A last-minute submission from the Ontario Medical Association urging the college not to force doctors to act directly against their moral or religious convictions failed to sway the governing council of the college to reconsider wording that demands doctors provide “an effective referral to another health-care provider” despite personal convictions, whether religious or moral.

The college did not provide a statistical breakdown of the 16,000 submissions it received online, other than to say that 90 per cent were from members of the public and most were against the policy.

The college also received a last-minute brief from the Ontario Human Rights Commission supporting the new policy, saying it is consistent with the case law on the balance between conflicting rights.

The strongest objection among the no votes on the council came from an abortion-providing atheist doctor who warned the policy was being hastily rammed through and would leave doctors in the dark about penalties they may face if they fail to comply.

Dr. Wayne Spotswood challenged his colleagues to speak in plain language about abortion, rather than vaguely referring to medical advice and procedures a doctor may find morally offensive.

“There is nothing about abortion, and that’s what we are here contesting today,” Spotswood said. “I’m not saying that’s the only issue, but it’s the reason we’ve got this response.”

The Kingston, Ont., doctor objected that college staff had waited until the day before the vote to provide members of the governing council with an FAQ (Frequently Asked Questions) document explaining the new policy. Spotswood also questioned whether there was a real issue of access to abortion services.

“Everybody who is 15 or 16 years old knows you can walk down the street” to find another doctor or clinic that will perform or refer for abortion, he said.

As a veteran member and vice chair of the college’s “inquiries, complaints and reports committee,” Spotswood said he was only aware of five complaints that touched on human rights — two involving what he called “fanatic” doctors, one concerning sex-change surgery, one on contraception and one about abortion.

Dr. Marc Gabel, who chaired the policy working group and spearheaded the public consultation, called the new policy “excellent, balanced and caring.”

“No rights are absolute,” said Gabel. “We may at times have to reconcile competing rights… It is to me a very Canadian place where we have come down.”

While the highly motivated responders to the online consultation process were “overwhelmingly” negative about the draft policy, private polling by the college found 94 per cent of Ontarians in favour of a policy that would require doctors to provide information about services they object to, 92 per cent would require doctors to identify another physician who would provide the service and 87 per cent would require doctors to provide a referral in cases where they object.

The new Ontario policy goes further than the Quebec college’s requirement that doctors offer to help find another doctor, or the Alberta, Manitoba and New Brunswick policies that require doctors to provide timely information about services available. The new Ontario policy is in line with a College of Physicians and Surgeons of Saskatchewan draft policy.

The American Medical Association wrote to the Ontario college objecting to the idea that doctors must provide an “effective referral” for a service they find morally or religiously objectionable.

“This seems to us to overstate a duty to refer, risks making the physician morally complicit in violation of deeply held personal beliefs and falls short of according appropriate respect to the physician as a moral agent,” said the AMA’s Feb. 18 letter.

Gabel said the drafting committee wanted to ensure there was no “wiggle room.”

“You cannot kick someone out of your office without providing care,” he said.

Posting a sign including the names and contact information for non-objecting doctors and clinics fails to respect the dignity and autonomy of patients, said Gabel.

Gabel also rejected suggestions that referring for an abortion makes a doctor complicit in whatever abortion or other service another doctor provides.

“The working group does not see a referral as equivalent to providing a service,” he said.

“It’s just a referral,” said Dr. Dennis Pitt. “It’s got nothing to do with my assessment of the patient.”

“With all those feedback and the phone calls we received, there must be a way to satisfy both sides,” said Dr. Haidair Mahmoud.

“When you’re dealing with belief systems, it’s very difficult,” said Gabel.

“This forces a doctor to do what he does not want to do,” said Dr. Peter Tadros.

The policy would reduce doctors to “an educated, well-paid puppet on a string,” Tadros said. “We must respect what the physician holds in his heart. If we want doctors to act ethically, why do we force them to do what they regard as wrong?”

The Windsor doctor tried to persuade council members to take more time and consider alternatives to the draft policy.

“I want to take umbrage with the fact you are cutting off debate,” Tadros said as college president Dr. Carol Leet called the vote.

The dissenting doctors were Tadros, Spotswood and Ottawa Dr. Andrew Falconer.