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Ethical Cleansing in Ontario

Sean Murphy*

An Ontario College of Physicians official, Dr. Marc Gabel, says that physicians unwilling to provide or facilitate abortion for reasons of conscience should not be family physicians.¹ The working group Dr. Gabel chairs wants the College to approve this policy.² If it does, ethical cleansing of Ontario’s medical profession will begin this year, ridding it of practitioners unwilling to do what they believe to be wrong. Dr. Gabel claims that this is required by professional practice and human rights legislation.

It is not clear that the Ontario Medical Association (OMA) will agree. After all, it requires some effort to maintain that physicians are ethically or morally obligated to do what they believe to be unethical or immoral. Moreover, last August, the OMA’s General and Family Practice Section warned Dr. Gabel’s working group that the quality of medical care would suffer if only students willing to sacrifice their personal integrity were accepted in medical school. Moreover, “What about remote areas of practice?” the Section asked. “Will more prescriptive policies drive physicians to feel that they will have no choice but to practice in more urban settings?”³

In other words, is it really better that a pregnant woman in Gravel Roads Only should have no local obstetrical care rather than the help of a rural physician unwilling to recommend or refer for abortion?

The concern expressed by the OMA is understandable, but actually beside the point. In truth, concern about access to services is not really what is behind the drive for ethical cleansing. That was made abundantly clear in Ottawa last year, after it was learned that an Ottawa physician was refusing to prescribe or refer for contraceptives. The story hit the front page of the Ottawa Citizen.

The Citizen did not report the mere facts: that a young woman had to drive around the block to get The Pill. That might have been dismissed as a first world problem. No: the Citizen had more ominous news. It had discovered, lurking in the nation’s capital, not just one, but three physicians who would not prescribe or refer for contraceptives or abortion.⁴ There was pandemonium. An activist group began preaching a crusade against the dissenters, a vitriolic feeding frenzy erupted on Facebook,⁵ vehement denunciations appeared elsewhere⁶ and the story became the subject of a province-wide CBC broadcast.⁷

One of the Facebookers helpfully suggested that the objecting physicians should move elsewhere, “maybe Dubai,” where they could be among their “own kind,”⁸ while others raged that they had “no business practicing family medicine”⁹ and “[did] not deserve to practice in Canada. PERIOD.”¹⁰

To find such comments on Facebook is not surprising. But it is surprising – and regrettable – that the comments offered by Dr. Gabel reflect the same attitude.

Now, there are about 4,000 physicians practising in the Ottawa area,¹¹ and contraceptives and abortion referrals are so widely available in the city that the Medical Officer of Health says that it is cause for celebration.¹² Thus, the wildly disproportionate reaction to news that 0.08% of Ottawa area physicians do not prescribe or refer for contraceptives cannot be explained as a rational response to a problem of supply and demand.

The crusade against the three physicians, now expanded by Dr. Gabel and his working group to a crusade for the ethical cleansing of the entire medical profession, is not driven by merely practical concerns about access to services. It is driven by an a markedly intolerant ideology masquerading as enlightened objectivity.

That is why the OMA’s concern that objecting physicians might be restricted to practising in urban centres is understandable, but misplaced. Ontario physicians must come to grips with the fact that, once ethical cleansing gets underway, dissenting physicians will have no refuge in big cities, even if it takes the crusaders longer to find them there.

Nor, if assisted suicide and euthanasia are legalized, will there be refuge for physicians who don’t want to participate in killing patients. The College’s draft policy on end of life care “requires physicians to sensitively respond to a patients wishes or requests to hasten death”¹³ and insists that physicians who “limit their practice on the basis of moral and/or religious grounds” must comply with College policy on human rights.¹⁴ If the law is changed, and Dr. Gabel and his working group get their way, this policy will require physicians who refuse to kill patients to help them find someone who will.

Physicians will be expected to prescribe, abort or refer, to lethally inject or refer, or get out of medicine – or get out of the country.

[PDF text]

Notes

1. “Catholics doctors who reject abortion told to get out of family medicine.” The Catholic Register, 17 December, 2014 (Accessed 2018-03-07)

2. College of Physicians and Surgeons of Ontario, “Professional Obligations and Human Rights (Draft).” (Accessed 2018-03-07)

3. Letter to the College of Physicians and Surgeons of Ontario from the Ontario Medical Association Section on General and Family Practice Re: Human Rights Code Policy, 6 August, 2014. (Accessed 2018-03-07)

4. Payne E. “Some Ottawa doctors refuse to prescribe birth control pills.” Ottawa Citizen, 30 January, 2014 (Accessed 2018-03-07)

5. Murphy S. “NO MORE CHRISTIAN DOCTORS.” Protection of Conscience Project.

6. “Some Ottawa doctors refusing to prescribe birth control, cite ‘ethical concerns and religious values.’” Reddit Ottawa (Accessed 2018-03-07)

7. CBC Radio, “Should doctors have the right to say no to prescribing birth control?” Ontario Today, 25 February, 2014 (Accessed 2018-03-07)

8. T___ M___, 29 January, 2014, 6:56 pm

9. A___ M___ 29 January, 2014, 7:41 pm

10. R___ V___, 29 January, 2014, 7:52 pm

11. College of Physicians and Surgeons of Ontario, All Doctor Search (Accessed 2014-07-29;2018-03-07)

12. Levy I. (Medical Officer of Health, Ottawa) and Abdullah A. (President, Academy of Medicine, Ottawa), Letter to the Ottawa Citizen, 1 February, 2014.

13. College of Physicians and Surgeons of Ontario, Planning for and Providing Quality End of Life Care: Key Features of the Draft Policy (Accessed 2018-03-07)

14. College of Physicians and Surgeons of Ontario, Planning for and Providing Quality End of Life Care (Draft), lines 363-365. (Accessed 2018-03-07)

CBC interviewer fails to ask tough questions

Sean Murphy*

A bill has been introduced in the Canadian Senate by Conservative Senator Nancy Ruth to legalize physician assisted suicide and euthanasia. Bill S-225’s definition of of “assist” is of particular interest. It means “to provide the person with the knowledge or means to commit suicide, or to perform an act with the intent to cause the person’s death.” Consistent with this, an “assisting physician” is one “who provides assistance” to a patient seeking euthanasia or physician-assisted suicide.

This indicates that indirectly facilitating suicide even by providing information for that purpose is equivalent to more direct forms of assistance, like providing a lethal prescription. Further, it implies that both providing information to facilitate suicide and actually killing someone are of comparable legal or moral significance. Many physicians and health care workers who object to assisted suicide and euthanasia would agree, and, for that reason, would refuse to refer or otherwise help a patient find someone willing to kill him or assist him in committing suicide.

The point was overlooked during an interview of Senator Ruth by Evan Solomon on CBC Television’s Power and Politics (2 December, 2014). After discussing the contents of the bill in general terms and asking Senator Ruth about her reasons for introducing it, Solomon raised the issue of conscientious objection:

Evan Solomon: A doctor might be watching this, and say, you know, “Great piece of legislation. What do you do if, what will you do to me if I don’t want to do this?”

Senator Ruth: Nothing. No doctor is coerced to do this, no patient is coerced to do this. This is about choice. The choice of doctors who want to assist in it and their protection . . .

Solomon failed to ask the tough questions. Among them:

If physicians will not be forced to kill patients, will they, nonetheless, be forced to help patients find someone who will?
Why is it that the bill is about the choice and the protection of doctors who want to help to kill patients, and not about the choice and protection of those who refuse?
When abortion was legalized, politicians and activists promised that no physician would be forced to provide abortions, but refused to include a protection of conscience provision in the law.¹ Now the College of Physicians of Ontario is proposing a policy that would compel physicians to provide abortions or help patients obtain them.² Dr. Marc Gabel, chair of the working group that produced the draft policy, warns that physicians who refuse to do this should get out of family practice.³ As written, the policy could be applied equally to euthanasia and assisted suicide. Why does Senator Ruth think that objecting physicians will not be coerced – if not sooner, then later?

Notes:

1. Murphy, S. “Promises, promises. Canadian law reformers promise tolerance, freedom of conscience:What happens after the law is changed is another story.” Protection of Conscience Project

2. “Ontario physicians to be forced to do what they believe to be wrong: Draft policy demands that objectors provide or refer. Policy would apply to euthanasia, if legalized.” Protection of Conscience Project news release, 10 December, 2014

3. Swan, M. “Catholics doctors who reject abortion told to get out of family medicine.” The Catholic Register, 17 December, 2014. (Accessed 2014-12-19)

Looking back on 15 years: an anniversary

December, 1999 to December, 2014

Sean Murphy*

The Protection of Conscience Project celebrates its 15th anniversary in December, 2014. The formation of the Project was one of the eventual results of a meeting in Vancouver with British Columbian Senator Ray Perrault1 in the spring of 1999.

Senator Perrault wished to continue the work of retiring Liberal Senator, Stanley Haidasz, whose protection of conscience bill was stalled in the upper chamber.2 Among the experiences that spurred Senator Perrault to continue Senator Haidasz’s work was an encounter while going door to door during an election campaign. A nurse, in tears, told him that she had quit work after 15 years because she was required to participate in abortions, and could no longer do so in good conscience.

The meeting was sponsored by the Catholic Physicians Guild of Vancouver. Most participants were physicians or pharmacists. They spoke of their growing concern that they would be penalized or forced out of their professions if they continued to practise in accordance with their religious or moral beliefs. It became clear that these health care professionals had come to recognize the growing threat to their freedom to serve their patients without violating their personal and professional integrity. This was a key factor in the establishment of the Protection of Conscience Project nine months later.

While the meeting in 1999 was called by a Catholic organization, the Protection of Conscience Project is a non-profit, non-denominational initiative that does not take a position on the acceptability of morally contested procedures like abortion, contraception or euthanasia: not even on torture. The focus is exclusively on freedom of conscience and religion.

The Project is supported by an Advisory Board drawn from different disciplines and religious traditions, a Human Rights Specialist and an Administrator, all of whom serve without remuneration.3 It was conceived as an initiative rather than an organization, association or society; it has no ‘members’ or structures of an incorporated entity. This ensures that the time and energy that would otherwise be needed to maintain corporate structures is spent on more immediately practical work. The name originated in a comment made by Iain Benson, then Senior Research Fellow of Canada’s Centre for Cultural Renewal, now Senior Resident Scholar, Massey College, University of Toronto.4

“We don’t need another organization,” he said. “We need a project.” [Full text]

When is a problem not a problem?

Refusing to dispense drugs to kill patients with psychiatric illness

Levenseinde Kliniek complains about uncooperative Dutch pharmacists

Sean Murphy*

In April, 2014, a complaint was made in the Netherlands that some Dutch pharmacists were refusing to provide euthanasia drugs. The complaint led members of the Dutch Parliament from the green party, GroenLinks, to ask for a debate with health minister, and members of other Dutch political parties let it be known that they were also concerned.

According to the news reports, over half the physicians at “the independent euthanasia clinic” had been refused lethal drugs, and 23 percent of 53 pharmacists surveyed reported that they sometimes refused to fill euthanasia prescriptions. It was argued that pharmacists should not be able to refuse drugs needed to kill patients if two physicians had approved the euthanasia request. However, while the law in the Netherlands permits physicians to provide euthanasia, it does not mention pharmacists. [Full Text]

Judgementalism and moralising in response to Brittany Maynard suicide

Sean Murphy*

On 1 November, Brittany Maynard, a 29 year old woman with terminal brain cancer, committed suicide in Oregon State with the assistance of a physician (and, presumably, a pharmacist), who provided the lethal medication she consumed. Assisted suicide is legal in Oregon; that is why Maynard moved to the state. In the weeks leading up to her death she had become a celebrity because of her public advocacy of assisted suicide, augmented by a kind of “countdown” to the date she had chosen to die. [NBC News]

It is not surprising that the announcement that she had killed herself as planned was followed by an outburst of judgementalism and moralising.

Prominent bioethicist Arthur Caplan stated, “did nothing immoral when she took a lethal dose of pills.” He dismisses the view that “only God should decide when we die” because he finds that inconsistent with the existence of free choice, adding, “To see God as having to work through respirators, kidney dialysis and heart-lung machines to decide when you will die is to trivialize the divine.” [Brittany Maynard’s Death Was an Ethical Choice]

Chuck Currie, a minister of the United Church of Christ in Oregon, also insisted that Maynard had “made a moral choice.” He described committing suicide under the terms of the Oregon law as taking “medically appropriate steps to make that death as painless and dignified as possible” – an appropriate exercise of “moral agency.” Like Caplan, his theological views about the nature of God inform his approach to the issue. [Brittany Maynard Made A Moral Choice]

Writing in the New York Post, Andrea Peyser did not explicitly address either moral or theological questions, but implicit in her headline and awestruck praise for Maynard’s suicide was the premise that the young woman had done a “brave” and good thing. [We should applaud terminally ill woman’s choice to die]

In contrast, the head of the Catholic Church’s Pontifical Academy for Life in Rome, Monsignor Ignacio Carrasco de Paula, said that Maynard’s killing herself was a “reprehensible” act that “in and of itself should be condemned,” though he stressed that he was speaking of the act of suicide itself, not Maynard’s moral culpability. [Daily News]

Those who condemn “judgementalism” and “moralising” ought to be offended by all of these commentators, because all of them – Caplan, Currie, Peyser and de Paula – have expressed moral or ethical judgements. To condemn suicide as “reprehensible” is surely to make a moral or ethical judgement, but moral judgement is equally involved in a declaration that suicide is a “moral” or “ethical” choice that should be applauded.

Health care workers who refuse to participate in some procedures for reasons of conscience or religion are often accused of being “judgemental” or of “moralising.” In fact, as the preceding examples illustrate, their accusers are not infrequently just as “judgemental” and “moralistic.” Such differences of opinion are not between moral or religious believers and unbelievers, but between people who believe in different moral absolutes.

This was one of the points made by Father Raymond De Souza during an interview about assisted suicide on CBC Radio’s Cross Country Checkup. Interviewer Rex Murphy asked him if he thought that “the idea of any absolute . . . even on the most difficult of questions of life and death . . . are no longer sufficient . . . for the modern world.” Fr. De Souza’s response:

It’s a shift, Rex, I would say from one set of absolutes to the other. And the absolute would be the absolute goodness of life, in one case, to assertion of personal autonomy, which is becoming an absolute assertion. And in fact in some of the arguments that have gone before the court, while acknowledging potential difficulties and philosophical objections, the right to personal autonomy trumps everything else. So, in a certain sense, I wouldn’t say we are moving away from absolutes, but shifting from one set of absolutes to the other . . . [34:21- 35:24]