Organization
[May 14, 2021 4:03 PM]
Action Life Ottawa
Good Morning: Action Life Ottawa is an educational pro-life organization counting more than 4,000 supporters in the Ottawa region. Our goal is to foster respect for every human life from conception to natural death. We welcome the opportunity to participate in this consultation on the College's policy on Professional Obligations and Human Rights and Medical Assistance in Dying. We respectfully recommend that the CPSO policy as presently mandated be amended to protect the fundamental freedoms of physicians who hold a religious or conscientious objection to particular services. The objecting physician should not be required to make an effective referral, give contact information of a willing non-objecting physician, nor direct the patient to an agency or point person who will provide coordination for the procedure. Conscientious objectors are not impeding access as patients have other options such as Telehealth Ontario, local clinics and hospitals. A triage system identifying patient queries and matching patients to a non-objecting physician is an acceptable option. In cases of euthanasia, an objecting physician may request a transfer of care and the new physician will make the necessary arrangements for the service. Naturally, physicians will assure the patient of continued care until the transfer is in place. While physicians willingly discuss euthanasia or abortion when raised or requested by the patient, they should not be obliged to present all services as an option or refer in spite of their objections. They would also inform the patient of their refusal to facilitate certain services when the patient enquires about them. Conscientious objectors care about their patients and want to address their concerns and fears. It is most unreasonable to force physician involvement in morally controversial services. Objecting physicians are not abandoning patients, they simply refuse any participation in intentionally causing their death. Conscientious objectors should suffer no discrimination, harassment or punishment for refusing to do what they believe to be wrong, injurious and detrimental. There should be no duty to inform about all clinical options or services available when they are deemed inappropriate, harmful to the patient, against the physician’s professional judgement, conscience or religious beliefs. The Physicians Alliance Against Euthanasia - Collectif des medecins contre l’euthanasie stated regarding the College of Physicians and Surgeons of Ontario’s policy: “The violence of the obligation to “inform” goes even beyond that of “effective referral” itself. Every patient who fits the criteria for euthanasia must be subjected to the terrible stress and doubt of learning that he or she belongs to that select group of people for whom medically-inflicted death has become an option. And no objection of judgement or of conscience can free the doctor from delivering that terrible message and its implicit suggestion.” (1) Discussion about euthanasia should be initiated by the patient not the physician. The risk of undue influence on vulnerable patients is real and the offer or suggestion of euthanasia made by the physician may be perceived by patients as euthanasia being the response to their medical condition. Consider that media reports have brought to light accounts of hospital staff exerting pressure in the direction of euthanasia on patients with disabilities. CTV News reported on the case of Roger Foley, a then 42-year-old man living with cerebellar ataxia, having been offered euthanasia when he was seeking assisted living services: According to Foley’s statement of claim, the only two options offered to him have been a “forced discharge” from the hospital “to work with contracted agencies that have failed him” or medically assisted death. Refusing to leave the hospital and unwilling to die by a doctor’s hand, Foley claims he has been threatened with a $1,800 per day hospital bill, which is roughly the non-OHIP daily rate for a hospital stay... According to Trudo Lemmens, a professor and Scholl Chair in Health Law and Policy at the University of Toronto’s Faculty of Law, Foley’s allegations -- if true -- are “very troubling.” “If true, we would have here an instance of a patient receiving an offer for MAID (medical assistance in dying) while the patient precisely complains about receiving substandard levels of care,” Lemmens said in an email to CTV News. “MAID should not be introduced as an option to someone who complains about sub-standard care and, clearly not to someone who is suicidal.” (2) Additionally, Catalina Devandas Aguilar, United Nations Rapporteur on the Rights of Persons with Disabilities expressed in her report following a visit to Canada: I am extremely concerned about the implementation of the legislation on medical assistance in dying from a disability perspective. I have been informed that there is no protocol in place to demonstrate that persons with disabilities have been provided with viable alternatives when eligible for assistive dying. I have further received worrisome claims about persons with disabilities in institutions being pressured to seek medical assistance in dying, and practitioners not formally reporting cases involving persons with disabilities. I urge the federal government to investigate these complaints and put into place adequate safeguards to ensure that persons with disabilities do not request assistive dying simply because of the absence of community-based alternatives and palliative care. (3) Hospices have also been subjected to coercion because they will not allow euthanasia on site. Serenity Hospice in North Bay was pressured by four euthanasia practitioners because the hospice would not permit euthanasia (MAID) on its premises. The North Bay Nugget reported: It is “unconscionable” that medical assistance in dying (MAiD) is not allowed at the Nipissing Serenity Hospice, the four doctors who perform the procedure say in a letter to the hospice’s board of directors...The four medical providers of MAiD say they “absolutely disagree” with the hospice’s position that MAiD “is not one of the tools in the palliative care basket.”...The doctors “suggest that the community be engaged and see what its position is on a publicly funded facility that denies MAiD to patients in hospice care. (4) The Delta Hospice Society had its assets seized and staff fired by the government of British Columbia due to its refusal to offer euthanasia in its facility. Both hospices followed the longstanding practice of palliative care endorsed by the Canadian Hospice Palliative Care Association and the Canadian Society of Palliative Care Physicians which seeks to help patients live as fully as possible, relieve pain and suffering until natural death. Euthanasia advocates are pushing for the inclusion of euthanasia within palliative care in spite of it being in direct opposition to the philosophy of palliative care. The Physicians Alliance Against Euthanasia reports that objecting physicians are being targeted: The Physicians Alliance against Euthanasia has received reports that unwilling physicians are being pressured and bullied to participate in Medical Assistance in Dying (MAiD): euphemism for euthanasia and assisted suicide. Fearing reprisals, physicians have asked that no information that could identify them be disclosed. The pressure has been intense for many physicians, especially amongst palliative specialists, some leaving even before this latest development. Descriptions were made of toxic practice environments and fear of discipline by medical regulators... The reports we are hearing from distressed physicians describe deliberate disruption of arrangements that were previously working satisfactorily and that had permitted patients to have access to MAiD while still allowing for conscience objectors to not be involved in facilitating the patient’s death. This bullying and betrayal of collegial relationships can poison practice environments and compromise patient care. Such behavior should not be tolerated by health care administrators in Canada. (5) Action Life believes the public interest can best be served by offering robust conscience rights protection for physicians. Patients have an equal right to receive care in a euthanasia free zone from a physician who will not suggest or introduce the topic of euthanasia. Some patients fear being treated by physicians who are euthanasia practitioners or being hospitalized in an institution where euthanasia is permitted. These situations may result in distress for the patient and a lack of trust between patient and physician. Concerning the medical assistance in dying policy, it is astonishing that physicians who euthanize patients are required to falsify death certificates by listing the underlying illness as cause of death rather than the actual cause, euthanasia. The World Medical Association (WMA) retains its opposition to euthanasia stating: The WMA reiterates its strong commitment to the principles of medical ethics and that utmost respect has to be maintained for human life. Therefore, the WMA is firmly opposed to euthanasia and physician-assisted suicide. Concerning referrals for euthanasia, the WMA says: “No physician should be forced to participate in euthanasia or assisted suicide, nor should any physician be obliged to make referral decisions to this end.” (6) The Canadian Medical Association in its 2016 submission to the College wrote: The argument that only mandatory referral puts patients' interests first or respects patient autonomy − and that not making a referral does not − is fundamentally erroneous. Action Life recognises that referrals present the objecting physician with a sense of complicity and cooperation with the procedure. We remain strongly opposed to effective referrals as they violate the most basic freedoms, the right to be free from coercion and to live and work fully in accordance with your conscience or religious beliefs. They are equally detrimental to the dignity and professional integrity of physicians who are not mere automatons forced to acquiesce to patient demands. Objecting physicians wish to practice medicine in accordance to the Hippocratic tradition which enjoins physicians to never participate in the intentional death of a patient. The Ontario Medical Association and the Canadian Medical Association both support conscience rights protection. We encourage the College to provide this protection in its policy. 1- https://collectifmedecins.org/en/conscience-and-canadian-doctors/ 2- https://www.ctvnews.ca/health/the-solution-is-assisted-life-offered-death-terminally-ill-ont-man-files-lawsuit-1.3845190 3- https://www.ohchr.org/EN/NewsEvents/Pages/DisplayNews.aspx?NewsID=24481 4- https://www.nugget.ca/news/local-news/controversy-emerges-at-new-hospice. 5- https://collectifmedecins.org/en/press-release-2/ 6- https://www.wma.net/policies-post/declaration-on-euthanasia-and-physician-assisted-suicide/&LangID=E (World medical Association Declaration ON EUTHANASIA AND PHYSICIAN-ASSISTED SUICIDE, Adopted by the 70th WMA General Assembly, Tbilisi, Georgia, October 2019
Organization
[May 14, 2021 3:02 PM]
Christian Legal Fellowship
Response in PDF format.
Organization
[May 14, 2021 12:09 PM]
Christian Medical and Dental Association of Canada (CMDA)
Response in PDF format.
Member of the public
[May 13, 2021 10:07 PM]
I respectively disagree. Simply because the Court of Appeal ruled in favour of the College – i.e. that the effective referral requirement was found to be permissible or justified in the given case that was argued does not mean that it is necessarily the only or best way to balance those rights. There can still be a discussion regarding concerns and better ways to address the issue. Regulation and legislation can always be improved or modified based on experience, values, and input of the public. I’ll also point out that Courts in many countries in the past have upheld or found things justified that today we would find discriminatory, unjustified, or non-ideal. We need to respect the Courts, but just because something was ruled one way does not mean that there should be no input or request for change/improvement.
Member of the public
[May 13, 2021 9:49 PM]
My response focuses on three aspects of the policy: effective referrals, emergency care, and discussion of religious beliefs: <> I object to the CPSO requiring conscientiously or religiously objecting physicians to provide an effective referral. I know of religious and consciously objecting groups for which providing such a referral is morally impermissible, and in speaking with them I have come to understand and respect why that is the case – and to agree with that position. As a patient I do not want any physician (or any person) to be placed in the position whereby they are forced to violate their conscience, including forcing them to take positive action to connect someone to another person or agency that will do something they believe is wrong. I accept that this could make finding a service a bit more challenging for me in a situation where I morally accept a service but my physician objects – but it is worth it to respect the views of others in a multicultural society such as Canada. Overall, I do not see the effective referral requirement as being in the public interest. I request that CPSO investigate other ways of enabling patient access when there is conscientious objection and to remove the effective referral requirement. In addition, I would like to raise the following points, which contribute to my objection to this portion of the policy: 1. The effective referral requirement will dissuade and may effectively bar individuals who conscientiously object from practicing medicine in our province – especially as general practitioners/family doctors but also, with the legalization of MAID, potentially in other disciplines/specialties as well. Further, as a result: 1a) It ends up becoming de-facto institutionalized discrimination against people belonging to religious groups that would conscientiously object to a given procedure or service. I find it disturbing and reprehensible that a policy that should protect against discrimination ends up being itself discriminatory. 1b) Conscientiously objecting physicians may service a particular community or group of people who share their values. In having a policy which will effectively bar, dissuade, or make it challenging for such physicians to practice – especially if it affects their ability to practices as general practitioners – it disadvantages those patients. In some cases, the lack of a conscientiously objecting physician may even create a partial impediment or barrier to people from these groups seeking medical advice/treatment. Thus, the requirement goes against one of the presumed goals of the policy. 1c) It may risk stifling innovation in the medical field. When the primary way of addressing a given medical issue is morally impermissible to a conscientiously objecting physician and their associated philosophical or religious group, it provides an impetus to find alternative ways to address that underlying medical issue. This can drive innovation by that physician. 2. Patient autonomy and patient rights could be supported in other ways besides requiring an effective referral. To name a few –services that connect patients to physicians, support groups or organizations for patients with specific conditions, connection groups organized by those who do not object that connect patients to specific services, listings of physicians that offer a given service, etc. <> Section 17 of the policy notes that “Physicians must provide care in an emergency, where it is necessary to prevent imminent harm, even where that care conflicts with their conscience or religious beliefs.” As mentioned above –people should be forced to violate their consciences or religious beliefs. This is the case even and especially in emergency situations. As a result, I oppose the portion of this section that states that physicians must provide care “even where that care conflicts with their conscience or religious belief.” That being said, it is reasonable to require physicians to help in emergency situations to the degree that they are able. I request that this section be modified to read: “Physicians must provide care in an emergency, where it is necessary to prevent imminent harm. Where that care may conflict with their conscience or religious beliefs, they are to provide any care that they are able to and to the degree that they are able given their conscience or religious beliefs.” <> Section 11 of the policy notes that: “Furthermore, physicians must not promote14 their own religious beliefs when interacting with patients, or those seeking to become patients, nor attempt to convert them.” Endnote 14 states “This includes implying that the physician’s religion is superior to the patient’s beliefs (spiritual, secular or religious).” I request CPSO add a clarification in the endnotes to the effect that “This is not intended to bar physicians from discussing their beliefs or aspects of it, including why they believe and what implications it has, when asked by a patient or when a patient indicates an openness to such as discussion.” Physicians deal with patients at some of the most life changing parts of their lives – moments where life’s larger questions of meaning, purpose, and whether there exists something beyond this mortal life, etc. can come to the fore. When facing the prospect of a life changing or terminal diagnosis or navigating through life a patient may wish to ask a physician what they believe, how they would cope, etc. It needs to be possible for a physician and patient to have a free and authentic discussion about these topics when the patient requests or is open. A patient should also be able to have a discussion about these matters as the physician-patient relationship develops if both they and the physician are open to it. Again, personally as a member of the public and a patient, I would like the option to be able to discuss (if my physician at the time is open to it) what they believe in order to better understand them and to inform my own thinking.
Member of the public
[May 13, 2021 9:35 PM]
In every abortion, the child is deliberately dismembered or poisoned. Doctors should not be killing children, and the medical establishment should be researching better treatment for the relatively rare ectopic pregnancy--for which, I note, even through current procedures, the intent is not to kill the child but to save the mother. As promotion of "abortion rights" manifestly incites violence, please outlaw any "treatment" based on the underlying personal beliefs. Abortion harms both the mother and the child.
Member of the public
[May 13, 2021 9:07 PM]
Actually, the CPSO is far more corrupt than you indicate. As reported by LifeSiteNews, the CPSO has said it will investigate doctors who post on social media their opposition to COVID-19 lockdowns, controversial public health measures, and vaccines. CPSO will also investigate their promotion of "unproven treatments for COVID-19." In a statement issued April 30, the College of Physicians and Surgeons of Ontario (CPSO) said that there have been "isolated incidents of physicians using social media to spread blatant misinformation and undermine public health measures meant to protect all of us." Far worse than the CPSO's craven promotion of and blind subservience to the civil government's quixotic "war" on a virus much like the flu is its eager support of the killing of the human fetus, the human nonagenarian, the human imbecile--any vulnerable person whose quality of life is considered or might be deemed substandard by others. The CPSO RELIES ON LIES for their propagation of this violence, e.g. the human fetus is not considered a person under the Criminal Code of Canada; and the CPSO REQUIRES LIES, e.g. the physician who administers MAiD must report on the death certificate something other MAiD as the cause of death. The CPSO will actually TAKE AWAY THE LICENSE of any doctor who refuses to participate in this violence.
Organization
[May 13, 2021 11:38 AM]
Ontario Medical Association
Response in PDF format
Organization
[May 13, 2021 8:30 AM]
Ontario Association for ACT and FACT (OAAF)
Response in PDF format.
Member of the public
[May 13, 2021 8:12 AM]
As we endure another stay at home order, I find myself reading about CPSO Professional Obligations and Human Rights policy. If the CPSO council has not publicly denounced the quarantine of healthy people, and I cannot find evidence of such a denouncement, they have no authority to postulate about "human rights".
Organization
[May 12, 2021 4:15 PM]
Canadian On Paper Society for Immigrant Physicians Equality, AND Foundation for International Medical Graduates, AND Create a PATH for International Medical Specialists to practice in Canada
Response in PDF format
Organization
[May 11, 2021 9:00 AM]
Society for Canadians Studying Medicine Abroad
The Human Rights Code contemplates that all social benefits and employment be available to all sectors of society so that all Canadians, old and new, have an equal opportunity to access and participate in all aspects of our society based on merit. Access to licensing so one can practice one's profession is perhaps one of the most fundamental of opportunities which goes to the heart of worth and dignity. The Colleges of Physicians and Surgeons across Canada have allowed the Ministries of Health and the Faculties of Medicine which jointly administer postgraduate medical training, to use this gateway to the profession to further interests which are unrelated to the competence of the individual. As a result Canadians who are international medical graduates are not afforded equal opportunity. They are marginalized and sidelined. Canadians who are international medical graduates are prohibited from applying for all but 10% of the entry level jobs to the profession (residency training positions) which are mandatory to become licensed for most international medical graduates. Not equal opportunity. There is literally no access in some disciplines for international medical graduates. Not equal opportunity. The positions that are available are largely in the underserviced disciplines which also tend to be on average lower paying. Not equal opportunity. And just to ensure that there is no issue about hierarchy in the medical profession, international medical graduates in all but two provinces can only accept residency positions that we have matched to after overcoming significant barriers, if we sign what is euphemistically called a return of service contract. This is a contract which amazingly, considering we are in Canada, but objectively, meets the definition of indentured servitude where one must pay off a debt by working on the terms of the master. This is a contract which separates or uproots families and takes away their right to choose how and where to live their lives. There is no similar debt obligation assigned to graduates of Canadian and American schools even though the education of Canadian medical school graduates has been significantly subsidized by taxpayers of the various provinces. There is also a double standard. While international medical graduates must pass and excel in the Medical Council of Canada Qualifying Examination Part 1 (MCCQE1) to be eligible and competitive for an entry level job to work as a resident physician, graduates of Canadian and American medical schools are free to fail this examination and work as resident physicians. The latter need only pass this examination in order to become fully licensed. The MCCQE1 is designed to determine whether a graduate has the critical medical knowledge and decision-making ability expected of a graduate of a Canadian medical school. The CPSO and all other provincial Colleges mandate a medical degree, and likely recognize that LCME accredited medical schools have a policy against failing weak students. Yet despite the fact that 3% 5o 5% of graduates of Canadian medical schools fail the MCCQE1 each year, neither the Colleges, nor the Ministries, nor Faculties of Medicine, require that graduates of Canadian or American medical schools pass the MCCQE1 before beginning work as resident physicians. If the limitations in the medical regulatory process were placed on a race or a religious group instead of international medical graduates, none of us would have difficulty recognizing that this process does not provide equal opportunity nor recognize the dignity and worthiness of this sector of society. Why is this not apparent if we substitute international medical graduates (comprised probably of 20-30% Canadians studying medicine abroad and 70-80% immigrant physicians with the majority being people of colour)? Is it time to begin the uncomfortable process of consciousness and discussion? We respectfully respect a platform from the CPSO where we can talk.
Physician (including retired)
[May 11, 2021 8:07 AM]
Note: the attached response was signed by First Nations representatives, Indigenous physicians, other health care workers, and members of the public. Response in PDF format.
Physician (including retired)
[April 29, 2021 7:45 PM]
The matter of effective referral was settled in the Ontario Court of Appeal. The appellants decided not to attempt an appeal to the Supreme zcourt because they were aware of the outcome going against them again. One notes in the comments a reframe that ignores this. They still expect the College to go against the rule of law in Canada which they would otherwise vociferously uphold as sacred. Righteousness is not the way to meet the vulnerable folk we care fir. Canada balances rights as the policy makes plain. When rights are in conflict, no. One sill leave fully satisfied. The scollego has walked the valence, the courts have affirmed and it is time to move on.
Organization
[April 27, 2021 9:33 PM]
Protection of Conscience Project
Response in PDF format.
Organization
[April 26, 2021 2:39 PM]
Catholic Health Association of Ontario
Response in PDF format.
Member of the public
[April 26, 2021 8:56 AM]
I have so many issues with the above statement. First, decisions based on conscientious objection are entirely different from decisions based on clinical and professional opinion. The two decision making processes are mutually exclusive. Second, patient care IS jeopardized when physicians don’t make effective referrals, for ANY reason. Third, the statement that patients can usually get what they want through another channel is tacit approval of abandoning patients, assuming that they will “usually “ be able to navigate a complex system on their own, without the help of the professional whose assistance they sought in the first place.
Physician (including retired)
[April 24, 2021 7:47 PM]
It's important that physicians respect the rights of patients, but the rights of physicians and patients should be equally respected and valued. Physicians should have the right to conscientious objection which is often based on clinical and professional opinion. I don't think patient care is jeopardized when physicians don't make effective referrals for these issues. Patients are usually able to still get what they want through another channel.
Member of the public
[April 22, 2021 1:09 PM]
Dear Minister Elliot, I am writing to ask you to support legislation for conscience protection and regulation of Medical Assistance in Dying (MAiD), so that no physician–or other regulated healthcare professional, such as a nurse practitioner, registered nurse or social worker–is obliged to raise MAiD as a treatment option or to refer a patient directly to another health professional for the purpose of receiving MAiD. My reasons for this request are numerous and as follows: -Bill C-7 will place persons at risk for wrongful deaths. Patients should have their suffering addressed by good medicine and support. -Medically administered death for life-suffering, instead of resources and medical care to live, is unconscionable. That amounts to abandoning patients at their lowest point, when they need help the most to find ways and reasons to go on living when things get difficult. Difficulties, and learning to overcome them, are an integral part of life, and various healthcare professionals have been well-trained to help patients with coping, to improve their resilience and their quality of life physically, mentally, emotionally and spiritually. -The College of Physicians and Surgeons of Ontario currently requires physicians to create a pathway for MAiD. -To have a policy that forces some health care professionals to violate their conscience is discriminatory against members of the profession who do not believe that death is a good treatment option for people with disabilities, chronic illness and mental illness. -Patients receive better care when their doctors are free to act with integrity. A patient should know that they are being offered what the doctor truly believes to be appropriate and the best clinical care, not what the doctors have been coerced into doing via threat of disciplinary action. I have worked on the front lines of healthcare for the past 30 years. I have worked in a setting that has regularly provided euthanasia aka MAiD ever since it became legal in 2016. So I speak from extensive experience. Requests for MAiD and deaths by MAiD have increased over time; at least in my work setting i.e. palliative care, MAiD is far from a rare occurrence these days. It will no doubt continue to increase as long as legislation keeps expanding MAiD to include more groups of people e.g. the disabled, mentally ill, seniors who feel they’ve lived long enough, mature minors, and younger minors whose parents choose death on their behalf. This is especially likely to be the default choice of too many Canadians as long as there is no significant improvement to the availability of services that enhance the health and quality of life of Canadians with terminal illness, disabilities or mental illness, frail elderly people, people in long-term care, etc. Especially those who are marginalized in one or more ways. Since euthanasia was decriminalized in 2016, I have witnessed highly skilled and experienced palliative care professionals, including physicians–who are in short supply at the best of times–leave their area of specialty so as not to have to deal with MAiD, given their philosophical and/or moral objection to it and the pressures placed on them legally and professionally. Some have left their profession entirely. Others, including myself, have “retired” earlier than we planned to or wanted to, because of undue pressure to act against our conscience when it comes to MAiD in the course of our practice. Still others have moved on to other professions, or from front line clinical work to research work, in order to “get away from” the pressures unduly imposed upon them by current legislation re:MAiD. It is unjust and oppressive to expect healthcare professionals with conscience objections to MAiD to have anything to do with it, including discussing it at length with a patient or making “an effective referral.” This can result in serious moral distress for practitioners and cast a pall on the good work they do to help patients live with the best possible quality of life, whatever circumstances in which they find themselves. There are enough healthcare professionals who are supportive of MAiD that they should be the only ones to have to address it in any way with patients. This will respect and protect the conscience rights of physicians and other healthcare professionals, who do not wish to feel complicit in what they perceive to be wrongdoing i.e. helping to end a patient’s life unnaturally–a practice that is highly controversial, including in ethics circles and among healthcare professionals of all disciplines, regardless of what their official governing body may say to the contrary. Conscience rights are supposed to be protected under Canada’s Charter of Rights and, in my province of Ontario, the Human Rights Code. This has yet to be allowed in practice. Please support full protection of the conscience rights of physicians and other healthcare professionals to not be involved in assisting a patient in any way, to any degree, to access MAiD. That is the right and fair thing to do.
Member of the public
[April 22, 2021 12:58 PM]
Here is what the Australian province called Victoria, does for their “conscientious objectors”: “There is strong protection in the legislation for health practitioners with a conscientious objection to voluntary assisted dying. Section 7 of the Act states that “[A] registered health practitioner who has a conscientious objection to voluntary assisted dying has the right to refuse to do any of the following (a) to provide information about voluntary assisted dying; (b) to participate in the request and assessment process; (c) to apply for a voluntary assisted dying permit; (d) to supply, prescribe or administer a voluntary assisted dying substance; (e) to be present at the time of administration of a voluntary assisted dying substance; (f) to dispense a prescription for a voluntary assisted dying substance”. There is no requirement for health professionals with a conscientious objection to voluntary assisted dying to refer patients on to a willing practitioner.” Parliament of Victoria: Voluntary assisted dying act (2017). https://www2.health.vic.gov.au/hospitals-and-health-services/patient-care/end-of-life-care/voluntary-assisted-dying/vad-overview.2Accessed 21 Nov 2018.
Member of the public
[April 22, 2021 12:20 PM]
• Bill C-7 will place persons at risk for wrongful deaths. Patients should have their suffering addressed by good medicine and support. • Medically administered death for life-suffering instead of resources and medical care to live is unconscionable. • The College of Physicians and Surgeons of Ontario currently requires physicians to create a pathway for MAiD. See Fletcher, J. CMAJ2015 editorial. • To have a policy that forces some health care professionals to violate their conscience is discriminatory against members of the profession who do not believe that death is a good treatment option for people with disabilities, chronic illness and mental illness. • Patients receive better care when their doctors are free to act with integrity. A patient should know that they are being offered what the doctor truly believes to be appropriate and the best clinical care, not what the doctors have been coerced into doing via threat of disciplinary action. • Canada is a diverse democracy. Manitoba followed Dr. Fletcher’s plan. Liberal democracies are meant to understand that we are not all alike, and accommodations should be made when possible.
Physician (including retired)
[April 22, 2021 9:42 AM]
Good Morning! The issue of MAiD has been a matter of controversy for quite some time. I have put a lot of thought into the matter and submitted a document as below to discuss the principles that relate to the respect of physician conscience in a pluralistic society. Included are suggestions how the CPSO could balance the disparate societal pressures in an equitable and ethical way. Please take time to read this—I know there is a lot to process!
Member of the public
[April 22, 2021 8:07 AM]
I know you are in the process of updating your policies on conscience rights for doctors and I earnestly ask you to word your statement so no medical staff should ever be asked to go against their conscience. This means proscribing any medication, providing MAID, being obliged to provide information about procuring MAID. This does not mean that a person who wants death cannot have it, but they cannot oblige another person whose conscience does not permit them to kill a person intentionally be obliged to do so. If, as the advocates are so vocal about the right to have it, let the medical staff who are willing to perform this deed advertise. In this day and age when it has become clear that the drug cocktail used to kill the person has been banned from executions in the US for being inhumane, and now a similar method is used for MAID, then it should stop being used until at least a fool proof way of non-suffering death is found. People have taken up to 36 hours of excruciating pain to die in some cases, as your studies show. How can medical staff tolerate this abuse of people in the name of "dying with dignity"? Please protect doctors who wish to follow their conscience. Let those who are willing advertise.
Organization
[April 13, 2021 2:07 PM]
Council of Canadians with Disabilities
Response in PDF format.
Organization
[April 07, 2021 9:31 PM]
Physicians Together With Vulnerable Canadians
Response in PDF format.
Organization
[April 07, 2021 9:22 AM]
Orthodox Rabbis of Ontario
Note: Some content has been edited in accordance with our posting guidelines. As community rabbis, we write on behalf of ourselves and our Jewish communities to express our very grave concerns about Bill C-7 and the expansion of “medical assistance in dying” (MAiD). One of Judaism’s fundamental precepts is the value of human life. Indeed the current COVID-19 pandemic has shown us the great lengths the world has gone to protect the most vulnerable amongst us. Yet, Bill C-7 endangers the lives of some of these very same vulnerable Canadians. The impending enactment of Bill C-7, along with the CPSO’s policy on requiring participation or facilitation of MAiD poses grave religious and moral issues to members of the Jewish faith. As it now stands Bill C-7 would mean observant Jews who are health care workers will either no longer be welcome in the medical field or will be forced to abandon their deeply held beliefs. Therefore, we are reaching out to ask for the following: 1. We ask that only patients initiate MAiD discussions, and the doctor should never bring it up as a treatment option (to avoid subtle patient coercion in the context of despair or suicidality). 2. We ask for stronger conscience rights for medical professionals to refrain from participating directly and indirectly in MAiD if they so choose. Canada has always been a compassionate nation where all of its citizens are welcome and protected. We ask that you continue to respect and protect the plurality and diversity of all Canadians. Sincerely, [redacted]
Member of the public
[April 05, 2021 9:11 PM]
To answer the second part of the above comment, providing an "effective" referral is already an accommodation of objectors - it's already a compromise of patients' right to healthcare. Referrals are a basic duty of doctors, and if a doctor can't even refer someone appropriately because of their personal beliefs, why are they a doctor? If some doctors are pushed out of practice because they refuse to provide essential healthcare including referrals, others with more integrity can and should replace them. The writer arrogantly states in relation to refusing to refer: "This has been the case for over 50 years of legalized abortion and it has never been a problem." But non-referral DOES harm patients by putting obstacles and delays in their way. Some patients may be unable to find another doctor or resource to help them. A lawsuit by Christian medical groups and doctors was decided in CPSO's favour in 2019. The Court unanimously ruled that patients’ rights to equitable access to medical services outweighs a physician’s freedom to refuse providing care on religious grounds. One important consideration was the vulnerability of many patients who might be unable to find alternative care on their own or in a timely way.
Member of the public
[April 05, 2021 8:58 PM]
The problem with this argument is that the majority of services objected to in Canada are in sexual and reproductive healthcare, which is primarily delivered to women and gender minorities. Only women need abortions and hormonal birth control. Only transgender people need gender-affirming surgery. Therefore, refusals of such treatments amount to discrimination. The supposed distinction between discriminating against vulnerable groups vs. refusing certain treatments is illusory, because these treatment refusals have discriminatory effects. The Supreme Court of Canada has ruled that the equality clause of the Canadian Charter of Rights and Freedoms (S.15) guards against not only direct discrimination, but acts that result in discrimination, regardless of intent. In the court's very first equality decision, Andrews v Law Society of British Columbia, [1989] 1 SCR 143, the court said: "Discrimination may be described as a distinction, whether intentional or not but based on grounds relating to personal characteristics of the individual or group, which has the effect of imposing burdens, obligations, or disadvantages on such individual or group not imposed upon others, or which withholds or limits access to opportunities, benefits, and advantages available to other members of society." (at 174-175, McIntyre J).
Organization
[April 05, 2021 10:56 AM]
Abortion Rights Coalition of Canada (ARCC)
Note: Some content has been edited in accordance with our posting guidelines. Dear College of Physicians and Surgeons of Ontario, I am [redacted] of the Abortion Rights Coalition of Canada. Thank you for the opportunity to provide feedback on your Professional Obligations and Human Rights policy. I have two recommendations to make. 1. Please reframe your policy to remove any reference to “conscience”-based refusals as a "right." Your policy says that physicians have a "right" to limit the health services they provide for reasons of conscience or religion. But this contradicts international human rights agreements and the World Health Organization, none of which characterize so-called "conscientious objection" as a right. Instead, they warn about the harms it often causes to patients and call for limits on its exercise. Further, in 2017, an expert group of 45 global experts arrived at a majority consensus that healthcare professionals should not be allowed to refuse care based on their personal or religious beliefs. Please see here for more info: • What International Human Rights Groups and Agreements, and Global Health Orgs, Say About “Conscientious Objection” in Healthcare: http://www.conscientious-objection.info/wp-content/uploads/2020/12/Intl-groups-agreements-CO.pdf • Expert group denounces the refusal to treat under 'conscientious objection' https://rabble.ca/columnists/2018/07/expert-group-denounces-refusal-treat-under-conscientious-objection While there is a general right to freedom of conscience, this does not equate to doctors having a “right” to refuse to do part of their jobs. Patients' right to healthcare must always be prioritized – not "balanced" with the “right” of doctors to refuse it, as the latter are in a position of trust and authority and the burden of refusal is placed on patients. Doctors take an oath to provide healthcare to patients – if they cannot fulfill part of their fiduciary duty to patients because of personal beliefs, they can exercise their right to conscience by transferring to a field where their objection won’t be an issue, or by pursuing another profession entirely. Further, treatment refusals due to “conscience” cannot be a “right” because they are often discriminatory. Most services objected to in Canada are in sexual and reproductive healthcare, which is primarily delivered to women and gender minorities. Only women need abortions and hormonal birth control. Only transgender people need gender-affirming surgery. The supposed distinction between discriminating against vulnerable groups vs. refusing certain treatments is illusory, because these treatment refusals have discriminatory effects, which the Supreme Court has said violates the Charter, Section 15(1). 2. Please add monitoring and enforcement measures to your policy and implement them. Doctors who would refuse treatment because of their personal beliefs are also likely to mistreat patients in other ways, regardless of any "musts" in your policy. For example, many doctors who are against abortion will simply flout your policy and never make any kind of referral. The CPSO has made an unwarranted assumption that it simply needs to enact a policy and objectors will obey it. I could not even answer your online survey due to its assumption that the ‘musts’ and ‘must nots’ are somehow the final answer. In fact, such language is futile when you’re up against religious beliefs. Many doctors will simply refuse to obey your policy and indeed are already doing so since they know they can get away with it – because there is no enforcement. The CPSO must implement another mechanism besides patient complaints because most patients won't complain for various reasons, including fear and stigma. I want to stress the harms to patients because of so-called “conscientious objection.” In 66 examples of such doctor refusals around the world that resulted in serious harm or injustice or death, researched by myself and my colleague [redacted], (http://www.conscientious-objection.info/category/victims-of-co/), most were accompanied by further abuse and mistreatment regardless of law or policy designed to prevent that. For example, objectors often treat abortion-seeking patients rudely and disrespectfully, refuse to refer, violate their privacy, and of course refuse care or referrals. In serious cases such as in Italy, doctors have refused to provide life-saving care in violation of the law: https://www.safeabortionwomensright.org/news/italy-seven-doctors-on-trial-for-manslaughter-in-the-death-in-sicily-of-valentina-milluzzo-in-2016/ I have been informed of such mistreatment in Canada as [redacted] of the Abortion Rights Coalition of Canada, when women tell us about their encounters with rude and judgmental objectors. [redacted] [redacted] and I have compiled some suggestions of measures that could be taken: • Require all objectors to register so they can be monitored. • Require all objectors to file a report every time they refuse services based on their personal or religious beliefs. • Investigate any inadequate or problematic reports. • Randomly conduct regular audits on objecting doctors. • Discipline those who violate the policy. • Develop a more robust disciplinary policy (one that does not rely solely on patient complaints). • Make the complaint process easier for patients, such as preventing the doctor from learning the complainant’s identity. • Hold objectors financially liable for any harms done to patients. • Prohibit existing objectors from working alone, especially in small communities where they are the only physician. • Encourage employers to prioritize hiring of non-objecting physicians, and to pay objecting physicians less. • Engage in public advocacy to encourage complaints when doctors refuse care or referrals – e.g., create a brochure for doctors’ offices, post easy instructions on your website, and publish media articles. To conclude, please: • Remove any reference to a “right” to refuse treatment based on personal beliefs. • Add monitoring and enforcement measures to your policy and implement them. Thank you very much. [redacted] Abortion Rights Coalition of Canada (ARCC) [redacted]
Organization
[March 31, 2021 7:37 AM]
Canadian Society of Palliative Care Physicians
Response in PDF format.
Member of the public
[March 21, 2021 9:15 PM]
I submitted comments through the CPSO survey tool on this consultation. The additional comments below focus on specific language. These comments are not designed to change the scope or meaning of the policy. Rather, they are designed to improve its clarity and effectiveness. 1. Sections 6 to 9. The policy is structured to imply that there are two reasons that physicians may refuse: (a) for reasons of clinical competence and (b) for reasons of conscience or religion. The policy misses an important third category. Here, the physician may not refuse for either competence or conscience, yet conscience still affects the physician’s judgment. For example, a physician morally uncomfortable with MAID may determine that the patient lacks capacity because they more rigorously test capacity when it comes to MAID. This bias may not even be conscious. But it is real, and the policy should do more to warn against it. I recognize that Section 2(b) warns against this in prohibiting discrimination when “providing existing patient with health care or services.” Later sections warn about providing full and complete information. But the policy could be more explicit in warning against allowing conscience to affect or corrupt medical judgment. Outright refusals are not the only way in which conscience and religion can affect patients. 2. Section 8. This language says: “physicians must provide a referral.” But since you already defined a specific term, “effective referral,” it seems appropriate to use that term here. 3. Section 8. You suggest that refusing a prospective patient can be “abandonment.” But abandonment applies only after formation of a treatment relationship. It does not apply when the physician refuses to form a relationship in the first place with “those seeking to become patients.” Physicians do not normally owe duties to non-patients. I understand that CPSO is adding the duty to refer when refusing to accept a patient. That is fine. But the explanation or rationale for imposing that duty should not be abandonment. 4. Section 17. The emergency exception is stated categorically: “must provide care in an emergency.” What if the objecting physician can find a timely substitute? The Advice document suggests that so long as the patient “will not experience an adverse clinical outcome,” the original physician has made an “effective referral.” 5. Endnote 2. The definition of “available and accessible” seems incomplete given the objectives. The referral location may be geographically convenient and “accepting patients.” But how soon can the patient be seen for the relevant service? The Advice document also focuses on only the timing of the “referral” and “connection” but not on timing of the actual health service.
Organization
[March 18, 2021 2:44 PM]
Canadian Medical Protective Association (CMPA)
Response in PDF format.
Physician (including retired)
[March 15, 2021 8:55 AM]
To avoid economic martyrdom we urge the CPSO to give MD conscience rights.
Organization
[March 11, 2021 4:43 PM]
Office of the Information and Privacy Commissioner of Ontario
Response in PDF format
Physician (including retired)
[March 08, 2021 11:34 PM]
I think it is correct to insist that physicians not discriminate against patients because of some personal characteristic such as sex or age or ethnicity. This is very different from a physician choosing to limit their practice for reasons of belief or conscience. This physician is not discriminating against patients, they are simply choosing which services they can offer in good conscience and which they cannot. Surely the vast majority of patients respect a physician who acts this way. For some physicians, referrals for procedures which they object to are equivalent to participation. This has been the case for over 50 years of legalized abortion and it has never been a problem. This policy (and the previous version, with the same "effective referral" mandate) is just going to push some doctors out of practice, force others to violate their integrity, and do nothing for patient access or patient rights. I'm not sure patients will appreciate it when their palliative care doctor or family doctor leaves because they might be put in a position to violate their beliefs. Removing the "effective referral" component is ultimately the most patient-centered choice.
Member of the public
[March 01, 2021 10:14 PM]
The policy is good at addressing the legalities of overt discrimination, but there needs to be attention paid to the systematic unconscious bias that is a serious barrier to good healthcare. Preconceived notions can have disastrous effects on diagnosis and treatment of what may be very serious health issues. The well documented problem of doctors dismissing pain and health concerns of women (as well as those who represent other protected grounds, such as age and race) is so well known, there is now a colloquial term for it: medical gaslighting. As a consumer of medical services in Ontario for over six decades, this has unfortunately become my expectation. How rare and refreshing when it doesn’t happen! The recent very public heated exchange on a national news channel between two Ontario doctors, one male, one female, regarding provincial Covid restrictions illustrated that sexism in medicine here is alive and well. While vigorous debate and civil disagreement ought to be welcome in any discussion, bullying should not. The condescending, even mocking tone of the male doctor toward his female colleague - “stop shouting “ (she wasn’t), “she needs a refresher “ - no doubt resonated with many women across Canada who recognize this behaviour as all too familiar. The medical community needs to acknowledge and grapple with its systemic discrimination. Having a policy is a good start, but it’s just a start. There is always room for more education. If this is not considered important enough to include in medical school curricula (and it should be), the College is in a good position to educate its members. Standards and values are changing for service providers in all sectors, and employers and regulatory bodies must keep their members up to date. It has become the norm for workers to be required, on a regular basis, to keep up with information that reflects these changes - WHMIS, and Accessibility for Ontarians with Disabilities training are two examples of this. It would be possible for the College to require members to complete a similar kind of training aimed at sensitivity to diversity. Fortunately, Ontario universities are rich in expertise on the kinds of issues that diversity training ought to address (sexism, racism, ageism), and could provide guidance on how this might be accomplished. Additionally, there are advocacy organizations (ie, C.A.R.P., Ontario Coalition of Rape Crisis Centres) that would be pleased to assist in the development of any tools that could enhance the likelihood of marginalized groups receiving appropriate and timely healthcare that is not tainted by bias.
Member of the public
[February 24, 2021 10:49 PM]
This is true. But this policy articulates human rights, thus not distinguishing appropriate/inappropriate service request. This matter must be covered by other policy.
Member of the public
[February 22, 2021 11:23 AM]
No doctor or nurse should be forced to act against their conscience.
Organization
[February 17, 2021 2:12 PM]
Professional Association of Residents of Ontario (PARO)
Response in PDF format
Member of the public
[February 10, 2021 10:27 AM]
Response in PDF format.
Prefer not to say
[January 16, 2021 4:25 PM]
The liability exclusion clause, more frequently becoming part of the consent to treatment contract, is a violation of human rights in Ontario not often considered. Disability, as very broadly defined in the Human Rights Code, could well apply to virtually every person seeking medical treatment. Liability exclusion clauses are often signed under duress, the patient knowing full well that services will be denied if the clause is not agreed to. To require a person seeking medical treatment to sign away rights that other Ontarians enjoy is a form of discrimination based on disability. To deny a person medical treatment because of reluctance to sign away rights creates an extra burden on the patient, already vulnerable due to need for medical assistance. It would be difficult for a doctor to argue undue hardship if the clause was removed, given the extensive protection that the CMPA provides, protection that is unrivalled anywhere else in the world. Again the deck is stacked against the patient, in that the patient bears the full cost of legal proceedings; the doctor has the exclusive advantage of being covered by a federally subsidized CMPA. The liability exclusion clause is an extra layer of protection, the necessity of which is therefore questionable. It is understandable that doctors should seek to protect themselves from frivolous and vexatious actions. However, liability exclusion clauses are increasingly worded to protect doctors from their own negligence, as well as accountability to the College. Consider, for example, the wording of the following, currently in use in Ontario: "I unequivocally agree not to hold the surgeon, or the clinic, responsible in any way, in any proceeding, legal or otherwise, in any forum, in any fashion, of any type..." The increase in use of such clauses results in an elite profession, accountable to no one, (including CPSO) and a badly under protected, increasingly vulnerable group - patients, who fear legal recriminations if they legitimately try to hold a doctor to account. CPSO could examine this emerging issue given its mandate to protect the public. It is quite possible to allow a compromise - liability exclusion that has some protection from the frivolous, but does not protect the doctor from negligence, or strip the patient of their right to seek the assistance of CPSO when it is warranted.
Physician (including retired)
[January 14, 2021 3:06 PM]
If a patient request for a service is clinically inappropriate, the physician should be able to decline making a referral. This should be true for all physicians including those with conscientious objection. The conscientious objection should not negate the above. The onus is on the physician to differentiate between the two.
Prefer not to say
[December 20, 2020 2:07 PM]
Note: some content has been edited in accordance with our posting guidelines. Doctors in Canada are members of the Canadian Medical Protective Association (CMPA), and to be members of this organization in good standing they must put the human rights of their colleagues before the human rights of patients. Some doctors become a second victim after medical error and there is legislation to try to protect these doctors who may suffer from mental illness and addictions. One of the last things anyone would want, myself included, is for a doctor to be a second victim and die by suicide. However, when complaints from injured patients are handled by the College and the doctor is mentally ill, injured patients cannot receive justice. Complaints are resolved in an unjust manner, causing psychological injury to the injured patient and/or their family. While the doctor may very well be a second victim, deserving of compassion, the injured patient and their family are the first victim, and their human rights are violated. The vast majority of injured patients cannot obtain justice after medical error and, very disgustingly, some injured patients, including seniors and the most vulnerable, receive further physical, psychological and financial harm if the CMPA can obtain an opinion based on falsified medical records. Meanwhile, the second victim [redacted] is fully protected, not only by the CMPA, but by the College - with as many undertakings as needed. Medical errors are a leading cause of death and disability in Canada and injured patients' and families' human rights are violated by the second victim, the CMPA and the College.
Physician (including retired)
[December 15, 2020 9:55 AM]
It may be helpful to include more examples of what would be considered legitimate and illegitimate refusals to care for patients because of religious beliefs. I feel like much of the general public would understand a physician not wanting to perform abortion, but would not support a physician refusing to see gay patients or to request STI testing.
Prefer not to say
[December 10, 2020 5:19 PM]
no comment. whats with all the woke questions?
Physician (including retired)
[December 10, 2020 4:54 PM]
Rights are particular to all . No professional or non-professional right supercedes the other . This is an absolute !