Doctors make charter challenge against CPSO

Doctors are doing a charter challenge against CPSO's discriminatory policy of forcing doctors to refer for procedurees that they conscientiously object to.

Good for the doctors.

CBC then reports this gem as the final line in their "news" report:

"The college also noted that it made the change only after a review process which included two public consultations."

What the CBC doesn't tell you in their so-called "news" item, is that those public consultations overwhelmingly supported doctor's freedom of conscience rights.

Good grief CBC, can you ever get out of the way of your own bias?

CPSO - Getting rid of pro-life doctors

The pro-abortions seem quite gleeful that doctors will now be forced to provide abortions and contraception.

Dr. Carol Leet president of CPSO says there have been complaints:

"There have been some complaints about access to care".

How many complaints? A handful? One?

Its pretty hard to believe that access is a problem, with the number of "pro-choice" doctors out there.

So what's the real motivation for this policy? I think CPSO just wants to rid their profession of pro-life doctors. Discrimination by any other name.

Conscience rights for doctors more important than ever

Now that the Supreme Court has struck down Canada’s laws against assisted suicide, doctor's conscience rights are even more important. Watch this short video.

Visit CMDScanada.org for more information

Deadline to submit feedback is Feb. 20, 2015 in Ontario. Visit the CPSO site to provide feedback and to view the policy entitled "Professional Obligations and Human Rights" .

CPSO - freedom of conscience rights are sacred

My letter in the National Post today

Why would the College of Physicians & Surgeons of Ontario insist doctors be forced to refer for treatment that goes against their conscience? As MP Maurice Vellacott recently stated, there is “no other jurisdiction that currently allows euthanasia or assisted suicide imposes such an obligation.”

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.

Patricia Maloney, Ottawa.

CPSO's "effective referral" policy misunderstood by spokesperson?

CPSO is seeking public input on a draft policy that would force doctors to refer for services which they are legally entitled to.

From the National Post:

"If ap­proved, the new pol­icy would re­quire doc­tors to make those re­fer­rals. 

In an emer­gency, doc­tors would even have to pro­vide ser­vi­ces them­selves, re­gardless of re­li­gious be­lief. 

Sim­i­lar poli­cies are al­read­y in place in Al­berta, Mani­toba, Que­bec and New Bruns­wick, 

Dr. Ga­bel says: “This is noth­ing new.”"

But Dr. Marc Gabel is wrong to say Alberta, Manitoba and NB have "similar" policies to CPSO's "effective referral" policy.

CPSO's "effective referral" is:

"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."

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.

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.

See my previous posts on CPSO and conscientious objection here and here.

CPSO is taking a dangerous position on conscience rights

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.

CPSO: Changing the definition of discrimination

College of Physicians, please stand up for religious minorities

JANUARY 2, 2015 BY FAYE SONIER LEAVE A COMMENT

*Dr. Gabel is Member of Council and Past President of the College of Physicians and Surgeons of Ontario. He is the chair of the College’s policy working group which issued the draft “Professional Obligations and Human Rights” policy.

Faye Sonier

Dear Dr. Marc Gabel,

I just read this article which was published in the Catholic  Register. You were quoted in the piece. Here is an excerpt:

Catholic doctors who won’t perform abortions or provide abortion referrals should leave family medicine, says an official of the College of Physicians and Surgeons of Ontario.

“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 Dr. Marc Gabel, chair of the college’s policy working group reviewing “Professional Obligations and Human Rights.”

The Ontario doctor’s organization released a draft policy Dec. 11 that would require all doctors to provide referrals for abortions, morning-after pills and contraception. The revised policy is in response to evolving obligations under the Ontario Human Rights Code, Gabel said.

There have been no Ontario Human Rights Tribunal decisions against doctors for failing to refer for abortion or contraception.

Gabel said there’s plenty of room for conscientious Catholics in various medical specialties, but a moral objection to abortion and contraception will put family doctors on the wrong side of human rights legislation and current professional practice.

“Medicine is an amazingly wide profession with many, many areas to practice medicine,” he said.

Yes, medicine is “an amazingly wide profession.” Thankfully, it is also a profession which attracts an “amazingly wide” array of Canadians. Of those Canadian physicians are some who share my pro-life perspective. They may refuse to refer for abortion due to their conscience, but they may also refuse to refer due to their religious beliefs (or both – we’re working out what this means under the Charter). They may be Christian, Muslim, Jewish or atheist physicians but they have an issue with abortion or contraceptives. For them, to refer for this procedure or these drugs is to be complicit in the actions and their consequences.

I am an Ontario resident. I’m a cancer survivor. I’m a mother.  I have spent far more than my fair share of time in Ontario hospitals and clinics being treated by wonderful Ontario doctors.

Over the last few years, I’ve gone out of my way to work with pro-life physicians who share my perspective. I reject the notion that killing and dismembering unborn children is medicine, and I wanted to work with physicians who share my values regarding human life and human dignity.  Due to the “amazingly wide” practice of medicine in Ontario, I was able to find a few, and become their patient. I am so thankful for their care.

But due to your working group’s proposed new policy, I might lose my family physicians. They will choose to practice medicine in a province that respects both their skills and their rights, rather than sacrifice their conscience or their sincerely held religious beliefs.

I’m also a human rights lawyer. The College’s reasoning for stripping physicians of their conscience and religious rights is not based on law. Your working group received a number of submissions on that point, so I’ll leave you to review them with your legal counsel. The doctors seeking to exercise their freedoms have a leg to stand on. Heck, they have Canadian and Ontario human rights law on their side.

Of great concern to me is the definition of “discrimination” which you provided when interviewed:

“We’re saying that the discrimination occurs when you are not acting in the best interest of the patient,” said Gabel. “When you are not communicating effectively or respectfully about this with the patient, when you’re not managing conflicts, when you differ from the patient and when you are not respecting the patient’s dignity and ensuring their access to care and protecting their safety. That’s the issue.”

Dr. Gabel, this is not the definition of “discrimination” at law. If someone chooses to make up definitions for words, they are free to do so. (My son, for example, seems to think that “babagaba” is a verb which means “to chew on mommy’s ankle.”)

However, for a body like the College of Physicians and Surgeons of Ontario to create a new definition of “discrimination” which will result in the stripping of legal and human rights of some of their members is shocking, and this new definition will not stand up in a court of law. I urge the College to abide by Canadian and Ontario law.

Dr. Gabel, I suspect you are well intentioned and a kind and caring psychotherapist, like so many of the wonderful doctors who have treated me over the years. But please don’t force my physicians from the province with your policy. My family depends on their expertise and professionalism. I like to see my own values reflected in the “amazingly wide” practice of medicine in Ontario. For someone like myself, a religious minority, this is very important.

The membership of your College is broad and wide enough to include some family physicians who happen to hold pro-life positions. If it is not, it should be.

Sincerely,

Faye Sonier

Conscience, Mind Manipulation, and the 4th “R”

Response to the Globe and Mail’s Dec. 11 editorial: "Ontario MDs should not refuse contraception out of religious belief"

By Jean Maloney

I found something quite outstanding about this editorial.

While it is clear the editorialist does not support physicians’ freedom to practice medicine according to conscience, what especially stands out for me is the lack of any cogent argument in defense of that position.

Let me say right off, I will not attempt in this article to defend freedom of conscience (although I do support it.) Rather, I will explain how the G&M’s attempt to justify its position against freedom of conscience is flawed. It behooves all of us to assess with a critical mind arguments put forward to justify a particular position on any controversial issue and not be misled by what might sound reasonable, but in fact, is either untrue or unsubstantiated.

To start with, there is an underlying false premise in the opening line: “A physician who is predisposed by faith or belief to make negative moral judgments about a patient is a bad doctor.” However, one needs to read the second paragraph before being able to put that opening line into context and thereby recognize the false premise. In the second paragraph we read: “The need for a new policy became clear when an Ottawa woman was turned away from a walk-in clinic last February after she attempted to get a refill on her birth-control medication – a rejection letter from one of the clinic’s doctors cited his ethical and religious objections.”

The G&M editorialist is in essence saying that the Ottawa doctor’s refusal to prescribe the birth-control pill to the woman amounts to that doctor making a “negative moral judgment about a patient.”

And that is false.

Although it is possible the woman may have felt that a negative moral judgment was being made about her, in fact, the physician was making a moral judgment not about her but about himself. He believed, for reasons having to do with medical judgment, professional ethics, and religious belief, that it would be wrong for him to prescribe the birth control pill, and thus to do so would make him culpable in an immoral act.

No one can get into the mind and heart of another person, and so no one is capable of judging the moral culpability of someone else, even if one might believe the action itself to be immoral. It would be up to the woman who wanted the pill to do her own conscientious reflection and morally judge herself. No one else can do it for her.

The G&M goes on to say “We turn to physicians to resolve our most intimate problems with wisdom and compassion and fairness, not to be rejected because we don't fit a sacred model.” But physicians who allow their moral/ethical code to inform their practice believe they are treating patients with “wisdom and compassion and fairness.” So it is clear that the G&M editorialist is using the words “wisdom” “compassion” and “fairness” to mean something entirely different than what conscientious physicians would mean by those terms. Yet without explaining what is meant by those three terms and showing how the physicians fall short of embodying the three qualities those terms express, the statement means nothing. And so it cannot advance the G&M’s argument (i.e. it carries no weight in defending the G&M’s position that physicians should simply give a patient the treatment they request, regardless of any objections the physician might have to that treatment).

Likewise with this statement: “But the College has refused to come down harshly on doctors who let their religious views get in the way of their duty to provide care.” The G&M has given no evidence that “religious views get in the way of [the Ottawa physicians’] duty to provide care.” The Ottawa physicians believe that prescribing the birth control pill is not a helpful form of care (why that is so is beyond the scope of this article). These physicians provide Natural Family Planning (NFP). That is the form of care they believe best comports with good medicine and respect for the dignity of their patients. And no doubt the Ottawa physician would have provided that care if the woman had requested it. Yet the G&M has given nothing to back up its claim that prescribing the birth control pill is good medical care, or why the alternative that the physicians do provide – NFP – is unacceptable medical care, or how the physician’s religious views got in the way.

Two more unsubstantiated claims that the editorialist makes are that conscientious physicians “confuse a religious judgment with a medical decision” and “substitute personal belief for science.” First of all, what does the editorialist mean by “religious judgment” and how is choosing not to prescribe the birth control pill an example of it? The editorialist doesn’t say. How is choosing not to prescribe the birth control pill not a medical decision? The editorialist doesn’t say. And how is prescribing the pill scientific but not prescribing it is not? Again, the editorialist doesn’t say.

Claim after claim made by the G&M editorialist is either untrue or unsubstantiated. If there is an argument to be made for forcing physicians to prescribe the birth control pill, the G&M hasn’t made it.

We arrive finally at what is so disturbing about this G&M editorial. It is not always easy to spot the lack of logically coherent arguments in opinion pieces. The reader may fail to recognize that a claim has not been backed up with evidence and may confuse opinion with fact. In the absence of sound reasoning, the reader may be swayed simply by emotionally evocative words and themes, for example, “wisdom and compassion and fairness,” “religious judgment,” “sinner,” “rejection,” “duty to provide care,” “dignity,” “personal belief vs science,” and so on.

This is disturbing. One would hope newspaper editorialists would feel duty bound, by their own professional code of ethics, to give a thoughtful reasoned argument in defence of their position, especially when something as fundamental as freedom of conscience is at stake, and when there is the potential for a whole class of citizens to be excluded from the medical profession if the draft policy of the College of Physicians and Surgeons of Ontario is adopted.

Instead, the G&M editorialist has chosen to make misleading and unsubstantiated claims using language that can manipulate readers into bypassing their own logical thought processes.

The important lesson here for anyone who wants to protect their minds from being manipulated into accepting potentially dangerous ideas, is this: learn to think critically. Learn to spot logical fallacies / errors in reasoning. There are courses and books and articles, in print and online, on Critical Thinking /Argument /Logical Reasoning. Why such courses aren’t compulsory in school, is a mystery to me.

Along with the existing 3 “R’s” – Reading, wRiting and aRithmetic – we ought to add a 4^th “R” to the core curriculum in our schools: Reasoning.

Equipped with the basic tools of logic, we will be better able to withstand the attempts by others, especially those in positions of power, to confuse and mislead us.

Leaving morals at the door is not possible

Below is a submission one resident of Ontario sent to the College of Physicians and Surgeons regarding CPSO's recent policy review on conscience rights.

Re: Physicians and the Ontario Human Rights Code

Thank you for the opportunity to provide input to your policy review process.

As a resident of Ontario, I urge you to uphold physicians’ freedom to practice medicine in

Ontario according to their deeply held conscientious beliefs. To quote Murphy and Genuis,

“willingness to do what one believes to be wrong must never be made a condition for

participation in public life or for membership in professional organizations.”1

If we coerce physicians into violating their consciences, I am concerned about the emotional

harm that could be inflicted on these physicians.

In their paper, Murphy and Genuis discuss how a sense of shame and guilt often haunt people

who have been forced into doing what they believe is wrong. It seems to me that such shame and

guilt could end up having significant detrimental effects on physicians’ health. While we often

hear from opponents of conscience protection that patients have the “right” to various non emergency

medical treatments (e.g. abortion, the birth control pill, etc.), in practice, how severe

and long-lasting is the harm, if any, that is actually done to patients when they are unable to

obtain that treatment immediately from a particular physician? And how does this stack up

against the potential harm to the physician who is forced to consistently violate his/her

conscience? It would seem to me that the supposed harm to these patients is more in the nature of

a possible inconvenience and thus cannot outweigh the potential harm that would be suffered by

the physician whose sense of moral integrity is at stake.

It is worth pointing out that the very Supreme Court Justice who (alone among seven Justices)

found that women have a “right to abortion,” spoke strongly in defence of freedom of

conscience. Madam Justice Bertha Wilson, in her reasons for judgment in the 1988 Morgentaler

decision striking down Canada’s abortion law, believed that it was inappropriate for the state to

take sides in the abortion debate,2 as to do so “is not only to endorse but also to enforce...one

conscientiously-held view at the expense of another. It is to deny freedom of conscience to some,

to treat them as means to an end, to deprive them, as Professor MacCormick puts it, of their

‘essential humanity.’” 3

1 Sean Murphy and Stephen J. Genuis, “Freedom of Conscience in Health Care: Distinctions and Limits,” Bioethical

Inquiry (2013) 10:347-354.

2 Although it is debatable whether the state could ever be truly neutral on the abortion issue since by definition

abortion involves competing interests (that of the woman’s vs that of the fetus’s), Justice Wilson’s comments at least

would imply that she felt third parties should not be forced to facilitate a woman’s choice to have an abortion.

Because if a third-party is forced against their will to take part in carrying out the woman’s choice, then that

person’s conscientiously-held beliefs are violated.

3 R v Morgentaler [1988] at page 179, http://scc-csc.lexum.com/scc-csc/scc-csc/en/item/288/index.do

Page 2

By extension, then, to force physicians to engage in practices that violate their consciences

would be to enforce one conscientiously-held view at the expense of another. It would be to treat

these physicians as a “means to an end” and would deprive them of their “essential humanity.”

Not only is a physician’s “essential humanity” at stake when freedom of conscience is denied,

but more broadly so is our democratic political tradition, as Justice Wilson notes:

...an emphasis on individual conscience and individual judgment also lies at the heart ofour democratic political tradition. The ability of each citizen to make free and informeddecisions is the absolute prerequisite for the legitimacy, acceptability, and efficacy of oursystem of self-government. It is because of the centrality of the rights associated withfreedom of individual conscience both to basic beliefs about human worth and dignityand to a free and democratic political system that American jurisprudence hasemphasized the primacy or "firstness" of the First Amendment. It is this same centralitythat in my view underlies their designation in the Canadian Charter of Rights andFreedoms as "fundamental". They are the sine qua non of the political traditionunderlying the Charter . (underlining in original)4

Not only is there potential for great harm to come to physicians, but I believe harm will also

come to patients, should CPSO decide to remove conscience protection. If a physician is

“willing” to provide or refer for a treatment that the physician believes is harmful, and if the

physician does this over and over again, the physician’s conscience becomes dulled. What other

treatments in future will physicians be asked to perform or make referrals for? Without a

conscience to guide them, how can physicians ultimately practice good medicine? I for one

would not want to be treated by a doctor who was not guided by their conscience, who simply

provided a treatment in blind obedience to a state-mandated edict to “leave their morals at the

door.” 5 Conscience is a bulwark against oppression by the state.

In fact, “leaving morals at the door” is not actually possible. As Murphy points out, “...every

decision concerning treatment is a moral decision, whether or not the physician specifically

adverts to that fact.”6 So the question becomes, since morality will always be a part of the

practice of medicine, whose version of morality will triumph?

Murphy explains that colleagues of the objecting physician may be disturbed by what appears to

them as a moral judgment, but those non-objecting physicians are also making a moral

judgment—they judge the treatment to be good. This leads Murphy to conclude that “What

unsettles them is really not that the objector has taken a moral position on the issue, but that he

has made an explicit moral judgement that differs from their implicit one.”

4 R v Morgentaler [1988] at page 177. http://scc-csc.lexum.com/scc-csc/scc-csc/en/item/288/index.do

5 “I think it is outrageous that doctors have the right to deny things like birth control. I believe if they plan on being

in a profession that helps other people, they need to leave their morals at the door.” –Kate Desjardins as quoted by

the Globe & Mail in “Should doctors have the right to refuse to treat a patient,” June 27, 2014,

http://www.theglobeandmail.com/life/health-and-fitness/health/do-doctors-have-right-to-refuse-totreat/

article19383553/

6 Sean Murphy, “No more Christian doctors - Part 3: Religious Values,”

http://www.consciencelaws.org/background/procedures/birth002-03.aspx

Page 3

I think this is an important insight from Murphy. It can help us to understand not only the

objecting physician’s colleagues, but also the strong negative (over?) reaction of a patient who is

denied a treatment she believes she is entitled to, as in the case of Ottawa woman Kate

Desjardins who was outraged for being handed a letter stating that the doctor on duty at a walkin

clinic would not prescribe the birth control pill.7 While Ms. Desjardins may not realize it

herself, it is certainly plausible that her strong negative emotions could stem from a belief that

her own moral judgment was being challenged. Was it disconcerting for her to think that

someone else might have moral concerns about the birth control pill? Was someone making a

moral judgment on her?

Whatever emotions Ms. Desjardins experienced (whether she was consciously aware of their

origins or not), it is clear that the physician who objected to prescribing the pill was not making a

moral judgment on her (or any other potential patient for that matter), but a moral judgment on

himself. He believed, for reasons of medical judgment, professional ethics, and religious belief,

that it would be wrong for him to prescribe the pill. But if Ms. Desjardins interpreted his reaction

as a moral judgment on her, well that is unfortunate, but we can hardly blame the physician for

doing what he believes he needs to do to maintain his own integrity and human dignity.

Some opponents of conscience protection believe that if physicians are not required to perform a

procedure (such as abortion), they should at least be required to refer the patient to another

doctor who will provide the service. But referring a patient for a procedure that the physician

believes would be immoral to perform, is also immoral because it involves complicity in the act.

This notion of complicity is already recognized in our existing laws. Aiding and abetting a

criminal offence is itself a criminal offence, according to section 21 of Canada’s Criminal Code.8

Not to apply the same logic in the case of what one deems to be a moral offence seems logically

inconsistent.

If physicians who object to providing/referring for controversial treatments such as the birth

control pill, abortion, (and euthanasia and assisted suicide if they are legalized) are punished for

doing what they believe is right and good, then physicians who object to providing such

treatments could eventually be weeded out of the profession. That would leave only those

physicians who support such controversial treatments remaining. Is this fair to all those patients

who hold similar values to the objecting physicians? Such patients will then only have access to

physicians who hold fundamentally different beliefs about what is good.

Morality cannot be separated from medicine, or any other discipline, no matter how much some

in our society wish otherwise. Everyone has a belief system that guides their behaviour. A doctor

who believes that abortion is as valid an option to an unplanned pregnancy as giving birth is

7 “Should doctors have the right to refuse to treat a patient,” Kelly Grant, The Globe & Mail, June 27, 2014,

http://www.theglobeandmail.com/life/health-and-fitness/health/do-doctors-have-right-to-refuse-totreat/

article19383553/

8 http://laws-lois.justice.gc.ca/eng/acts/C-46/FullText.html

21. (1) Every one is a party to an offence who

 (a) actually commits it;

 (b) does or omits to do anything for the purpose of aiding any person to commit it; or

 (c) abets any person in committing it.

Page 4

simply not going to be able to relate in the same way to a pregnant woman who believes with all

her heart and soul that her baby is a human being, as would a physician who believes that child is

a human being and worthy of the same respect as a born human being. Or if the birth control pill

is not an option for a woman because of her religious beliefs, will she be able to access Natural

Family Planning as readily as Ms. Desjardins feels she is entitled to access the birth control pill?

If conscientious physicians, like the three in Ottawa who have been castigated because of their

refusal to provide some reproductive health services, are driven from the profession, then it

seems to me that such physicians would not be the only victims of discrimination – so would

countless patients in Ontario who would no longer have the opportunity to access physicians who

hold an ethical worldview similar to their own and thus to medical treatment informed and

guided by such ethical beliefs. Maybe that is the intention of Ms. Desjardins and some abortion

activists,9 but I do not believe it is the intention of CPSO. I would hope that the College would

respect the diversity of conscientiously held views amongst the people of Ontario and not enact

any policy that would effectively discriminate against an entire class of citizens.

For all of these reasons, I respectfully urge the College to uphold and protect physicians’

freedom of conscience.

Thank you once again for the opportunity to provide these comments.

9 “Doctors do not have the right to discriminate and deny basic health care,” Joyce Arthur, August 1, 2014;

http://rabble.ca/columnists/2014/08/doctors-do-not-have-right-to-discriminate-and-deny-basic-health-care

Freedom of conscience is for everyone including doctors

I'm always dumbfounded by the inane and gloriously off-the-wall-and-off-topic-comments I often read on articles posted online on anything that could be even remotely associated with pro-life viewpoints.

To see what I mean check out Andrea Mrozek's thoughtful and coherant article posted on Huffington Post about doctor's freedom of conscience rights.

I think some of these commentors might want to stop talking about their disdain at doctors practicing freedom of conscience rights--which I might add are actual rights and not make-believe rights like "abortion rights"--and instead educate themselves on the subject.

But no. They'd prefer to hear themselves blather on instead. I think they just like to see their name in print. I guess it makes them feel important.

So here's the thing. Freedom of conscience is a right guaranteed under our Canadian Charter. That means everyone, including doctors have this right. It's not a right for the few, it is a right for all.

If you don't like the fact that a doctor won't provide you with your contraception, then you are free to go elsewhere for it. Nobody's forcing you to go to that doctor. The choice crowd is in love with the word "choice". So use it. Because I'd prefer to know my doctor bases his medical expertise in concert with his conscience, and doesn't ignore it. I imagine there were doctors who went against their conscience in the concentration camps in Auschwitz. Not something (I hope) we would ever want from our own doctors.

Here's something else to ponder for those who who like to hear themselves talk and say nothing. Joyce Arthur also thinks conscientious objection for doctors shouldn't be allowed. But surprisingly, not all of her compatriots agree with her: Global Doctors for Choice, bpas (The British pregnancy Advisory Service), and the International Journal of Gynecology and Obstetrics (IJGO), all believe that conscientious objection should be allowed.

To do - write to CPSO

Send your comments in to the College of Physicians and Surgeons of Ontario (CPSO) on their Human Rights Code Policy review, by August 5, 2014.

It is very important that every right thinking Ontario person do this. Our conscience rights and freedom of religion rights are supremely important to defend.

When we tell doctors to leave their conscience at the door, we are in effect saying, that we condone their acting unethically and immorally. That is what is meant, by not allowing our conscience to guide our actions. It is a very dangerous road to travel.

Our Church provides an excellent sample letter for people to use.

Our responsibility to act in our circle of influence

Fr. Yves talks today about God's mercy and justice.

In this life God's mercy is there for the taking. In the next life justice will be satisfied. God allows us to choose sin over his love. He gives us time to repent of our sin here on earth. Mercy is outward focus. Mercy counteracts evil. To do nothing about evil is a grave injustice against God. And we bring justice on ourselves. God offers us mercy to give us the opportunity to repent.

Fr. Yves goes on to say that we must, within our circle of influence, remind those that God's mercy and patience and will one day change to irrevocable judgement for sin.

He spoke about something that's happening within our circle of influence in Ontario: is that the College of Physicians and Surgeons of Ontario are reviewing their policy of human rights. There is pressure on the College that would require physicians to provide non-emergency services (abortion and emergency contraception) that go against their conscience. We can add our comments to CPSO's website on conscientious objection go here.

Looking for doctors who support conscientious objection

I understand that some doctors have been writing to newspapers regarding their freedom of conscience rights. And that maybe those letters haven't been published in those newspapers.

If you or someone you know has written such a letter, if you want to send it to me I would be happy to publish them on my blog.

Send to me at maloneyp64@gmail.com

Joyce Arthur: Conscientious objection should be punished

As we know, the College of Physicians and Surgeons of Ontario is reviewing their policy on conscientious objection (CO), and is looking for input from physicians and the public on their website. CPSO are also posting comments from anyone who would like to contribute to the policy.

Interesting comments on both sides of the debate.

And then there's Joyce Arthur's view on the topic. Arthur co-wrote a paper with Christian Fiala called “Dishonourable disobedience” – Why refusal to treat in reproductive healthcare is not conscientious objection

See below for some of Arthur's extreme opinions on conscientious objection. An extreme view by an extreme person. No surprise there.

But it's what happened next that was surprising. After Arthur's article was published, her paper was actually criticized by a pro-choice group: the British Pregnancy Advisory Service (bpas).

Jennie Bristow, editor of Reproductive Review, (the educational arm of BPAS) states:

"It is true that campaigns against abortion have often appropriated the language of ‘conscience’ to push across a more political agenda. However, there are good reasons why prochoice advocates have supported the ability of medical professionals to opt out of performing a procedure that goes against their conscience. The idea of forcing a doctor to perform an abortion when he or she thinks that this is murder sits very uncomfortably with the principles at the heart of a liberal society. So too, of course, does the idea of forcing a women to continue with a pregnancy that she does not want. 

In this regard, choice goes both ways; no woman or doctor should be forced to have or perform an abortion, but women and doctors should be free to choose for themselves whether to have or perform an abortion. That is ultimately why having laws that ban or restrict abortion are such a problem...

...compelling doctors to perform abortions against their wishes would, conversely, lead to unpleasant care for women and set a worrying precedent about how much the law can dictate the beliefs and practice of those working in reproductive healthcare. This includes those doctors and nurses who are motivated by their consciences to perform abortions, and care for the women who need them. 

The problem of abortion is one of too much legal regulation and restriction already. It is hard to see how laws designed to compel professionals to act against their conscience can be of benefit to anybody." (emphasis mine)

Arthur's position was also criticized by by Wendy Chavkin, Global Doctors for Choice.

We are all concerned that conscience-based refusal to provide contested components of reproductive health care exacerbates limited access to such care and thus threatens women’s health and rights. Where we differ with Arthur and Fiala is in our analysis of the issues at stake. We believe that there are competing rights here, and that resolution of such tension is primarily a societal, not individual, responsibility. We also differ in our pragmatic assessment of how best to proceed. 

From the human rights perspective, we see the ability to exercise conscience as fundamental to individual integrity. In fact, allegiance to this principle undergirds our collective defense of the individual woman’s right to autonomy in reproductive decision-making. The international and human rights covenants cited all concur that the individual’s right to hold and manifest beliefs and religion are essential, and subject only to limitations necessary to protect the fundamental rights of others. International and national professional associations have similarly defended the individual clinician’s right of conscience while also asserting that it should be circumscribed by the primary duty to the patient, including requirements to disclose, refer, and impart accurate information, and provide care in cases of emergency. 

The obvious tension here is when the rights of individuals collide: the objecting clinician’s right to refuse, another clinician’s conscience-based commitment to providing that care, the woman’s right to follow through on her conscientiously chosen course of action. (emphasis mine)

Then Arthur apparently felt defensive of her radical views in this rebuttal to their criticism:

"We received several critiques, one published in bpas Reproductive Review, another in RH Reality Check by Global Doctors for Choice, and a few informal criticisms relayed on listservs or online comments, and at a recent conference in Lisbon, Portugal, where we presented our ideas. We paraphrase these criticisms below – most of which we feel ignored or misunderstood our position – and follow with our response."

That's got to be a first. Pro-choicers not agreeing with every confused word that comes out of Joyce Arthur's extremist pro-abortion mouth.

No wonder pro-choicers felt compelled to comment on Arthur's views. Even they realize the importance of conscientious objection for doctors.

Below are excerpts from Arthur's and Fiala's original paper. Arthur's extremist nonsensical views pretty much speak for themselves.

(all emphasis are mine)

"Healthcare professionals who exercise CO are using their position of trust and authority to impose their personal beliefs on patients, who are completely dependent on them for essential healthcare. Health systems and institutions that prohibit staff from providing abortion or contraception services are being discriminatory by systematically denying healthcare services to a vulnerable population and disregarding conscience rights for abortion providers." 

"Some argue that abortion is a type of killing (of the foetus or embryo) and therefore CO is just as relevant in medicine as in the military. However, killing a living person in war cannot be equated with stopping the development of a gestational sac or foetus. 

Abortion and contraception preserve the health and lives of women, while those practicing CO put women's lives at risk and sometimes even sacrifice them (Attie & Goldwater Productions, 2005)."

"Because reproductive healthcare is largely delivered to women, CO in this field has implications for women's human rights and constitutes discrimination. Women are often expected to fulfil a motherhood role, so they frequently face ignorance, disapproval, or even hostility when requesting abortion. In these circumstances, the exercise of CO becomes a paternalistic initiative to compel women to give birth."

"Abortion is a necessary health intervention, as well as highly ethical."

"Termination of unwanted pregnancy is ethical because women do so only if they don’t see any responsible way to care for that potential child."

"Canada already struck down its law entirely in 1988 and never replaced it, proving that criminal abortion laws are unnecessary and counter-productive."

"Anti-choice objections to providing abortions are based on a denial of this evidence and historical experience. The provision of safe, legal abortion is a vital public interest that negates any grounds for CO."

"Doctors who invoke CO to not perform abortions can benefit professionally by spending more of their time delivering more “reputable” or higher status treatments compared to their abortion-providing colleagues. As a result, they can escape stigma and boost their careers, reputations, and salaries."

"When access to abortion care is reduced, restricted, and stigmatized in so many ways, allowing any degree of CO adds further to the already serious abrogation of patients’ rights and medical ethics."

"CO in reproductive healthcare is largely unworkable and inappropriate, and arguably unethical and unprofessional as well."

"The reliance on a doctor to protect one's life and health makes any right to CO in medicine unethical – and downright dangerous in light of the fact that women often resort to unsafe do-it-yourself abortions when they are unable to access medical care. If peoples’ right to life means anything, they must be able to access necessary healthcare, which should supersede the conscience rights of others."

"CO gives a person a pretext not to do their job, even though they were specifically hired to do that job and are being paid for it."

"The principle of public accommodation requires the discounting of individual conscience within a profession. Everyone's conscience is different and cannot be coerced, which is why a free democratic society places a high value on tolerance and equal respect for all citizens. However, if individuals are permitted to exercise their conscience when serving the public, it gives social sanction to the practice of intolerance. CO invites discrimination against people needing the services being refused, and infringes their freedom of conscience."

"The exercise of CO becomes an excuse for the doctor to exert personal power over the patient by imposing their own views."

"Even doctors who exercise CO within the law are arguably unsuited for their position because they are demonstrating an inability to perform their job – that is, they are allowing religious beliefs or some other personal issue to interfere with their job performance to the extent of negating their professional duty to patients."

 "we propose that healthcare providers be prohibited from a blanket right to refuse to perform or refer for abortion or dispense contraception for personal or religious reasons."

"we propose the following specific remedies to reduce and eventually eliminate CO in reproductive healthcare. Everyone aspiring to enter health professions that involve reproductive healthcare should be required to declare that they will not allow their personal beliefs to interfere with their management of patients to the point of discrimination. Medical students entering the Ob/Gyn specialty should be informed about the full scope of the specialty, including treating women with unwanted pregnancies. Students should be rejected if they do not wish to learn and prescribe contraception or perform abortions for CO reasons. All Ob/Gyns should be required to dispense birth control and perform abortions as part of their practice (unless there is a legitimate medical or professional reason not to). General practitioners should be expected to dispense contraception if requested, and perform abortions if they have the skills and capacity, or else refer appropriately. Pharmacists should be compelled to dispense all lawfully prescribed drugs without exceptions. Institutional CO should be completely prohibited for health systems and businesses that serve the general public."

"Monitoring and enforcement measures should be put into place to ensure that prohibitions on CO are followed. After all, CO is a form of resistance to rules or laws, so those who exercise CO must be prepared to accept punishment for their disobedience, just as in any other profession. Doctors should be sanctioned when they violate laws or codes of ethics that prohibit CO. Disciplinary measures could include a review process, an official reprimand and order to correct, and could escalate to loss of medical license, dismissal, or even criminal charges. In addition, any costs involved in the exercise of CO should be borne by the health professional or institution, who must be held liable for any health risks and negative consequences of their refusal. Patients should be legally entitled to sue and to claim compensation for any physical or mental harm, and for additional costs resulting from the refusal to treat."

"Other needed measures include compulsory training in contraception provision and abortion techniques at medical schools, security measures to protect doctors and patients such as clinic buffer zones, full funding of contraception and abortion through government health insurance, public education to reduce abortion stigma, and other initiatives." 

"Healthcare workers’ refusal to participate in reproductive care such as contraception and abortion is not a “conscientious objection;” rather, it is a refusal to treat that should be seen as unprofessional. A just society and an evidence-based medical system should deem it as “dishonourable disobedience,” an ethical breach that should be handled in the same way as any other professional negligence or malpractice, or a mental incapacity to perform one's duties."

"By manipulating women into continuing an unwanted pregnancy against their best interests, the exercise of CO undermines women's self-determination and liberty and risks their health and lives. As such, it has no place in a democratic society."