Conscience in Relation to “Health”
The folks who manage that superb website of the Protection of Conscience Project, www.consciencelaws.org, sent out a note earlier this week about a student at the medical school at the University of Manitoba. Apparently this medical student has been threatened with loss of graduation if, because of his stated religious reasons, he will not offer abortion as an option to a patient. In terms of the legal requirement, the issue is whether or not a physician is required to refer a patient for an abortion.
The answer is “no.”
A certain Dr. Brian Magwood, Associate Dean at the Faculty of Medicine states that “policy” requires that students tell patients about all treatment options which fall within “the medical standard of care.”
I don’t know who is advising the University of Manitoba medical school on the relevant law and medical ethics in this situation but they had better think again about the extremely thin ice upon which they are currently standing. The Canadian Medical Association, a body whose policies ought to have something to do with a determination of what is “the medical standard of care”, in its own Code of Conduct does not require, that qualified physicians refer patients for an abortion should that be something the patient seeks. They are right to make this distinction and the U of M is wrong to ignore it. Perhaps there is a misunderstanding on this point between the student and the University. If so, I hope that the few paragraphs that follow will provide some assistance to both parties.
Unless something is missing in the press reports to date, it appears as if, in this case, a student is in a conflict between his own conscience and religious beliefs (protected in the Charter of Rights by the way) and what might be the wishes of some future patient to have “a full-range of medical care” or, in this case, an abortion.
As with a fully-fledged physician, when such a conflict arises, and these will increasingly arise as technology raises more difficult moral questions, the answer to sorting out the conflict is not to apply a broad requirement that “all services” be provided or referred.
There are mid-points that introduce a necessary flexibility to professional duties. Nothing in medicine, its Codes of Conduct or medical ethics gives a “trump right” to a patient seeking a particular medical service that involves vexed ethical questions.
That is the way it ought to be in philosophy and in a free and democratic society.
Patients cannot demand all services from physicians (or for that matter pharmacists, nurses or anyone else in the health care sector). What is necessary is that both sides are clear about what they seek and what they refuse to provide. On the other hand, a physician must not hide his/her refusal to refer behind silence or euphemism or deceit. He or she must clearly state the grounds of the refusal so that the patient can “go elsewhere.”
There is a worrying movement afoot to try and make health care workers into the mere instruments of a patients’ will subordinating the physician’s conscience to the demands of the patient. This movement must be resisted. When there is a conflict of consciences - - or a conflict of dignities as it is ultimately best understood, we must have recourse to some other kind of principles than a “zero-sum” winner or loser scenario.
Without getting into the controversial question of how pregnancy could ever be a disease (and therefore a question of “health” at all) it is clear that no proper protection of conscience could force a person who believes abortion is murder to refer a person to another murderer. Sorry that this is put rather bluntly but that is how those who are opposed to abortion see things. That is the reality of why the Canadian Medical Association itself does not have a blanket “duty of referral” in the way that the University of Manitoba appears to be approaching the issue.
The conscientious objection, whatever ones’ view of abortion or whatever the controversial practice is, relates to the end point of the thing being sought and being part of the chain to the end point is the same, morally, as being the end point (i.e. the abortionist). This ought not to be too complicated for the administrators such as Dr. Magwood at the U of M to understand. If it is, they should call someone reliable in their philosophy department or, here’s a radical idea, the Canadian Medical Association or, perhaps, the World Medical Association, who also agree with the CMA that there is no blanket requirement to provide or refer for “all treatment options.”
The station that first carried this story has the following question on an on line poll (left sidebar) at http://www.cjob.com/: should a medical student be allowed to graduate, even though he won't offer abortion as an option?
The answer is that he or she, in a free and democratic society, can only be required to tell a patient the following: “I am conscientiously opposed to abortion and will neither perform one nor refer you to another physician who will. If that is what you seek you must go elsewhere.” End of story.
Time for the University of Manitoba to change its (politically motivated) position or start saving up the hefty damages that will likely (and should) follow if it persists in its current course of action. I hope someone lets the student know that he is on much thicker ice than the administration if the issue is properly focused….
CENTREBLOG Volume 21
Iain T. Benson©