Court challenge raises issue of “reasonable apprehension of bias”

Sean Murphy*

The College of Physicians and Surgeons of Ontario is facing a court challenge by the Christian Medical and Dental Society and the Canadian Federation of Catholic Physicians’ Societies.  They have filed an application in the Ontario Superior Court of Justice asking for an injunction against enforcement of the College’s controversial new policy, Professional Obligations and Human Rights.  According to the application the College acknowledged that it had received 15,977 submissions during the second consultation concerning the policy, which ended on 20 February, 2015.  The great majority of submissions opposed the policy.

While the consultation ended on 20 February, a working group wrote the final version of the policy by 11 February, at least nine days before the consultation closed.  This is one of the factors that gives rise to concern about what the CMDS application calls either “actual bias” or “a reasonable apprehension of bias” on the part of the working group.

On this point, the statistics provided by the College are of interest.

submissionsAccording to the briefing note supplied to the College Council, by 11 February, 2015 the College had received 3,105 submissions.  This means that 12,872 submissions were received from 12 to 20 February inclusive.  In other words, over 80% of the submissions in the second consultation were received after the final version of the policy was written.

Moreover, allowing sufficient time to receive feedback is only the beginning.  Having received them, one would expect that a working group seriously interested in feedback would allow sufficient time to review and analyse the submissions.

During the 64 days of consultation ending 11 February, the College received an average of almost 50 submissions per day.  There were 43 working days during that period.  Assuming someone spent eight full hours every working day reading the submissions, it would have taken one person about seven minutes to review each one.

analysisHowever, during the nine days of consultation ending 20 February, the College received an average of 60 submissions every hour.  With 16 working days available from 12 February to 5 March inclusive, the day before the Council meeting, one person reading eight hours a day would have had no more than 36 seconds to review each submission.

Presumably this will be one of the issues to which the attention of the court will be directed if the case goes to trial.

Christian doctors’ group says new college policy infringes on freedom of conscience

Christian Medical and Dental Society seeks protection from a College of Physicians rule requiring doctors to refer patients seeking abortions and, once it’s legal, euthanasia.

Toronto Star

Lauren Pelly

With physician-assisted suicide on the horizon, the Christian Medical and Dental Society of Canada is asking the Ontario Superior Court to declare that a new regulatory policy infringes upon doctors’ freedom of conscience.

The society, which represents close to 1,700 members, filed documents in court on Friday regarding the CPSO’s Professional Obligations and Human Rights policy that was announced on March 6. The policy means doctors who refuse to refer patients for services on religious and moral grounds, including abortions, could face discipline from their regulating body. . . [Full Text]

 

Ontario physicians seek court protection from CPSO policy

For immediate release

Christian Medical and Dental Society of Canada

TORONTO – Dr. Diane Haak, President of the Christian Medical and Dental Society (CMDS), Woodstock emergency room physician Dr. Michelle Korvemaker, and CMDS executive director Larry Worthen announced, today, that they have filed documents asking the Court to declare that a new College of Physicians and Surgeons (CPSO) policy infringes upon Ontario doctors’ freedom of conscience.

“My conscience and religious beliefs do not allow me to engage in procedures to which I have a moral, ethical or religious objection. I, and all physicians in Ontario, have the right to practice medicine according to my conscience and free from state compulsion,” said Dr. Korvemaker.

Dr. Haak added, “This policy may force physicians who do not feel they can refer or perform procedures that go against their conscience to leave the practice of medicine.”

CMDS filed an application for declaratory relief asking the court to declare that portions of the CPSO’s March 6, 2015, policy breach sections of the Canadian Charter of Rights and Freedoms.

Said Larry Worthen, ”We firmly believe that it is possible to ensure access to  controversial procedures and pharmaceuticals in Ontario without trampling upon the constitutional rights of physicians”

The CPSO policy violates freedoms of conscience and religion by requiring physicians and surgeons to make formal referrals when their consciences don’t permit their performing a procedure or treatment. The policy also violates Charter freedoms by requiring them to perform procedures when certain circumstances arise.

 CMDS Canada represents some 1600 physicians and dentists across Canada (http://www.cmdscanada.org). The Canadian Federation of Catholic Physician’s Societies is also supporting the application.

-30-

For more information, please contact:      Larry Worthen  902-880-2495

Gagging conscience, violating humanity

Sean Murphy*

Introduction

In 2008, when the Council of the College of Physicians and Surgeons of Ontario was considering the final draft of an earlier policy, Physicians and the Human Rights Code, a member of the Council seems to have been troubled by the policy direction being given to the Colllege by the Ontario Human Rights Commission (OHRC).

Speaking during the Council meeting, he drew his colleagues’ attention to a chilling New England Journal of Medicine article by Holocaust survivor, Elie Wiesel: “Without conscience.”1 It was about the crucial role played by German physicians in supporting Nazi horrors. “How can we explain their betrayal?” Wiesel asked. “What gagged their conscience? What happened to their humanity?”2

Now, however, to the applause of the OHRC,3 the College of Physicians and Surgeons of Ontario has approved a policy to gag the consciences of physicians in the province,4 and Saskatchewan is next in line.5  We may soon begin to discover the answers to Wiesel’s questions.

There is no duty to do what is believed to be wrong.

Policies like those adopted in Ontario and proposed in Saskatchewan are incoherent because they purport to include a duty to do what one believes to be wrong in a code of ethics or ethical guidelines, the very purpose of which is to encourage physicians to act ethically and avoid wrongdoing.

Beyond this, when discussion about difficulties associated with the exercise of freedom of conscience in health care is repeatedly characterized as “the problem of conscientious objection,”6 it becomes clear that the underlying premise is that people and institutions ought to do what they believe to be wrong, and that refusal to do what one believes to be wrong requires special justification.  This is exactly the opposite of what one would expect. Most people believe that we should not do what we believe to be wrong, and that refusing to do what we believe to be wrong is the norm. It is wrongdoing that needs special justification or excuse, not refusing to do wrong.

The inversion is troubling, since “a duty to do what is wrong” is being advanced by those who support the “war on terror.” They argue that there is, indeed, a duty to do what is wrong, and that this includes a duty to kill non-combatants and to torture terrorist suspects.7 The claim is sharply contested,8 but it does indicate how far a duty to do what is wrong might be pushed. In Quebec, in Ontario and in Saskatchewan it is now being pushed as far as requiring physicians to participate in killing patients, even if they believe it is wrong: even if they believe that it is homicide.9

This reminder is a warning that the community must be protected against the temptation to give credence to the dangerous idea that is now being advanced by medical regulators in Canada: that a learned or privileged class, a profession or state institutions can legitimately compel people to do what they believe to be wrong – even gravely wrong – and punish them if they refuse.

Forcing someone to do wrong is a violation of humanity, not a limitation of freedom.

Attempts to suppress freedom of conscience and religion in the medical profession are often defended using a statement of the Supreme Court of Canada: “the freedom to hold beliefs is broader than the freedom to act on them.”10

Click here to access Journal.

Click here to access Journal.

The statement is not wrong, but it is inadequate. It is simply not responsive to many of the questions about the exercise of freedom of conscience that arise in a society characterized by a plurality of moral and political viewpoints and conflicting demands. More refined distinctions are required. One of them is the distinction between perfective and preservative freedom of conscience, which reflects the two ways in which freedom of conscience is exercised: by pursuing apparent goods and avoiding apparent evils.11

It is generally agreed that the state may limit the exercise of perfective freedom of conscience if it is objectively harmful, or if the limitation serves the common good. Although there may be disagreement about how to apply these principles, and restrictions may go too far, no polity could long exist without restrictions of some sort on human acts, so some limitation of perfective freedom of conscience is not unexpected.

If the state can legitimately limit perfective freedom of conscience by preventing people from doing what they believe to be good, it does not follow that it is equally free to suppress preservative freedom of conscience by forcing them to do what they believe to be wrong. There is a significant difference between preventing someone from doing the good that he wishes to do and forcing him to do the evil that he abhors.

We have noted the danger inherent in the notion of a “duty to do what is wrong.” Here we add that, as a general rule, it is fundamentally unjust and offensive to suppress preservative freedom of conscience by forcing people to support, facilitate or participate in what they perceive to be wrongful acts; the more serious the wrongdoing, the graver the injustice and offence. It is a policy fundamentally opposed to civic friendship, which grounds and sustains political community and provides the strongest motive for justice. It is inconsistent with the best traditions and aspirations of liberal democracy, since it instills attitudes more suited to totalitarian regimes than to the demands of responsible freedom.

This does not mean that no limit can ever be placed on preservative freedom of conscience. It does mean, however, that even the strict approach taken to limiting other fundamental rights and freedoms is not sufficiently refined to be safely applied to limit freedom of conscience in its preservative form. Like the use of potentially deadly force, if the restriction of preservative freedom of conscience can be justified at all, it will only be as a last resort and only in the most exceptional circumstances.

None of these conditions have been met in Ontario or in Saskatchewan.


Notes:

1.  Email to the Administrator, Protection of Conscience Project, from P__ H__ (present at College Council meeting 18 September, 2008) (2014-02-11, 10:10 am)

2.  Wiesel E. “Without Conscience.N Engl J Med 352;15 april14, 2005 (Accessed 2014-02-24)

3.  Letter from the Office of the Chief Commissioner, Ontario Human Rights Commission, to the College of Physicians and Surgeons of Ontario, dated 19 February, 2015, Re CPSO Draft Policy: Professional Obligations and Human Rights

4.  College of Physicians and Surgeons of Ontario, Policy #2-15: Professional Obligations and Human Rights (Updated March, 2015) (Accessed 2015-03-16)

5.  College of Physicians and Surgeons of Saskatchewan, Policy: Conscientious Refusal.

6.  For example, Cannold L. “The questionable ethics of unregulated conscientious refusal.”  ABC Religion and Ethics, 25 March, 2011. (Accessed 2013-08-11)

7.  Gardner J. “Complicity and Causality,” 1 Crim. Law & Phil. 127, 129 (2007). Cited in Haque, A.A. “Torture, Terror, and the Inversion of Moral Principle.” New Criminal Law Review, Vol. 10, No. 4, pp. 613-657, 2007; Workshop: Criminal Law, Terrorism, and the State of Emergency, May 2007. (Accessed 2014-02-19)

8.  Haque, A.A. “Torture, Terror, and the Inversion of Moral Principle.” New Criminal Law Review, Vol. 10, No. 4, pp. 613-657, 2007; Workshop: Criminal Law, Terrorism, and the State of Emergency, May 2007. (Accessed 2014-02-19)

9.  Quebec has already passed a law purporting to legalize euthanasia: Murphy S. “Redefining the Practice of Medicine- Euthanasia in Quebec, Part 9: Codes of Ethics and Killing.” Protection of Conscience Project, July, 2014.  The Supreme Court of Canada has ordered legalization of physician assisted suicide and physician administered euthanasia.  When the ruling takes effect in early 2016, the Ontario and Saskatchewan policies, as written, will have the effect of forcing physicians unwilling to kill patients or help them kill themselves to find a colleague willing to do so.

10.  Trinity Western University v. College of Teachers, [2001] 1 S.C.R. 772, 2001 SCC 31 (Accessed 2014-07-29)

11.  This section of the paper draws from an extended discussion of the subject in Murphy S, Geunis S.J. “Freedom of Conscience in Health Care: Distinctions and Limits.” J Bioeth Inq. 2013 Oct; 10(3): 347-54

“The core of a modern pluralism”

Sean Murphy*

Introduction

In 2008 the Ontario Human Rights Commission (OHRC) attempted to suppress freedom of conscience and religion in the medical profession in Ontario on the grounds that physicians are “providers of secular public services.”1   The hostility of the OHRC toward religious believers in the medical profession contributed significantly to anti-religious sentiments and a climate of religious intolerance in the province.  This was displayed last year during a public crusade against three Ottawa physicians who refused to prescribe or refer for contraceptives or abortion, in part, because of their religious beliefs.2

Despite the fact that there was no evidence that even a single person in Ontario has ever been unable to access medical services because of conscientious objection by a physician, the College of Physicians and Surgeons of Ontario has now adopted a policy that requires all physicians who object to a procedure for reasons of conscience to direct patients to a colleague willing to provide it.3 A policy to the same effect has been approved in principle by the College of Physicians and Surgeons in Saskatchewan – also without evidence – though it is now under review.4

Submissions made by the Protection of Conscience Project to the Colleges in Ontario and Saskatchewan during public consultations included a discussion of religious belief, secularism and pluralism which has been adapted for this presentation.  The key points are that a proper understanding of “the secular” includes religious belief rather than excluding it, that the core of a modern pluralism requires the accommodation of different world views in the public square, and that this end is not served by authoritarian edicts issued by medical regulators.

A secular public square includes religious belief.

Those who would suppress freedom of conscience and religion in the medical profession on the grounds that physicians are “providers of secular public services”(emphasis added), erroneously presume that what is “secular” excludes religious belief.  The error is exposed by Dr. Iain Benson in his paper, Seeing Through the Secular Illusion.5

sccDr. Benson emphasizes that the full bench of the Supreme Court of Canada has unanimously affirmed that “secular” must be understood to include religious belief.  The relevant statement by the Court opens with the observation that “nothing in the [Canadian Charter of Rights and Freedoms], political or democratic theory, or a proper understanding of pluralism demands that atheistically based moral positions trump religiously based moral positions on matters of public policy.”

The Court rejected that view that,  “if one’s moral view manifests from a religiously grounded faith, it is not to be heard in the public square, but if it does not, then it is publicly acceptable.”

The problem with this approach is that everyone has ‘belief’ or ‘faith’ in something, be it atheistic, agnostic or religious. To construe the ‘secular’ as the realm of the ‘unbelief’ is therefore erroneous. Given this, why, then, should the religiously informed conscience be placed at a public disadvantage or disqualification? To do so would be to distort liberal principles in an illiberal fashion and would provide only a feeble notion of pluralism. The key is that people will disagree about important issues, and such disagreement, where it does not imperil community living, must be capable of being accommodated at the core of a modern pluralism.6

Thus, the Supreme Court of Canada has acknowledged that secularists, atheists and agnostics are believers, no less than Christians, Muslims, Jews and persons of other faiths. Neither a secular state nor a secular health care system (tax-paid or not) must be purged of the expression of religious belief.  Instead, rational democratic pluralism in Canada must make room for physicians who act upon religious beliefs when practising medicine.

However, College officials in Ontario and Saskatchewan are taking exactly the opposite approach.  They demand morally significant participation by all physicians in procedures known to be contrary to the teaching of major religious groups.  Such policies are inimical to the presence of religious believers in medical practice.  Where the Supreme Court has recognized that religious believers and religious communities are part of the warp and woof of the Canadian social fabric, medical regulators in Ontario and Saskatchwan act as if they don’t exist – or should be made to disappear.

Accommodate different conceptions of “the good life.”

It is worthwhile to contrast the illiberal attitude of College officials with the approach taken by Madame Justice Bertha Wilson of the Supreme Court of Canada in the landmark 1988 case R. v. Morgentaler. Addressing issues of freedom of conscience and abortion, Madame Justice Wilson argued that “an emphasis on individual conscience and individual judgment . . . lies at the heart of our democratic political tradition.”7

At this point in the judgement, Wilson was not discussing whether or not the conscience of a woman should prevail over that of an objecting physician, but how the conscientious judgement of an individual should stand against that of the state. Her answer was that, in a free and democratic society, “the state will respect choices made by individuals and, to the greatest extent possible, will avoid subordinating these choices to any one conception of the good life.”8  This statement was affirmed unanimously in 1991 by a panel of five judges, and by the full bench of the Court in1996.9

The accommodation recommended by Madame Justice Wilson and the kind of modern pluralism advocated by the Supreme Court of Canada contrast sharply with the authoritarian approach being taken by Colleges of Physicians and Surgeons in Ontario and Saskatchewan.

Avoid authoritarian solutions.

Making room in the public square for people motivated by different and sometimes opposing beliefs can lead to conflict, but, as we have seen, the Supreme Court warns against that singling out and excluding religious belief or conscientious convictions in order to prevent or minimize such conflict is a perverse distortion of liberal principles.6

It is also dangerous. It overlooks the possibility that some secularists – like some religious believers – can be uncritical and narrowly dogmatic in the development of their ethical thinking, and intolerant of anyone who disagrees with them. They might see them as heretics who must be driven from the professions, from the public square, perhaps from the country: sent to live across the sea with their “own kind,” as one of the crusaders against the Ottawa physicians put it.10

University of Victoria law professor Mary Anne Waldron provides a reminder and a warning:

Conflict in belief is an endemic part of human society and likely always will be. What has changed, I think, is the resurrection of the idea that we can and should compel belief through legal and administrative processes, or, if not compel the belief itself, at least force conformity. Unfortunately, that begins the cycle of repression that, if we are to maintain a democracy, we must break.11

On this point, it is essential to note that a secular ethic is not morally neutral.12 The claim that a secular ethic is morally neutral – or that one can practise medicine in a morally “neutral” fashion- is not merely fiction. It is an example of “bad faith authoritarianism. . . a dishonest way of advancing a moral view by pretending to have no moral view.”13

Ontario’s new policy and the one being considered in Saskatchewan illustrate one of the most common examples of “bad faith authoritarianism”: the pretence that forcing a physician who will not kill a patient to find someone willing to do so is an acceptable compromise that does not involve morally significant participation in killing.


Notes:

1.  Submission of the Ontario Human Rights Commission to the College of Physicians and Surgeons of Ontario Regarding the draft policy, “Physicians and the Ontario Human Rights Code.” 15 August, 2008. (Accessed 2014-03-11), citing Norton K.C. “Letter to Ontario’s Attorney General expressing concern about allowing public officials to refuse to marry same-sex couples.” (Accessed 2014-03-11)

2.  Murphy S.  “NO MORE CHRISTIAN DOCTORS.”  Protection of Conscience Project (March, 2014)

3.  College of Physicians and Surgeons of Ontario, Policy #2-15: Professional Obligations and Human Rights (Updated March, 2015) (Accessed 2015-03-16)

4.  College of Physicians and Surgeons of Saskatchewan, Policy: Conscientious Refusal.

5.  Benson, I.T., “Seeing Through the Secular Illusion” (July 29, 2013). NGTT Deel 54 Supplementum 4, 2013. (Accessed 2014-02-18)

6.  Chamberlain v. Surrey School District No. 36 [2002] 4 S.C.R. 710 (SCC), para. 137 (Accessed 2014-08-03). Dr. Benson adds: “Madam Justice McLachlin, who wrote the decision of the majority, accepted the reasoning of Mr. Justice Gonthier on this point thus making his the reasoning of all nine judges in relation to the interpretation of ‘secular.'” Benson I.T., “Seeing Through the Secular Illusion” (July 29, 2013). NGTT Deel 54 Supplementum 4, 2013.  (Accessed 2014-02-18)

7.  R. v. Morgentaler  (1988)1 S.C.R 30 (Supreme Court of Canada) p. 165.  Accessed 2015-02-26.

8.  R. v. Morgentaler  (1988)1 S.C.R 30 (Supreme Court of Canada) p. 166. Accessed 2015-02-26.

9.  R. v. Salituro[1991] 3 S.C.R. 654; Québec (Curateur public) c. Syndicat national des employés de l’Hôpital St-Ferdinand, [1996] 3 S.C.R. 211 (Accessed 2015-03-05).

10.   T___ M___, 29 January, 2014, 6:56 pm (Accessed 2014-02-10)

11.  Waldron, MA, “Campuses, Courts and Culture Wars.” Convivium, February/March 2014, p. 33

12.  The distinction between ethics and morality is mainly a matter of usage. Recent trends identify ethics as the application of morality to a specific discipline, like medicine or law. In a broader and older sense, ethics is concerned with how man ought to live, while the study of morality focuses on ethical obligations. See the entry on “Ethics and Morality” in Honderich T. (Ed.) The Oxford Companion to Philosophy (2nd Ed.) Oxford: Oxford University Press, 2005.

13.   “The question of neutrality has been profoundly obscured by the mistake of confusing neutrality with objectivity… neutrality and objectivity are not the same… objectivity is possible but neutrality is not. To be neutral, if that were possible, would be to have no presuppositions whatsoever. To be objective is to have certain presuppositions, along with the manners that allow us to keep faith with them.” Budziszewski J., “Handling Issues of Conscience.” The Newman Rambler, Vol. 3, No. 2, Spring/Summer 1999, P. 4.

Medicine, morality and humanity

Sean Murphy*

Introduction

The College of Physicians and Surgeons of Ontario, the state regulator of the practice of medicine in the province, has approved a policy that requires all physicians who object to a procedure for reasons of conscience to facilitate the procedure by referring patients to a colleague who will provide it. A policy to the same effect has been approved in principle by the College of Physicians and Surgeons in Saskatchewan, though it is now under review.2

Remarkably, no evidence was provided to justify the policy in either province.  There is no evidence that even a single person in either Ontario or Saskatchewan has ever been unable to access medical services because of conscientious objection by a physician.  Materials provided by the working group to the College Council in Ontario were deficient, erroneous and seriously misleading,3 while the development of the policy in Saskatchewan was marked by what appears to be a pattern of concealment, selective disclosure, and false or misleading statements.4

Submissions made by the Protection of Conscience Project to the Colleges in Ontario and Saskatchewan during public consultations included a discussion of morality and medical practice which has been adapted for this presentation.

Medicine is a moral enterprise.

physician-muslimThe practice of medicine is an inescapably moral enterprise precisely because physicians are always seeking to do some kind of good and avoid some kind of evil for their patients.5 However, the moral aspect of practice as it relates to the conduct and moral responsibility of a physician is usually implicit, not explicit. It is normally eclipsed by the needs of the patient and exigencies of practice. But it is never absent; every decision concerning treatment is a moral decision, whether or not the physician specifically adverts to that fact.

This point is frequently overlooked when a physician, for reasons of conscience, declines to participate in or provide a service or procedure that is routinely provided by his colleagues. They may be disturbed because they assume that, in making a moral decision about treatment, he has done something unusual, even improper. Seeing nothing wrong with the procedure, they see no moral judgement involved in providing it. In their view, the objector has brought morality into a situation where it doesn’t belong, and, worse, it is his morality.

In point of fact, the moral issue was there all along, but they didn’t notice it because they have been unreflectively doing what they were taught to do in medical school and residency, and what society expects them to do. Nonetheless, in deciding to provide the procedure they also implicitly concede its goodness; they would not provide it if they did not think it was a good thing to do. 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.

Hence, the demand that physicians must not be allowed to act upon beliefs is unacceptable because it is impossible; one cannot act morally without reference to beliefs, and cannot practise medicine without reference to beliefs. Relevant here is a comment by Professor Margaret Somerville. “In ethics,” she writes,”impossible goals are not neutral; they cause harm.”6

Once medicine is understood to be a moral enterprise, it becomes easier to understand why it is a mistake to think that moral or ethical views are unwelcome intruders upon the physician-patient relationship. Morality and ethics are actually intrinsic to it. Of course, some moral or ethical views may be erroneous, but that is a different matter that must be addressed by explaining why they are erroneous. It will not do to pretend, for example, that the claim that best medical practice in some circumstances means killing a patient does not involve at least implicit moral or ethical judgements.

Consistent with the practice of medicine understood as a moral enterprise, a physician first considers the well-being of the patient.7 Patient-centred medical practice is directed to ensuring good medical care, but good medical care is not provided by automatons. Medical schools do not manufacture made-to-order products that perform according to factory default settings, or finely machined cogs that keep health care delivery apparatus running smoothly. Medicine is a moral enterprise, morality is a human enterprise, and physicians, no less than patients, are moral agents.

Morality is a human enterprise.

All public behaviour – how one treats other people, how one treats animals, how one treats the environment – is determined by what one believes.  Some of these beliefs are religious, some not, but all are beliefs. This applies no less to “secular” ethics than to religious ethics.  That human dignity exists – or that it does not – or that human life is worthy of unconditional reverence – or merely conditional respect – and notions of beneficence, justice and equality are not the product of scientific enquiry, but rest upon faith: upon beliefs about human nature, the meaning and purpose of life, the existence of good and evil.

That everyone is a believer reflects the fact that the practice of morality is a human enterprise,8 but it is not a scientific enterprise. The classic ethical question, “How ought I to live?” is not a scientific question and cannot be answered by any of the disciplines of natural science, though natural science can provide raw material needed for adequate answers.

Answers to the question, “How ought I to live?” reflect two fundamental moral norms; do good, avoid evil. These basics have traditionally been undisputed; the disputes begin with identifying or defining good and evil and what constitutes “doing” and “avoiding.” Such explorations are the province of philosophy, ethics, theology and religion.

Internationally, religion continues to be the principal means by which concepts of good and evil and right and wrong conduct are sustained and transmitted.  Nonetheless, since the practice of morality is a human enterprise, reflections about morality and the development and transmission of ideas about right and wrong also occurs within culture and society outside the framework of identifiable academic disciplines and religions.

In consequence, the secular public square is populated by people with any number of moral viewpoints, some religious, some not: some tied to particular philosophical or ethical systems, some not: but all of them believers. There is no reason to deny the freedom to act upon religious belief because it is religious: no reason, that is, apart from anti-religious bigotry.

Further, since morality is a human enterprise, moral judgement is an essential activity of every human person, moral judgement necessarily involves some kind of individual or personal conviction, and maintaining one’s personal moral integrity is the aspiration of anyone who wishes to live rightly.  Thus, beliefs are “personal,” in the sense that one personally accepts them and is committed to them.

However, this does not mean that such “personal” beliefs are parochial, insignificant or erroneous. Christian, Jewish and Muslim beliefs, for example, are shared by hundreds of millions of people. They “personally” adhere to their beliefs, just as non-religious believers “personally” adhere to their non-religious beliefs. In neither case does the fact of this “personal” commitment provide grounds to set beliefs aside. Thus, it is important to recognize that pejorative or suspicious references to “personal” beliefs or “personal” values frequently reflect underlying and perhaps unexamined prejudice against them.

Notes:

1.  College of Physicians and Surgeons of Ontario, Policy #2-15: Professional Obligations and Human Rights (Updated March, 2015) (Accessed 2015-03-16)

2.  College of Physicians and Surgeons of Saskatchewan, Policy: Conscientious Refusal.

3.  Protection of Conscience Project, Submission to the College of Physicians and Surgeons of Ontario Re: Professional Obligations and Human Rights, Appendix “B”: Unreliability of Jurisdictional Review by College Working Group

4.  Protection of Conscience Project, Submission to the College of Physicians and Surgeons of Saskatchewan Re: Conscientious Refusal, Appendix “A” and “B”

5.  Maddock J.W. “Humanizing health care services. The practice of medicine as a moral enterprise.” J Natl Med Assoc. 1973 November; 65(6): 501–passim. PMCID: PMC2609038  (Accessed 2014-02-18)

6.  Somerville M. “Why are they throwing brickbats at God?” MercatorNet, 1 June, 2007 (Accessed 2014-08-03)

7.  Canadian Medical Association, Code of Ethics (2004): Fundamental Responsibilities No. 1. (Accessed 2014-02-15)

8.  This presumption obviously underlies standard bioethics texts. See, for example, Beauchamp TL, Childress JF, Principles of Biomedical Ethics (7th ed) New York: Oxford University Press, 2013

Lawyers to UN: Forcing nurses to assist abortions violates international law

 Parallel meeting in Geneva on 12 March

News Release

Alliance Defending Freedom

ADF International will hold a parallel event at the 28th session of the United Nations Human Rights Council in Geneva Thursday to call upon European nations to respect the fundamental right to freedom of conscience within the medical profession. Two ADF International lawyers will speak at the event and will be available for media interviews.

ADF International, in coalition with Scandinavian Human Rights Lawyers, will urge the UN Human Rights Council and the international community at large to confront the lack of protections for freedom of conscience in several European countries. Although this fundamental human right is protected under international and European human rights law, a growing trend – particularly within the medical profession – is to override it. As a result, doctors, nurses, and midwives are being fired for refusing to perform or partake in abortion procedures.

“No one deserves to  be denied a job simply because they are pro-life,” said Ruben Navarro, ADF International’s director of UN Advocacy-Geneva, who will speak at the event. “International law makes it clear that being pro-abortion cannot be a requirement for employment, nor can medical facilities force nurses and midwives with a conscience objection to assist with practices that can lead to an abortion.”

At the event, Ruth Nordström, president of Scandinavian Human Rights Lawyers and lead counsel in the case Grimmark vs. Jönköping City Council, will discuss the lack of conscience protections under Swedish law.

“Sweden has failed to develop a comprehensive and clear regulation that defines and regulates conscientious objection at the workplace, in particular for health care providers,” Nordström explains. “Swedish medical workers are being reprimanded, repositioned, fired, and put at a disadvantage in other ways as well. Their freedoms under international treaties are being violated.”

“Willingness to commit an abortion cannot be a litmus test for employment,” added ADF International Senior Legal Counsel and Director of UN Advocacy Paul Coleman. “Medical clinics and hospitals need to respect the desire and conviction of a midwife or nurse to protect life – a desire that led Ellinor Grimmark and others like her to pursue the profession in the first place.”

CMDS Canada plans legal challenge to new Ontario College of Physicians policy

Note:  The following message has been sent to members of the Christian Medical Dental Society of Canada concerning the decision of the College of Physicians and Surgeons of Ontario to enact a policy that demands that physicians facilitate procedures to which they object for reasons of conscience by referring patients to a non-objecting colleague or agency.  It is reproduced here with permission.

We received the disappointing news today that the CPSO has passed their policy “Professional Obligations and Human Rights”. We ask that all members across the country join in prayer and ask our Lord to have mercy on us and to act to undo this policy that tramples on the constitutional freedoms of doctors of conscience.

We have already been in discussion with our lawyer Albertos Polizogopoulos who has been asked to prepare an application in court to have the policy struck down because it runs contrary to the Canadian Charter of Rights and Freedoms.

We are planning a press conference in Toronto to launch this court challenge in the next two weeks and we sincerely hope this stops other colleges from following suit. We know that Saskatchewan has a similar policy up for consideration, and other provinces might be considering this. We need to act quickly to try to stop other provinces from taking this step. Bryan Dias, national president of the Canadian Federation of Catholic Physician’s Societies has indicated that his organization will join in the application as well and other groups are also welcome.

We will be making a solicitation of members for this cause next week. We will be preparing to move legally in Saskatchewan as well if we are not successful with the Saskatchewan College.  We are going to try to raise $150,000 for this project. $25,000 has already been raised from the CMDS Canada Board of Directors alone. The money raised will also go towards a public awareness campaign and towards the development of a database of supporters.

Three doctors have come forward to be named in the court application in Ontario. We would encourage other Ontario doctors who feel strongly about this matter to come forward and allow their names to stand as well.  For more information, contact Larry at lworthen@cmdscanada.org

Many doctors are concerned about what to do in their practice now that the policy has been passed. We will be asking Albertos for his advice on this and will get back to you on this with a note very shortly.

One of the things we could consider is to try to get before the court quickly to ask that the policy be suspended until it gets before a judge, to hear the merits of the case.

One thing is for sure – please do not give up hope. We have a good legal strategy and alot of people pulling for us. There were over 16,000 submissions to CPSO on this issue and it has been reported that most were in favour of conscience rights generally. Most importantly, we have a God who is looking out for us and who wants us to continue His healing ministry. Let us keep each other in prayer and let us ask our respective congregations and parishes to pray for us as well.

Let’s not worry – because we know that the Lord has a plan.

Larry Worthen BA, MA (Th.), LLB
Executive Director
Christian Medical and Dental Society of Canada
Cell: (902) 880-2495

National Office:
1-197D Main Street  Steinbach MB R5G 1Y5 Phone: 204-326-2523
Fax: 204-326-3098 Toll Free:  1-888-256-8653 Website: www.cmdscanada.org

Conscientious objection: a good for humanity

News Release

Bratislava

Consilium Conferentiarum Episcoporum Europae (CCEE)

While in Europe, strongly marked by secularism and liberalism, there is an increasing tendency to multiply the rights of individuals, especially at the beginning and end of life, proportionally,  freedom of conscience – a fundamental right at the foundation of democracy and the Rule of law of our European countries – is increasingly struggling, especially in the medical and educational field. On the contrary conscientious objection is not used against anyone or to undermine the legal system but for the common good. In Bratislava, the legal advisers of the Bishops’ Conferences of Europe talked about the real applicability of conscientious objection in the light of the current debate in European States and the consequences-challenges to church institutions.

The meeting was held from 4th to 6th of March in Bratislava, Slovakia. This was the second meeting of legal advisers, organized by the Council of European Bishops’ Conferences (CCEE). The first one was held in Strasbourg in 2013. Representatives of the Holy See, England, Belgium, Bosnia and Herzegovina, Czech Republic, Croatia, France, Germany, Spain, Hungary, Italy, Latvia, Lithuania, Poland, Portugal, Scotland, Slovakia, Slovenia and Ukraine attended the conference. The meeting was hosted by Msgr. Stanislav Zvolensky, Archbishop of Bratislava and President of the Slovak Bishops’ Conference, who opened the conference. Msgr. Mario Giordana, Apostolic Nuncio in Slovakia and Jan Figel, currently Vice President of the Slovak Parliament, greeted the participants during the meeting.

The main address was given by Prof. Marek Šmid, Rector of the University of Trnava (Slovakia) who focused on the legal regulation of conscientious objection. There is a diversity of situations in the states of Europe. The common element of their legal systems is the fact that the regulation of conscientious objection has an important impact in a number ethically sensitive areas.

In the case of members of the Catholic Church, conscientious objection should be instituted as a legal possibility that gives people the right to refuse duty, which is contrary to the general principles of doctrine and morals of the Church. This does not mean the right to disregard the laws of the country, but to enable the individual to comply with the laws of the State and avoid compromising their conscience at the same time.

Conscientious objection is in the interests of the individual and of the state which aims to be pluralistic, democratic and respectful of the rule of law. It enables citizens to enjoy the right to freedom of conscience and religion, which is one of the core values ​​of  society. In particular the effects of conscientious objection should extend to the inviolability of human life from conception to natural death and also related health services. Its effects should also extend to the field of teaching on sexual morality in public school, marriage as a life community of one man and one woman and the exercise of freedom of religion in public life, particularly through the use of religious symbols.

In health care the right to conscientious objection doesn’t belong only to doctors but also to other professional personnel (eg. nurses, psychologists, social workers). In particular, it must be possible in the following procedures: abortion, euthanasia, artificial insemination, research and organ transplants, as has been shown by Prof. Eva Grey, of St. Elisabeth University of Health and Social Work (Bratislava). However, conscientious objection may not outweigh the duty of medical personnel to protect or save human lives.

Other fundamental points underlined during the meeting were:

  • the fact that nowadays a new dimension of conscientious objection arises with respect to aggressive promotion of gender ideology through education and antidiscrimination legislation;
  • the need to bear in mind the role of ethics code in healthcare;
  • the need to promote the institutional aspects of conscientious objection: not just individuals but also institutions (hospitals, schools) should be allowed to object;
  • the role of families in creating conditions for conscientious objection;
  • and finally, the fact that Freedom of conscience inevitably provides awareness and recognition of the fundamental values ​​of society and of individuals. The States together with the civil societies, Churches and religious communities should cooperate in accordance with the principle of subsidiarity. This principle is particularly promoted by the social teaching of the Catholic Church.

On the afternoon of Thursday 5 March participants moved to Vienna. There, they visited the European Union Agency for Fundamental Rights (FRA). Then, they were introduced to the challenges for Church organisations in the current discussion on development of antidiscrimination laws by Ms Gudrun Kugler, President of the Observatory on Intolerance and Discrimination against Christians in Europe.  In the Austrian Capital they also met with Mgr. Janusz Urbańczyk and Mgr. Marinko Antolović from the Holy See’s Permanent Mission at the Organization for Security and Co-operation in Europe (OSCE).

Through a video recorded address from Judge Marta Cartabia, Vice President of the Italian Constitutional Court, participants were also introduced to the theme of freedom of expression. The Church strongly defend this fundamental right being aware, however, that nowadays freedom of expression, especially when it concerns the religious dimension of people, might need a reasonable accommodation between the State and religious communities. In case of conflict, experiences show that a better regulation of this right is reached where a Concordat – Agreement between the State and the Church has been established. Bilateral Agreement, in fact, remains the more reasonable solution in a pluralistic society preserving this pluralism without provoking the annulment of the differences or creating homologation.

In Bratislava, participants took also note on the recent redefinition of marriage in Slovenia and supported together with Slovenians bishops the efforts of civil society to overrule the complete assimilation of same-sex unions with the different-sex ones by the people in a referendum.

The final session saw a reflection followed by a dialogue with Msgr. Paul Gallagher, Secretary for the Relations with States (Holy See’s Secretariat of State) on The challenges for today’s Church in Pope Francis’ addresses to the European Parliament and the Council of Europe. Msgr. Gallagher stressed Pope Francis’ reflection on the need that we should rebuild “a Europe which contemplates the heavens and pursues lofty ideals”.

At the end of the meeting José Jesus López Nieto, legal adviser of the Spanish Bishops’ Conference, presented the conclusion of a short questionnaire that CCEE disseminated earlier this year. According to the responses received, it is important that CCEE fosters this network of Legal Advisers and to engage more with the specific invitation that Pope Francis has addressed to CCEE in Stasbourg to follow more deeply the activities of the Council of Europe, with the help of the Permanent Mission of the Holy See to the Council of Europe, represented during the meeting by Mgr. Paolo Rudelli, its Permanent Observer.

CPSS undermines, Supreme Court of Canada affirms conscience rights for Saskatchewan doctors

News Release

Christian Medical Dental Society of Canada

SASKATOON, March 6, 2015 /CNW/ – Several Saskatchewan physicians, including Dr. Amos Akinbiyi, Dr. Philip Fitzpatrick, and Dr. Randy Friesen, released a letter and legal brief (see below), today, describing how the conscience rights of Saskatchewan doctors are undermined by the College of Physicians and Surgeons of Saskatchewan (CPSS) draft policy on requirements for physicians and surgeons and upheld by the Supreme Court of Canada’s recent decision on assisted suicide in Carter, et al.

Said Dr. Philip Fitzpatrick, “In the recent Carter decision from the Supreme Court, they made explicit reference to conscience rights, and that physicians could not be forced to participate in an abortion or euthanasia. But the CPSS’s draft policy would require me to make a formal referral to another physician where my conscience would not permit me to do those procedures, and could require me to do it myself.”

The letter and brief (see below) were initiated by physicians who are members of the Christian Medical and Dental Society of Canada (CMDS) and the Canadian Federation of Catholic Physicians’ Societies (CFCPS).

CPSS is circulating a draft policy that would require physicians and surgeons to make a formal referral of patients to a physician or surgeon who would be willing to perform the legally permissible and publicly funded health services, irrespective of conscience rights. If another physician were not available to perform the service, the physician would be required to provide the service, whether or not performing the service conflicted with conscience.

“The CPSS seems to be creating conflicts between medical doctors’ conscience rights and patient care unnecessarily. No doctors concerned about conscience rights would put their patients’ health and well-being in jeopardy. I find that patients are very appreciative of my concern for their health and of my outlining all the options and alternatives for treatment,” said Dr. Friesen.

In their letter to CPSS and the accompanying legal brief, the Saskatchewan doctors outlined their concerns with the draft policy and how a few amendments to it would provide the conscience rights protections upheld by the Court.

Saskatchewan is a dynamic province with a growing population. Saskatchewan needs physicians, especially General Practitioners. GPs would be most affected by the CPSS policy. Our province will have a hard time keeping and recruiting GPs to serve communities where they would be required by the policy as now drafted to make care decisions they believe will harm patients,” added Dr. Akinbiyi.

CMDS represents more than 1600 physicians, surgeons and dentists across Canada and CFCPS is a national association of Catholic physicians’ guilds, associations and societies from eleven cities across Canada.

Letter: http://goo.gl/nKi6JN and the Legal Brief: http://goo.gl/Nf3Bp7.

SOURCE Christian Medical and Dental Society of Canada

For further information: Larry Worthen, (902) 880-2495