Category: Policies-Position Papers

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]

Freedom of conscience and nursing in Alberta

Sean Murphy*

Introduction

Nursing has often been described as a “caring profession.” For historical reasons associated with the development of nursing, it appears that most nursing guidance documents use the terms “care” or “nursing care” with respect to all nurse-patient interactions, including interventions or treatments ordered by attending physicians.

This puts objecting nurses at a rhetorical disadvantage. Objections are made to treatments or interventions, not to caring. However, in a nursing context this is more readily perceived or characterized as “refusing to care.”

The failure to distinguish between “care” and “treatment” can introduce uncertainty into guidance about conscientious objection, which, for example, may insist that an objecting nurse continue to provide “care” for a patient until relieved, without specifying that the care does not include the treatment or intervention to which the nurse objects…[Full text]

Physician freedom of conscience in Alberta

Sean Murphy*

Alberta has been identified by freedom of conscience advocates as providing a satisfactory model of accommodation that should be imitated across the country. In late 2019 the head of the Alberta Medical Association and sponsor of a controversial protection of conscience bill in the Alberta legislature agreed that existing protections were “appropriate and effective.” On the other hand, it has been reported that Alberta physicians are obliged to refer for morally contested services, including assisted suicide, which would be unacceptable to many objecting practitioners. The dissonant evaluations reflect differences between actual practice and two College policies that take different approaches to freedom of conscience…[Full text]