4.22.2008

c-537: another threat to choice and equality

Hard on the heels of C-484, the fetal homicide bill, another stealth anti-choice private member's bill is before the House of Commons.

This one is C-537, "an Act to amend the Criminal Code (protection of conscience rights in the health care profession)", brought by Maurice Vellacott, Member of Parliament for Sasaktoon-Wanuskewin. It's the third time this MP has introduced this same bill, which he frames as "freedom of choice for all health care workers". When Vellacott introduced the bill in Parliament, he said:
...the bill would prohibit coercion in medical procedures that offend a person's religion or belief that human life is inviolable. The bill seeks to ensure that health care providers will never be forced to participate against their will in procedures such as abortions or acts of euthanasia. ...

Canada has a long history of recognizing the rights of freedom of religion and of conscience in our country. Yet health care workers and those seeking to be educated for the health care system have often been denied those rights in medical facilities and educational institutions. Some have even been wrongfully dismissed.

This bill is anti-woman, anti-equality, anti-personal liberty, anti-choice and anti-common sense.

Health care providers cannot be allowed to pick and choose what legal procedures they want to perform or assist with. If a person cannot in good conscience have anything to do with abortion, or any other legal medical procedure, that person shouldn't be working in health care.

In the theocracy to the south, where models for all manner of anti-choice, anti-woman legislation can be found, reports of pharmacists refusing to fill prescriptions for contraception have been surfacing for many years. Some states have tried to pass laws upholding a pharmacist's right to do so, while other states have mandated that all licensed pharmacists must fill all legal prescriptions.

(I should note that I'm using pharmacists as an analogy, and not abortion providers, since as of 2000, 86% of US counties had no abortion provider. 97% of American women in non-metropolitan areas live in counties with no abortion provider. An opt-out law would hardly make a difference there.)

I blogged about the pharmacy issue a long time ago, and when I went back to look for the post, I saw this in comments:
When I first read about the move to allow pharmacists to not carry certain items according to their conscience, I thought, "Gee. That's a good idea. No one should be forced to do something they don't think is right."

But then I thought about it some more. Where does it end? Can an emergency room doc withhold treatment from a gang member because he disapproves of gang activity? Can he refuse to treat an injury caused by the patient's own stupidity? What if he wants to withhold surgery from someone because they are gay, or a different religion, or a different color? Just because they think it's wrong.

Back to the pharmacist. What if he wants to withhold AZT from someone with HIV because he assumes that AIDS is a gay disease and thinks it's wrong? What if he doesn't want to fill a prescription for pain killers because he would choose to tough it out and you should too?

Initially, I was even able to answer these questions with, "So what? You can always go to another pharmacist for your drugs." But if everyone in a conservative town is withholding the same prescriptions, it essentially becomes impossible to get.

I really appreciated this line from your post:
But if you can't do your job properly because your conscience is bothering you, you need to find another profession.

When you sign up to be a pharmacist, you know what you're getting into. It's not like you accidentally got the job; it takes a lot of time and effort. So to all the pharmacists out there, know what you're getting yourself into, then live up to your responsibility and quit complaining about it. Otherwise, find something else that's more compatible with your lifestyle.

That's it in a nutshell. (Thank you, former reader from Arkansas.) A health care provider's first responsibility is to the patient. Providers who cannot meet their obligations to their patients because of religious or conscience issues shouldn't be doing that job. Prospective employers must be free to screen for such potential issues and not hire people who might put a patient at risk because of a conflict of conscience.

For a more exhaustive list of what's wrong with C-537, and about the Conservatives' attacks on women in general, see this excellent post by The Regina Mom.

24 comments:

This Nurse said...

Perhaps you should lobby organisations like the College of Nurses of Ontario and College of Physicians and Surgeons to change their policies. Both allow their members to refuse to perform procedures they object to via scope of practice statements. Even in NY State as nurse I was free in my practice to refuse to perform acts that I deemed objectionable and the state board of nursing protected that right.

I think this is one issue where we'll have to agree to disagree. I don't believe as a nurse, I should be asked to do anything that violates my personal, ethical or religious beliefs as I've defined them. This could be widely interpreted to include a good deal of other issues besides abortion and abortion-related practices.

Just my two cents.

Jen said...

I have to agree with this nurse. Health care professions are self-regulating and autonomous. It was a long hard fight to be able to say "no" and advocate for the patient against unsafe &/or unethical practice (e.g.: giving meds, especially sedation, against the patient's will or unbeknownst to them; withholding information from patients at family's request, etc). The flip side of that coin is that practitioners are able to say no in a manner that this nurse articulates well.

The "by law you must do this" approach to practice was a huge motivator (among many other things) in the eugenics movement as another example of the end result of a very slippery slope.

lgirl said: "If a person cannot in good conscience have anything to do with abortion, or any other legal medical procedure, that person shouldn't be working in health care"

I'd amend that to "If a person cannot in good conscience have anything to do with abortion, or any other legal medical procedure, that person shouldn't be working in : Labour and delivery/ER/post partum".

Likewise, those opposed to/don't understand electro-convulsive therapy should steer clear of the psych units, those opposed to/don't understand harm reduction should steer clear of public health, etc. Health practice, individuals and patient needs are all to many and too varied for there to be an expectation of everyone to be on the same page.

Jen said...

Re: the law you're talking about and not the one lone paragraph about health care professionals (HCPs)having to do all things legally allowed:

I think this law has no teeth, but it is important to lobby against it all the same. The fact that this is the 3rd attempt gives me hope that it is regarded poorly and won't pass. Health care workers do have the freedom of choice to refuse as set out by their professional standards. The link doesn't set out specifically what "coercion in medical procedures" or specifics of the cases where people have been dismissed as a result of religious belief (I'll snoop around to find out what the heck he's referring to there...). What this proposed law may do is give HCPs the right to refuse [whatever action] and leave it at that rather than ensure continuity of care following their refusal That, in and of itself, is unethical (professional misconduct--abandonment).

HCPs do have a responsibility and an obligation to continue to provide care so that if you personally can't perform a procedure for a person due to some personal ethical dilemma you have to ensure that someone will

[which can be sticky in some of the examples that I gave (I'm looking for a recent blog post on just this), or if you are in a rural area with only one provider who is opposed to abortion as another example]

Currently section 1 (5) of the Nursing Act (1991, Ontario) states: Discontinuing professional services that are needed unless:
[...] ii alternative or replacement services are arranged, or
iii the client is given reasonable
opportunity to arrange alternative or replacement services
[...]constitutes professional misconduct (abandonment).
It would be grounds for review by the College and possible loss of registration given the circumstances.

From the CNO Standard of Practice "Refusing Assignments and Discontinuing Nursing Services":
In choosing the appropriate course of action,nurses are expected to do the following.
■ Carefully identify situations in which a conflict with her/his own values interferes with the care of clients (College of Nurses of Ontario, 2004b, p. 10)before accepting an assignment or
employment.
■ Identify concerns that affect her/his ability to provide safe, effective care.
■ Communicate effectively to resolve workplace issues.
■ Become familiar with the collective agreement or employment contract relevant to her/his
settings and take this into account when making decisions.
■ Learn about other legislation relevant to her/ his practice setting.
■ Give enough notice to employers so that client safety is not compromised.

L-girl said...

Thanks for the feedback, my two nurse friends. I see it's a more nuanced issue than I realized, which is not surprising. The pharmacy analogy really may not apply.

Jen's revision "...that person shouldn't be working in : Labour and delivery/ER/post partum" makes a lot more sense.

Both allow their members to refuse to perform procedures they object to via scope of practice statements.

I never realized that. Very interesting. And it certainly makes sense from a labour standpoint. (Labour as in workers, not as in obstetrics!)

Thanks again for your input. I'm going to rethink and see where I land.

And btw, This Nurse, I didn't know you were still reading. It's nice to see you here. Maybe we'll see you in person at wmtc3.

This Nurse said...

Hehe. Juggle work, school and cancer again, my hands have been a bit full but I do have you in my list of RSS feeds. :)

Scott M. said...

I believe the Ontario College of Physicians and Surgeons says that any professional can refuse to provide any service (except life-sustaining), but *must* be willing to refer patients to the appropriate resource and do as much as they can to help the person get the treatment they require.

I would not have it any other way. Doctors should not be forced to do anything they are uncomfortable doing in any way -- the consequences of a screw-up, for whatever reason, is too great. The pressure of doing the job correctly is enough without the added anxiety of working against your consience or outside your field of comfort.

The law, essentially, is useless as no college (in Canada) would not have that rule. CBC Radio's White Coat/Black Art did a great show on the ethics of religion in doctoring which covered many of these topics.

L-girl said...

Juggle work, school and cancer again, my hands have been a bit full but I do have you in my list of RSS feeds. :)

Cancer again, I didn't know that. Damn.

I have you on my iGoogle page, but perhaps you are blogging elsewhere, as there have been no updates in ages. Best of luck with all of it.

L-girl said...

The law, essentially, is useless as no college (in Canada) would not have that rule.

This is confusing. Explain?

Jen said...

I've been thinking about this all afternoon... good study stuff for me as all of this is applicable for my registration exam, thanks L-girl!

"The law, essentially, is useless as no college (in Canada) would not have that rule"

I take this to mean that the professional colleges (of Phys & Surgeons, Nurses, PT/OT, Pharm, etc) all allow their professionals to refuse care provided they also give timely & professional referral/transfer of care.

Thinking about this this afternoon, I have to wonder why this MP is makinging a federal case out of this. The practice of health care is a provincial responsibility and this is well covered in provincial Health Professional Acts & acts specific to the professions. I can't imagine there is a province or territory that hasn't covered the exact eventuality this law proposes in their own acts. This simply isn't a federal responsibility.

Also, this is a human rights &/or civil/tort issue, not one that should be covered by the criminal code. I'd guess he's citing cases where MDs or other HCPs have been found guilty of intentionally failing to act when they have a legal obligation--but I can't see how this is covered under criminal law and not intentional torts (granted, my understanding of law is based on conversations over beer and nachos with other students [law, med, nursing]...).

Also, I know you are re-evaluating L-girl, but just to add to the items to consider: don't non-health care professionals (lawyers, engineers, etc) have a right to refuse cases/projects that are unethical?

Jen said...

Leah (med student) adds that MDs not only have a responsibility to refer pts to someone who will be able to do [whatever procedure], but they must do so in a timely manner. So, real life Law and Order episode of referring someone after it is too late for [whatever procedure].

impudent strumpet said...

don't non-health care professionals (lawyers, engineers, etc) have a right to refuse cases/projects that are unethical?

Do they? I was just about to post "Is there even any other profession where people have the right to refuse to do work because it violates their personal ethics?"

Like you can always refuse to do the work and take the consequences, but I would assume that your job would be at risk then.

I guess it would depend on your employment situation. If I were a freelancer, I could accept or reject work on a whim, but as an employee I had to sign a contract quite specifically saying that I would translate anything to the best of my ability regardless of subject matter and even if it violates my personal ethics.

This Nurse said...

Yes, at least in Ontario, my profession is provided the right to refuse to perform work they object to (Whatever the reason. It may be simply that you disagree with the physician or other practitioner's plan of care.) There are organised procedures for initiating such a refusal but the right does exist. I suspect most other provinces and nursing boards elsewhere in North America provide the same right.

kim_in_to said...

"If a person cannot in good conscience have anything to do with abortion, or any other legal medical procedure, that person shouldn't be working in : Labour and delivery/ER/post partum".

This makes sense to me.

At a child-therapy seminar I helped organize at work, the speaker very bluntly advised the audience: "If you have a gay client, and you have a problem with homosexuality, you have an obligation to refer that client to someone who doesn't have a problem with it.

This may create a problem in a small town where there is no other therapist - but in terms of therapy anyway - I'd rather not be treated by someone who considers me to be an abomination.

Also - considering the shortage of doctors and nurses in this country - imagine how many health care workers are anti-choice, and then imagine eliminating them from the system...

Wrye said...

Well, MPs can't make provincial cases out of things, after all, Jen, or they would be MPPs or MLAs.

L-girl said...

don't non-health care professionals (lawyers, engineers, etc) have a right to refuse cases/projects that are unethical?

...

I guess it would depend on your employment situation. If I were a freelancer, I could accept or reject work on a whim, but as an employee I had to sign a contract quite specifically saying that I would translate anything to the best of my ability regardless of subject matter and even if it violates my personal ethics.


I was going to mention this, too. If you work on your own, you can always refuse work you find unethical and deal with the consequences yourself. But I'm on staff at a law firm, and I can't refuse to work on certain cases. (They're almost all unethical, afaic!)

I once had a co-worker who was Filipina, and an activist, and it turned out the firm we worked for was representing the Marcoses. She told the firm she didn't want to work on anything related to that case.

It ended up being handled on a very local level - her supervisor just gave her different work, and gave that work to someone else. But she had no legal right to this. Without a thoughtful supervisor, she could have lost her job. At least as I understood the employment law at the time, it would not have been wrongful dismissal, as she was refusing to do her job.

L-girl said...

Please note that this blog is not a forum for readers' views on abortion. Please stay on topic or your post will be deleted. Thank you for your cooperation.

Amy said...

a lawyer should decline employment if the intensity of personal feelings, as distinguished from a community attitude, may impair effective representation of a prospective client.

This is a part of the lawyer's code of ethics in many states. As a practical matter, a lawyer employed in a law firm may not feel empowered to turn down a case, but ethically he or she should if that will impaire effective representation.

kclare said...

Amended to read: (sorry for offense)

This conversation makes me think about an ethics class I took and the nuanced definition of a "right" vs. a "freedom". Let me explain:

A "right" is something that applies to individual humans, and is universal and unviolable. A "right" also always has the flip side of a "duty" for everyone else. In other words, if I have "right" to not be killed, everyone else has a "duty" not to kill me. If I have a "right" to my own property, everyone else has a "duty" not to steal it. If I want to create a "right" to 3 meals a day, I have to create a "duty" for someone to feed them. Perhaps a child has that "right" with their parents taking the "duty" to do their best to feed them, but I don't know beyond that how far that could reach.

In other words, under this definition, if there are abortion rights it implies a duty of a health care professional to perform an abortion upon demand, which is what is being discussed re: this law.

Any willing transaction between two willing individuals should not be impinged upon by 3rd parties, this is a right, with everyone else having a duty not to interfere.

Hope that's better.

Amy said...

My point, not artfully stated, is that lawyers not only can but should turn down representation if they believe that their personal feelings will affect their ability to represent the client effectively.

I think it is different for health care providers to the extent that a patient may suffer real harm if medical care is delayed. There is likely to be little harm if a client has to look for another lawyer and there is some delay, but a patient could die or get much sicker while searching for medical care.

L-girl said...

Kclare, I wasn't offended, but thank you for restating on topic.

impudent strumpet said...

I tried to comment in the other thread but I think blogger ate my comment. The weird thing about this bill is that they say they're about preventing coercion, but they're only talking about coercion of medical professionals rather than also protecting patients from coercion. And it's only when it has to do with a religious belief that human life is inviolable. Nothing about other ethical beliefs, nothing even about other religious beliefs, just that one belief in that one context for medical professionals only. That's why it smells really fishy. If they really cared about protecting people from coercion, they'd have a broader bill to let people be euthanized or let jehovah's witnesses bleed to death without a blood transfusion or let your organs be donated even without the consent of your next of kin.

Also, question for the medical people: is there some mechanism to help doctors find the right/best doctor to refer their patients to, or is it just who you know and who's on the CPSO list?

L-girl said...

ImpStrump, very good. Thanks for that.

I think the bill does say "conscience", not only religious convictions, I'll have to check. But yes, it's only those beliefs, and only for providers, not for patients.

Amy said...

Anyway, Laura, I hope you saw the posts I didn't delete. :)

L-girl said...

I see all. :)

Thanks for your input.