Tag: referral

Project Submission to the College of Physicians and Surgeons of Saskatchewan

Re: Conscientious Objection

Abstract

Conscientious Objection is 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.

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. In the absence of such evidence, the limits proposed in Conscientious Objection are neither reasonable nor demonstrably justified.

Conscientious Objection is not justified by the principles included in the policy because there is no necessary connection between the principles and a policy requiring physicians to do what they believe to be wrong. The principles can be applied to force physicians to facilitate morally contested procedures only if they are ideologically interpreted in order to impose one world view at the expense of others. The Supreme Court of Canada has unanimously affirmed that such an approach is unacceptable.

It is unrealistic to believe that the approach taken in Conscientious Objection will not be taken with respect to physician administered euthanasia and physician assisted suicide. The disclaimer to the contrary is ill-advised and misleading. A policy on Conscientious Objection should be sufficiently flexible to apply to direct or indirect participation in killing patients or helping them commit suicide. 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.

Alternatively, if the College believes that some kind of guidance should be provided with respect to this contentious issue, the Project offers an alternative that protects physician freedom of conscience and religion but does not obstruct patient access to services, including euthanasia and assisted suicide.

Contents

I.    Introduction

II.    Overview of this submission

III.    Limitation of fundamental freedoms

IV.    “Purpose” and “Principles”

V.    Scope of Conscientious Objection

V.1    The disclaimer

V.2    Dissecting the disclaimer

V.3    Summary

V.4    Recommendations

VI.    Physician obligations

5.1    Taking on new patients (Comment)

5.2    Providing information to patients

5.3    Exercise of freedom of conscience and religion

5.4    Necessary treatments to prevent harm to patients

Appendix “A” – Conscientious Objection– “Purpose” and “Principles”: Comment and critique

A1.    Introduction

A2.    “The fiduciary relationship between a physician and a patient.”

A3.    “Patient autonomy.”

A4.    “A patient’s right to continuity of care.”
“Patients should not be disadvantaged or left without appropriate care due to the personal beliefs of their physicians.”
“Physicians have an obligation not to abandon their patients.”

A5.    “A patient’s right to information about their care.”
“Physicians have an obligation to provide full and balanced health information, referrals and health services to their patients in a non-discriminatory fashion.”

A6.    “Physicians should not intentionally or unintentionally create barriers to patient care.”
“Physicians have an obligation not to interfere with or obstruct a patient’s right to access legally permissible and publicly-funded health services.”

A7.    “The College has a responsibility to impose reasonable limits on a physician’s ability to refuse to provide care where those limits are appropriate.”

A8.    “Medical care should be equitably available to patients whatever the patient’s situation, to the extent that can be achieved.”

A9.    “The College of Physicians and Surgeons has an obligation to serve and protect the public interest.”

A10.    “The Canadian medical profession as a whole has an obligation to ensure that people have access to the provision of legally permissible and publicly-funded health services.”

A11.    “Physicians’ freedom of conscience should be respected.”

A12.    “Physicians’ exercise of freedom of conscience to limit the health services that they provide should not impede, either directly or indirectly, access to legally permissible and publicly-funded health services.”

A13.    “Physicians’ exercise of freedom of conscience to limit the services that they provide to patients should be done in a manner that respects patient dignity, facilitates access to care and protects patient safety.”

A14.    Summary

Appendix “B” – Scope of Conscientious Objection
Purported non-applicability of policy to assisted suicide, euthanasia

B1.    Disclaimer

B2.    Disclaimer inconsistent with opinion of the CMPA

B3.    Disclaimer inconsistent with policy origin, previous statements

B4.    Disclaimer inconsistent with links between abortion and euthanasia

B5.    Principles support coercion of physicians to facilitate euthanasia

B5.3    “The fiduciary relationship between a physician and a patient.”

B5.4    “Patient autonomy.”

B5.5   “A patient’s right to continuity of care.”
“Patients should not be disadvantaged or left without appropriate care due to the personal beliefs of their physicians.”
“Physicians have an obligation not to abandon their patients.”

B5.6    “Physicians should not intentionally or unintentionally create barriers to patient care.”
“Physicians have an obligation not to interfere with or obstruct a patient’s right to access legally permissible and publicly funded health services.”
“Physicians’ exercise of freedom of conscience to limit the health services that they provide should not impede, either directly or indirectly, access to legally permissible and publicly-funded health services.”

B5.7    “Medical care should be equitably available to patients whatever the patient’s situation, to the extent that can be achieved.”

B5.8    “The College has a responsibility to impose reasonable limits on a physician’s ability to refuse to provide care where those limits are appropriate.”

B5.9    “The College of Physicians and Surgeons has an obligation to serve and protect the public interest. The Canadian Medical Profession as a whole has an obligation to ensure that people have access to the provision of legally permissible and publicly-funded health services.”

B6.    Unsatisfactory reasons offered to support the disclaimer

B6.1    Questioning the reasons

B6.2    Answering the questions

Appendix “C” – Conscientious Objection – 5.  Physician Obligations
Comment and Critque

C1.    5. Obligations (Project alternative)

5.1    Taking on new patients

5.2    Providing information to patients

5.3    Exercise of freedom of conscience and religion

5.4    Necessary treatments to prevent harm to patients

C2.    Conscientious Objection and Project alternative compared

Table A. Taking on new patients

Table B.  Providing information to patients

Table C.  Exercise of freedom of conscience and religion

Table D.  Necessary treatments to prevent harm to patients

C3.    Commentary corresponding to the tables in C2

Table A  5.1 Taking on new patients

Table B  5.2 Providing information to patients

Table C  5.3 Exercise of freedom of conscience and religion

Table D  5.4 Necessary treatments to prevent harm to patients.

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 19th, 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 20th-27th 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]

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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.

Contents

I.    Revision of draft policy – Conscientious Refusal

II.    Focus of this submission

III.    Section 5.3

IV.    Section 5.3: Suggested modification

V.    Section 2: Scope

VI.    Summary

Appendix “A” – Ontario College briefing materials

Appendix “B” – Providing Information

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

Does an Illinois bill threaten doctors’ conscience rights? Depends on whom you ask

Catholic News Agency

Matt Hadro

Springfield, Ill., May 29, 2015 / 03:13 pm (CNA/EWTN News).- An Illinois bill that some say threatens the conscience rights of medical providers is currently under consideration in the state’s general assembly.

Catholics and pro-lifers are divided among themselves over the implications of SB 1564 for the conscience rights of medical providers.

While the state’s Catholic Conference is neutral on the bill, the Christian legal group Alliance Defending Freedom states that it “would force medical facilities and physicians who conscientiously object to involvement in abortions (and other procedures) to refer for, make arrangements for someone else to perform, or arrange referral information that lists willing providers, for abortions.” . . . [Full text]