Dr. Ramona Coelho, front and centre, with her family. The London, Ont.-based doctor is fighting for the conscience rights of doctors as the College of Physicians and Surgeons of Ontario is trying to force doctors to refer for abortions and assisted suicide. Photo courtesy of Dr. Ramona Coelho

Dr. Coelho's ‘crazy’ battle for conscience rights

By 
  • February 19, 2017

It’s not surprising patients fall in love with Dr. Ramona Coelho. Not just because she’s a young, pretty doctor who smiles easily, laughs frequently and focuses her attention completely on whoever is talking to her.

Her patients in London, Ont., know that she’s a doctor who is in it for something more than the status, money or security attached to most medical practices.

“I love my work,” Coelho confesses. “I love being a doctor. I love helping people and being with them — trying to find solutions for them.”

Her practice is heavily slanted to marginalized patients. Her waiting room is full of refugees, ex-cons, the poor. Many of her patients are on permanent disability.

All that is at risk as the College of Physicians and Surgeons of Ontario mounts an ever more prickly defense of its “Professional Obligations and Human Rights Policy.” The policy is currently before the courts. It would force Ontario doctors to refer for abortions and for assisted suicide.

Coelho won’t do either and her patients know it. In 10 years of practice, her ethical limits have never been a problem. She’s never had an argument with a patient and no patient has complained.

In fact, an extraordinary number of her patients say they love her. Her average rating on ratemds.com is 4.5 out of five.

“Dr. Coelho has been our doctor for several years and we love her!” wrote a patient who rated her five-out-of -five in every category except punctuality (four-out-of-five).

“Dr. Coelho makes you feel so comfortable and it’s so nice to have a doctor care about her patients, you do not feel like a number with her,” wrote another.

Coelho convenes meetings of the London Catholic Doctor’s Guild and has spoken up in defence of conscience rights for doctors on a number of occasions. She knows she’s an easy target for anybody who might want to use the CPSO policy to drive Catholic doctors out of the profession.

“Still, on some level, I’m hoping this is just a crazy misunderstanding,” Coelho told The Catholic Register.

When Coelho graduated from McGill’s medical school, doctors at the McGill University Health Network took her on as a resident knowing and respecting her ethical convictions about abortion (euthanasia was not then legal). The professors and doctors worked out a protocol in case Coelho might be asked to refer.

“We had a system so we could accommodate. I didn’t have to do anything against my conscience,” said Coelho. “It was very respectful.”

As a young doctor, Coelho was asked to teach medical students about family medicine and was even encouraged to apply for a faculty position before she and her urologist husband made the move to London.

Somehow that accommodating, respectful and practical spirit began to evaporate after Coelho and her family moved to Ontario. As the College of Physicians and Surgeons began to review its human rights policy, it became clear that accommodating doctors who object to abortion or won’t prescribe chemical birth control was not on the agenda. Even though 90 per cent of people who responded to the college’s draft policy online wanted conscience protections for doctors, in 2015 the college voted 21-3 for a policy which placed a “duty to refer” over the conscience rights of doctors.

“What they’re saying is that if we don’t agree with their ethics we don’t belong in family medicine,” said Coelho. “What they’re trying to do is to create a monoculture of people who all think the same way.”

The Coalition for HealthCARE and Conscience, representing more than 5,000 doctors and over 100 health-care institutions across Canada, is trying to persuade the Ontario legislature to write conscience protections into a bill currently before Queen’s Park that would bring several Ontario laws into line with federal legislation that legalized voluntary euthanasia last year.

Coelho just wants to see a solution, preferably a new human rights policy from the College of Physicians and Surgeons, that respects her constitutional right to freedom of conscience.

“All of a sudden, I don’t have the protections, constitutional protection,” she said. “It just strikes me as crazy.”

Coelho has never stood in the way of her patients accessing services abortion or the pill. There’s no shortage of walk-in clinics. People can self-refer for abortion and contraception. It’s likely the province will soon have a system in place that will allow patients to self-refer for medical aid in dying. Most other provinces are already setting up some form of patient pathfinder system that would allow patients to choose for themselves whether to access palliative care or a medically induced early exit – all without a doctor’s referral.

But it seems the College of Physicians and Surgeons in Ontario simply can’t abide doctors with a different moral compass, said Coelho.

“I’m not sure what this caricature is that they have in their heads of us,” she said. “I don’t know if they think we’re shaming patients or…. I’m not sure what it is.”

The mother of four would rather be meeting with her mom’s group in her spare time than trying to lobby politicians and get meetings with her regulatory college, but she knows she’s fighting for more than her own practice. She fears the next generation of Catholic medical students will be steered out of family medicine and all its joys and challenges.

“If we change the culture, this will allow for discrimination in getting jobs. This will allow a lot of people – there are tons for doctors who are not comfortable with this – to force them to refer,” she said.

She could avoid the problem, but she won’t walk away from family medicine.

“It’s a very special privilege to have built into your work this kind of beautiful ability to serve daily, over and over again,” she said. “As a family doctor, I get to build relationships with these people over years and build a real, genuine affection and respect. I love my job.”

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