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Dear Canada, Respect for Conscience is Fundamental to Health Care

Rachael Wong is a lawyer from Auckland who is currently working as a legal consultant with the Law Reform Commission in Samoa. She has recently completed a Master of Bioethics and Health Law for which she wrote her dissertation on freedom of conscience in health care. She maintains that a health professional’s exercise of conscience is inseparable from their delivery of health care.

Writing for First Things, Wesley J. Smith describes the disturbing situation for health professionals in Canada in the wake of the Supreme Court’s decision in Carter last year:

Last year, the Canadian Supreme Court created a right to euthanasia and assisted suicide. To qualify for death, the court ruled unanimously, one must be a competent adult with a medically diagnosed condition causing “irremediable suffering”—a circumstance wholly determined by the patient and including “psychological suffering.”

The decision went well beyond mere legalization. Indeed, the court manufactured an enforceable legal right for qualified patients to receive what Canadian policymakers are euphemistically calling “medical aid in dying” (MAID).

But what about doctors opposed to euthanasia? The court left with Parliament and the medical colleges (associations) the decision of whether and how to accommodate doctors with conscience objections, granting a one-year (now extended) period within which to enact laws to govern the practice. Since then, civil liberties groups, provincial medical colleges, and official government commissions have urged Parliament [see here and here] to pass laws that would coerce doctors who are religiously or philosophically opposed to euthanasia to cooperate actively in the process of mercy killings by forcing them to procure death doctors for their patients [via what has been termed “effective referral”].

Strongly opposing such recommendations is the Coalition for HealthCARE and Conscience, a group of Canadian organisations representing over 5,000 doctors, who are committed to protecting conscience rights for health professionals and institutions.

Legally speaking, coercing health professionals to act against their consciences would seem to contradict the Canadian Charter of Rights and Freedoms, which states that everyone has the fundamental freedom of “conscience and religion”, not to mention the right to freedom of conscience protected in international law (see for example Article 18 of the Universal Declaration of Human Rights and Article 18 of the International Covenant on Civil and Political Rights).

Ethically speaking, coercing health professionals to participate in “health care” that contravenes their consciences – and in particular, that which they believe is contrary to their patients’ best interests and indeed the fundamental tenets of health care – is a violation of those professionals’ integrity and their dignity as moral agents.

There is a mistaken belief in some quarters, that “effective referral” respects a health professional’s freedom of conscience. Nothing could be further from the truth. A health professional cannot in good conscience object to providing a treatment to which they are morally opposed, only to then have to send the patient to another health professional who is willing to provide that same treatment. In the case of euthanasia or assisted suicide, participation in the process would for many health professionals be akin to saying, “I won’t murder this patient or help them to commit suicide, but please doctor-colleague, could you do it instead?” Such a request would contradict their objection in the first place and would make them complicit in the harm that they earnestly seek to avoid. It would also rightly call into question the health professional’s sincerity.

Respecting the consciences of health professionals is also vital for the wellbeing of patients. It is reasonable to suppose that if health professionals are routinely compelled to act contrary to their consciences and to act against what they believe to be for the patient’s good, this could corrode their concept of best patient care. As the saying goes, “if you don’t live according to what you believe, you begin to believe according to how you live.” It could also undermine the ethic to always pursue the patient’s good, and encourage a “doubling” phenomenon which protects health professionals from feelings of guilt and enables them to comply submissively with orders from higher authorities even if these are contrary to the patient’s good. Ultimately, the health professional’s conscience becomes defective and its owner is no longer able to serve the patient’s good effectively.

Finally, respect for the consciences of health professionals is integral to the purpose and profession of medicine. If health professionals are denied the right to conscientiously object to actions they consider contrary to the patient’s good, they are ultimately being made to act contrary to what it means to be a health professional and the professed ethics of their profession. In being obliged to act against their consciences, they are really being compelled to behave as technicians and not as genuine health professionals. In the end, what remains is not health care, but a poor caricature of it.

If Canadian lawmakers are genuinely committed to the good of health professionals, patients and the health care system as a whole, they will rigorously protect health professionals’ right to freedom of conscience.

(Photo credit: Adrian Wyld / Canadian Press)

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