About 4.6 million Canadians have no family doctor. The percentage of those without a regular GP spikes among young adults, an often transient but largely healthy population that tends to seek medical attention sporadically. More often than not, it's for sexual or reproductive health reasons.
This clientele is the mainstay of the dreaded walk-in clinic. It's bad enough that wait times at these patient mills can extend for hours, sucking up a young worker's day off from an often precarious job. It's even worse that the doctor on call can conscientiously object to treating them.
That's what happened to 25-year-old Kate Desjardins, who showed up at an Ottawa walk-in clinic for what she assumed would be a routine renewal of her prescription for birth control. When she explained the reason for her visit, the receptionist told her she'd have to come back another day or go elsewhere. The doctor on duty, it turned out, did not prescribe contraceptives.
"Please be advised that because of reasons of my own medical judgment, as well as professional ethical concerns and religious values, I can only provide one form of birth control – natural family planning," read a letter Ms. Desjardins was handed by the receptionist. It was signed by Dr. Edmond Kyrillos, who went on to explain that he would not refer patients "for vasectomies, abortions, nor prescribe the morning-after pill or any other artificial contraception."
Ms. Desjardins felt humiliated, as anyone her age standing in a crowded waiting room would. Dr. Kyrillos's letter sounds preachy, if not condescending. The safety and effectiveness of popular government-approved contraceptives is not generally considered a matter of "medical judgment" these days. And if doctors have the same religious freedoms as anyone, they are not absolute. There are instances where their exercise interferes with their professional obligations and the rights of patients.
Is this one of them? At the very least, it highlights the need for the College of Physicians and Surgeons of Ontario and its counterparts in other provinces to reassess their policies governing the religious accommodation of doctors. Without clearer rules and their enforcement, the collision between the rights of doctors and their patients is likely to become more common.
If Dr. Kyrillos's stunt is allowed to stand, it will embolden health-care professionals across the country to do the same. A similar incident involving a Calgary doctor came to light last week.
Indeed, many GPs even refuse to refer patients seeking reproductive health services to doctors who will provide them, after the Ontario college exempted them from that requirement in 2008. That appears to go too far. Requiring GPs to provide such referrals, without judgment, is hardly the same as asking them to perform abortions or in vitro fertilization. It is an essential service.
Religious accommodation of doctors, especially in a health-care system where the state pays their salaries, is only reasonable to the extent that it is (1) rare and (2) does not create an unnecessary burden for patients.
If this seems like an odd debate to be having in 2014, it is illustrative of our increasingly postsecular age. Religion is once again re-entering spheres of public life and institutions where it had been banished or forgotten decades ago. Societies across the West are once again struggling to establish the right balance between freedom of religion and freedom from religion.
South of the border, where application of the church-state divide is often inconsistent, 10 states have laws that explicitly allow individual health-care providers to refuse to provide services related to contraception. Six states permit pharmacists to refuse to dispense contraceptives.
Sean Murphy runs the B.C.-based Protection of Conscience Project, which pushes for similar legal protections for health-care providers in Canada. He compares imposing limits on the religious freedom of doctors to the "use of potentially deadly force." It is a "last resort" to be used "only in the most exceptional circumstances."
"That a young woman had to drive around the block to fill a birth-control prescription does not meet this standard," he wrote of Ms. Desjardins on LifeSiteNews.com, an anti-abortion portal.
To say that Ms. Desjardins could simply go elsewhere diminishes her rights. If she lived in a rural region, where few or no choices exist, it might even have deprived her of them altogether. That's not good enough in Canada, in 2014.
Konrad Yakabuski