Sunday, April 12, 2015

The Christian Medical and Dental Society's Legal Challenge To The Professional Obligations and Human Rights Policy

If you have been following my blog of late, you may recall my posts on the Ontario College of Physicians and Surgeons (CPSO) policy, Professional Obligations and Human RightsToday's post is an update on this policy and specifically focusses on the legal challenge brought forth by the Christian Medical and Dental Society (CMDS).

For those who are not aware of the controversy surrounding this anti-life policy, it infringes upon the rights of physicians and surgeons to freely treat patients according to their conscience, religious and moral beliefs. The fact that the CPSO seeks to impose "effective referrals" (lines 156-161 of the policy) upon physicians and surgeons spotlights one of the problems with this policy; that it attempts to provide solutions to nonexistent problems. Add to this, the policy's violation of the Canadian Charter of Rights and Freedoms and today's post increasingly becomes a matter of grave concern.

The video published with this blog post is the CMDS press conference held on March 24, announcing the legal challenge during which they took the opportunity to explain their many concerns. I encourage anyone who cares about the future of the medical profession and the value and inviolability of human life to watch and share this video.

In early March of this year the CPSO Council approved the Professional Obligations and Human Rights policy. It was a rather hastily approved document considering that it came only two weeks after the closure of the CPSO's external consultation process; one that encouraged public feedback with an on line survey, discussion forum, email and regular mail. The overwhelming majority of the respondents' submissions at the discussion forum urged the CPSO to respect physicians' freedom of religion and freedom of conscience. Sadly, that feedback seems to have been completely ignored. So overwhelming was the disapproval that two members of the CPSO Council recommended the vote on this policy be delayed in an effort to consider and analyze the submissions. It was a recommendation discarded by the council, who fourteen days after the external consultation deadline of February 20, voted and passed the Professional Obligations and Human Rights policy.

The CPSO's approval has disappointed many individuals and groups in Ontario, whose shared concerns with the CMDS, has prompted some to join the legal challenge, forming a group of "applicants," who filed a Notice of Application with the Ontario Superior Court of JusticeIn addition to the CMDS, this group is comprised of: the Canadian Federation of Catholic Physicians' Societies (CFCPS), Dr. Michelle Korvemaker, Dr. Betty-Ann Story, Dr. Isabel Nunes, Dr. Agnes Tanguay, and Dr. Donato Gugliotta.

According to the Notice of Application the applicants are seeking an interim and permanent injunction prohibiting the CPSO's enforcement of the Professional Obligations and Human Rights policy. Noteworthy are several declarations in which the applicants assert that the CPSOis subject to and bound by the Canadian Charter of Rights and Freedoms; that the CPSO can not implement and enforce policies which violate the Canadian Charter of Rights and Freedoms; that the Professional Obligations and Human Rights policy does in fact violate the Canadian Charter of Rights and Freedoms right to freedom of religion, conscience, equal treatment and benefit under the law of the individual applicants and other physicians. There are other items in the application that I will leave to the visitor at my blog the option of further reading at the CMDS's web site. It is abundantly clear that the CPSO has not only contributed to Canada's moral disorder with its effort to entrench a "culture of death" in the medical profession, but has made a legal mistake in the process.

In addition to the policy's violation of Canadian Charter of Rights and Freedoms, which guarantees everyone freedom from state interference or compulsion with regard to their freedom of conscience and religion, this application commenced as a result of the CPSO's refusal to address the concerns of the applicants. Both the CMDS and the CFCPS submitted detailed and thorough submissions to the CPSO on how the Professional Obligations and Human Rights policy would result in the violation of the Charter rights to freedom of religion and conscience for physicians; to no avail. The CPSO has ignored their concerns and continues to do so.

The remainder of this post details much of what was expressed at the press conference including segments from the question period. I have made an effort to provide this as an accommodation to those who may not have thirty minutes so readily available for the video. The information below is noteworthy and I hope it will prompt you to eventually watch the video for further details.

Statements by CMDS Executive Director Larry Worthen and Drs. Diane Haak and Michelle Korvemaker

The CMDS press conference was led by Larry Worthen, Executive Director of the Christian Medical and Dental Society. Joining him were three other panel members: Dr. Diane Haak, President of CMDS Canada; Dr. Michelle Korvemaker, a family physician from Woodstock, Ontario and board member of the CMDS; and the applicants' legal representative, Albertos Polizogopoulosa partner with the law firm Vincent Dagenais Gibson LLP/s.r.l. in Ottawa.

Larry Worthen

Worthen began the conference by stating that although the CMDS supports much of what is included in the Professional Obligations and Human Rights policy, there are certain aspects that are cause for grave concern. He made it very clear that none of the CMDS members seek to any way discriminate against patients; that they have dedicated their lives to the well being of patients. However, many physicians have conscious objections to participating in certain procedures or prescribing certain pharmaceuticals.

Worthen expanded upon the basis for these objections by stating that, "these objections are well reasoned and considered, firmly held and based on objective standards, like the Christian scriptures, Catechism of The Catholic Church and the traditional Hippocratic Oath. These standards are held by many people over time." Elaborating further, he stated that conscience objections come from a variety of sources including: the Christian, Jewish, Islamic faiths and even followers of secular creeds such as Humanism; all of whom may have objections to performing or participating in certain procedures.

Traditionally, conscience concern has always been respected in medicine. The CPSO's new policy changes that completely. In essence this policy forces doctors to refer patients to other doctors against their conscience. In addition, the policy requires that physicians actually provide certain procedures in an emergency to prevent imminent harm. There is much concern about the broad interpretation of the word "emergency," that it might completely erode conscience protection. 

As to the referral aspect of the policy, Worthen addressed why some have asked, "why is referral a problem?" His response to this was as follows, "The doctor who has conscientious objections considers the referral to mean they are facilitating a procedure that is contrary to their conscience. They perceive themselves to be aiding and abetting or an accomplice to an action that they know is morally wrong." He goes on to spotlight the paradoxical nature of the policy with respect to Canada's restriction on extraditing offenders to countries where capital punishment exists. So strong is Canada's objection to the death penalty, yet the CPSO's policy sets forth guidelines that potentially achieve the same immoral end; the death of a human being, be it while developing in the womb or in response to old age or ill health.

Particularly noteworthy was the part where Worthen explained how the changes in the policy are solutions to nonexistent problems. For example, the "need" to address conscientious objections. It is a need that simply does not exist because when it comes to certain procedures and pharmaceuticals, most doctors already inform their patients of their conscientious objections when they enter the practice.

Further clarifying the referral aspect of the policy, Worthen explained that in Ontario there is no requirement for doctors to refer patients for procedures such as an abortion, simply because patients can self refer. Elaborating on this, he provided an example that when a patient is confronted with an unwanted pregnancy, most doctors will discuss options and inform patients not only of their conscientious objections, but of the availability of self referral. Even after the occurrence of an abortion, the patient physician relationship is not ruptured at all; patients typically return to their physician for continued care. In keeping with the applicants' desire to serve their patients, Worthen explained that even though doctors have conscientious objections to certain procedures such as abortion, they in no way condemn patients for obtaining them; they are still willing and continue to be caring physicians for each individual patient. 

Doctor Diane Haak

Doctor Haak began her segment of the press conference by introducing herself as a family physician and president of CMDS Canada, representing approximately seventeen hundred kind and caring physicians who provide exemplary care to their patients. She then began to identify and elaborate on several significant concerns.

The first concern was with respect to the harm that this policy will cause most importantly to patients, but also doctors who serve them. Specifically, she mentioned how some doctors may feel compelled to leave their practice due to the policy's infringement upon freedom of conscience and the forced referral inclusion. 

Second, there is the physical, psychological and spiritual health of doctors to consider. Here is what Dr. Haak stated about this point, "Being forced to practice medicine in a way that conflicts with one's conscience creates an inner tension that is morally wounding, and can lead to physician burn out." 

Third, Doctor Haak also made it known that the Professional Obligations and Human Rights policy is contrary to Canadian Charter of Rights and Freedoms, which guarantees everyone to be free from state interference or compulsion with regard to their freedom of conscience and religion.

Fourth, she spotlighted the CPSO's continued rejection of public feedback; rejection that dated back to the college's external consultation on the previous policy, Physicians and The Ontario Human Rights Code. She clearly stated how the college ignored the results of that external consultation; results in which the overwhelmingly majority of respondents disapproved of the policy. Here is what she had to say about this:
The CPSO conducted a survey prior to adopting this policy asking the public whether a physician should be allowed to refuse to provide a patient with a treatment or procedure because it conflicts with the physicians religious or moral beliefs. More than thirty two thousand people responded with seventy seven percent in favour of physicians being allowed to continue to practice in accordance with their consciences. The CPSO also received sixteen thousand submissions, the overwhelming majority argued for physicians conscience rights. It puzzles me and concerns me then that the college could have passed a policy with clauses that take away this freedom.

Doctor Michelle Korvemaker

Doctor Korvemaker is a family physician from Woodstock, Ontario who works in the emergency department and in palliative care. She also works in Wingham, Ontario in the emergency department and fills in for doctors who are on leave. She stated that in the ten years of her practice, she always had the freedom practice medicine according to her conscience. 

Particular noteworthy was her mention and reference to the Canadian Medical Association's Code of Medical Ethicswhich requires doctors to inform patients when they don't perform certain procedures or prescribe medication for ethical or moral reasons. The fact that such a code of ethics exists further spotlights the CPSO's effort to provide solutions to nonexistent problems. Citing the example of an abortion, Dr. Korvemaker reiterated what Larry Worthen stated, that when CMDS doctors are confronted by patients with an unwanted pregnancy, doctors typically discuss the options and make it clear that they can not refer for abortion, but patients do have the option of self referral.

The CPSO's policy would force doctors to engage in and facilitate an abortion, which as Dr. Korvemaker stated would be against her conscience and religious beliefs. She raised particular concerns over the recent Supreme Court of Canada Carter vs. Canada euthanasia decision, in light of the CPSO's policy. As a palliative care physician, she could be faced with "physician assisted death," which the newly approved policy would require her to be involved in and facilitate such a procedure. She stated quite clearly that under such circumstances, her conscience and religious beliefs would preclude her from engaging in procedures to which she has a moral, ethical and religious objection. 

Doctor Korvemaker reinforced the point that she and all doctors in Ontario have the right to practice medicine according to their consciences free from state compulsion. Based on this right, the CMDS has launched this challenge.

Question Period 

As a courtesy to all who attended the press conference, the CMDS had provided copies of the legal application and invited Albertos Polizogopoulos to address any legal questions. Below are details of several of the questions that were presented to the panel.

Government Funded Care And Accessibility In Small Towns 

I was particularly concerned with two questions. The first was rather general, but it was followed up by a more specific question that immediately spotlighted the moral disorder in Canada. Here is the first part of the question, "Some people might say that because doctors are funded by the government, by the state, they should therefore provide services that are available or that are offered by the government or the state." Larry Worthen responded by saying that the state should be impartial and not impose its values on individuals.

The follow up question specifically addressed the concern regarding the so called "need" for women to access abortion in small towns in Canada, where such "care" may not be so readily available due to physicians' conscientious objections to provide or procure such a procedure. Worthen stated that with such a scenario, patients are able to self refer in seeking an abortion. Albertos then interjected to point out that the concern for the potential lack of availability for an abortion is a false one because such a scenario does not currently exist; nor has it ever been a problem.

It was a disturbing question to listen to in that it was stated in such a nonchalant manner. The fact that such a question could be asked in public without absolutely no regard for the life of a developing human being in the womb, is a telling sign of deep moral crisis in Canada.

The CPSO's Sudden Change In Policy

When asked about the CPSO's sudden change in policy, Worthen provided a brief background to the CPSO's policy development. It was interesting to discover that the Human Rights Commission approached the CPSO and informed them that from their perspective, the human rights code applied to physician behaviour. The CPSO was "told" that their policy needs to be adjusted accordingly.

The CMDS did not express any concern with respect to the human rights code because its members have not and do not want to discriminate against patients; it has never been a problem with any of its members. The CPSO policy goes beyond the issue of discrimination and attacks the freedom of conscience. This is completely unacceptable because such freedoms are protected in the Charter of Rights and Freedoms.

In 2008, there was some thought given by the CPSO to remove conscience rights with respect to referral and decided to defer that. It was in 2014 during the CPSO's regular policy review cycle that they decided to challenge the freedom of conscience with reference to referrals.

The Definition Of Emergency

The CMDS was asked to elaborate on their concerns regarding an "emergency" specifically within the context of a life threatening situation. The inclusion of an emergency clause or "urgent care" is located in the Protecting Patient Safety section at the last page of the policy (lines 166-169). Worthen explained that it is a concern in that an "emergency" is difficult to define. In life threatening situations, CMDS members would certainly assist patients, but the concern is with respect to the lack of specificity as to what exactly constitutes an emergency; whose definition would it reflect. 

Euthanasia is a prime example of how the issue of emergency becomes a very realistic concern. Given the recent Carter vs. Canada euthanasia decision, some members of the CMDS who are in palliative care might be placed into scenarios where requests for euthanasia are made under so called "emergency" situations. Worthen provided the example of a patient that has already requested euthanasia yet to be performed, who at some point becomes agitated and requests it immediately. Would such an agitated state be considered an "emergency?"

The concern by CMDS members is so great that some are seriously considering leaving palliative care. Worthen clearly spotlighted how unnecessary it was for the CPSO to have included such a clause that attempts to provide a solution to a nonexistent problem.

The Problem With Referrals

A question was asked regarding the issue of referral and why would it be a problem. The scenario presented was one in which an individual with back pain was referred to another physician. In so doing, the original physician would not be implicated in what ever treatment was given at the referral; therefore, why would there be any issue regarding referral?

Worthen stated very clearly, that the foundation of such a statement is completely flawed simply because there is no conflict between doctors and patients. He went on to further point out that there is absolutely no reason why freedom of conscience and access to "care" can not both exist. In agreement with such a statement is the Canadian Medical Association, the Ontario Medical Association, and the American Medical Association.

In addition, he pointed out that there is no jurisdiction in the world that requires physicians to refer for "care" such as euthanasia. So it begs the questions, why does the CPSO claim that "effective referral" is essential and somehow patients' access to services will be affected. From the CMDS's perspective, this is a complete dichotomy. 

He went on further to state that in a tolerant country like Canada, the way to go about resolving issues is through dialogue. The failure to do so regarding this policy is not from a lack of effort on the part of the CMDSIt is a point that Worthen spotlighted with the fact that the CMDS made repeated attempts to enter into discussions with the CPSO, all of which were met with rejection. He concluded this point by stating that the CPSO is trampling on the conscience rights of physicians, who are trying to do their best in providing health care for patients.

Healing Patients

Segueing from his last point, Worthen made it very clear that the CMDS members became doctors to help people. Here is what he stated: 
Our members got into medicine because they were convinced they could help people; that they could help heal them, that they could serve them and meet their needs. They did not get into the practice of medicine participating in procedures that they know are going to harm human life. That is not healing, that's not healing to refer somebody for euthanasia. It is not healing to refer someone for abortion. That is actually hurting people. 
Worthen went on to elaborate that for the government to ask its members to participate in the providing or procuring of anti-life procedures, would constitute a facilitation of these procedures. This would be an inappropriate imposition by the government and the CPSO. Conscience is an attribute of a Christian physician. 

It was shortly after this point that the press conference was concluded. 

What You Can Do To Help

There are many ways you can help this legal challenge. I hope every reader of this post will seriously consider doing so because the matter is grave and we need to support, encourage and stand in solidarity with our doctors. These men and women of Ontario have placed their education, training and experience at the service of life and now, with the CPSO's policy, they are being asked to do a total reversal should it be thrust upon them by their patients' requests. This is totally unacceptable.

As was noted in my initial post, Professional Obligations and Human Rights - An Anti-Life Policy From Ontario's College Of Physicians And Surgeons, the fundamental problem with the CPSO's anti-life policy is that if fails to recognize the sacredness of human life, as well as the basic human right for doctors to refuse to take part in committing an injustice. I hope this fact alone will encourage everyone to take action and help in any way that you can. Below are my recommendations:
  1. First and foremost, recognize the threat for what it is, a spiritual attack on God's plan for humanity. Abortion, euthanasia, contraception and every other threat to the value and inviolability of human life comes from the Evil One. Fight the good fight on a spiritual level; that is let prayer and fasting be at the root of all your efforts. Include in your intentions those who you intend to communicate to and come into contact with regarding this controversy. You may also be interested in reading the CMDS's prayer document.
  2. Second, you may want to consider a donation to help with the legal costs. Should you decide to do this, you can do so at the CMDS web site.
  3. Third, get informed. Bookmark the CMDS web site; add their blog to your reading list.  
  4. Fourth, spread the word on your social media networks. Let others know of this very important controversy in the medical profession. Share this blog post with others.
  5. Fifth, email everyone on your contacts list with a well written and thorough email that will be sure to inspire others into action.
  6. Sixth, contact the CMDS and express your support for the legal challenge.

The controversy surrounding the CPSO's Professional Obligations and Human Rights is an extremely serious one. It spotlights how the "culture of death," ushered into Canada in a very identifiable way with abortion in 1969, by the passing of the infamous Omnibus Bill, has negatively impacted the formation of conscience for many people in the medical profession.

I hope this blog post has instilled in you a sense of urgency with which all concerned citizens of Ontario need to become informed and active on this controversy and help restore Ontario and Canada to a "culture of life." 

May Saint Gianna Beretta Molla intercede for the success of this legal challenge.

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