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Protection of Conscience Project

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Service, not Servitude
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Submission to the College of Physicians and Surgeons of Ontario
Re:
Professional Obligations and Human Rights

Appendix "A"

The Review Process


AI.    Introduction

AI.1    Physicians and the Ontario Human Rights Code was adopted in 2008.1 The policy was slated for review by September, 2013, but a public announcement of the review was not made until June, 2014.

AII.    Public polling

AII.1    As part of the review process, the College surveyed 800 Ontario residents in May, 2014 "to capture public sentiment on conscientious objection in the health services context."

The online panel was recruited randomly using an Interactive Voice Response system.  Results can therefore be generalized to the online population of Ontario, which represents approximately 80% of the adult population.  Findings are accurate to +3.5% at the 95% level of confidence.2

AIII.    Preliminary consultation

AIII.1    The College invited the public and the profession to provide feedback on Physicians and the Ontario Human Rights Code by regular mail, email, and an on-line survey.  In addition, it provided an On-line Poll3 and Discussion Forum.4  The prompt for the On-line Poll, Discussion Forum and submissions was:

Do you think a physician should be allowed to refuse to provide a patient with a treatment or procedure because it conflicts with the physician’s religious or moral beliefs?  (Yes) (No) (Don't Know)5

AIII.2    The first stage of a public consultation about the policy closed on 5 August, 2014. 

AIV.    Research

AIV.1    Literature Review:  The working group conducted what was described as "a comprehensive literature review of Canadian and international scholarly articles, research papers, newspaper publications, conference proceedings and organizational publications."6

AIV.2    Jurisdictional Research: The working group compared and contrasted "the policy positions of Canadian medical regulators, Ontario regulated health professions, and selected international bodies with respect to conscientious objection and fulfilling obligations under Human Rights legislation."7 

AIV.3    Legal Research:  The working group reviewed the Ontario Human Rights Code and current case law concerning equality rights and freedom of conscience and religion.8

AV.    Report to College Council

AV.1    On December 4-5, 2014 the full College Council met to consider College business.  It was provided a 630 page briefing book dealing with agenda items.9  This included a seven page briefing note,10 a copy of the existing Physicians and the Ontario Human Rights Code  and a copy of its draft replacement, Professional Obligations and Human Rights (POHR).11

Public Polling

AV.2    The briefing note from the working group provided the following information to the College Council concerning the poll conducted in May:

  • 71% believed that physicians should not be allowed to refuse to provide a treatment or procedure because it conflicts with the physicians' religious or moral beliefs.
  • Objectors should be required
    •  Provide patients with information about treatment or procedure options (94%)
      o Identify another physician who will provide the treatment, and advise the patient to contact them (92%)
      o Make/coordinate the referral (87%)12
Consultation

AV.3    Concerning the consultation, the working group told that Council that "the vast majority of respondents expressed their support for freedom of conscience, and the idea that physicians should not have to provide services that conflict with their moral and/or religious beliefs," but added that the feedback was polarized.13  On the question of referral, the Council was told  "many respondents were in support of a referral requirement" but that "the opposing viewpoint was also strongly represented."14

AV.4    Appendix "C" demonstrates that this summary was inadequate and misleading.

Research

AV.5    An appendix to the working group's briefing note (Appendix 3) summarized the jursidictional research.15 Council was advised that the proposed draft policy,  Professional Obligations and Human Rights (POHR), "reflects research undertaken, feedback received during the preliminary consultation and public polling results."16

Action

AV.6    The working group asked the Council for feedback on the document and asked that it recommend that Professional Obligations and Human Rights (POHR) be released "for external consultation."  Council agreed.

AVI.    Working group comments

AVI.1    When POHR was released in December, 2014, Dr. Marc Gabel, then President of the College, stated that public polling by the College (AV.2) demonstrated that "the vast majority of Ontarians believe that [objecting physicians] should be required to identify another physician who will provide the treatment, and make and/or coordinate a referral."17

AVI.2    The Supreme Court of Canada announced that it would release its decision in Carter v. Canada on 6 February, 2015.  It was widely expected that the Court would legalize physician assisted suicide and euthanasia.  Media reports took note that Professional Obligations and Human Rights (POHR) would compel objecting physicians to refer for euthanasia.  Interviewed in anticipation of the ruling, Dr. Gabel did not deny this.

Whatever its policy ultimately looks like, the college is clear: a patient's right to access services outweighs a doctor's right to refuse them. "We prioritize the interests of our patients in facilitating access," says Dr. Marc Gabel, past president of the college and chair of the policy's working group.18

AVI.3    In addition, he claimed that POHR introduced nothing new:

Similar policies are already in place in Alberta, Manitoba, Quebec and New Brunswick, Dr. Gabel says: "This is nothing new."19

AVI.4    Appendix "B" demonstrates that, apart from Quebec, this claim is seriously misleading.


Notes

1.  College of Physicians and Surgeons of Ontario, Physicians and the Ontario Human Rights Code.  Approved by council September, 2008.  To be reviewed by September, 2013.

2.  College of Physicians and Surgeons of Ontario, Council Briefing Note: Professional Obligations and Human Rights - Draft for Consultation (For Decision) (December, 2014).  In Annual Meeting of Council, December 4-5, 2014, p. 330.

3.  College of Physicians and Surgeons of Ontario, College Consulations: Physicians and the Ontario Human Rights Code. (Accessed 2015-02-16)

4.  College of Physicians and Surgeons of Ontario, College Consulations: Physicians and the Ontario Human Rights Code- Discussion. (Accessed 2015-02-16)

5.  College of Physicians and Surgeons of Ontario, College Consulations: Physicians and the Ontario Human Rights Code. (Accessed 2015-02-16)

6.  College of Physicians and Surgeons of Ontario, Council Briefing Note: Professional Obligations and Human Rights - Draft for Consultation (For Decision) (December, 2014). In Annual Meeting of Council, December 4-5, 2014, p. 327 (Accessed 2015-02-03)

7.  College of Physicians and Surgeons of Ontario, Council Briefing Note: Professional Obligations and Human Rights - Draft for Consultation (For Decision) (December, 2014). In Annual Meeting of Council, December 4-5, 2014, p. 327 (Accessed 2015-02-03)

8.  College of Physicians and Surgeons of Ontario, Council Briefing Note: Professional Obligations and Human Rights - Draft for Consultation (For Decision) (December, 2014). In Annual Meeting of Council, December 4-5, 2014, p. 327 (Accessed 2015-02-03)

9.  College of Physicians and Surgeons of Ontario, Annual Meeting of Council, December 4-5, 2014. (Accessed 2015-02-03)

10.  College of Physicians and Surgeons of Ontario, Council Briefing Note: Professional Obligations and Human Rights - Draft for Consultation (For Decision) (December, 2014).  In Annual Meeting of Council, December 4-5, 2014, p. 326-332 (Accessed 2015-02-03)

11.  Professional Obligations and Human Rights (POHR) (Draft)

12.  College of Physicians and Surgeons of Ontario, Council Briefing Note: Professional Obligations and Human Rights - Draft for Consultation (For Decision) (December, 2014). In Annual Meeting of Council, December 4-5, 2014, p. 330 (Accessed 2015-02-03)

13.  College of Physicians and Surgeons of Ontario, Council Briefing Note: Professional Obligations and Human Rights - Draft for Consultation (For Decision) (December, 2014). In Annual Meeting of Council, December 4-5, 2014, p. 329 (Accessed 2015-02-03)

14.  College of Physicians and Surgeons of Ontario, Council Briefing Note: Professional Obligations and Human Rights - Draft for Consultation (For Decision) (December, 2014). In Annual Meeting of Council, December 4-5, 2014, p. 329-330 (Accessed 2015-02-03)

15.  College of Physicians and Surgeons of Ontario, Appendix 3- Jurisdictional Review. In Annual Meeting of Council, December 4-5, 2014, p. 342-352 (Accessed 2015-02-03)

16.  College of Physicians and Surgeons of Ontario, Council Briefing Note: Professional Obligations and Human Rights - Draft for Consultation (For Decision) (December, 2014).  In Annual Meeting of Council, December 4-5, 2014, p. 326 (Accessed 2015-02-03)

17.  Gabel, M. "Dear Colleagues." College of Physicians and Surgeons of Ontario, Dialogue, Vol. 10, Issue 4, 2014, p. 6. (Accessed 2015-02-02)

18.  Nasser S.  "If Supreme Court decriminalizes physician-assisted suicide, doctors may be obligated to help with euthanasia."  National Post, 4 February, 2015 (Accessed 2015-02-17)

19.  Nasser S.  "If Supreme Court decriminalizes physician-assisted suicide, doctors may be obligated to help with euthanasia."  National Post, 4 February, 2015 (Accessed 2015-02-17)

 

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