Ontario’s physician oversight body came out swinging Wednesday against a legal challenge to its policy requiring conscientious objectors to refer patients to other doctors for medical assistance in death.
Lawyers for the College of Physicians and Surgeons of Ontario (CPSO) told a three-judge panel of the Ontario Superior Court that its policy of “effective referral” to a non-objecting doctor balances practitioners’ religious freedoms with their “duty to provide patient-centred care for all.”
Referrals entail finding a physician who can perform the service, detailing a patient’s medical history and including the original doctor’s OHIP billing number on the file.
The case could have implications beyond assisted dying, as the policy applies to any health service to which a doctor might conscientiously object, such as abortion or birth control.
“Is a referral the equivalent of providing the service? That is a question that we need to defer to college expertise on,” said Lisa Brownstone, a lawyer for CPSO.
The independent regulatory body’s policy states that it “does not consider providing the patient with an effective referral as assisting in providing medical assistance in dying.”
A lawyer for the applicants — the Christian Medical and Dental Society of Canada, the Canadian Federation of Catholic Physicians’ Societies, and the Canadian Physicians for Life, as well as five individual doctors — said referrals still make the objecting physicians “complicit” in the death of a human being.
Brownstone countered that such a view gives “short shrift to patients who are trying to access health care services … that are central to patients’ dignity and autonomy.” It also ignores the college’s “essential duty to serve and protect the public interest,” she told the court.
Brownstone added that shedding that duty “places a disproportionate burden on vulnerable and marginalized groups — teenagers, the homeless, the mentally ill, people with language barriers, people with addiction, people with cultural barriers.”
Her colleague Vicki White said that freedom of conscience and religion, while enshrined in the Charter of Rights, must balance out with other rights and freedoms. “No right, including freedom of religion, is absolute,” she said.
White suggested “effective referrals” were a “trivial or insubstantial breach” of the applicants’ beliefs.
For Dr. Betty-Anne Story, a family doctor from Brantford and one of the five physician applicants, facilitating access to assisted death would be too big a cross to bear.
“It completely goes against my whole being. It would tear me apart, if I had to actually facilitate someone being killed,” Story told QP Briefing in an interview this week.
“I’ve trained as a doctor to try and help my patients to relieve suffering. And, as a Christian, Jesus said that he came to provide life, abundantly,” she said, invoking the Gospel.
“It sort of feels like it’s hanging over me all the time, because at any time any one of my patients could come to me and say: ‘Dr. Story, I think that I’m going to be passing on shortly, I’m with it now and please assist me to die.’”
Ontario’s Office of the Attorney General, one of more than a dozen interveners in the case, prefers the status quo: “[T]hese policies strike a reasonable balance between the sincerely held religious beliefs of objecting physicians and the important state interest in ensuring vulnerable patients are able to access legally available medical procedures.”
Health Minister Eric Hoskins stressed the “right balance between respecting conscience rights of health-care providers and … the rights of patients in Ontario, particularly vulnerable people near end of life.”
He pointed to the newly established co-ordinated care system for patients seeking assisted death, and pledged his faith in the courts as the venue to hash out the debate and an eventual resolution.
Physicians from several coalitions, including Concerned Ontario Doctors, have said they’ve stopped taking on new patients out of fear they will be forced to act against their faith or conscience.
Hearings wrap up Thursday, with a decision expected before the end of the year from justices Herman Wilton-Siegel, Wendy Matheson and Richard Lococo.
To contact the reporter on this story:
creynolds@qpbriefing.com
416-212-5789
Twitter: @ChrisAReynolds
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