft norms include: the European Court of Human Rights, the CEDAW Committee, provisions from the Platform for Action of the Beijing Fourth World Conference on Women, and reports from the Special Rapporteur on the Right to Health.)." ILPS Memo # 1, E2535

149. See Dickens, Bernard M. "Informed Consent": Chapter 5 in Downie, Joceyln, Caulfield, Timothy and Flood, Colleen (Eds.) Canadian Health Law and Policy (2nd Ed.). Toronto: Butterworths, 2002, p. 149.

150. Report of the Preparatory Commission for the International Criminal Court, Addendum: Finalized draft text of the Elements of Crimes. New York: 2000. Accessed 2008-09-30

151. Rome Statute of the International Criminal Court, Accessed 2008-09-30

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