Ontario Court of Appeal supports ‘effective referral’ for morally contested procedures, including euthanasia


Court unanimously affirms right of state to compel participation in homicide, suicide, etc.

News Release

Protection of Conscience Project

On 15 May, 2019, three judges of the Ontario Court of Appeal unanimously upheld a lower court ruling that physicians can be forced to facilitate procedures they find morally objectionable, including euthanasia and assisted suicide, by connecting patients with willing providers (“effective referral”).

The Court of Appeal judgement concerned a 2018 decision by the Ontario Divisional Court that had been appealed by the Christian Medical and Dental Society of Canada and others. The litigation was a response to a compulsory “effective referral” policy imposed by Ontario’s state medical regulator, the College of Physicians and Surgeons of Ontario.

The Protection of Conscience Project, Catholic Civil Rights League and Faith and Freedom Alliance jointly intervened at trial and in the appeal in support of freedom of conscience.

The Divisional Court and the Court of Appeal both acknowledged the joint intervention, but neither considered the arguments it proposed because the case was decided solely on the basis of freedom of religion claims. The Court of Appeal held that the evidence at trial was “insufficient to support an analysis of freedom of conscience.”

“To the extent the individual appellants raise issues of conscience,” said the Court, “they are inextricably grounded in their religious beliefs,” so that, “at its core, the appellants’ claim is grounded in freedom of religion.”[para. 85]

Since the arguments in the Project’s intervention were not addressed at trial or in the appeal, Project Administrator Sean Murphy believes that they are unaffected by the decision.

“The focus of the Court was on religiously-motivated refusal to participate in perceived wrongdoing,” said Murphy. “The analytical framework proposed in the joint intervention could easily have been adapted and applied to that particular form of the exercise of religious freedom. The evidentiary record would have been sufficient for that purpose.”

“However, the Court did not do this, so the arguments still stand, and they can be raised again in another appropriate case.”

The decision demonstrates that the judges uncritically adopted the view of the College that euthanasia, assisted suicide, abortion, contraception, sterilization, sex change surgery, etc. are acceptable forms of medical treatment or health care. They further noted that abortion, euthanasia and assisted suicide “carry the stigmatizing legacy of several centuries of criminalization grounded in religious and secular morality.” [para. 123]. On the other hand, they gave no weight to contrary views held by the plaintiffs.

The Court of Appeal also supported the College’s assertion that objecting physicians unwilling to comply with the demand for effective referral could change their scope of practice and move into fields like “sleep medicine, hair restoration, sport and exercise medicine, hernia repair, skin disorders . . . obesity medicine, aviation examinations, travel medicine . . . administrative medicine or surgical assistance.”[para. 71]

The appellants have 60 days to consider and appeal to the Supreme Court of Canada.

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Contact: Sean Murphy, Administrator
Protection of Conscience Project
Email: protection@consciencelaws.org

Catholic hospital group sued for refusing transgender hysterectomy

Cathoic News Agency

San Francisco, Calif., Mar 25, 2019 / 02:00 pm (CNA).- A group of five Catholic hospitals in California is being sued by a woman who identifies as a transgender man after one of its locations, St. Joseph Hospital, Eureka, refused to perform a hysterectomy.

Oliver Knight is suing St. Joseph Health of Northern California, alleging that she was refused the surgery because of her “gender orientation.”

The suit was filed in the Humboldt County Superior Court on Thursday, March 21. In the lawsuit, Knight says that workers at the hospital canceled the surgery because she identifies as transgender. . . [Full text]

Labour Court clarifies freedoms of religion and conscience in healthcare sector

Wistrand International Law Office

Jörgen Larsson

Introduction

Sweden is one of the most secular countries in the world with full freedom of religion. Further, freedom of conscience is a right protected by the European Convention on Human Rights (ECHR). However, domestic law recognises no right to conscientious objection. In this respect, Sweden differs from most other European countries.

In 2017 the Labour Court clarified from an employment law perspective whether freedom of conscience gives healthcare professionals a right to conscientious objection.

Facts

A midwife expressed that her religious beliefs forbid her from performing abortion services. When she expressed her opinion, three different healthcare regions in Sweden refused to employ her. The midwife brought the case to the Equality Ombudsman, which found that her refusal to perform abortion services was a manifestation of her religious beliefs and was thus protected by Article 9 of the ECHR. The Equality Ombudsman also found that the healthcare regions’ requirement that the midwife perform abortion services was reasonable and motivated by social interests in order to secure women’s effective access to abortion services. Therefore, the midwife’s freedom of religion had not been violated. . . . Full Text

New hope for Ontario doctors’ conscience fight

The Catholic Register

Michael Swan

New evidence heard in court has given Ontario’s medical conscientious objectors renewed hope.

Two days of hearings before the Ontario Court of Appeal Jan. 21-22 has provided Christian Medical and Dental Society (CMDS) executive director Deacon Larry Worthen a dollop of confidence as he waits for a decision from the three-judge panel.

“We gave a very good presentation,” Worthen told The Catholic Register after the appeal. “There were some new arguments. There was new evidence.”

The three-judge panel’s ruling has been reserved, with observers expecting a decision in March. . . [Full text]

New hope for Ontario doctors’ conscience fight

The Catholic Register

Michael Swan

New evidence heard in court has given Ontario’s medical conscientious objectors renewed hope.

Two days of hearings before the Ontario Court of Appeal Jan. 21-22 has provided Christian Medical and Dental Society (CMDS) executive director Deacon Larry Worthen a dollop of confidence as he waits for a decision from the three-judge panel. . . Full Text

Protection of Conscience at the Ontario Court of Appeal

News Release

Protection of Conscience Project

On 21/21 January the Protection of Conscience Project jointly intervened at the Court of Appeal of Ontario to support freedom of conscience against an oppressive policy of Ontario’s state medical regulator, the College of Physicians and Surgeons of Ontario (CPSO). CPSO policies demand that physicians who object to morally contested procedures – including euthanasia and assisted suicide – must help patients find a colleague willing to provide the contested services.

The Court was hearing the appeal of the Christian Medical and Dental Society of Canada, the Canadian Federation of Catholic Physicians’ Societies, Canadian Physicians for Life and five individual physicians against an Ontario Divisional Court decision . The Divisional Court had ruled in favour of the CPSO, ruling, in effect, that physicians unwilling to do what they believed to be wrong by providing “effective referrals” were free to move to medical specialties where they would not face conflicts of conscience.

Expert evidence from the appellants indicated that it is extremely difficult for physicians to retrain, and that only 2.5 per cent of all physician positions in Canada would be “safe” for objecting physicians: pathology, hair loss, obesity medicine, sleep disorders and research were among the few available specialities.

The appellants’ submissions were supported by the intervention of the Ontario Medical Association, representing more than 41,000 practising and retired physicians, medical students and residents.

Joining the Project as “Conscience Interveners” were the Catholic Civil Rights League and Faith and Freedom Alliance. The joint submission noted the difference between perfective freedom of conscience (doing what one believes to be good) and preservative freedom of conscience (refusing to do what one believes to be wrong), a distinction hitherto ignored in judicial analysis.

Acknowledging that freedom of conscience can be limited to safeguard the common good, the Conscience Interveners argued that it does not follow that limits on perfective and preservative freedom of conscience can be justified on the same grounds or to the same extent.

The joint intervention drew the Court’s attention to the opinion of Supreme Court Justice Bertha Wilson in R v. Morgentaler, the only extended discussion of freedom of conscience in Canadian jurisprudence. Justice Wilson’s reasoning drew upon the key principle that humans are not a means to an end, and we should never be exploited by someone as a tool to serve someone else’s good – a principle championed by people like Martin Luther King Jr.

This principle – identified as the principle against servitude – was proposed as a principle of fundamental justice, a novel and constitutionally significant assertion. Alternatively, the Conscience Interveners argued that the principle against servitude is so foundational to human rights and freedoms it is difficult to imagine how violating it might be justified.

Forcing someone to participate in perceived wrongdoing demands the submission of intellect, will, and conscience, and violates the principle against servitude by reducing that person to the status of a tool to be used by others. This manner of servitude cannot be reconciled with principles of equality. It is an assault on human dignity that deprives physicians of their essential humanity.

Factum of the Conscience Interveners

The Evangelical Fellowship of Canada, B’nai Brith, and the Justice Centre for Constitutional Freedoms intervened in support of the physician appellants. Dying With Dignity Canada and the Canadian Civil Liberties Association intervened against them.

The Court reserved its decision.

Related: CCRL news release

Contact: Sean Murphy, Administrator, Protection of Conscience Project Email: protection@consciencelaws.org

Group challenges ruling requiring doctors to give referrals for services that clash with beliefs

CTV News

Paola Loriggio

TORONTO — Ontario doctors challenging a court ruling that found physicians must give referrals for medical services that clash with their moral or religious beliefs say there is no proof that removing that requirement would hamper patients seeking treatment.

A group of five doctors and three professional organizations is appealing a divisional court decision that upheld a policy issued by the province’s medical regulator, arguing the lower court made several errors.

The group, which includes the Christian Medical and Dental Society of Canada, the Canadian Federation of Catholic Physicians’ Societies and Canadian Physicians for Life, is asking Ontario’s highest court to strike down the policy. The case is set to be heard in Toronto on Monday and Tuesday. . . [Full text]

Supreme Court opines on limitations of GPs’ freedom of conscience

International Law Office

Lise Gran, Ole Kristian Olseby

The Supreme Court recently deemed that a municipality’s termination of its agreement with a general practitioner (GP) after she refused to insert an intrauterine device (IUD) for a patient for reasons of conscience relating to her religion was invalid.

Legal background

The criterion for terminating an agreement with a GP is the same as that for terminating an employment agreement under Norwegian law (ie, it must be objectively justified). . . [Full text]

Court challenge raises issue of “reasonable apprehension of bias”

Sean Murphy*

Documents filed in an important Canadian court case bring into question the value and purpose of “public consultations” held by medical regulators, at least in the province of Ontario.

In March, 2015, the College of Physicians and Surgeons of Ontario (CPSO) approved a highly controversial policy, Professional Obligations and Human Rights.  The policy requires physicians  to facilitate services or procedures to which they object for reasons of conscience by making an “effective referral” to a colleague or agency willing to provide the service.  A constitutional challenge to the policy was dismissed by  the Ontario Divisonal Court in 2018.[1] An appeal of that ruling will be heard by the Ontario Court of Appeal on January 21-22, 2019.

Among the thousands of pages filed with the trial court are a number dealing with the public consultation conducted by the CPSO from 10 December, 2014 to 20 February, 2015.  In response to its invitation to stakeholders and the public, the CPSO received 9,262 submissions about the proposal, the great majority of which opposed it.[2]

College officials  finalized the wording of the policy on 19 January, 2015,[3]   a month before the consultation ended; only about 565 submissions would have been received by then.[4]  727 submissions had been received  by the time the policy was sent to the Executive Committee on 28 January,[5]  which promptly endorsed it and forwarded it to the College Council for final approval.[6]

According to the briefing note supplied to the Council, by 11 February, 2015 the College had received 3,105 submissions.[7]  Thus, the final version of the policy was written and approved by the College Executive before about  90% of the submissions in the second consultation had been received.

Submissions received by CPSO from 10 Dec 2014 to 20 Feb 2015

During the first 40 days ending 11 February, the College received an average of about 18 submissions per day.  Assuming someone spent eight full hours every working day reading the submissions, about 22 minutes could have been devoted to each.  Three staff members dedicated to the task could have inceased this average to about an hour, so the first 700 submissions could conceivably have received appropriate attention.

Time available for analysis of submissions

However, this seems unlikely in the case of more than 8,000 submissions received later.

By 11 February about 183 submissions were arriving at the College every day, increasing to about 684 daily in the last ten days of the consultation – one every two minutes.   A College staffer working eight hours daily without a break could have spent no more than about two minutes on each submission, and only about one minute on each of those received in the last ten days  – over 65% of the total.

A minute or two was likely sufficient if College officials deemed consultation results irrelevant because they had already decided the outcome.  This conclusion is consistent with the finalization and approval of the policy  by the six member College Executive (which included the Chair of the  working group that wrote it [8]).  To do this weeks before the consultation closed was contrary to normal practice.  CPSO policy manager Andréa Foti stated that working groups submit revised drafts to the Executive Committee  after public consultations close[9] – not before.

One would expect government agencies that invite submissions on important legal and public policy issues would allow sufficient time to review and analyse all of the feedback received before making decisions. The CPSO’s failure to do so does not reflect institutional respect for thousands of individuals and groups who responded in good faith to its invitation to comment on the draft policy.  Rather, such conduct invites a reasonable apprehension of bias that is unacceptable in the administration of public institutions.

1. The Christian Medical and Dental Society of Canada v. College of Physicians and Surgeons of Ontario, 2018 ONSC 579 (Can LII)  [CMDS v CPSO].

2. CMDS v CPSO, supra note 1  (Respondent’s Application Record, Volume 1, Tab 1, Affidavit of Andréa Foti [Foti] at para 121.

3.    Foti, supra note 2 at para 133.

4. Estimated daily average based on the total received by 28 January (727).

5. CMDS v CPSO, supra note 1  (Respondent’s Application Record, Volume 4, Tab WW, Exhibit “WW” attached to the Affidavit of Andréa Foti: Executive Committee Briefing Note (February, 2015) (CPSO Exhibit WW) at 1724.

6. CMDS v CPSO, supra note 1  (Respondent’s Application Record, Volume 4, Tab XX, Exhibit “XX” attached to the Affidavit of Andréa Foti: Proceedings of the Executive Committee – Minutes – 3 February, 2015) (CPSO Exhibit XX) at 1746-1748.

7. “Council Briefing Note: Professional Obligations and Human Rights – Consultation Report & Revised Draft Policy (For Decision)” [CPSO Briefing Note 2015].  In College of Physicians and Surgeons of Ontario, “Annual Meeting of Council, March 6, 2015” at 61.

8. Dr. Marc Gabel. See CPSO Exhibit WW, supra note 4 at 1722 (note 1), and CPSO Exhibit XX, supra note 5 at 1746.

9. Foti, supra note 2 at para 36.

Thousands step up in support of doctors’ conscience fight

The Catholic Register

Michael Swan

An Ontario campaign to pressure politicians over the protection of health care conscience rights is “democracy in action,” said an organizer.

The Coalition of HealthCARE has so far collected 19,000 names and e-mail addresses in its “Call for Conscience Campaign.” That does not include results from the Archdiocese of Toronto.

The non-partisan campaign was launched to oppose and raise awareness about regulations that force doctors to refer for assisted suicide and euthanasia against their moral convictions.

By the end of March, people who have signed up during the campaign should receive instructions about how to e-mail all the candidates in their ridings in the run-up to Ontario’s June 7 provincial election. . . [Full text]