Category: Ethics

Ethics Profiling in the Health Care Profession

Conscience Legislation  Needed to Stop Abuse of Authority

Ottawa
12 May, 2004

Will Johnston, MD President
Canadian Physicians for Life

The recent near-failing of a medical student at a Canadian university, solely because the student has pro-life convictions, shows how intolerant some people have become about choices they dislike. For years, Canadian     Physicians for Life has received anecdotal complaints from students who suspect that their medical school admission interview went badly after they truthfully answered questions which probed for pro-life beliefs. This recent case was blatant and completely documented, created undue anxiety for the student, and only ended after many months of unsuccessful appeals of the teachers’ intolerant actions. A modern democracy should have a keen interest in protecting vulnerable students from coercion by preceptors and professors who are unaware of, or insensitive to, the concept of freedom of conscience.

We don’t screen immigrants to Canada on the basis of race or religion. Why should such litmus tests be applied to citizens applying to enter key professions? Ethics profiling is no less objectionable than racial profiling.

Freedom of conscience, it seems, is now granted freely only to those whose views are acceptable to an authoritarian, secularist establishment. Others must endure the enormous costs and stress of legal challenges or implore sympathetic fellow citizens to petition those in power on their behalf. Until this situation is corrected, the Canadian experiment in pluralism will remain in a delayed adolescence.

Sincere proponents of multiculturalism and pluralism understand the importance of protection of conscience. But they must come to recognize that too many in positions of power need statutory reminders to treat fairly     those who disagree with them about the damage abortion does to women and children.

Basic conscience protection such as that provided in Bill C-276 begins to address the problems of abuse of authority and ethics profiling which lead to the kind of injustice seen in the recent case of the medical student. Such abuses must be explicitly treated in law, not left to an ad-hoc scramble by the victim and his or her friends.

The time is long overdue for the Parliament of Canada to follow the lead of countries like the United Kingdom, Australia, and New Zealand, and 46 American states to protect and clarify freedom of conscience for Canadian health care workers. In addition to necessary employment protection, the proposed Canadian legislation corrects deficiencies found in many such laws by explicitly protecting persons of conscience from exclusion from health sciences education and from discrimination by professional licensing bodies.

Canadian Physicians for Life 29 Moore Street, R.R. # 2 Richmond ON K0A 2Z0 ph/fax: 613-728-LIFE (5433) info@physiciansforlife.ca

Some corrections and clarifications

Project letter to the Calgary Herald

Sean Murphy*

While I am pleased to see that Laura Wershler is willing to accommodate freedom of conscience among health care workers, I must correct some misleading statements included in her article (“The morning after: Pro-life agenda misrepresents the emergency contraceptive pill, or ECP”,Calgary Herald, 13 February, 2004).

In the first place, http://www.consciencelaws.org is the URL of the Protection of Conscience Project, not “Repression of Conscience”. Contrary to Ms. Wershler’s assertion, this is a non-denominational human rights project, not a not a pro-life initiative. Pro-lifers are interested in the Project and sometimes link to our website, but the Project does not take a position on the morality of controversial procedures. It is enough to recognize the controversy, and advocate the accommodation of conscientious objectors. At least one pro-life pharmacist does not use the Project pamphlet about the morning-after pill precisely because the pamphlet does not argue against its use.

Second, Ms. Wershler’s article incorrectly attributes to the Project the use of the terms “abortion drug” and “emergency contraceptive (ECP)”. The Project does not use either term, except when quoting other sources. They are confusing, and complicate articulation of freedom of conscience issues.

“Abortion drug” is an appropriate description of mifepristone (RU486), which is designed specifically to cause the abortion of an embryo that has implanted in the uterus. The morning-after pill has not been designed for that purpose, and does not act in that way.

“Emergency contraception” is a fabulously successful marketing term. However, 94% of the women who take the morning-after pill do not require it to prevent childbirth. This statistic, provided by the drug’s advocates,[1] belies the notion of ’emergency’ that is often used to browbeat conscientious objectors. As to “contraceptive”, Ms.Wershler herself acknowledges that these drugs have three mechanisms of action, one of which may prevent implantation of the early embryo, thus causing its death. This is considered by many conscientious objectors to be the moral equivalent of abortion, a term acknowledged as appropriate by some authorities,[2] though the usage is not uncontested. The Project refers to these drugs generically as the ‘morning-after pill’ because this term is widely understood. We describe the morning-after pill as “potentially abortifacient”, in the sense that it may cause the death of the early embryo, but does not necessarily do so.

A final note to prevent further confusion: the meaning of “abortifacient” in a medical or scientific context is not the same as its meaning in a moral context. In a medical context, a drug that prevents fertilization (acts contraceptively) 95 to 99 times out of a hundred would be called a contraceptive rather than a abortifacient. But in a moral context, when the outcome may be death, a drug may be treated as an abortifacient if there is even a 1% chance of it killing the embryo by preventing implantation. A number of disputes that arise about the morning-after pill are a regrettable consequence of failing to recognize these distinctions.

Notes

1. Apply a calculator to the following statement: “In 16 months of ECP services, pharmacists provided almost 12,000 ECP prescriptions, which is estimated to have prevented about 700 unintended pregnancies.” Cooper, Janet, Brenda Osmond and Melanie Rantucci, “Emergency Contraceptive Pills- Questions and Answers”. Canadian Pharmaceutical Journal, June 2000, Vol. 133, No. 5, at p. 28.

2. Keith L. Moore and T.V.N. Persaud, The Developing Human: Clinically Oriented Embryology (6th ed.) (Philadelphia: W.B. Saunders Company, 1998), p. 532. Quoted in Irving, Diane N., A “One-Act Drama:The Early Human Embryo:’Scientific’ Myths and Scientific Facts:Implications for Ethics and Public Policy, Medicine and Human Dignity.” International Bioethics Conference, ‘Conceiving the Embryo’, Centre Culturel, Woluwe-St. Pierre, Brussels, Belgium: October 20, 2002 (9:30 A.M.)(Revised 23 October, 2002) Note 23.

Project Letter to The Daily News

Nova Scotia, Canada
27 December, 2002

Sean Murphy, Administrator
Protection of Conscience Project

This response to your article Bacon, eggs and peace of mind: Pharmacists, Planned Parenthood push for prescription-free morning-after pill (17 November, 2002) has been delayed by the need to consult the Nova Scotia College of Pharmacists.

With respect to the ‘morning-after-pill’, your article attributed the following quote to Kelly Grover of Planned Parenthood: “Nobody is forcing pharmacists to prescribe this. There is a code of ethics that requires them to refer patients.”

In fact, the College’s Code of Ethics does not require referral. A pharmacist who objects to providing a drug for reasons of conscience is to advise an employer of that fact when being hired. It then becomes the obligation of the employer, not the pharmacist, to find an alternative means to deliver the drug.

The disclosure requirement in the Code of Ethics is intended to ensure that the freedom of conscience of pharmacists is fully respected, without preventing patients from getting drugs or services that they want.  Unscrupulous employers could misuse the disclosure requirement by using it to identify conscientious objectors and deny them employment. One hopes that the College will defend pharmacists against this form of discrimination, as it would be a pity to see Nova Scotians forced to leave home to seek employment in more tolerant environments.

Who is “imposing morality” in Barrie?

Winnipeg, Manitoba
5 April, 2002

Sean Murphy,  Administrator
Protection of Conscience Project

The Canadian Broadcasting Corporation (CBC) is Canada’s publicly funded state radio and television broadcaster. The following was sent to the CBC in Winnipeg, Manitoba, asking whether or not it would be accepted for broadcast in the same region where Dr. Goldman’s editorial was aired. The CBC did not  reply.

In an editorial broadcast on CBC Radio on 7 March, 2002, Dr. Brian Goldman criticized Dr. Frederick Ross of Winnipeg, Manitoba, and Dr. Stephen Dawson of Barrie, Ontario. Dr. Ross had told his patients to stop smoking or find another doctor, while Dr. Dawson had refused to prescribe birth control pills or Viagra to single patients.

It does not seem that Winnipeg’s Dr. Ross believes that treating smokers is wrong, nor that it would be wrong to refer a smoker to another physician. His public statements do not preclude the possibility that he would treat smokers on an ad hoc basis (while standing in for an absent partner, for example).

In contrast, Dr. Dawson refuses to help single patients obtain birth control pills and Viagra under any circumstances, because he believes that by doing so he would be a party to immoral activity (i.e.,extramarital sex). Dr. Goldman was more sympathetic to this position, but criticized Dawson because he would not refer patients to other physicians who would prescribe the drugs.

Dr. Goldman recognized that his colleagues were acting for different reasons, but in drawing his conclusions he failed to maintain this distinction or recognize its significance. It is one thing to refuse to do something because it is inconvenient, difficult, frustrating, or pointless; it is quite another to refuse to do something because it is wrong. Grasping this distinction is the key to understanding the difference between the case of Dr. Ross, which does not seem to involve conscientious objection, and that of Dr. Dawson, which plainly does.

What some characterize as Dr. Dawson’s inflexibility actually illustrates the normal human reaction to a request to do something wrong. For example, a fifty year-old man who wanted to have sex with a fourteen year- old girl might be refused the use a friend’s apartment for that purpose. Nor would it be surprising if the unco-operative  friend also refused to refer the lecher to a more ‘flexible’ apartment owner.

We see the same principle at work in criminal law. It is an offence not only to commit a crime directly, but to counsel, aid or abet a crime committed by someone else. Again: many people who engage in ‘ethical investment’ do so because they do not want to be implicated, even indirectly, in business practices to which they object for reasons of conscience, even if the practices aren’t illegal.

Now, no one is suggesting that consensual extramarital sex between adults is morally equivalent to criminal activity. But when Dr. Dawson refused to provide birth control for single patients, he reacted exactly as an ‘ethical investor’ might react if asked to purchase shares in a company that exploits child labour. He reacted exactly as an honest man would act were he asked to help someone lie or cheat. In other words, he  acted as if extramarital sex really is wrong, and that its wrongness is not merely a matter of opinion or taste. That, in truth, is what has upset many of his critics; he has disturbed their repose in their  comfortable pews.

Of course, one may criticize a physician for causing needless distress to a patient by offering a poorly articulated or inappropriate explanation of his moral position. But that was not Dr. Goldman’s concern. Instead, he complained that Dr. Dawson had acted upon his own beliefs.

In fact, Dr. Goldman does exactly the same thing. He believes that he does nothing wrong by providing single patients with contraceptives and Viagra, and he acts upon that belief by writing prescriptions. Why should Dr. Goldman be allowed to act upon his beliefs by writing prescriptions, while Dr. Dawson is forbidden to act upon his by refusing  to do so? Is it because “the true north strong and free” is afraid of religious believers?

A physician who refuses, for reasons of conscience, to do something he believes to be wrong – falsifying a diagnosis, amputating a healthy limb, or prescribing contraceptives – does not force a patient to conform to his moral code. He is not “imposing morality.” To see what  “imposing morality” really means, watch this month when the Ontario College of Physicians and Surgeons tries to force Barrie’s Dr. Stephen Dawson to give up his Christian convictions, on pain of professional excommunication.

Project Letter to Telegraph Journal

New Brunswick, Canada
24 February, 2002

Sean Murphy, Administrator
Protection of Conscience Project

Dr. Monica Brewer’s characterization of physician referral for morally controversial purposes as a “black and white” issue is the result of inadequate reflection.(“MD’s Morals Restricting Birth Control Access,” February 9, 2002) Her suggestion that doctors who object to the morning-after-pill and contraception “should pair with doctors to whom they can refer” is a suitable solution only for those whose objections are simply matters of professional judgement or personal preference.

For example: physicians who know that 94% of the women who are sold the morning-after-pill do not actually require it to prevent pregnancy (the numbers are provided by those who support its widespread use1) may be unwilling to prescribe it for that reason. However, they might well refer a patient who wants the drug to a doctor who will.

Similarly, some physicians believe that women’s health and social interests are better served by learning to recognize their natural fertility cycles, so that they need not be dependent upon physicians or drug companies to plan or avoid pregnancy. These physicians may not prescribe birth control pills for ‘ecological’ reasons, but probably wouldn’t object to referral.

Finally, an obstetrician who thinks that aborting Down syndrome infants is a good idea, but finds performing abortions a traumatic experience, would probably welcome the opportunity to refer a patient to another colleague.

The situation is quite different when physicians are asked to refer a patient for something to which they have grave moral objections. They believe that by referring patients they are themselves morally culpable for facilitating the wrong that is done. Strange? Not at all.

Consider Newsweek columnist Jonathan Alter’s suggestion that, since physical torture is “contrary to American values”, the US should turn terrorist suspects who won’t talk over to “less squeamish allies.”2 No one would seriously argue that this would relieve the US of moral complicity in torture.

Of course, moral complicity in abortion, contraception and the morning-after-pill are not issues for people like Dr. Morgantaler and his associate, Judy Burwell, who think these are good things, and that those who think differently are mistaken. But it is surprising that they view freedom of conscience as a problem to be solved by abolishing it, at least for those who don’t agree with them.

After all, Dr. Morgantaler justified his defiance of Canadian abortion law in a 1970 article titled, “A Physician and His Moral Conscience.” 3

Notes (provided for editorial verification)

1. “In 16 months of ECP services, pharmacists provided almost 12,000 ECP prescriptions, which is estimated to have prevented about 700 unintended pregnancies.” Cooper, Janet, Brenda Osmond and Melanie Rantucci, “Emergency Contraceptive Pills- Questions and Answers”. Canadian Pharmaceutical Journal, June 2000, Vol.133, No. 5, at p. 28. See also Valpy, Michael, “The Long Morning After”, Globe and Mail, 15 December, 2001)

2. Alter, Jonathon, “Time to Think About Torture”. Newsweek, 5 November, 2001, p. 45.

3. The article appeared anonymously in The Humanist. Quoted in Pelrine, Eleanor Wright, Morgantaler: The Doctor Who Couldn’t Turn Away.  Canada: Gage Publishing, 1975, P. 79