The main policy contributions that our research group made was to publish a model policy on conscientious refusals and to consult with Ontario College of Physicians and Surgeon (CPSO) about their policies on conscientious refusals.

Our model policy was published as the paper, “Moving Forward With a Clear Conscience: A Model Conscientious Objection Policy for Canadian Colleges of Physicians and Surgeons” (Health Law Review, 2013).  The policy itself resulted from discussions we had at the Model Policy Workshop we organized at McGill University in April 2013 (see Events). Participants at this event included academics working in bioethics, law, and philosophy, as well as representatives from the College of Physicians and Surgeons of Ontario, the College of Physicians and Surgeons of Nova Scotia, le Collège des Médecins du Québec, and the College of Physicians and Surgeons of Saskatchewan.

We also responded twice to calls for consultation by the CPSO about its policies concerning conscientious refusals. Our first response centred on Policy 5-08, “Physicians and the Ontario Human Rights Code,” and Policy 4-07, “Physician Behaviour in the Professional Environment.” And our second response was to a revised version of policy 5-08, which is now Policy 2-15, “Professional Obligations and Human Rights.” Our submissions to the CPSO drew on the discussions we had at the Model Policy Workshop and on our paper in the Health Law Review.

We made many policy recommendations to the CPSO, but focused on two main areas. The first area concerned what conscientious objectors are obligated to do in the wake of their objection, in particular whether they are obligated to provide referrals to other health care providers who are willing and able to perform the relevant service. Policy 5-08 did not impose a referral requirement, but we argued that the new policy should do so. The second area had to do with discrimination and conscientious refusals. We recommended that the new policy consider potential grounds of discrimination beyond those listed in the Ontario Human Rights Code. An example is discrimination based on a patient’s engagement in activities that are perceived to contribute to ill health (e.g., smoking, and drug or alcohol abuse).

The most notable change to the CPSO’s policy concerning conscientious refusals is the introduction (again, in what is now Policy 2-15) of the requirement that conscientious objectors provide patients with “an effective referral to another health-care provider,” if they are unwilling to provide certain services, such as abortions, for reasons of conscience. An effective referral is defined as a “referral made in good faith, to a non-objecting, available, and accessible physician, other health-care professional, or agency.” The new policy also reflects some our recommendations regarding discrimination. For example, it requires that “[i]n the course of communicating their objection, physicians must not express personal moral judgments about the beliefs, lifestyle, identity or characteristics of existing patients, or those seeking to become patients. This includes not refusing or delaying treatment because the physician believes the patient’s own actions have contributed to their condition.”