Paul Tuns:

Following pressure to not change its medical standards that would severely restrict the conscience rights of doctors, the College of Physicians and Surgeons of Alberta (CPSA) backed down from a proposal to require doctors to make an “effective referral.”

Currently, doctors and nurses are not required to participate in or be complicit in abortion, euthanasia, birth control, or so-called gender-affirming care, because the CPSA acknowledges the conscience rights of health care professionals.

The CPSA proposed an update of its official Standards of Practice with new wording that, if adopted, would force doctors opposed to abortion, euthanasia, and other immoral practices to violate their conscience by ensuring that they would refer patients to doctors who would carry out the patients’ wishes.

The CPSA sought to reconsider “how regulated members can decline to provide treatment and what must be provided for the patient to ensure they continue to receive high quality care.” The proposal sought “clarifying language” on “the balance between a regulated members’ right to limit health service based on reasons of conscience, cultural belief, or religion, and patients’ right to timely access to safe, high-quality care” to “clearly break down permitted and prohibited actions.”

The substantial proposed change was to require “an effective referral” which means conscientiously objecting physicians would be required to refer patients to a doctor who would carry out the patient’s wishes.

According to CPSA’s proposed amendments to its standards, doctors must “proactively maintain an effective referral plan for the frequently requested services they are unwilling to provide” and that doctors “must not … expose patients to adverse clinical outcomes due to a delayed effective referral.”

Pete Baklinski, director of communication for Campaign Life Coalition, stated in a blog post that if the standard was amended, “doctors who practice medicine according to the Hippocratic oath of doing ‘no harm’ to those in their care and who, as a consequence, conscientiously object to any practice or procedure that causes the death of their patient,” will be “forced to violate their conscience or face disciplinary actions and even give up their practice.”

Baklinski said requiring doctors “to make an ‘effective referral plan’” is “forcing them to participate in the evil.” It is, he explained, “to hand over the patient to someone else who will be the patient’s hitman or assassin.”

The CPSA’s “effective referral” proposals have also been blasted by pro-life doctor groups.

The Canadian Physicians for Life (CPL) encouraged its members to contact the CPSA Council stating their opposition to inclusion of “effective referral” language in its standards. The Alberta Committee for Conscience Protection also urged its members to “send a clear message” that “the introduction of the term ‘effective referral’ that was added to the draft policy is not acceptable to many physicians and concerned members of the public.”

The CPSA sought input into their changes. The consultation was transparent, with comments available to the public on the CPSA’s website, and much of the feedback was opposed to the proposed changes.

Rebecca Genuis, an Alberta physician, stated: “I do not think that this policy change will serve patients better, and it will not serve physicians better,” explaining, “At a time when patients are increasingly facing inappropriately long wait times and suboptimal care because of the impossibly heavy burdens physicians are expected to bear, this policy feels out of step with the good work of the College.” Dr. Genuis urged the College to “remove the words ‘effective referral’ and maintain the morale of Alberta physicians.”

Another Alberta physician, Shauna Burkholder, stated, “Many physicians are ethically opposed to newer aspects of medicine, such as MAiD (euthanasia), as well as more established controversial medical services, such as abortion.” Dr. Burkholder said by being forced to provide an effective referral she would be “forced to participate, even at arm’s length, to a procedure I am morally opposed to, something I view akin to murder (and) I will be unable to continue practicing medicine in this province.”

Dr. Christin Hilbert opposed the “effective referral” language: the “whole point of conscientious objection is to not be involved in a referral, which means you are agreeing with the procedure, just referring to those with the technical skill to execute it.”

Cathy Perri, a registered nurse, said, “Healthcare professionals should never have to violate their conscience in providing care to their patients.” Perri explained:  “Trust in nurses and doctors is declining (and) many patients, me included, want providers whose values fit with theirs, and a large group of patients want to be served by providers who decline to offer certain procedures like MAiD (Medical Assistance in Dying).”

The consultation was closed on Jan. 15. The CPSA stated, “based on initial feedback received, the term ‘effective referral’ will be removed from the Conscientious Objection standard.”

The Conscientious Objection Standard was last reviewed in 2016 and the CPSA said it would review the topic again in the future.

Canadian Physicians for Life executive director Nicole Scheidl called the reversal “a big win” and noted that if it had passed, it would have led to some physicians closing their practice or moving to another part of the country as many Ontario doctors did after the province mandated “effective referrals” in 2016.

Campaign Life Coalition welcomed the CPSA’s announcement that it dropped its plan to force doctors to violate their conscience by providing “effective referrals.” CLC national president Jeff Gunnarson said, “The CPSA acted wisely when it listened to so many of the province’s doctors and citizens who raised concerns about this policy update.” Gunnarson said the province needs to pass legislation that protects conscience rights, including specifically stating that physicians do not need to provide an “effective referral.”

In November, a majority of party members at the United Conservative Party of Alberta’s annual general meeting voted in favour of a resolution calling a law protecting the conscience rights of health care providers.