New Freedom of Conscience Campaign in Ontario
Do You Want a Doctor with a Clear Conscience?
Consider the testimony of one Ontario doctor, who spoke to an Ontario legislative committee studying the issue of euthanasia. “I ignored my conscience, opting instead to follow the college policy and convincing myself that I had no choice … this was destructive to my very core. I felt like a shell of myself. Months later, I often still do. I came very close to leaving palliative care at the time, and every day I continue to question my ability to stay in this field.”
This is one example of a doctor who has been directly impacted by Ontario’s policies for medical professionals who are asked to provide euthanasia. Others have brought up concerns that they may have to leave the province, retire early, or change specialties to avoid violating their conscience. Students in medical school also have concerns about what their medical career will look like due to the lack of protections for freedom of conscience.
As eligibility for euthanasia has expanded in recent years, an increasing number of doctors are concerned about how to care for patients who request it.
What’s the Big Deal?
Every doctor in Ontario is regulated by the College of Physicians and Surgeons of Ontario (CPSO). If there is any malpractice, the CPSO will deal with it. The CPSO also develops policies for how to address situations where a patient requests euthanasia.
In most cases, doctors are permitted to use their professional expertise and refuse ‘services’ that a patient requests if they believe it is not in the patient’s best interest. For example, a patient might request severe body modifications like a tongue splitting. Doctors may have different opinions on whether they should approve such a request, and they are permitted to refuse. However, if the ‘service’ requested is a more controversial and politicized one such as euthanasia, the doctor is not permitted to simply refuse. Instead, he must provide an effective referral. This means that he must connect the patient with a doctor who is willing to provide that procedure. While the patient’s doctor is not required to personally provide euthanasia, he is required to participate by helping the patient get what they want.
You have often heard ARPA Canada talking about freedom of conscience for medical professionals. This is also the focus of a policy report we published in 2021. While Ontario’s policy is among the worst in Canada, Manitoba is the only province that has explicitly protected freedom of conscience around euthanasia provision. This remains a controversial subject, which many in Canada’s legislatures are not ready to do anything about.
Why is this an issue?
With the recent expansions to euthanasia, activists are concerned about so-called ‘access to care.’ If a doctor in a remote, rural area of Canada is unwilling to provide euthanasia, the patient might not be able to access it easily or quickly through another doctor. Others are concerned that a doctor is passing moral judgment on a patient for requesting euthanasia, and this is deemed offensive. Ultimately, they say, a doctor must accommodate to provide the best possible experience for patients who need proper ‘care.’ They argue that we need to strike an appropriate balance between freedom of conscience and access to care, and many think that a policy requiring effective referrals, like the one in Ontario, does this adequately.
Federal and provincial governments seem to be worried about the backlash that may come from activists as a result of protecting conscience for doctors. And they don’t seem to have an effective defense. The contrast is too often set up as a choice between something that is good for doctors or something that is good for patients, and it becomes a battle between two sides. Instead, we need to realize that protecting freedom of conscience will be good for doctors and patients.
Why the Hesitancy?
With the recent expansions to euthanasia, activists are concerned about so-called ‘access to care.’ If a doctor in a remote, rural area of Canada is unwilling to provide euthanasia, the patient might not be able to access it as easily or as quickly. Others are concerned that a doctor is passing moral judgment on a patient for requesting euthanasia, and this is deemed offensive. Ultimately, they say, a doctor must accommodate to provide the best possible experience for patients who need proper ‘care.’ They argue that we need to strike an appropriate balance between freedom of conscience and access to care, and many think that a policy like the one in Ontario does this adequately. Federal and provincial governments seem to be worried about the backlash that may come as a result of protecting conscience. And they don’t seem to have an effective defense.
The contrast is too often set up as something that is good for doctors or good for patients, and it becomes a battle between two sides. Instead, we need to realize that the protection of freedom of conscience will be good for doctors and patients.
Good for Doctors and Patients
Let’s look at a brief story to illustrate this idea. Dr. Ignaz Semmelweis was a young doctor at a famous teaching hospital in Vienna in the 1840s. At the time, the hospital was experiencing high mortality rates in the maternity ward. When Dr. Semmelweis was placed in charge of one of the obstetrical wards, he realized that the women who died were usually the ones who had been examined by physicians and students who had recently come from autopsying the women who had died the day before. Dr. Semmelweis made a rule that anyone who had participated in autopsies must wash their hands before examining living patients. The mortality rate dropped significantly.
Later, Dr. Semmelweis made a rule that everyone must wash their hands after examining each patient, as he saw how disease seemed to spread from one patient to another. Although the mortality rate decreased further, his colleagues protested and ultimately his contract was not renewed.
Dr. Semmelweis obtained a new job in a hospital in Budapest and instituted the same policy surrounding washing hands. Mortality rates decreased, but he was again scorned by many of his colleagues. Despite the proof of decreased mortality rates, the medical establishment was unwilling to accept the importance of handwashing in medicine for many years.
When doctors are permitted to question medical practices (especially in controversial areas), healthcare improves. A doctor who has been trained to quiet his conscience and simply follow the crowd will not do what is best for his patient. The above example is obviously different from the issue of euthanasia, but presents a similar dilemma. Should a doctor disagree with established medical practice if he is convinced that the practice is harming patients? Or should he simply go with the flow and avoid controversy? When a doctor today is asked to provide euthanasia, he faces pressure to silence his conscience and kill his patient.
Another side of this are the healthcare shortages throughout Canada. The news lately has been full of stories of how we need to improve healthcare. In Ontario, for example, the government is seeking to decrease wait times for surgeries, and trying to attract more medical professionals to the province. What they don’t realize is that the current policy around conscience is pushing doctors out of the profession.
Patients suffer when doctors are afraid of speaking out about their concerns. Doctors suffer when they are forced to violate their conscience. We must advocate for a medical system that encourages dialogue between doctors and patients and allows doctors to practice in a way that is consistent with their beliefs.
Our challenge to you: meet with your MPP on this important issue.
We’d be happy to help. Click here to participate in this conscience campaign; share your email address, your riding/MPP and we’ll respond with some resources (including our new Conscience One-Pager) to help make sure you have what you need to make sure your meeting is as good as it can be.
 Legislative Assembly of Ontario, Standing Committee on Finance and Economic Affairs, “Medical Assistance in Dying Statute Law Amendment Act 2017” in Official Report of Debates (Hansard) 41st Parl., 2nd Sess., No F-17 (30 March 2017) at F-570, JBA. The Committee witness was Dr. Natalia Novosedlik.