Project Submission to the College of Physicians and Surgeons of Saskatchewan

Re: Conscientious Refusal (as revised)

5 June, 2015

Abstract

Council has been given no evidence that anyone in Saskatchewan has ever been unable to access medical services or that the health of anyone in Saskatchewan has ever been adversely affected because a physician has declined to provide or refer for a procedure for reasons of conscience.

The conclusion that objecting physicians “should not be obligated to provide a referral to a physician who will ultimately potentially provide the service” is entirely satisfactory. It is a tacit admission that such a policy would be an unacceptable assault on freedom of conscience.

Conscientious Refusal as revised attempts to nullify the alleged ‘bias’ of physicians who object to a procedure for reasons of conscience by requiring them to refer patients to a non-objecting colleague. This proposal is not sound, since, if it is to be applied fairly and consistently, the ‘bias’ of physicians who do not object to a procedure should be nullified in the same way. This would simply exchange one kind of alleged ‘bias’ for another, inconvenience patients and provide them with no better care.

The more sensible course is to require all physicians to provide patients with sufficient information to satisfy the requirements of informed medical decision making.  Physicians must advise patients at the earliest reasonable opportunity of services or procedures they decline to recommend or provide for reasons of conscience, advise affected patients that they may seek the services elsewhere, and ensure that they have sufficient information to approach other physicians, heath care workers or community organizations.  They must not promote their own moral or religious beliefs when interacting with a patient.

Physicians unwilling to abide by these requirements must promptly arrange for a patient to be seen by another physician or health care worker who is able to do so.

If the College is determined to enact a policy on conscientious refusal, it should ensure that the policy adopted is sufficiently flexible to accommodate physicians with respect to all procedures or services. Otherwise, Council should reject Conscientious Refusal as revised and postpone policy development until after the Carter decision comes into force in 2016.

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Contents

I.    Revision of draft policy – Conscientious Refusal

II.    Focus of this submission

III.    Section 5.3

• III.1    Deletion of requirement to refer for a morally contested service
• III.2    Imposition of requirement to refer patients for information

IV.    Section 5.3: Suggested modification

V.    Section 2: Scope

• V.1    Purported non-applicability of policy to assisted suicide and euthanasia
• V.2    Disclaimer inconsistent with origin of policy and previous statements
• V.3    Disclaimer inconsistent with association of abortion/birth control and euthanasia/assisted suicide
• V.4    Dissecting the disclaimer
• V.5    Explaining the disclaimer
• V.6    Disposing of the disclaimer

VI.    Summary

Appendix “A” – Ontario College briefing materials

• A1.    Introduction
• A2.    Citation of Conscientious Refusal (CR No.1)
• A3.    Reasonable apprehension of bias
• A4.    Tunnel Vision at the College of Physicians

Appendix “B” – Providing Information

• Introduction
• Clarifications
  • Sufficient information
  • Relevant options
  • Disclosure
  • Advance notice
  • Respectful/non-demeaning communication

Appendix “C” – Conscientious Refusal and assisted suicide/euthanasia

• C1.      Introduction
• C.2      Euthanasia/assisted suicide supported by principles
  • C2.2    Fiduciary duty
  • C2.3    Patient autonomy
  • C2.4    Continuity of care/ left without appropriate care
  • C2.5    Intentional or unintentional barriers to care/disadvantage/equitable access
  • C2.6    Reasonable limits