Doctors’ public duty trumps religious beliefs
The license to practice medicine is a privilege accompanied by an obligation. Doctors who don’t get that should consider another profession. Using religion as an excuse to deny patient care or counsel is indefensible.
Earlier this year, the College of Physicians and Surgeons circulated a draft policy on “Professional Obligations and Human Rights” for its members. The College made clear that if a physician objects to providing a service to patients because it conflicts with the doctor’s own moral or religious beliefs, that doctor must refer the patient to another physician. This is eminently defensible.
No doctor can be compelled to offer a treatment or service that he or she feels ethically unable to provide. But neither can a doctor hold a patient hostage to his or her personal beliefs. Referral to another physician is the ethical and compassionate thing to do; it is what the law requires.
In an op-ed last February, 2015, three Ottawa religious leaders argued the new Policy Guidelines deny physicians the ability to practice according to their conscience. In their view “it makes no sense” to ask physicians to “facilitate a wrong” by referring to another doctor. They argued “To make the practice of medicine less hospitable to those who profess their faith is an unjust form of religious discrimination.” A legal challenge to the new Policy Guidelines has also been launched by five Ontario physicians and two doctor-advocacy organizations that claim both a religion and conscience objection to the Guidelines as well as a violation of equality rights.
Primary care physicians hold the key to almost all treatment options. The profession operates on a system of referrals. When a primary care doctor cannot perform the necessary treatment, he or she refers to one who can. That is standard practice.
What truly is discriminatory and wrong is for physicians to abandon their standard practice and professional obligations, prioritizing their faith over patients’ well-being. This is not a private matter for a physician. Canadian medical schools are located in publicly funded universities and taxpayers heavily subsidize the cost of a medical education. Graduates who remain in Canada will work in a taxpayer-subsidized health care system.
The two most notorious conscience matters for physicians are abortion and assisted death. While both remain areas of great public debate, they are settled Constitutional rights in law. Yes, the Charter of Rights and Freedoms protects a right to freedom of conscience and religion. Individuals are free to believe whatever they choose, and free to practice their beliefs (as long as they don’t contravene other laws or infringe on others’ freedoms). Physicians, as individuals, are entitled to the full protection of the Charter in their personal lives. But so are their clients. The Charter also protects my rights as a patient to make decisions about medical treatment, and to have my choices respected by health care providers. And it guarantees me access to necessary medical services.
People are never more vulnerable than when they require the help of physicians, and acutely so when seeking medical counsel about abortion and assisted death. That’s both an incredible burden and a precious obligation. When a doctor refuses to provide abortion or assisted death services or counseling for reasons of conscience, that already sends a coercive message. Given the trust and personal relationships we cultivate with physicians who see us at our worst, our most fragile and helpless, this disclosure might already be devastating. To then have your doctor usher you out the door, without any further guidance about where or how you might find help, is not a matter of conscience—it is unconscionable. Abandoning a patient at a time of great crisis is both unethical and unprofessional.
The new Policy Guidelines offer a simple compromise: refer the client to another doctor. A medical degree is a privilege—one that the public pays for—not a right. If a primary care practice requires you to compromise your beliefs, choose another practice area. There are many where such dilemmas would never arise.
Patients have the right to know all of their options when they’re hurt, sick, pregnant or dying. They have the right not to be abandoned when they’re in crisis.