The College of Physicians and Surgeons of Ontario is the regulatory and licensing authority for physicians and surgeons practising in Ontario.  In February, 2008, the Ontario Human Rights Commission responded to a draft policy of the College with a submission recommending that the exercise of freedom of conscience by physicians be restricted.

The College, in response, released a draft policy Physicians and the Ontario Human Rights Code, indicating that Ontario physicians will be expected to sacrifice their freedom of conscience to meet the demands of their patients and avoid prosecution by Ontario's human rights apparatus.

According to the College, the Ontario Human Rights Tribunal may take action against a physician who refuses to provide or refer for procedures that he finds morally objectionable. In addition to the possibility of prosecution by the Tribunal, the College states that it will consider the Human Rights Code in adjudicating complaints of professional misconduct. The College’s draft policy also suggests that the College plans to force objecting physicians to actively assist patients to obtain morally controversial services.  The Ontario Human Rights Commission has since commented further on the College’s proposals, and the tenor of its submission makes clear that the OHRC and related agencies pose a significant threat to the exercise of freedom of conscience by health care professionals. [For an overview of Ontario's human rights regime, see The New Inquisitors]

The existence of the draft College policy became generally known only on 14 August, 2008, the day before a deadline set for responses to the document. The subsequent controversy caused the College to extend the deadline for submissions to 12 September, 2008.

Responses to Physicians and the Ontario Human Rights Code

• Protection of Conscience Project
  Submission to the College of Physicians and Surgeons of Ontario
  Re: Physicians and the Ontario Human Rights Code (11 September, 2008)
   
• Centre for Cultural Renewal:
   A Principled Approach to Respecting the Rights of Physicians and Patients
   
• Ontario Medical Association:
   Response to CPSO Draft Policy Physicians and the Ontario Human Rights Code

  • “The OMA Responds.” National Post, 17 September, 2008

• Canadian Physicians for Life:
   Interim response to Physicians and the Ontario Human Rights Code
   
• Canadian Physicians for Life:
  Submission to the CPSO Re: Physicians and the Ontario Human Rights Code
   
• Canadian Centre for Bio-Ethical Reform:
  Re: Physicians and the Ontario Human Rights Code
   
• Catholic Archbishop of Toronto
  Re: Physicians and the Ontario Human Rights Code
   
• Catholic Civil Rights League:
  Re: Physicians and the Ontario Human Rights Code
   
• Catholic Organization for Life and Family Submission re: Physicians and the Ontario Human Rights Code
   
• Chalcedon Foundation: Canadian Doctors Warned to "Set Aside" God's Law
   
• Christian Legal Fellowship: Submission re: Physicians and the Ontario Human Rights Code
   
• Fr. Raymond De Souza, "Human Rights" vs. Basic Freedoms
   
• Dr. T.E. Lau Re: Physicians and the Ontario Human Rights Code
   
• Dr. Margaret Somerville, "Denying doctors free conscience unconscionable"
   
• John W. Veldkamp: Re: Physicians and the Ontario Human Rights Code

August 18, 2008

Council
College of Physicians and Surgeons of Ontario

RE: Proposed changes to College human rights policy – “Physicians and the Ontario Human Rights Code”

We are all just learning how to “do” a pluralistic society and it is not surprising that we are having some growing pains.  Parts of the Executive Committee’s recent draft policy entitled “Physicians and the Ontario Human Rights Code” demonstrate that errors are easily made in the  process of codifying the duties of physicians, tolerance, and ideals of patient autonomy.

The last time that a serious attempt was made to make the suppression of medical conscience respectable was the furiously opposed, and in effect finally officially renounced, 2006 CMAJ guest editorial by a pair of legal academics who were dismissive of medical qualms about abortion and obtuse about the reality that referring for a procedure means medical and ethical implication in the procedure.[1] 

Ironically, it is the laudable impulse to serve the diversity of our patients’ needs which has coincided with a mounting intolerance of diversity in our own medical colleagues’ sincerely held principles.  We recognize and affirm the marginalized patient whose life has taken a turn away from the mainstream, but the draft policy would marginalize the physician whose life-affirming ethics endure while the mainstream turns away. 

A consumerist approach to the acquisition of services, long gathering strength inside our medical system, was expressed a century ago by the commercial philosophy that “the customer is always right.” Our current challenge is to see the occasions of medical arrogance and paternalism of the past out the door without adopting the supine posture implied by the College’s draft policy and backgrounder. As these documents would seem to see it, a physician can properly back away from an ethically troubling request only by pleading incompetence.  The common scenario where the exercise of ethical competence and medical judgment frustrates a patient’s immediate wishes is inadequately supported and explored. 

Moral beliefs are indeed “central to the lives of physicians and their patients,” as the draft document states, including to the lives of those who think of themselves as non-religious.  In particular, we should have no tolerance for  amoral physicians.  Unfortunately, the document glides into a fundamental exercise in question-begging by assuming the true medical necessity of the contentious services for which it strives to guarantee practical, if not moral, acquiescence.

This controversy is not about the delivery of life-saving care or the correction of physical pathology.  Real-life examples of the conflicts the College wishes to address almost always involve a patient preference for a medical service which will subjectively enhance their quality of life or remove an impediment to a desired lifestyle, with no credible claim of medical emergency.  Such encounters may sometimes call for a tactful and respectful disengagement of the patient from the physician, but hardly the pre-emptive renunciation of freedom of conscience implied by the College document. 

Thus the draft policy’s anticipation that compliant physicians will be ready to  “set aside their personal beliefs” and its warning that decisions “based on moral or religious belief” may “constitute professional misconduct” seems particularly intemperate, a retrograde and illiberal lurch rather than a measured and sensitive evolution of standards.

The CPSO has put itself out on a limb with this undoubtedly well-meaning exercise in policy revision.  The spirit of the draft document would, for instance, impugn the President of l’Association medicale de Quebec, who recently defended obstetricians who decline to alter their call schedules to accommodate patients who do not want to be cared for by a male.[2] 

The College may also want to reconsider the implications of proposing policy revisions in the explicit context of the curious prediction that human rights complaints in Ontario will soon skyrocket to 3000 per year.  Does the College believe that the Human Rights Commission system will bring better standards of medical practice than the College has previously promoted? Has the College complaints process hitherto been deficient in addressing public concerns about medical issues?

The College documents present an unseemly image of the College preparing to shine its shoes before inspection by a higher authority.  And yet human rights commissions, as you are undoubtedly aware, are increasingly scrutinized for various abuses which they themselves engender.  Alan Borovoy, the pre-eminent Canadian civil liberties champion, recently lamented that “ during the years when my colleagues and I were labouring to create such commissions, we never imagined that they might ultimately be used against freedom of speech.”[3]  Others have criticized the asymmetrically onerous burdens, of proof and of legal expense, which the commissions cause to fall on defendants.

In short, it is still unclear how human rights commissions and codes are going to find a good fit with our traditions of fairness, equality, and freedom.  It is not a foregone conclusion that they are an improvement on the common law.  The best possible role that the CPSO could play in these turbulent seas would be as a beacon of moderation.  It should not lose confidence in the capacity of physicians to exercise their fundamental freedoms in a manner befitting responsible professionals in a free and democratic society, nor in the principle that a free society is best served by a humble but independent medical profession. The College may choose to trim its sails in the stiffening breeze of litigiousness fostered by human rights commissions, but it need not throw its cargo overboard. 

Authoritarian and coercive edicts like these draft policy documents suggest a fear of freedom that is unbecoming of a regulatory institution in a democratic country. They also raise serious questions about the CPSO’s understanding of, and competence to deal with, issues of freedom, pluralism, accommodation and tolerance.

The future will be filled with radical technological changes and social innovations.  It would be naïve to expect them all to be benign.  It is vitally important to our society that members of our profession, like their fellow citizens,  remain free to adhere to their conscientious convictions in choosing to participate in, ignore, or oppose any part of the torrent of change.

We strongly advise the Executive Council of the CPSO to study this policy in much greater depth before proposing changes to it.  A further submission will follow. 

Respectfully submitted,

Will Johnston, MD, President
Canadian Physicians for Life
PO Box 1289
Richmond ON  K0A 2Z0
Ph/Fax: 613-728-5433

[1] CMAJ • July 4, 2006 • 175(1)  page 9  or at: www.cmaj.ca/cgi/reprint/175/1/9

[2] www.cyberpresse.ca/article/20080815/CPACTUEL/808150793/1019/CPACTUALITES

[3] The Calgary Herald, Hearing complaint alters rights body's mandate,  A. Alan Borovoy, March 16, 2006  or at: www.safs.ca/issuescases/aborovoy.html

80 College Street

Toronto, Ontario, M5G 2E2

Dear Members of the Policy Department and Council:

Re: Draft policy document, “Physicians and the Ontario Human Rights Code”

As a nationwide group of pro-life physicians, we have viewed the recent interaction between the Ontario Human Rights Commission and the College of Physicians and Surgeons of Ontario with grave concern. [i]Reassurances from the College notwithstanding [ii], the freedom of physicians to avoid direct participation in contentious medical acts, and also to avoid de facto participation via coerced referral, is under attack. The practice of abortion provides the archetype for this conflict.

Abortion is not illegal in Canada and physicians can carry out abortions without incurring legal liability.  Any pregnant Canadian woman has the freedom to request an abortion within the public health system to destroy and remove the human being within her if participating in the pregnancy does not fit her aspirations for the conduct of her life. 

Likewise, physicians who have no ethical or moral reservations about destroying unborn human life are free to make that known and the pregnant woman is free to seek out and be treated by these physicians. 

Correlative to the freedoms of both pregnant women and pro-choice physicians, a Canadian pro-life physician has hitherto been free to avoid participation in the destruction of any human life, which would be a serious breach of his or her moral beliefs and ethics, and has been free to make this position known to patients or prospective patients.  In declining to refer a woman for an abortion, the physician who objects to abortion is exercising his or her freedom to choose not to be a segment of that woman’s self-chosen road to an abortion. It is not the responsibility of any physician to manage, promote, or enhance access to a procedure which he or she finds medically harmful and morally repugnant. 

The ethical bankruptcy of any society which would punish physicians who object to abortion, and the imprudence of doctors sitting in regulatory institutions who would threaten to punish their objecting colleagues, should be obvious.  To stimulate the moral imagination, we offer this analogy: Suppose you live in a society in which slavery is legal but you think it is wrong.  Someone comes to you, knowing that you are a knowledgeable native of the region, and asks directions to the nearest and most convenient slave market.  Should you be punished if you won't give directions?  Is it not obvious that directing the aspiring slave owner to the market means facilitating the purchase of a human being, a wrongful act?  What would you think of neighbours who wanted to deprive you of your livelihood or seize your assets and home because they were offended by your objection to slavery and they wanted to enforce your obedience to their way of thinking?

We have entered an era in which radical self-determination is endorsed by elites and fostered by the law.  Surgery which would formerly have been seen as mutilation is now portrayed as a right necessary for self-fulfillment.  The protection of human rights is the responsibility of us all, and the special interest of human rights commissions and tribunals who take their cues from a list of prohibited grounds of discrimination, a list with a tendency to grow. 

Problems arise, however, when such bodies want not only to protect certain lifestyles and designated groups from adversity but also to force others, such as physicians, to carry out acts to which they have moral and ethical objections, or which are contrary to their vision of good professional practice. Often such objections are dismissed on the grounds that they are connected with religion and that religious belief has no place in the public square or the practice of a profession. This assertion does not bear close scrutiny, and the presumption that all such objections are based on religious belief is erroneous.

For example, if physical stature became a prohibited ground, parents could demand human growth hormone supplements for constitutionally short children.  You might have no religiously-based objection to height augmentation and it might have been proven safe, or the principle that safety concerns are subsidiary might have been enshrined in legal precedent, but you still might have qualms about tinkering with the natural stature of the child in this way.  What would be your defense?  After all, under a human rights commission regime you couldn't just say “I need to study this” or “I don’t have any competence in this field of practice” without being coerced to refer – and in this hypothetical case, treatment lengthily delayed would be treatment denied.

The argument, sometimes heard, that it is because Canadian physicians work in a publicly funded system that HRCs have a responsibility to police them is particularly specious. That Canadian medicare for physician services is essentially publicly funded but privately administered is irrelevant to the issues which could as easily arise in a completely user-pay system.  The receipt of public funds does not diminish the civil rights of unemployed people on income assistance – should doctors working for public money not have the same rights? 

The importance of health care makes the practice of medicine a perennial topic of public discussion and many of our social controversies are intensified when placed in a medical context.  This is especially evident when social activists seek test cases to bring before human rights commissions, often for causes unrelated to the provision of health care. This has special implications for physicians who may be targeted for having unfashionable, or at least unprotected, moral, social, and medical opinions. It has been widely noticed that becoming enmeshed in the tribunal system imposes a considerable burden on the defendant – that, regardless of the final outcome, “the process is the punishment.”

It would seem that some conceive of the public sphere as a playing field onto which citizens may venture only if they are willing to obey rules that can be changed at any time by a committee (and, we suggest, a committee that doesn't even understand the nature of the game being played).  On this view, our actions on the field should simply reflect the rules, without intrusion by our private thoughts and beliefs.  We are expected to accept that we can be removed from the field and fined for infractions at the discretion of a referee who is a surrogate for, and takes orders from, the committee.

In reality, we live our lives on a continuous spectrum between the public and the private, in a condition of continuous intermingling of public acts and private thoughts. Human rights commissions must take this into account. Their goal should be to respect the rights of everyone, especially on matters of profound moral belief. 

Of course it is true that, in any functional society, the freedom to hold beliefs is broader than the freedom to act on them.  We are not debating the necessity of rules that limit actions, since everyone can agree that a functional society needs rules.  It is the precise nature of the rules and the sharing of the onus to limit oneself by rules which is under discussion.

Thus the concept of “accommodation” must be restored to its origins in mutual good faith.  Coercion must be assiduously avoided, especially in matters of deep moral conscience. The individual humanity of physicians, no less than patients, must be respected.  On the contrary, in the position taken by the OHRC one looks in vain for a balancing emphasis on the duty of the Canadian health care system to accommodate the religious or moral scruples of its employees. Why should every industry except health care have to accommodate its employees, right up to the point of “undue hardship,” regarding the protected-grounds-of-discrimination list? [iii]

Real and unjust discrimination is ethically wrong because it denies access to society's good things – such as education or employment – to those who do not “measure up” to some arbitrary and irrelevant standard like skin colour. The law rightly condemns and seeks to prevent it.   There is a true consensus that education is a good thing, and that employment is a good thing. But nothing of the sort can be said about morally controversial procedures like abortion, euthanasia, or artificial reproduction.  If there is a conflict between a physician and patient as a result of a refusal to facilitate such a procedure for reasons of conscience, the conflict originates not in discrimination but in a disagreement between the physician and the patient about what constitutes a good thing. Sometimes the disagreement results from the professional perspective, knowledge and experience of the physician, even if he or she does not, in principle, object to the procedure in question.

Consider the request of a 20 year old man for a vasectomy or a 20 year old woman for a tubal ligation. Such surgery has permanent implications for the patient which could be bitterly regretted later in life.  It would be, in our view, a misuse of the word “discrimination” to characterize a physician’s conscientious refusal to facilitate such surgery as wrongful “discrimination on the basis of a prohibited ground” (age or sex).   If this is discrimination, it is only so in the sense that one discriminates between a prudent and an imprudent act, or between acts that do harm and those that do not.  

When physician and patient disagree about whether or not a procedure is a good thing, the OHRC's Chief Commissioner herself, Barbara Hall, apparently expects the CPSO to coerce and punish the physician for failing to agree with the patient, on the grounds that the College should endorse and enforce the patient's views at the serious cost of breaching the human rights of the physician. This is precisely what Madam Justice Bertha Wilson said should never be done, for that would be to “deny freedom of conscience to some, to treat them as means to an end, to deprive them . . . of their ‘essential humanity’.”[iv]  We strongly object to the attempt by the OHRC to subvert thousands of years of medical ethics and to deny the essential humanity of physicians by suppressing their freedom to act in accord with their deepest moral beliefs, merely to avoid the inconvenience some patients might experience in having to “shop around” for morally controversial procedures.

When considering codes of behaviour, as a general principle freedoms may only be infringed if the harm caused by the infringement is not disproportionate to the harm the infringement seeks to prevent.  The suppression of conscience, religion, and free speech proposed by the OHRC is recklessly disproportionate to any conceivable harm which inconvenience or hurt feelings might represent to some patients.  Professional standards and public safety can be maintained without compromising physicians’ freedom of conscience, and in fact it is our duty to work together to achieve this.[v]

Importantly, this situation could be seen by the CPSO as an opportunity to strengthen the ethical practice of medicine in Canada by adopting standards of physician conscience protection which are truly reflective of the inclusive, diverse, and pluralistic society we should all be striving to create. 

The CPSO must not abdicate its obligation to bring medical and ethical judgment to the regulation of the medical profession and the practice of medicine in Ontario. It is inconsistent to expect ethical conduct from physicians who are told to check their personal moral and ethical beliefs at the door.  The College must refuse to become an agent for the promotion of such views. 

We wish the College well in its difficult but necessary review of this pivotal issue. 

On behalf of Canadian Physicians for Life

[iv]   R. v. Morgentaler (1988) 1 S.C.R. 178-179 (Supreme Court of Canada)  

[v]  Genuis SJ   “Dismembering the Ethical Physician”  Postgraduate Medical Journal 2006;82:233-238; doi:10.1136/pgmj.2005.037754.  Abstract at http://pmj.bmj.com/cgi/content/abstract/82/966/233

Dr. Preston Zuliani
Chair, Executive Committee
College of Physicians & Surgeons of Ontario

Dear Dr. Zuliani,

I understand that the Ontario College has developed a new draft policy entitled Physicians and the Ontario Human Rights Code and has asked for feedback on this important topic by August 15 2008. 

I am deeply concerned that while the draft document includes the statement that appears to recognize that religious and moral beliefs
are central to the lives of physicians and their patients,  I am worried that the interpretation of what is meant by the statement that “there will be times when it may be necessary for physicians to set aside their personal beliefs in order to ensure that patients or potential patients
are provided with the medical services they require.”

I am worried specifically about 1) “potential patients” and 2) “medical services they require.” 

With regards to potential patients, are you referring to an obligation to patients we have not attended to or have accepted the care of.  Practically this could include any person who wants to see you, even in a non-emergency situation, even though you feel strongly no therapeutic relationship is possible.  This would include even if you felt threatened by them.  Imagine if you were a Jew and your ‘potential’ patients were blatantly anti-Semetic, or if they knew you were Catholic and they held a personal grudge against the Church. They may demand something of you, not so much because they want it, but because they do not want you to practice your faith because of their distain for it.  With regards to required medical services, who defines this? What about if the physician disagrees with them about what
is required or necessary.

I will use four cases which will illustrate some of my concerns.

1)  Euthanasia
2)  Abortion
3)  Drug addiction
4)  Gender identity disorder

Case 1.  78 year old male who has a chronic illness and is severely suffering.  Hypothetically speaking, the private members bill that has already been introduced by a Bloc MP, has been passed.  The man is a member of the Hemlock Society.  He demands to be put out of his misery.  The person in this scenario could have a chronic treatment resistant depression.  The physician disagrees but now is forced to either kill the man or refer him to someone who will.

Case 2.  38 year old woman who is in her third trimester of her pregnancy.  She discovers during her second ultrasound that the baby is a girl.  She overheard her boyfriend say he would marry her since she was carrying his son.  She believes her boyfriend only wants a boy, therefore she wants an abortion.  Although most physicians in Ontario have moral/ethical problems with abortions after 20 weeks, and practically are reluctant to perform them (they are sent quietly to a clinic in the US at the taxpayers expense), the patient reads the new draft of the College and demands that you end the life of her baby.  They discover you are a practicing (Jew, Christian, Muslim etc) and are therefore compelled to believe they are being discriminated against.

Case 3.  24 year old male heroine drug addict that wants narcotics and believes that harm reduction is the way to go.  Unfortunately, he has been seeing many doctors for “harm reduction” at many clinics and you suspect he is selling the narcotics.  He is increasingly threatening and you are afraid of him.  You believe the best thing for him would be an abstinence based approach similar to the twelve steps program, which has a spiritual foundation.  He not only threatens you but says you are not respecting hi  complaint with the College and the Human Rights Commission as he is an atheist that rejects the twelve steps.

Case 4.  32 year old man who believes he is a woman.  He is physically attracted to men.  He has depression, an anxiety disorder, and a substance use disorder.  He feels needs to have surgery to become a woman and be complete.  As a physician you feel he needs to see a  psychiatrist.  He is convinced you are impinging on his rights and accuses you of discrimination.  He reads the new college policy and makes a complaint to both the human rights commission and disciplinary board of the CPSO.  He feels the treatment is necessary, indicated and required.

Please reconsider forcing physicians to go against their conscience. With the a new euthanasia bill on the horizon and the lack of any  limitation to abortion for any reason or at any stage, it is clear to me that taking this stand will endanger the principled, conscientious, and responsible care of our patients, not just now but in the years to come.

Sincerely,

Tim Lau, MD,
Ottawa

cc. 
Euthanasia Prevention Coalition
Canadian Physicians for Life
Catholic Civil Rights League
Catholic Federation of Physician Associations
Canadian Catholic Bioethics Institute
Catholic Health Care Association
Canadian Conference of Catholic Bishops
Protection of Conscience Project
Christian Medical Dental Association
B'nai Brith Canada
 

Andréa Foti
College of Physicians and Surgeons of Ontario
80 College Street, Toronto, Ontario, M5G 2E2

Dear Ms. Foti,

I recently read the CPSO’s draft policy document, “Physicians and the Ontario Human Rights Code.” In reviewing the document I was struck by its intolerance towards the deeply-held, truth-based beliefs of physicians. I therefore am writing, on behalf of the Canadian Centre for Bio-Ethical Reform, to express our reasons for concern and to appeal to the CPSO to reject its draft.

The draft says, in part,

Personal beliefs and values and cultural and religious practices are central to the lives of physicians and their patients. However, as a physician’s responsibility is to place the needs of the patient first, there will be times when it may be necessary for physicians to set aside their personal beliefs in order to ensure that patients or potential patients are provided with the medical treatment and services they require [emphasis added] (p. 4).

***

Then, when the draft refers to Court decisions considering cases where equality rights clash with religious freedoms, it says,

These principles appear to be generally applicable to circumstances in which a physician’s
religious beliefs conflict with a patient’s need or desire [emphasis added] for medical
procedures or treatments (p. 6).

What is particularly disconcerting about the draft’s standards is how they could be referenced, for example, regarding the matter of abortion. Here is a case in point: a physician may hold the belief that sex-selection abortion is wrong. If she has a pregnant patient whose culture prefers male children over female children, she should not have to violate her beliefs by facilitating (e.g., through referral) that
patient’s abortion. Yet, your policy seems to indicate she should.

Or to cite another example, an abortion-provider in British Columbia performed an abortion on a patient who felt her pregnancy interfered with a planned trip to Hawaii. Many medical professionals would disagree with that and they should not have to facilitate this behavior to which their consciences object. Even referring the patient to another physician to perform the abortion would be to bear some
participation with that abortion.

To support abortion would be to violate that physician’s oath to “do no harm.” It would also be to show disregard for her patients—the patient in-utero (confirmed by science to be a human being at fertilization) whose life would be ended by abortion and her pregnant patient, whose life would be negatively impacted by abortion. In fact, it would be this kind of physician who is truly placing “the needs of the patient first.” It would be this kind of physician who rejects killing one patient as a way of dealing with the difficult life circumstances of another patient. This kind of physician looks for ways to help her pregnant patient without harming that patient’s offspring.

In your online brochure, “We Care About Your Care,” you state,

For more than 125 years, the College of Physicians and Surgeons of Ontario, the self-regulatory body for the medical profession, has been ‘protecting the public and guiding the profession’ and helping to ensure that Ontario's doctors and the care they give are the best.

If you are to truly live up to the claim that “Ontario’s doctors and the care they give are the best,” then it is essential you protect Ontario doctors’ consciences. To strip a physician of his right to refuse involvement with immoral practices is to demand that physicians act without integrity—and that is hardly providing patients the best care.

Recently, medical students at the University of British Columbia were assigned to read “Without Conscience” by Elie Wiesel (New England Journal of Medicine, April 14, 2005). Wiesel reflects on the role physicians played in paving the way for the Holocaust. He states,

Inspired by Nazi ideology and implemented by its apostles, eugenics and euthanasia in the late 1930s and early 1940s served no social necessity and had no scientific justification. Like a poison, they ultimately contaminated all intellectual activity in Germany. But the doctors were the precursors [emphasis added]. How can we explain their betrayal? What made them forget or eclipse the Hippocratic Oath? What gagged their conscience? What happened to their humanity?

***

One day, Hitler and Himmler’s health minister made it known to leaders in the medical field that, according to a secret decision made at the highest level, it was necessary to get rid of “useless mouths” —the insane, the terminally ill, children, and elderly people who were condemned to misfortune by nature and to suffering and fear by God. Few in the German medical profession believed it worthy or good to refuse.

Thus, instead of doing their job, instead of bringing assistance and comfort to the sick people who needed them most, instead of helping the mutilated and the handicapped to live, eat, and hope one more day, one more hour, doctors became their executioners.

It is worth considering Wiesel’s reflection in light of the CPSO draft: were Nazi ideology to dominate today, the CPSO draft, in its demand for conformity, would prevent physicians who opposed the unjust regime from acting against it. If a parent, under such a Nazi regime, brought his handicapped child to a physician demanding that the child be euthanized, a physician forced to live under the CPSO draft policy would have to act on—or refer for—the patient’s wishes, or risk “professional misconduct” charges.

If anyone is guilty of professional misconduct, it is the CPSO for its repressive and intolerant draft policy.

Sincerely,

Stephanie Gray
Executive Director

Mailing Address: Box 123, 5 – 8720 Macleod Trail SE, Calgary, AB T2H 0M4
Telephone: 403-668-0485 E-mail: email@unmaskingchoice.ca Website: www.unmaskingchoice.ca
 

E-mail to Ontario College of Physicians and Surgeons
 

RE:       Physicians and the Ontario Human Rights Code

I have just become aware of the document "Physicians and the Ontario Human  Rights Code" and I feel compelled to inform the Ontario College of  Physicians and Surgeons (the "College") of my concerns that this document is both deeply flawed and unworkable.  This letter is not to be construed in  any way as providing legal advice but as a member of the Law Society of Alberta and a former member of the Law Society of Upper Canada I believe the wording of this policy may cause a number of unintended problems.

It is very disconcerting that the College advises that "it may be necessary for physicians to set aside their personal beliefs in order to ensure that  patients or potential patients are provided with the medical treatment and services they require" (emphasis added).  This statement does not require a  physician to provide medical treatment and services that are in the best  interests of the patient's health.  Rather it suggests that the overriding  emphasis should be on what the patient requires.  In addition a physician  must "[c]ommunicate clearly and promptly any treatments or procedures the physician chooses not to provide" and "provide information about all clinical options that may be available or appropriate based on the patient's clinical needs or concerns" (emphasis added).  As a result a physician is required to inform a patient of every treatment available (regardless of whether that treatment is appropriate) based on merely the concerns of a patient.  A patient could use this policy to make a complaint to the human rights commission that a physician did not provide them with all information of the treatments available for whatever health concern that patient might have.  In fact, your document suggests that withholding of all information would constitute professional misconduct.

To further illustrate the problems with your proposed policy here are some examples of how a physician could be in danger of committing professional misconduct:

1.      A physician would have to inform a patient about all for-profit health services outside of the public system.

2.      A physician would have to inform a patient about all holistic medicine options.

3.      Whenever performing a blood transfusion, a physician would have to  advise of all of the alternatives to blood transfusion in case the patient is a Jehovah's witness (and you are not permitted to ask if a person religious beliefs before treating them) as this would constitute discrimination by the physician on the basis of creed.

The last example shows that your policy requires doctors to provide  information to patients regardless of whether the physician believes such information is in the best interests of the health of the patient.  Our medical profession is in a very sorry state when the College is advocating that physicians be more concerned about offending the Ontario Human Rights Code that the health of the patient.

The main purpose of this policy appears to be directed to the situation where a doctor refuses provide abortion services.  The assumption appears to be that this refusal is based on the religious belief of the physician and therefore must constitute discrimination.  Of course many doctors do not provide abortion services because, in their professional opinion, such a procedure is not in the best interests of the health of the patient.  To avoid this objection the College was compelled to put forward a document that prevents physicians from exercising their professional judgement in order to provide patients with whatever services the patient requires.

I strongly encourage the College to withdraw the draft policy entitled "Physicians and the Ontario Human Rights Code" and instead focus on ways to support and encourage physicians in exercising their professional judgement in the best interests of the health of the patient.
 

Respectfully submitted,

John W. Veldkamp
Edmonton, Alberta