Tag: referral

If Supreme Court decriminalizes physician-assisted suicide, doctors may be obligated to help with euthanasia

National Post

Shanifa Nasser

Doctors may be forced to support euthanasia over their own religious objections if the Supreme Court of Canada decides to decriminalize physician-assisted suicide in a landmark ruling expected Friday.

The court announced Monday it is set to rule on the Carter case launched on behalf of B.C. women Kathleen Carter and Gloria Taylor, who have since died.

Ahead of the ruling, the College of Physicians and Surgeons of Ontario, which regulates medical doctors in Ontario, has been seeking public input on a draft policy that would force the province’s doctors to help patients access any services to which they are legally entitled. It will finalize the policy after the comment period ends on Feb. 20.

Whatever its policy ultimately looks like, the college is clear: a patient’s right to access services outweighs a doctor’s right to refuse them. “We prioritize the interests of our patients in facilitating access,” says Dr. Marc Gabel, past president of the college and chair of the policy’s working group. . . . [Full Text]

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.

[PDF Text]

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)

All Saskatchewan doctors must refer for abortions: draft policy

 LifeSiteNews

Steve Weatherbe

Saskatchewan pro-life doctors will soon be forced to act against their consciences and required to refer patients who want treatments such as abortion to other doctors. And if no other doctor is available, doctors could be required to do abortions provided they are technically competent.

So says a draft policy of the Saskatchewan Physicians and Surgeons that the organization’s ruling council approved in principle on January 16.  It will vote again to enshrine the document in the professional code of ethics at its meetings on March 26 and 27, and provides member doctors just until March 6 to give feedback. . . [Full text]

   

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.

[PDF Text]

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.

[PDF text]

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)