Category: Canada

Re: Conscientious Refusal

Abstract

The policy Conscientious Refusal requires all physicians who object to a procedure for reasons of conscience to facilitate the procedure by referring patients to a colleague who will provide it, even if it is homicide or suicide.  No evidence was provided to justify the policy.  None of the arguments provided to Council justify the policy, nor do the principles included in the text.

Conscientious Refusal fails to recognize that the practice of medicine is a moral enterprise, that morality is a human enterprise, and that physicians, no less than patients, are moral agents.

The original text virtually copied by Conscientious Refusal was written by believers: by people who believe that whatever is “legally permissible and publicly-funded” is morally acceptable- including euthanasia, assisted suicide and abortion. It is an assertion of those beliefs and an authoritarian attempt to compel others to conform to them. It is a partisan document that is profoundly disrespectful of the moral agency of physicians, not a compromise.

Conscientious Refusal advances the dangerous idea that a learned or privileged class, a profession or state institutions can legitimately compel people to do what they believe to be wrong and punish them if they refuse. This is not a limitation of fundamental freedoms, but a serious violation of human dignity. It is also incoherent, because it posits the existence of a moral or ethical duty to do what one believes to be wrong.

The Associate Registrar has made it clear that those who refuse to do what the policy demands will be disciplined by the College or forced out of the medical profession. This clashes seriously with the approach taken by the Supreme Court of Canada, which has affirmed that public policy must make room for physicians whose “concept of the good life” precludes their participation in abortion, euthanasia, assisted suicide or other morally contested procedures.

The burden of proof was on the Associate Registrar and the appointed committee to prove beyond doubt that Conscientious Refusal is justified and that no less authoritarian alternatives are available.  They failed to discharge that burden; neither has College Council discharged it. The policy should be withdrawn.

Contents

I.    Origin of the draft policy, Conscientious Refusal

II.    Content of the proposed policy

III.    Focus of this submission

IV.    Justification for the proposed policy

V.    The issues

VI.    Response to the issues

• VI.1    Does the proposed policy adversely affect freedom of conscience or religion?
• VI.2    Is the policy justified by evidence provided to Council?
• VI.3    Is the policy justified by the arguments provided to Council?
  • Arguments not offered
  • The argument offered
    • VI.3.5    Appeals to authority
    • VI.3.6    Appeal to consensus
    • VI.3.7    Claim of administrative convenience
  • Response to the argument
    • VI.3.8    Appeals to authority
    • VI.3.9    Appeal to consensus
    • VI.3.10    Administrative convenience
    • Summary
    • VI.3.15    Conclusion
• VI.4    Is the policy justified by the principles included in the policy?
  • VI.4.2    “. . .an obligation to serve and protect the public interest.”
  • VI.4.3    “. . .medical profession as a whole has obligation to ensure access.”
  • VI.4.4    “. . . physicians not to interfere with or obstruct access.”
  • VI.4.5    “. . .physicians not to abandon their patients.”
  • VI.4.6     “. . . legally permissible and publicly-funded . . .”
  • VI.4.7    “. . . health services. . . health . . . well-being. . .”
  • Summary
  • VI.4.12    Conclusion
• VI.5    Is the policy a compromise?
  • VI.5.9    Conclusion

VII.    Discussion

• VII.5    Medicine is a moral enterprise.
• VII.6    Consider first the well being of the patient.
• VII.7    Morality is a human enterprise.
• VII.8    A secular public square includes religious belief.
• VII.9.   Avoid authoritarian solutions.
• VII.10  There is no duty to do what is believed to be wrong.
• VII.11  Forcing someone to do wrong is violation, not limitation.
• VII.12. Accommodate different conceptions of “the good life.”

VIII.    Conclusions

Appendix “A”: Origin of the CPSS Draft Policy

• AI.    Attempts to coerce physicians: abortion
• AII.    Plans to coerce physicians: assisted suicide and euthanasia
• AIII.    Plans to coerce physicians: the CRG Model Policy
• AIV.    Saskatchewan College replicates the CRG Model

Appendix “B”:  Development of the CPSS Draft Policy

• BI.    Conscience Research Group (CRG)
• BII.    CRG convenes meeting with College representatives
• BIII.   Meeting of Registrars of BC, Alberta, Saskatchwan, Manitoba and Ontario
• BIV.    Controversy about Alberta physician declining to prescribe contraceptives
• BV.    Canadian Registrars advised to adopt uniform coercive policy
• BVI.    Memo to College Council proposes policy on “ethical objection”
• BVII.    College Council approves formation of committee
• BVIII.    Committee meeting
• BIX.    Council approval in principle

Appendix “C”: Interview of CPSS Associate Registrar

Appendix “D”:  Ontario, Alberta, Manitoba and Saskatchewan College Policies

• DII.    College of Physicians and Surgeons of Ontario
• DIII.    College of Physicians and Surgeons of Alberta
• DIV.    College of Physicians and Surgeons of Manitoba
• DV.    College of Physicians and Surgeons of Saskatchewan

Appendix “E”:  College of Physicians and Surgeons of Saskatchewan Re: Guideline: Unplanned Pregnancy

Appendix “F”:  Morally Significant Participation

• FI.    Conscientious Refusal within the context of Carter
• FII.    “The serious moral burdens of complicity”
• FIII.    “Parties” to killing
• FIV.    Participation in killing
  • FIV.2    World Medical Association
  • FIV.3    American Medical Association
• FV.    Participation in torture
  • FV.2    Extraordinary rendition
  • FV.3    Maher Arar
  • FV.4    Physician participation in torture
• FVI.    Participation in female genital cutting (mutilation)
• FVII.    Refusing to participate

Appendix “G”:  Notes on Referral, Abandonment and Fiduciary Duty

• GI.    Referral and abandonment
• GII.    Fiduciary duty