Submission to the Executive Council of the British Columbia Civil
19 September, 2000
Should people be compelled to participate,
directly or indirectly, in medical procedures to
which they object for reasons of conscience?
The Project website documents a number of cases
involving repression of freedom of conscience that
have arisen over the years,1
and takes note of circumstances that suggest a
potential for further conflict.2
That many of these cases concern abortion is
largely an accident of history, a result of the
legalisation of what continues to be a controversial
Developing technology promises to generate more moral controversy, not less. Disputes are
already underway about the ethics of artificial
reproduction, eugenics, genetic engineering,
embryonic experimentation, organ harvesting and
tissue trafficking. Lobbies for the legalisation of
assisted suicide and euthanasia have been successful
in some jurisdictions and continue to be persistent
The provision of such procedures would impact
many who are employed in health care and research.
Naturally enough, those debating the new
technologies or legalization of assisted suicide and
euthanasia have concentrated on arguments about the
rights of those seeking them; little or no attention
is paid to the position of those who do not wish to
participate in the procedures, yet may be expected
to do so. In consequence, the issue of conscientious
objection tends to be left out of political, policy
and legal analyses, arising (if at all) only as a
peripheral concern in implementation.3
The position of conscientious objectors is made
more difficult when professional organizations or
public institutions impose faith-based moral or
ethical norms, frequently in the service of what is
considered to be secular public policy.4
This is an exercise of power and influence
reminiscent of that exercised by organized religion
before the "separation of Church and State".
For example: the College of Pharmacists of
British Columbia states that pharmacists who object
to dispensing certain pharmacy products for moral or
religious reasons "must refer patients to colleagues
who will provide such services, and in the end
deliver these services themselves if it is
impractical or impossible for patients to otherwise
receive them." Further, the College warns
pharmacists that future services "might expand to
include preparation of drugs to assist voluntary or
involuntary suicide [sic], cloning, genetic
manipulation, or even execution . .
This policy conflicts with moral or religious
beliefs that absolutely proscribe direct involvement
in the service in question, and dismisses as
inconsequential any concerns about moral culpability
arising from referral.6
Yet the College asserts an absolute right to
force its institutional moral judgement upon those
The moral position of an
individual pharmacist, if it differs from the ethics
of the profession, cannot take precedence over that
of the profession as a whole.
When asked if conscientious objectors would be
compelled to dispense drugs intended to kill people
if euthanasia, assisted suicide or execution by
lethal injection were legalized
8 the Registrar offered the following
Until such time as these are
made legal or likely to be made legal, our College
will not establish whether such procedures are
recognized pharmacy services. In future, if any are
determined to be recognized pharmacy services, our
profession would be expected to provide them
according to our Code of Ethics.9
In an article published in the Canadian
Pharmaceutical Journal, this policy was urged as the
ethical norm for the profession by Frank Archer, a
B.C. pharmacist and member of the ethics committee
of the College of Pharmacists of B.C.10
The article - defective in several respects
11 - was
cited favourably at the June conference of the
Canadian Pharmacy Association. Not coincidentally,
spokesmen for conscientious objectors at the
conference were told by more than one colleague that
they should leave the profession.
Discussion of freedom of conscience in health
care must move beyond ongoing debates about the
morality of particular procedures. The practical
reason for this is that piecemeal efforts cannot
keep pace with new technological and social
developments. More important, to ask whether or not
Procedure X is morally or socially acceptable is to
ask the wrong question when one is attempting to
establish how freedom of conscience is to be
accommodated in a pluralistic society.
Instead, there is
for a principled approach. One must re-examine
the concepts of freedom, of morality, of conscience,
and the dignity of the human person, to discover how
differing views about these fundamentals can be
resolved or accommodated, and contribute as fully as
possible to the common good.
In pursuit of this objective, it is also
necessary to reconsider the language of public
discourse. One may question, for example, how far
'values language' clarifies or obscures points in
Moreover, 'rights talk', customary in discussions
about equality, is too confining when one must
address issues of conscience. An alternative is
suggested by the Charter of Rights, which
distinguishes between rights and freedoms.
There is a
need for adequate language, a language of
Finally, the moral outlook of conscientious
objectors is incomprehensible to many of their
colleagues, often because their colleagues
incorrectly consider their own views to be dictated
by fact rather than faith. A closer examination
frequently shows that the supposed faith-free
position of those who oppose freedom of conscience
in health care is equally an expression of beliefs
that must be held on faith. In the interests of
justice, there is
an urgent need to recognize the faith-based bias
of a supposedly faith-free secularity.
A. One should not be compelled to participate,
directly or indirectly, in something to which one
objects for reasons of conscience, nor suffer
adverse consequences for refusal to participate.
This principle protects fundamental goods of the
individual and society.
B. In cases of conflict in health care that
involve freedom of conscience, solutions that
adversely affect freedom of conscience should not be
considered unless other measures cannot be attempted
without imminent danger of death or serious bodily
C. Adverse impacts on freedom of conscience that
cannot be avoided must be minimized.
D. Ethical issues must not be overwhelmed by the
rapid pace of developments in biotechnology, driven,
in part, by 'consumer demand'. Introduction or
modification of health care delivery systems,
procedures, products and services should be preceded
and accompanied by ethical impact studies (analogous
to environmental impact studies) to ensure that the
changes will not harm the 'ethical environment', and
that the moral and ethical interests of all parties
are accommodated to the greatest possible extent.
Repression of Conscience.
3. See, for example, Re:
Rodriguez and Attorney General of British Columbia
et al, Supreme Court of Canada, 30 September,
1993: Court File 23476 107 D.L.R. (4th) 342, 85
C.C.C. (3d) 15, 20 W.C.B. (2d) 589.
Lamer, C.J.C. (dissenting) ". . .I have
held that S. 241(b) violates the equality rights of
all persons who desire to commit suicide but are or
will become physically unable to do so unassisted .
. . . One of McEachern C.J.B.C.'s conditions is that
the act of terminating the appellant's life be hers
and not anyone else's. While I believe this to be
appropriate in her current circumstances. . . why
should she be prevented the option of choosing
suicide should her physical condition degenerate to
the point where she is no longer even physically
able to press a button or blow into a tube? Surely,
it is in such circumstances that assistance is
required most. Given that Ms. Rodriguez has not
requested such an order, however, I need not decide
the issue at this time."
With respect, the Chief Justice appears not to
have recognized that the arguments he had heard for
and against Rodriguez rights and freedoms did not
address the rights and freedoms of those to whom
such an order would have been directed.
4. For the insights into "secular
fundamentalism" see Benson I. T. Notes Towards a
(Re) Definition of the Secular. (2000) 33 U.B.C.
Law Rev. 519 _549, Special Issue: "Religion,
Morality, and Law", p. 521. Mr. Benson has written a
popular summary of the main points in the Law Review
There are no Secular Unbelievers, which
appeared in Centre Points:Vol. 4, No. 1, Spring,
2000, the newsletter of the Centre for Cultural
5. College of Pharmacists of
British Columbia, Bulletin March/April 2000 Vol. 25
No. 2; Ethics in Practice: Moral Conflicts in
6. See Murphy, Sean,
Referral: A False Compromise.
7. See note 5.
8. Letter dated 29 April,
2000, from the Administrator, Protection of
Conscience Project, to the Registrar, College of
Pharmacists of British Columbia
9. Letter dated 9 May,
2000, from the Registrar, College of Pharmacists of
British Columbia to the Administrator, Protection of
10. Archer, Frank,
"Emergency Contraceptives and Professional Ethics".
Canadian Pharmaceutical Journal, May 2000, Vol.
133, No. 4, p. 22-26.
11. Murphy, Sean,
In Defence of the New Heretics: A Response to
Frank Archer (unpublished MS, July 2000)
12. Benson, Iain T.,
Are "Values" the Same as "Virtues"?.
Centrepoints, Vol. 2, No. 2, Article #1, Fall, 1996
(Newsletter of the Centre for Cultural Renewal).
13. See note 4, and the
Project Submission to the All-Party Oireachtais
Committee on the Constitution (Ireland).