The Christian Medical and Dental Society of Canada is throwing a tantrum over a new requirement that Ontario physicians must refer patients appropriately when they refuse to provide a health-care service they personally disagree with. On March 20, the group launched a lawsuit against the College of Physicians and Surgeons of Ontario.
The College's new policy on "Professional Obligations and Human Rights" is really a no-brainer, as well as long overdue. The part that is peeving the Christian doctors stipulates that if doctors are "unwilling to provide certain elements of care for reasons of conscience or religion" they must make an "effective referral" -- which means a timely referral made in good faith to a "non-objecting, available, and accessible physician, other health-care professional, or agency." Further, physicians must provide "urgent care" to prevent imminent harm, even when doing so conflicts with their conscience or religious beliefs. Those violating the new policy may face discipline. The Christian doctors are dead set against all of this.
If you're new to this issue, you might feel bewildered and alarmed at the prospect of doctors actually suing for their "right" to basically abandon patients and even put their health and lives at risk. Did these doctors miss the memo about modern medical ethics in which the patient comes first? Did they not swear an oath to that effect? Are they aware that 92 per cent of the public are in favour of requiring doctors to refer patients to another doctor who can provide the refused treatment?
Apparently, none of that matters. When you read some of the blustery fulminations on the topic from objecting doctors, it's all about ME, and MY RIGHTS, and HOW DARE YOU take away my privilege and power over subservient patients. Ok, that's my own interpretation, so to be fair, I'll let one of the doctors speak for herself:
"My conscience and religious beliefs do not allow me to engage in procedures to which I have a moral, ethical or religious objection. I, and all physicians in Ontario, have the right to practice medicine according to my conscience and free from state compulsion."
-- Michelle Korvemaker, emergency room physician
Actually, you do NOT have that right, Dr. Korvemaker, for several reasons. Canada's public medicare system means that Canadians are entitled to funded medical care on an equitable and comprehensive basis. Doctors are paid with taxpayers' money, making them much closer to public servants than private entrepreneurs. Doctors owe a fiduciary duty of care to patients, which must supersede their own personal beliefs. People who serve the public in their jobs cannot cite their personal beliefs to justify refusing services to a particular group of people -- that is discrimination and a violation of human rights.
Finally, Dr. Korvemaker and her fellow doctors are forgetting that physicians' autonomy and right to self-regulation is a privilege given to them by Canadians on the basis of trust. If we cannot trust certain physicians to fulfill their professional obligations by providing the most appropriate care that is available and legal, then those doctors do not deserve an unencumbered right to self-regulation. If doctors are allowed to continue refusing services, they should at least be subject to close monitoring by the College, and be disciplined if they flout the policy.
What are the services that Christian doctors don't want to provide? The vast lion's share of refusals relate to contraception and abortion, both of which are common and medically required. Further, these services are largely delivered to women, with abortion care provided only to women and some trans people. This makes these refusals discrimination, contrary to the claims of the Christian doctors.
Of course, anyone is entitled to believe that abortion and contraception are "immoral," but such a stance has no place in science-based medicine. Doctors' religious objections to providing this care are based on a denial of the overwhelming evidence that abortion and contraception save women's lives and health, allow them to participate fully in society, and give them a shot at equality. The provision of contraception and safe, legal abortion is therefore a vital public interest that negates any grounds for religiously based objections.
But never mind such trifling matters. The Christian doctors have placed their "BIG CONCERN" front and centre: doctor-assisted suicide. In the wake of the Supreme Court's February ruling that Canadians with severe and irremediable suffering have the right to end their life with a doctor's help, the Christian doctors fear they will be forced to participate in the "culture of death" by killing people.
Sorry, but I smell something fishy here. So did blogger Fern Hill, who observed: "[They] know exactly how ridiculous their stand on birth control and abortion is and are trying to divert the reasonable new requirements into a SHRIEEEEK-FEST over euthanasia." Likewise, Hill quoted Julie Lalonde of the pro-choice group Radical Handmaids, who said: "I think the assisted suicide issue is a red herring that is meant to dredge up support for their cause because they know that their views on birth control and abortion are in the minority. But since assisted suicide is a relatively new public discussion in Canada, they're trying to piggy-back on top of it to get people on their side."
It's far too early to know how doctor-assisted suicide will be handled in Canada. Considerable consultation and proper regulation will be required, and it's extremely improbable that doctors would be compelled to participate. Also, the College's new policy has nothing to do with euthanasia, so the Christian doctors are being disingenuous. The whole debate was sparked by three Ottawa doctors in January 2014, because they refused to prescribe birth control to their patients.
Right-wing lawyer John Carpay supports the Christian doctors, and claims that they have a Charter right to freedom of conscience, while patients have no Charter right to health care. Further, he says that while the Ontario College has a duty to uphold the Charter, individual doctors have no such obligation. This misstates the issue. Physicians work in a publicly funded and regulated profession, so they are accountable to the public through the College, as well as to the provincial and federal courts. Of course, doctors have the same Charter rights as anyone, but no right is absolute. When they conflict, they must be balanced, and it's the court's job to determine the right balance.
It sounds shocking and even offensive to say that Canadians have no right to health care. This argument certainly won't win the Christian doctors any fans. While there may not be a specific right to health care in the Charter, health-care delivery is governed by the federal Canada Health Act, which requires provinces to provide equitable access to funded health care to all Canadians. Regardless, it's not just about a patient's right to health care -- that's another smokescreen by the Christian doctors. Although you'll be hard-pressed to find any admission by them that patients have any rights at all, of course they do -- including Charter rights to life, conscience, liberty, equal protection, privacy, and dignity. Some or all of these may be compromised or denied when a doctor refuses treatment. This surely outweighs a doctor's right to freedom of conscience, even if we discount their professional duty to patients.
Actually, refusing care to patients is not even true freedom of conscience. It's an imposition of the doctor's personal beliefs onto the patient and an abuse of authority. This makes it "dishonourable disobedience." In the health-care field, true freedom of conscience can only be exercised when the objecting worker either quits their job or doesn't take the job in the first place. Anyone entering family practice or gynecology should be fully aware they will be expected to provide reproductive health care, so there is no excuse for going into those fields if you object to some of that care.
The Christian doctors claim there's no need to refer patients for abortion, because such referrals are not required. This is very misleading if not outright false. Many hospitals in Ontario that perform abortions DO require a referral. While patients can make their own appointments at abortion clinics, most people are likely unaware of that fact. Besides, if a doctor can't provide a particular service for whatever reason, what patient doesn't expect some immediate useful advice on where to go instead? The Christian doctors are trying to sow confusion by conflating this basic expected guidance to patients with a formal referral to a specialist. (The College's policy requires the former, not the latter.)
Finally, our medical system is not a capitalist supermarket where patients can easily pick and choose which doctors to go to. Many people don't even have a family doctor because it's so hard to find one. Doctors act as gatekeepers. They have a monopoly over medical care and patients are completely dependent on them. Refusals to refer can therefore represent a significant barrier to services.
I really hope that the College of Physicians and Surgeons of Ontario withstands this bully lawsuit by the Christian doctors, and that the courts uphold the new policy. The College's future challenge will lie in enforcement, because I predict that most anti-choice doctors will flout the policy and continue refusing to refer or provide care with which they disagree. They won't refer because they feel that makes them "complicit."
In my February submission to the College on behalf of the Abortion Rights Coalition of Canada, I recommended that they implement new safeguards to ensure that objectors are identified, monitored and disciplined appropriately as required. For example, they should be required to justify each refusal, as well as accept liability and discipline for each refusal, including the risk of being transferred, demoted or terminated. Objectors should be prohibited from working alone, especially in small communities where they are the only physician. Employers should be allowed to prioritize hiring of non-objecting physicians, and pay objecting physicians less. Over time, such measures should reduce or eliminate the presence of doctors who refuse to deliver health care for which they would normally be responsible.
Author's note: I would like to thank Dr. Christian Fiala for his original ideas and collaboration with me on the issue of "conscientious objection" in reproductive health care. He has contributed significantly to my views as expressed in this article.
Joyce Arthur is the founder and Executive Director of Canada's national pro-choice group, the Abortion Rights Coalition of Canada (ARCC), which protects the legal right to abortion on request and works to improve access to quality abortion services.