Canada
College of Physicians and Surgeons of New Brunswick
Policies & statements relevant to freedom of conscience
Comment: Moral Objections (November, 2002)
One of the most difficult dilemmas in the patient/physician relationship
occurs when the physician has a personal moral objection to a procedure or
treatment that the patient may request or inquire about. Such issues create
a conflict between the recognized autonomy of a competent patient to make
their own decisions regarding health care and the autonomy of physicians to
practice according to their own knowledge, experience and conscience. The Council's view that the autonomy of both patients and
physicians can be respected, on the basis of physicians following the
principles of good medical practice, the Code of Ethics, and College
Regulations.
To that end, it is a basic obligation under the Code of Ethics and
College Regulations for physicians to advise patients when their personal
morality would influence any recommendation or practice they may make
regarding a patient. In other words, it would be improper to refuse a
patient's request without stating such. The basic requirement is that
patients should be informed as to why a physician is declining to provide
the service or treatment requested.
Council also feels that, while it is not an obligation to do so, it is
preferred practice for physicians who have such objections to refer the
patient to another where such objections may not arise. Nevertheless, if the
physician feels even that is unacceptable, Council does view it as an
acceptable alternative for the physician to provide information, upon the
patient's request, regarding resources which may be directly accessible to
the patient.
In any case, any discussions, should these issues arise, should be dealt
with in a manner which is neither judgemental, nor intimidating.
Physicians are also reminded that other factors may have some influence
here. In addition to the Code of Ethics and College Regulations, the
Human Rights Act prevents physicians discriminating in access to care
based on a number of factors, including specifically "race, colour,
religion, national origin, ancestry, place of origin, age, physical
disability, mental disability, marital status, sexual orientation or sex."
Finally, physicians are reminded that, should a complaint arise, any care
offered will be judged by accepted medical and scientific standards.
Project Annotations
In a 2001
bulletin, the Council noted "that no physician is obligated to participate in a treatment or process to which they morally object" and sought feedback about appropriate guidelines for situations in which physicians have moral or ethical
objections to a service or procedure wanted by a patient. The statement above was issued the next
year.
The identification of referral as a "preferred" but not a "required"
practice is not necessarily problematic. It prompts objecting
physicians to consider, in each case, whether or not referral is a
morally acceptable option, thus providing them with the opportunity to
refine and better articulate their ethical reasoning.