These are the Remarks delivered by Dr. Mark D’Souza at our International Conscientious Objectors Day Rally on May 15, 2017:
Welcome, and Good evening,
My name is Mark D’Souza. I am an emergency room doctor from Toronto, and former palliative care doctor; I will elaborate on that later. I have been advocating for over a year for a patient-centred, sustainable, accessible, and quality healthcare system. I never thought while training to be a doctor I would ever be doing this – all I ever wanted to do was take care of patients. But as Ontario’s healthcare system disintegrates, I feel obliged to speak out to further care for patients, and my voice has only gotten louder. Most recently, I have worked to advocate for the protection of physicians’ conscience rights.
Bill 84 was the provincial government’s implementation of the federal government’s law on euthanasia. Every province had to come up with such a law. Regardless of whether you’re for or against euthanasia, the obvious flaw in Bill 84 was that it did not include explicit protection for conscience rights. I spoke to the Standing Committee of Ontario’s parliament on Bill 84 on March 28th. Sadly, they did not pass the requested amendment, and a few weeks later, Bill 84 passed into law.
I will speak for a moment as a palliative care physician. The law as it stands will actually decrease access to euthanasia. The proposed amendment that doctors sought would have prevented this paradoxical effect at no cost. Offer some form of self-referral to facilitate access, and don’t force us to refer. It could be a website, a 1-800 number, or even an app.
In section 2a of Bill C-14, the federal law on euthanasia, the federal government encourages provincial legislation to uphold the conscience rights of doctors. Every other jurisdiction in the world offering euthanasia has self-referral, including all the other provinces. Abortion in Ontario has the option of self-referral without infringing on conscience rights, why can’t euthanasia?
Here is some further background on why explicit conscience protection is necessary. In 2015, the College of Physicians and Surgeons of Ontario, the regulatory body of doctors, changed its human rights policy, saying that doctors have to effectively refer to another provider. This has to be written or on the phone. Why is this a big deal, many non-objectors ask? Well, signing our names to something is tantamount to indirect participation for many of us. Every major religion, and even secular humanist organizations, have denounced this policy. The Canadian, American, and Ontario Medical Associations have all said it is unnecessary. Why pit conscience rights and patients’ rights against each other? Isn’t freedom of conscience enshrined in the Canadian charter of rights and freedom? Calling a spade a spade, this law is about showing doctors who’s the boss – the government.
After so many groups were advocating for self-referral, in early April the Liberal government said they would implement a self-referral process. If implemented, which has not yet occurred, problem solved, right? Unfortunately no. As with many of their policies, this Liberal government is masterful at creating the right optics to fool just enough people that meaningful protest withers. As I said before, our college still mandates effective referral. So in the scenario where a patient asks me for euthanasia, I decline and instead offer the central referral number, yet the patient still wants me to refer, they can complain to our college and my license to practice medicine would be in jeopardy. This is why legislation needs to absolutely overrule the College of Physicians and Surgeons of Ontario’s human rights policy.
Speaking of infringements on beliefs, the Dean of Queen’s University’s faculty of health sciences’ strong views against conscientious objectors has caused widespread fear, hinting that beliefs on euthanasia would be part of the screening process. This year, Queen’s medical school included in their interviews a scenario in which the candidate was asked by a patient to provide euthanasia. After, there was a series of follow-up questions from the interviewers aiming to reveal the candidate’s beliefs on the topic. So essentially, Queen’s medical school is screening out applicants that are conscientious objectors. Ironically, that is the school that trained me to be a doctor in a more open-minded time. I am deeply saddened to learn of such a discriminatory filtering process existing in a country that claims to have tolerance in its bedrock. Medicine is a profession that is thousands of years old. In its history, we always abided by “first, do no harm.” In the last few decades, some places in the world have allowed for euthanasia. But suddenly in the face of millennia of tradition, we all have to be okay with it?
Now let me further elaborate on why the law as it stands will actually create less access to medical services, particularly palliative care. Studies show most people would prefer to die in their homes. However, about 60% of deaths in Ontario occur in hospital. Moreover, Ministry of Health data reveals that 10% of alternate level of care beds were filled with palliative patients that otherwise could be in their homes. Most limiting, it’s estimated there are only 500 palliative care physicians in our province. Well, I mean 499 now.
I am part of a group of 6 doctors who visit palliative care patients in their homes in Scarborough, the only group that does so specifically, and we are all conscientious objectors. As it is, Scarborough palliative care is grossly underserviced. We reached a waitlist high of 32 patients waiting for a palliative care doctor in their home in March. Imagine being told your days are numbered; you’re nauseated, constipated, and in agony with cancer all over your body, and now you’re 30 patients away for a doctor coming to take care of you. This number will multiply without explicit conscience protection.
Only 16-30% of Canadians actually have access to palliative care. It is a right guaranteed in other countries that have enabled euthanasia; but not in Canada. 75% of surveyed palliative care physicians do not want to participate in euthanasia. As an aside, it is estimated euthanasia will save up to $139 million dollars annually. I am rather surprised that no one in the media seems to wonder if there is at least partly a financial motivation behind government zeal to push euthanasia and marginalize palliative care. I am proud then to be the first to publicly pose this thought.
I do my job dreading being asked to kill someone. Euthanasia is the shadow that hangs over me, even on sunny days. Can you imagine what it’s like for me, when someone looks me in the eyes and asks me to kill them? Right before I presented to parliament, I accepted my final palliative care patient. While I will not abandon my current patients, I will not be accepting any more until I know conscience protection is guaranteed. I only have 2 patients left, and then I will cease to practice palliative care entirely. Half our group is considering leaving the field, one is even considering leaving the profession of medicine because of this issue. It breaks my heart that future patients will have no choice but to either suffer or seek expensive hospital care. And what is happening in my Scarborough physician group is a microcosm; this law will drive many of the 500 palliative care doctors from that field. But all of this can be prevented with a simple amendment.
Currently the Conservative Party of Ontario is trying to push a Bill through parliament to explicitly protect doctors’ conscience rights. While I am not optimistic it will pass given the Liberal majority and their consistent refusal to listen to anyone else on their policies, I ask that you support the PC’s in this initiative. Please sign the PC petition online led by the honourable MPP Monte McNaughton. In the macro, doctors are losing their human rights to an even more egregious degree with Bill 87, the Bill that makes us guilty before proven innocent. The Ontario government’s vilification of doctors pushes me closer and closer to leaving the province to continue the practice of medicine. I became a doctor because I simply wanted to help people. My colleagues and I started off motivated by love, love of patients. But in the past few years, we have become increasingly motivated by fear, fear that we won’t have enough resources to give quality care, that we will be sacrificed by politicians in the blame game, and most of all that patients will suffer unnecessarily. But this bigger picture is a story for another day.
I want to take a moment to talk about the challenges I have personally faced since taking a public stand in favour of the protection of doctors’ conscience rights. I thought that speaking out for this cause would rally the backing of the vast majority of doctors… and it did, for about 24 hours. After that, the ankle biting started. Those zealous for euthanasia came at me with various degrees of reason. Some were professional, some were not. This probably made people who were privately supporting me far less vocal about it, to not be targets themselves of venom. One called the pro-doctors’ conscience rights a fringe movement, even though a recent survey showed that 91% of Ontario doctors support our conscience rights. There was a mass email signed by 20 doctors against me and distributed publicly. I’ve been called despicable. I’ve been explicitly threatened by both a doctor and a lay person. To be fair, the attempts at bullying, threats, and intimidation are not just about this issue, but about me speaking out vociferously against the dark cloud that hangs over my profession. But when is this manner of interaction EVER acceptable?
What I’ve learned in the last 6 weeks is that in the lazy river of life, it is so easy to just go with the flow of things. “Just join the crowd, everyone will like you then!” “Don’t you want to be accepted?” Or in the words of my high school experience, “Mark, don’t you want to be cool?” Someone once said, the coward dies 1000 times, the courageous only once. It takes courage to go against the grain, to speak the truth, and to stand up for what is right. I appreciate from the bottom of my soul every bit of encouragement. So please support me as I continue to express my love and passion for patient care.
In conclusion, Ontario’s law on euthanasia creates access to a new legal service on the surface. But when you peel back just one layer of this onion, it paradoxically reduces access to multiple medical services. Healthcare in Ontario is on the brink of disaster, and the completely unnecessary infringement on physicians’ conscience rights is yet another nail in its coffin. I ask that the decision-makers of the province remember that healthcare is delivered at the bedside, not on paper, and that patients never come first when doctors are put last.