Category: Ethics

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

ARPA- Association for Reformed Political Action (Canada)

On Tuesday, August 5, ARPA’s legal counsel sent a formal submission to the College of Physicians and Surgeons of Ontario with respect to their policy as it relates to conscience rights and the Ontario Human Rights Code. The College had requested feedback as it underwent consultations while reviewing their policy. At stake is whether doctors have the right  to refuse treatment if they have conscientious objections to the treatment. For example, can a Christian doctor refuse to prescribe birth control pills if that particular doctor thinks that such a prescription is unethical, or is bad medicine? What if the objection is religiously motivated? These are not just hypothetical questions: three doctors in Ottawa recently came under fire for refusing to prescribe the birth control pill. . .  [Full text and submission]

 

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

General Practice Section, Ontario Medical Association

Re: Human Rights Code Policy

Dear College of Physicians and Surgeons of Ontario,

The Section on General and Family Practice appreciates the opportunity to provide  comment on the College’s Physicians and the Ontario Human Rights Code policy that is currently being reviewed.

This policy provides important guidance to physicians on sensitive matters and has generated a great deal of interest and discussion amongst our members since it has come up for review. Overall, the Section feels that the policy in its current form seems to strike a reasonable balance between the moral and religious beliefs of physicians and the legal obligations and professional expectations related to the medical services they provide and has served the profession well since it was approved in 2008.

Essentially, the Section feels that we as physicians are professionals. We communicate with our patients on the complex issues they bring to us and we use our best judgement in making decisions around care together with our patients. The system and communities that we work in have well established networks with our other provider colleagues that enable us to provide the care our patients require when that need falls outside of our ability to provide that care as individual physicians.

Since this policy has come up for review, there have been significant concerns raised amongst our members that tighter guidelines will be placed upon physicians requiring them to provide types of care that conflict with their own personal morals and beliefs. This has led to a number of concerns being raised as to the possible outcomes related to any potential changes to this policy that would be more onerous on physicians. Questions that have come to our attention from our members include the following.

  • Are we slowly heading to a system where individuals looking to enter the medical profession will be required to leave their moral and religious beliefs behind when they accept entry?
  • What about more remote areas of practice? Will more prescriptive policies drive physicians to feel that they will have no choice but to practice in more urban settings?
  • What happens if a physician becomes fearful for safety in their office due to the extreme nature of a particular patient’s behaviour or uncomfortable with a patient who refuses to respect the rules of a physician’s office that may or may not be related to an underlying medical condition? Will the physician lose the ability to end the doctor-patient relationship?
  • Will a stricter policy make it more difficult to manage inappropriate patient demands such as those for narcotic pain medications as it may be construed by some patients as a denial based on discrimination.

College policies can have far-reaching impact above and beyond regulation of physicians in practice. As such, they need to be carefully thought out. A more strict approach to Physicians and the Human Rights Code could lead to situations where well qualified students are, in a sense, denied entry into medical school because of a potential inability to honour their personal, socially accepted religious beliefs due to patient demand. The Section believes it is important to ensure that the public continues to have access to care from the best and brightest minds and we are concerned that quality could suffer if we only accept medical students who are willing to compromise their personal values. At the same time, the Section is well aware of recent items in the media that might compel the College to consider changes to the current policy that would place more onerous expectations upon physicians to personally provide any and all treatment even when it is in direct conflict with their own personal morals and beliefs. However, the Section is not aware that there has been a pattern of complaints that relate to this matter that would document a more significant underlying or systemic problem in this area. As such, it would seem that the policy in its current form is adequate.

An area that was identified as a potential area to be improved upon is in regards to the definition of “disability” within the context of this policy. Mental illness has been raised as an example of a medical condition or disability that has a wide range of expression. It is felt that there may be some room to better define disability or provide some guidance to allow for the use of professional judgement when it comes to disability and a physician’s ability to safely and appropriately provide care in their work environment.

Finally, a significant area for consideration has been raised about the importance of having clarity in regards to complaints being dealt with through the Ontario Human Rights Commission and the role of the College. Physicians are always exposed to the risk that the decisions they make will be challenged by a complaint to the OHRC. If there is a complaint against a physician to the OHRC, this should be allowed to run its course without necessitating involvement of the College. The College should not become involved in additional areas outside of its jurisdiction. For complaints that come to both the OHRC and the College, the College policy should clarify when the College steps aside and waits to assess whether issues of professional conduct remain after the OHRC has made its decision.

The Section feels that the policy in its current form seems to give appropriate guidance to physicians in regards to our legal obligations and our professional expectations but also does not place physicians in an unreasonable position of being forced to provide certain care if it conflicts with their own moral and religious beliefs. The ability for physicians to say “no” without retribution must be preserved as long as those decisions are not based on discrimination. In the rare instance that an individual physician’s professional conduct is felt to clearly fall outside of what is deemed to be reasonable, then the policy in its current form has sufficient substance to be able to deal with those individual situations.

The Section understands that this request for feedback is a preliminary consultation that is meant to assist the College as it begins its work to update this policy so we look forward to the opportunity to review the outcome of this work and once again provide input when it is recirculated for further comment.

General Practice Section
Ontario Medical Association

Ethics should colour doctor’s decisions

Wrong to ask MDs to leave their values at their exam room doors

Hamilton Spectator

Reproduced with permission

Lea Singh

In a recent column, Martin Regg Cohn throws spears in all directions as he attacks doctors who refuse to prescribe or refer for birth control pills. Cohn wants the College of Physicians and Surgeons of Ontario, which is reviewing its human rights guidelines, to clamp down on these doctors and force them to participate in treatments they consider unethical or risk losing their jobs.

First off, Cohn rejects the possibility that there could be sound medical judgment behind the decision not to prescribe birth control pills. He is wrong; birth control is not Tylenol. Popular pain relievers are very safe when used according to directions; their main danger comes from accidental overdose.

In contrast, a regular “safe” daily dose of birth control pills will nearly triple a woman’s risk of deadly blood clots, and newer pills like Yasmin further double or triple that risk. Last year, Yasmin was linked to the deaths of 23 Canadian women. This year, a major French report revealed that blood clots caused by birth control pills have killed about 20 French women per year since 2000. Many women who survived their blood clots have been left paralyzed, blind and otherwise disabled.

Yes, pregnancy also increases blood clot risks. Blood clots kill more pregnant women than any other cause in the developed world. But pregnancy only lasts nine months, while many women are on the pill for years or even decades, often with little monitoring.

And what about the fact that the World Health Organization has classified birth control pills as “carcinogenic to humans?” The WHO is hardly trying to promote a religious agenda, but in a 500-page report it found “sufficient evidence” that birth control pills increased the risk of breast cancer and cancers of the cervix and liver.

But medical judgment aside, should doctors have the right to opt out of treatments they believe to be deeply unethical? Cohn argues that doctors should leave their religious values and personal ethics out of their workplace.

This is a new and dangerously totalitarian way of thinking. In the past, we have always respected every person’s right to live according to their own moral and religious precepts. This is why our Charter says that “Everyone has the following fundamental freedoms: (a) freedom of conscience and religion.”

Living out our values is the essence of true freedom. In dictatorships, everyone is still free to think, but they cannot act on their beliefs. In democracies like Canada, citizens have the right to conform their actions to their deepest values.

Cohn would take away this Charter protection from doctors, to save patients from the inconvenience and annoyance of having to go elsewhere. But is minor inconvenience really too high a price to pay for the fundamental freedom of our doctors, or any citizens? Ontario patients have plenty of alternative venues from which to get their prescriptions, such as public health clinics and emergency rooms. Abortions don’t even need a referral in Ontario.

If the medical profession is different from other professions, it is because ethics are so much more important in the field of medicine. Doctors hold our health and our lives in their hands. For centuries, we have insisted that doctors promise to do no harm, because we know that internal ethical limits make doctors far more responsible in the use of their medical powers. If doctors become mere machines that take orders without question, patients will ultimately be far less safe.

How can we trust doctors who leave their personal ethical limits at the door of their workplace? To really undermine confidence in our health care system, populate it with morally schizophrenic doctors who won’t mind performing procedures they admit are deeply unethical.

The law is too rough, corruptible and imperfect to prevent doctors from playing God. What will hold back doctors if the law permits any unethical procedures? Is it wise to place all our faith in regulations as our only safeguard when the scalpel looms over us?

We will reap what we sow. Perhaps we have truly become so dogmatic that we can no longer tolerate any dissent from the mantra of reproductive and sexual rights, and freedom is the next casualty. But freedom is a mighty tree that should not be cut down lightly. Our pluralist, democratic society lives in its branches, and the aftershocks of such a fall will be felt by all of us.

Lea Singh is a blogger, writer and lawyer who resides in Ottawa. Her blog is at http://leazsingh.blogspot.ca/.