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Protection of Conscience Project

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Service, not Servitude
Background

Lacunae in Conscience

Reproduced with permission

Introduction

The following address was delivered at a time when a new abortion law (Bill C-43) was making its way through the Canadian parliament, the previous law regulating abortion having been struck down by the Supreme Court of Canada two years earlier. The circumstances described by Dr. Johnston arose during the period when legal abortion was available after having been approved by a hospital's 'therapeutic abortion committee'.

The bill failed to pass the Senate and was not re-introduced, so that Canada has been without any restrictions on abortion since the Supreme Court ruling of 1988. This has generated increasing pressure to participate in abortions, as illustrated by some of the cases found under Repression of Conscience or in situations described in this section of the Project site. [Administrator]

Williard Johnston. M.D. *

Address to the Civil Liberties Section,
B.C. Bar Association

March 28, 1990

. . . it seems odd to me that groups who would defend freedom of conscience vociferously in almost any context fall silent when the owner of that conscience is objecting to abortion. This silence is more than just selective indignation. It amounts to a disenfranchising of the concerns of the abortion objector in a way reminiscent of the refusal of the same groups to disenfranchise the unborn child.

I'd like to thank you for inviting me here today to discuss the protection of the consciences of health care workers in the context of our current national debate over abortion and the currently tabled Bill C-43, "An Act Respecting Abortion". "Lacunae" are small voids or vacuous areas (literally, "little lakes") and I remember coming across the term some years ago in a study of the ethics of enlisted soldiers, who were observed to have moral lacunae which were highly specific in nature, allowing them such self-awarded perks as petty theft from rations. These small deviations from principles-still-held-dear in the larger context of society are curious. Might the perpetrators feel that they had special moral authority, in their immediate world, to deviate from overarching principles, or might thoughts like "this situation is different" or "No one is being harmed" play a role?

I mention this obscure topic because it seems odd to me that groups who would defend freedom of conscience vociferously in almost any context fall silent when the owner of that conscience is objecting to abortion. This silence is more than just selective indignation. It amounts to a disenfranchising of the concerns of the abortion objector in a way reminiscent of the refusal of the same groups to disenfranchise the unborn child.

In practice, someone's conscientious wish to avoid participating in the act of abortion in any way can be denied at many stages. Consider medical school applicant selection committees. It is common knowledge that, due to the volume of applicants and the mechanics of the admission process, a single unfavourable interview can be ruinous. Countless anecdotes involving the questioning of an applicant about his or her views on abortion are available to us. Often the interview is in a one-on-one situation where no effective recourse is available to an applicant who suspects that a politically incorrect response to a life question scuttled his or her chances.

Given the complexity of factors which a medical school must consider in accepting an applicant, it should be obvious that any number of disingenuous or beside-the-point justifications can be returned to the unsuccessful applicant who complains. For reasons which deserve more debate, the orthodoxy of most Canadian Medical School administrations is now, subtly or otherwise, pro-choice on abortion. We at Canadian Physicians for Life are concerned that the entire complexion of our profession as regards the life issues has been, is being and will continue to be altered in the direction of utilitarianism.

The medical school entry level is just the start. Someone who applies to an obstetrics residency with no intention of cooperating with abortions is asking for a rough ride. Canadian Medical Association proclamations that those who object to abortion must not be obliged to associate with the procedure are wishful ideals, fought for against opposition at times, and maintained in the code of ethics at the displeasure of virulently pro-abortion elements. Once in practice, anti-abortion obstetricians will hear of egregious examples of discrimination, shunning, and outright harassment to remind them that they are on thin ice.

So poorly understood, in the pro-choice medical mind, are the conscientious objections of pro-life physicians that even the denial of a referral to an abortionist has been seriously criticized. Many pro-choice physicians simply cannot imagine why their pro-life colleagues would not point an unhappily pregnant woman in the direction of the nearest abortionist. After all, many of these pro-choice doctors will renounce any intention of ever actually doing an abortion themselves, as though to wash their hands of the matter.

When I survey the situation at the various entry points into different parts of our profession, I am moved to wonder whether some day soon the possession of serious compunctions about the sanctity of human life will disqualify one from entering medicine.

I will mention briefly the problem of hospital admitting privileges. Every hospital has a "Privileges Committee" which can exclude an applicant for many reasons. A much-publicized case in central B.C. involved the exclusion of a vociferous pro-life physician on the grounds that his personality would be disruptive to the functioning of the hospital.

The plight of nurses who wish to avoid complicity in abortions is especially bad. Applicants to general obstetrics and gynecology wards are rejected if they cannot be slotted into inflexible shift schedules which would include attendance at abortions. Abortions are mixed with general surgery cases on an operating room slate, with no provision for "opting out" by nurses who find the procedure abhorrent. Nurses distant from the operating room itself may find themselves obtaining consent form signatures for abortion. They may find themselves under a nursing duty obligation to assess the degree of informed consent which the patient is evincing. For example, a nurse is currently being investigated with a view to discipline because, among other charges, she demonstrated to a patient that the drug exposure for which the patient's physician was strongly urging an abortion, was actually a rare and minimal risk to the fetus. The pre-operative and post-operative care of an abortion patient, it would be fair to say, touches in some way on every employee of a hospital, as the system currently operates.

I am only a doctor. I know that any human rights legislation, the protection of conscience being no exception, must balance an employer's ability to provide services with the right of a citizen to be employed regardless of fundamental tenets of his or her beliefs. Yet the practice of abortion has several features which should make conscience protection practical.

First, it is entirely elective and optional and non-emergent.

Second, it is not so highly technical that it requires the full resources of an operating room in any but the most horrifying mid-trimester cases.

Third, true medical indications for abortion are so rare that, in practice, conscientious objectors to abortion have no doubt, and their employers have no doubt, which cases are ethically contentious and which are not.

Fourth, there is a growing body of evidence which documents the harmful psychological effects on health care providers of ongoing participation in abortion. Where this documentation is not being actively sought, I would suggest that we have a situation of employer negligence similar to that where an employer shows indifference to the effects of a toxic chemical in the work place.

I am told that other countries have found ways of protecting healthcare workers from gross violations of their consciences in the life issues. In Canada we should be doing the same.

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