The College of Physicians and Surgeons of Ontario (CPSO) recently released a draft policy on professional obligations and human rights that has deeply disturbed health service providers and patients. The draft policy forces physicians to do certain procedures or prescribe certain pharmaceuticals against their own moral or religious convictions in some cases, or to make a formal referral to another doctor in others. In doing so the CPSO has drafted a policy that violates Canadian law. This matter has taken on an even more serious tone given the possibility that assisted suicide and euthanasia may be legalized at some point in the future.
There is no human right in Canada to demand and receive particular services from a specific physician. The Ontario Human Rights Code prohibits discrimination against the public on a number of grounds that include among others, race, ethnicity, sex, sexual orientation, age or disability. This means that one must not deprive one group of services one provides to others. However, the Code does not dictate what services must be delivered. So, if a restaurant chooses not to serve pork because of the owner’s religious beliefs, there is no violation of the Code. If the restaurant choses to exclude people of a particular ethnic group however, that would amount to discrimination and a violation of the Code. In the same way, a physician who is unable to participate in a procedure or prescribe a pharmaceutical for moral or religious reasons is not discriminating against his or her patient provided all patients are treated the same. Unfortunately, the draft policy suggests that a physician’s objection to a specific procedure or pharmaceutical may result in the violation of a patient’s rights under the Charter or the Code. This reference makes clear that those who prepared this policy misunderstand the application and function of Ontario and Canadian law.
Physicians do have the right to be protected from state coercion to act against their moral or religious convictions, guaranteed by the Charter of Rights and Freedoms. Provided the services are delivered in a respectful way there are no competing rights. In such a case, the only human rights present are the physician’s human rights to freedom of religion and freedom of conscience. Furthermore, when the physician is an employee they have the additional right to be accommodated by their employer.
Referrals are as morally problematic as doing the procedure itself. This concept is supported in Canadian law. For instance, if an accused person refers an acquaintance to a drug dealer, the accused person is guilty of the crime of trafficking in narcotics. If a physician has the moral or religious conviction that abortion or euthanasia is the taking of an innocent human life, then the physician who formally refers a patient to the abortionist or euthanist has contributed to the taking of that life.
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Physicians who rely on these protections want to serve all patients in an open and inclusive manner, providing all relevant information in a fair and unbiased way, striving to be non judgemental and supportive in their approach. In a multicultural society, doctors relate with patients with widely divergent worldviews every day. The physician’s primary concern is for their patient’s health. Even when the physician is not able to participate in the implementation of the patient’s ultimate decision, the professional relationship between them can be maintained and may even be enhanced. Physicians in these circumstances are up front with their patients about what services they will or will not provide from the beginning of the relationship. Physicians simply request that their rights be respected just as they respect the rights and feelings of their patients.
Unfortunately, the purpose of this draft policy appears to be clear. It was not designed to ensure that physicians understand and comply with their legal obligations under the Code, but rather, it appears to have been designed with the goal of either compelling physicians who object to specific procedures and pharmaceuticals to act against their moral and religious convictions or, alternatively, to drive those who object to these procedures and pharmaceuticals out of the medical profession.
If the CPSO passes this policy, it will do great damage to many well-qualified physicians who are currently making significant contributions to health care in Canada. The CPSO will be alienating these physicians from their heart and soul that is their primary motivator for excellent patient care. And the CPSO will be depriving many members of the public of the type of doctor they would prefer to be treated by. This is discrimination. It is the systematic disqualification of perfectly acceptable practitioners because of their religious beliefs.
This policy cannot withstand Charter scrutiny as it results in a clear violation of physician’s conscience and religious rights. The CPSO perhaps assumes that physicians will not defend their Charter rights to freedom of religion and conscience. They are wrong.
Larry Worthen is a lawyer and the Executive Director of the Christian Medical and Dental Society of Canada, an association that represents 1600 physicians across Canada. The CMDS presented submissions to the CPSO in relation to the draft policy.
Albertos Polizogopoulos is a Partner with the firm Vincent Dagenais Gibson LLP/s.r.l. in Ottawa, Ontario. He regularly appears before courts and appellate courts including the Supreme Court of Canada to advocate for his clients’ rights to freedom of religion, freedom of conscience and other civil liberties. He also frequently appears in media interviews and on panels to discuss constitutional law. Albertos was counsel to the CMDS in making submissions to the CPSO on the draft policy. @CharterLaw