Doctors who refuse to provide services on moral grounds could face discipline under new Ontario policy

National Post

Sharon Kirkey

Doctors who refuse to prescribe birth control or other medical services because of their personal values could face possible disciplinary actions, Canada’s largest medical regulator says.

Moral or religious convictions of a doctor cannot impede a patient’s access to care, the College of Physicians and Surgeons of Ontario said Friday in a 21-3 vote supporting an updated Professional and Human Rights policy.

The policy makes clear: “You cannot kick someone out of your office without care,” said Dr. Marc Gabel, past president of the college and chairman of the policy’s working group.

Some council members said the new code, which the college expects physicians to comply with or face complaints of professional misconduct, could lead to “state-run” medicine, while others said the church has no place in a doctor’s office. . . [Full text]

UPDATED: Ontario doctors must refer for abortions, says College of Physicians

The Catholic Register

Michael Swan

TORONTO – Despite an overwhelmingly negative response from members of the public, physicians and organizations during a three-month online consultation, the Ontario College of Physicians and Surgeons voted 21-3 to force doctors to refer for abortions, contraception and other legal treatments or procedures even if they have moral or religious objections.

A last-minute submission from the Ontario Medical Association urging the college not to force doctors to act directly against their moral or religious convictions failed to sway the governing council of the college to reconsider wording that demands doctors provide “an effective referral to another health-care provider” despite personal convictions, whether religious or moral.

The college did not provide a statistical breakdown of the 16,000 submissions it received online, other than to say that 90 per cent were from members of the public and most were against the policy. . . [Full text]

If Supreme Court decriminalizes physician-assisted suicide, doctors may be obligated to help with euthanasia

National Post

Shanifa Nasser

Doctors may be forced to support euthanasia over their own religious objections if the Supreme Court of Canada decides to decriminalize physician-assisted suicide in a landmark ruling expected Friday.

The court announced Monday it is set to rule on the Carter case launched on behalf of B.C. women Kathleen Carter and Gloria Taylor, who have since died.

Ahead of the ruling, the College of Physicians and Surgeons of Ontario, which regulates medical doctors in Ontario, has been seeking public input on a draft policy that would force the province’s doctors to help patients access any services to which they are legally entitled. It will finalize the policy after the comment period ends on Feb. 20.

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. . . . [Full Text]

A modest proposal for respecting physicians’ freedom of conscience

National Post

Margaret Somerville

The Ontario College of Physicians and Surgeons is consulting on whether patients’ right of access to certain procedures, such as abortion, should trump the rights of those physicians who refuse, for reasons of conscience, to provide them. Dr. Marc Gabel, a College official, chairs the working group looking at this issue, which is drafting a new policy on “Professional Obligations and Human Rights.”

Dr. Gabel has been reported as saying that “physicians unwilling to provide or facilitate abortion for reasons of conscience should not be family physicians” and it seems wants the College to approve that stance. Sean Murphy, of the Protection of Conscience Project, argues that “if it does, ethical cleansing of Ontario’s medical profession will begin this year, ridding it of practitioners unwilling to do what they believe to be wrong.”

Freedom of conscience, like the other fundamental freedoms enshrined in the Canadian Charter of Rights and Freedoms, is a fundamental pillar of democracy. So how could breaching this right be, as Dr Gabel claims, “required by professional practice and human rights legislation”? . . . [Full text]

 

Ethical Cleansing in Ontario

 Sean Murphy*

An Ontario College of Physicians official, Dr. Marc Gabel, says that physicians unwilling to provide or facilitate abortion for reasons of conscience should not be family physicians.1 The working group Dr. Gabel chairs wants the College to approve this policy.2 If it does, ethical cleansing of Ontario’s medical profession will begin this year, ridding it of practitioners unwilling to do what they believe to be wrong. Dr. Gabel claims that this is required by professional practice and human rights legislation.

It is not clear that the Ontario Medical Association (OMA) will agree. After all, it requires some effort to maintain that physicians are ethically or morally obligated to do what they believe to be unethical or immoral. Moreover, last August, the OMA’s General and Family Practice Section warned Dr. Gabel’s working group that the quality of medical care would suffer if only students willing to sacrifice their personal integrity were accepted in medical school. Moreover, “What about remote areas of practice?” the Section asked. “Will more prescriptive policies drive physicians to feel that they will have no choice but to practice in more urban settings?”3

In other words, is it really better that a pregnant woman in Gravel Roads Only should have no local obstetrical care rather than the help of a rural physician unwilling to recommend or refer for abortion?

The concern expressed by the OMA is understandable, but actually beside the point. In truth, concern about access to services is not really what is behind the drive for ethical cleansing. That was made abundantly clear in Ottawa last year, after it was learned that an Ottawa physician was refusing to prescribe or refer for contraceptives. The story hit the front page of the Ottawa Citizen.

The Citizen did not report the mere facts: that a young woman had to drive around the block to get The Pill. That might have been dismissed as a first world problem. No: the Citizen had more ominous news. It had discovered, lurking in the nation’s capital, not just one, but three physicians who would not prescribe or refer for contraceptives or abortion.4 There was pandemonium. An activist group began preaching a crusade against the dissenters, a vitriolic feeding frenzy erupted on Facebook,5 vehement denunciations appeared elsewhere6 and the story became the subject of a province-wide CBC broadcast.7

One of the Facebookers helpfully suggested that the objecting physicians should move elsewhere, “maybe Dubai,” where they could be among their “own kind,”8 while others raged that they had “no business practicing family medicine”9 and “[did] not deserve to practice in Canada. PERIOD.”10

To find such comments on Facebook is not surprising. But it is surprising – and regrettable – that the comments offered by Dr. Gabel reflect the same attitude.

Now, there are about 4,000 physicians practising in the Ottawa area,11 and contraceptives and abortion referrals are so widely available in the city that the Medical Officer of Health says that it is cause for celebration.12 Thus, the wildly disproportionate reaction to news that 0.08% of Ottawa area physicians do not prescribe or refer for contraceptives cannot be explained as a rational response to a problem of supply and demand.

The crusade against the three physicians, now expanded by Dr. Gabel and his working group to a crusade for the ethical cleansing of the entire medical profession, is not driven by merely practical concerns about access to services. It is driven by an a markedly intolerant ideology masquerading as enlightened objectivity.

That is why the OMA’s concern that objecting physicians might be restricted to practising in urban centres is understandable, but misplaced. Ontario physicians must come to grips with the fact that, once ethical cleansing gets underway, dissenting physicians will have no refuge in big cities, even if it takes the crusaders longer to find them there.

Nor, if assisted suicide and euthanasia are legalized, will there be refuge for physicians who don’t want to participate in killing patients. The College’s draft policy on end of life care “requires physicians to sensitively respond to a patients wishes or requests to hasten death”13 and insists that physicians who “limit their practice on the basis of moral and/or religious grounds” must comply with College policy on human rights.14 If the law is changed, and Dr. Gabel and his working group get their way, this policy will require physicians who refuse to kill patients to help them find someone who will.

Physicians will be expected to prescribe, abort or refer, to lethally inject or refer, or get out of medicine – or get out of the country.

[PDF text]


Notes

1. “Catholics doctors who reject abortion told to get out of family medicine.” The Catholic Register, 17 December, 2014 (Accessed 2018-03-07)

2. College of Physicians and Surgeons of Ontario, “Professional Obligations and Human Rights (Draft).” (Accessed 2018-03-07)

3. Letter to the College of Physicians and Surgeons of Ontario from the Ontario Medical Association Section on General and Family Practice Re: Human Rights Code Policy, 6 August, 2014. (Accessed 2018-03-07)

4. Payne E. “Some Ottawa doctors refuse to prescribe birth control pills.” Ottawa Citizen, 30 January, 2014 (Accessed 2018-03-07)

5. Murphy S. “NO MORE CHRISTIAN DOCTORS.” Protection of Conscience Project.

6. “Some Ottawa doctors refusing to prescribe birth control, cite ‘ethical concerns and religious values.’” Reddit Ottawa (Accessed 2018-03-07)

7. CBC Radio, “Should doctors have the right to say no to prescribing birth control?” Ontario Today, 25 February, 2014 (Accessed 2018-03-07)

8.  T___ M___, 29 January, 2014, 6:56 pm

9.  A___ M___ 29 January, 2014, 7:41 pm

10. R___ V___, 29 January, 2014, 7:52 pm

11. College of Physicians and Surgeons of Ontario, All Doctor Search (Accessed 2014-07-29;2018-03-07)

12.  Levy I. (Medical Officer of Health, Ottawa) and Abdullah A. (President, Academy of Medicine, Ottawa), Letter to the Ottawa Citizen, 1 February, 2014.

13.  College of Physicians and Surgeons of Ontario, Planning for and Providing Quality End of Life Care: Key Features of the Draft Policy (Accessed 2018-03-07)

14. College of Physicians and Surgeons of Ontario, Planning for and Providing Quality End of Life Care (Draft), lines 363-365. (Accessed 2018-03-07)

College of Physicians, please stand up for religious minorities

ProWomanProLife

Reproduced with permission

Faye Sonier

*Dr. Gabel is Member of Council and Past President of the College of Physicians and Surgeons of Ontario. He is the chair of the College’s policy working group which issued the draft “Professional Obligations and Human Rights” policy.

Dear Dr. Marc Gabel,

I just read this article which was published in the Catholic  Register. You were quoted in the piece. Here is an excerpt:

Catholic doctors who won’t perform abortions or provide abortion referrals should leave family medicine, says an official of the College of Physicians and Surgeons of Ontario.

“It may well be that you would have to think about whether you can practice family medicine as it is defined in Canada and in most of the Western countries,” said Dr. Marc Gabel, chair of the college’s policy working group reviewing “Professional Obligations and Human Rights.”

The Ontario doctor’s organization released a draft policy Dec. 11 that would require all doctors to provide referrals for abortions, morning-after pills and contraception. The revised policy is in response to evolving obligations under the Ontario Human Rights Code, Gabel said.

There have been no Ontario Human Rights Tribunal decisions against doctors for failing to refer for abortion or contraception.

Gabel said there’s plenty of room for conscientious Catholics in various medical specialties, but a moral objection to abortion and contraception will put family doctors on the wrong side of human rights legislation and current professional practice.

“Medicine is an amazingly wide profession with many, many areas to practice medicine,” he said.

Yes, medicine is “an amazingly wide profession.” Thankfully, it is also a profession which attracts an “amazingly wide” array of Canadians. Of those Canadian physicians are some who share my pro-life perspective. They may refuse to refer for abortion due to their conscience, but they may also refuse to refer due to their religious beliefs (or both – we’re working out what this means under the Charter). They may be Christian, Muslim, Jewish or atheist physicians but they have an issue with abortion or contraceptives. For them, to refer for this procedure or these drugs is to be complicit in the actions and their consequences.

I am an Ontario resident. I’m a cancer survivor. I’m a mother.  I have spent far more than my fair share of time in Ontario hospitals and clinics being treated by wonderful Ontario doctors.

Over the last few years, I’ve gone out of my way to work with pro-life physicians who share my perspective. I reject the notion that killing and dismembering unborn children is medicine, and I wanted to work with physicians who share my values regarding human life and human dignity.  Due to the “amazingly wide” practice of medicine in Ontario, I was able to find a few, and become their patient. I am so thankful for their care.

But due to your working group’s proposed new policy, I might lose my family physicians. They will choose to practice medicine in a province that respects both their skills and their rights, rather than sacrifice their conscience or their sincerely held religious beliefs.

I’m also a human rights lawyer. The College’s reasoning for stripping physicians of their conscience and religious rights is not based on law. Your working group received a number of submissions on that point, so I’ll leave you to review them with your legal counsel. The doctors seeking to exercise their freedoms have a leg to stand on. Heck, they have Canadian and Ontario human rights law on their side.

Of great concern to me is the definition of “discrimination” which you provided when interviewed:

“We’re saying that the discrimination occurs when you are not acting in the best interest of the patient,” said Gabel. “When you are not communicating effectively or respectfully about this with the patient, when you’re not managing conflicts, when you differ from the patient and when you are not respecting the patient’s dignity and ensuring their access to care and protecting their safety. That’s the issue.”

Dr. Gabel, this is not the definition of “discrimination” at law. If someone chooses to make up definitions for words, they are free to do so. (My son, for example, seems to think that “babagaba” is a verb which means “to chew on mommy’s ankle.”)

However, for a body like the College of Physicians and Surgeons of Ontario to create a new definition of “discrimination” which will result in the stripping of legal and human rights of some of their members is shocking, and this new definition will not stand up in a court of law. I urge the College to abide by Canadian and Ontario law.

Dr. Gabel, I suspect you are well intentioned and a kind and caring psychotherapist, like so many of the wonderful doctors who have treated me over the years. But please don’t force my physicians from the province with your policy. My family depends on their expertise and professionalism. I like to see my own values reflected in the “amazingly wide” practice of medicine in Ontario. For someone like myself, a religious minority, this is very important.

The membership of your College is broad and wide enough to include some family physicians who happen to hold pro-life positions. If it is not, it should be.

Sincerely,

Faye Sonier

Doctors who oppose abortion should leave family medicine: Ontario College of Physicians

LifeSite News

Steve Weatherbe

Family doctors who object to referring patients for abortions should think about switching specialties, the man overseeing the Ontario College of Physicians and Surgeons’ revision of its ethics policy said this week.

Dr. Marc Gabel, a Toronto psychotherapist and past president of the college, told LifeSiteNews on Thursday that if his committee’s proposed revision of the college’s “Professional Obligations and Human Rights” is adopted, then if doctors refuse to refer patients to abortionists, or to doctors willing to prescribe contraceptives, they could face disciplinary action.

“If there were a complaint, every complaint is investigated by the complaint committee,” Dr. Gabel said. The complaint committee could deliver a mild private rebuke or turn over the matter to the disciplinary committee, which Gabel chaired for several years.

According to Dr. Carol Leet, the new president of the college, a doctor found guilty of professional misconduct by the disciplinary committee could face anything from remedial instruction to loss of his or her medical licence. . . [Full text]

 

Proposed policy of Ontario College of Physicians “appalling”

Medscape

Reproduced with permission of the author

Dr. Terence McQuiston, M.D.

Dr. Gabel is not alone in this opinion, but I find it nevertheless appalling. Ever since Hippocrates medical ethics were determined by our profession independently of government legislation (including human rights tribunals). We Canadians stood in judgement at Nuremberg over the German physicians of the Nazi period.

Their defense was that they had done nothing outside of the law (true). However, we took the view that ethics transcend and should inform legislation, not the other way around, and therefore we could hold them to account for their deeds.

Such transcendence of ethics is only possible by the exercise of conscience by all physicians. Granted there may be differences arising from this exercise, but we should do our best to accommodate these differences.

That’s why we permit conscientious objection in wartime. Individual conscience is too precious a part of our social fabric to be casually overridden. The policy defended by Dr. Gabel in effect puts conscience on ice. If euthanasia becomes legal, I for one still won’t do it.


This comment responds to the Medscape article “Doctors opposing draft abortion policy may need to rethink whether family practice is right for them, says CPSO official: Direct referrals a sticking point in Ontario’s human rights policy (17 December, 2014)  Dr. Marc Gabel was quoted to the effect that physicians unwilling to provide or facilitate abortion and contraception should not practice family medicine. Administrator

 

 

Catholics doctors who reject abortion told to get out of family medicine

The Catholic Register

Michael Swan

Catholic doctors who won’t perform abortions or provide abortion referrals should leave family medicine, says an official of the College of Physicians and Surgeons of Ontario.

“It may well be that you would have to think about whether you can practice family medicine as it is defined in Canada and in most of the Western countries,” said Dr. Marc Gabel, chair of the college’s policy working group reviewing “Professional Obligations and Human Rights.”

The Ontario doctor’s organization released a draft policy Dec. 11 that would require all doctors to provide referrals for abortions, morning-after pills and contraception. The revised policy is in response to evolving obligations under the Ontario Human Rights Code, Gabel said.

There have been no Ontario Human Rights Tribunal decisions against doctors for failing to refer for abortion or contraception.

Gabel said there’s plenty of room for conscientious Catholics in various medical specialties, but a moral objection to abortion and contraception will put family doctors on the wrong side of human rights legislation and current professional practice. . . [Full text]

 

‘Frightening’: Life and family leaders react to Ontario College of Physicians’ draft policy

LifeSite News

Pete Balinski

Numerous life-and-family groups have slammed a draft policy from Ontario’s College of Physicians and Surgeons that threatens to force doctors into providing abortions and contraceptives in some circumstances, calling it “inimical to living in a free society” and “frightening.”

“We can say goodbye to a slew of good doctors in Ontario [if the policy passes],” Andrea Mrozek, executive director of Institute of Marriage and Family Canada, told LifeSiteNews. “If I were one, with a young family, I’d leave. Who wants to live under the threat of constant legal action for doing what you believe is good care?”

The College Council approved the draft policy last week. The policy would force doctors who are “unwilling to provide certain elements of care due to their moral or religious beliefs” — such as abortion — to refer the patient “in good faith” to another doctor who would provide the service.

If there is nobody to whom the patient can be referred, then the doctor “must provide care that is urgent or otherwise necessary to prevent imminent harm, suffering, and/or deterioration, even where that care conflicts with their religious or moral beliefs.”

“Although physicians have [freedom of conscience and religion] under the Charter, the Supreme Court of Canada has determined that no rights are absolute,” the draft policy states, adding that the “right to freedom of conscience and religion can be limited.”

The College’s former president, Marc Gabel, has stated that doctors who fail to comply will face disciplinary action. . . [Full text]