Physician  freedom of conscience in Sasktachewan

Sean Murphy*

Abstract

Physician Assisted Dying adequately accommodates both physician freedom of conscience and patients’ access to services. It demonstrates that the College of Physicians and Surgeons of Saskatchewan could have taken the same approach to freedom of conscience in relation to other procedures and produced a satisfactory policy on conscientious objection.

Conscientious Objection is ambiguous with respect to effective referral and polemical in its treatment of a physician’s traditional obligation to render assistance in an emergency. It demonstrates the authors’ intention to suppress physician freedom of conscience by compelling them to provide or facilitate morally contested procedures, as well as the intricate wordplay necessary to achieve that end. . . [Full text]

The WMA and the Foundations of Medical Practice

Declaration of Geneva (1948), International Code of Medical Ethics (1949)

Sean Murphy, Ramona Coelho, Philippe D. Violette, Ewan C. Goligher, Timothy Lau, Sheila Rutledge Harding

The WMA and the Foundations of Medical Practice

Practising Medicine “with conscience and dignity”

Beginning with the Declaration of Geneva (the Declaration), for over 70 years the World Medical Association (WMA) has maintained that physicians must practise medicine with conscience and dignity [1]. On the Declaration’s 70th anniversary, seven associate WMA members raised serious concerns about their ability to remain in medical practice if they fulfil this obligation by refusing to support or collaborate in the killing of their patients by euthanasia and assisted suicide (EAS)[2].The physicians practise in Canada, where euthanasia and assisted suicide (EAS) are legal, [3,4] recognized as therapeutic medical services by the national medical association [5,6] and provided through a public health care system controlled by the state, which also regulates medical practice and medical ethics. The national government is now poised to make EAS available for any serious and incurable medical condition, vastly increasing the number of patients legally eligible for the service [7].

In these circumstances, it is urgent to reassert that the duty to practise medicine “with conscience and dignity” includes unyielding refusal to do what one believes to be wrong even in the face of overwhelming pressure exerted by the state, the medico-legal establishment and even by medical leaders and colleagues. That the founders of the WMA not only supported but expected such principled obstinacy is evident in the WMA’s early history and the development of the Declaration, all of which remain surprisingly relevant . . .


Murphy S, Coelho R, Violette PD, Goligher EC, Lau T, Harding SR. The WMA and the Foundations of Medical Practice: Declaration of Geneva (1948), International Code of Medical Ethics (1949) . WMJ [Internet]. 2020 Aug; 66(3): 2-8.

Quebec law and freedom of conscience for health care professionals

Sean Murphy*

Unlike other Canadian provinces, Quebec codes of ethics for health care professionals are enacted by provincial statute. Quebec is also unique in having a provincial euthanasia law, which includes a protection of conscience provision for health care professionals specific to that service.

Freedom of conscience for services other than euthanasia
Physicians

The Code of Ethics for Physicians1 and the gloss on the Code by ALDO Quebec,2 an authoritative document, require objecting physicians to advise patients of the consequences of not receiving the contested service, and “offer to help the patient find another physician.” They are not obliged to help the patient find someone willing to provide the contested service. Objecting physicians are normally quite willing to explain how patients can find other physicians or health care professionals. . . [Full text]

Pharmacist  freedom of conscience in Alberta

Sean Murphy*

Code of Ethics (2009)

A protection of conscience provision is found in the Alberta College  of Pharmacy Code of Ethics (2009).1 Objecting pharmacists are directed

  • to help patients “obtain appropriate pharmacy services from another pharmacist or health professional within a time frame fitting the patient’s needs” (clause 3);
  • to arrange their practices so that “the care of [their] patients will not be jeopardized” when they refuse to provide services for reasons of conscience (clause 4);
  • to continue “to provide professional services” until another pharmacist or health professional has assumed responsibility (clause 1).

The text seems to presume that the objecting pharmacist need not provide the morally contested service. The requirement to continue to provide “professional services” until someone else assumes responsiblity does not impose an obligation to provide it if another professional is not available within the relevant time frame. . . [Full text]

Freedom of conscience and nursing in Manitoba

Sean Murphy*

Abstract

For the most part, the codes of ethics and standards of Manitoba’s nurse regulators provide little insight into the regulators’ approach to freedom of conscience for nurses, and frequent failure to distinguish between “care” and “treatment” often impairs discussion of conscientious objection. The College of Licensed Practical Nurses of Manitoba code and standards appear inclined to separate personal and professional integrity, giving priority to the latter at the expense of the former. This encourages the view that nurses must leave their personal integrity in the parking lot when they report for work.

The regulators’ views about freedom of conscience for nurses are most clearly demonstrated in the joint publication Duty to Provide Care (2019). They recognize conscientious objection only to providing a service. They fail to recognize (or are unwilling to admit) that one can legitimately refuse to encourage or facilitate a service for reasons of conscience. Consistent with this, they demand that objecting nurses provide effective referral for all morally contested procedures, including euthanasia and accepted suicide. This would be unacceptable to anyone who believes that it is immoral to facilitate what one believes to be immoral.

Unlike earlier guidelines for euthanasia and assisted suicide, Duty to Provide Care (2019) fails to clearly distinguish between “care” and procedures or interventions, and it does not acknowledge the duty of employers (and regulators) to accommodate nurses in the exercise of freedom of conscience. . . [Full text]