DOC­TORS CAN’T SAY NO

On­tario MDs face sanc­tions for re­fus­ing care based on be­liefs

Ottawa Citizen - - CON­TEXT - SHARON KIRKEY

Doc­tors who refuse to pre­scribe birth con­trol or other med­i­cal ser­vices be­cause of their per­sonal val­ues could face pos­si­ble dis­ci­plinary ac­tions, Canada’s largest med­i­cal reg­u­la­tor says.

Mo­ral or re­li­gious con­vic­tions of a doc­tor can­not im­pede a pa­tient’s ac­cess to care, the Col­lege of Physi­cians and Sur­geons of On­tario said Fri­day in a 21-3 vote sup­port­ing an up­dated Pro­fes­sional and Hu­man Rights pol­icy.

The pol­icy makes clear: “You can­not kick some­one out of your of­fice with­out care,” said Dr. Marc Ga­bel, past pres­i­dent of the col­lege and chair­man of the pol­icy’s work­ing group.

Some coun­cil mem­bers said the new code, which the col­lege ex­pects physi­cians to com­ply with or face com­plaints of pro­fes­sional mis­con­duct, could lead to “state-run” medicine, while oth­ers said the church has no place in a doc­tor’s of­fice.

While it does not ad­dress physi­cian-as­sisted death, it could set the stage for con­flict with the Cana­dian Med­i­cal As­so­ci­a­tion, whose lead­ers want to pro­tect doc­tors against “manda­tory re­fer­ral” when the Supreme Court of Canada rul­ing le­gal­iz­ing doc­tor-has­tened dy­ing takes ef­fect next Fe­bru­ary.

The new On­tario pol­icy forces doc­tors un­will­ing to pro­vide cer­tain care, such as pre­scrip­tions for con­tra­cep­tion or re­fer­rals for an abor­tion, to re­fer pa­tients to a “non-ob­ject­ing, avail­able and ac­ces­si­ble physi­cian or other health­care provider.”

In emer­gen­cies, doc­tors would have to pro­vide the care them­selves, re­gard­less of their be­liefs. Ac­cord­ing to a back­ground doc­u­ment for physi­cians, the col­lege says that could in­clude ad­min­is­ter­ing life-sav­ing blood trans­fu­sions or treat­ing a woman for blood poi­son­ing “caused by a botched abor­tion.”

In a let­ter to the col­lege, the On­tario Hu­man Rights Com­mis­sion says the re­vised pol­icy rec­og­nizes that no right is ab­so­lute, that “rights can be lim­ited by the rights and free­doms of oth­ers” and that the pol­icy is in line with le­gal prin­ci­ples set out in court rul­ings.

The pol­icy’s un­der­ly­ing prin­ci­ple is that doc­tors have a “fidu­ciary” duty to act in their pa­tient’s best in­ter­est, and that even if a doc­tor morally ob­jects to pro­vid­ing care to which a pa­tient is legally en­ti­tled, he or she must re­fer to some­one else.

“The re­fer­ral re­quire­ment strikes an ap­pro­pri­ate bal­ance be­tween pa­tient and physi­cians’ rights, re­flects the ex­pec­ta­tions of the On­tario pub­lic and is con­sis­tent with other med­i­cal reg­u­la­tors in Canada,” said col­lege pres­i­dent Dr. Carol Leet.

More than 16,000 re­sponses were re­ceived dur­ing a pub­lic con­sul­ta­tion pe­riod — un­prece­dented feed­back, ac­cord­ing to Ga­bel. The ma­jor­ity op­posed the re­fer­ral re­quire­ment. But when the col­lege polled 800 On­tar­i­ans last May on “con­sci­en­tious ob­jec­tion,” a solid ma­jor­ity — 92 per cent — said doc­tors who refuse to pro­vide a ser­vice them­selves should help pa­tients find an­other doc­tor who would.

The On­tario Med­i­cal As­so­ci­a­tion also op­posed the re­vised pol­icy, ar­gu­ing that it forces physi­cians to do some­thing that may con­flict with their fun­da­men­tal be­liefs.

But Dr. Ga­bel said the col­lege ex­pects doc­tors to “re­spect the fun­da­men­tal rights of those who seek their med­i­cal ser­vices.”

Ot­tawa physi­cian and coun­cil mem­ber Dr. Den­nis Pitt said the needs of pa­tients must trump a doc­tor’s own moral or re­li­gious be­liefs. “I leave my re­li­gion at home when I go to work,” he said.

But Dr. Peter Tadros, of Wind­sor, Ont., said it would be “of­fen­sive” to force doc­tors to do some­thing that, in their view, is wrong.

One doc­tor who has per­formed and as­sisted in abor­tions in the past wor­ried that the pol­icy was be­ing pushed through.

The is­sue was stoked last year when doc­tors in two ma­jor cities made na­tional head­lines by deny­ing med­i­cal care based on re­li­gious grounds. A Cal­gary doc­tor work­ing at a walk-in clinic who re­fused to pre­scribe con­tra­cep­tion based on her per­sonal be­liefs posted a sign in the win­dow in­form­ing pa­tients “that the physi­cian on duty to­day will not pre­scribe the birth con­trol pill.” Women look­ing for the pill were in­stead pro­vided with a list of other clin­ics will­ing to pre­scribe it.

Three fam­ily doc­tors in Ot­tawa were also re­fus­ing to pro­vide ar­ti­fi­cial con­tra­cep­tion in any form, in­clud­ing the “morn­ing af­ter pill.”

The On­tario col­lege is warn­ing doc­tors that post­ing a no­tice in an of­fice an­nounc­ing they will not of­fer cer­tain treat­ments isn’t suf­fi­cient to “dis­charge your obli­ga­tions” un­der the re­vised pol­icy.

 JOE RAE­DLE/GETTY IM­AGES FILES

In a 21-3 vote on Fri­day, the Col­lege of Physi­cians and Sur­geons of On­tario agreed moral or re­li­gious con­vic­tions of a doc­tor can­not im­pede a pa­tient’s ac­cess to health care. Mean­while, the Cana­dian Med­i­cal As­so­ci­a­tion wants to pro­tect MDs from ‘manda­tory re­fer­ral.’

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