Category: Countries
Submission to the World Medical Association
Public Consultation on a draft devised version of the International Code of Medical Ethics
The Anscombe Bioethics Centre
The Anscombe Bioethics Centre
The Anscombe Bioethics Centre is the oldest national bioethics centre in the United Kingdom, established in 1977 by the Roman Catholic Archbishops of England and Wales. It was originally known as The Linacre Centre for Healthcare Ethics and was situated in London before moving to Oxford. The Centre engages with the moral questions arising in clinical practice and biomedical research. It brings to bear on those questions principles of natural law, virtue ethics, and the teaching of the Catholic Church, and seeks to develop the implications of that teaching for emerging fields of practice. The Centre engages in scholarly dialogue with academics and practitioners of other traditions. It contributes to public policy debates as well as to debates and consultations within the Church.
A key issue: conscientious objection
For the first time this draft Code introduces the idea of “conscientious objection”:
Paragraph 27 reads:
Physicians have an ethical obligation to minimise disruption to patient care. Conscientious objection must only be considered if the individual patient is not discriminated against or disadvantaged, the patient’s health is not endangered, and undelayed continuity of care is ensured through effective and timely referral to another qualified physician.*
* This paragraph will be debated in greater detail at the WMA’s dedicated conference on the subject of conscientious objection in 2021 or 2022. However, comments on this paragraph are also welcome at this time.
Unfortunately, this is deeply problematic as a statement of the rights of conscience in medicine. In the first place it utterly fails to establish the duty of doctors to object to practices and procedures that are unconscionable because harmful, discriminatory, unjust or unethical. The right to conscientious objection is based on the duty to be conscientious which is fundamental to medical ethics. . . continue reading
Comment on the draft International Code of Medical Ethics of the World Medical Association
European Institute of Bioethics
In the context of the International Code of Medical Ethics’ revision, the European Institute of Bioethics (EIB) would like to share some comments with the World Medical Association (WMA) Assembly on paragraph 27 of the draft.
Since 2001, the European Institute of Bioethics has developed an expertise in healthcare ethics, with a special focus on the right of healthcare practitioners to freedom of conscience in their practice.
We acknowledge that the International Code of Medical Ethics (hereafter: the Code) is not a binding instrument for the WMA member states. However, one cannot deny the considerable influence the Code may have on national codes of deontology and even on national laws. Moreover, physicians and healthcare organizations expect from the WMA to promote the highest quality of healthcare relationship between physicians and patients.
Paragraph 27 of the Code is drafted as follows:
Physicians have an ethical obligation to minimise disruption to patient care. Conscientious objection must only be considered if the individual patient is not discriminated against or disadvantaged, the patient’s health is not endangered, and undelayed continuity of care is ensured through effective and timely referral to another qualified physician.
In the following note, we discuss one by one the different parts of this paragraph which we consider, written as such, highly problematic for the physicians’ rights and the patients’ care. . . continue reading
Conscience Project critiques Ontario Physicians College euthanasia/assisted suicide policy
Referral, urgent situations, death certificates, criminal law
News Release
For immediate release
Protection of Conscience Project
Powell River, BC. (28 April, 2021) The 2019 decision of the Ontario Court of Appeal supporting the College of Physicians and Surgeons of Ontario was not the last word on the subject of physician freedom of conscience.
That message was delivered to the College by the Protection of Conscience Project in a submission responding to the College’s request for public feedback on its policy, Medical Assistance in Dying (MAiD). The submission focuses primarily on the College demand that physicians unwilling to provide euthanasia or assisted suicide (EAS) for reasons of conscience provide an “effective referral”: that is, connect the patient directly with someone willing to provide a lethal injection or assist with suicide.
The submission on MAiD addresses three points unique to euthanasia and assisted suicide.
Conflicts in urgent situations: If a patient is approved for EAS at some future date, a sudden deterioration of the patient’s condition may cause the patient to ask for immediate relief by EAS. In the absence of an EAS practitioner, other practitioners may be willing to alleviate the patient’s distress by palliative interventions, but not to provide EAS. The Project suggests how this conflict can be avoided.
Falsifying death certificates: Falsification of death certificates is contrary to accepted international standards and can be considered deceptive, unethical or professionally ill-advised. The Project suggests how EAS practitioners unwilling to falsify death certificates can be accommodated by the College and Office of the Chief Coroner even if current government policy does not change.
Criminal law limits on College policy: The Project’s position is that the College cannot proceed against practitioners who, having the opinion that a patient is not eligible for EAS, refuse to do anything that would entail criminal responsibility for homicide/assisted suicide, including “effective referral.” Further, to advise or attempt to coerce them to present EAS as treatment options or to participate by effective referral would seem to be a criminal offence. Finally, since counselling suicide remains a criminal offence, it appears that practitioners cannot be compelled to present assisted suicide or MaiD as treatment options unless a patient has expressed an interest in the services.
The College’s clarification that it does not require objecting practitioners to personally kill their patients is welcome. However, the Project’s position is that this ought to be the norm in a democratic society, not a “concession”or an element in the “accommodation” of freedom of conscience.
While the submission includes specific policy recommendations within the existing MAiD policy framework, it recommends that the College adopt a single protection of conscience policy in line with “the basic theory” of the Canadian Charter of Rights affirmed by the Supreme Court of Canada and consistent with rational moral pluralism. Such a generally applicable policy is included in the simultaneous Project submission to the College on Professional Obligations and Human Rights.
Public consultations on Professional Obligations and Human Rights [Consultation Page] and Medical Assistance in Dying [Consultation Page] are open until 14 May, 2021.
Contact: Sean Murphy,
Administrator, Protection of Conscience Project
protection@consciencelaws.org
Ontario College of Physicians policy challenged
Forcing physicians out of Covid fight not in public interest
News Release
For immediate release
Protection of Conscience Project
Powell River, B.C. (28 April, 2021) The 2019 decision of the Ontario Court of Appeal supporting the College of Physicians and Surgeons of Ontario was not the last word on the subject of physician freedom of conscience.
That message was delivered to the College by the Protection of Conscience Project in a submission responding to the College’s request for public feedback on its policy, Professional Obligations and Human Rights (POHR).
The submission includes a cautionary note about the potential implications of human rights law for practitioners providing euthanasia and assisted suicide. However, the primary focus is on the College demand that physicians unwilling to provide a service or procedure for reasons of conscience provide an “effective referral”: that is, connect the patient directly with someone willing to do what they consider immoral/unethical.
Practitioners who object to providing a service typically provide information and work cooperatively with patients and others in relation to patient access to services. While willing to respectfully cooperate, they are unwilling to collaborate by doing something that makes them a party to what they consider wrongful and/or harmful. The distinctions between providing information vs. providing a service and between cooperation vs. collaboration enable an approach that accommodates both patients and practitioners, argues the Project.
However, the College is clearly confused about such critical distinctions. Citing College policy and reasoning, the submission states, “the College’s assertion that effective referral for euthanasia/assisted suicide does not ‘signal’ endorsement or support for the procedures [Advice:MAiD] is either disingenuous or the product of badly muddled wishful thinking.”
“The College does not even correctly apply its own definition of effective referral in its companion policy document,” observes Sean Murphy, Administrator of the Project.
According to the College, physicians unwilling to comply with its effective referral policy should restrict their practices to specialties like hair restoration.[1] This would force all objecting physicians out of general practice.
“To put it in a currently relevant perspective,” says Murphy, “the College would have them terminate all Covid 19 pandemic activities and take up podiatry or aviation medicine. This is hardly consistent with ensuring access to health care or protecting the public interest.”
The Project recommends that the College adopt a single protection of conscience policy in line with “the basic theory” of the Canadian Charter of Rights affirmed by the Supreme Court of Canada and consistent with rational moral pluralism. The submission includes a such general policy, drawing on policy documents from the Canadian Medical Association, Canadian Nurses’ Association, Catholic Health Association of Canada and the Canadian Medical Protective Association.
The Protection of Conscience Project has also made a submission about College’s policy on euthanasia and assisted suicide, Medical Assistance in Dying. Public consultations on Professional Obligations and Human Rights [Consultation Page] and Medical Assistance in Dying [Consultation Page] are open until 14 May, 2021.
Notes
- Christian Medical and Dental Society of Canada v. College of Physicians and Surgeons of Ontario, 2019 ONCA 393 (CanLII) at para 184.
Contact: Sean Murphy,
Administrator, Protection of Conscience Project
protection@consciencelaws.org