Oncologist Dr. Ellen Warner told an all-party committee that physicians at Toronto’s Sunnybrook Hospital are “being bullied” and are experiencing a “horrendous stress level.” She described colleagues who object to assisted suicide speaking in code and using alternative email addresses to discuss doctor-assisted death.
“Physicians are afraid that they will lose their jobs if they say anything,” Warner said. “We feel sometimes like we’re in some sort of dystopian novel.”
NDP health critic France Gélinas said she was “horrified” by Warner’s testimony.
A majority of witnesses appearing before the March 23 hearings of the Finance and Economic Affairs Committee want conscience protection for physicians and other health care workers written into the new law. Bill 84 will bring a host of provincial laws governing coroners, the insurance industry, privacy and freedom of information, workers compensation, etc. into line with federal legislation that legalized assisted suicide last June.
Ontario is the only jurisdiction in the world that forces doctors to provide an effective referral for assisted suicide.
Hamilton Dr. Jane Dobson held back tears as she described the pressure she’s faced since the College of Physicians and Surgeons of Ontario ruled that doctors who have a moral, ethical or religious objection to assisted dying must nevertheless provide an “effective referral” for the procedure.
“If I don’t comply, I face fines and the possible suspension of my licence,” Dobson said.
Dobson described how her own brother became suicidal when, at the age of 50, he discovered his tonsillar cancer had spread to his brain.
“He was admitted to the psychiatric ward for therapy. His mood rebounded and he spent the next months of his life receiving care, first at home and then in hospice, where he was able to reconnect and reconcile with old friends and family members and he spent meaningful time with his two young sons and his wife,” Dobson said. “He was truly grateful for the extra time.”
University of Toronto professor and St. Michael’s Hospital endocrinologist Dr. Maria Wolfs said medical schools are facing pressure to weed out students who might object to assisted suicide.
“If conscience protection is not included in Bill-84, future physician training in Ontario may be at risk,” Wolfs said.
The University of Toronto School of Medicine encourages doctors in training to act on their consciences and to form an ethical foundation for their future practice, but the College of Physicians and Surgeons of Ontario’s duty-to-refer policy is undermining student training, said Wolfs.
“Those who are objecting conscientiously are worried that they might not be able to practise in areas that are either remote, because of the need for effective referral, or in areas such as palliative care, critical care and oncology. I’ve definitely heard that (from students),” she said.
Representing the B’Nai Brith Canada, psychiatrist Dr. Janice Halpern said the College of Physicians and Surgeons policy is at odds with the subtleties of a psychiatric doctor-patient relationship. How long can a psychiatrist work with a patient “on finding their will to live again” before referring that patient for assisted suicide, she asked.
“My regulatory body says this must be done in a ‘timely manner,’” Halpern said.
“Participating in killing, putting my need to keep my job first — none of you would want that on your conscience,” Halpern said. “We need protection from our own regulatory body, which is demanding something that no other province and no other country requires of their physicians — mandatory referral.”
The co-founder of MAID-GTA, Dr. Chantal Perrot, defended the duty-to-refer policy.
“There is already a lack of effective referral for MAID in Ontario,” Perrot said. “The CPSO policy on effective referral balances the rights of true conscientious objectors with the rights of patients to access a legal medical service. The focus should be on enforcing the policy, not eliminating or eroding it.”
Perrot dismissed the idea of creating a third-party care co-ordination system to replace the to duty-to-refer policy.
The president of the Assembly of Catholic Bishops of Ontario, London Bishop Ronald Fabbro, emphasized that seeking conscience rights for doctors is not about trying to re-fight the Supreme Court case that made assisted suicide legal.
“The law needs to strike a balance between legal rights here and fundamental rights that the Charter of Rights and Freedoms of our country say we stand up for — says it’s absolutely essential for us in a free democracy,” he said. “It is alarming to hear good doctors say that they would have to leave the practice of medicine in Ontario if they were forced to act against their conscience.”
Toronto Archbishop Cardinal Thomas Collins said health care institutions should be free to make moral choices about whether or not to offer euthanasia and assisted suicide.
“Institutions have consciences too. It’s called their mission,” Collins told Progressive Conservative health critic Jeff Yurek.
Liberal parliamentary secretary to the Minister of Health John Fraser repeated the government’s intention to create a care co-ordination service, however at present that proposal would still require a doctor’s referral. Fraser claimed any protection of conscience rights inside the “technical” bill was not appropriate.
Yurek said he will introduce an amendment to protect conscience rights for medical professionals.