SASKATOON — A public consultation regarding the College of Physicians and Surgeons of Saskatchewan (CPSS)’s draft policy on conscientious objection has received feedback from both local and national groups. The consultation closed August 7 and will likely be addressed at the CPSS’s upcoming Sept. 18 council meeting.
Concerns regarding the policy have centred on two main areas. First, the requirement that physicians “make arrangements” for their patients to access treatments that the physician finds morally objectionable. Second, the requirement that physicians provide treatment when it “must be provided within a limited time to be effective.” This could potentially include, for example, the chemical abortion pill RU-486, which was approved for use by Health Canada earlier this summer.
Suggested revisions to overcome these concerns were jointly presented by the Christian Medical and Dental Society (CMDS) Canada, the Canadian Federation of Catholic Physicians’ Societies (CFCPS) and Canadian Physicians for Life (CPL).
Regarding the requirement that physicians “make arrangements,” the physicians’ groups suggested that the language should be clarified to state that doctors are to provide patients “with information to allow the patient to arrange timely access” to full and balanced health information and/or to medical services. “This rephrasing clarifies the obligations of both physician and patient,” wrote the physicians’ groups, and “ensures the patient has access to the required information, and allows the physician the freedom to find creative solutions in the exercise of her conscience.”
The CMDS, CFCPS and CPL also proposed the removal of the requirement that physicians provide treatment that must be provided within a limited time. The physicians groups asserted that a “physician’s obligation to provide care to prevent imminent harm is indisputable,” and stated that this obligation, which is already present in the policy, should guide physicians through emergency situations.
In their submissions to the CPSS, both the Catholic Health Association of Saskatchewan (CHAS) and Bishop Donald Bolen of Saskatoon encouraged the CPSS to adopt the language proposed by the CMDS, CFCPS and CPL. Bolen also stressed the value of conscientious physicians.
“A physician of integrity is invaluable to his or her patients,” wrote Bolen. “Such physicians are able to bring all of their faculties to the care they provide, including their technical skills, knowledge, compassion, and sound judgment. It is impossible to ask physicians to leave their conscience behind when engaging patients because it is precisely this faculty that enables physicians to respectfully make decisions concerning appropriate care in their exercise of the art of medicine.”
In their submission, the Catholic Civil Rights League (CCRL) stressed that “the suggestion that one’s conscientious beliefs can be compartmentalized from good health care is a distinction that the (CPSS) cannot reasonably maintain, since a doctor’s informed conscience should be integral to their practice.” The CCRL defended physicians’ Charter of Rights freedom of conscience and religion, emphasizing that these rights must not be violated by the CPSS.
The draft policy was also criticized by the Protection of Conscience Project. Citing Section 1 of the Canadian Charter of Rights and Freedoms, the Project states that “the limits proposed in [the policy] are neither reasonable nor demonstrably justified” because the College had no evidence that conscientious objection by Saskatchewan physicians has ever deprived anyone of access to medical services or adversely affected anyone’s health.
Much of the discussion around previous drafts of the policy concerned the moral implications of making a formal referral. Most physicians who exercise a moral objection to procedures, such as sex-selective abortion, are willing to provide patients with information on how to legally access the procedure, but are not willing to be directly involved by providing a referral.
As Cardinal Thomas Collins explained in his March 24 letter concerning a similar policy in Ontario, “by insisting they provide an effective referral on [matters of conscience], in essence, the physician is being asked to serve as an accomplice in the procedure.” However, it is unclear whether or not the current CPSS draft wording, “making an arrangement,” is the equivalent of making a referral.
The current policy follows a previous draft that 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 early draft was met with criticism during a public consultation in which the majority of over 4,000 submissions supported conscience rights. The policy was sent back to a subcommittee for redrafting following the March 28 meeting of the CPSS council.
Concerns have also been raised that the policy could be applied to physician assisted suicide or euthanasia in the future. The CPPS council has struck a subcommittee to address the issue of “physician assisted dying,” which could be legally available in Canada on February 6, 2016, under a Supreme Court of Canada ruling. (See related story.)