"NO MORE CHRISTIAN DOCTORS"
Part 3: Religious values
The zeal and self-righteousness of the furious Facebookers in preaching
the crusade against the three physicians was noted in
Part 1. Part 2 suggested, in passing, that their passionate reaction might be accounted for
by a dogmatic belief that manufactured contraceptives are good and necessary
forms of health care, and that there are no reasonable alternatives to them.
Consequently, that a physician might refuse to provide contraceptives on the
basis of medical judgement they seem to have found completely
incomprehensible. Certainly, they ignored the physician's references to
"medical judgement" and "professional ethical concerns."
Instead, what generated the most frequent and heated anathemas from the
crusaders is the third reason the physician offered for his position -
"religious values." The possibility of an adverse medical judgement about
contraceptives was beyond their imaginings, but they were infuriated by a
refusal based on religious values. That they understood only too
well. That was heresy.
Afer all, everybody knows that a good physician should be "more than
happy to leave her religious beliefs out of her medical practice."1 It is
simply obvious that "faith doesn't have a damn thing to do with practicing
medicine."[sic]
If you were a trauma surgeon at the ER you'd have to
save a person's life even if they were a convicted murderer or rapist, your
personal values be damned. The same should apply with family physicians.2
And when the state is responsible for delivering health care, and people
pay for it through their taxes, everybody knows that they have a
right to
get what they pay for "within the limits of legality," and that "birth
control and vasectomies are LEGAL."3
Moreover, when taxpayers are financing health care, everybody knows that
"religion has NO PLACE in there."4
A tax-funded professional may make recommendations
based on their personal beliefs, but should never be permitted to refuse
legal and efficient procedures which align with their patient's personal
beliefs.5
These doctors . . . should be reminded that their
salary is paid by our taxes and our health system is a publicly regulated
system. As such, they cannot impose their religious beliefs, they must stay
neutral.6
Certainly, all Canadians are entitled to hold personal opinions and
beliefs- even religious beliefs, but everybody knows that "we live in a
society where religion is supposed to be a PRIVATE MATTER and not to be
imposed on other people."7
Everybody knows that "Canadians do not have the right to bring their
religious beliefs into the workplace,"8 that Canadians "are NOT entitled to
let their opinion interfere with their work,"9 and can't let "moral issues"
or religious beliefs keep them from doing their jobs.10
. . . He accepted a job as a doctor. He refuses to
fulfil his duties as a doctor. The reasons are irrelevant and the religious
belief trump card has no place in society, especially with occupations which
serve the diverse public. . . 11
Since it is so obvious that medical practitioners have no business acting
on "personal religious beliefs," the 'solution' to the 'problem' posed by
physicians who refuse to do what they believe to be immoral is just as
obvious:
"NO MORE CHRISTIAN DOCTORS."12
What we see in these comments parallels what was described in
Part 2 with
respect to the contraceptive culture. Just as the opinions and beliefs of
the young woman and her supporters have been shaped from infancy by a
dominant contraceptive culture, they have also been brought up in the 'religion' of secularism. They have learned the secularist catechism off by
heart because they have heard its lessons repeatedly from the pulpits of the
state, political and academic institutions, the media, and from innumerable
itinerant preachers evangelizing through popular culture.
That is why they are so quick to defend the dogmas of secularism
when they are challenged by people of other faiths, and why their response seems
driven by religious fervour, even though they would almost certainly deny
that there is anything religious about their beliefs.
And that may be so.
Their beliefs might be agnostic, or atheistic, or secularist. Some might
even describe themselves as religious believers who subscribe to secularism.
What matters is that, like it or not, admit it or not, they are all
believers.
Take, for example, Dr. James Robert Brown. In 2002, Dr. Brown, a professor of science and
religion of the University of Toronto, offered a simple
solution for health care workers who don't want to be involved with things
like abortion or contraception. These "scum" - that was his word - should
"resign from medicine and find another job." His reasoning was very simple.
Religious beliefs are highly emotional - as is any
belief that is affecting your behaviour in society. You have no right
letting your private beliefs affect your public behaviour.13
Of course, Dr. Brown was doing precisely that. He was acting publicly
upon his private belief that health care workers should not be allowed to
act publicly upon theirs. And the Facebook crusaders did the same thing;
they acted publicly on their beliefs, some of them in a "highly emotional"
manner. What principled reason can be given to justify the claim that one
may be guided by non-religious beliefs in public discourse, but not by
religious beliefs? That "highly emotional" beliefs are acceptable if they
are not religious, but unacceptable if they are? Surely, the relevant issue
is not whether the belief is religious or non-religious, but whether it is
true, or sound, or reasonable, or coherent.
All public behaviour - how one treats other people, how one treats
animals, how one treats the environment - is determined by what one
believes. All beliefs influence public behaviour. Some of these beliefs are
religious, some not, but all are beliefs.
This applies no less to "secular" ethics than to religious ethics. A
secular ethic may be independent of religion,14 but it is not faith-free, nor
is it beyond the influence of faith. On the contrary: a secular ethic, like
any ethic, is faith-based. That human dignity exists -or that it does not -
or that human life is worthy of unconditional reverence - or merely
conditional respect - and notions of beneficence, justice and equality are
not the product of scientific enquiry, but rest upon faith: upon beliefs
about human nature, the meaning and purpose of life, the existence of good
and evil.
Disputes about morality - about the morality of contraception, assisted
suicide, stem cell research or artificial reproduction - are always, at the
core, disputes between people of different beliefs, whether or not those
beliefs are religious. Nonetheless, as Dr. Iain Benson observes in Seeing
through the secular illusion, religious believers in many countries face an
"exclusionist attitude," a point well illustrated by the crusade against the
three physicians. He explains:
Those with a religious belief instead of an atheist or
agnostic belief are discriminated against, as their beliefs apparently
falling outside of the 'secular' and hence 'rational' realm of thought.
However, much of this discrimination rests on the understanding of secular
and the place of belief within society. Two things need to be recognised -
1) that we are all believers in something; it is not a question of whether
we believe, but what we believe in. 2) That in the secular sphere, correctly
understood as it is now under Canadian law, is inclusive of people of
religious belief and that they therefore should have equality under the law
and be placed at no disadvantage as against non-religious believers.15
Dr. Benson goes on:
If 'secular' means 'the opposite of religious' . . .
and if the public realm is defined in terms of the 'secular,' then the
public sphere has only one kind of believer removed from it - the religious
believers. I suggest that this way of using 'secular' is deeply flawed and
will tend to lead us in the direction of religious exclusivism.16
Of particular interest is Dr. Benson's reference to the meaning of
secular "correctly understood as it is now under Canadian law." He is
referring to a part a Supreme Court of Canada ruling in which the nine
justices were unanimous in holding that "secular" includes religious belief:
In my view, Saunders J. below erred in her assumption
that 'secular' effectively meant 'non-religious'. This is incorrect since
nothing in the Charter, political or democratic theory, or a proper
understanding of pluralism demands that atheistically based moral positions
trump religiously based moral positions on matters of public policy. I note
that the preamble to the Charter itself establishes that '... Canada is
founded upon principles that recognize the supremacy of God and the rule of
law'. According to the reasoning espoused by Saunders J., if one's moral
view manifests from a religiously grounded faith, it is not to be heard in
the public square, but if it does not, then it is publicly acceptable. The
problem with this approach is that everyone has 'belief' or 'faith' in
something, be it atheistic, agnostic or religious. To construe the 'secular'
as the realm of the 'unbelief' is therefore erroneous. Given this, why,
then, should the religiously informed conscience be placed at a public
disadvantage or disqualification? To do so would be to distort liberal
principles in an illiberal fashion and would provide only a feeble notion of
pluralism. The key is that people will disagree about important issues, and
such disagreement, where it does not imperil community living, must be
capable of being accommodated at the core of a modern pluralism.17
Thus, the Supreme Court of Canada has acknowledged that secularists,
atheists and agnostics are believers, no less than Christians, Muslims, Jews
and persons of other faiths. The notion that a secular state or a
secular health care system (tax-paid or not) must be purged of the
expression of religious belief is legally suspect, and the claim that a
secular state or a secular health care system is "faith-free" is radically
false.
More than that, it is dangerous. It overlooks the possibility that some
secularists - like some religious believers - can be uncritical and narrowly
dogmatic in the development of their ethical thinking, and intolerant of
anyone who disagrees with them. They might see them as heretics who must be
driven from the professions, from the public square, perhaps from the
country: sent to live across the sea with their "own kind."
On that point, it is essential to note that a secular ethic is not
morally neutral.18 The claim that a secular ethic is morally neutral is not
merely fiction. It is, as Professor Jay Budziszewski says, "bad faith
authoritarianism . . . a dishonest way of advancing a moral view by
pretending to have no moral view."19
By pretending, for example, that one can practise medicine in a morally
"neutral" fashion, or, as it was more colourfully expressed by a Facebooker,
that "faith doesn't have a damn thing to do with practicing medicine."
The example given by this Facebooker actually proves the point he was
attempting to deny. An emergency physician who intervenes to save the life
of a convicted murderer is not being morally "neutral." Most people would
describe his action as 'good' or moral because he is saving someone's life.
They would say he acts immorally if he fails or refuses to intervene. To say
that one must act "neutrally" in such a situation would be to say that a
physician might choose to intervene - or not - and that either choice would
be equally acceptable. Note, too, that the physician is in no way implicated
or complicit in murder because he saves a murderer's life, but that the case
would be quite different if he were to give someone a prescription for a
lethal drug to kill someone else. Conscientious objection might arise in the
latter case, but not in the former.
The practice of medicine is an inescapably moral enterprise precisely
because physicians are always seeking to do some kind of good and avoid some
kind of evil
for their patients.20 However, the moral aspect of practice as it relates to
the conduct and moral responsibility of a physician is usually implicit, not
explicit. It is assumed, not stated. It is normally eclipsed by the needs of
the patient and exigencies of practice. But it is never absent; every
decision concerning treatment is a moral decision, whether or not the
physician specifically adverts to that fact.
This point is frequently overlooked when a physician, for reasons of
conscience, declines to participate in or provide a service or procedure
that is routinely provided by his colleagues. They may be disturbed because
they assume that, in making a moral decision about treatment, he has done
something unusual, even improper. Seeing nothing wrong with the procedure,
they see no moral judgement involved in providing it. In their view, the
objector has brought morality into a situation where it doesn't belong, and,
worse, it is his morality.
In point of fact, the moral issue was there
all along, but they didn't notice it because they have been unreflectively
doing what they were taught to do in medical school and residency, and what
society expects them to do. Nonetheless, in deciding to provide the procedure they also
implicitly
concede its goodness; they would not provide it if they did not think it was
a good thing to do. What unsettles them is really not that the objector has
taken a moral position on the issue, but that he has made an explicit moral
judgement that differs from their implicit one.
This initial reaction is not surprising, and it can have positive results
if it leads to respectful discussion among colleagues. On the other hand,
there is a tendency in some quarters to adopt the pretence that no "real"
moral issues are involved, or that physicians are obliged to follow "the
ethics of the profession" or directives from state agencies which are
(erroneously) said to be "neutral." For example, in 2008 the Ontario Human
Rights Commission attempted to enforce its belief that physicians "must
essentially 'check their personal views at the door' in providing medical
care,"21 and the Facebook crusaders are attempting the same power play. This
is precisely the bad faith authoritarianism described by Professor
Budziszewski.
That everyone is a believer reflects the fact that the practice of
morality is a human enterprise,22 but it is not a scientific enterprise. The
classic ethical question, "How ought I to live?" is not a scientific
question and cannot be answered by any of the disciplines of natural
science, though natural science can provide raw material needed for adequate
answers.
Answers to the question, "How ought I to live?" reflect two fundamental
moral norms; do good, avoid evil. These basics have traditionally been
undisputed; the disputes begin with identifying or defining good and evil
and what constitutes "doing" and "avoiding." Such explorations are the
province of philosophy, ethics, theology and religion, and, internationally,
religion continues to be the principal means by which concepts of good and
evil and right and wrong conduct are sustained and transmitted. Nonetheless,
since the practice of morality is a human enterprise, reflections about
morality and the development and transmission of ideas about right and wrong
also occurs within culture and society outside the framework of identifiable
academic disciplines and religions.
In consequence, the secular public square is populated by people with any
number of moral viewpoints, some religious, some not: some tied to
particular philosophical or ethical systems, some not: but all of them
believers. As the Supreme Court of Canada has acknowledged, rational
democratic pluralism must make room for all of them. To single out and
exclude religious belief as a legitimate ground for conscientious objection
would, as the court stated, "distort liberal principles in an illiberal
fashion."
More important in the present context - if religious belief can be
excluded as a legitimate ground for conscientious objection, so can every
form of non-religious belief. If it is legitimate to compel religious
believers to do what they believe to be wrong, then it is equally legitimate
to compel non-religious believers to do what they think is wrong. It would,
in principle, establish a duty to do what is believed to be wrong.
For Andrei Marmor, "a duty to do what is wrong is surely an oxymoron,"23
and most people would agree, as did Dr. John Williams, then Director of
Ethics for the Canadian Medical Association. Speaking in 2002 of physicians
who decline to provide contraceptives for religious reasons, he said,
"[They're] under no obligation to do something that they feel is wrong."24
Despite this, attempts to impose a duty to do what is wrong is
characteristic of attacks on freedom of conscience among health care
workers. For example, the 2010 McAfferty report to the Parliamentary
Assembly of the Council of Europe stated that the Social, Health and Family
Affairs Committee was "deeply concerned about the increasing and largely
unregulated occurrence" of the exercise of freedom of conscience in Europe.
According to the Committee, too many European citizens in positions of
responsibility were refusing to do what they believed to be gravely wrong.
The Committee recommended that member states adopt "comprehensive and clear
regulations" to address this problem.25
When discussion about difficulties associated with the exercise of
freedom of conscience in health care is repeatedly characterized as "the
problem of conscientious objection,"26 it becomes clear that the underlying
premise is that people and institutions ought to do what they believe to be
wrong, and that refusal to do what one believes to be wrong requires special
justification. This is exactly the opposite of what one would expect. Most
people believe that we should not do what we believe to be wrong, and that
refusing to do what we believe to be wrong is the norm. It is wrongdoing
that needs special justification or excuse, not refusing to do wrong.
The inversion is troubling, since "a duty to do what is wrong" is being
advanced by those who support the "war on terror." They argue that there is,
indeed, a duty to do what is wrong, and that this includes a duty to kill
non-combatants and to torture terrorist suspects.27 The claim is sharply
contested,28 but it does indicate how
far a duty to do what is wrong might be pushed. We will next consider
an early effort to establish this purported duty in Canada, its rejection by
the medical profession, and the difficult compromise that was made possible
as a result.
1.
L___ T___, 30 January, 2014, 4:25 am
2. M___
J___ C___ P___ 29 January, 2014, 2:55 pm
3. C___
F___, 29 January, 2014, 7:04 pm
4.
C___ F___, 29 January, 2014, 9:50 pm;
S___ B___ 29 January, 2:35 pm
Gagnon S. "Contrary to democracy."
Letter to the editor, Ottawa Citizen, 1 February, 2014.
5.
C___T____, 29 January, 2014, 10:20 pm
6. Gagnon S. "Contrary to democracy." Letter
to the editor, Ottawa Citizen, 1 February, 2014;
M___ A___, 29 January, 2014, 7:19 pm
7.
C___ F___, 29 January, 2014, 9:45 pm
8.
T___ M____, 29 January, 6:56 pm
9.
M___ V___, 30 January, 2014, 5:21 am;
M___ A___, 29 January, 2014, 7:19 pm
10.
B___ A___ D___, 29 January, 2014, 2:45 pm
11. J___
O___, 30 January, 2014, 1:38 pm
12.
S___W___, 31 January, 4:48 am
13. "Dr. James Robert Brown, a professor of
science and religion at the University of Toronto, said he agrees with
prosecuting a doctor with that sort of conflict. "Suppose someone (doctor)
said, 'I'm uncomfortable with (treating) a minority,' I'd say, 'So long
scum'," said Brown."
"Brown believes performing abortions and
offering other forms of contraception are necessary and if Dawson won't
perform them, then, Brown added, 'Fine - just resign from medicine and find
another job."
"Religious beliefs are highly emotional - as is any
belief that is effecting your behaviour in society. You have no right
letting your private beliefs effect your public behaviour." Canning, Cheryl,
"Doctor's faith under
scrutiny:Barrie physician won't offer the pill, could lose his licence." The Barrie Examiner, February 21, 2002
14. Singer P. Practical Ethics (2nd
Ed.). Cambridge: Cambridge University Press, 1993, p. 3; Kreeft, Peter,
Fundamentals of the Faith. San Francisco: Ignatius Press, 1988,
p. 74-80. On line (Chapter 11) as "The Uniqueness of Christianity."
(Accessed 2007-11-08)
15. Benson I.T.,
Seeing Through the Secular
Illusion (July 29, 2013). NGTT Deel 54 Supplementum 4, 2013.
(Accessed 2014-02-18)
16. Benson I.T.,
Seeing Through the Secular
Illusion (July 29, 2013). NGTT Deel 54 Supplementum 4, 2013.
(Accessed 2014-02-18)
17.
Chamberlain v. Surrey School District No. 36 [2002] 4 S.C.R.
710 (SCC), para. 137 (Accessed 2014-02-19) Dr. Benson adds: "Madam Justice
McLachlin, who wrote the decision of the majority, accepted the reasoning of
Mr. Justice Gonthier on this point thus making his the reasoning of all nine
judges in relation to the interpretation of ‘secular.’) Benson I.T.,
Seeing Through the Secular
Illusion (July 29, 2013). NGTT Deel 54 Supplementum 4, 2013.
(Accessed 2014-02-18)
18. The distinction between ethics and morality
is mainly a matter of usage. Recent trends identify ethics as the
application of morality to a specific discipline, like medicine or law. In a
broader and older sense, ethics is concerned with how man ought to live,
while the study of morality focuses on ethical obligations. See the entry on
"Ethics and Morality" in Honderich T. (Ed.) The Oxford Companion to
Philosophy (2nd Ed.) Oxford: Oxford University Press, 2005.
19. "The question of neutrality has been
profoundly obscured by the mistake of confusing neutrality with
objectivity... neutrality and objectivity are not the same... objectivity is
possible but neutrality is not. To be neutral, if that were possible, would
be to have no presuppositions whatsoever. To be objective is to have certain
presuppositions, along with the manners that allow us to keep faith with
them." Budziszewski J.
"Handling Issues of Conscience." The Newman Rambler, Vol. 3,
No. 2, Spring/Summer 1999, P. 4.
20. Maddock J.W.
Humanizing health care services. The practice of medicine as a moral
enterprise. J Natl Med Assoc. 1973 November; 65(6): 501–passim.
PMCID: PMC2609038 (Accessed 2014-02-18)
21.
Submission of the Ontario Human Rights Commission to the College of
Physicians and Surgeons of Ontario Regarding the draft policy, "Physicians
and the Ontario Human Rights Code." 15 August, 2008. (Accessed
2008-08-31)
22. This presumption obviously underlies
standard bioethics texts. See, for example, Beauchamp TL, Childress JF,
Principles of Biomedical Ethics (7th ed) New York: Oxford University
Press, 2013
23. Marmor A. Law in the Age of Pluralism. New
York: Oxford University Press, 2007, p. 218
24. Mackay B.
Sign in office ends
clash between MD's beliefs, patients' requests. CMAJ January 7,
2003 vol. 168 no. 1 (Accessed 2014-02-16)
25. Report, Social Health and Family Affairs
Committee,
Women’s access to lawful medical care: the problem of unregulated use of
conscientious objection. Doc. 12347 (20 July, 2010)
Explanatory memorandum by Mrs. McCafferty, Part 1, paragraph 2, note 5
(Joanna Mishtal). (Accessed 2010-10-04)
26. Cannold L.
"The questionable ethics of unregulated conscientious refusal." ABC
Religion and Ethics, 25 March, 2011. (Accessed 2013-08-11)
Human
Rights Council, Twentieth session, Agenda items 2 and 3:
Annual Report of the Office of the United Nations High Commissioner for
Human Rights- Technical guidance on the application of a human rightsbased
approach to the implementation of policies and programmes to reduce
preventable maternal morbidity and mortality (2 July, 20012) para.
61, 30 (Accessed 2013-08-11)
O'Rourke A, De Crespigny L, and Pyman A.
"Abortion and Conscientious
Objection: The New Battleground" (July 10, 2012). Monash Law Review
(2012) Vol 38(3): 87-119. (Accessed 2013-08-18)
Finer L, Fine
J.B.
"Abortion Law Around the World: Progress and Pushback." American
Journal of Public Health, Apr 2013, Vol. 103 Issue 4, p. 585. (Accessed
2013-08-18)
Human Rights Council, 23nd Session - June 3, 2013.
Agenda Item 3: Presentation of Reports by the Special Rapporteur on Violence
against Women.
Oral Statement: Center for Reproductive Rights. (Accessed
20-13-08-11)
27. Gardner J. Complicity and Causality, 1 Crim.
Law & Phil. 127, 129 (2007). Cited in Haque A.A.
"Torture, Terror, and the
Inversion of Moral Principle." New Criminal Law Review, Vol.
10, No. 4, pp. 613-657, 2007; Workshop: Criminal Law, Terrorism, and the
State of Emergency, May 2007. (Accessed 2014-02-19)
28. Haque A.A.
"Torture, Terror, and the
Inversion of Moral Principle." New Criminal Law Review, Vol.
10, No. 4, pp. 613-657, 2007; Workshop: Criminal Law, Terrorism, and the
State of Emergency, May 2007.