Project Submission to the College of Physicians and Surgeons of Ontario

Re: Professional Obligations and Human Rights

Abstract

The focus of this submission about Professional Obligations and Human Rights (POHR) is its demand for “effective referral” – the demand that physicians do what they believe to be wrong – even gravely wrong – even arranging homicide or suicide – and the implied threat that they will be punished if they refuse.

This is a dangerous and extraordinarily authoritarian policy, completely at odds with liberal democratic aspirations and our national traditions. The burden of proof is on the working group to prove beyond doubt that it is justified and that no reasonable alternatives are available. The working group has not done so.

The working group provided no evidence that such a policy is necessary, and there is evidence that it is not. The briefing materials supplied to Council in support of POHR were not only seriously deficient, but erroneous and seriously misleading. “Public sentiment” captured by a random poll does not justify the suppression of fundamental freedoms, and the results of consultation, when carefully considered, suggest that a policy of “effective referral” is highly controversial.

An example of a reasonable alternative is available from the Australian Medical Association – an example not offered to Council members by the working group, which, instead, completely misrepresented AMA policy.

This submission, supported by detailed analysis in the appendices, provides good reason for Council members to doubt that the requirement for effective referral in POHR is necessary or justifiable, or prudent policy. It also provides reason for them to believe that reasonable alternatives can be developed.

Council members unpersuaded by the working group or left in doubt about POHR should give the benefit of doubt to freedom of conscience and refuse to approve the draft policy in its present form. They should direct the working group to collaborate with those opposed to the present draft to produce a broadly acceptable text. If the real goal is to ensure access – not ideologically driven ethical cleansing – there is no reason to demand that physicians do what they believe to be wrong. If the College’s real goal is to ensure access to services – not to punish objecting physicians, or drive them out of family practice, or out of the profession – that goal is best served by connecting patients with physicians willing to help them.

Introduction

Reasons for doubt

III. POHR in practice

Appendix “A”: The Review Process

Appendix “B”: Unreliability of Jurisdictional Review by College Working Group

Appendix “C”: Consultation on Physicians and the Human Rights Code

Appendix “D”: A Case for Evidence-based Policy Making

Appendix “E”: Legal Criticism

Full text available on line at https://news.consciencelaws.orgpublications/submissions/submissions-013-001-cpso.aspx.

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.

A watchdog in need of a leash

Ontario College of Physicians manipulates consultation process

New Release

For immediate release

Protection of Conscience Project

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

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

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

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

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

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

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

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

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

“It seems this watchdog needs a leash.”

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

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

Sean Murphy*

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

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

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

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

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

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

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

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

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

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

[PDF Text]

Notes

1. Submission of the Ontario Human Rights Commission to the College of Physicians and Surgeons of Ontario regarding the draft policies relating to establishing and ending physician-patient relationships. 14 February, 2008. (Accessed 2018-03-07)

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

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

4. Gabel, M. “Dear Colleagues.” College of Physicians and Surgeons of Ontario, Dialogue, Vol. 10, Issue 4, 2014, p. 6. (Accessed 2018-03-07)

5. College of Physicians and Surgeons of Ontario, Annual Meeting of Council, December 4-5, 2014, p. 330 (Accessed 2018-03-07)

6.College of Physicians and Surgeons of Ontario, Appendix 2, Transparency Principles (2013-09) Accessed 2018-03-07).

7. College of Physicians and Surgeons of Ontario, Annual Meeting of Council, December 4-5, 2014, p. 328 (Accessed 2018-03-07)

8. “Balancing MD and patient rights: Human rights draft policy open for consultation.” Dialogue, Vol. 10, Issue 4, 2014, p. 49. (Accessed 2018-03-07)

9. 3,104 responses. College of Physicians and Surgeons of Ontario, Physicians and the Ontario Human Rights Code Consultation: Online Survey Report and Analysis, Figure 4 (Accessed 2018-03-07)

Saskatchewan physicians to be forced to do what they believe to be wrong

Policy wording supplied by abortion and euthanasia activists

Policy would apply to euthanasia, if legalized.

Protection of Conscience Project News Release

The College of Physicians and Surgeons of Saskatchewan is proposing a draft policy demanding that physicians who object to “legally permissible and publicly-funded health services” must direct patients to colleagues who will provide them. If another physician is unavailable, the College demands that they provide “legally permissible and publicly-funded” services, even if doing so “conflicts with physicians’ deeply held and considered moral or religious beliefs.”

Physicians usually refuse to participate in abortion because they believe it is wrong to kill what the criminal law refers to as a child that has not become a human being.¹ The proposed policy will require them to find a physician willing to do the killing they won’t do. Should the Supreme Court of Canada legalize euthanasia, the policy will require objecting physicians who refuse to kill patients to find someone who will.

The seamless fit between referral for abortion and referral for euthanasia is not surprising. The draft College policy was largely written by abortion and euthanasia activists, notably Professor Jocelyn Downie of Dalhousie University.

In a 2006 guest editorial in the Canadian Medical Association Journal, Professor Downie and another law professor claimed that objecting physicians are obliged to refer patients for abortion.² Their views were vehemently rejected by physicians and repudiated by the Canadian Medical Association.³ Partly as a result of the negative response, Professor Downie and her colleagues in the “Conscience Research Group” decided to convince Colleges of Physicians and Surgeons to impose it.⁴

Saskatchewan’s draft policy is taken almost verbatim from their “Model Conscientious Objection Policy.”

The Conscience Research Group is a tax-funded initiative that includes Professors Downie and Daniel Weinstock.⁵ Both were members of an “expert panel” that recommended that health care professionals who object to killing patients should be compelled to refer patients to someone who would,⁶ because (they claimed) it is agreed that they can be compelled to refer for “reproductive health services.”⁷

Current efforts by the College of Physicians and Surgeons of Ontario to suppress freedom of conscience in the medical profession may have been influenced by the Conscience Research Group. However, the College in Saskatchewan is the first to copy and paste its preferred model into a draft policy.

The Project insists that it is incoherent and contrary to sound public policy to include a requirement to do what one believes to be wrong in a professional code of ethics. It is also an affront to the best traditions of liberal democracy, and, ultimately, dangerous.

The College Council has approved the policy in principle, but will accept feedback on it until 6 March, 2015.

Notes:

1. Criminal Code, Section 238(1). (Accessed 2014-12-02)

2. Rodgers S. Downie J. “Abortion: Ensuring Access.” CMAJ July 4, 2006 vol. 175 no. 1 doi: 10.1503/cmaj.060548 (Accessed 2014-12-02).

3. Blackmer J. Clarification of the CMA’s position on induced abortion. CMAJ April 24, 2007 vol. 176 no. 9 doi: 10.1503/cmaj.1070035 (Accessed 2014-02-22)

4. McLeod C, Downie J. “Let Conscience Be Their Guide? Conscientious Refusals in Health Care.” Bioethics ISSN 0269-9702 (print); 1467-8519 (online) doi:10.1111/bioe.12075 Volume 28 Number 1 2014 pp ii–iv

5. Let their conscience be their guide? Conscientious refusals in reproductive health care: Meet the team.(Accessed 2014-11-21)

6. Schuklenk U, van Delden J.J.M, Downie J, McLean S, Upshur R, Weinstock D. Report of the Royal Society of Canada Expert Panel on End-of-Life Decision Making (November, 2011) p. 101 (Accessed 2014-02-23)

7. Schuklenk U, van Delden J.J.M, Downie J, McLean S, Upshur R, Weinstock D. Report of the Royal Society of Canada Expert Panel on End-of-Life Decision Making (November, 2011) p. 62 (Accessed 2014-02-23)

Category: Protection of Conscience Project