Conscience fight moves to the political arena

The Catholic Register

Michael Swan

Having lost twice in court, the battle for conscience rights for health care workers in Ontario is now a political battle.

“We feel we really need legislation,” said Christian Medical and Dental Society of Canada executive director Deacon Larry Worthen. “It’s basically for us a call to action.”

The latest setback came May 15 when the Ontario Court of Appeal ruling upheld a College of Physicians and Surgeons of Ontario (CPSO) requirement that doctors in the province must give referral for medical services such as assisted dying and abortion that conflict with their moral or religious beliefs. . . [Full text]

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

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

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

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]

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]

World medical body pushes back on conscience fight

The Catholic Register

Michael Swan

The international society of Catholic doctors is using Canada as an example of what can go wrong when doctors are forced to refer for abortion.

The World Federation of Catholic Medical Associations is drawing on Canada’s experience to counter proposals before the World Medical Association to adopt forced referrals and signal ethical acceptance for euthanasia. . . [Full Text]