Category: Ethical Commentary

I was told to approve a lethal injection, but it violates my basic medical ethics

We risk botched executions so long as they are conducted in a scientific vacuum and medical professionals operate devoid of any moral compass

The Guardian

Marc Stern

I peered through the small window of an otherwise solid steel door of the isolation wing of the prison, and saw a small man on his knees in front of his steel framed bed. He had committed many murders and was sentenced to life without the possibility of parole. Perhaps he was praying. Perhaps he was looking for a pencil. But that’s when it struck me: There might be a punishment worse than execution.

Other than a maximum of one hour per day when he could be escorted to a recreational cage outdoors, he would spend the next 10, 20, perhaps 30 years of his life in this very room – eight feet by 10 feet. He would have little contact with other human beings aside from officers and medical professionals. Forging a new friendship or hugging a loved one, if possible at all, would be rare, supervised and not likely spontaneous. His life would be restricted to the same 80 square feet – forever. . . [Full Text]

 

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

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]