Magazines 2019 Mar - Apr The cost of conscience

The cost of conscience

01 April 2019 By Bruce J. Clemenger

A society that stops accommodating minorities hurts everyone

I recently attended an appeal court hearing about whether doctors in Ontario can be compelled to provide an effective referral for procedures they are morally opposed to – practices like assisted suicide and abortion.

Five doctors and three Christian medical associations are challenging the policy of the College of Physicians and Surgeons of Ontario. The Evangelical Fellowship of Canada intervened in support of the doctors with the Christian Legal Fellowship and the Assembly of Catholic Bishops of Ontario. (Get updates on the case at

It was difficult to hear some of the arguments made by lawyers about the motivations of the doctors, some of whom sat near me in the courtroom during almost two days of arguments.

Only a few years ago, it was a crime to assist someone to end their life. Back then, if a doctor made an effective referral for assisted suicide, they would have been complicit in a crime. But then decriminalization arrived in Canada in 2016. (Ontario developed its forced referrals policy in 2015.)

Objecting doctors got a lower court to recognize that forced referrals do infringe on the religious freedom of doctors, but that ruling ultimately sided with the CPSO argument that the infringement was necessary to prevent possible delays for patients.

As far as we know, all other provinces and jurisdictions worldwide that allow assisted death have found ways of accommodating the consciences of doctors without hindering access.

But the CPSO pressed for an effective referral, which it says "means a referral made in good faith, to a nonobjecting, available and accessible physician, nurse practitioner or agency." It’s not sufficient to provide the patient information about Ontario’s Care Coordination Service (a toll-free number) – the doctor needs to make the call or facilitate the patient making the call.

From the moral viewpoint of many doctors, that’s being compelled to take positive action to facilitate an immoral act. These are professionals who care passionately about their patients and want to continue upholding their centuries-old "do no harm" principle.

The cost of conscience for them is not only taking a stand against their professional association but enduring a long and uncertain legal journey. And if they are not successful, there will be additional cost.

the cpso policy


The CPSO policy of forced referrals for procedures doctors are morally opposed to continues to be challenged in Ontario’s courts.


A doctor who works in a big enough clinic may have a triage system where someone would direct the patient to a nonobjecting physician. But what about a sole practitioner or a clinic comprised of doctors who share the same moral beliefs?

The lower court said doctors have options to change "the nature of their practice if they intend to continue practicing medicine in Ontario" – either the doctor would change to a specialty without requests that conflict with their conscience, or else find a way to work with others willing to provide the referrals (perhaps by relocating to a hospital or clinic, or by hiring doctors or staff not bothered by the conscience issue).

All these options place significant burdens on doctors.

Think about a doctor changing their specialty. They trained to become excellent as a family physician, oncologist, cardiologist or geriatric specialist – and now they need to move to one of the very few specialties where the end of life won’t be an issue. They need to retrain, lose their practice, then build up another clientele. They can no longer care for the patients they’ve known for years. Many patients will lose a trusted physician.

Others may feel forced to move to another province or retire prematurely – causing their home province to lose out. Medical students are watching this case very closely as they consider their specialty and the province in which they will practise.

The other option to relocate to a hospital or larger clinic would be difficult for someone with a rural practice. And as for hiring a new colleague who would provide effective referrals – how would you screen the religious beliefs of applicants without violating employment law? And who would want to hire someone to do what you believe is immoral?

The cost to the rest of us who share the moral views of these doctors is that we will no longer find care from professionals who share our views of life and death, and for whom helping to kill us is not an option.

There are ways to accommodate diversity as other provinces have shown. But if the CPSO wins, what other professions will take a similar easy option, thus eroding our society’s prior commitment to respect freedom of conscience and religion?

This is a political issue as well as a legal one. It is important that we nurture a society in which freedom of conscience and religion is understood, valued and respected. We need to stand with others whose freedoms are being challenged and are absorbing the cost of conscience.

bruce j. clemenger


ONLINE UPDATE! Visit to read the EFC's response to the disappointing court decision that arrived in May, a few weeks after this column was written.

Bruce J. Clemenger is President of The Evangelical Fellowship of Canada. Pray for our work and support us at or toll-free 1-866-302-3362.