Category: Commentary

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)

Euthanasia is so accepted that doctors must now justify prolonging a life

National Post

Barbara Kay

In 1994, Dutch journalist Gerbert van Loenen’s partner Niek underwent surgery to remove what was thought to be a pea-sized brain tumour. More complicated than predicted, the operation resulted in a brain injury that left Niek permanently disabled, yet still able to enjoy quality of life.

Van Loenen willingly reorganized his life to care for Niek at home. But after four years, his career needs necessitated moving Niek to a wheelchair-accessible unit across the street from a nursing home, where he was content for six more years until the tumour returned, whereupon he died a natural death.

Van Loenen found himself brooding over certain friends’ reactions to their situation. “It would have been better if he had died,” one said at the outset. [Full text]

 

College of Physicians, please stand up for religious minorities

ProWomanProLife

Reproduced with permission

Faye Sonier

*Dr. Gabel is Member of Council and Past President of the College of Physicians and Surgeons of Ontario. He is the chair of the College’s policy working group which issued the draft “Professional Obligations and Human Rights” policy.

Dear Dr. Marc Gabel,

I just read this article which was published in the Catholic  Register. You were quoted in the piece. Here is an excerpt:

Catholic doctors who won’t perform abortions or provide abortion referrals should leave family medicine, says an official of the College of Physicians and Surgeons of Ontario.

“It may well be that you would have to think about whether you can practice family medicine as it is defined in Canada and in most of the Western countries,” said Dr. Marc Gabel, chair of the college’s policy working group reviewing “Professional Obligations and Human Rights.”

The Ontario doctor’s organization released a draft policy Dec. 11 that would require all doctors to provide referrals for abortions, morning-after pills and contraception. The revised policy is in response to evolving obligations under the Ontario Human Rights Code, Gabel said.

There have been no Ontario Human Rights Tribunal decisions against doctors for failing to refer for abortion or contraception.

Gabel said there’s plenty of room for conscientious Catholics in various medical specialties, but a moral objection to abortion and contraception will put family doctors on the wrong side of human rights legislation and current professional practice.

“Medicine is an amazingly wide profession with many, many areas to practice medicine,” he said.

Yes, medicine is “an amazingly wide profession.” Thankfully, it is also a profession which attracts an “amazingly wide” array of Canadians. Of those Canadian physicians are some who share my pro-life perspective. They may refuse to refer for abortion due to their conscience, but they may also refuse to refer due to their religious beliefs (or both – we’re working out what this means under the Charter). They may be Christian, Muslim, Jewish or atheist physicians but they have an issue with abortion or contraceptives. For them, to refer for this procedure or these drugs is to be complicit in the actions and their consequences.

I am an Ontario resident. I’m a cancer survivor. I’m a mother.  I have spent far more than my fair share of time in Ontario hospitals and clinics being treated by wonderful Ontario doctors.

Over the last few years, I’ve gone out of my way to work with pro-life physicians who share my perspective. I reject the notion that killing and dismembering unborn children is medicine, and I wanted to work with physicians who share my values regarding human life and human dignity.  Due to the “amazingly wide” practice of medicine in Ontario, I was able to find a few, and become their patient. I am so thankful for their care.

But due to your working group’s proposed new policy, I might lose my family physicians. They will choose to practice medicine in a province that respects both their skills and their rights, rather than sacrifice their conscience or their sincerely held religious beliefs.

I’m also a human rights lawyer. The College’s reasoning for stripping physicians of their conscience and religious rights is not based on law. Your working group received a number of submissions on that point, so I’ll leave you to review them with your legal counsel. The doctors seeking to exercise their freedoms have a leg to stand on. Heck, they have Canadian and Ontario human rights law on their side.

Of great concern to me is the definition of “discrimination” which you provided when interviewed:

“We’re saying that the discrimination occurs when you are not acting in the best interest of the patient,” said Gabel. “When you are not communicating effectively or respectfully about this with the patient, when you’re not managing conflicts, when you differ from the patient and when you are not respecting the patient’s dignity and ensuring their access to care and protecting their safety. That’s the issue.”

Dr. Gabel, this is not the definition of “discrimination” at law. If someone chooses to make up definitions for words, they are free to do so. (My son, for example, seems to think that “babagaba” is a verb which means “to chew on mommy’s ankle.”)

However, for a body like the College of Physicians and Surgeons of Ontario to create a new definition of “discrimination” which will result in the stripping of legal and human rights of some of their members is shocking, and this new definition will not stand up in a court of law. I urge the College to abide by Canadian and Ontario law.

Dr. Gabel, I suspect you are well intentioned and a kind and caring psychotherapist, like so many of the wonderful doctors who have treated me over the years. But please don’t force my physicians from the province with your policy. My family depends on their expertise and professionalism. I like to see my own values reflected in the “amazingly wide” practice of medicine in Ontario. For someone like myself, a religious minority, this is very important.

The membership of your College is broad and wide enough to include some family physicians who happen to hold pro-life positions. If it is not, it should be.

Sincerely,

Faye Sonier

New Brunswick health minister unaware of abortion-euthanasia connection

Project Letter to the Editor,
Fredericton Daily Gleaner

Sean Murphy*

Re: “Abortions won’t be available in all hospitals. “The Fredericton Daily Gleaner, 28 November, 2014

New Brunswick’s Minister of Health and the President of the province’s Medical Society both claim that physicians who refuse to provide abortion for reasons of conscience have an obligation to refer patients to colleagues who will. These assertions contradict the positions of the Canadian Medical Association and the College of Physicians and Surgeons of New Brunswick. Mr. Boudreau and Dr. Haddad also fail to recognize how such a policy would play out should assisted suicide and euthanasia be legalized. The Protection of Conscience Project intervened at the Supreme Court of Canada in the Carter case on precisely this point.1

Some influential academics have been attempting to force physicians to refer for abortion for years. They now claim that “because” physicians can be forced to refer for abortion, they should be forced to refer for euthanasia.2 If they have succeeded in converting Mr. Boudreau and Dr. Haddad to their point of view, it is not shared by physicians who refuse to be parties to killing, before or after birth.

The Canadian Medical Association expects physicians who decline to provide abortions for reasons of conscience to notify a patient seeking abortion “so that she may consult another physician.” There is no requirement for referral.3 The College of Physicians of New Brunswick suggests referral as a “preferred practice,” but acknowledges that referral may not be acceptable. Physicians may, instead, provide information about resources available to patients that they can use to obtain the service they want.4

Notes:

1.  Murphy, S. “Project Backgrounder Re: Joint intervention in Carter v. Canada.” Supreme Court of Canada, 15 October, 2014

2. 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. 70 (Accessed 2014-12-02)

3. Murphy S. “‘NO MORE CHRISTIAN DOCTORS.’ Appendix ‘F’- The Difficult Compromise: Canadian Medical Association, Abortion and Freedom of Conscience.” Protection of Conscience Project

4. Comment by College of Physicians and Surgeons of New Brunswick (November, 2002) Re: Declining to provide service on moral/religious grounds.

When is a problem not a problem?

Refusing to dispense drugs to kill patients with psychiatric illness

Levenseinde Kliniek complains about uncooperative Dutch pharmacists

Sean Murphy*

When is a problem not a problem?In April, 2014, a complaint was made in the Netherlands that some Dutch pharmacists were refusing to provide euthanasia drugs.  The complaint led members of the Dutch Parliament from the green party, GroenLinks, to ask for a debate with health minister, and members of other Dutch political parties let it be known that they were also concerned.

 According to the news reports, over half the physicians at “the independent euthanasia clinic” had been refused lethal drugs, and 23 percent of 53 pharmacists surveyed reported that they sometimes refused to fill euthanasia prescriptions.  It was argued that pharmacists should not be able to refuse drugs needed to kill patients if two physicians had approved the euthanasia request.  However, while the law in the Netherlands permits physicians to provide euthanasia, it does not mention pharmacists. [Full Text]