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Physicians refer draft policy back to committee

By Mary Deutscher

04/15/2015

SASKATOON — The College of Physicians and Surgeons of Saskatchewan (CPSS) ruling council sent their draft policy on conscientious refusal back to a subcommittee for further drafting after a meeting March 28 in Saskatoon. The draft policy, which was approved in principle at the college’s January meeting, proposed a regime in which doctors would be compelled to refer for, and in some cases provide, morally objectionable treatments, such as abortion and assisted suicide.

The decision came following a month of public consultation in which the council received over 4,000 submissions, the vast majority of which supported physicians’ conscience rights.

The council’s deliberations began at a March 26 meeting. The associate registrar, Bryan Salte, presented a new draft that incorporated some suggestions made in the public consultation.

Discussion centred on whether the policy would include an exemption for the Supreme Court’s Carter decision, leaving assisted suicide as the only “treatment” that physicians could refuse to provide on conscience grounds. Concerns were raised regarding how long such an exemption would be maintained as assisted suicide becomes normalized in Canadian society.

Council members also raised concerns regarding the impact the draft policy could have on future generations of physicians. Preston Smith, Dean of the College of Medicine, stated that “conscientiousness and perseverance are the two personality indicators that predict high clinical performance.” The draft policy would therefore select against the very people who should be encouraged to enter medical school.

All councilors agreed that the CPSS has an obligation to ensure that patients are not abandoned, but that the council requires more time to draft a policy that balances physician and patient interests.

The council reconvened March 28 to further discuss changes to the draft policy. The council made several recommendations to the subcommittee, including the need to provide a clear definition for the word “referral.”

While “referral” could mean to simply provide information regarding a treatment verbally, in medicine this word is used more formally to mean a written referral in which a physician entrusts care of his or her patient to another physician. While most physicians who object to procedures such as abortion are willing to provide their patients with information, a formal referral is understood to endorse the patient’s decision to pursue an option the physician believes is harmful.

The proposed policy identifies three scenarios in which a physician may wish to withdraw his or her services from a patient. First, when a patient requires information about possible treatments; second, when a patient requests a specific treatment; and third, when a patient requires a specific treatment in an emergency.

Following discussion, the council recommended that when a doctor is not willing to provide his or her patient with information regarding treatment options, he or she should refer the patient or direct the patient to an appropriate physician or service. This solution came after it was pointed out that in many cases it is more expedient for a patient to self-refer than to go through the formal medical referral process. No consensus was reached regarding a physician’s obligations when a patient requests a specific treatment.

Regarding the role of physicians in emergency situations, council members had difficulty defining an “emergency situation.” This issue was referred back to the subcommittee.

The council also directed that the policy’s title be changed from Conscientious Refusal, to the less adversarial Conscientious Objection.

The subcommittee will convene to create another draft, which will need to be approved in principle by the council before another public consultation can begin. The council hopes to have completed such a consultation before their June meeting, at which time they will vote on whether or not to approve a final policy.

Proponents of conscience rights applauded the CPSS decision to reconsider certain portions of the policy. Bishop Donald Bolen of Saskatoon stated that he was “very grateful to hear of the vigorous discussion among doctors at the meeting of the CPSS, and that they have chosen to delay the vote in order to discern more about this important issue.”

In reference to the response given by Catholics to the CPSS’s call for feedback, Bolen said, “I’m very proud of what the diocese has done and how many people have engaged in this vitally important discussion. We are living in a critical moment where decisions are still being made. We are capable of making a difference on this question in the here and now, both on a provincial and a national level.”

Christian Medical and Dental Society (CMDS) executive director Larry Worthen reiterated his organization’s commitment to protecting conscience, saying that any policy that fails to do so “effectively discriminates against a whole class of people based on their creed or religion.” He went on to state that “it is possible, with a little innovation and tolerance, to come up with solutions that can ensure patient access without trampling on the conscience rights of physicians. We invite the CPSS to a dialogue to develop those solutions.”

The CPSS’s meeting was held just weeks after the College of Physicians and Surgeons of Ontario (CPSO)’s March 6 decision to pass a similar policy which infringes on physicians’ conscience rights. Despite receiving 15,977 submissions, the vast majority of which supported conscience rights for physicians, the CPSO passed a policy that requires physicians to refer for and in some cases provide morally objectionable services.

On March 24, the CMDS and the Canadian Federation of Catholic Physicians’ Societies filed an application asking the Ontario Superior Court of Justice Court to declare that portions of the CPSO policy violate the Canadian Charter of Rights and Freedoms, which protects freedom of conscience.

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