Project Annotations

The CPSNB uses the 2004 version of the Canadian Medical Association Code of Ethics with comments added by the College Council to provide additional guidance.   Several provisions are relevant to physician freedom of conscience:

7. Resist any influence or interference that could undermine your professional integrity.

12.  Inform your patient when your personal values would influence the recommendation or practice of any medical procedure that the patient needs or wants.

• CPSNB Comment: If the denial or delay of treatment has the potential to cause harm, the physician is obligated to expedite access to another physician if possible. In any case, the physician cannot obstruct such access.

  • Project note: The meaning of "harm" may be disputed in relation to morally contested services like euthanasia and abortion.

18.  Provide whatever appropriate assistance you can to any person with an urgent need for medical care.

21.  Provide your patients with the information they need to make informed decisions about their medical care, and answer their questions to the best of your ability.

• CPSNB Comment: The physician is obligated, as part of the process of informed consent, to provide the patient with whatever information will, from the patient's perspective, have a bearing on his/her medical care decision-making.

  • Project note:  In the Project's experience, this does not usually present a problem for objecting physicians.

23.  Make every reasonable effort to communicate with your patients in such a way that information exchanged is understood.

• CPSNB Comment: Informed consent requires good communication.

22.  Recommend only those diagnostic and therapeutic services that you consider to be beneficial to your patient or to others. If a service is recommended for the benefit of others, as for example in matters of public health, inform your patient of this fact and proceed only with explicit informed consent or where required by law.

• CPSNB Comment: Physicians have a duty to promote public health and to protect society, even when the procedures in question may not be intended for the direct benefit of the individual patient (e.g. certain vaccinations or diagnostic procedures such as serologic typing of some viral infections for the purpose of public health surveillance). Such procedures still require informed consent, unless required by law.

Project Annotations

In a 2001 bulletin, the Council noted  "that no physician is obligated to participate in a treatment or process to which they morally object" and sought feedback about appropriate guidelines for situations in which physicians have moral or ethical objections to a service or procedure wanted by a patient.  The statement above was issued the next year.

The identification of referral as a "preferred" but not a "required" practice is not necessarily problematic.  It prompts objecting physicians to consider, in each case, whether or not referral is a morally acceptable option, thus providing them with the opportunity to refine and better articulate their ethical reasoning.

Project Annotations

This guideline was adopted in 2012, "based on an inititiative" by the College of Physicians and Surgeons of Alberta.  It recognizes a key distinction between providing information and providing or facilitating a morally contested service or procedure. 

i.  Physicians are expected to provide information necessary to satisfy the requirements of informed medical decision making, such as prognosis, the treatments or procedures available, benefits and burdens of treatment, risks, etc.  The point here is to balance the desire of a physician to avoid complicity in a wrongful act with the importance of informed decision-making by the patient, which requires that the patient have all of the information relevant for the purpose of choosing a course of treatment.  It is necessary to respect both the freedom of conscience of the physician and the freedom and right of the patient to make a fully informed choice. 

ii.  Only if a physician is unwilling to provide this information is an offer of "timely access" to another physician or resource required.  The purpose of arranging timely access in this situation is to ensure that the patient has information needed for decision-making.  Offering timely access may be achieved in various ways.