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Margaret Somerville: A Modest Proposal for Respecting Physicians’ Freedom of Conscience

10 Feb 2015
McGill University Professor Margaret Somerville (Construction of New Realities in Medicine) reflects on the controversy between patients’ right of access to abortion and doctors’ freedom of conscience.

The Ontario College of Physicians and Surgeons is consulting on whether patients’ right of access to certain procedures, such as abortion, should trump the rights of those physicians who refuse, for reasons of conscience, to provide them. Dr. Marc Gabel, a College official, chairs the working group looking at this issue, which is drafting a new policy on “Professional Obligations and Human Rights.”

Dr. Gabel has been reported as saying that “physicians unwilling to provide or facilitate abortion for reasons of conscience should not be family physicians” and it seems wants the College to approve that stance. Sean Murphy, of the Protection of Conscience Project, argues that “if it does, ethical cleansing of Ontario’s medical profession will begin this year, ridding it of practitioners unwilling to do what they believe to be wrong.”

Freedom of conscience, like the other fundamental freedoms enshrined in the Canadian Charter of Rights and Freedoms, is a fundamental pillar of democracy. So how could breaching this right be, as Dr Gabel claims, “required by professional practice and human rights legislation”? The best answer is that it is not. In fact, it would be a perversion of the norms and applications of both professional practice requirements and human rights legislation to interpret them as establishing such a requirement. So why is this argument being made?

Murphy explains that the “crusade for the ethical cleansing of the entire medical profession is not driven by merely practical concerns about access to services such as abortion or, possibly in the future, euthanasia. It is driven by a markedly intolerant ideology masquerading as enlightened objectivity.” This is yet another values battle in the culture wars.

In stark contrast to those “crusaders” who seek out physicians with conscientious objections and demand treatment they know they will refuse, I want the opposite. I don’t want to be treated by physicians who are willing either to act contrary to their conscience or who undertake interventions I believe to be seriously ethically wrong. For example, if the Quebec law legalizing euthanasia survives its constitutional challenge, I don’t want to be cared for by a physician who would be willing to give me — or anyone else — a lethal injection with the intention of killing me, or who would help me — or others — to commit suicide. So how might my “rights” in this regard be respected?

First, physicians with conscientious objections to supplying medical procedures that would destroy human life or contravene respect for it, including euthanasia and assisted suicide, must not be drummed out of the profession as Dr. Gabel proposes.

There may be rare circumstances where physicians exercising their right of conscientious objection would jeopardize a patient’s life or create a serious risk to their health and there are no reasonable alternatives. The ethical and legal validity of physicians’ refusals in such a situation would need to be determined on a case by case basis, not through steamrollering and obliterating physicians’ freedom of conscience as Dr. Gabel’s committee proposes.

Consideration should be given to creating a public list of physicians who register as having conscientious objection to providing a specified medical procedure. This would allow people who want to be treated by a physician  with such values to identify those physicians, at the same time allowing those who want such procedures to avoid those physicians.

Health-care institutions should have the right to declare themselves, for instance, “euthanasia free” and “physician-assisted suicide free” zones
A concern that physicians on such a list would be targets for abuse by those who oppose their values would need to be addressed. Reasonable steps would also need to be taken to ensure sufficient numbers of physicians were available on either side to honour Canadians’ choices. We should keep in mind in this regard that sometimes upholding important values, such as respect for freedom of conscience, is not cost-free and we should be prepared to pay what is necessary to do so.

Alternatively or in addition to the above, health-care institutions should have the right to declare themselves, for instance, “euthanasia free” and “physician-assisted suicide free” zones. Patients who object to those procedures could then be confident they would not be subject to them.

Forcing physicians to act against their conscience, to do something they believe is deeply wrong against their will, not only harms them. This coercive violation of their freedom of conscience also harms society and the values that inform its culture.

So-called “progressive values” adherents claim to give priority to respect for individual autonomy when values are in conflict, and pride themselves on  their tolerance.  Such claims are only tested, however, when “progressivists” do not agree with the stance that another person takes, such as a physician who for reasons of conscience refuses to participate in abortion or euthanasia.

In the current controversy, the “progressivists” are not scoring well on these tests.

This article was originally published in Canada’s National Post

Margaret Somerville participated in the STI Experts Meeting ‘Construction of New Realities in Medicine’. She is Founding Director of the Centre for Medicine, Ethics and Law at McGill University and professor of the schools of Law and Medicine at McGill.

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