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