Does faith have a place in medicine?


College of physicians debates doctors’ rights to refuse treatments

Sep 18, 2008 04:30 AM

Stuart Laidlaw, Toronto Star, Faith and Ethics reporter

In 20 years as a family doctor in Canada and the United States, David McCann has never so much as written a prescription for contraceptive pills. He has never referred a patient for artificial insemination and never given out the name of a doctor who performs abortions.

“Referring a patient for a procedure that violates my conscience also violates my conscience,” McCann says. “That’s a form of co-operation with evil.”

McCann, who is Catholic, hopes to be present today when the Ontario College of Physicians and Surgeons debates a controversial policy outlining doctors’ limited right to refuse to provide medical treatment to patients on the basis of their personal religious beliefs.

He worries that doctors are increasingly expected to check their beliefs at the door – something he says he cannot do.

“They are proposing a tacitly atheist set of rules,” he says.

The Catholic archbishop for Toronto, Thomas Collins, wrote to the college last week to say that, faith instilled in many doctors a desire to help others, and motivated them to get into medicine.

“Both physicians and patients must be free to remain true to their own convictions if medical decision-making is to retain its inherently moral character,” Collins wrote.

The Ontario Medical Association wants the college to scrap the policy draft altogether.

“We believe that it should never be professional misconduct for an Ontarian physician to act in accordance with his or her religious or moral beliefs,” the OMA said in a statement.

The draft policy warns “there will be times when it may be necessary for physicians to set aside their personal beliefs in order to ensure that patients or potential patients are provided with the medical treatment and services they require.”

College president Preston Zuliani says the policy is a warning to doctors that they could face human rights complaints over the issue in the future, and possibly disciplinary hearings before the college, should a patient take issue with a doctor’s decision.

“In our society, we all pay taxes for this medical system to receive services,” says Zuliani, a family doctor in St. Catharines.

“And if a citizen or taxpayer goes to access those services and they are blocked from receiving legitimate services by a physician, we don’t feel that’s acceptable.”

Changes to Ontario’s human rights laws are expected to lead to a jump in the number of complaints filed, which Zuliani says could lead to more complaints against doctors who, for religious reasons, refuse treatments, including abortions, birth control pills or artificial insemination for gay couples.

The college, he says, is not telling doctors they have to abandon their faith to do their job, but is trying to help them avoid complaints to the rights commission or to the college.

“The courts have generally ruled that the freedom to exercise one’s religious beliefs does not include the right to interfere with the rights of others,” he says.

The OMA, however, cautions against giving such guidance, saying in its statement that the college might inadvertently “misstate the law in this area,” thereby giving bad advice to doctors. It urges the college to simply refer any queries to the human rights commission.

The draft policy outlines several factors the college will take into consideration should a complaint be filed with the college, including whether doctors refusing service have been upfront with patients about their beliefs and provided advice to patients about obtaining the care they wanted elsewhere.

Zuliani says doctors are expected to provide a list of other doctors taking new patients. They would not, however, be expected to make a direct referral to another doctor who will provide a treatment they don’t support themselves.

“We are not asking doctors to be complicit by making a referral,” Zuliani says. “But they can’t withhold information, either.”

Dr. John Patrick of the Christian Medical and Dental Society said even giving patients a list of other doctors would make the doctor “an accessory to the act,” and so would be unacceptable.

“We need to figure out how we are going accommodate each other,” the retired pediatrician and biochemist said from his home in Ottawa.

McCann says he would not give a patient any such list, but says he is upfront with all patients about his beliefs. He would rather see the college fight on the behalf of doctors like himself to fight such human rights issues than send out warnings about potential problems.

Patrick says perhaps some sort of “dual system” – complete with separate medical schools – is needed for those who want their medicine to be based in religion, and those who do not.

Zuliani says he expects the policy to receive “some rewording” at the meeting today, saying the policy will be re-released for further debate if the changes are considered extensive enough.

The issue is also expected to be discussed at two Catholic medical conferences in Toronto next week.


Doctors’ body backs down on religion policy
Charles Lewis, National Post
Published: Wednesday, September 17, 2008

The regulating body for Ontario physicians has backed off a controversial proposal that would have forced doctors to put aside their religious views when dealing with patients.

Protests from the Ontario Medical Association and numerous religious groups appear to have tempered the thinking of the College of Physicians and Surgeons of Ontario.

The new document, released on Wednesday, has removed provisions that would have potentially seen doctors face more misconduct charges for putting their own conscience before the convenience of patients.

For example, it could have applied to doctors who not only refuse to prescribe birth control pills, or do fertility treatments for same-sex couples, but also to those who refuse to offer referrals to doctors who do those things.

“Referring is just a way of sloughing off your responsibility,” Rabbi Reuven Bulka of Congregation Machzikei Hadas in Ottawa, said last week. “If you’re opposed to these things, referring is the same as taking part in the evil.”

The College of Physicians and Surgeons released its first draft policy in August. It warned doctors that they could see more charges being filed through the Ontario Human Rights Commission for withholding services. But it also indicated that doctors would face misconduct charges by the college as well, something that happens in no other province.

The new policy, which is scheduled to be voted on today, now serves as more of a warning about what doctors may face from the Human Rights Commission.

“The draft policy was always meant as a basis for discussion,” said Jill Hefley, a spokeswoman for the college.

Last week, the Ontario Medical Association asked the college to abandon the draft policy because it “interfered with physicians’ existing rights and freedoms.” It said the draft failed to note that doctors are also protected under the Charter of Rights and Freedoms, like any other citizen.

“We believe it should never be professional misconduct for an Ontarian physician to act in accordance with his or her religious beliefs.”

Thomas Collins, Archbishop of the Dioceses of Toronto, also told the college that many physicians feared they would be “brought before human rights tribunals for following their consciences.” But he saw no reason why it would then be necessary for the college to add sanctions of its own. “Is that the cost of being true to one’s conscience?” he asked.

Sean Murphy of the Protection of Conscience Project, a group that tries to protect the rights of health workers, said the new document appears to be much improved from the original draft.

“It’s more clear in this document that the bogey man is the Ontario Human Rights Commission,” he said.

But he is concerned that one clause remaining in the policy could hurt doctors who exercise conscience.

It says the “college has its own expectations for physicians who limit their practice, refuse to accept individuals as patients, or end a physician-patient relationship on the basis of moral beliefs.”

He said this provision still needs to be clarified by officials.

National Post


We will not defy beliefs, doctors say
Regulator says patients should be told all options

Charles Lewis, National Post
Published: Saturday, September 13, 2008

The Ontario Medical Association wants the provincial licensing body to kill a proposal that would force physicians to put aside their religious beliefs when making decisions in their medical practice.

The controversial document by the College of Physicians and Surgeons Ontario, which will be voted on next week, warns doctors that the provincial Human Rights Commission will get more aggressive with those who appear to violate an individual’s right to get treatment. It also suggests doctors could face misconduct charges from the College for those human rights violations, something that does not exist now in the province or in any other part of Canada.

“The OMA is concerned that this draft policy may interfere with physicians’ existing rights and freedoms,” a statement said. “The OMA urges the College to abandon this [draft] policy.”

The OMA, which has 25,000 members, said the draft policy does not properly inform doctors that “their right to freedom of religion is protected under the Charter of Rights and Freedoms.”

Among other things, the draft policy from the College said doctors will have to set aside personal beliefs “to ensure that patients or potential patients are provided with the medical services they require.” It also said doctors who restrict medical service based on moral or religious beliefs may contravene the Human Rights Code and could be committing professional misconduct.

“We believe it should never be professional misconduct for an Ontarian physician to act in accordance with his or her religious belief,” the OMA said in reply.

For example, doctors not only can refuse to prescribe birth control pills, but they also do not have to make a referral to someone who would or even discuss it as a viable option. The same thing might go for referring a patient for an abortion or helping a same-sex couple get fertility treatment.

Yesterday, Thomas Collins, Archbishop for the Roman Catholic Diocese of Toronto, wrote to the College.

He said many doctors may have good reason to fear “they will be brought before human rights tribunals in our province for following their consciences. If so, the issues will be addressed at that time, case by case, and in any later appeals. I urge the College of Physicians and Surgeons to support a physician who seeks to follow his or her conscience …”

Archbishop Collins expressed concern the College would add sanctions of its own.

“If a physician cannot in conscience perform or facilitate an action that is requested, will that physician face the threat of being sanctioned for violating a patient’s human rights and for professional misconduct? Is that the cost of being true to one’s conscience?”

The draft policy will be voted on next week.

Dr. Preston Zuliani, president of the College, said yesterday that the draft policy has been revised to address the concerns of those doctors who are worried about their rights being violated though he could not reveal what those changes are.

“In our province, health care is provided by the government for the people and it’s funded by the taxpayer,” he said.

“And the OMA would take the position that the doctor has the right to withhold information about legitimate medical treatments that are available if the doctor disagrees with them.

“We would suggest that the doctor has an obligation to not withhold information about birth control and other treatments available. We are not saying that we would make the doctor make the referral.

“But in this province the expectation is that physicians will provide information to patients about all facets of their health care.

“We do not expect a physician to impose their religious beliefs on their patients. Let the patient make their own decision without the doctor having to make referral, but not to withhold any important information.”


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