Category: Canada

Demande à l’Ordre des médecins et chirurgiens de l’Ontario

Protection of Conscience Project

Objet : Les médecins et le Code des droits de la personne de l’Ontario

Résumé [En Anglais]

La Commission ontarienne des droits de la personne a commis une grave erreur en 2008 lorsqu’elle a tenté d’éliminer la liberté d’opinion et la liberté de religion de la profession médicale sous prétexte que les médecins sont des « fournisseurs de services publics laïcs ». Dans son interprétation publique de cette erreur, la Commission a largement contribué à la diffusion d’un esprit antireligieux et à la création d’un climat d’intolérance religieuse en Ontario. Ces deux phénomènes ont fait la manchette et ont été l’objet d’un scandale public plus tôt cette année lorsque trois médecins ont dit à leurs patients qu’ils ne recommanderaient, n’offriraient ou ne feraient pas ce qu’ils jugent immoral, contraire à l’éthique ou néfaste.

Ces médecins suivaient ainsi les directives de l’Association médicale canadienne et de l’Ordre des médecins et chirurgiens de l’Ontario. Les médecins doivent aviser leurs patients des traitements ou des procédures qu’ils refusent de leur recommander ou leur offrir pour motif moral ou religieux afin que ces derniers puissent recevoir des soins ailleurs. Les médecins ne sont pas tenus d’aider leurs patients à obtenir un service ou à suivre une procédure qu’ils jugent néfaste.

Ce compromis qui permet de protéger l’autonomie légitime des patients et de préserver l’intégrité des médecins est constamment attaqué par des activistes voulant contraindre les médecins à offrir ou à conseiller un avortement ou des moyens contraceptifs et, récemment, à pratiquer l’euthanasie alors qu’ils s’y objectent. Ces activistes croient essentiellement que les médecins ont le devoir de faire ce qu’ils tiennent comme étant mal, car ils ne doivent par agir en fonction de leurs convictions morales ou religieuses.

Il est toutefois incohérent d’inclure dans un code de déontologie le devoir de faire quelque chose considéré comme mal, puisque la nature même d’un tel code est d’encourager les médecins à agir de façon éthique et de prévenir les méfaits. De plus, il est impossible de pratiquer la médecine sans faire référence à des convictions, que celles-ci relèvent de l’éthique laïque ou religieuse, et ni une éthique laïque ni une éthique religieuse ne sont moralement neutres. Ainsi, demander que les médecins n’agissent pas en fonction de leurs convictions ou qu’ils pratiquent la médecine de manière moralement « neutre » est inacceptable, car cela est impossible.

Demander que les médecins n’agissent pas en fonction de leurs convictions religieuses puisque la médecine est une profession laïque est inacceptable, car cela est erroné. La Cour suprême du Canada a reconnu qu’une société laïque n’est pas sans foi; les personnes qui la composent peuvent avoir des convictions religieuses ou non, et un pluralisme démocratique rationnel doit accepter toutes ces personnes. La Court a mis en garde, en séance plénière, contre la défavorisation ou la suppression de la conscience au courant des aspects religieux des affaires publiques représente une distorsion mesquine des principes libéraux qui n’entraîne « qu’une piètre notion de pluralisme ».

S’il est légitime de contraindre des personnes ayant des convictions religieuses de faire ce qu’ils considèrent comme étant mal, il est donc également légitime de contraindre les personnes n’ayant pas de convictions religieuses à faire ce qu’ils considèrent comme étant mal. Ainsi, le compromis fait par l’Association médicale canadienne ne sert pas uniquement à protéger l’intégrité des médecins et l’autonomie légitime des patients, mais également à faire en sorte que la société ne soit pas tentée de croire en une idée dangereuse, à savoir qu’une classe, une profession ou une institution d’état privilégiée peut, de manière légitime, contraindre des gens à participer à des actes qu’ils jugent comme étant mal (même très mal, comme un meurtre) sous peine de représailles s’ils refusent.

La liberté d’opinion et la liberté de religion sont sujettes à des contraintes raisonnables, mais la maxime voulant que la liberté d’avoir des convictions soit plus large que la liberté d’agir en fonction de ces dernières est inadéquate. Il est nécessaire de faire appel à des distinctions plus précises pour affronter les difficultés d’une démocratie pluraliste. Une d’entre elles est la nuance entre les deux manières dont s’exerce la liberté d’opinion : en faisant le bien et en évitant le mal. Il existe une différence considérable entre le fait d’empêcher les gens à faire le bien qu’ils souhaitent faire et le fait de les contraindre à faire le mal qu’ils abhorrent.

De manière générale, il est fondamentalement injuste et offensant de contraindre des gens à soutenir, offrir ou participer à des actes qu’ils considèrent comme étant mal, et plus le méfait est grave, plus cette injustice ou cette offense est grave. Il s’agit d’une pratique fondamentalement opposée au civisme, lequel permet de maintenir une communauté politique et de favoriser une justice forte. Elle va à l’encontre des meilleures traditions et des aspirations d’une démocratie libérale.  Elle est de plus dangereuse, car elle encourage une attitude plus près de régimes totalitaires que des demandes qui caractérisent une liberté responsable.

Cela ne veut pas dire pour autant qu’il ne faille pas imposer de limites à la liberté d’opinion exercée pour préserver l’intégrité personnelle. Cela veut par contre dire que même l’approche stricte visant à imposer des limites à d’autres libertés et droits fondamentaux n’est pas assez précise pour pouvoir être appliquée sans danger ici. à l’instar de l’utilisation d’une force potentiellement mortelle, la restriction de la liberté d’opinion à des fins de protection ne peut être justifiée qu’en dernier recours et uniquement dans des circonstances exceptionnelles.

Lorsque l’Ordre des médecins et chirurgiens de l’Ontario reçoit des plaintes de patients qui n’ont pas pu obtenir les services qu’ils voulaient, il devrait aider ceux-ci à les mettre en contact avec des fournisseurs prêts à leur offrir ces services. Ceci sera plus constructif que de tenter d’éliminer la liberté d’opinion et la liberté de religion de la profession médicale. [Demande]

Submission to the College of Physicians and Surgeons of Ontario

Gift of Life Fertility Care Centre

Dear CPSO Members,

I teach women and couples how to understand and track their fertility using the Creighton Model FertilityCare™ System. I am writing in response to the review of your policy about Physicians and the Ontario Human Rights Code.

Several articles by major news outlets have documented the inconvenience experienced by a woman who wanted to get the birth-control pill only to find that the doctor on staff did not prescribe it. Despite attempts by these outlets to make it more than this, ultimately “inconvenience” is the right word for what this woman experienced. She lost, maybe, 30 minutes of her time going to another clinic.

What has been played up by these news outlets as an inconceivable travesty is common fare for the women who are my clients. I work with women who, in contrast to women who use the Pill, believe their fertility to be health, not disease, and therefore use methods of family planning based on their natural cycle. These women want to work with doctors who will treat their reproductive and gynaecological issues in accord with this mindset. Many of the women I have worked with would be glad if the worst thing that happened to them in their attempt to find such a doctor was a 30 minute detour to a different clinic. A significant number of my clients make regular 3 to 6 hour trips, each way, to see a doctor who will respect their decision to work with their fertility versus seeing it as a disease. Some have even travelled from other provinces, paying not only for travel but also hotel rooms and lost days of work.

To my knowledge, the woman in the above mentioned news articles never even interacted with a doctor. She was never judged for wanting the Pill, never pressured to get off of it, or never told she should be doing something else. In contrast, here are some of the things that women using natural methods have dealt with:

  1. More than once, a woman’s physician has pressured her to go on the Pill, despite her clearly telling her physician that she does not want that, after she has chosen to get pregnant and given birth. [Please note: “chosen” is the best word, as my experience in practice matches with the published method effectiveness for the Creighton Model of 99.5% to avoid pregnancy.)
  2. In one instance, an OBGYN was so insistent that a women use non-natural methods of family planning that she felt the need to get a letter from her lawyer before her scheduled C-section as she feared the OBGYN would tie her tubes.

In addition, clients have experienced ignorance, scorn, and downright rudeness from physicians who, horribly informed about modern methods of Natural Family Planning, chastise them for using the “Rhythm” method or no method at all.

This lack of respect for my clients’ desires is seen not only with their choice for family planning but also with their approach to pregnancy:

  1. A woman struggling from multiple miscarriages shared with me how callous her physician was in response to her distress regarding her most recent miscarriage; for him, loosing multiple unborn children was no big deal and he felt it should also be for her.
  2. A couple, given a potential negative prenatal diagnosis was repeatedly pressured by their physician to abort despite the couple telling the physician that they were morally opposed to abortion.

Finally women who are looking for real answers to their reproductive and gynaecological health issues, as opposed to suppressive/destructive approaches like the Pill, have sometimes found Pill-prescribing physicians more “dogmatic” than any of the physicians the media decided to highlight who do not prescribe the Pill. A number of my clients have been told by these Pill-prescribing physicians that the Pill was the only option to their problems. In case you were wondering, the Pill was not the only medical answer, as all of them have subsequently found out.

I find it ironic that, given the ubiquitous presence of the Pill and the ease at which hormonal contraception can be found – not only in private medical practice, but at any Public Health Unit or Family Planning Clinic – that the story of one woman’s inconvenience became national news. Meanwhile, the women that I work with continue to quietly accept the difficult and costly efforts they go to to find physicians who will work with them. These women are equally deserving of having physicians, such as those who only prescribe natural methods for family planning. Any attempt by the CPSO to change its referral policy and thus force such physicians out of practice is a clear statement by the CPSO that some women – particularly those who take the Pill – are more equal than others.

Gift of Life FertilityCare TM Centre,
Ottawa, Ontario

Doctors Should Not Be Forced to Prescribe the Pill

Huffington Post

There’s a Toronto-based business called the Red Tent Sisters, which gives sex advice to women. They are advocates for women’s health, offering classes in everything from contraception to fertility and sexuality. They encourage women to leave hormonal contraception behind. “Ditch the Pill,” says their website, “and reclaim your health, happiness and future fertility.” Ditch the pill? To reclaim health? Happiness? What? The founders of the Red Tent Sisters teach that fertility awareness, also known as natural family planning, provides reliable contraception and is better for women’s health and the environment. There are many methods, but the commonality between them is that they eschew daily hormones and put women themselves in charge of their own sexual health without relying on Big Pharma. In short, fertility awareness is healthy and empowering. It could also soon be forbidden to advise or explain it for Ontario’s doctors. . . [Full Text]

Submission to the College of Physicians and Surgeons of Ontario

Dr. Marc Gabel
President
College of Physicians and Surgeons of Ontario
80 College Street
Toronto, Ontario
MSG 2E2

Dear Dr. Gabel:

Re: Policy Review ‘Physicians and the Ontario Human Rights Code’

As the College of Physicians and Surgeons of Ontario prepares to review its policy on physicians and the human rights code, we are deeply disturbed by the many negative voices that have been urging the College to force doctors to “check their ethics at the door”. It should be obvious that now, only weeks after Quebec legalized euthanasia, we have arrived at the worst possible time in Canadian history to turn doctors into mere mechanics whose duty is to blindly do the bidding of their clients.

With euthanasia legal in Canada’s second-largest province, the debate about euthanasia and assisted suicide on the national level and in other provinces will only intensify. It is crucial that we preserve the right of our doctors to refuse to participate in such services even if they are legal.

Euthanasia and assisted suicide continue to be regarded as deeply unethical by many world religions, including Christianity, Judaism and Islam.

What is legal is no longer necessarily moral, and we would be unwise to place all our trust in the law as our shield, or to train our doctors to disregard their own ethical limits. Indeed, the properly formed conscience of our physicians may sometimes be the last moral and ethical boundary that protects us and provides us with life-affirming options and alternatives that respect our human dignity.

Canadians pride themselves on being a society made up of many cultures, religions and ethnicities. The freedom and democracy that underpin our pluralist society lead us to affirm the right of all citizens to participate fully in roles of leadership and the professional life, including the medical profession.  Any policy that would require doctors to contravene their consciences and to breach their most deeply held values would be outrageously exclusionary and unacceptable, as it would chase out of medicine those principled physicians who refuse to violate the central teachings of many of our largest and most ancient religions. For such doctors, referral for actions that they believe to be contrary to their medical judgement, ethical principles and religious beliefs would be as unacceptable as providing them, as it would be tantamount to outright cooperation with the action in question.

We refuse to believe that this is the kind of Canada that any of us would want to live in. The freedom of conscience is a basic human right recognized by many international agreements and protected by the Canadian Charter of Rights and Freedoms. It is essential to a truly democratic society and foundational for the protection of all other human rights, including the freedom of religion.

As such, we strongly encourage the College, as it reviews its policy on this matter, to continue to protect an authentic freedom of conscience for all physicians. No Canadian citizen, including any physician, should ever be disciplined or risk losing their professional standing for conducting their work in conformity with their most deeply held ethical or religious convictions.

Sincerely yours,

Rabbi Reuben Bulka
Congregation Machzikei Hadas, Ottawa

Terrence Prendergast, S.J.
Archbishop of Ottawa

Imam Sarni Metwally
Ottawa Main Mosque

CC:
President of the Ontario Medical Association
President of the Canadian Medical Association
President of the College of Family Physicians of Canada

Redefining the Practice of Medicine- Euthanasia in Quebec, Part 9: Codes of Ethics and Killing

Abstract

Redefining the Practice of Medicine- Euthanasia in Quebec, Part 9: Codes of Ethics and KillingRefusing to participate, even indirectly, in conduct believed to involve serious ethical violations or wrongdoing is the response expected of physicians by professional bodies and regulators.  It is not clear that Quebec legislators or professional regulators understand this.

A principal contributor to this lack of awareness – if not actually the source of it – is the Code of Ethics of the Collège des médecins, because it requires that physicians who are unwilling to provide a service for reasons of conscience help the patient obtain the service elsehere. The President of the Collège was pleased that law will allow physicians to shift responsibilty for finding someone willing to kill a patient to a health system administrator, avoiding an anticipated problem caused by the requirement for referral in the Code of Ethics.  However, the law does not displace the demand for referral in the Code, and can be interpreted to support it.

The Collège des médecins Code of Ethics demand for referral conflicts with the generally accepted view of culpable indirect participation.  Despite this, it continues to be used as a paradigm by other  professions, notably pharmacy.  It is thus not surprising that the College of Pharmacists also anticipates difficulty over the issue of referral.  Like the Collège des médecins, the College of Pharmacists would like to avoid these problems by allowing an objecting pharmacist to shift responsibility for obtaining lethal drugs to a health systems administrator.

Nurses cannot be delegated the task of killing a patient, it is not unreasonable to believe that nurses may be asked to participate in euthanasia in other ways. Thus, there remain concerns about indirect but morally significant participation in killing.  Their Code of Ethics imposes a duty to ensure both continuity of care and “treatment,” which is to include euthanasia.  However, under ARELC, an objecting nurse is required to ensure only continuity of care.  This should not be interpreted to require nurses to participate in euthanasia, though they may be pressured to do so.

As a general rule, it fundamentally unjust and offensive to human dignity to require people to support, facilitate or participate in what they perceive to be wrongful acts; the more serious the wrongdoing, the graver the injustice and offence.  It was a serious error to include this a requirement in code of ethics for Quebec physicians and pharmacists. The error became intuitively obvious to the Collège des médecins and College of Pharmacists when the subject shifted from facilitating access to birth control to facilitating the killing of patients.

A policy of mandatory referral of the kind found in the Code of Ethics of the Collège des médecins  is not only erroneous, but dangerous.  It establishes the priniciple that people can be compelled to do what they believe to be wrong – even gravely wrong – and punish them if they refuse.  It purports to entrench  a ‘duty to do what is wrong’ in medical practice, including a duty to kill or facilitate the killing of patients. To hold that the state or a profession can compel someone to commit or even to facilitate what he sees as murder is extraordinary.

Quebec’s medical establishment can correct the error by removing the mandatory referral provisions of their codes of ethics that nullify freedom of conscience.  This would prevent objecting physicians and pharmacists from being cited for professional misconduct for refusing to facilitate euthanasia or disciplined for refusing to facilitate other procedures to which they object for reasons of conscience, including contraception and abortion.  This would almost certainly antagonize consumers who have been conditioned to expect health care workers to set aside moral convictions.

It remains to be seen whether the Quebec medical establishment will maintain the erroneous provisions, preferring to force objecting health care workers to become parties to homicide rather than risk occasionally inconveniencing people, such as the young Ontario woman and her supporters who were outraged because she had to drive around the block to obtain The Pill. [Full Text]