DOCTORS CAN’T SAY NO
Ontario MDs face sanctions for refusing care based on beliefs
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.