Calgary doctor refusal to prescribe birth control covered by morality clause

An unexpected battleground in Canadian healthcare popped up again this week over a Calgary doctor's moral decision not to prescribe birth control to patients.

According to the Calgary Herald, a sign posted in the waiting room of Calgary's Westglen Medical Centre recently alerted patients that "the physician on duty today WILL NOT prescribe the Birth Control Pill."

The doctor in question, Chantal Barry, was reportedly the only doctor on staff at the time, and refused to prescribe the drug because of her personal beliefs.

A receptionist told the newspaper that patients looking for birth control were offered a list of other clinic that would prescribe it.

That slight addendum might be the difference between a doctor improperly refusing service and one exercising their moral principles.

Because as odd as this specific case may seem, Canadian doctors are allowed to refuse service that contradict their moral and religious beliefs, which could cover anything from performing abortions to providing access to birth control or Viagra.

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Most provincial medical boards include a morality clause in their code of conduct, which offers some guidance when refusing service.

The College of Physicians and Surgeons of Alberta’s policy on Moral or Religious Beliefs Affecting Medical Care states that physicians must "communicate clearly and promptly about any treatments or procedures the physician chooses not to provide because of his or her moral or religious beliefs."

The physician must also ensure that patients are offered timely access to someone who will assist them. In other words, if the lone doctor at a clinic bluntly refused service, there could be grounds to file a complaint.

While the debate around conscionable objection in Canadian healthcare most frequently surround the matter of abortion, the issue of providing contraceptives and birth control can fall under the same umbrella. The argument has been made in the past.

In February, an Ottawa walk-in clinic made headlines when three doctors refused to offer birth control based on moral and religious grounds.

In a photo of a doctor’s note that had been posted online by a rejected patient, Dr. Edmond Kyrillos stated:

Despite the bluster that followed, the clinic and those doctors were not reprimanded. The clarity of the sign may have had something to do with it.

In 2002, a doctor in Barrie, Ont., was dragged in front of the College of Physicians and Surgeons of Ontario after refusing to prescribe birth control to unmarried women and reportedly handing out letters to patients citing bible verses.

"If a Christian physician must forsake his religious beliefs to maintain his medical licence, we cannot delude ourselves to believe we live in a free country," said Dr. Stephen Dawson told the Barrie Examiner at the time.

(The Examiner reports Dawson was stripped of his licence in 2005 in a separate case relating to the sexual abuse of a patient.)

According to the Canadian Medical Association Journal, Dawson avoided losing his licence in 2002 by agreeing to post a warning in his waiting room that read in part, "As a Christian physician, the prescription of birth control pills to unmarried women is contrary to the dictates of my conscience and religion."

The Canadian Medical Association has a thorough code of ethics, which most notably requires members "inform your patients when your personal values would influence the recommendation or practice of any medical procedure that the patient needs or wants."

It also requires doctors to ensure patients have the information they need to find the help they are searching for.

Ontario's moral and religious beliefs clause asks doctors to "proceed cautiously with an understanding of the implications related to human rights. Personal beliefs and values and cultural and religious practices are central to the lives of physicians and their patients."

It goes on to note that the Human Rights Commission could find the decision to restrict or refuse service in violation of the Ontario Human Rights Code.

While the matter is dotted with uncertainty and potential misunderstanding, it seems that as long as doctors are upfront about their position, and ensure patients are still able to access the help they desire, they are free to follow their own compass.

A patient who was refused birth control at one Calgary walk-in clinic, for example, still has the opportunity to seek help elsewhere. Whether she should have to is another question altogether.

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