"Can't take the heat, get out of the kitchen"
Law professor tells senators how he deals with conscientious objectors
Winnipeg, Manitoba, Canada (1995-2000)
In November, 1999, a sub-committee of the
Canadian Senate convened in Ottawa to review the
Senate report, "Of Life and Death", published in
1995. The report was the product of hearings
into a number of issues, including euthanasia,
assisted suicide, the withholding and
withdrawing of life-support treatment,
palliative care, advance directives, and
The new sub-committee was
given the task of submitting an update to "Of
Life and Death" in June of 2000, the fifth
anniversary of its publication. The terms of
reference specified that the sub-committee's
review of the report should focus on four areas
- anything that was a unanimous
- progress on the implementation of the
- developments in Canada respecting the
issues dealt with;
- developments in foreign jurisdictions
respecting the issues dealt with.
In February, 2000, a law professor from
western Canada addressed the sub-committee. He
told the Senators about an incident that
occurred during a seminar at the Health Sciences
Centre in Winnipeg. The seminar, a role playing
exercise, had been organized by a professor of
medicine. The relevant portion the testimony has
been extracted from the transcript of the
sub-committee hearing. It is consistent with the
example of coercion cited by Canadian Member of
Parliament Maurice Vellacott when he introduced
his protection of conscience bill in the
Canadian House of Commons (See
Student pressured to participate in abortion).
It is noteworthy that this story does not
appear to have elicited so much as a raised
eyebrow from the Senators. On the contrary:
Senator Pepin adverted to what she seems to
consider a troublesome 'lobby' of medical
students who are reluctant to participate in
certain procedures. She even reminisced about
difficulty encountered in introducing birth
control when working in a hospital years before;
it was necessary to employ "persuasion" to get
nurses to cooperate.
It is not surprising that Senator Pepin opposed the protection of
conscience legislation presented in the Senate by Senator Haidasz.
Proceedings of the Subcommittee to Update "Of
Life and Death"
Ottawa, Monday, February 14, 2000
The Subcommittee to Update "Of Life and Death" of
the Standing Senate Committee on Social Affairs,
Science and Technology met this day at 2:01 p.m. to
examine the developments since the tabling in June
1995 of the final report of the Special Senate
Committee on Euthanasia and Assisted Suicide
entitled, "Of Life and Death".
Senator Sharon Carstairs (Chairman) in the
Professor Barney Sneiderman, Faculty of
Law, University of Manitoba: The Nancy B.
case is a decision by a trial court judge, yet the
case has had considerable impact. The people who
have had to get that message are the physicians. The
message they need to get is that a mentally
competent patient has the right to refuse treatment,
even if, in the physician's considered judgment, the
treatment will restore a quality of life that the
physician regards as tolerable.
I am sometimes involved in discussions with
physicians and with medical students. They all know
about this case. I can recall attending a seminar
with medical residents, where a nurse was brought in
on a gurney, playing the role of Nancy B., and each
of the residents would have to go up to her and
engage in a conversation.
"Nancy B." would begin the conversation by saying
it was time to remove the respirator and to let her
die, and there would be a discussion between the
patient and the medical resident. One of the medical
residents was arguing with "Nancy B." and telling
her that she could not abide by her request. She
explained that, out of her religious convictions, it
was simply impossible for her to grant the patient's
I then commented. I said to her, "There was a
sign on Harry Truman's desk: If you can't take the
heat, get out of the kitchen. You are going to be a
physician and your religious principles are a matter
between you and your God. If you feel you cannot
comply with her request, then you are obliged to
transfer her to another physician, but you have to
understand that that is her legal entitlement."
She did not respond to me. She looked rather
upset with me. Then a number of her fellow residents
injected comments supporting what I had said. They
said, "Look, you heard her. She said disconnect the
respirator, and she is mentally competent. You can
talk to her, you can certainly attempt to persuade
her otherwise, you cannot coerce her, but the bottom
line is that it is her decision."
This decision by a trial judge has had a
Senator Pépin: I was a nurse at a time when
we had to refuse to give morphine to a patient, even
if he or she was in a great deal of pain, if we knew
that, given the patient's weak state, the morphine
injection could be fatal. Later on, the legislation
as well as the Catholic position changed, so that
nurses were allowed to give morphine to such
patients. . . .
Senator Pépin: The other issue
concerned medical students. You told us about the
medical student who was refusing treatment based on
her religious beliefs.
Mr. Sneiderman: She was a resident.
Senator Pépin: She was a
resident. Currently, medical students and nurses are
lobbying to be transferred from one department to
another one because, for example, they may be
working in a department where they must assist in
abortions and they can not do so. I understand the
lobby is quite strong.
I have not been involved on a hospital floor for
many years, but I do remember the impact of the
discussion surrounding birth control and the
persuasion it took before nurses would cooperate. Of
course, the impact of that is not comparable to what
we are discussing now. What trends are young medical
Mr. Sneiderman: I really cannot
say, but I can tell you something about medical
students in Manitoba.
Senator Pépin: Are they more
inclined to accept what the patient says and to help
Mr. Sneiderman: I think that the
new generations of medical students and physicians
are more respectful of patients' rights than their
predecessors. There may be two reasons for that:
First, a recognition that the principle of patient
autonomy means something, and second, the fear of
being sued for disregarding the patient's
instructions. That may be even more effective.
Senator Pépin: I forgot about
Senator Corbin: Out of
curiosity, in the conscience case to which you
alluded where the nurse refused to comply with the
patient's wishes, did that event take place in a
religious environment? Was this a public hospital?
Was the patient of the same faith?
Mr. Sneiderman: This was in the
context of a seminar organized by one of the
professors of medicine who has expertise in medical
ethics, and it was an exercise in role playing. This
was at the Health Sciences Centre in Winnipeg. The
religious convictions of the patient were never
discussed. The medical resident referred to her
religious convictions but did not specify what they
were. She did say something about the sanctity of
life and that she simply could not abide the
decision by a patient to die. She said it might be
different if the patient were terminally ill and
dying, but this patient was not. That is all she
Senator Corbin: It was an ethics
Mr. Sneiderman: I have taken
part in a few of these scenarios, and it is
interesting how people really get caught up in it.
It is not play acting to them; it becomes real.
Senator Corbin: We have such
thing as war games. That is an analogy.
Mr. Sneiderman: Yes. . .