SASKATOON — Advocates working to protect the rights of doctors and other health professionals to practice according to the dictates of their conscience remain concerned as the College of Physicians and Surgeons of Saskatchewan considers a revised policy on conscientious objection.
“Conscience is not something that can be violated in any circumstance,” said Larry Worthen, executive director of the Christian Medical and Dental Society of Canada (CMDS) at a media conference June 17 in Saskatoon.
The College of Physicians and Surgeons of Saskatchewan is considering a revised conscientious objection policy, which was presented June 19, with plans for another public consultation in the near future (see related article).
“We support some aspects of the policy,” said Worthen, speaking on behalf of members of CMDS, as well as the Canadian Federation of Catholic Physicians’ Societies and Physicians for Life Canada. “After all, none of our members wish to discriminate against any patient. Our members have dedicated their lives to the care and well-being of their patients.”
However, Worthen expressed the opposition of these groups to any policy that would require doctors to provide or to refer for a procedure they are morally opposed to.
“In the Supreme Court of Canada decision on the Carter case, the court clearly stated that no physician can be forced to participate in an abortion or an assisted death,” he said. “In the question of referral, we consider the word ‘participate’ used by the Supreme Court of Canada to include referral.”
Worthen noted that both Catholic and Evangelical Christian physicians believe that any referral — other than providing information — makes one an accomplice to the procedure itself.
“Any policy that requires the physician to take action in a consultative process that goes against conscience would effectively drive practitioners who have conscience concerns out of the practice of medicine and will be a prima facie case of discrimination on the basis of religion or creed,” Worthen said.
Self-referral is already a commonly exercised option among patients, including for abortion, across most of Saskatchewan. Self-referral allows a doctor to avoid being involved in facilitating the provision of the service, and the patient still has access to the service.
A policy that requires doctors to act against their conscience is not in the best interest of patients, said Dr. Sheila Harding, MD, a Saskatoon hematologist.
“How can it be right to require doctors to do something that they think will harm their patients? Why would patients want to be cared for by doctors who would be willing to expose them to harm?” Harding queried.
“Many of our patients recognize the benefits to them of a physician who will stand on principle rather than going along to get along. They respect a doctor who tells them the truth. They understand that, although they may disagree on a particular issue, they may well benefit when that same doctor advocates for them in other circumstances.”
Rather than formal referral, which communicates endorsement, Harding said doctors who conscientiously object to a procedure such as abortion can simply provide the patient with information. “Provision of information without referral, communicates clearly the doctor’s conviction that the treatment being sought is likely to harm the patient, yet still reflects the autonomy of the patient as an independent moral agent. It’s an important and meaningful distinction,” she said.
A referral means that a doctor shares in responsibility for the subsequent treatment, she said. “The same Canadian law that currently criminalizes female circumcision also criminalizes referrals for female circumcision. The referral step is recognized as culpable participation in the process,” Harding pointed out. “On the other hand, if referral is not necessary, then it isn’t necessary, and shouldn’t be required.”
Harding described conscience as a faculty, like hearing or sight, which helps a physician discern how best to serve a patient. “Seen that way, I have a duty, an obligation, to practice according to conscience, as do all physicians,” she said.
“Physicians may disagree among ourselves about what is right and what is wrong in a given situation, but surely we can agree and respect that each of us is endeavouring to act in the best interest of our patients.” Every practitioner has a line they will not cross, dictated by their conscience and best judgment — and this freedom must not be removed, Harding added.
Mary Deutscher of the Justice and Peace Commission for the Roman Catholic Diocese of Saskatoon expressed gratitude to the College of Physicians of Surgeons of Saskatchewan for having the courage to address the issue and being willing to consult the public.
“The diocese continues to support conscience protection, not only for physicians, but for all health care professionals — including nurses, pharmacists, and others — as they work to provide the best outcomes for patients,” said Deutscher. “We hope that Saskatchewan will continue to be able to attract physicians of goodwill who devote themselves to the respectful care of their patients.”