The College of Physicians and Surgeons of Ontario (CPSO), wants to change how doctors are required to refer for care. Their draft policy, Professional Obligations and Human Rights 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. 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”Here are four reasons why CPSO shouldn't go ahead with this bad policy.
1) Freedom of conscience for doctors. It is wrong to force doctors to betray their conscience. This is not a difficult concept to understand. A civilized society does not force anyone to act against their conscience. And if a doctor is forced to refer for a procedure that is against her conscience, she is complicit in the act itself, which is the same (morally) as performing the act herself. This is wrong and against every moral definition one can think of.
2) Patient/doctor trust. If a patient knows their doctor can leave their conscience at the door when it comes to abortion, contraception or assisted suicide, how can the patient be expected to trust their doctor with their other health issues?
3) Retroactive requirements. Changing the guidelines in this way, is an unethical act towards the doctors affected. When doctors who are currently practicing, or are in medical school, first became doctors, they did so with the understanding that they would be able to conscientiously object to procedures that are against their conscience (including referring to another doctor).
This change would be a retroactive requirement of being a doctor. This is patently unfair to doctors. It means that doctors who are already in the profession or are in medical school, and chose the profession based on the current guidelines that do uphold their freedom of conscience rights, will now be expected to act according to a new and very different set of rules. Many doctors would have no choice but to leave their chosen profession in order to not be forced to be complicit in acts they find morally reprehensible.
4) Loss of livelihood to doctors. The huge investments required to become a doctor in the first place (time, money, family dependency on the doctor's livelihood, etc), would all be thrown away. Not only would these doctors who have invested large sums of money and time in becoming a doctor be forced to quit, but their entire livelihood would be at risk, and the livelihood of their families.
Dr. Marc Gabel who works for CPSO and is the chair of the college’s policy working group reviewing “Professional Obligations and Human Rights”, seems to have no problem with the harmful consequences this policy would impose on doctors:
“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.”
Dr. Gabel's flippant dismissal of the very real dilemma this new policy would incur for many doctors is worrisome. Forcing doctors to either refer for procedures that go against their conscience or, leave their profession altogether, is not a trivial matter.
These are all very serious considerations. CPSO and Dr. Gabel need to seriously rethink this policy because of these negative outcomes for doctors, the patients they treat, and society as a whole.
Doctors and members of the public can comment on the draft policy up to Feb. 20. Submit your comments here.