Answering Physicians Top 5 Legal Questions

In 2017, the medical students’ forum hosted by Canadian Physicians for Life included a question and answer session about legal issues. Albertos Polizogopoulos is lead counsel in the constitutional challenge to the College of Physicians and Surgeons of Ontario (CPSO) policy that demands effective referral for all morally contested services, including euthanasia and assisted suicide.  Phil Horgan, a Toronto lawyer, is President of the Catholic Civil Rights League, which jointly intervened in the case with the Faith and Freedom Alliance and Protection of Conscience Project.  Questions have been listed below with the corresponding time segments.  Links have been provided to background material concerning subjects covered in the answers.

1. How can physicians best disclose to their patients their conscientious objections?  (00:00-11:18)

2. What happens when a patient reports a physician to their college for exercising their right to conscientious objection?  (11:18-20:00)

3. How can conscience and religious rights be exercised, practically speaking?  (20:00-23:33)

4. Is there a sense that other provinces are just waiting to see what is going to happen with these current cases going on in Ontario? (23:33-34:35)

5. Can you comment on institutions?  Do they have rights themselves?   (34:45-40:15)

Physicians offer support to pro-life undergrads

The Catholic Register

Michael Swan

For the first time in nearly 20 years of pro-life medical conferences, Canadian Physicians for Life will offer a pre-conference event for students thinking about applying to medical schools.

“There’s a growing number of pro-life undergrads who are communicating to us that they’re not considering medicine anymore,” said Physicians for Life executive director and general counsel Faye Sonier. “They don’t want to enter a field where they’re fearful that they will be discriminated against because of their pro-life views.” . . . [Full text]

Canadian medical schools readying doctors to talk to patients about assisted suicide

National Post

Sharon Kirkey

Canada’s medical schools are preparing for what was once unimaginable — teaching medical students and residents how to help patients take their own lives.

As the nation moves toward legalized physician-assisted death, Canada’s 17 faculties of medicine have begun to consider how they will introduce assisted dying into the curriculum for the next generations of doctors.

It is a profound change for medical educators, who have long taught future doctors that it is immoral to end a life intentionally.

“If legislation passes, and if it becomes a standard of practice in Canada for a small subset of patients who desire assisted death, and where all the conditions are met, would we want a cadre of doctors that are trained in the emotional, communicative and technical aspects of making those decisions, and assisting patients,” said Dr. Richard Reznick, dean of the faculty of health sciences at Queen’s University in Kingston. “We would.” . . . [Full text]

Opinions on conscientious objection to induced abortion among Finnish medical and nursing students and professionals

Petteri Nieminen, Saara Lappalainen, Pauliina Ristimäki, Markku Myllykangas, Anne-Mari Mustonen

Abstract: Conscientious objection (CO) to participating in induced abortion is not present in the Finnish health care system or legislation unlike in many other European countries.

Methods: We conducted a questionnaire survey with the 1st- and the last-year medical and nursing students and professionals (548 respondents; response rate 66-100%) including several aspects of the abortion process and their relation to CO in 2013.

Results: The male medical respondents chose later time points of pregnancy than the nursing respondents when considering when the embryo/fetus ‘becomes a person’. Of all respondents, 3.5-14.1% expressed a personal wish to CO.

The medical professionals supported the right to CO more often (34.2%) than the nursing professionals (21.4%), while ≥62.4% could work with someone expressing CO. Yet ≥57.9% of the respondents anticipated social problems at work communities caused by CO.

Most respondents considered self-reported religious/ethical conviction to be adequate for CO but, at the same time, 30.1-50.7% considered that no conviction would be sufficient. The respondents most commonly included the medical doctor conducting surgical or medical abortion to be eligible to CO.

The nursing respondents considered that vacuum suction would be a better justification for CO than medical abortion. The indications most commonly included to potential CO were second-trimester abortions and social reasons.

Among the medical respondents, the men were more willing to grant CO also in case of a life-threatening emergency of the pregnant woman.

Conclusions: While the respondents mostly seemed to consider the continuation of adequate services important if CO is introduced, the viewpoint was often focused on the staff and surgical abortion procedure instead of the patients. The issue proved to be complex, which should be taken into consideration for legislation.

Nieminen P, Lappalainen S, Ristimäki P, Myllykangas M, Mustonen A-M. Opinions on conscientious objection to induced abortion among Finnish medical and nursing students and professionals. BMC Medical Ethics 2015, 16:17  doi:10.1186/s12910-015-0012-1

Medical students’ attitudes towards conscientious objection: a survey

J Med Ethics 2014;40:609-612 doi:10.1136/medethics-2013-101482

Sven Jakob Nordstrand, Magnus Andreas Nordstrand, Per Nortvedt, Morten Magelssen

Objective: To examine medical students’ views on conscientious objection and controversial medical procedures.

Methods: Questionnaire study among Norwegian 5th and 6th year medical students.

Results: Five hundred and thirty-one of 893 students (59%) responded. Respondents object to a range of procedures not limited to abortion (up to 19%)—notably euthanasia (62%), ritual circumcision for boys (52%), assisted reproduction for same-sex couples (9.7%) and ultrasound in the setting of prenatal diagnosis (5.0%). A small minority (4.9%) would object to referrals for abortion. In the case of abortion, up to 55% would tolerate conscientious refusals, whereas 42% would not. Higher proportions would tolerate refusals for euthanasia (89%) or ritual circumcision for boys (72%).

Discussion: A majority of Norwegian medical students would object to participation in euthanasia or ritual circumcision for boys. However, in most settings, many medical students think doctors should not be able to refuse participation on grounds of conscience. A minority would accept conscientious refusals for procedures they themselves do not object to personally. Most students would not accept conscientious refusals for referrals.

Conclusions: Conscientious objection remains a live issue in the context of several medical procedures not limited to abortion. Although most would want a right to object to participation in euthanasia, tolerance towards conscientious objectors in general was moderate or low. [Full Text]

Impartiality, complicity and perversity

 Sean Murphy*

Impartiality, complicity and perversityBenjamin Veness weighs in on behalf of the Australian Medical Students’ Association (AMSA) to demand that physicians who believe abortion is wrong should be forced to direct patients to a colleague willing to provide it (“Abortion need not be doctor’s dilemma too.” Sydney Morning Herald, 16 November, 2013).

He and medical students who share his views believe that Victoria’s abortion law is the model that ought to apply throughout Australia.  It follows from this that they believe that any Australian physician who refuses to help a patient find someone willing to do a sex selective abortion should be struck from the medical register or otherwise disciplined.

Mr. Veness correctly believes that this would be consistent with Victoria’s abortion law, and he is hardly alone in believing that physicians who refuse to facilitate abortion for reasons of conscience should be disciplined or expelled from the profession.

However, he and the students whom he represents are mistaken in their assumption that a physician who is morally opposed to abortion – whether in principle, or because he has more limited moral objections to practices like sex selective abortion – is not capable of providing information about the procedure and legal options available to a patient.  In fact, many physicians opposed to abortion are quite willing to do so for the very reasons given by Mr. Veness: that the patient may ultimately decide not to go ahead with it.

More remarkable is the fact that the outlook of Mr. Veness and the Australian Medical Students’ Association suggests that only people willing to do what they believe to be gravely wrong ought to become physicians.  Whether or not this is a condition for membership in the AMSA Mr. Veness does not say, but it is not a policy conducive to the ethical practice of medicine.

What is most striking is Mr. Veness’ belief that only physicians willing to facilitate or provide abortions are “impartial,” as if the judgement that an abortion ought to be provided does not involve a moral judgement.  A conviction that abortion is (or can be) a good thing is just as “partial” as the opposite conviction of an objecting physician.  Mr. Veness’ mistaken notion of what it means to be “impartial’ is evidence that he and the AMSA are anything but.

For some physicians, referral is an acceptable strategy for avoiding complicity in what they hold to be wrong or at least morally questionable.  Others find it unacceptable because they believe that referral and other forms of facilitation actively enable wrongdoing and make them parties to it.  Mr. Veness and the AMSA may dispute this, but it is hardly a novel idea.  It is reflected, for example, in Section 45 of the Australian Capital Territory’s Criminal Code (Complicity and common purpose).1

More relevant, perhaps, is the broad definition of “participation” developed by the American Medical Association in its prohibition of physician participation in capital punishment. This includes “an action which would assist, supervise, or contribute to the ability of another individual to directly cause the death of the condemned,” and even giving advice.2

Lest the connection with capital punishment be thought out of place here, Australian medical students and physicians should take note that the arguments used to compel objecting physicians to provide or facilitate abortion are the same ones used by euthanasia advocates who would  force physicians to lethally inject their patients, or help them find someone who will.  That has been obvious in Belgium from the beginning,3 and it has been equally evident in Canada,4 most recently in Quebec.5

What is gradually becoming clear is that policies and laws devised to ensure the “accessibility” of abortion by suppressing freedom of conscience among health care workers lead ultimately to a perverse conclusion: that one can be forced to do what one believes to be gravely wrong, even if that means killing someone else, or finding someone who is willing to do the killing.  That conclusion is profoundly inconsistent with principles that ought to inform the laws and policies of a liberal democracy.

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1.  Australian Capital Territory, Criminal Code 2002. (Accessed 2013-11-15)

2.  American Medical Association, Policy E-2.06 Capital Punishment (June, 2000) (Accessed 2013-11-15)

3.  Murphy, Sean. Belgium: Mandatory referral for euthanasia.

4.  A panel of the Royal Society of Canada recommended legalization of assisted suicide/euthanasia. The panel stated that, since physicians who are unwilling to provide what it delicately termed “certain reproductive health services” are obliged to refer patients to others who will (a contested assertion), physicians who refuse to provide (legal) euthanasia or assisted suicide for patients “are duty-bound to refer them in a timely fashion to a health care professional who will.” Schuklenk U, van Delden J.J.M, Downie J, McLean S, Upshur R, Weinstock D. Report of the Royal Society of Canada Expert Panel:  End of Life Decision Making.  November, 2011, p. 61-62 (Accessed 2011-12-31).

5.  Hearings were held recently by a committee of the Quebec National Assembly concerning a bill to legalize euthanasia by physicians.  State regulators of the professions of medicine, nursing and pharmacy all stated that their codes of ethics (developed as a result of controversies about abortion and birth control) require objecting professionals to refer or find colleagues willing to provide the service(s) to which they object.  It is clear that they mean to apply the same rule to euthanasia, although it is equally clear that this causes some of them some discomfort.  See, for example, the statement of Charles Bernard on behalf of the College of Physicians of Quebec at Quebec National Assembly, Consultations & hearings on Quebec Bill 52: College of Physicians of Quebec. Tuesday 17 September 2013 – Vol. 43 no. 34, T#154

Conscientious objection by Muslim students startling

J Med Ethics November 2013 Vol. 39 No. 11

Michelle McLean

physician-muslimI read Robert Card’s recent paper entitled ‘Is there no alternative? Conscientious objection by medical students’ with great interest.1 That Muslim students in America are able to conscientiously object (and this was entertained) to the cross-gender consultation is somewhat startling. I have just left the Middle East, where I worked as a medical educator for five-and-a-half years (2006–2011), and, to the best of my knowledge, even in the conservative, gender-segregated traditional Muslim culture of the United Arab Emirates, not once did a male or female student refuse to examine a patient of the opposite sex.

Several issues, many of which have been described by Padela and del Pozo,2 should be taken into consideration in relation to Muslim students’ conscientious objection to the cross-gender consultation on religious grounds. Although Islam prohibits touching or physical contact by the opposite gender, unless appropriate (eg,  by a spouse), in some circumstances, the ‘prohibited becomes permissible’.3 Medicine is one such circumstance. Islam does not … [Full Text]

Nursing school director opposes freedom of conscience

The Arkansas Legislature is considering HB 98, the Health Care Freedom of Conscience Act, which provides protection for freedom of conscience for individuals and institutions with respect to artificial birth control, assisted reproductive technologies, human embryonic stem-cell research; and contraceptive sterilization.  Meanwhile, Dr. Pegge Bell, Director of the Eleanor Mann School of Nursing at the University
of Arkansas, opposes the exercise of freedom of conscience as a violation of the principles of healthcare.  Dr. Bell suggests that objectors might be able to negotiate arrangements, but should otherwise change specialities, or, presumably, leave the profession. [NWA]

Twin protection of conscience bills introduced in Tennessee

Senate Bill 514 and House Bill 1185, identical bills that have been introduced in the Tennessee General Assembly, provide protection for students in post-secondary psychology, social work or counselling programmes who, by reason of religious beliefs, are unable to provide a client with the kind of counselling or therapy being sought.  The bills require objecting students to refer clients to another counsellor.

Medicine, Strasbourg, and conscientious objection

European Court of Human Rights decision

Julian Sheather*

. . .Conscientious objection is a live issue in medicine. . . Given the prevailing political pluralism—given the co-existence in our culture of different value systems—to what extent should medicine accommodate such objections? Should those whose consciences differ be treated differently? What forms of conscientious objection should be tolerated and on the basis of what criteria?
[Full Text]