POWELL RIVER, British Columbia, August 28, 2012 (LifeSiteNews.com) – After the Canadian Medical Association (CMA) voted two weeks ago to support the wording of the country’s Criminal Code which states that a baby becomes a “human being” only after being born, LifeSiteNews decided to track down where the CMA stands with regard to conscious rights for doctors who believe that babies are human before being born and want nothing to do with abortion.

CMA’s current 1988 policy for “induced abortion” in relation to doctors states that a physician “whose moral or religious beliefs prevent him or her from recommending or performing an abortion should inform the patient of this so that she may consult another physician.”

The CMA policy moreover clarifies that “no discrimination should be directed against doctors who do not perform or assist at induced abortions. Respect for the right of personal decision in this area must be stressed, particularly for doctors training in obstetrics and gynecology, and anesthesia.”

While the written policy sounds like it does protect pro-life physicians, LifeSiteNews contacted Sean Murphy, administrator for the Protection of Conscience Project (PCP), to find out more about how the policy is applied in practice, and about freedom of conscience for physicians in general in Canada.

LSN: Even the CMA, which holds rigorous views on abortion, still believes in conscience rights, but not completely. In 2007, Jeff Blackmer, executive director of the Office of Ethics for the CMA, wrote a piece titled “Clarification of the CMA’s position concerning induced abortion” wherein he states that a doctor “should not interfere in any way with this patient’s right to obtain the abortion. At the patient’s request, you [the doctor] should also indicate alternative sources where she might obtain a referral.”

PCP: This statement was published because of a controversy that erupted over a 2006 guest editorial in the CMA Journal by Professor Jocelyn Downie of Dalhousie University and Sanda Rogers of the University of Ottawa. They claimed that physicians were obliged to refer for abortion. Responses from the CPC and others are here.

Dr. Blackmer’s statement is not considered an assertion that physicians are obliged to refer for abortion. It would be sufficient for a physician to indicate that if the patient wished to pursue the matter she could contact other physicians or the College of Physicians and surgeons, or consult a telephone book. In my experience, physicians who object to referral for reasons of conscience (not all do) do not normally object to providing this kind of information.

In June, 1977, the CMA revised its Code of Ethics to include a clause that imposed an obligation to refer for morally contested procedures (abortion was not specifically named). The clause was removed the following year because of opposition from CMA members. David Williams, then CMA director of ethics, told me in 2000 that the policy was dropped because there was no ethical consensus to support it. Nothing has changed in this respect.

The issue of referral has appropriately been described as an intractable problem by Holly Fernandez-Lynch in Conflicts of Conscience in Health Care: An Institutional Compromise. See the PCP review here. It was highly controversial for the CMA in 1977, and it still is. Indeed, given Carter v Canada, [a case that recently legalized euthanasia and assisted suicide in Canada but was appealed by the government of Canada] it may become even more controversial. (see below)

LSN: How do you see the state of conscience rights for doctors in Canada?

PCP: ‘Rights’ language is problematic for a number of reasons, not the least of which is the use of rights language to justify ethical aggression and ethical cleansing of professions. The issue is better expressed in terms of fundamental human freedom.

The situation is precarious because much depends upon the attitude of the legal and human rights establishment, which both appear to be developing attitudes that are increasingly hostile to the exercise of freedom of conscience when the exercise expresses what might be termed politically incorrect views.

The underlying problem is disagreement about the nature of human rights. The foundational problem is disagreement about the nature of the human person.

Physicians are in a better position to defend their fundamental freedoms than most other health care workers because of their professional dominance and relative independence. A physician who has completed the educational and regulatory requirements for practice can, if need be, begin to practise independently. A qualified nurse, on the other hand, must find an employer in order to work, and remains dependent on an employer in order to continue to work and advance in the profession. Pharmacists are similarly disadvantaged.

LSN: Do you see an erosion happening with regard to conscience rights for doctors in Canada?

PCP: This is difficult to assess because factors that can contribute to erosion may operate out of the public eye: in law schools, in committees of Colleges of Physicians or associations, in seminars or meetings of ‘rights’ groups, and in government bureaucracies.

For example:

• Prof. Sanda Rogers was reported to have told a class at the University of Ottawa on 28 October, 2004, that a physician is required by law to refer patients for abortion, even if the physician objects to the procedure for reasons of conscience. The Dean of the Faculty of Medicine denied that the statement was made. However, the CMA Journal editorial she co-authored with Jocelyn Downie in 2006 appears to reflect the position attributed to her two years earlier. We do not know how often this kind of statement is made in post-secondary classrooms across the country.

• In 2008, the Ontario College of Physicians and Surgeons very nearly adopted a policy to prohibit physicians in the province from acting on their moral, ethical or religious beliefs. This was the result of pressure from the Ontario Human Rights Commission.

Most physicians in the province were unaware that this was happening until the day before the deadline for comment on the policy. The PCP issued a news release and alerted its contacts after being called by a physician who discovered the draft policy by accident.

The resulting uproar forced the College to backpedal somewhat. However, its revised draft was completed before the deadline for public consultation had expired, and the College refused to release the revised draft until the eve of the Council meeting that was to consider it, effectively precluding further critical comment on the document that the Council was to consider. Despite calls from the Ontario Medical Association and the PCP to postpone the vote, the policy was adopted. The most blatantly provocative sections were removed, but the amended policy is less than satisfactory.

• Another important consideration is the potential effect of Carter v. Canada, the BC Supreme Court judgement that proposes to legalize physician assisted suicide and therapeutic homicide (the term used by a CMA Journal editorial). The Royal Society of Canada “expert panel” on euthanasia and assisted suicide recommended that objecting physicians be forced to refer for the procedures. Three of the authors of that report were witnesses for the plaintiffs in Carter v. Canada, and a fourth, Joceyln Downie, instructed the plaintiffs’ expert witnesses. 

As noted above, Downie has long been a proponent of compulsory referral for abortion. The PCP does not take a position on the morality or desirability of assisted suicide or therapeutic homicide, but is concerned that legalization of the procedures would threaten freedom of conscience for health care workers. A response to the judgement from the CPC dealing with this issue is in preparation.

LSN: Do we need laws that affirm conscience rights? If so, what should those laws look like?

PCP: Yes, we need laws that affirm conscience rights. Laws can be general or procedure-specific. There are advantages and disadvantages to both approaches. See the Model Statute on the PCP website and examples of other proposed or existing legislation.

LSN: What can a doctor do to keep his job who has made the decision to be no part of a process that ends the life of a child in the womb?

PCP: It is a serious mistake to confine concerns about freedom of conscience to abortion.

• In the case of a morally contested procedure or service, an objecting physician should first ensure that he has a solid understanding of the essential facts concerning it, based on sound science and the latest reliable research.

• Academic discipline requires an ability to distinguish between what lies within the province of science and what lies elsewhere. “Personhood,” for example, can have distinctive philosophical or legal meanings, but it is not a scientific concept at all. Whether or not something “ought” to be done is a subject for philosophy, religion, or ethics - not science. Keeping clear about this is essential for good communication with patients and colleagues.

• Obtain copies of the policies of regulatory and licensing authorities and study them. Do not ignore the policies of specialist associations that may have considerable influence in setting ‘standards of care.’

• Some objectors encounter problems primarily because of the way they communicate with patients, colleagues or others. If it is necessary to explain your position, it must be done so in a way that refers to your own moral responsibility, not that of the patient or colleague. Avoid expressions that impute wrongdoing to others or that might come across as “preaching”.

• Conscientious objection is likely to make colleagues who do not share your views uncomfortable because it implies that what they are doing is wrong. It is unwise to increase their discomfort by making statements that will be perceived as questioning their moral judgement, as they are then likely to become hostile. Take note of their discomfort - “You seem troubled/ disturbed/surprised” and invite dialogue - “Have I offended you?”

• In addition to discomfort, you may encounter a belligerent challenge, contempt or condescension. If you are taken by surprise or become flustered, no harm is done by admitting the fact and suggesting that time should be made for an uninterrupted chat.

• Don’t rush into what might prove to be a contentious discussion simply to counter an offensive or ill-timed remark. Everyone will benefit if even a few minutes is taken to reflect and relax.

• Resist the urge to explain or defend yourself. Instead, ask your interlocutor to explain his concerns. Listen carefully, and ask questions, not to challenge his views, but to clarify the issues and identify any unexamined presuppositions that are governing his approach to them.

• There is no point exasperating a colleague by attempting to argue from incorrect assumptions about what he knows or believes. Let him tell you. Identify points of agreement and points of contention, and work together from there.

• The notion of working together with your critic is important. The goal is authentic and respectful communication, even if it involves serious argument and fundamental disagreements.

• If you are uncertain about how to reply to facts or an argument presented by your critic, you should simply admit it and promise to continue the discussion after you have had time to think further about it or research the problem. Offer your critic the same courtesy, unasked for, if need be. There is no need to resolve everything at once. In fact, it may prove difficult to resolve even preliminary matters in the first encounter.

• Long before a crisis looms you should seek the fellowship of students and professionals from other religious traditions (or none) who have a common interest in securing freedom of conscience in health care. You may be surprised to find that someone from a completely different faith and culture is more supportive of your views than a co-religionist who lives down the street.

Dr. Will Johnston, president of Canadian Physicians for Life recently told LifeSiteNews that Canadian doctors who want a “serious alternative” to the conversation provided by the CMA “can find it in Canadian Physicians for Life.”