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.

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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)

CBC interviewer fails to ask tough questions

Sean Murphy*

A bill has been introduced in the Canadian Senate by Conservative Senator Nancy Ruth to legalize physician assisted suicide and euthanasia.  Bill S-225’s definition of of “assist”  is of particular interest.  It means  “to provide the person with the knowledge or means to commit suicide, or to perform an act with the intent to cause the person’s death.”   Consistent with this, an “assisting physician” is one “who provides assistance” to a patient seeking euthanasia or physician-assisted suicide.

This indicates that indirectly facilitating suicide even by providing information for that purpose is equivalent to more direct forms of assistance, like providing a lethal prescription.  Further, it implies that both providing information to facilitate suicide and actually killing someone are of comparable legal or moral significance.  Many physicians and health care workers who object to assisted suicide and euthanasia would agree, and, for that reason, would refuse to refer or otherwise help a patient find someone willing to kill him or assist him in committing suicide.

The point was overlooked during an interview of Senator Ruth by Evan Solomon on CBC Television’s Power and Politics (2 December, 2014).  After discussing the contents of the bill in general terms and asking Senator Ruth about her reasons for introducing it, Solomon raised the issue of conscientious objection:

Evan Solomon:  A doctor might be watching this, and say, you know, “Great piece of legislation. What do you do if, what will you do to me if I don’t want to do this?”

Senator Ruth:  Nothing.  No doctor is coerced to do this, no patient is coerced to do this.  This is about choice.  The choice of doctors who want to assist in it and their protection . . .

Solomon failed to ask the tough questions.  Among them:

  1. If physicians will not be forced to kill patients, will they, nonetheless, be forced to help patients find someone who will?
  2. Why is it that the bill is about the choice and the protection of doctors who want to help to kill patients, and not about the choice and protection of those who refuse?
  3. When abortion was legalized, politicians and activists promised that no physician would be forced to provide abortions, but refused to include a protection of conscience provision in the law.1  Now the College of Physicians of Ontario is proposing a policy that would compel physicians to provide abortions or help  patients obtain them.2  Dr. Marc Gabel, chair of the working group that produced the draft policy, warns that physicians who refuse to do this should get out of family practice.3  As written, the policy could be applied equally to euthanasia and assisted suicide.  Why does Senator Ruth think that objecting physicians will not be coerced – if not sooner, then later?

Notes:

1. Murphy, S.  “Promises, promises.  Canadian law reformers promise tolerance, freedom of conscience:What happens after the law is changed is another story.” Protection of Conscience Project

2. “Ontario physicians to be forced to do what they believe to be wrong:  Draft policy demands that objectors provide or refer.  Policy would apply to euthanasia, if legalized.”  Protection of Conscience Project news release, 10 December, 2014

3.  Swan, M.   “Catholics doctors who reject abortion told to get out of family medicine.” The Catholic Register, 17 December, 2014.  (Accessed 2014-12-19)

 

 

New Brunswick health minister unaware of abortion-euthanasia connection

Project Letter to the Editor,
Fredericton Daily Gleaner

Sean Murphy*

Re: “Abortions won’t be available in all hospitals. “The Fredericton Daily Gleaner, 28 November, 2014

New Brunswick’s Minister of Health and the President of the province’s Medical Society both claim that physicians who refuse to provide abortion for reasons of conscience have an obligation to refer patients to colleagues who will. These assertions contradict the positions of the Canadian Medical Association and the College of Physicians and Surgeons of New Brunswick. Mr. Boudreau and Dr. Haddad also fail to recognize how such a policy would play out should assisted suicide and euthanasia be legalized. The Protection of Conscience Project intervened at the Supreme Court of Canada in the Carter case on precisely this point.1

Some influential academics have been attempting to force physicians to refer for abortion for years. They now claim that “because” physicians can be forced to refer for abortion, they should be forced to refer for euthanasia.2 If they have succeeded in converting Mr. Boudreau and Dr. Haddad to their point of view, it is not shared by physicians who refuse to be parties to killing, before or after birth.

The Canadian Medical Association expects physicians who decline to provide abortions for reasons of conscience to notify a patient seeking abortion “so that she may consult another physician.” There is no requirement for referral.3 The College of Physicians of New Brunswick suggests referral as a “preferred practice,” but acknowledges that referral may not be acceptable. Physicians may, instead, provide information about resources available to patients that they can use to obtain the service they want.4

Notes:

1.  Murphy, S. “Project Backgrounder Re: Joint intervention in Carter v. Canada.” Supreme Court of Canada, 15 October, 2014

2. 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. 70 (Accessed 2014-12-02)

3. Murphy S. “‘NO MORE CHRISTIAN DOCTORS.’ Appendix ‘F’- The Difficult Compromise: Canadian Medical Association, Abortion and Freedom of Conscience.” Protection of Conscience Project

4. Comment by College of Physicians and Surgeons of New Brunswick (November, 2002) Re: Declining to provide service on moral/religious grounds.

Looking back on 15 years: an anniversary

December, 1999 to December, 2014

Sean Murphy*

The Protection of Conscience Project celebrates its 15th anniversary in December, 2014. The formation of the Project was one of the eventual results of a meeting in Vancouver with British Columbian Senator Ray Perrault1 in the spring of 1999.

Senator Perrault wished to continue the work of retiring Liberal Senator, Stanley Haidasz, whose protection of conscience bill was stalled in the upper chamber.2 Among the experiences that spurred Senator Perrault to continue Senator Haidasz’s work was an encounter while going door to door during an election campaign. A nurse, in tears, told him that she had quit work after 15 years because she was required to participate in abortions, and could no longer do so in good conscience.

The meeting was sponsored by the Catholic Physicians Guild of Vancouver. Most participants were physicians or pharmacists. They spoke of their growing concern that they would be penalized or forced out of their professions if they continued to practise in accordance with their religious or moral beliefs. It became clear that these health care professionals had come to recognize the growing threat to their freedom to serve their patients without violating their personal and professional integrity. This was a key factor in the establishment of the Protection of Conscience Project nine months later.

While the meeting in 1999 was called by a Catholic organization, the Protection of Conscience Project is a non-profit, non-denominational initiative that does not take a position on the acceptability of morally contested procedures like abortion, contraception or euthanasia: not even on torture. The focus is exclusively on freedom of conscience and religion.

The Project is supported by an Advisory Board drawn from different disciplines and religious traditions, a Human Rights Specialist and an Administrator, all of whom serve without remuneration.3 It was conceived as an initiative rather than an organization, association or society; it has no ‘members’ or structures of an incorporated entity. This ensures that the time and energy that would otherwise be needed to maintain corporate structures is spent on more immediately practical work. The name originated in a comment made by Iain Benson, then Senior Research Fellow of Canada’s Centre for Cultural Renewal, now Senior Resident Scholar, Massey College, University of Toronto.4

“We don’t need another organization,” he said. “We need a project.”  [Full text]

 

 

Good News and Bad News

Presentation to the Catholic Physicians’ Guild of Vancouver

North Vancouver B.C.

Sean Murphy *

Introduction

Thank you for inviting me to speak this evening. I have never been asked to give a three hour presentation to a group of physicians. You will be relieved to know that I have not been asked to do that tonight.

Those of you who saw the BC Catholic headline may have been expecting a “lecture on medical ethics,” but, thanks to Dr. Bright’s introduction, you now know that I am an administrator, not an ethicist, and that my topic is freedom of conscience in health care.

Protection of Conscience Project

The Protection of Conscience Project will be 15 years old this December. Although a meeting sponsored by the Catholic Physicians Guild provided the impetus for its formation, the Project is a non-denominational initiative, not a Catholic enterprise. Thus, if I mention the Catholic Church or Catholic teaching tonight, it will be as an outsider, as it were, though an outsider with inside information.

One more thing: the Project does not take a position on the acceptability of morally contested procedures like abortion, contraception or euthanasia: not even on torture. The focus is exclusively on freedom of conscience.

Context

Supreme Court of Canada, OttawaThe context for my presentation is provided by the passage of the Quebec euthanasia law1 and the pending decision in Carter v. Canada in the Supreme Court.2 Physicians are now confronted by the prospect that laws against euthanasia and physician assisted suicide will be struck down or changed. If that happens, what does the future hold for Catholic physicians and others who share your beliefs?

Will you be forced to participate in suicide or euthanasia?

If you refuse, will you be disadvantaged, discriminated against, disciplined, sued or fired?

Will you be forced out of your specialty or profession, or forced to emigrate if you wish to continue in it?

What about those who come after you? If you avoid all of these difficulties, will they?

In sum, will freedom of conscience and religion for health care workers be protected if assisted suicide and euthanasia are legalized? [Full Text]

When is a problem not a problem?

Refusing to dispense drugs to kill patients with psychiatric illness

Levenseinde Kliniek complains about uncooperative Dutch pharmacists

Sean Murphy*

In April, 2014, a complaint was made in the Netherlands that some Dutch pharmacists were refusing to provide euthanasia drugs.  The complaint led members of the Dutch Parliament from the green party, GroenLinks, to ask for a debate with health minister, and members of other Dutch political parties let it be known that they were also concerned.

 According to the news reports, over half the physicians at “the independent euthanasia clinic” had been refused lethal drugs, and 23 percent of 53 pharmacists surveyed reported that they sometimes refused to fill euthanasia prescriptions.  It was argued that pharmacists should not be able to refuse drugs needed to kill patients if two physicians had approved the euthanasia request.  However, while the law in the Netherlands permits physicians to provide euthanasia, it does not mention pharmacists. [Full Text]

Judgementalism and moralising in response to Brittany Maynard suicide

Sean Murphy*

On 1 November, Brittany Maynard,  a 29 year old woman with terminal brain cancer, committed suicide in Oregon State with the assistance of a physician (and, presumably, a pharmacist), who provided the lethal medication she consumed.  Assisted suicide is legal in Oregon; that is why Maynard moved to the state.  In the weeks leading up to her death she had become a celebrity because of her public advocacy of assisted suicide, augmented by a kind of “countdown” to the date she had chosen to die. [NBC News]

It is not surprising that the announcement that she had killed herself as planned was followed by an outburst of judgementalism and moralising.

Prominent bioethicist Arthur Caplan stated, “did nothing immoral when she took a lethal dose of pills.”  He dismisses the view that “only God should decide when we die” because he finds that inconsistent with the existence of free choice, adding, “To see God as having to work through respirators, kidney dialysis and heart-lung machines to decide when you will die is to trivialize the divine.” [Brittany Maynard’s Death Was an Ethical Choice]

Chuck Currie, a minister of the United Church of Christ in Oregon, also insisted that Maynard had “made a moral choice.”  He described committing suicide under the terms of the Oregon law as taking “medically appropriate steps to make that death as painless and dignified as possible” – an appropriate exercise of “moral agency.”  Like Caplan, his theological views about the nature of God inform his approach to the issue. [Brittany Maynard Made A Moral Choice]

Writing in the New York Post, Andrea Peyser did not explicitly address either moral or theological questions, but implicit in her headline and awestruck praise for Maynard’s suicide was the premise that the young woman had done a “brave” and good thing. [We should applaud terminally ill woman’s choice to die]

In contrast, the head of the Catholic Church’s Pontifical Academy for Life in Rome, Monsignor Ignacio Carrasco de Paula, said that Maynard’s killing herself was a  “reprehensible” act that “in and of itself should be condemned,” though he stressed that he was speaking of the act of suicide itself, not Maynard’s moral culpability. [Daily News]

Those who condemn “judgementalism” and “moralising” ought to be offended by all of these commentators, because all of them –  Caplan, Currie, Peyser and de Paula – have expressed moral or ethical judgements.  To condemn suicide as “reprehensible” is surely to make a moral or ethical judgement, but moral judgement is equally involved in a declaration that suicide is a “moral” or “ethical” choice that should be applauded.

Health care workers who refuse to participate in some procedures for reasons of conscience or religion are often accused of being “judgemental” or of “moralising.”  In fact, as the preceding examples illustrate, their accusers are not infrequently just as “judgemental” and “moralistic.”   Such differences of opinion are not between moral or religious believers and unbelievers, but between people who believe in different moral absolutes.

This was one of the points made by Father Raymond De Souza during an interview about assisted suicide on CBC Radio’s Cross Country Checkup.  Interviewer Rex Murphy asked him if he thought that  “the idea of any absolute . . . even on the most difficult of questions of life and death . . . are no longer sufficient . . . for the modern world.”  Fr. De Souza’s response:

It’s a shift, Rex, I would say from one set of absolutes to the other.  And the absolute would be the absolute goodness of life, in one case, to assertion of personal autonomy, which is becoming an absolute assertion. And in fact in some of the arguments that have gone before the court, while acknowledging potential difficulties and philosophical objections, the right to personal autonomy trumps everything else.  So, in a certain sense, I wouldn’t say we are moving away from absolutes, but shifting from one set of absolutes to the other . . . [34:21- 35:24]

 

 

 

Promises, promises

Canadian law reformers promise tolerance, freedom of conscience

What happens after the law is changed is another story.

Sean Murphy*

Now let me finally cut to the chase, to the heart of this appeal.  The most vociferous opposition to our challenge comes from some church groups, and some disabled organizations.  To the church groups we simply say that we respect your religious views, but they cannot, in this secular society,  trump our clients’ constitutional rights.  And no one is suggesting that a physician who has a religious objection to assisting a patient with his or her death must do so.
Joseph Arvay, Q.C., Oral Submission to the Supreme Court of Canada,  Carter v. Canada, 15 October, 2014

Introduction

With the passage of the Quebec euthanasia law and the pending decision in Carter v. Canada in the Supreme Court of Canada, physicians, medical students, nurses and other health care workers opposed to euthanasia and assisted suicide for reasons of conscience are confronted by the prospect that laws against the procedures will be struck down or changed.  They may wonder what the future holds for them if that happens.

Will they be forced to provide or assist with something they find morally abhorrent?  If they refuse to do so, will they be disadvantaged, discriminated against, disciplined, sued or fired?  Will they be forced out of their specialty or profession, or forced to emigrate if they wish to continue in it?

The realpolitik of law reform

These questions have been largely ignored, since much of the public debate about euthanasia and assisted suicide has been about whether or not the procedures should be legalized, not about what effect legalization might have on freedom of conscience, particularly among health care workers.  Opponents of legalization understandably decline to raise the issue because they are concerned that doing so would compromise the message they want to deliver.

Advocates of legalization, on the other hand, generally recognize that support for euthanasia and assisted suicide may begin to evaporate if it appears that they intend to force unwilling physicians or health care workers to participate in killing patients.  In particular, they do not wish to alienate members of the health care community who, on principle or as a matter of prudent self-interest, would not support such a coercive policy.  Instead, they adopt a reassuring posture of respect for freedom of conscience and tolerance for opposing views within the medical profession.

It is instructive to see how this strategy has been applied in the case of the Quebec euthanasia law and the Carter case, and then to consider how it was applied in the case abortion, another morally controversial procedure.  While we cannot predict the future, we are now in a position to judge the worth of the assurances given when abortion was legalized over forty years ago, and to apply that judgement to assurances now being made about euthanasia. [Full Text]

Freedom of conscience

Presented to the Rotary Club
Powell River, British Columbia, Canada

Sean Murphy*

Thank you for inviting me to speak to you this evening. C.S. Lewis once observed that a lifetime of learning leaves a man a beginner in any subject, so I am here as a beginner who is still just beginning. The specific focus of the Protection of Conscience Project is freedom of conscience in health care. However, rather than address issues specific to health care I am going to speak more generally about freedom of conscience. I think a broader approach, a bigger picture, will be more useful for you as Rotarians. I’ll begin with some notes about the history of freedom of conscience and religion. . .  Full Text