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