Canada’s
Supreme Court decided that Canadians’ constitutional rights are violated by the
criminalisation of assisted dying. Canada’s politicians are currently scrambling
to come up with an assisted dying regime within the 12 month period that the
Supreme Court gave them to fix the problem.
Since
then the Canadian Medical Association, the country’s doctors’ lobby
organisation, has insisted not only that doctors must not be forced to provide
assisted dying, but also that doctors must not be required to transfer patients
asking for assisted dying on to a colleague who they know will oblige these
patients.(1)
In many
countries, including Canada, conscientious objection clauses protect – mostly -
health care professionals from being forced to act against their individual ideological
convictions. I suspect it isn’t unfair to note that these protections in the
real world are nothing other than protections for Christian doctors who are
unwilling to deliver services they would be obliged to deliver to patients who
are legally entitled to receive these services, were it not for their religiously
motivated objections.(2) Secular
health care professionals could arguably avail themselves of conscience
clauses, but in a liberal democracy, what reasonable conscience based cause
could they have to refuse the provision of health care services to patients?
Conscience clauses today are by and large a concession of special rights to
Christian health care professionals, at least in secular Western democracies.
An
uneasy compromise is often struck that stipulates that conscientious objectors
must not be forced to deliver the health care services that they object to, but
that they must ensure that patients will be transferred to a health care
professional willing to provide the requested service. Typically they are
prohibited from engaging in activities aimed at persuading the patient to see
the errors of their ways. Typically they must also transfer the patient in an
expeditious manner to their more obliging colleague.
Looked
at from a conscientious objector’s perspective, this compromise is anything but
a compromise. If I object to abortion because I believe that abortion is akin
to murder, as Christian objectors happen to believe, surely my moral responsibility
is barely smaller if I knowingly pass a pregnant woman looking for an abortion
on to a colleague who will commit the act rather than if I do it myself. Christians
are not typically known to see these issues through a consequentialist analytical
lense, but even from their perspective, moral responsibility is barely reduced
by the compromise. I sympathise with their objections to the compromise,
because it is not a compromise. A compromise under the circumstances arguably
is not feasible to begin with.
Patients
are entitled to receive uniform service delivery from health care
professionals. They ought not to be subjected to today’s conscientious
objection lottery. The Canadian Medical Association proposes that Canada ought
to establish a website where patients can ascertain where the nearest
non-objecting doctor is located.(3) One
difficulty with this proposition is that in many rural areas there might be
only one doctor and the next – more obliging - health care professional might actually
be a flight away. Nothing would stop us from taking this proposal to its absurd
logical conclusion: why not establish comprehensive websites where patients can
find out whether their doctor objects on grounds of conscience to treating sexually
active gay patients, or perhaps whether their conscience prohibits them from
treating patients of a particular objectionable ethnicity. Consequentialists
might well decide not to treat Ebola Virus Disease patients because of the risk
involved, call it their consequentialist conscience. Health care service
delivery would soon become a random event, entirely based on the vagaries of
conscientious objections. Incidentally, Canadian doctors’ legal conscience protections
do not actually cover
these kinds of objections, because really these protections are designed to
protect Christian doctors’ convictions, despite feeble attempts at giving them
a lick of neutrality paint. The odd thing about conscientious objections is
that there is no way to find out whether they are genuine or just a matter of
convenience. Even if they were genuinely held beliefs, why should that
constitute a sound reason for refusing service delivery?
The very
idea that we ought to countenance conscientious objection in any profession is
objectionable.(4) Nobody forces anyone to become a professional. It is a voluntary
choice. A conscientious objector in medicine is not dissimilar to a taxi driver
who joins a taxi company that runs a fleet of mostly combustion engine cars and
who objects on grounds of conscience to drive those cars due to environmental
concerns. Why did she become a taxi driver in the first place? Perhaps she
should have opened a bicycle taxi company instead. I recall well, during an
extended teaching stint in a dental school, that in every intake there were a
fair number of dental students mentioning that they settled on going to dental
school rather than medical school because of their objections to abortion. That
seems a much more reasonable decision than to join a medical school and cause throughout
one’s working life problems for patients seeking medical care for health issues
that they are legally entitled to receive medical care for and that one objects
to for one reason or another. Societies ought not to prioritise individual
ideological commitments of some health care professionals over patients’ rights
to receive professional care in a timely and hassle free fashion. Dying patients
living in rural areas should not be subjected to an access-to-assisted-dying-lottery
caused by conscientious objectors. Doctors are first and foremost providers of
health care services. Society has every right to determine what kinds of
services they ought to deliver.
That a
doctors’ lobby organisation such as the Canadian Medical Association should aim
to prioritise its members’ interests over patient access to care is not
terribly surprising, albeit disappointing. Canadian legislators would do well
to ignore its plea on this occasion.
UDO
SCHUKLENK
[1]
Sharon K. 2015. Unacceptable to force doctors to participate in assisted dying
against their conscience: CMA. National
Post March 05. http://news.nationalpost.com/2015/03/05/unacceptable-to-force-doctors-to-participate-in-assisted-dying-against-their-conscience-cma-head/
[Accessed March 26, 2015.]
[2]
Leiter B. 2013. Why Tolerate Religion?
Princeton, NJ: Princeton University Press.
[3] Kirkey
S. Op.cit.
[4]
Savulescu J. 2006. Conscientious objection in medicine. bmj 332: 294
