TORONTO (CCN) — Dr. Luigi Castagna doesn’t think of practising medicine as a protest movement. But a stalemate over conscience rights for doctors who object to physician-assisted dying may change that.
“We may have to resort to civil disobedience,” Castagna told The Catholic Register.
Castagna is a member and former president of the St. Joseph Moscati Toronto Catholic Doctors’ Guild. He doesn’t think helping a patient commit suicide is good medicine and he doesn’t think he should refer suicidal patients to doctors who believe it their duty to accommodate requests for death.
“You do, on occasion, encounter suicidal patients,” said Castagna. “That’s how we saw them before the (Supreme Court) decision. They were suicidal. It’s a psychological condition and you find out the reason. You do what you do with any patient. You do a history, a physical examination. You establish a diagnosis and you treat them. Successful treatment means that they now wish to live again.”
Given the College of Physicians and Surgeons of Ontario policy that forces doctors to provide an “effective referral” for any recognized, legal medical procedure or treatment, even in those cases where the doctor objects on moral or religious grounds, there is great fear among members of the Doctors’ Guild they will be forced to refer for assisted suicide.
University of Toronto department of medicine assistant professor Dr. Maria Wolfs, an endocrinologist at St. Michael’s Hospital, describes Guild members as “incredulous” when they get together to discuss what’s happening to their conscience rights.
“The difficulty lies in the frustration that this sort of fundamental human right (freedom of conscience) has been glossed over,” Wolfs said. “It’s the sense of injustice in the process and how egregious it is that no other jurisdiction in the world requires anything close to this.”
The Coalition for HealthCARE and Conscience is taking the College of Physicians’ and Surgeons of Ontario (CSPO) to court over its “Professional obligations and human rights” policy. The policy states, “Where physicians are unwilling to provide certain elements of care for reasons of conscience or religion, an effective referral to another health care provider must be provided to the patient. An effective referral means a referral made in good faith, to a non-objecting, available, and accessible physician.”
This would apply to requests for medically assisted suicide.
“If you’re going to capture the mood (among Guild doctors), it’s somewhat incredulous,” Wolfs said. “That something so fundamental has just been glossed over and bypassed.”
In the 10 months since Quebec legalized assisted suicide and five months since the federal government passed a national law allowing for it, at least 374 people in Canada have died with the help of a doctor, according to a Globe and Mail survey of available public records. There are no global government statistics collected on the procedure.
“If anyone had any doubt, it is now obvious that our country is going downhill on a very slippery slope,” Michèle Boulva, executive director of the Catholic Organization for Life and Family (COLF), wrote in an email to The Catholic Register after reading the Globe report.
Boulva said she is worried the assisted suicide law is corroding the conscience of citizens, doctors and health care institutions.
“This may be the new normal and the new legal, but it will never be moral,” said Boulva. “What is also truly disturbing is that we are all compelled against our wills to pay for this with our tax dollars, which would be better used in developing more palliative care.”
From the Canadian Conference of Catholic Bishops to individual doctors and health administrators, Catholics have often called for more palliative care as a way of reducing demand for assisted death. About 30 per cent of Canadians have timely access to quality palliative care.
But there’s little or no scientific literature that would suggest more or better palliative care reduces demand for assisted suicide, said Canadian Catholic Bioethics Institute executive director Moira McQueen.
“I don’t think it’s been around long enough to have good solid numbers to prove the point,” she said. “Inference is the only thing.”
In fact, the demand isn’t often prompted by untreatable, crippling pain, said Euthanasia Prevention Coalition executive director and international chair Alex Schadenberg.
“Some people are asking for voluntary euthanasia and it has nothing to do with palliative care. It has to do with their attitudes toward autonomy or radical control and their fear of suffering,” he said. “Data from the Netherlands shows that very few people are actually asking for euthanasia because of uncontrolled pain. Most of them — it’s because they’re fearing the future suffering. I’m not saying that no one has uncontrolled pain.”
Schadenberg doesn’t doubt that Canada needs more and better palliative care. But it won’t solve the assisted dying problem.
Conscience rights are threatened not only for individual doctors but for institutions. University of Ottawa Centre for Health Law, Policy and Ethics professor Daphne Gilbert argues that Catholic hospitals have no religious freedom protections under the Charter of Rights and Freedoms.
The Supreme Court ruled that Montreal’s Jesuit Loyola High School had religious freedom rights under the Charter when it comes to teaching Quebec’s mandatory ethics and religious culture courses, but the court said an institution only enjoyed such rights if “it is constituted primarily for religious purposes.”
“Publicly funded hospitals are not constituted primarily for religious purposes,” writes Gilbert in a Troy Media column.
“While an individual physician may have a Charter-protected religious right to ask another doctor to take over the role of ending a life, a hospital has no constitutional right to prohibit all of its physicians from doing so. Hospitals have no conscience, only the people who work in them do,” according to Gilbert.
That’s not how Providence Healthcare, which has just opened a state-of-the-art palliative care ward, sees things.
“If someone asks (for assisted death) at our hospital, we respond with compassion and respect, and we do not abandon them,” said Providence spokesperson Beth Johnson. “We make it clear that we do not provide physician-assisted death at Providence and we continue to provide quality palliative and end-of-life care.”
Providence Healthcare’s policy is shared by 21 Catholic health care institutions that belong to the Catholic Health Sponsors of Ontario.
“A non-judgmental, non-coercive approach will assist them (patients) to question their request for assisted death and to explore other alternative forms of medical care,” the CHSO said last December. “We will not provide the medical service of physician-assisted death in our institutions, nor will we directly or explicitly refer a patient to receive this same medical procedure.”
If patients request a transfer to another institution, for whatever reason, Ontario Catholic hospitals and nursing homes will accommodate the request.