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.

Conscientious Objection in Health Care

Letter

Stahl and Emanuel (April 6 issue)1 rightly differentiate between conscripts and physicians. Nonetheless, they state, “the profession . . . uses reflective equilibrium to self-correct. This dynamic process establishes professional obligations . . . regardless of . . . personal beliefs.”1 This point fails to recognize that conscientious objectors are engaging in the dynamic process from within the profession to counter problematic professional obligations and to correct mistakes. . . [Full text]

Liao L,Goligher E.  Conscientious Objection in Health Care, N Engl J Med 2017; 377:96-98 July 6, 2017 DOI: 10.1056/NEJMc1706233

‘Freedom of conscience’ a must, says doctor

Catholic Register

Michael Swan

TORONTO – It’s rare for an hour-long, academic lecture to get a standing ovation, but Dr. Ewan Goligher earned thunderous applause from about 100 people who turned up on a cold, rainy night to hear his defence of medical conscience.

The Toronto intensive care physician and researcher has become one of the leading voices opposing efforts to force doctors to make an “effective referral” for assisted suicide.

Goligher maintains that for the sake of medicine and democratic society, doctors must have a right to conscientious objection — not just for abortion but also for assisted killing.

“Freedom of conscience in the practice of medicine has been seriously eroded in recent years,” Goligher warned at the second annual deVeber Institute lecture delivered at the University of Toronto’s Wycliffe College on Oct. 27. . . [Full text]

The Ethics of Conscientious Objection in Health Care

deVeber Institute
Annual Public Lecture with Wycliffe College at the University of Toronto

In the wake of the legalization of physician-assisted death, conscientious objection in medicine has become a matter of considerable controversy. Some bioethicists have called for severe restrictions on the physician’s capacity to object to patient requests on ethical grounds, and some Colleges of Physicians have enacted such restrictions.

This issue raises fundamentally important questions: what is the basis of the physician’s professional obligations? To what extent is the physician obligated to honour patient requests? What is the goal and purpose of medical practice? How can we resolve differences in ethical beliefs in a deeply pluralistic society? This controversy engages contested ethical, political and religious matters and promises to influence patient care and the practice of medicine in Canada in coming years. This lecture aims to chart a course through these muddied waters.

Christian doctors challenge Ontario’s assisted-death referral requirement

Globe and Mail

Sean Fine

Groups representing more than 4,700 Christian doctors across the country have launched a court challenge to Ontario regulations that require them to refer patients to physicians willing to provide an assisted death, arguing the referrals are morally equivalent to participating in the procedure.

The College of Physicians and Surgeons of Ontario, however, takes issue with the faith groups’ position. “An effective referral does not foreshadow or guarantee an outcome,” college spokeswoman Tracey Sobers said in an e-mail.

Ewan Goligher, a doctor who works in the intensive care unit at Mount Sinai Hospital in Toronto, said he considers himself a conscientious objector to doctor-assisted dying and supports the court challenge. “I think the patient is of greater value than their preference, and I cannot lift my hand to destroy that which is of fundamental value,” he said in an interview. . . [Full Text]