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Saskatchewan physicians to be forced to participate in killing their patients

For Immediate Release

Maurice Vellacott, MP Saskatoon-Wanuskewin

OTTAWA – “The assault on freedom of conscience that is spreading across our country ought to be of grave concern to every freedom-loving Canadian ,” MP Maurice Vellacott said upon learning of yet another province (this time his own) that plans to force physicians to participate in morally objectionable procedures, including those that kill. “No health care worker should be forced against their will to take part in the killing of another human being. It would be a grotesque violation of their human dignity.”

The College of Physicians and Surgeons of Saskatchewan (CPSS) has adopted in principle a policy[i] which it basically “cut and paste” from the Conscience Research Group’s (CRG’s) Model Policy on Conscientious Objection in Medicine.[ii]

Mr. Vellcott asked a series of questions that paint a disturbing picture of the process, or lack thereof, that went into CPSS’s adoption of this objectionable policy:

“Was the CPSS aware that the drafters of the Model Policy, notably Professor Jocelyn Downie of Dalhousie University, are abortion and euthanasia activists?

Did the CPSS solicit input from anyone other than Professor Downie and her team at the CRG[iii] before adopting this policy?

Did the Saskatchewan College let on to anyone else that it was even considering this issue?

Is the CPSS aware that this policy was rejected by the Canadian Medical Association (CMA)?”

Mr. Vellacott explained: “Professor Downie and co-author Sanda Rodgers, in a 2006 guest editorial in the CMA Journal, ignited a firestorm of controversy when they falsely claimed that CMA policy requires physicians to make abortion referrals regardless of their conscientious/religious beliefs. As Sean Murphy, Administrator of the Protection of Conscience Project, points out in his recent news release, that claim was repudiated by the CMA and vehemently rejected by physicians. And partly as a result of that negative response, Professor Downie turned her attention to the regulatory Colleges to try to convince them to impose mandatory referral.”[iv]

Earlier this month, Mr. Vellacott spoke out against a similar draft policy of the College of Physicians and Surgeons of Ontario (CPSO). At that time, he expressed concerns that if the Supreme Court of Canada strikes down Canada’s current ban on euthanasia or assisted suicide, then CPSO’s policy would mean Ontario’s physicians would have a ‘duty to refer’ patients for these life-ending procedures. He stressed that no other jurisdiction that currently allows euthanasia or assisted suicide imposes such an obligation. [v]

“While the CPSO policy is not identical to the CPSS/CRG Model Policy, in principle it is the same—a coercive attempt to involve physicians in the killing of some of the most vulnerable members of our human family,” Mr. Vellacott said. “The sheer fact that these Colleges of Physicians and Surgeons feel that a coercive policy of referral for these controversial procedures is necessary, is itself testament to the fact that there is something inherently problematic about these procedures in the first place. If they were procedures just like any other medical procedure, there’d be no need to coerce physicians into sacrificing a fundamental part of who they are—their very consciences—in order to provide them.”

“No good can come from forcing a doctor to practice medicine in a way they find morally reprehensible. Killing the consciences of our medical doctors will cause inestimable harm to the people of Canada and society as a whole.”

“One cannot help but wonder, what is the real motivation of those pushing us down this dangerous path? And will we have the courage and wisdom and foresight to stop it?”

For information on providing input to CPSS on its draft policy, visit: http://www.cps.sk.ca/CPSS/CouncilAndCommittees/Council_Consultations_and_Surveys.aspx

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For further information and comment, call (613) 992-1966 or (613) 297-2249; email: maurice.vellacott.a1@parl.gc.ca

[i] The College of Physicians and Surgeons of Saskatchewan (CPSS) is currently seeking input on a conscientious objection policy dubbed “Conscientious Refusal,” which it has adopted in principle. This policy would require physicians who object to providing certain “legally permissible and publicly-funded health services” to “make a timely referral to another health care provider who is willing and able to accept the patient and provide the service.” In cases where the patient’s “health or well-being” would be jeopardized by a delay in finding another physician, the physician would be forced to provide the service even when it “conflicts with physicians’ deeply held and considered moral or religious beliefs.” See: http://www.cps.sk.ca/Documents/Council/2015%201%2019%20Conscientious%20Objection%20policy%20approved%20in%20principle%20by%20Council.pdf

[ii] http://carolynmcleod.com/wp-content/uploads/2014/05/04_Downie-McLeod-Shaw.pdf

[iii] http://conscience.carolynmcleod.com/meet-the-team/

[iv] “Saskatchewan physicians to be forced to do what they believe to be wrong,” Protection of Conscience Project news release, Jan. 27, 2015

[v] See Jan. 8, 2015 news release and Backgrounder.

Saskatchewan physicians to be forced to do what they believe to be wrong

Policy wording supplied by abortion and euthanasia activists

Policy would apply to euthanasia, if legalized.

Protection of Conscience Project News Release

The College of Physicians and Surgeons of Saskatchewan is proposing a draft policy demanding that physicians who object to “legally permissible and publicly-funded health services” must direct patients to colleagues who will provide them. If another physician is unavailable, the College demands that they provide “legally permissible and publicly-funded” services, even if doing so “conflicts with physicians’ deeply held and considered moral or religious beliefs.”

Physicians usually refuse to participate in abortion because they believe it is wrong to kill what the criminal law refers to as a child that has not become a human being.¹ The proposed policy will require them to find a physician willing to do the killing they won’t do. Should the Supreme Court of Canada legalize euthanasia, the policy will require objecting physicians who refuse to kill patients to find someone who will.

The seamless fit between referral for abortion and referral for euthanasia is not surprising. The draft College policy was largely written by abortion and euthanasia activists, notably Professor Jocelyn Downie of Dalhousie University.

In a 2006 guest editorial in the Canadian Medical Association Journal, Professor Downie and another law professor claimed that objecting physicians are obliged to refer patients for abortion.² Their views were vehemently rejected by physicians and repudiated by the Canadian Medical Association.³ Partly as a result of the negative response, Professor Downie and her colleagues in the “Conscience Research Group” decided to convince Colleges of Physicians and Surgeons to impose it.⁴

Saskatchewan’s draft policy is taken almost verbatim from their “Model Conscientious Objection Policy.”

The Conscience Research Group is a tax-funded initiative that includes Professors Downie and Daniel Weinstock.⁵ 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,⁶ because (they claimed) it is agreed that they can be compelled to refer for “reproductive health services.”⁷

Current efforts by the College of Physicians and Surgeons of Ontario to suppress freedom of conscience in the medical profession may have been influenced by the Conscience Research Group. However, the College in Saskatchewan is the first to copy and paste its preferred model into a draft policy.

The Project insists that it is incoherent and contrary to sound public policy to include a requirement to do what one believes to be wrong in a professional code of ethics. It is also an affront to the best traditions of liberal democracy, and, ultimately, dangerous.

The College Council has approved the policy in principle, but will accept feedback on it until 6 March, 2015.

Notes:

1. Criminal Code, Section 238(1). (Accessed 2014-12-02)

2. Rodgers S. Downie J. “Abortion: Ensuring Access.” CMAJ July 4, 2006 vol. 175 no. 1 doi: 10.1503/cmaj.060548 (Accessed 2014-12-02).

3. Blackmer J. Clarification of the CMA’s position on induced abortion. CMAJ April 24, 2007 vol. 176 no. 9 doi: 10.1503/cmaj.1070035 (Accessed 2014-02-22)

4. McLeod C, Downie J. “Let Conscience Be Their Guide? Conscientious Refusals in Health Care.” Bioethics ISSN 0269-9702 (print); 1467-8519 (online) doi:10.1111/bioe.12075 Volume 28 Number 1 2014 pp ii–iv

5. Let their conscience be their guide? Conscientious refusals in reproductive health care: Meet the team.(Accessed 2014-11-21)

6. 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 2014-02-23)

7. 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 2014-02-23)

Project letter to the New Brunswick Minister of Health

Re: compulsory referral for abortion

3 December, 2014

The Honourable Victor Boudreau,
Minister of Health,
HSBC Place,
P. O. Box 5100
Fredericton, NB
Canada E3B 5G8

Dear Mr. Boudreau:

The Protection of Conscience Project is a non-profit, non-denominational initiative that advocates for freedom of conscience in health care. The Project does not take a position on the acceptability of morally contested procedures.

I am writing about a statement attributed to you in the Fredericton Daily Gleaner:

Health Minister Victor Boudreau: “No physician can be forced to [perform abortions], but at the same time there is a duty to refer to someone who will.”¹

It is instructive to compare this to a demand made by a panel of experts of the Royal Society of Canada:

Royal Society Panel: “. . . health care professionals are not duty bound to accede to [requests for euthanasia and assisted suicide] . . . but . . . they are duty bound to refer their patients to a health care professional who will.”²Since you are new to the position of Minister of Health, you are likely unaware of the fact that arguments used by those who demand that physicians be forced to refer for abortion are also used to demand that they be forced to refer for euthanasia or assisted suicide. It was for this reason that the Protection of Conscience Project joined an intervention in the case of Carter v. Canada in the Supreme Court of Canada.³

Counsel for the Project told the Supreme Court justices that what is demanded by the Royal Society experts (and, perhaps, the New Brunswick government?) is “precisely the sort of thinking that, in our submission, ought to be protected against.”⁴

Any number of physicians may agree to referral for abortion or other controversial procedures because they find that it relieves them of a moral burden or of tasks 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 these physicians refuse to facilitate killing before birth by referring patients for abortion, they and other physicians would refuse to facilitate killing patients after birth by referring them for euthanasia or assisted suicide. Influential academics and abortion and euthanasia activists want to force objecting physicians to do both.

Professor Jocelyn Downie of Dalhousie University was one of the architects of the Carter case,⁷ a member of the Royal Society panel, and a long-time advocate of compulsory referral for abortion.⁸ She was live- tweeting the hearing from the courtroom. Udo Schuklenk, one of her fellow Royal Society experts, was following the proceedings via a live audio-video link. He described most of the interveners as “Christian activist groups, some more fundamentalist than others.” After questioning the integrity of “the God folks,” he commented on the joint intervention involving the Project:

Then there was a lawyer representing groups called the Faith and Freedom Alliance and the Protection of Conscience Project. He . . . asked that the Court direct parliament to ensure that health care professionals would not be forced to assist in dying if they had conscientious objections. That, of course, is the case already today in matters such as abortion. However, this lawyer wanted to extend conscience based protections. Today health care professionals are legally required to pass the help-seeking patient on to a health care professional willing to provide the requested service. The lawyer wanted to strike out such an obligation. I am not a fan of conscientious objection rights anyway, so I hope the Court will ignore this.⁹ (Emphasis added)You can see clearly from this that Professors Downie, Schuklenk and their supporters hold that because physicians can be forced to refer for abortion, they can and ought to be forced to refer for euthanasia and assisted suicide. The weakness in this claim is the false premise that objecting physicians can or ought to be compelled to refer for abortion. Notwithstanding your assertions and the views of Dr. Haddad and Professors Downie and Schuklenk, this claim is sharply disputed, and for good reason.

Physicians are required to disclose personal moral convictions that might prevent them from recommending abortion, but not to refer the patient or otherwise facilitate the procedure. The arrangement preserves the integrity of physicians, and it safeguards the legitimate autonomy of the patient, who is free to seek an abortion elsewhere.¹⁰ But it also protects the community against the temptation to give credence to a dangerous idea: that a learned or privileged class, a profession or state institutions can legitimately compel people to do what they believe to be wrong.

Just how far this can go is now coming into focus, thanks to the Royal Society’s panel of experts and their supporters. They argue that it is not sufficient to simply encourage and allow willing health care professionals to kill patients. They demand that health care professionals be compelled to participate in and facilitate the killing of patients – even if they believe it to be wrong, even if they believe it to be murder – and that they should be punished if they refuse to do so.

Killing is not surprising; even murder is not surprising. But to hold that the state or a profession can, in justice, compel an unwilling soul to commit or even to facilitate what he sees as murder, and justly punish or penalize him for refusing to do so – to make that claim ought to be beyond the pale. It is profoundly dangerous, for if the state or civil society or professional organizations can legitimately require people to commit or aid in the commission of murder, what can they not require?

Particularly in view of the possibility that the Supreme Court of Canada might legalize physician assisted suicide and euthanasia, it is of grave concern that your comments can be taken to be supportive of the movement to develop and entrench a ‘duty to do what is wrong’ in medical practice. I know of no other profession that has accepted such a duty as a requirement of membership, and I am certain that the Liberal Party of New Brunswick does not and would not impose such a duty upon its members.

I have enclosed an abstract (in English and French) of the Project’s recent submission to the College of Physicians and Surgeons of Ontario about its policy, Physicians and the Ontario Human Rights Code, which is relevant in this case. The full submission, which is on line, is available in English only.

I note that a CBC news reported in July that the President of the New Brunswick Medical Association, Dr. Camille Haddad, included refusal to refer for abortion among alleged “barriers to access” to the procedure. The CBC report added, “The society says it wants the New Brunswick government to come up with a plan to address those barriers.”¹¹

If Dr. Haddad or others have urged you to adopt policies to promote access to abortion, that is outside the scope of Project concerns. However, I respectfully suggest that a plan to address alleged “barriers” must not include the suppression of freedom of conscience among physicians by compelling them to refer for abortion. The state has other means at its disposal to deliver the service.

Sincerely,

Sean Murphy, Administrator
Protection of Conscience Project

Notes
1. Huras A. “Abortions won’t be available in all hospitals.” Fredericton Daily Gleaner, 28 November, 2014

2. 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. 70 (Accessed 2014-12-02)

3. Murphy S. “Re: Joint intervention in Carter v. Canada– Project Backgrounder.” Supreme Court of Canada, 15 October, 2014. Protection of Conscience Project

4. Murphy S. “Re: Joint intervention in Carter v. Canada- Selections from oral submissions.” Supreme Court of Canada, 15 October, 2014. Protection of Conscience Project

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 2014-12-02)

7. In a 2007 symposium at Carleton University in Ottawa, Professor Downie asserted that the Supreme Court of Canada might be willing to reverse its 1993 ruling in Rodriguez. She outlined the strategy for a legal challenge under Canada’s Charter of Rights and Freedoms and said that she was looking for an ideal test case to use to strike down the law. She published a paper and essay in 2008 that appear to have drawn from her Carleton presentation. The 2007 presentation and subsequent publication set out the strategy for the plaintiffs’ successful argument in Carter. Professor Downie assisted the plaintiffs in the Carter case in preparing their expert witnesses. “Rodriguez Revisited: Canadian Assisted Suicide Law and Policy in 2007.” Dalhousie University, ListServ Home Page, FABLIST Archives, Message from Rebecca Kukla, 6 February, 2007. “Symposium on physician assisted suicide.” (Accessed 2012-06-27); Schadenberg, Alex, “Dalhousie law professor seeks to re-visit Rodriguez court decision.” Euthanasia Prevention Coalition. Downie J, Bern S. “Rodriguez Redux.” Health Law Journal 2008 16:27-64. (Accessed 2012-06-27.) Carter v. Canada (Attorney General) 2012 BCSC 886, Supreme Court of British Columbia, 15 June, 2012. para. 124. (Accessed 2014-12-02)

8. Rodgers S. Downie J. “Abortion: Ensuring Access.” CMAJ July 4, 2006 vol. 175 no. 1 doi: 10.1503/cmaj.060548 (Accessed 2014-12-02). McLeod C, Downie J. “Let Conscience Be Their Guide? Conscientious Refusals in Health Care.” Bioethics ISSN 0269-9702 (print); 1467-8519 (online) doi:10.1111/bioe.12075 Volume 28 Number 1 2014 pp ii–iv

9. Schuklenk, U. “Supreme Court of Canada heard arguments in Charter challenge to assisted dying criminalisation.” Udo Schuklenk’s Ethx Blog Thursday, October 16, 2014 (Accessed 2014-12-02)

10. Murphy S. “‘NO MORE CHRISTIAN DOCTORS.’ Appendix ‘F’- The Difficult Compromise: Canadian Medical Association, Abortion and Freedom of Conscience.” Protection of Conscience Project

11. “New Brunswick Medical Society calls for abortion access plan: Doctors’ group says 2 doctor rule no different than any other procedure.” CBC News, 26 July, 2014 (Accessed 2014-12-02)

Promises, promises

Canadian law reformers promise tolerance, freedom of conscience

What happens after the law is changed is another story.

Sean Murphy*

Now let me finally cut to the chase, to the heart of this appeal. The most vociferous opposition to our challenge comes from some church groups, and some disabled organizations. To the church groups we simply say that we respect your religious views, but they cannot, in this secular society, trump our clients’ constitutional rights. And no one is suggesting that a physician who has a religious objection to assisting a patient with his or her death must do so.
Joseph Arvay, Q.C., Oral Submission to the Supreme Court of Canada, Carter v. Canada, 15 October, 2014

Introduction

With the passage of the Quebec euthanasia law and the pending decision in Carter v. Canada in the Supreme Court of Canada, physicians, medical students, nurses and other health care workers opposed to euthanasia and assisted suicide for reasons of conscience are confronted by the prospect that laws against the procedures will be struck down or changed. They may wonder what the future holds for them if that happens.

Will they be forced to provide or assist with something they find morally abhorrent? If they refuse to do so, will they be disadvantaged, discriminated against, disciplined, sued or fired? Will they be forced out of their specialty or profession, or forced to emigrate if they wish to continue in it?

The realpolitik of law reform

These questions have been largely ignored, since much of the public debate about euthanasia and assisted suicide has been about whether or not the procedures should be legalized, not about what effect legalization might have on freedom of conscience, particularly among health care workers. Opponents of legalization understandably decline to raise the issue because they are concerned that doing so would compromise the message they want to deliver.

Advocates of legalization, on the other hand, generally recognize that support for euthanasia and assisted suicide may begin to evaporate if it appears that they intend to force unwilling physicians or health care workers to participate in killing patients. In particular, they do not wish to alienate members of the health care community who, on principle or as a matter of prudent self-interest, would not support such a coercive policy. Instead, they adopt a reassuring posture of respect for freedom of conscience and tolerance for opposing views within the medical profession.

It is instructive to see how this strategy has been applied in the case of the Quebec euthanasia law and the Carter case, and then to consider how it was applied in the case abortion, another morally controversial procedure. While we cannot predict the future, we are now in a position to judge the worth of the assurances given when abortion was legalized over forty years ago, and to apply that judgement to assurances now being made about euthanasia. [Full Text]

Redefining the Practice of Medicine- Euthanasia in Quebec, Part 4: The Problem of Killing

Abstract

The original text of Bill 52 did not define “medical aid dying” (MAD), but it was understood that, whatever the law actually said, it was meant to authorize physicians to kill patients who met MAD guidelines. The Minister of Health admitted that it qualifed as homicide, while others acknowledged that MAD meant intentionally causing the death of a person, and that its purpose was death. Various witnesses in favour of the bill referred explicitly to lethal injection and the speed of the expected death of a patient.

Given the moral or ethical gravity involved in killing, it is not surprising to find serious disagreement about MAD among health care workers. Conflicting claims made about the extent of opposition to or support for euthanasia within health care professions are difficult to evaluate, but a review of the transcripts of the legislative committee hearings into Bill 52 is instructive.

One physician member of the committee was shocked by the assertion that there is no moral, ethical, or legal difference betwen withdrawing life support and lethally injecting a patient. Hospices and palliative care physicians rejected participation in euthanasia. Sharp differences of opinion among other health care workers were reported. Support for killing patients by lethal injection was likened to support for the death penalty; that is, many more agreed with the act in principle than were willing to do the actual killing. So marked was the evidence of opposition to euthanasia that doubts were raised about the possiblity of implementing the law.

Since the law was passed as a result of assurances from the Quebec medical establishment that it could be implemented, a committee member who is now a minister of the Quebec government warned that they would be called to account if it is found that few physicians are willing to participate. This political pressure is likely to provide an additional incentive for the medical establishment to secure the compliance of Quebec physicians.

The introduction of euthanasia into Quebec’s health care system is to be accomplished using the structures and powers established by other Quebec statutes that govern the delivery of health care in the province, which have established a multi-layered and overlapping bureaucracy of committees, councils, commissions, boards, directors, examiners, coordinators, syndics and commissioners. Physicians and other health care providers who object to euthanasia will find their working environments increasingly controlled by a MAD matrix functioning within this system, a prominent feature of which is an emphasis on patient rights.

Everyone authorized to enact or supervise adherence to policies or standards can become a MAD functionary, using codes of ethics, protocols, guidelines, directives, etc. to normalize euthanasia. Similarly, every disciplinary and complaints procedure can be used to force participation in MAD services. Those who openly advocate refusal to provide or facilitate euthanasia can be fined from $1,500.00 to $40,000.00 per day under Quebec’s Professional Code if they are deemed to have helped, encouraged, advised or consented to a member of a profession violating the profession’s code of ethics. [Full Text]