The CCRL Participates In Ontario Court of Appeal with Oral Arguments in Support of Physicians’ Conscience Rights

News Release

Catholic Civil Rights League

Toronto, ON January 25, 2019 – The Catholic Civil Rights League (CCRL) participated with oral arguments in the CMDS et al v. CPSO hearing at the Ontario Court of Appeal on January 21 and 22. Individual Catholic and Christian doctors and organizations had challenged the College of Physicians and Surgeons of Ontario (CPSO), which over the course of the past three years had stipulated an “effective referral” regime, forcing Ontario doctors who objected to morally objectionable procedures to provide an “effective referral” to a willing doctor for such services. Previously, doctors were relieved from any such obligation. Ontario is the only provincial or territorial jurisdiction which has made such demands of its doctors.

The Ontario Divisional Court had ruled in favour of the CPSO, on January 31, 2018, despite finding that the religious freedom of doctors had been infringed. The appellants and the League, in conjunction with the Faith and Freedom Alliance and the Protection of Conscience Project, had argued that such “effective referrals” made objecting doctors complicit in the provision of the objectionable procedures, such as abortion, or assisted suicide. The previous court decision allowed the infringement as a modest incursion into the rights of physicians, in the context of the ability of patients to access publicly available “services”. Moreover, the court previously ruled that objecting physicians could re-arrange their practice specialties to “accommodate” such referrals. The doctors and their respective organizations appealed.

In addition to the arguments presented by the lawyers for the appellants, the CCRL and its partners raised the particular arguments that such demands were in breach of the conscience rights of Ontario doctors, as forcing individuals to do something that they considered “wrong”, and was a form of enforced servitude.

Click here to view the CCRL’s written factum, submitted in November 2018, which made reference to important principles of law and philosophy, quoting Martin Luther King Jr., Jacques Maritain, and others.

At the appeal hearings, held at Toronto’s Osgoode Hall, arguments focused on whether the CPSO could justify its referral policy as a “reasonable limit” on the rights of objecting doctors. The CCRL’s lawyer, Mr. Emrys Davis, submitted that moral rights are central to one’s sense of human dignity, and that it was unacceptable to marginalize objecting physicians as religious extremists. Moreover, given that the Ontario Medical Association likewise opposed the “effective referral” regime, such concerns were shared by a large numbers of Ontario doctors. The CCRL and its partners argued that the referral requirement imposed the values of the state upon individuals, forcing them to violate their own constitutionally protected consciences, without justification.

The CPSO’s lawyers had suggested that objecting doctors could go so far as to instruct an intake employee to make the proposed referrals on their behalf. We argued that such doctors would still be responsible morally to such a proposal, and would be left with no meaningful choice. Telling an employee to commit an immoral act would still offend the consciences of objecting doctors. The choice imposed by the CPSO was either to violate one’s conscience, or become subject to professional discipline for refusing to make such referrals.

In his closing remarks, Chief Justice of Ontario George Strathy thanked the many interveners for bringing their unique viewpoints and knowledge to the assistance of the court, which reserved its decision to a later date. The CCRL thanks the fine work of our lawyers at Bennett, Jones in Toronto, for its efforts on behalf of our interveners.


About the CCRL

Catholic Civil Rights League (CCRL) (www.ccrl.ca) assists in creating conditions within which Catholic teachings can be better understood, cooperates with other organizations in defending civil rights in Canada, and opposes defamation and discrimination against Catholics on the basis of their beliefs. The CCRL was founded in 1985 as an independent lay organization with a large nationwide membership base. The CCRL is a Canadian non-profit organization entirely supported by the generosity of its members.

To donate to the CCRL, please click here.

For further information: Christian Domenic Elia, PhD CCRL Executive Director 416-466-8244 @CCRLtweets

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]

Physicians in Canada should be moral actors, not robotic bureaucrats

Doctors should not be obliged to write referrals for procedures they find morally objectionable

CBC

Brian Bird

Earlier this week, Ontario’s highest court heard a case that pits access to health care against the moral convictions of doctors. The case essentially tests the extent to which Canadians can follow their own moral compasses while operating in a professional capacity.

In Ontario, doctors can refuse to perform procedures or prescribe drugs that they consider immoral. However, the public body that regulates these doctors – the College of Physicians and Surgeons of Ontario (CPSO) – requires them to refer patients to doctors who are willing and able to provide the requested health care service. . .
Full text


Ban on assisted dying at St. Martha’s hospital should end, says law prof

Religious hospital in Antigonish, N.S., has agreement with province allowing it to forego MAID provision

CBC News

Frances Willick

Nova Scotia’s only Catholic hospital is at risk of being found in violation of the Charter of Rights and Freedoms and human rights legislation by refusing to provide medical assistance in dying, a Halifax law professor says.

St. Martha’s Regional Hospital in Antigonish, N.S., is a publicly funded health-care facility. But due to its religious ties, staff are not permitted to provide MAID. . . [Full text]

Alberta health minister reviewing rules around assisted dying at faith-based facilities

Sarah Hoffman acknowledges public complaints following CBC News investigation

CBC News

Jennie Russell

Health Minister Sarah Hoffman says her ministry is reviewing options that would allow Alberta Health Services to provide medical assistance in dying at faith-based health facilities while respecting religious objections, although she cautions the province is “not there yet.”

In an interview, Hoffman said she has received public feedback urging her to reverse her 2016 exemption that allowed Catholic health provider Covenant Health, which is publicly funded, to opt out of providing access to the procedure. . . [Full text]

Alarming gap in assisted dying in Antigonish

The Chronicle Herald

Jocelyn Downie

Today (Dec. 17) marks two and a half years since the coming into force of Canada’s federal legislation on medical assistance in dying (MAiD).

In Nova Scotia, MAiD has now been requested in about 400 cases and provided in about 200. Unfortunately, there is one particularly notable gap in access to MAiD: St. Martha’s Regional Hospital, a publicly funded faith-based institution in Antigonish, refuses to allow MAiD within its walls. . . [Full text]

Hospital, care-home policies must change so more people can access medical assistance in dying

The Province

Alex Muir

. . . an individual who is suffering intolerably and whose death is reasonably foreseeable has a constitutional right to medical assistance in dying (MAiD) if certain other criteria are met. . .

. . . most people in Vancouver’s West End will end up at St. Paul’s, a hospital run by Catholic-based Providence Health, which doesn’t allow MAiD to be performed in any of its facilities. Anyone wanting to access MAiD once at St. Paul’s must be transferred to Vancouver General Hospital or another willing facility. . .

. . . end the practice of forced transfers by insisting that all taxpayer-funded facilities, including Providence facilities, provide MAiD on site. . .[Full text]

Medical Assistance in Dying (MAiD): Ten Things Leaders Need to Know

Rosanne Beuthin, Anne Bruce

Abstract

The provision of MAiD will be in flux for a few years, as legislative challenges are underway. This article addresses what leaders need to know and do to support nurses today and in the future regarding care of patients choosing MAiD. Drawing on complexity leadership theory and research into nurses’ experiences in caring for persons choosing MAiD, we share 10 simple yet foundational things a leader must know. Underpinning our key messages are current evidence and familiar nursing concepts such as end-of-life care, death trajectories, conscientious objection, scope of practice, ethics, sense-making and care cultures. These key messages are embedded in a framework of leadership practices where attention to inter-relationships, emergence and innovation are highlighted. They provide nurse leaders with concrete actions to inspire a team dynamic for creating inclusive cultures of quality care. Leadership is needed across healthcare settings where MAiD is being enacted.


Beuthin R, Bruce A. Medical Assistance in Dying (MAiD): Ten Things Leaders Need to Know. Nurs Leadersh (Tor Ont). 2018 Dec;31(4):74-81. doi: 10.12927/cjnl.2019.25753.

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.