Why physicians ought not to perform virginity tests

J Med Ethics doi:10.1136/medethics-2014-102344

Kevin Gary Behrens

Abstract

In this article I argue that it is not morally justified for physicians to perform virginity tests. First, I contend that, on the basis of the principle of non-maleficence, physicians should not perform virginity tests, because of the potential harms to those who are tested that can result from such tests. Second, I highlight some of the social harms that the practice causes, and argue that physicians ought not to be complicit in causing these harms. Third, I argue that physicians ought not to perform virginity tests on the grounds that testing for virginity is scientifically impossible, and physicians are morally obliged to practise according to scientific principles. Finally, I contend that an ethically sound response to virginity testing requires that the medical profession as a whole should follow the example of the Quebec College of Physicians in declaring this practice by physicians as unethical.

Submission to the College of Physicians and Surgeons of Ontario

Re: Professional Obligations and Human Rights

Christian Medical and Dental Society

I am generally able to agree with the draft policy Physicians and the Ontario Human Rights Code. Physicians should not discriminate against their patients nor should physicians impose their religious beliefs on a patient. Patients should be adequately informed of their options for care. The majority of the policy outlines this nicely.

Despite the first part of the policy reading well, I do not believe this is a policy that should be adopted. Lines 156-168 are very concerning. All Canadians, under The Canadian Charter of Rights and Freedoms, have the right to live according to their religious and moral beliefs. Stating that a physician must refer a patient for a service that goes against his or her conscience disqualifies that right. It reduces his/her personal sense of integrity and creates internal conflict that may force very compassionate and effective physicians out of practice. It would not affect the right of the patient to receive care since a procedure such as abortion can be self-referred and, if a patient disagrees with a physician’s perspective, they are able to obtain a second opinion.

Presently, the Supreme Court of Canada is considering a case that may lead to the legalization of euthanasia in Canada. Should this happen, the draft policy could obligate physicians, who strongly feel that killing is wrong, to participate in an act of killing, i.e. euthanasia or physician assisted suicide. This is very concerning.

This past spring and summer the College conducted an online survey with the question “Do you think a physician should be allowed to refuse to provide a patient with a treatment or procedure because it conflicts with the physician’s religious or moral beliefs?”. Yes votes amounted to 25,230 or 77% of the total count. This is a large majority in favour of physicians being able to practice according to their consciences. This is a very large sample of the population (32,912) that voted. I am amazed, then, that the College should disregard this viewpoint as lines 156-168 of the draft policy indicate.

I sincerely hope that you will reconsider adoption of this policy. Revision of lines 156-168 to omit the obligation to refer for or, in certain cases, perform procedures that go against their moral or religious beliefs should be made. Anything less than that would go against The Canadian Charter of Rights and Freedoms, against the popular vote in Ontario and certainly against the well-being of many Ontario doctors.

Euthanasia clinic criticised for helping woman with severe tinnitus to die

DutchNews.nl

A special clinic in The Hague, set up to help people whose doctors do not support euthanasia, has been reprimanded for helping a 47-year-old woman with chronic tinnitus to die, broadcaster Nos says on Monday.

The independent commission charged with monitoring how Dutch euthanasia rules are applied recognises that extreme tinnitus could be a reason for mercy killing but said Gaby Olthuis should have undergone further psychiatric research. . . [Full Text]

 

Inside Canada’s secret world of medical error: ‘There is a lot of lying, there’s a lot of cover-up

National Post

Tom Blackwell

As Helen Church woke up one morning just before Christmas 2012, the pain that had been building for weeks behind her right eye reached an excruciating climax.

Screaming in agony, she ran around her east-end Toronto apartment before finally managing to call 911 and passing out.

For the second time in short succession, she had fallen victim to health care gone badly awry.

Just two years earlier, Ms. Church went to a nearby hospital to have an ovary removed as treatment for a painful cyst. She left hours later with the ovary still in place – and a piece of mesh embedded in her abdomen to repair a non-existent hernia.

Then, months later, a specialist replaced an artificial, cataract-correcting lens that he said had started to wear. The result: That eye was now blind and growing increasingly painful.

The ophthalmologist, another specialist told her later, had implanted the lens in the wrong position, obscuring her sight and puncturing a duct, causing a slow bleed and massive pressure.

“There was so much blood in there, it blew the eyeball out of my head. It was hanging on my cheek,” said Ms. Church, a razor-sharp 83-year-old. “The blood was just dripping everywhere … I was hysterical, the pain was so bad.” . . . [Full Text]

 

Access – or ethical cleansing?

Sean Murphy*

Despite a warning from the Ontario Medical Association that the quality of health care will suffer if people who refuse compromise their moral or ethical beliefs are driven from medical practice,1 the College of Physicians and Surgeons of Ontario plans to introduce a policy this year that will have that effect.2 The College is concerned that too many Ontario doctors are refusing to do what they believe to be wrong.

Ontario physicians may have more to say about this, since no other profession imposes an obligation to do what one believes to be wrong as a condition of membership. Indeed, it is extremely improbable that such a requirement can be found in the constitution of any occupational or community organization in this country – or any country.

On a more practical note, if the Supreme Court of Canada decides to legalize euthanasia and physician assisted suicide, the policies on human rights and end of life care that the College plans to enact this year will require physicians to kill patients or help them commit suicide, or direct them to someone who will: in the words of the draft policy, to make “an effective referral . . . to a non-objecting, available, and accessible physician or other health-care provider.”3

An undetermined number of physicians who don’t want to kill patients or assist with suicide themselves may, in fact, be willing to do this. But many physicians will not be willing to provide “an effective referral” because, in their view, to do that is morally equivalent to doing the killing themselves. In the words of the President of Quebec’s Collège des médecins, “[I]f you have a conscientious objection and it is you who must undertake to find someone who will do it, at this time, your conscientious objection is [nullified]. It is as if you did it anyway.”4

Physicians who think like this are the targets of the policy developed by Dr. Marc Gabel and his working group at the Ontario College of Physicians. Physicians who think like this, according to Dr. Gabel, should not be in family practice. He was not, of course, talking about euthanasia or assisted suicide. He was talking about abortion.

But the issue is exactly the same. Any number of physicians may agree to referral for abortion because they believe that referral relieves them of a moral burden or of a task they find disturbing or distasteful. However, for others, as Holly Fernandez-Lynch has observed, referral imposes “the serious moral burdens of complicity.”5 They refuse to refer for abortion because they do not wish to be morally complicit in killing a child, even if (to use the terminology of the criminal law) it is, legally speaking, “a child that has not become a human being.”6

Just as some physicians believe it is wrong to facilitate killing before birth by referring patients for abortion, they and other physicians believe it is wrong to facilitate killing after birth by referring patients for euthanasia or assisted suicide. Activists like Professors Jocelyn Downie and Daniel Weinstock disagree.

Both are members of the “Conscience Research Group.”7 The Group intends to entrench in medical practice a duty to refer for or otherwise facilitate contraception, abortion and other “reproductive health” services. Both were members of an “expert panel” that recommended that health care professionals who object to killing patients should be compelled to refer patients to someone who would,8 because (they claimed) it is agreed that they can be compelled to refer for “reproductive health services.”9

From the perspective of many objecting physicians, this amounts to imposing a duty to do what they believe to be wrong. But that is just what the Conscience Research Group asserts: that the state or a profession can impose upon physicians a duty to do what they believe to be wrong – even if it is killing someone – even if they believe it to be murder. And Dr. Gabel and his working group agree.

To make that claim is extraordinary, and extraordinarily dangerous. For if the state or a profession can require me to kill someone else – even if I am convinced that doing so is murder – what can it not require?

If the College’s real goal is to ensure access to services – not to punish objecting physicians – that goal is best served by connecting patients with physicians willing to help them. If the real goal is to ensure access – not ethical cleansing – there is no reason to demand that physicians do what they believe to be wrong.

[PDF Text]


Notes

1. Letter to the College of Physicians and Surgeons of Ontario from the Ontario Medical Association Section on General and Family Practice Re: Human Rights Code Policy, 6 August, 2014. (Accessed 2018-03-07)

2. College of Physicians and Surgeons of Ontario, “Professional Obligations and Human Rights (Draft)” (Accessed 2018-03-07)

3.  College of Physicians and Surgeons of Ontario, “Professional Obligations and Human Rights (Draft),” lines 156-160. (Accessed 2018-03-07)

4. “Parce que, si on a une objection de conscience puis c’est nous qui doive faire la démarche pour trouver la personne qui va le faire, à ce moment-là , notre objection de conscience ne s’applique plus. C’est comme si on le faisait quand meme.” Consultations & hearings on Quebec Bill 52. Tuesday 17 September 2013 – Vol. 43 no. 34. Collège des médecins du Québec: Dr. Charles Bernard, Dr. Yves Robert, Dr. Michelle Marchand, T#154

5.  Fernandez-Lynch, Holly, Conflicts of Conscience in Health Care: An Institutional Compromise. Cambridge, Mass.: The MIT Press, 2008, p. 229.

6.  Criminal Code, Section 238(1). (Accessed 2018-03-07).

7.  Let their conscience be their guide? Conscientious refusals in reproductive health care. (Accessed 2018-03-07)

8.  Schuklenk U, van Delden J.J.M, Downie J, McLean S, Upshur R, Weinstock D. Report of the Royal Society of Canada Expert Panel on End-of-Life Decision Making (November, 2011) p. 101 (Accessed 2018-03-07)

9.  Schuklenk U, van Delden J.J.M, Downie J, McLean S, Upshur R, Weinstock D. Report of the Royal Society of Canada Expert Panel on End-of-Life Decision Making (November, 2011) p. 62 (Accessed 2018-03-07)

Ethical Cleansing in Ontario

 Sean Murphy*

An Ontario College of Physicians official, Dr. Marc Gabel, says that physicians unwilling to provide or facilitate abortion for reasons of conscience should not be family physicians.1 The working group Dr. Gabel chairs wants the College to approve this policy.2 If it does, ethical cleansing of Ontario’s medical profession will begin this year, ridding it of practitioners unwilling to do what they believe to be wrong. Dr. Gabel claims that this is required by professional practice and human rights legislation.

It is not clear that the Ontario Medical Association (OMA) will agree. After all, it requires some effort to maintain that physicians are ethically or morally obligated to do what they believe to be unethical or immoral. Moreover, last August, the OMA’s General and Family Practice Section warned Dr. Gabel’s working group that the quality of medical care would suffer if only students willing to sacrifice their personal integrity were accepted in medical school. Moreover, “What about remote areas of practice?” the Section asked. “Will more prescriptive policies drive physicians to feel that they will have no choice but to practice in more urban settings?”3

In other words, is it really better that a pregnant woman in Gravel Roads Only should have no local obstetrical care rather than the help of a rural physician unwilling to recommend or refer for abortion?

The concern expressed by the OMA is understandable, but actually beside the point. In truth, concern about access to services is not really what is behind the drive for ethical cleansing. That was made abundantly clear in Ottawa last year, after it was learned that an Ottawa physician was refusing to prescribe or refer for contraceptives. The story hit the front page of the Ottawa Citizen.

The Citizen did not report the mere facts: that a young woman had to drive around the block to get The Pill. That might have been dismissed as a first world problem. No: the Citizen had more ominous news. It had discovered, lurking in the nation’s capital, not just one, but three physicians who would not prescribe or refer for contraceptives or abortion.4 There was pandemonium. An activist group began preaching a crusade against the dissenters, a vitriolic feeding frenzy erupted on Facebook,5 vehement denunciations appeared elsewhere6 and the story became the subject of a province-wide CBC broadcast.7

One of the Facebookers helpfully suggested that the objecting physicians should move elsewhere, “maybe Dubai,” where they could be among their “own kind,”8 while others raged that they had “no business practicing family medicine”9 and “[did] not deserve to practice in Canada. PERIOD.”10

To find such comments on Facebook is not surprising. But it is surprising – and regrettable – that the comments offered by Dr. Gabel reflect the same attitude.

Now, there are about 4,000 physicians practising in the Ottawa area,11 and contraceptives and abortion referrals are so widely available in the city that the Medical Officer of Health says that it is cause for celebration.12 Thus, the wildly disproportionate reaction to news that 0.08% of Ottawa area physicians do not prescribe or refer for contraceptives cannot be explained as a rational response to a problem of supply and demand.

The crusade against the three physicians, now expanded by Dr. Gabel and his working group to a crusade for the ethical cleansing of the entire medical profession, is not driven by merely practical concerns about access to services. It is driven by an a markedly intolerant ideology masquerading as enlightened objectivity.

That is why the OMA’s concern that objecting physicians might be restricted to practising in urban centres is understandable, but misplaced. Ontario physicians must come to grips with the fact that, once ethical cleansing gets underway, dissenting physicians will have no refuge in big cities, even if it takes the crusaders longer to find them there.

Nor, if assisted suicide and euthanasia are legalized, will there be refuge for physicians who don’t want to participate in killing patients. The College’s draft policy on end of life care “requires physicians to sensitively respond to a patients wishes or requests to hasten death”13 and insists that physicians who “limit their practice on the basis of moral and/or religious grounds” must comply with College policy on human rights.14 If the law is changed, and Dr. Gabel and his working group get their way, this policy will require physicians who refuse to kill patients to help them find someone who will.

Physicians will be expected to prescribe, abort or refer, to lethally inject or refer, or get out of medicine – or get out of the country.

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Notes

1. “Catholics doctors who reject abortion told to get out of family medicine.” The Catholic Register, 17 December, 2014 (Accessed 2018-03-07)

2. College of Physicians and Surgeons of Ontario, “Professional Obligations and Human Rights (Draft).” (Accessed 2018-03-07)

3. Letter to the College of Physicians and Surgeons of Ontario from the Ontario Medical Association Section on General and Family Practice Re: Human Rights Code Policy, 6 August, 2014. (Accessed 2018-03-07)

4. Payne E. “Some Ottawa doctors refuse to prescribe birth control pills.” Ottawa Citizen, 30 January, 2014 (Accessed 2018-03-07)

5. Murphy S. “NO MORE CHRISTIAN DOCTORS.” Protection of Conscience Project.

6. “Some Ottawa doctors refusing to prescribe birth control, cite ‘ethical concerns and religious values.’” Reddit Ottawa (Accessed 2018-03-07)

7. CBC Radio, “Should doctors have the right to say no to prescribing birth control?” Ontario Today, 25 February, 2014 (Accessed 2018-03-07)

8.  T___ M___, 29 January, 2014, 6:56 pm

9.  A___ M___ 29 January, 2014, 7:41 pm

10. R___ V___, 29 January, 2014, 7:52 pm

11. College of Physicians and Surgeons of Ontario, All Doctor Search (Accessed 2014-07-29;2018-03-07)

12.  Levy I. (Medical Officer of Health, Ottawa) and Abdullah A. (President, Academy of Medicine, Ottawa), Letter to the Ottawa Citizen, 1 February, 2014.

13.  College of Physicians and Surgeons of Ontario, Planning for and Providing Quality End of Life Care: Key Features of the Draft Policy (Accessed 2018-03-07)

14. College of Physicians and Surgeons of Ontario, Planning for and Providing Quality End of Life Care (Draft), lines 363-365. (Accessed 2018-03-07)

Decriminalization of assisted suicide and the violation of our rights

LifeSite News

 Albertos Polizogopoulos*

Note: This article appeared about one month before the Supreme Court of Canada ordered the  legalization of assisted suicide and euthanasia.

In October, the Supreme Court of Canada heard the Carter case, where parties are challenging Criminal Code prohibitions on physician assisted suicide in the hopes of decriminalizing it. If they’re successful, it will impact more than just physicians.

In the Carter case, I acted for two groups of Protestant and Catholic physicians and a group of Catholic healthcare institutions. We argued that life is sacred and that assisted suicide should not be decriminalized, but we went on to argue more. The physicians argued that killing was not medicine and the Catholic healthcare institutions argued that providing dignity in death to the terminally ill and suffering was accomplished through palliative care and spiritual care, not through prematurely ending patient lives.

Beyond that, and most importantly, both groups pleaded with the Court to protect freedom of religion and freedom of conscience should it decide to decriminalize assisted suicide. In short, the physicians asked that should the Court legalize assisted suicide, that it rule that physicians who object to the practice on moral or religious grounds cannot be compelled to engage in the practice. Similarly, the Catholic healthcare institutions asked that they not be required to offer assisted suicide in their facilities on the grounds that doing so would violate Catholic teaching. . . [Full text]

African church leaders worry about the ‘medicalization’ of female genital mutilation

Religion News Service

Fredrick Nzwili

NAIROBI, Kenya (RNS) International rights groups, churches and activists are escalating campaigns against female genital mutilation now that a new practice has emerged in which girls are checking into hospitals to have the procedure.

In what being referred to as the medicalization of FGM, doctors, nurses and other health practitioners are secretly performing the procedures at the request of families.

“Like abortion, they are performing FGM for the money in hospitals and other places,” said the Rev. Richard Nyangoto, a Roman Catholic priest in Kisii County, an area in the country’s southwest where FGM is widely practiced.

“Taking it to hospital does not make it right,” added Nyangoto. “It’s evil.”

Health care providers now perform up to 18 percent of FGM cases and the trend is growing, according to the World Health Organization. . . [Full Text]

 

No legal “duty to refer” for euthanasia or assisted suicide anywhere in the world

 

Maurice Vellacott, MP
Saskatoon-Wanuskewin

For Immediate Release

OTTAWA – In anticipation of the possible striking down of Canada’s laws against euthanasia and assisted suicide (pending the Supreme Court’s decision in the Carter case), and given the College of Physicians and Surgeons of Ontario’s (CPSO’s) draft policy “Professional Obligations and Human Rights” [i] which, if passed, would require Ontario physicians to make referrals for controversial medical procedures regardless of their conscientious/religious convictions, Member of Parliament Maurice Vellacott today issued the following statement:

I am deeply concerned about the assault on the fundamental freedoms of Ontario’s doctors should CPSO’s policy forcing doctors to make referrals for morally objectionable “treatments” pass. If the Supreme Court of Canada strikes down Canada’s current laws on euthanasia or assisted suicide, then CPSO’s policy would mean Ontario’s physicians would have a “duty to refer” patients for treatments intended to kill the patient.

From the research I have conducted, with the help of the Library of Parliament, I have learned there is not a single jurisdiction in the world that forces doctors to violate their consciences through mandatory referrals for these life-ending “treatments.” (See attached list of laws in jurisdictions which have legalized euthanasia or assisted suicide.)

We all recognize it is criminally wrong to aid or abet the commission of a criminal act.[ii] In the same way, it would be morally wrong for a doctor to aid or abet (i.e. through referral) the commission of what that doctor deems to be an immoral act – in this case, intentionally killing, or assisting in the killing of, their patient. Following one’s conscience in the provision of euthanasia or assisted suicide, then, entails making a conscientious decision not only about performing euthanasia or assisted suicide, but also about making referrals for them.

The Canadian Medical Association has long been a defender of a physician’s freedom to abstain from being involved in morally objectionable procedures. Last August, the CMA clearly expressed its support for physicians’ freedom of conscience in the provision of euthanasia and assisted suicide should those acts ever be legalized.[iii]

In spite of no jurisdiction in the world imposing on physicians a legal duty to refer for euthanasia or assisted suicide, and in spite of the support for freedom of conscience by the national medical organization representing Canada’s physicians, we have the regulatory body in Ontario poised to punish physicians who act upon their moral guidance system that tells them that killing their patients is wrong.

Over the years, there have been repeated attempts by activists and special interest groups to impose their version of morality on all health care workers (almost succeeding in 2008 to convince CPSO to impose mandatory referral, until a loud public outcry from right across the country compelled CPSO to reverse course.) Such was the threatening climate that compelled me to introduce several private members bills, in successive Parliaments, that would protect health care workers who had conscientious objections to being involved in practices that deliberately take human life.

If the Supreme Court strikes down our laws against assisted suicide/euthanasia, then it will be up to Parliament to come up with a new law. It is clear from CPSO’s actions that we can’t leave it to the regulatory bodies to protect freedom of conscience. Any new law to regulate these life-ending medical procedures will need to include explicit protection for those health care workers who won’t take part in any action that aids or abets the killing of their patients.

– 30 –

For further information and comment, call (613) 992-1966 or (613) 297-2249; email: maurice.vellacott.a1@parl.gc.ca


Notes

[i] http://policyconsult.cpso.on.ca/wp-content/uploads/2014/12/Draft-Professional-Obligations-and-Human-Rights.pdf

[ii]http://laws-lois.justice.gc.ca/eng/acts/C-46/FullText.html

  1. (1) Every one is a party to an offence who
  • (a) actually commits it;
  • (b) does or omits to do anything for the purpose of aiding any person to commit it; or
  • (c) abets any person in committing it.

[iii] “Medical Association vows to protect conscience rights,” by Michael Swain, The Catholic Register, August 27, 2014, http://www.catholicregister.org/item/18703-medical-association-vows-to-protect-conscience-rights;  and Resolution adopted by General Council at 2014 AGM: “The Canadian Medical Association (CMA) supports the right of all physicians, within the bounds of existing legislation, to follow their conscience when deciding whether to provide medical aid in dying as defined in CMA’s policy on euthanasia and assisted suicide.” (https://www.cma.ca/Assets/assets-library/document/en/GC/Final-Resolutions-GC-2014-Confirmed-Nov-2014.pdf )

Belgian serial rapist will not be euthanized: minister

Expatica (Belgium Edition)

A serial rapist and murderer who had won the right to die under Belgium’s controversial euthanasia laws will not now be put to death following fresh medical advice, authorities said Tuesday.

Frank Van Den Bleeken, who has spent 26 years in jail for repeated rapes and a rape-murder, will instead be moved from his prison in the northwestern city of Bruges to a new psychiatric treatment centre in Ghent, Justice Minister Koen Geens said.

The Flemish-language newspaper De Morgen reported Saturday that Van Den Bleeken would be voluntarily euthanized by lethal injection in Bruges prison on January 11. [Full text]