{"id":7253,"date":"2017-07-20T11:08:16","date_gmt":"2017-07-20T18:08:16","guid":{"rendered":"https:\/\/news.consciencelaws.org\/?p=7253"},"modified":"2018-03-04T20:00:05","modified_gmt":"2018-03-05T04:00:05","slug":"7253","status":"publish","type":"post","link":"https:\/\/news.consciencelaws.org\/?p=7253","title":{"rendered":"Ontario Today: Should doctors be forced to refer?"},"content":{"rendered":"<p><strong>CBC Radio<\/strong><\/p>\n<div style=\"text-align: center;\"><iframe loading=\"lazy\" src=\"\/\/www.cbc.ca\/i\/caffeine\/syndicate\/?mediaId=1007513155789\" width=\"620\" height=\"150\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/div>\n<p><strong>Outline of the programme<\/strong><\/p>\n<p><strong>00:00<\/strong> Introduction<\/p>\n<p><strong>03:00\u00a0<\/strong> <strong>Dr. Sephora Tang, psychiatrist (objecting physician)<\/strong>.\u00a0 Discussion points include potential problem of access to euthanasia\/assisted suicide faced by frail and isolated patients, those in rural areas or\u00a0 &#8220;negative elements&#8221; in families, central referral service alternative, issue of complicity, physician-patient relationship.<\/p>\n<p><strong>12:16\u00a0<\/strong> <strong>Caller Dr. Terry, primary care (objecting physician).<\/strong>\u00a0Discussion points include erosion of medical ethics, erosion of trust in physician-patient relationship,\u00a0relationship between law and ethics, distinction in skill sets needed for euthanasia\/assisted suicide vs. abortion.<\/p>\n<p><strong>19:25\u00a0<\/strong> <strong>Interviewer<\/strong>\u00a0outlines points in\u00a0<a href=\"https:\/\/www.consciencelaws.org\/background\/\/policy\/associations-013.aspx\">position of the Canadian Medical Association<\/a><\/p>\n<p><strong>20:19\u00a0<\/strong> <strong>Caller Vivi<\/strong>.\u00a0Favours compulsory referral because access to euthanasia\/assisted suicide should be considered from patient perspective, not doctor&#8217;s.<\/p>\n<p><strong>22:32<\/strong>\u00a0 <strong>Dr. Sephora Tang<\/strong> responds to points made by caller.<\/p>\n<p><strong>24:14\u00a0<\/strong> <strong>Interviewer<\/strong> outlines policy on effective referral of College of Physicians &amp; Surgeons of Ontario [There are two relevant documents: <a href=\"https:\/\/www.consciencelaws.org\/background\/\/policy\/regulators-001.aspx#pohr\">POHR<\/a> and <a href=\"https:\/\/www.consciencelaws.org\/background\/\/policy\/regulators-001.aspx#pad\">MAID<\/a>; Administrator]<\/p>\n<p><strong>24:34\u00a0<\/strong> <strong>Caller Dr. Ramona Coelho (objecting physician).<\/strong>\u00a0Explains why she will not make effective referral.<\/p>\n<p><strong>25:42<\/strong>\u00a0 <strong>Caller Dr. David Roussell, President, College of Physicians &amp; Surgeons of Ontario (CPSO).\u00a0<\/strong> Interviewer puts to him opposition to effective referral by the Canadian Medical Association, more liberal policies in other provinces.\u00a0 Dr. Roussell discusses College policy requiring effective referral.\u00a0\u00a0Asserts that the College is primarily concerned with access to euthanasia\/assisted suicide etc. by patients who might have difficulty doing do if their physician does not assist.\u00a0 Notes that both <a href=\"https:\/\/www.consciencelaws.org\/background\/\/policy\/regulators-009.aspx#Professional\">Nova Scotia <\/a>and <a href=\"https:\/\/www.consciencelaws.org\/background\/\/policy\/regulators-011.aspx#Code\">Quebec<\/a> have similar requirements, so Ontario is not alone.\u00a0 Notes that referral does not always result in procedure being obtained.\u00a0 Characterizes\u00a0objections to effective referral as\u00a0oversensitive.\u00a0 Acknowledges that loss of licence to practice is one possible outcome of complaint against a physician for refusing to refer.<\/p>\n<div>\n<p><strong>35:12\u00a0<\/strong> <strong>Caller Dr. Christine (objecting physician).<\/strong>\u00a0 Emphasizes central care coordinating system and self-referral by patients would be more efficient and avoid conflicts of conscience.<\/p>\n<p><strong>37:20<\/strong>\u00a0 <strong>Caller Dr. Roussell<\/strong> agrees that central coordination system and self-referral is promising, but asserts that this can &#8220;fall apart&#8221; in some cases.<\/p>\n<p><strong>38:25<\/strong> <strong>Caller David<\/strong>.\u00a0 Opposed to compulsory referral.\u00a0 Believes it is safer to ensure diversity of views in society, especially in life and death matters, by protecting freedom of conscience.<\/p>\n<p><strong>41:30<\/strong>\u00a0 <strong>Interviewer<\/strong> asks Dr. Roussell to respond to concerns about freedom of conscience.<\/p>\n<p><strong>42:00\u00a0<\/strong> <strong>Caller Dr. Roussell<\/strong> notes &#8220;private beliefs, religious or otherwise,\u00a0are not the purview, shouldn&#8217;t be the purview\u00a0of the College or the government . . . What we&#8217;re talking about here is from the public&#8217;s point of view. There&#8217;s a legally available service to, in most people&#8217;s minds, alleviate suffering, which is what medicine is supposed to be about.\u00a0 And the battle&#8217;s been fought, the war&#8217;s been won, the law has been passed.\u00a0 Why are we throwing up obstacles to a legally accessible service?\u00a0 Especially throwing up obstacles at the last moment to people who are in some sense suffering.&#8221;<\/p>\n<p><strong>43:04\u00a0Caller Joel (medical student)<\/strong>.\u00a0 Supports compulsory referral.\u00a0 &#8220;Doctors in Canada should not be practising medicine in Canada if they feel that their moral code supersedes what is law.&#8221;\u00a0 He adds, &#8220;It is great for doctors to unite and object on some things&#8221; and refers to the Alberta system (which has proved acceptable to objecting physicians).\u00a0 He believes that effective referral for euthanasia or assisted suicide does not make a physician a &#8220;conduit of death,&#8221; but means that the patient can access a specialist with appropriate training.\u00a0 He\u00a0characterizes acceptance of\u00a0conscientious objection as a &#8220;slippery slope.&#8221;<\/p>\n<p><strong>44:45\u00a0 Caller Erica<\/strong>.\u00a0 Supports compulsory referral.\u00a0 Her mother (whom she identified as a\u00a0Christian) was\u00a0suffering from multiple sclerosis.\u00a0 She was joyful when euthanasia was legalized [<em>Criminal Code<\/em> amendments given Royal Assent in June, 2016; Administrator].\u00a0 She was not euthanized\/assisted with suicide\u00a0until the end of December, 2016 because her physician (whom\u00a0Erica also identified as a\u00a0Christian)\u00a0refused, and refused to refer her.\u00a0Erica stated that this &#8220;absolutely shattered her.\u00a0 It took her days to pick herself up and decide she was going to keep trying to find somebody.&#8221;\u00a0Asserts that denying such people access to a medical procedure is unfair.<\/p>\n<\/div>\n<div>\n<p><strong>46:31\u00a0 Interviewer<\/strong> notes that less than 75 physicians in Ontario are actually providing euthanasia\/assisted suicide. Erica explains that\u00a0a doctor was found after a CBC interview made her situation public.<\/p>\n<p><strong>47:28\u00a0 Dr. Sephora Tang<\/strong> responds.\u00a0 Notes that patients want access, and she does not wish to impede.\u00a0 The system set up by the government made it impossible for patients to access euthanasia\/assisted suicide on their own. If society wants people to have access, there are alternative ways to ensure access that should be considered.<\/p>\n<div>\n<p><strong>48:07\u00a0 Interviewer<\/strong> asks about patients being fearful of the &#8220;judgement&#8221; of their physicians.<\/p>\n<p><strong>48:27\u00a0 Dr. Sephora Tang<\/strong> emphasizes importance of trust in physician-patient relationship.\u00a0\u00a0 It is better for the patient to know where she stands on some issues, so there &#8220;no guessing around that.&#8221;\u00a0 It is possible to agree to disagree.<\/p>\n<p><strong>49:16\u00a0 Dr. Chantal (euthanasia\/assisted suicide provider).\u00a0<\/strong> Supports compulsory referral, because &#8220;patients need access.&#8221;\u00a0\u00a0Abortion clinics are not an appropriate comparison.\u00a0 Referral must include all relevant medical information.\u00a0\u00a0&#8220;No\u00a0medical information is necessary for a physician to do an abortion,&#8221; but is needed prior to performing euthanasia\/assisted suicide.\u00a0 To expect patients to go to hospitals and doctors to gather all of the relevant medical information is &#8220;completely unreasonable.&#8221;\u00a0 Patients would be &#8220;significantly compromised&#8221; if objecting physicians refused to provide the relevant information.<\/p>\n<p><strong>Postscript from Dr. Christine <\/strong>(<em>Reproduced with permission<\/em>)<\/p>\n<p><em>Just because a physician may conscientiously object to formal participation <\/em><em><u>by the administrative\/legal\/ethical agreement implied by a documentation-based referral<\/u><\/em><em>\u00a0(re: linking billing numbers between 2 practitioners for review +\/- enactment of a desired procedure),<\/em><em>this does\u00a0<\/em><em>NOT mean that an objecting physician would ever dare to obstruct the subsequently requested movement of health file information <\/em><em>(which is first and foremost a property that emanates from the patient!) <\/em><em>to the clinician to whom the patient wishes to receive lethal injections from.\u00a0<\/em><\/p>\n<p><em>Furthermore:\u00a0 If a patient seeks a care pathway that may end in MAiD, through a care coordination service in the ideal case, then there are administrative health professionals in all the offices who can and do link with each other to physically get the records moving.\u00a0<\/em><\/p>\n<p><em>(Again, a physician is not the one pulling the files in a Norman Rockwell\/1950\u2019s-style office; we now have digital spigots to move information, and physicians are not required to unlock the content in our current collaborative environment of ConnectingOntario\/PRO\/OLIS).<\/em><\/p>\n<p><em>\u00a0<\/em><em>My original point in the call is that forcing a physician to fill out referrals (and limiting the power\/responsibility to do this, to physicians) is ironically creating (rather than removing) a barrier to care.\u00a0<\/em><\/p>\n<p><em>\u00a0<\/em><em>(Incidentally \u2013 and not all people know this \u2013 it is also quite typical\u00a0and not an exception\u00a0for most referrals to come with inadequate background case information, even in non-controversial indications; <\/em><em>doctors know how to probe for what\u2019s missing [and often have to ask for information in several iterations and from multiple parties], <\/em><em>and gaps from healthcare fragmentation are not so much a product of malfeasance as simply laziness\u2026)<\/em><\/p>\n<p>&nbsp;<\/p>\n<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>CBC Radio Outline of the programme 00:00 Introduction 03:00\u00a0 Dr. Sephora Tang, psychiatrist (objecting physician).\u00a0 Discussion points include potential problem of access to euthanasia\/assisted suicide faced by frail and isolated patients, those in rural areas or\u00a0 &#8220;negative elements&#8221; in families, central referral service alternative, issue of complicity, physician-patient relationship. 12:16\u00a0 Caller Dr. Terry, primary care &hellip; <a href=\"https:\/\/news.consciencelaws.org\/?p=7253\" class=\"more-link\">Continue reading<span class=\"screen-reader-text\"> &#8220;Ontario Today: Should doctors be forced to refer?&#8221;<\/span><\/a><\/p>\n","protected":false},"author":5432,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[77,629,32,4,5,162,7],"tags":[385,384,566,293],"post_folder":[4012],"class_list":["post-7253","post","type-post","status-publish","format-standard","hentry","category-assisted-suicide","category-audio-files","category-canada","category-commentary","category-ethics","category-euthanasia","category-law","tag-college-of-physicians-and-surgeons-of-ontario","tag-ontario","tag-physicians","tag-referral"],"yoast_head":"\r\n<title>Ontario Today: Should doctors be forced to refer? 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