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I've been puzzling about why Canadian "progressive" values
advocates, particularly those passionately in favour of the
legalization of euthanasia and physician-assisted suicide
("physician-assisted death" (PAD)), are so adamant in trying to
force healthcare professionals and institutions who have conscience
or religious objections to these procedures to become complicit in
Complicity would occur if objecting individual physicians were
forced to provide "effective referrals" or objecting institutions
were forced to allow PAD in their facilities. An "effective
referral" is defined by the Ontario College of Physicians and
Surgeons as "a referral made in good faith, to a non-objecting,
available, and accessible physician or other health-care provider."
In general, progressive values advocates claim to give priority
to rights to individual autonomy, choice, control over what happens
to oneself, and tolerance for those who believe differently. Yet in
relation to respect for the freedom of conscience and, where
relevant, religious belief, of physicians or institutions who oppose
PAD, none of these principles seem to be applied. Why?
The usual reason given by PAD supporters is that patients who
fulfil the required conditions have a right to access euthanasia now
that it's legal in certain circumstances, and that physicians have a
duty to enable that access. In other words they argue that pursuant
to the Carter case physicians have not only a duty not to
prevent patients from accessing PAD, but also, a duty to facilitate
patients' access to it. The latter would be complicity in PAD by
objecting physicians and, consequently, like personally carrying out
PAD, objectionable on conscience grounds.
With respect to institutions which refuse to allow PAD, its
supporters argue that the receipt of public funding negates rights
to freedom of conscience and religious belief. Yet, as the
Loyola School case in the Supreme Court of Canada shows,
the Canadian Charter of Rights and Freedoms
can protect private religious institutions from a breach by the
state of these fundamental human rights.
It is also argued in support of overriding institutions' refusals
to accommodate PAD that patients should not have to be transferred
to another institution willing to provide this intervention.
But for reasons of efficiency, access to necessary expertise and
its optimal use, and cost-saving, the transfer of patients between
institutions which share services occurs on a regular basis.
Treating PAD as such a service would be far from exceptional.
It's also noteworthy that up to the present no jurisdiction which
permits PAD has forced physicians or institutions to participate,
that is, physicians and institutions are free to opt out of any
So why this insistence that all physicians and institutions must
be complicit in PAD? Might the media stories about the cases of PAD
carried out in the last few weeks pursuant to specific judicial
authorization give us a clue? Pro-euthanasia advocates are reported
as having welcomed the deaths occurring in this way, indeed
celebrated that this was possible and legal.
I suggest one trigger for this reaction was that they saw their
values and beliefs as being affirmed by these deaths.
And, if correct, that insight might help to explain why
pro-euthanasia supporters will not allow respect for freedom of
conscience and may even welcome the opposition to their values and
beliefs which claims to freedom of conscience manifest. This would
be the case when overriding such opposition provides pro-euthanasia
advocates an opportunity to establish and affirm, first, that PAD
and their "progressive" values have become societal norms governing
how we die, and, second, that PAD is an acceptable exception to
upholding the value of respect for life at the societal level.
There may also be something even deeper at work here, especially
in the case of physicians who support imposing a duty on their
colleagues with conscientious objections to PAD to refer for it.
Conscientious objection to PAD is a direct and palpable
challenge, not only to the views and values of those who support it,
but also to the conduct involved in undertaking it. The graver
the moral issue involved in any given conduct, the greater is the
impact on its ethical acceptability of a challenge to it.
Since, hitherto, especially in medicine, the gravest moral issue has
been killing people (since Carter, it is failure to relieve
suffering), PAD proponents will react with particular vehemence to
suppress the challenge. Forcing physicians who object to PAD
to become complicit in it through referral waters down the impact of
those physicians' objections.
Similarly, the formal approval associated with the court rulings
authorizing PAD and media attention and applause for providing it
helps proponents to confirm the correctness of their views and could
assuage lingering doubts about the rightness of their conduct.
To repeat a warning I've delivered before, it must be kept in
mind that respect for physicians' freedom of conscience is not only
necessary to respect them, it is also required to protect patients
and can be the last such protection against doing them serious harm
or other serious wrongdoing. We must maintain respect for all
physicians' freedom of conscience in general, including with regard
to PAD, to maintain this protection of patients.
Finally, the warning in
Weber and Lin's excellent article in Public Discourse
(republished in MercatorNet) that recognizing claims that "gay
rights" should override rights to freedom of conscience undermines
the entire human rights structure, is equally applicable to
recognizing that claims to PAD override freedom of conscience.
article is published by Margaret Somerville and MercatorNet.com
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