Ethics should colour doctor’s decisions

Wrong to ask MDs to leave their values at their exam room doors

Hamilton Spectator

Reproduced with permission

Lea Singh

In a recent column, Martin Regg Cohn throws spears in all directions as he attacks doctors who refuse to prescribe or refer for birth control pills. Cohn wants the College of Physicians and Surgeons of Ontario, which is reviewing its human rights guidelines, to clamp down on these doctors and force them to participate in treatments they consider unethical or risk losing their jobs.

First off, Cohn rejects the possibility that there could be sound medical judgment behind the decision not to prescribe birth control pills. He is wrong; birth control is not Tylenol. Popular pain relievers are very safe when used according to directions; their main danger comes from accidental overdose.

In contrast, a regular “safe” daily dose of birth control pills will nearly triple a woman’s risk of deadly blood clots, and newer pills like Yasmin further double or triple that risk. Last year, Yasmin was linked to the deaths of 23 Canadian women. This year, a major French report revealed that blood clots caused by birth control pills have killed about 20 French women per year since 2000. Many women who survived their blood clots have been left paralyzed, blind and otherwise disabled.

Yes, pregnancy also increases blood clot risks. Blood clots kill more pregnant women than any other cause in the developed world. But pregnancy only lasts nine months, while many women are on the pill for years or even decades, often with little monitoring.

And what about the fact that the World Health Organization has classified birth control pills as “carcinogenic to humans?” The WHO is hardly trying to promote a religious agenda, but in a 500-page report it found “sufficient evidence” that birth control pills increased the risk of breast cancer and cancers of the cervix and liver.

But medical judgment aside, should doctors have the right to opt out of treatments they believe to be deeply unethical? Cohn argues that doctors should leave their religious values and personal ethics out of their workplace.

This is a new and dangerously totalitarian way of thinking. In the past, we have always respected every person’s right to live according to their own moral and religious precepts. This is why our Charter says that “Everyone has the following fundamental freedoms: (a) freedom of conscience and religion.”

Living out our values is the essence of true freedom. In dictatorships, everyone is still free to think, but they cannot act on their beliefs. In democracies like Canada, citizens have the right to conform their actions to their deepest values.

Cohn would take away this Charter protection from doctors, to save patients from the inconvenience and annoyance of having to go elsewhere. But is minor inconvenience really too high a price to pay for the fundamental freedom of our doctors, or any citizens? Ontario patients have plenty of alternative venues from which to get their prescriptions, such as public health clinics and emergency rooms. Abortions don’t even need a referral in Ontario.

If the medical profession is different from other professions, it is because ethics are so much more important in the field of medicine. Doctors hold our health and our lives in their hands. For centuries, we have insisted that doctors promise to do no harm, because we know that internal ethical limits make doctors far more responsible in the use of their medical powers. If doctors become mere machines that take orders without question, patients will ultimately be far less safe.

How can we trust doctors who leave their personal ethical limits at the door of their workplace? To really undermine confidence in our health care system, populate it with morally schizophrenic doctors who won’t mind performing procedures they admit are deeply unethical.

The law is too rough, corruptible and imperfect to prevent doctors from playing God. What will hold back doctors if the law permits any unethical procedures? Is it wise to place all our faith in regulations as our only safeguard when the scalpel looms over us?

We will reap what we sow. Perhaps we have truly become so dogmatic that we can no longer tolerate any dissent from the mantra of reproductive and sexual rights, and freedom is the next casualty. But freedom is a mighty tree that should not be cut down lightly. Our pluralist, democratic society lives in its branches, and the aftershocks of such a fall will be felt by all of us.

Lea Singh is a blogger, writer and lawyer who resides in Ottawa. Her blog is at

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