31 March, 2015

Why the College of Physicians and Surgeons of Ontario is wrong in trying to deny doctors the right to refuse to participate in the procurement of procedures that contravenes their conscience

The College of Physicians and Surgeons of Ontario (CPSO) in their recently published revised policy on ‘Professional Obligations and Human Rights’ of March 2015 states:


“Where physicians are unwilling to provide certain elements of care for reasons of conscience or religion, an effective referral to another health-care provider must be provided to the patient.”

Effectively this policy crushes the conscience rights of doctors and puts at risk the safety of their patients. By stripping from physicians the ability to care for their patients in a respectful and moral manner independent of government edicts, patients lose an essential ally dedicated to their care. Put plainly, who can patients best trust to ensure the security of their life? A politicians or their physician?

By bowing to the pressures of various government agencies such as provincial human rights commissions and tribunals the CPSO has allowed their membership to be disarmed in using their best medical and moral judgement in pursuing what they hold to be in the best interests of their patients. 

The CPSO document quite correctly points out that a physician may not, under any circumstances, discriminate against a patient based on their 'race, ancestry, place of origin, colour, ethnic origin, citizenship, creed, sex, sexual orientation, gender identity, gender expression, age, marital status, family status or disability.'  There can be no dispute that to discriminate against a patient on any of these grounds is both illegal and immoral and any health care professional that did so should be firmly sanctioned by the College. But this is not what the reformed policy affects. Nor is it even its intent to address this type of discrimination, although the College of Physicians and Surgeons would have you believe that it is, since they use this argument as a figleaf to cover their naked political promotion of abortion and euthanasia.

The refusal of a physician to either personally perform or refer a patient for a procedure that contravenes their informed conscience is an issue of the morality of the act itself. It has nothing to do with the status of the person requesting that act. She/he is simply exercising their right to act in accordance with their conscience in determining the best course of action for their patients. It's not the status of the patient that is the determining factor in their decision. It is the morality of the act itself.

But should a physician have such a right to refuse a patient's request? Wouldn’t such a doctor be culpable of trying to force their values upon their patient? Is this not just a case of something thinking that their ‘religious beliefs’ are more important that the health and welfare of a patient? This is the position taken by the CSPO. But it is the wrong position because they conflate ‘religious belief’ with ‘freedom of conscience’. Given the panoply of religious beliefs among the world’s populations a doctor could find one to justify refusing to perform a procedure. 

But one’s religious conviction serves only to inform their conscience. It is but one component that an individual uses to come to a fully formed moral decision. For this is the sole purpose of the human conscience: to be the final arbiter of the rightness or wrongness of any act.  The conscience needs far more than simple religious conviction to accomplish such an important task. One also requires reason to come to a truly moral decision, particularly if that decision affects the welfare of another. Freedom of conscience thus requires both faith AND reason to be legitimate. For this reason, it has a greater standing in the pantheon of human rights that informs and animates public morality than does simple religious belief.

So why would the CSPO make such a simple category error as conflating or confusing freedom of religion and freedom of conscience? They are doing so in a deliberate attempt to force physicians and surgeons to act in a manner that contravenes their basic human rights as outlined in the Canadian Charter of Rights and Freedoms and the U.N. Declaration of Human Rights. But they are accomplishing this end by using a logical fallacy, in this case, a Straw Man argument. For this reason, they are logically (and by extension morally) wrong in trying to force their members to act in contravention of their conscience since such a fallacy ultimately renders their argument useless. Let me explain why this is so.

Since toleration plays a key role in our multicultural society, giving too much credence to any one religious system of beliefs is a recipe for cultural confusion and conflict within the public square. Thus attacking a doctor’s conscience decision as being little more than an expression of personal religious belief renders that decision moot when balanced off against their fiduciary responsibility to attend to the health and welfare of their patients. This allows the College (in its opinion) to negate a doctor’s right of conscience as guaranteed by both legislation and court precedent by reducing it little more than a personal religious belief. Clearly the CPSO is wrong in this belief as it fails the test of rationality itself through its use of a logical fallacy. Their position might make for good rhetoric… but it clearly fails to meet the standard required to abrogate the fundamental right of an individual to act in accordance with their conscience.

Since the traditional taboo against the taking of an innocent life has now been abrogated by recent decisions of Canadian courts and parliaments it is more essential now than ever that physicians be allowed the maximum degree of personal autonomy possible in deciding whether such acts contravene their conscience. The CPSO decision is clearly a step in the wrong direction. 

(Note: This column is a work in progress. I inadvertently posted it before completing its editing and don't know how to get it back into my draft folder. My apologies to you, the reader. Check in again in the next day or two and hopefully it will make for a more coherent read.)

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