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Appeal court says doctors have to give referrals for services they oppose

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TORONTO — Ontario’s highest court ruled Wednesday that doctors in the province must give referrals for medical services that clash with their religious beliefs, calling it a compromise that balances the rights of physicians and the inter…


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  • TORONTO — Ontario’s highest court ruled Wednesday that doctors in the province must give referrals for medical services that clash with their religious beliefs, calling it a compromise that balances the rights of physicians and the interests of patients.

    In a unanimous ruling, a three-judge panel dismissed an appeal seeking to overturn a divisional court decision that upheld the requirement for an “effective referral,” an effort to connect patients with another, willing health-care provider. 

    The requirement is part of a set of policies issued in 2016 by the College of Physicians and Surgeons of Ontario to address issues surrounding, among other things, assisted dying, contraception and abortion.

    “The issues raised in this proceeding present difficult choices for religious physicians who object to the policies, but they do have choices,” the appeal court wrote.

    “While the solution is not a perfect one for some physicians, such as the individual appellants, it is not a perfect one for their patients either. They will lose the personal support of their physicians at a time when they are most vulnerable.”

    The policies “represent a compromise,” the court wrote. 

    “They strike a reasonable balance between patients’ interests and physicians’ Charter-protected religious freedom. They are reasonable limits prescribed by law that are demonstrably justified in a free and democratic society.”

    The college, which regulates doctors in Ontario, called the ruling a victory for patients.

    “The court has recognized the importance of ensuring patients get access to the care they need,” said Dr. Nancy Whitmore, its registrar and CEO. “Our effective referral policy ensures equitable access to health care, particularly on the part of the more vulnerable members of our society while respecting the rights of all of those involved.”

    Those behind the appeal expressed their disappointment at the outcome of the case, saying the decision will put some physicians in an impossible position.

    “Ultimately it is patient care that suffers, as our doctors will retire early, relocate, or change fields,” said Dr. Ryan Wilson, president of Canadian Physicians for Life, one of three professional organizations involved in the appeal, along with five individual doctors.

    “For many, their religious and conscience rights are being violated and they won’t be able to practise medicine in Ontario.”

    The appeal challenged a ruling last year by the divisional court, which found that while the referral requirement does infringe on doctors’ religious freedom, the benefits to the public outweigh the cost to physicians.

    The lower court noted an effective referral is not as involved as a formal one, in which a doctor is required to provide a letter and arrange an appointment with another physician. It said doctors can ask staff to handle the effective referral, or choose to specialize in a type of medicine where these issues are less frequent.

    In the appeal, the group of doctors argued the ruling was unreasonable because it gave more weight to an assumed problem with access to health care than to a real infringement of doctors’ rights.

    The group — which includes the Christian Medical and Dental Society of Canada, the Canadian Federation of Catholic Physicians’ Societies and Canadian Physicians for Life — said there is no evidence that patients would be harmed by not receiving a referral.

    It also alleged the court erred in saying doctors could pick specialties where fewer moral conflicts arise, arguing that presumes physicians can easily switch jobs.

    The group also introduced new evidence in the appeal, arguing Ontario’s Care Co-ordination Service meant to help navigate the assisted dying process was now accessible to the public rather than only physicians and could thus replace an effective referral.

    The appeal court agreed with the divisional court that “as a matter of logic and common sense” the requirement for an effective referral promotes equitable access to care, particularly for vulnerable patients.

    It also found that the self-referral method proposed by the doctors’ group would not meet the needs of patients seeking “the most intimate and urgent medical advice and care.”

    “It is impossible to conceive of more private, emotional or challenging issues for any patient,” the appeal court wrote. “Given the importance of family physicians as ‘gatekeepers’ and ‘patient navigators’ in the health-care system, there is compelling evidence that patients will suffer harm in the absence of an effective referral.”

    While the doctors’ group argued the requirement will force physicians to leave the province or cease practising medicine, which would harm the public, the appeal court noted no evidence to that effect was presented.

    Changing the scope of their practice may require sacrifices from physicians, the appeal court found. However, “the appellants have no common law, proprietary or constitutional right to practise medicine,” it said. 

    The college had brought new evidence on appeal suggesting doctors could change or narrow the scope of their practice without resorting to retraining. Its expert witness said some areas of medicine are unlikely to encounter requests for assisted death or reproductive health issues, including hair restoration, sport and exercise medicine, hernia repair and aviation examinations.

    Paola Loriggio, The Canadian Press




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    Focus on traumatized boys critical to gender equality, new research shows

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    TORONTO — Boys in poor urban areas around the world are suffering even more than girls from violence, abuse and neglect, groundbreaking international research published on Monday suggests.
    The study in the Journal of Adolescent Health, along with …


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  • TORONTO — Boys in poor urban areas around the world are suffering even more than girls from violence, abuse and neglect, groundbreaking international research published on Monday suggests.

    The study in the Journal of Adolescent Health, along with similar new research, suggests an adequate focus on helping boys is critical to achieving gender equality in the longer term.

    “This is the first global study to investigate how a cluster of traumatic childhood experiences known as ACEs, or adverse childhood experiences, work together to cause specific health issues in early adolescence, with terrible life-long consequences,” Dr. Robert Blum, the lead researcher for the global early adolescent study, said in a statement. “While we found young girls often suffer significantly, contrary to common belief, boys reported even greater exposure to violence and neglect, which makes them more likely to be violent in return.”

    The study from Johns Hopkins Bloomberg School of Public Health looked at childhood traumas suffered by 1,284 adolescents aged 10 to 14 in more than a dozen low-income urban settings around the world such as the United States, China, the U.K., Egypt and Bolivia.

    Overall, 46 per cent of young adolescents reported experiencing violence, 38 per cent said they suffered emotional neglect and 29 per cent experienced physical neglect. Boys, however, were more likely to report being victims of physical neglect, sexual abuse and violence.

    While higher levels of trauma lead both boys and girls to engage in more violent behaviours, boys are more likely to become violent. Girls tend to show higher levels of depression.

    Separately, a new report to be released next month at an international conference in Vancouver concludes that focusing on boys is critical to achieving gender parity. The report from the Bellagio Working Group on Gender Equality — a global coalition of adolescent health experts — finds boys and men are frequently overlooked in the equality equation.

    “We cannot achieve a gender-equitable world by ignoring half of its occupants,” the report states. “It is crucial that boys and men be included in efforts to promote gender equality and empowerment.”

    For the past six years, a consortium of 15 countries led by the Bloomberg School of Public Health and World Health Organization has been working on the global early adolescent study. The aim is to understand how gender norms are formed in early adolescence and how they predispose young people to sexual and other health risks.

    Evidence gathered by the study indicates boys experience as much disadvantage as girls but are more likely to smoke, drink and suffer injury and death in the second decade of life than their female counterparts.

    The key to achieving gender equality over the next decade or so — as the United Nations aims to do — involves addressing conditions and stereotypes that are harmful to both girls and boys, the researchers say. They also say it’s crucial to intervene as early as age 10. The norm is now age 15.

    “Gender norms, attitudes and beliefs appear to solidify by age 15 or 16,” the working group says. “We must actively engage girls and boys at the onset of adolescence to increase total social inclusion and produce generational change.”

    Leena Augimeri, a child mental-health expert with the Child Development Institute in Toronto, agreed with the need to focus on boys as well as girls. At the same time, she said, the genders do require different approaches.

    “Boys are equally at risk,” said Augimeri, who was not involved in the studies. “When we look at the various issues that impact our children, we have to look at it from different perspectives and lenses and you can’t think there’s a one fit for all.”

     

    Colin Perkel, The Canadian Press


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    ‘Dignity and wisdom’: Chief justice praises Gascon after final high-court case

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    OTTAWA — Supreme Court Justice Clement Gascon received a standing ovation Thursday after hearing his final case on the high court.
    Gascon graciously thanked his family and colleagues, saying it is an immense privilege to be a judge.
    Last month, Gascon,…


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  • OTTAWA — Supreme Court Justice Clement Gascon received a standing ovation Thursday after hearing his final case on the high court.

    Gascon graciously thanked his family and colleagues, saying it is an immense privilege to be a judge.

    Last month, Gascon, 58, announced plans to retire for unspecified personal and family reasons.

    He said this week he has long struggled with anxiety and depression, and while he has generally been able to manage the illness, it recently led to a difficult episode.

    Gascon said he suffered a panic attack before he briefly went missing May 8. He profusely apologized for the uncharacteristic absence, citing the effects of his difficult career decision and a change in medication.

    In the crowded courtroom Thursday, Chief Justice Richard Wagner praised Gascon as an exceptional person.

    “Our esteemed colleague has served Canadians with dignity and wisdom,” Wagner said. “His commitment and friendship will be missed.”

    Justice Sheilah Martin shed tears.

    Gascon officially steps down Sept. 15 but will continue to have input into judgments flowing from cases he has heard, as long as they are released within six months of his retirement date.

    Judgments released after mid-March will note that Gascon had no input into the decision.

    “My work as a judge is far from complete,” he said. “I can assure you that I will continue.”

    The Canadian Press


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