Protection of Conscience Project
Media Commentary: July - December, 2006

The CMAJ did not publish the Project's response to the guest editorial, but did publish several others critical of the position taken by Rodgers and Downie.  Those below are reproduced with the permission of the authors and the CMAJ.  Another, by by Dr. Daniel Holmes (University of British Columbia, Department of Pathology and Laboratory Medicine St. Paul’s Hospital Vancouver, BC) is available on the CMAJ website, as are some letters supportive of the editorial.
 

Moral Desensitization
Renata Leong, MDcM, CCFP, MHSc
DFCM, St. Michael's Hospital; Assistant Professor, DFCM, University of Toronto (26 July, 2006)

. . . A call for the silencing of one’s inner voice of conscience is not without cost. Research on medical education has documented moral distress and moral desensitization when trainees witness or participate in what they perceive as unethical acts, such as making derogatory comments about patients^1,2. One can only imagine the hundredfold impact of this phenomenon when a healthcare provider is faced with a perceived demand to promote or participate in the taking of another’s life. . . [Link to Letter]
 

Physician Autonomy and the Ethics of Intolerance
Stephen J. Genuis, MD FRCSC DABOG,
Associate Clinical Professor, University of Alberta (19 July, 2006)

. . . it may be preferable to have credible physicians debating conflict-ridden medical issues rather than sanctioning special interests outside the profession to expound unilaterally in scientific journals. . . The policy of coercing ethical doctors to do what they feel is unethical – whether it is by threat of lawsuits or disciplinary action – displays intolerance of diverse views and choice; it goes against the CMA code of ethics . . .  [Link to letter]

“Physician Autonomy and the Ethics of Intolerance” — eCMAJ 19-Jul-06 —In response to the original article from, CMAJ 04-Jul-06; 175(1), Page(s) 9 “Abortion ensuring access” by permission of the publisher. © 2006 Canadian Medical Association
 

Balanced Journalism Needed
Rene Leiva
SCO Health Centre Ottawa  (13 July, 2006)

To the editor:

I found the Guest Editorial in this week’s issue of CMAJ to be partial and misleading. (Abortion: ensuring access, CMAJ 175(1): July 4, 2006). One of the main issues is the false statement by the guest editors that physicians should refer to abortion even against their conscience:  . . .  [Link to letter]

“Balanced journalism needed” — eCMAJ 13-Jul-06 — In response to original article from, CMAJ 04-Jul-06; 175(1), Page(s) 9 “Abortion ensuring access” by permission of the publisher. © 2006 Canadian Medical Association
 

Before definitively forming an opinion on the editorial “Abortion: ensuring access” by Rodgers and Downie, I would like to ask them a few questions; . . . 2) What is the scientific evidence that abortion is good and/or essential for women? 3) How can abortion be a “constitutionally protected right” for women, and at the same time, the practice of abortion be “regulated like any other medical procedure”? . . . 7) I note that Rogers and Downie think the physicians “must” or “should do” on 9 occasions. How would members of the legal profession feel about physicians telling the legal profession how to conduct their affairs? . . .

"Abortion: ensuring access"” — eCMAJ 13-Jul-06 — In response to original article from, CMAJ 04-Jul-06; 175(1), Page(s) 9 “Abortion ensuring access” by permission of the publisher. © 2006 Canadian Medical Association
 

Abortion Access Editorial Worrisome
Williard P Johnston, MD
President, Canadian Physicians for Life (11 July, 2006)

It is disturbing that Rodgers and Downie have teaching contact with medical students on the topic of access to abortion. It seems clear to me that two of their central points are plainly false. . . the CMA policy on referral for abortion is unequivocal: a physician must make his or her position, and the right to consult another physician, clear to the patient but is in no way obliged to provide a referral for any procedure. . .  [Link to letter]

“Abortion access editorial worrisome” — eCMAJ 11-Jul-06 — In response to original article from, CMAJ 04-Jul-06; 175(1), Page(s) 9 “Abortion ensuring access” by permission of the publisher. © 2006 Canadian Medical Association
 

To the editor:

I would like to take exception to the Guest Editorial in this week’s issue of CMAJ (Abortion: ensuring access, CMAJ 175(1): July 4, 2006). . . women who are poor, young, immigrant, disabled and so on . . . have more difficulty accessing most health services . . .abortion has no unique status in this regard. As for the remarks about physicians who disagree with their position and do not refer all patients for abortion who request it, I can only say that they reflect an impoverished “one size fits all” understanding of physician integrity and the doctor-patient relationship.

“Response to "Abortion: ensuring access"” — eCMAJ 05-Jul-06 — In response to original article from, CMAJ 04-Jul-06; 175(1), Page(s) 9 “Abortion ensuring access” by permission of the publisher. © 2006 Canadian Medical Association
 

Canadian Medical Association
 (Induced Abortion)

Canadian Medical Association
(Joint Statement on Preventing
and Resolving Ethical Conflicts)

The authors almost (but not quite) assert that physicians opposed to abortion will “withhold a diagnosis,” “delay access,” “misdirect women,” and “provide punitive treatment.” They insert, in the midst of this list, the imaginary offence of “failing to provide appropriate referrals:” imaginary, because the Canadian Medical Association does not require referral for abortion, and none of the cases thus far proposed by some of the authors’ like-minded colleagues support such a claim.¹ Nonetheless, they insist that all of these practices, refusal to refer among them, constitute malpractice and can lead to "lawsuits and disciplinary proceedings."

This passage does three remarkable things, all in one breath: it subtly impugns the integrity of objecting physicians; it associates conscientious objection with “punitive treatment” and other unethical practices; and it envelopes conscientious objection to abortion in an atmosphere of menace. It is a masterful symphony of accusatory innuendo, contrived connections, and strategic omissions. An unprepared reader may overlook the lyrical niceties, but the melody - “thou shalt refer or else” - is unmistakable.

Professors Rodgers and Downie stand in relation to their students and medical professionals as medical professionals stand to their patients, but their editorial fails to respect the principle of informed consent. On the contrary: it parallels the discreditable practice of securing the consent of a patient by manipulative and selective communication. It makes no difference that the consent sought in this case is to a proposition and outcomes favoured by the authors, rather than diagnosis and treatment favoured by a physician.

The authors are free to pursue their goal of increasing access to abortion, but they ought to do so without suppressing freedom of conscience in another profession. They are, after all, lawyers and law professors, not health care workers, and they will not hold in their own hands the products of the policies they seek to impose upon others.

Sean Murphy,
Administrator

Notes:
1. Including Zimmer v. Ringrose (1981), 124 Dominion Law Reports (3d) 215 (Alberta Court of Appeal); Zimmer v. Ringrose (1978), 89 Dominion Law Reports (3d) 657 (Alberta Supreme Court); McInerney v. MacDonald (1992), 93 Dominion Law Reports (4th) 415 (Supreme Court of Canada); Malette v. Shulman (1990), 67 DLR (4th) 321 (Ont. Court of Appeal); Nancy B v Hotel Dieu de Quebec (1992), 86 DLR (4th) 385 (Quebec Superior Court); R. v. Morgentaler (1988)1 S.C.R 95-96 (Supreme Court of Canada). See Murphy, Sean, Postscript for the Journal of Obstetrics and Gynaecology Canada: Morgentaler vs. Professors Cook and Dickens.  [Back]