Protection of Conscience Project
Protection of Conscience Project
Service, not Servitude

Service, not Servitude

Submission to the Canadian Medical Association

Re: 2018 Revision of the CMA Code of Ethics

2 April, 2018

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Executive Summary

The CMA Code of Ethics Revision Task Force has proposed a substantial revision to the Association's Code of Ethics. The Project applauds the emphasis placed by the Task Force on the moral agency of both patients and physicians, on human dignity, and on the importance of integrity and freedom of conscience in medical practice.

However, the 2018 Revision adds a requirement quite inconsistent with that emphasis: that physicians provide a formal referral or initiate a transfer of care to facilitate procedures to which they object for reasons of conscience. This reverses the CMA's longstanding position against mandatory referral. It contradicts recently developed CMA policy, and it is inconsistent with a significant CMA position statement concerning freedom of conscience. Finally, it imposes a form of servitude that is offensive to human dignity, violates freedom of conscience and illicitly discriminates against physicians in a manner the CMA itself has rejected.

It is preferable to take a broad and principled approach that keeps the focus on the nature and importance of freedom of conscience, avoiding entanglement in controversies about the acceptability of morally contested procedures.  The Project proposes a serviceable stand-alone policy of this type that draws on past CMA statements, key elements of its submission to the CPSO on effective referral, and the revised CMA Medical Assistance in Dying policy. This ought to be fully acceptable to the Association, since the elements of the policy have already been considered and agreed upon.

Incidentally, the Project recommends deletion of a reference to torture incorporated into 2018 revision. Deleting the reference would not compromise patient interests nor detract from the revision, and would avoid potentially troublesome distractions.


Executive Summary
Part I:          Seeking reconciliation
Part II:        CMA against mandatory referral
Part III:      CMA: freedom of conscience
Part IV:      CMA Policy: Medical Assistance in Dying
Part V:      Reconciling obligations
Part VI:    In the CMA's words: a policy on physician freedom of conscience
Part VII:   CMA Plus: physician exercise of freedom of conscience
Part VIII:    Postscript: torture
Appendix "A":   2004 Code and 2018 revision compared

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