Project Annotations

Like its predecessors, the CMA’s Code of Ethics and Professionalism does not provide detailed guidance about the exercise of freedom of conscience by physicians; the relevant provisions are expressed in general rather than procedure-specific terms. However, The relevant sections of the Code of Ethics and Professionalism adopted by the Association reflect the traditional position of the CMA.  They support physicians who refuse to refer patients for procedures to which they object for reasons of conscience and/or professional judgement, while recognizing that they have other obligations to patients and colleagues.

Caution is warranted with respect to the emphasis on “professionalism” introduced into the new Code. Some prominent academics assert that “professionalism” demands that physicians must give such priority to patient “interests” (as defined by the patient or others) that physicians should be willing to serve those interests even by doing what they believe to be wrong. 

However, while self-sacrifice might entail going to jail or even the loss of one’s life, it has never been understood to include the sacrifice of one’s integrity.  It is thus important to note that a claim that “professional expectations” overrides physician freedom of conscience would contradict the emphasis placed on moral agency, integrity and conscience in the Code and CMA policy statements. Indeed, the Code explicitly states that it is “not exhaustive” and acknowledges the interdependence of the virtues of an ethical physician.

Further, claims about “professional expectations” are not neutral. Physicians may disagree profoundly about whether participation in a given morally contested procedure exemplifies professional commitment or professional corruption; euthanasia is only the most recent and obvious example. Requiring conformity to a dominant theory of professionalism that subordinates freedom of conscience to purportedly neutral “professional” obligations reflects an authoritarian mindset that will generate illicit discrimination and exacerbate rather than resolve conflict within the profession.

Related 

Project Submission to the Canadian Medical Association Re: 2018 Revision of the CMA Code of Ethics

Canadian Medical Association and Referral for Morally Contested Procedures