Regarding accepting new patients. I can see if a physician decides not to accept someone on the basis of race, ethnicity, income, etc. it would be discrimination. That is by the way the extent of exclusions that can be against human rights. The categories are well-defined and are not over-inclusive. But to say that everyone out there is entitled to my services if within my competence, and that I don’t have the right to say NO even if it is not an emergency or a recognized form of discrimination, is wrong, and borders on forced labor. I am not just a physician, but also a Canadian citizen and a human being. Part of my human rights is to be able to say NO to forced servitude and labor. I can see in an emergency, someone’s right to life overrides that right of mine, but it should not in non-emergencies. I am also not an employee of the College so the College should not and must not legally be able to tell me who I should and should not treat outside of emergencies and outside of the established legal discrimination categories of race, sex, ethnicity, income, etc.
This policy is about “human rights”. Reading the policy, one gets the impression that only patients are human, and somehow due to their professional choice, physicians are now some sort of non-human.
College is once again overstepping its jurisdiction and legal bounds.
I agree that the “college is once again overstepping its jurisdiction and legal bounds.” In fact, I still sing the national anthem praying that our land be kept glorious and FREE.
But what about the doctors freedom of rights.
Everyone should have the freedom to choose when it comes down to their beliefs unless it is breaking the law.What if at our workplace our basic rights were taken away from us because of our employers own beliefs, would that be ok?
I am very much in agreement with you. Leave the doctors to choose. Create a registry for those doctors that wish to assist with suicide and allow patients to choose the doctor. Some Patients already make those choices when they travel overseas to get this service.
I agree. Physicians should have the right to say no to providing certain forms of treatment. However, I’m particularly concerned with the requirement that physicians provide referrals for treatments which they feel are morally and ethically wrong. If a physician feels a treatment is morally and ethically wrong, then aren’t they still violating their conscience by asking someone else to perform the procedure? How is the physician’s right to freedom of conscience being protected under these circumstances? In addition to this, a physician might feel that if a procedure is morally wrong it would also be harmful to the patient. Under these circumstances the physician would be violating not only their conscience but also their hippocratic oath by referring the patient to someone else to perform the procedure.
My husband and I agree with this statement made by the above member of public as well we have a doctor who holds the same religious beliefs as we do. We are concerned for her rights as a doctor having to refer a patient to another doctor for a practice she believes is harmful to her patient. If a doctor believes a practice such as physician assisted suicide is wrong it is wrong for anyone to preform.
I agree with this statement. In addition, no one seems to be taking into account the long term psychological negative effect to the doctor (or anyone) who goes against what they believe to be right or wrong by committing an immoral act. We have seen these effects on women who have suffered psychological effects over the last 40 years since the roe vs wade decision.
I agree with this statement as it deals with not only the physician’s freedom of conscience but the part of requiring them to refer the patient to someone else to do the procedure.I urge you to seriously consider all of these aspects before making any changes in policy
I agree. It is NOT an acceptable position for the College to force doctors to refer patients they could not morally or ethically treat themselves. Perhaps patients need to be informed of their physician’s personal moral code before signing up with them.
I agree. Particularly if the moral view is a widely accepted one both by both common Canadian society and/or religious groups, why should one be required to go against, ones own beliefs and be complicit in the process.
I agree that the doctor as well as the patient should have the right to reject doing a procedure that they consider to be morally wrong. If I do not speak out against it, I would be as guilty as the Doctor doing it.
Some give the impression that doctors or superhuman….therefore patients expectations upon them and them alone is unrealistic. No one can fix another or fix another’s life that is up to the person and God and the plus is the blessing of the gifting of a professional to help guide them to corrective treatment or thinking or behavior. Doctors, forgive us for expecting the superhuman and divine from you. Forgive us .
I agree totally with the above physician. It seems like a select group of people in this country have rights. I a persons conscience tells him/her not to do something that should be respected. We need more people with a conscience and there weuld be a lot less wars breaking out.
I agree with this statement. It is NOT acceptable position for the College to force doctors to do anything that goes against the doctor’s conscience and that includes not forcing doctors to refer patients.
I also agree that is NOT acceptable to force doctors to go against their conscience. The doctor’s rights are being taken away and the patient’s rights are being placed above that of the doctor’s. And what about the right of patients to have a doctor who stands for life? Also the statement ‘emergency situation’ is very broad and will be open to much abuse.
I have two concerns about the referral requirement. Moral philosophers generally agree that if doing a thing is immoral then arranging for that thing to be done is also immoral. Isn’t arranging for someone to kill your patient just as immoral as killing your patient?
My second concern is that the referral requirement will trigger an expensive Charter challenge.
Why force physicians to violate their moral integrity and risk expensive legal entanglements when the previous policy was working?
Patients don’t have a right to death. The policy change is a political move. Doctors are supposed to extend, enhance and protect life. If death becomes a right, go find a murderer for your services.
Forcing doctors to violate their moral integrity is taking their rights away and it will likely mean that many doctors will be forced to leave, thus Canadians would have less access to the medical care they need. If a human being wants to suffer an incurable desease until natural death, it does not diminish in any way his value as a human being because suffering in Christ has spiritual value, a redeeming value. Only God has the right to end a life and no one else.
I agree that the right to conscientious objection is critical to maintaining physician integrity. However, in Canada we routinely choose to infringe on certain individual rights for the sake of the right of society at large — for example: free speech yes, hate speech no. If we as a society determine that a particular act or service is a standard of care, I think that patients’ right to health care should trump a physician’s right to conscientous objection. In many cases, there is fortunately a compromise position (e.g. refer to a colleague or allow patient to self-refer) but when there isn’t, or when it is an emergency, I think this policy is appropriate.
Additionally, I think that ignoring the power imbalance inherent in the physician-patient relationship is a bit disingenuous at best and dangerous at worst. We are in a position of power, like it or not. That arguably makes erring on the side of protecting the rights of our patients when they conflict with our own rights even more criticial.
Free speech is not free speech if it does not include “hate speech.” What is “hate speech”, after all? The “victim” declares himself a victim and what offended him is therefore “hate speech”. Only totalitarian governments attempt to police thought.
You speak of a power imbalance and yet you fail to see the irony and hypocrisy inherent in your defense of the CPSO draft policy. The facts are that mothers and doctors are decidedly in the position of power; the pre-born children in a fiduciary relationship with their parents, at least, are legally killed; and instead of trying to protect these children, the medical profession through this draft policy is attempting to force those doctors who refuse to kill the children either to kill them or to facilitate this killing.
What’s more, you wrote your defense of this evil draft policy under a comment pointing out that “arranging for someone to kill your patient [is] just as immoral as killing your patient.” Yet that is what this draft policy requires and what you are defending.
If we are going to speak of “hate speech”, then who is guilty of hate speech against pre-born children? And since there is power imbalance, why is this draft policy doing the exact opposite of what it purports to do, further legitimizing and requiring provision of “services” that turn healers into killers? Absurd! Evil!
There is a power imbalance inherent in the physician-patient relationship- this is true. However, if this draft policy becomes law, then the power imbalance will shift- physicians will no longer have the freedom to do what they feel is in the best interest of patients, and they will be forced to violate their consciences, which is harmful to their own wellbeing. In addition to this, such legistlation may mean that many doctors or future doctors will no longer feel free to practice their profession at all, if it means they will be forced to compromise their consciences to such an extent. This would be far more harmful to patients in the long run, as well as to the general public. There is already a shortage of physicians. Why make it worse?
It may be true this policy might deter certain individuals from pursing a medical career in Ontario (for the record, I doubt it).
Let me assure you that there would be hundreds of excellent candidates who would be thrilled to accept the medical school spot of those pre-emptive conscientious objectors. The OMSAS website gives a breakdown of the number of medical school applicants vs. number of spots. In 2014, there were 6593 applicants and 954 spots. I wouldn’t worry too much about causing a future shortage.
You are clueless in your first sentence. You doubt it because you aren’t one of the “conscientious objectors”. If you want to know what the secular humanist water is like, don’t ask the fish. Growing up in a Christian family in Ontario, I was warned by my father against occupations in law and politics because of the difficulty of keeping the faith. At great personal cost–in Canada we would have been considered poor–he sent me and my five siblings to the private Christian school where he was paid less to teach than his public school counterparts. We don’t work on the Lord’s day so many jobs we can’t apply for. We are discriminated against by Ontario’s law society. Large corporations discriminate against us. Since we refuse to kill people–according to a centuries-old church doctrinal standard, even helping to kill somebody is murder–family medicine is now closed to us. Ironically enough, we are the ones who have large families and know best what they need. You are clueless! This matter of referral will go to the courts, but because of the intolerant secular humanist state religion, I am not hopeful about the outcome.
Are you saying that people who hold a specific belief contrary to what is supported by this policy draft are better to be filled by people who do not have a conflict with this policy? Is that not discrimination based on religious or moral belief? Think about that you are saying.
I agree that self-referral is part of the solution here. Part of what we need to do is minimize the occasions where there will be a conflict between physician and patient values — self referral for contentious services will partially address that. However, as other commenters have said, self-referral or a public list of alternative providers does not go far enough towards ensuring that patients have the knowledge and access to standard-of-care services that is their right.
I don’t think anyone takes asking a physician to act contrary to their conscience lightly. It is something that we should avoid wherever possible. However, when no reasonable alternative exists, I think we need this provision in place to protect the more vulnerable party in the relationship.
You speak of “protecting the more vulnerable party in the relationship”, and yet you give no concrete examples. Here are a couple concrete examples:
(1) Abortion kills children. They are very vulnerable, especially before they are born, and their extreme vulnerability is the reason that God designed for them the womb. This draft policy can only increase the number of deliberate abortions and make all doctors complicit in their deaths.
(2) Euthanasia kills people who are extremely vulnerable, whether because of age, suffering, disease, or spiritual condition. This draft policy can only increase the number of people euthanized if euthanasia is legalized.
Clearly we need to SCRAP THIS DRAFT POLICY in the interests of a more compassionate society and more compassionate medical profession that protects those who are most vulnerable.
One grotesque characteristic of this draft policy and much commentary in favour of it is the false antithesis it manufactures for doctors between following one’s conscience and protecting one’s patient. This disfigurement is rendered odious and evil by the fact that the conscience rule at stake here is exactly that which protects those most vulnerable from being killed. When God punished the world for its violence with the Flood, He afterwards instructed the conscience of our ancestors in the words of this very old verse and basic principle of justice: “Whoever sheds man’s blood, By man his blood shall be shed, For in the image of God He made man” (Gen. 9:6).
So hold the doctors hostage because the the country hates babies? This is the line of civilation. You kill the weakest, most vulnerable members of society and feel we are any better than the terrorists? One day people will look back and say how could we be so lost?
Although the patient has rights, but so does the doctor. Even if a patient wants to be euthanized, who will do the euthanization? Who will prepare the dose? Who holds the power over someone’s life or death? Why should it be easier to kill someone when they want to die, than when they want to live? Who will be left remembering those they have killed? Can they be certain that is what the patient really wanted? When people are suicidal they are not considered mentally competent. So when someone is begging for death aren’t they asking for the suffering to end?
In the 21st century, with all our medical advances and equal rights we still have people suffering and I don’t think that it’s going to change. But is the way we are going to handle it as the human race to kill off those who can’t take it any longer. I think there must be something better that we can do. To reach out to those left a lone in the hospitals and change the structure of health care. Not just to treat the disease, but that patient as a whole.
Absolutely!
To be in agreement to or encourage an immoral act is as reprehensible as doing the act.
If I have to decide between my conscience and the College well….. so be it.
I agree that doctors ought to have the same right as other Canadians to live and act (or choose not to act) in accordance with their own conscience. Even if a patient has a right to die, that should not force the hand of a particular doctor to cause that death.
I think I understand where your concerns are coming from, but I don’t think you’ve framed the whole complexity. There’s also moral issues relating to what happens to the patient when you don’t refer them. What do they do? Where to they go? What could happen to them?
Refer them for what? CPSO is devising hideous complexity to obscure simple fundamentals that they want to ignore:
(1) It’s wrong to kill pre-born children. (No, you can’t ask what about ectopic pregnancies. They aren’t the reason for this draft policy. I know because my cousin had an ectopic pregnancy.)
(2) Doctors aren’t soldiers or executioners. They shouldn’t kill people.
(Again, the relatively rare ectopic pregnancy isn’t relevant here.)
(3) Whoever’s doing something–whether he’s a doctor or not–should not do something wrong. If it’s wrong, then it’s wrong. The real question is whether it’s wrong. And, yes, abortion is wrong.
Now I answer your questions about the pregnant patient who has no referral, and as you will see, there’s nothing wrong here, only that which is good and right:
(1) What does she do? Continue to do what she was doing: be a good mother and nurture her child.
(2) Where does she go? To a pregnancy care centre. My sister works in one and helps save babies who would otherwise be killed. It’s funded by people who truly CARE, not by tax-payers under compulsion to support “reproductive health care” (what an evil and despicable euphemism).
(3) What could happen to her? She will go to the hospital, and the doctor will deliver a baby. Now that’s part of his job description!
To the CPSO if not to you–stop butchering the English language! You do it to justify your butchering of people (in the name of “dignity”, another word you have butchered). Obviously–and more importantly–stop butchering people, too.
There are many doctors that would willingly perform the procedure if a certain physician would not. This is not a moral issue- unless perhaps the conscientious objector physician was the only one. And even if that was the case, a physician that cared enough about a patient to say no to a procedure they believed to be wrong or harmful would also ensure that the patient was told of alternative options.
“A physician that cared enough about a patient to say no to a procedure they believed to be wrong or harmful would also ensure that the patient was told of alternative options”–like a crisis pregnancy centre? Killing the child is, of course, not a valid option.
I so agree. If the College is so interested in making alternate physicians available to the public, then let them put together a list that is accessible to the public. Why force a doctor to become involved in a decision that is against his morals?
It isn’t just finding another physician (although that is part of it). It’s about transfer of knowledge: docs (usually) have it, patients (sometimes) don’t. It’s unfair and unjust to expect patients to know where to find that information on their own. If providing an effective referral is as simple as directing your patient to a list of providers that is available online: great! But it is still the duty of a physician to inform that patient about where that information can be found.
“It’s unfair and unjust to expect patients to know where to find that information on their own”–It’s orders of magnitude more unfair and unjust to KILL patients or to help to kill them by referral. It is still the duty of a physician to heal the patient, not kill him.
Well said! An analogy may help: Suppose I’m an accountant and a client asks me to help him cheat on his taxes. I refuse. Could I then in good conscience refer him to another accountant who doesn’t share my scruples and who would help him cheat? Obviously not. But suppose the association of accountants required me to make that sort of referral? Clearly the association would be violating my conscience.
I agree. Physicians PROFESSED to heal and not to kill. Physicians should be working together as they are trusted by their patients to take care of them and to find cure for their illnesses. Physicians go for extensive studies to find cure. Their Moral Conscience reveals to them the value of life and that is what they professed. Physicians who value life values the dignity of humanity. Killing will not resolve the problem it will just add more problems.
It is INHUMAN. Physicians who supports Euthanasia fails what they professed. They are not Physicians but EXECUTIONERS.
So much for freedom of conscience in our country: this draft violate doctor’s Charter rights. For instance, it will force doctors to refer for euthanasia regardless of their moral, medical or religious conscience.
They realize immoral practices need to include referral prohibition
“…Further, physicians must not refer patients to any person for the performance of FGC/M procedures.
The performance of, or referral for, FGC/M procedures by a physician will be regarded by the College as professional misconduct.”
Or…they will force a doctor to refer to sex-selective abortion
yet, They will impose referral depending on what? who is the arbiter what is obligatory or not? A moving target indeed and a dictatorship has been born
If the CPSO has decided to create an obligation to refer then it needs to better define the limits of that obligation. I object morally to infundibulation, as does most of the profession. Patients may request this procedure for religious or cultural reasons. There are physicians in other parts of the world willing to provide the procedure. Do I have an obligation to refer since I can’t deny access on moral grounds?
I object morally to vagina rejuvination surgery. I am aware of physicians just across the border in the US who disagree and patients request referral to those physicians. Am I obligated to refer?
The obligation to refer needs stated limits. Perhaps it should be limited to care which is available in Ontario or within Canada. Perhaps it should be limited to care which at least a significant minority of Ontario physicians beleive is moral and which they are willing to provide
If you have a moral objection to infundibulation and vagina rejuvenation surgery, then why would you help patients–by referring–to have these evils done? Aren’t you being a hypocrite by saying, “The CPSO made me do it?”
Or maybe these evils are only a little evil? Maybe you’re not sure they’re evil?
Take an example where the stakes are higher. Abortion is the killing of a pre-born human being. In God’s eyes, I’m an accessory to murder if I refer the mother. Whatever the CPSO says, I may not refer.
Physicians have an obligation to practice according to Canadian standards of care. THAT is the limit implicit in this policy. It’s irrelevant what those standards may be in another country.
I do not believe that the moral views of any minority should define the legal code under which all of us must operate.
Please openly state what you do believe. Should the moral views of the majority define the legal code under which all of us must operate (or die as the case often is with the pre-born)? How much should precedent–as in English common law–play a role? Surely you realize that the legal code is a moral teacher and that if we are not to have anarchy we cannot help but legislate morality.
Don’t you think it perhaps somewhat extreme to force healers to kill patients, whether recognized as such or not, and to justify this coercion on the (im)moral views of the secular humanist majority? How utterly intolerant and discriminatory!
Physicians who are not prepared to offer ALL services that fall within their area of competency (specialty) should not be licensed to practice medicine. They should rather be directed to become ministers/preachers/pastors instead.
You might as well say that theological students who refuse to blaspheme God should not be licensed to preach and not be ordained. Abortion and euthanasia are to medicine what heresy and worldliness are to the church. It ALL depends on what you call a “service”.
Anyway, why do you imply that your doctor is your slave? Be thankful for whatever services he does offer. He can be up-front about them. If you don’t like him, find another doctor–or become one yourself.
They have the right to follow their moral and religious beliefs!
Do we not have freedom of speech? Of religion?
The patient may find another physician.
We need to be very careful when stating that something ought to be done. Saying that something should or should not be done implies that there is a self-evident or absolute standard of right and wrong. Who set this law, this standard? If we are basing our opinion on arbitrary and/or mutually agreed-upon standards, then these are all equally valid and subject to discussion. I contend therefore that each individual should be allowed to work in public according to one’s conscience. It is against my conscience to refer a patient or client to have a procedure or treatment that I feel is ethically or morally wrong. As a crude example, it is equally wrong to murder someone as it is to hire someone else to do it. So for me to refer someone to have an abortion carried out is equal to performing it myself. In this diverse climate we must respect one another’s beliefs and must not force one another to act against one’s conscience. We must find common ground to be able to coexist and thrive. In this era of increasingly diverse culture we must recognize that there are areas that will remain contentious. In these instances we must not force physicians to act against their conscience but rather enable services for the public to access. There are self-referral clinics where a woman may access a physician for an abortion. Why must I be forced to make a referral for the same? And who wants a physician who is willing to act against their conscience?
I disagree, not for moral reasons but for practical ones. If I lack the knowledge or expertise to perform a skill that theoretically falls within my scope of practice (e.g. a family physicians who does not perform joint injections), that should not disqualify me from practicing in ways that I do feel I can safely and ethically perform. That said, it would be inappropriate for me to withhold a therapy that is the standard of care from my patients, which makes referral a reasonable option.
It is not reasonable to refer to another hitman. The immorality of such referral is also very practical and easily understood–and indeed recognized in our legal code–whether I do the killing or ask somebody else to do it, the victim still dies.
Re: Article in Toronto Star titled – “Anti-abortion doctors must refer patients to another physician, watchdog says” – dated Dec 11, 2014.
This move has to be seen as a propaganda to force all doctors to be supporting abortion. Leave alone human rights, this is violation of a doctor’s professional ethics. More than that this is a move to strip human beings of anything called personal values, by penalizing. Yes, to a doctor to support a life, will become digging his own career a grave.
We should learn lessons from the past, how the left wing propagandists have lied over and over to make people believe that a lie is a truth and how it has lead nations to destruction.
By the way, abortion is evil. It will not do any good to Canada, as we can see that we have to import tax payers (myself included) to keep this country going.
I do not agreed that doctors should have to refer their patients to another doctor for treatment that the doctor opposes on religious or moral grounds. The doctor should be REQUIRED TO PROVIDE TREATMENT regardless of their personal beliefs. There is no need for “balance”. Religion has no place in medicine, and a patient’s right to swift and appropriate care TRUMPS a physician’s personal religious/moral beliefs. If a physician does not agree with this they should surrender their license to practice medicine in Ontario.
Then why is one of the two patients never provided appropriate treatment in every case of abortion? Remember that the Ontario Human Rights Code does not allow discrimination on the basis of age.
What you fail to realize is that not every physician refuses to provide certain services based off of religious beliefs. There are many non-religious people who may be against abortion for ethical values, or even certain physicians who are against birth control for environmental reasons.
Don’t assume that religion is the sole thing physicians base their values and beliefs off of.
Not every physician who refuses certain services is doing so because of religious values. There are many physicians who refuse based on their personal beliefs and values.
For instance, not every Pro-Life physician is religious, many may not agree with abortion due to moral they chose.
Another example could be refusing to prescribe birth control for environmental reasons, as there are studies showing increased hormone levels in waters which affects animal and plant life.
Please don’t assume that physicians refuse simply because of religion – there are many reasons and justifications, and this should be a RIGHT that physicians have.
Many physician’s have an understanding of conception and the reality of when life begins, based on scientific evidence. Their decision to refuse is not based on religion but on the basic principle and respect for life and humanity. You don’t have to be a member of a recognized religion to object to abortion or assisted suicide, you just have to be human.
I totally agree!
Everyone, including physicians should have freedom of conscience as long as it does not harm another person. This is not necessarily freedom of religion.
Exactly — unfortunately, the consequences of allowing physicians to refuse to provide information or referrals on moral grounds DOES harm others (patients) when it poses a barrier to accessing standard-of-care medicine. This policy is intended to protect patients, which is what we as physicians are called to do.
The question posed by the OB/GYN above is irrelevant to the policy above — FGC/M is NOT standard of care in this country, nor is it supported by reliable evidence in any country.
When all else fails, change the English language and have words mean the opposite of what they originally meant. What adherents of the Christian religion have been resisting –and what adherents of the secular humanist religion are requiring in the draft policy–is “provision” of abortion, euthanasia, and sex change, all of which involve killing or mutilation of the human body (like FGC/M). To call them “standard of care” and “protection of patients from harm” is deceit and depravity.
I agree!!! Our charter of rights states that everyone in our country has the right to do what he/she thinks is morally correct as long as it does no harm to anyone else. By taking this right away physicians patient care is being compromised because when someone is forced to act against their conscience they are certainly not giving the best service they can.
We have freedom of religion in this country. It’s right at the beginning of the Charter. It means freedom to act (in your personal AND your public life) according to your religious beliefs. I suppose you must disagree with the Charter – not to mention the foundational values of our civilization.
The beginning of the Charter (section one) actually states that while Charter rights are guaranteed, the government has a right to reasonably limit the Charter rights of an individual to serve/protect the rights of society at large. As such, this policy is consistent with the Charter because while it does infringe on individual physicians’ right to freedom of conscience, it protects society’s right to health care and to their own freedom of conscience.
I am interested to see how long it will take for a Charter challenge to be brought on this issue as I am certain that one will be coming if this draft policy is enacted. I will clarify that I am in support of the policy but it’s quite clear that that position is not unanimous.
That phrase “reasonably limit” is most unreasonable and as bad as or worse than the “notwithstanding” clause. Real rights, as they were originally had in Canada, are possessed by the individual in relation to the state, to protect him from the power of the state. The newer rights, which are expressed negatively (“freedom from discrimination on the basis of…”) and based on group identity actually work to undermine and eradicate the old rights which developed over centuries of legal practice. Increasing the power of the state, these newer rights are expressed in both the horrible Charter and the even worse Ontario Human Rights Code, and they are the basis for this new draft policy.
This post is among the most concerning I see on this forum. Please understand that there are a number of very important issues on which we do not have consensus in this country! Euthanasia, for example, remains a highly contentious issue. Chances are very good that this will be legalized soon, based on a majority vote. But the majority, if/when it comes, will not be overwhelming. There will still be a very significant minority of both public and physician citizens that cannot agree with this procedure. But, soon enough, it is quite likely that it will be considered part of ‘appropriate care’, which we call ‘standard of care’ within the profession. So, where majority rules but as many as 48 or 49% disagree, do we obligate everyone to perform the procedure?
I believe this would be truly insane behaviour. To deny the rights of a conscientious objector on the basis that the majority says something is okay and legislates it into standard of care prevents the voice of conscience from speaking up when our society is going the wrong direction. And there are absolutely things going on in medicine today that large numbers of physicians believe are the wrong direction. As a family physician, denying my right to object when I’m asked to do something I truly believe is wrong (including euthanasia, as an example) will either smother my conscience (which is absolutely required for my daily practice of good medicine) and injury my humanity or force me to leave the province and practice somewhere that my conscience is allowed to remain intact.
There are some issues upon which I do not think we will ever reach consensus. Many of those raised by others in this discussion thread fall into that category.
However, I don’t think that an interaction with a patient is the best place to be airing your conscience. Choose a different, more appropriate venue that does not expose your patient (and your relationship with that patient) to potential harms that may result from your objection.
As a physician, I can and do provide care for people who have different belief structures than I do. Like it or not, that’s part of the job. It’s no more my place to direct someone’s cancer care towards palliation instead of active treatment than it would be to exert undue influence on other consequential decisions in their lives. I hold my beliefs no less passionately than others, but part of the sacrifice that is asked of you when you choose this profession is to sometimes put your patients’ needs above your own. This policy document merely makes that implicit duty more explicit.
An interaction with a patient is certainly not the best place to be disobeying your conscience and what you know to be wrong. Choose a different venue that does not expose your patient (whether or not he is born) to potential harms that may result from questioning your conscience.
As a physician, you can and do provide care for people who may or may not have different belief structures than you do. (Note that pre-born people have not had a chance to create belief structures.) Like it or not, that’s part of your job. It’s no more your place to direct an expectant mother to an abortionist than it would be kill the child yourself. You hold your beliefs no less passionately than do others, but part of the sacrifice that was asked of you when you chose the medical profession is to sometimes put your patients’ needs above your own–no matter how young, weak, and insignificant you might find your patients to be. This policy document is absolutely worthless in helping you make that sacrifice.
I would ask you: Have you ever killed anything? Anyone? How have you the right to ask anyone to do that on your behalf? Treatment is pain management and care.
This is NOT good enough. What you’re doing is allowing a licensed medical doctor to put their personal choice ahead of that of the patient, showing an absolute disrespect and disregard for the patient’s care, health and well-being. Any doctor doing this should be mandated to also report to the College and face disciplinary action and sanctions up to and including the revocation of their medical license. If a doctor can’t operate by putting the needs of the clients first then they shouldn’t be allowed to practice in Canada. Do you understand how vulgar your acceptance of this is? Imagine if a licensed financial advisor with decides that they can only recommend to a client the highest cost funds because otherwise it impacts their paycheque!? The analogy is the same. It’s wrong.
The needs of the patient (not client) is their health and well-being based on the professional judgement of the doctor. If the doctor believes that providing drugs or surgery that could cause death or severe harm is inappropriate, then the doctor should not do so, nor should (s)he refer to someone who will disagree with her/him.
The patient’s health and well being is NOT based on the judgement of the physician, but instead is based on the patient’s own decisions regarding their well-being. This is autonomy, the first ethical principle that physicians are sworn to abide by, so long as the patient is able to understand the implications and consequences.
Really? This is the first (and hopefully last) time I’ve heard of a Patient Autonomy oath that all physicians take. But I’ve often heard of the ancient Hippocratic oath, the essence of which is to first of all do no harm. It included the promise not to cause an abortion, which is, of course, harm.
Autonomy is only one of the pillars of bioethics. It is not the only.
Beneficence: promoting what is best for the patient
Non-maleficence: do no harm
Justice. Resources are limited; you cannot cure everybody and so priorities must be set (hence the notion of triage) is what the patient asking for fair?
“Ethical issues arise when not all values can be respected. The values in conflict must then be prioritized and the essence of ‘doing ethics’ is to justify breaching the values that are not respected.” (Margaret Somerville, November 2008)
What kind of doctor would one be if they could not conscientiously object? One that would lack integrity and honesty. How many of us would feel secure in the hands of such an individual.
The practice of medicine is inherently a moral and ethical endeavour. The effect of this policy as stated would be the exclusion of a large segment of society from the practice of medicine, leading to the silencing of voices of dissent in ethical and moral matters as they relate to medicine. This would be a great risk to the public safety, as important checks and balances would be removed.
Contrary to the College’s mandate to protect the public, this policy will lead to vulnerable individuals being put at unacceptable risk, as advocates within the system will be silenced.
I don’t think it’s a secret how challenging it is for many people to access primary care in this province. There are 900 000 people without a primary care provider, and many thousands more who have one but have to wait weeks or months to actually get any time with that provider. To suggest that when your doctor’s morals collide with your right to health care that you should just get a different one is highly unrealistic and unhelpful.
I don’t think it’s a secret how challenging it is for many pre-born people to survive in this country. There are annually 100,000 such Canadians killed. To suggest that when your doctor’s morals LINE UP with your baby’s right to life, you should have both destroyed is highly unrealistic and evil.
Doctors aren’t retail employees providing services from a menu. They are professionals giving advice to patients (who can then make their own decisions). Medical advice is almost always both scientific and moral in character – since you are making a moral choice for health over pleasure in many cases. So a physician has a right to decline to give what they consider immoral treatments (including referrals).
How can this be possibly be a good compromise between physicians? If a doctor, for religious grounds or moral grounds, feels abortion is wrong, be expected to tell a patient to go to see Dr. X and have him kill your unborn baby.
Consider other cases. “If a doctor, for religious grounds or moral grounds, feels” blood transfusions are “wrong, be expected to tell a patient to go to see Dr. X and have him” transfuse blood to save your life.
What about a physician who becomes a follower of Christian Science, who believe “that sickness is an illusion that can be corrected by prayer alone.”? Should they be allowed to deny a transfer to another doctor because they feel it is morally wrong to provide medical care rather than prayer?
An MD that feels practicing “M” is immoral? Can you imagine the patients lining up to make this their doctor, the one who does nothing, nothing, but pray for them?
Quite the hypothetical! Why that adherent of “Christian Science” would ever–and how he could ever–become an MD in the first place is beyond my comprehension.
Why don’t we imagine a more plausible scenario? What about a physician who is a secular humanist, who believes the value of a pre-born person’s life is almost nothing? Should he be allowed to kill a baby because the mother requests an abortion?
Why? Why should your secular humanism have precedence over my Christianity? Canada was –and in some ways still is–a Christian country. If you know all four English stanzas of the Canadian anthem, or even just its chorus, then you will know what I mean.
But your answer is inconsistent even with your own standards. You are discriminating on the basis of age. I’m not talking of an artificial legal world; I’m speaking of reality–life as it is lived–in which every human being has age after conception.
If a physician became a follower of Christian Science, believing “sickness can be corrected by prayer alone”, why would he remain a physician? Is pregnancy a sickness or illusion? Old age?
Are you kidding? I was an RN for 45 + years. For all of that time I knew that I had to refer to another RN when caring for a patient who wanted services I could not provide due to moral beliefs. FYI I do believe in choice for abortion services and in birth control.
Whom do you think you are kidding? Your “moral beliefs” do not amount to much if, as you have implied, you are unwilling to act on them. You revealed your guiding principle of conduct when you wrote, “I knew that I had to…”
I know that I have to love my neighbour, not kill him–and whether or not people call the killing “abortion services” or “birth control” makes absolutely no difference.
When the CPSO’s expectations differ from God’s, whom do you think the Christian physician will follow?
The provincial government and CPSO are essentially trying to convert all physicians–and therefore, patients, too (because we’re in a system together)–to the state religion of secular humanism.
The Supreme Court has determined that human rights are not absolute. I believe that when studying human rights, this is not always obvious and depends on the perspective and narrative provided. I believe the Supreme Court is acknowledging that human rights often conflict with each other, and this problem with not go away with the current approach.
For example, a young female doctor who worked in our group left her practice recently, and I believe she did this because she felt uncomfortable dealing with certain patients. Did she have the right to refuse to accept patients who made her feel uncomfortable? Not having this problem dealt with resulted in all her patients suddenly losing their family doctor and being extremely unhappy with the alternatives presented to them. We now have another young female graduate working with us, and I question whether the same problem could develop. If she is allowed to accept only patients she is comfortable with, I believe she will be happy and so will her patients. If she is forced to accept patients she is uncomfortable with I question whether she will also leave and practice in an area where she feels more comfortable. If she is forced to accept patients she is uncomfortable with I question whether there is more potential for conflict and adverse outcomes.
The area our group practice services is very eclectic and multicultural, and also has a substantial amount of poverty and social problems. The new graduate female physicians involved are both members of visible minorities, and I felt they would understand the unique types of problems some of our patients experience.
Do these physicians have the right not to feel uncomfortable, or in only taking patients they are comfortable with are they discriminating? Could they be discriminating in an unprofessional way, or is this just an example of rights conflicting with each other? I found it ironic that the physician who left could could “discriminate” in a completely professional and acceptable way by quitting the practice altogether and simply moving to another area where she is less likely to encounter patients who make her uncomfortable.
Here is another example of rights conflicting;
A patient I have never seen before recently came into our office with no appointment and demanded to be seen. They demanded I authorize medical marijuana for them, and demanded I don’t withhold treatment. I felt they were being coached by a company which produces medical marijuana. I felt his case was outside my scope of practice. He then demanded I refer him to someone who would prescribe him medical marijuana. Am I “withholding treatment” if I refuse to prescribe medical marijuana or refuse to refer him to someone who will? In this context, I oppose some of the expectations/ statements in the colleges draft policy on professional obligations and human rights. In most cases and situations the draft guidelines are reasonable, but there are situations and contexts where I would want the freedom and the right not to have to follow the expectations.
When the Supreme Court ruled that human rights are not absolute, I believe they were saying that they can definitely conflict with one another, and one person demanding their perceived human rights from another can paradoxically violate another unwilling persons human rights.
I believe the college should proceed with caution in this area, because informing people of rights they have which are not absolute, but are relative, can embolden and unintentionally misinform the public into believing they have something they may not have (depending on point of view and context of each individual, unique situation) and this could cause many unnecessary complaints and conflict involving the college in the future.
It is entirely possible that despite the draft policy being clear, it could be challenged by a physician in the future and found to have violated an individual physicians rights. See previous comments/ examples in this comment.
Thank you for the opportunity to participate, I am honestly providing my input in the hopes of improving professional relationships between the college, patients, and physicians.
Is there any way that physicians can demand a vote on this draft policy? Your comment that a physician may be able to challenge the policy in the future made me think: Is there any way to stop this now? The draft as I read it reduces the high calling of a physician to a clinician: follow the rules, bow to the powers that be and keep your brain in check. So very sad that the CPSO is making it even more difficult for doctors today. I can’t imagine after all that you went through to become a medical doctor in this country, that you now have to be hand tied and silenced, Shame on you policy makers. Let these doctors work with the “First, do no harm” policy and let them become the great men and women they are destined to be.
So if someone comes to me asking me to kill someone, but I refuse because I believe that murder is morally wrong, I have to refer him or her to a hit man that I know will do it? This is the same thing as forcIng a doctor morally opposed to abortion to refer his or her patient to a doctor that willer form the abortion.
Yes … because an individual doctor is not allowed to decide that abortion should not be provided to a patient. Abortion is legally available in Canada and has been for years. For a doctor to both refuse to provide said service AND refuse to provide a referral, they are standing in the way of a legal right of Canadian women. The law is not made nor interpreted on the individual level, but on the societal level.
Abortion is the killing of a child. Canada has no abortion law. It should have a law against abortion because killing people is murder. Doctors should heal people, not kill them.
And even in the D&C for the relatively infrequent ectopic pregnancy, the goal is not to kill the child but save the mother. Otherwise, both will die. An ectopic pregnancy truly is a disease.
If “society” feels so strongly that X is a fundamental right, “society” can simply remove the artificial barrier of referral so that patients can avail themselves of X. This already happens with abortion and can happen with other services as well, without putting objecting physicians in moral hazard.
Of course none of this is about removing barriers. It is about forcing a political and philosophical viewpoint on physicians and eliminating dissent.
It’s not just about the referrals. It’s important to provide patients the information they need to know what their options are for any given health problem. Sometimes patients don’t even know that a particular therapy or treatment is a possibility for them — how can we expect them to self-refer for that?
I agree that certain services should be available on a self-referral basis to further minimize the number of ethical conflicts that arise from the need to obtain a physician’s referral. However, even where self-referral exists, it is still critical to make explicit the duty to provide information about those options.
Some physicians apparently don’t realize that what they call a “particular therapy or treatment” is wrong. I’ve noticed that supporters of the draft policy generally speak in generalities and rarely speak of specifics. Here’s one specific: abortion is wrong, and it’s just as wrong for somebody else to kill the child as for me to kill it.
Just do your job, doctor! And take this hint: killing us is not part of your job description.
Totally agreed. Murder is murder including to those yet not born and to those who are terminally ill. Assisting (including referring)in this murder in any way makes that person an accessory to the murder. Doctors want to help their patients not hurt them. If in the case of pain in terminal illness the doctor will do their best to ease the suffering. It is hard to see someone like this but it is not up to us or them when their life should end. A doctor should never have to go against his/her moral beliefs which is a fundamental right in this wonderful country of ours.
I believe that the language where a doctor can be forced to perform against his beliefs should be clearer and indicate that this compelling must only take place under LIFE THREATENING CIRCUMSTANCES. Any less criterion would leave room for loose interpretation leading to situations where a doctor is forced to violate his beliefs over a relatively minor patient risk.
The Ontario Human Rights Code protects Ontario residents from discrimination on the basis of age. The Ontario physician may not kill a baby at the request of its mother. Remember that every pregnancy involves at least two patients.
What circumstances are LIFE THREATENING? Every abortion results in the death of a child. Many abortions are justified on the basis that the quality of life of the mother is threatened.
I disagree — sometimes referrals need to happen within a particular timeline (e.g. for prenatal serum screening), even if the issue is not life threatening. I don’t think “life-threatening” is broad enough to accommodate services for which time is of the essence despite the lack of life-or-limb emergency.
Your example only reinforces the argument for changing the wording to include only life-or-limb emergencies. What urgent need is there for prenatal screening except to kill the child if he is found in some way to be defective? No doctor should be compelled to offer a service in which the only difference with not offering it is the possible killing of a patient, who would not have died without the “service”.
The tests we use become less accurate after a particular gestational age, irrespective of what patients choose to do with the information. Many of my patients have chosen to have the testing, knowing in advance that they could never reconcile an abortion with their personal beliefs but wishing to have information that will help them prepare to be the best parents they can be to their particular child.
I hope that helps to clarify the “urgent” requirement in this particular example.
Some of the tests in themselves carry a risk of harm to the baby. I know because as a parent I was presented with just such a scenario after the triple test (not at all dangerous). Knowing that I would never kill my baby, I decided not to take further tests which might harm the baby. The costs are extreme (non-negligible risk to the baby) but the benefits are minimal. Why proceeed?
But I am unaware of any pro-life doctor who would be unwilling to refer in this example. The draft policy needlessly guarantees saving of the bath water (parents’ preparation) and throwing out the baby (forcing doctors to force abortions).
Why doesn’t the policy simply require a means by which all pro-life physicians may be identified to patients as pro-life? That way, any woman who wants to end the life that depends on her for existence, or wants to prevent that life, will know in advance that these “services” should be sought elsewhere, thereby avoiding any obstacle to the putative “care that is urgent or otherwise necessary to prevent imminent harm, suffering, and/or deterioration.”
I think taking steps to minimize the moral conflicts (e.g. allowing self-referral, publicizing physicians’ personal policy on the provision of certain services) is an important piece of the solution, but would be inadequate to fully address the issue. Seeking services elsewhere isn’t always possible or feasible.
“Seeking services elsewhere isn’t always possible or feasible”–and this draft policy, both in principle and practice, assures that they won’t be! How will I be able to get a doctor I can trust in ten years’ time? Your ridiculous policy will drive out all conscientious doctors and replace them with true believers in the secular humanist religion and with cynics who can play the system to their personal profit. I don’t want a doctor who can’t talk frankly and openly with me about what he believes and what he can and cannot do as a result. Keep out of my life, CPSO! I don’t trust you secular humanists, but I do trust the pro-life doctors I have had.
I believe that the The Hippocratic Oath should take precedence when a doctor is faced with a life threatening situation, wherein a course of treatment may violate their own moral/religious/etc “code”.
If a pregnancy imminently threatens the life of the mother and terminating said pregnancy will save the mother’s life, I feel that any doctor should provide this emergency procedure, regardless of personal belief.
Putting the patient first is paramount when practicing medicine, in my humble opinion.
I support “freedom of religion” and other associated freedoms, but if your “personal code” so restricts you from considering the welfare of the patient, perhaps a thorough review of your commitment to patient care is in order, and, perhaps, a career change too.
I don’t want doctors to take a “Hypocratic” Oath so that they can do what a patient tells them to do. A doctor is a human, and has moral values, i.e. understands that some things are good while others are bad. This has nothing to do with religion. Non-religious persons also have their internal “do’s” and “dont’s”. A doctor that puts patient’s demands first, because the law forces her/him to do so, is not a doctor anymore but just a slave. I do not want to be a patient of a slave,that will give in to my “demands”. The proposed new policy is VERY WRONG. It will destroy trust between patients and doctors.
“A thorough review of your commitment to patient care” includes these considerations: a Christian doctor’s faith is, in fact, primarily what motivates him to consider the welfare of his patient in the first place; every pregnancy involves at least two patients, the mother and her child; (euthanasia will eventually be used on those deemed to have insufficient quality of life; and secular humanism is becoming quite unhinged from reality.
I think this policy is a step in the wrong direction. There is an inherent conflict in the policy: The first principle listed states that doctors should act in the best interests of their patients, and then the policy goes on to state that doctors must refer even if they think the requested treatment will harm their patient. How is it in a patient’s best interest to be harmed? Do we really want doctors who will make these referrals? If assisted suicide is legalized, are we saying that doctors shouldn’t try to talk their patients out of suicide and should just refer them to someone who will give them what they want? This policy seems to be missing the larger picture, and it is turning our physicians from healers into healthcare dispensers. I urge the College to reconsider it.
Agreed! This legislation would make doctors go against their principle of helping the patient instead of harming them. Also, how can killing an unborn baby be in his/ her best interest?
The draft policy reads: “Where physicians are unwilling to provide certain elements of care due to their moral or religious 156 beliefs, an effective referral to another health care provider must be provided to the patient…..”
It is not clear weather this is a formal referral by fax to the other provider, or by giving the patient information about how to self-refer and access the other provider.
The example is the walk-in clinic attended by a physician that does not prescribe oral contraceptives. Is it sufficient for the referral to be a list of other area walk-in clinics given to the patient to call and go to; or is the expectation that the physician makes a formal referral for the patient to another walk-in clinic?
Walk-in clinics and abortion clinics operate on a self-referral basis, and a formal referral is not necessary.
“Following orders” was not an acceptable defence for Nazi doctors participating in euthanasia, the world expected that their conscience, their MORALS would have prevented them from obeying such orders.
To now suggest that physicians simply comply with whatever the social norms are in the country, ignoring their own moral beliefs, is dangerous. Social norms can change.
Thank you, thank you! This policy is not about a specific procedure or service, but about the right of physicians to dissent, and protecting this right is of huge importance on a societal level.
We’re not dealing with Nazi Germany culture. But the authorities, cultural trends, or even the majority opinion don’t always get morality right. Things in Nazi Germany fell apart with terrifying speed, starting with the euthanization of one severely developmentally delayed child by a physician on Hitler’s orders, and we need to know, as physicians and citizens, that our College and our courts will back us up if we need to object to something an authority figure, or even the majority culture, says is required of us. Not to do this is, as the previous post said, is extremely dangerous.
You can’t make physicians provide abortions, that goes against the Hippocratic oath, anyone who is supporting this will be accountable to the LAWS of the land. If the board can’t do what is morally right, the only option is to disband the “College”, kick everyone out, refuse to fund it, and start over. I for one would support a class action suit against the so called “College”.
I think this is a fantastic improvement to the policy! If enforced, it will ensure physicians remain professional and respectful of patients’ rights to evidence-based health care in a timely manner.
And the evidence suggests that abortion harms a woman and kills her and its father’s child, improperly prescribed drugs are dangerous for health, and euthanasia kills a patient.
Not allowing physicians to have freedom of conscience is a violation of the Canadian Charter of Human Rights. Of course no rights are absolute, so how can a patient’s right trumps a physician’s, or a College imposes it upon physicians? Someone cannot be forced to do what he or she believes is wrong, or to collaborate in it. How many times physicians have refused to prescribe medications that are requested by their patients based on the ground that they think the drug is harmful to the patient (for example, when drug abuse or addiction is suspected)? Is a referral needed? In the same way, if a physician knows that abortion or contraception is bad for the patient’s health, why would he or she have to provide it or refer the patient? The first principle in the Hippocratic Oath is to “Do No Harm”. The College cannot possibly force a physician to do or to collaborate in what he or she thinks is harmful to the patient, or else it is encouraging the violation of the basic principle of medicine. This does not promote the practice of good medicine at all. Moreover, in a free society, patients are free to choose their providers, and referrals are not needed for abortion. Also, it is against the current national policy of the Canadian Medical Association not to respect physicians’ conscience rights.
No, we aren’t free anymore. I would suggest that we Ontarians are slowly being forced into various things that are infringing on our rights and freedoms. It doesn’t just pertain to this subject, though this is the scariest. Forcing doctors to go against what they believe or value is sickening. After so much sacrifice on their behalf, to have them chose between their profession or what they perceive to be morally wrong (who they are) is disgusting. Haven’t we already seen enough doctors leave our Province?? We don’t want robots taking care of us!!! We want doctors who have values, have a conscience and who are able to make their own decisions. Doctors who we can trust. Doctors who affirm life first, before all other things. We should learn from other countries who have gone one step further and legalized Euthanasia, for example. They have seen terrible abuses already. Anyone who believes that with time abuses won’t take place, is living in a fantasy land! http://guardianlv.com/2014/02/euthanasia-already-out-of-control-in-belgium/
It resembles Alice’s Wonderland. Words mean their opposite. The draft policy is rife with language that defies its plain meaning and common sense. Nonsensario: it’s yours to discover!
“Freedom of conscience” (line 115) means that an expectant mother can have her unwanted child killed (rationale of the Supreme Court in 1988), but it does not mean that a doctor can refuse to help her kill him (line 163) or both (Supreme Court’s decision of February 6).
Why must the doctor help kill them? That explanation accounts for most of this draft policy, but it is summarized in lines 129 to 135. The doctor must help kill this mother and/or her child in order to:
(1) “Respect patient dignity” (line 133). As the pre-born child is no longer recognized as a patient or one seeking to be a patient, he has no human dignity; he is a replaceable commodity like a car part. As for the mother as the recognized patient, her dignity does not refer, as was originally understood–since Canada “is founded on principles that recognize the supremacy of God”–to her original likeness to God in some ways but to her being her own god and–because she is nevertheless mortal–deciding the time and manner of her death. Previously her dignity prevented the doctor from killing her; now (line 143) it can prevent him from protecting her safety and her child’s access to care.
(2) “Ensure access to care” (line 134). “Care” means harm: the child and/or the mother dies. Similarly, “service” in line 164 is the violence of dismemberment or poison injection. “Access to care” for the mother means no access to care for the child. To “ensure access to care” and obey her will, the doctor must disobey her Creator’s clearly expressed will (line 157 cf. Lord’s Day 40 of the Heidelberg Catechism).
(3) “Protect patient safety” (line 135). “Protecting patient safety” means, if anything, killing the child. Although pregnancy is not a disease and her safety is not at risk, the expectant mother is the recognized patient; there’s no concern for the safety of the unrecognized patient, her unwanted pre-born child. Both abortifacient “contraception” and surgical abortion are time-sensitive and therefore can be considered “urgent care” (line 168).
“Protecting patient safety” can also mean killing the mother. She should not have to endure the subjective suffering she believes the future holds for her. “Imminent suffering” (line 168) is also a reason to kill her pre-born child if she believes he will cause her suffering. An hour of “suffering prevention” (line 168) is worth a lifetime of suffering mitigation.
Each of the above reasons represents–without ever honestly acknowledging–the shift from Christianity to secular humanism as Canada’s dominant religion. People are now treated as disposable animals and not individually the special property of a good God. Secular humanism has become so intolerant and totalitarian that it attempts forced conversion of Christian doctors to secular humanism while forbidding them from promoting Christianity when interacting with their patients (line 147). It thereby effectively also imposes on Christian patients accommodation to a pro-death doctor (since it forces out of the profession Christian doctors and other conscientiously pro-life doctors).
Why is the shift so total and the policy’s language so ridiculous? Life is religion. There is nothing more determinative of my identity than my religion. Do I trace my lineage back to a sovereign Creator or to apes? My source indicates my destination. The philosopher Friedrich Nietzsche announced that the West had killed God but wondered whether it would survive without Him. Nietzsche died in A.D. 1900 after a decade of insanity.
“156 Where physicians are unwilling to provide certain elements of care due to their moral or religious
157 beliefs, an effective referral to another health care provider must be provided to the patient. An
158 effective referral means a referral made in good faith, to a non-objecting, available, and accessible physician or other health-care provider.
159 The referral must be made in a timely manner”
To be clear, considering my local walk-in clinic, if there is a physician who is unwilling to provide care because of moral reasons, there should be another physician on hand to provide such care. If this means that the patient has to wait another hour or two because the clinic is trying to use its staff ‘efficiently’, that is not ‘timely’.
“42 Discrimination may be described as an act, decision or communication that results in the unfair
43 treatment of a person or group by either imposing a burden on them, or denying them a right, privilege,
44 benefit or opportunity enjoyed by others.”
An hour to wait imposes a burden on a patient whose physician is unwilling to treat them for moral or philosophical reasons. It is non-trivial.
“138 Where physicians are unwilling to provide certain elements of care due to their moral or religious
139 beliefs, physicians must communicate their objection directly and with sensitivity to existing patients, or
140 those seeking to become patients, and inform them that the objection is due to personal and not clinical
141 reasons. ”
As this communication must be sensitive, simply posting a sign at the front desk is insufficient. Further, it should be explained in advance; when the patient checks in for the service that the physician finds objectionable, they should be informed at that time, not when they see the physician, that the physician will not accommodate their needs.
I feel that, in essence, if a clinic takes on a physician who has such objections, that they must take on a second physician at the same time who does not, who is also available, at a moment’s notice, to be able to fulfill the duties that the first physician is unwilling to. Any clinic that is found to be delaying medical services to patients because they are requesting services that a physician is unwilling to provide, because the clinic doesn’t have sufficient physicians who are willing to provide that service, is infringing upon the rights of the patient through discriminatory practises.
I am certain that, with such a bar set, that clinics will be unlikely to take on many if any physicians with such objections, as the need to provide equal service to all patients will be infringed upon before the physician’s wish not to provide said services would be infringed upon.
“Physicians must communicate their objection directly and with sensitivity to existing patients (line 139)”–and then, if the objection is to performing an abortion, arrange to have another physician dismember the patient that is the child.
Your comment is open to interpretation and easily taken the wrong way.
Doctors do not have the right to kill their patients. The “negative impact and adverse effects” are the deaths annually of one hundred thousand young Canadians.
These doctors abuse their application of medical science and should be kicked out of the profession.
The politicians in Ontario’s government who have been pushing the evil draft policy which is the subject of this consultation should be kicked out of power.
Yes, often a woman will also have physical and/or emotional problems because of an abortion. So now the baby is dead and the mother is harmed. Pro-abortionists don’t talk about these long term effects.
If you’re a doctor, you’re required to provide the services you’re paid to provide, whether or not those services ‘coincide’ with your religious beliefs. This ridiculous double standard is only held up when it affects women. When a married man comes to see a doctor for a venereal disease, does the doctor refuse treatment because the man contracted the disease from an affair? Or refuse him Viagra even if he’s not sleeping with his wife? Of course not. A doctor must provide patient care, regardless of their own ‘personal beliefs’. Do your job or get out of the way of those who will.
You imply that physicians are employees. As a physician wrote at 12:34 pm on December 15, 2014 (currently the comment numbered 29), the overwhelming majority of physicians in Ontario are independent contractors.
Also, many Ontario doctors currently do more than merely refuse to provide care to pre-born children whose mothers do not want them. In fact, the treatment given this very vulnerable minority can accurately be described as poisoning or dismemberment.
Talk about a ridiculous double standard! The mother gets rid of her “product of conception”, and her child gets death. I would suggest that the doctors start again taking the age-old oath to, first of all, do no harm.
Do your job, doctors! College, either repent of your evil policy or rename yourself the Ontario College of Killers, Physicians, and Surgeons.
If a physician discriminates against a patient (as in the example above), sure, that would be wrong. But this policy is about taking away a physician’s right to discriminate against a procedure, for whatever reason, and procedures don’t have rights the way a physician (who is a human, with human rights) does.
My moral and ethical worldview create a canvas by which I will (do) practice as a medical student and future physician. Without the opportunity to express and work within my established worldview, I am ripped of the morals that governed my entrance into the field in the first place. I signed up for this journey of many years of learning because my desire is to serve and honour others.
Without the opportunity to work in the context of my morality, I will be separated from what led me here in the first place. Further, without my morality, how am I to decide and advocate on behalf of my patients? It is my morality, combined with my education, that governs treatment suggestions and recommendations. First referral for abortions and performing abortions, but then what? If I am not able to decide the code I will adhere to while I practice who will decide where/when things go too far? Without a line or boundary, I fear for where the roles of physicians will be extended. The government should not be dictating what physicians do and do not do, it is the physician’s responsibility to determine how they will practice, assuming that all that is done is within the confines of the legal rights of the patient and their best interest.
Impressive statement. You will make a wonderful doctor! Hopefully, you will feel comfortable practicing in Ontario and not feel forced to move away in the future! Good luck!
In my opinion, I feel that not allowing physicians to use their moral and/or religious beliefs as a means to not comply or refer a patient to another doctor is absurd. This makes doctors seem like robots that are under some sort of control and cannot make moral decisions that are BEST for the patient based on what is morally right. What would be the point of a patient coming to see the physician anyway if what they want is their final decision? It’s as if the patient is out rightly forcing the physician to do what they say with no questions asked (i.e. like a criminal who has someone in hostage). As doctors, they have consciences as well and they should have the right to not be a hypocrite and go against their consciences as that should be the foundation of their decisions whereby what they know is morally right is what should be done and not based on what the patient thinks is right. Hospitals and clinics are not fast-food restaurants where “the customer is always right”. Physicians should have the right to voice their own opinion and not have to do a procedure they disagree with nor refer their patients to another doctor to do what they don’t think is morally right to do to begin with. The notion for physicians to throw out their moral beliefs to help a person is wrong and I for one disagree that they should be forced to recommend/refer another physician to do something that is amoral.
I hope the College takes this thought into consideration.
well said.
As a nurse, I could tell you patient centered care which is the rhetoric in many places like the College and hospitals, has at its core the motto that “the customer is always right”. The ministry of health and hospitals have been promoting this dangerous and motto for many years. The reason is not ethics, morality, or evidence-based medicine. The reason is pure and simple politics. The politicians love getting elected and re-elected and don’t care what the frontline workers in terms of doctors and nurses have to put up with. They think patient centered care gets them more happiness with the voters and election results. The Colleges are also just an arm of the ministry. Don’t let the word “self-regulation” fool you. The Colleges always do what the ministry wants for fear of losing their regulation status.
Yes.
It seems we are going from a health care system where there were patients (those who are suffering) to one where there are clients (those who are served).
Let’s make sure we are doing things for the right reasons.
As an advocate of preborn human rights and a parent who has great respect for medical professionals across the province, I highly object to the college’s proposal to discriminate against people of faith and moral conviction and infringe against the religious freedom of doctors and specialists who morally oppose a policy that mandates members to counsel patients to have an abortion or refer patients to seek access to abortion.
The rights of those who advocate abortion should not trump the religious freedoms of medical professionals who support preborn human rights.
some members of the public have wrongly suggested that as “employees” of the ministry or gov, physicians are obliged to do what their employer requires, which in this case they interpret as any non-urgent treatment they desire or to establish a doctor-patient relationship despite the physician’s wishes.
It should be clarified to members of the public that, except in a small percentage of cases, physicians are NOT employees of the gov, ministry of health or the College of Physicians. The College does NOT employ physicians.
Legally speaking, the overwhelming majority of physicians in Ont are independent contractors who bill the gov for the services performed. Physicians are not civil servants, they are not unionized, and they have no employment benefits or collective bargaining rights.
Other independent contractors are most lawyers, accountants, dentists, plumbers, builders, all trades etc. The only difference is that these contractors bill the client directly, and the physician bills the gov for the services provided. This must not give the wrong impression that physicians are employees of the gov. The other independent contractors in the province can choose or not choose to enter into a relationship with a client. You can’t force a lawyer, dentist, plumber, accountant to take you as a client, as they are “independent”.
This is a very important issue that needs to be realized when discussing patient rights v. physician obligations.
It’s sad and disheartening, to find bias, discrimination, even hatred, from a medical practitioner, and the support staff.
To find that my mental health issues, or manner of speech, would have me barred from being a patient.. I am told this happens routinely, to elders, who might have been cherished as wise older ..but instead are told to shut up or get out.
At least you have a keyboard to write your comment, right? Hopefully you also have the ability to find a more sympathetic doctor.
Indeed, it IS sad and disheartening to find bias, discrimination, and even hatred from a medical practitioner and the support staff. To find that one’s stage of development or inability to speak would have one barred from being a patient–I know this happens routinely to pre-born children, who might have been cherished as innocent and vulnerable but instead are forced to get out and die.
That the draft policy would actually increase discrimination and hatred against minorities–what an intolerant and evil thing it is!
There is no way in our society today that ANYBODY should be forced to do something that in their mind is morally wrong. The real wrong here is the College feeling it has dictatorship over doctors in this regard. A rather disgusting draft proposal and very draconian in my opinion.
It encourages doctors to be dishonest with their patients–just as CPSO is being dishonest with its doctors in pretending that they can still be family doctors if they are unwilling to perform or, at least, facilitate abortions.
I have a serious concern that Doctor’s will be told what to do as far as birth control and abortions.
Doctors are suppose to save lives not destroy lives.
This loses my confidence in the medical profession.
Please allow doctor’s to practice medicine based on their moral beliefs.
As a parent in Canada, the thought that a doctor who operates on my child could also be a doctor that just the other day ended the life of another is terrifying because you loose confidence that the doctor has any respect for the life of your child.
Instead of forcing doctors to kill, force them to acknowledge to their patients whether they also perform abortions.
Brave New World is here, and who would have ever guessed that C.S. Lewis’s NICE was actually the CPSO on the other side of the Atlantic? Good doctors don’t deliberately kill people, CPSO. Good colleges don’t compel their doctors to kill people or to facilitate their killing.
The doctors need to talk to patients and their families honestly about patients condition . I know from experience that some doctors do not talk about death with their patients. I know from family experience and being a retired nurse, that patients with COPD receive the worst end of life care from doctors. They wait till there is a crisis before having orders in place to make their death more peaceful. It hurts to be told that your loved one will not make it but it does help if the doctor is honest and explains what is or will happen. Be honest but gentle.
My guess is that the above comment was submitted to the discussion forum for the wrong consultation, but the commenter’s last sentence is relevant here.
Human dignity has as its only origin man’s original likeness to God. Age, size, sex, level of development, ability, etc. are all irrelevant. Because God made man a little like Himself, the pill, IVF, abortion, euthanasia, and anything else that reduces human life to a nameless, replaceable commodity like livestock is an indignity.
This draft policy, therefore, requires doctors to violate the dignity of their patients.
To the extent this proposed policy would require the cooperation of physicians in the destruction of innocent human life, it would be an intolerable abomination which anyone of good conscience should ignore. No less would be a mandate to prescribe contraceptives if doing so would be violative of a physicians conscience. This propose policy is reminiscent of life in the USSR, or in Nazi Germany. In both nations the medical profession was corrupted and put at the service of its state masters. This policy would put the medical profession in Canada on the same course. I strongly urge the Ontario College of Physicians and Surgeons not to make take this immoral and unjust step.
This is the end of Health care if this goes through. How can a real doctor give his all to healing the sick if he is required to kill as well? Please let the doctors go on healing and hire a new bunch of people to do the killing. How can we trust our doctor to help if he kills?
Well said. If we are to speak of a “patient’s rights,” then a right to a trustworthy doctor is more basic than a right, for example, to “contraceptive” prescription from every doctor.
Or, to state things more bluntly, the proposed policy is based on a right of an Ontario mother to a dead child and to have any and every doctor in Ontario do his best to accomplish this end if she so desires. The oath to first of all do no harm has become transferred into a primary commitment to harm. This is insanity.
So the government of Ontario, true believers in their humanist religion, want to drive out pro-life, Christian doctors and replace them with unprincipled, irreverent tools to further the culture of death.
As a future physician, this policy is very concerning. I have heard people say of the medical encounter, that when you enter the room, you must leave your morals at the door. They mean to highlight that the patients values are the only ones that are to be considered. I cannot imagine a practice of medicine in which a physician is not guided by their morals. Their practice would be undoubtedly unethical. This policy is resonant with all crimes against humanity; medicine without morals is dangerous for society. I imagine there were many physicians in Nazi Germany who did not believe in eugenics or in an inferior race or the worthlessness of people with disabilities. One must remember that hindsight is twenty/twenty and history will tell us that we continue to commit crimes against society. A policy such as this, does not protect the physicians who choose to act according to morals rather than social pressures, and thus, does not protect society.
There are much more important issues than access to euthanasia and abortions at the current moment in the medical landscape of Canada. If the CPSO is committed to reining in physicians and removing their rights, perhaps they could put themselves to work on the prescription drug addiction issue.
If physicians feel obligated to provide a service to which they disagree you introduce a physician patient disconnect. The term “caring for a patient” does not simply mean filling an order at a drive through. “Caring” requires a physician to engage in a deeper relationship. I believe if physicians feel obligated to provide services to which they fundamentally disagree with, then they will likely as a consequence have to somewhat disengage themselves from their patients. For example, we all know great physicians who care for their patients more then others. The kind of physician we would refer a family member to. These physicians believe in the care they are providing. They are invested in the well being of their patients. If you force these physicians to change their practice such that they disagree with the care they have to provide. That will create internal conflict that they will have to resolve. To resolve that conflict they may well become less invested in their patients. With physician burnout being a real issue that has cost our health care system many good physicians, I would implore you to see the potential consequences here. You likely know a physician who has burned out in the past, and if you ask these physicians why they quit you’ll see it is largely due to imposed limitations that impeded their ability to care for their patients. This can be a very overwhelming struggle and we as physicians are people too who deserve and need the freedom of choice. Without such a necessary freedom I believe the practice of medicine will suffer. It’s clear your motivation in writing such a policy is with good intention, to improve access to medical care for our patients. I’m afraid however, that you will accomplish the opposite. You may slightly improve access to “medicine”, but you will greatly jeopardize their “care” if you force a physician to disconnect the service they provide from their beliefs.
As social animals humans always create societies with different classes of individuals.
Those who took the Oath of Hippocrates have always been respected, persecuted and punished for seeing humanity where the societies deem there is none. For unlike societies doctors only know of one kind of human being: the sacred kind.
If Hippocrates appeared today he would be unable to obtain privileges from the cpso. If the cpso appeared today before Hippocrates it would not enjoy his approval.
My guess is that 2 millenia hence , few will have heard of the cpso. Hippocrates’ Oath will be used to evaluate us, just as we evaluate our colleagues from societies long past, like Dr. Georg Groscurth.
I have a huge issue with line 168 of the policy. This would effectively terminate my role as a palliative physician working in the hospice setting. Right now I enjoy and pride myself on the fact that I can focus on and improved the remaining quality of LIFE of a patient. This is a serious infringement of physician’s rights.
168: Doctors are required to perform procedures that are against their moral or religious convictions in situations where that is deemed to be “urgent or otherwise necessary care” (Line168)
Forcing doctors to treat patients or refer patients when it goes against the moral and/or religious beliefs of the doctor is not only discriminatory against doctors, it relegates the doctor to a status less than that of other Canadian citizens — or other citizens of the world. If a patient cannot find a doctor to perform the procedure they want, then provide a 800 number where they can call (and provide transportation if necessary) to see a doctor who will perform the procedure. Why force some doctors to violate their conscience by playing a role, for example, in killing people (abortions) when there are other doctors in Canada quite willing to do the killing all by themselves?
Supplying a 1-800 number for getting abortion referrals violates the moral principle recognizing unborn babies as human persons deserving our respect and love.
I consider myself an atheist, and I do myself prescribe birth control and tell patients about abortion clinics, but I still find myself disagreeing with this proposal.
To force a doctor to write out a “referral” to another doctor when all walkin clinics and abortion clinics operate on self-referral is strange and unnecessary. In most Canadian cities, a patient has many choices in terms of walkin clinics, urgent care centers and emergency rooms to get what they want.
This proposal is a slippery slope. If it’s needed for patients to simply ask for a medication and just get it, then they should have the medication available without a prescription. It’s birth control now and next it will be narcotics, antibiotics, benzos, stimulants, etc. So next time I say no to an antibiotic for a viral cold, am I required to write out a referral to another walkin clinic that will give the patient the unneeded antibiotic ?
It seems some posters are turning this into a debate on abortion. That is not what the topic here is for consultation.
I prescribe birth control and refer for abortion, but I still don’t agree with this policy. A physician who does not prescribe birth control or refer for abortion is not violating any patient’s rights. It’s not like that physician is saying the patient cannot call or go to any other practitioner and get this service. Is it anyone’s rights to get something from all doctors in non-urgent situations? Where does it say that in the charter of rights or any other human rights document of this country?
I think the CPSO is opening itself to much litigation by this policy.
Physicians of religious conviction are not going to simply violate their beliefs because of a demanding patient who insists on getting birth control from this doctor and not the walkin clinic across the street. A referral is not necessary for walkin clinics and abortion clinics, almost all of which operate on self-referral basis. Posting a sign with addresses and phone numbers should be sufficient.
It seems that some commenters don’t realize that this debate is very much about abortion, much as I appreciate the additional arguments in the comments at 1:39 pm and 11:49 am.
That’s because every abortion kills a patient currently unrecognized by the above commenter and by society in general. As my Grade 8 teacher would say, “Denial is not just a river in Egypt.”
With that in mind, consider the following three “key revisions and additions reflected in the draft policy” (although all the key changes do apply, these three are the most obvious):
* “The draft policy clarifies that the legal duty to refrain from discrimination under the Ontario Human Rights Code includes a duty to accommodate patient needs, where a disability or other personal circumstance may impede access to care.” Pre-born children have easily recognizable personal circumstances that impede their access to care.
* “The draft requires physicians, who choose to limit the health services they provide on moral or religious grounds, to do so in a manner that respects patient dignity, ensures access to care, and protects patient safety.” That many physicians choose on secular humanist religious grounds to discriminate in favour of the mother in the case of an unwanted child obviously does NOT protect the safety of the child.
* “In order to protect patient safety, the draft policy requires that physicians provide care that is urgent or otherwise necessary to prevent imminent harm, suffering, and/or deterioration, even where that care conflicts with their religious or moral beliefs.” In other words, secular humanist religious convictions are not a sufficient basis to induce an abortion, one of the most obvious examples of “imminent harm, suffering, and deterioration.”
This part of the policy appears to be a political move to eradicate from the medical profession any deep ethical principles in light of which killing unborn babies is seen as abhorrent. “Killing babies is part of our standard of care. If you’re not perfectly happy with that, then get out of medicine.” I agree with your judgment that it seems unnecessary, since a doctor, by refusing to refer a mother to abortion is not stopping her from simply crossing the street and getting an abortion referral at the walk-in clinic.
However, those implementing this policy know that too. Their behaviour points rather to an ideological mission to cripple and silence every moral position opposed to their own.
yes I agree that is certainly what this is- an ideological mission to cripple and silence a moral position – I would go further and call it an arrogant, ignorant, foolish and hopefully futile attempt to suppress the truth and those who embrace it
I suppose the question is whether or not posting that sign would satisfy your duty to “refer”.
Perhaps it should be clarified that the duty is to provide information on what a patient’s medical options are and information on how to access a non-objecting service provider, OR refer when self-referral or going to an alternate provider for that referral is not possible/practical.
The obligations to physicians who limiting their practice based on competence seems to have been equated with those pertaining to physicians limiting their practice based on moral or religious belief. These are two separate issues and should be treated as such.
For example, I am aware from reading comments on this or the previous consultation (the one about doctors and the “human rights” code) that many secular humanist doctors are woefully ignorant about natural methods of contraception. They also provide inaccurate information about it. This incompetence of theirs likely originates in their easy acceptance of “contraceptives” because of their lack of Christian scruples.
It’s important to note here that in addition to all its other harmful effects, the pill is now known to be carcinogenic.
I find it interesting that the policy seems to target physicians religious or moral beliefs more that anything else. For instance does a patient who has a disability have a right to their doctor making a housecall when they have great difficulty getting in to the office? Are they not being discriminated against by having a barrier put in place to healthcare because the vast majority of family doctors refuse to do housecalls. It seems to be okay to punish a doctor for not doing something for religious or ethical reasons but no mention is made of sanctioning doctors who won’t provide services because it is inconvenient to them or they just don’t want to be bothered. All family doctors can make housecalls. How about nursing home care? In my small community once a patient gets admitted to the nursing home the family doctor refuses to provide ongoing care. Nursing home care isn’t rocket science the vast majority of family doctors should be able to provide it but it is okay that they don’t just because they don’t want to be bothered. In my small community I am carrying 90 percent of the load in the local nursing home. For the last ten years I have tried to interest and integrate other physicians in this work but no one will. Often it involves seeing patients at night or on weekends in crisis due to illness or pain. I’m getting quite burned out but I keep doing it because I have a belief that we all have an inherent dignity because we are all created by God and deserve basic medical care. I anticipate that in the next year the supreme court will determine that euthanasia is legal. If this CPSO policy is approved I will have to leave providing nursing home care because nursing home patients are one of the groups that are likely to request euthanasia which I have a moral objection to. Then these patients don’t have care and if they do get a doctor it will likely be one of the few other doctors in the area doing this work who is already burnt out and geographically quite distant from the patients which makes it very difficult to provide care. I am not sure how this helps anyone.
The draft policy doesn’t help anybody except libertines and nihilists. It is also fundamentally dishonest. The authors believe that they themselves have no “religious or moral beliefs”, and yet –as you have pointed out so well–they are such animals that an adult’s sexual drive trumps a child’s right to life and a sufferer’s despair carries more weight than the healer’s oath to “do no harm.” These radical presuppositions are “religious or moral beliefs”, too.
Does nobody suspect that with regard to those in nursing homes, one motivation for the provincial government to push euthanasia–as it does in this CPSO draft policy–is to reduce health care costs? Death panels, anybody? But rest assured that senior citizens can get easy access to contraception and abortion services!
I am concerned about the point in the draft policy that would require “physicians, who are unwilling to provide certain elements of care due to their moral or religious beliefs, [to] refer the patient to another health-care provider.” As a potential patient, I want the freedom to choose a doctor who will not support , in any way, certain elements of care that I believe to be immoral and harmful, such as abortion and gender reassignment. I want this freedom, both as a matter of principle and as a matter of my comfort with my physician that he or she will neither pressure me nor feel pressured by me to discuss those options for my health care.
People have posted comments about whether a doctor should follow the Hippocratic Oath. Here is a link to the actual oath found at the national library of medicine in the USA which would be a reputable site: http://www.nlm.nih.gov/hmd/greek/greek_oath.html
The Hippocratic Oath contains the following:
“I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan; and similarly I will not give a woman a pessary to cause an abortion.”
In general, doctors are no longer required to take this oath when they graduate from medical school. My medical school composed its own oath for our graduation. A group of us took the original Hippocratic Oath which was Christianized in that we made our oath to the God of the Bible.
In order to be true to this oath, I do not refer for abortions and if euthanasia becomes legal, I will not refer for that either. I would be compromising my integrity as a human being to do so. I would no longer be trustworthy.
As a previous physician has mentioned, one does not need a referral for abortion in Ontario. Patients aren’t truly impeded from obtaining the prescriptions or “services” that they want because one physician tells them that they can’t provide that on moral or religious grounds. Most of the time these things are easily available from other physicians.
We have to be careful of making medicine like going to a fast food restaurant. We have to try to live together peacefully in this society where there are many conflicting beliefs and opinions. The doctor isn’t forcing their opinion on the patient by acting in accordance with their moral or religious beliefs. They are being consistent with who they are. One can’t be trusted if they aren’t consistent with who they are.
Why should pro abortion and pro euthanasia opinions trump pro life opinions? This is not consistent with the “tolerance” that our society trumpets as being so valuable.
While it is true that the Canadian Charter of Rights and Freedoms maintains that NO RIGHTS ARE ABSOLUTE ( lines 113-117 of the CPSO document) this is equally true of the right to freedom of conscience and religion as it of patient autonomy. There are reasonable limits to ALL our freedoms. A patient cannot demand a physician perform or refer for services for which the physician is morally obliged to decline. The physician must be respectful to the patient, and the patient must be respectful of the physician as an individual. There are limits to patient autonomy in other areas as well, for example a patient cannot demand a physician perform or refer for services that are not medically necessary, like an amputation of a healthy limb, or removal of a normal appendix. This document in its introduction (lines 4-13) is clearly weighted towards patient autonomy as the most important value, when in fact the physicians moral conscience is equally important and must be part of a humane medical system. It is important to remember that physicians represent a cross-section of the population represented by our patients and by limiting physician conscience we would eliminate our patient’s voices in medicine.
In looking over the most recent draft policy, I am particularly concerned with lines 143, 144, 168 and 169. These concerns are primarily based upon my concerns for not just religious and conscientious freedom, but also for reasons of diagnostic integrity.
Doctors provide not only a consultative role in the facilitation of good health, but they also provide what could be called a “prophetic role”. In other words, a Doctor will often be empowered to state the truth even when the truth is uncomfortable. And in an age given to niceties and mere pleasantries, it is extremely important that doctors fulfill their diagnostic role with some latitude to be socio-prophetic— regardless of whether these pronouncements may look like “judgements”. No one, for example, would think it unusual for a doctor to allude to the proven life-threatening realities of cigarette smoking. So, in this, doctors are free to judge. However, if one were to allude to the proven life-lessening (or self-destructive) elements of certain sexual behaviours, would this somehow be in breach of lines 143 and 144? As long as there are codes that disqualify a doctor from using bonafide science in expressing real health risk (because it might seem “judgemental” or “offensive”) the College policies will be hindering doctors, not helping them do their jobs. And yet I feel it likely that while some “judgements” will be just fine, other truths will be censured.
Secondly, the idea that the College is prepared to coercively compel pro-life doctors to perform abortions, for example, is simply a “bridge too far”. And yet, this is precisely the implication of your draft policy in lines 168 and 169. The present Canadian legal climate, which does not recognize the legal existence (or personhood) of the unborn, will continue to contribute to the systemic abuse of babies in the womb— and your draft policy, without change, will be an accessory to that “crime”. Absolutely no one should be compelled against their will to perform an outrageous act of destruction simply because of perceived difficulties in finding an abortionist to do the job.
It is bad enough that this country has annihilated about 4 million of its own future citizens and taxpayers, without forcing those of conscience to take part in yet another dastardly act empowered by this remarkably flippant culture— a culture which absurdly believes that individual sovereignty is somehow defined by whether a child is “wanted” in the womb or not.
I would urge you, therefore, to eliminate altogether these lines in your draft policy which function only to hamper good medical judgement, or to sift the conscience of good medical doctors.
I am writing to express my concerns regarding the draft policy “Professional Obligations and Human Rights”.
My two main areas of concern are:
1. Doctors are required to refer for procedures that are against their moral or religious convictions (Lines 156-8) 2. Doctors are required to perform procedures that are against their moral or religious convictions in situations where that is deemed to be “urgent or otherwise necessary care” (Line168)
Having started medicine with the Hippocratic Oath of do no harm many physicians have the moral conviction that the purpose of medicine is to heal people. They did not choose to be a doctor to end life in the womb or at end of life which are aspects that this policy can dictate. Unfortunately if physicians refuse to conform to the imposed vision of this policy it states that they can be subjected to disciplinary action up to and including being stripped of their ability to practice medicine. If physicians are required to refer patients for procedures that are against their moral or religious convictions then it is no different than if they were doing the procedures themselves.
As a palliative care consultant I just had a discussion with the family of a patient who came into my care because of pain crisis which was very difficult to control but which we were able to control. This patient is living with a good quality of life. The family member spontaneously shared with me that their values on euthanasia have changed and stated that if euthanasia had been legal the patient would no longer have been alive because of the intensity of the patient’s suffering. Now however, having received excellent palliative care, the family member is not in favor of euthanasia as before.
Unfortunately, this policy would put physicians into an untenable situation having to refer for procedures against their moral and religious convictions, even when they know there are other excellent alternatives that can provide quality of care.
Under this policy doctors are required to perform procedures that are against their moral or religious convictions in situations where it is deemed to be “urgent or otherwise necessary care”. Who determines whether a situation is urgent or necessary – is a pain crisis deemed as an urgent reason to euthanize a patient?
I agree with CMDS’ statement: “This policy is an assault on diversity in the practice of medicine”. It puts at risk the future of doctors practicing according to their conscience and also eliminates the option of patients’ choosing physicians based on their worldviews.
Please, I am begging you – do not force doctors to perform abortions, refer for them, or prescribe contraceptive medications or devices. It would be extremely unethical to make a doctor decide between his scientifically-supported views on how these things end human life and his or her profession and ability to make support themselves and their family. Please don’t make doctors make this choice, or refer patients to a professional or facility where they can kill their child. Doctors shouldn’t have to slay their own conscience just to continue being a doctor.
I , along with many of my fellow physicians and memebers of the public thankfully, are very concerned with the changes implied in this draft policy. I disagree with it on humanist and religious grounds. I, like every other Canadian, should be able to help others with an ethical standard that respects my personal beliefs (religious or other:scientific opinion). If I feel something is not in my patient’s best interest (considering the whole picture that the patient present) then to force me to send them to someone else who I would obviously believe is “unethical” seems wrong. I would feel harm will be done to that individual and society in the long run.
The line 168 obligation to provide care that is “urgent or otherwise necessary to prevent (harm)”, is too loosely worded and an obviously politically vague statement meant to open up the future grounds for areas such as Euthanasia. There needs to be a further fleshing out of the parties who will decide “urgency” standards and define “harm” more clearly. Should this policy pass as is, we will quickly see that the CPSO, on “behalf” of the public in part, will demand that all and any physicians provide “death’ therapy for those asking for it. Such will not only be harmful for some physicians ethically and emotionally, but also for many patients that end up being terminated when other options exist. The slippery slope of Euthanasia is felt to not exist but is clearly seen in other countries. We once though abortion would be only for certain select situations and now is done in part as a means of birth control for some and a means of sex selection for others. To open ourselves as a society to such harm, we cannot allow policies such as this to erode the moral standards on which compassionate care is founded …if we do, it will be to the detriment of medicine and good medical care as a whole.
although I agree with the spirit of this policy I feel it is unlikely to resolve the issue at hand. In fact I am not sure any policy will resolve the issue as can be seen by the comments below. People are entrenched in each side of the debate and the presence of a policy seems to be asking for legal challenge to be launched, during which time MD’s will continue to act as they have been acting
The solution starts at medical school acceptance and in training.
I think physicians need to be given tools to help them help their patients.
The concept of indirect referral needs to be incorporated to a greater degree. There needs to be easily accessed information for patients directing them to physicians who are pro-choice or GLBT friendly or integrative care friendly. Pre-printed flyers, stickers etc by the CPSO that physicians can post in their offices directing patient to appropriate care – this takes it out the physicians hands
We also need to remember that a physician is not comfortable with providing a service for moral or religious reason they are likely not as competent to provide this service- A physician who does not provide birth control will not be up to date on the latest standard of care and guidelines regarding the use of birth control and therefore the wrong person to be providing this service- it then falls outside of their scope and a patient should be directed to someone who is up to date on current knowledge
“The solution starts at medical school acceptance and in training.”
Yes, accept only students who believe in the sanctity of human life. Reinstate the Hippocratic oath to do no harm. Emphasize that medicine is all about healing, not killing. Include a course on its Christian roots and development. Include another course examining medical practice under the Nazis to show the dangers of socialism and total state control. Scrap the fancy euphemisms. Include a civics course. Regularly sing the Canadian anthem, not forgetting the prayer that “God keep our land glorious and free.”
The most important determinant of ethical behaviour is one’s conscience, not rules imposed by others. The College should not impose rules that force some physicians to violate their deeply held beliefs.
This is the first time in history that a physician is mandated to perform an immoral and still illegal act. To refer a patient to a another physician would make me complicit in a procedure that I consider immoral.
The draft policy reads well except for the conclusion line 156-160 where a physician with moral or religious beliefs are required to make an effective referral to a non objecting, available and accessible health provider. This requires physicians to be agents in potentially objectionable practices. The College has essentially suggested that physicians must act and become agents in practices that the physician finds morally or religiously objectionable and as a result to diminish the physicians humanity and to eliminate their autonomy. What happened to the Supreme Court understanding that “there is no hierarchy of rights”? In essence this policy will make physicians technicians of the state. The college policy as written is extremely discriminatory. In any particular interaction I bring technical expertise, but also my humanity and compassion to give dignity respect and access to patients. The college president has oddly suggested that physicians may have to rethink their ability to practice if they have opinions or beliefs that are different than the patient and are unwilling to refer patients for objectionable practices. I am surprised this attitude of the current CPSO president is acceptable within a western democracy. He has essentially eliminated the dignity, autonomy and respect of the physician and eliminated all physicians with an ethos or morality. One cannot act against themselves without destroying them self. Hippocrates, the oath of physicians for centuries, would not have supported this policy as he understood that the physician was required to do what was best for the patient. Patient’s want physicians that respect them and treat them with dignity. It is after a technical as well as ethical/moral endeavor. To diminish this is to eliminate the profession at the patient peril.
I think that this should be a shorter and more positive document. Specifically, lines 123 – 169 could be eliminated. This section starts with explanations about the courts, and then moves into obligating physicians to violate their consciences while making quick referrals. This is unacceptable. Also, please give patients and their representatives more credit; we can find our own alternate health care. Let’s respect diversity among doctors and patients. This draft document creates unnecessary obligations, and needs to be cleaned up.
Conscience, the ability to choose and act according to one’s own personal belief and moral code is intrinsic to human agency. It implies free will and necessitates a discerning exercise of said will. To take away this capacity from anyone is wrong. The motion you are putting forth is an infringement on human rights. please reconsider it.
I am disappointed that such a divisive issue has been brought to the fore. We as a society have a history of differing passionately but respectfully, and then coexisting peacefully. Professional misconduct threats just entrench opposite positions.
Could the issue not be resolved by having each practitioner post a College-required “check list” notice board, stating practice limitations?
And speaking of notice boards, my colleagues who post in their clinic a “One Problem Only” sign may be, intentionally or not, practicing elder discrimination! I suggest this “misconduct” occurs much more frequently and negates human rights more grievously.
Good point about physicians who are discriminating on the basis of age. But at least elderly patients are not killed–not yet, anyway. At the other end of the age range, at the beginning of life, many children lose their lives as physicians discriminate against them with impunity. Their tiny corpses are the abortionists’ bread and butter.
Taking away someone’s life is a killing. A doctor that refers to someone that does the killing, is an accomplice quilty of assistance in the killing. That has been the Law for centuries. Even most uneducated simple folk has been aware of this, and has understood. These days, you say there is no killing but just procedures i.e. abortion or euthanasia, but the life stops thereafter. Now you propose something you call a “policy” that is to exonerated those who kill and assist in killing – read provide medical service, and punish those who do not and will not participate in ending some’s life. This is brutal, barbaric, unhuman. Why your policy does not say, referrals yes but excluding abortions,euthanasia or other life threatening procedures?
In your draft policy you write:
156. Where physicians are unwilling to provide certain elements of care due to their moral or religious
157. beliefs, an effective referral to another health care provider must be provided to the patient. An
158. effective referral means a referral made in good faith, to a non-objecting, available, and accessible
159. physician or other health-care provider. The referral must be made in a timely manner to reduce the
160. risk of adverse clinical outcomes. Physicians must not impede access to care for existing patients, or
161. those seeking to become patients.
162.
163. The College expects physicians to proactively maintain an effective referral plan for the frequently
164. requested services they are unwilling to provide.
This part of the draft policy on Professional Obligations and Human Rights renders an individual doctor’s conscience meaningless. It attempts to establish the judgments of the College as an absolute moral code overriding the consciences of doctors. For instance, if a doctor’s conscience convinces her that killing an unborn baby is an act of murder violating the inherent rights of that baby, the College forces the doctor to help the mother find another doctor who will do the killing. In effect, the College forces the doctor to assist in committing what, in her conscience, is an act of murder. This is a gross violation of the doctor’s conscience. The response of the chair of the College’s policy working group reviewing “Professional Obligations and Human Rights” is basically this: if you don’t like killing unborn babies, then don’t become a doctor in Ontario.
In the shifting moral sands, this sets a dangerous precedent. Not long ago, it was deemed morally abhorrent to kill unborn babies. Today, our moral code has shifted so that killing unborn babies is an acceptable and common practice. If we can go through such a profound moral shift, what reason do you have for asserting that the same moral shift could not happen with babies that have been born. Already, there are moral philosophers (Michael Tooley, Jonathan Glover, Peter Singer, Jeff McMahan and John Harris – refer to http://jme.bmj.com/content/39/5.toc) arguing that killing born babies should be permitted. Given the moral shift that has opened the door to killing unborn babies, what assurance can you give that there will be no such similar moral shift allowing the killing of born babies? After all, born babies are more demanding on mothers than unborn babies. If a mother decides she doesn’t want the inconvenience of her born baby, why couldn’t she take it to a doctor who would kill it? Just as there were few doctors to start with who would do abortions, so there might be few doctors to start with willing to kill born babies. But when the moral shift is complete, killing born babies will become as common a practice as abortion. Then will the College tell physicians: if you don’t like killing born babies, don’t become doctors in Ontario? Your current policy of overriding doctors’ consciences sets a frightening precedent by which you will inevitably force them to kill born babies in the future.
The consciences of good and often religious doctors are what convince them to avoid killing babies – both born and unborn. Overriding their consciences, and forcing them out of the medical profession, you will banish all hope that medical professionals in Ontario might once again treat all human persons with love and respect. Please change your policy to acknowledge the consciences and religious convictions of medical doctors in Ontario. They will contribute to the moral compass the medical profession needs to regain and retain its moral integrity.
I completely agree. What history teaches us is that we don’t learn from history. If we do away with morals and ethics we end up with whatever feels good or right will become acceptable. We are already on that slippery slope and the farther away we get from GOD the more the world becomes depraved. We are becoming our own gods and saying that our GOD made mistakes but now that we are wiser we will rewrite his laws to correct his errors. The people that think science is the be all and end all that surpasses everything must not read or pay attention to how often science proves itself wrong almost on a daily occurrence. Don’t get me wrong science is wonderful also but thank GOD he is the same yesterday,today and forever.
This policy doesn’t support freedom of religion or speech. If this policy goes through you will lose a lot of good doctors in time when GPs are scare. I am an RN and I can say from firsthand experience that it is better for patients if they have doctors who are able to follow their conscience.
Where in Canadian laws, does it say that it is a “human right” to be entitled to get non-urgent birth control and elective abortion services from ALL physicians at ALL times? Please point to that piece of legislature. An independent contractor physician not willing to provide this ELECTIVE service is by no means denying the patient’s rights to “security of person”, since in almost 100% of situations, the patient does have other options in terms of providers to get this service from on their own and without a mandatory referral.
I hope this case goes all the way to the Supreme court, as it seems it cannot be settled here.
I have taken time to review the third draft of the CPSO policy document, “Professional Obligations and Human Rights”. I am deeply concerned that my rights to freedom of conscience, and freedom of religion, will be violated if this draft document passes. I do not believe the College has found the correct balance between physician rights and public safety. I strongly urge the CPSO to reconsider the following areas of the document:
1. Lines 156-160, referenced under “Ensuring Access to Care”. Without a doubt, providing a referral for an aspect of patient care, involves myself in that act and therefore makes me morally culpable. Being forced into this action is a violation of my Charter-guaranteed freedom, and I cannot accept this. I feel the previous requirement that my patient be informed of the availability of the service, and how it may be accessed satisfies the requirement to “not impede access to care for existing patients, or
those seeking to become patients”.
2. Lines 166-169, entitled “Protecting Patient Safety”. This is a very ambiguous statement, which I do not believe contributes in any way to patient safety or care. Certainly, any physician who deliberately puts a patient requiring urgent intervention at risk, is guilty of negligence! This is already well present in law, and does not bear repeating. My concern is that the College may widely interpret this statement so it may force physicians to “provide care” against their religious beliefs, protected by the Charter.
Once again, I sincerely hope that the College recognizes the infringement this draft polices imposes on my freedom of religion and conscience, and appropriately revises the problematic sections referenced above.
At this point in my career I still have 20 plus years to work – but if I am going to work in an environment that doesn’t respect my freedom of thought and religion then I may choose to not renew my lease. I do not want to work in fear. I went in to medicine to heal, to help, not to kill people or dishonor God. Medicine needs to respect all religions – it is a constitutional right in Canada – the college has no jurisdiction to contradict national rights. If someone feels that referal will affect their faith they should not be forced to refer. Certainly, no one should be forced to do a procedure or write a prescription against their conscience/faith- regardless of urgency – after all saving life is the only emergent medical need and that is what emergency rooms were made for. There is no need to change the policy to limit physicians freedom. Lines 156-8 and line 168 are very concerning.
This policy by seeming to increase access to care will result in a decrease in access by all.
Doctors as a group are driven by their internal values and morals. Many enter the profession driven by altruistic desires to do good and to heal.
Taking away the ability to practice as dictated by one’s conscience will drive doctors from the most needed specialty of primary care and put them in the less needed specialties in medicine. I see this as a bad move that will take out those physicians that have the most to offer to our profession and will increasingly drive the move to specialization. This time not driven by what a physician wants to practice, but rather driven by what his or her conscience will allow them to practice.
There are many grey areas in medicine, as time goes on these moral grey areas will only increase with the advancement of technology. It has long been known that regulations of any sort trail this advancement in technology. Allowing individual physicians to determine their practices wthin reasonable bounds somewhat insulates them against these grey areas and increases physician satisfaction. This internal satisfaction cannot be replaced with money or any other incentives and in itself will allow for practicionors to continue to be productive and contented members of the medical community. Conversely, removing this ability to practice in a comfort zone will produce early retirement, disgruntled physicians, and a lack of applicants to the areas in which we are most deficient.
There is one main question we should consider when critiquing a CPSO draft policy: How does this policy improve medicine in Ontario?
1. Will this improve patient access to care?
Currently abortion and contraception are available through self-referral service. There are various sexual heath and planned parenthood locations that do not need referrals. In fact many of them have “drop-in” appointments available. This means a referral is not needed to access these services. Similarly emergency contraception is available at pharmacies over the counter. This means a prescription is not needed for their procurement. Therefore, no, this policy will have absolutely no change in patient access to these services.
2. Will this policy make patient access to care worse?
This policy would make it even harder to recruit new physicians interested in alternatives to hormonal contraception, for example Natural Family Planning (NFP). Many patients report it is very difficult to find a care provider with even basic competency, never mind expertise, in this field. This policy would only make this gap in care even worse.
3. Will this policy improve doctor-patient relationships?
The entire practice of medicine is based on fiduciary duty, meaning that we promise to act in our patient’s best interests. If a physician truly believes that referring for abortion has serious risk of harm, both psychologically and physically, then forcing him/her to do so is forcing them to break their fiduciary duty. Without this there can be no trust in medicine. And without trust the entire patient-physician relationship is undermined. This policy would deteriorate the doctor-patient relationship on an individual basis, as well as at the societal level.
In summary, the new policy would not improve patient access to abortion, Plan B or contraceptives as these are already accessible without a referral or prescription from the primary family physician. In fact, it would do the opposite of its intended purpose, and would further decrease patient access to NFP trained providers. It would actively diminish the doctor-patient relationship by undermining the principle of fiduciary duty. And it sets a dangerous precedent for not only allowing, but encouraging physicians to act against their best judgement. I recommend no changes to the current policy.
Doctors of medicine ARE NOT agents of the state, they have inherent natural rights like all private citizens to determine for themselves which acts in which they choose to participate and which they do not; to take away that freedom is a crime against humanity and civilization itself. CANADA do not become a tyranny!
I am concerned that in enforcing abortion referral, the CPSO is essentially telling Catholics, other Christians and other people who oppose abortion that they need not apply to become doctors.
It essentially says that only those who agree that abortion is good medicine can apply to be doctors. There is no right to dissent.
As Joyce Arthur, the Executive Director of the Abortion Rights Coalition of Canada once said, “there is no, per se, right to abortion.”
However, Section 2 does protect the right to conscience.
If pro-lifers are not allowed to exercise their conscience, that’s a violation of an explicit Charter right.
It is also wrong to expect a fetal rights supporter to refer for an abortion. The CMA policy I think has it right: Inform the patient that they do not involve themselves in abortion. The patient is then free to go elsewhere.
Another aspect to consider is that patients should have the right to choose doctors with similar values. When you exclude pro-lifers from the medical community, you deny patients the right to choose a doctor with similar beliefs. Comfort and communication are easier when you deal with a doctor of a similar moral background. It makes medical appointments a lot smoother. For instance, If you don’t use contraception because you oppose it, and you visit a doctor who supports contraception, a lot of time is wasted discussing contraception. I have told doctors I don’t use contraception, and they get antsy. They can’t imagine someone who doesn’t use contraception. I’ve been told to use condoms even though I oppose them.
Another aspect I’d like considered is that if doctors are forced to violate their conscience on referral, down the line they will be forced to violate their conscience on other issues. Right now doctors do not have to co-operate with abortion. We know that there is a shortage of abortion providers. Will conscience rights be eliminated to deal with that problem? Will doctors who only want to do 1st trimester abortions be forced to do 2nd trimester abortions? And what about the brave new transsexual surgery. What if a doctor opposes surgery in that case, and won’t refer? Will he be forced? Transhumanism is a growing trend. Bodily modification may become a thing.
On-demand medicine creates a lot of hazards. The “customer” is always right and has all the rights, whereas the doctor becomes a supplier, and is in effect dehumanized because his wishes and ideas are dismissed. His only function becomes to satisfy the needs of the client instead of answering his own aspirations.
There’s no great outcry of people being denied abortion and contraception because of conscience rights, so why fix the system if ain’t broke?
I realize the CPS is well-intentioned, but this draft policy is inherently dangerous because it does not allow physicians to opt out of referring procedures that they view as dangerous for their patients or even immoral.
If this had to do with urgent, life-saving care, that would be one thing. One could posit that the patient’s life outweighs conscience rights. But most of the procedures/medications that are the focus of this policy (such as birth control, abortion and euthanasia should she latter become legal) are almost always elective ones.
Given that this policy doesn’t really define “medical necessity,” it does not stretch the imagination to envision how this policy could end up requiring doctors to be the puppets of the patients, forced to accommodate any patent request, however dangerous or wrong. What of the doctor being asked to abort a healthy 38-week old fetus? What of the doctor being asked to abort a female fetus because she is a girl? This new policy would force doctors to leave their clinical judgement at the door. Just as I am sure Hitler’s doctors were invited to leave their consciences at the door. This is how it starts.
Moreover, the CPSO is inconsistent because it specifically directs doctors not to refer patients for (female genital mutilation). Thus, the College recognizes that referring for a morally objectionable procedure is just as wrong as doing the procedure. Then, in this new policy, the College asks doctors to set aside their principles and refer patients for treatments that they believe, in their clinical judgement, are harmful for the patient. How is this promoting clinical practice?
Finally, the proposed policy erodes patients’ rights. In stripping away the clinical discretion of doctors, it leaves patients at risk of receiving treatments that are not medically advisable for them.
Please, I beg the College to reconsider this dangerous policy, for the betterment of the practice of medicine and the Ontario public!
“If this had to do with urgent, life-saving care”–but it perversely does! It makes life-saving care in the elective situations you have mentioned all but impossible. So extreme is the culture of death that secular humanists are pushing! No doctor may any longer advise a mother against killing her “healthy 38-week-old” child–unless perhaps he is ultimately willing to help her to do it–nor may he advise her against abortifacient “contraception” that prevents implantation. All too horribly soon, likely, doctors will be forced to present euthanasia as an alternative to a life of pain management.
We should also be honest and speak of the secular humanist’s conscience (or whatever is its equivalent). If one can posit that a human being’s life outweighs conscience rights, then no child should be killed to relieve the mother’s distress. No terminally ill elderly person should be killed to relieve his own distress.
Please, I beg the College to reconsider this wrong policy, for the betterment of the practice of medicine and the Ontario public!
The proposed policy is a violation of physician autonomy and will require many physicians to seriously compromise their moral integrity.
The requirement that physicians offer referrals for procedures violating their moral beliefs is unfair and unnecessary.
Physicians are not technicians operating a service-oriented business; they provide carefully considered professional opinions to support patient’s healthcare needs and interests. Insofar as patients cannot require physicians to provide services that they deem unnecessary or harmful to the patient, physicians ought not to be forced to provide such referrals.
Compromising the moral integrity of some members of the profession will have serious consequences: we expect all members of the profession to uphold the highest level of commitment to moral and ethical integrity; forcing a doctor to act in a way that she finds ethically unacceptable may give physicians more generally the impression that one is not required to maintain high standards of personal and ethical integrity.
Inasmuch as many physicians base their objections against many ethically controversial procedures upon their religious beliefs, the proposed policy changes actually represent a serious and pronounced violation of the Human Rights Code and the Charter of Rights and Freedoms. This is a serious and unacceptable form of tyranny.
In sum, the draft policy proposal is ill-considered, unnecessary, and serious violation of the very rights it purports to uphold. The College should reverse this proposal and maintain the status quo. Patients’ rights are already strongly protected and where they are violated, suitable means of prosecution already exist.
Upon reviewing the third draft of the policy “Professional Obligations and Human Rights” I would like to express my extreme concern and alarm at what seems to be a newly added clause. I would ask you to delete or change this clause.
I refer to lines 156/157 referenced under “Ensuring Access to Care”. I believe that what you refer to as an “effective referral” made for a service that one finds unacceptable due to moral or religious beliefs, makes the referring practitioner morally culpable and therefore is in itself unacceptable.
I feel that as long as the patient is informed of the availability of the service and how to access the service, that a referral (i.e. traditionally a request/letter sent from one practitioner to another) is not necessary.
I trust you will take my concern under serious consideration,
I am not a doctor, and I have never been backed into the dire situation that pro-life doctors now face, but as a Christian I cannot imagine even the compromise that you appear willing to make, i.e. informing the patient of the availability of a “service” and how to access it. A mother should not kill her child, nor should a despairing sufferer kill himself–and I should not in any way imply that these are valid options. They aren’t.
Don’t just delete lines 156 and 157; delete the whole draft.
Far from advancing professionalism, by mandating referral for controversial procedures, the document “Professional Obligations and Human Rights” would turn physicians into unquestioning automatons with its expectation that they check their deepest convictions at the clinic door. The practice of medicine is a moral endeavour, requiring wisdom and compassion, and it should concern patients that physicians might be coerced to act contrary to what they believe to be right and in their patients’ best interests. The doctor-patient relationship depends on mutual trust, which necessarily includes the freedom to respectfully disagree about a course of action. For patient safety, physicians must not become instruments of the state, with its own vested interests. The best way to protect the public is to respect physicians’ desire to practice with moral integrity.
While much of the policy is sound, I have real concerns with the section on college requirements for a physician who is unable to provide a requested service for moral reasons.
In the event that I could not perform an action for moral reasons (eg assisted suicide or euthanasia in the event of these becoming legal and accepted) I would be required to refer them to a physician who is”non-objecting,available and accessible” This in conscience I could not do. It would be as much complicit in the action as actually doing it.
I could offer to transfer all medical care to a physician of the patient’s choosing or to remain their physician if they so wish.
We need to be careful on how we define “access to care” if we are to mandate physicians refer a patient for a therapy or procedure they do not feel is in the best interest of their patient (regardless of the reason: medical, moral, ethical, or religious). The call to respect patient autonomy was put in place so that doctors were not forcing our patients to take our therapies. This respect for patient autonomy was never meant to force doctors told do whatever the patient wants even if it is bad for them (the patient does not have this right). There are two types of standard care: The first is therapy which the vast majority of physicians believe is in a patient’s best interest because of the evidence of benefit (e.g. treating diabetes to prevent complications) or the universal acceptance that the treatment is in the patient’s good (e.g. furosemide for acute heart failure which has little evidence but we know works). The second type of “standard care” involves treatments that have been approved for use in Canada but is not universally agreed upon by doctors and/or lacks evidence of clear benefit. This second category is not just limited to ethical matters such as abortion and physician assisted suicide but includes experimental chemotherapy, or off-label use of medications. Some doctors are more comfortable practicing on the fringe of medicine than others. This does not mean every doctor who is not on the fringe must refer a patient. And even if that fringe grows larger to 50 or even 80% of doctors, that is still not a reason to mandate the other 20% to refer if they have good reason not to. The only thing that should be mandated is the provision of evidence-based or universally accepted medicine unless the competent patient declines such help. Everything else is up to the treating physician to exercise his/her judgment. We cannot force someone to perform an action he/she views as wrong when there is no evidence to suggest the action is beneficial.
This policy violates a physicians human rights as guaranteed by the Charter of Rights. I fail to see why the CPSO willingly likes to start idealogical fires instead of focusing on things that matter.
Disbanding the CPSO, ending “self-regulation” and moving to the US-style medical board model is the best way forward.
Since the CPSO is so intent on providing mutilation and killing services–and forcing every doctor into them–rename it the CMKO and have pro-life doctors start a new CPSO.
Please read the words of Dr. Leo Alexander, M.D., a psychiatrist who served in the Office of the Chief Counsel for War Crimes in Nuremberg, Germany at the end of the Second World War, who wrote ‘Medical Science Under Dictatorship’, NEJM, vol 2, No. 241, July, 1949 [download from nejm.org.] This is a slice of history worth reflecting on and learning from. His key message was that:
Whatever proportions these [medical] crimes [during the holocaust] finally assumed, it became evident to all who investigated them that they had started from small beginnings. The beginnings at first were merely a subtle shift in emphasis in the basic attitude of the physicians. It started with the acceptance of the attitude, basic in the euthanasia movement, that there is such a thing as life not worthy to be lived.
Let those who think that we are far too enlightened a culture to head down a similar slippery slope are blind to the reality of what happens to medicine when it is ruled by political systems that have lost their soul. We are heading there slowly but surely. This draft policy, while drafted with the best of intentions, is part of the thin edge of that wedge, causing a “subtle shift in emphasis in the basic attitude of the physicians”…Are we fostering a new group called “Doctors Without Conscience”?
As a resident doctor I am troubled as I read through the comments. Although I am still in training I see that every patient encounter involves understanding the individual story, considering the options and weighing the risks compared to benefits of any course of action (including waiting). In other words, we are constantly making judgment calls all day, every day. When possible, of course, we want our patients to choose which course of action has the best risk:benefit ratio in their opinion.
If we start forcing physicians to act against their consciences in some area, that damages their moral integrity and over time may adversely affect future decision making.
Furthermore, who is deciding which “services” are required? By trying to avoid discrimination against patients, this new policy effectively discriminates against physicians with certain moral beliefs as well as violating their rights to freedom of conscience and/or religion. I accept that I am biased, but this still seems to me a poor trade.
As a patient, I would not trust a doctor who I thought might harm me or who I knew to have no moral integrity. As such, I cannot support a policy which may violate both.
Very good words of wisdom from someone just starting out.
I trust those at the College who have to make the final decision on this policy will sincerely consider this wisdom from “the mouth of babes”.
In making it a requirement that Doctors MUST give a referral to another Doctor who will perform a procedure that the first Doctor feels is morally wrong (for whatever reason) the College is making Doctors into second-class citizens whose rights are subservient to those of their patients. The Supreme Court has acknowledged that there can be times when there is a tension between the rights of one person and the rights of another. This draft seeks to remove all ambiguity. You cannot make a “grey” area “black and white” without trampling on someones rights. It is only as we maintain the tension that we truly support the rights of all individuals.
First, I would to thank the Ontario College of Physicians and Surgeons for allowing public input on the current draft policy.
As a Roman Catholic, there are many aspects of this document that I find disturbing. I am not going to share all that concerns me within one forum post, but I would like to propose to the college that it seriously rethinks this entire draft policy over. Below are some of my thoughts that I hope the college will consider.
It is rather paradoxical that part of this draft policy’s title includes, “Human Rights,” when the most fundamental human right, the right to life, has not been identified and protected. Further, the college sets out certain guidelines and expectations that direct its members to act against their conscience should an “element of care” or “health care service” conflict with their moral or religious beliefs. This is an attack on the freedom of conscience and a lack of respect for moral and religious beliefs. An example of this exists at lines 150-165 under the subheading of Ensuring Access To Care, whereby the college expects doctors to “ensure access to care,” either by providing information and/or referrals. For Catholic this constitutes being an accessory to a patient’s sin, if the patient’s “health care service” or “element of care” is an abortion or contraception. It also spotlights the college’s additional failure to recognize another basic human right, the right to not take part in an injustice. For Catholics, when any civil law is in conflict with God’s moral law, we have a moral obligation to “obey God rather than human authority.” (Acts 5:29)
In my view, the college must specifically and explicitly make very clear that no physician or surgeon should consider abortion, euthanasia, contraception and any other threat to the value and inviolability of human life, acceptable and apart of any definition of, reference to or inclusion in “elements of care” or “health care services.” Such is a necessary and clear statement in the draft policy that not only recognizes the sacredness of human life, but also identifies and denounces all anti-life acts and practices. At the same time the draft policy should reinforce to the college’s members that their education, training and experience should always be placed at the service of life. What this translates into is the moral duty of physicians and surgeons to respect and protect life from the moment of conception to natural death.
If there is any intention to encourage conscientious Catholic medical students and others of good will to pursue careers as physicians and surgeons in Ontario, then freedom of conscience and moral and religious beliefs must be guaranteed and protected. The college must also illustrate that it recognizes and acknowledges the truth and dignity of the human person.
I hope that my input today will encourage the college to have the moral courage and certitude to rethink this entire policy all over again. Thank you again for the opportunity to provide public input.
It is troubling to read that Catholic doctors for example could be put in such compromising positions. It is troubling to see that a governing body could hold such power false in principle. The references to Morgentaler are disturbing. May our good Catholic doctors not be sacrificed at the political will of those who have their own faulty and immoral agenda. Women and babies deserve to be protected in the womb and outside the womb.
I am quite concerned about this new proposed policy on Professional Obligations and Human Rights. My concerns are as follows:
1) The population wants both respect of human rights and equality as well as ethical and honest physicians. This proposed policy falls on only one side of that equation and ignores that patients clearly and unanimously prefer a physician who is ethical and honest to a physician who is willing and comfortable changing their views in inconsistent and dishonest ways. Trust building is the core feature of the physician-patient relationship and encouraging physicians to act in discordance to their values, morals, and ethical frameworks is asking physicians to be dishonest, thus harming the physician-patient relationship at its very core.
2) With the introduction of euthanasia in Quebec (which Palliative Care practitioners are almost unanimously opposed to) the one saving grace has been that we would be allowed to opt out of this new and dangerous practice. To invoke this policy in Ontario would prepare the scene for forcing Palliative Care physicians to participate actively in euthanasia against their professional opinion and moral framework. This occurred in the Northern Territory of Australia in 1995 and led to a drastic reduction in Palliative Care physicians in the province and was quickly overturned by the Federal government as a result of the unexpected results. It is clear that if you advance this policy it will be eventually enacted in other provinces, including Quebec, and will eventually co-exist with euthanasia legislation across the country leading to a potentially severe reduction in Palliative Care services.
3) Vulnerable populations need to be protected from the potential human rights violations of physicians, and on this point I agree with this policy. Vulnerable people also need to be protected from the Health Care system as a whole since in actual fact it is the health care system that is able to and in fact does violate the human rights of the population in a much more severe way than an individual physician. For instance, the partial coverage of certain medications or the absence of coverage of other medications is a human rights violation in a health care system that is supposed to be equitable and fair regardless of patient circumstances. For instance, for the vulnerable Palliative population in Ontario, there are a large number of new and helpful analgesics and other medications such as Methylnaltrexone for opioid-induced constipation, that the Ontario health care system refuses to cover for patients who cannot afford it, even in cases where the medication has excellent evidence and has been used successfully for a patient at their own expense. This is not equitable and is a sad story for those extremely vulnerable patients.
4) Physician well-being has been shown to be related to factors such as a sense of accomplishing something worthwhile, something positive for the good of the society, a sense of doing good and being good at what we do, and a sense of being a good person for doing what we do. This law essentially attacks this core aspect of physician satisfaction and well-being. It is not reasonable, in a profession where burnout is so common and suicide is a real risk, to make changes that will negatively affect practitioner well-being.
5) For the many colleagues I have had over the years who follow any number of religions such as Christianity, Judaism, Islam, Buddhism, Hinduism, and even atheism, these belief systems come with ethical frameworks that are core to their practitioners. Discouraging people from becoming physicians because of their religious affiliation is a human rights infraction. Encouraging such existing physicians to choose between their religious beliefs and their work is immoral and is also a human rights problem. Asking physicians to act in the best interest of their patients is excellent and I applaud the CPSO for tackling this issue. There is no reason a person of faith, with a religiously based moral compass, cannot act in the best interest of their patients while remaining true to their belief system. They are already doing it! I have seen them do it and I have seen how satisfied their patients are with their care. I have seen this in so many situations that I cannot even believe that the CPSO is so out of tune with real practice that they would propose such an ultimatum as: you can’t be religious while also taking your patient’s perspective as the priority. In fact, in Palliative Care and Family Medicine we are the model of patient-centered care in the Canadian health care system. We know our patients situations over years (in Family Medicine) and know the intricacies of their lives. We seek their direction and input as we discuss topics from antibiotic therapy for common infections to their CPR wishes and level of care preferences. We discuss the pros and cons of prostate screening before ordering a barrage of tests. We are actually doing a great job of respecting patients’ wishes in 99% of cases. This policy should seek to encourage the existing high level of practice in Ontario and clarify the specific areas of concern when it comes to human rights and offer consequences when there are violations. Prohibiting physicians from having their own moral frameworks is not helpful or necessary.
6) At a basic level, medicine is an ethical endeavour. The example I have heard in the past is as follows: If I had developed a cure for lung cancer and had the ability to disseminate such a cure it is my moral framework that would tell me whether or not I ought to share this discovery with others. Said another way, terrorists look at medical knowledge about a dangerous bacteria and think of ways to kill people with it. Health care practitioners choose the moral system that says that one should prevent the spread of dangerous diseases and in fact spend billions of dollars trying to find cures for diseases. It is the moral framework that makes all the difference when it comes to practicing medicine. There are not unanimous agreements about ethics however, so the CPSO’s role is to encourage the basic levels of ethical norms throughout the health care system but this cannot lead to discrediting and eliminating all other variations on the theme of helping others and having the patient’s interests at heart. The CPSO needs to set boundaries but it should not have such a narrow ethical boundary that it feels the need to attack all other moral systems.
Thank you for listening to my thoughts on the matter. I trust that you will be receiving many opinions over the next few months. I hope that you will value the quality of people’s arguments and not just the quantity for and against.
I strongly object to this proposed policy. The requirement that physicians ignore their moral or religious convictions in “urgent” circumstances or to protect “patient safety” will undoubtedly be used to attack physicians with “unpopular” moral or religious beliefs. While you may imagine that this policy will only affect a small number of physicians who object to abortion, you should anticipate the enormous adverse consequences that this policy will have on a very large number of physicians if/when euthanasia is legalized.
Your draft effectively eliminates a doctor’s right to act in accordance with his moral and religious beliefs. It does so in two ways of which you are well aware.
Firstly, a doctor who does not wish to perform an abortion would have to refer a patient to somebody who actually performs abortions. This is the same as being complicit in aiding somebody to get an abortion. The word complicit is defined as involved with others in an illegal activity or wrongdoing. To doctors of conscience, abortion is a wrongdoing because it puts the mother’s life in psychological, spiritual, and often physical peril, and takes the life of her child. Both a pregnant woman and her child comprise two patients whose lives and well-being a doctor must uphold.
By supposedly catering to the rights of a woman seeking an abortion, you are demolishing the rights of doctors to object to abortion.
Secondly, if no other doctor were available to terminate a child whose mother was seeking an abortion, a doctor of good conscience –who spends most of waking life trying to preserve life– would be forced to end somebody’s life.
To force a doctor or nurse to perform an abortion is morally wrong and abhorrent. What about his or her right to act in a moral way, to be free from guilt, to have a choice?
You are weeding out good people from the medical profession. In addition, pro-life patients deserve the right to have care from somebody who is aware of the humanity of a fetus, and seeks to preserve its life despite challenges. Many women are being pressured to abort children with Down’s Syndrome, Trisomy 13, etc.. These women have rights to!!! Their children–who are human– have rights, too!
Please restore some democracy in the medical profession! Do not trample on the rights of doctors to offer whatever services they wish to without having to refer patients for abortions, assisted-suicide, or other immoral services!!! Do not force doctors to go against their will.
I disagree with the premise that physicians have to set aside their religious and moral values when acting in their professional capacity. On the contrary, the higher the moral standard of a physician (or any other professional), the better the quality of his/her care. Morality is strongly related to religion, at least those religions that promote love of neighbour. Therefore, if the physician’s religion expressly forbids abortion or assisting at abortions, then the physician should let the patient know of other means of natural contraception, and counsel the patient accordingly. Personally, I would hesitate to consult a physician whose morality standard is known to be low, or who counsels patients to go for abortions.
I am a second year Plastic surgery resident and I would like to share my perspective on the proposed changes to the Professional Obligations and Human Rights policy.
Firstly, and most importantly, no patient’s rights are being violated in Ontario under the existing policy. Abortion is one of the few health services that can be obtained on a self-referral basis. This is the ideal solution to ensure that we continue to respect the rights of both the patient and the health care provider. There is no need to change the current policy to improve access to abortion as there are absolutely no limits to accessing abortion. It is self-referral meaning anyone, regardless of their primary family physician, can make an appointment or drop in without a referral.
Similarly, the “Plan B” pill is available over the counter and thus does not require a prescription from a physician to be obtained. Again this is ideal, as neither the patient’s nor the physician’s rights are being infringed upon in any way.
With respect to contraception, again there are no significant barriers to patient access. Birth control is available through a variety of sexual health clinics throughout Ontario. Again patients do not need a referral from their primary family physician to access these clinics; they are self-referral.
Not only would this new policy fail to improve patient access to care, it would actively decrease it. Patient’s access to physicians trained in alternatives to hormonal contraception, such as Natural Family Planning (NFP), is already very limited. The new policy would make it even more difficult for these physicians to continue to practice or indeed to recruit new trainees interested in this field. Just as patient’s seeking abortion have a right to timely access, patient’s seeking advice and counselling consistent with NFP have a right to timely access. This policy would very likely limit this already scare area of expertise among our primary care physicians.
Furthermore, this policy would undermine and deteriorate the doctor-patient relationship on an individual basis, as well as at the societal level. As you have rightly highlighted in the policy, some of our key values are compassion, service, altruism and trustworthiness. We have a fiduciary duty to our patients. This is defined as a legal duty to act solely in another party’s best interests. A physician who contentiously objects to OCP, truly believes that it is harmful both psychosocially and physically to their patient. Forcing this physician to write a prescription for OCP would, by definition, force them to break their fiduciary relationship. They would actively be writing a prescription from something they believed to be harmful to their patient. We, as a self-regulated body, go to great lengths to prevent such a grievous breach of duty. This policy would not only permit such a breach, but in fact, force such a breach to be made.
Finally, I fear the repercussions this policy change could have on other areas of medicine. As a plastic surgery resident I observe my preceptors denying patient’s requested cosmetic procedures for any number of reasons. For example, body dysmorphic syndrome, unrealistic expectations, procedural risks too high, medical comorbidities, smoking status, inappropriate motivation for procedure (e.g. pressure from partner), not finished having children (prior to abdominoplasty), etc. This policy could certainly conceivably be used to coerce a surgeon into performing a procedure that they truly felt was not in the patient’s best interest, or in fact, not safe to do. This policy sets a very dangerous precedent to destabilize the incredibly unique and powerful partnership between a patient and his/her physician.
In summary, the new policy would not improve patient access to abortion, Plan B or contraceptives as these are already accessible without a referral or prescription from the primary family physician. In fact, it would do the opposite of its intended purpose, and would further decrease patient access to NFP trained providers. It would actively diminish the doctor-patient relationship by undermining the principle of fiduciary duty. And it sets a dangerous precedent for not only allowing, but encouraging physicians to act against their best judgement.
Please do not change the current policy. However, if you do decide a revision is necessary, this draft is unacceptable in its current form and requires significant changes.
To pick up on the last point regarding complaints to the College when a physician tells a patient NO to a requested surgery (also read procedure,test,prescription etc) is quite relevant. I don’t think the College intends, as it will do, to open the floodgates of patient complaints. Beware of the policy’s consequences.
I am writing regarding the proposed changes to “Physicians and the Ontario Human Rights Code.” Canadians rightly hold the medical profession in high regard, thanks to your organization and to the work of our doctors. It is my observation that most doctors have chosen their profession for moral, not practical reasons. Being bright and motivated people they could surely do well in other fields that do not require such demanding training or difficult work, but they choose to be doctors none the less. Consider the implications of taking moral decision making away from a profession whose members joined for moral reasons. Why, then, would such people become doctors? What would such a change do for the future of the profession? It is imperative that you do not allow the proposed changes to go forward.
I believe aspects of the proposed policy are misguided, and represent an assault on your members’ freedom of conscience and an insult to their professionalism. Obliging doctors to refer patients is making them full participants in procedures they strongly oppose. For many specialized procedures, referring a patient would be the extent of their involvement anyway. Only by allowing doctors to be complete non-participants do you respect their conscience and moral judgement. This does not meaningfully hinder a patient from seeking a procedure through other channels. Organizations exist to facilitate access to many forms of controversial care, and if access is the true aim of your policy then surely this is sufficient. You achieve no improvement to the freedom of patients by so severely limiting the freedom of doctors.
Writing policy in a world of competing views and opinions cannot be easy, but forcing your members to participate in procedures they object to is not the way forward. History has rarely condemned an organization for respecting freedom of conscience, and I hope you will come to see that these proposed changes do your members a grave injustice.
Forcing anyone to violate their conscience is immoral. Especially when issues of life and death are involved, how can a physician be expected to act against his or her conscience? The proposed changes are a step backward and not forward.
The draft policy claims to be based on the CPSO’s Practice Guide (http://www.cpso.on.ca/Policies-Publications/The-Practice-Guide-Medical-Professionalism-and-Col/Introduction). The Guide contains the following statement: “This practice guide does not stand alone. There are many resources available, which through varying approaches, provide excellent guidance to physicians on how to practice well. These include the principles of bioethics, the Royal College of Physicians and Surgeons of Canada’s CanMEDS framework, the Canadian Medical Association’s Code of Ethics, and codes and guidelines from other medical leaders across Canada and internationally. The CPSO’s practice guide is not intended to replace these resources; rather, it is intended to organize the information in a way that will best guide Ontario physicians in how to meet the expectations of their profession. It should be used in companionship with other resources, rather than in isolation.”
In fact, the draft policy contradicts some of these documents, which arguably have more credibility in the field of medical ethics than does the CPSO. For example, the Code of Ethics of the Canadian Medical Association, the main professional organization for all Canadian physicians, includes the following provisions:
7. Resist any influence or interference that could undermine your professional integrity.
9. Refuse to participate in or support practices that violate basic human rights.
12. Inform your patient when your personal values would influence the recommendation or practice of any medical procedure that the patient needs or wants.
23. Recommend only those diagnostic and
therapeutic services that you consider to be
beneficial to your patient or to others.
The World Medical Association International Code of Medical Ethics states:
A Physician shall always exercise his/her independent professional judgment and maintain the highest standards of professional conduct.
A Physician shall be dedicated to providing competent medical service in full professional and moral independence, with compassion and respect for human dignity.
None of these documents supports the proposed changes in the CPSO policy . The new draft of the policy has three goals: it sets out physicians’ existing legal obligations under the Ontario Human Rights Code (the “Code”), and the College’s expectation that physicians will respect the fundamental rights of those who seek their medical services. It also sets out the College’s expectations for physicians who limit the health services they provide due to their personal values and beliefs. The first goal is appropriate for the CPSO. The second is acceptable as written, although it should not overstep the first. However, the third is where the document fails, due to its unwarranted limitations on physician independence and freedom of conscience.
I realize the CPS is well-intentioned, but this draft policy is inherently dangerous because it does not allow physicians to opt out of referring procedures that they view as dangerous for their patients or even immoral.
If this had to do with urgent, life-saving care, that would be one thing. One could (reasonably) posit that the patient’s right to emergency life-sustaining treatment outweighs conscience rights of the attending physician. But this does not apply in most of the situations which would be addressed by the policy. Most of the procedures/medications that are its focus (such as birth control, abortion and euthanasia should the latter become legal) almost always relate to elective ones. For example, abortion is only very rarely needed to save the life of the mother and, in fact, the overwhelming majority of abortions are performed during healthy pregnancies during which no medical indicators are present at all.
Given that this policy doesn’t really define “medical necessity,” it does not stretch the imagination to envision how this policy could end up requiring doctors to be the puppets of the patients, forced to accommodate any patent request, however dangerous or wrong. What of the doctor being ordered to abort a healthy 38-week old fetus? What of the doctor being ordered to abort a female fetus because she is a girl? What of the doctor being ordered to perform an abortion on a woman who doesn’t want one and is being coerced by her partner/family? These are all realistic contingencies under the proposed policy.
This new policy would force doctors to leave their clinical judgement at the door. Just as I am sure Hitler’s doctors were invited to leave their consciences at the door. This is how it starts. Does the CPSO truly expect doctors to ignore their consciences at all times when treating patients, and yet retain their humanity? This is an inherent contradiction and will drive caring physicians out of the profession when it is caring physicians whom patients need the most.
Moreover, the CPSO is inconsistent in its insistence on referrals. For example, the College specifically directs doctors not to refer patients for FGM (female genital mutilation). Thus, the College recognizes that it is not only wrong to perform a morally objectionable procedure; it is also wrong to refer for one. In contrast, this proposed policy would require doctors to set aside their principles and refer patients for treatments that they believe, in their clinical judgement, are harmful for the patient and/or unethical. How is this promoting good clinical practice?
Finally, the proposed policy erodes patients’ rights in two ways. Firstly, by eroding the clinical discretion of doctors, it leaves patients at risk of receiving treatments that are not medically advisable for them. This would be a breach of care. Secondly, by forcing physicians of conscience out of the profession, this proposed policy would limit many patients’ rights to access doctors who share their values (for example, that human life has inherent value and dignity).
Please, I beg the College to reconsider revising this policy to eliminate the referral requirement. This would make the policy a fair and equitable one, for the betterment of the practice of medicine and the Ontario public.
To Whom it may concern.
As a Canadian citizen, a Christin and an advocate of freedom of religion, I am extremely upset by the draft proposal.
I believe it is immoral, illogical and illegal to force someone to do something that is against their religious beliefs, such as making a Dr provide a referral or perform a service that they have a religious personal reason not to.
We are so concerned about the rights of others that we forget the individual’s rights.
Also in the case of abortion a Dr due to their beliefs and also the Hippocratic oath, of doing no harm to a human being, is entitled to abstain from providing the service or giving a referral. This service is available elsewhere and the Dr in question should not be forced to be involved.
In the matter of not having discussions/promoting ones faith, why can someone who is anti-Christian/religion able to promote their position, this makes no sense.
Also especially in the area of palliative care it has been shown that many people have questions and want to ask about faith etc. My mother was dying from CA and had many questions and looked for a Christian Dr to speak to even though she did not have a personal faith.
In summary I am against several aspects of this DRAFT policy and do not believe that my Dr should be forced to adhere to these discriminatory policies.
They are just wrong!!!!
I object to this new draft policy. Sounds like a dictatorship. Medical doctors require freedom of conscience to treat patients as they think best. They ought not to be forced to offer patients treatment, or refer them to other doctors for treatment, that they believe is morally wrong.
I am writing concerning the revised draft policy with the new title of “Professional Obligations and Human Rights”.
Here are the major areas of concern I have with the draft policy:
1. Doctors are required to refer for procedures that are against their moral or religious convictions (Lines 156-8)
2. Doctors are required to perform procedures that are against their moral or religious convictions in situations where that is deemed to be “urgent or otherwise necessary care” (Line168)
Many physicians have the moral conviction that the purpose of medicine is to heal people. They did not choose to be a doctor to end life in the womb or at end of life. They arrive at this conclusion from different worldviews and perspectives. Some have religious beliefs, while some have moral convictions based on humanist creed. Under this policy they can all be subjected to disciplinary actions up to and including being stripped of their ability to practice medicine, for refusing to conform to the imposed vision in this policy.
The future of doctors practicing according to conscience and of patients having the option to choose a physician who practices according to their worldview is at risk. This is an assault on diversity in the practice of medicine.
I am very concerned about the moral direction of this policy. It is important to protect the patients’ rights but it is also of equal importance to allow physicians to practice according to their moral and religious beliefs. I feel this is of imperative when it comes to building a relationship of trust between a patient and their physician. If I disagree with the convictions and decisions of my doctor, I am welcome to consult elsewhere. We should not require all doctors to conform to practices that are contrary to their convictions..
After reviewing the third draft of the policy “Professional Obligations and
Human Rights” I would like to express my utmost concern and I request you delete or amend this clause.
I refer to lines 156/157 under “Ensuring Access to Care”. I believe that what you refer to as an “effective referral” made for a service that one finds unacceptable due to moral or religious beliefs, makes the referring practitioner morally culpable and therefore is in itself unacceptable. I feel that as long as the patient is informed of the
availability of the service and how to access the service, that a referral (i.e.
traditionally a request/letter sent from one practitioner to another) is not
necessary.
I trust you will take my concern under serious consideration,
I disagree with your graft about “Professional Obligations and Human Rights.” According to the draft the patients’ rights to services are about the physicians’ right to follow their conscience, and this is wrong. This is a move to strip human beings of anything called personal values, by penalizing.
Dear CPSO representative,
I am writing to you today about a matter of grave importance. You currently have a draft of a policy forcing doctors in some circumstances to provide abortions, contraceptives, and vasectomies even if they are “unwilling to provide certain elements of care due to their moral or religious beliefs” or at least to refer the patient “in good faith” to another doctor who would provide the service”.
Despite the fact that abortion is available on a self-referral basis in Canada, you insist upon violating fundamental human rights. Why would you compromise the integrity of your fellows when patients already have access to abortion services?
It is painfully obvious that you are, in fact, posturing to force doctors to perform euthanasia, which is not readily available. You are working staunchly against public opinion, which you received loud and clear this August. I see right through this political move. If you can deny a doctor freedom of conscience with regards to prescribing birth control, you have precedent to deny freedom of conscience for euthanasia. This is the kind of cowardice that makes me sick. You will force good doctors out family medicine, especially in rural areas with such despicable rulings.
Many people have argued that it is only religious doctors who object on religious grounds, but that is patently false. We are discussing moral issues that affect all physicians. If a doctor objects to physician-assisted suicide on any grounds (as the vast majority do) you have a responsibility to protect their Canadian Charter and UN guaranteed rights, whether they come from religious grounds or not.
I am writing to you today about a matter of grave importance. You currently have a draft of a policy forcing doctors in some circumstances to provide abortions, contraceptives, and vasectomies even if they are “unwilling to provide certain elements of care due to their moral or religious beliefs” or at least to refer the patient “in good faith” to another doctor who would provide the service”.
The most troubling part of this is your cavalier decision to trample Canadian Charter and UN guaranteed rights for a political agenda.
The most confusing part of this is why it is being tabled. Canada has no shortage of access to birth control; near free birth control is in fact a mandate of basically every public health unit. Also, it is far, far more difficult to obtain a knee replacement in a timely fashion anywhere in the country than it is to obtain an abortion. Even an MRI for a potential malignancy often involves incredible wait times and a great deal of travel to obtain it. Considering the many inconvenient things we subject Canadian patients to (especially our rural and remote patients), abortion access is not one of them.
It is one thing to require doctors to honestly express limitations or restrictions on the care they can/will provide to patients in a respectful manner. It is quite another to violate fundamental human rights and force doctors into situations that cannot be good for their moral health. Would you really want to make a doctor perform an abortion if he/she believed they were killing an innocent (and non-consenting) person? If you force a physician to, how can you expect them to continue to practice with true beneficence and non-malfeasance (ideals that are still taught in medical school today, because they are essential for truly good medicine)?
Further, if you require one doctor to perform or refer for abortions even though they privately are gravely opposed, simply because the patient wants them to, why should a doctor not also be required to refer or perform an abortion that is purely for sex selection? As much as some groups would like to say that the abortion debate is over, it is far from settled, and new horrifying implications are being realized all the time.
One final thought – a recent CNN article titled “For birth control, what’s old is new again” (Thursday, Jan 8, 2015) discusses an emerging trend for health conscience women to use technology to that up to 30% of women abandon using any form of hormonal birth control (including Mirena IUDs) due to side effects such as decreased libido. This is just one more, small reason why trying to mandate conformity is always a bad idea. Just as Canadian woman currently have exceptional access to traditional birth control (including abortion), they should certainly have access to physicians who specialize in alternatives. Also, there are absolutely physicians who do not wish to prescribe hormonal contraceptives purely because other Natural Family Planning techniques are becoming so user friendly and accurate that the risks of traditional birth control seem unconscionable.
Contraception is available at every health unit nearly free of charge. Abortion is a self-referral process in most provinces. There is no reason to tear down your fellow physicians with patently immoral and degrading policies. Ultimately, these kinds of policies ask physicians to stop critically appraising what they are doing, act against their conscience, and act in a manner they believe causes harm to their patient. For these reasons, all this policy will do is harm patients, without appreciatively improving access to contraception or abortion.
Dear Members of the Consultations Committee:
Subject: Draft Policy “Professional Obligations and Human Rights”.
I am writing to you with grave concern regarding the proposed draft policy. Sections 8, 10 and 11
suggest that physicians who decline to participate in certain acts for reasons of conscience should be
compelled to refer their patients to other physicians who will perform these acts. It does not address the
fact that many of these same physicians will find the act of referral itself objectionable, as material
cooperation with the act.
As an internist, there are several situations that I can forsee occurring where I will not be able to follow
this policy. For example, if euthanasia is legalized, I will not be offering this in my practice, and I do
not intend to refer my patients for this service, as the referral in itself lends support to the act. The
policy as it stands would not support my stance, and violates my right to freedom of conscience.
There is significant disagreement in our society as to what constitutes a moral act, and I do not expect
the College to define or limit morality. All I expect is that physicians, as professionals, be allowed to
respect their own consciences. Freedom of conscience is foundational to our free society and cannot be
limited, even for the best of intentions.
I encourage you to revise the sections above, and include a clear defense of the right to freedom of
conscience for all physicians.
I am a Canadian citizen and Ontario resident, and many of my friends are practicing doctors in the College of Physicians and Surgeons of Ontario. They have brought to my attention a concern they are having in their profession, which concerns me as well. They have informed me of the draft policy you are writing, “Professional Obligations and Human Rights”, which will limit physician freedom of conscience and religion. Specifically, if a doctor chooses not to perform/provide a procedure on moral/religious/ethical grounds, your draft policy would require him/her to refer the patient to another doctor who could perform the procedure. Forcing doctors to do so is requiring them to act against their conscience. If they consider a specific procedure unethical, then it is not something they would want their fellow doctors to perform either. Both performing the procedure, and referring it to someone else, are unethical choices for that doctor. And to require someone to act unethically is unethical in itself. I ask that you please reconsider this portion of the draft policy, and strive to uphold freedom of conscience and religion in every aspect of your profession.
Let us remember that doctors are humans who have consciences, and not machines that we can manipulate to do as we please.
Alternatives to patient care can be provided without necessitating a written referral. When it comes to “morally objectionable care” perhaps the ministry can provide a published listing of services available (who, where, when) thereby bypassing the referral process and actually speeding up access care.
Better yet, the ministry can stop using the terms “care” and “service” for procedures intended to kill. Of course, the ministry would also eliminate them from OHIP.
I see most people are commenting about the ethics part of this, but I want to talk about the accessibility/accommodation stuff.
I have just moved here from Alberta and reading this gives me hope that I will have better luck in my new province. The “one size fits all” treatment I have had my whole life, most certainly did not fit me. I tried a few times to ask for accommodations, but since oral communication is my biggest challenge, I was almost always unsuccessful.
I have Asperger’s, which means I am terrible at talking with people (I may do alright here, because writing is more comfortable than speaking and also I can think more clearly without pressure). I have trouble with finding my words especially when a Dr is staring at me or hurrying me. I’ve had Drs yell at me “just spit it out!” and that just makes my brain freeze up so I can’t think at all. or they want “the highlights” of a situation, and because of the way my mind works, I can’t tell which symptoms (or lifestyle habits or whatnot) are the highlights. I need a gentle, patient Dr who will tolerate my rambling, ineffective way of speaking. Since that is so hard to find, mostly I have given up on trying to communicate with Drs and neglected my health problems. I don’t want to do that anymore. I should get my problems treated, so they don’t get worse. I pay taxes; I DESERVE to get my health problems treated. But when I’m there in the office I usually feel like I am unwelcome and undeserving.
When I do try to discuss something, there are other hurdles, for instance I am easily pushed into giving an agreeable answer. For years I was getting antidepressants forced on me for fatigue & other symptoms, which it now seems were caused by thyroid trouble the whole time. I would try to tell Drs that the pills were having no effect, and the Dr would say “Are you SURE? It SHOULD be helping” & I’d cave and agree that it was helping rather than fight. I’ve had Drs rattle off a list of symptoms that went with a certain diagnosis and I said “No, that doesn’t sound like me. I have only a couple out of that whole list” and they’d say “Are you SURE?” & then again, I would get pressured into agreeing to a misdiagnosis.
Drs don’t understand how hard it is for autistics to speak defiantly or challenge an authority figure. Even when I’d tell them about me having Asperger’s, none of them seemed to really get what that meant or act any different with me.
My second issue which needs accommodation is a severe reaction to most synthetic fragrances. I remember once I sprained my ankle in a small town & the only Dr in the ER was drenched in Axe, despite “Fragrance-free Zone” signage all over the hospital. He was hostile to me when I explained my problem & that I couldn’t be near him. Looking back, perhaps putting an oxygen mask on me, or having a nurse examine me while he observed from afar would have been a suitable accommodation. Instead I was treated like a trouble-maker, & I was given a “diagnosis” without an examination, which caused trouble since it turned out a bone had been wrenched out of place, so it was actually more than a basic sprain.
I encountered room scent devices such as “plug-ins” in examination rooms when I was seeing a Dr specifically about my bad reactions to artificial fragrances. Such ironic inconvenience is not a rare occurance. I have two friends who have gone to specialists for their migraines in one case, allergies in the other, and there was room scent or Febreze present, triggering the very health problem they were there to work on! I’m sure asthmatics sometimes have the same trouble. It’s shocking enough when one can’t see a GP without getting exposed, but I’d like to think such specialists at least would understand that many people can’t tolerate fumes.
It would be nice if all clinics (and labs) were safe for scent-sensitive patients. The pleasure a Dr (or their staff) gains from using room scent, laundry scent, or personal fragrance, is so minor, compared to the suffering of sensitive patients who can not find a clinic they can safely enter!
Thank you for giving us a chance to put in our “two cents” about accessibility!
I am a retired primary care physician with more than a half million patient consultations on two continents.
I have lived under Hitler, I have had to practise cost-conscious medicine in the third world, I have agonized over hundreds of AIDS patients whom I could not help.
I shudder physically and emotionally as I have read all of the proposed guidelines for practising Ont. physicians, as well as the 149 responses posted above. I agree with most of them.
What is this country coming to?
I am glad I am no longer active in a profession that is developing a culture of death, with our leaders strangulating our best and brightest.
Please scrap the whole process and review your destructive worldview!
Regarding “referrals” (lines 156-164) and “necessary care” in urgent situations (168–) which may be contrary to the physician’s moral or religious beliefs:
Our concern is that “care” is becoming an increasingly subjective term, largely for “societal” rather than “medical-scientific” reasons and that the medical profession has been unable or unwilling to invoke “science” to resist these external pressures. As a matter of principle, we are very concerned that the College may be contemplating requiring physicians to leave their moral consciences at the door, so to speak. We are even more concerned as we contemplate the way in which medical practice, under the influence of non-medical non-scientific external forces will tend to treat “care” as a malleable concept which will quickly come to include physician-assisted suicide (=”self-murder”) and inevitably after that physician-provided death (=murder). We therefore respectfully ask the College to carefully review the referenced lines of the present draft in that light. We would prefer that the policy should require the physician to provide the care which in the physician’s sole judgement is medically required.
I do not currently practice in Ontario but have in the past. This document is of great concern to me, particularly in the way it needlessly imposes one morality on those whose morals may differ. It seems to shrug off moral objection to certain acts or procedures as of little value and uses “access to care” as a means to impose the majority morality on those who may disagree. Perhaps a reminder is in order that procedures or acts that were once legal are now illegal and considered morally objectionable by the majority; for example, female genital mutilation was not always illegal in Canada. If this policy had been in effect, there would be a duty to refer even if one recognized the procedure as immoral. There may be similar situations in the future.
While it is good to address the issue of medical acts which are considered immoral by a significant proportion of practitioners, the approach suggested fails to protect physicians from coercion to act in unconscionable ways and fails to protect patients from doctors who are willing to be be coerced into participating in immoral acts simply because they happen to be legal at this point in our history. To state the obvious, referral constitutes participation.
The right to die soon becomes the duty to die. No one is an island.
A patient that we rescued from a suicide attempt triggered by finding her Parkinsonism was interfering with her tennis game couldn’t understand when her daughters were angry with her. She thought her insurance would pay their way through college. I explained that she had almost killed their mother. She said, “I never thought of it that way.
We should not be focusing on physicians involvement but on the perverse incentives that require legal sanctions against counseling, aiding, or abetting suicide for balance. One can’t punish a corpse but one must not wink at counseling self destruction.
I find that the proposed document is discriminatory against any physician who morally can not recommend euthanasia, abortion, female circumcision, etc.
The lack of a Canadian law against abortion, or euthanasia, does not make it the correct course of action in every situation – therefore there will be patients who request a procedure that should not get the procedure.
All of medicine requires critical and discriminatory thought and decision making.
The Law is constantly discriminating – those who abide or do not abide within the law are consistently differentiated. That is why there is a determined desire to remove law, change it or to weaken it.
Those who want to participate in or promote illegal behaviour for their own comfort, want to change the laws so they are less “law-like and discriminatory.”
That the lack of law suddenly engenders a new professionalism ‘law’ to force compliance with morally repugnant actions is in itself discriminatory.
Must we now defend the right of those who want to promote that which was once clearly illegal, before the changing of the laws? To Not do so is ‘morally repugnant” and subject to discipline ? ? ?
The immoral is made moral, and the moral is made immoral.
It seems to me as if I have heard of this somewhere.
If the right of the physician is not ultimately defended, there can be no rights for the patient.
I am a physician who holds to the ancient Hippocratic oath of doing no harm.
Personal choice, rights and freedoms:
What “no harm” is should not be forced upon me by others.
The freedom of conscience and moral belief is one of the most important qualities of a physician as a caring individual and human being (we are people too!) It is also a respected entity protected and guaranteed by the Canadian Charter of Rights and Freedoms.
Mistakes of our past:
If we choose to retract the physicians ability to step away from something he or she feels is wrong we ignore the important lessons we have learned from the history of medicine. We risk repeating the horrors of the past (recall nazi experimentation on Jews, homosexuals, twins…all in the name of medical progress). Had those physicians had the freedom of choice to say “no, I cannot do this as I feel this is wrong”, hundreds of innocent lives would be saved.
Impact on the physician:
More than that, I answer to a God, the great physician, whom I have dedicated my practice of medicine to. One must consider the ramifications of enforcing acts which will cause personal guilt and shame on physicians who are already overworked and statistically known to have high rates of burn out, exhaustion, depression and suicide. Are we willing to risk this on a much needed resource?
Other options:
I have trained in the north were physicians and resources are few. However even in remote areas self referral lines still exist and colleagues are able to take over when individual physicians are not comfortable with various referrals and procedures. We are all different in personality, beliefs, and comfort levels and that makes us able to relate best to our patients as humans, not robots. If alternate routes are not accessible funding should be aimed at creating them so all will be content. In most cases, these are already in place for “controversial procedures.”
I humbly submit my opinion and firmly back up my resistance to any change of law or policy that challenges the rights of myself and my colleagues – it is just unnecessary, wrong, and frankly dangerous.
Making an “effective referral” for a service that one finds morally unacceptable is morally no different than providing the service oneself and is therefore a violation of the physician’s right to freedom of conscience. In terms of the balancing of rights, a patient can choose from many physicians, a physician only has one conscience. As long as the patient is informed of the availability of the service and how to access the service, a referral is not necessary.
The draft policy thirteen times specifies “those seeking to become patients.” The second instance includes them when emphasizing that even vulnerable and marginalized populations should receive equitable access to care. The fourth instance requires their best interest in any conflict that arises because of a different value system than the doctor’s. The sixth instance requires reasonable accommodation to them if a disability or other personal circumstance limits their access to care.
Does nobody else see a logical problem here? By using the word “seek”, the draft policy has discriminated against and effectively excluded “vulnerable and marginalized populations” who because of the majority’s “different value system” and/or their own “personal circumstances” CANNOT seek to become patients.
Children are an obvious example. Because of their early stage of development, babies cannot communicate much. Because of the majority’s secular humanist value system, they are marginalized. Secular humanist doctors currently kill many of them before birth in Canada and–if euthanasia is legalized–will eventually kill them after birth as Dutch doctors do. When is anyone more vulnerable than while a baby? The womb is supposed to be a place of safety, and a doctor is supposed to heal. These should be self-evident truths.
This draft policy will actually accomplish the opposite of what it purports to do. Ontario is already such an intolerant place that those who dare point out logical inconsistency–if they do so in the wrong setting, i.e. where the abuse is happening–will be put in jail. And if, in solidarity with babies, they refuse to speak in their own defense, they will remain in jail. This draft policy will only make the inequity and injustice worse.
I have 2 concerns about the draft policy.
1) Line 168: Physicians must provide care that is urgent or otherwise necessary to prevent imminent harm, suffering, and/or deterioration, even where that care conflicts with their religious or moral beliefs.
This is very vague as to what may be required here. Please specify what is imminent harm, suffering , or deterioration. I am also concerned that such a broad statement would infringe upon doctors’ right of conscientious objection.
2) Line 146-48
Furthermore, physicians must not promote their own religious beliefs when interacting with patients, or those seeking to become patients, nor attempt to convert them.
A blanket ban on discussion of religious issues between doctor and patient is overstepping the reach of the CPSO in my opinion. A ban on UNSOLICITED or unwanted discussion of religious issues would be more appropriate. Furthermore, this should apply not only to physicians with religious belief but also those without any religious persuasion.
I am gravely concerned about the draft policy you have put forward. I know of several physicians – myself included – who pursued medicine partly because of values instilled by our various religious and moral beliefs. I firmly believe that all physicians can still provide timely, appropriate and patient-centred care while maintaining their freedom of conscience and without having to compromise on their beliefs. Please reconsider your policy. Thank you.
Although my personally think I would rather my MD not share his religious information with me. My concern is that in DEMANDING that the physician make REFERRAL to an abortion clinic etc you are not hindering their belief system. You my in fact find many MDs pulling out of their practices if this is forced upon them. Thus crippling an already over burdened healthcare system. I note that the information regarding abortions etc is already widely posted on the internet and patients can easily access this information by simple google search. MD’s that have a religious back ground generally post that on their walls and the patients in tern know this in advance of coming into the practice.
I think that the proposed policy is contrary to the charter of Rights and Freedoms and is discriminatory against doctors who cannot participate in these procedures because of religious beliefs. This proposal should not become policy as it will deny many doctors the right to act according to their conscience in areas that are not life threatening.
It has always been my understanding that a physician is in a covenantal relationship with each of his patients. That covenantal relationship consists of an unstated, understood promise to do whatever is necessary and possible to maximize health for that particular individual. The therapeutic activity is based on scientific evidence and the best judgment of the physician and it is a negotiated activity with the patient.
However, if the physician were asked to participate in euthanasia or abortion, and were to comply, despite her deeply held judgment that that was not in the best interest of the patient, she would’ve lost her integrity. At that point, no patient would have any reason to trust that physician any further. Trust is a precious commodity and absolutely critical to the therapeutic relationship.
It would be the destruction of a physician in his function as a physician for the CPSO to insist on participation in intentionally lethal actions on his patients.
If asked to murder, or to assist in killing, I were to comply, I would be simply a contractor, doing a job for a fee or no fee. I certainly would not be a covenantal physician in the historical understanding of that phrase.
Upon reviewing the third draft of the policy “Professional Obligations and Human Rights” I would like to express my extreme concern and alarm at what seems to be a newly added clause. I would ask you to delete or change this clause.
I refer to lines 156/157 referenced under “Ensuring Access to Care”. I believe that what you refer to as an “effective referral” made for a service that one finds unacceptable due to moral or religious beliefs, makes the referring practitioner morally culpable and therefore is in itself unacceptable. I feel that as long as the patient is informed of the availability of the service and how to access the service, that a referral (i.e. traditionally a request/letter sent from one practitioner to another) is not necessary.
I trust you will take my concern under serious consideration
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.
RE: Professional Obligations and Human Rights policy consultation
I am deeply concerned about the move to force physicians to refer for procedures which violate their conscience.
i) Participation. Those drafting the policy seem to lack understanding regarding the fact that referring for a procedure involves a participation in an act which the physician deems immoral.
ii) Fiduciary responsibility. With regards to a fiduciary responsibility, physicians with conscientious objections to certain procedures, do so in the best interest of their patients. In fact, in the case of abortion, these physicians see a fiduciary responsibility to the second patient in the womb as well.
iii) Minority discrimination. The College is being overly dogmatic in demanding that a very small minority of physicians who have conscientious objections ignore their beliefs for the sake of services that can be provided by the vast majority of physicians. The reality of the situation is that most patients are not being inconvenienced by these few physicians, but imposing the College’s policy on this minority does a great service to the physicians’ dignity who have deeply held convictions about their beliefs. (Genuis, S. J. (2008). Discrimination on the basis of ethical orientation. Canadian Family Physician Médecin De Famille Canadien, 54(12), 1679–1680.)
iv) Erosion of conscience. Forcing the hand of physicians against their will, in this case of referral, is the beginning of a “small shift in emphasis” that has wide ranging consequences (Alexander, L. (1949). Medical Science under Dictatorship. The New England Journal of Medicine, 241(2), 39–47). With the possibility of euthanasia on the horizon in Canada, physicians who fundamentally object to killing patients would be forced to refer for the procedure.
v) Professionalism. A healthy respect for disagreement among colleagues is essential in medicine, respecting the safety of patients. Since patients are able to access care from a vast majority of physicians who don’t have objections to the morally controversial procedures in question, it seems unprofessional to impose unilaterally a way of acting that does not directly affect the life or limb of patients. In fact, it may happen that one day the only thing that stands to protect a person’s life is the conscience of a physician
I would be more than happy to discuss this in more detail over email or by phone should you care to discuss it. Your engagement with physicians and care to respect all perspectives is much appreciated.
Dear Members of the Consultations Committee:
Subject: Draft Policy “Professional Obligations and Human Rights”.
As a medical student and a future physician, I am very concerned about many of the details in your proposed draft policy. Sections 8, 10 and 11 suggest that physicians who decline to participate in certain acts for reasons of conscience should be compelled to refer their patients to other physicians who will perform these acts. It does not address the fact that many of these same physicians will find the act of referral itself objectionable, as they consider it material cooperation with the act. By compelling physicians to refer, your policy will inflict much moral anguish and distress to the physicians affected. The draft that you have proposed will limit the physician’s right to conscientious objection.
There is significant disagreement in our society as to what constitutes a moral act, therefore, I do not expect the College to define or limit morality. Within the medical profession and the general public, there are a plethora of views of what constitutes a moral act. In order to respect this diversity of thought, I strongly believe that your policy must also reflect the diversity of views regarding morality within our society.
All I expect is that physicians, as professionals, be allowed to respect their own consciences. It is unfair to force physicians to perform acts that will cause them certain moral anguish and distress. Freedom of conscience is foundational to our free society and cannot be limited, even for the best of intentions. If we coerce physicians into violating their consciences, we will inevitably erode the personal integrity which is the basis of the physician’s relationship with their patients. I encourage you to revise the sections above, and include a clear defense of the right to freedom of conscience for all physicians.
I am a physician who holds to the ancient Hippocratic oath of doing no harm.
Personal choice, rights and freedoms:
What “no harm” is should not be forced upon me by others.
The freedom of conscience and moral belief is one of the most important qualities of a physician as a caring individual and human being (we are people too!) It is also a respected entity protected and guaranteed by the Canadian Charter of Rights and Freedoms.
Mistakes of our past:
If we choose to retract the physicians ability to step away from something he or she feels is wrong we ignore the important lessons we have learned from the history of medicine. We risk repeating the horrors of the past (recall nazi experimentation on Jews, homosexuals, twins…all in the name of medical progress). Had those physicians had the freedom of choice to say “no, I cannot do this as I feel this is wrong”, hundreds of innocent lives would be saved.
Impact on the physician:
More than that, I answer to a God, the great physician, whom I have dedicated my practice of medicine to. One must consider the ramifications of enforcing acts which will cause personal guilt and shame on physicians who are already overworked and statistically known to have high rates of burn out, exhaustion, depression and suicide. Are we willing to risk this on a much needed resource?
Other options:
I have trained in the north were physicians and resources are few. However even in remote areas self referral lines still exist and colleagues are able to take over when individual physicians are not comfortable with various referrals and procedures. We are all different in personality, beliefs, and comfort levels and that makes us able to relate best to our patients as humans, not robots. If alternate routes are not accessible funding should be aimed at creating them so all will be content. In most cases, these are already in place for “controversial procedures.”
I humbly submit my opinion and firmly back up my resistance to any change of law or policy that challenges the rights of myself and my colleagues – it is just unnecessary, wrong, and frankly dangerous.
I would ask you to delete or change this clause in lines 156 and 157 referenced under “Ensuring Access to Care”. Making an “effective referral” for a service that one finds morally unacceptable is morally no different than providing the service oneself and is therefore a violation of the physician’s right to freedom of religion and conscience. In terms of the balancing of rights, a patient can choose from many physicians, a physician only has one conscience. As long as the patient is informed of the availability of the service and how to access the service, a referral is not necessary.
When I see my patients, it is a meeting of two people, and both of us have been given beautiful lives. I am called to look at it this way always, both professionally and as a Christian. It is a precious relationship, where I am being called upon to help, and give my best to the next person. I am to call on my learning in medicine and the sciences; and also on the knowledge I have of the person in front of me as a son or daughter, with all the amazing pieces that make that person individual and alive.
It is only respectful to the both of us, when I can present what I truly feel are the best options are for health for that person. When I short change that person of the best options, I am also acting devaluing myself as a doctor and as a person, as a brother/neighbour.
My patients don’t know know me well, but I think they know that I consider their stories and their workup and treatments within their contexts. I discuss it with them. Regardless of whether it is a test or a medication or a referral, we can talk about what is a better choice or what might be harmful, what I may not recommend even, based on our goals. I would hope that in these discussions, that they sense why I love my practice of medicine: not because I want to direct and be right, but because each of them has a life that is inherently sacred and valuable from beginning to end, in all its fullness and with all its potential. I am called to defend that life, and to help somehow nurse it back if I am allowed to.
This is not a question about separating morality , religion and medicine and science. I could not divorce myself from the reasons I practice because those reasons are inherent to who I am.
To be asked to lay aside questions of morality is to ask me to be less than myself. as a physician and as a Canadian and as a Christian.
To those who wish I did not practice medicine, I only want you to ask yourselves: would you really want a physician who practiced without his or her morals? Who didn’t really consider what is best for you? Who like you,also reserves the right to beliefs, whether you agree or not?
I have been wrong so many times in my life and in my practice. But thank God for the opportunity to do so. If we lose that freedom in Canada, we will lose the ability to truly care for one another.
I cannot agree to be required to refer someone for services that are against my beliefs. All of us share differences of opinions and beliefs and that richness makes my day fascinating – I meet some really amazing folk everyday! the differences I have with my patients are points of discovery. When we disagree on what would be helpful to them as far a improving their health, here I am being asked for a recommendation. I sometimes have to recommend against what they are seeking. It is always in their best interest, to the best of my knowledge that day. sometimes that medical opinion has direct roots in my spiritual being, but it is never haphazard.
To then be required to send my patient to another doctor who would agree with a treatment that I find harmful to my patient is absurd. I can understand the desire for this ease. But this is equivalent to participating in harming my patient. How can I be asked to carry this on my conscience? What is the point of even debating a person’s values, if they can be overridden?
The text of the policy is not the issue. the idea of the policy revision is the issue. We have stepped into an area where the physician becomes the purveyor of services on demand, not the professional advisor.
Thank you for giving us this opportunity to discuss the draft policy “Professional Obligations and Human Rights”.
1) I am concerned about line 168-169 and would strongly advise the revision or deletion of this sentence as it currently stands:
“Physicians must provide care that is urgent or otherwise necessary to prevent
imminent harm, suffering, and/or deterioration, even where that care conflicts with their religious or moral beliefs.”
The words “urgent” or “necessary” “care” are too nonspecific and too open to subjective interpretation. Who determines that the care is urgently needed to prevent imminent suffering? A suffering patient who just wants to die? The grieving family? The physician? The CPSO? For example, if euthanizing a patient is considered urgently necessary by the patient, does the policy then force a physician to take her life? No! How can professional obligation ever trump moral law? Legal authority this policy may have, but moral authority never. By ordering physicians to perform acts conflicting with moral/religious belief, this policy sets itself up as a higher authority than God, an authority it does not have.
I would recommend that we use concrete examples within this policy. For clarity, the policy statement could specify explicitly the expected “elements of care” which a physician must provide that are commonly contrary to religious or moral beliefs. This will help us spell out clearly what actions the policy wishes to enforce–although I want to stress again that legality of an action does not imply its moral rectitude. We are all responsible to God for disobeying any law that sets itself against God’s Law.
I hope you understand my serious concern with this sentence. Thank you for taking it into consideration.
2) I am also concerned about line 146-148:
“Furthermore, physicians must not promote their own religious beliefs when interacting with patients, or those seeking to become patients, nor attempt to
convert them.”
Please clarify what is meant by “promoting religious beliefs”. This life is a response to what God has graciously done, and every aspect of my working and visiting patients and providing care is a promotion of that belief. In fact, in my limited experience, some patients find it both therapeutic and much appreciated when we speak about hope in God’s goodness and pray together.
Finally, no environment exists in which religious beliefs are not being promoted. Just as promoting theistic belief is speaking about God, so avoiding all mention of God promotes atheist belief.
I would recommend that we amend this to read that physicians will not coerce patients to share their beliefs and again to specify explicitly what actions are considered a “promotion of belief”.
I hope you understand my concern with this sentence. Thank you for taking it also into consideration.
The proposed policy change is absurd, as it erases the concept of physician as professional and personal advisor, and puts us in the position of purveyor of services on demand. What it the point of debating issues of conscience if we will be asked to act against our best judgments, and act as accomplices to the very acts we would normally find ourselves objecting to? Now my conscience will be burdened with the guilt of either having done wrong for my patient, or of having disobeyed college policy? It is a no win situation as soon as one finds one self morally challenged by a patient over a treatment decision. This is professionalism?
I think you have to understand the College is all about money, business and politics and as such these policies should be taken with a big grain of salt. The College or your patients should not and cannot lead you to compromise the soul of your morality as you can never please the College nor all your patients. If push comes to shove and you had to defend your decision not to participate in any form in abortion or euthanasia, I am supremely confident you or any doctor would successfully defend themselves. Morality is a fundamental sacred right which no other man or policy has the right to override.
RE: DRAFT POLICY ON OBLIGATION OF DOCTORS TO PARTICIPATE IN ABORTION, CONTRACEPTION AND EUTHENESIA.
In my opinion doctors may not be compelled to participate in practices which are against their conscience. Their rights under Canadian Charter of Rights and Freedoms must be protected.
While I support nearly the entire draft “Professional Obligations and Human Rights”, I would like to register my disagreement with the clause that requires a physician to make an “effective referral” for a service one finds unacceptable. I believe that explaining all options in a respectful and caring manner, including how the services are accessed, would and should be sufficient and could avoid infringing the rights of one person while attending the rights of another.
I’m not a doctor, but if I were, I would indeed attempt to speak in a respectful and caring manner, AND I would also be honest and trustworthy. I would NOT provide contact information for help with performing a forced abortion. I would not even mention it as an option. It isn’t. It’s unspeakable. It’s disrespectful and uncaring in the extreme. Pregnancy isn’t a disease, good parents don’t kill their children, and a good medical profession doesn’t engage in murder (which abortion is according to God’s law).
I am deeply concerned about the extent to which the draft policy goes to facilitate practice of physicians in areas clouded by differing and sometimes conflicting ethical values. Particularly the judging of what is “necessary to prevent imminent…suffering and/or deterioration”. This statement will invite legal battles and will compromise the delivery of consistent, compassionate and courageous care by the majority of physicians who remain against legalized assisted death and euthanasia.
After reading the policies & and most of the responses from both physicians and members of the public, I want to echo the concerns of lines 156 to 164.
These lines must be reworded such that a physician is NOT obligated to make a referral if the referral is against the physicians moral or religious beliefs.
Patients have the ability to obtain second opinions or in the case of abortion they can self-refer. It is not necessary for a physician to make a referral when it opposes his/her moral beliefs.
Physicians must be able to maintain their conscious rights. As a patient I would not want my own doctor to be restricted from his/her own freedom of thought and moral beliefs. My physician should remain a free thinker rather than a slave whom just provides whatever treatment or investigation I request. The benefit patient and physician who maintains his/her conscious rights is mutual. There is no coercion, no resentment, no guilt and therefore less conflict.
As a medical student, I make the following suggestions acknowledging that this topic carries important implications for my future practice.
Regarding the sentence spanning lines 146-148:
I agree with this statement but ask that context be clarified for its application in order to avoid unnecessary confusion. Consider a physician (who does not drink alcohol due to a religious belief) who recommends abstinence from alcohol to a patient who is recovering from alcoholic hepatitis.
Regarding lines 156-161:
I believe the definition of ‘effective referral’ needs more work. What does ‘non-objecting’ mean? Not objecting to seeing the patient or not objecting to this patient receiving a certain element of care? An aspect of an effective referral that should also be included in the definition is clinical competence in providing said element of care.
Regarding lines 168-169:
This statement’s use of the word ‘must’ is inappropriate for there are certain exceptions.
I have read the policy of reviewed comments from all. This policy should not move forward. Physicians must be treated as human beings with rights as well. Forcing physicans essentially violates their rights as well as the physician patient relationship.
I agree.
I am surprised to read so few comments in favour of the proposals. I was lead to believe from the Dialogue that there was overwhelming support from the public. Please show us the data.
It is with great dismay that I find the College taking a position that would punish a a physician for following their conscience. Are you saying that a Catholic or a devout Jew or Christian cannot become a doctor? The College is showing itself to be fascist. Yes, fascist and if that word offends you, it is your problem. Abortion is the killing of a baby. My physician has a crucifix in his office, one in the reception area and one in each exam room. Are you going to tell him to take it down?
To whom it may concern! What a tremendous low for the Physicians and Surgeons who work diligently in their profession to save lives. There are, unfortunately, a number of so-called doctors who would willingly take the life of a child growing in the womb. Any physician would know that this child is a living human being – it can survive outside of the womb, with help, as young as 21 weeks gestation…and yet on the other hand, we are willing to suction or dismember that child out of its mother’s body all for the sake of convenience. This is treacherous and inhumane. It’s murder is what it is. Please do not force doctors with a conscience to have to murder!
I am concerned that the College of Physicians is arrogating to themselves authority they do not have and are not entitled to. How can anyone force someone else to go against their moral or religious values? Smacks of fascism to me! Will doctors have to be engaged in civil disobedience in order to make their point? I would prefer to have a doctor with a moral compass based on traditional Canadian values. Otherwise I may fear being used as an experiment for unsafe drugs such as RU-486 or Gardasil or worse.
patients need to be able to trust their doctor completely in order to partner with them in their own care. When that trust is broken, care becomes inferior and the quality of many lives are lost. Stay out of the moral issues! Don’t force your immorality on those who wish to have a moral foundation to their work and practice!
The present news sheds some light on the current issue of PAS/E and Canadian Human Rights. Events in the Middle East have reminded us of our freedoms: especially freedom of association, freedom of belief, freedom of conscience, and the right to practice one’s career in the light of these freedoms. Such freedoms are an integral part of a free and democratic society. On these grounds the coercive aspects of the CPSO’s draft Professional Obligations and Human Rights Draft Policy must be withdrawn.
CPSO mandate is to protect public by maintaining the highest professional standards of their members. The physicians are expected to provide care within the scope of their training, irrespective of their religious beliefs. The freedom of religion should not entitle physicians to refuse care to their patients just because abortions are wrong or gay peoples are sinner, according to their irrational religious beliefs. These physicians can exercise their religious freedom in their churches or privacy of their home, but not at the expense of the publicly funded health care system. If you can’t provide care to your patients within the scope of your training because of your beliefs, even if they are religious, then leave the profession and do something else.
You took an oath not to harm anyone and abortion ends human life. Therefore every physician, nurse or aid should have the right to refuse participation irregardless of where they came up with the idea that killing is wrong. If policy makers can’t understand that then they need to find a different line of work, not those who spent a lifetime training to reach a life goal of helping and sustaining life.
Life is religion, and everybody is religious. You and I are as religious as fish are aquatic.
The CPSO is supposed to regulate the practice of medicine in order to protect the public interest; the police are supposed to protect the public. But whether the CPSO has a mandate to “protect the public” or protect the public interest, they should not be requiring their members to kill or mutilate people.
Abortion is wrong because it is the deliberate killing of a human being. Your denial of his existence is, to use your term, an “irrational religious belief”. Abortion isn’t care; it’s killing.
Freedom of religion as a right developed in a Christian context. Isn’t it related to the separation of church and state and to disestablishmentarianism? I might go to a different church than you, but there was no question that we shared a Christian world and life view. I realize that now the majority of Canadians adhere to secular humanism, but in the days when the Canadian anthem was written, Christianity was the dominant religion. And it is a reasonable faith.
To rephrase your advice, if you are going to kill or mutilate your patients or those entrusted to them because of your beliefs, which are religious, then leave the profession and do something else. Please do no harm.
I am deeply saddened. How hypocritical to say you can not cause not cause harm to your patients, yet you are now setting a mandatory policy to kill them. Abortion ends human life, the exact opposite reason more than just most but approaching all people get into medicine. With all the information that shows the traumatic effects on mothers and even fathers who regret their choice to abort, I find it completely appauling that anyone who simply wants to work is going to be forced into participating in this kind of medicine. So now not only are we saying someone in the equation doesn’t have the right to live, but now also that we have no rights to act on conscience, spiritual beliefs or engaging in mentally unhealthy work.
I would like to express my strong objections to the CPSO draft policy on “Professional Obligations and Human Rights.” In particular, under the section “Ensuring Access to Care,” the requirement that doctors make an “effective referral” for a service that one finds unacceptable due to moral or religious beliefs is essentially a requirement that physicians act against their beliefs. For example, if euthanasia is legalized in the near future, are physicians who are morally opposed to euthanasia required to refer patients for euthanasia? Such a referral makes the referring practitioner morally culpable and is therefore unacceptable. It is sufficient for patients to be informed of the availability of a service and how to access the service. Thus, I urge you to remove this clause from the policy.
The Physicians and the Ontario Human Rights Code policy,
Is only directed towards the abortion issue or other similar issues related to care when a patient refuses care on religious grounds.
You are concentrating on this Policy and denigrating the overall Patient complaint/Patient Rights and basic Human Rights issues.
We need a forward thinking system of Patient Guardians in nursing homes, Patient Guardians for children, and generally that ANYONE can access in ANY hospital or healthcare facility that would independently investigate and monitor a patients critical issues in the system. I implemented such a system in Guardianship Monitors in the State of Florida for elderly who were at their own homes. We found abuses and recovered $500,000.00 in “misappropriated” funds for Seniors in one County alone.
The CPSO should advocate that this whole issue of cooperative care with different monitors and health care providers that is preventative not reactionary as its focus.
We simply do not have that system.
We need to build that first. This policy review should be secondary to that initiative.
I object to the revised Professional Obligations and Human Rights. Physicians should not be forced to participate in controversial procedures such as birth control, abortion and euthanasia. These practices have the potential to do harm to patients, and mandating them puts physicians in a bad position. As a current medical student, the passing of this draft would discourage me from pursuing my medical career in the province of Ontario. I recommend the rejection of the current recommendation. Thank you for your consideration.
People become doctors because they are called to a vocation of healing. They are in the business of healing not hurting, of respecting and enhancing a person’s quality of life; Catholic physicians believe in the sanctity of human life. They are not in the business of ending a life, rather they are dedicated to the healing process. Please continue to allow Doctor’s to work wihin their religious belief’s. Being a Catholic, I would want to see a doctor who had the same belief’s as I since they could provide counciling that was not contrary to my own.
This is the grossest discrimination against doctors and will have a chilling affect on the general public. Doctors have a right to refuse to participate in the death of their patient. This is a nakedly violent act of ideological warfare. So much for pluralism and democratic values. Lots of abortionist and euthanist doctors will jump at the chance to end a life. So why force a doctor of good conscience. How could you even think to pass such a draconian measure?
Thank you for the opportunity to respond to this draft policy currently under review. The primary concerns addressed by this revision centre on the rights of patients to a desired treatments and the rights of physicians to practice medicine in a manner congruent with their moral principles. The two major areas that currently appear on the discussion board are abortion and euthanasia/assisted suicide.
One issue rarely addressed in discussions of accessibility in a variety of situations, not just in medicine, is that whenever you draw a line that permits only one course of action you have actually simply created a new form of discrimination. The inevitable consequence of placing one particular point of view or belief ahead of any other points of view or belief is the unintended establishment of reverse discrimination. For example, it is as discriminatory to say a physician’s moral position is unacceptable in the practice of medicine as it is for a physician to harass a patient for expressing a desire for a treatment or procedure that is against the physician’s beliefs. Both actions are discriminatory and should be prohibited, not just one. In my experience Christian physicians are very willing to provide information about all options to patients in a respectful, professional way, helping the patient sort out their feelings and questions about the various possibilities so they can make an informed choice. If the patient does make a decision that the physician cannot personally be involved with the patient now has the information needed to access their chosen treatment with the physician being able to maintain his/her moral integrity by not participating directly. This approach preserves human rights for both the physician and the patient.
As a physician with many years of experience and a set of moral values/beliefs that are important to me and to many patients, I could share examples of patient interactions where my understanding of their ethical framework actually led to the refusal of extreme medical procedures with a clear mind and heart about the decision, and family members who could continue in peaceful acceptance of the realities of the situation rather than distrust and confusion. I could share times when recognition of the fears and belief structure of a patient facing major surgery led to a request for prayer which had a profound calming effect on the patient.
A patients’ belief system, whether Jewish or Muslim or Christian or some other religion can have a profound impact on their handling of an illness. A doctor who has no understanding of the potential impact a patient’s values/beliefs may have on their decisions and stresses will actually be a less effective physician. There is value to maintaining a diversity of belief within the medical profession.
There must be ways of resolving access issues short of mandating that ALL physicians must be willing to perform or refer for procedures that violate their core beliefs. For example, although access to abortion is constantly raised as a critical issue in discussions of physicians who don’t want to be involved in that particular procedure, in reality Ontario patients can already self-refer. One would expect that model could be expanded to other areas.
There is no question that disrespectful behaviour or approaches that stir up fear or guilt are inappropriate in ANY medical encounter, and should be disciplined appropriately.
Information is essential for a fully informed patient decision. Christian physicians are willing to provide information to patients about all possible options. This is a necessary part of an informed discussion of all available choices, but may be something that the CPSis not aware of. Such information sessions need to be calm, factual, non-judgmental and professional. A caring discussion allows the patient to sort out their values and feelings about procedures and then allows the patient to make an informed decision. If at that point the patient makes a choice that the doctor is unable to participate in then the patient knows how to access the procedure and the doctor is able to maintain their moral integrity by not participating in the action. In this kind of interchange a professional relationship can be maintained that is truly non-discriminatory of either party.
Hopefully most physicians go into medicine because of their strong desire to serve the needs of their patients. This may or may not have a faith-related component to their motivation. A physician who is forced to end up practicing medicine as a robot…. unable to live and work in congruence with deeply help beliefs that shape his/her very being, will not be functioning from a place of wholeness and will burn out or seek other areas of work.
Human ‘rights’ will always have places of potential tension. To be otherwise would require a forced absence of diversity that would destroy the vary heart of the physician-patient relationship. I strongly request that the CPSO reconsider this policy.
If a physician does not wish to preform abortions, they should not have to. It just wrong to force your beliefs upon someone else. Let people who would like to have or need an abortion go to physicians who are ok with preforming them!
this is getting weirder and weirder here this new doctors coming in to save lives and you now make them killers against their will. there is no authority that can force others to destroy life. but then again the medical society is so corrupt they are not in it to save they are in it to kill and how can we kill more. Oh vaccines and radiation
get a life and leave others alone
As Physician said, if a physician decides not to accept someone because of creed, race, income … it is discrimination. But if a physician decides not to perform certain procedures because of his or her believes and or conscience that MUST be not only respected but also protected. We are supposed to be in a FREE country after all.
The conscience and believes of the physician MUST be not only respected but also protected. A physician SHOULD NOT be obligated to perform a procedure that goes against his/her conscience and/or believes. We are in a free country after all.
This policy is EVIL and all WRONG! God have mercy…you have no idea what you’re getting yourselves into.
No physician should be forced to become like the devil and perform or “treat” what is against his/her beliefs! This is MURDER!!
I understand the College of Physicians and Surgeons of Ontario is considering a policy of compelling doctors to murder unwanted people to wit: unborn babies and elderly people. If the policy is to allow this kind of barbarism, well, everyone has their own conscience and eternal soul to contend with. But the very idea of compelling anyone to commit these heinous crimes is abhorrent. I for one would not trust any doctor with no conscience and personally object to anyone forced to commit murder. Why not just march them off to the gas chamber.
Abortion and birth control are at the highest degree of morality for the doctors who wish to refuse these services. Abortion, as well as birth control in the case where the fertilized egg does not attach itself, is seen as ending the life of a human being. What I mean by “highest degree of morality” is that it is not simply at the same level as stealing a piece of candy from the store: our law system recognizes that the ending of a human life requires the offender receive arguably the highest degree of punishment. And these doctors believe, with strong rational and scientific backing, that the acts which the doctor must provide or refer for are breaking the aforementioned law: the ending of a human life. Thus by asking our doctors to provide or even refer something that is at odds with this moral belief, which again stands at the highest level of importance in their life, you are in essence asking them to violate their highest level of conscious belief. I think it is more than reasonable (of course very rationale if one simply look at the evidence) to state, given the belief has very strong reasoning behind the ethics of ‘why’ it is believed, asking doctors to violate this fundamental belief so that room can be made for this very recent demand is utterly shocking and stands no ground of comparison. There is simply not enough evidence supporting that the right to a referral or an abortion trumps the most fundamental religious and/or moral belief of the individual. This is not trumping the right to attend a service (though this has its own strong implications), this would trump the conscience of the individual, wherein lies the decision on the highest moral ground. To trump this is unconstitutional, and would represent the slamming down of a post-modern foot via ignoring the very strong rationale for the stance against providing the services. If the College is prepared to undermine human reasoning for the relativistic stance of providing for those citizens who shed bloody tears to win the College’s vote, then I must seriously question if I am safe to attend my doctor knowing the College’s view on the essence of being human.
It is absolutely ridiculous that you are even thinking of making a human being perform a procedure such as this, against their will. We already have had enough GOOD doctors who have left this province/country because of the ridiculous policies placed upon them. This is violating the physicians human rights, did you think about that part? Or were you too busy trying to be politically correct? I chose my obstetrician partly on the premise that he does not perform these procedures. What about my choice?
I absolutely unequivocally disapprove of this. This is a violation of the human rights of our physicians. You need to take the rights of our physicians into consideration. If the demand for these procedures outweighs the availability of service, you need to start looking at other potential avenues where you have failed, before imposing your will or policies on another human being. Especially our beloved physicians who we desperately need in this province.
I sincerely hope that this draft does not become reality. Ontario, you continue to disappoint me.
Last year I expressed my opinion on this subject and I am doing it again:
Keep conscientious rights for doctors in place!!!!!.
Don’t force doctors to act against their conscience, like robots.
Last years survey told you that the majority who responded to your survey voted for conscience rights.
Why are you now drafting a policy that would get rid of those rights?
If you do, we will be stuck with uncaring, unfeeling, robots as doctors. How sad.
What a shame you did away with the Hippocratic oath. When did that happen?
This goes for the question of Euthanasia as well.
Don’t kill people. At least feed and hydrate them if the patient has it in his/her living will, the family, or guardian wants that.
This goes especially for coma patients.
So please keep conscience rights for doctors in place!!!
I am writing to voice my concerns with the proposed CPSO draft policy on Professional Obligations and Human Rights with especial reference to the requirements for a physician who is unable to provide a requested service for moral reasons.
My concerns are from my perspective as a palliative care physician. The overriding philosophy in palliative care, in seeking the comfort of the patient, is neither to prolong life nor to hasten death. For this reason neither assisted suicide nor euthanasia can ever be part of palliative care. There is a real possibility however that the Supreme Court in the near future will rule in favour of assisted suicide and that it will become accepted practice by the medical profession.
Thus faced with a request for assisted suicide from a patient, I would be required, by this College policy, to refer them to a physician who is “non-objecting, available and accessible “ to facilitate the assisted suicide. This in conscience I could not do. It would be as much participation in assisted suicide as actually implementing it and it is not right for the College to compel this. The two options that could be offered to the patient are to facilitate the transfer of all their medical care, without prejudice, to a physician of their choosing, or to remain as their physician if they so wish (non-abandonment)
I therefore strongly request that the policy be modified to take into account these concerns.
I need to express my objection to any pressure on doctors who through a conscience objection feel unable to perform abortions , euthanasia or birth control. They must be able to follow their duty to save life , not destroy it.
To Whom it may concern:
I object to your new policy not allowing doctors to in accordance to their religious and moral beliefs!
If I knew my doctor believed in euthanasia I would find a new one! The reverse also applies ,if I want an abortion and my doctor doesn’t believe in them then I will have to go some where else.
There are enough amoral people in the world!
This is a crime that you are infringing on the physician’s freedoms and rights!
Heaven forbid what the future will be like for my grandchildren when we have so called knowledgeable and prestigious organizations as yours advocating such devaluing of people!
As an advocate of preborn human rights and a parent who has great respect for medical professionals across the province, I highly object to the college’s proposal to discriminate against people of faith and moral conviction and infringe against the religious freedom of doctors and specialists who morally oppose a policy that mandates members to counsel patients to have an abortion or refer patients to seek access to abortion.
The rights of those who advocate abortion should not trump the religious freedoms of medical professionals who support preborn human rights.
Are you considering the original feedback – I can’t find it on the website. My comments remain the same, including about your website as set out below – and I would add that it would help if you had a more explanatory title. It certainly is not obvious that this includes prescribing birth control and providing abortions. You appear to be simply inviting the same people to comment – from the first two days worth mostly physicians who are pro-life and members of the public who share my position.
First of all, your website is difficult to navigate. Even though I knew of the consultation from the Globe and Mail article today, it took me some time to find it and then to work my way through it. This is hardly transparent.
On to the policy. It is unacceptable, whether framed in terms of an Ontario Human Rights Code violation or not, for physicians to refuse legally available treatment that is within the area they are practicing. If they do not wish to prescribe birth control, conduct prenatal tests that may lead to abortion, etc., then they should not practice in these areas or should not practice medicine at all.This is/should be no different than Catholic pharmacists being required to fill prescriptions for birth control (or I suppose a Scientologist pharmacist being required to fill a prescription for an anti-depressant) and Muslim taxi drivers being required to pick up passengers who are carrying alcohol. A medical practice, like a pharmacy or a taxicab is not a place of worship, essentially a club setting the rules for its membership.
Over two decades ago, I “went elsewhere” for an abortion as my doctor at the time was not supportive. I was supported by family, well-educated, financially secure and close to alternative resources – advantages many women do not have and should not be required for them to receive the treatment they need.
It is unacceptable, whether framed in terms of an Ontario Human Rights Code violation or not, for physicians to offer abortifacients or do abortions. Killing the child is not an acceptable way of solving a problem pregnancy.
May the day come when every doctor is a pro-life doctor and all children have a recognized right to life.
This is nothing short of a violation of our basic rights and freedoms, especially freedom of conscience and religion, under the Charter. We all know that to enforce such a Draconian law or requirement will mean automatic dismissal or termination of employment for medical doctors/personnel who hold strong religious convictions about the sanctity of human life. Shame on them to impose such political correctness on medical doctors/personnel that chose to practice medicine here because we are supposed to believe in tolerance and respect the beliefs and values of others. If this is someone’s idea of “progress” God help us.
I also say it is for the doctor to decide because they whenthey became doctore to uphold and work for the keeping of a person alive and healing them. Abortion, they are killing a small baby who is not able yet to speak for them selves. There has to be a better way. Having the child and have an organization to have that child adopted by capable and loving people who can’t have their own children or want more children, 8r just do not want to go through birthing process, but would love to have a child. So many good reasons for keeping tbeir child till birth. Give the unheard child a chance. It is not their fault they are being born to a person who does not want the child.
As a retired Palliative Care physician, I am very concerned about the words apparently given to the Press regarding physicians rights (or lack of them). It would appear that, rather than supporting Ontario physicians, there would be a form of “ethnic cleansing” and many MDs of Christian, Jewish and Muslim background would be ousted from the profession to which many of us have devoted our entire professional life.(This is especially pertinent to my husband and myself who have two grandchildren in Med School – what we say to them?) Probably Dr Somervilles suggestion that the College set up a list, easily accessible, of MDs who are willing to provide “doctor-assisted suicide” and/or abortion, is a very reasonable idea.
I, too, am in full agreement with Margaret Somerville. Whether they admit it or not, the CPSO is indeed effectively telling physicians unwilling to provide or facilitate abortions that they should not be family physicians.
The CPSO has been most deceptive in its approach. Hell by any other name is still hell, and natural death can take you there fast enough already.
REPLY FROM ADMINISTRATOR: Recently, the National Post published a commentary that falsely attributed the following statement to a College spokesperson: “Physicians unwilling to provide or facilitate abortion for reasons of conscience should not be family physicians.” This quote is categorically false, and misrepresents the College’s expectations of physicians who limit the health services they provide on moral or religious grounds. The College has asked the National Post to publish the following letter to correct this false statement and to clarify the College’s position: http://policyconsult.cpso.on.ca/wp-content/uploads/2015/01/Letter-to-National-Post-January-23-2015.pdf
To the Administrator: Please answer what a physician would be required to do if the following excerpt from your letter to the National Post was not achievable?
“More specifically, our draft policy (which is currently open for public consultation), says that physicians,
who are unwilling to provide certain elements of care due to their moral or religious beliefs, are required to
refer the patient to another health care provider. This must be an “effective referral” which means one that
is made in good faith, to a non-objecting, available and accessible physician or other health care provider.”
There are numerous concerns with the CPSO’s proposed Professional Obligations and Human Rights document.
Beginning with the introduction, there are rare times when a physician’s morals conflict with the rights, autonomy, dignity and diversity of patients.
One example has already been provided: female genital mutilation (FGM). On this topic the CPSO has categorically stated that the provider is just as complicit in the act regardless of wether they are referring for it or providing the service.
Case closed. The CPSO has answered that question already. The CPSO has openly stated that if it is wrong to do the procedure it is just as wrong to refer for it.
Patients have the right to self refer. They do not have the right to expect doctors to violate their conscience. If a patient had the resources to find the first doctor they can use those same resources to find a second.
Line 163 of the document suggests that the physician who objects to the procedure should keep an up to date list of physicians who will do the procedure.
This violates the CPSO mandate listed above.
If the CPSO requires a list of physicians who are willing to perform controversial procedures then they should have the duty to provide it on their website; not the doctors who object to the procedures.
The CPSO can assume responsibility for what they advocate and can ensure that patients have timely access to services. Instead of demanding that others do it they can simply do it themselves.
2. My second concern involves rural physicians. The point has already been made that these revisions will cause more problems than they will resolve.
Residents of rural communities understand they they do not have the same access to services as those who live in larger centres (cardiac cath labs, stroke units and in some cases abortion services). It is their choice to live there.
If the physician objects to certain procedures because it violates their conscience and the college forces them to become involved in these procedures (either performing them or referring for them) they are far more likely to leave their practices then to conform to a dictator. This would leave an entire community without a physician (who performed far more services than they objected to). These communities are difficult and very costly to recruit physicians into especially if they know they will have to sacrifice their own rights to work there.
3. The third issue is of discrimination. If doctors are forced to violate their conscience this is severe discrimination against their rights, autonomy, dignity and diversity.
4. This document also lists compassion as their number one key value (line 15). These doctors do not feel that ending life is compassionate. You may disagree with them. But before you require them to become complicit in it; think about a specific example of something you find morally abhorrent. Something that disgusts you to your core. Now imagine a situation where many of those in society disagreed with you and forced you to perform these acts as part of your profession.
What would that do to you?
How would that affect you?
What would your response be?
Keep in mind that if you support the premise of not be able to object to procedures you believe are wrong you may find yourself being forced to do this in the future. There might not be anything you object to now but laws change all the time and unless we defend “conscience rights” now you will not have them in the future. How would you feel about being forced to sterilize mentally handicapped patients or to sterilize muslims in an effort to curb ISIS enrolment? You may object to it but if society deems it necessary and you have forfeited conscience rights then you now have no choice.
“Well that would never happen”. That is what Canadian’s said about abortion and euthanasia in the past.
5. The college also requires effective communication (lines 103 and 139). When I was in medical school we were told never to use Latin terms with patients and always to use terminology the patient can understand. For effective communication.
The only exception was when discussing abortion.
The term “fetus” is latin for “young one” or “offspring”. Blastocyst is a term for the early cell division stage of human development. After a human ovum and sperm unite they have all the DNA info required to become a person sitting across the room from you. The only thing they need is time and the proper environment. The same things all of us need to continue our development as humans.
The question becomes are they people deserving of rights?
In Canada the current answer is no. But Canada does not have a very good record of recognizing the personhood of humans within our boarders. We have denied it to women, First Nations, and Japanese (during wars) to name a few.
I was also taught that when a woman request abortion she will need an ultrasound. The point that was stressed the most is that the woman must never see the screen. Seeing the beating heart may influence her decision.
Line 153 states that physicians must NOT withhold information. I would submit that if the college requires effective communication from their members then abortion providers should be required to ask the mother if she wants to see the screen during her ultrasound. Additionally, they should be required to ask the mother if she wants to know about fetal development; including when the fetal/ young one’s heart starts beating. This is usually before women even know they are pregnant.
They should also be required to inform pregnant women about pregnancy care centres who support women in crisis (Line 152 requires physicians to inform patients of all clinical options).
This should be her right to make an informed choice.
Doctors are permitted to use the term baby at anytime during a wanted pregnancy. Why the duplicity? This is not effective communication.
If the CPSO requires effective communication they must insist on it from all their members at all times; not just the ones with conscience objections.
6. The CPSO requires that physicians act in the best interest of the patients (Line 18). There have been many times when patients have not known what was in their best interest and they required a doctor’s expertise. What they were requesting was not in their best interest. This is not paternalistic it is simply the result of my 13 years of study in the field. To simply say a doctor must do everything a patient requests when they may know a better solution is very irresponsible.
7. Lines 76-77 outline that physicians DO NOT have to accommodate requests beyond the point of undue hardships (including excessive health concerns and legal rights of others).
I can not think of a greater hardship than requiring someone to be involved in what they believe to be the murder of another human being against their will.
This will certainly violate the legal rights of the doctor.
Does the CPSO disagree that this is an undue hardship or that the doctor has legal rights?
Line 120 of the document explains that there is no hierarchy of rights. So the doctor’s rights are not more important than the patient’s. By the same standard the patient’s rights are not more important than the doctor’s; as this document suggests.
Line 126 further clarifies that one can not justify not doing an act for religious reasons if the act does not interfere with the religious belief in more than trivial or insubstantial manner.
I do not think that anyone regards murder or involvement in murder as trivial or insubstantial.
Additionally, Line 62 outlines that physicians must take reasonable steps to accommodate patients. This includes allowing guide dogs into the office. Abdicating their morality is NOT reasonable and not comparable to a wheelchair ramp.
Finally line 168. The document ends by explaining that in the case of an emergency a doctor must act accordingly. This does not need to be explained to doctors who act morally and in good conscience.
In the case of abortion the only emergency is when the mother’s life is endangered. In these cases doctors will save the mother’s life at all cost. If they can not save her then they will save the child if possible. Please refer to ALSO, ALARM and ATLS.
This is not controversial.
In the case of euthanasia there are no emergencies. There are emergencies in palliative care; but do not confuse palliative care with Euthanasia. Emergencies imply impending death or disability if not dealt with immediately. Euthanasia’s desired outcome is death.
There may be a pain crisis. This can be managed appropriately until an operator (I do not think that these people should be physicians; but that is a separate topic) willing to perform euthanasia can be obtained.
So in summary, the CPSO has already stated it is their position that a referral for an immoral procedure is just as complicit as performing the procedure.
If they require physicians refer against their moral views they will have to change the CPSO policy on FGM referrals to be consistent with this position.
They have also stated that Physicians do not have to perform or refer if it will cause them undue hardships. Involvement in what they believe is murder is clearly an undue hardship.
If the CPSO decides to pursue this endeavour they will find they will lose more than they will gain.
They will be left with physicians who strongly believe something is wrong but are willing to do it anyways (no one will want to be cared for by these physicians) or skilled physicians will leave their practices and relocate to other provinces or countries.
Keep in mind this is not a small fringe group. There are many physicians who do not agree with abortion and euthanasia. These are not hacks in some back alley practice. They are skilled, compassionate, valuable contributors to medicine across all specialties.
It is very clear from the responses above that the majority does not agree with the CPSO policy as it is. I hope there are no political ties that will let this policy pass without considering the feedback of physician members. With due respect, I ask CPSO to change the draft with due consideration of the physicians’ consciences and convictions.
I agree Just glancing over all the above comments and question if it would not be beneficial if CPSO members would remember their oath which I believe is to preserve life.As a nation we allowed abortions and now recently allowed euthnatia. when we go down this path we cannot but expect that we will run into conscience dilemnas, we there fore may not and cannot bind the consciences of those physions who for personal or religeous reasons are unable to assist in these matters ( A general comment.)If as a nation we do not go back to values and morals what will we leave the next generation?
This is a valuable comment. What kind of example is being given to our youth when they see physicians being bullied by the CPSO to violate their consciences? Selfishness and expediency will become the dominant motivators in our society if our doctors are forced to violate their consciences by the CPSO. It appears that “Might” has become “Right”
I am also a physician. I have been in practice for more than 30 years. I fully endorse the comments made here.
May I emphasize the last point? I submit that there is at least a sizable minority of doctors who agree with these statements. It is more likely to be a great majority.
There are many who, for example, believe that abortion is wrong and who would never perform one (has anyone noticed how few doctors are willing to perform abortions?). Yet, they would refer on to one who would. Why is that? I submit, that at least in some of these cases it is out of fear of personal conflict or of reprisal. Doctors fear the power of public perception. There are many more in fear of the “kangaroo court” to which the CPSO may subject them in the case of a complaint.
Perhaps a new look at the fable “The Emperor’s New Clothes” may be in order. I submit that a large majority in our society knows that doctors (and others) should not kill. Why does our society support the very few who are “hell-bent” on demanding that doctors do this?
The College of Physicians and Surgeons of Ontario Recently, the National Post published a commentary that falsely attributed the following statement to a College spokesperson: “Physicians unwilling to provide or facilitate abortion for reasons of conscience should not be family physicians.” This quote is categorically false, and misrepresents the College’s expectations of physicians who limit the health services they provide on moral or religious grounds. The College has asked the National Post to publish the letter below to correct this false statement and to clarify the College’s position. Read the letter here
Whether the quotation is direct or indirect, it is a true statement. The College is misrepresenting its own draft policy. There is more than one primary source of more than one CPSO spokesperson in December 2014 making or confirming an equivalent statement, but the College made no objection until the January 23 National Post article.
If you want to do something that is against your doctors beliefs then you should find a doctor that suits you. He should just tell you to find a new doctor. Gov should not have the ability to force anyone to recommend a treatment that they don’t agree with. Doctors have rights too!
I am deeply concerned about this approach to legislation that deleteriously harms the personal freedom of physicians to act with their conscience.
I would ask you to delete or change this clause in lines 156 and 157 referenced under “Ensuring Access to Care”. Making an “effective referral” for a service that one finds morally unacceptable is morally equivalent to providing the service oneself and is therefore a violation of the physician’s right to freedom of religion and conscience. In terms of the balancing of rights, a patient can choose from many physicians, a physician only has one conscience. As long as the patient is informed of the availability of the service and how to access the service, a referral is not necessary.
I have committed 35 years practice to ensuring that my patients can trust me to care for their health and wellbeing.
I will never participate in killing them or helping to do so.
I am a 20 year old women who happens to be seven weeks pregnant. And do you know how I got that way? Because I slept with my boyfriend of seven years and decided to get pregnant. If all these women don’t want to be pregnant they can get themselves on birth control or their partners to wear a condom. How do you think that I wasn’t 16 and knocked up? Because I took responsibility for my actions and made sure that I was protected against pregnancy until I was good and ready. It’s not difficult. What will be difficult is all these doctors having to live with themselves and the fact that they’ve been forced to murder countless innocent children. Those are lives, with beating hearts and brain waves. This proposition to force our health care team to murder, is disgusting. We have sickos who dedicate their lives to that already, and honestly, with all the information that we have, I don’t even understand why this is even up for debate. We don’t have enough doctors as it is and now we’ll be losing a lot more when thousands decide that they aren’t going to put their morals at risk for this sick, disgusting medical practice.
This policy came to my attention through social media and I am glad to have read it. I believe this policy provides the correct amount of middle ground for both patients and their doctors. I feel it’s important that physician be capable of exhibiting a high-level of professional objectivity when it comes to controversial but legal treatment options, regardless of personal belief.
Your claims regarding “professional objectivity” and “personal belief” rest on a number of wrong assumptions:
(1) Despite what you imply, Canada’s state religion is not secular humanism. The state should not be attempting through regulation of the medical profession to convert all doctors to your religion. They should be free to promote their own religion, their own “personal beliefs.”
(2) If a personal belief is really, truly, a personal belief, then it will be acted upon. If it isn’t acted upon, then it wasn’t strongly held to begin with. You are essentially advising the state to enable patients to offend their doctors right to the core of their identity–a very dangerous recommendation!
(3) Contrary to the practical effects of what you are feeling and believing, the objective of the medical profession (the “professional objectivity” you spoke of) is NOT to kill and mutilate people.
(4) There is more totalitarianism in your comment masked by your phrase “correct amount of middle ground”, but I’ll just say that Canada is a free country. Nobody should be able to force a grocer to provide bread, and nobody should be able, for example, to force a doctor to recommend “contraceptives” (many of which aren’t truly contraceptive, anyway).
Absolutely ABHORANT. This is human life!! Not just some growth to excise!! Repulsive. If there is no harm to the mom or baby and there is no medical reason to kill, there should be a strict law that this sickening murder be banned forever and the defenseless human being have a life that he/she is entitled to. So vile to force a doctor to do such an inhumane act. This is so harmful to the doctors wellbeing and psyche even if he is the middle man to refer to another doctor! So barbaric. I can’t believe that functioning “human beings” would even think of such things. Disgusting.
The new Professional Obligations infringe Charter rights freedom of conscience, religion,thought, opinion and expression. They also presume to now or in the future (with legalisation of euthanasia) to oblige one person to kill another, or aid in killing another person. The College is way beyond its scope of jurisdiction
Last time I checked, doctors are people with feelings and beliefs as well. It sickens me to think that the government feels it’s acceptable to force doctors to perform procedures that go against their own beliefs. What on earth is wrong with a person going out and just finding a doctor that is willing to perform a particular procedure??
The College asked, “Are there any issues not included in the draft policy that should be addressed? If so, what are they?
One major issue over which the College has some degree of influence involves medical students, medical residents, and student nurses who obtain a major part of their hands-on training in hospitals, hospices, and other institutions that provide patient care. If that “care” includes abortion (or eventually, perhaps euthanasia), students and residents will be expected to participate in such procedures as an essential part of their training. Even at present, students who have medical, moral, ethical, or religious scruples about abortion may find their training situation made quite unpleasant by instructors who push them to participate.
A second major issue is the absence of a clear definition of what constitutes “medical care”. Very rarely is an abortion necessary to save either the life or the physical health of the mother. At present, the vast majority of abortions are carried out for social, economic, or psychological reasons (“I just can’t have a baby right now!”). To me, such abortions do not appear to be any recognizable form of “medical care”. They might more appropriately be assigned to designated social workers who have received special training for that particular job. In other words, social workers (rather than physicians) would become trained and licensed as abortionists, leaving physicians free to concentrate on their calling – to promote life and care for the living.
I am concerned about the psychological health of physicians who routinely carry out abortions. Those who kill people for a living necessarily become hardened to their work. Some may try to lie to themselves about what they are actually doing, but in either case, the emotional stress of repeated killings will lead to psychological damage of one sort or another.
My clinical experience in Canada goes back to the days when abortion was illegal. I have never been able to identify a natural dividing line that might (even in concept) distinguish a fertilized human egg (which by standard scientific criteria is unequivocally human) from either a newborn baby or a very elderly adult, both of which also are human by the very same criteria. Of course there are obvious differences, but the process of human development and senescence seems to me to be a continuum, with no biologically significant break until death. Any dividing line that we try to make between a “person” and a “pre-person” or a “non-person” will be quite arbitrary, a line that has shifted in the past and will continue to shift with further advances in fetal care and palliative medicine.
In Canada, full-term abortion is not illegal. With no biologically significant way to distinguish between a living full-term fetus and a living newborn baby, is there any possibility that we might soon be required to include the killing of unwanted newborns as a part of our “patient care”? Killing newborns by exposure has a long history, and in certain countries (including Canada) it is still being practiced unofficially. When I first began my practice, I never would have believed that any Canadian physician might come to accept the killing of either a full-term fetus or a mentally-deficient adult as anything other than murder, but we certainly seem to be heading in that direction.
The slaughter of the unborn is the greatest moral tragedy of our time. Forcing our physicians to be complicit in murder would put them on a par with the Nazi medical establishment. The pathetic lie of “choice” has once again been demonstrated.
If the College has any integrity left it will reverse itself on this issue and stand up for a tradition of care and healing dating back to Hippocrates.
We may not agree on what a constitutes a moral medical act, but surely we must still agree that freedom of conscience is a fundamental human right. If a physician, in conscience, decides that referral or provision of a certain service is immoral, they have a right to conscientiously object. The CPSO is severely overstepping its authority in trying to remove a human right by means of policy.
On another note: Last summer’s consultation clearly showed opposition to mandatory referral in all cases (50% opposed vs 44% in favour). This is easily accessible information found in the report on the consultation. Why does the CPSO continue to press this particular issue? There was no major disagreement on most of the other parts of that consultation – they could have approved their revisions and removed the mandatory referral section. I think the CPSO is pressing this issue because the policy committee has a predetermined outcome in mind, aligned with their own political and philosophical beliefs, and they are trying to force this on the profession. Shameful.
I am a Registered Nurse working in Saskatchewan, where the difficulty of accommodating the needs of our large and dispersed rural population is a considerable feet. I believe that providing safe and ethical care to these persons and communities is a top priority. However, I do not believe that the burden of responsibility for the current disparity in services should fall on the shoulders of individual care providers, but rather on the health regions and governing bodies that are ultimately responsible for the equitable dispersion of resources. Therefore, I do not believe that care providers have an individual “duty to accommodate.” As citizens, we recognize that our resources are limited, not only our financial resources, but also the capabilities and availability of each care provider within the systems of care. I believe that it is important that each care provider be clear about what they can and cannot offer (for whatever reasons that may be), and then with that foreknowledge, means of accessing different services within the health care field might be clearly outlined to persons who are requesting care.
Freedom of conscience, like the other fundamental freedoms enshrined in the Canadian Charter of Rights and Freedoms, is a fundamental pillar of being a Canadian!
Society is going too far… be ever embracing markedly intolerant ideology masquerading as enlightened objectivity.
The day that a “committee” overrules one right to adhere to the teachings of ones faith is the day that our society is at risk to the will of a few… kind of reminds me of other country regimes (Communism and worse) that could overrule what is sacred to each individual human being – God and the value of life in all stages of development from conception to a natural death.
This if adopted by the Doctors is but the first step… what’s next.. in 20 years time if a person is old and requires too much of our medical system that it is better for society that that person get’s a needle so that they are no longer a burden to society?
If people want birth control pills or an abortion there are those who will meet the requests of the patient.. so go and see someone else.
Freedom of faith is a God given right and not one controlled by a committee.
Are Doctors not there to save and promote life? That is what the committee needs to be focused on. Have the courage to stand up and not give in to the politically correct world… and when we say correct – to whose standards?
Were I a physician who for moral or religious grounds could not perform an abortion, or euthanize a patient, I would be equally conscience bound to not refer a patient to another doctor willing to carry out the procedure. So the College of Physicians and Surgeons seems determined to place a significant portion of their membership in a moral dilemma, under the guise of a policy of non-discrimination. In fact this policy discriminates in a far more serious manner against physicians who hold moral or religious objections against abortion, and very likely, in the foreseeable future, against euthanasia. This is in fact a policy that seeks to impose it’s own discriminatory moral standards (or lack of them) upon conscientious objectors. I would argue that this is far more serious infringement upon the Charter of Rights and Freedoms, than leaving it up to a patient to find a doctor willing to provide the services they are seeking.
What has become of the right of a physician NOT to kill?
What has become of the Hippocratic oath that imposes the duty not to do harm to your patient? You forget that the physician who takes care of a pregnant woman has TWO patients, not one. In normal circumstances and in all times past, the physician used to give the best care to the mother AND the baby.
And what has become of freedom of conscience? Presecution of Christians is rampant in all countries of the world from Iran to Canada, although the forms of persecution differ. Exclusion of doctors from the medical profession because of their beliefs will be the most detrimental thing to the whole system, because they are physicians who do care about their patients.
One, the human rights of the Christian physician are totally ignored; two, the human rights of the unborn human baby is even more ignored, totally trampled; three, the “right” to kill a human being is NOT a human right.
“Physicians must not withhold information about the existence of a procedure or treatment because the procedure conflicts with their religious or moral beliefs.”
SO WRONG on every level. Let’s speak plainly. If a physician is against abortion but is expected to make a referral to someone else who will perform the abortion, and s/he does make the referral, that physician will be personally involved in and accountable for the abortion, even though not directly performed by him/herself.
In other words, this is not an exception at all for physicians of conscience.
“I won’t do it, but so-and-so will” is just as bad as saying, “I will do it.” At the very least, that physician would be acting as an accomplice, and his or her sin would be complicity with what they know to be murder.
Women who want an abortion can find one pretty much anywhere, sadly, and the only reason for trying to force good physicians of conscience to abide by these ridiculous (proposed) laws is to persecute and harass them.
This policy is wrong in every way, from start to finish, and provides no recourse whatsoever for physicians of conscience. I totally oppose it.
I think doctors should be able to work under whatever moral compass they would like. It is their practice. If a patient does not like it they can choose to find a new family doctor! Having a doctor who has integrity and morals is refreshing in this day and age!
No matter your profession we are people and everyone should be allowed a freedom of believe
If the doctor or physician has told you all your options but at the same time what he/she is comfortable with then the patient is informed and can change doctors or physicians if needed
We do not force a parent or a teacher or a lawyer to do what they feel morally wrong we ask/need teachers to be informed and if needed give the facts and good parents do the same but we do not make them practice it.
Today’s society is to be free of discrimination,harassment and bullying in society and at work but we are making laws to enforce actions and beliefs on others.
If I go to a doctor that tells me I do not deal with certain issues then I know and if these issues effect me I need to find a new doctor or ask for a referral. Today’s society prides itself on knowledge and how to get it they no longer look at a doctor as the one and only source, they ask for 2nd opinions and even 3rd so why are we making an issue with doctors. ALL Doctors have years of studying on saving life and it is a passion and calling and we need them let them do that . Transparency is informing patients of all options and if needed referring them.
As a family physician I have great concern with this policy. To begin with, Canadians have the right to follow their moral beliefs in personal and professional spheres. Not all those who oppose referral for abortions, prescription of birth control, other other things (FGM) do so for religious reasons, yet those physicians seem to be singled out. Many people have the same beliefs, as secular humanists, environmentalists etc, so all rights should be protected. Absolutely, the rights to conscience are foundational values of society. We live in a diverse world, and so need to be able to respect our differences.
For all of the situations being discussed, I simply cannot see how any direct harm is being presented to the patient by their primary physician refraining from making a referral or writing a prescription. All physicians I know who have personal opposition to various procedures or pharmaceuticals are upfront with their patients about this, and enjoy excellent relationships with them. It is very easy – and ultimately faster than a referral – to visit a walk in clinic for any of the procedures / prescriptions in question.
Reading the CPSO policy on FGM, they say themselves, “Further, physicians must not refer patients to any person for the performance of FGC/M procedures.” Why not? Because they know it isn’t right. How, therefore, can they attempt to mandate a physician to do something they themselves believe isn’t right. We should be encouraging a culture of principled physicians.
I worry that for the province of Ontario this policy will alienate physicians, and very well would cause many to leave – causing unknown thousands to be without a family doctor or other specialist. I absolutely agree that we exist to serve our patients, but doing so does not mean partaking in those things against one has a deeply held, sincere belief.
One thing that should be clear to us all is on the right and voice of the unborn. Who stands for the unborn? Some approach this from economic point of view, convenience point of view etc.
Human Life should be respected and given right at any point in time it starts. We should use education and awareness to our younger generation to make them responsible but once life starts it is not up to the parents or physicians to decide on its fate, that life in the womb is defenseless and must be defended otherwise it should be considered crime. May be it is that unborn child that was meant to help the parent grow, and humanity grow, we don’t know what we are killing, we are just acting selfish.
The concern I have is that our country is fostering a culture of death, rather than of life. This situation is not going to get better until we see our belief in the sanctity of human life covering both edges of life, the beginning and the end. We must speak to the integrity and dignity of the human person from conception to natural death. Taking one’s life is not a right. To prematurely end’s one life usurps a prerogative that belongs to God alone. We are not authors of our lives, and we ought not be the finishers of our lives. When healers become accomplices in killing, the trust of patients plummets. Elderly patients will be afraid to go to their doctors or into the hospital for fear that if their life isn’t judged to be worthy of living it will be prematurely ended by a medical community that doesn’t see that as being particularly problematic. In our broken health care system, the elderly, the disabled and people with terminal illnesses or chronic conditions will feel threatened. NO ONE should be ordered to go against any of their moral or religious beliefs in any profession under any circumstance, especially doctors & nurses. These are the people that are called to care for and heal the sick not to kill them. Let us pray that God will give us the strength and grace to bear up under the most difficult and painful of hardships till our last breath when He calls us home. NO DOCTOR should be ordered to kill at a patient’s will.
The prevailing wisdom is that medical school admission should be guided not simply by the best grades, but by a deeper dedication to the service of others. Indeed, good medicine is more than good scientific technique. Good clinicians are expected to be medical experts on one hand, and conscientious caregivers on the other. It may thus appear paradoxical that the very organization that is supposed to promote good medicine in Ontario plans to impose drastic restrictions on the rights of physicians to freedom of conscience.
The CPSO policy attempts to redefine physician integrity. Merriam Webster defines the term as the quality of being honest and fair, and as the state of being complete and whole. For the CPSO, however, it boils down to ensuring timely and effective delivery of medical acts no matter one’s moral objections, and the state of separating one’s beliefs in personal life from those in professional life.
Until now, outside of emergency situations, the CPSO had allowed doctors to step aside when a patient requested a treatment in conflict with their moral convictions. The emergency clause was present because of irreparable consequences of treatment delay, for example, if an ER physician were to refuse to give blood transfusions in a life-and-death situation. The argument of urgency does not apply for a gynecologist who runs a practice where abortions are not performed. Likewise, a family physician who offers thorough holistic patient care may choose not to offer referrals to abortion clinics on moral grounds. The idea that a referral is not morally implicating is flawed, because an active involvement in the chain of medical acts implies complicity. The CPSO itself recognizes this principle, which is why, in the case of banned medical practices, it sanctions not only the operator of a procedure but also the referring physician (e.g. CPSO Policy Statement #2-11).
For this to represent a true limitation of patients access to treatment, there would need to be a significant proportion of physicians that take a stance. Such a resistance movement may exist, but only when clear lack of consensus exists … in which case intellectual honesty forces us not to use biased terms such as “access to care” when others might just as well speak of “access to morally questionable medical acts”.
It is a fundamental principle that anyone in a democratic society be able to perform their work in a manner that is consistent with their beliefs and values. Simply informing a patient that they should seek out another physician for a particular service — if any physician prefers not to perform or refer for a service — should suffice.
I have just finished reading the latest Dialogue.
I would like to respond to the draft policy “Professional Obligations and Human Rights”.
I believe that in clinical matters where there can be harm to patients, that physicians’ conscience rights should be pre-eminent and physicians should not be obligated to treat or refer patients when it is against their best judgment.
In cases of controversial medical services, a physician’s obligation should not go beyond ensuring that their patient is aware of both the availability and accessibility of the medical service. In the case of induced abortion in Ontario, at present a patient can self-refer.
I believe that patients are best served when the integrity of their physician remains intact and that this is vital in maintaining a healthy therapeutic relationship.
Therefore, I believe the proposals in the draft policy that a physician be obligated to refer a patient even when morally unacceptable (lines 156,157) or provide treatment in certain cases under the same circumstances (lines 168,169) should not go forward. As to the second issue, the wording “imminent suffering” is too broad and will lead to significant difficulty with interpretation and implementation.
I trust you will seriously reconsider these proposals .
Once again our Christian beliefs are trodden on by Government. We are being told our beliefs mean nothing, they are not important. We are being forced to practice only what the Government allows us to. Is it any wonder more and more people disrespect politicians and their bleeding heart friends. Slowly but surely we are loosing our rights in the charter of rights.
I am pro choice but I would never want doctors in Ontario to be forced to perform abortions. I agree that in some remote places it may make access to safe, legal abortions difficult. But this is a burden which must be placed on our society as a whole- not on individual doctors. We need as many doctors who care about preserving the life of an unborn child as doctors who view this decision differently.
The Canada that I have lived in all my life and love for its diversity and acceptance of everyone’s religion and beliefs would not for people to go totally against their beliefs to perform abortions. As a country we have modified police uniforms to include turbans and allowed school children to carry swords as a part of Gheorghe religious beliefs. Every day this country accommodates people of different religions and beliefs especially immigrants. And yet we are going to tell someone they have to go against their beliefs and provide abortions. To me as a Christian that is like telling a person who is Jewish that they must eat pork or a person who is Muslim that they may not stop their work to pray. Why do we go out of our way to accommodate every belief EXCEPT for Christian. It isn’t fair and it isn’t right and it isn’t what I expect from my Canada.
I am a family physician in practice for 20 years. I have been privileged to be able to share both the joys and sorrows of many patients, from the young to the old, from patients with chronic illnesses to those with end- stage diseases. I have always been clear to my patients about what I will, and will not do as their physician. I do this with the utmost care and thought with their best interest in mind.
My patients have respected my position and we often find common ground in finding a solution to their problems. This does not include me referring them to another physician who will do what they ask. My patients respected me for having a moral belief and my rights to conscience, and more than once they started thinking deeply about what it is they were asking for and decided against it.
I strongly oppose the CPSO’s draft policy that limit physicians Rights to Freedom of Conscience and Religion guaranteed in the Charter, and require them to make an effective referral to another physician if they refuse their patient’s requests, such as for euthanasia should it be legalized.
Thank you for your attention in this important matter.
As I understand, the draft of the Professional Obligations and Human Rights policy has been approved by Council for external consultation, and thus I would like to offer my comments on the named document which I have read.
I am a Registered Nurse working in Saskatchewan, where the difficulty of accommodating the needs of our large and dispersed rural population is a considerable feet. I believe that providing safe and ethical care to these persons and communities is a top priority. However, I do not believe that the burden of responsibility for the current disparity in services should fall on the shoulders of individual care providers, but rather on the health regions and governing bodies that are ultimately responsible for the equitable dispersion of resources. Therefore, I do not believe that care providers have an individual “duty to accommodate.” As citizens, we recognize that our resources are limited, not only our financial resources, but also the capabilities and availability of each care provider within the systems of care. I believe that it is important that each care provider be clear about what they can and cannot offer (for whatever reasons that may be), and then with that foreknowledge, means of accessing different services within the health care field might be clearly outlined to persons who are requesting care.
I do not like your planned implementation of insisting that all doctors will have to refer for abortion or birth control even if it is against their conscience. That goes against the right of citizens to hold their own conscience sacred. If a citizen can’t get their car fixed at one repair shop, they quickly find another more affable. If a woman wants a referral for abortion and one doctor won’t give her one, then she is quite capable of going to another doctor. Why should the doctor be forced by law to tell her to go to doctor “D” (offering death) rather than doctor “L” offering Life.
I can see that it won’t be long and doctors will be forced to counsel for euthanasia. That would go against some doctors’ consciences. I would be very afraid to go to a doctor then because who knows if I would be counselled to accept death or offered care to restore life.
Protect the conscience rights of doctors and the credibility of doctors’ oath to first do no harm!
I am very concerned about the prosed legislation and how it will impact the ability of my physician to provide care in a way that does not violate her rights as a human being.
While I agree that doctors should not discriminate against patients and patient care is of the utmost priority,
deciding not to offer a service in no way discriminates against patients provided that the service is not offered to any group.
It is hard to see how limiting physicians Rights to Freedom of Conscience and Religion guaranteed in the Charter will result in less discrimination or better patient care
Requiring referrals or requiring the doctor to participate in procedures that go against their beliefs may eliminate them from practice, and reduce their personal sense of integrity, if they remain in practice. Interior dissonance between deeply held beliefs and professional requirements can lead to burnout. This is systemic discrimination based on conscience or religious belief. It will impact patient care.
The requirement for referrals may actually slow down patient access to services. For instance in ON patients self refer for abortion.
This policy will cover euthanasia should it be legalized. Forcing doctors to refer for something, or perform something they consider to be killing a patient will completely go against the whole reason they got into medicine in the first place – to heal patients – not to harm them. This is a coercive action that involves a large percentage of physicians who do not want to be involved in euthanasia/assisted suicide. Their rights to conscience were asserted by the CMA at their August meeting.
There are many creative ways to maintain conscience rights and allow patients to access these controversial services. Surely a tolerant country like Canada can come up with a way to make this work.
Dear College of Physicians and Surgeons of Ontario,
I am writing to you as a member of the public in regards to the College’s Professional Obligations and Human Rights draft policy. I caution against the release of this draft as an official policy because it discriminates against both conscientious physicians and those who seek care from them.
Canada is a pluralistic country that values many different viewpoints and welcomes diversity. If physicians who maintain conscientious objections to certain procedures are forced to leave Ontario (or Canada if your policy is adopted by other provinces), many Canadians such as myself will be robbed of care that is in keeping with our understanding of the goals of medicine. I do not want to be treated by a physician who is comfortable checking her conscience at the door, nor by someone who is willing to treat me in a manner that she does not believe is in my best interests. I want my physician to use all her faculties, including her conscience, when she treats me.
Please do not impose one view of medicine on the Canadian public. Please allow me the freedom to see a doctor who will treat me in a manner that respects my human dignity. Please do not adopt this policy.
I am writing to you in regards to CPSO’s draft policy on “Professional Obligations and Humans Rights”. I have been a member of the CPSO since 2013 when I started family medicine residency. I currently work as a licensed family physician in Toronto.
I am very concerned about the ideas and guidelines set out in the policy stating that all physicians must make an effective referral for all procedures or medications that they do not provide out of moral objection. While it is important to ensure optimal patient care, this change in policy hinders physician freedom of conscience and religion. It is necessary to protect physician rights as well. Physicians should not be forced to refer for procedures against their conscience. Even if physicians don’t refer for these procedures, patients are still able to get them in a timely manner without compromising the physicians’ freedom of conscience.
I strongly urge the CPSO to change the draft policy.
Even though I live in Alberta, I read the proposals of CPSO with considerable alarm. There is much that is good about the document. The practice of ‘cherry-picking’ patients based on how little or much care they might need is rampant in alberta as well and needs to be discouraged. However there are oceans of difference between refusing a patient because of convenience or financial reasons and refusing care for reasons of conscience. This document represents an attack on personal conscience, and a very major one at that. Respect for human life forms the basis of our practice of medicine. That is why we are in medicine.
• Human rights legislation in Canada guarantees freedom of conscience. That freedom cannot be abrogated for any except very compelling reasons. There are no such reasons in your document.
• It is individual conscience that often acts as the last defence against serious wrong-doing and the first impetus for righting a wrong. The drive for the elimination of slavery occurred because of the spiritual and political energies of individuals whose conscience told them ‘this is wrong’. The dissenters from the coercion of the medical profession to hideous ends by the Nazis did so for reasons of conscience. Physicians in dictatorships and even in some democracies around the world who object to torture do so for reasons of conscience. Physicians in many countries who object to female mutilation do so for reasons of conscience. When the state seeks to control the conscience of the physician, it seeks to become ‘one conscience (or lack of it) for all.’ Such arrogance does not become a government in an enlightened state.
• To suggest that physicians who refuse to check their consciences at the medical schools door shouldn’t choose certain types of medicine is rather arrogant. What it says in effect is that patients who want a physician that is willing to do (refer) abortions should be catered to; but patients who want a physician who holds a high view of human life should not.
• To suggest that physicians who will not do abortions must refer patients onward ‘thereby sparing their consciences’ is morally naive. If we refuse to do female mutilations, is it alright to refer patients elsewhere for it?
I find the increasing appetite for moral coercion in our regulatory bodies alarming, and as a soon to be patient (I am 75) I find it frightening.
I wish to comment on the draft Professional Obligations and Human Rights policy. I particular, I want to raise some issues concerning “physicians’ rights and obligations in limiting health services”.
Indeed, “no rights are absolute”. But that should apply to a physician’s “right to freedom of conscience” as equally to the “fundamental rights and freedoms of others”. To privilege some rights simply by calling them “fundamental” is more about political coercion and legal fiat than consensus and reason. I am referring in particular to the rights and freedoms to abortion and contraception. Unlike sex, colour and race these freedoms are essentially about “choice”. Between the “freedom of conscience” and “freedom of choice” as human rights, conscience necessarily trumps choice. Here is the reason.
All peoples and all cultures, past and present, accept that human beings, unique among all beings, possess the notion of right and wrong, i.e. a conscience. Of course, the recognition of a conscience (which is universal) does not signify agreement of what constitutes a right and what constitutes a wrong among different people (no consensus of consciences). But without the legally protected right to freedom of conscience there is neither need to talk about human rights nor a basis to validate any specific rights. In fact, the justification any specific human right, including the freedom of choice (provided these are “conscientious” choices), is predicated on the universal right to freedom of conscience. Right to freedom of conscious is no more absolute than the right to freedom of choice, but certainly more fundamental.
I understand that the CPSO has to set specific and practical policies and may be in no mood to entertain philosophical arguments, but philosophy is really about first principles, without which any decision is just arbitrary, and perhaps even cynical. I hope the CPSO can examine the fundamentals of “fundamental rights” and refrain from further tightening the grip on physicians’ exercising their freedom of conscience as human beings, because the right to freedom of conscience is what a free society is truly about.
Subject: Draft Policy “Professional Obligations and Human Rights”.
I am writing to you with grave concern regarding the content of your proposed draft policy. Sections 8, 10 and 11 suggest that physicians who decline to participate in certain acts for reasons of conscience should be compelled to refer their patients to other physicians who will perform these acts. It does not address the fact that many of these same physicians will find the act of referral itself objectionable, as they consider it material cooperation with the act. In compelling physicians to refer, you are limiting their right to conscientious objection.
There is significant disagreement in our society as to what constitutes a moral act, and I do not expect the College to define or limit morality. All I expect is that physicians, as professionals, be allowed to respect their own consciences. Freedom of conscience is foundational to our free society and cannot be limited, even for the best of intentions. If we coerce physicians into violating their consciences we will inevitably erode the personal integrity which is the basis of the physician’s relationship with their patients.
I encourage you to revise the sections above, and include a clear defence of the right to freedom of conscience for all physicians.
I have reviewed the College of Ontario’s draft policy and would like to make this comment
I have been practising medicine in Canada for 42 years and am semi retired .The draft states that the moral and religious rights of physicians under the Charter can be overridden “to protect public safety , order , health , of patients etc” . However it remains a mystery to me how certain procedures such as euthanasia abortion etc actually do this i.e. protect safety ,order ,health of the patient especially since the patient will be killed by the doctor ??? Is this your plan to enforce doctors to go against their moral and religious beliefs to perform procedures like euthanasia [which most likely will become legal]? My understanding of the Hippocratic Code that I swore in 1972 is to preserve life and heal patients .
I can see a number of specialities including General Practice being emptied of doctors who are religious and have moral beliefs if this passes and I strongly disagree with this approach and I am saddened to see how this will harm our great and noble profession.
As a citizen residing in Ontario, I am deeply concerned about the new draft policy which would require physicians
to refer patients to other doctors for services they object to on moral or religious grounds.
While this proposal is presented under the guise of respect for patients’ rights and avoidance of discrimination, it neglects the fact that physicians themselves also possess such rights and should not be discriminated against. The proposal does not provide any convincing rationale as to why one set of rights takes precedence over the other or why a certain belief system must be imposed on all physicians.
The policy also presents a false notion of “rights.” For example, there is no “right” to abortion or birth control. Hence, no physician would be violating human rights by refusing to be involved in such practices.
All the treatments which physicians may oppose because of personal beliefs are fundamentally unethical and contrary to the dignity of the human person.
As a patient, I do not want my physician’s expert judgment on the best course of treatment to be influenced or coerced by some politically-correct policy.
The whole notion that patients are suffering because of physicians’ personal values is a canard. No physician would put the life of their patient in danger because of their values.
You are running the risk of forcing many physicians to cease practising in Ontario and move to other provinces, which would only exacerbate our current shortage.
I strongly encourage you to stay out of physicians’ consciences and let them provide ethical treatments as best they know how.
in my humble opinion doctors should not have to refer patent’s to other doctors for the sole purpose of euthanasia.i agree with euthanasia but if it conflicts with some ones beliefs the patient or power of attorney should find a doctor who condones it our family doctor is very religious but she has notices around her office proclaiming this i think that is all she needs.we have been patents for many years my wife passed away two years ago with lung cancer our doctor was fantastic through this traumatic time we could not ask for more the people who suggest that a doctor should be removed because of their beliefs should be ashamed of themselves i believe in god but do not practice that is my choice.the people that do practice is there choice and nobody should be able to take that away
I am concerned line 157 is a threat to physician autonomy. Forces physician to have a role in something they may be morally opposed to. Patients are not limited in seeking other care.
I am writing in response to the College’s request for feedback regarding the human rights policy draft. I am a family doctor in British Columbia. I am deeply concerned about the proposed changes outlined in the policy for Ontario and the precedent this will set for the rest of Canada.
Specifically, I am concerned that doctors will be required to refer for or in some cases take part in medical interventions to which they are morally opposed. We need conscience protection in order to be professionals with integrity. In lines 123-128 of the policy, it says the courts will decide which actions truly counteract a doctor’s religious beliefs. For myself as a Catholic, I already know which medically related actions go against my personal religious beliefs. The Catholic Church makes that very clear. If the courts decided contrary to that, it would mean I would have to give up medical practice. This seems ludicrous since I live in a democratic country and in a city that is in need of more family doctors. Referring for and directly providing are equivalent participation in these acts to which I cannot take part in and remain a Catholic.
I appreciate my colleagues and patients, of all different faiths and ethical frameworks, who respect my freedom. I respect theirs. We come up with solutions when this difference in beliefs is an issue in practice. I understand that sometimes this means patients will choose to see a different doctor. Sometimes it means patients seek me out because of shared beliefs. Isn’t this what democracy is all about?
The recently updated CMA policy on euthanasia and assisted death clearly states that doctors should have the freedom to follow their own consciences with regards to end of life care. How will the College be upholding that policy with this human rights policy?
I know that these issues are often emotionally charged, but I think we need to remain calm and rational when making sweeping decisions in policy. Patients and doctors can work through these differences relationally in a setting of mutual respect. That process is one I take pride in as a Canadian physician.
Dear Members of the Consultations Committee:
I am very concern regarding the content of your proposed draft policy:
Sections 8, 10 and 11 suggest that physicians who decline to participate in certain acts for reasons of conscience should be compelled to refer their patients to other physicians who will perform these acts. This sounds like an act of justice towards the patient, but it is completely unfair to the physician for whom the act of referral itself is objectionable, as it is a material cooperation with the act. In compelling physicians to refer, you are limiting their right to conscientious objection.
All I am asking is that physicians be allowed to respect their own consciences in their profession. Freedom of conscience is foundational to our free society and cannot be limited, even for the best of intentions. If we coerce physicians into violating their consciences we will inevitably erode the
personal integrity which is the basis of the physician’s relationship with their patients.
I ask that sections 8, 10 and 11 be revised so that it includes a clear defence of the right to freedom of conscience for all physicians.
Only very recently the CMA moved from the stance that PAS (Physician assisted Euthanasia)is not within the scope of medical practice and should not be practiced by doctors – to “up to the conscience of the patient and physician”. There is currently still the caveat that this is not proscribed but an individual doctor/patient decison. In this, it seems as though doctors and patients are placed on the same level of “rights” – the patient can request PAS (or request NOT to have PAS) but thedoctor has the right to “abstain”. I find the genital mutilation comment below interesting, because if something is as morally objectionable to a practitioner, then they should not be forced to refer and passively participate in the procedure they are trying to avoid participating in. As long as the patient has full knowledge of the physician’s moral objection to participation in a certain prescription or procedure, then the patient should have to accept the physician’s right to choose. Again, we all know this can’t involve life-threatening situations, but that is really not what’s being discussed here. As a physician working in the public sector, I feel we often wear a dual hat – a public servant and an entrepreneur. But I do not feel that we should be so owned by the system that we are forced to go against our conscience.
These lines should be removed without hesitation. “This includes not refusing or delaying treatment because the physician believes the patient’s own actions have contributed to their condition. Furthermore, physicians must not promote their own 146 religious beliefs when interacting with patients, or those seeking to become patients, nor attempt to 147 convert them.”
Religion or moral perspective on an issue is irrelevant when considering whether a patient is responsible for their health situation or not. Are you saying this only applies to a woman who wants an abortion and not a person who weighs 600 lbs? Doctors are professionals and even if they don’t agree with a choice a patient has made their objections will not all be based on religious or moral issues. You are focusing this policy on far too narrow a field and you shouldn’t be. Faith and moral positions exist in our world and professionals are called to set that aside when providing patients with their best health advice. The Charter guarantees Canadians freedom of religion not freedom from it and this policy is trying to legislate against it when there should be no need for the policy in the first place. There is no need for a policy of this length to single out any one professional behavior or process of thought over another. The Charter does that and so does the Code, there is no need for this policy to define how a religious or morally focused physician should conduct themselves when providing treatment. College is overstepping its jurisdiction and should not speak to or further define the rights people are already guaranteed under far better legislation.
Re: physicians who do not provide certain services due to moral or religious objections. Patients have a right to know this before they see the doctor. All physicians who provide direct service to the public should be required to provide this information in the form of a poster in the waiting room or at reception, information on physician website, and register their objection with the CPSO so it can form part of the physician listing for those who are looking for an MD.
On the contrary, abortion should be illegal, and euthanasia and assisted suicide should continue to be illegal. Killing people is not part of a physician’s job description.
I guess I just feel that as long as we are living in a secular country with separation of church and state, and as long as physician’s salaries are coming from everybody’s tax dollars (including people from all religious/non-religious backgrounds), people who CHOOSE to become doctors in this country must do so with the understanding that they are practicing under the legal guidelines of our country. If one doesn’t feel comfortable with the medical laws we have, one is under no obligation to practice medicine. However, if you make the CHOICE to join the Canadian medical community, you must comply with the standards of practice that go along with that. I think it is very reasonable to say that someone is allowed to “pass” on a procedure they are morally uncomfortable with. And doesn’t the fact that the policy requires “that physicians provide care that is urgent or otherwise necessary to prevent imminent harm, suffering, and/or deterioration, even where that care conflicts with their religious or moral beliefs” fall in line with the Hippocratic oath: “I will take care that they suffer no hurt or damage.”
There are many other professions one could choose in which they have the option to not perform certain “morally objectionable” medical procedures, and surely no one would judge them for choosing to pursue one of those other noble careers. But as long as you are choosing to remain a doctor, you must follow Canadian secular standards when treating your patients (and yes all patients in Canada are clients, because we are all paying for the medical services being provided).
Who told you that you were living in a “secular country”? Historically Canada has been a Christian country and a free country. If separation of church and state means that the church should not intrude on the realm of the state, then the state also should not intrude on the realm of the church. And medical ethics is certainly the realm of the church. Doesn’t the doctrine of church and state assume a Christian country?
Anyway, exactly what kind of care do you think is threatened by doctors with a conscience? Why do they refer to their Hippocratic oath as part of the basis for their rejection of this “care”? What are these medical services that we are all paying for? I suggest you look a little closer: things are not what they seem.
I am a strong beleiver of providing equal opportunities to all and removing barriers for access to medical care especially disabled but in the real world there is limitation to what you can do eg if your office space is located at a place not accessible by people with mobility limitations.Are skate holders or organizations willing to help doctors set up a system not costing them for making accomodations in their offices?
Dear CPSO Policy Department,
I am a practicing respirologist in Ontario. Thank-you for the opportunity to provide feedback on the College’s draft policy statement on “Physician Obligations and Human Rights”. It is both ironic and unfortunate that the draft statement so clearly discriminates against and infringes upon the rights of physician members of the College.
The most serious problem with the policy is the language around physician referral (lines 156-161), which states that a physician is required to provide “effective referral” to another “non-objecting” provider for “health services” when the first physician is morally/ethically opposed to such services. This clearly does not provide adequate protection of the conscience rights of physicians, as it does not provide sufficient moral distance from the act in question. In legal terms this would be conceived of as “accessory to” the act; in moral terms it is “material cooperation”.
Where the rights of the physician member (to refrain from participation in acts believed to be morally indefensible) conflict with the rights of the patient (that is, “competing rights” situations), the courts have not systematically negated physician rights, nor specified a hierarchy of rights. The current CPSO policy would have the effect of systematically subjugating the conscience and moral rights of physicians to the rights of patients. This is not how competing rights situations should be handled (and the courts agree with this), particularly in instances where one or both parties considers the moral issues at play to be grave. It is more appropriate for the College itself, given its resources, to maintain a publically available list of physicians willing to provide (or not) certain specific services, than it is to force a person to participate in an act which he/she considers morally indefensible.
Another problem with the policy as outlined is that it does not sufficiently consider the implications on physicians and society at large of the interactions between [1] non-discrimination on the protected grounds of disability, [2] proposed obligations upon physicians to provide or arrange for all requested “health services”, and [3] the expected imminent dismissal by the Supreme Court of Canada of criminal code provisions forbidding physician assisted death and euthanasia. The policy as written would impose upon doctors (generalist and specialist) a positive obligation to refer people (or even directly arrange, depending on the degree of patient debility) for euthanasia and physician assisted death. It would seem that the current policy is insufficient to carefully address an issue of this magnitude, given that other issues (palliative sedation, euthanasia without explicit consent, physician assisted death of children, etc. etc.) would also fall under this obligation.
A further difficulty with the policy is a confusion between legal obligations on physicians (as per the provincial human rights code) and moral obligations on physicians. A legal obligation to avoid discrimination (on a protected ground in the Code) in no way creates a positive obligation upon a physician to perform (or arrange to be performed) any specific service. Refusing to perform a particular health service for any and all patients (i.e. euthanasia) is neither discriminatory nor inequitable. Importantly, the recommendation by the Ontario human rights commission to limit physicians’ conscience rights is nothing more than an opinion, devoid of actual legal force, and not clearly in the best interests of patients. It seems inappropriate, and in fact bizarre, that something as profoundly important as the physician-patient relationship, which is inherently moral, should be judged according to a local (provincial) statute written for an entirely different purpose (the Code). Perhaps we need two policies, one that outlines physician obligations around protected grounds in the Code and another to handle issues related to conscience and moral freedom?
It is interesting that the current policy seeks to impose significant “fiduciary relationship” constraints upon physicians whilst at the same time demolishing physician autonomy (as in the context of requiring “effective” referral for a morally objectionable “health service”). Removal of a physician’s autonomy actually creates a circumstance where a fiduciary relationship is impossible. A fiduciary relationship in the practice of medicine is one in which the patient entrusts the doctor with medical decision-making, which relies on the physician’s good judgement and input from the patient and all other relevant parties. The patient trusts the doctor to advise him/her as to what is actually in the patient’s best interest. Those interests are understood to be agreed upon, in their essentials, by both parties. If a doctor believes a course of action is morally wrong, the doctor will be unable to believe that it is in the best interest of the patient. If the doctor is then forced to carry out the action on behalf of the patient, the doctor cannot be said to be acting in a fiduciary capacity. There would, in fact, be a breach of the fiduciary relationship; that is, a breach of trust.
Finally, based on the current draft policy, it would seem plausible that the College could itself be the subject of a human rights complaint by a physician, on the basis of discrimination on the grounds of creed. A dispute of this nature would probably reflect poorly on our ability as physicians to self-regulate and might have unintended consequences for our profession.
The draft policy as it stands is deeply flawed and I urge its revision.
Thank-you for your time and consideration of these points,
We would like to add our voices to those who object to family physicians being forced to refer or perform abortions or to euthanize patients. Under the Charter of Rights, physicians should be able to exercise their religious and ethical rights to abstain from these practices. This does not mean that we oppose those physicians who are willing to perform these practices from doing so.
My additional comment would be a statement regarding a physician’s obligation to respect the Ontario Human Rights Code when dealing with colleagues and co-workers in the work environment (clinic, hospital etc) and not limit the obligations to patients only. Thanks,
Time for good, dedicated people of religious convictions to be supported by the Community they serve.
I disagree with the policy that would punish men and women of faith from exercising their human rights. In this case it is in regard to those in the profession who do not agree with the providing of the following procedures: abortion, euthanasia and other contraceptive procedures by taking away there right to practice medicine.
It’s obvious that this association is overrun by a certain group of one mind who are set upon the work of muzzling a certain group of its members by bullying them into doing violence to their consciences.
We are a pluralistic society. All need to be included.
It’s like we have created a group with ultimate power to have there way, especially when it violates the rights of People of Faith and in particular Roman Catholics.
Read it more carefully. Killing is still killing even if it is called “care” or a “service.” I consider myself to have been a patient before I was born (but after I had been conceived) and to still be a potential patient when I become senile. Details are important.
Why do you keep trying to strip doctors of their right to conscientious objection? It seems that every time I turn around you are attacking me, and through your efforts to enact new human rights policies, indirectly accusing me of not caring for my patients.
Let’s cut right to the chase. This policy takes aim squarely at physicians who are unable to refer patients for abortions because of their moral beliefs. Don’t even bother using the term “religious.” That term further polarizes the discussion and insinuates that physicians on the side of rationality, evidence and science would surely be willing to refer. I have studied science for many years and I have yet to see a scientific experiment which showed that the willingness to refer for abortions is “good.”
This may sound odd, but there are actually doctors in Ontario, thoughtful and good doctors mind you, who believe that abortion is nothing less than killing a child. Of course I understand that a woman has the right to do what she wishes with her own body but to use this argument in support of your policy is question-begging to the highest order. That a child in utero is part of a woman’s body is not a scientific given. Science has not and never will demonstrate that an unborn baby is not a small human being. If anything, science continues to reveal the amazing cognitive and perceptual capacities of children in utero while technology continues to lower the age of viability. And these aren’t just the words of “religious nuts.”
Christopher Hitchens himself believed this. Please try to understand that abortions are ontologically different than appendectomies and haircuts.
Furthermore, there is no national consensus on abortion. We are a nation deeply divided on this issue. Do not try to force physicians to act as if this is not the case.
I don’t care what any law or any policy says, there are doctors in this province who, thank goodness, will never aid in killing. Have you read The Nazi Doctors by Robert Lifton? You should, especially if you are trying to enact a policy that limits the conscientious rights of physicians.
The College of Physicians and Surgeons of Ontario Recently, the National Post published a commentary that falsely attributed the following statement to a College spokesperson: “Physicians unwilling to provide or facilitate abortion for reasons of conscience should not be family physicians.” This quote is categorically false, and misrepresents the College’s expectations of physicians who limit the health services they provide on moral or religious grounds. The College has asked the National Post to publish the letter below to correct this false statement and to clarify the College’s position. Read the letter here.
Whether or not CPSO said that–an important point, to be sure, if it was a direct quotation–it does indeed represent CPSO’s position. The draft policy implies that family physicians will be expected to either perform abortions or refer for them. Is not abortion currently considered by CPSO to be one kind of “care”, a legal OHIP “service”? Then some patients will request it, and some doctors will either have to perform (provide) them or facilitate them (make referrals).
REFERRAL = COMPLICITY
It is irresponsible and disingenuous for CPSO to imply otherwise.
“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 the chair of the college’s policy working group reviewing “Professional Obligations and Human Rights.” This quote is found across a number of publications from December 2014. Is it accurate? If not, then the original source should be asked to retract it. If it is accurate, then the College is implicitly saying that those opposed to abortions should not enter family medicine (even if not explicitly saying that).
The College of Physicians and Surgeons of Ontario Recently, the National Post published a commentary that falsely attributed the following statement to a College spokesperson: “Physicians unwilling to provide or facilitate abortion for reasons of conscience should not be family physicians.” This quote is categorically false, and misrepresents the College’s expectations of physicians who limit the health services they provide on moral or religious grounds. The College has asked the National Post to publish the following letter to correct this false statement and to clarify the College’s position: http://policyconsult.cpso.on.ca/wp-content/uploads/2015/01/Letter-to-National-Post-January-23-2015.pdf
I would like to inform you that my husband and I are shocked to see Ontario physicians and surgeons being stripped of their
right to conscientious objections to performing certain procedures that go against their conscience. In a democratic country like Canada this is
incredible!
Attention: Policy Department
Regarding: “Professional Obligations and Human Rights”
I would like to express my sincere thanks to the committee for their work in developing the draft policy cited above and for inviting input from physicians and the public.
While I agree with much of the policy as written, there are a number of sections which I have outlined and discussed below that are of grave concern to me and many physicians and members of the public and which, I believe, warrant revision in the interests of all patients and doctors in Ontario.
Failure to make the revisions to the policy in these areas, I believe, will result in some serious adverse and unintended consequences in relation to patient access to appropriate care and to the proper respect and balancing of patient and physician rights and freedoms in the Canadian Charter of Rights and Freedoms (The Charter).
I respectfully and earnestly put forward my concerns below for the consideration of the committee. Please accept my comments as sincere and well Intentioned.
Portions of the Policy Both Unnecessarily and Improperly Violate the Charter and Require Doctors to Violate Their Conscience When Better, Less Problematic Alternatives Exist.
Regarding Lines 129-135.
The CPSO draft proposes that the patient’s right of access to a morally controversial service such as abortion or, pending the ruling of the SCOC, physician assisted suicide (services arguably not falling under the definition of medical care) supersedes the right of the physician to refuse to refer or to facilitate access to these services based on their moral convictions.
This is an assertion contrary to the Charter and beyond the mandate of the CPSO. A right of deeply held moral conviction on the part of a physician is right under the Charter and is not, and should not be treated, as subject to the College’s proposed modifications and constraints. Further, according to the draft CPSO policy, (Line 130-131); the physician may not refuse the initiation of a doctor/patient relationship initiated by a patient who is seeking access to a morally controversial medical services even if the physician makes it generally known that they are not able to provide these services to any patient because of the constraint of the physician’s moral convictions.
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There isn’t a need to force doctors to violate conscience and faith in order to comply with law. Years of experience has shown that Ontario patients can get abortions while not requiring Physician’s to violate their conscience. No case has been made, that patients who want abortions aren’t able to get them, despite the fact that there are doctors who won’t refer for abortion for reasons of conscience or faith.
The policy comes across as a social policy rather than a medical policy which alone is within the mandate of the CPSO. Consider that abortion is readily available in Ontario without a physician referral and therefore access to this procedure is not dependent on a physician’s referral. Would the CPSO feel this policy applies to referral for abortion on the basis of the access argument? While assisted suicide has not yet been (and may not be) legalized, it is hard to understand how the taking of life can be construed as health care. Will physicians be required to assist in the taking of human life should this be legalized under this policy?
This policy, as written, is discriminatory, un-inclusive and seems certain to reduce the diversity in physician healthcare providers in Ontario. The diversity in physician providers has been and continues to be critically important in the provision of the best care to an equally diverse patient population in Ontario. While not intended, this policy gives the impression that it is aimed at physicians holding traditional moral and religious convictions. As such it will only serve to limit access of patients to like-minded physician healthcare providers. This unfortunate outcome would be contrary to the spirit of the policy which aims to insure access of appropriate care to the diverse patient population served by Ontario physicians.
Regarding Lines 152-169
This section permits the violation of the physician’s rights under the Charter forcing them to be an accessory to an act that for them may be morally reprehensible. A mandated requirement as proposed in the CPSO draft for physicians to refer patients for such services against their moral convictions or to, in any way, cause physicians against conscience to facilitate access to these services places them as accessories to the act. For many this would make them an accessory to murder in the case of abortion and assisted suicide. For those “non-religious” physicians who have taken it in its original form on graduation from medical school, this also violates their Hippocratic Oath.
“…Nor shall any man’s entreaty prevail upon me to administer poison to anyone; neither will I counsel any man to do so. Moreover, I will get no sort of medicine to any pregnant woman, with a view to destroy the child.”
The Policy as Written is Vague and Unnecessarily Restricts the Religious Freedom of Patients and Their Physicians:
Regarding Lines 146-148
The wording in this section is vague and seems to favor a secular/ non-religious perspective and, as such, is subject to serious abuse. The wording seems intrinsically biased against religious minorities. While it is acknowledged that physicians should not use their position of significant influence to inappropriately impact patients about their religious, humanistic or atheistic
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convictions, a spiritual history and respectful dialogue about spiritual matters is an important part of good healthcare delivery for many patients and their doctors especially in the context of palliative care and end of life counseling. Wording in this section will restrict the religious freedom of both the patient and the physician in this important dimension of spiritual care of the patient. The vague and unqualified wording of the policy in this area will only serve to unnecessarily threaten physicians. The following questions, not addressed in the policy, underscore the vagueness of the policy and the potential impact it might have on the delivery of care.
• What do the terms “moral and religious” (line 138) mean in the policy? Do they include atheistic humanism and other faith-based secular philosophies and world views? If not, why is this diversity of moral and philosophical perspective embraced by physicians not reflected in the policy? Should not the forced advancement of secular perspectives on a religious patient by an atheist physician not also be specified as a violation as well? Properly applied with equity, this policy would serve to discourage any philosophical discussion from the physician-patient encounter, secular or religious? How would the physician help a patient deal with the fear of imminent death or the loss of a loved one? Improperly applied as written, it will be unfairly discriminatory against a physician holding a minority “religious and moral” conviction that restricts his/her provision of a certain service based on that conviction.
• How does one “communicate an objection” (line 139) without “promoting (a physician’s] religious belief” (line 146). What is “promoting” is unclear and it is easy to imagine situations where the patient will ask questions of the doctor in response to a doctor’s objection which leaves a doctor in the position of not knowing whether answering a question is “promoting” thus exposing the doctor to CPSO discipline. This wording unfairly forces a “Catch 22″ upon the physician holding moral conviction.
In my view inclusiveness and latitude for physicians to maintain their moral convictions is critical if they are to provide proper access of all levels of care to the diverse patient populations they serve in Ontario. In my opinion, moral conviction and integrity are key ingredients of the best physicians I have had the privilege to work with.
Much of this policy excluding the sections I have outlined is appropriate and needed and I am thankful to the committee for putting it forward. While this policy in the areas I have outlined above is no doubt well intentioned it falls far short.
If put forward as policy, I am certain it will be challenged in the courts in reference to the areas outlined above. If it stands as written and is advanced through the courts successfully it will selectively remove many of the very best doctors from the Ontario healthcare system. This loss will be shouldered by the patients they so faithfully care for who will be denied access not only to these excellent physicians but also to the dimensions of spiritual care and support they are
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accustomed to receive or are seeking from these physicians. This would be a tragic outcome and I am certain, an unintended consequence on the part of the committee drafting this policy. Moral and Charter arguments aside, all this, worst of all, will be done unnecessarily because there is really no evidence put forward by the CPSO that would justify forcing doctors to violate conscience using the arguments of limited access to morally controversial services.
My Recommendations:
I would respectfully request that the CPSO committee retract this policy as written and revise it in such a way that;
1. It is not discriminatory against patients and physicians holding minority religious and moral convictions.
2. It facilitates and does not hinder spiritual care and emotional support of patients and their families
3. It is not vague and contradictory in its wording, but very specific on the matters outlined above, at all times protecting the Charter freedoms of religion, philosophical perspective and faith of both the patient and the physician.
4. It does not discriminate and restrict the freedoms of physicians holding minority religious and moral convictions, based on these convictions to practice medicine in the field of their training and choice.
5. I would strongly recommend that the tabling of this revised policy be delayed pending the Supreme Court of Canada decision on the matter of physician assisted suicide.
Thank-you for the opportunity to comment on this draft policy “Professional Obligations and Human Rights.”
First off, I am disappointed to see that, despite the overwhelming number of comments against the direction of previous consultation document, this draft continues to override the legitimate rights of physicians who refuse, for reasons of conscience, to provide certain procedures.
I am also alarmed by the reported comments of a College official to the effect that “physicians unwilling to provide or facilitate abortion for reasons of conscience should not be family physicians.” At a time when Ontario is experiencing a shortage of family physicians (something which I went through when trying to find a new family physician), to say that some of them should leave profession because of their moral or religious beliefs is appalling. I am in full agreement with this statement by Margaret Somerville (National Post, January 23, 2015): “Physicians with conscientious objections to supplying medical procedures that would destroy human life or contravene respect for it, including euthanasia and assisted suicide, must not be drummed out of the profession.” We need doctors, and we need to have choice in health care, and this includes having physicians who honour Canadian’s choices on either side of a life issue. I don’t want a doctor taking care of me who would be willing to kill me (though assisted suicide, euthanasia, care in dying, or whatever term you want to employ).
Again, to quote Ms. Somerville: “Forcing physicians to act against their conscience, to do something they believe is deeply wrong against their will, not only harms them. This coercive violation of their freedom of conscience also harms society and the values that inform its culture.” I believe physicians should have a means to state their clinical, religious or ethical limitations of care so that I can make an informed choice when seeking health care. This is an extremely important aspect for me in selecting a health care professional. I believe the implications of this draft policy, and certainly the comments of one of the College’s officials, would remove this choice for me by forcing physicians to act against their conscience.
“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 chair of the college’s policy working group reviewing “Professional Obligations and Human Rights.” This quote is found across a number of publications from December 2014. Is it accurate? If not, then the original source should be asked to retract it. If it is accurate, then [Name omitted] is implicitly saying that those opposed to abortions should not enter family medicine (even if not explicitly saying that).
This is like a Monty Python skit – it’s utterly stunning that the CPSO would claim to respect a physician’s human right to conscience and therefore their wish to not provide or not facilitate abortions, yet expect that very same physician to stay in relatively close contact with a service that they would consider an ‘abortion mill’ to ensure that the patient can have an abortion scheduled. Is this not facilitating an abortion? Is the CPSO not forcing a physician with a conscience into an incredibly unfortunate and sadistically ironic position that insults the physician’s deeply held beliefs? I suggest as a compromise, that the CPSO do the job of the gate keeper for abortion services in the Province, and that pro-life physicians only need to refer patients to the CPSO for clarification.
Whether or not the attribution is false, the statement is true. [Name omitted], past president of the college, told LifeSiteNews on December 18 that if his committee’s proposed revision of the college’s “Professional Obligations and Human Rights” is adopted, then if doctors refuse to refer patients to abortionists, or to doctors willing to prescribe contraceptives, they could face disciplinary action.
The College of Physicians and Surgeons of Ontario Recently, the National Post published a commentary that falsely attributed the following statement to a College spokesperson: “Physicians unwilling to provide or facilitate abortion for reasons of conscience should not be family physicians.” This quote is categorically false, and misrepresents the College’s expectations of physicians who limit the health services they provide on moral or religious grounds. The College has asked the National Post to publish the letter below to correct this false statement and to clarify the College’s position. See letter here.
The statement is true, and CPSO is misrepresenting its own draft policy. [Name omitted], past president of the college, told LifeSiteNews on December 18 that if his committee’s proposed revision of the college’s “Professional Obligations and Human Rights” is adopted, then if doctors refuse to refer patients to abortionists, or to doctors willing to prescribe contraceptives, they could face disciplinary action.
The draft policy implies that family physicians will be expected to either perform abortions or refer for them. Is not abortion currently considered by CPSO to be one kind of “care”, a legal OHIP “service”? Then some patients will request it, and some doctors will either have to perform (provide) them or facilitate them (make referrals).
REFERRAL = COMPLICITY
It is irresponsible and disingenuous for CPSO to say otherwise.
This letter is in response to the invitation to review the College of Physicians and Surgeons of Ontario’s draft of their 2015 update to the policy “Professional Obligations and Human Rights”.
The first thing I would like to point out is the language in line 18 “Acting in the best interests of their patients.” Society now finds itself at risk of defining principles such as beneficence in radically different ways. Because it no longer has a shared philosophical anthropology, it may no longer have a joint understanding of what is good for human beings. If it can no longer determine what is good for human beings, then it is difficult to determine what is in the best interests of their patients. All physicians know from experience that what the patient wants is sometimes clearly NOT what is in their best interests. Therefore as legal avenues to requests for lethal prescriptions expand in geographical scope, health practitioners may be at risk of determining medicine’s principles in irreconcilable ways.
Fortunately, the statement following this line clarifies and points to exactly the concern: Line 19/20 “This is especially important with respect to vulnerable and/or marginalized populations.”Patients who are very ill, whether terminally so or not(many different definitions of terminal, also somewhat irreconcilable) are in a vulnerable state. Vulnerable patients need protection.
Line 22 also requires reinterpretation when a patient is requesting something harmful or damaging from a practitioner rather than something to address symptom management or which would improve health.
Principle 3 (line 24-26) The wording suggests that physician’s values may be in conflict with the patient’s best interests. Again, there implies tension here where professionally there really ought to be none. When a health professional is acting in the patient’s best interests, she may not always be doing what the patient wants, but remains committed to providing care in the best possible way for the patient. This will generally support their autonomy but may not always be simply acquiescing to their autonomous wishes.
Page 4 Subheading ii) Moral or Religious Beliefs.
I am pleased that there is a recognition of moral or religious beliefs of physicians as a right, and that it deserves a separate section. I am pleased that there is not a pitting of rights against each other in lines 121/122. I am not pleased that the whole section reads like a veiled threat intended to discourage physicians from asserting their moral/religious rights, and which in fact may cause them to give up their rights before they are tested in courts. Professional bodies such as the college of physicians and surgeons has an obligation not only to patients, but also to physicians, many of whom do not believe that ending a patient’s life, or referring to have said lives ended is morally defensible. To support them and their consciences is just as important in documents such as these. Therefore, I suggest removing the sentence in lines 115-117 “The right to freedom of conscience and religion can be limited… to protect the fundamental rights and freedoms of others.”
Page 5:References to ensuring access to care in lines 130, 134 should have the word “care” clarified or else separate sentences added regarding physician assisted death if it becomes legal in Ontario. The word care does not include ending lives in many physician’s vocabularies.
Page 5 Section ii Ensuring access to care and section iii protecting patient safety. There is no provision here for physicians who consider a referral for physician assisted death unconscionable. There should be. Duty to refer may be considered a subset of duty to aid. “Because liberal societies seek to minimze the imposition of aims or values on individuals, duties to aid are formulated in a manner that restricts such duties to the least intrusive requirements.” (Thomas May. Bioethics in a liberal society p. 84) Granted, professional bodies may impose stricter requirements, but the case of assisted death calls for some recognition of what they are requesting that their members do. There are a number of physicians who consider providing a lethal prescription a murderous act, and that their professional duty to care does not require them to cooperate in any way with such requests. Some of them, including myself, would consider referring for such a purpose even more morally repugnant because it involves duplicity, as if by this act I could distance myself from being an accomplice, and consider myself free from guilt. There needs to be recognition of the burden of this that you are placing not only on myself, but for those in the generation to come; those who with civil courage will not acquiesce to patients’ requests to end their lives, and who will not refer, but who recognize that with the push of a computer button patients could easily find a physician to comply with their request through the internet. A separate section indicating how physicians who will not refer for such acts will be protected would be ideal. Lines 156,157, 158,159 are ones I cannot live with in the context of physician assisted death.
In summary, what lawyer Holly Fernandez Lynch refers to as the ‘bleaching out’ of one’s religion, moral base, race, gender, ethnicity and culture by professional norms should not take place. Nor should policies such as ‘professional obligations and human rights’ attempt to do so. Howard Lesnick states that ‘in finding in its pluralist quality a counsel of restraint in its enocunters with the varying religious scruples of individual attorneys, society is therefore not merely indulging in an individual’s interest, but recognizing their ‘collective value’ as well.’ The same should apply to conscientious refusers in the medical profession.
Dr. Stephen Genuis warns that ‘A policy to coerce health professionals to act against their judgments will convert doctors into skilled technological servants, not professionals.’ He states that ‘without a foundational ethic, unbridled diversity may ultimately lead to enforced uniformity – tolerance for non-adherents may be sacrificed….The drive to eliminate freedom of conscience suggests that secularism can be intolerant of minorities and wiling to discriminate on the basis of moral conviction and ethical orientation…Ironically, in an era of expanding initiatives dedicated to ending intolerance and bullying, official regulatory bodies are becoming intolerant of doctors for being faithful to their consciences.. ” Let it not be said that the College of Physicians and Surgeons of Ontario is one of them.
Lynch, HF Conflicts of conscience in health care: An intitutional compromise MIT Press Cabridge 2008 p.31
Genuis S The advent of ethical imperialism in healthcare. FOCUS magazine Dec 2014
Subject: Draft Policy “Professional Obligations and Human Rights”.
I am writing to you with grave concern regarding the content of your proposed draft policy. Sections 8, 10 and 11 suggest that physicians who decline to participate in certain acts for reasons of conscience should be compelled to refer their patients to other physicians who will perform these acts. It does not address the fact that many of these same physicians will find the act of referral itself objectionable, as they consider it material cooperation with the act. In compelling physicians to refer, you are limiting their right to conscientious objection.
There is significant disagreement in our society as to what constitutes a moral act, and I do not expect the College to define or limit morality. All I expect is that physicians, as professionals, be allowed to respect their own consciences. Freedom of conscience is foundational to our free society and cannot be limited, even for the best of intentions. If we coerce physicians into violating their consciences we will inevitably erode the personal integrity which is the basis of the physician’s relationship with their patients.
I encourage you to revise the sections above, and include a clear defence of the right to freedom of conscience for all physicians.
a christian doctor should not have to give abortion referral or send patienta to other doctors who will. My doctor has posted in her office no abortion referral,no morning after pill, no viagra for unmarried men.
She is the daughter of missionaries and a wonderful doctor. I support her.
The line about getting out of family practice is insulting and offensive.
I do not believe your president’ statement on this. She sounded angry but did not sayshe sopports doctors rights to act like my doctor. I do believe her or trust her.
CPSO is playing a tricky word game. The policy’s effect will be to prevent physicians unwilling to provide or facilitate abortion for reasons of conscience from becoming–or even remaining, like your doctor–family physicians. However, CPSO cannot explicitly say that or they will be guilty of discrimination in contravention of our horrible Ontario Human Rights Code.
So, even if they have made such a statement or one similar to it in the past–and I believe they have–they are now pretending that they did not. Like you, I do not trust the CPSO, but there is not much we can do about it except keep writing these comments and hope they will be published without tampering.
Please do not force medical doctors to go against their principles, religious belief and code of ethics that they take when they become doctors. This is suppose to be a democratic country, then why are you forcing the doctors, when they are in so much demand, to either do it or possibility loose their ability to practice medicine. Doctors who feel strongly against this will leave the province.
It is unconscionable that College would seek to even consider abrogating the right of a Physician to decide who he will treat on the basis of his informed conscience, i.e., if by treatment sought totally is counter to his firm beliefs. God Bless the Physicians who are acting on their beliefs and conscience. I simply cannot see anyone going without the treatment they are seeking out a professional who is of the same conscience as their own ill-informed view and beliefs in the sanctity of life in all forms – unfortunately there are too many of them.
I strongly believe that a physician should not be forced to act against his conscience.
And that he should only have, in the matter of referrals on moral grounds, the obligation to refer to a properly designated referee.
I would not feel safe if my physician participates in euthanasia or assisted suicide. Physicians need to uphold their promise not to do harm. If euthanasia or assisted suicide is legalized, physicians must have the right of conscience to refuse to participate in any way, including to right not to refer to another physician.
Well educated doctors should realize that life begins at fertilization. Any Biology textbook will confirm this as a fact. Why do we continue to allow the killing of innocent human life and now, even force doctors, against their consciences to participate in this horror? This sounds too much like Nazi Germany to me.
The proposed policy demands that physicians make referral, and in some cases actually perform, procedures like birth control, abortion, and, should it be legalized, euthanasia, if the regulator (CPSO) considers them to be “urgent or otherwise necessary to prevent imminent harm, suffering, and/or deterioration.” This wording is open to broad and subjective interpretation and therefore abuse. Doctors who cannot participate due to deeply held moral or religious commitments will be vulnerable to punishment from the CPSO, even though their fundamental freedom of conscience and religion is guaranteed by the Canadian Charter of Rights and Freedoms. Why is this requirement being advanced now, since for all practical purposes this has been a non-issue for decades, as patients may self-refer for pregnancy termination?
Doctors should have the right to decline a “service” to a patient if their best judgement and conscience decides other wise. Your policy states that physicians must act in their patient’s best interest. A patient’s request for provision of an immoral action by a doctor or nurse may not be in their best interest, even though the former may think so. Therefore the expectation that the initial physician will refer the patient to another doctor to provide the service is indirect collaboration, which is equally immoral. This would be a coercion to violate
ate freedom of conscience
These proposals are very disconcerting as doctors would be required to refer for procedures that are against their moral or religious convictions.
Also they would be required to perform procedures that are against their moral or religious convictions in situations where that is deemed to be “urgent or otherwise necessary care”.
Certainly this is a proposal that would have far reaching and dangerous implications for the medical profession.
Re: my comment Number 227 below, I change my words both on the matter of conscience and on the matter of referral.
I modify my comment as follows:
“I strongly believe that a physician should not be forced to go against his conscience.
And that in such matter he should not have the obligation to refer.”
It is truly disturbing that with zero legal basis for doing so, that a lower level jurisdictional body like the CPSO would actually stoop to the consideration of becoming a totalitarian body that forces physicians with a free conscience in a democratic country possessing rights of conscience, to perform an act that they would consider to be morally abhorrent and repugnant. There are numerous doctors out there who would only be too happy to provide direction and counselling on abortions, and the only direction a physician with an pro-life conscience need provide is to direct the patient to the CPSO for further information and clarification. Period.
I do not agree that a doctor must provide information about other doctors who provide a service that is in direct conflict with his/her moral or religious beliefs.
This is cruel and extremely unusual behavior on your part. If a doctor is unable to provide the service due to religious or moral beliefs, how can you expect him to make a referral that is so obviously grossly abhorrent to him? “I won’t kill your baby or your grandfather, but here is a list of people who will”. This does not make any sense. A patient who wants this kind of service is fully capable of finding it on their own.
Everyone has a fundamental freedom of conscience and religion. In addition to this, physicians take an oath to observe the code of professional behaviour. Primarily their job is to heal and save lives and when doing so to consider what is best for the patient.
When a physician is requested to act against his moral beliefs in order to accommodate a woman wishing to terminate her child, he should not have to. Obviously abortions are easily accessible as millions have been performed annually. All the physicians I have known throughout my life have treated those women with respect and referred them to other sources for help. I have never read of anyone who died of pregnancy. It is not an illness and should therefore not be treated as such. We should also remember that the physician has two patients to consider when an abortion is discussed. Regardless of personal opinion, the fact is that thousands of preborn babies have been surgically treated and others delivered safely prior to their full term. Walls of some hospitals are covered with photos of these. To pretend that the unborn child is not human has, of course,been scientifically disproven but there are those who will stand by our country’s 400 year old law which says otherwise.
The bottom line is that our freedoms should not be removed to accommodate that which is not a “right”, even though the law permits it. Let us remember the many injustices and atrocities that were considered legal in our time. Perhaps in the near future, we can look back at baby killing with the same shame.
Well in regard to the Physician comment below—-You took an oath so as all other groups that have oaths in their makeup—then why not leave the position and find one without an oath, or do you have something else in your mind? If you have the right to kill, why do we have courts. As Doctors have proven — an unborn baby is exactly the same as a born one; regardless of the mishmash put out by certain ones. I agree they are entitled to their opinions -but-!
Now Physician 2 seems to be a normal thinking person. Why should his thoughts be forcefully changed?
Basically we see the usual workings of a minority +I do not like what you are doing+ — change it to my way thank you, like all the other things changed, quite often by one person complaining.
Are their rights more important than ours. It seems that the majority come in second. One person’s viewpoint should not lay the ground work for a massive change in things by so called ruling people.
I trust that Ontario’s College of Physicians and Surgeons will reconsider the present movement to require physicians to refer patients for all medical procedure in disregard for the beliefs, principles and consciences of the doctors.
Not only does such a requirement trample on the rights of doctors to determine and uphold their moral outlook, it also denies patients the right to choose doctors whose beliefs are coherent with their own.
Why must every health care provider assume a generic outlook? Why cannot patients register with doctors whose attitudes to life and death accord with their own attitudes? And what kind of a doctor could shed deeply held beliefs in order to subscribe to medical procedures that are deeply abhorrent to both doctor and patient?
Why, on contentious issues, must we suffer from the well-publicized implication that there are no consequences to moral choices? In light of the natural law that is written deeply in the heart of every human being, there are going to be consequences for the disrespect for human life, whether we choose to believe it or not. If particular lives are not valuable at vulnerable moments, then neither are ours.
My family and I respectfully request that freedom of conscience remain the right of every physician and health care provider.
I think physician should respect patients believe, and provide care to all equally. However, if a physician does not believe to certain culture/ religion/believe, or is not comfortable providing service to a group of patients, I think the quality of service will be jeopardized.
Physician should disclose their believe to patients, and in non-urgent cases refer them to different physician, or advised to find different doctor, but if there is no other option for the patient, I think physician should continue providing care and service to patient.
Physicians should not be forced to go against their conscience if they do not agree with providing a specific treatment or medical procedure. The patient has the option to seek out other physicians who may be willing to offer what they want. In some instances this may provide the chance for a “sober second thought” to a procedure which may be irreversible and life changing.
Freedom of Religion should be first and foremost in the minds and hearts of every Canadian. The College of Physicians and Surgeons of Ontario are destroying human rights. We hear of the bad Human Rights in other countries e.g. China but it is also happening right here to moral faith filled people. We are part of the many people that helped to keep Canada STRONG AND FREE. I don’t call this new legislation following those rules. The people desiring this legislation should move where they can live their way not change our country that our ancestors worked hard to achieve the freedom.
I don’t understand how the elected people can decide to take away our human rights. When babies have a heart beat at conception, our grandchild had a heart beat at 6 weeks in the womb when they were worried about a miscarriage and took and ultrasound. The doctor confirmed that there was no worries because the baby had a strong heart beat. Since that is true how can any person do an abortion or even want an abortion when it is a living person. Many people are in prison for many reasons that are not as horrific as murdering a baby before he or she can be born.
Physicians, like all human beings, must make decisions according to their conscience. A patient asking for treatment that goes against the conscience of a physician cannot expect that physician to provide the service or to make a referral for that service. After the physician has explained his reason for refusing treatment, the patient is on his own to decide the next step. He has freedom of choice to act according to his conscience.
My Doctor is fabulous. Very helpful, always willing and able to see me. She is religious and practices within her faith. I am pro choice and pro euthanasia but recognize she is not. This does not bother me as we all are entitled to our own opinions, and religious beliefs should be protected under the charter of rights and freedom. If I needed an abortion I would never dream of going to see her. There are other clinics and drs. Also if I strongly disagreed with her stance I could find another doc. Please do not impose things in people with morals and religious beliefs.
On learning of the document entitled “Professional Obligations and Human Rights I am deeply disturbed that it will force doctors to perform procedures or give advice which runs counter to deeplly held beliefs held by the doctor. Why force a doctor to carry out an act which is deeply offensive to their secular or religious belief when there others willing to carry out the task?
While there are many positive aspects in this new draft policy, I am very concerned about the requirement for physicians to perform or refer for procedures that they believe are morally unacceptable.
I believe that health care is strengthened by the diversity in medicine and in providers beliefs. I believe that making physicians simply a technician is not the answer and that patients will suffer if this is what occurs. We, as physicians, must be able to do what we believe is best for our patients and patients should be able to seek out physicians who share values with their own.
Please do not accept the policy in it’s current form. Please protect the conscience rights of physicians. If we don’t – it’s the patients who will ultimately suffer – by losing many incredible, ethical, knowledgeable, and dedicated physicians who will leave the practice of medicine rather than compromise their moral or religious beliefs.
Thank you.
Hi there,
I am so free to provide my input on your human rights policy draft as your relatively new member.
I think referring the patient to another health-care provider for treatment you are unwilling to provide based on your moral or religious beliefs is actually the same as providing the treatment and forcing the physicians to go against their beliefs.
Right of the patient to have some medical procedure shouldn’t go against the right of the physician to act according to his own beliefs otherwise this policy if accepted, might be introduction to the totalitarian rule.
This policy would be too harsh and inappropriate, especially here in Canada where you have so many resources and health-care providers so patients can get easy access to controversial treatments and procedures even if refused by provider who is not willing to provide them.
One of the pillars of CPSO’ work and acting in the public sphere should be keeping physicians autonomy, and as you know from the history human rights and their interpretation vary by the society, political rule and current context and are not absolute.
Dear Members of the Consultations Committee:
Subject: Draft Policy “Professional Obligations and Human Right.”
I would like to express my deep concern for the proposed revision of the draft policy. This revision states that physicians who are unable to participate in services due to moral or religious beliefs are required to make referrals to individuals who are able to perform those services in order to ensure timely access to health care. The draft does not clearly give examples of these services but we can assume that the oral contraceptive pill, abortions, and perhaps euthanasia – should it become legal and the standard of care in Canada – are the main topics of contention. Many of the same physicians who refuse to participate in these services would also be opposed to making referrals as they believe it is akin to actively cooperating with the act.
Abortions are made on a self-referral basis and are already widely available to the public. Emergency contraceptive, also known as “Plan B” is available over the counter and does not require a prescription from a physician. The birth control pill is promoted from a society perspective as a main form of contraception and is readily available at many sexual health clinics throughout Ontario. There is no need to increase access to these services since they are already available through many interfaces.
As you clearly described, physicians have a fiduciary responsibly to their patients and we must legally act in their best interests. In today’s moral landscape, there is much dissent in defining what constitutes a morally permissible act. Some physicians are strong proponents that abortion and oral contraceptive pills negatively affect one’s psychosocial and physical well being. In forcing these physicians to prescribe OCP and make referrals to those who are able to perform abortions, it is diminishing and undermining the fiduciary duty physicians have towards their patients. Freedom of conscience is paramount in upholding a free society, and if we cannot defend physicians from conscientious refusal we are coercing these people to violate their conscience and act in a manner that is degrading to their integrity, both as a person and as a physician.
On behalf of my colleagues and I who share this grave concern, I encourage you to reconsider this version and make the appropriate amendments to incorporate a clear defense for the right to religious, moral, and conscientious refusal of procedures.
To whom it may Concern,
I am strongly opposed to the proposed draft to force physicians to prescribe or refer against their conscience. This is an assault against their freedoms.
Let me give a parallel situation with another profession.
I am a recently retired physiotherapist.
In my years of practice I have developed preferences for certain techniques to use in the care I give. And there are even a few techniques that I do not use because I believe they are ineffective or harmful.
To suggest a regulation that would allow a client to demand I use a certain technique & claim I am violating THEIR rights if I don’t is totally preposterous!
It is a fact that this draft would adversely affect many experienced & capable physicians contributing to some leaving the profession through conscience or burn out.
Maybe none on this council have moved & tried to get into a Family Physicians office lately. It is extremely difficult so that many must rely on drop in clinics with no continuity of care.
It is clear to me that this draft has the purpose of compelling physicians to be involved in not giving life but taking it through abortions & euthanasia. That is the bottom line.
Shame on you,
Hello,
Forcing doctors to act against their consciences harms both our doctors and all Canadians. Do not force doctors to practice medicine in a way they find reprehensible.
Please allow our doctors to practice according to their conscience. There are always other doctors who do not hold the same convictions to whom a patient can be referred. Forcing a practitioner to act in discord with their core beliefs not only fragments a person, but causes them inestimable stress, distraction of mind, and ultimately impacts their practices in a myriad negative ways.
Freedom of conscience, along with freedom of speech, are core values that define liberty and the free world. Start chipping away at those, and you signal the beginning of the end of our way of life as we know it.
Please do not slough off or decry the above statement. It is profoundly important to us as Canadians going forward.
Thank you
We must protect the physician’s conscience rights. We are not God, and neither should we play God, by hastening death. He alone knows the hour of death; a patient affected by medication and trauma, a
doctor biased, a family member fed up or motivated by ulterior motives simply cannot provide the right answer. God gave life, he will also take it away. If we are left to the whim’s of man in these and other
issues, its my word against yours, my preferences vs someone else, my opinion, my rights. God says in His sacred Word: “For the wages of sin is death, but the gift of God is eternal life
through Jesus Christ our Lord” Romans 6:23. And in Revelations 1:18 “I am He that liveth, and was dead; and, behold, I am alive for evermore, Amen, and have the keys of hell and death”
To the College of Physicians and Surgeons of Ontario,
I strongly urge you to reconsider this new set of regulations you are planning to implement. While it is true that persons in all kinds of distress may have legitimate concerns and whose legitimate rights must be respected, another fundamental human right must not be neglected: the freedom to act in accordance with moral values informed by legitimate beliefs.
I am concerned the legitimacy of those beliefs is what is being questioned. Nothing in your proposal appears to recognize that a great many Ontarians do not share the belief of others regarding certain “health services.” The proposal simply takes for granted that these “health services” are a human right that must be respected at the expense of another human right: the freedom never to be compelled to act against one’s legitimate convictions.
Some doctors will feel that although they are allowed to refuse said “services” on the grounds of private convictions, they are obligated to refer the patient to another who will offer those “services” and in the end it makes no difference. If they have not committed the act (of abortion or euthanasia) directly, they have contributed to it all the same.
Please reconsider this proposal. Many Ontarians do not believe that these health “services” are a fundamental human right. You cannot use the language of human rights and equality while you are stamping out the rights of conscience of many doctors.
I am a family physician in practice for 20 years. I have read the CPSO Draft policy on Physician Rights of Conscience and Freedom and strongly oppose such infringement on our human rights.
The ability of doctors and other health professionals to act according to conscience is a fundamental human right that is not respected in the draft and must be.
Thank you.
I find it reprehensible that the College of Physicians and Surgeons has drafted a policy that would require physicians to make a referral for a patient even if the “care” or “treatment” the patient requests requires action that goes against the doctor’s moral conscience. We all know to what these lines refer: access to abortion. Providing a referral to a patient is still helping the patient to receive an abortion. It makes no difference if the doctor performs it or sends the patient off to another who does perform abortions. By forcing a doctor to offer a referral for an abortion is forcing the doctor to violate his/her right to exercise his/her freedom of conscience, plain and simple.
Patients can do their own homework to find an abortionist doctor. In light of the culture of death in this country, not to mention around the world, there are plenty around! Please stop using euphemisms such as “care” in your policy when referring to abortion. Providing an abortion is not care. Pretending it is damages all involved since pretending is never honest.
I would encourage you to retain the moral stance that the existing Charter rights of freedom of religion and conscience guarantees.
Professionals such as doctors should not be forced to carry out actions contrary to their rational decisions as provided to them by the Canadian Charter of Human Rights.
Thanks for your openness and consideration of public input.
Your going to be responsible for every EVIL act your asking our doctors to do and how is this going to benefit this world? Do honestly think GOD’S wrath won’t come? Better think again on that one.
I do not believe the law should force Doctors to perform procedures against their moral beliefs. Also a Doctor’s pledge is to save lives NOT to destroy them.
The Policy needs to be specific that matters such as referral to abortion clinic, or unsafe/invasive reproductive technology clinic or euthanasia clinic, and to any intervention that causes harm… are NOT considered as health issues and thus NOT as matters of treatment or care.
This has to be clarified especially in section ii: Ensuring access to care. Although it is implicit in the “Protecting patient safety” section iii: This latter section does mean that abortion, euthanasia, unsafe reproductive technology, etc… – matters which all great religions and the moral natural law clearly oppose – are inacceptable and rejected by the Policy because they cause harm. But this is implicit in section iii.
It has to be clear and specified. The best place to specify this is in section ii “Ensuring access to care”.
Note well that while you understand section iii to implicitly exclude such “care” as killing by abortion, IVF, or euthanasia, the CPSO does not. In fact, many secular humanists believe that an unplanned pregnancy, for example, will result in “imminent harm or suffering” to the mother if allowed to end in the ordinary delivery of the unwanted child. They don’t believe in the existence of a pre-born person. For this reason, I think, the CPSO has specifically required provision of care “even where that care conflicts with [the doctor's] religious or moral beliefs.” Secular humanism is now the state religion, and its practice is required by law (this policy, for example).
The freedom for one to live by one’s religious conviction should be irrevocable.
Why persecute one who chooses to do so when a doctor who is willing to comply with a patient’s wishes is readily available? Why the personal attack?
I just read in the MD Dialogue magazine ‘Message from the President’ that ‘we would like to know whether [physicians] agree with the draft policy ‘Professional Obligations and Human Rights’. The President in the same letter states that ‘we’ [the CPSO executive, I assume] feel that expecting physicians who limit the services they provide on moral or religious grounds to refer their patients to those who have no such reservations ‘strikes an appropriate balance between physician and patient rights in this context’. I then went to the discussion forum where, to my surprise given the attitude taken by the CPSO, it seems every single comment, both from physicians and members of the public, is against the draft policy, for intelligent reasons. Your agenda is clearly political. You despise a certain moral position and are willing to cause a great deal of expense and trouble to remove those who embrace it. No self-respecting physician is going to follow your policy even if you ‘succeed’ in getting it passed as law. In a battle between truth and lies, truth will always ultimately win out although martyrs are made along the way. And martyrdom often has the effect of strengthening a cause that has truth on its side. At the moment your organization is on record as being on the dark side- I agree with the CMDS assessment of this issue and their recommendations.
Doctors are to save lives not kill them!! Unborn are also a life from the time of conception !! Euthanasia should never happen. Only God has the right to take life!
As a resident who is soon to graduate, I am gravely concerned about this draft policy. Many respondents have raised the same concerns I have, specifically the freedom of conscience, which is a Charter protected right as a Canadian. I think a good question to ponder is if we want our physicians to practice medicine with their moral integrity intact. Because what the CPSO would essentially be mandating me to do is to break my moral integrity, and thus have irreparable consequences on my personal and professional conscience. I do not support this policy, and if approved, it will definitively make me think twice about setting up practice in the province of Ontario.
A physician has the same great human dignity as any patient, not more and not less. Not more means that the physician cannot be expected to play God. Not less means that the physician is expected to have and to follow a personal human conscience. For the College to presume to intrude by ‘defining’ the position of God, or by declaring the proper conscience, is prejudice of the worst kind.
Now I learn that if this draft document is passed, medical doctors will be asked to kill their consciences, as well as kill life in the womb. Many wonderful family physicians, obstetricians and gynaecologists, who took the oath to “ first do no harm”, will not continue practising and many much needed hospitals will shut down. Recently a British Medical Journal, published an article demonstrating that abortion does indeed do harm and is linked to breast cancer among other psychological side effects .
According to the Universal Declaration of Human Rights there is a special obligation for doctors to provide “special care and assistance to motherhood.” This means that all women should have access to competent obstetrical and gynaecological care which includes appropriate care of the child in the uterus and assistance to establish breast feeding of the child after birth. This has been a priority for the government foreign policy in Africa. Therefore provincial bills should be drafted consistent to the theme of safeguarding life, health and fertility, rather than the one on the table that is disastrous to life, freedom of conscience and happiness of our hardworking doctors who are being asked to satisfy the whims of their patients. One such bill might ensure a woman’s right to be informed about how to manage her fertility simply, naturally, and effectively and without cost to government purse or her health: http://www.thebillingsovulationmethod.org
While the Chinese Medical Journal, 1998, proved that knowledge of the Billings Ovulation Method® of natural fertility regulation, among nearly a million Chinese couples, is extremely effective when used to avoid pregnancy (99%) the study also showed successful outcomes for helping couples, having difficulties in conceiving. The study demonstrated that abortion plummeted in those areas where the authentic Method was taught. Surely we could reduce abortion in Canada too in the same way? If a young woman is old enough to conceive and bear a child she is entitled to this knowledge. “All women have the right to knowledge and understanding of her fertility and reproductive health”. “Under no circumstance must abortion be used as family planning” was the conclusion of the United Nations ICPD Report of 1994 and yet twenty years on policies to force doctors to refer or do abortion are in the works…shame on us!
I want my doctor to be free to follow conscience. I trust my doctor’s integrity and would not want her/him to be forced to perform procedures or make referrals against her conscience. To illustrate: my boss once sent me to do something which I believed was wrong. Fortunately, I was sent back to make correction later. I felt terribly guilty, for I knew that dictators in history were able to do horrible things through people who did those horrible things because they were just following orders.
our doctors should NOT be forced to violate their moral integrity. Do they not have their rights to their moral believe? We have the choice to chose the doctor known what their moral integrity is.
I am deeply disturbed by this abuse of CPSO’s power because the policy would be an infringement of physicians’ rights and would also limit a patient’s right to be treated by the type of doctor he or she would prefer. The policy would also deter many men and women from choosing medical practice as a profession, as they would be forced to do certain procedures or refer to others (just as problematic, because the physician would still be contributing to something he or she objects to). Physicians’ rights must be respected in the same way that physicians respect the rights and feelings of the patients coming to them with widely divergent worldviews. This policy is clearly discriminatory and a violation of physicians’ conscience and religious rights. Most physicians (and patients) believe that the purpose of medicine is to HEAL people. They did not choose this profession to intentionally end life.
For this particular issue, it amaze me to see how far Physicians and Surgeons of Ontario will go to push their agenda and how naive they seem to be by not realizing the impact it will have to every community in our province. If many doctors with a conscience will loose their license because of the mandate, it will make it more difficult for patient to see a doctor or find new ones where it is already difficult for some, many doctors will move to other countries, baby boomers doctors or doctors with few years left to practice will retire early, no new doctors will be available, there will be long wait for appointment, more people will die before seeing a doctor etc…..and in the process, downgrading our quality of care. As it is right now we are desperate for new doctors, many time we have to import them from other countries where it will take time to re-trained them to our medical standard and most of those import recruits will be killer doctors. I would hate to have to go see a doctor with that kind of practice on his plate.
Re: Draft Policy “Professional Obligations and Human Rights”.
I am writing to you with grave concern regarding the content of your proposed draft policy, which indicates that physicians who decline to participate in certain acts for reasons of conscience should be compelled to refer their patients to other physicians who will perform these acts. It does not address the fact that many of these same physicians will find the act of referral itself objectionable, as they consider it material cooperation with the act. In compelling physicians to refer, you are limiting their right to conscientious objection. I am opposed to this.
There is significant disagreement in our society as to what constitutes a moral act, and I do not expect the College to define or limit morality. All I expect is that physicians, as professionals, be allowed to respect their own consciences. Freedom of conscience is foundational to our free society and cannot be limited, even for the best of intentions.
If we coerce physicians into violating their consciences we will inevitably erode the personal integrity which is the basis of the physician’s relationship with their patients. I encourage you to revise the sections above, and include a clear defence of the right to freedom of conscience for all physicians.
[**MESSAGE FROM ADMINISTRATOR: DURING THE CONSULTATION PERIOD, WE RECEIVED 270 RESPONSES FROM INDIVIDUAL RESPONDENTS CONTAINING THE CONTENT PUBLISHED ABOVE. ALTHOUGH THIS FEEDBACK HAS NOT BEEN PUBLISHED IN DUPLICATE, THE COLLEGE ACKNOWLEDGES RECEIPT OF THESE SUBMISSIONS.**]
Thank-you for the opportunity to respond to the CPSO’s draft policy. I’m a family physician in British Columbia who is concerned that similar changes may occur here. Also, for twenty years I’ve been teaching a medical ethics curriculum to family practice residents from across Canada.
In medical ethics, as well as in law, the principle of patient autonomy is paramount—but it is not absolute. A great medical ethicist has said that one of the limits to patient autonomy is the physician’s autonomy. Both the patient and the physician are moral agents. The doctor-patient relationship is based on mutual trust and respect. When patient autonomy is the “ace of trumps” the moral integrity of the physician counts for naught, and the doctor-patient relationship suffers. The physician becomes a mere instrument to enable the patient’s wishes; a technician rather than a healer.
One of the features of the draft policy is the obligation to refer for objectionable procedures. The problem here is that referral makes the physician complicit. The door man in a bank heist is just as culpable as the robbers who enter the bank with weapons drawn. If I’m obliged to refer my patients for euthanasia, say (almost certainly to be declared a right this year by the Supreme Court), then I am cooperating in an act which I find abhorrent, and which I pledged in the Hippocratic Oath to never perform.
A Law professor and former Dean of Law has written a timely book on these matters. She maintains that Canada is big enough to tolerate physicians of all backgrounds—First Nations, Muslims, Christians, Jews, atheists, etc. We can all “live and let live” without subjecting certain groups to intolerance and coercion based on creed.
Please reconsider your draft policy on Professional Obligations and Human Rights.
Dear Member of the CPSO:
I am writing to express serious concerns about the drafted changes to the policy, Professional Obligations and the Human Rights Code.
It is a fact that the authorities, and even the majority, do not always get decisions involving morality right. The Holocaust was inarguably evil. And it was authorized, even required, by the Nazi government. In retrospect, we don’t excuse the actions of those who perpetrated it based on the fact that they were ordered to carry them out: we believe that they ought to have acted based on a higher sense of morality, not on their orders. They could only have acted rightly if they objected to the authorities’ requirements of them.
The right to object on moral grounds is fundamental to a free and tolerant society. Historically, we have permitted conscientious objection based on three conditions: first, that the objector has a respectable case on why they object to a particular action, second, that the consequences of the action based on the objectors beliefs are grave, and finally, that the objector holds the beliefs they assert with sincerity. These are somewhat stringent criteria. But applied, for example, to a pacifist during a draft, they ensure that people are not required to commit acts for which their conscience would condemn them and that people are not allowed to use those rights of conscience protection inappropriately for their gain.
The debate regarding this policy has been wrongly set up as a debate about several particular services and whether there ought to be full access to these services. The rightness or wrongness of those services ought to be debated with regard to the CPSO’s stance on those services. This debate is about something far more important. It is about whether or not we will allow physicians to act on their conviction that something they’re being asked to do is wrong.
Protecting rights of conscience does not mean that we will all agree on every issue. On the contrary, it recognizes that, in certain cases, there is legitimacy in having convictions which depart from the convictions of the majority. It recognizes that, although the majority is not won over by an objector’s case for why the action they object to is wrong, still they have a respectable case. It recognizes that asking someone to perform those actions anyway, where the consequences are, in their mind, grave, is dangerous and inhumane.
Conceding that the objecting physician may refer is insufficient: if I believe an action is wrong, I ought not to commit it, and I ought not to commission it. It’s an old and tired but still valid comparison that, if someone really believes that to kill a particular person is wrong, hiring a hit man to do it instead would also be wrong. As long as the proposed action would be a significant transgression to one’s conscience, I believe the analogy holds.
Requiring that the objecting physician commit the objectionable action in urgent cases is unacceptable: the fact that there is urgent wish for the act believed to be wrong by the physician does not make it any less wrong. The fact that there is a war on and the authorities believe that people need to be killed does not invalidate the rights of the pacifist conscientious objector; rather, it makes the objection all the more pertinent. The validity of the objector’s objection is not changed by the urgency of the request.
Please contact me if anything I’ve written is unclear or if you wish to discuss these matters further.
All sorts of notions are arising these days under the guise of “Human Rights”: some are local, some are being touted internationally and have not been officially accepted and yet are foisted on nations as law, others have been denied by courts of law.
The notion of separating a person’s conscience from the person’s practice is, I respectfully submit, an attempt to proximate a schizophrenic condition. A person should be guided in their decisions and actions by an informed conscience and the forming of that conscience, reason suggests, is outside the competence of medicine and civil law: the latter should be there to protect what I shall call natural law. The number of medical practitioners and clinics and hospitals available in Ontario allows any reasonable person enough choice not to burden any single practitioner with having to cater to the so-called “needs” of everyone, particularly when those “needs” happen not to be necessary for or relevant to the preservation of life – which one would hope is the goal of the Hippocratic oath.
Accordingly, I urge your College to adhere resolutely to the Hippocratic oath and not allow a Commission on human rights to distract you from your noble calling. It was Aristotle who identified nobility with virtue even in the pagan era. Matters of sex and sexuality seem to be ruling the day: don’t fall for it, but stand nobly on principle. Your members are the better educated in the population and, hopefully, that education encompassed the ability for critical thinking which we, the citizenry, need to inform the public square by your noble principles and practices rather than succumbing to every fad and fancy of the day.
It is disturbing to have anyone require doctors to provide what the State has deemed acceptable in defiance of the Hippocratic oath. Ironic that this should be happening on a Holocaust anniversary.
As a Hippocractic physician I found the proposed Professional Obligations and Human Rights Policy and the questionnaire that flows from it nauseatingly condescending, morally empty and a sad reflection of the ethical vacuum of a post-Christian culture. Does a “Human Rights commission” really determine the standards of our society?
Is it really necessary to tell physicians to respect the dignity of their patients? Do we need to be told not to “discriminate” against the weak, the marginalized, etc.?
Would it not be simpler to remind ourselves of Medicine’s Christian roots? To love our patients as we love ourselves? Do we need anything more?
To Whom It May Concern: I’m writing to you in concern about this new policy your trying to approve and it shouldn’t be approved at all. This is regarding the “Freedom Of Conscience for Physicians” and how your trying to force Doctors to do unspeakable crimes against GOD and HIS Commandments. I would also think that our fellow fallen soldiers who fought in several Wars in this world would all matter to you since they gave us the “Freedom of Our Rights to do what is right for ourselves and not for your unlawful acts. I refuse to stand by this and not voice my opionion that this is not what GOD wants and I pray to GOD to all of you that HE will have mercy on all your souls because you need it now more than you ever have in your life. Abortion is an unspeakable crime against GOD. It’s not a choice it’s a CHILD and a GIFT from GOD. There is nothing good that comes out of an Abortion and GOD knows this as well. As for reproduction and end-of life care this is wrong as well. It’s up to GOD to take us home and no one else. Just like Capital Punishment is wrong too. It’s murder when you do that too. It’s pure EVIL and that is WRONG. I just hope and pray for each and everyone one of you to when you have to look at the face of GOD when it comes to your near death that HE will have Mercy on all your souls and I will continue to pray for you on all of this. GOD Bless you all.
Dear CPSO consult group,
I wish to register my husband and my opposition to the Professional Obligations and human rights points below:
1 Doctors are required to refer for procedures that are against their moral or religious convictions (Lines 156-8)
2. Doctors are required to perform procedures that are against their moral or religious convictions in situations where that is deemed to be “urgent or otherwise necessary care” (Line 168)
We live in a free country and believe that every governing body should allow for a person to act according to their moral or religious convictions.
ps Thank you for allowing the public to weigh in on this very critical topic.
I am a professor of health care ethics. Protecting the rights of freedom of conscience and religion is a basic human right both articulated in the UNO Declaration of Human Rights and in our Canadian Charter of Rights and Freedoms. So far it is also protected in the CMA Code of Ethics, n. 12. It is important that these rights be continued to be respected and not violated by some trying to bully and impose their morality on others. This is hardly tolerance or respect fopr one’s fellow human beings. Atheists and liberals are often the worst bullies today trying to trample on the rights of sincere Christians and others by imposing their narrow agendas. Respecting the rights of Christian and others who are among the most caring health care professionals does not take away the rights of freedom of conscience of other health care professionals including liberals and atheists or the patients.
It is a disgrace that I even feel a need to write such a letter in a free country like Canada. Do not listen to the bullies and intolerant people in your profession!!
While the Charter entitles physicians to limit the health services they provide on moral or religious
129 grounds, this cannot impede, either directly or indirectly, access to care for existing patients, or those
130 seeking to become patients. Therefore, the College requires physicians who choose to limit the health
132 rvices they provide on moral or religious grounds to do so in a manner that:
;
133i. Respects patient dignity
134 ii Ensures access to care; and
135 iii. Protects patient safety
The sections immediately before are well written, clearly vetted with a constitutional lawyer.
However, this section, which I cite above, bears no relationship to the rest. It is not founded in fact, law or rational thought. It is clearly opinion and is the novel imposition by the College of its interpretation of how a Court would handle situations which, just a paragraph above, are described as warranted individual consideration. Therefore, this section should be considered outside the reach of the college. It is an affront to the personal integrity, personal and religious freedoms of practicing physicians and a denial of the entire preamble which precedes it. Moreover, let me state as a matter of my opinion, IT IS TYPICAL OF THE ARROGANT, ARBITRARY THINKING WHICH UNDERLIES THE CONDUCT OF THIS COLLEGE IN THIS AND SO MANY MORE AREAS OF ITS INTRUSION INTO MATTERS THAT DO NOT BEAR ON PHYSICIAN-PATIENT RELATIONSHIP AND CARE. IT IS, IN SHORT, TYPICAL OF A BULLY; AND IF THERE IS A WORD WHICH BEST DESCRIBES THE CPSO IT IS BULLY.
I would be deeply concerned if this policy were not revised to protect the personal freedom of the individual physician. As it is presented it would obligate the conscientious medical practitioner to perform a service that could include, what to them would be totally against there code of ethics as someone who works to preserve and protect life. . In other words if this policy becomes law as it is now presented, it would mean that the physician is obligated to participate in ending a life; be that an unborn child through abortion, or if Euthanasia becomes legal, that of some other person. This would be tantamount to murder.
Surely our great country of diversity and tolerance can find a way to preserve the indivdual rights and freedoms of all Canadians.
I am not in favour of some of the proposed revisions to the Professional Obligations and Human Rights Code for the Physicians and Surgeons for the Province of Ontario.
I do not believe these proposed changes will result in better patient care. In addition I believe the proposed changes will systematically discriminate against doctors who do have a conscience and will adversely affect the profession as those who have a conscience will no longer choose to become a doctor. Furthermore I consider doctors to be servants of the state not slaves as this code would demand.
Since there is a clear dichotomy of opinion in society regarding the rights of the child in the womb, it would be immoral and I believe unethical to adopt a code at this time that will be enacted on the premise that the child in the womb does not have a right to life. And it is not a small or insignificant number of folks in this province or country who hold these views. For example a survey by Abacus in 2011 indicated that 59% of Canadians surveyed believed that human life should be legally protected in some way before birth, 27% of Canadians believe that human life should be protected from the moment of conception, 32% believe human life should be protected during pregnancy.
For this reason I believe the case of pregnancy presents a unique situation. It is the only situation where the doctor is dealing with two patients at the same time.
Therefore, in this situation, the code must consider the needs not only for the patient that can speak for themselves but also for the patient that can not speak for themselves, (the preborn child). The need for protection from imminent harm, suffering and/or deterioration of both the preborn child and the mother need to be considered. If you proceed with changes, abortion should be positively identified as a medical service that doctors are exempt from providing or having to refer. I do not consider doctors who refuse to refer for abortion services as discriminating against their patients as they treat all their patients the same way and they usually make that known up front. A patient is always free to seek those services elsewhere.
I believe euthanasia or assisted suicide, should they ever become legal, would be another medical service that doctors should be exempt from providing or referring. A doctor’s role begins and ends at healing the patient. Killing the patient is not and should not ever be considered as the role for a doctor.
Dear Sirs:
While not living in the province of Ontario, I am aware of your draft policy with respect to “Professional Obligations And Human Rights” and would like to provide you with a few points of feedback.
1. It is important that physicians do not discriminate against any patient but it is equally important that policies governing the work of physicians do not discriminate against the practicing physician.
2. Forcing anyone to do something that is morally abhorrent to him/her, especially when freedom of conscience with respect to that issue is guaranteed in the Charter of Rights and Freedoms, would seem to contravene a fundamental Canadian cultural value and legal right.
3. Given the fact that access to the specific services/treatments being targeted by this policy are already provided, there seems to be no good reason to override the conscience of physicians who refuse to perform such services/treatments since their refusal does not limit the ability of patients to access said services through a physician willing to perform them.
Surely, in a country where tolerance is valued as a cardinal virtue, there are ways and means to provide superb patient care without trampling on the rights of those providing that care. I stronly urge those responsible for this draft policy to re-draft it with a view to securing the freedom of conscience for those physicians whose moral or religious views do not permit them to function according to the policy as it is currently drafted.
It is with tremendous thought that I am writing to ask you to vote against physician assisted suicide and uphold the rights of doctors and other health care professionals to be able to work in an environment that does not threaten their freedom of conscience.
I do not agree to ‘Force physicians to act against their conscience, to do something they believe is deeply wrong against their will is unconstitutional’! No one has the right to force their beliefs upon another nor force someone to do a medical procedures that they do not agree with!
DO NOT LET THIS HAPPEN!
Thank you for taking the time to review feedback on your draft policy about physician conscience rights. I am concerned about Sections 8, 10 and 11 that discuss forcing physicians to refer for services they themselves find morally reprehensible. I do not feel that this policy is either necessary or ethically right.
From my understanding, the issue at the heart of this debate is conscience rights to object performing procedures such as abortion and providing access to contraception. Fortunately, because of the way our health care system is structured, a referral is not necessary to gain access to either of these services. Abortion clinics do not require a referral from primary care doctors. Therefore, forced referrals is a moot point. In the matter of contraception, a woman is free to go to a doctor that does prescribe contraception (these far outnumber those who do not). There is no shortage of physicians providing OCPs to justify forcing the minority to refer their patients.
A change in the policy would be morally wrong because it would result in forcing physicians to act against their conscience. Currently, as the policy stands, all parties involved are treated fairly. Physicians are practicing in ways that are in line with their beliefs. And patients are receiving the services they want. We have yet to have a case of a woman not receiving any contraception because one physician was not able to provide the care. However, with the change in policy physicians will be forced to participate in an act they believe to be wrong. While having little to no impact on the quality of care patients already receive.
I hope the CPSO recognizes how important it is for physicians to act according to their moral compass. Of course, I am not suggesting that any and all conscientious objections be entertained. I feel it should be based on a case-by-case basis rather than this proposed “blanket veto” approach. The College should be doing their best to encourage integrity and honesty in their doctors. This is certainly not a religious issue. Even in “secular” medicine we prevent narcotics abuse in patients because of its harm. Similarly, contraception is not prescribed because of the many known negative side effects that can be overcome by using NFP (a natural, cost free alternative). A policy encouraging physicians to practice without their conscience is certainly a dangerous policy to create.
I encourage you to revise the sections above, and include a clear defense of the right to freedom of conscience for all physicians.
I am concerned with Sections 8, 10 and 11 of your proposed draft policy that indicate that physicians who decline to participate in certain acts for reasons of conscience must refer their patients to other physicians who will perform these acts. The act of referring a patient is in itself for many physicians morally objectionable, as they consider it material cooperation with the act. In compelling physicians to refer, you are limiting their right to conscientious objection. Also, Section 11 indicates that in an emergency, the physician must provide medical services that are against his or her moral or religious beliefs. This goes against freedom of conscience under the Canadian Charter of Rights and Freedoms and is contrary to our free society. The proposed policy is currently proposing a totalitarian regime against our Canadian values. Furthermore, how can we trust a physician who violates his or her conscience? This goes against personal integrity which is the basis of the physician’s relationship with their patients.
Physicians and health professionals should be allowed to respect their own consciences. I encourage you to revise the sections above and include a clear defence of the right to freedom of conscience for all physicians. If not, you risk losing many great physicians, the respect of many patients, and you will be in violation of the Charter and our basic Canadian values.
I am writing in regards to the new College of Physicians of Ontario’s policy. Particularly I am writing with concerns regarding the draft policy’s requirements for Doctors to potentially act their conscience (lines 113-122 of the draft code). This policy could lead to Doctors whom have certain religious beliefs, such as Catholic or Muslim, to act against their morals. I believe this is a violation to the Rights to Freedom of Conscience and Religion guaranteed in the Charter, and will not result in less discrimination or better patient care.
I am writing to you in regards to CPSO’s draft policy on “Professional Obligations and Human Rights”.
I am very concerned about the ideas and guidelines set out in the policy stating that all physicians must make an effective referral for all procedures or medications that they do not provide out of moral objection. While it is important to ensure optimal patient care, this change in policy hinders physician freedom of conscience and religion. It is necessary to protect physician rights as well. Physicians should not be forced to refer for procedures against their conscience. Even if physicians don’t refer for these procedures, patients are still able to get them in a timely manner without compromising the physicians’ freedom of conscience.
I strongly urge the CPSO to change the draft policy.
It has come to my attention that the CPSO is considering a revision of the “Physicians and the Ontario Human Rights Code”. I understand that the CPSO’s plans to limit physicians Rights to Freedom of Conscience and Religion and require them to make a referral to another physician when they elect not to comply with their patients’ requests for contraception, abortion and euthanasia (should that be legalised!).
As a Canadian and a concerned catholic, with many family and friends as practicing medical doctors, I find your draft policy to be authoritarian and is no different than that of a military commander asking his soldiers to blindly obey orders to kill or torture in the name of discipline. To a layman, your proposed revision seems to suggest that you do not trust nor respect physicians, who are all well educated and have spent their life dedicated to the well being of patients, to make ethical choices that would not undermine the interests of their patients as a result.
I hope that you will give due respect to the physician’s human rights and their professionalism when considering the revision of this code.
I would like to voice my opinion against euthanasia.
Physicians should not be placed in situations where they ‘must’ assist or ‘refer’ patients in regards to euthanasia. Their role is to assist in healing.
Physicians nor patients should be the deciding factor when death should occur. There are many circumstances where it can become a ‘slippery slope’ if this legislation goes into effect.
Consider that you would be asking someone to end a life. How can you even consider taking that choice away from a Doctor or any medical person? Well I guess she/he does have the choice of leaving their field. Then I wonder what kind of individuals would be left.
I understand that the College is inviting feedback on your proposed revision of its human rights policy. As a licensed physician practising here in Toronto, and having read the proposal, I’d like to respond.
First, thank you for your work on this important topic. I can certainly understand that the College (and all of us) need to be aware of human rights legislation and how the courts and Human Rights Commissions and Tribunals deal with it, especially on issues that may affect our practice.
That said, I’m concerned about the College’s present and past utterances about issues around physicians refusing on ethical grounds to provide certain services on request. The general tone is to disqualify “personal morality or religious beliefs” and call on the ethical minorities among our colleagues in effect to hold their noses and see to it that the patients get what they want. The authors at the College seem to think that for such physicians to refer the question to a compliant colleague solves everybody’s problem. It seems to me they authors haven’t seriously listened to the minority concerns. In the case of abortion, their approach seems to trivialize the ethical concern to mere squeamishness. Western culture’s experience of trying to live ethically in confusing and challenging times led us as a society to the view that personal ethics are vital to the health of social ethics, and that without personal ethics we’re helpless to challenge society’s ethics if they’ve gone awry. Consider the experience of the US Civil Rights movement which challenged the majority ethical consensus of white society in the US South. Consider also that we Canadians stood in judgement at Nuremberg over the German physicians of the Nazi period. Their defense was that they had done nothing outside of the law (true). However, we took the view that ethics transcend and should inform legislation, not the other way around, and therefore we could hold them to account for their deeds. Such transcendence of ethics is only possible by the exercise of conscience by all physicians. Granted there may be differences arising from this exercise, but we should do our best to accommodate these differences.
Who among us does not have “personal morality”? What patient could trust a physician who had none? Is the College not recommending a corporate or societal morality to be followed instead? If so, how is that corporate moral consensus to be discovered without starting from the personal moralities of each participant at the table? However this process works, the result will usually be that we get a majority report and a minority report, just as we do in politics and jurisprudence.
Where do we go with that? I think one of the geniuses of our society is that we discovered the option of Conscientious Objection. We worked this through in the context of conscription for warfare, but I think we can learn from this and constructively apply the principle to medical ethics, balancing the human rights of patients with the conscience rights of physicians. Individual conscience is too precious a part of our social fabric to be casually overridden.
One suggestion I’ve heard that may be worth considering is for the OMA and / or the College to develop a registry available to the public of physicians willing to provide legal but ethically controversial services to patients whose own physicians cannot in conscience provide them.
If and when euthanasia becomes legal, the College will sooner or later be faced with adjudicating ethical dissonance within the profession such as it’s now having to do with abortion and contraception. The human rights / conscience rights issue will be much the same, and I would suggest to the College a similar approach.
To the College of Physicians and Surgeons of Ontario:
Freedom of conscience is a fundamental freedom in the Canadian Charter of Rights. We demand that the Ontario College of Physicians and Surgeons respect the diversity of medical judgment and not coerce doctors to perform or refer for procedures to which they conscientiously object. We expect that every provincial medical authority will allow doctors to practice in the spirit of Canadian pluralism and with the freedom guaranteed in our Constitution.
[**MESSAGE FROM ADMINISTRATOR: DURING THE CONSULTATION PERIOD, WE RECEIVED 5387 RESPONSES FROM INDIVIDUAL RESPONDENTS CONTAINING THE CONTENT PUBLISHED ABOVE. ALTHOUGH THIS FEEDBACK HAS NOT BEEN PUBLISHED IN DUPLICATE, THE COLLEGE ACKNOWLEDGES RECEIPT OF THESE SUBMISSIONS.**]
Are the human rights of the Physicians not equal to those whom they serve? Human Rights legislation is for the protection of all citizens. It is not meant to divide the rights, or lessen the rights of some; nor to allow the rights of some to supersede the rights of others.
So the college of physicians wants to remove the rights of doctors who will assert their right to freedom of religion? This is tyrany. Any doctor who refuses to be part of a medical procedure that would contravene their religious beliefs and then has to fear reprisal from their own professional organization is living in a society run by tyrants. There is nothing preventing anyone who wants medical services from seeking a doctor who is willing to undertake certain procedures or medical assistance that was defined as immoral up until the time of moral relativism that is attempting to take control of the laws in Canadian society. Doctors should not have to give up their charter rights nor have one ‘charter right’, trump the semial charter right of religious freedom free from persecution.
I appreciate that The College is constructing a document to protect patients’ rights. I am concerned that in the zeal to protect patients, doctor rights are not adequately protected. I do not think it should be considered professional misconduct if I refuse to perform euthanasia or refer a patient for euthanasia if I am morally opposed. I do agree that I should make the patient aware of the grounds for my refusal
Maybe for you. I represent a future Christian patient, and I think a Christian family doctor is not too much to ask. This policy will drive Christians out of the profession.
I am a young woman and Ontario resident and would like to express my concern about the draft policy entitled “Professional Obligations and Human Rights”. I am strongly opposed to the way that this new policy would force doctors to violate their consciences in regards to referring for procedures/services that they consider to be profoundly immoral.
Although I do believe in non-discrimination, having a doctor that does not provide particular services (or referrals) does not constitute discrimination against a group – as long as they do not selectively deny that particular service to some and not to others.
I do not understand how forcing doctors to violate their freedom of religion and conscience would result in less discrimination or better patient care. In fact, this would erode my trust in physicians. Furthermore, I do not want to see doctors with strong moral stances to be eliminated from practice or to reduce their sense of integrity. This is the real source of discrimination and it will impact our doctors and impact patient care.
Please respect the conscience and religious rights of doctors and make amendments to the policy that will not force them to refer for services they conscientiously object to.
I understand that the CPSO is proposing a draft policy that would compel physicians to refer patients for procedures they find morally objectionable.
This policy seeks to impose moral conformity on issues for which there is no societal consensus. I strongly oppose this policy and urge the CPSO to respect the rights of its members to meaningfully exercise their freedom of conscience.
I understand that the College is inviting feedback on your proposed revision of its human rights policy. As a licensed physician practising here in Toronto, and having read the proposal, I’d like to respond.
First, thank you for your work on this important topic. I can certainly understand that the College (and all of us) need to be aware of human rights legislation and how the courts and Human Rights Commissions and Tribunals deal with it, especially on issues that may affect our practice.
That said, I’m concerned about the College’s present and past utterances about issues around physicians refusing on ethical grounds to provide certain services on request. The general tone is to disqualify “personal morality or religious beliefs” and call on the ethical minorities among our colleagues in effect to hold their noses and see to it that the patients get what they want. The authors at the College seem to think that for such physicians to refer the question to a compliant colleague solves everybody’s problem. It seems to me they authors haven’t seriously listened to the minority concerns. In the case of abortion, their approach seems to trivialize the ethical concern to mere squeamishness. Western culture’s experience of trying to live ethically in confusing and challenging times led us as a society to the view that personal ethics are vital to the health of social ethics, and that without personal ethics we’re helpless to challenge society’s ethics if they’ve gone awry. Consider the experience of the US Civil Rights movement which challenged the majority ethical consensus of white society in the US South. Consider also that we Canadians stood in judgement at Nuremberg over the German physicians of the Nazi period. Their defense was that they had done nothing outside of the law (true). However, we took the view that ethics transcend and should inform legislation, not the other way around, and therefore we could hold them to account for their deeds. Such transcendence of ethics is only possible by the exercise of conscience by all physicians. Granted there may be differences arising from this exercise, but we should do our best to accommodate these differences.
Who among us does not have “personal morality”? What patient could trust a physician who had none? Is the College not recommending a corporate or societal morality to be followed instead? If so, how is that corporate moral consensus to be discovered without starting from the personal moralities of each participant at the table? However this process works, the result will usually be that we get a majority report and a minority report, just as we do in politics and jurisprudence.
Where do we go with that? I think one of the geniuses of our society is that we discovered the option of Conscientious Objection. We worked this through in the context of conscription for warfare, but I think we can learn from this and constructively apply the principle to medical ethics, balancing the human rights of patients with the conscience rights of physicians. Individual conscience is too precious a part of our social fabric to be casually overridden.
One suggestion I’ve heard that may be worth considering is for the OMA and / or the College to develop a registry available to the public of physicians willing to provide legal but ethically controversial services to patients whose own physicians cannot in conscience provide them.
If and when euthanasia becomes legal, the College will sooner or later be faced with adjudicating ethical dissonance within the profession such as it’s now having to do with abortion and contraception. The human rights / conscience rights issue will be much the same, and I would suggest to the College a similar approach.
In many cases, patient services which go against the conscience of physicians are things these physicians believe to be harmful to the patient they are treating. Abortion, for example, is not by any means a low risk procedure, having the potential to pose grave physical and long term mental health effects to the women undergoing the procedure, not to mention the fatality to the in utero patient. By their Hippocratic oath, physicians swear not to unduly harm patients, something they’d be doing if they were required to carry out or even refer out these objectionable services.
Physicians are not robots, nor are they treating them. They are compassionate humans, striving to treat patients in a caring manner. I implore the province of Ontario to give their physicians the continued latitude to do so.
Re: Draft Policy “Professional Obligations and Human Rights”
I am writing to object to the new policy presented where you eliminate the right of doctors to conscientiously object to performing a procedure they are morally opposed to.
Would you like to be forced to do something you believe is wrong? Then don’t force anyone else to do what you wouldn’t want to be forced to do.
One by one these fundamental human rights we fought hard to implement we are now stripping away from each other in the name of “I know better”, “I should get what I want”, and “me first”. What are we teaching our next generation other than a self serving, only I matter attitude. I don’t like seeing my loved one like this so let’s stop the pain! And if doctor so and so won’t do it I’ll sue them for not doing what I want or complain so the board forces them to do what I want not what they believe is right. We are not showing the next generation to think “what will I learn from going through this experience and how will it make me a stronger person?” but only live in the moment and if it’s painful then end it.
It’s as simple as that. Even if you don’t believe in the sovereignty of God, as a human being you have to see where our society is going when we start forcing those who desire to preserve life to end it. Soon there will be no one left on earth who wants life to continue. If we start making it a “this person’s quality of life isn’t as good as that one’s” then where will we stop. Either life is sacred or it isn’t. If the person can not take their own life, then their life will end in God’s good timing. We’ve seen many cases popping up lately where a comatose patient wakes saying they were aware of everything going on around them and after years of coma they awake! Doctors say they will never live again and they wake from their coma. The point is, tho doctors are very knowledgeable and better deemed to make these calls than the average person, they still don’t know with absolute certainty, there is always a chance of being wrong.
Don’t force our doctors to act against their own conscience’s. That my dear committee, is one of our last basic human rights.
“As a practicing family doctor since 1987 I’ve seen a countless number of women regret having abortions, yet I have not yet met any woman who regrets keeping her child. Not only is it my duty to follow my conscience, but sharing experiences has proved to be worthwhile as mentioned by several patients. Recent scientifically valid research noted in the book Complications: Abortion’s Impact on Women published in 2013 by the deVeber Institute points to several medical complications including: (1) subsequent increased preterm labour and placenta previa, (2) Asherman’s syndrome, and (3) increased suicide and substance abuse. I do hope the CPSO reads this literature. Passing this bill would cause many middle-aged physicians to retire prematurely.”
This physician’s comment has a theme common to many comments here: what the patient asks the physician to do is often not in the patient’s best interest. As a Christian, I find that my faith agrees with reality, but I see secular humanism ever farther diverging from reality. As a result, we speak euphemistically of gender identity, homosexual fertility, dignity in death, and reproductive health.
As a member of the public, I would like to highlight this letter from an obviously compassionate, service-oriented, altruistic, and trustworthy physician that CPSO should work to get and keep. The letter demonstrates the irony that the effects of the new policy, an increased number of patients legally abandoned and decreased quality of service, will be EXACTLY OPPOSITE to the professed intent of the new policy, respect for patient dignity and access to care.
I am writing in regard to the new provisions which seek to override physicians’ freedom of conscience. In particular, I refer to provisions such as this one:
Where physicians are unwilling to provide certain elements of care due to their moral or religious beliefs, an effective referral to another health care provider must be provided to the patient. An effective referral means a referral made in good faith, to a non-objecting, available, and accessible physician or other health-care provider.
Physicians who object on grounds of conscience are exercising one of their fundamental freedoms in a free society. To refer someone to another member of the profession who is willing to perform an immoral act is itself immoral. For example, an accountant who sends clients to a colleague who enables illegal tax evasion is complicit in the illegal and immoral act. The same thing applies to a physician who enables an act he believes to be immoral.
I am afraid that the new draft rides roughshod over physicians’ rights, and seeks to create of profession of amoral robots. This is the road to a totalitarian state, not an expression of democratic pluralism.
Alliance for Life Ontario It appears that the CPSO draft policy has been written in order to eliminate any physician with an, ethical, moral or religious conscience from remaining in the profession and also to prevent people with such views entering the profession.
Supreme Court of Canada
In R. v. Big M Drug Mart,[5] Chief Justice Dickson’s judgment for the Supreme Court of Canada began by saying that the essence of the freedom of religion under section 2 of the Charter is “the right to entertain such religious beliefs as a person chooses, the right to declare religious beliefs openly and without fear of hindrance or reprisal, and the right to manifest belief by worship and practice or by teaching and dissemination”.
However, the Court went further to find that freedom of religion includes more than simply the right to hold religious beliefs and exercise religious practices. It also means “the absence of coercion or constraint”, because if a person is pushed one way or another he or she is not freely choosing. And such coercion includes “indirect forms of control which determine or limit alternative course of conduct”.
Thus, freedom of religion means “both the absence of coercion and constraint, and the right to manifest beliefs and practices”; that is, that “no one is forced to act in a way contrary to his beliefs or his conscience”.
The only limitation upon an individual’s freedom of conscience or religion recognized by the Supreme Court of Canada is that its manifestation must not injure others or interfere with their right to manifest their own beliefs and opinions.
Therefore there is a point where rights collide and there is a “collision of dignities” but one does not annihilate nor trump the other. Physician and patient have equal rights and the CPSO would do well to find an accommodation which does not trample either individual’s rights and forcing physicians into actions they believe immoral, is not one of them.
Physicians who do not wish to co-operate in the killing of children before birth or prescribe Class #1 carcinogens for women as birth control and sadly I fear with the CMA change on assisted suicide, medical killing at the end of life, will be under further duress.
If physicians are not protected from coercion in our great country then much will be lost, including the integrity and honour of those doctors who refuse to kill. The medical profession will suffer and so will patients.
On a question so significant as whether a fetus is a human being, please don’t force people who believe it is to participate in any fashion with what they believe is murder.
I believe doctors should be given an option whether to refer or conduct any procedure that is against their moral conscience/ethics. This will allow them to act on their freedom of speech and rights as a Canadian. Not all Canadians have to same shared values and surely as an expression of freedom these doctors should be given the right to chose.
Re your passing draft legislation forcing doctors to act against their better judgement and requiring that these doctors either perform or refer for medical procedures that they object to:
Forcing doctors to act against their consciences harms both our doctors and all Canadians!
I agree with this article:
Dr. Margaret Somerville writes in
this National Post article;
“Forcing physicians to act against their conscience, to do something they believe is deeply wrong against their will, not only harms them. This coercive violation of their freedom of conscience also harms society and the values that inform its culture.”
and also Maurice Vellacot, Member of Parliament:
“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.”
I ask that you refrain from forcing our Canadian doctors to act against their will.
The Catholic Civil Rights League The Catholic Civil Rights League (CCRL) is pleased to provide this submission to the College of Physicians and Surgeons of Ontario (CPSO) regarding the revised and approved draft policy Professional Obligations and Human Rights. We strongly advocate for a robust understanding and protection of the Charter right of freedom of conscience and religion for all Canadians, and indeed physicians in the daily routine of their care to patients and in the overall forming of their individual medical practices. The CCRL therefore rejects the proposed mandate for an “effective referral” as it is a breach of a physician’s rights and a serious incursion into the professional standing of a physician.
We previously provided a submission in August of 2014, when external consultation was sought regarding proposed changes to Physicians and the Ontario Human Rights Code. In 2008, we raised similar concerns in that consultative process. We are as adamant with our concerns today as we were seven years ago. Doctors and other health care professionals, indeed all Canadians, enjoy the Charter right of freedom of conscience and religion. A proper balancing of the rights of physicians with the concept of patient autonomy must not result in the trumping of the rights of physicians in their medical practices. Such rights extend not only to refusing to perform morally objectionable services, but the right not to be obliged to refer to other practitioners who may be willing to provide such services. This clearly would constitute participation in wrong. The proposed mandate for an “effective referral” must be rejected.
Lines 156-159 are wholly unacceptable to the CCRL:
Where physicians are unwilling to provide certain elements of care due to their moral or religious beliefs, an effective referral to another health care provider must be provided to the patient. An effective referral means a referral made in good faith, to a non-objecting, available, and accessible physician or other health-care provider.
The CCRL appeals to the Executive Committee and Council to strike from this policy the necessity to “provide an effective referral”. This is an unacceptable inclusion, an unnecessary and unwanted change from the 2008 policy. Compelling a physician to provide an effective referral to another physician or health-care provider in order to carry out a procedure to which he or she objects on the grounds of conscience or religion also compels the physician to violate his or her own conscience by being a participant in the very act, the very procedure to which he or she objects in the first place.
The current CPSO policy also states that:
The balancing of rights must be done in context. In relation to freedom of religion specifically, courts will consider how directly the act in question interferes with a core religious belief. Courts will seek to determine whether the act interferes with the religious belief in a ‘manner that is more than trivial or insubstantial.’ The less direct the impact on a religious belief, the less likely courts are to find that freedom of religion is infringed.
The CCRL submits that issues pertaining to the sanctity of life from conception until natural death is a core Catholic belief. There is also a growing body of medical research which has questioned in recent years the merits of artificial birth control, and the further risks to women from abortion. A Catholic physician is entitled in conscience to avoid providing artificial contraception or abortifacients, or procuring an abortion unless the mother’s life is in imminent threat. In the event that Canada adopts a regime of physician assisted suicide, the threat to conscientious objection is that much greater. We assure the CPSO that under no circumstances would any of the aforementioned practices be considered ‘trivial or insubstantial’.
The CCRL further submits that there are numerous procedures which may violate good medicine, or violate the consciences of many other physicians belonging to other religions or those holding sincere beliefs, religious or otherwise. The point is that despite our mandate to educate the public and defend and promote the Catholic perspective, we at the CCRL nonetheless submit that a physician must have the right to carry out their duties in line with their consciences, period. Neither the College nor the courts determine what comprises religious belief and to what extent acts may or may not interfere. Once the sincerity of religious belief is understood, neither the College or courts should interfere in a delineation of what the particular faith may prescribe. It is far more logical to simply respect physicians’ consciences as has been the case in Ontario with the policy in place since 2008. The compulsion to effectively refer violates this right of freedom of conscience and religion and there is no reason to institute the need to provide an effective referral, whether it is on the grounds of access to care, or on any other grounds.
Regarding the ‘balancing of rights’ referred to by the CPSO, the CCRL believes that the current status quo in Ontario maintains this balance between the Charter rights of conscience and religion with the concept of patient autonomy. Using the previous listed examples of practices that would be morally objectionable to a serious Catholic physician, consider that the number of said physicians is minute in comparison to those who would have no objection whatsoever. If a lack of balance exists, it is surely found in the vast difference between physicians who choose to conscientiously dissent versus those who do not. This difference is so great that it cannot be objectively stated that a member of the public in Ontario would have their rights to autonomy violated by any physician following the 2008 CPSO policy.
With this submission, we at the CCRL call upon the CPSO’s Executive Committee and Council to reject the mandate for “effective referrals”. The medical profession, as with any grouping of individuals is not truly free to live and free to grow if its members are not able to govern their actions in accordance with their individual consciences, whether informed by moral and religious beliefs or otherwise.
Canada is a pluralist society, and an authentic pluralism recognizes that there will be differences in the public sphere, and that we live with such differences in a civil society. The proposed CPSO policy engages in a trumping exercise, mandating that a patient’s autonomy trumps recognized conscientious and religious rights of physicians. The demand for acceptance of a regime of “effective referral” of morally objectionable practices would lead to patients losing trust in the professional status of doctors. There is also the likelihood of numerous physicians opposing the new proposed policy and their refusal to comply, generating unwarranted complaints and possible exits from the jurisdiction. The extent of potential disruption is unknown, but greater instability would certainly follow in the provision of medical services. Ontario can ill afford such a tearing of the social fabric of our society. The better alternative is to accept that we are respectful of differences, especially when they concern aspects of one’s moral or religious beliefs, in no way trivial, but rather as the basis of a well-developed civil society.
FIRST POINT, NO WONDER WE HAVE TROUBLE GETTING DOCTORS WHEN THEY ARE TREATED THIS WAY ESPECIALLY IN LIGHT LIBERAL WUNNES PLANS FOR THE DOCTORS , NOW THEIR RELIGIOUS BELIEFS AND FREEDOM OF CHOICE TO FOLLOW THEIR CONSCIENCIOUSNESS IS IN JEP. RODY AND DISCRIMINATIONING IN ITSELF.ALTHOUGH THE DRAFT SEEMS CLEAR IT LEAVES FAR TOO MUCH FOR INTERPRETATION AND POSSIBLITY OF MISUSE.
FIRST POINT, NO WONDER WE HAVE TROUBLE GETTING DOCTORS WHEN THEY ARE TREATED THIS WAY ESPECIALLY IN LIGHT OF LIBERAL WYNNES PLANS FOR THE DOCTORS .NOW THEIR RELIGIOUS BELIEFS AND FREEDOM OF CHOICE TO FOLLOW THEIR OWN CONSCIENCIOUS IS IN JEPORDY AND DISCRIMINATIONING IN ITSELF.ALTHOUGH THE DRAFT SEEMS CLEAR IT LEAVES FAR TOO MUCH FOR INTERPRETATION AND POSSIBLITY OF MISUSE.
I feel that physicians should have the right to act or conches and not provide certain services under their constitutional right to freedom of religion. Arrangements can be made so that those services are provided by other doctors but by making them provide services they’re uncomfortable with we are sending one person’s personal Rights ahead of another’s and violating Canadian constitutional law
Pro Life movement Personal freedom has always been cherished in Canada. Certainly the freedom of religion and freedom to act or refrain from action based on religious and moral ground must be held paramount. Even in war, the military may be excused from active duty on moral and religious grounds. Patients have right and freedom to receive care from ‘other’ caregivers.
It has always been my belief that Canada’s Charter of Rights and Freedoms, guaranteed freedom of religion and freedom of conscience. Speaking from a patients point of view, I personally would not want any doctor without conscience rights caring for me, as I would not trust him.
Unfortunately, my present trust in the College of Physicians and Surgeons of Ontario is rapidly diminishing. Therefore, while there is still time, I sincerely request the proposed harmful policy changes be dropped.
If the College of Physicians and Surgeons explicitly requires a physician to do something he or she believes is immoral, it is like having a club that says you can’t be one of us unless you sacrifice your integrity. Remembering Hippocrates and the oath physicians take, it is like saying you can’t be in our club unless you violate the oath you took to get in. Huh? Doesn’t bode well for our logical civilisation.
Also, there is no legal right to abortion enshrined anywhere in Canada. There is just no law against it. People are self-regulating – just like some professional societies. First do no harm.
The “Moral or Religious Beliefs” section of the draft seems written to conjure up only one scenario, at least it reads that way to me, namely, the scenario wherein the patient is demanding some sort of service or procedure and the physician is “limiting” the services provided on religious or moral grounds. This section comes across as mechanical and seems to assume an adversarial doctor-patient relationship.
Given that “[t]he doctor-patient relationship is the foundation of the practice of medicine” (Practice Guide, p. 9) and that the balance of knowledge and information favours the physician (Ibid), why is this draft written in such prescriptive language and conveying such an adversarial tone?
I WANT my physician to have an opinion, clinical for sure, but based on a well-formed conscience also. I do NOT want to be treated by a physician that is going against his own moral calculus.
The draft as written is a monumental failure in terms of promoting strength in the very relationships that the College exists to support!
Above is my general comment. Getting to the policy on referrals in the draft, where such referrals involve a pregnant women seeking an abortion, the College should take a page from our experience with detainees in Afghanistan. Our Government and military went through a LOT of machinations and “policy pain” before everyone figured out, some tacitly, others overtly, that transferring our detainees was wrong. Why? Because they got the crap kicked out of them when not in Canadian hands.
In this case, whether it is a “human being” according to Section 223 of the Criminal Code or not, the physician, ney, all of us, are aware that, AS A MINIMUM, the POTENTIAL for a human life is sitting in front of the doctor in such cases. There are two patients, not one! Does the College really think that the actions that need to follow from limiting services on moral grounds can be reduced to such a simplistic prescription as referral without seriously damaging the profession in the longer term? WOW… that is short-sighted.
How about letting the physician apply the four values in the Practice Guide toward strengthening the doctor-patient relationship to the point where all reasonable efforts at identifying the correct problem have been undertaken (fear, sadness, uncertainty, anger, etc.)? The pregnancy might not be the “problem” that needs solving! The so-called “referral” might need to be to people and organizations that can serve the needs of both patients (mom + unborn child) by helping mom to consider things not yet considered, etc.
If we want a mechanical medical system, we really don’t need the complex medical selection and training process that we have. We can just train clinicians and let them do the cutting according to patient desires.
I for one WANT to be challenged toward the right decision by everyone that I consult with, especially my highly trained, highly ethical and highly informed doctor.
I am in agreement with comments 14, 16, 21, 26, 27, 78, 79, 82, 181 and a several others who do not support this draft.
OK, besides all of that, the draft has some internal logic inconsistencies. Will send those in a separate post.
Dear
> Members of the Consultations
> Committee:
>
>
>
> Re: Draft Policy “Professional Obligations and Human
> Rights”.
>
>
>
> I am writing to you with grave concern regarding the content
> of your proposed
> draft policy, which indicates that physicians who decline to
> participate in certain
> acts for reasons of conscience should be compelled to refer
> their patients to other
> physicians who will perform these acts. It does not address
> the fact that many
> of these same physicians will find the act of referral
> itself objectionable, as
> they consider it material cooperation with the act. In
> compelling physicians to
> refer, you are limiting their
>
> right to conscientious objection. I am opposed to this.
>
>
>
> There is significant disagreement in our society as to what
> constitutes a moral
> act, and I do not expect the College to define or limit
> morality. All I expect
> is that physicians, as professionals, be allowed to respect
> their own
> consciences. Freedom of conscience is foundational to our
> free society and cannot
> be limited, even for the best of intentions.
>
>
>
> If we
> coerce physicians into violating
> their consciences we will inevitably erode the personal
> integrity which is the
> basis of the physician’s relationship with their
> patients. I encourage you to
> revise the sections above, and include a clear defence of
> the right to freedom
> of conscience for all physicians.
>
>
>
> Yours
> sincerely,
>
Thank you for the opportunity to provide feedback on the Draft Policy entitled Professional Obligations and Human Rights.
As a senior resident in psychiatry, I would like to comment on two particular sections of the draft that, if accepted, would have serious ramifications to the practice and ethical standards of medicine that are inherent to our profession.
Section: Ensuring Access to Care (Lines 156-164)
“Where physicians are unwilling to provide certain elements of care due to their moral or religious beliefs, an effective referral to another health care provider must be provided to the patient. An effective referral means a referral made in good faith, to a non-objecting, available, and accessible physician or other health-care provider. The referral must be made in a timely manner to reduce the risk of adverse clinical outcomes. . .”
The policy refers to “religious or moral beliefs”. The term “moral” as defined by the oxford dictionary refers to concern with “the principles of right and wrong behavior.” The same dictionary defines “ethics” as “moral principles that govern a person’s behavior or the conducting of an activity.” Morals and ethics are thus synonymous, and the practice of medicine is understood to be practiced within an ethical framework, regardless of whether one ascribes to a particular religious faith or not. One of the most fundamental ethical principles in medicine is “do no harm.”
The above stipulation in lines 156-164 is problematic for several reasons and I will use the example of abortion as a procedure that carries ethical considerations to illustrate.
The first is a practical problem: Most abortion providers, who may perform abortions in the earlier stages of pregnancy, do not for reasons of conscience, perform abortions past the point of viability of the fetus. If a woman requests a late term abortion because she does not wish to have a daughter (ie. female sex-selective abortion), it would be impractical to expect a GP to be able to secure the services of a non-objecting and available abortion provider who would agree to terminate this pregnancy for purely social reasons.
Second, on an ethical level, requiring a physician to refer for a procedure to which the physician is morally opposed would make the physician complicit in an act that he/she believes to be wrong or harmful. The oxford dictionary defines the word “complicit” as: “Involved with others in an activity that is unlawful or morally wrong.” The concept of complicity is recognized in the Criminal Code of Canada (sec. 21) where a person who abets (i.e. assists) in an offence is considered a party to the offence, even if they did not directly commit the offence. In the case of morally contested services, physicians who would recoil from directly providing a particular service would also have conscientious objections to referring for the same service because it implicates them indirectly in the provision of a morally objectionable service which they honestly believe to be unethical because of the harm it can cause.
Furthermore, forcing physicians to violate their conscience by forcing them to assist in procuring a service that they believe to be harmful is incompatible with the college’s expectations that physicians uphold the profession’s value of trustworthiness (line 16). By being forced to act in a way that is inconsistent with their moral framework, the trustworthiness and integrity of a physician is destroyed. How can one trust a physician who is capable of acting against their conscience in the provision of care?
As a patient, I would not want to force my physician to do anything she believes to be morally wrong, and as a physician, I would likewise appreciate the same respect from my patients and my College. A separate college-imposed set of ethics with arguably questionable components that requires its physicians to act in a way that is inconsistent with their conscience would make me question the integrity and quality of care provided by physicians who are forced to practice under this code.
“Physicians must provide care that is urgent or otherwise necessary to prevent imminent harm, suffering, and/or deterioration, even where that care conflicts with their religious or moral beliefs.”
The context provided in which physicians are expected to provide care even if it conflicts with their religious or moral beliefs is too broadly stated in the stipulation above. Forcing a physician to violate their Charter-protected rights to Freedom of Religion and Conscience in the provision of care can only be justified for compelling reasons where the life of the patient is imminently at risk, or to prevent imminent harm from coming to the patient. Any criteria less than this could be subject to abuse and misinterpretation. For one, “suffering” is subjective and poorly defined. It includes concepts of physical, emotional, spiritual, and existential suffering with varying degrees of severity that can never be objectively measured. Suffering is a universal experience that every member of the human race has and will experience, but it in itself is not a compelling enough reason to force a physician to violate his conscience in providing a service to which he has conscientious objections.
To illustrate, consider this hypothetical situation: A patient requests a late term abortion because the father of the unborn child abandons the mother late in her pregnancy. In her distress, the pregnant patient requests an abortion at 28 weeks of pregnancy, and she claims that not procuring an abortion would cause her imminent psychological distress if the baby were to be born. It is important to acknowledge that the psychological suffering of the pregnant woman, who has just been abandoned by her partner with seemingly no recourse, is real. A compassionate response to her distress might include helping her articulate the underlying reasons for her distress, the sources of her fear, and providing additional counselling as to the risks (medical, and psychological) of having an abortion late in her pregnancy. She should also be provided with support, and given avenues to obtain additional resources and support if she changes her mind and decides to carry the pregnancy to term for adoption, or decides in the end to raise the child herself. However, at the end of the day, if the woman insists on having a late-term abortion, her distress level must be weighed against that of the physician who has been asked to provide a procedure to which he may have serious ethical reservations. What if the obstetrician-gynecologist has conscientious objections to providing late-term abortions when the mother’s life is not at imminent risk from the pregnancy and he is unable to find another abortion provider who is willing (because nobody else in the vicinity wants to provide the abortion either)? Does the CPSO really expect this physician to violate his conscience to terminate this pregnancy based on patient request, as lines 166-169 would imply? Remember that a failed abortion at this stage could result in a live birth which has obvious ethical implications; an abortion provider who may be comfortable providing abortions in the first and second trimester may not necessarily be comfortable providing abortions past the point of fetal viability because of ethical considerations. Correct me if I’m wrong, but as far as I am aware, there are no medical guidelines that address late term abortions in the third trimester in Canada. The decision to carry through with a late term abortion or not depends upon the comfort level of the physician according to his conscience, and possibly also according to hospital policies. Thus, what kind of psychological distress would this physician (not to mention other members of the health care team) have to undergo if he is forced to perform this abortion unwillingly, to alleviate the psychological distress (i.e. psychological suffering) of the patient? And how will the impact of the physician’s psychological distress impact his ability to care for future patients, or his desire to continue in his profession? These are all important questions to consider, as this policy, as worded, provides no flexibility for physicians with conscientious objections.
As another example, most medically ill patients are in a state of suffering or deterioration, otherwise, they would not be requiring medical care. In the event that euthanasia is legalized, if such a patient was being cared for in a rural setting, meets the eligibility requirements for euthanasia, and requests his physician to euthanize him, would his physician, the sole physician practicing in the small rural community, be obligated to end the life of this patient upon demand? What kind of harm would this act do to the psyche of this physician who has moral and ethical objections against euthanasia? The Canadian Medical Association (CMA) acknowledged the importance of protecting the conscience rights of physicians at their August 2014 General Council Meeting. This CPSO policy, as worded, would effectively do the opposite.
This policy may also have other unintended side effects. For example, physicians who wish to adhere to certain moral values may be compelled to work in urban centers to avoid working in rural areas where expectations for them to provide objectionable services would be higher. Patients living in rural areas would thus be deprived of other valuable services such as obstetrics care, or palliative pain management, which the physician could otherwise have provided. In addition, bright, compassionate, and ethically-minded potential future students of medicine may be dissuaded from entering the medical profession because they do not wish to be part of a profession that would force them to act contrary to their morals and ethics. The quality of healthcare and the integrity of the medical profession in Canada would be increasingly adversely affected for years down the road, and patients who wish to have physicians who share their morals and ethical standards, for example, that of respecting and protecting human life, would be deprived of like-minded physicians. These unintended side effects of this policy would be a great disservice to the public.
As Canadians, we value the democratic freedoms that have been the cornerstone of this country. This policy effectively eliminates protection of conscience rights for physicians; is a serious assault on Canadian freedoms; and unfortunately, pits the concerns of patients against the rights of physicians, undermining the possibility of an effective therapeutic physician-patient relationship.
I urge the CPSO to uphold the ability of physicians to practice medicine with integrity and according to their conscience, if such conscientious objection does not cause imminent harm or endanger the life of patients.
This policy is fundamentally skewed towards the right of the patient while completely trampling on the right of the physician to freedom of religion and moral objection of conscience. I thinkI the proponents of policy to refer a patient for a procedure or service to which one objects to is the same as providing the service, this violates the physicians conscience and right. The objecting physician should be allowed to respectfully tell the patient her stand without imposing his/ her belief on the patient. Any policy that does not respect the right of all involved parties is already discriminatory.
Was this draft intended as A Modest Proposal in the style of Jonathan Swift?
It claims to make family doctors more COMPASSIONATE yet demands that every last one participate in killing unwanted children. Eventually, as in the Netherlands, doctors will also kill senile citizens and anybody else deemed to have insufficient quality of life.
The draft claims to make family doctors more SERVICE-oriented yet drives out of the profession the conscientious ones (especially in rural areas), who are most likely to be service-oriented. This phenomenon will also have the short-term effect of reducing the supply of doctors available to provide service.
The draft claims to make doctors more ALTRUISTIC yet requires their servile compliance. The doctors most likely to comply are those acting out of selfish ambition, not those will a well-formed conscience. Communists also appealed to altruism for the creation of a workers’ paradise, but they failed to understand faulty human nature.
The draft claims to make doctors more TRUSTWORTHY yet violates their conscience and the sensibilities of their patients. As somebody who believes in the sanctity of human life from conception to natural death, I only trust pro-life family doctors, and yet the draft, in effect if not intent, targets them for removal.
If you really want compassion, service, altruism, and trustworthiness in the medical profession, then scrap this draft.
The foremost professional obligation is to do no harm.
The foremost human right is the God-given right to life. (Rights are of the citizen with respect to the civil government. With respect to God we only have a right to death; salvation is only possible through His grace.)
“You know it is wrong to end a life, any life, after you so proudly swore the Hippocratic Oath so many years ago.”
Indeed, it is worthwhile asking whether the authors of this policy are themselves breaking an oath they once took–or whether they are by this policy forcing others to do what they swore not to do. Only those with integrity should lead the medical profession.
I have ES (electrosensitivity).
My ES condition, which I consider to be an environmental impairment, needs to be accommodated, by giving me access to medical care without the physical stress of being in a wireless environment. My body cannot function healthfully in a wireless environment, therefore, I cannot be medically evaluated properly as it causes severe heart complications and general inability to function, causing many distressing symptoms that are otherwise absent in a normal, non-radiated environment.
I agree with this letter, which is expressed less antagonistically than comments I have made. Allow me to highlight its thesis:
“The current policy draft to exclude certain moral beliefs is problematic for three reasons: it fragments the humanity of the practitioner, it is logically and practically impossible to exclude moral beliefs from practice, and it presupposes that these moral beliefs are wrong without actually demonstrating so.”
What a beautifully articulated response from a Doctor. Thank you. Will keep you and all doctors and nurses in our prayers so that your freedom of conscience is protected.
The doctor wrote, “Despite a significant number of dissenting physicians, the demand to refer is maintained.”
There are also a great number of patients repulsed by this requirement to refer. It discriminates against their need for compassionate, service-oriented, trustworthy doctors who will refuse to kill them or their children or tempt them to choose despair and death. Altruism is too much to ask for but will be demonstrated by those pro-life doctors who continue in the profession and evade the requirement to refer if CPSO puts it into force.
The demand to refer also discriminates against the very young or very old who will be killed at the request of family members and by doctors corrupted by a power to kill. These vulnerable patients have no voice and need others to speak up for them. For a demonstration of altruism that all Ontario doctors could emulate, witness those Ontario women so courageous as to have plainly but sensitively spoken out on behalf of pre-born children even to the point of these women’s long-term wrongful imprisonment.
In the West, the justice system historically assumes innocence in the absence of evidence; and capital punishment, where it is still exercised, is reserved for the most heinous offenses. Because of due process, the government’s authority to kill murderers is not easily used. To give imperfect, faulty healers a broad power to kill is stupidity, irresponsibility, and perversion.
When the cat’s away, the mice will play. From personal experience I know that some contractors constructing municipal works will do shoddy work and skimp on the more expensive material if they can cover everything up before inspection by the engineer. What could go wrong with a doctor given the power to kill and required to use it in certain supposedly very tightly controlled situations? Power corrupts. Might it be in his long-term interest–to cover up a mistake yet unknown to the patient, for example–to influence the patient to choose euthanasia?
Or as another example, since doctors are legally allowed–and by this draft policy even required–to cooperate with a mother in killing her pre-born child, might not a grown child conspire with a doctor to kill the aging mother?
Yet CPSO is inviting unintendend consequences by favouring the practice of unscrupulous doctors willing to use the final solution.
I wish to comment on the draft policy of the CPSO regarding the conscience rights of physicians.
I am certain that [Name omitted] is aware of the principle of co-operation and its application in ethics; he would hardly be in his present role were he not. If this is so, the alternatives are that he has abandoned the principle ( perhaps as a relic of a superstitious age) or that he has applied it erroneously. In case the later is true, it may be helpful to recall that cooperation with evil may be either formal, when the cooperator’s intention is the same as the perpetrator of the evil, or material, when the cooperator does not intend the perpetrator’s evil act. Referral to a physician who one knows will perform an act one deems to be evil is formal cooperation. The cooperator ( referring physician) then fully shares moral responsibility for the perpetrators act.
If the former is true — that he has abandoned the principle — or, that he denies the existence of conscience, it may be helpful to recall a speech of Herman Goering’s, made sometime in the 1930s. A question of conscience was raised, and the Reichs Marshall’s response was “I have no conscience.” Then, pointing to the Fuhrer, seated nearby, he added, “Hitler is my conscience!”
I do not mean to suggest any equivalence between [Name omitted] Final Solution to the problem of family physicians with consciences and the measures adopted by Goering. Only a few lives will be ruined by [Name omitted] proposal, and they will not thereby be ended. One can envision the future family physicians of Ontario saluting as they proclaim, before meals and on arising, “I have no conscience; [Name omitted] is my conscience!”
A Doctor takes an oath of ‘First do no harm’ This proposed legislation overrides that completely.
In China to keep the birth rate down abortion is not only forced on the Mother, but forces the physician who will be arrested themselves if they refuse to perform this very brutal act. As we’ll obviously be joining this Country in it’s policy if this goes through, then we lose our rights to protest anything else they do. So it’s not just this one act but alters our own future. I am going to ask Amnesty Canada to join in this Please everyone reading this do the same. There are alternatives to abortion as everyone knows.
I am writing to express my concern over the draft policy on “Professional Obligations and Human Rights” particularly the statement, “Where physicians are unwilling to provide certain elements of care due to their moral or religious beliefs, an effective referral to another health care provider must be provided to the patient.”
I believe that this is an unacceptable infringement on the conscience rights of physicians. Requiring that a physician give a referral for an element of care which is contrary to his or her religious convictions is a violation of that physician’s right to freedom of religion and conscience.
According to the Christian Medical and Dental Society of Canada, “Referral is as problematic as actually performing the controverted procedure. In a referral, the physician is essentially recommending that the procedure needs to be done, and expects that the physician who receives the referral will do it. This is morally equivalent to doing the action.”
I would therefore request that the draft policy in question be amended so that doctors with conscience issues with certain elements of care not be forced to give referrals for such procedures.
Respectfully submitted
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Please protect the rights of doctors and nurses to exercise their freedom of conscience. It breaks my heart that they may be compelled to do unethical actions like assisting with a suicide. This is wrong on so many levels. Doctors took an oath, please help them to uphold it. Think of the many capable, smart, compassionate people that will not enter into the medical field because of this threat to their very being. Please, uphold what is right.
The draft policy’s requirement that physicians provide an “effective referral” for morally objectionable services is an unacceptable infringement on freedom of religion and freedom of conscience.
In light of today’s ruling by the Supreme Court of Canada on assisted suicide, it is clear that this draft policy is woefully misguided. It should be withdrawn immediately and revised to provide a robust defence of freedom of conscience for all physicians.
I am currently a medical student, and I would like to voice my opinion regarding this policy. There are some things with which I agree; however, there are others with which I have serious concerns.
I will begin with the things I appreciate about the policy:
1. I am pleased to see that the policy addresses the discrimination against gender identity and expression, and I fully support the clarification surrounding the duty to accommodate patient needs with respect to disabilities and access to care.
2. The policy also requires that physicians who limit the health services that they provide due to moral or religious grounds to do so in a manner that respects patient dignity and protects the safety of patients. I appreciate that physicians can refuse services that are contrary to their moral or religious beliefs, provided they are not offered at all.
3. My decision to go into medicine was largely due to my desire to help people- to provide support and healing for others. Patient care should always remain of utmost priority.
Now I will address my concerns with the policy:
1. There are some procedures that are legal in Canada that go against my moral beliefs, as they involve the ending of someone’s life. For me, this crosses over into the “do no harm” role of the physician. I will not debate here whether or not these procedures should or should not be legal, but my concern with the policy is that it requires physicians to perform these acts under vague and unclear conditions: “…urgent or otherwise necessary to prevent imminent harm, suffering, and/or deterioration.” In the case of abortion, the situation may not be urgent, yet the patient may argue that “further-along” pregnancy is considered deterioration of their condition, and I would be obligated to perform the abortion. I would like to see a clarification of the terms (urgent, imminent harm, suffering, and deterioration) around which a physician is obligated to perform these acts.
2. My rights as a human allow me to express my moral or religious beliefs. Unfortunately, the policy requires performing certain procedures even when it is against my religious or moral beliefs. This is an impingement on my rights as a human being. It is not possible to separate my moral beliefs from my professional obligations. Attempting to do so will lead to psychological and emotional distress and burnout in many physicians. This will most definitely impact the quality of patient care. Furthermore physicians may be forced to leave the profession based on conscience or religious belief. This is an act of discrimination, and should not be allowed.
Thank you for taking the time to consider my views on this draft policy.
Doctors should not be forced to violate their conscience by being forced to perform procedures that they view as morally wrong. This comes into play especially in cases of abortion and (most recently) through doctor assisted suicide. Doctors who view abortion to be the intentional killing of a human being, should not and cannot be forced to commit such an act. To force them to do so would violate their rights to freedom of conscience as a human person and a citizen of Canada. Moreover, forcing such a doctor to refer his patient for an abortion, is also unjustifiable, because referring the patient for an abortion (which he/she feels is gravely wrong) could be just as much against the doctor’s conscience as performing the abortion him/herself. By referring the patient for abortion, he/she is referring the death of his/her patient’s unborn child, which would likewise contradict the doctor’s conscience. The same is true for the recently introduced practice of assisted suicide. No doctor should be forced to perform abortions or kill their own patients who are seeking to end their life through assisted suicide. Neither should the same doctor be forced to refer these same procedures, because even a referral of such morally contentious procedures could violate his conscience. Doctors have rights too, and one of these rights that must be upheld in a free country like Canada, is the right to not be forced to perform or refer procedures against his/her individual conscience.
If the law about professional obligations and human rights is going to be examined, so be it. Have physicians properly trained and knowledgeable about Natural Family Planning an alternative to artificial contraception and knowledgeable and fully trained in all pain relief alternatives, including knowledge of the social and spiritual support/treatment people need in the face of disease and suffering. We need to have the right to knowledge of all our options.
St. Hyacinth Church I truly believe that a doctor should be able to act upon his or her beliefs. if doctors will be forced to perform the service that will lead them to the moral guilt, then the doctors will become victims. it is against human rights to force a person to perform immoral labour. Such acting should be classified as a crime.
I ask that doctors in Ontario be allowed to follow their conscience and not be mandated to refer patients for procedures and treatments that goes against their conscience. Please.
The denial of physician’s rights to follow their consciences in the practice of their profession seems very wrong and worrisome to me. We want doctors to be ethical practitioners, so we must not expect them to act against their consciences. It is a denial of their human rights.
I hope the college will reconsider going down this road.
I tried to complete the survey but was cut off about 60% of the way through. Clearly I had too much to say – a fair amount of it critical. Maybe there isn’t room for expression of views that don’t align with those expressed in the draft policy!
I am tremendously concerned about this policy for several reasons. This policy, if passed, will effectively isolate and compel some physicians to perform actions against their own conscience. How can we expect physicians to perform with compassion and care if you are going to force them to perform and refer procedures they are morally against? This policy will alient and discourge aspiring students, like myself, who hope to pursue a career in medicine and healthcare. I ask that you honestly consider the implications this will have on physicians and health care as a whole. Improving access to certain aspects of health care can be effectively done without the need to strip doctors their conscientious rights.
The following Hippocratic Oath was originally drafted in 1948 and minimally revised on several occasions. It followed the Nuremberg Code of August, 1947 against Nazi Doctors who performed in human experiments against the code of conduct of Hippocrates (of which they refused to pledge).
The Declaration of Geneva (WMA):
At the time of being admitted as a member of the medical profession:
• I solemnly pledge to consecrate my life to the service of humanity;
• I will give to my teachers the respect and gratitude that is their due;
• I will practice my profession with conscience and dignity;
• The health of my patient will be my first consideration;
• I will respect the secrets that are confided in me, even after the patient has died;
• I will maintain by all the means in my power, the honour and the noble traditions of the medical profession;
• My colleagues will be my sisters and brothers;
• I will not permit considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing or any other factor to intervene between my duty and my patient;
• I will maintain the utmost respect for human life;
• I will not use my medical knowledge to violate human rights and civil liberties, even under threat;
• I make these promises solemnly, freely and upon my honour.
I expect every doctor, active or retired, to live according to this pledge in union with his/her own conscience whether made with human compassion and/or religious principles. Furthermore, I believe it is the responsibility of every potential patient to question and evaluate their health care providers according to their own conscience and according to compassion and/or religious principles, It’s our healthcare system, and we need to have full ownership over it.
These are basic human rights that belong to all, equally and without reservation, and not just to a few. I may not always agree with a physician’s diagnosis, but I do respect it and when in question asking for a second opinion is never questioned. Informed consent is the duty of all.
In reference to the Supreme Court ruling on assisted suicide yesterday:
“This decision affects every Canadian now and in the future. It will teach this generation and generations to come that some lives are not worth living, that killing patients can be a medical option, and that death at the hand of a doctor is somehow a human right.
This decision will also have a lasting impact on our physicians, who may be pressured to either administer death or face professional censorship and discipline.”
-Life Canada
My thoughts:
What is most problematic is forcing doctors to be complicit in this act. You cannot impose your desire to die on someone else or coerce them to participate in killing, especially if it is against their moral standards. And even if it is not, there has been research conducted to show that doctors who have willingly performed assisted suicides have been bothered by it years later. Everyone is entitled to their opinions and freedom of choice, but this seems to be taking it away from health care professionals.
Furthermore, what constitutes a level of suffering worthy of death? What of those with mental illness? It’s unquantifiable. And how can a doctor make that decision? They are only human beings/ medical professionals, not gods.
And what of palliative care? The potential for slippery slope in this ruling may render palliative care initiatives underfunded and unimportant, and actually encourage those in need to resort to premature death. Where is the dignity of life in that? Who’s economic interest are we supporting?
This ruling is changing the meaning of health care. I see a huge contradiction between health care (aimed at ameliorating and preserving life) and killing.
Also, what kinds of doctors can we expect in the future if conscience rights are neglected? People are not machines, and we should not force them to act like them.
I believe that the integrity of physicians is paramount to their role in the healthcare of their patients and in society. I am deeply troubled by the Supreme Court’s decision about Physician-Assisted Suicide. I am, however, even more concerned about the potential consequences on physicians that do not chose to participate in this activity. Forcing physicians to commit an action that is immoral to them, or to refer to such actions is a deliberate degradation of their integrity, and thus no physician should be under such pressure. In addition, I believe that this would also be against the physician’s rights of freedom and faith. A patient who is seeking a service that is not agreeable for the doctor, be it abortion, contraception, IVF, patient-assisted suicide, or euthanasia, should take the responsibility of finding a physician that provides that service rather than forcing the physician to compromise their integrity.
With regards to obligatory referrals, to my understanding it as an attempt to balance a patient’s right to access care against the freedom of religion and conscience rights of the physician. The CPSO states that it feels freedom of religion can be waived if the act in question is not more than a trivial or insubstantial infringement on a core religious belief. In this case, with physicians being required to provide referrals for procedures they are morally opposed to, it seems that the College is deeming it to be a trivial infringement. I find it interesting that it is the College that decides for the physician which aspects of their beliefs are core and which ones are not, as there exists many physicians that would consider providing referrals to be morally repulsive and gravely infringing on their core religious beliefs.
On the other side, with specific regards to abortion, there does not seem to be a large infringement on the patient’s right of access to care. There is a plethora of abortion clinics that do not require a GP referral, and the information to find these clinics is available readily on the internet. There is even a phone line that can guide patients towards getting a referral should they really desire one. If a GP refuses to give a referral, the patient is inconvenienced and forced to go home and make a google search to find another place to perform the abortion. From the little internet browsing that I have done, it seems that there are plenty of resources available to the patient seeking an abortion; the infringment on right to access care is minimal.
I am not a physician, but have many friends who do practice in this field. Certain aspects of this policy greatly concern me on behalf of them and the rest of the Canadian public. As many commenters have already pointed out, the current draft of this policy clearly discriminates (takes away freedom of choice) against those who believe that abortion and euthanasia are morally wrong (not “health care” at all) and also harmful to either the individuals they serve or the general population, especially in the long run. Those who would hold to this position in the field of medicine are many, including my own friends; enforcing this policy the way it stands now would have the twofold severely detrimental effect of seeing these skilled, caring practitioners leave their vocations and showing the world that “freedom” in Canada is becoming a forgotten concept.
As physician we should not be forced by anybody to do things against our conscious )abortions +euthanasia).We like to stand by our compassionate care but have right to not be an accomplish to care that goes against our morals and beliefs .
while I would not allow myself to impose my beliefs and morals on other people, I find that I have to follow my conscience in practicing medicine in Ontario.
If a physician disagrees with a certain practice wished or demanded by a patient, because of his/her beliefs, the physician should absolutely be allowed to decline providing this service.
It should not be the physician’s role to refer the patient to have that same service by another colleague whose conscience allow him/her to perform this procedure(s).
I suggest that patients who have their wishes (in these matters)declined by their treating physician to have access to other practitioners identified by the CPSO through a direct communication between the patient (or next of kin)and the CPSO.
Physicians need to retain their autonomy. Should a patient wish a ‘service’ that is not provided by their physician, WIC, local ER etc, that patient could be “effectively referred” to the cpso website. The cpso website could then ‘host’ a list of clinics or physicians who willing wish to have their name or clinic associated with a particular service.
Canada the land of the free….
This draft is a contradiction to that, no free Canadian should be made to go against their moral and ethical values ….
This draft says otherwise this is a form of discrimination against our doctors basic rights.( or maybe they don’t have those rights?)
156 Where physicians are unwilling to provide certain elements of care due to their moral or religious
157 beliefs, an effective referral to another health care provider must be provided to the patient. An
158 effective referral means a referral made in good faith, to a non-objecting, available, and accessible
physician or other health-care provider.
Have you ever refused a referral because it was in the patient’s best interests to do so? I have.
Please replace “effective referral” with “effective referral or enabling self-referral”.
Disagree with draft policy. The effectiveness of patient -doctor relationship is not only based on technical skills but also trust. If a doctor cannot exercize his conscience in an open transparent way it violates the fundamental principle of “do no harm” which is a fundamental tenet of the medical profession. The requirement to refer a patient to a doctor who will perform an act he considers inappropriate or immoral further exacerbates the situation. Even in countries like Belgium where euthanasia is more common there is no referral requirement . Why do we need one in Ontario. Disagree strongly with proposed draft.
Have read the draft and feel strongly the physicians right to refer a client to another physician if they have a conflict due to morals/values should continue to be included.
Need to clarify an error in my comment above that should read should NOT be included… Physicians should not have to refer someone for treatment that will be carried out by another physician that he feels is wrong..
” 8. Where physicians limit the health services they provide due to their moral or religious beliefs, the draft policy states that they must do so in a manner that ensures access to care.”
That is like telling a parent they must refer a child who wishes to die or have an ear cut off or a leg or etc. to someone who is willing to fulfill their wishes. A parent as well as a Doctor is not called to fulfill a person or people groups wishes but rather to care for those who are in their care especially those who are clearly not able to make wise decisions for themselves and to protect them even from themselves if necessary.
” 10. Where physicians limit the health services they provide due to their moral or religious beliefs, the draft policy states that they must do so in a manner that protects patient safety.”
Allowing the taking of life as an option for preventing suffering is open to all manner of abuse. Who are we to say that a child or teenager or person of any age who has mental suffering is not actually suffering more than someone who is suffering physically. We cannot make a life and death decision subjective to an individual or individuals, it is not a decision that is ours to give. Our responsibility is to provide relief from suffering mentally and physically – Yes. Through death – No.
The definition of discrimination is open to too many loopholes. It would allow any criminal group to claim discrimination. There are many valid reasons for discrimination. That is what our countrie’s laws define. This definition outlaws all discrimination and with it all our countries laws…
Trying to remove the moral element from a doctor’s professional life is a fundamental assault on their integrity, the very quality that I and other patients want in their doctor. Under the guise of protecting patients CPSO is proposing a policy which tramples physicians’s rights. I wish to be recorded as an objector to the proposed policy.
traditionally soldiers with conscience objections [e.g. quakers] are not compelled to kill.
its unconscionable that you would differ.
since abortion is explicitly proscribed in the Hippocratic oath as a medical ethics violation
your proposed policy is a medical ethics violation
as would be any move to enforce it
No one must be forced to go against his/her conscience. Do we really want doctors who are willing to go against their conscience to be treating us? I don’t
I would like to respectfully state my opposition to the implementation of the following measure outlined in the CPSO draft policy;
As part of ensuring access to care for patients, the draft policy requires that physicians, who are unwilling to provide certain elements of care due to their moral or religious beliefs, refer the patient to another health¬care provider.
How will the doctor¬ patient relationship be affected if physicians are in a position to be disciplined by their own professional body for following their better judgment? To me, our best judgment is always going to be the best to follow. We all have a moral conscience, and when we cross the line and violate our moral conscience, we are on a slippery slope. As a nephrologist, I often get asked by patients to help them expedite kidney transplants in foreign countries. In some of these countries, kidneys are sold by the poor. In other countries, criminals are executed and their organs are harvested for donation. I have always steadfastly refused to assist in the procurement of organs abroad because it violates my conscience. I feel that I would be an accomplice to a crime if I were to be a middleman in this process.
How can trust be maintained within a relationship that is inherently and deeply personal, when the physician is expected to rigidly follow institutional guidelines? I believe the relationship between a doctor and a patient is a sacred one. I need to give a patient my honest opinion and need to do the best for them. I feel that much of medicine is art and crosses into the realm where there may not always be black and white answers. Often the best solutions come from honest and frank discussions where I may challenge a patient is coming from. For example, there may be cases where I think it is too dangerous for someone to get pregnant and I will tell them what a high risk it is. I may tell them they are depriving their current children of a healthy mother if they proceed. At other times, a patient may want to terminate a pregnancy because she is fearful that it will cause her kidneys to fail when in fact the risk is not much higher than the general population. I feel like I need to speak openly and freely and not be subject to reprimand because of what I say. I always try my best to do what is best for my patients, and when asked, will usually tell them what I would do if I were in the situation. Sometimes it is a toss-up and I will tell them so.
To whom will a patient, by definition a person in distress, turn when he is seeking a healing relationship?Are we as physicians to continue in our role as professionals, as healers, as practitioners of a liberal art, or become technicians, biotechnology providers, enablers? In which role are we more likely to serve the best interest of both the individual and of society? I would argue that in the traditional role as healers, that we are the most effective in the practice of medicine. We all practice medicine a little differently, but that’s what makes this profession so great. Patients can find the practitioner they are most comfortable with. In my area, I look after patients from the time they are diagnosed with chronic kidney disease to the time they die. I feel like I have to be honest to my core beliefs and be honest to my patients in all aspects of their care for me to be a good doctor for them. I think any compromise on my core beliefs will jeopardize the special healing relationship I have with my patients. It is rare that I have had a patient that did not feel comfortable with me or I with that patient. In a career that spans over 23 years, I cannot think of many examples. In those instances where I told patients I could not refer them to someone in China who would do a kidney transplant on them for ethical reasons, they seemed comfortable with that, continued to be my patients, and somehow were able to find their own contacts over the internet. The difference was our healing relationship remained intact and I was not an accomplice in the execution of a jailed person who was waiting to donate their kidney to someone paying money.
I think this draft policy should not be implemented. I think patients are generally able to find what they need on the internet these days. I think it is wrong to make physicians go against their moral conscience and to make them accomplices in something they feel is not in keeping with their beliefs.
I am writing to express my concern that the College of Physicians and Surgeons of Ontario (CPSO) and now the College of Physicians and Surgeons of Saskatchewan (CPSS) are passing draft legislation forcing doctors to act against their better judgement and requiring that these doctors either perform or refer for medical procedures that they object to.
Are we expecting our doctors to act without consciences? Does this not seem like a very bad idea to you?
In the words of ethicist, Dr. Margaret Somerville, “I don’t want to be treated by physicians who are willing either to act contrary to their conscience or who undertake interventions I believe to be seriously ethically wrong.”
And I repeat the words of MP Maurice Vellacot for you as well: “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.”
Please do the right thing and protect conscience rights for our physicians in Ontario. The rest of the country is watching, and will follow the example that Ontario sets.
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A physician who feels it is immoral to perform an abortion or other procedure will also consider it immoral to facilitate such a procedure by referring the patient to a physician who will carry out the procedure. Obliging him to refer the patient is also a violation of his human rights and charter rights.
I am writing to express my concern that the College of Physicians and Surgeons of Ontario (CPSO) and now the College of Physicians and Surgeons of Saskatchewan (CPSS) are passing draft legislation forcing doctors to act against their better judgement and requiring that these doctors either perform or refer for medical procedures that they object to.
Is it not a founding principal of a free society for a person to act according to their conscience and to be free from intimidation or coercion to act otherwise? I believe that forcing doctors to act in this way will destroy the patient doctor relationship. I for on would not want to be under the care of a doctor who could be forced to act unethically.
Cosgrove [Columbia, New York,NY] delivered 67,000 patients 1933-1941. Only 4 needed maternally-indicated abortions. From 1943-1951 he delivered 70,000 with no maternally indicated abortions. Irish studies indicate it is safer to never perform abortion than to do so in some cases.
The policy is about discrimination against physicians, not safety.
I am a prospective medical student and my father is a physician in Ontario. I am writing to the College of Physicians and Surgeons of Ontario to voice my great concern regarding the draft legislation that would force doctors to act against their better judgement and requiring that these doctors either perform or refer for medical procedures that they object to.
Are we expecting our doctors to act without consciences? How are physicians going to be able to attend to the needs of their patients if they cannot do what they judge to be best?
In the words of ethicist, Dr. Margaret Somerville, “I don’t want to be treated by physicians who are willing either to act contrary to their conscience or who undertake interventions I believe to be seriously ethically wrong.”
And I repeat the words of MP Maurice Vellacot for you as well: “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.”
Please do the right thing and protect conscience rights for our physicians in Ontario. The rest of the country is watching, and will follow the example that Ontario sets.
The new draft policy of the CPSO is extremely disturbing to those of us who have strongly-held religious beliefs regarding respect for human life.
The draft policy attempts to sound as if it respects the rights of all involved, but it does not. In effect, the document states that patient rights trump physician rights. The doctor has no rights to avoid referrals for procedures which he may find morally repugnant.
I do not ask you or anyone at the College to agree with the position that killing an unborn child, for example, is objectionable. However, I do ask you to understand that some people believe it is murder and do NOT wish to be involved in it in any way. These are serious concerns for some and must come first.
If someone came to you asking where he can buy a gun so he can shoot his mother-in-law because she is “unwanted”, should you have an obligation to find the nearest store for them? You may not believe these cases are on the same level, morally, but it is imperative the College recognizes that some physicians do place them on the same level and these doctors deserve have their rights protected.
Patients already have alternate access to other “services” at clinics or hospitals, or even from doctors who share the same office with their family physician. Patients are free to seek medical care elsewhere. Doctors cannot so easily go out and seek jobs elsewhere. The obligation to provide a referral is completely unnecessary.
Let us not forget that the last country which forced healthcare workers to set aside their consciences was Germany, circa 1930s.
I just participated in your on-line survey for the College of Physicians. I hope that you will take what I answered there into consideration.
Discrimination can go both ways.
I agree that physicians are obligated to give all necessary health care to all patients despite race, religion, disabled, older citizens, sexual orientation, etc., as long as they are not asking for care that goes against the laws of God, who, or course, in my opinion, comes first.
I do not want any harm to come to any human being by not receiving medical care that will make a person healthy, if possible. To me healthy can include being pregnant and carrying a baby to full term. Nothing healthier than that. All possible care should be given to that baby as well as to the mother. In my opinion, there is more discrimination to the unborn babies than to any other segment of society here in Canada.
I believe it is discrimination to force physicians to go against their fundamental beliefs and threaten their positions if they don’t abide by the current trends, regarding abortion, euthanasia and assisted suicide.
Don’t force doctors to kill their patients just because that is what the patient wants. Doctors have to live with their actions like the rest of us and shouldn’t be told to do anything that is contrary to saving a life. I, for one, would be very nervous if the doctor had that power, no matter the checks and balances in your system. I was recently told of a survey of people who tried to commit suicide for one reason or another and were unsuccessful. Over 80% said they are glad they were saved. There is nothing dignified about suicide or abortion not for the patient and not for the doctor asked to commit these heinous crimes. Just because something is legal doesn’t make it moral or ethical. Please think about that before you try to force doctors to go against their conscience or religious belief. We may lose a lot of good physicians who will go elsewhere to practice.
Your draft policy states that “physicians must strive to create and foster an environment in which the rights, autonomy, dignity and diversity of all patients, or those seeking to become patients, are respected”. The draft policy further states…”The policy also sets out the College’s expectations for physicians who limit the health services they
provide due to clinical competence or because of their personal values and beliefs.”
The problem facing some physicians today is with the definition of the word “PATIENT” in regards to artificial family planning requiring abortion.
First of all is getting pregnant a sickness? Secondly does pregnancy destroy a woman’s health?
The whole issue of some physicians wanting to follow their conscience has to do with assistance to save life and not to destroy life. In some physicians beliefs not only the pregnant woman but also the fetus she carries is a patient that needs care. Therefore they are faced with a dilemma when faced with a situation where a woman seeks help for abortion. They do not want to be an accessory to destroying human life even by referring a person to end the life of a fetus in a woman’s womb. Is there anything wrong with that?
Therefore isn’t it the logical and the right thing for the CPSO to allow doctors who do not want to have anything to do with abortion to allow them to follow their conscience???
Why cannot CPSO (at this technologically advanced age) provide a public list (website) of doctors who would cater to women seeking artificial family planning instead of trying to impose this issue on those doctors who wish to follow their conscience?
In addition, at a time when there is an acute shortage of physicians in Ontario to deal with various kinds of real diseases why would the CPSO want to lose physicians over this abortion issue????
Is the CPSO caving under the pressure of pro abortion lobby groups instead of working toward the good of all Ontarians and finding solutions to find a balance???
I write to express my dismay at the recently published draft document “Professional Obligations and Human Rights” of the CPSO. The effect of this document is to deny physicians their right in conscience to refuse medical treatment which violates their morals, and referrals that would make them complicit in procedures they know to be immoral.
Because a procedure is legal it does not follow that it is moral. We recoil in horror at the barbaric acts of ISIS, but close our eyes to our home-grown horror of abortion, because the unborn are disenfranchised, and because our governments lack the courage to acknowledge the humanity and citizenship of the unborn.
Surely you do not want physicians who are false to their own sacred principles. Long ago, Shakespeare wrote, “This above all to thine own self be true, and it shall follow as the night the day thou canst not then be false to any man. (Hamlet, act 1, scene 3)”
If you deny physicians the fundamental right to be true to themselves, you are forgetting that there are more ancient and noble codes of law than those emanating from Toronto and Ottawa.
Dear CPSO Board Members,
Thank you for the opportunity to respond to the CPSO’s draft policy “Professional Obligations and Human Rights”.
I am a family physician in Nova Scotia who is very concerned about the policy changes that are being proposed and what they mean for health care professionals and patients.
There are many positive aspects in this new draft policy: I commend and agree with the CPSO’s advocacy for high standards of patient care and their strong stand against discrimination. However, I have significant concerns about the requirement for physicians to perform or refer for procedures that they believe are morally unacceptable. Physicians and health care providers with high moral standards are precisely the professionals that I want as colleagues and that I want looking after myself and my family members. Please continue to protect the conscience rights of these individuals, including myself.
I believe that health care is strengthened by the diversity in medicine and in providers’ beliefs. I believe that making physicians simply a technician is not the answer and that patients will suffer if this is what occurs. We, as physicians, must be able to do what we believe is best for our patients and patients have a right to be able to seek out physicians who share their values.
Please do not accept the policy in its current form. Please protect the conscience rights of physicians. There are many incredible, ethical, knowledgeable, and dedicated physicians who have moral objection to one issue or another. These individuals will either leave the practice of medicine rather than compromise their moral or religious beliefs, or worse, they will lose themselves in compromising. In either scenario, it is patients and healthcare who will suffer.
We are very concerned about your draft policy, which suggests in certain sections that physicians who do not take part in acts for conscience reasons should be forced to refer their patients to other physicians who will perform those acts. Many or most of the objecting physicians will also object to the act of referring itself, because it is cooperating with the act. This very seriously limits their right to conscientious objection.
We have the privilege of living in a free society, and freedom of conscience is one of our most fundamental freedoms. We cannot limit it even if we think we are doing the right thing in limiting it.
Indeed, personal integrity is the foundation of a physician’s relationship with their patients, and that integrity will be hugely compromised if we force physicians to violate there consciences.
There is increasing disagreement in society as to what constitutes a moral act, so the College is not expected to make a determination in this regard, or to limit morality. Physicians are professionals, and they must be allowed to respect their own consciences.
Please do not make doctors act against there conscience. This is evil. Moral issues especially. It’s to bad we can’t tell government what we want. And they actually do what the people that the SERVE want.
I earnestly ask that you reject the draft policy “Professional Obligations and Human Rights”.
As a healthcare worker myself working as a Registered Nurse, I have experienced what it is to advocate for patient’s rights, freedom of choice, and the value and dignity of human life. A violation of the universally recognized right of freedom of conscience which is guaranteed under Canada’s Charter of Rights and Freedom undermines the very basis of human dignity under which all human rights exist.
I respectfully ask, therefore, that your honorable body reject this draft policy and work towards protection of human life in all its forms.
Dear Members of the Consultation Committee:
Subject: Draft Policy “Professional Obligations and Human Rights”.
My letter concerns the new proposed draft policy. Sections 8, 10 and 11 state that a physician can refer a patient to another physician if they find the proposed action immoral. This goes against a physician’s right to conscientious objection.
Freedom of conscience is an integral foundation for any career, and it is not right for a physician’s freedom of conscience to be limited.
Please revise the draft, and include a section on respecting the freedom of conscience for physicians.
Please allow freedom of conscience and freedom of religion for all physicians. Doctors need to be unequivocally allowed to abide by their religious and moral beliefs.
I am writing to express my concerns with the following two points in the draft:
Doctors are required to refer for procedures that are against their moral or religious convictions (Lines 156-8)
Doctors are required to perform procedures that are against their moral or religious convictions in situations where that is deemed to be “urgent or otherwise necessary care”
Forcing doctors to offer procedures or drugs against their better judgement or moral convictions is not only wrong, it is dangerous. Please protect the freedom of doctors, for the good of all Canadians.
The rights of physicians who have moral objection to conscience due to their religious beliefs must and should always be protected as those of the patients. Each of these have been and should continue to be protected. This new policy is skewed towards negation of physician right. It amounts to advocating a dichotomy in the lives of these physicians. The faith and conscience of each person defines who the person is and animates ones professional life. Developing policies that advocate otherwise is tantamount disintegration and destruction.
I do not agree that a doctor should be forced too perform any medical action that goes against his conscience. Please uphold this in any future policy draft.
To whom it may concern at the CPSO,
RE: CPSO Draft Document on Professional Obligations and Human Rights
I hereby wish to thank-you first of all for being open to consultation to the public with regards to this Draft Document. I appreciate that the College accepts the existing Charter of rights and freedom of religion and conscience.
In regard to this Draft Document I would encourage you to maintain that moral stance, which is based on conscience and is rational and evidence-based. This moral stance deserves the full protection of all members of society, including physicians. Other documents such as the Canadian Charter and the United Nations’ Universal Declaration of Human Rights embrace this equality of dignity and rights among all people, and so I would encourage you to maintain the same policy in your Document on Professional Obligations and Human Rights. I would request that you respect both patient and physician rights, that is, the balance should not tip one way or the other.
A physician, as a human being with a moral stance, even if reinforced by religious beliefs, should never be compelled to act against rational conscience decisions. Being forced to do so goes against the Charter and human rights. Refusing to perform or provide referrals for some procedures has more to do with the freedom of all to make rational conscience decisions, based on absolutes that are transcendent and not on the changing winds of time.
Thank-you for helping to preserve the integrity of your members. In so doing you will optimize the health and well-being of the patients we serve, in protecting the physician’s ability to practise medicine in good conscience, and ultimately promoting the dignity of personhood as it was created to be.
I appreciate your careful consideration of this submission in due time.
Re: Draft Policy “Professional Obligations and Human Rights”.
I am writing to express my concern about the proposed draft policy, which states that physicians who decline to participate in certain acts for reasons of conscience should be compelled to refer their patients to other physicians who will perform these acts. It fails to address the fact that these same physicians will find the act of referral itself objectionable, as it makes them an accessory to the act. In compelling physicians to refer, you are limiting their right to conscientious objection. I am strongly opposed to this.
In light of today’s ruling by the Supreme Court of Canada on assisted suicide it is clear that this draft policy is woefully misguided. It should be withdrawn immediately and revised to provide a clear defence of the right to freedom of conscience for all physicians.
Dear CPSO:
I am incensed at the notion that doctors can be coerced to involve themselves with abortion referrals or other objectionable issues(euthanasia), when
there is absolutely no practical necessity for such referrals. Any simple citizen can find the services for themselves. So, coercion is simply a matter of
crass, tyrannical persecution of conscience by a secularistic, dictatorial regime.
I think it is a disgrace that some people are trying to force doctors to do something that is against their conscience.
Doctors are supposed to save lives not destroy them. Those who are against killing, anyone, should be free not to do so.
By referring patients to someone who will do this evil act makes the doctor an accessory to murder.
This is against Freedom of Religion which we are supposed to have in Canada, therefore unconstitutional.
You must not let this get through. If not, remember that you will be held accountable to God, someday.
I am a proud Canadian. I just returned from traveling to the Middle East where many rights and freedoms are restricted. Canada has a fine reputation for welcoming and accommodating all who land here from everywhere else. All are given the freedom to practice whatever lifestyle they choose. Why, then, are the rights and freedoms of physicians and other health care workers being impinged upon by legislating that, regardless of their personally held religious and/or moral beliefs, they must refer patients for procedures that cause those physicians to act against their own conscience? Where is tolerance in this instance? Is tolerance only limited to specific groups? It is becoming glaringly obvious that discrimination is alive and well, and even thriving in Canada – against Christians, Jews, and those whose morals forbid them to participate in the taking of a life.
Rights and freedoms should be afforded to everyone, regardless of race, colour, sexual orientation, or creed. THAT is the Canada I want to belong to.
If your going in the wrong direction the most progressive response is to admit it by turning around.
Morality must be based on objective truths not on subjective or relativistic principles or grounds of consensus.
What happened to conscience rights? Religious freedom? And, the Christian foundations that gave birth to Western democracies?
In the 20th Century totalitarian systems of governance implemented similar policies in the spirit of advancing their societies welfare but, at what cost?
When will we learn from the mistakes of history?
If your going in the wrong direction the most progressive response is to admit it by turning around.
The draft proposal is not acceptable as it requires medical persons to give up their own right of conscience. As a patient I would not trust a doctor or a medical ethos that gives up a persons right to do the right thing as they see it. Every person has the right to the dignity of practicing what they believe.If I believe it is wrong to steal, then hiring someone to steal for me is OK?
I am writing to you with grave concern regarding the content of your proposed
draft policy, which indicates that physicians who decline to participate in certain acts for reasons of conscience should be compelled to refer their patients to other physicians who will perform these acts. It does not address the fact that many
of these same physicians will find the act of referral itself objectionable, as
they consider it material cooperation with the act. In compelling physicians to
refer, you are limiting their right to conscientious objection. I am opposed to this.
There is significant disagreement in our society as to what constitutes a moral
act, and I do not expect the College to define or limit morality. All I expect
is that physicians, as professionals, be allowed to respect their own consciences. Freedom of conscience is foundational to our
free society and cannot be limited, even for the best of intentions.
If we coerce physicians into violating
their consciences we will inevitably erode the personal integrity which is the
basis of the physician’s relationship with their patients. I encourage you to
revise the sections above, and include a clear defence of the right to freedom
of conscience for all physicians.
I strongly disagree with the proposed policy changes disallowing physicians their heretofore (and current) “right” to refuse to provide specific medical services or perform specific procedures to which they would have religious or moral objections.
As a patient, I would lose all trust in my doctor’s ability to ‘freely’ practice medicine to the best of his ability. NO patient should, under any circumstances, ever insist or expect a doctor to compromise his own moral compass; nor do I expect my doctor to compromise mine!
When I seek a doctor’s medical care and/or advice, I expect to be treated with dignity and respect for me as a free person … and I reserve the ‘right’ to choose whether or not I will follow his/her advice. In most cases, I’ve chosen my doctors based on their medical knowledge and expertise; choosing someone with whom I can build a rapport and who can understand and respect MY own moral objections to various medical procedures.
In my opinion, enacting and enforcing these changes to your Policy, will open up a can of worms you really don’t want to open! As ‘reasonable’ as some of the policy changes seem to be, they are actually ‘anti-democratic’ and others are downright ‘draconian’. Doctors (with a moral code/conscience) will leave Ontario in droves! As well, I sincerely fear that these kinds of changes could eventually lead to terms similar to, but harsher than, the terms of this CPSO Policy, becoming the ‘law of the land’ for every kind of ‘service provider’ and indeed, for every Canadian citizen.
To rob physicians of their right to ‘conscientiously object’ to practices and procedures based on their religious or moral grounds is downright heinous. It reeks of communist ideology, and is an attempt to rob our Canadian Physicians of a basic human right/freedom that was enshrined in our country from its very beginning for every single Canadian … including physicians.
All human beings have been endowed by our Creator, the freedom of conscience and no man can take that away. Forcing doctors to commit atrocities against our society’s most vulnerable is an evil that shows the true barbaric nature of our “modern” civilization. That life begins at conception is an indisputable truth supported by the scientific community at large as well as all God-fearing men and women around the globe.
The pro-life movement is getting stronger, with voices of the millennials now growing in numbers to support justice and freedom for all mankind. The unborn also have a voice but are not given any choice by the “pro-choicers”. The Lord hears their cries and will show no mercy to those with the stain of unrepentant sin. Our movement will not stop until abortion ends, and our first step is to defund. It is unconstitutional to force tax-payers to fund such a horrific crime, contrary to their beliefs.
When you try to remove God from people, and attempt to suppress thought and moral conscience, you bring us one step closer to Communism and all the evil nature that comes with it.
I strongly oppose any changes in the policy of the CPSO that would infringe on the constitutional right of physicians to act according to their own conscience.
This is a blatant violation of both the individual and professional rights, not withstanding the human rights of self determination based on own conscience, religious beliefs and ethics.
Will the Human Rights Commission do the right thing to protect the physicians and rule against the College of Physicians proposed policy?
For brevity; both the Canadian Physicians for life and the Christian medical society articulate my views on compulsion of a physician’s conscience precisely and completely. If you do not change course you will end up driving many very conscientious, hard-working and dedicated physicians out of practice.
Re: Professional Obligations and Human Rights.
I am deeply concerned about the limiting of physicians’ freedom of conscience in their practice. Freedom of conscience is the essence of a person and the core of one’s integrity. How can a physician practice while being denied this basic freedom our Charter upholds? This policy is detrimental to physicians and to their clients.
The College of Physicians and Surgeons of Ontario.
My feedback applies to other Colleges too who are challenging adherence to a conscience clause as assisted suicide is state approved in Canada .
Adherence should never be questioned or challenged regardless of pressures within the medical profession or from State or the public. This is the time for all doctors who will retain professional ethics and not succumb to becoming funded contract killers to stand up and say so loud and clear in public. The divide is obvious amongst the medical ranks .The public has the right to safe medical practices .Promoting assisted suicide a la Supreme Court of Canada ‘s malpractice of a ”Ruling” runs counter to safety and further confidence in the medical profession. We can all foresee the enlargement of abuse of any restrictions and so called ”safeguards” .
“The CDA strongly supports the College of Physicians and Surgeons in its approach to patient dignity and access to care.”
I believe the CDA is foolish to do so.
The original Christian understanding of human dignity gave each individual intrinsic worth as a human being. The new understanding removes such protection and makes people with disabilities vulnerable to abuse.
Referral is not a problem when motivated by lack of competence. However, when the government or profession requires violence of doctors in the name of care–forced abortion and assisted suicide are or will be covered by OHIP–then morally speaking “access to care” means murder and referral makes the doctor an accessory to murder.
Since no doubt you are aware that people with disabilities are already targeted for death before their birth, surely you should reconsider your support of the CPSO approach to patient dignity and access to care. Canadians with disabilities will now be vulnerable throughout the rest of their lifespan as well. The Netherlands has legalized voluntary euthanasia for children older than twelve and for the younger children tolerates the Groningen Protocol for Euthanasia of Severely Ill Newborns. Belgium has legalized euthanasia for all ages. Identical twin brothers there, born deaf but 45 years old, asked to be killed after learning that they were going blind.
I am writing to express my concern that the College of Physicians and Surgeons of Ontario (CPSO) are passing draft legislation forcing doctors to act against their better judgement and requiring that these doctors either perform or refer for medical procedures that they object to.
Why would we in Canada want our doctors to take actions without consciences? Can you fathom doctors performing their duties without thought of doing what they think is truly best care practices for their patients; going thorough motions and procedures without a moral compass? Why would we risk trusting this type of doctor with the lives of Canadian citizens?
I beg you to do the right thing and protect conscience rights for our physicians in Ontario. What happens here will impact the rest of Canada.
re Balancing Physician and Patient Rights
Since the decision of the Supreme Court of Canada, Carter v Canada regarding physician assisted death, this is a difficult time for physicians and their provincial regulatory colleges.
I note that the justices made it clear that nothing in the decision compels doctors to provide assistance in dying.
The CPSO policy on Professional Obligations and Human Rights, should therefore reflect the ethical conscience rights of the physician not to provide assistance in dying.
I believe that physicians will be respected for having clear ethical positions.
I have reflected on your draft of “Professional Obligations and Human Rights” and have great reservations and concerns about the proposed policy.
Freedom of conscience is protected under the Canadian charter of rights and freedoms. It assumes a society that dogmatically forces their own version of right and wrong on the individual does much more harm to society in the long run- with examples throughout history of the destruction that can take place when individuals do not stand up for what is morally right).
The new policy is concerning especially in the face of the recent legalization of euthanasia.
As a medical student I declared I would not administer a poison to a patient. Today, I am told that if I don’t administer or refer for that poison the college will suspend me?
This is not just an example but a real scenario as last year I was asked by a patient “to kill him” well declaring the situation an “emergency”. I declined and offered him excellent palliative care and compassion during his last days. Although at that time I had the law on my side – in the future I will have neither the law or the college on my side.
I assume that the college wants its physicians to be honest, emphatic, and kind but the same ethos that drives my belief in the worth and respect of every individual is also the basis for my refusal to “administer poison”.
Now the college aims to silence and marginalize any physician who believes in the value of life through disciplinary action?
Specifically my concern lies in the requirement to refer (lines 156 and 157). An “effective referral” does not absolve the referring physician of the harm that has taken place.
I strongly ask you to reconsider the broader implications of your policy and reject the proposed draft.
Dear College of Physicians and Surgeons of Ontario:
I am writing this letter to offer my comments on the proposed Ontario College of Physicians and Surgeons (“the College”)
policy that would require Ontario’s doctors to refer patients for abortion or euthanasia services when asked, even if such referrals go against their conscience.
I will begin by saying that I am 58 years old, and have only experienced professional care from Ontario’s doctors when I have been stricken with the need for medical attention. I say the same for my parents, 88 and 89 years old, and in relatively good health. Their longevity is in part attributable to their lifestyle, but also to very good care from Ontario’s doctors. Therefore, I am surprised to hear that the College is considering a policy which would restrict the Freedom of Conscience and Religion to their members who oppose referring patients for abortion or euthanasia services. Freedom of conscience is guaranteed in the Charter, is it not? But for these members of the College, who have worked and studied and met the full standard of their profession for offering care which promotes health, healing, and pain management, the proposed policy will remove this freedom. This freedom must be respected, as it is an essential element in what makes us human, and not simply “utilitarian”, valued solely for our perceived contribution to the good of society. I will give an example to explain my point.
If you have an 18 year old son who is an only child, in good physical health but suffers a bi-polar condition, and he approaches you to refer him as a candidate for euthanasia, are you going to accede to his request? I think you would do everything in your
power to advise him against this. I do not think you would say, “son, you are right, quality of life is everything…since your quality of life is not consistently joyous and stable, I suggest you proceed with this decision.” No, you would probably refer him to specialists who would help him better understand his pain “triggers”, medication, and support systems. You would tell him that you love him. You would see his value more than he himself sees his value, and you would try with all your might to expand his vision of himself.
IN my view, the reason people choose abortion or euthanasia is that they feel there is no hope. However, when people experience love, and are taught to receive love, they grow in hope, even if they have a terminal illness. With such hope, they carry their illnesses better, and see that their existence, though difficult, has a purpose, and that purpose is to LOVE.
By adopting the recommended policy of requiring all members of the College to make abortion and euthanasia referrals, the college seems to have embraced an understanding of patient care that states “not only have you convinced yourself that there is no reason for you to have hope in this world, but you have convinced us too, such that we will force from our ranks those who still believe your life has a valued purpose, by making it legally binding for them to enshrine your hopelessness, by forcing them against their will to obey your wishes for a euthanasia referral, or be removed from the College.”
A more just way for the College to proceed, I believe, would be for allowing those doctors who conscientiously object to the new policy to give notice to all new patients of a “patient bill of rights” stating up front what services are and are not (i.e. abortion and euthanasia) offered. Those who wish an abortion or euthanasia referral could be directed to call the College directly for a listing of physicians and surgeons in their area who provide such services. This would be a more just solution, and a way of minimizing the pain of losing more medical professionals at a time when shortages remain in many communities.
I’ve read your comments regarding doctors’ obligations while in private practise, i.e. working from their offices.
My question pertains to doctors and nurses working in the hospital setting. Do they have the right to refuse to perform and/or assist at abortions? (without being fired from their jobs that is).
I live in Ontario, and I’m writing in response to the draft policy with the new title, “Professional Obligations and Human Rights.” I appreciate the fact that you are addressing these important issues. However, I strongly disagree with the direction this new draft policy is going. If a doctor has a religious or moral view opposed to the patient’s views, it is incredibly disrespectful and belittling of a medical doctor to expect them to still refer such a patient to another medical doctor who has a view in line with the patient. This type of approach is belittling of a doctor’s personal views. A doctor’s role is to protect lives–and issues like abortion and assisted suicide–cannot be deemed as neutral issues that all should expect to follow. So I would like to request the College to change the policy, so that doctors are NOT expected to refer patients to other doctors when an issue goes against their moral or religious views. If one doctor thinks that abortion or assisted suicide is murder, how can you expect a doctor to refer such a patient to a doctor who doesn’t think abortion or assisted suicide is murder? Please honor the rights of all doctors, even those who may have opposing beliefs. I’m not a medical doctor myself, but I am very aware of the issues involved in the medical profession.
Furthermore, I would like to remind the College that those who have strong moral and religious beliefs, often seek to be a doctor with integrity. They do not want to cheat the system. They want to do good, and not harm. These doctors are often the ones who provide medical assistance to those in great need, sometimes even overseas–they are often not merely in it for the money. To challenge the views of such doctors could greatly harm the future of the College of Physicians and Surgeons of Ontario. If you were to blatantly disrespect the views of such doctors, they may be tempted to find work elsewhere. I, for one, am very grateful for doctors who seek to live with integrity as a doctor–to force them to go against their value system would be quite damaging to our system here in Ontario.
Dear CPSO:
It is heartening to see that College accepts existing Charter rights of freedom of religion and conscience. The challenge at hand is maintain that moral stance with respect to conscience decisions, and ensure that there is no coercion or compulsion which would contravene the Charter and human rights.
It is important to note that refusing to provide or perform some procedures is not discriminatory when it is based on a properly informed conscience. This has fundamentally to do with the recognition of the physician as an independent entity, with inherent moral judgment and with conscience.
With respect to the draft document from CPSO:
The duty to refrain from discrimination does not prevent physicians from limiting the health services they provide for legitimate reasons. …physicians may be unwilling to provide care that is contrary to their moral or religious beliefs.
Comment: This is an important and fundamental principle which recognizes and respects the moral autonomy and judgment of the physician. This autonomy cannot be undermined by external regulations or coercion.
Where physicians choose to limit the health services they provide for moral or religious reasons, this may impede access to care resulting in a violation of patient rights under the Charter and the Code. The courts have determined that there is no hierarchy of rights; all rights are of equal importance. Should a conflict arise, the aim of the courts is to respect the importance of both sets of rights to the extent possible. Where physicians are unwilling to provide certain elements of care due to their moral or religious beliefs, an effective referral to another health care provider must be provided to the patient. An effective referral means a referral made in good faith, to a non-objecting, available, and accessible physician or other health-care provider.
Comment: This is an appropriate expectation of professional conduct on the part of the physician, since he or she can reconcile the requested intervention while at the same time not impede requested care by making a timely referral or transfer of care. The CPSO must enshrine the freedom of the individual physician to act in a way which is concordant with his/her moral and religious beliefs. This is an urgent item, as the Supreme Court has decided that an individual has a legal right to suicide, even in the absence of a terminal illness. Such suicidal ideation is not uncommon in depression, and the court decision as stated has the potential to infringe on the sanctity of human life by mandating physician-assisted suicide when requested by a patient. The moral framework of the health care system is best guarded by respecting and incorporating the moral judgment of its individual practicing physicians. The CPSO should defend this.
You “can reconcile the requested intervention”, referral, with your conscience. How do you do that in your example of assisting a patient’s suicide? Doesn’t your assistance by referral make you partially responsible for his murder? That’s especially true since you are in a fiduciary relationship with him.
The Christian physician’s proper response to this draft policy, I believe, is the same as the apostle Peter’s in Acts 5:29. Such a response, ironically enough, requires a conscience strengthened by the Christ’s words in Matthew 10:28. He is the ultimate example of both holiness and sacrificial compassion, of course, and we can only begin to imitate Him. There is the test of faith.
Please respect the most sacred of commandments “Thou shalt not kill” respect for life from birth to “natural death” When has society become “God” Murder is against the law no matter how sick mentally or physically or disabled a human being is we have no right to play “God”
Physicians cannot be asked to check their most deeply held moral convictions at the door of Med School. Insisting that physicians in Ontario participate in medical practices that are antithetical to their own personal beliefs is to trample on one parties human rights, in an effort to promote that of another party. Doctors in Ontario should be protected from having to council or perform selective abortions or prescribe medication that will cause a spontaneous abortion, to council suicide or perform homicide, and any of the other medical interventions that contravene their beliefs in the sanctity of life. Like the Federal Leader of the third Party, Who has made it clear that politicians who do not share their views on abortion, that they can not become members of the party, the same will hold true for CPSO, if you close the doors to doctors who do not share your views on ethics and morality regarding human life. I would think that an observant Jew or a devout Muslim, an orthodox Christian or Roman Catholic would have to practice in another jurisdiction, or avoid a career in medicine altogether, if they were not permitted to use their own conscience as a guide as to how and when they would provide medical services to patients in Ontario.
I’d like clarification on Item 3: The patient’s best interests must remain paramount.
The word “paramount” is defined as more important than anything else. This suggests/implies that the patient’s interest rules over and above that of the physician. This then is a situation of reverse discrimination: the physician has to subordinate his/her beliefs to the patient’s interests.
In practice, it would mean that a physician believing abortions to be contrary to his/her religious beliefs would still be required to direct the patient to a doctor who does perform abortions. In other words, the physician would have to, aid, abet and assist in the patient’s abortion.
He/she could not just say, I’m sorry I cannot help you; and allow the patient to find an alternative doctor. The College’s expectations do not allow that option.
The College’s expectations of physicians who limit the health services they provide on moral or religious
grounds is that they must do so in a manner that respects patient dignity, ensures access to care and protects patient safety.
A patient could claim that by not providing abortion information they were not given access to (abortion) care and that their safety was jeopardized.
Therefore, the rules as stated do not foster, nor protect the physician’s right of freedom of religious belief.
Dear Members of CPSO,
In your new proposed draft document it states:
“Where physicians are unwilling to provide certain elements of care due to their moral or religious beliefs, an effective referral to another health care provider must be provided to the patient”.
I believe that a mandate for an “effective referral” is a violation of a physician’s rights, as it compels the physician to violate his or her own conscience by being a participant in the very act, the very procedure to which he or she objects in the first place.
Please withdraw such policy.
Thanks for your attention!
Dear College of Physicians and Surgeons of Ontario,
I am a citizen of the Province of Ontario, and I am writing in response to your new draft policy entitled “Professional Obligations and Human Rights,” which, if enacted, will jeopardize the ability of some physicians in Ontario to follow their consciences in their practice of family medicine. I demand that the CPSO respect the diversity of medical judgment and not coerce doctors to perform or refer for procedures to which they conscientiously object.
I do not believe that physicians should discriminate against patients, and I do in fact believe that patient is care is of the utmost priority. However, deciding not to offer a service in no way discriminates against patients, provided the service is not offered to any group. It is difficult to see how limiting the physician’s Rights to Freedom and Conscience and Religion, which are guaranteed in the Charter of Rights and Freedoms, will result in less discrimination or better patient care.
This policy, which I have read, misses the fact that there are two human beings with rights and freedoms in the patient-physician relationship. It prioritizes the patient’s rights and freedoms, while eliminating those of the doctor. This move is certainly not “helpful to physicians” (as per the document), nor is it helpful to those patients of an ethical minority who might wish to be counseled by a family doctor of the same ethical persuasion.
The CPSO draft refers to the Supreme Court of Canada’s decision to limit personal rights and freedoms with regards to those issues that involve the public “good.” What the CPSO fails to understand, and has repeatedly failed to understand, is that those physicians who are against the medical practices stated in the document believe that their stance is for the public good, both medically and ethically speaking, and that the use of such procedures and medications has had devastating effects on society and women’s health. Their position has good arguments behind it, including results from many medical studies. To treat their position, even implicitly, as threatening the public good, means that the CPSO is claiming to represent the one and only way of defining what “good” is, for patients and for society. Surely the CPSO board, with its scientifically trained members, recognizes that to shut down debate and discussion in contested issues is never the answer.
In this document, the CPSO therefore represents an imbalance of power. The availability of abortion and contraception is not threatened by the presence of family physicians who hold other ethical positions. In fact, referrals for abortion and contraception prescriptions are more easy to come by than ever. This draft policy does, however, threaten the right to freedom of conscience and religion for those doctors who hold to other definitions of the “good” of their patient. If this policy is enacted, I know of doctors who may be forced out of family practice because they will not compromise their well-reasoned beliefs. This draft policy is damaging to both physicians and the public because of its utter lack of balance and comprehensiveness.
I’m calling on the CPSO to retract this version of their “Professional Obligations” policy.
Good morning, I would like to comment on your proposed policy that would deny health professionals freedom of conscience to refuse to participate in morally questionable practices such as abortion, and assisting someone to kill themselves. I strongly object to any infringement on the freedom of anyone, including doctors, nurses, pharmacists, etc. to refuse to participate in any way including informing someone on how to get these procedures.
Essentially if you pass this policy, you are preventing a large portion of the population from becoming or continuing as health professionals. You are discriminating against them. Referring someone for these procedures is participating in them. A person who refuses to participate also cannot refer in good conscience. For the record, I would also like to be able to choose to have a family physician who I know will NOT do these procedure or assist in them in any way, including referral, who wants to cure illness and prevent death, not deal it. I cannot trust any health professional who is willing to perform or refer for these procedures to treat me in good faith, especially when I become elderly.
Further, the demands of patients for specific procedures can be highly unreasonable, ill-informed and not in their best interests. Doctors and other health professionals should not be required to either meet the demands of patients, parents of patients, attorneys, or refer them for the procedures they want. They need protection from having to do so, especially when they firmly believe that the procedures in question are highly unethical, no matter what the law says. For e.g. what if a 16 year old patient who is 8 months pregnant wants an abortion (not illegal to do in Canada), is your organization prepared to require doctors to refer her for one? What if her parents want her to have one, but it looks like she is ambiguous about having the abortion, will you require doctors to refer? What about the baby who if delivered at 8 months will probably survive? Even doctors who believe in abortion rights would have difficulty in referring in this case, I believe, or at least I hope.
Not everyone in this provinces believes that abortion and euthanasia is ok , this fact will not change, and the province’s laws and policies should reflect this fact and ensure protection for those professionals who object to participating and referring for these procedures.
Thank-you for giving me the opportunity to comment.
Forcing physicians,against their strongly held views, to refer patients for euthanasia is ethically and morally wrong. In the Netherlands, there are clinics available which do not require referral from the patient’s physician.
Excellent point.
This is currently what happens in Ontario with regard to induced abortions.
This would be a practical way of both respecting doctors’ conscience rights and still ensuring access to patients for services they may want. Wouldn’t this uphold both of the competing rights that the College is trying to balance in this policy?.
Dear Friends,
Recent changes proposed are quite terrifying. Although not all may agree that abortion and euthanasia are health needs or not yet our trusted Health Care Physicians must be allowed a conscience regarding referral to other Professionals who are willing to commit these life ending acts .Please carefully consider this, each patient matters.
Recently our family had to change Physicians on learning our Doctor was pro abortion. Whether logical or not we
are afraid that anyone who does not value all Life might not be trusted with our own.
Thank you for your kind and thoughtful attention to these, for some of us, terrifying matters. In my 75 years as a
Canadian I have never before experienced the fear felt now.
Thank you very much for the opportunity to provide feedback on this policy.
I am a family physician with a roster of approximately 2000 individuals. Since I started my practice 10 years ago, my patients have been made aware of certain restrictions in my practice due to my Roman Catholic faith. This includes referrals for procedures that result in the termination of life i.e. abortion, fertility clinics that destroy fertilized eggs etc. I have signs in my office that provides patients with this information.
My main concern with the current draft policy is the fact that a doctor is mandated to make a referral when requested. I provide my patients with objective information on all of the available options that they have but they are aware that I will not make referrals for procedures that my faith clearly objects to. If a patient proceeds with an option that I object to, I treat them no differently upon their next visit to my clinic. Making a direct referral for a procedure that destroys life i.e. abortion, perhaps euthanasia in the future, connects me directly to the procedure and would violate my conscience.
I hope that the CPSO will consider this feedback and alter the draft proposal. I agree that ALL patients require respect and compassion, but I don’t think that this involves forcing doctors to act in a fashion that violates their own personal religious beliefs and faith. There are other ways for the Govt of Ontario and the CPSO to ensure access to these types of services for all patients. Thank you.
A physician should definitely not be required to act against his moral or ethical beliefs to assist patient suicide. Furthermore there is no physician that should carry out patient suicide as it could have a lasting and devastating effect on their ability to administer effective health care to their patients. A physician should do everything in their power to administer health care that will prolong the life of their patient as this is an integral part of their oath and profession.
I am writing to you today because I have heard about your proposed draft policy, and I have serious concerns.
This draft states: “Where physicians are unwilling to provide certain elements of care due to their due to their moral or religious beliefs, an effective referral to another health care provider must be provided to the patient.”
Catholic physicians believe that a mandate for an ‘effective referral’ is a violation of the physicians’s rights, as it compels the physician to violate his or her own conscience by being a participant in the very act, the very procedure to which he or she objects in the first place.
I strongly disagree with this part of the draft proposal. The Charter right of freedom of conscience and religion for physicians must be respected.
I ask that you reconsider and revise this section of the proposed draft policy on Professional Obligations and Human Rights.
How can the Supreme Court of Canada determine that no right are absolute? Does that mean that there is no absolute truth? If God exists and is the Creator of all life how can we decide to give a doctor who is in a profession of healing the right to help his patient to commit suicide?
Just like abortion we are in a very slippery rope. I want my physician to have the absolute right of following his conscience and be free of being coerced into making referral in matters that violate his/her moral or religious beliefs. My physician needs to be protected and not coerced into having making referral which are against his/her conscience.
Think of your own end of life, how are you going to be able to stand in front of the judgement seat of God, which you will, whether you believe it or not, and explain your position.
Re: “Professional Obligations and Human Rights” Draft Policy –
“We want to hear your thoughts”
Having carefully read and reflected upon the draft policy, I submit the following thoughts.
First, thank you for your openness to consultation with the public. This policy is of direct relevance to the life of every Canadian, not all of whom will be able to read and respond to this draft.
I appreciate that the College respects the existing Charter of rights of freedom of religion and conscience, and applaud the Draft’s retaining that positive moral stance. These freedoms are ensured in many other documents, including the United Nations’ Universal Declaration of Human Rights, and Canadian documents need to follow this model.
Human rights must always be balanced (as the Draft Policy points out, no right is absolute, line 115), and in the case of medicine, patient and physician rights need to be held in tension.
The physican’s right and responsibility to an informed conscience, and to act in accordance with that conscience, is essential. Upholding this right actually supports the patient’s rights. The Draft Policy eliminates the physician’s right to exercise informed conscience. It allows physicians to refrain from providing elements of care that contravene their moral or religious beliefs, but requires them to ensure that these elements of care are provided by someone else. (“Where physicians are unwilling to provide certain elements of care due to their moral or religious beliefs, an effective referral to another health care provider must be provided to the patient. An effective referral means a referral made in good faith, to a non-objecting, available, and accessible physician or other health-care provider”; lines 156-159)
Clearly, whatever code of morality one operates by, arranging for someone else to do something one considers immoral is as blameworthy as doing it oneself. The law prosecutes a person who hires someone else to commit a crime, for example.
This Draft Policy not only fails to protect the consciences of physicians, but actually may require physicians to take actions they consider morally unacceptable.
I do not expect my physician to think as I do on every subject. I do want my physicians to operate in good faith, to have properly informed consciences, and to advise me as to how they understand the nature and effects of any intervention they provide, recommend or make available. Physicians have extensive knowledge their patients do not have; patients rely upon physicians to understand what they are recommending or referring them to.
Nobody holds a morally neutral stance. Refusing to perform or provide certain procedures is not discriminatory when it is based upon informed conscience; it is not a question at this point of the patient’s right to particular procedures, but of the physician’s understanding of those procedures, the physician’s right to freedom of conscience and religion, and the physician’s obligation to provide the best possible care to the patient.
“Above all, do no harm.” Every physician must build a fence around this law. Your Draft Policy tears down that fence.
Compelling doctors to refer something they consider killing a patient will go against the reason they went into medicine – to heal patients, not to harm them.
I would not feel safe in the care of a doctor who was forced to refer patients for procedures that go against a doctor’s conscience.
Compelling Ontario doctors to violate their rights to conscience – which were asserted by the CMA at their August meeting – will lower public trust and confidence in doctors.
I don’t believe it’s right to take away a physician’s right to act within their moral or religious beliefs. In today’s information age, if a patient was refused service based on their physician’s moral/religious beliefs, it would be very easy for a patient to, on their own, find another service elsewhere that would provide what they want. A quick search on the internet would give them the information they need without forcing their physician to be involved in or refer a service they believed was wrong. People who desire abortions, physician-assisted suicide (etc), will find a way to obtain it. Professionals do not need to violate their own consciences in order for the patients to receive the service they want.
I am writing this e-mail to express my concerns regarding the proposed changes to the CPSO’s human rights policy. Specifically, my concerns lie in the requirements being laid out in the policy regarding physicians’ moral or religious beliefs, and in particular the following two clauses:
• As part of ensuring access to care for patients, the draft policy requires that physicians, who are unwilling to provide certain elements of care due to their moral or religious beliefs, refer the patient to another health-care provider.
• In order to protect patient safety, the draft policy requires that physicians provide care that is urgent or otherwise necessary to prevent imminent harm, suffering, and/or deterioration, even where that care conflicts with their religious or moral beliefs.
Regarding the requirement of referral to another health-care provider to provide a service that goes against a physician’s moral or religious beliefs, it is important to note that if a physician is unable to provide a certain service for moral or religious reasons, even to refer a patient for such a service may violate the physician’s conscience. In legal cases outside of the healthcare profession, it does not matter whether a crime was committed directly by an individual, or whether that individual simply facilitated the crime being committed by another individual. The facilitator is also culpable, at least to a certain extent. While the elements of health care in question would not be considered criminal in a court of law, for the physician with moral or religious objections, facilitating these services through referral would still place some responsibility on the physician, thus contravening his or her own moral or religious standards. Previously, physicians with moral or religious objections to providing or facilitating certain services have been required to state these limitations clearly, continue to provide information regarding all the options, and give the patient the option of seeking care elsewhere on that particular issue, without discriminating against them and without refusing to provide other aspects of care to the patient. I believe that this should remain the case, and that physicians should NOT be required to refer for services that contravene their own moral or religious beliefs. An exception to this may be related to the second point, where under very specific circumstances (e.g. imminent threat to life) referral may be a patient safety issue and thus may be something that should be required. However, these would be rare circumstances and ought to be the exception rather than the rule.
Regarding the second point, patient safety is, of course, very important, and no physician would argue with the need to prevent imminent harm, suffering and/or deterioration of a patient. However, without very clear definitions of what “harm, suffering, and/or deterioration” mean, this is open to very broad interpretation, and places physicians with conscience-related conflicts in a very vulnerable position. I would argue that in cases where patient safety is truly in question (and again, this need to be defined clearly and strictly), perhaps urgent referral should be required, but it ought not to be required that the physician him or herself provide that care unless there truly is no other option.
Canadian physicians (Ontario included) are a diverse group, and there are many physicians of faith, with deeply held religious convictions. To require them to go against these convictions would result in a few possible outcomes, none of which would be desirable:
1) The physician may follow the policy, going against his/her deeply held religious or moral beliefs, and then suffer from guilt, shame, or a sense of failure. This could lead to long-term psychological suffering on the part of the physician, and also predispose the physician to burnout if he/she is consistently required to live with the tension of being required to do something that he/she is opposed to on moral or religious grounds.
2) The physician may not follow the policy, risking disciplinary action, and thus the province risking losing, either temporarily or permanently, a physician who otherwise is providing excellent care for his/her patients
3) The physician may decide that he/she cannot practice in a province where it is required for him/her to go against his/her conscience, and thus leave Ontario and seek to practice medicine elsewhere where he/she still has that freedom. Again, good physicians lost in an era where physician shortage is an issue.
Does the CPSO really believe that requiring physicians to violate their consciences is a viable path to take? I would submit that Canadians/Ontarians want doctors who are people of conscience, and to take away the freedom of conscience from physicians is a grave mistake. I would ask that these points be removed from this policy and that they be replaced by alternative statements that still allow for physicians to maintain their own moral integrity.
No doctor or medical practioner should be required to perform a procedure that they believe to be ethically or morally wrong. Nor should they be compelled to refer a patient to someone who does. We must protect the individual’s right for freedom of religion and all that entails and how their religion affects their work.
I am writing today to offer comments with regards the draft policy entitled “Professional Obligations and Human Rights”.
Firstly, I share with the CPSO that patient care must of the paramount priority and protection of patients from discrimination is a necessary component of good patient care. However, I am gravely concerned that the implementation of this new draft policy would in fact do damage to patient care in Ontario without adding the desired protection of patients from discrimination.
[Name omitted] , Chair of the CPSO Policy Working Group has publicly stated that physicians who are unable to comply with the policy should think about whether they should be practicing family medicine. Many physicians in this province have deeply held moral beliefs that certain practices, such as abortion, are wrong and hence cannot be included in their practice, should their practice be carried out as one they know to be morally upright and focused on patient care. Forcing a duty to refer for procedures one is unwilling to perform oneself is not arriving at a middle ground, rather, it forces physician participation in that which they have judged to be morally inexorable. Physicians, who previously practiced without fault to patient care, will be forced to leave a practice that can no longer achieve moral accord- as predicted by [Name omitted]. Alternatively, our physicians may decide to comply with the CPSO’s requirement and participate in an element of practice that goes against deeply held beliefs; such interior conflict will undoubtedly lead to physician burnout. Either way, Ontarians will suffer the loss of their well-qualified family physicians, and hence, compromise access to good quality, sustainable patient care in the province.
Consider too that there are members of the public who share their physicians’ moral framework and appreciate the opportunity to access medical services from a physician who they deem to be morally upright. Medicine is both a science and an art. A patient is best served, and the public best protected, when a physician masters both the art and science of medicine by carefully examining the clinical scenario within an ethical framework. We want our physicians to be practicing in a manner that fully engages their ethical reasoning; this ethical reasoning cannot be separated from a physician’s moral and religious beliefs.
The CPSO must reconsider what it defines as “discrimination” in their draft policy. The Ontario Human Rights Code prohibits discrimination against the public based on protected grounds, such as age, race, sex, sexual orientation, disability, or family status. This means that one must not deprive one group of services one provides to others. The Code does not dictate what services must be delivered. If a physician chooses, for moral reasons, not to prescribe a pharmaceutical, there is no discrimination if the same decision and practice is applied to all his/her patients equally, that is, without discrimination.
We must draft a policy that maintains physicians’, as well as patients’, rights as defined by the Charter of Rights and Freedoms in order to avoid systemic discrimination based on conscience or religious beliefs. Any policy that is effected by the CPSO that will limit a physician’s Right to Freedom of Conscience and Religion by forcing a duty to refer or provide a service is in affronts with what Canadians’ value as set out in the tenets of Canadian law. Consider carefully this draft policy. I urge you not to compromise the Canadian value that all must be protected under the Charter of Rights Freedoms, including the providers of services. Please, protect our physicians’ freedom from systemic discrimination.
I am writing to you regarding your proposed draft policy. Sections 8, 10 and 11 suggest that physicians who decline to participate in certain acts for reasons of conscience should be compelled to refer their patients to other physicians who will perform these acts.
I have a concern about the proposed content. If physicians will be “forced” to refer, they obviously become limited to their freedom of conscience. If we truly live in a free society, I expect that you will consider to revise the sections mentioned and include clear guideline as to the rights of freedom of conscience for all physicians.
I realize that it is very difficult to define in our society today as to what constitutes a moral act — but if a physician believes and finds a certain act to be against his/her own beliefs, they deserve to be able to stand by that belief and to continue to practice in confidence. If they are forced to refer, they stand to loose the integrity of the therapeutic relationship between doctor and patient. This may lead to increased stress, added negative pressures, and depression.
Physicians, as professionals, who have worked so hard to achieve their positions, and have invested so much of their time and money into education and now sacrifice so much of their own lives to help others, should be allowed to respect their own consciences.
Thank you for your time, and I hope to see that the draft policy on professional obligations and human rights come to include guidelines to respect the freedom of conscience for all physicians.
I have a few comments regarding the questions on the survey put out regarding the proposed Physicians and the Ontario Human Rights Code policy and the definition of discrimination.
* 8. Where physicians limit the health services they provide due to their moral or religious beliefs, the draft policy states that they must do so in a manner that ensures access to care.
That is like telling a parent they must refer a child who wishes to die or have an ear cut off or a leg or etc. to someone who is willing to fulfill their wishes. A parent as well as a Doctor is not called to fulfill a person or people groups wishes but rather to care for those who are in their care especially those who are clearly not able to make wise decisions for themselves and to protect them even from themselves if necessary.
* 10. Where physicians limit the health services they provide due to their moral or religious beliefs, the draft policy states that they must do so in a manner that protects patient safety.
Allowing the taking of life as an option for preventing suffering is open to all manner of abuse. Who are we to say that a child or teenager or person of any age who has mental suffering is not actually suffering more than someone who is suffering physically. We cannot make a life and death decision subjective to an individual or individuals, it is not a decision that is ours to give. Our responsibility is to provide relief from suffering mentally and physically – Yes. Through death – No.
The definition of discrimination is open to too many loopholes. It would allow any criminal group to claim discrimination. There are many valid reasons for discrimination. That is what our countries laws define. This definition outlaws all discrimination and with it all our countries laws…
To whom it may concern,
I believe that doctor’s should have the right to hold onto their personal values and beliefs. They should not have to be forced to go against what they belief as they too have human rights.
Thank you for hearing me out,
I would like to express my objections to the term ” effective referral” as used in your new draft document…”where physicians are unwilling to provide certain elements of care due to their moral or religious elders, an effective referral to another health care provider must be provided.”
A mandate for an effective referral is a violation of a physician’s rights, as it compels the physician to violate his own conscience by being a participant in the very act, the very procedure to which he objects to in the first place.
I am writing this email as a manner of feedback on the “Professional Obligations and Human Rights” policy draft. I am an Ontario resident. I am 2 months shy of completing my Bachelor of Nursing.
In response to this policy, I agree that patients’ interest and safety should be of utmost priority to a physician and that a person should never be treated with less dignity based on their race, sexual identity, religion, creed, etc.
However, denying a patient a service based on the physician’s moral code is not a discrimination on the person. Rather, it is about the physician. If a physician states they are unable to prescribe a procedure or medication to a patient for a particular use because of the physician’s moral code, the physician would give that response to any patient, regardless of who they were. It is not a form of discrimination because it has nothing to do with the one asking for it. Rather, it is because the physician does not believe this action to be in the patient’s best interest, which is why they are morally opposed to it. This physician may not be part of an organized religion, for which they could appeal to the “Limiting Health Services for Legitimate Reasons” section of this policy.
Granted, surely there are times that freedom could be abused. As with all things, it could be used to hurt patients, judge or belittle them, etc. However, the cost is far greater to encourage the physicians of this province to ignore their own morality. How can we ask doctors to practice this way? How can they simultaneously seek out their patient’s best interests while ignoring their own conscience? How will they be able to advocate for their patient’s rights when family members, or those in higher authority advocate against them if they are forbidden from letting their moral code guide their practice? As a member of the health care team, I truly believe that this policy is dangerous to enforce. By forbidding doctors to utilize their morality in practice, I think we will gradually see an end to doctors voicing their concerns and advocating for their patients’ best interest, and instead will merely act as they are told. Institutions spend a great deal of time and resources to ensure that their accepted medical students are good people; not just that they are intelligent or hard working but they have integrity and sound moral character. It seems a waste to throw it away by binding their very moral character that allowed them entrance into the profession.
Subject: Draft Policy “Professional Obligations and Human Rights”
Thank you for the opportunity to provide input into this proposed policy.
I write to express strong concern about the policy’s lack of respect for the conscience rights of all physicians.
As you are likely aware, conscience rights are a “fundamental freedom” as outlined in the Canadian Charter of Rights and Freedoms. On the other hand, access to certain health services from a particular doctor cannot be interpreted as a “fundamental right.”
Doctors must be free of compulsion, and being required to refer patients to other doctors who will do what they find morally objectionable is a participation in the act itself which they disagree with.
With proper notification about the doctor’s beliefs, patients are free to find other doctors who will perform the procedures or offer services that they desire. New or existing patients should be informed early on about a doctor’s beliefs and approaches, and the patient can either accept this, or they can find another doctor. The result of such an approach will likely be that some doctors will lose patients, while some may gain patients because of their positions. Allowing patients this choice should be a goal of the College, rather than a blanket approach that results in moral homogeneity and is contrary to the Charter’s fundamental freedoms.
The conscience rights of medical professionals, perhaps more than any other profession, must be protected. Freedom of conscience is foundational to our free society and must never be limited. Doctors of clear and strong moral belief and standing must be supported for the health of the medical profession.
The College of Physicians and Surgeons of Ontario proposes that the organization “would require all doctors to provide referrals for abortions, morning-after pills and contraception.” There will be no allowance for conscience of the doctors.
God forbid that doctors be allowed to have a conscience!
Surely there are enough doctors willing to carry out these procedures, that those who object on grounds of conscience should be allowed to live their conscience!
This seems like a policy designed to a) have a cookie cutter approach to medicine, and b) No Catholics need apply!
Thanks for the opportunity to comment on the above.
I cannot accept, as a citizen of the Province of Ontario, your suggested proposal regarding patient accommodation by physicians; it is fundamentally flawed.
Never, should an individual’s well-considered, mature,moral stances and constitutional rights be subordinated to a conflicting right without reasoned balancing (which must fully consider ALL accommodations). Diminishing (or undervaluing) the rights of one to accommodate the needs of another is not only unjust, it is an insult to honesty and respect in such a grave matter.
Please, reconsider, re-evaluate and develop an optimal accommodation policy which respects both the professionals’ and patients’ needs.
Please be advised that among millions of other Catholics and Christians, we REJECT the proposed “effective referral” mandate for doctors whose Charter right of freedom of conscience and religion must be respected.
We join Roman Catholics and Christians to say that all human beings must have the right to live.
God is the One who chose to give us life and only God must choose when to take it away.
Keep it simple, have the people that are involved (for example the physicians that have the position of moral issues) have a say in how the draft should be designed and or have a voting process of the involved physicians (all physicians) of Canada to vote on the issues the draft will present affecting the decisions of physicians in Canada.
Do no harm, that also includes the physicians who are serving the patients out there.
There are morality principles that need to be adhered to rather then manipulated by drafting policies that are immoral and force doctors to wayout decisions in their moral beliefs.
There needs to be more accountability by those imposing the draft to those who have strong moral beliefs in this area.
Our country is becoming less free by the day. The unelected judges usurp authority from our elected representatives. They are turning our country into a dictatorship of the minority.
Now we have the college of physicians and surgeons acting in the same manner. I have had trouble trusting doctors for a long time, knowing the hold that big pharma has over them. If the college pushes this through I will have even less reason to trust one. Any doctor practising would probably accept our supreme courts decision on killing patients; and judging by Holland and Belgium’s experience I know that the killing won’t stop at ‘assisted suicide’.
I wouldn’t know if this doctor would kill me, because in his opinion,I was a financial burden on society.
Historically, Hippocrates developed his oath in order that people could trust doctors not to kill them. Before that doctors were for hire as assassins because of their knowledge of poisons. How ironic that we are once again in that position, and some members of the public are so naïve or brainwashed that they think that handing doctors a licence to kill is a good thing.
Doctors who don’t want to kill people should not be forced to do so ,or forced to refer people to a doctor who will. I would want to know the ethical position of any doctor so I would know I would be safe from harm.
I understand that the CPSO recently released a draft policy that would compel doctors to participate in abortion and potentially euthanasia, among other services, even if doing so violates their religious convictions. For as long as there has been a medical profession distinctly recognized as such, it has rested on a guiding principle that lies at its very core, which is to do no harm.
The implications for Canada’s medical industry are chilling. If the doctors who are ethically bound to the sanctity of life – to doing no harm – are driven from practice, what sort of doctors might that leave in their place? I would not be entirely comfortable trusting such doctors with my health and my life, even in the direst of circumstances.
Saskatchewan Pro-Life Association Please, do reconsider ever influencing a Doctor to cause anyone’s death in any way, for any reason. A person who wants to die should have a person assist them to commit their suicide, however this skilled individual can NOT be a doctor. This service must also be paid for by the person who wants to die and NOT by us the taxpayers. Please recall that pre-born human beings were at one time believed to be human. It was once a crime to have an abortion. We now have one pre-born child destroyed for every three live births in Canada. This is why I am certain that assisted suicide can easily grow into Euthanasia. It comes down to our basic human nature. When I have been given an inch I have taken a mile. I know that all the problems of LIFE can be solved by the one solution of Death but I strongly believe we need to offer better options to all of life’s trials than ending that life.
Now that the Supreme Court of Canada (in Carter) has said it is unconstitutional for a person not to have access to physician assisted death (PAD), it is paramount that the final CPSO Draft Policy be modified to protect physician’s conscience rights.
This would be in keeping with both the CMA and Supreme Court’s opinions that a physician should not be obligated to participate in a morally objectionable act such as PAD. It is clear in my mind and logical that a medical referral for such an act makes a person as culpable as doing the act themselves.
I would appeal to the College make these modifications.
As a member of the public, and also a practicing Christian, I believe the preservation of life with dignity is within the rights of every individual in this country, including unborn children, the infirm, and elderly. There are couples who cannot for some reason, conceive and have children, who would love to adopt an unborn child, thus avoiding a killing. Would it not be better for the physician to be able to refer the pregnant woman to an adoption agency, rather than to another physician willing to abort the unwanted child. Physicians have rights and their job is to preserve life. Assisted suicide is repugnant. There are ways to alleviate pain. It would be much better to do this, and let nature take its course, rather than to force a physician to have murder on his conscience. I am afraid our country and province are being led down a wicked spiralling path to ever more and more destruction of human life by these trends.
We as a society will be stepping onto a slippery slope if we force doctors into the dilemma of having to grant people the right to end life. Once started, it will not end & individuals rights’ to death will see boundaries pushed. God help us to see the importance of stopping this before it becomes law.
I am most concerned about your proposal to obligate doctors to forsake their consciences and perform assisted suicide, which I consider to be murder as it now is. The option to have doctors refer is a non option because conscience will still be violated. Better to have patients go to a website to identify those that wish to participate in this awful action. Allow doctors the same freedom being offered to patients, to have a choice. Not only am I disappointed with SCC ruling, but I am amazed that no one in the health Establishment is not speaking out clearly about what is going on with legalized suicide in other countries. Those European with this practice are now killing infants, elderly and disabled without express permission from them. They didn’t start out this way, but there they are. Do you think Canada will be any different? In our pride, the Establishment believe (I think), that human nature in Canada is any different. Once done and doctors are forced to perform these acts, it will only be a matter of time before we are where those European countries are on this issue. Why don’t we learn from what is clearly before us? The European stats are there. I must admit that I am afraid for the future and the lesser value being placed on life. This is a major issue decided by the SCC,and though you cannot reverse that decision, you can give doctors the freedom to choose how they practice their medicine. Do not take away their right. This is fundamentally a moral and therefore spiritual and religious issue for Canadians. Their rights should not be violated either. I believe in a Creator who has placed a high value on human beings. This SCC ruling has negated that concept and is now pushing Canadians to embrace their new value system. It is indeed a sad day for us. In closing, leave the doctors who wish to do no harm alone by creating a website of those that wish to carry out that action so patients can choose where can access this service. Individual choices will still be satisfied. May God help us all. Seems like there is so much death related news going on around us now. This SCC decision is not what I had wished for us Canadians
Please don’t do this to our country, to our physicians, to our health care system and to the weak in this country. Think about the Pandora’s box you are opening here. Legalized assisted suicide in the end will not help those suffering, but will hurt them. It is a slippery slope and before you know it, the “suicide” will be without consent and/or will involve those who would otherwise have a bright future ahead.
I believe giving doctors the right to end life is putting the doctors on a slippery slope of being able to interfere and intervene in innocent patients’ rights to life. Our society has not improved on the Hippocratic oath of the past; it is showing it’s own depravity by taking life into its own hands. Let God be God even when we don’t understand why he allows suffering, and let us truly care for those who are sick instead of cheapening life by ending it when the going gets rough.
In this day and age of rights, why are some people’s rights more “right” than others? Why does a patient’s right to die, come before a doctor’s right to live by his/her conscience? Personally, I would feel safer in the care of a doctor who believes in doing no harm, than one who is willing to do something to help me die…I think going in the direction of physician assisted suicide is a mistake.
I just want to voice my opinion that I am against doctor assisted suicide and I want doctors who have moral convictions to have the freedom to deny assisted suicide and even the freedom to deny refering a patient to another doctor for assisted suicide.
Mankind is created in the image of God. We are not dogs that can be put down. This is a slippery slope. Don’t physicians swear an oath to do no harm. Then why kill people? This is outside of the job description. Doctors are not mercenaries.
I believe the effective referral of patients to other health care providers, infringes on the rights of physicians to decide the most effective treatment for patients in their care. Physicians should not be forced to chose between their moral and religious beliefs when providing care as I believe those are the basis of an effective treatment plan
I note from the Feb 6, 2015 Supreme Court of Canada ruling that: “The physician’s decision to participate in assisted dying is a matter of conscience and religious belief” (para. 132)
The CPSO should follow the intent of this ruling and not force physicians to extinguish their conscience to refer or perform procedures against their conscience.
I suggest that information on what procedures or treatments a physician does not perform be available on the CPSO public website. The public can then be free to choose physicians who provide the services that they need. This would respect a patient’s desire to have services they need and the conscience rights of the physician.
This information can be gathered from each physician on their annual CPSO license renewal with a new optional section that will be put verbatim on the CPSO website under that physician’s public information under the new heading “Practice restrictions”.
I am writing to express my opinion on this proposed policy. With the recent Supreme Court decision on physician assisted suicide the ground has shifted on us all. It is time that the CPSO rescinds this proposal and start over. It was one thing to sanction Catholic physicians for refusal to prescribe a morning after pill or refer for abortion, it is quite another to have our College and colleagues enforce state sanctioned violence towards patients. In our country, despite citizen’s differences on the morality of killing another in the time of war we still allowed for conscientious objectors. Ironically, many of those were allowed to serve as health care workers as an alternative. Now we are risking with this policy that those who have a pacifist position would be forced not just by patients but by our own College to put their professional status in jeopardy.
As an example, a physician working in a nursing home or as a director could be forced to choose between keeping his privileges or making referrals for assisted suicides/euthanasia for his patients if they were not willing to offer this “service”. I presently work in a Home for the Aged and this policy has weighed on my decision to continue to work in this field of practice.
Would I be disciplined if a depressed patient asked me to perform PAS and I declined? What if that same patient reminded me that their privacy rights forbade me from telling their family of their suicidal wish and I was willing to perform PAS? Would I be disciplined by the college when their family makes a complaint. Would I be disciplined for not putting a suicidal patient on a Form 1? What about an incapable patient who’s care giver wants to report me for not easing their loved one’s suffering ( no legal definition that is not subjective) by mercy killing?
Your policy as proposed is simply too dangerous to our profession and good care. It is time to take a step back and allow for the safeguards and legal opinions to be worked through rather than push through an agenda that seems poorly thought out.
Please pass this message to:
College of Physicians and Surgeons of Ontario,
I, as a Christian Canadian, find it deplorable that
you are considering forcing Pro-Life doctors to perform abortions
or assisted suicide. They are CANADIAN and have a right to act according
to their consciences. They are not harming anyone. Punish them, for what?
STOP this insanity NOW, PLEASE!
I do not agree with the Professional Obligation and Human Rights policy. It impedes physician freedom of conscience. I live in Ontario and think that our physicians should be able to practice medicine in a conscientious manner. My daughter is a family physician and she should not be required to perform services or prescribe medications or make referrals that she does not morally agree with. Physicians are human beings too and their rights need to be protected as well. This does not mean that patient rights will be violated. Both physicians and patients’ rights can be protected.
To the College of Physicians
I agree that physicians should not discriminate against patients, but deciding not to offer certain services in no way discriminates against them. Requiring referrals or requiring doctors to participate in procedures (euthanesia) that go against their beliefs is according to me, not acceptable. The right of freedom of conscience and religion cannot be limited. The policy as is now may eliminate doctors from practice, reduce their sense of of integrity, or force them to leave Canada for a country where their beliefs can be respected. I suggest that the draft remove the articles referring to obligatory referrals or to limiting their freedom of conscience (religion). Physicians are called upon to heal not to harm.
I’m writing to indicate my concern regarding the CPSO’s current policy “Professional Obligations and Human Rights”. I do not feel that the draft as currently written adequately provides for physicians to follow their conscience rights while practicing medicine. I cannot see how obliging physicians to perform medical tasks that are against their own moral code of conduct will be helpful to society, or to our physician work force. Physicians should never work “mindlessly” – whether that be in the application of specialist guidelines, considering the suitability of further testing, or other matters of life and death.
We are privileged to come alongside our patients in providing care that does no harm, is not negligent, and serves their best interests. For myself, part of this high standard of medical practice necessarily involves moral decision-making regarding what is safest and best. This can be viewed as paternalistic or in opposition to patient-centred care, but I strongly feel that it is in fact what makes for excellent, caring physicians.
I do not have any interest in abusing the position of power and privilege that physicians occupy in the lives of their patients. I do wish for my patients to experience the best that medicine can offer, in a free and just society. I sincerely hope that the CPSO balances the rights of my patients to the care they deserve, with my right to practice in a manner that is internally consistent and holistic. It would be unconscionable for me to practice in any other manner.
I sincerely thank you for your consideration, and look forward to seeing further revision to the Professional Obligations and Human Rights policy that better balances the rights of physicians and patients in this challenging area of medical policy.
Thank you for seeking public consultation on this very important proposed document. It is certainly true that physicians should not discriminate against patients or show partiality and differing care to different patients. Physicians should keep patient care as the highest priority.
The draft in its current state implies that physicians would be discriminating against some patients if physicians did not provide or refer for certain services due to moral or religious beliefs of the physician. However, such conscientious objections would not be discriminatory, because such services would not be provided to any patient of the physician. This is different than providing services at times to some individuals, but not to others, for reasons such as ethnicity. For example, as a restaurant owner, it is not discriminatory to own a restaurant and not serve pork to anyone, including someone who would request to eat pork, because as a restaurant owner your religious belief may preclude preparing and serving pork. This restaurant owner is not discriminating because he is not selectively choosing to serve pork to some, but not to other patrons.
To require a referral from the health care provider is just as morally convicting to the provider as performing the service, as the physician would be formally facilitating the treatment in conflict with his/her moral or religious beliefs. When a physician has the moral conviction that an abortion or physician-assisted suicide is the wrongful taking of human life, to refer for such is to be a complicit in this act.
The proposed policy will limit physicians’ freedom of conscience and religion as guaranteed in the Charter. Unfortunately, this document will fail to ensure that physicians perform their duties ethically, but instead, force physicians to perform or prescribe treatments against their moral and religious convictions or risk disciplinary action from the college because of their religious convictions. If this draft were to be approved in its current form it would place limitations on the freedom to practice religion, while also practicing medicine. For physicians who have religious convictions which preclude them from participating in abortion or physician-assisted suicide, this would force them to move their practice out of province or give up practicing medicine altogether.
Physicians have a right to freedom of religion as much as any other Canadian. A patient’s desire to access services such as abortion or physician-assisted suicide does not render a physician’s right to freedom of religion invalid.
As a governing college, we hope that you will protect the rights of the physicians you govern just as strongly as you protect the rights of the patients they serve.
Subject: Draft Policy “Professional Obligations and Human Rights”.
I am writing to express my grave concern regarding the content of your proposed draft policy. Sections 8, 10 and 11 indicate that should physicians decline to participate in certain acts for religious or moral belief, they will none-the-less be mandated to refer their patients to other physicians who will perform these acts. In compelling physicians to refer, you are limiting their right to conscientious objection.
Quality of patient care will be impacted should this draft policy be accepted without revision to the aforementioned sections. Physicians who feel forced to participate in procedures that go against their beliefs may experience burnout, suffer from a lack of integrity and may even decide to leave their practice. As a member of the public, I want to be served by physicians who are allowed to follow their conscience.
I strongly encourage you to revise the sections above, and include a clear defence of the right to freedom of conscience for all physicians.
Dear CPSO,
I am writing to you to express my concern over the CPSO’s recent draft policy entitled “Professional Obligations and Human Rights.” I think this policy, while sound in parts, is highly misguided in other respects. The major area of concern is the portion of the policy stating that physicians shall be “required to refer for procedures that are against their moral or religious convictions.”
Firstly, there is no need for this clause. Physicians in Ontario who have ethical objections to various medical acts have been getting along quite well with creative compromise solutions, as befits a tolerant, multi-cultural society. There should be room for a wide range of ethical opinions in the Ontario medical community.
Secondly, the clause likely violates the Canadian Charter of Rights and Freedoms, which names the freedom of conscience and religion as one of the paramount principles of Canadian law. The CMA itself recently asserted a physician’s right to conscientious objection. It is in fact abusive of the CPSO to suggest that all physicians must park their codes of ethics at the office door, and the proposed policy simply goes against all historical and legal precedent.
Finally, I note that the policy would impact patient care, make no mistake about it. If passed, and legislatively enforced, I know a number of physicians who will cease practice, move, or burn out due to the tension between personal beliefs and professional requirements.
In light of the above, I ask you to oppose or revise the CPSO’s draft policy.
In accordance to the recent Supreme Court of Canada’s decision to move forward with the law of physician assisted suicide, I would like to write to you about my concerns. If possible, can the law be altered so the integrity and basic human rights of doctors who believe its immorally right to assist a patient with suicide, be excused or exempt from the practice without punishment by the facility.
Please do not promote assisted suicide and abortions in our Canadian society. Keep our medical profession to save life and promote good morality. Doctors have values and morals.
I am very concerned about the proposed draft policy requiring physicians to violate their conscience and perform or refer patients for services to which they morally object. I believe that, if this policy would be put into place, some of our best and most caring physicians would be forced to move their practices or change careers. My own family doctor, who is an excellent and caring physician, would be forced to either go against her conscience (which is not an option for her) or close down her practice. As a patient, I sought her out specifically because I felt I could trust her, since I knew that her morals and views on certain issues were similar to mine.
Part of establishing trust in the doctor-patient relationship is knowing that the doctor truly cares about their patient’s well-being and that they would not recommend something that they believe would do more harm than good. If they were forced to perform or refer for something that they believed would gravely harm or kill a patient, how can they truly be caring and looking out for the patient’s welfare? And, if they were to do so anyway, they would tend to distance themselves from the patient and undoubtedly be suffering due to not being true to their own moral values. Physicians are, after all, citizens of this country, and should be able to practice medicine while still having their rights to freedom of conscience and religion respected.
Most physicians go into medicine in order to help people be as healthy as possible and to save lives. Performing abortions or euthanasia does not save lives, it only kills lives, and should not be required of anyone in the medical field who objects to it on moral grounds. Furthermore, for many physicians, referring to someone who would perform such a “service” would be like morally objecting to execute a patient, but sending the patient to be executed by a colleague instead. How could a physician who violates his conscience be trusted? Do not forget that physicians must first and foremost abide by the Hippocratic Oath, which is meant to represent their “selfless dedication to the preservation of human life” (University of Ottawa Faculty of Medicine website).
Forcing physicians to act against their conscience would discriminate against physicians who practice with integrity. I urge you to modify your drafted policy to allow Ontario physicians to practice according to their conscience, as well as remove the requirement to refer if it violates their conscience.
Dear Sirs:
As a family physician, having had licensure in MB, SK, and now AB at various times since 1996, it is with great concern that I learn of the proposed by-law introduced in ON.
While it is true that procedures and services such as abortion (and perhaps physician assisted suicide in the not to distant future) are legal and publicly funded, our profession must not force its members to violate conscience in the practice of medicine. It is one thing to say that the physician must notify the patient of all available options and to explain which ones the physician is comfortable providing. It is quite another to force the physician to be party to the provision of a service (whether by direct service or by referral with the expressed purpose of obtaining the same service) which to him/her is against personal moral conviction.
Such a regulation forces the physician to choose between continuing as a medical practitioner without any true moral convictions (after all, convictions that are compromised are not true convictions at all) or cease to practice medicine.
Is it the desire of the ON college to force its pro-life physicians to make this type of decision? If that is the case, then the message being sent is that truly pro-life doctors (or prospective students of medicine) are not welcome in Ontario.
I would propose an alternative: if the doctor is unable for reasons of conscience to provide a service, he/she would provide the name of a doctor or office that is taking new patients (which may be a walk-in clinic) so as to seek that type of service. In the words of one of my former medical school professors “The patient is not powerless–he/she did come here!” Alternatively (especially in the case of a hospitalized patient), the care of the patient could be transferred to another doctor.
Whatever the solution (the above suggestions are only two possibilities), one must not be forced to violate conscience and break the oath taken which says:
“Nor shall any man’s entreaty prevail upon me to administer poison to anyone; neither will I counsel any man to do so. Moreover, I will get no sort of medicine to any pregnant woman, with a view to destroy the child.
Further, I will comport myself and use my knowledge in a godly manner.”
Good evening. I write to you to object to the draft policy being proposed for permanency by the College of Physicians and Surgeons of Ontario (CPSO) entitled “Professional Obligations and Human Rights”.
Sections 8, 10 and 11 suggest that physicians who decline to participate in certain acts for reasons of conscience should be compelled to refer their patients to other physicians who will perform these acts. It does not address the fact that many of these same physicians will find the act of referral itself objectionable, as they consider it material cooperation with the act. In compelling physicians to refer, you are limiting their right to conscientious objection.
You state that physicians Rights and Freedoms under the Charter for rejecting morally and religiously objectionable procedures will be subject to a courts ruling on “trivial nature” and “substantiates” (line 125-126, draft policy). Your corollary, implied in line 128, that the physicians Rights would therefore, possibly, not be protected is incredibly flawed: you are passing judgement on such morally and religiously reprehensible procedures as being trivial. That is not for the CPSO to decide, as you state in line 76-77, or lines 82 and 84. Citing applicable law (footnote 13) only supports the nature of the courts to decide, not the CPSO. It is expected (certainly my opinion) that morally and religiously reprehensible procedures will NOT be considered trivial or insubstantial by the courts. Abortion, early end-of-life and birth control procedures certainly have not been treated trivially in the past.
If equitable “care” is the goal, then questionable and morally/religiously reprehensible procedures does not fit the definition of “care”. The word “care” implies “healing”. By that logic, such morally/religiously reprehensible procedures should not be subject to the physicians responsibility to provide “care”.
When I graduated we repeated a version of the Hippocratic Oath. When my daughter graduated a year ago, she did as well, and any physicians looking on were invited to join in. My understanding of both versions was that I would not knowingly do harm to a patient. As a practitioner who tries to consider the physical, psychological, and existential (spiritual) health of patients, I would not want to be made part of actions that could cause harm in any of those areas.
I hope that the College of Physicians and Surgeons of Ontario will not ask physicians to retract oaths made in good faith, nor to violate conscience, nor to tread on their protected rights of freedom of religion as they practice with personal integrity to the best of their abilities.
As something more than a promise, an oath cannot be retracted. The taker of an oath calls on God as witness to punish him with any curses made in the oath if he breaks it. I took an oath when I married to always be faithful to my wife. She made a similar oath.
To whom it may concern,
Although I understand your desire to give all patients equal access to all health care services in order to uphold their human rights, it cannot be done at the expense of the doctor’s rights and freedoms. I refer in specific to doctors being required by law to refer for abortion, birth control or any other service that is in direct opposition to their religious beliefs.
A doctor takes an oath to “do no harm” and to refer for an abortion is harming, nay killing a human being, a patient under the doctor’s care (when a pregnant mother comes in the doctor is serving two patients). To force that doctor to go against his or her conscience is to take away their freedom of religious belief and to undermine the Hippocratic Oath taken by the same.
Please do not violate one person’s human rights in order to accommodate that of another.
Physicians should have the right to say no to providing certain forms of treatment. However, I’m particularly concerned with the requirement that physicians provide referrals for treatments which they feel are morally and ethically wrong. If a physician feels a treatment is morally and ethically wrong, then aren’t they still violating their conscience by asking someone else to perform the procedure? How is the physician’s right to freedom of conscience being protected under these circumstances? In addition to this, a physician might feel that if a procedure is morally wrong it would also be harmful to the patient. Under these circumstances the physician would be violating not only their conscience but also their hippocratic oath by referring the patient to someone else to perform the procedure.
I am writing to you with grave concern regarding the content of your proposed draft
policy. Sections 8, 10 and 11 suggest that physicians who decline to participate in certain
acts for reasons of conscience should be compelled to refer their patients to other
physicians who will perform these acts. It does not address the fact that many of these
same physicians will find the act of referral itself objectionable, as they consider it
material cooperation with the act. In compelling physicians to refer, you are limiting their
right to conscientious objection. You are insisting that they be complicit in murder.
There is significant disagreement in our society as to what constitutes a moral act, and I
do not expect the College to define or limit morality. All I expect is that physicians, as
professionals, be allowed to respect their own consciences. Freedom of conscience is
foundational to our free society and cannot be limited, even for the best of intentions. If
we coerce physicians into violating their consciences we will inevitably erode the
personal integrity which is the basis of the physician’s relationship with their patients.
I encourage you to revise the sections above, and include a clear defence of the right to
freedom of conscience for all physicians.
I recall when we were promised that no one would be forced to work on Sunday’s.
Obviously, the reality is different. Just one example of many consequences to what was
thought to be a good thing by some. This action follows the same course. Do not limit a
doctor’s right to act morally.
It is a disservice to society. You will ultimately cause the loss of many more good doctors
from choosing this career.
This is to inform the .CPSO that I reject the proposal by the College of Physicians and Surgeons of Ontario and anywhere else “Where physicians are unwilling to provide certain elements of care due to their moral or religious beliefs, an effective refe…
To Whom It May Concern:
I write this with regard to the proposed Professional Obligations and Human Rights policy. I write this in the context of being a rural family physician, who also practices in rural emergency departments, and has significant concerns about the draft policy.
First, let me state that I understand the importance of respecting the rights of patients. However, designating certain things as ‘rights’ places a corresponding ‘duty’ on another party, in this case the physician.
I also understand the concerns about avoiding discrimination. Discrimination on inappropriate grounds should absolutely be avoided. However, there are two points I would make. First, not all ‘discrimination’ is bad – I ‘discriminate’ on the basis of sex when I don’t offer my female patients PSA testing, or my male patients Pap tests. This ‘discrimination’ is better known as clinical judgment, and I feel it blurs discussions to simplify it to “Discrimination is bad.” Second, there is a difference between discriminating against a patient and discriminating against a procedure. Not offering a particular treatment or procedure to any patient is actually treating them all equally, the opposite of discrimination. For example, the clinic where I currently work has a policy of “No medical marijuana.” This is discriminating against medical marijuana, not against chronic pain patients, even though this is who it potentially affects. Under this new policy, a patient to whom I refuse to prescribe medical marijuana could potentially argue that I am discriminating against him or her on the basis of ‘chronic pain disability’ by not providing a legalized medical service – does this not contradict your own policies (at least as of 2006, the most recent policy on the website) that a physician is not obligated to support a patient’s request for medical marijuana?
I read the letter you submitted to the National Post dated January 23, 2015 regarding this policy where you stated a spokesperson was misquoted as saying “Physicians unwilling to provide or facilitate abortion for reasons of conscience should not be family physicians”, and clarified that a physician is instead expected to provide an “effective referral”, defined as “one that is made in good faith, to a non-objecting, available and accessible physician or other health care provider.” While I accept your spokesperson did not state the original quotation, I would appreciate your definition of ‘facilitate’ as the definition of ‘effective referral’ seems to be exactly that. Therefore, if a physicians is unwilling for moral or ethical reasons to provide an ‘effective referral’ for abortion, i.e. facilitate an abortion, it seems under this policy that the physicians is in fact in the wrong profession, as they are not able to fulfill their ‘duty’ to fulfill another’s ‘rights’. It seems to me the statement was accurate, though the attribution was not.
I also have no doubt that you are aware of the recent Supreme Court judgment striking down legal prohibitions to “physician-assisted dying”. The concerns of the above paragraph apply in the same way to this issue. In addition, section iii. Protecting Patient Safety raises another concern in the context of euthanasia. “Physicians must provide care that is urgent or otherwise necessary to prevent imminent harm, suffering, and/or deterioration, even where that care conflicts with their religious or moral beliefs.” As I previously stated, I work in rural emergency departments. If a competent adult arrives in my department who“has a grievous and irremediable medical condition (including an illness, disease or disability) that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition” (per paragraph 127 of the judgment), and is presenting for the reason of the intolerable suffering, no matter my moral stance on the matter, it could be reasonably interpreted that I would be required not only to present euthanasia as a legitimate medical option, but potentially be required to administer such to prevent “imminent… suffering”.
In other words, does this policy require that I be prepared to offer to kill and to actively kill my patients, should they so choose? I did not enter medicine to kill people.
There used to be another policy of sorts in medicine. It was called the Hippocratic Oath. It read in part, “I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan; and similarly I will not give a woman a pessary to cause an abortion.” It seems that any physician who adheres to the statements of the Hippocratic Oath will be placing themselves in professional jeopardy under the proposed policy.
If it is not yet clear, I am opposed to abortion and euthanasia. Should this policy be passed, I will be in a difficult position with limited options. The first would be to completely change my scope of practice to remove myself from the possibility of being forced into an immoral and unethical position. This would mean ceasing to practice as a family physician and emergency room physician – and this would be a loss of a much needed (and greatly appreciated according to my patients and colleagues) rural physician. Alternatively, I could move to a different jurisdiction that does not mandate participation in such acts, so while the profession as a whole would not suffer the loss, Ontario still would. Or I could cease to practice as a physician altogether.
I would prefer to not be forced into making one of those choices. I also suspect I would not be the only physician taking one of those options. Just because something is legal does not make it moral or ethical, as history easily shows – I think it very unwise to force out physicians who are willing to take a stand.
I hope you take these thoughts under consideration and make substantial revisions to your draft policy prior to considering it for adoption. Thank you for taking the time to read this letter.
Excellent letter! Here is my attempt to list its main points:
(1) Granting the patient a right imposes a corresponding duty on the physician.
(2) Clinical judgement or discrimination on appropriate grounds is good and right.
(3) Discriminating against a procedure is the opposite of discriminating against a patient. At least as recently as 2006 CPSO had a policy allowing discrimination against medical marijuana. Because the new policy fails to recognize the distinction (discriminate between) a patient and a procedure, it will actually promote discrimination against the patient.
(4) The new policy limits freedom of conscience. It requires, at the minimum, effective referral. Effectively referring for abortion is facilitating it. By implication–despite CPSO’s refusal to make the connection–physicians unwilling to provide or facilitate abortion for reasons of conscience should not be family physicians.
(5) The new policy limiting freedom of conscience requires care necessary to prevent imminent suffering. The Supreme Court recently made euthanasia valid care. By implication, physicians unwilling to offer or perform euthanasia for reasons of conscience to any competent adult fearful of intolerable suffering should not staff emergency departments.
(6) Some doctors entered the medical profession before it required them to potentially kill people. In fact, they took the Hippocratic Oath and swore that as good physicians they would not force or facilitate abortions, nor would they offer or perform euthanasia.
(7) This new policy forces a significant number of much needed and greatly appreciated physicians to quit their practice, completely change its scope, or move it outside Ontario.
With respect to your forthcoming “Professional Obligations and Human Rights” policy revision, please respect and affirm the personal integrity , professionalism, dignity, and freedom of conscience of the fine physicians in this province by not forcing any of them to be complicit in procedures that they deem to be in conflict with their moral or religious beliefs. Given the recent Supreme Court ruling on Doctor assisted suicide, we need now more than ever, Medical Doctors who will stand by their moral convictions and with integrity affirm the constituent adage of doing “No Harm”. Please do not attack or trample upon their rights by trying to expunge or limit their moral integrity. They are professionals and we implicitly trust them.
Dear CPSO, concerning the Draft Document on Obligations and Human Rights.
On the two main changes they wish to make………. interpretation of discrimination,
and refusal to treat patients on personal beliefs.
Please recognize that there should always be a balancing of rights. Both patient and physician rights always be respected; accommodation should not be one way!
A physician should never be compelled to act against rational conscience decisions, and that compulsion goes against [ Charter and Human rights.]
I thank the CPSO for being opened to consultation with the public [ I being one of them]
mother,grandmother,and retired HCA.
P.S. Rights themselves should never be limited to a one sided manner in favor of the patient. Both patient and physician should have protection! Personal beliefs and moral stances or “informed conscience”
are not in the same category. Beliefs should not be used in policy documents it is inadequate.
Dear members of the College of Physicians and Surgeons of Ontario,
I support you in your retaining your right to refuse to provide procedures or treatments that violate your moral of religious beliefs WITHOUT being required to provide effective or any other referral to your patients in these instances.
Thank you for this opportunity to provide our input. I believe that we submitted our concerns in 2012. We appreciate that the college accepts existing Charter of rights of freedom of religion and conscience and urge you to maintain this moral stance. Moral stances based on conscience are rational and evidence-based, often reinforced by religious beliefs and deserve protection. As Canadians who live under the Canadian Charter, the United Nations’ Universal Declaration of Human Rights, Article 1 states “All human beings are born free and equal in dignity and rights. They are endowed with reason and conscience and should act towards one another in a spirit of brotherhood”. There should always be a balancing of rights, but we request that both the patient and the physicians rights be respected, accommodation should not be one way. A physician should never be compelled to act against rational conscience decisions, and that compulsion goes against Charter and human rights. We believe that a physician that refuses to provide or perform some procedures is not discriminatory when it is based on a properly informed conscience: that has nothing to do with the patient requesting a procedure, and everything to do with the physician’s decision about the wrongness of those procedures.
Thanks again for allowing us to submit our concerns. We do not want Ontario or Canada to lose doctors because they are being forced to go against their conscience and/or religious beliefs.
I have read the Draft policy of the CPSO – Professional Obligations and Human Rights.
I am concerned in general with the section beginning on page four and continuing to the end of the document dealing with the moral and religious beliefs of physicians.
I wonder when I read that “The right to freedom of conscience and religion can be limited, as necessary, to protect … health, morals, or the fundamental rights and freedoms of others.” how these things will be or are defined? Or should I ask who will define these things: health, morals, rights and freedoms? When these definitions differ between patient and physician I fear there is not much chance that a physicians conscience will be honoured.
More specifically I am concerned with the “effective referral”. If a physicain is obligated to refer to a non-objecting colleague and the eventual outcome of that referral is the very result he or she cannot by conscience provide how is that different from providing the service directly? The referring physcians will still feel that they have participated in the process and not had a true opportunity to maintain their conviction of conscience. This is not really a protection of the doctor’s right to freedom of conscience or religion. Will we lose good, conscientious, caring physians because they are oblgated to act against their consciences and provide or assist through referrals in providing clinical options that they deem inappropriate?
I appreciate the opportunity to express these views and concerns.
To Whom It May Concern
I am writing to plead with you to NOT take away the conscience rights of physicians.
In your list of principles you state that the patient’s best interests must remain paramount. You must realize that the doctor may have the patients best interests at heart when refusing for instance to prescribe birth control; refer for abortion or to kill them (assisted suicide). There are many risks in taking birth control pills. Abortion kills an unborn child and harms the mother (I personally know of 3 such situations where the mothers regretted their abortion and attempted suicide). And forcing doctors to kill their patients or refer them to be killed is barbaric. None of these situations are in the best interest of the patient, even if the patient may think so at the time.
Once again, I beg you, reconsider!
Dear Sir Madam,
I do not believe that the policy addresses the freedom of conscience issue. It seems to deny a physician the right to the exercise of this freedom guaranteed under the charter. A physician is forced to act against his conscience, which is much more than simple “ moral believes”. In today’s world of technology and new methods of communication, there are more than one way to accommodate a divergent positions without initiating conflict between all parties involved.In my opinion, it is not acceptable as it stands, especially when a euthanasia debate has been opened .
I’d simply like to add my voice to the voices of those who defend the right of a physician to follow her/his conscience when asked to provide a referral in the case of a request for an abortion or an assisted suicide. He/she should not be required by law, to provide such a referral if it goes against his/her convictions.
To Whom it may Concern:
I am writing you to express my outrage over the decision to not allow doctor’s to practice medicine according to their consciences. I am very happy to say that I have a family doctor who is currently practicing medicine according to our (his and my) Catholic faith. I choose him as my doctor for this reason, I DO NOT WHAT TO BE FORCED into a decision that would kill me or an unborn baby in my womb. I hope that you listen to my concerns and the concerns of the majority of Canadians living in Ontario and Saskatchewan.
I thank the College for allowing public consultation on this important policy, and I appreciate that the College accepts existing Charter right of freedom of religion and conscience. I strongly urge the College to maintain this moral stance.
Moral stances based on conscience are rational and evidence-based, often reinforced by religious beliefs, and deserve protection.
It should be noted that there is inclusion of freedom of religion and conscience rights in other documents, and that Canadian document should do the same. (Cf., Canadian Charter; The United Nations’ Universal Declaration of Human Rights, Article 1 states: “All human beings are born free and equal in dignity and rights. They are endowed with reason and conscience and should act towards one another in a spirit of brother hood.”(sic)
It is important that there is a balance of rights and both the rights of the patient and physician should be respected; accommodation should not be only one way. The physician should never be compelled to act against rational conscience decisions and any compulsion goes against the Charter and human rights.
Finally, I point to the fact that refusing to provide or perform some procedures is not discriminatory when it is based on a properly informed conscience: this has nothing to do with the patient requesting a procedure and everything to do with the physician’s decision about the wrongness of those.
Thanks you for your attention to this urgent message
As a professional organization, your proposal to force physicians to participate in assisted suicides is repugnant. Freedom of conscience in this matter ensures that patients receive the best care; that those who agree with assisted suicide can administer this service in a caring manner, leaving those who don’t to focus on helping patients in other ways. You are not a Walmart, but rather, a professional organization helping its members. Forcing compliance is not helping; its a cop out.
Patients are often referred by Physicians for “second opinions” when either a serious operation is needed or a certain form of treatment is being considered. I believe that the CPSO has to consider the patient first. While I accept that my physician may have a moral or religious reason for refusing their service that should not preclude me, the patient, from receiving the treatment. Whether my physician refers me to a colleague, or whether my physician agrees to provide the service themselves,the result is the same. As such, I am in full agreement with the CPSO. As a patient, I should never have to worry that my care may be compromised by a physician with their moral or religious issues.
I believe to take away a doctor`s right to say no is discrimination here in Canada. Doctors have the right to exercise their conscience not just patients.
Many are “for life“. You would be forcing doctors to accessory to murder against their will pure and simple.
This policy should be abolished.
Dear Members of the Consultations Committee:
I am a health professional with forty years of experience across the life span inclusive of providing extensive maternity care and also end of life care for many elderly and vulnerable individuals. I have reviewed your proposed CPSO policy titled “Professional Obligations and Human Rights” and am strongly opposed to the planned changes for the following reasons:
First, physicians who decline to participate in certain acts make these decisions based on carefully and rationally formed conscience. This has an honourable medical history going back 2400 years to the School of Hippocrates whose members chose to act unselfishly and only in the interest of the patient and his/her well-being. Such a code of professional ethics & morality encompasses a physician’s entire being inclusive of religious beliefs but not exclusive to them. To refer to this as “personal beliefs” trivialises and makes matters
of conscience and religion into something highly subjective or arbitrary. It should not be the role of the college to create policy that defines or limits morality.
Second, referral to other physicians who will perform the act(s) ignores the fact that these same physicians will consider the act of referral as material cooperation with the act. As an example, would you expect a physician to refer a female infant to a surgeon to perform genital mutilation at the request of the parents? How would you care for that referring physician who had overridden his own conscience at the College’s coercion? How can the college insist on a referral policy that not only limits physicians’ rights to conscientious objection but could also risk their psycho-social & spiritual well being?
Third, although this policy “Professional Obligations and Human Rights” refers to ‘care’ 13 times in the document, healthcare 6 times and health services 8 times, it is important to note the following:
i) By the definitions of both ‘care’ and ‘health’, the physician’s response of declining to provide treatments resulting in death would not constitute ‘impeding’ that individual’s ‘access to health care or health service’.
ii) Similarly, the physician who might attempt to act according to this new policy and follows through with requested treatments such as a lethal dose, in fact denies the individual who requests such treatment access to good care. The physician providing good ‘care’ on the other hand, would not only address physical need for effective pain control but would also assist individuals to find meaning at their ‘End of Life’ and allow them to experience compassionate holistic care.
I hope that it is not the intent of the college to revise policy such that it would interfere with the physician’s professional duty to accommodate each person through the provision of quality care addressing all dimensions of health.
I trust that the college will withdraw this draft of the policy now that it has a clearer understanding that physicians, as professionals must be allowed to respect their own consciences. Freedom of conscience is foundational to our professional ethical practice and indeed our free society and cannot be limited, even for the best of intentions.
Thank you in advance for responding to my serious concerns by letting me know that you will not implement these proposed changes to the policy.
Subject: Draft Policy “Professional Obligations and Human Rights”
Freedom of conscience and religion are fundamental rights that are guaranteed for all Canadians under the Charter of Rights and Freedoms. This, of course, applies to physicians. In particular, physicians must have the right to decline providing certain elements of care that conflict with their moral or religious beliefs. As the body that regulates the practice of medicine in Ontario, the College of Physicians and Surgeons of Ontario has the duty and responsibility to ensure that physicians’ freedoms of conscience and religion are protected.
It is for this reason that I am deeply troubled by your draft policy titled “Professional Obligations and Human Rights.” Lines 156-159 suggest that physicians who choose not to provide certain elements of care must actively refer their patients to health care providers that will provide these services. However, I believe that many physicians will view this act of referral as a form of cooperation with the element of care that they do not support in conscience. This will certainly be the case for a Catholic physician – I can attest to this as a Catholic myself. For example, both prescribing a patient contraceptives and referring a patient to another physician who will prescribe contraceptives are equally against Catholic teaching and are considered by Catholics to be gravely immoral. Forcing this physician to perform such a referral is, in effect, forcing the physician to violate his or her conscience. This is clearly unacceptable. In our democratic and multicultural society, freedom of conscience is an essential right that must be protected.
I urge you to modify this section of your draft policy so that the Charter rights of all physicians will be protected.
I am deeply concerned by this ruling of the Supreme Court of Canada which now allows physician-assisted suicide in this country. I do not think that doctors who in conscience believe they can have no part in this should be mandated to participate in any way; not even to having to refer for it. Therefore I reject the proposal for an “effective referral” mandate.
To Whom It May Concern
I am sending this letter in support of the Catholic Physicians ‘charter of freedom of conscience and religion who should be allowed to make their own decisions reflecting their moral & religious beliefs.
The proposed document “Where physicians are unwilling to provide certain elements of care due to their moral or religious beliefs, an effective referral to another health care provider must be provided to the patient.” Is a violation of a physician’s rights as it compels the physician to violate his or her own conscience by being a participant in the very act the very procedure to which he or she objects in the first place.
Any citizen in this country should be allowed to practise their beliefs. And retain their Civil Rights. What the CPSO is proposing is nothing short of dictatorship and should not be allowed to go through.
I am writing to express my deep concern over and strong opposition to the Professional Obligations and Human Rights draft that is being considered for approval. This policy violates and tramples the rights of physicians with moral or religious convictions. Physicians ought to be able to perform their profession according to their convictions under Canada’s Bill of Rights which allows freedom of religion. In granting freedom of religion to physicians, this does in no way trample the rights of the patient. It is the duty of the patient to find another individual who will do what they ask. The physician ought not to do what is against his convictions, neither ought he/she to recommend someone else who will perform the controversial procedure.
The parish bullein’s request to protest the “effective referral” idea by the College of Physicians and Surgeons of Ontario strikes me as so shortsighted that I am indeed writing–to support CPSO.
While there are always some people willing to go to the wall for whatever principle they regard as “sacred,” most people search for ways to accomodate each other.
When some are advocating that doctors and other health professionals–who are paid from the public purse–be prohibitted from exercising any moral stand in their work, the proposal by the College is a reasonable compromise. “Compromise with evil” is not really laudable, but reality is generally not black-and-white. Canada exists because rabid Protestant and Catholic rivalries were put aside: it was better to “hang together than to hang apart” vis-à-vis a bellicose U.S.A. after their Civil War.
During the ascendancy of communism and fascism, Pope Pius XI said he’d make an agreement with the Devil for the good of the Church. After pondering this disturbing quote, I realized that Vatican City State exists because of the Lateran Treaty, while Il Duce’s regime is long gone. Yes, Cardinal Mindszenty left Budapest, but the Communists aren’t ruling there either. Now there are other “democratic” autocrats drooling for power–but that’s a separate problem.
There will always be demand for immoral and unsavoury things. And others who are willing to supply them. It will ever be thus, so pick your battles sensibly.
The effort by the College of Physicians and Surgeons should be praised and supported. If one can think of a way of improving it, then build on this foundation and move to something better.
I’m a Protestant, and my church’s catechism is very clear (see my emphasis in upper case below) that referral for abortion or euthanasia is a form of murder. We use the Heidelberg Catechism, which was written in 1563.
Question 105: What does God require in the sixth commandment?
Answer: I am not to dishonour, hate, injure, or kill my neighbour by thoughts, words, or gestures, and much less by deeds, whether personally OR THROUGH ANOTHER; rather, I am to put away all desire of revenge. Moreover, I am not to harm or recklessly endanger myself. Therefore, also, the government bears the sword to prevent murder.
I would like to respectfully state my opposition to the implementation of the following measure outlined in the CPSO draft policy:
“As part of ensuring access to care for patients, the draft policy requires that physicians, who are unwilling to provide certain elements of care due to their moral or religious beliefs, refer the patient to another health-care provider.”
My opposition to the proposed changes does not intend to address the ethics of the specific interventions the policy would be likely to address (e.g.: contraception, abortion, technology assisted reproduction and other biotechnological interventions for which there is room for reasoned disagreement). Instead, I would like, to propose that moral principles, informed by religious or philosophical considerations, cannot be separated from other factors involved in a professional decision, specifically in the practice of medicine, without compromising its integrity.
A few practical examples will illustrate my position:
1) A patients with a viral illness insists in requesting a prescription for an antibiotic, even after he has provided with a clear explanations to why this is not indicated. The physician, faced with a full waiting room with other acutely ill patients, will have to decide whether to accommodate the patient wishes, perhaps reasoning that the risk of adverse effects is low, or that the patient will probably obtain a prescription from an other practitioner if refused. On the other hand he might decide to spend additional time to counsel and educate, or as a third option to simply deny the patient his request.
2) A consultant on duty in a hospital department is called at 2 am about an acutely ill patient. He will have to decide, whether to provide a consultation over the phone, or undertake a trip to the hospital, with the prospect of an intense and demanding full day of work starting later on the same morning. His decision will be made both taking into account clinical and ethical considerations, and will reflect his moral commitment to the welfare of his patient, countered by a feeling of exhaustion from overwork.
3) A female patient requests a prescription for the birth control pill for the purpose of contraception. The physician may have considered that cooperation with this cultural practice, currently highly prevalent in western societies, justifies the potential adverse effect of hormonal treatment, and that, as long as the risks have been clearly explained, following the patient’s wishes and the generally accepted standards of practice exonerate him from further responsibility. He may also feel that the treatment will provide the patient with real social benefits, basing his opinion on a broad societal consensus on this issue. An other practitioner might consider the lack of objective evidence for the benefits of contraception in the professional literature, and that contraception does not prevent a pathological condition, but disrupts a healthy physiological process. He regards societal consensus with skepticism, and concludes that the uncommon, but potentially serious and well documented adverse effects of hormonal treatment are not justified, in this case, by substantial benefits.
4) A generally healthy patient in the first trimester of an unintended pregnancy requests a referral for an induced abortion because of personal reasons. The physician might find this practice acceptable on the ground of wider social acceptance, or act on the conviction (of broadly philosophical, ethical, and political nature), that abortions on demand are in fact essential medical services resulting in a benefit for the patient. He may be of the view that a physician is not just a healer, but an enabler of his clients’ autonomous decision. An other physician would decide that he cannot honestly identify to the best of knowledge any possible benefits for this procedure carried out on a healthy women with a normal pregnancy. He would consider that adverse emotional consequences are well documented in women who have undergone abortions, that there are risks inherent to any surgical procedure, and that irreversible, definitive and deliberate harm would be inflicted on the embryo or foetus, whom the physician understands to be a human being in an early stage of development. As a healer, committed to do no harm, he must decline to provide this service. Referral to an other physician would constitute aiding and abetting a harmful (if not currently illegal) intervention.
The issues in the first two examples are straight forward and uncontroversial, yet any practicing physician will have experienced at one point the conflictual aspects of the described scenarios. The two examples that follow, on the other hand, are likely to trigger heated discussions among health care professionals. In all four examples, the physician bases his decision on scientific knowledge, clinical judgment, his evaluation of risks versus benefits, his understanding of his professional role, and the ethical standards he is obliged to adhere to as the member of a profession. I hope this is helpful to illustrate how scientific knowledge, clinical skills, evaluation of risks and benefits, and evaluative judgment based on moral considerations (appropriately referred to as “conscience” whether or not they are informed by philosophical or religious principles) cannot in fact be separated. This is an essential characteristic of any professional practice, especially within the liberal arts. The practitioner has a duty to educate, direct, enhance the freedom and promote the flourishing of his patient in the context of a relationship based on trust and reciprocal respect between equals, rather then simply providing skills or technical know-how in a subordinate role and in response to a customer’s request.
But ignoring the importance of the free exercise of conscience in professional practice has even broader societal and political implications, and I would like to point this out with the help of the following anecdote.
My grandfather practiced neuropsychiatry in Germany in the 1930′s. When the government introduced a program of involuntary euthanasia directed at the disabled and the mentally ill, he resigned his position as a consultant to avoid participating in the terminations. His decision was principled, though economically and professionally ruinous, but he could not prevent the death of thousands. Where were his colleagues at that crucial moment? Why was there no organised refusal to comply with institutional directives, at least by those members of the medical profession who opposed them in principle? How could these policies have been introduced in a country which only a few years before could be counted among the civilised nations? Why did they not follow their conscience and act accordingly? Many lives might have been protected, and later even more iniquitous developments perhaps mitigated. The dignity of our profession would certainly have been upheld.
We are fortunate to live in less troubled times, in a country where the regime does not ruthlessly pursue the interests of a particular group, or affirm the triumph of the individual will at the price of human decency and compassion. The following questions, nonetheless, address core issues in our professional practice here and now:
How will the doctor-patient relationship be affected if physicians are in a position to be disciplined by their own professional body for following their better judgment?
How can trust be maintained within a relationship that is inherently and deeply personal, when the physician is expected to rigidly follow institutional guidelines?
To whom will a patient, by definition a person in distress, turn when he is seeking a healing relationship?
Are we as physicians to continue in our role as professionals, as healers, as practitioners of a liberal art, or become technicians, biotechnology providers, enablers?
In which role are we more likely to serve the best interest of both the individual and of society?
An insightful and edifying piece. Glad I took time to read it.
Thank you, Doctor, for explaining why we must keep in mind that ‘scientific knowledge, clinical skills, evaluation of risks and benefits, and evaluative judgment based on moral considerations (appropriately referred to as “conscience” whether or not they are informed by philosophical or religious principles) cannot in fact be separated.’
We would all do well to ponder seriously the list of questions at the end.
First off, I would like to thank you for the work you have done striving for enhanced patient care and the desire to respect patients’ rights.
Upon reviewing the CPSO’s recent Profession Obligations and Human Rights policy, I would like to share my sincere concern over what is written in this policy. I have listed my concerns with explanations below. I hope you will consider my arguments and revise the policy.
1) Requirement to refer when it goes against your moral or religious beliefs
Lines 156-8 of the policy have serious flaws that require attention. There are multiple issues with the clause based on philosophical and legal frameworks.
Philosophically, the policy has not defined what it means by ‘moral’ or ‘religious’ beliefs. Does this statement mean that any decision made with a moral framework is incorrect or ‘wrong’? Patients expect physicians to practice with moral integrity; shouldn’t the college expect the same from it’s members? Hence, practising medicine without moral integrity is not only concerning, but a slippery slope that would lead to more patient harm. Secondly, why does this policy stipulate those with religious beliefs? Why not stipulate anyone making a decision based upon world views instead? For a religious belief is a worldview just as trying to not be religious is a worldview i.e. atheism. This clause on a philosophical level fails to appreciate how it’s not morals or religious beliefs that determine decisions, but rather world views.
On a legal framework, this is likely the greatest concern. First off, there is no human right in Canada that demands someone to receive a particular service from a specific physician. In fact, The Ontario Human Rights Code prohibits discrimination against others based upon race, ethnicity, sex, sexual orientation, age or disability. However, it is important to understand this means a service can not be provided to one group and excluded from another. For example, a restaurant owner choosing to not offer pork due to a religious belief is not a violation because it does not dictate the service to be provided but rather to whom; either to all or none. Likewise, a physician choosing to not offer a particular procedure or treatment for moral or religious beliefs is not discrimination as long as it’s denied to all and not selectively permitted for certain groups. Hence, the reference in this policy shows that whoever wrote this clause does not understand the application of The Ontario Human Rights Code.
Moreover, federal law guarantees by the Charter of Rights and Freedoms that a person, including physicians, have protected rights that are fundamental. Those rights are free from coercion to act against moral or religious convictions that a citizen possesses (section 2 of the Charter). In fact, this policy also discriminates against physicians’ right to freedom of conscience. This policy is forcing physicians to refer a patient for a procedure he or she believes based on moral, religious and/or medical reasons to be harmful and in doing so would make them morally culpable; this fact is supported by case law. For example, if an accused individual refers a person to a narcotics dealer then the accused is also guilty of trafficking narcotics. Likewise, if a physician has moral or religious convictions that abortion or euthanasia is taking of an innocent life, then the physician who formally refers the patient to be euthanized or aborted then they would have contributed to taking that life. Forcing physicians to act against their conscience, moral or religious beliefs goes directly against the Charter’s protection of fundamental rights of conscience and religion. This section of the policy is a textbook example of systematically trying to disqualify physicians based on religious or moral beliefs. That is the definition of discrimination and appropriate application of The Ontario Human Rights Code. This policy has the appearance of attempting to alienate fellow colleagues from the profession based on a discriminatory effort to promote a worldview which has medicine devoid of morals or religious beliefs. That attempt would be a clear violation of The Charter of Rights and Freedoms.
Unfortunately, this policy also has the appearance of trying not to ensure physicians comply with legal obligations, but rather to compel and even drive physicians out of the medical profession that disagree with the means or ends certain procedures or medications achieve. In fact, I am concerned that this policy actually harms patient care by alienating physicians who practice with moral integrity and hinder patients who wish to be treated by them.
2) Perform procedures even when against beliefs if “urgent”
Line 168 of the policy implies physicians’ right to freedom of conscience is conditional based on the patient’s “urgent” need. There is an essential question the CPSO must answer, do you want physicians to practice with moral integrity or not? If yes, then such a clause is unjustified and absurd to want physicians to have integrity yet go against their moral compass. However, if you say no, then in fact research and epistemology into what makes us human is lost, which is the ability to make moral decisions. By the CPSO removing moral decision making they would have essentially removed that which makes physicians human. Patients want compassionate medical experts, not inhumane machines dictating their medical care.
Lastly, who determines what is “urgent”? The patient or physician? Would urgent assume only if life threatening? There needs to be definitions given or else this is left up to the individual which may lead to more harm than good.
Overall, I urge the CPSO to remove this clause.
3) Not allowed to promote religious beliefs
Line 146-8 is not as serious as my other points, however this clause indicates a double standard. Why is this clause directed only at individuals with religious beliefs? Why not generally towards physicians with any beliefs? Why are only religious beliefs stipulated? In fact, those who claim to not be religious still have beliefs. For example, those stating religious beliefs are wrong is a belief. This clause directly discriminates against all religious expression and freedom of speech which are protected under The Charter of Rights and Freedoms. Hence, a stipulation only against religious beliefs is by definition discrimination. Secular physicians hold beliefs and can promote them just as easily as other physicians. Moreover, all doctors regardless of religious creed, sexual orientation, etc ought to have the same obligations.
Also, will the CPSO go as far to eliminate religious questions from patients’ that they feel may be pertinent to their medical care? For example, a Jehovah’s Witness asking about the implication of their religious beliefs and medical management for a particular illness? Those discussions should not be discouraged, but rather encouraged. The CPSO should be enhancing transparent and open discussions.
In summary, I am greatly concerned by the recent draft of the Professional Obligations and Human Rights policy. Points 1-3 stress on philosophical and legal frameworks how the policy has either purposely or incidentally drafted clauses that alienate and discriminate protected rights, which are freedom of conscience, speech and religious expression. These rights are protected under The Charter of Rights and Freedoms for all citizens.
I urge the members of the CPSO to remove or edit appropriately lines 156-8, 168 and 146-8 to correct these issues. Failure to do so would, in my opinion, lead to an unnecessary and expensive Charter challenge that protects physicians’ rights as Canadian citizens under The Charter of Rights and Freedoms. Most importantly, we all want the same goal, which is to have the best patient care by the most appropriate means. However, physicians will disagree on what should or ought not to be done based on clinical, moral and/or beliefs. Accepting this fact makes us human clinicians. Removing such inherent characteristics to each physician renders them without moral integrity and inhuman. I know this is not what the CPSO or patients want. Lets work together to build a collegial, transparent and open environment respecting the rights and freedoms of patients and physicians.
Good afternoon, I write to you to object to the draft policy being proposed for permanency by the College of Physicians and Surgeons of Ontario (CPSO) entitled “Professional Obligations and Human Rights”.
Sections 8, 10 and 11 suggest that physicians who decline to participate in certain acts for reasons of conscience should be compelled to refer their patients to other physicians who will perform these acts. It does not address the fact that many of these same physicians will find the act of referral itself objectionable, as they consider it material cooperation with the act. In compelling physicians to refer, you are limiting their right to conscientious objection.
You state that physicians Rights and Freedoms under the Charter for rejecting morally and religiously objectionable procedures will be subject to a courts ruling on “trivial nature” and “substantiates” (line 125-126, draft policy). Your corollary, implied in line 128, that the physicians Rights would therefore, possibly, not be protected is incredibly flawed: you are passing judgement on such morally and religiously reprehensible procedures as being trivial. That is not for the CPSO to decide, as you state in line 76-77, or lines 82 and 84. Citing applicable law (footnote 13) only supports the nature of the courts to decide, not the CPSO. It is expected (certainly my opinion) that morally and religiously reprehensible procedures will NOT be considered trivial or insubstantial by the courts. Abortion, early end-of-life and birth control procedures certainly have not been treated trivially in the past.
If equitable “care” is the goal, then questionable and morally/religiously reprehensible procedures does not fit the definition of “care”. The word “care” implies “healing”. By that logic, such morally/religiously reprehensible procedures should not be subject to the physicians responsibility to provide “care
Subject: Draft Policy “Professional Obligations and Human Rights”.
As a registered nurse in long term care for the past 14 years, I have witnessed and comforted many patients who are suffering and dying. I will admit quite readily that this is hard to watch, feeling helpless wanting to do more to ease their pain. The best thing that I can provide is human companionship, to spend the time providing care and compassion for their suffering.
In these final moments, of hours, days, weeks and months that I have witnessed, I have seen the most amazing things happen. I have seen patients struggle with pain lie still when a family member comes to hold their hand and just sit and be still. I have seen the wonderful humour of the dying patient give their family and care givers a good laugh about long lost memories that they shared and are now reminiscing about or joke with them about how much longer they will be around to pester them. I have participated in conversations with patients about their life that they just want to have someone listen to them to express themselves when it seems no one will listen. I have witnessed people in such poor health who can no longer feed themselves or have a understandable conversation be put on palliative care and have their medications stopped only to have them respond and improve so much that they start to be able to feed themselves get up out of bed and have conversations that are completely understandable, expressing their memories, wishes and desires.
Every life is precious, even when it`s difficult to care for. We are all here to provide something to someone in this world. We are all here to leave our mark, when we have done this, and fulfilled our purpose then and only then will our time end.
I am writing to you with grave concern regarding the content of your proposed draft policy. Sections 8, 10 and 11 suggest that physicians who decline to participate in certain acts for reasons of conscience should be compelled to refer their patients to other physicians who will perform these acts. It does not address the fact that many of these same physicians will find the act of referral itself objectionable, as they consider it material cooperation with the act. In compelling physicians to refer, you are limiting their right to conscientious objection.
There is significant disagreement in our society as to what constitutes a moral act, and I do not expect the College to define or limit morality. All I expect is that physicians, as professionals, be allowed to respect their own consciences. Freedom of conscience is foundational to our free society and cannot be limited, even for the best of intentions. If we coerce physicians into violating their consciences we will inevitably erode the personal integrity which is the basis of the physician’s relationship with their patients.
I encourage you to revise the sections above, and include a clear defence of the right to freedom of conscience for all physicians.
Greetings,
May I be brief. Our laws in Canada are based upon Biblical Principles … God knows what he is doing, and is more than a figment of someone’s imagination.
His Word and instruction reminds us that all life is sacred and he has a plan for each individual (Psalm 139). I believe that by laying this responsibility on physicians and support staff to make such a call for patients is putting a burden upon them that will have some very adverse results psychologically. The cost of treatment for staff per case could be more than what we as a people should be responsible for. If the govt. and court want to make this legal, then I would suggest that the presiding judges and governing officials be tasked with the job of “pulling the plug” or inserting the needle. This would at least protect our physicians from such a burden and moral concern.
Another question I would pose is such: Why do we need such a law at this time? I would imagine that the majority of Canadians would not want to endorse such a law if it was put to a vote, with information provided that covers every avenue of this proposed legislation.
As a pastor I see people dying. When people pass away with a clean heart and clear conscience knowing they have dealt with their past and present, and have prepared for their eternity, they look forward to death. HOWEVER, I have also seen the terror and fear of people slipping into a lost eternity when they have denied the basics of faith in God, and have not taken the opportunity to take care of business. I can assure you that at those moments they are feeling the pain and sting of death and they enter into it with a severe struggle. How will our judges and legislators handle this scenario in court when a family believes that something has gone wrong during the medical procedure and caused deep and lasting negative emotions the family will have to deal with … you can be sure that the lawsuits will be forthcoming, and it will place a huge burden on society. The only positive side is the lining of financial blessing for the lawyers who take on this challenge. I can see the lapping of tongues with eager anticipation already from the law society … just waiting to move forward on this.
Thank you for considering these thoughts.
We believe that the one who gives life is the only one to take a life; the dear Lord Himself and that doctors have a right to say no to this procedure!
Regarding the CPSO’s repeated claim that the National Post “misrepresented” the CPSO policy in reporting that physicians were told “Physicians unwilling to provide or facilitate abortion for reasons of conscience should not be family physicians,” I would say (quoting the Bard) “the lady doth protest too much, methinks.” Even if this is technically a misquote, it still accurately captures the essence of what the actual policy as it is written MEANS for doctors – that if they don’t want to be killers or accessories to killing by referring abortions, they will not be allowed to continue to be family physicians in Ontario if they do not comply with the CPSO’s new policy.
[I expect my scholar’s response to the draft CPSO policy was too long. Here is a shortened version. I apologize for any punctuation that did not transfer well that I missed]
It is well said that those who do not learn from history are destined to repeat its mistakes, and the College of Physicians and Surgeons of Ontario (CPSO) has shown great ignorance of history and thus made an exceptional mistake in drafting a new policy that will force doctors to facilitate the taking of human lives (against the great medical tradition of healers to “do no harm”) or else lose their licences to be doctors in Ontario (which would greatly impoverish medical care, if precisely those doctors who most value the human lives they treat are not allowed to be doctors).
There is a gravely serious aspect of the current discussion about this which most people likely miss, but which stands out clear as day to me as a scholar with a wide breadth of historical knowledge and as a professor of a course approximately covering the First Millennium (107 AD to 1014 AD), during which period the groundwork for all later human rights and freedoms was laid. The CPSO’s intention to take away a doctor’s rights to refuse to participate (including by referral) in procedures against their conscience, including abortions which end the human lives of the unborn human babies involved (and including the just recently legalized euthenasia/assisted suicide of old and/or sick humans), ACTUALLY UNDERCUTS THE VERY HISTORIC AND LOGICAL FOUNDATIONS OF ALL OUR MODERN DEMOCRATIC FREEDOMS AND HUMAN RIGHTS. These things only began to be possible after Western Civilization learned to value ALL human life, without exceptions, and protect human life without exceptions, starting in the 4th Century AD.
What Western Civilization Was Like Before the 4th Century
Before the 4th Century it used to be the norm that human life was cheap, not valued very highly except as it could serve the greater State (whatever form the State took). Governments provided a basic societal stability but had no interest at all in helping individual humans find their individual human fulfillment (life, liberty and the pursuit of happiness and such), governments had no interest in providing health care or education for all their subjects, and governments could even be the biggest threat not only to individual human freedom but also to individual human lives. Even in the most highly civilized society, the Roman Empire, the popular entertainment, the “TV” of the day, was public torture and murder in the Roman arenas, where human lives were taken in various ways, such as wild animals tearing them apart, and athletes like gladiators murdered each other with government approval. No surprise then that in this most advanced and civilized of ancient western cultures where even here human life was so very cheap a “Pro-choice” philosophy ruled the day, where parents (particularly fathers) had the right to choose whether to raise or kill their children, whether before birth by abortifacient potions and other abortion methods or after birth by exposure or other forms of infanticide. Thus the sewers of ancient Rome were clogged with dead babies who ran afoul of their parents’ choice, and some ancient cities had convenient garbage dumps outside of the city specifically for human children (girls were particularly targeted for infanticide). Parents could sell their children as slaves, since there were no human rights or basic freedoms. Many citizens became slaves if they could not pay their debts, and governments could enslave or kill their citizens whenever they felt it suited them. Fully 1/3 of the population of the Roman Empire were slaves. Slave or free, full citizens or lesser conquered subjects, all were NOT free to seek and find their human fulfillment and meaning in life through searching religion/spirituality or any other means. It was normal worldwide for the government, whether a tribal chieftain, a national king or international emperor or even a republic (as the Roman Republic before the Empire), to set religious policy. The government normally decided which religion was the Official Religion, and which other religions were tolerated and which were persecuted, and to what degree. Religious freedom to seek and find meaning and fulfilment in life was unheard of. Even in the ancient experiments with republican democracy as in Greece and the Roman Republic before the Empire, only upper-class free men could have any say in government. Most men and all women were excluded from voting because there was NO PRINCIPLE OF EQUALITY AMONG HUMANS but quite the opposite. Greeks considered the less civilized “barbarians” to be profoundly inferior. Roman citizens and subjects might be proud to be part of the Roman Republic or the Roman Empire, the greatest the world had ever known, but they still did not expect their government to necessarily protect either their lives or their freedom.
So what happened to change all this? What led to the human rights and freedoms we have and enjoy today? What turned us from human individuals serving a greater State which frequently threatened both our freedoms and our lives to being human PERSONS who are instead served BY the Democratic State (which is why our political leaders often now call themselves “Ministers”,because they minister to the needs of human persons, and provide safety and freedom to help their citizens seek and find their human fulfillment).
What Changed in the 4th Century That Made Modern Human Rights and Democracy Possible
What happened is that in the 4th Century Western Civilization learned that ALL human life, without exception, was inherently valuable and precious, and started to treat ALL human life as valuable and precious. Gladiatorial fights to the death and other entertainment killing in the Roman arenas, and parental Pro-choice” abortion and infanticide were soon outlawed, and further centuries of reflection on this Pro-life” conviction of the SUPREME value and EQUAL dignity of every human life without exception would naturally and logically lead eventually to the end of slavery in any form, modern democracy (for all) and human rights, including previously unheard of human rights to health care and education which enhance all our human lives. Governments from the 4th Century on would be judged and remembered by the standard of how they treated their subjects, because all human subjects were now seen to be immeasurably valuable.
A Brief Overview of the Development of Modern Human Rights and Democracy Starting From Their 4th Century First Principles
Where did this great and immensely fruitful 4th Century insight into the supreme dignity and value of all human life without exception, which is at the very foundation of our safe, free and democratic civilization, come from? It came from Western Civilization first legalizing Christianity in the 4th Century and then embracing Christianity’s religious convictions that every human life (male and female – Genesis 1:27) is created in God’s Image and is extremely valuable and precious to a Loving God, and thus that humans must LIVE and be FREE from government coercion so as to seek and find their human fulfillment in this great Truth about humanity’s outstanding value. In fact, the very term and concept of “Apersonhood” comes from Christian theology. Human individuals were not called “persons” until after Christian theologians developed their terminology of One God in Three Persons (Father, Son, and Holy Spirit – Parenthood, Childhood, and the Bond of Love which binds them, a Divine “Family” who IS Love in its deepest essence, reflected in loving human families made in God’s Image). The Christian message effectively told the government,first in the Roman Empire, then in the later Kingdoms of Western Europe, and in the Eastern Roman or Byzantine Empire which lasted 1000 years after the Fall of Rome,that any government’s job was no longer to lord it over the lives of human individuals who served the greater State, but that any government’s job was now to provide safety and security for human PERSONS made in the Image of the One God in Three Persons, so that they may be free to seek and find their human fulfilment and a meaningful life as their Loving Creator desires for them. Human individuals had lives that were cheap, and the government could use human lives to serve the greater State, or take or enslave human lives, at will. But human PERSONS made in the Image of the One God in Three Persons had HUMAN RIGHTS rooted in God’s Love for them, starting with the right to Life which is why murderous entertainment and parental abortion and infanticide were almost immediately outlawed (and remained outlawed until very recently); and human persons had the right to be FREE from religious coercion, free to seek and hopefully find their human fulfilment in this wonderful Truth about their supreme human value which no other religion taught. From this point on, instead of the political State being the highest authority and using individual humans however it wanted, all States would be held accountable to a Truth higher than any State which had revealed in the Bible that slaves and their masters, political rulers and their subjects, were all EQUAL, and EQUALLY PRECIOUS, before God who made them all in love,and therefore slave owners and those who govern were now accountable before God to treat their slaves and subjects accordingly (e.g. Ephesians 6:9). The Bible further testifies that neither nationality/ethnicity, social class nor status, nor gender make any difference to a human person’s exceptional value before God (e.g. Galatians 3:28). Thus Christians, who invented hospitals, typically provided health care and education to all (Christian or not) wherever they spread as missionaries, as a service of love appropriate to the great value and dignity of all human beings without exception, and later Christian governments would start to take this function on themselves since governments now served the people instead of the people serving the State (and now we take these things for granted having forgotten where they came from).
Old habits die hard. The new Christian ideal Pro-Life values took many centuries to really penetrate into Western Civilization’s societal mindset. Only gradually did some of these Christian values overcome the long established pre-Christian norms so as to eventually yield more of their full logical fruit, like the end of slavery as an institution and equal opportunities for equally capable women. Indeed this process still continues. Yet the foundations for these were laid in the 4th Century and the long but natural and logical process towards the human rights and equal democratic freedoms we have today began in earnest right away: human life was no longer considered cheap but valuable, and protected by new laws; extremely common female infanticide was almost immediately banned, by 318 AD, 5 years after the 313 legalization of Christianity [I digress here to note it is near the height of absurdity to claim that legal abortion is about "women’s rights,” since it has in fact effectively brought back the long-banned common female infanticide in the new form of sex-selective abortions of females just for being female, which in many locations has worryingly skewed nature’s balance of nearly 50-50 female to male births; the supreme height of absurdity is to claim that legal abortion is somehow a "human right,” since it kills a human life in violation of the very first human right, the right to live, on which all other human rights historically and logically depend. Human rights were unheard of before ancient abortion and infanticide were banned]; slavery and its worst abuses were also reduced and eventually slavery ended in any form in Western Civilization (human trafficking still acceptable in other cultures), notably by dedicated Christians like William Wilberforce in Britain insisting the laws reflect those Biblical Christian values that made slaves equal to their owners before God, meaning that it was ultimately entirely inappropriate for any human being to say they “owned” another; the lingering after-effects of slavery in the U.S.A. were also successfully combated by Christians like the Reverend Martin Luther King, Jr. insisting on Christian values being put into practice at the societal level.
The specifically Christian British Empire, the largest and most advanced Empire the world ever knew, starting with the 1215 Magna Carta which limited the monarch’s power from its pre-Christian norms, very gradually and by many small stages developed modern democracy in an entirely Christian context and then spread its (Christian-based) ideals all over the globe through colonization, including the colonization of America, Aland of the free.” The Parliament in London gradually gave more and more say in government to gradually more and more of the people, entirely in a Christian cultural context and in practical development of the Christian belief in the immense and equal value of all human persons: that regardless of social strata a king and a peasant were EQUAL before God, and equally loved by God. The various colonizations from Christian Europe, for all their sad failures and lack of respect for some indigenous cultures, still also imported these Christian values of human rights and freedoms worldwide, these taking root to greater or lesser degree in the colonies. Thus it is that Biblical and Christian Pro-Life” religious values are the historical foundation of all International Law, including all Human Rights. The countries which are today described by the UN as the most notorious violators of human rights are precisely the most markedly non-Christian countries, precisely because these governments do not share the Christian religious and moral conviction about the immense value and worth of all human life without exception. Not sharing this foundation, rooted in specifically Christian religious conviction, makes democratic freedoms and human rights a very foreign concept to the governments of these countries. And worst of all, history shows, are countries with a Christian background whose governments specifically rejected their Christian heritage: they eventually revert to totalitarian states just like the totalitarian states before Christianity which typically threatened the lives and freedom of their own citizens. The two worst genocides in history were perpetrated by such governments, who actively rejected and persecuted their countries’ Christian heritage, Stalin’s Soviet forced starvation of 7 million of my fellow Ukrainians in 1932-33 just as the occultist Hitler’s Nazi Holocaust of 6 million Jews was starting (Hitler’s ideal “Aryan Race” comes from occultic mythology; thousands of Catholic priests and others who stood against Hitler’s rounding up of Jews as sub-human and no longer protected by the government were sent to the death camps as well). All totalitarian states have in common the rejection of the specifically Christian beliefs about the supreme value and dignity of all human lives without exception.
New or Proposed Law and Policy Changes Attack and Erode the Very Foundation of Our Modern Democracies
Because of this history of the development of our modern democracies, it is ridiculous to claim, as CPSO does, that religious and moral beliefs are merely private and have no place in public policy or in doctor’s offices, specifically Christian religious beliefs, including the Pro-Life Principle, are NOT MERELY PRIVATE BELIEFS BUT ARE THE PUBLIC FOUNDATION OF ALL HUMAN RIGHTS AND DEMOCRATIC FREEDOMS. They are not incidental to them, they are logically essential to them, and where they are lost, human rights and democracy are logically (if gradually) lost, as in Germany and the Soviet Union. The Pro-Life Principle historically made democracy possible in the first place, as demonstrated above, and it is the very best long-term guarantee of democracy, simply because it is only the Pro-Life principle that says every human life without exception MATTERS such that every human life must be allowed to LIVE and must be FREE from coercion in living that life. Those who are ignorant of history are destined to repeat its mistakes.” The legalization of abortion in many countries since the late 1960s and early 1970s ignorantly reversed the banning of abortion and infanticide by 318 AD which had made all subsequent development of human rights and democracy possible because it was the first legal recognition of the immense and equal value of all human lives without exception. Legalizing abortion after this long history of the development of our modern human rights and freedoms flowing logically from abortion being banned is LOGICALLY TANTAMOUNT TO OUR GOVERNMENTS NO LONGER RECOGNIZING IN ANYONE AN INHERENT HUMAN RIGHT TO LIVE, JUST LIKE IN ANY TOTALITARIAN STATE. If you and I could have been legally killed when we were of fetal age, this must logically mean our government no longer recognizes in either you or I any INHERENT right to live just for being human and for being alive. Others than ourselves decide if we humans live or die: Our mothers before we were born merely allowed us to live (lucky us), and after we were born our government decided to protect our lives with laws. But note many other governments did not and do not protect all human lives after birth, particularly totalitarian states. But democracy only ever developed in the Pro-Life” context that taught that all human life without exception was precious regardless of any State’s laws; governments that violated the Pro-Life” principle by treating their citizens badly since the 4th Century were judged against this principle of supreme human value, higher than any particular State. By abandoning the Pro-Life principle our democracies have already taken the first big step towards becoming totalitarian states such as were common before the Pro-Life principle entered Western Civilization in the 4th Century, and now it is just by simple logic starting from that abandonment decades ago that current new and proposed law and policy changes will take us even closer to exhibiting characteristics of a totalitarian state. RIGHT NOW in Ontario, doctors are SCARED that they can lose their jobs because they value human life like doctors as healers traditionally have,this is not something that is supposed to happen in a democracy! Recent developments like coercing doctors to participate in killing human lives against their will (even by Aeffective referral” to someone willing to kill), OR ELSE LOSE YOUR LICENCE AND JOB AS A DOCTOR, as the CPSO’s draft policy will make happen in Ontario, strikes at the very heart of not only the doctor’s personal democratic freedoms but strikes at the very foundation of democracy itself.
I agree with the physician of December 10 2014. It is very well stated. This proposed policy has serious errors and consequences for physicians and the public at large.
This policy will force physicians to refer to a provider or clinic that provides abortions or other services that go against the conscience of the clinician. We are trained to approach our patients holistically, yet divide ourselves into to compartments. To expect ourselves to do this is unrealistic. I think this is one attitude that leads to burnout among physicians. We need to be real with ourselves while respecting patients. Sometimes we have to agree to disagree with what they decide but I don’t think we should have to participate or facilitate in a decision we do not morally agree with. Currently, we can practice like this, but with the CPSO, this may change. Sad day indeed when we cannot practise according to our conscience. This whole policy is socialism just like Nazi Germany forcing its evil philosophy on people and physicains. If I don’t agree with abortion or euthanasia, it is my constitutional right to act according to my conscience by not facilitating the referral.
The CPSO is not necessarily putting the best interests of the patients first, they are simply superimposing their subjective moral beliefs over the moral beliefs of service providers. This is not ethical and it is in fact an imposition of discrimination towards these doctors who may object for very good reasons. More consultation must be had with doctors who have strong ethical-moral convictions and with doctors of faith backgrounds. Asking these doctors to fracture their moral views from their professional obligations may lead to a homogeneity of doctors who only support abortion/euthanasia, it may reduce their personal sense of integrity, and it may lead to burnout as they are forced to practice medicine disingenuously. This is systemic discrimination based on conscience or religious belief.
Please remember that moral stances based on conscience are rational and evidence-based, often reinforced by religious beliefs, and deserve protection. There should always be a balancing of rights, but both patient and physician rights be respected; accommodation should not be one way.
There are many rights and freedoms granted to us in this wonderful country Canada. If you draw an analogy to the same sex marriage debate, it did not force religious organizations to marry people if there religion was opposed to it.
I believe forcing a Dr. or health care provider to perform a procedure that is against their moral or religious beliefs is in unacceptable!
That said, I believe a physician should be up front when accepting a patient or during the course of his practice state to the patient which procedures or practices they will not do. If as patient, I have no issues with this as long it is up front.
The patient then can make a decision on when and where to receive treatment they desire.
I believe a common sense approach like this would be appropriate to protect the physicians rights and the patients rights.
This is first time entered a comment. The web site says that I have entered a duplicate comment. Why is this? So I will rephrase my feedback
We are fortunate to live in Country like Canada where we have the Charter of Rights and Freedoms. During the debate on same sex marriage, the law the eventually fell out of this debate made allowances to not force religious denominations to perform same sex marriages if it violated their beliefs.
I do not believe you should force a physician to perform medical procedures if it violates their moral beliefs.
That said I do believe a physician should state to their patients which procedures or services they will not perform when accepting patients or during course of treatment.
I have no issues with a physician holding their beliefs if it is clearly stated to the patient.
The draft policy speaks of freedom of religion and religious beliefs. It nowhere defines them. Here is the Christian description of religion put into action:
“Religion that is pure and undefiled before God, the Father, is this: to visit orphans and widows in their affliction, and to keep oneself unstained from the world” (Jas. 1:28)
In A.D. 2015, Christians still provide crisis pregnancy care and visit old age homes. They sit with the sufferer; they don’t kill him. King Saul fell on his sword, and the apostle Judas hanged himself, but King David and the apostle Peter repented and received forgiveness.
As Theocritus, Cicero, and Stephen Hawking have said, “While there is life, there is hope”–and none of them had–or do not yet have–the Christian’s assurance of heaven.
I agree that the conscience rights of physicians must be respected.
I oppose the mandate for effective referral because it is against physicians rights and should be rejected.
No one should be forced to do something against their conscience. This means not just doctors, lawyers, teachers, but all people. This is true diversity, true freedom and true repect for our fellow man. If society is built on true respect, it will prosper. If people are denied this freedom, society will be in turmoil.
Forcing doctors to kill is wrong. Do you not see this? I want a doctor who has a backbone and lives according to good principles. Your policy would turn good people away from medicine—this is not right.
Please consider the profound consequences of your policies.
I am writing to you with grave concern regarding the content of your proposed draft policy. Sections 8, 10 and 11 suggest that physicians who decline to participate in certain acts for reasons of conscience should be compelled to refer their patients to other physicians who will perform these acts. It does not address the fact that many of these same physicians will find the act of referral itself objectionable, as they consider it material cooperation with the act. In compelling physicians to refer, you are limiting their right to conscientious objection.
I strongly object to wording of this policy. The physician who disagrees with assisted suicide should not be put in the position of having to refer the client to someone who will do the job for him. You must respect the individual’s right to conscientious objection by not making them responsible to find someone who will perform the killing of another. In a case of murder that person is as culpable as the one performing the act itself. I urge you to reconsider the wording of the policy and remove the onus “should be compelled to refer their patients to other physicians who will perform these acts.”
I encourage you to revise the sections above, and include a clear defense of the right to freedom of conscience for all physicians.
I have always held to the belief that my doctor is under the vow to ‘do no harm’. I have since my teens been witness to doctors bullying, lying and manipulating friends and family into having abortions. WITH NO PUNISHMENT FROM YOU. I took my time to search for a doctor that has a conscience and holds to the vow.
I do not want to loose my doctor and others that hold to the same believes as my own.
Abortion and early death are not healthcare. The supreme court may have decided it isn’t against the law for a person to have either however it should be against law to force another to participate in any way to this end.
“Effective Referral” or demanding participating in such acts will diminish all doctors into bullies, liars, and manipulators that are no longer working for the well being of Canadians but the financial bottom line of organizations and government.
Please accept my comments as per the external consultation you are facilitating on the issues of the professional and ethical obligations of physicians.
My opinion is that the CPSO is engaging in discrimination towards physicians who may object to questionable procedures in medical service. In order to make clear my point that the CPSO is proposing a discriminatory policy, I will refer you to your own definition of discrimination provided in your survey. Discrimination, according to your source, is defined as the following:
Discrimination may be described as an act, decision or communication that results in the unfair treatment of a person or group by either imposing a burden on them, or denying them a right, privilege, benefit or opportunity enjoyed by others. Discrimination may be direct and intentional. Alternatively, discrimination may be entirely unintentional, where rules, practices or procedures appear neutral, but may have the effect of disadvantaging certain groups of people.
These professional-moral imposition are exactly the “unfair treatment of a person or group by either imposing a burden on them, or denying them a right, privilege, benefit or opportunity enjoyed by others…” This is not equitable. Having physicians refer patients to a non-objecting physician is one thing, but to mandate that they actually must perform procedures that they may consider infanticide or murder is both Draconian and unethical.
One could also argue that such a mandate is not necessarily putting the best interests of the patients first, since the medical providers in question equally believe that they are keeping the best interests of the patients first in not conducting what they believe are harmful procedures on them. This sort of policy, in my view, simply superimposes the subjective moral beliefs of the CPSO over the moral beliefs of these physicians in question. These doctors object for very good and highly nuanced and sophisticated reasons. More consultation must be had with doctors who have strong ethical-moral convictions and with doctors of faith backgrounds. I look forward to hearing about such consultation work.
To whom it may concern:
Patients are of course the primary concern.
To force Doctors to violate their conscience is not in the best interest of patients. Patients can easily find other Doctors to comply with values similar to their own – why force such measures on Doctors?
This is ideology overruling good medical practice.
Dear College of Physicians and Surgeons of Ontario, Professional Obligations and Human Rights Policy Drafters,
I am writing to let you know that as a member of the public, I am concerned about what I consider a threat to doctors’ freedom of conscience regarding their “duty to refer” (particularly with regards to issues that are related to religious morality). Requiring a doctor to provide referrals when they cannot perform a procedure for reasons of conscience is still forcing them to abet an action which goes against their conscience. Removing the moral element from a doctor’s professional life is a fundamental assault on their personal integrity. Doctors’ freedom of conscience should not be eliminated through policy.
Please reconsider your policy draft, particularly the section entitled “Ensuring Access to Care.”
I would like to state that I reject the proposed “effective referral” mandate in the draft dealing with physician assisted suicide. This “effective referral” compels a physician to violate his of her own conscience by being a participant in the very act, the very procedure, which he or she objects to in the first place.
Freedom of conscience and religion are guaranteed by the constitution and must be respected and upheld.
[**MESSAGE FROM ADMINISTRATOR: DURING THE CONSULTATION PERIOD, WE RECEIVED 17 RESPONSES FROM INDIVIDUAL RESPONDENTS CONTAINING THE CONTENT PUBLISHED ABOVE. ALTHOUGH THIS FEEDBACK HAS NOT BEEN PUBLISHED IN DUPLICATE, THE COLLEGE ACKNOWLEDGES RECEIPT OF THESE SUBMISSIONS.**]
Please support freedom of conscience and religion for physicians.
Physicians need to uphold their promise to “Do No Harm.”
Now that assisted suicide is legal and the possibility of
euthanasia on the horizon, physicians must maintain their right
of conscience to refuse to participate in any way.
I would not feel safe if my physician participates in these
immoral actions.
This is to inform you that I reject the proposed “effective referral” mandate for doctors,whose Charter right of freedom of conscience and religion must be respected.
Subject: Draft Policy “Professional Obligations and Human Rights”.
I am writing about Sections 8,10 and 11 of the proposed draft policy. They suggest that a physician who is declining to participate in certain acts for reasons of conscience is still being asked to go against their conscience by referring their patients to other physicians who will perform these acts.
Referring a patient to another physician who will perform the act can be in itself against the conscience. Both patient and physician have rights. We should respect them both equally. I suggest you change the wording of these sections to include language that respects both physician and patient rights. Limiting the freedom of conscience should not be allowed in a free and open society.
Hello,
After reading the draft policy, I would appreciate if, at Line 70 you include the provision of a scent free environment to accommodate those of us who suffer with environmental sensitivities. The Canadian Human Rights Tribunal recognizes Environmental Sensitivities as a disability but this is not widely known. My own family physician understands my disability but wears scented aftershave anyway making every visit to see him a danger to me. He believes, as many do, that he has a right to wear scented products even if his patients are allergic.
specifically noted accommodation of MCS (Multiple Chemical Sensitivities) in the paragraph at Line 70 would make exercising my rights much easier in a climate with a shortage of family doctors.
I would also request provision of a safe environment to accommodate those of us with Multiple Chemical Sensitivities and Environmental Sensitivities. I find that most medical offices, clinics and hospitals are toxic, thanks to fragrances and chemicals used by professionals, other staff, other patients, and visitors.
Most places that post fragrance-free policies do nothing to enforce such policies. They often still use fragranced cleaning products, soaps, and hand sanitizers. When patients and visitors show up wearing their usual fragrances, with toxic laundry products or dry-cleaning chemicals clinging to their garments, in general, no effort is made to educate them, let alone ask them to leave or to wait outside the clinic.
For starters, I would request that the examples of disabilities to be accommodated included Environmental Sensitivities.
It would also be helpful if practices that treat patients with migraines (such as pain clinics) were lit with LED lights instead of fluorescent tubes. I am not sure whether this would be another example of accommodations for environmental sensitivities, or whether migraines fall under a different disability category.
Re: “Professional Obligations and Human Rights” draft policy.
Dear Colleagues,
As a Christian physician, I along with many others of different faiths and/or convictions of conscience, am deeply concerned about the content and questionable agenda of this draft policy, and encourage counsel to drastically revise it.
The policy appears to contain elements of reverse discrimination i.e. patients rights subjugating and dominating physicians rights. This is quite ironic in a document ostensibly mandated to minimize discrimination. Yet a careful read of this draft shows several pretty significant biases against those “objecting physicians” who do so on the basis of “morals or religion”. Both conscience and religion are protected under the Charter of Rights and Freedoms, yet the draft policy spends nearly the entire second half of the document itemizing all of the contexts and limitations that would apply to mainly one arena for potential discrimination – that of conscience and religion. Alternatively, a long list of other arenas for discrimination such as race, gender, ethnicity etc. are only summarily mentioned much earlier in the document. This imbalance smacks of bias.
Many different character-shaping influences form our conscience a.k.a. “inner voice”. Religion is just one among them. This document fails to acknowledge the fact that every single human, not just those with identifiable religious “brands”, operates using a moral compass directly informed by their conscience. It is a universal instrument of the soul.
It is offensive to me to see the degree of blindness to this self evident fact, and instead, see this policy divide physicians into groups that could only be described as those with a conscience and those without; perhaps more accurately those with an acceptable conscience and those whose conscientious objection is unacceptable. The Canadian Charter makes no such distinction! Two weeks in practice and any one of us realizes that every decision to engage in or refrain from full endorsement of a patient’s requests involves a complex intersection of conscientious AND evidentiary elements. It is not so reductionistic as to be wholly one or the other. The way this draft policy is worded, such decisions are made out to be so reductionistic.
Not providing a procedure is not the same as not providing care. Many of us [perhaps not all] would object, for example, to facilitating infundibulation for a female patient. It is possible to both professionally and in a dignified way, without discrimination, decline such a request for a patient. While you could disclose that part of your objection is on conscientious ground, I would argue that another part is on the grounds that this can involve unacceptable risk for a medically unnecessary procedure. If I were that patient, you should not have to tell me every last detail of why you object to this. Most certainly you should not be forced to explain “every available option” and provide substantial information as well as a referral to another “non-objecting physician”. That would be unfair. You either endorse it for me or you don’t! As both another human being as well as my physician, I need to accept your right to do so.
The act of referral and coordination of services is tantamount to the procedure in question itself, and for this reason I believe the draft policy goes much too far in terms of the nearly punitive measures required for physicians who “dare” to object to various procedures in their professional opinion, which may include (to varying degrees) matters of conscience and religion.
Lastly, this all becomes doubly concerning in light of last Friday’s Supreme Court decision to overturn the ban on Physician-assisted suicide, and re: euthanasia. Should death become a “medical procedure” (something inexplicably heinous to me and thousands of others), the reverse discrimination issues in this draft policy have a heightened consequence. Voluntarily giving physicians a “license to kill” would be bad enough. Making this nearly involuntarily is unthinkable. If and when death is put on the OHIP billing schedule, and rolled out into practice, I and hundreds of others like me need to be able to easily abstain without massive repercussions both legally and morally. I have no confidence of that with this current draft policy. We need to know we have the support of our College, the OMA, and a full recognition of our Charter rights. The same goes for what has always been an extreme minority of other medical decisions or procedures we each might object to.
Thank you for your careful consideration of this high priority matter.
Do not force someone to do what he/she is unwilling to do so. It is inhuman. This policy may respect the patients, but it abruptly fails to respect physicians. Freedom of conscience! Where are the human rights of the physicians?
I am writing today to offer comments with regards the draft policy entitled “Professional Obligations and Human Rights”. Firstly, I share with the CPSO that patient care must of the paramount priority and protection of patients from discrimination is a necessary component of good patient care. However, I am gravely concerned that the implementation of this new draft policy would in fact do damage to patient care in Ontario without adding the desired protection of patients from discrimination.
Chair of the CPSO Policy Working Group has publicly stated that physicians who are unable to comply with the policy should think about whether they should be practicing family medicine. Many physicians in this province have deeply held moral beliefs that certain practices, such as abortion, are wrong and hence cannot be included in their practice, should their practice be carried out as one they know to be morally upright and focused on patient care. Forcing a duty to refer for procedures one is unwilling to perform oneself is not arriving at a middle ground, rather, it forces physician participation in that which they have judged to be morally inexorable. Physicians, who previously practiced without fault to patient care, will be forced to leave a practice that can no longer achieve moral accord- as predicted by [Name omitted].
Alternatively, our physicians may decide to comply with the CPSO’s requirement and participate in an element of practice that goes against deeply held beliefs; such interior conflict will undoubtedly lead to physician burnout. Either way, Ontarians will suffer the loss of their well-qualified family physicians, and hence, compromise access to good quality, sustainable patient care in the province.
Consider too that there are members of the public who share their physicians’ moral framework and appreciate the opportunity to access medical services from a physician who they deem to be morally upright.
Medicine is both a science and an art. A patient is best served, and the public best protected, when a physician masters both the art and science of medicine by carefully examining the clinical scenario within an ethical framework. We want our physicians to be practicing in a manner that fully engages their ethical reasoning; this ethical reasoning cannot be separated from a physician’s moral and religious beliefs.
The CPSO must reconsider what it defines as “discrimination” in their draft policy. The Ontario Human Rights Code prohibits discrimination against the public based on protected grounds, such as age, race, sex, sexual orientation, disability, or family status. This means that one must not deprive one group of services one provides to others. The Code does not dictate what services must be delivered. If a physician chooses, for moral reasons, not to prescribe a pharmaceutical, there is no discrimination if the same decision and practice is applied to all his/her patients equally, that is, without discrimination.
We must draft a policy that maintains physicians’, as well as patients’, rights as defined by the Charter of Rights and Freedoms in order to avoid systemic discrimination based on conscience or religious beliefs. Any policy that is effected by the CPSO that will limit a physician’s Right to Freedom of Conscience and Religion by forcing a duty to refer or provide a service is in affronts with what Canadians’ value as set out in the tenets of Canadian law. Consider carefully this draft policy. I urge you not to compromise the Canadian value that all must be protected under the Charter of Rights Freedoms, including the providers of services. Please, protect our physicians’ freedom from systemic discrimination.
REPLY FROM ADMINISTRATOR: Recently, the National Post published a commentary that falsely attributed the following statement to a College spokesperson: “Physicians unwilling to provide or facilitate abortion for reasons of conscience should not be family physicians.” This quote is categorically false, and misrepresents the College’s expectations of physicians who limit the health services they provide on moral or religious grounds. The College has asked the National Post to publish the following letter to correct this false statement and to clarify the College’s position: http://policyconsult.cpso.on.ca/wp-content/uploads/2015/01/Letter-to-National-Post-January-23-2015.pdf
The College is misrepresenting its expectations of physicians who limit the health services they provide on moral or religious grounds. Under this policy, I cannot become a doctor in Ontario unless I renounce my Christianity and become willing to commit murder and mutilation or participate in murder and mutilation.
Dear CPSO council:
I trained as a family physician and gained extra training for rural medicine. At present, I work mainly between two Ontario towns. One is a small city and I work part time in the Emergency department. I also do locums in palliative care at the local hospice. The other is a rural community where I do Emergency shifts and do locums for family doctors which includes office work and inpatient care.
I am also a Christian and there are certain procedures which are legally available in Ontario and Canada which I have problems with ethically and morally. At present, I am not required to refer for procedures with which I have a conscientious objection. This new policy draft suggests that the CPSO would require me to refer for these procedures despite these being against my conscience. I view providing an “effective referral” as being complicit with the procedure to which I object according to my conscience. This would constitute imposition of another (usually secularist) belief system on my own belief system. In a pluralistic society, we need to respect each others belief systems. When I encounter a patient who wants a procedure or medication which I can not provide according to my conscience, I do not judge them or discriminate against them. Respectfully, I inform them of my conscientious objection and if these procedures are available without referral, I inform them of where they may go to obtain them. In this way, I am able to act according to my conscience and maintain my integrity. If I were to compromise in this regard, I would be violating my integrity and no patient could trust me.
It should be noted that Hippocrates himself and all his followers, would not have been allowed to practice medicine according to their conscience if this draft policy had been in force during their time period. The Hippocratic Oath explicitly states that:
I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan; and similarly I will not give a woman a pessary to cause an abortion.
Given the recent ruling with the Supreme Court of Canada on the Carter case, it is particularly worrisome to me that the CPSO is modifying this policy in this way at this time. I have taken an oath not to cause the death of anyone in my care. I will not be able to help someone commit suicide. I am able to provide palliative care and there are so many ways that one can control pain and other symptoms which occur at the end of life. We need to improve access to palliative care in Ontario, rather than put doctors like myself in positions where we will have to take the risk of CPSO discipline to provide the best care possible or possibly leave the province to practice ethically.
In a dualistic society, there are ways to make controversial procedures and medications available to those who want them without compromising the integrity of those who object to these procedures and medications on conscientious grounds. Abortion, for example, if available by self referral in Ontario.
Family physicians who object to certain procedures or medications are up front with their patients about what they can and can not do according to their religious and moral beliefs. Patients are free to become part of this doctor’s practice or move on to join an alternative doctor’s practice with which they agree.
I urge the College of Physicians and Surgeons of Ontario to re-write this draft policy, Professional Obligations and Human Rights, such that the stipulation to provide “effective referral” is removed. I similarly urge the college to support the right of physicians to practice medicine according to their consciences.
I strongly agree with this opinion. Physicians like her/him are trustworthy, they have integrity and respect for life. It would be a shame if Ontario loss this kind of professionals. The College of Physicians and Surgeons should support the right of physicians to practice medicine according to their consciences.
Dear members of the College of Physicians and Surgeons of Ontario,
I am writing this email several days after the Supreme Court of Canada has struck down the laws against euthanasia and physician assisted death (PAD). Should your draft policy on “Professional Obligations and Human Rights” be adopted, patients could force physicians to refer them for PAD even if the physician objected to this not only from moral grounds but medical or philosophical grounds. In your opening preamble to the draft policy, you state that “The fiduciary nature of the physician-patient relationship requires that physicians act in their patients’ best interests.” If a physician denies a patient a referral for PAD on the basis that it would not be in the best interests of that patient, then your policy is inherantly contradictory.
The wording of the draft policy is so vague that almost any procedure could be included. On your forum many have cited examples of vaginal reconstruction, or female circumcission as procedures that could be requested and put a physician in conflict and thereby contravene the policy if they did not refer. If the college is fearful that some patients are being denied access to specific procedures then they should work to ensure that patients can have access to these procedures without requiring referral rather than creating a vaguely worded policy that is a veil to force physicians to refer for specific controversial procedures. Indeed in Calgary, if a patient wants an abortion, then they can access this directly without referral.
Currently if a patient does not like their physician, they already have the right to find a new physician. If the college feels that patients cannot find physicians then they should work to improve access and not force physicians to act against their consciences. Indeed, I would strongly recommend that you read Margaret Wente’s Globe and Mail editorial from August 7, 2014 entitled “We can’t force doctors into being moral eunuchs”
I am writing to you with grave concern regarding the content of your proposed draft policy. Sections 8, 10 and 11 suggest that physicians who decline to participate in certain acts for reasons of conscience should be compelled to refer their patients to other physicians who will perform these acts. It does not address the fact that many of these same physicians will find the act of referral itself objectionable, as they consider it material cooperation with the act. In compelling physicians to refer, you are limiting their right to conscientious objection.
There is significant disagreement in our society as to what constitutes a moral act, and I do not expect the College to define or limit morality. All I expect is that physicians, as professionals, be allowed to respect their own consciences. Freedom of conscience is foundational to our free society and cannot be limited, even for the best of intentions. If we coerce physicians into violating their consciences we will inevitably erode the personal integrity which is the basis of the physician’s relationship with their patients.
Also, to suggest that individuals who cannot support these acts should not become physicians within specific specialties is a contravention of their rights and freedoms. It also denies me as a consumer of medical services to obtain those services from a physician who shares the same moral compass as I do.
I encourage you to revise the sections above, and include a clear defence of the right to freedom of conscience for all physicians, as you did in the past.
Thank you for seeking public consultation on this very important proposed document. It is certainly true that physicians should not discriminate against patients or show partiality and differing care to different patients. Physicians should keep patient care as the highest priority.
The draft in its current state implies that physicians would be discriminating against some patients if physicians did not provide or refer for certain services due to moral or religious beliefs of the physician. However, such conscientious objections would not be discriminatory, because such services would not be provided to any patient of the physician. This is different than providing services at times to some individuals, but not to others, for reasons such as ethnicity. For example, as a restaurant owner, it is not discriminatory to own a restaurant and not serve pork to anyone, including someone who would request to eat pork, because as a restaurant owner your religious belief may preclude preparing and serving pork. This restaurant owner is not discriminating because he is not selectively choosing to serve pork to some, but not to other patrons.
To require a referral from the health care provider is just as morally convicting to the provider as performing the service, as the physician would be formally facilitating the treatment in conflict with his/her moral or religious beliefs. When a physician has the moral conviction that an abortion or physician-assisted suicide is the wrongful taking of human life, to refer for such is to be a complicit in this act.
The proposed policy will limit physicians’ freedom of conscience and religion as guaranteed in the Charter. Unfortunately, this document will fail to ensure that physicians perform their duties ethically, but instead, force physicians to perform or prescribe treatments against their moral and religious convictions or risk disciplinary action from the college because of their religious convictions. If this draft were to be approved in its current form it would place limitations on the freedom to practice religion, while also practicing medicine. For physicians who have religious convictions which preclude them from participating in abortion or physician-assisted suicide, this would force them to move their practice out of province or give up practicing medicine altogether.
Physicians have a right to freedom of religion as much as any other Canadian. A patient’s desire to access services such as abortion or physician-assisted suicide does not render a physician’s right to freedom of religion invalid.
As someone who was born and raised in Ontario, and who was strongly considering returning to Ontario after the completion of my Family Medicine residency to open a practice, this decision will certainly influence where I practice.
As a governing college, I hope that you will protect my rights as a physician just as strongly as you safeguard the wellbeing of the patients we serve.
I am writing to you to express my concerns re: the draft document on Professional Obligations
and Human Rights.
First of all, I thank you for being open to consultation with the public on this matter.
In doing so, the College obviously accepts existing Charter of Rights of freedom, of religion
and conscience and therefore I urge you to maintain that moral stance.
I would like to emphasize that moral stances based on conscience are rational and evidence-based,
often reinforced by religious beliefs and therefore deserve protection.
Freedom of religion and conscience rights are included in other documents and therefore
Canadian documents should reflect these values.
(Cf., Canadian Charter; the United Nations’ Universal Declaration of Human Rights, Article 1 states:
“All human beings are born free and equal in dignity and rights. They are endowed with reason and conscience and should act towards one another in a spirit of brotherhood”.
Thus, there should always be a balancing of rights, but I request that both patient and physician rights be respected; accommodation should not be only one way.
A physician should never be compelled to act against rational conscience decisions and that such
compulsion goes against the Charter and human rights.
Therefore, by refusing to provide or perform some procedures is not discriminatory when it is based on a properly informed conscience: this has nothing to do with the patient, requesting a procedure, and everything to do with the physician’s decision about the wrongness of the procedure in question.
In conclusion, I would strongly hope that when you are making changes to your original policy,
you would seriously consider the reflections I have put forward,
When suffering vets committed suicide everyone was angry. When suffering
citizens commit assisted suicide everyone is happy. Are canadian authorities + others extremely confused concerning life? YES Sorry, you are not free, but subject to life, your personality, your knowledge & experience and the present situation, issue. You cannot, not do, what you are doing! What should life & fatherhood think ????? WHY ????
From fatherhood and life’s perspective what should we think about “RIGHTS“,
now that authorities i.e. justices, politicians, medical professionals, + others are ?attacking? Life at its beginning and ending? Is life without HUMAN RIGHTS? Is it being excluded, rejected, destroyed by artificial-birth control and abortion. And now we have added assisted-suicide!
Are human rights the new oppressive, abusive religion? Who is godphobic, religionphobic, lifephobic? fatherhoodphobic? Why?
Are pro-life persons in canada the Bonhoeffer’s of the nazi era? & I wonder,
what is a citizen’s personal future if authorities reject, destroy their own child in the womb? Who is fatherhoodphobic, godphobic, religionphobic, lifephobic in canada/world? Why?
“Before I formed you in the womb, I knew you…”
Jeremiah 1:5
Is fatherhood, motherhood or child in the womb a core canadian/world human value/right .. sorry, just kidding!
“Intolerance is itself a form of violence and an obstacle to the growth of a true democratic spirit” Mahatma Ghandi. Over the last few days we have been “treated” to “Trudeaumockracy”, a cross between a tyranical benevolence and a dictatorship. You can have no thoughts but my thoughts, no opinion, conscience or moral view unless […]
To who it My Concern,
What I see is that over time, the clock has ticked so slowly that our society has not even seen its slow but sure descent into moral relativism and the decay of the human conscience.
What I see is the unbearable pressure on society by special interest groups. Everyone seems to be caving in to this erosion of moral principles.
I remember speaking with a very good doctor, a surgeon, about abortion, which he refused to ever perform. He said that if he did perform one, he would no longer be living according to the Hippocratic Oath but the Hypocritc Oath. I couldn’t have said it better.
To put physicians in this dire position of performing abortions against their consciences or forcing them to find someone to ‘do the job’ is like asking them to find a hit man.
You must take a deep breath and remember that your decision is going to have eternal consequences for yourselves and those who you place in such a dangerous position, to say nothing of the mistrust that patients will have for their doctors. Once you force them to do this, it will not be long and you will be forcing them to kill the elderly as well, then the handicapped, then the imperfect, then …….? Only God knows how deplorable it could get, as though it isn’t deplorable enough already!!
I may be off base here, but I would like to see the words “ environmental sensitivities” as a disability in there somewhere. My doctor does not believe that this illness exists, and it greatly needs to be recognized. There is a lot of suffering with this illness and if your doctor cannot or will not help, or recommend someone else, that is immoral.
Je suis chrétienne et pourtant jamais Notre Seigneur Jésus nous a dit dans La Très Sainte Bible que nous avons le droit de prendre des décisions contraires à notre Foi Chrétienne.Dieu nous laisse libre de l’aimer ou de ne pas croire en lui comme nous sommes libre d’être sauver ou damner.Pour ma part je réalise à quel point notre société régresse lamentablement .Les élus qui osent se prendre pour Dieu et décident de laisser passer des lois qui mèneront à l’avortement ,au suicide et l’euthanasie devront dans l’autre vie rendre des comptes à Notre Dieu Créateur.Les Dix Commandements existent toujours et Dieu nous laisse libre mais ceux qui ne respecteront pas ses lois iront en Enfer à jamais ( Tu ne tueras pas a dit le Seigneur Dieu qui est Roi et Maître de tout l’Univers ).La Cour Suprême sera un jour jugé à son tour par le Grand Juge Dieu.
Avec des lois qui choisissent la mort plutôt que de sauvegarder le droit à la vie notre société s’en va droit en Enfer .Je croyais que le Canada aidait les plus faibles .
Une Ontarienne qui demande que justice soit faites pour les pauvres futures victimes de cette loi qui ne respecte pas le droit à la vie.Les médecins doivent sauver des vies et non le contraire.À voir les gens agir ainsi de nos jours Notre Seigneur Jésus serait crucifier une seconde fois.Notre société n’a plus de morale ni de Foi et nous ,nous demandons pourquoi tout va si mal.La complaisance mène seulement à ne pas déplaire aux hommes mais déplaît fortement à Dieu.Que Dieu vienne en aide à ceux qui le défi .
La médecine existe pour être au service de Dieu pour la sauvegarde de la vie jusqu’à ce que Dieu décide de notre dernier moment à vivre sur cette Terre .
Commentaires sur le projet de loi sur les droits de la personne :
Sous prétexte de respecter la liberté de tous, on nie aux médecins, dont la conscience serait opprimée en raison de leurs valeurs morales, le droit de s’objecter et de souhaiter ne pas prendre part aux traitements menant sciemment à la fin d’une vie.
Puisque je suis catholique, je ne parlerai que de cette Église dont la position est très claire. Elle a toujours enseigné aux chrétiens d’obéir aux pouvoirs publics légitimement constitués, mais elle a donné en même temps le ferme avertissement qu’« il faut obéir à Dieu plutôt qu’aux hommes » . L’Église considère l’euthanasie comme un crime qu’aucune loi humaine ne peut prétendre légitimer.
Je n’espère pas aujourd’hui convaincre le Collège des médecins d’abandonner ce projet de loi, ce serait trop beau. Ce que je voudrais, tout simplement, c’est que les médecins catholiques ne soient pas forcer de nier Dieu pour vous plaire.
Quant aux droits des patients, ils pourraient j’en suis certaine, être respectés par d’autres médecins pour qui ce problème moral et fondamental ne se pose pas.
I’m writing further to the tabling of a draft policy by The College of Physicians and Surgeons of Ontario which demands that doctors participate in controversial procedures like abortion and euthanasia by making referrals and doing the procedure in certain circumstances. I understand that doctors who refuse to follow the policy will be vulnerable to discipline, even though their fundamental freedom of conscience and religion is guaranteed by the Canadian Charter of Rights and Freedoms.
I firmly believe that one cannot act against one’s religious and moral beliefs without creating an internal conflict. Medical professionals should never be penalized for taking a stance that is dictated to them by their conscience. We should never force our doctors to violate their own consciences. Laws should never impose that kind of pressure on people. With the recent Supreme Court of Canada decision on euthanasia, this proposed policy is even more disconcerting.
I ask you to please reconsider the policy and amend appropriately.
I’m writing further to the tabling of a draft policy by The College of Physicians and Surgeons of Ontario which demands that doctors participate in controversial procedures like abortion and euthanasia by making referrals and doing the procedure in certain circumstances. I understand that doctors who refuse to follow the policy will be vulnerable to discipline, even though their fundamental freedom of conscience and religion is guaranteed by the Canadian Charter of Rights and Freedoms.
I firmly believe that one cannot act against one’s religious and moral beliefs without creating an internal conflict. Medical professionals should never be penalized for taking a stance that is dictated to them by their conscience. We should never force our doctors to violate their own consciences. Laws should never impose that kind of pressure on people. With the recent Supreme Court of Canada decision on euthanasia, this proposed policy is even more disconcerting.
I ask you to please reconsider the policy and amend appropriately.
I would like to state that I reject the proposed “effective referral” mandate in the draft dealing with physician assisted suicide. This “effective referral” compels a physician to violate his of her own conscience by being a participant in the very act, the very procedure, which he or she objects to in the first place.
Freedom of conscience and religion are guaranteed by the constitution and must be respected and upheld. This ruling & application is too close to the practice of eugenics of the Third Reich.
And its language is too close to the propaganda of the former Soviet Union. The “balancing of rights” reflects that all people are equal but some people are more equal than others. The policy takes the same viewpoint on religion that Karl Marx did in his opium quote:
“The criticism of religion disillusions man, so that he will think, act, and fashion his reality like a man who has discarded his illusions and regained his senses, so that he will move around himself as his own true Sun.”
I disagree with the proposed requirement that doctors be required to provide referrals when they cannot perform a procedure for reasons of conscience. Referring a patient for an immoral act makes the doctor complicit
This policy is filled will double talk that seems to shield the physician on the one hand, yet leaves him/her wide open to a law suit on the other. It is social engineering with a thin vinear of politically correct jargon to give some sort of legitimacy. If I was a physician with a shred of religious conscience I’d be packing my bags now and heading for the States. If we think we have a doctors shortage now, just wait until this Orwellian nightmare becomes law!
If a doctor wants to keep his professional oath to do no harm, he should not be required to recommend another doctor who does not support his ethical or moral beliefs. If I do not want to kill my sister’s baby or her husband, I should be under no obligation to find someone who will.
What is truly frightening about this situation is its insanity. Here we have the learned people of our society working very hard to draft a policy forcing their fellow doctors to go against their consciences. This is the equivalent of working very hard to draft a policy which forces someone to ignore policies, regulations and laws including the policy they are working so hard to draft. Conscience is that quiet inner voice that tells us it is good to do what is right such as obey just laws. The word “unconscionable” is reserved for the horrific acts of those the judiciary labels thugs. To what will you appeal after you have told the world that conscience must not be obeyed. Religious or not I am sure you want to continue to enjoy the benefits of a lawful society. That is why civilizations have realized it is necessary to preserve the freedom to act in accord with one’s conscience.
And as many have said before that includes in this case the right of doctors to refuse to refer or perform against their conscience.
This is a truly frightening situation.
People working very hard to draft a policy
forcing doctors to go against their consciences is the equivalent of a policy
forcing doctors to go against policies in
general. Conscience is that quiet inner voice that tells us it is good to do what is right such as obey just laws. The word
“unconscionable” is reserved for horrific acts. To what will we appeal after we have told the world that conscience must not be obeyed. We all want to continue to enjoy the benefits of a lawful society. That is why civilizations have realized that it is
necessary to preserve the freedom to act in
accord with one’s conscience.
And as many have said before that includes the right of doctors to refuse to perform or refer against their conscience.
Our country has laws in place for the common good. However, in later years, some laws eventually, changed ,after much effort and sacrifice by people who knew the laws were wrong, ethically. Women came to be considered more than just possession and embraced the right to vote. Currently, in spite of all the medical proof out there, unborn children are not considered human with the right to life until they leave the womb. A mother myself, what could be more ludicrous! Doctors are supposed to heal and preserve life. Euthanasia flies in the face of this ! To take a life oneself or to get someone else to do it are basically one and the same. I am angry that my tax dollars are used to pay for services that are wrong and we make people who have real medical needs, wait. Our country is very misguided.
After the Supreme Court decision that Canadians have the right to physician assisted death, I strongly believe that physician’s right to conscientious objection is even more an imperative. Conscientious objection when viewed from the perspective of reproductive health, including abortion, is a fairly small issue as most physicians who morally cannot do abortions are protected simply by not being competent to perform abortions. Consequently another person or physician will do the procedure.
Unlike abortion the ability to assist a person to die is technically within the knowledge of many more medical disciplines and therefore impacting more physicians who will be asked to assist a person to die. A question arises that if physician assisted death is a right will an MD run afoul of the CPSO if they don’t comply as it violates human rights? I agree with those who argue that physicians have human rights as well as the general populace.
As we move forward the rights of physicians in hospitals will need to be protected and their ability to have and/or maintain privileges should not be affected if their conscience does not permit them to participate in assisted death. Again, unlike the abortion request, this affects many more physicians in hospital practices who will be asked to assist in dying.
Until the federal government response to the Supreme Court decision we will not know to what extent conscientious objection will be protected. Consequently, while waiting for federal legislation to determine its impact on Canadian human rights, I wonder if redrafting of this CPSO policy should be put on hold? Especially as this impacts far more physicians than those who may have to deal with reproductive health.
Lastly, I believe that most physicians believe and uphold human rights that protect from discrimination and do not exclude any person from care. I also believe that physicians should have the right to conscientiously object to doing and participating in procedures they morally object to. What should be encouraged if not enforced is transparency that enables a patient to know what a physician will or will not do.
How does the patient have rights but the physician does not? If rights are selective where do the ordinary people stand? I want my doctor to be a healer not a killer.
I agree with the the supreme court’s decision,that patients have the right to have assistance to end their lives. (I would not apply this rule to patients with psychiatric problems, where the situation may change greatly with treatment.)
However physicians also have their rights and moral believes. If any doctor does not want to co-operate with the ruling,it is not his/her duty to refer the patients to someone who is willing and available. This is against this physician’s moral beliefs.
An organization,such as the CPSO may provide a list of physicians available for this task and patients when requested may be given these names by the CPSO.
There is certainly no need to take extreme measures to extend the length of life. When people are dying, effective palliative care with the best medical assistants is a society’s responsibility. But there is a profound difference between compassionately journeying with someone who is dying, versus killing that person, or assisting that person to commit suicide.
Assisted suicide means a person is incapable of killing oneself and hence demanding a second party to commit cooperative homicide. Legalization of assisted suicide involves a willing homicidal partner. What will happen if the second party is obliged to participate in the process of such against one’s conscience? A spiritual or moral suicide of the participatory party hence resulted. Physicians are trustworthy due largely in part of our inherent conscience. No citizen wants to be cared by a physician without conscience.
No one has a right to take away anyone’s life, and it is simply wrong for the state to allow or to encourage that. It is even more wrong for a medical body to endorse that. There may be demand or misguided statistics to support its legalization. It is usually the weakest, the disabled and the incapacitated who lack or hind their voice for fear of burdening the “progressive and productive” majority.
It is a perversion of the vocation of physicians to have them engaged in helping people to kill themselves. Physicians are called to be servants of healing, not agents of death.
The yardstick is morality and human conscience cannot be graduated or defined by statistics.
Assisted suicide is the deceptively attractive face of euthanasia. The most compelling cases grip our attention and sway the debate, and so the Court opens the door to assisted suicide. A set of limiting conditions, such as informed consent, were established. But the state is authorizing the killing of an innocent person, whatever controls are in place, and even those limitations can over time be swept away, leading to the more widespread practice of euthanasia. We have only to look at some European countries to see what lies ahead. We Canadians patriotically believe our country is special, but it is not so special as to be immune to the dynamics of increasing access to medical killing, as individualist rationales make persuasive the argument for that in more and more cases.
The court, recognizing that many physicians, faithful to their healing vocation, will not assist people to kill themselves, makes some very slight room for freedom of conscience. It trusts local Colleges of Physicians and other such groups to deal appropriately with the conscience issue.
As a practicing physician for twenty years, I do know that not everyone’s conscience is equal.
Some of us have weaker conscience.
Do all surgeons explain the surgical consent 100%?
Do all MDs explain side effect of medications 100%
Do all Obstetricians explain the implication of prenatal testing 100%
Everything can be lawful, but not all lawful are beneficial to human being.
The Law does not equate human conscience.
Public trust has been misplaced. Currently the College of Physicians and Surgeons of Ontario is proposing a draft conscience policy which states that physicians who refuse to perform a procedure to which they morally object must arrange that the procedure gets done by someone else. In other words, they are compelled to become accomplices. I urge the College not to go through with this unjust policy. This represents an assault on freedom of conscience of all physicians. Every Canadian with a conscience should speak up against it.
Any society that authorizes killing people through assisted suicide and euthanasia has lost its moral compass.
“The Ballad of Narayama” is a 1958 Japanese film of great beauty and elegant artifice, telling a story of startling cruelty. The poor village enforces a tradition of carrying those who have reached the age of 70 up the side of mountain and abandoning them there to die of exposure. It won 3 Mainichi film awards. A story of a necessity of survival became tradition which became an enforced culture. A thriller which is of worthy of review before casting your vote of conscience.
All Doctors should have the right to refuse assisting in euthanasia procedures & be able to refer patients elsewhere as a right to follow their moral conscience without being subject to any disciplinary action.
In my first comment I erred in saying that all Doctors should have the right to refer patients elsewhere—I meant to say that they should be able to refuse referring patients without facing any disciplinary action.
It always seems to start with some stories of how this is a humane thing to do, euthanasia, abortion….perhaps even a nice catch phrase like “every child a wanted child” and maybe now “you’re right to chose” will be for your own right to live or die for any variety of reasons that sound noble. Life is hard work, so is loving someone when it’s hard to do so. Relationships are inconvenient when the going gets tough. I wonder if it’s just an easy way to not be bothered with the messy facts of living for health professionals, family members, friends of those hurting. In saying this, I intend not to minimize the struggle of those hurting in any way. Is the only answer death?
I strongly oppose the CPSO’s draft policy that limit physicians Rights to Freedom of Conscience and Religion guaranteed in the Charter, and require them to make an effective referral to another physician if they refuse their patient’s requests, such as for euthanasia should it be legalized.
Thank you for your attention in this important matter.
Physicians should be able to have a right according to their conscience, religious or moral, to refuse procedures that is in total contrast to their belief and moral standings.
The College of Physicians & Surgeons of Ontario should not force doctors to refer for treatment that goes against their conscience.
MP Maurice Vellacott recently stated that there is “no other jurisdiction that currently allows euthanasia or assisted suicide imposes such an obligation.” So why would Ontario do this?
In fact, a National Post article recently reported that “similar policies are already in place in Alberta, Manitoba, Quebec and New Brunswick,” and that [Name omitted] said: “This is nothing new.””
But [Name omitted] is wrong to say Alberta, Manitoba and NB have “similar” policies to CPSO’s “effective referral” policy.
New Brunswick:
Referrals: When moral or religious beliefs prevent a physician from providing or offering access to information about a legally available medical or surgical treatment or service, that physician must ensure that the patient who seeks such advice or medical care is offered timely access to another physician or resource that will provide accurate information about all available medical options.
Manitoba:
Referrals: If the moral or religious beliefs of a member prevent him or her from providing or offering access to information about a legally available medical treatment or procedure, the member must ensure that the patient who seeks that advice or medical care is offered timely access to another member or resource that will provide accurate information about all available medical options.
Alberta:
Referrals: When moral or religious beliefs prevent a physician from providing or offering access to information about a legally available medical or surgical treatment or service, that physician must ensure that the patient who seeks such advice or medical care is offered timely access to another physician or resource that will provide accurate information about all available medical options.
Requiring doctors to act against their conscience and/or be complicit in an act they find morally reprehensible is a surely not a road we wish them to travel. If I knew my doctor could so easily leave his conscience by the side of the road when treating me for “A,” then how could I ever trust him when treating me for “B”?
When doctors signed up to become doctors, they did so knowing their freedom of conscience rights were sacred. Creating a policy that tramples on these fundamental rights is wrong and dangerous.
Please do not impose this declaration on our doctors. All persons,Doctors included, have the right to practise their profession in accordence to their own concience and religeos beliefs
The draft of this policy does not inlude the(humam) rights of doctors. These dedicated professionals have a right to practice medicine in accordance with their individual concience and religeous beliefs
It is imperative that all doctors be allowed to practice in a way which reflects their moral convictions.No doctor should be forced to counsel a patient against his/her ethical beliefs.
I am deeply concerned about the draft policy that would require a physician to participate directly or indirectly in any procedure that they disagreed with. Their reasons for disagreement maybe and often are multifactorial including scientific, environmental and moral reasons etc. Moral views are not necessarily religious views, as anytime something is said to be good or bad, a moral statement is being made. As a patient, I want my physician to be someone of moral integrity who I can trust with my health and my life. Should the draft policy be passed as written it will erode my trust in the medical profession as I will no longer be able to trust that my care providers will value my life, or the life of my family members. Physicians are trained to care, comfort and heal, not to kill their patients by participating in PAS /euthanasia. A number of people have spoken about the right of a personal autonomy with respect to the issue of PAS/euthanasia. Does that right supersede the right of a practitioner to decline for all the various reasons they may do so, moral or otherwise? Does the patient have a right to have this performed by a specific person? I think not. Patients don’t currently have a right to have a certain physician deliver their baby, perform their hip replacement or remove their mole etc. Many family physicians and specialists do not perform a variety of procedures or types of care for any of their patients for a variety of reasons that are not discriminatory in nature. As a physician, patients have asked me and I have declined to write fraudulent prescriptions or to lie on their behalf. It was my moral code that dictated that I not comply with these requests. It was also my moral code that dictated that I decline in a respectful manner. The current draft policy would force some physicians to violate their moral code or face disciplinary consequences. This is nothing short of discrimination and oppression against those whose moral code is different from that of the policy makers. What will happen to the many patients who may lose their physician should the policy not be changed?
Physicians have a long history of ethical guidelines which have stood the test of time. The Hippocratic Oath which I subscribe to and which has all the safeguards that protect patients and guide physicians. The Canadian Bill of rights protects the conscience rights and religious rights of all Canadians. Canadians are privileged to live in a society which protects these rights. The College of Physicians and Surgeons of Ontario is entertaining changing policies that currently work. If the changes proposed are passed the professional services of many physicians will be seriously impacted. I can’t imagine what the professional services of physicians would be like if they did not use their conscience. It would not be a healthy move in my opinion.
I agree that patients should be treated with respect and without discrimination. However, physicians should be able to follow their conscience when asked to perform or provide services which violate their principles or beliefs.The relationship that exists between patients and physicians is of such a personal nature, that it should be evident what beliefs the physician adheres to. The patient is free to choose a physician who can provide services to them which does not violate the physicians beliefs. The physician should never be forced to compromise their values nor should they force their values on their patients. Health care providers have rights too!
For the first time in my life, the inner security I have always known toward the medical profession has been shaken. Should this draft policy be adopted, I will no longer feel safe to place my trust in doctors.
The solution needed is more and better support for access to palliative care, not a medical profession licensed to assist suffering people by helping them kill themselves.
I do not believe the recent decision of the Supreme Court judges was in the best interests of society. When non-elected judges rather than parliament determine our laws, Canada’s democracy is seriously compromised.
Doctors must be allowed to maintain their freedom of conscience. By initiating or supporting legislation that would help Canadians feel safe. The C.P.S.O. would be wise to institute a truly trustworthy and honourable “medical aid in dying” based on caring, not killing.
Canada’s constitution guaranteed freedom of conscience and religion, therefore, physicians have the right to work with morality and integrity. Physicians can not be force to refer or provide medical procedures that violate their consciences.
The wording of the policy is too vague and broad as can be seen in the bottom line requirement that “physicians must provide care that is urgent or otherwise necessary to prevent imminent harm, suffering, and/or deterioration, even where that care conflicts with their religious or moral beliefs.” This statement is saying that conscience means nothing if the care is deemed “necessary… to prevent suffering.” Suffering is a very broad term that does not require physical pain. It can be psychological pain. So basically this policy leaves no grounds for conscience at all as abortion and euthanasia could both arguably be necessary to prevent suffering. In this the college is being discriminatory to its members. Amazing to think the college is supposed to be representing its members and it is taking away basic human rights and freedoms from its members. I am staggered by this policy and wonder who in the college feels entitled to ram this through? I would think there would be some remnant of respect for doctors having a conscience. I do not understand why the responsibility for providing all care should fall on the shoulders of each doctor – our supreme court has now ruled that citizens have a right to assisted death. I would think it would be the responsibility of the state to ensure access to this, not the responsibility of each individual physician. I would think a coordinated provincial approach could offer coverage for controversial procedures in a way that would respect and protect a doctor’s conscience rights. I am very disappointed in the college that they so quickly want to put their members on the line for something that calls for a coordinated approach. As another physician said, the “College is once again overstepping its jurisdiction and legal bounds.”
Physicians & Surgeons are people with rights also, as do patients. Doctors have taken a hypocritic oath to protect life. He is also, or should be protected under the Charter as is his patients. To infringe the patients right over a doctors is not morally right. Are we in a free country or a dictatorship? If a doctor wants to refuse to do a procedure or refer a patient to another doctor because of his moral or religious beliefs – he should be free to do so. As a patient, we should have the opportunity to have a doctor that might share those same beliefs and those that don’t should have the same opportunity to have a doctor that shares theirs.
To take away a persons freedom of conscience right is a tragic loss to our country.
I am a final year medical student in Ontario. I am hoping to pursue residency in Family Medicine next year. It must first be stated that when we are accepted into medical school, there is no contractual obligation that requires us to leave our morals and values behind in order to study or practice medicine. In fact, it is quite the opposite. We are encouraged to take our experiences and background into account when we make clinical judgments. It may surprise many, but my religious background and desire to serve others is the reason I entered a career in medicine in the first place. My religious background and teachings influence my motivation to study every day, the way I treat my patients, and how I interact with others.
I have been taught that practicing medicine is an “art” and that many factors go into clinical decisions. Theses factors include patient requests, but in good conscience, I will not always prescribe antibiotics because I am requested to, or put a person currently addicted to alcohol at the top of the liver transplantation list. As a future physician, I am called upon to use my skills, knowledge and personal experiences to provide care. My knowledge and ability to use evidence based medicine does not support certain medical practices including euthanasia. Referral is participation in acts that are against my conscience.
We live in a society that celebrates differences and people of all backgrounds. When I meet a patient for the first time, whether that patient has a Qur’an or a Bible in her hand, or does not hold any religious beliefs, she is treated with the same respect and dignity. Likewise, I also hope my patients respect my beliefs and recognize that if they request a certain medication or procedure that violates my moral code, there are other ways to obtain these services (that are very accessible, especially in Ontario). I respect my patients’ differences and recognize that their beliefs may be different from my own. However, this does not justify requiring an act that goes against my conscience, especially with respect to services that are already accessible through public health units, hospitals, walk in clinics, and many other physicians. The physician that does not provide for or refer for a particular service does not abandon her patients because she seeks these services elsewhere.
I appreciate the College’s work on the policy entitled, “Professional Obligations and Human Rights.” I agree that patients must be informed of their options but there should not be an obligation to provide or refer for services that doctors find morally objectionable. In compelling physicians to refer, you are limiting their right to conscientious objection. There is significant disagreement in our society as to what constitutes a moral act, and I do not expect the College to define or limit morality. All I expect is that physicians, as professionals, be allowed to respect their own consciences. Freedom of conscience is foundational to our free society and cannot be limited, even for the best of intentions. If we coerce physicians into violating their consciences we will inevitably erode the personal integrity which is the basis of the physician’s relationship with their patients.
With the Supreme Court’s recent legalization of assisted suicide in Canada, your proposed policy is becoming extraordinarily frightening for new physicians. Medical students should not fear practicing in this province. Doctors should not be forced to refer or provide services that they are morally opposed to. Your proposed policy will influence where I practice.
I hope you will do what is best for the people of Ontario and the doctors of the province by amending this proposed policy.
Telling doctors they have to do something they believe is wrong or go practice somewhere else will not help to provide care for all the people who need doctors and don’t have them.
The suggestion of a list of doctors willing to assist in death requests is more favorable (if this policy does get approved) then telling doctors not to practice in the province they were licensed in.
The College is overstepping its boundaries. I believe that physicians should be allowed to treat patients according to their beliefs. Physicians have rights as well, and should not be forced to provide services that go against their conscience.
I am writing to you with grave concern regarding the content of your proposed draft policy. Sections 8,10,11 suggest that physicians who decline to participate in certain acts for reasons of conscience should be compelled to refer their patients to other physicians who will perform these acts. it does not address the fact that many of these physicians will find the act of referral itself objectionable, as they consider it material cooperation with the act. In compelling physicians to refer, you are limiting their right to conscientious objection. There is significant disagreement in our society asa to what constitutes a moral act, and I do not expect the College to define or limit morality. All I expect is that physicians, as professionals, be allowed to respect their own consciences. Freedom of conscience is foundational to our free society and cannot be limited, even for the best of intentions. If we coerce physicians into violating their conscience we will inevitably erode the personal integrity which is the basis of the physicians relationship with their patients. I encourage you to revise the sections above, and include a clear defence of the right tp freedom of conscience for all physicians!
I believe that if a physician cannot help a patient to put an end to his/her sufferings on the basis of his religious beliefs, he/she should be able to refuse. However, I also believe that it is the physician’s duty to refer the patient to another physician in the name of compassion and the patient’s human rights. Personal morals and beliefs should not interfere with the delivery of care. In addition, the decision should be taken by a team of doctors and health specialists as it is done in Belgium, a special committee, not by one physician only. It would be wrong to burden one person with such a responsibility.
As an Ontarian and Catholic I still believe that freedom of conscience still matters and cannot be eliminated through policy . The college is again overstepping it, s boundaries.
I strongly disagree with this proposed new policy that requires physicians to refer and in some cases perform procedures contrary to their conscience. If doing a thing is immoral, so is arranging for someone else to do it immoral. Doctors are there to extend, enhance and PROTECT human life. The camel has his head in the door of the tent(abortion) and now he wants to put his whole body in (euthanasia).
To compel a physician to make a formal referral for abortion or physician assisted suicide when the physician would consider such action to be contrary to his religious beliefs and moral code is contrary to the concept of freedom of religion and conscience which is at the core of the Charter of Rights and Freedoms.
What may be legal may not be ethical or moral-a concept behind the Nuremberg war crimes trials.
The C.P.S.O. would be well advised not to proceed with this policy lest they find themselves cast by a fickle prevailing wind upon a rocky shore of legislated intolerance.
Physicians conscience rights must be protected. I strongly oppose this draft policy and its requirement for many physicians to practice contrary to their moral beliefs, which will lead some doctors to consider leaving practice in Ontario (I know many personally who have expressed this consideration), and others who will avoid family medicine and other needed specialities which will require practices (such as euthanasia) they are morally opposed to. Infringing on the rights of doctors who strive to practice with integrity would be a huge step in the wrong direction for medical care here in Ontario.
Physicians should have the right to say NO to providing certain forms of treatment. However, I’m particularly concerned with the requirement that physicians provide referrals for treatments which they feel are morally and ethically wrong.
If a physician feels a treatment is morally and ethically wrong, and then aren’t they still violating their conscience by asking someone else to perform the procedure? How is the physician’s right to freedom of conscience being protected under these circumstances? In addition to this, a physician might feel that if a procedure is morally wrong it would also be harmful to the patient. Under these circumstances the physician would be violating not only their conscience, but also their Hippocratic Oath by referring the patient to someone else to perform the procedure.
I trust that the Draft Policy be revisited in consequence of the Carter decision.
Surely if a physician is opposed to physician assisted death, he does not have a duty to refer the patient to another physician.
Further, the Policy should address the conflicts that may arise between the CPSO
Policy and the Contract/Undertakings that a Physician may have entered into with a health care provider such as a hospital.
A physician may well be conflicted between the two.
Physicians should be defended in their
discretion and integrity ,which is not evident in the draft policy.
I believe that doctors should have their right of freedom in religions and conscience protected, without a mandate for an ” effective referral “, which is equivalent to hiring a ” hit man ” to do the dirty job.
Regarding the 2015 Draft Document “Profession Obligations and Human Rights”
Introduction
The College of Physicians and Surgeons of Ontario has been meticulous to address the quality and fiduciary obligations of physicians practising in a pluralistic society. In 99.9% of medical practice, there are few discrepancies of perspective about what constitutes proper practice and how to make referrals when necessary. However, in 0.1% of medical practice there are controversial situations that involve moral and ethical considerations and these situations have been and will continue to be problematic for both physicians and the College since consensus is difficult to achieve. What follows is a proposal for the College to be innovative in promoting a model which would allow individuals to have access to their choice of service in controversial services and at the same time, safeguard the conscientious behaviour of physicians.
WITH A WISE MODEL, BOTH PATIENT CHOICE AND RESPECT FOR A PHYSICIANS CONSTRAINTS OF CONSCIENCE IN CONTROVERSIAL ETHICAL AND MORAL MATTERS IS POSSIBLE……read on:
Background Observations/Facts/Premises
We live in a pluralistic society.
There is a very wide spectrum of ethnicity, religious persuasion, worldview etc.
These same diversities are evident within all professions including the healthcare sector.
Both the Canadian Bill of Rights and Charter of Rights endorse the respect for diversity.
Ethical persuasions will depend on the foundational premises which undergird a particular point of view.
A uniformity of perspectives on many ethical and moral matters will never be achieved since there will never be consensus on the premises. For example a theistic conviction will never mesh with an atheistic one.
These diversities, therefore, will always require innovative resolution in the provision of services within the healthcare sector if individual rights are to be preserved.
Without some form of societal compromise and civil honest dialogue, there will be an inevitable effort to coerce some to “park their convictions outside of their workplace” and to act contrary to their conscience.
There is a risk for individuals as well as groups to claim freedom for their own perspectives whilst denying the freedom for others holding a contrary view. Ironically, global rules can be mandated by but a few individuals.
What is “legal” as defined by law is not necessarily what is right or wrong by more absolute standards. As an example, the murder and torture of a slave in the old South was legal but hardly moral, ethical or right.
There have been massive paradigm shifts in the Oaths taken by graduating physicians. The Hippocratic Oath, considered normative for a couple of thousand years, clearly forbade abortion and euthanasia. That boundary has been moved substantially with graduates swearing allegiance to the law which can relatively easily be changed (and has been changed).
What we have before us is both a practical matter but also a political matter. The practicalities are well understood by the CPSO, and there are safeguards for the provision of good healthcare in all its aspects. But what also needs to be understood is the pressure by some to change and homogenize society to their own agendas by political coercion.
To give an example, a complaint is lodged against a physician who refuses to prescribe the birth control pill as a result of religious convictions. The physician has announced the office policy clearly aforehand. There are innumerable other physicians within the community who are able to accommodate the patient’s request but instead of accepting the one physician’s policy and finding an accommodating physician, a complaint is lodged and it becomes a College and legal battle. This has ceased being a practical matter of obtaining the requested birth control pill since there is almost no difficulty in obtaining it from an alternate physician. Instead, it has become a political lever to coerce the physician to change her view and, despite conscientious objections, to prescribe.
One must differentiate the practical considerations from the political
Within the medical profession, there is represented a very wide spectrum of persuasion/conscience pertaining to the ethical tensions within our society. For any given patient, there will be no shortage of physicians that can be matched to their particular preferences. Thus, in practice, there will always be the ability to match patient to physician.
The spectrum of diversity within the medical profession always provides options for the individual seeking various services that may be controversial.
The key question is how the matching can be done without physicians having to put their consciences into deep freeze. The College has tightened the wording in the current draft on Professional Obligations and Human Rights in comparison to the document of 2008. There is a subtle implication that the rights of the patient will trump the rights of the physician on controversial issues. (Line 118 and 119). The term “care” in this sentence is not defined and given the context, obviously will apply to a minuscule slice of a physician’s practice. Nor is the term “impede” clarified. In real and practical terms, there will always be alternative routes for the patient. However, those with a political agenda to shape society may use these concepts to coerce physicians into complicity with convictions other than their own.
The College appropriately emphasizes that how something is communicated is as important as what is communicated. This indeed is important and a tone of care and understanding must be maintained.
However, the one very important sticking point for many physicians will be College’s directive to provide “an effective referral [which] means a referral made in good faith, to a non-objecting, available, and accessible physician or other health-care provider.” (Line 156 and 157) This statement constrains a physician more stringently than the statement of 2008 which stated that the physician “Advise patients or individuals who wish to become patients that they can see another physician with whom they can discuss their situation and in some circumstances, help the patient or individual make arrangements to do so.”
This shift in the proposed draft is putting the onus of responsibility on a physician who potentially feels herself to be an accomplice to an objectionable pathway, be it abortion or physician-assisted suicide etc. Is this necessary? Is there any way around this? Yes, there is. In a 2008 edition of “Dialogue” the notion of “balance” was discussed. There is a way to achieve respect for the diversity that prevails within our society and also respect the diversity of conviction amongst physicians.
The standard paradigm of guidelines, rules, and management of quality issues in the provision of healthcare has been well established and there is broad consensus about this. However, when there are controversial matters (and there will always be controversies as long as there are different world views), the rules established by the College, of necessity, will have to recognize the diversity of opinion. Otherwise, there will be a forced uniformity which obliterates bona fide protestations of conscience.
The approach to the controversial areas (which always will be with us) requires wise innovation to preserve the intent of the Charter of Rights to respect the rights of all concerned: patients and physicians ALIKE.
PROPOSAL OF A WORKING MODEL
Physicians should post within their offices or websites the areas of clinical services that they provide and any disclaimers that address potentially controversial matters (already, I believe, a College policy).
Patients accommodated within the practice should sign that they have read and understand the parameters of that particular practice.
The Ontario Government, OMA, CPSO etc. can establish easily accessible websites which list and identify physicians, clinics, and organizations which would provide services that are controversial and are willing to accommodate individuals for these. Publicly instituted series of options can be made easily accessible and transparent.
Physicians who feel unable to make referrals, could simply direct the individuals to the website(s) which patients can easily access, and find accommodating physicians.
Innovative models are easily constructed to ensure access to controversial services whilst safeguarding a physician’s integrity of conscience and practice.
As a society, we have somehow pushed theological considerations aside notwithstanding the Nation’s “Canadian Bill of Rights” attestation that we are a nation “under God”. It is not the prevue of the College to address these issues but, an adverse judgment for honestly held scruples is fraught with mischief in the long run. It is worth keeping in mind that over half of our population holds to firm religious convictions that surely speak principles into the public space and that our very laws have been religiously premised.
It cannot be ignored that over half of our population holds to firm religious convictions.
ALGORITHM
Before implementing the draft, it would also be wise for the College to explore the algorithm of how it would handle a complaint that a given physician would not provide a service on the basis of religious or moral convictions. There already have been such cases but this will increasingly be an issue as the Supreme Court has struck down the laws circumscribing Physician Assisted Suicide and new laws are enacted. One can be quite confident that a large segment of the physician community in Canada will have nothing to do with intentionally killing patients. There could be hundreds of cases of complaint.
Once physician-assisted suicide becomes legal, there will large numbers of physicians who will have nothing to do with intentionally killing patients. Will they be brought to tribunals?
Will the College resist the politicization of healthcare and support the right to conscience of physicians who commit themselves to a high standard of care for their patients? Will the College recognize that there are models which enable patients to obtain the care that they wish whilst at the same time safeguard the integrity of conscience of physicians who subscribe to convictions that may be Christian, Jewish, Muslim, Hindu or otherwise? Or will the College strip physicians of their licenses if they refuse to bend to a purely humanistic politic? Will there be coercive measures to force compliance when alternative neutral models can be constructed?
The College also needs to be vigilant to discern complaints which are designed to target dissenting physicians for political ends as compared with bona fide complaints pertaining to quality or true accessibility issues. The publication of services via the media or websites or identifying the same on practice profiles would go a long way to resolve complaints and avoid the politically motivated agendas. The recently well publicized comment of one physician who expressed the opinion that physicians with scruples should get out of medicine (or not be 55allowed in), exemplifies the politics of intolerance that is hurtful and harmful to our society. It also contravenes the Human Rights Code.
Without the College making adequate accommodation for physicians who are constrained by conscience on controversial situations, the logical outcome would be the blocking of such individuals from being accepted into medical schools (contrary to the Human Rights Code) and practicing medicine. For that matter, there are politically motivated individuals and organizations who would shape society to their own agendas by preventing those with religious convictions from entering the legal profession, government, as well as medicine. Intimidating and expensive lawsuits are not uncommon. There is, of course, nothing new about such a strategy. Honest debate and dialogue are sometimes in short supply.
Before implementing the draft policy, it would be advisable for the College to study the algorithm of response when complaints are brought against physicians who feel constrained by the voice of conscience in controversial matters.
Summary:
We live in a pluralistic society which is safeguarded by the laws of the land.
There are models by which the diversity of conviction can be respected and at the same time services provided that are controversial.
This is a call for the CPSO to support and promote (or at least recognize) the models that avoid arbitrary penalties for those who seek to practice to high moral and ethical standards.
The current proposed rigidity with regard to making referrals in morally and ethically controversial situations plays into the political agenda rather than recognizing that in reality, there is no lack of physicians willing to provide service on the other side of the controversy.
I commend the efforts of the College to formulate policies that are fair and balanced but I also perceive that the College is bending to a political agenda that seeks to squash the soul of the medical profession. I trust that these reflections will provide a helpful perspective. A broad view of how we came to be and where we are going is essential!
One of the major concerns of this Orwellian proposal by the CPSO is that doctors would be forced to refer patients for procedures that violate the doctors own personal conscience. Those in favor of the proposal might say, “What’s the problem here?–they’re aren’t being forced to actually do the procedure are they?” Perhaps not, but they would be a complicit as would any other co-conspiritor would be in a criminal act. The chemical companies in Nazi Germany were, in principle, as complicit in the death camps as were the people who operated the ovens. How in the wide world can a civilized country like Canada fail to see the implications? Words fail the trained mind.
The proposed policy requires physicians who choose to limit the health services they provide on moral or religious grounds to do so in a manner that:
i. Respects patient dignity;
Comment: This is mostly a matter of communication, and is already dealt with at the level of medical education programs;
ii. Ensures access to care;
Comment: Framing of the issue of the access to care in conjunction with the freedom of conscience and moral or religious beliefs is misplaced and potentially dangerous, especially since “This policy sets out the legal obligations under the Code for physicians to provide health services without discrimination”.
In the first place, the College is overstepping its jurisdiction on legal (since the establishment of legal obligations is the role of parliament and the courts) and moral grounds,
Next, since the Nuremberg Trials, it is essential to justice that conscience cannot be ignored in the name of legal methodology and by legal methodology (The College might want to consult such reference documents as Reawakening memory: The Nuremberg congress ‘medicine and conscience 50 years after the Nuremberg trial of German doctors’ Medicine, Conflict and Survival, Vol. 13, Issue 3, 1997). Personal responsibility and conscience form the very essence of a positive and moral law.
In practical terms, the access to care is currently, in the scope of the proposed policy, a non-issue (for example, abortion is self-referred in Ontario). The big issue is euthanasia. Given the Supreme Court decision, the policy MUST NOT pre-establish or impose any regulations pertaining to the provision of euthanasia before a judicial framework is established. The right to life is fundamental. It is not merely equal in importance to other specific rights.
Let us also remember that access to care in Ontario is limited much more by economic or administrative factors than by conscientious decisions of individual physicians.
iii. Protects patient safety
Comment: This is precisely the area of the College jurisdiction, and more specific guidelines with regard to “suffering, and/or deterioration” would be helpful.
In summary, the proposed policy gives an impression of a hastily written document aimed at appeasing bureaucratic bodies rather than seriously addressing a complex and multifaceted issue of the place of conscience and religious beliefs in the practice of medicine. The document should be withdrawn, and completely rewritten before any resubmition.
Human beings are not wired to divorce conscience, world-life view, opinion and beliefs from practice(s), robots are. Especially in the medical field where I presume professionalism is essential and expected, a doctor should be able to, and have the freedom to be upfront with me and say what is on his or her mind concerning my varied health needs and treatment options. If I disagree I can always obtain a 2nd opinion but at the very least I respect the right of my doctor to provide an opinion even if the opinion involves faith based fundamentals. I do not think a policy statement should handcuff a doctor in this matter.
I am writing to express my opposition to the College of Physicians and Surgeons of Ontario’s draft policy mandating that physicians must make referrals for procedures and ‘treatments” even if it is against their conscience This is a violation of a physician’s freedom of conscience rights enshrined in our Constitution.
I ask that you reconsider this due to the ramifications of such a policy on both doctor and patient
It is so important the we do not legislate away freedom in this country that has been built on the basis of freedom. Doctors need the right to freedom of conscience. And patients can shop around to get the treatments they feel that they need. If a significant enough number of doctors refuse to provide a certain treatment, perhaps the idea that it is essential for the common good and true need for it should be more carefully studied.
I am writing to express my opposition to CPSO of Ontario draft policy mandating that physicians must make referrals for procedures and treatments even if is against their conscience.This is a violation of a Doctorès freedom of conscience rights which is enshrined in our Constitution.
I urge you to seriously consider the ramifications of such a change
Thank you for your efforts to ensure that healthcare in Ontario is provided free from discrimination in a manner that best serves patient interests. I do, however, have a number of concerns with the proposed policy “Professional Obligations and Human Rights” that I hope you will consider in revising the current draft. Many (if not all) of these have already been expressed in earlier posts, but I would like to summarize and hopefully further develop some of them.
1. Rights: The policy acknowledges the Charter right to freedom of conscience and religion as well as highlighting situations in which such rights may be limited. It then summarizes factors that may be considered in balancing competing rights, citing the Syndicat Northcrest vs. Amselem case in which the Supreme Court ruled that the religious right of a group of Orthodox Jews to build succahs on their apartment balconies outweighed the property and personal security rights of the building owners that would be infringed upon through such a practice. I would argue that the physician rights being infringed upon by the proposed CPSO policy significantly outweigh any patient rights that may be compromised. The act of referring for and/or performing a health service that is contrary to a physician’s moral or religious beliefs, including procedures that involve the ending of life and thus violate some of the most important moral or religious precepts an individual may hold true, is no trivial matter. In contrast, such services can relatively easily be made available by self-referral for patients that desire them, thereby avoiding any compromise to the integrity and wellbeing of physicians without interfering with patient access to care. Good patient care depends upon the maintenance of such integrity and wellbeing as apart from it physician function is impaired and societal needs disserved. I don’t have a legal background, but I am not aware of any legal precedent in Canada that would directly suggest that a physician is obligated to refer for and/or provide a health service against good conscience (please let me know if I am incorrect). To the contrary, my understanding is that the Supreme Court of Canada has recently upheld the right of individual physicians to choose not to participate in physician assisted death once it is legalized. It is inappropriate and I believe harmful to both the medical profession and more importantly patient care for the CPSO to create this unnecessary policy that if anything directly contradicts the ruling of the country’s highest court. It is an insult to the rule of law. Were such a policy nonetheless adopted by council, I would certainly be interested in contributing to a legal challenge against it.
2. Discrimination: A physician who chooses not to provide a particular health service to all of their current or prospective patients is not being discriminatory in even an indirect and unintentional manner. In contrast, the proposed CPSO policy specifically discriminates against physicians with particular moral or religious beliefs and limits its scope by requiring that physicians abstain from promoting religious beliefs without addressing any other potentially inappropriate non-religious beliefs that a physician might promote in the course of their practice.
3. Service: If I understand it correctly, the objective of this policy is to establish CPSO expectations that will ultimately facilitate access to care for patients in Ontario. I would suggest, however, that it may in fact have the opposite effect. In particular, I have noticed several postings on the public form expressing concerns about physicians re-locating or otherwise changing their practice if the new policy were adopted. As a first year family medicine resident who has completed all of his medical education in Ontario, I feel indebted to this province and would prefer to remain here to practice. If, however, the CPSO were to require referral and in some cases provision of health services that violate my ethical principles, this would affect my career decision making and would provide reason to consider practicing in another jurisdiction. Furthermore, I am interested in completing a care of the elderly fellowship and focusing part of my practice on geriatric patients, but would be discouraged from doing so if I were not confident that I would be exempt from having to refer select patients at the end of life for physician assisted death. I know a number of other like-minded medical trainees and physicians, and although we remain a minority, the effect this policy could have on our practice decisions nonetheless may impact negatively on patient care access.
Thank you very much for your consideration of these points. I hope that they will be helpful to you in revising the proposed policy in such a manner as to optimize patient care in Ontario.
As a medical student in the Province of Ontario, I am writing to you with grave concern regarding the content of your draft policy, “Professional Obligations and Human Rights”. I ask the Consultations Committee to retract this draft policy for the reasons I have outlined below.
If adopted, the draft policy will jeopardize the ability of physicians in Ontario to follow their consciences. The policy suggests that physicians who decline to participate in certain acts for reasons of conscience should be compelled to provide an effective referral to other physicians who will perform those acts. This requirement does not address the fact that many physicians find the act of referral itself to be objectionable, as it is considered material cooperation with the act. If a physician finds a certain act to be immoral, it follows that facilitating and arranging for that act to be done is also immoral. In compelling physicians to refer, you are limiting their right to freedom of conscience and freedom of religion. I would like to remind you of the fact that the very Canadian Charter of Rights and Freedoms that you cite in your draft policy protects freedom of conscience and freedom of religion. The CPSO’s draft policy inherently prioritizes the freedoms and rights of patients over that of physicians, despite the fact that the CPSO does not have the legal jurisdiction to rule on such matters. I ask that the CPSO respect our country’s constitution and recognize the importance of diversity of medical and ethical judgement.
I do not believe that physicians should discriminate against patients, and in fact believe that patient care is of the utmost priority. However, contrary to what the draft policy implies, deciding not to offer a particular service in no way discriminates against patients, provided that the service is not offered to any group at all. It is difficult to see how limiting physicians’ right to freedom of conscience and religion will result in any less discrimination. In fact, moving ahead with this policy will actually create systematic discrimination based on conscience or religious belief.
Moreover, compelling physicians to make referrals that they do not morally agree with will not improve patient care. Requiring doctors to participate in procedures that go against their beliefs will reduce their personal sense of integrity if they continue to practice. This will significantly harm the physician-patient relationship, as physicians would be recommending their patients receive procedures or medications that they do not personally believe in. If approved, this draft policy will coerce a large percentage of physicians to participate in assisted-suicide despite their moral objection. I bring your attention to the Canadian Medical Association, which asserted physicians’ right to conscience in their August 2014 meeting.
Access to care will also not be improved by implementing the draft policy. Common actions and procedures that physicians may object to include abortion and contraception. The availability of these services is not threatened by physicians who morally object to them. In fact, these services are easily accessible without referrals, given the ability of patients to self-refer to clinics that provide such services.
I would also like to bring your attention to the final section of the draft policy, which is entitled “Protecting Patient Safety”. The language used in this section is ambiguous and unacceptable in its current form. There is no clear guideline as to what is considered “imminent” harm, suffering, and/or deterioration. The incredible lack of balance and comprehensiveness to this section of the draft policy implies the CPSO has little regard for the implications of the policy.
In summary, I believe that the CPSO is overstepping its jurisdiction in defining and limiting morality. Freedom of conscience is foundational to our free society and is protected by law. I ask the CPSO to retract this draft policy on “Professional Obligations and Human Rights” in light of the Canadian Charter of Rights and Freedoms. Instead, the CPSO should create a policy to defend the right to freedom of conscience for all physicians.
[**MESSAGE FROM ADMINISTRATOR: DURING THE CONSULTATION PERIOD, WE RECEIVED 3 RESPONSES FROM INDIVIDUAL RESPONDENTS CONTAINING THE CONTENT PUBLISHED ABOVE. ALTHOUGH THIS FEEDBACK HAS NOT BEEN PUBLISHED IN DUPLICATE, THE COLLEGE ACKNOWLEDGES RECEIPT OF THESE SUBMISSIONS.**]
Forcing someone to do something which they are morally opposed to is a human rights violation. Doctors should not be subject to such a human rights violation simply because they are doctors. Their rights and freedoms should be protected. Expecting a doctor to refer a patient for a service which they feel is immoral is absolutely ludicrous.
I believe CPSO should not force their physicians to refer to another physician for services they cannot provide for reasons of conflict of conscience. CPSO should respect the conscience rights of their own physicians just as they do of all citizens of Ontario. Abortion, physician-assisted suicide and euthanasia are morally serious issues because they are life-and-death issues and these questions are intrinsically important to every person – this is our human nature. These are extraordinary issues and deserve extraordinary measures of handling.
If CPSO believes it will be too difficult for patients to find another physician to help them with their needs, then I believe CPSO itself should provide some means of assisting the public with access to another physician. This may become increasing more practical for all citizens of Ontario when physician-assisted suicide and euthanasia become established practice.
Perhaps a register of physicians could be established, outlining those who do and those who do not provide such services. The CPSO website physician search function already outlines which professional specialties as physician provides. Could this tool not be expanded to include other morally-controversial questions of service?
Asking a physician to refer does not provide a full accommodation of the physician’s own conscience rights and I believe the physician deserves a full accommodation of his rights. I also believe this could be done without causing great hardship to the public. And this is mandated under the Ontario Human Rights Code.
I am a pharmacist, and pharmacists in Ontario experience the same disregard of their conscience rights by their College as is now proposed by CPSO for their physician members.
I believe our Colleges could balance the rights of the citizens of Ontario with the rights of their own members in a more appropriate fashion which would not deny the conscience rights of the medical professional. It is an issue that deserves a little more organization and strategy, but I believe it is important enough to warrant it. I believe our medical professionals deserve a full accommodation of their own conscience rights and ask the College of Physicians and Surgeons to seriously reassess their proposed policy.
Please consider the Freedom of Expression
of Doctors who because of Christian Principals, CANN0T agree with your proposed
policies.
We DO NOT AGREE WITH YOUR PROPOSAL.
Religous beliefs make a person who they are. It is part of theie being. For most, it makes them more compassionate and kind. I think the College is overstepping. Please let doctors be who they really are
If the patients have rights to choose, so should the doctors. Why should the patient be more superior, esp when generally the doctor is more knowledgeable. If the doctor has religious convictions, he should be allowed to act on them. They are what make him who he is, both as a citizen and as a doctor. For many, the value of life is waht made them become a doctor in the 1st place – to help and save others. How can the College tell them the must act more on “facts” or patients wants than their own religious convictions?
I agree, Doctors should have the choice to say no, as long as it is not an emergency, If people want euthanasia then they choose a Doctor that will perform such.
Dear College of Physicians and Surgeons of Ontario,
I am writing to you with deep concern regarding the draft proposal “Professional Obligations and Human Rights”. Your current draft has far reaching implications given the recent ruling of the Supreme Court regarding doctor assisted suicide and I disagree with the intention to force a physician to do something against their conscience.
I propose these areas of contention should be a matter of discussion between doctor and patient before establishing a doctor-patient relationship. Patients can then be cared for by doctors of like-minded values, giving the highest level of care physically, mentally and emotionally. I also propose that the College consider the future implications of recent rulings and how they have morphed in other societies to include euthanizing babies, handicapped, depressed and elderly people. This is not health care and it puts patients at risk when they are concerned that they will be a “burden” to their loved ones. Health care provides caring patient and family support and quality palliative care. These are the things that should be valued in patient care and advise the government of the importance of these services safeguarding the vulnerable.
Just because something is not criminal, doesn’t mean it is ethical and moral. Ethical and moral doctors are critical for quality health care, I want a physician who has not been required to divorce these qualities to remain in practice. This policy would essentially force conscientious objectors out of your profession and decrease the quality of care. It is intolerant ideology masquerading as enlightened objectivity, no one should have the right to force someone to do something against their conscience or tell them they are not welcome in their profession. It is discriminatory.
Dear College of Physicians and Surgeons of Ontario, Professional Obligations and Human Rights Policy Drafters,
I am writing to let you know that as a member of the public, I am concerned about what I consider a threat to doctors’ freedom of conscience regarding their “duty to refer” (particularly with regards to issues that are related to religious morality). Requiring a doctor to provide referrals when they cannot perform a procedure for reasons of conscience is still forcing them to abet an action which goes against their conscience. Removing the moral element from a doctor’s professional life is a fundamental assault on their personal integrity. Doctors’ freedom of conscience should not be eliminated through policy.
Please reconsider your policy draft, particularly the section entitled “Ensuring Access to Care.”
Do you not consider it a violation of a doctor’s conscience and human right forcing him or her to perform abortions? Killing doctors’ consciences will be a horrific travesty for our country not unlike Nazi doctors.
Don’t do this. I realize this sounds dramatic but mull it over to find the truth of it.
Just because we have moved exponentially into the science and technology fields; I still feel the matter of life and death is in the hands of our creator and should remain as such. Helping people to have babies and helping people to end their lives is a slippery slope where ethics and values are compromised to such an extent, there is no turning back. What happened to: “Render unto Caesar the things that are Caesar’s and render to God the things that are God’s.” Thank you!
Subject: Draft Policy “Professional Obligations and Human Rights”.
I am writing to you with grave concern regarding the content of your proposed draft policy. Sections 8, 10 and 11 suggest that physicians who decline to participate in certain acts for reasons of conscience should be compelled to refer their patients to other physicians who will perform these acts. It does not address the fact that many of these same physicians will find the act of referral itself objectionable.
One of my concerns as a Catholic priest is the decrease in Catholic doctors that this policy will bring about. Catholic doctors who cannot in their conscience give an effective referral for euthanasia or abortion, for example, will be forced eventually to stop practicing medicine in Ontario. Potential Catholic doctors will be discouraged from studying medicine in order to become a doctor in Ontario. Catholic women especially, however, greatly benefit from having practicing Catholic doctors. These women benefit from doctors who understand things like Natural Family Planning.
I am concerned that your draft policy would also lead to similar policies for other medical professions. We are in great need of Catholic nurses and psychologists. Many Catholics and Christians suffer from severe depression, bipolar disease, and schizophrenia. They too benefit from medical professionals who understand their faith from the inside. The effect of your policy will be to decrease the likelihood of their being any Catholic doctors in Ontario.
In closing, I mention the following. Until someone from a warm climate actually experiences the winter in Ontario, it is very hard to understand what it is like. In a similar way, it is hard to understand many Catholic patients without experience of being Catholic. We have many young people who want to be Catholics and doctors. Please do not take this possibility away from them.
Please recognize the human rights of our physicians, surgeons, and medical personnel when you are implementing legislation. I ask the College of Physicians and Surgeons of Ontario – to please protect the freedom of conscience of all its members. The conscience of many people does not allow the taking of anyone’s life.
Thank you for realizing this important concept.
Peace,
I am writing re the issue of physicians’ right to follow their conscience.
In line 120 of the draft “Professional Obligations and Human Rights” the courts are quoted as stating, “All rights are of equal importance.” This seems to me to imply the rights of patients and physicians are of equal importance. Yet physicians’ rights to follow their consciences may be violated by the requirement to make referrals for clinical options that go against their moral, religious, or even clinical beliefs. Even were this not to pose a problem currently, social norms can change and be accepted over time. One need only look to Nazi Germany to see where changing norms can lead.
No physician, for example, should be required to refer a patient for experimental procedures which are of no medical value to the patient or which are for such purposes as eugenics.
As another example, a physician should not be required to refer a girl for female circumcision at her parents’ request.
With regard to physician assisted suicide, there undoubtedly are physicians who will find it contrary to their consciences to refer patients for this procedure. Could there not be established a way for patients to access the procedure without a doctor’s referral. Contraception and abortion are available without such a referral. Perhaps there could be some sort of public registry whereby patients on their own could access such procedures.
In summary, I believe the document re Professional Obligations and Human Rights needs to be broadened to protect physicians’ right to follow their conscience.
I am a family physician in British Columbia. I am writing to state that I am strongly opposed to requiring physicians to participate in procedures or care that goes against their conscience and that they do not agree with on a moral basis. Although physician assisted suicide has been ratified by the courts, many physicians including myself feel that they could not in good conscience participate in providing this service. I strongly feel that the right of physicians to follow their conscience should be upheld.
Participating in physician assisted suicide may violate physicians sense of duty, morality, religious freedom and/or the hypocratic oath.
I do hope that the Ontario College of Physicians will uphold physicians’ right to conscience.
Forcing doctors to violate their moral integrity is not only damaging to the doctor but to the patient and to medical staff and medical care they want and need. No doctor should
be forced to perform an abortion or euthanasia (if it becomes legal).
I would like to advise you that I strongly object to the limitation of the rights of doctors which would result should the following statement contained in the draft policy be retained in the final draft:
“Where physicians are unwilling to provide certain elements of care due to their moral or religious beliefs, an effective referral to another health care provider must be provided to the patient”.
Please make note of this objection. It puts the physician in the position of being hypocritical: by passing on his/her responsibility thereby encouraging someone else to undertake an action to which his/her conscience objects.
Hi,
The revised policy does not take into consideration the human rights of physicians, it only considers the patient.
Physicians have rights the same as everybody else.
Just because a person decides on a career as a physician does not mean you can violate their human rights.
A physician must be able to have moral and religious beliefs and be permitted by their working policies and judicial laws to live by them.
The policies being put forward are totally contrary to why a person chose the career as a physician in the first place, a person chooses to become a physician to HELP patients and IMPROVE their quality of life and not to END it.
Why is it that everybody thinks that to end a life this act must be performed by a physician?
Anybody can be trained to give someone else a lethal injection it does not have to be a physician.
If the High Court of Canada wants to play God and then pass their ruling over to the Government to create the necessary laws to implement their ruling then the Government has it in their power to create a new professional career as an ‘executioner’ or what ever other name they want to give it.
A person requesting assisted suicide could apply to the Supreme Court of Canada, who obviously have all the answers, and if their decision is yes then they can refer the person to a member in the new profession in order for their life to be terminated.
To end a life does not have to be the responsibility of a physician.
As Catholics we believe in the value and dignity of every human life. When someone is suffering we as a society should extend all the love and support and best medical assistance possible in the final stages of life. Any society that authorizes killing people through assisted suicide and euthanasia has lost its moral compass.
Please ensure that Catholic Physicians have a right to refuse effective referral since this violates their own conscience and basic human rights.
As a Canadian I really hope our doctors will not be coerced into acting against their own consciences in order to maintain active membership in their own professional organization. Please ensure that those whose beliefs are not in line with the so-called up to date ways of thinking – i.e abortion on demand, or death by doctor, etc. are still valuable members whose rights must also be respected. I shudder at the prospects of a society where those not wanted or considered undesirable can be dispatched as the majority desires. Please reconsider any such proposals. All our hard-working and dedicated physicians deserve no less.
The draft policy on Professional Obligations and Human Rights of the College of Physicians and Surgeons of Ontario is lacking in balance in favour of a purely secular lifestyle. Failure to protect physicians who exercise their moral conscience is a violation of the ability of such physicians to practice their faith. As well, the act of abstaining from contribution to certain contentious medical procedures by such physicians does not effectively limit patient access to those procedures in contemporary society, thus it is not an issue of acesss to care. Importantly, deterring individuals of faith from pursuing a medical profession, or any section of the profession, so as to avoid a conflict of conscience is entirely unreasonable and contrary to basic good judgement.
Please respect and protect all stages of human life from the moment of conception until natural death.
MAY GOD BLESS ALL OF YOU AND GRANT YOU ALL WISDOM TO KNOW BETWEEN RIGHT AND WRONG!
[**MESSAGE FROM ADMINISTRATOR: DURING THE CONSULTATION PERIOD, WE RECEIVED 3 RESPONSES FROM INDIVIDUAL RESPONDENTS CONTAINING THE CONTENT PUBLISHED ABOVE. ALTHOUGH THIS FEEDBACK HAS NOT BEEN PUBLISHED IN DUPLICATE, THE COLLEGE ACKNOWLEDGES RECEIPT OF THESE SUBMISSIONS.**]
To Whom It May Concern;
Please be advised that I reject the proposed “effective referral” mandate for doctors, whose Charter right of freedom of conscience and religion must be respected.
I am writing to voice my objection to the draft document of the College of Physicians and Surgeons of Ontario.
The CMA only recently determined that doctors’ rights to conscience should be respected. The College of Physicians and Surgeons of Ontario should be supporting this position, not undermining it.
Doctors should have the right to practice medicine in keeping with the dictates of their conscience. They should not be expected to do procedures they do not agree with in conscience, nor refer to other practicioners for those procedures,.
If respecting an individual’s right to die is what this is about, then the other side of this is…. that you should be respecting the Dr’s right not to kill a person or be involved in any way if it goes against their belief or conscience. It is a violation of their rights and freedoms.
I feel a great sense of urgency and anxiety over the idea of physicians being forced to do things against their conscience, it’s a violation of their human rights. It scares me because it is the start of a slippery slope that could lead to moral degradation in medicine and among society as a whole. I personally know several doctors and all of them are greatly distressed over the idea. Many doctors will stop practicing if they find themselves forced to do things against their conscience and we already have a shortage of doctors as it is.
I want to have a doctor who shares my moral beliefs, and I would never trust a doctor who continues in a line of work that goes against their conscience, what short of human being would that be? And what sort of human being would force another to do it?
Please, for the sake of basic morality, do not change the physicians and Ontario human rights code.
Subject: Draft Policy “Professional Obligations and Human Rights”.
I am writing to you as a concerned citizen, a teacher and as a mother of four to express my concerns with sections 8, 10 and 11 of the proposed draft policy. The policy suggests that physicians who decline to participate in certain acts for reasons of conscience should be compelled to refer their patients to other physicians who will perform these acts. It does not address the fact that many of these same physicians will find the act of referral itself objectionable, as they consider it material cooperation with the act. In compelling physicians to refer, you are limiting their right to conscientious objection.
As a parent and a teacher I encourage youth to explore pathways that will lead to careers which help others and that build a positive society. I always hold the vocation of the physician as an ideal career example to my children and students. The draft policy is of great concern to me because if it goes into effect I cannot encourage my children and students to be the future doctors of Ontario. How can I encourage them into a position that will force them to act against their conscience?
I encourage you to revise the sections above, and include a clear defense of the right to freedom of conscience for all physicians.
Hello – I am writing to make known my objection to the proposed new draft of the document – Physicians and Surgeons of Ontario, Professional Obligations and Human Rights. I believe the document seriously limits the freedom of conscience and religion of physicians by compelling them to refer patients to other physicians when they are “unwilling to provide certain elements of care due to their moral or religious beliefs”. By forcing physicians to refer patients you are forcing them to participate in what they believe to be an immoral and unethical act.
I strongly disagree with this document and ask that the segment that forces doctors to refer be removed or re-written to ensure no moral or religious boundaries are broken.
I thank you for considering this request and expect the final document will protect any physician’s conscientious objection because of religious or moral grounds to be fully respected.
Human Rights include the right of Conscience,and must not be trampled on.
Physicians and Surgeons should not be ,in their practice,forced to Go Against their conscience to commit or give referral for actions contrary to their Moral Conscience.
Subject: Draft Policy “Professional Obligations and Human Rights”.
I am writing to you with grave concern regarding the content of your proposed draft policy. Sections 8, 10 and 11 suggest that physicians who decline to participate in certain acts for reasons of conscience should be compelled to refer their patients to other physicians who will perform these acts. It does not address the fact that many of these same physicians will find the act of referral itself objectionable, as they consider it material cooperation with the act. In compelling physicians to refer, you are limiting their right to conscientious objection.
I reject the proposed “effective referral” mandate for doctors whose Charter right of freedom of conscience and religion must be respected.
Doctors are doctors to save lives. They did not become doctors to remove life. They should not forced to terminate life or be punished for refusing to do so.
It’s that simple.
We reject the proposed “effective referral”mandate for doctors whose Charter right of freedom of conscience and religion MUST be respected.
Canada is a democracy, not a dictatorship.
As a concerned citizen of Canada, and a resident of Ontario, I first want to thank the CPSO for being open to public consultation regarding the proposed revisions to the Document on Professional Obligations and Human Rights. I also wish to emphasize my support for the College’s acceptance of the existing Charter rights of freedom of religion and conscience; I am writing this letter to urge the CPSO to continue defending these two fundamental rights for patients and health-care providers, alike.
After reading the proposed new draft of the Document, however, I am deeply concerned that the physician’s “duty to accommodate” means, at various points throughout the draft, his “duty” to dispense with his conscience. Repeatedly, throughout the draft, the patient’s ‘rights’ (which, in the case of suicide and other procedure, are not rights at all) are seen as superseding any reasonable reservations, on moral and rational grounds, that a physician may have for refusing to provide or refer certain medical procedures. As such, this draft seems to equate ‘conscientious objection’ with ‘unjust discrimination’ and this is a philosophically, morally, and socially problematic association: the draft fails to recognize that, in certain circumstances, the physician is bound to take a moral stance, based on rational and evidence-based facts, even if this stance goes against the wishes or intents of the patient. A physician refusing to provide or refer certain procedures is not unjustly discriminating against a patient. Rather, he is making a moral judgement about an action. Conscientious objection means discerning that certain actions are objectively wrong and cannot be supported either directly or indirectly.
I would remind the College that offering physicians the right to kill in positive law is a Rubicon we do not want to cross. To force physicians to kill their patients, or force them to refer to someone who will (amounting to formal cooperation in the act), is to add insult to injury, applying coercive pressure to their conscience.
If the draft is approved in its current state, most physicians who wish to offer their skills and services in Ontario will face undue and unethical pressure from the very institutional body that is supposed to support and protect both them and their patients. Compelling individuals to act against their rational conscience decisions violates the Charter and the United Nation’s Universal Declaration of Human Rights, as outlined in Article 1, which states that “All human beings are born free and equal in dignity and rights. They are endowed with reason and conscience and should act towards one another in a spirit of brotherhood.” And, as mentioned, Section 2 of our own Charter of Rights and Freedoms clearly provides for “freedom of religion and conscience”.
Moral convictions based on careful reasoning and scientific evidence, which may be supported by religious belief but is not specifically ‘religious’, need to be protected in Canada—a nation that prides itself on upholding and promoting the principles of democracy. I strongly urge the CPSO to carefully reconsider the wording and ethics of its current draft of the Professional Obligations and Human Rights document.
To whom it may concern,
In response to the College’s invitation for feedback on your draft policy – “Professional Obligations and Human Rights”, I want to express my grave concerns. As a teacher who has, for over 37 years, guided countless individuals into the medical profession, and who counts among her friends many physicians, I object to a policy that is intimidating to physicians who “choose to limit the health services they provide for moral or religious reasons” and requires that they “must” provide patients with referrals to other health care providers in cases where their conscience prohibits them from providing a patient with a service.
The right to refer to another physician constitutes absolutely no protection for physicians whose religious rights preclude them from providing certain services such as abortion. Indeed, the Catechism of the Catholic Church (Canon Law: 1868) states that “we have a responsibility for the sins committed by others when we cooperate in them: by participating directly and voluntarily in them; by ordering, advising, praising, or approving them…”
In the case of abortion, the Catechism expressly states: “Formal cooperation in an abortion constitutes a grave offense. The Church attaches the canonical penalty of excommunication to this crime against human life.” This means that a physician who refers a patient to another physician faces the canonical penalty of excommunication as an accessory. (Canon: 2272)
In the case of euthanasia, or assisted death, the Catechism (Canons: 2276-2277) states: “Whatever its motives and means, direct euthanasia consists in putting an end to the lives of handicapped, sick, or dying persons. It is morally unacceptable. Thus an act or omission which, of itself or by intention, causes death in order to eliminate suffering constitutes a murder gravely contrary to the dignity of the human person and to the respect due to the living God, his Creator. The error of judgment into which one can fall in good faith does not change the nature of this murderous act, which must always be forbidden and excluded.”
Murder is regarded as a grave sin for Catholic physicians. Those in grave sin are excluded from the sacraments of the Church and are everlastingly damned if they do not seek reconciliation and forgiveness. However, the fundamental condition for forgiveness is the resolution not to commit the sin again (Canon: 1451). Further, “… conversion and repentance, entails sorrow for and abhorrence of sins committed, and the firm purpose of sinning no more in the future.” (Canon: 1490)
Under the draft policy, physicians know that if faced with another request for the same services, the College will require them to commit the sin again. This means that they can never, according to Canon Law, achieve reconciliation and therefore they face excommunication and eternal damnation (Canon: 1035).
The proposed policy has catastrophic consequences for any Catholic doctor. Indeed, I think it could be said that it would prevent a Catholic doctor from practising. It constitutes a direct impact on religious beliefs, and an interference that is “more than trivial or insubstantial”.
A doctor’s moral beliefs are fundamental to his or her philosophy as a practitioner. Please reconsider this intimidating policy that offers members of the College absolutely no support for the fundamental beliefs that led them to become doctors in the first place, and threatens them with termination of their careers.
Please, consider that patients have responsibilities as well. If they can seek out one doctor, they can seek out another one who shares their philosophy. I was once in a situation where my doctor told my mother that I was likely to give birth to a baby with Downs Syndrome (I was on vacation at the time). Because the doctor broke confidentiality, but more importantly because she had already advised me on my rights to an abortion, I sought out another physician. That baby is now in law school. Patients can find their own doctors.
Please change your policy for the sake of the doctors, and more importantly for the sake of the patients of this province.
I have reviewed the draft policy. I have no hesitation in saying that it is morally objectionable to anyone who follows the Roman Catholic faith.
The policy is inherently flawed with respect to physicians who “choose to limit the health services they provide for moral or religious reasons” and the requirement that an effective referral to another health care provider “must be provided”.
The College appears to believe that the religious rights of physicians are respected if they do not have to provide objectionable services personally, and that the right to refer to another physician is sufficient protection for physicians. This ignores the express teachings of the Catholic Church as set out in the Catechism. It is not necessary to actually participate in an act to incur sin. One may sin as an accessory, as set out in Canon 1868:
1868 Sin is a personal act. Moreover, we have a responsibility for the sins committed by others when we cooperate in them:
- by participating directly and voluntarily in them;
- by ordering, advising, praising, or approving them;
- …
In the case of abortion, the Catechism states:
2272 Formal cooperation in an abortion constitutes a grave offense. The Church attaches the canonical penalty of excommunication to this crime against human life. “A person who procures a completed abortion incurs excommunication latae sententiae,” “by the very commission of the offense,” and subject to the conditions provided by Canon Law. The Church does not thereby intend to restrict the scope of mercy. Rather, she makes clear the gravity of the crime committed, the irreparable harm done to the innocent who is put to death, as well as to the parents and the whole of society.
This means that a physician who refers a patient to another physician faces the canonical penalty of excommunication as an accessory.
In the case of euthanasia or assisted death, the Catechism states:
2276 Those whose lives are diminished or weakened deserve special respect. Sick or handicapped persons should be helped to lead lives as normal as possible.
2277 Whatever its motives and means, direct euthanasia consists in putting an end to the lives of handicapped, sick, or dying persons. It is morally unacceptable.
Thus an act or omission which, of itself or by intention, causes death in order to eliminate suffering constitutes a murder gravely contrary to the dignity of the human person and to the respect due to the living God, his Creator. The error of judgment into which one can fall in good faith does not change the nature of this murderous act, which must always be forbidden and excluded.
Murder is regarded as a grave sin. Those in grave sin are excluded from the sacraments of the Church, until they repent and confess the sin. However, a condition for forgiveness is the resolution not to commit the sin again – Canons 1451, 1490:
1451 Among the penitent’s acts contrition occupies first place. Contrition is “sorrow of the soul and detestation for the sin committed, together with the resolution not to sin again.”
1490 The movement of return to God, called conversion and repentance, entails sorrow for and abhorrence of sins committed, and the firm purpose of sinning no more in the future. Conversion touches the past and the future and is nourished by hope in God’s mercy. (Emphasis added)
Under the draft policy, a physician knows that if faced with the same request for services, the College will require him to commit the sin again. This raises the question whether he or she can ever have the requisite contrition to be absolved.
Those who die in a state of serious sin are denied entry into heaven – eternal damnation is their state.
1035: The teaching of the Church affirms the existence of hell and its eternity. Immediately after death the souls of those who die in a state of mortal sin descend into hell, where they suffer the punishments of hell, “eternal fire.”
There will always be physicians who do not find these procedures morally objectionable, so patients will have alternatives, whether it is through advertising or a list compiled by the College. But placing the burden on the individual physician places a morally indefensible requirement on him or her.
It seems to me that the proposed policy has potentially catastrophic effects for any Catholic physician. Indeed, I think it could be said that it would prevent a Catholic doctor from practising. Where then, is the balancing of rights, (Policy 123-128)? There is here clearly a direct impact on religious beliefs, and an interference that is “more than trivial or insubstantial”.
Speaking as a lawyer of 35 years experience, I believe a constitutional challenge of this policy is a certainty. While there are doubtless physicians whose beliefs are not offended, and therefore the patient has other options, the Policy leaves no option for physicians who cannot in conscience provide services. Speaking as one who has instructed converts to the Catholic faith for over 25 years, the proposed policy is morally objectionable.
Freedom of conscience must be paramount. As the patron saint of lawyers, St. Thomas More, said as he suffered execution for following his conscience: he was the King’s loyal subject, but God’s [subject] first.
I support to reject the proposed “effective referral” mandate for doctors whose Charter right of freedom of conscience and religion must be respected.
They should also be allowed to advise their clients on alternative solutions available. In most cases such desperate patients are lacking a word of encouragement. In the end the Physician and the Patient will have joy.
This is to inform you that I strongly object to the following statement in your draft policy “Professional Obligations and Human Rights”
“Where physicians are unwilling to provide certain elements of care due to their moral or religious beliefs, an effective referral to another health care provider must be provided to the patient”
Here you are asking physicians to again support an action to which they object in their own conscience. Surely this is contrary to their rights protected in the foundation of our free society, and the trust placed in them by patients.
Respectfully submitted.
I wish to oppose any legistration that forces medical practioners to go against their moral beliefs. Their rights should be protected our constitution and not be forced otherwise by vote seeking politicians.
This is to inform you that I reject the proposed “effective referral” mandate for doctors as indicated in the proposed new draft document of the College of Physicians and Surgeons of Ontario. I believe that it violates the doctors’ Charter right to freedom of conscience and religion.
À QUI DE DROIT!
TOUTE PERSONNE SUR CETTE PLANÈTE A LE DROIT, LE PRIVILÈGE,ET JE DIRAIS LE DEVOIR D’ÉCOUTER SA CONSCIENCE!
DONC, LE MÉDECIN QUI SOIGNE, DOIT AGIR SELON SA CONSCIENCE. COMMENT PEUT-IL AUTREMENT DORMIR LE SOIR?
DE MÊME, EN LE FORÇANT À RÉFÉRER UN PATIENT À UN AUTRE MÉDECIN QUI ACCOMPLIRA À SA PLACE CE QUI POUR LUI EST MAL EST AUSSI GRAVE!
RÉVEILLEZ-VOUS! MISEZ SUR LES SOINS PALLIATIFS ET VOUS VERREZ LE PROBLÈME SE RÉSOUDRE CAR, LES PATIENTS ONT SURTOUT BESOIN D’ÉCOUTE ET DE SOINS POUR ATTÉNUER LEURS SOUFFRANCES ET LEUR ANGOISSE.
The inherent problem with the statement that physicians who “choose to limit the health services they provide for moral or religious reasons” and the requirement that an effective referral to another health care provider “must be provided” is simple.
The College appears to believe that the religious rights of physicians are respected if they do not have to provide objectionable services personally.
Sins need not be personally committed. One may sin as an accessory, as set out in Canon 1868 of the Catechism of the Catholic Church:
1868 Sin is a personal act. Moreover, we have a responsibility for the sins committed by others when we cooperate in them:
- by participating directly and voluntarily in them;
- by ordering, advising, praising, or approving them;
To deny a doctor freedom of conscience is also a violation of human rights–and to claim such a referral process is part of “a balance” (123-128) shows a lack of understanding of the religious objections. There will be doctors willing to perform euthanasia and abortions, but for a Catholic doctor, even referring someone would place a heavy toll on their conscience.
Freedom of choice should include freedom of conscience. To deny freedom of conscience is to remove part of that choice. This would not impact all doctors, nor would it impact legislation. It would merely allow Catholic doctors to practise without violating their religious codes. The choice is still there, but now doctors would be able to choose as well.
I would like to state my opposition to any government bill
forcing the medical profession to go against their freedom of conscience
and forcing them to be a participant in an act violating their morals
I wish to be made law, protecting the medical profession and nothing less.
I would like this opinion of mine brought forward especially by my elected M.P.
Please no political jargon just my belief in this put to the gorverment assembly.
I wish to support the Physicians Charter of Right of Freedom of Conscience in the matter of the new draft document stating that physicians must provide an effective referral to another health care provider- which I believe to be a clear violation of a physicians rights and morals.
hysicians should have the right to say NO to providing certain forms of treatment. However, I’m particularly concerned with the requirement that physicians provide referrals for treatments which they feel are morally and ethically wrong.
If a physician feels a treatment is morally and ethically wrong, and then aren’t they still violating their conscience by asking someone else to perform the procedure? How is the physician’s right to freedom of conscience being protected under these circumstances? In addition to this, a physcian might feel that if a procedure is morally wrong it would also be harmful to the patient. Under these circumstances the physician would be violating not only their conscience, but also their Hippocratic Oath by referring the patient to someone else to perform the procedure.
We want to be served by doctors with moral integrity!
Physicians should have the right to say NO to providing certain forms of treatment. However, I’m particularly concerned with the requirement that physicians provide referrals for treatments which they feel are morally and ethically wrong.
If a physician feels a treatment is morally and ethically wrong, and then aren’t they still violating their conscience by asking someone else to perform the procedure? How is the physician’s right to freedom of conscience being protected under these circumstances? In addition to this, a physician might feel that if a procedure is morally wrong it would also be harmful to the patient. Under these circumstances the physician would be violating not only their conscience, but also their Hippocratic Oath by referring the patient to someone else to perform the procedure.
Most human beings who suffer a debilitating illness especially if this includes pain, will, at some point, say: “I wish I were dead”. This is more an expression of frustration than a death wish. The desire to live is the strongest desire of the human heart. No one of sound mind would actively choose suicide.
Legalizing assisted suicide in not the answer to pain and suffering. A compassionate response is effective palliative and long term care. These services are already in place and need to be expanded.
Physicians are trained to provide life giving care and recognize that extreme measures to prolong life are not needed nor advisable. However, killing a person goes contrary to the physician’s training and conscience. Referring a patient for assisted suicide makes one complicit in the act and no physician should be forced to go against her or his better judgement.
11. Where physicians limit the health services they provide due to their moral or
religious beliefs, the draft policy states that they must do so in a manner that respects
patient dignity.
Do you support or oppose the following expectations, which aim to respect patient dignity
in this context?
Physicians must communicate objection directly to the patient.
Strongly support
Physicians must inform the patient that objection is due to personal and
not clinical reasons.
Strongly support
When communicating objection, physicians must not express personal
judgment about the patient.
Strongly support
Physicians must not promote their own religious beliefs when
interacting with patients.
Neither Support or Oppose
Physicians must not attempt to convert patients
Neither Support or Oppose
13. Where physicians limit the health services they provide due to their moral or
religious beliefs, the draft policy states that they must do so in a manner that ensures
access to care.
Do you support or oppose the following expectations, which aim to facilitate access to
care in this context?
*
Physicians must provide information about all options that are available
and clinically indicated for the patient, even if the options conflict with
physicians’ moral or religious beliefs.
Somewhat Support
Physicians must not withhold information about the existence of a
procedure/treatment due to their moral or religious beliefs.
Somewhat Support
Physicians must refer patients to another health
care provider for any
care that they are unwilling to provide due to their moral or religious
beliefs.
Strongly Oppose
Physicians must refer the patient to a non
objecting, available and
accessible physician or other health
care provider.
Strongly Oppose
Physicians must make a referral in a timely fashion.
Strongly Oppose
Physicians must maintain an effective referral plan for the frequently
requested services they are unwilling to provide.
Strongly Oppose
Physicians have to be honest, inform patients about options, but they should not make referrals because they would be more involve in the situation they do not believe in. Patients should be responsible to find a physician that will provide the service they want, the service the Physician explain at the first place.
15. Where physicians limit the health services they provide due to their moral or
religious beliefs, the draft policy states that they must do so in a manner that protects
patient safety.
Do you support or oppose the following expectation, which aims to protect patient safety?
*
Physicians must provide care that is urgent or otherwise necessary to
prevent harm, suffering, and/or deterioration (i.e. emergency situations),
even where that care conflicts with their religious or moral beliefs
I am writing to you regarding the contents of your proposed draft policy, which suggests that physicians be compelled to provide an effective referral to their patients in cases where the physician’s conscience will not allow him to do the patient’s bidding.
We all know what kind of cases this will most likely come up in: abortion, euthanasia, and medical mutilation such as sterilization. Whatever the courts or the legislature may say about these things, these acts are intrinsically evil. And to force someone to cooperate in their execution is a violation of his conscience.
Yes, I am well aware that large segments of our society think that good and evil are meaningless terms, which can be refashioned in whatever way the powers that be find useful to hold on to their power and augment it. But I also know what happens to societies that take this route and I do not want ours to go there.
We need good doctors – and politicians also need good doctors. Protect the good doctors already in the profession and keep the profession something that young people might aspire to. Do not grovel before the altar of political and judicial power. Defend the doctors whose consciences still speak clearly and make it possible for them to practice their honourable profession of healing without doing harm. They must not be forced to cooperate with the culture of death. Executioners can easily be found. Good doctors are much harder to come by.
Dear Members of the Consultations Committee:
Subject: Draft Policy “Professional Obligations and Human Rights”.
I am writing to you at this time specifically regarding the content of your proposed draft policy.
Sections 8, 10 and 11 suggest that physicians who decline to participate in certain acts for reasons
of conscience should be compelled to refer their patients to other physicians who will perform
these acts. It does not address the fact that many of these same physicians will find the act of
referral itself objectionable, as they consider it material cooperation with the act. In compelling
physicians to refer, you are limiting their right to conscientious objection.
There is significant disagreement in our society as to what constitutes a moral act, and it is
beyond the mandate of the College to define or limit morality. Physicians, as professionals of
medicine, must be allowed to respect their own consciences. Freedom of conscience is
foundational to our free society and cannot be limited, whether by groups such as the Islamic
State, population control elements of society or professional societies, even for the best of
intentions. If we coerce physicians into violating their consciences, we will inevitably erode the
personal integrity which is the basis of the physician’s relationship with their patients.
Medical practice seems increasingly inundated with moral issues. The knee-jerk reaction of the
College recently has been to suggest limiting the number of members of various religious and
cultural groups in the different specialties. This marks a significant milestone in mandate
definition and it signifies that now is the time to open up all aspects of the medical profession
management in Ontario, from the selection of medical school candidates to job allocation to the
annual review of physician performance and how physicians treat patients – some with arrogance
and a prime focus on compensation. All of these aspects must become transparent for the benefit
of the people of Ontario.
I encourage you to revise the Professional Obligations and Human Rights sections above, and
include a clear defence of the right to freedom of conscience for all physicians.
I am writing to you with great concern with your proposed draft policy. Your policy as is suggests that physicians who decline to participate in certain acts that go against their conscience should refer the patient to another doctor. This does not address the fact that many of these same doctors will find that act of referral objectionable as well. This means you are limiting a doctors right to conscientious objection. I think it is important for our physicians to have the ability, as professionals, be allowed to respect their own consciences. This is a fundamental freedom in our society.
Thank you for reading this message and I encourage you to revise sections 8, 10, and 11 and include a clear defence of the right to freedom of conscience for all physicians.
I am against the proposed new draft document of “effective referral”. This goes against the physicians’ right of his own conscience. We need physicians who have conscience and integrity.
I think democracy, freedom, and human rights are going down the drain in Canada if there is a policy to limit the doctors’ right to freedom of conscience and religion. Therefore, I strongly object to the policy of forcing doctors to refer their patients to other doctors for abortion or euthanasia if they, due to their conscience and religion, cannot comply with their patients’ requests.
I am very concerned about your draft policy that seems ill-considered and Draconian. Referring for procedures is being complicit, Canadians already understand that. As Canadians we refuse to refer for capital punishment. We will not extradite a prisoner to any jurisdiction where that person could face the death penalty unless we have a guarantee from the government trying the case that the person will not be executed. If we understand this with such a tenuous connection and before the person is even tried, surely we understand how asking physicians who have ethical objections to refer for this procedure would be asking them to be complicit. Many will leave medicine rather than be complicit in killing. This will not help the physician shortage. Would citizens like a doctor who does everything in family practice except these ethically unacceptable procedures and referrals, or no doctor at all? To avoid any embarrassment on either side, the colleges of physicians and surgeons in the provinces could keep registries of those physicians willing to participate and refer. If this is as great a good as it is being reported to be, and very “mainstream”, surely there will be enough physicians who will be willing to participate to satisfy the requests of what supporters say will be a “very small” number of patients in “extreme” cases who may wish to die.” Besides, do citizens want physicians who will stand by their convictions and stand up to the government when they think it is wrong, or do they really want a doctor who will do whatever the government asks?
I think that doctors should have freedom of conscience in providing health care. Their freedom cannot be eliminated through policy.
Requiring them to violate their freedom will result in less available health care.
I am writing to you regarding the proposed draft policy, Sections 8,10, and 11 which indicate that physicians are compelled to refer their patients to other physicians if they are unable to provide care /perform acts because of religious or moral reasons. By compelling physicians to refer, they are limiting their right to conscientious objection.
Please revise the sections above and include a clear defence of the right to freedom of conscience for all physicians.
No physician should be forced to either to perform the killing of another human being or to refer the deed to some other physician. We are heading into a Hitleresque area which will morph into getting rid of those whom the state deems unfit. It goes all the way back to Margaret Sanger’s getting rid of “human weeds.” You think I am kidding? Look what is really happening in the Netherlands and Belgium. We don’t need to promote the Culture of Death in Canada. We have already crossed the line with abortion of children in their mothers’’ wombs which should be the safest place in the world.
I strongly object to the draft policy of CPSO limiting physicians’ right to conscience and religion. I think the Supreme Court should not be given the power to force their judgment on the vast majority of people by saying that no right is absolute. This is unconstitutional and against the Canadian Charter of Rights, I think it is against human rights and medical ethics for the CPSO to make a policy forcing physicians to act against their conscience and religion, namely by forcing them to refer their patients to another physician for cases like abortion or assisted suicide when they would not perform the act themselves because they know and believe that it is wrong to do so. This is totally something that a democratic and free country should not even contemplate to do.
I write to let you know that I oppose your stance on making it mandatory for doctors to refer clients to other doctors when they themselves are opposed to doing abortions, assisted suicide etc.
Dear Sir/Madam,
Please reconsider your proposed “effective referral” mandate. It is a violation of a physician’s rights and freedom of conscience, so therefore must be rejected
I recently learned that The College of Physicians and Surgeons of Ontario has proposed a new drafted policy in Physicians and the Ontario Human Rights Code, stating “Where physicians are unwilling to provide certain elements of care due to their moral or religious beliefs, an effective referral to another health care provider must be provided to the patient. An effective referral means a referral made in good faith, to a non-objecting, available, and accessible physician or other health-care provider.”
If this proposed policy is approved, Ontario physicians and surgeons would be obligated to refer patients to effect medically assisted suicide which may be the very thing that they object in the first place. I find this very unsettling. It is not right for anyone to take away lives. It is even more so to propose policies that endorse such idea. I sincerely urge CPSO to reconsider the mandatory obligation for physicians and surgeons to “provide an effective referral”.
I am writing to express my concern with the Draft Policy on Professional Obligations and Human Rights currently under review by the College of Physicians and Surgeons of Ontario.
The requirement that health care professionals provide referrals to other care providers or provide care to patients in urgent circumstances where that care conflicts with their conscience is a troubling proposal.
I trust that the medical professionals I receive care from are free to make complex ethical decisions guided both by professional guidelines and their own consciences. It would cause me deep discomfort to know that the professionals I seek care from were risking being sanctioned for engaging in moral and ethical deliberation about the care they perform.
The Ontario Human Rights Code protects all Ontarians, including health care providers in an employment setting, from discrimination on the basis of a protected ground. The detrimental impact of the Draft Policy on human rights would not be limited to health care providers themselves; the policy will contribute to a professional culture where individuals are discouraged from exercizing their professional and ethical judgement to prevent discrimination and other violations of the human rights of their patients. I refer specifically to the rights of persons with disabilities in circumstances where substitute decision makers are directing their care.
I would urge the College to reconsider the thrust of these proposed amendments to its policy on human rights, and instead ensure robust protection for the freedom of conscience of its members.
Re: Professional Obligations and Human Rights policy
Thank you for providing us with the opportunity to provide feedback on the Professional Obligations and Human Right policy. I trust, since your obligation by law is to protect the best interest of the public, you will consider my comments regarding this policy.
I strongly oppose the draft of the Professional Obligations and Human Rights policy, for several reasons:
1) The policy as drafted is not in the best interest of the citizens of Ontario. As a citizen of Ontario, I appreciate having, and am convinced it is in my best interest to have, a Christian doctor who holds and makes decisions from the same personal values and beliefs as I hold and are based on God’s Word, the Holy Bible. This way, when I am faced with a health care decision, my physician can provide me with advice that is in accordance with the Bible and thus with my personal values and beliefs. If my doctor would be required to refer patients for procedures that he is opposed to on moral grounds or face some sort of penalty, as this policy mandates, he would no longer be able to practice medicine in Ontario with a pure conscience (something that is of tantamount importance to a Christian). If this would happen, I would lose my family physician, and would no longer receive medical advice in line with my personal values and beliefs and therefore no longer receive medical advice that is in my best interest. I assure you that this is a concern for a significant number of Ontario citizens.
2) Requiring someone, whether it is a physician or otherwise, to do something that is against his conscience and/or religious beliefs violates his/her freedom of conscience and religion. Do doctors no longer have “human rights”?
3) A physician may advise a patient not to receive or undergo a certain procedure based on scientific reasons and if this recommendation is also in accord with his religious convictions it could be construed as the physician trying to convert a patient.
4) Everybody, physicians included, operates from a “worldview”. As such, all the decisions we make are in line with that worldview. This is true of the decisions and advice given by physicians as well. If we are to be a multi-cultural society we have to accept this and not force or coerce everybody to operate from the politically expedient “worldview” as seems to be the case with this proposed policy.
5) A physician who on conscientious grounds does not provide specific services also believes that these services are not in the patient’s or society’s best interest. Forcing physicians to provide such services contradicts the opening line of your draft policy: “The fiduciary nature of the physician-patient relationship requires that physicians act in their patients’ best interest.”
I strongly recommend and insist that this policy be revised to enable all physicians in our province to practice in a way that is in our (as patient’s) best interest, in accordance with their religious convictions, and supported by scientific evidence.
I am an Ontario resident who has just finished reading the Professional Obligations and Human Rights draft policy. I was taken aback by some of the things outlined in the policy, especially in regards to the physician’s religious or moral convictions. While I am thankful that a physician does not need to provide a service to which s/he objects, I am baffled as to how they are to make a referral in good conscience. For example, if a physician holds a strongly held religious or moral conviction that abortion is murder and therefore will not provide that service, that physician will also view referring a patient to an abortion provider as accomplice to murder. The draft policy states that, “Physicians embody these values and uphold the reputation of the profession by, among other things … Properly managing conflicts, especially where the physician’s values differ from those of their patients, or those seeking to become patients. The patient’s best interests must remain paramount”. In my example, who determines the patient’s best interest? Such a physician knows the physical, emotional, psychological, and spiritual toll that abortion will have on his/her patient and views the unborn child as a patient.
As a Christian, I am very concerned about any wording in the draft policy which would force any physician from any faith or world view to act against his conscience even through the act of referring the client to another physician. I realize the dilemma this presents when weighing the rights of physicians against clients. I am however convinced that there is an absolute standard of morality established by God, designed for the protection, love and honour of all living creatures. I would recommend to you such books as “Mere Christianity” by C.S. Lewis and “The Reason for God” by Timothy Keller to further investigate such a claim. I believe you will find the arguments reasonable, logical and possibly life altering.
I think it is very important that each individual kept his own conscience. Therefore, doctors should also have that rights in their profession, even if law allows people to act differently. Their association should NOT make them to do something against their conscience.
The CPSO draft policy demands that doctors participate in controversial procedures like abortion and even euthanasia by making referrals and doing the procedure in certain circumstances.
Doctors who refuse to follow the policy will be vulnerable to discipline, even though their fundamental freedom of conscience and religion is guaranteed by the Canadian Charter of Rights and Freedoms.
I demand that our doctors keep their right of Freedom and Conscience for the most Common Good.
Dear members of the Consultations Committee:
I am writing to express my concern regarding the content of your proposed draft policy that would compel physicians to refer their patients to other physicians to perform acts to which they object as being against their conscience.
I expect that physicians, as professionals, be allowed to respect their own consciences – something which is fundamental to a free society.
I request that you revise the sections relevant to this issue to respect the right to freedom of conscience for all physicians.
I am a Canadian citizen, living in Ontario and I am displeased with the new draft policy being proposed by the CPSO. Regarding the new draft policy, please do not force physicians to do something that goes against their conscience. Please uphold their rights also. If doing something is wrong and immoral, then arranging for that thing to be done (by a referral) is also wrong and immoral. If abortion and physician-assisted suicide is ending the life of a human being, and a physician feels this is immoral, then doing a referral would be seen as arranging to kill the patient, and this is not something anyone should be forced to do. It is not mentally healthy for a physician to deal with that in their profession and practice.
Please allow doctors to protect and preserve life and not destroy life.
I am very troubled by the thought of doctors being forced to be complicit in providing services which they are morally opposed to by forcing them to provide referrals or consulting for those services. I feel that this would be a grave violation of the rights and freedoms of doctors.
It would be very irresponsible and reprehensible for the College of Physicians and Surgeons of Ontario to impose these obligations on the doctors of Ontario.
The College of Physicians and Surgeons of Ontario proposed amendments to “Professional Obligations and Human Rights” includes an obligation for physicians whose religious or moral objections to a procedure to refer the patient to a physician who does not share those objections. This is at best hypocritical: under the guise of allowing a doctor to exercise his/her conscience, it nevertheless forces the physician to enable the very action to which he/she, in good conscience, considers wrong. That renders the exemption moot. It’s like saying to an opponent of capital punishment, “You don’t have to throw the switch, but make sure you show the person who will where it is.”
To my mind, the very nature of being a professional is the indepdendent exercise of one’s judgment. There is no distinction here between professional, technical judgment and moral ones. If a doctor, for example, thinks the recent Supreme Court ruling regarding assisted-suicide places him/her in violation of the Hippocratic Oath, and the duty to do no harm, whether that conclusion is founded on a purely logical interpretation of the Oath, or on religious/ethical grounds, or on concerns that under the current, largely triage system of state-provided medicine the policy might be abused, is irrelevant. All are exercises of professional judgment on a matter of how to treat a patient.
My personal, separate opinion, is that the CPSO would do far better to devote its efforts to enhancing choice for all (doctors and patients alike) in medicine by allowing doctors to opt out of the public health care system, by allowing patients to pay doctors directly for care, and for doctors to actually assert their independence as professionals by demanding what the lowest laborer is entitle to have: control over the offering of his/her own services.
I do not expect the College to define or limit morality. I believe that physicians, as professionals, should be allowed to respect their own consciences as part of a free society.
I believe that Canadians must support these basic tenants of Human Rights and we must not permit the CPSO to limit a physician’s right to conscientious objection.
I write to support Pyhsicians’ Charter Right of Freedom of Conscience and Religion. I believe strongly that a mandate for an “effective referral” is a violation of a physician’s rights, as it compels the physician to violate his or her own conscience by being a participant in the very act, the very procedure to which he or she objects in the first place.
I feel strongly that to ask our doctors to perform procedures that are against their consciences violates their Hippocratic oath.
They cannot possibly work to their potential when faced with working against their principles.
Please give doctors the best room to do their so important service to Canadians and not force them to swear oaths that will compromise their beliefs.
For the benefit of Canadians it is best to honour the doctors decision / opinion on what he/she can feel is part of their principles.
I am a practising family physician with special interest in women’s health in Toronto. Thank-you for the opportunity to provide feedback on the College’s draft policy statement on “Physician Obligations and Human Rights”. It is very troubling that the draft statement so clearly discriminates against and infringes upon the rights of physician members of the College.
Most troubling are the lines to do with physician referral as stated (No. 156-161), that a physician is required to provide “effective referral” to another “non-objecting” provider for “health services” when the first physician is morally/ethically opposed to such services. Such action would conceptually and essentially render the physician, in the legal sense, as an “accessory” to an act they have morally objected to, or in the moral sense, as a “material cooperator.”
As such, the physician’s,
1. Moral integrity has been compromised,
2. Conscience right has been compromised,
3. Human dignity has been assaulted,
4. Ability to exercise true professonalism has been breeched,
5. Professional commitment to “First do no harm” has been forcefully undermined,
To the detriment of the patient, who
1. Has sought professional attention that is specifically human and moral,
2. Has done so with the hope and trust that the physician will use their knowledge and understanding to act in the patient’s best interest,
3. In a fiduciary relationship, has entrusted the doctor with medical decision-making, by relying on the physician’s good judgement and input from the patient and considering all relevant circumstances. The doctor acting by force to carry out an action on behalf of the patient, yet in a way that they have determined not to be in the patient’s best interest, has been forced to breech this trust.
In truth, doctors should not discriminate against patients, and patient care is clearly utmost in priority. However, deciding not to provide a service (felt by the doctor to incur harm on the patient), in no way discriminates provided that the service is not offered to any group.
Alternatives exist whereby patients find the services they seek, that are widely available within the province. Perhaps the College can reinforce these avenues publicly, so that patients can continue to effectively pursue the ends they seek by their own means, if that is what the College is intending to protect, through doctors who have no concerns with what is being requested.
As it has been suggested and considered publicly (in media) and secretly (by discerning medical students), the notion that any student physician who refuses to perform or to “effectively refer” for a particular service, such as abortion, should not pursue fields such as Family Medicine, or Obstetrics and Gynecology, is utterly abhorrent and a cause for grave concern. This would be the utmost discrimmination against the emerging physician, or the practising physician who has taken up a pivotal moral viewpoint in this regard.
The proposed change in policy has already led to the allusion that doctors with such moral views should not enter fields, where the physician’s viewpoint might oppose the “norm,” regarding services not offered. This would skew populations of physicians in a way as to cause societal harm, to not mention, again, the obvious and brutal injustice to the physician so frankly discriminated against. Such a physician might actually have skills, talents and interest in serving within those disciplines, to the detriment, again, of patients who would have been otherwise professionally served.
Indeed, there exists a concrete population of patients who seek physicians in the above-named fields, that live and practice within this moral framework– a moral framework which they share or specifically respect. They entrust their care to these specifically-sought, self-announced physicians, knowing that they and their families will be offered ethical medical alternatives, sound clinical judgement and advice, and positive moral support through times of difficulty. These patient populations will be robbed of the doctors that the current policy would bully out of practicing in those extensive and far-reaching fields, both general and specialized, such as those fields named above. The result will be increasing public mistrust of the medical profession, starting with the patient population described here.
The policy consideration that physicians’ fundamental rights and freedoms in decisions influenced by conscience, can be “limited by the fundamental rights and freedoms of others,” is also of grave concern, and causes me to wonder whether the College is indeed committed to safeguarding the essential qualities and nature of our Profession. It is my hope that this commitment is indeed intact at the College. Without freedom of conscience in the medical profession, the best interest of the patient cannot be safeguarded, and the special vocation of the physician is reduced to that of a sort of pawn or clerk, with inherent, serious consequences. The resulting milieu would bear some serious resemblance with the medical practice setting found in Germany during WW II.
Based on the current draft policy, it would actually seem plausible that the College could itself be the subject of a human rights complaint by a physician, on the basis of discrimination on the grounds of creed. A dispute of this nature may reflect poorly on our ability as physicians to self-regulate and might have unintended consequences for our profession.
The draft policy as it stands is deeply flawed and I urge its revision.
Lines 152 – 164 of the above draft contains the term “effective referral” which I believe is objectionable. I also believe that any physician who is unwilling to provide certain elements of care due to their moral or religious beliefs would find this “effective referral” mandate unacceptable. Such a mandate would be a violation of those physicians’ rights, as it compels the physician to violate his or her own conscience by being a participant in the very act, the very procedure to which he or she objects in the first place. In other words, such a physician becomes complicit in an unacceptable action.
Please remove all reference to the “effective referral” mandate and use only language which ensures all physicians will have their Charter right of freedom of conscience and religion respected.
Dear Members of the Consultations Committee:
Subject: Draft Policy “Professional Obligations and Human Rights”.
I am writing to you as a family physician with 28 years of practice in Ontario. I have
grave concern regarding the content of your proposed draft policy. Sections 8, 10 and 11
suggest that physicians who decline to participate in certain acts for reasons of
conscience should be compelled to refer their patients to other physicians who will
perform these acts. This effectively places a physician in the position of participating in
the very act that they object to.
In compelling physicians to refer, this policy removes their individual right to
conscientious objection. More universally, this policy limits any chance for ongoing
ethical objection around what may be some very complicated care decisions in our
society.
There is significant disagreement in our society as to what constitutes a moral act, and I
do not expect the College to define or limit morality. All I expect is that physicians, as
professionals, be allowed to respect their own consciences. Freedom of conscience is
foundational to our free society and cannot be limited, even for the best of intentions. If
we coerce physicians into violating their consciences we will inevitably erode the
personal integrity which is the basis of the physician’s relationship with their patients.
I encourage you to revise the sections above, and include a clear defence of the right to
freedom of conscience for all physicians.
I am writing to express my great concern over your possible change to a Policy on physicians duties and responsibilities where a religious believe is in conflict with a patients request for services.
If the Colleges or our society force doctors to go against their moral and religious beliefs, care will be undermined not enhanced. Patients need to know where their doctor stands on ethical issues, to trust them, and to know what care to expect. This applies to all healthcare workers.
The CMA Code of Ethics has always supported a Physician’s moral or religious rights and Colleges have always taught physicians the proper methods of explaining this to patients. This should not change nor need to change.
To force to treat or refer for treatment is not respecting the CMA Code nor is it respecting a large number of dedicated caring physicians.
I would urge you to read Professor Mary Anne Waldron’s book, “Free to Believe”. This book emphasizes the importance of accepting diverse beliefs for any Democratic society. Surely our “tolerant’ Canadian society should reflect and respect the moral and religious rights of large and small segments of our society.
Please reject these changes as proposed!
Re: CPSO draft policy announcement: Professional obligations and human rights
It is with deep regret that the above draft policy makes reference to:
“ Where physicians are unwilling to provide certain elements of care due to their moral or religious beliefs, an effective referral to another health care provider must be provided to the patient”.
This specific mandate for an effective referral to another physician is a violation of the physician’s right as it compels the physician to violate his/her own conscience to being a participant in the very procedure that h/she objects to in the first place!
The above mandate would be an unacceptable serious violation of the Canadian Charter of Rights of freedom of religion and conscience – which must be respected at all times.
Ontario’s Human Rights Code articulates the right of every Ontario resident to receive equal treatment with respect to goods, services and facilities without discrimination based on a number of grounds, including race, age, colour, sex, sexual orientation, and disability.
Are Ontario’s physicians not deserving of the same basic rights?
[**MESSAGE FROM ADMINISTRATOR: DURING THE CONSULTATION PERIOD, WE RECEIVED 10 RESPONSES FROM INDIVIDUAL RESPONDENTS CONTAINING THE CONTENT PUBLISHED ABOVE. ALTHOUGH THIS FEEDBACK HAS NOT BEEN PUBLISHED IN DUPLICATE, THE COLLEGE ACKNOWLEDGES RECEIPT OF THESE SUBMISSIONS.**]
To: College of Physicians and Surgeons
It is with deep regret that the above draft policy makes reference to:
“Where physicians are unwilling to provide certain elements of care due to their moral or religious beliefs, an effective referral to another health care provider must be provided to the patient”.
This specific mandate for an effective referral to another physician is a violation of the physician’s right as it compels the physician to violate his/her own conscience to being a participant in the very procedure that h/she objects to in the first place!
The above is unacceptable serious violation of the Canadian Charter of Rights of freedom of religion and conscience, which must be respected at all times.
Ontario’s Human Rights Code articulates the right of every Ontario resident to receive equal treatment with respect to goods, services and facilities without discrimination based on a number of grounds, including race, age, colour, sex, sexual orientation, and disability.
Are our physicians not deserving of the same basic rights?
[**MESSAGE FROM ADMINISTRATOR: DURING THE CONSULTATION PERIOD, WE RECEIVED 9 RESPONSES FROM INDIVIDUAL RESPONDENTS CONTAINING THE CONTENT PUBLISHED ABOVE. ALTHOUGH THIS FEEDBACK HAS NOT BEEN PUBLISHED IN DUPLICATE, THE COLLEGE ACKNOWLEDGES RECEIPT OF THESE SUBMISSIONS.**]
As a pastor in a Christian church with many Christian physicians practising in our city, I am writing to you in regard to the Draft Policy. I am also writing as a parent of a child who had significant health issues in his first year of life. I would like you to reconsider sections 8,10, and 11 in regard to this Draft Policy: “Professional Obligations and Human Rights”.
Sections 8, 10 and 11 suggest that physicians who decline to participate in certain acts for reasons of conscience should be compelled to refer their patients to other physicians who will perform these acts. It does not address the fact that many of these same physicians will find the act of referral itself objectionable, as they consider it material cooperation with the act. In compelling physicians to refer, you are limiting their right to conscientious objection.
There is significant disagreement in our society as to what constitutes a moral act, and I do not expect the College to define or limit morality. All I expect is that physicians, as professionals, be allowed to respect their own consciences. Freedom of conscience is foundational to our free society and cannot be limited, even for the best of intentions. If we coerce physicians into violating their consciences we will inevitably erode the personal integrity which is the basis of the physician’s relationship with their patients.
When I think back to some critical decisions in the medical path pursued for our son, we encountered grey areas where we unsure of what to do. I think it would be wrong that a doctor with strong moral convictions in these areas would be forced to violate the Hippocratic oath by having to refer patients or in this case parents to those she or he feel are committing a morally wrong or possibly an illegal act ie. lethal doses of morphine for babies with special needs who are no longer wanted because of their special need.
I encourage you to revise the sections above, and include a clear defence of the right to freedom of conscience for all physicians.
I am writing with respect to your draft conscience policy requiring physicians who object to perform a procedure against their morals have to refer the patient to someone who will.
My grandfather and father were physicians in Ontario and now my youngest son is focusing his education on medical school. I was thrilled to know that his time and talent could in the future be used in service to the sick as a physician. Now I feel absolutely sick to my stomach with worry about this draft policy and the impact it will have on him and future generations. What type of person will choose a profession where they effectively don’t have freedom of conscience (given the potential requirement to become an accomplice)? I won’t want to entrust my healthcare Ito them. This is communist medicine.
When my father was dying of cancer, he asked me to pray with him that God would bring him home. God answers prayer. My father would have been mortified to know of this draft policy. Please reconsider.
I would like to inform you that I reject the proposed effective referral mandate for doctors whose Charter right of freedom of conscience and religion must be respected.
The Hippocratic Oath states that the role of the physician is to heal and comfort the patient and not harm them. This ” effective referral” is a violation of a physician’s rights as it compels him or her to violate his or her own conscience by being a participant in the very act, the very procedure to which he or she objects to in the first place.
Currently the CPSO bans doctors from performing female genital cutting of refer patients of doctors who would perform such procedures on grounds that both acts are immoral. This arrangement has safeguarded the freedom of conscience of doctors without infringing on the right of patients to good health care.
The CPSO is now proposing that doctors be obliged to provide referrals when they cannot perform a procedure for reasons of conscience.
To try to remove the moral element from a doctor’s professional life is a fundamental assault on their personal integrity. A doctor lacking in personal integrity is not the type of doctor that we should trust with the health care of the country.
In response to your proposed new draft document stating that “Where physicians are unwilling to provide certain elements of care due to their moral or religious beliefs, an effective referral to another health care provider must be provided to the patient”, I would like to voice my concern. As every professional has the right to practise what he or she believes and it should be respected, please do not force the professional to go against their conscience. Thank you for your consideration.
I was born in Ontario, raised my family in Ontario, worked and retired in Ontario and have always been proud of that. However, I am truly disheartened and dismayed by what is happening in our province and country.
This draft policy not only goes against the beliefs of many people in Ontario and Canada but it more than tips the scale of ‘freedom of choice’ and ‘freedom of religion’ for the physicians with moral integrity. How dare any organization in Ontario/Canada, especially the College of Physicians and Surgeons of Ontario, demand that doctors participate in controversial procedures such as abortion and now euthanasia (if legalized). I was naive enough to believe that the governing body for physician and surgeons had a moral obligation to ensure every effort is made to preserve life. We all have heard of the ‘God’ syndrome within the medical profession. In my opinion, this is the ultimate ‘God’ syndrome. How dare you force physicians with a moral conscience to perform or take part in (in any way) procedures that they themselves find immoral and against their values and beliefs. This may force these professionals to take early retirement and/or leave the province if not the country or just stop practicing. Forcing doctors to violate their moral integrity is just morally wrong. This is a circumstance that could be likened to people saying, ‘I was just following orders’ (you pick the situation – there are many). I believe, as many do, that someone will be and should be held accountable – at some point.
Obviously, I am vehemently opposed to this policy. While I would typically not respond to policy changes, even when I fundamentally disagree, this is too important to everyone not to make my voice heard. I have a wide circle of family and friends and virtually 95% of them agree with my comments. It’s time to take a second moral look at this. Stop this before it’s too late. Think about the far reaching effects of this. Think about how this could affect you in the future!?! PLEASE!
I wish to state my conviction that one of our freedoms as persons and Canadians is the exercise of freedom of conscience. This right to act according to one’s conscience can not justly be taken away through government or College policy. I am referring at this time to present discussions as to a doctor’s practice and referrals in the matters of abortions and assisted suicide. Our doctors should not be forced to face decisions between being true to their beliefs and being able to practise their profession in Ontario and ALL of Canada.
Subject: Draft Policy “Professional Obligations and Human Rights”.
I am writing to you with grave concern regarding the content of your proposed draft policy. Sections 8, 10 and 11 suggest that physicians who decline to participate in certain acts for reasons of conscience should be compelled to refer their patients to other physicians who will perform these acts. It does not address the fact that many of these same physicians will find the act of referral itself objectionable, as they consider it material cooperation with the act. In compelling physicians to refer, you are limiting their right to conscientious objection.
There is significant disagreement in our society as to what constitutes a moral act, and I do not expect the College to define or limit morality. All I expect is that physicians, as professionals, be allowed to respect their own consciences. Freedom of conscience is foundational to our free society and cannot be limited, even for the best of intentions. If we coerce physicians into violating their consciences we will inevitably erode the personal integrity which is the basis of the physician’s relationship with their patients.
One way to resolve this is to have a neutral body or a panel within the College of Physicians and Surgeons of Ontario to handle these cases, and rid physicians of such a burden. I can see a few benefits of such a panel:
1. It relieves the physicians from living with the psychological and mental burden of material cooperation with the act
2. Physicians can move around cities and can change their position on moral issues. As such, physicians may have out-dated information on other physicians in the province. The panel within the College of Physicians and Surgeons of Ontario, on the other hand, is the body that would have the most up-to-date information of all Ontario physicians and their practices
3. The panel can provide patients with more choices of physicians who could help them
I encourage you to revise the sections above, to the effect of providing a clear defence of the right to freedom of conscience for all physicians. It is not good to have burnout physicians. I believe the welfare of the physicians is just as important as the welfare of the patients.
Please be advised that the the freedom of conscience still matters for Doctors of Ontario and cannot be eliminated through policy. . I urge you to take this into consideration.
Re: Professional Obligations and Human Rights policy
I have completed the online survey and appreciate the opportunity to email to CPSO as well.
I oppose the Professional Obligations and Human Rights policy draft; these are my concerns:
1) It seems that the policy is not in the best interest of some Ontario citizens. I am a Christian and am very happy with the privilege I have of going to a Christian doctor. I know that he values the same things I do and will provide medical advice and options that are in the best interest for me, the patient. If he had to provide medical recommendations that he did not believe were in my best interest, he would no longer be fulfilling his obligations in the “relationship of trust” he has as a doctor. I am certain that I am not the only Ontario citizen who appreciates their doctor for this.
2) Doctors have “human rights” just like everyone else and no one should be forced to do something against their beliefs or be penalized if they do not.
3) The draft is somewhat vague in some areas and could be interpreted unfairly. If a doctor does not recommend and treatment procedure because he/she really does not think it is in the best interest of the patient (and that recommendation also lines up with his/her personal values) the patient could interpret that as the recommendation being the result of personal values rather than scientific or medical reasons.
I would ask that this draft policy be revised to allow physicians to practice according to medical and scientific reasoning as well as moral values, so that we has the patients will receive the best care possible that aligns with our own personal values
I cannot believe that patient rights trump a doctors right to refuse participation in an act that kills a patient requested or otherwise. If a patient requests suicide assistance it is up to the CPSO to provide the patient with a list of qualified physicians who are willing to provide this assistance. The proposal which lists a mandate to provide “an effective referral” is completely unacceptable. I reject this proposal.
We are a family of five, with large extended family in Toronto. We would like to thank the CPSO for all the wonderful care we have received througout the last century. My mother, for instance,second youngest of a family of nine just celebrated her nintiieth birthday: you can imagine how much help she has received from Ontario doctors. My father’s family of ten siblings still boasts two remaining members.
I would like you to conclude that this objection to and rejection of the proposed effective referral mandate is representative of many who are concerned about the drastic effect this measure would have on the medical profession in Ontario should such a violation of every doctor’s Charter right of freedom of conscience and religion be made operative policy.
Thank you for your prompt attention to this objection.
I reject the proposed “effective referral” mandate for doctors. I believe that their Charter right of freedom of religion and conscience must be respected.
1. It is hard to see how limiting physicians Rights to Freedom of Conscience and Religion guaranteed in the Charter will result in less discrimination or better patient care
2. Requiring referrals or requiring the doctor to participate in procedures that go against their beliefs may eliminate them from practice, and reduce their personal sense of integrity, if they remain in practice. Interior dissonance between deeply held beliefs and professional requirements can lead to burnout. This is systemic discrimination based on conscience or religious belief. It will impact patient care.
3. The requirement for referrals may actually slow down patient access to services. For instance in ON patients self refer for abortion.
4. Forcing doctors to refer for something, or perform something they consider to be killing a patient will completely go against the whole reason they got into medicine in the first place – to heal patients – not to harm them. This is a coercive action that involves a large percentage of physicians who do not want to be involved in euthanasia/assisted suicide.
Subject : Draft Policy – Professional Obligations and Human Rights
I am writing to you on behalf of Action Life Ottawa regarding the draft policy of the College of Physicians and Surgeons of Ontario. Action Life is a non-denominational educational pro-life organization promoting respect for human life from conception to natural death. We count approximately 4,000 supporters in Ottawa and the surrounding region.
Action Life is greatly troubled by the sections of the draft policy pertaining to freedom of conscience and religion for doctors. The draft policy requires physicians who will not provide certain services for reasons of conscience or religious beliefs to refer to another “non-objecting, available, and accessible physician or other health care provider”. For objecting physicians, the act of referral itself would violate their conscience. Physicians should not be forced to refer for services to which they object on moral or religious grounds.
Freedom of conscience and religion are fundamental in a free and democratic society. To demand that physicians leave their conscience at the door is an attack on the physician’s integrity and his constitutional rights to freedom of conscience and religion as enshrined in the Canadian Charter of Rights and Freedoms. Physicians have a right to practice in accordance to their conscience. Patients do not have a right to demand services to which the physician objects. Physicians should be able to work without fear of retribution if they decline to provide services which are in opposition to their moral and religious beliefs. The recent Supreme Court of Canada’s decision on euthanasia and assisted suicide will further increase pressure on physicians. If the physician will not kill the patient or write a prescription for a lethal dose of drugs, will he now be forced to refer to someone who will?
Attacks on the freedom of conscience of physicians continue to mount. We share the grave concerns of some physicians who wonder if the field of medicine will now only be opened to those who are willing to compromise their moral and religious beliefs. The Ontario Medical Association’s Section on General and Family Practice in its August 6, 2014 letter to the College of Physicians and Surgeons observed: “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.”
We ask that the College abandon the sections of its draft policy which would force physicians to act contrary to their conscience and religious beliefs. In its place, the policy should include a protection of conscience clause for physicians to ensure that freedom of conscience and religion is respected.
I wish to express my thoughts on this ‘Mandate’ and after reading the ‘draft proposal’; feel that the mandate does impose an ‘obligatory’ stance on physicians to act in a manner that restricts their ‘freedom of conscience’ and exert pressure on them to ‘concede’ or ‘assist’ in decisions that would violate their ‘conscience’ even if they applied the ‘referral mandate’; thereby contributing to actions, that violate the ‘Hippocratic Oath’ to protect and preserve life and that in good conscience they do not wish to support.
Therefore, in light of this, I wish to express my opposition to this proposal.
I am writing to you in regards to the CPSO’s draft policy which I have read and strongly oppose. This draft policy limits a physician’s Rights to Freedom of Conscience and Religion which is guaranteed in the Charter by requiring him or her to make an effective referral to another physician if they refuse their patient’s request, such as euthanasia should it be legalized.
I don’t think doctor’s should discriminate against patients and absolutely feel that patient care is of the utmost priority. However, deciding not to offer a service in no way discriminates against patients provided that the service is not offered to any group. I do not see how limiting physicians Rights to Freedom of Conscience and Religion which is guaranteed in the Charter will result in less discrimination or better patient care. Requiring referrals or requiring the doctor to participate in procedures that go against their beliefs may eliminate them from practice, and reduce their personal sense of integrity, if they remain in practice. Internal dissonance between deeply held beliefs and professional requirements can lead to burnout. The is systematic discrimination based on conscience or religious belief and the results of this will no doubt impact patient care.
This policy will cover euthanasia should it be legalized. Forcing doctors to refer for something, or perform something they consider to be killing a patient will completely go against the whole reason they got into medicine in the first place – to heal patients – not to harm them. This is a coercive action that involves a large percentage of physicians who do not want to be involved in euthanasia / assisted suicide. Their rights to conscience were asserted by the CMA at their August meeting.
The draft ignored the results of the online public poll Summer 2014 3:1 in support of physicians’ conscience rights. In addition, there are internal inconsistencies within the draft policy. As an example, while line 76/77 states that the duty to accommodate is not absolute – physicians do not have to accommodate beyond the point of undue hardship, where excessive cost, health or safety concerns will result. The duty to accommodate is also limited where it significantly interferes with the rights of others – the latter part of the policy (line 108-110, 156-160) contradicts the rights of the physician by specifically requiring physicians
to refer the patient to another provider though they have moral or religious objection.
The draft policy is supporting that physicians’ fundamental rights and freedoms in matters of morally objectionable medical procedures and treatments can be limited by the “fundamental rights and freedoms of others” This essentially implies that physicians are second-class citizens and that only patient have “fundamental rights and freedoms”
Thank you for your attention in this important matter.
I certainly object to assisted suicide by a physician or anyone else. I am a mother of four children and when our time on earth is up, God will decide, not another human being,
I strongly feel that if a physician’s conscience did not agree that he/she should perform a procedure such as euthanasia, that they should NOT have to refer the patient to another doctor for this procedure.
My wife agrees with me on this matter. Please pass this on to the right person so that our feelings will be known to those who will make a decision in this matter.
I have read the Draft Policy “Professional Obligations and Human Rights,” and I am appalled this is under consideration.
I have friends in the medical profession who are equally appalled and anxious that one day they might find themselves forced to refuse some of these procedures and possibly lose their licenses.
I read a recent study that revealed 74% of palliative care physicians would refuse to partake in assisted suicide or euthanasia.
I note that the CPSO draft policy is titled: “Professional Obligations and Human Rights.” In a “College of Physicians and Surgeons,” should this policy title not read “Professional Obligations, Physicians’ Rights, and Human Rights”? Here is the flaw exposed in our Charter of Rights and Freedoms, and now in our CPSO: we now have human rights trumping human rights.
“God keep our land glorious and free!” states our national anthem. And what of the freedom of physicians to follow their own consciences without fear of professional recrimination? Draft policies like these do not belong in our province or our nation. Shame on those who crafted it. Permit our physicians and nurses the unlimited right of freedom of conscience and morals.
I find it most disturbing that you are proposing a policy Which will discourage, especially those in Family Medicine, from growing in medical integrity. Could you please explain how such a policy contributes to the common good of Medicine & its practice?
No, No, No! The supreme court got it wrong as they did when they struck down the abortion laws of our country.
My suspicion is that in Nazi Germany many physicians were forced to participate in terminating unsuspecting victims.
No doctor (who became a doctor to heal and not kill) should be forced to participate in any way, referrals included, in this giant step backward.
Let the proponents of euthanasia have their own death houses. Many doctors who perform abortions would be glad to add this to their resume. Indeed, one does not need a medical degree to have over a deadly poison to a willing participant, nor should a pharmacist be forced to dispense these drugs.
With the most profound advances in palliative care in recent years can we not bring some sanity to this issue.
The supreme court is an unelected body of individuals whose sense of what is right is skewed in this matter. Why unanimous? No one would put their name to the ruling because it is wrong.
I am a physician in British Columbia. I would like to say that I strongly oppose the requirement for physicians to refer for procedures they find morally objectionable. Referral makes one an accomplice and is a clear violation of charter rights. I agree that no single right trumps all others. However, the central and extremely controversial issues that this policy will at the ground level impact are not emergency life and death issues. Therefore, I strongly believe that the violation of the physician’s charter rights of conscience and religion distinctly outweigh the violation of the patients rights to have the physician they are currently sitting in front of make the given referral. If we are honest, this referral is for the non-emergent issues that we are really talking about: abortion and physician assisted suicide and perhaps birth control. Abortion and physician assisted suicide are very controversial among both physicians and the people of Canada. One can perhaps dream up an extreme example where the need for an abortion is urgent and life-saving. Few, if any, physicians would argue about the obvious required life-saving action. Additionally, few if any physician regulating bodies and provincial judiciary institutions would disagree on the obvious legal obligation to provide life saving care. Let’s be honest and acknowledge that we are not talking about these types of situations.
Dear College of Physicians and Surgeons of Ontario,
I am writing to you with deep concern regarding the draft proposal “Professional Obligations and Human Rights”. Your current draft has far reaching implications given the recent ruling of the Supreme Court regarding doctor assisted suicide and I disagree with the intention to force a physician to do something against their conscience.
I propose these areas of contention should be a matter of discussion between doctor and patient before establishing a doctor-patient relationship. Patients can then be cared for by doctors of like-minded values, giving the highest level of care physically, mentally and emotionally. I also propose that the College consider the future implications of recent rulings and how they have morphed in other societies to include euthanizing unwanted babies, handicapped, those with mental illness and elderly people. This is not health care and it puts patients at risk when they are concerned that they will be a “burden” to their loved ones. Health care provides caring patient and family support and quality palliative care. These are the things that should be valued in patient care and advise the government of the importance of these services safeguarding the vulnerable.
Just because something is not deemed criminal, doesn’t mean it is ethical and moral. Ethical and moral doctors are critical for quality health care, I want a physician who has not been required to divorce these qualities to remain in practice. This policy would essentially force conscientious objectors out of your profession and decrease the quality of care. It is intolerant ideology masquerading as enlightened objectivity, no one should have the right to force someone to do something against their conscience or tell them they are not welcome in their profession. It is discriminatory.
I am writing to inform you that I reject the proposed “effective referral” mandate for doctors whose Charter right of freedom of conscience and religion must be respected. If I were a physician, I would fall into the category of being unwilling to provide certain elements of care due to my moral and religious beliefs. I would therefore, be unwilling to provide effective referral to another health care provider to the patient. This “effective referral” is a violation of a physician’s rights, as it compels the physician to violate his/her conscience by being a participant in the very act, the very procedure to which he/she objects in the first place.
I am shocked to read the proposed draft conscience policy proposed by the College of Physicians and Surgeons of Ontario (CPSO) which states that physicians who refuse to perform a procedure to which they morally object must arrange that the procedure gets done by someone else. In other words, they are compelled to become accomplices.
This is against our faith, moral conscience and religious freedom!
I wish to express my following comments:
Physicians should have the right to say no to providing certain forms of treatment. I’m particularly concerned with the requirement that physicians provide referrals for treatments which they feel are morally and ethically wrong.
If a physician feels a treatment is morally and ethically wrong, aren’t they still violating their conscience by asking someone else to perform the procedure? How is the physician’s right to freedom of conscience being protected under these circumstances? Also the physician might feel that if a procedure is morally wrong it would also be harmful to the patient. Under those circumstances the physician would be violating not only their conscience but also their hippocratic oath by referring the patient to someone else to perform the porcedure.
One aspect of the draft policy that I feel should be addressed is the forcing of a doctor to assist a patient in ending the patient’s life when it goes against the doctors moral or religious beliefs. Also i don’t think that a doctor must refer such a need of similar request by a patient to any other doctor to do something that the first doctor finds repulsive.
I agree with the comment of a Member of the Public, posted on Feb 6,2015, at 1.29 am.
A physician or surgeon is a professional of the highest calibre as he has to deal with so many aspects of a patient’s life. He should be allowed full freedom to act in acordance with professional standards and his own conscience. If a procedure to abort a child in the womb is wrong by his religion, he must not be compelled to do it. Nor must he be compelled to refer the patient to another physician who is not of the same moral conscience. A similar principle applied to a physician who is asked to assist in a suicde or in euthanizing a patient. If the procedure is against his religious principles he should not be compelled to do it, nor to refer the patient to another physician who might be prepared to carry out the procedure. Making mandatory rules in these circumstance would destroy the independence of physicians/surgeons and we are then heading for disaster.
I disagree most strongly with the idea that doctors should be forced to perform actions such as abortions and assisted suicide or euthanasia when it is against their religious and moral beliefs to do so. Nor should they be forced to refer a patient to another doctor willing to perform these actions. They have a right to act according to their conscience. A human right. No one has the right to deny them this freedom. There is a reason that Man has been given a conscience. Forcing a person to ignore his conscience is gravely wrong.
I am totally against abortion and assisted suicide. I think we were not consulted when we were born and should have no say when we are to die, a natural death.
From the Professional Obligations and Human Rights Draft Policy: “Where physicians are unwilling to provide certain elements of care due to their moral or religious beliefs, an effective referral to another health care provider must be provided to the patient. An effective referral means a referral made in good faith, to a non-objecting, available, and accessible physician or other health care provider. “
According to the Hippocratic Oath: “Nor shall any man’s entreaty prevail upon me to administer poison to anyone; neither will I counsel any man to do so.”
February 6, 2015 was the most profoundly disappointing day I have experienced as a Canadian and also as a physician. Nine unelected Supreme Court judges ruled that Canada’s law against physician-assisted suicide is unconstitutional. This decision is disturbing for many physicians, such as myself, that provide acute medical care and end-of-life care for our population.
Switzerland, Holland, Belgium and five US states allow various degrees of physician-assisted suicide and euthanasia. Belgium in fact passed a law in 2014 extending euthanasia even to children, after it initially approved the practice in 2003. Over 1800 patients were euthanised in 2013 alone (a 25% increase over 2012), in this small European country. Many Belgians have been euthanized not because they have a terminal illness, but because of mental illness. Please refer to the story of Godelieva De Troyer, a depressed woman who requested and was granted euthanasia. Her son Tom, is now a vocal opponent of euthanasia in Belgium. The sad irony is that the majority of Euthanasia in Belgium occurs in Flanders, where so many young Canadians sacrificed their lives for our freedom during the First World War.
My father was a veteran of World War II. He experienced both Nazi and Soviet atrocities during the war. He eventually immigrated to Canada, with the hope that this country would provide the freedom and liberty that he had fought for.
How quickly we forget about the atrocities that were performed in Germany during the 1930s until 1945, including horrific euthanasia practices.
The Reich Committee for the Scientific Registering of Hereditary and Congenital Illnesses was established in August 1939. It was to prepare and proceed with the registration of ill children or newborns with severe disabilities, from Down syndrome, paralysis to various physical malformations. The reports were assessed by a panel of medical experts, of whom three were required to give their approval before a child could be euthanized. Between 1939 and 1941, more than 5,000 children had been killed.
The official program for killing adults with mental or physical disabilities (T4 Euthanasia program) began with a letter from Hitler issued in October 1939.
“Reich Leader Bouhler and Dr. Karl Brandt (Hitler’s personal physician) are charged with the responsibility of enlarging the competence of certain physicians, designated by name, so that patients who, on the basis of human judgment, are considered incurable, can be granted mercy death after a discerning diagnosis.” — Adolf Hitler
In October 1939, all hospitals, nursing homes, old-age homes, sanatoria were required to report all patients who had been institutionalised for five years or more, or who had been diagnosed with any of a list conditions: schizophrenia, epilepsy, Huntington’s chorea, senile dementia, paralysis and progressive neurological diseases.
As with the disabled children, the adult cases were assessed by a panel of experts, working at the T4 offices. Three “death” verdicts condemned the person concerned. As with reviews of children, over time these processes became less rigorous, the range of conditions considered “unsustainable” grew broader, and zealous Nazis further down the chain of command increasingly made decisions on their own initiative.
The T4 Program was run by some 50 physicians. It was discontinued in 1941 after increasing opposition from both the general population and the clergy. Amongst the resistance that did emerge, only a small part was driven by the medical profession. Should doctors, through their Hippocratic Oath, not have been the natural profession to oppose? Doctors, however, had joined the National Socialist (Nazi) party in higher percentages than any other profession. These barbaric practices occurred not even a century ago. Over 70,000 people were killed.
The Canadian supreme court decision is chillingly similar to Quebec’s assisted suicide legislation, where patients must suffer “a serious and incurable illness” and be “in a state of irreversible decline”, suffering pain “which cannot be relieved in a manner the patient deems tolerable”. This suggests the law is not just limited to people who are terminally ill.
We have allowed a small vocal minority of people (the euthanasia and assisted suicide lobby) to change the history of this great country in favour of crossing the threshold from life into death. If we as physicians do not speak out against these decisions, on moral or ethical grounds, then who will?
We have made huge strides in palliative care in this country and our energies should be focused on further improving palliative care, not euthanizing or assisting people to end their own lives.
We, as physicians, should be given a voice to stand against such a practice, not be silenced by the proposed “Professional Obligations and Human Rights Policy.”
Section 2 of the Charter guarantees freedom of conscience and religion as a fundamental right. Forcing a doctor to make a referral for the performance of a procedure or prescription that he or she finds morally objectionable is forcing material cooperation in that procedure or prescription. The doctor is thereby being forced to violate his or her own conscience, which according to the Charter, is a violation of a fundamental human right. I do not see how the College of Physicians and Surgeons of Ontario can force this state of affairs on its members. It is a severe violation of the human dignity of physicians. Please respect freedom of conscience.
The CPSO’s proposed new policy can be summed up in one word: unconstitutional. Mandating for an “effective referral” is a gross violation of a physician’s freedom of conscience. It compels the physician to violate his or her own conscience by being a participant in the very act, the very procedure to which he or she objects in the first place. With physician-assisted suicide making its way into Canada, I find it completely disturbing that the College might one day force me to refer my patients to other doctors who would be willing to kill them. As a current medical student in the province of Ontario who believes in the sanctity of life from the moment of conception to natural death, I strongly urge the College to not infringe upon the rights of doctors and to uphold freedom of conscience for the benefit of all Canadians.
Dear CPSO,
Thank you for inviting feedback on this draft proposal regarding Freedom of Conscience. As a physician for 40 years, I have tried always to treat my patients with respect and compassion, and have worked as an advocate for them as they pursued their health issues. I do not believe that I have ever discriminated against a patient.
I cannot agree with the CPSO draft saying that I must give up my Freedom of Conscience, and provide or refer patients for treatment or procedures that I truly believe are morally wrong and harmful to the well being of my patient. This, of course, would include participating in the taking of a human life as in the case of euthanasia or abortion. This goes completely against the reason I got into medicine in the first place ” first, do no harm”.
I can give the testimony of my many years in family practice. I did not refer for abortions, and I would explain this to patients, always trying to be respectful and non-judgmental. Interestingly, many of those women said they ” did not believe in abortion either, but they had no choice”…they had no one to support them (they were going against their conscience, and many suffered terrible mental anguish in later years). After our discussion about the abortion, those who still wanted an abortion were able to self refer to another physician. It is true that some of those women did not return to my practice, but a great number of those women did continue on with me as their family doctor, and I don’t believe our relationship was damaged; there always seemed to be a mutual respect. Also, after our discussion about abortion, a few of these women did choose not to go ahead with their abortion, and later wrote me to say how happy they were with their choice.
In summary, I am asking that you to reconsider your proposal, and, please, do not take away our Freedom of Conscience.
Thank you.
I wish to register my disapproval with the proposed changes to the Physicians and Human Rights Code. Forcing a physician to refer a patient for procedures which go against his/her moral or religious beliefs is no different than requiring him/her to perform the procedure. This is not consistent nor logical. If I am against people hitting themselves in the head with a hammer, how is it OK for me to tell them where they can buy a hammer elsewhere? If I am against recreational drugs and refuse to supply someone with such drugs, how it is OK for me to suggest they go to someone else?If one believes something to be immoral, referring them to someone else is also a participation in the immoral act.
• Thank you for asking for feedback!
• To this statement: “Physicians must provide care that is urgent or otherwise necessary to prevent imminent harm, suffering, and/or deterioration, even where that care conflicts with their religious or moral beliefs.” … What exactly constitutes “imminent suffering, and/or deterioration”? Consider a patient seeking assisted suicide because they are either suffering or deteriorating. Where is the distinction between the severity and proportionality of these cases?
• To this statement: “Where physicians are unwilling to provide certain elements of care due to their moral or religious beliefs, an effective referral to another health care provider must be provided to the patient.” There is a clear and faulty assumption here that referral for a morally objectionable procedure somehow removes the physician from ethical responsibility. If it is wrong to kill someone, it is wrong to make arrangements for someone else to kill them. Ending a life is serious and referral is still participation.
• Unless a physician’s refusal makes it impossible for a person to access a legally acceptable and effective procedure, there should be major responsibility to prove that the physician’s serious (ie. killing) objections should be overridden – not the other way around. This also needs to recognize that referral is complicity.
• Thank you for opening this up for public feedback and I hope my assessment is considered!
Subject: Draft Policy “Professional Obligations and Human Rights”.
I am writing to you with grave concern regarding the content of your proposed draft policy. Sections 8, 10 and 11 suggest that physicians who decline to participate in certain acts for reasons of conscience should be compelled to refer their patients to other physicians who will perform these acts. It does not address the fact that many of these same physicians will find the act of referral itself objectionable, as they consider it material cooperation with the act. In compelling physicians to refer, you are limiting their right to conscientious objection.
The “effective referral” is a violation of the physician’s rights, as it compels the physician to violate his own conscience by being a participant in the very act, the very procedure to which he objects in the first place
There is significant disagreement in our society as to what constitutes a moral act, and I do not expect the College to define or limit morality. All I expect is that physicians, as professionals, be allowed to respect their own consciences. Freedom of conscience is foundational to our free society and cannot be limited, even for the best of intentions. If we coerce physicians into violating their consciences we will inevitably erode the personal integrity which is the basis of the physician’s relationship with their patients.
I encourage you to revise the sections above, and include a clear defence of the right to freedom of conscience for all physicians.
I am compelled to write in response to your request for feedback to the draft policy for Freedom of Conscience, and I welcome this opportunity to do so.
The Human Rights Code discusses Discrimination, and protection from Discrimination for all Ontario Residents, which includes physicians. The Courts have not established a hierarchy of rights, “all rights are of equal importance”, but given the wording of this Draft Policy from the College of Physicians and Surgeons of Ontario, it appears clear that physician-citizen’s right to freedom of conscience would be trumped by another citizen’s right to a unilateral autonomous demand. Why would the College initiate a policy that would automatically subjugate a physician’s right of freedom of conscience to a patient’s right to do whatever that patient demanded, when the Courts themselves have no such stated policy?
I am particularly concerned at this time because of the impending legalization of doctor-assisted suicide. I practice as a paediatric neurologist in Scarborough. Many of my patients are severely disabled. In 30 years of practicing medicine I cannot remember one patient or family who wanted to end their life despite sometimes unimaginable circumstances. So, what if I, as a physician, am asked to euthanize a disabled child or adolescent? If I am obliged to Accommodate my patients (line 59-61) under this proposed College policy, I would be forced to do it, or be an accomplice to the action, even if it were against my conscience. In contrast, both the University of Toronto and the Ontario Medical Association recognize freedom of conscience as a fundamental human right, and would support me in my decision not to conduct this terrible act. Neither am I able to screen out patients or their families who specifically come to me (in good faith or otherwise) to force me to end their or their dependent’s life. Under this Policy, I could refuse to kill these patients, but would be obliged to provide an effective referral (line 157), making me, an accomplice to suicide, or murder as it really is. My personal freedom of a conscientious objection to intentionally end life would be overridden.
Is the College expecting physicians to disassociate themselves from their conscience? Isn’t conscience an integral part of one’s being? And I may ask, what kind of human would be willing to go against his/her conscience? Would you want that person to be your physician? All of the decisions made by physicians involve the physician’s conscience, and will continue to do so unless we are being replaced by robots, care plans and protocols. Just like German physicians feared for their lives and the lives of their families for not obeying orders to murder mentally-challenged patients en mass, will Canadian physicians be forced to carry out deeds against their conscience for fear of losing their livelihood and homes? We have to be accountable to ourselves at the end of the day.
I never entered medicine to end life. I willingly took the Hippocratic Oath-”First Do No Harm”. I was taught my role as a physician is “as a mediator between the patient and his illness, to enhance the prospects of cure, diminish unreasonable fear and assist in the process of adaptation”, to quote my Social Studies teacher. I always seek to act in good faith in the best interests of my patients. My fiduciary duty as a doctor is to provide that information to my patients. Removing any decision-making power from the physician automatically ends this fiduciary relationship, and this Policy actually removes any fiduciary role for the physician. Every clinical decision requires thought and assessment of risks and benefits to the individual, and reference to practice evidence-based medicine. Many of the “quick -fix” procedures commonly requested by patients have outcomes not properly understood or even studied. Patients seeking unilateral autonomy in decision-making may not understand the basis or implications of their decisions.
I have three suggestions for the College:
1. It would be wise for the CPSO to distance itself from any politically-motivated personal agenda of its committee members and any blatantly discriminating statements, in order to maintain public trust in the process at hand. 2. The CPSO could maintain a register of physicians willing to commit doctor-assisted suicide or abortion, etc., on their website and make this part of the new doctor-assisted suicide process that will be coming to Ontario. This would circumvent the need of a direct effective referral. And most importantly, 3. The College MUST protect Freedom of Conscience for its members.
I am greatly concerned that 2 provincial colleges, including the College of Physicians and Surgeons of Ontario, have proposed policies that force physicians to refer and in some cases provide treatments or perform procedures that are contrary to their personal or professional ethics and conscience.
Excuse me. We are talking about doctors. They are among the most well educated professionals in our society. They are thinkers and have good judgement. They are human beings with a conscience. They desire to do good, to heal. They should never be forced to provide a referral or actually provide a service that contradicts their conscience. They should never be put in a position where they have to choose between their practice and their conscience on matters such as abortion, sterilization/contraception, euthanasia and assisted suicide.
I was astonished to hear that the college would entertain requiring doctors to provide referrals for abortions, morning-after pills and contraception. This requirement would prevent many doctors from following their conscience.
This sort of policy would prevent many doctors from practicing and further supports the degradation of morality and ethics. Will the next step be to remove all onus on patients and make life and death decisions based on a doctor’s decisions or policy. The death penalty was removed from law but is being re-introduced in a different manner.
I am writing in response to your draft policy as titled above, after the recent court decision on assisted suicide. My viewpoint is in disagreement of the drafted policy. I disagree with the College to oblige a physician to ensure the access of the care when the nature of that care contradict a physician’s belief. While the Supreme Court ruled that it is not criminal to assist suicide, it does not mean that assisted suicide is an accepted duty of a physician. The court, recognizing that many physicians, faithful to their healing vocation, will not assist people to kill themselves, makes some very slight room for freedom of conscience. It trusts local Colleges of Physicians and other such groups to deal appropriately with the conscience issue. Currently the College of Physicians and Surgeons of Ontario is proposing a draft conscience policy which states that physicians who refuse to perform a procedure to which they morally object must arrange that the procedure gets done by someone else. In other words, they are compelled to become accomplices. I urge the College not to go through with this unjust policy. This represents an assault on freedom of conscience of all physicians. Every Canadian with a conscience should speak up against it.
Any society that authorizes killing people through assisted suicide and euthanasia has lost its moral compass.
I am writing in response to the CPSO draft titled Professional Obligations and Human Rights. As an academic physician registered with the college since 1999, I am writing to express my concern and to request that the policy be revised to respect the rights of physicians and to remove the proposed mandate for “effective referral”.
As a medical educator, I foresee that the CPSO draft policy as it stands would have a devastating effect on current and future physicians and their relationship with their patients. The proposed mandate for “effective referral” goes contrary to two pillars in medical ethics and professionalism: the Hippocratic oath and the tenet to do no harm.
The Hippocratic oath developed in response to a prevailing medical culture in ancient Greece where physicians took bribes, administered poisons, and had powers that were feared by the public. Hippocates and his followers proposed a paradigm where physicians could be
trusted: the oath was sworn under Apollo, acknowledging that a physician’s behaviour was answerable to a higher-than-human authority.
It also forbade the giving of drugs to end life, even in the womb.
The physician was called to be one who would heal and comfort and not harm – laying a foundation for Western medicine for centuries to come.
A basic and fundamental tenet of medical professionalism is primum non nocere – first, do no harm. This is spelled out because there is no other profession with such a unique access to treatments and
procedures that can cause harm, even death. Therefore, when a
physician is asked to prescribe a medication or perform a procedure that he or she knows may cause harm, he or she cannot do so without violating this basic ethical principle. The refusal, in this case, is not discrimination against the person requesting the procedure, but rather in response to a rational evaluation that this would cause harm. The refusal is out of response for the patient and to honour the trust that the patient has made in the physician’s professional judgment.
I am grateful that the CPSO for upholding the rights of patients – in no way should any physician discriminate against patients and patient care for any reason. Discrimination based on “race, ancestry, place of origin, colour, ethnic origin, citizenship, creed, sex, sexual orientation, gender identity, gender expression, age, marital status, family status or disability” is always unacceptable. Therefore, a physician who refuses to treat or refer a patient on such grounds should be subject to correction. However, when a physician refuses to treat or refer based on the nature of the treatment requested, the physician’s moral stance has nothing to do with the individual patient and is therefore NOT discrimination. The refusal has to do with the physician’s conscience – a rational moral stance, which is based on reason and can be explained in terms of observation and judgment of good done or evil avoided.
Conscience is not merely a belief system, subject to public opinion or personal feelings. It is an innate human faculty, universal, and is recognized as the core of a person’s freedom and individuality. It is more than simply a faculty for decision-making, it in the inner arbiter for deciding one’s actions as individuals and cannot be simply dismissed as mere “personal beliefs”. To force a person to act against their conscience is to destroy their core and fundamental integrity. Freedom of conscience is therefore fundamental to the freedom of an individual, and must be protected as an innate human right. Such rights cannot be limited in a one-sided manner in favour of patients. Both patients and physicians require protection.
The draft’s requirement for “effective referral” is an affront against the fundamental rights of physicians. A patient’s requests for medical treatments and procedures cannot override the moral harm that referral for such a procedure would cause to the physician. Such a referral is akin to cooperating with a treatment or procedure that the physician has found repugnant and therefore creates a moral dualism
within a physician that erodes his or her moral integrity.
Effectively, the physician is forced to act contrary to him or herself, and duplicity enters into the patient-physician relationship.
An erosion of the physician’s integrity at his or her core moral level would have devastating consequences for patient and society at large.
Once a physician violates their fundamental core values, the heart of their professional integrity is fractured. It follows that all of the core tenets of medical professionalism then come under risk: honesty, integrity, justice, and veracity. The loss of these would irreparably damage the physician-patient relationship.
In order to avoid violating their consciences, physicians may choose to avoid areas of medicine where they would be involved in referring
for procedures or treatments that they do not perform or prescribe.
Although such physicians constitute a small minority, they will be excluded from fields in which they could have otherwise brought their expertise and compassion (e.g. rural medicine, women’s health,
palliative care). This may even limit the diversity of applicants
to medicine, impacting the area of medical education and the future of medical care in Ontario.
One of the joys of being a medical educator is interacting with medical trainees from a variety of religious and cultural backgrounds.
As the diversity of our patients increases, so should the diversity of physicians – this ensures that patients can receive culturally sensitive care. In order to ensure this diversity, we must be equally respectful and open to the personal values and beliefs of our current and future physicians. This is why the University of Toronto Medical School, the largest in Canada, has existing ethics guidelines that support trainees’ right to refuse participation in activities for ethical reasons. The CPSO should also continue to endorse that physicians not be compelled to provide what they discern are unethical services – only in this way will Ontario remain a culturally respectful and safe environment for physicians to learn and serve.
You should not abandon your physicians. You must respect their right to their moral conscience just the same as every other citizen of Ontario. Patients will not be greatly harmed if physicians are allowed respect for their own conscience. There is no need for physicians to be required to refer. Many citizens of Ontario agree with their physicians who object to providing service for reasons of religious or moral conscience. The citizens of Ontario are not helpless. They can find another physician to help them.
If you consider a physician to be a private business, then you have no authority to dictate to him which services he must provide, just as no one would have that authority over any private business. If you do not consider him a private business, then you, CPSO, have a duty to protect his rights just the same as any other citizen. When needed, it should be the responsibility of CPSO to assist patients with finding a physician to take care of their needs. This will become increasing more necessary when physician-assisted suicide and euthanasia become established practices. You must not mandate that all physicians become involved. These are life-and-death issues, just as abortion, and they deserve extraordinary organizational measures. You must establish registers of your physicians, taking into account these important human issues. They are not the same as “gall bladder surgery” or “treatment of influenza” for example, or any other less morally-involved medical procedure. These issues deserve extraordinary means of handling because they are extraordinary issues. Any reasonable person will understand the difference. I believe CPSO should understand the difference as well.
I am a pharmacist in Ontario and I do not agree with the Ontario College of Pharmacists expectation that pharmacists also must refer to another pharmacist to provide service to the patient. I believe the Ontario College of Pharmacists has neglected its pharmacists and I would like to see that CPSO does not follow the same course of treatment of its members.
Thank you for your consideration.
Please do not abandon your physicians.
The CPSO policy re Professional Obligations and Human Rights:
The following are some thoughts for consideration by the drafters of the above policy:
1) Principles (see lines 15-17) a very good section re key values of professionalism, but seems inconsistent with the rest of the policy.
A trustworthy physician has to be consistent: to say one thing and to do another destroys trust. How can having a set of beliefs or a morals and being known to act inconsistently with them promote trust?
A number of my classmates and I took an updated Hippocratic Oath upon graduation from medical school and promised not to assist to obtain or to do abortions or to assist to cause death or to cause death. A copy was submitted to the College last year and always hangs in my waiting room. I may not break that oath and continue to practice medicine without perjuring myself and breaking the trust I have built up with my patients.
RECOMMENDATION: that the policy be amended to state that physicians may post a list of procedures or practices that they neither can do nor assist patients in obtaining (which has been the CPSO policy since 2008).
2) Access to care:
CONSDERATION: the wishes and rights of one patient versus the rights of a physician and all the other patients in the physician’s practice.
a) There is no law stating that a particular patient must seek medical care from a particular physician. If the patient-physician relationship is not a good fit, the patient may seek care elsewhere (even in underserviced areas such as where I practice). To insist that a particular patient must get a referral for a procedure or have a procedure by a specific doctor who may not wish to provide such based on religious or moral beliefs is unreasonable (re lines 156-159). Forcing the physician to do what the patient requests would cause stress to the doctor and, in the worst case scenario, would force the doctor to close their practice thus leaving all the rest of the patients without medical care. We are crying out for more family doctors so enacting a policy that could force some to leave is counterproductive and reduces access to care.
b) Abortions and the morning after pill are by self referral in Ontario, so insisting that an objecting physician do the referral would slow access to care.
RECOMMENDATION: that the policy be updated to reflect the facts in Ontario re access to morally controversial procedures and to reassure both physicians and their patients that religious and moral beliefs remain valid reasons to refuse certain aspects of care without penalty.
3) Assisted Death and Euthanasia:
The Supreme Court of Canada when it struck down the ban on assisted death did say in effect that physicians were not to be forced to assist with euthanasia or to refer for it if it was against their religious or moral beliefs. We who have been medically trained in Canada were all trained to be healers not assistants to causing death.
RECOMMENDATION: that the policy be changed to give all physicians the right to refuse to assist to cause death or to refer for assisted death.
I liked the section on Clinical Competence.
I trust that the above thoughts will prove helpful as you review the policy.
I know you have a difficult job with many pressures. It is hard to balance the needs of the few and the needs of the many, so falling back on the rich medical tradition of the last 2000-2500 years and the realization that Hippocratic Medicine has helped civilization for millennia should be reassuring. We physicians do want the best for our patients, but we ourselves also are vulnerable and need some protection.
Thank you for the opportunity to give you some input.
As an Ontario resident and member of the public, I am concerned that the draft policy on Professional Obligations and Human Rights, particularly 156-161, does not adequately protect a physicians’ freedom of conscience and religion, because it requires a physician who cannot provide a particular health service for moral or religious reasons to provide “an effective referral” to another health care provider. But an “effective referral” is exactly how physicians provide health services to patients whenever the physician, for pretty much any reason whatsoever, is unable to provide that service themselves. In fact, a great many specialized health services generally cannot be provided to patients at all unless a physician makes an “effective referral” to a suitable specialist.
For this reason, when a physician makes an”effective referral” for a particular health service, the physician is facilitating the provision of that service to the patient. Because of this, the proposed policy, particularly lines 156-161, clearly violates a physician’s freedom of conscience.
A better approach, more respectful of the human rights of physicians, would be to permit a physician to decline to facilitate (including referrals) any health service that violates the physician’s conscience, If patient access to services is of concern, other physicians who do offer those services can themselves communicate with prospective patients, and prospective patients can themselves seek out such physicians.
One possible objection to my suggestion is that this is too accommodating of physicians rights, and not accommodating enough of patient rights. My answer to this objection is threefold. One, while there is not a “hierarchy” of rights per se, freedom of conscience and religion is an established human right. Access to any particular health service is not in itself a right at all. Secondly, it is harmful to the profession to establish a policy, such as lines 156-161 of the draft, that effectively limits the ability of persons with moral beliefs to practice as physicians without violating those beliefs. Finally, equal and uniform patient access to every possible health service is not achievable anyway: the huge variations in access to health services arising from the location of a patient in Ontario are far greater than any variation in access arising out of the freedom of conscience of physicians for those few health services that are morally problematic.
The College of Physicians and Surgeons of Ontario
Re: Draft Policy: Professional Obligations and Human Rights
I wish first, to commend the College for its transparency in submitting the draft policy to public scrutiny and open discussion.
I wish second, to praise the emphasis on human rights in the document, particularly for its recognition of freedom of conscience.
However, I disagree profoundly with the CPSO’s assertion that there are limits to the freedom of conscience that require that a physician provide “effective referral” in matters in which the physician has moral objections to the service requested, especially those matters that involve the termination of developing human life (abortion) or the deliberate ending of life, as in assisted suicide. The proposal, if established and enforced, will require whole classes of physicians in Ontario to violate their own conscience in order to avoid charges of discrimination. If, as the Draft states in footnote 11, the courts have determined that “there is no hierarchy of rights”; all rights are equal”, then the right of a patient or prospective patient to a procedure or treatment that is contrary to the physician’s conscience cannot easily trump the right to free exercise of conscience.
“Personal values or beliefs” are not necessarily individual opinions without any basis in reason. They are not mere subjective claims. Still less are they only “emotional” reactions to what is thought to be morally wrong. On the contrary, they may be the developed tenets of a whole body of philosophical thought or religious tradition over centuries. Conscience, properly understood, is simply human reason aware of moral principles and deliberating about what is good or evil and coming to rational conclusions about specific courses of action to choose.
It may be claimed that an “effective referral” should relieve a physician of moral responsibility of providing the requested service him/herself. But such a referral makes the practitioner complicit in the controversial procedure; although he or she does not directly cause the perceived harm, the physician is indirectly engaged: there is tacit approval of the harm. The causal relationship is too close to absolve the physician of personal moral responsibility.
To have a considerable number of Ontario physicians forced to act contrary to their conscience and the source of continuing public controversy and interpersonal tension with patients is hardly conducive to the public good. The Supreme Court, in the Carter case, has stated that a total ban on assisted suicide is “overbroad and grossly disproportionate” in pursuit of the goal of protecting the vulnerable. I suggest that the requirement that individual physicians provide effective referral is also an overbroad and grossly disproportionate method of ensuring the rights of some patients from discrimination.
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Many physicians may not know the identity of those willing to provide the controversial service; they may not associate with them at all or have knowledge of their practice. If the CPSO wishes to ensure effective referral, would it not be preferable for the College itself to become the referring entity in cases of conflict, rather than forcing individual physicians to resolve the conflict at the expense of violating their consciences? The College has the resources to manage this task. It may wish to appear neutral on the matter, but in advancing this proposed policy, it is hardly being neutral; it is clearly taking sides with those who desire the morally controversial procedures. The College’s assumption of this the role would not be a disproportionate response to the problem.
I urge the CPSO to reconsider this element of the draft policy, and to try to find other ways of providing accommodation for both patient requests, and the freedom of conscience of physicians: a balance of rights, not a victory of one over the other.
I am writing in response to your darft policy as tiltled above, after the recent court decision on assisted suicide.
There is certainly no need to take extreme measures to extend the length of life. When people are dying, effective palliative care with the best medical assistants is a society’s responsibility. But there is a profound difference between compassionately journeying with someone who is dying, versus killing that person, or assisting that person to commit suicide.
Assisted suicide means a person is incapable of killing oneself and hence demanding a second party to commit cooperative homicide. Legalization of assisted suicide involves a willing homicidal partner. What will happen if the second party is obliged to participate in the process of such against one’s conscience? A spiritual or moral suicide of the participatory party hence resulted. Physicians are trustworthy due largely in part of our inherent conscience. No citizen wants to be cared by a physician without conscience.
No one has a right to take away anyone’s life, and it is simply wrong for the state to allow or to encourage that. It is even more wrong for a medical body to endorse that. There may be demand or misguided statistics to support its legalization. It is usually the weakest, the disabled and the incapacitated who lack or hind their voice for fear of burdening the “progressive and productive” majority.
It is a perversion of the vocation of physicians to have them engaged in helping people to kill themselves. Physicians are called to be servants of healing, not agents of death.
The yardstick is morality and human conscience cannot be graduated or defined by statistics.
Assisted suicide is the deceptively attractive face of euthanasia. The most compelling cases grip our attention and sway the debate, and so the Court opens the door to assisted suicide. A set of limiting conditions, such as informed consent, were established. But the state is authorizing the killing of an innocent person, whatever controls are in place, and even those limitations can over time be swept away, leading to the more widespread practice of euthanasia. We have only to look at some European countries to see what lies ahead. We Canadians patriotically believe our country is special, but it is not so special as to be immune to the dynamics of increasing access to medical killing, as individualist rationales make persuasive the argument for that in more and more cases.
The court, recognizing that many physicians, faithful to their healing vocation, will not assist people to kill themselves, makes some very slight room for freedom of conscience. It trusts local Colleges of Physicians and other such groups to deal appropriately with the conscience issue.
As a practicing physician for twenty years, I do know that not everyone’s conscience is equal.
Some of us have weaker conscience, including myself, at times.
Do all surgeons explain the surgical consent 100%?
Do all MDs explain side effect of medications 100%
Do all Obstetricians explain the implication of prenatal testing 100%
Everything can be lawful, but not all lawful are beneficial to human being.
The Law does not equate human conscience.
Public trust has been misplaced. Currently the College of Physicians and Surgeons of Ontario is proposing a draft conscience policy which states that physicians who refuse to perform a procedure to which they morally object must arrange that the procedure gets done by someone else. In other words, they are compelled to become accomplices. I urge the College not to go through with this unjust policy. This represents an assault on freedom of conscience of all physicians. Every Canadian with a conscience should speak up against it.
Any society that authorizes killing people through assisted suicide and euthanasia has lost its moral compass.
“The Ballad of Narayama” is a 1958 Japanese film of great beauty and elegant artifice, telling a story of startling cruelty. The poor village enforces a tradition of carrying those who have reached the age of 70 up the side of mountain and abandoning them there to die of exposure. It won 3 Mainichi film awards. A story of a necessity of survival became tradition which became an enforced culture. A thriller which is of worthy of review before casting your vote of conscience.
A doctor’s right as a citizen should be honoured. If a doctor wishes to uphold her values about protecting life, it should be honoured. Only the giver of life has the right to call it back!
Dear CPSO,
We have good health care in Canada. As a nurse for over twenty-five years, I have seen great strides in the health care system, one of those areas includes end of life treatment. Patients no longer suffer as they did years ago. Legalized euthanasia concerns me. Many people have a long drawn out death because family will not withdraw heroics, not because euthanasia isn’t available. Legalized euthanasia could be abused. Forcing doctors to administer practices that go against their better judgement let alone their morals limits their ability to give the kind of care they would like to see in their own practices. Is not protecting the rights of the minority just as important as the majority? My doctor would not perform a circumcision on my child because of his own beliefs but does this mean he must go to jail?! Freedom of conscience for physicians is imperative. Please consider this carefully.
Thank you.
As the brother of a practicing physician, I have had many discussions about the proposed Euthanasia laws. I am opposed to any law that forces doctors to either perform a mercy killing or forces them to refer their patient to a sympathetic doctor. This goes against the very moral fabric of most doctors. “Do No Harm”.
Dear Sir/Madam:
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> I have read the draft policy:
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> Rights of Conscience and Freedom
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> and disagree.
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> A member of the Canadian public who is very concerned with your DRAFT!
I wish to express my deep concern regarding changes to the human rights policy for Ontario physicians. Changes that would require physicians to refer in cases of moral and ethical objections to medical treatments requested by a patient violates physician rights to hold moral and ethical positions.
As a patient I want to be treated by a physician who has a conscience and is free to practice medicine guided by that conscience. I object to the notion that a physician must refer-this makes the physician complicit in a morally objectionable act and compromises integrity at the deepest level. I do not wish to live in a country where physicians must leave their conscience at the office door.
Physicians must be free to practice the principle of “do no harm”. This underlying principle is of first importance and coercing physicians to abandon this principle will cause harm to both physicians and patients.
Hi,
The more I think about the Supreme Court of Canada decision to legalize assisted suicide I realize it has far reaching effects and I also believe the majority of Canadians will not agree with this ruling but now can do very little to prevent its incorporation into law.
This ruling will cut across many Canadians moral and religious beliefs, including Health Care Professionals. I also believe, as has been proven in other countries who have adopted this law, that it will be abused and the weakest of our society will be on the butt end and the Supreme Court of Canada will not be able to prevent or stop this abuse. The Supreme Court of Canada has made a decision they cannot guarantee will be respected.
Assisted suicide is said to be a human right to end one’s life deliberately. I strongly disagree that assisted suicide has any bearing on human rights. I do believe if a person wants to commit suicide then that is their personal decision that you really cannot take away from them, however under normal circumstances people will try to persuade a person otherwise.
I also believe that assisted suicide should not become part of our National Health System. Our National Health System is dedicated to helping to overcome illnesses in order to improve health and quality of life. Our health system is staffed by people who chose Health Care for a career in order to help and save lives; you might say it is their vocation rather than their career. We must not expect people dedicated to saving lives to deliberately end lives as this is totally contrary to who they are as a person and the reason they entered the Health Care System.
To insist Health Care Professionals should be responsible to assist people wishing to commit suicide by making it law is totally unjust and against their human rights. Enforcing anyone to end a human life or to assist in deliberately ending a human life is so wrong, wrong, wrong. I simply cannot believe the Supreme Court of Canada made this ruling. By all means make a law legalizing assisted suicide but why pin the responsibility on Physicians; I can only see such a hue and cry with the result many Physicians will resign along with other Health Care Professionals. If you think we currently have a shortage of Health Care Professionals just wait and see what is around the corner. Already too many go south.
If Canada insists on legalizing assisted suicide then the Federal Government should provide separate facilities (clinics) where this can take place in a controlled manner and which will be staffed by suitable trained people (it does not have to be a physician) who will have no moral and/or religious issues about assisting people to commit suicide. For me the only way to try and prevent abuse of this law is to limit people’s access to this service by creating dedicated facilities (clinics) where all of the necessary criteria must be established before assisted suicide can takes place.
Also I do not believe the costs associated with assisted suicide should be incorporated into the National Health Budget. Assisted suicide by its very nature has nothing to do with ‘Health Care’.
I also believe that assisted suicide should not be at the expense of the general public i.e. paid by tax dollars. Why should Canadians who will be against this law on grounds of it being morally wrong and against their religious beliefs have to abet assisted suicide by financing it? Assisted suicide should be treated similarly to Funerals, you die you pay.
I have many concerns with the proposed “Professional Obligations and Human Rights” proposed policy. I will list them in no particular order of priority, but more as they flow from following the document.
In the first paragraph, the fiduciary duty to work in the patients best interests is stated and then compared to equal access to other services. The assumption is that everyone has equal access to all services. This is wrong practically and in reality. For example, anyone living in a rural area can tell you they do not have equal access to services. This is accepted because the government cannot provide them practically and those living in rural areas are expected to accept it because of their choice to live rurally. This is not a human rights issue, it is a choice issue, respected by both government policy and those making the choice to live rurally. In a similar way, a patient cannot expect all physicians to deliver all services and if they wish certain services they should seek out a physician offering the services, rather than demanding them based on a false sense or interpretation of the notion of equal access.
It is true that most physicians wish to work in their patients’ best interests. This is part of the “do no harm” directive. Practically, however, “best interests” is not easily defined. For example, from a medical standpoint, for a Jehovah Witness patient who suffers a massive GI bleed, the best interest of that patient is a blood transfusion, but we do not force the patient to do so as we respect their autonomy and moral beliefs. This policy, however, would violate that same principle for physicians. The CPSO can not endorse a policy that is hypocritical in the direction it gives physicians.
The policy states we must respect the rights, autonomy, dignity and diversity of all patients or those seeking to be patients. The necessary corollary for any such argument is that those same conditions apply to the physician. If they do not, there is not an equal relationship morally. Again, the CPSO can not endorse a policy that respects and demands the moral rights of patients without extending the same level of respect to its members.
The policy goes on to state its purpose is to eliminate barriers that may exist due to the physicians personal beliefs and values. Again, there is a necessary corollary that the barrier may be a result of the patient’s personal beliefs and values. How can the CPSO or any agency dictate whose personal beliefs and values have precedence. It is an untenable stance if equality is the basis of the policy. Further, there must be evidence that barriers actually exist and no proof is offered, only an assertion that they may exist. It is inappropriate to create a policy that limits physicians rights based on a “maybe”.
The policy goes on to state that the key values of professionalism include compassion, service, altruism and trustworthiness. None of these exist outside a moral framework. The CPSO cannot demand that its members embody and embrace morality and then declare that it has no importance or value when their moral choices differs from the patients. Morality is either important or it is not. True morality cannot be turned on and off. It either is or it is not.
In bullet number 3, the discussion is made of conflict of moral values or beliefs and that the patient’s best interests must be paramount. That statement is wonderful if there is a standard for “best interests”. Best interests cannot be defined individually which this could be interpreted to mean. For example, if a patient believes female circumcision is in the best interest of his daughter in his/her culture and moral code, does that mean we have to assent? The obvious answer is no, as we as Canadians draw a line based on our own moral code. Why are physicians being denied this right that we as a nation have no problem asserting and enforcing. Why as physicians should we not be able to make moral choices based on our view of best interests even if they are in conflict with the patients view of their best interests. Further, when it comes to medical decisions, we by virtue of training and expectation, do and should have a better concept of “best interest” devoid of moral sway on either side. We are able to do as the CPSO asserts we should do which is “protect the public” by doing what is best.
In reference to the Human Rights Code and the need for all agencies or individuals to honor it, even the code does allow discrimination on the very criteria it embodies based on best interest. For example, there is supposed to be no discrimination based on age, but underage adults will not be served alcohol as society has deemed that to be correct. These rights and criteria are not universal. As is noted later in the policy, the Canadian Charter does allow for restrictions, but they must be reasonable and just. I do not think the proposed CPSO policy of negating physician rights carte blanche when they conflict with patient’s beliefs would be seen as embodying that.
There is also a problem with the notion that clinical competence means members must offer services, even if they find them morally repugnant. For example, all OB/GYN have the clinical competence to perform D & C. Under this new policy it could be interpreted that all OB/GYN perform abortions as they cannot claim they lack the skills. This would be a dangerous precedent to set for the safety of Ontarian residents as there could be potentially a mass exodus of OB/GYN as they would not wish to practice in an environment that violates their moral code. Similarly, any licensed MD could administer a lethal dose of medications should euthanasia be legalized. Again, what would happen to Ontario if every MD who found euthanasia morally wrong either had their license removed by the CPSO or resigned. This policy would suddenly create a doctor shortage based on the conflict of moral values and not competence. We live in a real world and the potential far reaching consequences of this policy cannot be ignored.
There is also an error in assuming a right is the same as a moral code. A moral code exists regardless of the rights granted to it. Martyrs for any belief system illustrate what occurs when rights (or a lack thereof) come into conflict with a personal moral code. Neither the CPSO nor any regulatory body can legislate a moral code away. If the CPSO wishes to try to limit the exercise of a moral code or belief system it must also weigh carefully the risk/benefit ratio of its actions. Strictly speaking, society has achieved most of its benefits from an observance of moral codes. The anti-slavery, anti-child labor and suffragette movement, for example, have all been championed by people with a high moral view that was in opposition to the perceived best interests of society at that time. The CPSO would be in error to believe that the we would be protecting the public and guiding the profession by demanding physicians be functionally amoral in their practice. One cannot divorce the practice from the practitioner and expect to get the same result of professionalism.
Lastly, the final words of the policy are a minefield because they lack any definition and are so open to broad interpretation. Can the CPSO accurately define any “care that is urgent or otherwise necessary to prevent imminent harm, suffering and/or deterioration” that has a moral basis. Certainly, there are medical interventions that can be defined so personally, but not universally. For example, how does one quantify “suffering”. It is subjective not objective. Any member can testify of how different patients react to same diagnosis or problem in vastly different ways. Likewise is deterioration to be objective or subjective or based on some as yet to be determined external standard. Consider the cancer patient in an era where euthanasia exists. Who defines deterioration and hopeless intervention from depression or delusion or undue influence from an external party? The phrase is fraught with more possible misinterpretations than direction. It also totally ignores our professionalism and training to do what is in the “best interests” of the patient when their very suffering or deterioration or fear of hurt (mistaken as harm) clouds their decision making. I am not saying we get the final say, but it also wrong to say we have no say. If we don’t, then we are ignoring the CPSO policy to protect the public.
In total, I can only say the proposed policy is fatally flawed on many levels and needs to be restarted from scratch. Any policy must respect the rights and moral values of physicians and patients equally. We offer health care services, not a ethic- neutral commodity which is the case with most other government agencies under the “Code”. We have to have our own policy that reflects the unique relationship that exists between patient and physician. That relationship exists because of a moral code not in the absence of one. Trust cannot exist in the absence of moral code or belief system. Trust is the basis of our patient/physician relationship. We need to work within this system to ensure unjust discrimination is removed, but this must be differentiated from the good practice of discriminating between want and need, choice and right, and equal respect for all participants in the decision making process.
To all Physicians,
These words modified from a letter from the Coalition for the Prevention of Assisted Suicide echo my concerns for our right to live.
Will our lives be safe if our physician is lethally injecting or prescribing a lethal dose to his/her patients?
When we are going through a difficult situation, how will we feel if our physician is urging us to die?
At the annual Canadian Medical Association (CMA) meeting, many physicians urged the CMA to protect conscience rights with respect to euthanasia and assisted suicide. Will the CMA intervene to protect conscience rights?
Conscience rights for physicians enable us to choose a physician who will not pressure us to death.
The appeal of the Bentley “feeding” case will be heard on Wednesday, Feb 11. The case concerns Margot Bentley, who is being fed by spoon and who drinks with a cup, and who lives with dementia. Last year, a British Columbia court decided that normal feeding is not medical treatment but is basic personal care. The Bentley family are asking the appeal court to order that feeding be stopped and that Margot die by dehydration.
Please speak out against this insanity. Do you wish to be coerced into providing “legal services” to every patient, even when the physician conscientiously objects?
To Whom it may concern:
I’ve always worked as a nurse on health care teams that respect diversity. If I were assigned to a patient whose medication or procedure I couldn’t provide for reasons of conscience, I would continue to provide nursing care for her, and alert my team that I couldn’t provide the treatment as soon as the ethical dilemma arose. I would not make an “effective referral” to a colleague.
The CPSO draft “Professional Obligations and Human Rights” does not acknowledge the moral equivalence of performing and referring for a procedure that violates a physician’s conscience. Instead, it proposes that doctors with values like mine face disciplinary measures if they do not refer. Like the Carter decision, the CPSO draft places higher priority on patient autonomy than it does on the principle of respect for a person’s life.
The requirement for “effective referral” is intended to provide patients with timely access to procedures, but I think coercing physicians to act against conscience places patients at risk. We need health care providers who think clearly, free of intimidation, because their attention to ethical dilemmas protects patients. I trust my health care providers to base their care on ethical decision-making as much as I value their compassion and expertise.
In my specialty of mental health, a patient’s desire for death can be overwhelming. My role is to hold hope and maintain safety until the person responds to treatment, instead of acting on his expressed desire to end his suffering. I am aware of having saved at least one person’s life by not endorsing his autonomous decision that life was not worth living.
The absence of legal constraints against life-ending procedures normalizes them for health care teams over time. When the ethical dilemma over terminating the life of patients seems “settled”, individual responsibility for ethical reasoning is all the more important. That’s why I’ve written to object to the proposal that requires doctors to make “effective referrals” for treatment that they can’t provide for reasons of conscience.
Thank you for the opportunity to provide feedback. To answer your questions:
1) Does the draft policy provide useful guidance?
Not if a patient claims to be a dieffenbachia or a cat, or perfect. There are many cases where a physician might have to politely humour someone’s self-perception, but they will still have to treat them according to what they are. The moral and religious beliefs referred to include, for some physicians, adultery, fornication, and lying, and for most physicians, murder, theft, and kidnapping. None of those are on the agenda, nor are they likely to come up during a visit to the doctor.
2) Are there any issues not included in the draft policy that should be addressed?
Plant and animal identity, and delusions of deity.
The supreme court’s decision that no rights are absolute. The point is valid when referring to Middle Ages crusades, or shooting unarmed soldiers at monuments, or Jack the Ripper. But in this case it needs to be qualified:
“The supreme court has determined” doesn’t mean they’re right. They once determined that a baby in the womb is not a person.
“No rights are absolute” must include human rights, or the statement is nonsense. If not, we must conclude that, a) some rights are absolute, b) there is some variable scale of absoluteness, or c) all rights are absolute. If some or a scale, we must then decide whose or which rights are more rightful than others, and on what grounds. If all, we must then include individual conscience rights of all, including physicians.
The College is addressing physicians regarding their personal values and beliefs, so address patients likewise. The College expects physicians to respect the fundamental rights of patients, so expect patients to respect the fundamental rights of physicians. Protect physicians as much as they are being protected against. Treat respect with the same absoluteness as rights.
3) Are there other ways in which the draft policy should be improved?
Recognize that “best interests” doesn’t mean giving everyone everything they want just because they want it, that sometimes it means denying subjective wants in the face of real needs. Otherwise the health care system will become a servant to emotional preferences.
Allow a physician to refuse or delay treatment because he believes the patient’s own actions have contributed to their condition. If someone does something stupid and gets hurt, he should have to wait until others are treated first, emergencies excepted. If a smoker goes to emergency with symptoms directly related to his smoking, he should be sent home to quit first. Physicians have an obligation to the healthcare system and taxpayers, too. If the system is being abused the abuse needs to be stopped, and physicians are in a good position to do it.
Recognize that when a physician limits services for moral or religious reasons, they are promoting their beliefs to a degree. Recognize that some faiths include the duty to tell others, which is included in the general right of freedom. Recognize that a physician’s office is part of the public square where open dialogue and exchange of ideas are fundamental to a free society, public funding notwithstanding. If people don’t like the conversation they will vote with their feet. If the physician deserves that, he’ll get it.
Recognize that to impose a restriction on the expression of moral conviction is itself expressing a moral conviction. Give the same respect you expect.
Recognize that as a professional association, the College may have an obligation to maintain a uniform standard of medical care through a uniform standard of competence, but it has no right to infringe on the keeping, practice, or expression of morals, conscience, or religion. Neither does it have an obligation to be a cultural toady.
It is my firm belief that no doctor should be forced under the law to perform an act which goes against his/her conscience or ethical beliefs. Nor do I agree that they should have to refer a patient to someone else to carry out a procedure which they will not, in conscience, carry out.
Having seen notices posted in Doctors’ offices with regard to unavailable services, I believe that a physician should have the right to post this notice as well, thus eliminating the need to refer. Perhaps a publicly available roster of Doctors willing to assist could be made available on-line.
Thank you for asking for physicians for their input on the draft policy on Professional Obligations and Human Rights. I agree with much of the spirit of the document and that no doctor should ever discriminate against a patient or judge a patient’s choices based on that doctor’s personal beliefs, and I have strived to provide care with this ideal in mind my entire career. However regarding the areas in which I disagree with the draft policy, my input is as follows.
The following sections need to be revised, as they would force some doctors to choose between acting against their conscience by mandatory referrals for life ending treatments, and losing their livelihood. This is a choice that no jurisdiction in the free world currently forces their doctors to make.
Lines 129-135
The draft policy states that the patient’s right of access to abortion or, if legalized, physician assisted suicide supersedes the physician’s right to freedom of conscience (ie. refuse to facilitate access to abortion or euthanasia). This contradicts The Canadian Charter of Rights and Freedoms which applies to everyone.
The Canadian Charter of Rights and Freedoms guarantees that;
“2. Everyone has the following fundamental freedoms:
(a) freedom of conscience”
In Ontario, patients can get abortions without a physician referral. To date, no case has been made in Ontario that a patient who wanted an abortion was not able to get one. Therefore, the draft policy, which violates The Charter is redundant in this situation.
Lines 139 and 146
The above lines are vague and contradict one another. How does a physician ‘communicate an objection directly and with sensitivity’ without being accused of ‘promoting religious belief’? This should be removed to prevent unnecessary and unwarranted accusations against physicians.
Lines 152-169
The lines above forces the physicians to act against their calling to save, preserve and protect life making them an accessory to abortion or, if legalized, assisted suicide and will violate the physician’s rights under The Charter if they object to it on the basis of conscience. For a physician to use their skills to take human life violates the Hippocratic Oath which many doctors have taken at graduation and aspire to for their careers.
“…Nor shall any man’s entreaty prevail upon me to administer poison to anyone; neither will I counsel any man to do so. Moreover, I will get no sort of medicine to any pregnant woman, with a view to destroy the child.”
- excerpt from the Hippocratic Oath
The draft policy, as it stands, doesn’t acknowledge the physician’s right to freedom of conscience. Therefore, please revise the draft policy.
I was born and raised in Malaysia, once a very tolerant land. This was Malaysia’s greatest asset and helped unify its diverse multiethnic (Malays, Chinese and Indians) and multi-faith (Muslim, Buddhist, Taoist, Hindu, Sikh and Christian) population and built it into an emerging power in Southeast Asia, but the past 3 decades have seen the erosion of this tolerance and with it free speech and diversity. Canadians are known the world over for their tolerance. This is one of the major reasons I have chosen to call Canada my home. This draft policy 1) fails to acknowledge the strength that diversity confers upon its physicians in caring for Ontario’s equally diverse patient population, and 2) in forcing doctors to act against their conscience is intolerant, something distinctly un-Canadian (see The Charter). In its current form, this policy will reduce the diversity of Ontario’s doctors and thereby weaken the quality of care to Ontario’s diverse patients; and I would invite anyone who thinks otherwise to visit St Michael’s Hospital and its ethnically diverse group of physicians.
If this draft policy becomes finalized as policy and I am faced with this decision, I will still choose to exercise my right to freedom of conscience and bear the consequences.
I wish to first highlight that the policy fairly and clearly addresses discrimination.
I have very serious concerns, however, about the sections on “Limiting Health Services For Legitimate Reasons.” It is vague, too broad, and open to abuse – so much so that it seems it is deliberately so and not drafted in good faith but as a thinly-veiled attempt to allow particular interest groups or political factions to force their will on the rest of the profession and the public.
Consider the line:
“Where physicians choose to limit the health services they provide for moral or religious reasons, this may impede access to care resulting in a violation of patient rights…”
While this is true, there is not clear recognition of proportionality of competing rights, nor in the reality of how much it “impedes access to care.” This draws to mind a recent media firestorm about the tiny minority of Calgary physicians who would not prescribe certain contraceptives – and were thus “impeding access.” In this case it was widely viewed that needing to go (literally) around the corner to one of the other 99.9% of physicians is “impeding access.” If this is the case, then no physician can refuse to provide any procedure.
While the college of physicians would not have been prone to such a vitriolic and reactive interpretation as the media and vocal members of the public, the pressure of the media and public on these decisions and on legal proceedings is not nil. Clear policy is required to support decisions.
Another vague line, open to abuse:
Physicians must provide care that is urgent or otherwise necessary to prevent imminent harm, suffering, and/or deterioration, even where that care conflicts with their religious or moral beliefs.
What exactly constitutes “imminent suffering, and/or deterioration”? Consider a patient seeking assisted suicide because they are either suffering or deteriorating. Could the argument not be made, based on the quotation above, that the physician must provide “care”? There is no recognition or definition of proportionality here. Does someone suffering (however broadly that can be interpreted) for an extra week while they find another physician override the physician’s conscience rights on something as serious as not killing. What about a one month wait? One year? Nor is the proportionality of the conscience objection considered either. One physician refuses to perform a blood transfusion that is urgently needed on grounds of “integrity of body”. Another physician refuses to assist with the suicide a patient suffering from depression on grounds of “not killing”. Where is the distinction between the severity and proportionality of these cases?
The biggest problem with the policy is very clearly stated, however:
Where physicians are unwilling to provide certain elements of care due to their moral or religious beliefs, an effective referral to another health care provider must be provided to the patient.
Did anyone even consult an ethicist about this one? There is a clear and grievously faulty assumption here that referral for a morally objectionable procedure somehow removes the physician from ethical responsibility. Consider the following analogous situations:
* A pharmacist refuses to give morphine to a begging addict, but she makes arrangements for the person to contact an illegal opiate dealer.
* A man refuses to murder an enemy of his friend, but agrees to put him in contact with an assassin.
* An uncle refuses to help his nephew burn a mosque, but tells him that there are cans of gasoline is in the backyard shed.
Are any of these people ethically removed from the action?
If it is wrong to kill someone, it is wrong to make arrangements for someone else to kill them. Although many elements of society (including the law) do not object to killing a person if they want to die, or have not yet been born, that does not remove the immense moral/ethical weight of the killing from those who do not agree with the present legal situation.
Unless a physician’s refusal makes it impossible for a person to access a legally acceptable and effective procedure, there should be major responsibility to prove that the physician’s serious (ie. killing) objections should be overridden – not the other way around. This also needs to recognize that referral is complicity.
Thank you for opening this up for public feedback and I hope my assessment is considered.
I am writing to support the decision of the Arch Diocese of Toronto to oppose the proposed draft conscience policy for the College of Physicians and Surgeons of Ontario.
The policy states that physicians who refuse to perform a procedure to which they morally object must arrange that the procedure gets done by someone else. There are many cultural situations which affect an understanding of morality and putting a policy like this in place could result in many undesired consequences whether it be forced suicide under pressure, euthanasia, female circumcision or any other number of medical processes. We live in a complex society where norms are fading and the complexity of understanding what is truly right is becoming a grey area at best with the balance between reason and emotions being lost.
Catholic moral teaching particularly in the hospital environment has always called for looking at the whole picture facing a person and a family including economic circumstances, understanding family relationships and the impact that a decision would have not just on the individual but on the greater community. Our society has put in place life saving and life giving opportunities for people, called for pain management and dying with dignity among other areas in the Western culture. However, opening up a policy such as this one, could lead to consequences that cannot be forseen for those in a vulnerable position, feeling the pressure of being a burden on others or simply not understanding the implications of the consequences of their decisions in complex cases where they do not have the education or information provided to them to consider the emotional and practical matters at hand. Some people may not be of sound mind and simply agree to the decision out of pressure to end their life and indicate to their physicians that they know what they are doing. With migrants coming to Canada, the aged and a multi-cultural society, I stand with the Church and ask that this policy and the decision for assisted suicide be re-considered.
We put animals to sleep or to death when their pain becomes unbearable, however, an animal can only express it’s needs in non verbal ways and in our care for them, we make the decision for them. By a similar token, those facing death or dying may not fully understand the options available to them. Many people come out of a coma after many years. While there is no proof that this is because of or not because of the care given to them, there is a mystery to the human spirit that needs to be considered. I recently read of a man who came out of a coma and he had heard all the nasty things his mother had said to him while he was in the coma, yet he survived. To me, this policy is similar to saying if you can’t beat them, join them in crimes committed against humanity or other complex situations. Taken at face value it may inflict more harm than good. In the Western world many people are alone, many people are single and the community aspect is found in ways that are not traditional which again makes this situation very complex in terms of understanding how a decision is reached by a person, through the influence of others or alone. I am a Roman Catholic and I think that there is enough scope and freedom within the systems available not to have to encourage suicide and a culture of death and hurting others and yourself, as a right.
Life is a gift. The physicians oath is do no harm. The original oath was not to give poison, harm women when in their homes and to offer due care through passing on knowledge to the next generation.
This policy is going to shape the minds and hearts of the young to come and one day we all will face death or procedures that could result in death including heart surgery or any other number of situations. It opens up physicians to being sued for refusing to offer a referral and being sued if something goes wrong and they perform act the patient asked for. We trust our doctors to do what is best for us in their expert opinion, balanced with our needs as patients, and this is an important change to the way medicine will be done.
I urge you not to put physicians in a place where they are forced to go against their conscience, where they may be pressure to conform that is unbearable and to consider what is truly best for the patient and for our society in the long run.
Thank you for your efforts to ensure that healthcare in Ontario is provided free from discrimination in a manner that best serves patient interests. I do, however, have a number of concerns with the proposed policy “Professional Obligations and Human Rights” that I hope you will consider.
1. Rights: The policy acknowledges the Charter right to freedom of conscience and religion as well as highlighting situations in which such rights may be limited. It then summarizes factors that may be considered in balancing competing rights, citing the Syndicat Northcrest vs. Amselem case in which the Supreme Court ruled that the religious right of a group of Orthodox Jews to build succahs on their apartment balconies outweighed the property and personal security rights of the building owners that would be infringed upon through such a practice. I would argue that the physician rights being infringed upon by the proposed CPSO policy significantly outweigh any patient rights that may be compromised. The act of referring for and/or performing a health service that is contrary to a physician’s moral or religious beliefs, including procedures that involve the ending of life and thus violate some of the most important moral or religious precepts an individual may hold true, is no trivial matter. In contrast, such services can relatively easily be made available by self-referral for patients that desire them, thereby avoiding any compromise to the integrity and wellbeing of physicians without interfering with patient access to care. Good patient care depends upon the maintenance of such integrity and wellbeing as apart from it physician function is impaired and societal needs disserved. I don’t have a legal background, but I am not aware of any legal precedent in Canada that would directly suggest that a physician is obligated to refer for and/or provide a health service against good conscience (please let me know if I am incorrect). To the contrary, my understanding is that the Supreme Court of Canada has recently upheld the right of individual physicians to choose not to participate in physician assisted death once it is legalized. It is inappropriate and I believe harmful to both the medical profession and more importantly patient care for the CPSO to create this unnecessary policy that if anything directly contradicts the ruling of the country’s highest court. It is an insult to the rule of law. Were such a policy nonetheless adopted by council, I would certainly be interested in contributing to a legal challenge against it.
2. Discrimination: A physician who chooses not to provide a particular health service to all of their current or prospective patients is not being discriminatory in even an indirect and unintentional manner. In contrast, the proposed CPSO policy specifically discriminates against physicians with particular moral or religious beliefs and limits its scope by requiring that physicians abstain from promoting religious beliefs without addressing any other potentially inappropriate non-religious beliefs that a physician might promote in the course of their practice. I consider this an affront to the pluralism and tolerance that our society values.
3. Service: If I understand it correctly, the objective of this policy is to establish CPSO expectations that will ultimately facilitate patient access to care and choice in Ontario. I would suggest, however, that it may in fact have the opposite effect. In particular, I have noticed several postings on the public form expressing concerns about physicians re-locating or otherwise changing their practice if the new policy were adopted. As a first year family medicine resident who has completed all of his medical education in Ontario, I feel indebted to this great province and would prefer to remain here to practice. If, however, the CPSO were to require referral and in some cases provision of health services that violate my ethical principles, this may affect my career decision making and would provide reason to consider practicing in another jurisdiction. Furthermore, I am interested in completing a care of the elderly fellowship and focusing part of my practice on geriatric patients, but would be discouraged from doing so if I were not confident that I would be exempt from having to refer select patients at the end of life for physician assisted death. I know a number of other like-minded medical trainees and physicians, and although we remain a minority, the influence this policy could have on our practice decisions nonetheless may impact negatively on patient care access. In particular, it may restrict access to such physicians by patients with similar values who prefer to receive services from healthcare providers who better understand their belief systems.
Thank you very much for your consideration of these points. I hope that they will be helpful to you in revising the proposed policy in such a manner as to optimize patient care in Ontario.
Peoples Christian Academy Freedom of conscience is entrenched in the Canadian Charter of Rights and Freedoms. Your declaration is clearly an abrogation of physicians’ rights and freedoms. It is heavy-handed and prejudicial to deem matters of conscience on the part of professional doctors to be invalid.
A key point of the Nuremburg trials of Nazis was whether or not they followed their conscience or obeyed immoral orders. We cannot force our doctors to go against their conscience. It is, as the draft policy re-iterates, their professional duty to act in the patient’s best interests, and this includes refusing to perform or enable medical procedures which actively cause death, such as abortion and euthanasia. They can refuse such requests in a way that respects the patient’s dignity, as when a parent has to refuse their child what they are asking for out of a greater love for their well-being. Refusing to perform any medical operation which they judge harmful must remain a conscience right of the doctor, otherwise we might as well create soulless robots to do our medicine!
I don’t weigh-in on a lot of issues b/c it often seems fruitless or after the fact.
However, I am glad of this opportunity to add my voice to this discussion – thanks for that.
I hope that a policy such as this will NOT go into effect. It de-humanizes the very people that we are asking to care for us, sometimes when we are in the darkest time of our life.
You can’t legislate morality. People will just stop becoming doctors or finding other ways around the new rules. Why make them spend their time with that instead of working with patients? We are building a culture where people are afraid to speak up about their beliefs b/c they will be harmed in some way (i.e. in this case, unable to make a living in their chosen profession).
Do we have so many doctors that we should winnow the field like this? I think not.
to even have to refer a patient for euthanasia makes one party to the procedure which is not a medical one. If there is to be euthanasia then a new professional will need to be trained – an exterminator or terminator. As one who has subscribed to the Hippocratic Oath, I cannot be involved with euthanasia in any way, shape or form. None of this detracts from the suffering of some terminal people, but don’t dump the elimination on doctors. We are not trained for this.
I may be a “member of the public” but I worked as an RN for 50 yrs. Isn’t part of the Hippocratic Oath “first do no harm”? What more harm can one do to a patient then to help them to die? Someone has written that the number of applicants to the number of medial training spots far outnumber those spots and therefore we shouldn’t worry about the scarcity of physicians…..where are they? There are many that are without a treating physician for day to day care let alone something as extraordinary as telling a TREATING physician how they MUST perform in their practise regardless of their faith or conscience!! I agree that the College has overstepped its bounds. Those who are seeking such procedures as “end of life” have found their own way in the past and they should be allowed to continue to do so. By telling a treating physician that they should refer for a procedure they find morally incomprehensible is the same as doing it yourself. The psychological affects of doing so would undoubtedly create a physician who would probably end up not being able to function effectivley in their day to day practise! I do know whereof I speak as I had a brother-in-law die naturally of ALS!
My concern is the definition of urgent or more especially emergent, neither of which I can easily envisage when the Supreme Court decision seems to specify that our patient must be of sound mind and a time interval must be recognized. I should be much relieved if the College would
identify exactly what is meant so that a physician would have adequate time to refer to a receptive colleague, a list
of whom should be published by our College.
Thank you for letting us comment on this policy. A physician should never be compelled to act against traditional conscience decisions, this goes against Charter and human rights. A physician should not be discriminated for refusing to provide or perform some procedures such as abortion or euthanasia.
To the College of Physicians and Surgeons of Ontario:
In response to the draft policy on Professional Obligations and Human Rights, I have serious concerns about the proposed restrictions on physicians’ conscience rights and the obligation to provide referrals for procedures that they believe would be harmful to their patients and violate their moral or religious beliefs.
Declining to participate in a practice contrary to one’s conscience is an act of integrity, which we as patients rightly expect of the medical profession. Physicians are not obliged to provide a service merely because it is permitted by law. Slavery was once permitted by law in some jurisdictions. Such an obligation would reduce physicians from professionals into robots whose good in a given situation is determined by persons other than themselves, who have no medical qualifications. No one, including physicians, must be treated as a means rather than as an end.
Canada’s Charter of Rights and Freedoms guarantees freedom of conscience and religion. Over-riding this fundamental right is certainly not “required by professional practice and human rights legislation”. Freedom of conscience is a fundamental freedom. It is consistent with the Ontario Human Rights Code.
Compelling physicians to “check their personal views at the door” is contrary to the goal of ensuring the best quality care for patients. It threatens physicians’ independence from political interference in their professional judgement. Patients who share their vision of the human person may have difficulty finding medical care that addresses their needs if physicians who cannot in good conscience comply with the policy are forced to leave the medical profession in Ontario. This would also exacerbate the shortage of physicians in rural Ontario by reducing the pool of available doctors.
By attempting to impose policies on ethics for which there is no moral consensus, the CPSO is acting outside of its legal mandate and impeding the ability of physicians to to act in the best medical interests of their patients. Physicians need to uphold their promise to “Do No Harm. By providing referrals for procedures they believe will be harmful, physicians would be contributing to that harm.
In taking the position that doctors need to leave their ethics at the door, the CPSO is abdicating its duty to protect the public interest.
I wish to express my deep concern regarding changes to the human rights policy for Ontario physicians. Changes that would require physicians to refer in cases of moral and ethical objections to medical treatments requested by a patient violates physician rights to hold moral and ethical positions.
As a patient I want to be treated by a physician who has a conscience and is free to practice medicine guided by that conscience. I object to the notion that a physician must refer-this makes the physician complicit in a morally objectionable act and compromises integrity at the deepest level. I do not wish to live in a country where physicians must leave their conscience at the office door. Physicians need to have the same protection of conscience that every Canadian is entitled to.
Physicians must be free to practice the principle of “do no harm”. This underlying principle is of first importance and coercing physicians to abandon this principle will cause harm to both physicians and patients.
I’m alarmed that you are drafing a new document restricting physicians’ rights and freedoms by way of “Where physicians are unwilling to provide certain elements of care due to their moral or religious beliefs, an effective referral to another health care provider must be provided to the patient.” Asking a physician to refer to someone who will act contrary to the physicians’ beliefs is, in fact, making them complicit in the act. I’m so concerned with where this is taking us with regard to the future of Canadians and a reverence and dignity for human life.
It never ceases to amaze me that all those who are so concerned with their rights are so willing to deny others the same consideration, I am sure there are enough Drs. willing to assist these patients without treading on another person right to refuse on grounds of conscience or religious belief, In the not to distant past state sanctioned killing of the infirm or mentally handicapped was carried and in some places still is. I implore you to give such a policy deep and respectful consideration. Such questions as who makes the final decision must be covered and strict guidelines in place. However forcing someone to perform and action that is abhorrent or against their beliefs is unconscionable.
There are few issues more important than the dignity of human life and also of the need to respect conscience. It is crucial that laws and policies respect the dignity of physicians’ consciences. If a doctor is morally opposed to a procedure, forcing him to then refer a patient to receive that procedure violates his conscience.
This is not only morality, but basic common sense. Let us be truly just and sincere.
I would like to state that I reject the proposed “effective referral” mandate in the draft dealing with physician assisted suicide. This “effective referral” compels a physician to violate his/her own conscience by being a participant in the very act, the very procedure, which he or she objects to in the first place.
Freedom of conscience and religion are guaranteed by the constitution and must be respected and upheld. I deeply believe this and urge your appropriate action.
Please accept my opposition to the proposal mandating that the physicians of Ontario violate their conscience by formal cooperation. The proposal to force people to violate their fundamental moral and religious beliefs seems to me to be anti-human right, anti-democratic, anti- freedom, against the Charter of Rights and UnCanadian. Please rethink this.
As Roman Catholics we are very much against Euthanasia.
Euthanasia is nothing more than legalized murder by those who perform this procedure and legally permitting a patient to commit suicide.
Murder in the judicial system is a crime and punishable by law. Assisting a person to die is also murder. It is a mortal sin to take another human beings life or to take ones own life.
Therefore, in the eyes of the law and in the beliefs of a Christian EUTHANASIA IS WRONG!
Do not allow a bill to take ones life into ones hands be passed.
We want to be served by doctors with moral integrity!
Physicians should have the right to say NO to providing certain forms of treatment. However, I’m particularly concerned with the requirement that physicians provide referrals for treatments which they feel are morally and ethically wrong.
If a physician feels a treatment is morally and ethically wrong, and then aren’t they still violating their conscience by asking someone else to perform the procedure? How is the physician’s right to freedom of conscience being protected under these circumstances? In addition to this, a physician might feel that if a procedure is morally wrong it would also be harmful to the patient. Under these circumstances the physician would be violating not only their conscience, but also their Hippocratic Oath by referring the patient to someone else to perform the procedure.
[**MESSAGE FROM ADMINISTRATOR: DURING THE CONSULTATION PERIOD, WE RECEIVED 3 RESPONSES FROM INDIVIDUAL RESPONDENTS CONTAINING THE CONTENT PUBLISHED ABOVE. ALTHOUGH THIS FEEDBACK HAS NOT BEEN PUBLISHED IN DUPLICATE, THE COLLEGE ACKNOWLEDGES RECEIPT OF THESE SUBMISSIONS.**]
I object to your draft policy because the mandate for an effective referral is a violation of a physicians rights, as it compels the physician to violate his or her own conscience by being a participant In the very act, the very procedure to which he or she objected to in the first place.
Aren’t physicians supposed to try to save lives? We are entering a slippery slope with physician-assisted death. Evidence has shown, even with so-called safeguards , mistakes occur.
We wish to express our disappointment with the CPSO of ontario for attempting to force doctors to violate their moral conscience in providing treatment and effective referral to patients which runs contrary to their moral and religious beliefs. By referring , one becomes a participant in the act. Surely you people must be aware of this! This is a blatant violation of the Charter of Rights and Freedoms.
Physicians should have the right to say no to providing certain forms of treatment. However, I’m particularly concerned with the requirement that physicians provide referrals for treatments which they feel are morally and ethically wrong. If a physician feels a treatment is morally and ethically wrong, then aren’t they still violating their conscience by asking someone else to perform the procedure? How is the physician’s right to freedom of conscience being protected under these circumstances? In addition to this, a physician might feel that if a procedure is morally wrong it would also be harmful to the patient. Under these circumstances the physician would be violating not only their conscience but also their hippocratic oath by referring the patient to someone else to perform the procedure.
Freedom is inclusive not exclusive, it’s right to agree or disagree. This is what makes this country great.
I’m writing to voice my concern about the College of Physicians and Surgeons of Ontario proposed policies that force physicians to refer and in some cases provide treatments or perform procedures that are contrary to their personal or professional ethics and conscience. One thing I love about this country is it’s diversity. People are allowed to have varying beliefs and are not forced to act against their conscience, as opposed to communist countries and those communities where freedom – freedom of speech, religion and conscience is not respected and even penalized. In reality, this is what is happening with the policies being pushed forth by the College of Physicians and Surgeons of Ontario. Doctors either must choose to deny their conscience or are being told they are no longer welcome. This is VERY troubling.
Please reconsider. There are many physicians I hold in high esteem who have given their lives for the betterment of others. This policy will rob us all of so many excellent doctors and why? So we can further become a society that disregards the importance of respecting others who may not share our exact beliefs?
Please put an end to these appalling proposals!
I appreciate you taking the time to consider my concerns in this matter.
To Whom it May Concern,
I am strongly opposed to the Effective Referral Mandate which is being proposed to all the doctors of Ontario, for the following reasons:
1. This proposal overrides the freedom of conscience of individual doctors, namely those doctors who are against euthanasia. By being forced to refer a patient to a doctor who will meet the request for an induced death, the doctor making the referral is an accomplice to the act of euthanasia.
2. This proposal negates the Hippocratic oath taken by all doctors when they receive their license to practice medicine. This oath clearly states that they will not harm those in their care. By this action they are rendered unworthy of trust by those who may be seeking their help.
I trust that my concerns will be given serious consideration.
I am quite surprised that a doctor would be obliged to act against his or her conscience in performing or directing a person to perform a medical act that is against his moral code of saving lives vs. taking lives. Let’s be honest, access to abortion in Canada is not a problem. It is not difficult to go to an abortion clinic or find a doctor who is willing to do an abortion or give a referral. So why is there a need to threaten all doctors by pushing this ridiculous policy forward? We need doctors…let’s not push them over the border where they will be respected for their integrity to act according to their beliefs and make more money! I’m very surprised by this action by CPSO and I don’t approve of it.
It is so difficult for persons to pay the huge toll on their personal lives, finances, and the vast amount of time it takes to become a Physician. We are so privledged as a country to have such high standards for our Physicians. I think it would be wrong to now assault these same physicians by forcing them to sear their own conscious if they are so inclined, rather leave the responsibilities to those who have no objection. In short, the government needs to respect the physicians.
I deeply troubled by the draft policy regarding Professional Obligations and Human Rights. The draft seems to either ignore the human rights of the physicians or consider them to be of less value than that of patients deemed terminally ill. Surely no amount of suffering on the part of patients can justify being the cause of new mental anguish inflicted on physicians who cannot in good conscience refer patients to other physicians who are not troubled by performing
certain kinds of treatment. The consequence of disregarding the
rights of those burdened by a conscious and forcing them to act against their will, will invariably lead to a dissolution of the relationship said physicians allow to have with their patients.
I ask that you please revise sections 8, 10 and 11 of the draft for the betterment of the rights for all.
I object to the proposed “effective referral” mandate for doctors.
It is not right to insist that a doctor participate in violating their own conscience, and in participating in the death of pre-term babies and vulnerable adults. This violates the basic human right of the doctors, and the persons entrusted to them.
It makes it clear that the life of a pre-term baby, or a vulnerable adult, has no value to society, or to themselves.
As a citizen of the Province of Ontario, I am writing to you with grave concern regarding the content of your draft policy, “Professional Obligations and Human Rights”. I ask the Consultations Committee to retract this draft policy for the reasons I have outlined below.
If adopted, the draft policy will jeopardize the ability of physicians in Ontario to follow their consciences. The policy suggests that physicians who decline to participate in certain acts for reasons of conscience should be compelled to provide an effective referral to other physicians who will perform those acts. This requirement does not address the fact that many physicians find the act of referral itself to be objectionable, as it is considered material cooperation with the act. If a physician finds a certain act to be immoral, it follows that facilitating and arranging for that act to be done is also immoral. In compelling physicians to refer, you are limiting their right to freedom of conscience and freedom of religion. I would like to remind you of the fact that the very Canadian Charter of Rights and Freedoms that you cite in your draft policy protects freedom of conscience and freedom of religion. The CPSO’s draft policy inherently prioritizes the freedoms and rights of patients over that of physicians, despite the fact that the CPSO does not have the legal jurisdiction to rule on such matters. I ask that the CPSO respect our country’s constitution and recognize the importance of diversity of medical and ethical judgement.
I do not believe that physicians should discriminate against patients, and in fact believe that patient care is of the utmost priority. However, contrary to what the draft policy implies, deciding not to offer a particular service in no way discriminates against patients, provided that the service is not offered to any group at all. It is difficult to see how limiting physicians’ right to freedom of conscience and religion will result in any less discrimination. In fact, moving ahead with this policy will actually create systematic discrimination based on conscience or religious belief.
Moreover, compelling physicians to make referrals that they do not morally agree with will not improve patient care. Requiring doctors to participate in procedures that go against their beliefs will reduce their personal sense of integrity if they continue to practice. This will significantly harm the physician-patient relationship, as physicians would be recommending their patients receive procedures or medications that they do not personally believe in. If approved, this draft policy will coerce a large percentage of physicians to participate in assisted-suicide despite their moral objection. I bring your attention to the Canadian Medical Association, which asserted physicians’ right to conscience in their August 2014 meeting.
Access to care will also not be improved by implementing the draft policy. Common actions and procedures that physicians may object to include abortion and contraception. The availability of these services is not threatened by physicians who morally object to them. In fact, these services are easily accessible without referrals, given the ability of patients to self-refer to clinics that provide such services.
I would also like to bring your attention to the final section of the draft policy, which is entitled “Protecting Patient Safety”. The language used in this section is ambiguous and unacceptable in its current form. There is no clear guideline as to what is considered “imminent” harm, suffering, and/or deterioration. The incredible lack of balance and comprehensiveness to this section of the draft policy implies the CPSO has little regard for the implications of the policy.
In summary, I believe that the CPSO is overstepping its jurisdiction in defining and limiting morality. Freedom of conscience is foundational to our free society and is protected by law. I ask the CPSO to retract this draft policy on “Professional Obligations and Human Rights” in light of the Canadian Charter of Rights and Freedoms. Instead, the CPSO should create a policy to defend the right to freedom of conscience for all physicians.
[**MESSAGE FROM ADMINISTRATOR: DURING THE CONSULTATION PERIOD, WE RECEIVED 3 RESPONSES FROM INDIVIDUAL RESPONDENTS CONTAINING THE CONTENT PUBLISHED ABOVE. ALTHOUGH THIS FEEDBACK HAS NOT BEEN PUBLISHED IN DUPLICATE, THE COLLEGE ACKNOWLEDGES RECEIPT OF THESE SUBMISSIONS.**]
I reject the proposed “effective referral” mandate for doctors. I believe that their Charter right of freedom of religion and conscience must be respected.
[**MESSAGE FROM ADMINISTRATOR: DURING THE CONSULTATION PERIOD, WE RECEIVED 7 RESPONSES FROM INDIVIDUAL RESPONDENTS CONTAINING THE CONTENT PUBLISHED ABOVE. ALTHOUGH THIS FEEDBACK HAS NOT BEEN PUBLISHED IN DUPLICATE, THE COLLEGE ACKNOWLEDGES RECEIPT OF THESE SUBMISSIONS.**]
To the Working Group of the Professional Obligations and Human Rights Draft,
I am writing to inform you of my objection to the draft and its proposed changes.
I greatly appreciate the work that the College does on behalf of physicians and to protect patient safety, but as a physician, I am appalled that the College that I trust to defend the rights of patients and physicians is proposing such a draft.
My first question is: In the spirit of transparency, where is the drive for such change coming from? Is this physician-led or patient-led?
My second question is: Will the College be more clear about what this policy will actually mean in practice? Which situations will this policy apply to? Emergencies are understandably diverse and heavily nuanced — the College must be explicit in the situations to which this policy applies, otherwise the interpretation of this policy may result in more harm than benefit.
I have three major objections to this draft:
Firstly, this draft has a strong undertone that physicians are Canadian citizens whose rights as human beings come second to patients’ rights as patients. I believe that this is an unconscionable position for an advocating body such as the College to make, and which smacks of the unconstitutional. It is our human right to use our moral codes to make moral decisions, many of which occur in medicine — the interface between humanity and science. We live in Canada, a nation where varying moral codes are accepted as long as they are not unlawful. I do not understand how physicians morally objecting to provide services that they fundamentally cannot support is unlawful.
Physicians are not politicians. In the vast majority of cases, we actually do want to do the best for our patients. We do not object to providing services because we have ulterior motives as to what we want for our patients, but rather because we as human beings cannot propose or support medical interventions that we find ultimately more harmful than beneficial to the patients we care much for. Are doctors second-rate citizens? In addition to the sacrifices of time, family, and personal well-being that we give up in the name of medicine, must we also give up our moral consciences, which are arguably the characteristic that makes human beings human?
The other aspect of this issue that I do not understand (and which relates to my first question of transparency) is that for those patients who are not receiving the interventions that they would like are free to pursue care from other professionals. In the modern age of the Internet, easily accessible information, and savvy patients who have no qualms about advocating for themselves, I see this draft policy as a moot point. Most of the patients who this draft would apply to, do not need such a draft in order to access care. And if this proposed draft were to be put forward, those few physicians to whom this draft does apply will be required to practice medicine in a way that they cannot support, or be required to leave the profession altogether.
Thirdly, I question what kind of physician development the College is supporting. Which physician does not use their moral judgment when providing medical care? Moral judgment is inherent in medicine — we are constantly making moral decisions, and I would argue that every medical decision has a moral aspect inherent to it. Because medicine is an art as well as a science, because we work with complex human beings as well as intricate organic pathophysiology, demanding that physicians leave their moral code at their office door borders on the ludicrous. Where would it be appropriate, safe, or in the best interests of the public to ask an architect to plan a corporate 100-floor building without a ruler? Or to require a pilot to fly a plane without a compass? Doing so takes away one of the essential tools of their trade. For physicians, our moral code is one of those essential tools.
Moreover, physicians belong to one of the noble professions, of which firefighting, policing, and paramedicine are other examples. It would be unconscionable to ask a police officer to leave their conscience and moral judgment at home when they work a shift. Why is there a double standard for doctors? Why is the College supporting a policy that would require this?
In conclusion, I find this policy deeply troubling. I cannot foresee how such enforcement will better patient safety or patient care. I do foresee that physicians’ rights as human beings are the true crux of the issue, and they are at high risk of being eroded away.
I have invested my personal well-being and years of my life to provide safe, competent, and compassionate medical care to my patients. But I cannot also sacrifice my conscience as a human being for the sake of medicine. If this is the future of medicine in Ontario, I am saddened to say that I seriously question whether I can consider myself part of that future.
Thank you for asking for feedback regarding this policy.
I think it unconscionable that CPSO would even consider the “Subject Matter”.
If a physician refuses to murder a patient, then how can “The College” propose to order that physician to become complicit in the murder by referring the act to a willing physician.
What has happened to the Hippocratic Oath? How can a profession that was once dedicated to the preservation of life become one that will be at the forefront of taking it?
Referring to legislation regarding abortion, which originally had very limited legal application, we now have abortion on demand for virtually, if not actually, any reason. CPSO and all other organizations will be complicit in the certain erosion of safeguards for future vulnerable people in our society by agreeing to this heinous act of assisted suicide.
Since some in our society are hell bent on flying in the face of such values as the sanctity of life, I implore you to cease any imposition of rules/regulations/procedures etc. that violate the beliefs of others.
We all have the gift of “Morale Conscience” and we exercise it in everything we do on a daily basis. It fuels the passion, which directs our lives. It is important, we keep our morale conscience strong and clear in order to do the best job we can everyday.
Can any person afford, especially a physician, to have his personal morale conscience overlooked and disrespected? Our morale conscience makes up the very heart of our being, of our existence.
Each one of us,Ontarians, look up to our doctors because they always behave in an ethical manner and with solid and sound morale conscience behind each interaction with their patient(s). This new proposed “effective referral” is mandating doctors to disregard their morale conscience and to act, in spite of their moral or religious beliefs.
Canada, as a nation, has always taken pride in being a mosaic of cultures and, religions. This is what makes our current nation “strong and free”. This very basic element of our society is being jeopardized with this new proposed mandated effective referral.
As a nation, as a province, do we really want to lose our Canadian identity?
Ontario physicians have a patient’s best interest at heart always. As a province and as a nation, there is incredible pride in this knowledge; however this proposed effective referral mandate, destroys the very core and ethical essence of this premise.
As much as I am appalled by the Supreme Court decision on the approval of “Assisted Suicide”. I am devastated by the fact that, in recognizing this federal decision. our Ontario College of Physicians and Surgeons wants to DISRESPECT a doctor’s Freedom of Morale Conscience.
It is important to all of us, as human beings, as Ontario citizens, who need doctors, that take care of us, through their respective practice, to always act with a sound mind and body and to strongly uphold their morale ethics and freedom of conscience in their interactions with each one of us, as their patients. A mandated effective referral, like the one proposed, strips and strips and will continue to strip the very heart of what makes Ontario doctors great. Moreover, doctors, who are not respected here at home in Ontario may very well need to relocate. A doctor will always be a profession, that needs to be properly fueled with active morale conscience. If this is removed, from their being, they discontinue to be doctors and become medical agents.
Does the Ontario College of Physicians and Surgeons want their doctors to leave?
Does the Ontario College of Physicians and Surgeons not care about a doctors’s ethics, religion and morale conscience?
Does the Ontario College of Physicians and Surgeons have so much disrespect for their professional members to mandate an effective referral, even after, so many wonderful doctors are so adamantly opposed to it?
In this life, we all live, we have to respect one another, regardless of our culture, backgrounds, and religious beliefs. We each, as individuals, have to firmly hold on to our freedom of morale conscience. We have to be true to our flag, ” … strong and free”.
I firmly oppose and strongly reject the proposed effective referral mandate.
Dear Ontario College of Physicians and Surgeons, I kindly implore you to respectfully maintain the Freedom of Morale Conscience, amongst our current and future doctors, in tact, strong and free.
I thank you in advance, for your serious deliberation and I hope and trust, the Ontario College of Physicians and Surgeons will exercise all due respect to all its’ doctors and will allow each doctor, to use his/her morale conscience as they confront (request(s) of Assisted Suicide within their respective medical practice in the future.
I find it hard to believe that the CPSO proposals on conscience rights have not blown up and destroyed the credibility of the committee responsible for this ignorant dismissal of other views. We deserve a public apology. Why?
Because the CPSO committee thinks the issue of conscience rights is primarily a religious bias, they dismiss them as inadmissible in the practice of medicine. But that is not so. Even a committee, as a-historical as this one seems to be, should have thought about conscience rights in a war situation. In the western world we have accepted these rights for almost a century on three conditions: the argument must be based on a rational premise, it must be demonstrably true on occasion, and it must be sincerely held over a long period. Pacifism is not irrational; war kills people and it is a deeply held rational position that it is wrong.
Similarly, it is not irrational to say that human life begins at fertilization because that is the only point at which we receive a uniquely coded genetic blueprint (twins are a special case). Left to its own devices the baby would be born. It cannot give consent so gratuitous harm is done. As in conscientious objection to war we have non-religious grounds for objection to abortion and euthanasia. Furthermore, for the mother, the evidence that abortion is not an inconsequential action is steadily increasing. Physicians have always objected to abortion since Hippocrates. No one can defend doing gratuitous harm to an innocent human being, yet this is what abortion is. Thus, unless the committee dismisses the argument in the case of pacifism, it must accept that it applies also to abortion and euthanasia.
In addition the committee is imposing a minority view on everyone. Statistics Canada data shows that the vast majority of Canadians belong to religious groups that have traditionally opposed abortion and any killing by doctors. After WWII everyone was appalled to discover that physicians had run the Holocaust killings, which were legalized authorized. Laws are by no means always just.
In a society where we have no moral consensus we can only function if we respect one another’s rights. This proposed protocol is a disgraceful attempt put an end to all other views. Hippocrates and his colleagues understood that medicine was a moral activity because there is no compunction to accept the physician’s advice. Thus a physician is fundamentally helping patients to decide what they ought to do. “Oughts” do not spontaneously generate themselves from physical facts; they come from deeply held, often visceral commitments to ideas about the meaning of life.
What the committee should have done is to see how patients can be connected to physicians who share the informative story of the patient. Yes, in our society we have granted the right to abortion but not the right to coerce doctors to choose between moral integrity and losing their employment. Doctors, of all stripes, should be required to post their philosophical commitments so that patients know what to expect. We ought to have learned by now that passing a law does not necessarily make an act ethical. The holocaust was legal; the Dred Scott decision that deemed slaves to be not persons was legal.
If the committee knew these things and chose to dismiss them, they ought to be ashamed but, if they were ignorant, they need to be replaced by more appropriately educated people. If ethicists were involved, I would like to hear from them in public.
The essential requirement now is to defend the rights of doctors who do not agree with the CPSO position, because there are many(probably the majority) patients who want them now, as both Barbara Kay and Margaret Somerville have pointed out. Many more will want them when they are vulnerable. After all thinking rationally would you trust a doctor more or less if he has a visceral objection to killing patients.
I am concerned about this proposal. Specifically sections 8, 10, and 11. If this proposal goes through then our doctors will lose their freedom of conscience. I encourage these sections to be amended so that doctors are not forced to make referrals.
I am concerned about this proposal. Specifically sections 8, 10, and 11. If this proposal goes through then our doctors will lose their freedom of conscience. I encourage these sections to be amended so that doctors are not forced to make referrals.
With respect to physicians conscience rights, it is my view that physicians need to uphold their promise to “do no harm”. If euthanasia or assisted suicide is legalized, Ontario physicians must maintain their right of conscience to refuse to participate in ANY way. I would NOT FEEL SAFE if my physician participates in euthanasia or assisted suicide. No one has a right kill a person who is suffering. No one has a right to help someone commit suicide. Physicians are called to be servants of healing, not agents of death. It is wrong/evil for the College to force physicians to act against their conscience, compelling them to become accomplices (i.e., the draft policy states that physicians who refuse to perform a procedure to which they morally object MUST arrange that the procedure gets done by someone else). As a patient, I would refuse to have a physician who aborts or euthanizes. Patients must have the right to have access to physicians who respect human life from the moment of conception to natural death.
Keep Physician polices the same as they are. Please continue giving them the rights to deny specific referrals to patients such as for abortions. I wish to continue having the option of going to a physician with moral integrity, religious freedoms and rights.
As a patient I would appreciate it if my physician was able to vocalize their opinions or religious beliefs. This makes for a more personal relationship and allows for the patient to be comfortable with their physician. They too have rights and should be allowed to express them.
I believe Physicians should have the right to say No to providing certain forms of treatment. However, I’m concerned with the requirement that physicians provide referrals for treatments which they feel are morally & ethically wrong. if a physician feels a treatment is morally & ethically wrong, then aren’t they still violating their conscience by asking someone else to perform the procedure? How is a physician’s right to freedom of conscience being protected under these circumstances? In addition to this , a physician might feel that if a procedure is morally wrong it would also be harmful to the patient.. Under these circumstances the physician would be violating not only their conscience but also their hippo ratio oath by referring the patient to someone else to perform the procedure….
Life is not perfect and who are we to end it.
Euthanasia is not the answer and legalization is not a solution.
I admire the physicians who are against it.
Canada, China (Mainland only) and Vietnam have no legal limit on when an abortion can be performed thus full term babies are being killed. This is barbaric and equivalent to what ISIS is doing- the killing of innocent people. Why are we asking our Physicians to participate in the ‘harming of life’ (infant or adult)when they take an oath of doing no harm.
I am writing to you with grave concern regarding the content of your proposed draft policy, which indicates that physicians who decline to participate in certain acts for reasons of conscience should be compelled to refer their patients to other physicians who will perform these acts. It does not address the fact that many of these same physicians will find the act of referral itself objectionable, as they consider it material cooperation with the act. In compelling physicians to refer, you are limiting their
right to conscientious objection. I am opposed to this.
There is significant disagreement in our society as to what constitutes a moral act, and I do not expect the College to define or limit morality. All I expect is that physicians, as professionals, be allowed to respect their own consciences. Freedom of conscience is foundational to our free society and cannot be limited, even for the best of intentions.
If we coerce physicians into violating their consciences we will inevitably erode the personal integrity which is the basis of the physician’s relationship with their patients. I encourage you to revise the sections above, and include a clear defence of the right to freedom of conscience for all physicians.
I think that physicians, who have a moral and religious conscience, should have the right to say “No” to performing acts that are contrary to their beliefs. God has said in His word that we are not to kill, whether that is by our own hand or through the hand of another.
It is unethical to force anyone, no matter what profession they choose,to act in a manner that is contrary to their rights and freedom. They must be able to stay true to their core beliefs and values.
All physicians take a vow to do no harm. The choice to refuse or comply to end a life, no matter if it is considered merciful, should be taken away from any person.
If someone can be a conscientious objector in the military or other professions, then how can a person committed to saving and improving life (physicians and health care professionals)be forced to take an action contrary to their values?
It is well documented that patients sometimes make decisions that are not in their own best interests, there is a sad history of persons who take on the responsibility to end lives of elderly patients (I believe some have considered themselves “Angels of Death”)against the wishes of the patient and their families, and many people, patients and doctors have suffered from remorse, guilt and mental health issues following abortion procedures. This issue is too convoluted to make it a black and white choice. To do so is against all of the persons involved (health care workers/patients and their families) charter of rights that are enshrined by Canadian law.
The College of Physicians and Surgeons of Ontario must not put this policy into practice. The College has overstepped its mandate by proposing to interfere with the core ethics and human rights of physicians. If the CPSO proposes to rewrite the Canadian Medical Association’s Code of Ethics, it should poll its membership on their desire for such a step.
While researching the Web page on the College of physicians, I was able to see how they regulate themselves and manage things around them. One thing that stood out in particular was the fact that they have no morals or ethics defined in their system, and even so, another thing which shocked was that this apparent “group” of morally unstable people have an incredible amount of power. So much so that they can even change laws. Keeping in mind that this “group” which is discussing our future laws regarding Human Rights and discrimination is a small number of 32-34 members, half of which are not even physicians and are APPOINTED by the government with an extraordinary large salary they carry around paid by our taxes ($457.- per half day plus travel expenses and preparation time)
How can they decided how to apply the word discrimination to one part and not to the other in a relationship of 2 doctor-patient?
How can a College can pretend to change or define for their own political agenda the meaning of words like Human Rights? Do they want to ignore their own members as Human beings? This is not their role, it sounds ridiculous. I wonder… what exactly they protect? If their mission, vision and values can be change at any time? It is clear for me that if they do not respect the legal order, not the dignity of their own members, they would not care for the public interest, that is mine. I have the right to see a doctor that has moral, values and fear of the Lord, because by knowing that, I will know he/she will always see for the best interest of mine.
The draft policy is all too clear. It is aimed at forcing physicians to act against their conscience by acquiescing to a patient’s request for a “service” that would end a life. To refer for such a service is equivalent to performing it. Somehow medical care is being turned upside down. We are asked to be robots and turn off our belief and conscience for certain acts but continue to care and act in good conscience the rest of the time. This is an untenable position morally and has the potential of being soul destructive. I agree that the College is overstepping its jurisdiction and legal bounds.
The Hippocratic Oath says that doctors are to do no harm. As patients we want Physicians who have high moral and/or religious convictions. They are members of our society and are highly respected. We don’t want physicians who violate their convictions. Physicians are not here to kill their patients, violating the do no harm part of the oath. Line 127-128 says that to harm a patient would not automatically be protected. Please do not force physicians to harm patients. Our society has made patient autonomy the ultimate trump card. It is such a “me” focus. It violates our connections with other members of society- family, friends, workmates. We are all connected. If an individual says, “kill me” and the physician says, ” I cannot violate my conscience” to do so, we need to protect both parties. I do not want physicians who violate their conscience.
I have the same question. There are physicians in Ontario who have taken the traditional Hippocratic Oath upon graduating from medicine. Are they expected to become liars and carry out or facilitate procedures they swore not to do in the oath? Is this what you are expecting of them?
It is clear from the responses given above that I and the majority do not agree with the CPSO policy as it has been drafted. I think that revising the draft and permitting some discussion will be beneficial to both the public, CPSO and the doctors. Clarity is key to all that we do. Thank you for redrafting the Policy.
I would say that if there is moral/religious conflict for the physician to perform some specific procedures, the physician could refer the patient to other physicians that do not share the same religious conflict to perform such procedures. In case the physician is in a rural area that there are no other physicians available to perform such procedure, the physician cannot be hold accountable for that. The patient should be connected to the closest hospital to find information of where they could go.
The physician should also made known to the existing patients that there are a certain procedures they feel are out of their moral acceptance. The patient could plan ahead.
Perhaps, the certain procedures that cause concern should be named on the draft, if there is a need to have this instruction at all.
Whose “rights” trump whose? If I have a Charter Right, that should not in forcibly infringed by another’s Right….doctors have to be able to make moral and ethical judgements based on their own conscience…no interference from their governing body
Regarding Physician assisted end of life. No one should have to go agains their conscience when providing a service. A doctor should be able to inform a patient that he can not advise or participate in Physician assisted suicide, nor have to refer to another physician. That is up to the patient. When reading the obligations for the physicians, the responsibilities are overwhelming. (needing to bring up end of life procedures repeatedly, determining whether the end of life wish is due to a ‘curable’ condition (i.e. depression). It seems like a courtroom nightmare. The last thing we want is our doctors tied up in court rooms, rather than helping the public.
The physicians professed to heal not to kill.
The College of Physicians and Surgeons spend their time studying and researching to find cure. This is what they PROFESSED. No one has the right to kill. It is MURDER.
If that is the case for those who practice Euthanasia, then, what is the purpose of going to Med school? Why bother going to the Doctor? They can just take poison and kill themselves. Why waste time and money to go to Med School if the purpose is to eliminate life? Anyone can just take poison and give to whom they want to eliminate.
The CPSO makes some important distinctions that you do not recognize, but sophistication and nuance aside, I do agree that killing does not belong in the healing arts. I also agree that the right to die transforms into the duty to die and that power corrupts. The effects can already be seen in the Netherlands and Belgium.
RE: DRAFT POLICY: PROFESSIONAL OBLIGATIONS AND HUMAN RIGHTS
I am writing to express my disappointment with the proposals in the Draft Policy on Professional Obligations and Human Rights, especially Sections 8,10 and 11.
The medical profession has always been respected for it’s professionalism and integrity. The mandating of effective referrals without respecting conscience rights of physicians will undermine the trust patients have towards physicians. Physicians who have objections to procedures or treatments will not be fully open and honest nor will they be professional if they do not disclose all their objections to these procedures or treatments.
In today’s Canada, diversity and open discussion should be encouraged and not minimized or blocked as your Draft Policy would mandate. As a Canadian citizen and Ontarian, I urge you to allow physicians to practice their profession with personal integrity and honesty. A defense of conscience rights for physicians is what I expect the College to do for the citizens of Ontario.
I have just read the draft version of the “Professional Obligations and Human Rights” policy published by The College of Physicians and Surgeons of Ontario, and I have great concern over the details it contains.
It seems that the physicians are being stripped of their human rights in order to serve their patients. All citizens have the right to practice their religion both in their private and public life. This draft policy seems to place the “Human Rights Code” above the “Canadian Charter of Rights and Freedoms”. It also makes some statements that are at best unclear and at worst contradictory. For instance, line 114-115 states that “the Supreme Court of Canada has determined that no rights are absolute.” Immediately following it says, “The right to freedom of conscience and religion can be limited, as necessary, to protect public safety, order, health, morals, or the fundamental rights and freedoms of others.” I thought “no rights are absolute”? How, then can there be “fundamental rights”? Also, this seems to say that there are different levels of rights, and it is up to the Supreme Court to decide who has the righter right. Lines 123-128 are especially troubling, as the “courts will seek to determine whether the act in question interferes with a sincerely held religious belief…in a manner that is more than trivial or insubstantial”. A secular court has no place determining whether a religious belief is trivial or insubstantial.
In lines 143-148, the physician’s rights are limited in that they are not allowed to explain the reason they will not provide the service (at least this is how it reads to me). The physician should be able to explain, based on their religious or moral convictions, why they will not provide the service. An explanation does not necessarily equate to an attempt to convert them, but the wording leaves this open to debate.
While I agree that physicians should not impede access to care (see lines 152-164), they should not be forced to provide a referral to another physician willing to perform the requested procedure. If the patient is not satisfied with their physicians answer, then they, as the patient, have the right to find another physician who will. But the physician who refused should not be forced to become an accessory in what they would not do themselves.
Patients do have rights, but so do physicians. The patients need to respect the rights of the physicians. Where there is a conflict, they have the opportunity to seek services elsewhere.
We do not need, but implementing a restricting code such as this, to force physicians to leave the province and find a different location where they can practice according to their religious or moral beliefs.
I have read several comments on the forum regarding this draft code, and I hope you will take into consideration what many people, including physicians, are stating about this code.
While not everyone has religious beliefs, there are many who do, and they should be able to practice medicine according to these beliefs, and to seek the services of a physician who practices according to these beliefs.
I agree that no one should purposefully insult the sensibilities of another person, but part of free speech also involves the right to state opinions, whether based on religion or other belief systems. Opinions may offend at times, but that does not mean they cannot be spoken. Stripping one person of rights to satisfy another person is not democratic, and is contrary to the rights of everyone.
I hope you will take this, and other comments received into consideration, and will reconsider the need for this revised code. Thank you
The CPSO draft policy demands that doctors participate in controversial procedures like abortion and even euthanasia by making referrals and doing the procedure in certain circumstances.
Doctors who refuse to follow the policy will be vulnerable to discipline, even though their fundamental freedom of conscience and religion is guaranteed by the Canadian Charter of Rights and Freedoms.
Such a law is unacceptable and is clearly opposed to not only the doctor’s freedom of conscience but also his ability to discern what is best for his patient.
I demand that our doctors keep their right of Freedom and Conscience for the most Common Good.
Please reverse the current policy on abortion in Ontario. Every life is precious from time of conception babies have a right to life. To terminate their lives is legalky approved murder.
All are ceated in the image of God according to the Holy Bible therefore,
to end their lives is just wrong. Only Almighty God had the right to take what he has created.
Our Doctors’ rights are being violated because of the decision of the Supreme Court concerning assisted suicide. No physician should be made to defy the Hippocratic oath. Life is sacred and any doctors I know would never kill a patient.
Please be advised that I am spreading the word! I have tried to contact my rep and senators as well because ultimately the legislature is responsible, including in protecting the civil rights of physicians. I am daily astounded at the number of citizens do not see that they are lining up for govetnment sponsored gas chambers!
CPSO:
I would like to express my views on the Professional Obligations and Human Rights policy you are preparing and for which you are requesting input.
I recognize the difficulty of balancing obligations and rights in today’s environment and applaud you for your attempt to do so.
At the same time, I do find it disturbing that you foresee requiring a physician to refer a patient to another physician to carry out a procedure that goes against their beliefs. Obviously, if they have strong beliefs about the procedure, they would see this participation, however secondary, as going against their beliefs as well.
The recent euthanasia/assisted suicide decision by the Supreme Court expressly protects the rights of conscience for physicians objecting to this activity. I support the CMA’s position recommending physicians be allowed to follow their consciences on euthanasia/assisted suicide as the one that the CPSO should follow.
I hope you reconsider and eliminate the provision forcing doctors to refer patients to procedures to which they are opposed on moral grounds.
Thank you for considering my input,
I am an Ontario citizen writing in response to the CPSO draft document on Professional Obligations and Human Rights. I appreciate your invitation to open consultation regarding this policy and would like to express my thoughts and concerns regarding the proposed changes.
Firstly, I would like to affirm the document’s recognition of Charter rights of freedom of religion and conscience. Unfortunately, I find that the new policy challenges the rights of physicians to these freedoms by requiring physicians to refer patients for procedures they believe are morally objectionable. Although I agree, as stated in the policy, that the rights of physicians have limitations because they must be balanced with the rights of patients, this mandate is not a balancing of rights. Rather it is a sacrificing of physician rights in favour of patient rights. I find this to be gravely concerning as the freedom of conscience is at the core of human individuality and freedom and cannot be taken lightly or confused with mere “personal beliefs”. While “personal beliefs” may be subjective and irrational, moral stances stemming from an informed conscience are founded on evidence and reason and deserve to be defended.
In addition, while I fully agree that patients should be protected against discrimination, the refusal to treat or refer a patient is not discriminatory when it is rooted in the moral stances of the physician regarding the procedure. Such refusal is not based on the personal characteristics of the individual patient, but rather on the nature of the treatment. Coercing physicians to provide referrals against their moral stance would force them to be complicit in acts that betray their conscience, violating their human rights. Furthermore, it will lead to the erosion of the personal integrity of physicians and damage patient-physician trust.
Again, I would like to thank you for being open to consultation with the public and I strongly urge you to revise your new policy to ensure the protection of the conscience of physicians.
RE: Draft Policy ‘Profession Obligations and Human Rights”.
I am opposed to the draft policy whereby the College of Physicians and Surgeons of Ontario would force physicians to make referrals to procedures (e.g. abortion, possible end-of-life issues) that may violate their moral obligations or relegious beliefs.
According to some sources, the Charter of Rights and Freedoms protects physicians from being told “You have to assist in euthanasia”. Some writings out of the College suggest that they will override this right. How is this not political correctness gone amok?
Re:Draft Policy “Professional Obligations and Human Rights”
I am opposed to the draft policy whereby Physicians and Surgeons of Ontario would be forced to make referrals for abortions , end of life issues , that may violate their moral or religious belief, resulting in becoming Pontias Pilates “!!
I strongly believe that forcing a physician to perform procedures that go against their conscience or to refer patients for the same is a violation of their human rights. God is the one who gives life, and He is the only One that can take a life, whether in the womb, in old age, or in extreme suffering, without it being murder. Once again it is those who want abortion, euthanasia, gender change, etc. that are discriminating against those who do not.
I am writing to object to the following paragraph in the “Professional Obligations and Human Rights”
ii) Moral or Religious Beliefs
“Where physicians are unwilling to provide certain elements of care due to their moral or religious 157 beliefs, an effective referral to another health care provider must be provided to the patient. An 158 effective referral means a referral made in good faith, to a non-objecting, available, and accessible physician or other health-care provider.”
The bottom line is we don’t help people who have a mental illness to commit suicide so why should doctors and other health care professionals assist people with physiological illnesses to commit suicide? Doctors and the health care system is in place to save lives, not take them. God gives life and takes it away. Who are doctors to play God?
I reject the proposed “effective referral” mandate for doctors whose Charter right of freedom of conscience and religion must be respected. If there is no freedom of conscience, there is no freedom at all.
I would like to submit feedback on the Draft policy regarding Professional Obligations and Human Rights.
I am concerned, in particular, with the section on “Ensuring access to care” (lines 150ff). I believe that this should be substantially changed or removed.
To require a physician to refer a patient for a treatment that he/she, the physician, finds to be morally unacceptable is, de facto, to require the physician to participate in immediate material cooperation with evil. Doing such necessarily forces one to violate the sanctuary of the human conscience given the degree of cooperation that such an act entails. It is, per se, wrong to force such cooperation and shows a surprising level of disrespect for and lack of confidence in the physician. In addition, it creates a very problematic precedent whereby a physician can be forced – and dare I even say coerced which is what this policy does – to participate in an immediate way with an action they deem to be evil.
In addition to the concerns listed above, I can speak personally of several very fine physicians who have a tremendous concern for their patients, a desire to serve well society, and great respect for the science and art of medicine, who would be unjustly marginalized by such a policy and perhaps even be forced out of the practice of medicine. They are precisely the type of physicians – men and women of character, concern, dedication, integrity, and generosity – of whom the College and Ontarians alike should be proud. In our society, it is too rare to find people of such integrity who would stand up for a deeply held belief despite the personal cost to them. I have much more respect for a person like this – and would find them to be much more qualified in this sense to serve in the noble profession of medicine – than I would for a person who claims to hold that a certain action is evil, but then refers a patient to another physician to carry out that very act for the sake of remaining in good standing within your College.
I appreciate the opportunity to participate in this consultation. If I can be of any other service in the drafting of this policy, please do not hesitate to contact me.
I have read your draft policy Professional Obligations and Human Rights.
This policy is very troubling especially with physician assisted suicide likely to become legal within one year.
Assuming legalization, this policy would appear to require a doctor to refer a patient who requests assisted suicide to a physician who will participate. Meanwhile your own draft policy on end of life care notes that a request for assisted suicide could be “motivated by an underlying and treatable condition”. In short these two policies are placing a doctor in a no-win situation. If they refer – are they perhaps failing in their professional obligation to recognize the possible ‘treatable’ motivation behind a request for assisted suicide. On the other – if they decline to provide the referral – somebody could argue that the reason why the referral was not provided was due to the doctor’s moral views and hence end up in violation of the Professional Obligations and Human Rights policy.
I also fail to see why it is necessary for a doctor to provide an ‘effective referral’ for a procedure that goes against their religion or conscience. Are there cases where a patient has been denied a service for moral/religious reasons and was truly unable to access this service from any other means? I imagine the College is typically referring to abortion or other sexual health services – which a simple internet search can easily identify several clinics that provide these services. If being part of these services or referring for them – violates a doctor’s conscience – why is the College insisting on that doctor providing the referral – when the patient can access the information and the service themselves? Again I ask – are there situations were patients were not just mildly inconvenienced but actually denied services because of the conscience or religious views of one doctor? This seems incredibly unlikely and as such I ask that the requirement to provide an effective referral be removed. This kind of policy may deter certain minorities from seeking a career in medicine (e.g. Muslims, orthodox Jews and Christians.) This imposition is completely unnecessary as it result in no tangle benefit to anyone, violates the conscience and religious beliefs of some doctors, deters others for entering the profession and results in patients with strong religious views having fewer doctors that they will feel comfortable entrusting their care to.
Please remove the referral requirement. – Thank-you.
Thank you for the opportunity to comment on the CPSO Draft Policy.
The concerns I have are with the requirements as outlined in the section “Moral or Religious Beliefs”.
I would suggest that most people choose a doctor with whom they feel comfortable and who they trust to provide the best care for them under all circumstances. This new policy seems to be forcing a “view” upon doctors which they may not necessarily hold to or with which they may not agree. It also seems to be limiting doctors to what they may and may not say to their patients, again patients who have chosen this doctor to be their care giver because of who he /she is. Basically what is being asked is that doctors, especially Christian doctors, leave themselves out of the care giving situation and only provide care as is dictated by the college. It seems to be an attempt to coerce Christian doctors to agree that their thoughts of required care are limited and they must use the treatment plans initiated by those who have no respect for human life and thus support abortion and euthanasia! This does not describe the character of a doctor in whom I would place my trust for health care.
I trust that the policy will be revised to allow all doctors to practice in accordance with their moral and religious beliefs, not by those pressed on to them by the College.
• I am opposed to the college forcing physicians to make referrals for procedures (e.g., abortion) that may violate their moral or religious beliefs (cf. draft policy excerpt below).
As part of ensuring access to care for patients, the draft policy requires that physicians, who are unwilling to provide certain elements of care due to their moral or religious beliefs, refer the patient to another health-care provider.
While there are some positive aspects related to the draft policy, the section on “Moral or Religious Beliefs” under “Limiting Health Services for Legitimate Reasons” is of specific concern. Medical doctors are not robots, but operate from a specific worldview, just like every other person in society. This is what makes for great doctor-patient relationships, where a patient entrusts his care to a doctor with a compatible worldview. Doctors are professionals whose mandate is to do no harm and who desire nothing other than the betterment of patients and the society they make up. Forcing a doctor to be a part of something he rejects for moral or religious reasons (by requiring ‘effective referrals’) is belittling the profession and the ‘rights’ of the doctor himself. The draft policy must be changed such that the ‘moral and religious beliefs’ of doctors are actually honored and recognized as a critical component to the patient’s best interest.
I would first of all like to commend the CPSO on its excellent public consultation process. I am grateful for the opportunity to express my opinion on CPSO policy as a citizen of this province and as a fellow professional. The CPSO’s aim to ensure that its policies are in line with the public’s expectations for the Canadian medical profession is also admirable. Indeed, it is for this very reason that I write to you, for I fear that you are forgetting the diversity of moral opinions that still exist in this society.
I have grave concerns about sections 8, 10 and 11 of the draft policy on “Professional obligations and human rights.” Specifically, I am unable to support any wording that would see physicians compelled to choose between referring patients for acts they deem morally objectionable or risking disciplinary action. As a user of publicly funded healthcare in Ontario, I do not believe that any inconvenience caused to a relatively small number of patients can possibly outweigh the catastrophic attack on freedom of conscience enjoyed by members of the medical profession. A patient’s access to particular clinical procedures is not restricted if a physician conscientiously objects to referral for those procedures; there are ways to ensure that both patient and physician can be satisfied without trampling on the latter’s right to moral objection.
Please revise the sections noted above, and allow your members the right to exercise their conscience as professionals
I would like to thank those who have been involved in drafting the proposed Professional Obligations and Human Rights[1] policy. This task surely has required much time and effort, and I greatly appreciate the hard work and careful thought the authors have put into it. As a practicing doctor in Ontario, I sincerely believe in the CPSO’s key values of professionalism—compassion, service, altruism, and trustworthiness—for they reflect the core of what motivated me to go into medicine and foundationally shape how I practice my vocation. Unfortunately, some sections of the draft policy are highly problematic and would actually force many of my colleagues and me to practice medicine in ways that would be contrary to what these values mean to us in our daily work. In effect, the draft policy would compel many doctors to be involved in practices that they believe to be unethical and, thus, to gravely violate their consciences. This would have significantly negative implications for the trustworthiness of the medical profession, the human rights of doctors, and the overall availability of medical services to patients in Ontario. Therefore, I ask the CPSO to amend the draft policy such that these problems are avoided. In this letter, I will explain in detail my specific concerns.
Requirement to refer for elements of care to which a physician morally objects
My first concern is with lines 156-164, which state:
Where physicians are unwilling to provide certain elements of care due to their moral or religious beliefs, an effective referral to another health care provider must be provided to the patient. An effective referral means a referral made in good faith, to a non-objecting, available, and accessible physician or other health-care provider. The referral must be made in a timely manner to reduce the risk of adverse clinical outcomes. Physicians must not impede access to care for existing patients, or those seeking to become patients.
The College expects physicians to proactively maintain an effective referral plan for the frequently requested services they are unwilling to provide.
This section of the draft policy seems to assume that a doctor bears little to no responsibility for what happens to a patient when she makes a referral. This is an erroneous assumption. First, a referral implies the referring doctor’s endorsement of the patient’s receiving the service being requested. When a doctor makes a referral, she puts her name behind the request and, in effect, indicates that she believes a patient would benefit from the service being sought. To compel referrals that do not genuinely embody the referring doctor’s endorsement is to radically alter the essence of what a referral is. Second, making a referral is a deliberate action undertaken by a doctor that has intended consequences for the patient. Although the referring doctor does not directly provide the requested service to the patient, in making a referral her actions are closely linked to and play a causal role in what ultimately happens. Third, the principle that one shares responsibility for an action performed by another person if one facilitates or arranges that action is engrained in our society’s norms. For example, a hockey player who passes the puck to someone who then scores a goal is awarded an “assist”; businesses have programs that reward customers for referring friends to them; and one can be convicted for “aiding and abetting” a crime by facilitating another person’s performing an illegal activity. Carrying out an activity one’s self or arranging for someone else to do it are morally equivalent. Requiring doctors to refer for services to which they morally object coerces them to become active participants in acts that they believe to be harmful and, therefore, to act against their consciences.
Vague wording regarding “urgent” care
I am also concerned with lines 168-169:
Physicians must provide care that is urgent or otherwise necessary to prevent imminent harm, suffering, and/or deterioration, even where that care conflicts with their religious or moral beliefs.
The wording in this section is vague and could potentially be interpreted so broadly that there could be extremely far-reaching consequences. Terms such as “imminent harm, suffering, and/or deterioration” will undoubtedly be interpreted differently by different people. For example, is an obstetrician who refuses to perform a medically non-indicated Caesarean-section that is requested by a patient for social reasons or personal preference (i.e., a “C-section on demand”) guilty of professional misconduct? After all, it could be argued that the patient will otherwise suffer significant psychological distress imminently by having to wait any longer to have her baby or by facing the prospect of a painful labour and vaginal delivery. In this sense, from the patient’s perspective, the C-section is of an urgent nature to prevent a form of suffering. And at the same time, the basis of most obstetricians’ objecting to C-sections on demand is essentially a “moral belief.”[2] I don’t intend to downplay the concerns of a mother in this sort of situation—on the contrary, I think she should receive the utmost respect and sympathy—but I hardly believe that professional medical bodies or any of my medical colleagues would truly believe that an obstetrician who refrains from participating in C-sections on demand is guilty of professional misconduct. Indeed, the SOGC has explicitly stated that it does not support C-sections on demand.[3] Unfortunately, the wording of lines 168-169 is so vague that one could use it to argue that obstetricians must not refuse to be involved in these kinds of C-sections. In fact, with its current wording, the draft policy could be construed such that doctors could be forced to provide almost any medical service in almost any situation simply on the basis of patient demand.
I would agree that doctors should ensure that patients requiring emergent treatment for acute “life or limb” threatening conditions receive such treatment immediately. If this truly is the intent of lines 168-169 of the draft policy, then the wording should more precisely reflect this. That said, I have never actually come across or heard of a doctor who would refuse to provide emergent care in these kinds of situations on the basis of moral or religious beliefs. So I do honestly wonder if such a policy would address a problem that actually occurs in reality. Regardless, I think care should be taken to use precise terminology so that patients and doctors are clear on the exact kinds of situations to which this section of the draft policy would apply. There are detailed objective scoring systems such as the Canadian Triage and Acuity Scale (CTAS) used to classify the degree of acuity of a comprehensive range of conditions; I suggest reference to such a classification system be considered instead of using vague terms. Otherwise, this section of the draft policy could be interpreted in such a way that doctors would be required to provide services to which they have strong ethical objections even in situations where such services are not required emergently to save life or limb—which would be completely unnecessary and unjustifiable.
Implications of compelling doctors to violate their consciences
Forcing doctors to perform or refer for services to which they morally object forces them to act against their consciences. Unfortunately, as I’ve already outlined, there are two sections in the CPSO’s draft policy that would do precisely that. A policy that requires doctors to abandon their consciences will undermine the trustworthiness of the medical profession as a whole, violate the fundamental human rights of doctors, and result in an overall reduction in the availability of medical services to patients in our province.
Firstly, fundamental to the trustworthiness of the medical profession is the understanding that doctors will act ethically. There are various frameworks for ethical decision making in medicine, but essentially—and by definition—for a doctor to act ethically means that she does what is right and avoids doing what is wrong.[4] The problem is that on some matters there is no consensus, and people of goodwill (including doctors and their patients) may come to differing conclusions about what is ethical. So in light of this reality, how is the trustworthiness of the medical profession upheld? Some might argue that a doctor should simply do what a patient asks her to do, regardless of the doctor’s convictions. I think this is a myopic conclusion and that such an approach would severely undermine—not uphold—the trustworthiness of our profession. If a doctor routinely and with little hesitation will contravene her conscience, she cannot be trusted. Even if I don’t agree with my doctor on everything, crucial to my trust in her is knowing that she will not intentionally do something that she thinks is wrong or harmful to me. Doctors often come under pressure by third-parties or other external factors to act in ways that are contrary to their patients’ best interests. But when doctors are, as a matter of policy, required to regularly jettison their consciences, it is difficult to have any sort of assurance that they would always resist these pressures and act ethically. A person who is most trustworthy is not someone who does exactly what I ask of her, regardless of whether she thinks it is right or wrong; rather, it is someone who has a conscience, acts in accordance with her conscience, and is honest and transparent about what she is willing and not willing to do.
Furthermore, while laws and regulations play important roles in ensuring the ethical conduct of doctors, these alone are not always sufficient. The practice of medicine sometimes involves extremely complex and nuanced situations. Hence, laws and regulations cannot cover every possible scenario, so in some cases doctors must use their own judgement to determine the proper course of action. Additionally, some patients are inadequately empowered to alert authorities should they ever be mistreated, and thus truly are at the mercy of their doctors. Since laws and policies are not sufficient on their own to always ensure ethical conduct, it is crucial to cultivate a culture within the medical profession where the ethical treatment of patients is a most highly esteemed objective. Forcing doctors to regularly ignore their consciences would be a precedent that is extremely counterproductive to cultivating a robust ethical culture and would not ultimately serve to promote the trustworthiness of our profession or benefit patients.
Secondly, a policy that requires doctors to provide or refer for services to which they morally object would result in situations where an undue burden would be placed on doctors’ consciences and their fundamental human rights would be violated. In lines 113-128 of the CPSO’s draft policy, it is explained that the Supreme Court has determined that no rights are absolute, and that the rights to freedom of religion and conscience can be limited in order to protect the rights of others; in seeking to balance the rights of various parties when there is a conflict, courts would seek to determine whether religious beliefs (and I would presume moral beliefs held on other grounds) are interfered with in a manner that is “more than trivial or insubstantial.” So let’s be clear that in many cases, the burden to objecting doctors’ consciences would be substantial—not trivial—if they are forced to provide or refer for services that they believe are unethical and harmful to patients. For example, with the recent Supreme Court ruling that will allow the legalization of assisted suicide, with the current wording of the CPSO draft policy, many of my colleagues would be forced to participate in what they believe is the intentional killing of another person. Whether one supports physician assisted suicide or not, it should at least be understandable why being involved in the taking the life of another person would be something some doctors would not want to be a part of. Similar things could be said about other controversial services such as abortion. Indeed, in lines 129-130 of the CPSO’s draft policy, it is rightly recognized that the Charter of Rights and Freedoms entitles a doctor to refrain from providing services to which she objects on religious or moral grounds—the underlying reason being that a significant burden on the doctor’s conscience would be imposed. Yet, the CPSO’s draft policy then contradictorily denies this right to refrain from acting against one’s conscience when it comes to making a referral. As I have explained earlier, in cases where doctors are forced to refer for services to which they morally object, burdens would be imposed on their consciences that would be of comparable magnitude as would result from having to directly provide the service. In either case, requiring doctors to violate their consciences places an undue burden on them and would violate the Charter.
Thirdly, requiring doctors to provide or refer for services to which they morally object would result in an overall reduction in the availability of medical services for patients. The draft policy would put many doctors in a position that simply is untenable: Violate one’s conscience by doing what one believes to be wrong in order to comply with the CPSO’s rules; or refuse to violate one’s conscience and risk facing disciplinary action by the CPSO. Therefore, in order to maintain both their professional and personal integrity, many doctors would relocate to other jurisdictions where they would be able to practice in ways that do not violate their consciences; others may quit medicine altogether; and some of those who continue to practice in Ontario would withdraw from practicing in certain areas of medicine or settings so as to minimize the likelihood that they would encounter a situation where they would be forced to do what they believe is wrong. In my estimation, the number of doctors who would seriously consider these options is considerable. It is important to remember that these “conscientious objectors” happily provide or refer for a huge majority of the services that their patients seek when medically appropriate; it is generally only a few services in which they object to being involved. The CPSO’s draft policy would push these doctors out of Ontario’s medical system, and the net effect would be an overall reduction in the availability of medical services of all kinds. Places where there is a relative shortage of doctors, such as rural areas, would be particularly hurt. Ostensibly, the CPSO’s proposal to require doctors to refer for, or in some case to directly provide, services to which they morally object is being made in the name of ensuring patient access to medical services. However, the reality is that the net effect of this policy would be quite the opposite.
Conclusion
The CPSO’s draft policy, Professional Obligations and Human Rights, would force many dedicated, compassionate doctors to practice medicine in ways that would grossly violate their consciences and to become involved in things that they sincerely believe harm their patients. This would be unconscionable and create a situation where neither patients’ interests are protected nor doctors can practice medicine with integrity. For these reasons, I must express my opposition to the current version of the draft policy and request that it be amended so that such a regrettable situation will not arise.
Thank you for considering my concerns and for taking the time to read my letter!
To members of CPSO,
I reject the proposed “effective referral” mandate in the draft dealing with physician assisted suicide. This “effective referral” would compel a physician to violate his/her own conscience by being a participant in the very act, the very procedure, to which he/she objects in the first place.
Freedom of conscience
In an attempt to give patients freedom of human rights, the most recent changes in government policy regarding assisted suicide have brought on another human rights concern.
I am greatly concerned how this will effect the practice of physicians to whom these procedures and those like them, i.e. Abortion go against their conscience.
I fear that if these physicians are forced to participate, even by way of referral, they by their conscience may have to leave the practice of medicine. Which may result in the college losing some of the most conscientious physicians in our nation.
Please take these concerns to heart when making final decisions regarding these policies.
The attached document is respectfully submitted for your attention.
Either we have a free society with freedom of conscience or we have a totalitarian regime. If we coerce physicians into violating their conscience we will inevitably erode the personal integrity which is the basis of the physician’s relationship with patients.
I urge you to reconsider forcing decisions on physicians forcing objectionable action on their part.
It is with deep alarm that I learned of the proposal of the CPSO to force doctors who stand by their right of freedom of conscience and religion and are unwilling to treat a patient with a treatment or a procedure that they themselves find harmful or immoral, according to their conscience. The long standing Hippocratic oath was made to assure patients that their doctor would do everything he/she could do to restore them to good health and do no harm. That assurance helped people to trust that the physician’s judgment would be sound and in their best interest. If a physician acts against his conscience and is forced to refer a patient to another for a treatment or procedure which he/she considers harmful or wrong, he/she would be acting against the best interest of the patient which he/she promised to uphold when becoming a doctor. As a patient myself, I would be very apprehensive to put myself under the care of anyone who would act contrary to his/her conscience in order to carry out my demands. As a matter of fact, I would rather have that doctor explain why he objected to the treatment and then decide whether to seek another doctor’s opinion or rethink my own reason for asking for a procedure or treatment.
The right of freedom of conscience and religion are absolutely necessary for all people. We all have witnessed the news of current murders of Christians in Syria and neighbouring countries because the extremists want to force everyone to convert to their thinking. We have seen the news of the battles that have been taking place in the Ukraine with the invasion of Russian military. We have seen seen these horrors of force and the pain and suffering it causes. Is this what you want? We need to believe that the doctors we visit will really have our best interest at heart and they can’t have that if they act against what they believe is right. A patient can always seek another opinion but a doctor can’t give good advice when he is forced to say or do what he does not believe.
Please reconsider and remember that it is the doctor that acts in good conscience that is the reliable and trustworthy physician that patients can trust; not the one who will bend to giving treatment or a procedure that to him/her is wrong or harmful.
I am opposed to the draft policy which seeks to imposed a physician ” duty to refer.” I believe physicians should maintain their right of conscience. They should not be forced to participate in acts that go against their conscience.
I am deeply disturbed by the recent Supreme Court ruling that wants to revisit Assisted suicide. I have lost a close family member to cancer, the process was lengthly and quite painful towards the end.
I believe that he had a right, not to decide to die, but to experience all that our earthly life has to offer, even suffering. During this suffering, he grew spiritually, in a way I can’t even describe, a changed man for the better. I think robbing people of this chance, to have an epiphany….. to hang on one more day of pain to see a relative that needs to experience forgiveness, a long lost child or loved one that has been away…. these are complex issues, more painful potentially that physical pain, and more detrimental if denied, than physical suffering
I am writing to you with grave concern regarding the content of your proposed draft policy, which indicates that physicians who decline to participate in certain acts for reasons of conscience should be compelled to refer their patients to other physicians who will perform these acts. It does not address the fact that many of these same physicians will find the act of referral itself objectionable, as they consider it material cooperation with the act. In compelling physicians to refer, you are limiting their
right to conscientious objection. I am opposed to this.
There is significant disagreement in our society as to what constitutes a moral act, and I do not expect the College to define or limit morality. All I expect is that physicians, as professionals, be allowed to respect their own consciences. Freedom of conscience is foundational to our free society and cannot be limited, even for the best of intentions.
If we coerce physicians into violating their consciences we will inevitably erode the personal integrity which is the basis of the physician’s relationship with their patients. I encourage you to revise the sections above, and include a cleardefense of the right to freedom of conscience for all physicians.
Furthermore, I would like to study in the medical profession and eventually become a nurse, then maybe a doctor.
How can I chose this career, if I do not have a choice to act morally in this profession? Please help to fight against this huge injustice to our society!
Sir or Ms: I cannot believe that you would force a fellow practitioner to participate in services that are repugnant to him or her, by insisting that they supply referrals to doctors who believe that these services are beneficial to patients and are willing to preform them. That is the same as telling someone who wishes to kill somebody, where that person will be and when he or she will be most vulnerable. SHAM E.
To whom it may concern,
I am very concerned about this new policy that is trying to be passed. Doctors ought to have the right to follow their moral and religious beliefs. They should not be forced to carry out procedures that goes against what they believe.
Just like every Canadian, they should also have their rights upheld.
Thank you for hearing me out,
I am writing to voice my concerns about the proposed policy of the College of Physicians and Surgeons of Ontario (CPSO) which would affectively strip away the conscience rights of those doctors who object to providing services that run counter to their moral principles and their understanding of what is in the best interest of their patients.
One of my main concerns is that this proposed policy is not really about the best interests or dignity of patients, but is, rather, an attempt by a few ideologically-inspired academics and medical activists to force their own beliefs onto Ontario’s doctors and patients. Simply put, it is not about choice, tolerance or diversity. Rather it is the very opposite. For it would, if implemented, reduce patient choice and restrict the cultural and religious diversity of Ontario’s doctors. And forcing doctors to betray their conscience or leave the practice of medicine in this province can hardly be termed a tolerant approach to those with whom one disagrees.
Secondly, I am troubled that some in the College have such an impoverished view of freedom of conscience and freedom of religion – both of which are guaranteed in the Charter of Rights and Freedoms – that they would deny the exercise of such rights to others. These are after all hallowed principles, developed over a millennium of struggle, that lie at the heart of the Western democratic tradition. To deny them in so cavalier a manner is to turn our backs on those things that are best about our country and its core beliefs.
Finally, I worry that this policy, if implemented, may do irreparable damage to the practice of medicine in this province. For the politicization of medicine – which lies at the heart of this draft policy – is never a good thing. Every time such politicization has been undertaken – with its advocates espousing the highest of motives – the result has been a disaster. And while the ideology at the heart of this particular policy may be slightly different from those of past social engineering experiments, the end result will almost certainly be much the same – with future generations of doctors and patients being called upon to clean up the resulting mess.
In closing, I want to thank you for providing Ontario residents like me with the opportunity to voice our views on this draft policy. It is my hope that common sense will ultimately prevail in this matter,
I completely reject the ‘effective referral” mandate being proposed by the College of Physicians and Surgeons of Ontario. I may not be the one who pulled the trigger, but if I hand the gun to the killer I’m very much an accessory to the crime. Doctors should absolutely not be forced to become accessories against their consciences – in a civilized country it’s called freedom of religion.
As a citizen of Canada, and someone who did my medical school training at Queen’s University (class of 2000), I implore you to please protect the conscience of physicians. This is a fundamental right and the only way we can best care for our patients.
I am in full agreement with this policy which requires an update in view of the recent Supreme Court decision. The latter explicitly allows medically assisted suicide but still rules out euthanasia.
As has Canada (see the preamble to the Charter), and as do many good physicians in Ontario, I have recognized and do recognize that the ruling of the supreme court still stands. “You shall not murder.” Abortion, suicide, and euthanasia are still illegal.
To compromise one’s conscience is to violate one’s moral integrity. How can any sane country demand that physicians, or anyone, do this? Physicians should be guaranteed the right to refuse to perform procedures that violate their conscience and this would include the obligation to refer.
I understand that you are accepting submissions from Ontario citizens regarding the “effective referral” mandate for doctors. I believe that this mandate is a violation of a physician’s rights, as it compels the physician to violate his or her own conscience by being a participant in the very act/procedure to which he or she objects to in the first place.
I request that this mandate be removed from the CPSO document, so that a physician’s Charter right of freedom of conscience and religion be respected.
It is tyrannical of The College of Physicians and Surgeons of Ontario to propose severely restricting the rights of conscience of medical practitioners in Ontario. The implications of the proposed policy change would be devastating for Ontario doctors who seek to inform their consciences by their faith – and not only by College policy – and who, as a consequence, may be forced to leave the province or the practice of medicine in order to maintain their integrity. These implications would also be disturbing for many patients who want to be treated by physicians who share their vision of the human person.
Is the College saying that doctors must choose between having a conscience or being successful?
I am writing with regard to the proposal that doctors should be obliged to provide a referral to provide services which they cannot themselves provide in good conscience due to moral and religious concerns. In my view, this proposal is a grave threat to freedom of conscience and freedom of religion. Doctors who firmly believe that abortion and euthanasia constitute murder cannot aid the patient in finding someone who will perform the procedure without themselves becoming – in the view of their conscience and faith tradition – accessories to murder. To say that such people, men and women of conscience who have dedicated their lives to helping people as part of the medical profession, must violate their conscience or cease to practice medicine is discriminatory in the extreme.
Not only would current doctors be forced out of practice, but students seeking to become doctors in the future will be unable to if they come from a faith that prohibits providing or abetting the practice of procedures like abortion and euthanasia. It would be tantamount to hanging a “Catholics not welcome” sign on the doors of med schools, and similarly offend many, perhaps most, other faiths. The proposed changes fly in the face of the Charter rights to freedom of religion, and must be rejected.
It is my strong belief that the conscience right of physicians should and must be respected in any policy decisions that the College may make.
To ask a doctor to refer a patient to another doctor to do what he believes goes agains his own conscience is disrespectful of human dignity and integrity.
As I have read some of the responses written by physicians, I have been impressed with their desire to continue to make medical decisions based on their conscience and their respect for life. I, personally, want physicians of this calibre.
I have also been impressed with how they have carefully looked at the CPSO draft and are aware of what the changes would mean not only for them but for their patients.
Sadly, not only will we lose excellent physicians if their concerns are not heeded, but we will be heading down a slippery slope that will affect even those who are now supporting the CPSO draft policy.
My hope is that the physicians’ input against this draft will be very carefully considered.
I am opposed to the draft policy whereby the College of Physicians and Surgeons of Ontario would force physicians to make referrals for procedures, eg, abortion and possible end-of -life issues that may violate their moral or religious beliefs.
I am a concerned Ontario citizen who have read the draft policy for the College of Physicians and Surgeons and have grave concerns for this document. This policy violates the Charter right of freedom of conscience and religion when physicians are required to provide “effective referral” of medical procedures against their faith or conscience.
As a medical patient in Ontario, I feel that my right and choice of a doctor that does not want to participate in controversial medical treatments or procedures such as physician assisted suicide and abortion is being taken away. Not only is the health care professional’s rights being violated, my own rights as a patient is being violated. This draft policy if implemented will take away my trust and faith in the Ontario medical profession.
I suggest that this draft policy be amended to respect the religious rights and freedoms of the citizens of Ontario by allowing a doctor to decline “effective referrals”.
[**MESSAGE FROM ADMINISTRATOR: DURING THE CONSULTATION PERIOD, WE RECEIVED 3 RESPONSES FROM INDIVIDUAL RESPONDENTS CONTAINING THE CONTENT PUBLISHED ABOVE. ALTHOUGH THIS FEEDBACK HAS NOT BEEN PUBLISHED IN DUPLICATE, THE COLLEGE ACKNOWLEDGES RECEIPT OF THESE SUBMISSIONS.**]
Please allow our physicians to continue to have the freedom to follow their consciences on matters concerning their patients. This is a basic human right therefore in the best interest of our society. Let us ensure that our country remain strong and free!
I understand that you are accepting submissions from Ontario citizens regarding the “effective referral” mandate for doctors. I believe that this mandate is a violation of a physician’s rights, as it compels the physician to violate his or her own conscience by being a participant in the very act/procedure to which he or she objects to in the first place.
I request that this mandate be removed from the CPSO document, so that a physician’s Charter right of freedom of conscience and religion be respected.
I am very much against this entire idea and am totally opposed to requiring doctors to assist in any way whatsoever with any procedure that is against their conscience or religious beliefs whether it is abortion or assisted suicide or any other procedure that deliberately terminates a human life.
Subject: Draft Policy “Professional Obligations and Human Rights”.
I am writing to you with grave concern regarding the content of your proposed draft policy. Sections 8, 10 and 11 suggest that physicians who decline to participate in certain acts for reasons of conscience should be compelled to refer their patients to other physicians who will perform these acts. It does not address the fact that many of these same physicians will find the act of referral itself objectionable, as they consider it material cooperation with the act. In compelling physicians to refer, you are limiting their right to conscientious objection.
There is significant disagreement in our society as to what constitutes a moral act, and I do not expect the College to define or limit morality. All I expect is that physicians, as professionals, be allowed to respect their own consciences. Freedom of conscience is foundational to our free society and cannot be limited, even for the best of intentions. If we coerce physicians into violating their consciences we will inevitably erode the personal integrity which is the basis of the physician’s relationship with their patients.
The physicians that deserve the most respect and who should be leading society are not those who would kill, but rather those who would protect life. On the day when such physicians are forced to compromise and join in the killing, our society has taken a massive step backwards; how can any other member of society withstand the onslaught that will inevitably follow.
I note also the legitimate concerns that are expressed by those members of our society who suffer from long term disability. The vulnerable of our society will have no one to defend them against those who will take their lives. Once you have silenced the physician that has a conscience, there will be no one left to protect the most vulnerable of our society.
I encourage you to revise the sections above, and include a clear defence of the right to freedom of conscience for all physicians.
This is to notify those who are concerned that it is of deep concern to me that physicians in Canada should not have the freedom to practice in a matter that conforms to their personal and religious ethics. Physicians in Canada should never be forced to be involved with the performance of certain medical acts, namely contraception, sterilization, abortion and medical assisted suicide and euthanasia that are against their religious ethics. These physicians should have the right to refer and to address the concerns of these patients in a manner that corresponds to their own religious ethics.
I am writing to you regarding the content of your proposed draft policy. Your policy suggests that physicians who decline to participate in certain acts for reasons of conscience must refer their patients to other physicians who will perform these acts. However, by requiring a effective referral these physicians who find the act requested objectionable are forced to be co-operators in this act. Compelling physicians to refer patients to another health care provider limits their right to conscientious objection.
It is dangerous to force physicians to sacrifice their integrity to support a customer centered approach to health care masquerading as client centered care. It is imperative that physicians, as professionals, be allowed to respect their own consciences. Freedom of conscience is at the very foundation of a free society and must not be limited. A system which foces physicians into violating their consciences will degrade the personal integrity which is the basis of the relationship between patient and health care worker.
I encourage you to revise your policy, and include a clear defense of the right to freedom of conscience for all physicians.
I come by this message to give you my comments on the draft law on Professional Obligations and Human Rights
Human Rights applies to both the patient’s side and the doctor.
I think yes it must respect human rights but in both directions and therefore respect that some doctors may also assert them through their own values.
It’s fine to want to meet has a majority, but there are also some people who share the same values. I do not think the Christian doctors does not ensure the life of his patient unless another doctor, but I say do not close the doors and to some colleagues that we want to be perceived as different because they share some religious values … the patient will have the choice to decide for itself to which doctor he feels more comfortable. Is that not how it happens again?
For patients’ rights, let them to choose instead to impose the same practice. It is still HIS life.
My grandfather, my great uncle, my father and my sister are all physicians. They have held dear the goal that all physicians should have as their utmost concern, the respect for human life.from conception to natural death.
Please allow in the Professional Obligations and Human Rights policy the right to freedom of conscience for all physicians.
To whom it may concern,
I am very, very concerned that we are even talking about the possibility of forcing doctors to either cooperate with something that they believe is wrong, or else to leave their practices that they have worked so hard to build. How can our memory as a society be so short? Look to any of the times in history (World War II Germany), or even places in the world right now (Middle East/ ISIS), where people are forced to go against their consciences or else suffer extreme consequences. When we can see how horrible it is in the extreme, why are we discussing taking any step in that direction in our own country? Leave doctors with the freedom to follow their own consciences and restrict the services they provide to the ones that they can do in good conscience.
I do not agree with your draft policy regarding the duties of medical professionalism where it demands that doctors must refer patients for any procedure which they are morally and ethically unwilling to perform themselves. This infringes on those doctors’ Charter rights to freedom of conscience.
My family and I want to be able to access health care from those very same doctors who refuse to compromise their beliefs and values in carrying out their professional duties.
In fact, as taxpayers, we demand that those doctors be allowed to continue to practice, so that we have a real choice when it comes to the kind of health care providers we are able to access as patients.
I have read your draft policy regarding ‘moral and religious beliefs’ and I am against your proposed draft policy.
Forcing doctor’s to act against their conscience will weaken and undermine your profession. The people of Ontario are best served by doctors who practice medicine while respecting their consciences, as opposed to by doctors who are forced to contravene their consciences.
I object to the proposed “effective referral” mandate in the draft dealing with physician assisted suicide. This “effective referral” compels a physician to violate his or her own conscience by being a participant in the very act or procedure which he or she objects to in the first place. Freedom of conscience and religion are guaranteed by the Constitution and must be respected and upheld.
I am opposed to the proposed amendments, and appalled that the policy says it reflects ‘human rights’ – what about
the rights of the unborn and the rights of some medical professionals to religious freedom. Surely these two ‘rights’ are equally as important and should be protected at all costs. Don’t force the doctors to kill.
Do NOT mess around with this. Did you know you could lose your rights to SPEAK for Doctors? OH, yes you can. And, if you continue on this path we will organize a protest the size and type which you never could have imagined. If you wish to work for Satan, come out and identify yourselves as his slaves !
I have read your draft policy regarding ‘moral and religious beliefs’ and I am against your proposed draft policy.
Forcing doctor’s to act against their conscience will weaken and undermine your profession. The people of Ontario are best served by doctors who practice medicine while respecting their consciences, as opposed to by doctors who are forced to contravene their consciences.
We wish to express to you our concern over your reported intention to force doctors to perform procedures contrary to their consciences.
If in fact doctors are currently exempt on conscience grounds from performing the above procedures, your efforts to force them to make referrals for these procedures – the Duty to Refer provision – are equally objectionable.
Freedom of conscience is one of the most fundamental freedoms in Western society.
Surely, the CPSO does not intend to violate such a sacred value.
I do not feel or think that any organization has the right to control the actions of someone, especially a Doctor, and require them to be involved in any action that they require as immoral. I thought that Nazi Germany taught us this. The action proposed allows one group or individual to utimately control everyone.
To assist in a patient’s death, or to send that patient to his/her death, no difference.
The vaguely worded Sixth item, that a doctor MUST help in the case of ‘suffering’ or ‘disablement’. Exactly what will be the criteria and who will decide, patient or doctor? And how imminent would the ‘help’ of the Doctor have to be? Guess who will decide? The left-wing high courts, of course.
Will someone please tell us exactly how we are to stop the craziness in Canada?
I am opposed to the proposed revised document. How is it possible to speak of ‘human rights’ while denying the religious rights of some medical professionals. To deny THESE human rights
is truly appalling. To not force our medical professionals to kill.
Doctors have the right to make medical decisions regarding THEIR PATIENTS in matters related to moral and ethical situations according to their beliefs, religion and conscience. Regardless of the situation life is precious at all stages and no one has the right to intentionally end a person’s life.
To the CPSO and our Canadian Doctors:
My husband and I are so deeply saddened that this policy was drafted at all. We pride ourselves on keeping up with the news and this draft policy has not been adequately presented to the public. What we need is an honestly worded question/s to the Ontario Doctors and the public so that we can put this draft in the trash where it belongs. The fact that so many people are spending their valuable time to tell the CPSO that the draft policy is unacceptable is a testament to our collective abiding nature. Physicians unite! Do make the noise that CPSO needs to hear from you. We appreciate what it took for you to become what you are today, don’t let anyone take that away from you. We stand behind you 100%. We know it’s not fair and that you are among the hardest working Canadians there are but they need to hear from you in a personal way. A National Post news item stated that the CPSO will make their decision by March 5th. CPSO and the Supreme Court of Canada- SHAME ON YOU for wreaking havoc with the minds and souls of our doctors!
“SHAME ON YOU for wreaking havoc with the minds and souls of our doctors!”–and the bodies of their patients, especially those at the beginning or end of life or those with disabilities.
doctors have the right to make medical, end of life decisions for their patients ACCORDING TO THEIR BELIEFS ,religion and conscience. no one has the right to intentionally take the life of a person who is sick, terminally ill, disabled, mentally ill, depressed, old age etc. ALL LIFE IS PRECIOUS.
I pray that doctors will never be forced against THEIR BELIEFS AND CONSCIENCE TO INTENTIONALLY KILL A PATIENT or REFER THE PATIENT TO ANOTHER DOCTOR TO DO SO. I am no longer proud to be a Canadian when a small group of people can bring forth a policy to have doctors forced to kill people. I thought Canada was a democracy. may God be merciful toward those judges.
I believe that converting someone to a religion should not be done in the workplace, however I feel that this policy is too constricting in that if a patient wishes to speak about these things then a physician should be allowed to have a conversation with them about these things. I believe that a physician should have the right to say he will not do a procedure or operation for religious reasons and if the patient should ask why, that he be able to say why. I believe that a physician should not have to refer the patient to another doctor who will do the procedure if he will not do it for religious reasons. For if he does, the physician will feel that he has done something wrong against his God by referring him to some one else to the procedure. Its like if a person believes a strip club is wrong he should not have to refer a patient to another physician who will refer that patient to the strip club. He should never have to assist the patient in doing something that he believes to be wrong. The patient should then take the initiative to find another doctor who will do the procedure.
I do not agree that any doctor should be required to go against his/her own beliefs to perform any action that would result in the death of another human being, whether that be abortion or assisted suicide. ONLY GOD HAS THE RIGHT TO DECIDE WHEN WE LIVE AND DIE!
Please, if I may ask, who on Earth raised this idea of assisted suicide? What differentiate between the pains sick people are passing through, from the pains the so called healthy people are undergoing due to the ups and downs of life. Of which some people take their life in such situations, yet we frown at such behavior. In effect, if we should encourage murder because someone is sick and in pain, we should equally encourage people who are frustrated in life, despair and wants to die but hadn’t the courage to kill themselves to go to the doctor to help them.
How can we prove that by stopping someone from breathing, we have really put an end to the person’s suffering. Who has investigated to know what is really happening when we stop breathing. If the person is actually relief from the pain or that we have worsen the person’s condition by sending him where no one is there to alleviate his pain by giving him pain killer. When shall we stop falling prey to the devil’s trick. Murder is murder and the consequences is there. So many issues which are not suppose to be heard of are now throw open for public discussion, even to the extent of think of passing it into a law. What will this law enforce? Forcing people to commit murder against their wish? I repeat my question. How are we sure that termination of life actually terminate the pains???????????
Please, please, is high time that our eyes will open, to see extent to which the devil had misled mankind, all in an effort to provoke God.
Please, I sincerely plead that this issue should with immediate effect be buried and never come to light as issue for discussion talk less of thinking of passing it as a law. It does not show true concern for some one in pain.
The new law has changed how 99.9% of Canadians will now view their doctor: from a trusted caregiver with the medical knowledge and commitment to treat and care for us to someone with the obligation to administer death. This reversal is not acceptable to most Canadians, in spite of being acceptable to the judges.
As well, our physicians should not be coerced to violate conscience, whatever its source, just as we as citizens should not be coerced to do so. I hope that as a College, you will fight this total reversal of the aim of medical care, by including a clear defence of the right to freedom of conscience for all physicians, at the very least.
Dear Members of the Consultations Committee:
I should like to thank you for opening this draft policy paper for public consultation and input.
While there is value in the document, there are areas of concern—notably the areas of “personal beliefs”, “conscience”, and “moral or religious beliefs”.
Of recent interest is the ruling of the Supreme Court of Canada on assisted suicide. I have no doubt that this will come to be a huge challenge to your profession. Without trying to pick out anything in your current standard practices as an example, the issue of assisted suicide highlights a potential issue related to conscience.
There will be physicians who will conscientiously object to ending a human life. To force them, for whatever reason, to assist in the ending of a human life by providing an “effective referral” would be to make them complicit in the very thing to which they conscientiously object.
There must be very few situations where decision making is so urgent that the patient who declines the advice of his physician cannot find alternatives without the physician being forced to violate his own conscience, his own integrity.
In Canada we have a history of legitimate conscientious objection. This is an integral part of the freedoms that we enjoy in Canada.
I would encourage you to revise the sections of the document Professional Obligations and Human Rights which refer to the “effective referral” and to any limiting of rights of conscientious objection.
More than that, I would encourage you to entrench in your document a statement declaring your support for all your colleagues and declaring freedom of conscience rights for all your physicians and surgeons.
Please be advised that I do not support this initiative and see this as a very deliberate attempt at social engineering. It is bothersome that the OCPS does not recognize the importance of ethical and moral conviction in the practice of medicine. Please register me as a NO!
Although I do not personally support abortion or euthanasia, I do understand that there are others who do not share my belief. In such a circumstance I would have thought it advisable to offer different solutions to accommodate different beliefs and not try to make this a categorical, one-sided “human rights” issue. What are human rights anyway? Did they not come from moral and ethical standards in the first place? I can not support your position and believe that such a course of action puts society on a very slippery slope.
RE. PROPOSED DRAFT DOCUMENT WHICH STATES .. “where physicians are unwilling to provide certain elements of care due to their moral or religious beliefs, an effective referral to another healthcare provider must be provided to the patient”
Dear Sir/ Madam
With due respect I am certain that it is totally wrong to force another person to violate their own conscience by being a participant in the very act,the very procedure to which he or she objects to in the first place.
I sincerely hope that your group will take this into consideration in making your final decisions.
It is my firm belief that we who live in the best country in the world – with so many great health advancements will find a fair and ethical way to resolve this matter.
I am looking forward to hearing from you sometime soon
As a loyal and concerned citizen of this wonderful and Gloriously free country I feel strongly that …
Where Physicians and Surgeons feel that for moral or religious reasons they are unwilling to provide certain elements of care- then it is morally wrong to expect that these same Physicions or Surgeons
should be required to ‘pass the buck’ by reffering these tasks to someone else.
Also, if the CPSO believes that all physicians and surgeons must ensure access to death and mutilation “services”, then their (im)morality is not merely benign but thoroughly malignant, and we need a new CPSO to teach them right from wrong.
With regard to the revised and approved draft policy Professional Obligations and Human Rights, I wish to advocate for a robust understanding and protection of the Charter right of freedom of conscience and religion for all Canadians, and indeed physicians in the daily routine of their care to patients and in the overall forming of their individual medical practices. I therefore reject the proposed mandate for an “effective referral” as it is a breach of a physicians’s rights and a serious incursion into the professional standing of a physician.
Doctors and other health care professionals, indeed all Canadians, enjoy the Charter right of freedom of conscience and and religion. In the event that Canada adopts a regime of physician assisted suicide, the threat to conscientious objection is that much greater.
If we agree to this policy of “effective referral” it is indeed a s l i p p e r y s l o p e towards vulnerability towards human life for all of us “especially towards the physically or mentally challenged” –if we are to play God. Looking towards the future, any excuse and every excuse could be applied to end human life. DO WE WANT THIS KIND OF WORLD??
The balancing of rights must be done in context. In relation to freedom of religion specifically, courts will consider how directly the
act in question interferes with a core religious belief. Courts will seek to determine whether an act interferes with the religious belief in a ‘manner that is more than trivial or insubstantial’. The less direct the impact on a religious belief, the less likely courts are to find that freedom of religion is infringed.
Please review your draft with due diligence and care and strike this policy of “effective referral” from your proposed draft.
Regarding the recent decision by the Supreme Court Justices of Canada overturning the ban on doctor-assisted suicide, I would like to question their rationale as to why medical doctors are required to assist patients who want to terminate their lives. By their very training and professional duties, doctors have upheld the care and recovery of their patients. I have always found the doctors that attended me on my numerous visits to be dedicated, concerned and helpful in my recovery. Now the Supreme Court judges, heavy-handed in their unanimous decision and without thought to the general public, will thereby force those medical doctors to go against their training and practice and become agents of death. How can these Justices act in a most un-Canadian and unjust fashion?
There have been multiple media reports of patients, in those countries in Europe which allow doctor-assisted suicide, who had been hospitalized for minor and temporary ailments and were found to be subsequently euthanized. The “killing fields” have become an European reality. We don’t want to follow suit. For certain, once this law is passed, it will create a lot of fear and anxiety among Canadians requiring hospitalization. Moreover, this fear will accompany many even on their usual visits to their doctors that they may be given lethal prescriptions instead of their expected ones.
I would strongly urge that doctors not be involved in assisted suicide. Morticians and representatives from the drug companies are the most suitable personnel for dealing with death.
As future members of Ontario’s health care system (future nurses), we find ourselves alarmed at the possibility of physicians being forced to practice medicine without freedom of conscience. As nurses, we completely understand and agree that patient care and the patient care quality are of the utmost importance. Discrimination in regards to receiving important and daily medical care is unacceptable.
However, deciding not to offer a service in no way discriminates against patients, providded that the service is not offered to any other group.
Also, for cases such as birth control or an abortion, there are many other facilities and physicians available to provide these services, and means of finding these physicians without referral is quite simple.
As patients, we would find it alarming and damaging to the therapeutic relationship, if we knew that our doctor was incapable of practicing according to his/her conscience. We are also worried that many experienced doctors will refuse to practice if they cannot do so according to their conscience, and this will drastically affect the quality of the patient care that the college is so desperately trying to protect. Any remaining physicians may decide to keep practicing, but at the expense of their own personal integrity. Interior dissonance between deeply held beliefs and professional requirements can lead to burnout.
This is systemic discrimination based on conscience or religious belief.
It will also impact patient care.
In conclusion, we are in complete agreement that quality patient care and a health care system centered on the patient is of the utmost priority. However, if this is achieved at the expense of our physicians right to Freedom of conscience, is it really worth it in the long run?
We don’t think so. Refusing to provide a service that is readily available elsewhere is not discriminatory and should not be something that physicians are forced to do.
We hope to be able to continue to live in a country where EVERYONE’S rights are protected and upheld, and not just a certain party.
Subject: Draft Policy “Professional Obligations and Human Rights”.
I am writing to you with grave concern regarding the content of your proposed draft policy, particularly sections 8, 10 and 11. The “effective referral” mandate suggests that physicians who decline to participate in certain acts for reasons of conscience should be compelled to refer their patients to other physicians who will perform these acts, even if in their reasoned judgement, that procedure is not in the patient’s or society’s best interests.
We are a democratic nation that is not governed by a totalitarian elite. Freedom of conscience is foundational to our free society and cannot be limited, even for the best of intentions. The proposed CPSO policy, by mandating that a patient’s autonomy trumps recognized conscientious and religious rights of physicians, is contrary to that Charter mandated democratic right. Charter rights of freedom of conscience and religion must be respected.
There are those, even among physicians, who do not see mercy killing as inherently wrong. There is significant disagreement in our society as to what constitutes a moral act. Physicians, as professionals, must be allowed to respect their own consciences. If we coerce physicians into violating their consciences we will inevitably erode the physician’s personal integrity and restrict their employment opportunities and career advancement. Taking a human life must be seen by Canadian society as unacceptable.
I encourage you to uphold a clear defence of the right to freedom of conscience for all physicians.
Public Health Sexual Health Nurses of the Chatham-Kent Public Health Unit To Whom This May Concern:
We the Public Health Sexual Health Nurses of the Chatham-Kent Public Health Unit appreciate the opportunity to respond to your draft policy titled “Professional Obligations and Human Rights.”
We recognize the complexity of the physician-patient relationship and it is our hope that these changes will enhance patient’s access to essential health care services.
The Public Health Sexual Health Nurses are available for sexual health questions, concerns, therapeutic abortion referrals, low cost birth control and more, while providing a non-judgemental atmosphere at our clinics.
Please encourage your doctors “who limit the health services they provide due to clinical competence or because of their personal values and beliefs,” to refer their patients to the local Public Health Unit Sexual Health Clinic Services. In Chatham-Kent these services are located at:
Chatham-Kent Public Health Clinic Services
177 King Street East
Chatham, Ontario
N7M 3N1
Phone: (519) 355-1071 x5901
Fax: (519) 355-0848 http://www.chatham-kent.ca/publichealth
Nurses as client advocates,
The Chatham-Kent Public Health Unit Sexual Health Clinic Services Nurses
As just one of many members of the public who advocate prenatal health and survival, I appreciate the opportunity to respond to your draft policy on professional obligations and human rights.
We recognize the complexity of the physician-patients relationship, and it is our hope to have everybody recognize a pre-born patient’s right to essential health services.
Pro-life pregnancy centres are available for pregnancy testing, pregnancy counselling, and practical care. They are funded and staffed by people who truly care about both the mother and her baby.
Please encourage all your doctors, to direct expectant mothers welcoming assistance–to the extent that such direction is legally possible–to crisis pregnancy centres where the health of ALL patients matters.
I am a Canadian citizen, a mother of 5 beautiful children and the wife of a wonderful husband who happens to be a Catholic Doctor. It is with great distress that I right to defend the rights of our doctors and their ethical decisions to protect life, not end life.
I am very grieved that this country and its so called judicial system have warped the meaning of compassion to mean terminating life rather than to suffer with someone, to bring value to their suffering and a redemptive property, to allow other family members the beauty of sharing in and helping their family member die a death with dignity not a death of fear.
The proposal to have our physicians forced to refer a patient with this request is more a dictatorship than a democracy, to think that our country wants to bully its physicians through fear tactics such as removing their licence to practice is mind boggling. To think that a judicial system would revoke a faithful, committed physicians licence and ruin his or her families future because they did not participate in the act of referring someone to a doctor of death is far from any democratic moral society.
Physicians do not see their calling as a job but as a vocation in life to better the wellness of humanity. I fear for my children’s future when our country and its judicial system are more concerned about sustaining a culture of death rather than a culture of life. How tragic.
This proposed “effective referral “mandate violates our very human right to take care and respect human life. We did not call ourselves into being and we should not pretend that we can call ourselves out of ‘being’.
I reject the proposed “effective referral” mandate for physicians unwilling to comprimise their conscience, in providing certain elements of patient care, based upon the fact that it is an infringement which denies their Charter right of freedom of conscience and religion..
The College of Physicians and Surgeons should concern itself solely with respecting life according to the Principle of Life itself, and not try to keep pace with the ever-evolving definitions out there. This isn’t a matter of popularity. It is a matter of integrity. You either have it, or you do not.
I would like to state that I reject the proposed “effective referral” mandate in the draft dealing with physician assisted suicide. The “effective referral” compels a physician to violate his or her own conscience by being a participant in the very act, the very procedure, which he or she objects to in the first place.
Freedom of conscience and religion are guaranteed by the constitution and must be respected and upheld.
Do not restrict freedom of conscience for doctors. Allow them to refuse to perform a .procedure that is ethically unacceptable to them, and to refuse to refer to another doctor for that procedure. Both acts would be immoral. CPSO has already recognized this in its policy regarding female genital mutilation.
If you limit doctors freedom of conscience in matters which they deem immoral you will reduce health care to a very basic level. A doctor who will kill is not the best doctor for healing. A doctor who will not kill babies, disabled and elderly is the best doctor but under your guidelines will not be allowed to practice medicine. It is very important to retain conscientious objection in health care or we do not have freedom of choice.
I write you to say I disagree with the College of Physicians & Surgeons of Ontario mandate of mandatory effective referral for prescribing the Oral Contraceptive Pill.
Ontario Doctors should not be compelled to prescribe this carcinogen and this would be a violation of their conscience rights.
I reject the proposed change suggested in the new CPSO draft document that mandates effective referral for physicians.
Physicians currently enjoy a Charter right of freedom of conscience and religion; I totally support this right and believe it must be protected. Physicians should not have to find a colleague to perform an action that they deem is either morally wrong or that violates their religious beliefs.
Whatever happened to the Hippocratic Oath? That ought to be entrenched in your document. Patients want to have trustworthy, ethical physicians who genuinely care for their health vs. efficient, polite ‘killers’ in medical robes who have stopped believing that every human life is of value. Physicians should provide the best medical care to all while “doing no harm” to their patients. This can only be achieved when it is principled and physicians have the freedom to act according to their values. Don’t force them to leave their values at the doorstep of their clinic or hospital–they are part and parcel of who they are and how they act. They guide them to act ethically.
Your proposed effective referral mandate would take away physicians moral integrity causing harm to both them and the patients they are supposed to be helping. Having to refer patients for unhealthy practices which harm them physically, mentally and even spiritually, such as contraception, abortion, invitro-fertilization (these first three also causing harm to new life), passive euthanasia, assisted suicide, etc. would perpetuate a great injustice.
Please protect the conscience and religious rights of our physicians by removing the mandate to effectively refer from your draft.
I am opposed to the draft policy whereby CPSO would force physicians to make referrals for procedures ( e.g. abortions, possible end of life issues ) that may violate their moral or religious beliefs.
Dear members of the College of Physicians and Surgeons of Ontario,
I am writing in regard to the draft policy of the CPSO, “Professional Obligations and Human Rights”, specifically to object to the section regarding ‘effective referral’:
“Where physicians are unwilling to provide certain elements of care due to their moral or religious beliefs, an effective referral to another health care provider must be provided to the patient. An effective referral means a referral made in good faith, to a non-objecting, available, and accessible physician or other health-care provider.”
This attempt to protect the human rights of patients would in fact infringe the human rights of physicians.
Physicians from before the time of Hippocrates have seen their calling as sacred, and have determined for conscientious reasons that certain sorts of requested treatment are in fact not good health care and not a part of the good practice of medicine. The Hippocratic Oath and the Declaration of Geneva both stress the sacredness of the medical calling and the physician’s duty in conscience to respect human life. The Hippocratic Oath explicitly rejects abortion and the provision of fatal drugs. A physician today who believes that assisted suicide or abortion is not in a patient’s best interests and is morally wrong would be required by the draft policy to refer the patient to another health care provider who would do precisely that act which the physician conscientiously believes is morally wrong. This violation of the physician’s conscience is an infringement of the physician’s human rights.
I urge the CPSO not to enact this policy of ‘effective referral’.
I believe that no doctor should be forced to participate in any procedure that goes agains his or her conscience. But to me that also means that the doctor should have no duty to refer patients to doctors who will do those procedures. A doctor would never be forced to perform an abortion but from this draft policy it appears he or she could be forced to refer his patient to someone who would. This goes against all principles of true freedom. The same may come to pass with euthanasia. If the Supreme Court of Canada has its way we may soon have legalized euthanasia in Canada for a variety for maladies both physical and deadly to such ailments as depression and chronic pain. No doctor should ever be forced to find someone who has no qualms about euthanasia.
Personally I would not trust a doctor who would go against his or her own conscience. You seem very concerned about patient’s rights, as you should. But there has to be a balance. The patient could ask from the get go whether the doctor has moral objections to certain things. At that point the client will be clear. The argument will be that in small towns there may not be the choice. Frankly, I’m not sure how often that happens. But I would go so far as to allow the doctor to follow his or her conscience regardless.
We are nothing without the guide of our conscience.
The same idea applies to the death penalty. Canada doesn’t allow it and nor will this country extradite someone to a country where the person charged could face capital punishment. I’m sure many people find the idea of saving the lives of murderers distasteful but yet we respect that the government refuses to take part in something it finds immoral.
Please allow our doctors to follow their beliefs. Just because something might be inconvenient for a patient is not reason to take away the one thing that makes us human rather than robots.
Dear College of Physicians and Surgeons of Ontario,
Thank you for allowing the public the opportunity to comment on your draft documents. I
would like to provide my feedback on “Professional Obligations and Human Rights.”
It goes without saying that physicians must practise with compassion, altruism, and
trustworthiness. The physician’s role is to care for everyone equally. This is what you have
outlined on your web page, “Respect for Human Rights”- respecting and supporting the public
policy goals of the Ontario Human Rights Code.
You also state that the College strives to ensure that “it creates and fosters an environment in
which the personal worth and dignity of every individual is respected.”
These goals should also include the rights of your member physicians as well.
That is why I am particularly disturbed by line 169 of the “Professional Obligations and Human
Rights” document, that a physician must provide care “even when that care conflicts with their
religious or moral beliefs.”
The duties of a physician to her/his patients should not compromise or undermine the rights of
that physician. A physician is not just some cold, unfeeling robot who jumps up at the whim of
the government or at the sound of other people’s demands.
On the aforementioned web page on human rights, you also state that: “…The College seeks
to achieve this goal … by striving to provide services to the public and the profession without
discrimination on protected grounds…”
According to the “Professional Obligations and Human Rights”document however, “Physician
A” MUST refer on to “Physician B” (for the sake of simplicity I’m using these terms) when a
patient requests a procedure to which Physician A finds morally objectionable and which
Physician B can perform.
How is this fair to the physicians of the CPSO, and how does it respect their human rights, as
you stated on your web page? Your “Respect for Human Rights” goals are double standard.
Mandating Physician A to refer a patient on to Physician B forces Physician A to be compliant
in the very act which is in conflict with her/his beliefs. This situation becomes even more
contentious by the possibility that Physician A will be prosecuted by the CPSO should she/he fail
to meet the requirement of referring on to Physician B.
The physician herself/himself in that case is being persecuted for practising her/his beliefs and
following her/his conscience. Ultimately, this is discrimination of such a physician, which is a
violation of human rights.
Since when did the CPSO become the final judge and jury of a person’s right to practice her/his
faith and beliefs?
As the CPSO protects the patients of this province, I am requesting that the CPSO fully protect
the rights of their member physicians to practise their beliefs, and to follow their consciences
and value systems without persecution.
Furthermore, that the CPSO not interfere in the realm of a member’s right to religious freedom.
I hope that you will give consideration to my feedback.
Thank you and may God bless you
Bring back the Hippocratic oath! Hitler’s Germany happened because of a slippery slope of discrimination. Let us learn from history and protect the rights and freedoms of all people from the moment of conception until natural death. Let us not bully Our physicians into acting against their conscience and partaking in this Culture of Death! Freedom!
Dear College of Physicians and Surgeons of Ontario:
I have read your draft of Professional Obligation and Human Rights. I have also completed the survey. I will also mail you a copy of this letter.
Even thought for the most part the policy draft wishes to meet the needs of all parties, it does not. It actually imposes and infringes upon the rights of individuals to exercise without compromise their religious beliefs and consciences. When one has a formed and informed conscience and deeply held religious convictions, not just personal but institutional as well, as in the collective faith of a particular religion, then there can be no compromise, and insisting, legally, that one has to go contrary to their beliefs and conscience is in itself is a violation of human rights.
I ask the College two things:
1. To take the moral and ethical stand to defend and protect human life. How can the College themselves let alone ask a member physician or surgeon to violate the principle of do no harm in both cases of abortion [and along with it embryonic stem cell research, abortifacient contraception and birth control practices methods or practices, in vitro fertilization], and euthanasia and doctor assisted suicide (AS) . Euthanasia or AS is not law yet, and I hope and pray that it never will be, for a doctor has an obligation to do no harm as every other human being has. Where was the College when abortion was being pushed in the late sixties? Where was the College when euthanasia and AS was and still is being pushed for their legalization? In the Mary Wagner legal case presently before the courts, her challenge is to challenge section 223(1) of the Criminal Code of Canada. Mary Wagner knows it, the mothers know it, so do many world religions know it, and doctors know it, that the unborn thing in the womb of a woman or in a petri dish is a human being. It is not a fact contrary to science, and it is a no brainer. But based on this outdated and erroneous law (223), the courts and professional bodies like the College, like the Human Rights Commission, make legal constructs that only want to deny the truths of the value and dignity of human beings, and force their political agendas to support the lies. The College needs to defend and protect the rights of all human beings, including the unborn, human beings that they truly are, and also those at the other end of life – the sick and dying.
Lines 166-169 of the draft document seem to be so contrary to the mandate of a physician or surgeon, to see preventing imminent harm as being ethical and moral in cases of abortion, euthanasia or doctor assisted suicide! How low have our health professions and governments gone to see such wording proposed to be part of the College of Physicians and Surgeon’s’ Policy?
2. To amend this draft document (lines 108-110, 113-117, 152-164) to ensure that physicians and surgeons be granted the protection to opt out of participating in any activity (including giving referrals) that involves or leads to the killing of human beings, at whatever stage of human development or denouement they are at, either at conception/fertilization or terminal illness, or in between. The College really needs to respect the integrity and worth of its members. That integrity starts at respecting human life and every human being from conception.
I wish you all the best in drafting a policy that will be in the best interests of all persons, born and unborn, including physicians and surgeons.
Subject: Draft Policy “Professional Obligations and Human Rights”.
I have witnessed the gradual erosion of the rights of health care workers in this province in the past generation and am no longer content to remain silent on the matter. I have serious reservations about certain sections of the CPSO’s draft policy; specifically, sections 8, 10 and 11. These clearly violate the right to conscientious objection by requiring physicians whose consciences prevent them from engaging in certain procedures to refer their patients to other physicians who will perform these procedures. This in itself is unconscionable, for by forcing physicians to refer, they would be rendered morally complicit in the procedure itself.
Our society was predicated on the freedom of conscience. Each and
every one of us, physicians included, should be allowed to respect their own informed conscience. The CPSO should not be the arbiter of morality, but rather, should respect their members’ freedom of conscience. Coercing physicians into violating their consciences will ultimately damage the physician’s relationship with their patients.
I encourage you to revise the sections above, and include a clear defence of the right to freedom of conscience for all physicians.
I strongly oppose this policy change. It would greatly affect the physicians ability to deal with their patient’s honestly, as well as infringe on their rights and freedoms.
Religion (or lack of), is the true identity of oneself and will manifest itself at some point in ones life, and physicians are not excluded from this.
I am deeply scandalised and sad that the supreme court has forced the government to come up with new laws that will force physicians, surgeons and patients to abide by new rules that will go against their freedom of conscience. If those who dared contesting our freedom of conscience get away with forcing the creation of news laws going against freedom of conscience, then it will open the door to anything goes regardless of objections from those who cherish their freedom of conscience.
If a person’s freedom of conscience in matters of right to life until natural death is to be contested by news rules, then we are no longer free persons but prisoners of conscience. What is coming to this world anyway? Two world wars were fought to keep our country glorious and free, the very words in our national anthem.
If our freedom of conscience is eroded through the will of a few who have been appointed (almost all) by our present Prime Minister, how are we going to feel singing our national anthem when those dark days come to pass in what a lot of canadians consider unfair laws to say the least? It is something to ponder about.
Hippocrates, the father of Western medicine stated “Do no harm”.Doctors must not be compelled to participate in abortion,euthanasia, or any other services which destroy life. They are to be people who care for others and support life. If their convictions. or conscience does not allow them to provide a service, they must not be required to refer their patient to another doctor who’d provide it. Doctors who don’t comply must not face disciplinary action.
The draft policy is contrary to democracy, tradition and “The draft policy contradicts the Code of Ethics of the Canadian Medical Association :
7. Resist any influence or interference that could undermine your professional integrity.
9. Refuse to participate in or support practices that violate basic human rights.
12. Inform your patient when your personal values would influence the recommendation or practice of any medical procedure that the patient needs or wants.
23. Recommend only those diagnostic and therapeutic services that you consider to be beneficial to your patient or to others.
16. Health care providers should not be expected or required to participate in procedures that are contrary to their professional judgement or personal moral values or that are contrary to the values or mission of their facility or agency. Health care providers should declare in advance their inability to participate in procedures that are contrary to their professional or moral values. Health care providers should not be subject to discrimination or reprisal for acting on their beliefs. The exercise of this provision should never put the person receiving care at risk of harm or abandonment….
11. If a health care provider cannot support the decision that prevails as a matter of professional judgement or personal morality, allow him or her to withdraw without reprisal from participation in carrying out the decision, after ensuring that the person receiving care is not at risk of harm or abandonment.
The CPSO must defend freedom of conscience rights strongly.
While this policy is seeming to place the emphasis on the physician’s moral or religious views, ultimately it seems to be saying that a ‘physician is entitled to do whatever his patient requests regardless of the physician’s knowledge and experience’. While I agree a physician’s moral and religious views can influence his practice and services given, so much more also does a physician’s health knowledge and experience give credibility to his morals and religious beliefs. A patient with limited knowledge may be requesting a procedure that is totally not the proper or necessary procedure. By limiting a physician’s approach and discourse on the subject, you are making the patient’s limited knowledge worth more than the physician’s much higher knowledge. Furthermore, in the same regards, there has to be a datum for even doctor work from a moral standpoint. If a patient believes in killing themselves, are we now to judge that that is ok because the patient wants it. We have to give some credibility to the high standing a physician has and at least allow the physician to discourse with the patient on moral and religious views.
As a medical student, I am thankful that the CPSO has had a second public consultation on this policy.
I have confidence that the CPSO will utilize the substantial feedback provided in this public consultation when drafting the final policy and when revising this policy. I hope this consultation is not simply an administrative hurdle; I hope it shapes policy.
The overwhelming majority commenting here recognize the importance of protecting physician conscience rights in addition to providing care to patients. A referral is not necessary for many medical procedures that physicians are opposed to in Canada (abortion is self-referral, physicians who do not prescribe birth control tell their patients in advance in detailed forms or with signs, etc.). A referral is not a necessary part of this policy and should not be mandated by the College. Providing information on all options available should be enough. Patients self-refer for a number of other services and do not require referrals for those as well.
I am pursuing a career in Family Medicine starting this July. I sincerely hope that my right to conscientious objection under the Charter will be respected, especially in light of the latest reassurances of conscience protection for physicians from both the Supreme Court of Canada and the Canadian Medical Association.
Thank you for consulting the public on this important issue, and once again, I hope all of these comments will be read and have an impact on the revision of this policy.
I congratulate the CPSO in makig this discussion forum public. This policy comes from an organization that is meant to uphold the highest standards of professionalism, and to serve the public trust. I would propose that with this policy it has failed on both fronts, and that considerable self-reflection by the CPSO into its own process of policy-making is in order. Restoration of the organization’s status as a dependable leader depends on it.
I am a BC family physican who has worked both in sessional and private office-based practice in addressing the needs of vulnerable populations.
I commend the CPSO for allowing for response not only from physicians outside of Ontario but also the general public, for in doing so the CPSO is acknowledging that physicians outside of Ontario as well as the general public are important stakeholders in this process. Most Canadian physicians outside of Ontario would agree that proposals drafted in one Canadian province certainly have potential to be precedent-setting in impacting decision-making at the College level in other provinces.
Our office group recently started discussing the proposal drafted by the CPSO, and we were significantly concerned in particular about how lines 155-169 of this proposal may affect the protection of conscience rights of physicians across Canada across all disciplines and specialties. Particularly in the wake of the Supreme Court ruling on February 6th regarding physician-assisted suicide, conscience protection has now become an issue not only for those whose clinical duties include reproductive medicine, but for any physician who works with a patient suffering from an illness, disease, or disability. In short, it now affects us all of us who practice clinical medicine. The fact that a CMA poll revealed that 91% of physicians polled at last summer’s meeting support the right of physicians to act within their conscience with respect to medical aid in dying seems to make it difficult to justify a policy that necessitates physicians acting against their conscience in certain situations described in the draft policy, situations which certainly could include a patient request for physician-assisted suicide.
We were also concerned that many of us did not even realize until quite recently that such a potentially precedent-setting proposal was being tabled, and that it was not through official regulatory body communication to Canadian physicians that we heard of this but rather by word of mouth.
We certainly empathize with the challenges faced by the CPSO in responding responsibly to complaints made by patients who feel that their human rights are being violated when they encounter physicians who do not provide the services they seek, for reason of physician conscience. However, we would submit that the mere existence of these situations does not mean that physicians are in professional error for respectfully declining to provide certain services for reason of conscience, but rather that the existence of these scenarios is the challenging by-product of the good phenomenon of diversity in a free society. While one of Canada’s strengths as a nation is the many freedoms afforded to its citizens (e.g. freedom of speech, religious assembly etc), these freedoms by nature do result in a diversity of opinions on moral, ethical, and religious matters in both private life and how private expression of personal views may be conducted appropriately in public life. With diversity of opinion there will inevitably be times at which opinions clash, and where one citizen may hold a view that is diametrically opposed to another. Canada’s diversity is a hallmark of our nation, but it does present a not insignificant challenge to legislators and regulatory bodies such as the CPSO in how to enact policy that will allow for individual diversity of opinion to be upheld while maintaining overall public peace and harmony for the common good.
One particular challenge in addressing diversity and freedom of opinion within the context of the doctor-patient relationship is the fact that there is an inherent power imbalance in this relationship, necessitating the frequent reminder to physicians of the fiduciary nature of their roles. Society has granted physicians access to valuable knowledge and skills not available to the general public, and physicians, as guardians of this sacred trust, have a duty to uphold the best interests of their patients in every clinical encounter. The privilege of having a fiduciary role must never be used to exploit for the purpose of personal gain, be it financial gain from services provided or perhaps “ideological gain” from pressuring a vulnerable patient to verbally express conformity to the physician’s personal views on moral issues when the patient in fact does not truly assent to these views. At times, this fiduciary role may also entail some measure of personal sacrifice on the part of the physician in terms of the impact of clinical duties on his or her personal life. However, having a fiduciary role does not mean that the physician must be subjected to the unnecessary and significant personal harm of being forced to act against his or her conscience, or that the physician should be pressured to express personal conformity to the patient’s personal values and beliefs. In fact, pressuring physicians to act against their conscience presents an erosion in itself to the fiduciary relationship, as the physician is now truly not in good conscience acting in the best interests of the patient. In this, we agree with lines 76-78 of the proposed policy on limits of the duty to accommodate patients presented with barriers to access of care, which states that:
“While physicians have a legal, professional and ethical duty to accommodate, there are limits to this duty. Physicians do not have to accommodate beyond the point of undue hardship, where excessive cost or health or safety concerns would result. The duty to accommodate is also limited where it significantly intereferes with the legal rights of others.”
In our opinion, expecting physicians to act against their conscience in any situation presents undue hardship to physicians and certainly interferes with their own legal rights.
While we commend the CPSO for trying to respect physician conscience in non-emergency situations by providing referral to a colleague as an alternative, we are concerned that this fails to adequately address conscience protection as a significant number of physicians currently hold the view that referral entails complicity. Diversity of opinion on this topic must be respected at the College level, particularly given that a physician may by some regulatory bodies be found culpable of complicity by referring for procedures that most societies believe to be objectionable e.g. female genital mutilation.
We are also concerned that the last lines of the policy regarding a duty for physicians to provide “care that is urgent or otherwise necessary to prevent imminent harm, suffering, and/or deterioration, even where that care conflicts with their religious or moral beliefs” is too loosely worded so as to allow for abuse of interpretation in scenarios unintended by the authors of the proposal. Again, given that physician-assisted suicide will be legalized within the coming 12 months, and as currently defined as to eligible patients, it is entirely possible that physicians across all disciplines may be faced with the threat of discipline if they object to providing this service or urgent referral for physician-assisted suicide. As currently estimated percentages of physicians comfortable with providing this service are at best 27%, it is very concerning as to how this draft proposal may affect the remaining 73% majority.
Lastly, we humbly submit that perhaps there is another way of respectfully addressing the challenges of living in and practicing medicine in a diverse society. Currently, adherents to some religious groups within medicine certainly have expressed their view that this draft proposal has ostracized them and could create an intolerant environment in which it would be impossible for them to continue to provide clinical care in good conscience in Ontario. A more collaborative approach would be to perhaps invite important stakeholders from a diverse cross-section of religious and moral beliefs to work together to create policies that could address the particular clinical scenarios they seek to improve, rather than imposing a blanket policy that will certainly create harm on not just those said physicians, but potentially on Ontario taxpayers as well by the potential for significant court battles should this policy be approved.
We are concerned that the religious & moral freedom of physicians is not adequately protected by this draft policy. To provide a direct and effective referral to a morally objectionable act (such as intentionally ending the life of any innocent human being) is to become materially complicit in that act. Furthermore, it is fair to say that a doctor or other health care professional objects to both an abortion and euthanasia on clinical as well as moral grounds, as his or her profession is the care of the body, and these acts are contrary to the health of the bodies (in the case of abortion) or body. A healthcare professional should not be silenced from sharing the scientific fact that an abortion or assisted suicide ends an individual, unique, and viable human life. Other morally objectionable services are often contrary to the health and well being of the body as well, and healthcare providers should be encouraged to share these professional, clinical concerns so that the patient is given the most complete information with which to make their decision.
Subject: Draft Policy “Professional Obligations and Human Rights”.
I am writing to you to voice my concern with your draft policy and in particular to the following statements under the section entitled “Ensuring Access to Care” (2015):
“Physicians must not withhold information about the existence of a procedure or treatment because the procedure conflicts with their religious or moral beliefs.
Where physicians are unwilling to provide certain elements of care due to their moral or religious beliefs, an effective referral to another health care provider must be provided to the patient. An effective referral means a referral made in good faith, to a non-objecting, available, and accessible physician or other health-care provider”.
I ask you to strike out the requirement “to provide an effective referral.” This proposed section of the draft policy is deeply troubling because it does not address the fact that many of these same physicians will find the act of referral itself objectionable, as they consider it material cooperation with the act. In compelling physicians to refer, you are limiting their right to conscientious objection.
The conscious moral and religious objections of individual physicians need to be respected. As such, physicians should have the right to object to the direct performing of the service in question and to participating in the acquisition of such a service through acts such as referrals.
I ask that you allow physicians, as professionals, to respect their own consciences. Freedom of conscience is foundational to our free society. If we force physicians into violating their consciences then we threaten the very basis of the physician’s relationship with their patients to serve patients truthfully.
Subject: Draft Policy “Professional Obligations and Human Rights”.
A member of my congregation who is a physician has approached me recently with a concern that he might have to leave his profession because of current legislation being considered that would force him to act against his conscience.
There is significant disagreement in our society as to what constitutes a moral act, and I do not expect the College to define or limit morality. All I expect is that physicians, as professionals, be allowed to respect their own consciences. Freedom of conscience is foundational to our free society and cannot be limited, even for the best of intentions. If we coerce physicians into violating their consciences we will inevitably erode the personal integrity which is the basis of the physician’s relationship with their patients.
I encourage you to revise the sections above, and include a clear defence of the right to freedom of conscience for all physicians.
I am writing with regards to the proposed Draft Policy that will limit physicians Right to Conscience and Freedom. I have read the draft policy and am deeply troubled by the blatant discrimination that is found within it.
By attempting to limit the right to freedom of conscious and religion through mandatory referrals for treatments/procedures physicians find morally objectionable, it is obvious that this policy is trying to drive out of medicine any doctor who does not blindly follow a pro-abortion, pro-euthanasia and pro-contraception mindset. In addition, it it equally discriminatory against patients like myself and my friends who have actively sought out doctors who share the same moral worldview as we do. We do no trust a physician to care for our unborn child who would just as happily cut him to pieces, our elderly mother to one who would just as happily euthanize her, or our sexuality to one who just pushes the Pill on us.
This totalitarian Draft Policy will take away our health care providers as well as taking away the livelihood of any doctor who actually cares about the lives of all of his/her patients, unborn, disabled, terminally or chronically ill. It needs to be changed immediately to reflect the freedom of ALL doctors – not just the abortion/euthanasia/contraception pushing ones – to act on their well-formed conscience which obviously includes not referring for a procedure/treatment that he/she deems morally unacceptable.
Canada is a multi-cultural and diverse society – the College of Physicians and Surgeons blatant attempt to discriminate against entire groups of doctors and patients in such a society is deplorable.
Dear CPSO: I do not understand why, after all the feedback CPSO received in support of freedom of conscience during the earlier round of consultations which ended in August 2014, CPSO would include in its “Professional Obligations and Human Rights” policy a requirement for physicians who morally object to certain procedures (like abortion, euthanasia, and physician-assisted suicide) to make “effective referrals” to a “non-objecting, available and accessible physician or other health-care provider,” as this amounts to complicity in an act that the physician finds morally reprehensible: the taking of a human life. Your policy also requires physicians to perform these procedures in certain situations. It is not in the best interests of anyone in our society to force physicians to do what they believe to be wrong.
I fully agree that patients should not be discriminated against. But refusal to facilitate the provision of certain procedures does not involve discriminating against a patient, it involves discriminating between various “treatments.” When a physician does not want to offer a “treatment” that kills, it is because the physician believes that “treatment” is morally wrong, regardless of who the patient is. In fact, the physician is treating all their patients equally in not offering the offending treatment to any of their patients.
Your policy is also unfair to those residents of Ontario who want to be treated by physicians who respect the inherent dignity of all human beings, including the most vulnerable, and who do not see intentional killing as a solution to a medical or social problem. That is because the CPSO policy could have the effect of weeding these conscientiously objecting physicians out of the profession, leaving only physicians who are willing to kill to treat the people of Ontario (although this would no doubt please the abortion and euthanasia activists who have been trying for years to impose such a policy on the rest of us: see recent press release by Member of Parliament Maurice Vellacott, responding to a similar policy of the College of Physicians and Surgeons of Saskatchewan: http://www.mauricevellacott.ca/2003%20MV%20Speaks/Jan.%2029,%202015%20-%20MV%20Release%20-%20Saskatchewan%20physicians%20to%20be%20forced%20to%20participate%20in%20killing%20their%20patients.pdf
And what about physicians who object not to abortion, per se, but to some abortions, like sex-selective abortions? Those physicians will have to refer for sex selective abortions since such abortions are legal in this country. Abortions are also legal for the full nine months of pregnancy, so if a woman wants one for whatever reason, a physician who may support abortion in the earlier stages but feels queasy about killing a near full term fetus, will be required to refer for a late-term abortion. Has CPSO contemplated these scenarios?
There are so many ethically problematic and discriminatory consequences that would result if CPSO tries to coerce physicians into doing what they believe to be wrong. CPSO, please uphold physicians’ freedom to practice medicine according to their sincere and deeply-held conscientious convictions. Please ensure your policies are respectful of the rights of all Ontario physicians, not just the ones who support the use of life-ending procedures like abortion, euthanasia and assisted suicide as “solutions” to life’s difficult problems. And in so doing, you will be serving the needs of all Ontarians, regardless of their conscientious/religious beliefs.
Thank you for the opportunity to comment on your proposed policy, “Professional Obligations and Human Rights.”
As a citizen of Ontario, I am writing to inform the CPSO that I reject the proposed ‘effective referral’ for doctors whose charter right to freedom of conscience and religion must be respected.
With the legalization of assisted suicide, I am concerned that physicians will be forced to go against their religions and beliefs in order to take part in euthanasia. Please respect their religions and beliefs. Taking part in assisted suicide is taking part in murder.
Dear Sir or Miss or Mrs.,
I would like to express my dismay regarding this proposed policy. I feel this proposal undermines the freedom of conscience of the physician if he is forced to give counsel or treatment to a patient against his beliefs and values. The policy would undermine the doctor’s human right while the patient is free to seek alternative avenues – their right is not taken away. This policy is discriminatory and should not go forward. Thank you for your consideration.
We are writing to you because of our concern about your recent policy proposal.
The proposal is for a policy change that will mandate that physicians will have to make referrals for procedures and “treatment” (such as abortion, euthanasia, assisted suicide) even if doing so would be against their conscience.
If implemented such new policy would contradict and violate physicians rights guaranteed in the Canadian Charter of Rights and Freedoms.
Please protect physicians fundamental human right to act based on their conscience without fear of being persecuted.
I am writing to support conscience rights for doctors. The proposed policy of the Ontario College of Physicians and Surgeons would mandate referral for treatments that many doctors believe are bad medicine.
My own family doctor’s moral stance against abortion, assisted suicide or sterilisation is, I know, not merely a personal belief; rather she has reached this position through scientific knowledge, medical experience and philosophical reasoning. She is convinced as a professional that some medical procedures are not good for her patients, and she will not practice them nor counsel her patients to seek other doctors who would be willing so to practice. She rightly fears that should the proposed policy be enforced, she would have to give up medical practice entirely. And that would be an enormous loss for our small community.
Such doctors should be protected from any and all compulsion to act against their consciences. These consciences were formed in the crucible of family practice and deserve respect. I for one am grateful to have found such a doctor !
With the ever increasing decrease in morals and simply doing what is right, the LAST person I want to do things simply because of a direction or money is my Doctor or Dentist (There enough un scrupulous people in the world, that if a Doctor does not want to do something he should be able to have the right to provide information or suggestions for a patient to see one of those people).
When people are forced to go against their morals eventually the lines for everything get blurry and they start handling any/all situations with a sense of un concern for the right or wrong.
We do not support this type of policy to be imposed on any professional person what we are expected to be able to trust.
To the College of Physicians and Surgeons of Ontario,
I am providing some of the requested feedback on the proposed policy of Professional Obligations and Human Rights. I write as a practicing pediatric surgeon who completed part of my training in Ontario, a citizen of both Canada and Germany. I am concerned about the proposed policy’s limitations of the freedom of conscience for practicing physicians and presumably trainees. I support the efforts directed to protecting access to health care, but I think the solution you have arrived at – limiting physician’s ability to follow their conscience in circumstances deemed by the legal system to limit patient access to health care – is intrinsically flawed.
At the United Nations Organization the international community has respected the freedom of conscience and religion.1 It has also acknowledged that the basis for doing so is the dignity of the human person, acting freely “according to the imperatives of conscience.”2 It is a serious proposal to systematically deny these rights to a group of people. Would the CPSO recommend this proposal as an advisable policy for other Colleges? What about an environment where it is legal and requested by patients to provide female genital mutilation? While I think this is a terrible practice and would conscientiously object, would I be limited in my ability to do so by this policy? As a pediatric surgeon I would have a hard time claiming I do not have clinical competence to do this surgical procedure and I would still be unwilling to refer a patient, generally a child whose parents are making decisions for her and may feel there is a sense of urgency, to another practitioner who does not object. Perhaps this seems to be a ludicrous and extreme example, but I work in Africa and can see that systematically denying physician’s rights could be very dangerous and conceivably lead to such a situation. I would not want the law to assume the right to decide my professional actions if and when they violate my conscience. An example that occurred in the country of my birth, in the last century, is the well-known example of doctors working under the fascist Nazi regime, which mandated their participation and removed the ability to conscientiously object to horrific experimentation, sterilization procedures, and killing of patients based on the legal requirements of the day. I hope that I would have had the strength to object, but many physicians did not. If I have grown used to being denied the right to follow my conscience due to my profession, how much would I question it if the law decided to mandate sterilization of certain segments of the population? What else would I do if legally required? The Milgram experiment on obedience to authority figures, where subjects are prompted to give increasing voltage shocks to another subject that is apparently in pain or even unconscious as a result, has shown that humans are very susceptible to follow orders and ignore their conscience.3 Stanley Milgram concludes that “Ordinary people, simply doing their jobs, and without any particular hostility on their part, can become agents in a terrible destructive process. Moreover, even when the destructive effects of their work become patently clear, and they are asked to carry out actions incompatible with fundamental standards of morality, relatively few people have the resources needed to resist authority.”4 What would happen when the cooperation with authority over following one’s conscience is the expectation?
I am concerned as a human who values my freedom of conscience, and specifically as a catholic, that I will be expected to provide medical treatment, or referral for the same, that is morally objectionable. When commenting on this particular problem, John Paul II stated that “To refuse to take part in committing an injustice is not only a moral duty, it is also a basic human right. Where it not so, the human person would be forced to perform an action intrinsically incompatible with human dignity, and in this way human freedom itself, the authentic meaning and purpose of which are found in its orientation to the truth and the good, would be radically compromised. What is at stake therefore, is an essential right which, precisely as such, should be acknowledged and protected by civil law. In this sense, the opportunity to refuse to take part in the phases of consultation, preparation and execution of these acts against life should be guaranteed to physicians, health-care personnel, and directors of hospitals, clinics and convalescent facilities.”5
While I applaud the stated goal of the policy to care for patients in a “manner that is respectful of the dignity, autonomy and privacy of the person”, I am concerned that this same manner is not extended to the physicians affected by it. Do you think the proposed policy maintains the autonomy of the physician? Is this without value?
I thank you for having this consultative process prior to making such a policy change and urge you to change the method of safeguarding access to health care in such a way that you do not remove the human right and freedom, enshrined by the United Nations, of following one’s conscience.
1.United Nations Declaration on Human Rights, Dec. 10, 1948 (article 18): International Covenant on Political Rights of the United Nations on Dec. 16, 1966. (article 18).
2.Final Act of the Conference on European Security and Cooperation. Aug. 1, 1975.
3.Milgram, Stanley (1963). “Behavioral Study of Obedience”. Journal of Abnormal and Social Psychology 67 (4): 371–8.
4.Milgram, Stanley (1974). “The Perils of Obedience”. Harper’s Magazine. Abridged and adapted from Obedience to Authority.
5.Evangelium Vitae, Encyclical Letter, John Paul 11, 1995
To Whom it May Concern,
I am compelled to provide feedback regarding The College of Physicians and Surgeons of Ontario’s new revision to “The Physicians and the Ontario Human Rights Code.” The revisions in which the doctor must prescribe – or refer a patient to a doctor who will prescribe – anything which he or she is against, goes against our most basic rights as Canadian citizens. What the doctor believes, regardless of whether it is based on moral views or mere health considerations, he has every right to uphold. In a country where we are free to believe what we please and practice as we please, it is abhorring that such rules are even being considered in the revision. It seems as though we are becoming less free despite the fact that our country is in one of the most free phases it has ever been since its foundation. For the patient looking for anything from abortion and contraception to euthanasia, there are many doctors who will provide those things, it is completely unnecessary that every doctor be obliged to provide them. I completely agree that the greatest respect should be shown to each and every patient, however I do not believe that the only way of showing respect and care is by giving the patient whatever he or she requests. This is an abuse to the doctors of Ontario. I hope that these changes will not be implemented, for I fear that if they are, Ontario will lose many of its respectable and good doctors. That would be the worse slight to all patients. Please consider the consequences of the revision of this policy.
I am completely opposed to the proposed mandate to require physicians in Ontario to refer patients to doctors willing to commit euthanasia.
This is a complete violation of freedom of religion and conscience and I am appalled that it is even being considered. If you bring this policy in, it will be challenged to the Supreme Court. It will also drive out physicians from the province.
I am against this new draft policy which includes measures that basically force physicians to take measures that go against their consciences. Please do not change the policy. Thank you
1. This draft policy is claimed, (by CPSO) to be a policy which necessarily flows from the Ontario Human Rights code and the Charter of Rights and Freedoms of Canada. This is a misrepresentation of the facts. This policy is going “beyond” each of these. There is no “right to treatment” in either document, so for the CPSO to claim that this document is balancing rights is not accurate.
2. Our society depends on ethical and moral behaviour from its citizens. It should not be difficult to see where trampling of these ethics and morals leads. If doctors cannot act on ethical and moral values, then who can? Who is next? If you are going to posit that the ethics and morals are appropriately dictated by a governing body, such as (self appointed) members of the CPSO, then who gives them such authority? Is the current, at any time, popular fad enough? If killing people (far any reason) is now called medical care, is there any limit to where we may find ourselves?
St Mary's Parish Council (Chairman), Carleton Place I,too, am opposed to the draft policy whereby the College of Physicians and Surgeons of Ontario would force physicians to make referrals for procedures (e.g. abortion, possible end-of-life issues) that may violate their moral or religious beliefs.
I do not like this draft. There is a constant negative attitude towards religion, suggesting the state to be supreme, and doctors’ decisions to be better and more skilled and knowledgeable. Medicine is a very fine profession but it is a technical training, not a moral training. Doctor’s only know science, medical science, not all the deeper dimensions of theology, ethics, morality and spirituality. Doctors made their own decisions in concentration camps.. thousands did. They were given this right by the state. Religious leaders were mocked and thousands murdered. Do we not have any sense of history?
This draft is anti-life. I ask that it be rescinded as it will take us down yet another very dangerous path, in conscience. And it means that moral minded, faithful doctors will have to ‘ditch ‘ their consciences.. as will all health careworkers. Kill the draft, please
I appreciate the opportunity to voice my views and the willingness of the CPSO to engage in an open dialogue on the issue of whether it is discriminatory to refuse to refer or in some way or other aid and abet a patient-driven healthcare decision. I am a physician working in a busy hospital.
In the conduct of my practice I am often asked by my patients for recommendations as to what to do in difficult situations.
In addressing these issues I rely on my knowledge base and clinical judgement to be the best patient advocate that I can be. My clinical judgement is informed by my experiences and by my conscience: my experiences because I all too often am also involved in trying to redress the consequences of patient inactions or ill-advised actions, and my conscience because it provides me with the confidence and conviction I need in making my recommendations. Built on a set of defensible moral principals, my conscience guides my activities and moral decisions, across all dimensions of my professional and personal life. It is different from my beliefs which are inherently personal, not defensible, and which do not and should not have a role in my clinical judgement.
Without my conscience serving as a reference point and as a compass for my clinical judgement, I would be left with only my knowledge and my experience to help me in my dealings with increasingly complex medical issues. I believe that patients benefit from the reliance of their doctors on their conscience. I also believe that the doctors are better and more compassionate when they can incorporate their conscience with their interactions with patients.
To follow one’s conscience and refuse to aid and abet a patient in pursuing a course of action that is at odds with one’s moral principals is not discriminating against the patient’s rights. It is simply allowing doctors to be the best patient advocates that they can be.
My significant concern is with the section on Limiting Services on Moral or Religious Grounds. Were the opportunity for more indirection present, as I’ve onlined, it still serves the purpose outlined by the College, while respecting my religious right not to do certain things.
I am grateful for the opportunity to again voice my grave concerns with regards to your present draft policy: Professional Obligations and Human Rights.
I was very taken back by the contents of this proposed draft as it did not seem to include any of the many objections provided in the first “Physicians and the Ontario Human Rights Code policy back in September 2008.
In reviewing this recent draft policy we were very concerned about the tone and use of wording that seemed to strip the physicians/surgeons’ God-given rights to their well-informed conscience and moral obligations. It seems that the CPSO is sadly discriminating against their own by attacking the integrity and professionalism of all physicians/surgeons and threatening to remove their licenses if they do not conform to the CPSO’s views on what is ethical and moral. This forceful method only causes anxieties for both physicians/surgeons and a multitude of patients who depend on these good physicians/surgeons. How can such a policy benefit the greater good of society at large in Ontario, when we already battle the shortage of physicians/surgeons? It is obvious that a sudden exodus of many good morally conscious physicians/surgeons would create a panic for the patients left behind and an overload of patients for those physicians/surgeons left to pick up the load. How can the CPSO claim to provide services without discrimination by first discriminating against their own?
The following resolution presented previously and still being presented is what is needed to protect all parties concerned: CPSO can require all physicians/surgeons to post an upfront declaration of where they stand with regards to their moral and religious views (i.e. access or not to contraceptives, morning-after-pill, assisted suicide, etc.) or their own clinical/medical competence (i.e. child specialist, geriatric specialist, gynaecologist etc.). These physicians/surgeons have no need to post a list of alternatives and referrals as this would be morally wrong for them. Such upfront signs or declarations would in no way affect negatively the fiduciary nature of the physician-patient relationship; instead it would strengthen it, as all parties would be on the same page. After all we live in a world that provides easy access to everything one inquires about through internet, phone books, and word of mouth, just add “signs or declarations in all these areas and all would be taken care of without causing any discrimination against these good physicians/surgeons or the patients.
Other concerns are who defines “ethical” and “health”? Certainly one with no moral conscience or a weak and ill-formed conscience would do so quite differently than one with a well-formed conscience.
Did CPSO take note of the Classic Hippocratic Oath of 1943 (by Baltimore: John Hopkins Press) where it states “I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect. Similarly I will not give to a woman an abortive remedy. In purity and holiness I will guard my life and my art.” Even if you would choose the 1964 modern version (by Louis Lasagna, Dean of the School of Medicine at Tufts University) instead, we would hope that you would be mindful of these words “Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God…May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.” Please pay particular attention to the words “I must not play at God” and “May I always act so as to preserve the finest traditions of my calling”.
The policy you are proposing only serves to undermine the foundations of all democratic freedoms, not to mention human rights. History and the present shows us that all totalitarian states have one thing in common and that is the rejection of Christian morals and beliefs about the innate value of the dignity of all human lives from conception to natural death.
Physicians/surgeons who refuse some of these so-called “procedures” because of their well-formed consciences are no different from those who would refuse the same “procedures” on account of the scientific evidence that support their decisions – this is exactly what “the patient’s best interests must remain paramount” means. The very physicians/surgeons you (CPSO) are targeting are only placing their patients’ physical, emotional and psychological health (both long-term and short-term) at the forefront … that is being mindful of their patient’s total well-being. It is very puzzling to see CPSO discriminating against them; have you not considered their rights? Are you not imposing a grave burden upon them and denying them their rights? This draft has all indications of being intentional discrimination against physicians/surgeons of faith and moral obligations.
We pray that the CPSO will reconsider this clear mandate to ignore the very foundations of democracy by attacking clearly innocent physicians/surgeons and this time around listen to the many who are sharing their legitimate fears for the loss of democratic freedom of speech and religion. We must learn from history and avoid repeating the grave errors committed against the God-given dignity and life of every human person from conception to natural death regardless of their race, ancestry, place of origin, colour, ethnic origin, citizenship, creed, sex, sexual orientation, gender identity, gender expression, age, marital status, family status or disability. Doctors swore an oath to do no harm to any of their patients. Because of this, it is their obligation to inform them of what through evidence is either good or detrimental to their patients’ well-being and so why would the CPSO want to cast them out for doing exactly as they vowed to do?
Subject: Policy “Professional Obligations and Human Rights”.
I am deeply concerned about the content of your proposed draft policy. Sections 8, 10 and 11 propose that if it goes against a physician’s conscience to participate in certain acts, then he must refer the patient to another physician willing to perform these acts. It does not take into account the fact that the act of referral makes the physician indirectly responsible for the act. In getting the physicians to refer, you are limiting their ability to refuse participation in this act that according to some beliefs are immoral, by making them part of it.
When it comes to judging if an action is moral or not, it may be difficult for anyone to set the rules. Every person has different beliefs and moral standards; the important thing is to respect these differences. The ability to have freedom of conscience is so fundamentally important to human dignity. If we try to limit physicians’ rights to this freedom, it could make their lives very difficult and subject them to injustice. Physicians are meant to promote health and human life, anything against their freedom of conscience should be especially spared considering they already face enormous pressure in their day to day lives. Allowing their integrity as physicians will lead to the maintenance of better relations between the physicians and the patients.
I encourage you to revise the sections above, and include a clear defense of the right to freedom of conscience for all physicians.
I agree. Physicians should have the right to say no to providing certain forms of treatment. However, I’m particularly concerned with the requirement that physicians provide referrals for treatments which they feel are morally and ethically wrong. If a physician feels a treatment is morally and ethically wrong, then aren’t they still violating their conscience by asking someone else to perform the procedure? How is the physician’s right to freedom of conscience being protected under these circumstances? In addition to this, a physician might feel that if a procedure is morally wrong it would also be harmful to the patient. Under these circumstances the physician would be violating not only their conscience but also their hippocratic oath by referring the patient to someone else to perform the procedure.
The College is mistaken in trying to enforce this moral leveling. The Charter recognizes the sacredness of the conscious and religion as it should, while the Supreme Court, like a brute beast, trods over this sanctity by declaring that there are no absolute moral rights, senseless of the consequences, and without any foundation for making such a bold statement. The College is foolish in making policies based on the Supreme Court’s statement, and also should see dangers in forcing this moral collectivism. The dangers of this leveling place enormous weight upon the physicians who’s rights are being infringed upon. They are being surrounded, directed, and oppressed. To take away, or at least to suspend, these inalienable rights that our Charter lays out, is a procedure as preposterous and absurd in argument as it is oppressive and cruel in its effect.
A doctor must be allowed to refer patients, such as abortion or euthanasia to another physician or councelor without recourse of legal action by a prospective patient regardless of charter rights. Court rulings of late lack wisdom based on freedom of religion, especially Christian roots in Canada were our constitution is being under-valued by our highest courts who make rulings that should be made by referendums that represent the values of all Canadians.
I strongly support the doctors have their choices not to perform treatments against their moral / religious beliefs [example abortion, and euthanasia].
Society does not have the right to dispose of life. The College of Physicians is not above society. Only individuals have choice, as they responsible for their own conscience. Society, however has a responsibility to help individuals. Economics concerns should not be a concern for life. We cannot and should not ask doctors to go against their conscience. Doctors are after all in the business of making life better, not to end it or to help end it.
It seems to me that in attempting to “balance” the rights of the patient with the rights of the physician, we are taking away the physician’s rights. How is that balancing? It is not fair that he is obligated to do things he is opposed to simply for the profession he chose. With the shortages of doctors as is, why make it more difficult for them to practice medicine according to their morals and possibly result in fewer people choosing that as their profession.
Forcing Physicians to participate in what they consider murder is absolutely repugnant.
This is a disgrace unprecedented in civilization outside of Stalinist Russia and Nazi Germany. What on earth do you think yo are doing? Have you not heard the screams from Dr. Theo in the Netherlands, where at least participation is not forced.
Perhaps the doctor chooses not to perform or refer for abortion not because of religious beliefs, but because scientifically he realizes that abortion kills a living, developing human being. Then to refuse to perform or refer for this “treatment” is not a personal decision, but a medical decision. Do we now say that the patient is more qualified to make decisions about medical things than a physician who spent years in school learning these things? If my doctor prescribed me some medication, but I wanted to take something herbal or natural instead, I may do that, but I can’t expect the doctor to facilitate that. Using his background knowledge and experience, he advised me how to proceed. If I choose a different path, he should not be required to go against what he knows/believes to be true to facilitate my decision. On the contrary, he can and should advise me on why he thinks my decision might be unwise/foolish/dangerous.
I think all professionals working in institutions receiving public funding should be required to conform to the laws of the land. That includes giving contraception to women requesting it; giving abortions to those requesting it up to whatever the cut off date is but only public paid for a max. of 3 abortions, and also, under very tight supervision so it is never used as a cost cutting measure – death with dignity to those requesting it.
It is absolutely ridiculous that a doctor would be forced to participate or suggest a procedure that they would deem unhealthy. Enough evidence exists to suggest that abortion can physically and (especially) psychologically harm a woman.
But more importantly, physicians should not be forced to do a procedure they do not think is good.
Allowing the state to compel individuals, physicians or otherwise, to violate their conscience is absolutely contrary to a free society. This policy would force any physician committed to the position that human life has the highest value, to deny and discard a concept upon which Western Society was built and has been sustained for two millennia. This Christian anthropology distinguished Western culture as reasoned and balanced and was the impetus for propelling human advancement and well-being. In a stroke this proposed legislation would wipe out this dynamic foundation and return us to a society where individual rights trump the common good. Don’t be coerced to legalize what amounts to unrestrained entitlement at the expense of the inviolability of conscience, the common good, and what will certainly lead to a profoundly disturbing rending and negation of fundamental personal principles and the destructive undermining of hard won societal ideals.
In some cases the requirement of providing a referral demands that a principled, moral and/or religious person cooperate with the intentional and direct ending of a human life. Clearly this will go against deep, sincere beliefs, and go against many phisicians motive and directive to heal patients and ‘do no harm’. Physicians human rights must also be respected, and Freedom of conscience is foundational to our free society.
Doctors must have the right to follow their own conscience in dealing with the recent Supreme Court ruling on assisted suicide. I strongly disagree with physician performing or referring for abortion, euthanasia and other matters of conscience. CPSO must lobby the federal government to respect the rights of individuals, both patients and practitioners.
I would appreciate it if the CPSO would continue to allow us (the public) to read the comments after the discussion has been closed to public input. I wish to follow closely what the College does with all of the input to this discussion. I do appreciate that we have been able to contribute thus far but I’m afraid that the vast majority of Ontarians/Canadians have no idea about this issue yet.
I just want to begin by saying that the practice of medicine in Canada is a challenging yet satisfying endeavor, and it always amazes me that even in its culturally pluralistic context a high standard of care for patients is readily met. The fact that this standard is met, I believe, is because of the role of conscience in a physician’s thought and action, not in spite of it. In fact, I would go so far as to say that physicians of conscience may tend to choose areas of medicine, specialties, vulnerable populations etc. that are less attractive, less profitable, and quite possibly deal with a messier side of the human condition! The formation of my conscience as a Catholic physician prompted me to choose to serve a population that was underserviced.
I truly believe that the proposed draft policy will bar other like-minded individuals from considering the profession or considering areas of medicine that are more ethically sensitive. Further, I suggest that there is a proportion of the patient population that are not only supportive of, but desiring of treatment by, physicians holding to certain ethical tenets (ie. on life in both its beginnings and ends). You are likely aware of the proposal by Prof. Margaret Somerville and others as to a registry of physicians holding to certain tenets based on conscience. I think that this would be an appropriate middle ground that would make those values well known to patients in advance, and also similarly help some patients reach like-minded physicians. The above can easily be done without the danger of perceived “personal judgment” or “discrimination”. Additionally, with physician-assisted suicide on the table now, I’m sure the College will be finding that more physicians “of conscience” will be coming out of the wood-work. Lastly, a word about complicity and referral. Many seem to think that referral to another physician who would then perform or prescribe the objectionable action or medication should look after conscience concerns. Both the College and the Criminal Code understand what it means to aid, abet, counsel or be a party to an offense. I refer you, as an example, to the College’s policy on Female Circumcision (Policy #2-11). It would be impermissible as per policy to refer a woman for such a procedure. The College has appropriately renounced this procedure. There exists in other areas of medicine similarly contestable procedures – the fact that the majority of physicians in Ontario still oppose physician assisted suicide as an example. For a physician of conscience, to refer a patient would also be as compromising as would more direct intervention.
No one in this country (Canada) should be obligated by the state to disregard their religious belief. Not to receive medical treatment due to moral belief needs to be respected. If they don’t agree with blood transfusion and the lack of that service will cause death then the obligation should be towards life. This service is proven effective towards life. If their culture stresses a particular choice outside of the conventional that choice should be respected even though it may or most probably will lead to death. we need to respect their cultural attempt at caring for the sick. To implement killing to particular sick will create a tradition of irreversible wrong. Such a direction would have us holding to a culture of life but not really. To coerce those committed to sustaining life (not at all cost) to kill by threatening to take their means for maintaining a living speaks against freedom, something many Canadians died to establish. Therefore it will be an affront at least to the died if there is no God in one’s life. This is totally unjust and if taken the time it would be extremely obvious.
This implementation corrupts Canada’s moral character. Yes a country should have a moral character. “Give me liberty or give me death” or “God keep our land”, There are many “goods” that could define Canada, “kill the suffering” should be regarded as a bad choice especially for the country I call home. To force others to do the killing is…you name that.
I am very concerned about the welfare of all Canadian patients with this new development. I believe that funding for palliative care, nursing homes, and other programs for vulnerable populations, will be reduced in an increasing climate of euthanasia and physician assisted suicide. I am also concerned that in hospitals with limited resources and funding combined with the fact that patients’ often express feelings of not wanting to be a burden on their families and the health care system, that a patient’s “right to euthanasia” will quickly become an “obligation to be euthanized”.
I am concerned about the significant impact and erosion of trust this will have on the patient-physician relationship; in a climate of euthanasia and assisted suicide, I believe that patients will question whether their physician is seeking to heal or euthanize them.
I’m also concerned that we may face the loss of knowledgeable, compassionate, caring individuals from the field of medicine. Individuals who went into medicine to alleviate pain and suffering, decrease anxiety, and delay preventable death – not to kill their patients. Many of these physicians will relocate or leave medicine all together rather than compromise their morals. Canadians who share the moral opinions and beliefs of these professionals will be denied the right to have physicians who share their beliefs. I am concerned that physicians who value life may become non existent or at least discriminated against in this new era.
The proposed changes require doctors to keep abreast of treatment options (regarding both procedures and facilities) that they consider morally objectionable so as to provide referrals to patients seeking these forms of care.
Put another way, a Dr must be able to say, “This procedure is wrong, damaging to the person, and is, in my assessment, in discord with the practice of medicine. But I know all about it, and where you can get it, and here is the best place to do so.”
No matter how widely accepted a procedure may be, a person cannot be coerced into denying through participation his or her ultimate sense of being simply because he is a doctor.
A legal opening like this is against principles of freedom, and is sufficiently broad and vague as to be a vulnerability to many doctors who adhere to longstanding and eminently reasonable traditions. They should not be compromised simply because a wave of modern support rises against them.
Everything about the consultation process on this policy this time appears to be calculated to obtain a pre-determined outcome on the part of the College. Why was there no public opinion poll this time? Is it because the last two times the public supported conscientious objection rights for physicians, against the apparent goal of the College on this policy? Instead, the College used a long and tedious survey that very few people really have the kind of time (15 or 20 minutes) to fill out among the many other duties of their lives. All this, in addition to the strange reappearance of this policy draft only a few months after the public expressed its opposition (only this last summer) presents a picture of a very calculated intent by the College to push this policy through, regardless of the fact that the majority of the public does not support it. This “consultation” was a farce. It was apparently meant to give the mere appearance of valuing public opinion. How unprofessional and shameful. This truly appears to be a case in which opinions and views only count if they do not conflict with those of the College on this policy.
It will be a dangerous world if we force doctors to do what they think is wrong.
I am against any policy that would force doctors to do what they think is wrong, especially when there are options for the patient to seek care elsewhere in a reasonable time or with slight inconvenience.
You cannot legislate good, up to date medical practice because it is an art which balances technology, scientific knowledge, observation and knowledge of the patient, social sciences and compassion in the context of a doctor who has integrity, and who won’t do what he or she thinks is wrong for the individual or family.
No, a doctor should not have the option to refuse care on any ground.
Let’s begin with the Oath to the profession – the Hippocratic Oath. Does the Oath allow for exceptions? Do no harm, therefore, period!
Human rights codes prohibit unlawful discrimination based on prescribed grounds of the Code. If a doctor refuses care on any ground of the Code, they must be subjected to consequences equal to any meted out to other violators.
The complication might be competing rights as in rights based on the ground of creed, for example, that may compete with a claim of discrimination on ground of sexual orientation.
The analysis in such a case, must use multiple lenses and employ procedures for resolution prescribed by Human rights policy.
The CPSO must play its part by informing future prospects about Code requirements so that anybody who chooses to join the profession will do so with full knowledge of Human Rights law, policy and procedures.
“The Canadian Charter of Rights and Freedoms (the “Charter”) protects the right to freedom of conscience and religion. Although physicians have this freedom under the Charter, the Supreme Court of Canada has determined that no rights are absolute. The right to freedom of conscience and religion can be limited, as necessary, to protect public safety, order, health, morals, or the fundamental rights and freedoms of others.”
“Where physicians are unwilling to provide certain elements of care due to their moral or religious beliefs, an effective referral to another health care provider must be provided to the patient.”
An Open Letter to the College of Physicians and Surgeons
I would like to point out some concerns regarding your proposed Draft Policy to limit physicians’ rights to Conscience and Freedom when they choose not to peform physician-assited suicide.
First of all, I am appalled at the way doctors are being used as instruments of death rather than being able to fulfill their true purpose in their profession – that of healing. When was assisting to kill a patient part of a doctor’s oath? That stretches the boundaries of patient care a little bit too far. Even if the Supreme Court hands down a ruling on physician-assisted suicide, you still have a moral and ethical responsibility to your patients. It sickens me to the pit of my stomach to know that people do not seem to know anymore what is moral and not.
Secondly, shouldn’t limits to these rights be applied only to those who are on the wrong side of the law, not to those who are law-abiding citizens? If that’s not the case, then why do we even have these laws when it will not protect us? “…to protect public safety, order, health, morals, or the fundamental rights and freedoms of others”. What can be more fundamental than a right to conscience????
I don’t know if anyone realizes this but doctors are just being used as pawns by these cowardly people who refuse to suffer. They will trample on the rights of doctors just so they can get what they want – death, not by their own doing, but by passing the burden to these health care providers.
Thirdly, how different is it to allow doctors to refuse to take part in assisted suicide, but oblige them to refer the patient to a willing health care provider? Is there too much apathy in this world that people cannot see the obvious? For a man of conscience, there is no difference between doing the act itself or passing the responsibility to another person. The act will still be done.
It gives me the chills to think of what this will bring to the future of our children. There might not be a right to life by then.
Before you make this big step, ask your Creator if you have made the right choice.
I understand that the CPSO is considering a revision of the “Physicians and the Ontario Human Rights Code”. As a scholar in bioethics and involved in the questions of human rights and religion, as well as being a member of CPSO, I hope that my concerns will be heard.
It is good to remember that the Ontario Code of Human Rights and many other similar statements were based on the Universal Declaration of Human Rights of the United Nations. These documents rightly defend individual human rights against abuses and discrimination based on race, sex, language etc. This first Declaration was a response to the atrocities committed during the Second World War, and especially from totalitarian regimes.
The Nuremberg trials on the Nazi doctors were the inspiration of many regulations on experimentations on human subjects such as the Nuremburg Code, Declaration of Helsinki and many subsequent pronouncements by the United Nations and Council of Europe. We should also recall that the Nazis doctors performed sterilizations and horrendous experimentations on certain subgroups of the population like the Jews or concentration camp prisoners. These procedures were performed at that time what was considered state-sanctioned, standard and approved practices. Later on, when the Nazi doctors appealed to the trials that they were only performing their state-sanctioned duty, they were found guilty of crimes against humanity. This means that they were judged by a law that appeals to all human persons in the depth of their conscience. Even without arguing from a religious perspective, everyone’s conscience is indeed sacrosanct and should never be infringed upon without grave violation of the person’s right.
There are parts of this revision touching on the role of conscientious objection by providers that is of great concern to me, since there is a danger that they can paradoxically negates the very thing they seek to defend—human rights. The part where the objecting physician has to make available services that he or she objects to for patients is particularly problematic. This is akin to a Nazi doctor refusing to perform sterilization on a patient, but is obliged to refer other doctors who are willing to do it. The new policies of CPSO will enforce a standard of medical practice where physicians would not be allowed to deviate. If this “standard of practice” is considered the golden rule of ethical practice, negating the any possibility of conscientious objection, then how is this different from the Nazi imposition on the doctors? Hence, if true conscientious objection were denied to the physicians, then we run the risk of returning to the same standard of Nazi totalitarianism, where physicians are basically automaton unable to work according to their own conscience of what they consider to be right.
In fact, while it might seem at a first glance a defense of the human rights of patients not to be discriminated against, this position may actually infringe on the most basic of human rights of health care providers. For what can be more basic a right than one’s ability to act according to one’s conscience?
I hope this letter would make you carefully consider the implication of this code, and thus avoid a grave injustice towards health care providers in their exercise of one of the most basic human rights.
In light of the public debate regarding physicians’ rights to freedom of conscience and religion, I respectfully urge the College of Physicians and Surgeons of Ontario (CPSO) to uphold policy guidelines that respect the freedom of physicians to practice their profession in a manner that does not violate their conscience or moral and ethical beliefs.
Forcing physicians to disregard their conscience or moral and ethical beliefs in the provision of legally sanctioned non-emergency medical services has serious and far-reaching consequences that affect the integrity and practice of medicine. Cultivating a medical culture that encourages physicians to disregard their conscience by forcing them to do what they believe to be wrong or harmful has the potential to compromise the well-being of patients, physicians, and society.
Freedom of conscience and religion are fundamental freedoms in Canada under Section 2 of the Charter of Rights and Freedoms. A policy that restricts the freedom of physicians to practice their profession in a manner consistent with their conscience or moral and ethical beliefs infringes upon these Charter rights. That is, no person should be forced to materially cooperate with any activity that they regard to be wrong or harmful by the sole dictate of the State.
I urge the CPSO to defend these fundamental freedoms that are essential to the proper functioning of a free and democratic society and firmly hope that the CPSO will dutifully uphold the rights of physicians to practice their profession without compromising their integrity, conscience and moral or ethical values.
I am writing to express an opinion on the Draft Policy entitled “Professional Obligations and Human Rights.” As a member of the public of Ontario, I wish to again express, as I did in 2008 and 2014, my deep concern over how this policy addresses a physician’s conscience, or his/her moral and religious beliefs.
The College of Physicians and Surgeons of Ontario exists to regulate physicians in this province, protecting the public. Perhaps the single most important quality that helps to protect the public is integrity. Indeed, in the regulatory and ethical codes of many professions (such as the legal profession), integrity is considered a cornerstone. Integrity indicates a wholeness of person and is closely tied to personal honesty. In proposing that physicians not follow their deeply held beliefs, the College is discouraging and even dismantling the integrity they are at the same time demanding. This cannot be anything but harmful to the mental health of physicians and lead to great distress. It is only at a great cost that one can act against beliefs that are as deeply held as moral and religious ones. Furthermore, it is a cost that many good physicians and potential physicians will not be able to accept. True religious and moral beliefs are not mere feelings that can be swept aside. They are informed and reasoned beliefs that guide a person. It is one thing to put in long hours, risk one’s health, and deal with the daily frustrations of medical practice to treat patients. It is another to sacrifice one’s integrity and be asked to dismantle what the person him/herself is. Please understand that this is what is being proposed.
A patient’s choice is not made in a vacuum with physicians who are there merely to carry out their wishes. Otherwise, the College could spread the word that well-rounded, mature people of integrity are not encouraged to become physicians; rather, those sought are easily programmable people with no particular attachment to values other than the ones they are told by the state to embrace. I do not know many people who would welcome having such physicians. Patients are people too, many with deeply held moral beliefs themselves. We are taught to respect and celebrate diversity and should not be surprised that our physicians also have moral beliefs. I suspect that most patients are willing to respect the beliefs of their physicians and the consequences of these beliefs, as long as they are aware of them up front. The College should fight for the integrity of its members and not open the door to interpreting the Human Rights Code in a manner that would be harmful to not only its members, but the public as well. A physician who acts based on what s/he truly believes to be right or wrong is not acting for the sake of thwarting patient choice. S/he is instead acting based on what s/he really believes is harmful to patients.
I believe that there are better ways than this Draft Policy to handle situations where physicians do not wish to provide certain treatments. One idea that has been suggested is to create a registry or include the information in the CPSO doctor registry search. This would seem to be a better balance between the rights of patients and of physicians. Instead, the Draft Policy appears to be taking an extreme position of targeting physicians who hold increasingly minority beliefs. At least the 2008 policy statement #5-08 “Physicians and the Ontario Human Rights Code” has a more balanced approach.
The section of the Draft Policy entitled “Ensuring Access to Care” is also problematic. It shows a lack of understanding of the moral principle of complicity. Requiring that a physician recommend someone else to provide the refused treatment makes a mockery of the ability to behave according to one’s conscience. Generally, in moral philosophy, it is accepted that if I find it morally objectionable to do something, it is also morally objectionable for me to have someone else do it instead.
I am aware that the College’s position may be to say that the Draft Policy is necessary due to the Ontario Human Rights Code. However, the “it’s not us, it’s them” response is no response at all. There are no substantive changes to the grounds in the Human Rights Code. The College should not be eager to direct the course by setting new rules that patients have a ‘right’ that previously did not exist – the ‘right’ to force the abdication of physicians’ moral and religious beliefs on demand. This Draft Policy is intolerant and coercive.
Physicians’ freedom of conscience should not be removed simply because it comes into conflict with other rights and freedoms. Freedoms have a cost and we must be willing to shoulder the responsibility of bearing that cost. There is no basis for holding that the cost of physician freedom of conscience and religion is too high. Indeed, people in totalitarian countries throughout the world fight and risk their very lives for that freedom.
It is so intensely and uniquely human to have beliefs, act based on conscience, and experience moral responsibility. Physicians should not be advised to cut off this part of their humanity and proceed with merely hands and eyes, or as if they were robots.
I urge you to reconsider the Draft Policy and consider alternatives or keeping the current policy.
I am writing in response to the CPSO draft titled Professional Obligations and Human Rights. The policy would better serve the public if the proposed mandate for effective referral be removed.
As a member of the public who accesses health care, it is very important to me that my physician be an professional with integrity. Requiring a physician to act against his or her conscience or mandating that a physician provide a referral for services that he or she finds objectionable destroys that integrity.
I do not expect that my physician will have the same moral and cultural outlook as I do – I respect differences that are handled with mutual respect. Insisting that a physician act against his or her conscience breaks the bonds of respect inherent in the patient-physician relationship. My physician cannot demand that I act against my conscience – neither should my requests override my physician’s rights to act in accordance with his or hers. I trust the professional expertise of my physician – that is why I am accessing their assistance.
I request that the policy reflect the rights of both members of the patient-physician relationship and not force physicians to act or refer against their conscience.
We would like to register our strong opposition to the CPSO’s draft policy that limit physicians Rights to Freedom of Conscience and Religion guaranteed in the Charter, and require them to make an effective referral to another physician if they refuse their patient’s requests, such as for euthanasia should it be legalized.
Thank you for your attention to this important matter.
I am writing to you with grave concern regarding the content of your proposed draft policy, which indicates that physicians who decline to participate in certain acts for reasons of conscience should be compelled to refer their patients to other physicians who will perform these acts. It does not address the fact that many of these same physicians will find the act of referral itself objectionable, as they consider it material cooperation with the act.
Physicians moral stances, based on rational conscience decisions, deserve protection. Compelling physicians to act against conscience decisions violates the Canadian Charter of Rights and Freedom.
A physician’s refusal to provide or perform some procedures does not constitute discrimination when this decision is based on a properly informed conscience. This decision is not based on the characteristics of the patient requesting the service, but on the nature of the procedure requested. I demand you to revise the sections above, and include a clear defence of the right to freedom of conscience for all physicians.
I feel very strongly that physicians, surgeons and health care professionals have the right to refuse to do that which they consider to go against their conscience and faith. This right is contained in the Charter of Rights and Freedoms. It is every person’s right. Physicians take an oath to do no harm and there is a line which they should not be asked to cross.
I am deeply concerned about the proposed draft human rights policy that the College of Physicians and Surgeons of Ontario recently released. I am a physician next door in Manitoba. This policy would directly impinge on the religious rights of physicians. Should it be passed, I am very concerned for the future of other provincial Colleges, which may follow suit.
The point of a human rights policy is to protect the rights of all humans—physicians included. While it’s commendable that the CPSO aims to protect the rights of patients, it does so at the expense of the rights of physicians. Physicians must be free to provide services in keeping with their moral codes, even when that means patients might have to go somewhere else. Doctors must not be forced to participate in practices they find morally objectionable or abhorrent. An obligation to refer constitutes tacit agreement. Therefore physicians must not be forced to refer.
Abortion has been available by self-referral for over a decade. Forcing doctors to refer is superfluous.
I am writing this note with grave concern by expressing my objection to the fact that Doctors in Ontario will soon not be permitted to vote according to their position of conscience. What this is in fact doing is no different than if one were in a position of conflict where a person is backed into a corner and then ordered to be exterminated because someone without conscience has ordered it so. Allowing physician assisted suicide begins the slide down the tip of the slippery slope inviting human abuse to occur which will soon not be questioned as the bottom line begins to dictate overall patient outcomes because money with then begin to rule all decisions as if it were the highest power in the land.
What I have always understood a Physician to be was a professional who was in a position of trust and honour and who would do no harm. To be a physician was to be a person of the highest moral character and integrity who was above reproach for anything other than for good.
Physician Assisted Suicide and taking a life prematurely is blatantly wrong both ethically and morally. No one has the right to take a life….that is no different than committing blatant murder. Committing murder goes against the Hippocratic Oath which states a physician should heal thyself and do no harm.
Allowing physician assisted suicide will begin the blurring of what is and what isn’t. What should and shouldn’t be to serve purposes other than what Medicine originally intended. Physicians are not God, nor should they act as if they are so. In so doing they are placing themselves in a position of distrust. What will occur is no different than what occurred in WWII. While the semantics are different, the outcome would be similar. Certain persons were forced to die at the whim of those who felt for their own justifiable reasons they should do so without conscience and without question.
That was called an atrocity when judged on the world stage. What will occur in this country of Canada is no different because it’s foundation was created based on Judeo Christian Principles which do not allow for freedom of choice around the issue of killing. Kindly give your heads a good shake and realize what you are going to create if your proposed amendment is allowed to stand.
There are medications available where patients can be made comfortable until their Maker is ready to take and receive them. Good Palliative Care allows for that. I would urge that before considering this reprehensible vote that one reflect on what led to the great fall of previous empires. It was wrong human judgment that began the deterioration. What will occur over time is such an erosion of what is good that anyone will be able to commit whatever they wish under the blind blanket statement where physicians cannot vote according to conscience. Murder is Murder, There is a reason for Thou Shalt Not Kill. Insisting on it is no different than sanctioning a regime that was once called Communism where there was no belief, other than what was set down in the skewed laws of the dictatorship. Forcing Physicians to vote against what their conscience may believe is an imposed rule that would be permitted within a Dictatorship. Is this what you wish to reduce this country to after Veteran Soldiers gave their blood and their lives for our Freedom to Live in a peaceful and safe society?
I strongly urge that you read and consider what I have written which is sent without prejudice but only with a heart of love and concern for our humanity and our country. Killing is not justifiable under any circumstances and most certainly not in a health care setting. People flee from countries where such behavior occurs. Now people will fear entering hospitals and health care centres. Soon this country will become no different than those from which people are running away only for different reasons, but the out come will be the same. Someone in a position of control had made a bad or improper decision.
Thank you for kindly taking the time to kindly reflect on my note and for recognizing that my words are written purely in good conscience.
I find one aspect of the draft policy on “Professional Obligations and Human Rights” highly problematic, and that is the obligation to provide an “effective referral” (read, to an available and accessible non-objecting provider) in a timely manner.
The problem lies in placing the onus upon the physician to achieve a rapid referral to such a provider, and faulting the physician if they cannot provide a referral in a timely fashion–that is, as rapidly as the patient demands it.
Under the current wording, a northern/rural Ontario patient can demand (for example) an assisted suicide immediately. First of all, what if their family physician disagrees that they qualify for it, or that suicide is the correct course of action? In such a case, it appears the family physician will still be compelled to find someone right away who is willing to perform this practice, or else be in violation of a major CPSO policy with all the attendant consequences. I do not believe this is right. Secondly, what if all the “available” local physicians also disagree to provide the service to this particular patient? In the situation where a local referral cannot be found, or a distant one cannot be arranged in a timely fashion, the family physician would be in violation of the draft policy. This is unfair to the physician, who cannot always be expected to produce whatever service the patient demands–especially where the service requested is highly ethically questionable.
Or what if a patient demands a sex-selective abortion, a practice which many physicians find morally unacceptable? The draft policy would compel the physician to find a way to make it happen, right away. Any delay or lack of availability or accessibility of the requested service would fall on the referring physician’s shoulders as a failure to follow the draft policy. Is the referring physician to be held accountable for not only his own moral objections to a certain practice, but other physicians’ objections as well? How far must the referring physician go to satisfy a patient’s demands? Under the draft policy, much too far.
What if a patient demands cosmetic surgeries such as labiaplasty? The draft policy would compel me, as a family physician, whatever the circumstances, to make a referral happen as soon as the patient wants it, to someone, somewhere, who would be willing to perform the service. I don’t think this is reasonable at all.
Individual physicians must be guided primarily by their consciences. Indeed, a sense of what is right and wrong influences the hundreds of decisions we make during each clinical encounter, and it is for the opportunity to do good for our patients that most of us chose a career in medicine, presumably. We may have different definitions of what that “good” is, some open to compromise, others not. But you can’t hold a physician responsible for ensuring that whatever demand a patient makes, especially one with complex ethical dilemmas, must be fulfilled in a timely manner. This imposes too onerous an obligation upon the physician and removes too much of his or her power to listen to clinical judgment and conscience in deciding what is right and wrong, in his or her view. The draft policy threatens to let patients and society dictate too much of what a doctor must do, under threat of loss of their medical licences.
I think the wording should at least be changed to “Where physicians are unwilling to provide certain elements of care due to their moral or religious beliefs, an effective referral to another health care provider, or reasonable assistance in locating such a provider, should be provided to the patient.” This would express the possibility that not all requests made by patients, especially ethically problematic ones, need be fulfilled by a responsible, conscientious referring physician.
I am writing to The College of Physicians and Surgeons of Ontario to express my objections to the proposed changes in the document entitled “Professional Obligations and Human Rights”.
I am particularly concerned about the The College’s attempt to violate physicians’ human rights by coercing physicians to act against their conscience in certain situations that may arise in their practices.
At issue is the attempt of The College to force physicians to make an “effective referral” to a physician who is willing to perform a procedure which is deemed by some to be morally objectionable.
It is imperative that The College recognize that physicians who make such “effective referrals” are in fact participating in the immoral act which they are trying to avoid. This is not a case of simply passing the responsibility to someone else; it is in fact to participate in the act and thus to incur moral culpability on the part of the referring physician.
The main point in this discussion is the status and defense of physician’s human rights and the defense of a robust pluralistic society in Canada.
Our Charter of Rights and Freedoms, in section 2, clearly spells out the “Freedom of Conscience” and “Freedom of Religion” for all citizens of Canada. This should naturally also include physicians.
I strongly object to The College’s attempt to violate physicians’ fundamental freedoms and rights. This totalitarian impulse must be opposed.
I also strongly object to the The College’s presumption that Canada is not a pluralistic nation. Pluralism is a fundamental value and reality in Canada. It is entrenched in the very fabric of our liberal, democratic political society.
Pluralism means that there exists a diversity of opinions, beliefs, ways of life, and cultures. Canadians do not all share the same opinions and beliefs, especially on important moral and political matters. The fact of pluralism should be recognized and defended. The antithesis of pluralism is totalitarianism, where only one view or opinion is allowed to be promoted.
By proposing these changes for its professional conduct policies, The College of Physicians and Surgeons of Ontario is expecting physicians to all think alike and to ignore their objections to certain procedures on moral and religious grounds. It is a gross injustice for The College to impose a uniformity of belief and opinion on all its members on issues dealing with morality, religion and politics. This is in clear contrast to the fact of pluralism in our free and democratic society. And it is in clear violation of our most basic human rights.
I entreat The College of Physicians and Surgeons of Ontario to abandon their attempt to violate physicians’ conscience rights.
I am writing to express my deep concern over the draft human rights policy released by the College of Physicians and Surgeons of Ontario in late 2014. As it currently stands, the policy would compel physicians to act contrary to their consciences, forcing countless doctors to provide services, or facilitate the provision of services, which they consider wrong for moral or religious reasons.
This is reprehensible.
Not only does such a policy ignore the basic rights of physicians, it also undermines confidence in the medical system at large. By forcing physicians to act in ways they consider immoral and unethical, the CPSO signals to wider Canadian society that it is not concerned about the personal integrity of its members. In fact, it suggests the CPSO considers personal integrity something to be discouraged among physicians.
In Canada, we are privileged to enjoy a number of rights and freedoms. I am pleased to see the CPSO committing itself to upholding these rights by producing a draft human rights policy. I am aghast, however, to see that a document purportedly devoted to respecting these rights nevertheless severely undermines the rights of physicians.
The draft policy correctly notes that the Canadian Charter of Rights and Freedoms protects physicians’ right to freedom of conscience and religion, but it is clear that the policy fails to appreciate the full implications of this right. Physicians ought not be forced to refer patients for treatments that the physicians, for reasons of conscience or religion, find objectionable. To require otherwise is to make the objecting physician a party to the treatment he finds objectionable
It’s all very good to say that physicians have the right to freedom of religion and conscience, but it must be further recognized that these freedoms apply not only to thought but also to action. It is not enough to say “Alright, you may believe such and such. You do not need to perform the act yourself, but you must refer patients to someone who will.” If, for example, a physician is opposed to abortion or assisted suicide for reasons of conscience or religion, forcing them to refer a patient for such a procedure impinges directly on the physician’s freedom. The physician will understand herself morally culpable for the final act, in that she facilitated its being carried out. She will have been forced to act in a way contrary to conscience.
As the Nova Scotia Supreme Court recently reminded us, and as the CPSO’s draft policy itself notes, rights in Canada are not hierarchical. When the rights of one individual come into competition with the rights of another, they are to be balanced. “If there are competing rights the issue is whether there are alternative measures by which both rights can be accommodated,” Justice Jamie Campbell writes in his judgment on TWU vs. NSBS. “That involves a consideration or whether one right has been disproportionately affected or the other disproportionately privileged.”
It seems clear that, if the CPSO adopts its draft policy without significant alteration, then the rights of physicians to freedom of conscience and religion will be disproportionately affected—and thus, that their freedom will be infringed upon. As Justice Campbell explains, “An infringement is made out when the claimant sincerely maintains a belief or practice that has a nexus with religion, and the impugned measure interferes with the claimant’s ability to act in accordance with those beliefs in a way that is more than trivial or insubstantial. Trivial or insubstantial interference is interference that does not threaten the belief or conduct.”
Requiring physicians to facilitate a treatment they consider morally objectionable, perhaps even evil, is neither trivial nor insubstantial. Consequently, the draft policy as it stands infringes upon physicians’ rights.
The CPSO should rewrite its draft policy to more clearly protect the freedoms of physicians, including their right to act in accordance with conscience in choosing not to refer patients for treatments they find morally objectionable.
[**MESSAGE FROM ADMINISTRATOR: DURING THE CONSULTATION PERIOD, WE RECEIVED 2 RESPONSES FROM INDIVIDUAL RESPONDENTS CONTAINING THE CONTENT PUBLISHED ABOVE. ALTHOUGH THIS FEEDBACK HAS NOT BEEN PUBLISHED IN DUPLICATE, THE COLLEGE ACKNOWLEDGES RECEIPT OF THESE SUBMISSIONS.**]
The proposed “effective referral” mandate is violation of a physician’s rights that must be rejected. The entire medical profession operates on the oath to “do no harm”, which is globally understood to mean protect and make better the life of the individual. The medical profession is founded on the ethical and moral foundation of protecting and preserving life as best as it can. When life is inevitably ending, the medical profession then acts on its oath to institute comfort care to help ease the patient into natural death.
With effective referral, the Ontario College of Physicians is violating the rights of all Canadian citizens in the following ways:
1. Undermining the definition of “care”.
Care cannot include the act of killing a person. Care goes with life, the living, nurturing. To be under a physician’s care is to be receiving treatment to regain health or manage chronic illness or to receive medical comfort as death draws near. Care follows the tides of nature and shows dignity for life. Euthanasia cannot ever fall under the auspices “care” for a patient.
2. Contravening a doctor’s right to not deliver a medical service that is contrary to ethical or religious beliefs.
Ethical beliefs: the medical profession is based on an ethical approach to Care (see point 1). Do no harm is the professional oath. It is unethical that the College has refused to challenge the Supreme Court ruling on physician-assisted suicide on behalf of all of its practicing doctors as the ruling contravenes the foundational belief of “do no harm”. Why is the College allowing the court to dictate terms of medical care?
Religious beliefs: the College violates doctors’ rights when suggesting that they can opt out from providing care based on religious grounds, then advises they must be accessories to the same procedures. Assisted suicide is directly contrary to any belief that life should be protected and respected. A physician violates their beliefs by helping a person even find a doctor who would perform such an abuse.
3. Refusing to protect life.
When life is no longer valued, chaos ensues. This is the operational system of much of the Middle East. It cannot be our ultimate goal. One’s life must be protected at all cost – we need a universal value placed on life, regardless of state or station so we move with unity to make things better for EVERYONE. Assisted suicide becomes another example in a devastating commentary on how we only want certain kinds of life…that which is tidy, convenient, only perfectly healthy, maybe only with a few flaws, but not with many because that is hard to take, sad to watch, because it requires us to feel and act in love towards our fellow humans on our natural journey through this life.
The law must protect all life, regardless of deemed quality. It really is an all or nothing proposition, much like pregnancy: you cannot be sort of pregnant any more than you can defend life, mostly. You either do defend life and act to do no harm, or you don’t. I request the Ontario College of Physicians stand down from effective referrals based on the physician’s oath, a need for a steadfast morale code in Canadian society, physician’s religious beliefs and the rights already granted them by the College. I further ask the College to stand up for the principle’s on which it was founded by challenging the Supreme Court’s decision of assisted suicide based on basic rights to life.
Thank you for the opportunity to provide input to the CPSO Draft Document on Professional Obligations and Human Rights. I have read the draft document with care.
The importance, sensitivity and reciprocal nature of the physician/patient relationship has been evident in my own life and in the lives of family members, colleagues and clients.
I am pleased that the CPSO draft document recognizes the right of physicians to freedom of conscience and religion under the Canadian Charter of Rights and Freedoms. Freedom of conscience is included in the United Nations’ Universal Declaration of Human Rights and is a fundamental right upheld throughout much of the world.
As outlined in an article by Moira McQueen, LLB, Mdiv PhD, entitled Bioethics Matters, February 2015, the need for conscience to be properly formed ensures that conscience decisions are reasonable and rational. They are open to discussion, factual evidence, challenge and sometimes change. A physician’s moral stance has nothing to do with any individual patient but with the nature of the procedure itself and an observation and judgement of good done or evil avoided. The conclusions of conscience are much more than “personal beliefs”.
Several aspects of the draft document are of concern, as they favour the rights of the patient over the rights of the physician. There should always be a balancing of rights; the rights of both patient and physician should be respected.
Lines 156 to 164 are particularly problematic in that a physician would be compelled against conscience to make a referral. There is no balancing of rights here, but rather compulsion.
Please ensure that physicians are never compelled to act against rational conscience decisions, the bedrock of our medical heritage.
I am a resident of Ontario and have read your draft policy on Professional Obligations and Human Rights.
The policy, as written, will take away my right as a health care patient and consumer to find a doctor that I can trust. I must assume that this was not your intention, but this is nevertheless the effect.
I am asking you to not take away my right to access doctors I can trust. Eventually, the identity of such doctors would become unknown as they are forced to comply with referrals for services that I would consider gravely unjust. I seek out doctors who share my moral values and I do this intentionally. These are the men and women I am willing to entrust with my health care. I know many others who do the same.
Forty years from now when I am old and seeking medical help, I would like to have the option of going to a doctor whom I know with all certainty will not “prescribe” or refer for assisted suicide. If this policy goes through, that will be impossible.
The policy is therefore unjust to myself and to many others who perhaps have not thought about it yet, who perhaps are not even aware that this policy has been drafted. I will be informing my network of friends who seek out morally aligned doctors so that they are aware this policy has been drafted. They may be too late to submit feedback, so I am asking you to consider that I represent many others in writing to you today.
By requiring that all physicians provide “an effective referral” for care that conflicts with their moral beliefs, and that physicians must provide care that is “urgent” to prevent “suffering” even if it conflicts with their moral beliefs, you are removing conscience rights from professionals who have every right to practice their profession in a way they deem moral. This cannot stand, as the Charter guarantees these rights for each of us. It is blatantly discriminatory against certain groups.
Furthermore, the role of physician is not that of a health care vending machine; the patient does not request and receive treatments of their own choosing but receives the treatment that the physician offers based on their own discernment, with the patient’s consent. It is not the right of the patient to demand a service from any particular doctor any more than it is the right of a hungry patron to walk into a restaurant and expect to be served a particular entree they demand that is not on the menu. This is true even if the patient is “suffering” from hunger. This proposed reduction of the role of the physician is insulting to all physicians who have worked hard to earn their credentials. They have a right to choose which health care services they will provide generally speaking, as long as they do it without discriminating between patients. I was alarmed to read this policy and surprised that the CPSO would have such little respect for their own profession.
Please amend the policy to acknowledge that physicians have a Charter right to not participate in services that conflict with their moral or religious beliefs. Do this for the sake of integrity of the profession, and to respect my right as a taxpaying citizen to seek out a doctor whom I can trust.
[**MESSAGE FROM ADMINISTRATOR: DURING THE CONSULTATION PERIOD, WE RECEIVED 2 RESPONSES FROM INDIVIDUAL RESPONDENTS CONTAINING THE CONTENT PUBLISHED ABOVE. ALTHOUGH THIS FEEDBACK HAS NOT BEEN PUBLISHED IN DUPLICATE, THE COLLEGE ACKNOWLEDGES RECEIPT OF THESE SUBMISSIONS.**]
This message is to provide our comments on the Draft Policy on Professional Obligations and Human Rights to which Ontario physicians would become subject if implemented.
Our main concern with this draft policy is the potential obligation that would be placed on physicians to refer patients to other licenced physicians when the type of treatment or action sought by a patient would go against the physician’s conscience due to moral or religious beliefs.
In the event that the Federal Government were to enact a law permitting the act of euthanasia or assisted suicide, an Ontario physician refusing to provide the service would be required under the draft policy to refer the patient to a physician who is prepared to provide the service. In this case, the obligation of referral would place the morally or religiously conscientious physician in a position where they would be seen to be cooperating with an act deemed to be gravely immoral or illicit in accordance with the faith community they belong. It is untenable to put someone in such a position because of their deeply held moral or religious beliefs.
The enactment of this draft policy could result in the departure of many competent physicians in our Province who will not want to compromise on their beliefs. By extension, it could be expected that the enactment of this policy would also eventually be enacted for nurses and consequently, we could expect an exodus of nurses from our stretched health care system for reasons of conscience.
Consequently, we disagree with the draft policy as presented and implore that it be revised to allow physicians the full right to exercise decisions according to their moral and religious beliefs, even in cases where the patient may be requesting a legally permitted action or treatment.
With regard to the revised and approved draft policy Professional Obligations and Human Rights, I wish to advocate for a robust understanding and protection of the Charter right of freedom of conscience and religion for all Canadians, and indeed physicians in the daily routine of their care to patients and in the overall forming of their individual medical practices. I therefore reject the proposed mandate for an “effective referral” as it is a breach of a physicians’s rights and a serious incursion into the professional standing of a physician.
Doctors and other health care professionals, indeed all Canadians, enjoy the Charter right of freedom of conscience and and religion. In the event that Canada adopts a regime of physician assisted suicide, the threat to conscientious objection is that much greater.
If we agree to this policy of “effective referral” it is indeed a s l i p p e r y s l o p e towards vulnerability towards human life for all of us “especially towards the physically or mentally challenged” –if we are to play God. Looking towards the future, any excuse and every excuse could be applied to end human life. DO WE WANT THIS KIND OF WORLD??
The balancing of rights must be done in context. In relation to freedom of religion specifically, courts will consider how directly the
act in question interferes with a core religious belief. Courts will seek to determine whether an act interferes with the religious belief in a ‘manner that is more than trivial or insubstantial’. The less direct the impact on a religious belief, the less likely courts are to find that freedom of religion is infringed.
Please review your draft with due diligence and care and strike this policy of “effective referral” from your proposed draft.
Regarding the draft policy, “Professional Obligations and Human Rights”: the policy effectively defines the obligations of doctors to avoid treating patients in a prejudiced fashion, and the steps which they ought to take in order to avoid discrimination. However, it does so by emphasizing the autonomy of the patient, at the expense of the physician’s freedom and judgment. Essentially, the policy requires that the question of what constitutes “good health” be left up to the patient’s opinion, and that the physician merely provide expert advice on how the patient may reach this state.
This is especially troubling in light of the practice of abortion, which many physicians, to say nothing of people in general, view as being an act of murder, as well as the practice of physician-assisted suicide, which is considered by many to be likewise an act of murder. Under the draft policy, a physician who wishes to avoid taking another person’s life unnecessarily will no longer have the power to determine what constitutes “unnecessarily.” Far from saving lives, doctors will now be required by law to take them whenever a patient decides they no longer wish to live, or to be pregnant.
I understand the need to prevent doctors from causing harm to their patients on account of their own moral and religious beliefs. For example, a Jehovah’s Witness doctor, who believes that blood transfusion is morally wrong, should not be permitted to let a patient die if a blood transfusion could save his life. But allowing a patient to die is a far different thing than refusing to take a patient’s life; and the current policy, while seeking to prevent the former, ultimately seeks to sanction the latter as well.
There are many people in Canada who personally wish to be served by physicians who refuse to take a life under any circumstances, whose dedication to the protection of life prevents them even from assisting people to commit suicide or to terminate unwanted pregnancies. If we are truly to respect the autonomy of all patients, we must leave them the opportunity to seek the service of physicians who will exercise their rights of conscience and refuse to perform procedures which are seen by some to be morally compromising.
I am grateful for the opportunity to give input into the draft policy “Professional Obligations and Human Rights.”
I am very disturbed by the proposed draft policy. Sections 8, 10 and 11 suggest that physicians who decline to participate in certain acts for reasons of conscience should be compelled to refer their patients to other physicians who will perform these acts. Most physicians who are morally opposed to certain acts will also find referral to another doctor who will perform these acts objectional as they will understand themselves to be complicit in the act. In compelling physicians to refer, you are limiting their right to conscientious objection. This is a fundamental right protected by our Canadian Charter of Rights and Freedoms. I cannot believe the CPSO finds this an appropriate solution.
As a patient, I would much prefer to have the freedom to choose my physician based on an understanding of his or her moral and religious beliefs. I want to be able to trust my physician with my life, if need be, and to do this I need to believe in his or her integrity. The proposed changes to the policy will completely undermine this relationship of trust. I do not see why physicians are being asked to conform their moral and religious beliefs to those of their patients (never mind that this is well nigh impossible given the number of patients a doctor is likely to see with varying moral and religious beliefs). Surely, the patient is the one who needs to ensure that their moral and religious beliefs will be well respected by the doctor they have chosen. Otherwise, there is nothing to stop the patient from moving on to another doctor. I find the CPSO’s approach highly patronizing and would suggest a new committee be formed that will be able to uphold the relationship between the doctor and their patient without violating the Canadian Charter of Rights and Freedoms.
I would ask you to revise the sections above, and include a clear defence of the right to freedom of conscience for all physicians.
I strongly reject the proposed mandate in the draft dealing with Physician Assisted Suicide. The referral compels a physician to
to violate his or her own conscious by being a participant in the very act which he or she objects to in the first place.
I agree with some of the positive aspects of draft policy, “Professional Obligations and Human Rights”, for example, that doctors should not discriminate against patients and that patient care is of highest priority. I am, however, very opposed to the draft policy elements that threaten a physician’s fundamental rights to freedom of religion and conscience. This, of course, is in reference to the proposed policy that demands doctors refer, and in some cases perform, procedures such as birth-control, abortion and euthanasia in violation to their moral or religious beliefs. It is very disturbing to think that the OMA and CPSO would even consider this type of discriminatory control tactic. I think the integrity of a physician directly affects the level of patient care they administer and your policy’s coercive mandates would undermine this integrity. Perhaps your policy should focus on the very real threats to public health that already exist.
In the meantime, it should not take too much creativity to allow patients to make personal choices regarding physicians and services without stripping physicians of their fundamental rights to freedom of conscience and religion.
I am writing to you today to voice my concern regarding your new draft policy entitled “Professional Obligations and Human Rights”. As a Canadian citizen who has resided in Ontario his entire life, and who intends to reside in this province for many more years to come, I consider it to be in my best interest to speak out against this draft, as I believe that implementing it could cause many upstanding physicians, especially in the field of family medicine, to leave their practice so as to avoid acting against their consciences.
When discussing a physician’s right to freedom of conscience and religion, this draft policy refers to the Supreme Court’s ruling that these rights can be limited in order to protect such values as the safety, rights and freedoms of others. However, if these rights were to be limited in cases of doctors refusing to prescribe contraceptives or to perform or refer a patient for an abortion for example, I believe that these limitations would not only be unnecessary, but actually harmful to the medical profession in Ontario. These limitations strike me as unnecessary because I do not believe that the widespread access to contraceptives or abortion in Ontario would be significantly threatened in any way by the fact that a small percentage of doctors could refuse to offer these services. Furthermore, I believe these limitations could harm the medical profession for two main reasons: in the first place, forbidding doctors to act according to their consciences in matters such as these is harmful because it would stifle healthy debate and discussion of what is good for the public by deeming this group’s stance – which is also taken in order to uphold the public good – to be invalid and untenable. Secondly, as previously stated, these limitations of physicians’ rights and freedoms could cause many conscientious physicians to leave the practice, thereby damaging not only the profession but the public’s ability to access quality health care in Ontario.
In light of my above-mentioned concerns, I strongly urge the College to retract this draft policy.
I appreciate your consultation on the difficult questions of balancing the rights of doctors and patients in matters of conscience. My hope is that the resulting regulations will provide the highest possible level of protection to doctors to provide treatment in accordance with their ethical beliefs, for the simple reason that I believe any erosion of these freedoms will, in the long run, undermine the integrity of the medical profession in Ontario.
I am very reluctant to ask a doctor, under any circumstances, to do something which violates his or her conscience – even if it is something which does not violate mine. Why? For the simple reason that I do not wish a doctor to become used to doing something he or she considers to be wrong. If a doctor becomes accustomed to violating a deeply held sense of ethics in one case, might it not be easier to violate it in others? If one feels pressured, for example, to violate one’s deepest beliefs about human dignity and purpose, in order to practise medicine, how can this not undermine one’s commitment to common honesty and decency? If I cannot trust my doctor to refuse me if I’m asking him to do something he considers unconscionable, what can I trust him to do — or not to do?
I expect the highest level of professionalism and ethical conduct from my doctor. Even if I am personally comfortable with a treatment or procedure I request, if it violates the ethics of the doctor in question, I really do not want to go there. Do I wish to be treated with respect? Yes, of course. But if a doctor truly believes that what I am asking for is unethical, how can he or she in good conscience even recommend another physician to provide the service?
Often difficulties arise because of the relationship between ethics and religion. However, how can one possibly disentangle the two? If one makes the argument that a doctor should, for example, not consider her own ethical beliefs on a subject such as contraception, abortion or assisted suicide – on the basis that they might be religiously motivated – then why should the same doctor follow the teachings of their religion when it teaches “Thou shalt not steal”? And how does one distinguish between a physician imposing a personal moral belief on patients, and when the doctor is giving a carefully considered medical opinion? After all, there are deeply religious doctors who are very comfortable performing abortions or prescribing birth control, just as there are deeply secular or atheist doctors who have sincere ethical objections. In any case, to ask a doctor to provide a service that he or she believes to be unethical is to ask that doctor to violate the spirit of service that fuels their entire practice of medicine!
As we enter ever more and more into a “brave new world”, with new advances in reproductive technology, the advent of physician assisted dying, and whatever else may lie in our future, I believe we need to do all we can to encourage doctors to listen to their consciences – especially when they are swimming against the current. More than ever, we need a diversity of opinion, and a healthy debate, as we explore what it means to be human in the 21st century. If a doctor has a concern about where we’re heading, even if I don’t share that particular concern – even if I believe my doctor is deeply mistaken – I would rather not silence that voice, or force one to violate the dictates of conscience whom I should trust more than any other to follow them, shall we say, religiously.
Again, my thanks for your hard work on this matter.
Conscience rights are incredibly important, as our conscience is what separates us from other animals. Please respect our health providers’ conscience.
As an aside, I find it fascinating that conscience laws may be revamped, but there’s no regulations on alternative medicine that have no scientific basis
I urge you to remove from from your draft, the mandate for effective referral, so that physicians may
practice medicine with integrity, thus not violating their own conscience.
As a patient, I value my doctor’s honesty and concern for my wellbeing and respect him for acting
with integrity. If for some reason, my doctor refuses to refer me for a procedure which I insist on in
spite of his counsel, it is my own responsibility to seek out the doctor who will cooperate with my request.
Such information is most easily obtained.
A doctor’s duty is to preserve and enhance life, not deliberately end it. I find it reprehensible that you should require that a doctor who in good conscience will not perform abortions or assisted suicides should be forced to provide the patient with an “effective referral”. Since when does the right of the patient, or those pushing this agenda, trump the moral right of a doctor to, in conscience, refrain from taking a direct or indirect role in killing a life. That’s right, “killing a life”. Have you ever seen or heard an elated mother get excited over the “fetus in my womb”? No, No! “Here is an ultrasound of my baby” she announces to the world. And is the life of the sick or elderly any less of a life? You want me (if I were a doctor) to be complicit in taking another’s life? I would refuse, and every doctor that feels the same should refuse. I am sure that those offering these services of abortion and assisted suicide will have more than ample advertisements in the papers, radio,TV, Bill-boards, hospital lobbies, social media etc. that a patient will not require an “effective referral” from his/her doctor. Show some respect to your fellow doctors who do not wish to participate in morally reprehensible behaviour by removing this abomination from your draft and final policy. Or have we become a Nazi State where some doctors are forced to perform what are to them ‘atrocities’?
As I said before, show some respect to your fellow doctors and respect their rights and freedoms. May God bless and guide you in your deliberations.
I wish to express my grave concern regarding the content of your proposed draft policy. I am opposed to the idea that some physicians may feel pressured to participate in certain acts that go against their beliefs. Physicians should not be compelled to compromise their consciences even through referrals to other physicians who are willing to perform these procedures. I strongly believe that in a free society everyone has the right to uphold their moral principles and not be persuaded to abandon their conscience at any level. As a society we must respect the right of individuals to their freedom of conscience especially for physicians who are trusted and committed to helping improve the lives of others. They should not be put in the situation of either giving up their passion to help people or giving up their consciences.
It is important to me to have a doctor whose values reflect my own. In light of the recent Supreme Court decision, I hope the College of Physicians and Surgeons of Ontario will consider the many patients who want care from someone whose whole focus is on providing care, not death. The Supreme Court called for freedom of conscience for physicians. As the head of the CMA said, ” I think it’s fair to say no patient would want a physician to be individually coerced into doing something he or she felt was against his or her personal ethics or religious beliefs.”
Please protect our doctors’ right to freedom of conscience, and their right to practice as they see medically and morally fit. Doctors are individuals as well, and should not be coerced to becoming accomplices for others to do what they believe is unethical or wrong. The patient/customer is not always right. Case in point: A doctor should not have to refer a patient who has a viral illness to another physician for antibiotics, simply because that is what the patient has requested.
Physicians are employed to the field of medicine through their conviction to aid all patients to the best of each of their abilities. We, as patients, benefit greatly from the variety of medical advances
that are a direct result of physicians employing
their gifts and talents to resolve ailments from which we may suffer. These gifts and talents stem from the physician’s conscience and their ability to adhere to their ethical compass rooted within the natural law. The conscience of the physician will not transfuse into adherence to a synthetic law, simply because the physician is told to ignore their personal convictions. One cannot trick oneself. The moral dichotomy forced on a physician to professionally perform or recommend a procedure which is against their own conscience will cause conditions of depression and PTSD in those very individuals whom we enlist to provide healing and wholistic health to our ailing society.
To mandate that physicians must provide and/or provide referrals to medical practices which transgress their own conscience is to liken them to the doctors enlisted by Hitler in Nazi Germany who were mandated to perform inhumane experimental procedures on Jewish and Catholic prisoners within the concentration camps. Hitler never considered he would lose the war, or that he and his army would ever be held accountable for their heinous crimes against humanity.
Are our own physicians to be submitted to the same ruthless subjection, in that they too, are mandated to perform or refer patients for procedures which transgress their own conscience?
Currently, there is no law prohibiting abortion in Canada, and the legalization of Euthanasia may be on its horizon. But to mandate that physicians must provide these procedures or refer patients for them
against their consciences negate the very essence of what constitutes an ethical and moral medical practitioner. Such a physician is not desirable in the least. Patients demand that physicians always have their best interests at the forefront of their care, and this requires a character of conscience.
I am writing as a resident physician to notify you of my concerns as a member of the CPSO with the proposed policy “Professional Obligations and Human Rights”, which would require physicians unwilling to perform a procedure to refer the patient who desires the procedure to a fellow physician who will perform it. For physicians for whom such a procedure goes against their moral and/or religious beliefs, to refer to someone who will perform it is still to participate in the process.
For such physicians, acting on the basis of moral and/or religious beliefs, this policy would not be in keeping with the fundamental freedom of freedom of conscience under the Canadian Charter of Rights and Freedoms, and therefore could be considered discriminatory. It could also be considered to be a discrimination of creed under the Ontario Human Rights Code.
I would respectfully urge that the CPSO consider revising this policy as it relates to conscience.
Every Canadian has the right to exercise their freedom of conscience in their work.
With regards to the practices of euthanasia, sterilization/contraception, assisted suicide and abortion, any regulation policy that coerces medical care providers including doctors and physicians to provide treatments or perform procedures that are contrary to their personal or professional ethics and conscience would be in terrible detriment to the profession and to the Canadian people as a whole.
You would potentially be excluding from medical practice a large segment of the Canadian medical profession if they choose to obey their conscience and lose their jobs. Any regulation or policy regulating medical actions drafted by the CPSO must respect the right of medical practitioners to act according to their ethics and conscience in the performance of their work.
I am a medical school student. While I have never resided in Ontario before, I am personally vested in this policy draft, given that this will impact where I choose to train for residency, and that its implementation will likely influence colleges of other provinces.
I agree that physicians have a duty to provide care that respects patient dignity, ensures access to care, and protect patient safety, as outlined in the new draft policy. However, I have qualms with two parts of the draft policy–first with how the policy argues specifically in regards for limiting religious rights (line 123), and the universal requirement that physicians provide referrals for services they cannot provide without violating their own conscience (line 156).
First, the draft policy argues that if the interference with religious rights is insubstantial or not direct, then religious rights that may cause harm to others would not be protected by the charter. Later, I will discuss my thoughts about whether religious rights in this case would actually harm others, but first I would like to say that the issue here is less to do with religious rights and more to do with moral rights. There is no Bible on morality, and thus it would be difficult for the Supreme court to evaluate whether an interference with moral rights is truly substantial or not. Truth be told, regardless of my religion, I find it morally repugnant to provide the exact details of someone to terminate the life of an unborn child, for example. One might argue that such an objection to referrals is trivial (“You don’t have to perform the abortion!”), and that an infringement of my moral rights in this case is also trivial. I would say to that, that argument asserts that my morality–an unwillingness to actively participate in what I perceive to be murder–as trivial. I do not believe this morality to be trivial. Now, is morality a catch-all term that permits one to act as one wishes? No–I believe it comes down to whether these moral beliefs are reasonable. I think my morality is reasonable. I think a reasonable person would understand that a belief that a human fetus is a human life–that this belief is a very reasonable one (I am not arguing about the truth value of a fetus being a human life; I am merely stating that a belief in such a statement is within the realm of reasonableness). A reasonable person would also agree that actively enabling a wrong would make one complicit in said wrong. And thus a reasonable person would agree that it is reasonable to refuse to refer for an abortion, given that the belief in a fetus as a human life is a very reasonable belief and that referring to terminate what is believed to be human life would make one complicit in this termination. I do not believe such morality to be trivial. I do not subscribe to this belief because of what is written in a religious text, rather, I am convinced of this as a result of a sum of life experiences that influence what I believe to be right or wrong. This is how morality is derived, regardless of religiosity. Not everyone is religious, but eveyrone has morals, and reasonable morals ought to be respected. I believe my morality is reasonable, that my morality is compatible with western notions of a free and democratic society, and that the draft policy would do violence to my morality in a non-trivial way.
However, my previous argument would be complicated if enforcing my rights to morality and conscience would result in denying patients’ access to care. Nevertheless, I believe this contention to be moot, as there can still be proper access to care for patients without enforcing a universal requirement for physician referrals. Similar to the way the courts decided that a universal ban on euthanasia was overly broad and not “minimally impairing,” I believe that a universal requirement for physicians to refer is also overly broad and not minimally impairing. Abortion clinics in BC and Ontario, for example, do not require referrals and are covered by provincial insurance, and so there would be no substantial reason to require physicians to act against their own conscience to provide a service that would be available anyways. The real healthcare access issue here is the pitiful availability of abortion services outside of Ottawa or the GTA, an issue that calls for more health care providers in northern Ontario,, and not requiring healthcare professionals to violate their conscience. Providing more self-referrals and more clinics is the better solution.
Thank you for your time. I understand how difficult this policy was to draft and I appreciate the clarity in its logic and its intent. I also appreciate this opportunity for feedback. I would once again like to emphasize my belief in my morality as a reasonable stance, and that a universal requirement for referrals is overly broad, and that there are alternative methods that would ensure more access to patients while protecting the conscience rights of physicians involved.
I am a retired physician and appreciate the opportunity to provide feedback on the draft policy under consideration. While I did attempt to complete the survey, I found the questionnaire focused much on the clarity and comprehension of the wording, rather than the actual content of the changes proposed.
Firstly I should mention that I endorse the existing Charter of rights of freedom of religion and conscience and urge that this moral stance be retained. I endorse the recognition of human rights for all, patient and physician alike. This, however, should not be interpreted in a one sided manner to favour the patient, rather both patient and physician should have that protection. Physicians should not be compelled to act against their conscience, a compulsion that goes against Charter and human rights and, in itself, a form of discrimination, one that has not been addressed in the definition of ‘Discrimination’ in the Draft Policy.
Refusal to perform certain procedures, based on a rational informed conscience, which is often reinforced by religious beliefs, has nothing to do with the patient requesting a procedure, rather the physician’s decision about the wrongness of the procedure itself. It also follows that ordering physicians to make a referral for a procedure that they consider in conscience to be morally wrong and repugnant, ignores their conscience rights and rests on compulsion. An absence of external compulsion is fundamental to the exercise of conscience and the freedom of the individual, and is an established human right which should always be protected.
I strongly urge the College to continue to recognize the concerns stated above and recognize the same in the reformulated policy.
I am writing to express my opinion and wish that the cpso reject the proposal to include a mandated “effective referral” in it’s policy regarding physicians’ refusal to participate in procedures or treatments which violate their own moral or religious beliefs.
I am opposed to the draft policy whereby the College of Physicians and Surgeons of Ontario would force physicians to make referrals for procedures (e.g. abortion, possible end-of-life issues) that may violate their moral or religious beliefs.
We support the Physician’s Charter of Right of Freedom of Conscience and Religion. Mandating the Catholic doctors who are unwilling to provide certain elements of care – namely abortion, euthanasia – to refer their patients to another health care provider is to violate his or her own conscience and religious beliefs. Their chart of rights must also be respected.
We hereby ask you to protect the freedom and charter of rights of these catholic doctors.
Your proposed draft policy, most notably Sections 8, 10 and 11, represents a serious attack on the principle of the respect for individual conscience rights, a principle which is an essential part of any society which truly values diversity. By insisting that physicians refer patients to other doctors who will provide services which they believe to be deeply immoral it renders the whole concept of respect for conscience nugatory.
The obvious impact is that if this policy prevails not only will many people of faith (and quite a wide variety of faiths) be driven out of the health care field, but others will be prevented from entering. Individuals will be frozen out of careers which ought to legitimately be open to them. As well, health care will be deprived of the services of many who would make an immense contribution to it. Such a drastic policy, with such devastating impacts, requires clear proof that there is an urgent and overwhelming problem which can be dealt with in no other way. Is there any compelling reason to do this? Clearly not – the status quo is working well.
This ill-considered proposal must be rejected. To carry it out would be an abuse of power, deeply destructive of a genuinely liberal and diverse society. Please reject this proposed policy.
Thank you for the opportunity to comment on your proposed revised policy, “Professional Obligations and Human Rights”.
I have three major concerns with the proposal. Firstly, it ignores the constitutional right of physicians to freedom of conscience which cannot be abridged as easily as this presumes to do. As a physician, I can not be made to go against my moral obligation to do what is correct, according to my conscience. The policy therefore is beyond the power of the College. It makes a mockery of professional education, and informed opinion. Ethical practice is inimical to being forced to act against ones conscience.
Secondly, it seeks to imply that referring for an objectionable service is somehow morally different than actually performing it oneself. This is clearly incorrect. I am responsible for all of my decisions, including making a referral for services.
Thirdly, there is an implication that such objectionable services are medically necessary, when in fact they are choices made by individuals when other choices are available. My role as a physician is to educate and advise my patients, not to do whatever they wish to have done.
Frequently patients may request any number of tests or referrals, and frequently after discussion, they become aware of the implications of those choices, and are enabled to make better health care decisions.
I am saddened by the College’s repeated attempts to bring in this ill-advised and inappropriate policy which tramples on physicians rights. It is the role of the courts and the human rights commissions to decide on these cases, not the CPSO.
I have been practicing medicine for more than a decade as a family doctor with a special interest in emergency medicine. During the interview process for residency, I divulged my philosophical opposition to abortion. This admission was met with almost universal acceptance. The family medicine staff did not share my philosophy about abortion, but nevertheless, fully accepted and encouraged me to practice medicine according to my conscience.
When during my residency, I became increasingly drawn to medically based, effective alternatives to contraception, they also supported me. Eventually, I sought additional training in the Billings Ovulation method of natural family planning and stopped prescribing contraception.
After several years of providing locum family medicine coverage, I began practicing mostly emergency medicine. My colleagues have also always supported my decision to practice according to my conscience, specifically the fact I do not refer for abortion or prescribe contraception. They know I am a competent and compassionate physician even if they do not share my philosophy.
For the past decade, we have been able to work together to accommodate the different philosophies of the physicians and patients in our community. We consider these differences a strength and not an obstacle to excellent health care.
To dictate that all physicians must refer for abortion and prescribe contraception is an affront to the autonomous medical profession and fails to appreciate the diversity of philosophies which enrich our Canadian culture. Let the dialogue between patients and physicians and among physicians continue about issues of conscience. We can work together to appreciate our diversity. We do not need to adopt an exclusive, rigid policy about these important reproductive health issues.
Thank you for being open to consultation with the public on this matter.
In doing so, the College obviously accepts existing Charter of Rights of freedom, of religion
and conscience and therefore I urge you to maintain that moral stance.
I would like to emphasize that moral stances based on conscience are rational and evidence-based, often reinforced by religious beliefs and therefore deserve protection.
Freedom of religion and conscience rights are included in other documents and therefore
Canadian documents should reflect these values.
(Cf., Canadian Charter; the United Nations’ Universal Declaration of Human Rights, Article 1 states:
“All human beings are born free and equal in dignity and rights. They are endowed with reason and conscience and should act towards one another in a spirit of brotherhood”.
Thus, there should always be a balancing of rights, and I request that both patient and physician rights be respected; accommodation should not be only one way.
A physician should never be compelled to act against rational conscience decisions, nor should he/she be required to be an accomplice in achieving what goes against their conscience as such compulsion goes against the Charter and human rights.
Therefore, by refusing to provide or perform some procedures is not discriminatory when it is based on a properly informed conscience: this has nothing to do with the patient, requesting a procedure, and everything to do with the physician’s decision about the wrongness of the procedure in question.
In conclusion, I would strongly hope that when you are making changes to your original policy,
you would seriously consider the reflections I have put forward,
I am very concerned with the contents of your draft policy which will force physicians who do not chose to participate in certain acts (like euthanasia or abortion for example) for reasons of conscience to refer their patients to other doctors to perform these acts. This still makes them complicit in the act in their minds and is unacceptable to their human rights. They should have the right to conscientious objection and I oppose the policy you are proposing that takes away that right.
I do not expect you to define or limit morality but I do expect that physicians be allowed to respect their own consciences. This is foundational to the function of our society.
If we coerce physicians into violating their consciences we will inevitably erode the personal integrity which is the basis of the physician’s relationship with their patients. I encourage you to revise the sections above, and include a clear defence of the right to freedom of conscience for all physicians.
If this policy proceeds it will change the type of people who choose medicine as a career and that will change the profession entirely and in the wrong direction for the good of the people.
I am writing with deep concern over some of the points contained in the draft policy “Professional Obligations and Human Rights”.
On lines 156-160, a physician will be required to refer for procedures which are against his/her belief system. This is an excellent way to destroy the physician’s integrity and is an infringement on a physician’s freedom of conscience which is guaranteed by the Canadian Charter of Rights and Freedoms. I believe that this policy is heavy handed and an abuse of the CPSO’s position of power. I believe it is sufficient for a physician to provide the necessary accurate information in a respectful manner with full disclosure and allow the patient to go elsewhere for what they seek, as is currently the standard of care. As a physician in practice for almost 25 years, I am very distressed to see the misapplication of this policy as it relates to the Ontario Human Rights Code.
To make matters worse, Line 168 states that in “urgent” cases, a physician is obligated to provide the requested care or procedure…this is open to misuse and various interpretations. If a procedure or course of action is deemed ethically unacceptable, then the context does not change the nature of the action. I can understand the concerns behind this policy and I applaud the CPSO for the progress made but theses concepts need to be revisited in order to avoid doing damage to the profession. The Canadian Medical Association has long been a defender of a physician’s freedom to abstain from being involved in morally objectionable procedures. This draft policy flies in the face of this view and has me deeply troubled.
Ultimately, this policy could be used to coerce physicians to be involved in procedures against their conscience and will harm the fabric of medicine and will result in the limitation of patient’s choices. The dignity of patients as well as their safety can still be protected in other less restrictive ways and access to care can still be available without these further proposed measures.
Thank you for the opportunity to provide feedback on this important draft policy.
Like many of my colleagues, I have significant concerns regarding the recent legal rulings which allow a physician to assist in the death of a patient who consents to death.
I am deeply concerned that this sends a message that life is not always important, especially if that life causes suffering to an individual and/or to society. It sends the message that an acceptable solution to prevent such suffering is to inflict death. I disagree with this message.
I also disagree that physicians should have the authority to decide whether a life is filled with enough suffering that it can be willfully ended.
I would ask that the CPSO establish policies that allow physicians to opt out of participation in activities and procedures that go against their conscience, especially when it concerns acts that would result in ending a person’s life. Physicians should not be required to refer for or participate in such acts.
In medical school and residency, physicians are taught to practice ethically and with integrity. One cannot practice with integrity and also participate in acts that violate one’s conscience.
I read with alarm the proposal of the O.C.P.S. working group to impose a decree on practicing physicians in the Province of Ontario. This decree would force them to perform procedures or be complicit in procedures through referral, which would be contrary to their personal conscience.
Such a regulation will deny physicians freedom of conscience, a conscience that for each is developed over a lifetime. I would suggest that conscience forms an integral part of a human being and cannot be altered for a specific occasion. It defines the integrity of the person.
Many physicians will be unable to comply with such a decree. They would be forced out of the noble profession of medicine. Additionally, future and worthy candidates for the study of medicine will be lost.
Communities throughout Ontario will be deprived of many excellent and competent physicians. These individuals will be forced out of practice in order to preserve the integrity of their conscience.
It is my hope that the Policy Working Group will not propose that physicians be forced to perform or refer patients for abortions to terminate developing human life, or other procedures contrary to their conscience. I believe this to be an attack on a particular physician’s human rights.
To deny the freedom of a physician, or any person, to abide by their informed conscience in very serious and professional actions regarding life issues is, at best, irresponsible.
Issues mentioned in the C.P.S.O. Policy Working Group are contrary to the freedom of conscience of Ontario Physicians and I strongly object to such a regulation being imposed.
I suggest there currently exists objection to the Policy Working Group from a wide representation of society and not merely from specific religious groups as has been mentioned.
Please register my emphatic objection to the proposed regulatory change by the Policy Working Group of the Professional Obligations and Human Rights Committee of the O.C.P.S.
To remove freedom of conscience from Ontario’s Physicians is a denial of their human rights. It is fearful to consider our society heading down that path.
As a healthcare worker and member of a fellow professional regulatory college, I am writing to you with grave concern regarding the content of your proposed draft policy, which indicates that physicians who decline to participate in certain acts for reasons of conscience should be compelled to refer their patients to other physicians who will perform these acts. It does not address the fact that many of these same physicians will find the act of referral itself objectionable, as they consider it material cooperation with the act. In compelling physicians to refer, you are limiting their
right to conscientious objection. I am opposed to this.
There is significant disagreement in our society as to what constitutes a moral act, and I do not expect the College to define or limit morality. All I expect is that physicians, as professionals, be allowed to respect their own consciences. Freedom of conscience is foundational to our free society and cannot be limited, even for the best of intentions.
If we coerce physicians into violating their consciences we will inevitably erode the personal integrity which is the basis of the physician’s relationship with their patients. I encourage you to revise the sections above, and include a clear defence of the right to freedom of conscience for all physicians.
I am writing to support conscience rights for doctors. The proposed policy of the Ontario College of Physicians and Surgeons would mandate referral for treatments that many doctors believe are bad medicine.
My own family doctor’s moral stance against abortion, assisted suicide or sterilisation is, I know, not merely a personal belief; rather she has reached this position through scientific knowledge, medical experience and philosophical reasoning. She is convinced as a professional that some medical procedures are not good for her patients, and she will not practice them nor counsel her patients to seek other doctors who would be willing so to practice. She rightly fears that should the proposed policy be enforced, she would have to give up medical practice entirely. And that would be an enormous loss for our small community.
Such doctors should be protected from any and all compulsion to act against their consciences. These consciences were formed in the crucible of family practice and deserve respect. I for one am grateful to have found such a doctor !
I would like to state that I reject the proposed “effective referral” mandate in the draft dealing with physician-assisted suicide. This “effective referral” compels a physician to violate his or her own conscience by being a participant in the very act, the very procedure, which he or she objects to in the first place.
Freedom of conscience and religion are guaranteed by the constitution and must be respected and upheld.
I am a person of faith and I have served as a voluntary spiritual care chaplain.
I have read the draft policy document entitled Professional Obligations and Human Rights issued by the College of Physicians and Surgeons of Ontario. I have also seen in today’s Ottawa Citizen the statement of Rabbi Reuven Bulka, Imam Samy Metwally and Archbishop Terrence Prendergast that they “do not question the right of individuals to medical interventions for which they are entitled by law. That is their right. But to force a physician, as this draft policy would, to be party to such interventions which the physician objects to on moral or religious grounds is to deny the physician his/her basic right”.
I write to express my support for the views expressed by the leaders of the three faiths in Canada.
I am not in agreement with the recent Supreme Court decision to legalize euthanasia in Canada. I also support the freedom of conscience for all doctors in this matter as well, who do not agree with euthanasia.
Thanks!
I am very thankful that we still have doctors in this country with strong consciences, begging us to defend them. In a country where we are crying for more doctors, where the wait-lists for patients without doctors is years-long in some communities, imagine forcing good doctors to choose between their consciences and their practices? If we lose even one doctor over this ridiculous issue, it will be too many. Thousands more patients with a multitude of health needs will be without a doctor, simply because the doctor would not cooperate with a handful of meds or procedures that he/she believes is wrong. Leave doctors to follow their own consciences.
am not in agreement with the recent Supreme Court decision to legalize euthanasia in Canada. I also support the freedom of conscience for all doctors in this mater as well, who do not agree with euthanasia.
I am a Palliative Care physician and I am writing regarding the CPSO Draft Policy, “Professional Obligations and Human Rights.” I have reviewed this policy and a number of the comments in the discussion forum. I thank you for the opportunity to comment on this policy.
While I respect that this policy has been created with the intention of respecting the rights of patients and acting in their best interests, I would like to echo the concern of a number of other physicians and members of the public regarding the requirement to refer for services that one does not provide for moral or religious reasons.
As a Palliative Care physician, I am specifically concerned about this in the context of the recent Supreme Court ruling regarding medical aid in dying. Like the majority of Palliative Care physicians (Canadian Society of Palliative Care Physicians Position on Euthanasia and Physician Assisted Suicide, February 2015, http://www.cspcp.ca/wp-content/uploads/2014/10/CSPCP-Position-on-Euthanasia-and-Assisted-Suicide-Feb-6-2015.pdf), I am opposed to euthanasia and assisted suicide and do not believe that they should be part of Palliative Care. I would not be comfortable referring a patient for either of these services because I would still feel that I was assisting in the active termination of a patient’s life. It is my understanding that under the current ban on euthanasia and assisted suicide, referrals for these practices (for example to the assisted suicide program in Switzerland, which takes international referrals) can result in criminal conviction. (This is my understanding based on having attended educational activities dealing with how to respond to requests for hastened death- if I have misunderstood any part of this then I apologize.) Therefore, I don’t think it should come as any surprise that objection to euthanasia and assisted suicide and objection to referral for euthanasia or assisted suicide would go together. I can only imagine that carrying out an act which violates one’s moral core would result in long term moral distress and a breach to personal integrity which would be personally and professionally damaging. Asking physicians to choose between this option, violating CPSO policy, and leaving or drastically modifying their practice in order to avoid requests for services to which they object, is unreasonable. I believe it will engender fear and distress amongst physicians who are put in this difficult position, and will hamper their ability to have honest and trusting relationships with patients. As others have mentioned, another potential outcome is the diminishment of diversity in physician beliefs and perspectives, making physicians as a group less representative of the patients whom they serve. I do not think that any of this is good for patient care.
I agree with the comments of others who suggest finding ways in which patients can self-refer for services that providers may not provide for moral or religious reasons. I realize that this may sometimes be easier said than done, but I think that taking measures to provide access to controversial services while minimizing the risk that physicians will be asked to compromise their personal integrity is a better reflection of respecting the rights of both parties.
I also would like to address lines 168-169 which deal with “care that is urgent or otherwise necessary to prevent imminent harm, suffering and/or deterioration.” I agree with the comments of others that this wording is too vague. I am concerned that it could be interpreted to apply to a large number of patients who are requesting euthanasia or assisted suicide because suffering and deterioration, which may well be “imminent” or already in progress, are generally the reasons for these requests. This interpretation could, at least in theory, create an implication that physicians are required to actually provide euthanasia or assisted suicide in many cases where these services are being requested. I implore you to ensure that this does not occur.
I would like to note that although I have been commenting on this policy as it might relate to the legalization of euthanasia and/or physician assisted suicide, I do believe the ramifications of ignoring one’s conscience that I discussed above would apply to physicians who are asked to refer for other services to which they morally object. I have been addressing an issue which is relevant to my practice but I recognize that this policy similarly affects other physicians around a range of issues.
In Palliative Care, as in other areas of medicine, we strive to care for the whole patient. We deal with intense, complex, and emotionally draining situations on a daily basis. Certainly these types of circumstances are encountered by all physicians at some point, and by many as a matter of routine. Caring for patients in these challenging scenarios with the necessary degree of attentiveness and compassion and without burning out requires physicians to adequately attend to their own bio-psycho-social-spiritual needs. This is hardly possible in a professional environment that poses a threat to personal morality, a basic part of an intact identity.
I do not feel that this policy represents an appropriate balance of patient and physician rights. I urge you to reconsider what is really being asked of physicians, and I hope that this policy does not go through in its current form.
I am writing to you with grave concern regarding the content of your proposed draft policy, which indicates that physicians who decline to participate in certain acts for reasons of conscience should be compelled to refer their patients to other physicians who will perform these acts. It does not address the fact that many of these same physicians will find the act of referral itself objectionable, as they consider it material cooperation with the act.
Physicians moral stances, based on rational conscience decisions, deserve protection. Compelling physicians to act against conscience decisions violates the Canadian Charter of Rights and Freedom.
A physician’s refusal to provide or perform some procedures does not constitute discrimination when this decision is based on a properly informed conscience. This decision is not based on the characteristics of the patient requesting the service, but on the nature of the procedure requested.
I encourage you to revise the sections above, and include a clear defence of the right to freedom of conscience for all physicians.
Forcing physicians to refer patients to other health-care providers for procedures that they are unwilling to provide due to moral or religious beliefs is discriminatory. Physicians must be permitted to refuse to provide services that conflict with their consciences. This must include both the objectionable procedures and the referrals to other health-care providers for said procedures. Freedom of conscience is a cornerstone of our free society.
Furthermore, there is a clear danger of confusion between moral, religious and scientific/clinical objections. For example, abortion may be objected to on religious, moral, or scientific/clinical grounds. If religious beliefs are a private matter, morals are perhaps less private, and scientific opinions are and ought to be public. If a doctor refuses to perform abortions, not for religious reasons, but for scientifically informed moral reasons, is he not allowed to explain that life begins at conception when a unique DNA signature is created, and that, as a doctor, his job is to protect human life wherever possible? Religion need not enter the discussion at all. But it is the physician’s responsibility to inform the patient of these concerns. Forbidding him to do so is a violations of the patient’s right to that information and a violation of the physician’s freedom of conscience.
Requiring physicians to make referrals upon announcing their objections to procedures is equivalent forcing them to be complicit in the procedures, qualitatively not different from forcing them to perform those procedures, but merely once removed.
In a free society we must not limit freedom of conscience. If we do that, our society is no longer free. I strongly object to the content of your proposed draft policy, and request that it be amended to facilitate full freedom of conscience to physicians.
Please consider these points when revising the policy Professional Obligations and Human Rights.
It is hard to see how limiting physicians Rights to Freedom of Conscience and Religion guaranteed in the Charter will result in less discrimination or better patient care. I want to be treated by a doctor of integrity, who acts according to their conscience and won’t undertake interventions I believe to be seriously ethically wrong, such as taking a life. Requiring referrals is the same as doing it one’s self. Requiring referrals or requiring the doctor to participate in procedures that go against their beliefs may eliminate them from practice. I want access to doctors of integrity. How might my rights in this regard be respected? Requiring referrals or requiring the doctor to participate in procedures that go against their beliefs may reduce their personal sense of integrity, if they remain in practice. Interior dissonance between deeply held beliefs and professional requirements can lead to burnout. This is systemic discrimination based on conscience. It will impact patient care. Forcing physicians to act against their conscience, to do something they believe is deeply wrong against their will, not only harms them. This coercive violation of their freedom of conscience also harms society and the values that inform its culture. The requirement for referrals may actually slow down patient access to services. For instance in Ontario, patients may self-refer for abortion. I am looking for a doctor of integrity and who believes in “First do not harm”. I count on and trust that my physician follows their oath, to do no harm. There are many creative ways to maintain conscience rights and allow patients to access these controversial services. Surely a tolerant country like Canada can come up with a way to make this work.
I agree that the potions should be made available and patients who want alternative care can seek it from other physicians
I am writing to you with grave concern regarding the content of your proposed draft policy. Sections 8, 10 and 11 suggest that physicians who decline to participate in certain acts for reasons of conscience should be compelled to refer their patients to other physicians who will perform these acts. It does not address the fact that many of these same physicians will find the act of referral itself objectionable, as they consider it material cooperation with the act. In compelling physicians to refer, you are limiting their right to conscientious objection.
There is significant disagreement in our society as to what constitutes a moral act, and I do not expect the College to define or limit morality. All I expect is that physicians, as professionals, be allowed to respect their own consciences. Freedom of conscience is foundational to our free society and cannot be limited, even for the best of intentions. If we coerce physicians into violating their consciences we will inevitably erode the personal integrity which is the basis of the physician’s relationship with their patients.
I encourage you to revise the sections above, and include a clear defence of the right to freedom of conscience for all physicians.
[**MESSAGE FROM ADMINISTRATOR: DURING THE CONSULTATION PERIOD, WE RECEIVED 91 RESPONSES FROM INDIVIDUAL RESPONDENTS CONTAINING THE CONTENT PUBLISHED ABOVE. ALTHOUGH THIS FEEDBACK HAS NOT BEEN PUBLISHED IN DUPLICATE, THE COLLEGE ACKNOWLEDGES RECEIPT OF THESE SUBMISSIONS.**]
I cannot imagine having a doctor who would work against his/her moral principles and beliefs, nor can I imagine a professional body, meant to protect and guide physicians advocating that forcing a doctor to refer his/her patient to another doctor to do what he/she finds morally reprehensible is not similar to “hiring someone to kill” for you!
Please listen to the people, and to the religious leaders in our country.
As a member of the public accessing the care of physicians, it is important to me that physicians act in accordance with their conscience and not be required to provide referrals for services or treatments that are contrary to their conscience.
I am writing to express my concern and to request that the policy be revised to respect the rights of physicians and to remove the proposed mandate for “effective referral”.
[**MESSAGE FROM ADMINISTRATOR: DURING THE CONSULTATION PERIOD, WE RECEIVED 21 RESPONSES FROM INDIVIDUAL RESPONDENTS CONTAINING THE CONTENT PUBLISHED ABOVE. ALTHOUGH THIS FEEDBACK HAS NOT BEEN PUBLISHED IN DUPLICATE, THE COLLEGE ACKNOWLEDGES RECEIPT OF THESE SUBMISSIONS.**]
I strongly object to the provision in your draft policy that all Doctors (and nurses) will have to provide services that violate their most deeply held moral convictions.
Killing vulnerable people (the unborn, the infirm, the elderly) instead of caring for them is not something that society embraces and should definitely not be a part of any policy today.
Please consider this change to your proposed policy.
As a member of the public accessing the care of physicians, it is important to me that physicians act in accordance with their conscience and not be required to provide referrals for services or treatments that are contrary to their conscience. This is part of my criteria for choosing a doctor and, although my doctor and I do not always have to agree, we do need to respect each other, and I need to know that they are always acting to protect my well-being.
I am writing to express my concern and to request that the policy be revised to respect the rights of physicians and to remove the proposed mandate for “effective referral”.
Thank you for giving us the opportunity to give you our feedback concerning the Professional Obligations and Human Rights draft policy.
I STRONGLY OPPOSE the draft of the Professional Obligations and Human Rights policy for the reasons outlined below:
1) The policy as drafted is not in the best interest of the citizens of Ontario. I appreciate having a Christian doctor who has the same worldview, values, and beliefs as I do, based on the Holy Bible. I can rest assured that when I face a health care decision, he will give me advice that is in accordance with the Bible and therefore with my worldview, values, and beliefs. If my doctor would be required to refer patients for ‘procedures’ that he is opposed to on moral and religious grounds, he could no longer conscientiously practice medicine in Ontario. I would lose my doctor and would no longer be able to receive medical advice in line with my values and therefore not receive advice that is in my best interest.
2) Ontario’s government appears to be attempting to convert everybody to secular humanism. In an attempt to give everyone equal rights in regards to access to ‘medical care’, they are taking away the rights of physicians who hold to moral and conscientious standards that are not necessarily in line with the government’s standards. Do doctors have no ‘human rights’?
3) Canada is a free country. When a doctor is unwilling to refer a patient for certain types of ‘medical care’, it is often because of the doctor’s own moral or religious beliefs. By pushing doctors to provide ‘care’ that goes against their beliefs, their freedom of conscience and religion is being taken away, something that is outlined in Canada’s Charter of Rights and Freedoms.
I strongly recommend that this policy be revised so that physicians are able to practice with the patient’s best interest in mind and according to their own religious and conscientious beliefs.
I am writing to express my deep concern over the proposed “effective referral” mandate.
First, I would like to state that I could not successfully navigate my way through the CPSO’s online survey. I found it beyond my comprehension and I wonder if the majority of Ontarians would find it similarly difficult, causing me to question how reflective of general public opinion the results might be. I read the policy, then started the survey and found the questions confusing, limiting and leading.
My concerns with this proposed “effective referral” mandate, and any policy which turns doctors into killers instead of caregivers, are multiple. The most fundamental concern is the violation of a physician’s Charter right to freedom of conscience and religion.
We are dealing with serious, life-threatening issues which, until recently, have been legislated as criminal offences. Until recently,doctors could have been charged with abetting a criminal offence. A change in legislation does not thereby make an action right or justified. To compel a physician to refer a patient to another healthcare provider who will provide a “certain element of care” is to compel that physician to violate his or her conscience and beliefs, to become an abettor. Are we so unenlightened as to stoop to tyranny?
I have many fears concerning my future care, as a patient with serious depression who experiences suicidal thinking. I am not able to express my personal concerns well under these circumstances. However, I urge you to protect physicians’ conscience rights. This protection will ultimately protect my life from undue influence to end it, at times when I am most vulnerable.
I wish to oppose this policy. I cannot accept the use of the key ethical notion of conscience that this policy presupposes. It is here invoked in a pejorative sense that dismisses the importance of the physician being true to the convictions that guide his or her practice and to absent himself or herself from cooperation in courses of action that he or she nudges to be unethical. Conscience acts in this manner, and by it one accuses or excuses oneself.
As Dr. Rabelais said during similar discussions during the Renaissance, “Science without conscience is the ruin of humans (translation from French).
I strongly support the “Physicians’ Charter Right of Freedom of Conscience and Religion” in regard to the proposed Assisted Suicide draft law.
It is contradictory to ask a physician who objects to assisting in someone’s suicide to suggest another physician who will assist. By doing so, he is again complicit in the “assisted suicide.”
May I suggest that the law be so written as to excuse the the physician who objects and not ask him to suggest another doctor. Perhaps there should be a list of physicians who will participate in assisting a suffering person and/or a list of physicians who will not.
This controversy has arisen because some physicians insist on “hooking” up people who are terminally ill to all kinds of machines. Were the patients left to die with dignity without an all the tubes that are put in them to sustain life, perhaps we would not have needed an “Assisted Suicide” law. Of course, I realize that in some cases it may be necessary to intervene; however, one cannot take one person’s right to die and deny another person’s right to object to the procedure.
I would like to write about the proposed allowing of Assisted Suicide. I will not call it “helping someone die” as that is not what this will end up being.
We had a lovely Doctor come to speak to our women’s group about this topic. Its one thing to allow this but he said the College of Physicians and Surgeons of Ontario will be forcing Doctors who do not believe in this for either moral or religious reason to be threaten with discipline for refusing to do this dreadful act or even referring them to someone else who will .
Even my Veterinarians can not be forced to kill or put down or euthanasia an animals against their beliefs. This is why many of us work for hard for NO KILL shelters for animals.
I have read that in some countries who started out saying no one would be force to be put to death are finding 25% increase in person who are having this done who didn’t want it. One article was a wife who’s husband needed treatment and they put him down instead..she was devastated.
Also its one thing to tell an ASL person okay you can decided to end your life if you want to … but to let someone who is depressed and feels life is not worth living decide to be put to sleep like a pet dog or cat is barbaric. What happened to offering help instead.
I have suffered from depression my whole life and even taken myself to a hospital once to ask for help as I was scare I was going to end it. Would they have offered to help me end my “mental” pain????? as this new law has been saying or offered me help?
I also thought that suicide was against the law? Are we now just not going to bother helping someone who has suicidal thoughts and say “Oh well their mental pain is to much to bear..so be it…bye bye and so long”.
What will happen to be one day in an old age home? I have no children, thus no one to speak for me to say NO.she wants to die naturally. What if they, the board of directors of the home, decide I am taking up too much time and room and resources decided that they are “pretty sure” I wanted to be put down?????
It reminds me too much of what the Nazi did to the Mentally challenged, handicapped or homosexuals during the war. They were considered “defective” and killed!
There are lots of us who do not believe in “putting people” to sleep or death…which is the real words…we are “assisting” in killing a human bean, not helping them.
Fine take committing suicide out of the law books as wrong and illegal but don’t make other people do it for you especially someone who takes a vow to “do no harm”!
College of Physicians and Surgeons of Saskatchewan This draft policy covers nicely the issues. The distinction set out in the first paragraph between what is legal and what is the College’s professional and ethical obligations is useful. The explanation pertaining to a physicians who choose to limit the health services they provide on moral/religious grounds is excellent. I like the further detail provided under respects patients dignity; ensures access to care and protects patient safety. Physicians should find this guidance helpful.
I am writing to you with grave concern regarding the content of your proposed draft policy. Sections 8, 10 and 11 suggest that physicians who decline to participate in certain acts for reasons of conscience should be compelled to refer their patients to other physicians who will perform these acts. It does not address the fact that many of these same physicians will find the act of referral itself objectionable, as they consider it material cooperation with the act. In compelling physicians to refer, you are limiting their right to conscientious objection.
There is significant disagreement in our society as to what constitutes a moral act, and I do not expect the College to define or limit morality. All I expect is that physicians, as professionals, be allowed to respect their own consciences. Freedom of consciences. Freedom of conscience is foundational to our free society and cannot be limited, even for the best of intentions. If we coerce physicians into violating their consciences we will inevitably erode the personal integrity which is the basis of the physician’s relationship with their patients.
I encourage you to revise the sections above, and include a clear defence of the right to freedom of conscience for all physicians.
1. Being an accessory to an action is as engaged as the one omitting the action.
2. Authentic human freedom is quite different than formalistic human freedom.
3. Formalizing another’s behaviour is a violation of their liberty. When it is done as against another’s conscience it is not just.
4. Is it not a contradictory paradox that one may help the life, liberty and security of another by helping them to commit suicide either by direct action or referral.
5. Consider choice which is always free. One would choose to escape prolonged pain. Shouldn’t one choose what is choice-worthy? G.K. Chesterton says: “our being is to be filled not just with ourselves but with what is good beyond ourselves. The only finite person who fills his being only with his own good is the devil”.
6. Human Life is sacro-sanet. To allow ourselves to be apathetic about things true, good and beautiful is to lock ourselves up in ourselves.
I write you to say I disagree with the College of Physicians & Surgeons of Ontario mandate of mandatory effective referral for prescribing the Oral Contraceptive Pill.
Ontario Doctors should not be compelled to prescribe this carcinogen and this would be a violation of their conscience rights.
The Physicians and the Ontario Human Rights Code policy is currently under review and you have publicly sought out consultation and feedback. I am writing this to provide my opinion. I have reviewed the draft and have some serious concerns.
As is available on your website “The draft policy sets out physicians’ existing legal obligations under the Ontario Human Rights Code (the “Code”), and the College’s expectation that physicians will respect the fundamental rights of those who seek their medical services.”
In any clinical encounter there are at least two people making choices, each hoping to follow their conscience. Reconciling patients’ rights with doctors’ is at the core of the matter.
The recent decision of the Supreme Court pointed out that “a physician’s decision to participate in assisted dying is a matter of conscience”. On it, they referred to the 1988 Morgentaler’s decision that a physician could not be compelled to participate in abortion. In Ontario, as you know, any patient can access abortion by self-referral.
In my opinion, the burden is on the CPSO to substantiate that one is not able to ensure access to this practice without encroaching on the Charter rights of doctors.
Likewise, this approach should apply to anything else including assisted suicide. In this area, some have suggested that a potential solution is for the CPSO to create a “willing-physician’s referral service” that would direct inquiries from Ontario patients to those doctors who are prepared to provide assisted suicide. Additionally, the CPSO draft policy suggestion that doctors participate in doing the act in case there is no referral available should be definitely clarified (lines 166-169 of the draft policy).
A further point is to clarify that there is no jurisdiction where assisted suicide or euthanasia is current practiced demands referral (1,2). We need to take this seriously: it is our conscience that guides us in every day and no one should be forced to violate it. Its bad medicine to try to coerce physicians to do what they think is wrong for their patients. To have our professional college, which is supposed to be a group of our peers as a self regulatory body, encourage their individual members to engage in what they perceive to be unethical behaviour is hard to comprehend.
In my opinion, if this draft policy passes as it is, thousands of physicians will join together and initiate a legal challenge supported (financially and morally) by all the major religions and people of good conscience, as an Ottawa joint declaration suggests (3).
Thank you for taking to time to consider my feedback.
As a member of the public accessing the care of physicians, as well as a Registered Nurse practicing and living in Ontario, it is important to me that physicians act in accordance with their conscience and not be required to provide referrals for services or treatments that are contrary to their conscience.
I am writing to express my concern and to request that the policy be revised to respect the rights of physicians and to remove the proposed mandate for “effective referral”.
Thank-you for considering submissions from the public regarding your draft Professional Obligations and Human Rights document.
Having reviewed said document, I see it as an attempt by the College to ensure that its doctors will be practising medicine within the confines of the Ontario Human Rights Code. In my review I am thinking specifically of the issues of euthanasia and ‘assisted suicide’.
While I understand that the College may wish to form their policy with a view to avoiding any legal challenges, what I do not understand is your failure to take a stand that would protect your doctors, should they wish to refrain from either participating in or referring for assisted suicide on moral or religious grounds. Doctors are in business to heal people, not to kill them. Doctors at their Canadian Medical Association conference last August voted overwhelmingly to reject assisted suicide.
When anyone acts against their own conscience, it causes conflict within themselves, leading to high levels of stress and burnout. The more important the issue, the higher the stress level, and this one is literally life and death. Doctors are under enough stress now, without adding this burden onto them. Doctors must not be forced to participate in, or refer patients elsewhere for, assisted suicide.
The College of Physicians and Surgeons ought to be standing up for their doctors, not going against their wishes.
I am writing to you today to urge you to maintain conscience clauses in your membership policies that ensure doctors are not compelled to perform procedures such as abortion and assisted suicide.
As a member of the public, accessing the care of physicians, it is important that the physicians act in accordance with their conscience and not be required to provide referrals for services or treatments that are contrary to their conscience.
I am writing to express my concern and to request that the policy be revised to respect the rights of physicians and to remove the proposed mandate for “effective referral”.
[**MESSAGE FROM ADMINISTRATOR: DURING THE CONSULTATION PERIOD, WE RECEIVED 6 RESPONSES FROM INDIVIDUAL RESPONDENTS CONTAINING THE CONTENT PUBLISHED ABOVE. ALTHOUGH THIS FEEDBACK HAS NOT BEEN PUBLISHED IN DUPLICATE, THE COLLEGE ACKNOWLEDGES RECEIPT OF THESE SUBMISSIONS.**]
I object, in the strongest terms, to the “effective referral” proposal of the CPSO that would force Ontario physicians, in cases where they are unwilling to provide certain elements of care due to their religious beliefs, to refer patients to other physicians who would provide care which they found objectionable.
In my opinion this would be a violation of a physician’s rights since it would compel he or she to be an accessory to a procedure or act, which they found objectionable in the first place.
Such a requirement is also, in our opinion, a violation, in principle, of the Ontario Human Rights Code and the Canadian Charter of Rights and Freedoms.
I am writing because I find the section on Ensuring Access to Care (Lines 150 to 164) of your “Draft Policy on Professional Obligations and Human Rights” very disturbing. The requirement that physicians must provide an effective referral if they are unwilling to provide certain elements of “care” out of moral or religious beliefs clearly takes away their Charter-protected right to freedom of conscience and religion.
Doctors who firmly believe that certain actions (e.g., doctor assisted suicide) violate the Hippocratic oath by which they are bound, should not be forced to provide a referral for such actions because in doing so, they are in fact participating in the very act to which they object.
Freedom of conscience is foundational to our free society. If we coerce physicians into violating their consciences, Ontario will potentially lose some of its best doctors and undoubtedly many of our brightest and most compassionate young people will find it necessary to re-think their career options.
I encourage you to revise the section on Ensuring Access to Care, and include a clear defence of the right to freedom of conscience for all physicians.
I am very concerned about aspects of the CPSO draft policy on Professional Obligations and Human Rights.
It is paramount that not only patient rights but also physician’s moral/religious rights are equally addressed in the policy especially since there is no hierarchy of rights in the Canadian Human rights code. As long as patients are informed of the physician position, in a respectful and non judgemental fashion, the physician should not be compelled to refer the patient as this act itself would be a complicit participation in the morally objectionable treatment. The patient can be generally instructed as to where they may seek alternate treatment without the need for a formal referral to a colleague to initiate treatment that would be morally objectionable to the physician. The only exception to this would be in emergency situations where life or limb were at risk. Most requests that fall under this area of concern, such as therapeutic abortion, or possible euthanasia requests ( in the near future) are rarely emergency in nature and can be initiated by the patient themselves without the express involvement of the physician who may find these treatment morally objectionable.
This is especially true in the present age of internet access to information for such services. This would not constitute a excessive burden on the patient.
Forcing physicians to participate in actions that deeply contravene their own personal moral convictions would be a grievous imposition on the human rights of that physician and all physicians. In a pluralistic society there needs to be room on both sides of morally controversial treatments for respect and latitude, so that both the general public and medical professionals are equally treated. Physicians should be allowed to operate in their chosen profession, like every other Canadian citizen, without discrimination and pressure to be involved in activities that are deemed morally objectionable to that physician.
Therefore I strongly recommend that the policy be changed to reflect this.
We reject the proposed “effective referral” mandate for doctors whose Charter right of freedom of conscience and religion must be respected.
Catholic physicians believe that a mandate for an “effective referral” is a violation of a physician’s rights, as it compels the physician to violate his or her own conscience by being a participant in the very act, the very procedure to which he or she objects in the first place.
Catholics Physicians rights must be respected
I reject the proposed “effective referral” mandate for doctors. I believe that their Charter right of freedom of religion and conscience must be respected.
1. It is hard to see how limiting physicians Rights to Freedom of Conscience and Religion guaranteed in the Charter will result in less discrimination or better patient care
2. Requiring referrals or requiring the doctor to participate in procedures that go against their beliefs may eliminate them from practice, and reduce their personal sense of integrity, if they remain in practice. Interior dissonance between deeply held beliefs and professional requirements can lead to burnout. This is systemic discrimination based on conscience or religious belief. It will impact patient care.
3. The requirement for referrals may actually slow down patient access to services. For instance in ON patients self refer for abortion.
4. Forcing doctors to refer for something, or perform something they consider to be killing a patient will completely go against the whole reason they got into medicine in the first place – to heal patients – not to harm them. This is a coercive action that involves a large percentage of physicians who do not want to be involved in euthanasia/assisted suicide.
Physicians, hospitals, clinics, etc. have not fulfilled their obligations under the Ontario Huamn Rights Code in relation to those patients with Environmental Sensitivities/Multiple Chemical Sensitivities/Chemically Induced Injury.
In order to even have access to where Doctors work, a comprehensive program to make these places safe (for everyone) must be undertaken immediately.
Physicians have obligations also under the AODA’s Customer Service Standards to make the places they work accessible.
The information the College requires in at the Canadian Human Rights Commission: There are two papers outlining the Medical and Legal aspects that provide everything that you need to know: proper signage to ‘encourage’ others entering the space to be scent-free; information and education for all doctors, patients, etc. on this issue; non chemical cleaning products that are safe; any furniture, flooring, reno’s, etc. done with safe materials in a safe manner, etc.
There is no point in going into the kind of discrimination, bullying, etc. that those of use with this disability (whatever it is called) have suffered. Image peanut bullying and what can be done with fabric softener, perfume, etc. Also, we are being injured whenever we come in contact with these modern-day chemicals that do no good, but only harm and make a profit for big corporations. If doctors are to ‘do no harm’, how can doctors be fulfilling their mandate but not warning people and helping them avoid these injurious chemicals.
The College should also enhance the Environmental Medicine department and have the information needed by doctors provided in workshops, magazines, etc. Why don’t doctors know that: a) besides cigarette smoke being connected to SIDS that chemicals in everyday products are killing children (imagine a child breathing in Tide and fabric softener all night!!); that pollution from fabric softenershas been found to be a significant polluter (I can’t walk outside because of it); that third-hand smoke is bad but third-hand fabric softener, air freshener, etc. is worse and is becoming even more injurious.
Pediatricians should be made aware and work with their patients to avoid the numerous chemicals, that work on an immunological level, are injuring people; that so-called ‘natural flavour’ (‘Health’ Canada has approved the change from ‘artificial’ to ‘natural’!) and other additives in factory food makes these ‘foods’ addictive and injurious — and along with other chemicals, such as obesagens, is at the heart of obesity.
The general public is becoming aware of these issues and if our doctors aren’t at the forefront then how can they be trusted?
By accommodating those of us with a disability that makes us the ‘canaries in the mine’ of the modern world, you will not only be helping us to be healthier and have access to the world around us (we are very isolated, have lost our jobs, have lost social contact, are repeatedly injured even in our homes, etc.) but you will be making life safer for everyone — and you will see the difference in your patients (and yourselves) with the avoidance of these ‘poisons for profit’.
Once again, this is a very serious statement that the College of Physicians and Surgeons must ensure that all physicians and surgeons, etc. are accommodating every patient, including those of us with Chemically-Induced Injuries.
We are writing to you to express our concern about your proposed draft policy on “Moral Obligations and Human Rights.” In particular, the proposed policy on “effective referral” (found at l. 156-159) seriously compromises the freedom of conscience of the physicians of Ontario. For matters of grave moral concern, many physicians hold that a referral to perform the objectionable procedure is not meaningfully different from performing the procedure themselves. As such, it puts a serious limit on their freedom of conscience.
The College should recognize that there are several medical procedures that remain highly controversial in Ontarian society. To take one example, doctor-assisted suicide will soon be legal in Canada. For those physicians who oppose this practice, it would be impossible to reconcile any role in such a practice with their duty to act “in the best interests of their patients” (Draft policy, l.18) or to “prevent imminent harm” (l.168). It is in the interest of the people of Ontario to recruit physicians with strong moral principles in their professional and personal lives. The draft proposal would be a serious barrier to many such doctors in this province.
I have read and disagree with your recent draft policy that will require physicians to make referrals for care that are against their morals and religious beliefs to perform.
I do not believe that physicians who have a moral or religious belief that would limit access for patients to receive clinical care (ie abortion, euthanasia) should be mandated to refer these patients to other care providers who will provide these services.
Referral should be optional.
Neither abortion or euthanasia is an urgent or life threatening condition. Patients should be able to access these care providers directly without placing other physicians in a position of referral that is conscientionably objectional.
I am writing today because I have several friends/collegues who are physicians and I believe some of the wording in this draft will directly affect their work as doctors.
The portions I would like to address below:
113-114 “The Canadian Charter of Rights and Freedoms (the “Charter”) protects the right to freedom of conscience and religion. Although physicians have this freedom under the Charter, the Supreme Court of Canada has determined that no rights are absolute.”
123-124 “In relation to freedom of religion specifically, courts will consider how directly the act in question interferes with a sincerely held religious belief.”
156-157 “Where physicians are unwilling to provide certain elements of care due to their moral or religious beliefs, an effective referral to another health care provider must be provided to the patient.”
Including the requirement that physicians give referrals does not address the fact that many of these same physicians will find the act of referral itself objectionable, as they consider it material cooperation with the act. In compelling physicians to refer, you are limiting their right to conscientious objection.
In the cases of abortion or euthanasia (which is currently before parliament) the requirement of providing a referral demands that a principled, moral and/or religious person cooperate with the intentional and direct ending of a human life. Clearly this will go against deep, sincere beliefs, and go against many phisicians motive and directive to heal patients and ‘do no harm’.
I expect that physicians, as professionals, be allowed to respect their own consciences. Freedom of conscience is foundational to our free society and cannot be limited, even for the best of intentions.
If we coerce physicians into violating their consciences we will inevitably erode the personal integrity which is the basis of the physician’s relationship with their patients.
Thank you for the opportunity to provide feedback. I encourage you to revise the sections above, and include a clear defense of the right to freedom of conscience for all physicians.
If patients have rights, doctors have rights to freedom of concsience and religion.
Thus, I strongly oppose and disagree with the propose policy to limit the doctors’ rights to freedom of conscience and religion.so that if a patient comes to a doctor asking for an abortion or euthanasia, and if that doctor will not perform it because of his conscience or religion, he has to refer the patient to another doctor.
I strongly oppose the CPSO’s draft policy that limits a physician’s Rights to Freedom of Conscience and Religion- which is guaranteed in the Charter- and requires them to make an effective referral to another physician if they refuse their patient’s requests, such as euthanasia, especially now that it is legalized.
To whom it may concern, We wish to align our thoughts on this most fundamental matter with those eloquently and scholarly expressed by the Catholic Civil Rights League in their recent submission to you.
The path you are proposing is ultimately Orwellian and previous history in Nazi Germany and more recently in the likes of Belgium and the Netherlands clearly demonstrates that this move, however well intentioned, embarks on a slippery slope Canadian doctors clearly must avoid.
We love our Doctor but this would expose him to the possible loss of his immortal soul, yes that’s right, his IMMORTAL soul, we just had to register our responsibility for that.
thank you for asking the public for submission of ideas on Supreme Court Carter decision.
I urge the College, together with nurses to work diligently with government and health authorities to improve access to Palliative Care. We know that with palliative care that takes away pain and reduces sufferings, their desire for assisted suicide almost always go away.
And I urge the Physicians, before referring dying patients to another physician, to try your best to remind family, friends to spend time with the dying and disabled. We, the Catholic communities across the country are mobilized to send out more members to visit patients, to provide some needed comfort. I believe the churches and diocesan offices will be very happy to be of assistance to work with the College on this front.
As for protecting Physician’s conscience right, I believe the existing policy and procedure that protect physician’s right not to provide abortion and assist the distraught mother to obtain helps so she can deliver the baby safely and to keep her baby or give up for adoption. Can sometime along that line be included in this Euthanasia draft policy?
Having read the draft proposal I must say I was quite alarmed when I reached line 152 and again when I reached line 168. In lines 152 and 168 the Doctor’s rights are not protected, in particular their religious and moral rights may be violated. It has elements that would surely have Stalin or Hitler smiling in their graves. Is there not an oath?
Is it not an offence in this great country of our’s to coach someone how to end a life? Even if Doctors are granted exemption, it should never, ever, trump religious conscientious and moral grounds to save lives, if that is what the Doctor chooses. A doctor should be able to say “I’m sorry I will not help you with expediting death or aborting a baby” and not face discipline. As well it is my belief that a Doctor should not be obliged to coach someone where to receive such life ending procedures as that could challenge their morality.
The draft proposal Forces a Doctor to do something they may not want to do.
I am strongly opposed to the draft proposal, but particularly to lines 152 and 168, let’s send it back to the drawing board.
My family and I do not support policies that would have doctors disciplined for following the conscience when having to perform medical procedures. A Christian doctor for instance is for life. having him perform an abortion would be a sin for him.
I strongly advocate for a robust understanding and protection of the Charter right of freedom of conscience and religion for all Canadians, and indeed physicians in the daily routine of their care to patients and in the overall forming of their individual medical practices. I reject the proposed mandate for an “effective referral” as it is a breach of a physician’s rights and a serious incursion into the professional standing of a physician.
Doctors and other health care professionals, indeed all Canadians, enjoy the Charter right of freedom of conscience and religion. A proper balancing of the rights of physicians with the concept of patient autonomy must not result in the trumping of the rights of physicians in their medical practices. Such rights extend not only to refusing to perform morally objectionable services, but the right not to be obliged to refer to other practitioners who may be willing to provide such services. This clearly would constitute participation in wrong. The proposed mandate for an “effective referral” must be rejected.
Compelling a physician to provide an effective referral to another physician or health-care provider in order to carry out a procedure to which he or she objects on the grounds of conscience or religion also compels the physician to violate his or her own conscience by being a participant in the very act, the very procedure to which he or she objects in the first place.
When we are given the position of deciding who will live or die we are on a very s l i p p e r y s l o p e all of us. Patients who are mentally or physically challenged are yet on an even more slippery slope. God help all of us when and if this happens. We must not let our lawmakers allow this.
We, (my father and |), call upon the College of Physicians and Surgeons of Ontario’s Executive Committee and Council to reject the mandate for “effective referrals”. The medical profession, as with any grouping of individuals is not truly free to live and grow if its members are not able to govern their actions in accordance with their individual consciences, whether informed by moral and religious beliefs or otherwise.
I am dismayed at the proposed policy requiring doctors to provide effective referral to another health care provider for procedures which violate their moral or religious beliefs. This is an abandonment of the Charter rights of the profession which you represent.
As an alternative, to require informing patients of these beliefs so they can make informed decisions regarding medical treatment and the choice of doctors makes sense. In fact, it could require some practitioners to state that they have no moral or religious beliefs regarding medical practice, which may be the most chilling statement a patient could hear.
I struggle to imagine other professional associations such as teachers, accountants or engineers being required by their professional associations to provide effective referrals for services they are unwilling to provide due to their moral beliefs. Professions are founded on the bedrock of right behaviour at the individual level. Do not disgrace the medical profession by abandoning this attribute of a professional.
Thank you for this opportunity to voice my concerns about the freedom of choice and beliefs for physicians and their own personal rights as human beings in Canada.
Physicians are expected to provide care, not provide assisted death. Their focus is healing and comfort not murder.
Please consider the physicians who will always honour life. I would be terribly concerned if my life career changed to include assisting to murder the very people I was committed to help.
Please be advised that I am rejecting the proposal for the “effective referral” mandate for Catholic physicians, whose Charter right of freedom of conscience and religion needs to be respected.
This “effective referral” compels the physician to violate his or her own conscience by being a participant in the very act, the very procedure to which he or she objects to in the first place.
I reject the proposed “effective referral” mandate for doctors. I believe that their Charter right of freedom of religion and conscience must be respected.
1. It is hard to see how limiting physicians Rights to Freedom of Conscience and Religion guaranteed in the Charter will result in less discrimination or better patient care
2. Requiring referrals or requiring the doctor to participate in procedures that go against their beliefs may eliminate them from practice, and reduce their personal sense of integrity, if they remain in practice. Interior dissonance between deeply held beliefs and professional requirements can lead to burnout. This is systemic discrimination based on conscience or religious belief. It will impact patient care.
3. The requirement for referrals may actually slow down patient access to services. For instance in ON patients self refer for abortion.
4. Forcing doctors to refer for something, or perform something they consider to be killing a patient will completely go against the whole reason they got into medicine in the first place – to heal patients – not to harm them. This is a coercive action that involves a large percentage of physicians who do not want to be involved in euthanasia/assisted suicide.
Do NOT under any circumstances allow Canadian physicians to provide assisted suicide.
What is needed is a much, much greater supply of palliative care.
All reports from countries who have permitted assisted suicide indicate wide spreading abuse is an inevitable result.
At age 83 I have lived a long, fulfilling, and useful life.
I have discussed with my family my preferred treatment in the case of incurable illness, etc., and wish for palliative care.
If there is no further hope of any recovery they will request that extraordinary means, which would be futile, be refused.
I do not want to spend my remaining years in fear of a medical system that would rather assist in my death than provide needed freedom from pain ,and the comfort that should be provided in palliative care. Doctor’s mantra has always been Do No Harm, and hopefully that will continue to be in effect.
No other person should deem whether or not I should live, nor should they decide the life or death of persons with disabilities, physical or mental, etc.
By striking down the laws regarding abortion in the misguided idea of helping a relatively small number of women who found themselves in untenable situations – we have lost millions of unborn children (who have NO right to life or safety in Canada) merely because they are an inconvenience. Abortion has become just another form of birth control.
Surely educated men and women can foresee the loopholes and disasters that will arise if the College of Physicians permits assisted end-of-life practices to become the norm.
I strongly object to the proposal that physicians who cannot in good conscience perform certain procedures, be required to refer a client to another physician who will usually perform the same procedure that he or she considers unethical. This requirement would undoubtedly cause the physician to sin against his own conscience and in many instances against his or her perception of the almighty GOD. When an individual fears JEHOVAH, an act such as what is being proposed to be made a requirement, is a travesty of the rights and freedoms of the physician.
How can this be in a country such as Canada where much is made of the rights of individuals? Why should the rights of the client supersede the rights of the physician? There are other recourses available to the client while the physician is left to suffer the loss of integrity and feelings of guilt within himself or herself. I find it unconscionable that our Canadian physician’s and surgeon’s rights and freedoms would be completely disregarded in this critical decision. These are stresses added on to a physician that could and should be prevented. If this proposal is made a law some may even decide against becoming a physician.
Please do not follow through with this proposal. We as a society and as individuals are being greatly affected, negatively speaking, by the systematic disregard of the rights of persons of conscience. In many cases individuals with conscience in matters such as these are the cornerstone of our Canadian heritage. It is on many of these principles that our foundations were laid.
JEHOVAH is love. He is equally just. We as a society will not emerge unscathed if we disregard His principles. I ask with respect, that those who have a conscience against certain practices not be required to be the vehicle by which they will result.
Please do not let this go through. Doctors are meant to save lives and treat them in order to get better.. not assist in destroying life. Let doctors who do NOT want to assist in terminating life have the choice and right to not do so especially if it goes against their beliefs and morals.
Definition of physician:
“a person who is skilled in the art of healing.”
Thank you for your efforts in drafting a new Human Rights Code policy.
I’m writing as a member of the public to express some concern over one part of the policy. Under Limiting Health Services for Legitimate Reasons, ii) iii., it appears a little unclear to me what is meant by services necessary to prevent suffering. It seems this leaves large questions to individual judgment. Could a doctor be sued for not performing assisted suicide if the patient’s family considered it urgently necessary to prevent suffering? I really don’t know–I’m not in the health services field. But I would benefit from a little more explanation, and maybe others would too.
Others have written to you, I’m sure, to express their concern for the sincerely held personal religious convictions about human life. I share these concerns. But I’d also suggest that some amount of pluralism in medical practices is a good thing. Maybe it’s best to let some doctors talk about and perform euthanasia and others not to talk about it if they’d rather not. Science remains ultimately silent on whether euthanasia is good medical practice. There are broader questions involved with assisted suicide, and with abortion, than those that usually fall within the realm of medical care. Usually we assume life is the goal–here we cannot … so maybe we can let diverse personal convictions have their say in the market, so to speak.
I am writing this is in response to the Proposed Draft re Norms and Guidelines of Patient Care (i.e. Effective Referral Mandate).
I am personally against “Assisted Suicide” / “Euthanasia” for a number of reasons (4 itemized here):
1. My faith as a Catholic (as the Licence plate cover says “From Conception to Natural Death”).
2. Euthanasia opens the door to the Health Care System terminating life for whatever political/financial reasons it deems appropriate.
3. Doctors take an oath, the Hippocratic Oath, including the clause “First do no harm”.
4. There is a tried and true alternative called Palliative Care for terminal patients.
Physicians unwilling to provide “certain” elements of care due to their or religious beliefs should not be required to provide a referral to another physician, “effective referral mandate”. This compels the physician to violate his or her own conscience by being a participant in the very act or procedure they object to in the first place. Physicians have a Charter right of freedom of conscience and religion to not participate.
If CPSO is determined to have “alternatives” for patients, then maybe CPSO should maintain the list of willing physicians that patients can access through your 1-800 telephone or on your CPSO website! There is of course the issue that physicians pays yearly dues to CPSO, does this make them peripherally participants?
I hope that CPSO “wakes up” and makes the right decision, which of course is not the current path they are on now.
I wish to thank you for this opportunity to voice my concerns about the freedom of choice and beliefs for physicians and their own personal rights as human beings in Canada.
Physicians are expected to provide care, not provide assisted death. Their focus is healing and comfort not murder.
Please consider the physicians who will always honour life.
I would be terribly concerned for all, myself and the lives of my loved ones if physician’s and health care worker’s life career changed to include assisting to murder the very people they are committed to help.
I understand that you are accepting submissions from Ontario citizens
regarding the “effective referral” mandate for doctors. I believe that
this mandate is a violation of a physician’s rights, as it compels the
physician to violate his or her own conscience by being a participant in
the very act/procedure to which he or she objects to in the first place.
I request that this mandate be removed from the CPSO document, so that a
physician’s Charter right of freedom of conscience and religion be
respected.
I disagree with the proposed changes to the above that obligates a physician to refer a patient to other physicians for procedures related to euthanasia.
Diocese of Alexandria-Cornwall Please consider this to be the Diocese of Alexandria-Cornwall’s response to the above draft policy.
To begin, we would like to take this opportunity to thank the College for asking for the public’s input with respect to this draft policy.
We urge the College to remember that the Canadian Charter of Rights and Freedoms clearly recognizes that everyone has the fundamental freedom of conscience and religion. It is crucial that the College recognize that while patients have rights, so to do the physicians. Therefore, the rights of both patients and physicians must be respected and protected. It is important that rights themselves must never be limited in a one-sided manner in favour of the patient. Both patient and physician are entitled to protection.
Accommodation cannot be a one way street. Physicians are not robots who check their morals and conscience at the door when they arrive at their office. Rather, they are humans who are equally entitled to the protection of this most fundamental of freedoms.
A moral stance based on one’s conscience is rational and evidence-based, often reinforced by one’s religious beliefs and thus deserving of protection. Physicians should never be compelled to act against rational conscience decisions.
Refusing to provide or perform certain procedures is not discriminatory when it is based on a properly informed conscience. In fact, such a refusal has nothing to do with any of the grounds of discrimination enumerated in Ontario’s Human Rights Code since the refusal is not about the patient. Rather, the refusal is all about the procedure and the physician’s decision about the wrongness of the particular procedure in question.
We draw your attention to lines 115 through 117 of the draft policy. If you read all of paragraph 95 in the Big M Drug case you will find the following:
If a person is compelled by the state or the will of another to a course of action or inaction which he would not otherwise have chosen, he is not acting of his own volition and he cannot be said to be truly free.
Any policy that would force or coerce a physician into performing or referring for a procedure that goes against his/her conscience clearly contravenes the above statement of the Supreme Court of Canada.
Further, what the draft policy is paraphrasing does not accurately represent what the Supreme Court said.
Freedom means that, subject to such limitations as are necessary to protect public safety, order, health, or morals or the fundamental rights and freedoms of others, no one is to be forced to act in a way contrary to his beliefs or his conscience.
The bolded section is a statement of the general rule, that is to say the individual’s freedom that is to be protected. The unbolded portion is the exception to that general rule and therefore is to be applied exceptionally.
Abortion and assisted suicide (the two main procedures that are not doubt being referred to in this policy) are never going to be necessary to protect public safety, order, health, or morals such that the freedom of conscience of a physician should be trampled on. With respect to the fundamental rights and freedoms of the patient, again this is about the procedure, not the person and therefore not about any of grounds listed in section 15 of the Charter.
In following one’s conscience decisions are not based on any of these personal characteristics, since it’s about the procedure and not the person. The physician’s moral stance has nothing to do with the person.
The absence of external compulsion is fundamental to the exercise of conscience and the freedom of the individual/physician, to order a physician to make a referral ignores conscience rights and therefore rests on compulsion.
We urge the College to be concerned and to protect its own members’ section 2 rights just as much as the patients’.
I am writing to express my serious concern with your draft policy, which would require physicians to give referrals for treatments that they themselves find morally objectionable, including contraception, sterilization, abortion, euthanasia and assisted suicide. This policy would force doctors to violate their own conscience, as the act of referral is still a participation in the objectionable treatment.
Freedom of conscience must be respected for all, including the physicians who are seeking, to the best of their ability, to care for all the citizens of our country.
Please revise your policy to include a clear protection of every physician’s right to act freely according to his or her conscience.
[**MESSAGE FROM ADMINISTRATOR: DURING THE CONSULTATION PERIOD, WE RECEIVED 2 RESPONSES FROM INDIVIDUAL RESPONDENTS CONTAINING THE CONTENT PUBLISHED ABOVE. ALTHOUGH THIS FEEDBACK HAS NOT BEEN PUBLISHED IN DUPLICATE, THE COLLEGE ACKNOWLEDGES RECEIPT OF THESE SUBMISSIONS.**]
I am a concerned Canadian citizen living in British Columbia who has been following the development of your Policy of Professional Obligations and Human Rights. I am well aware that the decisions you make regarding this policy will have a significant national impact and shape the development of similar policies by other provincial and territorial Colleges of Physicians and Surgeons.
There are several points made within this draft policy which cause me concern.
My first concern is the requirement that physicians inform patients that any moral objection they may have to particular services “is due to personal and not clinical reasons.” There are procedures to which a physician may morally object both on religious and clinical grounds. Physicians should be free to inform patients of both the religious and clinical reasoning behind their objections. Clinical reasons and personal or religious moral objections are not mutually exclusive.
I am also greatly concerned by the policy’s requirement of physicians to provide referrals to services to which they morally object. Requiring a physician to make such referrals forces them to assume a position of indirect participation in services which conflicts with their personal conscience. The obligation to provide referrals therefore impinges upon the physician’s freedom of conscience.
This draft policy states that “physicians must provide care that is urgent or otherwise necessary to prevent imminent harm, suffering, and/or deterioration, even when that care conflicts with their religious or moral beliefs.” This policy needs to clarify what they mean by the term “suffering.” According to the policy as it stands now in the proposed draft a person like me, who has spinal muscular atrophy, would be vulnerable to “treatment” which may end my life in order to prevent suffering and deterioration. Physicians must always act in a manner that upholds the Hippocratic Oath and their obligation to do no harm. Causing physical harm in order to alleviate suffering or prevent deterioration compromises this oath.
While it is appropriate that physicians “should not promote their own religious beliefs when interacting with patients” they should be free to share these beliefs when relevant. One of the great attributes of our nation is the defense of religious freedom. Canadians should be free to hold diverse religious beliefs. A person’s character and professional life cannot be separated from their religious beliefs. While it is entirely reasonable that physicians should never force their religious beliefs upon their patients they should be free to share these beliefs when need be and relevant to patient care.
We are appalled at the unethical demands being made on our Doctors – in order to facilitate the destruction of life.
Please allow our doctors to be faithful to their ethical conscience.
I am writing you as I have serious concerns regarding the recent draft Policy of Professional Obligations and Human Rights as proposed by your College. I recognize that when your new policy is approved it will set national precedence and have a significant impact on the development of similar policies by other Colleges of Physicians and Surgeons throughout Canada.
There are several aspects of this draft policy which cause me grave concern.
This draft policy requires that physicians inform patients that any moral objection they may have to particular services “is due to personal and not clinical reasons.” I believe there are, however, procedures to which a physician may morally object both on religious and clinical grounds. Religious beliefs do not stand in opposition to science but rather are often supported by scientific and clinical data. Physicians should be free to inform patients of both the religious and clinical reasoning behind their objections. Clinical reasons and personal or religious moral objections are not mutually exclusive and cannot be alienated from each other. Allowing a physician to provide both moral and clinical objections is necessary in order to protect personal and professional integrity.
I am also greatly concerned by the policy’s requirement of physicians to provide referrals to services to which they morally object. Requiring a physician to make such referrals forces them to indirectly participate in services which conflicts with their personal conscience. The obligation to provide referrals therefore violates the physician’s freedom of conscience.
This draft policy states that “physicians must provide care that is urgent or otherwise necessary to prevent imminent harm, suffering, and/or deterioration, even when that care conflicts with their religious or moral beliefs.” This policy needs to clarify what they mean by the term “suffering.” As someone who has struggled with serious mental illness I am greatly concerned that this policy would allow for physicians to alleviate my suffering by ending my life if I were to request this of them. There have been several occasions I have refused treatment for overdoses and told the attending physicians to kill me or allow me to die. If they had chosen to act on my request to terminate my psychological suffering I would not be alive today.
While it is appropriate that physicians “should not promote their own religious beliefs when interacting with patients” they should be free to share these beliefs when relevant. One of the great attributes of our nation is the defense of religious freedom. Canadians should be free to hold diverse religious beliefs. A person’s character and professional life cannot be separated from their religious beliefs. While it is entirely reasonable that physicians should never force their religious beliefs upon their patients they should be free to share these beliefs when need be and relevant to patient care.
I would just like to voice my disagreement with the following proposed policy as relating to the Right to Die legislation:
“Where physicians are unwilling to provide certain elements of care due to their moral or religious beliefs, an effective referral to another health care provider must be provided to the patient.”
I believe that patients should be able to self-refer to a willing provider if they wish to die. Physicians who do not want to participate should not be forced to participate at any level for any reason.
Helping to kill another human being, regarless of the individual circumstance, goes against basic human nature. Forcing anyone, physician or otherwise to participate, unless they are completely comfortable with that participation, can only result in harm. How much harm and how it will eventually manifest itself is difficult to determine but some level of psychological damage is the only possible outcome and therefore it is something that should be avoided at all costs. Self-referring is a simple and effective option where no one is harmed so please consider this option in your legislation.
As a pastor at a church in Ontario I wish to register my opposition to any effort to force our Canadian physicians to ever violate their religious beliefs in reference to care, in particular forcing physicians to perform abortions or to end life.
I would like to give my reaction to your draft policy, and I will be brief. I vehemently condemn those sections which would strip physicians of their freedom of conscience, and compel them to provide referrals for services which they regard as morally wrong. I encourage you – indeed, for the good of society I implore you – to frame a policy which guarantees a genuine freedom of conscience for all physicians.
I strongly disagree with the proposed changes to the above that obligates a physician to refer a patient to other physicians for procedures related to euthanasia.
I stand in solidarity with physicians who, in conscience, do not want to kill patients, or help patients kill themselves, or refer them to physicians who will kill patients or help patients kill themselves.
If you compel physicians to kill or refer to killer physicians, you take away their right to conscientious objection.
Freedom of conscience is foundational to our free society.
I am a Canadian citizen residing in Onatrio. I have gone through the details of the new policy regarding the physician’s rights, to be implemented soon. Whether you are a physician or not, everyone has a conscience and it is mentally stressful and make you feel guilty, when you act against your conscience. It is equally wrong whether you kill a person by your own hands or you arrange someone else to kill the person. If you kill a person by yourself or you arrange a ‘hitman’ to do the killing for you, you are guilty before the court. If so, it is equally wrong for a physician to administer the lethal dose for the patient by himself or herself, or to arrange it to be done by another physician. So please allow all the doctors to act according to their conscience. If needed, add a line in the consent form, whether the physician will be willing or not, to administer the lethal dose, if needed, so that the patient or the responsible person for the patient, can choose whether to be treated by that physician or not.
The College has proposed that “Physicians must provide care that is urgent or otherwise necessary to prevent imminent harm, suffering, and/or deterioration, even where that care conflicts with their religious or moral beliefs.” I recognize that the College is likely implementing this change to prevent some physicians from maltreating patients in the name of ‘conscience’, such as a physician who refuses to treat a woman who goes into hypovolemic shock after an abortion. This is gross malpractice, even the pro-life ethics manual of Catholic Health Alliance explicitly states as much.
However, I believe that the wording of the College’s draft as it stands holds a significant flaw. It falsely assumes that all physicians share the same definition of “urgent or otherwise necessary care to prevent imminent harm.” A doctor’s rational and scientific judgment may lead him to conclude that a patient comes into existence at conception. Consequently, that doctor believes that conscientiously objecting to an abortion (where the life of the mother is not in imminent jeopardy) “prevents imminent harm” to the unborn child – a patient in the mind of the objecting doctor.
To such a physician, the College’s statement reads as follows: “[Pro-abortion] physicians must provide care that is urgent or otherwise necessary to prevent imminent harm, suffering, and/or deterioration [to an unborn patient], even where that care conflicts with their religious or moral beliefs [as proponents of abortion].”
I believe that the College intended it to read: “[Anti-abortion] physicians must provide care that is urgent or otherwise necessary to prevent imminent harm, suffering, and/or deterioration [to an pregnant patient], even where that care conflicts with their religious or moral beliefs [as opponents of abortion].”
It is evident that by merely changing the implied subjects and indirect objects of the sentence, the College’s statement can also be interpreted as both a ban on and order to perform elective abortions.
Please allow doctors to exercise well-formed judgements about what it means to provide “provide care that is urgent or otherwise necessary to prevent imminent harm, suffering, and/or deterioration”.
In the history of medical practice, many mistakes have been made by physicians. However, at least since the time of Hippocrates there has been a guide and a set of principles available to the community of medical practitioners to help minimize the errors and mistakes. It would be foolish to ignore or lay aside the guidance that the Hippocratic Oath has provided to generations and centuries of medical practitioners.
As an additional guide available to every person in the course of their lives and in the practice of their respective professions is the moral compass provided by the individual’s conscience. The “dictates of conscience” are the compass by which each person, in their full dignity as a person, can steer and choose correctly the options open to them, in both professional practice and in moral decision-making. If some alien force were to try and deprive us of the compass of our conscience, we would rightly resist, as we would otherwise lose our essential freedom and dignity as a person.
The dictates of conscience and the acceptance of the individual’s right and obligation to follow their conscience must be respected by any professional association. My concern is that the draft policy of the CPSO referenced above aims to deprive the physician of this right and obligation.
In the history of medicine there has been a long list of practitioners who abandoned the guidance of conscience and have then brought utter disrespect and contempt to the title of “physician”. I expect the CPSO to not make this error. As a profession you are obliged to respect the rights and dignity of your members by enabling them to follow the guidance of their consciences.
I am writing to express my expectation and insistence that the sections above will be revised to include a clear defence of the right to freedom of conscience for all physicians.
I have heard that the College is accepting possible changes to the Draft Policy that will limit physicians’ Right to Conscience and Freedom. I ask that we all fight for true rights that are inalienable and should not be taken away.
“The Canadian Charter of Rights and Freedoms (the “Charter”) protects the right to freedom of conscience and religion. Although physicians have this freedom under the Charter, the Supreme Court of Canada has determined that no rights are absolute. The right to freedom of conscience and religion can be limited, as necessary, to protect public safety, order, health, morals, or the fundamental rights and freedoms of others.”
“Where physicians are unwilling to provide certain elements of care due to their moral or religious beliefs, an effective referral to another health care provider must be provided to the patient.”
This means that if a physician does not want to refer for abortion or perform physician assisted -suicide (it is coming to Ontario), he/she must refer to another doctor who will. This is no difference than doing the act oneself.
It is hard to see how limiting physicians Rights to Freedom of Conscience and Religion guaranteed in the Charter will result in less discrimination or better patient care. Allowing this form of “care” is a small foot in the door that will pry open a wider opportunity for this not being exceptional, but what others believe to be the better way to “care” by ending one’s life out of convenience.
Please continue to support Doctors’ decision to refuse certain requests and not force or pressure them to refer to another to carry out the task of physician assisted death.
As a concerned member of the public accessing the care of physicians, and as a mother, it is important to me that physicians act in accordance with their conscience and not be required to provide referrals for services or
treatments that are contrary to their conscience.
As a society, we owe it to ourselves to continue to behave democratically, and allow persons- professionals or otherwise- to act according to conscience.
I am writing to express my concern and to request that the policy be
revised to respect the rights of physicians and to remove the proposed
mandate for “effective referral”.
It is absolutely horrifying that the draft copy of the “Professional Obligations and Human Rights” draft does not leave conscience rights for doctors. The medical profession has always been seen as a place that we can trust to have people with a higher bar when it comes to controversial moral matters. Let’s use abortion for starters on how your proposed methodology works. Some abortion practices require the ripping apart of a small but real person. This is a barbaric action done on fully formed unborn babies.. The beheading of people by ISIS is horrifying: ripping babies apart in the womb is also barbaric. It is only one of the actions that no person with an active conscience could participate in – but your draft copy would take away the right not to have any part in such a horrific actions. No, you think – but they can be true to their conscience by pointing the patient and the terrorist to some one else to do the killing .
The Nazi’s used that kind of thinking. They were eventually charged with Crimes against Humanity.
Thank you for being open to consultation on this very significant document.
I am a practicing family physician and the Professional Obligations and Human Rights (POHR) document is of deep concern to me.
I recognize that the proposed policy “Where physicians are unwilling to provide certain elements of care due to their moral or religious beliefs, an effective referral to another health care provider must be provided to the patient” is an attempt to reach a compromise between the competing rights of the patient for access and those of the physician to freedom of conscience and religion, but it is ill-conceived and should be withdrawn.
Firstly, for many physicians who are unwilling to provide certain elements of care for conscience reasons, referring to another health provider who will provide that element of care constitutes material cooperation and is also immoral. To include in a professional code of ethics a requirement to do what one believes to be wrong does not make sense and is ultimately dangerous and totalitarian. One need only read R J Lifton, “The Nazi Doctors—Medical Killing and the Psychology of Genocide” to see how wrong this could be.
Secondly, in parallel to the arguments in the recent Supreme Court decision in Carter v. Canada, the question is whether mandatory referral with its heavy impact on the physician’s s. 2 rights to freedom of conscience and religion is the least drastic means of achieving the objective of patient access. I assert that the restriction on the physician’s s. 2 rights is not proportionate to the objective, and that it is reasonable to develop alternative processes for ensuring patient access while not infringing on the physician’s rights of freedom of conscience and religion. For example, the College could maintain a publicly accessible listing of physicians who are willing to provide contested elements of care. This could be part of the annual re-licensing procedures, with physicians indicating which elements of care they are willing to provide.
Thirdly, I am suspicious of the sources of this draft policy. The College of Physicians and Surgeons of Saskatchewan has also issued a draft Conscientious Refusal policy, which is almost verbatim the policy suggested by Downie, McLeod and Shaw in “Moving Forward with a Clear Conscience: A Model Conscientious Objection Policy for Canadian Colleges of Physicians and Surgeons”, Health Law Review 21:3, Summer 2013 (published by the Health Law Institute of the Faculty of Law, University of Alberta). Downie et al are very clear about the motivation for their suggested policy, which is access to abortion services (but will be equally applicable to the newly confirmed patient right to physician-assisted killing). The research was funded by the Canadian Institutes of Health Research, the government of Canada’s health research investment agency. I have read their articles published in Bioethics in January 2014 (Co-editor-in-chief Dr. Udo Shüklenk, Ontario Research Chair in Bioethics at Queen’s University, and chair of the expert panel of the Royal Society of Canada on End-of-Life Decision Making) and I do not think that they demonstrate a need for mandatory referral. They do not appear to have considered any arguments put forward by conscientious objectors, and the whole process appears to be designed to support a particular pre-formed ideology. I saw no mention of existing documents such as the Joint Statement on Preventing and Resolving Ethical Conflicts involving Health Care Providers and Persons Receiving Care (1999), or The Royal College of Physicians and Surgeons of Canada paper “Conflict Resolution” which stresses that it is a collaborative approach that leads to durable outcomes. I suggest that the CPSO should collaborate with those who oppose mandatory referral to come up with a policy that ensures access while not demanding that physicians do what they believe to be wrong.
Finally, I anticipate that if this draft policy is promulgated in Ontario, that a significant number of physicians will find it unacceptable and either leave medical practice or move to a jurisdiction that is more accepting and supportive of a diversity of values.
Although I see this draft policy as problematic in several ways, most of my concerns become moot if one overarching problem is addressed. I believe a paradigm shift is needed, beginning with an examination of how human beings arrive at opinions and make decisions.
Each person has a conscience which governs what the person considers morally good or bad. The conscience can be informed by a variety of influences: philosophical, metaphysical, sociological principles, etc. A person’s conscience does not operate in a vacuum: it cannot be divorced from the many other factors at play in decision-making. A physician, when offering his medical opinion, employs all of the following: scientific knowledge acquired in his training and continuing education; evaluation of benefits and risks; his own clinical judgment based on experience; the ethical standards he must uphold as a physician; and his own moral compass (i.e., his conscience). These factors operate together within a person and are not diametrically opposed to one another: this is personal integrity.
This draft policy makes a ridiculous presupposition, namely, that doctors who are unwilling to facilitate a particular intervention are taking that stand ONLY for moral or religious reasons—somehow irrationally separated from evidence-based clinical judgment! This preposterous notion is clearly revealed in lines 138-141:
“Where physicians are unwilling to provide certain elements of care due to their moral or religious beliefs, physicians must communicate their objection directly and with sensitivity to existing patients, or those seeking to become patients, and inform them that the objection is due to personal and not clinical reasons.”
“Due to personal and NOT clinical reasons”? The authors here assert that these doctors are acting without integrity, i.e., that the doctor’s conscience is at variance with his clinical and scientific knowledge. The statement also implies that a standard body of medical interventions exists to which no reasonable doctor can object on medical grounds—that any objection is based merely on the doctor’s (irrational, it is implied) moral considerations. The authors’ bias is further revealed in phrases such as “unwilling to provide certain elements of care”. Doctors do not agree in all cases as to what is a legitimate “element of care” and what isn’t. This diversity is and always has been good and right in the medical profession. No governing body is in a position to define standard “elements of care” that all doctors must facilitate.
As many respondents have noted, there is no real difference ethically between “doing” and “facilitating”. If it is unacceptable for a physician to provide a particular intervention, then it is equally unacceptable for her to facilitate it. Thus, “effective referral” requires doctors to act contrary to their moral and clinical judgment.
No patient has the right to receive a particular intervention from a particular doctor, nor to receive that doctor’s “stamp of approval” (i.e., referral) for the intervention requested. Patients have the right to seek other medical opinions. A doctor who is acting humbly and ethically will ungrudgingly encourage patients to do so. (The practical obstacles to getting a second opinion, e.g., in rural settings, are acknowledged. Our health care system can find acceptable ways of overcoming these obstacles. Compromising our physicians’ personal and professional integrity is unacceptable.)
Though I realize the College has no control over any legal proceedings or decisions made by government bodies, I believe the following assertion is worth serious reflection: If any particular medical intervention is deemed a right—meaning therefore that our public health care system has a duty to provide it at a patient’s request—then the integrity of the medical profession as a whole is compromised. Let’s do what we can to prevent having our physicians reduced to automatons who are compelled to check their own clinical and moral standards at the door.
I don’t question the good intentions behind this draft policy. People enter the medical field because they genuinely want to serve and benefit their fellow human beings, and this document’s authors surely are no exceptions. However, this policy leaves all physicians—and all patients—very vulnerable. This document as worded puts all physicians under threat of discipline for following their own clinical and moral judgment. How can real trust and openness exist between doctor and patient in a situation like this? Where can bewildered patients go when they truly desire a medical opinion?
I invite the College to discuss publicly any and all specific problems it is seeking to correct with this policy. Perhaps together we will discover completely different solutions to those challenges.
As a member of the public who is old enough to remember when abortion was legalized, the promise made repeatedly at the time was that if physicians objected to abortion, they would never have to participate in it.
In light of the recent Supreme Court decision that again states that no physician should be compelled to take part in Physician Assisted Suicide if they object, it is astounding to hear of the College’s blatant attack on conscience rights, particularly with respect to abortion.
Abortion and physician-assisted suicide are both very much issues with active national debate about the morality of the procedures. Doctors who refuse to participate are by no means antiquated outliers. Former abortionists, who entered into the practice freely have become haunted by the reality of what they were doing and turned firmly against it. Are those nightmares and horrors really something you would foist on your rural and remote physicians? They will surely leave their post, and instead of having an obstetrician in the area with somewhat limited services, there will simply be absolutely no service at all.
The freedoms we enjoy in Canada have made us the envy of much of the world. A patient’s “freedom” to have access to abortion, etcetera, does NOT supersede a physician’s right to have their Charter protected Freedom of Conscience and Religion upheld. A patient who wishes an abortion can go to a walk-in clinic, emergency room, change doctors, or self-refer in most provinces. Patients frequently decide to do these things if their physician won’t give them antibiotics while practicing good antibiotic stewardship, or refuse narcotics after a broken contract. If a woman really wants an abortion, she can certainly find a way; and if she experiences a slight delay after a physician objects to referring her, that may give her a chance to avoid an abortion that will haunt her. I firmly believe that expediting referrals, and excessively streamlining the process when a woman is contemplating an abortion pushes her in that direction. If a person chooses abortion, the responsibility for its consequences belong to them, not to a third party forced to participate in it.
Please take the time to read this article: http://ottawacitizen.com/news/national/doctors-duty-consciences. It makes the clear point that referring for abortion or physician-assisted suicide is extremely morally objectionable for many physicians.
“Being a facilitator of such action is no different than actually doing it. It may seem different, but for those with principled objections, it involves the same compromise of one’s moral or religious persuasions.” Courts find people morally and legally culpable who have paid a third party to kill someone even though they did not actually commit the murder with their own hands. Physicians who refer for abortion would also be morally culpable in the same way.
Freedom of conscience is a basic human right enshrined in our Charter of Rights and Freedoms. No one should ever be compelled to bring about the death of another. Physicians have the weighty responsibility of dealing with matters of life and death on a daily basis while striving “first, to do no harm”.
You as our College, working in the interests of us, the public, must protect our ability to find physicians who will take care of us with their consciences in tact. I am horrified by the idea that I might not be able to find a physician who DOES NOT perform or refer for assisted-suicide, realizing people have been euthanized against their will in the Netherlands (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3070710/#b10-conc-18-e38). One final quote from the Ottawa Citizen article, previously mentioned: “The practice of medicine and the practice of religion have been inextricably linked for millennia. It follows because both are concerned with the human person, a unity of body and soul. It is good for medicine – for both doctors and patients – to benefit from the broad horizons offered by the world of faith. The draft policy should be amended to recognize that.”
I would like to respond to the draft proposal and appreciate the opportunity to do so. However, since I only became aware of this opportunity a couple of hours ago, there is not enough time to do it justice. I am not writing this from my own computer.
I am a Canadian citizen living outside of Ontario, not a professional, but with a keen interest in both medicine and human rights. I have read the draft policy, and the survey questions, and noted the correction of the info apparently stated in the National Post.
Having read the draft and deduced all its implications, I, myself, would come the the conclusion the College does not want physicians of integrity irritating them by acting as a conscience for a profession that is hell-bent on denying there is a higher law than they. This is tantamount to the accusation in the POST.
Moral judgments without a moral compass are purely subjective. If the Charter is only what it is according to the particular, subjective interpretation of some body or judge, it is nothing. The finely-crafted Soviet Constitution did not protect the Soviet people. It brought them to their knees.
The draft uses words that are disingenuous,exploiting the naive trust especially of older folk who actually did used to be able to trust their doctor. Now the College uses right-sounding words to undermine the conscientious care that men and women of high moral stature want to spend their lives giving. Who is the loser? The very ones you claim to be trying to protect will now have nowhere to turn for real healing and guidance, and will have to live with regret, guilt and despair. Ah, but then they can come back for assisted suicide!
I am so thankful for the “barriers” in my life that prevented me from terminating my children or my own life. Don’t steal people’s hope by being so quick to agree there is no hope: there will be a better day; life will again be good; your children will thank you for life. To LIFE!
You who come up with these vacuous, intolerant policies do not deserve to regulate yourselves. That is a privilege reserved for such as those doctors whose consciences you want to rein-in.
A doctor will always put the patient first if he or she is true to himself/herself. You do not need more codes and policies: you need men and women of conscience and character like the ones who started most of the humble healing institutions in our country.”This above all, to thine own self be true; and it follows, as the night the day, thou canst not be false to any man.”
Confused, prideful people have turned our hospitals into self-serving icons almost devoid of humanity. Please, do no more harm.
I would ask that the provisions of the draft policy which would compel doctors who choose not to participate in certain acts for reasons of conscience and moral objection, to nevertheless refer their patients to other doctors who will, be redrafted. As a scientist, I am appalled that others would be forced to be complicit in actions they consider morally objectionable.
A doctor is not only a technician, but should bring good moral character in the care of his patients. That is what I expect of doctors who treat me and want to know that there is room in Ontario’s medical system for doctors of good moral conscience. In particular, this draft policy would hound good Catholic doctors out of our system and even prevent them from serving in this province in the first place.
In reviewing your draft policy on Professional Obligations on Human Rights I have serious concerns regarding the wordings of the following:
- “In the course of communicating their objection, physicians must not express personal judgments about the beliefs, lifestyle, identity or characteristics of existing patients, or those seeking to become patients. This includes not refusing or delaying treatment because the physician believes the patient’s ow actions have contributed to their condition. Furthermore, physicians must not promote their own religious beliefs when interacting with patients, or those seeking to become patients, nor attempt to convert them” –
Such a statement wrongly assumes that one’s faith can be separated or turned off on demand as if it did not constitute an ingrained element within a person. If adopted such a statement would run the risk of forcing a doctor to directly go against their religious beliefs should one of their patients ask for an opinion on a particular option for treatment that the doctor’s faith says is morally wrong. Also forcing doctors to remain silent about that which challenges their faith, can make them not only morally complicit in an unjust act, but could have negative long-term impacts on a physician’s personal conscience.
- Physicians must provide information about all clinical options that may be available or appropriate to meet patients’ clinical needs or concerns. Physicians must not withhold information about the existence of a procedure or treatment because the procedure conflicts with their religious or moral beliefs. Where physicians are unwilling to provide certain elements of care due to their moral or religious beliefs, an effective referral to another health care provider must be provided to the patient. An effective referral means a referral made in good faith, to a non-objecting, available, and accessible physician or other health-care provider.15 The referral must be made in a timely manner to reduce the risk of adverse clinical outcomes. Physicians must not impede access to care for existing patients, or those seeking to become patients.”
Again such a statement directly conflicts with one’s freedom of religion and thus their human rights. Should a doctor have moral objections about a particular procedure, they should not be forced to provide a referral to another doctor who would encourage such a procedure. If adopted, such a statement could tie doctors freedom of conscience by forcing them to take part (in a secondary way through referral) in acts that their faith’s find morally wrong. Forcing doctors to act against their conscience goes against one of the basic principals found in democracies.
Whether one recognizes it or not, faith is an essential (constitutive) element for many doctors and surgeons in Ontario. In fact, I have known doctors whose faith/religion plays a significant role in how they respond to the unique needs of their patients. I fear that should the statements noted above be adopted it would put many doctors in a moral quandary and could even run the risk of discouraging many talented members of our faith communities from pursuing medicine out of fears that they would be required to act against their consciences at any time during their career.
I strongly urge the College of Physicians and Surgeons to reconsider the adoption of these policies as currently worded.
Freedom of Conscience and Religion is imperative in a civilized and free society. No one should be forced to kill another person or to have to arrange for someone else to do it.
Please respect all people of all and any religion who refuse to kill other people.
I am writing to object to your proposed “effective referral” mandating physicians to participate in the very act that they,because of the religious belief would not do. I am sure all the physicians who studied to become doctors because the wanted to save lives not to cause deaths.
I totally disagree the legalize Physician Assisted Suicide.
All our days in the world has been written in God hands.
the life is given by HIM, and nobody has the right to end others’ lives earlier than the date planned.
I strongly oppose the CPSO’s draft policy that limit physicians Rights to Freedom of Conscience and Religion guaranteed in the Charter, and require them to make an effective referral to another physician if they refuse their patient’s requests, such as for euthanasia should it be legalized.
Thank you for your attention in this important matter.
It is entirely objectionable to legislate that Doctors, unethically and contrary to their personal beliefs, be forced to become Accomplices in Assisted Suicide Referrals.
Please be advised that I strongly oppose the CPSO’s draft policy that limit physicians Rights to Freedom of Conscience and Religion guaranteed in the Charter, and require them to make an effective referral to another physician if they refuse their patient’s requests, such as for euthanasia should it be legalized.
I understand that the CPSO has, in a draft of its document on Professional Obligations and Human Rights, proposes to mandate that in the case that a physicians moral or religious beliefs interdict a certain course of action which can be considered medical, they must provide to the patient, an effective referral to another health care provider, who is non-objecting, available and accessible.
I would like to express my opinion on the implications of such a mandate.
Freedom of conscience.
Conscience is an innate human faculty. It is moreover the essence of our humanity. Conscience develops in parallel with consciousness – consciousness of our human environment, of our community. It is what enables us to relate to this community with justice and with compassion. Conscience and empathy, then, seem to me to be intricately linked. They are also therefore the basis of the practice of medicine that addresses the whole person. We increasingly demand that the formation of a professional identity in physicians include leadership in the practice of medicine that is both compassionate and moral. It seems contradictory then, to ask the same physicians to park their conscience at the door of the office and practice a medicine that may not conform with their moral conscience.
Unfortunately, in the face of a practice that is morally objectionable to them, physicians are mandated [proposal] by the College, in its draft on Professional Obligations and Human Rights, to provide “an effective referral to another health care provider” who is non-objecting, for the patient. The moral, and therefore professional, practice of medicine cannot permit this since it is intrinsically inconsistent. Demands for such incoherence, such moral dualism strike at the integrity of the person and therefore are clearly at odds with the human rights of the physician. It also damages the protection of pluralism and diversity in our society, which we treasure. More remote perhaps, is society’s potential selection against conscience and empathy in its physicians – a somewhat chilling thought.
Finally, it is not difficult to see that, with a little imagination, access for patients to any legally permitted procedure that is appropriate for their state of health, can be implemented without infringing on the conscience rights of the physician.
The Carter case
The Supreme court of Canada has coincidentally and very recently ruled that, under certain conditions, patients have the right to euthanasia and physician-assisted suicide. This provides an immediate example of the type of situation where the conscience rights of the physician can be harmed.
It also provides an example where the patient may be harmed – irreversibly. Since one is dealing with people who are suffering, who are depressed, who are aging, who are dying, one is also dealing with a population that is extremely vulnerable. We are told, by palliative care physicians that the greatest causes of suffering in these patients is not their pain, but the loss of their integrity, the feeling of being a burden on their loved ones, on society. How terribly easy it could be to convince someone like this that a quicker death is the optimal solution. In spite of some upbeat reports on the European experience, there has been a shift in attitudes that cannot be said to be compatible with the Hippocratic oath, and is not encouraging. Yet again, palliative care physicians tell us that we have advanced to a state where there is very little pain that cannot be controlled. What the patient needs is compassion, connection -and, yes, access to excellent palliative care. If, under those circumstances, the patient still chooses to die, clearly there are those who can help. But physicians who choose to ease the pain, and care for the patient in this way should not be forced to cooperate in euthanasia or suicide. One might add that a number of patients, misunderstanding the implications of the decision and fearful of “being euthanized”, will cooperate less fully in pain management and care, which is their right, and of which they are thus being deprived.
Conclusions
Given these two coincidental events – proposals for amendments to the codes of conduct, and the Carter decision, there are two pressing issues that need to be addressed:
Firstly, the protection of the most vulnerable among us from any undue pressure to consent to solutions that they do not intend. Following from this as well, is the patient’s right to optimal care, including palliative care.
Secondly, the protection of conscience rights for all – including physicians. It has been a long time since they have been this threatened.
It should be noted that both the Canadian Medical Association and the Supreme Court in the Carter case ruling, have spoken for these conscience rights. It is my fervent hope that the College of Physicians and Surgeons will also maintain them.
I am appalled that health professionals may be faced with disciplinary action if they refuse to be involved in abortions, birth control,and euthanasia. These areas should be left to the conscience of the physician and if he/she finds them ethically abhorrent they should have the right not to participate in such practices.
I write as a member of the public and as the mother of adult children.
I am also writing as someone with a family member who has struggled with several years of mental illness and has made multiple suicide attempts, accompanied with statements such as “just let me die”, “I can’t go on living like this”… if the Supreme Court’s decision becomes a legal obligation on the part of physicians to comply with their request at times when their life view is bleak and hopeless, then their family might not have the opportunity to relay that message to the physicians involved in their death.
I dread the day that I, or my immediate family members, are being attended by physicians who are agents of death, rather than of healing or of palliative care and pain management. I hope that the Colleges of Physicians and Surgeons compile a publicly accessible registry of physicians who will aid in direct killing or assist in the suicide of their patients, so that health care consumers will know whom they can trust and turn to for medical care no matter on which side of the debate they stand.
I strongly object to the College’s draft policy. Requiring physicians to refer procedures that violate their moral or religious beliefs, such as abortion or euthanasia, to a doctor prepared to undertake these procedures is immoral and unethical. Your draft policy will seriously erode the confidence of the public in the College’s commitment to act in an ethical manner. It is appalling that the College would consider a draconian measure so disrespectful of human rights of doctors and of the conscience of the individual physician.
Your draft policy states that physicians must obey the Ontario Human Rights Code. That is so only if the Code itself does not contradict the Canadian Constitution, including the Charter of Rights and Freedoms which explicitly states in Section 2a that the first of our fundamental freedoms are freedoms of conscience and religion.
The Ontario Human Rights Code does not state that doctors must refer patients contrary to the doctors conscience or religious beliefs. In any case the Code is subservient to the Charter, as law. The Code says that:
“Every person has a right to equal treatment with respect to services, goods and facilities, without discrimination because of race, ancestry, place of origin, colour, ethnic origin, citizenship, creed, sex, sexual orientation, gender identity, gender expression, age, marital status, family status or disability.”
It is not clear where services to patients in general falls under this list of protected groups for the purposes of the Code. It is unclear because it is not there.
The duty to accommodate in the draft omits the obligation of the College to accommodate the conscience rights of doctors, as well as the rights of patients.
The draft policy states:
“The patient’s best interests must remain paramount;”
Just so, and the best way to do this is by adhering to classical Hippocratic oath and not participate in the contemporary culture of death. As you know, that oath says among other things that:
“With regard to healing the sick, I will devise and order for them the best diet, according to my judgment and means; and I will take care that they suffer no hurt or damage. Nor shall any man’s entreaty prevail upon me to administer poison to anyone; neither will I counsel any man to do so. Moreover, I will get no sort of medicine to any pregnant woman, with a view to destroy the child.”
If, as a College, you can’t follow the Hippocratic oath then at least allow doctors who for reasons of conscience or religion reject practices such as abortion or assisted suicide the option obeying their own consciences.
Not so long ago in, a less morally debased society, it was unnecessary to explain to professionals why the sanctity of conscience and freedom of religion matter.
I feel that compelling physicians to provide services that go against their moral beliefs is unsettling. I agree that patient autonomy is of the utmost importance, however there are ways for that autonomy to be promoted without compromising another person’s conscience. For example, creating an online tool that has physicians register which services they do or do not provide in their practices would be a helpful solution. In this way patients would be able to access the information online and decide which physician or clinic they would like to visit. It would help avoid patients feeling that they are not receiving the care they desire and also protect physicians from violating their moral beliefs.
Once a physician starts participating in activities that they are morally opposed to, due to societal pressure/obligation, there is a strong possibility that in the future they may more easily participate in other actions that they or others consider unethical (i.e. it blurs their moral compass/lines). Having already violated their beliefs once may predispose these physicians to more easily violate their other ethical standards. It may also cause these physicians to be less effective advocates (i.e. they may feel less heard and respected and therefore be less likely to advocate for fairer laws and better patient care). Overall, I feel that although patient autonomy is very important, so is a physician’s right to freedom of conscience and compelling a physician to violate their conscience, and therefore their personal autonomy, is a slippery slope.
Having read and thought the draft policy I have concerns.
I am concerned that you have in incorrect understanding of religion. This incorrect understanding may lead to the policy, as written, having a detrimental effect on the practice of medicine for both a patients and physicians.
The policy, as written, implies that being religious is only part of who we are, meaning that it is something about ourselves that can be turned on or off. This is not true. Religion is really the essence of who we are. This is true for all people. All people have a religion. Religion is behind what each person believes about right and wrong.
As humans, our every action flows from the essence of who we are. This means that every actions flows from what one believes. The Christian Bible put it this way, “out of the abundance of the heart the mouth speaks.” (Luke 6:45) Even if a persons does not speak explicitly of what they believe, if you spend enough time with a person, that person’s beliefs about life will show through.
The nature of Family Medicine is that physicians and patients build relationships with each other over time. The building of relationships cannot be avoided as we humans are relational beings. A significant portion of Family Medicine is based on these relationships. Of course, there are appropriate boundaries that ought to define these relationships, but the underlying values of both the physician and the patient will, over time show through. The beliefs of patients and the beliefs of physicians will affect how they relate to one another.
Some things in medicine, such as sewing up cut fingers, are dealt with in a similar way, no matter what one’s underlying belief system is; while other aspects of medicine are dealt with in different ways depending on one’s belief system. This is especially true of those aspects of medicine that pertain to life and death. Those who really believes that every person is precious from their conception, will not be able to willingly involve themselves in taking a person’s life away. This means they will not be able, without denying the essence of who they are, to involve themselves in things like induced abortions, whether by actually performing them or by referring to someone who will. People, who pursue things like the taking of other people’s lives, can only continue to live with themselves when they believe that such killing is right.
All belief systems have a position on killing. The Christian Bible is clear saying, “you shall not kill.” It says he who kills will be in danger of the judgement. It says, “once to die and after that the judgement.” It says, “God will bring every work into judgment, Including every secret thing, whether good or evil.” Whether you believe these things or not does not change the fact that many people do. Those who believe these things will not without extreme difficulty be able to involve themselves in killing, whether they are physicians or patients.
The policy, as written, is saying that doctors cannot be who they are. This is an unworkable situation. The solution to say that doctors, who do not believe that it is right to kill should not be doctors, would deny patients the right to continue with their doctor whom they have come to trust in spite of, and often because of, what their doctor believes. The policy, as written, will not solve the problem.
What will solve the problem of real discrimination is a true love and concern for other people. The example given in the Bible for Christians to follow, Jesus Christ, reached out and cared for those who many people of that day were treating as outcasts, or, in other words, were discriminating against. He did this because of love.
Rather than implement the policy, as written, that honors belief systems that find killing acceptable at the expense of belief systems that do not, it would make more sense to allow for a more flexible system where physicians are allowed, like patients and everyone in society, to be who they are, rather then someone they are not. If it is felt necessary to direct doctors in order that patients not be misled and be given opportunity to exercise their right to choose treatments that some doctors do not believe in, then it is reasonable to require physicians to explicitly state up front what their underlying beliefs are, so that patients have opportunity to seek out doctors with similar beliefs if they desire to.
I hope this information is helpful and will pray that the Lord guide you in your endeavors.
I object to forcing Doctors to assist in the suicide requests and to force Doctors to make referrals if they do not perform.
Doctors are here to help us get better. This is what they study for.
The do not study to assistant people to die and have their license terminated , when they do not terminate or refer a person who request for assistant suicide.
As a physician I much appreciate the opportunity to comment on the draft of this policy.
Most briefly, I support, (apart from some reservations about the terminology), the Introduction, Principles, and Purpose of the policy, and most of the Policy section. However, I object to the lines 156-169, namely, the implementation of obligations that a physician has to refer for services or even carry out the services which a physician in good conscience is unable to provide.
I will propose some changes in the terminology and language of the policy and I will offer several arguments why the new obligations, written in the last 10 lines of this policy, are not appropriate and in fact would be dangerous to our patients and society.
The concern I have about the terminology is the repeated use of the expression, “moral and religious beliefs” and “personal beliefs.” The policy leaves out any reference to other beliefs, that are non-religious, and which may be just as important, and it ignores the fact that moral, ethical decisions are much more complex than the term “belief” implies. The terms “moral stance” or “moral position” or in some context, “conscience” may be more appropriate for this policy. Another concern is the expression “duty to accommodate” when referring to health services and at the same time linking it to the Human Rights Code. Because the Code is using the term “accommodation” only when referring to a domicile, a place to live or residence, this creates a confusion for those who wish to study both the College policy and the Code.
I will now review some arguments to justify my objections to the end section of the policy draft.
Firstly, there is no legal or regulatory reasons why the policy should contain provisions compelling physicians to refer for, or provide such care that is in conflict with their conscience, and there are strong reasons against it, among others:
1. Neither the Canadian Charter of Right and Freedoms, nor the Ontario Code of Human Rights require that physicians adopt obligations of which this policy draft is describing in lines 156-169.
2. Contrary, the Canadian Charter of Rights and Freedoms names “freedom of conscience and religion” as “Fundamental Freedoms”, listed prior democratic rights, mobility rights, legal rights and equality rights. Freedom of consciences and religion is not then just one of many rights, to be suppressed or traded readily for a right to receive a particular medical procedure.
3. The Ontario Code prohibits discrimination of individuals and groups on listed personal characteristics. The Code cannot be used to compel a physician to refer or treat when she or he makes a decision not on the basis of personal characteristics of patient requesting the procedure, but on the nature of the procedure itself.
4. The Supreme Court of Canada, in its recent decision, striking down the law prohibiting assisted suicide, stated that nothing in its decision would compel physicians to provide assistance in dying.
5. The Canadian Medical Association General Council meeting in August 2014 voted 91% in favor of a resolution allowing doctors to follow their conscience when deciding whether or not to provide any medical aid in dying.
6. Historical evidence indicates that conscientious objection has been recognized as limiting obligation of citizens in most states and historical periods. When in the past, state laws and apparatus were used to force physicians to violate their conscience, it led to gruesome and reprehensible acts. Under the Communist rule in the Soviet Union, physicians were forced to assist in drugging or liquidating political opponents of the regime. In Nazi controlled Germany, physicians were conscripted for euthanasia of the mentally ill, disabled, ethic minorities and prisoners, and inhumane experimentation.
Secondly, there are strong moral and ethical reasons why the physician should not be obligated to refer or provided a procedure that is contrary to her or his conscience:
1. The policy draft correctly recognizes in lines 114 that physicians have freedom of conscience and religion based on the Canadian Charter. However, later in lines 161- 165 , the draft creates an obligation to refer for a procedure that a physician would not himself or herself offer in good conscience. This already represents for many physicians a cooperation with unethical acts. In addition, lines168-169 would create an obligation to carry out any such procedure under circumstances when some intervention is considered by someone as “urgent or otherwise necessary.” This vaguely formulated obligation, together with the obligation to refer would entirely eliminate the freedom of conscience. This is clearly not an act balancing of rights that is intended in line123, the proposed accommodation is done entirely one way.
2. Freedom of conscience is a core of human freedom and individuality. It has a been a pillar of integrity of the profession, and a policy that would oblige a physician to violate his or her conscience would be harming the profession. It would reduce the physician to a role of a robot/technician, expected to provide a service that a customer is asking, without the physician considering the benefits and harm for that person or others.
2. Decisions of what care to offer that are based on an the informed conscience of a physician are, or should be rational and evidence-based, and ought to incorporate not only the personal values, but also comprehension of impact of various care options on the patient and society. The voice of conscience cannot be dismissed as mere subjective and unscientific “personal beliefs”.
3. Acting on informed conscience is not self serving, it is not just about allowing a physician to follow his “moral or religious beliefs”, as the policy draft seems to suggest. The voice of conscience offers a protection to the patient, actually the most important protection there is, because a regulator cannot be present in all those millions of encounters between patients and physicians. The point is that once a regulator insists on eliminating a role for conscience in one type of decision it will affect the whole practice of medicine. It is the voice of conscience, the pre-existing moral stand, which prevents a physician to recommend a treatment that would be financially advantageous or would improve a physician’s research standing, but not best for the patient, even if it could be carried out with impunity. It is the voice of conscience which prevents physicians from not inflating his or her credentials and capabilities and not over-billing for services. Clearly, “moral flexibility” of physicians, which the policy demands, may be a temporary convenience for some patients at some time but it will place patients at risk and will be detrimental to the whole society. The section entitled Protecting Patient Safety may actually have an opposite effect than the title implies.
4. The policy opening statement refers to the fiduciary nature of the physician-patient relationship, and this is an excellent starting point. However, fiduciary, meaning in good faith, presupposes that the physician has an active, well informed conscience that will lead him or her to act at all times for the sole benefit of the patient. Fiduciary relationship is different from a business relationship in which laws and contracts determine the behaviour of parties. In order to promote a fiduciary relationship, the policy has to inform and support the conscience of the physician rather than make it impossible to one to follow one’s conscience.
I became aware of this policy draft only most recently, and when soliciting opinions of some of my colleagues, I find that most are unaware of these developments. Given that this policy would lead to fundamental re-ordering of physicians’ obligations and surrendering the protection of conscience provided by the Canadian Charter, I would like to suggest, with all respect for the work done so far, that the consultation with the profession concerning this policy be continued until we have a clear, unequivocal, sustainable and well balanced document.
Canadian Centre for Bio-Ethical Reform Canada is a free country and physicians may have different reasons for not accommodating a patients’ request. I’ve had physicians explain the adverse health effects of hormonal birth control to me, for example, and I’ve had a physician explain she would not accommodate because of her moral code. The same would be the case in other circumstances, such as when it comes to abortion, assisted suicide, sex changes, or circumcision. I have always been grateful for the diversity and well-informed choices our country offers. It is in no way the physician’s responsibility to accommodate me at the expense of medical facts, moral beliefs, religious convictions, or otherwise. Forcing one to do so by way of this policy is an affront to the democratic nature of our country and to the profession of physicians.
Requiring physicians to refer for a service that they are morally opposed to is forcing them to participate. This is completely undemocratic and unCanadian. Additionally, why would we want physicians to leave their moral beliefs at their office door, so to speak? Wouldn’t we want doctors who work within a moral framework? Those who cannot, out of religious conviction, participate in or refer for certain services (e.g. birth control, abortion, etc.) are very often people with Judeo-Christian values which dictate deep respect for all human beings.
It is because of this belief that they cannot help with or refer for services that harm human beings. Regardless of whether I agree or not, this is a huge positive in a profession that promises to do no harm. The CPSO’s draft policy denies all of this and is hugely ideological in the way it leaves professionals without a choice. In a diverse country like ours, it is to be expected that there are different values and ideas about various practices. That should be respected.
* Re: “Physicians must provide care that is urgent or otherwise necessary to prevent harm, suffering, and/or deterioration (i.e.
emergency situations), even where that care conflicts with their religious or moral beliefs.”
At face-value, I would agree with this statement, but when reflecting on the meaning of it, I strongly oppose because it all depends on what is meant with harm, suffering and/or deterioration. A patient may argue that access to abortion would prevent harm to her, but what does that mean? Does it refer to her physical well-being, her financial stability, her emotional state? This is completely unclear. In addition to that, since abortion ends the life of a human being who started his or her life at fertilization, access to abortion does not prevent but actually causes harm to a smaller human being. Considering this, what is the physician to do? Also, what constitutes suffering? Not being able to use birth control because this prevents one from engaging in the type of sex they want? But what if the physician recognizes that the pill, for example, harmful for one’s well-being? (This is one reason my physician does not prescribe–see all the side effects, e.g. stroke, blood clots, etc. I’m grateful he recognizes this and values my physical well-being
more!) There are far too many conflicts and the new policy does not take that into account. We ought to leave it up to the integrity and professionalism of the physician to navigate these issues and discuss them openly with patients, rather than be forced to do whatever the patient requests.
The expectations and requirement in the new draft policy are very broad and will be open to abuse. In a province that already lacks enough health care providers, why does the CPSO requiring competent physicians to abide by their standards, knowing that this will create moral conflict and inevitably result in a loss of physicians as they will not be able to practice medicine when forced to engage in actions that are harmful to other human beings? How does this, in any way, help our healthcare system or us as citizens of Ontario? Please revise your policy and please act in the best interest of the entire public.
Regarding accepting new patients. I can see if a physician decides not to accept someone on the basis of race, ethnicity, income, etc. it would be discrimination. That is by the way the extent of exclusions that can be against human rights. The categories are well-defined and are not over-inclusive. But to say that everyone out there is entitled to my services if within my competence, and that I don’t have the right to say NO even if it is not an emergency or a recognized form of discrimination, is wrong, and borders on forced labor. I am not just a physician, but also a Canadian citizen and a human being. Part of my human rights is to be able to say NO to forced servitude and labor. I can see in an emergency, someone’s right to life overrides that right of mine, but it should not in non-emergencies. I am also not an employee of the College so the College should not and must not legally be able to tell me who I should and should not treat outside of emergencies and outside of the established legal discrimination categories of race, sex, ethnicity, income, etc.
This policy is about “human rights”. Reading the policy, one gets the impression that only patients are human, and somehow due to their professional choice, physicians are now some sort of non-human.
College is once again overstepping its jurisdiction and legal bounds.
I agree that the “college is once again overstepping its jurisdiction and legal bounds.” In fact, I still sing the national anthem praying that our land be kept glorious and FREE.
I so agree
But what about the doctors freedom of rights.
Everyone should have the freedom to choose when it comes down to their beliefs unless it is breaking the law.What if at our workplace our basic rights were taken away from us because of our employers own beliefs, would that be ok?
I am very much in agreement with you. Leave the doctors to choose. Create a registry for those doctors that wish to assist with suicide and allow patients to choose the doctor. Some Patients already make those choices when they travel overseas to get this service.
I agree. Physicians should have the right to say no to providing certain forms of treatment. However, I’m particularly concerned with the requirement that physicians provide referrals for treatments which they feel are morally and ethically wrong. If a physician feels a treatment is morally and ethically wrong, then aren’t they still violating their conscience by asking someone else to perform the procedure? How is the physician’s right to freedom of conscience being protected under these circumstances? In addition to this, a physician might feel that if a procedure is morally wrong it would also be harmful to the patient. Under these circumstances the physician would be violating not only their conscience but also their hippocratic oath by referring the patient to someone else to perform the procedure.
My husband and I agree with this statement made by the above member of public as well we have a doctor who holds the same religious beliefs as we do. We are concerned for her rights as a doctor having to refer a patient to another doctor for a practice she believes is harmful to her patient. If a doctor believes a practice such as physician assisted suicide is wrong it is wrong for anyone to preform.
I agree – doctors should have the right to refuse assisted suicide if their conscience and moral ethics forbid it.
I agree with this statement. In addition, no one seems to be taking into account the long term psychological negative effect to the doctor (or anyone) who goes against what they believe to be right or wrong by committing an immoral act. We have seen these effects on women who have suffered psychological effects over the last 40 years since the roe vs wade decision.
I agree with this statement as it deals with not only the physician’s freedom of conscience but the part of requiring them to refer the patient to someone else to do the procedure.I urge you to seriously consider all of these aspects before making any changes in policy
I agree. It is NOT an acceptable position for the College to force doctors to refer patients they could not morally or ethically treat themselves. Perhaps patients need to be informed of their physician’s personal moral code before signing up with them.
I agree. Particularly if the moral view is a widely accepted one both by both common Canadian society and/or religious groups, why should one be required to go against, ones own beliefs and be complicit in the process.
I agree that the doctor as well as the patient should have the right to reject doing a procedure that they consider to be morally wrong. If I do not speak out against it, I would be as guilty as the Doctor doing it.
Some give the impression that doctors or superhuman….therefore patients expectations upon them and them alone is unrealistic. No one can fix another or fix another’s life that is up to the person and God and the plus is the blessing of the gifting of a professional to help guide them to corrective treatment or thinking or behavior. Doctors, forgive us for expecting the superhuman and divine from you. Forgive us .
I agree totally with the above physician. It seems like a select group of people in this country have rights. I a persons conscience tells him/her not to do something that should be respected. We need more people with a conscience and there weuld be a lot less wars breaking out.
I agree with this statement. It is NOT acceptable position for the College to force doctors to do anything that goes against the doctor’s conscience and that includes not forcing doctors to refer patients.
I also agree that is NOT acceptable to force doctors to go against their conscience. The doctor’s rights are being taken away and the patient’s rights are being placed above that of the doctor’s. And what about the right of patients to have a doctor who stands for life? Also the statement ‘emergency situation’ is very broad and will be open to much abuse.
I so agree…also praying that God would “keep our land glorious and FREE”
I have two concerns about the referral requirement. Moral philosophers generally agree that if doing a thing is immoral then arranging for that thing to be done is also immoral. Isn’t arranging for someone to kill your patient just as immoral as killing your patient?
My second concern is that the referral requirement will trigger an expensive Charter challenge.
Why force physicians to violate their moral integrity and risk expensive legal entanglements when the previous policy was working?
Because it was violating the rights of patients? Why else would they change the policy?
Patients don’t have a right to death. The policy change is a political move. Doctors are supposed to extend, enhance and protect life. If death becomes a right, go find a murderer for your services.
Forcing doctors to violate their moral integrity is taking their rights away and it will likely mean that many doctors will be forced to leave, thus Canadians would have less access to the medical care they need. If a human being wants to suffer an incurable desease until natural death, it does not diminish in any way his value as a human being because suffering in Christ has spiritual value, a redeeming value. Only God has the right to end a life and no one else.
Are we suppose to put patients’ rights over the ones of physicians’? I do not think so…
I agree that the right to conscientious objection is critical to maintaining physician integrity. However, in Canada we routinely choose to infringe on certain individual rights for the sake of the right of society at large — for example: free speech yes, hate speech no. If we as a society determine that a particular act or service is a standard of care, I think that patients’ right to health care should trump a physician’s right to conscientous objection. In many cases, there is fortunately a compromise position (e.g. refer to a colleague or allow patient to self-refer) but when there isn’t, or when it is an emergency, I think this policy is appropriate.
Additionally, I think that ignoring the power imbalance inherent in the physician-patient relationship is a bit disingenuous at best and dangerous at worst. We are in a position of power, like it or not. That arguably makes erring on the side of protecting the rights of our patients when they conflict with our own rights even more criticial.
Free speech is not free speech if it does not include “hate speech.” What is “hate speech”, after all? The “victim” declares himself a victim and what offended him is therefore “hate speech”. Only totalitarian governments attempt to police thought.
You speak of a power imbalance and yet you fail to see the irony and hypocrisy inherent in your defense of the CPSO draft policy. The facts are that mothers and doctors are decidedly in the position of power; the pre-born children in a fiduciary relationship with their parents, at least, are legally killed; and instead of trying to protect these children, the medical profession through this draft policy is attempting to force those doctors who refuse to kill the children either to kill them or to facilitate this killing.
What’s more, you wrote your defense of this evil draft policy under a comment pointing out that “arranging for someone to kill your patient [is] just as immoral as killing your patient.” Yet that is what this draft policy requires and what you are defending.
If we are going to speak of “hate speech”, then who is guilty of hate speech against pre-born children? And since there is power imbalance, why is this draft policy doing the exact opposite of what it purports to do, further legitimizing and requiring provision of “services” that turn healers into killers? Absurd! Evil!
There is a power imbalance inherent in the physician-patient relationship- this is true. However, if this draft policy becomes law, then the power imbalance will shift- physicians will no longer have the freedom to do what they feel is in the best interest of patients, and they will be forced to violate their consciences, which is harmful to their own wellbeing. In addition to this, such legistlation may mean that many doctors or future doctors will no longer feel free to practice their profession at all, if it means they will be forced to compromise their consciences to such an extent. This would be far more harmful to patients in the long run, as well as to the general public. There is already a shortage of physicians. Why make it worse?
It may be true this policy might deter certain individuals from pursing a medical career in Ontario (for the record, I doubt it).
Let me assure you that there would be hundreds of excellent candidates who would be thrilled to accept the medical school spot of those pre-emptive conscientious objectors. The OMSAS website gives a breakdown of the number of medical school applicants vs. number of spots. In 2014, there were 6593 applicants and 954 spots. I wouldn’t worry too much about causing a future shortage.
You are clueless in your first sentence. You doubt it because you aren’t one of the “conscientious objectors”. If you want to know what the secular humanist water is like, don’t ask the fish. Growing up in a Christian family in Ontario, I was warned by my father against occupations in law and politics because of the difficulty of keeping the faith. At great personal cost–in Canada we would have been considered poor–he sent me and my five siblings to the private Christian school where he was paid less to teach than his public school counterparts. We don’t work on the Lord’s day so many jobs we can’t apply for. We are discriminated against by Ontario’s law society. Large corporations discriminate against us. Since we refuse to kill people–according to a centuries-old church doctrinal standard, even helping to kill somebody is murder–family medicine is now closed to us. Ironically enough, we are the ones who have large families and know best what they need. You are clueless! This matter of referral will go to the courts, but because of the intolerant secular humanist state religion, I am not hopeful about the outcome.
Are you saying that people who hold a specific belief contrary to what is supported by this policy draft are better to be filled by people who do not have a conflict with this policy? Is that not discrimination based on religious or moral belief? Think about that you are saying.
Self referring would be a good option. Asking a physician to violate their conscience is a problematic option.
I agree that self-referral is part of the solution here. Part of what we need to do is minimize the occasions where there will be a conflict between physician and patient values — self referral for contentious services will partially address that. However, as other commenters have said, self-referral or a public list of alternative providers does not go far enough towards ensuring that patients have the knowledge and access to standard-of-care services that is their right.
I don’t think anyone takes asking a physician to act contrary to their conscience lightly. It is something that we should avoid wherever possible. However, when no reasonable alternative exists, I think we need this provision in place to protect the more vulnerable party in the relationship.
You speak of “protecting the more vulnerable party in the relationship”, and yet you give no concrete examples. Here are a couple concrete examples:
(1) Abortion kills children. They are very vulnerable, especially before they are born, and their extreme vulnerability is the reason that God designed for them the womb. This draft policy can only increase the number of deliberate abortions and make all doctors complicit in their deaths.
(2) Euthanasia kills people who are extremely vulnerable, whether because of age, suffering, disease, or spiritual condition. This draft policy can only increase the number of people euthanized if euthanasia is legalized.
Clearly we need to SCRAP THIS DRAFT POLICY in the interests of a more compassionate society and more compassionate medical profession that protects those who are most vulnerable.
One grotesque characteristic of this draft policy and much commentary in favour of it is the false antithesis it manufactures for doctors between following one’s conscience and protecting one’s patient. This disfigurement is rendered odious and evil by the fact that the conscience rule at stake here is exactly that which protects those most vulnerable from being killed. When God punished the world for its violence with the Flood, He afterwards instructed the conscience of our ancestors in the words of this very old verse and basic principle of justice: “Whoever sheds man’s blood, By man his blood shall be shed, For in the image of God He made man” (Gen. 9:6).
So hold the doctors hostage because the the country hates babies? This is the line of civilation. You kill the weakest, most vulnerable members of society and feel we are any better than the terrorists? One day people will look back and say how could we be so lost?
What right was it violating?
Although the patient has rights, but so does the doctor. Even if a patient wants to be euthanized, who will do the euthanization? Who will prepare the dose? Who holds the power over someone’s life or death? Why should it be easier to kill someone when they want to die, than when they want to live? Who will be left remembering those they have killed? Can they be certain that is what the patient really wanted? When people are suicidal they are not considered mentally competent. So when someone is begging for death aren’t they asking for the suffering to end?
In the 21st century, with all our medical advances and equal rights we still have people suffering and I don’t think that it’s going to change. But is the way we are going to handle it as the human race to kill off those who can’t take it any longer. I think there must be something better that we can do. To reach out to those left a lone in the hospitals and change the structure of health care. Not just to treat the disease, but that patient as a whole.
I totally agree with you also. Well said !
My concern as well. Well said!
My thoughts as well! Whether you are directly administering the lethal medication directly or provide the referral – your hands are involved!
Absolutely!
To be in agreement to or encourage an immoral act is as reprehensible as doing the act.
If I have to decide between my conscience and the College well….. so be it.
I agree that doctors ought to have the same right as other Canadians to live and act (or choose not to act) in accordance with their own conscience. Even if a patient has a right to die, that should not force the hand of a particular doctor to cause that death.
I think I understand where your concerns are coming from, but I don’t think you’ve framed the whole complexity. There’s also moral issues relating to what happens to the patient when you don’t refer them. What do they do? Where to they go? What could happen to them?
These considerations also need to be weighed.
Refer them for what? CPSO is devising hideous complexity to obscure simple fundamentals that they want to ignore:
(1) It’s wrong to kill pre-born children. (No, you can’t ask what about ectopic pregnancies. They aren’t the reason for this draft policy. I know because my cousin had an ectopic pregnancy.)
(2) Doctors aren’t soldiers or executioners. They shouldn’t kill people.
(Again, the relatively rare ectopic pregnancy isn’t relevant here.)
(3) Whoever’s doing something–whether he’s a doctor or not–should not do something wrong. If it’s wrong, then it’s wrong. The real question is whether it’s wrong. And, yes, abortion is wrong.
Now I answer your questions about the pregnant patient who has no referral, and as you will see, there’s nothing wrong here, only that which is good and right:
(1) What does she do? Continue to do what she was doing: be a good mother and nurture her child.
(2) Where does she go? To a pregnancy care centre. My sister works in one and helps save babies who would otherwise be killed. It’s funded by people who truly CARE, not by tax-payers under compulsion to support “reproductive health care” (what an evil and despicable euphemism).
(3) What could happen to her? She will go to the hospital, and the doctor will deliver a baby. Now that’s part of his job description!
To the CPSO if not to you–stop butchering the English language! You do it to justify your butchering of people (in the name of “dignity”, another word you have butchered). Obviously–and more importantly–stop butchering people, too.
There are many doctors that would willingly perform the procedure if a certain physician would not. This is not a moral issue- unless perhaps the conscientious objector physician was the only one. And even if that was the case, a physician that cared enough about a patient to say no to a procedure they believed to be wrong or harmful would also ensure that the patient was told of alternative options.
“A physician that cared enough about a patient to say no to a procedure they believed to be wrong or harmful would also ensure that the patient was told of alternative options”–like a crisis pregnancy centre? Killing the child is, of course, not a valid option.
I so agree. If the College is so interested in making alternate physicians available to the public, then let them put together a list that is accessible to the public. Why force a doctor to become involved in a decision that is against his morals?
It isn’t just finding another physician (although that is part of it). It’s about transfer of knowledge: docs (usually) have it, patients (sometimes) don’t. It’s unfair and unjust to expect patients to know where to find that information on their own. If providing an effective referral is as simple as directing your patient to a list of providers that is available online: great! But it is still the duty of a physician to inform that patient about where that information can be found.
“It’s unfair and unjust to expect patients to know where to find that information on their own”–It’s orders of magnitude more unfair and unjust to KILL patients or to help to kill them by referral. It is still the duty of a physician to heal the patient, not kill him.
Well said! An analogy may help: Suppose I’m an accountant and a client asks me to help him cheat on his taxes. I refuse. Could I then in good conscience refer him to another accountant who doesn’t share my scruples and who would help him cheat? Obviously not. But suppose the association of accountants required me to make that sort of referral? Clearly the association would be violating my conscience.
excellent analogy
I agree. Physicians PROFESSED to heal and not to kill. Physicians should be working together as they are trusted by their patients to take care of them and to find cure for their illnesses. Physicians go for extensive studies to find cure. Their Moral Conscience reveals to them the value of life and that is what they professed. Physicians who value life values the dignity of humanity. Killing will not resolve the problem it will just add more problems.
It is INHUMAN. Physicians who supports Euthanasia fails what they professed. They are not Physicians but EXECUTIONERS.
So much for freedom of conscience in our country: this draft violate doctor’s Charter rights. For instance, it will force doctors to refer for euthanasia regardless of their moral, medical or religious conscience.
The CPSO is incoherent:
http://www.cpso.on.ca/policies-publications/policy/female-genital-cutting-%28mutilation%29
They realize immoral practices need to include referral prohibition
“…Further, physicians must not refer patients to any person for the performance of FGC/M procedures.
The performance of, or referral for, FGC/M procedures by a physician will be regarded by the College as professional misconduct.”
Or…they will force a doctor to refer to sex-selective abortion
yet, They will impose referral depending on what? who is the arbiter what is obligatory or not? A moving target indeed and a dictatorship has been born
If the CPSO has decided to create an obligation to refer then it needs to better define the limits of that obligation. I object morally to infundibulation, as does most of the profession. Patients may request this procedure for religious or cultural reasons. There are physicians in other parts of the world willing to provide the procedure. Do I have an obligation to refer since I can’t deny access on moral grounds?
I object morally to vagina rejuvination surgery. I am aware of physicians just across the border in the US who disagree and patients request referral to those physicians. Am I obligated to refer?
The obligation to refer needs stated limits. Perhaps it should be limited to care which is available in Ontario or within Canada. Perhaps it should be limited to care which at least a significant minority of Ontario physicians beleive is moral and which they are willing to provide
If you have a moral objection to infundibulation and vagina rejuvenation surgery, then why would you help patients–by referring–to have these evils done? Aren’t you being a hypocrite by saying, “The CPSO made me do it?”
Or maybe these evils are only a little evil? Maybe you’re not sure they’re evil?
Take an example where the stakes are higher. Abortion is the killing of a pre-born human being. In God’s eyes, I’m an accessory to murder if I refer the mother. Whatever the CPSO says, I may not refer.
Physicians have an obligation to practice according to Canadian standards of care. THAT is the limit implicit in this policy. It’s irrelevant what those standards may be in another country.
I do not believe that the moral views of any minority should define the legal code under which all of us must operate.
Please openly state what you do believe. Should the moral views of the majority define the legal code under which all of us must operate (or die as the case often is with the pre-born)? How much should precedent–as in English common law–play a role? Surely you realize that the legal code is a moral teacher and that if we are not to have anarchy we cannot help but legislate morality.
Don’t you think it perhaps somewhat extreme to force healers to kill patients, whether recognized as such or not, and to justify this coercion on the (im)moral views of the secular humanist majority? How utterly intolerant and discriminatory!
Physicians who are not prepared to offer ALL services that fall within their area of competency (specialty) should not be licensed to practice medicine. They should rather be directed to become ministers/preachers/pastors instead.
Hear hear!
You might as well say that theological students who refuse to blaspheme God should not be licensed to preach and not be ordained. Abortion and euthanasia are to medicine what heresy and worldliness are to the church. It ALL depends on what you call a “service”.
Anyway, why do you imply that your doctor is your slave? Be thankful for whatever services he does offer. He can be up-front about them. If you don’t like him, find another doctor–or become one yourself.
They have the right to follow their moral and religious beliefs!
Do we not have freedom of speech? Of religion?
The patient may find another physician.
We need to be very careful when stating that something ought to be done. Saying that something should or should not be done implies that there is a self-evident or absolute standard of right and wrong. Who set this law, this standard? If we are basing our opinion on arbitrary and/or mutually agreed-upon standards, then these are all equally valid and subject to discussion. I contend therefore that each individual should be allowed to work in public according to one’s conscience. It is against my conscience to refer a patient or client to have a procedure or treatment that I feel is ethically or morally wrong. As a crude example, it is equally wrong to murder someone as it is to hire someone else to do it. So for me to refer someone to have an abortion carried out is equal to performing it myself. In this diverse climate we must respect one another’s beliefs and must not force one another to act against one’s conscience. We must find common ground to be able to coexist and thrive. In this era of increasingly diverse culture we must recognize that there are areas that will remain contentious. In these instances we must not force physicians to act against their conscience but rather enable services for the public to access. There are self-referral clinics where a woman may access a physician for an abortion. Why must I be forced to make a referral for the same? And who wants a physician who is willing to act against their conscience?
I agree- and thank you for standing up for your freedom of conscience. I’ll stand with you!
Very well said. I fully agree and support your position.
That was a discriminatory remark.
I disagree, not for moral reasons but for practical ones. If I lack the knowledge or expertise to perform a skill that theoretically falls within my scope of practice (e.g. a family physicians who does not perform joint injections), that should not disqualify me from practicing in ways that I do feel I can safely and ethically perform. That said, it would be inappropriate for me to withhold a therapy that is the standard of care from my patients, which makes referral a reasonable option.
It is not reasonable to refer to another hitman. The immorality of such referral is also very practical and easily understood–and indeed recognized in our legal code–whether I do the killing or ask somebody else to do it, the victim still dies.
Re: Article in Toronto Star titled – “Anti-abortion doctors must refer patients to another physician, watchdog says” – dated Dec 11, 2014.
This move has to be seen as a propaganda to force all doctors to be supporting abortion. Leave alone human rights, this is violation of a doctor’s professional ethics. More than that this is a move to strip human beings of anything called personal values, by penalizing. Yes, to a doctor to support a life, will become digging his own career a grave.
We should learn lessons from the past, how the left wing propagandists have lied over and over to make people believe that a lie is a truth and how it has lead nations to destruction.
By the way, abortion is evil. It will not do any good to Canada, as we can see that we have to import tax payers (myself included) to keep this country going.
Wake up before its too late.
I do not agreed that doctors should have to refer their patients to another doctor for treatment that the doctor opposes on religious or moral grounds. The doctor should be REQUIRED TO PROVIDE TREATMENT regardless of their personal beliefs. There is no need for “balance”. Religion has no place in medicine, and a patient’s right to swift and appropriate care TRUMPS a physician’s personal religious/moral beliefs. If a physician does not agree with this they should surrender their license to practice medicine in Ontario.
Then why is one of the two patients never provided appropriate treatment in every case of abortion? Remember that the Ontario Human Rights Code does not allow discrimination on the basis of age.
So if a patient wants me (as an OB GYN) to perform a female circumcision (aka genital cutting)then I’m obligated??….you make no sense
Wrong! Wrong!
What you fail to realize is that not every physician refuses to provide certain services based off of religious beliefs. There are many non-religious people who may be against abortion for ethical values, or even certain physicians who are against birth control for environmental reasons.
Don’t assume that religion is the sole thing physicians base their values and beliefs off of.
Not every physician who refuses certain services is doing so because of religious values. There are many physicians who refuse based on their personal beliefs and values.
For instance, not every Pro-Life physician is religious, many may not agree with abortion due to moral they chose.
Another example could be refusing to prescribe birth control for environmental reasons, as there are studies showing increased hormone levels in waters which affects animal and plant life.
Please don’t assume that physicians refuse simply because of religion – there are many reasons and justifications, and this should be a RIGHT that physicians have.
Many physician’s have an understanding of conception and the reality of when life begins, based on scientific evidence. Their decision to refuse is not based on religion but on the basic principle and respect for life and humanity. You don’t have to be a member of a recognized religion to object to abortion or assisted suicide, you just have to be human.
I totally agree!
Everyone, including physicians should have freedom of conscience as long as it does not harm another person. This is not necessarily freedom of religion.
Exactly — unfortunately, the consequences of allowing physicians to refuse to provide information or referrals on moral grounds DOES harm others (patients) when it poses a barrier to accessing standard-of-care medicine. This policy is intended to protect patients, which is what we as physicians are called to do.
The question posed by the OB/GYN above is irrelevant to the policy above — FGC/M is NOT standard of care in this country, nor is it supported by reliable evidence in any country.
When all else fails, change the English language and have words mean the opposite of what they originally meant. What adherents of the Christian religion have been resisting –and what adherents of the secular humanist religion are requiring in the draft policy–is “provision” of abortion, euthanasia, and sex change, all of which involve killing or mutilation of the human body (like FGC/M). To call them “standard of care” and “protection of patients from harm” is deceit and depravity.
I agree!!! Our charter of rights states that everyone in our country has the right to do what he/she thinks is morally correct as long as it does no harm to anyone else. By taking this right away physicians patient care is being compromised because when someone is forced to act against their conscience they are certainly not giving the best service they can.
We have freedom of religion in this country. It’s right at the beginning of the Charter. It means freedom to act (in your personal AND your public life) according to your religious beliefs. I suppose you must disagree with the Charter – not to mention the foundational values of our civilization.
The beginning of the Charter (section one) actually states that while Charter rights are guaranteed, the government has a right to reasonably limit the Charter rights of an individual to serve/protect the rights of society at large. As such, this policy is consistent with the Charter because while it does infringe on individual physicians’ right to freedom of conscience, it protects society’s right to health care and to their own freedom of conscience.
I am interested to see how long it will take for a Charter challenge to be brought on this issue as I am certain that one will be coming if this draft policy is enacted. I will clarify that I am in support of the policy but it’s quite clear that that position is not unanimous.
That phrase “reasonably limit” is most unreasonable and as bad as or worse than the “notwithstanding” clause. Real rights, as they were originally had in Canada, are possessed by the individual in relation to the state, to protect him from the power of the state. The newer rights, which are expressed negatively (“freedom from discrimination on the basis of…”) and based on group identity actually work to undermine and eradicate the old rights which developed over centuries of legal practice. Increasing the power of the state, these newer rights are expressed in both the horrible Charter and the even worse Ontario Human Rights Code, and they are the basis for this new draft policy.
This post is among the most concerning I see on this forum. Please understand that there are a number of very important issues on which we do not have consensus in this country! Euthanasia, for example, remains a highly contentious issue. Chances are very good that this will be legalized soon, based on a majority vote. But the majority, if/when it comes, will not be overwhelming. There will still be a very significant minority of both public and physician citizens that cannot agree with this procedure. But, soon enough, it is quite likely that it will be considered part of ‘appropriate care’, which we call ‘standard of care’ within the profession. So, where majority rules but as many as 48 or 49% disagree, do we obligate everyone to perform the procedure?
I believe this would be truly insane behaviour. To deny the rights of a conscientious objector on the basis that the majority says something is okay and legislates it into standard of care prevents the voice of conscience from speaking up when our society is going the wrong direction. And there are absolutely things going on in medicine today that large numbers of physicians believe are the wrong direction. As a family physician, denying my right to object when I’m asked to do something I truly believe is wrong (including euthanasia, as an example) will either smother my conscience (which is absolutely required for my daily practice of good medicine) and injury my humanity or force me to leave the province and practice somewhere that my conscience is allowed to remain intact.
There are some issues upon which I do not think we will ever reach consensus. Many of those raised by others in this discussion thread fall into that category.
However, I don’t think that an interaction with a patient is the best place to be airing your conscience. Choose a different, more appropriate venue that does not expose your patient (and your relationship with that patient) to potential harms that may result from your objection.
As a physician, I can and do provide care for people who have different belief structures than I do. Like it or not, that’s part of the job. It’s no more my place to direct someone’s cancer care towards palliation instead of active treatment than it would be to exert undue influence on other consequential decisions in their lives. I hold my beliefs no less passionately than others, but part of the sacrifice that is asked of you when you choose this profession is to sometimes put your patients’ needs above your own. This policy document merely makes that implicit duty more explicit.
An interaction with a patient is certainly not the best place to be disobeying your conscience and what you know to be wrong. Choose a different venue that does not expose your patient (whether or not he is born) to potential harms that may result from questioning your conscience.
As a physician, you can and do provide care for people who may or may not have different belief structures than you do. (Note that pre-born people have not had a chance to create belief structures.) Like it or not, that’s part of your job. It’s no more your place to direct an expectant mother to an abortionist than it would be kill the child yourself. You hold your beliefs no less passionately than do others, but part of the sacrifice that was asked of you when you chose the medical profession is to sometimes put your patients’ needs above your own–no matter how young, weak, and insignificant you might find your patients to be. This policy document is absolutely worthless in helping you make that sacrifice.
Murder is not a TREATMENT.
I would ask you: Have you ever killed anything? Anyone? How have you the right to ask anyone to do that on your behalf? Treatment is pain management and care.
This is NOT good enough. What you’re doing is allowing a licensed medical doctor to put their personal choice ahead of that of the patient, showing an absolute disrespect and disregard for the patient’s care, health and well-being. Any doctor doing this should be mandated to also report to the College and face disciplinary action and sanctions up to and including the revocation of their medical license. If a doctor can’t operate by putting the needs of the clients first then they shouldn’t be allowed to practice in Canada. Do you understand how vulgar your acceptance of this is? Imagine if a licensed financial advisor with decides that they can only recommend to a client the highest cost funds because otherwise it impacts their paycheque!? The analogy is the same. It’s wrong.
The needs of the patient (not client) is their health and well-being based on the professional judgement of the doctor. If the doctor believes that providing drugs or surgery that could cause death or severe harm is inappropriate, then the doctor should not do so, nor should (s)he refer to someone who will disagree with her/him.
The patient’s health and well being is NOT based on the judgement of the physician, but instead is based on the patient’s own decisions regarding their well-being. This is autonomy, the first ethical principle that physicians are sworn to abide by, so long as the patient is able to understand the implications and consequences.
Really? This is the first (and hopefully last) time I’ve heard of a Patient Autonomy oath that all physicians take. But I’ve often heard of the ancient Hippocratic oath, the essence of which is to first of all do no harm. It included the promise not to cause an abortion, which is, of course, harm.
Autonomy is only one of the pillars of bioethics. It is not the only.
Beneficence: promoting what is best for the patient
Non-maleficence: do no harm
Justice. Resources are limited; you cannot cure everybody and so priorities must be set (hence the notion of triage) is what the patient asking for fair?
“Ethical issues arise when not all values can be respected. The values in conflict must then be prioritized and the essence of ‘doing ethics’ is to justify breaching the values that are not respected.” (Margaret Somerville, November 2008)
What kind of doctor would one be if they could not conscientiously object? One that would lack integrity and honesty. How many of us would feel secure in the hands of such an individual.
The practice of medicine is inherently a moral and ethical endeavour. The effect of this policy as stated would be the exclusion of a large segment of society from the practice of medicine, leading to the silencing of voices of dissent in ethical and moral matters as they relate to medicine. This would be a great risk to the public safety, as important checks and balances would be removed.
Contrary to the College’s mandate to protect the public, this policy will lead to vulnerable individuals being put at unacceptable risk, as advocates within the system will be silenced.
Very well put. How can I trust a doctor who cannot follow his conscience?
Now, if that isn’t a bunch of nonsense.
Then you would just get a different adviser. That’s your choice.
I don’t think it’s a secret how challenging it is for many people to access primary care in this province. There are 900 000 people without a primary care provider, and many thousands more who have one but have to wait weeks or months to actually get any time with that provider. To suggest that when your doctor’s morals collide with your right to health care that you should just get a different one is highly unrealistic and unhelpful.
I don’t think it’s a secret how challenging it is for many pre-born people to survive in this country. There are annually 100,000 such Canadians killed. To suggest that when your doctor’s morals LINE UP with your baby’s right to life, you should have both destroyed is highly unrealistic and evil.
Doctors aren’t retail employees providing services from a menu. They are professionals giving advice to patients (who can then make their own decisions). Medical advice is almost always both scientific and moral in character – since you are making a moral choice for health over pleasure in many cases. So a physician has a right to decline to give what they consider immoral treatments (including referrals).
How can this be possibly be a good compromise between physicians? If a doctor, for religious grounds or moral grounds, feels abortion is wrong, be expected to tell a patient to go to see Dr. X and have him kill your unborn baby.
Consider other cases. “If a doctor, for religious grounds or moral grounds, feels” blood transfusions are “wrong, be expected to tell a patient to go to see Dr. X and have him” transfuse blood to save your life.
What about a physician who becomes a follower of Christian Science, who believe “that sickness is an illusion that can be corrected by prayer alone.”? Should they be allowed to deny a transfer to another doctor because they feel it is morally wrong to provide medical care rather than prayer?
An MD that feels practicing “M” is immoral? Can you imagine the patients lining up to make this their doctor, the one who does nothing, nothing, but pray for them?
Quite the hypothetical! Why that adherent of “Christian Science” would ever–and how he could ever–become an MD in the first place is beyond my comprehension.
Why don’t we imagine a more plausible scenario? What about a physician who is a secular humanist, who believes the value of a pre-born person’s life is almost nothing? Should he be allowed to kill a baby because the mother requests an abortion?
Yes.
Why? Why should your secular humanism have precedence over my Christianity? Canada was –and in some ways still is–a Christian country. If you know all four English stanzas of the Canadian anthem, or even just its chorus, then you will know what I mean.
But your answer is inconsistent even with your own standards. You are discriminating on the basis of age. I’m not talking of an artificial legal world; I’m speaking of reality–life as it is lived–in which every human being has age after conception.
If a physician became a follower of Christian Science, believing “sickness can be corrected by prayer alone”, why would he remain a physician? Is pregnancy a sickness or illusion? Old age?
Are you kidding? I was an RN for 45 + years. For all of that time I knew that I had to refer to another RN when caring for a patient who wanted services I could not provide due to moral beliefs. FYI I do believe in choice for abortion services and in birth control.
Whom do you think you are kidding? Your “moral beliefs” do not amount to much if, as you have implied, you are unwilling to act on them. You revealed your guiding principle of conduct when you wrote, “I knew that I had to…”
I know that I have to love my neighbour, not kill him–and whether or not people call the killing “abortion services” or “birth control” makes absolutely no difference.
I agree — I thought this was already the expectation for physicians. I am glad to see that it will now be an explicitly stated duty.
When the CPSO’s expectations differ from God’s, whom do you think the Christian physician will follow?
The provincial government and CPSO are essentially trying to convert all physicians–and therefore, patients, too (because we’re in a system together)–to the state religion of secular humanism.
The Supreme Court has determined that human rights are not absolute. I believe that when studying human rights, this is not always obvious and depends on the perspective and narrative provided. I believe the Supreme Court is acknowledging that human rights often conflict with each other, and this problem with not go away with the current approach.
For example, a young female doctor who worked in our group left her practice recently, and I believe she did this because she felt uncomfortable dealing with certain patients. Did she have the right to refuse to accept patients who made her feel uncomfortable? Not having this problem dealt with resulted in all her patients suddenly losing their family doctor and being extremely unhappy with the alternatives presented to them. We now have another young female graduate working with us, and I question whether the same problem could develop. If she is allowed to accept only patients she is comfortable with, I believe she will be happy and so will her patients. If she is forced to accept patients she is uncomfortable with I question whether she will also leave and practice in an area where she feels more comfortable. If she is forced to accept patients she is uncomfortable with I question whether there is more potential for conflict and adverse outcomes.
The area our group practice services is very eclectic and multicultural, and also has a substantial amount of poverty and social problems. The new graduate female physicians involved are both members of visible minorities, and I felt they would understand the unique types of problems some of our patients experience.
Do these physicians have the right not to feel uncomfortable, or in only taking patients they are comfortable with are they discriminating? Could they be discriminating in an unprofessional way, or is this just an example of rights conflicting with each other? I found it ironic that the physician who left could could “discriminate” in a completely professional and acceptable way by quitting the practice altogether and simply moving to another area where she is less likely to encounter patients who make her uncomfortable.
Here is another example of rights conflicting;
A patient I have never seen before recently came into our office with no appointment and demanded to be seen. They demanded I authorize medical marijuana for them, and demanded I don’t withhold treatment. I felt they were being coached by a company which produces medical marijuana. I felt his case was outside my scope of practice. He then demanded I refer him to someone who would prescribe him medical marijuana. Am I “withholding treatment” if I refuse to prescribe medical marijuana or refuse to refer him to someone who will? In this context, I oppose some of the expectations/ statements in the colleges draft policy on professional obligations and human rights. In most cases and situations the draft guidelines are reasonable, but there are situations and contexts where I would want the freedom and the right not to have to follow the expectations.
When the Supreme Court ruled that human rights are not absolute, I believe they were saying that they can definitely conflict with one another, and one person demanding their perceived human rights from another can paradoxically violate another unwilling persons human rights.
I believe the college should proceed with caution in this area, because informing people of rights they have which are not absolute, but are relative, can embolden and unintentionally misinform the public into believing they have something they may not have (depending on point of view and context of each individual, unique situation) and this could cause many unnecessary complaints and conflict involving the college in the future.
It is entirely possible that despite the draft policy being clear, it could be challenged by a physician in the future and found to have violated an individual physicians rights. See previous comments/ examples in this comment.
Thank you for the opportunity to participate, I am honestly providing my input in the hopes of improving professional relationships between the college, patients, and physicians.
Is there any way that physicians can demand a vote on this draft policy? Your comment that a physician may be able to challenge the policy in the future made me think: Is there any way to stop this now? The draft as I read it reduces the high calling of a physician to a clinician: follow the rules, bow to the powers that be and keep your brain in check. So very sad that the CPSO is making it even more difficult for doctors today. I can’t imagine after all that you went through to become a medical doctor in this country, that you now have to be hand tied and silenced, Shame on you policy makers. Let these doctors work with the “First, do no harm” policy and let them become the great men and women they are destined to be.
Well said, “First do NO harm” – save lives – do NOT end life.
So if someone comes to me asking me to kill someone, but I refuse because I believe that murder is morally wrong, I have to refer him or her to a hit man that I know will do it? This is the same thing as forcIng a doctor morally opposed to abortion to refer his or her patient to a doctor that willer form the abortion.
Yes … because an individual doctor is not allowed to decide that abortion should not be provided to a patient. Abortion is legally available in Canada and has been for years. For a doctor to both refuse to provide said service AND refuse to provide a referral, they are standing in the way of a legal right of Canadian women. The law is not made nor interpreted on the individual level, but on the societal level.
Abortion is the killing of a child. Canada has no abortion law. It should have a law against abortion because killing people is murder. Doctors should heal people, not kill them.
And even in the D&C for the relatively infrequent ectopic pregnancy, the goal is not to kill the child but save the mother. Otherwise, both will die. An ectopic pregnancy truly is a disease.
If abortion is legal in Canada, could you state the legal Act that has made it legal?
Abortioni is simply not illegal which does not make a right nor an obligationi. it is simply tolerated in absence of a body of laws.
If “society” feels so strongly that X is a fundamental right, “society” can simply remove the artificial barrier of referral so that patients can avail themselves of X. This already happens with abortion and can happen with other services as well, without putting objecting physicians in moral hazard.
Of course none of this is about removing barriers. It is about forcing a political and philosophical viewpoint on physicians and eliminating dissent.
It’s not just about the referrals. It’s important to provide patients the information they need to know what their options are for any given health problem. Sometimes patients don’t even know that a particular therapy or treatment is a possibility for them — how can we expect them to self-refer for that?
I agree that certain services should be available on a self-referral basis to further minimize the number of ethical conflicts that arise from the need to obtain a physician’s referral. However, even where self-referral exists, it is still critical to make explicit the duty to provide information about those options.
Dear Doctor,
Some physicians apparently don’t realize that what they call a “particular therapy or treatment” is wrong. I’ve noticed that supporters of the draft policy generally speak in generalities and rarely speak of specifics. Here’s one specific: abortion is wrong, and it’s just as wrong for somebody else to kill the child as for me to kill it.
Just do your job, doctor! And take this hint: killing us is not part of your job description.
Totally agreed. Murder is murder including to those yet not born and to those who are terminally ill. Assisting (including referring)in this murder in any way makes that person an accessory to the murder. Doctors want to help their patients not hurt them. If in the case of pain in terminal illness the doctor will do their best to ease the suffering. It is hard to see someone like this but it is not up to us or them when their life should end. A doctor should never have to go against his/her moral beliefs which is a fundamental right in this wonderful country of ours.
I believe that the language where a doctor can be forced to perform against his beliefs should be clearer and indicate that this compelling must only take place under LIFE THREATENING CIRCUMSTANCES. Any less criterion would leave room for loose interpretation leading to situations where a doctor is forced to violate his beliefs over a relatively minor patient risk.
The Ontario Human Rights Code protects Ontario residents from discrimination on the basis of age. The Ontario physician may not kill a baby at the request of its mother. Remember that every pregnancy involves at least two patients.
What circumstances are LIFE THREATENING? Every abortion results in the death of a child. Many abortions are justified on the basis that the quality of life of the mother is threatened.
I completely agree with this. “Urgent” situations should only include those where “life saving health services” are required.
Good insight!
I hope the College changes the wording as suggested above.
I disagree — sometimes referrals need to happen within a particular timeline (e.g. for prenatal serum screening), even if the issue is not life threatening. I don’t think “life-threatening” is broad enough to accommodate services for which time is of the essence despite the lack of life-or-limb emergency.
Your example only reinforces the argument for changing the wording to include only life-or-limb emergencies. What urgent need is there for prenatal screening except to kill the child if he is found in some way to be defective? No doctor should be compelled to offer a service in which the only difference with not offering it is the possible killing of a patient, who would not have died without the “service”.
The tests we use become less accurate after a particular gestational age, irrespective of what patients choose to do with the information. Many of my patients have chosen to have the testing, knowing in advance that they could never reconcile an abortion with their personal beliefs but wishing to have information that will help them prepare to be the best parents they can be to their particular child.
I hope that helps to clarify the “urgent” requirement in this particular example.
Some of the tests in themselves carry a risk of harm to the baby. I know because as a parent I was presented with just such a scenario after the triple test (not at all dangerous). Knowing that I would never kill my baby, I decided not to take further tests which might harm the baby. The costs are extreme (non-negligible risk to the baby) but the benefits are minimal. Why proceeed?
But I am unaware of any pro-life doctor who would be unwilling to refer in this example. The draft policy needlessly guarantees saving of the bath water (parents’ preparation) and throwing out the baby (forcing doctors to force abortions).
Why doesn’t the policy simply require a means by which all pro-life physicians may be identified to patients as pro-life? That way, any woman who wants to end the life that depends on her for existence, or wants to prevent that life, will know in advance that these “services” should be sought elsewhere, thereby avoiding any obstacle to the putative “care that is urgent or otherwise necessary to prevent imminent harm, suffering, and/or deterioration.”
I think taking steps to minimize the moral conflicts (e.g. allowing self-referral, publicizing physicians’ personal policy on the provision of certain services) is an important piece of the solution, but would be inadequate to fully address the issue. Seeking services elsewhere isn’t always possible or feasible.
“Seeking services elsewhere isn’t always possible or feasible”–and this draft policy, both in principle and practice, assures that they won’t be! How will I be able to get a doctor I can trust in ten years’ time? Your ridiculous policy will drive out all conscientious doctors and replace them with true believers in the secular humanist religion and with cynics who can play the system to their personal profit. I don’t want a doctor who can’t talk frankly and openly with me about what he believes and what he can and cannot do as a result. Keep out of my life, CPSO! I don’t trust you secular humanists, but I do trust the pro-life doctors I have had.
I believe that the The Hippocratic Oath should take precedence when a doctor is faced with a life threatening situation, wherein a course of treatment may violate their own moral/religious/etc “code”.
If a pregnancy imminently threatens the life of the mother and terminating said pregnancy will save the mother’s life, I feel that any doctor should provide this emergency procedure, regardless of personal belief.
Putting the patient first is paramount when practicing medicine, in my humble opinion.
I support “freedom of religion” and other associated freedoms, but if your “personal code” so restricts you from considering the welfare of the patient, perhaps a thorough review of your commitment to patient care is in order, and, perhaps, a career change too.
I don’t want doctors to take a “Hypocratic” Oath so that they can do what a patient tells them to do. A doctor is a human, and has moral values, i.e. understands that some things are good while others are bad. This has nothing to do with religion. Non-religious persons also have their internal “do’s” and “dont’s”. A doctor that puts patient’s demands first, because the law forces her/him to do so, is not a doctor anymore but just a slave. I do not want to be a patient of a slave,that will give in to my “demands”. The proposed new policy is VERY WRONG. It will destroy trust between patients and doctors.
“A thorough review of your commitment to patient care” includes these considerations: a Christian doctor’s faith is, in fact, primarily what motivates him to consider the welfare of his patient in the first place; every pregnancy involves at least two patients, the mother and her child; (euthanasia will eventually be used on those deemed to have insufficient quality of life; and secular humanism is becoming quite unhinged from reality.
I think this policy is a step in the wrong direction. There is an inherent conflict in the policy: The first principle listed states that doctors should act in the best interests of their patients, and then the policy goes on to state that doctors must refer even if they think the requested treatment will harm their patient. How is it in a patient’s best interest to be harmed? Do we really want doctors who will make these referrals? If assisted suicide is legalized, are we saying that doctors shouldn’t try to talk their patients out of suicide and should just refer them to someone who will give them what they want? This policy seems to be missing the larger picture, and it is turning our physicians from healers into healthcare dispensers. I urge the College to reconsider it.
I think this covers it perfectly.
Wow!
Well said.
Thank You
Agreed! This legislation would make doctors go against their principle of helping the patient instead of harming them. Also, how can killing an unborn baby be in his/ her best interest?
The draft policy reads: “Where physicians are unwilling to provide certain elements of care due to their moral or religious 156 beliefs, an effective referral to another health care provider must be provided to the patient…..”
It is not clear weather this is a formal referral by fax to the other provider, or by giving the patient information about how to self-refer and access the other provider.
The example is the walk-in clinic attended by a physician that does not prescribe oral contraceptives. Is it sufficient for the referral to be a list of other area walk-in clinics given to the patient to call and go to; or is the expectation that the physician makes a formal referral for the patient to another walk-in clinic?
Walk-in clinics and abortion clinics operate on a self-referral basis, and a formal referral is not necessary.
Could you make this part of the policy clearer?
Could you delete it? Killing people–or helping to kill them–is not part of a doctor’s job description.
“Following orders” was not an acceptable defence for Nazi doctors participating in euthanasia, the world expected that their conscience, their MORALS would have prevented them from obeying such orders.
To now suggest that physicians simply comply with whatever the social norms are in the country, ignoring their own moral beliefs, is dangerous. Social norms can change.
Thank you, thank you! This policy is not about a specific procedure or service, but about the right of physicians to dissent, and protecting this right is of huge importance on a societal level.
We’re not dealing with Nazi Germany culture. But the authorities, cultural trends, or even the majority opinion don’t always get morality right. Things in Nazi Germany fell apart with terrifying speed, starting with the euthanization of one severely developmentally delayed child by a physician on Hitler’s orders, and we need to know, as physicians and citizens, that our College and our courts will back us up if we need to object to something an authority figure, or even the majority culture, says is required of us. Not to do this is, as the previous post said, is extremely dangerous.
Your example is bleak, stark and ultimately terrifying. I agree, the elimination of dissent represents a massive threat to public safety.
This policy does not eliminate dissent, it redirects it to a more appropriate venue.
No, it forces the physician to either perform or make a referral that makes him/her a participator in that with which he/she is in dissent!
You can’t make physicians provide abortions, that goes against the Hippocratic oath, anyone who is supporting this will be accountable to the LAWS of the land. If the board can’t do what is morally right, the only option is to disband the “College”, kick everyone out, refuse to fund it, and start over. I for one would support a class action suit against the so called “College”.
I think this is a fantastic improvement to the policy! If enforced, it will ensure physicians remain professional and respectful of patients’ rights to evidence-based health care in a timely manner.
And the evidence suggests that abortion harms a woman and kills her and its father’s child, improperly prescribed drugs are dangerous for health, and euthanasia kills a patient.
Not allowing physicians to have freedom of conscience is a violation of the Canadian Charter of Human Rights. Of course no rights are absolute, so how can a patient’s right trumps a physician’s, or a College imposes it upon physicians? Someone cannot be forced to do what he or she believes is wrong, or to collaborate in it. How many times physicians have refused to prescribe medications that are requested by their patients based on the ground that they think the drug is harmful to the patient (for example, when drug abuse or addiction is suspected)? Is a referral needed? In the same way, if a physician knows that abortion or contraception is bad for the patient’s health, why would he or she have to provide it or refer the patient? The first principle in the Hippocratic Oath is to “Do No Harm”. The College cannot possibly force a physician to do or to collaborate in what he or she thinks is harmful to the patient, or else it is encouraging the violation of the basic principle of medicine. This does not promote the practice of good medicine at all. Moreover, in a free society, patients are free to choose their providers, and referrals are not needed for abortion. Also, it is against the current national policy of the Canadian Medical Association not to respect physicians’ conscience rights.
So much for freedom of conscience! Is this a free country?
No, we aren’t free anymore. I would suggest that we Ontarians are slowly being forced into various things that are infringing on our rights and freedoms. It doesn’t just pertain to this subject, though this is the scariest. Forcing doctors to go against what they believe or value is sickening. After so much sacrifice on their behalf, to have them chose between their profession or what they perceive to be morally wrong (who they are) is disgusting. Haven’t we already seen enough doctors leave our Province?? We don’t want robots taking care of us!!! We want doctors who have values, have a conscience and who are able to make their own decisions. Doctors who we can trust. Doctors who affirm life first, before all other things. We should learn from other countries who have gone one step further and legalized Euthanasia, for example. They have seen terrible abuses already. Anyone who believes that with time abuses won’t take place, is living in a fantasy land!
http://guardianlv.com/2014/02/euthanasia-already-out-of-control-in-belgium/
It resembles Alice’s Wonderland. Words mean their opposite. The draft policy is rife with language that defies its plain meaning and common sense. Nonsensario: it’s yours to discover!
“Freedom of conscience” (line 115) means that an expectant mother can have her unwanted child killed (rationale of the Supreme Court in 1988), but it does not mean that a doctor can refuse to help her kill him (line 163) or both (Supreme Court’s decision of February 6).
Why must the doctor help kill them? That explanation accounts for most of this draft policy, but it is summarized in lines 129 to 135. The doctor must help kill this mother and/or her child in order to:
(1) “Respect patient dignity” (line 133). As the pre-born child is no longer recognized as a patient or one seeking to be a patient, he has no human dignity; he is a replaceable commodity like a car part. As for the mother as the recognized patient, her dignity does not refer, as was originally understood–since Canada “is founded on principles that recognize the supremacy of God”–to her original likeness to God in some ways but to her being her own god and–because she is nevertheless mortal–deciding the time and manner of her death. Previously her dignity prevented the doctor from killing her; now (line 143) it can prevent him from protecting her safety and her child’s access to care.
(2) “Ensure access to care” (line 134). “Care” means harm: the child and/or the mother dies. Similarly, “service” in line 164 is the violence of dismemberment or poison injection. “Access to care” for the mother means no access to care for the child. To “ensure access to care” and obey her will, the doctor must disobey her Creator’s clearly expressed will (line 157 cf. Lord’s Day 40 of the Heidelberg Catechism).
(3) “Protect patient safety” (line 135). “Protecting patient safety” means, if anything, killing the child. Although pregnancy is not a disease and her safety is not at risk, the expectant mother is the recognized patient; there’s no concern for the safety of the unrecognized patient, her unwanted pre-born child. Both abortifacient “contraception” and surgical abortion are time-sensitive and therefore can be considered “urgent care” (line 168).
“Protecting patient safety” can also mean killing the mother. She should not have to endure the subjective suffering she believes the future holds for her. “Imminent suffering” (line 168) is also a reason to kill her pre-born child if she believes he will cause her suffering. An hour of “suffering prevention” (line 168) is worth a lifetime of suffering mitigation.
Each of the above reasons represents–without ever honestly acknowledging–the shift from Christianity to secular humanism as Canada’s dominant religion. People are now treated as disposable animals and not individually the special property of a good God. Secular humanism has become so intolerant and totalitarian that it attempts forced conversion of Christian doctors to secular humanism while forbidding them from promoting Christianity when interacting with their patients (line 147). It thereby effectively also imposes on Christian patients accommodation to a pro-death doctor (since it forces out of the profession Christian doctors and other conscientiously pro-life doctors).
Why is the shift so total and the policy’s language so ridiculous? Life is religion. There is nothing more determinative of my identity than my religion. Do I trace my lineage back to a sovereign Creator or to apes? My source indicates my destination. The philosopher Friedrich Nietzsche announced that the West had killed God but wondered whether it would survive without Him. Nietzsche died in A.D. 1900 after a decade of insanity.
“156 Where physicians are unwilling to provide certain elements of care due to their moral or religious
157 beliefs, an effective referral to another health care provider must be provided to the patient. An
158 effective referral means a referral made in good faith, to a non-objecting, available, and accessible physician or other health-care provider.
159 The referral must be made in a timely manner”
To be clear, considering my local walk-in clinic, if there is a physician who is unwilling to provide care because of moral reasons, there should be another physician on hand to provide such care. If this means that the patient has to wait another hour or two because the clinic is trying to use its staff ‘efficiently’, that is not ‘timely’.
“42 Discrimination may be described as an act, decision or communication that results in the unfair
43 treatment of a person or group by either imposing a burden on them, or denying them a right, privilege,
44 benefit or opportunity enjoyed by others.”
An hour to wait imposes a burden on a patient whose physician is unwilling to treat them for moral or philosophical reasons. It is non-trivial.
“138 Where physicians are unwilling to provide certain elements of care due to their moral or religious
139 beliefs, physicians must communicate their objection directly and with sensitivity to existing patients, or
140 those seeking to become patients, and inform them that the objection is due to personal and not clinical
141 reasons. ”
As this communication must be sensitive, simply posting a sign at the front desk is insufficient. Further, it should be explained in advance; when the patient checks in for the service that the physician finds objectionable, they should be informed at that time, not when they see the physician, that the physician will not accommodate their needs.
I feel that, in essence, if a clinic takes on a physician who has such objections, that they must take on a second physician at the same time who does not, who is also available, at a moment’s notice, to be able to fulfill the duties that the first physician is unwilling to. Any clinic that is found to be delaying medical services to patients because they are requesting services that a physician is unwilling to provide, because the clinic doesn’t have sufficient physicians who are willing to provide that service, is infringing upon the rights of the patient through discriminatory practises.
I am certain that, with such a bar set, that clinics will be unlikely to take on many if any physicians with such objections, as the need to provide equal service to all patients will be infringed upon before the physician’s wish not to provide said services would be infringed upon.
“Physicians must communicate their objection directly and with sensitivity to existing patients (line 139)”–and then, if the objection is to performing an abortion, arrange to have another physician dismember the patient that is the child.
Doctors do not have the right to impose their religious views on patients and act upon them causing a negative impact and adverse effects.
If doctors, for whatever reason, cannot fulfil their medical and science-based mandate, they should lose their right to practise medicine.
Your comment is open to interpretation and easily taken the wrong way.
Doctors do not have the right to kill their patients. The “negative impact and adverse effects” are the deaths annually of one hundred thousand young Canadians.
These doctors abuse their application of medical science and should be kicked out of the profession.
The politicians in Ontario’s government who have been pushing the evil draft policy which is the subject of this consultation should be kicked out of power.
Completely agree!!
Yes, often a woman will also have physical and/or emotional problems because of an abortion. So now the baby is dead and the mother is harmed. Pro-abortionists don’t talk about these long term effects.
If you’re a doctor, you’re required to provide the services you’re paid to provide, whether or not those services ‘coincide’ with your religious beliefs. This ridiculous double standard is only held up when it affects women. When a married man comes to see a doctor for a venereal disease, does the doctor refuse treatment because the man contracted the disease from an affair? Or refuse him Viagra even if he’s not sleeping with his wife? Of course not. A doctor must provide patient care, regardless of their own ‘personal beliefs’. Do your job or get out of the way of those who will.
You imply that physicians are employees. As a physician wrote at 12:34 pm on December 15, 2014 (currently the comment numbered 29), the overwhelming majority of physicians in Ontario are independent contractors.
Also, many Ontario doctors currently do more than merely refuse to provide care to pre-born children whose mothers do not want them. In fact, the treatment given this very vulnerable minority can accurately be described as poisoning or dismemberment.
Talk about a ridiculous double standard! The mother gets rid of her “product of conception”, and her child gets death. I would suggest that the doctors start again taking the age-old oath to, first of all, do no harm.
Do your job, doctors! College, either repent of your evil policy or rename yourself the Ontario College of Killers, Physicians, and Surgeons.
If a physician discriminates against a patient (as in the example above), sure, that would be wrong. But this policy is about taking away a physician’s right to discriminate against a procedure, for whatever reason, and procedures don’t have rights the way a physician (who is a human, with human rights) does.
My moral and ethical worldview create a canvas by which I will (do) practice as a medical student and future physician. Without the opportunity to express and work within my established worldview, I am ripped of the morals that governed my entrance into the field in the first place. I signed up for this journey of many years of learning because my desire is to serve and honour others.
Without the opportunity to work in the context of my morality, I will be separated from what led me here in the first place. Further, without my morality, how am I to decide and advocate on behalf of my patients? It is my morality, combined with my education, that governs treatment suggestions and recommendations. First referral for abortions and performing abortions, but then what? If I am not able to decide the code I will adhere to while I practice who will decide where/when things go too far? Without a line or boundary, I fear for where the roles of physicians will be extended. The government should not be dictating what physicians do and do not do, it is the physician’s responsibility to determine how they will practice, assuming that all that is done is within the confines of the legal rights of the patient and their best interest.
Impressive statement. You will make a wonderful doctor! Hopefully, you will feel comfortable practicing in Ontario and not feel forced to move away in the future! Good luck!
In my opinion, I feel that not allowing physicians to use their moral and/or religious beliefs as a means to not comply or refer a patient to another doctor is absurd. This makes doctors seem like robots that are under some sort of control and cannot make moral decisions that are BEST for the patient based on what is morally right. What would be the point of a patient coming to see the physician anyway if what they want is their final decision? It’s as if the patient is out rightly forcing the physician to do what they say with no questions asked (i.e. like a criminal who has someone in hostage). As doctors, they have consciences as well and they should have the right to not be a hypocrite and go against their consciences as that should be the foundation of their decisions whereby what they know is morally right is what should be done and not based on what the patient thinks is right. Hospitals and clinics are not fast-food restaurants where “the customer is always right”. Physicians should have the right to voice their own opinion and not have to do a procedure they disagree with nor refer their patients to another doctor to do what they don’t think is morally right to do to begin with. The notion for physicians to throw out their moral beliefs to help a person is wrong and I for one disagree that they should be forced to recommend/refer another physician to do something that is amoral.
I hope the College takes this thought into consideration.
well said.
As a nurse, I could tell you patient centered care which is the rhetoric in many places like the College and hospitals, has at its core the motto that “the customer is always right”. The ministry of health and hospitals have been promoting this dangerous and motto for many years. The reason is not ethics, morality, or evidence-based medicine. The reason is pure and simple politics. The politicians love getting elected and re-elected and don’t care what the frontline workers in terms of doctors and nurses have to put up with. They think patient centered care gets them more happiness with the voters and election results. The Colleges are also just an arm of the ministry. Don’t let the word “self-regulation” fool you. The Colleges always do what the ministry wants for fear of losing their regulation status.
Yes.
It seems we are going from a health care system where there were patients (those who are suffering) to one where there are clients (those who are served).
Let’s make sure we are doing things for the right reasons.
As an advocate of preborn human rights and a parent who has great respect for medical professionals across the province, I highly object to the college’s proposal to discriminate against people of faith and moral conviction and infringe against the religious freedom of doctors and specialists who morally oppose a policy that mandates members to counsel patients to have an abortion or refer patients to seek access to abortion.
The rights of those who advocate abortion should not trump the religious freedoms of medical professionals who support preborn human rights.
some members of the public have wrongly suggested that as “employees” of the ministry or gov, physicians are obliged to do what their employer requires, which in this case they interpret as any non-urgent treatment they desire or to establish a doctor-patient relationship despite the physician’s wishes.
It should be clarified to members of the public that, except in a small percentage of cases, physicians are NOT employees of the gov, ministry of health or the College of Physicians. The College does NOT employ physicians.
Legally speaking, the overwhelming majority of physicians in Ont are independent contractors who bill the gov for the services performed. Physicians are not civil servants, they are not unionized, and they have no employment benefits or collective bargaining rights.
Other independent contractors are most lawyers, accountants, dentists, plumbers, builders, all trades etc. The only difference is that these contractors bill the client directly, and the physician bills the gov for the services provided. This must not give the wrong impression that physicians are employees of the gov. The other independent contractors in the province can choose or not choose to enter into a relationship with a client. You can’t force a lawyer, dentist, plumber, accountant to take you as a client, as they are “independent”.
This is a very important issue that needs to be realized when discussing patient rights v. physician obligations.
An excellent presentation. This site needs a way to up-vote a comment without having to write additional comments
It’s sad and disheartening, to find bias, discrimination, even hatred, from a medical practitioner, and the support staff.
To find that my mental health issues, or manner of speech, would have me barred from being a patient.. I am told this happens routinely, to elders, who might have been cherished as wise older ..but instead are told to shut up or get out.
At least you have a keyboard to write your comment, right? Hopefully you also have the ability to find a more sympathetic doctor.
Indeed, it IS sad and disheartening to find bias, discrimination, and even hatred from a medical practitioner and the support staff. To find that one’s stage of development or inability to speak would have one barred from being a patient–I know this happens routinely to pre-born children, who might have been cherished as innocent and vulnerable but instead are forced to get out and die.
That the draft policy would actually increase discrimination and hatred against minorities–what an intolerant and evil thing it is!
There is no way in our society today that ANYBODY should be forced to do something that in their mind is morally wrong. The real wrong here is the College feeling it has dictatorship over doctors in this regard. A rather disgusting draft proposal and very draconian in my opinion.
It encourages doctors to be dishonest with their patients–just as CPSO is being dishonest with its doctors in pretending that they can still be family doctors if they are unwilling to perform or, at least, facilitate abortions.
I have a serious concern that Doctor’s will be told what to do as far as birth control and abortions.
Doctors are suppose to save lives not destroy lives.
This loses my confidence in the medical profession.
Please allow doctor’s to practice medicine based on their moral beliefs.
As a parent in Canada, the thought that a doctor who operates on my child could also be a doctor that just the other day ended the life of another is terrifying because you loose confidence that the doctor has any respect for the life of your child.
Instead of forcing doctors to kill, force them to acknowledge to their patients whether they also perform abortions.
Brave New World is here, and who would have ever guessed that C.S. Lewis’s NICE was actually the CPSO on the other side of the Atlantic? Good doctors don’t deliberately kill people, CPSO. Good colleges don’t compel their doctors to kill people or to facilitate their killing.
Nicely said! I would also have trouble trusting someone who willingly kills unborn children.
The doctors need to talk to patients and their families honestly about patients condition . I know from experience that some doctors do not talk about death with their patients. I know from family experience and being a retired nurse, that patients with COPD receive the worst end of life care from doctors. They wait till there is a crisis before having orders in place to make their death more peaceful. It hurts to be told that your loved one will not make it but it does help if the doctor is honest and explains what is or will happen. Be honest but gentle.
Please let patients keep their dignity .
My guess is that the above comment was submitted to the discussion forum for the wrong consultation, but the commenter’s last sentence is relevant here.
Human dignity has as its only origin man’s original likeness to God. Age, size, sex, level of development, ability, etc. are all irrelevant. Because God made man a little like Himself, the pill, IVF, abortion, euthanasia, and anything else that reduces human life to a nameless, replaceable commodity like livestock is an indignity.
This draft policy, therefore, requires doctors to violate the dignity of their patients.
To the extent this proposed policy would require the cooperation of physicians in the destruction of innocent human life, it would be an intolerable abomination which anyone of good conscience should ignore. No less would be a mandate to prescribe contraceptives if doing so would be violative of a physicians conscience. This propose policy is reminiscent of life in the USSR, or in Nazi Germany. In both nations the medical profession was corrupted and put at the service of its state masters. This policy would put the medical profession in Canada on the same course. I strongly urge the Ontario College of Physicians and Surgeons not to make take this immoral and unjust step.
This is the end of Health care if this goes through. How can a real doctor give his all to healing the sick if he is required to kill as well? Please let the doctors go on healing and hire a new bunch of people to do the killing. How can we trust our doctor to help if he kills?
Well said. If we are to speak of a “patient’s rights,” then a right to a trustworthy doctor is more basic than a right, for example, to “contraceptive” prescription from every doctor.
Or, to state things more bluntly, the proposed policy is based on a right of an Ontario mother to a dead child and to have any and every doctor in Ontario do his best to accomplish this end if she so desires. The oath to first of all do no harm has become transferred into a primary commitment to harm. This is insanity.
So the government of Ontario, true believers in their humanist religion, want to drive out pro-life, Christian doctors and replace them with unprincipled, irreverent tools to further the culture of death.
As a future physician, this policy is very concerning. I have heard people say of the medical encounter, that when you enter the room, you must leave your morals at the door. They mean to highlight that the patients values are the only ones that are to be considered. I cannot imagine a practice of medicine in which a physician is not guided by their morals. Their practice would be undoubtedly unethical. This policy is resonant with all crimes against humanity; medicine without morals is dangerous for society. I imagine there were many physicians in Nazi Germany who did not believe in eugenics or in an inferior race or the worthlessness of people with disabilities. One must remember that hindsight is twenty/twenty and history will tell us that we continue to commit crimes against society. A policy such as this, does not protect the physicians who choose to act according to morals rather than social pressures, and thus, does not protect society.
There are much more important issues than access to euthanasia and abortions at the current moment in the medical landscape of Canada. If the CPSO is committed to reining in physicians and removing their rights, perhaps they could put themselves to work on the prescription drug addiction issue.
If physicians feel obligated to provide a service to which they disagree you introduce a physician patient disconnect. The term “caring for a patient” does not simply mean filling an order at a drive through. “Caring” requires a physician to engage in a deeper relationship. I believe if physicians feel obligated to provide services to which they fundamentally disagree with, then they will likely as a consequence have to somewhat disengage themselves from their patients. For example, we all know great physicians who care for their patients more then others. The kind of physician we would refer a family member to. These physicians believe in the care they are providing. They are invested in the well being of their patients. If you force these physicians to change their practice such that they disagree with the care they have to provide. That will create internal conflict that they will have to resolve. To resolve that conflict they may well become less invested in their patients. With physician burnout being a real issue that has cost our health care system many good physicians, I would implore you to see the potential consequences here. You likely know a physician who has burned out in the past, and if you ask these physicians why they quit you’ll see it is largely due to imposed limitations that impeded their ability to care for their patients. This can be a very overwhelming struggle and we as physicians are people too who deserve and need the freedom of choice. Without such a necessary freedom I believe the practice of medicine will suffer. It’s clear your motivation in writing such a policy is with good intention, to improve access to medical care for our patients. I’m afraid however, that you will accomplish the opposite. You may slightly improve access to “medicine”, but you will greatly jeopardize their “care” if you force a physician to disconnect the service they provide from their beliefs.
Very good!
Thank you.
As social animals humans always create societies with different classes of individuals.
Those who took the Oath of Hippocrates have always been respected, persecuted and punished for seeing humanity where the societies deem there is none. For unlike societies doctors only know of one kind of human being: the sacred kind.
If Hippocrates appeared today he would be unable to obtain privileges from the cpso. If the cpso appeared today before Hippocrates it would not enjoy his approval.
My guess is that 2 millenia hence , few will have heard of the cpso. Hippocrates’ Oath will be used to evaluate us, just as we evaluate our colleagues from societies long past, like Dr. Georg Groscurth.
I have a huge issue with line 168 of the policy. This would effectively terminate my role as a palliative physician working in the hospice setting. Right now I enjoy and pride myself on the fact that I can focus on and improved the remaining quality of LIFE of a patient. This is a serious infringement of physician’s rights.
168: Doctors are required to perform procedures that are against their moral or religious convictions in situations where that is deemed to be “urgent or otherwise necessary care” (Line168)
Wow!!! Very important point.
Forcing doctors to treat patients or refer patients when it goes against the moral and/or religious beliefs of the doctor is not only discriminatory against doctors, it relegates the doctor to a status less than that of other Canadian citizens — or other citizens of the world. If a patient cannot find a doctor to perform the procedure they want, then provide a 800 number where they can call (and provide transportation if necessary) to see a doctor who will perform the procedure. Why force some doctors to violate their conscience by playing a role, for example, in killing people (abortions) when there are other doctors in Canada quite willing to do the killing all by themselves?
Supplying a 1-800 number for getting abortion referrals violates the moral principle recognizing unborn babies as human persons deserving our respect and love.
What about the rights of doctors who have taken the oath to protect all human life?
Please don’t give in to anti-choice “doctors” who refuse reproductive health care to women!
I consider myself an atheist, and I do myself prescribe birth control and tell patients about abortion clinics, but I still find myself disagreeing with this proposal.
To force a doctor to write out a “referral” to another doctor when all walkin clinics and abortion clinics operate on self-referral is strange and unnecessary. In most Canadian cities, a patient has many choices in terms of walkin clinics, urgent care centers and emergency rooms to get what they want.
This proposal is a slippery slope. If it’s needed for patients to simply ask for a medication and just get it, then they should have the medication available without a prescription. It’s birth control now and next it will be narcotics, antibiotics, benzos, stimulants, etc. So next time I say no to an antibiotic for a viral cold, am I required to write out a referral to another walkin clinic that will give the patient the unneeded antibiotic ?
Please don’t give in to pro-abort “doctors” who kill babies. Pregnancy isn’t a disease, and “reproductive health care” isn’t medicine.
It seems some posters are turning this into a debate on abortion. That is not what the topic here is for consultation.
I prescribe birth control and refer for abortion, but I still don’t agree with this policy. A physician who does not prescribe birth control or refer for abortion is not violating any patient’s rights. It’s not like that physician is saying the patient cannot call or go to any other practitioner and get this service. Is it anyone’s rights to get something from all doctors in non-urgent situations? Where does it say that in the charter of rights or any other human rights document of this country?
I think the CPSO is opening itself to much litigation by this policy.
Physicians of religious conviction are not going to simply violate their beliefs because of a demanding patient who insists on getting birth control from this doctor and not the walkin clinic across the street. A referral is not necessary for walkin clinics and abortion clinics, almost all of which operate on self-referral basis. Posting a sign with addresses and phone numbers should be sufficient.
It seems that some commenters don’t realize that this debate is very much about abortion, much as I appreciate the additional arguments in the comments at 1:39 pm and 11:49 am.
That’s because every abortion kills a patient currently unrecognized by the above commenter and by society in general. As my Grade 8 teacher would say, “Denial is not just a river in Egypt.”
With that in mind, consider the following three “key revisions and additions reflected in the draft policy” (although all the key changes do apply, these three are the most obvious):
* “The draft policy clarifies that the legal duty to refrain from discrimination under the Ontario Human Rights Code includes a duty to accommodate patient needs, where a disability or other personal circumstance may impede access to care.” Pre-born children have easily recognizable personal circumstances that impede their access to care.
* “The draft requires physicians, who choose to limit the health services they provide on moral or religious grounds, to do so in a manner that respects patient dignity, ensures access to care, and protects patient safety.” That many physicians choose on secular humanist religious grounds to discriminate in favour of the mother in the case of an unwanted child obviously does NOT protect the safety of the child.
* “In order to protect patient safety, the draft policy requires that physicians provide care that is urgent or otherwise necessary to prevent imminent harm, suffering, and/or deterioration, even where that care conflicts with their religious or moral beliefs.” In other words, secular humanist religious convictions are not a sufficient basis to induce an abortion, one of the most obvious examples of “imminent harm, suffering, and deterioration.”
This part of the policy appears to be a political move to eradicate from the medical profession any deep ethical principles in light of which killing unborn babies is seen as abhorrent. “Killing babies is part of our standard of care. If you’re not perfectly happy with that, then get out of medicine.” I agree with your judgment that it seems unnecessary, since a doctor, by refusing to refer a mother to abortion is not stopping her from simply crossing the street and getting an abortion referral at the walk-in clinic.
However, those implementing this policy know that too. Their behaviour points rather to an ideological mission to cripple and silence every moral position opposed to their own.
yes I agree that is certainly what this is- an ideological mission to cripple and silence a moral position – I would go further and call it an arrogant, ignorant, foolish and hopefully futile attempt to suppress the truth and those who embrace it
I suppose the question is whether or not posting that sign would satisfy your duty to “refer”.
Perhaps it should be clarified that the duty is to provide information on what a patient’s medical options are and information on how to access a non-objecting service provider, OR refer when self-referral or going to an alternate provider for that referral is not possible/practical.
Perhaps it should be clarified that doctors should not kill people.
The obligations to physicians who limiting their practice based on competence seems to have been equated with those pertaining to physicians limiting their practice based on moral or religious belief. These are two separate issues and should be treated as such.
Not always, and maybe not even often.
For example, I am aware from reading comments on this or the previous consultation (the one about doctors and the “human rights” code) that many secular humanist doctors are woefully ignorant about natural methods of contraception. They also provide inaccurate information about it. This incompetence of theirs likely originates in their easy acceptance of “contraceptives” because of their lack of Christian scruples.
It’s important to note here that in addition to all its other harmful effects, the pill is now known to be carcinogenic.
I find it interesting that the policy seems to target physicians religious or moral beliefs more that anything else. For instance does a patient who has a disability have a right to their doctor making a housecall when they have great difficulty getting in to the office? Are they not being discriminated against by having a barrier put in place to healthcare because the vast majority of family doctors refuse to do housecalls. It seems to be okay to punish a doctor for not doing something for religious or ethical reasons but no mention is made of sanctioning doctors who won’t provide services because it is inconvenient to them or they just don’t want to be bothered. All family doctors can make housecalls. How about nursing home care? In my small community once a patient gets admitted to the nursing home the family doctor refuses to provide ongoing care. Nursing home care isn’t rocket science the vast majority of family doctors should be able to provide it but it is okay that they don’t just because they don’t want to be bothered. In my small community I am carrying 90 percent of the load in the local nursing home. For the last ten years I have tried to interest and integrate other physicians in this work but no one will. Often it involves seeing patients at night or on weekends in crisis due to illness or pain. I’m getting quite burned out but I keep doing it because I have a belief that we all have an inherent dignity because we are all created by God and deserve basic medical care. I anticipate that in the next year the supreme court will determine that euthanasia is legal. If this CPSO policy is approved I will have to leave providing nursing home care because nursing home patients are one of the groups that are likely to request euthanasia which I have a moral objection to. Then these patients don’t have care and if they do get a doctor it will likely be one of the few other doctors in the area doing this work who is already burnt out and geographically quite distant from the patients which makes it very difficult to provide care. I am not sure how this helps anyone.
The draft policy doesn’t help anybody except libertines and nihilists. It is also fundamentally dishonest. The authors believe that they themselves have no “religious or moral beliefs”, and yet –as you have pointed out so well–they are such animals that an adult’s sexual drive trumps a child’s right to life and a sufferer’s despair carries more weight than the healer’s oath to “do no harm.” These radical presuppositions are “religious or moral beliefs”, too.
Does nobody suspect that with regard to those in nursing homes, one motivation for the provincial government to push euthanasia–as it does in this CPSO draft policy–is to reduce health care costs? Death panels, anybody? But rest assured that senior citizens can get easy access to contraception and abortion services!
I am concerned about the point in the draft policy that would require “physicians, who are unwilling to provide certain elements of care due to their moral or religious beliefs, [to] refer the patient to another health-care provider.” As a potential patient, I want the freedom to choose a doctor who will not support , in any way, certain elements of care that I believe to be immoral and harmful, such as abortion and gender reassignment. I want this freedom, both as a matter of principle and as a matter of my comfort with my physician that he or she will neither pressure me nor feel pressured by me to discuss those options for my health care.
You may have heard of the Rolling Stones? They sing a song called “You Can’t Always Get What You Want” and it applies here.
To whom? To the mother wanting a hitman or the potential patient wanting a doctor?
People have posted comments about whether a doctor should follow the Hippocratic Oath. Here is a link to the actual oath found at the national library of medicine in the USA which would be a reputable site:
http://www.nlm.nih.gov/hmd/greek/greek_oath.html
The Hippocratic Oath contains the following:
“I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan; and similarly I will not give a woman a pessary to cause an abortion.”
In general, doctors are no longer required to take this oath when they graduate from medical school. My medical school composed its own oath for our graduation. A group of us took the original Hippocratic Oath which was Christianized in that we made our oath to the God of the Bible.
In order to be true to this oath, I do not refer for abortions and if euthanasia becomes legal, I will not refer for that either. I would be compromising my integrity as a human being to do so. I would no longer be trustworthy.
As a previous physician has mentioned, one does not need a referral for abortion in Ontario. Patients aren’t truly impeded from obtaining the prescriptions or “services” that they want because one physician tells them that they can’t provide that on moral or religious grounds. Most of the time these things are easily available from other physicians.
We have to be careful of making medicine like going to a fast food restaurant. We have to try to live together peacefully in this society where there are many conflicting beliefs and opinions. The doctor isn’t forcing their opinion on the patient by acting in accordance with their moral or religious beliefs. They are being consistent with who they are. One can’t be trusted if they aren’t consistent with who they are.
Why should pro abortion and pro euthanasia opinions trump pro life opinions? This is not consistent with the “tolerance” that our society trumpets as being so valuable.
While it is true that the Canadian Charter of Rights and Freedoms maintains that NO RIGHTS ARE ABSOLUTE ( lines 113-117 of the CPSO document) this is equally true of the right to freedom of conscience and religion as it of patient autonomy. There are reasonable limits to ALL our freedoms. A patient cannot demand a physician perform or refer for services for which the physician is morally obliged to decline. The physician must be respectful to the patient, and the patient must be respectful of the physician as an individual. There are limits to patient autonomy in other areas as well, for example a patient cannot demand a physician perform or refer for services that are not medically necessary, like an amputation of a healthy limb, or removal of a normal appendix. This document in its introduction (lines 4-13) is clearly weighted towards patient autonomy as the most important value, when in fact the physicians moral conscience is equally important and must be part of a humane medical system. It is important to remember that physicians represent a cross-section of the population represented by our patients and by limiting physician conscience we would eliminate our patient’s voices in medicine.
I agree.
Taking away physicians’ conscience rights is bad for our patients, bad for our medical system. Don’t do it!
In looking over the most recent draft policy, I am particularly concerned with lines 143, 144, 168 and 169. These concerns are primarily based upon my concerns for not just religious and conscientious freedom, but also for reasons of diagnostic integrity.
Doctors provide not only a consultative role in the facilitation of good health, but they also provide what could be called a “prophetic role”. In other words, a Doctor will often be empowered to state the truth even when the truth is uncomfortable. And in an age given to niceties and mere pleasantries, it is extremely important that doctors fulfill their diagnostic role with some latitude to be socio-prophetic— regardless of whether these pronouncements may look like “judgements”. No one, for example, would think it unusual for a doctor to allude to the proven life-threatening realities of cigarette smoking. So, in this, doctors are free to judge. However, if one were to allude to the proven life-lessening (or self-destructive) elements of certain sexual behaviours, would this somehow be in breach of lines 143 and 144? As long as there are codes that disqualify a doctor from using bonafide science in expressing real health risk (because it might seem “judgemental” or “offensive”) the College policies will be hindering doctors, not helping them do their jobs. And yet I feel it likely that while some “judgements” will be just fine, other truths will be censured.
Secondly, the idea that the College is prepared to coercively compel pro-life doctors to perform abortions, for example, is simply a “bridge too far”. And yet, this is precisely the implication of your draft policy in lines 168 and 169. The present Canadian legal climate, which does not recognize the legal existence (or personhood) of the unborn, will continue to contribute to the systemic abuse of babies in the womb— and your draft policy, without change, will be an accessory to that “crime”. Absolutely no one should be compelled against their will to perform an outrageous act of destruction simply because of perceived difficulties in finding an abortionist to do the job.
It is bad enough that this country has annihilated about 4 million of its own future citizens and taxpayers, without forcing those of conscience to take part in yet another dastardly act empowered by this remarkably flippant culture— a culture which absurdly believes that individual sovereignty is somehow defined by whether a child is “wanted” in the womb or not.
I would urge you, therefore, to eliminate altogether these lines in your draft policy which function only to hamper good medical judgement, or to sift the conscience of good medical doctors.
I am writing to express my concerns regarding the draft policy “Professional Obligations and Human Rights”.
My two main areas of concern are:
1. Doctors are required to refer for procedures that are against their moral or religious convictions (Lines 156-8) 2. Doctors are required to perform procedures that are against their moral or religious convictions in situations where that is deemed to be “urgent or otherwise necessary care” (Line168)
Having started medicine with the Hippocratic Oath of do no harm many physicians have the moral conviction that the purpose of medicine is to heal people. They did not choose to be a doctor to end life in the womb or at end of life which are aspects that this policy can dictate. Unfortunately if physicians refuse to conform to the imposed vision of this policy it states that they can be subjected to disciplinary action up to and including being stripped of their ability to practice medicine. If physicians are required to refer patients for procedures that are against their moral or religious convictions then it is no different than if they were doing the procedures themselves.
As a palliative care consultant I just had a discussion with the family of a patient who came into my care because of pain crisis which was very difficult to control but which we were able to control. This patient is living with a good quality of life. The family member spontaneously shared with me that their values on euthanasia have changed and stated that if euthanasia had been legal the patient would no longer have been alive because of the intensity of the patient’s suffering. Now however, having received excellent palliative care, the family member is not in favor of euthanasia as before.
Unfortunately, this policy would put physicians into an untenable situation having to refer for procedures against their moral and religious convictions, even when they know there are other excellent alternatives that can provide quality of care.
Under this policy doctors are required to perform procedures that are against their moral or religious convictions in situations where it is deemed to be “urgent or otherwise necessary care”. Who determines whether a situation is urgent or necessary – is a pain crisis deemed as an urgent reason to euthanize a patient?
I agree with CMDS’ statement: “This policy is an assault on diversity in the practice of medicine”. It puts at risk the future of doctors practicing according to their conscience and also eliminates the option of patients’ choosing physicians based on their worldviews.
Please, I am begging you – do not force doctors to perform abortions, refer for them, or prescribe contraceptive medications or devices. It would be extremely unethical to make a doctor decide between his scientifically-supported views on how these things end human life and his or her profession and ability to make support themselves and their family. Please don’t make doctors make this choice, or refer patients to a professional or facility where they can kill their child. Doctors shouldn’t have to slay their own conscience just to continue being a doctor.
I , along with many of my fellow physicians and memebers of the public thankfully, are very concerned with the changes implied in this draft policy. I disagree with it on humanist and religious grounds. I, like every other Canadian, should be able to help others with an ethical standard that respects my personal beliefs (religious or other:scientific opinion). If I feel something is not in my patient’s best interest (considering the whole picture that the patient present) then to force me to send them to someone else who I would obviously believe is “unethical” seems wrong. I would feel harm will be done to that individual and society in the long run.
The line 168 obligation to provide care that is “urgent or otherwise necessary to prevent (harm)”, is too loosely worded and an obviously politically vague statement meant to open up the future grounds for areas such as Euthanasia. There needs to be a further fleshing out of the parties who will decide “urgency” standards and define “harm” more clearly. Should this policy pass as is, we will quickly see that the CPSO, on “behalf” of the public in part, will demand that all and any physicians provide “death’ therapy for those asking for it. Such will not only be harmful for some physicians ethically and emotionally, but also for many patients that end up being terminated when other options exist. The slippery slope of Euthanasia is felt to not exist but is clearly seen in other countries. We once though abortion would be only for certain select situations and now is done in part as a means of birth control for some and a means of sex selection for others. To open ourselves as a society to such harm, we cannot allow policies such as this to erode the moral standards on which compassionate care is founded …if we do, it will be to the detriment of medicine and good medical care as a whole.
although I agree with the spirit of this policy I feel it is unlikely to resolve the issue at hand. In fact I am not sure any policy will resolve the issue as can be seen by the comments below. People are entrenched in each side of the debate and the presence of a policy seems to be asking for legal challenge to be launched, during which time MD’s will continue to act as they have been acting
The solution starts at medical school acceptance and in training.
I think physicians need to be given tools to help them help their patients.
The concept of indirect referral needs to be incorporated to a greater degree. There needs to be easily accessed information for patients directing them to physicians who are pro-choice or GLBT friendly or integrative care friendly. Pre-printed flyers, stickers etc by the CPSO that physicians can post in their offices directing patient to appropriate care – this takes it out the physicians hands
We also need to remember that a physician is not comfortable with providing a service for moral or religious reason they are likely not as competent to provide this service- A physician who does not provide birth control will not be up to date on the latest standard of care and guidelines regarding the use of birth control and therefore the wrong person to be providing this service- it then falls outside of their scope and a patient should be directed to someone who is up to date on current knowledge
“The solution starts at medical school acceptance and in training.”
Yes, accept only students who believe in the sanctity of human life. Reinstate the Hippocratic oath to do no harm. Emphasize that medicine is all about healing, not killing. Include a course on its Christian roots and development. Include another course examining medical practice under the Nazis to show the dangers of socialism and total state control. Scrap the fancy euphemisms. Include a civics course. Regularly sing the Canadian anthem, not forgetting the prayer that “God keep our land glorious and free.”
The most important determinant of ethical behaviour is one’s conscience, not rules imposed by others. The College should not impose rules that force some physicians to violate their deeply held beliefs.
Yes.
The health care system is strengthened by conscientious phyisicians.
This is the first time in history that a physician is mandated to perform an immoral and still illegal act. To refer a patient to a another physician would make me complicit in a procedure that I consider immoral.
The draft policy reads well except for the conclusion line 156-160 where a physician with moral or religious beliefs are required to make an effective referral to a non objecting, available and accessible health provider. This requires physicians to be agents in potentially objectionable practices. The College has essentially suggested that physicians must act and become agents in practices that the physician finds morally or religiously objectionable and as a result to diminish the physicians humanity and to eliminate their autonomy. What happened to the Supreme Court understanding that “there is no hierarchy of rights”? In essence this policy will make physicians technicians of the state. The college policy as written is extremely discriminatory. In any particular interaction I bring technical expertise, but also my humanity and compassion to give dignity respect and access to patients. The college president has oddly suggested that physicians may have to rethink their ability to practice if they have opinions or beliefs that are different than the patient and are unwilling to refer patients for objectionable practices. I am surprised this attitude of the current CPSO president is acceptable within a western democracy. He has essentially eliminated the dignity, autonomy and respect of the physician and eliminated all physicians with an ethos or morality. One cannot act against themselves without destroying them self. Hippocrates, the oath of physicians for centuries, would not have supported this policy as he understood that the physician was required to do what was best for the patient. Patient’s want physicians that respect them and treat them with dignity. It is after a technical as well as ethical/moral endeavor. To diminish this is to eliminate the profession at the patient peril.
I think that this should be a shorter and more positive document. Specifically, lines 123 – 169 could be eliminated. This section starts with explanations about the courts, and then moves into obligating physicians to violate their consciences while making quick referrals. This is unacceptable. Also, please give patients and their representatives more credit; we can find our own alternate health care. Let’s respect diversity among doctors and patients. This draft document creates unnecessary obligations, and needs to be cleaned up.
Even shorter and more positive–eliminate the entire document. It does not respect the real human rights.
Conscience, the ability to choose and act according to one’s own personal belief and moral code is intrinsic to human agency. It implies free will and necessitates a discerning exercise of said will. To take away this capacity from anyone is wrong. The motion you are putting forth is an infringement on human rights. please reconsider it.
I am disappointed that such a divisive issue has been brought to the fore. We as a society have a history of differing passionately but respectfully, and then coexisting peacefully. Professional misconduct threats just entrench opposite positions.
Could the issue not be resolved by having each practitioner post a College-required “check list” notice board, stating practice limitations?
And speaking of notice boards, my colleagues who post in their clinic a “One Problem Only” sign may be, intentionally or not, practicing elder discrimination! I suggest this “misconduct” occurs much more frequently and negates human rights more grievously.
Good point about physicians who are discriminating on the basis of age. But at least elderly patients are not killed–not yet, anyway. At the other end of the age range, at the beginning of life, many children lose their lives as physicians discriminate against them with impunity. Their tiny corpses are the abortionists’ bread and butter.
Taking away someone’s life is a killing. A doctor that refers to someone that does the killing, is an accomplice quilty of assistance in the killing. That has been the Law for centuries. Even most uneducated simple folk has been aware of this, and has understood. These days, you say there is no killing but just procedures i.e. abortion or euthanasia, but the life stops thereafter. Now you propose something you call a “policy” that is to exonerated those who kill and assist in killing – read provide medical service, and punish those who do not and will not participate in ending some’s life. This is brutal, barbaric, unhuman. Why your policy does not say, referrals yes but excluding abortions,euthanasia or other life threatening procedures?
In your draft policy you write:
156. Where physicians are unwilling to provide certain elements of care due to their moral or religious
157. beliefs, an effective referral to another health care provider must be provided to the patient. An
158. effective referral means a referral made in good faith, to a non-objecting, available, and accessible
159. physician or other health-care provider. The referral must be made in a timely manner to reduce the
160. risk of adverse clinical outcomes. Physicians must not impede access to care for existing patients, or
161. those seeking to become patients.
162.
163. The College expects physicians to proactively maintain an effective referral plan for the frequently
164. requested services they are unwilling to provide.
This part of the draft policy on Professional Obligations and Human Rights renders an individual doctor’s conscience meaningless. It attempts to establish the judgments of the College as an absolute moral code overriding the consciences of doctors. For instance, if a doctor’s conscience convinces her that killing an unborn baby is an act of murder violating the inherent rights of that baby, the College forces the doctor to help the mother find another doctor who will do the killing. In effect, the College forces the doctor to assist in committing what, in her conscience, is an act of murder. This is a gross violation of the doctor’s conscience. The response of the chair of the College’s policy working group reviewing “Professional Obligations and Human Rights” is basically this: if you don’t like killing unborn babies, then don’t become a doctor in Ontario.
In the shifting moral sands, this sets a dangerous precedent. Not long ago, it was deemed morally abhorrent to kill unborn babies. Today, our moral code has shifted so that killing unborn babies is an acceptable and common practice. If we can go through such a profound moral shift, what reason do you have for asserting that the same moral shift could not happen with babies that have been born. Already, there are moral philosophers (Michael Tooley, Jonathan Glover, Peter Singer, Jeff McMahan and John Harris – refer to http://jme.bmj.com/content/39/5.toc) arguing that killing born babies should be permitted. Given the moral shift that has opened the door to killing unborn babies, what assurance can you give that there will be no such similar moral shift allowing the killing of born babies? After all, born babies are more demanding on mothers than unborn babies. If a mother decides she doesn’t want the inconvenience of her born baby, why couldn’t she take it to a doctor who would kill it? Just as there were few doctors to start with who would do abortions, so there might be few doctors to start with willing to kill born babies. But when the moral shift is complete, killing born babies will become as common a practice as abortion. Then will the College tell physicians: if you don’t like killing born babies, don’t become doctors in Ontario? Your current policy of overriding doctors’ consciences sets a frightening precedent by which you will inevitably force them to kill born babies in the future.
The consciences of good and often religious doctors are what convince them to avoid killing babies – both born and unborn. Overriding their consciences, and forcing them out of the medical profession, you will banish all hope that medical professionals in Ontario might once again treat all human persons with love and respect. Please change your policy to acknowledge the consciences and religious convictions of medical doctors in Ontario. They will contribute to the moral compass the medical profession needs to regain and retain its moral integrity.
I completely agree. What history teaches us is that we don’t learn from history. If we do away with morals and ethics we end up with whatever feels good or right will become acceptable. We are already on that slippery slope and the farther away we get from GOD the more the world becomes depraved. We are becoming our own gods and saying that our GOD made mistakes but now that we are wiser we will rewrite his laws to correct his errors. The people that think science is the be all and end all that surpasses everything must not read or pay attention to how often science proves itself wrong almost on a daily occurrence. Don’t get me wrong science is wonderful also but thank GOD he is the same yesterday,today and forever.
This policy doesn’t support freedom of religion or speech. If this policy goes through you will lose a lot of good doctors in time when GPs are scare. I am an RN and I can say from firsthand experience that it is better for patients if they have doctors who are able to follow their conscience.
Where in Canadian laws, does it say that it is a “human right” to be entitled to get non-urgent birth control and elective abortion services from ALL physicians at ALL times? Please point to that piece of legislature. An independent contractor physician not willing to provide this ELECTIVE service is by no means denying the patient’s rights to “security of person”, since in almost 100% of situations, the patient does have other options in terms of providers to get this service from on their own and without a mandatory referral.
I hope this case goes all the way to the Supreme court, as it seems it cannot be settled here.
I have taken time to review the third draft of the CPSO policy document, “Professional Obligations and Human Rights”. I am deeply concerned that my rights to freedom of conscience, and freedom of religion, will be violated if this draft document passes. I do not believe the College has found the correct balance between physician rights and public safety. I strongly urge the CPSO to reconsider the following areas of the document:
1. Lines 156-160, referenced under “Ensuring Access to Care”. Without a doubt, providing a referral for an aspect of patient care, involves myself in that act and therefore makes me morally culpable. Being forced into this action is a violation of my Charter-guaranteed freedom, and I cannot accept this. I feel the previous requirement that my patient be informed of the availability of the service, and how it may be accessed satisfies the requirement to “not impede access to care for existing patients, or
those seeking to become patients”.
2. Lines 166-169, entitled “Protecting Patient Safety”. This is a very ambiguous statement, which I do not believe contributes in any way to patient safety or care. Certainly, any physician who deliberately puts a patient requiring urgent intervention at risk, is guilty of negligence! This is already well present in law, and does not bear repeating. My concern is that the College may widely interpret this statement so it may force physicians to “provide care” against their religious beliefs, protected by the Charter.
Once again, I sincerely hope that the College recognizes the infringement this draft polices imposes on my freedom of religion and conscience, and appropriately revises the problematic sections referenced above.
At this point in my career I still have 20 plus years to work – but if I am going to work in an environment that doesn’t respect my freedom of thought and religion then I may choose to not renew my lease. I do not want to work in fear. I went in to medicine to heal, to help, not to kill people or dishonor God. Medicine needs to respect all religions – it is a constitutional right in Canada – the college has no jurisdiction to contradict national rights. If someone feels that referal will affect their faith they should not be forced to refer. Certainly, no one should be forced to do a procedure or write a prescription against their conscience/faith- regardless of urgency – after all saving life is the only emergent medical need and that is what emergency rooms were made for. There is no need to change the policy to limit physicians freedom. Lines 156-8 and line 168 are very concerning.
This policy by seeming to increase access to care will result in a decrease in access by all.
Doctors as a group are driven by their internal values and morals. Many enter the profession driven by altruistic desires to do good and to heal.
Taking away the ability to practice as dictated by one’s conscience will drive doctors from the most needed specialty of primary care and put them in the less needed specialties in medicine. I see this as a bad move that will take out those physicians that have the most to offer to our profession and will increasingly drive the move to specialization. This time not driven by what a physician wants to practice, but rather driven by what his or her conscience will allow them to practice.
There are many grey areas in medicine, as time goes on these moral grey areas will only increase with the advancement of technology. It has long been known that regulations of any sort trail this advancement in technology. Allowing individual physicians to determine their practices wthin reasonable bounds somewhat insulates them against these grey areas and increases physician satisfaction. This internal satisfaction cannot be replaced with money or any other incentives and in itself will allow for practicionors to continue to be productive and contented members of the medical community. Conversely, removing this ability to practice in a comfort zone will produce early retirement, disgruntled physicians, and a lack of applicants to the areas in which we are most deficient.
There is one main question we should consider when critiquing a CPSO draft policy: How does this policy improve medicine in Ontario?
1. Will this improve patient access to care?
Currently abortion and contraception are available through self-referral service. There are various sexual heath and planned parenthood locations that do not need referrals. In fact many of them have “drop-in” appointments available. This means a referral is not needed to access these services. Similarly emergency contraception is available at pharmacies over the counter. This means a prescription is not needed for their procurement. Therefore, no, this policy will have absolutely no change in patient access to these services.
2. Will this policy make patient access to care worse?
This policy would make it even harder to recruit new physicians interested in alternatives to hormonal contraception, for example Natural Family Planning (NFP). Many patients report it is very difficult to find a care provider with even basic competency, never mind expertise, in this field. This policy would only make this gap in care even worse.
3. Will this policy improve doctor-patient relationships?
The entire practice of medicine is based on fiduciary duty, meaning that we promise to act in our patient’s best interests. If a physician truly believes that referring for abortion has serious risk of harm, both psychologically and physically, then forcing him/her to do so is forcing them to break their fiduciary duty. Without this there can be no trust in medicine. And without trust the entire patient-physician relationship is undermined. This policy would deteriorate the doctor-patient relationship on an individual basis, as well as at the societal level.
In summary, the new policy would not improve patient access to abortion, Plan B or contraceptives as these are already accessible without a referral or prescription from the primary family physician. In fact, it would do the opposite of its intended purpose, and would further decrease patient access to NFP trained providers. It would actively diminish the doctor-patient relationship by undermining the principle of fiduciary duty. And it sets a dangerous precedent for not only allowing, but encouraging physicians to act against their best judgement. I recommend no changes to the current policy.
Very good points.
If it’s not broken, don’t fix it!
Doctors of medicine ARE NOT agents of the state, they have inherent natural rights like all private citizens to determine for themselves which acts in which they choose to participate and which they do not; to take away that freedom is a crime against humanity and civilization itself. CANADA do not become a tyranny!
I am concerned that in enforcing abortion referral, the CPSO is essentially telling Catholics, other Christians and other people who oppose abortion that they need not apply to become doctors.
It essentially says that only those who agree that abortion is good medicine can apply to be doctors. There is no right to dissent.
As Joyce Arthur, the Executive Director of the Abortion Rights Coalition of Canada once said, “there is no, per se, right to abortion.”
However, Section 2 does protect the right to conscience.
If pro-lifers are not allowed to exercise their conscience, that’s a violation of an explicit Charter right.
It is also wrong to expect a fetal rights supporter to refer for an abortion. The CMA policy I think has it right: Inform the patient that they do not involve themselves in abortion. The patient is then free to go elsewhere.
Another aspect to consider is that patients should have the right to choose doctors with similar values. When you exclude pro-lifers from the medical community, you deny patients the right to choose a doctor with similar beliefs. Comfort and communication are easier when you deal with a doctor of a similar moral background. It makes medical appointments a lot smoother. For instance, If you don’t use contraception because you oppose it, and you visit a doctor who supports contraception, a lot of time is wasted discussing contraception. I have told doctors I don’t use contraception, and they get antsy. They can’t imagine someone who doesn’t use contraception. I’ve been told to use condoms even though I oppose them.
Another aspect I’d like considered is that if doctors are forced to violate their conscience on referral, down the line they will be forced to violate their conscience on other issues. Right now doctors do not have to co-operate with abortion. We know that there is a shortage of abortion providers. Will conscience rights be eliminated to deal with that problem? Will doctors who only want to do 1st trimester abortions be forced to do 2nd trimester abortions? And what about the brave new transsexual surgery. What if a doctor opposes surgery in that case, and won’t refer? Will he be forced? Transhumanism is a growing trend. Bodily modification may become a thing.
On-demand medicine creates a lot of hazards. The “customer” is always right and has all the rights, whereas the doctor becomes a supplier, and is in effect dehumanized because his wishes and ideas are dismissed. His only function becomes to satisfy the needs of the client instead of answering his own aspirations.
There’s no great outcry of people being denied abortion and contraception because of conscience rights, so why fix the system if ain’t broke?
I realize the CPS is well-intentioned, but this draft policy is inherently dangerous because it does not allow physicians to opt out of referring procedures that they view as dangerous for their patients or even immoral.
If this had to do with urgent, life-saving care, that would be one thing. One could posit that the patient’s life outweighs conscience rights. But most of the procedures/medications that are the focus of this policy (such as birth control, abortion and euthanasia should she latter become legal) are almost always elective ones.
Given that this policy doesn’t really define “medical necessity,” it does not stretch the imagination to envision how this policy could end up requiring doctors to be the puppets of the patients, forced to accommodate any patent request, however dangerous or wrong. What of the doctor being asked to abort a healthy 38-week old fetus? What of the doctor being asked to abort a female fetus because she is a girl? This new policy would force doctors to leave their clinical judgement at the door. Just as I am sure Hitler’s doctors were invited to leave their consciences at the door. This is how it starts.
Moreover, the CPSO is inconsistent because it specifically directs doctors not to refer patients for (female genital mutilation). Thus, the College recognizes that referring for a morally objectionable procedure is just as wrong as doing the procedure. Then, in this new policy, the College asks doctors to set aside their principles and refer patients for treatments that they believe, in their clinical judgement, are harmful for the patient. How is this promoting clinical practice?
Finally, the proposed policy erodes patients’ rights. In stripping away the clinical discretion of doctors, it leaves patients at risk of receiving treatments that are not medically advisable for them.
Please, I beg the College to reconsider this dangerous policy, for the betterment of the practice of medicine and the Ontario public!
“If this had to do with urgent, life-saving care”–but it perversely does! It makes life-saving care in the elective situations you have mentioned all but impossible. So extreme is the culture of death that secular humanists are pushing! No doctor may any longer advise a mother against killing her “healthy 38-week-old” child–unless perhaps he is ultimately willing to help her to do it–nor may he advise her against abortifacient “contraception” that prevents implantation. All too horribly soon, likely, doctors will be forced to present euthanasia as an alternative to a life of pain management.
We should also be honest and speak of the secular humanist’s conscience (or whatever is its equivalent). If one can posit that a human being’s life outweighs conscience rights, then no child should be killed to relieve the mother’s distress. No terminally ill elderly person should be killed to relieve his own distress.
Please, I beg the College to reconsider this wrong policy, for the betterment of the practice of medicine and the Ontario public!
The proposed policy is a violation of physician autonomy and will require many physicians to seriously compromise their moral integrity.
The requirement that physicians offer referrals for procedures violating their moral beliefs is unfair and unnecessary.
Physicians are not technicians operating a service-oriented business; they provide carefully considered professional opinions to support patient’s healthcare needs and interests. Insofar as patients cannot require physicians to provide services that they deem unnecessary or harmful to the patient, physicians ought not to be forced to provide such referrals.
Compromising the moral integrity of some members of the profession will have serious consequences: we expect all members of the profession to uphold the highest level of commitment to moral and ethical integrity; forcing a doctor to act in a way that she finds ethically unacceptable may give physicians more generally the impression that one is not required to maintain high standards of personal and ethical integrity.
Inasmuch as many physicians base their objections against many ethically controversial procedures upon their religious beliefs, the proposed policy changes actually represent a serious and pronounced violation of the Human Rights Code and the Charter of Rights and Freedoms. This is a serious and unacceptable form of tyranny.
In sum, the draft policy proposal is ill-considered, unnecessary, and serious violation of the very rights it purports to uphold. The College should reverse this proposal and maintain the status quo. Patients’ rights are already strongly protected and where they are violated, suitable means of prosecution already exist.
Upon reviewing the third draft of the policy “Professional Obligations and Human Rights” I would like to express my extreme concern and alarm at what seems to be a newly added clause. I would ask you to delete or change this clause.
I refer to lines 156/157 referenced under “Ensuring Access to Care”. I believe that what you refer to as an “effective referral” made for a service that one finds unacceptable due to moral or religious beliefs, makes the referring practitioner morally culpable and therefore is in itself unacceptable.
I feel that as long as the patient is informed of the availability of the service and how to access the service, that a referral (i.e. traditionally a request/letter sent from one practitioner to another) is not necessary.
I trust you will take my concern under serious consideration,
I am not a doctor, and I have never been backed into the dire situation that pro-life doctors now face, but as a Christian I cannot imagine even the compromise that you appear willing to make, i.e. informing the patient of the availability of a “service” and how to access it. A mother should not kill her child, nor should a despairing sufferer kill himself–and I should not in any way imply that these are valid options. They aren’t.
Don’t just delete lines 156 and 157; delete the whole draft.
Far from advancing professionalism, by mandating referral for controversial procedures, the document “Professional Obligations and Human Rights” would turn physicians into unquestioning automatons with its expectation that they check their deepest convictions at the clinic door. The practice of medicine is a moral endeavour, requiring wisdom and compassion, and it should concern patients that physicians might be coerced to act contrary to what they believe to be right and in their patients’ best interests. The doctor-patient relationship depends on mutual trust, which necessarily includes the freedom to respectfully disagree about a course of action. For patient safety, physicians must not become instruments of the state, with its own vested interests. The best way to protect the public is to respect physicians’ desire to practice with moral integrity.
While much of the policy is sound, I have real concerns with the section on college requirements for a physician who is unable to provide a requested service for moral reasons.
In the event that I could not perform an action for moral reasons (eg assisted suicide or euthanasia in the event of these becoming legal and accepted) I would be required to refer them to a physician who is”non-objecting,available and accessible” This in conscience I could not do. It would be as much complicit in the action as actually doing it.
I could offer to transfer all medical care to a physician of the patient’s choosing or to remain their physician if they so wish.
We need to be careful on how we define “access to care” if we are to mandate physicians refer a patient for a therapy or procedure they do not feel is in the best interest of their patient (regardless of the reason: medical, moral, ethical, or religious). The call to respect patient autonomy was put in place so that doctors were not forcing our patients to take our therapies. This respect for patient autonomy was never meant to force doctors told do whatever the patient wants even if it is bad for them (the patient does not have this right). There are two types of standard care: The first is therapy which the vast majority of physicians believe is in a patient’s best interest because of the evidence of benefit (e.g. treating diabetes to prevent complications) or the universal acceptance that the treatment is in the patient’s good (e.g. furosemide for acute heart failure which has little evidence but we know works). The second type of “standard care” involves treatments that have been approved for use in Canada but is not universally agreed upon by doctors and/or lacks evidence of clear benefit. This second category is not just limited to ethical matters such as abortion and physician assisted suicide but includes experimental chemotherapy, or off-label use of medications. Some doctors are more comfortable practicing on the fringe of medicine than others. This does not mean every doctor who is not on the fringe must refer a patient. And even if that fringe grows larger to 50 or even 80% of doctors, that is still not a reason to mandate the other 20% to refer if they have good reason not to. The only thing that should be mandated is the provision of evidence-based or universally accepted medicine unless the competent patient declines such help. Everything else is up to the treating physician to exercise his/her judgment. We cannot force someone to perform an action he/she views as wrong when there is no evidence to suggest the action is beneficial.
This policy violates a physicians human rights as guaranteed by the Charter of Rights. I fail to see why the CPSO willingly likes to start idealogical fires instead of focusing on things that matter.
Disbanding the CPSO, ending “self-regulation” and moving to the US-style medical board model is the best way forward.
Since the CPSO is so intent on providing mutilation and killing services–and forcing every doctor into them–rename it the CMKO and have pro-life doctors start a new CPSO.
From an M.D. who has practiced for 40 years:
Please read the words of Dr. Leo Alexander, M.D., a psychiatrist who served in the Office of the Chief Counsel for War Crimes in Nuremberg, Germany at the end of the Second World War, who wrote ‘Medical Science Under Dictatorship’, NEJM, vol 2, No. 241, July, 1949 [download from nejm.org.] This is a slice of history worth reflecting on and learning from. His key message was that:
Whatever proportions these [medical] crimes [during the holocaust] finally assumed, it became evident to all who investigated them that they had started from small beginnings. The beginnings at first were merely a subtle shift in emphasis in the basic attitude of the physicians. It started with the acceptance of the attitude, basic in the euthanasia movement, that there is such a thing as life not worthy to be lived.
Let those who think that we are far too enlightened a culture to head down a similar slippery slope are blind to the reality of what happens to medicine when it is ruled by political systems that have lost their soul. We are heading there slowly but surely. This draft policy, while drafted with the best of intentions, is part of the thin edge of that wedge, causing a “subtle shift in emphasis in the basic attitude of the physicians”…Are we fostering a new group called “Doctors Without Conscience”?
Well said.We should learn from history because it can repeat itself if we follow the same path.
Totally agree. We need to learn from history and not make the same mistakes as were made in the past.
As a resident doctor I am troubled as I read through the comments. Although I am still in training I see that every patient encounter involves understanding the individual story, considering the options and weighing the risks compared to benefits of any course of action (including waiting). In other words, we are constantly making judgment calls all day, every day. When possible, of course, we want our patients to choose which course of action has the best risk:benefit ratio in their opinion.
If we start forcing physicians to act against their consciences in some area, that damages their moral integrity and over time may adversely affect future decision making.
Furthermore, who is deciding which “services” are required? By trying to avoid discrimination against patients, this new policy effectively discriminates against physicians with certain moral beliefs as well as violating their rights to freedom of conscience and/or religion. I accept that I am biased, but this still seems to me a poor trade.
As a patient, I would not trust a doctor who I thought might harm me or who I knew to have no moral integrity. As such, I cannot support a policy which may violate both.
Very good words of wisdom from someone just starting out.
I trust those at the College who have to make the final decision on this policy will sincerely consider this wisdom from “the mouth of babes”.
In making it a requirement that Doctors MUST give a referral to another Doctor who will perform a procedure that the first Doctor feels is morally wrong (for whatever reason) the College is making Doctors into second-class citizens whose rights are subservient to those of their patients. The Supreme Court has acknowledged that there can be times when there is a tension between the rights of one person and the rights of another. This draft seeks to remove all ambiguity. You cannot make a “grey” area “black and white” without trampling on someones rights. It is only as we maintain the tension that we truly support the rights of all individuals.
First, I would to thank the Ontario College of Physicians and Surgeons for allowing public input on the current draft policy.
As a Roman Catholic, there are many aspects of this document that I find disturbing. I am not going to share all that concerns me within one forum post, but I would like to propose to the college that it seriously rethinks this entire draft policy over. Below are some of my thoughts that I hope the college will consider.
It is rather paradoxical that part of this draft policy’s title includes, “Human Rights,” when the most fundamental human right, the right to life, has not been identified and protected. Further, the college sets out certain guidelines and expectations that direct its members to act against their conscience should an “element of care” or “health care service” conflict with their moral or religious beliefs. This is an attack on the freedom of conscience and a lack of respect for moral and religious beliefs. An example of this exists at lines 150-165 under the subheading of Ensuring Access To Care, whereby the college expects doctors to “ensure access to care,” either by providing information and/or referrals. For Catholic this constitutes being an accessory to a patient’s sin, if the patient’s “health care service” or “element of care” is an abortion or contraception. It also spotlights the college’s additional failure to recognize another basic human right, the right to not take part in an injustice. For Catholics, when any civil law is in conflict with God’s moral law, we have a moral obligation to “obey God rather than human authority.” (Acts 5:29)
In my view, the college must specifically and explicitly make very clear that no physician or surgeon should consider abortion, euthanasia, contraception and any other threat to the value and inviolability of human life, acceptable and apart of any definition of, reference to or inclusion in “elements of care” or “health care services.” Such is a necessary and clear statement in the draft policy that not only recognizes the sacredness of human life, but also identifies and denounces all anti-life acts and practices. At the same time the draft policy should reinforce to the college’s members that their education, training and experience should always be placed at the service of life. What this translates into is the moral duty of physicians and surgeons to respect and protect life from the moment of conception to natural death.
If there is any intention to encourage conscientious Catholic medical students and others of good will to pursue careers as physicians and surgeons in Ontario, then freedom of conscience and moral and religious beliefs must be guaranteed and protected. The college must also illustrate that it recognizes and acknowledges the truth and dignity of the human person.
I hope that my input today will encourage the college to have the moral courage and certitude to rethink this entire policy all over again. Thank you again for the opportunity to provide public input.
It is troubling to read that Catholic doctors for example could be put in such compromising positions. It is troubling to see that a governing body could hold such power false in principle. The references to Morgentaler are disturbing. May our good Catholic doctors not be sacrificed at the political will of those who have their own faulty and immoral agenda. Women and babies deserve to be protected in the womb and outside the womb.
I am quite concerned about this new proposed policy on Professional Obligations and Human Rights. My concerns are as follows:
1) The population wants both respect of human rights and equality as well as ethical and honest physicians. This proposed policy falls on only one side of that equation and ignores that patients clearly and unanimously prefer a physician who is ethical and honest to a physician who is willing and comfortable changing their views in inconsistent and dishonest ways. Trust building is the core feature of the physician-patient relationship and encouraging physicians to act in discordance to their values, morals, and ethical frameworks is asking physicians to be dishonest, thus harming the physician-patient relationship at its very core.
2) With the introduction of euthanasia in Quebec (which Palliative Care practitioners are almost unanimously opposed to) the one saving grace has been that we would be allowed to opt out of this new and dangerous practice. To invoke this policy in Ontario would prepare the scene for forcing Palliative Care physicians to participate actively in euthanasia against their professional opinion and moral framework. This occurred in the Northern Territory of Australia in 1995 and led to a drastic reduction in Palliative Care physicians in the province and was quickly overturned by the Federal government as a result of the unexpected results. It is clear that if you advance this policy it will be eventually enacted in other provinces, including Quebec, and will eventually co-exist with euthanasia legislation across the country leading to a potentially severe reduction in Palliative Care services.
3) Vulnerable populations need to be protected from the potential human rights violations of physicians, and on this point I agree with this policy. Vulnerable people also need to be protected from the Health Care system as a whole since in actual fact it is the health care system that is able to and in fact does violate the human rights of the population in a much more severe way than an individual physician. For instance, the partial coverage of certain medications or the absence of coverage of other medications is a human rights violation in a health care system that is supposed to be equitable and fair regardless of patient circumstances. For instance, for the vulnerable Palliative population in Ontario, there are a large number of new and helpful analgesics and other medications such as Methylnaltrexone for opioid-induced constipation, that the Ontario health care system refuses to cover for patients who cannot afford it, even in cases where the medication has excellent evidence and has been used successfully for a patient at their own expense. This is not equitable and is a sad story for those extremely vulnerable patients.
4) Physician well-being has been shown to be related to factors such as a sense of accomplishing something worthwhile, something positive for the good of the society, a sense of doing good and being good at what we do, and a sense of being a good person for doing what we do. This law essentially attacks this core aspect of physician satisfaction and well-being. It is not reasonable, in a profession where burnout is so common and suicide is a real risk, to make changes that will negatively affect practitioner well-being.
5) For the many colleagues I have had over the years who follow any number of religions such as Christianity, Judaism, Islam, Buddhism, Hinduism, and even atheism, these belief systems come with ethical frameworks that are core to their practitioners. Discouraging people from becoming physicians because of their religious affiliation is a human rights infraction. Encouraging such existing physicians to choose between their religious beliefs and their work is immoral and is also a human rights problem. Asking physicians to act in the best interest of their patients is excellent and I applaud the CPSO for tackling this issue. There is no reason a person of faith, with a religiously based moral compass, cannot act in the best interest of their patients while remaining true to their belief system. They are already doing it! I have seen them do it and I have seen how satisfied their patients are with their care. I have seen this in so many situations that I cannot even believe that the CPSO is so out of tune with real practice that they would propose such an ultimatum as: you can’t be religious while also taking your patient’s perspective as the priority. In fact, in Palliative Care and Family Medicine we are the model of patient-centered care in the Canadian health care system. We know our patients situations over years (in Family Medicine) and know the intricacies of their lives. We seek their direction and input as we discuss topics from antibiotic therapy for common infections to their CPR wishes and level of care preferences. We discuss the pros and cons of prostate screening before ordering a barrage of tests. We are actually doing a great job of respecting patients’ wishes in 99% of cases. This policy should seek to encourage the existing high level of practice in Ontario and clarify the specific areas of concern when it comes to human rights and offer consequences when there are violations. Prohibiting physicians from having their own moral frameworks is not helpful or necessary.
6) At a basic level, medicine is an ethical endeavour. The example I have heard in the past is as follows: If I had developed a cure for lung cancer and had the ability to disseminate such a cure it is my moral framework that would tell me whether or not I ought to share this discovery with others. Said another way, terrorists look at medical knowledge about a dangerous bacteria and think of ways to kill people with it. Health care practitioners choose the moral system that says that one should prevent the spread of dangerous diseases and in fact spend billions of dollars trying to find cures for diseases. It is the moral framework that makes all the difference when it comes to practicing medicine. There are not unanimous agreements about ethics however, so the CPSO’s role is to encourage the basic levels of ethical norms throughout the health care system but this cannot lead to discrediting and eliminating all other variations on the theme of helping others and having the patient’s interests at heart. The CPSO needs to set boundaries but it should not have such a narrow ethical boundary that it feels the need to attack all other moral systems.
Thank you for listening to my thoughts on the matter. I trust that you will be receiving many opinions over the next few months. I hope that you will value the quality of people’s arguments and not just the quantity for and against.
I strongly object to this proposed policy. The requirement that physicians ignore their moral or religious convictions in “urgent” circumstances or to protect “patient safety” will undoubtedly be used to attack physicians with “unpopular” moral or religious beliefs. While you may imagine that this policy will only affect a small number of physicians who object to abortion, you should anticipate the enormous adverse consequences that this policy will have on a very large number of physicians if/when euthanasia is legalized.
Your draft effectively eliminates a doctor’s right to act in accordance with his moral and religious beliefs. It does so in two ways of which you are well aware.
Firstly, a doctor who does not wish to perform an abortion would have to refer a patient to somebody who actually performs abortions. This is the same as being complicit in aiding somebody to get an abortion. The word complicit is defined as involved with others in an illegal activity or wrongdoing. To doctors of conscience, abortion is a wrongdoing because it puts the mother’s life in psychological, spiritual, and often physical peril, and takes the life of her child. Both a pregnant woman and her child comprise two patients whose lives and well-being a doctor must uphold.
By supposedly catering to the rights of a woman seeking an abortion, you are demolishing the rights of doctors to object to abortion.
Secondly, if no other doctor were available to terminate a child whose mother was seeking an abortion, a doctor of good conscience –who spends most of waking life trying to preserve life– would be forced to end somebody’s life.
To force a doctor or nurse to perform an abortion is morally wrong and abhorrent. What about his or her right to act in a moral way, to be free from guilt, to have a choice?
You are weeding out good people from the medical profession. In addition, pro-life patients deserve the right to have care from somebody who is aware of the humanity of a fetus, and seeks to preserve its life despite challenges. Many women are being pressured to abort children with Down’s Syndrome, Trisomy 13, etc.. These women have rights to!!! Their children–who are human– have rights, too!
Please restore some democracy in the medical profession! Do not trample on the rights of doctors to offer whatever services they wish to without having to refer patients for abortions, assisted-suicide, or other immoral services!!! Do not force doctors to go against their will.
I disagree with the premise that physicians have to set aside their religious and moral values when acting in their professional capacity. On the contrary, the higher the moral standard of a physician (or any other professional), the better the quality of his/her care. Morality is strongly related to religion, at least those religions that promote love of neighbour. Therefore, if the physician’s religion expressly forbids abortion or assisting at abortions, then the physician should let the patient know of other means of natural contraception, and counsel the patient accordingly. Personally, I would hesitate to consult a physician whose morality standard is known to be low, or who counsels patients to go for abortions.
Our physicians must have the freedom to follow their religious and moral beliefs.
We are all hurt if this freedom is not allowed. We cannot have our doctors become puppets of the government or of patients and their families.
I am a second year Plastic surgery resident and I would like to share my perspective on the proposed changes to the Professional Obligations and Human Rights policy.
Firstly, and most importantly, no patient’s rights are being violated in Ontario under the existing policy. Abortion is one of the few health services that can be obtained on a self-referral basis. This is the ideal solution to ensure that we continue to respect the rights of both the patient and the health care provider. There is no need to change the current policy to improve access to abortion as there are absolutely no limits to accessing abortion. It is self-referral meaning anyone, regardless of their primary family physician, can make an appointment or drop in without a referral.
Similarly, the “Plan B” pill is available over the counter and thus does not require a prescription from a physician to be obtained. Again this is ideal, as neither the patient’s nor the physician’s rights are being infringed upon in any way.
With respect to contraception, again there are no significant barriers to patient access. Birth control is available through a variety of sexual health clinics throughout Ontario. Again patients do not need a referral from their primary family physician to access these clinics; they are self-referral.
Not only would this new policy fail to improve patient access to care, it would actively decrease it. Patient’s access to physicians trained in alternatives to hormonal contraception, such as Natural Family Planning (NFP), is already very limited. The new policy would make it even more difficult for these physicians to continue to practice or indeed to recruit new trainees interested in this field. Just as patient’s seeking abortion have a right to timely access, patient’s seeking advice and counselling consistent with NFP have a right to timely access. This policy would very likely limit this already scare area of expertise among our primary care physicians.
Furthermore, this policy would undermine and deteriorate the doctor-patient relationship on an individual basis, as well as at the societal level. As you have rightly highlighted in the policy, some of our key values are compassion, service, altruism and trustworthiness. We have a fiduciary duty to our patients. This is defined as a legal duty to act solely in another party’s best interests. A physician who contentiously objects to OCP, truly believes that it is harmful both psychosocially and physically to their patient. Forcing this physician to write a prescription for OCP would, by definition, force them to break their fiduciary relationship. They would actively be writing a prescription from something they believed to be harmful to their patient. We, as a self-regulated body, go to great lengths to prevent such a grievous breach of duty. This policy would not only permit such a breach, but in fact, force such a breach to be made.
Finally, I fear the repercussions this policy change could have on other areas of medicine. As a plastic surgery resident I observe my preceptors denying patient’s requested cosmetic procedures for any number of reasons. For example, body dysmorphic syndrome, unrealistic expectations, procedural risks too high, medical comorbidities, smoking status, inappropriate motivation for procedure (e.g. pressure from partner), not finished having children (prior to abdominoplasty), etc. This policy could certainly conceivably be used to coerce a surgeon into performing a procedure that they truly felt was not in the patient’s best interest, or in fact, not safe to do. This policy sets a very dangerous precedent to destabilize the incredibly unique and powerful partnership between a patient and his/her physician.
In summary, the new policy would not improve patient access to abortion, Plan B or contraceptives as these are already accessible without a referral or prescription from the primary family physician. In fact, it would do the opposite of its intended purpose, and would further decrease patient access to NFP trained providers. It would actively diminish the doctor-patient relationship by undermining the principle of fiduciary duty. And it sets a dangerous precedent for not only allowing, but encouraging physicians to act against their best judgement.
Please do not change the current policy. However, if you do decide a revision is necessary, this draft is unacceptable in its current form and requires significant changes.
To pick up on the last point regarding complaints to the College when a physician tells a patient NO to a requested surgery (also read procedure,test,prescription etc) is quite relevant. I don’t think the College intends, as it will do, to open the floodgates of patient complaints. Beware of the policy’s consequences.
Hello,
I am writing regarding the proposed changes to “Physicians and the Ontario Human Rights Code.” Canadians rightly hold the medical profession in high regard, thanks to your organization and to the work of our doctors. It is my observation that most doctors have chosen their profession for moral, not practical reasons. Being bright and motivated people they could surely do well in other fields that do not require such demanding training or difficult work, but they choose to be doctors none the less. Consider the implications of taking moral decision making away from a profession whose members joined for moral reasons. Why, then, would such people become doctors? What would such a change do for the future of the profession? It is imperative that you do not allow the proposed changes to go forward.
I believe aspects of the proposed policy are misguided, and represent an assault on your members’ freedom of conscience and an insult to their professionalism. Obliging doctors to refer patients is making them full participants in procedures they strongly oppose. For many specialized procedures, referring a patient would be the extent of their involvement anyway. Only by allowing doctors to be complete non-participants do you respect their conscience and moral judgement. This does not meaningfully hinder a patient from seeking a procedure through other channels. Organizations exist to facilitate access to many forms of controversial care, and if access is the true aim of your policy then surely this is sufficient. You achieve no improvement to the freedom of patients by so severely limiting the freedom of doctors.
Writing policy in a world of competing views and opinions cannot be easy, but forcing your members to participate in procedures they object to is not the way forward. History has rarely condemned an organization for respecting freedom of conscience, and I hope you will come to see that these proposed changes do your members a grave injustice.
Forcing anyone to violate their conscience is immoral. Especially when issues of life and death are involved, how can a physician be expected to act against his or her conscience? The proposed changes are a step backward and not forward.
The draft policy claims to be based on the CPSO’s Practice Guide (http://www.cpso.on.ca/Policies-Publications/The-Practice-Guide-Medical-Professionalism-and-Col/Introduction). The Guide contains the following statement: “This practice guide does not stand alone. There are many resources available, which through varying approaches, provide excellent guidance to physicians on how to practice well. These include the principles of bioethics, the Royal College of Physicians and Surgeons of Canada’s CanMEDS framework, the Canadian Medical Association’s Code of Ethics, and codes and guidelines from other medical leaders across Canada and internationally. The CPSO’s practice guide is not intended to replace these resources; rather, it is intended to organize the information in a way that will best guide Ontario physicians in how to meet the expectations of their profession. It should be used in companionship with other resources, rather than in isolation.”
In fact, the draft policy contradicts some of these documents, which arguably have more credibility in the field of medical ethics than does the CPSO. For example, the Code of Ethics of the Canadian Medical Association, the main professional organization for all Canadian physicians, includes the following provisions:
7. Resist any influence or interference that could undermine your professional integrity.
9. Refuse to participate in or support practices that violate basic human rights.
12. Inform your patient when your personal values would influence the recommendation or practice of any medical procedure that the patient needs or wants.
23. Recommend only those diagnostic and
therapeutic services that you consider to be
beneficial to your patient or to others.
The 2015 Update of the Royal College CanMEDS Framework (http://www.royalcollege.ca/portal/page/portal/rc/common/documents/canmeds/frameworkcanmeds2015_framework_series_II_e.pdf)includes the following:
Communicator Key Competencies – 1.3
Recognize when the values, biases, or perspectives of patients, physicians, or other health care providers may have an impact on the quality of care, and modify the
approach to the patient appropriately.
The World Medical Association International Code of Medical Ethics states:
A Physician shall always exercise his/her independent professional judgment and maintain the highest standards of professional conduct.
A Physician shall be dedicated to providing competent medical service in full professional and moral independence, with compassion and respect for human dignity.
None of these documents supports the proposed changes in the CPSO policy . The new draft of the policy has three goals: it sets out physicians’ existing legal obligations under the Ontario Human Rights Code (the “Code”), and the College’s expectation that physicians will respect the fundamental rights of those who seek their medical services. It also sets out the College’s expectations for physicians who limit the health services they provide due to their personal values and beliefs. The first goal is appropriate for the CPSO. The second is acceptable as written, although it should not overstep the first. However, the third is where the document fails, due to its unwarranted limitations on physician independence and freedom of conscience.
Dear Sir/Madam,
I realize the CPS is well-intentioned, but this draft policy is inherently dangerous because it does not allow physicians to opt out of referring procedures that they view as dangerous for their patients or even immoral.
If this had to do with urgent, life-saving care, that would be one thing. One could (reasonably) posit that the patient’s right to emergency life-sustaining treatment outweighs conscience rights of the attending physician. But this does not apply in most of the situations which would be addressed by the policy. Most of the procedures/medications that are its focus (such as birth control, abortion and euthanasia should the latter become legal) almost always relate to elective ones. For example, abortion is only very rarely needed to save the life of the mother and, in fact, the overwhelming majority of abortions are performed during healthy pregnancies during which no medical indicators are present at all.
Given that this policy doesn’t really define “medical necessity,” it does not stretch the imagination to envision how this policy could end up requiring doctors to be the puppets of the patients, forced to accommodate any patent request, however dangerous or wrong. What of the doctor being ordered to abort a healthy 38-week old fetus? What of the doctor being ordered to abort a female fetus because she is a girl? What of the doctor being ordered to perform an abortion on a woman who doesn’t want one and is being coerced by her partner/family? These are all realistic contingencies under the proposed policy.
This new policy would force doctors to leave their clinical judgement at the door. Just as I am sure Hitler’s doctors were invited to leave their consciences at the door. This is how it starts. Does the CPSO truly expect doctors to ignore their consciences at all times when treating patients, and yet retain their humanity? This is an inherent contradiction and will drive caring physicians out of the profession when it is caring physicians whom patients need the most.
Moreover, the CPSO is inconsistent in its insistence on referrals. For example, the College specifically directs doctors not to refer patients for FGM (female genital mutilation). Thus, the College recognizes that it is not only wrong to perform a morally objectionable procedure; it is also wrong to refer for one. In contrast, this proposed policy would require doctors to set aside their principles and refer patients for treatments that they believe, in their clinical judgement, are harmful for the patient and/or unethical. How is this promoting good clinical practice?
Finally, the proposed policy erodes patients’ rights in two ways. Firstly, by eroding the clinical discretion of doctors, it leaves patients at risk of receiving treatments that are not medically advisable for them. This would be a breach of care. Secondly, by forcing physicians of conscience out of the profession, this proposed policy would limit many patients’ rights to access doctors who share their values (for example, that human life has inherent value and dignity).
Please, I beg the College to reconsider revising this policy to eliminate the referral requirement. This would make the policy a fair and equitable one, for the betterment of the practice of medicine and the Ontario public.
To Whom it may concern.
As a Canadian citizen, a Christin and an advocate of freedom of religion, I am extremely upset by the draft proposal.
I believe it is immoral, illogical and illegal to force someone to do something that is against their religious beliefs, such as making a Dr provide a referral or perform a service that they have a religious personal reason not to.
We are so concerned about the rights of others that we forget the individual’s rights.
Also in the case of abortion a Dr due to their beliefs and also the Hippocratic oath, of doing no harm to a human being, is entitled to abstain from providing the service or giving a referral. This service is available elsewhere and the Dr in question should not be forced to be involved.
In the matter of not having discussions/promoting ones faith, why can someone who is anti-Christian/religion able to promote their position, this makes no sense.
Also especially in the area of palliative care it has been shown that many people have questions and want to ask about faith etc. My mother was dying from CA and had many questions and looked for a Christian Dr to speak to even though she did not have a personal faith.
In summary I am against several aspects of this DRAFT policy and do not believe that my Dr should be forced to adhere to these discriminatory policies.
They are just wrong!!!!
Hello,
I object to this new draft policy. Sounds like a dictatorship. Medical doctors require freedom of conscience to treat patients as they think best. They ought not to be forced to offer patients treatment, or refer them to other doctors for treatment, that they believe is morally wrong.
I am writing concerning the revised draft policy with the new title of “Professional Obligations and Human Rights”.
Here are the major areas of concern I have with the draft policy:
1. Doctors are required to refer for procedures that are against their moral or religious convictions (Lines 156-8)
2. Doctors are required to perform procedures that are against their moral or religious convictions in situations where that is deemed to be “urgent or otherwise necessary care” (Line168)
Many physicians have the moral conviction that the purpose of medicine is to heal people. They did not choose to be a doctor to end life in the womb or at end of life. They arrive at this conclusion from different worldviews and perspectives. Some have religious beliefs, while some have moral convictions based on humanist creed. Under this policy they can all be subjected to disciplinary actions up to and including being stripped of their ability to practice medicine, for refusing to conform to the imposed vision in this policy.
The future of doctors practicing according to conscience and of patients having the option to choose a physician who practices according to their worldview is at risk. This is an assault on diversity in the practice of medicine.
I am very concerned about the moral direction of this policy. It is important to protect the patients’ rights but it is also of equal importance to allow physicians to practice according to their moral and religious beliefs. I feel this is of imperative when it comes to building a relationship of trust between a patient and their physician. If I disagree with the convictions and decisions of my doctor, I am welcome to consult elsewhere. We should not require all doctors to conform to practices that are contrary to their convictions..
You may feel self-righteous and good about becoming dictatorial, but nobody likes a dictator who forces his/her way on people.
After reviewing the third draft of the policy “Professional Obligations and
Human Rights” I would like to express my utmost concern and I request you delete or amend this clause.
I refer to lines 156/157 under “Ensuring Access to Care”. I believe that what you refer to as an “effective referral” made for a service that one finds unacceptable due to moral or religious beliefs, makes the referring practitioner morally culpable and therefore is in itself unacceptable. I feel that as long as the patient is informed of the
availability of the service and how to access the service, that a referral (i.e.
traditionally a request/letter sent from one practitioner to another) is not
necessary.
I trust you will take my concern under serious consideration,
I disagree with your graft about “Professional Obligations and Human Rights.” According to the draft the patients’ rights to services are about the physicians’ right to follow their conscience, and this is wrong. This is a move to strip human beings of anything called personal values, by penalizing.
Dear CPSO representative,
I am writing to you today about a matter of grave importance. You currently have a draft of a policy forcing doctors in some circumstances to provide abortions, contraceptives, and vasectomies even if they are “unwilling to provide certain elements of care due to their moral or religious beliefs” or at least to refer the patient “in good faith” to another doctor who would provide the service”.
Despite the fact that abortion is available on a self-referral basis in Canada, you insist upon violating fundamental human rights. Why would you compromise the integrity of your fellows when patients already have access to abortion services?
It is painfully obvious that you are, in fact, posturing to force doctors to perform euthanasia, which is not readily available. You are working staunchly against public opinion, which you received loud and clear this August. I see right through this political move. If you can deny a doctor freedom of conscience with regards to prescribing birth control, you have precedent to deny freedom of conscience for euthanasia. This is the kind of cowardice that makes me sick. You will force good doctors out family medicine, especially in rural areas with such despicable rulings.
Many people have argued that it is only religious doctors who object on religious grounds, but that is patently false. We are discussing moral issues that affect all physicians. If a doctor objects to physician-assisted suicide on any grounds (as the vast majority do) you have a responsibility to protect their Canadian Charter and UN guaranteed rights, whether they come from religious grounds or not.
January 13, 2015
Dear CPSO representative,
I am writing to you today about a matter of grave importance. You currently have a draft of a policy forcing doctors in some circumstances to provide abortions, contraceptives, and vasectomies even if they are “unwilling to provide certain elements of care due to their moral or religious beliefs” or at least to refer the patient “in good faith” to another doctor who would provide the service”.
The most troubling part of this is your cavalier decision to trample Canadian Charter and UN guaranteed rights for a political agenda.
The most confusing part of this is why it is being tabled. Canada has no shortage of access to birth control; near free birth control is in fact a mandate of basically every public health unit. Also, it is far, far more difficult to obtain a knee replacement in a timely fashion anywhere in the country than it is to obtain an abortion. Even an MRI for a potential malignancy often involves incredible wait times and a great deal of travel to obtain it. Considering the many inconvenient things we subject Canadian patients to (especially our rural and remote patients), abortion access is not one of them.
It is one thing to require doctors to honestly express limitations or restrictions on the care they can/will provide to patients in a respectful manner. It is quite another to violate fundamental human rights and force doctors into situations that cannot be good for their moral health. Would you really want to make a doctor perform an abortion if he/she believed they were killing an innocent (and non-consenting) person? If you force a physician to, how can you expect them to continue to practice with true beneficence and non-malfeasance (ideals that are still taught in medical school today, because they are essential for truly good medicine)?
Further, if you require one doctor to perform or refer for abortions even though they privately are gravely opposed, simply because the patient wants them to, why should a doctor not also be required to refer or perform an abortion that is purely for sex selection? As much as some groups would like to say that the abortion debate is over, it is far from settled, and new horrifying implications are being realized all the time.
One final thought – a recent CNN article titled “For birth control, what’s old is new again” (Thursday, Jan 8, 2015) discusses an emerging trend for health conscience women to use technology to that up to 30% of women abandon using any form of hormonal birth control (including Mirena IUDs) due to side effects such as decreased libido. This is just one more, small reason why trying to mandate conformity is always a bad idea. Just as Canadian woman currently have exceptional access to traditional birth control (including abortion), they should certainly have access to physicians who specialize in alternatives. Also, there are absolutely physicians who do not wish to prescribe hormonal contraceptives purely because other Natural Family Planning techniques are becoming so user friendly and accurate that the risks of traditional birth control seem unconscionable.
Contraception is available at every health unit nearly free of charge. Abortion is a self-referral process in most provinces. There is no reason to tear down your fellow physicians with patently immoral and degrading policies. Ultimately, these kinds of policies ask physicians to stop critically appraising what they are doing, act against their conscience, and act in a manner they believe causes harm to their patient. For these reasons, all this policy will do is harm patients, without appreciatively improving access to contraception or abortion.
Dear Members of the Consultations Committee:
Subject: Draft Policy “Professional Obligations and Human Rights”.
I am writing to you with grave concern regarding the proposed draft policy. Sections 8, 10 and 11
suggest that physicians who decline to participate in certain acts for reasons of conscience should be
compelled to refer their patients to other physicians who will perform these acts. It does not address the
fact that many of these same physicians will find the act of referral itself objectionable, as material
cooperation with the act.
As an internist, there are several situations that I can forsee occurring where I will not be able to follow
this policy. For example, if euthanasia is legalized, I will not be offering this in my practice, and I do
not intend to refer my patients for this service, as the referral in itself lends support to the act. The
policy as it stands would not support my stance, and violates my right to freedom of conscience.
There is significant disagreement in our society as to what constitutes a moral act, and I do not expect
the College to define or limit morality. All I expect is that physicians, as professionals, be allowed to
respect their own consciences. Freedom of conscience is foundational to our free society and cannot be
limited, even for the best of intentions.
I encourage you to revise the sections above, and include a clear defense of the right to freedom of
conscience for all physicians.
To whom it may concern,
I am a Canadian citizen and Ontario resident, and many of my friends are practicing doctors in the College of Physicians and Surgeons of Ontario. They have brought to my attention a concern they are having in their profession, which concerns me as well. They have informed me of the draft policy you are writing, “Professional Obligations and Human Rights”, which will limit physician freedom of conscience and religion. Specifically, if a doctor chooses not to perform/provide a procedure on moral/religious/ethical grounds, your draft policy would require him/her to refer the patient to another doctor who could perform the procedure. Forcing doctors to do so is requiring them to act against their conscience. If they consider a specific procedure unethical, then it is not something they would want their fellow doctors to perform either. Both performing the procedure, and referring it to someone else, are unethical choices for that doctor. And to require someone to act unethically is unethical in itself. I ask that you please reconsider this portion of the draft policy, and strive to uphold freedom of conscience and religion in every aspect of your profession.
Let us remember that doctors are humans who have consciences, and not machines that we can manipulate to do as we please.
Alternatives to patient care can be provided without necessitating a written referral. When it comes to “morally objectionable care” perhaps the ministry can provide a published listing of services available (who, where, when) thereby bypassing the referral process and actually speeding up access care.
Better yet, the ministry can stop using the terms “care” and “service” for procedures intended to kill. Of course, the ministry would also eliminate them from OHIP.
I see most people are commenting about the ethics part of this, but I want to talk about the accessibility/accommodation stuff.
I have just moved here from Alberta and reading this gives me hope that I will have better luck in my new province. The “one size fits all” treatment I have had my whole life, most certainly did not fit me. I tried a few times to ask for accommodations, but since oral communication is my biggest challenge, I was almost always unsuccessful.
I have Asperger’s, which means I am terrible at talking with people (I may do alright here, because writing is more comfortable than speaking and also I can think more clearly without pressure). I have trouble with finding my words especially when a Dr is staring at me or hurrying me. I’ve had Drs yell at me “just spit it out!” and that just makes my brain freeze up so I can’t think at all. or they want “the highlights” of a situation, and because of the way my mind works, I can’t tell which symptoms (or lifestyle habits or whatnot) are the highlights. I need a gentle, patient Dr who will tolerate my rambling, ineffective way of speaking. Since that is so hard to find, mostly I have given up on trying to communicate with Drs and neglected my health problems. I don’t want to do that anymore. I should get my problems treated, so they don’t get worse. I pay taxes; I DESERVE to get my health problems treated. But when I’m there in the office I usually feel like I am unwelcome and undeserving.
When I do try to discuss something, there are other hurdles, for instance I am easily pushed into giving an agreeable answer. For years I was getting antidepressants forced on me for fatigue & other symptoms, which it now seems were caused by thyroid trouble the whole time. I would try to tell Drs that the pills were having no effect, and the Dr would say “Are you SURE? It SHOULD be helping” & I’d cave and agree that it was helping rather than fight. I’ve had Drs rattle off a list of symptoms that went with a certain diagnosis and I said “No, that doesn’t sound like me. I have only a couple out of that whole list” and they’d say “Are you SURE?” & then again, I would get pressured into agreeing to a misdiagnosis.
Drs don’t understand how hard it is for autistics to speak defiantly or challenge an authority figure. Even when I’d tell them about me having Asperger’s, none of them seemed to really get what that meant or act any different with me.
My second issue which needs accommodation is a severe reaction to most synthetic fragrances. I remember once I sprained my ankle in a small town & the only Dr in the ER was drenched in Axe, despite “Fragrance-free Zone” signage all over the hospital. He was hostile to me when I explained my problem & that I couldn’t be near him. Looking back, perhaps putting an oxygen mask on me, or having a nurse examine me while he observed from afar would have been a suitable accommodation. Instead I was treated like a trouble-maker, & I was given a “diagnosis” without an examination, which caused trouble since it turned out a bone had been wrenched out of place, so it was actually more than a basic sprain.
I encountered room scent devices such as “plug-ins” in examination rooms when I was seeing a Dr specifically about my bad reactions to artificial fragrances. Such ironic inconvenience is not a rare occurance. I have two friends who have gone to specialists for their migraines in one case, allergies in the other, and there was room scent or Febreze present, triggering the very health problem they were there to work on! I’m sure asthmatics sometimes have the same trouble. It’s shocking enough when one can’t see a GP without getting exposed, but I’d like to think such specialists at least would understand that many people can’t tolerate fumes.
It would be nice if all clinics (and labs) were safe for scent-sensitive patients. The pleasure a Dr (or their staff) gains from using room scent, laundry scent, or personal fragrance, is so minor, compared to the suffering of sensitive patients who can not find a clinic they can safely enter!
Thank you for giving us a chance to put in our “two cents” about accessibility!
I am a retired primary care physician with more than a half million patient consultations on two continents.
I have lived under Hitler, I have had to practise cost-conscious medicine in the third world, I have agonized over hundreds of AIDS patients whom I could not help.
I shudder physically and emotionally as I have read all of the proposed guidelines for practising Ont. physicians, as well as the 149 responses posted above. I agree with most of them.
What is this country coming to?
I am glad I am no longer active in a profession that is developing a culture of death, with our leaders strangulating our best and brightest.
Please scrap the whole process and review your destructive worldview!
Regarding “referrals” (lines 156-164) and “necessary care” in urgent situations (168–) which may be contrary to the physician’s moral or religious beliefs:
Our concern is that “care” is becoming an increasingly subjective term, largely for “societal” rather than “medical-scientific” reasons and that the medical profession has been unable or unwilling to invoke “science” to resist these external pressures. As a matter of principle, we are very concerned that the College may be contemplating requiring physicians to leave their moral consciences at the door, so to speak. We are even more concerned as we contemplate the way in which medical practice, under the influence of non-medical non-scientific external forces will tend to treat “care” as a malleable concept which will quickly come to include physician-assisted suicide (=”self-murder”) and inevitably after that physician-provided death (=murder). We therefore respectfully ask the College to carefully review the referenced lines of the present draft in that light. We would prefer that the policy should require the physician to provide the care which in the physician’s sole judgement is medically required.
I do not currently practice in Ontario but have in the past. This document is of great concern to me, particularly in the way it needlessly imposes one morality on those whose morals may differ. It seems to shrug off moral objection to certain acts or procedures as of little value and uses “access to care” as a means to impose the majority morality on those who may disagree. Perhaps a reminder is in order that procedures or acts that were once legal are now illegal and considered morally objectionable by the majority; for example, female genital mutilation was not always illegal in Canada. If this policy had been in effect, there would be a duty to refer even if one recognized the procedure as immoral. There may be similar situations in the future.
While it is good to address the issue of medical acts which are considered immoral by a significant proportion of practitioners, the approach suggested fails to protect physicians from coercion to act in unconscionable ways and fails to protect patients from doctors who are willing to be be coerced into participating in immoral acts simply because they happen to be legal at this point in our history. To state the obvious, referral constitutes participation.
The right to die soon becomes the duty to die. No one is an island.
A patient that we rescued from a suicide attempt triggered by finding her Parkinsonism was interfering with her tennis game couldn’t understand when her daughters were angry with her. She thought her insurance would pay their way through college. I explained that she had almost killed their mother. She said, “I never thought of it that way.
We should not be focusing on physicians involvement but on the perverse incentives that require legal sanctions against counseling, aiding, or abetting suicide for balance. One can’t punish a corpse but one must not wink at counseling self destruction.
I find that the proposed document is discriminatory against any physician who morally can not recommend euthanasia, abortion, female circumcision, etc.
The lack of a Canadian law against abortion, or euthanasia, does not make it the correct course of action in every situation – therefore there will be patients who request a procedure that should not get the procedure.
All of medicine requires critical and discriminatory thought and decision making.
The Law is constantly discriminating – those who abide or do not abide within the law are consistently differentiated. That is why there is a determined desire to remove law, change it or to weaken it.
Those who want to participate in or promote illegal behaviour for their own comfort, want to change the laws so they are less “law-like and discriminatory.”
That the lack of law suddenly engenders a new professionalism ‘law’ to force compliance with morally repugnant actions is in itself discriminatory.
Must we now defend the right of those who want to promote that which was once clearly illegal, before the changing of the laws? To Not do so is ‘morally repugnant” and subject to discipline ? ? ?
The immoral is made moral, and the moral is made immoral.
It seems to me as if I have heard of this somewhere.
If the right of the physician is not ultimately defended, there can be no rights for the patient.
Quo Vadis?
I am a physician who holds to the ancient Hippocratic oath of doing no harm.
Personal choice, rights and freedoms:
What “no harm” is should not be forced upon me by others.
The freedom of conscience and moral belief is one of the most important qualities of a physician as a caring individual and human being (we are people too!) It is also a respected entity protected and guaranteed by the Canadian Charter of Rights and Freedoms.
Mistakes of our past:
If we choose to retract the physicians ability to step away from something he or she feels is wrong we ignore the important lessons we have learned from the history of medicine. We risk repeating the horrors of the past (recall nazi experimentation on Jews, homosexuals, twins…all in the name of medical progress). Had those physicians had the freedom of choice to say “no, I cannot do this as I feel this is wrong”, hundreds of innocent lives would be saved.
Impact on the physician:
More than that, I answer to a God, the great physician, whom I have dedicated my practice of medicine to. One must consider the ramifications of enforcing acts which will cause personal guilt and shame on physicians who are already overworked and statistically known to have high rates of burn out, exhaustion, depression and suicide. Are we willing to risk this on a much needed resource?
Other options:
I have trained in the north were physicians and resources are few. However even in remote areas self referral lines still exist and colleagues are able to take over when individual physicians are not comfortable with various referrals and procedures. We are all different in personality, beliefs, and comfort levels and that makes us able to relate best to our patients as humans, not robots. If alternate routes are not accessible funding should be aimed at creating them so all will be content. In most cases, these are already in place for “controversial procedures.”
I humbly submit my opinion and firmly back up my resistance to any change of law or policy that challenges the rights of myself and my colleagues – it is just unnecessary, wrong, and frankly dangerous.
Making an “effective referral” for a service that one finds morally unacceptable is morally no different than providing the service oneself and is therefore a violation of the physician’s right to freedom of conscience. In terms of the balancing of rights, a patient can choose from many physicians, a physician only has one conscience. As long as the patient is informed of the availability of the service and how to access the service, a referral is not necessary.
The draft policy thirteen times specifies “those seeking to become patients.” The second instance includes them when emphasizing that even vulnerable and marginalized populations should receive equitable access to care. The fourth instance requires their best interest in any conflict that arises because of a different value system than the doctor’s. The sixth instance requires reasonable accommodation to them if a disability or other personal circumstance limits their access to care.
Does nobody else see a logical problem here? By using the word “seek”, the draft policy has discriminated against and effectively excluded “vulnerable and marginalized populations” who because of the majority’s “different value system” and/or their own “personal circumstances” CANNOT seek to become patients.
Children are an obvious example. Because of their early stage of development, babies cannot communicate much. Because of the majority’s secular humanist value system, they are marginalized. Secular humanist doctors currently kill many of them before birth in Canada and–if euthanasia is legalized–will eventually kill them after birth as Dutch doctors do. When is anyone more vulnerable than while a baby? The womb is supposed to be a place of safety, and a doctor is supposed to heal. These should be self-evident truths.
This draft policy will actually accomplish the opposite of what it purports to do. Ontario is already such an intolerant place that those who dare point out logical inconsistency–if they do so in the wrong setting, i.e. where the abuse is happening–will be put in jail. And if, in solidarity with babies, they refuse to speak in their own defense, they will remain in jail. This draft policy will only make the inequity and injustice worse.
I have 2 concerns about the draft policy.
1) Line 168: Physicians must provide care that is urgent or otherwise necessary to prevent imminent harm, suffering, and/or deterioration, even where that care conflicts with their religious or moral beliefs.
This is very vague as to what may be required here. Please specify what is imminent harm, suffering , or deterioration. I am also concerned that such a broad statement would infringe upon doctors’ right of conscientious objection.
2) Line 146-48
Furthermore, physicians must not promote their own religious beliefs when interacting with patients, or those seeking to become patients, nor attempt to convert them.
A blanket ban on discussion of religious issues between doctor and patient is overstepping the reach of the CPSO in my opinion. A ban on UNSOLICITED or unwanted discussion of religious issues would be more appropriate. Furthermore, this should apply not only to physicians with religious belief but also those without any religious persuasion.
I am gravely concerned about the draft policy you have put forward. I know of several physicians – myself included – who pursued medicine partly because of values instilled by our various religious and moral beliefs. I firmly believe that all physicians can still provide timely, appropriate and patient-centred care while maintaining their freedom of conscience and without having to compromise on their beliefs. Please reconsider your policy. Thank you.
Doctors will leave Ontario because of this. There are plenty of other places to practice that don’t involve the compromise of ones moral integrity.
Methinks the lawyers will be the winners in the long run…
Although my personally think I would rather my MD not share his religious information with me. My concern is that in DEMANDING that the physician make REFERRAL to an abortion clinic etc you are not hindering their belief system. You my in fact find many MDs pulling out of their practices if this is forced upon them. Thus crippling an already over burdened healthcare system. I note that the information regarding abortions etc is already widely posted on the internet and patients can easily access this information by simple google search. MD’s that have a religious back ground generally post that on their walls and the patients in tern know this in advance of coming into the practice.
I think that the proposed policy is contrary to the charter of Rights and Freedoms and is discriminatory against doctors who cannot participate in these procedures because of religious beliefs. This proposal should not become policy as it will deny many doctors the right to act according to their conscience in areas that are not life threatening.
Dear Sir/Madam:
It has always been my understanding that a physician is in a covenantal relationship with each of his patients. That covenantal relationship consists of an unstated, understood promise to do whatever is necessary and possible to maximize health for that particular individual. The therapeutic activity is based on scientific evidence and the best judgment of the physician and it is a negotiated activity with the patient.
However, if the physician were asked to participate in euthanasia or abortion, and were to comply, despite her deeply held judgment that that was not in the best interest of the patient, she would’ve lost her integrity. At that point, no patient would have any reason to trust that physician any further. Trust is a precious commodity and absolutely critical to the therapeutic relationship.
It would be the destruction of a physician in his function as a physician for the CPSO to insist on participation in intentionally lethal actions on his patients.
If asked to murder, or to assist in killing, I were to comply, I would be simply a contractor, doing a job for a fee or no fee. I certainly would not be a covenantal physician in the historical understanding of that phrase.
Upon reviewing the third draft of the policy “Professional Obligations and Human Rights” I would like to express my extreme concern and alarm at what seems to be a newly added clause. I would ask you to delete or change this clause.
I refer to lines 156/157 referenced under “Ensuring Access to Care”. I believe that what you refer to as an “effective referral” made for a service that one finds unacceptable due to moral or religious beliefs, makes the referring practitioner morally culpable and therefore is in itself unacceptable. I feel that as long as the patient is informed of the availability of the service and how to access the service, that a referral (i.e. traditionally a request/letter sent from one practitioner to another) is not necessary.
I trust you will take my concern under serious consideration
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.
The numbers speak for themselves!
Delete lines 156-168.
Dear CPSO,
RE: Professional Obligations and Human Rights policy consultation
I am deeply concerned about the move to force physicians to refer for procedures which violate their conscience.
i) Participation. Those drafting the policy seem to lack understanding regarding the fact that referring for a procedure involves a participation in an act which the physician deems immoral.
ii) Fiduciary responsibility. With regards to a fiduciary responsibility, physicians with conscientious objections to certain procedures, do so in the best interest of their patients. In fact, in the case of abortion, these physicians see a fiduciary responsibility to the second patient in the womb as well.
iii) Minority discrimination. The College is being overly dogmatic in demanding that a very small minority of physicians who have conscientious objections ignore their beliefs for the sake of services that can be provided by the vast majority of physicians. The reality of the situation is that most patients are not being inconvenienced by these few physicians, but imposing the College’s policy on this minority does a great service to the physicians’ dignity who have deeply held convictions about their beliefs. (Genuis, S. J. (2008). Discrimination on the basis of ethical orientation. Canadian Family Physician Médecin De Famille Canadien, 54(12), 1679–1680.)
iv) Erosion of conscience. Forcing the hand of physicians against their will, in this case of referral, is the beginning of a “small shift in emphasis” that has wide ranging consequences (Alexander, L. (1949). Medical Science under Dictatorship. The New England Journal of Medicine, 241(2), 39–47). With the possibility of euthanasia on the horizon in Canada, physicians who fundamentally object to killing patients would be forced to refer for the procedure.
v) Professionalism. A healthy respect for disagreement among colleagues is essential in medicine, respecting the safety of patients. Since patients are able to access care from a vast majority of physicians who don’t have objections to the morally controversial procedures in question, it seems unprofessional to impose unilaterally a way of acting that does not directly affect the life or limb of patients. In fact, it may happen that one day the only thing that stands to protect a person’s life is the conscience of a physician
I would be more than happy to discuss this in more detail over email or by phone should you care to discuss it. Your engagement with physicians and care to respect all perspectives is much appreciated.
Dear Members of the Consultations Committee:
Subject: Draft Policy “Professional Obligations and Human Rights”.
As a medical student and a future physician, I am very concerned about many of the details in your proposed draft policy. Sections 8, 10 and 11 suggest that physicians who decline to participate in certain acts for reasons of conscience should be compelled to refer their patients to other physicians who will perform these acts. It does not address the fact that many of these same physicians will find the act of referral itself objectionable, as they consider it material cooperation with the act. By compelling physicians to refer, your policy will inflict much moral anguish and distress to the physicians affected. The draft that you have proposed will limit the physician’s right to conscientious objection.
There is significant disagreement in our society as to what constitutes a moral act, therefore, I do not expect the College to define or limit morality. Within the medical profession and the general public, there are a plethora of views of what constitutes a moral act. In order to respect this diversity of thought, I strongly believe that your policy must also reflect the diversity of views regarding morality within our society.
All I expect is that physicians, as professionals, be allowed to respect their own consciences. It is unfair to force physicians to perform acts that will cause them certain moral anguish and distress. Freedom of conscience is foundational to our free society and cannot be limited, even for the best of intentions. If we coerce physicians into violating their consciences, we will inevitably erode the personal integrity which is the basis of the physician’s relationship with their patients. I encourage you to revise the sections above, and include a clear defense of the right to freedom of conscience for all physicians.
I am a physician who holds to the ancient Hippocratic oath of doing no harm.
Personal choice, rights and freedoms:
What “no harm” is should not be forced upon me by others.
The freedom of conscience and moral belief is one of the most important qualities of a physician as a caring individual and human being (we are people too!) It is also a respected entity protected and guaranteed by the Canadian Charter of Rights and Freedoms.
Mistakes of our past:
If we choose to retract the physicians ability to step away from something he or she feels is wrong we ignore the important lessons we have learned from the history of medicine. We risk repeating the horrors of the past (recall nazi experimentation on Jews, homosexuals, twins…all in the name of medical progress). Had those physicians had the freedom of choice to say “no, I cannot do this as I feel this is wrong”, hundreds of innocent lives would be saved.
Impact on the physician:
More than that, I answer to a God, the great physician, whom I have dedicated my practice of medicine to. One must consider the ramifications of enforcing acts which will cause personal guilt and shame on physicians who are already overworked and statistically known to have high rates of burn out, exhaustion, depression and suicide. Are we willing to risk this on a much needed resource?
Other options:
I have trained in the north were physicians and resources are few. However even in remote areas self referral lines still exist and colleagues are able to take over when individual physicians are not comfortable with various referrals and procedures. We are all different in personality, beliefs, and comfort levels and that makes us able to relate best to our patients as humans, not robots. If alternate routes are not accessible funding should be aimed at creating them so all will be content. In most cases, these are already in place for “controversial procedures.”
I humbly submit my opinion and firmly back up my resistance to any change of law or policy that challenges the rights of myself and my colleagues – it is just unnecessary, wrong, and frankly dangerous.
I would ask you to delete or change this clause in lines 156 and 157 referenced under “Ensuring Access to Care”. Making an “effective referral” for a service that one finds morally unacceptable is morally no different than providing the service oneself and is therefore a violation of the physician’s right to freedom of religion and conscience. In terms of the balancing of rights, a patient can choose from many physicians, a physician only has one conscience. As long as the patient is informed of the availability of the service and how to access the service, a referral is not necessary.
When I see my patients, it is a meeting of two people, and both of us have been given beautiful lives. I am called to look at it this way always, both professionally and as a Christian. It is a precious relationship, where I am being called upon to help, and give my best to the next person. I am to call on my learning in medicine and the sciences; and also on the knowledge I have of the person in front of me as a son or daughter, with all the amazing pieces that make that person individual and alive.
It is only respectful to the both of us, when I can present what I truly feel are the best options are for health for that person. When I short change that person of the best options, I am also acting devaluing myself as a doctor and as a person, as a brother/neighbour.
My patients don’t know know me well, but I think they know that I consider their stories and their workup and treatments within their contexts. I discuss it with them. Regardless of whether it is a test or a medication or a referral, we can talk about what is a better choice or what might be harmful, what I may not recommend even, based on our goals. I would hope that in these discussions, that they sense why I love my practice of medicine: not because I want to direct and be right, but because each of them has a life that is inherently sacred and valuable from beginning to end, in all its fullness and with all its potential. I am called to defend that life, and to help somehow nurse it back if I am allowed to.
This is not a question about separating morality , religion and medicine and science. I could not divorce myself from the reasons I practice because those reasons are inherent to who I am.
To be asked to lay aside questions of morality is to ask me to be less than myself. as a physician and as a Canadian and as a Christian.
To those who wish I did not practice medicine, I only want you to ask yourselves: would you really want a physician who practiced without his or her morals? Who didn’t really consider what is best for you? Who like you,also reserves the right to beliefs, whether you agree or not?
I have been wrong so many times in my life and in my practice. But thank God for the opportunity to do so. If we lose that freedom in Canada, we will lose the ability to truly care for one another.
I cannot agree to be required to refer someone for services that are against my beliefs. All of us share differences of opinions and beliefs and that richness makes my day fascinating – I meet some really amazing folk everyday! the differences I have with my patients are points of discovery. When we disagree on what would be helpful to them as far a improving their health, here I am being asked for a recommendation. I sometimes have to recommend against what they are seeking. It is always in their best interest, to the best of my knowledge that day. sometimes that medical opinion has direct roots in my spiritual being, but it is never haphazard.
To then be required to send my patient to another doctor who would agree with a treatment that I find harmful to my patient is absurd. I can understand the desire for this ease. But this is equivalent to participating in harming my patient. How can I be asked to carry this on my conscience? What is the point of even debating a person’s values, if they can be overridden?
The text of the policy is not the issue. the idea of the policy revision is the issue. We have stepped into an area where the physician becomes the purveyor of services on demand, not the professional advisor.
Thank you for giving us this opportunity to discuss the draft policy “Professional Obligations and Human Rights”.
1) I am concerned about line 168-169 and would strongly advise the revision or deletion of this sentence as it currently stands:
“Physicians must provide care that is urgent or otherwise necessary to prevent
imminent harm, suffering, and/or deterioration, even where that care conflicts with their religious or moral beliefs.”
The words “urgent” or “necessary” “care” are too nonspecific and too open to subjective interpretation. Who determines that the care is urgently needed to prevent imminent suffering? A suffering patient who just wants to die? The grieving family? The physician? The CPSO? For example, if euthanizing a patient is considered urgently necessary by the patient, does the policy then force a physician to take her life? No! How can professional obligation ever trump moral law? Legal authority this policy may have, but moral authority never. By ordering physicians to perform acts conflicting with moral/religious belief, this policy sets itself up as a higher authority than God, an authority it does not have.
I would recommend that we use concrete examples within this policy. For clarity, the policy statement could specify explicitly the expected “elements of care” which a physician must provide that are commonly contrary to religious or moral beliefs. This will help us spell out clearly what actions the policy wishes to enforce–although I want to stress again that legality of an action does not imply its moral rectitude. We are all responsible to God for disobeying any law that sets itself against God’s Law.
I hope you understand my serious concern with this sentence. Thank you for taking it into consideration.
2) I am also concerned about line 146-148:
“Furthermore, physicians must not promote their own religious beliefs when interacting with patients, or those seeking to become patients, nor attempt to
convert them.”
Please clarify what is meant by “promoting religious beliefs”. This life is a response to what God has graciously done, and every aspect of my working and visiting patients and providing care is a promotion of that belief. In fact, in my limited experience, some patients find it both therapeutic and much appreciated when we speak about hope in God’s goodness and pray together.
Finally, no environment exists in which religious beliefs are not being promoted. Just as promoting theistic belief is speaking about God, so avoiding all mention of God promotes atheist belief.
I would recommend that we amend this to read that physicians will not coerce patients to share their beliefs and again to specify explicitly what actions are considered a “promotion of belief”.
I hope you understand my concern with this sentence. Thank you for taking it also into consideration.
-Medical student
The proposed policy change is absurd, as it erases the concept of physician as professional and personal advisor, and puts us in the position of purveyor of services on demand. What it the point of debating issues of conscience if we will be asked to act against our best judgments, and act as accomplices to the very acts we would normally find ourselves objecting to? Now my conscience will be burdened with the guilt of either having done wrong for my patient, or of having disobeyed college policy? It is a no win situation as soon as one finds one self morally challenged by a patient over a treatment decision. This is professionalism?
I think you have to understand the College is all about money, business and politics and as such these policies should be taken with a big grain of salt. The College or your patients should not and cannot lead you to compromise the soul of your morality as you can never please the College nor all your patients. If push comes to shove and you had to defend your decision not to participate in any form in abortion or euthanasia, I am supremely confident you or any doctor would successfully defend themselves. Morality is a fundamental sacred right which no other man or policy has the right to override.
RE: DRAFT POLICY ON OBLIGATION OF DOCTORS TO PARTICIPATE IN ABORTION, CONTRACEPTION AND EUTHENESIA.
In my opinion doctors may not be compelled to participate in practices which are against their conscience. Their rights under Canadian Charter of Rights and Freedoms must be protected.
While I support nearly the entire draft “Professional Obligations and Human Rights”, I would like to register my disagreement with the clause that requires a physician to make an “effective referral” for a service one finds unacceptable. I believe that explaining all options in a respectful and caring manner, including how the services are accessed, would and should be sufficient and could avoid infringing the rights of one person while attending the rights of another.
I’m not a doctor, but if I were, I would indeed attempt to speak in a respectful and caring manner, AND I would also be honest and trustworthy. I would NOT provide contact information for help with performing a forced abortion. I would not even mention it as an option. It isn’t. It’s unspeakable. It’s disrespectful and uncaring in the extreme. Pregnancy isn’t a disease, good parents don’t kill their children, and a good medical profession doesn’t engage in murder (which abortion is according to God’s law).
I am deeply concerned about the extent to which the draft policy goes to facilitate practice of physicians in areas clouded by differing and sometimes conflicting ethical values. Particularly the judging of what is “necessary to prevent imminent…suffering and/or deterioration”. This statement will invite legal battles and will compromise the delivery of consistent, compassionate and courageous care by the majority of physicians who remain against legalized assisted death and euthanasia.
I agree that “imminent suffering ” is vague, open to interpretation and over all just bad policy language. It will only lead to much difficulty.
After reading the policies & and most of the responses from both physicians and members of the public, I want to echo the concerns of lines 156 to 164.
These lines must be reworded such that a physician is NOT obligated to make a referral if the referral is against the physicians moral or religious beliefs.
Patients have the ability to obtain second opinions or in the case of abortion they can self-refer. It is not necessary for a physician to make a referral when it opposes his/her moral beliefs.
Physicians must be able to maintain their conscious rights. As a patient I would not want my own doctor to be restricted from his/her own freedom of thought and moral beliefs. My physician should remain a free thinker rather than a slave whom just provides whatever treatment or investigation I request. The benefit patient and physician who maintains his/her conscious rights is mutual. There is no coercion, no resentment, no guilt and therefore less conflict.
As a medical student, I make the following suggestions acknowledging that this topic carries important implications for my future practice.
Regarding the sentence spanning lines 146-148:
I agree with this statement but ask that context be clarified for its application in order to avoid unnecessary confusion. Consider a physician (who does not drink alcohol due to a religious belief) who recommends abstinence from alcohol to a patient who is recovering from alcoholic hepatitis.
Regarding lines 156-161:
I believe the definition of ‘effective referral’ needs more work. What does ‘non-objecting’ mean? Not objecting to seeing the patient or not objecting to this patient receiving a certain element of care? An aspect of an effective referral that should also be included in the definition is clinical competence in providing said element of care.
Regarding lines 168-169:
This statement’s use of the word ‘must’ is inappropriate for there are certain exceptions.
Thank you for reading
I have read the policy of reviewed comments from all. This policy should not move forward. Physicians must be treated as human beings with rights as well. Forcing physicans essentially violates their rights as well as the physician patient relationship.
I agree.
I am surprised to read so few comments in favour of the proposals. I was lead to believe from the Dialogue that there was overwhelming support from the public. Please show us the data.
It is with great dismay that I find the College taking a position that would punish a a physician for following their conscience. Are you saying that a Catholic or a devout Jew or Christian cannot become a doctor? The College is showing itself to be fascist. Yes, fascist and if that word offends you, it is your problem. Abortion is the killing of a baby. My physician has a crucifix in his office, one in the reception area and one in each exam room. Are you going to tell him to take it down?
Enough of this!
In my opinion the following quote summarizes the CPSO:
‘There is no crueler tyranny than that which is perpetuated under the shield of law and in the name of justice’.
Charles de Montesquieu
To whom it may concern! What a tremendous low for the Physicians and Surgeons who work diligently in their profession to save lives. There are, unfortunately, a number of so-called doctors who would willingly take the life of a child growing in the womb. Any physician would know that this child is a living human being – it can survive outside of the womb, with help, as young as 21 weeks gestation…and yet on the other hand, we are willing to suction or dismember that child out of its mother’s body all for the sake of convenience. This is treacherous and inhumane. It’s murder is what it is. Please do not force doctors with a conscience to have to murder!
I am concerned that the College of Physicians is arrogating to themselves authority they do not have and are not entitled to. How can anyone force someone else to go against their moral or religious values? Smacks of fascism to me! Will doctors have to be engaged in civil disobedience in order to make their point? I would prefer to have a doctor with a moral compass based on traditional Canadian values. Otherwise I may fear being used as an experiment for unsafe drugs such as RU-486 or Gardasil or worse.
patients need to be able to trust their doctor completely in order to partner with them in their own care. When that trust is broken, care becomes inferior and the quality of many lives are lost. Stay out of the moral issues! Don’t force your immorality on those who wish to have a moral foundation to their work and practice!
The present news sheds some light on the current issue of PAS/E and Canadian Human Rights. Events in the Middle East have reminded us of our freedoms: especially freedom of association, freedom of belief, freedom of conscience, and the right to practice one’s career in the light of these freedoms. Such freedoms are an integral part of a free and democratic society. On these grounds the coercive aspects of the CPSO’s draft Professional Obligations and Human Rights Draft Policy must be withdrawn.
CPSO mandate is to protect public by maintaining the highest professional standards of their members. The physicians are expected to provide care within the scope of their training, irrespective of their religious beliefs. The freedom of religion should not entitle physicians to refuse care to their patients just because abortions are wrong or gay peoples are sinner, according to their irrational religious beliefs. These physicians can exercise their religious freedom in their churches or privacy of their home, but not at the expense of the publicly funded health care system. If you can’t provide care to your patients within the scope of your training because of your beliefs, even if they are religious, then leave the profession and do something else.
You took an oath not to harm anyone and abortion ends human life. Therefore every physician, nurse or aid should have the right to refuse participation irregardless of where they came up with the idea that killing is wrong. If policy makers can’t understand that then they need to find a different line of work, not those who spent a lifetime training to reach a life goal of helping and sustaining life.
Life is religion, and everybody is religious. You and I are as religious as fish are aquatic.
The CPSO is supposed to regulate the practice of medicine in order to protect the public interest; the police are supposed to protect the public. But whether the CPSO has a mandate to “protect the public” or protect the public interest, they should not be requiring their members to kill or mutilate people.
Abortion is wrong because it is the deliberate killing of a human being. Your denial of his existence is, to use your term, an “irrational religious belief”. Abortion isn’t care; it’s killing.
Freedom of religion as a right developed in a Christian context. Isn’t it related to the separation of church and state and to disestablishmentarianism? I might go to a different church than you, but there was no question that we shared a Christian world and life view. I realize that now the majority of Canadians adhere to secular humanism, but in the days when the Canadian anthem was written, Christianity was the dominant religion. And it is a reasonable faith.
To rephrase your advice, if you are going to kill or mutilate your patients or those entrusted to them because of your beliefs, which are religious, then leave the profession and do something else. Please do no harm.
The attitude here sadly assumes an adversarial role with pro-life doctors. This is not needed.
Please consider advocating for the Child Benefit Payment. Can we buy our freedom? The great Christian hero, Wilberforce said yes. http://www.huffingtonpost.ca/bill-haines/can-we-buy-our-freedom-wi_b_2940361.html
I am deeply saddened. How hypocritical to say you can not cause not cause harm to your patients, yet you are now setting a mandatory policy to kill them. Abortion ends human life, the exact opposite reason more than just most but approaching all people get into medicine. With all the information that shows the traumatic effects on mothers and even fathers who regret their choice to abort, I find it completely appauling that anyone who simply wants to work is going to be forced into participating in this kind of medicine. So now not only are we saying someone in the equation doesn’t have the right to live, but now also that we have no rights to act on conscience, spiritual beliefs or engaging in mentally unhealthy work.
I would like to express my strong objections to the CPSO draft policy on “Professional Obligations and Human Rights.” In particular, under the section “Ensuring Access to Care,” the requirement that doctors make an “effective referral” for a service that one finds unacceptable due to moral or religious beliefs is essentially a requirement that physicians act against their beliefs. For example, if euthanasia is legalized in the near future, are physicians who are morally opposed to euthanasia required to refer patients for euthanasia? Such a referral makes the referring practitioner morally culpable and is therefore unacceptable. It is sufficient for patients to be informed of the availability of a service and how to access the service. Thus, I urge you to remove this clause from the policy.
1-This truly violates my rights of freedom of choice.
2- If the public does not agree with this type of practice, change doctors.
3- Yes doctors are hard to find, this will make it almost impossible to find a doctor now.
4- Government, as a canadian I respect your choices, now respect mine, leave it up to me
as a canadians to decide which doctor I choose.
5- I AM TOTALLY AGAINST THIS DRAFT POLICY.
I am sensing that your policy review of the
The Physicians and the Ontario Human Rights Code policy,
Is only directed towards the abortion issue or other similar issues related to care when a patient refuses care on religious grounds.
You are concentrating on this Policy and denigrating the overall Patient complaint/Patient Rights and basic Human Rights issues.
We need a forward thinking system of Patient Guardians in nursing homes, Patient Guardians for children, and generally that ANYONE can access in ANY hospital or healthcare facility that would independently investigate and monitor a patients critical issues in the system. I implemented such a system in Guardianship Monitors in the State of Florida for elderly who were at their own homes. We found abuses and recovered $500,000.00 in “misappropriated” funds for Seniors in one County alone.
The CPSO should advocate that this whole issue of cooperative care with different monitors and health care providers that is preventative not reactionary as its focus.
We simply do not have that system.
We need to build that first. This policy review should be secondary to that initiative.
Dear Sir or Ma’am,
I object to the revised Professional Obligations and Human Rights. Physicians should not be forced to participate in controversial procedures such as birth control, abortion and euthanasia. These practices have the potential to do harm to patients, and mandating them puts physicians in a bad position. As a current medical student, the passing of this draft would discourage me from pursuing my medical career in the province of Ontario. I recommend the rejection of the current recommendation. Thank you for your consideration.
To whom it may concern
People become doctors because they are called to a vocation of healing. They are in the business of healing not hurting, of respecting and enhancing a person’s quality of life; Catholic physicians believe in the sanctity of human life. They are not in the business of ending a life, rather they are dedicated to the healing process. Please continue to allow Doctor’s to work wihin their religious belief’s. Being a Catholic, I would want to see a doctor who had the same belief’s as I since they could provide counciling that was not contrary to my own.
Thank you.
This is the grossest discrimination against doctors and will have a chilling affect on the general public. Doctors have a right to refuse to participate in the death of their patient. This is a nakedly violent act of ideological warfare. So much for pluralism and democratic values. Lots of abortionist and euthanist doctors will jump at the chance to end a life. So why force a doctor of good conscience. How could you even think to pass such a draconian measure?
Thank you for the opportunity to respond to this draft policy currently under review. The primary concerns addressed by this revision centre on the rights of patients to a desired treatments and the rights of physicians to practice medicine in a manner congruent with their moral principles. The two major areas that currently appear on the discussion board are abortion and euthanasia/assisted suicide.
One issue rarely addressed in discussions of accessibility in a variety of situations, not just in medicine, is that whenever you draw a line that permits only one course of action you have actually simply created a new form of discrimination. The inevitable consequence of placing one particular point of view or belief ahead of any other points of view or belief is the unintended establishment of reverse discrimination. For example, it is as discriminatory to say a physician’s moral position is unacceptable in the practice of medicine as it is for a physician to harass a patient for expressing a desire for a treatment or procedure that is against the physician’s beliefs. Both actions are discriminatory and should be prohibited, not just one. In my experience Christian physicians are very willing to provide information about all options to patients in a respectful, professional way, helping the patient sort out their feelings and questions about the various possibilities so they can make an informed choice. If the patient does make a decision that the physician cannot personally be involved with the patient now has the information needed to access their chosen treatment with the physician being able to maintain his/her moral integrity by not participating directly. This approach preserves human rights for both the physician and the patient.
As a physician with many years of experience and a set of moral values/beliefs that are important to me and to many patients, I could share examples of patient interactions where my understanding of their ethical framework actually led to the refusal of extreme medical procedures with a clear mind and heart about the decision, and family members who could continue in peaceful acceptance of the realities of the situation rather than distrust and confusion. I could share times when recognition of the fears and belief structure of a patient facing major surgery led to a request for prayer which had a profound calming effect on the patient.
A patients’ belief system, whether Jewish or Muslim or Christian or some other religion can have a profound impact on their handling of an illness. A doctor who has no understanding of the potential impact a patient’s values/beliefs may have on their decisions and stresses will actually be a less effective physician. There is value to maintaining a diversity of belief within the medical profession.
There must be ways of resolving access issues short of mandating that ALL physicians must be willing to perform or refer for procedures that violate their core beliefs. For example, although access to abortion is constantly raised as a critical issue in discussions of physicians who don’t want to be involved in that particular procedure, in reality Ontario patients can already self-refer. One would expect that model could be expanded to other areas.
There is no question that disrespectful behaviour or approaches that stir up fear or guilt are inappropriate in ANY medical encounter, and should be disciplined appropriately.
Information is essential for a fully informed patient decision. Christian physicians are willing to provide information to patients about all possible options. This is a necessary part of an informed discussion of all available choices, but may be something that the CPSis not aware of. Such information sessions need to be calm, factual, non-judgmental and professional. A caring discussion allows the patient to sort out their values and feelings about procedures and then allows the patient to make an informed decision. If at that point the patient makes a choice that the doctor is unable to participate in then the patient knows how to access the procedure and the doctor is able to maintain their moral integrity by not participating in the action. In this kind of interchange a professional relationship can be maintained that is truly non-discriminatory of either party.
Hopefully most physicians go into medicine because of their strong desire to serve the needs of their patients. This may or may not have a faith-related component to their motivation. A physician who is forced to end up practicing medicine as a robot…. unable to live and work in congruence with deeply help beliefs that shape his/her very being, will not be functioning from a place of wholeness and will burn out or seek other areas of work.
Human ‘rights’ will always have places of potential tension. To be otherwise would require a forced absence of diversity that would destroy the vary heart of the physician-patient relationship. I strongly request that the CPSO reconsider this policy.
If a physician does not wish to preform abortions, they should not have to. It just wrong to force your beliefs upon someone else. Let people who would like to have or need an abortion go to physicians who are ok with preforming them!
Forcing someone to promote something against their beliefs is sooo wrong. Doctors are human too
Those who do not respect the moral obligations that others hold dear continue to try to strip away from them what defines their entire life!!!
this is getting weirder and weirder here this new doctors coming in to save lives and you now make them killers against their will. there is no authority that can force others to destroy life. but then again the medical society is so corrupt they are not in it to save they are in it to kill and how can we kill more. Oh vaccines and radiation
get a life and leave others alone
As Physician said, if a physician decides not to accept someone because of creed, race, income … it is discrimination. But if a physician decides not to perform certain procedures because of his or her believes and or conscience that MUST be not only respected but also protected. We are supposed to be in a FREE country after all.
The conscience and believes of the physician MUST be not only respected but also protected. A physician SHOULD NOT be obligated to perform a procedure that goes against his/her conscience and/or believes. We are in a free country after all.
I strongly disagree that a physician should have to kill a pre-born child especially if it goes against his or her personal and professional beliefs.
This policy is EVIL and all WRONG! God have mercy…you have no idea what you’re getting yourselves into.
No physician should be forced to become like the devil and perform or “treat” what is against his/her beliefs! This is MURDER!!
Won day we well cry over this baby’s that we killd and we well sofer It es killing …… No mater what it es killing human Ben
I understand the College of Physicians and Surgeons of Ontario is considering a policy of compelling doctors to murder unwanted people to wit: unborn babies and elderly people. If the policy is to allow this kind of barbarism, well, everyone has their own conscience and eternal soul to contend with. But the very idea of compelling anyone to commit these heinous crimes is abhorrent. I for one would not trust any doctor with no conscience and personally object to anyone forced to commit murder. Why not just march them off to the gas chamber.
Abortion and birth control are at the highest degree of morality for the doctors who wish to refuse these services. Abortion, as well as birth control in the case where the fertilized egg does not attach itself, is seen as ending the life of a human being. What I mean by “highest degree of morality” is that it is not simply at the same level as stealing a piece of candy from the store: our law system recognizes that the ending of a human life requires the offender receive arguably the highest degree of punishment. And these doctors believe, with strong rational and scientific backing, that the acts which the doctor must provide or refer for are breaking the aforementioned law: the ending of a human life. Thus by asking our doctors to provide or even refer something that is at odds with this moral belief, which again stands at the highest level of importance in their life, you are in essence asking them to violate their highest level of conscious belief. I think it is more than reasonable (of course very rationale if one simply look at the evidence) to state, given the belief has very strong reasoning behind the ethics of ‘why’ it is believed, asking doctors to violate this fundamental belief so that room can be made for this very recent demand is utterly shocking and stands no ground of comparison. There is simply not enough evidence supporting that the right to a referral or an abortion trumps the most fundamental religious and/or moral belief of the individual. This is not trumping the right to attend a service (though this has its own strong implications), this would trump the conscience of the individual, wherein lies the decision on the highest moral ground. To trump this is unconstitutional, and would represent the slamming down of a post-modern foot via ignoring the very strong rationale for the stance against providing the services. If the College is prepared to undermine human reasoning for the relativistic stance of providing for those citizens who shed bloody tears to win the College’s vote, then I must seriously question if I am safe to attend my doctor knowing the College’s view on the essence of being human.
I hope it does not come to this.
It is absolutely ridiculous that you are even thinking of making a human being perform a procedure such as this, against their will. We already have had enough GOOD doctors who have left this province/country because of the ridiculous policies placed upon them. This is violating the physicians human rights, did you think about that part? Or were you too busy trying to be politically correct? I chose my obstetrician partly on the premise that he does not perform these procedures. What about my choice?
I absolutely unequivocally disapprove of this. This is a violation of the human rights of our physicians. You need to take the rights of our physicians into consideration. If the demand for these procedures outweighs the availability of service, you need to start looking at other potential avenues where you have failed, before imposing your will or policies on another human being. Especially our beloved physicians who we desperately need in this province.
I sincerely hope that this draft does not become reality. Ontario, you continue to disappoint me.
Last year I expressed my opinion on this subject and I am doing it again:
Keep conscientious rights for doctors in place!!!!!.
Don’t force doctors to act against their conscience, like robots.
Last years survey told you that the majority who responded to your survey voted for conscience rights.
Why are you now drafting a policy that would get rid of those rights?
If you do, we will be stuck with uncaring, unfeeling, robots as doctors. How sad.
What a shame you did away with the Hippocratic oath. When did that happen?
This goes for the question of Euthanasia as well.
Don’t kill people. At least feed and hydrate them if the patient has it in his/her living will, the family, or guardian wants that.
This goes especially for coma patients.
So please keep conscience rights for doctors in place!!!
I am writing to voice my concerns with the proposed CPSO draft policy on Professional Obligations and Human Rights with especial reference to the requirements for a physician who is unable to provide a requested service for moral reasons.
My concerns are from my perspective as a palliative care physician. The overriding philosophy in palliative care, in seeking the comfort of the patient, is neither to prolong life nor to hasten death. For this reason neither assisted suicide nor euthanasia can ever be part of palliative care. There is a real possibility however that the Supreme Court in the near future will rule in favour of assisted suicide and that it will become accepted practice by the medical profession.
Thus faced with a request for assisted suicide from a patient, I would be required, by this College policy, to refer them to a physician who is “non-objecting, available and accessible “ to facilitate the assisted suicide. This in conscience I could not do. It would be as much participation in assisted suicide as actually implementing it and it is not right for the College to compel this. The two options that could be offered to the patient are to facilitate the transfer of all their medical care, without prejudice, to a physician of their choosing, or to remain as their physician if they so wish (non-abandonment)
I therefore strongly request that the policy be modified to take into account these concerns.
I need to express my objection to any pressure on doctors who through a conscience objection feel unable to perform abortions , euthanasia or birth control. They must be able to follow their duty to save life , not destroy it.
Just a note to let you know that those of us in this country that still have a conscience are against going into the womb and killing babies.
You probably have a few doctors that have a conscience.
I bet Hitler had a few doctors that had a conscience.
Shame on you!
To Whom it may concern:
I object to your new policy not allowing doctors to in accordance to their religious and moral beliefs!
If I knew my doctor believed in euthanasia I would find a new one! The reverse also applies ,if I want an abortion and my doctor doesn’t believe in them then I will have to go some where else.
There are enough amoral people in the world!
This is a crime that you are infringing on the physician’s freedoms and rights!
Heaven forbid what the future will be like for my grandchildren when we have so called knowledgeable and prestigious organizations as yours advocating such devaluing of people!
As an advocate of preborn human rights and a parent who has great respect for medical professionals across the province, I highly object to the college’s proposal to discriminate against people of faith and moral conviction and infringe against the religious freedom of doctors and specialists who morally oppose a policy that mandates members to counsel patients to have an abortion or refer patients to seek access to abortion.
The rights of those who advocate abortion should not trump the religious freedoms of medical professionals who support preborn human rights.
Are you considering the original feedback – I can’t find it on the website. My comments remain the same, including about your website as set out below – and I would add that it would help if you had a more explanatory title. It certainly is not obvious that this includes prescribing birth control and providing abortions. You appear to be simply inviting the same people to comment – from the first two days worth mostly physicians who are pro-life and members of the public who share my position.
First of all, your website is difficult to navigate. Even though I knew of the consultation from the Globe and Mail article today, it took me some time to find it and then to work my way through it. This is hardly transparent.
On to the policy. It is unacceptable, whether framed in terms of an Ontario Human Rights Code violation or not, for physicians to refuse legally available treatment that is within the area they are practicing. If they do not wish to prescribe birth control, conduct prenatal tests that may lead to abortion, etc., then they should not practice in these areas or should not practice medicine at all.This is/should be no different than Catholic pharmacists being required to fill prescriptions for birth control (or I suppose a Scientologist pharmacist being required to fill a prescription for an anti-depressant) and Muslim taxi drivers being required to pick up passengers who are carrying alcohol. A medical practice, like a pharmacy or a taxicab is not a place of worship, essentially a club setting the rules for its membership.
Over two decades ago, I “went elsewhere” for an abortion as my doctor at the time was not supportive. I was supported by family, well-educated, financially secure and close to alternative resources – advantages many women do not have and should not be required for them to receive the treatment they need.
It is unacceptable, whether framed in terms of an Ontario Human Rights Code violation or not, for physicians to offer abortifacients or do abortions. Killing the child is not an acceptable way of solving a problem pregnancy.
May the day come when every doctor is a pro-life doctor and all children have a recognized right to life.
This is nothing short of a violation of our basic rights and freedoms, especially freedom of conscience and religion, under the Charter. We all know that to enforce such a Draconian law or requirement will mean automatic dismissal or termination of employment for medical doctors/personnel who hold strong religious convictions about the sanctity of human life. Shame on them to impose such political correctness on medical doctors/personnel that chose to practice medicine here because we are supposed to believe in tolerance and respect the beliefs and values of others. If this is someone’s idea of “progress” God help us.
I also say it is for the doctor to decide because they whenthey became doctore to uphold and work for the keeping of a person alive and healing them. Abortion, they are killing a small baby who is not able yet to speak for them selves. There has to be a better way. Having the child and have an organization to have that child adopted by capable and loving people who can’t have their own children or want more children, 8r just do not want to go through birthing process, but would love to have a child. So many good reasons for keeping tbeir child till birth. Give the unheard child a chance. It is not their fault they are being born to a person who does not want the child.
As a retired Palliative Care physician, I am very concerned about the words apparently given to the Press regarding physicians rights (or lack of them). It would appear that, rather than supporting Ontario physicians, there would be a form of “ethnic cleansing” and many MDs of Christian, Jewish and Muslim background would be ousted from the profession to which many of us have devoted our entire professional life.(This is especially pertinent to my husband and myself who have two grandchildren in Med School – what we say to them?) Probably Dr Somervilles suggestion that the College set up a list, easily accessible, of MDs who are willing to provide “doctor-assisted suicide” and/or abortion, is a very reasonable idea.
On the contrary, the statement is true, and the College is misrepresenting its own draft policy.
I, too, am in full agreement with Margaret Somerville. Whether they admit it or not, the CPSO is indeed effectively telling physicians unwilling to provide or facilitate abortions that they should not be family physicians.
Past president of the CPSO reportedly said to the CATHOLIC REGISTER: “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. … Medicine is an amazingly wide profession with many, many areas to practice medicine.” (https://www.lifesitenews.com/news/doctors-who-oppose-abortion-should-leave-family-medicine-ontario-college-of)
The CPSO has been most deceptive in its approach. Hell by any other name is still hell, and natural death can take you there fast enough already.
REPLY FROM ADMINISTRATOR: Recently, the National Post published a commentary that falsely attributed the following statement to a College spokesperson: “Physicians unwilling to provide or facilitate abortion for reasons of conscience should not be family physicians.” This quote is categorically false, and misrepresents the College’s expectations of physicians who limit the health services they provide on moral or religious grounds. The College has asked the National Post to publish the following letter to correct this false statement and to clarify the College’s position: http://policyconsult.cpso.on.ca/wp-content/uploads/2015/01/Letter-to-National-Post-January-23-2015.pdf
To the Administrator: Please answer what a physician would be required to do if the following excerpt from your letter to the National Post was not achievable?
“More specifically, our draft policy (which is currently open for public consultation), says that physicians,
who are unwilling to provide certain elements of care due to their moral or religious beliefs, are required to
refer the patient to another health care provider. This must be an “effective referral” which means one that
is made in good faith, to a non-objecting, available and accessible physician or other health care provider.”
There are numerous concerns with the CPSO’s proposed Professional Obligations and Human Rights document.
Beginning with the introduction, there are rare times when a physician’s morals conflict with the rights, autonomy, dignity and diversity of patients.
One example has already been provided: female genital mutilation (FGM). On this topic the CPSO has categorically stated that the provider is just as complicit in the act regardless of wether they are referring for it or providing the service.
Case closed. The CPSO has answered that question already. The CPSO has openly stated that if it is wrong to do the procedure it is just as wrong to refer for it.
http://www.cpso.on.ca/policies-publications/policy/female-genital-cutting-%28mutilation%29
Patients have the right to self refer. They do not have the right to expect doctors to violate their conscience. If a patient had the resources to find the first doctor they can use those same resources to find a second.
Line 163 of the document suggests that the physician who objects to the procedure should keep an up to date list of physicians who will do the procedure.
This violates the CPSO mandate listed above.
If the CPSO requires a list of physicians who are willing to perform controversial procedures then they should have the duty to provide it on their website; not the doctors who object to the procedures.
The CPSO can assume responsibility for what they advocate and can ensure that patients have timely access to services. Instead of demanding that others do it they can simply do it themselves.
2. My second concern involves rural physicians. The point has already been made that these revisions will cause more problems than they will resolve.
Residents of rural communities understand they they do not have the same access to services as those who live in larger centres (cardiac cath labs, stroke units and in some cases abortion services). It is their choice to live there.
If the physician objects to certain procedures because it violates their conscience and the college forces them to become involved in these procedures (either performing them or referring for them) they are far more likely to leave their practices then to conform to a dictator. This would leave an entire community without a physician (who performed far more services than they objected to). These communities are difficult and very costly to recruit physicians into especially if they know they will have to sacrifice their own rights to work there.
3. The third issue is of discrimination. If doctors are forced to violate their conscience this is severe discrimination against their rights, autonomy, dignity and diversity.
4. This document also lists compassion as their number one key value (line 15). These doctors do not feel that ending life is compassionate. You may disagree with them. But before you require them to become complicit in it; think about a specific example of something you find morally abhorrent. Something that disgusts you to your core. Now imagine a situation where many of those in society disagreed with you and forced you to perform these acts as part of your profession.
What would that do to you?
How would that affect you?
What would your response be?
Keep in mind that if you support the premise of not be able to object to procedures you believe are wrong you may find yourself being forced to do this in the future. There might not be anything you object to now but laws change all the time and unless we defend “conscience rights” now you will not have them in the future. How would you feel about being forced to sterilize mentally handicapped patients or to sterilize muslims in an effort to curb ISIS enrolment? You may object to it but if society deems it necessary and you have forfeited conscience rights then you now have no choice.
“Well that would never happen”. That is what Canadian’s said about abortion and euthanasia in the past.
5. The college also requires effective communication (lines 103 and 139). When I was in medical school we were told never to use Latin terms with patients and always to use terminology the patient can understand. For effective communication.
The only exception was when discussing abortion.
The term “fetus” is latin for “young one” or “offspring”. Blastocyst is a term for the early cell division stage of human development. After a human ovum and sperm unite they have all the DNA info required to become a person sitting across the room from you. The only thing they need is time and the proper environment. The same things all of us need to continue our development as humans.
The question becomes are they people deserving of rights?
In Canada the current answer is no. But Canada does not have a very good record of recognizing the personhood of humans within our boarders. We have denied it to women, First Nations, and Japanese (during wars) to name a few.
I was also taught that when a woman request abortion she will need an ultrasound. The point that was stressed the most is that the woman must never see the screen. Seeing the beating heart may influence her decision.
Line 153 states that physicians must NOT withhold information. I would submit that if the college requires effective communication from their members then abortion providers should be required to ask the mother if she wants to see the screen during her ultrasound. Additionally, they should be required to ask the mother if she wants to know about fetal development; including when the fetal/ young one’s heart starts beating. This is usually before women even know they are pregnant.
They should also be required to inform pregnant women about pregnancy care centres who support women in crisis (Line 152 requires physicians to inform patients of all clinical options).
This should be her right to make an informed choice.
Doctors are permitted to use the term baby at anytime during a wanted pregnancy. Why the duplicity? This is not effective communication.
If the CPSO requires effective communication they must insist on it from all their members at all times; not just the ones with conscience objections.
6. The CPSO requires that physicians act in the best interest of the patients (Line 18). There have been many times when patients have not known what was in their best interest and they required a doctor’s expertise. What they were requesting was not in their best interest. This is not paternalistic it is simply the result of my 13 years of study in the field. To simply say a doctor must do everything a patient requests when they may know a better solution is very irresponsible.
7. Lines 76-77 outline that physicians DO NOT have to accommodate requests beyond the point of undue hardships (including excessive health concerns and legal rights of others).
I can not think of a greater hardship than requiring someone to be involved in what they believe to be the murder of another human being against their will.
This will certainly violate the legal rights of the doctor.
Does the CPSO disagree that this is an undue hardship or that the doctor has legal rights?
Line 120 of the document explains that there is no hierarchy of rights. So the doctor’s rights are not more important than the patient’s. By the same standard the patient’s rights are not more important than the doctor’s; as this document suggests.
Line 126 further clarifies that one can not justify not doing an act for religious reasons if the act does not interfere with the religious belief in more than trivial or insubstantial manner.
I do not think that anyone regards murder or involvement in murder as trivial or insubstantial.
Additionally, Line 62 outlines that physicians must take reasonable steps to accommodate patients. This includes allowing guide dogs into the office. Abdicating their morality is NOT reasonable and not comparable to a wheelchair ramp.
Finally line 168. The document ends by explaining that in the case of an emergency a doctor must act accordingly. This does not need to be explained to doctors who act morally and in good conscience.
In the case of abortion the only emergency is when the mother’s life is endangered. In these cases doctors will save the mother’s life at all cost. If they can not save her then they will save the child if possible. Please refer to ALSO, ALARM and ATLS.
This is not controversial.
In the case of euthanasia there are no emergencies. There are emergencies in palliative care; but do not confuse palliative care with Euthanasia. Emergencies imply impending death or disability if not dealt with immediately. Euthanasia’s desired outcome is death.
There may be a pain crisis. This can be managed appropriately until an operator (I do not think that these people should be physicians; but that is a separate topic) willing to perform euthanasia can be obtained.
So in summary, the CPSO has already stated it is their position that a referral for an immoral procedure is just as complicit as performing the procedure.
If they require physicians refer against their moral views they will have to change the CPSO policy on FGM referrals to be consistent with this position.
They have also stated that Physicians do not have to perform or refer if it will cause them undue hardships. Involvement in what they believe is murder is clearly an undue hardship.
If the CPSO decides to pursue this endeavour they will find they will lose more than they will gain.
They will be left with physicians who strongly believe something is wrong but are willing to do it anyways (no one will want to be cared for by these physicians) or skilled physicians will leave their practices and relocate to other provinces or countries.
Keep in mind this is not a small fringe group. There are many physicians who do not agree with abortion and euthanasia. These are not hacks in some back alley practice. They are skilled, compassionate, valuable contributors to medicine across all specialties.
Thank you for reviewing this document.
It is very clear from the responses above that the majority does not agree with the CPSO policy as it is. I hope there are no political ties that will let this policy pass without considering the feedback of physician members. With due respect, I ask CPSO to change the draft with due consideration of the physicians’ consciences and convictions.
I agree Just glancing over all the above comments and question if it would not be beneficial if CPSO members would remember their oath which I believe is to preserve life.As a nation we allowed abortions and now recently allowed euthnatia. when we go down this path we cannot but expect that we will run into conscience dilemnas, we there fore may not and cannot bind the consciences of those physions who for personal or religeous reasons are unable to assist in these matters ( A general comment.)If as a nation we do not go back to values and morals what will we leave the next generation?
This is a valuable comment. What kind of example is being given to our youth when they see physicians being bullied by the CPSO to violate their consciences? Selfishness and expediency will become the dominant motivators in our society if our doctors are forced to violate their consciences by the CPSO. It appears that “Might” has become “Right”
I am also a physician. I have been in practice for more than 30 years. I fully endorse the comments made here.
May I emphasize the last point? I submit that there is at least a sizable minority of doctors who agree with these statements. It is more likely to be a great majority.
There are many who, for example, believe that abortion is wrong and who would never perform one (has anyone noticed how few doctors are willing to perform abortions?). Yet, they would refer on to one who would. Why is that? I submit, that at least in some of these cases it is out of fear of personal conflict or of reprisal. Doctors fear the power of public perception. There are many more in fear of the “kangaroo court” to which the CPSO may subject them in the case of a complaint.
Perhaps a new look at the fable “The Emperor’s New Clothes” may be in order. I submit that a large majority in our society knows that doctors (and others) should not kill. Why does our society support the very few who are “hell-bent” on demanding that doctors do this?
I agree with this.
Thank you, Doctor, for taking the time to make this response.
You are the kind of doctor of whom I would like to be a patient.
To the CPSO: please do not force this, or any other doctor, to violate his/her conscience.
The College of Physicians and Surgeons of Ontario
Recently, the National Post published a commentary that falsely attributed the following statement to a College spokesperson: “Physicians unwilling to provide or facilitate abortion for reasons of conscience should not be family physicians.” This quote is categorically false, and misrepresents the College’s expectations of physicians who limit the health services they provide on moral or religious grounds. The College has asked the National Post to publish the letter below to correct this false statement and to clarify the College’s position. Read the letter here
Whether the quotation is direct or indirect, it is a true statement. The College is misrepresenting its own draft policy. There is more than one primary source of more than one CPSO spokesperson in December 2014 making or confirming an equivalent statement, but the College made no objection until the January 23 National Post article.
If you want to do something that is against your doctors beliefs then you should find a doctor that suits you. He should just tell you to find a new doctor. Gov should not have the ability to force anyone to recommend a treatment that they don’t agree with. Doctors have rights too!
I am deeply concerned about this approach to legislation that deleteriously harms the personal freedom of physicians to act with their conscience.
I would ask you to delete or change this clause in lines 156 and 157 referenced under “Ensuring Access to Care”. Making an “effective referral” for a service that one finds morally unacceptable is morally equivalent to providing the service oneself and is therefore a violation of the physician’s right to freedom of religion and conscience. In terms of the balancing of rights, a patient can choose from many physicians, a physician only has one conscience. As long as the patient is informed of the availability of the service and how to access the service, a referral is not necessary.
In the name of Lord Jesus Christ: Do Not Kill Beautiful Babies Full of Life
I have committed 35 years practice to ensuring that my patients can trust me to care for their health and wellbeing.
I will never participate in killing them or helping to do so.
I am a 20 year old women who happens to be seven weeks pregnant. And do you know how I got that way? Because I slept with my boyfriend of seven years and decided to get pregnant. If all these women don’t want to be pregnant they can get themselves on birth control or their partners to wear a condom. How do you think that I wasn’t 16 and knocked up? Because I took responsibility for my actions and made sure that I was protected against pregnancy until I was good and ready. It’s not difficult. What will be difficult is all these doctors having to live with themselves and the fact that they’ve been forced to murder countless innocent children. Those are lives, with beating hearts and brain waves. This proposition to force our health care team to murder, is disgusting. We have sickos who dedicate their lives to that already, and honestly, with all the information that we have, I don’t even understand why this is even up for debate. We don’t have enough doctors as it is and now we’ll be losing a lot more when thousands decide that they aren’t going to put their morals at risk for this sick, disgusting medical practice.
This policy came to my attention through social media and I am glad to have read it. I believe this policy provides the correct amount of middle ground for both patients and their doctors. I feel it’s important that physician be capable of exhibiting a high-level of professional objectivity when it comes to controversial but legal treatment options, regardless of personal belief.
Your claims regarding “professional objectivity” and “personal belief” rest on a number of wrong assumptions:
(1) Despite what you imply, Canada’s state religion is not secular humanism. The state should not be attempting through regulation of the medical profession to convert all doctors to your religion. They should be free to promote their own religion, their own “personal beliefs.”
(2) If a personal belief is really, truly, a personal belief, then it will be acted upon. If it isn’t acted upon, then it wasn’t strongly held to begin with. You are essentially advising the state to enable patients to offend their doctors right to the core of their identity–a very dangerous recommendation!
(3) Contrary to the practical effects of what you are feeling and believing, the objective of the medical profession (the “professional objectivity” you spoke of) is NOT to kill and mutilate people.
(4) There is more totalitarianism in your comment masked by your phrase “correct amount of middle ground”, but I’ll just say that Canada is a free country. Nobody should be able to force a grocer to provide bread, and nobody should be able, for example, to force a doctor to recommend “contraceptives” (many of which aren’t truly contraceptive, anyway).
Absolutely ABHORANT. This is human life!! Not just some growth to excise!! Repulsive. If there is no harm to the mom or baby and there is no medical reason to kill, there should be a strict law that this sickening murder be banned forever and the defenseless human being have a life that he/she is entitled to. So vile to force a doctor to do such an inhumane act. This is so harmful to the doctors wellbeing and psyche even if he is the middle man to refer to another doctor! So barbaric. I can’t believe that functioning “human beings” would even think of such things. Disgusting.
The new Professional Obligations infringe Charter rights freedom of conscience, religion,thought, opinion and expression. They also presume to now or in the future (with legalisation of euthanasia) to oblige one person to kill another, or aid in killing another person. The College is way beyond its scope of jurisdiction
Last time I checked, doctors are people with feelings and beliefs as well. It sickens me to think that the government feels it’s acceptable to force doctors to perform procedures that go against their own beliefs. What on earth is wrong with a person going out and just finding a doctor that is willing to perform a particular procedure??
The College asked, “Are there any issues not included in the draft policy that should be addressed? If so, what are they?
One major issue over which the College has some degree of influence involves medical students, medical residents, and student nurses who obtain a major part of their hands-on training in hospitals, hospices, and other institutions that provide patient care. If that “care” includes abortion (or eventually, perhaps euthanasia), students and residents will be expected to participate in such procedures as an essential part of their training. Even at present, students who have medical, moral, ethical, or religious scruples about abortion may find their training situation made quite unpleasant by instructors who push them to participate.
A second major issue is the absence of a clear definition of what constitutes “medical care”. Very rarely is an abortion necessary to save either the life or the physical health of the mother. At present, the vast majority of abortions are carried out for social, economic, or psychological reasons (“I just can’t have a baby right now!”). To me, such abortions do not appear to be any recognizable form of “medical care”. They might more appropriately be assigned to designated social workers who have received special training for that particular job. In other words, social workers (rather than physicians) would become trained and licensed as abortionists, leaving physicians free to concentrate on their calling – to promote life and care for the living.
I am concerned about the psychological health of physicians who routinely carry out abortions. Those who kill people for a living necessarily become hardened to their work. Some may try to lie to themselves about what they are actually doing, but in either case, the emotional stress of repeated killings will lead to psychological damage of one sort or another.
My clinical experience in Canada goes back to the days when abortion was illegal. I have never been able to identify a natural dividing line that might (even in concept) distinguish a fertilized human egg (which by standard scientific criteria is unequivocally human) from either a newborn baby or a very elderly adult, both of which also are human by the very same criteria. Of course there are obvious differences, but the process of human development and senescence seems to me to be a continuum, with no biologically significant break until death. Any dividing line that we try to make between a “person” and a “pre-person” or a “non-person” will be quite arbitrary, a line that has shifted in the past and will continue to shift with further advances in fetal care and palliative medicine.
In Canada, full-term abortion is not illegal. With no biologically significant way to distinguish between a living full-term fetus and a living newborn baby, is there any possibility that we might soon be required to include the killing of unwanted newborns as a part of our “patient care”? Killing newborns by exposure has a long history, and in certain countries (including Canada) it is still being practiced unofficially. When I first began my practice, I never would have believed that any Canadian physician might come to accept the killing of either a full-term fetus or a mentally-deficient adult as anything other than murder, but we certainly seem to be heading in that direction.
The slaughter of the unborn is the greatest moral tragedy of our time. Forcing our physicians to be complicit in murder would put them on a par with the Nazi medical establishment. The pathetic lie of “choice” has once again been demonstrated.
If the College has any integrity left it will reverse itself on this issue and stand up for a tradition of care and healing dating back to Hippocrates.
We may not agree on what a constitutes a moral medical act, but surely we must still agree that freedom of conscience is a fundamental human right. If a physician, in conscience, decides that referral or provision of a certain service is immoral, they have a right to conscientiously object. The CPSO is severely overstepping its authority in trying to remove a human right by means of policy.
On another note: Last summer’s consultation clearly showed opposition to mandatory referral in all cases (50% opposed vs 44% in favour). This is easily accessible information found in the report on the consultation. Why does the CPSO continue to press this particular issue? There was no major disagreement on most of the other parts of that consultation – they could have approved their revisions and removed the mandatory referral section. I think the CPSO is pressing this issue because the policy committee has a predetermined outcome in mind, aligned with their own political and philosophical beliefs, and they are trying to force this on the profession. Shameful.
I am a Registered Nurse working in Saskatchewan, where the difficulty of accommodating the needs of our large and dispersed rural population is a considerable feet. I believe that providing safe and ethical care to these persons and communities is a top priority. However, I do not believe that the burden of responsibility for the current disparity in services should fall on the shoulders of individual care providers, but rather on the health regions and governing bodies that are ultimately responsible for the equitable dispersion of resources. Therefore, I do not believe that care providers have an individual “duty to accommodate.” As citizens, we recognize that our resources are limited, not only our financial resources, but also the capabilities and availability of each care provider within the systems of care. I believe that it is important that each care provider be clear about what they can and cannot offer (for whatever reasons that may be), and then with that foreknowledge, means of accessing different services within the health care field might be clearly outlined to persons who are requesting care.
Freedom of conscience, like the other fundamental freedoms enshrined in the Canadian Charter of Rights and Freedoms, is a fundamental pillar of being a Canadian!
Society is going too far… be ever embracing markedly intolerant ideology masquerading as enlightened objectivity.
The day that a “committee” overrules one right to adhere to the teachings of ones faith is the day that our society is at risk to the will of a few… kind of reminds me of other country regimes (Communism and worse) that could overrule what is sacred to each individual human being – God and the value of life in all stages of development from conception to a natural death.
This if adopted by the Doctors is but the first step… what’s next.. in 20 years time if a person is old and requires too much of our medical system that it is better for society that that person get’s a needle so that they are no longer a burden to society?
If people want birth control pills or an abortion there are those who will meet the requests of the patient.. so go and see someone else.
Freedom of faith is a God given right and not one controlled by a committee.
Are Doctors not there to save and promote life? That is what the committee needs to be focused on. Have the courage to stand up and not give in to the politically correct world… and when we say correct – to whose standards?
Were I a physician who for moral or religious grounds could not perform an abortion, or euthanize a patient, I would be equally conscience bound to not refer a patient to another doctor willing to carry out the procedure. So the College of Physicians and Surgeons seems determined to place a significant portion of their membership in a moral dilemma, under the guise of a policy of non-discrimination. In fact this policy discriminates in a far more serious manner against physicians who hold moral or religious objections against abortion, and very likely, in the foreseeable future, against euthanasia. This is in fact a policy that seeks to impose it’s own discriminatory moral standards (or lack of them) upon conscientious objectors. I would argue that this is far more serious infringement upon the Charter of Rights and Freedoms, than leaving it up to a patient to find a doctor willing to provide the services they are seeking.
What has become of the right of a physician NOT to kill?
What has become of the Hippocratic oath that imposes the duty not to do harm to your patient? You forget that the physician who takes care of a pregnant woman has TWO patients, not one. In normal circumstances and in all times past, the physician used to give the best care to the mother AND the baby.
And what has become of freedom of conscience? Presecution of Christians is rampant in all countries of the world from Iran to Canada, although the forms of persecution differ. Exclusion of doctors from the medical profession because of their beliefs will be the most detrimental thing to the whole system, because they are physicians who do care about their patients.
One, the human rights of the Christian physician are totally ignored; two, the human rights of the unborn human baby is even more ignored, totally trampled; three, the “right” to kill a human being is NOT a human right.
“Physicians must not withhold information about the existence of a procedure or treatment because the procedure conflicts with their religious or moral beliefs.”
SO WRONG on every level. Let’s speak plainly. If a physician is against abortion but is expected to make a referral to someone else who will perform the abortion, and s/he does make the referral, that physician will be personally involved in and accountable for the abortion, even though not directly performed by him/herself.
In other words, this is not an exception at all for physicians of conscience.
“I won’t do it, but so-and-so will” is just as bad as saying, “I will do it.” At the very least, that physician would be acting as an accomplice, and his or her sin would be complicity with what they know to be murder.
Women who want an abortion can find one pretty much anywhere, sadly, and the only reason for trying to force good physicians of conscience to abide by these ridiculous (proposed) laws is to persecute and harass them.
This policy is wrong in every way, from start to finish, and provides no recourse whatsoever for physicians of conscience. I totally oppose it.
I think doctors should be able to work under whatever moral compass they would like. It is their practice. If a patient does not like it they can choose to find a new family doctor! Having a doctor who has integrity and morals is refreshing in this day and age!
No matter your profession we are people and everyone should be allowed a freedom of believe
If the doctor or physician has told you all your options but at the same time what he/she is comfortable with then the patient is informed and can change doctors or physicians if needed
We do not force a parent or a teacher or a lawyer to do what they feel morally wrong we ask/need teachers to be informed and if needed give the facts and good parents do the same but we do not make them practice it.
Today’s society is to be free of discrimination,harassment and bullying in society and at work but we are making laws to enforce actions and beliefs on others.
If I go to a doctor that tells me I do not deal with certain issues then I know and if these issues effect me I need to find a new doctor or ask for a referral. Today’s society prides itself on knowledge and how to get it they no longer look at a doctor as the one and only source, they ask for 2nd opinions and even 3rd so why are we making an issue with doctors. ALL Doctors have years of studying on saving life and it is a passion and calling and we need them let them do that . Transparency is informing patients of all options and if needed referring them.
As a family physician I have great concern with this policy. To begin with, Canadians have the right to follow their moral beliefs in personal and professional spheres. Not all those who oppose referral for abortions, prescription of birth control, other other things (FGM) do so for religious reasons, yet those physicians seem to be singled out. Many people have the same beliefs, as secular humanists, environmentalists etc, so all rights should be protected. Absolutely, the rights to conscience are foundational values of society. We live in a diverse world, and so need to be able to respect our differences.
For all of the situations being discussed, I simply cannot see how any direct harm is being presented to the patient by their primary physician refraining from making a referral or writing a prescription. All physicians I know who have personal opposition to various procedures or pharmaceuticals are upfront with their patients about this, and enjoy excellent relationships with them. It is very easy – and ultimately faster than a referral – to visit a walk in clinic for any of the procedures / prescriptions in question.
Reading the CPSO policy on FGM, they say themselves, “Further, physicians must not refer patients to any person for the performance of FGC/M procedures.” Why not? Because they know it isn’t right. How, therefore, can they attempt to mandate a physician to do something they themselves believe isn’t right. We should be encouraging a culture of principled physicians.
I worry that for the province of Ontario this policy will alienate physicians, and very well would cause many to leave – causing unknown thousands to be without a family doctor or other specialist. I absolutely agree that we exist to serve our patients, but doing so does not mean partaking in those things against one has a deeply held, sincere belief.
One thing that should be clear to us all is on the right and voice of the unborn. Who stands for the unborn? Some approach this from economic point of view, convenience point of view etc.
Human Life should be respected and given right at any point in time it starts. We should use education and awareness to our younger generation to make them responsible but once life starts it is not up to the parents or physicians to decide on its fate, that life in the womb is defenseless and must be defended otherwise it should be considered crime. May be it is that unborn child that was meant to help the parent grow, and humanity grow, we don’t know what we are killing, we are just acting selfish.
The concern I have is that our country is fostering a culture of death, rather than of life. This situation is not going to get better until we see our belief in the sanctity of human life covering both edges of life, the beginning and the end. We must speak to the integrity and dignity of the human person from conception to natural death. Taking one’s life is not a right. To prematurely end’s one life usurps a prerogative that belongs to God alone. We are not authors of our lives, and we ought not be the finishers of our lives. When healers become accomplices in killing, the trust of patients plummets. Elderly patients will be afraid to go to their doctors or into the hospital for fear that if their life isn’t judged to be worthy of living it will be prematurely ended by a medical community that doesn’t see that as being particularly problematic. In our broken health care system, the elderly, the disabled and people with terminal illnesses or chronic conditions will feel threatened. NO ONE should be ordered to go against any of their moral or religious beliefs in any profession under any circumstance, especially doctors & nurses. These are the people that are called to care for and heal the sick not to kill them. Let us pray that God will give us the strength and grace to bear up under the most difficult and painful of hardships till our last breath when He calls us home. NO DOCTOR should be ordered to kill at a patient’s will.
The prevailing wisdom is that medical school admission should be guided not simply by the best grades, but by a deeper dedication to the service of others. Indeed, good medicine is more than good scientific technique. Good clinicians are expected to be medical experts on one hand, and conscientious caregivers on the other. It may thus appear paradoxical that the very organization that is supposed to promote good medicine in Ontario plans to impose drastic restrictions on the rights of physicians to freedom of conscience.
The CPSO policy attempts to redefine physician integrity. Merriam Webster defines the term as the quality of being honest and fair, and as the state of being complete and whole. For the CPSO, however, it boils down to ensuring timely and effective delivery of medical acts no matter one’s moral objections, and the state of separating one’s beliefs in personal life from those in professional life.
Until now, outside of emergency situations, the CPSO had allowed doctors to step aside when a patient requested a treatment in conflict with their moral convictions. The emergency clause was present because of irreparable consequences of treatment delay, for example, if an ER physician were to refuse to give blood transfusions in a life-and-death situation. The argument of urgency does not apply for a gynecologist who runs a practice where abortions are not performed. Likewise, a family physician who offers thorough holistic patient care may choose not to offer referrals to abortion clinics on moral grounds. The idea that a referral is not morally implicating is flawed, because an active involvement in the chain of medical acts implies complicity. The CPSO itself recognizes this principle, which is why, in the case of banned medical practices, it sanctions not only the operator of a procedure but also the referring physician (e.g. CPSO Policy Statement #2-11).
For this to represent a true limitation of patients access to treatment, there would need to be a significant proportion of physicians that take a stance. Such a resistance movement may exist, but only when clear lack of consensus exists … in which case intellectual honesty forces us not to use biased terms such as “access to care” when others might just as well speak of “access to morally questionable medical acts”.
It is a fundamental principle that anyone in a democratic society be able to perform their work in a manner that is consistent with their beliefs and values. Simply informing a patient that they should seek out another physician for a particular service — if any physician prefers not to perform or refer for a service — should suffice.
I have just finished reading the latest Dialogue.
I would like to respond to the draft policy “Professional Obligations and Human Rights”.
I believe that in clinical matters where there can be harm to patients, that physicians’ conscience rights should be pre-eminent and physicians should not be obligated to treat or refer patients when it is against their best judgment.
In cases of controversial medical services, a physician’s obligation should not go beyond ensuring that their patient is aware of both the availability and accessibility of the medical service. In the case of induced abortion in Ontario, at present a patient can self-refer.
I believe that patients are best served when the integrity of their physician remains intact and that this is vital in maintaining a healthy therapeutic relationship.
Therefore, I believe the proposals in the draft policy that a physician be obligated to refer a patient even when morally unacceptable (lines 156,157) or provide treatment in certain cases under the same circumstances (lines 168,169) should not go forward. As to the second issue, the wording “imminent suffering” is too broad and will lead to significant difficulty with interpretation and implementation.
I trust you will seriously reconsider these proposals .
Once again our Christian beliefs are trodden on by Government. We are being told our beliefs mean nothing, they are not important. We are being forced to practice only what the Government allows us to. Is it any wonder more and more people disrespect politicians and their bleeding heart friends. Slowly but surely we are loosing our rights in the charter of rights.
I am pro choice but I would never want doctors in Ontario to be forced to perform abortions. I agree that in some remote places it may make access to safe, legal abortions difficult. But this is a burden which must be placed on our society as a whole- not on individual doctors. We need as many doctors who care about preserving the life of an unborn child as doctors who view this decision differently.
The Canada that I have lived in all my life and love for its diversity and acceptance of everyone’s religion and beliefs would not for people to go totally against their beliefs to perform abortions. As a country we have modified police uniforms to include turbans and allowed school children to carry swords as a part of Gheorghe religious beliefs. Every day this country accommodates people of different religions and beliefs especially immigrants. And yet we are going to tell someone they have to go against their beliefs and provide abortions. To me as a Christian that is like telling a person who is Jewish that they must eat pork or a person who is Muslim that they may not stop their work to pray. Why do we go out of our way to accommodate every belief EXCEPT for Christian. It isn’t fair and it isn’t right and it isn’t what I expect from my Canada.
Dear Sir/Madam,
I am a family physician in practice for 20 years. I have been privileged to be able to share both the joys and sorrows of many patients, from the young to the old, from patients with chronic illnesses to those with end- stage diseases. I have always been clear to my patients about what I will, and will not do as their physician. I do this with the utmost care and thought with their best interest in mind.
My patients have respected my position and we often find common ground in finding a solution to their problems. This does not include me referring them to another physician who will do what they ask. My patients respected me for having a moral belief and my rights to conscience, and more than once they started thinking deeply about what it is they were asking for and decided against it.
I strongly oppose the CPSO’s draft policy that limit physicians Rights to Freedom of Conscience and Religion guaranteed in the Charter, and require them to make an effective referral to another physician if they refuse their patient’s requests, such as for euthanasia should it be legalized.
Thank you for your attention in this important matter.
doctors should be allowed to perform procedures based on their own moral convictions.
coercion is not necessary and in itself immoral.
respectfully submitted,
As I understand, the draft of the Professional Obligations and Human Rights policy has been approved by Council for external consultation, and thus I would like to offer my comments on the named document which I have read.
I am a Registered Nurse working in Saskatchewan, where the difficulty of accommodating the needs of our large and dispersed rural population is a considerable feet. I believe that providing safe and ethical care to these persons and communities is a top priority. However, I do not believe that the burden of responsibility for the current disparity in services should fall on the shoulders of individual care providers, but rather on the health regions and governing bodies that are ultimately responsible for the equitable dispersion of resources. Therefore, I do not believe that care providers have an individual “duty to accommodate.” As citizens, we recognize that our resources are limited, not only our financial resources, but also the capabilities and availability of each care provider within the systems of care. I believe that it is important that each care provider be clear about what they can and cannot offer (for whatever reasons that may be), and then with that foreknowledge, means of accessing different services within the health care field might be clearly outlined to persons who are requesting care.
Dear college members,
I do not like your planned implementation of insisting that all doctors will have to refer for abortion or birth control even if it is against their conscience. That goes against the right of citizens to hold their own conscience sacred. If a citizen can’t get their car fixed at one repair shop, they quickly find another more affable. If a woman wants a referral for abortion and one doctor won’t give her one, then she is quite capable of going to another doctor. Why should the doctor be forced by law to tell her to go to doctor “D” (offering death) rather than doctor “L” offering Life.
I can see that it won’t be long and doctors will be forced to counsel for euthanasia. That would go against some doctors’ consciences. I would be very afraid to go to a doctor then because who knows if I would be counselled to accept death or offered care to restore life.
Protect the conscience rights of doctors and the credibility of doctors’ oath to first do no harm!
I am very concerned about the prosed legislation and how it will impact the ability of my physician to provide care in a way that does not violate her rights as a human being.
While I agree that doctors should not discriminate against patients and patient care is of the utmost priority,
deciding not to offer a service in no way discriminates against patients provided that the service is not offered to any group.
It is hard to see how limiting physicians Rights to Freedom of Conscience and Religion guaranteed in the Charter will result in less discrimination or better patient care
Requiring referrals or requiring the doctor to participate in procedures that go against their beliefs may eliminate them from practice, and reduce their personal sense of integrity, if they remain in practice. Interior dissonance between deeply held beliefs and professional requirements can lead to burnout. This is systemic discrimination based on conscience or religious belief. It will impact patient care.
The requirement for referrals may actually slow down patient access to services. For instance in ON patients self refer for abortion.
This policy will cover euthanasia should it be legalized. Forcing doctors to refer for something, or perform something they consider to be killing a patient will completely go against the whole reason they got into medicine in the first place – to heal patients – not to harm them. This is a coercive action that involves a large percentage of physicians who do not want to be involved in euthanasia/assisted suicide. Their rights to conscience were asserted by the CMA at their August meeting.
There are many creative ways to maintain conscience rights and allow patients to access these controversial services. Surely a tolerant country like Canada can come up with a way to make this work.
Dear College of Physicians and Surgeons of Ontario,
I am writing to you as a member of the public in regards to the College’s Professional Obligations and Human Rights draft policy. I caution against the release of this draft as an official policy because it discriminates against both conscientious physicians and those who seek care from them.
Canada is a pluralistic country that values many different viewpoints and welcomes diversity. If physicians who maintain conscientious objections to certain procedures are forced to leave Ontario (or Canada if your policy is adopted by other provinces), many Canadians such as myself will be robbed of care that is in keeping with our understanding of the goals of medicine. I do not want to be treated by a physician who is comfortable checking her conscience at the door, nor by someone who is willing to treat me in a manner that she does not believe is in my best interests. I want my physician to use all her faculties, including her conscience, when she treats me.
Please do not impose one view of medicine on the Canadian public. Please allow me the freedom to see a doctor who will treat me in a manner that respects my human dignity. Please do not adopt this policy.
Dear CPSO,
I am writing to you in regards to CPSO’s draft policy on “Professional Obligations and Humans Rights”. I have been a member of the CPSO since 2013 when I started family medicine residency. I currently work as a licensed family physician in Toronto.
I am very concerned about the ideas and guidelines set out in the policy stating that all physicians must make an effective referral for all procedures or medications that they do not provide out of moral objection. While it is important to ensure optimal patient care, this change in policy hinders physician freedom of conscience and religion. It is necessary to protect physician rights as well. Physicians should not be forced to refer for procedures against their conscience. Even if physicians don’t refer for these procedures, patients are still able to get them in a timely manner without compromising the physicians’ freedom of conscience.
I strongly urge the CPSO to change the draft policy.
Even though I live in Alberta, I read the proposals of CPSO with considerable alarm. There is much that is good about the document. The practice of ‘cherry-picking’ patients based on how little or much care they might need is rampant in alberta as well and needs to be discouraged. However there are oceans of difference between refusing a patient because of convenience or financial reasons and refusing care for reasons of conscience. This document represents an attack on personal conscience, and a very major one at that. Respect for human life forms the basis of our practice of medicine. That is why we are in medicine.
• Human rights legislation in Canada guarantees freedom of conscience. That freedom cannot be abrogated for any except very compelling reasons. There are no such reasons in your document.
• It is individual conscience that often acts as the last defence against serious wrong-doing and the first impetus for righting a wrong. The drive for the elimination of slavery occurred because of the spiritual and political energies of individuals whose conscience told them ‘this is wrong’. The dissenters from the coercion of the medical profession to hideous ends by the Nazis did so for reasons of conscience. Physicians in dictatorships and even in some democracies around the world who object to torture do so for reasons of conscience. Physicians in many countries who object to female mutilation do so for reasons of conscience. When the state seeks to control the conscience of the physician, it seeks to become ‘one conscience (or lack of it) for all.’ Such arrogance does not become a government in an enlightened state.
• To suggest that physicians who refuse to check their consciences at the medical schools door shouldn’t choose certain types of medicine is rather arrogant. What it says in effect is that patients who want a physician that is willing to do (refer) abortions should be catered to; but patients who want a physician who holds a high view of human life should not.
• To suggest that physicians who will not do abortions must refer patients onward ‘thereby sparing their consciences’ is morally naive. If we refuse to do female mutilations, is it alright to refer patients elsewhere for it?
I find the increasing appetite for moral coercion in our regulatory bodies alarming, and as a soon to be patient (I am 75) I find it frightening.
To whom it may concern,
I wish to comment on the draft Professional Obligations and Human Rights policy. I particular, I want to raise some issues concerning “physicians’ rights and obligations in limiting health services”.
Indeed, “no rights are absolute”. But that should apply to a physician’s “right to freedom of conscience” as equally to the “fundamental rights and freedoms of others”. To privilege some rights simply by calling them “fundamental” is more about political coercion and legal fiat than consensus and reason. I am referring in particular to the rights and freedoms to abortion and contraception. Unlike sex, colour and race these freedoms are essentially about “choice”. Between the “freedom of conscience” and “freedom of choice” as human rights, conscience necessarily trumps choice. Here is the reason.
All peoples and all cultures, past and present, accept that human beings, unique among all beings, possess the notion of right and wrong, i.e. a conscience. Of course, the recognition of a conscience (which is universal) does not signify agreement of what constitutes a right and what constitutes a wrong among different people (no consensus of consciences). But without the legally protected right to freedom of conscience there is neither need to talk about human rights nor a basis to validate any specific rights. In fact, the justification any specific human right, including the freedom of choice (provided these are “conscientious” choices), is predicated on the universal right to freedom of conscience. Right to freedom of conscious is no more absolute than the right to freedom of choice, but certainly more fundamental.
I understand that the CPSO has to set specific and practical policies and may be in no mood to entertain philosophical arguments, but philosophy is really about first principles, without which any decision is just arbitrary, and perhaps even cynical. I hope the CPSO can examine the fundamentals of “fundamental rights” and refrain from further tightening the grip on physicians’ exercising their freedom of conscience as human beings, because the right to freedom of conscience is what a free society is truly about.
Dear Members of the Consultations Committee:
Subject: Draft Policy “Professional Obligations and Human Rights”.
I am writing to you with grave concern regarding the content of your proposed draft policy. Sections 8, 10 and 11 suggest that physicians who decline to participate in certain acts for reasons of conscience should be compelled to refer their patients to other physicians who will perform these acts. It does not address the fact that many of these same physicians will find the act of referral itself objectionable, as they consider it material cooperation with the act. In compelling physicians to refer, you are limiting their right to conscientious objection.
There is significant disagreement in our society as to what constitutes a moral act, and I do not expect the College to define or limit morality. All I expect is that physicians, as professionals, be allowed to respect their own consciences. Freedom of conscience is foundational to our free society and cannot be limited, even for the best of intentions. If we coerce physicians into violating their consciences we will inevitably erode the personal integrity which is the basis of the physician’s relationship with their patients.
I encourage you to revise the sections above, and include a clear defence of the right to freedom of conscience for all physicians.
I have reviewed the College of Ontario’s draft policy and would like to make this comment
I have been practising medicine in Canada for 42 years and am semi retired .The draft states that the moral and religious rights of physicians under the Charter can be overridden “to protect public safety , order , health , of patients etc” . However it remains a mystery to me how certain procedures such as euthanasia abortion etc actually do this i.e. protect safety ,order ,health of the patient especially since the patient will be killed by the doctor ??? Is this your plan to enforce doctors to go against their moral and religious beliefs to perform procedures like euthanasia [which most likely will become legal]? My understanding of the Hippocratic Code that I swore in 1972 is to preserve life and heal patients .
I can see a number of specialities including General Practice being emptied of doctors who are religious and have moral beliefs if this passes and I strongly disagree with this approach and I am saddened to see how this will harm our great and noble profession.
Dear Sir or Madam,
Thank you for the opportunity to provide input.
As a citizen residing in Ontario, I am deeply concerned about the new draft policy which would require physicians
to refer patients to other doctors for services they object to on moral or religious grounds.
While this proposal is presented under the guise of respect for patients’ rights and avoidance of discrimination, it neglects the fact that physicians themselves also possess such rights and should not be discriminated against. The proposal does not provide any convincing rationale as to why one set of rights takes precedence over the other or why a certain belief system must be imposed on all physicians.
The policy also presents a false notion of “rights.” For example, there is no “right” to abortion or birth control. Hence, no physician would be violating human rights by refusing to be involved in such practices.
All the treatments which physicians may oppose because of personal beliefs are fundamentally unethical and contrary to the dignity of the human person.
As a patient, I do not want my physician’s expert judgment on the best course of treatment to be influenced or coerced by some politically-correct policy.
The whole notion that patients are suffering because of physicians’ personal values is a canard. No physician would put the life of their patient in danger because of their values.
You are running the risk of forcing many physicians to cease practising in Ontario and move to other provinces, which would only exacerbate our current shortage.
I strongly encourage you to stay out of physicians’ consciences and let them provide ethical treatments as best they know how.
in my humble opinion doctors should not have to refer patent’s to other doctors for the sole purpose of euthanasia.i agree with euthanasia but if it conflicts with some ones beliefs the patient or power of attorney should find a doctor who condones it our family doctor is very religious but she has notices around her office proclaiming this i think that is all she needs.we have been patents for many years my wife passed away two years ago with lung cancer our doctor was fantastic through this traumatic time we could not ask for more the people who suggest that a doctor should be removed because of their beliefs should be ashamed of themselves i believe in god but do not practice that is my choice.the people that do practice is there choice and nobody should be able to take that away
Hi,
I am concerned line 157 is a threat to physician autonomy. Forces physician to have a role in something they may be morally opposed to. Patients are not limited in seeking other care.
I am writing in response to the College’s request for feedback regarding the human rights policy draft. I am a family doctor in British Columbia. I am deeply concerned about the proposed changes outlined in the policy for Ontario and the precedent this will set for the rest of Canada.
Specifically, I am concerned that doctors will be required to refer for or in some cases take part in medical interventions to which they are morally opposed. We need conscience protection in order to be professionals with integrity. In lines 123-128 of the policy, it says the courts will decide which actions truly counteract a doctor’s religious beliefs. For myself as a Catholic, I already know which medically related actions go against my personal religious beliefs. The Catholic Church makes that very clear. If the courts decided contrary to that, it would mean I would have to give up medical practice. This seems ludicrous since I live in a democratic country and in a city that is in need of more family doctors. Referring for and directly providing are equivalent participation in these acts to which I cannot take part in and remain a Catholic.
I appreciate my colleagues and patients, of all different faiths and ethical frameworks, who respect my freedom. I respect theirs. We come up with solutions when this difference in beliefs is an issue in practice. I understand that sometimes this means patients will choose to see a different doctor. Sometimes it means patients seek me out because of shared beliefs. Isn’t this what democracy is all about?
The recently updated CMA policy on euthanasia and assisted death clearly states that doctors should have the freedom to follow their own consciences with regards to end of life care. How will the College be upholding that policy with this human rights policy?
I know that these issues are often emotionally charged, but I think we need to remain calm and rational when making sweeping decisions in policy. Patients and doctors can work through these differences relationally in a setting of mutual respect. That process is one I take pride in as a Canadian physician.
Dear Members of the Consultations Committee:
I am very concern regarding the content of your proposed draft policy:
Sections 8, 10 and 11 suggest that physicians who decline to participate in certain acts for reasons of conscience should be compelled to refer their patients to other physicians who will perform these acts. This sounds like an act of justice towards the patient, but it is completely unfair to the physician for whom the act of referral itself is objectionable, as it is a material cooperation with the act. In compelling physicians to refer, you are limiting their right to conscientious objection.
All I am asking is that physicians be allowed to respect their own consciences in their profession. Freedom of conscience is foundational to our free society and cannot be limited, even for the best of intentions. If we coerce physicians into violating their consciences we will inevitably erode the
personal integrity which is the basis of the physician’s relationship with their patients.
I ask that sections 8, 10 and 11 be revised so that it includes a clear defence of the right to freedom of conscience for all physicians.
Only very recently the CMA moved from the stance that PAS (Physician assisted Euthanasia)is not within the scope of medical practice and should not be practiced by doctors – to “up to the conscience of the patient and physician”. There is currently still the caveat that this is not proscribed but an individual doctor/patient decison. In this, it seems as though doctors and patients are placed on the same level of “rights” – the patient can request PAS (or request NOT to have PAS) but thedoctor has the right to “abstain”. I find the genital mutilation comment below interesting, because if something is as morally objectionable to a practitioner, then they should not be forced to refer and passively participate in the procedure they are trying to avoid participating in. As long as the patient has full knowledge of the physician’s moral objection to participation in a certain prescription or procedure, then the patient should have to accept the physician’s right to choose. Again, we all know this can’t involve life-threatening situations, but that is really not what’s being discussed here. As a physician working in the public sector, I feel we often wear a dual hat – a public servant and an entrepreneur. But I do not feel that we should be so owned by the system that we are forced to go against our conscience.
These lines should be removed without hesitation. “This includes not refusing or delaying treatment because the physician believes the patient’s own actions have contributed to their condition. Furthermore, physicians must not promote their own 146 religious beliefs when interacting with patients, or those seeking to become patients, nor attempt to 147 convert them.”
Religion or moral perspective on an issue is irrelevant when considering whether a patient is responsible for their health situation or not. Are you saying this only applies to a woman who wants an abortion and not a person who weighs 600 lbs? Doctors are professionals and even if they don’t agree with a choice a patient has made their objections will not all be based on religious or moral issues. You are focusing this policy on far too narrow a field and you shouldn’t be. Faith and moral positions exist in our world and professionals are called to set that aside when providing patients with their best health advice. The Charter guarantees Canadians freedom of religion not freedom from it and this policy is trying to legislate against it when there should be no need for the policy in the first place. There is no need for a policy of this length to single out any one professional behavior or process of thought over another. The Charter does that and so does the Code, there is no need for this policy to define how a religious or morally focused physician should conduct themselves when providing treatment. College is overstepping its jurisdiction and should not speak to or further define the rights people are already guaranteed under far better legislation.
Re: physicians who do not provide certain services due to moral or religious objections. Patients have a right to know this before they see the doctor. All physicians who provide direct service to the public should be required to provide this information in the form of a poster in the waiting room or at reception, information on physician website, and register their objection with the CPSO so it can form part of the physician listing for those who are looking for an MD.
On the contrary, abortion should be illegal, and euthanasia and assisted suicide should continue to be illegal. Killing people is not part of a physician’s job description.
I guess I just feel that as long as we are living in a secular country with separation of church and state, and as long as physician’s salaries are coming from everybody’s tax dollars (including people from all religious/non-religious backgrounds), people who CHOOSE to become doctors in this country must do so with the understanding that they are practicing under the legal guidelines of our country. If one doesn’t feel comfortable with the medical laws we have, one is under no obligation to practice medicine. However, if you make the CHOICE to join the Canadian medical community, you must comply with the standards of practice that go along with that. I think it is very reasonable to say that someone is allowed to “pass” on a procedure they are morally uncomfortable with. And doesn’t the fact that the policy requires “that physicians provide care that is urgent or otherwise necessary to prevent imminent harm, suffering, and/or deterioration, even where that care conflicts with their religious or moral beliefs” fall in line with the Hippocratic oath: “I will take care that they suffer no hurt or damage.”
There are many other professions one could choose in which they have the option to not perform certain “morally objectionable” medical procedures, and surely no one would judge them for choosing to pursue one of those other noble careers. But as long as you are choosing to remain a doctor, you must follow Canadian secular standards when treating your patients (and yes all patients in Canada are clients, because we are all paying for the medical services being provided).
Who told you that you were living in a “secular country”? Historically Canada has been a Christian country and a free country. If separation of church and state means that the church should not intrude on the realm of the state, then the state also should not intrude on the realm of the church. And medical ethics is certainly the realm of the church. Doesn’t the doctrine of church and state assume a Christian country?
Anyway, exactly what kind of care do you think is threatened by doctors with a conscience? Why do they refer to their Hippocratic oath as part of the basis for their rejection of this “care”? What are these medical services that we are all paying for? I suggest you look a little closer: things are not what they seem.
I am a strong beleiver of providing equal opportunities to all and removing barriers for access to medical care especially disabled but in the real world there is limitation to what you can do eg if your office space is located at a place not accessible by people with mobility limitations.Are skate holders or organizations willing to help doctors set up a system not costing them for making accomodations in their offices?
Dear CPSO Policy Department,
I am a practicing respirologist in Ontario. Thank-you for the opportunity to provide feedback on the College’s draft policy statement on “Physician Obligations and Human Rights”. It is both ironic and unfortunate that the draft statement so clearly discriminates against and infringes upon the rights of physician members of the College.
The most serious problem with the policy is the language around physician referral (lines 156-161), which states that a physician is required to provide “effective referral” to another “non-objecting” provider for “health services” when the first physician is morally/ethically opposed to such services. This clearly does not provide adequate protection of the conscience rights of physicians, as it does not provide sufficient moral distance from the act in question. In legal terms this would be conceived of as “accessory to” the act; in moral terms it is “material cooperation”.
Where the rights of the physician member (to refrain from participation in acts believed to be morally indefensible) conflict with the rights of the patient (that is, “competing rights” situations), the courts have not systematically negated physician rights, nor specified a hierarchy of rights. The current CPSO policy would have the effect of systematically subjugating the conscience and moral rights of physicians to the rights of patients. This is not how competing rights situations should be handled (and the courts agree with this), particularly in instances where one or both parties considers the moral issues at play to be grave. It is more appropriate for the College itself, given its resources, to maintain a publically available list of physicians willing to provide (or not) certain specific services, than it is to force a person to participate in an act which he/she considers morally indefensible.
Another problem with the policy as outlined is that it does not sufficiently consider the implications on physicians and society at large of the interactions between [1] non-discrimination on the protected grounds of disability, [2] proposed obligations upon physicians to provide or arrange for all requested “health services”, and [3] the expected imminent dismissal by the Supreme Court of Canada of criminal code provisions forbidding physician assisted death and euthanasia. The policy as written would impose upon doctors (generalist and specialist) a positive obligation to refer people (or even directly arrange, depending on the degree of patient debility) for euthanasia and physician assisted death. It would seem that the current policy is insufficient to carefully address an issue of this magnitude, given that other issues (palliative sedation, euthanasia without explicit consent, physician assisted death of children, etc. etc.) would also fall under this obligation.
A further difficulty with the policy is a confusion between legal obligations on physicians (as per the provincial human rights code) and moral obligations on physicians. A legal obligation to avoid discrimination (on a protected ground in the Code) in no way creates a positive obligation upon a physician to perform (or arrange to be performed) any specific service. Refusing to perform a particular health service for any and all patients (i.e. euthanasia) is neither discriminatory nor inequitable. Importantly, the recommendation by the Ontario human rights commission to limit physicians’ conscience rights is nothing more than an opinion, devoid of actual legal force, and not clearly in the best interests of patients. It seems inappropriate, and in fact bizarre, that something as profoundly important as the physician-patient relationship, which is inherently moral, should be judged according to a local (provincial) statute written for an entirely different purpose (the Code). Perhaps we need two policies, one that outlines physician obligations around protected grounds in the Code and another to handle issues related to conscience and moral freedom?
It is interesting that the current policy seeks to impose significant “fiduciary relationship” constraints upon physicians whilst at the same time demolishing physician autonomy (as in the context of requiring “effective” referral for a morally objectionable “health service”). Removal of a physician’s autonomy actually creates a circumstance where a fiduciary relationship is impossible. A fiduciary relationship in the practice of medicine is one in which the patient entrusts the doctor with medical decision-making, which relies on the physician’s good judgement and input from the patient and all other relevant parties. The patient trusts the doctor to advise him/her as to what is actually in the patient’s best interest. Those interests are understood to be agreed upon, in their essentials, by both parties. If a doctor believes a course of action is morally wrong, the doctor will be unable to believe that it is in the best interest of the patient. If the doctor is then forced to carry out the action on behalf of the patient, the doctor cannot be said to be acting in a fiduciary capacity. There would, in fact, be a breach of the fiduciary relationship; that is, a breach of trust.
Finally, based on the current draft policy, it would seem plausible that the College could itself be the subject of a human rights complaint by a physician, on the basis of discrimination on the grounds of creed. A dispute of this nature would probably reflect poorly on our ability as physicians to self-regulate and might have unintended consequences for our profession.
The draft policy as it stands is deeply flawed and I urge its revision.
Thank-you for your time and consideration of these points,
We would like to add our voices to those who object to family physicians being forced to refer or perform abortions or to euthanize patients. Under the Charter of Rights, physicians should be able to exercise their religious and ethical rights to abstain from these practices. This does not mean that we oppose those physicians who are willing to perform these practices from doing so.
My additional comment would be a statement regarding a physician’s obligation to respect the Ontario Human Rights Code when dealing with colleagues and co-workers in the work environment (clinic, hospital etc) and not limit the obligations to patients only. Thanks,
Time for good, dedicated people of religious convictions to be supported by the Community they serve.
I disagree with the policy that would punish men and women of faith from exercising their human rights. In this case it is in regard to those in the profession who do not agree with the providing of the following procedures: abortion, euthanasia and other contraceptive procedures by taking away there right to practice medicine.
It’s obvious that this association is overrun by a certain group of one mind who are set upon the work of muzzling a certain group of its members by bullying them into doing violence to their consciences.
We are a pluralistic society. All need to be included.
It’s like we have created a group with ultimate power to have there way, especially when it violates the rights of People of Faith and in particular Roman Catholics.
Stop it.
Hello
I was particularly interested in the draft policy on physician obligations and human rights. From my perspective it passes the test of common sense.
Best wishes for continued success and respectful sensitivity with both patients and practicing physicians
Always moving forward!
Read it more carefully. Killing is still killing even if it is called “care” or a “service.” I consider myself to have been a patient before I was born (but after I had been conceived) and to still be a potential patient when I become senile. Details are important.
Why do you keep trying to strip doctors of their right to conscientious objection? It seems that every time I turn around you are attacking me, and through your efforts to enact new human rights policies, indirectly accusing me of not caring for my patients.
Let’s cut right to the chase. This policy takes aim squarely at physicians who are unable to refer patients for abortions because of their moral beliefs. Don’t even bother using the term “religious.” That term further polarizes the discussion and insinuates that physicians on the side of rationality, evidence and science would surely be willing to refer. I have studied science for many years and I have yet to see a scientific experiment which showed that the willingness to refer for abortions is “good.”
This may sound odd, but there are actually doctors in Ontario, thoughtful and good doctors mind you, who believe that abortion is nothing less than killing a child. Of course I understand that a woman has the right to do what she wishes with her own body but to use this argument in support of your policy is question-begging to the highest order. That a child in utero is part of a woman’s body is not a scientific given. Science has not and never will demonstrate that an unborn baby is not a small human being. If anything, science continues to reveal the amazing cognitive and perceptual capacities of children in utero while technology continues to lower the age of viability. And these aren’t just the words of “religious nuts.”
Christopher Hitchens himself believed this. Please try to understand that abortions are ontologically different than appendectomies and haircuts.
Furthermore, there is no national consensus on abortion. We are a nation deeply divided on this issue. Do not try to force physicians to act as if this is not the case.
I don’t care what any law or any policy says, there are doctors in this province who, thank goodness, will never aid in killing. Have you read The Nazi Doctors by Robert Lifton? You should, especially if you are trying to enact a policy that limits the conscientious rights of physicians.
Thank you for confirming that Godwin’s Law is alive and well.
The shoe fits. I do not thank you for ignoring the children in utero. Some of them are NOT alive and well.
Wow. Thank-you for validating Desensitization Theory.
You have completely ignored all of your colleague’s valid comments.
The College of Physicians and Surgeons of Ontario
Recently, the National Post published a commentary that falsely attributed the following statement to a College spokesperson: “Physicians unwilling to provide or facilitate abortion for reasons of conscience should not be family physicians.” This quote is categorically false, and misrepresents the College’s expectations of physicians who limit the health services they provide on moral or religious grounds. The College has asked the National Post to publish the letter below to correct this false statement and to clarify the College’s position. Read the letter here.
Whether or not CPSO said that–an important point, to be sure, if it was a direct quotation–it does indeed represent CPSO’s position. The draft policy implies that family physicians will be expected to either perform abortions or refer for them. Is not abortion currently considered by CPSO to be one kind of “care”, a legal OHIP “service”? Then some patients will request it, and some doctors will either have to perform (provide) them or facilitate them (make referrals).
REFERRAL = COMPLICITY
It is irresponsible and disingenuous for CPSO to imply otherwise.
“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 the chair of the college’s policy working group reviewing “Professional Obligations and Human Rights.” This quote is found across a number of publications from December 2014. Is it accurate? If not, then the original source should be asked to retract it. If it is accurate, then the College is implicitly saying that those opposed to abortions should not enter family medicine (even if not explicitly saying that).
The College of Physicians and Surgeons of Ontario
Recently, the National Post published a commentary that falsely attributed the following statement to a College spokesperson: “Physicians unwilling to provide or facilitate abortion for reasons of conscience should not be family physicians.” This quote is categorically false, and misrepresents the College’s expectations of physicians who limit the health services they provide on moral or religious grounds. The College has asked the National Post to publish the following letter to correct this false statement and to clarify the College’s position: http://policyconsult.cpso.on.ca/wp-content/uploads/2015/01/Letter-to-National-Post-January-23-2015.pdf
December 2014 is earlier than January 2015. CPSO’s comment appears to be irrelevant.
I would like to inform you that my husband and I are shocked to see Ontario physicians and surgeons being stripped of their
right to conscientious objections to performing certain procedures that go against their conscience. In a democratic country like Canada this is
incredible!
Attention: Policy Department
Regarding: “Professional Obligations and Human Rights”
I would like to express my sincere thanks to the committee for their work in developing the draft policy cited above and for inviting input from physicians and the public.
While I agree with much of the policy as written, there are a number of sections which I have outlined and discussed below that are of grave concern to me and many physicians and members of the public and which, I believe, warrant revision in the interests of all patients and doctors in Ontario.
Failure to make the revisions to the policy in these areas, I believe, will result in some serious adverse and unintended consequences in relation to patient access to appropriate care and to the proper respect and balancing of patient and physician rights and freedoms in the Canadian Charter of Rights and Freedoms (The Charter).
I respectfully and earnestly put forward my concerns below for the consideration of the committee. Please accept my comments as sincere and well Intentioned.
Portions of the Policy Both Unnecessarily and Improperly Violate the Charter and Require Doctors to Violate Their Conscience When Better, Less Problematic Alternatives Exist.
Regarding Lines 129-135.
The CPSO draft proposes that the patient’s right of access to a morally controversial service such as abortion or, pending the ruling of the SCOC, physician assisted suicide (services arguably not falling under the definition of medical care) supersedes the right of the physician to refuse to refer or to facilitate access to these services based on their moral convictions.
This is an assertion contrary to the Charter and beyond the mandate of the CPSO. A right of deeply held moral conviction on the part of a physician is right under the Charter and is not, and should not be treated, as subject to the College’s proposed modifications and constraints. Further, according to the draft CPSO policy, (Line 130-131); the physician may not refuse the initiation of a doctor/patient relationship initiated by a patient who is seeking access to a morally controversial medical services even if the physician makes it generally known that they are not able to provide these services to any patient because of the constraint of the physician’s moral convictions.
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There isn’t a need to force doctors to violate conscience and faith in order to comply with law. Years of experience has shown that Ontario patients can get abortions while not requiring Physician’s to violate their conscience. No case has been made, that patients who want abortions aren’t able to get them, despite the fact that there are doctors who won’t refer for abortion for reasons of conscience or faith.
The policy comes across as a social policy rather than a medical policy which alone is within the mandate of the CPSO. Consider that abortion is readily available in Ontario without a physician referral and therefore access to this procedure is not dependent on a physician’s referral. Would the CPSO feel this policy applies to referral for abortion on the basis of the access argument? While assisted suicide has not yet been (and may not be) legalized, it is hard to understand how the taking of life can be construed as health care. Will physicians be required to assist in the taking of human life should this be legalized under this policy?
This policy, as written, is discriminatory, un-inclusive and seems certain to reduce the diversity in physician healthcare providers in Ontario. The diversity in physician providers has been and continues to be critically important in the provision of the best care to an equally diverse patient population in Ontario. While not intended, this policy gives the impression that it is aimed at physicians holding traditional moral and religious convictions. As such it will only serve to limit access of patients to like-minded physician healthcare providers. This unfortunate outcome would be contrary to the spirit of the policy which aims to insure access of appropriate care to the diverse patient population served by Ontario physicians.
Regarding Lines 152-169
This section permits the violation of the physician’s rights under the Charter forcing them to be an accessory to an act that for them may be morally reprehensible. A mandated requirement as proposed in the CPSO draft for physicians to refer patients for such services against their moral convictions or to, in any way, cause physicians against conscience to facilitate access to these services places them as accessories to the act. For many this would make them an accessory to murder in the case of abortion and assisted suicide. For those “non-religious” physicians who have taken it in its original form on graduation from medical school, this also violates their Hippocratic Oath.
“…Nor shall any man’s entreaty prevail upon me to administer poison to anyone; neither will I counsel any man to do so. Moreover, I will get no sort of medicine to any pregnant woman, with a view to destroy the child.”
The Policy as Written is Vague and Unnecessarily Restricts the Religious Freedom of Patients and Their Physicians:
Regarding Lines 146-148
The wording in this section is vague and seems to favor a secular/ non-religious perspective and, as such, is subject to serious abuse. The wording seems intrinsically biased against religious minorities. While it is acknowledged that physicians should not use their position of significant influence to inappropriately impact patients about their religious, humanistic or atheistic
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convictions, a spiritual history and respectful dialogue about spiritual matters is an important part of good healthcare delivery for many patients and their doctors especially in the context of palliative care and end of life counseling. Wording in this section will restrict the religious freedom of both the patient and the physician in this important dimension of spiritual care of the patient. The vague and unqualified wording of the policy in this area will only serve to unnecessarily threaten physicians. The following questions, not addressed in the policy, underscore the vagueness of the policy and the potential impact it might have on the delivery of care.
• What do the terms “moral and religious” (line 138) mean in the policy? Do they include atheistic humanism and other faith-based secular philosophies and world views? If not, why is this diversity of moral and philosophical perspective embraced by physicians not reflected in the policy? Should not the forced advancement of secular perspectives on a religious patient by an atheist physician not also be specified as a violation as well? Properly applied with equity, this policy would serve to discourage any philosophical discussion from the physician-patient encounter, secular or religious? How would the physician help a patient deal with the fear of imminent death or the loss of a loved one? Improperly applied as written, it will be unfairly discriminatory against a physician holding a minority “religious and moral” conviction that restricts his/her provision of a certain service based on that conviction.
• How does one “communicate an objection” (line 139) without “promoting (a physician’s] religious belief” (line 146). What is “promoting” is unclear and it is easy to imagine situations where the patient will ask questions of the doctor in response to a doctor’s objection which leaves a doctor in the position of not knowing whether answering a question is “promoting” thus exposing the doctor to CPSO discipline. This wording unfairly forces a “Catch 22″ upon the physician holding moral conviction.
In my view inclusiveness and latitude for physicians to maintain their moral convictions is critical if they are to provide proper access of all levels of care to the diverse patient populations they serve in Ontario. In my opinion, moral conviction and integrity are key ingredients of the best physicians I have had the privilege to work with.
Much of this policy excluding the sections I have outlined is appropriate and needed and I am thankful to the committee for putting it forward. While this policy in the areas I have outlined above is no doubt well intentioned it falls far short.
If put forward as policy, I am certain it will be challenged in the courts in reference to the areas outlined above. If it stands as written and is advanced through the courts successfully it will selectively remove many of the very best doctors from the Ontario healthcare system. This loss will be shouldered by the patients they so faithfully care for who will be denied access not only to these excellent physicians but also to the dimensions of spiritual care and support they are
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accustomed to receive or are seeking from these physicians. This would be a tragic outcome and I am certain, an unintended consequence on the part of the committee drafting this policy. Moral and Charter arguments aside, all this, worst of all, will be done unnecessarily because there is really no evidence put forward by the CPSO that would justify forcing doctors to violate conscience using the arguments of limited access to morally controversial services.
My Recommendations:
I would respectfully request that the CPSO committee retract this policy as written and revise it in such a way that;
1. It is not discriminatory against patients and physicians holding minority religious and moral convictions.
2. It facilitates and does not hinder spiritual care and emotional support of patients and their families
3. It is not vague and contradictory in its wording, but very specific on the matters outlined above, at all times protecting the Charter freedoms of religion, philosophical perspective and faith of both the patient and the physician.
4. It does not discriminate and restrict the freedoms of physicians holding minority religious and moral convictions, based on these convictions to practice medicine in the field of their training and choice.
5. I would strongly recommend that the tabling of this revised policy be delayed pending the Supreme Court of Canada decision on the matter of physician assisted suicide.
Thank-you for the opportunity to comment on this draft policy “Professional Obligations and Human Rights.”
First off, I am disappointed to see that, despite the overwhelming number of comments against the direction of previous consultation document, this draft continues to override the legitimate rights of physicians who refuse, for reasons of conscience, to provide certain procedures.
I am also alarmed by the reported comments of a College official to the effect that “physicians unwilling to provide or facilitate abortion for reasons of conscience should not be family physicians.” At a time when Ontario is experiencing a shortage of family physicians (something which I went through when trying to find a new family physician), to say that some of them should leave profession because of their moral or religious beliefs is appalling. I am in full agreement with this statement by Margaret Somerville (National Post, January 23, 2015): “Physicians with conscientious objections to supplying medical procedures that would destroy human life or contravene respect for it, including euthanasia and assisted suicide, must not be drummed out of the profession.” We need doctors, and we need to have choice in health care, and this includes having physicians who honour Canadian’s choices on either side of a life issue. I don’t want a doctor taking care of me who would be willing to kill me (though assisted suicide, euthanasia, care in dying, or whatever term you want to employ).
Again, to quote Ms. Somerville: “Forcing physicians to act against their conscience, to do something they believe is deeply wrong against their will, not only harms them. This coercive violation of their freedom of conscience also harms society and the values that inform its culture.” I believe physicians should have a means to state their clinical, religious or ethical limitations of care so that I can make an informed choice when seeking health care. This is an extremely important aspect for me in selecting a health care professional. I believe the implications of this draft policy, and certainly the comments of one of the College’s officials, would remove this choice for me by forcing physicians to act against their conscience.
As commented above:
“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 chair of the college’s policy working group reviewing “Professional Obligations and Human Rights.” This quote is found across a number of publications from December 2014. Is it accurate? If not, then the original source should be asked to retract it. If it is accurate, then [Name omitted] is implicitly saying that those opposed to abortions should not enter family medicine (even if not explicitly saying that).
This is like a Monty Python skit – it’s utterly stunning that the CPSO would claim to respect a physician’s human right to conscience and therefore their wish to not provide or not facilitate abortions, yet expect that very same physician to stay in relatively close contact with a service that they would consider an ‘abortion mill’ to ensure that the patient can have an abortion scheduled. Is this not facilitating an abortion? Is the CPSO not forcing a physician with a conscience into an incredibly unfortunate and sadistically ironic position that insults the physician’s deeply held beliefs? I suggest as a compromise, that the CPSO do the job of the gate keeper for abortion services in the Province, and that pro-life physicians only need to refer patients to the CPSO for clarification.
Whether or not the attribution is false, the statement is true. [Name omitted], past president of the college, told LifeSiteNews on December 18 that if his committee’s proposed revision of the college’s “Professional Obligations and Human Rights” is adopted, then if doctors refuse to refer patients to abortionists, or to doctors willing to prescribe contraceptives, they could face disciplinary action.
The College of Physicians and Surgeons of Ontario
Recently, the National Post published a commentary that falsely attributed the following statement to a College spokesperson: “Physicians unwilling to provide or facilitate abortion for reasons of conscience should not be family physicians.” This quote is categorically false, and misrepresents the College’s expectations of physicians who limit the health services they provide on moral or religious grounds. The College has asked the National Post to publish the letter below to correct this false statement and to clarify the College’s position. See letter here.
The statement is true, and CPSO is misrepresenting its own draft policy. [Name omitted], past president of the college, told LifeSiteNews on December 18 that if his committee’s proposed revision of the college’s “Professional Obligations and Human Rights” is adopted, then if doctors refuse to refer patients to abortionists, or to doctors willing to prescribe contraceptives, they could face disciplinary action.
The draft policy implies that family physicians will be expected to either perform abortions or refer for them. Is not abortion currently considered by CPSO to be one kind of “care”, a legal OHIP “service”? Then some patients will request it, and some doctors will either have to perform (provide) them or facilitate them (make referrals).
REFERRAL = COMPLICITY
It is irresponsible and disingenuous for CPSO to say otherwise.
This letter is in response to the invitation to review the College of Physicians and Surgeons of Ontario’s draft of their 2015 update to the policy “Professional Obligations and Human Rights”.
The first thing I would like to point out is the language in line 18 “Acting in the best interests of their patients.” Society now finds itself at risk of defining principles such as beneficence in radically different ways. Because it no longer has a shared philosophical anthropology, it may no longer have a joint understanding of what is good for human beings. If it can no longer determine what is good for human beings, then it is difficult to determine what is in the best interests of their patients. All physicians know from experience that what the patient wants is sometimes clearly NOT what is in their best interests. Therefore as legal avenues to requests for lethal prescriptions expand in geographical scope, health practitioners may be at risk of determining medicine’s principles in irreconcilable ways.
Fortunately, the statement following this line clarifies and points to exactly the concern: Line 19/20 “This is especially important with respect to vulnerable and/or marginalized populations.”Patients who are very ill, whether terminally so or not(many different definitions of terminal, also somewhat irreconcilable) are in a vulnerable state. Vulnerable patients need protection.
Line 22 also requires reinterpretation when a patient is requesting something harmful or damaging from a practitioner rather than something to address symptom management or which would improve health.
Principle 3 (line 24-26) The wording suggests that physician’s values may be in conflict with the patient’s best interests. Again, there implies tension here where professionally there really ought to be none. When a health professional is acting in the patient’s best interests, she may not always be doing what the patient wants, but remains committed to providing care in the best possible way for the patient. This will generally support their autonomy but may not always be simply acquiescing to their autonomous wishes.
Page 4 Subheading ii) Moral or Religious Beliefs.
I am pleased that there is a recognition of moral or religious beliefs of physicians as a right, and that it deserves a separate section. I am pleased that there is not a pitting of rights against each other in lines 121/122. I am not pleased that the whole section reads like a veiled threat intended to discourage physicians from asserting their moral/religious rights, and which in fact may cause them to give up their rights before they are tested in courts. Professional bodies such as the college of physicians and surgeons has an obligation not only to patients, but also to physicians, many of whom do not believe that ending a patient’s life, or referring to have said lives ended is morally defensible. To support them and their consciences is just as important in documents such as these. Therefore, I suggest removing the sentence in lines 115-117 “The right to freedom of conscience and religion can be limited… to protect the fundamental rights and freedoms of others.”
Page 5:References to ensuring access to care in lines 130, 134 should have the word “care” clarified or else separate sentences added regarding physician assisted death if it becomes legal in Ontario. The word care does not include ending lives in many physician’s vocabularies.
Page 5 Section ii Ensuring access to care and section iii protecting patient safety. There is no provision here for physicians who consider a referral for physician assisted death unconscionable. There should be. Duty to refer may be considered a subset of duty to aid. “Because liberal societies seek to minimze the imposition of aims or values on individuals, duties to aid are formulated in a manner that restricts such duties to the least intrusive requirements.” (Thomas May. Bioethics in a liberal society p. 84) Granted, professional bodies may impose stricter requirements, but the case of assisted death calls for some recognition of what they are requesting that their members do. There are a number of physicians who consider providing a lethal prescription a murderous act, and that their professional duty to care does not require them to cooperate in any way with such requests. Some of them, including myself, would consider referring for such a purpose even more morally repugnant because it involves duplicity, as if by this act I could distance myself from being an accomplice, and consider myself free from guilt. There needs to be recognition of the burden of this that you are placing not only on myself, but for those in the generation to come; those who with civil courage will not acquiesce to patients’ requests to end their lives, and who will not refer, but who recognize that with the push of a computer button patients could easily find a physician to comply with their request through the internet. A separate section indicating how physicians who will not refer for such acts will be protected would be ideal. Lines 156,157, 158,159 are ones I cannot live with in the context of physician assisted death.
In summary, what lawyer Holly Fernandez Lynch refers to as the ‘bleaching out’ of one’s religion, moral base, race, gender, ethnicity and culture by professional norms should not take place. Nor should policies such as ‘professional obligations and human rights’ attempt to do so. Howard Lesnick states that ‘in finding in its pluralist quality a counsel of restraint in its enocunters with the varying religious scruples of individual attorneys, society is therefore not merely indulging in an individual’s interest, but recognizing their ‘collective value’ as well.’ The same should apply to conscientious refusers in the medical profession.
Dr. Stephen Genuis warns that ‘A policy to coerce health professionals to act against their judgments will convert doctors into skilled technological servants, not professionals.’ He states that ‘without a foundational ethic, unbridled diversity may ultimately lead to enforced uniformity – tolerance for non-adherents may be sacrificed….The drive to eliminate freedom of conscience suggests that secularism can be intolerant of minorities and wiling to discriminate on the basis of moral conviction and ethical orientation…Ironically, in an era of expanding initiatives dedicated to ending intolerance and bullying, official regulatory bodies are becoming intolerant of doctors for being faithful to their consciences.. ” Let it not be said that the College of Physicians and Surgeons of Ontario is one of them.
Lynch, HF Conflicts of conscience in health care: An intitutional compromise MIT Press Cabridge 2008 p.31
Genuis S The advent of ethical imperialism in healthcare. FOCUS magazine Dec 2014
Well said. Bullying in schools not allowed–medical field,??????
Dear Members of the Consultations Committee:
Subject: Draft Policy “Professional Obligations and Human Rights”.
I am writing to you with grave concern regarding the content of your proposed draft policy. Sections 8, 10 and 11 suggest that physicians who decline to participate in certain acts for reasons of conscience should be compelled to refer their patients to other physicians who will perform these acts. It does not address the fact that many of these same physicians will find the act of referral itself objectionable, as they consider it material cooperation with the act. In compelling physicians to refer, you are limiting their right to conscientious objection.
There is significant disagreement in our society as to what constitutes a moral act, and I do not expect the College to define or limit morality. All I expect is that physicians, as professionals, be allowed to respect their own consciences. Freedom of conscience is foundational to our free society and cannot be limited, even for the best of intentions. If we coerce physicians into violating their consciences we will inevitably erode the personal integrity which is the basis of the physician’s relationship with their patients.
I encourage you to revise the sections above, and include a clear defence of the right to freedom of conscience for all physicians.
This is very well stated.
a christian doctor should not have to give abortion referral or send patienta to other doctors who will. My doctor has posted in her office no abortion referral,no morning after pill, no viagra for unmarried men.
She is the daughter of missionaries and a wonderful doctor. I support her.
The line about getting out of family practice is insulting and offensive.
I do not believe your president’ statement on this. She sounded angry but did not sayshe sopports doctors rights to act like my doctor. I do believe her or trust her.
Your president’s reply is not believable.
Insulting and offensive
CPSO is playing a tricky word game. The policy’s effect will be to prevent physicians unwilling to provide or facilitate abortion for reasons of conscience from becoming–or even remaining, like your doctor–family physicians. However, CPSO cannot explicitly say that or they will be guilty of discrimination in contravention of our horrible Ontario Human Rights Code.
So, even if they have made such a statement or one similar to it in the past–and I believe they have–they are now pretending that they did not. Like you, I do not trust the CPSO, but there is not much we can do about it except keep writing these comments and hope they will be published without tampering.
Please do not force medical doctors to go against their principles, religious belief and code of ethics that they take when they become doctors. This is suppose to be a democratic country, then why are you forcing the doctors, when they are in so much demand, to either do it or possibility loose their ability to practice medicine. Doctors who feel strongly against this will leave the province.
It is unconscionable that College would seek to even consider abrogating the right of a Physician to decide who he will treat on the basis of his informed conscience, i.e., if by treatment sought totally is counter to his firm beliefs. God Bless the Physicians who are acting on their beliefs and conscience. I simply cannot see anyone going without the treatment they are seeking out a professional who is of the same conscience as their own ill-informed view and beliefs in the sanctity of life in all forms – unfortunately there are too many of them.
I strongly believe that a physician should not be forced to act against his conscience.
And that he should only have, in the matter of referrals on moral grounds, the obligation to refer to a properly designated referee.
I would not feel safe if my physician participates in euthanasia or assisted suicide. Physicians need to uphold their promise not to do harm. If euthanasia or assisted suicide is legalized, physicians must have the right of conscience to refuse to participate in any way, including to right not to refer to another physician.
Well educated doctors should realize that life begins at fertilization. Any Biology textbook will confirm this as a fact. Why do we continue to allow the killing of innocent human life and now, even force doctors, against their consciences to participate in this horror? This sounds too much like Nazi Germany to me.
It worked in Germany because many “just did what they were told” instead of following their conscience.
The proposed policy demands that physicians make referral, and in some cases actually perform, procedures like birth control, abortion, and, should it be legalized, euthanasia, if the regulator (CPSO) considers them to be “urgent or otherwise necessary to prevent imminent harm, suffering, and/or deterioration.” This wording is open to broad and subjective interpretation and therefore abuse. Doctors who cannot participate due to deeply held moral or religious commitments will be vulnerable to punishment from the CPSO, even though their fundamental freedom of conscience and religion is guaranteed by the Canadian Charter of Rights and Freedoms. Why is this requirement being advanced now, since for all practical purposes this has been a non-issue for decades, as patients may self-refer for pregnancy termination?
PLEASE DO NOT GO AHEAD WITH THIS PROPOSAL RE INCRIMINATING DOCTORS AT LEAST TO THEIR OWN CONSCIENCES
Doctors should have the right to decline a “service” to a patient if their best judgement and conscience decides other wise. Your policy states that physicians must act in their patient’s best interest. A patient’s request for provision of an immoral action by a doctor or nurse may not be in their best interest, even though the former may think so. Therefore the expectation that the initial physician will refer the patient to another doctor to provide the service is indirect collaboration, which is equally immoral. This would be a coercion to violate
ate freedom of conscience
These proposals are very disconcerting as doctors would be required to refer for procedures that are against their moral or religious convictions.
Also they would be required to perform procedures that are against their moral or religious convictions in situations where that is deemed to be “urgent or otherwise necessary care”.
Certainly this is a proposal that would have far reaching and dangerous implications for the medical profession.
Re: my comment Number 227 below, I change my words both on the matter of conscience and on the matter of referral.
I modify my comment as follows:
“I strongly believe that a physician should not be forced to go against his conscience.
And that in such matter he should not have the obligation to refer.”
It is truly disturbing that with zero legal basis for doing so, that a lower level jurisdictional body like the CPSO would actually stoop to the consideration of becoming a totalitarian body that forces physicians with a free conscience in a democratic country possessing rights of conscience, to perform an act that they would consider to be morally abhorrent and repugnant. There are numerous doctors out there who would only be too happy to provide direction and counselling on abortions, and the only direction a physician with an pro-life conscience need provide is to direct the patient to the CPSO for further information and clarification. Period.
I do not agree that a doctor must provide information about other doctors who provide a service that is in direct conflict with his/her moral or religious beliefs.
This is cruel and extremely unusual behavior on your part. If a doctor is unable to provide the service due to religious or moral beliefs, how can you expect him to make a referral that is so obviously grossly abhorrent to him? “I won’t kill your baby or your grandfather, but here is a list of people who will”. This does not make any sense. A patient who wants this kind of service is fully capable of finding it on their own.
Human rights should work both ways – there are doctors who believe in life and they should be protected.
Everyone has a fundamental freedom of conscience and religion. In addition to this, physicians take an oath to observe the code of professional behaviour. Primarily their job is to heal and save lives and when doing so to consider what is best for the patient.
When a physician is requested to act against his moral beliefs in order to accommodate a woman wishing to terminate her child, he should not have to. Obviously abortions are easily accessible as millions have been performed annually. All the physicians I have known throughout my life have treated those women with respect and referred them to other sources for help. I have never read of anyone who died of pregnancy. It is not an illness and should therefore not be treated as such. We should also remember that the physician has two patients to consider when an abortion is discussed. Regardless of personal opinion, the fact is that thousands of preborn babies have been surgically treated and others delivered safely prior to their full term. Walls of some hospitals are covered with photos of these. To pretend that the unborn child is not human has, of course,been scientifically disproven but there are those who will stand by our country’s 400 year old law which says otherwise.
The bottom line is that our freedoms should not be removed to accommodate that which is not a “right”, even though the law permits it. Let us remember the many injustices and atrocities that were considered legal in our time. Perhaps in the near future, we can look back at baby killing with the same shame.
Well in regard to the Physician comment below—-You took an oath so as all other groups that have oaths in their makeup—then why not leave the position and find one without an oath, or do you have something else in your mind? If you have the right to kill, why do we have courts. As Doctors have proven — an unborn baby is exactly the same as a born one; regardless of the mishmash put out by certain ones. I agree they are entitled to their opinions -but-!
Now Physician 2 seems to be a normal thinking person. Why should his thoughts be forcefully changed?
Basically we see the usual workings of a minority +I do not like what you are doing+ — change it to my way thank you, like all the other things changed, quite often by one person complaining.
Are their rights more important than ours. It seems that the majority come in second. One person’s viewpoint should not lay the ground work for a massive change in things by so called ruling people.
I trust that Ontario’s College of Physicians and Surgeons will reconsider the present movement to require physicians to refer patients for all medical procedure in disregard for the beliefs, principles and consciences of the doctors.
Not only does such a requirement trample on the rights of doctors to determine and uphold their moral outlook, it also denies patients the right to choose doctors whose beliefs are coherent with their own.
Why must every health care provider assume a generic outlook? Why cannot patients register with doctors whose attitudes to life and death accord with their own attitudes? And what kind of a doctor could shed deeply held beliefs in order to subscribe to medical procedures that are deeply abhorrent to both doctor and patient?
Why, on contentious issues, must we suffer from the well-publicized implication that there are no consequences to moral choices? In light of the natural law that is written deeply in the heart of every human being, there are going to be consequences for the disrespect for human life, whether we choose to believe it or not. If particular lives are not valuable at vulnerable moments, then neither are ours.
My family and I respectfully request that freedom of conscience remain the right of every physician and health care provider.
I think physician should respect patients believe, and provide care to all equally. However, if a physician does not believe to certain culture/ religion/believe, or is not comfortable providing service to a group of patients, I think the quality of service will be jeopardized.
Physician should disclose their believe to patients, and in non-urgent cases refer them to different physician, or advised to find different doctor, but if there is no other option for the patient, I think physician should continue providing care and service to patient.
Physicians should not be forced to go against their conscience if they do not agree with providing a specific treatment or medical procedure. The patient has the option to seek out other physicians who may be willing to offer what they want. In some instances this may provide the chance for a “sober second thought” to a procedure which may be irreversible and life changing.
Freedom of Religion should be first and foremost in the minds and hearts of every Canadian. The College of Physicians and Surgeons of Ontario are destroying human rights. We hear of the bad Human Rights in other countries e.g. China but it is also happening right here to moral faith filled people. We are part of the many people that helped to keep Canada STRONG AND FREE. I don’t call this new legislation following those rules. The people desiring this legislation should move where they can live their way not change our country that our ancestors worked hard to achieve the freedom.
I don’t understand how the elected people can decide to take away our human rights. When babies have a heart beat at conception, our grandchild had a heart beat at 6 weeks in the womb when they were worried about a miscarriage and took and ultrasound. The doctor confirmed that there was no worries because the baby had a strong heart beat. Since that is true how can any person do an abortion or even want an abortion when it is a living person. Many people are in prison for many reasons that are not as horrific as murdering a baby before he or she can be born.
Physicians, like all human beings, must make decisions according to their conscience. A patient asking for treatment that goes against the conscience of a physician cannot expect that physician to provide the service or to make a referral for that service. After the physician has explained his reason for refusing treatment, the patient is on his own to decide the next step. He has freedom of choice to act according to his conscience.
My Doctor is fabulous. Very helpful, always willing and able to see me. She is religious and practices within her faith. I am pro choice and pro euthanasia but recognize she is not. This does not bother me as we all are entitled to our own opinions, and religious beliefs should be protected under the charter of rights and freedom. If I needed an abortion I would never dream of going to see her. There are other clinics and drs. Also if I strongly disagreed with her stance I could find another doc. Please do not impose things in people with morals and religious beliefs.
On learning of the document entitled “Professional Obligations and Human Rights I am deeply disturbed that it will force doctors to perform procedures or give advice which runs counter to deeplly held beliefs held by the doctor. Why force a doctor to carry out an act which is deeply offensive to their secular or religious belief when there others willing to carry out the task?
While there are many positive aspects in this new draft policy, I am very concerned about the requirement for physicians to perform or refer for procedures that they believe are morally unacceptable.
I believe that health care is strengthened by the diversity in medicine and in providers beliefs. I believe that making physicians simply a technician is not the answer and that patients will suffer if this is what occurs. We, as physicians, must be able to do what we believe is best for our patients and patients should be able to seek out physicians who share values with their own.
Please do not accept the policy in it’s current form. Please protect the conscience rights of physicians. If we don’t – it’s the patients who will ultimately suffer – by losing many incredible, ethical, knowledgeable, and dedicated physicians who will leave the practice of medicine rather than compromise their moral or religious beliefs.
Thank you.
Hi there,
I am so free to provide my input on your human rights policy draft as your relatively new member.
I think referring the patient to another health-care provider for treatment you are unwilling to provide based on your moral or religious beliefs is actually the same as providing the treatment and forcing the physicians to go against their beliefs.
Right of the patient to have some medical procedure shouldn’t go against the right of the physician to act according to his own beliefs otherwise this policy if accepted, might be introduction to the totalitarian rule.
This policy would be too harsh and inappropriate, especially here in Canada where you have so many resources and health-care providers so patients can get easy access to controversial treatments and procedures even if refused by provider who is not willing to provide them.
One of the pillars of CPSO’ work and acting in the public sphere should be keeping physicians autonomy, and as you know from the history human rights and their interpretation vary by the society, political rule and current context and are not absolute.
Dear Members of the Consultations Committee:
Subject: Draft Policy “Professional Obligations and Human Right.”
I would like to express my deep concern for the proposed revision of the draft policy. This revision states that physicians who are unable to participate in services due to moral or religious beliefs are required to make referrals to individuals who are able to perform those services in order to ensure timely access to health care. The draft does not clearly give examples of these services but we can assume that the oral contraceptive pill, abortions, and perhaps euthanasia – should it become legal and the standard of care in Canada – are the main topics of contention. Many of the same physicians who refuse to participate in these services would also be opposed to making referrals as they believe it is akin to actively cooperating with the act.
Abortions are made on a self-referral basis and are already widely available to the public. Emergency contraceptive, also known as “Plan B” is available over the counter and does not require a prescription from a physician. The birth control pill is promoted from a society perspective as a main form of contraception and is readily available at many sexual health clinics throughout Ontario. There is no need to increase access to these services since they are already available through many interfaces.
As you clearly described, physicians have a fiduciary responsibly to their patients and we must legally act in their best interests. In today’s moral landscape, there is much dissent in defining what constitutes a morally permissible act. Some physicians are strong proponents that abortion and oral contraceptive pills negatively affect one’s psychosocial and physical well being. In forcing these physicians to prescribe OCP and make referrals to those who are able to perform abortions, it is diminishing and undermining the fiduciary duty physicians have towards their patients. Freedom of conscience is paramount in upholding a free society, and if we cannot defend physicians from conscientious refusal we are coercing these people to violate their conscience and act in a manner that is degrading to their integrity, both as a person and as a physician.
On behalf of my colleagues and I who share this grave concern, I encourage you to reconsider this version and make the appropriate amendments to incorporate a clear defense for the right to religious, moral, and conscientious refusal of procedures.
To whom it may Concern,
I am strongly opposed to the proposed draft to force physicians to prescribe or refer against their conscience. This is an assault against their freedoms.
Let me give a parallel situation with another profession.
I am a recently retired physiotherapist.
In my years of practice I have developed preferences for certain techniques to use in the care I give. And there are even a few techniques that I do not use because I believe they are ineffective or harmful.
To suggest a regulation that would allow a client to demand I use a certain technique & claim I am violating THEIR rights if I don’t is totally preposterous!
It is a fact that this draft would adversely affect many experienced & capable physicians contributing to some leaving the profession through conscience or burn out.
Maybe none on this council have moved & tried to get into a Family Physicians office lately. It is extremely difficult so that many must rely on drop in clinics with no continuity of care.
It is clear to me that this draft has the purpose of compelling physicians to be involved in not giving life but taking it through abortions & euthanasia. That is the bottom line.
Shame on you,
Hello,
Forcing doctors to act against their consciences harms both our doctors and all Canadians. Do not force doctors to practice medicine in a way they find reprehensible.
Please do not bind the conscience of our health care workers by forcing them to do procedures to which they object.
Please allow our doctors to practice according to their conscience. There are always other doctors who do not hold the same convictions to whom a patient can be referred. Forcing a practitioner to act in discord with their core beliefs not only fragments a person, but causes them inestimable stress, distraction of mind, and ultimately impacts their practices in a myriad negative ways.
Freedom of conscience, along with freedom of speech, are core values that define liberty and the free world. Start chipping away at those, and you signal the beginning of the end of our way of life as we know it.
Please do not slough off or decry the above statement. It is profoundly important to us as Canadians going forward.
Thank you
Please do NOT force physicians to act against their conscience. Please allow them to exercise their moral standards.
Forcing Physicians to act against their conscience will harm them and will ultimately harm society.
Please do not do this!
We must protect the physician’s conscience rights. We are not God, and neither should we play God, by hastening death. He alone knows the hour of death; a patient affected by medication and trauma, a
doctor biased, a family member fed up or motivated by ulterior motives simply cannot provide the right answer. God gave life, he will also take it away. If we are left to the whim’s of man in these and other
issues, its my word against yours, my preferences vs someone else, my opinion, my rights. God says in His sacred Word: “For the wages of sin is death, but the gift of God is eternal life
through Jesus Christ our Lord” Romans 6:23. And in Revelations 1:18 “I am He that liveth, and was dead; and, behold, I am alive for evermore, Amen, and have the keys of hell and death”
To the College of Physicians and Surgeons of Ontario,
I strongly urge you to reconsider this new set of regulations you are planning to implement. While it is true that persons in all kinds of distress may have legitimate concerns and whose legitimate rights must be respected, another fundamental human right must not be neglected: the freedom to act in accordance with moral values informed by legitimate beliefs.
I am concerned the legitimacy of those beliefs is what is being questioned. Nothing in your proposal appears to recognize that a great many Ontarians do not share the belief of others regarding certain “health services.” The proposal simply takes for granted that these “health services” are a human right that must be respected at the expense of another human right: the freedom never to be compelled to act against one’s legitimate convictions.
Some doctors will feel that although they are allowed to refuse said “services” on the grounds of private convictions, they are obligated to refer the patient to another who will offer those “services” and in the end it makes no difference. If they have not committed the act (of abortion or euthanasia) directly, they have contributed to it all the same.
Please reconsider this proposal. Many Ontarians do not believe that these health “services” are a fundamental human right. You cannot use the language of human rights and equality while you are stamping out the rights of conscience of many doctors.
To whom it may concern,
I am a family physician in practice for 20 years. I have read the CPSO Draft policy on Physician Rights of Conscience and Freedom and strongly oppose such infringement on our human rights.
Thanks for your attention.
The ability of doctors and other health professionals to act according to conscience is a fundamental human right that is not respected in the draft and must be.
Thank you.
Lines 156-164
I find it reprehensible that the College of Physicians and Surgeons has drafted a policy that would require physicians to make a referral for a patient even if the “care” or “treatment” the patient requests requires action that goes against the doctor’s moral conscience. We all know to what these lines refer: access to abortion. Providing a referral to a patient is still helping the patient to receive an abortion. It makes no difference if the doctor performs it or sends the patient off to another who does perform abortions. By forcing a doctor to offer a referral for an abortion is forcing the doctor to violate his/her right to exercise his/her freedom of conscience, plain and simple.
Patients can do their own homework to find an abortionist doctor. In light of the culture of death in this country, not to mention around the world, there are plenty around! Please stop using euphemisms such as “care” in your policy when referring to abortion. Providing an abortion is not care. Pretending it is damages all involved since pretending is never honest.
Dear College members:
I would encourage you to retain the moral stance that the existing Charter rights of freedom of religion and conscience guarantees.
Professionals such as doctors should not be forced to carry out actions contrary to their rational decisions as provided to them by the Canadian Charter of Human Rights.
Thanks for your openness and consideration of public input.
Dear Sir/Madam
I oppose the draft policy.
Your contradicting your title by not letting us have the Freedom and Right to say no when GOD says NO to all of this and you know that.
Your asking everyone to choose EVIL over GOOD and that is WRONG
Your going to be responsible for every EVIL act your asking our doctors to do and how is this going to benefit this world? Do honestly think GOD’S wrath won’t come? Better think again on that one.
I do not believe the law should force Doctors to perform procedures against their moral beliefs. Also a Doctor’s pledge is to save lives NOT to destroy them.
To the writers of the draft policy,
The Policy needs to be specific that matters such as referral to abortion clinic, or unsafe/invasive reproductive technology clinic or euthanasia clinic, and to any intervention that causes harm… are NOT considered as health issues and thus NOT as matters of treatment or care.
This has to be clarified especially in section ii: Ensuring access to care. Although it is implicit in the “Protecting patient safety” section iii: This latter section does mean that abortion, euthanasia, unsafe reproductive technology, etc… – matters which all great religions and the moral natural law clearly oppose – are inacceptable and rejected by the Policy because they cause harm. But this is implicit in section iii.
It has to be clear and specified. The best place to specify this is in section ii “Ensuring access to care”.
Note well that while you understand section iii to implicitly exclude such “care” as killing by abortion, IVF, or euthanasia, the CPSO does not. In fact, many secular humanists believe that an unplanned pregnancy, for example, will result in “imminent harm or suffering” to the mother if allowed to end in the ordinary delivery of the unwanted child. They don’t believe in the existence of a pre-born person. For this reason, I think, the CPSO has specifically required provision of care “even where that care conflicts with [the doctor's] religious or moral beliefs.” Secular humanism is now the state religion, and its practice is required by law (this policy, for example).
The freedom for one to live by one’s religious conviction should be irrevocable.
Why persecute one who chooses to do so when a doctor who is willing to comply with a patient’s wishes is readily available? Why the personal attack?
I just read in the MD Dialogue magazine ‘Message from the President’ that ‘we would like to know whether [physicians] agree with the draft policy ‘Professional Obligations and Human Rights’. The President in the same letter states that ‘we’ [the CPSO executive, I assume] feel that expecting physicians who limit the services they provide on moral or religious grounds to refer their patients to those who have no such reservations ‘strikes an appropriate balance between physician and patient rights in this context’. I then went to the discussion forum where, to my surprise given the attitude taken by the CPSO, it seems every single comment, both from physicians and members of the public, is against the draft policy, for intelligent reasons. Your agenda is clearly political. You despise a certain moral position and are willing to cause a great deal of expense and trouble to remove those who embrace it. No self-respecting physician is going to follow your policy even if you ‘succeed’ in getting it passed as law. In a battle between truth and lies, truth will always ultimately win out although martyrs are made along the way. And martyrdom often has the effect of strengthening a cause that has truth on its side. At the moment your organization is on record as being on the dark side- I agree with the CMDS assessment of this issue and their recommendations.
Doctors are to save lives not kill them!! Unborn are also a life from the time of conception !! Euthanasia should never happen. Only God has the right to take life!
As a resident who is soon to graduate, I am gravely concerned about this draft policy. Many respondents have raised the same concerns I have, specifically the freedom of conscience, which is a Charter protected right as a Canadian. I think a good question to ponder is if we want our physicians to practice medicine with their moral integrity intact. Because what the CPSO would essentially be mandating me to do is to break my moral integrity, and thus have irreparable consequences on my personal and professional conscience. I do not support this policy, and if approved, it will definitively make me think twice about setting up practice in the province of Ontario.
A physician has the same great human dignity as any patient, not more and not less. Not more means that the physician cannot be expected to play God. Not less means that the physician is expected to have and to follow a personal human conscience. For the College to presume to intrude by ‘defining’ the position of God, or by declaring the proper conscience, is prejudice of the worst kind.
Now I learn that if this draft document is passed, medical doctors will be asked to kill their consciences, as well as kill life in the womb. Many wonderful family physicians, obstetricians and gynaecologists, who took the oath to “ first do no harm”, will not continue practising and many much needed hospitals will shut down. Recently a British Medical Journal, published an article demonstrating that abortion does indeed do harm and is linked to breast cancer among other psychological side effects .
According to the Universal Declaration of Human Rights there is a special obligation for doctors to provide “special care and assistance to motherhood.” This means that all women should have access to competent obstetrical and gynaecological care which includes appropriate care of the child in the uterus and assistance to establish breast feeding of the child after birth. This has been a priority for the government foreign policy in Africa. Therefore provincial bills should be drafted consistent to the theme of safeguarding life, health and fertility, rather than the one on the table that is disastrous to life, freedom of conscience and happiness of our hardworking doctors who are being asked to satisfy the whims of their patients. One such bill might ensure a woman’s right to be informed about how to manage her fertility simply, naturally, and effectively and without cost to government purse or her health: http://www.thebillingsovulationmethod.org
While the Chinese Medical Journal, 1998, proved that knowledge of the Billings Ovulation Method® of natural fertility regulation, among nearly a million Chinese couples, is extremely effective when used to avoid pregnancy (99%) the study also showed successful outcomes for helping couples, having difficulties in conceiving. The study demonstrated that abortion plummeted in those areas where the authentic Method was taught. Surely we could reduce abortion in Canada too in the same way? If a young woman is old enough to conceive and bear a child she is entitled to this knowledge. “All women have the right to knowledge and understanding of her fertility and reproductive health”. “Under no circumstance must abortion be used as family planning” was the conclusion of the United Nations ICPD Report of 1994 and yet twenty years on policies to force doctors to refer or do abortion are in the works…shame on us!
I want my doctor to be free to follow conscience. I trust my doctor’s integrity and would not want her/him to be forced to perform procedures or make referrals against her conscience. To illustrate: my boss once sent me to do something which I believed was wrong. Fortunately, I was sent back to make correction later. I felt terribly guilty, for I knew that dictators in history were able to do horrible things through people who did those horrible things because they were just following orders.
our doctors should NOT be forced to violate their moral integrity. Do they not have their rights to their moral believe? We have the choice to chose the doctor known what their moral integrity is.
I want a Doctor with Moral Integrity!
I am deeply disturbed by this abuse of CPSO’s power because the policy would be an infringement of physicians’ rights and would also limit a patient’s right to be treated by the type of doctor he or she would prefer. The policy would also deter many men and women from choosing medical practice as a profession, as they would be forced to do certain procedures or refer to others (just as problematic, because the physician would still be contributing to something he or she objects to). Physicians’ rights must be respected in the same way that physicians respect the rights and feelings of the patients coming to them with widely divergent worldviews. This policy is clearly discriminatory and a violation of physicians’ conscience and religious rights. Most physicians (and patients) believe that the purpose of medicine is to HEAL people. They did not choose this profession to intentionally end life.
For this particular issue, it amaze me to see how far Physicians and Surgeons of Ontario will go to push their agenda and how naive they seem to be by not realizing the impact it will have to every community in our province. If many doctors with a conscience will loose their license because of the mandate, it will make it more difficult for patient to see a doctor or find new ones where it is already difficult for some, many doctors will move to other countries, baby boomers doctors or doctors with few years left to practice will retire early, no new doctors will be available, there will be long wait for appointment, more people will die before seeing a doctor etc…..and in the process, downgrading our quality of care. As it is right now we are desperate for new doctors, many time we have to import them from other countries where it will take time to re-trained them to our medical standard and most of those import recruits will be killer doctors. I would hate to have to go see a doctor with that kind of practice on his plate.
Dear Members of the Consultations Committee:
Re: Draft Policy “Professional Obligations and Human Rights”.
I am writing to you with grave concern regarding the content of your proposed draft policy, which indicates that physicians who decline to participate in certain acts for reasons of conscience should be compelled to refer their patients to other physicians who will perform these acts. It does not address the fact that many of these same physicians will find the act of referral itself objectionable, as they consider it material cooperation with the act. In compelling physicians to refer, you are limiting their right to conscientious objection. I am opposed to this.
There is significant disagreement in our society as to what constitutes a moral act, and I do not expect the College to define or limit morality. All I expect is that physicians, as professionals, be allowed to respect their own consciences. Freedom of conscience is foundational to our free society and cannot be limited, even for the best of intentions.
If we coerce physicians into violating their consciences we will inevitably erode the personal integrity which is the basis of the physician’s relationship with their patients. I encourage you to revise the sections above, and include a clear defence of the right to freedom of conscience for all physicians.
[**MESSAGE FROM ADMINISTRATOR: DURING THE CONSULTATION PERIOD, WE RECEIVED 270 RESPONSES FROM INDIVIDUAL RESPONDENTS CONTAINING THE CONTENT PUBLISHED ABOVE. ALTHOUGH THIS FEEDBACK HAS NOT BEEN PUBLISHED IN DUPLICATE, THE COLLEGE ACKNOWLEDGES RECEIPT OF THESE SUBMISSIONS.**]
Thank-you for the opportunity to respond to the CPSO’s draft policy. I’m a family physician in British Columbia who is concerned that similar changes may occur here. Also, for twenty years I’ve been teaching a medical ethics curriculum to family practice residents from across Canada.
In medical ethics, as well as in law, the principle of patient autonomy is paramount—but it is not absolute. A great medical ethicist has said that one of the limits to patient autonomy is the physician’s autonomy. Both the patient and the physician are moral agents. The doctor-patient relationship is based on mutual trust and respect. When patient autonomy is the “ace of trumps” the moral integrity of the physician counts for naught, and the doctor-patient relationship suffers. The physician becomes a mere instrument to enable the patient’s wishes; a technician rather than a healer.
One of the features of the draft policy is the obligation to refer for objectionable procedures. The problem here is that referral makes the physician complicit. The door man in a bank heist is just as culpable as the robbers who enter the bank with weapons drawn. If I’m obliged to refer my patients for euthanasia, say (almost certainly to be declared a right this year by the Supreme Court), then I am cooperating in an act which I find abhorrent, and which I pledged in the Hippocratic Oath to never perform.
A Law professor and former Dean of Law has written a timely book on these matters. She maintains that Canada is big enough to tolerate physicians of all backgrounds—First Nations, Muslims, Christians, Jews, atheists, etc. We can all “live and let live” without subjecting certain groups to intolerance and coercion based on creed.
Please reconsider your draft policy on Professional Obligations and Human Rights.
Dear Member of the CPSO:
I am writing to express serious concerns about the drafted changes to the policy, Professional Obligations and the Human Rights Code.
It is a fact that the authorities, and even the majority, do not always get decisions involving morality right. The Holocaust was inarguably evil. And it was authorized, even required, by the Nazi government. In retrospect, we don’t excuse the actions of those who perpetrated it based on the fact that they were ordered to carry them out: we believe that they ought to have acted based on a higher sense of morality, not on their orders. They could only have acted rightly if they objected to the authorities’ requirements of them.
The right to object on moral grounds is fundamental to a free and tolerant society. Historically, we have permitted conscientious objection based on three conditions: first, that the objector has a respectable case on why they object to a particular action, second, that the consequences of the action based on the objectors beliefs are grave, and finally, that the objector holds the beliefs they assert with sincerity. These are somewhat stringent criteria. But applied, for example, to a pacifist during a draft, they ensure that people are not required to commit acts for which their conscience would condemn them and that people are not allowed to use those rights of conscience protection inappropriately for their gain.
The debate regarding this policy has been wrongly set up as a debate about several particular services and whether there ought to be full access to these services. The rightness or wrongness of those services ought to be debated with regard to the CPSO’s stance on those services. This debate is about something far more important. It is about whether or not we will allow physicians to act on their conviction that something they’re being asked to do is wrong.
Protecting rights of conscience does not mean that we will all agree on every issue. On the contrary, it recognizes that, in certain cases, there is legitimacy in having convictions which depart from the convictions of the majority. It recognizes that, although the majority is not won over by an objector’s case for why the action they object to is wrong, still they have a respectable case. It recognizes that asking someone to perform those actions anyway, where the consequences are, in their mind, grave, is dangerous and inhumane.
Conceding that the objecting physician may refer is insufficient: if I believe an action is wrong, I ought not to commit it, and I ought not to commission it. It’s an old and tired but still valid comparison that, if someone really believes that to kill a particular person is wrong, hiring a hit man to do it instead would also be wrong. As long as the proposed action would be a significant transgression to one’s conscience, I believe the analogy holds.
Requiring that the objecting physician commit the objectionable action in urgent cases is unacceptable: the fact that there is urgent wish for the act believed to be wrong by the physician does not make it any less wrong. The fact that there is a war on and the authorities believe that people need to be killed does not invalidate the rights of the pacifist conscientious objector; rather, it makes the objection all the more pertinent. The validity of the objector’s objection is not changed by the urgency of the request.
Please contact me if anything I’ve written is unclear or if you wish to discuss these matters further.
Dear Sirs,
All sorts of notions are arising these days under the guise of “Human Rights”: some are local, some are being touted internationally and have not been officially accepted and yet are foisted on nations as law, others have been denied by courts of law.
The notion of separating a person’s conscience from the person’s practice is, I respectfully submit, an attempt to proximate a schizophrenic condition. A person should be guided in their decisions and actions by an informed conscience and the forming of that conscience, reason suggests, is outside the competence of medicine and civil law: the latter should be there to protect what I shall call natural law. The number of medical practitioners and clinics and hospitals available in Ontario allows any reasonable person enough choice not to burden any single practitioner with having to cater to the so-called “needs” of everyone, particularly when those “needs” happen not to be necessary for or relevant to the preservation of life – which one would hope is the goal of the Hippocratic oath.
Accordingly, I urge your College to adhere resolutely to the Hippocratic oath and not allow a Commission on human rights to distract you from your noble calling. It was Aristotle who identified nobility with virtue even in the pagan era. Matters of sex and sexuality seem to be ruling the day: don’t fall for it, but stand nobly on principle. Your members are the better educated in the population and, hopefully, that education encompassed the ability for critical thinking which we, the citizenry, need to inform the public square by your noble principles and practices rather than succumbing to every fad and fancy of the day.
I wish you God’s guidance in your deliberations.
It is disturbing to have anyone require doctors to provide what the State has deemed acceptable in defiance of the Hippocratic oath. Ironic that this should be happening on a Holocaust anniversary.
As a Hippocractic physician I found the proposed Professional Obligations and Human Rights Policy and the questionnaire that flows from it nauseatingly condescending, morally empty and a sad reflection of the ethical vacuum of a post-Christian culture. Does a “Human Rights commission” really determine the standards of our society?
Is it really necessary to tell physicians to respect the dignity of their patients? Do we need to be told not to “discriminate” against the weak, the marginalized, etc.?
Would it not be simpler to remind ourselves of Medicine’s Christian roots? To love our patients as we love ourselves? Do we need anything more?
To Whom It May Concern: I’m writing to you in concern about this new policy your trying to approve and it shouldn’t be approved at all. This is regarding the “Freedom Of Conscience for Physicians” and how your trying to force Doctors to do unspeakable crimes against GOD and HIS Commandments. I would also think that our fellow fallen soldiers who fought in several Wars in this world would all matter to you since they gave us the “Freedom of Our Rights to do what is right for ourselves and not for your unlawful acts. I refuse to stand by this and not voice my opionion that this is not what GOD wants and I pray to GOD to all of you that HE will have mercy on all your souls because you need it now more than you ever have in your life. Abortion is an unspeakable crime against GOD. It’s not a choice it’s a CHILD and a GIFT from GOD. There is nothing good that comes out of an Abortion and GOD knows this as well. As for reproduction and end-of life care this is wrong as well. It’s up to GOD to take us home and no one else. Just like Capital Punishment is wrong too. It’s murder when you do that too. It’s pure EVIL and that is WRONG. I just hope and pray for each and everyone one of you to when you have to look at the face of GOD when it comes to your near death that HE will have Mercy on all your souls and I will continue to pray for you on all of this. GOD Bless you all.
Dear CPSO consult group,
I wish to register my husband and my opposition to the Professional Obligations and human rights points below:
1 Doctors are required to refer for procedures that are against their moral or religious convictions (Lines 156-8)
2. Doctors are required to perform procedures that are against their moral or religious convictions in situations where that is deemed to be “urgent or otherwise necessary care” (Line 168)
We live in a free country and believe that every governing body should allow for a person to act according to their moral or religious convictions.
ps Thank you for allowing the public to weigh in on this very critical topic.
To Whom it May Concern:
I am a professor of health care ethics. Protecting the rights of freedom of conscience and religion is a basic human right both articulated in the UNO Declaration of Human Rights and in our Canadian Charter of Rights and Freedoms. So far it is also protected in the CMA Code of Ethics, n. 12. It is important that these rights be continued to be respected and not violated by some trying to bully and impose their morality on others. This is hardly tolerance or respect fopr one’s fellow human beings. Atheists and liberals are often the worst bullies today trying to trample on the rights of sincere Christians and others by imposing their narrow agendas. Respecting the rights of Christian and others who are among the most caring health care professionals does not take away the rights of freedom of conscience of other health care professionals including liberals and atheists or the patients.
It is a disgrace that I even feel a need to write such a letter in a free country like Canada. Do not listen to the bullies and intolerant people in your profession!!
While the Charter entitles physicians to limit the health services they provide on moral or religious
129 grounds, this cannot impede, either directly or indirectly, access to care for existing patients, or those
130 seeking to become patients. Therefore, the College requires physicians who choose to limit the health
132 rvices they provide on moral or religious grounds to do so in a manner that:
;
133i. Respects patient dignity
134 ii Ensures access to care; and
135 iii. Protects patient safety
The sections immediately before are well written, clearly vetted with a constitutional lawyer.
However, this section, which I cite above, bears no relationship to the rest. It is not founded in fact, law or rational thought. It is clearly opinion and is the novel imposition by the College of its interpretation of how a Court would handle situations which, just a paragraph above, are described as warranted individual consideration. Therefore, this section should be considered outside the reach of the college. It is an affront to the personal integrity, personal and religious freedoms of practicing physicians and a denial of the entire preamble which precedes it. Moreover, let me state as a matter of my opinion, IT IS TYPICAL OF THE ARROGANT, ARBITRARY THINKING WHICH UNDERLIES THE CONDUCT OF THIS COLLEGE IN THIS AND SO MANY MORE AREAS OF ITS INTRUSION INTO MATTERS THAT DO NOT BEAR ON PHYSICIAN-PATIENT RELATIONSHIP AND CARE. IT IS, IN SHORT, TYPICAL OF A BULLY; AND IF THERE IS A WORD WHICH BEST DESCRIBES THE CPSO IT IS BULLY.
I would be deeply concerned if this policy were not revised to protect the personal freedom of the individual physician. As it is presented it would obligate the conscientious medical practitioner to perform a service that could include, what to them would be totally against there code of ethics as someone who works to preserve and protect life. . In other words if this policy becomes law as it is now presented, it would mean that the physician is obligated to participate in ending a life; be that an unborn child through abortion, or if Euthanasia becomes legal, that of some other person. This would be tantamount to murder.
Surely our great country of diversity and tolerance can find a way to preserve the indivdual rights and freedoms of all Canadians.
Comments on the Human Rights Code
I am not in favour of some of the proposed revisions to the Professional Obligations and Human Rights Code for the Physicians and Surgeons for the Province of Ontario.
I do not believe these proposed changes will result in better patient care. In addition I believe the proposed changes will systematically discriminate against doctors who do have a conscience and will adversely affect the profession as those who have a conscience will no longer choose to become a doctor. Furthermore I consider doctors to be servants of the state not slaves as this code would demand.
Since there is a clear dichotomy of opinion in society regarding the rights of the child in the womb, it would be immoral and I believe unethical to adopt a code at this time that will be enacted on the premise that the child in the womb does not have a right to life. And it is not a small or insignificant number of folks in this province or country who hold these views. For example a survey by Abacus in 2011 indicated that 59% of Canadians surveyed believed that human life should be legally protected in some way before birth, 27% of Canadians believe that human life should be protected from the moment of conception, 32% believe human life should be protected during pregnancy.
http://abacusdata.ca/wp-content/uploads/2011/05/Abortion-Report-May-11-2011.pdf
For this reason I believe the case of pregnancy presents a unique situation. It is the only situation where the doctor is dealing with two patients at the same time.
Therefore, in this situation, the code must consider the needs not only for the patient that can speak for themselves but also for the patient that can not speak for themselves, (the preborn child). The need for protection from imminent harm, suffering and/or deterioration of both the preborn child and the mother need to be considered. If you proceed with changes, abortion should be positively identified as a medical service that doctors are exempt from providing or having to refer. I do not consider doctors who refuse to refer for abortion services as discriminating against their patients as they treat all their patients the same way and they usually make that known up front. A patient is always free to seek those services elsewhere.
I believe euthanasia or assisted suicide, should they ever become legal, would be another medical service that doctors should be exempt from providing or referring. A doctor’s role begins and ends at healing the patient. Killing the patient is not and should not ever be considered as the role for a doctor.
Dear Sirs:
While not living in the province of Ontario, I am aware of your draft policy with respect to “Professional Obligations And Human Rights” and would like to provide you with a few points of feedback.
1. It is important that physicians do not discriminate against any patient but it is equally important that policies governing the work of physicians do not discriminate against the practicing physician.
2. Forcing anyone to do something that is morally abhorrent to him/her, especially when freedom of conscience with respect to that issue is guaranteed in the Charter of Rights and Freedoms, would seem to contravene a fundamental Canadian cultural value and legal right.
3. Given the fact that access to the specific services/treatments being targeted by this policy are already provided, there seems to be no good reason to override the conscience of physicians who refuse to perform such services/treatments since their refusal does not limit the ability of patients to access said services through a physician willing to perform them.
Surely, in a country where tolerance is valued as a cardinal virtue, there are ways and means to provide superb patient care without trampling on the rights of those providing that care. I stronly urge those responsible for this draft policy to re-draft it with a view to securing the freedom of conscience for those physicians whose moral or religious views do not permit them to function according to the policy as it is currently drafted.
To the CPOS,
It is with tremendous thought that I am writing to ask you to vote against physician assisted suicide and uphold the rights of doctors and other health care professionals to be able to work in an environment that does not threaten their freedom of conscience.
To Whom It May Concern,
I do not agree to ‘Force physicians to act against their conscience, to do something they believe is deeply wrong against their will is unconstitutional’! No one has the right to force their beliefs upon another nor force someone to do a medical procedures that they do not agree with!
DO NOT LET THIS HAPPEN!
Dear CPSO consult team,
Thank you for taking the time to review feedback on your draft policy about physician conscience rights. I am concerned about Sections 8, 10 and 11 that discuss forcing physicians to refer for services they themselves find morally reprehensible. I do not feel that this policy is either necessary or ethically right.
From my understanding, the issue at the heart of this debate is conscience rights to object performing procedures such as abortion and providing access to contraception. Fortunately, because of the way our health care system is structured, a referral is not necessary to gain access to either of these services. Abortion clinics do not require a referral from primary care doctors. Therefore, forced referrals is a moot point. In the matter of contraception, a woman is free to go to a doctor that does prescribe contraception (these far outnumber those who do not). There is no shortage of physicians providing OCPs to justify forcing the minority to refer their patients.
A change in the policy would be morally wrong because it would result in forcing physicians to act against their conscience. Currently, as the policy stands, all parties involved are treated fairly. Physicians are practicing in ways that are in line with their beliefs. And patients are receiving the services they want. We have yet to have a case of a woman not receiving any contraception because one physician was not able to provide the care. However, with the change in policy physicians will be forced to participate in an act they believe to be wrong. While having little to no impact on the quality of care patients already receive.
I hope the CPSO recognizes how important it is for physicians to act according to their moral compass. Of course, I am not suggesting that any and all conscientious objections be entertained. I feel it should be based on a case-by-case basis rather than this proposed “blanket veto” approach. The College should be doing their best to encourage integrity and honesty in their doctors. This is certainly not a religious issue. Even in “secular” medicine we prevent narcotics abuse in patients because of its harm. Similarly, contraception is not prescribed because of the many known negative side effects that can be overcome by using NFP (a natural, cost free alternative). A policy encouraging physicians to practice without their conscience is certainly a dangerous policy to create.
I encourage you to revise the sections above, and include a clear defense of the right to freedom of conscience for all physicians.
Dear Members of the Consultations Committee:
I am concerned with Sections 8, 10 and 11 of your proposed draft policy that indicate that physicians who decline to participate in certain acts for reasons of conscience must refer their patients to other physicians who will perform these acts. The act of referring a patient is in itself for many physicians morally objectionable, as they consider it material cooperation with the act. In compelling physicians to refer, you are limiting their right to conscientious objection. Also, Section 11 indicates that in an emergency, the physician must provide medical services that are against his or her moral or religious beliefs. This goes against freedom of conscience under the Canadian Charter of Rights and Freedoms and is contrary to our free society. The proposed policy is currently proposing a totalitarian regime against our Canadian values. Furthermore, how can we trust a physician who violates his or her conscience? This goes against personal integrity which is the basis of the physician’s relationship with their patients.
Physicians and health professionals should be allowed to respect their own consciences. I encourage you to revise the sections above and include a clear defence of the right to freedom of conscience for all physicians. If not, you risk losing many great physicians, the respect of many patients, and you will be in violation of the Charter and our basic Canadian values.
Good evening,
I am writing in regards to the new College of Physicians of Ontario’s policy. Particularly I am writing with concerns regarding the draft policy’s requirements for Doctors to potentially act their conscience (lines 113-122 of the draft code). This policy could lead to Doctors whom have certain religious beliefs, such as Catholic or Muslim, to act against their morals. I believe this is a violation to the Rights to Freedom of Conscience and Religion guaranteed in the Charter, and will not result in less discrimination or better patient care.
Thank you for your consideration.
Dear CPSO,
I am writing to you in regards to CPSO’s draft policy on “Professional Obligations and Human Rights”.
I am very concerned about the ideas and guidelines set out in the policy stating that all physicians must make an effective referral for all procedures or medications that they do not provide out of moral objection. While it is important to ensure optimal patient care, this change in policy hinders physician freedom of conscience and religion. It is necessary to protect physician rights as well. Physicians should not be forced to refer for procedures against their conscience. Even if physicians don’t refer for these procedures, patients are still able to get them in a timely manner without compromising the physicians’ freedom of conscience.
I strongly urge the CPSO to change the draft policy.
Dear Sirs,
It has come to my attention that the CPSO is considering a revision of the “Physicians and the Ontario Human Rights Code”. I understand that the CPSO’s plans to limit physicians Rights to Freedom of Conscience and Religion and require them to make a referral to another physician when they elect not to comply with their patients’ requests for contraception, abortion and euthanasia (should that be legalised!).
As a Canadian and a concerned catholic, with many family and friends as practicing medical doctors, I find your draft policy to be authoritarian and is no different than that of a military commander asking his soldiers to blindly obey orders to kill or torture in the name of discipline. To a layman, your proposed revision seems to suggest that you do not trust nor respect physicians, who are all well educated and have spent their life dedicated to the well being of patients, to make ethical choices that would not undermine the interests of their patients as a result.
I hope that you will give due respect to the physician’s human rights and their professionalism when considering the revision of this code.
Good afternoon
I would like to voice my opinion against euthanasia.
Physicians should not be placed in situations where they ‘must’ assist or ‘refer’ patients in regards to euthanasia. Their role is to assist in healing.
Physicians nor patients should be the deciding factor when death should occur. There are many circumstances where it can become a ‘slippery slope’ if this legislation goes into effect.
Consider that you would be asking someone to end a life. How can you even consider taking that choice away from a Doctor or any medical person? Well I guess she/he does have the choice of leaving their field. Then I wonder what kind of individuals would be left.
I understand that the College is inviting feedback on your proposed revision of its human rights policy. As a licensed physician practising here in Toronto, and having read the proposal, I’d like to respond.
First, thank you for your work on this important topic. I can certainly understand that the College (and all of us) need to be aware of human rights legislation and how the courts and Human Rights Commissions and Tribunals deal with it, especially on issues that may affect our practice.
That said, I’m concerned about the College’s present and past utterances about issues around physicians refusing on ethical grounds to provide certain services on request. The general tone is to disqualify “personal morality or religious beliefs” and call on the ethical minorities among our colleagues in effect to hold their noses and see to it that the patients get what they want. The authors at the College seem to think that for such physicians to refer the question to a compliant colleague solves everybody’s problem. It seems to me they authors haven’t seriously listened to the minority concerns. In the case of abortion, their approach seems to trivialize the ethical concern to mere squeamishness. Western culture’s experience of trying to live ethically in confusing and challenging times led us as a society to the view that personal ethics are vital to the health of social ethics, and that without personal ethics we’re helpless to challenge society’s ethics if they’ve gone awry. Consider the experience of the US Civil Rights movement which challenged the majority ethical consensus of white society in the US South. Consider also that we Canadians stood in judgement at Nuremberg over the German physicians of the Nazi period. Their defense was that they had done nothing outside of the law (true). However, we took the view that ethics transcend and should inform legislation, not the other way around, and therefore we could hold them to account for their deeds. Such transcendence of ethics is only possible by the exercise of conscience by all physicians. Granted there may be differences arising from this exercise, but we should do our best to accommodate these differences.
Who among us does not have “personal morality”? What patient could trust a physician who had none? Is the College not recommending a corporate or societal morality to be followed instead? If so, how is that corporate moral consensus to be discovered without starting from the personal moralities of each participant at the table? However this process works, the result will usually be that we get a majority report and a minority report, just as we do in politics and jurisprudence.
Where do we go with that? I think one of the geniuses of our society is that we discovered the option of Conscientious Objection. We worked this through in the context of conscription for warfare, but I think we can learn from this and constructively apply the principle to medical ethics, balancing the human rights of patients with the conscience rights of physicians. Individual conscience is too precious a part of our social fabric to be casually overridden.
One suggestion I’ve heard that may be worth considering is for the OMA and / or the College to develop a registry available to the public of physicians willing to provide legal but ethically controversial services to patients whose own physicians cannot in conscience provide them.
If and when euthanasia becomes legal, the College will sooner or later be faced with adjudicating ethical dissonance within the profession such as it’s now having to do with abortion and contraception. The human rights / conscience rights issue will be much the same, and I would suggest to the College a similar approach.
To the College of Physicians and Surgeons of Ontario:
Freedom of conscience is a fundamental freedom in the Canadian Charter of Rights. We demand that the Ontario College of Physicians and Surgeons respect the diversity of medical judgment and not coerce doctors to perform or refer for procedures to which they conscientiously object. We expect that every provincial medical authority will allow doctors to practice in the spirit of Canadian pluralism and with the freedom guaranteed in our Constitution.
[**MESSAGE FROM ADMINISTRATOR: DURING THE CONSULTATION PERIOD, WE RECEIVED 5387 RESPONSES FROM INDIVIDUAL RESPONDENTS CONTAINING THE CONTENT PUBLISHED ABOVE. ALTHOUGH THIS FEEDBACK HAS NOT BEEN PUBLISHED IN DUPLICATE, THE COLLEGE ACKNOWLEDGES RECEIPT OF THESE SUBMISSIONS.**]
Are the human rights of the Physicians not equal to those whom they serve? Human Rights legislation is for the protection of all citizens. It is not meant to divide the rights, or lessen the rights of some; nor to allow the rights of some to supersede the rights of others.
Response in PDF format.
So the college of physicians wants to remove the rights of doctors who will assert their right to freedom of religion? This is tyrany. Any doctor who refuses to be part of a medical procedure that would contravene their religious beliefs and then has to fear reprisal from their own professional organization is living in a society run by tyrants. There is nothing preventing anyone who wants medical services from seeking a doctor who is willing to undertake certain procedures or medical assistance that was defined as immoral up until the time of moral relativism that is attempting to take control of the laws in Canadian society. Doctors should not have to give up their charter rights nor have one ‘charter right’, trump the semial charter right of religious freedom free from persecution.
DO NOT strike down the Criminal Code prohibitions to assisted suicide. Doctors cannot be forced to act against their consciences.
I appreciate that The College is constructing a document to protect patients’ rights. I am concerned that in the zeal to protect patients, doctor rights are not adequately protected. I do not think it should be considered professional misconduct if I refuse to perform euthanasia or refer a patient for euthanasia if I am morally opposed. I do agree that I should make the patient aware of the grounds for my refusal
Good as is.
Maybe for you. I represent a future Christian patient, and I think a Christian family doctor is not too much to ask. This policy will drive Christians out of the profession.
The status quo is better.
I am a young woman and Ontario resident and would like to express my concern about the draft policy entitled “Professional Obligations and Human Rights”. I am strongly opposed to the way that this new policy would force doctors to violate their consciences in regards to referring for procedures/services that they consider to be profoundly immoral.
Although I do believe in non-discrimination, having a doctor that does not provide particular services (or referrals) does not constitute discrimination against a group – as long as they do not selectively deny that particular service to some and not to others.
I do not understand how forcing doctors to violate their freedom of religion and conscience would result in less discrimination or better patient care. In fact, this would erode my trust in physicians. Furthermore, I do not want to see doctors with strong moral stances to be eliminated from practice or to reduce their sense of integrity. This is the real source of discrimination and it will impact our doctors and impact patient care.
Please respect the conscience and religious rights of doctors and make amendments to the policy that will not force them to refer for services they conscientiously object to.
Dear Members of the Consultations Committee:
I understand that the CPSO is proposing a draft policy that would compel physicians to refer patients for procedures they find morally objectionable.
This policy seeks to impose moral conformity on issues for which there is no societal consensus. I strongly oppose this policy and urge the CPSO to respect the rights of its members to meaningfully exercise their freedom of conscience.
Catholic Organization for Life and Family
Response in PDF format.
I understand that the College is inviting feedback on your proposed revision of its human rights policy. As a licensed physician practising here in Toronto, and having read the proposal, I’d like to respond.
First, thank you for your work on this important topic. I can certainly understand that the College (and all of us) need to be aware of human rights legislation and how the courts and Human Rights Commissions and Tribunals deal with it, especially on issues that may affect our practice.
That said, I’m concerned about the College’s present and past utterances about issues around physicians refusing on ethical grounds to provide certain services on request. The general tone is to disqualify “personal morality or religious beliefs” and call on the ethical minorities among our colleagues in effect to hold their noses and see to it that the patients get what they want. The authors at the College seem to think that for such physicians to refer the question to a compliant colleague solves everybody’s problem. It seems to me they authors haven’t seriously listened to the minority concerns. In the case of abortion, their approach seems to trivialize the ethical concern to mere squeamishness. Western culture’s experience of trying to live ethically in confusing and challenging times led us as a society to the view that personal ethics are vital to the health of social ethics, and that without personal ethics we’re helpless to challenge society’s ethics if they’ve gone awry. Consider the experience of the US Civil Rights movement which challenged the majority ethical consensus of white society in the US South. Consider also that we Canadians stood in judgement at Nuremberg over the German physicians of the Nazi period. Their defense was that they had done nothing outside of the law (true). However, we took the view that ethics transcend and should inform legislation, not the other way around, and therefore we could hold them to account for their deeds. Such transcendence of ethics is only possible by the exercise of conscience by all physicians. Granted there may be differences arising from this exercise, but we should do our best to accommodate these differences.
Who among us does not have “personal morality”? What patient could trust a physician who had none? Is the College not recommending a corporate or societal morality to be followed instead? If so, how is that corporate moral consensus to be discovered without starting from the personal moralities of each participant at the table? However this process works, the result will usually be that we get a majority report and a minority report, just as we do in politics and jurisprudence.
Where do we go with that? I think one of the geniuses of our society is that we discovered the option of Conscientious Objection. We worked this through in the context of conscription for warfare, but I think we can learn from this and constructively apply the principle to medical ethics, balancing the human rights of patients with the conscience rights of physicians. Individual conscience is too precious a part of our social fabric to be casually overridden.
One suggestion I’ve heard that may be worth considering is for the OMA and / or the College to develop a registry available to the public of physicians willing to provide legal but ethically controversial services to patients whose own physicians cannot in conscience provide them.
If and when euthanasia becomes legal, the College will sooner or later be faced with adjudicating ethical dissonance within the profession such as it’s now having to do with abortion and contraception. The human rights / conscience rights issue will be much the same, and I would suggest to the College a similar approach.
Good evening.
I am very concerned about this draft policy.
In many cases, patient services which go against the conscience of physicians are things these physicians believe to be harmful to the patient they are treating. Abortion, for example, is not by any means a low risk procedure, having the potential to pose grave physical and long term mental health effects to the women undergoing the procedure, not to mention the fatality to the in utero patient. By their Hippocratic oath, physicians swear not to unduly harm patients, something they’d be doing if they were required to carry out or even refer out these objectionable services.
Physicians are not robots, nor are they treating them. They are compassionate humans, striving to treat patients in a caring manner. I implore the province of Ontario to give their physicians the continued latitude to do so.
Dear Members of the Consultations Committee:
Re: Draft Policy “Professional Obligations and Human Rights”
I am writing to object to the new policy presented where you eliminate the right of doctors to conscientiously object to performing a procedure they are morally opposed to.
Would you like to be forced to do something you believe is wrong? Then don’t force anyone else to do what you wouldn’t want to be forced to do.
One by one these fundamental human rights we fought hard to implement we are now stripping away from each other in the name of “I know better”, “I should get what I want”, and “me first”. What are we teaching our next generation other than a self serving, only I matter attitude. I don’t like seeing my loved one like this so let’s stop the pain! And if doctor so and so won’t do it I’ll sue them for not doing what I want or complain so the board forces them to do what I want not what they believe is right. We are not showing the next generation to think “what will I learn from going through this experience and how will it make me a stronger person?” but only live in the moment and if it’s painful then end it.
It’s as simple as that. Even if you don’t believe in the sovereignty of God, as a human being you have to see where our society is going when we start forcing those who desire to preserve life to end it. Soon there will be no one left on earth who wants life to continue. If we start making it a “this person’s quality of life isn’t as good as that one’s” then where will we stop. Either life is sacred or it isn’t. If the person can not take their own life, then their life will end in God’s good timing. We’ve seen many cases popping up lately where a comatose patient wakes saying they were aware of everything going on around them and after years of coma they awake! Doctors say they will never live again and they wake from their coma. The point is, tho doctors are very knowledgeable and better deemed to make these calls than the average person, they still don’t know with absolute certainty, there is always a chance of being wrong.
Don’t force our doctors to act against their own conscience’s. That my dear committee, is one of our last basic human rights.
Response in PDF format.
Response in PDF format.
“As a practicing family doctor since 1987 I’ve seen a countless number of women regret having abortions, yet I have not yet met any woman who regrets keeping her child. Not only is it my duty to follow my conscience, but sharing experiences has proved to be worthwhile as mentioned by several patients. Recent scientifically valid research noted in the book Complications: Abortion’s Impact on Women published in 2013 by the deVeber Institute points to several medical complications including: (1) subsequent increased preterm labour and placenta previa, (2) Asherman’s syndrome, and (3) increased suicide and substance abuse. I do hope the CPSO reads this literature. Passing this bill would cause many middle-aged physicians to retire prematurely.”
This physician’s comment has a theme common to many comments here: what the patient asks the physician to do is often not in the patient’s best interest. As a Christian, I find that my faith agrees with reality, but I see secular humanism ever farther diverging from reality. As a result, we speak euphemistically of gender identity, homosexual fertility, dignity in death, and reproductive health.
Response in PDF format.
Response in PDF format..
Response in PDF format.
As a member of the public, I would like to highlight this letter from an obviously compassionate, service-oriented, altruistic, and trustworthy physician that CPSO should work to get and keep. The letter demonstrates the irony that the effects of the new policy, an increased number of patients legally abandoned and decreased quality of service, will be EXACTLY OPPOSITE to the professed intent of the new policy, respect for patient dignity and access to care.
To whom it may concern,
I am writing in regard to the new provisions which seek to override physicians’ freedom of conscience. In particular, I refer to provisions such as this one:
Where physicians are unwilling to provide certain elements of care due to their moral or religious beliefs, an effective referral to another health care provider must be provided to the patient. An effective referral means a referral made in good faith, to a non-objecting, available, and accessible physician or other health-care provider.
Physicians who object on grounds of conscience are exercising one of their fundamental freedoms in a free society. To refer someone to another member of the profession who is willing to perform an immoral act is itself immoral. For example, an accountant who sends clients to a colleague who enables illegal tax evasion is complicit in the illegal and immoral act. The same thing applies to a physician who enables an act he believes to be immoral.
I am afraid that the new draft rides roughshod over physicians’ rights, and seeks to create of profession of amoral robots. This is the road to a totalitarian state, not an expression of democratic pluralism.
Alliance for Life Ontario
It appears that the CPSO draft policy has been written in order to eliminate any physician with an, ethical, moral or religious conscience from remaining in the profession and also to prevent people with such views entering the profession.
Supreme Court of Canada
In R. v. Big M Drug Mart,[5] Chief Justice Dickson’s judgment for the Supreme Court of Canada began by saying that the essence of the freedom of religion under section 2 of the Charter is “the right to entertain such religious beliefs as a person chooses, the right to declare religious beliefs openly and without fear of hindrance or reprisal, and the right to manifest belief by worship and practice or by teaching and dissemination”.
However, the Court went further to find that freedom of religion includes more than simply the right to hold religious beliefs and exercise religious practices. It also means “the absence of coercion or constraint”, because if a person is pushed one way or another he or she is not freely choosing. And such coercion includes “indirect forms of control which determine or limit alternative course of conduct”.
Thus, freedom of religion means “both the absence of coercion and constraint, and the right to manifest beliefs and practices”; that is, that “no one is forced to act in a way contrary to his beliefs or his conscience”.
The only limitation upon an individual’s freedom of conscience or religion recognized by the Supreme Court of Canada is that its manifestation must not injure others or interfere with their right to manifest their own beliefs and opinions.
Therefore there is a point where rights collide and there is a “collision of dignities” but one does not annihilate nor trump the other. Physician and patient have equal rights and the CPSO would do well to find an accommodation which does not trample either individual’s rights and forcing physicians into actions they believe immoral, is not one of them.
Physicians who do not wish to co-operate in the killing of children before birth or prescribe Class #1 carcinogens for women as birth control and sadly I fear with the CMA change on assisted suicide, medical killing at the end of life, will be under further duress.
If physicians are not protected from coercion in our great country then much will be lost, including the integrity and honour of those doctors who refuse to kill. The medical profession will suffer and so will patients.
On a question so significant as whether a fetus is a human being, please don’t force people who believe it is to participate in any fashion with what they believe is murder.
I believe doctors should be given an option whether to refer or conduct any procedure that is against their moral conscience/ethics. This will allow them to act on their freedom of speech and rights as a Canadian. Not all Canadians have to same shared values and surely as an expression of freedom these doctors should be given the right to chose.
Re your passing draft legislation forcing doctors to act against their better judgement and requiring that these doctors either perform or refer for medical procedures that they object to:
Forcing doctors to act against their consciences harms both our doctors and all Canadians!
I agree with this article:
Dr. Margaret Somerville writes in
this National Post article;
“Forcing physicians to act against their conscience, to do something they believe is deeply wrong against their will, not only harms them. This coercive violation of their freedom of conscience also harms society and the values that inform its culture.”
and also Maurice Vellacot, Member of Parliament:
“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.”
I ask that you refrain from forcing our Canadian doctors to act against their will.
The Catholic Civil Rights League
The Catholic Civil Rights League (CCRL) is pleased to provide this submission to the College of Physicians and Surgeons of Ontario (CPSO) regarding the revised and approved draft policy Professional Obligations and Human Rights. We strongly advocate for a robust understanding and protection of the Charter right of freedom of conscience and religion for all Canadians, and indeed physicians in the daily routine of their care to patients and in the overall forming of their individual medical practices. The CCRL therefore rejects the proposed mandate for an “effective referral” as it is a breach of a physician’s rights and a serious incursion into the professional standing of a physician.
We previously provided a submission in August of 2014, when external consultation was sought regarding proposed changes to Physicians and the Ontario Human Rights Code. In 2008, we raised similar concerns in that consultative process. We are as adamant with our concerns today as we were seven years ago. Doctors and other health care professionals, indeed all Canadians, enjoy the Charter right of freedom of conscience and religion. A proper balancing of the rights of physicians with the concept of patient autonomy must not result in the trumping of the rights of physicians in their medical practices. Such rights extend not only to refusing to perform morally objectionable services, but the right not to be obliged to refer to other practitioners who may be willing to provide such services. This clearly would constitute participation in wrong. The proposed mandate for an “effective referral” must be rejected.
Lines 156-159 are wholly unacceptable to the CCRL:
Where physicians are unwilling to provide certain elements of care due to their moral or religious beliefs, an effective referral to another health care provider must be provided to the patient. An effective referral means a referral made in good faith, to a non-objecting, available, and accessible physician or other health-care provider.
The CCRL appeals to the Executive Committee and Council to strike from this policy the necessity to “provide an effective referral”. This is an unacceptable inclusion, an unnecessary and unwanted change from the 2008 policy. Compelling a physician to provide an effective referral to another physician or health-care provider in order to carry out a procedure to which he or she objects on the grounds of conscience or religion also compels the physician to violate his or her own conscience by being a participant in the very act, the very procedure to which he or she objects in the first place.
The current CPSO policy also states that:
The balancing of rights must be done in context. In relation to freedom of religion specifically, courts will consider how directly the act in question interferes with a core religious belief. Courts will seek to determine whether the act interferes with the religious belief in a ‘manner that is more than trivial or insubstantial.’ The less direct the impact on a religious belief, the less likely courts are to find that freedom of religion is infringed.
The CCRL submits that issues pertaining to the sanctity of life from conception until natural death is a core Catholic belief. There is also a growing body of medical research which has questioned in recent years the merits of artificial birth control, and the further risks to women from abortion. A Catholic physician is entitled in conscience to avoid providing artificial contraception or abortifacients, or procuring an abortion unless the mother’s life is in imminent threat. In the event that Canada adopts a regime of physician assisted suicide, the threat to conscientious objection is that much greater. We assure the CPSO that under no circumstances would any of the aforementioned practices be considered ‘trivial or insubstantial’.
The CCRL further submits that there are numerous procedures which may violate good medicine, or violate the consciences of many other physicians belonging to other religions or those holding sincere beliefs, religious or otherwise. The point is that despite our mandate to educate the public and defend and promote the Catholic perspective, we at the CCRL nonetheless submit that a physician must have the right to carry out their duties in line with their consciences, period. Neither the College nor the courts determine what comprises religious belief and to what extent acts may or may not interfere. Once the sincerity of religious belief is understood, neither the College or courts should interfere in a delineation of what the particular faith may prescribe. It is far more logical to simply respect physicians’ consciences as has been the case in Ontario with the policy in place since 2008. The compulsion to effectively refer violates this right of freedom of conscience and religion and there is no reason to institute the need to provide an effective referral, whether it is on the grounds of access to care, or on any other grounds.
Regarding the ‘balancing of rights’ referred to by the CPSO, the CCRL believes that the current status quo in Ontario maintains this balance between the Charter rights of conscience and religion with the concept of patient autonomy. Using the previous listed examples of practices that would be morally objectionable to a serious Catholic physician, consider that the number of said physicians is minute in comparison to those who would have no objection whatsoever. If a lack of balance exists, it is surely found in the vast difference between physicians who choose to conscientiously dissent versus those who do not. This difference is so great that it cannot be objectively stated that a member of the public in Ontario would have their rights to autonomy violated by any physician following the 2008 CPSO policy.
With this submission, we at the CCRL call upon the CPSO’s Executive Committee and Council to reject the mandate for “effective referrals”. The medical profession, as with any grouping of individuals is not truly free to live and free to grow if its members are not able to govern their actions in accordance with their individual consciences, whether informed by moral and religious beliefs or otherwise.
Canada is a pluralist society, and an authentic pluralism recognizes that there will be differences in the public sphere, and that we live with such differences in a civil society. The proposed CPSO policy engages in a trumping exercise, mandating that a patient’s autonomy trumps recognized conscientious and religious rights of physicians. The demand for acceptance of a regime of “effective referral” of morally objectionable practices would lead to patients losing trust in the professional status of doctors. There is also the likelihood of numerous physicians opposing the new proposed policy and their refusal to comply, generating unwarranted complaints and possible exits from the jurisdiction. The extent of potential disruption is unknown, but greater instability would certainly follow in the provision of medical services. Ontario can ill afford such a tearing of the social fabric of our society. The better alternative is to accept that we are respectful of differences, especially when they concern aspects of one’s moral or religious beliefs, in no way trivial, but rather as the basis of a well-developed civil society.
FIRST POINT, NO WONDER WE HAVE TROUBLE GETTING DOCTORS WHEN THEY ARE TREATED THIS WAY ESPECIALLY IN LIGHT LIBERAL WUNNES PLANS FOR THE DOCTORS , NOW THEIR RELIGIOUS BELIEFS AND FREEDOM OF CHOICE TO FOLLOW THEIR CONSCIENCIOUSNESS IS IN JEP. RODY AND DISCRIMINATIONING IN ITSELF.ALTHOUGH THE DRAFT SEEMS CLEAR IT LEAVES FAR TOO MUCH FOR INTERPRETATION AND POSSIBLITY OF MISUSE.
FIRST POINT, NO WONDER WE HAVE TROUBLE GETTING DOCTORS WHEN THEY ARE TREATED THIS WAY ESPECIALLY IN LIGHT OF LIBERAL WYNNES PLANS FOR THE DOCTORS .NOW THEIR RELIGIOUS BELIEFS AND FREEDOM OF CHOICE TO FOLLOW THEIR OWN CONSCIENCIOUS IS IN JEPORDY AND DISCRIMINATIONING IN ITSELF.ALTHOUGH THE DRAFT SEEMS CLEAR IT LEAVES FAR TOO MUCH FOR INTERPRETATION AND POSSIBLITY OF MISUSE.
I feel that physicians should have the right to act or conches and not provide certain services under their constitutional right to freedom of religion. Arrangements can be made so that those services are provided by other doctors but by making them provide services they’re uncomfortable with we are sending one person’s personal Rights ahead of another’s and violating Canadian constitutional law
Pro Life movement
Personal freedom has always been cherished in Canada. Certainly the freedom of religion and freedom to act or refrain from action based on religious and moral ground must be held paramount. Even in war, the military may be excused from active duty on moral and religious grounds. Patients have right and freedom to receive care from ‘other’ caregivers.
It has always been my belief that Canada’s Charter of Rights and Freedoms, guaranteed freedom of religion and freedom of conscience. Speaking from a patients point of view, I personally would not want any doctor without conscience rights caring for me, as I would not trust him.
Unfortunately, my present trust in the College of Physicians and Surgeons of Ontario is rapidly diminishing. Therefore, while there is still time, I sincerely request the proposed harmful policy changes be dropped.
If the College of Physicians and Surgeons explicitly requires a physician to do something he or she believes is immoral, it is like having a club that says you can’t be one of us unless you sacrifice your integrity. Remembering Hippocrates and the oath physicians take, it is like saying you can’t be in our club unless you violate the oath you took to get in. Huh? Doesn’t bode well for our logical civilisation.
Also, there is no legal right to abortion enshrined anywhere in Canada. There is just no law against it. People are self-regulating – just like some professional societies. First do no harm.
The “Moral or Religious Beliefs” section of the draft seems written to conjure up only one scenario, at least it reads that way to me, namely, the scenario wherein the patient is demanding some sort of service or procedure and the physician is “limiting” the services provided on religious or moral grounds. This section comes across as mechanical and seems to assume an adversarial doctor-patient relationship.
Given that “[t]he doctor-patient relationship is the foundation of the practice of medicine” (Practice Guide, p. 9) and that the balance of knowledge and information favours the physician (Ibid), why is this draft written in such prescriptive language and conveying such an adversarial tone?
I WANT my physician to have an opinion, clinical for sure, but based on a well-formed conscience also. I do NOT want to be treated by a physician that is going against his own moral calculus.
The draft as written is a monumental failure in terms of promoting strength in the very relationships that the College exists to support!
Above is my general comment. Getting to the policy on referrals in the draft, where such referrals involve a pregnant women seeking an abortion, the College should take a page from our experience with detainees in Afghanistan. Our Government and military went through a LOT of machinations and “policy pain” before everyone figured out, some tacitly, others overtly, that transferring our detainees was wrong. Why? Because they got the crap kicked out of them when not in Canadian hands.
In this case, whether it is a “human being” according to Section 223 of the Criminal Code or not, the physician, ney, all of us, are aware that, AS A MINIMUM, the POTENTIAL for a human life is sitting in front of the doctor in such cases. There are two patients, not one! Does the College really think that the actions that need to follow from limiting services on moral grounds can be reduced to such a simplistic prescription as referral without seriously damaging the profession in the longer term? WOW… that is short-sighted.
How about letting the physician apply the four values in the Practice Guide toward strengthening the doctor-patient relationship to the point where all reasonable efforts at identifying the correct problem have been undertaken (fear, sadness, uncertainty, anger, etc.)? The pregnancy might not be the “problem” that needs solving! The so-called “referral” might need to be to people and organizations that can serve the needs of both patients (mom + unborn child) by helping mom to consider things not yet considered, etc.
If we want a mechanical medical system, we really don’t need the complex medical selection and training process that we have. We can just train clinicians and let them do the cutting according to patient desires.
I for one WANT to be challenged toward the right decision by everyone that I consult with, especially my highly trained, highly ethical and highly informed doctor.
I am in agreement with comments 14, 16, 21, 26, 27, 78, 79, 82, 181 and a several others who do not support this draft.
OK, besides all of that, the draft has some internal logic inconsistencies. Will send those in a separate post.
Dear
> Members of the Consultations
> Committee:
>
>
>
> Re: Draft Policy “Professional Obligations and Human
> Rights”.
>
>
>
> I am writing to you with grave concern regarding the content
> of your proposed
> draft policy, which indicates that physicians who decline to
> participate in certain
> acts for reasons of conscience should be compelled to refer
> their patients to other
> physicians who will perform these acts. It does not address
> the fact that many
> of these same physicians will find the act of referral
> itself objectionable, as
> they consider it material cooperation with the act. In
> compelling physicians to
> refer, you are limiting their
>
> right to conscientious objection. I am opposed to this.
>
>
>
> There is significant disagreement in our society as to what
> constitutes a moral
> act, and I do not expect the College to define or limit
> morality. All I expect
> is that physicians, as professionals, be allowed to respect
> their own
> consciences. Freedom of conscience is foundational to our
> free society and cannot
> be limited, even for the best of intentions.
>
>
>
> If we
> coerce physicians into violating
> their consciences we will inevitably erode the personal
> integrity which is the
> basis of the physician’s relationship with their
> patients. I encourage you to
> revise the sections above, and include a clear defence of
> the right to freedom
> of conscience for all physicians.
>
>
>
> Yours
> sincerely,
>
To the CPSO council:
Thank you for the opportunity to provide feedback on the Draft Policy entitled Professional Obligations and Human Rights.
As a senior resident in psychiatry, I would like to comment on two particular sections of the draft that, if accepted, would have serious ramifications to the practice and ethical standards of medicine that are inherent to our profession.
Section: Ensuring Access to Care (Lines 156-164)
“Where physicians are unwilling to provide certain elements of care due to their moral or religious beliefs, an effective referral to another health care provider must be provided to the patient. An effective referral means a referral made in good faith, to a non-objecting, available, and accessible physician or other health-care provider. The referral must be made in a timely manner to reduce the risk of adverse clinical outcomes. . .”
The policy refers to “religious or moral beliefs”. The term “moral” as defined by the oxford dictionary refers to concern with “the principles of right and wrong behavior.” The same dictionary defines “ethics” as “moral principles that govern a person’s behavior or the conducting of an activity.” Morals and ethics are thus synonymous, and the practice of medicine is understood to be practiced within an ethical framework, regardless of whether one ascribes to a particular religious faith or not. One of the most fundamental ethical principles in medicine is “do no harm.”
The above stipulation in lines 156-164 is problematic for several reasons and I will use the example of abortion as a procedure that carries ethical considerations to illustrate.
The first is a practical problem: Most abortion providers, who may perform abortions in the earlier stages of pregnancy, do not for reasons of conscience, perform abortions past the point of viability of the fetus. If a woman requests a late term abortion because she does not wish to have a daughter (ie. female sex-selective abortion), it would be impractical to expect a GP to be able to secure the services of a non-objecting and available abortion provider who would agree to terminate this pregnancy for purely social reasons.
Second, on an ethical level, requiring a physician to refer for a procedure to which the physician is morally opposed would make the physician complicit in an act that he/she believes to be wrong or harmful. The oxford dictionary defines the word “complicit” as: “Involved with others in an activity that is unlawful or morally wrong.” The concept of complicity is recognized in the Criminal Code of Canada (sec. 21) where a person who abets (i.e. assists) in an offence is considered a party to the offence, even if they did not directly commit the offence. In the case of morally contested services, physicians who would recoil from directly providing a particular service would also have conscientious objections to referring for the same service because it implicates them indirectly in the provision of a morally objectionable service which they honestly believe to be unethical because of the harm it can cause.
Furthermore, forcing physicians to violate their conscience by forcing them to assist in procuring a service that they believe to be harmful is incompatible with the college’s expectations that physicians uphold the profession’s value of trustworthiness (line 16). By being forced to act in a way that is inconsistent with their moral framework, the trustworthiness and integrity of a physician is destroyed. How can one trust a physician who is capable of acting against their conscience in the provision of care?
As a patient, I would not want to force my physician to do anything she believes to be morally wrong, and as a physician, I would likewise appreciate the same respect from my patients and my College. A separate college-imposed set of ethics with arguably questionable components that requires its physicians to act in a way that is inconsistent with their conscience would make me question the integrity and quality of care provided by physicians who are forced to practice under this code.
Section: Protecting Patient Safety (Lines 166-169)
“Physicians must provide care that is urgent or otherwise necessary to prevent imminent harm, suffering, and/or deterioration, even where that care conflicts with their religious or moral beliefs.”
The context provided in which physicians are expected to provide care even if it conflicts with their religious or moral beliefs is too broadly stated in the stipulation above. Forcing a physician to violate their Charter-protected rights to Freedom of Religion and Conscience in the provision of care can only be justified for compelling reasons where the life of the patient is imminently at risk, or to prevent imminent harm from coming to the patient. Any criteria less than this could be subject to abuse and misinterpretation. For one, “suffering” is subjective and poorly defined. It includes concepts of physical, emotional, spiritual, and existential suffering with varying degrees of severity that can never be objectively measured. Suffering is a universal experience that every member of the human race has and will experience, but it in itself is not a compelling enough reason to force a physician to violate his conscience in providing a service to which he has conscientious objections.
To illustrate, consider this hypothetical situation: A patient requests a late term abortion because the father of the unborn child abandons the mother late in her pregnancy. In her distress, the pregnant patient requests an abortion at 28 weeks of pregnancy, and she claims that not procuring an abortion would cause her imminent psychological distress if the baby were to be born. It is important to acknowledge that the psychological suffering of the pregnant woman, who has just been abandoned by her partner with seemingly no recourse, is real. A compassionate response to her distress might include helping her articulate the underlying reasons for her distress, the sources of her fear, and providing additional counselling as to the risks (medical, and psychological) of having an abortion late in her pregnancy. She should also be provided with support, and given avenues to obtain additional resources and support if she changes her mind and decides to carry the pregnancy to term for adoption, or decides in the end to raise the child herself. However, at the end of the day, if the woman insists on having a late-term abortion, her distress level must be weighed against that of the physician who has been asked to provide a procedure to which he may have serious ethical reservations. What if the obstetrician-gynecologist has conscientious objections to providing late-term abortions when the mother’s life is not at imminent risk from the pregnancy and he is unable to find another abortion provider who is willing (because nobody else in the vicinity wants to provide the abortion either)? Does the CPSO really expect this physician to violate his conscience to terminate this pregnancy based on patient request, as lines 166-169 would imply? Remember that a failed abortion at this stage could result in a live birth which has obvious ethical implications; an abortion provider who may be comfortable providing abortions in the first and second trimester may not necessarily be comfortable providing abortions past the point of fetal viability because of ethical considerations. Correct me if I’m wrong, but as far as I am aware, there are no medical guidelines that address late term abortions in the third trimester in Canada. The decision to carry through with a late term abortion or not depends upon the comfort level of the physician according to his conscience, and possibly also according to hospital policies. Thus, what kind of psychological distress would this physician (not to mention other members of the health care team) have to undergo if he is forced to perform this abortion unwillingly, to alleviate the psychological distress (i.e. psychological suffering) of the patient? And how will the impact of the physician’s psychological distress impact his ability to care for future patients, or his desire to continue in his profession? These are all important questions to consider, as this policy, as worded, provides no flexibility for physicians with conscientious objections.
As another example, most medically ill patients are in a state of suffering or deterioration, otherwise, they would not be requiring medical care. In the event that euthanasia is legalized, if such a patient was being cared for in a rural setting, meets the eligibility requirements for euthanasia, and requests his physician to euthanize him, would his physician, the sole physician practicing in the small rural community, be obligated to end the life of this patient upon demand? What kind of harm would this act do to the psyche of this physician who has moral and ethical objections against euthanasia? The Canadian Medical Association (CMA) acknowledged the importance of protecting the conscience rights of physicians at their August 2014 General Council Meeting. This CPSO policy, as worded, would effectively do the opposite.
This policy may also have other unintended side effects. For example, physicians who wish to adhere to certain moral values may be compelled to work in urban centers to avoid working in rural areas where expectations for them to provide objectionable services would be higher. Patients living in rural areas would thus be deprived of other valuable services such as obstetrics care, or palliative pain management, which the physician could otherwise have provided. In addition, bright, compassionate, and ethically-minded potential future students of medicine may be dissuaded from entering the medical profession because they do not wish to be part of a profession that would force them to act contrary to their morals and ethics. The quality of healthcare and the integrity of the medical profession in Canada would be increasingly adversely affected for years down the road, and patients who wish to have physicians who share their morals and ethical standards, for example, that of respecting and protecting human life, would be deprived of like-minded physicians. These unintended side effects of this policy would be a great disservice to the public.
As Canadians, we value the democratic freedoms that have been the cornerstone of this country. This policy effectively eliminates protection of conscience rights for physicians; is a serious assault on Canadian freedoms; and unfortunately, pits the concerns of patients against the rights of physicians, undermining the possibility of an effective therapeutic physician-patient relationship.
In reviewing the existing 2008 policy, I feel that the College’s Expectations outlined on page 4 of the 2008 policy under the section “Moral or Religious Beliefs” do not need modifications, are sufficiently clear, and strikes a good balance between the needs of the patients and respect for the values of the physician.
http://www.cpso.on.ca/CPSO/media/uploadedfiles/downloads/CPSOdocuments/policies/policies/human_rights.pdf?ext=.pdf
I urge the CPSO to uphold the ability of physicians to practice medicine with integrity and according to their conscience, if such conscientious objection does not cause imminent harm or endanger the life of patients.
This policy is fundamentally skewed towards the right of the patient while completely trampling on the right of the physician to freedom of religion and moral objection of conscience. I thinkI the proponents of policy to refer a patient for a procedure or service to which one objects to is the same as providing the service, this violates the physicians conscience and right. The objecting physician should be allowed to respectfully tell the patient her stand without imposing his/ her belief on the patient. Any policy that does not respect the right of all involved parties is already discriminatory.
Was this draft intended as A Modest Proposal in the style of Jonathan Swift?
It claims to make family doctors more COMPASSIONATE yet demands that every last one participate in killing unwanted children. Eventually, as in the Netherlands, doctors will also kill senile citizens and anybody else deemed to have insufficient quality of life.
The draft claims to make family doctors more SERVICE-oriented yet drives out of the profession the conscientious ones (especially in rural areas), who are most likely to be service-oriented. This phenomenon will also have the short-term effect of reducing the supply of doctors available to provide service.
The draft claims to make doctors more ALTRUISTIC yet requires their servile compliance. The doctors most likely to comply are those acting out of selfish ambition, not those will a well-formed conscience. Communists also appealed to altruism for the creation of a workers’ paradise, but they failed to understand faulty human nature.
The draft claims to make doctors more TRUSTWORTHY yet violates their conscience and the sensibilities of their patients. As somebody who believes in the sanctity of human life from conception to natural death, I only trust pro-life family doctors, and yet the draft, in effect if not intent, targets them for removal.
If you really want compassion, service, altruism, and trustworthiness in the medical profession, then scrap this draft.
The foremost professional obligation is to do no harm.
The foremost human right is the God-given right to life. (Rights are of the citizen with respect to the civil government. With respect to God we only have a right to death; salvation is only possible through His grace.)
Response in PDF format.
“You know it is wrong to end a life, any life, after you so proudly swore the Hippocratic Oath so many years ago.”
Indeed, it is worthwhile asking whether the authors of this policy are themselves breaking an oath they once took–or whether they are by this policy forcing others to do what they swore not to do. Only those with integrity should lead the medical profession.
Response in PDF format.
I have ES (electrosensitivity).
My ES condition, which I consider to be an environmental impairment, needs to be accommodated, by giving me access to medical care without the physical stress of being in a wireless environment. My body cannot function healthfully in a wireless environment, therefore, I cannot be medically evaluated properly as it causes severe heart complications and general inability to function, causing many distressing symptoms that are otherwise absent in a normal, non-radiated environment.
Response in PDF format.
I agree with this letter, which is expressed less antagonistically than comments I have made. Allow me to highlight its thesis:
“The current policy draft to exclude certain moral beliefs is problematic for three reasons: it fragments the humanity of the practitioner, it is logically and practically impossible to exclude moral beliefs from practice, and it presupposes that these moral beliefs are wrong without actually demonstrating so.”
Response in PDF format.
Response in PDF format.
Response in PDF format.
What a beautifully articulated response from a Doctor. Thank you. Will keep you and all doctors and nurses in our prayers so that your freedom of conscience is protected.
The doctor wrote, “Despite a significant number of dissenting physicians, the demand to refer is maintained.”
There are also a great number of patients repulsed by this requirement to refer. It discriminates against their need for compassionate, service-oriented, trustworthy doctors who will refuse to kill them or their children or tempt them to choose despair and death. Altruism is too much to ask for but will be demonstrated by those pro-life doctors who continue in the profession and evade the requirement to refer if CPSO puts it into force.
The demand to refer also discriminates against the very young or very old who will be killed at the request of family members and by doctors corrupted by a power to kill. These vulnerable patients have no voice and need others to speak up for them. For a demonstration of altruism that all Ontario doctors could emulate, witness those Ontario women so courageous as to have plainly but sensitively spoken out on behalf of pre-born children even to the point of these women’s long-term wrongful imprisonment.
In the West, the justice system historically assumes innocence in the absence of evidence; and capital punishment, where it is still exercised, is reserved for the most heinous offenses. Because of due process, the government’s authority to kill murderers is not easily used. To give imperfect, faulty healers a broad power to kill is stupidity, irresponsibility, and perversion.
When the cat’s away, the mice will play. From personal experience I know that some contractors constructing municipal works will do shoddy work and skimp on the more expensive material if they can cover everything up before inspection by the engineer. What could go wrong with a doctor given the power to kill and required to use it in certain supposedly very tightly controlled situations? Power corrupts. Might it be in his long-term interest–to cover up a mistake yet unknown to the patient, for example–to influence the patient to choose euthanasia?
Or as another example, since doctors are legally allowed–and by this draft policy even required–to cooperate with a mother in killing her pre-born child, might not a grown child conspire with a doctor to kill the aging mother?
Yet CPSO is inviting unintendend consequences by favouring the practice of unscrupulous doctors willing to use the final solution.
Dear CPSO,
Here are my comments on your freedom of conscience rights policy for doctors.
Thank you.
http://run-with-life.blogspot.ca/2015/01/cpso-is-taking-dangerous-position-on.html
http://www.prowomanprolife.org/2015/01/02/college-of-physicians-please-stand-up-for-religious-minorities .
I wish to comment on the draft policy of the CPSO regarding the conscience rights of physicians.
I am certain that [Name omitted] is aware of the principle of co-operation and its application in ethics; he would hardly be in his present role were he not. If this is so, the alternatives are that he has abandoned the principle ( perhaps as a relic of a superstitious age) or that he has applied it erroneously. In case the later is true, it may be helpful to recall that cooperation with evil may be either formal, when the cooperator’s intention is the same as the perpetrator of the evil, or material, when the cooperator does not intend the perpetrator’s evil act. Referral to a physician who one knows will perform an act one deems to be evil is formal cooperation. The cooperator ( referring physician) then fully shares moral responsibility for the perpetrators act.
If the former is true — that he has abandoned the principle — or, that he denies the existence of conscience, it may be helpful to recall a speech of Herman Goering’s, made sometime in the 1930s. A question of conscience was raised, and the Reichs Marshall’s response was “I have no conscience.” Then, pointing to the Fuhrer, seated nearby, he added, “Hitler is my conscience!”
I do not mean to suggest any equivalence between [Name omitted] Final Solution to the problem of family physicians with consciences and the measures adopted by Goering. Only a few lives will be ruined by [Name omitted] proposal, and they will not thereby be ended. One can envision the future family physicians of Ontario saluting as they proclaim, before meals and on arising, “I have no conscience; [Name omitted] is my conscience!”
A Doctor takes an oath of ‘First do no harm’ This proposed legislation overrides that completely.
In China to keep the birth rate down abortion is not only forced on the Mother, but forces the physician who will be arrested themselves if they refuse to perform this very brutal act. As we’ll obviously be joining this Country in it’s policy if this goes through, then we lose our rights to protest anything else they do. So it’s not just this one act but alters our own future. I am going to ask Amnesty Canada to join in this Please everyone reading this do the same. There are alternatives to abortion as everyone knows.
To Whom It May Concern:
I am writing to express my concern over the draft policy on “Professional Obligations and Human Rights” particularly the statement, “Where physicians are unwilling to provide certain elements of care due to their moral or religious beliefs, an effective referral to another health care provider must be provided to the patient.”
I believe that this is an unacceptable infringement on the conscience rights of physicians. Requiring that a physician give a referral for an element of care which is contrary to his or her religious convictions is a violation of that physician’s right to freedom of religion and conscience.
According to the Christian Medical and Dental Society of Canada, “Referral is as problematic as actually performing the controverted procedure. In a referral, the physician is essentially recommending that the procedure needs to be done, and expects that the physician who receives the referral will do it. This is morally equivalent to doing the action.”
I would therefore request that the draft policy in question be amended so that doctors with conscience issues with certain elements of care not be forced to give referrals for such procedures.
Respectfully submitted
[**MESSAGE FROM ADMINISTRATOR: DURING THE CONSULTATION PERIOD, WE RECEIVED 111 RESPONSES FROM INDIVIDUAL RESPONDENTS CONTAINING THE CONTENT PUBLISHED ABOVE. ALTHOUGH THIS FEEDBACK HAS NOT BEEN PUBLISHED IN DUPLICATE, THE COLLEGE ACKNOWLEDGES RECEIPT OF THESE SUBMISSIONS.**]
Please protect the rights of doctors and nurses to exercise their freedom of conscience. It breaks my heart that they may be compelled to do unethical actions like assisting with a suicide. This is wrong on so many levels. Doctors took an oath, please help them to uphold it. Think of the many capable, smart, compassionate people that will not enter into the medical field because of this threat to their very being. Please, uphold what is right.
The draft policy’s requirement that physicians provide an “effective referral” for morally objectionable services is an unacceptable infringement on freedom of religion and freedom of conscience.
In light of today’s ruling by the Supreme Court of Canada on assisted suicide, it is clear that this draft policy is woefully misguided. It should be withdrawn immediately and revised to provide a robust defence of freedom of conscience for all physicians.
I am currently a medical student, and I would like to voice my opinion regarding this policy. There are some things with which I agree; however, there are others with which I have serious concerns.
I will begin with the things I appreciate about the policy:
1. I am pleased to see that the policy addresses the discrimination against gender identity and expression, and I fully support the clarification surrounding the duty to accommodate patient needs with respect to disabilities and access to care.
2. The policy also requires that physicians who limit the health services that they provide due to moral or religious grounds to do so in a manner that respects patient dignity and protects the safety of patients. I appreciate that physicians can refuse services that are contrary to their moral or religious beliefs, provided they are not offered at all.
3. My decision to go into medicine was largely due to my desire to help people- to provide support and healing for others. Patient care should always remain of utmost priority.
Now I will address my concerns with the policy:
1. There are some procedures that are legal in Canada that go against my moral beliefs, as they involve the ending of someone’s life. For me, this crosses over into the “do no harm” role of the physician. I will not debate here whether or not these procedures should or should not be legal, but my concern with the policy is that it requires physicians to perform these acts under vague and unclear conditions: “…urgent or otherwise necessary to prevent imminent harm, suffering, and/or deterioration.” In the case of abortion, the situation may not be urgent, yet the patient may argue that “further-along” pregnancy is considered deterioration of their condition, and I would be obligated to perform the abortion. I would like to see a clarification of the terms (urgent, imminent harm, suffering, and deterioration) around which a physician is obligated to perform these acts.
2. My rights as a human allow me to express my moral or religious beliefs. Unfortunately, the policy requires performing certain procedures even when it is against my religious or moral beliefs. This is an impingement on my rights as a human being. It is not possible to separate my moral beliefs from my professional obligations. Attempting to do so will lead to psychological and emotional distress and burnout in many physicians. This will most definitely impact the quality of patient care. Furthermore physicians may be forced to leave the profession based on conscience or religious belief. This is an act of discrimination, and should not be allowed.
Thank you for taking the time to consider my views on this draft policy.
Doctors should not be forced to violate their conscience by being forced to perform procedures that they view as morally wrong. This comes into play especially in cases of abortion and (most recently) through doctor assisted suicide. Doctors who view abortion to be the intentional killing of a human being, should not and cannot be forced to commit such an act. To force them to do so would violate their rights to freedom of conscience as a human person and a citizen of Canada. Moreover, forcing such a doctor to refer his patient for an abortion, is also unjustifiable, because referring the patient for an abortion (which he/she feels is gravely wrong) could be just as much against the doctor’s conscience as performing the abortion him/herself. By referring the patient for abortion, he/she is referring the death of his/her patient’s unborn child, which would likewise contradict the doctor’s conscience. The same is true for the recently introduced practice of assisted suicide. No doctor should be forced to perform abortions or kill their own patients who are seeking to end their life through assisted suicide. Neither should the same doctor be forced to refer these same procedures, because even a referral of such morally contentious procedures could violate his conscience. Doctors have rights too, and one of these rights that must be upheld in a free country like Canada, is the right to not be forced to perform or refer procedures against his/her individual conscience.
If the law about professional obligations and human rights is going to be examined, so be it. Have physicians properly trained and knowledgeable about Natural Family Planning an alternative to artificial contraception and knowledgeable and fully trained in all pain relief alternatives, including knowledge of the social and spiritual support/treatment people need in the face of disease and suffering. We need to have the right to knowledge of all our options.
St. Hyacinth Church
I truly believe that a doctor should be able to act upon his or her beliefs. if doctors will be forced to perform the service that will lead them to the moral guilt, then the doctors will become victims. it is against human rights to force a person to perform immoral labour. Such acting should be classified as a crime.
First words of the Hippocratic Oath: First, do no harm. End of story. Period.
I ask that doctors in Ontario be allowed to follow their conscience and not be mandated to refer patients for procedures and treatments that goes against their conscience. Please.
Physician should be allowed to say no to procedures that go against their beliefs and consciences.
The denial of physician’s rights to follow their consciences in the practice of their profession seems very wrong and worrisome to me. We want doctors to be ethical practitioners, so we must not expect them to act against their consciences. It is a denial of their human rights.
I hope the college will reconsider going down this road.
I tried to complete the survey but was cut off about 60% of the way through. Clearly I had too much to say – a fair amount of it critical. Maybe there isn’t room for expression of views that don’t align with those expressed in the draft policy!
I am tremendously concerned about this policy for several reasons. This policy, if passed, will effectively isolate and compel some physicians to perform actions against their own conscience. How can we expect physicians to perform with compassion and care if you are going to force them to perform and refer procedures they are morally against? This policy will alient and discourge aspiring students, like myself, who hope to pursue a career in medicine and healthcare. I ask that you honestly consider the implications this will have on physicians and health care as a whole. Improving access to certain aspects of health care can be effectively done without the need to strip doctors their conscientious rights.
The following Hippocratic Oath was originally drafted in 1948 and minimally revised on several occasions. It followed the Nuremberg Code of August, 1947 against Nazi Doctors who performed in human experiments against the code of conduct of Hippocrates (of which they refused to pledge).
The Declaration of Geneva (WMA):
At the time of being admitted as a member of the medical profession:
• I solemnly pledge to consecrate my life to the service of humanity;
• I will give to my teachers the respect and gratitude that is their due;
• I will practice my profession with conscience and dignity;
• The health of my patient will be my first consideration;
• I will respect the secrets that are confided in me, even after the patient has died;
• I will maintain by all the means in my power, the honour and the noble traditions of the medical profession;
• My colleagues will be my sisters and brothers;
• I will not permit considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing or any other factor to intervene between my duty and my patient;
• I will maintain the utmost respect for human life;
• I will not use my medical knowledge to violate human rights and civil liberties, even under threat;
• I make these promises solemnly, freely and upon my honour.
I expect every doctor, active or retired, to live according to this pledge in union with his/her own conscience whether made with human compassion and/or religious principles. Furthermore, I believe it is the responsibility of every potential patient to question and evaluate their health care providers according to their own conscience and according to compassion and/or religious principles, It’s our healthcare system, and we need to have full ownership over it.
These are basic human rights that belong to all, equally and without reservation, and not just to a few. I may not always agree with a physician’s diagnosis, but I do respect it and when in question asking for a second opinion is never questioned. Informed consent is the duty of all.
In reference to the Supreme Court ruling on assisted suicide yesterday:
“This decision affects every Canadian now and in the future. It will teach this generation and generations to come that some lives are not worth living, that killing patients can be a medical option, and that death at the hand of a doctor is somehow a human right.
This decision will also have a lasting impact on our physicians, who may be pressured to either administer death or face professional censorship and discipline.”
-Life Canada
My thoughts:
What is most problematic is forcing doctors to be complicit in this act. You cannot impose your desire to die on someone else or coerce them to participate in killing, especially if it is against their moral standards. And even if it is not, there has been research conducted to show that doctors who have willingly performed assisted suicides have been bothered by it years later. Everyone is entitled to their opinions and freedom of choice, but this seems to be taking it away from health care professionals.
Furthermore, what constitutes a level of suffering worthy of death? What of those with mental illness? It’s unquantifiable. And how can a doctor make that decision? They are only human beings/ medical professionals, not gods.
And what of palliative care? The potential for slippery slope in this ruling may render palliative care initiatives underfunded and unimportant, and actually encourage those in need to resort to premature death. Where is the dignity of life in that? Who’s economic interest are we supporting?
This ruling is changing the meaning of health care. I see a huge contradiction between health care (aimed at ameliorating and preserving life) and killing.
Also, what kinds of doctors can we expect in the future if conscience rights are neglected? People are not machines, and we should not force them to act like them.
I believe that the integrity of physicians is paramount to their role in the healthcare of their patients and in society. I am deeply troubled by the Supreme Court’s decision about Physician-Assisted Suicide. I am, however, even more concerned about the potential consequences on physicians that do not chose to participate in this activity. Forcing physicians to commit an action that is immoral to them, or to refer to such actions is a deliberate degradation of their integrity, and thus no physician should be under such pressure. In addition, I believe that this would also be against the physician’s rights of freedom and faith. A patient who is seeking a service that is not agreeable for the doctor, be it abortion, contraception, IVF, patient-assisted suicide, or euthanasia, should take the responsibility of finding a physician that provides that service rather than forcing the physician to compromise their integrity.
With regards to obligatory referrals, to my understanding it as an attempt to balance a patient’s right to access care against the freedom of religion and conscience rights of the physician. The CPSO states that it feels freedom of religion can be waived if the act in question is not more than a trivial or insubstantial infringement on a core religious belief. In this case, with physicians being required to provide referrals for procedures they are morally opposed to, it seems that the College is deeming it to be a trivial infringement. I find it interesting that it is the College that decides for the physician which aspects of their beliefs are core and which ones are not, as there exists many physicians that would consider providing referrals to be morally repulsive and gravely infringing on their core religious beliefs.
On the other side, with specific regards to abortion, there does not seem to be a large infringement on the patient’s right of access to care. There is a plethora of abortion clinics that do not require a GP referral, and the information to find these clinics is available readily on the internet. There is even a phone line that can guide patients towards getting a referral should they really desire one. If a GP refuses to give a referral, the patient is inconvenienced and forced to go home and make a google search to find another place to perform the abortion. From the little internet browsing that I have done, it seems that there are plenty of resources available to the patient seeking an abortion; the infringment on right to access care is minimal.
Please respect the conscience rights of physicians and surgeons
I am not a physician, but have many friends who do practice in this field. Certain aspects of this policy greatly concern me on behalf of them and the rest of the Canadian public. As many commenters have already pointed out, the current draft of this policy clearly discriminates (takes away freedom of choice) against those who believe that abortion and euthanasia are morally wrong (not “health care” at all) and also harmful to either the individuals they serve or the general population, especially in the long run. Those who would hold to this position in the field of medicine are many, including my own friends; enforcing this policy the way it stands now would have the twofold severely detrimental effect of seeing these skilled, caring practitioners leave their vocations and showing the world that “freedom” in Canada is becoming a forgotten concept.
As physician we should not be forced by anybody to do things against our conscious )abortions +euthanasia).We like to stand by our compassionate care but have right to not be an accomplish to care that goes against our morals and beliefs .
while I would not allow myself to impose my beliefs and morals on other people, I find that I have to follow my conscience in practicing medicine in Ontario.
If a physician disagrees with a certain practice wished or demanded by a patient, because of his/her beliefs, the physician should absolutely be allowed to decline providing this service.
It should not be the physician’s role to refer the patient to have that same service by another colleague whose conscience allow him/her to perform this procedure(s).
I suggest that patients who have their wishes (in these matters)declined by their treating physician to have access to other practitioners identified by the CPSO through a direct communication between the patient (or next of kin)and the CPSO.
Physicians need to retain their autonomy. Should a patient wish a ‘service’ that is not provided by their physician, WIC, local ER etc, that patient could be “effectively referred” to the cpso website. The cpso website could then ‘host’ a list of clinics or physicians who willing wish to have their name or clinic associated with a particular service.
Canada the land of the free….
This draft is a contradiction to that, no free Canadian should be made to go against their moral and ethical values ….
This draft says otherwise this is a form of discrimination against our doctors basic rights.( or maybe they don’t have those rights?)
156 Where physicians are unwilling to provide certain elements of care due to their moral or religious
157 beliefs, an effective referral to another health care provider must be provided to the patient. An
158 effective referral means a referral made in good faith, to a non-objecting, available, and accessible
physician or other health-care provider.
Have you ever refused a referral because it was in the patient’s best interests to do so? I have.
Please replace “effective referral” with “effective referral or enabling self-referral”.
Disagree with draft policy. The effectiveness of patient -doctor relationship is not only based on technical skills but also trust. If a doctor cannot exercize his conscience in an open transparent way it violates the fundamental principle of “do no harm” which is a fundamental tenet of the medical profession. The requirement to refer a patient to a doctor who will perform an act he considers inappropriate or immoral further exacerbates the situation. Even in countries like Belgium where euthanasia is more common there is no referral requirement . Why do we need one in Ontario. Disagree strongly with proposed draft.
Have read the draft and feel strongly the physicians right to refer a client to another physician if they have a conflict due to morals/values should continue to be included.
Need to clarify an error in my comment above that should read should NOT be included… Physicians should not have to refer someone for treatment that will be carried out by another physician that he feels is wrong..
” 8. Where physicians limit the health services they provide due to their moral or religious beliefs, the draft policy states that they must do so in a manner that ensures access to care.”
That is like telling a parent they must refer a child who wishes to die or have an ear cut off or a leg or etc. to someone who is willing to fulfill their wishes. A parent as well as a Doctor is not called to fulfill a person or people groups wishes but rather to care for those who are in their care especially those who are clearly not able to make wise decisions for themselves and to protect them even from themselves if necessary.
” 10. Where physicians limit the health services they provide due to their moral or religious beliefs, the draft policy states that they must do so in a manner that protects patient safety.”
Allowing the taking of life as an option for preventing suffering is open to all manner of abuse. Who are we to say that a child or teenager or person of any age who has mental suffering is not actually suffering more than someone who is suffering physically. We cannot make a life and death decision subjective to an individual or individuals, it is not a decision that is ours to give. Our responsibility is to provide relief from suffering mentally and physically – Yes. Through death – No.
The definition of discrimination is open to too many loopholes. It would allow any criminal group to claim discrimination. There are many valid reasons for discrimination. That is what our countrie’s laws define. This definition outlaws all discrimination and with it all our countries laws…
Trying to remove the moral element from a doctor’s professional life is a fundamental assault on their integrity, the very quality that I and other patients want in their doctor. Under the guise of protecting patients CPSO is proposing a policy which tramples physicians’s rights. I wish to be recorded as an objector to the proposed policy.
I don’t believe that physicians should be asked to provide procedures that go against their moral beliefs or be penalized for refusing to do so.
traditionally soldiers with conscience objections [e.g. quakers] are not compelled to kill.
its unconscionable that you would differ.
since abortion is explicitly proscribed in the Hippocratic oath as a medical ethics violation
your proposed policy is a medical ethics violation
as would be any move to enforce it
No one must be forced to go against his/her conscience. Do we really want doctors who are willing to go against their conscience to be treating us? I don’t
Dear Sir/Madam,
I would like to respectfully state my opposition to the implementation of the following measure outlined in the CPSO draft policy;
As part of ensuring access to care for patients, the draft policy requires that physicians, who are unwilling to provide certain elements of care due to their moral or religious beliefs, refer the patient to another health¬care provider.
How will the doctor¬ patient relationship be affected if physicians are in a position to be disciplined by their own professional body for following their better judgment? To me, our best judgment is always going to be the best to follow. We all have a moral conscience, and when we cross the line and violate our moral conscience, we are on a slippery slope. As a nephrologist, I often get asked by patients to help them expedite kidney transplants in foreign countries. In some of these countries, kidneys are sold by the poor. In other countries, criminals are executed and their organs are harvested for donation. I have always steadfastly refused to assist in the procurement of organs abroad because it violates my conscience. I feel that I would be an accomplice to a crime if I were to be a middleman in this process.
How can trust be maintained within a relationship that is inherently and deeply personal, when the physician is expected to rigidly follow institutional guidelines? I believe the relationship between a doctor and a patient is a sacred one. I need to give a patient my honest opinion and need to do the best for them. I feel that much of medicine is art and crosses into the realm where there may not always be black and white answers. Often the best solutions come from honest and frank discussions where I may challenge a patient is coming from. For example, there may be cases where I think it is too dangerous for someone to get pregnant and I will tell them what a high risk it is. I may tell them they are depriving their current children of a healthy mother if they proceed. At other times, a patient may want to terminate a pregnancy because she is fearful that it will cause her kidneys to fail when in fact the risk is not much higher than the general population. I feel like I need to speak openly and freely and not be subject to reprimand because of what I say. I always try my best to do what is best for my patients, and when asked, will usually tell them what I would do if I were in the situation. Sometimes it is a toss-up and I will tell them so.
To whom will a patient, by definition a person in distress, turn when he is seeking a healing relationship?Are we as physicians to continue in our role as professionals, as healers, as practitioners of a liberal art, or become technicians, biotechnology providers, enablers? In which role are we more likely to serve the best interest of both the individual and of society? I would argue that in the traditional role as healers, that we are the most effective in the practice of medicine. We all practice medicine a little differently, but that’s what makes this profession so great. Patients can find the practitioner they are most comfortable with. In my area, I look after patients from the time they are diagnosed with chronic kidney disease to the time they die. I feel like I have to be honest to my core beliefs and be honest to my patients in all aspects of their care for me to be a good doctor for them. I think any compromise on my core beliefs will jeopardize the special healing relationship I have with my patients. It is rare that I have had a patient that did not feel comfortable with me or I with that patient. In a career that spans over 23 years, I cannot think of many examples. In those instances where I told patients I could not refer them to someone in China who would do a kidney transplant on them for ethical reasons, they seemed comfortable with that, continued to be my patients, and somehow were able to find their own contacts over the internet. The difference was our healing relationship remained intact and I was not an accomplice in the execution of a jailed person who was waiting to donate their kidney to someone paying money.
I think this draft policy should not be implemented. I think patients are generally able to find what they need on the internet these days. I think it is wrong to make physicians go against their moral conscience and to make them accomplices in something they feel is not in keeping with their beliefs.
I am writing to express my concern that the College of Physicians and Surgeons of Ontario (CPSO) and now the College of Physicians and Surgeons of Saskatchewan (CPSS) are passing draft legislation forcing doctors to act against their better judgement and requiring that these doctors either perform or refer for medical procedures that they object to.
Are we expecting our doctors to act without consciences? Does this not seem like a very bad idea to you?
In the words of ethicist, Dr. Margaret Somerville, “I don’t want to be treated by physicians who are willing either to act contrary to their conscience or who undertake interventions I believe to be seriously ethically wrong.”
And I repeat the words of MP Maurice Vellacot for you as well: “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.”
Please do the right thing and protect conscience rights for our physicians in Ontario. The rest of the country is watching, and will follow the example that Ontario sets.
[**MESSAGE FROM ADMINISTRATOR: DURING THE CONSULTATION PERIOD, WE RECEIVED 8 RESPONSES FROM INDIVIDUAL RESPONDENTS CONTAINING THE CONTENT PUBLISHED ABOVE. ALTHOUGH THIS FEEDBACK HAS NOT BEEN PUBLISHED IN DUPLICATE, THE COLLEGE ACKNOWLEDGES RECEIPT OF THESE SUBMISSIONS.**]
A physician who feels it is immoral to perform an abortion or other procedure will also consider it immoral to facilitate such a procedure by referring the patient to a physician who will carry out the procedure. Obliging him to refer the patient is also a violation of his human rights and charter rights.
I am writing to express my concern that the College of Physicians and Surgeons of Ontario (CPSO) and now the College of Physicians and Surgeons of Saskatchewan (CPSS) are passing draft legislation forcing doctors to act against their better judgement and requiring that these doctors either perform or refer for medical procedures that they object to.
Is it not a founding principal of a free society for a person to act according to their conscience and to be free from intimidation or coercion to act otherwise? I believe that forcing doctors to act in this way will destroy the patient doctor relationship. I for on would not want to be under the care of a doctor who could be forced to act unethically.
Cosgrove [Columbia, New York,NY] delivered 67,000 patients 1933-1941. Only 4 needed maternally-indicated abortions. From 1943-1951 he delivered 70,000 with no maternally indicated abortions. Irish studies indicate it is safer to never perform abortion than to do so in some cases.
The policy is about discrimination against physicians, not safety.
I am a prospective medical student and my father is a physician in Ontario. I am writing to the College of Physicians and Surgeons of Ontario to voice my great concern regarding the draft legislation that would force doctors to act against their better judgement and requiring that these doctors either perform or refer for medical procedures that they object to.
Are we expecting our doctors to act without consciences? How are physicians going to be able to attend to the needs of their patients if they cannot do what they judge to be best?
In the words of ethicist, Dr. Margaret Somerville, “I don’t want to be treated by physicians who are willing either to act contrary to their conscience or who undertake interventions I believe to be seriously ethically wrong.”
And I repeat the words of MP Maurice Vellacot for you as well: “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.”
Please do the right thing and protect conscience rights for our physicians in Ontario. The rest of the country is watching, and will follow the example that Ontario sets.
Dear Sir or Madame,
The new draft policy of the CPSO is extremely disturbing to those of us who have strongly-held religious beliefs regarding respect for human life.
The draft policy attempts to sound as if it respects the rights of all involved, but it does not. In effect, the document states that patient rights trump physician rights. The doctor has no rights to avoid referrals for procedures which he may find morally repugnant.
I do not ask you or anyone at the College to agree with the position that killing an unborn child, for example, is objectionable. However, I do ask you to understand that some people believe it is murder and do NOT wish to be involved in it in any way. These are serious concerns for some and must come first.
If someone came to you asking where he can buy a gun so he can shoot his mother-in-law because she is “unwanted”, should you have an obligation to find the nearest store for them? You may not believe these cases are on the same level, morally, but it is imperative the College recognizes that some physicians do place them on the same level and these doctors deserve have their rights protected.
Patients already have alternate access to other “services” at clinics or hospitals, or even from doctors who share the same office with their family physician. Patients are free to seek medical care elsewhere. Doctors cannot so easily go out and seek jobs elsewhere. The obligation to provide a referral is completely unnecessary.
Let us not forget that the last country which forced healthcare workers to set aside their consciences was Germany, circa 1930s.
To all concerned:
I just participated in your on-line survey for the College of Physicians. I hope that you will take what I answered there into consideration.
Discrimination can go both ways.
I agree that physicians are obligated to give all necessary health care to all patients despite race, religion, disabled, older citizens, sexual orientation, etc., as long as they are not asking for care that goes against the laws of God, who, or course, in my opinion, comes first.
I do not want any harm to come to any human being by not receiving medical care that will make a person healthy, if possible. To me healthy can include being pregnant and carrying a baby to full term. Nothing healthier than that. All possible care should be given to that baby as well as to the mother. In my opinion, there is more discrimination to the unborn babies than to any other segment of society here in Canada.
I believe it is discrimination to force physicians to go against their fundamental beliefs and threaten their positions if they don’t abide by the current trends, regarding abortion, euthanasia and assisted suicide.
Dear Sir/Madam,
Don’t force doctors to kill their patients just because that is what the patient wants. Doctors have to live with their actions like the rest of us and shouldn’t be told to do anything that is contrary to saving a life. I, for one, would be very nervous if the doctor had that power, no matter the checks and balances in your system. I was recently told of a survey of people who tried to commit suicide for one reason or another and were unsuccessful. Over 80% said they are glad they were saved. There is nothing dignified about suicide or abortion not for the patient and not for the doctor asked to commit these heinous crimes. Just because something is legal doesn’t make it moral or ethical. Please think about that before you try to force doctors to go against their conscience or religious belief. We may lose a lot of good physicians who will go elsewhere to practice.
Thank you for your time,
Your draft policy states that “physicians must strive to create and foster an environment in which the rights, autonomy, dignity and diversity of all patients, or those seeking to become patients, are respected”. The draft policy further states…”The policy also sets out the College’s expectations for physicians who limit the health services they
provide due to clinical competence or because of their personal values and beliefs.”
The problem facing some physicians today is with the definition of the word “PATIENT” in regards to artificial family planning requiring abortion.
First of all is getting pregnant a sickness? Secondly does pregnancy destroy a woman’s health?
The whole issue of some physicians wanting to follow their conscience has to do with assistance to save life and not to destroy life. In some physicians beliefs not only the pregnant woman but also the fetus she carries is a patient that needs care. Therefore they are faced with a dilemma when faced with a situation where a woman seeks help for abortion. They do not want to be an accessory to destroying human life even by referring a person to end the life of a fetus in a woman’s womb. Is there anything wrong with that?
Therefore isn’t it the logical and the right thing for the CPSO to allow doctors who do not want to have anything to do with abortion to allow them to follow their conscience???
Why cannot CPSO (at this technologically advanced age) provide a public list (website) of doctors who would cater to women seeking artificial family planning instead of trying to impose this issue on those doctors who wish to follow their conscience?
In addition, at a time when there is an acute shortage of physicians in Ontario to deal with various kinds of real diseases why would the CPSO want to lose physicians over this abortion issue????
Is the CPSO caving under the pressure of pro abortion lobby groups instead of working toward the good of all Ontarians and finding solutions to find a balance???
Dear Sir or Madam:
I write to express my dismay at the recently published draft document “Professional Obligations and Human Rights” of the CPSO. The effect of this document is to deny physicians their right in conscience to refuse medical treatment which violates their morals, and referrals that would make them complicit in procedures they know to be immoral.
Because a procedure is legal it does not follow that it is moral. We recoil in horror at the barbaric acts of ISIS, but close our eyes to our home-grown horror of abortion, because the unborn are disenfranchised, and because our governments lack the courage to acknowledge the humanity and citizenship of the unborn.
Surely you do not want physicians who are false to their own sacred principles. Long ago, Shakespeare wrote, “This above all to thine own self be true, and it shall follow as the night the day thou canst not then be false to any man. (Hamlet, act 1, scene 3)”
If you deny physicians the fundamental right to be true to themselves, you are forgetting that there are more ancient and noble codes of law than those emanating from Toronto and Ottawa.
Dear CPSO Board Members,
Thank you for the opportunity to respond to the CPSO’s draft policy “Professional Obligations and Human Rights”.
I am a family physician in Nova Scotia who is very concerned about the policy changes that are being proposed and what they mean for health care professionals and patients.
There are many positive aspects in this new draft policy: I commend and agree with the CPSO’s advocacy for high standards of patient care and their strong stand against discrimination. However, I have significant concerns about the requirement for physicians to perform or refer for procedures that they believe are morally unacceptable. Physicians and health care providers with high moral standards are precisely the professionals that I want as colleagues and that I want looking after myself and my family members. Please continue to protect the conscience rights of these individuals, including myself.
I believe that health care is strengthened by the diversity in medicine and in providers’ beliefs. I believe that making physicians simply a technician is not the answer and that patients will suffer if this is what occurs. We, as physicians, must be able to do what we believe is best for our patients and patients have a right to be able to seek out physicians who share their values.
Please do not accept the policy in its current form. Please protect the conscience rights of physicians. There are many incredible, ethical, knowledgeable, and dedicated physicians who have moral objection to one issue or another. These individuals will either leave the practice of medicine rather than compromise their moral or religious beliefs, or worse, they will lose themselves in compromising. In either scenario, it is patients and healthcare who will suffer.
Dear Members of the Consultation Committee:
We are very concerned about your draft policy, which suggests in certain sections that physicians who do not take part in acts for conscience reasons should be forced to refer their patients to other physicians who will perform those acts. Many or most of the objecting physicians will also object to the act of referring itself, because it is cooperating with the act. This very seriously limits their right to conscientious objection.
We have the privilege of living in a free society, and freedom of conscience is one of our most fundamental freedoms. We cannot limit it even if we think we are doing the right thing in limiting it.
Indeed, personal integrity is the foundation of a physician’s relationship with their patients, and that integrity will be hugely compromised if we force physicians to violate there consciences.
There is increasing disagreement in society as to what constitutes a moral act, so the College is not expected to make a determination in this regard, or to limit morality. Physicians are professionals, and they must be allowed to respect their own consciences.
Please do not make doctors act against there conscience. This is evil. Moral issues especially. It’s to bad we can’t tell government what we want. And they actually do what the people that the SERVE want.
Be Still and know that I AM GOD……..
I earnestly ask that you reject the draft policy “Professional Obligations and Human Rights”.
As a healthcare worker myself working as a Registered Nurse, I have experienced what it is to advocate for patient’s rights, freedom of choice, and the value and dignity of human life. A violation of the universally recognized right of freedom of conscience which is guaranteed under Canada’s Charter of Rights and Freedom undermines the very basis of human dignity under which all human rights exist.
I respectfully ask, therefore, that your honorable body reject this draft policy and work towards protection of human life in all its forms.
Dear Members of the Consultation Committee:
Subject: Draft Policy “Professional Obligations and Human Rights”.
My letter concerns the new proposed draft policy. Sections 8, 10 and 11 state that a physician can refer a patient to another physician if they find the proposed action immoral. This goes against a physician’s right to conscientious objection.
Freedom of conscience is an integral foundation for any career, and it is not right for a physician’s freedom of conscience to be limited.
Please revise the draft, and include a section on respecting the freedom of conscience for physicians.
Dear Sir/Madam,
Please allow freedom of conscience and freedom of religion for all physicians. Doctors need to be unequivocally allowed to abide by their religious and moral beliefs.
I am writing to express my concerns with the following two points in the draft:
Doctors are required to refer for procedures that are against their moral or religious convictions (Lines 156-8)
Doctors are required to perform procedures that are against their moral or religious convictions in situations where that is deemed to be “urgent or otherwise necessary care”
Forcing doctors to offer procedures or drugs against their better judgement or moral convictions is not only wrong, it is dangerous. Please protect the freedom of doctors, for the good of all Canadians.
The rights of physicians who have moral objection to conscience due to their religious beliefs must and should always be protected as those of the patients. Each of these have been and should continue to be protected. This new policy is skewed towards negation of physician right. It amounts to advocating a dichotomy in the lives of these physicians. The faith and conscience of each person defines who the person is and animates ones professional life. Developing policies that advocate otherwise is tantamount disintegration and destruction.
I do not agree that a doctor should be forced too perform any medical action that goes against his conscience. Please uphold this in any future policy draft.
In other words, this current draft policy should be scrapped.
To whom it may concern at the CPSO,
RE: CPSO Draft Document on Professional Obligations and Human Rights
I hereby wish to thank-you first of all for being open to consultation to the public with regards to this Draft Document. I appreciate that the College accepts the existing Charter of rights and freedom of religion and conscience.
In regard to this Draft Document I would encourage you to maintain that moral stance, which is based on conscience and is rational and evidence-based. This moral stance deserves the full protection of all members of society, including physicians. Other documents such as the Canadian Charter and the United Nations’ Universal Declaration of Human Rights embrace this equality of dignity and rights among all people, and so I would encourage you to maintain the same policy in your Document on Professional Obligations and Human Rights. I would request that you respect both patient and physician rights, that is, the balance should not tip one way or the other.
A physician, as a human being with a moral stance, even if reinforced by religious beliefs, should never be compelled to act against rational conscience decisions. Being forced to do so goes against the Charter and human rights. Refusing to perform or provide referrals for some procedures has more to do with the freedom of all to make rational conscience decisions, based on absolutes that are transcendent and not on the changing winds of time.
Thank-you for helping to preserve the integrity of your members. In so doing you will optimize the health and well-being of the patients we serve, in protecting the physician’s ability to practise medicine in good conscience, and ultimately promoting the dignity of personhood as it was created to be.
I appreciate your careful consideration of this submission in due time.
Dear CPSO Consultations Committee:
Re: Draft Policy “Professional Obligations and Human Rights”.
I am writing to express my concern about the proposed draft policy, which states that physicians who decline to participate in certain acts for reasons of conscience should be compelled to refer their patients to other physicians who will perform these acts. It fails to address the fact that these same physicians will find the act of referral itself objectionable, as it makes them an accessory to the act. In compelling physicians to refer, you are limiting their right to conscientious objection. I am strongly opposed to this.
In light of today’s ruling by the Supreme Court of Canada on assisted suicide it is clear that this draft policy is woefully misguided. It should be withdrawn immediately and revised to provide a clear defence of the right to freedom of conscience for all physicians.
Dear CPSO:
I am incensed at the notion that doctors can be coerced to involve themselves with abortion referrals or other objectionable issues(euthanasia), when
there is absolutely no practical necessity for such referrals. Any simple citizen can find the services for themselves. So, coercion is simply a matter of
crass, tyrannical persecution of conscience by a secularistic, dictatorial regime.
I think it is a disgrace that some people are trying to force doctors to do something that is against their conscience.
Doctors are supposed to save lives not destroy them. Those who are against killing, anyone, should be free not to do so.
By referring patients to someone who will do this evil act makes the doctor an accessory to murder.
This is against Freedom of Religion which we are supposed to have in Canada, therefore unconstitutional.
You must not let this get through. If not, remember that you will be held accountable to God, someday.
I am a proud Canadian. I just returned from traveling to the Middle East where many rights and freedoms are restricted. Canada has a fine reputation for welcoming and accommodating all who land here from everywhere else. All are given the freedom to practice whatever lifestyle they choose. Why, then, are the rights and freedoms of physicians and other health care workers being impinged upon by legislating that, regardless of their personally held religious and/or moral beliefs, they must refer patients for procedures that cause those physicians to act against their own conscience? Where is tolerance in this instance? Is tolerance only limited to specific groups? It is becoming glaringly obvious that discrimination is alive and well, and even thriving in Canada – against Christians, Jews, and those whose morals forbid them to participate in the taking of a life.
Rights and freedoms should be afforded to everyone, regardless of race, colour, sexual orientation, or creed. THAT is the Canada I want to belong to.
If your going in the wrong direction the most progressive response is to admit it by turning around.
Morality must be based on objective truths not on subjective or relativistic principles or grounds of consensus.
What happened to conscience rights? Religious freedom? And, the Christian foundations that gave birth to Western democracies?
In the 20th Century totalitarian systems of governance implemented similar policies in the spirit of advancing their societies welfare but, at what cost?
When will we learn from the mistakes of history?
If your going in the wrong direction the most progressive response is to admit it by turning around.
The draft proposal is not acceptable as it requires medical persons to give up their own right of conscience. As a patient I would not trust a doctor or a medical ethos that gives up a persons right to do the right thing as they see it. Every person has the right to the dignity of practicing what they believe.If I believe it is wrong to steal, then hiring someone to steal for me is OK?
I am writing to you with grave concern regarding the content of your proposed
draft policy, which indicates that physicians who decline to participate in certain acts for reasons of conscience should be compelled to refer their patients to other physicians who will perform these acts. It does not address the fact that many
of these same physicians will find the act of referral itself objectionable, as
they consider it material cooperation with the act. In compelling physicians to
refer, you are limiting their right to conscientious objection. I am opposed to this.
There is significant disagreement in our society as to what constitutes a moral
act, and I do not expect the College to define or limit morality. All I expect
is that physicians, as professionals, be allowed to respect their own consciences. Freedom of conscience is foundational to our
free society and cannot be limited, even for the best of intentions.
If we coerce physicians into violating
their consciences we will inevitably erode the personal integrity which is the
basis of the physician’s relationship with their patients. I encourage you to
revise the sections above, and include a clear defence of the right to freedom
of conscience for all physicians.
TO POLICY MAKERS:
I strongly disagree with the proposed policy changes disallowing physicians their heretofore (and current) “right” to refuse to provide specific medical services or perform specific procedures to which they would have religious or moral objections.
As a patient, I would lose all trust in my doctor’s ability to ‘freely’ practice medicine to the best of his ability. NO patient should, under any circumstances, ever insist or expect a doctor to compromise his own moral compass; nor do I expect my doctor to compromise mine!
When I seek a doctor’s medical care and/or advice, I expect to be treated with dignity and respect for me as a free person … and I reserve the ‘right’ to choose whether or not I will follow his/her advice. In most cases, I’ve chosen my doctors based on their medical knowledge and expertise; choosing someone with whom I can build a rapport and who can understand and respect MY own moral objections to various medical procedures.
In my opinion, enacting and enforcing these changes to your Policy, will open up a can of worms you really don’t want to open! As ‘reasonable’ as some of the policy changes seem to be, they are actually ‘anti-democratic’ and others are downright ‘draconian’. Doctors (with a moral code/conscience) will leave Ontario in droves! As well, I sincerely fear that these kinds of changes could eventually lead to terms similar to, but harsher than, the terms of this CPSO Policy, becoming the ‘law of the land’ for every kind of ‘service provider’ and indeed, for every Canadian citizen.
To rob physicians of their right to ‘conscientiously object’ to practices and procedures based on their religious or moral grounds is downright heinous. It reeks of communist ideology, and is an attempt to rob our Canadian Physicians of a basic human right/freedom that was enshrined in our country from its very beginning for every single Canadian … including physicians.
All human beings have been endowed by our Creator, the freedom of conscience and no man can take that away. Forcing doctors to commit atrocities against our society’s most vulnerable is an evil that shows the true barbaric nature of our “modern” civilization. That life begins at conception is an indisputable truth supported by the scientific community at large as well as all God-fearing men and women around the globe.
The pro-life movement is getting stronger, with voices of the millennials now growing in numbers to support justice and freedom for all mankind. The unborn also have a voice but are not given any choice by the “pro-choicers”. The Lord hears their cries and will show no mercy to those with the stain of unrepentant sin. Our movement will not stop until abortion ends, and our first step is to defund. It is unconstitutional to force tax-payers to fund such a horrific crime, contrary to their beliefs.
When you try to remove God from people, and attempt to suppress thought and moral conscience, you bring us one step closer to Communism and all the evil nature that comes with it.
Shame on the College of Physicians.
I strongly oppose any changes in the policy of the CPSO that would infringe on the constitutional right of physicians to act according to their own conscience.
This is a blatant violation of both the individual and professional rights, not withstanding the human rights of self determination based on own conscience, religious beliefs and ethics.
Will the Human Rights Commission do the right thing to protect the physicians and rule against the College of Physicians proposed policy?
For brevity; both the Canadian Physicians for life and the Christian medical society articulate my views on compulsion of a physician’s conscience precisely and completely. If you do not change course you will end up driving many very conscientious, hard-working and dedicated physicians out of practice.
Re: Professional Obligations and Human Rights.
I am deeply concerned about the limiting of physicians’ freedom of conscience in their practice. Freedom of conscience is the essence of a person and the core of one’s integrity. How can a physician practice while being denied this basic freedom our Charter upholds? This policy is detrimental to physicians and to their clients.
The College of Physicians and Surgeons of Ontario.
My feedback applies to other Colleges too who are challenging adherence to a conscience clause as assisted suicide is state approved in Canada .
Adherence should never be questioned or challenged regardless of pressures within the medical profession or from State or the public. This is the time for all doctors who will retain professional ethics and not succumb to becoming funded contract killers to stand up and say so loud and clear in public. The divide is obvious amongst the medical ranks .The public has the right to safe medical practices .Promoting assisted suicide a la Supreme Court of Canada ‘s malpractice of a ”Ruling” runs counter to safety and further confidence in the medical profession. We can all foresee the enlargement of abuse of any restrictions and so called ”safeguards” .
Canadian Disability Alliance
Response in PDF format.
“The CDA strongly supports the College of Physicians and Surgeons in its approach to patient dignity and access to care.”
I believe the CDA is foolish to do so.
The original Christian understanding of human dignity gave each individual intrinsic worth as a human being. The new understanding removes such protection and makes people with disabilities vulnerable to abuse.
Referral is not a problem when motivated by lack of competence. However, when the government or profession requires violence of doctors in the name of care–forced abortion and assisted suicide are or will be covered by OHIP–then morally speaking “access to care” means murder and referral makes the doctor an accessory to murder.
Since no doubt you are aware that people with disabilities are already targeted for death before their birth, surely you should reconsider your support of the CPSO approach to patient dignity and access to care. Canadians with disabilities will now be vulnerable throughout the rest of their lifespan as well. The Netherlands has legalized voluntary euthanasia for children older than twelve and for the younger children tolerates the Groningen Protocol for Euthanasia of Severely Ill Newborns. Belgium has legalized euthanasia for all ages. Identical twin brothers there, born deaf but 45 years old, asked to be killed after learning that they were going blind.
https://www.lifesitenews.com/news/six-lessons-from-death-in-belgium
I am writing to express my concern that the College of Physicians and Surgeons of Ontario (CPSO) are passing draft legislation forcing doctors to act against their better judgement and requiring that these doctors either perform or refer for medical procedures that they object to.
Why would we in Canada want our doctors to take actions without consciences? Can you fathom doctors performing their duties without thought of doing what they think is truly best care practices for their patients; going thorough motions and procedures without a moral compass? Why would we risk trusting this type of doctor with the lives of Canadian citizens?
I beg you to do the right thing and protect conscience rights for our physicians in Ontario. What happens here will impact the rest of Canada.
re Balancing Physician and Patient Rights
Since the decision of the Supreme Court of Canada, Carter v Canada regarding physician assisted death, this is a difficult time for physicians and their provincial regulatory colleges.
I note that the justices made it clear that nothing in the decision compels doctors to provide assistance in dying.
The CPSO policy on Professional Obligations and Human Rights, should therefore reflect the ethical conscience rights of the physician not to provide assistance in dying.
I believe that physicians will be respected for having clear ethical positions.
To the ethics committee,
I have reflected on your draft of “Professional Obligations and Human Rights” and have great reservations and concerns about the proposed policy.
Freedom of conscience is protected under the Canadian charter of rights and freedoms. It assumes a society that dogmatically forces their own version of right and wrong on the individual does much more harm to society in the long run- with examples throughout history of the destruction that can take place when individuals do not stand up for what is morally right).
The new policy is concerning especially in the face of the recent legalization of euthanasia.
As a medical student I declared I would not administer a poison to a patient. Today, I am told that if I don’t administer or refer for that poison the college will suspend me?
This is not just an example but a real scenario as last year I was asked by a patient “to kill him” well declaring the situation an “emergency”. I declined and offered him excellent palliative care and compassion during his last days. Although at that time I had the law on my side – in the future I will have neither the law or the college on my side.
I assume that the college wants its physicians to be honest, emphatic, and kind but the same ethos that drives my belief in the worth and respect of every individual is also the basis for my refusal to “administer poison”.
Now the college aims to silence and marginalize any physician who believes in the value of life through disciplinary action?
Specifically my concern lies in the requirement to refer (lines 156 and 157). An “effective referral” does not absolve the referring physician of the harm that has taken place.
I strongly ask you to reconsider the broader implications of your policy and reject the proposed draft.
Dear College of Physicians and Surgeons of Ontario:
I am writing this letter to offer my comments on the proposed Ontario College of Physicians and Surgeons (“the College”)
policy that would require Ontario’s doctors to refer patients for abortion or euthanasia services when asked, even if such referrals go against their conscience.
I will begin by saying that I am 58 years old, and have only experienced professional care from Ontario’s doctors when I have been stricken with the need for medical attention. I say the same for my parents, 88 and 89 years old, and in relatively good health. Their longevity is in part attributable to their lifestyle, but also to very good care from Ontario’s doctors. Therefore, I am surprised to hear that the College is considering a policy which would restrict the Freedom of Conscience and Religion to their members who oppose referring patients for abortion or euthanasia services. Freedom of conscience is guaranteed in the Charter, is it not? But for these members of the College, who have worked and studied and met the full standard of their profession for offering care which promotes health, healing, and pain management, the proposed policy will remove this freedom. This freedom must be respected, as it is an essential element in what makes us human, and not simply “utilitarian”, valued solely for our perceived contribution to the good of society. I will give an example to explain my point.
If you have an 18 year old son who is an only child, in good physical health but suffers a bi-polar condition, and he approaches you to refer him as a candidate for euthanasia, are you going to accede to his request? I think you would do everything in your
power to advise him against this. I do not think you would say, “son, you are right, quality of life is everything…since your quality of life is not consistently joyous and stable, I suggest you proceed with this decision.” No, you would probably refer him to specialists who would help him better understand his pain “triggers”, medication, and support systems. You would tell him that you love him. You would see his value more than he himself sees his value, and you would try with all your might to expand his vision of himself.
IN my view, the reason people choose abortion or euthanasia is that they feel there is no hope. However, when people experience love, and are taught to receive love, they grow in hope, even if they have a terminal illness. With such hope, they carry their illnesses better, and see that their existence, though difficult, has a purpose, and that purpose is to LOVE.
By adopting the recommended policy of requiring all members of the College to make abortion and euthanasia referrals, the college seems to have embraced an understanding of patient care that states “not only have you convinced yourself that there is no reason for you to have hope in this world, but you have convinced us too, such that we will force from our ranks those who still believe your life has a valued purpose, by making it legally binding for them to enshrine your hopelessness, by forcing them against their will to obey your wishes for a euthanasia referral, or be removed from the College.”
A more just way for the College to proceed, I believe, would be for allowing those doctors who conscientiously object to the new policy to give notice to all new patients of a “patient bill of rights” stating up front what services are and are not (i.e. abortion and euthanasia) offered. Those who wish an abortion or euthanasia referral could be directed to call the College directly for a listing of physicians and surgeons in their area who provide such services. This would be a more just solution, and a way of minimizing the pain of losing more medical professionals at a time when shortages remain in many communities.
I’ve read your comments regarding doctors’ obligations while in private practise, i.e. working from their offices.
My question pertains to doctors and nurses working in the hospital setting. Do they have the right to refuse to perform and/or assist at abortions? (without being fired from their jobs that is).
Whom It May Concern,
I live in Ontario, and I’m writing in response to the draft policy with the new title, “Professional Obligations and Human Rights.” I appreciate the fact that you are addressing these important issues. However, I strongly disagree with the direction this new draft policy is going. If a doctor has a religious or moral view opposed to the patient’s views, it is incredibly disrespectful and belittling of a medical doctor to expect them to still refer such a patient to another medical doctor who has a view in line with the patient. This type of approach is belittling of a doctor’s personal views. A doctor’s role is to protect lives–and issues like abortion and assisted suicide–cannot be deemed as neutral issues that all should expect to follow. So I would like to request the College to change the policy, so that doctors are NOT expected to refer patients to other doctors when an issue goes against their moral or religious views. If one doctor thinks that abortion or assisted suicide is murder, how can you expect a doctor to refer such a patient to a doctor who doesn’t think abortion or assisted suicide is murder? Please honor the rights of all doctors, even those who may have opposing beliefs. I’m not a medical doctor myself, but I am very aware of the issues involved in the medical profession.
Furthermore, I would like to remind the College that those who have strong moral and religious beliefs, often seek to be a doctor with integrity. They do not want to cheat the system. They want to do good, and not harm. These doctors are often the ones who provide medical assistance to those in great need, sometimes even overseas–they are often not merely in it for the money. To challenge the views of such doctors could greatly harm the future of the College of Physicians and Surgeons of Ontario. If you were to blatantly disrespect the views of such doctors, they may be tempted to find work elsewhere. I, for one, am very grateful for doctors who seek to live with integrity as a doctor–to force them to go against their value system would be quite damaging to our system here in Ontario.
Dear CPSO:
It is heartening to see that College accepts existing Charter rights of freedom of religion and conscience. The challenge at hand is maintain that moral stance with respect to conscience decisions, and ensure that there is no coercion or compulsion which would contravene the Charter and human rights.
It is important to note that refusing to provide or perform some procedures is not discriminatory when it is based on a properly informed conscience. This has fundamentally to do with the recognition of the physician as an independent entity, with inherent moral judgment and with conscience.
With respect to the draft document from CPSO:
The duty to refrain from discrimination does not prevent physicians from limiting the health services they provide for legitimate reasons. …physicians may be unwilling to provide care that is contrary to their moral or religious beliefs.
Comment: This is an important and fundamental principle which recognizes and respects the moral autonomy and judgment of the physician. This autonomy cannot be undermined by external regulations or coercion.
Where physicians choose to limit the health services they provide for moral or religious reasons, this may impede access to care resulting in a violation of patient rights under the Charter and the Code. The courts have determined that there is no hierarchy of rights; all rights are of equal importance. Should a conflict arise, the aim of the courts is to respect the importance of both sets of rights to the extent possible. Where physicians are unwilling to provide certain elements of care due to their moral or religious beliefs, an effective referral to another health care provider must be provided to the patient. An effective referral means a referral made in good faith, to a non-objecting, available, and accessible physician or other health-care provider.
Comment: This is an appropriate expectation of professional conduct on the part of the physician, since he or she can reconcile the requested intervention while at the same time not impede requested care by making a timely referral or transfer of care. The CPSO must enshrine the freedom of the individual physician to act in a way which is concordant with his/her moral and religious beliefs. This is an urgent item, as the Supreme Court has decided that an individual has a legal right to suicide, even in the absence of a terminal illness. Such suicidal ideation is not uncommon in depression, and the court decision as stated has the potential to infringe on the sanctity of human life by mandating physician-assisted suicide when requested by a patient. The moral framework of the health care system is best guarded by respecting and incorporating the moral judgment of its individual practicing physicians. The CPSO should defend this.
You “can reconcile the requested intervention”, referral, with your conscience. How do you do that in your example of assisting a patient’s suicide? Doesn’t your assistance by referral make you partially responsible for his murder? That’s especially true since you are in a fiduciary relationship with him.
The Christian physician’s proper response to this draft policy, I believe, is the same as the apostle Peter’s in Acts 5:29. Such a response, ironically enough, requires a conscience strengthened by the Christ’s words in Matthew 10:28. He is the ultimate example of both holiness and sacrificial compassion, of course, and we can only begin to imitate Him. There is the test of faith.
February 10, 2015
Please respect the most sacred of commandments “Thou shalt not kill” respect for life from birth to “natural death” When has society become “God” Murder is against the law no matter how sick mentally or physically or disabled a human being is we have no right to play “God”
Physicians cannot be asked to check their most deeply held moral convictions at the door of Med School. Insisting that physicians in Ontario participate in medical practices that are antithetical to their own personal beliefs is to trample on one parties human rights, in an effort to promote that of another party. Doctors in Ontario should be protected from having to council or perform selective abortions or prescribe medication that will cause a spontaneous abortion, to council suicide or perform homicide, and any of the other medical interventions that contravene their beliefs in the sanctity of life. Like the Federal Leader of the third Party, Who has made it clear that politicians who do not share their views on abortion, that they can not become members of the party, the same will hold true for CPSO, if you close the doors to doctors who do not share your views on ethics and morality regarding human life. I would think that an observant Jew or a devout Muslim, an orthodox Christian or Roman Catholic would have to practice in another jurisdiction, or avoid a career in medicine altogether, if they were not permitted to use their own conscience as a guide as to how and when they would provide medical services to patients in Ontario.
I’d like clarification on Item 3: The patient’s best interests must remain paramount.
The word “paramount” is defined as more important than anything else. This suggests/implies that the patient’s interest rules over and above that of the physician. This then is a situation of reverse discrimination: the physician has to subordinate his/her beliefs to the patient’s interests.
In practice, it would mean that a physician believing abortions to be contrary to his/her religious beliefs would still be required to direct the patient to a doctor who does perform abortions. In other words, the physician would have to, aid, abet and assist in the patient’s abortion.
He/she could not just say, I’m sorry I cannot help you; and allow the patient to find an alternative doctor. The College’s expectations do not allow that option.
The College’s expectations of physicians who limit the health services they provide on moral or religious
grounds is that they must do so in a manner that respects patient dignity, ensures access to care and protects patient safety.
A patient could claim that by not providing abortion information they were not given access to (abortion) care and that their safety was jeopardized.
Therefore, the rules as stated do not foster, nor protect the physician’s right of freedom of religious belief.
Dear Members of CPSO,
In your new proposed draft document it states:
“Where physicians are unwilling to provide certain elements of care due to their moral or religious beliefs, an effective referral to another health care provider must be provided to the patient”.
I believe that a mandate for an “effective referral” is a violation of a physician’s rights, as it compels the physician to violate his or her own conscience by being a participant in the very act, the very procedure to which he or she objects in the first place.
Please withdraw such policy.
Thanks for your attention!
Dear College of Physicians and Surgeons of Ontario,
I am a citizen of the Province of Ontario, and I am writing in response to your new draft policy entitled “Professional Obligations and Human Rights,” which, if enacted, will jeopardize the ability of some physicians in Ontario to follow their consciences in their practice of family medicine. I demand that the CPSO respect the diversity of medical judgment and not coerce doctors to perform or refer for procedures to which they conscientiously object.
I do not believe that physicians should discriminate against patients, and I do in fact believe that patient is care is of the utmost priority. However, deciding not to offer a service in no way discriminates against patients, provided the service is not offered to any group. It is difficult to see how limiting the physician’s Rights to Freedom and Conscience and Religion, which are guaranteed in the Charter of Rights and Freedoms, will result in less discrimination or better patient care.
This policy, which I have read, misses the fact that there are two human beings with rights and freedoms in the patient-physician relationship. It prioritizes the patient’s rights and freedoms, while eliminating those of the doctor. This move is certainly not “helpful to physicians” (as per the document), nor is it helpful to those patients of an ethical minority who might wish to be counseled by a family doctor of the same ethical persuasion.
The CPSO draft refers to the Supreme Court of Canada’s decision to limit personal rights and freedoms with regards to those issues that involve the public “good.” What the CPSO fails to understand, and has repeatedly failed to understand, is that those physicians who are against the medical practices stated in the document believe that their stance is for the public good, both medically and ethically speaking, and that the use of such procedures and medications has had devastating effects on society and women’s health. Their position has good arguments behind it, including results from many medical studies. To treat their position, even implicitly, as threatening the public good, means that the CPSO is claiming to represent the one and only way of defining what “good” is, for patients and for society. Surely the CPSO board, with its scientifically trained members, recognizes that to shut down debate and discussion in contested issues is never the answer.
In this document, the CPSO therefore represents an imbalance of power. The availability of abortion and contraception is not threatened by the presence of family physicians who hold other ethical positions. In fact, referrals for abortion and contraception prescriptions are more easy to come by than ever. This draft policy does, however, threaten the right to freedom of conscience and religion for those doctors who hold to other definitions of the “good” of their patient. If this policy is enacted, I know of doctors who may be forced out of family practice because they will not compromise their well-reasoned beliefs. This draft policy is damaging to both physicians and the public because of its utter lack of balance and comprehensiveness.
I’m calling on the CPSO to retract this version of their “Professional Obligations” policy.
Good morning, I would like to comment on your proposed policy that would deny health professionals freedom of conscience to refuse to participate in morally questionable practices such as abortion, and assisting someone to kill themselves. I strongly object to any infringement on the freedom of anyone, including doctors, nurses, pharmacists, etc. to refuse to participate in any way including informing someone on how to get these procedures.
Essentially if you pass this policy, you are preventing a large portion of the population from becoming or continuing as health professionals. You are discriminating against them. Referring someone for these procedures is participating in them. A person who refuses to participate also cannot refer in good conscience. For the record, I would also like to be able to choose to have a family physician who I know will NOT do these procedure or assist in them in any way, including referral, who wants to cure illness and prevent death, not deal it. I cannot trust any health professional who is willing to perform or refer for these procedures to treat me in good faith, especially when I become elderly.
Further, the demands of patients for specific procedures can be highly unreasonable, ill-informed and not in their best interests. Doctors and other health professionals should not be required to either meet the demands of patients, parents of patients, attorneys, or refer them for the procedures they want. They need protection from having to do so, especially when they firmly believe that the procedures in question are highly unethical, no matter what the law says. For e.g. what if a 16 year old patient who is 8 months pregnant wants an abortion (not illegal to do in Canada), is your organization prepared to require doctors to refer her for one? What if her parents want her to have one, but it looks like she is ambiguous about having the abortion, will you require doctors to refer? What about the baby who if delivered at 8 months will probably survive? Even doctors who believe in abortion rights would have difficulty in referring in this case, I believe, or at least I hope.
Not everyone in this provinces believes that abortion and euthanasia is ok , this fact will not change, and the province’s laws and policies should reflect this fact and ensure protection for those professionals who object to participating and referring for these procedures.
Thank-you for giving me the opportunity to comment.
Forcing physicians,against their strongly held views, to refer patients for euthanasia is ethically and morally wrong. In the Netherlands, there are clinics available which do not require referral from the patient’s physician.
Excellent point.
This is currently what happens in Ontario with regard to induced abortions.
This would be a practical way of both respecting doctors’ conscience rights and still ensuring access to patients for services they may want. Wouldn’t this uphold both of the competing rights that the College is trying to balance in this policy?.
Dear Friends,
Recent changes proposed are quite terrifying. Although not all may agree that abortion and euthanasia are health needs or not yet our trusted Health Care Physicians must be allowed a conscience regarding referral to other Professionals who are willing to commit these life ending acts .Please carefully consider this, each patient matters.
Recently our family had to change Physicians on learning our Doctor was pro abortion. Whether logical or not we
are afraid that anyone who does not value all Life might not be trusted with our own.
Thank you for your kind and thoughtful attention to these, for some of us, terrifying matters. In my 75 years as a
Canadian I have never before experienced the fear felt now.
Doctors need to have and keep their freedom of conciense .
This protect me and all Canadians.
thank you
Thank you very much for the opportunity to provide feedback on this policy.
I am a family physician with a roster of approximately 2000 individuals. Since I started my practice 10 years ago, my patients have been made aware of certain restrictions in my practice due to my Roman Catholic faith. This includes referrals for procedures that result in the termination of life i.e. abortion, fertility clinics that destroy fertilized eggs etc. I have signs in my office that provides patients with this information.
My main concern with the current draft policy is the fact that a doctor is mandated to make a referral when requested. I provide my patients with objective information on all of the available options that they have but they are aware that I will not make referrals for procedures that my faith clearly objects to. If a patient proceeds with an option that I object to, I treat them no differently upon their next visit to my clinic. Making a direct referral for a procedure that destroys life i.e. abortion, perhaps euthanasia in the future, connects me directly to the procedure and would violate my conscience.
I hope that the CPSO will consider this feedback and alter the draft proposal. I agree that ALL patients require respect and compassion, but I don’t think that this involves forcing doctors to act in a fashion that violates their own personal religious beliefs and faith. There are other ways for the Govt of Ontario and the CPSO to ensure access to these types of services for all patients. Thank you.
A physician should definitely not be required to act against his moral or ethical beliefs to assist patient suicide. Furthermore there is no physician that should carry out patient suicide as it could have a lasting and devastating effect on their ability to administer effective health care to their patients. A physician should do everything in their power to administer health care that will prolong the life of their patient as this is an integral part of their oath and profession.
Dear Members of the Consultations Committee,
I am writing to you today because I have heard about your proposed draft policy, and I have serious concerns.
This draft states: “Where physicians are unwilling to provide certain elements of care due to their due to their moral or religious beliefs, an effective referral to another health care provider must be provided to the patient.”
Catholic physicians believe that a mandate for an ‘effective referral’ is a violation of the physicians’s rights, as it compels the physician to violate his or her own conscience by being a participant in the very act, the very procedure to which he or she objects in the first place.
I strongly disagree with this part of the draft proposal. The Charter right of freedom of conscience and religion for physicians must be respected.
I ask that you reconsider and revise this section of the proposed draft policy on Professional Obligations and Human Rights.
How can the Supreme Court of Canada determine that no right are absolute? Does that mean that there is no absolute truth? If God exists and is the Creator of all life how can we decide to give a doctor who is in a profession of healing the right to help his patient to commit suicide?
Just like abortion we are in a very slippery rope. I want my physician to have the absolute right of following his conscience and be free of being coerced into making referral in matters that violate his/her moral or religious beliefs. My physician needs to be protected and not coerced into having making referral which are against his/her conscience.
Think of your own end of life, how are you going to be able to stand in front of the judgement seat of God, which you will, whether you believe it or not, and explain your position.
Dear College Representatives:
Re: “Professional Obligations and Human Rights” Draft Policy –
“We want to hear your thoughts”
Having carefully read and reflected upon the draft policy, I submit the following thoughts.
First, thank you for your openness to consultation with the public. This policy is of direct relevance to the life of every Canadian, not all of whom will be able to read and respond to this draft.
I appreciate that the College respects the existing Charter of rights of freedom of religion and conscience, and applaud the Draft’s retaining that positive moral stance. These freedoms are ensured in many other documents, including the United Nations’ Universal Declaration of Human Rights, and Canadian documents need to follow this model.
Human rights must always be balanced (as the Draft Policy points out, no right is absolute, line 115), and in the case of medicine, patient and physician rights need to be held in tension.
The physican’s right and responsibility to an informed conscience, and to act in accordance with that conscience, is essential. Upholding this right actually supports the patient’s rights. The Draft Policy eliminates the physician’s right to exercise informed conscience. It allows physicians to refrain from providing elements of care that contravene their moral or religious beliefs, but requires them to ensure that these elements of care are provided by someone else. (“Where physicians are unwilling to provide certain elements of care due to their moral or religious beliefs, an effective referral to another health care provider must be provided to the patient. An effective referral means a referral made in good faith, to a non-objecting, available, and accessible physician or other health-care provider”; lines 156-159)
Clearly, whatever code of morality one operates by, arranging for someone else to do something one considers immoral is as blameworthy as doing it oneself. The law prosecutes a person who hires someone else to commit a crime, for example.
This Draft Policy not only fails to protect the consciences of physicians, but actually may require physicians to take actions they consider morally unacceptable.
I do not expect my physician to think as I do on every subject. I do want my physicians to operate in good faith, to have properly informed consciences, and to advise me as to how they understand the nature and effects of any intervention they provide, recommend or make available. Physicians have extensive knowledge their patients do not have; patients rely upon physicians to understand what they are recommending or referring them to.
Nobody holds a morally neutral stance. Refusing to perform or provide certain procedures is not discriminatory when it is based upon informed conscience; it is not a question at this point of the patient’s right to particular procedures, but of the physician’s understanding of those procedures, the physician’s right to freedom of conscience and religion, and the physician’s obligation to provide the best possible care to the patient.
“Above all, do no harm.” Every physician must build a fence around this law. Your Draft Policy tears down that fence.
Thank you for your attention to my comments.
Compelling doctors to refer something they consider killing a patient will go against the reason they went into medicine – to heal patients, not to harm them.
I would not feel safe in the care of a doctor who was forced to refer patients for procedures that go against a doctor’s conscience.
Compelling Ontario doctors to violate their rights to conscience – which were asserted by the CMA at their August meeting – will lower public trust and confidence in doctors.
Doctors should not be forced to go against their conscience.
I don’t believe it’s right to take away a physician’s right to act within their moral or religious beliefs. In today’s information age, if a patient was refused service based on their physician’s moral/religious beliefs, it would be very easy for a patient to, on their own, find another service elsewhere that would provide what they want. A quick search on the internet would give them the information they need without forcing their physician to be involved in or refer a service they believed was wrong. People who desire abortions, physician-assisted suicide (etc), will find a way to obtain it. Professionals do not need to violate their own consciences in order for the patients to receive the service they want.
To whom it may concern:
I am writing this e-mail to express my concerns regarding the proposed changes to the CPSO’s human rights policy. Specifically, my concerns lie in the requirements being laid out in the policy regarding physicians’ moral or religious beliefs, and in particular the following two clauses:
• As part of ensuring access to care for patients, the draft policy requires that physicians, who are unwilling to provide certain elements of care due to their moral or religious beliefs, refer the patient to another health-care provider.
• In order to protect patient safety, the draft policy requires that physicians provide care that is urgent or otherwise necessary to prevent imminent harm, suffering, and/or deterioration, even where that care conflicts with their religious or moral beliefs.
Regarding the requirement of referral to another health-care provider to provide a service that goes against a physician’s moral or religious beliefs, it is important to note that if a physician is unable to provide a certain service for moral or religious reasons, even to refer a patient for such a service may violate the physician’s conscience. In legal cases outside of the healthcare profession, it does not matter whether a crime was committed directly by an individual, or whether that individual simply facilitated the crime being committed by another individual. The facilitator is also culpable, at least to a certain extent. While the elements of health care in question would not be considered criminal in a court of law, for the physician with moral or religious objections, facilitating these services through referral would still place some responsibility on the physician, thus contravening his or her own moral or religious standards. Previously, physicians with moral or religious objections to providing or facilitating certain services have been required to state these limitations clearly, continue to provide information regarding all the options, and give the patient the option of seeking care elsewhere on that particular issue, without discriminating against them and without refusing to provide other aspects of care to the patient. I believe that this should remain the case, and that physicians should NOT be required to refer for services that contravene their own moral or religious beliefs. An exception to this may be related to the second point, where under very specific circumstances (e.g. imminent threat to life) referral may be a patient safety issue and thus may be something that should be required. However, these would be rare circumstances and ought to be the exception rather than the rule.
Regarding the second point, patient safety is, of course, very important, and no physician would argue with the need to prevent imminent harm, suffering and/or deterioration of a patient. However, without very clear definitions of what “harm, suffering, and/or deterioration” mean, this is open to very broad interpretation, and places physicians with conscience-related conflicts in a very vulnerable position. I would argue that in cases where patient safety is truly in question (and again, this need to be defined clearly and strictly), perhaps urgent referral should be required, but it ought not to be required that the physician him or herself provide that care unless there truly is no other option.
Canadian physicians (Ontario included) are a diverse group, and there are many physicians of faith, with deeply held religious convictions. To require them to go against these convictions would result in a few possible outcomes, none of which would be desirable:
1) The physician may follow the policy, going against his/her deeply held religious or moral beliefs, and then suffer from guilt, shame, or a sense of failure. This could lead to long-term psychological suffering on the part of the physician, and also predispose the physician to burnout if he/she is consistently required to live with the tension of being required to do something that he/she is opposed to on moral or religious grounds.
2) The physician may not follow the policy, risking disciplinary action, and thus the province risking losing, either temporarily or permanently, a physician who otherwise is providing excellent care for his/her patients
3) The physician may decide that he/she cannot practice in a province where it is required for him/her to go against his/her conscience, and thus leave Ontario and seek to practice medicine elsewhere where he/she still has that freedom. Again, good physicians lost in an era where physician shortage is an issue.
Does the CPSO really believe that requiring physicians to violate their consciences is a viable path to take? I would submit that Canadians/Ontarians want doctors who are people of conscience, and to take away the freedom of conscience from physicians is a grave mistake. I would ask that these points be removed from this policy and that they be replaced by alternative statements that still allow for physicians to maintain their own moral integrity.
No doctor or medical practioner should be required to perform a procedure that they believe to be ethically or morally wrong. Nor should they be compelled to refer a patient to someone who does. We must protect the individual’s right for freedom of religion and all that entails and how their religion affects their work.
Dear CPSO Council Members,
I am writing today to offer comments with regards the draft policy entitled “Professional Obligations and Human Rights”.
Firstly, I share with the CPSO that patient care must of the paramount priority and protection of patients from discrimination is a necessary component of good patient care. However, I am gravely concerned that the implementation of this new draft policy would in fact do damage to patient care in Ontario without adding the desired protection of patients from discrimination.
[Name omitted] , Chair of the CPSO Policy Working Group has publicly stated that physicians who are unable to comply with the policy should think about whether they should be practicing family medicine. Many physicians in this province have deeply held moral beliefs that certain practices, such as abortion, are wrong and hence cannot be included in their practice, should their practice be carried out as one they know to be morally upright and focused on patient care. Forcing a duty to refer for procedures one is unwilling to perform oneself is not arriving at a middle ground, rather, it forces physician participation in that which they have judged to be morally inexorable. Physicians, who previously practiced without fault to patient care, will be forced to leave a practice that can no longer achieve moral accord- as predicted by [Name omitted]. Alternatively, our physicians may decide to comply with the CPSO’s requirement and participate in an element of practice that goes against deeply held beliefs; such interior conflict will undoubtedly lead to physician burnout. Either way, Ontarians will suffer the loss of their well-qualified family physicians, and hence, compromise access to good quality, sustainable patient care in the province.
Consider too that there are members of the public who share their physicians’ moral framework and appreciate the opportunity to access medical services from a physician who they deem to be morally upright. Medicine is both a science and an art. A patient is best served, and the public best protected, when a physician masters both the art and science of medicine by carefully examining the clinical scenario within an ethical framework. We want our physicians to be practicing in a manner that fully engages their ethical reasoning; this ethical reasoning cannot be separated from a physician’s moral and religious beliefs.
The CPSO must reconsider what it defines as “discrimination” in their draft policy. The Ontario Human Rights Code prohibits discrimination against the public based on protected grounds, such as age, race, sex, sexual orientation, disability, or family status. This means that one must not deprive one group of services one provides to others. The Code does not dictate what services must be delivered. If a physician chooses, for moral reasons, not to prescribe a pharmaceutical, there is no discrimination if the same decision and practice is applied to all his/her patients equally, that is, without discrimination.
We must draft a policy that maintains physicians’, as well as patients’, rights as defined by the Charter of Rights and Freedoms in order to avoid systemic discrimination based on conscience or religious beliefs. Any policy that is effected by the CPSO that will limit a physician’s Right to Freedom of Conscience and Religion by forcing a duty to refer or provide a service is in affronts with what Canadians’ value as set out in the tenets of Canadian law. Consider carefully this draft policy. I urge you not to compromise the Canadian value that all must be protected under the Charter of Rights Freedoms, including the providers of services. Please, protect our physicians’ freedom from systemic discrimination.
Dear Members of the Consultations Committee:
I am writing to you regarding your proposed draft policy. Sections 8, 10 and 11 suggest that physicians who decline to participate in certain acts for reasons of conscience should be compelled to refer their patients to other physicians who will perform these acts.
I have a concern about the proposed content. If physicians will be “forced” to refer, they obviously become limited to their freedom of conscience. If we truly live in a free society, I expect that you will consider to revise the sections mentioned and include clear guideline as to the rights of freedom of conscience for all physicians.
I realize that it is very difficult to define in our society today as to what constitutes a moral act — but if a physician believes and finds a certain act to be against his/her own beliefs, they deserve to be able to stand by that belief and to continue to practice in confidence. If they are forced to refer, they stand to loose the integrity of the therapeutic relationship between doctor and patient. This may lead to increased stress, added negative pressures, and depression.
Physicians, as professionals, who have worked so hard to achieve their positions, and have invested so much of their time and money into education and now sacrifice so much of their own lives to help others, should be allowed to respect their own consciences.
Thank you for your time, and I hope to see that the draft policy on professional obligations and human rights come to include guidelines to respect the freedom of conscience for all physicians.
Dear Madam/Sir,
I have a few comments regarding the questions on the survey put out regarding the proposed Physicians and the Ontario Human Rights Code policy and the definition of discrimination.
* 8. Where physicians limit the health services they provide due to their moral or religious beliefs, the draft policy states that they must do so in a manner that ensures access to care.
That is like telling a parent they must refer a child who wishes to die or have an ear cut off or a leg or etc. to someone who is willing to fulfill their wishes. A parent as well as a Doctor is not called to fulfill a person or people groups wishes but rather to care for those who are in their care especially those who are clearly not able to make wise decisions for themselves and to protect them even from themselves if necessary.
* 10. Where physicians limit the health services they provide due to their moral or religious beliefs, the draft policy states that they must do so in a manner that protects patient safety.
Allowing the taking of life as an option for preventing suffering is open to all manner of abuse. Who are we to say that a child or teenager or person of any age who has mental suffering is not actually suffering more than someone who is suffering physically. We cannot make a life and death decision subjective to an individual or individuals, it is not a decision that is ours to give. Our responsibility is to provide relief from suffering mentally and physically – Yes. Through death – No.
The definition of discrimination is open to too many loopholes. It would allow any criminal group to claim discrimination. There are many valid reasons for discrimination. That is what our countries laws define. This definition outlaws all discrimination and with it all our countries laws…
To whom it may concern,
I believe that doctor’s should have the right to hold onto their personal values and beliefs. They should not have to be forced to go against what they belief as they too have human rights.
Thank you for hearing me out,
I would like to express my objections to the term ” effective referral” as used in your new draft document…”where physicians are unwilling to provide certain elements of care due to their moral or religious elders, an effective referral to another health care provider must be provided.”
A mandate for an effective referral is a violation of a physician’s rights, as it compels the physician to violate his own conscience by being a participant in the very act, the very procedure to which he objects to in the first place.
Thank you for your attention,
To: The College of Physicians and Surgeons of Ontario (CPSO)
Your attempt to drastically restrict the freedom-of-conscience rights of doctors is deplorable. Shame on you!
Where is your conscience?
To whoever it may concern,
I am writing this email as a manner of feedback on the “Professional Obligations and Human Rights” policy draft. I am an Ontario resident. I am 2 months shy of completing my Bachelor of Nursing.
In response to this policy, I agree that patients’ interest and safety should be of utmost priority to a physician and that a person should never be treated with less dignity based on their race, sexual identity, religion, creed, etc.
However, denying a patient a service based on the physician’s moral code is not a discrimination on the person. Rather, it is about the physician. If a physician states they are unable to prescribe a procedure or medication to a patient for a particular use because of the physician’s moral code, the physician would give that response to any patient, regardless of who they were. It is not a form of discrimination because it has nothing to do with the one asking for it. Rather, it is because the physician does not believe this action to be in the patient’s best interest, which is why they are morally opposed to it. This physician may not be part of an organized religion, for which they could appeal to the “Limiting Health Services for Legitimate Reasons” section of this policy.
Granted, surely there are times that freedom could be abused. As with all things, it could be used to hurt patients, judge or belittle them, etc. However, the cost is far greater to encourage the physicians of this province to ignore their own morality. How can we ask doctors to practice this way? How can they simultaneously seek out their patient’s best interests while ignoring their own conscience? How will they be able to advocate for their patient’s rights when family members, or those in higher authority advocate against them if they are forbidden from letting their moral code guide their practice? As a member of the health care team, I truly believe that this policy is dangerous to enforce. By forbidding doctors to utilize their morality in practice, I think we will gradually see an end to doctors voicing their concerns and advocating for their patients’ best interest, and instead will merely act as they are told. Institutions spend a great deal of time and resources to ensure that their accepted medical students are good people; not just that they are intelligent or hard working but they have integrity and sound moral character. It seems a waste to throw it away by binding their very moral character that allowed them entrance into the profession.
Just want to say I’m against the position of assisted suicide or euthanasia; and that doctors are to protect life not take it
Dear Members of the Consultations Committee:
Subject: Draft Policy “Professional Obligations and Human Rights”
Thank you for the opportunity to provide input into this proposed policy.
I write to express strong concern about the policy’s lack of respect for the conscience rights of all physicians.
As you are likely aware, conscience rights are a “fundamental freedom” as outlined in the Canadian Charter of Rights and Freedoms. On the other hand, access to certain health services from a particular doctor cannot be interpreted as a “fundamental right.”
Doctors must be free of compulsion, and being required to refer patients to other doctors who will do what they find morally objectionable is a participation in the act itself which they disagree with.
With proper notification about the doctor’s beliefs, patients are free to find other doctors who will perform the procedures or offer services that they desire. New or existing patients should be informed early on about a doctor’s beliefs and approaches, and the patient can either accept this, or they can find another doctor. The result of such an approach will likely be that some doctors will lose patients, while some may gain patients because of their positions. Allowing patients this choice should be a goal of the College, rather than a blanket approach that results in moral homogeneity and is contrary to the Charter’s fundamental freedoms.
The conscience rights of medical professionals, perhaps more than any other profession, must be protected. Freedom of conscience is foundational to our free society and must never be limited. Doctors of clear and strong moral belief and standing must be supported for the health of the medical profession.
The College of Physicians and Surgeons of Ontario proposes that the organization “would require all doctors to provide referrals for abortions, morning-after pills and contraception.” There will be no allowance for conscience of the doctors.
God forbid that doctors be allowed to have a conscience!
Surely there are enough doctors willing to carry out these procedures, that those who object on grounds of conscience should be allowed to live their conscience!
This seems like a policy designed to a) have a cookie cutter approach to medicine, and b) No Catholics need apply!
What a shameful approach! Please reconsider.
Thanks for the opportunity to comment on the above.
I cannot accept, as a citizen of the Province of Ontario, your suggested proposal regarding patient accommodation by physicians; it is fundamentally flawed.
Never, should an individual’s well-considered, mature,moral stances and constitutional rights be subordinated to a conflicting right without reasoned balancing (which must fully consider ALL accommodations). Diminishing (or undervaluing) the rights of one to accommodate the needs of another is not only unjust, it is an insult to honesty and respect in such a grave matter.
Please, reconsider, re-evaluate and develop an optimal accommodation policy which respects both the professionals’ and patients’ needs.
Please be advised that among millions of other Catholics and Christians, we REJECT the proposed “effective referral” mandate for doctors whose Charter right of freedom of conscience and religion must be respected.
We join Roman Catholics and Christians to say that all human beings must have the right to live.
God is the One who chose to give us life and only God must choose when to take it away.
Thank you.
Keep it simple, have the people that are involved (for example the physicians that have the position of moral issues) have a say in how the draft should be designed and or have a voting process of the involved physicians (all physicians) of Canada to vote on the issues the draft will present affecting the decisions of physicians in Canada.
Do no harm, that also includes the physicians who are serving the patients out there.
There are morality principles that need to be adhered to rather then manipulated by drafting policies that are immoral and force doctors to wayout decisions in their moral beliefs.
There needs to be more accountability by those imposing the draft to those who have strong moral beliefs in this area.
Our country is becoming less free by the day. The unelected judges usurp authority from our elected representatives. They are turning our country into a dictatorship of the minority.
Now we have the college of physicians and surgeons acting in the same manner. I have had trouble trusting doctors for a long time, knowing the hold that big pharma has over them. If the college pushes this through I will have even less reason to trust one. Any doctor practising would probably accept our supreme courts decision on killing patients; and judging by Holland and Belgium’s experience I know that the killing won’t stop at ‘assisted suicide’.
I wouldn’t know if this doctor would kill me, because in his opinion,I was a financial burden on society.
Historically, Hippocrates developed his oath in order that people could trust doctors not to kill them. Before that doctors were for hire as assassins because of their knowledge of poisons. How ironic that we are once again in that position, and some members of the public are so naïve or brainwashed that they think that handing doctors a licence to kill is a good thing.
Doctors who don’t want to kill people should not be forced to do so ,or forced to refer people to a doctor who will. I would want to know the ethical position of any doctor so I would know I would be safe from harm.
I understand that the CPSO recently released a draft policy that would compel doctors to participate in abortion and potentially euthanasia, among other services, even if doing so violates their religious convictions. For as long as there has been a medical profession distinctly recognized as such, it has rested on a guiding principle that lies at its very core, which is to do no harm.
The implications for Canada’s medical industry are chilling. If the doctors who are ethically bound to the sanctity of life – to doing no harm – are driven from practice, what sort of doctors might that leave in their place? I would not be entirely comfortable trusting such doctors with my health and my life, even in the direst of circumstances.
Saskatchewan Pro-Life Association
Please, do reconsider ever influencing a Doctor to cause anyone’s death in any way, for any reason. A person who wants to die should have a person assist them to commit their suicide, however this skilled individual can NOT be a doctor. This service must also be paid for by the person who wants to die and NOT by us the taxpayers. Please recall that pre-born human beings were at one time believed to be human. It was once a crime to have an abortion. We now have one pre-born child destroyed for every three live births in Canada. This is why I am certain that assisted suicide can easily grow into Euthanasia. It comes down to our basic human nature. When I have been given an inch I have taken a mile. I know that all the problems of LIFE can be solved by the one solution of Death but I strongly believe we need to offer better options to all of life’s trials than ending that life.
Now that the Supreme Court of Canada (in Carter) has said it is unconstitutional for a person not to have access to physician assisted death (PAD), it is paramount that the final CPSO Draft Policy be modified to protect physician’s conscience rights.
This would be in keeping with both the CMA and Supreme Court’s opinions that a physician should not be obligated to participate in a morally objectionable act such as PAD. It is clear in my mind and logical that a medical referral for such an act makes a person as culpable as doing the act themselves.
I would appeal to the College make these modifications.
As a member of the public, and also a practicing Christian, I believe the preservation of life with dignity is within the rights of every individual in this country, including unborn children, the infirm, and elderly. There are couples who cannot for some reason, conceive and have children, who would love to adopt an unborn child, thus avoiding a killing. Would it not be better for the physician to be able to refer the pregnant woman to an adoption agency, rather than to another physician willing to abort the unwanted child. Physicians have rights and their job is to preserve life. Assisted suicide is repugnant. There are ways to alleviate pain. It would be much better to do this, and let nature take its course, rather than to force a physician to have murder on his conscience. I am afraid our country and province are being led down a wicked spiralling path to ever more and more destruction of human life by these trends.
We as a society will be stepping onto a slippery slope if we force doctors into the dilemma of having to grant people the right to end life. Once started, it will not end & individuals rights’ to death will see boundaries pushed. God help us to see the importance of stopping this before it becomes law.
I am most concerned about your proposal to obligate doctors to forsake their consciences and perform assisted suicide, which I consider to be murder as it now is. The option to have doctors refer is a non option because conscience will still be violated. Better to have patients go to a website to identify those that wish to participate in this awful action. Allow doctors the same freedom being offered to patients, to have a choice. Not only am I disappointed with SCC ruling, but I am amazed that no one in the health Establishment is not speaking out clearly about what is going on with legalized suicide in other countries. Those European with this practice are now killing infants, elderly and disabled without express permission from them. They didn’t start out this way, but there they are. Do you think Canada will be any different? In our pride, the Establishment believe (I think), that human nature in Canada is any different. Once done and doctors are forced to perform these acts, it will only be a matter of time before we are where those European countries are on this issue. Why don’t we learn from what is clearly before us? The European stats are there. I must admit that I am afraid for the future and the lesser value being placed on life. This is a major issue decided by the SCC,and though you cannot reverse that decision, you can give doctors the freedom to choose how they practice their medicine. Do not take away their right. This is fundamentally a moral and therefore spiritual and religious issue for Canadians. Their rights should not be violated either. I believe in a Creator who has placed a high value on human beings. This SCC ruling has negated that concept and is now pushing Canadians to embrace their new value system. It is indeed a sad day for us. In closing, leave the doctors who wish to do no harm alone by creating a website of those that wish to carry out that action so patients can choose where can access this service. Individual choices will still be satisfied. May God help us all. Seems like there is so much death related news going on around us now. This SCC decision is not what I had wished for us Canadians
Please don’t do this to our country, to our physicians, to our health care system and to the weak in this country. Think about the Pandora’s box you are opening here. Legalized assisted suicide in the end will not help those suffering, but will hurt them. It is a slippery slope and before you know it, the “suicide” will be without consent and/or will involve those who would otherwise have a bright future ahead.
I believe giving doctors the right to end life is putting the doctors on a slippery slope of being able to interfere and intervene in innocent patients’ rights to life. Our society has not improved on the Hippocratic oath of the past; it is showing it’s own depravity by taking life into its own hands. Let God be God even when we don’t understand why he allows suffering, and let us truly care for those who are sick instead of cheapening life by ending it when the going gets rough.
In this day and age of rights, why are some people’s rights more “right” than others? Why does a patient’s right to die, come before a doctor’s right to live by his/her conscience? Personally, I would feel safer in the care of a doctor who believes in doing no harm, than one who is willing to do something to help me die…I think going in the direction of physician assisted suicide is a mistake.
I just want to voice my opinion that I am against doctor assisted suicide and I want doctors who have moral convictions to have the freedom to deny assisted suicide and even the freedom to deny refering a patient to another doctor for assisted suicide.
Mankind is created in the image of God. We are not dogs that can be put down. This is a slippery slope. Don’t physicians swear an oath to do no harm. Then why kill people? This is outside of the job description. Doctors are not mercenaries.
I believe the effective referral of patients to other health care providers, infringes on the rights of physicians to decide the most effective treatment for patients in their care. Physicians should not be forced to chose between their moral and religious beliefs when providing care as I believe those are the basis of an effective treatment plan
I note from the Feb 6, 2015 Supreme Court of Canada ruling that: “The physician’s decision to participate in assisted dying is a matter of conscience and religious belief” (para. 132)
The CPSO should follow the intent of this ruling and not force physicians to extinguish their conscience to refer or perform procedures against their conscience.
I suggest that information on what procedures or treatments a physician does not perform be available on the CPSO public website. The public can then be free to choose physicians who provide the services that they need. This would respect a patient’s desire to have services they need and the conscience rights of the physician.
This information can be gathered from each physician on their annual CPSO license renewal with a new optional section that will be put verbatim on the CPSO website under that physician’s public information under the new heading “Practice restrictions”.
Please do not limit physicians Rights to Freedom of Conscience and Religion .
I am writing to express my opinion on this proposed policy. With the recent Supreme Court decision on physician assisted suicide the ground has shifted on us all. It is time that the CPSO rescinds this proposal and start over. It was one thing to sanction Catholic physicians for refusal to prescribe a morning after pill or refer for abortion, it is quite another to have our College and colleagues enforce state sanctioned violence towards patients. In our country, despite citizen’s differences on the morality of killing another in the time of war we still allowed for conscientious objectors. Ironically, many of those were allowed to serve as health care workers as an alternative. Now we are risking with this policy that those who have a pacifist position would be forced not just by patients but by our own College to put their professional status in jeopardy.
As an example, a physician working in a nursing home or as a director could be forced to choose between keeping his privileges or making referrals for assisted suicides/euthanasia for his patients if they were not willing to offer this “service”. I presently work in a Home for the Aged and this policy has weighed on my decision to continue to work in this field of practice.
Would I be disciplined if a depressed patient asked me to perform PAS and I declined? What if that same patient reminded me that their privacy rights forbade me from telling their family of their suicidal wish and I was willing to perform PAS? Would I be disciplined by the college when their family makes a complaint. Would I be disciplined for not putting a suicidal patient on a Form 1? What about an incapable patient who’s care giver wants to report me for not easing their loved one’s suffering ( no legal definition that is not subjective) by mercy killing?
Your policy as proposed is simply too dangerous to our profession and good care. It is time to take a step back and allow for the safeguards and legal opinions to be worked through rather than push through an agenda that seems poorly thought out.
Abortion, whether forced by an abortifacient pill or by surgical removal of the baby, is also “state-sanctioned violence”.
Please pass this message to:
College of Physicians and Surgeons of Ontario,
I, as a Christian Canadian, find it deplorable that
you are considering forcing Pro-Life doctors to perform abortions
or assisted suicide. They are CANADIAN and have a right to act according
to their consciences. They are not harming anyone. Punish them, for what?
STOP this insanity NOW, PLEASE!
Dear CPSO
I do not agree with the Professional Obligation and Human Rights policy. It impedes physician freedom of conscience. I live in Ontario and think that our physicians should be able to practice medicine in a conscientious manner. My daughter is a family physician and she should not be required to perform services or prescribe medications or make referrals that she does not morally agree with. Physicians are human beings too and their rights need to be protected as well. This does not mean that patient rights will be violated. Both physicians and patients’ rights can be protected.
To the College of Physicians
I agree that physicians should not discriminate against patients, but deciding not to offer certain services in no way discriminates against them. Requiring referrals or requiring doctors to participate in procedures (euthanesia) that go against their beliefs is according to me, not acceptable. The right of freedom of conscience and religion cannot be limited. The policy as is now may eliminate doctors from practice, reduce their sense of of integrity, or force them to leave Canada for a country where their beliefs can be respected. I suggest that the draft remove the articles referring to obligatory referrals or to limiting their freedom of conscience (religion). Physicians are called upon to heal not to harm.
Good evening,
I’m writing to indicate my concern regarding the CPSO’s current policy “Professional Obligations and Human Rights”. I do not feel that the draft as currently written adequately provides for physicians to follow their conscience rights while practicing medicine. I cannot see how obliging physicians to perform medical tasks that are against their own moral code of conduct will be helpful to society, or to our physician work force. Physicians should never work “mindlessly” – whether that be in the application of specialist guidelines, considering the suitability of further testing, or other matters of life and death.
We are privileged to come alongside our patients in providing care that does no harm, is not negligent, and serves their best interests. For myself, part of this high standard of medical practice necessarily involves moral decision-making regarding what is safest and best. This can be viewed as paternalistic or in opposition to patient-centred care, but I strongly feel that it is in fact what makes for excellent, caring physicians.
I do not have any interest in abusing the position of power and privilege that physicians occupy in the lives of their patients. I do wish for my patients to experience the best that medicine can offer, in a free and just society. I sincerely hope that the CPSO balances the rights of my patients to the care they deserve, with my right to practice in a manner that is internally consistent and holistic. It would be unconscionable for me to practice in any other manner.
I sincerely thank you for your consideration, and look forward to seeing further revision to the Professional Obligations and Human Rights policy that better balances the rights of physicians and patients in this challenging area of medical policy.
Dear Council Members,
Thank you for seeking public consultation on this very important proposed document. It is certainly true that physicians should not discriminate against patients or show partiality and differing care to different patients. Physicians should keep patient care as the highest priority.
The draft in its current state implies that physicians would be discriminating against some patients if physicians did not provide or refer for certain services due to moral or religious beliefs of the physician. However, such conscientious objections would not be discriminatory, because such services would not be provided to any patient of the physician. This is different than providing services at times to some individuals, but not to others, for reasons such as ethnicity. For example, as a restaurant owner, it is not discriminatory to own a restaurant and not serve pork to anyone, including someone who would request to eat pork, because as a restaurant owner your religious belief may preclude preparing and serving pork. This restaurant owner is not discriminating because he is not selectively choosing to serve pork to some, but not to other patrons.
To require a referral from the health care provider is just as morally convicting to the provider as performing the service, as the physician would be formally facilitating the treatment in conflict with his/her moral or religious beliefs. When a physician has the moral conviction that an abortion or physician-assisted suicide is the wrongful taking of human life, to refer for such is to be a complicit in this act.
The proposed policy will limit physicians’ freedom of conscience and religion as guaranteed in the Charter. Unfortunately, this document will fail to ensure that physicians perform their duties ethically, but instead, force physicians to perform or prescribe treatments against their moral and religious convictions or risk disciplinary action from the college because of their religious convictions. If this draft were to be approved in its current form it would place limitations on the freedom to practice religion, while also practicing medicine. For physicians who have religious convictions which preclude them from participating in abortion or physician-assisted suicide, this would force them to move their practice out of province or give up practicing medicine altogether.
Physicians have a right to freedom of religion as much as any other Canadian. A patient’s desire to access services such as abortion or physician-assisted suicide does not render a physician’s right to freedom of religion invalid.
As a governing college, we hope that you will protect the rights of the physicians you govern just as strongly as you protect the rights of the patients they serve.
Dear Members of the Consultations Committee:
Subject: Draft Policy “Professional Obligations and Human Rights”.
I am writing to express my grave concern regarding the content of your proposed draft policy. Sections 8, 10 and 11 indicate that should physicians decline to participate in certain acts for religious or moral belief, they will none-the-less be mandated to refer their patients to other physicians who will perform these acts. In compelling physicians to refer, you are limiting their right to conscientious objection.
Quality of patient care will be impacted should this draft policy be accepted without revision to the aforementioned sections. Physicians who feel forced to participate in procedures that go against their beliefs may experience burnout, suffer from a lack of integrity and may even decide to leave their practice. As a member of the public, I want to be served by physicians who are allowed to follow their conscience.
I strongly encourage you to revise the sections above, and include a clear defence of the right to freedom of conscience for all physicians.
Dear CPSO,
I am writing to you to express my concern over the CPSO’s recent draft policy entitled “Professional Obligations and Human Rights.” I think this policy, while sound in parts, is highly misguided in other respects. The major area of concern is the portion of the policy stating that physicians shall be “required to refer for procedures that are against their moral or religious convictions.”
Firstly, there is no need for this clause. Physicians in Ontario who have ethical objections to various medical acts have been getting along quite well with creative compromise solutions, as befits a tolerant, multi-cultural society. There should be room for a wide range of ethical opinions in the Ontario medical community.
Secondly, the clause likely violates the Canadian Charter of Rights and Freedoms, which names the freedom of conscience and religion as one of the paramount principles of Canadian law. The CMA itself recently asserted a physician’s right to conscientious objection. It is in fact abusive of the CPSO to suggest that all physicians must park their codes of ethics at the office door, and the proposed policy simply goes against all historical and legal precedent.
Finally, I note that the policy would impact patient care, make no mistake about it. If passed, and legislatively enforced, I know a number of physicians who will cease practice, move, or burn out due to the tension between personal beliefs and professional requirements.
In light of the above, I ask you to oppose or revise the CPSO’s draft policy.
Hello,
In accordance to the recent Supreme Court of Canada’s decision to move forward with the law of physician assisted suicide, I would like to write to you about my concerns. If possible, can the law be altered so the integrity and basic human rights of doctors who believe its immorally right to assist a patient with suicide, be excused or exempt from the practice without punishment by the facility.
Thank you for your consideration,
Please do not promote assisted suicide and abortions in our Canadian society. Keep our medical profession to save life and promote good morality. Doctors have values and morals.
Dear members of the CPSO,
I am very concerned about the proposed draft policy requiring physicians to violate their conscience and perform or refer patients for services to which they morally object. I believe that, if this policy would be put into place, some of our best and most caring physicians would be forced to move their practices or change careers. My own family doctor, who is an excellent and caring physician, would be forced to either go against her conscience (which is not an option for her) or close down her practice. As a patient, I sought her out specifically because I felt I could trust her, since I knew that her morals and views on certain issues were similar to mine.
Part of establishing trust in the doctor-patient relationship is knowing that the doctor truly cares about their patient’s well-being and that they would not recommend something that they believe would do more harm than good. If they were forced to perform or refer for something that they believed would gravely harm or kill a patient, how can they truly be caring and looking out for the patient’s welfare? And, if they were to do so anyway, they would tend to distance themselves from the patient and undoubtedly be suffering due to not being true to their own moral values. Physicians are, after all, citizens of this country, and should be able to practice medicine while still having their rights to freedom of conscience and religion respected.
Most physicians go into medicine in order to help people be as healthy as possible and to save lives. Performing abortions or euthanasia does not save lives, it only kills lives, and should not be required of anyone in the medical field who objects to it on moral grounds. Furthermore, for many physicians, referring to someone who would perform such a “service” would be like morally objecting to execute a patient, but sending the patient to be executed by a colleague instead. How could a physician who violates his conscience be trusted? Do not forget that physicians must first and foremost abide by the Hippocratic Oath, which is meant to represent their “selfless dedication to the preservation of human life” (University of Ottawa Faculty of Medicine website).
Forcing physicians to act against their conscience would discriminate against physicians who practice with integrity. I urge you to modify your drafted policy to allow Ontario physicians to practice according to their conscience, as well as remove the requirement to refer if it violates their conscience.
Dear Sirs:
As a family physician, having had licensure in MB, SK, and now AB at various times since 1996, it is with great concern that I learn of the proposed by-law introduced in ON.
While it is true that procedures and services such as abortion (and perhaps physician assisted suicide in the not to distant future) are legal and publicly funded, our profession must not force its members to violate conscience in the practice of medicine. It is one thing to say that the physician must notify the patient of all available options and to explain which ones the physician is comfortable providing. It is quite another to force the physician to be party to the provision of a service (whether by direct service or by referral with the expressed purpose of obtaining the same service) which to him/her is against personal moral conviction.
Such a regulation forces the physician to choose between continuing as a medical practitioner without any true moral convictions (after all, convictions that are compromised are not true convictions at all) or cease to practice medicine.
Is it the desire of the ON college to force its pro-life physicians to make this type of decision? If that is the case, then the message being sent is that truly pro-life doctors (or prospective students of medicine) are not welcome in Ontario.
I would propose an alternative: if the doctor is unable for reasons of conscience to provide a service, he/she would provide the name of a doctor or office that is taking new patients (which may be a walk-in clinic) so as to seek that type of service. In the words of one of my former medical school professors “The patient is not powerless–he/she did come here!” Alternatively (especially in the case of a hospitalized patient), the care of the patient could be transferred to another doctor.
Whatever the solution (the above suggestions are only two possibilities), one must not be forced to violate conscience and break the oath taken which says:
“Nor shall any man’s entreaty prevail upon me to administer poison to anyone; neither will I counsel any man to do so. Moreover, I will get no sort of medicine to any pregnant woman, with a view to destroy the child.
Further, I will comport myself and use my knowledge in a godly manner.”
Good evening. I write to you to object to the draft policy being proposed for permanency by the College of Physicians and Surgeons of Ontario (CPSO) entitled “Professional Obligations and Human Rights”.
Sections 8, 10 and 11 suggest that physicians who decline to participate in certain acts for reasons of conscience should be compelled to refer their patients to other physicians who will perform these acts. It does not address the fact that many of these same physicians will find the act of referral itself objectionable, as they consider it material cooperation with the act. In compelling physicians to refer, you are limiting their right to conscientious objection.
You state that physicians Rights and Freedoms under the Charter for rejecting morally and religiously objectionable procedures will be subject to a courts ruling on “trivial nature” and “substantiates” (line 125-126, draft policy). Your corollary, implied in line 128, that the physicians Rights would therefore, possibly, not be protected is incredibly flawed: you are passing judgement on such morally and religiously reprehensible procedures as being trivial. That is not for the CPSO to decide, as you state in line 76-77, or lines 82 and 84. Citing applicable law (footnote 13) only supports the nature of the courts to decide, not the CPSO. It is expected (certainly my opinion) that morally and religiously reprehensible procedures will NOT be considered trivial or insubstantial by the courts. Abortion, early end-of-life and birth control procedures certainly have not been treated trivially in the past.
If equitable “care” is the goal, then questionable and morally/religiously reprehensible procedures does not fit the definition of “care”. The word “care” implies “healing”. By that logic, such morally/religiously reprehensible procedures should not be subject to the physicians responsibility to provide “care”.
Dear Sirs/Madams,
When I graduated we repeated a version of the Hippocratic Oath. When my daughter graduated a year ago, she did as well, and any physicians looking on were invited to join in. My understanding of both versions was that I would not knowingly do harm to a patient. As a practitioner who tries to consider the physical, psychological, and existential (spiritual) health of patients, I would not want to be made part of actions that could cause harm in any of those areas.
I hope that the College of Physicians and Surgeons of Ontario will not ask physicians to retract oaths made in good faith, nor to violate conscience, nor to tread on their protected rights of freedom of religion as they practice with personal integrity to the best of their abilities.
As something more than a promise, an oath cannot be retracted. The taker of an oath calls on God as witness to punish him with any curses made in the oath if he breaks it. I took an oath when I married to always be faithful to my wife. She made a similar oath.
To whom it may concern,
Although I understand your desire to give all patients equal access to all health care services in order to uphold their human rights, it cannot be done at the expense of the doctor’s rights and freedoms. I refer in specific to doctors being required by law to refer for abortion, birth control or any other service that is in direct opposition to their religious beliefs.
A doctor takes an oath to “do no harm” and to refer for an abortion is harming, nay killing a human being, a patient under the doctor’s care (when a pregnant mother comes in the doctor is serving two patients). To force that doctor to go against his or her conscience is to take away their freedom of religious belief and to undermine the Hippocratic Oath taken by the same.
Please do not violate one person’s human rights in order to accommodate that of another.
Physicians should have the right to say no to providing certain forms of treatment. However, I’m particularly concerned with the requirement that physicians provide referrals for treatments which they feel are morally and ethically wrong. If a physician feels a treatment is morally and ethically wrong, then aren’t they still violating their conscience by asking someone else to perform the procedure? How is the physician’s right to freedom of conscience being protected under these circumstances? In addition to this, a physician might feel that if a procedure is morally wrong it would also be harmful to the patient. Under these circumstances the physician would be violating not only their conscience but also their hippocratic oath by referring the patient to someone else to perform the procedure.
Effective referral violates physician,s rights .
Stop with opretopns of moral citizens . Enough.
I am writing to you with grave concern regarding the content of your proposed draft
policy. Sections 8, 10 and 11 suggest that physicians who decline to participate in certain
acts for reasons of conscience should be compelled to refer their patients to other
physicians who will perform these acts. It does not address the fact that many of these
same physicians will find the act of referral itself objectionable, as they consider it
material cooperation with the act. In compelling physicians to refer, you are limiting their
right to conscientious objection. You are insisting that they be complicit in murder.
There is significant disagreement in our society as to what constitutes a moral act, and I
do not expect the College to define or limit morality. All I expect is that physicians, as
professionals, be allowed to respect their own consciences. Freedom of conscience is
foundational to our free society and cannot be limited, even for the best of intentions. If
we coerce physicians into violating their consciences we will inevitably erode the
personal integrity which is the basis of the physician’s relationship with their patients.
I encourage you to revise the sections above, and include a clear defence of the right to
freedom of conscience for all physicians.
I recall when we were promised that no one would be forced to work on Sunday’s.
Obviously, the reality is different. Just one example of many consequences to what was
thought to be a good thing by some. This action follows the same course. Do not limit a
doctor’s right to act morally.
It is a disservice to society. You will ultimately cause the loss of many more good doctors
from choosing this career.
This is to inform the .CPSO that I reject the proposal by the College of Physicians and Surgeons of Ontario and anywhere else “Where physicians are unwilling to provide certain elements of care due to their moral or religious beliefs, an effective refe…
To Whom It May Concern:
I write this with regard to the proposed Professional Obligations and Human Rights policy. I write this in the context of being a rural family physician, who also practices in rural emergency departments, and has significant concerns about the draft policy.
First, let me state that I understand the importance of respecting the rights of patients. However, designating certain things as ‘rights’ places a corresponding ‘duty’ on another party, in this case the physician.
I also understand the concerns about avoiding discrimination. Discrimination on inappropriate grounds should absolutely be avoided. However, there are two points I would make. First, not all ‘discrimination’ is bad – I ‘discriminate’ on the basis of sex when I don’t offer my female patients PSA testing, or my male patients Pap tests. This ‘discrimination’ is better known as clinical judgment, and I feel it blurs discussions to simplify it to “Discrimination is bad.” Second, there is a difference between discriminating against a patient and discriminating against a procedure. Not offering a particular treatment or procedure to any patient is actually treating them all equally, the opposite of discrimination. For example, the clinic where I currently work has a policy of “No medical marijuana.” This is discriminating against medical marijuana, not against chronic pain patients, even though this is who it potentially affects. Under this new policy, a patient to whom I refuse to prescribe medical marijuana could potentially argue that I am discriminating against him or her on the basis of ‘chronic pain disability’ by not providing a legalized medical service – does this not contradict your own policies (at least as of 2006, the most recent policy on the website) that a physician is not obligated to support a patient’s request for medical marijuana?
I read the letter you submitted to the National Post dated January 23, 2015 regarding this policy where you stated a spokesperson was misquoted as saying “Physicians unwilling to provide or facilitate abortion for reasons of conscience should not be family physicians”, and clarified that a physician is instead expected to provide an “effective referral”, defined as “one that is made in good faith, to a non-objecting, available and accessible physician or other health care provider.” While I accept your spokesperson did not state the original quotation, I would appreciate your definition of ‘facilitate’ as the definition of ‘effective referral’ seems to be exactly that. Therefore, if a physicians is unwilling for moral or ethical reasons to provide an ‘effective referral’ for abortion, i.e. facilitate an abortion, it seems under this policy that the physicians is in fact in the wrong profession, as they are not able to fulfill their ‘duty’ to fulfill another’s ‘rights’. It seems to me the statement was accurate, though the attribution was not.
I also have no doubt that you are aware of the recent Supreme Court judgment striking down legal prohibitions to “physician-assisted dying”. The concerns of the above paragraph apply in the same way to this issue. In addition, section iii. Protecting Patient Safety raises another concern in the context of euthanasia. “Physicians must provide care that is urgent or otherwise necessary to prevent imminent harm, suffering, and/or deterioration, even where that care conflicts with their religious or moral beliefs.” As I previously stated, I work in rural emergency departments. If a competent adult arrives in my department who“has a grievous and irremediable medical condition (including an illness, disease or disability) that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition” (per paragraph 127 of the judgment), and is presenting for the reason of the intolerable suffering, no matter my moral stance on the matter, it could be reasonably interpreted that I would be required not only to present euthanasia as a legitimate medical option, but potentially be required to administer such to prevent “imminent… suffering”.
In other words, does this policy require that I be prepared to offer to kill and to actively kill my patients, should they so choose? I did not enter medicine to kill people.
There used to be another policy of sorts in medicine. It was called the Hippocratic Oath. It read in part, “I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan; and similarly I will not give a woman a pessary to cause an abortion.” It seems that any physician who adheres to the statements of the Hippocratic Oath will be placing themselves in professional jeopardy under the proposed policy.
If it is not yet clear, I am opposed to abortion and euthanasia. Should this policy be passed, I will be in a difficult position with limited options. The first would be to completely change my scope of practice to remove myself from the possibility of being forced into an immoral and unethical position. This would mean ceasing to practice as a family physician and emergency room physician – and this would be a loss of a much needed (and greatly appreciated according to my patients and colleagues) rural physician. Alternatively, I could move to a different jurisdiction that does not mandate participation in such acts, so while the profession as a whole would not suffer the loss, Ontario still would. Or I could cease to practice as a physician altogether.
I would prefer to not be forced into making one of those choices. I also suspect I would not be the only physician taking one of those options. Just because something is legal does not make it moral or ethical, as history easily shows – I think it very unwise to force out physicians who are willing to take a stand.
I hope you take these thoughts under consideration and make substantial revisions to your draft policy prior to considering it for adoption. Thank you for taking the time to read this letter.
Excellent letter! Here is my attempt to list its main points:
(1) Granting the patient a right imposes a corresponding duty on the physician.
(2) Clinical judgement or discrimination on appropriate grounds is good and right.
(3) Discriminating against a procedure is the opposite of discriminating against a patient. At least as recently as 2006 CPSO had a policy allowing discrimination against medical marijuana. Because the new policy fails to recognize the distinction (discriminate between) a patient and a procedure, it will actually promote discrimination against the patient.
(4) The new policy limits freedom of conscience. It requires, at the minimum, effective referral. Effectively referring for abortion is facilitating it. By implication–despite CPSO’s refusal to make the connection–physicians unwilling to provide or facilitate abortion for reasons of conscience should not be family physicians.
(5) The new policy limiting freedom of conscience requires care necessary to prevent imminent suffering. The Supreme Court recently made euthanasia valid care. By implication, physicians unwilling to offer or perform euthanasia for reasons of conscience to any competent adult fearful of intolerable suffering should not staff emergency departments.
(6) Some doctors entered the medical profession before it required them to potentially kill people. In fact, they took the Hippocratic Oath and swore that as good physicians they would not force or facilitate abortions, nor would they offer or perform euthanasia.
(7) This new policy forces a significant number of much needed and greatly appreciated physicians to quit their practice, completely change its scope, or move it outside Ontario.
To whom it may concern:
With respect to your forthcoming “Professional Obligations and Human Rights” policy revision, please respect and affirm the personal integrity , professionalism, dignity, and freedom of conscience of the fine physicians in this province by not forcing any of them to be complicit in procedures that they deem to be in conflict with their moral or religious beliefs. Given the recent Supreme Court ruling on Doctor assisted suicide, we need now more than ever, Medical Doctors who will stand by their moral convictions and with integrity affirm the constituent adage of doing “No Harm”. Please do not attack or trample upon their rights by trying to expunge or limit their moral integrity. They are professionals and we implicitly trust them.
Dear CPSO, concerning the Draft Document on Obligations and Human Rights.
On the two main changes they wish to make………. interpretation of discrimination,
and refusal to treat patients on personal beliefs.
Please recognize that there should always be a balancing of rights. Both patient and physician rights always be respected; accommodation should not be one way!
A physician should never be compelled to act against rational conscience decisions, and that compulsion goes against [ Charter and Human rights.]
I thank the CPSO for being opened to consultation with the public [ I being one of them]
mother,grandmother,and retired HCA.
P.S. Rights themselves should never be limited to a one sided manner in favor of the patient. Both patient and physician should have protection! Personal beliefs and moral stances or “informed conscience”
are not in the same category. Beliefs should not be used in policy documents it is inadequate.
thank you again for hearing my input!
Dear members of the College of Physicians and Surgeons of Ontario,
I support you in your retaining your right to refuse to provide procedures or treatments that violate your moral of religious beliefs WITHOUT being required to provide effective or any other referral to your patients in these instances.
Thank you for this opportunity to provide our input. I believe that we submitted our concerns in 2012. We appreciate that the college accepts existing Charter of rights of freedom of religion and conscience and urge you to maintain this moral stance. Moral stances based on conscience are rational and evidence-based, often reinforced by religious beliefs and deserve protection. As Canadians who live under the Canadian Charter, the United Nations’ Universal Declaration of Human Rights, Article 1 states “All human beings are born free and equal in dignity and rights. They are endowed with reason and conscience and should act towards one another in a spirit of brotherhood”. There should always be a balancing of rights, but we request that both the patient and the physicians rights be respected, accommodation should not be one way. A physician should never be compelled to act against rational conscience decisions, and that compulsion goes against Charter and human rights. We believe that a physician that refuses to provide or perform some procedures is not discriminatory when it is based on a properly informed conscience: that has nothing to do with the patient requesting a procedure, and everything to do with the physician’s decision about the wrongness of those procedures.
Thanks again for allowing us to submit our concerns. We do not want Ontario or Canada to lose doctors because they are being forced to go against their conscience and/or religious beliefs.
I have read the Draft policy of the CPSO – Professional Obligations and Human Rights.
I am concerned in general with the section beginning on page four and continuing to the end of the document dealing with the moral and religious beliefs of physicians.
I wonder when I read that “The right to freedom of conscience and religion can be limited, as necessary, to protect … health, morals, or the fundamental rights and freedoms of others.” how these things will be or are defined? Or should I ask who will define these things: health, morals, rights and freedoms? When these definitions differ between patient and physician I fear there is not much chance that a physicians conscience will be honoured.
More specifically I am concerned with the “effective referral”. If a physicain is obligated to refer to a non-objecting colleague and the eventual outcome of that referral is the very result he or she cannot by conscience provide how is that different from providing the service directly? The referring physcians will still feel that they have participated in the process and not had a true opportunity to maintain their conviction of conscience. This is not really a protection of the doctor’s right to freedom of conscience or religion. Will we lose good, conscientious, caring physians because they are oblgated to act against their consciences and provide or assist through referrals in providing clinical options that they deem inappropriate?
I appreciate the opportunity to express these views and concerns.
To Whom It May Concern
I am writing to plead with you to NOT take away the conscience rights of physicians.
In your list of principles you state that the patient’s best interests must remain paramount. You must realize that the doctor may have the patients best interests at heart when refusing for instance to prescribe birth control; refer for abortion or to kill them (assisted suicide). There are many risks in taking birth control pills. Abortion kills an unborn child and harms the mother (I personally know of 3 such situations where the mothers regretted their abortion and attempted suicide). And forcing doctors to kill their patients or refer them to be killed is barbaric. None of these situations are in the best interest of the patient, even if the patient may think so at the time.
Once again, I beg you, reconsider!
Dear Sir Madam,
I do not believe that the policy addresses the freedom of conscience issue. It seems to deny a physician the right to the exercise of this freedom guaranteed under the charter. A physician is forced to act against his conscience, which is much more than simple “ moral believes”. In today’s world of technology and new methods of communication, there are more than one way to accommodate a divergent positions without initiating conflict between all parties involved.In my opinion, it is not acceptable as it stands, especially when a euthanasia debate has been opened .
Greetings,
I’d simply like to add my voice to the voices of those who defend the right of a physician to follow her/his conscience when asked to provide a referral in the case of a request for an abortion or an assisted suicide. He/she should not be required by law, to provide such a referral if it goes against his/her convictions.
To Whom it may Concern:
I am writing you to express my outrage over the decision to not allow doctor’s to practice medicine according to their consciences. I am very happy to say that I have a family doctor who is currently practicing medicine according to our (his and my) Catholic faith. I choose him as my doctor for this reason, I DO NOT WHAT TO BE FORCED into a decision that would kill me or an unborn baby in my womb. I hope that you listen to my concerns and the concerns of the majority of Canadians living in Ontario and Saskatchewan.
Dear CPSO,
I endorse your stance that freedom of conscience must be supported in Canada.
Good luck.
The substance of their policy under consideration here is actually rejection of freedom of conscience.
I thank the College for allowing public consultation on this important policy, and I appreciate that the College accepts existing Charter right of freedom of religion and conscience. I strongly urge the College to maintain this moral stance.
Moral stances based on conscience are rational and evidence-based, often reinforced by religious beliefs, and deserve protection.
It should be noted that there is inclusion of freedom of religion and conscience rights in other documents, and that Canadian document should do the same. (Cf., Canadian Charter; The United Nations’ Universal Declaration of Human Rights, Article 1 states: “All human beings are born free and equal in dignity and rights. They are endowed with reason and conscience and should act towards one another in a spirit of brother hood.”(sic)
It is important that there is a balance of rights and both the rights of the patient and physician should be respected; accommodation should not be only one way. The physician should never be compelled to act against rational conscience decisions and any compulsion goes against the Charter and human rights.
Finally, I point to the fact that refusing to provide or perform some procedures is not discriminatory when it is based on a properly informed conscience: this has nothing to do with the patient requesting a procedure and everything to do with the physician’s decision about the wrongness of those.
Thanks you for your attention to this urgent message
As a professional organization, your proposal to force physicians to participate in assisted suicides is repugnant. Freedom of conscience in this matter ensures that patients receive the best care; that those who agree with assisted suicide can administer this service in a caring manner, leaving those who don’t to focus on helping patients in other ways. You are not a Walmart, but rather, a professional organization helping its members. Forcing compliance is not helping; its a cop out.
Doctors should not be compelled to do procedures or refer to Doctors who will do procedures which go against their conscience.
Patients are often referred by Physicians for “second opinions” when either a serious operation is needed or a certain form of treatment is being considered. I believe that the CPSO has to consider the patient first. While I accept that my physician may have a moral or religious reason for refusing their service that should not preclude me, the patient, from receiving the treatment. Whether my physician refers me to a colleague, or whether my physician agrees to provide the service themselves,the result is the same. As such, I am in full agreement with the CPSO. As a patient, I should never have to worry that my care may be compromised by a physician with their moral or religious issues.
EX 20:13 YOU SHALL NOT MURDER
I believe to take away a doctor`s right to say no is discrimination here in Canada. Doctors have the right to exercise their conscience not just patients.
Many are “for life“. You would be forcing doctors to accessory to murder against their will pure and simple.
This policy should be abolished.
Dear Members of the Consultations Committee:
I am a health professional with forty years of experience across the life span inclusive of providing extensive maternity care and also end of life care for many elderly and vulnerable individuals. I have reviewed your proposed CPSO policy titled “Professional Obligations and Human Rights” and am strongly opposed to the planned changes for the following reasons:
First, physicians who decline to participate in certain acts make these decisions based on carefully and rationally formed conscience. This has an honourable medical history going back 2400 years to the School of Hippocrates whose members chose to act unselfishly and only in the interest of the patient and his/her well-being. Such a code of professional ethics & morality encompasses a physician’s entire being inclusive of religious beliefs but not exclusive to them. To refer to this as “personal beliefs” trivialises and makes matters
of conscience and religion into something highly subjective or arbitrary. It should not be the role of the college to create policy that defines or limits morality.
Second, referral to other physicians who will perform the act(s) ignores the fact that these same physicians will consider the act of referral as material cooperation with the act. As an example, would you expect a physician to refer a female infant to a surgeon to perform genital mutilation at the request of the parents? How would you care for that referring physician who had overridden his own conscience at the College’s coercion? How can the college insist on a referral policy that not only limits physicians’ rights to conscientious objection but could also risk their psycho-social & spiritual well being?
Third, although this policy “Professional Obligations and Human Rights” refers to ‘care’ 13 times in the document, healthcare 6 times and health services 8 times, it is important to note the following:
i) By the definitions of both ‘care’ and ‘health’, the physician’s response of declining to provide treatments resulting in death would not constitute ‘impeding’ that individual’s ‘access to health care or health service’.
ii) Similarly, the physician who might attempt to act according to this new policy and follows through with requested treatments such as a lethal dose, in fact denies the individual who requests such treatment access to good care. The physician providing good ‘care’ on the other hand, would not only address physical need for effective pain control but would also assist individuals to find meaning at their ‘End of Life’ and allow them to experience compassionate holistic care.
I hope that it is not the intent of the college to revise policy such that it would interfere with the physician’s professional duty to accommodate each person through the provision of quality care addressing all dimensions of health.
I trust that the college will withdraw this draft of the policy now that it has a clearer understanding that physicians, as professionals must be allowed to respect their own consciences. Freedom of conscience is foundational to our professional ethical practice and indeed our free society and cannot be limited, even for the best of intentions.
Thank you in advance for responding to my serious concerns by letting me know that you will not implement these proposed changes to the policy.
Dear Members of the Consultations Committee:
Subject: Draft Policy “Professional Obligations and Human Rights”
Freedom of conscience and religion are fundamental rights that are guaranteed for all Canadians under the Charter of Rights and Freedoms. This, of course, applies to physicians. In particular, physicians must have the right to decline providing certain elements of care that conflict with their moral or religious beliefs. As the body that regulates the practice of medicine in Ontario, the College of Physicians and Surgeons of Ontario has the duty and responsibility to ensure that physicians’ freedoms of conscience and religion are protected.
It is for this reason that I am deeply troubled by your draft policy titled “Professional Obligations and Human Rights.” Lines 156-159 suggest that physicians who choose not to provide certain elements of care must actively refer their patients to health care providers that will provide these services. However, I believe that many physicians will view this act of referral as a form of cooperation with the element of care that they do not support in conscience. This will certainly be the case for a Catholic physician – I can attest to this as a Catholic myself. For example, both prescribing a patient contraceptives and referring a patient to another physician who will prescribe contraceptives are equally against Catholic teaching and are considered by Catholics to be gravely immoral. Forcing this physician to perform such a referral is, in effect, forcing the physician to violate his or her conscience. This is clearly unacceptable. In our democratic and multicultural society, freedom of conscience is an essential right that must be protected.
I urge you to modify this section of your draft policy so that the Charter rights of all physicians will be protected.
Dear Sir/Madam:
I am deeply concerned by this ruling of the Supreme Court of Canada which now allows physician-assisted suicide in this country. I do not think that doctors who in conscience believe they can have no part in this should be mandated to participate in any way; not even to having to refer for it. Therefore I reject the proposal for an “effective referral” mandate.
To Whom It May Concern
I am sending this letter in support of the Catholic Physicians ‘charter of freedom of conscience and religion who should be allowed to make their own decisions reflecting their moral & religious beliefs.
The proposed document “Where physicians are unwilling to provide certain elements of care due to their moral or religious beliefs, an effective referral to another health care provider must be provided to the patient.” Is a violation of a physician’s rights as it compels the physician to violate his or her own conscience by being a participant in the very act the very procedure to which he or she objects in the first place.
Any citizen in this country should be allowed to practise their beliefs. And retain their Civil Rights. What the CPSO is proposing is nothing short of dictatorship and should not be allowed to go through.
To Whom It May Concern,
I am writing to express my deep concern over and strong opposition to the Professional Obligations and Human Rights draft that is being considered for approval. This policy violates and tramples the rights of physicians with moral or religious convictions. Physicians ought to be able to perform their profession according to their convictions under Canada’s Bill of Rights which allows freedom of religion. In granting freedom of religion to physicians, this does in no way trample the rights of the patient. It is the duty of the patient to find another individual who will do what they ask. The physician ought not to do what is against his convictions, neither ought he/she to recommend someone else who will perform the controversial procedure.
Thank you for taking time to read my feedback!
To the College and its colleagues:
The parish bullein’s request to protest the “effective referral” idea by the College of Physicians and Surgeons of Ontario strikes me as so shortsighted that I am indeed writing–to support CPSO.
While there are always some people willing to go to the wall for whatever principle they regard as “sacred,” most people search for ways to accomodate each other.
When some are advocating that doctors and other health professionals–who are paid from the public purse–be prohibitted from exercising any moral stand in their work, the proposal by the College is a reasonable compromise. “Compromise with evil” is not really laudable, but reality is generally not black-and-white. Canada exists because rabid Protestant and Catholic rivalries were put aside: it was better to “hang together than to hang apart” vis-à-vis a bellicose U.S.A. after their Civil War.
During the ascendancy of communism and fascism, Pope Pius XI said he’d make an agreement with the Devil for the good of the Church. After pondering this disturbing quote, I realized that Vatican City State exists because of the Lateran Treaty, while Il Duce’s regime is long gone. Yes, Cardinal Mindszenty left Budapest, but the Communists aren’t ruling there either. Now there are other “democratic” autocrats drooling for power–but that’s a separate problem.
There will always be demand for immoral and unsavoury things. And others who are willing to supply them. It will ever be thus, so pick your battles sensibly.
The effort by the College of Physicians and Surgeons should be praised and supported. If one can think of a way of improving it, then build on this foundation and move to something better.
Did you ever learn your catechism?
I’m a Protestant, and my church’s catechism is very clear (see my emphasis in upper case below) that referral for abortion or euthanasia is a form of murder. We use the Heidelberg Catechism, which was written in 1563.
Question 105: What does God require in the sixth commandment?
Answer: I am not to dishonour, hate, injure, or kill my neighbour by thoughts, words, or gestures, and much less by deeds, whether personally OR THROUGH ANOTHER; rather, I am to put away all desire of revenge. Moreover, I am not to harm or recklessly endanger myself. Therefore, also, the government bears the sword to prevent murder.
Dear Sir/Madam,
I would like to respectfully state my opposition to the implementation of the following measure outlined in the CPSO draft policy:
“As part of ensuring access to care for patients, the draft policy requires that physicians, who are unwilling to provide certain elements of care due to their moral or religious beliefs, refer the patient to another health-care provider.”
My opposition to the proposed changes does not intend to address the ethics of the specific interventions the policy would be likely to address (e.g.: contraception, abortion, technology assisted reproduction and other biotechnological interventions for which there is room for reasoned disagreement). Instead, I would like, to propose that moral principles, informed by religious or philosophical considerations, cannot be separated from other factors involved in a professional decision, specifically in the practice of medicine, without compromising its integrity.
A few practical examples will illustrate my position:
1) A patients with a viral illness insists in requesting a prescription for an antibiotic, even after he has provided with a clear explanations to why this is not indicated. The physician, faced with a full waiting room with other acutely ill patients, will have to decide whether to accommodate the patient wishes, perhaps reasoning that the risk of adverse effects is low, or that the patient will probably obtain a prescription from an other practitioner if refused. On the other hand he might decide to spend additional time to counsel and educate, or as a third option to simply deny the patient his request.
2) A consultant on duty in a hospital department is called at 2 am about an acutely ill patient. He will have to decide, whether to provide a consultation over the phone, or undertake a trip to the hospital, with the prospect of an intense and demanding full day of work starting later on the same morning. His decision will be made both taking into account clinical and ethical considerations, and will reflect his moral commitment to the welfare of his patient, countered by a feeling of exhaustion from overwork.
3) A female patient requests a prescription for the birth control pill for the purpose of contraception. The physician may have considered that cooperation with this cultural practice, currently highly prevalent in western societies, justifies the potential adverse effect of hormonal treatment, and that, as long as the risks have been clearly explained, following the patient’s wishes and the generally accepted standards of practice exonerate him from further responsibility. He may also feel that the treatment will provide the patient with real social benefits, basing his opinion on a broad societal consensus on this issue. An other practitioner might consider the lack of objective evidence for the benefits of contraception in the professional literature, and that contraception does not prevent a pathological condition, but disrupts a healthy physiological process. He regards societal consensus with skepticism, and concludes that the uncommon, but potentially serious and well documented adverse effects of hormonal treatment are not justified, in this case, by substantial benefits.
4) A generally healthy patient in the first trimester of an unintended pregnancy requests a referral for an induced abortion because of personal reasons. The physician might find this practice acceptable on the ground of wider social acceptance, or act on the conviction (of broadly philosophical, ethical, and political nature), that abortions on demand are in fact essential medical services resulting in a benefit for the patient. He may be of the view that a physician is not just a healer, but an enabler of his clients’ autonomous decision. An other physician would decide that he cannot honestly identify to the best of knowledge any possible benefits for this procedure carried out on a healthy women with a normal pregnancy. He would consider that adverse emotional consequences are well documented in women who have undergone abortions, that there are risks inherent to any surgical procedure, and that irreversible, definitive and deliberate harm would be inflicted on the embryo or foetus, whom the physician understands to be a human being in an early stage of development. As a healer, committed to do no harm, he must decline to provide this service. Referral to an other physician would constitute aiding and abetting a harmful (if not currently illegal) intervention.
The issues in the first two examples are straight forward and uncontroversial, yet any practicing physician will have experienced at one point the conflictual aspects of the described scenarios. The two examples that follow, on the other hand, are likely to trigger heated discussions among health care professionals. In all four examples, the physician bases his decision on scientific knowledge, clinical judgment, his evaluation of risks versus benefits, his understanding of his professional role, and the ethical standards he is obliged to adhere to as the member of a profession. I hope this is helpful to illustrate how scientific knowledge, clinical skills, evaluation of risks and benefits, and evaluative judgment based on moral considerations (appropriately referred to as “conscience” whether or not they are informed by philosophical or religious principles) cannot in fact be separated. This is an essential characteristic of any professional practice, especially within the liberal arts. The practitioner has a duty to educate, direct, enhance the freedom and promote the flourishing of his patient in the context of a relationship based on trust and reciprocal respect between equals, rather then simply providing skills or technical know-how in a subordinate role and in response to a customer’s request.
But ignoring the importance of the free exercise of conscience in professional practice has even broader societal and political implications, and I would like to point this out with the help of the following anecdote.
My grandfather practiced neuropsychiatry in Germany in the 1930′s. When the government introduced a program of involuntary euthanasia directed at the disabled and the mentally ill, he resigned his position as a consultant to avoid participating in the terminations. His decision was principled, though economically and professionally ruinous, but he could not prevent the death of thousands. Where were his colleagues at that crucial moment? Why was there no organised refusal to comply with institutional directives, at least by those members of the medical profession who opposed them in principle? How could these policies have been introduced in a country which only a few years before could be counted among the civilised nations? Why did they not follow their conscience and act accordingly? Many lives might have been protected, and later even more iniquitous developments perhaps mitigated. The dignity of our profession would certainly have been upheld.
We are fortunate to live in less troubled times, in a country where the regime does not ruthlessly pursue the interests of a particular group, or affirm the triumph of the individual will at the price of human decency and compassion. The following questions, nonetheless, address core issues in our professional practice here and now:
How will the doctor-patient relationship be affected if physicians are in a position to be disciplined by their own professional body for following their better judgment?
How can trust be maintained within a relationship that is inherently and deeply personal, when the physician is expected to rigidly follow institutional guidelines?
To whom will a patient, by definition a person in distress, turn when he is seeking a healing relationship?
Are we as physicians to continue in our role as professionals, as healers, as practitioners of a liberal art, or become technicians, biotechnology providers, enablers?
In which role are we more likely to serve the best interest of both the individual and of society?
An insightful and edifying piece. Glad I took time to read it.
Thank you, Doctor, for explaining why we must keep in mind that ‘scientific knowledge, clinical skills, evaluation of risks and benefits, and evaluative judgment based on moral considerations (appropriately referred to as “conscience” whether or not they are informed by philosophical or religious principles) cannot in fact be separated.’
We would all do well to ponder seriously the list of questions at the end.
To Whom It May Concern,
First off, I would like to thank you for the work you have done striving for enhanced patient care and the desire to respect patients’ rights.
Upon reviewing the CPSO’s recent Profession Obligations and Human Rights policy, I would like to share my sincere concern over what is written in this policy. I have listed my concerns with explanations below. I hope you will consider my arguments and revise the policy.
1) Requirement to refer when it goes against your moral or religious beliefs
Lines 156-8 of the policy have serious flaws that require attention. There are multiple issues with the clause based on philosophical and legal frameworks.
Philosophically, the policy has not defined what it means by ‘moral’ or ‘religious’ beliefs. Does this statement mean that any decision made with a moral framework is incorrect or ‘wrong’? Patients expect physicians to practice with moral integrity; shouldn’t the college expect the same from it’s members? Hence, practising medicine without moral integrity is not only concerning, but a slippery slope that would lead to more patient harm. Secondly, why does this policy stipulate those with religious beliefs? Why not stipulate anyone making a decision based upon world views instead? For a religious belief is a worldview just as trying to not be religious is a worldview i.e. atheism. This clause on a philosophical level fails to appreciate how it’s not morals or religious beliefs that determine decisions, but rather world views.
On a legal framework, this is likely the greatest concern. First off, there is no human right in Canada that demands someone to receive a particular service from a specific physician. In fact, The Ontario Human Rights Code prohibits discrimination against others based upon race, ethnicity, sex, sexual orientation, age or disability. However, it is important to understand this means a service can not be provided to one group and excluded from another. For example, a restaurant owner choosing to not offer pork due to a religious belief is not a violation because it does not dictate the service to be provided but rather to whom; either to all or none. Likewise, a physician choosing to not offer a particular procedure or treatment for moral or religious beliefs is not discrimination as long as it’s denied to all and not selectively permitted for certain groups. Hence, the reference in this policy shows that whoever wrote this clause does not understand the application of The Ontario Human Rights Code.
Moreover, federal law guarantees by the Charter of Rights and Freedoms that a person, including physicians, have protected rights that are fundamental. Those rights are free from coercion to act against moral or religious convictions that a citizen possesses (section 2 of the Charter). In fact, this policy also discriminates against physicians’ right to freedom of conscience. This policy is forcing physicians to refer a patient for a procedure he or she believes based on moral, religious and/or medical reasons to be harmful and in doing so would make them morally culpable; this fact is supported by case law. For example, if an accused individual refers a person to a narcotics dealer then the accused is also guilty of trafficking narcotics. Likewise, if a physician has moral or religious convictions that abortion or euthanasia is taking of an innocent life, then the physician who formally refers the patient to be euthanized or aborted then they would have contributed to taking that life. Forcing physicians to act against their conscience, moral or religious beliefs goes directly against the Charter’s protection of fundamental rights of conscience and religion. This section of the policy is a textbook example of systematically trying to disqualify physicians based on religious or moral beliefs. That is the definition of discrimination and appropriate application of The Ontario Human Rights Code. This policy has the appearance of attempting to alienate fellow colleagues from the profession based on a discriminatory effort to promote a worldview which has medicine devoid of morals or religious beliefs. That attempt would be a clear violation of The Charter of Rights and Freedoms.
Unfortunately, this policy also has the appearance of trying not to ensure physicians comply with legal obligations, but rather to compel and even drive physicians out of the medical profession that disagree with the means or ends certain procedures or medications achieve. In fact, I am concerned that this policy actually harms patient care by alienating physicians who practice with moral integrity and hinder patients who wish to be treated by them.
2) Perform procedures even when against beliefs if “urgent”
Line 168 of the policy implies physicians’ right to freedom of conscience is conditional based on the patient’s “urgent” need. There is an essential question the CPSO must answer, do you want physicians to practice with moral integrity or not? If yes, then such a clause is unjustified and absurd to want physicians to have integrity yet go against their moral compass. However, if you say no, then in fact research and epistemology into what makes us human is lost, which is the ability to make moral decisions. By the CPSO removing moral decision making they would have essentially removed that which makes physicians human. Patients want compassionate medical experts, not inhumane machines dictating their medical care.
Lastly, who determines what is “urgent”? The patient or physician? Would urgent assume only if life threatening? There needs to be definitions given or else this is left up to the individual which may lead to more harm than good.
Overall, I urge the CPSO to remove this clause.
3) Not allowed to promote religious beliefs
Line 146-8 is not as serious as my other points, however this clause indicates a double standard. Why is this clause directed only at individuals with religious beliefs? Why not generally towards physicians with any beliefs? Why are only religious beliefs stipulated? In fact, those who claim to not be religious still have beliefs. For example, those stating religious beliefs are wrong is a belief. This clause directly discriminates against all religious expression and freedom of speech which are protected under The Charter of Rights and Freedoms. Hence, a stipulation only against religious beliefs is by definition discrimination. Secular physicians hold beliefs and can promote them just as easily as other physicians. Moreover, all doctors regardless of religious creed, sexual orientation, etc ought to have the same obligations.
Also, will the CPSO go as far to eliminate religious questions from patients’ that they feel may be pertinent to their medical care? For example, a Jehovah’s Witness asking about the implication of their religious beliefs and medical management for a particular illness? Those discussions should not be discouraged, but rather encouraged. The CPSO should be enhancing transparent and open discussions.
In summary, I am greatly concerned by the recent draft of the Professional Obligations and Human Rights policy. Points 1-3 stress on philosophical and legal frameworks how the policy has either purposely or incidentally drafted clauses that alienate and discriminate protected rights, which are freedom of conscience, speech and religious expression. These rights are protected under The Charter of Rights and Freedoms for all citizens.
I urge the members of the CPSO to remove or edit appropriately lines 156-8, 168 and 146-8 to correct these issues. Failure to do so would, in my opinion, lead to an unnecessary and expensive Charter challenge that protects physicians’ rights as Canadian citizens under The Charter of Rights and Freedoms. Most importantly, we all want the same goal, which is to have the best patient care by the most appropriate means. However, physicians will disagree on what should or ought not to be done based on clinical, moral and/or beliefs. Accepting this fact makes us human clinicians. Removing such inherent characteristics to each physician renders them without moral integrity and inhuman. I know this is not what the CPSO or patients want. Lets work together to build a collegial, transparent and open environment respecting the rights and freedoms of patients and physicians.
Good afternoon, I write to you to object to the draft policy being proposed for permanency by the College of Physicians and Surgeons of Ontario (CPSO) entitled “Professional Obligations and Human Rights”.
Sections 8, 10 and 11 suggest that physicians who decline to participate in certain acts for reasons of conscience should be compelled to refer their patients to other physicians who will perform these acts. It does not address the fact that many of these same physicians will find the act of referral itself objectionable, as they consider it material cooperation with the act. In compelling physicians to refer, you are limiting their right to conscientious objection.
You state that physicians Rights and Freedoms under the Charter for rejecting morally and religiously objectionable procedures will be subject to a courts ruling on “trivial nature” and “substantiates” (line 125-126, draft policy). Your corollary, implied in line 128, that the physicians Rights would therefore, possibly, not be protected is incredibly flawed: you are passing judgement on such morally and religiously reprehensible procedures as being trivial. That is not for the CPSO to decide, as you state in line 76-77, or lines 82 and 84. Citing applicable law (footnote 13) only supports the nature of the courts to decide, not the CPSO. It is expected (certainly my opinion) that morally and religiously reprehensible procedures will NOT be considered trivial or insubstantial by the courts. Abortion, early end-of-life and birth control procedures certainly have not been treated trivially in the past.
If equitable “care” is the goal, then questionable and morally/religiously reprehensible procedures does not fit the definition of “care”. The word “care” implies “healing”. By that logic, such morally/religiously reprehensible procedures should not be subject to the physicians responsibility to provide “care
Dear Members of the Consultations Committee:
Subject: Draft Policy “Professional Obligations and Human Rights”.
As a registered nurse in long term care for the past 14 years, I have witnessed and comforted many patients who are suffering and dying. I will admit quite readily that this is hard to watch, feeling helpless wanting to do more to ease their pain. The best thing that I can provide is human companionship, to spend the time providing care and compassion for their suffering.
In these final moments, of hours, days, weeks and months that I have witnessed, I have seen the most amazing things happen. I have seen patients struggle with pain lie still when a family member comes to hold their hand and just sit and be still. I have seen the wonderful humour of the dying patient give their family and care givers a good laugh about long lost memories that they shared and are now reminiscing about or joke with them about how much longer they will be around to pester them. I have participated in conversations with patients about their life that they just want to have someone listen to them to express themselves when it seems no one will listen. I have witnessed people in such poor health who can no longer feed themselves or have a understandable conversation be put on palliative care and have their medications stopped only to have them respond and improve so much that they start to be able to feed themselves get up out of bed and have conversations that are completely understandable, expressing their memories, wishes and desires.
Every life is precious, even when it`s difficult to care for. We are all here to provide something to someone in this world. We are all here to leave our mark, when we have done this, and fulfilled our purpose then and only then will our time end.
I am writing to you with grave concern regarding the content of your proposed draft policy. Sections 8, 10 and 11 suggest that physicians who decline to participate in certain acts for reasons of conscience should be compelled to refer their patients to other physicians who will perform these acts. It does not address the fact that many of these same physicians will find the act of referral itself objectionable, as they consider it material cooperation with the act. In compelling physicians to refer, you are limiting their right to conscientious objection.
There is significant disagreement in our society as to what constitutes a moral act, and I do not expect the College to define or limit morality. All I expect is that physicians, as professionals, be allowed to respect their own consciences. Freedom of conscience is foundational to our free society and cannot be limited, even for the best of intentions. If we coerce physicians into violating their consciences we will inevitably erode the personal integrity which is the basis of the physician’s relationship with their patients.
I encourage you to revise the sections above, and include a clear defence of the right to freedom of conscience for all physicians.
Greetings,
May I be brief. Our laws in Canada are based upon Biblical Principles … God knows what he is doing, and is more than a figment of someone’s imagination.
His Word and instruction reminds us that all life is sacred and he has a plan for each individual (Psalm 139). I believe that by laying this responsibility on physicians and support staff to make such a call for patients is putting a burden upon them that will have some very adverse results psychologically. The cost of treatment for staff per case could be more than what we as a people should be responsible for. If the govt. and court want to make this legal, then I would suggest that the presiding judges and governing officials be tasked with the job of “pulling the plug” or inserting the needle. This would at least protect our physicians from such a burden and moral concern.
Another question I would pose is such: Why do we need such a law at this time? I would imagine that the majority of Canadians would not want to endorse such a law if it was put to a vote, with information provided that covers every avenue of this proposed legislation.
As a pastor I see people dying. When people pass away with a clean heart and clear conscience knowing they have dealt with their past and present, and have prepared for their eternity, they look forward to death. HOWEVER, I have also seen the terror and fear of people slipping into a lost eternity when they have denied the basics of faith in God, and have not taken the opportunity to take care of business. I can assure you that at those moments they are feeling the pain and sting of death and they enter into it with a severe struggle. How will our judges and legislators handle this scenario in court when a family believes that something has gone wrong during the medical procedure and caused deep and lasting negative emotions the family will have to deal with … you can be sure that the lawsuits will be forthcoming, and it will place a huge burden on society. The only positive side is the lining of financial blessing for the lawyers who take on this challenge. I can see the lapping of tongues with eager anticipation already from the law society … just waiting to move forward on this.
Thank you for considering these thoughts.
Response in PDF format.
Response in PDF format.
Response in PDF format.
Response in PDF format.
We believe that the one who gives life is the only one to take a life; the dear Lord Himself and that doctors have a right to say no to this procedure!
Don’t be so timid, fellow human being! All genuine doctors have the DUTY to say no to this policy’s second half. Decency demands that they despise it.
Regarding the CPSO’s repeated claim that the National Post “misrepresented” the CPSO policy in reporting that physicians were told “Physicians unwilling to provide or facilitate abortion for reasons of conscience should not be family physicians,” I would say (quoting the Bard) “the lady doth protest too much, methinks.” Even if this is technically a misquote, it still accurately captures the essence of what the actual policy as it is written MEANS for doctors – that if they don’t want to be killers or accessories to killing by referring abortions, they will not be allowed to continue to be family physicians in Ontario if they do not comply with the CPSO’s new policy.
[I expect my scholar’s response to the draft CPSO policy was too long. Here is a shortened version. I apologize for any punctuation that did not transfer well that I missed]
It is well said that those who do not learn from history are destined to repeat its mistakes, and the College of Physicians and Surgeons of Ontario (CPSO) has shown great ignorance of history and thus made an exceptional mistake in drafting a new policy that will force doctors to facilitate the taking of human lives (against the great medical tradition of healers to “do no harm”) or else lose their licences to be doctors in Ontario (which would greatly impoverish medical care, if precisely those doctors who most value the human lives they treat are not allowed to be doctors).
There is a gravely serious aspect of the current discussion about this which most people likely miss, but which stands out clear as day to me as a scholar with a wide breadth of historical knowledge and as a professor of a course approximately covering the First Millennium (107 AD to 1014 AD), during which period the groundwork for all later human rights and freedoms was laid. The CPSO’s intention to take away a doctor’s rights to refuse to participate (including by referral) in procedures against their conscience, including abortions which end the human lives of the unborn human babies involved (and including the just recently legalized euthenasia/assisted suicide of old and/or sick humans), ACTUALLY UNDERCUTS THE VERY HISTORIC AND LOGICAL FOUNDATIONS OF ALL OUR MODERN DEMOCRATIC FREEDOMS AND HUMAN RIGHTS. These things only began to be possible after Western Civilization learned to value ALL human life, without exceptions, and protect human life without exceptions, starting in the 4th Century AD.
What Western Civilization Was Like Before the 4th Century
Before the 4th Century it used to be the norm that human life was cheap, not valued very highly except as it could serve the greater State (whatever form the State took). Governments provided a basic societal stability but had no interest at all in helping individual humans find their individual human fulfillment (life, liberty and the pursuit of happiness and such), governments had no interest in providing health care or education for all their subjects, and governments could even be the biggest threat not only to individual human freedom but also to individual human lives. Even in the most highly civilized society, the Roman Empire, the popular entertainment, the “TV” of the day, was public torture and murder in the Roman arenas, where human lives were taken in various ways, such as wild animals tearing them apart, and athletes like gladiators murdered each other with government approval. No surprise then that in this most advanced and civilized of ancient western cultures where even here human life was so very cheap a “Pro-choice” philosophy ruled the day, where parents (particularly fathers) had the right to choose whether to raise or kill their children, whether before birth by abortifacient potions and other abortion methods or after birth by exposure or other forms of infanticide. Thus the sewers of ancient Rome were clogged with dead babies who ran afoul of their parents’ choice, and some ancient cities had convenient garbage dumps outside of the city specifically for human children (girls were particularly targeted for infanticide). Parents could sell their children as slaves, since there were no human rights or basic freedoms. Many citizens became slaves if they could not pay their debts, and governments could enslave or kill their citizens whenever they felt it suited them. Fully 1/3 of the population of the Roman Empire were slaves. Slave or free, full citizens or lesser conquered subjects, all were NOT free to seek and find their human fulfillment and meaning in life through searching religion/spirituality or any other means. It was normal worldwide for the government, whether a tribal chieftain, a national king or international emperor or even a republic (as the Roman Republic before the Empire), to set religious policy. The government normally decided which religion was the Official Religion, and which other religions were tolerated and which were persecuted, and to what degree. Religious freedom to seek and find meaning and fulfilment in life was unheard of. Even in the ancient experiments with republican democracy as in Greece and the Roman Republic before the Empire, only upper-class free men could have any say in government. Most men and all women were excluded from voting because there was NO PRINCIPLE OF EQUALITY AMONG HUMANS but quite the opposite. Greeks considered the less civilized “barbarians” to be profoundly inferior. Roman citizens and subjects might be proud to be part of the Roman Republic or the Roman Empire, the greatest the world had ever known, but they still did not expect their government to necessarily protect either their lives or their freedom.
So what happened to change all this? What led to the human rights and freedoms we have and enjoy today? What turned us from human individuals serving a greater State which frequently threatened both our freedoms and our lives to being human PERSONS who are instead served BY the Democratic State (which is why our political leaders often now call themselves “Ministers”,because they minister to the needs of human persons, and provide safety and freedom to help their citizens seek and find their human fulfillment).
What Changed in the 4th Century That Made Modern Human Rights and Democracy Possible
What happened is that in the 4th Century Western Civilization learned that ALL human life, without exception, was inherently valuable and precious, and started to treat ALL human life as valuable and precious. Gladiatorial fights to the death and other entertainment killing in the Roman arenas, and parental Pro-choice” abortion and infanticide were soon outlawed, and further centuries of reflection on this Pro-life” conviction of the SUPREME value and EQUAL dignity of every human life without exception would naturally and logically lead eventually to the end of slavery in any form, modern democracy (for all) and human rights, including previously unheard of human rights to health care and education which enhance all our human lives. Governments from the 4th Century on would be judged and remembered by the standard of how they treated their subjects, because all human subjects were now seen to be immeasurably valuable.
A Brief Overview of the Development of Modern Human Rights and Democracy Starting From Their 4th Century First Principles
Where did this great and immensely fruitful 4th Century insight into the supreme dignity and value of all human life without exception, which is at the very foundation of our safe, free and democratic civilization, come from? It came from Western Civilization first legalizing Christianity in the 4th Century and then embracing Christianity’s religious convictions that every human life (male and female – Genesis 1:27) is created in God’s Image and is extremely valuable and precious to a Loving God, and thus that humans must LIVE and be FREE from government coercion so as to seek and find their human fulfillment in this great Truth about humanity’s outstanding value. In fact, the very term and concept of “Apersonhood” comes from Christian theology. Human individuals were not called “persons” until after Christian theologians developed their terminology of One God in Three Persons (Father, Son, and Holy Spirit – Parenthood, Childhood, and the Bond of Love which binds them, a Divine “Family” who IS Love in its deepest essence, reflected in loving human families made in God’s Image). The Christian message effectively told the government,first in the Roman Empire, then in the later Kingdoms of Western Europe, and in the Eastern Roman or Byzantine Empire which lasted 1000 years after the Fall of Rome,that any government’s job was no longer to lord it over the lives of human individuals who served the greater State, but that any government’s job was now to provide safety and security for human PERSONS made in the Image of the One God in Three Persons, so that they may be free to seek and find their human fulfilment and a meaningful life as their Loving Creator desires for them. Human individuals had lives that were cheap, and the government could use human lives to serve the greater State, or take or enslave human lives, at will. But human PERSONS made in the Image of the One God in Three Persons had HUMAN RIGHTS rooted in God’s Love for them, starting with the right to Life which is why murderous entertainment and parental abortion and infanticide were almost immediately outlawed (and remained outlawed until very recently); and human persons had the right to be FREE from religious coercion, free to seek and hopefully find their human fulfilment in this wonderful Truth about their supreme human value which no other religion taught. From this point on, instead of the political State being the highest authority and using individual humans however it wanted, all States would be held accountable to a Truth higher than any State which had revealed in the Bible that slaves and their masters, political rulers and their subjects, were all EQUAL, and EQUALLY PRECIOUS, before God who made them all in love,and therefore slave owners and those who govern were now accountable before God to treat their slaves and subjects accordingly (e.g. Ephesians 6:9). The Bible further testifies that neither nationality/ethnicity, social class nor status, nor gender make any difference to a human person’s exceptional value before God (e.g. Galatians 3:28). Thus Christians, who invented hospitals, typically provided health care and education to all (Christian or not) wherever they spread as missionaries, as a service of love appropriate to the great value and dignity of all human beings without exception, and later Christian governments would start to take this function on themselves since governments now served the people instead of the people serving the State (and now we take these things for granted having forgotten where they came from).
Old habits die hard. The new Christian ideal Pro-Life values took many centuries to really penetrate into Western Civilization’s societal mindset. Only gradually did some of these Christian values overcome the long established pre-Christian norms so as to eventually yield more of their full logical fruit, like the end of slavery as an institution and equal opportunities for equally capable women. Indeed this process still continues. Yet the foundations for these were laid in the 4th Century and the long but natural and logical process towards the human rights and equal democratic freedoms we have today began in earnest right away: human life was no longer considered cheap but valuable, and protected by new laws; extremely common female infanticide was almost immediately banned, by 318 AD, 5 years after the 313 legalization of Christianity [I digress here to note it is near the height of absurdity to claim that legal abortion is about "women’s rights,” since it has in fact effectively brought back the long-banned common female infanticide in the new form of sex-selective abortions of females just for being female, which in many locations has worryingly skewed nature’s balance of nearly 50-50 female to male births; the supreme height of absurdity is to claim that legal abortion is somehow a "human right,” since it kills a human life in violation of the very first human right, the right to live, on which all other human rights historically and logically depend. Human rights were unheard of before ancient abortion and infanticide were banned]; slavery and its worst abuses were also reduced and eventually slavery ended in any form in Western Civilization (human trafficking still acceptable in other cultures), notably by dedicated Christians like William Wilberforce in Britain insisting the laws reflect those Biblical Christian values that made slaves equal to their owners before God, meaning that it was ultimately entirely inappropriate for any human being to say they “owned” another; the lingering after-effects of slavery in the U.S.A. were also successfully combated by Christians like the Reverend Martin Luther King, Jr. insisting on Christian values being put into practice at the societal level.
The specifically Christian British Empire, the largest and most advanced Empire the world ever knew, starting with the 1215 Magna Carta which limited the monarch’s power from its pre-Christian norms, very gradually and by many small stages developed modern democracy in an entirely Christian context and then spread its (Christian-based) ideals all over the globe through colonization, including the colonization of America, Aland of the free.” The Parliament in London gradually gave more and more say in government to gradually more and more of the people, entirely in a Christian cultural context and in practical development of the Christian belief in the immense and equal value of all human persons: that regardless of social strata a king and a peasant were EQUAL before God, and equally loved by God. The various colonizations from Christian Europe, for all their sad failures and lack of respect for some indigenous cultures, still also imported these Christian values of human rights and freedoms worldwide, these taking root to greater or lesser degree in the colonies. Thus it is that Biblical and Christian Pro-Life” religious values are the historical foundation of all International Law, including all Human Rights. The countries which are today described by the UN as the most notorious violators of human rights are precisely the most markedly non-Christian countries, precisely because these governments do not share the Christian religious and moral conviction about the immense value and worth of all human life without exception. Not sharing this foundation, rooted in specifically Christian religious conviction, makes democratic freedoms and human rights a very foreign concept to the governments of these countries. And worst of all, history shows, are countries with a Christian background whose governments specifically rejected their Christian heritage: they eventually revert to totalitarian states just like the totalitarian states before Christianity which typically threatened the lives and freedom of their own citizens. The two worst genocides in history were perpetrated by such governments, who actively rejected and persecuted their countries’ Christian heritage, Stalin’s Soviet forced starvation of 7 million of my fellow Ukrainians in 1932-33 just as the occultist Hitler’s Nazi Holocaust of 6 million Jews was starting (Hitler’s ideal “Aryan Race” comes from occultic mythology; thousands of Catholic priests and others who stood against Hitler’s rounding up of Jews as sub-human and no longer protected by the government were sent to the death camps as well). All totalitarian states have in common the rejection of the specifically Christian beliefs about the supreme value and dignity of all human lives without exception.
New or Proposed Law and Policy Changes Attack and Erode the Very Foundation of Our Modern Democracies
Because of this history of the development of our modern democracies, it is ridiculous to claim, as CPSO does, that religious and moral beliefs are merely private and have no place in public policy or in doctor’s offices, specifically Christian religious beliefs, including the Pro-Life Principle, are NOT MERELY PRIVATE BELIEFS BUT ARE THE PUBLIC FOUNDATION OF ALL HUMAN RIGHTS AND DEMOCRATIC FREEDOMS. They are not incidental to them, they are logically essential to them, and where they are lost, human rights and democracy are logically (if gradually) lost, as in Germany and the Soviet Union. The Pro-Life Principle historically made democracy possible in the first place, as demonstrated above, and it is the very best long-term guarantee of democracy, simply because it is only the Pro-Life principle that says every human life without exception MATTERS such that every human life must be allowed to LIVE and must be FREE from coercion in living that life. Those who are ignorant of history are destined to repeat its mistakes.” The legalization of abortion in many countries since the late 1960s and early 1970s ignorantly reversed the banning of abortion and infanticide by 318 AD which had made all subsequent development of human rights and democracy possible because it was the first legal recognition of the immense and equal value of all human lives without exception. Legalizing abortion after this long history of the development of our modern human rights and freedoms flowing logically from abortion being banned is LOGICALLY TANTAMOUNT TO OUR GOVERNMENTS NO LONGER RECOGNIZING IN ANYONE AN INHERENT HUMAN RIGHT TO LIVE, JUST LIKE IN ANY TOTALITARIAN STATE. If you and I could have been legally killed when we were of fetal age, this must logically mean our government no longer recognizes in either you or I any INHERENT right to live just for being human and for being alive. Others than ourselves decide if we humans live or die: Our mothers before we were born merely allowed us to live (lucky us), and after we were born our government decided to protect our lives with laws. But note many other governments did not and do not protect all human lives after birth, particularly totalitarian states. But democracy only ever developed in the Pro-Life” context that taught that all human life without exception was precious regardless of any State’s laws; governments that violated the Pro-Life” principle by treating their citizens badly since the 4th Century were judged against this principle of supreme human value, higher than any particular State. By abandoning the Pro-Life principle our democracies have already taken the first big step towards becoming totalitarian states such as were common before the Pro-Life principle entered Western Civilization in the 4th Century, and now it is just by simple logic starting from that abandonment decades ago that current new and proposed law and policy changes will take us even closer to exhibiting characteristics of a totalitarian state. RIGHT NOW in Ontario, doctors are SCARED that they can lose their jobs because they value human life like doctors as healers traditionally have,this is not something that is supposed to happen in a democracy! Recent developments like coercing doctors to participate in killing human lives against their will (even by Aeffective referral” to someone willing to kill), OR ELSE LOSE YOUR LICENCE AND JOB AS A DOCTOR, as the CPSO’s draft policy will make happen in Ontario, strikes at the very heart of not only the doctor’s personal democratic freedoms but strikes at the very foundation of democracy itself.
I agree with the physician of December 10 2014. It is very well stated. This proposed policy has serious errors and consequences for physicians and the public at large.
This policy will force physicians to refer to a provider or clinic that provides abortions or other services that go against the conscience of the clinician. We are trained to approach our patients holistically, yet divide ourselves into to compartments. To expect ourselves to do this is unrealistic. I think this is one attitude that leads to burnout among physicians. We need to be real with ourselves while respecting patients. Sometimes we have to agree to disagree with what they decide but I don’t think we should have to participate or facilitate in a decision we do not morally agree with. Currently, we can practice like this, but with the CPSO, this may change. Sad day indeed when we cannot practise according to our conscience. This whole policy is socialism just like Nazi Germany forcing its evil philosophy on people and physicains. If I don’t agree with abortion or euthanasia, it is my constitutional right to act according to my conscience by not facilitating the referral.
The CPSO is not necessarily putting the best interests of the patients first, they are simply superimposing their subjective moral beliefs over the moral beliefs of service providers. This is not ethical and it is in fact an imposition of discrimination towards these doctors who may object for very good reasons. More consultation must be had with doctors who have strong ethical-moral convictions and with doctors of faith backgrounds. Asking these doctors to fracture their moral views from their professional obligations may lead to a homogeneity of doctors who only support abortion/euthanasia, it may reduce their personal sense of integrity, and it may lead to burnout as they are forced to practice medicine disingenuously. This is systemic discrimination based on conscience or religious belief.
Please remember that moral stances based on conscience are rational and evidence-based, often reinforced by religious beliefs, and deserve protection. There should always be a balancing of rights, but both patient and physician rights be respected; accommodation should not be one way.
There are many rights and freedoms granted to us in this wonderful country Canada. If you draw an analogy to the same sex marriage debate, it did not force religious organizations to marry people if there religion was opposed to it.
I believe forcing a Dr. or health care provider to perform a procedure that is against their moral or religious beliefs is in unacceptable!
That said, I believe a physician should be up front when accepting a patient or during the course of his practice state to the patient which procedures or practices they will not do. If as patient, I have no issues with this as long it is up front.
The patient then can make a decision on when and where to receive treatment they desire.
I believe a common sense approach like this would be appropriate to protect the physicians rights and the patients rights.
This is first time entered a comment. The web site says that I have entered a duplicate comment. Why is this? So I will rephrase my feedback
We are fortunate to live in Country like Canada where we have the Charter of Rights and Freedoms. During the debate on same sex marriage, the law the eventually fell out of this debate made allowances to not force religious denominations to perform same sex marriages if it violated their beliefs.
I do not believe you should force a physician to perform medical procedures if it violates their moral beliefs.
That said I do believe a physician should state to their patients which procedures or services they will not perform when accepting patients or during course of treatment.
I have no issues with a physician holding their beliefs if it is clearly stated to the patient.
The draft policy speaks of freedom of religion and religious beliefs. It nowhere defines them. Here is the Christian description of religion put into action:
“Religion that is pure and undefiled before God, the Father, is this: to visit orphans and widows in their affliction, and to keep oneself unstained from the world” (Jas. 1:28)
In A.D. 2015, Christians still provide crisis pregnancy care and visit old age homes. They sit with the sufferer; they don’t kill him. King Saul fell on his sword, and the apostle Judas hanged himself, but King David and the apostle Peter repented and received forgiveness.
As Theocritus, Cicero, and Stephen Hawking have said, “While there is life, there is hope”–and none of them had–or do not yet have–the Christian’s assurance of heaven.
I agree that the conscience rights of physicians must be respected.
I oppose the mandate for effective referral because it is against physicians rights and should be rejected.
CPSO
No one should be forced to do something against their conscience. This means not just doctors, lawyers, teachers, but all people. This is true diversity, true freedom and true repect for our fellow man. If society is built on true respect, it will prosper. If people are denied this freedom, society will be in turmoil.
Forcing doctors to kill is wrong. Do you not see this? I want a doctor who has a backbone and lives according to good principles. Your policy would turn good people away from medicine—this is not right.
Please consider the profound consequences of your policies.
Thank you for your attention.
Dear Members of the Consultations Committee:
I am writing to you with grave concern regarding the content of your proposed draft policy. Sections 8, 10 and 11 suggest that physicians who decline to participate in certain acts for reasons of conscience should be compelled to refer their patients to other physicians who will perform these acts. It does not address the fact that many of these same physicians will find the act of referral itself objectionable, as they consider it material cooperation with the act. In compelling physicians to refer, you are limiting their right to conscientious objection.
I strongly object to wording of this policy. The physician who disagrees with assisted suicide should not be put in the position of having to refer the client to someone who will do the job for him. You must respect the individual’s right to conscientious objection by not making them responsible to find someone who will perform the killing of another. In a case of murder that person is as culpable as the one performing the act itself. I urge you to reconsider the wording of the policy and remove the onus “should be compelled to refer their patients to other physicians who will perform these acts.”
I encourage you to revise the sections above, and include a clear defense of the right to freedom of conscience for all physicians.
To Whom this may Concern:
I have always held to the belief that my doctor is under the vow to ‘do no harm’. I have since my teens been witness to doctors bullying, lying and manipulating friends and family into having abortions. WITH NO PUNISHMENT FROM YOU. I took my time to search for a doctor that has a conscience and holds to the vow.
I do not want to loose my doctor and others that hold to the same believes as my own.
Abortion and early death are not healthcare. The supreme court may have decided it isn’t against the law for a person to have either however it should be against law to force another to participate in any way to this end.
“Effective Referral” or demanding participating in such acts will diminish all doctors into bullies, liars, and manipulators that are no longer working for the well being of Canadians but the financial bottom line of organizations and government.
Dear Council,
Please accept my comments as per the external consultation you are facilitating on the issues of the professional and ethical obligations of physicians.
My opinion is that the CPSO is engaging in discrimination towards physicians who may object to questionable procedures in medical service. In order to make clear my point that the CPSO is proposing a discriminatory policy, I will refer you to your own definition of discrimination provided in your survey. Discrimination, according to your source, is defined as the following:
Discrimination may be described as an act, decision or communication that results in the unfair treatment of a person or group by either imposing a burden on them, or denying them a right, privilege, benefit or opportunity enjoyed by others. Discrimination may be direct and intentional. Alternatively, discrimination may be entirely unintentional, where rules, practices or procedures appear neutral, but may have the effect of disadvantaging certain groups of people.
These professional-moral imposition are exactly the “unfair treatment of a person or group by either imposing a burden on them, or denying them a right, privilege, benefit or opportunity enjoyed by others…” This is not equitable. Having physicians refer patients to a non-objecting physician is one thing, but to mandate that they actually must perform procedures that they may consider infanticide or murder is both Draconian and unethical.
One could also argue that such a mandate is not necessarily putting the best interests of the patients first, since the medical providers in question equally believe that they are keeping the best interests of the patients first in not conducting what they believe are harmful procedures on them. This sort of policy, in my view, simply superimposes the subjective moral beliefs of the CPSO over the moral beliefs of these physicians in question. These doctors object for very good and highly nuanced and sophisticated reasons. More consultation must be had with doctors who have strong ethical-moral convictions and with doctors of faith backgrounds. I look forward to hearing about such consultation work.
To whom it may concern:
Patients are of course the primary concern.
To force Doctors to violate their conscience is not in the best interest of patients. Patients can easily find other Doctors to comply with values similar to their own – why force such measures on Doctors?
This is ideology overruling good medical practice.
Dear College of Physicians and Surgeons of Ontario, Professional Obligations and Human Rights Policy Drafters,
I am writing to let you know that as a member of the public, I am concerned about what I consider a threat to doctors’ freedom of conscience regarding their “duty to refer” (particularly with regards to issues that are related to religious morality). Requiring a doctor to provide referrals when they cannot perform a procedure for reasons of conscience is still forcing them to abet an action which goes against their conscience. Removing the moral element from a doctor’s professional life is a fundamental assault on their personal integrity. Doctors’ freedom of conscience should not be eliminated through policy.
Please reconsider your policy draft, particularly the section entitled “Ensuring Access to Care.”
To the Members of CPSO
I would like to state that I reject the proposed “effective referral” mandate in the draft dealing with physician assisted suicide. This “effective referral” compels a physician to violate his of her own conscience by being a participant in the very act, the very procedure, which he or she objects to in the first place.
Freedom of conscience and religion are guaranteed by the constitution and must be respected and upheld.
[**MESSAGE FROM ADMINISTRATOR: DURING THE CONSULTATION PERIOD, WE RECEIVED 17 RESPONSES FROM INDIVIDUAL RESPONDENTS CONTAINING THE CONTENT PUBLISHED ABOVE. ALTHOUGH THIS FEEDBACK HAS NOT BEEN PUBLISHED IN DUPLICATE, THE COLLEGE ACKNOWLEDGES RECEIPT OF THESE SUBMISSIONS.**]
To whom it may concern
Please support freedom of conscience and religion for physicians.
Physicians need to uphold their promise to “Do No Harm.”
Now that assisted suicide is legal and the possibility of
euthanasia on the horizon, physicians must maintain their right
of conscience to refuse to participate in any way.
I would not feel safe if my physician participates in these
immoral actions.
This is to inform you that I reject the proposed “effective referral” mandate for doctors,whose Charter right of freedom of conscience and religion must be respected.
Dear Members of the Consultations Committee:
Subject: Draft Policy “Professional Obligations and Human Rights”.
I am writing about Sections 8,10 and 11 of the proposed draft policy. They suggest that a physician who is declining to participate in certain acts for reasons of conscience is still being asked to go against their conscience by referring their patients to other physicians who will perform these acts.
Referring a patient to another physician who will perform the act can be in itself against the conscience. Both patient and physician have rights. We should respect them both equally. I suggest you change the wording of these sections to include language that respects both physician and patient rights. Limiting the freedom of conscience should not be allowed in a free and open society.
Hello,
After reading the draft policy, I would appreciate if, at Line 70 you include the provision of a scent free environment to accommodate those of us who suffer with environmental sensitivities. The Canadian Human Rights Tribunal recognizes Environmental Sensitivities as a disability but this is not widely known. My own family physician understands my disability but wears scented aftershave anyway making every visit to see him a danger to me. He believes, as many do, that he has a right to wear scented products even if his patients are allergic.
specifically noted accommodation of MCS (Multiple Chemical Sensitivities) in the paragraph at Line 70 would make exercising my rights much easier in a climate with a shortage of family doctors.
I would also request provision of a safe environment to accommodate those of us with Multiple Chemical Sensitivities and Environmental Sensitivities. I find that most medical offices, clinics and hospitals are toxic, thanks to fragrances and chemicals used by professionals, other staff, other patients, and visitors.
Most places that post fragrance-free policies do nothing to enforce such policies. They often still use fragranced cleaning products, soaps, and hand sanitizers. When patients and visitors show up wearing their usual fragrances, with toxic laundry products or dry-cleaning chemicals clinging to their garments, in general, no effort is made to educate them, let alone ask them to leave or to wait outside the clinic.
For starters, I would request that the examples of disabilities to be accommodated included Environmental Sensitivities.
It would also be helpful if practices that treat patients with migraines (such as pain clinics) were lit with LED lights instead of fluorescent tubes. I am not sure whether this would be another example of accommodations for environmental sensitivities, or whether migraines fall under a different disability category.
Re: “Professional Obligations and Human Rights” draft policy.
Dear Colleagues,
As a Christian physician, I along with many others of different faiths and/or convictions of conscience, am deeply concerned about the content and questionable agenda of this draft policy, and encourage counsel to drastically revise it.
The policy appears to contain elements of reverse discrimination i.e. patients rights subjugating and dominating physicians rights. This is quite ironic in a document ostensibly mandated to minimize discrimination. Yet a careful read of this draft shows several pretty significant biases against those “objecting physicians” who do so on the basis of “morals or religion”. Both conscience and religion are protected under the Charter of Rights and Freedoms, yet the draft policy spends nearly the entire second half of the document itemizing all of the contexts and limitations that would apply to mainly one arena for potential discrimination – that of conscience and religion. Alternatively, a long list of other arenas for discrimination such as race, gender, ethnicity etc. are only summarily mentioned much earlier in the document. This imbalance smacks of bias.
Many different character-shaping influences form our conscience a.k.a. “inner voice”. Religion is just one among them. This document fails to acknowledge the fact that every single human, not just those with identifiable religious “brands”, operates using a moral compass directly informed by their conscience. It is a universal instrument of the soul.
It is offensive to me to see the degree of blindness to this self evident fact, and instead, see this policy divide physicians into groups that could only be described as those with a conscience and those without; perhaps more accurately those with an acceptable conscience and those whose conscientious objection is unacceptable. The Canadian Charter makes no such distinction! Two weeks in practice and any one of us realizes that every decision to engage in or refrain from full endorsement of a patient’s requests involves a complex intersection of conscientious AND evidentiary elements. It is not so reductionistic as to be wholly one or the other. The way this draft policy is worded, such decisions are made out to be so reductionistic.
Not providing a procedure is not the same as not providing care. Many of us [perhaps not all] would object, for example, to facilitating infundibulation for a female patient. It is possible to both professionally and in a dignified way, without discrimination, decline such a request for a patient. While you could disclose that part of your objection is on conscientious ground, I would argue that another part is on the grounds that this can involve unacceptable risk for a medically unnecessary procedure. If I were that patient, you should not have to tell me every last detail of why you object to this. Most certainly you should not be forced to explain “every available option” and provide substantial information as well as a referral to another “non-objecting physician”. That would be unfair. You either endorse it for me or you don’t! As both another human being as well as my physician, I need to accept your right to do so.
The act of referral and coordination of services is tantamount to the procedure in question itself, and for this reason I believe the draft policy goes much too far in terms of the nearly punitive measures required for physicians who “dare” to object to various procedures in their professional opinion, which may include (to varying degrees) matters of conscience and religion.
Lastly, this all becomes doubly concerning in light of last Friday’s Supreme Court decision to overturn the ban on Physician-assisted suicide, and re: euthanasia. Should death become a “medical procedure” (something inexplicably heinous to me and thousands of others), the reverse discrimination issues in this draft policy have a heightened consequence. Voluntarily giving physicians a “license to kill” would be bad enough. Making this nearly involuntarily is unthinkable. If and when death is put on the OHIP billing schedule, and rolled out into practice, I and hundreds of others like me need to be able to easily abstain without massive repercussions both legally and morally. I have no confidence of that with this current draft policy. We need to know we have the support of our College, the OMA, and a full recognition of our Charter rights. The same goes for what has always been an extreme minority of other medical decisions or procedures we each might object to.
Thank you for your careful consideration of this high priority matter.
Do not force someone to do what he/she is unwilling to do so. It is inhuman. This policy may respect the patients, but it abruptly fails to respect physicians. Freedom of conscience! Where are the human rights of the physicians?
Dear CPSO Council Members,
I am writing today to offer comments with regards the draft policy entitled “Professional Obligations and Human Rights”. Firstly, I share with the CPSO that patient care must of the paramount priority and protection of patients from discrimination is a necessary component of good patient care. However, I am gravely concerned that the implementation of this new draft policy would in fact do damage to patient care in Ontario without adding the desired protection of patients from discrimination.
Chair of the CPSO Policy Working Group has publicly stated that physicians who are unable to comply with the policy should think about whether they should be practicing family medicine. Many physicians in this province have deeply held moral beliefs that certain practices, such as abortion, are wrong and hence cannot be included in their practice, should their practice be carried out as one they know to be morally upright and focused on patient care. Forcing a duty to refer for procedures one is unwilling to perform oneself is not arriving at a middle ground, rather, it forces physician participation in that which they have judged to be morally inexorable. Physicians, who previously practiced without fault to patient care, will be forced to leave a practice that can no longer achieve moral accord- as predicted by [Name omitted].
Alternatively, our physicians may decide to comply with the CPSO’s requirement and participate in an element of practice that goes against deeply held beliefs; such interior conflict will undoubtedly lead to physician burnout. Either way, Ontarians will suffer the loss of their well-qualified family physicians, and hence, compromise access to good quality, sustainable patient care in the province.
Consider too that there are members of the public who share their physicians’ moral framework and appreciate the opportunity to access medical services from a physician who they deem to be morally upright.
Medicine is both a science and an art. A patient is best served, and the public best protected, when a physician masters both the art and science of medicine by carefully examining the clinical scenario within an ethical framework. We want our physicians to be practicing in a manner that fully engages their ethical reasoning; this ethical reasoning cannot be separated from a physician’s moral and religious beliefs.
The CPSO must reconsider what it defines as “discrimination” in their draft policy. The Ontario Human Rights Code prohibits discrimination against the public based on protected grounds, such as age, race, sex, sexual orientation, disability, or family status. This means that one must not deprive one group of services one provides to others. The Code does not dictate what services must be delivered. If a physician chooses, for moral reasons, not to prescribe a pharmaceutical, there is no discrimination if the same decision and practice is applied to all his/her patients equally, that is, without discrimination.
We must draft a policy that maintains physicians’, as well as patients’, rights as defined by the Charter of Rights and Freedoms in order to avoid systemic discrimination based on conscience or religious beliefs. Any policy that is effected by the CPSO that will limit a physician’s Right to Freedom of Conscience and Religion by forcing a duty to refer or provide a service is in affronts with what Canadians’ value as set out in the tenets of Canadian law. Consider carefully this draft policy. I urge you not to compromise the Canadian value that all must be protected under the Charter of Rights Freedoms, including the providers of services. Please, protect our physicians’ freedom from systemic discrimination.
REPLY FROM ADMINISTRATOR: Recently, the National Post published a commentary that falsely attributed the following statement to a College spokesperson: “Physicians unwilling to provide or facilitate abortion for reasons of conscience should not be family physicians.” This quote is categorically false, and misrepresents the College’s expectations of physicians who limit the health services they provide on moral or religious grounds. The College has asked the National Post to publish the following letter to correct this false statement and to clarify the College’s position: http://policyconsult.cpso.on.ca/wp-content/uploads/2015/01/Letter-to-National-Post-January-23-2015.pdf
The College is misrepresenting its expectations of physicians who limit the health services they provide on moral or religious grounds. Under this policy, I cannot become a doctor in Ontario unless I renounce my Christianity and become willing to commit murder and mutilation or participate in murder and mutilation.
*** cannot become a FAMILY doctor ***
Dear CPSO council:
I trained as a family physician and gained extra training for rural medicine. At present, I work mainly between two Ontario towns. One is a small city and I work part time in the Emergency department. I also do locums in palliative care at the local hospice. The other is a rural community where I do Emergency shifts and do locums for family doctors which includes office work and inpatient care.
I am also a Christian and there are certain procedures which are legally available in Ontario and Canada which I have problems with ethically and morally. At present, I am not required to refer for procedures with which I have a conscientious objection. This new policy draft suggests that the CPSO would require me to refer for these procedures despite these being against my conscience. I view providing an “effective referral” as being complicit with the procedure to which I object according to my conscience. This would constitute imposition of another (usually secularist) belief system on my own belief system. In a pluralistic society, we need to respect each others belief systems. When I encounter a patient who wants a procedure or medication which I can not provide according to my conscience, I do not judge them or discriminate against them. Respectfully, I inform them of my conscientious objection and if these procedures are available without referral, I inform them of where they may go to obtain them. In this way, I am able to act according to my conscience and maintain my integrity. If I were to compromise in this regard, I would be violating my integrity and no patient could trust me.
It should be noted that Hippocrates himself and all his followers, would not have been allowed to practice medicine according to their conscience if this draft policy had been in force during their time period. The Hippocratic Oath explicitly states that:
I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan; and similarly I will not give a woman a pessary to cause an abortion.
Given the recent ruling with the Supreme Court of Canada on the Carter case, it is particularly worrisome to me that the CPSO is modifying this policy in this way at this time. I have taken an oath not to cause the death of anyone in my care. I will not be able to help someone commit suicide. I am able to provide palliative care and there are so many ways that one can control pain and other symptoms which occur at the end of life. We need to improve access to palliative care in Ontario, rather than put doctors like myself in positions where we will have to take the risk of CPSO discipline to provide the best care possible or possibly leave the province to practice ethically.
In a dualistic society, there are ways to make controversial procedures and medications available to those who want them without compromising the integrity of those who object to these procedures and medications on conscientious grounds. Abortion, for example, if available by self referral in Ontario.
Family physicians who object to certain procedures or medications are up front with their patients about what they can and can not do according to their religious and moral beliefs. Patients are free to become part of this doctor’s practice or move on to join an alternative doctor’s practice with which they agree.
I urge the College of Physicians and Surgeons of Ontario to re-write this draft policy, Professional Obligations and Human Rights, such that the stipulation to provide “effective referral” is removed. I similarly urge the college to support the right of physicians to practice medicine according to their consciences.
I strongly agree with this opinion. Physicians like her/him are trustworthy, they have integrity and respect for life. It would be a shame if Ontario loss this kind of professionals. The College of Physicians and Surgeons should support the right of physicians to practice medicine according to their consciences.
Dear members of the College of Physicians and Surgeons of Ontario,
I am writing this email several days after the Supreme Court of Canada has struck down the laws against euthanasia and physician assisted death (PAD). Should your draft policy on “Professional Obligations and Human Rights” be adopted, patients could force physicians to refer them for PAD even if the physician objected to this not only from moral grounds but medical or philosophical grounds. In your opening preamble to the draft policy, you state that “The fiduciary nature of the physician-patient relationship requires that physicians act in their patients’ best interests.” If a physician denies a patient a referral for PAD on the basis that it would not be in the best interests of that patient, then your policy is inherantly contradictory.
The wording of the draft policy is so vague that almost any procedure could be included. On your forum many have cited examples of vaginal reconstruction, or female circumcission as procedures that could be requested and put a physician in conflict and thereby contravene the policy if they did not refer. If the college is fearful that some patients are being denied access to specific procedures then they should work to ensure that patients can have access to these procedures without requiring referral rather than creating a vaguely worded policy that is a veil to force physicians to refer for specific controversial procedures. Indeed in Calgary, if a patient wants an abortion, then they can access this directly without referral.
Currently if a patient does not like their physician, they already have the right to find a new physician. If the college feels that patients cannot find physicians then they should work to improve access and not force physicians to act against their consciences. Indeed, I would strongly recommend that you read Margaret Wente’s Globe and Mail editorial from August 7, 2014 entitled “We can’t force doctors into being moral eunuchs”
http://www.theglobeandmail.com/globe-debate/we-cant-turn-doctors-into-moral-eunuchs/article19946476/
Dear Members of the Consultations Committee:
I am writing to you with grave concern regarding the content of your proposed draft policy. Sections 8, 10 and 11 suggest that physicians who decline to participate in certain acts for reasons of conscience should be compelled to refer their patients to other physicians who will perform these acts. It does not address the fact that many of these same physicians will find the act of referral itself objectionable, as they consider it material cooperation with the act. In compelling physicians to refer, you are limiting their right to conscientious objection.
There is significant disagreement in our society as to what constitutes a moral act, and I do not expect the College to define or limit morality. All I expect is that physicians, as professionals, be allowed to respect their own consciences. Freedom of conscience is foundational to our free society and cannot be limited, even for the best of intentions. If we coerce physicians into violating their consciences we will inevitably erode the personal integrity which is the basis of the physician’s relationship with their patients.
Also, to suggest that individuals who cannot support these acts should not become physicians within specific specialties is a contravention of their rights and freedoms. It also denies me as a consumer of medical services to obtain those services from a physician who shares the same moral compass as I do.
I encourage you to revise the sections above, and include a clear defence of the right to freedom of conscience for all physicians, as you did in the past.
Dear Council Members,
Thank you for seeking public consultation on this very important proposed document. It is certainly true that physicians should not discriminate against patients or show partiality and differing care to different patients. Physicians should keep patient care as the highest priority.
The draft in its current state implies that physicians would be discriminating against some patients if physicians did not provide or refer for certain services due to moral or religious beliefs of the physician. However, such conscientious objections would not be discriminatory, because such services would not be provided to any patient of the physician. This is different than providing services at times to some individuals, but not to others, for reasons such as ethnicity. For example, as a restaurant owner, it is not discriminatory to own a restaurant and not serve pork to anyone, including someone who would request to eat pork, because as a restaurant owner your religious belief may preclude preparing and serving pork. This restaurant owner is not discriminating because he is not selectively choosing to serve pork to some, but not to other patrons.
To require a referral from the health care provider is just as morally convicting to the provider as performing the service, as the physician would be formally facilitating the treatment in conflict with his/her moral or religious beliefs. When a physician has the moral conviction that an abortion or physician-assisted suicide is the wrongful taking of human life, to refer for such is to be a complicit in this act.
The proposed policy will limit physicians’ freedom of conscience and religion as guaranteed in the Charter. Unfortunately, this document will fail to ensure that physicians perform their duties ethically, but instead, force physicians to perform or prescribe treatments against their moral and religious convictions or risk disciplinary action from the college because of their religious convictions. If this draft were to be approved in its current form it would place limitations on the freedom to practice religion, while also practicing medicine. For physicians who have religious convictions which preclude them from participating in abortion or physician-assisted suicide, this would force them to move their practice out of province or give up practicing medicine altogether.
Physicians have a right to freedom of religion as much as any other Canadian. A patient’s desire to access services such as abortion or physician-assisted suicide does not render a physician’s right to freedom of religion invalid.
As someone who was born and raised in Ontario, and who was strongly considering returning to Ontario after the completion of my Family Medicine residency to open a practice, this decision will certainly influence where I practice.
As a governing college, I hope that you will protect my rights as a physician just as strongly as you safeguard the wellbeing of the patients we serve.
Thank you
Dear College Members,
I am writing to you to express my concerns re: the draft document on Professional Obligations
and Human Rights.
First of all, I thank you for being open to consultation with the public on this matter.
In doing so, the College obviously accepts existing Charter of Rights of freedom, of religion
and conscience and therefore I urge you to maintain that moral stance.
I would like to emphasize that moral stances based on conscience are rational and evidence-based,
often reinforced by religious beliefs and therefore deserve protection.
Freedom of religion and conscience rights are included in other documents and therefore
Canadian documents should reflect these values.
(Cf., Canadian Charter; the United Nations’ Universal Declaration of Human Rights, Article 1 states:
“All human beings are born free and equal in dignity and rights. They are endowed with reason and conscience and should act towards one another in a spirit of brotherhood”.
Thus, there should always be a balancing of rights, but I request that both patient and physician rights be respected; accommodation should not be only one way.
A physician should never be compelled to act against rational conscience decisions and that such
compulsion goes against the Charter and human rights.
Therefore, by refusing to provide or perform some procedures is not discriminatory when it is based on a properly informed conscience: this has nothing to do with the patient, requesting a procedure, and everything to do with the physician’s decision about the wrongness of the procedure in question.
In conclusion, I would strongly hope that when you are making changes to your original policy,
you would seriously consider the reflections I have put forward,
When suffering vets committed suicide everyone was angry. When suffering
citizens commit assisted suicide everyone is happy. Are canadian authorities + others extremely confused concerning life? YES Sorry, you are not free, but subject to life, your personality, your knowledge & experience and the present situation, issue. You cannot, not do, what you are doing! What should life & fatherhood think ????? WHY ????
From fatherhood and life’s perspective what should we think about “RIGHTS“,
now that authorities i.e. justices, politicians, medical professionals, + others are ?attacking? Life at its beginning and ending? Is life without HUMAN RIGHTS? Is it being excluded, rejected, destroyed by artificial-birth control and abortion. And now we have added assisted-suicide!
Are human rights the new oppressive, abusive religion? Who is godphobic, religionphobic, lifephobic? fatherhoodphobic? Why?
Are pro-life persons in canada the Bonhoeffer’s of the nazi era? & I wonder,
what is a citizen’s personal future if authorities reject, destroy their own child in the womb? Who is fatherhoodphobic, godphobic, religionphobic, lifephobic in canada/world? Why?
“Before I formed you in the womb, I knew you…”
Jeremiah 1:5
Is fatherhood, motherhood or child in the womb a core canadian/world human value/right .. sorry, just kidding!
“Intolerance is itself a form of violence and an obstacle to the growth of a true democratic spirit” Mahatma Ghandi. Over the last few days we have been “treated” to “Trudeaumockracy”, a cross between a tyranical benevolence and a dictatorship. You can have no thoughts but my thoughts, no opinion, conscience or moral view unless […]
To who it My Concern,
What I see is that over time, the clock has ticked so slowly that our society has not even seen its slow but sure descent into moral relativism and the decay of the human conscience.
What I see is the unbearable pressure on society by special interest groups. Everyone seems to be caving in to this erosion of moral principles.
I remember speaking with a very good doctor, a surgeon, about abortion, which he refused to ever perform. He said that if he did perform one, he would no longer be living according to the Hippocratic Oath but the Hypocritc Oath. I couldn’t have said it better.
To put physicians in this dire position of performing abortions against their consciences or forcing them to find someone to ‘do the job’ is like asking them to find a hit man.
You must take a deep breath and remember that your decision is going to have eternal consequences for yourselves and those who you place in such a dangerous position, to say nothing of the mistrust that patients will have for their doctors. Once you force them to do this, it will not be long and you will be forcing them to kill the elderly as well, then the handicapped, then the imperfect, then …….? Only God knows how deplorable it could get, as though it isn’t deplorable enough already!!
Hi there,
I may be off base here, but I would like to see the words “ environmental sensitivities” as a disability in there somewhere. My doctor does not believe that this illness exists, and it greatly needs to be recognized. There is a lot of suffering with this illness and if your doctor cannot or will not help, or recommend someone else, that is immoral.
Je suis chrétienne et pourtant jamais Notre Seigneur Jésus nous a dit dans La Très Sainte Bible que nous avons le droit de prendre des décisions contraires à notre Foi Chrétienne.Dieu nous laisse libre de l’aimer ou de ne pas croire en lui comme nous sommes libre d’être sauver ou damner.Pour ma part je réalise à quel point notre société régresse lamentablement .Les élus qui osent se prendre pour Dieu et décident de laisser passer des lois qui mèneront à l’avortement ,au suicide et l’euthanasie devront dans l’autre vie rendre des comptes à Notre Dieu Créateur.Les Dix Commandements existent toujours et Dieu nous laisse libre mais ceux qui ne respecteront pas ses lois iront en Enfer à jamais ( Tu ne tueras pas a dit le Seigneur Dieu qui est Roi et Maître de tout l’Univers ).La Cour Suprême sera un jour jugé à son tour par le Grand Juge Dieu.
Avec des lois qui choisissent la mort plutôt que de sauvegarder le droit à la vie notre société s’en va droit en Enfer .Je croyais que le Canada aidait les plus faibles .
Une Ontarienne qui demande que justice soit faites pour les pauvres futures victimes de cette loi qui ne respecte pas le droit à la vie.Les médecins doivent sauver des vies et non le contraire.À voir les gens agir ainsi de nos jours Notre Seigneur Jésus serait crucifier une seconde fois.Notre société n’a plus de morale ni de Foi et nous ,nous demandons pourquoi tout va si mal.La complaisance mène seulement à ne pas déplaire aux hommes mais déplaît fortement à Dieu.Que Dieu vienne en aide à ceux qui le défi .
La médecine existe pour être au service de Dieu pour la sauvegarde de la vie jusqu’à ce que Dieu décide de notre dernier moment à vivre sur cette Terre .
Commentaires sur le projet de loi sur les droits de la personne :
Sous prétexte de respecter la liberté de tous, on nie aux médecins, dont la conscience serait opprimée en raison de leurs valeurs morales, le droit de s’objecter et de souhaiter ne pas prendre part aux traitements menant sciemment à la fin d’une vie.
Puisque je suis catholique, je ne parlerai que de cette Église dont la position est très claire. Elle a toujours enseigné aux chrétiens d’obéir aux pouvoirs publics légitimement constitués, mais elle a donné en même temps le ferme avertissement qu’« il faut obéir à Dieu plutôt qu’aux hommes » . L’Église considère l’euthanasie comme un crime qu’aucune loi humaine ne peut prétendre légitimer.
Je n’espère pas aujourd’hui convaincre le Collège des médecins d’abandonner ce projet de loi, ce serait trop beau. Ce que je voudrais, tout simplement, c’est que les médecins catholiques ne soient pas forcer de nier Dieu pour vous plaire.
Quant aux droits des patients, ils pourraient j’en suis certaine, être respectés par d’autres médecins pour qui ce problème moral et fondamental ne se pose pas.
Merci.
I’m writing further to the tabling of a draft policy by The College of Physicians and Surgeons of Ontario which demands that doctors participate in controversial procedures like abortion and euthanasia by making referrals and doing the procedure in certain circumstances. I understand that doctors who refuse to follow the policy will be vulnerable to discipline, even though their fundamental freedom of conscience and religion is guaranteed by the Canadian Charter of Rights and Freedoms.
I firmly believe that one cannot act against one’s religious and moral beliefs without creating an internal conflict. Medical professionals should never be penalized for taking a stance that is dictated to them by their conscience. We should never force our doctors to violate their own consciences. Laws should never impose that kind of pressure on people. With the recent Supreme Court of Canada decision on euthanasia, this proposed policy is even more disconcerting.
I ask you to please reconsider the policy and amend appropriately.
I’m writing further to the tabling of a draft policy by The College of Physicians and Surgeons of Ontario which demands that doctors participate in controversial procedures like abortion and euthanasia by making referrals and doing the procedure in certain circumstances. I understand that doctors who refuse to follow the policy will be vulnerable to discipline, even though their fundamental freedom of conscience and religion is guaranteed by the Canadian Charter of Rights and Freedoms.
I firmly believe that one cannot act against one’s religious and moral beliefs without creating an internal conflict. Medical professionals should never be penalized for taking a stance that is dictated to them by their conscience. We should never force our doctors to violate their own consciences. Laws should never impose that kind of pressure on people. With the recent Supreme Court of Canada decision on euthanasia, this proposed policy is even more disconcerting.
I ask you to please reconsider the policy and amend appropriately.
To the Members of CPSO
I would like to state that I reject the proposed “effective referral” mandate in the draft dealing with physician assisted suicide. This “effective referral” compels a physician to violate his of her own conscience by being a participant in the very act, the very procedure, which he or she objects to in the first place.
Freedom of conscience and religion are guaranteed by the constitution and must be respected and upheld. This ruling & application is too close to the practice of eugenics of the Third Reich.
And its language is too close to the propaganda of the former Soviet Union. The “balancing of rights” reflects that all people are equal but some people are more equal than others. The policy takes the same viewpoint on religion that Karl Marx did in his opium quote:
“The criticism of religion disillusions man, so that he will think, act, and fashion his reality like a man who has discarded his illusions and regained his senses, so that he will move around himself as his own true Sun.”
I disagree with the proposed requirement that doctors be required to provide referrals when they cannot perform a procedure for reasons of conscience. Referring a patient for an immoral act makes the doctor complicit
This policy is one more nail in the coffin of freedom of conscience and expression in Canada.The Orwellian nightmare isn’t coming…it’s here.
This policy is filled will double talk that seems to shield the physician on the one hand, yet leaves him/her wide open to a law suit on the other. It is social engineering with a thin vinear of politically correct jargon to give some sort of legitimacy. If I was a physician with a shred of religious conscience I’d be packing my bags now and heading for the States. If we think we have a doctors shortage now, just wait until this Orwellian nightmare becomes law!
If a doctor wants to keep his professional oath to do no harm, he should not be required to recommend another doctor who does not support his ethical or moral beliefs. If I do not want to kill my sister’s baby or her husband, I should be under no obligation to find someone who will.
What is truly frightening about this situation is its insanity. Here we have the learned people of our society working very hard to draft a policy forcing their fellow doctors to go against their consciences. This is the equivalent of working very hard to draft a policy which forces someone to ignore policies, regulations and laws including the policy they are working so hard to draft. Conscience is that quiet inner voice that tells us it is good to do what is right such as obey just laws. The word “unconscionable” is reserved for the horrific acts of those the judiciary labels thugs. To what will you appeal after you have told the world that conscience must not be obeyed. Religious or not I am sure you want to continue to enjoy the benefits of a lawful society. That is why civilizations have realized it is necessary to preserve the freedom to act in accord with one’s conscience.
And as many have said before that includes in this case the right of doctors to refuse to refer or perform against their conscience.
This is a truly frightening situation.
People working very hard to draft a policy
forcing doctors to go against their consciences is the equivalent of a policy
forcing doctors to go against policies in
general. Conscience is that quiet inner voice that tells us it is good to do what is right such as obey just laws. The word
“unconscionable” is reserved for horrific acts. To what will we appeal after we have told the world that conscience must not be obeyed. We all want to continue to enjoy the benefits of a lawful society. That is why civilizations have realized that it is
necessary to preserve the freedom to act in
accord with one’s conscience.
And as many have said before that includes the right of doctors to refuse to perform or refer against their conscience.
Our country has laws in place for the common good. However, in later years, some laws eventually, changed ,after much effort and sacrifice by people who knew the laws were wrong, ethically. Women came to be considered more than just possession and embraced the right to vote. Currently, in spite of all the medical proof out there, unborn children are not considered human with the right to life until they leave the womb. A mother myself, what could be more ludicrous! Doctors are supposed to heal and preserve life. Euthanasia flies in the face of this ! To take a life oneself or to get someone else to do it are basically one and the same. I am angry that my tax dollars are used to pay for services that are wrong and we make people who have real medical needs, wait. Our country is very misguided.
How would you feel if you were FORCED to do something against your OWN values/beliefs? Is that a good or bad feeling?
Is it a good or bad to SUPPRESS one’s conscience? Is that a ‘healthy, wholesome’ way of living promoted by the CPSO for it’s physicians?
Will physicians be replaced in the future by robots as they can easily remedy any moral/ethical issues? They’re PROGRAMMABLE.
After the Supreme Court decision that Canadians have the right to physician assisted death, I strongly believe that physician’s right to conscientious objection is even more an imperative. Conscientious objection when viewed from the perspective of reproductive health, including abortion, is a fairly small issue as most physicians who morally cannot do abortions are protected simply by not being competent to perform abortions. Consequently another person or physician will do the procedure.
Unlike abortion the ability to assist a person to die is technically within the knowledge of many more medical disciplines and therefore impacting more physicians who will be asked to assist a person to die. A question arises that if physician assisted death is a right will an MD run afoul of the CPSO if they don’t comply as it violates human rights? I agree with those who argue that physicians have human rights as well as the general populace.
As we move forward the rights of physicians in hospitals will need to be protected and their ability to have and/or maintain privileges should not be affected if their conscience does not permit them to participate in assisted death. Again, unlike the abortion request, this affects many more physicians in hospital practices who will be asked to assist in dying.
Until the federal government response to the Supreme Court decision we will not know to what extent conscientious objection will be protected. Consequently, while waiting for federal legislation to determine its impact on Canadian human rights, I wonder if redrafting of this CPSO policy should be put on hold? Especially as this impacts far more physicians than those who may have to deal with reproductive health.
Lastly, I believe that most physicians believe and uphold human rights that protect from discrimination and do not exclude any person from care. I also believe that physicians should have the right to conscientiously object to doing and participating in procedures they morally object to. What should be encouraged if not enforced is transparency that enables a patient to know what a physician will or will not do.
How does the patient have rights but the physician does not? If rights are selective where do the ordinary people stand? I want my doctor to be a healer not a killer.
I agree with the the supreme court’s decision,that patients have the right to have assistance to end their lives. (I would not apply this rule to patients with psychiatric problems, where the situation may change greatly with treatment.)
However physicians also have their rights and moral believes. If any doctor does not want to co-operate with the ruling,it is not his/her duty to refer the patients to someone who is willing and available. This is against this physician’s moral beliefs.
An organization,such as the CPSO may provide a list of physicians available for this task and patients when requested may be given these names by the CPSO.
Dear members of CPSO,
There is certainly no need to take extreme measures to extend the length of life. When people are dying, effective palliative care with the best medical assistants is a society’s responsibility. But there is a profound difference between compassionately journeying with someone who is dying, versus killing that person, or assisting that person to commit suicide.
Assisted suicide means a person is incapable of killing oneself and hence demanding a second party to commit cooperative homicide. Legalization of assisted suicide involves a willing homicidal partner. What will happen if the second party is obliged to participate in the process of such against one’s conscience? A spiritual or moral suicide of the participatory party hence resulted. Physicians are trustworthy due largely in part of our inherent conscience. No citizen wants to be cared by a physician without conscience.
No one has a right to take away anyone’s life, and it is simply wrong for the state to allow or to encourage that. It is even more wrong for a medical body to endorse that. There may be demand or misguided statistics to support its legalization. It is usually the weakest, the disabled and the incapacitated who lack or hind their voice for fear of burdening the “progressive and productive” majority.
It is a perversion of the vocation of physicians to have them engaged in helping people to kill themselves. Physicians are called to be servants of healing, not agents of death.
The yardstick is morality and human conscience cannot be graduated or defined by statistics.
Assisted suicide is the deceptively attractive face of euthanasia. The most compelling cases grip our attention and sway the debate, and so the Court opens the door to assisted suicide. A set of limiting conditions, such as informed consent, were established. But the state is authorizing the killing of an innocent person, whatever controls are in place, and even those limitations can over time be swept away, leading to the more widespread practice of euthanasia. We have only to look at some European countries to see what lies ahead. We Canadians patriotically believe our country is special, but it is not so special as to be immune to the dynamics of increasing access to medical killing, as individualist rationales make persuasive the argument for that in more and more cases.
The court, recognizing that many physicians, faithful to their healing vocation, will not assist people to kill themselves, makes some very slight room for freedom of conscience. It trusts local Colleges of Physicians and other such groups to deal appropriately with the conscience issue.
As a practicing physician for twenty years, I do know that not everyone’s conscience is equal.
Some of us have weaker conscience.
Do all surgeons explain the surgical consent 100%?
Do all MDs explain side effect of medications 100%
Do all Obstetricians explain the implication of prenatal testing 100%
Everything can be lawful, but not all lawful are beneficial to human being.
The Law does not equate human conscience.
Public trust has been misplaced. Currently the College of Physicians and Surgeons of Ontario is proposing a draft conscience policy which states that physicians who refuse to perform a procedure to which they morally object must arrange that the procedure gets done by someone else. In other words, they are compelled to become accomplices. I urge the College not to go through with this unjust policy. This represents an assault on freedom of conscience of all physicians. Every Canadian with a conscience should speak up against it.
Any society that authorizes killing people through assisted suicide and euthanasia has lost its moral compass.
“The Ballad of Narayama” is a 1958 Japanese film of great beauty and elegant artifice, telling a story of startling cruelty. The poor village enforces a tradition of carrying those who have reached the age of 70 up the side of mountain and abandoning them there to die of exposure. It won 3 Mainichi film awards. A story of a necessity of survival became tradition which became an enforced culture. A thriller which is of worthy of review before casting your vote of conscience.
All Doctors should have the right to refuse assisting in euthanasia procedures & be able to refer patients elsewhere as a right to follow their moral conscience without being subject to any disciplinary action.
In my first comment I erred in saying that all Doctors should have the right to refer patients elsewhere—I meant to say that they should be able to refuse referring patients without facing any disciplinary action.
It always seems to start with some stories of how this is a humane thing to do, euthanasia, abortion….perhaps even a nice catch phrase like “every child a wanted child” and maybe now “you’re right to chose” will be for your own right to live or die for any variety of reasons that sound noble. Life is hard work, so is loving someone when it’s hard to do so. Relationships are inconvenient when the going gets tough. I wonder if it’s just an easy way to not be bothered with the messy facts of living for health professionals, family members, friends of those hurting. In saying this, I intend not to minimize the struggle of those hurting in any way. Is the only answer death?
I strongly oppose the CPSO’s draft policy that limit physicians Rights to Freedom of Conscience and Religion guaranteed in the Charter, and require them to make an effective referral to another physician if they refuse their patient’s requests, such as for euthanasia should it be legalized.
Thank you for your attention in this important matter.
Hope this will help settle this issue once and for all time.
Physicians should be able to have a right according to their conscience, religious or moral, to refuse procedures that is in total contrast to their belief and moral standings.
The College of Physicians & Surgeons of Ontario should not force doctors to refer for treatment that goes against their conscience.
MP Maurice Vellacott recently stated that there is “no other jurisdiction that currently allows euthanasia or assisted suicide imposes such an obligation.” So why would Ontario do this?
In fact, a National Post article recently reported that “similar policies are already in place in Alberta, Manitoba, Quebec and New Brunswick,” and that [Name omitted] said: “This is nothing new.””
But [Name omitted] is wrong to say Alberta, Manitoba and NB have “similar” policies to CPSO’s “effective referral” policy.
Those provinces require a referral to a doctor who will provide information about a procedure, not the procedure itself. See: Appendix 3 of CPSO’s annual meeting of Council:
http://www.cpso.on.ca/CPSO/media/documents/Council/Council-Materials_Dec2014.pdf
New Brunswick:
Referrals: When moral or religious beliefs prevent a physician from providing or offering access to information about a legally available medical or surgical treatment or service, that physician must ensure that the patient who seeks such advice or medical care is offered timely access to another physician or resource that will provide accurate information about all available medical options.
Manitoba:
Referrals: If the moral or religious beliefs of a member prevent him or her from providing or offering access to information about a legally available medical treatment or procedure, the member must ensure that the patient who seeks that advice or medical care is offered timely access to another member or resource that will provide accurate information about all available medical options.
Alberta:
Referrals: When moral or religious beliefs prevent a physician from providing or offering access to information about a legally available medical or surgical treatment or service, that physician must ensure that the patient who seeks such advice or medical care is offered timely access to another physician or resource that will provide accurate information about all available medical options.
Requiring doctors to act against their conscience and/or be complicit in an act they find morally reprehensible is a surely not a road we wish them to travel. If I knew my doctor could so easily leave his conscience by the side of the road when treating me for “A,” then how could I ever trust him when treating me for “B”?
When doctors signed up to become doctors, they did so knowing their freedom of conscience rights were sacred. Creating a policy that tramples on these fundamental rights is wrong and dangerous.
Please do not impose this declaration on our doctors. All persons,Doctors included, have the right to practise their profession in accordence to their own concience and religeos beliefs
The draft of this policy does not inlude the(humam) rights of doctors. These dedicated professionals have a right to practice medicine in accordance with their individual concience and religeous beliefs
It is imperative that all doctors be allowed to practice in a way which reflects their moral convictions.No doctor should be forced to counsel a patient against his/her ethical beliefs.
I am deeply concerned about the draft policy that would require a physician to participate directly or indirectly in any procedure that they disagreed with. Their reasons for disagreement maybe and often are multifactorial including scientific, environmental and moral reasons etc. Moral views are not necessarily religious views, as anytime something is said to be good or bad, a moral statement is being made. As a patient, I want my physician to be someone of moral integrity who I can trust with my health and my life. Should the draft policy be passed as written it will erode my trust in the medical profession as I will no longer be able to trust that my care providers will value my life, or the life of my family members. Physicians are trained to care, comfort and heal, not to kill their patients by participating in PAS /euthanasia. A number of people have spoken about the right of a personal autonomy with respect to the issue of PAS/euthanasia. Does that right supersede the right of a practitioner to decline for all the various reasons they may do so, moral or otherwise? Does the patient have a right to have this performed by a specific person? I think not. Patients don’t currently have a right to have a certain physician deliver their baby, perform their hip replacement or remove their mole etc. Many family physicians and specialists do not perform a variety of procedures or types of care for any of their patients for a variety of reasons that are not discriminatory in nature. As a physician, patients have asked me and I have declined to write fraudulent prescriptions or to lie on their behalf. It was my moral code that dictated that I not comply with these requests. It was also my moral code that dictated that I decline in a respectful manner. The current draft policy would force some physicians to violate their moral code or face disciplinary consequences. This is nothing short of discrimination and oppression against those whose moral code is different from that of the policy makers. What will happen to the many patients who may lose their physician should the policy not be changed?
Physicians have a long history of ethical guidelines which have stood the test of time. The Hippocratic Oath which I subscribe to and which has all the safeguards that protect patients and guide physicians. The Canadian Bill of rights protects the conscience rights and religious rights of all Canadians. Canadians are privileged to live in a society which protects these rights. The College of Physicians and Surgeons of Ontario is entertaining changing policies that currently work. If the changes proposed are passed the professional services of many physicians will be seriously impacted. I can’t imagine what the professional services of physicians would be like if they did not use their conscience. It would not be a healthy move in my opinion.
I agree that patients should be treated with respect and without discrimination. However, physicians should be able to follow their conscience when asked to perform or provide services which violate their principles or beliefs.The relationship that exists between patients and physicians is of such a personal nature, that it should be evident what beliefs the physician adheres to. The patient is free to choose a physician who can provide services to them which does not violate the physicians beliefs. The physician should never be forced to compromise their values nor should they force their values on their patients. Health care providers have rights too!
For the first time in my life, the inner security I have always known toward the medical profession has been shaken. Should this draft policy be adopted, I will no longer feel safe to place my trust in doctors.
The solution needed is more and better support for access to palliative care, not a medical profession licensed to assist suffering people by helping them kill themselves.
I do not believe the recent decision of the Supreme Court judges was in the best interests of society. When non-elected judges rather than parliament determine our laws, Canada’s democracy is seriously compromised.
Doctors must be allowed to maintain their freedom of conscience. By initiating or supporting legislation that would help Canadians feel safe. The C.P.S.O. would be wise to institute a truly trustworthy and honourable “medical aid in dying” based on caring, not killing.
Canada’s constitution guaranteed freedom of conscience and religion, therefore, physicians have the right to work with morality and integrity. Physicians can not be force to refer or provide medical procedures that violate their consciences.
The wording of the policy is too vague and broad as can be seen in the bottom line requirement that “physicians must provide care that is urgent or otherwise necessary to prevent imminent harm, suffering, and/or deterioration, even where that care conflicts with their religious or moral beliefs.” This statement is saying that conscience means nothing if the care is deemed “necessary… to prevent suffering.” Suffering is a very broad term that does not require physical pain. It can be psychological pain. So basically this policy leaves no grounds for conscience at all as abortion and euthanasia could both arguably be necessary to prevent suffering. In this the college is being discriminatory to its members. Amazing to think the college is supposed to be representing its members and it is taking away basic human rights and freedoms from its members. I am staggered by this policy and wonder who in the college feels entitled to ram this through? I would think there would be some remnant of respect for doctors having a conscience. I do not understand why the responsibility for providing all care should fall on the shoulders of each doctor – our supreme court has now ruled that citizens have a right to assisted death. I would think it would be the responsibility of the state to ensure access to this, not the responsibility of each individual physician. I would think a coordinated provincial approach could offer coverage for controversial procedures in a way that would respect and protect a doctor’s conscience rights. I am very disappointed in the college that they so quickly want to put their members on the line for something that calls for a coordinated approach. As another physician said, the “College is once again overstepping its jurisdiction and legal bounds.”
Physicians & Surgeons are people with rights also, as do patients. Doctors have taken a hypocritic oath to protect life. He is also, or should be protected under the Charter as is his patients. To infringe the patients right over a doctors is not morally right. Are we in a free country or a dictatorship? If a doctor wants to refuse to do a procedure or refer a patient to another doctor because of his moral or religious beliefs – he should be free to do so. As a patient, we should have the opportunity to have a doctor that might share those same beliefs and those that don’t should have the same opportunity to have a doctor that shares theirs.
To take away a persons freedom of conscience right is a tragic loss to our country.
Dear CPSO,
I am a final year medical student in Ontario. I am hoping to pursue residency in Family Medicine next year. It must first be stated that when we are accepted into medical school, there is no contractual obligation that requires us to leave our morals and values behind in order to study or practice medicine. In fact, it is quite the opposite. We are encouraged to take our experiences and background into account when we make clinical judgments. It may surprise many, but my religious background and desire to serve others is the reason I entered a career in medicine in the first place. My religious background and teachings influence my motivation to study every day, the way I treat my patients, and how I interact with others.
I have been taught that practicing medicine is an “art” and that many factors go into clinical decisions. Theses factors include patient requests, but in good conscience, I will not always prescribe antibiotics because I am requested to, or put a person currently addicted to alcohol at the top of the liver transplantation list. As a future physician, I am called upon to use my skills, knowledge and personal experiences to provide care. My knowledge and ability to use evidence based medicine does not support certain medical practices including euthanasia. Referral is participation in acts that are against my conscience.
We live in a society that celebrates differences and people of all backgrounds. When I meet a patient for the first time, whether that patient has a Qur’an or a Bible in her hand, or does not hold any religious beliefs, she is treated with the same respect and dignity. Likewise, I also hope my patients respect my beliefs and recognize that if they request a certain medication or procedure that violates my moral code, there are other ways to obtain these services (that are very accessible, especially in Ontario). I respect my patients’ differences and recognize that their beliefs may be different from my own. However, this does not justify requiring an act that goes against my conscience, especially with respect to services that are already accessible through public health units, hospitals, walk in clinics, and many other physicians. The physician that does not provide for or refer for a particular service does not abandon her patients because she seeks these services elsewhere.
I appreciate the College’s work on the policy entitled, “Professional Obligations and Human Rights.” I agree that patients must be informed of their options but there should not be an obligation to provide or refer for services that doctors find morally objectionable. In compelling physicians to refer, you are limiting their right to conscientious objection. There is significant disagreement in our society as to what constitutes a moral act, and I do not expect the College to define or limit morality. All I expect is that physicians, as professionals, be allowed to respect their own consciences. Freedom of conscience is foundational to our free society and cannot be limited, even for the best of intentions. If we coerce physicians into violating their consciences we will inevitably erode the personal integrity which is the basis of the physician’s relationship with their patients.
With the Supreme Court’s recent legalization of assisted suicide in Canada, your proposed policy is becoming extraordinarily frightening for new physicians. Medical students should not fear practicing in this province. Doctors should not be forced to refer or provide services that they are morally opposed to. Your proposed policy will influence where I practice.
I hope you will do what is best for the people of Ontario and the doctors of the province by amending this proposed policy.
Thank you for your consideration.
I think this draft policy should not be approved.
Telling doctors they have to do something they believe is wrong or go practice somewhere else will not help to provide care for all the people who need doctors and don’t have them.
The suggestion of a list of doctors willing to assist in death requests is more favorable (if this policy does get approved) then telling doctors not to practice in the province they were licensed in.
The College is overstepping its boundaries. I believe that physicians should be allowed to treat patients according to their beliefs. Physicians have rights as well, and should not be forced to provide services that go against their conscience.
TO WHOM IT MAY CONCERN:
I am writing to you with grave concern regarding the content of your proposed draft policy. Sections 8,10,11 suggest that physicians who decline to participate in certain acts for reasons of conscience should be compelled to refer their patients to other physicians who will perform these acts. it does not address the fact that many of these physicians will find the act of referral itself objectionable, as they consider it material cooperation with the act. In compelling physicians to refer, you are limiting their right to conscientious objection. There is significant disagreement in our society asa to what constitutes a moral act, and I do not expect the College to define or limit morality. All I expect is that physicians, as professionals, be allowed to respect their own consciences. Freedom of conscience is foundational to our free society and cannot be limited, even for the best of intentions. If we coerce physicians into violating their conscience we will inevitably erode the personal integrity which is the basis of the physicians relationship with their patients. I encourage you to revise the sections above, and include a clear defence of the right tp freedom of conscience for all physicians!
I believe that if a physician cannot help a patient to put an end to his/her sufferings on the basis of his religious beliefs, he/she should be able to refuse. However, I also believe that it is the physician’s duty to refer the patient to another physician in the name of compassion and the patient’s human rights. Personal morals and beliefs should not interfere with the delivery of care. In addition, the decision should be taken by a team of doctors and health specialists as it is done in Belgium, a special committee, not by one physician only. It would be wrong to burden one person with such a responsibility.
As an Ontarian and Catholic I still believe that freedom of conscience still matters and cannot be eliminated through policy . The college is again overstepping it, s boundaries.
I strongly disagree with this proposed new policy that requires physicians to refer and in some cases perform procedures contrary to their conscience. If doing a thing is immoral, so is arranging for someone else to do it immoral. Doctors are there to extend, enhance and PROTECT human life. The camel has his head in the door of the tent(abortion) and now he wants to put his whole body in (euthanasia).
To compel a physician to make a formal referral for abortion or physician assisted suicide when the physician would consider such action to be contrary to his religious beliefs and moral code is contrary to the concept of freedom of religion and conscience which is at the core of the Charter of Rights and Freedoms.
What may be legal may not be ethical or moral-a concept behind the Nuremberg war crimes trials.
The C.P.S.O. would be well advised not to proceed with this policy lest they find themselves cast by a fickle prevailing wind upon a rocky shore of legislated intolerance.
Physicians conscience rights must be protected. I strongly oppose this draft policy and its requirement for many physicians to practice contrary to their moral beliefs, which will lead some doctors to consider leaving practice in Ontario (I know many personally who have expressed this consideration), and others who will avoid family medicine and other needed specialities which will require practices (such as euthanasia) they are morally opposed to. Infringing on the rights of doctors who strive to practice with integrity would be a huge step in the wrong direction for medical care here in Ontario.
Do you want a doctor with moral integrity?
Physicians should have the right to say NO to providing certain forms of treatment. However, I’m particularly concerned with the requirement that physicians provide referrals for treatments which they feel are morally and ethically wrong.
If a physician feels a treatment is morally and ethically wrong, and then aren’t they still violating their conscience by asking someone else to perform the procedure? How is the physician’s right to freedom of conscience being protected under these circumstances? In addition to this, a physician might feel that if a procedure is morally wrong it would also be harmful to the patient. Under these circumstances the physician would be violating not only their conscience, but also their Hippocratic Oath by referring the patient to someone else to perform the procedure.
I trust that the Draft Policy be revisited in consequence of the Carter decision.
Surely if a physician is opposed to physician assisted death, he does not have a duty to refer the patient to another physician.
Further, the Policy should address the conflicts that may arise between the CPSO
Policy and the Contract/Undertakings that a Physician may have entered into with a health care provider such as a hospital.
A physician may well be conflicted between the two.
Physicians should be defended in their
discretion and integrity ,which is not evident in the draft policy.
I believe that doctors should have their right of freedom in religions and conscience protected, without a mandate for an ” effective referral “, which is equivalent to hiring a ” hit man ” to do the dirty job.
An Open Letter to the CPSO
Regarding the 2015 Draft Document “Profession Obligations and Human Rights”
Introduction
The College of Physicians and Surgeons of Ontario has been meticulous to address the quality and fiduciary obligations of physicians practising in a pluralistic society. In 99.9% of medical practice, there are few discrepancies of perspective about what constitutes proper practice and how to make referrals when necessary. However, in 0.1% of medical practice there are controversial situations that involve moral and ethical considerations and these situations have been and will continue to be problematic for both physicians and the College since consensus is difficult to achieve. What follows is a proposal for the College to be innovative in promoting a model which would allow individuals to have access to their choice of service in controversial services and at the same time, safeguard the conscientious behaviour of physicians.
WITH A WISE MODEL, BOTH PATIENT CHOICE AND RESPECT FOR A PHYSICIANS CONSTRAINTS OF CONSCIENCE IN CONTROVERSIAL ETHICAL AND MORAL MATTERS IS POSSIBLE……read on:
Background Observations/Facts/Premises
We live in a pluralistic society.
There is a very wide spectrum of ethnicity, religious persuasion, worldview etc.
These same diversities are evident within all professions including the healthcare sector.
Both the Canadian Bill of Rights and Charter of Rights endorse the respect for diversity.
Ethical persuasions will depend on the foundational premises which undergird a particular point of view.
A uniformity of perspectives on many ethical and moral matters will never be achieved since there will never be consensus on the premises. For example a theistic conviction will never mesh with an atheistic one.
These diversities, therefore, will always require innovative resolution in the provision of services within the healthcare sector if individual rights are to be preserved.
Without some form of societal compromise and civil honest dialogue, there will be an inevitable effort to coerce some to “park their convictions outside of their workplace” and to act contrary to their conscience.
There is a risk for individuals as well as groups to claim freedom for their own perspectives whilst denying the freedom for others holding a contrary view. Ironically, global rules can be mandated by but a few individuals.
What is “legal” as defined by law is not necessarily what is right or wrong by more absolute standards. As an example, the murder and torture of a slave in the old South was legal but hardly moral, ethical or right.
There have been massive paradigm shifts in the Oaths taken by graduating physicians. The Hippocratic Oath, considered normative for a couple of thousand years, clearly forbade abortion and euthanasia. That boundary has been moved substantially with graduates swearing allegiance to the law which can relatively easily be changed (and has been changed).
What we have before us is both a practical matter but also a political matter. The practicalities are well understood by the CPSO, and there are safeguards for the provision of good healthcare in all its aspects. But what also needs to be understood is the pressure by some to change and homogenize society to their own agendas by political coercion.
To give an example, a complaint is lodged against a physician who refuses to prescribe the birth control pill as a result of religious convictions. The physician has announced the office policy clearly aforehand. There are innumerable other physicians within the community who are able to accommodate the patient’s request but instead of accepting the one physician’s policy and finding an accommodating physician, a complaint is lodged and it becomes a College and legal battle. This has ceased being a practical matter of obtaining the requested birth control pill since there is almost no difficulty in obtaining it from an alternate physician. Instead, it has become a political lever to coerce the physician to change her view and, despite conscientious objections, to prescribe.
One must differentiate the practical considerations from the political
Within the medical profession, there is represented a very wide spectrum of persuasion/conscience pertaining to the ethical tensions within our society. For any given patient, there will be no shortage of physicians that can be matched to their particular preferences. Thus, in practice, there will always be the ability to match patient to physician.
The spectrum of diversity within the medical profession always provides options for the individual seeking various services that may be controversial.
The key question is how the matching can be done without physicians having to put their consciences into deep freeze. The College has tightened the wording in the current draft on Professional Obligations and Human Rights in comparison to the document of 2008. There is a subtle implication that the rights of the patient will trump the rights of the physician on controversial issues. (Line 118 and 119). The term “care” in this sentence is not defined and given the context, obviously will apply to a minuscule slice of a physician’s practice. Nor is the term “impede” clarified. In real and practical terms, there will always be alternative routes for the patient. However, those with a political agenda to shape society may use these concepts to coerce physicians into complicity with convictions other than their own.
The College appropriately emphasizes that how something is communicated is as important as what is communicated. This indeed is important and a tone of care and understanding must be maintained.
However, the one very important sticking point for many physicians will be College’s directive to provide “an effective referral [which] means a referral made in good faith, to a non-objecting, available, and accessible physician or other health-care provider.” (Line 156 and 157) This statement constrains a physician more stringently than the statement of 2008 which stated that the physician “Advise patients or individuals who wish to become patients that they can see another physician with whom they can discuss their situation and in some circumstances, help the patient or individual make arrangements to do so.”
This shift in the proposed draft is putting the onus of responsibility on a physician who potentially feels herself to be an accomplice to an objectionable pathway, be it abortion or physician-assisted suicide etc. Is this necessary? Is there any way around this? Yes, there is. In a 2008 edition of “Dialogue” the notion of “balance” was discussed. There is a way to achieve respect for the diversity that prevails within our society and also respect the diversity of conviction amongst physicians.
The standard paradigm of guidelines, rules, and management of quality issues in the provision of healthcare has been well established and there is broad consensus about this. However, when there are controversial matters (and there will always be controversies as long as there are different world views), the rules established by the College, of necessity, will have to recognize the diversity of opinion. Otherwise, there will be a forced uniformity which obliterates bona fide protestations of conscience.
The approach to the controversial areas (which always will be with us) requires wise innovation to preserve the intent of the Charter of Rights to respect the rights of all concerned: patients and physicians ALIKE.
PROPOSAL OF A WORKING MODEL
Physicians should post within their offices or websites the areas of clinical services that they provide and any disclaimers that address potentially controversial matters (already, I believe, a College policy).
Patients accommodated within the practice should sign that they have read and understand the parameters of that particular practice.
The Ontario Government, OMA, CPSO etc. can establish easily accessible websites which list and identify physicians, clinics, and organizations which would provide services that are controversial and are willing to accommodate individuals for these. Publicly instituted series of options can be made easily accessible and transparent.
Physicians who feel unable to make referrals, could simply direct the individuals to the website(s) which patients can easily access, and find accommodating physicians.
Innovative models are easily constructed to ensure access to controversial services whilst safeguarding a physician’s integrity of conscience and practice.
As a society, we have somehow pushed theological considerations aside notwithstanding the Nation’s “Canadian Bill of Rights” attestation that we are a nation “under God”. It is not the prevue of the College to address these issues but, an adverse judgment for honestly held scruples is fraught with mischief in the long run. It is worth keeping in mind that over half of our population holds to firm religious convictions that surely speak principles into the public space and that our very laws have been religiously premised.
It cannot be ignored that over half of our population holds to firm religious convictions.
ALGORITHM
Before implementing the draft, it would also be wise for the College to explore the algorithm of how it would handle a complaint that a given physician would not provide a service on the basis of religious or moral convictions. There already have been such cases but this will increasingly be an issue as the Supreme Court has struck down the laws circumscribing Physician Assisted Suicide and new laws are enacted. One can be quite confident that a large segment of the physician community in Canada will have nothing to do with intentionally killing patients. There could be hundreds of cases of complaint.
Once physician-assisted suicide becomes legal, there will large numbers of physicians who will have nothing to do with intentionally killing patients. Will they be brought to tribunals?
Will the College resist the politicization of healthcare and support the right to conscience of physicians who commit themselves to a high standard of care for their patients? Will the College recognize that there are models which enable patients to obtain the care that they wish whilst at the same time safeguard the integrity of conscience of physicians who subscribe to convictions that may be Christian, Jewish, Muslim, Hindu or otherwise? Or will the College strip physicians of their licenses if they refuse to bend to a purely humanistic politic? Will there be coercive measures to force compliance when alternative neutral models can be constructed?
The College also needs to be vigilant to discern complaints which are designed to target dissenting physicians for political ends as compared with bona fide complaints pertaining to quality or true accessibility issues. The publication of services via the media or websites or identifying the same on practice profiles would go a long way to resolve complaints and avoid the politically motivated agendas. The recently well publicized comment of one physician who expressed the opinion that physicians with scruples should get out of medicine (or not be 55allowed in), exemplifies the politics of intolerance that is hurtful and harmful to our society. It also contravenes the Human Rights Code.
Without the College making adequate accommodation for physicians who are constrained by conscience on controversial situations, the logical outcome would be the blocking of such individuals from being accepted into medical schools (contrary to the Human Rights Code) and practicing medicine. For that matter, there are politically motivated individuals and organizations who would shape society to their own agendas by preventing those with religious convictions from entering the legal profession, government, as well as medicine. Intimidating and expensive lawsuits are not uncommon. There is, of course, nothing new about such a strategy. Honest debate and dialogue are sometimes in short supply.
Before implementing the draft policy, it would be advisable for the College to study the algorithm of response when complaints are brought against physicians who feel constrained by the voice of conscience in controversial matters.
Summary:
We live in a pluralistic society which is safeguarded by the laws of the land.
There are models by which the diversity of conviction can be respected and at the same time services provided that are controversial.
This is a call for the CPSO to support and promote (or at least recognize) the models that avoid arbitrary penalties for those who seek to practice to high moral and ethical standards.
The current proposed rigidity with regard to making referrals in morally and ethically controversial situations plays into the political agenda rather than recognizing that in reality, there is no lack of physicians willing to provide service on the other side of the controversy.
I commend the efforts of the College to formulate policies that are fair and balanced but I also perceive that the College is bending to a political agenda that seeks to squash the soul of the medical profession. I trust that these reflections will provide a helpful perspective. A broad view of how we came to be and where we are going is essential!
Respectfully submitted,
One of the major concerns of this Orwellian proposal by the CPSO is that doctors would be forced to refer patients for procedures that violate the doctors own personal conscience. Those in favor of the proposal might say, “What’s the problem here?–they’re aren’t being forced to actually do the procedure are they?” Perhaps not, but they would be a complicit as would any other co-conspiritor would be in a criminal act. The chemical companies in Nazi Germany were, in principle, as complicit in the death camps as were the people who operated the ovens. How in the wide world can a civilized country like Canada fail to see the implications? Words fail the trained mind.
The proposed policy requires physicians who choose to limit the health services they provide on moral or religious grounds to do so in a manner that:
i. Respects patient dignity;
Comment: This is mostly a matter of communication, and is already dealt with at the level of medical education programs;
ii. Ensures access to care;
Comment: Framing of the issue of the access to care in conjunction with the freedom of conscience and moral or religious beliefs is misplaced and potentially dangerous, especially since “This policy sets out the legal obligations under the Code for physicians to provide health services without discrimination”.
In the first place, the College is overstepping its jurisdiction on legal (since the establishment of legal obligations is the role of parliament and the courts) and moral grounds,
Next, since the Nuremberg Trials, it is essential to justice that conscience cannot be ignored in the name of legal methodology and by legal methodology (The College might want to consult such reference documents as Reawakening memory: The Nuremberg congress ‘medicine and conscience 50 years after the Nuremberg trial of German doctors’ Medicine, Conflict and Survival, Vol. 13, Issue 3, 1997). Personal responsibility and conscience form the very essence of a positive and moral law.
In practical terms, the access to care is currently, in the scope of the proposed policy, a non-issue (for example, abortion is self-referred in Ontario). The big issue is euthanasia. Given the Supreme Court decision, the policy MUST NOT pre-establish or impose any regulations pertaining to the provision of euthanasia before a judicial framework is established. The right to life is fundamental. It is not merely equal in importance to other specific rights.
Let us also remember that access to care in Ontario is limited much more by economic or administrative factors than by conscientious decisions of individual physicians.
iii. Protects patient safety
Comment: This is precisely the area of the College jurisdiction, and more specific guidelines with regard to “suffering, and/or deterioration” would be helpful.
In summary, the proposed policy gives an impression of a hastily written document aimed at appeasing bureaucratic bodies rather than seriously addressing a complex and multifaceted issue of the place of conscience and religious beliefs in the practice of medicine. The document should be withdrawn, and completely rewritten before any resubmition.
Human beings are not wired to divorce conscience, world-life view, opinion and beliefs from practice(s), robots are. Especially in the medical field where I presume professionalism is essential and expected, a doctor should be able to, and have the freedom to be upfront with me and say what is on his or her mind concerning my varied health needs and treatment options. If I disagree I can always obtain a 2nd opinion but at the very least I respect the right of my doctor to provide an opinion even if the opinion involves faith based fundamentals. I do not think a policy statement should handcuff a doctor in this matter.
I am writing to express my opposition to the College of Physicians and Surgeons of Ontario’s draft policy mandating that physicians must make referrals for procedures and ‘treatments” even if it is against their conscience This is a violation of a physician’s freedom of conscience rights enshrined in our Constitution.
I ask that you reconsider this due to the ramifications of such a policy on both doctor and patient
It is so important the we do not legislate away freedom in this country that has been built on the basis of freedom. Doctors need the right to freedom of conscience. And patients can shop around to get the treatments they feel that they need. If a significant enough number of doctors refuse to provide a certain treatment, perhaps the idea that it is essential for the common good and true need for it should be more carefully studied.
I am writing to express my opposition to CPSO of Ontario draft policy mandating that physicians must make referrals for procedures and treatments even if is against their conscience.This is a violation of a Doctorès freedom of conscience rights which is enshrined in our Constitution.
I urge you to seriously consider the ramifications of such a change
Dear CPSO Council Members;
Thank you for your efforts to ensure that healthcare in Ontario is provided free from discrimination in a manner that best serves patient interests. I do, however, have a number of concerns with the proposed policy “Professional Obligations and Human Rights” that I hope you will consider in revising the current draft. Many (if not all) of these have already been expressed in earlier posts, but I would like to summarize and hopefully further develop some of them.
1. Rights: The policy acknowledges the Charter right to freedom of conscience and religion as well as highlighting situations in which such rights may be limited. It then summarizes factors that may be considered in balancing competing rights, citing the Syndicat Northcrest vs. Amselem case in which the Supreme Court ruled that the religious right of a group of Orthodox Jews to build succahs on their apartment balconies outweighed the property and personal security rights of the building owners that would be infringed upon through such a practice. I would argue that the physician rights being infringed upon by the proposed CPSO policy significantly outweigh any patient rights that may be compromised. The act of referring for and/or performing a health service that is contrary to a physician’s moral or religious beliefs, including procedures that involve the ending of life and thus violate some of the most important moral or religious precepts an individual may hold true, is no trivial matter. In contrast, such services can relatively easily be made available by self-referral for patients that desire them, thereby avoiding any compromise to the integrity and wellbeing of physicians without interfering with patient access to care. Good patient care depends upon the maintenance of such integrity and wellbeing as apart from it physician function is impaired and societal needs disserved. I don’t have a legal background, but I am not aware of any legal precedent in Canada that would directly suggest that a physician is obligated to refer for and/or provide a health service against good conscience (please let me know if I am incorrect). To the contrary, my understanding is that the Supreme Court of Canada has recently upheld the right of individual physicians to choose not to participate in physician assisted death once it is legalized. It is inappropriate and I believe harmful to both the medical profession and more importantly patient care for the CPSO to create this unnecessary policy that if anything directly contradicts the ruling of the country’s highest court. It is an insult to the rule of law. Were such a policy nonetheless adopted by council, I would certainly be interested in contributing to a legal challenge against it.
2. Discrimination: A physician who chooses not to provide a particular health service to all of their current or prospective patients is not being discriminatory in even an indirect and unintentional manner. In contrast, the proposed CPSO policy specifically discriminates against physicians with particular moral or religious beliefs and limits its scope by requiring that physicians abstain from promoting religious beliefs without addressing any other potentially inappropriate non-religious beliefs that a physician might promote in the course of their practice.
3. Service: If I understand it correctly, the objective of this policy is to establish CPSO expectations that will ultimately facilitate access to care for patients in Ontario. I would suggest, however, that it may in fact have the opposite effect. In particular, I have noticed several postings on the public form expressing concerns about physicians re-locating or otherwise changing their practice if the new policy were adopted. As a first year family medicine resident who has completed all of his medical education in Ontario, I feel indebted to this province and would prefer to remain here to practice. If, however, the CPSO were to require referral and in some cases provision of health services that violate my ethical principles, this would affect my career decision making and would provide reason to consider practicing in another jurisdiction. Furthermore, I am interested in completing a care of the elderly fellowship and focusing part of my practice on geriatric patients, but would be discouraged from doing so if I were not confident that I would be exempt from having to refer select patients at the end of life for physician assisted death. I know a number of other like-minded medical trainees and physicians, and although we remain a minority, the effect this policy could have on our practice decisions nonetheless may impact negatively on patient care access.
Thank you very much for your consideration of these points. I hope that they will be helpful to you in revising the proposed policy in such a manner as to optimize patient care in Ontario.
The draft policy does not truly respect the moral or religious beliefs of physicians and surgeons. What about their human rights?
Dear Members of the Consultations Committee:
As a medical student in the Province of Ontario, I am writing to you with grave concern regarding the content of your draft policy, “Professional Obligations and Human Rights”. I ask the Consultations Committee to retract this draft policy for the reasons I have outlined below.
If adopted, the draft policy will jeopardize the ability of physicians in Ontario to follow their consciences. The policy suggests that physicians who decline to participate in certain acts for reasons of conscience should be compelled to provide an effective referral to other physicians who will perform those acts. This requirement does not address the fact that many physicians find the act of referral itself to be objectionable, as it is considered material cooperation with the act. If a physician finds a certain act to be immoral, it follows that facilitating and arranging for that act to be done is also immoral. In compelling physicians to refer, you are limiting their right to freedom of conscience and freedom of religion. I would like to remind you of the fact that the very Canadian Charter of Rights and Freedoms that you cite in your draft policy protects freedom of conscience and freedom of religion. The CPSO’s draft policy inherently prioritizes the freedoms and rights of patients over that of physicians, despite the fact that the CPSO does not have the legal jurisdiction to rule on such matters. I ask that the CPSO respect our country’s constitution and recognize the importance of diversity of medical and ethical judgement.
I do not believe that physicians should discriminate against patients, and in fact believe that patient care is of the utmost priority. However, contrary to what the draft policy implies, deciding not to offer a particular service in no way discriminates against patients, provided that the service is not offered to any group at all. It is difficult to see how limiting physicians’ right to freedom of conscience and religion will result in any less discrimination. In fact, moving ahead with this policy will actually create systematic discrimination based on conscience or religious belief.
Moreover, compelling physicians to make referrals that they do not morally agree with will not improve patient care. Requiring doctors to participate in procedures that go against their beliefs will reduce their personal sense of integrity if they continue to practice. This will significantly harm the physician-patient relationship, as physicians would be recommending their patients receive procedures or medications that they do not personally believe in. If approved, this draft policy will coerce a large percentage of physicians to participate in assisted-suicide despite their moral objection. I bring your attention to the Canadian Medical Association, which asserted physicians’ right to conscience in their August 2014 meeting.
Access to care will also not be improved by implementing the draft policy. Common actions and procedures that physicians may object to include abortion and contraception. The availability of these services is not threatened by physicians who morally object to them. In fact, these services are easily accessible without referrals, given the ability of patients to self-refer to clinics that provide such services.
I would also like to bring your attention to the final section of the draft policy, which is entitled “Protecting Patient Safety”. The language used in this section is ambiguous and unacceptable in its current form. There is no clear guideline as to what is considered “imminent” harm, suffering, and/or deterioration. The incredible lack of balance and comprehensiveness to this section of the draft policy implies the CPSO has little regard for the implications of the policy.
In summary, I believe that the CPSO is overstepping its jurisdiction in defining and limiting morality. Freedom of conscience is foundational to our free society and is protected by law. I ask the CPSO to retract this draft policy on “Professional Obligations and Human Rights” in light of the Canadian Charter of Rights and Freedoms. Instead, the CPSO should create a policy to defend the right to freedom of conscience for all physicians.
[**MESSAGE FROM ADMINISTRATOR: DURING THE CONSULTATION PERIOD, WE RECEIVED 3 RESPONSES FROM INDIVIDUAL RESPONDENTS CONTAINING THE CONTENT PUBLISHED ABOVE. ALTHOUGH THIS FEEDBACK HAS NOT BEEN PUBLISHED IN DUPLICATE, THE COLLEGE ACKNOWLEDGES RECEIPT OF THESE SUBMISSIONS.**]
Forcing someone to do something which they are morally opposed to is a human rights violation. Doctors should not be subject to such a human rights violation simply because they are doctors. Their rights and freedoms should be protected. Expecting a doctor to refer a patient for a service which they feel is immoral is absolutely ludicrous.
I believe CPSO should not force their physicians to refer to another physician for services they cannot provide for reasons of conflict of conscience. CPSO should respect the conscience rights of their own physicians just as they do of all citizens of Ontario. Abortion, physician-assisted suicide and euthanasia are morally serious issues because they are life-and-death issues and these questions are intrinsically important to every person – this is our human nature. These are extraordinary issues and deserve extraordinary measures of handling.
If CPSO believes it will be too difficult for patients to find another physician to help them with their needs, then I believe CPSO itself should provide some means of assisting the public with access to another physician. This may become increasing more practical for all citizens of Ontario when physician-assisted suicide and euthanasia become established practice.
Perhaps a register of physicians could be established, outlining those who do and those who do not provide such services. The CPSO website physician search function already outlines which professional specialties as physician provides. Could this tool not be expanded to include other morally-controversial questions of service?
Asking a physician to refer does not provide a full accommodation of the physician’s own conscience rights and I believe the physician deserves a full accommodation of his rights. I also believe this could be done without causing great hardship to the public. And this is mandated under the Ontario Human Rights Code.
I am a pharmacist, and pharmacists in Ontario experience the same disregard of their conscience rights by their College as is now proposed by CPSO for their physician members.
I believe our Colleges could balance the rights of the citizens of Ontario with the rights of their own members in a more appropriate fashion which would not deny the conscience rights of the medical professional. It is an issue that deserves a little more organization and strategy, but I believe it is important enough to warrant it. I believe our medical professionals deserve a full accommodation of their own conscience rights and ask the College of Physicians and Surgeons to seriously reassess their proposed policy.
Please consider the Freedom of Expression
of Doctors who because of Christian Principals, CANN0T agree with your proposed
policies.
We DO NOT AGREE WITH YOUR PROPOSAL.
WE DO NOT AGREE WITH YOUR PROPOSALS
WE SUPPORT FREEDOM OF SPEECH &
CHRISTIAN PRINCIPALS
Religous beliefs make a person who they are. It is part of theie being. For most, it makes them more compassionate and kind. I think the College is overstepping. Please let doctors be who they really are
If the patients have rights to choose, so should the doctors. Why should the patient be more superior, esp when generally the doctor is more knowledgeable. If the doctor has religious convictions, he should be allowed to act on them. They are what make him who he is, both as a citizen and as a doctor. For many, the value of life is waht made them become a doctor in the 1st place – to help and save others. How can the College tell them the must act more on “facts” or patients wants than their own religious convictions?
I agree, Doctors should have the choice to say no, as long as it is not an emergency, If people want euthanasia then they choose a Doctor that will perform such.
Please let the doctors decide.
Do no harm. It’s a good motto! Why would anyone trust a physician who would do them harm?
Dear College of Physicians and Surgeons of Ontario,
I am writing to you with deep concern regarding the draft proposal “Professional Obligations and Human Rights”. Your current draft has far reaching implications given the recent ruling of the Supreme Court regarding doctor assisted suicide and I disagree with the intention to force a physician to do something against their conscience.
I propose these areas of contention should be a matter of discussion between doctor and patient before establishing a doctor-patient relationship. Patients can then be cared for by doctors of like-minded values, giving the highest level of care physically, mentally and emotionally. I also propose that the College consider the future implications of recent rulings and how they have morphed in other societies to include euthanizing babies, handicapped, depressed and elderly people. This is not health care and it puts patients at risk when they are concerned that they will be a “burden” to their loved ones. Health care provides caring patient and family support and quality palliative care. These are the things that should be valued in patient care and advise the government of the importance of these services safeguarding the vulnerable.
Just because something is not criminal, doesn’t mean it is ethical and moral. Ethical and moral doctors are critical for quality health care, I want a physician who has not been required to divorce these qualities to remain in practice. This policy would essentially force conscientious objectors out of your profession and decrease the quality of care. It is intolerant ideology masquerading as enlightened objectivity, no one should have the right to force someone to do something against their conscience or tell them they are not welcome in their profession. It is discriminatory.
I STRONGLY DISAGREE with physicians performing OR referring for abortion, euthanasia, and other matters of conscience TODAY!
I STRONGLY DISAGREE with physicians performing OR REFERRING FOR ABORTION,EUTHANASIA and other matters of conscience TODAY.
Dear College of Physicians and Surgeons of Ontario, Professional Obligations and Human Rights Policy Drafters,
I am writing to let you know that as a member of the public, I am concerned about what I consider a threat to doctors’ freedom of conscience regarding their “duty to refer” (particularly with regards to issues that are related to religious morality). Requiring a doctor to provide referrals when they cannot perform a procedure for reasons of conscience is still forcing them to abet an action which goes against their conscience. Removing the moral element from a doctor’s professional life is a fundamental assault on their personal integrity. Doctors’ freedom of conscience should not be eliminated through policy.
Please reconsider your policy draft, particularly the section entitled “Ensuring Access to Care.”
Do you not consider it a violation of a doctor’s conscience and human right forcing him or her to perform abortions? Killing doctors’ consciences will be a horrific travesty for our country not unlike Nazi doctors.
Don’t do this. I realize this sounds dramatic but mull it over to find the truth of it.
Just because we have moved exponentially into the science and technology fields; I still feel the matter of life and death is in the hands of our creator and should remain as such. Helping people to have babies and helping people to end their lives is a slippery slope where ethics and values are compromised to such an extent, there is no turning back. What happened to: “Render unto Caesar the things that are Caesar’s and render to God the things that are God’s.” Thank you!
Dear Members of the Consultations Committee:
Subject: Draft Policy “Professional Obligations and Human Rights”.
I am writing to you with grave concern regarding the content of your proposed draft policy. Sections 8, 10 and 11 suggest that physicians who decline to participate in certain acts for reasons of conscience should be compelled to refer their patients to other physicians who will perform these acts. It does not address the fact that many of these same physicians will find the act of referral itself objectionable.
One of my concerns as a Catholic priest is the decrease in Catholic doctors that this policy will bring about. Catholic doctors who cannot in their conscience give an effective referral for euthanasia or abortion, for example, will be forced eventually to stop practicing medicine in Ontario. Potential Catholic doctors will be discouraged from studying medicine in order to become a doctor in Ontario. Catholic women especially, however, greatly benefit from having practicing Catholic doctors. These women benefit from doctors who understand things like Natural Family Planning.
I am concerned that your draft policy would also lead to similar policies for other medical professions. We are in great need of Catholic nurses and psychologists. Many Catholics and Christians suffer from severe depression, bipolar disease, and schizophrenia. They too benefit from medical professionals who understand their faith from the inside. The effect of your policy will be to decrease the likelihood of their being any Catholic doctors in Ontario.
In closing, I mention the following. Until someone from a warm climate actually experiences the winter in Ontario, it is very hard to understand what it is like. In a similar way, it is hard to understand many Catholic patients without experience of being Catholic. We have many young people who want to be Catholics and doctors. Please do not take this possibility away from them.
Please recognize the human rights of our physicians, surgeons, and medical personnel when you are implementing legislation. I ask the College of Physicians and Surgeons of Ontario – to please protect the freedom of conscience of all its members. The conscience of many people does not allow the taking of anyone’s life.
Thank you for realizing this important concept.
Peace,
I am writing re the issue of physicians’ right to follow their conscience.
In line 120 of the draft “Professional Obligations and Human Rights” the courts are quoted as stating, “All rights are of equal importance.” This seems to me to imply the rights of patients and physicians are of equal importance. Yet physicians’ rights to follow their consciences may be violated by the requirement to make referrals for clinical options that go against their moral, religious, or even clinical beliefs. Even were this not to pose a problem currently, social norms can change and be accepted over time. One need only look to Nazi Germany to see where changing norms can lead.
No physician, for example, should be required to refer a patient for experimental procedures which are of no medical value to the patient or which are for such purposes as eugenics.
As another example, a physician should not be required to refer a girl for female circumcision at her parents’ request.
With regard to physician assisted suicide, there undoubtedly are physicians who will find it contrary to their consciences to refer patients for this procedure. Could there not be established a way for patients to access the procedure without a doctor’s referral. Contraception and abortion are available without such a referral. Perhaps there could be some sort of public registry whereby patients on their own could access such procedures.
In summary, I believe the document re Professional Obligations and Human Rights needs to be broadened to protect physicians’ right to follow their conscience.
Thank you for this opportunity for input.
I am a family physician in British Columbia. I am writing to state that I am strongly opposed to requiring physicians to participate in procedures or care that goes against their conscience and that they do not agree with on a moral basis. Although physician assisted suicide has been ratified by the courts, many physicians including myself feel that they could not in good conscience participate in providing this service. I strongly feel that the right of physicians to follow their conscience should be upheld.
Participating in physician assisted suicide may violate physicians sense of duty, morality, religious freedom and/or the hypocratic oath.
I do hope that the Ontario College of Physicians will uphold physicians’ right to conscience.
Dear Sir or Madam,
Forcing doctors to violate their moral integrity is not only damaging to the doctor but to the patient and to medical staff and medical care they want and need. No doctor should
be forced to perform an abortion or euthanasia (if it becomes legal).
To those concerned with human rights at CPSO,
I would like to advise you that I strongly object to the limitation of the rights of doctors which would result should the following statement contained in the draft policy be retained in the final draft:
“Where physicians are unwilling to provide certain elements of care due to their moral or religious beliefs, an effective referral to another health care provider must be provided to the patient”.
Please make note of this objection. It puts the physician in the position of being hypocritical: by passing on his/her responsibility thereby encouraging someone else to undertake an action to which his/her conscience objects.
Hi,
The revised policy does not take into consideration the human rights of physicians, it only considers the patient.
Physicians have rights the same as everybody else.
Just because a person decides on a career as a physician does not mean you can violate their human rights.
A physician must be able to have moral and religious beliefs and be permitted by their working policies and judicial laws to live by them.
The policies being put forward are totally contrary to why a person chose the career as a physician in the first place, a person chooses to become a physician to HELP patients and IMPROVE their quality of life and not to END it.
Why is it that everybody thinks that to end a life this act must be performed by a physician?
Anybody can be trained to give someone else a lethal injection it does not have to be a physician.
If the High Court of Canada wants to play God and then pass their ruling over to the Government to create the necessary laws to implement their ruling then the Government has it in their power to create a new professional career as an ‘executioner’ or what ever other name they want to give it.
A person requesting assisted suicide could apply to the Supreme Court of Canada, who obviously have all the answers, and if their decision is yes then they can refer the person to a member in the new profession in order for their life to be terminated.
To end a life does not have to be the responsibility of a physician.
As Catholics we believe in the value and dignity of every human life. When someone is suffering we as a society should extend all the love and support and best medical assistance possible in the final stages of life. Any society that authorizes killing people through assisted suicide and euthanasia has lost its moral compass.
Please ensure that Catholic Physicians have a right to refuse effective referral since this violates their own conscience and basic human rights.
As a Canadian I really hope our doctors will not be coerced into acting against their own consciences in order to maintain active membership in their own professional organization. Please ensure that those whose beliefs are not in line with the so-called up to date ways of thinking – i.e abortion on demand, or death by doctor, etc. are still valuable members whose rights must also be respected. I shudder at the prospects of a society where those not wanted or considered undesirable can be dispatched as the majority desires. Please reconsider any such proposals. All our hard-working and dedicated physicians deserve no less.
I respectfully submit the following:
The draft policy on Professional Obligations and Human Rights of the College of Physicians and Surgeons of Ontario is lacking in balance in favour of a purely secular lifestyle. Failure to protect physicians who exercise their moral conscience is a violation of the ability of such physicians to practice their faith. As well, the act of abstaining from contribution to certain contentious medical procedures by such physicians does not effectively limit patient access to those procedures in contemporary society, thus it is not an issue of acesss to care. Importantly, deterring individuals of faith from pursuing a medical profession, or any section of the profession, so as to avoid a conflict of conscience is entirely unreasonable and contrary to basic good judgement.
Please respect and protect every life from the moment of conception to natural death.
MAY GOD BLESS ALL THE DOCTORS AND SURGEONS OF ONTARIO!
Please respect and protect all stages of human life from the moment of conception until natural death.
MAY GOD BLESS ALL OF YOU AND GRANT YOU ALL WISDOM TO KNOW BETWEEN RIGHT AND WRONG!
[**MESSAGE FROM ADMINISTRATOR: DURING THE CONSULTATION PERIOD, WE RECEIVED 3 RESPONSES FROM INDIVIDUAL RESPONDENTS CONTAINING THE CONTENT PUBLISHED ABOVE. ALTHOUGH THIS FEEDBACK HAS NOT BEEN PUBLISHED IN DUPLICATE, THE COLLEGE ACKNOWLEDGES RECEIPT OF THESE SUBMISSIONS.**]
To Whom It May Concern;
Please be advised that I reject the proposed “effective referral” mandate for doctors, whose Charter right of freedom of conscience and religion must be respected.
I reject the proposed ‘effective referral’ mandate for doctors whose Charter right of freedom of conscience and religion must be respected.
Dear Sir,
I am writing to voice my objection to the draft document of the College of Physicians and Surgeons of Ontario.
The CMA only recently determined that doctors’ rights to conscience should be respected. The College of Physicians and Surgeons of Ontario should be supporting this position, not undermining it.
Doctors should have the right to practice medicine in keeping with the dictates of their conscience. They should not be expected to do procedures they do not agree with in conscience, nor refer to other practicioners for those procedures,.
To whom it may concern,
I implore you to do all that is in your might to save and protect Human Life.
If respecting an individual’s right to die is what this is about, then the other side of this is…. that you should be respecting the Dr’s right not to kill a person or be involved in any way if it goes against their belief or conscience. It is a violation of their rights and freedoms.
To whom it may concern,
I feel a great sense of urgency and anxiety over the idea of physicians being forced to do things against their conscience, it’s a violation of their human rights. It scares me because it is the start of a slippery slope that could lead to moral degradation in medicine and among society as a whole. I personally know several doctors and all of them are greatly distressed over the idea. Many doctors will stop practicing if they find themselves forced to do things against their conscience and we already have a shortage of doctors as it is.
I want to have a doctor who shares my moral beliefs, and I would never trust a doctor who continues in a line of work that goes against their conscience, what short of human being would that be? And what sort of human being would force another to do it?
Please, for the sake of basic morality, do not change the physicians and Ontario human rights code.
Dear Members of the Consultations Committee:
Subject: Draft Policy “Professional Obligations and Human Rights”.
I am writing to you as a concerned citizen, a teacher and as a mother of four to express my concerns with sections 8, 10 and 11 of the proposed draft policy. The policy suggests that physicians who decline to participate in certain acts for reasons of conscience should be compelled to refer their patients to other physicians who will perform these acts. It does not address the fact that many of these same physicians will find the act of referral itself objectionable, as they consider it material cooperation with the act. In compelling physicians to refer, you are limiting their right to conscientious objection.
As a parent and a teacher I encourage youth to explore pathways that will lead to careers which help others and that build a positive society. I always hold the vocation of the physician as an ideal career example to my children and students. The draft policy is of great concern to me because if it goes into effect I cannot encourage my children and students to be the future doctors of Ontario. How can I encourage them into a position that will force them to act against their conscience?
I encourage you to revise the sections above, and include a clear defense of the right to freedom of conscience for all physicians.
Hello – I am writing to make known my objection to the proposed new draft of the document – Physicians and Surgeons of Ontario, Professional Obligations and Human Rights. I believe the document seriously limits the freedom of conscience and religion of physicians by compelling them to refer patients to other physicians when they are “unwilling to provide certain elements of care due to their moral or religious beliefs”. By forcing physicians to refer patients you are forcing them to participate in what they believe to be an immoral and unethical act.
I strongly disagree with this document and ask that the segment that forces doctors to refer be removed or re-written to ensure no moral or religious boundaries are broken.
I thank you for considering this request and expect the final document will protect any physician’s conscientious objection because of religious or moral grounds to be fully respected.
Human Rights include the right of Conscience,and must not be trampled on.
Physicians and Surgeons should not be ,in their practice,forced to Go Against their conscience to commit or give referral for actions contrary to their Moral Conscience.
Dear Members of the Consultations Committee:
Subject: Draft Policy “Professional Obligations and Human Rights”.
I am writing to you with grave concern regarding the content of your proposed draft policy. Sections 8, 10 and 11 suggest that physicians who decline to participate in certain acts for reasons of conscience should be compelled to refer their patients to other physicians who will perform these acts. It does not address the fact that many of these same physicians will find the act of referral itself objectionable, as they consider it material cooperation with the act. In compelling physicians to refer, you are limiting their right to conscientious objection.
I reject the proposed “effective referral” mandate for doctors whose Charter right of freedom of conscience and religion must be respected.
Doctors are doctors to save lives. They did not become doctors to remove life. They should not forced to terminate life or be punished for refusing to do so.
It’s that simple.
TO WHOM IT MAY CONCERN
We reject the proposed “effective referral”mandate for doctors whose Charter right of freedom of conscience and religion MUST be respected.
Canada is a democracy, not a dictatorship.
As a concerned citizen of Canada, and a resident of Ontario, I first want to thank the CPSO for being open to public consultation regarding the proposed revisions to the Document on Professional Obligations and Human Rights. I also wish to emphasize my support for the College’s acceptance of the existing Charter rights of freedom of religion and conscience; I am writing this letter to urge the CPSO to continue defending these two fundamental rights for patients and health-care providers, alike.
After reading the proposed new draft of the Document, however, I am deeply concerned that the physician’s “duty to accommodate” means, at various points throughout the draft, his “duty” to dispense with his conscience. Repeatedly, throughout the draft, the patient’s ‘rights’ (which, in the case of suicide and other procedure, are not rights at all) are seen as superseding any reasonable reservations, on moral and rational grounds, that a physician may have for refusing to provide or refer certain medical procedures. As such, this draft seems to equate ‘conscientious objection’ with ‘unjust discrimination’ and this is a philosophically, morally, and socially problematic association: the draft fails to recognize that, in certain circumstances, the physician is bound to take a moral stance, based on rational and evidence-based facts, even if this stance goes against the wishes or intents of the patient. A physician refusing to provide or refer certain procedures is not unjustly discriminating against a patient. Rather, he is making a moral judgement about an action. Conscientious objection means discerning that certain actions are objectively wrong and cannot be supported either directly or indirectly.
I would remind the College that offering physicians the right to kill in positive law is a Rubicon we do not want to cross. To force physicians to kill their patients, or force them to refer to someone who will (amounting to formal cooperation in the act), is to add insult to injury, applying coercive pressure to their conscience.
If the draft is approved in its current state, most physicians who wish to offer their skills and services in Ontario will face undue and unethical pressure from the very institutional body that is supposed to support and protect both them and their patients. Compelling individuals to act against their rational conscience decisions violates the Charter and the United Nation’s Universal Declaration of Human Rights, as outlined in Article 1, which states that “All human beings are born free and equal in dignity and rights. They are endowed with reason and conscience and should act towards one another in a spirit of brotherhood.” And, as mentioned, Section 2 of our own Charter of Rights and Freedoms clearly provides for “freedom of religion and conscience”.
Moral convictions based on careful reasoning and scientific evidence, which may be supported by religious belief but is not specifically ‘religious’, need to be protected in Canada—a nation that prides itself on upholding and promoting the principles of democracy. I strongly urge the CPSO to carefully reconsider the wording and ethics of its current draft of the Professional Obligations and Human Rights document.
To whom it may concern,
In response to the College’s invitation for feedback on your draft policy – “Professional Obligations and Human Rights”, I want to express my grave concerns. As a teacher who has, for over 37 years, guided countless individuals into the medical profession, and who counts among her friends many physicians, I object to a policy that is intimidating to physicians who “choose to limit the health services they provide for moral or religious reasons” and requires that they “must” provide patients with referrals to other health care providers in cases where their conscience prohibits them from providing a patient with a service.
The right to refer to another physician constitutes absolutely no protection for physicians whose religious rights preclude them from providing certain services such as abortion. Indeed, the Catechism of the Catholic Church (Canon Law: 1868) states that “we have a responsibility for the sins committed by others when we cooperate in them: by participating directly and voluntarily in them; by ordering, advising, praising, or approving them…”
In the case of abortion, the Catechism expressly states: “Formal cooperation in an abortion constitutes a grave offense. The Church attaches the canonical penalty of excommunication to this crime against human life.” This means that a physician who refers a patient to another physician faces the canonical penalty of excommunication as an accessory. (Canon: 2272)
In the case of euthanasia, or assisted death, the Catechism (Canons: 2276-2277) states: “Whatever its motives and means, direct euthanasia consists in putting an end to the lives of handicapped, sick, or dying persons. It is morally unacceptable. Thus an act or omission which, of itself or by intention, causes death in order to eliminate suffering constitutes a murder gravely contrary to the dignity of the human person and to the respect due to the living God, his Creator. The error of judgment into which one can fall in good faith does not change the nature of this murderous act, which must always be forbidden and excluded.”
Murder is regarded as a grave sin for Catholic physicians. Those in grave sin are excluded from the sacraments of the Church and are everlastingly damned if they do not seek reconciliation and forgiveness. However, the fundamental condition for forgiveness is the resolution not to commit the sin again (Canon: 1451). Further, “… conversion and repentance, entails sorrow for and abhorrence of sins committed, and the firm purpose of sinning no more in the future.” (Canon: 1490)
Under the draft policy, physicians know that if faced with another request for the same services, the College will require them to commit the sin again. This means that they can never, according to Canon Law, achieve reconciliation and therefore they face excommunication and eternal damnation (Canon: 1035).
The proposed policy has catastrophic consequences for any Catholic doctor. Indeed, I think it could be said that it would prevent a Catholic doctor from practising. It constitutes a direct impact on religious beliefs, and an interference that is “more than trivial or insubstantial”.
A doctor’s moral beliefs are fundamental to his or her philosophy as a practitioner. Please reconsider this intimidating policy that offers members of the College absolutely no support for the fundamental beliefs that led them to become doctors in the first place, and threatens them with termination of their careers.
Please, consider that patients have responsibilities as well. If they can seek out one doctor, they can seek out another one who shares their philosophy. I was once in a situation where my doctor told my mother that I was likely to give birth to a baby with Downs Syndrome (I was on vacation at the time). Because the doctor broke confidentiality, but more importantly because she had already advised me on my rights to an abortion, I sought out another physician. That baby is now in law school. Patients can find their own doctors.
Please change your policy for the sake of the doctors, and more importantly for the sake of the patients of this province.
To whom it may concern:
I have reviewed the draft policy. I have no hesitation in saying that it is morally objectionable to anyone who follows the Roman Catholic faith.
The policy is inherently flawed with respect to physicians who “choose to limit the health services they provide for moral or religious reasons” and the requirement that an effective referral to another health care provider “must be provided”.
The College appears to believe that the religious rights of physicians are respected if they do not have to provide objectionable services personally, and that the right to refer to another physician is sufficient protection for physicians. This ignores the express teachings of the Catholic Church as set out in the Catechism. It is not necessary to actually participate in an act to incur sin. One may sin as an accessory, as set out in Canon 1868:
1868 Sin is a personal act. Moreover, we have a responsibility for the sins committed by others when we cooperate in them:
- by participating directly and voluntarily in them;
- by ordering, advising, praising, or approving them;
- …
In the case of abortion, the Catechism states:
2272 Formal cooperation in an abortion constitutes a grave offense. The Church attaches the canonical penalty of excommunication to this crime against human life. “A person who procures a completed abortion incurs excommunication latae sententiae,” “by the very commission of the offense,” and subject to the conditions provided by Canon Law. The Church does not thereby intend to restrict the scope of mercy. Rather, she makes clear the gravity of the crime committed, the irreparable harm done to the innocent who is put to death, as well as to the parents and the whole of society.
This means that a physician who refers a patient to another physician faces the canonical penalty of excommunication as an accessory.
In the case of euthanasia or assisted death, the Catechism states:
2276 Those whose lives are diminished or weakened deserve special respect. Sick or handicapped persons should be helped to lead lives as normal as possible.
2277 Whatever its motives and means, direct euthanasia consists in putting an end to the lives of handicapped, sick, or dying persons. It is morally unacceptable.
Thus an act or omission which, of itself or by intention, causes death in order to eliminate suffering constitutes a murder gravely contrary to the dignity of the human person and to the respect due to the living God, his Creator. The error of judgment into which one can fall in good faith does not change the nature of this murderous act, which must always be forbidden and excluded.
Murder is regarded as a grave sin. Those in grave sin are excluded from the sacraments of the Church, until they repent and confess the sin. However, a condition for forgiveness is the resolution not to commit the sin again – Canons 1451, 1490:
1451 Among the penitent’s acts contrition occupies first place. Contrition is “sorrow of the soul and detestation for the sin committed, together with the resolution not to sin again.”
1490 The movement of return to God, called conversion and repentance, entails sorrow for and abhorrence of sins committed, and the firm purpose of sinning no more in the future. Conversion touches the past and the future and is nourished by hope in God’s mercy. (Emphasis added)
Under the draft policy, a physician knows that if faced with the same request for services, the College will require him to commit the sin again. This raises the question whether he or she can ever have the requisite contrition to be absolved.
Those who die in a state of serious sin are denied entry into heaven – eternal damnation is their state.
1035: The teaching of the Church affirms the existence of hell and its eternity. Immediately after death the souls of those who die in a state of mortal sin descend into hell, where they suffer the punishments of hell, “eternal fire.”
There will always be physicians who do not find these procedures morally objectionable, so patients will have alternatives, whether it is through advertising or a list compiled by the College. But placing the burden on the individual physician places a morally indefensible requirement on him or her.
It seems to me that the proposed policy has potentially catastrophic effects for any Catholic physician. Indeed, I think it could be said that it would prevent a Catholic doctor from practising. Where then, is the balancing of rights, (Policy 123-128)? There is here clearly a direct impact on religious beliefs, and an interference that is “more than trivial or insubstantial”.
Speaking as a lawyer of 35 years experience, I believe a constitutional challenge of this policy is a certainty. While there are doubtless physicians whose beliefs are not offended, and therefore the patient has other options, the Policy leaves no option for physicians who cannot in conscience provide services. Speaking as one who has instructed converts to the Catholic faith for over 25 years, the proposed policy is morally objectionable.
Freedom of conscience must be paramount. As the patron saint of lawyers, St. Thomas More, said as he suffered execution for following his conscience: he was the King’s loyal subject, but God’s [subject] first.
I support to reject the proposed “effective referral” mandate for doctors whose Charter right of freedom of conscience and religion must be respected.
They should also be allowed to advise their clients on alternative solutions available. In most cases such desperate patients are lacking a word of encouragement. In the end the Physician and the Patient will have joy.
God bless our generation.
This is to inform you that I strongly object to the following statement in your draft policy “Professional Obligations and Human Rights”
“Where physicians are unwilling to provide certain elements of care due to their moral or religious beliefs, an effective referral to another health care provider must be provided to the patient”
Here you are asking physicians to again support an action to which they object in their own conscience. Surely this is contrary to their rights protected in the foundation of our free society, and the trust placed in them by patients.
Respectfully submitted.
I wish to oppose any legistration that forces medical practioners to go against their moral beliefs. Their rights should be protected our constitution and not be forced otherwise by vote seeking politicians.
To Whom it May Concern:
This is to inform you that I reject the proposed “effective referral” mandate for doctors as indicated in the proposed new draft document of the College of Physicians and Surgeons of Ontario. I believe that it violates the doctors’ Charter right to freedom of conscience and religion.
À QUI DE DROIT!
TOUTE PERSONNE SUR CETTE PLANÈTE A LE DROIT, LE PRIVILÈGE,ET JE DIRAIS LE DEVOIR D’ÉCOUTER SA CONSCIENCE!
DONC, LE MÉDECIN QUI SOIGNE, DOIT AGIR SELON SA CONSCIENCE. COMMENT PEUT-IL AUTREMENT DORMIR LE SOIR?
DE MÊME, EN LE FORÇANT À RÉFÉRER UN PATIENT À UN AUTRE MÉDECIN QUI ACCOMPLIRA À SA PLACE CE QUI POUR LUI EST MAL EST AUSSI GRAVE!
RÉVEILLEZ-VOUS! MISEZ SUR LES SOINS PALLIATIFS ET VOUS VERREZ LE PROBLÈME SE RÉSOUDRE CAR, LES PATIENTS ONT SURTOUT BESOIN D’ÉCOUTE ET DE SOINS POUR ATTÉNUER LEURS SOUFFRANCES ET LEUR ANGOISSE.
The inherent problem with the statement that physicians who “choose to limit the health services they provide for moral or religious reasons” and the requirement that an effective referral to another health care provider “must be provided” is simple.
The College appears to believe that the religious rights of physicians are respected if they do not have to provide objectionable services personally.
Sins need not be personally committed. One may sin as an accessory, as set out in Canon 1868 of the Catechism of the Catholic Church:
1868 Sin is a personal act. Moreover, we have a responsibility for the sins committed by others when we cooperate in them:
- by participating directly and voluntarily in them;
- by ordering, advising, praising, or approving them;
To deny a doctor freedom of conscience is also a violation of human rights–and to claim such a referral process is part of “a balance” (123-128) shows a lack of understanding of the religious objections. There will be doctors willing to perform euthanasia and abortions, but for a Catholic doctor, even referring someone would place a heavy toll on their conscience.
Freedom of choice should include freedom of conscience. To deny freedom of conscience is to remove part of that choice. This would not impact all doctors, nor would it impact legislation. It would merely allow Catholic doctors to practise without violating their religious codes. The choice is still there, but now doctors would be able to choose as well.
I would like to state my opposition to any government bill
forcing the medical profession to go against their freedom of conscience
and forcing them to be a participant in an act violating their morals
I wish to be made law, protecting the medical profession and nothing less.
I would like this opinion of mine brought forward especially by my elected M.P.
Please no political jargon just my belief in this put to the gorverment assembly.
I wish to support the Physicians Charter of Right of Freedom of Conscience in the matter of the new draft document stating that physicians must provide an effective referral to another health care provider- which I believe to be a clear violation of a physicians rights and morals.
Dear Sirs/Madames
Do you want a doctor with moral integrity?
hysicians should have the right to say NO to providing certain forms of treatment. However, I’m particularly concerned with the requirement that physicians provide referrals for treatments which they feel are morally and ethically wrong.
If a physician feels a treatment is morally and ethically wrong, and then aren’t they still violating their conscience by asking someone else to perform the procedure? How is the physician’s right to freedom of conscience being protected under these circumstances? In addition to this, a physcian might feel that if a procedure is morally wrong it would also be harmful to the patient. Under these circumstances the physician would be violating not only their conscience, but also their Hippocratic Oath by referring the patient to someone else to perform the procedure.
Dear Sirs/Madames
We want to be served by doctors with moral integrity!
Physicians should have the right to say NO to providing certain forms of treatment. However, I’m particularly concerned with the requirement that physicians provide referrals for treatments which they feel are morally and ethically wrong.
If a physician feels a treatment is morally and ethically wrong, and then aren’t they still violating their conscience by asking someone else to perform the procedure? How is the physician’s right to freedom of conscience being protected under these circumstances? In addition to this, a physician might feel that if a procedure is morally wrong it would also be harmful to the patient. Under these circumstances the physician would be violating not only their conscience, but also their Hippocratic Oath by referring the patient to someone else to perform the procedure.
Most human beings who suffer a debilitating illness especially if this includes pain, will, at some point, say: “I wish I were dead”. This is more an expression of frustration than a death wish. The desire to live is the strongest desire of the human heart. No one of sound mind would actively choose suicide.
Legalizing assisted suicide in not the answer to pain and suffering. A compassionate response is effective palliative and long term care. These services are already in place and need to be expanded.
Physicians are trained to provide life giving care and recognize that extreme measures to prolong life are not needed nor advisable. However, killing a person goes contrary to the physician’s training and conscience. Referring a patient for assisted suicide makes one complicit in the act and no physician should be forced to go against her or his better judgement.
11. Where physicians limit the health services they provide due to their moral or
religious beliefs, the draft policy states that they must do so in a manner that respects
patient dignity.
Do you support or oppose the following expectations, which aim to respect patient dignity
in this context?
Physicians must communicate objection directly to the patient.
Strongly support
Physicians must inform the patient that objection is due to personal and
not clinical reasons.
Strongly support
When communicating objection, physicians must not express personal
judgment about the patient.
Strongly support
Physicians must not promote their own religious beliefs when
interacting with patients.
Neither Support or Oppose
Physicians must not attempt to convert patients
Neither Support or Oppose
13. Where physicians limit the health services they provide due to their moral or
religious beliefs, the draft policy states that they must do so in a manner that ensures
access to care.
Do you support or oppose the following expectations, which aim to facilitate access to
care in this context?
*
Physicians must provide information about all options that are available
and clinically indicated for the patient, even if the options conflict with
physicians’ moral or religious beliefs.
Somewhat Support
Physicians must not withhold information about the existence of a
procedure/treatment due to their moral or religious beliefs.
Somewhat Support
Physicians must refer patients to another health
care provider for any
care that they are unwilling to provide due to their moral or religious
beliefs.
Strongly Oppose
Physicians must refer the patient to a non
objecting, available and
accessible physician or other health
care provider.
Strongly Oppose
Physicians must make a referral in a timely fashion.
Strongly Oppose
Physicians must maintain an effective referral plan for the frequently
requested services they are unwilling to provide.
Strongly Oppose
Physicians have to be honest, inform patients about options, but they should not make referrals because they would be more involve in the situation they do not believe in. Patients should be responsible to find a physician that will provide the service they want, the service the Physician explain at the first place.
15. Where physicians limit the health services they provide due to their moral or
religious beliefs, the draft policy states that they must do so in a manner that protects
patient safety.
Do you support or oppose the following expectation, which aims to protect patient safety?
*
Physicians must provide care that is urgent or otherwise necessary to
prevent harm, suffering, and/or deterioration (i.e. emergency situations),
even where that care conflicts with their religious or moral beliefs
Strongly Oppose
Dear Members of the Consultations Committee:
I am writing to you regarding the contents of your proposed draft policy, which suggests that physicians be compelled to provide an effective referral to their patients in cases where the physician’s conscience will not allow him to do the patient’s bidding.
We all know what kind of cases this will most likely come up in: abortion, euthanasia, and medical mutilation such as sterilization. Whatever the courts or the legislature may say about these things, these acts are intrinsically evil. And to force someone to cooperate in their execution is a violation of his conscience.
Yes, I am well aware that large segments of our society think that good and evil are meaningless terms, which can be refashioned in whatever way the powers that be find useful to hold on to their power and augment it. But I also know what happens to societies that take this route and I do not want ours to go there.
We need good doctors – and politicians also need good doctors. Protect the good doctors already in the profession and keep the profession something that young people might aspire to. Do not grovel before the altar of political and judicial power. Defend the doctors whose consciences still speak clearly and make it possible for them to practice their honourable profession of healing without doing harm. They must not be forced to cooperate with the culture of death. Executioners can easily be found. Good doctors are much harder to come by.
Dear Members of the Consultations Committee:
Subject: Draft Policy “Professional Obligations and Human Rights”.
I am writing to you at this time specifically regarding the content of your proposed draft policy.
Sections 8, 10 and 11 suggest that physicians who decline to participate in certain acts for reasons
of conscience should be compelled to refer their patients to other physicians who will perform
these acts. It does not address the fact that many of these same physicians will find the act of
referral itself objectionable, as they consider it material cooperation with the act. In compelling
physicians to refer, you are limiting their right to conscientious objection.
There is significant disagreement in our society as to what constitutes a moral act, and it is
beyond the mandate of the College to define or limit morality. Physicians, as professionals of
medicine, must be allowed to respect their own consciences. Freedom of conscience is
foundational to our free society and cannot be limited, whether by groups such as the Islamic
State, population control elements of society or professional societies, even for the best of
intentions. If we coerce physicians into violating their consciences, we will inevitably erode the
personal integrity which is the basis of the physician’s relationship with their patients.
Medical practice seems increasingly inundated with moral issues. The knee-jerk reaction of the
College recently has been to suggest limiting the number of members of various religious and
cultural groups in the different specialties. This marks a significant milestone in mandate
definition and it signifies that now is the time to open up all aspects of the medical profession
management in Ontario, from the selection of medical school candidates to job allocation to the
annual review of physician performance and how physicians treat patients – some with arrogance
and a prime focus on compensation. All of these aspects must become transparent for the benefit
of the people of Ontario.
I encourage you to revise the Professional Obligations and Human Rights sections above, and
include a clear defence of the right to freedom of conscience for all physicians.
The proposed “effective referral” mandate is violation of a physician’s rights that must be rejected.
Dear Members of the Consultations Committee,
I am writing to you with great concern with your proposed draft policy. Your policy as is suggests that physicians who decline to participate in certain acts that go against their conscience should refer the patient to another doctor. This does not address the fact that many of these same doctors will find that act of referral objectionable as well. This means you are limiting a doctors right to conscientious objection. I think it is important for our physicians to have the ability, as professionals, be allowed to respect their own consciences. This is a fundamental freedom in our society.
Thank you for reading this message and I encourage you to revise sections 8, 10, and 11 and include a clear defence of the right to freedom of conscience for all physicians.
I am against the proposed new draft document of “effective referral”. This goes against the physicians’ right of his own conscience. We need physicians who have conscience and integrity.
Dear Sirs/Madams:
I think democracy, freedom, and human rights are going down the drain in Canada if there is a policy to limit the doctors’ right to freedom of conscience and religion. Therefore, I strongly object to the policy of forcing doctors to refer their patients to other doctors for abortion or euthanasia if they, due to their conscience and religion, cannot comply with their patients’ requests.
I am very concerned about your draft policy that seems ill-considered and Draconian. Referring for procedures is being complicit, Canadians already understand that. As Canadians we refuse to refer for capital punishment. We will not extradite a prisoner to any jurisdiction where that person could face the death penalty unless we have a guarantee from the government trying the case that the person will not be executed. If we understand this with such a tenuous connection and before the person is even tried, surely we understand how asking physicians who have ethical objections to refer for this procedure would be asking them to be complicit. Many will leave medicine rather than be complicit in killing. This will not help the physician shortage. Would citizens like a doctor who does everything in family practice except these ethically unacceptable procedures and referrals, or no doctor at all? To avoid any embarrassment on either side, the colleges of physicians and surgeons in the provinces could keep registries of those physicians willing to participate and refer. If this is as great a good as it is being reported to be, and very “mainstream”, surely there will be enough physicians who will be willing to participate to satisfy the requests of what supporters say will be a “very small” number of patients in “extreme” cases who may wish to die.” Besides, do citizens want physicians who will stand by their convictions and stand up to the government when they think it is wrong, or do they really want a doctor who will do whatever the government asks?
I think that doctors should have freedom of conscience in providing health care. Their freedom cannot be eliminated through policy.
Requiring them to violate their freedom will result in less available health care.
Dear Members of the Consultations Committee,
I am writing to you regarding the proposed draft policy, Sections 8,10, and 11 which indicate that physicians are compelled to refer their patients to other physicians if they are unable to provide care /perform acts because of religious or moral reasons. By compelling physicians to refer, they are limiting their right to conscientious objection.
Please revise the sections above and include a clear defence of the right to freedom of conscience for all physicians.
Thank you.
No physician should be forced to either to perform the killing of another human being or to refer the deed to some other physician. We are heading into a Hitleresque area which will morph into getting rid of those whom the state deems unfit. It goes all the way back to Margaret Sanger’s getting rid of “human weeds.” You think I am kidding? Look what is really happening in the Netherlands and Belgium. We don’t need to promote the Culture of Death in Canada. We have already crossed the line with abortion of children in their mothers’’ wombs which should be the safest place in the world.
Dear CPSO,
I strongly object to the draft policy of CPSO limiting physicians’ right to conscience and religion. I think the Supreme Court should not be given the power to force their judgment on the vast majority of people by saying that no right is absolute. This is unconstitutional and against the Canadian Charter of Rights, I think it is against human rights and medical ethics for the CPSO to make a policy forcing physicians to act against their conscience and religion, namely by forcing them to refer their patients to another physician for cases like abortion or assisted suicide when they would not perform the act themselves because they know and believe that it is wrong to do so. This is totally something that a democratic and free country should not even contemplate to do.
I write to let you know that I oppose your stance on making it mandatory for doctors to refer clients to other doctors when they themselves are opposed to doing abortions, assisted suicide etc.
Dear Sir/Madam,
Please reconsider your proposed “effective referral” mandate. It is a violation of a physician’s rights and freedom of conscience, so therefore must be rejected
Dear members of the Council of CPSO:
I recently learned that The College of Physicians and Surgeons of Ontario has proposed a new drafted policy in Physicians and the Ontario Human Rights Code, stating “Where physicians are unwilling to provide certain elements of care due to their moral or religious beliefs, an effective referral to another health care provider must be provided to the patient. An effective referral means a referral made in good faith, to a non-objecting, available, and accessible physician or other health-care provider.”
If this proposed policy is approved, Ontario physicians and surgeons would be obligated to refer patients to effect medically assisted suicide which may be the very thing that they object in the first place. I find this very unsettling. It is not right for anyone to take away lives. It is even more so to propose policies that endorse such idea. I sincerely urge CPSO to reconsider the mandatory obligation for physicians and surgeons to “provide an effective referral”.
I am writing to express my concern with the Draft Policy on Professional Obligations and Human Rights currently under review by the College of Physicians and Surgeons of Ontario.
The requirement that health care professionals provide referrals to other care providers or provide care to patients in urgent circumstances where that care conflicts with their conscience is a troubling proposal.
I trust that the medical professionals I receive care from are free to make complex ethical decisions guided both by professional guidelines and their own consciences. It would cause me deep discomfort to know that the professionals I seek care from were risking being sanctioned for engaging in moral and ethical deliberation about the care they perform.
The Ontario Human Rights Code protects all Ontarians, including health care providers in an employment setting, from discrimination on the basis of a protected ground. The detrimental impact of the Draft Policy on human rights would not be limited to health care providers themselves; the policy will contribute to a professional culture where individuals are discouraged from exercizing their professional and ethical judgement to prevent discrimination and other violations of the human rights of their patients. I refer specifically to the rights of persons with disabilities in circumstances where substitute decision makers are directing their care.
I would urge the College to reconsider the thrust of these proposed amendments to its policy on human rights, and instead ensure robust protection for the freedom of conscience of its members.
To Whom it May Concern,
Re: Professional Obligations and Human Rights policy
Thank you for providing us with the opportunity to provide feedback on the Professional Obligations and Human Right policy. I trust, since your obligation by law is to protect the best interest of the public, you will consider my comments regarding this policy.
I strongly oppose the draft of the Professional Obligations and Human Rights policy, for several reasons:
1) The policy as drafted is not in the best interest of the citizens of Ontario. As a citizen of Ontario, I appreciate having, and am convinced it is in my best interest to have, a Christian doctor who holds and makes decisions from the same personal values and beliefs as I hold and are based on God’s Word, the Holy Bible. This way, when I am faced with a health care decision, my physician can provide me with advice that is in accordance with the Bible and thus with my personal values and beliefs. If my doctor would be required to refer patients for procedures that he is opposed to on moral grounds or face some sort of penalty, as this policy mandates, he would no longer be able to practice medicine in Ontario with a pure conscience (something that is of tantamount importance to a Christian). If this would happen, I would lose my family physician, and would no longer receive medical advice in line with my personal values and beliefs and therefore no longer receive medical advice that is in my best interest. I assure you that this is a concern for a significant number of Ontario citizens.
2) Requiring someone, whether it is a physician or otherwise, to do something that is against his conscience and/or religious beliefs violates his/her freedom of conscience and religion. Do doctors no longer have “human rights”?
3) A physician may advise a patient not to receive or undergo a certain procedure based on scientific reasons and if this recommendation is also in accord with his religious convictions it could be construed as the physician trying to convert a patient.
4) Everybody, physicians included, operates from a “worldview”. As such, all the decisions we make are in line with that worldview. This is true of the decisions and advice given by physicians as well. If we are to be a multi-cultural society we have to accept this and not force or coerce everybody to operate from the politically expedient “worldview” as seems to be the case with this proposed policy.
5) A physician who on conscientious grounds does not provide specific services also believes that these services are not in the patient’s or society’s best interest. Forcing physicians to provide such services contradicts the opening line of your draft policy: “The fiduciary nature of the physician-patient relationship requires that physicians act in their patients’ best interest.”
I strongly recommend and insist that this policy be revised to enable all physicians in our province to practice in a way that is in our (as patient’s) best interest, in accordance with their religious convictions, and supported by scientific evidence.
I am an Ontario resident who has just finished reading the Professional Obligations and Human Rights draft policy. I was taken aback by some of the things outlined in the policy, especially in regards to the physician’s religious or moral convictions. While I am thankful that a physician does not need to provide a service to which s/he objects, I am baffled as to how they are to make a referral in good conscience. For example, if a physician holds a strongly held religious or moral conviction that abortion is murder and therefore will not provide that service, that physician will also view referring a patient to an abortion provider as accomplice to murder. The draft policy states that, “Physicians embody these values and uphold the reputation of the profession by, among other things … Properly managing conflicts, especially where the physician’s values differ from those of their patients, or those seeking to become patients. The patient’s best interests must remain paramount”. In my example, who determines the patient’s best interest? Such a physician knows the physical, emotional, psychological, and spiritual toll that abortion will have on his/her patient and views the unborn child as a patient.
Hello:
As a Christian, I am very concerned about any wording in the draft policy which would force any physician from any faith or world view to act against his conscience even through the act of referring the client to another physician. I realize the dilemma this presents when weighing the rights of physicians against clients. I am however convinced that there is an absolute standard of morality established by God, designed for the protection, love and honour of all living creatures. I would recommend to you such books as “Mere Christianity” by C.S. Lewis and “The Reason for God” by Timothy Keller to further investigate such a claim. I believe you will find the arguments reasonable, logical and possibly life altering.
Thank-you
I wish you only the best.
Ontario and Canada are diverse populations.
This is also reflected in those in the medical profession as well as those they serve.
People should be able to respect their conscience in their profession, please don’t take away this right.
Many people want health care professionals they know they can trust to be authentic in their professional practice and morals.
I think it is very important that each individual kept his own conscience. Therefore, doctors should also have that rights in their profession, even if law allows people to act differently. Their association should NOT make them to do something against their conscience.
To whom it may concern,
The CPSO draft policy demands that doctors participate in controversial procedures like abortion and even euthanasia by making referrals and doing the procedure in certain circumstances.
Doctors who refuse to follow the policy will be vulnerable to discipline, even though their fundamental freedom of conscience and religion is guaranteed by the Canadian Charter of Rights and Freedoms.
I demand that our doctors keep their right of Freedom and Conscience for the most Common Good.
Dear members of the Consultations Committee:
I am writing to express my concern regarding the content of your proposed draft policy that would compel physicians to refer their patients to other physicians to perform acts to which they object as being against their conscience.
I expect that physicians, as professionals, be allowed to respect their own consciences – something which is fundamental to a free society.
I request that you revise the sections relevant to this issue to respect the right to freedom of conscience for all physicians.
I am a Canadian citizen, living in Ontario and I am displeased with the new draft policy being proposed by the CPSO. Regarding the new draft policy, please do not force physicians to do something that goes against their conscience. Please uphold their rights also. If doing something is wrong and immoral, then arranging for that thing to be done (by a referral) is also wrong and immoral. If abortion and physician-assisted suicide is ending the life of a human being, and a physician feels this is immoral, then doing a referral would be seen as arranging to kill the patient, and this is not something anyone should be forced to do. It is not mentally healthy for a physician to deal with that in their profession and practice.
Please allow doctors to protect and preserve life and not destroy life.
I am very troubled by the thought of doctors being forced to be complicit in providing services which they are morally opposed to by forcing them to provide referrals or consulting for those services. I feel that this would be a grave violation of the rights and freedoms of doctors.
It would be very irresponsible and reprehensible for the College of Physicians and Surgeons of Ontario to impose these obligations on the doctors of Ontario.
Dear Sir,
The College of Physicians and Surgeons of Ontario proposed amendments to “Professional Obligations and Human Rights” includes an obligation for physicians whose religious or moral objections to a procedure to refer the patient to a physician who does not share those objections. This is at best hypocritical: under the guise of allowing a doctor to exercise his/her conscience, it nevertheless forces the physician to enable the very action to which he/she, in good conscience, considers wrong. That renders the exemption moot. It’s like saying to an opponent of capital punishment, “You don’t have to throw the switch, but make sure you show the person who will where it is.”
To my mind, the very nature of being a professional is the indepdendent exercise of one’s judgment. There is no distinction here between professional, technical judgment and moral ones. If a doctor, for example, thinks the recent Supreme Court ruling regarding assisted-suicide places him/her in violation of the Hippocratic Oath, and the duty to do no harm, whether that conclusion is founded on a purely logical interpretation of the Oath, or on religious/ethical grounds, or on concerns that under the current, largely triage system of state-provided medicine the policy might be abused, is irrelevant. All are exercises of professional judgment on a matter of how to treat a patient.
My personal, separate opinion, is that the CPSO would do far better to devote its efforts to enhancing choice for all (doctors and patients alike) in medicine by allowing doctors to opt out of the public health care system, by allowing patients to pay doctors directly for care, and for doctors to actually assert their independence as professionals by demanding what the lowest laborer is entitle to have: control over the offering of his/her own services.
To Whom It May Concern,
I do not expect the College to define or limit morality. I believe that physicians, as professionals, should be allowed to respect their own consciences as part of a free society.
I believe that Canadians must support these basic tenants of Human Rights and we must not permit the CPSO to limit a physician’s right to conscientious objection.
I write to support Pyhsicians’ Charter Right of Freedom of Conscience and Religion. I believe strongly that a mandate for an “effective referral” is a violation of a physician’s rights, as it compels the physician to violate his or her own conscience by being a participant in the very act, the very procedure to which he or she objects in the first place.
I feel strongly that to ask our doctors to perform procedures that are against their consciences violates their Hippocratic oath.
They cannot possibly work to their potential when faced with working against their principles.
Please give doctors the best room to do their so important service to Canadians and not force them to swear oaths that will compromise their beliefs.
For the benefit of Canadians it is best to honour the doctors decision / opinion on what he/she can feel is part of their principles.
Dear CPSO Policy Department,
I am a practising family physician with special interest in women’s health in Toronto. Thank-you for the opportunity to provide feedback on the College’s draft policy statement on “Physician Obligations and Human Rights”. It is very troubling that the draft statement so clearly discriminates against and infringes upon the rights of physician members of the College.
Most troubling are the lines to do with physician referral as stated (No. 156-161), that a physician is required to provide “effective referral” to another “non-objecting” provider for “health services” when the first physician is morally/ethically opposed to such services. Such action would conceptually and essentially render the physician, in the legal sense, as an “accessory” to an act they have morally objected to, or in the moral sense, as a “material cooperator.”
As such, the physician’s,
1. Moral integrity has been compromised,
2. Conscience right has been compromised,
3. Human dignity has been assaulted,
4. Ability to exercise true professonalism has been breeched,
5. Professional commitment to “First do no harm” has been forcefully undermined,
To the detriment of the patient, who
1. Has sought professional attention that is specifically human and moral,
2. Has done so with the hope and trust that the physician will use their knowledge and understanding to act in the patient’s best interest,
3. In a fiduciary relationship, has entrusted the doctor with medical decision-making, by relying on the physician’s good judgement and input from the patient and considering all relevant circumstances. The doctor acting by force to carry out an action on behalf of the patient, yet in a way that they have determined not to be in the patient’s best interest, has been forced to breech this trust.
In truth, doctors should not discriminate against patients, and patient care is clearly utmost in priority. However, deciding not to provide a service (felt by the doctor to incur harm on the patient), in no way discriminates provided that the service is not offered to any group.
Alternatives exist whereby patients find the services they seek, that are widely available within the province. Perhaps the College can reinforce these avenues publicly, so that patients can continue to effectively pursue the ends they seek by their own means, if that is what the College is intending to protect, through doctors who have no concerns with what is being requested.
As it has been suggested and considered publicly (in media) and secretly (by discerning medical students), the notion that any student physician who refuses to perform or to “effectively refer” for a particular service, such as abortion, should not pursue fields such as Family Medicine, or Obstetrics and Gynecology, is utterly abhorrent and a cause for grave concern. This would be the utmost discrimmination against the emerging physician, or the practising physician who has taken up a pivotal moral viewpoint in this regard.
The proposed change in policy has already led to the allusion that doctors with such moral views should not enter fields, where the physician’s viewpoint might oppose the “norm,” regarding services not offered. This would skew populations of physicians in a way as to cause societal harm, to not mention, again, the obvious and brutal injustice to the physician so frankly discriminated against. Such a physician might actually have skills, talents and interest in serving within those disciplines, to the detriment, again, of patients who would have been otherwise professionally served.
Indeed, there exists a concrete population of patients who seek physicians in the above-named fields, that live and practice within this moral framework– a moral framework which they share or specifically respect. They entrust their care to these specifically-sought, self-announced physicians, knowing that they and their families will be offered ethical medical alternatives, sound clinical judgement and advice, and positive moral support through times of difficulty. These patient populations will be robbed of the doctors that the current policy would bully out of practicing in those extensive and far-reaching fields, both general and specialized, such as those fields named above. The result will be increasing public mistrust of the medical profession, starting with the patient population described here.
The policy consideration that physicians’ fundamental rights and freedoms in decisions influenced by conscience, can be “limited by the fundamental rights and freedoms of others,” is also of grave concern, and causes me to wonder whether the College is indeed committed to safeguarding the essential qualities and nature of our Profession. It is my hope that this commitment is indeed intact at the College. Without freedom of conscience in the medical profession, the best interest of the patient cannot be safeguarded, and the special vocation of the physician is reduced to that of a sort of pawn or clerk, with inherent, serious consequences. The resulting milieu would bear some serious resemblance with the medical practice setting found in Germany during WW II.
Based on the current draft policy, it would actually seem plausible that the College could itself be the subject of a human rights complaint by a physician, on the basis of discrimination on the grounds of creed. A dispute of this nature may reflect poorly on our ability as physicians to self-regulate and might have unintended consequences for our profession.
The draft policy as it stands is deeply flawed and I urge its revision.
Thank-you for your time and consideration,
Lines 152 – 164 of the above draft contains the term “effective referral” which I believe is objectionable. I also believe that any physician who is unwilling to provide certain elements of care due to their moral or religious beliefs would find this “effective referral” mandate unacceptable. Such a mandate would be a violation of those physicians’ rights, as it compels the physician to violate his or her own conscience by being a participant in the very act, the very procedure to which he or she objects in the first place. In other words, such a physician becomes complicit in an unacceptable action.
Please remove all reference to the “effective referral” mandate and use only language which ensures all physicians will have their Charter right of freedom of conscience and religion respected.
Dear Members of the Consultations Committee:
Subject: Draft Policy “Professional Obligations and Human Rights”.
I am writing to you as a family physician with 28 years of practice in Ontario. I have
grave concern regarding the content of your proposed draft policy. Sections 8, 10 and 11
suggest that physicians who decline to participate in certain acts for reasons of
conscience should be compelled to refer their patients to other physicians who will
perform these acts. This effectively places a physician in the position of participating in
the very act that they object to.
In compelling physicians to refer, this policy removes their individual right to
conscientious objection. More universally, this policy limits any chance for ongoing
ethical objection around what may be some very complicated care decisions in our
society.
There is significant disagreement in our society as to what constitutes a moral act, and I
do not expect the College to define or limit morality. All I expect is that physicians, as
professionals, be allowed to respect their own consciences. Freedom of conscience is
foundational to our free society and cannot be limited, even for the best of intentions. If
we coerce physicians into violating their consciences we will inevitably erode the
personal integrity which is the basis of the physician’s relationship with their patients.
I encourage you to revise the sections above, and include a clear defence of the right to
freedom of conscience for all physicians.
I am writing to express my great concern over your possible change to a Policy on physicians duties and responsibilities where a religious believe is in conflict with a patients request for services.
If the Colleges or our society force doctors to go against their moral and religious beliefs, care will be undermined not enhanced. Patients need to know where their doctor stands on ethical issues, to trust them, and to know what care to expect. This applies to all healthcare workers.
The CMA Code of Ethics has always supported a Physician’s moral or religious rights and Colleges have always taught physicians the proper methods of explaining this to patients. This should not change nor need to change.
To force to treat or refer for treatment is not respecting the CMA Code nor is it respecting a large number of dedicated caring physicians.
I would urge you to read Professor Mary Anne Waldron’s book, “Free to Believe”. This book emphasizes the importance of accepting diverse beliefs for any Democratic society. Surely our “tolerant’ Canadian society should reflect and respect the moral and religious rights of large and small segments of our society.
Please reject these changes as proposed!
To:
College of Physicians and Surgeons of Ontario
Re: CPSO draft policy announcement: Professional obligations and human rights
It is with deep regret that the above draft policy makes reference to:
“ Where physicians are unwilling to provide certain elements of care due to their moral or religious beliefs, an effective referral to another health care provider must be provided to the patient”.
This specific mandate for an effective referral to another physician is a violation of the physician’s right as it compels the physician to violate his/her own conscience to being a participant in the very procedure that h/she objects to in the first place!
The above mandate would be an unacceptable serious violation of the Canadian Charter of Rights of freedom of religion and conscience – which must be respected at all times.
Ontario’s Human Rights Code articulates the right of every Ontario resident to receive equal treatment with respect to goods, services and facilities without discrimination based on a number of grounds, including race, age, colour, sex, sexual orientation, and disability.
Are Ontario’s physicians not deserving of the same basic rights?
[**MESSAGE FROM ADMINISTRATOR: DURING THE CONSULTATION PERIOD, WE RECEIVED 10 RESPONSES FROM INDIVIDUAL RESPONDENTS CONTAINING THE CONTENT PUBLISHED ABOVE. ALTHOUGH THIS FEEDBACK HAS NOT BEEN PUBLISHED IN DUPLICATE, THE COLLEGE ACKNOWLEDGES RECEIPT OF THESE SUBMISSIONS.**]
To: College of Physicians and Surgeons
It is with deep regret that the above draft policy makes reference to:
“Where physicians are unwilling to provide certain elements of care due to their moral or religious beliefs, an effective referral to another health care provider must be provided to the patient”.
This specific mandate for an effective referral to another physician is a violation of the physician’s right as it compels the physician to violate his/her own conscience to being a participant in the very procedure that h/she objects to in the first place!
The above is unacceptable serious violation of the Canadian Charter of Rights of freedom of religion and conscience, which must be respected at all times.
Ontario’s Human Rights Code articulates the right of every Ontario resident to receive equal treatment with respect to goods, services and facilities without discrimination based on a number of grounds, including race, age, colour, sex, sexual orientation, and disability.
Are our physicians not deserving of the same basic rights?
[**MESSAGE FROM ADMINISTRATOR: DURING THE CONSULTATION PERIOD, WE RECEIVED 9 RESPONSES FROM INDIVIDUAL RESPONDENTS CONTAINING THE CONTENT PUBLISHED ABOVE. ALTHOUGH THIS FEEDBACK HAS NOT BEEN PUBLISHED IN DUPLICATE, THE COLLEGE ACKNOWLEDGES RECEIPT OF THESE SUBMISSIONS.**]
The proposed “effective referral” mandate is violation of a physician’s rights and it must be rejected.
Thanks!
Dear Members of the Consultations Committee:
As a pastor in a Christian church with many Christian physicians practising in our city, I am writing to you in regard to the Draft Policy. I am also writing as a parent of a child who had significant health issues in his first year of life. I would like you to reconsider sections 8,10, and 11 in regard to this Draft Policy: “Professional Obligations and Human Rights”.
Sections 8, 10 and 11 suggest that physicians who decline to participate in certain acts for reasons of conscience should be compelled to refer their patients to other physicians who will perform these acts. It does not address the fact that many of these same physicians will find the act of referral itself objectionable, as they consider it material cooperation with the act. In compelling physicians to refer, you are limiting their right to conscientious objection.
There is significant disagreement in our society as to what constitutes a moral act, and I do not expect the College to define or limit morality. All I expect is that physicians, as professionals, be allowed to respect their own consciences. Freedom of conscience is foundational to our free society and cannot be limited, even for the best of intentions. If we coerce physicians into violating their consciences we will inevitably erode the personal integrity which is the basis of the physician’s relationship with their patients.
When I think back to some critical decisions in the medical path pursued for our son, we encountered grey areas where we unsure of what to do. I think it would be wrong that a doctor with strong moral convictions in these areas would be forced to violate the Hippocratic oath by having to refer patients or in this case parents to those she or he feel are committing a morally wrong or possibly an illegal act ie. lethal doses of morphine for babies with special needs who are no longer wanted because of their special need.
I encourage you to revise the sections above, and include a clear defence of the right to freedom of conscience for all physicians.
I am writing with respect to your draft conscience policy requiring physicians who object to perform a procedure against their morals have to refer the patient to someone who will.
My grandfather and father were physicians in Ontario and now my youngest son is focusing his education on medical school. I was thrilled to know that his time and talent could in the future be used in service to the sick as a physician. Now I feel absolutely sick to my stomach with worry about this draft policy and the impact it will have on him and future generations. What type of person will choose a profession where they effectively don’t have freedom of conscience (given the potential requirement to become an accomplice)? I won’t want to entrust my healthcare Ito them. This is communist medicine.
When my father was dying of cancer, he asked me to pray with him that God would bring him home. God answers prayer. My father would have been mortified to know of this draft policy. Please reconsider.
I would like to inform you that I reject the proposed effective referral mandate for doctors whose Charter right of freedom of conscience and religion must be respected.
The Hippocratic Oath states that the role of the physician is to heal and comfort the patient and not harm them. This ” effective referral” is a violation of a physician’s rights as it compels him or her to violate his or her own conscience by being a participant in the very act, the very procedure to which he or she objects to in the first place.
Currently the CPSO bans doctors from performing female genital cutting of refer patients of doctors who would perform such procedures on grounds that both acts are immoral. This arrangement has safeguarded the freedom of conscience of doctors without infringing on the right of patients to good health care.
The CPSO is now proposing that doctors be obliged to provide referrals when they cannot perform a procedure for reasons of conscience.
To try to remove the moral element from a doctor’s professional life is a fundamental assault on their personal integrity. A doctor lacking in personal integrity is not the type of doctor that we should trust with the health care of the country.
Dear Sir/Madam,
In response to your proposed new draft document stating that “Where physicians are unwilling to provide certain elements of care due to their moral or religious beliefs, an effective referral to another health care provider must be provided to the patient”, I would like to voice my concern. As every professional has the right to practise what he or she believes and it should be respected, please do not force the professional to go against their conscience. Thank you for your consideration.
I was born in Ontario, raised my family in Ontario, worked and retired in Ontario and have always been proud of that. However, I am truly disheartened and dismayed by what is happening in our province and country.
This draft policy not only goes against the beliefs of many people in Ontario and Canada but it more than tips the scale of ‘freedom of choice’ and ‘freedom of religion’ for the physicians with moral integrity. How dare any organization in Ontario/Canada, especially the College of Physicians and Surgeons of Ontario, demand that doctors participate in controversial procedures such as abortion and now euthanasia (if legalized). I was naive enough to believe that the governing body for physician and surgeons had a moral obligation to ensure every effort is made to preserve life. We all have heard of the ‘God’ syndrome within the medical profession. In my opinion, this is the ultimate ‘God’ syndrome. How dare you force physicians with a moral conscience to perform or take part in (in any way) procedures that they themselves find immoral and against their values and beliefs. This may force these professionals to take early retirement and/or leave the province if not the country or just stop practicing. Forcing doctors to violate their moral integrity is just morally wrong. This is a circumstance that could be likened to people saying, ‘I was just following orders’ (you pick the situation – there are many). I believe, as many do, that someone will be and should be held accountable – at some point.
Obviously, I am vehemently opposed to this policy. While I would typically not respond to policy changes, even when I fundamentally disagree, this is too important to everyone not to make my voice heard. I have a wide circle of family and friends and virtually 95% of them agree with my comments. It’s time to take a second moral look at this. Stop this before it’s too late. Think about the far reaching effects of this. Think about how this could affect you in the future!?! PLEASE!
I wish to state my conviction that one of our freedoms as persons and Canadians is the exercise of freedom of conscience. This right to act according to one’s conscience can not justly be taken away through government or College policy. I am referring at this time to present discussions as to a doctor’s practice and referrals in the matters of abortions and assisted suicide. Our doctors should not be forced to face decisions between being true to their beliefs and being able to practise their profession in Ontario and ALL of Canada.
Dear Members of the Consultations Committee:
Subject: Draft Policy “Professional Obligations and Human Rights”.
I am writing to you with grave concern regarding the content of your proposed draft policy. Sections 8, 10 and 11 suggest that physicians who decline to participate in certain acts for reasons of conscience should be compelled to refer their patients to other physicians who will perform these acts. It does not address the fact that many of these same physicians will find the act of referral itself objectionable, as they consider it material cooperation with the act. In compelling physicians to refer, you are limiting their right to conscientious objection.
There is significant disagreement in our society as to what constitutes a moral act, and I do not expect the College to define or limit morality. All I expect is that physicians, as professionals, be allowed to respect their own consciences. Freedom of conscience is foundational to our free society and cannot be limited, even for the best of intentions. If we coerce physicians into violating their consciences we will inevitably erode the personal integrity which is the basis of the physician’s relationship with their patients.
One way to resolve this is to have a neutral body or a panel within the College of Physicians and Surgeons of Ontario to handle these cases, and rid physicians of such a burden. I can see a few benefits of such a panel:
1. It relieves the physicians from living with the psychological and mental burden of material cooperation with the act
2. Physicians can move around cities and can change their position on moral issues. As such, physicians may have out-dated information on other physicians in the province. The panel within the College of Physicians and Surgeons of Ontario, on the other hand, is the body that would have the most up-to-date information of all Ontario physicians and their practices
3. The panel can provide patients with more choices of physicians who could help them
I encourage you to revise the sections above, to the effect of providing a clear defence of the right to freedom of conscience for all physicians. It is not good to have burnout physicians. I believe the welfare of the physicians is just as important as the welfare of the patients.
Dear Sirs:
Please be advised that the the freedom of conscience still matters for Doctors of Ontario and cannot be eliminated through policy. . I urge you to take this into consideration.
Let us discuss and think creatively how to enact legislation which allows all to work in freedom of conscience.
BLESSINGS
To Whom it May Concern,
Re: Professional Obligations and Human Rights policy
I have completed the online survey and appreciate the opportunity to email to CPSO as well.
I oppose the Professional Obligations and Human Rights policy draft; these are my concerns:
1) It seems that the policy is not in the best interest of some Ontario citizens. I am a Christian and am very happy with the privilege I have of going to a Christian doctor. I know that he values the same things I do and will provide medical advice and options that are in the best interest for me, the patient. If he had to provide medical recommendations that he did not believe were in my best interest, he would no longer be fulfilling his obligations in the “relationship of trust” he has as a doctor. I am certain that I am not the only Ontario citizen who appreciates their doctor for this.
2) Doctors have “human rights” just like everyone else and no one should be forced to do something against their beliefs or be penalized if they do not.
3) The draft is somewhat vague in some areas and could be interpreted unfairly. If a doctor does not recommend and treatment procedure because he/she really does not think it is in the best interest of the patient (and that recommendation also lines up with his/her personal values) the patient could interpret that as the recommendation being the result of personal values rather than scientific or medical reasons.
I would ask that this draft policy be revised to allow physicians to practice according to medical and scientific reasoning as well as moral values, so that we has the patients will receive the best care possible that aligns with our own personal values
I cannot believe that patient rights trump a doctors right to refuse participation in an act that kills a patient requested or otherwise. If a patient requests suicide assistance it is up to the CPSO to provide the patient with a list of qualified physicians who are willing to provide this assistance. The proposal which lists a mandate to provide “an effective referral” is completely unacceptable. I reject this proposal.
Good morning,
We are a family of five, with large extended family in Toronto. We would like to thank the CPSO for all the wonderful care we have received througout the last century. My mother, for instance,second youngest of a family of nine just celebrated her nintiieth birthday: you can imagine how much help she has received from Ontario doctors. My father’s family of ten siblings still boasts two remaining members.
I would like you to conclude that this objection to and rejection of the proposed effective referral mandate is representative of many who are concerned about the drastic effect this measure would have on the medical profession in Ontario should such a violation of every doctor’s Charter right of freedom of conscience and religion be made operative policy.
Thank you for your prompt attention to this objection.
To the members of CPSO,
I reject the proposed “effective referral” mandate for doctors. I believe that their Charter right of freedom of religion and conscience must be respected.
1. It is hard to see how limiting physicians Rights to Freedom of Conscience and Religion guaranteed in the Charter will result in less discrimination or better patient care
2. Requiring referrals or requiring the doctor to participate in procedures that go against their beliefs may eliminate them from practice, and reduce their personal sense of integrity, if they remain in practice. Interior dissonance between deeply held beliefs and professional requirements can lead to burnout. This is systemic discrimination based on conscience or religious belief. It will impact patient care.
3. The requirement for referrals may actually slow down patient access to services. For instance in ON patients self refer for abortion.
4. Forcing doctors to refer for something, or perform something they consider to be killing a patient will completely go against the whole reason they got into medicine in the first place – to heal patients – not to harm them. This is a coercive action that involves a large percentage of physicians who do not want to be involved in euthanasia/assisted suicide.
Action Life Ottawa
Dear Members:
Subject : Draft Policy – Professional Obligations and Human Rights
I am writing to you on behalf of Action Life Ottawa regarding the draft policy of the College of Physicians and Surgeons of Ontario. Action Life is a non-denominational educational pro-life organization promoting respect for human life from conception to natural death. We count approximately 4,000 supporters in Ottawa and the surrounding region.
Action Life is greatly troubled by the sections of the draft policy pertaining to freedom of conscience and religion for doctors. The draft policy requires physicians who will not provide certain services for reasons of conscience or religious beliefs to refer to another “non-objecting, available, and accessible physician or other health care provider”. For objecting physicians, the act of referral itself would violate their conscience. Physicians should not be forced to refer for services to which they object on moral or religious grounds.
Freedom of conscience and religion are fundamental in a free and democratic society. To demand that physicians leave their conscience at the door is an attack on the physician’s integrity and his constitutional rights to freedom of conscience and religion as enshrined in the Canadian Charter of Rights and Freedoms. Physicians have a right to practice in accordance to their conscience. Patients do not have a right to demand services to which the physician objects. Physicians should be able to work without fear of retribution if they decline to provide services which are in opposition to their moral and religious beliefs. The recent Supreme Court of Canada’s decision on euthanasia and assisted suicide will further increase pressure on physicians. If the physician will not kill the patient or write a prescription for a lethal dose of drugs, will he now be forced to refer to someone who will?
Attacks on the freedom of conscience of physicians continue to mount. We share the grave concerns of some physicians who wonder if the field of medicine will now only be opened to those who are willing to compromise their moral and religious beliefs. The Ontario Medical Association’s Section on General and Family Practice in its August 6, 2014 letter to the College of Physicians and Surgeons observed: “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.”
We ask that the College abandon the sections of its draft policy which would force physicians to act contrary to their conscience and religious beliefs. In its place, the policy should include a protection of conscience clause for physicians to ensure that freedom of conscience and religion is respected.
Sir,
I wish to express my thoughts on this ‘Mandate’ and after reading the ‘draft proposal’; feel that the mandate does impose an ‘obligatory’ stance on physicians to act in a manner that restricts their ‘freedom of conscience’ and exert pressure on them to ‘concede’ or ‘assist’ in decisions that would violate their ‘conscience’ even if they applied the ‘referral mandate’; thereby contributing to actions, that violate the ‘Hippocratic Oath’ to protect and preserve life and that in good conscience they do not wish to support.
Therefore, in light of this, I wish to express my opposition to this proposal.
Dear Sir / Madam,
I am writing to you in regards to the CPSO’s draft policy which I have read and strongly oppose. This draft policy limits a physician’s Rights to Freedom of Conscience and Religion which is guaranteed in the Charter by requiring him or her to make an effective referral to another physician if they refuse their patient’s request, such as euthanasia should it be legalized.
I don’t think doctor’s should discriminate against patients and absolutely feel that patient care is of the utmost priority. However, deciding not to offer a service in no way discriminates against patients provided that the service is not offered to any group. I do not see how limiting physicians Rights to Freedom of Conscience and Religion which is guaranteed in the Charter will result in less discrimination or better patient care. Requiring referrals or requiring the doctor to participate in procedures that go against their beliefs may eliminate them from practice, and reduce their personal sense of integrity, if they remain in practice. Internal dissonance between deeply held beliefs and professional requirements can lead to burnout. The is systematic discrimination based on conscience or religious belief and the results of this will no doubt impact patient care.
This policy will cover euthanasia should it be legalized. Forcing doctors to refer for something, or perform something they consider to be killing a patient will completely go against the whole reason they got into medicine in the first place – to heal patients – not to harm them. This is a coercive action that involves a large percentage of physicians who do not want to be involved in euthanasia / assisted suicide. Their rights to conscience were asserted by the CMA at their August meeting.
The draft ignored the results of the online public poll Summer 2014 3:1 in support of physicians’ conscience rights. In addition, there are internal inconsistencies within the draft policy. As an example, while line 76/77 states that the duty to accommodate is not absolute – physicians do not have to accommodate beyond the point of undue hardship, where excessive cost, health or safety concerns will result. The duty to accommodate is also limited where it significantly interferes with the rights of others – the latter part of the policy (line 108-110, 156-160) contradicts the rights of the physician by specifically requiring physicians
to refer the patient to another provider though they have moral or religious objection.
The draft policy is supporting that physicians’ fundamental rights and freedoms in matters of morally objectionable medical procedures and treatments can be limited by the “fundamental rights and freedoms of others” This essentially implies that physicians are second-class citizens and that only patient have “fundamental rights and freedoms”
Thank you for your attention in this important matter.
I submit to the CPSO that the proposed “effective referral” mandate is violation of a physician’s rights that must be rejected!
To whom it may concern,
Please respect and protect all stages of human life from the moment of conception until natural death.
May God Bless All Of You And Grant You All Wisdom To Know Between Right And Wrong!
I certainly object to assisted suicide by a physician or anyone else. I am a mother of four children and when our time on earth is up, God will decide, not another human being,
I strongly feel that if a physician’s conscience did not agree that he/she should perform a procedure such as euthanasia, that they should NOT have to refer the patient to another doctor for this procedure.
My wife agrees with me on this matter. Please pass this on to the right person so that our feelings will be known to those who will make a decision in this matter.
Hello:
I have read the Draft Policy “Professional Obligations and Human Rights,” and I am appalled this is under consideration.
I have friends in the medical profession who are equally appalled and anxious that one day they might find themselves forced to refuse some of these procedures and possibly lose their licenses.
I read a recent study that revealed 74% of palliative care physicians would refuse to partake in assisted suicide or euthanasia.
I note that the CPSO draft policy is titled: “Professional Obligations and Human Rights.” In a “College of Physicians and Surgeons,” should this policy title not read “Professional Obligations, Physicians’ Rights, and Human Rights”? Here is the flaw exposed in our Charter of Rights and Freedoms, and now in our CPSO: we now have human rights trumping human rights.
“God keep our land glorious and free!” states our national anthem. And what of the freedom of physicians to follow their own consciences without fear of professional recrimination? Draft policies like these do not belong in our province or our nation. Shame on those who crafted it. Permit our physicians and nurses the unlimited right of freedom of conscience and morals.
Dear Sirs,
I find it most disturbing that you are proposing a policy Which will discourage, especially those in Family Medicine, from growing in medical integrity. Could you please explain how such a policy contributes to the common good of Medicine & its practice?
1. No person ought be forced to provide or refer this service.
2. Euthanasia is contrary to the ethical principle: do good, avoid evil. It goes against natural law.
3. Euthanasia is contrary to the Hippocratic Oath: “I will give no deadly medicine to any one if asked, nor suggest any such counsel”
Where we cease to be reasonable we open the door to
No, No, No! The supreme court got it wrong as they did when they struck down the abortion laws of our country.
My suspicion is that in Nazi Germany many physicians were forced to participate in terminating unsuspecting victims.
No doctor (who became a doctor to heal and not kill) should be forced to participate in any way, referrals included, in this giant step backward.
Let the proponents of euthanasia have their own death houses. Many doctors who perform abortions would be glad to add this to their resume. Indeed, one does not need a medical degree to have over a deadly poison to a willing participant, nor should a pharmacist be forced to dispense these drugs.
With the most profound advances in palliative care in recent years can we not bring some sanity to this issue.
The supreme court is an unelected body of individuals whose sense of what is right is skewed in this matter. Why unanimous? No one would put their name to the ruling because it is wrong.
I am a physician in British Columbia. I would like to say that I strongly oppose the requirement for physicians to refer for procedures they find morally objectionable. Referral makes one an accomplice and is a clear violation of charter rights. I agree that no single right trumps all others. However, the central and extremely controversial issues that this policy will at the ground level impact are not emergency life and death issues. Therefore, I strongly believe that the violation of the physician’s charter rights of conscience and religion distinctly outweigh the violation of the patients rights to have the physician they are currently sitting in front of make the given referral. If we are honest, this referral is for the non-emergent issues that we are really talking about: abortion and physician assisted suicide and perhaps birth control. Abortion and physician assisted suicide are very controversial among both physicians and the people of Canada. One can perhaps dream up an extreme example where the need for an abortion is urgent and life-saving. Few, if any, physicians would argue about the obvious required life-saving action. Additionally, few if any physician regulating bodies and provincial judiciary institutions would disagree on the obvious legal obligation to provide life saving care. Let’s be honest and acknowledge that we are not talking about these types of situations.
Dear College of Physicians and Surgeons of Ontario,
I am writing to you with deep concern regarding the draft proposal “Professional Obligations and Human Rights”. Your current draft has far reaching implications given the recent ruling of the Supreme Court regarding doctor assisted suicide and I disagree with the intention to force a physician to do something against their conscience.
I propose these areas of contention should be a matter of discussion between doctor and patient before establishing a doctor-patient relationship. Patients can then be cared for by doctors of like-minded values, giving the highest level of care physically, mentally and emotionally. I also propose that the College consider the future implications of recent rulings and how they have morphed in other societies to include euthanizing unwanted babies, handicapped, those with mental illness and elderly people. This is not health care and it puts patients at risk when they are concerned that they will be a “burden” to their loved ones. Health care provides caring patient and family support and quality palliative care. These are the things that should be valued in patient care and advise the government of the importance of these services safeguarding the vulnerable.
Just because something is not deemed criminal, doesn’t mean it is ethical and moral. Ethical and moral doctors are critical for quality health care, I want a physician who has not been required to divorce these qualities to remain in practice. This policy would essentially force conscientious objectors out of your profession and decrease the quality of care. It is intolerant ideology masquerading as enlightened objectivity, no one should have the right to force someone to do something against their conscience or tell them they are not welcome in their profession. It is discriminatory.
I am writing to voice my opposition to the policy that will limit doctors’ right of freedom of conscience and religion .
Dear Sir/Madam,
I am writing to inform you that I reject the proposed “effective referral” mandate for doctors whose Charter right of freedom of conscience and religion must be respected. If I were a physician, I would fall into the category of being unwilling to provide certain elements of care due to my moral and religious beliefs. I would therefore, be unwilling to provide effective referral to another health care provider to the patient. This “effective referral” is a violation of a physician’s rights, as it compels the physician to violate his/her conscience by being a participant in the very act, the very procedure to which he/she objects in the first place.
I am shocked to read the proposed draft conscience policy proposed by the College of Physicians and Surgeons of Ontario (CPSO) which states that physicians who refuse to perform a procedure to which they morally object must arrange that the procedure gets done by someone else. In other words, they are compelled to become accomplices.
This is against our faith, moral conscience and religious freedom!
Drop this policy now.
I wish to express my following comments:
Physicians should have the right to say no to providing certain forms of treatment. I’m particularly concerned with the requirement that physicians provide referrals for treatments which they feel are morally and ethically wrong.
If a physician feels a treatment is morally and ethically wrong, aren’t they still violating their conscience by asking someone else to perform the procedure? How is the physician’s right to freedom of conscience being protected under these circumstances? Also the physician might feel that if a procedure is morally wrong it would also be harmful to the patient. Under those circumstances the physician would be violating not only their conscience but also their hippocratic oath by referring the patient to someone else to perform the porcedure.
One aspect of the draft policy that I feel should be addressed is the forcing of a doctor to assist a patient in ending the patient’s life when it goes against the doctors moral or religious beliefs. Also i don’t think that a doctor must refer such a need of similar request by a patient to any other doctor to do something that the first doctor finds repulsive.
I agree with the comment of a Member of the Public, posted on Feb 6,2015, at 1.29 am.
A physician or surgeon is a professional of the highest calibre as he has to deal with so many aspects of a patient’s life. He should be allowed full freedom to act in acordance with professional standards and his own conscience. If a procedure to abort a child in the womb is wrong by his religion, he must not be compelled to do it. Nor must he be compelled to refer the patient to another physician who is not of the same moral conscience. A similar principle applied to a physician who is asked to assist in a suicde or in euthanizing a patient. If the procedure is against his religious principles he should not be compelled to do it, nor to refer the patient to another physician who might be prepared to carry out the procedure. Making mandatory rules in these circumstance would destroy the independence of physicians/surgeons and we are then heading for disaster.
I disagree most strongly with the idea that doctors should be forced to perform actions such as abortions and assisted suicide or euthanasia when it is against their religious and moral beliefs to do so. Nor should they be forced to refer a patient to another doctor willing to perform these actions. They have a right to act according to their conscience. A human right. No one has the right to deny them this freedom. There is a reason that Man has been given a conscience. Forcing a person to ignore his conscience is gravely wrong.
I am totally against abortion and assisted suicide. I think we were not consulted when we were born and should have no say when we are to die, a natural death.
From the Professional Obligations and Human Rights Draft Policy: “Where physicians are unwilling to provide certain elements of care due to their moral or religious beliefs, an effective referral to another health care provider must be provided to the patient. An effective referral means a referral made in good faith, to a non-objecting, available, and accessible physician or other health care provider. “
According to the Hippocratic Oath: “Nor shall any man’s entreaty prevail upon me to administer poison to anyone; neither will I counsel any man to do so.”
February 6, 2015 was the most profoundly disappointing day I have experienced as a Canadian and also as a physician. Nine unelected Supreme Court judges ruled that Canada’s law against physician-assisted suicide is unconstitutional. This decision is disturbing for many physicians, such as myself, that provide acute medical care and end-of-life care for our population.
Switzerland, Holland, Belgium and five US states allow various degrees of physician-assisted suicide and euthanasia. Belgium in fact passed a law in 2014 extending euthanasia even to children, after it initially approved the practice in 2003. Over 1800 patients were euthanised in 2013 alone (a 25% increase over 2012), in this small European country. Many Belgians have been euthanized not because they have a terminal illness, but because of mental illness. Please refer to the story of Godelieva De Troyer, a depressed woman who requested and was granted euthanasia. Her son Tom, is now a vocal opponent of euthanasia in Belgium. The sad irony is that the majority of Euthanasia in Belgium occurs in Flanders, where so many young Canadians sacrificed their lives for our freedom during the First World War.
My father was a veteran of World War II. He experienced both Nazi and Soviet atrocities during the war. He eventually immigrated to Canada, with the hope that this country would provide the freedom and liberty that he had fought for.
How quickly we forget about the atrocities that were performed in Germany during the 1930s until 1945, including horrific euthanasia practices.
The Reich Committee for the Scientific Registering of Hereditary and Congenital Illnesses was established in August 1939. It was to prepare and proceed with the registration of ill children or newborns with severe disabilities, from Down syndrome, paralysis to various physical malformations. The reports were assessed by a panel of medical experts, of whom three were required to give their approval before a child could be euthanized. Between 1939 and 1941, more than 5,000 children had been killed.
The official program for killing adults with mental or physical disabilities (T4 Euthanasia program) began with a letter from Hitler issued in October 1939.
“Reich Leader Bouhler and Dr. Karl Brandt (Hitler’s personal physician) are charged with the responsibility of enlarging the competence of certain physicians, designated by name, so that patients who, on the basis of human judgment, are considered incurable, can be granted mercy death after a discerning diagnosis.” — Adolf Hitler
In October 1939, all hospitals, nursing homes, old-age homes, sanatoria were required to report all patients who had been institutionalised for five years or more, or who had been diagnosed with any of a list conditions: schizophrenia, epilepsy, Huntington’s chorea, senile dementia, paralysis and progressive neurological diseases.
As with the disabled children, the adult cases were assessed by a panel of experts, working at the T4 offices. Three “death” verdicts condemned the person concerned. As with reviews of children, over time these processes became less rigorous, the range of conditions considered “unsustainable” grew broader, and zealous Nazis further down the chain of command increasingly made decisions on their own initiative.
The T4 Program was run by some 50 physicians. It was discontinued in 1941 after increasing opposition from both the general population and the clergy. Amongst the resistance that did emerge, only a small part was driven by the medical profession. Should doctors, through their Hippocratic Oath, not have been the natural profession to oppose? Doctors, however, had joined the National Socialist (Nazi) party in higher percentages than any other profession. These barbaric practices occurred not even a century ago. Over 70,000 people were killed.
The Canadian supreme court decision is chillingly similar to Quebec’s assisted suicide legislation, where patients must suffer “a serious and incurable illness” and be “in a state of irreversible decline”, suffering pain “which cannot be relieved in a manner the patient deems tolerable”. This suggests the law is not just limited to people who are terminally ill.
We have allowed a small vocal minority of people (the euthanasia and assisted suicide lobby) to change the history of this great country in favour of crossing the threshold from life into death. If we as physicians do not speak out against these decisions, on moral or ethical grounds, then who will?
We have made huge strides in palliative care in this country and our energies should be focused on further improving palliative care, not euthanizing or assisting people to end their own lives.
We, as physicians, should be given a voice to stand against such a practice, not be silenced by the proposed “Professional Obligations and Human Rights Policy.”
Section 2 of the Charter guarantees freedom of conscience and religion as a fundamental right. Forcing a doctor to make a referral for the performance of a procedure or prescription that he or she finds morally objectionable is forcing material cooperation in that procedure or prescription. The doctor is thereby being forced to violate his or her own conscience, which according to the Charter, is a violation of a fundamental human right. I do not see how the College of Physicians and Surgeons of Ontario can force this state of affairs on its members. It is a severe violation of the human dignity of physicians. Please respect freedom of conscience.
The CPSO’s proposed new policy can be summed up in one word: unconstitutional. Mandating for an “effective referral” is a gross violation of a physician’s freedom of conscience. It compels the physician to violate his or her own conscience by being a participant in the very act, the very procedure to which he or she objects in the first place. With physician-assisted suicide making its way into Canada, I find it completely disturbing that the College might one day force me to refer my patients to other doctors who would be willing to kill them. As a current medical student in the province of Ontario who believes in the sanctity of life from the moment of conception to natural death, I strongly urge the College to not infringe upon the rights of doctors and to uphold freedom of conscience for the benefit of all Canadians.
Dear CPSO,
Thank you for inviting feedback on this draft proposal regarding Freedom of Conscience. As a physician for 40 years, I have tried always to treat my patients with respect and compassion, and have worked as an advocate for them as they pursued their health issues. I do not believe that I have ever discriminated against a patient.
I cannot agree with the CPSO draft saying that I must give up my Freedom of Conscience, and provide or refer patients for treatment or procedures that I truly believe are morally wrong and harmful to the well being of my patient. This, of course, would include participating in the taking of a human life as in the case of euthanasia or abortion. This goes completely against the reason I got into medicine in the first place ” first, do no harm”.
I can give the testimony of my many years in family practice. I did not refer for abortions, and I would explain this to patients, always trying to be respectful and non-judgmental. Interestingly, many of those women said they ” did not believe in abortion either, but they had no choice”…they had no one to support them (they were going against their conscience, and many suffered terrible mental anguish in later years). After our discussion about the abortion, those who still wanted an abortion were able to self refer to another physician. It is true that some of those women did not return to my practice, but a great number of those women did continue on with me as their family doctor, and I don’t believe our relationship was damaged; there always seemed to be a mutual respect. Also, after our discussion about abortion, a few of these women did choose not to go ahead with their abortion, and later wrote me to say how happy they were with their choice.
In summary, I am asking that you to reconsider your proposal, and, please, do not take away our Freedom of Conscience.
Thank you.
Hello,
I wish to register my disapproval with the proposed changes to the Physicians and Human Rights Code. Forcing a physician to refer a patient for procedures which go against his/her moral or religious beliefs is no different than requiring him/her to perform the procedure. This is not consistent nor logical. If I am against people hitting themselves in the head with a hammer, how is it OK for me to tell them where they can buy a hammer elsewhere? If I am against recreational drugs and refuse to supply someone with such drugs, how it is OK for me to suggest they go to someone else?If one believes something to be immoral, referring them to someone else is also a participation in the immoral act.
Please reconsider this proposed requirement.
• Thank you for asking for feedback!
• To this statement: “Physicians must provide care that is urgent or otherwise necessary to prevent imminent harm, suffering, and/or deterioration, even where that care conflicts with their religious or moral beliefs.” … What exactly constitutes “imminent suffering, and/or deterioration”? Consider a patient seeking assisted suicide because they are either suffering or deteriorating. Where is the distinction between the severity and proportionality of these cases?
• To this statement: “Where physicians are unwilling to provide certain elements of care due to their moral or religious beliefs, an effective referral to another health care provider must be provided to the patient.” There is a clear and faulty assumption here that referral for a morally objectionable procedure somehow removes the physician from ethical responsibility. If it is wrong to kill someone, it is wrong to make arrangements for someone else to kill them. Ending a life is serious and referral is still participation.
• Unless a physician’s refusal makes it impossible for a person to access a legally acceptable and effective procedure, there should be major responsibility to prove that the physician’s serious (ie. killing) objections should be overridden – not the other way around. This also needs to recognize that referral is complicity.
• Thank you for opening this up for public feedback and I hope my assessment is considered!
Dear Members of the Consultations Committee:
Subject: Draft Policy “Professional Obligations and Human Rights”.
I am writing to you with grave concern regarding the content of your proposed draft policy. Sections 8, 10 and 11 suggest that physicians who decline to participate in certain acts for reasons of conscience should be compelled to refer their patients to other physicians who will perform these acts. It does not address the fact that many of these same physicians will find the act of referral itself objectionable, as they consider it material cooperation with the act. In compelling physicians to refer, you are limiting their right to conscientious objection.
The “effective referral” is a violation of the physician’s rights, as it compels the physician to violate his own conscience by being a participant in the very act, the very procedure to which he objects in the first place
There is significant disagreement in our society as to what constitutes a moral act, and I do not expect the College to define or limit morality. All I expect is that physicians, as professionals, be allowed to respect their own consciences. Freedom of conscience is foundational to our free society and cannot be limited, even for the best of intentions. If we coerce physicians into violating their consciences we will inevitably erode the personal integrity which is the basis of the physician’s relationship with their patients.
I encourage you to revise the sections above, and include a clear defence of the right to freedom of conscience for all physicians.
Dear CPSO,
I am compelled to write in response to your request for feedback to the draft policy for Freedom of Conscience, and I welcome this opportunity to do so.
The Human Rights Code discusses Discrimination, and protection from Discrimination for all Ontario Residents, which includes physicians. The Courts have not established a hierarchy of rights, “all rights are of equal importance”, but given the wording of this Draft Policy from the College of Physicians and Surgeons of Ontario, it appears clear that physician-citizen’s right to freedom of conscience would be trumped by another citizen’s right to a unilateral autonomous demand. Why would the College initiate a policy that would automatically subjugate a physician’s right of freedom of conscience to a patient’s right to do whatever that patient demanded, when the Courts themselves have no such stated policy?
I am particularly concerned at this time because of the impending legalization of doctor-assisted suicide. I practice as a paediatric neurologist in Scarborough. Many of my patients are severely disabled. In 30 years of practicing medicine I cannot remember one patient or family who wanted to end their life despite sometimes unimaginable circumstances. So, what if I, as a physician, am asked to euthanize a disabled child or adolescent? If I am obliged to Accommodate my patients (line 59-61) under this proposed College policy, I would be forced to do it, or be an accomplice to the action, even if it were against my conscience. In contrast, both the University of Toronto and the Ontario Medical Association recognize freedom of conscience as a fundamental human right, and would support me in my decision not to conduct this terrible act. Neither am I able to screen out patients or their families who specifically come to me (in good faith or otherwise) to force me to end their or their dependent’s life. Under this Policy, I could refuse to kill these patients, but would be obliged to provide an effective referral (line 157), making me, an accomplice to suicide, or murder as it really is. My personal freedom of a conscientious objection to intentionally end life would be overridden.
Is the College expecting physicians to disassociate themselves from their conscience? Isn’t conscience an integral part of one’s being? And I may ask, what kind of human would be willing to go against his/her conscience? Would you want that person to be your physician? All of the decisions made by physicians involve the physician’s conscience, and will continue to do so unless we are being replaced by robots, care plans and protocols. Just like German physicians feared for their lives and the lives of their families for not obeying orders to murder mentally-challenged patients en mass, will Canadian physicians be forced to carry out deeds against their conscience for fear of losing their livelihood and homes? We have to be accountable to ourselves at the end of the day.
I never entered medicine to end life. I willingly took the Hippocratic Oath-”First Do No Harm”. I was taught my role as a physician is “as a mediator between the patient and his illness, to enhance the prospects of cure, diminish unreasonable fear and assist in the process of adaptation”, to quote my Social Studies teacher. I always seek to act in good faith in the best interests of my patients. My fiduciary duty as a doctor is to provide that information to my patients. Removing any decision-making power from the physician automatically ends this fiduciary relationship, and this Policy actually removes any fiduciary role for the physician. Every clinical decision requires thought and assessment of risks and benefits to the individual, and reference to practice evidence-based medicine. Many of the “quick -fix” procedures commonly requested by patients have outcomes not properly understood or even studied. Patients seeking unilateral autonomy in decision-making may not understand the basis or implications of their decisions.
I have three suggestions for the College:
1. It would be wise for the CPSO to distance itself from any politically-motivated personal agenda of its committee members and any blatantly discriminating statements, in order to maintain public trust in the process at hand. 2. The CPSO could maintain a register of physicians willing to commit doctor-assisted suicide or abortion, etc., on their website and make this part of the new doctor-assisted suicide process that will be coming to Ontario. This would circumvent the need of a direct effective referral. And most importantly, 3. The College MUST protect Freedom of Conscience for its members.
Hello CPSO.
I am greatly concerned that 2 provincial colleges, including the College of Physicians and Surgeons of Ontario, have proposed policies that force physicians to refer and in some cases provide treatments or perform procedures that are contrary to their personal or professional ethics and conscience.
Excuse me. We are talking about doctors. They are among the most well educated professionals in our society. They are thinkers and have good judgement. They are human beings with a conscience. They desire to do good, to heal. They should never be forced to provide a referral or actually provide a service that contradicts their conscience. They should never be put in a position where they have to choose between their practice and their conscience on matters such as abortion, sterilization/contraception, euthanasia and assisted suicide.
We are not re-creating Nazi Germany.
I was astonished to hear that the college would entertain requiring doctors to provide referrals for abortions, morning-after pills and contraception. This requirement would prevent many doctors from following their conscience.
This sort of policy would prevent many doctors from practicing and further supports the degradation of morality and ethics. Will the next step be to remove all onus on patients and make life and death decisions based on a doctor’s decisions or policy. The death penalty was removed from law but is being re-introduced in a different manner.
Dear members of the Council of CPSO:
I am writing in response to your draft policy as titled above, after the recent court decision on assisted suicide. My viewpoint is in disagreement of the drafted policy. I disagree with the College to oblige a physician to ensure the access of the care when the nature of that care contradict a physician’s belief. While the Supreme Court ruled that it is not criminal to assist suicide, it does not mean that assisted suicide is an accepted duty of a physician. The court, recognizing that many physicians, faithful to their healing vocation, will not assist people to kill themselves, makes some very slight room for freedom of conscience. It trusts local Colleges of Physicians and other such groups to deal appropriately with the conscience issue. Currently the College of Physicians and Surgeons of Ontario is proposing a draft conscience policy which states that physicians who refuse to perform a procedure to which they morally object must arrange that the procedure gets done by someone else. In other words, they are compelled to become accomplices. I urge the College not to go through with this unjust policy. This represents an assault on freedom of conscience of all physicians. Every Canadian with a conscience should speak up against it.
Any society that authorizes killing people through assisted suicide and euthanasia has lost its moral compass.
Dear Members of the Council,
I am writing in response to the CPSO draft titled Professional Obligations and Human Rights. As an academic physician registered with the college since 1999, I am writing to express my concern and to request that the policy be revised to respect the rights of physicians and to remove the proposed mandate for “effective referral”.
As a medical educator, I foresee that the CPSO draft policy as it stands would have a devastating effect on current and future physicians and their relationship with their patients. The proposed mandate for “effective referral” goes contrary to two pillars in medical ethics and professionalism: the Hippocratic oath and the tenet to do no harm.
The Hippocratic oath developed in response to a prevailing medical culture in ancient Greece where physicians took bribes, administered poisons, and had powers that were feared by the public. Hippocates and his followers proposed a paradigm where physicians could be
trusted: the oath was sworn under Apollo, acknowledging that a physician’s behaviour was answerable to a higher-than-human authority.
It also forbade the giving of drugs to end life, even in the womb.
The physician was called to be one who would heal and comfort and not harm – laying a foundation for Western medicine for centuries to come.
A basic and fundamental tenet of medical professionalism is primum non nocere – first, do no harm. This is spelled out because there is no other profession with such a unique access to treatments and
procedures that can cause harm, even death. Therefore, when a
physician is asked to prescribe a medication or perform a procedure that he or she knows may cause harm, he or she cannot do so without violating this basic ethical principle. The refusal, in this case, is not discrimination against the person requesting the procedure, but rather in response to a rational evaluation that this would cause harm. The refusal is out of response for the patient and to honour the trust that the patient has made in the physician’s professional judgment.
I am grateful that the CPSO for upholding the rights of patients – in no way should any physician discriminate against patients and patient care for any reason. Discrimination based on “race, ancestry, place of origin, colour, ethnic origin, citizenship, creed, sex, sexual orientation, gender identity, gender expression, age, marital status, family status or disability” is always unacceptable. Therefore, a physician who refuses to treat or refer a patient on such grounds should be subject to correction. However, when a physician refuses to treat or refer based on the nature of the treatment requested, the physician’s moral stance has nothing to do with the individual patient and is therefore NOT discrimination. The refusal has to do with the physician’s conscience – a rational moral stance, which is based on reason and can be explained in terms of observation and judgment of good done or evil avoided.
Conscience is not merely a belief system, subject to public opinion or personal feelings. It is an innate human faculty, universal, and is recognized as the core of a person’s freedom and individuality. It is more than simply a faculty for decision-making, it in the inner arbiter for deciding one’s actions as individuals and cannot be simply dismissed as mere “personal beliefs”. To force a person to act against their conscience is to destroy their core and fundamental integrity. Freedom of conscience is therefore fundamental to the freedom of an individual, and must be protected as an innate human right. Such rights cannot be limited in a one-sided manner in favour of patients. Both patients and physicians require protection.
The draft’s requirement for “effective referral” is an affront against the fundamental rights of physicians. A patient’s requests for medical treatments and procedures cannot override the moral harm that referral for such a procedure would cause to the physician. Such a referral is akin to cooperating with a treatment or procedure that the physician has found repugnant and therefore creates a moral dualism
within a physician that erodes his or her moral integrity.
Effectively, the physician is forced to act contrary to him or herself, and duplicity enters into the patient-physician relationship.
An erosion of the physician’s integrity at his or her core moral level would have devastating consequences for patient and society at large.
Once a physician violates their fundamental core values, the heart of their professional integrity is fractured. It follows that all of the core tenets of medical professionalism then come under risk: honesty, integrity, justice, and veracity. The loss of these would irreparably damage the physician-patient relationship.
In order to avoid violating their consciences, physicians may choose to avoid areas of medicine where they would be involved in referring
for procedures or treatments that they do not perform or prescribe.
Although such physicians constitute a small minority, they will be excluded from fields in which they could have otherwise brought their expertise and compassion (e.g. rural medicine, women’s health,
palliative care). This may even limit the diversity of applicants
to medicine, impacting the area of medical education and the future of medical care in Ontario.
One of the joys of being a medical educator is interacting with medical trainees from a variety of religious and cultural backgrounds.
As the diversity of our patients increases, so should the diversity of physicians – this ensures that patients can receive culturally sensitive care. In order to ensure this diversity, we must be equally respectful and open to the personal values and beliefs of our current and future physicians. This is why the University of Toronto Medical School, the largest in Canada, has existing ethics guidelines that support trainees’ right to refuse participation in activities for ethical reasons. The CPSO should also continue to endorse that physicians not be compelled to provide what they discern are unethical services – only in this way will Ontario remain a culturally respectful and safe environment for physicians to learn and serve.
Dear CPSO,
You should not abandon your physicians. You must respect their right to their moral conscience just the same as every other citizen of Ontario. Patients will not be greatly harmed if physicians are allowed respect for their own conscience. There is no need for physicians to be required to refer. Many citizens of Ontario agree with their physicians who object to providing service for reasons of religious or moral conscience. The citizens of Ontario are not helpless. They can find another physician to help them.
If you consider a physician to be a private business, then you have no authority to dictate to him which services he must provide, just as no one would have that authority over any private business. If you do not consider him a private business, then you, CPSO, have a duty to protect his rights just the same as any other citizen. When needed, it should be the responsibility of CPSO to assist patients with finding a physician to take care of their needs. This will become increasing more necessary when physician-assisted suicide and euthanasia become established practices. You must not mandate that all physicians become involved. These are life-and-death issues, just as abortion, and they deserve extraordinary organizational measures. You must establish registers of your physicians, taking into account these important human issues. They are not the same as “gall bladder surgery” or “treatment of influenza” for example, or any other less morally-involved medical procedure. These issues deserve extraordinary means of handling because they are extraordinary issues. Any reasonable person will understand the difference. I believe CPSO should understand the difference as well.
I am a pharmacist in Ontario and I do not agree with the Ontario College of Pharmacists expectation that pharmacists also must refer to another pharmacist to provide service to the patient. I believe the Ontario College of Pharmacists has neglected its pharmacists and I would like to see that CPSO does not follow the same course of treatment of its members.
Thank you for your consideration.
Please do not abandon your physicians.
The CPSO policy re Professional Obligations and Human Rights:
The following are some thoughts for consideration by the drafters of the above policy:
1) Principles (see lines 15-17) a very good section re key values of professionalism, but seems inconsistent with the rest of the policy.
A trustworthy physician has to be consistent: to say one thing and to do another destroys trust. How can having a set of beliefs or a morals and being known to act inconsistently with them promote trust?
A number of my classmates and I took an updated Hippocratic Oath upon graduation from medical school and promised not to assist to obtain or to do abortions or to assist to cause death or to cause death. A copy was submitted to the College last year and always hangs in my waiting room. I may not break that oath and continue to practice medicine without perjuring myself and breaking the trust I have built up with my patients.
RECOMMENDATION: that the policy be amended to state that physicians may post a list of procedures or practices that they neither can do nor assist patients in obtaining (which has been the CPSO policy since 2008).
2) Access to care:
CONSDERATION: the wishes and rights of one patient versus the rights of a physician and all the other patients in the physician’s practice.
a) There is no law stating that a particular patient must seek medical care from a particular physician. If the patient-physician relationship is not a good fit, the patient may seek care elsewhere (even in underserviced areas such as where I practice). To insist that a particular patient must get a referral for a procedure or have a procedure by a specific doctor who may not wish to provide such based on religious or moral beliefs is unreasonable (re lines 156-159). Forcing the physician to do what the patient requests would cause stress to the doctor and, in the worst case scenario, would force the doctor to close their practice thus leaving all the rest of the patients without medical care. We are crying out for more family doctors so enacting a policy that could force some to leave is counterproductive and reduces access to care.
b) Abortions and the morning after pill are by self referral in Ontario, so insisting that an objecting physician do the referral would slow access to care.
RECOMMENDATION: that the policy be updated to reflect the facts in Ontario re access to morally controversial procedures and to reassure both physicians and their patients that religious and moral beliefs remain valid reasons to refuse certain aspects of care without penalty.
3) Assisted Death and Euthanasia:
The Supreme Court of Canada when it struck down the ban on assisted death did say in effect that physicians were not to be forced to assist with euthanasia or to refer for it if it was against their religious or moral beliefs. We who have been medically trained in Canada were all trained to be healers not assistants to causing death.
RECOMMENDATION: that the policy be changed to give all physicians the right to refuse to assist to cause death or to refer for assisted death.
I liked the section on Clinical Competence.
I trust that the above thoughts will prove helpful as you review the policy.
I know you have a difficult job with many pressures. It is hard to balance the needs of the few and the needs of the many, so falling back on the rich medical tradition of the last 2000-2500 years and the realization that Hippocratic Medicine has helped civilization for millennia should be reassuring. We physicians do want the best for our patients, but we ourselves also are vulnerable and need some protection.
Thank you for the opportunity to give you some input.
As an Ontario resident and member of the public, I am concerned that the draft policy on Professional Obligations and Human Rights, particularly 156-161, does not adequately protect a physicians’ freedom of conscience and religion, because it requires a physician who cannot provide a particular health service for moral or religious reasons to provide “an effective referral” to another health care provider. But an “effective referral” is exactly how physicians provide health services to patients whenever the physician, for pretty much any reason whatsoever, is unable to provide that service themselves. In fact, a great many specialized health services generally cannot be provided to patients at all unless a physician makes an “effective referral” to a suitable specialist.
For this reason, when a physician makes an”effective referral” for a particular health service, the physician is facilitating the provision of that service to the patient. Because of this, the proposed policy, particularly lines 156-161, clearly violates a physician’s freedom of conscience.
A better approach, more respectful of the human rights of physicians, would be to permit a physician to decline to facilitate (including referrals) any health service that violates the physician’s conscience, If patient access to services is of concern, other physicians who do offer those services can themselves communicate with prospective patients, and prospective patients can themselves seek out such physicians.
One possible objection to my suggestion is that this is too accommodating of physicians rights, and not accommodating enough of patient rights. My answer to this objection is threefold. One, while there is not a “hierarchy” of rights per se, freedom of conscience and religion is an established human right. Access to any particular health service is not in itself a right at all. Secondly, it is harmful to the profession to establish a policy, such as lines 156-161 of the draft, that effectively limits the ability of persons with moral beliefs to practice as physicians without violating those beliefs. Finally, equal and uniform patient access to every possible health service is not achievable anyway: the huge variations in access to health services arising from the location of a patient in Ontario are far greater than any variation in access arising out of the freedom of conscience of physicians for those few health services that are morally problematic.
The College of Physicians and Surgeons of Ontario
Re: Draft Policy: Professional Obligations and Human Rights
I wish first, to commend the College for its transparency in submitting the draft policy to public scrutiny and open discussion.
I wish second, to praise the emphasis on human rights in the document, particularly for its recognition of freedom of conscience.
However, I disagree profoundly with the CPSO’s assertion that there are limits to the freedom of conscience that require that a physician provide “effective referral” in matters in which the physician has moral objections to the service requested, especially those matters that involve the termination of developing human life (abortion) or the deliberate ending of life, as in assisted suicide. The proposal, if established and enforced, will require whole classes of physicians in Ontario to violate their own conscience in order to avoid charges of discrimination. If, as the Draft states in footnote 11, the courts have determined that “there is no hierarchy of rights”; all rights are equal”, then the right of a patient or prospective patient to a procedure or treatment that is contrary to the physician’s conscience cannot easily trump the right to free exercise of conscience.
“Personal values or beliefs” are not necessarily individual opinions without any basis in reason. They are not mere subjective claims. Still less are they only “emotional” reactions to what is thought to be morally wrong. On the contrary, they may be the developed tenets of a whole body of philosophical thought or religious tradition over centuries. Conscience, properly understood, is simply human reason aware of moral principles and deliberating about what is good or evil and coming to rational conclusions about specific courses of action to choose.
It may be claimed that an “effective referral” should relieve a physician of moral responsibility of providing the requested service him/herself. But such a referral makes the practitioner complicit in the controversial procedure; although he or she does not directly cause the perceived harm, the physician is indirectly engaged: there is tacit approval of the harm. The causal relationship is too close to absolve the physician of personal moral responsibility.
To have a considerable number of Ontario physicians forced to act contrary to their conscience and the source of continuing public controversy and interpersonal tension with patients is hardly conducive to the public good. The Supreme Court, in the Carter case, has stated that a total ban on assisted suicide is “overbroad and grossly disproportionate” in pursuit of the goal of protecting the vulnerable. I suggest that the requirement that individual physicians provide effective referral is also an overbroad and grossly disproportionate method of ensuring the rights of some patients from discrimination.
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Many physicians may not know the identity of those willing to provide the controversial service; they may not associate with them at all or have knowledge of their practice. If the CPSO wishes to ensure effective referral, would it not be preferable for the College itself to become the referring entity in cases of conflict, rather than forcing individual physicians to resolve the conflict at the expense of violating their consciences? The College has the resources to manage this task. It may wish to appear neutral on the matter, but in advancing this proposed policy, it is hardly being neutral; it is clearly taking sides with those who desire the morally controversial procedures. The College’s assumption of this the role would not be a disproportionate response to the problem.
I urge the CPSO to reconsider this element of the draft policy, and to try to find other ways of providing accommodation for both patient requests, and the freedom of conscience of physicians: a balance of rights, not a victory of one over the other.
Dear members of the Council of CPSO:
I am writing in response to your darft policy as tiltled above, after the recent court decision on assisted suicide.
There is certainly no need to take extreme measures to extend the length of life. When people are dying, effective palliative care with the best medical assistants is a society’s responsibility. But there is a profound difference between compassionately journeying with someone who is dying, versus killing that person, or assisting that person to commit suicide.
Assisted suicide means a person is incapable of killing oneself and hence demanding a second party to commit cooperative homicide. Legalization of assisted suicide involves a willing homicidal partner. What will happen if the second party is obliged to participate in the process of such against one’s conscience? A spiritual or moral suicide of the participatory party hence resulted. Physicians are trustworthy due largely in part of our inherent conscience. No citizen wants to be cared by a physician without conscience.
No one has a right to take away anyone’s life, and it is simply wrong for the state to allow or to encourage that. It is even more wrong for a medical body to endorse that. There may be demand or misguided statistics to support its legalization. It is usually the weakest, the disabled and the incapacitated who lack or hind their voice for fear of burdening the “progressive and productive” majority.
It is a perversion of the vocation of physicians to have them engaged in helping people to kill themselves. Physicians are called to be servants of healing, not agents of death.
The yardstick is morality and human conscience cannot be graduated or defined by statistics.
Assisted suicide is the deceptively attractive face of euthanasia. The most compelling cases grip our attention and sway the debate, and so the Court opens the door to assisted suicide. A set of limiting conditions, such as informed consent, were established. But the state is authorizing the killing of an innocent person, whatever controls are in place, and even those limitations can over time be swept away, leading to the more widespread practice of euthanasia. We have only to look at some European countries to see what lies ahead. We Canadians patriotically believe our country is special, but it is not so special as to be immune to the dynamics of increasing access to medical killing, as individualist rationales make persuasive the argument for that in more and more cases.
The court, recognizing that many physicians, faithful to their healing vocation, will not assist people to kill themselves, makes some very slight room for freedom of conscience. It trusts local Colleges of Physicians and other such groups to deal appropriately with the conscience issue.
As a practicing physician for twenty years, I do know that not everyone’s conscience is equal.
Some of us have weaker conscience, including myself, at times.
Do all surgeons explain the surgical consent 100%?
Do all MDs explain side effect of medications 100%
Do all Obstetricians explain the implication of prenatal testing 100%
Everything can be lawful, but not all lawful are beneficial to human being.
The Law does not equate human conscience.
Public trust has been misplaced. Currently the College of Physicians and Surgeons of Ontario is proposing a draft conscience policy which states that physicians who refuse to perform a procedure to which they morally object must arrange that the procedure gets done by someone else. In other words, they are compelled to become accomplices. I urge the College not to go through with this unjust policy. This represents an assault on freedom of conscience of all physicians. Every Canadian with a conscience should speak up against it.
Any society that authorizes killing people through assisted suicide and euthanasia has lost its moral compass.
“The Ballad of Narayama” is a 1958 Japanese film of great beauty and elegant artifice, telling a story of startling cruelty. The poor village enforces a tradition of carrying those who have reached the age of 70 up the side of mountain and abandoning them there to die of exposure. It won 3 Mainichi film awards. A story of a necessity of survival became tradition which became an enforced culture. A thriller which is of worthy of review before casting your vote of conscience.
A doctor’s right as a citizen should be honoured. If a doctor wishes to uphold her values about protecting life, it should be honoured. Only the giver of life has the right to call it back!
Dear CPSO,
We have good health care in Canada. As a nurse for over twenty-five years, I have seen great strides in the health care system, one of those areas includes end of life treatment. Patients no longer suffer as they did years ago. Legalized euthanasia concerns me. Many people have a long drawn out death because family will not withdraw heroics, not because euthanasia isn’t available. Legalized euthanasia could be abused. Forcing doctors to administer practices that go against their better judgement let alone their morals limits their ability to give the kind of care they would like to see in their own practices. Is not protecting the rights of the minority just as important as the majority? My doctor would not perform a circumcision on my child because of his own beliefs but does this mean he must go to jail?! Freedom of conscience for physicians is imperative. Please consider this carefully.
Thank you.
As the brother of a practicing physician, I have had many discussions about the proposed Euthanasia laws. I am opposed to any law that forces doctors to either perform a mercy killing or forces them to refer their patient to a sympathetic doctor. This goes against the very moral fabric of most doctors. “Do No Harm”.
Dear Sir/Madam:
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> I have read the draft policy:
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> Rights of Conscience and Freedom
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> and disagree.
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> A member of the Canadian public who is very concerned with your DRAFT!
I wish to express my deep concern regarding changes to the human rights policy for Ontario physicians. Changes that would require physicians to refer in cases of moral and ethical objections to medical treatments requested by a patient violates physician rights to hold moral and ethical positions.
As a patient I want to be treated by a physician who has a conscience and is free to practice medicine guided by that conscience. I object to the notion that a physician must refer-this makes the physician complicit in a morally objectionable act and compromises integrity at the deepest level. I do not wish to live in a country where physicians must leave their conscience at the office door.
Physicians must be free to practice the principle of “do no harm”. This underlying principle is of first importance and coercing physicians to abandon this principle will cause harm to both physicians and patients.
Hi,
The more I think about the Supreme Court of Canada decision to legalize assisted suicide I realize it has far reaching effects and I also believe the majority of Canadians will not agree with this ruling but now can do very little to prevent its incorporation into law.
This ruling will cut across many Canadians moral and religious beliefs, including Health Care Professionals. I also believe, as has been proven in other countries who have adopted this law, that it will be abused and the weakest of our society will be on the butt end and the Supreme Court of Canada will not be able to prevent or stop this abuse. The Supreme Court of Canada has made a decision they cannot guarantee will be respected.
Assisted suicide is said to be a human right to end one’s life deliberately. I strongly disagree that assisted suicide has any bearing on human rights. I do believe if a person wants to commit suicide then that is their personal decision that you really cannot take away from them, however under normal circumstances people will try to persuade a person otherwise.
I also believe that assisted suicide should not become part of our National Health System. Our National Health System is dedicated to helping to overcome illnesses in order to improve health and quality of life. Our health system is staffed by people who chose Health Care for a career in order to help and save lives; you might say it is their vocation rather than their career. We must not expect people dedicated to saving lives to deliberately end lives as this is totally contrary to who they are as a person and the reason they entered the Health Care System.
To insist Health Care Professionals should be responsible to assist people wishing to commit suicide by making it law is totally unjust and against their human rights. Enforcing anyone to end a human life or to assist in deliberately ending a human life is so wrong, wrong, wrong. I simply cannot believe the Supreme Court of Canada made this ruling. By all means make a law legalizing assisted suicide but why pin the responsibility on Physicians; I can only see such a hue and cry with the result many Physicians will resign along with other Health Care Professionals. If you think we currently have a shortage of Health Care Professionals just wait and see what is around the corner. Already too many go south.
If Canada insists on legalizing assisted suicide then the Federal Government should provide separate facilities (clinics) where this can take place in a controlled manner and which will be staffed by suitable trained people (it does not have to be a physician) who will have no moral and/or religious issues about assisting people to commit suicide. For me the only way to try and prevent abuse of this law is to limit people’s access to this service by creating dedicated facilities (clinics) where all of the necessary criteria must be established before assisted suicide can takes place.
Also I do not believe the costs associated with assisted suicide should be incorporated into the National Health Budget. Assisted suicide by its very nature has nothing to do with ‘Health Care’.
I also believe that assisted suicide should not be at the expense of the general public i.e. paid by tax dollars. Why should Canadians who will be against this law on grounds of it being morally wrong and against their religious beliefs have to abet assisted suicide by financing it? Assisted suicide should be treated similarly to Funerals, you die you pay.
Dear CPSO policy makers,
I have many concerns with the proposed “Professional Obligations and Human Rights” proposed policy. I will list them in no particular order of priority, but more as they flow from following the document.
In the first paragraph, the fiduciary duty to work in the patients best interests is stated and then compared to equal access to other services. The assumption is that everyone has equal access to all services. This is wrong practically and in reality. For example, anyone living in a rural area can tell you they do not have equal access to services. This is accepted because the government cannot provide them practically and those living in rural areas are expected to accept it because of their choice to live rurally. This is not a human rights issue, it is a choice issue, respected by both government policy and those making the choice to live rurally. In a similar way, a patient cannot expect all physicians to deliver all services and if they wish certain services they should seek out a physician offering the services, rather than demanding them based on a false sense or interpretation of the notion of equal access.
It is true that most physicians wish to work in their patients’ best interests. This is part of the “do no harm” directive. Practically, however, “best interests” is not easily defined. For example, from a medical standpoint, for a Jehovah Witness patient who suffers a massive GI bleed, the best interest of that patient is a blood transfusion, but we do not force the patient to do so as we respect their autonomy and moral beliefs. This policy, however, would violate that same principle for physicians. The CPSO can not endorse a policy that is hypocritical in the direction it gives physicians.
The policy states we must respect the rights, autonomy, dignity and diversity of all patients or those seeking to be patients. The necessary corollary for any such argument is that those same conditions apply to the physician. If they do not, there is not an equal relationship morally. Again, the CPSO can not endorse a policy that respects and demands the moral rights of patients without extending the same level of respect to its members.
The policy goes on to state its purpose is to eliminate barriers that may exist due to the physicians personal beliefs and values. Again, there is a necessary corollary that the barrier may be a result of the patient’s personal beliefs and values. How can the CPSO or any agency dictate whose personal beliefs and values have precedence. It is an untenable stance if equality is the basis of the policy. Further, there must be evidence that barriers actually exist and no proof is offered, only an assertion that they may exist. It is inappropriate to create a policy that limits physicians rights based on a “maybe”.
The policy goes on to state that the key values of professionalism include compassion, service, altruism and trustworthiness. None of these exist outside a moral framework. The CPSO cannot demand that its members embody and embrace morality and then declare that it has no importance or value when their moral choices differs from the patients. Morality is either important or it is not. True morality cannot be turned on and off. It either is or it is not.
In bullet number 3, the discussion is made of conflict of moral values or beliefs and that the patient’s best interests must be paramount. That statement is wonderful if there is a standard for “best interests”. Best interests cannot be defined individually which this could be interpreted to mean. For example, if a patient believes female circumcision is in the best interest of his daughter in his/her culture and moral code, does that mean we have to assent? The obvious answer is no, as we as Canadians draw a line based on our own moral code. Why are physicians being denied this right that we as a nation have no problem asserting and enforcing. Why as physicians should we not be able to make moral choices based on our view of best interests even if they are in conflict with the patients view of their best interests. Further, when it comes to medical decisions, we by virtue of training and expectation, do and should have a better concept of “best interest” devoid of moral sway on either side. We are able to do as the CPSO asserts we should do which is “protect the public” by doing what is best.
In reference to the Human Rights Code and the need for all agencies or individuals to honor it, even the code does allow discrimination on the very criteria it embodies based on best interest. For example, there is supposed to be no discrimination based on age, but underage adults will not be served alcohol as society has deemed that to be correct. These rights and criteria are not universal. As is noted later in the policy, the Canadian Charter does allow for restrictions, but they must be reasonable and just. I do not think the proposed CPSO policy of negating physician rights carte blanche when they conflict with patient’s beliefs would be seen as embodying that.
There is also a problem with the notion that clinical competence means members must offer services, even if they find them morally repugnant. For example, all OB/GYN have the clinical competence to perform D & C. Under this new policy it could be interpreted that all OB/GYN perform abortions as they cannot claim they lack the skills. This would be a dangerous precedent to set for the safety of Ontarian residents as there could be potentially a mass exodus of OB/GYN as they would not wish to practice in an environment that violates their moral code. Similarly, any licensed MD could administer a lethal dose of medications should euthanasia be legalized. Again, what would happen to Ontario if every MD who found euthanasia morally wrong either had their license removed by the CPSO or resigned. This policy would suddenly create a doctor shortage based on the conflict of moral values and not competence. We live in a real world and the potential far reaching consequences of this policy cannot be ignored.
There is also an error in assuming a right is the same as a moral code. A moral code exists regardless of the rights granted to it. Martyrs for any belief system illustrate what occurs when rights (or a lack thereof) come into conflict with a personal moral code. Neither the CPSO nor any regulatory body can legislate a moral code away. If the CPSO wishes to try to limit the exercise of a moral code or belief system it must also weigh carefully the risk/benefit ratio of its actions. Strictly speaking, society has achieved most of its benefits from an observance of moral codes. The anti-slavery, anti-child labor and suffragette movement, for example, have all been championed by people with a high moral view that was in opposition to the perceived best interests of society at that time. The CPSO would be in error to believe that the we would be protecting the public and guiding the profession by demanding physicians be functionally amoral in their practice. One cannot divorce the practice from the practitioner and expect to get the same result of professionalism.
Lastly, the final words of the policy are a minefield because they lack any definition and are so open to broad interpretation. Can the CPSO accurately define any “care that is urgent or otherwise necessary to prevent imminent harm, suffering and/or deterioration” that has a moral basis. Certainly, there are medical interventions that can be defined so personally, but not universally. For example, how does one quantify “suffering”. It is subjective not objective. Any member can testify of how different patients react to same diagnosis or problem in vastly different ways. Likewise is deterioration to be objective or subjective or based on some as yet to be determined external standard. Consider the cancer patient in an era where euthanasia exists. Who defines deterioration and hopeless intervention from depression or delusion or undue influence from an external party? The phrase is fraught with more possible misinterpretations than direction. It also totally ignores our professionalism and training to do what is in the “best interests” of the patient when their very suffering or deterioration or fear of hurt (mistaken as harm) clouds their decision making. I am not saying we get the final say, but it also wrong to say we have no say. If we don’t, then we are ignoring the CPSO policy to protect the public.
In total, I can only say the proposed policy is fatally flawed on many levels and needs to be restarted from scratch. Any policy must respect the rights and moral values of physicians and patients equally. We offer health care services, not a ethic- neutral commodity which is the case with most other government agencies under the “Code”. We have to have our own policy that reflects the unique relationship that exists between patient and physician. That relationship exists because of a moral code not in the absence of one. Trust cannot exist in the absence of moral code or belief system. Trust is the basis of our patient/physician relationship. We need to work within this system to ensure unjust discrimination is removed, but this must be differentiated from the good practice of discriminating between want and need, choice and right, and equal respect for all participants in the decision making process.
To all Physicians,
These words modified from a letter from the Coalition for the Prevention of Assisted Suicide echo my concerns for our right to live.
Will our lives be safe if our physician is lethally injecting or prescribing a lethal dose to his/her patients?
When we are going through a difficult situation, how will we feel if our physician is urging us to die?
At the annual Canadian Medical Association (CMA) meeting, many physicians urged the CMA to protect conscience rights with respect to euthanasia and assisted suicide. Will the CMA intervene to protect conscience rights?
Conscience rights for physicians enable us to choose a physician who will not pressure us to death.
The appeal of the Bentley “feeding” case will be heard on Wednesday, Feb 11. The case concerns Margot Bentley, who is being fed by spoon and who drinks with a cup, and who lives with dementia. Last year, a British Columbia court decided that normal feeding is not medical treatment but is basic personal care. The Bentley family are asking the appeal court to order that feeding be stopped and that Margot die by dehydration.
Please speak out against this insanity. Do you wish to be coerced into providing “legal services” to every patient, even when the physician conscientiously objects?
To Whom it may concern:
I’ve always worked as a nurse on health care teams that respect diversity. If I were assigned to a patient whose medication or procedure I couldn’t provide for reasons of conscience, I would continue to provide nursing care for her, and alert my team that I couldn’t provide the treatment as soon as the ethical dilemma arose. I would not make an “effective referral” to a colleague.
The CPSO draft “Professional Obligations and Human Rights” does not acknowledge the moral equivalence of performing and referring for a procedure that violates a physician’s conscience. Instead, it proposes that doctors with values like mine face disciplinary measures if they do not refer. Like the Carter decision, the CPSO draft places higher priority on patient autonomy than it does on the principle of respect for a person’s life.
The requirement for “effective referral” is intended to provide patients with timely access to procedures, but I think coercing physicians to act against conscience places patients at risk. We need health care providers who think clearly, free of intimidation, because their attention to ethical dilemmas protects patients. I trust my health care providers to base their care on ethical decision-making as much as I value their compassion and expertise.
In my specialty of mental health, a patient’s desire for death can be overwhelming. My role is to hold hope and maintain safety until the person responds to treatment, instead of acting on his expressed desire to end his suffering. I am aware of having saved at least one person’s life by not endorsing his autonomous decision that life was not worth living.
The absence of legal constraints against life-ending procedures normalizes them for health care teams over time. When the ethical dilemma over terminating the life of patients seems “settled”, individual responsibility for ethical reasoning is all the more important. That’s why I’ve written to object to the proposal that requires doctors to make “effective referrals” for treatment that they can’t provide for reasons of conscience.
To Whom It May Concern:
Thank you for the opportunity to provide feedback. To answer your questions:
1) Does the draft policy provide useful guidance?
Not if a patient claims to be a dieffenbachia or a cat, or perfect. There are many cases where a physician might have to politely humour someone’s self-perception, but they will still have to treat them according to what they are. The moral and religious beliefs referred to include, for some physicians, adultery, fornication, and lying, and for most physicians, murder, theft, and kidnapping. None of those are on the agenda, nor are they likely to come up during a visit to the doctor.
2) Are there any issues not included in the draft policy that should be addressed?
Plant and animal identity, and delusions of deity.
The supreme court’s decision that no rights are absolute. The point is valid when referring to Middle Ages crusades, or shooting unarmed soldiers at monuments, or Jack the Ripper. But in this case it needs to be qualified:
“The supreme court has determined” doesn’t mean they’re right. They once determined that a baby in the womb is not a person.
“No rights are absolute” must include human rights, or the statement is nonsense. If not, we must conclude that, a) some rights are absolute, b) there is some variable scale of absoluteness, or c) all rights are absolute. If some or a scale, we must then decide whose or which rights are more rightful than others, and on what grounds. If all, we must then include individual conscience rights of all, including physicians.
The College is addressing physicians regarding their personal values and beliefs, so address patients likewise. The College expects physicians to respect the fundamental rights of patients, so expect patients to respect the fundamental rights of physicians. Protect physicians as much as they are being protected against. Treat respect with the same absoluteness as rights.
3) Are there other ways in which the draft policy should be improved?
Recognize that “best interests” doesn’t mean giving everyone everything they want just because they want it, that sometimes it means denying subjective wants in the face of real needs. Otherwise the health care system will become a servant to emotional preferences.
Allow a physician to refuse or delay treatment because he believes the patient’s own actions have contributed to their condition. If someone does something stupid and gets hurt, he should have to wait until others are treated first, emergencies excepted. If a smoker goes to emergency with symptoms directly related to his smoking, he should be sent home to quit first. Physicians have an obligation to the healthcare system and taxpayers, too. If the system is being abused the abuse needs to be stopped, and physicians are in a good position to do it.
Recognize that when a physician limits services for moral or religious reasons, they are promoting their beliefs to a degree. Recognize that some faiths include the duty to tell others, which is included in the general right of freedom. Recognize that a physician’s office is part of the public square where open dialogue and exchange of ideas are fundamental to a free society, public funding notwithstanding. If people don’t like the conversation they will vote with their feet. If the physician deserves that, he’ll get it.
Recognize that to impose a restriction on the expression of moral conviction is itself expressing a moral conviction. Give the same respect you expect.
Recognize that as a professional association, the College may have an obligation to maintain a uniform standard of medical care through a uniform standard of competence, but it has no right to infringe on the keeping, practice, or expression of morals, conscience, or religion. Neither does it have an obligation to be a cultural toady.
Thank you again for the opportunity.
It is my firm belief that no doctor should be forced under the law to perform an act which goes against his/her conscience or ethical beliefs. Nor do I agree that they should have to refer a patient to someone else to carry out a procedure which they will not, in conscience, carry out.
Having seen notices posted in Doctors’ offices with regard to unavailable services, I believe that a physician should have the right to post this notice as well, thus eliminating the need to refer. Perhaps a publicly available roster of Doctors willing to assist could be made available on-line.
Dear Sir/ Madam,
Thank you for asking for physicians for their input on the draft policy on Professional Obligations and Human Rights. I agree with much of the spirit of the document and that no doctor should ever discriminate against a patient or judge a patient’s choices based on that doctor’s personal beliefs, and I have strived to provide care with this ideal in mind my entire career. However regarding the areas in which I disagree with the draft policy, my input is as follows.
The following sections need to be revised, as they would force some doctors to choose between acting against their conscience by mandatory referrals for life ending treatments, and losing their livelihood. This is a choice that no jurisdiction in the free world currently forces their doctors to make.
Lines 129-135
The draft policy states that the patient’s right of access to abortion or, if legalized, physician assisted suicide supersedes the physician’s right to freedom of conscience (ie. refuse to facilitate access to abortion or euthanasia). This contradicts The Canadian Charter of Rights and Freedoms which applies to everyone.
The Canadian Charter of Rights and Freedoms guarantees that;
“2. Everyone has the following fundamental freedoms:
(a) freedom of conscience”
In Ontario, patients can get abortions without a physician referral. To date, no case has been made in Ontario that a patient who wanted an abortion was not able to get one. Therefore, the draft policy, which violates The Charter is redundant in this situation.
Lines 139 and 146
The above lines are vague and contradict one another. How does a physician ‘communicate an objection directly and with sensitivity’ without being accused of ‘promoting religious belief’? This should be removed to prevent unnecessary and unwarranted accusations against physicians.
Lines 152-169
The lines above forces the physicians to act against their calling to save, preserve and protect life making them an accessory to abortion or, if legalized, assisted suicide and will violate the physician’s rights under The Charter if they object to it on the basis of conscience. For a physician to use their skills to take human life violates the Hippocratic Oath which many doctors have taken at graduation and aspire to for their careers.
“…Nor shall any man’s entreaty prevail upon me to administer poison to anyone; neither will I counsel any man to do so. Moreover, I will get no sort of medicine to any pregnant woman, with a view to destroy the child.”
- excerpt from the Hippocratic Oath
The draft policy, as it stands, doesn’t acknowledge the physician’s right to freedom of conscience. Therefore, please revise the draft policy.
I was born and raised in Malaysia, once a very tolerant land. This was Malaysia’s greatest asset and helped unify its diverse multiethnic (Malays, Chinese and Indians) and multi-faith (Muslim, Buddhist, Taoist, Hindu, Sikh and Christian) population and built it into an emerging power in Southeast Asia, but the past 3 decades have seen the erosion of this tolerance and with it free speech and diversity. Canadians are known the world over for their tolerance. This is one of the major reasons I have chosen to call Canada my home. This draft policy 1) fails to acknowledge the strength that diversity confers upon its physicians in caring for Ontario’s equally diverse patient population, and 2) in forcing doctors to act against their conscience is intolerant, something distinctly un-Canadian (see The Charter). In its current form, this policy will reduce the diversity of Ontario’s doctors and thereby weaken the quality of care to Ontario’s diverse patients; and I would invite anyone who thinks otherwise to visit St Michael’s Hospital and its ethnically diverse group of physicians.
If this draft policy becomes finalized as policy and I am faced with this decision, I will still choose to exercise my right to freedom of conscience and bear the consequences.
I wish to first highlight that the policy fairly and clearly addresses discrimination.
I have very serious concerns, however, about the sections on “Limiting Health Services For Legitimate Reasons.” It is vague, too broad, and open to abuse – so much so that it seems it is deliberately so and not drafted in good faith but as a thinly-veiled attempt to allow particular interest groups or political factions to force their will on the rest of the profession and the public.
Consider the line:
“Where physicians choose to limit the health services they provide for moral or religious reasons, this may impede access to care resulting in a violation of patient rights…”
While this is true, there is not clear recognition of proportionality of competing rights, nor in the reality of how much it “impedes access to care.” This draws to mind a recent media firestorm about the tiny minority of Calgary physicians who would not prescribe certain contraceptives – and were thus “impeding access.” In this case it was widely viewed that needing to go (literally) around the corner to one of the other 99.9% of physicians is “impeding access.” If this is the case, then no physician can refuse to provide any procedure.
While the college of physicians would not have been prone to such a vitriolic and reactive interpretation as the media and vocal members of the public, the pressure of the media and public on these decisions and on legal proceedings is not nil. Clear policy is required to support decisions.
Another vague line, open to abuse:
Physicians must provide care that is urgent or otherwise necessary to prevent imminent harm, suffering, and/or deterioration, even where that care conflicts with their religious or moral beliefs.
What exactly constitutes “imminent suffering, and/or deterioration”? Consider a patient seeking assisted suicide because they are either suffering or deteriorating. Could the argument not be made, based on the quotation above, that the physician must provide “care”? There is no recognition or definition of proportionality here. Does someone suffering (however broadly that can be interpreted) for an extra week while they find another physician override the physician’s conscience rights on something as serious as not killing. What about a one month wait? One year? Nor is the proportionality of the conscience objection considered either. One physician refuses to perform a blood transfusion that is urgently needed on grounds of “integrity of body”. Another physician refuses to assist with the suicide a patient suffering from depression on grounds of “not killing”. Where is the distinction between the severity and proportionality of these cases?
The biggest problem with the policy is very clearly stated, however:
Where physicians are unwilling to provide certain elements of care due to their moral or religious beliefs, an effective referral to another health care provider must be provided to the patient.
Did anyone even consult an ethicist about this one? There is a clear and grievously faulty assumption here that referral for a morally objectionable procedure somehow removes the physician from ethical responsibility. Consider the following analogous situations:
* A pharmacist refuses to give morphine to a begging addict, but she makes arrangements for the person to contact an illegal opiate dealer.
* A man refuses to murder an enemy of his friend, but agrees to put him in contact with an assassin.
* An uncle refuses to help his nephew burn a mosque, but tells him that there are cans of gasoline is in the backyard shed.
Are any of these people ethically removed from the action?
If it is wrong to kill someone, it is wrong to make arrangements for someone else to kill them. Although many elements of society (including the law) do not object to killing a person if they want to die, or have not yet been born, that does not remove the immense moral/ethical weight of the killing from those who do not agree with the present legal situation.
Unless a physician’s refusal makes it impossible for a person to access a legally acceptable and effective procedure, there should be major responsibility to prove that the physician’s serious (ie. killing) objections should be overridden – not the other way around. This also needs to recognize that referral is complicity.
Thank you for opening this up for public feedback and I hope my assessment is considered.
Dear Sir of Madam,
I am writing to support the decision of the Arch Diocese of Toronto to oppose the proposed draft conscience policy for the College of Physicians and Surgeons of Ontario.
The policy states that physicians who refuse to perform a procedure to which they morally object must arrange that the procedure gets done by someone else. There are many cultural situations which affect an understanding of morality and putting a policy like this in place could result in many undesired consequences whether it be forced suicide under pressure, euthanasia, female circumcision or any other number of medical processes. We live in a complex society where norms are fading and the complexity of understanding what is truly right is becoming a grey area at best with the balance between reason and emotions being lost.
Catholic moral teaching particularly in the hospital environment has always called for looking at the whole picture facing a person and a family including economic circumstances, understanding family relationships and the impact that a decision would have not just on the individual but on the greater community. Our society has put in place life saving and life giving opportunities for people, called for pain management and dying with dignity among other areas in the Western culture. However, opening up a policy such as this one, could lead to consequences that cannot be forseen for those in a vulnerable position, feeling the pressure of being a burden on others or simply not understanding the implications of the consequences of their decisions in complex cases where they do not have the education or information provided to them to consider the emotional and practical matters at hand. Some people may not be of sound mind and simply agree to the decision out of pressure to end their life and indicate to their physicians that they know what they are doing. With migrants coming to Canada, the aged and a multi-cultural society, I stand with the Church and ask that this policy and the decision for assisted suicide be re-considered.
We put animals to sleep or to death when their pain becomes unbearable, however, an animal can only express it’s needs in non verbal ways and in our care for them, we make the decision for them. By a similar token, those facing death or dying may not fully understand the options available to them. Many people come out of a coma after many years. While there is no proof that this is because of or not because of the care given to them, there is a mystery to the human spirit that needs to be considered. I recently read of a man who came out of a coma and he had heard all the nasty things his mother had said to him while he was in the coma, yet he survived. To me, this policy is similar to saying if you can’t beat them, join them in crimes committed against humanity or other complex situations. Taken at face value it may inflict more harm than good. In the Western world many people are alone, many people are single and the community aspect is found in ways that are not traditional which again makes this situation very complex in terms of understanding how a decision is reached by a person, through the influence of others or alone. I am a Roman Catholic and I think that there is enough scope and freedom within the systems available not to have to encourage suicide and a culture of death and hurting others and yourself, as a right.
Life is a gift. The physicians oath is do no harm. The original oath was not to give poison, harm women when in their homes and to offer due care through passing on knowledge to the next generation.
This policy is going to shape the minds and hearts of the young to come and one day we all will face death or procedures that could result in death including heart surgery or any other number of situations. It opens up physicians to being sued for refusing to offer a referral and being sued if something goes wrong and they perform act the patient asked for. We trust our doctors to do what is best for us in their expert opinion, balanced with our needs as patients, and this is an important change to the way medicine will be done.
I urge you not to put physicians in a place where they are forced to go against their conscience, where they may be pressure to conform that is unbearable and to consider what is truly best for the patient and for our society in the long run.
Dear CPSO Council Members;
Thank you for your efforts to ensure that healthcare in Ontario is provided free from discrimination in a manner that best serves patient interests. I do, however, have a number of concerns with the proposed policy “Professional Obligations and Human Rights” that I hope you will consider.
1. Rights: The policy acknowledges the Charter right to freedom of conscience and religion as well as highlighting situations in which such rights may be limited. It then summarizes factors that may be considered in balancing competing rights, citing the Syndicat Northcrest vs. Amselem case in which the Supreme Court ruled that the religious right of a group of Orthodox Jews to build succahs on their apartment balconies outweighed the property and personal security rights of the building owners that would be infringed upon through such a practice. I would argue that the physician rights being infringed upon by the proposed CPSO policy significantly outweigh any patient rights that may be compromised. The act of referring for and/or performing a health service that is contrary to a physician’s moral or religious beliefs, including procedures that involve the ending of life and thus violate some of the most important moral or religious precepts an individual may hold true, is no trivial matter. In contrast, such services can relatively easily be made available by self-referral for patients that desire them, thereby avoiding any compromise to the integrity and wellbeing of physicians without interfering with patient access to care. Good patient care depends upon the maintenance of such integrity and wellbeing as apart from it physician function is impaired and societal needs disserved. I don’t have a legal background, but I am not aware of any legal precedent in Canada that would directly suggest that a physician is obligated to refer for and/or provide a health service against good conscience (please let me know if I am incorrect). To the contrary, my understanding is that the Supreme Court of Canada has recently upheld the right of individual physicians to choose not to participate in physician assisted death once it is legalized. It is inappropriate and I believe harmful to both the medical profession and more importantly patient care for the CPSO to create this unnecessary policy that if anything directly contradicts the ruling of the country’s highest court. It is an insult to the rule of law. Were such a policy nonetheless adopted by council, I would certainly be interested in contributing to a legal challenge against it.
2. Discrimination: A physician who chooses not to provide a particular health service to all of their current or prospective patients is not being discriminatory in even an indirect and unintentional manner. In contrast, the proposed CPSO policy specifically discriminates against physicians with particular moral or religious beliefs and limits its scope by requiring that physicians abstain from promoting religious beliefs without addressing any other potentially inappropriate non-religious beliefs that a physician might promote in the course of their practice. I consider this an affront to the pluralism and tolerance that our society values.
3. Service: If I understand it correctly, the objective of this policy is to establish CPSO expectations that will ultimately facilitate patient access to care and choice in Ontario. I would suggest, however, that it may in fact have the opposite effect. In particular, I have noticed several postings on the public form expressing concerns about physicians re-locating or otherwise changing their practice if the new policy were adopted. As a first year family medicine resident who has completed all of his medical education in Ontario, I feel indebted to this great province and would prefer to remain here to practice. If, however, the CPSO were to require referral and in some cases provision of health services that violate my ethical principles, this may affect my career decision making and would provide reason to consider practicing in another jurisdiction. Furthermore, I am interested in completing a care of the elderly fellowship and focusing part of my practice on geriatric patients, but would be discouraged from doing so if I were not confident that I would be exempt from having to refer select patients at the end of life for physician assisted death. I know a number of other like-minded medical trainees and physicians, and although we remain a minority, the influence this policy could have on our practice decisions nonetheless may impact negatively on patient care access. In particular, it may restrict access to such physicians by patients with similar values who prefer to receive services from healthcare providers who better understand their belief systems.
Thank you very much for your consideration of these points. I hope that they will be helpful to you in revising the proposed policy in such a manner as to optimize patient care in Ontario.
Peoples Christian Academy
Freedom of conscience is entrenched in the Canadian Charter of Rights and Freedoms. Your declaration is clearly an abrogation of physicians’ rights and freedoms. It is heavy-handed and prejudicial to deem matters of conscience on the part of professional doctors to be invalid.
Please revisit this unjust requirement.
A key point of the Nuremburg trials of Nazis was whether or not they followed their conscience or obeyed immoral orders. We cannot force our doctors to go against their conscience. It is, as the draft policy re-iterates, their professional duty to act in the patient’s best interests, and this includes refusing to perform or enable medical procedures which actively cause death, such as abortion and euthanasia. They can refuse such requests in a way that respects the patient’s dignity, as when a parent has to refuse their child what they are asking for out of a greater love for their well-being. Refusing to perform any medical operation which they judge harmful must remain a conscience right of the doctor, otherwise we might as well create soulless robots to do our medicine!
I don’t weigh-in on a lot of issues b/c it often seems fruitless or after the fact.
However, I am glad of this opportunity to add my voice to this discussion – thanks for that.
I hope that a policy such as this will NOT go into effect. It de-humanizes the very people that we are asking to care for us, sometimes when we are in the darkest time of our life.
You can’t legislate morality. People will just stop becoming doctors or finding other ways around the new rules. Why make them spend their time with that instead of working with patients? We are building a culture where people are afraid to speak up about their beliefs b/c they will be harmed in some way (i.e. in this case, unable to make a living in their chosen profession).
Do we have so many doctors that we should winnow the field like this? I think not.
to even have to refer a patient for euthanasia makes one party to the procedure which is not a medical one. If there is to be euthanasia then a new professional will need to be trained – an exterminator or terminator. As one who has subscribed to the Hippocratic Oath, I cannot be involved with euthanasia in any way, shape or form. None of this detracts from the suffering of some terminal people, but don’t dump the elimination on doctors. We are not trained for this.
I may be a “member of the public” but I worked as an RN for 50 yrs. Isn’t part of the Hippocratic Oath “first do no harm”? What more harm can one do to a patient then to help them to die? Someone has written that the number of applicants to the number of medial training spots far outnumber those spots and therefore we shouldn’t worry about the scarcity of physicians…..where are they? There are many that are without a treating physician for day to day care let alone something as extraordinary as telling a TREATING physician how they MUST perform in their practise regardless of their faith or conscience!! I agree that the College has overstepped its bounds. Those who are seeking such procedures as “end of life” have found their own way in the past and they should be allowed to continue to do so. By telling a treating physician that they should refer for a procedure they find morally incomprehensible is the same as doing it yourself. The psychological affects of doing so would undoubtedly create a physician who would probably end up not being able to function effectivley in their day to day practise! I do know whereof I speak as I had a brother-in-law die naturally of ALS!
My concern is the definition of urgent or more especially emergent, neither of which I can easily envisage when the Supreme Court decision seems to specify that our patient must be of sound mind and a time interval must be recognized. I should be much relieved if the College would
identify exactly what is meant so that a physician would have adequate time to refer to a receptive colleague, a list
of whom should be published by our College.
Thank you for letting us comment on this policy. A physician should never be compelled to act against traditional conscience decisions, this goes against Charter and human rights. A physician should not be discriminated for refusing to provide or perform some procedures such as abortion or euthanasia.
To the College of Physicians and Surgeons of Ontario:
In response to the draft policy on Professional Obligations and Human Rights, I have serious concerns about the proposed restrictions on physicians’ conscience rights and the obligation to provide referrals for procedures that they believe would be harmful to their patients and violate their moral or religious beliefs.
Declining to participate in a practice contrary to one’s conscience is an act of integrity, which we as patients rightly expect of the medical profession. Physicians are not obliged to provide a service merely because it is permitted by law. Slavery was once permitted by law in some jurisdictions. Such an obligation would reduce physicians from professionals into robots whose good in a given situation is determined by persons other than themselves, who have no medical qualifications. No one, including physicians, must be treated as a means rather than as an end.
Canada’s Charter of Rights and Freedoms guarantees freedom of conscience and religion. Over-riding this fundamental right is certainly not “required by professional practice and human rights legislation”. Freedom of conscience is a fundamental freedom. It is consistent with the Ontario Human Rights Code.
Compelling physicians to “check their personal views at the door” is contrary to the goal of ensuring the best quality care for patients. It threatens physicians’ independence from political interference in their professional judgement. Patients who share their vision of the human person may have difficulty finding medical care that addresses their needs if physicians who cannot in good conscience comply with the policy are forced to leave the medical profession in Ontario. This would also exacerbate the shortage of physicians in rural Ontario by reducing the pool of available doctors.
By attempting to impose policies on ethics for which there is no moral consensus, the CPSO is acting outside of its legal mandate and impeding the ability of physicians to to act in the best medical interests of their patients. Physicians need to uphold their promise to “Do No Harm. By providing referrals for procedures they believe will be harmful, physicians would be contributing to that harm.
In taking the position that doctors need to leave their ethics at the door, the CPSO is abdicating its duty to protect the public interest.
I wish to express my deep concern regarding changes to the human rights policy for Ontario physicians. Changes that would require physicians to refer in cases of moral and ethical objections to medical treatments requested by a patient violates physician rights to hold moral and ethical positions.
As a patient I want to be treated by a physician who has a conscience and is free to practice medicine guided by that conscience. I object to the notion that a physician must refer-this makes the physician complicit in a morally objectionable act and compromises integrity at the deepest level. I do not wish to live in a country where physicians must leave their conscience at the office door. Physicians need to have the same protection of conscience that every Canadian is entitled to.
Physicians must be free to practice the principle of “do no harm”. This underlying principle is of first importance and coercing physicians to abandon this principle will cause harm to both physicians and patients.
Dear Sirs,
I read the policy draft and DISAGREE
Thank you for your attention
I’m alarmed that you are drafing a new document restricting physicians’ rights and freedoms by way of “Where physicians are unwilling to provide certain elements of care due to their moral or religious beliefs, an effective referral to another health care provider must be provided to the patient.” Asking a physician to refer to someone who will act contrary to the physicians’ beliefs is, in fact, making them complicit in the act. I’m so concerned with where this is taking us with regard to the future of Canadians and a reverence and dignity for human life.
It never ceases to amaze me that all those who are so concerned with their rights are so willing to deny others the same consideration, I am sure there are enough Drs. willing to assist these patients without treading on another person right to refuse on grounds of conscience or religious belief, In the not to distant past state sanctioned killing of the infirm or mentally handicapped was carried and in some places still is. I implore you to give such a policy deep and respectful consideration. Such questions as who makes the final decision must be covered and strict guidelines in place. However forcing someone to perform and action that is abhorrent or against their beliefs is unconscionable.
Please respect the human rights of doctors. They are not robots of the government. They need to have conscience rights (unlike in Nazi Germany).
What happens if the Death Penalty came back to Canada? Would you force doctors to kill prisoners despite the conscience objection?
Please STAND UP and protect the rights of doctors!
There are few issues more important than the dignity of human life and also of the need to respect conscience. It is crucial that laws and policies respect the dignity of physicians’ consciences. If a doctor is morally opposed to a procedure, forcing him to then refer a patient to receive that procedure violates his conscience.
This is not only morality, but basic common sense. Let us be truly just and sincere.
To the Members of CPSO
I would like to state that I reject the proposed “effective referral” mandate in the draft dealing with physician assisted suicide. This “effective referral” compels a physician to violate his/her own conscience by being a participant in the very act, the very procedure, which he or she objects to in the first place.
Freedom of conscience and religion are guaranteed by the constitution and must be respected and upheld. I deeply believe this and urge your appropriate action.
Please accept my opposition to the proposal mandating that the physicians of Ontario violate their conscience by formal cooperation. The proposal to force people to violate their fundamental moral and religious beliefs seems to me to be anti-human right, anti-democratic, anti- freedom, against the Charter of Rights and UnCanadian. Please rethink this.
As Roman Catholics we are very much against Euthanasia.
Euthanasia is nothing more than legalized murder by those who perform this procedure and legally permitting a patient to commit suicide.
Murder in the judicial system is a crime and punishable by law. Assisting a person to die is also murder. It is a mortal sin to take another human beings life or to take ones own life.
Therefore, in the eyes of the law and in the beliefs of a Christian EUTHANASIA IS WRONG!
Do not allow a bill to take ones life into ones hands be passed.
May our prayers be answered.
Dear Sirs/Madames
We want to be served by doctors with moral integrity!
Physicians should have the right to say NO to providing certain forms of treatment. However, I’m particularly concerned with the requirement that physicians provide referrals for treatments which they feel are morally and ethically wrong.
If a physician feels a treatment is morally and ethically wrong, and then aren’t they still violating their conscience by asking someone else to perform the procedure? How is the physician’s right to freedom of conscience being protected under these circumstances? In addition to this, a physician might feel that if a procedure is morally wrong it would also be harmful to the patient. Under these circumstances the physician would be violating not only their conscience, but also their Hippocratic Oath by referring the patient to someone else to perform the procedure.
[**MESSAGE FROM ADMINISTRATOR: DURING THE CONSULTATION PERIOD, WE RECEIVED 3 RESPONSES FROM INDIVIDUAL RESPONDENTS CONTAINING THE CONTENT PUBLISHED ABOVE. ALTHOUGH THIS FEEDBACK HAS NOT BEEN PUBLISHED IN DUPLICATE, THE COLLEGE ACKNOWLEDGES RECEIPT OF THESE SUBMISSIONS.**]
I object to your draft policy because the mandate for an effective referral is a violation of a physicians rights, as it compels the physician to violate his or her own conscience by being a participant In the very act, the very procedure to which he or she objected to in the first place.
Aren’t physicians supposed to try to save lives? We are entering a slippery slope with physician-assisted death. Evidence has shown, even with so-called safeguards , mistakes occur.
We wish to express our disappointment with the CPSO of ontario for attempting to force doctors to violate their moral conscience in providing treatment and effective referral to patients which runs contrary to their moral and religious beliefs. By referring , one becomes a participant in the act. Surely you people must be aware of this! This is a blatant violation of the Charter of Rights and Freedoms.
I strongly disagree that a physician’s Conscience Rights should be taken away.
Do you want a doctor with moral integrity?
Absolutely Yes,
Physicians should have the right to say no to providing certain forms of treatment. However, I’m particularly concerned with the requirement that physicians provide referrals for treatments which they feel are morally and ethically wrong. If a physician feels a treatment is morally and ethically wrong, then aren’t they still violating their conscience by asking someone else to perform the procedure? How is the physician’s right to freedom of conscience being protected under these circumstances? In addition to this, a physician might feel that if a procedure is morally wrong it would also be harmful to the patient. Under these circumstances the physician would be violating not only their conscience but also their hippocratic oath by referring the patient to someone else to perform the procedure.
Freedom is inclusive not exclusive, it’s right to agree or disagree. This is what makes this country great.
Thank-you, for your consideration.
Hello,
I’m writing to voice my concern about the College of Physicians and Surgeons of Ontario proposed policies that force physicians to refer and in some cases provide treatments or perform procedures that are contrary to their personal or professional ethics and conscience. One thing I love about this country is it’s diversity. People are allowed to have varying beliefs and are not forced to act against their conscience, as opposed to communist countries and those communities where freedom – freedom of speech, religion and conscience is not respected and even penalized. In reality, this is what is happening with the policies being pushed forth by the College of Physicians and Surgeons of Ontario. Doctors either must choose to deny their conscience or are being told they are no longer welcome. This is VERY troubling.
Please reconsider. There are many physicians I hold in high esteem who have given their lives for the betterment of others. This policy will rob us all of so many excellent doctors and why? So we can further become a society that disregards the importance of respecting others who may not share our exact beliefs?
Please put an end to these appalling proposals!
I appreciate you taking the time to consider my concerns in this matter.
To Whom it May Concern,
I am strongly opposed to the Effective Referral Mandate which is being proposed to all the doctors of Ontario, for the following reasons:
1. This proposal overrides the freedom of conscience of individual doctors, namely those doctors who are against euthanasia. By being forced to refer a patient to a doctor who will meet the request for an induced death, the doctor making the referral is an accomplice to the act of euthanasia.
2. This proposal negates the Hippocratic oath taken by all doctors when they receive their license to practice medicine. This oath clearly states that they will not harm those in their care. By this action they are rendered unworthy of trust by those who may be seeking their help.
I trust that my concerns will be given serious consideration.
I am strongly against the draft policy of limiting doctors’ right to freedom of conscience and religion.
I am quite surprised that a doctor would be obliged to act against his or her conscience in performing or directing a person to perform a medical act that is against his moral code of saving lives vs. taking lives. Let’s be honest, access to abortion in Canada is not a problem. It is not difficult to go to an abortion clinic or find a doctor who is willing to do an abortion or give a referral. So why is there a need to threaten all doctors by pushing this ridiculous policy forward? We need doctors…let’s not push them over the border where they will be respected for their integrity to act according to their beliefs and make more money! I’m very surprised by this action by CPSO and I don’t approve of it.
It is so difficult for persons to pay the huge toll on their personal lives, finances, and the vast amount of time it takes to become a Physician. We are so privledged as a country to have such high standards for our Physicians. I think it would be wrong to now assault these same physicians by forcing them to sear their own conscious if they are so inclined, rather leave the responsibilities to those who have no objection. In short, the government needs to respect the physicians.
Dear Members of the Consultations Committee:
I deeply troubled by the draft policy regarding Professional Obligations and Human Rights. The draft seems to either ignore the human rights of the physicians or consider them to be of less value than that of patients deemed terminally ill. Surely no amount of suffering on the part of patients can justify being the cause of new mental anguish inflicted on physicians who cannot in good conscience refer patients to other physicians who are not troubled by performing
certain kinds of treatment. The consequence of disregarding the
rights of those burdened by a conscious and forcing them to act against their will, will invariably lead to a dissolution of the relationship said physicians allow to have with their patients.
I ask that you please revise sections 8, 10 and 11 of the draft for the betterment of the rights for all.
I object to the proposed “effective referral” mandate for doctors.
It is not right to insist that a doctor participate in violating their own conscience, and in participating in the death of pre-term babies and vulnerable adults. This violates the basic human right of the doctors, and the persons entrusted to them.
It makes it clear that the life of a pre-term baby, or a vulnerable adult, has no value to society, or to themselves.
Response in PDF format.
Dear Members of the Consultations Committee:
As a citizen of the Province of Ontario, I am writing to you with grave concern regarding the content of your draft policy, “Professional Obligations and Human Rights”. I ask the Consultations Committee to retract this draft policy for the reasons I have outlined below.
If adopted, the draft policy will jeopardize the ability of physicians in Ontario to follow their consciences. The policy suggests that physicians who decline to participate in certain acts for reasons of conscience should be compelled to provide an effective referral to other physicians who will perform those acts. This requirement does not address the fact that many physicians find the act of referral itself to be objectionable, as it is considered material cooperation with the act. If a physician finds a certain act to be immoral, it follows that facilitating and arranging for that act to be done is also immoral. In compelling physicians to refer, you are limiting their right to freedom of conscience and freedom of religion. I would like to remind you of the fact that the very Canadian Charter of Rights and Freedoms that you cite in your draft policy protects freedom of conscience and freedom of religion. The CPSO’s draft policy inherently prioritizes the freedoms and rights of patients over that of physicians, despite the fact that the CPSO does not have the legal jurisdiction to rule on such matters. I ask that the CPSO respect our country’s constitution and recognize the importance of diversity of medical and ethical judgement.
I do not believe that physicians should discriminate against patients, and in fact believe that patient care is of the utmost priority. However, contrary to what the draft policy implies, deciding not to offer a particular service in no way discriminates against patients, provided that the service is not offered to any group at all. It is difficult to see how limiting physicians’ right to freedom of conscience and religion will result in any less discrimination. In fact, moving ahead with this policy will actually create systematic discrimination based on conscience or religious belief.
Moreover, compelling physicians to make referrals that they do not morally agree with will not improve patient care. Requiring doctors to participate in procedures that go against their beliefs will reduce their personal sense of integrity if they continue to practice. This will significantly harm the physician-patient relationship, as physicians would be recommending their patients receive procedures or medications that they do not personally believe in. If approved, this draft policy will coerce a large percentage of physicians to participate in assisted-suicide despite their moral objection. I bring your attention to the Canadian Medical Association, which asserted physicians’ right to conscience in their August 2014 meeting.
Access to care will also not be improved by implementing the draft policy. Common actions and procedures that physicians may object to include abortion and contraception. The availability of these services is not threatened by physicians who morally object to them. In fact, these services are easily accessible without referrals, given the ability of patients to self-refer to clinics that provide such services.
I would also like to bring your attention to the final section of the draft policy, which is entitled “Protecting Patient Safety”. The language used in this section is ambiguous and unacceptable in its current form. There is no clear guideline as to what is considered “imminent” harm, suffering, and/or deterioration. The incredible lack of balance and comprehensiveness to this section of the draft policy implies the CPSO has little regard for the implications of the policy.
In summary, I believe that the CPSO is overstepping its jurisdiction in defining and limiting morality. Freedom of conscience is foundational to our free society and is protected by law. I ask the CPSO to retract this draft policy on “Professional Obligations and Human Rights” in light of the Canadian Charter of Rights and Freedoms. Instead, the CPSO should create a policy to defend the right to freedom of conscience for all physicians.
[**MESSAGE FROM ADMINISTRATOR: DURING THE CONSULTATION PERIOD, WE RECEIVED 3 RESPONSES FROM INDIVIDUAL RESPONDENTS CONTAINING THE CONTENT PUBLISHED ABOVE. ALTHOUGH THIS FEEDBACK HAS NOT BEEN PUBLISHED IN DUPLICATE, THE COLLEGE ACKNOWLEDGES RECEIPT OF THESE SUBMISSIONS.**]
Response in PDF format.
To the members of CPSO,
I reject the proposed “effective referral” mandate for doctors. I believe that their Charter right of freedom of religion and conscience must be respected.
[**MESSAGE FROM ADMINISTRATOR: DURING THE CONSULTATION PERIOD, WE RECEIVED 7 RESPONSES FROM INDIVIDUAL RESPONDENTS CONTAINING THE CONTENT PUBLISHED ABOVE. ALTHOUGH THIS FEEDBACK HAS NOT BEEN PUBLISHED IN DUPLICATE, THE COLLEGE ACKNOWLEDGES RECEIPT OF THESE SUBMISSIONS.**]
To the Working Group of the Professional Obligations and Human Rights Draft,
I am writing to inform you of my objection to the draft and its proposed changes.
I greatly appreciate the work that the College does on behalf of physicians and to protect patient safety, but as a physician, I am appalled that the College that I trust to defend the rights of patients and physicians is proposing such a draft.
My first question is: In the spirit of transparency, where is the drive for such change coming from? Is this physician-led or patient-led?
My second question is: Will the College be more clear about what this policy will actually mean in practice? Which situations will this policy apply to? Emergencies are understandably diverse and heavily nuanced — the College must be explicit in the situations to which this policy applies, otherwise the interpretation of this policy may result in more harm than benefit.
I have three major objections to this draft:
Firstly, this draft has a strong undertone that physicians are Canadian citizens whose rights as human beings come second to patients’ rights as patients. I believe that this is an unconscionable position for an advocating body such as the College to make, and which smacks of the unconstitutional. It is our human right to use our moral codes to make moral decisions, many of which occur in medicine — the interface between humanity and science. We live in Canada, a nation where varying moral codes are accepted as long as they are not unlawful. I do not understand how physicians morally objecting to provide services that they fundamentally cannot support is unlawful.
Physicians are not politicians. In the vast majority of cases, we actually do want to do the best for our patients. We do not object to providing services because we have ulterior motives as to what we want for our patients, but rather because we as human beings cannot propose or support medical interventions that we find ultimately more harmful than beneficial to the patients we care much for. Are doctors second-rate citizens? In addition to the sacrifices of time, family, and personal well-being that we give up in the name of medicine, must we also give up our moral consciences, which are arguably the characteristic that makes human beings human?
The other aspect of this issue that I do not understand (and which relates to my first question of transparency) is that for those patients who are not receiving the interventions that they would like are free to pursue care from other professionals. In the modern age of the Internet, easily accessible information, and savvy patients who have no qualms about advocating for themselves, I see this draft policy as a moot point. Most of the patients who this draft would apply to, do not need such a draft in order to access care. And if this proposed draft were to be put forward, those few physicians to whom this draft does apply will be required to practice medicine in a way that they cannot support, or be required to leave the profession altogether.
Thirdly, I question what kind of physician development the College is supporting. Which physician does not use their moral judgment when providing medical care? Moral judgment is inherent in medicine — we are constantly making moral decisions, and I would argue that every medical decision has a moral aspect inherent to it. Because medicine is an art as well as a science, because we work with complex human beings as well as intricate organic pathophysiology, demanding that physicians leave their moral code at their office door borders on the ludicrous. Where would it be appropriate, safe, or in the best interests of the public to ask an architect to plan a corporate 100-floor building without a ruler? Or to require a pilot to fly a plane without a compass? Doing so takes away one of the essential tools of their trade. For physicians, our moral code is one of those essential tools.
Moreover, physicians belong to one of the noble professions, of which firefighting, policing, and paramedicine are other examples. It would be unconscionable to ask a police officer to leave their conscience and moral judgment at home when they work a shift. Why is there a double standard for doctors? Why is the College supporting a policy that would require this?
In conclusion, I find this policy deeply troubling. I cannot foresee how such enforcement will better patient safety or patient care. I do foresee that physicians’ rights as human beings are the true crux of the issue, and they are at high risk of being eroded away.
I have invested my personal well-being and years of my life to provide safe, competent, and compassionate medical care to my patients. But I cannot also sacrifice my conscience as a human being for the sake of medicine. If this is the future of medicine in Ontario, I am saddened to say that I seriously question whether I can consider myself part of that future.
Thank you for asking for feedback regarding this policy.
I think it unconscionable that CPSO would even consider the “Subject Matter”.
If a physician refuses to murder a patient, then how can “The College” propose to order that physician to become complicit in the murder by referring the act to a willing physician.
What has happened to the Hippocratic Oath? How can a profession that was once dedicated to the preservation of life become one that will be at the forefront of taking it?
Referring to legislation regarding abortion, which originally had very limited legal application, we now have abortion on demand for virtually, if not actually, any reason. CPSO and all other organizations will be complicit in the certain erosion of safeguards for future vulnerable people in our society by agreeing to this heinous act of assisted suicide.
Since some in our society are hell bent on flying in the face of such values as the sanctity of life, I implore you to cease any imposition of rules/regulations/procedures etc. that violate the beliefs of others.
To Whom It May Concern,
We all have the gift of “Morale Conscience” and we exercise it in everything we do on a daily basis. It fuels the passion, which directs our lives. It is important, we keep our morale conscience strong and clear in order to do the best job we can everyday.
Can any person afford, especially a physician, to have his personal morale conscience overlooked and disrespected? Our morale conscience makes up the very heart of our being, of our existence.
Each one of us,Ontarians, look up to our doctors because they always behave in an ethical manner and with solid and sound morale conscience behind each interaction with their patient(s). This new proposed “effective referral” is mandating doctors to disregard their morale conscience and to act, in spite of their moral or religious beliefs.
Canada, as a nation, has always taken pride in being a mosaic of cultures and, religions. This is what makes our current nation “strong and free”. This very basic element of our society is being jeopardized with this new proposed mandated effective referral.
As a nation, as a province, do we really want to lose our Canadian identity?
Ontario physicians have a patient’s best interest at heart always. As a province and as a nation, there is incredible pride in this knowledge; however this proposed effective referral mandate, destroys the very core and ethical essence of this premise.
As much as I am appalled by the Supreme Court decision on the approval of “Assisted Suicide”. I am devastated by the fact that, in recognizing this federal decision. our Ontario College of Physicians and Surgeons wants to DISRESPECT a doctor’s Freedom of Morale Conscience.
It is important to all of us, as human beings, as Ontario citizens, who need doctors, that take care of us, through their respective practice, to always act with a sound mind and body and to strongly uphold their morale ethics and freedom of conscience in their interactions with each one of us, as their patients. A mandated effective referral, like the one proposed, strips and strips and will continue to strip the very heart of what makes Ontario doctors great. Moreover, doctors, who are not respected here at home in Ontario may very well need to relocate. A doctor will always be a profession, that needs to be properly fueled with active morale conscience. If this is removed, from their being, they discontinue to be doctors and become medical agents.
Does the Ontario College of Physicians and Surgeons want their doctors to leave?
Does the Ontario College of Physicians and Surgeons not care about a doctors’s ethics, religion and morale conscience?
Does the Ontario College of Physicians and Surgeons have so much disrespect for their professional members to mandate an effective referral, even after, so many wonderful doctors are so adamantly opposed to it?
In this life, we all live, we have to respect one another, regardless of our culture, backgrounds, and religious beliefs. We each, as individuals, have to firmly hold on to our freedom of morale conscience. We have to be true to our flag, ” … strong and free”.
I firmly oppose and strongly reject the proposed effective referral mandate.
Dear Ontario College of Physicians and Surgeons, I kindly implore you to respectfully maintain the Freedom of Morale Conscience, amongst our current and future doctors, in tact, strong and free.
I thank you in advance, for your serious deliberation and I hope and trust, the Ontario College of Physicians and Surgeons will exercise all due respect to all its’ doctors and will allow each doctor, to use his/her morale conscience as they confront (request(s) of Assisted Suicide within their respective medical practice in the future.
With much thanks and kindest regards,
I find it hard to believe that the CPSO proposals on conscience rights have not blown up and destroyed the credibility of the committee responsible for this ignorant dismissal of other views. We deserve a public apology. Why?
Because the CPSO committee thinks the issue of conscience rights is primarily a religious bias, they dismiss them as inadmissible in the practice of medicine. But that is not so. Even a committee, as a-historical as this one seems to be, should have thought about conscience rights in a war situation. In the western world we have accepted these rights for almost a century on three conditions: the argument must be based on a rational premise, it must be demonstrably true on occasion, and it must be sincerely held over a long period. Pacifism is not irrational; war kills people and it is a deeply held rational position that it is wrong.
Similarly, it is not irrational to say that human life begins at fertilization because that is the only point at which we receive a uniquely coded genetic blueprint (twins are a special case). Left to its own devices the baby would be born. It cannot give consent so gratuitous harm is done. As in conscientious objection to war we have non-religious grounds for objection to abortion and euthanasia. Furthermore, for the mother, the evidence that abortion is not an inconsequential action is steadily increasing. Physicians have always objected to abortion since Hippocrates. No one can defend doing gratuitous harm to an innocent human being, yet this is what abortion is. Thus, unless the committee dismisses the argument in the case of pacifism, it must accept that it applies also to abortion and euthanasia.
In addition the committee is imposing a minority view on everyone. Statistics Canada data shows that the vast majority of Canadians belong to religious groups that have traditionally opposed abortion and any killing by doctors. After WWII everyone was appalled to discover that physicians had run the Holocaust killings, which were legalized authorized. Laws are by no means always just.
In a society where we have no moral consensus we can only function if we respect one another’s rights. This proposed protocol is a disgraceful attempt put an end to all other views. Hippocrates and his colleagues understood that medicine was a moral activity because there is no compunction to accept the physician’s advice. Thus a physician is fundamentally helping patients to decide what they ought to do. “Oughts” do not spontaneously generate themselves from physical facts; they come from deeply held, often visceral commitments to ideas about the meaning of life.
What the committee should have done is to see how patients can be connected to physicians who share the informative story of the patient. Yes, in our society we have granted the right to abortion but not the right to coerce doctors to choose between moral integrity and losing their employment. Doctors, of all stripes, should be required to post their philosophical commitments so that patients know what to expect. We ought to have learned by now that passing a law does not necessarily make an act ethical. The holocaust was legal; the Dred Scott decision that deemed slaves to be not persons was legal.
If the committee knew these things and chose to dismiss them, they ought to be ashamed but, if they were ignorant, they need to be replaced by more appropriately educated people. If ethicists were involved, I would like to hear from them in public.
The essential requirement now is to defend the rights of doctors who do not agree with the CPSO position, because there are many(probably the majority) patients who want them now, as both Barbara Kay and Margaret Somerville have pointed out. Many more will want them when they are vulnerable. After all thinking rationally would you trust a doctor more or less if he has a visceral objection to killing patients.
Response in PDF format.
Response in PDF format.
Response in PDF format.
Response in PDF format.
I am concerned about this proposal. Specifically sections 8, 10, and 11. If this proposal goes through then our doctors will lose their freedom of conscience. I encourage these sections to be amended so that doctors are not forced to make referrals.
I am concerned about this proposal. Specifically sections 8, 10, and 11. If this proposal goes through then our doctors will lose their freedom of conscience. I encourage these sections to be amended so that doctors are not forced to make referrals.
With respect to physicians conscience rights, it is my view that physicians need to uphold their promise to “do no harm”. If euthanasia or assisted suicide is legalized, Ontario physicians must maintain their right of conscience to refuse to participate in ANY way. I would NOT FEEL SAFE if my physician participates in euthanasia or assisted suicide. No one has a right kill a person who is suffering. No one has a right to help someone commit suicide. Physicians are called to be servants of healing, not agents of death. It is wrong/evil for the College to force physicians to act against their conscience, compelling them to become accomplices (i.e., the draft policy states that physicians who refuse to perform a procedure to which they morally object MUST arrange that the procedure gets done by someone else). As a patient, I would refuse to have a physician who aborts or euthanizes. Patients must have the right to have access to physicians who respect human life from the moment of conception to natural death.
Keep Physician polices the same as they are. Please continue giving them the rights to deny specific referrals to patients such as for abortions. I wish to continue having the option of going to a physician with moral integrity, religious freedoms and rights.
Thankyou
I oppose abortion of any kind.
As a patient I would appreciate it if my physician was able to vocalize their opinions or religious beliefs. This makes for a more personal relationship and allows for the patient to be comfortable with their physician. They too have rights and should be allowed to express them.
I believe Physicians should have the right to say No to providing certain forms of treatment. However, I’m concerned with the requirement that physicians provide referrals for treatments which they feel are morally & ethically wrong. if a physician feels a treatment is morally & ethically wrong, then aren’t they still violating their conscience by asking someone else to perform the procedure? How is a physician’s right to freedom of conscience being protected under these circumstances? In addition to this , a physician might feel that if a procedure is morally wrong it would also be harmful to the patient.. Under these circumstances the physician would be violating not only their conscience but also their hippo ratio oath by referring the patient to someone else to perform the procedure….
Life is not perfect and who are we to end it.
Euthanasia is not the answer and legalization is not a solution.
I admire the physicians who are against it.
Canada, China (Mainland only) and Vietnam have no legal limit on when an abortion can be performed thus full term babies are being killed. This is barbaric and equivalent to what ISIS is doing- the killing of innocent people. Why are we asking our Physicians to participate in the ‘harming of life’ (infant or adult)when they take an oath of doing no harm.
I am writing to you with grave concern regarding the content of your proposed draft policy, which indicates that physicians who decline to participate in certain acts for reasons of conscience should be compelled to refer their patients to other physicians who will perform these acts. It does not address the fact that many of these same physicians will find the act of referral itself objectionable, as they consider it material cooperation with the act. In compelling physicians to refer, you are limiting their
right to conscientious objection. I am opposed to this.
There is significant disagreement in our society as to what constitutes a moral act, and I do not expect the College to define or limit morality. All I expect is that physicians, as professionals, be allowed to respect their own consciences. Freedom of conscience is foundational to our free society and cannot be limited, even for the best of intentions.
If we coerce physicians into violating their consciences we will inevitably erode the personal integrity which is the basis of the physician’s relationship with their patients. I encourage you to revise the sections above, and include a clear defence of the right to freedom of conscience for all physicians.
I think that physicians, who have a moral and religious conscience, should have the right to say “No” to performing acts that are contrary to their beliefs. God has said in His word that we are not to kill, whether that is by our own hand or through the hand of another.
It is unethical to force anyone, no matter what profession they choose,to act in a manner that is contrary to their rights and freedom. They must be able to stay true to their core beliefs and values.
All physicians take a vow to do no harm. The choice to refuse or comply to end a life, no matter if it is considered merciful, should be taken away from any person.
If someone can be a conscientious objector in the military or other professions, then how can a person committed to saving and improving life (physicians and health care professionals)be forced to take an action contrary to their values?
It is well documented that patients sometimes make decisions that are not in their own best interests, there is a sad history of persons who take on the responsibility to end lives of elderly patients (I believe some have considered themselves “Angels of Death”)against the wishes of the patient and their families, and many people, patients and doctors have suffered from remorse, guilt and mental health issues following abortion procedures. This issue is too convoluted to make it a black and white choice. To do so is against all of the persons involved (health care workers/patients and their families) charter of rights that are enshrined by Canadian law.
The College of Physicians and Surgeons of Ontario must not put this policy into practice. The College has overstepped its mandate by proposing to interfere with the core ethics and human rights of physicians. If the CPSO proposes to rewrite the Canadian Medical Association’s Code of Ethics, it should poll its membership on their desire for such a step.
While researching the Web page on the College of physicians, I was able to see how they regulate themselves and manage things around them. One thing that stood out in particular was the fact that they have no morals or ethics defined in their system, and even so, another thing which shocked was that this apparent “group” of morally unstable people have an incredible amount of power. So much so that they can even change laws. Keeping in mind that this “group” which is discussing our future laws regarding Human Rights and discrimination is a small number of 32-34 members, half of which are not even physicians and are APPOINTED by the government with an extraordinary large salary they carry around paid by our taxes ($457.- per half day plus travel expenses and preparation time)
How can they decided how to apply the word discrimination to one part and not to the other in a relationship of 2 doctor-patient?
How can a College can pretend to change or define for their own political agenda the meaning of words like Human Rights? Do they want to ignore their own members as Human beings? This is not their role, it sounds ridiculous. I wonder… what exactly they protect? If their mission, vision and values can be change at any time? It is clear for me that if they do not respect the legal order, not the dignity of their own members, they would not care for the public interest, that is mine. I have the right to see a doctor that has moral, values and fear of the Lord, because by knowing that, I will know he/she will always see for the best interest of mine.
The draft policy is all too clear. It is aimed at forcing physicians to act against their conscience by acquiescing to a patient’s request for a “service” that would end a life. To refer for such a service is equivalent to performing it. Somehow medical care is being turned upside down. We are asked to be robots and turn off our belief and conscience for certain acts but continue to care and act in good conscience the rest of the time. This is an untenable position morally and has the potential of being soul destructive. I agree that the College is overstepping its jurisdiction and legal bounds.
The Hippocratic Oath says that doctors are to do no harm. As patients we want Physicians who have high moral and/or religious convictions. They are members of our society and are highly respected. We don’t want physicians who violate their convictions. Physicians are not here to kill their patients, violating the do no harm part of the oath. Line 127-128 says that to harm a patient would not automatically be protected. Please do not force physicians to harm patients. Our society has made patient autonomy the ultimate trump card. It is such a “me” focus. It violates our connections with other members of society- family, friends, workmates. We are all connected. If an individual says, “kill me” and the physician says, ” I cannot violate my conscience” to do so, we need to protect both parties. I do not want physicians who violate their conscience.
I have the same question. There are physicians in Ontario who have taken the traditional Hippocratic Oath upon graduating from medicine. Are they expected to become liars and carry out or facilitate procedures they swore not to do in the oath? Is this what you are expecting of them?
It is clear from the responses given above that I and the majority do not agree with the CPSO policy as it has been drafted. I think that revising the draft and permitting some discussion will be beneficial to both the public, CPSO and the doctors. Clarity is key to all that we do. Thank you for redrafting the Policy.
I would say that if there is moral/religious conflict for the physician to perform some specific procedures, the physician could refer the patient to other physicians that do not share the same religious conflict to perform such procedures. In case the physician is in a rural area that there are no other physicians available to perform such procedure, the physician cannot be hold accountable for that. The patient should be connected to the closest hospital to find information of where they could go.
The physician should also made known to the existing patients that there are a certain procedures they feel are out of their moral acceptance. The patient could plan ahead.
Perhaps, the certain procedures that cause concern should be named on the draft, if there is a need to have this instruction at all.
Whose “rights” trump whose? If I have a Charter Right, that should not in forcibly infringed by another’s Right….doctors have to be able to make moral and ethical judgements based on their own conscience…no interference from their governing body
Regarding Physician assisted end of life. No one should have to go agains their conscience when providing a service. A doctor should be able to inform a patient that he can not advise or participate in Physician assisted suicide, nor have to refer to another physician. That is up to the patient. When reading the obligations for the physicians, the responsibilities are overwhelming. (needing to bring up end of life procedures repeatedly, determining whether the end of life wish is due to a ‘curable’ condition (i.e. depression). It seems like a courtroom nightmare. The last thing we want is our doctors tied up in court rooms, rather than helping the public.
The physicians professed to heal not to kill.
The College of Physicians and Surgeons spend their time studying and researching to find cure. This is what they PROFESSED. No one has the right to kill. It is MURDER.
If that is the case for those who practice Euthanasia, then, what is the purpose of going to Med school? Why bother going to the Doctor? They can just take poison and kill themselves. Why waste time and money to go to Med School if the purpose is to eliminate life? Anyone can just take poison and give to whom they want to eliminate.
The CPSO makes some important distinctions that you do not recognize, but sophistication and nuance aside, I do agree that killing does not belong in the healing arts. I also agree that the right to die transforms into the duty to die and that power corrupts. The effects can already be seen in the Netherlands and Belgium.
Dear Members of the Consultations Committee,
RE: DRAFT POLICY: PROFESSIONAL OBLIGATIONS AND HUMAN RIGHTS
I am writing to express my disappointment with the proposals in the Draft Policy on Professional Obligations and Human Rights, especially Sections 8,10 and 11.
The medical profession has always been respected for it’s professionalism and integrity. The mandating of effective referrals without respecting conscience rights of physicians will undermine the trust patients have towards physicians. Physicians who have objections to procedures or treatments will not be fully open and honest nor will they be professional if they do not disclose all their objections to these procedures or treatments.
In today’s Canada, diversity and open discussion should be encouraged and not minimized or blocked as your Draft Policy would mandate. As a Canadian citizen and Ontarian, I urge you to allow physicians to practice their profession with personal integrity and honesty. A defense of conscience rights for physicians is what I expect the College to do for the citizens of Ontario.
Hello,
I have just read the draft version of the “Professional Obligations and Human Rights” policy published by The College of Physicians and Surgeons of Ontario, and I have great concern over the details it contains.
It seems that the physicians are being stripped of their human rights in order to serve their patients. All citizens have the right to practice their religion both in their private and public life. This draft policy seems to place the “Human Rights Code” above the “Canadian Charter of Rights and Freedoms”. It also makes some statements that are at best unclear and at worst contradictory. For instance, line 114-115 states that “the Supreme Court of Canada has determined that no rights are absolute.” Immediately following it says, “The right to freedom of conscience and religion can be limited, as necessary, to protect public safety, order, health, morals, or the fundamental rights and freedoms of others.” I thought “no rights are absolute”? How, then can there be “fundamental rights”? Also, this seems to say that there are different levels of rights, and it is up to the Supreme Court to decide who has the righter right. Lines 123-128 are especially troubling, as the “courts will seek to determine whether the act in question interferes with a sincerely held religious belief…in a manner that is more than trivial or insubstantial”. A secular court has no place determining whether a religious belief is trivial or insubstantial.
In lines 143-148, the physician’s rights are limited in that they are not allowed to explain the reason they will not provide the service (at least this is how it reads to me). The physician should be able to explain, based on their religious or moral convictions, why they will not provide the service. An explanation does not necessarily equate to an attempt to convert them, but the wording leaves this open to debate.
While I agree that physicians should not impede access to care (see lines 152-164), they should not be forced to provide a referral to another physician willing to perform the requested procedure. If the patient is not satisfied with their physicians answer, then they, as the patient, have the right to find another physician who will. But the physician who refused should not be forced to become an accessory in what they would not do themselves.
Patients do have rights, but so do physicians. The patients need to respect the rights of the physicians. Where there is a conflict, they have the opportunity to seek services elsewhere.
We do not need, but implementing a restricting code such as this, to force physicians to leave the province and find a different location where they can practice according to their religious or moral beliefs.
I have read several comments on the forum regarding this draft code, and I hope you will take into consideration what many people, including physicians, are stating about this code.
While not everyone has religious beliefs, there are many who do, and they should be able to practice medicine according to these beliefs, and to seek the services of a physician who practices according to these beliefs.
I agree that no one should purposefully insult the sensibilities of another person, but part of free speech also involves the right to state opinions, whether based on religion or other belief systems. Opinions may offend at times, but that does not mean they cannot be spoken. Stripping one person of rights to satisfy another person is not democratic, and is contrary to the rights of everyone.
I hope you will take this, and other comments received into consideration, and will reconsider the need for this revised code. Thank you
To whom it may concern,
The CPSO draft policy demands that doctors participate in controversial procedures like abortion and even euthanasia by making referrals and doing the procedure in certain circumstances.
Doctors who refuse to follow the policy will be vulnerable to discipline, even though their fundamental freedom of conscience and religion is guaranteed by the Canadian Charter of Rights and Freedoms.
Such a law is unacceptable and is clearly opposed to not only the doctor’s freedom of conscience but also his ability to discern what is best for his patient.
I demand that our doctors keep their right of Freedom and Conscience for the most Common Good.
To whom it may concern:
Please reverse the current policy on abortion in Ontario. Every life is precious from time of conception babies have a right to life. To terminate their lives is legalky approved murder.
All are ceated in the image of God according to the Holy Bible therefore,
to end their lives is just wrong. Only Almighty God had the right to take what he has created.
Our Doctors’ rights are being violated because of the decision of the Supreme Court concerning assisted suicide. No physician should be made to defy the Hippocratic oath. Life is sacred and any doctors I know would never kill a patient.
Please be advised that I am spreading the word! I have tried to contact my rep and senators as well because ultimately the legislature is responsible, including in protecting the civil rights of physicians. I am daily astounded at the number of citizens do not see that they are lining up for govetnment sponsored gas chambers!
CPSO:
I would like to express my views on the Professional Obligations and Human Rights policy you are preparing and for which you are requesting input.
I recognize the difficulty of balancing obligations and rights in today’s environment and applaud you for your attempt to do so.
At the same time, I do find it disturbing that you foresee requiring a physician to refer a patient to another physician to carry out a procedure that goes against their beliefs. Obviously, if they have strong beliefs about the procedure, they would see this participation, however secondary, as going against their beliefs as well.
The recent euthanasia/assisted suicide decision by the Supreme Court expressly protects the rights of conscience for physicians objecting to this activity. I support the CMA’s position recommending physicians be allowed to follow their consciences on euthanasia/assisted suicide as the one that the CPSO should follow.
I hope you reconsider and eliminate the provision forcing doctors to refer patients to procedures to which they are opposed on moral grounds.
Thank you for considering my input,
Dear Members of the Consultations Committee,
I am an Ontario citizen writing in response to the CPSO draft document on Professional Obligations and Human Rights. I appreciate your invitation to open consultation regarding this policy and would like to express my thoughts and concerns regarding the proposed changes.
Firstly, I would like to affirm the document’s recognition of Charter rights of freedom of religion and conscience. Unfortunately, I find that the new policy challenges the rights of physicians to these freedoms by requiring physicians to refer patients for procedures they believe are morally objectionable. Although I agree, as stated in the policy, that the rights of physicians have limitations because they must be balanced with the rights of patients, this mandate is not a balancing of rights. Rather it is a sacrificing of physician rights in favour of patient rights. I find this to be gravely concerning as the freedom of conscience is at the core of human individuality and freedom and cannot be taken lightly or confused with mere “personal beliefs”. While “personal beliefs” may be subjective and irrational, moral stances stemming from an informed conscience are founded on evidence and reason and deserve to be defended.
In addition, while I fully agree that patients should be protected against discrimination, the refusal to treat or refer a patient is not discriminatory when it is rooted in the moral stances of the physician regarding the procedure. Such refusal is not based on the personal characteristics of the individual patient, but rather on the nature of the treatment. Coercing physicians to provide referrals against their moral stance would force them to be complicit in acts that betray their conscience, violating their human rights. Furthermore, it will lead to the erosion of the personal integrity of physicians and damage patient-physician trust.
Again, I would like to thank you for being open to consultation with the public and I strongly urge you to revise your new policy to ensure the protection of the conscience of physicians.
RE: Draft Policy ‘Profession Obligations and Human Rights”.
I am opposed to the draft policy whereby the College of Physicians and Surgeons of Ontario would force physicians to make referrals to procedures (e.g. abortion, possible end-of-life issues) that may violate their moral obligations or relegious beliefs.
According to some sources, the Charter of Rights and Freedoms protects physicians from being told “You have to assist in euthanasia”. Some writings out of the College suggest that they will override this right. How is this not political correctness gone amok?
Re:Draft Policy “Professional Obligations and Human Rights”
I am opposed to the draft policy whereby Physicians and Surgeons of Ontario would be forced to make referrals for abortions , end of life issues , that may violate their moral or religious belief, resulting in becoming Pontias Pilates “!!
I strongly believe that forcing a physician to perform procedures that go against their conscience or to refer patients for the same is a violation of their human rights. God is the one who gives life, and He is the only One that can take a life, whether in the womb, in old age, or in extreme suffering, without it being murder. Once again it is those who want abortion, euthanasia, gender change, etc. that are discriminating against those who do not.
Doctors must retain full freedom of choice and full freedom of conscience to practice medicine in the manner they deem best.
Hello,
I am writing to object to the following paragraph in the “Professional Obligations and Human Rights”
ii) Moral or Religious Beliefs
“Where physicians are unwilling to provide certain elements of care due to their moral or religious 157 beliefs, an effective referral to another health care provider must be provided to the patient. An 158 effective referral means a referral made in good faith, to a non-objecting, available, and accessible physician or other health-care provider.”
The bottom line is we don’t help people who have a mental illness to commit suicide so why should doctors and other health care professionals assist people with physiological illnesses to commit suicide? Doctors and the health care system is in place to save lives, not take them. God gives life and takes it away. Who are doctors to play God?
I don’t agree with this. It is wrong.
To the CPSO:
I reject the proposed “effective referral” mandate for doctors whose Charter right of freedom of conscience and religion must be respected. If there is no freedom of conscience, there is no freedom at all.
Good evening,
I would like to submit feedback on the Draft policy regarding Professional Obligations and Human Rights.
I am concerned, in particular, with the section on “Ensuring access to care” (lines 150ff). I believe that this should be substantially changed or removed.
To require a physician to refer a patient for a treatment that he/she, the physician, finds to be morally unacceptable is, de facto, to require the physician to participate in immediate material cooperation with evil. Doing such necessarily forces one to violate the sanctuary of the human conscience given the degree of cooperation that such an act entails. It is, per se, wrong to force such cooperation and shows a surprising level of disrespect for and lack of confidence in the physician. In addition, it creates a very problematic precedent whereby a physician can be forced – and dare I even say coerced which is what this policy does – to participate in an immediate way with an action they deem to be evil.
In addition to the concerns listed above, I can speak personally of several very fine physicians who have a tremendous concern for their patients, a desire to serve well society, and great respect for the science and art of medicine, who would be unjustly marginalized by such a policy and perhaps even be forced out of the practice of medicine. They are precisely the type of physicians – men and women of character, concern, dedication, integrity, and generosity – of whom the College and Ontarians alike should be proud. In our society, it is too rare to find people of such integrity who would stand up for a deeply held belief despite the personal cost to them. I have much more respect for a person like this – and would find them to be much more qualified in this sense to serve in the noble profession of medicine – than I would for a person who claims to hold that a certain action is evil, but then refers a patient to another physician to carry out that very act for the sake of remaining in good standing within your College.
I appreciate the opportunity to participate in this consultation. If I can be of any other service in the drafting of this policy, please do not hesitate to contact me.
Yours truly,
Hi,
I have read your draft policy Professional Obligations and Human Rights.
This policy is very troubling especially with physician assisted suicide likely to become legal within one year.
Assuming legalization, this policy would appear to require a doctor to refer a patient who requests assisted suicide to a physician who will participate. Meanwhile your own draft policy on end of life care notes that a request for assisted suicide could be “motivated by an underlying and treatable condition”. In short these two policies are placing a doctor in a no-win situation. If they refer – are they perhaps failing in their professional obligation to recognize the possible ‘treatable’ motivation behind a request for assisted suicide. On the other – if they decline to provide the referral – somebody could argue that the reason why the referral was not provided was due to the doctor’s moral views and hence end up in violation of the Professional Obligations and Human Rights policy.
I also fail to see why it is necessary for a doctor to provide an ‘effective referral’ for a procedure that goes against their religion or conscience. Are there cases where a patient has been denied a service for moral/religious reasons and was truly unable to access this service from any other means? I imagine the College is typically referring to abortion or other sexual health services – which a simple internet search can easily identify several clinics that provide these services. If being part of these services or referring for them – violates a doctor’s conscience – why is the College insisting on that doctor providing the referral – when the patient can access the information and the service themselves? Again I ask – are there situations were patients were not just mildly inconvenienced but actually denied services because of the conscience or religious views of one doctor? This seems incredibly unlikely and as such I ask that the requirement to provide an effective referral be removed. This kind of policy may deter certain minorities from seeking a career in medicine (e.g. Muslims, orthodox Jews and Christians.) This imposition is completely unnecessary as it result in no tangle benefit to anyone, violates the conscience and religious beliefs of some doctors, deters others for entering the profession and results in patients with strong religious views having fewer doctors that they will feel comfortable entrusting their care to.
Please remove the referral requirement. – Thank-you.
To Whom It May Concern,
Thank you for the opportunity to comment on the CPSO Draft Policy.
The concerns I have are with the requirements as outlined in the section “Moral or Religious Beliefs”.
I would suggest that most people choose a doctor with whom they feel comfortable and who they trust to provide the best care for them under all circumstances. This new policy seems to be forcing a “view” upon doctors which they may not necessarily hold to or with which they may not agree. It also seems to be limiting doctors to what they may and may not say to their patients, again patients who have chosen this doctor to be their care giver because of who he /she is. Basically what is being asked is that doctors, especially Christian doctors, leave themselves out of the care giving situation and only provide care as is dictated by the college. It seems to be an attempt to coerce Christian doctors to agree that their thoughts of required care are limited and they must use the treatment plans initiated by those who have no respect for human life and thus support abortion and euthanasia! This does not describe the character of a doctor in whom I would place my trust for health care.
I trust that the policy will be revised to allow all doctors to practice in accordance with their moral and religious beliefs, not by those pressed on to them by the College.
• I am opposed to the college forcing physicians to make referrals for procedures (e.g., abortion) that may violate their moral or religious beliefs (cf. draft policy excerpt below).
As part of ensuring access to care for patients, the draft policy requires that physicians, who are unwilling to provide certain elements of care due to their moral or religious beliefs, refer the patient to another health-care provider.
Dear CPSO Council,
While there are some positive aspects related to the draft policy, the section on “Moral or Religious Beliefs” under “Limiting Health Services for Legitimate Reasons” is of specific concern. Medical doctors are not robots, but operate from a specific worldview, just like every other person in society. This is what makes for great doctor-patient relationships, where a patient entrusts his care to a doctor with a compatible worldview. Doctors are professionals whose mandate is to do no harm and who desire nothing other than the betterment of patients and the society they make up. Forcing a doctor to be a part of something he rejects for moral or religious reasons (by requiring ‘effective referrals’) is belittling the profession and the ‘rights’ of the doctor himself. The draft policy must be changed such that the ‘moral and religious beliefs’ of doctors are actually honored and recognized as a critical component to the patient’s best interest.
Dear Members of the Consultations Committee,
I would first of all like to commend the CPSO on its excellent public consultation process. I am grateful for the opportunity to express my opinion on CPSO policy as a citizen of this province and as a fellow professional. The CPSO’s aim to ensure that its policies are in line with the public’s expectations for the Canadian medical profession is also admirable. Indeed, it is for this very reason that I write to you, for I fear that you are forgetting the diversity of moral opinions that still exist in this society.
I have grave concerns about sections 8, 10 and 11 of the draft policy on “Professional obligations and human rights.” Specifically, I am unable to support any wording that would see physicians compelled to choose between referring patients for acts they deem morally objectionable or risking disciplinary action. As a user of publicly funded healthcare in Ontario, I do not believe that any inconvenience caused to a relatively small number of patients can possibly outweigh the catastrophic attack on freedom of conscience enjoyed by members of the medical profession. A patient’s access to particular clinical procedures is not restricted if a physician conscientiously objects to referral for those procedures; there are ways to ensure that both patient and physician can be satisfied without trampling on the latter’s right to moral objection.
Please revise the sections noted above, and allow your members the right to exercise their conscience as professionals
I would like to thank those who have been involved in drafting the proposed Professional Obligations and Human Rights[1] policy. This task surely has required much time and effort, and I greatly appreciate the hard work and careful thought the authors have put into it. As a practicing doctor in Ontario, I sincerely believe in the CPSO’s key values of professionalism—compassion, service, altruism, and trustworthiness—for they reflect the core of what motivated me to go into medicine and foundationally shape how I practice my vocation. Unfortunately, some sections of the draft policy are highly problematic and would actually force many of my colleagues and me to practice medicine in ways that would be contrary to what these values mean to us in our daily work. In effect, the draft policy would compel many doctors to be involved in practices that they believe to be unethical and, thus, to gravely violate their consciences. This would have significantly negative implications for the trustworthiness of the medical profession, the human rights of doctors, and the overall availability of medical services to patients in Ontario. Therefore, I ask the CPSO to amend the draft policy such that these problems are avoided. In this letter, I will explain in detail my specific concerns.
Requirement to refer for elements of care to which a physician morally objects
My first concern is with lines 156-164, which state:
Where physicians are unwilling to provide certain elements of care due to their moral or religious beliefs, an effective referral to another health care provider must be provided to the patient. An effective referral means a referral made in good faith, to a non-objecting, available, and accessible physician or other health-care provider. The referral must be made in a timely manner to reduce the risk of adverse clinical outcomes. Physicians must not impede access to care for existing patients, or those seeking to become patients.
The College expects physicians to proactively maintain an effective referral plan for the frequently requested services they are unwilling to provide.
This section of the draft policy seems to assume that a doctor bears little to no responsibility for what happens to a patient when she makes a referral. This is an erroneous assumption. First, a referral implies the referring doctor’s endorsement of the patient’s receiving the service being requested. When a doctor makes a referral, she puts her name behind the request and, in effect, indicates that she believes a patient would benefit from the service being sought. To compel referrals that do not genuinely embody the referring doctor’s endorsement is to radically alter the essence of what a referral is. Second, making a referral is a deliberate action undertaken by a doctor that has intended consequences for the patient. Although the referring doctor does not directly provide the requested service to the patient, in making a referral her actions are closely linked to and play a causal role in what ultimately happens. Third, the principle that one shares responsibility for an action performed by another person if one facilitates or arranges that action is engrained in our society’s norms. For example, a hockey player who passes the puck to someone who then scores a goal is awarded an “assist”; businesses have programs that reward customers for referring friends to them; and one can be convicted for “aiding and abetting” a crime by facilitating another person’s performing an illegal activity. Carrying out an activity one’s self or arranging for someone else to do it are morally equivalent. Requiring doctors to refer for services to which they morally object coerces them to become active participants in acts that they believe to be harmful and, therefore, to act against their consciences.
Vague wording regarding “urgent” care
I am also concerned with lines 168-169:
Physicians must provide care that is urgent or otherwise necessary to prevent imminent harm, suffering, and/or deterioration, even where that care conflicts with their religious or moral beliefs.
The wording in this section is vague and could potentially be interpreted so broadly that there could be extremely far-reaching consequences. Terms such as “imminent harm, suffering, and/or deterioration” will undoubtedly be interpreted differently by different people. For example, is an obstetrician who refuses to perform a medically non-indicated Caesarean-section that is requested by a patient for social reasons or personal preference (i.e., a “C-section on demand”) guilty of professional misconduct? After all, it could be argued that the patient will otherwise suffer significant psychological distress imminently by having to wait any longer to have her baby or by facing the prospect of a painful labour and vaginal delivery. In this sense, from the patient’s perspective, the C-section is of an urgent nature to prevent a form of suffering. And at the same time, the basis of most obstetricians’ objecting to C-sections on demand is essentially a “moral belief.”[2] I don’t intend to downplay the concerns of a mother in this sort of situation—on the contrary, I think she should receive the utmost respect and sympathy—but I hardly believe that professional medical bodies or any of my medical colleagues would truly believe that an obstetrician who refrains from participating in C-sections on demand is guilty of professional misconduct. Indeed, the SOGC has explicitly stated that it does not support C-sections on demand.[3] Unfortunately, the wording of lines 168-169 is so vague that one could use it to argue that obstetricians must not refuse to be involved in these kinds of C-sections. In fact, with its current wording, the draft policy could be construed such that doctors could be forced to provide almost any medical service in almost any situation simply on the basis of patient demand.
I would agree that doctors should ensure that patients requiring emergent treatment for acute “life or limb” threatening conditions receive such treatment immediately. If this truly is the intent of lines 168-169 of the draft policy, then the wording should more precisely reflect this. That said, I have never actually come across or heard of a doctor who would refuse to provide emergent care in these kinds of situations on the basis of moral or religious beliefs. So I do honestly wonder if such a policy would address a problem that actually occurs in reality. Regardless, I think care should be taken to use precise terminology so that patients and doctors are clear on the exact kinds of situations to which this section of the draft policy would apply. There are detailed objective scoring systems such as the Canadian Triage and Acuity Scale (CTAS) used to classify the degree of acuity of a comprehensive range of conditions; I suggest reference to such a classification system be considered instead of using vague terms. Otherwise, this section of the draft policy could be interpreted in such a way that doctors would be required to provide services to which they have strong ethical objections even in situations where such services are not required emergently to save life or limb—which would be completely unnecessary and unjustifiable.
Implications of compelling doctors to violate their consciences
Forcing doctors to perform or refer for services to which they morally object forces them to act against their consciences. Unfortunately, as I’ve already outlined, there are two sections in the CPSO’s draft policy that would do precisely that. A policy that requires doctors to abandon their consciences will undermine the trustworthiness of the medical profession as a whole, violate the fundamental human rights of doctors, and result in an overall reduction in the availability of medical services to patients in our province.
Firstly, fundamental to the trustworthiness of the medical profession is the understanding that doctors will act ethically. There are various frameworks for ethical decision making in medicine, but essentially—and by definition—for a doctor to act ethically means that she does what is right and avoids doing what is wrong.[4] The problem is that on some matters there is no consensus, and people of goodwill (including doctors and their patients) may come to differing conclusions about what is ethical. So in light of this reality, how is the trustworthiness of the medical profession upheld? Some might argue that a doctor should simply do what a patient asks her to do, regardless of the doctor’s convictions. I think this is a myopic conclusion and that such an approach would severely undermine—not uphold—the trustworthiness of our profession. If a doctor routinely and with little hesitation will contravene her conscience, she cannot be trusted. Even if I don’t agree with my doctor on everything, crucial to my trust in her is knowing that she will not intentionally do something that she thinks is wrong or harmful to me. Doctors often come under pressure by third-parties or other external factors to act in ways that are contrary to their patients’ best interests. But when doctors are, as a matter of policy, required to regularly jettison their consciences, it is difficult to have any sort of assurance that they would always resist these pressures and act ethically. A person who is most trustworthy is not someone who does exactly what I ask of her, regardless of whether she thinks it is right or wrong; rather, it is someone who has a conscience, acts in accordance with her conscience, and is honest and transparent about what she is willing and not willing to do.
Furthermore, while laws and regulations play important roles in ensuring the ethical conduct of doctors, these alone are not always sufficient. The practice of medicine sometimes involves extremely complex and nuanced situations. Hence, laws and regulations cannot cover every possible scenario, so in some cases doctors must use their own judgement to determine the proper course of action. Additionally, some patients are inadequately empowered to alert authorities should they ever be mistreated, and thus truly are at the mercy of their doctors. Since laws and policies are not sufficient on their own to always ensure ethical conduct, it is crucial to cultivate a culture within the medical profession where the ethical treatment of patients is a most highly esteemed objective. Forcing doctors to regularly ignore their consciences would be a precedent that is extremely counterproductive to cultivating a robust ethical culture and would not ultimately serve to promote the trustworthiness of our profession or benefit patients.
Secondly, a policy that requires doctors to provide or refer for services to which they morally object would result in situations where an undue burden would be placed on doctors’ consciences and their fundamental human rights would be violated. In lines 113-128 of the CPSO’s draft policy, it is explained that the Supreme Court has determined that no rights are absolute, and that the rights to freedom of religion and conscience can be limited in order to protect the rights of others; in seeking to balance the rights of various parties when there is a conflict, courts would seek to determine whether religious beliefs (and I would presume moral beliefs held on other grounds) are interfered with in a manner that is “more than trivial or insubstantial.” So let’s be clear that in many cases, the burden to objecting doctors’ consciences would be substantial—not trivial—if they are forced to provide or refer for services that they believe are unethical and harmful to patients. For example, with the recent Supreme Court ruling that will allow the legalization of assisted suicide, with the current wording of the CPSO draft policy, many of my colleagues would be forced to participate in what they believe is the intentional killing of another person. Whether one supports physician assisted suicide or not, it should at least be understandable why being involved in the taking the life of another person would be something some doctors would not want to be a part of. Similar things could be said about other controversial services such as abortion. Indeed, in lines 129-130 of the CPSO’s draft policy, it is rightly recognized that the Charter of Rights and Freedoms entitles a doctor to refrain from providing services to which she objects on religious or moral grounds—the underlying reason being that a significant burden on the doctor’s conscience would be imposed. Yet, the CPSO’s draft policy then contradictorily denies this right to refrain from acting against one’s conscience when it comes to making a referral. As I have explained earlier, in cases where doctors are forced to refer for services to which they morally object, burdens would be imposed on their consciences that would be of comparable magnitude as would result from having to directly provide the service. In either case, requiring doctors to violate their consciences places an undue burden on them and would violate the Charter.
Thirdly, requiring doctors to provide or refer for services to which they morally object would result in an overall reduction in the availability of medical services for patients. The draft policy would put many doctors in a position that simply is untenable: Violate one’s conscience by doing what one believes to be wrong in order to comply with the CPSO’s rules; or refuse to violate one’s conscience and risk facing disciplinary action by the CPSO. Therefore, in order to maintain both their professional and personal integrity, many doctors would relocate to other jurisdictions where they would be able to practice in ways that do not violate their consciences; others may quit medicine altogether; and some of those who continue to practice in Ontario would withdraw from practicing in certain areas of medicine or settings so as to minimize the likelihood that they would encounter a situation where they would be forced to do what they believe is wrong. In my estimation, the number of doctors who would seriously consider these options is considerable. It is important to remember that these “conscientious objectors” happily provide or refer for a huge majority of the services that their patients seek when medically appropriate; it is generally only a few services in which they object to being involved. The CPSO’s draft policy would push these doctors out of Ontario’s medical system, and the net effect would be an overall reduction in the availability of medical services of all kinds. Places where there is a relative shortage of doctors, such as rural areas, would be particularly hurt. Ostensibly, the CPSO’s proposal to require doctors to refer for, or in some case to directly provide, services to which they morally object is being made in the name of ensuring patient access to medical services. However, the reality is that the net effect of this policy would be quite the opposite.
Conclusion
The CPSO’s draft policy, Professional Obligations and Human Rights, would force many dedicated, compassionate doctors to practice medicine in ways that would grossly violate their consciences and to become involved in things that they sincerely believe harm their patients. This would be unconscionable and create a situation where neither patients’ interests are protected nor doctors can practice medicine with integrity. For these reasons, I must express my opposition to the current version of the draft policy and request that it be amended so that such a regrettable situation will not arise.
Thank you for considering my concerns and for taking the time to read my letter!
To members of CPSO,
I reject the proposed “effective referral” mandate in the draft dealing with physician assisted suicide. This “effective referral” would compel a physician to violate his/her own conscience by being a participant in the very act, the very procedure, to which he/she objects in the first place.
Freedom of conscience
To whom it may concern,
In an attempt to give patients freedom of human rights, the most recent changes in government policy regarding assisted suicide have brought on another human rights concern.
I am greatly concerned how this will effect the practice of physicians to whom these procedures and those like them, i.e. Abortion go against their conscience.
I fear that if these physicians are forced to participate, even by way of referral, they by their conscience may have to leave the practice of medicine. Which may result in the college losing some of the most conscientious physicians in our nation.
Please take these concerns to heart when making final decisions regarding these policies.
Sir/Madam:
The attached document is respectfully submitted for your attention.
Either we have a free society with freedom of conscience or we have a totalitarian regime. If we coerce physicians into violating their conscience we will inevitably erode the personal integrity which is the basis of the physician’s relationship with patients.
I urge you to reconsider forcing decisions on physicians forcing objectionable action on their part.
It is with deep alarm that I learned of the proposal of the CPSO to force doctors who stand by their right of freedom of conscience and religion and are unwilling to treat a patient with a treatment or a procedure that they themselves find harmful or immoral, according to their conscience. The long standing Hippocratic oath was made to assure patients that their doctor would do everything he/she could do to restore them to good health and do no harm. That assurance helped people to trust that the physician’s judgment would be sound and in their best interest. If a physician acts against his conscience and is forced to refer a patient to another for a treatment or procedure which he/she considers harmful or wrong, he/she would be acting against the best interest of the patient which he/she promised to uphold when becoming a doctor. As a patient myself, I would be very apprehensive to put myself under the care of anyone who would act contrary to his/her conscience in order to carry out my demands. As a matter of fact, I would rather have that doctor explain why he objected to the treatment and then decide whether to seek another doctor’s opinion or rethink my own reason for asking for a procedure or treatment.
The right of freedom of conscience and religion are absolutely necessary for all people. We all have witnessed the news of current murders of Christians in Syria and neighbouring countries because the extremists want to force everyone to convert to their thinking. We have seen the news of the battles that have been taking place in the Ukraine with the invasion of Russian military. We have seen seen these horrors of force and the pain and suffering it causes. Is this what you want? We need to believe that the doctors we visit will really have our best interest at heart and they can’t have that if they act against what they believe is right. A patient can always seek another opinion but a doctor can’t give good advice when he is forced to say or do what he does not believe.
Please reconsider and remember that it is the doctor that acts in good conscience that is the reliable and trustworthy physician that patients can trust; not the one who will bend to giving treatment or a procedure that to him/her is wrong or harmful.
I am opposed to the draft policy which seeks to imposed a physician ” duty to refer.” I believe physicians should maintain their right of conscience. They should not be forced to participate in acts that go against their conscience.
To whom it may concern,
I am deeply disturbed by the recent Supreme Court ruling that wants to revisit Assisted suicide. I have lost a close family member to cancer, the process was lengthly and quite painful towards the end.
I believe that he had a right, not to decide to die, but to experience all that our earthly life has to offer, even suffering. During this suffering, he grew spiritually, in a way I can’t even describe, a changed man for the better. I think robbing people of this chance, to have an epiphany….. to hang on one more day of pain to see a relative that needs to experience forgiveness, a long lost child or loved one that has been away…. these are complex issues, more painful potentially that physical pain, and more detrimental if denied, than physical suffering
Dear Members of the Consultations Committee:
I am writing to you with grave concern regarding the content of your proposed draft policy, which indicates that physicians who decline to participate in certain acts for reasons of conscience should be compelled to refer their patients to other physicians who will perform these acts. It does not address the fact that many of these same physicians will find the act of referral itself objectionable, as they consider it material cooperation with the act. In compelling physicians to refer, you are limiting their
right to conscientious objection. I am opposed to this.
There is significant disagreement in our society as to what constitutes a moral act, and I do not expect the College to define or limit morality. All I expect is that physicians, as professionals, be allowed to respect their own consciences. Freedom of conscience is foundational to our free society and cannot be limited, even for the best of intentions.
If we coerce physicians into violating their consciences we will inevitably erode the personal integrity which is the basis of the physician’s relationship with their patients. I encourage you to revise the sections above, and include a cleardefense of the right to freedom of conscience for all physicians.
Furthermore, I would like to study in the medical profession and eventually become a nurse, then maybe a doctor.
How can I chose this career, if I do not have a choice to act morally in this profession? Please help to fight against this huge injustice to our society!
Sir or Ms: I cannot believe that you would force a fellow practitioner to participate in services that are repugnant to him or her, by insisting that they supply referrals to doctors who believe that these services are beneficial to patients and are willing to preform them. That is the same as telling someone who wishes to kill somebody, where that person will be and when he or she will be most vulnerable. SHAM E.
To whom it may concern,
I am very concerned about this new policy that is trying to be passed. Doctors ought to have the right to follow their moral and religious beliefs. They should not be forced to carry out procedures that goes against what they believe.
Just like every Canadian, they should also have their rights upheld.
Thank you for hearing me out,
Dear Sir or Madam:
I am writing to voice my concerns about the proposed policy of the College of Physicians and Surgeons of Ontario (CPSO) which would affectively strip away the conscience rights of those doctors who object to providing services that run counter to their moral principles and their understanding of what is in the best interest of their patients.
One of my main concerns is that this proposed policy is not really about the best interests or dignity of patients, but is, rather, an attempt by a few ideologically-inspired academics and medical activists to force their own beliefs onto Ontario’s doctors and patients. Simply put, it is not about choice, tolerance or diversity. Rather it is the very opposite. For it would, if implemented, reduce patient choice and restrict the cultural and religious diversity of Ontario’s doctors. And forcing doctors to betray their conscience or leave the practice of medicine in this province can hardly be termed a tolerant approach to those with whom one disagrees.
Secondly, I am troubled that some in the College have such an impoverished view of freedom of conscience and freedom of religion – both of which are guaranteed in the Charter of Rights and Freedoms – that they would deny the exercise of such rights to others. These are after all hallowed principles, developed over a millennium of struggle, that lie at the heart of the Western democratic tradition. To deny them in so cavalier a manner is to turn our backs on those things that are best about our country and its core beliefs.
Finally, I worry that this policy, if implemented, may do irreparable damage to the practice of medicine in this province. For the politicization of medicine – which lies at the heart of this draft policy – is never a good thing. Every time such politicization has been undertaken – with its advocates espousing the highest of motives – the result has been a disaster. And while the ideology at the heart of this particular policy may be slightly different from those of past social engineering experiments, the end result will almost certainly be much the same – with future generations of doctors and patients being called upon to clean up the resulting mess.
In closing, I want to thank you for providing Ontario residents like me with the opportunity to voice our views on this draft policy. It is my hope that common sense will ultimately prevail in this matter,
I completely reject the ‘effective referral” mandate being proposed by the College of Physicians and Surgeons of Ontario. I may not be the one who pulled the trigger, but if I hand the gun to the killer I’m very much an accessory to the crime. Doctors should absolutely not be forced to become accessories against their consciences – in a civilized country it’s called freedom of religion.
To Whom It May Concern,
As a citizen of Canada, and someone who did my medical school training at Queen’s University (class of 2000), I implore you to please protect the conscience of physicians. This is a fundamental right and the only way we can best care for our patients.
I am in full agreement with this policy which requires an update in view of the recent Supreme Court decision. The latter explicitly allows medically assisted suicide but still rules out euthanasia.
As has Canada (see the preamble to the Charter), and as do many good physicians in Ontario, I have recognized and do recognize that the ruling of the supreme court still stands. “You shall not murder.” Abortion, suicide, and euthanasia are still illegal.
What’s required is retraction of the policy.
To compromise one’s conscience is to violate one’s moral integrity. How can any sane country demand that physicians, or anyone, do this? Physicians should be guaranteed the right to refuse to perform procedures that violate their conscience and this would include the obligation to refer.
To whom it may concern,
I understand that you are accepting submissions from Ontario citizens regarding the “effective referral” mandate for doctors. I believe that this mandate is a violation of a physician’s rights, as it compels the physician to violate his or her own conscience by being a participant in the very act/procedure to which he or she objects to in the first place.
I request that this mandate be removed from the CPSO document, so that a physician’s Charter right of freedom of conscience and religion be respected.
It is tyrannical of The College of Physicians and Surgeons of Ontario to propose severely restricting the rights of conscience of medical practitioners in Ontario. The implications of the proposed policy change would be devastating for Ontario doctors who seek to inform their consciences by their faith – and not only by College policy – and who, as a consequence, may be forced to leave the province or the practice of medicine in order to maintain their integrity. These implications would also be disturbing for many patients who want to be treated by physicians who share their vision of the human person.
Is the College saying that doctors must choose between having a conscience or being successful?
To whom it may concern,
I am writing with regard to the proposal that doctors should be obliged to provide a referral to provide services which they cannot themselves provide in good conscience due to moral and religious concerns. In my view, this proposal is a grave threat to freedom of conscience and freedom of religion. Doctors who firmly believe that abortion and euthanasia constitute murder cannot aid the patient in finding someone who will perform the procedure without themselves becoming – in the view of their conscience and faith tradition – accessories to murder. To say that such people, men and women of conscience who have dedicated their lives to helping people as part of the medical profession, must violate their conscience or cease to practice medicine is discriminatory in the extreme.
Not only would current doctors be forced out of practice, but students seeking to become doctors in the future will be unable to if they come from a faith that prohibits providing or abetting the practice of procedures like abortion and euthanasia. It would be tantamount to hanging a “Catholics not welcome” sign on the doors of med schools, and similarly offend many, perhaps most, other faiths. The proposed changes fly in the face of the Charter rights to freedom of religion, and must be rejected.
It is my strong belief that the conscience right of physicians should and must be respected in any policy decisions that the College may make.
To ask a doctor to refer a patient to another doctor to do what he believes goes agains his own conscience is disrespectful of human dignity and integrity.
As I have read some of the responses written by physicians, I have been impressed with their desire to continue to make medical decisions based on their conscience and their respect for life. I, personally, want physicians of this calibre.
I have also been impressed with how they have carefully looked at the CPSO draft and are aware of what the changes would mean not only for them but for their patients.
Sadly, not only will we lose excellent physicians if their concerns are not heeded, but we will be heading down a slippery slope that will affect even those who are now supporting the CPSO draft policy.
My hope is that the physicians’ input against this draft will be very carefully considered.
I am opposed to the draft policy whereby the College of Physicians and Surgeons of Ontario would force physicians to make referrals for procedures, eg, abortion and possible end-of -life issues that may violate their moral or religious beliefs.
Dear Members of the Consultations Committee:
I am a concerned Ontario citizen who have read the draft policy for the College of Physicians and Surgeons and have grave concerns for this document. This policy violates the Charter right of freedom of conscience and religion when physicians are required to provide “effective referral” of medical procedures against their faith or conscience.
As a medical patient in Ontario, I feel that my right and choice of a doctor that does not want to participate in controversial medical treatments or procedures such as physician assisted suicide and abortion is being taken away. Not only is the health care professional’s rights being violated, my own rights as a patient is being violated. This draft policy if implemented will take away my trust and faith in the Ontario medical profession.
I suggest that this draft policy be amended to respect the religious rights and freedoms of the citizens of Ontario by allowing a doctor to decline “effective referrals”.
[**MESSAGE FROM ADMINISTRATOR: DURING THE CONSULTATION PERIOD, WE RECEIVED 3 RESPONSES FROM INDIVIDUAL RESPONDENTS CONTAINING THE CONTENT PUBLISHED ABOVE. ALTHOUGH THIS FEEDBACK HAS NOT BEEN PUBLISHED IN DUPLICATE, THE COLLEGE ACKNOWLEDGES RECEIPT OF THESE SUBMISSIONS.**]
Please allow our physicians to continue to have the freedom to follow their consciences on matters concerning their patients. This is a basic human right therefore in the best interest of our society. Let us ensure that our country remain strong and free!
To whom it may concern,
I understand that you are accepting submissions from Ontario citizens regarding the “effective referral” mandate for doctors. I believe that this mandate is a violation of a physician’s rights, as it compels the physician to violate his or her own conscience by being a participant in the very act/procedure to which he or she objects to in the first place.
I request that this mandate be removed from the CPSO document, so that a physician’s Charter right of freedom of conscience and religion be respected.
I am very much against this entire idea and am totally opposed to requiring doctors to assist in any way whatsoever with any procedure that is against their conscience or religious beliefs whether it is abortion or assisted suicide or any other procedure that deliberately terminates a human life.
Dear Members of the Consultations Committee:
Subject: Draft Policy “Professional Obligations and Human Rights”.
I am writing to you with grave concern regarding the content of your proposed draft policy. Sections 8, 10 and 11 suggest that physicians who decline to participate in certain acts for reasons of conscience should be compelled to refer their patients to other physicians who will perform these acts. It does not address the fact that many of these same physicians will find the act of referral itself objectionable, as they consider it material cooperation with the act. In compelling physicians to refer, you are limiting their right to conscientious objection.
There is significant disagreement in our society as to what constitutes a moral act, and I do not expect the College to define or limit morality. All I expect is that physicians, as professionals, be allowed to respect their own consciences. Freedom of conscience is foundational to our free society and cannot be limited, even for the best of intentions. If we coerce physicians into violating their consciences we will inevitably erode the personal integrity which is the basis of the physician’s relationship with their patients.
The physicians that deserve the most respect and who should be leading society are not those who would kill, but rather those who would protect life. On the day when such physicians are forced to compromise and join in the killing, our society has taken a massive step backwards; how can any other member of society withstand the onslaught that will inevitably follow.
I note also the legitimate concerns that are expressed by those members of our society who suffer from long term disability. The vulnerable of our society will have no one to defend them against those who will take their lives. Once you have silenced the physician that has a conscience, there will be no one left to protect the most vulnerable of our society.
I encourage you to revise the sections above, and include a clear defence of the right to freedom of conscience for all physicians.
This is to notify those who are concerned that it is of deep concern to me that physicians in Canada should not have the freedom to practice in a matter that conforms to their personal and religious ethics. Physicians in Canada should never be forced to be involved with the performance of certain medical acts, namely contraception, sterilization, abortion and medical assisted suicide and euthanasia that are against their religious ethics. These physicians should have the right to refer and to address the concerns of these patients in a manner that corresponds to their own religious ethics.
I am writing to you regarding the content of your proposed draft policy. Your policy suggests that physicians who decline to participate in certain acts for reasons of conscience must refer their patients to other physicians who will perform these acts. However, by requiring a effective referral these physicians who find the act requested objectionable are forced to be co-operators in this act. Compelling physicians to refer patients to another health care provider limits their right to conscientious objection.
It is dangerous to force physicians to sacrifice their integrity to support a customer centered approach to health care masquerading as client centered care. It is imperative that physicians, as professionals, be allowed to respect their own consciences. Freedom of conscience is at the very foundation of a free society and must not be limited. A system which foces physicians into violating their consciences will degrade the personal integrity which is the basis of the relationship between patient and health care worker.
I encourage you to revise your policy, and include a clear defense of the right to freedom of conscience for all physicians.
I come by this message to give you my comments on the draft law on Professional Obligations and Human Rights
Human Rights applies to both the patient’s side and the doctor.
I think yes it must respect human rights but in both directions and therefore respect that some doctors may also assert them through their own values.
It’s fine to want to meet has a majority, but there are also some people who share the same values. I do not think the Christian doctors does not ensure the life of his patient unless another doctor, but I say do not close the doors and to some colleagues that we want to be perceived as different because they share some religious values … the patient will have the choice to decide for itself to which doctor he feels more comfortable. Is that not how it happens again?
For patients’ rights, let them to choose instead to impose the same practice. It is still HIS life.
Thank you to consider my comment
Dear Members of the Consultations Committee:
My grandfather, my great uncle, my father and my sister are all physicians. They have held dear the goal that all physicians should have as their utmost concern, the respect for human life.from conception to natural death.
Please allow in the Professional Obligations and Human Rights policy the right to freedom of conscience for all physicians.
Lives depend on it.
Thank you.
To whom it may concern,
I am very, very concerned that we are even talking about the possibility of forcing doctors to either cooperate with something that they believe is wrong, or else to leave their practices that they have worked so hard to build. How can our memory as a society be so short? Look to any of the times in history (World War II Germany), or even places in the world right now (Middle East/ ISIS), where people are forced to go against their consciences or else suffer extreme consequences. When we can see how horrible it is in the extreme, why are we discussing taking any step in that direction in our own country? Leave doctors with the freedom to follow their own consciences and restrict the services they provide to the ones that they can do in good conscience.
I do not agree with your draft policy regarding the duties of medical professionalism where it demands that doctors must refer patients for any procedure which they are morally and ethically unwilling to perform themselves. This infringes on those doctors’ Charter rights to freedom of conscience.
My family and I want to be able to access health care from those very same doctors who refuse to compromise their beliefs and values in carrying out their professional duties.
In fact, as taxpayers, we demand that those doctors be allowed to continue to practice, so that we have a real choice when it comes to the kind of health care providers we are able to access as patients.
Dear CPSO,
I have read your draft policy regarding ‘moral and religious beliefs’ and I am against your proposed draft policy.
Forcing doctor’s to act against their conscience will weaken and undermine your profession. The people of Ontario are best served by doctors who practice medicine while respecting their consciences, as opposed to by doctors who are forced to contravene their consciences.
To members of CPSO,
I object to the proposed “effective referral” mandate in the draft dealing with physician assisted suicide. This “effective referral” compels a physician to violate his or her own conscience by being a participant in the very act or procedure which he or she objects to in the first place. Freedom of conscience and religion are guaranteed by the Constitution and must be respected and upheld.
I am opposed to the proposed amendments, and appalled that the policy says it reflects ‘human rights’ – what about
the rights of the unborn and the rights of some medical professionals to religious freedom. Surely these two ‘rights’ are equally as important and should be protected at all costs. Don’t force the doctors to kill.
Do NOT mess around with this. Did you know you could lose your rights to SPEAK for Doctors? OH, yes you can. And, if you continue on this path we will organize a protest the size and type which you never could have imagined. If you wish to work for Satan, come out and identify yourselves as his slaves !
Dear CPSO,
I have read your draft policy regarding ‘moral and religious beliefs’ and I am against your proposed draft policy.
Forcing doctor’s to act against their conscience will weaken and undermine your profession. The people of Ontario are best served by doctors who practice medicine while respecting their consciences, as opposed to by doctors who are forced to contravene their consciences.
We wish to express to you our concern over your reported intention to force doctors to perform procedures contrary to their consciences.
If in fact doctors are currently exempt on conscience grounds from performing the above procedures, your efforts to force them to make referrals for these procedures – the Duty to Refer provision – are equally objectionable.
Freedom of conscience is one of the most fundamental freedoms in Western society.
Surely, the CPSO does not intend to violate such a sacred value.
DEAR SIR/MADAME
I do not feel or think that any organization has the right to control the actions of someone, especially a Doctor, and require them to be involved in any action that they require as immoral. I thought that Nazi Germany taught us this. The action proposed allows one group or individual to utimately control everyone.
To assist in a patient’s death, or to send that patient to his/her death, no difference.
The vaguely worded Sixth item, that a doctor MUST help in the case of ‘suffering’ or ‘disablement’. Exactly what will be the criteria and who will decide, patient or doctor? And how imminent would the ‘help’ of the Doctor have to be? Guess who will decide? The left-wing high courts, of course.
Will someone please tell us exactly how we are to stop the craziness in Canada?
I am opposed to the proposed revised document. How is it possible to speak of ‘human rights’ while denying the religious rights of some medical professionals. To deny THESE human rights
is truly appalling. To not force our medical professionals to kill.
Doctors have the right to make medical decisions regarding THEIR PATIENTS in matters related to moral and ethical situations according to their beliefs, religion and conscience. Regardless of the situation life is precious at all stages and no one has the right to intentionally end a person’s life.
To the CPSO and our Canadian Doctors:
My husband and I are so deeply saddened that this policy was drafted at all. We pride ourselves on keeping up with the news and this draft policy has not been adequately presented to the public. What we need is an honestly worded question/s to the Ontario Doctors and the public so that we can put this draft in the trash where it belongs. The fact that so many people are spending their valuable time to tell the CPSO that the draft policy is unacceptable is a testament to our collective abiding nature. Physicians unite! Do make the noise that CPSO needs to hear from you. We appreciate what it took for you to become what you are today, don’t let anyone take that away from you. We stand behind you 100%. We know it’s not fair and that you are among the hardest working Canadians there are but they need to hear from you in a personal way. A National Post news item stated that the CPSO will make their decision by March 5th. CPSO and the Supreme Court of Canada- SHAME ON YOU for wreaking havoc with the minds and souls of our doctors!
“SHAME ON YOU for wreaking havoc with the minds and souls of our doctors!”–and the bodies of their patients, especially those at the beginning or end of life or those with disabilities.
doctors have the right to make medical, end of life decisions for their patients ACCORDING TO THEIR BELIEFS ,religion and conscience. no one has the right to intentionally take the life of a person who is sick, terminally ill, disabled, mentally ill, depressed, old age etc. ALL LIFE IS PRECIOUS.
I pray that doctors will never be forced against THEIR BELIEFS AND CONSCIENCE TO INTENTIONALLY KILL A PATIENT or REFER THE PATIENT TO ANOTHER DOCTOR TO DO SO. I am no longer proud to be a Canadian when a small group of people can bring forth a policy to have doctors forced to kill people. I thought Canada was a democracy. may God be merciful toward those judges.
I believe that converting someone to a religion should not be done in the workplace, however I feel that this policy is too constricting in that if a patient wishes to speak about these things then a physician should be allowed to have a conversation with them about these things. I believe that a physician should have the right to say he will not do a procedure or operation for religious reasons and if the patient should ask why, that he be able to say why. I believe that a physician should not have to refer the patient to another doctor who will do the procedure if he will not do it for religious reasons. For if he does, the physician will feel that he has done something wrong against his God by referring him to some one else to the procedure. Its like if a person believes a strip club is wrong he should not have to refer a patient to another physician who will refer that patient to the strip club. He should never have to assist the patient in doing something that he believes to be wrong. The patient should then take the initiative to find another doctor who will do the procedure.
I do not agree that any doctor should be required to go against his/her own beliefs to perform any action that would result in the death of another human being, whether that be abortion or assisted suicide. ONLY GOD HAS THE RIGHT TO DECIDE WHEN WE LIVE AND DIE!
Please, if I may ask, who on Earth raised this idea of assisted suicide? What differentiate between the pains sick people are passing through, from the pains the so called healthy people are undergoing due to the ups and downs of life. Of which some people take their life in such situations, yet we frown at such behavior. In effect, if we should encourage murder because someone is sick and in pain, we should equally encourage people who are frustrated in life, despair and wants to die but hadn’t the courage to kill themselves to go to the doctor to help them.
How can we prove that by stopping someone from breathing, we have really put an end to the person’s suffering. Who has investigated to know what is really happening when we stop breathing. If the person is actually relief from the pain or that we have worsen the person’s condition by sending him where no one is there to alleviate his pain by giving him pain killer. When shall we stop falling prey to the devil’s trick. Murder is murder and the consequences is there. So many issues which are not suppose to be heard of are now throw open for public discussion, even to the extent of think of passing it into a law. What will this law enforce? Forcing people to commit murder against their wish? I repeat my question. How are we sure that termination of life actually terminate the pains???????????
Please, please, is high time that our eyes will open, to see extent to which the devil had misled mankind, all in an effort to provoke God.
Please, I sincerely plead that this issue should with immediate effect be buried and never come to light as issue for discussion talk less of thinking of passing it as a law. It does not show true concern for some one in pain.
The new law has changed how 99.9% of Canadians will now view their doctor: from a trusted caregiver with the medical knowledge and commitment to treat and care for us to someone with the obligation to administer death. This reversal is not acceptable to most Canadians, in spite of being acceptable to the judges.
As well, our physicians should not be coerced to violate conscience, whatever its source, just as we as citizens should not be coerced to do so. I hope that as a College, you will fight this total reversal of the aim of medical care, by including a clear defence of the right to freedom of conscience for all physicians, at the very least.
Dear Members of the Consultations Committee:
I should like to thank you for opening this draft policy paper for public consultation and input.
While there is value in the document, there are areas of concern—notably the areas of “personal beliefs”, “conscience”, and “moral or religious beliefs”.
Of recent interest is the ruling of the Supreme Court of Canada on assisted suicide. I have no doubt that this will come to be a huge challenge to your profession. Without trying to pick out anything in your current standard practices as an example, the issue of assisted suicide highlights a potential issue related to conscience.
There will be physicians who will conscientiously object to ending a human life. To force them, for whatever reason, to assist in the ending of a human life by providing an “effective referral” would be to make them complicit in the very thing to which they conscientiously object.
There must be very few situations where decision making is so urgent that the patient who declines the advice of his physician cannot find alternatives without the physician being forced to violate his own conscience, his own integrity.
In Canada we have a history of legitimate conscientious objection. This is an integral part of the freedoms that we enjoy in Canada.
I would encourage you to revise the sections of the document Professional Obligations and Human Rights which refer to the “effective referral” and to any limiting of rights of conscientious objection.
More than that, I would encourage you to entrench in your document a statement declaring your support for all your colleagues and declaring freedom of conscience rights for all your physicians and surgeons.
Please be advised that I do not support this initiative and see this as a very deliberate attempt at social engineering. It is bothersome that the OCPS does not recognize the importance of ethical and moral conviction in the practice of medicine. Please register me as a NO!
Although I do not personally support abortion or euthanasia, I do understand that there are others who do not share my belief. In such a circumstance I would have thought it advisable to offer different solutions to accommodate different beliefs and not try to make this a categorical, one-sided “human rights” issue. What are human rights anyway? Did they not come from moral and ethical standards in the first place? I can not support your position and believe that such a course of action puts society on a very slippery slope.
please accept my disapproval of this referral mandate.
RE. PROPOSED DRAFT DOCUMENT WHICH STATES .. “where physicians are unwilling to provide certain elements of care due to their moral or religious beliefs, an effective referral to another healthcare provider must be provided to the patient”
Dear Sir/ Madam
With due respect I am certain that it is totally wrong to force another person to violate their own conscience by being a participant in the very act,the very procedure to which he or she objects to in the first place.
I sincerely hope that your group will take this into consideration in making your final decisions.
It is my firm belief that we who live in the best country in the world – with so many great health advancements will find a fair and ethical way to resolve this matter.
I am looking forward to hearing from you sometime soon
Dear Sir /Madam
As a loyal and concerned citizen of this wonderful and Gloriously free country I feel strongly that …
Where Physicians and Surgeons feel that for moral or religious reasons they are unwilling to provide certain elements of care- then it is morally wrong to expect that these same Physicions or Surgeons
should be required to ‘pass the buck’ by reffering these tasks to someone else.
Also, if the CPSO believes that all physicians and surgeons must ensure access to death and mutilation “services”, then their (im)morality is not merely benign but thoroughly malignant, and we need a new CPSO to teach them right from wrong.
With regard to the revised and approved draft policy Professional Obligations and Human Rights, I wish to advocate for a robust understanding and protection of the Charter right of freedom of conscience and religion for all Canadians, and indeed physicians in the daily routine of their care to patients and in the overall forming of their individual medical practices. I therefore reject the proposed mandate for an “effective referral” as it is a breach of a physicians’s rights and a serious incursion into the professional standing of a physician.
Doctors and other health care professionals, indeed all Canadians, enjoy the Charter right of freedom of conscience and and religion. In the event that Canada adopts a regime of physician assisted suicide, the threat to conscientious objection is that much greater.
If we agree to this policy of “effective referral” it is indeed a s l i p p e r y s l o p e towards vulnerability towards human life for all of us “especially towards the physically or mentally challenged” –if we are to play God. Looking towards the future, any excuse and every excuse could be applied to end human life. DO WE WANT THIS KIND OF WORLD??
The balancing of rights must be done in context. In relation to freedom of religion specifically, courts will consider how directly the
act in question interferes with a core religious belief. Courts will seek to determine whether an act interferes with the religious belief in a ‘manner that is more than trivial or insubstantial’. The less direct the impact on a religious belief, the less likely courts are to find that freedom of religion is infringed.
Please review your draft with due diligence and care and strike this policy of “effective referral” from your proposed draft.
Thank you for your attention to this letter.
Regarding the recent decision by the Supreme Court Justices of Canada overturning the ban on doctor-assisted suicide, I would like to question their rationale as to why medical doctors are required to assist patients who want to terminate their lives. By their very training and professional duties, doctors have upheld the care and recovery of their patients. I have always found the doctors that attended me on my numerous visits to be dedicated, concerned and helpful in my recovery. Now the Supreme Court judges, heavy-handed in their unanimous decision and without thought to the general public, will thereby force those medical doctors to go against their training and practice and become agents of death. How can these Justices act in a most un-Canadian and unjust fashion?
There have been multiple media reports of patients, in those countries in Europe which allow doctor-assisted suicide, who had been hospitalized for minor and temporary ailments and were found to be subsequently euthanized. The “killing fields” have become an European reality. We don’t want to follow suit. For certain, once this law is passed, it will create a lot of fear and anxiety among Canadians requiring hospitalization. Moreover, this fear will accompany many even on their usual visits to their doctors that they may be given lethal prescriptions instead of their expected ones.
I would strongly urge that doctors not be involved in assisted suicide. Morticians and representatives from the drug companies are the most suitable personnel for dealing with death.
As future members of Ontario’s health care system (future nurses), we find ourselves alarmed at the possibility of physicians being forced to practice medicine without freedom of conscience. As nurses, we completely understand and agree that patient care and the patient care quality are of the utmost importance. Discrimination in regards to receiving important and daily medical care is unacceptable.
However, deciding not to offer a service in no way discriminates against patients, providded that the service is not offered to any other group.
Also, for cases such as birth control or an abortion, there are many other facilities and physicians available to provide these services, and means of finding these physicians without referral is quite simple.
As patients, we would find it alarming and damaging to the therapeutic relationship, if we knew that our doctor was incapable of practicing according to his/her conscience. We are also worried that many experienced doctors will refuse to practice if they cannot do so according to their conscience, and this will drastically affect the quality of the patient care that the college is so desperately trying to protect. Any remaining physicians may decide to keep practicing, but at the expense of their own personal integrity. Interior dissonance between deeply held beliefs and professional requirements can lead to burnout.
This is systemic discrimination based on conscience or religious belief.
It will also impact patient care.
In conclusion, we are in complete agreement that quality patient care and a health care system centered on the patient is of the utmost priority. However, if this is achieved at the expense of our physicians right to Freedom of conscience, is it really worth it in the long run?
We don’t think so. Refusing to provide a service that is readily available elsewhere is not discriminatory and should not be something that physicians are forced to do.
We hope to be able to continue to live in a country where EVERYONE’S rights are protected and upheld, and not just a certain party.
Dear Members of the Consultations Committee:
Subject: Draft Policy “Professional Obligations and Human Rights”.
I am writing to you with grave concern regarding the content of your proposed draft policy, particularly sections 8, 10 and 11. The “effective referral” mandate suggests that physicians who decline to participate in certain acts for reasons of conscience should be compelled to refer their patients to other physicians who will perform these acts, even if in their reasoned judgement, that procedure is not in the patient’s or society’s best interests.
We are a democratic nation that is not governed by a totalitarian elite. Freedom of conscience is foundational to our free society and cannot be limited, even for the best of intentions. The proposed CPSO policy, by mandating that a patient’s autonomy trumps recognized conscientious and religious rights of physicians, is contrary to that Charter mandated democratic right. Charter rights of freedom of conscience and religion must be respected.
There are those, even among physicians, who do not see mercy killing as inherently wrong. There is significant disagreement in our society as to what constitutes a moral act. Physicians, as professionals, must be allowed to respect their own consciences. If we coerce physicians into violating their consciences we will inevitably erode the physician’s personal integrity and restrict their employment opportunities and career advancement. Taking a human life must be seen by Canadian society as unacceptable.
I encourage you to uphold a clear defence of the right to freedom of conscience for all physicians.
Public Health Sexual Health Nurses of the Chatham-Kent Public Health Unit
To Whom This May Concern:
We the Public Health Sexual Health Nurses of the Chatham-Kent Public Health Unit appreciate the opportunity to respond to your draft policy titled “Professional Obligations and Human Rights.”
We recognize the complexity of the physician-patient relationship and it is our hope that these changes will enhance patient’s access to essential health care services.
The Public Health Sexual Health Nurses are available for sexual health questions, concerns, therapeutic abortion referrals, low cost birth control and more, while providing a non-judgemental atmosphere at our clinics.
Please encourage your doctors “who limit the health services they provide due to clinical competence or because of their personal values and beliefs,” to refer their patients to the local Public Health Unit Sexual Health Clinic Services. In Chatham-Kent these services are located at:
Chatham-Kent Public Health Clinic Services
177 King Street East
Chatham, Ontario
N7M 3N1
Phone: (519) 355-1071 x5901
Fax: (519) 355-0848
http://www.chatham-kent.ca/publichealth
Nurses as client advocates,
The Chatham-Kent Public Health Unit Sexual Health Clinic Services Nurses
To Whom This May Concern:
As just one of many members of the public who advocate prenatal health and survival, I appreciate the opportunity to respond to your draft policy on professional obligations and human rights.
We recognize the complexity of the physician-patients relationship, and it is our hope to have everybody recognize a pre-born patient’s right to essential health services.
Pro-life pregnancy centres are available for pregnancy testing, pregnancy counselling, and practical care. They are funded and staffed by people who truly care about both the mother and her baby.
Please encourage all your doctors, to direct expectant mothers welcoming assistance–to the extent that such direction is legally possible–to crisis pregnancy centres where the health of ALL patients matters.
To whom this may concern
I am a Canadian citizen, a mother of 5 beautiful children and the wife of a wonderful husband who happens to be a Catholic Doctor. It is with great distress that I right to defend the rights of our doctors and their ethical decisions to protect life, not end life.
I am very grieved that this country and its so called judicial system have warped the meaning of compassion to mean terminating life rather than to suffer with someone, to bring value to their suffering and a redemptive property, to allow other family members the beauty of sharing in and helping their family member die a death with dignity not a death of fear.
The proposal to have our physicians forced to refer a patient with this request is more a dictatorship than a democracy, to think that our country wants to bully its physicians through fear tactics such as removing their licence to practice is mind boggling. To think that a judicial system would revoke a faithful, committed physicians licence and ruin his or her families future because they did not participate in the act of referring someone to a doctor of death is far from any democratic moral society.
Physicians do not see their calling as a job but as a vocation in life to better the wellness of humanity. I fear for my children’s future when our country and its judicial system are more concerned about sustaining a culture of death rather than a culture of life. How tragic.
This proposed “effective referral “mandate violates our very human right to take care and respect human life. We did not call ourselves into being and we should not pretend that we can call ourselves out of ‘being’.
Physicians Rights:
I reject the proposed “effective referral” mandate for physicians unwilling to comprimise their conscience, in providing certain elements of patient care, based upon the fact that it is an infringement which denies their Charter right of freedom of conscience and religion..
The College of Physicians and Surgeons should concern itself solely with respecting life according to the Principle of Life itself, and not try to keep pace with the ever-evolving definitions out there. This isn’t a matter of popularity. It is a matter of integrity. You either have it, or you do not.
To the Members of CPSO
I would like to state that I reject the proposed “effective referral” mandate in the draft dealing with physician assisted suicide. The “effective referral” compels a physician to violate his or her own conscience by being a participant in the very act, the very procedure, which he or she objects to in the first place.
Freedom of conscience and religion are guaranteed by the constitution and must be respected and upheld.
Do not restrict freedom of conscience for doctors. Allow them to refuse to perform a .procedure that is ethically unacceptable to them, and to refuse to refer to another doctor for that procedure. Both acts would be immoral. CPSO has already recognized this in its policy regarding female genital mutilation.
If you limit doctors freedom of conscience in matters which they deem immoral you will reduce health care to a very basic level. A doctor who will kill is not the best doctor for healing. A doctor who will not kill babies, disabled and elderly is the best doctor but under your guidelines will not be allowed to practice medicine. It is very important to retain conscientious objection in health care or we do not have freedom of choice.
Dear Sirs and Madams,
I write you to say I disagree with the College of Physicians & Surgeons of Ontario mandate of mandatory effective referral for prescribing the Oral Contraceptive Pill.
Ontario Doctors should not be compelled to prescribe this carcinogen and this would be a violation of their conscience rights.
Ladies & Gentlemen:
I reject the proposed change suggested in the new CPSO draft document that mandates effective referral for physicians.
Physicians currently enjoy a Charter right of freedom of conscience and religion; I totally support this right and believe it must be protected. Physicians should not have to find a colleague to perform an action that they deem is either morally wrong or that violates their religious beliefs.
Whatever happened to the Hippocratic Oath? That ought to be entrenched in your document. Patients want to have trustworthy, ethical physicians who genuinely care for their health vs. efficient, polite ‘killers’ in medical robes who have stopped believing that every human life is of value. Physicians should provide the best medical care to all while “doing no harm” to their patients. This can only be achieved when it is principled and physicians have the freedom to act according to their values. Don’t force them to leave their values at the doorstep of their clinic or hospital–they are part and parcel of who they are and how they act. They guide them to act ethically.
Your proposed effective referral mandate would take away physicians moral integrity causing harm to both them and the patients they are supposed to be helping. Having to refer patients for unhealthy practices which harm them physically, mentally and even spiritually, such as contraception, abortion, invitro-fertilization (these first three also causing harm to new life), passive euthanasia, assisted suicide, etc. would perpetuate a great injustice.
Please protect the conscience and religious rights of our physicians by removing the mandate to effectively refer from your draft.
Doctors have to be free to do their job and not be force to go against the commitment to protect peoples lives.
I am opposed to the draft policy whereby CPSO would force physicians to make referrals for procedures ( e.g. abortions, possible end of life issues ) that may violate their moral or religious beliefs.
Dear members of the College of Physicians and Surgeons of Ontario,
I am writing in regard to the draft policy of the CPSO, “Professional Obligations and Human Rights”, specifically to object to the section regarding ‘effective referral’:
“Where physicians are unwilling to provide certain elements of care due to their moral or religious beliefs, an effective referral to another health care provider must be provided to the patient. An effective referral means a referral made in good faith, to a non-objecting, available, and accessible physician or other health-care provider.”
This attempt to protect the human rights of patients would in fact infringe the human rights of physicians.
Physicians from before the time of Hippocrates have seen their calling as sacred, and have determined for conscientious reasons that certain sorts of requested treatment are in fact not good health care and not a part of the good practice of medicine. The Hippocratic Oath and the Declaration of Geneva both stress the sacredness of the medical calling and the physician’s duty in conscience to respect human life. The Hippocratic Oath explicitly rejects abortion and the provision of fatal drugs. A physician today who believes that assisted suicide or abortion is not in a patient’s best interests and is morally wrong would be required by the draft policy to refer the patient to another health care provider who would do precisely that act which the physician conscientiously believes is morally wrong. This violation of the physician’s conscience is an infringement of the physician’s human rights.
I urge the CPSO not to enact this policy of ‘effective referral’.
I believe that no doctor should be forced to participate in any procedure that goes agains his or her conscience. But to me that also means that the doctor should have no duty to refer patients to doctors who will do those procedures. A doctor would never be forced to perform an abortion but from this draft policy it appears he or she could be forced to refer his patient to someone who would. This goes against all principles of true freedom. The same may come to pass with euthanasia. If the Supreme Court of Canada has its way we may soon have legalized euthanasia in Canada for a variety for maladies both physical and deadly to such ailments as depression and chronic pain. No doctor should ever be forced to find someone who has no qualms about euthanasia.
Personally I would not trust a doctor who would go against his or her own conscience. You seem very concerned about patient’s rights, as you should. But there has to be a balance. The patient could ask from the get go whether the doctor has moral objections to certain things. At that point the client will be clear. The argument will be that in small towns there may not be the choice. Frankly, I’m not sure how often that happens. But I would go so far as to allow the doctor to follow his or her conscience regardless.
We are nothing without the guide of our conscience.
The same idea applies to the death penalty. Canada doesn’t allow it and nor will this country extradite someone to a country where the person charged could face capital punishment. I’m sure many people find the idea of saving the lives of murderers distasteful but yet we respect that the government refuses to take part in something it finds immoral.
Please allow our doctors to follow their beliefs. Just because something might be inconvenient for a patient is not reason to take away the one thing that makes us human rather than robots.
Dear College of Physicians and Surgeons of Ontario,
Thank you for allowing the public the opportunity to comment on your draft documents. I
would like to provide my feedback on “Professional Obligations and Human Rights.”
It goes without saying that physicians must practise with compassion, altruism, and
trustworthiness. The physician’s role is to care for everyone equally. This is what you have
outlined on your web page, “Respect for Human Rights”- respecting and supporting the public
policy goals of the Ontario Human Rights Code.
You also state that the College strives to ensure that “it creates and fosters an environment in
which the personal worth and dignity of every individual is respected.”
These goals should also include the rights of your member physicians as well.
That is why I am particularly disturbed by line 169 of the “Professional Obligations and Human
Rights” document, that a physician must provide care “even when that care conflicts with their
religious or moral beliefs.”
The duties of a physician to her/his patients should not compromise or undermine the rights of
that physician. A physician is not just some cold, unfeeling robot who jumps up at the whim of
the government or at the sound of other people’s demands.
On the aforementioned web page on human rights, you also state that: “…The College seeks
to achieve this goal … by striving to provide services to the public and the profession without
discrimination on protected grounds…”
According to the “Professional Obligations and Human Rights”document however, “Physician
A” MUST refer on to “Physician B” (for the sake of simplicity I’m using these terms) when a
patient requests a procedure to which Physician A finds morally objectionable and which
Physician B can perform.
How is this fair to the physicians of the CPSO, and how does it respect their human rights, as
you stated on your web page? Your “Respect for Human Rights” goals are double standard.
Mandating Physician A to refer a patient on to Physician B forces Physician A to be compliant
in the very act which is in conflict with her/his beliefs. This situation becomes even more
contentious by the possibility that Physician A will be prosecuted by the CPSO should she/he fail
to meet the requirement of referring on to Physician B.
The physician herself/himself in that case is being persecuted for practising her/his beliefs and
following her/his conscience. Ultimately, this is discrimination of such a physician, which is a
violation of human rights.
Since when did the CPSO become the final judge and jury of a person’s right to practice her/his
faith and beliefs?
As the CPSO protects the patients of this province, I am requesting that the CPSO fully protect
the rights of their member physicians to practise their beliefs, and to follow their consciences
and value systems without persecution.
Furthermore, that the CPSO not interfere in the realm of a member’s right to religious freedom.
I hope that you will give consideration to my feedback.
Thank you and may God bless you
Bring back the Hippocratic oath! Hitler’s Germany happened because of a slippery slope of discrimination. Let us learn from history and protect the rights and freedoms of all people from the moment of conception until natural death. Let us not bully Our physicians into acting against their conscience and partaking in this Culture of Death! Freedom!
I am absolutely opposed to compelling doctors to undertake any action that is contrary to their moral or religious beliefs.
Dear College of Physicians and Surgeons of Ontario:
I have read your draft of Professional Obligation and Human Rights. I have also completed the survey. I will also mail you a copy of this letter.
Even thought for the most part the policy draft wishes to meet the needs of all parties, it does not. It actually imposes and infringes upon the rights of individuals to exercise without compromise their religious beliefs and consciences. When one has a formed and informed conscience and deeply held religious convictions, not just personal but institutional as well, as in the collective faith of a particular religion, then there can be no compromise, and insisting, legally, that one has to go contrary to their beliefs and conscience is in itself is a violation of human rights.
I ask the College two things:
1. To take the moral and ethical stand to defend and protect human life. How can the College themselves let alone ask a member physician or surgeon to violate the principle of do no harm in both cases of abortion [and along with it embryonic stem cell research, abortifacient contraception and birth control practices methods or practices, in vitro fertilization], and euthanasia and doctor assisted suicide (AS) . Euthanasia or AS is not law yet, and I hope and pray that it never will be, for a doctor has an obligation to do no harm as every other human being has. Where was the College when abortion was being pushed in the late sixties? Where was the College when euthanasia and AS was and still is being pushed for their legalization? In the Mary Wagner legal case presently before the courts, her challenge is to challenge section 223(1) of the Criminal Code of Canada. Mary Wagner knows it, the mothers know it, so do many world religions know it, and doctors know it, that the unborn thing in the womb of a woman or in a petri dish is a human being. It is not a fact contrary to science, and it is a no brainer. But based on this outdated and erroneous law (223), the courts and professional bodies like the College, like the Human Rights Commission, make legal constructs that only want to deny the truths of the value and dignity of human beings, and force their political agendas to support the lies. The College needs to defend and protect the rights of all human beings, including the unborn, human beings that they truly are, and also those at the other end of life – the sick and dying.
Lines 166-169 of the draft document seem to be so contrary to the mandate of a physician or surgeon, to see preventing imminent harm as being ethical and moral in cases of abortion, euthanasia or doctor assisted suicide! How low have our health professions and governments gone to see such wording proposed to be part of the College of Physicians and Surgeon’s’ Policy?
2. To amend this draft document (lines 108-110, 113-117, 152-164) to ensure that physicians and surgeons be granted the protection to opt out of participating in any activity (including giving referrals) that involves or leads to the killing of human beings, at whatever stage of human development or denouement they are at, either at conception/fertilization or terminal illness, or in between. The College really needs to respect the integrity and worth of its members. That integrity starts at respecting human life and every human being from conception.
I wish you all the best in drafting a policy that will be in the best interests of all persons, born and unborn, including physicians and surgeons.
Dear Members of the Consultations Committee:
Subject: Draft Policy “Professional Obligations and Human Rights”.
I have witnessed the gradual erosion of the rights of health care workers in this province in the past generation and am no longer content to remain silent on the matter. I have serious reservations about certain sections of the CPSO’s draft policy; specifically, sections 8, 10 and 11. These clearly violate the right to conscientious objection by requiring physicians whose consciences prevent them from engaging in certain procedures to refer their patients to other physicians who will perform these procedures. This in itself is unconscionable, for by forcing physicians to refer, they would be rendered morally complicit in the procedure itself.
Our society was predicated on the freedom of conscience. Each and
every one of us, physicians included, should be allowed to respect their own informed conscience. The CPSO should not be the arbiter of morality, but rather, should respect their members’ freedom of conscience. Coercing physicians into violating their consciences will ultimately damage the physician’s relationship with their patients.
I encourage you to revise the sections above, and include a clear defence of the right to freedom of conscience for all physicians.
I strongly oppose this proposed change in policy. Let us allow our physicians to have freedom of speech and religion in their practice.
I strongly oppose this policy change. It would greatly affect the physicians ability to deal with their patient’s honestly, as well as infringe on their rights and freedoms.
Religion (or lack of), is the true identity of oneself and will manifest itself at some point in ones life, and physicians are not excluded from this.
I am deeply scandalised and sad that the supreme court has forced the government to come up with new laws that will force physicians, surgeons and patients to abide by new rules that will go against their freedom of conscience. If those who dared contesting our freedom of conscience get away with forcing the creation of news laws going against freedom of conscience, then it will open the door to anything goes regardless of objections from those who cherish their freedom of conscience.
If a person’s freedom of conscience in matters of right to life until natural death is to be contested by news rules, then we are no longer free persons but prisoners of conscience. What is coming to this world anyway? Two world wars were fought to keep our country glorious and free, the very words in our national anthem.
If our freedom of conscience is eroded through the will of a few who have been appointed (almost all) by our present Prime Minister, how are we going to feel singing our national anthem when those dark days come to pass in what a lot of canadians consider unfair laws to say the least? It is something to ponder about.
Hippocrates, the father of Western medicine stated “Do no harm”.Doctors must not be compelled to participate in abortion,euthanasia, or any other services which destroy life. They are to be people who care for others and support life. If their convictions. or conscience does not allow them to provide a service, they must not be required to refer their patient to another doctor who’d provide it. Doctors who don’t comply must not face disciplinary action.
The draft policy is contrary to democracy, tradition and “The draft policy contradicts the Code of Ethics of the Canadian Medical Association :
7. Resist any influence or interference that could undermine your professional integrity.
9. Refuse to participate in or support practices that violate basic human rights.
12. Inform your patient when your personal values would influence the recommendation or practice of any medical procedure that the patient needs or wants.
23. Recommend only those diagnostic and therapeutic services that you consider to be beneficial to your patient or to others.
and it contradicts the document ‘ JOINT STATEMENT ON PREVENTING AND RESOLVING ETHICAL CONFLICTS INVOLVING HEALTH CARE PROVIDERS AND PERSONS RECEIVING CARE”:http://policybase.cma.ca/dbtw-wpd/PolicyPDF/PD99-03.pdf
16. Health care providers should not be expected or required to participate in procedures that are contrary to their professional judgement or personal moral values or that are contrary to the values or mission of their facility or agency. Health care providers should declare in advance their inability to participate in procedures that are contrary to their professional or moral values. Health care providers should not be subject to discrimination or reprisal for acting on their beliefs. The exercise of this provision should never put the person receiving care at risk of harm or abandonment….
11. If a health care provider cannot support the decision that prevails as a matter of professional judgement or personal morality, allow him or her to withdraw without reprisal from participation in carrying out the decision, after ensuring that the person receiving care is not at risk of harm or abandonment.
The CPSO must defend freedom of conscience rights strongly.
No one has the right to help one end their life. God made us and will take us.
While this policy is seeming to place the emphasis on the physician’s moral or religious views, ultimately it seems to be saying that a ‘physician is entitled to do whatever his patient requests regardless of the physician’s knowledge and experience’. While I agree a physician’s moral and religious views can influence his practice and services given, so much more also does a physician’s health knowledge and experience give credibility to his morals and religious beliefs. A patient with limited knowledge may be requesting a procedure that is totally not the proper or necessary procedure. By limiting a physician’s approach and discourse on the subject, you are making the patient’s limited knowledge worth more than the physician’s much higher knowledge. Furthermore, in the same regards, there has to be a datum for even doctor work from a moral standpoint. If a patient believes in killing themselves, are we now to judge that that is ok because the patient wants it. We have to give some credibility to the high standing a physician has and at least allow the physician to discourse with the patient on moral and religious views.
As a medical student, I am thankful that the CPSO has had a second public consultation on this policy.
I have confidence that the CPSO will utilize the substantial feedback provided in this public consultation when drafting the final policy and when revising this policy. I hope this consultation is not simply an administrative hurdle; I hope it shapes policy.
The overwhelming majority commenting here recognize the importance of protecting physician conscience rights in addition to providing care to patients. A referral is not necessary for many medical procedures that physicians are opposed to in Canada (abortion is self-referral, physicians who do not prescribe birth control tell their patients in advance in detailed forms or with signs, etc.). A referral is not a necessary part of this policy and should not be mandated by the College. Providing information on all options available should be enough. Patients self-refer for a number of other services and do not require referrals for those as well.
I am pursuing a career in Family Medicine starting this July. I sincerely hope that my right to conscientious objection under the Charter will be respected, especially in light of the latest reassurances of conscience protection for physicians from both the Supreme Court of Canada and the Canadian Medical Association.
Thank you for consulting the public on this important issue, and once again, I hope all of these comments will be read and have an impact on the revision of this policy.
I congratulate the CPSO in makig this discussion forum public. This policy comes from an organization that is meant to uphold the highest standards of professionalism, and to serve the public trust. I would propose that with this policy it has failed on both fronts, and that considerable self-reflection by the CPSO into its own process of policy-making is in order. Restoration of the organization’s status as a dependable leader depends on it.
I am a BC family physican who has worked both in sessional and private office-based practice in addressing the needs of vulnerable populations.
I commend the CPSO for allowing for response not only from physicians outside of Ontario but also the general public, for in doing so the CPSO is acknowledging that physicians outside of Ontario as well as the general public are important stakeholders in this process. Most Canadian physicians outside of Ontario would agree that proposals drafted in one Canadian province certainly have potential to be precedent-setting in impacting decision-making at the College level in other provinces.
Our office group recently started discussing the proposal drafted by the CPSO, and we were significantly concerned in particular about how lines 155-169 of this proposal may affect the protection of conscience rights of physicians across Canada across all disciplines and specialties. Particularly in the wake of the Supreme Court ruling on February 6th regarding physician-assisted suicide, conscience protection has now become an issue not only for those whose clinical duties include reproductive medicine, but for any physician who works with a patient suffering from an illness, disease, or disability. In short, it now affects us all of us who practice clinical medicine. The fact that a CMA poll revealed that 91% of physicians polled at last summer’s meeting support the right of physicians to act within their conscience with respect to medical aid in dying seems to make it difficult to justify a policy that necessitates physicians acting against their conscience in certain situations described in the draft policy, situations which certainly could include a patient request for physician-assisted suicide.
We were also concerned that many of us did not even realize until quite recently that such a potentially precedent-setting proposal was being tabled, and that it was not through official regulatory body communication to Canadian physicians that we heard of this but rather by word of mouth.
We certainly empathize with the challenges faced by the CPSO in responding responsibly to complaints made by patients who feel that their human rights are being violated when they encounter physicians who do not provide the services they seek, for reason of physician conscience. However, we would submit that the mere existence of these situations does not mean that physicians are in professional error for respectfully declining to provide certain services for reason of conscience, but rather that the existence of these scenarios is the challenging by-product of the good phenomenon of diversity in a free society. While one of Canada’s strengths as a nation is the many freedoms afforded to its citizens (e.g. freedom of speech, religious assembly etc), these freedoms by nature do result in a diversity of opinions on moral, ethical, and religious matters in both private life and how private expression of personal views may be conducted appropriately in public life. With diversity of opinion there will inevitably be times at which opinions clash, and where one citizen may hold a view that is diametrically opposed to another. Canada’s diversity is a hallmark of our nation, but it does present a not insignificant challenge to legislators and regulatory bodies such as the CPSO in how to enact policy that will allow for individual diversity of opinion to be upheld while maintaining overall public peace and harmony for the common good.
One particular challenge in addressing diversity and freedom of opinion within the context of the doctor-patient relationship is the fact that there is an inherent power imbalance in this relationship, necessitating the frequent reminder to physicians of the fiduciary nature of their roles. Society has granted physicians access to valuable knowledge and skills not available to the general public, and physicians, as guardians of this sacred trust, have a duty to uphold the best interests of their patients in every clinical encounter. The privilege of having a fiduciary role must never be used to exploit for the purpose of personal gain, be it financial gain from services provided or perhaps “ideological gain” from pressuring a vulnerable patient to verbally express conformity to the physician’s personal views on moral issues when the patient in fact does not truly assent to these views. At times, this fiduciary role may also entail some measure of personal sacrifice on the part of the physician in terms of the impact of clinical duties on his or her personal life. However, having a fiduciary role does not mean that the physician must be subjected to the unnecessary and significant personal harm of being forced to act against his or her conscience, or that the physician should be pressured to express personal conformity to the patient’s personal values and beliefs. In fact, pressuring physicians to act against their conscience presents an erosion in itself to the fiduciary relationship, as the physician is now truly not in good conscience acting in the best interests of the patient. In this, we agree with lines 76-78 of the proposed policy on limits of the duty to accommodate patients presented with barriers to access of care, which states that:
“While physicians have a legal, professional and ethical duty to accommodate, there are limits to this duty. Physicians do not have to accommodate beyond the point of undue hardship, where excessive cost or health or safety concerns would result. The duty to accommodate is also limited where it significantly intereferes with the legal rights of others.”
In our opinion, expecting physicians to act against their conscience in any situation presents undue hardship to physicians and certainly interferes with their own legal rights.
While we commend the CPSO for trying to respect physician conscience in non-emergency situations by providing referral to a colleague as an alternative, we are concerned that this fails to adequately address conscience protection as a significant number of physicians currently hold the view that referral entails complicity. Diversity of opinion on this topic must be respected at the College level, particularly given that a physician may by some regulatory bodies be found culpable of complicity by referring for procedures that most societies believe to be objectionable e.g. female genital mutilation.
We are also concerned that the last lines of the policy regarding a duty for physicians to provide “care that is urgent or otherwise necessary to prevent imminent harm, suffering, and/or deterioration, even where that care conflicts with their religious or moral beliefs” is too loosely worded so as to allow for abuse of interpretation in scenarios unintended by the authors of the proposal. Again, given that physician-assisted suicide will be legalized within the coming 12 months, and as currently defined as to eligible patients, it is entirely possible that physicians across all disciplines may be faced with the threat of discipline if they object to providing this service or urgent referral for physician-assisted suicide. As currently estimated percentages of physicians comfortable with providing this service are at best 27%, it is very concerning as to how this draft proposal may affect the remaining 73% majority.
Lastly, we humbly submit that perhaps there is another way of respectfully addressing the challenges of living in and practicing medicine in a diverse society. Currently, adherents to some religious groups within medicine certainly have expressed their view that this draft proposal has ostracized them and could create an intolerant environment in which it would be impossible for them to continue to provide clinical care in good conscience in Ontario. A more collaborative approach would be to perhaps invite important stakeholders from a diverse cross-section of religious and moral beliefs to work together to create policies that could address the particular clinical scenarios they seek to improve, rather than imposing a blanket policy that will certainly create harm on not just those said physicians, but potentially on Ontario taxpayers as well by the potential for significant court battles should this policy be approved.
Respectfully,
We are concerned that the religious & moral freedom of physicians is not adequately protected by this draft policy. To provide a direct and effective referral to a morally objectionable act (such as intentionally ending the life of any innocent human being) is to become materially complicit in that act. Furthermore, it is fair to say that a doctor or other health care professional objects to both an abortion and euthanasia on clinical as well as moral grounds, as his or her profession is the care of the body, and these acts are contrary to the health of the bodies (in the case of abortion) or body. A healthcare professional should not be silenced from sharing the scientific fact that an abortion or assisted suicide ends an individual, unique, and viable human life. Other morally objectionable services are often contrary to the health and well being of the body as well, and healthcare providers should be encouraged to share these professional, clinical concerns so that the patient is given the most complete information with which to make their decision.
Dear Members of the Consultations Committee:
Subject: Draft Policy “Professional Obligations and Human Rights”.
I am writing to you to voice my concern with your draft policy and in particular to the following statements under the section entitled “Ensuring Access to Care” (2015):
“Physicians must not withhold information about the existence of a procedure or treatment because the procedure conflicts with their religious or moral beliefs.
Where physicians are unwilling to provide certain elements of care due to their moral or religious beliefs, an effective referral to another health care provider must be provided to the patient. An effective referral means a referral made in good faith, to a non-objecting, available, and accessible physician or other health-care provider”.
I ask you to strike out the requirement “to provide an effective referral.” This proposed section of the draft policy is deeply troubling because it does not address the fact that many of these same physicians will find the act of referral itself objectionable, as they consider it material cooperation with the act. In compelling physicians to refer, you are limiting their right to conscientious objection.
The conscious moral and religious objections of individual physicians need to be respected. As such, physicians should have the right to object to the direct performing of the service in question and to participating in the acquisition of such a service through acts such as referrals.
I ask that you allow physicians, as professionals, to respect their own consciences. Freedom of conscience is foundational to our free society. If we force physicians into violating their consciences then we threaten the very basis of the physician’s relationship with their patients to serve patients truthfully.
I encourage you to revise the sections above.
Thank you.
Dear Members of the Consultations Committee:
Subject: Draft Policy “Professional Obligations and Human Rights”.
A member of my congregation who is a physician has approached me recently with a concern that he might have to leave his profession because of current legislation being considered that would force him to act against his conscience.
There is significant disagreement in our society as to what constitutes a moral act, and I do not expect the College to define or limit morality. All I expect is that physicians, as professionals, be allowed to respect their own consciences. Freedom of conscience is foundational to our free society and cannot be limited, even for the best of intentions. If we coerce physicians into violating their consciences we will inevitably erode the personal integrity which is the basis of the physician’s relationship with their patients.
I encourage you to revise the sections above, and include a clear defence of the right to freedom of conscience for all physicians.
Dear College of Physicians and Surgeons,
I am writing with regards to the proposed Draft Policy that will limit physicians Right to Conscience and Freedom. I have read the draft policy and am deeply troubled by the blatant discrimination that is found within it.
By attempting to limit the right to freedom of conscious and religion through mandatory referrals for treatments/procedures physicians find morally objectionable, it is obvious that this policy is trying to drive out of medicine any doctor who does not blindly follow a pro-abortion, pro-euthanasia and pro-contraception mindset. In addition, it it equally discriminatory against patients like myself and my friends who have actively sought out doctors who share the same moral worldview as we do. We do no trust a physician to care for our unborn child who would just as happily cut him to pieces, our elderly mother to one who would just as happily euthanize her, or our sexuality to one who just pushes the Pill on us.
This totalitarian Draft Policy will take away our health care providers as well as taking away the livelihood of any doctor who actually cares about the lives of all of his/her patients, unborn, disabled, terminally or chronically ill. It needs to be changed immediately to reflect the freedom of ALL doctors – not just the abortion/euthanasia/contraception pushing ones – to act on their well-formed conscience which obviously includes not referring for a procedure/treatment that he/she deems morally unacceptable.
Canada is a multi-cultural and diverse society – the College of Physicians and Surgeons blatant attempt to discriminate against entire groups of doctors and patients in such a society is deplorable.
Dear CPSO: I do not understand why, after all the feedback CPSO received in support of freedom of conscience during the earlier round of consultations which ended in August 2014, CPSO would include in its “Professional Obligations and Human Rights” policy a requirement for physicians who morally object to certain procedures (like abortion, euthanasia, and physician-assisted suicide) to make “effective referrals” to a “non-objecting, available and accessible physician or other health-care provider,” as this amounts to complicity in an act that the physician finds morally reprehensible: the taking of a human life. Your policy also requires physicians to perform these procedures in certain situations. It is not in the best interests of anyone in our society to force physicians to do what they believe to be wrong.
I fully agree that patients should not be discriminated against. But refusal to facilitate the provision of certain procedures does not involve discriminating against a patient, it involves discriminating between various “treatments.” When a physician does not want to offer a “treatment” that kills, it is because the physician believes that “treatment” is morally wrong, regardless of who the patient is. In fact, the physician is treating all their patients equally in not offering the offending treatment to any of their patients.
Your policy is also unfair to those residents of Ontario who want to be treated by physicians who respect the inherent dignity of all human beings, including the most vulnerable, and who do not see intentional killing as a solution to a medical or social problem. That is because the CPSO policy could have the effect of weeding these conscientiously objecting physicians out of the profession, leaving only physicians who are willing to kill to treat the people of Ontario (although this would no doubt please the abortion and euthanasia activists who have been trying for years to impose such a policy on the rest of us: see recent press release by Member of Parliament Maurice Vellacott, responding to a similar policy of the College of Physicians and Surgeons of Saskatchewan:
http://www.mauricevellacott.ca/2003%20MV%20Speaks/Jan.%2029,%202015%20-%20MV%20Release%20-%20Saskatchewan%20physicians%20to%20be%20forced%20to%20participate%20in%20killing%20their%20patients.pdf
And what about physicians who object not to abortion, per se, but to some abortions, like sex-selective abortions? Those physicians will have to refer for sex selective abortions since such abortions are legal in this country. Abortions are also legal for the full nine months of pregnancy, so if a woman wants one for whatever reason, a physician who may support abortion in the earlier stages but feels queasy about killing a near full term fetus, will be required to refer for a late-term abortion. Has CPSO contemplated these scenarios?
There are so many ethically problematic and discriminatory consequences that would result if CPSO tries to coerce physicians into doing what they believe to be wrong. CPSO, please uphold physicians’ freedom to practice medicine according to their sincere and deeply-held conscientious convictions. Please ensure your policies are respectful of the rights of all Ontario physicians, not just the ones who support the use of life-ending procedures like abortion, euthanasia and assisted suicide as “solutions” to life’s difficult problems. And in so doing, you will be serving the needs of all Ontarians, regardless of their conscientious/religious beliefs.
Thank you for the opportunity to comment on your proposed policy, “Professional Obligations and Human Rights.”
As a citizen of Ontario, I am writing to inform the CPSO that I reject the proposed ‘effective referral’ for doctors whose charter right to freedom of conscience and religion must be respected.
With the legalization of assisted suicide, I am concerned that physicians will be forced to go against their religions and beliefs in order to take part in euthanasia. Please respect their religions and beliefs. Taking part in assisted suicide is taking part in murder.
Dear Sir or Miss or Mrs.,
I would like to express my dismay regarding this proposed policy. I feel this proposal undermines the freedom of conscience of the physician if he is forced to give counsel or treatment to a patient against his beliefs and values. The policy would undermine the doctor’s human right while the patient is free to seek alternative avenues – their right is not taken away. This policy is discriminatory and should not go forward. Thank you for your consideration.
Dear College of Physicians of Ontario,
We are writing to you because of our concern about your recent policy proposal.
The proposal is for a policy change that will mandate that physicians will have to make referrals for procedures and “treatment” (such as abortion, euthanasia, assisted suicide) even if doing so would be against their conscience.
If implemented such new policy would contradict and violate physicians rights guaranteed in the Canadian Charter of Rights and Freedoms.
Please protect physicians fundamental human right to act based on their conscience without fear of being persecuted.
Good evening, Sirs / Mesdames:
I am writing to support conscience rights for doctors. The proposed policy of the Ontario College of Physicians and Surgeons would mandate referral for treatments that many doctors believe are bad medicine.
My own family doctor’s moral stance against abortion, assisted suicide or sterilisation is, I know, not merely a personal belief; rather she has reached this position through scientific knowledge, medical experience and philosophical reasoning. She is convinced as a professional that some medical procedures are not good for her patients, and she will not practice them nor counsel her patients to seek other doctors who would be willing so to practice. She rightly fears that should the proposed policy be enforced, she would have to give up medical practice entirely. And that would be an enormous loss for our small community.
Such doctors should be protected from any and all compulsion to act against their consciences. These consciences were formed in the crucible of family practice and deserve respect. I for one am grateful to have found such a doctor !
With the ever increasing decrease in morals and simply doing what is right, the LAST person I want to do things simply because of a direction or money is my Doctor or Dentist (There enough un scrupulous people in the world, that if a Doctor does not want to do something he should be able to have the right to provide information or suggestions for a patient to see one of those people).
When people are forced to go against their morals eventually the lines for everything get blurry and they start handling any/all situations with a sense of un concern for the right or wrong.
We do not support this type of policy to be imposed on any professional person what we are expected to be able to trust.
To the College of Physicians and Surgeons of Ontario,
I am providing some of the requested feedback on the proposed policy of Professional Obligations and Human Rights. I write as a practicing pediatric surgeon who completed part of my training in Ontario, a citizen of both Canada and Germany. I am concerned about the proposed policy’s limitations of the freedom of conscience for practicing physicians and presumably trainees. I support the efforts directed to protecting access to health care, but I think the solution you have arrived at – limiting physician’s ability to follow their conscience in circumstances deemed by the legal system to limit patient access to health care – is intrinsically flawed.
At the United Nations Organization the international community has respected the freedom of conscience and religion.1 It has also acknowledged that the basis for doing so is the dignity of the human person, acting freely “according to the imperatives of conscience.”2 It is a serious proposal to systematically deny these rights to a group of people. Would the CPSO recommend this proposal as an advisable policy for other Colleges? What about an environment where it is legal and requested by patients to provide female genital mutilation? While I think this is a terrible practice and would conscientiously object, would I be limited in my ability to do so by this policy? As a pediatric surgeon I would have a hard time claiming I do not have clinical competence to do this surgical procedure and I would still be unwilling to refer a patient, generally a child whose parents are making decisions for her and may feel there is a sense of urgency, to another practitioner who does not object. Perhaps this seems to be a ludicrous and extreme example, but I work in Africa and can see that systematically denying physician’s rights could be very dangerous and conceivably lead to such a situation. I would not want the law to assume the right to decide my professional actions if and when they violate my conscience. An example that occurred in the country of my birth, in the last century, is the well-known example of doctors working under the fascist Nazi regime, which mandated their participation and removed the ability to conscientiously object to horrific experimentation, sterilization procedures, and killing of patients based on the legal requirements of the day. I hope that I would have had the strength to object, but many physicians did not. If I have grown used to being denied the right to follow my conscience due to my profession, how much would I question it if the law decided to mandate sterilization of certain segments of the population? What else would I do if legally required? The Milgram experiment on obedience to authority figures, where subjects are prompted to give increasing voltage shocks to another subject that is apparently in pain or even unconscious as a result, has shown that humans are very susceptible to follow orders and ignore their conscience.3 Stanley Milgram concludes that “Ordinary people, simply doing their jobs, and without any particular hostility on their part, can become agents in a terrible destructive process. Moreover, even when the destructive effects of their work become patently clear, and they are asked to carry out actions incompatible with fundamental standards of morality, relatively few people have the resources needed to resist authority.”4 What would happen when the cooperation with authority over following one’s conscience is the expectation?
I am concerned as a human who values my freedom of conscience, and specifically as a catholic, that I will be expected to provide medical treatment, or referral for the same, that is morally objectionable. When commenting on this particular problem, John Paul II stated that “To refuse to take part in committing an injustice is not only a moral duty, it is also a basic human right. Where it not so, the human person would be forced to perform an action intrinsically incompatible with human dignity, and in this way human freedom itself, the authentic meaning and purpose of which are found in its orientation to the truth and the good, would be radically compromised. What is at stake therefore, is an essential right which, precisely as such, should be acknowledged and protected by civil law. In this sense, the opportunity to refuse to take part in the phases of consultation, preparation and execution of these acts against life should be guaranteed to physicians, health-care personnel, and directors of hospitals, clinics and convalescent facilities.”5
While I applaud the stated goal of the policy to care for patients in a “manner that is respectful of the dignity, autonomy and privacy of the person”, I am concerned that this same manner is not extended to the physicians affected by it. Do you think the proposed policy maintains the autonomy of the physician? Is this without value?
I thank you for having this consultative process prior to making such a policy change and urge you to change the method of safeguarding access to health care in such a way that you do not remove the human right and freedom, enshrined by the United Nations, of following one’s conscience.
1.United Nations Declaration on Human Rights, Dec. 10, 1948 (article 18): International Covenant on Political Rights of the United Nations on Dec. 16, 1966. (article 18).
2.Final Act of the Conference on European Security and Cooperation. Aug. 1, 1975.
3.Milgram, Stanley (1963). “Behavioral Study of Obedience”. Journal of Abnormal and Social Psychology 67 (4): 371–8.
4.Milgram, Stanley (1974). “The Perils of Obedience”. Harper’s Magazine. Abridged and adapted from Obedience to Authority.
5.Evangelium Vitae, Encyclical Letter, John Paul 11, 1995
To Whom it May Concern,
I am compelled to provide feedback regarding The College of Physicians and Surgeons of Ontario’s new revision to “The Physicians and the Ontario Human Rights Code.” The revisions in which the doctor must prescribe – or refer a patient to a doctor who will prescribe – anything which he or she is against, goes against our most basic rights as Canadian citizens. What the doctor believes, regardless of whether it is based on moral views or mere health considerations, he has every right to uphold. In a country where we are free to believe what we please and practice as we please, it is abhorring that such rules are even being considered in the revision. It seems as though we are becoming less free despite the fact that our country is in one of the most free phases it has ever been since its foundation. For the patient looking for anything from abortion and contraception to euthanasia, there are many doctors who will provide those things, it is completely unnecessary that every doctor be obliged to provide them. I completely agree that the greatest respect should be shown to each and every patient, however I do not believe that the only way of showing respect and care is by giving the patient whatever he or she requests. This is an abuse to the doctors of Ontario. I hope that these changes will not be implemented, for I fear that if they are, Ontario will lose many of its respectable and good doctors. That would be the worse slight to all patients. Please consider the consequences of the revision of this policy.
To whom it may concern,
I am completely opposed to the proposed mandate to require physicians in Ontario to refer patients to doctors willing to commit euthanasia.
This is a complete violation of freedom of religion and conscience and I am appalled that it is even being considered. If you bring this policy in, it will be challenged to the Supreme Court. It will also drive out physicians from the province.
I am against this new draft policy which includes measures that basically force physicians to take measures that go against their consciences. Please do not change the policy. Thank you
1. This draft policy is claimed, (by CPSO) to be a policy which necessarily flows from the Ontario Human Rights code and the Charter of Rights and Freedoms of Canada. This is a misrepresentation of the facts. This policy is going “beyond” each of these. There is no “right to treatment” in either document, so for the CPSO to claim that this document is balancing rights is not accurate.
2. Our society depends on ethical and moral behaviour from its citizens. It should not be difficult to see where trampling of these ethics and morals leads. If doctors cannot act on ethical and moral values, then who can? Who is next? If you are going to posit that the ethics and morals are appropriately dictated by a governing body, such as (self appointed) members of the CPSO, then who gives them such authority? Is the current, at any time, popular fad enough? If killing people (far any reason) is now called medical care, is there any limit to where we may find ourselves?
St Mary's Parish Council (Chairman), Carleton Place
I,too, am opposed to the draft policy whereby the College of Physicians and Surgeons of Ontario would force physicians to make referrals for procedures (e.g. abortion, possible end-of-life issues) that may violate their moral or religious beliefs.
I do not like this draft. There is a constant negative attitude towards religion, suggesting the state to be supreme, and doctors’ decisions to be better and more skilled and knowledgeable. Medicine is a very fine profession but it is a technical training, not a moral training. Doctor’s only know science, medical science, not all the deeper dimensions of theology, ethics, morality and spirituality. Doctors made their own decisions in concentration camps.. thousands did. They were given this right by the state. Religious leaders were mocked and thousands murdered. Do we not have any sense of history?
This draft is anti-life. I ask that it be rescinded as it will take us down yet another very dangerous path, in conscience. And it means that moral minded, faithful doctors will have to ‘ditch ‘ their consciences.. as will all health careworkers. Kill the draft, please
To Whom It May Concern:
I appreciate the opportunity to voice my views and the willingness of the CPSO to engage in an open dialogue on the issue of whether it is discriminatory to refuse to refer or in some way or other aid and abet a patient-driven healthcare decision. I am a physician working in a busy hospital.
In the conduct of my practice I am often asked by my patients for recommendations as to what to do in difficult situations.
In addressing these issues I rely on my knowledge base and clinical judgement to be the best patient advocate that I can be. My clinical judgement is informed by my experiences and by my conscience: my experiences because I all too often am also involved in trying to redress the consequences of patient inactions or ill-advised actions, and my conscience because it provides me with the confidence and conviction I need in making my recommendations. Built on a set of defensible moral principals, my conscience guides my activities and moral decisions, across all dimensions of my professional and personal life. It is different from my beliefs which are inherently personal, not defensible, and which do not and should not have a role in my clinical judgement.
Without my conscience serving as a reference point and as a compass for my clinical judgement, I would be left with only my knowledge and my experience to help me in my dealings with increasingly complex medical issues. I believe that patients benefit from the reliance of their doctors on their conscience. I also believe that the doctors are better and more compassionate when they can incorporate their conscience with their interactions with patients.
To follow one’s conscience and refuse to aid and abet a patient in pursuing a course of action that is at odds with one’s moral principals is not discriminating against the patient’s rights. It is simply allowing doctors to be the best patient advocates that they can be.
This policy would achieve precisely what it affirms it wants to preclude: discrimination!
My significant concern is with the section on Limiting Services on Moral or Religious Grounds. Were the opportunity for more indirection present, as I’ve onlined, it still serves the purpose outlined by the College, while respecting my religious right not to do certain things.
To Whom It May Concern:
I am grateful for the opportunity to again voice my grave concerns with regards to your present draft policy: Professional Obligations and Human Rights.
I was very taken back by the contents of this proposed draft as it did not seem to include any of the many objections provided in the first “Physicians and the Ontario Human Rights Code policy back in September 2008.
In reviewing this recent draft policy we were very concerned about the tone and use of wording that seemed to strip the physicians/surgeons’ God-given rights to their well-informed conscience and moral obligations. It seems that the CPSO is sadly discriminating against their own by attacking the integrity and professionalism of all physicians/surgeons and threatening to remove their licenses if they do not conform to the CPSO’s views on what is ethical and moral. This forceful method only causes anxieties for both physicians/surgeons and a multitude of patients who depend on these good physicians/surgeons. How can such a policy benefit the greater good of society at large in Ontario, when we already battle the shortage of physicians/surgeons? It is obvious that a sudden exodus of many good morally conscious physicians/surgeons would create a panic for the patients left behind and an overload of patients for those physicians/surgeons left to pick up the load. How can the CPSO claim to provide services without discrimination by first discriminating against their own?
The following resolution presented previously and still being presented is what is needed to protect all parties concerned: CPSO can require all physicians/surgeons to post an upfront declaration of where they stand with regards to their moral and religious views (i.e. access or not to contraceptives, morning-after-pill, assisted suicide, etc.) or their own clinical/medical competence (i.e. child specialist, geriatric specialist, gynaecologist etc.). These physicians/surgeons have no need to post a list of alternatives and referrals as this would be morally wrong for them. Such upfront signs or declarations would in no way affect negatively the fiduciary nature of the physician-patient relationship; instead it would strengthen it, as all parties would be on the same page. After all we live in a world that provides easy access to everything one inquires about through internet, phone books, and word of mouth, just add “signs or declarations in all these areas and all would be taken care of without causing any discrimination against these good physicians/surgeons or the patients.
Other concerns are who defines “ethical” and “health”? Certainly one with no moral conscience or a weak and ill-formed conscience would do so quite differently than one with a well-formed conscience.
Did CPSO take note of the Classic Hippocratic Oath of 1943 (by Baltimore: John Hopkins Press) where it states “I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect. Similarly I will not give to a woman an abortive remedy. In purity and holiness I will guard my life and my art.” Even if you would choose the 1964 modern version (by Louis Lasagna, Dean of the School of Medicine at Tufts University) instead, we would hope that you would be mindful of these words “Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God…May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.” Please pay particular attention to the words “I must not play at God” and “May I always act so as to preserve the finest traditions of my calling”.
The policy you are proposing only serves to undermine the foundations of all democratic freedoms, not to mention human rights. History and the present shows us that all totalitarian states have one thing in common and that is the rejection of Christian morals and beliefs about the innate value of the dignity of all human lives from conception to natural death.
Physicians/surgeons who refuse some of these so-called “procedures” because of their well-formed consciences are no different from those who would refuse the same “procedures” on account of the scientific evidence that support their decisions – this is exactly what “the patient’s best interests must remain paramount” means. The very physicians/surgeons you (CPSO) are targeting are only placing their patients’ physical, emotional and psychological health (both long-term and short-term) at the forefront … that is being mindful of their patient’s total well-being. It is very puzzling to see CPSO discriminating against them; have you not considered their rights? Are you not imposing a grave burden upon them and denying them their rights? This draft has all indications of being intentional discrimination against physicians/surgeons of faith and moral obligations.
We pray that the CPSO will reconsider this clear mandate to ignore the very foundations of democracy by attacking clearly innocent physicians/surgeons and this time around listen to the many who are sharing their legitimate fears for the loss of democratic freedom of speech and religion. We must learn from history and avoid repeating the grave errors committed against the God-given dignity and life of every human person from conception to natural death regardless of their race, ancestry, place of origin, colour, ethnic origin, citizenship, creed, sex, sexual orientation, gender identity, gender expression, age, marital status, family status or disability. Doctors swore an oath to do no harm to any of their patients. Because of this, it is their obligation to inform them of what through evidence is either good or detrimental to their patients’ well-being and so why would the CPSO want to cast them out for doing exactly as they vowed to do?
We need the govt to stop intervening and calling it equality over freedom of choice.
Response in PDF format.
A Doctor announced today on our CKTB 610 that there are 60,000 people in the Niagara region without a doctor.
Dear Members of the Consultations Committee:
Subject: Policy “Professional Obligations and Human Rights”.
I am deeply concerned about the content of your proposed draft policy. Sections 8, 10 and 11 propose that if it goes against a physician’s conscience to participate in certain acts, then he must refer the patient to another physician willing to perform these acts. It does not take into account the fact that the act of referral makes the physician indirectly responsible for the act. In getting the physicians to refer, you are limiting their ability to refuse participation in this act that according to some beliefs are immoral, by making them part of it.
When it comes to judging if an action is moral or not, it may be difficult for anyone to set the rules. Every person has different beliefs and moral standards; the important thing is to respect these differences. The ability to have freedom of conscience is so fundamentally important to human dignity. If we try to limit physicians’ rights to this freedom, it could make their lives very difficult and subject them to injustice. Physicians are meant to promote health and human life, anything against their freedom of conscience should be especially spared considering they already face enormous pressure in their day to day lives. Allowing their integrity as physicians will lead to the maintenance of better relations between the physicians and the patients.
I encourage you to revise the sections above, and include a clear defense of the right to freedom of conscience for all physicians.
Ontario Human Rights Commission
Response in PDF format.
Ontario Medical Association
Response in PDF format.
American Medical Association
Response in PDF format.
I agree. Physicians should have the right to say no to providing certain forms of treatment. However, I’m particularly concerned with the requirement that physicians provide referrals for treatments which they feel are morally and ethically wrong. If a physician feels a treatment is morally and ethically wrong, then aren’t they still violating their conscience by asking someone else to perform the procedure? How is the physician’s right to freedom of conscience being protected under these circumstances? In addition to this, a physician might feel that if a procedure is morally wrong it would also be harmful to the patient. Under these circumstances the physician would be violating not only their conscience but also their hippocratic oath by referring the patient to someone else to perform the procedure.
College of Physicians and Surgeons of Alberta
Response in PDF format.
The College is mistaken in trying to enforce this moral leveling. The Charter recognizes the sacredness of the conscious and religion as it should, while the Supreme Court, like a brute beast, trods over this sanctity by declaring that there are no absolute moral rights, senseless of the consequences, and without any foundation for making such a bold statement. The College is foolish in making policies based on the Supreme Court’s statement, and also should see dangers in forcing this moral collectivism. The dangers of this leveling place enormous weight upon the physicians who’s rights are being infringed upon. They are being surrounded, directed, and oppressed. To take away, or at least to suspend, these inalienable rights that our Charter lays out, is a procedure as preposterous and absurd in argument as it is oppressive and cruel in its effect.
A doctor must be allowed to refer patients, such as abortion or euthanasia to another physician or councelor without recourse of legal action by a prospective patient regardless of charter rights. Court rulings of late lack wisdom based on freedom of religion, especially Christian roots in Canada were our constitution is being under-valued by our highest courts who make rulings that should be made by referendums that represent the values of all Canadians.
I strongly support the doctors have their choices not to perform treatments against their moral / religious beliefs [example abortion, and euthanasia].
I do not agree. Please reconsider. Thanks
Society does not have the right to dispose of life. The College of Physicians is not above society. Only individuals have choice, as they responsible for their own conscience. Society, however has a responsibility to help individuals. Economics concerns should not be a concern for life. We cannot and should not ask doctors to go against their conscience. Doctors are after all in the business of making life better, not to end it or to help end it.
Response in PDF format.
It seems to me that in attempting to “balance” the rights of the patient with the rights of the physician, we are taking away the physician’s rights. How is that balancing? It is not fair that he is obligated to do things he is opposed to simply for the profession he chose. With the shortages of doctors as is, why make it more difficult for them to practice medicine according to their morals and possibly result in fewer people choosing that as their profession.
Response in PDF format.
Forcing Physicians to participate in what they consider murder is absolutely repugnant.
This is a disgrace unprecedented in civilization outside of Stalinist Russia and Nazi Germany. What on earth do you think yo are doing? Have you not heard the screams from Dr. Theo in the Netherlands, where at least participation is not forced.
The Canada I grew up in is gone.
Perhaps the doctor chooses not to perform or refer for abortion not because of religious beliefs, but because scientifically he realizes that abortion kills a living, developing human being. Then to refuse to perform or refer for this “treatment” is not a personal decision, but a medical decision. Do we now say that the patient is more qualified to make decisions about medical things than a physician who spent years in school learning these things? If my doctor prescribed me some medication, but I wanted to take something herbal or natural instead, I may do that, but I can’t expect the doctor to facilitate that. Using his background knowledge and experience, he advised me how to proceed. If I choose a different path, he should not be required to go against what he knows/believes to be true to facilitate my decision. On the contrary, he can and should advise me on why he thinks my decision might be unwise/foolish/dangerous.
I am strongly opposed to the stand taken by the College on the grounds of Religious freedom period.
I think all professionals working in institutions receiving public funding should be required to conform to the laws of the land. That includes giving contraception to women requesting it; giving abortions to those requesting it up to whatever the cut off date is but only public paid for a max. of 3 abortions, and also, under very tight supervision so it is never used as a cost cutting measure – death with dignity to those requesting it.
I am strongly opposed to the stand taken by the College on the grounds of Religious freedom and freedom of conscience.
Legalizing killing! Really? And requiring others to follow suit? Where is my Nazi Swasztika?
It is absolutely ridiculous that a doctor would be forced to participate or suggest a procedure that they would deem unhealthy. Enough evidence exists to suggest that abortion can physically and (especially) psychologically harm a woman.
But more importantly, physicians should not be forced to do a procedure they do not think is good.
Allowing the state to compel individuals, physicians or otherwise, to violate their conscience is absolutely contrary to a free society. This policy would force any physician committed to the position that human life has the highest value, to deny and discard a concept upon which Western Society was built and has been sustained for two millennia. This Christian anthropology distinguished Western culture as reasoned and balanced and was the impetus for propelling human advancement and well-being. In a stroke this proposed legislation would wipe out this dynamic foundation and return us to a society where individual rights trump the common good. Don’t be coerced to legalize what amounts to unrestrained entitlement at the expense of the inviolability of conscience, the common good, and what will certainly lead to a profoundly disturbing rending and negation of fundamental personal principles and the destructive undermining of hard won societal ideals.
In some cases the requirement of providing a referral demands that a principled, moral and/or religious person cooperate with the intentional and direct ending of a human life. Clearly this will go against deep, sincere beliefs, and go against many phisicians motive and directive to heal patients and ‘do no harm’. Physicians human rights must also be respected, and Freedom of conscience is foundational to our free society.
Response in PDF format.
Doctors must have the right to follow their own conscience in dealing with the recent Supreme Court ruling on assisted suicide. I strongly disagree with physician performing or referring for abortion, euthanasia and other matters of conscience. CPSO must lobby the federal government to respect the rights of individuals, both patients and practitioners.
I would appreciate it if the CPSO would continue to allow us (the public) to read the comments after the discussion has been closed to public input. I wish to follow closely what the College does with all of the input to this discussion. I do appreciate that we have been able to contribute thus far but I’m afraid that the vast majority of Ontarians/Canadians have no idea about this issue yet.
Any policy that requires professionals to act against their own conscience has no place in a democracy. If we don’t have conscience, we have nothing.
I just want to begin by saying that the practice of medicine in Canada is a challenging yet satisfying endeavor, and it always amazes me that even in its culturally pluralistic context a high standard of care for patients is readily met. The fact that this standard is met, I believe, is because of the role of conscience in a physician’s thought and action, not in spite of it. In fact, I would go so far as to say that physicians of conscience may tend to choose areas of medicine, specialties, vulnerable populations etc. that are less attractive, less profitable, and quite possibly deal with a messier side of the human condition! The formation of my conscience as a Catholic physician prompted me to choose to serve a population that was underserviced.
I truly believe that the proposed draft policy will bar other like-minded individuals from considering the profession or considering areas of medicine that are more ethically sensitive. Further, I suggest that there is a proportion of the patient population that are not only supportive of, but desiring of treatment by, physicians holding to certain ethical tenets (ie. on life in both its beginnings and ends). You are likely aware of the proposal by Prof. Margaret Somerville and others as to a registry of physicians holding to certain tenets based on conscience. I think that this would be an appropriate middle ground that would make those values well known to patients in advance, and also similarly help some patients reach like-minded physicians. The above can easily be done without the danger of perceived “personal judgment” or “discrimination”. Additionally, with physician-assisted suicide on the table now, I’m sure the College will be finding that more physicians “of conscience” will be coming out of the wood-work. Lastly, a word about complicity and referral. Many seem to think that referral to another physician who would then perform or prescribe the objectionable action or medication should look after conscience concerns. Both the College and the Criminal Code understand what it means to aid, abet, counsel or be a party to an offense. I refer you, as an example, to the College’s policy on Female Circumcision (Policy #2-11). It would be impermissible as per policy to refer a woman for such a procedure. The College has appropriately renounced this procedure. There exists in other areas of medicine similarly contestable procedures – the fact that the majority of physicians in Ontario still oppose physician assisted suicide as an example. For a physician of conscience, to refer a patient would also be as compromising as would more direct intervention.
No one in this country (Canada) should be obligated by the state to disregard their religious belief. Not to receive medical treatment due to moral belief needs to be respected. If they don’t agree with blood transfusion and the lack of that service will cause death then the obligation should be towards life. This service is proven effective towards life. If their culture stresses a particular choice outside of the conventional that choice should be respected even though it may or most probably will lead to death. we need to respect their cultural attempt at caring for the sick. To implement killing to particular sick will create a tradition of irreversible wrong. Such a direction would have us holding to a culture of life but not really. To coerce those committed to sustaining life (not at all cost) to kill by threatening to take their means for maintaining a living speaks against freedom, something many Canadians died to establish. Therefore it will be an affront at least to the died if there is no God in one’s life. This is totally unjust and if taken the time it would be extremely obvious.
This implementation corrupts Canada’s moral character. Yes a country should have a moral character. “Give me liberty or give me death” or “God keep our land”, There are many “goods” that could define Canada, “kill the suffering” should be regarded as a bad choice especially for the country I call home. To force others to do the killing is…you name that.
I am very concerned about the welfare of all Canadian patients with this new development. I believe that funding for palliative care, nursing homes, and other programs for vulnerable populations, will be reduced in an increasing climate of euthanasia and physician assisted suicide. I am also concerned that in hospitals with limited resources and funding combined with the fact that patients’ often express feelings of not wanting to be a burden on their families and the health care system, that a patient’s “right to euthanasia” will quickly become an “obligation to be euthanized”.
I am concerned about the significant impact and erosion of trust this will have on the patient-physician relationship; in a climate of euthanasia and assisted suicide, I believe that patients will question whether their physician is seeking to heal or euthanize them.
I’m also concerned that we may face the loss of knowledgeable, compassionate, caring individuals from the field of medicine. Individuals who went into medicine to alleviate pain and suffering, decrease anxiety, and delay preventable death – not to kill their patients. Many of these physicians will relocate or leave medicine all together rather than compromise their morals. Canadians who share the moral opinions and beliefs of these professionals will be denied the right to have physicians who share their beliefs. I am concerned that physicians who value life may become non existent or at least discriminated against in this new era.
The proposed changes require doctors to keep abreast of treatment options (regarding both procedures and facilities) that they consider morally objectionable so as to provide referrals to patients seeking these forms of care.
Put another way, a Dr must be able to say, “This procedure is wrong, damaging to the person, and is, in my assessment, in discord with the practice of medicine. But I know all about it, and where you can get it, and here is the best place to do so.”
No matter how widely accepted a procedure may be, a person cannot be coerced into denying through participation his or her ultimate sense of being simply because he is a doctor.
A legal opening like this is against principles of freedom, and is sufficiently broad and vague as to be a vulnerability to many doctors who adhere to longstanding and eminently reasonable traditions. They should not be compromised simply because a wave of modern support rises against them.
Everything about the consultation process on this policy this time appears to be calculated to obtain a pre-determined outcome on the part of the College. Why was there no public opinion poll this time? Is it because the last two times the public supported conscientious objection rights for physicians, against the apparent goal of the College on this policy? Instead, the College used a long and tedious survey that very few people really have the kind of time (15 or 20 minutes) to fill out among the many other duties of their lives. All this, in addition to the strange reappearance of this policy draft only a few months after the public expressed its opposition (only this last summer) presents a picture of a very calculated intent by the College to push this policy through, regardless of the fact that the majority of the public does not support it. This “consultation” was a farce. It was apparently meant to give the mere appearance of valuing public opinion. How unprofessional and shameful. This truly appears to be a case in which opinions and views only count if they do not conflict with those of the College on this policy.
It will be a dangerous world if we force doctors to do what they think is wrong.
I am against any policy that would force doctors to do what they think is wrong, especially when there are options for the patient to seek care elsewhere in a reasonable time or with slight inconvenience.
You cannot legislate good, up to date medical practice because it is an art which balances technology, scientific knowledge, observation and knowledge of the patient, social sciences and compassion in the context of a doctor who has integrity, and who won’t do what he or she thinks is wrong for the individual or family.
No, a doctor should not have the option to refuse care on any ground.
Let’s begin with the Oath to the profession – the Hippocratic Oath. Does the Oath allow for exceptions? Do no harm, therefore, period!
Human rights codes prohibit unlawful discrimination based on prescribed grounds of the Code. If a doctor refuses care on any ground of the Code, they must be subjected to consequences equal to any meted out to other violators.
The complication might be competing rights as in rights based on the ground of creed, for example, that may compete with a claim of discrimination on ground of sexual orientation.
The analysis in such a case, must use multiple lenses and employ procedures for resolution prescribed by Human rights policy.
The CPSO must play its part by informing future prospects about Code requirements so that anybody who chooses to join the profession will do so with full knowledge of Human Rights law, policy and procedures.
Save the Mothers
Response in PDF format.
“The Canadian Charter of Rights and Freedoms (the “Charter”) protects the right to freedom of conscience and religion. Although physicians have this freedom under the Charter, the Supreme Court of Canada has determined that no rights are absolute. The right to freedom of conscience and religion can be limited, as necessary, to protect public safety, order, health, morals, or the fundamental rights and freedoms of others.”
“Where physicians are unwilling to provide certain elements of care due to their moral or religious beliefs, an effective referral to another health care provider must be provided to the patient.”
An Open Letter to the College of Physicians and Surgeons
I would like to point out some concerns regarding your proposed Draft Policy to limit physicians’ rights to Conscience and Freedom when they choose not to peform physician-assited suicide.
First of all, I am appalled at the way doctors are being used as instruments of death rather than being able to fulfill their true purpose in their profession – that of healing. When was assisting to kill a patient part of a doctor’s oath? That stretches the boundaries of patient care a little bit too far. Even if the Supreme Court hands down a ruling on physician-assisted suicide, you still have a moral and ethical responsibility to your patients. It sickens me to the pit of my stomach to know that people do not seem to know anymore what is moral and not.
Secondly, shouldn’t limits to these rights be applied only to those who are on the wrong side of the law, not to those who are law-abiding citizens? If that’s not the case, then why do we even have these laws when it will not protect us? “…to protect public safety, order, health, morals, or the fundamental rights and freedoms of others”. What can be more fundamental than a right to conscience????
I don’t know if anyone realizes this but doctors are just being used as pawns by these cowardly people who refuse to suffer. They will trample on the rights of doctors just so they can get what they want – death, not by their own doing, but by passing the burden to these health care providers.
Thirdly, how different is it to allow doctors to refuse to take part in assisted suicide, but oblige them to refer the patient to a willing health care provider? Is there too much apathy in this world that people cannot see the obvious? For a man of conscience, there is no difference between doing the act itself or passing the responsibility to another person. The act will still be done.
It gives me the chills to think of what this will bring to the future of our children. There might not be a right to life by then.
Before you make this big step, ask your Creator if you have made the right choice.
Response in PDF format.
Response in PDF format.
Dear sirs,
I understand that the CPSO is considering a revision of the “Physicians and the Ontario Human Rights Code”. As a scholar in bioethics and involved in the questions of human rights and religion, as well as being a member of CPSO, I hope that my concerns will be heard.
It is good to remember that the Ontario Code of Human Rights and many other similar statements were based on the Universal Declaration of Human Rights of the United Nations. These documents rightly defend individual human rights against abuses and discrimination based on race, sex, language etc. This first Declaration was a response to the atrocities committed during the Second World War, and especially from totalitarian regimes.
The Nuremberg trials on the Nazi doctors were the inspiration of many regulations on experimentations on human subjects such as the Nuremburg Code, Declaration of Helsinki and many subsequent pronouncements by the United Nations and Council of Europe. We should also recall that the Nazis doctors performed sterilizations and horrendous experimentations on certain subgroups of the population like the Jews or concentration camp prisoners. These procedures were performed at that time what was considered state-sanctioned, standard and approved practices. Later on, when the Nazi doctors appealed to the trials that they were only performing their state-sanctioned duty, they were found guilty of crimes against humanity. This means that they were judged by a law that appeals to all human persons in the depth of their conscience. Even without arguing from a religious perspective, everyone’s conscience is indeed sacrosanct and should never be infringed upon without grave violation of the person’s right.
There are parts of this revision touching on the role of conscientious objection by providers that is of great concern to me, since there is a danger that they can paradoxically negates the very thing they seek to defend—human rights. The part where the objecting physician has to make available services that he or she objects to for patients is particularly problematic. This is akin to a Nazi doctor refusing to perform sterilization on a patient, but is obliged to refer other doctors who are willing to do it. The new policies of CPSO will enforce a standard of medical practice where physicians would not be allowed to deviate. If this “standard of practice” is considered the golden rule of ethical practice, negating the any possibility of conscientious objection, then how is this different from the Nazi imposition on the doctors? Hence, if true conscientious objection were denied to the physicians, then we run the risk of returning to the same standard of Nazi totalitarianism, where physicians are basically automaton unable to work according to their own conscience of what they consider to be right.
In fact, while it might seem at a first glance a defense of the human rights of patients not to be discriminated against, this position may actually infringe on the most basic of human rights of health care providers. For what can be more basic a right than one’s ability to act according to one’s conscience?
I hope this letter would make you carefully consider the implication of this code, and thus avoid a grave injustice towards health care providers in their exercise of one of the most basic human rights.
Professional Association of Residents of Ontario
Response in PDF format.
Abortion Rights Coalition of Canada
Response in PDF format.
Dear Madam or Sir,
In light of the public debate regarding physicians’ rights to freedom of conscience and religion, I respectfully urge the College of Physicians and Surgeons of Ontario (CPSO) to uphold policy guidelines that respect the freedom of physicians to practice their profession in a manner that does not violate their conscience or moral and ethical beliefs.
Forcing physicians to disregard their conscience or moral and ethical beliefs in the provision of legally sanctioned non-emergency medical services has serious and far-reaching consequences that affect the integrity and practice of medicine. Cultivating a medical culture that encourages physicians to disregard their conscience by forcing them to do what they believe to be wrong or harmful has the potential to compromise the well-being of patients, physicians, and society.
Freedom of conscience and religion are fundamental freedoms in Canada under Section 2 of the Charter of Rights and Freedoms. A policy that restricts the freedom of physicians to practice their profession in a manner consistent with their conscience or moral and ethical beliefs infringes upon these Charter rights. That is, no person should be forced to materially cooperate with any activity that they regard to be wrong or harmful by the sole dictate of the State.
I urge the CPSO to defend these fundamental freedoms that are essential to the proper functioning of a free and democratic society and firmly hope that the CPSO will dutifully uphold the rights of physicians to practice their profession without compromising their integrity, conscience and moral or ethical values.
To Whom It May Concern:
I am writing to express an opinion on the Draft Policy entitled “Professional Obligations and Human Rights.” As a member of the public of Ontario, I wish to again express, as I did in 2008 and 2014, my deep concern over how this policy addresses a physician’s conscience, or his/her moral and religious beliefs.
The College of Physicians and Surgeons of Ontario exists to regulate physicians in this province, protecting the public. Perhaps the single most important quality that helps to protect the public is integrity. Indeed, in the regulatory and ethical codes of many professions (such as the legal profession), integrity is considered a cornerstone. Integrity indicates a wholeness of person and is closely tied to personal honesty. In proposing that physicians not follow their deeply held beliefs, the College is discouraging and even dismantling the integrity they are at the same time demanding. This cannot be anything but harmful to the mental health of physicians and lead to great distress. It is only at a great cost that one can act against beliefs that are as deeply held as moral and religious ones. Furthermore, it is a cost that many good physicians and potential physicians will not be able to accept. True religious and moral beliefs are not mere feelings that can be swept aside. They are informed and reasoned beliefs that guide a person. It is one thing to put in long hours, risk one’s health, and deal with the daily frustrations of medical practice to treat patients. It is another to sacrifice one’s integrity and be asked to dismantle what the person him/herself is. Please understand that this is what is being proposed.
A patient’s choice is not made in a vacuum with physicians who are there merely to carry out their wishes. Otherwise, the College could spread the word that well-rounded, mature people of integrity are not encouraged to become physicians; rather, those sought are easily programmable people with no particular attachment to values other than the ones they are told by the state to embrace. I do not know many people who would welcome having such physicians. Patients are people too, many with deeply held moral beliefs themselves. We are taught to respect and celebrate diversity and should not be surprised that our physicians also have moral beliefs. I suspect that most patients are willing to respect the beliefs of their physicians and the consequences of these beliefs, as long as they are aware of them up front. The College should fight for the integrity of its members and not open the door to interpreting the Human Rights Code in a manner that would be harmful to not only its members, but the public as well. A physician who acts based on what s/he truly believes to be right or wrong is not acting for the sake of thwarting patient choice. S/he is instead acting based on what s/he really believes is harmful to patients.
I believe that there are better ways than this Draft Policy to handle situations where physicians do not wish to provide certain treatments. One idea that has been suggested is to create a registry or include the information in the CPSO doctor registry search. This would seem to be a better balance between the rights of patients and of physicians. Instead, the Draft Policy appears to be taking an extreme position of targeting physicians who hold increasingly minority beliefs. At least the 2008 policy statement #5-08 “Physicians and the Ontario Human Rights Code” has a more balanced approach.
The section of the Draft Policy entitled “Ensuring Access to Care” is also problematic. It shows a lack of understanding of the moral principle of complicity. Requiring that a physician recommend someone else to provide the refused treatment makes a mockery of the ability to behave according to one’s conscience. Generally, in moral philosophy, it is accepted that if I find it morally objectionable to do something, it is also morally objectionable for me to have someone else do it instead.
I am aware that the College’s position may be to say that the Draft Policy is necessary due to the Ontario Human Rights Code. However, the “it’s not us, it’s them” response is no response at all. There are no substantive changes to the grounds in the Human Rights Code. The College should not be eager to direct the course by setting new rules that patients have a ‘right’ that previously did not exist – the ‘right’ to force the abdication of physicians’ moral and religious beliefs on demand. This Draft Policy is intolerant and coercive.
Physicians’ freedom of conscience should not be removed simply because it comes into conflict with other rights and freedoms. Freedoms have a cost and we must be willing to shoulder the responsibility of bearing that cost. There is no basis for holding that the cost of physician freedom of conscience and religion is too high. Indeed, people in totalitarian countries throughout the world fight and risk their very lives for that freedom.
It is so intensely and uniquely human to have beliefs, act based on conscience, and experience moral responsibility. Physicians should not be advised to cut off this part of their humanity and proceed with merely hands and eyes, or as if they were robots.
I urge you to reconsider the Draft Policy and consider alternatives or keeping the current policy.
I am writing in response to the CPSO draft titled Professional Obligations and Human Rights. The policy would better serve the public if the proposed mandate for effective referral be removed.
As a member of the public who accesses health care, it is very important to me that my physician be an professional with integrity. Requiring a physician to act against his or her conscience or mandating that a physician provide a referral for services that he or she finds objectionable destroys that integrity.
I do not expect that my physician will have the same moral and cultural outlook as I do – I respect differences that are handled with mutual respect. Insisting that a physician act against his or her conscience breaks the bonds of respect inherent in the patient-physician relationship. My physician cannot demand that I act against my conscience – neither should my requests override my physician’s rights to act in accordance with his or hers. I trust the professional expertise of my physician – that is why I am accessing their assistance.
I request that the policy reflect the rights of both members of the patient-physician relationship and not force physicians to act or refer against their conscience.
We would like to register our strong opposition to the CPSO’s draft policy that limit physicians Rights to Freedom of Conscience and Religion guaranteed in the Charter, and require them to make an effective referral to another physician if they refuse their patient’s requests, such as for euthanasia should it be legalized.
Thank you for your attention to this important matter.
I am writing to you with grave concern regarding the content of your proposed draft policy, which indicates that physicians who decline to participate in certain acts for reasons of conscience should be compelled to refer their patients to other physicians who will perform these acts. It does not address the fact that many of these same physicians will find the act of referral itself objectionable, as they consider it material cooperation with the act.
Physicians moral stances, based on rational conscience decisions, deserve protection. Compelling physicians to act against conscience decisions violates the Canadian Charter of Rights and Freedom.
A physician’s refusal to provide or perform some procedures does not constitute discrimination when this decision is based on a properly informed conscience. This decision is not based on the characteristics of the patient requesting the service, but on the nature of the procedure requested. I demand you to revise the sections above, and include a clear defence of the right to freedom of conscience for all physicians.
I feel very strongly that physicians, surgeons and health care professionals have the right to refuse to do that which they consider to go against their conscience and faith. This right is contained in the Charter of Rights and Freedoms. It is every person’s right. Physicians take an oath to do no harm and there is a line which they should not be asked to cross.
Dear CPSO,
I am deeply concerned about the proposed draft human rights policy that the College of Physicians and Surgeons of Ontario recently released. I am a physician next door in Manitoba. This policy would directly impinge on the religious rights of physicians. Should it be passed, I am very concerned for the future of other provincial Colleges, which may follow suit.
The point of a human rights policy is to protect the rights of all humans—physicians included. While it’s commendable that the CPSO aims to protect the rights of patients, it does so at the expense of the rights of physicians. Physicians must be free to provide services in keeping with their moral codes, even when that means patients might have to go somewhere else. Doctors must not be forced to participate in practices they find morally objectionable or abhorrent. An obligation to refer constitutes tacit agreement. Therefore physicians must not be forced to refer.
Abortion has been available by self-referral for over a decade. Forcing doctors to refer is superfluous.
I look forward to reading the next draft.
Dear Members of the Consultations Committee,
I am writing this note with grave concern by expressing my objection to the fact that Doctors in Ontario will soon not be permitted to vote according to their position of conscience. What this is in fact doing is no different than if one were in a position of conflict where a person is backed into a corner and then ordered to be exterminated because someone without conscience has ordered it so. Allowing physician assisted suicide begins the slide down the tip of the slippery slope inviting human abuse to occur which will soon not be questioned as the bottom line begins to dictate overall patient outcomes because money with then begin to rule all decisions as if it were the highest power in the land.
What I have always understood a Physician to be was a professional who was in a position of trust and honour and who would do no harm. To be a physician was to be a person of the highest moral character and integrity who was above reproach for anything other than for good.
Physician Assisted Suicide and taking a life prematurely is blatantly wrong both ethically and morally. No one has the right to take a life….that is no different than committing blatant murder. Committing murder goes against the Hippocratic Oath which states a physician should heal thyself and do no harm.
Allowing physician assisted suicide will begin the blurring of what is and what isn’t. What should and shouldn’t be to serve purposes other than what Medicine originally intended. Physicians are not God, nor should they act as if they are so. In so doing they are placing themselves in a position of distrust. What will occur is no different than what occurred in WWII. While the semantics are different, the outcome would be similar. Certain persons were forced to die at the whim of those who felt for their own justifiable reasons they should do so without conscience and without question.
That was called an atrocity when judged on the world stage. What will occur in this country of Canada is no different because it’s foundation was created based on Judeo Christian Principles which do not allow for freedom of choice around the issue of killing. Kindly give your heads a good shake and realize what you are going to create if your proposed amendment is allowed to stand.
There are medications available where patients can be made comfortable until their Maker is ready to take and receive them. Good Palliative Care allows for that. I would urge that before considering this reprehensible vote that one reflect on what led to the great fall of previous empires. It was wrong human judgment that began the deterioration. What will occur over time is such an erosion of what is good that anyone will be able to commit whatever they wish under the blind blanket statement where physicians cannot vote according to conscience. Murder is Murder, There is a reason for Thou Shalt Not Kill. Insisting on it is no different than sanctioning a regime that was once called Communism where there was no belief, other than what was set down in the skewed laws of the dictatorship. Forcing Physicians to vote against what their conscience may believe is an imposed rule that would be permitted within a Dictatorship. Is this what you wish to reduce this country to after Veteran Soldiers gave their blood and their lives for our Freedom to Live in a peaceful and safe society?
I strongly urge that you read and consider what I have written which is sent without prejudice but only with a heart of love and concern for our humanity and our country. Killing is not justifiable under any circumstances and most certainly not in a health care setting. People flee from countries where such behavior occurs. Now people will fear entering hospitals and health care centres. Soon this country will become no different than those from which people are running away only for different reasons, but the out come will be the same. Someone in a position of control had made a bad or improper decision.
Thank you for kindly taking the time to kindly reflect on my note and for recognizing that my words are written purely in good conscience.
I am a CPSO member in active practice.
I find one aspect of the draft policy on “Professional Obligations and Human Rights” highly problematic, and that is the obligation to provide an “effective referral” (read, to an available and accessible non-objecting provider) in a timely manner.
The problem lies in placing the onus upon the physician to achieve a rapid referral to such a provider, and faulting the physician if they cannot provide a referral in a timely fashion–that is, as rapidly as the patient demands it.
Under the current wording, a northern/rural Ontario patient can demand (for example) an assisted suicide immediately. First of all, what if their family physician disagrees that they qualify for it, or that suicide is the correct course of action? In such a case, it appears the family physician will still be compelled to find someone right away who is willing to perform this practice, or else be in violation of a major CPSO policy with all the attendant consequences. I do not believe this is right. Secondly, what if all the “available” local physicians also disagree to provide the service to this particular patient? In the situation where a local referral cannot be found, or a distant one cannot be arranged in a timely fashion, the family physician would be in violation of the draft policy. This is unfair to the physician, who cannot always be expected to produce whatever service the patient demands–especially where the service requested is highly ethically questionable.
Or what if a patient demands a sex-selective abortion, a practice which many physicians find morally unacceptable? The draft policy would compel the physician to find a way to make it happen, right away. Any delay or lack of availability or accessibility of the requested service would fall on the referring physician’s shoulders as a failure to follow the draft policy. Is the referring physician to be held accountable for not only his own moral objections to a certain practice, but other physicians’ objections as well? How far must the referring physician go to satisfy a patient’s demands? Under the draft policy, much too far.
What if a patient demands cosmetic surgeries such as labiaplasty? The draft policy would compel me, as a family physician, whatever the circumstances, to make a referral happen as soon as the patient wants it, to someone, somewhere, who would be willing to perform the service. I don’t think this is reasonable at all.
Individual physicians must be guided primarily by their consciences. Indeed, a sense of what is right and wrong influences the hundreds of decisions we make during each clinical encounter, and it is for the opportunity to do good for our patients that most of us chose a career in medicine, presumably. We may have different definitions of what that “good” is, some open to compromise, others not. But you can’t hold a physician responsible for ensuring that whatever demand a patient makes, especially one with complex ethical dilemmas, must be fulfilled in a timely manner. This imposes too onerous an obligation upon the physician and removes too much of his or her power to listen to clinical judgment and conscience in deciding what is right and wrong, in his or her view. The draft policy threatens to let patients and society dictate too much of what a doctor must do, under threat of loss of their medical licences.
I think the wording should at least be changed to “Where physicians are unwilling to provide certain elements of care due to their moral or religious beliefs, an effective referral to another health care provider, or reasonable assistance in locating such a provider, should be provided to the patient.” This would express the possibility that not all requests made by patients, especially ethically problematic ones, need be fulfilled by a responsible, conscientious referring physician.
I am writing to The College of Physicians and Surgeons of Ontario to express my objections to the proposed changes in the document entitled “Professional Obligations and Human Rights”.
I am particularly concerned about the The College’s attempt to violate physicians’ human rights by coercing physicians to act against their conscience in certain situations that may arise in their practices.
At issue is the attempt of The College to force physicians to make an “effective referral” to a physician who is willing to perform a procedure which is deemed by some to be morally objectionable.
It is imperative that The College recognize that physicians who make such “effective referrals” are in fact participating in the immoral act which they are trying to avoid. This is not a case of simply passing the responsibility to someone else; it is in fact to participate in the act and thus to incur moral culpability on the part of the referring physician.
The main point in this discussion is the status and defense of physician’s human rights and the defense of a robust pluralistic society in Canada.
Our Charter of Rights and Freedoms, in section 2, clearly spells out the “Freedom of Conscience” and “Freedom of Religion” for all citizens of Canada. This should naturally also include physicians.
I strongly object to The College’s attempt to violate physicians’ fundamental freedoms and rights. This totalitarian impulse must be opposed.
I also strongly object to the The College’s presumption that Canada is not a pluralistic nation. Pluralism is a fundamental value and reality in Canada. It is entrenched in the very fabric of our liberal, democratic political society.
Pluralism means that there exists a diversity of opinions, beliefs, ways of life, and cultures. Canadians do not all share the same opinions and beliefs, especially on important moral and political matters. The fact of pluralism should be recognized and defended. The antithesis of pluralism is totalitarianism, where only one view or opinion is allowed to be promoted.
By proposing these changes for its professional conduct policies, The College of Physicians and Surgeons of Ontario is expecting physicians to all think alike and to ignore their objections to certain procedures on moral and religious grounds. It is a gross injustice for The College to impose a uniformity of belief and opinion on all its members on issues dealing with morality, religion and politics. This is in clear contrast to the fact of pluralism in our free and democratic society. And it is in clear violation of our most basic human rights.
I entreat The College of Physicians and Surgeons of Ontario to abandon their attempt to violate physicians’ conscience rights.
I am writing to express my deep concern over the draft human rights policy released by the College of Physicians and Surgeons of Ontario in late 2014. As it currently stands, the policy would compel physicians to act contrary to their consciences, forcing countless doctors to provide services, or facilitate the provision of services, which they consider wrong for moral or religious reasons.
This is reprehensible.
Not only does such a policy ignore the basic rights of physicians, it also undermines confidence in the medical system at large. By forcing physicians to act in ways they consider immoral and unethical, the CPSO signals to wider Canadian society that it is not concerned about the personal integrity of its members. In fact, it suggests the CPSO considers personal integrity something to be discouraged among physicians.
In Canada, we are privileged to enjoy a number of rights and freedoms. I am pleased to see the CPSO committing itself to upholding these rights by producing a draft human rights policy. I am aghast, however, to see that a document purportedly devoted to respecting these rights nevertheless severely undermines the rights of physicians.
The draft policy correctly notes that the Canadian Charter of Rights and Freedoms protects physicians’ right to freedom of conscience and religion, but it is clear that the policy fails to appreciate the full implications of this right. Physicians ought not be forced to refer patients for treatments that the physicians, for reasons of conscience or religion, find objectionable. To require otherwise is to make the objecting physician a party to the treatment he finds objectionable
It’s all very good to say that physicians have the right to freedom of religion and conscience, but it must be further recognized that these freedoms apply not only to thought but also to action. It is not enough to say “Alright, you may believe such and such. You do not need to perform the act yourself, but you must refer patients to someone who will.” If, for example, a physician is opposed to abortion or assisted suicide for reasons of conscience or religion, forcing them to refer a patient for such a procedure impinges directly on the physician’s freedom. The physician will understand herself morally culpable for the final act, in that she facilitated its being carried out. She will have been forced to act in a way contrary to conscience.
As the Nova Scotia Supreme Court recently reminded us, and as the CPSO’s draft policy itself notes, rights in Canada are not hierarchical. When the rights of one individual come into competition with the rights of another, they are to be balanced. “If there are competing rights the issue is whether there are alternative measures by which both rights can be accommodated,” Justice Jamie Campbell writes in his judgment on TWU vs. NSBS. “That involves a consideration or whether one right has been disproportionately affected or the other disproportionately privileged.”
It seems clear that, if the CPSO adopts its draft policy without significant alteration, then the rights of physicians to freedom of conscience and religion will be disproportionately affected—and thus, that their freedom will be infringed upon. As Justice Campbell explains, “An infringement is made out when the claimant sincerely maintains a belief or practice that has a nexus with religion, and the impugned measure interferes with the claimant’s ability to act in accordance with those beliefs in a way that is more than trivial or insubstantial. Trivial or insubstantial interference is interference that does not threaten the belief or conduct.”
Requiring physicians to facilitate a treatment they consider morally objectionable, perhaps even evil, is neither trivial nor insubstantial. Consequently, the draft policy as it stands infringes upon physicians’ rights.
The CPSO should rewrite its draft policy to more clearly protect the freedoms of physicians, including their right to act in accordance with conscience in choosing not to refer patients for treatments they find morally objectionable.
[**MESSAGE FROM ADMINISTRATOR: DURING THE CONSULTATION PERIOD, WE RECEIVED 2 RESPONSES FROM INDIVIDUAL RESPONDENTS CONTAINING THE CONTENT PUBLISHED ABOVE. ALTHOUGH THIS FEEDBACK HAS NOT BEEN PUBLISHED IN DUPLICATE, THE COLLEGE ACKNOWLEDGES RECEIPT OF THESE SUBMISSIONS.**]
The proposed “effective referral” mandate is violation of a physician’s rights that must be rejected. The entire medical profession operates on the oath to “do no harm”, which is globally understood to mean protect and make better the life of the individual. The medical profession is founded on the ethical and moral foundation of protecting and preserving life as best as it can. When life is inevitably ending, the medical profession then acts on its oath to institute comfort care to help ease the patient into natural death.
With effective referral, the Ontario College of Physicians is violating the rights of all Canadian citizens in the following ways:
1. Undermining the definition of “care”.
Care cannot include the act of killing a person. Care goes with life, the living, nurturing. To be under a physician’s care is to be receiving treatment to regain health or manage chronic illness or to receive medical comfort as death draws near. Care follows the tides of nature and shows dignity for life. Euthanasia cannot ever fall under the auspices “care” for a patient.
2. Contravening a doctor’s right to not deliver a medical service that is contrary to ethical or religious beliefs.
Ethical beliefs: the medical profession is based on an ethical approach to Care (see point 1). Do no harm is the professional oath. It is unethical that the College has refused to challenge the Supreme Court ruling on physician-assisted suicide on behalf of all of its practicing doctors as the ruling contravenes the foundational belief of “do no harm”. Why is the College allowing the court to dictate terms of medical care?
Religious beliefs: the College violates doctors’ rights when suggesting that they can opt out from providing care based on religious grounds, then advises they must be accessories to the same procedures. Assisted suicide is directly contrary to any belief that life should be protected and respected. A physician violates their beliefs by helping a person even find a doctor who would perform such an abuse.
3. Refusing to protect life.
When life is no longer valued, chaos ensues. This is the operational system of much of the Middle East. It cannot be our ultimate goal. One’s life must be protected at all cost – we need a universal value placed on life, regardless of state or station so we move with unity to make things better for EVERYONE. Assisted suicide becomes another example in a devastating commentary on how we only want certain kinds of life…that which is tidy, convenient, only perfectly healthy, maybe only with a few flaws, but not with many because that is hard to take, sad to watch, because it requires us to feel and act in love towards our fellow humans on our natural journey through this life.
The law must protect all life, regardless of deemed quality. It really is an all or nothing proposition, much like pregnancy: you cannot be sort of pregnant any more than you can defend life, mostly. You either do defend life and act to do no harm, or you don’t. I request the Ontario College of Physicians stand down from effective referrals based on the physician’s oath, a need for a steadfast morale code in Canadian society, physician’s religious beliefs and the rights already granted them by the College. I further ask the College to stand up for the principle’s on which it was founded by challenging the Supreme Court’s decision of assisted suicide based on basic rights to life.
Thank you for the opportunity to provide input to the CPSO Draft Document on Professional Obligations and Human Rights. I have read the draft document with care.
The importance, sensitivity and reciprocal nature of the physician/patient relationship has been evident in my own life and in the lives of family members, colleagues and clients.
I am pleased that the CPSO draft document recognizes the right of physicians to freedom of conscience and religion under the Canadian Charter of Rights and Freedoms. Freedom of conscience is included in the United Nations’ Universal Declaration of Human Rights and is a fundamental right upheld throughout much of the world.
As outlined in an article by Moira McQueen, LLB, Mdiv PhD, entitled Bioethics Matters, February 2015, the need for conscience to be properly formed ensures that conscience decisions are reasonable and rational. They are open to discussion, factual evidence, challenge and sometimes change. A physician’s moral stance has nothing to do with any individual patient but with the nature of the procedure itself and an observation and judgement of good done or evil avoided. The conclusions of conscience are much more than “personal beliefs”.
Several aspects of the draft document are of concern, as they favour the rights of the patient over the rights of the physician. There should always be a balancing of rights; the rights of both patient and physician should be respected.
Lines 156 to 164 are particularly problematic in that a physician would be compelled against conscience to make a referral. There is no balancing of rights here, but rather compulsion.
Please ensure that physicians are never compelled to act against rational conscience decisions, the bedrock of our medical heritage.
Thank you for considering my comments.
I am a resident of Ontario and have read your draft policy on Professional Obligations and Human Rights.
The policy, as written, will take away my right as a health care patient and consumer to find a doctor that I can trust. I must assume that this was not your intention, but this is nevertheless the effect.
I am asking you to not take away my right to access doctors I can trust. Eventually, the identity of such doctors would become unknown as they are forced to comply with referrals for services that I would consider gravely unjust. I seek out doctors who share my moral values and I do this intentionally. These are the men and women I am willing to entrust with my health care. I know many others who do the same.
Forty years from now when I am old and seeking medical help, I would like to have the option of going to a doctor whom I know with all certainty will not “prescribe” or refer for assisted suicide. If this policy goes through, that will be impossible.
The policy is therefore unjust to myself and to many others who perhaps have not thought about it yet, who perhaps are not even aware that this policy has been drafted. I will be informing my network of friends who seek out morally aligned doctors so that they are aware this policy has been drafted. They may be too late to submit feedback, so I am asking you to consider that I represent many others in writing to you today.
By requiring that all physicians provide “an effective referral” for care that conflicts with their moral beliefs, and that physicians must provide care that is “urgent” to prevent “suffering” even if it conflicts with their moral beliefs, you are removing conscience rights from professionals who have every right to practice their profession in a way they deem moral. This cannot stand, as the Charter guarantees these rights for each of us. It is blatantly discriminatory against certain groups.
Furthermore, the role of physician is not that of a health care vending machine; the patient does not request and receive treatments of their own choosing but receives the treatment that the physician offers based on their own discernment, with the patient’s consent. It is not the right of the patient to demand a service from any particular doctor any more than it is the right of a hungry patron to walk into a restaurant and expect to be served a particular entree they demand that is not on the menu. This is true even if the patient is “suffering” from hunger. This proposed reduction of the role of the physician is insulting to all physicians who have worked hard to earn their credentials. They have a right to choose which health care services they will provide generally speaking, as long as they do it without discriminating between patients. I was alarmed to read this policy and surprised that the CPSO would have such little respect for their own profession.
Please amend the policy to acknowledge that physicians have a Charter right to not participate in services that conflict with their moral or religious beliefs. Do this for the sake of integrity of the profession, and to respect my right as a taxpaying citizen to seek out a doctor whom I can trust.
[**MESSAGE FROM ADMINISTRATOR: DURING THE CONSULTATION PERIOD, WE RECEIVED 2 RESPONSES FROM INDIVIDUAL RESPONDENTS CONTAINING THE CONTENT PUBLISHED ABOVE. ALTHOUGH THIS FEEDBACK HAS NOT BEEN PUBLISHED IN DUPLICATE, THE COLLEGE ACKNOWLEDGES RECEIPT OF THESE SUBMISSIONS.**]
Response in PDF format.
This message is to provide our comments on the Draft Policy on Professional Obligations and Human Rights to which Ontario physicians would become subject if implemented.
Our main concern with this draft policy is the potential obligation that would be placed on physicians to refer patients to other licenced physicians when the type of treatment or action sought by a patient would go against the physician’s conscience due to moral or religious beliefs.
In the event that the Federal Government were to enact a law permitting the act of euthanasia or assisted suicide, an Ontario physician refusing to provide the service would be required under the draft policy to refer the patient to a physician who is prepared to provide the service. In this case, the obligation of referral would place the morally or religiously conscientious physician in a position where they would be seen to be cooperating with an act deemed to be gravely immoral or illicit in accordance with the faith community they belong. It is untenable to put someone in such a position because of their deeply held moral or religious beliefs.
The enactment of this draft policy could result in the departure of many competent physicians in our Province who will not want to compromise on their beliefs. By extension, it could be expected that the enactment of this policy would also eventually be enacted for nurses and consequently, we could expect an exodus of nurses from our stretched health care system for reasons of conscience.
Consequently, we disagree with the draft policy as presented and implore that it be revised to allow physicians the full right to exercise decisions according to their moral and religious beliefs, even in cases where the patient may be requesting a legally permitted action or treatment.
With regard to the revised and approved draft policy Professional Obligations and Human Rights, I wish to advocate for a robust understanding and protection of the Charter right of freedom of conscience and religion for all Canadians, and indeed physicians in the daily routine of their care to patients and in the overall forming of their individual medical practices. I therefore reject the proposed mandate for an “effective referral” as it is a breach of a physicians’s rights and a serious incursion into the professional standing of a physician.
Doctors and other health care professionals, indeed all Canadians, enjoy the Charter right of freedom of conscience and and religion. In the event that Canada adopts a regime of physician assisted suicide, the threat to conscientious objection is that much greater.
If we agree to this policy of “effective referral” it is indeed a s l i p p e r y s l o p e towards vulnerability towards human life for all of us “especially towards the physically or mentally challenged” –if we are to play God. Looking towards the future, any excuse and every excuse could be applied to end human life. DO WE WANT THIS KIND OF WORLD??
The balancing of rights must be done in context. In relation to freedom of religion specifically, courts will consider how directly the
act in question interferes with a core religious belief. Courts will seek to determine whether an act interferes with the religious belief in a ‘manner that is more than trivial or insubstantial’. The less direct the impact on a religious belief, the less likely courts are to find that freedom of religion is infringed.
Please review your draft with due diligence and care and strike this policy of “effective referral” from your proposed draft.
Regarding the draft policy, “Professional Obligations and Human Rights”: the policy effectively defines the obligations of doctors to avoid treating patients in a prejudiced fashion, and the steps which they ought to take in order to avoid discrimination. However, it does so by emphasizing the autonomy of the patient, at the expense of the physician’s freedom and judgment. Essentially, the policy requires that the question of what constitutes “good health” be left up to the patient’s opinion, and that the physician merely provide expert advice on how the patient may reach this state.
This is especially troubling in light of the practice of abortion, which many physicians, to say nothing of people in general, view as being an act of murder, as well as the practice of physician-assisted suicide, which is considered by many to be likewise an act of murder. Under the draft policy, a physician who wishes to avoid taking another person’s life unnecessarily will no longer have the power to determine what constitutes “unnecessarily.” Far from saving lives, doctors will now be required by law to take them whenever a patient decides they no longer wish to live, or to be pregnant.
I understand the need to prevent doctors from causing harm to their patients on account of their own moral and religious beliefs. For example, a Jehovah’s Witness doctor, who believes that blood transfusion is morally wrong, should not be permitted to let a patient die if a blood transfusion could save his life. But allowing a patient to die is a far different thing than refusing to take a patient’s life; and the current policy, while seeking to prevent the former, ultimately seeks to sanction the latter as well.
There are many people in Canada who personally wish to be served by physicians who refuse to take a life under any circumstances, whose dedication to the protection of life prevents them even from assisting people to commit suicide or to terminate unwanted pregnancies. If we are truly to respect the autonomy of all patients, we must leave them the opportunity to seek the service of physicians who will exercise their rights of conscience and refuse to perform procedures which are seen by some to be morally compromising.
I am grateful for the opportunity to give input into the draft policy “Professional Obligations and Human Rights.”
I am very disturbed by the proposed draft policy. Sections 8, 10 and 11 suggest that physicians who decline to participate in certain acts for reasons of conscience should be compelled to refer their patients to other physicians who will perform these acts. Most physicians who are morally opposed to certain acts will also find referral to another doctor who will perform these acts objectional as they will understand themselves to be complicit in the act. In compelling physicians to refer, you are limiting their right to conscientious objection. This is a fundamental right protected by our Canadian Charter of Rights and Freedoms. I cannot believe the CPSO finds this an appropriate solution.
As a patient, I would much prefer to have the freedom to choose my physician based on an understanding of his or her moral and religious beliefs. I want to be able to trust my physician with my life, if need be, and to do this I need to believe in his or her integrity. The proposed changes to the policy will completely undermine this relationship of trust. I do not see why physicians are being asked to conform their moral and religious beliefs to those of their patients (never mind that this is well nigh impossible given the number of patients a doctor is likely to see with varying moral and religious beliefs). Surely, the patient is the one who needs to ensure that their moral and religious beliefs will be well respected by the doctor they have chosen. Otherwise, there is nothing to stop the patient from moving on to another doctor. I find the CPSO’s approach highly patronizing and would suggest a new committee be formed that will be able to uphold the relationship between the doctor and their patient without violating the Canadian Charter of Rights and Freedoms.
I would ask you to revise the sections above, and include a clear defence of the right to freedom of conscience for all physicians.
I strongly reject the proposed mandate in the draft dealing with Physician Assisted Suicide. The referral compels a physician to
to violate his or her own conscious by being a participant in the very act which he or she objects to in the first place.
Response in PDF format.
I agree with some of the positive aspects of draft policy, “Professional Obligations and Human Rights”, for example, that doctors should not discriminate against patients and that patient care is of highest priority. I am, however, very opposed to the draft policy elements that threaten a physician’s fundamental rights to freedom of religion and conscience. This, of course, is in reference to the proposed policy that demands doctors refer, and in some cases perform, procedures such as birth-control, abortion and euthanasia in violation to their moral or religious beliefs. It is very disturbing to think that the OMA and CPSO would even consider this type of discriminatory control tactic. I think the integrity of a physician directly affects the level of patient care they administer and your policy’s coercive mandates would undermine this integrity. Perhaps your policy should focus on the very real threats to public health that already exist.
In the meantime, it should not take too much creativity to allow patients to make personal choices regarding physicians and services without stripping physicians of their fundamental rights to freedom of conscience and religion.
I am writing to you today to voice my concern regarding your new draft policy entitled “Professional Obligations and Human Rights”. As a Canadian citizen who has resided in Ontario his entire life, and who intends to reside in this province for many more years to come, I consider it to be in my best interest to speak out against this draft, as I believe that implementing it could cause many upstanding physicians, especially in the field of family medicine, to leave their practice so as to avoid acting against their consciences.
When discussing a physician’s right to freedom of conscience and religion, this draft policy refers to the Supreme Court’s ruling that these rights can be limited in order to protect such values as the safety, rights and freedoms of others. However, if these rights were to be limited in cases of doctors refusing to prescribe contraceptives or to perform or refer a patient for an abortion for example, I believe that these limitations would not only be unnecessary, but actually harmful to the medical profession in Ontario. These limitations strike me as unnecessary because I do not believe that the widespread access to contraceptives or abortion in Ontario would be significantly threatened in any way by the fact that a small percentage of doctors could refuse to offer these services. Furthermore, I believe these limitations could harm the medical profession for two main reasons: in the first place, forbidding doctors to act according to their consciences in matters such as these is harmful because it would stifle healthy debate and discussion of what is good for the public by deeming this group’s stance – which is also taken in order to uphold the public good – to be invalid and untenable. Secondly, as previously stated, these limitations of physicians’ rights and freedoms could cause many conscientious physicians to leave the practice, thereby damaging not only the profession but the public’s ability to access quality health care in Ontario.
In light of my above-mentioned concerns, I strongly urge the College to retract this draft policy.
I appreciate your consultation on the difficult questions of balancing the rights of doctors and patients in matters of conscience. My hope is that the resulting regulations will provide the highest possible level of protection to doctors to provide treatment in accordance with their ethical beliefs, for the simple reason that I believe any erosion of these freedoms will, in the long run, undermine the integrity of the medical profession in Ontario.
I am very reluctant to ask a doctor, under any circumstances, to do something which violates his or her conscience – even if it is something which does not violate mine. Why? For the simple reason that I do not wish a doctor to become used to doing something he or she considers to be wrong. If a doctor becomes accustomed to violating a deeply held sense of ethics in one case, might it not be easier to violate it in others? If one feels pressured, for example, to violate one’s deepest beliefs about human dignity and purpose, in order to practise medicine, how can this not undermine one’s commitment to common honesty and decency? If I cannot trust my doctor to refuse me if I’m asking him to do something he considers unconscionable, what can I trust him to do — or not to do?
I expect the highest level of professionalism and ethical conduct from my doctor. Even if I am personally comfortable with a treatment or procedure I request, if it violates the ethics of the doctor in question, I really do not want to go there. Do I wish to be treated with respect? Yes, of course. But if a doctor truly believes that what I am asking for is unethical, how can he or she in good conscience even recommend another physician to provide the service?
Often difficulties arise because of the relationship between ethics and religion. However, how can one possibly disentangle the two? If one makes the argument that a doctor should, for example, not consider her own ethical beliefs on a subject such as contraception, abortion or assisted suicide – on the basis that they might be religiously motivated – then why should the same doctor follow the teachings of their religion when it teaches “Thou shalt not steal”? And how does one distinguish between a physician imposing a personal moral belief on patients, and when the doctor is giving a carefully considered medical opinion? After all, there are deeply religious doctors who are very comfortable performing abortions or prescribing birth control, just as there are deeply secular or atheist doctors who have sincere ethical objections. In any case, to ask a doctor to provide a service that he or she believes to be unethical is to ask that doctor to violate the spirit of service that fuels their entire practice of medicine!
As we enter ever more and more into a “brave new world”, with new advances in reproductive technology, the advent of physician assisted dying, and whatever else may lie in our future, I believe we need to do all we can to encourage doctors to listen to their consciences – especially when they are swimming against the current. More than ever, we need a diversity of opinion, and a healthy debate, as we explore what it means to be human in the 21st century. If a doctor has a concern about where we’re heading, even if I don’t share that particular concern – even if I believe my doctor is deeply mistaken – I would rather not silence that voice, or force one to violate the dictates of conscience whom I should trust more than any other to follow them, shall we say, religiously.
Again, my thanks for your hard work on this matter.
Conscience rights are incredibly important, as our conscience is what separates us from other animals. Please respect our health providers’ conscience.
As an aside, I find it fascinating that conscience laws may be revamped, but there’s no regulations on alternative medicine that have no scientific basis
I urge you to remove from from your draft, the mandate for effective referral, so that physicians may
practice medicine with integrity, thus not violating their own conscience.
As a patient, I value my doctor’s honesty and concern for my wellbeing and respect him for acting
with integrity. If for some reason, my doctor refuses to refer me for a procedure which I insist on in
spite of his counsel, it is my own responsibility to seek out the doctor who will cooperate with my request.
Such information is most easily obtained.
A doctor’s duty is to preserve and enhance life, not deliberately end it. I find it reprehensible that you should require that a doctor who in good conscience will not perform abortions or assisted suicides should be forced to provide the patient with an “effective referral”. Since when does the right of the patient, or those pushing this agenda, trump the moral right of a doctor to, in conscience, refrain from taking a direct or indirect role in killing a life. That’s right, “killing a life”. Have you ever seen or heard an elated mother get excited over the “fetus in my womb”? No, No! “Here is an ultrasound of my baby” she announces to the world. And is the life of the sick or elderly any less of a life? You want me (if I were a doctor) to be complicit in taking another’s life? I would refuse, and every doctor that feels the same should refuse. I am sure that those offering these services of abortion and assisted suicide will have more than ample advertisements in the papers, radio,TV, Bill-boards, hospital lobbies, social media etc. that a patient will not require an “effective referral” from his/her doctor. Show some respect to your fellow doctors who do not wish to participate in morally reprehensible behaviour by removing this abomination from your draft and final policy. Or have we become a Nazi State where some doctors are forced to perform what are to them ‘atrocities’?
As I said before, show some respect to your fellow doctors and respect their rights and freedoms. May God bless and guide you in your deliberations.
I wish to express my grave concern regarding the content of your proposed draft policy. I am opposed to the idea that some physicians may feel pressured to participate in certain acts that go against their beliefs. Physicians should not be compelled to compromise their consciences even through referrals to other physicians who are willing to perform these procedures. I strongly believe that in a free society everyone has the right to uphold their moral principles and not be persuaded to abandon their conscience at any level. As a society we must respect the right of individuals to their freedom of conscience especially for physicians who are trusted and committed to helping improve the lives of others. They should not be put in the situation of either giving up their passion to help people or giving up their consciences.
It is important to me to have a doctor whose values reflect my own. In light of the recent Supreme Court decision, I hope the College of Physicians and Surgeons of Ontario will consider the many patients who want care from someone whose whole focus is on providing care, not death. The Supreme Court called for freedom of conscience for physicians. As the head of the CMA said, ” I think it’s fair to say no patient would want a physician to be individually coerced into doing something he or she felt was against his or her personal ethics or religious beliefs.”
Please protect our doctors’ right to freedom of conscience, and their right to practice as they see medically and morally fit. Doctors are individuals as well, and should not be coerced to becoming accomplices for others to do what they believe is unethical or wrong. The patient/customer is not always right. Case in point: A doctor should not have to refer a patient who has a viral illness to another physician for antibiotics, simply because that is what the patient has requested.
Response in PDF format.
Physicians are employed to the field of medicine through their conviction to aid all patients to the best of each of their abilities. We, as patients, benefit greatly from the variety of medical advances
that are a direct result of physicians employing
their gifts and talents to resolve ailments from which we may suffer. These gifts and talents stem from the physician’s conscience and their ability to adhere to their ethical compass rooted within the natural law. The conscience of the physician will not transfuse into adherence to a synthetic law, simply because the physician is told to ignore their personal convictions. One cannot trick oneself. The moral dichotomy forced on a physician to professionally perform or recommend a procedure which is against their own conscience will cause conditions of depression and PTSD in those very individuals whom we enlist to provide healing and wholistic health to our ailing society.
To mandate that physicians must provide and/or provide referrals to medical practices which transgress their own conscience is to liken them to the doctors enlisted by Hitler in Nazi Germany who were mandated to perform inhumane experimental procedures on Jewish and Catholic prisoners within the concentration camps. Hitler never considered he would lose the war, or that he and his army would ever be held accountable for their heinous crimes against humanity.
Are our own physicians to be submitted to the same ruthless subjection, in that they too, are mandated to perform or refer patients for procedures which transgress their own conscience?
Currently, there is no law prohibiting abortion in Canada, and the legalization of Euthanasia may be on its horizon. But to mandate that physicians must provide these procedures or refer patients for them
against their consciences negate the very essence of what constitutes an ethical and moral medical practitioner. Such a physician is not desirable in the least. Patients demand that physicians always have their best interests at the forefront of their care, and this requires a character of conscience.
Response in PDF format.
I am writing as a resident physician to notify you of my concerns as a member of the CPSO with the proposed policy “Professional Obligations and Human Rights”, which would require physicians unwilling to perform a procedure to refer the patient who desires the procedure to a fellow physician who will perform it. For physicians for whom such a procedure goes against their moral and/or religious beliefs, to refer to someone who will perform it is still to participate in the process.
For such physicians, acting on the basis of moral and/or religious beliefs, this policy would not be in keeping with the fundamental freedom of freedom of conscience under the Canadian Charter of Rights and Freedoms, and therefore could be considered discriminatory. It could also be considered to be a discrimination of creed under the Ontario Human Rights Code.
I would respectfully urge that the CPSO consider revising this policy as it relates to conscience.
Every Canadian has the right to exercise their freedom of conscience in their work.
With regards to the practices of euthanasia, sterilization/contraception, assisted suicide and abortion, any regulation policy that coerces medical care providers including doctors and physicians to provide treatments or perform procedures that are contrary to their personal or professional ethics and conscience would be in terrible detriment to the profession and to the Canadian people as a whole.
You would potentially be excluding from medical practice a large segment of the Canadian medical profession if they choose to obey their conscience and lose their jobs. Any regulation or policy regulating medical actions drafted by the CPSO must respect the right of medical practitioners to act according to their ethics and conscience in the performance of their work.
I am a medical school student. While I have never resided in Ontario before, I am personally vested in this policy draft, given that this will impact where I choose to train for residency, and that its implementation will likely influence colleges of other provinces.
I agree that physicians have a duty to provide care that respects patient dignity, ensures access to care, and protect patient safety, as outlined in the new draft policy. However, I have qualms with two parts of the draft policy–first with how the policy argues specifically in regards for limiting religious rights (line 123), and the universal requirement that physicians provide referrals for services they cannot provide without violating their own conscience (line 156).
First, the draft policy argues that if the interference with religious rights is insubstantial or not direct, then religious rights that may cause harm to others would not be protected by the charter. Later, I will discuss my thoughts about whether religious rights in this case would actually harm others, but first I would like to say that the issue here is less to do with religious rights and more to do with moral rights. There is no Bible on morality, and thus it would be difficult for the Supreme court to evaluate whether an interference with moral rights is truly substantial or not. Truth be told, regardless of my religion, I find it morally repugnant to provide the exact details of someone to terminate the life of an unborn child, for example. One might argue that such an objection to referrals is trivial (“You don’t have to perform the abortion!”), and that an infringement of my moral rights in this case is also trivial. I would say to that, that argument asserts that my morality–an unwillingness to actively participate in what I perceive to be murder–as trivial. I do not believe this morality to be trivial. Now, is morality a catch-all term that permits one to act as one wishes? No–I believe it comes down to whether these moral beliefs are reasonable. I think my morality is reasonable. I think a reasonable person would understand that a belief that a human fetus is a human life–that this belief is a very reasonable one (I am not arguing about the truth value of a fetus being a human life; I am merely stating that a belief in such a statement is within the realm of reasonableness). A reasonable person would also agree that actively enabling a wrong would make one complicit in said wrong. And thus a reasonable person would agree that it is reasonable to refuse to refer for an abortion, given that the belief in a fetus as a human life is a very reasonable belief and that referring to terminate what is believed to be human life would make one complicit in this termination. I do not believe such morality to be trivial. I do not subscribe to this belief because of what is written in a religious text, rather, I am convinced of this as a result of a sum of life experiences that influence what I believe to be right or wrong. This is how morality is derived, regardless of religiosity. Not everyone is religious, but eveyrone has morals, and reasonable morals ought to be respected. I believe my morality is reasonable, that my morality is compatible with western notions of a free and democratic society, and that the draft policy would do violence to my morality in a non-trivial way.
However, my previous argument would be complicated if enforcing my rights to morality and conscience would result in denying patients’ access to care. Nevertheless, I believe this contention to be moot, as there can still be proper access to care for patients without enforcing a universal requirement for physician referrals. Similar to the way the courts decided that a universal ban on euthanasia was overly broad and not “minimally impairing,” I believe that a universal requirement for physicians to refer is also overly broad and not minimally impairing. Abortion clinics in BC and Ontario, for example, do not require referrals and are covered by provincial insurance, and so there would be no substantial reason to require physicians to act against their own conscience to provide a service that would be available anyways. The real healthcare access issue here is the pitiful availability of abortion services outside of Ottawa or the GTA, an issue that calls for more health care providers in northern Ontario,, and not requiring healthcare professionals to violate their conscience. Providing more self-referrals and more clinics is the better solution.
Thank you for your time. I understand how difficult this policy was to draft and I appreciate the clarity in its logic and its intent. I also appreciate this opportunity for feedback. I would once again like to emphasize my belief in my morality as a reasonable stance, and that a universal requirement for referrals is overly broad, and that there are alternative methods that would ensure more access to patients while protecting the conscience rights of physicians involved.
I am a retired physician and appreciate the opportunity to provide feedback on the draft policy under consideration. While I did attempt to complete the survey, I found the questionnaire focused much on the clarity and comprehension of the wording, rather than the actual content of the changes proposed.
Firstly I should mention that I endorse the existing Charter of rights of freedom of religion and conscience and urge that this moral stance be retained. I endorse the recognition of human rights for all, patient and physician alike. This, however, should not be interpreted in a one sided manner to favour the patient, rather both patient and physician should have that protection. Physicians should not be compelled to act against their conscience, a compulsion that goes against Charter and human rights and, in itself, a form of discrimination, one that has not been addressed in the definition of ‘Discrimination’ in the Draft Policy.
Refusal to perform certain procedures, based on a rational informed conscience, which is often reinforced by religious beliefs, has nothing to do with the patient requesting a procedure, rather the physician’s decision about the wrongness of the procedure itself. It also follows that ordering physicians to make a referral for a procedure that they consider in conscience to be morally wrong and repugnant, ignores their conscience rights and rests on compulsion. An absence of external compulsion is fundamental to the exercise of conscience and the freedom of the individual, and is an established human right which should always be protected.
I strongly urge the College to continue to recognize the concerns stated above and recognize the same in the reformulated policy.
I am writing to express my opinion and wish that the cpso reject the proposal to include a mandated “effective referral” in it’s policy regarding physicians’ refusal to participate in procedures or treatments which violate their own moral or religious beliefs.
I am opposed to the draft policy whereby the College of Physicians and Surgeons of Ontario would force physicians to make referrals for procedures (e.g. abortion, possible end-of-life issues) that may violate their moral or religious beliefs.
We support the Physician’s Charter of Right of Freedom of Conscience and Religion. Mandating the Catholic doctors who are unwilling to provide certain elements of care – namely abortion, euthanasia – to refer their patients to another health care provider is to violate his or her own conscience and religious beliefs. Their chart of rights must also be respected.
We hereby ask you to protect the freedom and charter of rights of these catholic doctors.
Your proposed draft policy, most notably Sections 8, 10 and 11, represents a serious attack on the principle of the respect for individual conscience rights, a principle which is an essential part of any society which truly values diversity. By insisting that physicians refer patients to other doctors who will provide services which they believe to be deeply immoral it renders the whole concept of respect for conscience nugatory.
The obvious impact is that if this policy prevails not only will many people of faith (and quite a wide variety of faiths) be driven out of the health care field, but others will be prevented from entering. Individuals will be frozen out of careers which ought to legitimately be open to them. As well, health care will be deprived of the services of many who would make an immense contribution to it. Such a drastic policy, with such devastating impacts, requires clear proof that there is an urgent and overwhelming problem which can be dealt with in no other way. Is there any compelling reason to do this? Clearly not – the status quo is working well.
This ill-considered proposal must be rejected. To carry it out would be an abuse of power, deeply destructive of a genuinely liberal and diverse society. Please reject this proposed policy.
Thank you for the opportunity to comment on your proposed revised policy, “Professional Obligations and Human Rights”.
I have three major concerns with the proposal. Firstly, it ignores the constitutional right of physicians to freedom of conscience which cannot be abridged as easily as this presumes to do. As a physician, I can not be made to go against my moral obligation to do what is correct, according to my conscience. The policy therefore is beyond the power of the College. It makes a mockery of professional education, and informed opinion. Ethical practice is inimical to being forced to act against ones conscience.
Secondly, it seeks to imply that referring for an objectionable service is somehow morally different than actually performing it oneself. This is clearly incorrect. I am responsible for all of my decisions, including making a referral for services.
Thirdly, there is an implication that such objectionable services are medically necessary, when in fact they are choices made by individuals when other choices are available. My role as a physician is to educate and advise my patients, not to do whatever they wish to have done.
Frequently patients may request any number of tests or referrals, and frequently after discussion, they become aware of the implications of those choices, and are enabled to make better health care decisions.
I am saddened by the College’s repeated attempts to bring in this ill-advised and inappropriate policy which tramples on physicians rights. It is the role of the courts and the human rights commissions to decide on these cases, not the CPSO.
I have been practicing medicine for more than a decade as a family doctor with a special interest in emergency medicine. During the interview process for residency, I divulged my philosophical opposition to abortion. This admission was met with almost universal acceptance. The family medicine staff did not share my philosophy about abortion, but nevertheless, fully accepted and encouraged me to practice medicine according to my conscience.
When during my residency, I became increasingly drawn to medically based, effective alternatives to contraception, they also supported me. Eventually, I sought additional training in the Billings Ovulation method of natural family planning and stopped prescribing contraception.
After several years of providing locum family medicine coverage, I began practicing mostly emergency medicine. My colleagues have also always supported my decision to practice according to my conscience, specifically the fact I do not refer for abortion or prescribe contraception. They know I am a competent and compassionate physician even if they do not share my philosophy.
For the past decade, we have been able to work together to accommodate the different philosophies of the physicians and patients in our community. We consider these differences a strength and not an obstacle to excellent health care.
To dictate that all physicians must refer for abortion and prescribe contraception is an affront to the autonomous medical profession and fails to appreciate the diversity of philosophies which enrich our Canadian culture. Let the dialogue between patients and physicians and among physicians continue about issues of conscience. We can work together to appreciate our diversity. We do not need to adopt an exclusive, rigid policy about these important reproductive health issues.
Response in PDF format.
Thank you for being open to consultation with the public on this matter.
In doing so, the College obviously accepts existing Charter of Rights of freedom, of religion
and conscience and therefore I urge you to maintain that moral stance.
I would like to emphasize that moral stances based on conscience are rational and evidence-based, often reinforced by religious beliefs and therefore deserve protection.
Freedom of religion and conscience rights are included in other documents and therefore
Canadian documents should reflect these values.
(Cf., Canadian Charter; the United Nations’ Universal Declaration of Human Rights, Article 1 states:
“All human beings are born free and equal in dignity and rights. They are endowed with reason and conscience and should act towards one another in a spirit of brotherhood”.
Thus, there should always be a balancing of rights, and I request that both patient and physician rights be respected; accommodation should not be only one way.
A physician should never be compelled to act against rational conscience decisions, nor should he/she be required to be an accomplice in achieving what goes against their conscience as such compulsion goes against the Charter and human rights.
Therefore, by refusing to provide or perform some procedures is not discriminatory when it is based on a properly informed conscience: this has nothing to do with the patient, requesting a procedure, and everything to do with the physician’s decision about the wrongness of the procedure in question.
In conclusion, I would strongly hope that when you are making changes to your original policy,
you would seriously consider the reflections I have put forward,
I am very concerned with the contents of your draft policy which will force physicians who do not chose to participate in certain acts (like euthanasia or abortion for example) for reasons of conscience to refer their patients to other doctors to perform these acts. This still makes them complicit in the act in their minds and is unacceptable to their human rights. They should have the right to conscientious objection and I oppose the policy you are proposing that takes away that right.
I do not expect you to define or limit morality but I do expect that physicians be allowed to respect their own consciences. This is foundational to the function of our society.
If we coerce physicians into violating their consciences we will inevitably erode the personal integrity which is the basis of the physician’s relationship with their patients. I encourage you to revise the sections above, and include a clear defence of the right to freedom of conscience for all physicians.
If this policy proceeds it will change the type of people who choose medicine as a career and that will change the profession entirely and in the wrong direction for the good of the people.
Please reconsider this policy.
I am writing with deep concern over some of the points contained in the draft policy “Professional Obligations and Human Rights”.
On lines 156-160, a physician will be required to refer for procedures which are against his/her belief system. This is an excellent way to destroy the physician’s integrity and is an infringement on a physician’s freedom of conscience which is guaranteed by the Canadian Charter of Rights and Freedoms. I believe that this policy is heavy handed and an abuse of the CPSO’s position of power. I believe it is sufficient for a physician to provide the necessary accurate information in a respectful manner with full disclosure and allow the patient to go elsewhere for what they seek, as is currently the standard of care. As a physician in practice for almost 25 years, I am very distressed to see the misapplication of this policy as it relates to the Ontario Human Rights Code.
To make matters worse, Line 168 states that in “urgent” cases, a physician is obligated to provide the requested care or procedure…this is open to misuse and various interpretations. If a procedure or course of action is deemed ethically unacceptable, then the context does not change the nature of the action. I can understand the concerns behind this policy and I applaud the CPSO for the progress made but theses concepts need to be revisited in order to avoid doing damage to the profession. The Canadian Medical Association has long been a defender of a physician’s freedom to abstain from being involved in morally objectionable procedures. This draft policy flies in the face of this view and has me deeply troubled.
Ultimately, this policy could be used to coerce physicians to be involved in procedures against their conscience and will harm the fabric of medicine and will result in the limitation of patient’s choices. The dignity of patients as well as their safety can still be protected in other less restrictive ways and access to care can still be available without these further proposed measures.
Thank you for the opportunity to provide feedback on this important draft policy.
Like many of my colleagues, I have significant concerns regarding the recent legal rulings which allow a physician to assist in the death of a patient who consents to death.
I am deeply concerned that this sends a message that life is not always important, especially if that life causes suffering to an individual and/or to society. It sends the message that an acceptable solution to prevent such suffering is to inflict death. I disagree with this message.
I also disagree that physicians should have the authority to decide whether a life is filled with enough suffering that it can be willfully ended.
I would ask that the CPSO establish policies that allow physicians to opt out of participation in activities and procedures that go against their conscience, especially when it concerns acts that would result in ending a person’s life. Physicians should not be required to refer for or participate in such acts.
In medical school and residency, physicians are taught to practice ethically and with integrity. One cannot practice with integrity and also participate in acts that violate one’s conscience.
I read with alarm the proposal of the O.C.P.S. working group to impose a decree on practicing physicians in the Province of Ontario. This decree would force them to perform procedures or be complicit in procedures through referral, which would be contrary to their personal conscience.
Such a regulation will deny physicians freedom of conscience, a conscience that for each is developed over a lifetime. I would suggest that conscience forms an integral part of a human being and cannot be altered for a specific occasion. It defines the integrity of the person.
Many physicians will be unable to comply with such a decree. They would be forced out of the noble profession of medicine. Additionally, future and worthy candidates for the study of medicine will be lost.
Communities throughout Ontario will be deprived of many excellent and competent physicians. These individuals will be forced out of practice in order to preserve the integrity of their conscience.
It is my hope that the Policy Working Group will not propose that physicians be forced to perform or refer patients for abortions to terminate developing human life, or other procedures contrary to their conscience. I believe this to be an attack on a particular physician’s human rights.
To deny the freedom of a physician, or any person, to abide by their informed conscience in very serious and professional actions regarding life issues is, at best, irresponsible.
Issues mentioned in the C.P.S.O. Policy Working Group are contrary to the freedom of conscience of Ontario Physicians and I strongly object to such a regulation being imposed.
I suggest there currently exists objection to the Policy Working Group from a wide representation of society and not merely from specific religious groups as has been mentioned.
Please register my emphatic objection to the proposed regulatory change by the Policy Working Group of the Professional Obligations and Human Rights Committee of the O.C.P.S.
To remove freedom of conscience from Ontario’s Physicians is a denial of their human rights. It is fearful to consider our society heading down that path.
As a healthcare worker and member of a fellow professional regulatory college, I am writing to you with grave concern regarding the content of your proposed draft policy, which indicates that physicians who decline to participate in certain acts for reasons of conscience should be compelled to refer their patients to other physicians who will perform these acts. It does not address the fact that many of these same physicians will find the act of referral itself objectionable, as they consider it material cooperation with the act. In compelling physicians to refer, you are limiting their
right to conscientious objection. I am opposed to this.
There is significant disagreement in our society as to what constitutes a moral act, and I do not expect the College to define or limit morality. All I expect is that physicians, as professionals, be allowed to respect their own consciences. Freedom of conscience is foundational to our free society and cannot be limited, even for the best of intentions.
If we coerce physicians into violating their consciences we will inevitably erode the personal integrity which is the basis of the physician’s relationship with their patients. I encourage you to revise the sections above, and include a clear defence of the right to freedom of conscience for all physicians.
I am writing to support conscience rights for doctors. The proposed policy of the Ontario College of Physicians and Surgeons would mandate referral for treatments that many doctors believe are bad medicine.
My own family doctor’s moral stance against abortion, assisted suicide or sterilisation is, I know, not merely a personal belief; rather she has reached this position through scientific knowledge, medical experience and philosophical reasoning. She is convinced as a professional that some medical procedures are not good for her patients, and she will not practice them nor counsel her patients to seek other doctors who would be willing so to practice. She rightly fears that should the proposed policy be enforced, she would have to give up medical practice entirely. And that would be an enormous loss for our small community.
Such doctors should be protected from any and all compulsion to act against their consciences. These consciences were formed in the crucible of family practice and deserve respect. I for one am grateful to have found such a doctor !
I would like to state that I reject the proposed “effective referral” mandate in the draft dealing with physician-assisted suicide. This “effective referral” compels a physician to violate his or her own conscience by being a participant in the very act, the very procedure, which he or she objects to in the first place.
Freedom of conscience and religion are guaranteed by the constitution and must be respected and upheld.
I am a person of faith and I have served as a voluntary spiritual care chaplain.
I have read the draft policy document entitled Professional Obligations and Human Rights issued by the College of Physicians and Surgeons of Ontario. I have also seen in today’s Ottawa Citizen the statement of Rabbi Reuven Bulka, Imam Samy Metwally and Archbishop Terrence Prendergast that they “do not question the right of individuals to medical interventions for which they are entitled by law. That is their right. But to force a physician, as this draft policy would, to be party to such interventions which the physician objects to on moral or religious grounds is to deny the physician his/her basic right”.
I write to express my support for the views expressed by the leaders of the three faiths in Canada.
I am not in agreement with the recent Supreme Court decision to legalize euthanasia in Canada. I also support the freedom of conscience for all doctors in this matter as well, who do not agree with euthanasia.
Thanks!
I am very thankful that we still have doctors in this country with strong consciences, begging us to defend them. In a country where we are crying for more doctors, where the wait-lists for patients without doctors is years-long in some communities, imagine forcing good doctors to choose between their consciences and their practices? If we lose even one doctor over this ridiculous issue, it will be too many. Thousands more patients with a multitude of health needs will be without a doctor, simply because the doctor would not cooperate with a handful of meds or procedures that he/she believes is wrong. Leave doctors to follow their own consciences.
am not in agreement with the recent Supreme Court decision to legalize euthanasia in Canada. I also support the freedom of conscience for all doctors in this mater as well, who do not agree with euthanasia.
I am a Palliative Care physician and I am writing regarding the CPSO Draft Policy, “Professional Obligations and Human Rights.” I have reviewed this policy and a number of the comments in the discussion forum. I thank you for the opportunity to comment on this policy.
While I respect that this policy has been created with the intention of respecting the rights of patients and acting in their best interests, I would like to echo the concern of a number of other physicians and members of the public regarding the requirement to refer for services that one does not provide for moral or religious reasons.
As a Palliative Care physician, I am specifically concerned about this in the context of the recent Supreme Court ruling regarding medical aid in dying. Like the majority of Palliative Care physicians (Canadian Society of Palliative Care Physicians Position on Euthanasia and Physician Assisted Suicide, February 2015, http://www.cspcp.ca/wp-content/uploads/2014/10/CSPCP-Position-on-Euthanasia-and-Assisted-Suicide-Feb-6-2015.pdf), I am opposed to euthanasia and assisted suicide and do not believe that they should be part of Palliative Care. I would not be comfortable referring a patient for either of these services because I would still feel that I was assisting in the active termination of a patient’s life. It is my understanding that under the current ban on euthanasia and assisted suicide, referrals for these practices (for example to the assisted suicide program in Switzerland, which takes international referrals) can result in criminal conviction. (This is my understanding based on having attended educational activities dealing with how to respond to requests for hastened death- if I have misunderstood any part of this then I apologize.) Therefore, I don’t think it should come as any surprise that objection to euthanasia and assisted suicide and objection to referral for euthanasia or assisted suicide would go together. I can only imagine that carrying out an act which violates one’s moral core would result in long term moral distress and a breach to personal integrity which would be personally and professionally damaging. Asking physicians to choose between this option, violating CPSO policy, and leaving or drastically modifying their practice in order to avoid requests for services to which they object, is unreasonable. I believe it will engender fear and distress amongst physicians who are put in this difficult position, and will hamper their ability to have honest and trusting relationships with patients. As others have mentioned, another potential outcome is the diminishment of diversity in physician beliefs and perspectives, making physicians as a group less representative of the patients whom they serve. I do not think that any of this is good for patient care.
I agree with the comments of others who suggest finding ways in which patients can self-refer for services that providers may not provide for moral or religious reasons. I realize that this may sometimes be easier said than done, but I think that taking measures to provide access to controversial services while minimizing the risk that physicians will be asked to compromise their personal integrity is a better reflection of respecting the rights of both parties.
I also would like to address lines 168-169 which deal with “care that is urgent or otherwise necessary to prevent imminent harm, suffering and/or deterioration.” I agree with the comments of others that this wording is too vague. I am concerned that it could be interpreted to apply to a large number of patients who are requesting euthanasia or assisted suicide because suffering and deterioration, which may well be “imminent” or already in progress, are generally the reasons for these requests. This interpretation could, at least in theory, create an implication that physicians are required to actually provide euthanasia or assisted suicide in many cases where these services are being requested. I implore you to ensure that this does not occur.
I would like to note that although I have been commenting on this policy as it might relate to the legalization of euthanasia and/or physician assisted suicide, I do believe the ramifications of ignoring one’s conscience that I discussed above would apply to physicians who are asked to refer for other services to which they morally object. I have been addressing an issue which is relevant to my practice but I recognize that this policy similarly affects other physicians around a range of issues.
In Palliative Care, as in other areas of medicine, we strive to care for the whole patient. We deal with intense, complex, and emotionally draining situations on a daily basis. Certainly these types of circumstances are encountered by all physicians at some point, and by many as a matter of routine. Caring for patients in these challenging scenarios with the necessary degree of attentiveness and compassion and without burning out requires physicians to adequately attend to their own bio-psycho-social-spiritual needs. This is hardly possible in a professional environment that poses a threat to personal morality, a basic part of an intact identity.
I do not feel that this policy represents an appropriate balance of patient and physician rights. I urge you to reconsider what is really being asked of physicians, and I hope that this policy does not go through in its current form.
I am writing to you with grave concern regarding the content of your proposed draft policy, which indicates that physicians who decline to participate in certain acts for reasons of conscience should be compelled to refer their patients to other physicians who will perform these acts. It does not address the fact that many of these same physicians will find the act of referral itself objectionable, as they consider it material cooperation with the act.
Physicians moral stances, based on rational conscience decisions, deserve protection. Compelling physicians to act against conscience decisions violates the Canadian Charter of Rights and Freedom.
A physician’s refusal to provide or perform some procedures does not constitute discrimination when this decision is based on a properly informed conscience. This decision is not based on the characteristics of the patient requesting the service, but on the nature of the procedure requested.
I encourage you to revise the sections above, and include a clear defence of the right to freedom of conscience for all physicians.
Forcing physicians to refer patients to other health-care providers for procedures that they are unwilling to provide due to moral or religious beliefs is discriminatory. Physicians must be permitted to refuse to provide services that conflict with their consciences. This must include both the objectionable procedures and the referrals to other health-care providers for said procedures. Freedom of conscience is a cornerstone of our free society.
Furthermore, there is a clear danger of confusion between moral, religious and scientific/clinical objections. For example, abortion may be objected to on religious, moral, or scientific/clinical grounds. If religious beliefs are a private matter, morals are perhaps less private, and scientific opinions are and ought to be public. If a doctor refuses to perform abortions, not for religious reasons, but for scientifically informed moral reasons, is he not allowed to explain that life begins at conception when a unique DNA signature is created, and that, as a doctor, his job is to protect human life wherever possible? Religion need not enter the discussion at all. But it is the physician’s responsibility to inform the patient of these concerns. Forbidding him to do so is a violations of the patient’s right to that information and a violation of the physician’s freedom of conscience.
Requiring physicians to make referrals upon announcing their objections to procedures is equivalent forcing them to be complicit in the procedures, qualitatively not different from forcing them to perform those procedures, but merely once removed.
In a free society we must not limit freedom of conscience. If we do that, our society is no longer free. I strongly object to the content of your proposed draft policy, and request that it be amended to facilitate full freedom of conscience to physicians.
Please consider these points when revising the policy Professional Obligations and Human Rights.
It is hard to see how limiting physicians Rights to Freedom of Conscience and Religion guaranteed in the Charter will result in less discrimination or better patient care. I want to be treated by a doctor of integrity, who acts according to their conscience and won’t undertake interventions I believe to be seriously ethically wrong, such as taking a life. Requiring referrals is the same as doing it one’s self. Requiring referrals or requiring the doctor to participate in procedures that go against their beliefs may eliminate them from practice. I want access to doctors of integrity. How might my rights in this regard be respected? Requiring referrals or requiring the doctor to participate in procedures that go against their beliefs may reduce their personal sense of integrity, if they remain in practice. Interior dissonance between deeply held beliefs and professional requirements can lead to burnout. This is systemic discrimination based on conscience. It will impact patient care. Forcing physicians to act against their conscience, to do something they believe is deeply wrong against their will, not only harms them. This coercive violation of their freedom of conscience also harms society and the values that inform its culture. The requirement for referrals may actually slow down patient access to services. For instance in Ontario, patients may self-refer for abortion. I am looking for a doctor of integrity and who believes in “First do not harm”. I count on and trust that my physician follows their oath, to do no harm. There are many creative ways to maintain conscience rights and allow patients to access these controversial services. Surely a tolerant country like Canada can come up with a way to make this work.
I agree that the potions should be made available and patients who want alternative care can seek it from other physicians
I am writing to you with grave concern regarding the content of your proposed draft policy. Sections 8, 10 and 11 suggest that physicians who decline to participate in certain acts for reasons of conscience should be compelled to refer their patients to other physicians who will perform these acts. It does not address the fact that many of these same physicians will find the act of referral itself objectionable, as they consider it material cooperation with the act. In compelling physicians to refer, you are limiting their right to conscientious objection.
There is significant disagreement in our society as to what constitutes a moral act, and I do not expect the College to define or limit morality. All I expect is that physicians, as professionals, be allowed to respect their own consciences. Freedom of conscience is foundational to our free society and cannot be limited, even for the best of intentions. If we coerce physicians into violating their consciences we will inevitably erode the personal integrity which is the basis of the physician’s relationship with their patients.
I encourage you to revise the sections above, and include a clear defence of the right to freedom of conscience for all physicians.
[**MESSAGE FROM ADMINISTRATOR: DURING THE CONSULTATION PERIOD, WE RECEIVED 91 RESPONSES FROM INDIVIDUAL RESPONDENTS CONTAINING THE CONTENT PUBLISHED ABOVE. ALTHOUGH THIS FEEDBACK HAS NOT BEEN PUBLISHED IN DUPLICATE, THE COLLEGE ACKNOWLEDGES RECEIPT OF THESE SUBMISSIONS.**]
I cannot imagine having a doctor who would work against his/her moral principles and beliefs, nor can I imagine a professional body, meant to protect and guide physicians advocating that forcing a doctor to refer his/her patient to another doctor to do what he/she finds morally reprehensible is not similar to “hiring someone to kill” for you!
Please listen to the people, and to the religious leaders in our country.
As a member of the public accessing the care of physicians, it is important to me that physicians act in accordance with their conscience and not be required to provide referrals for services or treatments that are contrary to their conscience.
I am writing to express my concern and to request that the policy be revised to respect the rights of physicians and to remove the proposed mandate for “effective referral”.
[**MESSAGE FROM ADMINISTRATOR: DURING THE CONSULTATION PERIOD, WE RECEIVED 21 RESPONSES FROM INDIVIDUAL RESPONDENTS CONTAINING THE CONTENT PUBLISHED ABOVE. ALTHOUGH THIS FEEDBACK HAS NOT BEEN PUBLISHED IN DUPLICATE, THE COLLEGE ACKNOWLEDGES RECEIPT OF THESE SUBMISSIONS.**]
I vehemently oppose to your proposed draft policy on Assisted Suicide and Euthanasia.
I strongly object to the provision in your draft policy that all Doctors (and nurses) will have to provide services that violate their most deeply held moral convictions.
Killing vulnerable people (the unborn, the infirm, the elderly) instead of caring for them is not something that society embraces and should definitely not be a part of any policy today.
Please consider this change to your proposed policy.
As a member of the public accessing the care of physicians, it is important to me that physicians act in accordance with their conscience and not be required to provide referrals for services or treatments that are contrary to their conscience. This is part of my criteria for choosing a doctor and, although my doctor and I do not always have to agree, we do need to respect each other, and I need to know that they are always acting to protect my well-being.
I am writing to express my concern and to request that the policy be revised to respect the rights of physicians and to remove the proposed mandate for “effective referral”.
Response in PDF format.
Response in PDF format.
Thank you for giving us the opportunity to give you our feedback concerning the Professional Obligations and Human Rights draft policy.
I STRONGLY OPPOSE the draft of the Professional Obligations and Human Rights policy for the reasons outlined below:
1) The policy as drafted is not in the best interest of the citizens of Ontario. I appreciate having a Christian doctor who has the same worldview, values, and beliefs as I do, based on the Holy Bible. I can rest assured that when I face a health care decision, he will give me advice that is in accordance with the Bible and therefore with my worldview, values, and beliefs. If my doctor would be required to refer patients for ‘procedures’ that he is opposed to on moral and religious grounds, he could no longer conscientiously practice medicine in Ontario. I would lose my doctor and would no longer be able to receive medical advice in line with my values and therefore not receive advice that is in my best interest.
2) Ontario’s government appears to be attempting to convert everybody to secular humanism. In an attempt to give everyone equal rights in regards to access to ‘medical care’, they are taking away the rights of physicians who hold to moral and conscientious standards that are not necessarily in line with the government’s standards. Do doctors have no ‘human rights’?
3) Canada is a free country. When a doctor is unwilling to refer a patient for certain types of ‘medical care’, it is often because of the doctor’s own moral or religious beliefs. By pushing doctors to provide ‘care’ that goes against their beliefs, their freedom of conscience and religion is being taken away, something that is outlined in Canada’s Charter of Rights and Freedoms.
I strongly recommend that this policy be revised so that physicians are able to practice with the patient’s best interest in mind and according to their own religious and conscientious beliefs.
I am writing to express my deep concern over the proposed “effective referral” mandate.
First, I would like to state that I could not successfully navigate my way through the CPSO’s online survey. I found it beyond my comprehension and I wonder if the majority of Ontarians would find it similarly difficult, causing me to question how reflective of general public opinion the results might be. I read the policy, then started the survey and found the questions confusing, limiting and leading.
My concerns with this proposed “effective referral” mandate, and any policy which turns doctors into killers instead of caregivers, are multiple. The most fundamental concern is the violation of a physician’s Charter right to freedom of conscience and religion.
We are dealing with serious, life-threatening issues which, until recently, have been legislated as criminal offences. Until recently,doctors could have been charged with abetting a criminal offence. A change in legislation does not thereby make an action right or justified. To compel a physician to refer a patient to another healthcare provider who will provide a “certain element of care” is to compel that physician to violate his or her conscience and beliefs, to become an abettor. Are we so unenlightened as to stoop to tyranny?
I have many fears concerning my future care, as a patient with serious depression who experiences suicidal thinking. I am not able to express my personal concerns well under these circumstances. However, I urge you to protect physicians’ conscience rights. This protection will ultimately protect my life from undue influence to end it, at times when I am most vulnerable.
I wish to oppose this policy. I cannot accept the use of the key ethical notion of conscience that this policy presupposes. It is here invoked in a pejorative sense that dismisses the importance of the physician being true to the convictions that guide his or her practice and to absent himself or herself from cooperation in courses of action that he or she nudges to be unethical. Conscience acts in this manner, and by it one accuses or excuses oneself.
As Dr. Rabelais said during similar discussions during the Renaissance, “Science without conscience is the ruin of humans (translation from French).
I strongly support the “Physicians’ Charter Right of Freedom of Conscience and Religion” in regard to the proposed Assisted Suicide draft law.
It is contradictory to ask a physician who objects to assisting in someone’s suicide to suggest another physician who will assist. By doing so, he is again complicit in the “assisted suicide.”
May I suggest that the law be so written as to excuse the the physician who objects and not ask him to suggest another doctor. Perhaps there should be a list of physicians who will participate in assisting a suffering person and/or a list of physicians who will not.
This controversy has arisen because some physicians insist on “hooking” up people who are terminally ill to all kinds of machines. Were the patients left to die with dignity without an all the tubes that are put in them to sustain life, perhaps we would not have needed an “Assisted Suicide” law. Of course, I realize that in some cases it may be necessary to intervene; however, one cannot take one person’s right to die and deny another person’s right to object to the procedure.
stop this nonsense please
I would like to write about the proposed allowing of Assisted Suicide. I will not call it “helping someone die” as that is not what this will end up being.
We had a lovely Doctor come to speak to our women’s group about this topic. Its one thing to allow this but he said the College of Physicians and Surgeons of Ontario will be forcing Doctors who do not believe in this for either moral or religious reason to be threaten with discipline for refusing to do this dreadful act or even referring them to someone else who will .
Even my Veterinarians can not be forced to kill or put down or euthanasia an animals against their beliefs. This is why many of us work for hard for NO KILL shelters for animals.
I have read that in some countries who started out saying no one would be force to be put to death are finding 25% increase in person who are having this done who didn’t want it. One article was a wife who’s husband needed treatment and they put him down instead..she was devastated.
Also its one thing to tell an ASL person okay you can decided to end your life if you want to … but to let someone who is depressed and feels life is not worth living decide to be put to sleep like a pet dog or cat is barbaric. What happened to offering help instead.
I have suffered from depression my whole life and even taken myself to a hospital once to ask for help as I was scare I was going to end it. Would they have offered to help me end my “mental” pain????? as this new law has been saying or offered me help?
I also thought that suicide was against the law? Are we now just not going to bother helping someone who has suicidal thoughts and say “Oh well their mental pain is to much to bear..so be it…bye bye and so long”.
What will happen to be one day in an old age home? I have no children, thus no one to speak for me to say NO.she wants to die naturally. What if they, the board of directors of the home, decide I am taking up too much time and room and resources decided that they are “pretty sure” I wanted to be put down?????
It reminds me too much of what the Nazi did to the Mentally challenged, handicapped or homosexuals during the war. They were considered “defective” and killed!
There are lots of us who do not believe in “putting people” to sleep or death…which is the real words…we are “assisting” in killing a human bean, not helping them.
Fine take committing suicide out of the law books as wrong and illegal but don’t make other people do it for you especially someone who takes a vow to “do no harm”!
College of Physicians and Surgeons of Saskatchewan
This draft policy covers nicely the issues. The distinction set out in the first paragraph between what is legal and what is the College’s professional and ethical obligations is useful. The explanation pertaining to a physicians who choose to limit the health services they provide on moral/religious grounds is excellent. I like the further detail provided under respects patients dignity; ensures access to care and protects patient safety. Physicians should find this guidance helpful.
Response in PDF format.
I am writing to you with grave concern regarding the content of your proposed draft policy. Sections 8, 10 and 11 suggest that physicians who decline to participate in certain acts for reasons of conscience should be compelled to refer their patients to other physicians who will perform these acts. It does not address the fact that many of these same physicians will find the act of referral itself objectionable, as they consider it material cooperation with the act. In compelling physicians to refer, you are limiting their right to conscientious objection.
There is significant disagreement in our society as to what constitutes a moral act, and I do not expect the College to define or limit morality. All I expect is that physicians, as professionals, be allowed to respect their own consciences. Freedom of consciences. Freedom of conscience is foundational to our free society and cannot be limited, even for the best of intentions. If we coerce physicians into violating their consciences we will inevitably erode the personal integrity which is the basis of the physician’s relationship with their patients.
I encourage you to revise the sections above, and include a clear defence of the right to freedom of conscience for all physicians.
1. Being an accessory to an action is as engaged as the one omitting the action.
2. Authentic human freedom is quite different than formalistic human freedom.
3. Formalizing another’s behaviour is a violation of their liberty. When it is done as against another’s conscience it is not just.
4. Is it not a contradictory paradox that one may help the life, liberty and security of another by helping them to commit suicide either by direct action or referral.
5. Consider choice which is always free. One would choose to escape prolonged pain. Shouldn’t one choose what is choice-worthy? G.K. Chesterton says: “our being is to be filled not just with ourselves but with what is good beyond ourselves. The only finite person who fills his being only with his own good is the devil”.
6. Human Life is sacro-sanet. To allow ourselves to be apathetic about things true, good and beautiful is to lock ourselves up in ourselves.
I write you to say I disagree with the College of Physicians & Surgeons of Ontario mandate of mandatory effective referral for prescribing the Oral Contraceptive Pill.
Ontario Doctors should not be compelled to prescribe this carcinogen and this would be a violation of their conscience rights.
The Physicians and the Ontario Human Rights Code policy is currently under review and you have publicly sought out consultation and feedback. I am writing this to provide my opinion. I have reviewed the draft and have some serious concerns.
As is available on your website “The draft policy sets out physicians’ existing legal obligations under the Ontario Human Rights Code (the “Code”), and the College’s expectation that physicians will respect the fundamental rights of those who seek their medical services.”
In any clinical encounter there are at least two people making choices, each hoping to follow their conscience. Reconciling patients’ rights with doctors’ is at the core of the matter.
The recent decision of the Supreme Court pointed out that “a physician’s decision to participate in assisted dying is a matter of conscience”. On it, they referred to the 1988 Morgentaler’s decision that a physician could not be compelled to participate in abortion. In Ontario, as you know, any patient can access abortion by self-referral.
In my opinion, the burden is on the CPSO to substantiate that one is not able to ensure access to this practice without encroaching on the Charter rights of doctors.
Likewise, this approach should apply to anything else including assisted suicide. In this area, some have suggested that a potential solution is for the CPSO to create a “willing-physician’s referral service” that would direct inquiries from Ontario patients to those doctors who are prepared to provide assisted suicide. Additionally, the CPSO draft policy suggestion that doctors participate in doing the act in case there is no referral available should be definitely clarified (lines 166-169 of the draft policy).
A further point is to clarify that there is no jurisdiction where assisted suicide or euthanasia is current practiced demands referral (1,2). We need to take this seriously: it is our conscience that guides us in every day and no one should be forced to violate it. Its bad medicine to try to coerce physicians to do what they think is wrong for their patients. To have our professional college, which is supposed to be a group of our peers as a self regulatory body, encourage their individual members to engage in what they perceive to be unethical behaviour is hard to comprehend.
In my opinion, if this draft policy passes as it is, thousands of physicians will join together and initiate a legal challenge supported (financially and morally) by all the major religions and people of good conscience, as an Ottawa joint declaration suggests (3).
Thank you for taking to time to consider my feedback.
References
1. No legal “duty to refer” for euthanasia or assisted suicide anywhere in the world http://www.mauricevellacott.ca/2003%20MV%20Speaks/Jan.%208,%202015%20-%20MV%20Release%20-%20No%20legal%20'duty%20to%20refer'%20for%20euthanasia%20or%20assisted%20suicide%20anywhere%20in%20the%20world.pdf
2. Backgrounder Euthanasia/Assisted Suicide and “Duty to Refer”: What are the legal obligations around the world?
http://www.mauricevellacott.ca/2003%20MV%20Speaks/Jan.%208,%202015%20-%20MV%20Release%20-%20No%20legal%20'duty%20to%20refer'%20for%20euthanasia%20or%20assisted%20suicide%20anywhere%20in%20the%20world%20-%20Backgrounder.pdf
3. http://ottawacitizen.com/news/national/doctors-duty-consciences
Response in PDF format.
As a member of the public accessing the care of physicians, as well as a Registered Nurse practicing and living in Ontario, it is important to me that physicians act in accordance with their conscience and not be required to provide referrals for services or treatments that are contrary to their conscience.
I am writing to express my concern and to request that the policy be revised to respect the rights of physicians and to remove the proposed mandate for “effective referral”.
Thank-you for considering submissions from the public regarding your draft Professional Obligations and Human Rights document.
Having reviewed said document, I see it as an attempt by the College to ensure that its doctors will be practising medicine within the confines of the Ontario Human Rights Code. In my review I am thinking specifically of the issues of euthanasia and ‘assisted suicide’.
While I understand that the College may wish to form their policy with a view to avoiding any legal challenges, what I do not understand is your failure to take a stand that would protect your doctors, should they wish to refrain from either participating in or referring for assisted suicide on moral or religious grounds. Doctors are in business to heal people, not to kill them. Doctors at their Canadian Medical Association conference last August voted overwhelmingly to reject assisted suicide.
When anyone acts against their own conscience, it causes conflict within themselves, leading to high levels of stress and burnout. The more important the issue, the higher the stress level, and this one is literally life and death. Doctors are under enough stress now, without adding this burden onto them. Doctors must not be forced to participate in, or refer patients elsewhere for, assisted suicide.
The College of Physicians and Surgeons ought to be standing up for their doctors, not going against their wishes.
I am writing to you today to urge you to maintain conscience clauses in your membership policies that ensure doctors are not compelled to perform procedures such as abortion and assisted suicide.
As a member of the public, accessing the care of physicians, it is important that the physicians act in accordance with their conscience and not be required to provide referrals for services or treatments that are contrary to their conscience.
I am writing to express my concern and to request that the policy be revised to respect the rights of physicians and to remove the proposed mandate for “effective referral”.
[**MESSAGE FROM ADMINISTRATOR: DURING THE CONSULTATION PERIOD, WE RECEIVED 6 RESPONSES FROM INDIVIDUAL RESPONDENTS CONTAINING THE CONTENT PUBLISHED ABOVE. ALTHOUGH THIS FEEDBACK HAS NOT BEEN PUBLISHED IN DUPLICATE, THE COLLEGE ACKNOWLEDGES RECEIPT OF THESE SUBMISSIONS.**]
I object, in the strongest terms, to the “effective referral” proposal of the CPSO that would force Ontario physicians, in cases where they are unwilling to provide certain elements of care due to their religious beliefs, to refer patients to other physicians who would provide care which they found objectionable.
In my opinion this would be a violation of a physician’s rights since it would compel he or she to be an accessory to a procedure or act, which they found objectionable in the first place.
Such a requirement is also, in our opinion, a violation, in principle, of the Ontario Human Rights Code and the Canadian Charter of Rights and Freedoms.
Don’t do this
I am writing because I find the section on Ensuring Access to Care (Lines 150 to 164) of your “Draft Policy on Professional Obligations and Human Rights” very disturbing. The requirement that physicians must provide an effective referral if they are unwilling to provide certain elements of “care” out of moral or religious beliefs clearly takes away their Charter-protected right to freedom of conscience and religion.
Doctors who firmly believe that certain actions (e.g., doctor assisted suicide) violate the Hippocratic oath by which they are bound, should not be forced to provide a referral for such actions because in doing so, they are in fact participating in the very act to which they object.
Freedom of conscience is foundational to our free society. If we coerce physicians into violating their consciences, Ontario will potentially lose some of its best doctors and undoubtedly many of our brightest and most compassionate young people will find it necessary to re-think their career options.
I encourage you to revise the section on Ensuring Access to Care, and include a clear defence of the right to freedom of conscience for all physicians.
I am very concerned about aspects of the CPSO draft policy on Professional Obligations and Human Rights.
It is paramount that not only patient rights but also physician’s moral/religious rights are equally addressed in the policy especially since there is no hierarchy of rights in the Canadian Human rights code. As long as patients are informed of the physician position, in a respectful and non judgemental fashion, the physician should not be compelled to refer the patient as this act itself would be a complicit participation in the morally objectionable treatment. The patient can be generally instructed as to where they may seek alternate treatment without the need for a formal referral to a colleague to initiate treatment that would be morally objectionable to the physician. The only exception to this would be in emergency situations where life or limb were at risk. Most requests that fall under this area of concern, such as therapeutic abortion, or possible euthanasia requests ( in the near future) are rarely emergency in nature and can be initiated by the patient themselves without the express involvement of the physician who may find these treatment morally objectionable.
This is especially true in the present age of internet access to information for such services. This would not constitute a excessive burden on the patient.
Forcing physicians to participate in actions that deeply contravene their own personal moral convictions would be a grievous imposition on the human rights of that physician and all physicians. In a pluralistic society there needs to be room on both sides of morally controversial treatments for respect and latitude, so that both the general public and medical professionals are equally treated. Physicians should be allowed to operate in their chosen profession, like every other Canadian citizen, without discrimination and pressure to be involved in activities that are deemed morally objectionable to that physician.
Therefore I strongly recommend that the policy be changed to reflect this.
We reject the proposed “effective referral” mandate for doctors whose Charter right of freedom of conscience and religion must be respected.
Catholic physicians believe that a mandate for an “effective referral” is a violation of a physician’s rights, as it compels the physician to violate his or her own conscience by being a participant in the very act, the very procedure to which he or she objects in the first place.
Catholics Physicians rights must be respected
Response in PDF format.
Response in PDF format.
I reject the proposed “effective referral” mandate for doctors. I believe that their Charter right of freedom of religion and conscience must be respected.
1. It is hard to see how limiting physicians Rights to Freedom of Conscience and Religion guaranteed in the Charter will result in less discrimination or better patient care
2. Requiring referrals or requiring the doctor to participate in procedures that go against their beliefs may eliminate them from practice, and reduce their personal sense of integrity, if they remain in practice. Interior dissonance between deeply held beliefs and professional requirements can lead to burnout. This is systemic discrimination based on conscience or religious belief. It will impact patient care.
3. The requirement for referrals may actually slow down patient access to services. For instance in ON patients self refer for abortion.
4. Forcing doctors to refer for something, or perform something they consider to be killing a patient will completely go against the whole reason they got into medicine in the first place – to heal patients – not to harm them. This is a coercive action that involves a large percentage of physicians who do not want to be involved in euthanasia/assisted suicide.
Physicians, hospitals, clinics, etc. have not fulfilled their obligations under the Ontario Huamn Rights Code in relation to those patients with Environmental Sensitivities/Multiple Chemical Sensitivities/Chemically Induced Injury.
In order to even have access to where Doctors work, a comprehensive program to make these places safe (for everyone) must be undertaken immediately.
Physicians have obligations also under the AODA’s Customer Service Standards to make the places they work accessible.
The information the College requires in at the Canadian Human Rights Commission: There are two papers outlining the Medical and Legal aspects that provide everything that you need to know: proper signage to ‘encourage’ others entering the space to be scent-free; information and education for all doctors, patients, etc. on this issue; non chemical cleaning products that are safe; any furniture, flooring, reno’s, etc. done with safe materials in a safe manner, etc.
There is no point in going into the kind of discrimination, bullying, etc. that those of use with this disability (whatever it is called) have suffered. Image peanut bullying and what can be done with fabric softener, perfume, etc. Also, we are being injured whenever we come in contact with these modern-day chemicals that do no good, but only harm and make a profit for big corporations. If doctors are to ‘do no harm’, how can doctors be fulfilling their mandate but not warning people and helping them avoid these injurious chemicals.
The College should also enhance the Environmental Medicine department and have the information needed by doctors provided in workshops, magazines, etc. Why don’t doctors know that: a) besides cigarette smoke being connected to SIDS that chemicals in everyday products are killing children (imagine a child breathing in Tide and fabric softener all night!!); that pollution from fabric softenershas been found to be a significant polluter (I can’t walk outside because of it); that third-hand smoke is bad but third-hand fabric softener, air freshener, etc. is worse and is becoming even more injurious.
Pediatricians should be made aware and work with their patients to avoid the numerous chemicals, that work on an immunological level, are injuring people; that so-called ‘natural flavour’ (‘Health’ Canada has approved the change from ‘artificial’ to ‘natural’!) and other additives in factory food makes these ‘foods’ addictive and injurious — and along with other chemicals, such as obesagens, is at the heart of obesity.
The general public is becoming aware of these issues and if our doctors aren’t at the forefront then how can they be trusted?
By accommodating those of us with a disability that makes us the ‘canaries in the mine’ of the modern world, you will not only be helping us to be healthier and have access to the world around us (we are very isolated, have lost our jobs, have lost social contact, are repeatedly injured even in our homes, etc.) but you will be making life safer for everyone — and you will see the difference in your patients (and yourselves) with the avoidance of these ‘poisons for profit’.
Once again, this is a very serious statement that the College of Physicians and Surgeons must ensure that all physicians and surgeons, etc. are accommodating every patient, including those of us with Chemically-Induced Injuries.
We are writing to you to express our concern about your proposed draft policy on “Moral Obligations and Human Rights.” In particular, the proposed policy on “effective referral” (found at l. 156-159) seriously compromises the freedom of conscience of the physicians of Ontario. For matters of grave moral concern, many physicians hold that a referral to perform the objectionable procedure is not meaningfully different from performing the procedure themselves. As such, it puts a serious limit on their freedom of conscience.
The College should recognize that there are several medical procedures that remain highly controversial in Ontarian society. To take one example, doctor-assisted suicide will soon be legal in Canada. For those physicians who oppose this practice, it would be impossible to reconcile any role in such a practice with their duty to act “in the best interests of their patients” (Draft policy, l.18) or to “prevent imminent harm” (l.168). It is in the interest of the people of Ontario to recruit physicians with strong moral principles in their professional and personal lives. The draft proposal would be a serious barrier to many such doctors in this province.
I have read and disagree with your recent draft policy that will require physicians to make referrals for care that are against their morals and religious beliefs to perform.
Response in PDF format.
Response in PDF format.
I do not believe that physicians who have a moral or religious belief that would limit access for patients to receive clinical care (ie abortion, euthanasia) should be mandated to refer these patients to other care providers who will provide these services.
Referral should be optional.
Neither abortion or euthanasia is an urgent or life threatening condition. Patients should be able to access these care providers directly without placing other physicians in a position of referral that is conscientionably objectional.
I am writing today because I have several friends/collegues who are physicians and I believe some of the wording in this draft will directly affect their work as doctors.
The portions I would like to address below:
113-114 “The Canadian Charter of Rights and Freedoms (the “Charter”) protects the right to freedom of conscience and religion. Although physicians have this freedom under the Charter, the Supreme Court of Canada has determined that no rights are absolute.”
123-124 “In relation to freedom of religion specifically, courts will consider how directly the act in question interferes with a sincerely held religious belief.”
156-157 “Where physicians are unwilling to provide certain elements of care due to their moral or religious beliefs, an effective referral to another health care provider must be provided to the patient.”
Including the requirement that physicians give referrals does not address the fact that many of these same physicians will find the act of referral itself objectionable, as they consider it material cooperation with the act. In compelling physicians to refer, you are limiting their right to conscientious objection.
In the cases of abortion or euthanasia (which is currently before parliament) the requirement of providing a referral demands that a principled, moral and/or religious person cooperate with the intentional and direct ending of a human life. Clearly this will go against deep, sincere beliefs, and go against many phisicians motive and directive to heal patients and ‘do no harm’.
I expect that physicians, as professionals, be allowed to respect their own consciences. Freedom of conscience is foundational to our free society and cannot be limited, even for the best of intentions.
If we coerce physicians into violating their consciences we will inevitably erode the personal integrity which is the basis of the physician’s relationship with their patients.
Thank you for the opportunity to provide feedback. I encourage you to revise the sections above, and include a clear defense of the right to freedom of conscience for all physicians.
If patients have rights, doctors have rights to freedom of concsience and religion.
Thus, I strongly oppose and disagree with the propose policy to limit the doctors’ rights to freedom of conscience and religion.so that if a patient comes to a doctor asking for an abortion or euthanasia, and if that doctor will not perform it because of his conscience or religion, he has to refer the patient to another doctor.
Response in PDF format.
I strongly oppose the CPSO’s draft policy that limits a physician’s Rights to Freedom of Conscience and Religion- which is guaranteed in the Charter- and requires them to make an effective referral to another physician if they refuse their patient’s requests, such as euthanasia, especially now that it is legalized.
To whom it may concern, We wish to align our thoughts on this most fundamental matter with those eloquently and scholarly expressed by the Catholic Civil Rights League in their recent submission to you.
The path you are proposing is ultimately Orwellian and previous history in Nazi Germany and more recently in the likes of Belgium and the Netherlands clearly demonstrates that this move, however well intentioned, embarks on a slippery slope Canadian doctors clearly must avoid.
We love our Doctor but this would expose him to the possible loss of his immortal soul, yes that’s right, his IMMORTAL soul, we just had to register our responsibility for that.
thank you for asking the public for submission of ideas on Supreme Court Carter decision.
I urge the College, together with nurses to work diligently with government and health authorities to improve access to Palliative Care. We know that with palliative care that takes away pain and reduces sufferings, their desire for assisted suicide almost always go away.
And I urge the Physicians, before referring dying patients to another physician, to try your best to remind family, friends to spend time with the dying and disabled. We, the Catholic communities across the country are mobilized to send out more members to visit patients, to provide some needed comfort. I believe the churches and diocesan offices will be very happy to be of assistance to work with the College on this front.
As for protecting Physician’s conscience right, I believe the existing policy and procedure that protect physician’s right not to provide abortion and assist the distraught mother to obtain helps so she can deliver the baby safely and to keep her baby or give up for adoption. Can sometime along that line be included in this Euthanasia draft policy?
Having read the draft proposal I must say I was quite alarmed when I reached line 152 and again when I reached line 168. In lines 152 and 168 the Doctor’s rights are not protected, in particular their religious and moral rights may be violated. It has elements that would surely have Stalin or Hitler smiling in their graves. Is there not an oath?
Is it not an offence in this great country of our’s to coach someone how to end a life? Even if Doctors are granted exemption, it should never, ever, trump religious conscientious and moral grounds to save lives, if that is what the Doctor chooses. A doctor should be able to say “I’m sorry I will not help you with expediting death or aborting a baby” and not face discipline. As well it is my belief that a Doctor should not be obliged to coach someone where to receive such life ending procedures as that could challenge their morality.
The draft proposal Forces a Doctor to do something they may not want to do.
I am strongly opposed to the draft proposal, but particularly to lines 152 and 168, let’s send it back to the drawing board.
I want a Doctor with moral integrity.
My family and I do not support policies that would have doctors disciplined for following the conscience when having to perform medical procedures. A Christian doctor for instance is for life. having him perform an abortion would be a sin for him.
Response in PDF format.
I strongly advocate for a robust understanding and protection of the Charter right of freedom of conscience and religion for all Canadians, and indeed physicians in the daily routine of their care to patients and in the overall forming of their individual medical practices. I reject the proposed mandate for an “effective referral” as it is a breach of a physician’s rights and a serious incursion into the professional standing of a physician.
Doctors and other health care professionals, indeed all Canadians, enjoy the Charter right of freedom of conscience and religion. A proper balancing of the rights of physicians with the concept of patient autonomy must not result in the trumping of the rights of physicians in their medical practices. Such rights extend not only to refusing to perform morally objectionable services, but the right not to be obliged to refer to other practitioners who may be willing to provide such services. This clearly would constitute participation in wrong. The proposed mandate for an “effective referral” must be rejected.
Compelling a physician to provide an effective referral to another physician or health-care provider in order to carry out a procedure to which he or she objects on the grounds of conscience or religion also compels the physician to violate his or her own conscience by being a participant in the very act, the very procedure to which he or she objects in the first place.
When we are given the position of deciding who will live or die we are on a very s l i p p e r y s l o p e all of us. Patients who are mentally or physically challenged are yet on an even more slippery slope. God help all of us when and if this happens. We must not let our lawmakers allow this.
We, (my father and |), call upon the College of Physicians and Surgeons of Ontario’s Executive Committee and Council to reject the mandate for “effective referrals”. The medical profession, as with any grouping of individuals is not truly free to live and grow if its members are not able to govern their actions in accordance with their individual consciences, whether informed by moral and religious beliefs or otherwise.
Christian Legal Fellowship
Response in PDF format.
I am dismayed at the proposed policy requiring doctors to provide effective referral to another health care provider for procedures which violate their moral or religious beliefs. This is an abandonment of the Charter rights of the profession which you represent.
As an alternative, to require informing patients of these beliefs so they can make informed decisions regarding medical treatment and the choice of doctors makes sense. In fact, it could require some practitioners to state that they have no moral or religious beliefs regarding medical practice, which may be the most chilling statement a patient could hear.
I struggle to imagine other professional associations such as teachers, accountants or engineers being required by their professional associations to provide effective referrals for services they are unwilling to provide due to their moral beliefs. Professions are founded on the bedrock of right behaviour at the individual level. Do not disgrace the medical profession by abandoning this attribute of a professional.
Thank you for this opportunity to voice my concerns about the freedom of choice and beliefs for physicians and their own personal rights as human beings in Canada.
Physicians are expected to provide care, not provide assisted death. Their focus is healing and comfort not murder.
Please consider the physicians who will always honour life. I would be terribly concerned if my life career changed to include assisting to murder the very people I was committed to help.
Please be advised that I am rejecting the proposal for the “effective referral” mandate for Catholic physicians, whose Charter right of freedom of conscience and religion needs to be respected.
This “effective referral” compels the physician to violate his or her own conscience by being a participant in the very act, the very procedure to which he or she objects to in the first place.
Hope our voices will be heard.
Protection of Conscience Project
Response in PDF format.
I reject the proposed “effective referral” mandate for doctors. I believe that their Charter right of freedom of religion and conscience must be respected.
1. It is hard to see how limiting physicians Rights to Freedom of Conscience and Religion guaranteed in the Charter will result in less discrimination or better patient care
2. Requiring referrals or requiring the doctor to participate in procedures that go against their beliefs may eliminate them from practice, and reduce their personal sense of integrity, if they remain in practice. Interior dissonance between deeply held beliefs and professional requirements can lead to burnout. This is systemic discrimination based on conscience or religious belief. It will impact patient care.
3. The requirement for referrals may actually slow down patient access to services. For instance in ON patients self refer for abortion.
4. Forcing doctors to refer for something, or perform something they consider to be killing a patient will completely go against the whole reason they got into medicine in the first place – to heal patients – not to harm them. This is a coercive action that involves a large percentage of physicians who do not want to be involved in euthanasia/assisted suicide.
Do NOT under any circumstances allow Canadian physicians to provide assisted suicide.
What is needed is a much, much greater supply of palliative care.
All reports from countries who have permitted assisted suicide indicate wide spreading abuse is an inevitable result.
At age 83 I have lived a long, fulfilling, and useful life.
I have discussed with my family my preferred treatment in the case of incurable illness, etc., and wish for palliative care.
If there is no further hope of any recovery they will request that extraordinary means, which would be futile, be refused.
I do not want to spend my remaining years in fear of a medical system that would rather assist in my death than provide needed freedom from pain ,and the comfort that should be provided in palliative care. Doctor’s mantra has always been Do No Harm, and hopefully that will continue to be in effect.
No other person should deem whether or not I should live, nor should they decide the life or death of persons with disabilities, physical or mental, etc.
By striking down the laws regarding abortion in the misguided idea of helping a relatively small number of women who found themselves in untenable situations – we have lost millions of unborn children (who have NO right to life or safety in Canada) merely because they are an inconvenience. Abortion has become just another form of birth control.
Surely educated men and women can foresee the loopholes and disasters that will arise if the College of Physicians permits assisted end-of-life practices to become the norm.
I strongly object to the proposal that physicians who cannot in good conscience perform certain procedures, be required to refer a client to another physician who will usually perform the same procedure that he or she considers unethical. This requirement would undoubtedly cause the physician to sin against his own conscience and in many instances against his or her perception of the almighty GOD. When an individual fears JEHOVAH, an act such as what is being proposed to be made a requirement, is a travesty of the rights and freedoms of the physician.
How can this be in a country such as Canada where much is made of the rights of individuals? Why should the rights of the client supersede the rights of the physician? There are other recourses available to the client while the physician is left to suffer the loss of integrity and feelings of guilt within himself or herself. I find it unconscionable that our Canadian physician’s and surgeon’s rights and freedoms would be completely disregarded in this critical decision. These are stresses added on to a physician that could and should be prevented. If this proposal is made a law some may even decide against becoming a physician.
Please do not follow through with this proposal. We as a society and as individuals are being greatly affected, negatively speaking, by the systematic disregard of the rights of persons of conscience. In many cases individuals with conscience in matters such as these are the cornerstone of our Canadian heritage. It is on many of these principles that our foundations were laid.
JEHOVAH is love. He is equally just. We as a society will not emerge unscathed if we disregard His principles. I ask with respect, that those who have a conscience against certain practices not be required to be the vehicle by which they will result.
Please do not let this go through. Doctors are meant to save lives and treat them in order to get better.. not assist in destroying life. Let doctors who do NOT want to assist in terminating life have the choice and right to not do so especially if it goes against their beliefs and morals.
Definition of physician:
“a person who is skilled in the art of healing.”
Thank you for your efforts in drafting a new Human Rights Code policy.
I’m writing as a member of the public to express some concern over one part of the policy. Under Limiting Health Services for Legitimate Reasons, ii) iii., it appears a little unclear to me what is meant by services necessary to prevent suffering. It seems this leaves large questions to individual judgment. Could a doctor be sued for not performing assisted suicide if the patient’s family considered it urgently necessary to prevent suffering? I really don’t know–I’m not in the health services field. But I would benefit from a little more explanation, and maybe others would too.
Others have written to you, I’m sure, to express their concern for the sincerely held personal religious convictions about human life. I share these concerns. But I’d also suggest that some amount of pluralism in medical practices is a good thing. Maybe it’s best to let some doctors talk about and perform euthanasia and others not to talk about it if they’d rather not. Science remains ultimately silent on whether euthanasia is good medical practice. There are broader questions involved with assisted suicide, and with abortion, than those that usually fall within the realm of medical care. Usually we assume life is the goal–here we cannot … so maybe we can let diverse personal convictions have their say in the market, so to speak.
I am writing this is in response to the Proposed Draft re Norms and Guidelines of Patient Care (i.e. Effective Referral Mandate).
I am personally against “Assisted Suicide” / “Euthanasia” for a number of reasons (4 itemized here):
1. My faith as a Catholic (as the Licence plate cover says “From Conception to Natural Death”).
2. Euthanasia opens the door to the Health Care System terminating life for whatever political/financial reasons it deems appropriate.
3. Doctors take an oath, the Hippocratic Oath, including the clause “First do no harm”.
4. There is a tried and true alternative called Palliative Care for terminal patients.
Physicians unwilling to provide “certain” elements of care due to their or religious beliefs should not be required to provide a referral to another physician, “effective referral mandate”. This compels the physician to violate his or her own conscience by being a participant in the very act or procedure they object to in the first place. Physicians have a Charter right of freedom of conscience and religion to not participate.
If CPSO is determined to have “alternatives” for patients, then maybe CPSO should maintain the list of willing physicians that patients can access through your 1-800 telephone or on your CPSO website! There is of course the issue that physicians pays yearly dues to CPSO, does this make them peripherally participants?
I hope that CPSO “wakes up” and makes the right decision, which of course is not the current path they are on now.
I wish to thank you for this opportunity to voice my concerns about the freedom of choice and beliefs for physicians and their own personal rights as human beings in Canada.
Physicians are expected to provide care, not provide assisted death. Their focus is healing and comfort not murder.
Please consider the physicians who will always honour life.
I would be terribly concerned for all, myself and the lives of my loved ones if physician’s and health care worker’s life career changed to include assisting to murder the very people they are committed to help.
I understand that you are accepting submissions from Ontario citizens
regarding the “effective referral” mandate for doctors. I believe that
this mandate is a violation of a physician’s rights, as it compels the
physician to violate his or her own conscience by being a participant in
the very act/procedure to which he or she objects to in the first place.
I request that this mandate be removed from the CPSO document, so that a
physician’s Charter right of freedom of conscience and religion be
respected.
I disagree with the proposed changes to the above that obligates a physician to refer a patient to other physicians for procedures related to euthanasia.
Diocese of Alexandria-Cornwall
Please consider this to be the Diocese of Alexandria-Cornwall’s response to the above draft policy.
To begin, we would like to take this opportunity to thank the College for asking for the public’s input with respect to this draft policy.
We urge the College to remember that the Canadian Charter of Rights and Freedoms clearly recognizes that everyone has the fundamental freedom of conscience and religion. It is crucial that the College recognize that while patients have rights, so to do the physicians. Therefore, the rights of both patients and physicians must be respected and protected. It is important that rights themselves must never be limited in a one-sided manner in favour of the patient. Both patient and physician are entitled to protection.
Accommodation cannot be a one way street. Physicians are not robots who check their morals and conscience at the door when they arrive at their office. Rather, they are humans who are equally entitled to the protection of this most fundamental of freedoms.
A moral stance based on one’s conscience is rational and evidence-based, often reinforced by one’s religious beliefs and thus deserving of protection. Physicians should never be compelled to act against rational conscience decisions.
Refusing to provide or perform certain procedures is not discriminatory when it is based on a properly informed conscience. In fact, such a refusal has nothing to do with any of the grounds of discrimination enumerated in Ontario’s Human Rights Code since the refusal is not about the patient. Rather, the refusal is all about the procedure and the physician’s decision about the wrongness of the particular procedure in question.
We draw your attention to lines 115 through 117 of the draft policy. If you read all of paragraph 95 in the Big M Drug case you will find the following:
If a person is compelled by the state or the will of another to a course of action or inaction which he would not otherwise have chosen, he is not acting of his own volition and he cannot be said to be truly free.
Any policy that would force or coerce a physician into performing or referring for a procedure that goes against his/her conscience clearly contravenes the above statement of the Supreme Court of Canada.
Further, what the draft policy is paraphrasing does not accurately represent what the Supreme Court said.
Freedom means that, subject to such limitations as are necessary to protect public safety, order, health, or morals or the fundamental rights and freedoms of others, no one is to be forced to act in a way contrary to his beliefs or his conscience.
The bolded section is a statement of the general rule, that is to say the individual’s freedom that is to be protected. The unbolded portion is the exception to that general rule and therefore is to be applied exceptionally.
Abortion and assisted suicide (the two main procedures that are not doubt being referred to in this policy) are never going to be necessary to protect public safety, order, health, or morals such that the freedom of conscience of a physician should be trampled on. With respect to the fundamental rights and freedoms of the patient, again this is about the procedure, not the person and therefore not about any of grounds listed in section 15 of the Charter.
In following one’s conscience decisions are not based on any of these personal characteristics, since it’s about the procedure and not the person. The physician’s moral stance has nothing to do with the person.
The absence of external compulsion is fundamental to the exercise of conscience and the freedom of the individual/physician, to order a physician to make a referral ignores conscience rights and therefore rests on compulsion.
We urge the College to be concerned and to protect its own members’ section 2 rights just as much as the patients’.
Response in PDF format.
I am writing to express my serious concern with your draft policy, which would require physicians to give referrals for treatments that they themselves find morally objectionable, including contraception, sterilization, abortion, euthanasia and assisted suicide. This policy would force doctors to violate their own conscience, as the act of referral is still a participation in the objectionable treatment.
Freedom of conscience must be respected for all, including the physicians who are seeking, to the best of their ability, to care for all the citizens of our country.
Please revise your policy to include a clear protection of every physician’s right to act freely according to his or her conscience.
[**MESSAGE FROM ADMINISTRATOR: DURING THE CONSULTATION PERIOD, WE RECEIVED 2 RESPONSES FROM INDIVIDUAL RESPONDENTS CONTAINING THE CONTENT PUBLISHED ABOVE. ALTHOUGH THIS FEEDBACK HAS NOT BEEN PUBLISHED IN DUPLICATE, THE COLLEGE ACKNOWLEDGES RECEIPT OF THESE SUBMISSIONS.**]
I am a concerned Canadian citizen living in British Columbia who has been following the development of your Policy of Professional Obligations and Human Rights. I am well aware that the decisions you make regarding this policy will have a significant national impact and shape the development of similar policies by other provincial and territorial Colleges of Physicians and Surgeons.
There are several points made within this draft policy which cause me concern.
My first concern is the requirement that physicians inform patients that any moral objection they may have to particular services “is due to personal and not clinical reasons.” There are procedures to which a physician may morally object both on religious and clinical grounds. Physicians should be free to inform patients of both the religious and clinical reasoning behind their objections. Clinical reasons and personal or religious moral objections are not mutually exclusive.
I am also greatly concerned by the policy’s requirement of physicians to provide referrals to services to which they morally object. Requiring a physician to make such referrals forces them to assume a position of indirect participation in services which conflicts with their personal conscience. The obligation to provide referrals therefore impinges upon the physician’s freedom of conscience.
This draft policy states that “physicians must provide care that is urgent or otherwise necessary to prevent imminent harm, suffering, and/or deterioration, even when that care conflicts with their religious or moral beliefs.” This policy needs to clarify what they mean by the term “suffering.” According to the policy as it stands now in the proposed draft a person like me, who has spinal muscular atrophy, would be vulnerable to “treatment” which may end my life in order to prevent suffering and deterioration. Physicians must always act in a manner that upholds the Hippocratic Oath and their obligation to do no harm. Causing physical harm in order to alleviate suffering or prevent deterioration compromises this oath.
While it is appropriate that physicians “should not promote their own religious beliefs when interacting with patients” they should be free to share these beliefs when relevant. One of the great attributes of our nation is the defense of religious freedom. Canadians should be free to hold diverse religious beliefs. A person’s character and professional life cannot be separated from their religious beliefs. While it is entirely reasonable that physicians should never force their religious beliefs upon their patients they should be free to share these beliefs when need be and relevant to patient care.
We are appalled at the unethical demands being made on our Doctors – in order to facilitate the destruction of life.
Please allow our doctors to be faithful to their ethical conscience.
I am writing you as I have serious concerns regarding the recent draft Policy of Professional Obligations and Human Rights as proposed by your College. I recognize that when your new policy is approved it will set national precedence and have a significant impact on the development of similar policies by other Colleges of Physicians and Surgeons throughout Canada.
There are several aspects of this draft policy which cause me grave concern.
This draft policy requires that physicians inform patients that any moral objection they may have to particular services “is due to personal and not clinical reasons.” I believe there are, however, procedures to which a physician may morally object both on religious and clinical grounds. Religious beliefs do not stand in opposition to science but rather are often supported by scientific and clinical data. Physicians should be free to inform patients of both the religious and clinical reasoning behind their objections. Clinical reasons and personal or religious moral objections are not mutually exclusive and cannot be alienated from each other. Allowing a physician to provide both moral and clinical objections is necessary in order to protect personal and professional integrity.
I am also greatly concerned by the policy’s requirement of physicians to provide referrals to services to which they morally object. Requiring a physician to make such referrals forces them to indirectly participate in services which conflicts with their personal conscience. The obligation to provide referrals therefore violates the physician’s freedom of conscience.
This draft policy states that “physicians must provide care that is urgent or otherwise necessary to prevent imminent harm, suffering, and/or deterioration, even when that care conflicts with their religious or moral beliefs.” This policy needs to clarify what they mean by the term “suffering.” As someone who has struggled with serious mental illness I am greatly concerned that this policy would allow for physicians to alleviate my suffering by ending my life if I were to request this of them. There have been several occasions I have refused treatment for overdoses and told the attending physicians to kill me or allow me to die. If they had chosen to act on my request to terminate my psychological suffering I would not be alive today.
While it is appropriate that physicians “should not promote their own religious beliefs when interacting with patients” they should be free to share these beliefs when relevant. One of the great attributes of our nation is the defense of religious freedom. Canadians should be free to hold diverse religious beliefs. A person’s character and professional life cannot be separated from their religious beliefs. While it is entirely reasonable that physicians should never force their religious beliefs upon their patients they should be free to share these beliefs when need be and relevant to patient care.
I would just like to voice my disagreement with the following proposed policy as relating to the Right to Die legislation:
“Where physicians are unwilling to provide certain elements of care due to their moral or religious beliefs, an effective referral to another health care provider must be provided to the patient.”
I believe that patients should be able to self-refer to a willing provider if they wish to die. Physicians who do not want to participate should not be forced to participate at any level for any reason.
Helping to kill another human being, regarless of the individual circumstance, goes against basic human nature. Forcing anyone, physician or otherwise to participate, unless they are completely comfortable with that participation, can only result in harm. How much harm and how it will eventually manifest itself is difficult to determine but some level of psychological damage is the only possible outcome and therefore it is something that should be avoided at all costs. Self-referring is a simple and effective option where no one is harmed so please consider this option in your legislation.
As a pastor at a church in Ontario I wish to register my opposition to any effort to force our Canadian physicians to ever violate their religious beliefs in reference to care, in particular forcing physicians to perform abortions or to end life.
I would like to give my reaction to your draft policy, and I will be brief. I vehemently condemn those sections which would strip physicians of their freedom of conscience, and compel them to provide referrals for services which they regard as morally wrong. I encourage you – indeed, for the good of society I implore you – to frame a policy which guarantees a genuine freedom of conscience for all physicians.
I strongly disagree with the proposed changes to the above that obligates a physician to refer a patient to other physicians for procedures related to euthanasia.
I stand in solidarity with physicians who, in conscience, do not want to kill patients, or help patients kill themselves, or refer them to physicians who will kill patients or help patients kill themselves.
If you compel physicians to kill or refer to killer physicians, you take away their right to conscientious objection.
Freedom of conscience is foundational to our free society.
I am a Canadian citizen residing in Onatrio. I have gone through the details of the new policy regarding the physician’s rights, to be implemented soon. Whether you are a physician or not, everyone has a conscience and it is mentally stressful and make you feel guilty, when you act against your conscience. It is equally wrong whether you kill a person by your own hands or you arrange someone else to kill the person. If you kill a person by yourself or you arrange a ‘hitman’ to do the killing for you, you are guilty before the court. If so, it is equally wrong for a physician to administer the lethal dose for the patient by himself or herself, or to arrange it to be done by another physician. So please allow all the doctors to act according to their conscience. If needed, add a line in the consent form, whether the physician will be willing or not, to administer the lethal dose, if needed, so that the patient or the responsible person for the patient, can choose whether to be treated by that physician or not.
The College has proposed that “Physicians must provide care that is urgent or otherwise necessary to prevent imminent harm, suffering, and/or deterioration, even where that care conflicts with their religious or moral beliefs.” I recognize that the College is likely implementing this change to prevent some physicians from maltreating patients in the name of ‘conscience’, such as a physician who refuses to treat a woman who goes into hypovolemic shock after an abortion. This is gross malpractice, even the pro-life ethics manual of Catholic Health Alliance explicitly states as much.
However, I believe that the wording of the College’s draft as it stands holds a significant flaw. It falsely assumes that all physicians share the same definition of “urgent or otherwise necessary care to prevent imminent harm.” A doctor’s rational and scientific judgment may lead him to conclude that a patient comes into existence at conception. Consequently, that doctor believes that conscientiously objecting to an abortion (where the life of the mother is not in imminent jeopardy) “prevents imminent harm” to the unborn child – a patient in the mind of the objecting doctor.
To such a physician, the College’s statement reads as follows: “[Pro-abortion] physicians must provide care that is urgent or otherwise necessary to prevent imminent harm, suffering, and/or deterioration [to an unborn patient], even where that care conflicts with their religious or moral beliefs [as proponents of abortion].”
I believe that the College intended it to read: “[Anti-abortion] physicians must provide care that is urgent or otherwise necessary to prevent imminent harm, suffering, and/or deterioration [to an pregnant patient], even where that care conflicts with their religious or moral beliefs [as opponents of abortion].”
It is evident that by merely changing the implied subjects and indirect objects of the sentence, the College’s statement can also be interpreted as both a ban on and order to perform elective abortions.
Please allow doctors to exercise well-formed judgements about what it means to provide “provide care that is urgent or otherwise necessary to prevent imminent harm, suffering, and/or deterioration”.
In the history of medical practice, many mistakes have been made by physicians. However, at least since the time of Hippocrates there has been a guide and a set of principles available to the community of medical practitioners to help minimize the errors and mistakes. It would be foolish to ignore or lay aside the guidance that the Hippocratic Oath has provided to generations and centuries of medical practitioners.
As an additional guide available to every person in the course of their lives and in the practice of their respective professions is the moral compass provided by the individual’s conscience. The “dictates of conscience” are the compass by which each person, in their full dignity as a person, can steer and choose correctly the options open to them, in both professional practice and in moral decision-making. If some alien force were to try and deprive us of the compass of our conscience, we would rightly resist, as we would otherwise lose our essential freedom and dignity as a person.
The dictates of conscience and the acceptance of the individual’s right and obligation to follow their conscience must be respected by any professional association. My concern is that the draft policy of the CPSO referenced above aims to deprive the physician of this right and obligation.
In the history of medicine there has been a long list of practitioners who abandoned the guidance of conscience and have then brought utter disrespect and contempt to the title of “physician”. I expect the CPSO to not make this error. As a profession you are obliged to respect the rights and dignity of your members by enabling them to follow the guidance of their consciences.
I am writing to express my expectation and insistence that the sections above will be revised to include a clear defence of the right to freedom of conscience for all physicians.
I have heard that the College is accepting possible changes to the Draft Policy that will limit physicians’ Right to Conscience and Freedom. I ask that we all fight for true rights that are inalienable and should not be taken away.
“The Canadian Charter of Rights and Freedoms (the “Charter”) protects the right to freedom of conscience and religion. Although physicians have this freedom under the Charter, the Supreme Court of Canada has determined that no rights are absolute. The right to freedom of conscience and religion can be limited, as necessary, to protect public safety, order, health, morals, or the fundamental rights and freedoms of others.”
“Where physicians are unwilling to provide certain elements of care due to their moral or religious beliefs, an effective referral to another health care provider must be provided to the patient.”
This means that if a physician does not want to refer for abortion or perform physician assisted -suicide (it is coming to Ontario), he/she must refer to another doctor who will. This is no difference than doing the act oneself.
It is hard to see how limiting physicians Rights to Freedom of Conscience and Religion guaranteed in the Charter will result in less discrimination or better patient care. Allowing this form of “care” is a small foot in the door that will pry open a wider opportunity for this not being exceptional, but what others believe to be the better way to “care” by ending one’s life out of convenience.
Please continue to support Doctors’ decision to refuse certain requests and not force or pressure them to refer to another to carry out the task of physician assisted death.
Rainbow Health Ontario and LGBTQ Parenting Network
Response in PDF format.
As a concerned member of the public accessing the care of physicians, and as a mother, it is important to me that physicians act in accordance with their conscience and not be required to provide referrals for services or
treatments that are contrary to their conscience.
As a society, we owe it to ourselves to continue to behave democratically, and allow persons- professionals or otherwise- to act according to conscience.
I am writing to express my concern and to request that the policy be
revised to respect the rights of physicians and to remove the proposed
mandate for “effective referral”.
It is absolutely horrifying that the draft copy of the “Professional Obligations and Human Rights” draft does not leave conscience rights for doctors. The medical profession has always been seen as a place that we can trust to have people with a higher bar when it comes to controversial moral matters. Let’s use abortion for starters on how your proposed methodology works. Some abortion practices require the ripping apart of a small but real person. This is a barbaric action done on fully formed unborn babies.. The beheading of people by ISIS is horrifying: ripping babies apart in the womb is also barbaric. It is only one of the actions that no person with an active conscience could participate in – but your draft copy would take away the right not to have any part in such a horrific actions. No, you think – but they can be true to their conscience by pointing the patient and the terrorist to some one else to do the killing .
The Nazi’s used that kind of thinking. They were eventually charged with Crimes against Humanity.
Thank you for being open to consultation on this very significant document.
I am a practicing family physician and the Professional Obligations and Human Rights (POHR) document is of deep concern to me.
I recognize that the proposed policy “Where physicians are unwilling to provide certain elements of care due to their moral or religious beliefs, an effective referral to another health care provider must be provided to the patient” is an attempt to reach a compromise between the competing rights of the patient for access and those of the physician to freedom of conscience and religion, but it is ill-conceived and should be withdrawn.
Firstly, for many physicians who are unwilling to provide certain elements of care for conscience reasons, referring to another health provider who will provide that element of care constitutes material cooperation and is also immoral. To include in a professional code of ethics a requirement to do what one believes to be wrong does not make sense and is ultimately dangerous and totalitarian. One need only read R J Lifton, “The Nazi Doctors—Medical Killing and the Psychology of Genocide” to see how wrong this could be.
Secondly, in parallel to the arguments in the recent Supreme Court decision in Carter v. Canada, the question is whether mandatory referral with its heavy impact on the physician’s s. 2 rights to freedom of conscience and religion is the least drastic means of achieving the objective of patient access. I assert that the restriction on the physician’s s. 2 rights is not proportionate to the objective, and that it is reasonable to develop alternative processes for ensuring patient access while not infringing on the physician’s rights of freedom of conscience and religion. For example, the College could maintain a publicly accessible listing of physicians who are willing to provide contested elements of care. This could be part of the annual re-licensing procedures, with physicians indicating which elements of care they are willing to provide.
Thirdly, I am suspicious of the sources of this draft policy. The College of Physicians and Surgeons of Saskatchewan has also issued a draft Conscientious Refusal policy, which is almost verbatim the policy suggested by Downie, McLeod and Shaw in “Moving Forward with a Clear Conscience: A Model Conscientious Objection Policy for Canadian Colleges of Physicians and Surgeons”, Health Law Review 21:3, Summer 2013 (published by the Health Law Institute of the Faculty of Law, University of Alberta). Downie et al are very clear about the motivation for their suggested policy, which is access to abortion services (but will be equally applicable to the newly confirmed patient right to physician-assisted killing). The research was funded by the Canadian Institutes of Health Research, the government of Canada’s health research investment agency. I have read their articles published in Bioethics in January 2014 (Co-editor-in-chief Dr. Udo Shüklenk, Ontario Research Chair in Bioethics at Queen’s University, and chair of the expert panel of the Royal Society of Canada on End-of-Life Decision Making) and I do not think that they demonstrate a need for mandatory referral. They do not appear to have considered any arguments put forward by conscientious objectors, and the whole process appears to be designed to support a particular pre-formed ideology. I saw no mention of existing documents such as the Joint Statement on Preventing and Resolving Ethical Conflicts involving Health Care Providers and Persons Receiving Care (1999), or The Royal College of Physicians and Surgeons of Canada paper “Conflict Resolution” which stresses that it is a collaborative approach that leads to durable outcomes. I suggest that the CPSO should collaborate with those who oppose mandatory referral to come up with a policy that ensures access while not demanding that physicians do what they believe to be wrong.
Finally, I anticipate that if this draft policy is promulgated in Ontario, that a significant number of physicians will find it unacceptable and either leave medical practice or move to a jurisdiction that is more accepting and supportive of a diversity of values.
Although I see this draft policy as problematic in several ways, most of my concerns become moot if one overarching problem is addressed. I believe a paradigm shift is needed, beginning with an examination of how human beings arrive at opinions and make decisions.
Each person has a conscience which governs what the person considers morally good or bad. The conscience can be informed by a variety of influences: philosophical, metaphysical, sociological principles, etc. A person’s conscience does not operate in a vacuum: it cannot be divorced from the many other factors at play in decision-making. A physician, when offering his medical opinion, employs all of the following: scientific knowledge acquired in his training and continuing education; evaluation of benefits and risks; his own clinical judgment based on experience; the ethical standards he must uphold as a physician; and his own moral compass (i.e., his conscience). These factors operate together within a person and are not diametrically opposed to one another: this is personal integrity.
This draft policy makes a ridiculous presupposition, namely, that doctors who are unwilling to facilitate a particular intervention are taking that stand ONLY for moral or religious reasons—somehow irrationally separated from evidence-based clinical judgment! This preposterous notion is clearly revealed in lines 138-141:
“Where physicians are unwilling to provide certain elements of care due to their moral or religious beliefs, physicians must communicate their objection directly and with sensitivity to existing patients, or those seeking to become patients, and inform them that the objection is due to personal and not clinical reasons.”
“Due to personal and NOT clinical reasons”? The authors here assert that these doctors are acting without integrity, i.e., that the doctor’s conscience is at variance with his clinical and scientific knowledge. The statement also implies that a standard body of medical interventions exists to which no reasonable doctor can object on medical grounds—that any objection is based merely on the doctor’s (irrational, it is implied) moral considerations. The authors’ bias is further revealed in phrases such as “unwilling to provide certain elements of care”. Doctors do not agree in all cases as to what is a legitimate “element of care” and what isn’t. This diversity is and always has been good and right in the medical profession. No governing body is in a position to define standard “elements of care” that all doctors must facilitate.
As many respondents have noted, there is no real difference ethically between “doing” and “facilitating”. If it is unacceptable for a physician to provide a particular intervention, then it is equally unacceptable for her to facilitate it. Thus, “effective referral” requires doctors to act contrary to their moral and clinical judgment.
No patient has the right to receive a particular intervention from a particular doctor, nor to receive that doctor’s “stamp of approval” (i.e., referral) for the intervention requested. Patients have the right to seek other medical opinions. A doctor who is acting humbly and ethically will ungrudgingly encourage patients to do so. (The practical obstacles to getting a second opinion, e.g., in rural settings, are acknowledged. Our health care system can find acceptable ways of overcoming these obstacles. Compromising our physicians’ personal and professional integrity is unacceptable.)
Though I realize the College has no control over any legal proceedings or decisions made by government bodies, I believe the following assertion is worth serious reflection: If any particular medical intervention is deemed a right—meaning therefore that our public health care system has a duty to provide it at a patient’s request—then the integrity of the medical profession as a whole is compromised. Let’s do what we can to prevent having our physicians reduced to automatons who are compelled to check their own clinical and moral standards at the door.
I don’t question the good intentions behind this draft policy. People enter the medical field because they genuinely want to serve and benefit their fellow human beings, and this document’s authors surely are no exceptions. However, this policy leaves all physicians—and all patients—very vulnerable. This document as worded puts all physicians under threat of discipline for following their own clinical and moral judgment. How can real trust and openness exist between doctor and patient in a situation like this? Where can bewildered patients go when they truly desire a medical opinion?
I invite the College to discuss publicly any and all specific problems it is seeking to correct with this policy. Perhaps together we will discover completely different solutions to those challenges.
As a member of the public who is old enough to remember when abortion was legalized, the promise made repeatedly at the time was that if physicians objected to abortion, they would never have to participate in it.
In light of the recent Supreme Court decision that again states that no physician should be compelled to take part in Physician Assisted Suicide if they object, it is astounding to hear of the College’s blatant attack on conscience rights, particularly with respect to abortion.
Abortion and physician-assisted suicide are both very much issues with active national debate about the morality of the procedures. Doctors who refuse to participate are by no means antiquated outliers. Former abortionists, who entered into the practice freely have become haunted by the reality of what they were doing and turned firmly against it. Are those nightmares and horrors really something you would foist on your rural and remote physicians? They will surely leave their post, and instead of having an obstetrician in the area with somewhat limited services, there will simply be absolutely no service at all.
The freedoms we enjoy in Canada have made us the envy of much of the world. A patient’s “freedom” to have access to abortion, etcetera, does NOT supersede a physician’s right to have their Charter protected Freedom of Conscience and Religion upheld. A patient who wishes an abortion can go to a walk-in clinic, emergency room, change doctors, or self-refer in most provinces. Patients frequently decide to do these things if their physician won’t give them antibiotics while practicing good antibiotic stewardship, or refuse narcotics after a broken contract. If a woman really wants an abortion, she can certainly find a way; and if she experiences a slight delay after a physician objects to referring her, that may give her a chance to avoid an abortion that will haunt her. I firmly believe that expediting referrals, and excessively streamlining the process when a woman is contemplating an abortion pushes her in that direction. If a person chooses abortion, the responsibility for its consequences belong to them, not to a third party forced to participate in it.
Please take the time to read this article: http://ottawacitizen.com/news/national/doctors-duty-consciences. It makes the clear point that referring for abortion or physician-assisted suicide is extremely morally objectionable for many physicians.
“Being a facilitator of such action is no different than actually doing it. It may seem different, but for those with principled objections, it involves the same compromise of one’s moral or religious persuasions.” Courts find people morally and legally culpable who have paid a third party to kill someone even though they did not actually commit the murder with their own hands. Physicians who refer for abortion would also be morally culpable in the same way.
Freedom of conscience is a basic human right enshrined in our Charter of Rights and Freedoms. No one should ever be compelled to bring about the death of another. Physicians have the weighty responsibility of dealing with matters of life and death on a daily basis while striving “first, to do no harm”.
You as our College, working in the interests of us, the public, must protect our ability to find physicians who will take care of us with their consciences in tact. I am horrified by the idea that I might not be able to find a physician who DOES NOT perform or refer for assisted-suicide, realizing people have been euthanized against their will in the Netherlands (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3070710/#b10-conc-18-e38). One final quote from the Ottawa Citizen article, previously mentioned: “The practice of medicine and the practice of religion have been inextricably linked for millennia. It follows because both are concerned with the human person, a unity of body and soul. It is good for medicine – for both doctors and patients – to benefit from the broad horizons offered by the world of faith. The draft policy should be amended to recognize that.”
I would like to respond to the draft proposal and appreciate the opportunity to do so. However, since I only became aware of this opportunity a couple of hours ago, there is not enough time to do it justice. I am not writing this from my own computer.
I am a Canadian citizen living outside of Ontario, not a professional, but with a keen interest in both medicine and human rights. I have read the draft policy, and the survey questions, and noted the correction of the info apparently stated in the National Post.
Having read the draft and deduced all its implications, I, myself, would come the the conclusion the College does not want physicians of integrity irritating them by acting as a conscience for a profession that is hell-bent on denying there is a higher law than they. This is tantamount to the accusation in the POST.
Moral judgments without a moral compass are purely subjective. If the Charter is only what it is according to the particular, subjective interpretation of some body or judge, it is nothing. The finely-crafted Soviet Constitution did not protect the Soviet people. It brought them to their knees.
The draft uses words that are disingenuous,exploiting the naive trust especially of older folk who actually did used to be able to trust their doctor. Now the College uses right-sounding words to undermine the conscientious care that men and women of high moral stature want to spend their lives giving. Who is the loser? The very ones you claim to be trying to protect will now have nowhere to turn for real healing and guidance, and will have to live with regret, guilt and despair. Ah, but then they can come back for assisted suicide!
I am so thankful for the “barriers” in my life that prevented me from terminating my children or my own life. Don’t steal people’s hope by being so quick to agree there is no hope: there will be a better day; life will again be good; your children will thank you for life. To LIFE!
You who come up with these vacuous, intolerant policies do not deserve to regulate yourselves. That is a privilege reserved for such as those doctors whose consciences you want to rein-in.
A doctor will always put the patient first if he or she is true to himself/herself. You do not need more codes and policies: you need men and women of conscience and character like the ones who started most of the humble healing institutions in our country.”This above all, to thine own self be true; and it follows, as the night the day, thou canst not be false to any man.”
Confused, prideful people have turned our hospitals into self-serving icons almost devoid of humanity. Please, do no more harm.
I would ask that the provisions of the draft policy which would compel doctors who choose not to participate in certain acts for reasons of conscience and moral objection, to nevertheless refer their patients to other doctors who will, be redrafted. As a scientist, I am appalled that others would be forced to be complicit in actions they consider morally objectionable.
A doctor is not only a technician, but should bring good moral character in the care of his patients. That is what I expect of doctors who treat me and want to know that there is room in Ontario’s medical system for doctors of good moral conscience. In particular, this draft policy would hound good Catholic doctors out of our system and even prevent them from serving in this province in the first place.
I ask you to please seriously reconsider.
In reviewing your draft policy on Professional Obligations on Human Rights I have serious concerns regarding the wordings of the following:
- “In the course of communicating their objection, physicians must not express personal judgments about the beliefs, lifestyle, identity or characteristics of existing patients, or those seeking to become patients. This includes not refusing or delaying treatment because the physician believes the patient’s ow actions have contributed to their condition. Furthermore, physicians must not promote their own religious beliefs when interacting with patients, or those seeking to become patients, nor attempt to convert them” –
Such a statement wrongly assumes that one’s faith can be separated or turned off on demand as if it did not constitute an ingrained element within a person. If adopted such a statement would run the risk of forcing a doctor to directly go against their religious beliefs should one of their patients ask for an opinion on a particular option for treatment that the doctor’s faith says is morally wrong. Also forcing doctors to remain silent about that which challenges their faith, can make them not only morally complicit in an unjust act, but could have negative long-term impacts on a physician’s personal conscience.
- Physicians must provide information about all clinical options that may be available or appropriate to meet patients’ clinical needs or concerns. Physicians must not withhold information about the existence of a procedure or treatment because the procedure conflicts with their religious or moral beliefs. Where physicians are unwilling to provide certain elements of care due to their moral or religious beliefs, an effective referral to another health care provider must be provided to the patient. An effective referral means a referral made in good faith, to a non-objecting, available, and accessible physician or other health-care provider.15 The referral must be made in a timely manner to reduce the risk of adverse clinical outcomes. Physicians must not impede access to care for existing patients, or those seeking to become patients.”
Again such a statement directly conflicts with one’s freedom of religion and thus their human rights. Should a doctor have moral objections about a particular procedure, they should not be forced to provide a referral to another doctor who would encourage such a procedure. If adopted, such a statement could tie doctors freedom of conscience by forcing them to take part (in a secondary way through referral) in acts that their faith’s find morally wrong. Forcing doctors to act against their conscience goes against one of the basic principals found in democracies.
Whether one recognizes it or not, faith is an essential (constitutive) element for many doctors and surgeons in Ontario. In fact, I have known doctors whose faith/religion plays a significant role in how they respond to the unique needs of their patients. I fear that should the statements noted above be adopted it would put many doctors in a moral quandary and could even run the risk of discouraging many talented members of our faith communities from pursuing medicine out of fears that they would be required to act against their consciences at any time during their career.
I strongly urge the College of Physicians and Surgeons to reconsider the adoption of these policies as currently worded.
Freedom of Conscience and Religion is imperative in a civilized and free society. No one should be forced to kill another person or to have to arrange for someone else to do it.
Please respect all people of all and any religion who refuse to kill other people.
I am writing to object to your proposed “effective referral” mandating physicians to participate in the very act that they,because of the religious belief would not do. I am sure all the physicians who studied to become doctors because the wanted to save lives not to cause deaths.
We cannot play “God”.
Justice Centre for Constitutional Freedoms
Response in PDF format.
I totally disagree the legalize Physician Assisted Suicide.
All our days in the world has been written in God hands.
the life is given by HIM, and nobody has the right to end others’ lives earlier than the date planned.
I strongly oppose the CPSO’s draft policy that limit physicians Rights to Freedom of Conscience and Religion guaranteed in the Charter, and require them to make an effective referral to another physician if they refuse their patient’s requests, such as for euthanasia should it be legalized.
Thank you for your attention in this important matter.
It is entirely objectionable to legislate that Doctors, unethically and contrary to their personal beliefs, be forced to become Accomplices in Assisted Suicide Referrals.
DOCTORS’ SOCRATES OATH MEANS “ THOU SHALL NOT KILL”
Please be advised that I strongly oppose the CPSO’s draft policy that limit physicians Rights to Freedom of Conscience and Religion guaranteed in the Charter, and require them to make an effective referral to another physician if they refuse their patient’s requests, such as for euthanasia should it be legalized.
I understand that the CPSO has, in a draft of its document on Professional Obligations and Human Rights, proposes to mandate that in the case that a physicians moral or religious beliefs interdict a certain course of action which can be considered medical, they must provide to the patient, an effective referral to another health care provider, who is non-objecting, available and accessible.
I would like to express my opinion on the implications of such a mandate.
Freedom of conscience.
Conscience is an innate human faculty. It is moreover the essence of our humanity. Conscience develops in parallel with consciousness – consciousness of our human environment, of our community. It is what enables us to relate to this community with justice and with compassion. Conscience and empathy, then, seem to me to be intricately linked. They are also therefore the basis of the practice of medicine that addresses the whole person. We increasingly demand that the formation of a professional identity in physicians include leadership in the practice of medicine that is both compassionate and moral. It seems contradictory then, to ask the same physicians to park their conscience at the door of the office and practice a medicine that may not conform with their moral conscience.
Unfortunately, in the face of a practice that is morally objectionable to them, physicians are mandated [proposal] by the College, in its draft on Professional Obligations and Human Rights, to provide “an effective referral to another health care provider” who is non-objecting, for the patient. The moral, and therefore professional, practice of medicine cannot permit this since it is intrinsically inconsistent. Demands for such incoherence, such moral dualism strike at the integrity of the person and therefore are clearly at odds with the human rights of the physician. It also damages the protection of pluralism and diversity in our society, which we treasure. More remote perhaps, is society’s potential selection against conscience and empathy in its physicians – a somewhat chilling thought.
Finally, it is not difficult to see that, with a little imagination, access for patients to any legally permitted procedure that is appropriate for their state of health, can be implemented without infringing on the conscience rights of the physician.
The Carter case
The Supreme court of Canada has coincidentally and very recently ruled that, under certain conditions, patients have the right to euthanasia and physician-assisted suicide. This provides an immediate example of the type of situation where the conscience rights of the physician can be harmed.
It also provides an example where the patient may be harmed – irreversibly. Since one is dealing with people who are suffering, who are depressed, who are aging, who are dying, one is also dealing with a population that is extremely vulnerable. We are told, by palliative care physicians that the greatest causes of suffering in these patients is not their pain, but the loss of their integrity, the feeling of being a burden on their loved ones, on society. How terribly easy it could be to convince someone like this that a quicker death is the optimal solution. In spite of some upbeat reports on the European experience, there has been a shift in attitudes that cannot be said to be compatible with the Hippocratic oath, and is not encouraging. Yet again, palliative care physicians tell us that we have advanced to a state where there is very little pain that cannot be controlled. What the patient needs is compassion, connection -and, yes, access to excellent palliative care. If, under those circumstances, the patient still chooses to die, clearly there are those who can help. But physicians who choose to ease the pain, and care for the patient in this way should not be forced to cooperate in euthanasia or suicide. One might add that a number of patients, misunderstanding the implications of the decision and fearful of “being euthanized”, will cooperate less fully in pain management and care, which is their right, and of which they are thus being deprived.
Conclusions
Given these two coincidental events – proposals for amendments to the codes of conduct, and the Carter decision, there are two pressing issues that need to be addressed:
Firstly, the protection of the most vulnerable among us from any undue pressure to consent to solutions that they do not intend. Following from this as well, is the patient’s right to optimal care, including palliative care.
Secondly, the protection of conscience rights for all – including physicians. It has been a long time since they have been this threatened.
It should be noted that both the Canadian Medical Association and the Supreme Court in the Carter case ruling, have spoken for these conscience rights. It is my fervent hope that the College of Physicians and Surgeons will also maintain them.
I am appalled that health professionals may be faced with disciplinary action if they refuse to be involved in abortions, birth control,and euthanasia. These areas should be left to the conscience of the physician and if he/she finds them ethically abhorrent they should have the right not to participate in such practices.
I write as a member of the public and as the mother of adult children.
I am also writing as someone with a family member who has struggled with several years of mental illness and has made multiple suicide attempts, accompanied with statements such as “just let me die”, “I can’t go on living like this”… if the Supreme Court’s decision becomes a legal obligation on the part of physicians to comply with their request at times when their life view is bleak and hopeless, then their family might not have the opportunity to relay that message to the physicians involved in their death.
I dread the day that I, or my immediate family members, are being attended by physicians who are agents of death, rather than of healing or of palliative care and pain management. I hope that the Colleges of Physicians and Surgeons compile a publicly accessible registry of physicians who will aid in direct killing or assist in the suicide of their patients, so that health care consumers will know whom they can trust and turn to for medical care no matter on which side of the debate they stand.
I strongly object to the College’s draft policy. Requiring physicians to refer procedures that violate their moral or religious beliefs, such as abortion or euthanasia, to a doctor prepared to undertake these procedures is immoral and unethical. Your draft policy will seriously erode the confidence of the public in the College’s commitment to act in an ethical manner. It is appalling that the College would consider a draconian measure so disrespectful of human rights of doctors and of the conscience of the individual physician.
Your draft policy states that physicians must obey the Ontario Human Rights Code. That is so only if the Code itself does not contradict the Canadian Constitution, including the Charter of Rights and Freedoms which explicitly states in Section 2a that the first of our fundamental freedoms are freedoms of conscience and religion.
The Ontario Human Rights Code does not state that doctors must refer patients contrary to the doctors conscience or religious beliefs. In any case the Code is subservient to the Charter, as law. The Code says that:
“Every person has a right to equal treatment with respect to services, goods and facilities, without discrimination because of race, ancestry, place of origin, colour, ethnic origin, citizenship, creed, sex, sexual orientation, gender identity, gender expression, age, marital status, family status or disability.”
It is not clear where services to patients in general falls under this list of protected groups for the purposes of the Code. It is unclear because it is not there.
The duty to accommodate in the draft omits the obligation of the College to accommodate the conscience rights of doctors, as well as the rights of patients.
The draft policy states:
“The patient’s best interests must remain paramount;”
Just so, and the best way to do this is by adhering to classical Hippocratic oath and not participate in the contemporary culture of death. As you know, that oath says among other things that:
“With regard to healing the sick, I will devise and order for them the best diet, according to my judgment and means; and I will take care that they suffer no hurt or damage. Nor shall any man’s entreaty prevail upon me to administer poison to anyone; neither will I counsel any man to do so. Moreover, I will get no sort of medicine to any pregnant woman, with a view to destroy the child.”
If, as a College, you can’t follow the Hippocratic oath then at least allow doctors who for reasons of conscience or religion reject practices such as abortion or assisted suicide the option obeying their own consciences.
Not so long ago in, a less morally debased society, it was unnecessary to explain to professionals why the sanctity of conscience and freedom of religion matter.
I feel that compelling physicians to provide services that go against their moral beliefs is unsettling. I agree that patient autonomy is of the utmost importance, however there are ways for that autonomy to be promoted without compromising another person’s conscience. For example, creating an online tool that has physicians register which services they do or do not provide in their practices would be a helpful solution. In this way patients would be able to access the information online and decide which physician or clinic they would like to visit. It would help avoid patients feeling that they are not receiving the care they desire and also protect physicians from violating their moral beliefs.
Once a physician starts participating in activities that they are morally opposed to, due to societal pressure/obligation, there is a strong possibility that in the future they may more easily participate in other actions that they or others consider unethical (i.e. it blurs their moral compass/lines). Having already violated their beliefs once may predispose these physicians to more easily violate their other ethical standards. It may also cause these physicians to be less effective advocates (i.e. they may feel less heard and respected and therefore be less likely to advocate for fairer laws and better patient care). Overall, I feel that although patient autonomy is very important, so is a physician’s right to freedom of conscience and compelling a physician to violate their conscience, and therefore their personal autonomy, is a slippery slope.
Having read and thought the draft policy I have concerns.
I am concerned that you have in incorrect understanding of religion. This incorrect understanding may lead to the policy, as written, having a detrimental effect on the practice of medicine for both a patients and physicians.
The policy, as written, implies that being religious is only part of who we are, meaning that it is something about ourselves that can be turned on or off. This is not true. Religion is really the essence of who we are. This is true for all people. All people have a religion. Religion is behind what each person believes about right and wrong.
As humans, our every action flows from the essence of who we are. This means that every actions flows from what one believes. The Christian Bible put it this way, “out of the abundance of the heart the mouth speaks.” (Luke 6:45) Even if a persons does not speak explicitly of what they believe, if you spend enough time with a person, that person’s beliefs about life will show through.
The nature of Family Medicine is that physicians and patients build relationships with each other over time. The building of relationships cannot be avoided as we humans are relational beings. A significant portion of Family Medicine is based on these relationships. Of course, there are appropriate boundaries that ought to define these relationships, but the underlying values of both the physician and the patient will, over time show through. The beliefs of patients and the beliefs of physicians will affect how they relate to one another.
Some things in medicine, such as sewing up cut fingers, are dealt with in a similar way, no matter what one’s underlying belief system is; while other aspects of medicine are dealt with in different ways depending on one’s belief system. This is especially true of those aspects of medicine that pertain to life and death. Those who really believes that every person is precious from their conception, will not be able to willingly involve themselves in taking a person’s life away. This means they will not be able, without denying the essence of who they are, to involve themselves in things like induced abortions, whether by actually performing them or by referring to someone who will. People, who pursue things like the taking of other people’s lives, can only continue to live with themselves when they believe that such killing is right.
All belief systems have a position on killing. The Christian Bible is clear saying, “you shall not kill.” It says he who kills will be in danger of the judgement. It says, “once to die and after that the judgement.” It says, “God will bring every work into judgment, Including every secret thing, whether good or evil.” Whether you believe these things or not does not change the fact that many people do. Those who believe these things will not without extreme difficulty be able to involve themselves in killing, whether they are physicians or patients.
The policy, as written, is saying that doctors cannot be who they are. This is an unworkable situation. The solution to say that doctors, who do not believe that it is right to kill should not be doctors, would deny patients the right to continue with their doctor whom they have come to trust in spite of, and often because of, what their doctor believes. The policy, as written, will not solve the problem.
What will solve the problem of real discrimination is a true love and concern for other people. The example given in the Bible for Christians to follow, Jesus Christ, reached out and cared for those who many people of that day were treating as outcasts, or, in other words, were discriminating against. He did this because of love.
Rather than implement the policy, as written, that honors belief systems that find killing acceptable at the expense of belief systems that do not, it would make more sense to allow for a more flexible system where physicians are allowed, like patients and everyone in society, to be who they are, rather then someone they are not. If it is felt necessary to direct doctors in order that patients not be misled and be given opportunity to exercise their right to choose treatments that some doctors do not believe in, then it is reasonable to require physicians to explicitly state up front what their underlying beliefs are, so that patients have opportunity to seek out doctors with similar beliefs if they desire to.
I hope this information is helpful and will pray that the Lord guide you in your endeavors.
I do not support any action against a human being.Only God is the owner of all the human life.
I object to forcing Doctors to assist in the suicide requests and to force Doctors to make referrals if they do not perform.
Doctors are here to help us get better. This is what they study for.
The do not study to assistant people to die and have their license terminated , when they do not terminate or refer a person who request for assistant suicide.
As a physician I much appreciate the opportunity to comment on the draft of this policy.
Most briefly, I support, (apart from some reservations about the terminology), the Introduction, Principles, and Purpose of the policy, and most of the Policy section. However, I object to the lines 156-169, namely, the implementation of obligations that a physician has to refer for services or even carry out the services which a physician in good conscience is unable to provide.
I will propose some changes in the terminology and language of the policy and I will offer several arguments why the new obligations, written in the last 10 lines of this policy, are not appropriate and in fact would be dangerous to our patients and society.
The concern I have about the terminology is the repeated use of the expression, “moral and religious beliefs” and “personal beliefs.” The policy leaves out any reference to other beliefs, that are non-religious, and which may be just as important, and it ignores the fact that moral, ethical decisions are much more complex than the term “belief” implies. The terms “moral stance” or “moral position” or in some context, “conscience” may be more appropriate for this policy. Another concern is the expression “duty to accommodate” when referring to health services and at the same time linking it to the Human Rights Code. Because the Code is using the term “accommodation” only when referring to a domicile, a place to live or residence, this creates a confusion for those who wish to study both the College policy and the Code.
I will now review some arguments to justify my objections to the end section of the policy draft.
Firstly, there is no legal or regulatory reasons why the policy should contain provisions compelling physicians to refer for, or provide such care that is in conflict with their conscience, and there are strong reasons against it, among others:
1. Neither the Canadian Charter of Right and Freedoms, nor the Ontario Code of Human Rights require that physicians adopt obligations of which this policy draft is describing in lines 156-169.
2. Contrary, the Canadian Charter of Rights and Freedoms names “freedom of conscience and religion” as “Fundamental Freedoms”, listed prior democratic rights, mobility rights, legal rights and equality rights. Freedom of consciences and religion is not then just one of many rights, to be suppressed or traded readily for a right to receive a particular medical procedure.
3. The Ontario Code prohibits discrimination of individuals and groups on listed personal characteristics. The Code cannot be used to compel a physician to refer or treat when she or he makes a decision not on the basis of personal characteristics of patient requesting the procedure, but on the nature of the procedure itself.
4. The Supreme Court of Canada, in its recent decision, striking down the law prohibiting assisted suicide, stated that nothing in its decision would compel physicians to provide assistance in dying.
5. The Canadian Medical Association General Council meeting in August 2014 voted 91% in favor of a resolution allowing doctors to follow their conscience when deciding whether or not to provide any medical aid in dying.
6. Historical evidence indicates that conscientious objection has been recognized as limiting obligation of citizens in most states and historical periods. When in the past, state laws and apparatus were used to force physicians to violate their conscience, it led to gruesome and reprehensible acts. Under the Communist rule in the Soviet Union, physicians were forced to assist in drugging or liquidating political opponents of the regime. In Nazi controlled Germany, physicians were conscripted for euthanasia of the mentally ill, disabled, ethic minorities and prisoners, and inhumane experimentation.
Secondly, there are strong moral and ethical reasons why the physician should not be obligated to refer or provided a procedure that is contrary to her or his conscience:
1. The policy draft correctly recognizes in lines 114 that physicians have freedom of conscience and religion based on the Canadian Charter. However, later in lines 161- 165 , the draft creates an obligation to refer for a procedure that a physician would not himself or herself offer in good conscience. This already represents for many physicians a cooperation with unethical acts. In addition, lines168-169 would create an obligation to carry out any such procedure under circumstances when some intervention is considered by someone as “urgent or otherwise necessary.” This vaguely formulated obligation, together with the obligation to refer would entirely eliminate the freedom of conscience. This is clearly not an act balancing of rights that is intended in line123, the proposed accommodation is done entirely one way.
2. Freedom of conscience is a core of human freedom and individuality. It has a been a pillar of integrity of the profession, and a policy that would oblige a physician to violate his or her conscience would be harming the profession. It would reduce the physician to a role of a robot/technician, expected to provide a service that a customer is asking, without the physician considering the benefits and harm for that person or others.
2. Decisions of what care to offer that are based on an the informed conscience of a physician are, or should be rational and evidence-based, and ought to incorporate not only the personal values, but also comprehension of impact of various care options on the patient and society. The voice of conscience cannot be dismissed as mere subjective and unscientific “personal beliefs”.
3. Acting on informed conscience is not self serving, it is not just about allowing a physician to follow his “moral or religious beliefs”, as the policy draft seems to suggest. The voice of conscience offers a protection to the patient, actually the most important protection there is, because a regulator cannot be present in all those millions of encounters between patients and physicians. The point is that once a regulator insists on eliminating a role for conscience in one type of decision it will affect the whole practice of medicine. It is the voice of conscience, the pre-existing moral stand, which prevents a physician to recommend a treatment that would be financially advantageous or would improve a physician’s research standing, but not best for the patient, even if it could be carried out with impunity. It is the voice of conscience which prevents physicians from not inflating his or her credentials and capabilities and not over-billing for services. Clearly, “moral flexibility” of physicians, which the policy demands, may be a temporary convenience for some patients at some time but it will place patients at risk and will be detrimental to the whole society. The section entitled Protecting Patient Safety may actually have an opposite effect than the title implies.
4. The policy opening statement refers to the fiduciary nature of the physician-patient relationship, and this is an excellent starting point. However, fiduciary, meaning in good faith, presupposes that the physician has an active, well informed conscience that will lead him or her to act at all times for the sole benefit of the patient. Fiduciary relationship is different from a business relationship in which laws and contracts determine the behaviour of parties. In order to promote a fiduciary relationship, the policy has to inform and support the conscience of the physician rather than make it impossible to one to follow one’s conscience.
I became aware of this policy draft only most recently, and when soliciting opinions of some of my colleagues, I find that most are unaware of these developments. Given that this policy would lead to fundamental re-ordering of physicians’ obligations and surrendering the protection of conscience provided by the Canadian Charter, I would like to suggest, with all respect for the work done so far, that the consultation with the profession concerning this policy be continued until we have a clear, unequivocal, sustainable and well balanced document.
Canadian Centre for Bio-Ethical Reform
Canada is a free country and physicians may have different reasons for not accommodating a patients’ request. I’ve had physicians explain the adverse health effects of hormonal birth control to me, for example, and I’ve had a physician explain she would not accommodate because of her moral code. The same would be the case in other circumstances, such as when it comes to abortion, assisted suicide, sex changes, or circumcision. I have always been grateful for the diversity and well-informed choices our country offers. It is in no way the physician’s responsibility to accommodate me at the expense of medical facts, moral beliefs, religious convictions, or otherwise. Forcing one to do so by way of this policy is an affront to the democratic nature of our country and to the profession of physicians.
Requiring physicians to refer for a service that they are morally opposed to is forcing them to participate. This is completely undemocratic and unCanadian. Additionally, why would we want physicians to leave their moral beliefs at their office door, so to speak? Wouldn’t we want doctors who work within a moral framework? Those who cannot, out of religious conviction, participate in or refer for certain services (e.g. birth control, abortion, etc.) are very often people with Judeo-Christian values which dictate deep respect for all human beings.
It is because of this belief that they cannot help with or refer for services that harm human beings. Regardless of whether I agree or not, this is a huge positive in a profession that promises to do no harm. The CPSO’s draft policy denies all of this and is hugely ideological in the way it leaves professionals without a choice. In a diverse country like ours, it is to be expected that there are different values and ideas about various practices. That should be respected.
* Re: “Physicians must provide care that is urgent or otherwise necessary to prevent harm, suffering, and/or deterioration (i.e.
emergency situations), even where that care conflicts with their religious or moral beliefs.”
At face-value, I would agree with this statement, but when reflecting on the meaning of it, I strongly oppose because it all depends on what is meant with harm, suffering and/or deterioration. A patient may argue that access to abortion would prevent harm to her, but what does that mean? Does it refer to her physical well-being, her financial stability, her emotional state? This is completely unclear. In addition to that, since abortion ends the life of a human being who started his or her life at fertilization, access to abortion does not prevent but actually causes harm to a smaller human being. Considering this, what is the physician to do? Also, what constitutes suffering? Not being able to use birth control because this prevents one from engaging in the type of sex they want? But what if the physician recognizes that the pill, for example, harmful for one’s well-being? (This is one reason my physician does not prescribe–see all the side effects, e.g. stroke, blood clots, etc. I’m grateful he recognizes this and values my physical well-being
more!) There are far too many conflicts and the new policy does not take that into account. We ought to leave it up to the integrity and professionalism of the physician to navigate these issues and discuss them openly with patients, rather than be forced to do whatever the patient requests.
The expectations and requirement in the new draft policy are very broad and will be open to abuse. In a province that already lacks enough health care providers, why does the CPSO requiring competent physicians to abide by their standards, knowing that this will create moral conflict and inevitably result in a loss of physicians as they will not be able to practice medicine when forced to engage in actions that are harmful to other human beings? How does this, in any way, help our healthcare system or us as citizens of Ontario? Please revise your policy and please act in the best interest of the entire public.
Please do not compel a doctor to perform actions or refer patients to other doctors actions which go against their conscience.
It really scares me .
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Christian Medical and Dental Society of Canada and the Canadian Federation of Catholic Physicians’ Societies
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The Evangelical Fellowship of Canada
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