Protection of Conscience Project
Protection of Conscience Project
Service, not Servitude

Service, not Servitude

Submission to the College of Physicians and Surgeons of Saskatchewan (5 March, 2015)
Conscientious Refusal

Appendix "C"

Interview of Associate Registrar, College of Physicians and Surgeons of Saskatchewan

Re: CPSS Draft Policy Conscientious Refusal

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Bryan Salte
Saskatchewan doctors could face discipline over assisted suicide.
Global News, 13 February, 2015 (Accessed 2015-02-25)

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.    00:38

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 a 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.    01:32

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.    01:42

CIII.1    Salte: Well, it means that if this becomes a policy, and it currently is a requirement, for example, in the case of an unwanted pregnancyThis is not the case. See note at the end of the interview., and it currently is the policy in other provinces in dealing with some of those issues.See Appendix "D", "E". Quebec is the only province in which an objecting physician is expected to help a patient find a physician who will provide the morally contested service.

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.    02:18

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.    02:25

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, and what the draft policy talks about is, in fact, a compromise between the extreme position, which would be that physicians are compelled to provide this service, on the one side, and the other extreme position which is physicians can simply refuse to discuss with their patients what is going to become a legal procedure.See Part VI.5, "Is the policy a compromise?"

CVI.    03:26

CVI.1    Interviewer: So will you wait for the CMA to weigh in on this?

CVII.    03:29

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 it.

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 either.

CVIII.    04:06

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.    04:13

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.

End 04:54


Re: CIII.1    ". . . it is currently a requirement in the case of unwanted pregnancy."

This is not the case.  The policy in question is Guideline on 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 enough information."
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 Appendix "E."

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