"NO MORE CHRISTIAN DOCTORS"
Part 2: Medical judgement and professional ethical concerns
"I thought that was very weird."
Full Text
The patient who said that she owed her life to the physician whom others
were calling a disgusting, incompetent, unethical jerk considered him an
excellent doctor. However, she was as puzzled as the crusading Facebookers
by his refusal to prescribe contraceptives. She understood it to be related
to his religious views, but it was, she thought, "very weird." However,
having had a hysterectomy, she was not concerned about it and did not pursue
it further.
Her reaction is hardly surprising.
The contraceptive culture
The birth control pill hit the market in about 1960 and became
increasingly available as time went on. The advent of "the pill" was soon
followed by an exponential increase in out-of-wedlock births and eventually
by legalization of abortion, from which point the number of abortions also
dramatically increased. (See Appendix "D").
Despite the fact that medical professionals involved in family planning had
long known that contraception was associated with abortion rates,1 the demand
for abortion following legalization caught the medical establishment off
guard.2 It appears that many attributed the increase to the surfacing of
patients who would otherwise have sought clandestine abortions.3
In any case, the continuing escalation of out-of-wedlock births and
demands for abortion reinforced the establishment view that these problems
could only be solved by the wider use of contraception. Hence, the
pharmaceutical industry and medical establishments in the developed world
have made a variety of contraceptives increasingly available and have
marketed them so aggressively that most people are unaware that there are
any alternatives. In fact, most people have been convinced that a failure to
use manufactured contraceptives of some kind is highly irresponsible. In
addition, the social progress made by women in the last decades, especially
their greater participation the job market, is widely attributed to their
use of manufactured contraceptives.
As a result, abortion is now widely viewed and officially recognized as a
'backup' for failed contraception, and both have been linked in many minds
to the social and economic well-being of women,4 even as many people continue
to advocate contraception because they claim it reduces abortion.
Challenging the culture
The consequence of all of this is that physicians or other health care
workers who object to prescribing or dispensing contraceptives for reasons
of conscience face an enormous challenge. Many people conclude that they are
not only ignorant of the facts of life, so to speak, but also medically or
scientifically ignorant and profoundly disrespectful of women. This largely
explains the surprise of the young woman who had to drive around the block
for her birth control pills and the vehement reaction of the Facebook
crusaders. By and large, they have grown up in a culture shaped by the
widespread and unquestioning use of manufactured contraceptives. They
instinctively perceive any contrary viewpoint to be "very weird" - or worse.
This kind of insular upbringing affects not only patients, but
colleagues, physician regulators, government officials, bureaucrats, lawyers
and judges, many of whom may be called upon to respond to complaints about
an objecting physician. They have no difficulty understanding that
reasonable people may have moral or ethical objections to abortion,
euthanasia, or the amputation of healthy body parts. However, even the fairest and most well-intentioned of them may
well be mystified when faced with a physician who challenges the
acceptability of contraception. One might as well ask perennial desert
dwellers for an opinion about what kind of snow is best suited for building
igloos.
This affects the approach of the Protection of Conscience Project in
responding to the attacks being made on the three physicians in Ottawa. The
Project does not take a position on the morality of services or procedures,
but focuses, instead, on supporting freedom of conscience. This works well
enough when people appreciate the basis for the position taken by objectors
on familiar contentious subjects, like assisted suicide.
However, this is insufficient when, as in the present case, an attack on
freedom of conscience resembles a religious crusade, when, with supreme
self-righteous confidence, people demand absolute conformity to dogmas like
"the right to choose" or "secularism," when they urge the professional
excommunication of dissenting physicians, and when they treat unfamiliar
world-views as dangerous heresies that must be driven from the public
square.
In this situation, what is needed at the outset is not a call to arms,
but an invitation to consider a different perspective. That is the purpose
of this part of the Project's response. The goal here is not to convince
others that an objector's viewpoint is correct, but to demonstrate that it
is sufficiently plausible to warrant the deference customarily accorded in
liberal democracies to thoughtful and considered dissent.
The original story about the young woman who had to drive around the
block for her birth control pills began with a letter, and the story that
displaced the original and became an epic of sorts began with the same
letter. Now that the dust of the crusading host has abated somewhat, we can
return to the beginning of both stories and read the letter once again: this
time, attentively.
The physician states that the only kind of birth control he provides is
Natural Family Planning, and that he will not prescribe or refer for
artificial contraception, abortion, vasectomies, or the morning after pill.
He offers three reasons for his practice, not one: "medical judgement,"
"professional ethical concerns," and "religious values." Religious belief is
not offered as the first reason, nor as the exclusive reason; none of the
three reasons offered need exclude the others.
Since all of the services he declines to provide and the single kind of
service he will provide all involve the control of human fertility, we must
assume that the control of human fertility is the focus of the medical
judgement, professional ethical concerns and religious values to which he
refers.
We will begin where the physician begins: with medical judgement
pertaining to human fertility. The essentials are set out in general terms
in Appendix "E."
The physician in this case implies that, in his medical judgement,
Natural Family Planning (NFP) is not only preferable to contraception, but
is the only medically appropriate means to control human
fertility. The physician’s mention of medical judgement was almost
completely ignored by the Facebookers. Only one referred to it, and that was
for the sole purpose of mockery - as if the very possibility of adverse
medical judgement were absurd, and the reference to it by the physician a
disingenuous subterfuge.5 This
illustrates that, for them, as for most, belief in the necessity and
goondess of manufactured contraceptives that has been encouraged by the
state, pharmaceutical industry and medical establishment has assumed the
character of unquestioned and even unquestionable dogma. And that, in
turn, suggests an explanation for the vehemence of their reaction.
Now, sound medical judgement begins with and remains focused on the
patient and is exercised respectfully. It must be informed by correct
science, avoiding or minimizing foreseeable risks or harm. It must seek a
reasonably effective response to the needs of the patient, the anticipated
benefits of which outweigh potential risks or harms. Medical judgement
requires the reasonable exercise of discretion, which is shaped and refined
by clinical wisdom born of experience. More could be added, but these
elements are essential.
Relying on these criteria, we can ask the relevant question. Is there a
plausible justification for the physician's medical judgement that NFP is
preferable and that contraception should be avoided?
The patient and establishment practice
The majority of physicians favour the control of fertility by
contraception, post-coital intervention and sterilization, and many
recommend and facilitate abortion when these measures fail. It is
instructive, at this point, to reproduce three of the charts from
Appendix "E". (Click on
chart to enlarge.)
With these charts in view, note that women who do not wish to become
pregnant are advised by most physicians that they should take a birth
control pill every day or use some form of contraception every time they
have sexual intercourse, and that if ever they have "unprotected"
intercourse they should forthwith take the morning after pill. Notice the
assumptions: that it is possible for a woman to become pregnant 365 days a
year, and possible for a woman to become pregnant every time she has sexual
intercourse.
The patient and alternative medical judgement
The comparative charts make it abundantly clear that these assumptions
cannot possibly be derived from female physiology or fertility cycles. A
woman can conceive only during a 12 to 24 hour period during each menstrual
cycle, and she can become pregnant as a result of sexual intercourse during
only about 25% of her reproductive lifetime, but she is advised to use
contraceptive drugs or devices every day, 100% of the time, if she wishes to
avoid pregnancy. Thus, the design and recommended use of contraceptives
appear to reflect male physiology and fertility. Moreover, much of current
contraceptive practice appears to reflect the assumption that normal,
healthy female physiology and fertility present problems that have to be
solved.
Beginning with a focus on the patient, one might propose a basic premise:
women are not men.
If this premise is accepted, it implies that the human male is not the
paradigm in whose likeness the human female ought to be remade for her own
good or that of the community. From the fact that a man can never become
pregnant from an act of sexual intercourse, it does not follow that a woman
is defective because she can, and that medical intervention is required to
correct the purported defect.
If this premise is accepted, it implies that a woman who comes to a
physician should receive medical treatment and health care that reflects her
physiology, including her fertility pattern. It implies that it is not
appropriate to provide a woman with reproductive health care that is based
on male reproductive physiology and fertility, nor to act as if female
physiology and fertility are pathological conditions requiring treatment
with drugs, medical appliances or surgery.
The principal Natural Family Planning methods - the Billings Ovulation
Method, the Sympto-Thermal Method and Creighton Method - all demand that a
physician recognize and respect a woman's actual physiology and fertility
pattern, and not offer treatment or advice based on male physiology and
fertility. NFP methods are unquestionably patient-centred, and do not treat
women like men.
Science, establishment practice and alternative medical judgement
There is no doubt that contraception and related practices are
well-grounded in science, but so, too, are the principal Natural Family
Planning methods, so this element in the formation of medical judgement
cannot be decisive in and of itself.
However, it should be noted that the principal NFP methods are not only
informed by scientific investigation of human fertility and make use of its
findings; practitioners communicate those findings to patients. This is what
makes it possible for them teach women and men how to recognize the days
when sexual intercourse may result in conception, so that they can avoid or
achieve a pregnancy. Since the Society of Obstetricians and Gynaecologists
acknowledges that most women are not well informed about their fertility
cycles,6 a physician who opts for NFP
rather than contraception can reasonably cite this as a factor influencing
his medical judgement.
Avoiding harm, establishment practice and alternative medical judgement
It is widely recognized that the use of commonly recommended
contraceptives entails a variety of side effects and health risks. A
recently published paper7 identified
six:
i) The BCP is a human carcinogen in women[125-127],
in men [128] (through environmental contamination) and in offspring [129]
(through vertical transmission).
ii) The BCP significantly increases the risk of
cardiovascular events [130], hypertension [131, 132], and cerebrovascular
disease [133].
iii) The BCP is a significant determinant of
diminished and irreversible female sexual dysfunction [134, 135].
iv) The BCP exerts an adverse effect on mood in some
women [136, 137].
v) The BCP is a widespread and escalating endocrine
disrupting contaminant in the ecosystem and domestic water supply [128, 138,
139]
vi) Some BCPs increase the risk of adverse birth
outcomes and allergy in offspring of users [140, 141]
Certainly, side effects and risks are associated with any medical
intervention and have to be balanced against benefits for the patient.
Moreover, the significance and probability of the side effects and risks
associated with contraceptives may be disputed.
However, no health risks or adverse side effects are associated with the
practice of Natural Family Planning. Of interest here are the comments in
the guidelines of the Society of Obstetricians and Gynaecologists of Canada.
The only identified "risk" is the "high probability of failure with all
fertility awareness methods if they are not used consistently and
correctly." On the other hand, the guidelines acknowledge "non-contraceptive
benefits":
Women who monitor or chart their fertility signs often
have greater awareness of their own gynaecological health and are better
able to discern the difference between normal and abnormal cervical
secretions. As well, charting fertility signs can alert women to factors
that may contribute to infertility, such as anovulation. Incorporating this
information into family planning programs generally would greatly benefit
women.8
Thus, a physician might plausibly conclude that it is medically
inappropriate to recommend procedures or treatments that are known to
involve risks for the patient when there are reasonably effective
alternatives that do not, and which, moreover, offer additional health
benefits for patients.
Effectiveness, establishment practice and alternative medical judgement
The effectiveness of manufactured contraceptives is not disputed, but
neither is the effectiveness of the principal Natural Family Planning
methods, if used consistently and correctly. They compare favourably to the
effectiveness of manufactured contraceptives, although "typical use"
effectiveness is less well established for the Billings Ovulation Method
(See Appendix "D2"). In fact, the Society
of Obstetricians and Gynaecologists of Canada states that it is a "myth"
that NFP is unreliable: "These methods can be quite reliable when used
correctly."9
In addition, instruments that can accurately identify times when
pregnancy can occur have been on the market for some time. Cost is a factor
affecting their availability, but their effectiveness in birth control is
comparable to that of manufactured contraceptives. One such instrument is
included in Chart D2.1.1.
The effectiveness of NFP (correctly and consistently applied) is not
widely known, as is reflected by one of the first comments on the
'pro-choice' Facebook page:
OMG. This is a recent letter?? The name for "Natural
Family Planning" is "parenthood"!10
It is true that pregnancy can result if NFP methods are used, but that is
also true of manufactured contraceptives, and more often than might be
expected. A recent report states that 66% of women who had abortions in the
United Kingdom were practising contraception; 40% of the contraceptors were
using the birth control pill.11
This introduces another factor that might reasonably affect medical
judgement. Acknowledged experts known to be supportive of contraception have
repeatedly acknowledged that women who use contraceptives are much more
likely to have abortions than women who do not.12
If a physician believes that abortions are medically undesirable (an issue
well beyond the scope of this paper) this might tip an otherwise even
balance against contraception.
Professional ethical concerns
While the physician's letter notes that he has "professional ethical
concerns" that are related to the control of human fertility, the generality
of the statement and the broad range of issues that might be covered by it
preclude close consideration of all that this might entail.
Nonetheless, professional ethical concerns are usually connected to medical
judgement, so we might usefully consider the first three sections of the
Code of Ethics of the Canadian Medical Association in light of the
foregoing discussion.13
#1. Consider first the well-being of the
patient
What constitutes or contributes to the "well-being" of a
patient is largely determined by a competent patient, not by a physician,
though a physician may well contribute to the patient's decision. However,
it does not follow that a physician is always obliged to agree with the
patient's decision or to give effect to it. What happens in the case of such
disagreements is largely dependent upon patient and physician concerned and
their respective evaluations of what is at stake.
More relevant here is the obligation of the physician
to offer the patient his best medical judgement about a recommended course
of treatment or action, and, in so doing, select treatments that avoid or
minimize health risks or adverse side effects. In light of the discussion
about medical judgement, it is not unreasonable to think that professional
ethical concerns related to the first section of the CMA Code of Ethics
might be engaged in a decision by a physician offer Natural Family Planning
and decline to offer contraceptive services.
#2. Practise the profession of medicine in a
manner that treats the patient with dignity and as a person worthy of
respect
A physician who subscribes to this provision may well
give effect to it by providing a woman with assistance in controlling her
fertility that is informed and shaped by female physiology and fertility.
Similarly, he might consider an attempt to treat female fertility according
to the paradigm of male fertility a violation of this section of the Code.
#3. Provide for appropriate care for your
patient . . .
What is expected here is that the physician should
offer treatment and care that he deems to be appropriate. As indicated by
the foregoing discussion, a physician might put this section of the Code
into practice precisely by declining to provide contraceptive services and
offering NFP instead.
Discrimination
In 2008, the Ontario Human Rights Commission attempted unsuccessfully to
suppress freedom of conscience in the medical profession through the College
of Physicians and Surgeons of Ontario.14
In view of the Commission's demonstrated hostility to freedom of conscience
among health care workers and its inquisitorial powers,15
it is appropriate to consider one final point under this head: the ethical
obligation of physicians to refrain from illegal discrimination.
It is occasionally alleged that refusing to prescribe, provide or refer
for contraceptives constitutes illegal discrimination against women.
Assuming that a physician is motivated by the kind of alternative medical
judgement described above, such a claim in this context is not only
implausible, but incoherent.
It would imply that a physician who offers medical advice and assistance
to a woman that is guided by and fully respects her physiology and fertility
cycles is treating her unfairly. It would imply that a physician who helps a
woman to avoid or achieve pregnancy by helping her to understand her own
reproductive physiology is failing to treat her as a unique individual.
Ultimately, it would imply that a physician is a bigot if he insists that
women are not men, and should not have to make do with fertility control
techniques that assume the normative value of male reproductive physiology
and treat female reproductive physiology as a birth defect.
Beyond the absurdity involved in such claims, they are also dangerous,
because they invite human rights bureaucrats to substitute their opinions
for those of medical professionals in medical decision-making.
Case study
Having reflected upon what might inform the medical and professional
ethical judgement of an NFP-only physician, we can return to the letter that
set activist drums beating in the nation's capital and consider the
judgement passed upon it by one of their number:
Any female doctor who wrote this, as well as any MALE
doctor who wrote this, as well as any other NON BINARY GENDER TYPE DOCTOR
who would DARE send any patient this notice does not deserve to practice in
Canada. PERIOD.16
They expect the College of Physicians and Surgeons of Ontario and other
regulatory authorities across the country to compel NFP-only physicians to
"stand and deliver" when patients demand contraceptives, or revoke their
licences to practise. It seems that nothing short of that will satisfy them.
This expectation can be considered within the context of a case study.
The accused
A physician entering practice in Ontario acknowledges that men and women
may have reasons for avoiding pregnancy. He wishes to assist his patients in
controlling their fertility, and considers the range of birth control
measures available.
He observes that the design and recommended use of contraceptives appear
to reflect male physiology and fertility patterns. He notes that officially
recommended contraceptive practice seems to assume that normal, healthy
female physiology and fertility present problems that have to be solved, if
not pathological conditions. His research confirms that some of the most
common and highly recommended contraceptives are associated with a variety
of adverse side effects and health risks, though their frequency and
significance are subjects of some dispute.
The physician believes that it is medically inappropriate and
disrespectful to recommend or provide a woman with contraceptive methods
that suppress her normal, healthy bodily functions. He believes that a
physician's practice should reflect the fact that a woman is a woman, and
not a man - let alone a defective man. He wishes to provide women with
assistance with fertility control that is scientifically sound and
effective, but also responsive to and respectful female reproductive
physiology.
Having heard about Natural Family Planning as a result of a controversy
in Ottawa, he researches the Billings Ovulation Method, the Sympto-Thermal
Method and Creighton Method. He learns that all of the methods are
responsive to and respectful of both male and female reproductive
physiology, that they have a sound scientific basis, and that no health
risks are associated with their use. He finds that, if used correctly and
consistently, they are as effective as manufactured contraceptives.
The physician learns that NFP instructors teach women and men about human
fertility and how they can recognize the days when sexual intercourse may
result in conception, so that they can avoid or achieve a pregnancy. He
knows that most women are not well informed about their fertility cycles, so
he values the fertility awareness instruction offered by NFP. He also
recognizes the non-contraceptive benefits associated with NFP that have been
acknowledged by the Society of Obstetricians and Gynaecologists of Canada.
Based on all of this, he concludes that he will offer his patients only
Natural Family Planning, and will not prescribe, recommend or refer for
contraceptives. Knowing that this approach will be unexpected, he ensures
that patients are aware of his position in advance and that potential
patients are notified by means of a notice in his waiting room, a practice
required of another physician by the College of Physicians and Surgeons of
Ontario.17 While willing to explain his
position during clinical encounters and to provide information about other
forms of birth control, he understands that some patients may be
inconvenienced and annoyed if they are told about his policy only after
waiting for an appointment. He hopes the notice will minimize inconvenience
for patients who want only manufactured contraceptives.
The accusers
One day, a young woman comes to his clinic to get a prescription for the
birth control pill. She is surprised and annoyed by the notice posted in the
waiting room. She crosses the street to get her prescription at another
clinic, and then posts an account of her experience on Facebook. In short
order, the physician learns that he is "jerk," a "complete anachronism,"
"disgusting," incompetent, "unethical and unprofessional," a "worthless
piece of ____," a "crummy doctor," "an idiot," and a judgemental "goofball."
The College
The College of Physicians receives complaints that the physician's
NFP-only policy and notice to patients is unacceptable, and demands that his
licence to practise medicine be revoked.
For present purposes, it is
sufficient to consider some of the questions raised by the complaints and
demands of the accusers.
Is the physician in the case study a "jerk"? Is he "disgusting"? Is he an
"idiot"? A "goofball"?
More specifically, within the context of the College's mandate, is the
physician in the case study "unethical and unprofessional"? Is he a "crummy
doctor"? Is there evidence that he is incompetent? Can the College
demonstrate that his reasoning is unsound? That he is misinformed, or
uninformed? Has the physician in the case study demonstrated conduct or
attitudes unbecoming a member of the profession?
Is it fit, proper and right that the physician in the case study - and
those like him - should be driven from the practice of medicine if they
insist that their medical judgement, formed in the manner described here,
should be respected, even if it differs from that of the establishment?
Diversity, respect and tolerance
At this stage there is no question of the accommodation of religious
belief. We are simply considering how a different perspective might yield a
different approach to fertility control and produce alternative medical and
professional ethical judgements. Moreover, the case study has taken a
bare-bones approach to the issue; in an actual case an accused physician
would likely have much more to say.
However, the expectations and demands of the accusers notwithstanding, it
appears that a medical judgement formed in the manner described here is
sufficiently plausible to warrant the respect customarily accorded to
divergent opinions and practice within the medical profession, and to the
tolerance citizens of a liberal democracy have a right to expect.
We have
not yet come to the issue of freedom of conscience. That cannot be taken up
until we have considered the third reason offered by the Ottawa physician
for his practice: "religious values."
Notes
1.
As early as 1932, a physician observed that women practising contraception
seemed naturally to seek an abortion if contraception failed. He commented
that he was "Contraceptive measures are undoubtedly one factor in lowering
the incidence of demand for abortion, and within recent years I have been
rather impressed with the attitude of mind of the woman, who has practised
contraception and who has failed to attain her object. Such woman seems to
feel that she has a right to demand the termination of an unwanted
pregnancy. The criminal aspect of the matter does not appear to enter her
mind at all." Whitehouse B.
"A
paper on indications for induction of abortion." Br Med J. 1932 August
20; 2(3737): 337–341. (Accessed 2014-02-14)
Four years later Dr.
Raymond Pearl (for whom the Pearl Index is named) observed that frequency of
abortion was "three to four or more times greater, generally speaking, among
contraceptors than among non-contraceptors." and that "white married women .
. .who practise contraception . . .resort to criminally induced abortions
about three times as often proportionately as do their comparable
non-contraceptor contemporaries." He concluded that perhaps three quarters
of criminal abortions were attributable to the birth controllers and the
current imperfections in the technique of their art." Pearl R. The
Natural History of Population. London: Oxford University Press, 1939)
p. 222, 240-241.
According to a study published in 1940 by Margaret
Sanger's Clinical Research Bureau, 41 percent of the pregnancies of
contracepting women were ended by abortion, but only 3.5 percent of
non-contracepting women resorted to the procedure. Stix RK, Notestein F.
Controlled Fertility: An Evaluation of Clinic Studies. Baltimore:
William and Wilkins, 1940, p. 79-87. Cited in Whitehead KD, "Do Sex
Education and Access to Contraception Cut Down on Abortion?"
FCS
Quarterly, Vol. 21, No. 3, Summer, 1998 (Accessed 2014-02-14)
By
1955, Planned Parenthood concluded that there was still no evidence that
increased availability of contraception would reduce the illegal abortion
rate. Dr. Alfred Kinsey reminded a Planned Parenthood conference that "we
have found the highest frequency of induced abortion in the group which most
frequently uses contraceptives." Calderone M. (Ed.) Abortion in the
United States. New York: Harper and Row, 1958, p. 157. Cited in
Whitehead KD, "Do Sex Education and Access to Contraception Cut Down on
Abortion?"
FCS
Quarterly, Vol. 21, No. 3, Summer, 1998 (Accessed 2014-02-14)
Almost thirty years later, Planned Parenthood officials acknowledged
that pregnant women who use contraception were more likely to have abortions
than those who were not, and associated an increase in contraceptive use
with an increase in abortion. Tietze C. "Abortion and Contraception" in
Sachev P. Abortion: Readings and Research. Toronto: Butterworths,
1981, p. 54-60. Potts M. "Abortion and Contraception in Relation to Family
Planning Service" in Hodgson J. (Ed.) Abortion and the Politics of
Motherhood. Berkeley: University of California Press, 1984, p. 112. Both
quoted in Whitehead KD, "Do Sex Education and Access to Contraception Cut
Down on Abortion?"
FCS
Quarterly, Vol. 21, No. 3, Summer, 1998 (Accessed 2014-02-14)
2. "Therapeutic abortion: Government
figures show big increase in '71." CMAJ, 20 May, 1972, Vol. 106, 1131.
Lewis TLT.
The Abortion Act. Br Med J. 1969 January 25; 1(5638):
241–242 (Accessed 2014-02-14)
3. Hordern A. Legal Abortion: The
English Experience. Oxford: Pergamon Press, 1971, p. 102.
4. Ann Furedi the chief executive of the
British Pregnancy Advisory Service, told New Zealanders that abortion is
required as a part of family planning programmes because contraception
is not always effective. She noted that abortion rates do not drop when
more effective means of contraception are available because women are no
longer willing to tolerate the consequences of contraceptive failure.
Abortion a necessary option: advocate. 18 October, 2010, TVNZ.
(Accessed 2014-02-15)
Over twenty years ago, the U.S. Supreme
Court stated that "for two decades of economic and social developments,
people have organized intimate relationships and made choices that
define their views of themselves and their places in society, in
reliance on the availability of abortion in the event that contraception
should fail. The ability of women to participate equally in the economic
and social life of the Nation has been facilitated by their ability to
control their reproductive lives."
Planned Parenthood of Southeastern Pa. v. Casey - 505 U.S.
833 (1992), p. 856 (Accessed 2014-02-15)
5. L__J__M___,
30 January, 2014, 10:15 am (Accessed 2014-02-10)
6. Black A, Francoeur D, Rowe T.
Canadian Contraception Consensus. SOGC Practice Guideline
No. 143- Part 3 of 3 (April, 2004) Chapter 9, p. 365 (Accessed
2014-02-11)
7. Genuis SJ, Lipp C.
Ethical
Diversity and the Role of Conscience in Clinical Medicine. Int
J Family Med. 2013;2013:587541 (Accessed 2014-02-15)
8. Black A, Francoeur D, Rowe T.
Canadian Contraception Consensus. SOGC Practice Guideline
No. 143- Part 3 of 3 (April, 2004) Chapter 9, p. 365 (Accessed
2014-02-11)
9.
Black A, Francoeur D, Rowe T.
Canadian Contraception Consensus. SOGC Practice Guideline
No. 143- Part 3 of 3 (April, 2004) Chapter 9, p. 365 (Accessed
2014-02-11)
10.
M___ L___, 29
January, 2014, 5:55 pm. (Accessed 2014-02-10)
11. Women trying hard to avoid unwanted pregnancy, research shows.
British Pregnancy Advisory Service news release, 4 February, 2014
(Accessed 2014-02-15)
12. See notes 1, 4
13. Canadian Medical Association,
CMA Code of Ethics (Update 2004) (Accessed 2014-02-15)
14. Protection of Conscience Project, Ethics:
Resisting Ethical Aggression.
Notable Challenges -
Physicians and the Ontario Human Rights Code.
15.
Murphy S. The New
Inquisitors. Protection of Conscience Project (31 August, 2008)
16. R___ V___, 29
January, 2014, 7:52 pm (Accessed 2014-02-10)
17. In 2002 the College formally approved
a written notice to patients and directed that it be made available in the
physician's waiting room. Citing the Canadian Medial Association's Code of
Ethics, the notice conveyed in explict terms the physician's religiously
based objection to providing or arranging for abortions, or for
prescriptions for birth control for unmarried patients, or Viagra for
unmarried men. Murphy S.
Ontario College of
Physicians and Surgeons accommodates Christian physician.
Protection of Conscience Project, August, 2002