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Canadian Medical Association plans for physician assisted suicide, euthanasia

Commentary on draft framework (August, 2015)

Sean Murphy*

Abstract

The Canadian Medical Association (CMA) draft framework, Principles Based Approach to Assisted Dying in Canada presumes that physicians have an obligation to kill patients or help them commit suicide in the circumstances described by the Supreme Court of Canada in Carter v. Canada. It claims that objecting physicians are obliged to support physicians who do so, and to facilitate their work. By presuming these contested obligations as normative, the framework imposes a structure for response and discussion that is prejudicial to objecting physicians.

CMA officials define “participation” in the draft framework to mean only providing a lethal injection or writing a lethal prescription, although this is not stated in the document. Referral is not counted as “participation,” and the draft framework appears to reflect the view that referral is the preferred method for reconciling conflicts between patients seeking euthanasia or assisted suicide and physicians unwilling to be involved with homicide or suicide. This introduces a fundamental structural bias in framing the CMA approach to accommodating freedom of conscience and religion.

The bias in favour of mandatory referral becomes particularly evident in Schedule B, which considers only compulsory referral as a means of reconciling freedom of conscience and access to services. Further, the structural bias is reflected and reinforced by numerous erroneous and substantially misleading statements.

What support might be offered to physicians unwilling to provide or facilitate euthanasia and assisted suicide is conditional upon their referring the patient to a third party, but the formulation in the draft framework is insufficiently clear and has been compromised by revisions to fundamental principles. An acceptable policy will not require objecting physicians to become part of a chain of causation culminating in a morally contested procedure.

Despite the bias apparent in the draft framework, it should be possible to reconcile respect for the fundamental freedoms of physicians and demands for access to morally contested services. This can be done within the framework proposed by the CMA in the manner suggested in this commentary..

Project to Saskatchewan regulator: no evidence to support limitation of fundamental freedoms

Draft policy attacks character, competence of physicians

News Release

Protection of Conscience Project

Project to Saskatchewan regulator: no evidence to support limitation of fundamental freedoms For the third time this year, the Protection of Conscience Project has criticized a draft policy proposed by officials of the College of Physicians and Surgeons of Saskatchewan who want to control the exercise of freedom of conscience and religion by physicians. The draft policy, Conscientious Objection, was approved in principle by the College Council on 19 June and released for a public consultation that ended on 7 August.

Citing Section 1 of the Canadian Charter of Rights and Freedoms, the Project states that “the limits proposed in Conscientious Objection are neither reasonable nor demonstrably justified” because the College had no evidence that conscientious objection by Saskatchewan physicians has ever deprived anyone of access medical services or adversely affected anyone’s health.

The Project submission calls Conscientious Objection unacceptable “because it attacks the character and competence of objecting physicians, and it nullifies their freedom of conscience by compelling them to arrange for patients to obtain services to which they object.”

This has become of particular concern because physician assisted suicide and physician administered euthanasia will be legal in Canada in February of next year. The draft policy states that it does not apply to those services, but the Project submission rejects that disclaimer, calling it “ill-advised and misleading.”

Among other things, the Project points out that, even after the Supreme Court of Canada ordered the legalization of physician assisted suicide and euthanasia, the College’s Associate Registrar “defended the proposition that physicians should be disciplined or fired if they refuse to at least help to find someone willing to kill patients or help them commit suicide.”

The disclaimer was added only after it became clear that the policy faced overwhelming opposition, either as a tactic to secure the approval of the policy, or because some of its supporters began to realize the policy’s implications.

The submission warns the College that a policy on conscientious objection should be flexible enough to apply to requests for assisted suicide and euthanasia.

” If Council is uncertain how this can be done, it should postpone policy development concerning Conscientious Objection until after the Carter decision comes into force in 2016.”

The Project also strongly criticizes the policy because it suggests that physicians who refuse to do what they believe to be wrong cannot be trusted.

“Solely on the basis of their beliefs,” the submission notes, “it implies that they are unacceptably biased and effectively prohibits objecting physicians from communicating with their patients about morally contested procedures.”

Instead, the policy demands that they refer their patients to someone who can provide “full and balanced health information,” apparently assuming that physicians who have moral viewpoints are incapable of properly communicating with patients.

“But all physicians have moral viewpoints,” the Project reminds the College. “Conscientious Objection simply exchanges one kind of ‘bias’ for another.”

The Project submission includes an alternative policy that protects physician freedom of conscience and religion but does not obstruct patient access to services, including euthanasia and assisted suicide. The alternative draws on the CPSS draft policy, the Canadian Medical Association Code of Ethics, and a joint statement by the Canadian Medical Association, Canadian Healthcare Association, Canadian Nurses’ Association, and Catholic Health Association of Canada.

The proposed CPSS policy has also been criticized by the Christian Medical and Dental Societies, the Federation of Catholic Physicians Societies of Canada and Canadian Physicians for Life. Their joint submission states that Conscientious Objection “does not adequately deal with physicians’ human rights” and “does not accurately reflect the law.”

Lack of Conscientious Objection Clause for Medical Staff in Sweden

Decision of the European Committee of Social Rights

News Release

European Federation of Catholic Family Associations (FAFCE)

Contrary to Resolution 1763 adopted by the Parliamentary Assembly of the Council of Europe (PACE) on 10 October 2011, Medical Staff in Sweden have no legal right to conscientious objection in case of ethically sensitive issues which occur particularly at the beginning and the end of life. The European Federation of Catholic Family Associations (FAFCE) which has a participatory status with the Council of Europe submitted a collective complaint against Sweden in 2013 based on the above grounds and the right to health, together with the Swedish organisations Provita and Christian Medical Doctors and Students (KLM). The decision of the European Committee of Social Rights was made public today.

One of the issues addressed in the Collective Complaint against Sweden was freedom of conscience for medical staff. In its response to the Complaint the Swedish Government argued that freedom of conscience should be discussed in the work place and that if the issue can’t be resolved in a satisfactory manner for the employee, it can be brought before Court, based on article 9 of the European Convention on Human Rights which is incorporated into the Swedish law and on the grounds of the anti-discrimination law for the individual. The right to freedom of conscience is enshrined in article 18 of the Universal Declaration of Human Rights and in article 9 of the European Convention on Human Rights.

In its response the Government also notes that contacts have been established with the concerned employers and workers union: none of these could provide examples of situations where freedom of conscience had been problematic. Thus the Government considers that the problem is purely theoretical.

”It is of course very noteworthy that the Government stated that denied freedom of conscience only is a theoretical problem in its response to the European Social Rights Committee. In a recent complaint to the United Nations Swedish by European Centre for Law and Justice, medical staff – four midwifes, three general practioners and two pediatricians – testify of how the negative attitude towards freedom of conscience has limited them and their colleagues in their professional practice”, says Mrs Nordström, CEO or Provita and President of Scandianvian Human Rights Lawyers, and the legal representative of a Swedish midwife, Ellinor Grimmark, in an ongoing courtcase about freedom of conscience in Sweden. Mrs Grimmark lost her job and was refused employment due to her refusal to perform abortions as part of her tasks as a midwife at several Swedish hospitals. – “This is a concrete case that proves that freedom of conscience for medical staff is all but a theoretical problem in Sweden”, says Ruth Nordström.

In its decision the European Committee of Social Rights states that it has previously, in a Collective Complaint against Italy, considered whether freedom of conscience in accordance with article 11 of the European Social Rights Charter affects women’s access to abortion in Italy (International Planned Parenthood Federation vs. Italy (Complaint 87/2012)).

”The Committee establishes that article 11 is not applicable in this case, where the situation is the opposite, i.e. where women’s access to abortion is not affected. Since article 11 is not applicable the Committee does not take a position regarding the issue of discrimination according to article E in the European Social Rights Charter.” says Ruth Nordström.

The Swedish Federation of Medical Doctors (Läkarförbundet) and the Swedish Federation of Medical Staff (Vårdförbundet) together with the Swedish Planned Parenthood Federation (RFSU) recently claimed that ”conscience clauses threaten free abortion”. In other words the official representative bodies of medical staff in Sweden consider access to abortion as superior to freedom of conscience. FAFCE’s President Antoine Renard remarks that “this statement is a stark contrast to the position recently expressed in another Council of Europe Member State, namely France where The National Council of the Order of Medical Doctors publically opposes the suppression of the conscience clause related to abortion and “recalls that it is a fundamental provision foreseen by the medical deontological statute-book and by the public health law.”

Furthermore, the Committee considers that it cannot be proven that the number of abortions in Sweden is considerably high or that these abortions are a result of insufficient access to preventive measures.

FAFCE’s Secretary General Maria Hildingsson underlines that ”Sweden has among the highest abortion rates in Europe, year after year, statistics show this trend very clearly.” She considers that “it is regrettable that the European Committee of Social Rights does not take a clear stance in favour of stronger legal protection regarding the ethical issues addressed in the Complaint.”

Regarding sex selective abortions in Sweden, another issue reported in the Complaint and the treatment of infants surviving late term abortions the Committee states in its decision ”that FAFCE’s complaints relate to an issue which is very sensitive for many of the State Parties to the Charter, i.e. the question of when human life begins, which depends on the wide diversity of values and traditions in the different states.”. The Committee pursues by saying that “States Parties enjoy a wide margin of appreciation in deciding when life begins and it is therefore for each State Party to determine, within this margin of appreciation, the extent to which a foetus has a right to health.”

“The issue of infants surviving late term abortion has caught considerable attention across Europe during the recent months, namely in connection with a petition signed by over 200 000 citizens which will be debated in the Legal Affairs and Human Rights Committee of the PACE next week” underlines FAFCE’s President Antoine Renard.

“It is astonishing that the Committee argues that Member States should decide when life begins. It is an undisputed biological fact that life begins at conception. What the committee is likely to mean is when the unborn life should be protected and granted human dignity. This wording can hardly be due to ignorance, but rather it is a rhetorical approach that’s both tendentious and cynically” says Tomas Seidal, Vice President of KLM.

”The issue of abortion has been, is and will remain controversial for us who work in medical care, since it is a unique intervention with the consequence of putting an end to a human life. We also consider that the issue becomes particularly complicated when the unborn child is the object of medical care in other circumstances, and as such a patient with the right to life and health care. If it collides with a strongly established conviction and belief against extinguishing a life at its beginning, there must be room for conscientious freedom” says Tomas Seidal.

Contact:

Maria Hildingsson, Secretary General, European Federation of Catholic Family Associations (FAFCE)
+32 4 70 20 39 18
m.hildingsson@fafce.org

Ruth Nordström, President, Provita
+46 70 725 1917
ruth.nordstrom@provitasweden.org

Tomas Seidal, Vice-President, Christian Medical Doctors and Students (KLM)
ht.seidal@gmail.com

Founded in 1997 the European Federation of Catholic Family Associations (FAFCE) holds a participatory status with the Council of Europe, is a member of the EU Fundamental Rights Agency Platform, and represents family associations from 15 European countries.

Sask MDs, doctors’ groups ask for a hearing by College of Physicians and Surgeons

News Release

Christian Medical and Dental Society of Canada

SASKATOON, June 17, 2015 /CNW/ – Larry Worthen, Executive Director of the Christian Medical and Dental Society of Canada (CMDS), urged the College of Physicians and Surgeons of Saskatchewan (CPSS), today, to support freedom of conscience when they meet on Friday, June 19^th, to consider a policy on conscientious objection. CMDS and other doctors’ groups are asking for a meeting with the College’s drafting committee to express their concerns.

Said Larry Worthen, “To ask physicians to act against deeply held moral convictions would be a clear infringement on physicians’ rights to the Section 2 fundamental freedoms of conscience and religion guaranteed by the Canadian Charter of Rights and Freedoms. The College’s Associate Registrar Brian Salte has ties to the Conscience Research Project led by one of Canada’s leading proponents of abortion, assisted suicide and euthanasia, and Mr. Salte has attended briefings of that group. We ask that the College would give us equal time to present our side of the argument and hear concerns about how this policy will affect patient care in Saskatchewan.”

Previous CPSS policy drafts required that physicians refer patients for procedures even when performing such procedures went against the moral convictions of the physician. Under the drafts, physicians would even be forced to actually perform procedures even though to do so would go against strongly held moral and religious convictions. Physicians who refused to comply would be vulnerable to sanctions up to and including losing their licences.

“No one’s interests are served by effectively disqualifying certain Saskatchewan physicians from the practice of medicine,” said Worthen.

Roman Catholic and evangelical Protestant physicians hold grave concerns about the negative effects when they are forced to act against their consciences.

“Going against one’s conscience can cause moral distress which has been shown to affect patient care adversely. We need to have physicians who are free to bring their whole selves to their patients, including their compassion and their ethics,” said Mary Deutscher, member of the Roman Catholic Diocese of Saskatoon Justice and Peace Commission. “For Catholic physicians, participation in a formal referral makes them an accomplice in the procedure. This position is supported by many evangelical Protestant experts and other groups as well.”

This is also reflected in the positions of CMDS, Canadian Physicians for Life (CPL) and the Canadian Federation of Catholic Physicians’ Societies (CFCPS).

“Should the College choose to adopt this policy, it would assume the role of judge and jury deciding who could or could not exercise their constitutionally protected rights,” said Faye Sonier, CPL’s General Legal Counsel. “Physicians who cannot perform certain procedures due to their beliefs would become a class of citizens who fall outside the protection of the Canadian Charter of Rights and Freedoms.”

“Physicians who hold conscientious objections do so with profound respect for both the well-being and the autonomy of their patients. Their conscientious objections also stem from a deep commitment to the Hippocratic Oath,” said Dr. Thomas Bouchard, M.D., of the CFCPS. “In debates about conscience rights, the debate is often framed as a competition between the rights of a patient to access services versus the conscience of a physician. But physicians in these circumstances do not care solely about their conscience rights. These physicians also care deeply about the good of their patients.”

Self-referral is already a commonly exercised option among patients, including in respect of abortion services, across most of Saskatchewan. Self-referral allows the doctor to avoid being involved in facilitating the provision of the service, and the patient gets prompt access to the service.

A public opinion survey conducted May 20^th-27^th by Abingdon Research indicated that when a patient and doctor have different views on best treatment because of the doctor’s moral convictions, 47.5% of the Saskatchewan public felt that a patient could seek further advice or help from a different doctor without a formal referral, compared with 44.1% who felt the doctor should provide a formal referral. More than 53% of Saskatchewan residents felt that “nothing should happen to the doctor” who was unwilling to provide a treatment or a referral for reasons of moral conviction.

“Doctors represented by our groups are willing to discuss all procedures with their patients in a caring and objective way. We simply ask that when the patient makes a decision that the doctor cannot support for moral reasons that the patient access another service provider directly,” added Dr. Sheila Harding, M.D., a Saskatoon haematologist. “I have heard of many cases where doctor and patient agree to disagree and the patient returns to the physician’s practice after the procedure. If anything, the physician-patient relationship was enhanced.”

CMDS (Christian Medical and Dental Society) represents some 1600 physicians and dentists across Canada (cmdscanada.org). The Canadian Federation of Catholic Physicians’ Societies (canadiancatholicphysicians.com) represents groups from across Canada. Canadian Physicians for Life (physiciansforlife.ca is the national association of pro-life physicians and provides resources and educational opportunities to thousands of physicians and medical students each year.

SOURCE Christian Medical and Dental Society of Canada

For further information: Larry Worthen at 902-880-2495. Larry is available for interviews in Saskatoon after 10:00 a.m., Wednesday, June 17th, until Noon, Saturday, June 20th.

Conscientious objection policy rasies thorny issues for Sask. doctors

Saskatoon Star Phoenix

Jonathon Charlton

A draft policy under review by the College of Physicians and Surgeons of Saskatchewan does not require doctors who refuse to perform an abortion to refer patients to one who will.

Associate registrar Bryan Salte declined to comment on specifics in the draft, noting they could change. The CPSS committee working on the policy was set to review it further Friday, and it will go to the full CPSS council for formal approval in principle June 19. . . [Full text]

Category: News

Canadian Medical Association plans for physician assisted suicide, euthanasia

Commentary on draft framework (August, 2015)

Abstract

Table of Contents

I. Introduction

III. Principles Based Approach to Assisted Dying in Canada

IV. Schedule A: Draft Principles-Based Recommendations

V. Schedule B: Legislative Criteria Across Jurisdictions

VI. Project Summary