Category: Religion

Submission to the College of Physicians and Surgeons of Ontario

Cardinal Thomas Collins

Re: College of Physicians and Surgeons of Ontario consultation on the policy “Physicians and the Ontario Human Rights Code”

I welcome the opportunity to participate in the consultation concerning the College of Physicians and Surgeons policy “Physicians and the Ontario Human Rights Code,” approved in September of 2008. I will specifically be referring to the subsection ii “Moral or Religious Beliefs” in Providing medical services without discrimination.”

The first part of subsection ii surveys the legal context in Ontario, and specifically the Ontario Human Rights Code, and offers observations on how that affects the practice of medicine. It offers physicians “an indication of what principles may inform the decisions of Courts and Tribunals”, and so is largely informative, and does not take a position on issues.

The “College Expectations” section, however, establishes guidelines for physicians to follow.

I am glad that in the first of the “College Expectations” (“Communicate clearly and promptly about any treatments or procedures the physician chooses not to provide because of his or her moral beliefs.” ) the policy recognizes that there may well be some treatments or procedures that a physician cannot, in good conscience, offer. It is vital that our society respect freedom of conscience. For the common good of any society it is essential that the state, or professional associations with power over their members, not intrude into the sanctuary of conscience. The protection of freedom of conscience is a basic human right of all people, whatever their  faith or lack of faith. Many people with clear religious beliefs selflessly serve others as a result of those beliefs, in medicine and in other areas, and their service is of inestimable benefit to all of us. Our society would be poorer without that service, and from that perspective alone it is important that freedom of conscience be respected. In my September, 2008, submission, the last time there was a consultation on this policy, I wrote:

“Profound moral and religious convictions motivate and guide individual physicians, as well as nurses, pharmacists, and others. When I refer to physicians I also have in mind the others who use their skills and knowledge in the work of healing. In our province, and around the world, individuals and health care institutions motivated and guided by moral and religious convictions serve the sick and the suffering, and do so with respect and compassion. The benefits to society have been, and are, immense. For those who so generously devote their lives to the noble vocation of healing, ethical and religious convictions are not something optional or disconnected from the good they do.”

The third expectation, in the paragraph “Treat patients or individuals .. . ” is admirable. All patients should be treated with respect, and the physician-patient relationship should not be used as a forum for seeking to convert someone to one’s religious beliefs, or for criticizing other people, or entering into a debate with them. Those who have given their lives to the sacred vocation of medicine, and whose service is motivated by religious belief, treat the patient with special reverence, for he or she is seen as a child of God. Speaking only of my own religious tradition, physicians and hospitals whose mission is modeled on that of”Christ the Healer” are now, and have always been, agents of profound healing, and that is most appreciated by those who experience it, whatever their faith or lack of faith. If a physician, operating out of that richly beneficial medical tradition, politely declines to become involved with things such as contraception, abortion or (as may happen, eventually) euthanasia, then it would be a grave injustice to the physician, but also a loss to society, to seek to suppress his or her freedom of conscience.

The second expectation “Provide information about all clinical options . . . ” and the fourth “Advise patients or individuals . .. ” could have the potential for an infringement upon the rights of conscience of a physician, depending on the extent to which he or she is required to become actively involved in facilitating actions which go against his or her conscience. A lot depends on what is involved in “help the patient or individual make arrangements to do so.”

I will end with a quote from my submission to the previous consultation, in 2008:

“I urge the College of Physicians and Surgeons to support a physician who seeks to follow his or her conscience, and to take this opportunity of the preparation of a policy, to provide helpful and practical guidance to physicians on how to deal with the sometimes difficult situations they face, in a way that will allow them to maintain their moral integrity.”

Cardinal Thomas Collins,
Archbishop of Toronto
President of the Assembly of Catholic Bishops of Ontario

Submission to the Ontario College of Physicians and Surgeons

Catholic Civil Rights League

The Catholic Civil Rights League (CCRL) is pleased to provide this submission to the College of Physicians and Surgeons of Ontario (CPSO) regarding the review of the current policy Physicians and the Ontario Human Rights Code. The CCRL made a previous submission in 2008 prior to the adoption of the current policy. We make this submission on behalf of our membership nationally, particularly for those in Ontario.
Our concern today is similar to that of 6 years ago. We strongly advocate for the protection of the Charter right of freedom of conscience and religion for all Canadians, including physicians in the daily routine of their care to patients and in the overall forming of their individual medical practices. We believe this is key to the maintenance and growth of our social fabric in the province of Ontario and all of Canada. Your policy should reflect a true pluralistic society so as to avoid a climate for discrimination of any kind, including discrimination based on religious and moral beliefs and the exercise of one’s conscience.

The CCRL acknowledges the assertion in the current policy which states that, “There is no hierarchy of rights in the Charter; freedom of religion and conscience, and equality rights are of equal importance.” We also acknowledge that many citizens in Ontario subscribe to a belief in secular humanism, which often demands the relegating of issues informed by religion as private matters, which ought not be expressed or acted on in the public square. We would like to remind the CPSO that the Charter itself does not mention “freedom of religion” independent of “freedom of conscience and religion”, so that the right of one’s freedom of conscience informed by a religion, a philosophical system or otherwise is crucial regardless of society’s current views regarding religion.
The current CPSO policy also states that:

The balancing of rights must be done in context. In relation to freedom of religion specifically, Courts will consider how directly the act in question interferes with a core religious belief. Courts will seek to determine whether the act interferes with the religious belief in a ‘manner that is more than trivial or insubstantial.’ The more indirect the impact on a religious belief, the more likely Courts are to find that the freedom of religion should be limited.

The CCRL submits that issues pertaining to the sanctity of life from conception until natural death are at the core of Catholic beliefs. Such beliefs are also based in reason and medical science. To the Catholic physician, this would impact the providing of prescriptions of birth control pills and abortifacients and the performing of an abortion or its procural unless the mother’s life is in imminent threat. But such understandings go beyond these areas, and touch upon all aspects of medical care, whether for the disabled, the elderly, or those with mental afflictions. We assure the CPSO that under no circumstances would any of the aforementioned practices be considered ‘trivial or insubstantial’.

Secondly, we submit that the College must ensure that a physician’s conscience rights must be observed at first instance, especially given that there are numerous procedures which may cause such physicians, religious or otherwise, difficulty, regardless of their availability under the publicly funded system. In keeping with our mandate to educate the public and defend and promote the Catholic perspective, we at the CCRL submit that a physician must have the right to carry out their duties in line with their respective consciences.

We submit that it would be offensive and a fundamental injustice 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 that would occur. We urge the College to resist any policy revision to establish the principle that people can be compelled to do what they believe to be wrong – or face the risk of sanction if they refuse. The College should avoid any suggestion that physicians be required to observe a ‘duty to do what is wrong’ in medical practice.

In referring to the ‘balancing of rights’ referred to in the above excerpt from the 2008 policy, the CCRL submits that the current policy attempts to maintain this balance outlined in the Charter rights of conscience and religion and the Ontario Human Rights Code. Using the previous listed examples of practices that would be morally objectionable to a serious Catholic physician, the number of said physicians is minute in comparison to those who would have no objection whatsoever. If a lack of balance exists, it is surely found in the vast difference between physicians who choose to conscientiously dissent versus those who do not. A member of the public in Ontario has ample resources and options available for recourse to a physician to perform publicly funded services, without violating the conscience rights of a physician who may object.

With this submission, we at the CCRL sincerely hope that the September 2008 CPSO policy regarding Physicians and the Ontario Human Rights Code is not altered in a manner that would diminish a physician’s right to freedom of conscious and religion in carrying out his or her duties according to the professional standards and guidelines of the CPSO. The medical profession, as with any grouping of individuals is not truly free to live and free to grow if its members are not able to govern their actions in accordance with their individual consciences whether informed by moral and religious beliefs or otherwise. In no way is this subtractive to the social fabric of our society, rather it greatly contributes to a true pluralist and diverse population. We should be allowed to agree or to disagree at times, always respectful of differences especially when they concern aspects of one’s moral or religious core, in no way trivial, but rather at the basis of a well-developed, civil society.

Submission to the Ontario College of Physicians and Surgeons

Action Life Ottawa

Action Life Ottawa is a non-denominational, non-profit organization dedicated to the defence of human life through education. We believe that all human beings have an equal right to life before and after birth and that society has the duty to uphold and protect that right. Our organization counts 4,000 supporters.

Concerning the consultation on freedom of conscience, Action Life holds that physicians should not be expected to refer or provide services to which the physician is opposed on conscientious or religious grounds. To force physicians to act against their conscience or religious beliefs would constitute coercion and reduces the role of the physician to that of a technician who must fulfill every patient demand. The physician is not merely a technician providing services to patients. He/she cannot be expected to leave his/her moral integrity at the door. A physician’s ethics are informed as well by medical and scientific knowledge. It is vital that a physician not be forced to refer for abortion or other procedures which the physician finds morally or ethically objectionable. Some of these procedures or services, the physician might find harmful to a patient’s health.

Consider the practice of euthanasia recently legalized in Québec, what does the future hold for physicians in Ontario regarding this practice? Many physicians would be opposed to referring or performing euthanasia if it were legalized. Freedom of conscience and religion must be respected.

Provisions in the Code should protect physicians in Ontario from coercion and discrimination. The Constitution of Canada recognizes freedom of religion and conscience and these rights are protected by the Charter of Rights and Freedoms. The policy of the Canadian Medical Association (CMA) allows physicians to opt out of referrals for abortion. The present policy of the Canadian Medical Association is clear; physicians are under no obligation to provide or refer for abortion. In fact, the CMA’s policy on induced abortion states:

“A physician whose moral or religious beliefs prevent him or her from recommending or performing an abortion should inform the patient of this so that she may consult another physician. No discrimination should be directed against doctors who do not perform or assist at induced abortions. Respect for the right of personal decision in this area must be stressed, particularly for doctors training in obstetrics and gynecology and anesthesia.”

Attacks are mounting on the conscience rights of physicians. In 2007, a letter requesting a change to the CMA referral policy on abortion was sent by The National Abortion Federation an organization representing abortion providers in the U.S. and Canada. The National Abortion Federation was seeking a policy which would force physicians to refer for abortion. It received the following response from Dr. Colin McMillan, then President of the CMA who wrote “The CMA’s policy on induced abortion does not violate our Code of Ethics…Nor does it treat women unfairly or impede their access to critical health care.”

A controversy arose in 2006 when a guest editorial by two professors, published in the Canadian Medical Association Journal of July 4, stated in relation to induced abortion that “Health care professionals who …fail to provide appropriate referrals…are committing malpractice and risk lawsuits and disciplinary proceedings.” In response, the Journal published a letter from the CMA’s Director of Ethics clarifying that the CMA policy on abortion did not require physicians to refer for abortions if doing so would be a violation of their conscience.

The Ontario Medical Association, in response to the College of Physicians and Surgeons of Ontario‘s draft policy in 2008 stated:

“It is the OMA’s position that physicians maintain a right to exercise their own moral judgment and freedom of choice in making decisions regarding medical care and that the CPSO not insert itself into the interpretation of human rights statutes.”

We would agree with the Ontario Medical Association that “…it should never be professional misconduct for an Ontario physician to act in accordance with his or her religious or moral beliefs.” Action Life calls on the College of Physicians and Surgeons to strengthen measures to ensure the right of physicians to practice medicine in accordance with their conscience or religious beliefs.

Thank you for the opportunity to comment on this issue.

Action Life Ottawa

Submission to the College of Physicians and Surgeons of Ontario

Evangelical Fellowship of Canada

Re: CPSO Policy #5-08: Physicians and the Human Rights Code

The Evangelical Fellowship of Canada (EFC) appreciates the ability to offer comments on this policy review. The EFC is a national association of denominations, ministry organizations, post-secondary educational institutions including seminaries, colleges and universities, and local churches. Some of our affiliates provide medical and health care in Canada and overseas, and many physicians are members of our affiliated denominations.

Having reviewed to policy, we note that while there is a strong emphasis on the duty not to discriminate in the provision of services, there is a lack of emphasis on the religious freedom and freedom of conscience guarantees and protections offered in Canadian law to individuals and, in this context, physicians.

We endorse the analysis and commentary in the written submission and covering letter of the Christian Medical Dental Society (CMDS) and the Canadian Federation of Catholic Physician Societies. The CMDS is an EFC affiliate, and we commend these documents to you.

Christianity has a long history of fostering and promoting medical care. It was and continues to be a distinctive of the Christian tradition, as documented by Gary Ferngren in his book Medicine and Health Care in Early Christianity (Johns Hopkins, 2009). Integrity of belief and practice is a core element of the Christian faith and respect for religious freedom is critical to the ability of individuals and groups to live out their faith in an integral way before God and in the service of others.

Evangelical Fellowship of Canada

 

Submission to the College of Physicians and Surgeons of Ontario

Christian Legal Fellowship

RE: Physicians and the Ontario Human Rights Code Consultations

The College of Physicians and Surgeons of Ontario (“CPSO”) has invited feedback from al 1 stakeholders in regard to its review of Policy Statement #5-08. Physicians and the Ontario Human Rights Code (”the Policy”). In particular, the CPSO has asked if the Policy provides useful guidance, whether the Policy fails to address any issues, and any other ways in which the Policy should be improved. The Christian Legal Fellowship (“CLF”) appreciates the opportunity to participate in this discussion, as we did in the prior CPSO consultation on Human Rights in September of 2008, and makes the following introduction and submissions.

The CLF is a national charitable association that exists to strengthen the spiritual life of its members, and encourage among Christians in the vocation of law the integration of faith with contemporary legal, moral, social and political issues. The CLF’s membership consists of approximately 550 lawyers, law students, professors, and others who support its work; with approximately one third of its members in the Province of Ontario. It has 14 chapters in cities across Canada and student chapters in most Canadian law schools. While having no direct denominational affiliation, CLF’s members represent more than 30 Christian denominations working in association together. As an association of Christian professionals, we welcome the opportunity to address the issues which the CPSO have raised in this consultation process.

The CLF has intervened in numerous legal cases relating to matters of conscience and religious freedom at the appellate and Supreme Court level. The organization also engages in policy consultations raising issues that impact, among other things, religious freedom and human rights. CLF is therefore knowledgeable and well-positioned to comment on this CPSO policy.

In reviewing the Policy, there are three broad areas of concern for CLF. First, we submit that the Policy fails to recognize that physicians have the right to freedom of religion and conscience. Second, the Policy fails to recognize that the law protects physicians with religious beliefs from engaging in activities that violate their religious beliefs, their moral beliefs and their conscience. Third, the Policy obligates physicians, in “some circumstances” to actively refer a patient for services which violate the beliefs or conscience of the physician.

(l)        Physicians have the right to freedom or religion and conscience.

In its current format, the Policy mentions “personal beliefs and values and cultural and religious practices are central to the lives of physicians and their patients”. This description fails to acknowledge the legal status of beliefs and religion. In fact, conscience and religion, thought, belief, opinion and expression are protected as fundamental freedoms by the Charter of Rights and Freedoms.1  Further, the Human Rights Code2 upon which the Policy is based, protects from discrimination on the basis of creed.3

The Policy also precludes physicians from sharing their religious beliefs with patients: “physicians should not promote their own religious beliefs when interacting with patients, nor should they seek to convert existing patients or individuals who wish to become patients to their own religion”. While this conduct may not be appropriate in all circumstances, a blanket prohibition is problematic and a clear violation of freedom of religion and expression.

Religion as a protected freedom is more than the right to privately think or believe certain ideas and principles. It is broadly defined and demands robust protection. Freedom of religion encompasses the right to entertain religious beliefs of one’s own choosing, the right to declare religious belief openly and without fear of hindrance or reprisal, the right to manifest those beliefs by worship and practice, by teaching and dissemination.4It precludes forcing an individual to act [lacuna] conscience. Under the law, physicians must be afforded the ability to align their practices with their conscience in these controversial areas and others, and that right must be made clear in the CPSO Policy.

CLF therefore urges the CPSO to modify its Policy to reflect the principles outlined above, ensuring it accurately reflects physicians’ rights pursuant to the Charter and the Human Rights Code.

Please note the endorsements that follow. CLF would be pleased to provide further assistance in any way the CPSO believes would be appropriate. Thank you for your consideration of our submissions.

Christian Legal Fellowship

Notes
1. The Constitution Act1982, Schedule B to the Canada Act 1982 (U.K.), 1982, c. 11.

2. Ontario Human Rights Code,R.S.O. 1990, e. H .19.

3. Ontario Human Rights Commission: Policy 011 Creed and the Accommodation of Religious Observances, October 20, 1996. While creed is not a defined term in the Code, the OHRC has adopted the following definition of creed in its Policy: “Creed is interpreted to mean “religious creed” or “religion.” Tt is defined as a professed system and confession of faith, including both beliefs and observances or worship. A belief in a God or gods, or a single supreme being or deity is not a requisite … The existence of religious beliefs and practices are both necessary and sufficient to the meaning of creed, if the beliefs and practices are sincerely held and/or observed. “Creed” is defined subjectively. The Code protects personal religious beliefs, practices or observances, even if they are not essential elements of tne creed provided they are sincerely held.” Policy page 4-5. ” In the case of discrimination in the workplace, both management and the union have a duty to accommodate. In Central Okanagan School District No. 23 v. Renaud the Court noted that although the principle of equal liability applies, the employer has charge of the workplace and will be in a better position to formulate measures of accommodation. The employer, therefore, can be expected to initiate the process of taking measures to accommodate an employee. Nevenhelcss, the Court also noted that they will not absolve a union of its duty if it fails to put forward alternative measures that are available. In short, when a union is a co-discriminator with an employer it shares the obligation to remove or alleviate the source of the discriminatory effect.” Policy page 9. “Conclusion: Religious pluralism poses a challenge in any multicultural society, especially one as diverse as ours. Although the law is developing rapidly in this area, an informed spirit of tolerance and compromise is indispensable to any civil society, as well as to its capacity to make opportunities available to everyone, on equal terms, regardless of creed [or other protected right].” Policy page 16. “R v. Rig M Drug Mart l 1985] I SCR 295 at336-337