TORONTO, ON August 7 2015 – The Catholic Civil Rights League (CCRL) makes this second submission to the College of Physicians and Surgeons of Saskatchewan (CPSS) regarding the unacceptable draft policy Conscientious Objection. The CCRL’s first submission to the CPSS was made on February 27, 2015 regarding the original draft policy Conscientious Refusal.
August 7, 2015
Updated Submission to the College of Physicians and Surgeons of Saskatchewan
To the Registrar:
We take this opportunity to provide brief comments in respect of the invitation to address the June 19 2015 draft revised policy on Conscientious Objection, posted on the College’s website.
The Catholic Civil Rights League reiterates our submissions from February, 2015, in which we advocated for a robust understanding and protection of freedom of conscience and religion for all Canadians, and for physicians in their care to patients and in the overall forming of their individual medical practices.
There has been no evidence provided to the Council to our knowledge of the inability of anyone in Saskatchewan to access medical services or that the health of anyone in Saskatchewan has ever been adversely affected because a physician has declined to provide or refer for a procedure for reasons of conscience.
As we stated in our previous submission, an erosion of the physician’s integrity at a core moral level would have devastating consequences for the patient, for the practice of medicine, and for society at large. Checking one’s conscience at the door of the clinic would not facilitate quality patient care.
We previously submitted that the proper analysis should be framed in the following way in response to a patient request for a morally objectionable treatment. A doctor could reasonably ask, “As your physician, would you prefer that I act with moral integrity?” with the expectation that a patient would say yes, as a negative answer could lead to tragic consequences. That doctor could then reasonably assert that a demand to perform an objectionable service, while of interest to the patient, would irrevocably violate and damage that doctor’s integrity.
We remain concerned that it is entirely conceivable that conscientious doctors would leave the province rather than be forced to face discipline for exercising their conscientious beliefs.
Turning to the new draft proposals, we have the following comments:
5.1 Taking on New Patients
Excerpt: “Where physicians know in advance that they will not provide specific services, but will only arrange for the patient to obtain the necessary information from another source or arrange for the patient to obtain access to a medical treatment from another source (in accordance with paragraphs 5.2 or 5.3)”
The League maintains that physicians have the right to inform patients or prospective patients in advance that they will not provide specific services. It is our view that patients could then make further inquiries to determine other doctors who may be willing to perform such services, without engaging the objecting physician to make that information available. The College could be a source for such information. The objecting physician should not be compelled to provide information on the availability of objectionable services, if it breaches his/her conscience. In any event, it is our position the physician’s position is inextricably linked with their proper understanding of good health care.
5.2 Provision of Information to Patients
Presumably, the physician will be in a position to provide information to patients, in conjunction with our comments from the previous section 5.1, which accords with his/her understanding of good health care, and in accordance with the physician’s conscience.
Excerpt: “Physicians must provide their patients with full and balanced health information required to make legally valid, informed choices about medical treatment (e.g., diagnosis, prognosis, and clinically appropriate treatment options, including the option of no treatment or treatment other than that recommended by the physician), even if the provision of such information conflicts with the physician’s deeply held and considered moral or religious beliefs.
“Physicians must not promote their own moral or religious beliefs when interacting with a patient.”
The League objects to these proposed guidelines, as they engage a breach of a physician’s right to religious and/or conscientious objection.
We reiterate our previous submissions on the importance of a physician acting in accordance with their moral integrity, for their own good, and for the good of the patient.
In our submission, physicians should be allowed to decline to provide publicly-funded health services if providing those services violates their freedom of conscience. Moreover, a physician should not be prevented from providing the basis of their objection, as a matter of communicating his/her views of good health care, even if it may be based on an informed conscience, or on the basis of religious beliefs.
As the League stated in February, such communications should be acceptable in a society informed by authentic pluralism. A doctor should use their professional judgment, even from his/her position of trust or fiduciary relationship, to discuss how the doctor’s position is part of their view of sound, relevant, and good health care, so long as the doctor does not abuse that position of trust.
5.3 Providing or Arranging Access to Health Services
The League notes the deletion of the previous proposal for a “timely referral” in favour of new language that physicians “make an arrangement” for the provision of objectionable services.
However, our objections to this language remains unchanged, for the reasons advanced in our previous submission from February, 2015.
As we previously submitted, neither the College nor the courts determine what comprises conscientious or religious belief and to what extent acts may or may not interfere. Once the sincerity of religious belief is understood, or what one’s conscience may decide, neither the College nor a court should interfere in a delineation of what the particular faith or conscience may prescribe. It is far more logical to simply respect physicians’ consciences, as integral to the delivery of good health care, as has been the case.
The suggestion to “make an arrangement” has the risk of violating the right of freedom of conscience and is not displaced by a patient’s request to access to care, or a particular procedure or service.
5.4 Necessary Treatments
The League reiterates our previous objections.
We object to the compulsion to provide the patient with all health services where there is a conflict with one’s religious or conscientious beliefs, even in cases of emergency or lack of other referral options.
We reiterate that a doctor’s conscientious belief is integral to the proper delivery of good health care. The suggestion that one’s conscientious beliefs can be compartmentalized from good health care is a distinction that the College cannot reasonably maintain, since a doctor’s informed conscience should be integral to their practice. The prospect of a perceived emergency situation does not invalidate the doctor’s conscientious objections.
While we note that your proposed policy is not specifically applicable to the prospect of assisted suicide, the League notes that its suggestions are specifically mindful of the need for a robust understanding of conscientious objection by physicians, nurses, and all others engaged in health care, should an assisted suicide regime be engaged.
It should be noted that the League has objected, and continues to object to the proposition of the introduction of assisted suicide to Canada.
We trust that our submissions will be of assistance to your deliberations.
Yours very truly,
Philip H. Horgan
President, Catholic Civil Rights League (CCRL)
About the CCRL
Catholic Civil Rights League (CCRL) (www.ccrl.ca) assists in creating conditions within which Catholic teachings can be better understood, cooperates with other organizations in defending civil rights in Canada, and opposes defamation and discrimination against Catholics on the basis of their beliefs. The CCRL was founded in 1985 as an independent lay organization with a large nationwide membership base. The CCRL is a Canadian non-profit organization entirely supported by the generosity of its members.
For further information:
Christian Domenic Elia, PhD
CCRL Executive Director