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Arguments Against Bill C-537
"Protection of Conscience Rights in the Health Care Profession"

by Joyce Arthur of the Abortion Rights Coalition of Canada (www.arcc-cdac.ca)

May 6, 2008

On April 16, a bill was introduced by Conservative MP Maurice Vellacott (Saskatoon-Wanuskewin), called "Protection of conscience rights in the health care profession." Read the text of the bill and read Vellacott's press release. This is the third time Velacott has introduced this same bill. It does not seem likely at this point that the bill will go anywhere, but if passed, it would violate patients' right to healthcare, as well as conflict with Prime Minister Harper's election promise not to legislate on abortion.

Arguments against the bill are listed below.
 
1. The bill exempts medical personnel from the duty to practice medicine. It makes no mention whatsoever about health care professionals' responsibility toward patients, but instead absolves them of any obligation towards any patient, so long as they have a religious objection. Patients could be harmed as a result of provider refusal, but would have no legal recourse. This bill endangers patient safety just to protect provider conscience, making it a serious violation of medical ethics.

2. The bill exempts physicians from ethical obligations towards patients. The bill appears to violate sections 1, 2, 9, 17, 19, 21 of the Canadian Medical Association Code of Ethics. Since most provincial colleges and other medical organizations have some version of the CMA Code as part of their expectations for members, the bill likely conflicts broadly with many other medical codes and policies. The bill would require all of these to be rewritten to shift the focus from patients' rights, to providers' "right" to refuse care. However, it is the patient's conscience and rights that must be paramount; the physician's job is to serve the patient.

3. There is no need for Bill C-537 because most medical codes of ethics already allow health professionals to opt out, provided they inform and refer patients appropriately. The bill goes much further though, it protects health professionals from providing services "directly or in an advisory capacity," which would likely cover the duty to refer, or give any information whatsoever. There is no requirement for physicians to even tell patients of their religious objection. Under the bill, employers and professional organizations can be criminally prosecuted for punishing physicians who deny patients care that they need, even if the physician gives no reason for denying care, gives no forewarning for such denials, and gives the patient no opportunity or information for accessing the care elsewhere. By not requiring the physician to inform the patient of his/her objection to the care requested, the Bill violates sections 11 & 12 of the Canadian Medical Assocation Code of Ethics: "11. Recognize and disclose conflicts of interest that arise in the course of your professional duties and activities, and resolve them in the best interest of patients. 12. Inform your patient when your personal values would influence the recommendation or practice of any medical procedure that the patient needs or wants."

4. The bill would force medical institutions to hire personnel who refuse to perform services the institution specializes in. For example, it would force abortion clinics to hire anti-choice staff who refuse to do abortions.

5. It would impair the ability of professional medical organizations to regulate health professionals. In some cases, the bill would make it a crime to fire or reprimand a physician for violating various sections of the CMA Code. Or, if a patient complains to the College of Physicians and Surgeons about a treatment that resulted in sub-standard care, the physician can just say it's related to his/her religious beliefs.

6. There is no evidence this law is needed. Dismissals or rejections of providers over conscience refusals appear to be extremely rare, if they occur at all. We know of no such cases. On the other hand, women are frequently refused help when seeking abortion care (see the Canadians for Choice "Reality Check" report.) The evidence instead favours a law guaranteeing access to abortion and contraception for women.
 
7. The bill is discriminatory against women in particular, because the primary effect would be a refusal to provide abortion care or referrals, and contraceptive services and information.

8. It would decrease access to abortion and contraception, and stigmatize both. It's an abortion restriction that can be used as a wedge to re-criminalize abortion. It conflicts directly with Prime Minister Harper's promise not to legislate on abortion.
 
9. It could lead to legal personhood for fetuses, because it confuses the definition of "human being" under the Criminal Code by defining the term "human life" as including fertilized eggs and embryos. This could result in restrictions on the rights of pregnant women, as well as restrictions on abortion.

10. The bill gives special legal protection to religious believers, but not to non-religious people (making it discriminatory). The word "tenet" is defined very narrowly to refer to a specific sectarian religious doctrine about the value of human life. This is not the normal English meaning of the word "tenet", plus the definition implies that only religious people value life.
 
11. The bill is unjust because it favours religious belief over other personal beliefs. There is no reason to privilege religious belief over any other personal reason to refuse services. If we allow a religious objection, perhaps we should also allow health professionals to refuse to treat a person because, for example, they don't like Jews, or gay people, or Christians, or because they disapprove of a patient whose illness or injury is their own fault, or for any other personal reason, even seemingly trivial ones. 
 
12. The bill singles out only health professionals for protection. This begs the question as to why only the consciences of medical personnel deserve protection. Why shouldn't others working for the public trust, such as police, firefighters, and government employees, also be allowed to refuse to serve some members of the public for personal reasons? This aspect of the bill points to the anti-abortion agenda behind it.
 
13. It's a matter for civil law, not criminal law, so cannot be included in the Criminal Code anyway.