SASKATOON — The College of Physicians and Surgeons of Saskatchewan (CPSS) have passed a controversial policy on conscientious objection. The policy passed by a vote of nine in favour, three against, with three abstentions at a Sept. 18 council meeting, despite having received criticism from a number of groups.
The policy was drafted in June and was open to public consultation over the summer months. Following 15 minutes of discussion, council members made only one alteration to the draft, changing the phrase “physician-assisted death” to “physician-assisted dying” under the assumption that this phrasing is preferred by palliative care physicians.
One council member warned that the policy as passed will put good physicians in jeopardy, and that the council should anticipate physicians being brought forward for disciplinary action.
Saskatoon Physician Dr. Sheila Harding expressed concern about patient welfare under the new policy. “I am deeply dismayed by this policy,” Harding said. “It requires that, in some circumstances, doctors must intentionally harm our patients or risk discipline by our provincial regulatory authority.”
The Christian Medical and Dental Society of Canada (CMDS) is consulting its legal team to determine whether it will begin a legal application similar to the one that was begun against a conscientious objection policy in Ontario earlier this year.
In a recent letter to the Prairie Messenger, CMDS Executive Director Larry Worthen stated: “passage of this policy means that physicians who have conscience concerns about specific procedures will be discriminated against by the College simply because of their religious or moral convictions. Canadians’ rights of conscience and protection from discrimination are guaranteed by the Charter of Rights and Freedoms.”
Concerns regarding the policy have centred on two main areas. First, the ambiguous wording in 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 and it is not reasonably possible to arrange for another physician or health care provider to provide that treatment.” This could potentially include, for example, the chemical abortion pill RU-486, which was approved by Health Canada this summer for use in first trimester pregnancies.
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.”
Suggested revisions to overcome these concerns were jointly presented by the CMDS, the Canadian Federation of Catholic Physicians’ Societies (CFCPS) and Canadian Physicians for Life (CPL).
Regarding the requirement that physicians “make arrangements,” these 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, “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.
These concerns were shared by Bishop Donald Bolen of the Diocese of Saskatoon, as well as by a number of other Catholic groups, including the Catholic Health Association of Saskatchewan. However, the CPSS Council only had a brief discussion regarding the submissions made by these groups before passing the policy.
“I am profoundly disappointed and concerned that the Council of the College of Physicians and Surgeons of Saskatchewan did not take concerns about the conscience rights of physicians to heart in passing this policy,” said Bolen of the Roman Catholic Diocese of Saskatoon, which has joined with other organizations in working to raise awareness about the policy and its implications. “I commend the Christian Medical and Dental Society of Canada for their ongoing efforts to challenge policies that threaten the rights of medical professionals to act with integrity and follow their conscience.”
Although the policy specifically states that it does not apply to “physician-assisted dying,” concerns were raised at the council meeting that the policy could be applied to euthanasia and assisted suicide in the future. Associate registrar Bryan Salte dismissed these concerns, stating that “physician-assisted dying” is a substantially different issue because it ends a life (see related article).