Submission to the College of Physicians and Surgeons of
(5 March, 2015)
Re: Conscientious Refusal
Interview of Associate Registrar, College of Physicians and
Surgeons of Saskatchewan
Re: CPSS Draft Policy Conscientious Refusal
Note: The interview was preceded by a video
clip of an interview with a Saskatchewan physician unwilling to
participate in of facilitate assisted suicide. Mouseover red text
for Project annotations.
CI.1 Interviewer: Now you heard him say he doesn't even want to refer a
patient to another doctor willing to help a patient end their lives. Bryan,
where are you at in coming up with the regulations for this?
CI.2 Salte: Well, it's a fairly broad question. So if what you're asking is
solely on the issue of, of what do we expect in terms of referring for what
is at some point in time going to be a legal procedure, we currently have
draft policy that is being circulated for discussion, which applies much
more broadly than just physician assisted death.
CI.3 It deals with birth control
and abortion and all of the other areas where there is a clash between
physicians' personal values and the services which patients may wish.
CI.4 So, at
the moment, it's a draft policy that, uh, discusses how a physician tries to
reconcile their own personal beliefs with the legal services which are
available in Canada, despite the fact that their, those legal services may
clash with the personal beliefs of the physician.
CII.1 Interviewer: So your policy on conscience obligation says
doctors have to refer even if they don't agree. What does this mean for
doctors who don't want to?
CIII.1 Salte: Well, it means that if this becomes a policy, and
CIII.2 The issue of physician assisted dying is, of course a new issue.
CIII.3 But, the expectation would be that, uh, physicians will follow the
directions which come from the College of Physicians and Surgeons which are
going to be established, of course, by their colleagues as part of the, the
uh, expectations of practice.
CIII.4 So, if a physician feels that the directives
are wrong, they will still, we would expect follow those directives despite
the fact that they may not agree with them.
CIV.1 Interviewer: Do you think there is any room for a middle ground, or will
doctors who disagree with assisted suicide end up being disciplined, could
they lose their jobs . . .?
CV.1 Salte: Well, certainly, um, we try to avoid discipline whenever possible.
But if there are physicians who engage in behaviour which is regarded as
unacceptable or unprofessional, then that is a possible outcome.
CV.2 Certainly, with any physician what we would try to do is we would work and
see if there is some mutually acceptable solution.
CV.3 But you speak about
compromise. Um, there are those who, for example, take the position that
physicians are compelled to provide legal procedures, and so there those who
take the position that by saying physicians who are capable of providing
birth control don't actually have to provide it, that already we have
engaged in a compromise which is unacceptable.
CV.4 So there is a broad range of,
uh, of beliefs out there, there's a broad range of perspectives out there,
CVI.1 Interviewer: So will you wait for the
CMA to weigh in on this?
CVII.1 Salte: Well, there's a lot of consultation that's going on. I was just at a
national meeting and that was a fairly significant subject associated with
CVII.2 So the issue is going to be how do we come up with best guidance for
physicians on a variety of issues and certainly physician assisted suicide
or physician assisted death is one of those.
CVII.3 The other thing, of course, is
that this is going to take some number of months to resolve itself, so
nothing changes for the next 12 months, or unless the federal government
introduces legislation more quickly than that. So, there is a period of time
for us to try to get this right. It's not indefinite, but it's not next week
CVIII.1 Interviewer: How tough is this for you to deal with? You obviously have
had a long career. Is this one of the biggest challenges you've ever faced?
CIX.1 Salte: I wouldn't say it's one of the biggest, but it is a difficult
challenge. Any time that you have people who believe very strong ethically
about certain issues, and certainly we've dealt with that with birth
control, we've dealt with that with abortion, we've dealt with that with the
morning after pill, there's a variety of other areas that are right now such
. . .
CIX.2 Interviewer: . . .Grey area.
CIX.3 Salte: Very grey areas. People feel very strongly about them and feel
that, ethically, they believe that the other side is just completely wrong.
CIX.4 So trying to reconcile some of those and try to find ways where you can
impose as little as possible upon the rights or obligations of some part of
civilization, where at the same time imposing as little as possible upon the
other side is a difficult compromise without question.
Re: CIII.1 ". . . it is currently a
requirement in the case of unwanted pregnancy."
This is not the case. The policy in question is
Unplanned Pregnancy, adopted in 2011. It opens with the
statement, "An unplanned pregnancy is not necessarily and unwanted
pregnancy." Although, at the time, some of the major papers reported that the policy
required objecting physicians to refer for abortion, this was incorrect.
The changes are intended to provide clarity, said Dr. Karen Shaw, the
college's deputy registrar. They weren't prompted by any specific concerns,
but were part of a regular review of college guidelines. The new guidelines
were adopted at the council's most recent meeting on Friday.
"We didn't change the actual policy," she said. "It just made it clearer
that people can state up front that they have difficulty with this and make
a referral or they can assist the patient through all the steps they're
comfortable with, until the point where they are more uncomfortable or the
patient understands they're not willing to do the last step -which is to
refer to someone they know will perform the abortion -but they must provide
Scissons H. "Abortion guidelines updated: Rules clarify protocol for doctors unwilling to terminate pregnancy."
Saskatchewan Star Phoenix, 9 February, 2011
For a detailed explanation, see