Tag: Ontario

Results of the first consultation on Physicians and the Human Rights Code

Sean Murphy*

In February, 2008, the  Ontario Human Rights Commission responded to a draft policy of the College of Physicians and Surgeons of Ontario with a submission recommending that physicians “must essentially ‘check their personal views at the door’ in providing medical care.”1

The College, in response, released a draft policy, Physicians and the Ontario Human Rights Code, stating, “there will be times when it may be necessary for physicians to set aside their personal beliefs in order to ensure that patients or potential patients are provided with the medical treatment and services they require.”2

As a result of the subsequent controversy and public pressure the demand that physicians abandon their moral or religious beliefs was dropped before Physicians and the Ontario Human Rights Code was adopted. The policy was slated for review by September, 2013, but a public announcement of the review was not made until June, 2014.  The first stage of a public consultation about the policy closed on 5 August, 2014.

In December, 2014, a working group at the College released a new policy draft called Professional Obligations and Human Rights (POHR)  for a second stage of consultation ending on 20 February, 2015. The most contentious element in POHR is a requirement that physicians who object to a procedure for reasons of conscience must help the patient find a colleague who will provide it.3

According to the College, POHR takes into account feedback received during the first consultation. When the new draft policy was released in December, Dr. Marc Gabel, then President of the College, stated that “public polling” by the College had demonstrated that “the vast majority of Ontarians believe that [objecting physicians] should be required to identify another physician who will provide the treatment, and make and/or coordinate a referral.”4

The “public polling” to which Dr. Gabel referred appears to be an on-line random survey of 800 Ontario residents conducted by the College in May, 2014. The participants were randomly selected “using a Voice Response system,” and College Council was told that the results can be generalized to the online population of the province (80% of adults), with an accuracy of +3.5% and a 95% level of confidence.5 Beyond that, the College has not disclosed details of the poll that would permit an independent assessment of its validity. Particularly on such an important question, this seems inconsistent with its commitment to greater transparency.6

An analysis of consultation feedback posted on the College website produces quite a different result.

College Council was told that the consultation produced 6,710 responses7 – an “unprecedented volume.”8 However, an unknown number of respondents contributed both to the On-line Survey and Discussion Forum, so the number of unduplicated consultation responses actually available for analysis may have been far less than 6,700. Less than half that number responded to a question about the extremely contentious issue of mandatory referral, and only 50% of that group supported it.9

In any case, an overwhelming majority of responses in a Discussion Forum supported freedom of conscience for physicians, but only about 2% advocated a policy of mandatory referral. Nor were On-line Survey responses supportive of a policy of mandatory referral, suggesting, instead, that such a policy is controversial.

A detailed analysis of the results of the consultation is available here.

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Notes

1.  Submission of the Ontario Human Rights Commission to the College of Physicians and Surgeons of Ontario regarding the draft policies relating to establishing and ending physician-patient relationships. 14 February, 2008. (Accessed 2018-03-07)

2.  College of Physicians and Surgeons of Ontario, Physicians and the Ontario Human Rights Code, p. 4

3.  College of Physicians and Surgeons of Ontario, Professional Obligations and Human Rights (Draft, December, 2014)

4.  Gabel, M. “Dear Colleagues.” College of Physicians and Surgeons of Ontario, Dialogue, Vol. 10, Issue 4, 2014, p. 6. (Accessed 2018-03-07)

5.  College of Physicians and Surgeons of Ontario, Annual Meeting of Council, December 4-5, 2014, p. 330 (Accessed 2018-03-07)

6.College of Physicians and Surgeons of Ontario, Appendix 2, Transparency Principles (2013-09) Accessed 2018-03-07).

7.  College of Physicians and Surgeons of Ontario, Annual Meeting of Council, December 4-5, 2014, p. 328 (Accessed 2018-03-07)

8.  “Balancing MD and patient rights: Human rights draft policy open for consultation.”  Dialogue, Vol. 10, Issue 4, 2014, p. 49.  (Accessed 2018-03-07)

9.  3,104 responses. College of Physicians and Surgeons of Ontario, Physicians and the Ontario Human Rights Code Consultation: Online Survey Report and Analysis, Figure 4 (Accessed 2018-03-07)

Submission to the College of Physicians and Surgeons of Ontario

Re: Professional Obligations and Human Rights

Christian Medical and Dental Society

I am generally able to agree with the draft policy Physicians and the Ontario Human Rights Code. Physicians should not discriminate against their patients nor should physicians impose their religious beliefs on a patient. Patients should be adequately informed of their options for care. The majority of the policy outlines this nicely.

Despite the first part of the policy reading well, I do not believe this is a policy that should be adopted. Lines 156-168 are very concerning. All Canadians, under The Canadian Charter of Rights and Freedoms, have the right to live according to their religious and moral beliefs. Stating that a physician must refer a patient for a service that goes against his or her conscience disqualifies that right. It reduces his/her personal sense of integrity and creates internal conflict that may force very compassionate and effective physicians out of practice. It would not affect the right of the patient to receive care since a procedure such as abortion can be self-referred and, if a patient disagrees with a physician’s perspective, they are able to obtain a second opinion.

Presently, the Supreme Court of Canada is considering a case that may lead to the legalization of euthanasia in Canada. Should this happen, the draft policy could obligate physicians, who strongly feel that killing is wrong, to participate in an act of killing, i.e. euthanasia or physician assisted suicide. This is very concerning.

This past spring and summer the College conducted an online survey with the question “Do you think a physician should be allowed to refuse to provide a patient with a treatment or procedure because it conflicts with the physician’s religious or moral beliefs?”. Yes votes amounted to 25,230 or 77% of the total count. This is a large majority in favour of physicians being able to practice according to their consciences. This is a very large sample of the population (32,912) that voted. I am amazed, then, that the College should disregard this viewpoint as lines 156-168 of the draft policy indicate.

I sincerely hope that you will reconsider adoption of this policy. Revision of lines 156-168 to omit the obligation to refer for or, in certain cases, perform procedures that go against their moral or religious beliefs should be made. Anything less than that would go against The Canadian Charter of Rights and Freedoms, against the popular vote in Ontario and certainly against the well-being of many Ontario doctors.

Access – or ethical cleansing?

Sean Murphy*

Despite a warning from the Ontario Medical Association that the quality of health care will suffer if people who refuse compromise their moral or ethical beliefs are driven from medical practice,1 the College of Physicians and Surgeons of Ontario plans to introduce a policy this year that will have that effect.2 The College is concerned that too many Ontario doctors are refusing to do what they believe to be wrong.

Ontario physicians may have more to say about this, since no other profession imposes an obligation to do what one believes to be wrong as a condition of membership. Indeed, it is extremely improbable that such a requirement can be found in the constitution of any occupational or community organization in this country – or any country.

On a more practical note, if the Supreme Court of Canada decides to legalize euthanasia and physician assisted suicide, the policies on human rights and end of life care that the College plans to enact this year will require physicians to kill patients or help them commit suicide, or direct them to someone who will: in the words of the draft policy, to make “an effective referral . . . to a non-objecting, available, and accessible physician or other health-care provider.”3

An undetermined number of physicians who don’t want to kill patients or assist with suicide themselves may, in fact, be willing to do this. But many physicians will not be willing to provide “an effective referral” because, in their view, to do that is morally equivalent to doing the killing themselves. In the words of the President of Quebec’s Collège des médecins, “[I]f you have a conscientious objection and it is you who must undertake to find someone who will do it, at this time, your conscientious objection is [nullified]. It is as if you did it anyway.”4

Physicians who think like this are the targets of the policy developed by Dr. Marc Gabel and his working group at the Ontario College of Physicians. Physicians who think like this, according to Dr. Gabel, should not be in family practice. He was not, of course, talking about euthanasia or assisted suicide. He was talking about abortion.

But the issue is exactly the same. Any number of physicians may agree to referral for abortion because they believe that referral relieves them of a moral burden or of a task they find disturbing or distasteful. However, for others, as Holly Fernandez-Lynch has observed, referral imposes “the serious moral burdens of complicity.”5 They refuse to refer for abortion because they do not wish to be morally complicit in killing a child, even if (to use the terminology of the criminal law) it is, legally speaking, “a child that has not become a human being.”6

Just as some physicians believe it is wrong to facilitate killing before birth by referring patients for abortion, they and other physicians believe it is wrong to facilitate killing after birth by referring patients for euthanasia or assisted suicide. Activists like Professors Jocelyn Downie and Daniel Weinstock disagree.

Both are members of the “Conscience Research Group.”7 The Group intends to entrench in medical practice a duty to refer for or otherwise facilitate contraception, abortion and other “reproductive health” services. Both were members of an “expert panel” that recommended that health care professionals who object to killing patients should be compelled to refer patients to someone who would,8 because (they claimed) it is agreed that they can be compelled to refer for “reproductive health services.”9

From the perspective of many objecting physicians, this amounts to imposing a duty to do what they believe to be wrong. But that is just what the Conscience Research Group asserts: that the state or a profession can impose upon physicians a duty to do what they believe to be wrong – even if it is killing someone – even if they believe it to be murder. And Dr. Gabel and his working group agree.

To make that claim is extraordinary, and extraordinarily dangerous. For if the state or a profession can require me to kill someone else – even if I am convinced that doing so is murder – what can it not require?

If the College’s real goal is to ensure access to services – not to punish objecting physicians – that goal is best served by connecting patients with physicians willing to help them. If the real goal is to ensure access – not ethical cleansing – there is no reason to demand that physicians do what they believe to be wrong.

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Notes

1. Letter to the College of Physicians and Surgeons of Ontario from the Ontario Medical Association Section on General and Family Practice Re: Human Rights Code Policy, 6 August, 2014. (Accessed 2018-03-07)

2. College of Physicians and Surgeons of Ontario, “Professional Obligations and Human Rights (Draft)” (Accessed 2018-03-07)

3.  College of Physicians and Surgeons of Ontario, “Professional Obligations and Human Rights (Draft),” lines 156-160. (Accessed 2018-03-07)

4. “Parce que, si on a une objection de conscience puis c’est nous qui doive faire la démarche pour trouver la personne qui va le faire, à ce moment-là , notre objection de conscience ne s’applique plus. C’est comme si on le faisait quand meme.” Consultations & hearings on Quebec Bill 52. Tuesday 17 September 2013 – Vol. 43 no. 34. Collège des médecins du Québec: Dr. Charles Bernard, Dr. Yves Robert, Dr. Michelle Marchand, T#154

5.  Fernandez-Lynch, Holly, Conflicts of Conscience in Health Care: An Institutional Compromise. Cambridge, Mass.: The MIT Press, 2008, p. 229.

6.  Criminal Code, Section 238(1). (Accessed 2018-03-07).

7.  Let their conscience be their guide? Conscientious refusals in reproductive health care. (Accessed 2018-03-07)

8.  Schuklenk U, van Delden J.J.M, Downie J, McLean S, Upshur R, Weinstock D. Report of the Royal Society of Canada Expert Panel on End-of-Life Decision Making (November, 2011) p. 101 (Accessed 2018-03-07)

9.  Schuklenk U, van Delden J.J.M, Downie J, McLean S, Upshur R, Weinstock D. Report of the Royal Society of Canada Expert Panel on End-of-Life Decision Making (November, 2011) p. 62 (Accessed 2018-03-07)

Ethical Cleansing in Ontario

 Sean Murphy*

An Ontario College of Physicians official, Dr. Marc Gabel, says that physicians unwilling to provide or facilitate abortion for reasons of conscience should not be family physicians.1 The working group Dr. Gabel chairs wants the College to approve this policy.2 If it does, ethical cleansing of Ontario’s medical profession will begin this year, ridding it of practitioners unwilling to do what they believe to be wrong. Dr. Gabel claims that this is required by professional practice and human rights legislation.

It is not clear that the Ontario Medical Association (OMA) will agree. After all, it requires some effort to maintain that physicians are ethically or morally obligated to do what they believe to be unethical or immoral. Moreover, last August, the OMA’s General and Family Practice Section warned Dr. Gabel’s working group that the quality of medical care would suffer if only students willing to sacrifice their personal integrity were accepted in medical school. Moreover, “What about remote areas of practice?” the Section asked. “Will more prescriptive policies drive physicians to feel that they will have no choice but to practice in more urban settings?”3

In other words, is it really better that a pregnant woman in Gravel Roads Only should have no local obstetrical care rather than the help of a rural physician unwilling to recommend or refer for abortion?

The concern expressed by the OMA is understandable, but actually beside the point. In truth, concern about access to services is not really what is behind the drive for ethical cleansing. That was made abundantly clear in Ottawa last year, after it was learned that an Ottawa physician was refusing to prescribe or refer for contraceptives. The story hit the front page of the Ottawa Citizen.

The Citizen did not report the mere facts: that a young woman had to drive around the block to get The Pill. That might have been dismissed as a first world problem. No: the Citizen had more ominous news. It had discovered, lurking in the nation’s capital, not just one, but three physicians who would not prescribe or refer for contraceptives or abortion.4 There was pandemonium. An activist group began preaching a crusade against the dissenters, a vitriolic feeding frenzy erupted on Facebook,5 vehement denunciations appeared elsewhere6 and the story became the subject of a province-wide CBC broadcast.7

One of the Facebookers helpfully suggested that the objecting physicians should move elsewhere, “maybe Dubai,” where they could be among their “own kind,”8 while others raged that they had “no business practicing family medicine”9 and “[did] not deserve to practice in Canada. PERIOD.”10

To find such comments on Facebook is not surprising. But it is surprising – and regrettable – that the comments offered by Dr. Gabel reflect the same attitude.

Now, there are about 4,000 physicians practising in the Ottawa area,11 and contraceptives and abortion referrals are so widely available in the city that the Medical Officer of Health says that it is cause for celebration.12 Thus, the wildly disproportionate reaction to news that 0.08% of Ottawa area physicians do not prescribe or refer for contraceptives cannot be explained as a rational response to a problem of supply and demand.

The crusade against the three physicians, now expanded by Dr. Gabel and his working group to a crusade for the ethical cleansing of the entire medical profession, is not driven by merely practical concerns about access to services. It is driven by an a markedly intolerant ideology masquerading as enlightened objectivity.

That is why the OMA’s concern that objecting physicians might be restricted to practising in urban centres is understandable, but misplaced. Ontario physicians must come to grips with the fact that, once ethical cleansing gets underway, dissenting physicians will have no refuge in big cities, even if it takes the crusaders longer to find them there.

Nor, if assisted suicide and euthanasia are legalized, will there be refuge for physicians who don’t want to participate in killing patients. The College’s draft policy on end of life care “requires physicians to sensitively respond to a patients wishes or requests to hasten death”13 and insists that physicians who “limit their practice on the basis of moral and/or religious grounds” must comply with College policy on human rights.14 If the law is changed, and Dr. Gabel and his working group get their way, this policy will require physicians who refuse to kill patients to help them find someone who will.

Physicians will be expected to prescribe, abort or refer, to lethally inject or refer, or get out of medicine – or get out of the country.

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Notes

1. “Catholics doctors who reject abortion told to get out of family medicine.” The Catholic Register, 17 December, 2014 (Accessed 2018-03-07)

2. College of Physicians and Surgeons of Ontario, “Professional Obligations and Human Rights (Draft).” (Accessed 2018-03-07)

3. Letter to the College of Physicians and Surgeons of Ontario from the Ontario Medical Association Section on General and Family Practice Re: Human Rights Code Policy, 6 August, 2014. (Accessed 2018-03-07)

4. Payne E. “Some Ottawa doctors refuse to prescribe birth control pills.” Ottawa Citizen, 30 January, 2014 (Accessed 2018-03-07)

5. Murphy S. “NO MORE CHRISTIAN DOCTORS.” Protection of Conscience Project.

6. “Some Ottawa doctors refusing to prescribe birth control, cite ‘ethical concerns and religious values.’” Reddit Ottawa (Accessed 2018-03-07)

7. CBC Radio, “Should doctors have the right to say no to prescribing birth control?” Ontario Today, 25 February, 2014 (Accessed 2018-03-07)

8.  T___ M___, 29 January, 2014, 6:56 pm

9.  A___ M___ 29 January, 2014, 7:41 pm

10. R___ V___, 29 January, 2014, 7:52 pm

11. College of Physicians and Surgeons of Ontario, All Doctor Search (Accessed 2014-07-29;2018-03-07)

12.  Levy I. (Medical Officer of Health, Ottawa) and Abdullah A. (President, Academy of Medicine, Ottawa), Letter to the Ottawa Citizen, 1 February, 2014.

13.  College of Physicians and Surgeons of Ontario, Planning for and Providing Quality End of Life Care: Key Features of the Draft Policy (Accessed 2018-03-07)

14. College of Physicians and Surgeons of Ontario, Planning for and Providing Quality End of Life Care (Draft), lines 363-365. (Accessed 2018-03-07)

College of Physicians, please stand up for religious minorities

ProWomanProLife

Reproduced with permission

Faye Sonier

*Dr. Gabel is Member of Council and Past President of the College of Physicians and Surgeons of Ontario. He is the chair of the College’s policy working group which issued the draft “Professional Obligations and Human Rights” policy.

Dear Dr. Marc Gabel,

I just read this article which was published in the Catholic  Register. You were quoted in the piece. Here is an excerpt:

Catholic doctors who won’t perform abortions or provide abortion referrals should leave family medicine, says an official of the College of Physicians and Surgeons of Ontario.

“It may well be that you would have to think about whether you can practice family medicine as it is defined in Canada and in most of the Western countries,” said Dr. Marc Gabel, chair of the college’s policy working group reviewing “Professional Obligations and Human Rights.”

The Ontario doctor’s organization released a draft policy Dec. 11 that would require all doctors to provide referrals for abortions, morning-after pills and contraception. The revised policy is in response to evolving obligations under the Ontario Human Rights Code, Gabel said.

There have been no Ontario Human Rights Tribunal decisions against doctors for failing to refer for abortion or contraception.

Gabel said there’s plenty of room for conscientious Catholics in various medical specialties, but a moral objection to abortion and contraception will put family doctors on the wrong side of human rights legislation and current professional practice.

“Medicine is an amazingly wide profession with many, many areas to practice medicine,” he said.

Yes, medicine is “an amazingly wide profession.” Thankfully, it is also a profession which attracts an “amazingly wide” array of Canadians. Of those Canadian physicians are some who share my pro-life perspective. They may refuse to refer for abortion due to their conscience, but they may also refuse to refer due to their religious beliefs (or both – we’re working out what this means under the Charter). They may be Christian, Muslim, Jewish or atheist physicians but they have an issue with abortion or contraceptives. For them, to refer for this procedure or these drugs is to be complicit in the actions and their consequences.

I am an Ontario resident. I’m a cancer survivor. I’m a mother.  I have spent far more than my fair share of time in Ontario hospitals and clinics being treated by wonderful Ontario doctors.

Over the last few years, I’ve gone out of my way to work with pro-life physicians who share my perspective. I reject the notion that killing and dismembering unborn children is medicine, and I wanted to work with physicians who share my values regarding human life and human dignity.  Due to the “amazingly wide” practice of medicine in Ontario, I was able to find a few, and become their patient. I am so thankful for their care.

But due to your working group’s proposed new policy, I might lose my family physicians. They will choose to practice medicine in a province that respects both their skills and their rights, rather than sacrifice their conscience or their sincerely held religious beliefs.

I’m also a human rights lawyer. The College’s reasoning for stripping physicians of their conscience and religious rights is not based on law. Your working group received a number of submissions on that point, so I’ll leave you to review them with your legal counsel. The doctors seeking to exercise their freedoms have a leg to stand on. Heck, they have Canadian and Ontario human rights law on their side.

Of great concern to me is the definition of “discrimination” which you provided when interviewed:

“We’re saying that the discrimination occurs when you are not acting in the best interest of the patient,” said Gabel. “When you are not communicating effectively or respectfully about this with the patient, when you’re not managing conflicts, when you differ from the patient and when you are not respecting the patient’s dignity and ensuring their access to care and protecting their safety. That’s the issue.”

Dr. Gabel, this is not the definition of “discrimination” at law. If someone chooses to make up definitions for words, they are free to do so. (My son, for example, seems to think that “babagaba” is a verb which means “to chew on mommy’s ankle.”)

However, for a body like the College of Physicians and Surgeons of Ontario to create a new definition of “discrimination” which will result in the stripping of legal and human rights of some of their members is shocking, and this new definition will not stand up in a court of law. I urge the College to abide by Canadian and Ontario law.

Dr. Gabel, I suspect you are well intentioned and a kind and caring psychotherapist, like so many of the wonderful doctors who have treated me over the years. But please don’t force my physicians from the province with your policy. My family depends on their expertise and professionalism. I like to see my own values reflected in the “amazingly wide” practice of medicine in Ontario. For someone like myself, a religious minority, this is very important.

The membership of your College is broad and wide enough to include some family physicians who happen to hold pro-life positions. If it is not, it should be.

Sincerely,

Faye Sonier