Ontario physician first to announce plans to quit medicine due to demand for referral for euthanasia

Sean Murphy*

Moral imperialism by state authorities in Canada is beginning to take its toll.  A physician in Strathroy, Ontario, has publicly announced that she will not be renewing her licence to practise medicine because the College of Physicians and Surgeons of Ontario demands that she must either kill patients or help them commit suicide, or arrange for someone else to do so.

The College policy is a response to the 2015 Supreme Court of Canada ruling in Carter v. Canada (Attorney General).

Writing in the professional journal Canadian Family Physician in response to an article by Dr. Stephen Genuis (Emerging assault on freedom of conscience), Dr. Nancy Naylor thanked him for eloquently expressing her thoughts.  She states that mandatory referral for euthanasia or assisted suicide is “an assault on my integrity and ethics as a physician.”

Dr. Naylor has been a family physician for 37 years and has been exclusively providing palliative care for the past three years.

“I have no wish to stop,” she writes.  “But I will not be told that I must go against my moral conscience to provide standard of care.”



Emerging assault on freedom of conscience

Canadian Family Physician

Stephen J. Genuis

Discussion on physician autonomy at the 2014 and 2015 Canadian Medical Association (CMA) annual meetings highlighted an emerging issue of enormous importance: the contentious matter of freedom of conscience (FOC) within clinical practice. In 2014, a motion was passed by delegates to CMA’s General Council,and affirmed by the Board of Directors, supporting the right of all physicians, within the bounds of existing legislation, to follow their conscience with regard to providing medical aid in dying. The overwhelming sentiment among those in attendance was that physicians should retain the right to choose when it comes to matters of conscience related to end-of-life intervention. Support for doctors refusing to engage in care that clashes with their beliefs was reaffirmed in 2015. However, a registrar from a provincial college of physicians and surgeons is reported to have a differing perspective, stating “Patient rights trump our rights. Patient needs trump our needs.1

So, do the personal wishes of doctors hold much sway in Canadian society, where physicians are increasingly perceived as publicly funded service providers? Should the colleges of physicians and surgeons have the power to remove competent physicians who refuse to violate their own conscience?

And what about FOC in a range of other thorny medical situations unrelated to physician-assisted dying?

Genuis SJ. Emerging assault on freedom of conscience.  Canadian Family Physician April 2016 vol. 62 no. 4 293-296  [Full text]


Conscientious objection: the struggle continues


Reproduced with permission

Michael Cook*

The fight over conscientious objection to abortion has moved from the evening news to the academic journals. In the April issue of the American Journal of Public Health, two defenders of reproductive rights outline strategies to restrict abortion rights. They complain that “unregulated conscientious objection” seems to be growing, especially in countries where opposition to abortion is strong.

In a SSRN paper which is yet to be published, Lachlan De Crespigny, an Australian doctor writing from Oxford, and two academics from Monash University fiercely defend a recent law in the state of Victoria which forces doctors to refer for abortion. “The unregulated use of conscientious objection impedes women’s rights to access safe lawful medical procedures,” they write. “As such, we contend that a physician’s withdrawal from patient care on the basis of conscience must be limited to certain circumstances.”.

They contend that arguments in support of conscientious objection are often a smokescreen for imposing Catholic dogma. But women who conscientiously desire abortions also have rights. “The choice of abortion is in many cases the morally responsible decision that should not be overridden by the imposition of another’s conscience.”

A recent paper in the Journal of Bioethical Inquiry by two Canadians, a doctor and a lawyer, tries to make some philosophical distinctions which make conscientious objection to abortion more plausible. They distinguish between “perfective” and “preservative” freedom of conscience. The former is exercised in the pursuit of a perceived good. This must often be limited. The latter is more fundamental and cannot legitimately be coerced except in the most exceptional circumstances.

“If the state can legitimately limit perfective freedom of conscience by preventing people from doing what they believe to be good, it does not follow that it is equally free to suppress preservative freedom of conscience by forcing them to do what they believe to be wrong. There is a significant difference between preventing someone from doing the good that he/she wishes to do and forcing him/her to do the evil that he/she abhors.”

It could be argued that an ethics committee, or an institution or a government assumes the moral responsibility for a coerced decision. But this does not take into account the well-documented guilt and shame felt by concentration camp survivors who were forced to participate in heinous crimes. “When it is suppressed by coercion, the result is the kind of spiritual rape suffered by those victims of the camps who were forced to do what they believed to be wrong.”

Freedom of Conscience in Health Care: Distinctions and Limits


The widespread emergence of innumerable technologies within health care has complicated the choices facing caregivers and their patients. The escalation of knowledge and technical innovation has been accompanied by an erosion of moral and ethical consensus among health providers that is reflected in the abandonment of the Hippocratic Oath as the immutable bedrock of medical ethics. Ethical conflicts arise when the values of health professionals collide with the expressed wishes of patients or the dictates of regulatory bodies and administrators. Increasing attempts by groups outside of the medical profession to limit freedom of conscience for health providers has raised concern and consternation among some health professionals. The personal and professional impact of health professionals surrendering freedom of conscience and participating in actions they deem malevolent or unethical has not been adequately studied and may not be inconsequential when considering the recognized impact of other circumstances of coerced complicity. We argue that the distinction between the two ways that freedom of conscience is exercised (avoiding a perceived evil and seeking a perceived good) provides a rational basis for a principled limitation of this fundamental freedom.