Response to the draft CPSO policy entitled “Physicians and the Ontario Human Rights Code”

Tuesday, 16 September 2008
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Doctor Preston Zuliani
President
The College of Physicians and Surgeons of Ontario (CPSO)
80 College Street
Toronto, Ontario
M5G 2E2

Re: Response to the draft CPSO policy entitled "Physicians and the Ontario Human Rights Code"

Dear Dr. Zuliani,

In response to your invitation for public input, the Catholic Organization for Life and Family (COLF) is submitting its comments on your draft policy entitled "Physicians and the Ontario Human Rights Code". COLF is a national nonprofit organization whose mission is to promote respect for human life and dignity and the essential role of the family. It is co-sponsored by the Canadian Conference of Catholic Bishops and the Supreme Council of the Knights of Columbus.

Two main concerns arise for COLF in this draft policy. First, COLF is concerned about the policy's implicit expectations upon physicians with respect to engaging in a medical act to which they may have a conscientious objection. Second, we are concerned about the policy's seeming redefinition and narrowing of the role of the physician vis-à-vis the patient and within society.

The policy states that "Physicians should be aware that decisions to restrict medical services offered, to accept individuals as patients or to end physician-patient relationships that are based on moral or religious belief may contravene the Code, and/or constitute professional misconduct." Thus, the policy clearly articulates that some conscientious objections may not be tolerated by the CPSO.

The College gives only general guidance as to the criteria it will consider in examining specific cases: the extent to which the physician has communicated clearly with the patient, treated the patient with respect, and given information about accessing another physician. The guidance is not nearly specific enough, and cannot but leave physicians confused and uncertain, placing a chill on their freedom to exercise conscientious objection.

Moreover, one of the criteria that is supposed to enable conscientious objection in fact does the opposite, as it requires doctors to at least indirectly violate their conscience. The requirement that a physician must provide information about access to another physician who would provide the service is unacceptable, because it requires the physician to cooperate with the procuring of a service that he cannot morally support.

To help dispel this uncertainty, COLF invites the CPSO to include in their draft a specific provision which would state that (a) that the CPSO will not discriminate against physicians who oppose procedures such as abortion, contraception (including the birth control pill and the morning-after pill) and the use of certain assisted reproductive technologies; (b) that the CPSO will uphold the rights of physicians to exercise their conscientious objection to such medical acts, and; (c) that the CPSO will not require doctors to refer patients, or potential patients, to other doctors for such medical acts.

An example that may be useful is the recent support for the protection of the freedom of conscience of physicians in the United States, where the government drafted a bill that would protect physicians from discrimination for refusing to provide or refer for abortion.

The CPSO policy should also clearly specify the definitions of key terms such as "clear" and "prompt" communication and "religious beliefs", and provide more guidance, including situational examples, as to the statements that include these phrases.  Of concern especially is the statement that "physicians should not express personal judgments about the beliefs, lifestyle, identity or characteristics of the patient or potential patient". This very general and vague prohibition could be understood as having the serious consequence of tending towards a transformation of physicians into silent technicians who place aside their ethics and simply deliver requested services to their customers.

Such an understanding of the physician would do a great disservice to the medical profession and to society in general. The role of the physician has always been understood in a holistic way to include care for the patient's overall well-being, including his or her moral and psychological health. To prevent our doctors from commenting on a patient's "lifestyle" is to take a grave step away from the "never do harm" of the Hippocratic Oath and towards the philosophy of the marketplace, where "the customer is always right". This would be a dangerous development because in health-related matters the customer is sometimes mistaken, and could greatly benefit from the sound advice and guidance of a physician. Indeed, many patients expect and rely on such medical and ethical guidance from their doctors. Thank you for providing an opportunity for the public to comment on your draft policy, which will affect not only Ontario physicians but also society at large.

Sincerely,

Michèle Boulva
Director

c.c. Andréa Foti, Policy Analyst
Policy Department
The College of Physicians and Surgeons of Ontario (CPSO)
80 College Street
Toronto, Ontario
M5G 2E2