Category: Ethics

Lessons Learned: May a Healthcare Professional Say No To Treating Ebola?

JD Supra Business Advisor

Daniel Meier

May a licensed healthcare professional refuse to treat a patient?  Healthcare providers have legal, ethical and professional duties to address a patient’s needs that fall within the provider’s scope of practice. However, are doctors, and other health care personnel, required to treat any and all patients, even if doing so might cost them their lives? While this is an issue that has arisen with the recent Ebola outbreak, it is not a new issue and has been previously addressed.

History of Refusing to Treat

During the early HIV/AIDS era in the 1980s, when there was little known about the disease, there were physicians and other health care workers who refused to treat HIV infected patients.  Accordingly, in 1992, the American Medical Association declared in an ethics opinion that “A physician may not ethically refuse to treat a patient whose condition is within the physician’s current realm of competence solely because the patient is seropositive for HIV. Persons who are seropositive should not be subjected to discrimination based on fear or prejudice.” AMA Opinion 9.131 (March 1992, updated June 1996 and June 1998).

Similarly, the American Dental Association stated in its Principles of Ethics and Code of Professional Conduct that, “[a] dentist has a general obligation to provide care to those in need. A decision not to provide treatment to an individual because the individual has AIDS or is HIV seropositive based solely on that fact is unethical.”  American Dental Association, ADA Principles of Ethics and Code of Professional Conduct III § 4.A.1 (2012).

During the recent Ebola outbreak, healthcare personnel were once again refusing to treat infected patients.  Is this acceptable? . . [Full text]

 

Proposed policy of Ontario College of Physicians “appalling”

Medscape

Reproduced with permission of the author

Dr. Terence McQuiston, M.D.

Dr. Gabel is not alone in this opinion, but I find it nevertheless appalling. Ever since Hippocrates medical ethics were determined by our profession independently of government legislation (including human rights tribunals). We Canadians stood in judgement at Nuremberg over the German physicians of the Nazi period.

Their defense was that they had done nothing outside of the law (true). However, we took the view that ethics transcend and should inform legislation, not the other way around, and therefore we could hold them to account for their deeds.

Such transcendence of ethics is only possible by the exercise of conscience by all physicians. Granted there may be differences arising from this exercise, but we should do our best to accommodate these differences.

That’s why we permit conscientious objection in wartime. Individual conscience is too precious a part of our social fabric to be casually overridden. The policy defended by Dr. Gabel in effect puts conscience on ice. If euthanasia becomes legal, I for one still won’t do it.

This comment responds to the Medscape article “Doctors opposing draft abortion policy may need to rethink whether family practice is right for them, says CPSO official: Direct referrals a sticking point in Ontario’s human rights policy (17 December, 2014)  Dr. Marc Gabel was quoted to the effect that physicians unwilling to provide or facilitate abortion and contraception should not practice family medicine. Administrator

 

 

Catholics doctors who reject abortion told to get out of family medicine

The Catholic Register

Michael Swan

Catholic doctors who won’t perform abortions or provide abortion referrals should leave family medicine, says an official of the College of Physicians and Surgeons of Ontario.

“It may well be that you would have to think about whether you can practice family medicine as it is defined in Canada and in most of the Western countries,” said Dr. Marc Gabel, chair of the college’s policy working group reviewing “Professional Obligations and Human Rights.”

The Ontario doctor’s organization released a draft policy Dec. 11 that would require all doctors to provide referrals for abortions, morning-after pills and contraception. The revised policy is in response to evolving obligations under the Ontario Human Rights Code, Gabel said.

There have been no Ontario Human Rights Tribunal decisions against doctors for failing to refer for abortion or contraception.

Gabel said there’s plenty of room for conscientious Catholics in various medical specialties, but a moral objection to abortion and contraception will put family doctors on the wrong side of human rights legislation and current professional practice. . . [Full text]

 

‘Frightening’: Life and family leaders react to Ontario College of Physicians’ draft policy

LifeSite News

Pete Balinski

Numerous life-and-family groups have slammed a draft policy from Ontario’s College of Physicians and Surgeons that threatens to force doctors into providing abortions and contraceptives in some circumstances, calling it “inimical to living in a free society” and “frightening.”

“We can say goodbye to a slew of good doctors in Ontario [if the policy passes],” Andrea Mrozek, executive director of Institute of Marriage and Family Canada, told LifeSiteNews. “If I were one, with a young family, I’d leave. Who wants to live under the threat of constant legal action for doing what you believe is good care?”

The College Council approved the draft policy last week. The policy would force doctors who are “unwilling to provide certain elements of care due to their moral or religious beliefs” — such as abortion — to refer the patient “in good faith” to another doctor who would provide the service.

If there is nobody to whom the patient can be referred, then the doctor “must provide care that is urgent or otherwise necessary to prevent imminent harm, suffering, and/or deterioration, even where that care conflicts with their religious or moral beliefs.”

“Although physicians have [freedom of conscience and religion] under the Charter, the Supreme Court of Canada has determined that no rights are absolute,” the draft policy states, adding that the “right to freedom of conscience and religion can be limited.”

The College’s former president, Marc Gabel, has stated that doctors who fail to comply will face disciplinary action. . . [Full text]

The Globe and Mail: bullying from a bully pulpit

Re: Globe and Mail Editorial, 11/12 December, 2014

Will Johnston

If Tommy Douglas had foreseen that the public funding of  Medicare  would one day be the excuse to savagely persecute doctors with minority opinions about the birth control pill,  he might have been taken aback.  When Douglas was fighting for Medicare, the Pill had barely been invented though hundreds of women had already died from clots caused by that Pill’s high estrogen doses. Modern pills use a tiny fraction of the estrogen dose of the first generation Pill, but still result in side effects ranging from depression (common)  to fatal embolism (rare) in some users.   Modern birth control pills cause some breast cancer but prevent some ovarian and uterine cancer.  They can harm.

A minority of doctors, following  their own medical judgment, and soberly ignoring  edicts  from cranky Globe and Mail editorialists,  decide not to associate themselves with the Pill just as they and the majority would not refer a young woman whose family insists on clitoridectomy.  Some doctors do not prescribe antidepressants,  preferring other therapies for depression.  Few doctors would refer for or perform the removal of a healthy limb (yes, there is an activist group who clamor for that “service” too). Public funding doesn’t mean that doctors should discard their judgment.   Referring for something means approving of it.

If you tell a nasty stormtrooper where to go to find some refugees, but don’t personally persecute anyone, you are still implicated in the persecution.  If you tip off an addict as to where to get his drugs, but don’t personally sell the drugs, you are still complicit in the addict’s self-harm.  If you arrange the sale of a gun to a murderer, you become a link in the chain of responsibility for the consequences.

So we are left with some  questions:

1. What harm is there in forcing some doctors to refer to other doctors who have no principles  likely to   frustrate  the patient’s desires?  None, if you have no problem insisting that some doctors do what they think is wrong.

2.  Should the doctor’s disinclination to refer for some item on some politician’s list, promptly and obediently,  justify a quick end to the doctor’s career? Yes, if you want the medical system to end by serving the powerful and not the people.

3. In what way is referring a patient for an abortion like selling a murder weapon, abetting self-harm, or betraying the hiding place of a refugee ?  In each way, for those with eyes to see.

The Globe editorial is a bully’s cry demanding that the authorities hurt certain doctors with minority  opinions about controversial medical care.  These doctors  are to be hurt by being pulled away from the patients they have laboured to serve and by having their livelihoods destroyed.

The authors of the Globe editorial appear to have no idea who bequeathed  them the freedom to express themselves . Strident opinions can’t land them in jail or get them murdered by the police because this is not Iran or Russia. Their irritable and intemperate attack on a few earnest doctors betrays  an  impulse to coerce which, if not exposed and ridiculed, must end in totalitarianism.   We had better not let it.