Stahl and Emanuel (April 6 issue)1 rightly differentiate between conscripts and physicians. Nonetheless, they state, “the profession . . . uses reflective equilibrium to self-correct. This dynamic process establishes professional obligations . . . regardless of . . . personal beliefs.”1 This point fails to recognize that conscientious objectors are engaging in the dynamic process from within the profession to counter problematic professional obligations and to correct mistakes. . . [Full text]
Liao L,Goligher E. Conscientious Objection in Health Care, N Engl J Med 2017; 377:96-98 July 6, 2017 DOI: 10.1056/NEJMc1706233
TORONTO – It’s rare for an hour-long, academic lecture to get a standing ovation, but Dr. Ewan Goligher earned thunderous applause from about 100 people who turned up on a cold, rainy night to hear his defence of medical conscience.
The Toronto intensive care physician and researcher has become one of the leading voices opposing efforts to force doctors to make an “effective referral” for assisted suicide.
Goligher maintains that for the sake of medicine and democratic society, doctors must have a right to conscientious objection — not just for abortion but also for assisted killing.
“Freedom of conscience in the practice of medicine has been seriously eroded in recent years,” Goligher warned at the second annual deVeber Institute lecture delivered at the University of Toronto’s Wycliffe College on Oct. 27. . . [Full text]
deVeber Institute Annual Public Lecture with Wycliffe College at the University of Toronto
In the wake of the legalization of physician-assisted death, conscientious objection in medicine has become a matter of considerable controversy. Some bioethicists have called for severe restrictions on the physician’s capacity to object to patient requests on ethical grounds, and some Colleges of Physicians have enacted such restrictions.
This issue raises fundamentally important questions: what is the basis of the physician’s professional obligations? To what extent is the physician obligated to honour patient requests? What is the goal and purpose of medical practice? How can we resolve differences in ethical beliefs in a deeply pluralistic society? This controversy engages contested ethical, political and religious matters and promises to influence patient care and the practice of medicine in Canada in coming years. This lecture aims to chart a course through these muddied waters.
Groups representing more than 4,700 Christian doctors across the country have launched a court challenge to Ontario regulations that require them to refer patients to physicians willing to provide an assisted death, arguing the referrals are morally equivalent to participating in the procedure.
The College of Physicians and Surgeons of Ontario, however, takes issue with the faith groups’ position. “An effective referral does not foreshadow or guarantee an outcome,” college spokeswoman Tracey Sobers said in an e-mail.
Ewan Goligher, a doctor who works in the intensive care unit at Mount Sinai Hospital in Toronto, said he considers himself a conscientious objector to doctor-assisted dying and supports the court challenge. “I think the patient is of greater value than their preference, and I cannot lift my hand to destroy that which is of fundamental value,” he said in an interview. . . [Full Text]
Canadian policy makers have recently proposed to require all doctors to provide an effective referral for physician-assisted death (PAD) upon the patient’s request. Forcing doctors to knowingly send their patient to another doctor willing to cause the patient’s death will seriously compromise the moral integrity of conscientiously objecting doctors and risks undermining the quality of patient care. To understand the position of conscientiously objecting doctors, consider the following questions.
1. Should doctors provide physician-assisted death merely because it is legal?
2. Must all doctors accept the assumptions underpinning the claim that physician-assisted death is good medical care?
3. If physician-assisted death remained illegal, would doctors be legally liable for making an effective referral?
4. Does the Charter right of Freedom of Conscience apply to doctors?
5. How does respect for conscientious objection affect patient care?
6. Will respect for conscientious objection obstruct access to physician-assisted death?