Tag: Ontario

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]

 

Submission to the College of Physicians and Surgeons of Ontario

Evangelical Fellowship of Canada

Re: CPSO Policy #5-08: Physicians and the Human Rights Code

The Evangelical Fellowship of Canada (EFC) appreciates the ability to offer comments on this policy review. The EFC is a national association of denominations, ministry organizations, post-secondary educational institutions including seminaries, colleges and universities, and local churches. Some of our affiliates provide medical and health care in Canada and overseas, and many physicians are members of our affiliated denominations.

Having reviewed to policy, we note that while there is a strong emphasis on the duty not to discriminate in the provision of services, there is a lack of emphasis on the religious freedom and freedom of conscience guarantees and protections offered in Canadian law to individuals and, in this context, physicians.

We endorse the analysis and commentary in the written submission and covering letter of the Christian Medical Dental Society (CMDS) and the Canadian Federation of Catholic Physician Societies. The CMDS is an EFC affiliate, and we commend these documents to you.

Christianity has a long history of fostering and promoting medical care. It was and continues to be a distinctive of the Christian tradition, as documented by Gary Ferngren in his book Medicine and Health Care in Early Christianity (Johns Hopkins, 2009). Integrity of belief and practice is a core element of the Christian faith and respect for religious freedom is critical to the ability of individuals and groups to live out their faith in an integral way before God and in the service of others.

Evangelical Fellowship of Canada

 

Submission to the College of Physicians and Surgeons of Ontario

General Practice Section, Ontario Medical Association

Re: Human Rights Code Policy

Dear College of Physicians and Surgeons of Ontario,

The Section on General and Family Practice appreciates the opportunity to provide  comment on the College’s Physicians and the Ontario Human Rights Code policy that is currently being reviewed.

This policy provides important guidance to physicians on sensitive matters and has generated a great deal of interest and discussion amongst our members since it has come up for review. Overall, the Section feels that the policy in its current form seems to strike a reasonable balance between the moral and religious beliefs of physicians and the legal obligations and professional expectations related to the medical services they provide and has served the profession well since it was approved in 2008.

Essentially, the Section feels that we as physicians are professionals. We communicate with our patients on the complex issues they bring to us and we use our best judgement in making decisions around care together with our patients. The system and communities that we work in have well established networks with our other provider colleagues that enable us to provide the care our patients require when that need falls outside of our ability to provide that care as individual physicians.

Since this policy has come up for review, there have been significant concerns raised amongst our members that tighter guidelines will be placed upon physicians requiring them to provide types of care that conflict with their own personal morals and beliefs. This has led to a number of concerns being raised as to the possible outcomes related to any potential changes to this policy that would be more onerous on physicians. Questions that have come to our attention from our members include the following.

  • Are we slowly heading to a system where individuals looking to enter the medical profession will be required to leave their moral and religious beliefs behind when they accept entry?
  • What about more remote areas of practice? Will more prescriptive policies drive physicians to feel that they will have no choice but to practice in more urban settings?
  • What happens if a physician becomes fearful for safety in their office due to the extreme nature of a particular patient’s behaviour or uncomfortable with a patient who refuses to respect the rules of a physician’s office that may or may not be related to an underlying medical condition? Will the physician lose the ability to end the doctor-patient relationship?
  • Will a stricter policy make it more difficult to manage inappropriate patient demands such as those for narcotic pain medications as it may be construed by some patients as a denial based on discrimination.

College policies can have far-reaching impact above and beyond regulation of physicians in practice. As such, they need to be carefully thought out. A more strict approach to Physicians and the Human Rights Code could lead to situations where well qualified students are, in a sense, denied entry into medical school because of a potential inability to honour their personal, socially accepted religious beliefs due to patient demand. The Section believes it is important to ensure that the public continues to have access to care from the best and brightest minds and we are concerned that quality could suffer if we only accept medical students who are willing to compromise their personal values. At the same time, the Section is well aware of recent items in the media that might compel the College to consider changes to the current policy that would place more onerous expectations upon physicians to personally provide any and all treatment even when it is in direct conflict with their own personal morals and beliefs. However, the Section is not aware that there has been a pattern of complaints that relate to this matter that would document a more significant underlying or systemic problem in this area. As such, it would seem that the policy in its current form is adequate.

An area that was identified as a potential area to be improved upon is in regards to the definition of “disability” within the context of this policy. Mental illness has been raised as an example of a medical condition or disability that has a wide range of expression. It is felt that there may be some room to better define disability or provide some guidance to allow for the use of professional judgement when it comes to disability and a physician’s ability to safely and appropriately provide care in their work environment.

Finally, a significant area for consideration has been raised about the importance of having clarity in regards to complaints being dealt with through the Ontario Human Rights Commission and the role of the College. Physicians are always exposed to the risk that the decisions they make will be challenged by a complaint to the OHRC. If there is a complaint against a physician to the OHRC, this should be allowed to run its course without necessitating involvement of the College. The College should not become involved in additional areas outside of its jurisdiction. For complaints that come to both the OHRC and the College, the College policy should clarify when the College steps aside and waits to assess whether issues of professional conduct remain after the OHRC has made its decision.

The Section feels that the policy in its current form seems to give appropriate guidance to physicians in regards to our legal obligations and our professional expectations but also does not place physicians in an unreasonable position of being forced to provide certain care if it conflicts with their own moral and religious beliefs. The ability for physicians to say “no” without retribution must be preserved as long as those decisions are not based on discrimination. In the rare instance that an individual physician’s professional conduct is felt to clearly fall outside of what is deemed to be reasonable, then the policy in its current form has sufficient substance to be able to deal with those individual situations.

The Section understands that this request for feedback is a preliminary consultation that is meant to assist the College as it begins its work to update this policy so we look forward to the opportunity to review the outcome of this work and once again provide input when it is recirculated for further comment.

General Practice Section
Ontario Medical Association

Submission to the College of Physicians and Surgeons of Ontario

Christian Legal Fellowship

RE: Physicians and the Ontario Human Rights Code Consultations

The College of Physicians and Surgeons of Ontario (“CPSO”) has invited feedback from al 1 stakeholders in regard to its review of Policy Statement #5-08. Physicians and the Ontario Human Rights Code (”the Policy”). In particular, the CPSO has asked if the Policy provides useful guidance, whether the Policy fails to address any issues, and any other ways in which the Policy should be improved. The Christian Legal Fellowship (“CLF”) appreciates the opportunity to participate in this discussion, as we did in the prior CPSO consultation on Human Rights in September of 2008, and makes the following introduction and submissions.

The CLF is a national charitable association that exists to strengthen the spiritual life of its members, and encourage among Christians in the vocation of law the integration of faith with contemporary legal, moral, social and political issues. The CLF’s membership consists of approximately 550 lawyers, law students, professors, and others who support its work; with approximately one third of its members in the Province of Ontario. It has 14 chapters in cities across Canada and student chapters in most Canadian law schools. While having no direct denominational affiliation, CLF’s members represent more than 30 Christian denominations working in association together. As an association of Christian professionals, we welcome the opportunity to address the issues which the CPSO have raised in this consultation process.

The CLF has intervened in numerous legal cases relating to matters of conscience and religious freedom at the appellate and Supreme Court level. The organization also engages in policy consultations raising issues that impact, among other things, religious freedom and human rights. CLF is therefore knowledgeable and well-positioned to comment on this CPSO policy.

In reviewing the Policy, there are three broad areas of concern for CLF. First, we submit that the Policy fails to recognize that physicians have the right to freedom of religion and conscience. Second, the Policy fails to recognize that the law protects physicians with religious beliefs from engaging in activities that violate their religious beliefs, their moral beliefs and their conscience. Third, the Policy obligates physicians, in “some circumstances” to actively refer a patient for services which violate the beliefs or conscience of the physician.

(l)        Physicians have the right to freedom or religion and conscience.

In its current format, the Policy mentions “personal beliefs and values and cultural and religious practices are central to the lives of physicians and their patients”. This description fails to acknowledge the legal status of beliefs and religion. In fact, conscience and religion, thought, belief, opinion and expression are protected as fundamental freedoms by the Charter of Rights and Freedoms.1  Further, the Human Rights Code2 upon which the Policy is based, protects from discrimination on the basis of creed.3

The Policy also precludes physicians from sharing their religious beliefs with patients: “physicians should not promote their own religious beliefs when interacting with patients, nor should they seek to convert existing patients or individuals who wish to become patients to their own religion”. While this conduct may not be appropriate in all circumstances, a blanket prohibition is problematic and a clear violation of freedom of religion and expression.

Religion as a protected freedom is more than the right to privately think or believe certain ideas and principles. It is broadly defined and demands robust protection. Freedom of religion encompasses the right to entertain religious beliefs of one’s own choosing, the right to declare religious belief openly and without fear of hindrance or reprisal, the right to manifest those beliefs by worship and practice, by teaching and dissemination.4It precludes forcing an individual to act [lacuna] conscience. Under the law, physicians must be afforded the ability to align their practices with their conscience in these controversial areas and others, and that right must be made clear in the CPSO Policy.

CLF therefore urges the CPSO to modify its Policy to reflect the principles outlined above, ensuring it accurately reflects physicians’ rights pursuant to the Charter and the Human Rights Code.

Please note the endorsements that follow. CLF would be pleased to provide further assistance in any way the CPSO believes would be appropriate. Thank you for your consideration of our submissions.

Christian Legal Fellowship

Notes
1. The Constitution Act1982, Schedule B to the Canada Act 1982 (U.K.), 1982, c. 11.

2. Ontario Human Rights Code,R.S.O. 1990, e. H .19.

3. Ontario Human Rights Commission: Policy 011 Creed and the Accommodation of Religious Observances, October 20, 1996. While creed is not a defined term in the Code, the OHRC has adopted the following definition of creed in its Policy: “Creed is interpreted to mean “religious creed” or “religion.” Tt is defined as a professed system and confession of faith, including both beliefs and observances or worship. A belief in a God or gods, or a single supreme being or deity is not a requisite … The existence of religious beliefs and practices are both necessary and sufficient to the meaning of creed, if the beliefs and practices are sincerely held and/or observed. “Creed” is defined subjectively. The Code protects personal religious beliefs, practices or observances, even if they are not essential elements of tne creed provided they are sincerely held.” Policy page 4-5. ” In the case of discrimination in the workplace, both management and the union have a duty to accommodate. In Central Okanagan School District No. 23 v. Renaud the Court noted that although the principle of equal liability applies, the employer has charge of the workplace and will be in a better position to formulate measures of accommodation. The employer, therefore, can be expected to initiate the process of taking measures to accommodate an employee. Nevenhelcss, the Court also noted that they will not absolve a union of its duty if it fails to put forward alternative measures that are available. In short, when a union is a co-discriminator with an employer it shares the obligation to remove or alleviate the source of the discriminatory effect.” Policy page 9. “Conclusion: Religious pluralism poses a challenge in any multicultural society, especially one as diverse as ours. Although the law is developing rapidly in this area, an informed spirit of tolerance and compromise is indispensable to any civil society, as well as to its capacity to make opportunities available to everyone, on equal terms, regardless of creed [or other protected right].” Policy page 16. “R v. Rig M Drug Mart l 1985] I SCR 295 at336-337