Physicians can no longer impede access to care: are we on the right path?

I was quite happy to read last week that the CPSO updated its policy to now state that doctors moral or religious convictions cannot impede patient’s access to care, and that doctors could face disciplinary action if they refuse to at least refer patients on. I have no problem with doctors refusing care in certain instances, as long as they ensure the patient gets to see another physician in a reasonable amount of time who is willing to provide appropriate access.

The ethics behind such a situation are interesting to consider. The core principles of medical ethics (autonomy, beneficence, non-maleficence, and justice) are widely accepted and generally hold across societies and cultures. But the rest of medical ethics, the shades of gray, are largely influenced by the moral standards of the society in which a particular doctor practices. That is why I believe that it is more important for patients to have access to medical standard of care than it is to “protect” doctors who have moral or religious objections.

The primary example that is always used in this argument is that of family or walk-in doctors refusing to prescribe oral contraceptive pills (OCP), which has happened recently in Calgary and Ottawa. Personally, I can’t believe that in 2015 there are Canadian trained doctors who refuse to dispense OCP even if their religious upbringing has taught them it is somehow “wrong”. But the previous CPSO policy of allowing doctors to refuse treatment *and* refuse to refer patients on sets a bad standard that places already vulnerable patients in a precarious situation. For example, what should happen if a pediatrician refuses to provide care for a baby girl because her parents are a single-sex female couple? Sounds like a disgusting situation that is made up, right? Nope, it happened just last month (in the US, but still). Under the CPSO’s prior policy, the pediatrician has the full right to refuse to care for the baby, and has no obligation to find another pediatrician who will. And what if that baby lived in a remote area with only one pediatrician in town?

I fear that the new policy doesn’t go far enough, as many patients will not be aware that their doctor must provide an appropriate referral; they also likely won’t know that this is now a situation whereby a complaint could lead to disciplinary action. I have argued before (in reference to physician assisted dying) that medical laws and practice guidelines in Canada should be dictated by the wishes of the majority of Canadians, not by the majority of doctors. That is why the 92% of the Canadian public who favor this new policy should outweigh the “vast majority” of doctors who oppose it. Physicians are employed to treat their patients, not to assuage their own moral or religious baggage.

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