Entrenching a 'Duty to Do Wrong' in Medicine: Canadian Government Funds Project to Suppress Freedom of Conscience and Religion

After a young woman had to go to a clinic in the next block to get birth control pills, a crusade was started against three physicians who decline to prescribe contraceptives that spilled into mainstream media and earned a blog posting by Professor Carolyn McLeod on Impact Ethics. Professor McLeod objects to the physicians’ practice for three reasons. First: it implies - falsely, in her view - that there are medical reasons to prefer natural family planning to manufactured contraceptives. Second, she claims that refusing to refer for contraceptives and abortions violates a purported “right” of access to legal services. Third, she insists that the physician should not have used a written notice, but met the patient to explain himself and then helped her to obtain contraception elsewhere by referral. However, there is still room in the medical profession for critical thinking; note that the Canadian Medical Association Code of Ethics requires physicians to advise patients if their views are not representative of those of the profession as a whole. While a face-to-face meeting with patients is normally preferable, it may actually be preferable for walk-in clinic patients to be advised promptly by the receptionist when they arrive. Professor McLeod makes surprising and erroneous claims that if freedom of conscience and religion is not limited, Muslim physicians would refuse to accept female patients, and Catholic physicians would deny care to women who have had previous abortions. This bespeaks a complete lack of intellectual engagement with Islamic medical ethics and with Catholic moral theology. Her claim that physicians “cannot act on moral beliefs that prevent them from providing referrals for standard services” is contradicted by Canadian Medical Association policy and by the 25,000 member Ontario Medical Association (OMA). A central goal of Professor McLeod’s Canadian Institutes of Health Research (CIHR) funded project is to entrench in medical practice a duty to refer for or otherwise facilitate morally contested procedures. From the perspective of many objecting physicians, this amounts to imposing a duty to do what they believe to be wrong. Two other leaders of this insist that objecting physicians also be forced to refer for euthanasia and assisted suicide. That the state can legitimately compel people to do what they believe to be wrong and punish them if they refuse is a dangerous idea that turns foundational ethical principles upside down. CMA and OMA policy on freedom of conscience safeguards the legitimate autonomy of patients and the integrity of physicians. The policy also protects the community against a particularly deadly form of authoritarianism: a demand that physicians kill their patients or help to arrange for the killing, even if they believe doing so is wrong.