Protection of Conscience Project
Protection of Conscience Project
www.consciencelaws.org
Service, not Servitude

Service, not Servitude

Canadian Medical Association and Referral for Morally Contested Procedures

20 October, 2022


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1.    Brownell AKW, Brownwell E, editors. Canadian Medical Association Code of Ethics (1970) [Internet]. Ottawa: Royal College of Physicians and Surgeons of Canada; 2001 Apr [cited 2022 Oct 15].

2.    The Physician and the Liberal Society: Understanding in Winnipeg. Can Med Assoc J [Internet]. 1970 Jul 18 [cited 2022 Oct 16];103(2):193, 195, 198-201, 204-209, 212-219 at 195.

3.    Canadian Medical Association 104th Annual Meeting, Halifax, Nova Scotia. Can Med Assoc J [Internet]. 1971 Jun 19 [cited 2022 Oct 16]; 104(12):1132-1134.

4.    Abortion Problem. Ottawa Journal. 1970 Aug 08.

5.    Waring G. Report from Ottawa. Can Med Assoc J [Internet]. 1967 Nov 11 [cited 2022 Oct 16]; 97(20):1233.

6.    The number of abortions increased from 11,152 in 1970 to almost 39,000 in 1971, an increase from a rate of 3.0 to 8.3 per 100 live births. See Therapeutic abortion: government figures show big increase in ‘71. Can Med Assoc J [Internet]. 1972 May 20 [cited 2022 Oct 16]; 106(10):1131.

7.    Geekie DA. Abortion: a review of CMA policy and positions. Can Med Assoc J [Internet] .1974 Sep 7 [cited 2022 Oct 16]; 111(5):474-477 at 477.

8.    By 1975 the rate was 13.8/100. See JBS. 1975 abortion report more informative than its predecessors. Can Med Assoc J [Internet]. 1977 Oct 22 [cited 2022 Oct 16]; 117(8): 933.

9.    In 1976 there were about 54,500 abortions (14.9/100 live births). See EMR. 1976 advance report on abortion compares statistics with 1975. Can Med Assoc J [Internet]. 1978 Jan 7 [cited 2022 Oct 16]; 118(1):76.

10.    Gibbard B. Letter: Therapeutic abortion. Can Med Assoc J [Internet]. 1975 Jan 7, [cited 2022 Oct 16]; 112(1):25-27.

11.    Geekie DA. Alberta medical association annual meeting quiet - by western standards. Can Med Assoc J [Internet]. 1976 Nov 6 [cited 2022 Oct 16]; 115(9):908-910.

12.    Protection of Conscience Project Bibliography: Periodicals & Papers (1970-1974) [Internet]. Powell River, BC: Protection of Conscience Project; 2022 [cited 2022 Oct 16].

13.    Protection of Conscience Project Bibliography: Periodicals & Papers (1975-1979) [Internet]. Powell River, BC: Protection of Conscience Project; 2022 [cited 2022 Oct 16].

14.    Canadian Medical Association. Proceedings of the 110th Annual Meeting including the Transactions of the General Council, Quebec City, Quebec, June 20, 21, 22, 1977, Ottawa, Library and Archives Canada (G28-I343 / R3676, MIKAN 4975968, Container 3, File 6) at 86.

15.    Geekie DA. Abortion referral and MD emigration: areas of concern and study for CMA. Can Med Assoc J [Internet]. 1978 Jan 21 [cited 2022 Oct 16]; 118(2):175-206.

16.    Quebec City is a lively place, CMA annual meeting delegates discover. Can Med Assoc J [Internet]. 1977 July 9 [cited 2022 Oct 16]; 117(1):63-65, 67-73, 75-78, 80-82, 84-86 at 76.

17.    Describing the 1978 Council meeting that saw provision revert to its former wording, the CMAJ stated: “The major part of the debate concerned the wording of the paragraph of the Code of Ethics that deals with personal morality. Unlike last year, the discussion was brief and free of emotion.” Ethics problem reappears. Can Med Assoc J [Internet]. 1978 Jul 8 [cited 2022 Oct 16]; 119(1):61-62.

18.    Wilson RG. Letter: Code of Ethics: abortion referral. Can Med Assoc J [Internet]. 1978 Apr 22 [cited 202 Oct 16];118(8):896.

19.    Firth ST. Letter: Code of Ethics: abortion referral. Can Med Assoc J [Internet]. 1978 Apr 22 [cited 2022 Oct 16];118(8):895.

20.    Budziszewski J. Handling Issues of Conscience. The Newman Rambler. 1999 Spring/Summer; 3(2).

21.    Shea JB. Letter: Code of Ethics: abortion referral. Can Med Assoc J [Internet]. 1978 Apr 22 [cited 2022 Oct 16];118(8):890.

22.    Forster JM. Letter: Code of Ethics: abortion referral. Can Med Assoc J [Internet]. 1978 Apr 22 [cited 2022 Oct 16];118(8):888.

23.    Cameron P, Cohen M, Rapson L, Watters WW. Letter: Code of Ethics: abortion referral. Can Med Assoc J [Internet]. 1978 Ap 22 [cited 2022 Oct 16]; 118(8):890, 895.

24.    Brownell AKW, Brownwell E, editors. Canadian Medical Association. Code of Ethics (1978) [Internet]. Ottawa: Royal College of Physicians and Surgeons of Canada. 2001 Apr [cited 2022 Oct 15].

25.    Canadian Medical Association. Policy: Induced abortion. CMAJ [Internet]. 1988 Dec 15 [cited 2022 Oct 15]; 139(12):1176A-1176B.

26.    World Medical Association Medical Ethics Manual [Internet] 3rd ed. Ferney-Voltaire Cedex, France: WMA; 2015 [cited 2022 Oct 16].

27.    The statement was made during a telephone conversation when Dr. Williams called the Project Administrator in response to a letter from the Project in the spring of 2000. Digital records of the letter and conversation were subsequently lost to a computer virus. The conversation with Dr. Williams was noted in a letter to the Globe and Mail on 28 April, 2000. See Murphy S. Project letter to the Globe and Mail (unpublished) [Internet] Powell River, BC: Protection of Conscience Project; 2000 Apr 28 [cited 2022 Oct 18].

28.    Mackay B. Sign in office ends clash between MD's beliefs, patients' requests. CMAJ [Internet] 2003 Jan 7 [cited 2022 Oct 16];168(1):78-78-a.

29.    Mellor C. The Canadian Medical Association Code of Ethics annotated for psychiatrists. The position of the Canadian Psychiatric Association. Can J Psychiatry 1980 Aug [cited 2022 Oct 08]; 25(5):432-8. doi: 10.1177/070674378002500512.

30.    Rodgers S, Downie J. Abortion: Ensuring Access. CMAJ [Internet]. 2006 July 4 [cited 2022 Oct 16];175(1):9. doi: 10.1503/cmaj.060548.

31.    Rodgers S, Downie J. Access to abortion: The authors respond. CMAJ [Internet]. 2007 Feb 13 [cited 2022 Oct 16];176(4):494. doi: 10.1503/cmaj.1060202.

32.   Blackmer J. Clarification of the CMA’s position on induced abortion. CMAJ [Internet]. 2007 Apr 24 [cited 2022 Oct 08]; 176(9):1310. doi: 10.1503/cmaj.1070035.

33.    McLeod C, Downie J. Let Conscience Be Their Guide? Conscientious Refusals in Health Care. Bioethics [Internet] 2014 Jan [cited 2022 Oct 16]; 28(1):ii-iv.

34.    Ontario Human Rights Commission. Submission of the Ontario Human Rights Commission to the College of Physicians and Surgeons of Ontario Regarding the draft policy, "Physicians and the Ontario Human Rights Code” [Internet]. Toronto: OHRC, 2008 Aug 15 [cited 2022 Oct 16].

35.    OMA Urges CPSO to Abandon Draft Policy on Physicians and the Ontario Human Rights Code. OMA President's Update, 2008 Sep 12;13(23).

36.    Ontario Medical Association. OMA Response to CPSO Draft Policy “Physicians and the Ontario Human Rights Code.” 2008 Sep 11.

37.    Borsellino M. 10 questions with CMA's ethics champion Dr. Bonnie Cham. Medical Post. 2008 Sep 25; Questions 6, 9.

38.    Schuklenk U, van Delden JJM, Downie J, McLean S, Upshur R, Weinstock D. Report of the Royal Society of Canada Expert Panel on End-of-Life Decision Making [Internet]. Ottawa: Royal Society of Canada, 2011 Nov [cited 2022 Oct 16].

39.    Dr. Ross Upshur and Dr. Johannes J.M. van Delden.

40.    Downie J. Dying Justice: A Case for Decriminalizing Euthanasia and Assisted Suicide in Canada. Toronto: University of Toronto Press, 2004. 250 p.

41.    Schüklenk U. 50 Voices of Disbelief: Why We Are Atheists [Internet]. Blackwell On Line; 2009 Sep 10. p 323-331, Human Self-Determination, Biomedical Progress, and God [cited 2022 Oct 10]. Available from: .

42.    McLean S, Brittan A. The Case for Physician Assisted Suicide. London: Pandora Press, 1997. 114 p.

43.    van Delden JJM, Battin MP. Euthanasia: Not Just for Rich Countries (Draft Version) [Internet]. Madrid: Asociación Federal Derecho a Morir Dignamente (DMD), 2005 Dec 20 [cited 2022 Oct 16].

44.    Carter v. Canada (Attorney General) 2012 BCSC 886 (CanLII).

45.    Eggertson L. CMA delegates defer call for national discussion of medically assisted death. CMAJ [Internet] 2013 Sep 17 [cited 2022 Oct 16];185(13):E623-624.

46.    Canadian Medical Association. Resolutions Adopted, 146th Annual Meeting of the Canadian Medical Association (Calgary, AB) [Internet]. 2013 Aug 19-21 [cited 2022 Oct 08]. 

47.    Canadian Medical Association. 147th General Council Delegates’ Motions - End-of-Life Care: Motion DM 5-6 [Internet].  Powell River, BC: Protection of Conscience Project [cited 2022 Oct 08].

48.    Kirkey S. Canadian doctors seek freedom to choose whether to offer medical aid in dying. Montreal Gazette [Internet] 2014 Aug 20 [cited 2022 Oct 08].

49.    Swan M. Medical association vows to protect conscience rights. The Catholic Register [Internet]. 2014 Aug 27 [cited 2022 Oct 16].

50.    McFadden J. Yk docs bring motions on doctor-assisted death: Canadian law on euthanasia could be overturned by next month. Northern News Services [Internet]. 2014 Sep 8 [cited 2018 Mar 29].

51.    Martin S. The story behind the CMA's overwhelming change on assisted death. The Globe and Mail [Internet]. 2014 Nov 6 [cited 2022 Oct 22]. 

52.   Carter v. Canada (Attorney General), 2015 SCC 5 (Oral argument, Intervener: Canadian Medical Association at 228:32/491:20).

53.    Carter v. Canada (Attorney General), 2015 SCC 5 (Factum of the Intervener: Canadian Medical Association at para 3).

54.    Canadian Medical Association. Policy: Euthanasia and Assisted Death Update 2014 [Internet]. Powell River, BC: Protection of Conscience Project [cited 2022 Oct 08].

55.    Murphy S. A "uniquely Canadian approach" to freedom of conscience: Provincial-Territorial Experts recommend coercion to ensure delivery of euthanasia and assisted suicide [Internet]. Powell River, BC: Protection of Conscience Project; c2018. Appendix “D”: Canadian Medical Association on euthanasia and assisted suicide. D2.1: Surveys on supprt for euthanasia/assisted suicide; 2018 Jun 15 [cited 2022 Oct 16] .

56.    Contrast the position of the CMA with that of the Royal New Zealand College of General Practitioners, which explicitly declined to endorse euthanasia or assisted suicide, while recognizing that individual practitioners might participate if they wished to do so. The Royal New Zealand College of General Practitioners. Submission to the Justice Committee re: End of Life Choice Bill [Internet]. Powell River, BC: Protection of Conscience Project, 2018 Mar 6 [cited 2022 Oct 08].

57.    Carter v. Canada (Attorney General), 2015 SCC 5.

58.    Murphy, S. Canadian Medical Association and euthanasia and assisted suicide in Canada: Critical review of CMA approach to changes in policy and law [Internet]. Powell River, BC: Protection of Conscience Project; 2018 Sep [cited 2022 Oct 16].

59.    Canadian Medical Association. Principles-based Recommendations for a Canadian Approach to Assisted Dying. In: CMA Submission to the Federal External Panel on Options for a Legislative Response to Carter vs. Canada (Federal External Panel) [Internet]. 2015 Oct 19 [cited 2022 Oct 08]. A2-1 to A2-6 at A2-1, Foundational Principle 2.

60.    Canadian Medical Association. Submission to the College of Physicians and Surgeons of Ontario: Consultation on CPSO Interim Guidance on Physician-Assisted Death [Internet]. Powell River, BC: Protection of Conscience Project; 2018 Sep [cited 2022 Oct 16].

61.    Professional Obligations and Human Rights [Internet]. Toronto: CPSO; 2008 Sep, updated 2015 Mar [cited 2022 Oct 16].

62.    Forbes C, Blackmer J. (Canadian Medical Association). Letter to Robert Oliphant, MP and Hon. Kenneth Ogilvie, PC MP (Co-Chairs Special Joint Committee on Physician-Assisted Dying, Parliament of Canada) re: Correcting misinformation about the position of the Canadian Medical Association [Internet]. Ottawa: House of Commons; 2016 February 4 [cited 2022 Oct 16].

63.    Canadian Medical Association. Supporting the enactment of Bill C-14, Medical Assistance in Dying: Submission to the House of Commons Standing Committee on Justice and Human Rights [Internet]. Ottawa: House of Commons; 2016 May 2 [cited 2022 Oct 16].

64.    Canadian Medical Association. Policy: Medical Assistance in Dying [Internet]. Ottawa: CMA; 2017 May [cited 2022 Oct 16].

65.    Carter v. Canada (Attorney General), 2015 SCC 5 (Evidence: Affidavit of Dr. Chris Simpson at para. 29).

66.    Canadian Medical Association. Untitled draft [Internet]. Powell River, BC: Protection of Conscience Project; 2018 Apr 02 [cited 2022 Oct 16].

67.    Protection of Conscience Project. Submission to the Canadian Medical Association Re: 2018 Revision of the CMA Code of Ethics [Internet]. Powell River, BC: Protection of Conscience Project; 2018 Apr 02 [cited 2022 Oct 16].

68.    Canadian Medical Association. Code of Ethics and Professionalism [Internet]. Ottawa: CMA, c2018 [cited 2022 Oct 22].

69.    Savulescu J, Schuklenk U. Doctors Have no Right to Refuse Medical Assistance in Dying, Abortion or Contraception. Bioethics [Internet]. 2017 Mar [cited 2022 Oct 16];31(3):162-170.

70.    Charo RA. The Celestial Fire of Conscience- Refusing to Deliver Medical Care. N Engl J Med [Internet]. 2005 Jun 16 [cited 2022 Oct 16] 352:2471-2473.

71.    McCulloch I. "The greatest devotion to duty": Dr. Francis Scrimger and his Victoria Cross. CMAJ [Internet]. 1994 Feb 1 [cited 2022 Oct 16]; 150(3):414–416.

72.    Murphy S. Conscientious objection: resisting ethical aggression in medicine (Responding to Cantor JD. Conscientious Objection Gone Awry - Restoring Selfless Professionalism in Medicine) [Internet]. Powell River, BC: Protection of Conscience Project; 2009 Apr 17 [cited 2022 Oct 16].

73.    McLeod C. Demanding Referral in the Wake of Conscientious Objection to Abortion.  In Cohen JC, Keelan JE editors. Comparative Program on Health Law and Society, Lupina Foundation Working Papers Series 2004–2005 [Internet]. Toronto: University of Toronto, Munk Centre for International Studies; c2006 [cited 2018-03-18]. 130-138. 

74.    McLeod C. Referral in the Wake of Conscientious Objection to Abortion. Hypatia 2008; 23(4): 30-47. doi: 10.1111/j.1527-2001.2008.tb01432.x.

75.    Kantymir L, McLeod C. Justification for Conscience Exemptions in Health Care. Bioethics 2014; 28(1):16-23 [emphasis added]. doi: 10.1111/bioe.12055.

76.    Downie J, McLeod C, Shaw J. Moving Forward with a Clear Conscience: A Model Conscientious Objection Policy for Canadian Colleges of Physicians and Surgeons. Health L Rev 2013; 21(3):28-32.

77.    The Christian Medical and Dental Society of Canada v. College of Physicians and Surgeons of Ontario, 2018 ONSC 579 (Can LII) (Evidence, Affidavit of Andréa Foti re: Court File No. 15-63717 at para 130-131).

78.    The Christian Medical and Dental Society of Canada v. College of Physicians and Surgeons of Ontario, 2018 ONSC 579 (Can LII) (Evidence, Affidavit of Andréa Foti re: Court File No. DC-16-2217 at para 98, last bullet).