"NO MORE CHRISTIAN DOCTORS"

Part 3: "Religious values"

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The flashpoint

The zeal and self-righteousness of the furious Facebookers in preaching the crusade against the three physicians was noted in Part 1. Part 2 suggested, in passing, that their passionate reaction might be accounted for by a dogmatic belief that manufactured contraceptives are good and necessary forms of health care, and that there are no reasonable alternatives to them. Consequently, that a physician might refuse to provide contraceptives on the basis of medical judgement they seem to have found completely incomprehensible. Certainly, they ignored the physician’s references to “medical judgement” and “professional ethical concerns.”

Instead, what generated the most frequent and heated anathemas from the crusaders is the third reason the physician offered for his position - “religious values.” The possibility of an adverse medical judgement about contraceptives was beyond their imaginings, but they were infuriated by a refusal based on religious values. That they understood only too well. That was heresy.

What everybody knows (or ought to)

Afer all, everybody knows that a good physician should be “more than happy to leave her religious beliefs out of her medical practice.” It is simply obvious that “faith doesn’t have a damn thing to do with practicing medicine.”[sic]1

If you were a trauma surgeon at the ER you’d have to save a person’s life even if they were a convicted murderer or rapist, your personal values be damned. The same should apply with family physicians.2

And when the state is responsible for delivering health care, and people pay for it through their taxes, everybody knows that they have a right to get what they pay for “within the limits of legality,” and that “birth control and vasectomies are LEGAL.”3

Moreover, when taxpayers are financing health care, everybody knows that “religion has NO PLACE in there.”4

A tax-funded professional may make recommendations based on their personal beliefs, but should never be permitted to refuse legal and efficient procedures which align with their patient’s personal beliefs.5

These doctors . . . should be reminded that their salary is paid by our taxes and our health system is a publicly regulated system. As such, they cannot impose their religious beliefs, they must stay neutral.6

Certainly, all Canadians are entitled to hold personal opinions and beliefs - even religious beliefs, but everybody knows that “we live in a society where religion is supposed to be a PRIVATE MATTER and not to be imposed on other people.”7

Everybody knows that “Canadians do not have the right to bring their religious beliefs into the workplace,”8 that Canadians “are NOT entitled to let their opinion interfere with their work,”9 and can’t let “moral issues” or religious beliefs keep them from doing their jobs.10

 . . . He accepted a job as a doctor. He refuses to fulfil his duties as a doctor. The reasons are irrelevant and the religious belief trump card has no place in society, especially with occupations which serve the diverse public. . .11

Since it is so obvious that medical practitioners have no business acting on “personal religious beliefs,” the ‘solution’ to the ‘problem’ posed by physicians who refuse to do what they believe to be immoral is just as obvious: “NO MORE CHRISTIAN DOCTORS.”12

Dogmatic secularism

What we see in these comments parallels what was described in Part 2 with respect to the contraceptive culture. Just as the opinions and beliefs of the young woman and her supporters have been shaped from infancy by a dominant contraceptive culture, they have also been brought up in the ‘religion’ of secularism. They have learned the secularist catechism off by heart because they have heard its lessons repeatedly from the pulpits of the state, political and academic institutions, the media, and from innumerable itinerant preachers evangelizing through popular culture.

That is why they are so quick to defend the dogmas of secularism when they are challenged by people of other faiths, and why their response seems driven by religious fervour, even though they would almost certainly deny that there is anything religious about their beliefs.

And that may be so. Their beliefs might be agnostic, or atheistic, or secularist. Some might even describe themselves as religious believers who subscribe to secularism. What matters is that, like it or not, admit it or not, they are all believers.

Take, for example, Dr. James Robert Brown. In 2002, Dr. Brown, a professor of science and religion of the University of Toronto, offered a simple solution for health care workers who don’t want to be involved with things like abortion or contraception. These “scum” - that was his word - should “resign from medicine and find another job." His reasoning was very simple.

Religious beliefs are highly emotional - as is any belief that is affecting your behaviour in society. You have no right letting your private beliefs affect your public behaviour.13

Of course, Dr. Brown was doing precisely that. He was acting publicly upon his private belief that health care workers should not be allowed to act publicly upon theirs. And the Facebook crusaders did the same thing; they acted publicly on their beliefs, some of them in a “highly emotional” manner. What principled reason can be given to justify the claim that one may be guided by non-religious beliefs in public discourse, but not by religious beliefs? That “highly emotional” beliefs are acceptable if they are not religious, but unacceptable if they are? Surely, the relevant issue is not whether the belief is religious or non-religious, but whether it is true, or sound, or reasonable, or coherent.

Everyone is a believer

All public behaviour - how one treats other people, how one treats animals, how one treats the environment - is determined by what one believes. All beliefs influence public behaviour. Some of these beliefs are religious, some not, but all are beliefs.

This applies no less to “secular” ethics than to religious ethics. A secular ethic may be independent of religion,14 but it is not faith-free, nor is it beyond the influence of faith. On the contrary: a secular ethic, like any ethic, is faith-based. That human dignity exists - or that it does not - or that human life is worthy of unconditional reverence - or merely conditional respect - and notions of beneficence, justice and equality are not the product of scientific enquiry, but rest upon faith: upon beliefs about human nature, the meaning and purpose of life, the existence of good and evil.

“Seeing through the secular illusion”

Disputes about morality - about the morality of contraception, assisted suicide, stem cell research or artificial reproduction - are always, at the core, disputes between people of different beliefs, whether or not those beliefs are religious. Nonetheless, as Dr. Iain Benson observes in Seeing through the secular illusion, religious believers in many countries face an “exclusionist attitude,” a point well illustrated by the crusade against the three physicians. He explains:

Those with a religious belief instead of an atheist or agnostic belief are discriminated against, as their beliefs apparently falling outside of the ‘secular’ and hence ‘rational’ realm of thought. However, much of this discrimination rests on the understanding of secular and the place of belief within society. Two things need to be recognised - 1) that we are all believers in something; it is not a question of whether we believe, but what we believe in. 2) That in the secular sphere, correctly understood as it is now under Canadian law, is inclusive of people of religious belief and that they therefore should have equality under the law and be placed at no disadvantage as against non-religious believers.15

Dr. Benson goes on:

If ‘secular’ means ‘the opposite of religious’ . . . and if the public realm is defined in terms of the ‘secular,’ then the public sphere has only one kind of believer removed from it - the religious believers. I suggest that this way of using ‘secular’ is deeply flawed and will tend to lead us in the direction of religious exclusivism.16

Of particular interest is Dr. Benson’s reference to the meaning of secular “correctly understood as it is now under Canadian law.” He is referring to a part of the Supreme Court of Canada ruling in which the nine justices were unanimous in holding that “secular” includes religious belief:

In my view, Saunders J. below erred in her assumption that ‘secular’ effectively meant ‘non-religious’. This is incorrect since nothing in the Charter, political or democratic theory, or a proper understanding of pluralism demands that atheistically based moral positions trump religiously based moral positions on matters of public policy. I note that the preamble to the Charter itself establishes that ‘... Canada is founded upon principles that recognize the supremacy of God and the rule of law’. According to the reasoning espoused by Saunders J., if one’s moral view manifests from a religiously grounded faith, it is not to be heard in the public square, but if it does not, then it is publicly acceptable. The problem with this approach is that everyone has ‘belief’ or ‘faith’ in something, be it atheistic, agnostic or religious. To construe the ‘secular’ as the realm of the ‘unbelief’ is therefore erroneous. Given this, why, then, should the religiously informed conscience be placed at a public disadvantage or disqualification? To do so would be to distort liberal principles in an illiberal fashion and would provide only a feeble notion of pluralism. The key is that people will disagree about important issues, and such disagreement, where it does not imperil community living, must be capable of being accommodated at the core of a modern pluralism.17

Thus, the Supreme Court of Canada has acknowledged that secularists, atheists and agnostics are believers, no less than Christians, Muslims, Jews and persons of other faiths. The notion that a secular state or a secular health care system (tax-paid or not) must be purged of the expression of religious belief is legally suspect, and the claim that a secular state or a secular health care system is “faith-free” is radically false.

The danger of secular authoritarianism

More than that, it is dangerous. It overlooks the possibility that some secularists - like some religious believers - can be uncritical and narrowly dogmatic in the development of their ethical thinking, and intolerant of anyone who disagrees with them. They might see them as heretics who must be driven from the professions, from the public square, perhaps from the country: sent to live across the sea with their “own kind.”

On that point, it is essential to note that a secular ethic is not morally neutral.18 The claim that a secular ethic is morally neutral is not merely fiction. It is, as Professor Jay Budziszewski says, “bad faith authoritarianism . . . a dishonest way of advancing a moral view by pretending to have no moral view.”19

By pretending, for example, that one can practise medicine in a morally “neutral” fashion, or, as it was more colourfully expressed by a Facebooker, that “faith doesn’t have a damn thing to do with practicing medicine.”

The practice of medicine as a moral enterprise

The example given by this Facebooker actually proves the point he was attempting to deny. An emergency physician who intervenes to save the life of a convicted murderer is not being morally “neutral.” Most people would describe his action as ‘good’ or moral because he is saving someone’s life. They would say he acts immorally if he fails or refuses to intervene. To say that one must act “neutrally” in such a situation would be to say that a physician might choose to intervene - or not - and that either choice would be equally acceptable. Note, too, that the physician is in no way implicated or complicit in murder because he saves a murderer’s life, but that the case would be quite different if he were to give someone a prescription for a lethal drug to kill someone else. Conscientious objection might arise in the latter case, but not in the former.

The practice of medicine is an inescapably moral enterprise precisely because physicians are always seeking to do some kind of good and avoid some kind of evil for their patients.20 However, the moral aspect of practice as it relates to the conduct and moral responsibility of a physician is usually implicit, not explicit. It is assumed, not stated. It is normally eclipsed by the needs of the patient and exigencies of practice. But it is never absent; every decision concerning treatment is a moral decision, whether or not the physician specifically adverts to that fact.

This point is frequently overlooked when a physician, for reasons of conscience, declines to participate in or provide a service or procedure that is routinely provided by his colleagues. They may be disturbed because they assume that, in making a moral decision about treatment, he has done something unusual, even improper. Seeing nothing wrong with the procedure, they see no moral judgement involved in providing it. In their view, the objector has brought morality into a situation where it doesn’t belong, and, worse, it is his morality.

In point of fact, the moral issue was there all along, but they didn’t notice it because they have been unreflectively doing what they were taught to do in medical school and residency, and what society expects them to do. Nonetheless, in deciding to provide the procedure they also implicitly concede its goodness; they would not provide it if they did not think it was a good thing to do. What unsettles them is really not that the objector has taken a moral position on the issue, but that he has made an explicit moral judgement that differs from their implicit one.

This initial reaction is not surprising, and it can have positive results if it leads to respectful discussion among colleagues. On the other hand, there is a tendency in some quarters to adopt the pretence that no “real” moral issues are involved, or that physicians are obliged to follow “the ethics of the profession” or directives from state agencies which are (erroneously) said to be “neutral.” For example, in 2008 the Ontario Human Rights Commission attempted to enforce its belief that physicians “must essentially ‘check their personal views at the door’ in providing medical care,”21 and the Facebook crusaders are attempting the same power play. This is precisely the bad faith authoritarianism described by Professor Budziszewski.

The practice of morality as a human enterprise

That everyone is a believer reflects the fact that the practice of morality is a human enterprise,22 but it is not a scientific enterprise. The classic ethical question, “How ought I to live?” is not a scientific question and cannot be answered by any of the disciplines of natural science, though natural science can provide raw material needed for adequate answers.

Answers to the question, “How ought I to live?” reflect two fundamental moral norms; do good, avoid evil. These basics have traditionally been undisputed; the disputes begin with identifying or defining good and evil and what constitutes “doing” and “avoiding.” Such explorations are the province of philosophy, ethics, theology and religion, and, internationally, religion continues to be the principal means by which concepts of good and evil and right and wrong conduct are sustained and transmitted. Nonetheless, since the practice of morality is a human enterprise, reflections about morality and the development and transmission of ideas about right and wrong also occurs within culture and society outside the framework of identifiable academic disciplines and religions.

In consequence, the secular public square is populated by people with any number of moral viewpoints, some religious, some not: some tied to particular philosophical or ethical systems, some not: but all of them believers. As the Supreme Court of Canada has acknowledged, rational democratic pluralism must make room for all of them. To single out and exclude religious belief as a legitimate ground for conscientious objection would, as the court stated, “distort liberal principles in an illiberal fashion.”

A duty to do what is wrong

More important in the present context - if religious belief can be excluded as a legitimate ground for conscientious objection, so can every form of non-religious belief. If it is legitimate to compel religious believers to do what they believe to be wrong, then it is equally legitimate to compel non-religious believers to do what they think is wrong. It would, in principle, establish a duty to do what is believed to be wrong.

For Andrei Marmor, “a duty to do what is wrong is surely an oxymoron,”23 and most people would agree, as did Dr. John Williams, then Director of Ethics for the Canadian Medical Association. Speaking in 2002 of physicians who decline to provide or refer for contraceptives for religious reasons, he said, “[They're] under no obligation to do something that they feel is wrong.”24

 Despite this, attempts to impose a duty to do what is wrong is characteristic of attacks on freedom of conscience among health care workers. For example, the 2010 McAfferty report to the Parliamentary Assembly of the Council of Europe stated that the Social, Health and Family Affairs Committee was “deeply concerned about the increasing and largely unregulated occurrence” of the exercise of freedom of conscience in Europe. According to the Committee, too many European citizens in positions of responsibility were refusing to do what they believed to be gravely wrong. The Committee recommended that member states adopt “comprehensive and clear regulations” to address this problem.25

 When discussion about difficulties associated with the exercise of freedom of conscience in health care is repeatedly characterized as “the problem of conscientious objection,”26 it becomes clear that the underlying premise is that people and institutions ought to do what they believe to be wrong, and that refusal to do what one believes to be wrong requires special justification. This is exactly the opposite of what one would expect. Most people believe that we should not do what we believe to be wrong, and that refusing to do what we believe to be wrong is the norm. It is wrongdoing that needs special justification or excuse, not refusing to do wrong.

A troubling inversion

The inversion is troubling, since “a duty to do what is wrong” is being advanced by those who support the “war on terror.” They argue that there is, indeed, a duty to do what is wrong, and that this includes a duty to kill non-combatants and to torture terrorist suspects.27 The claim is sharply contested,28 but it does indicate how far a duty to do what is wrong might be pushed. We will next consider an early effort to establish this purported duty in Canada, its rejection by the medical profession, and the difficult compromise that was made possible as a result.

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Note

1.    L___ T___, 30 January, 2014, 4:25 am

2.    M___ J___ C___ P___ 29 January, 2014, 2:55 pm

3.   C___ F___, 29 January, 2014, 7:04 pm

4.  C___ F___, 29 January, 2014, 9:50 pm; S___ B___ 29 January, 2:35 pm; Gagnon S. “Contrary to democracy.” Letter to the editor, Ottawa Citizen, 1 February, 2014.

5. C___T____, 29 January, 2014, 10:20 pm

6. Gagnon S. “Contrary to democracy.” Letter to the editor, Ottawa Citizen, 1 February, 2014. M___ A___, 29 January, 2014, 7:19 pm

7.  C___ F___, 29 January, 2014, 9:45 pm

8.  T___ M____, 29 January, 6:56 pm

9.  M___ V___, 30 January, 2014, 5:21 am; M___ A___, 29 January, 2014, 7:19 pm

10.  B___ A___ D___, 29 January, 2014, 2:45 pm

11.  J___ O___, 30 January, 2014, 1:38 pm

12.  S___W___, 31 January, 4:48 am

13.  “Dr. James Robert Brown, a professor of science and religion at the University of Toronto, said he agrees with prosecuting a doctor with that sort of conflict. "Suppose someone (doctor) said, 'I'm uncomfortable with (treating) a minority,' I'd say, 'So long scum'," said Brown.”

“Brown believes performing abortions and offering other forms of contraception are necessary and if Dawson won't perform them, then, Brown added, 'Fine - just resign from medicine and find another job."

"Religious beliefs are highly emotional - as is any belief that is effecting your behaviour in society. You have no right letting your private beliefs effect your public behaviour." Canning C. “Doctor's faith under scrutiny:Barrie physician won't offer the pill, could lose his licence.” The Barrie Examiner, February 21, 2002

14.  Singer P. Practical Ethics (2nd Ed.). Cambridge: Cambridge University Press, 1993, p. 3; Kreeft P. Fundamentals of the Faith. San Francisco: Ignatius Press, 1988, p. 74-80. On line (Chapter 11) as “The Uniqueness of Christianity.” Accessed 2007-11-08

15. Benson, I.T., Seeing Through the Secular Illusion (July 29, 2013). NGTT Deel 54 Supplementum 4, 2013.  (Accessed 2014-02-18)

16.  Benson, I.T., Seeing Through the Secular Illusion (July 29, 2013). NGTT Deel 54 Supplementum 4, 2013.  (Accessed 2014-02-18)

17.   Chamberlain v. Surrey School District No. 36 [2002] 4 S.C.R. 710 (SCC), para. 137. Accessed 2014-02-19. Dr. Benson adds: “Madam Justice McLachlin, who wrote the decision of the majority, accepted the reasoning of Mr. Justice Gonthier on this point thus making his the reasoning of all nine judges in relation to the interpretation of ‘secular.’) Benson I.T., Seeing Through the Secular Illusion (July 29, 2013). NGTT Deel 54 Supplementum 4, 2013. (Accessed 2014-02-18)

18.    The distinction between ethics and morality is mainly a matter of usage. Recent trends identify ethics as the application of morality to a specific discipline, like medicine or law. In a broader and older sense, ethics is concerned with how man ought to live, while the study of morality focuses on ethical obligations. See the entry on “Ethics and Morality” in Honderich T. (Ed.) The Oxford Companion to Philosophy (2nd Ed.) Oxford: Oxford University Press, 2005.

19.    “The question of neutrality has been profoundly obscured by the mistake of confusing neutrality with objectivity... neutrality and objectivity are not the same... objectivity is possible but neutrality is not. To be neutral, if that were possible, would be to have no presuppositions whatsoever. To be objective is to have certain presuppositions, along with the manners that allow us to keep faith with them.” Budziszewski J., “Handling Issues of Conscience.” The Newman Rambler, Vol. 3, No. 2, Spring/Summer 1999, P. 4.

20.    Maddock J.W. Humanizing health care services. The practice of medicine as a moral enterprise. J Natl Med Assoc. 1973 November; 65(6): 501–passim. PMCID: PMC2609038. Accessed 2014-02-18

21.    Submission of the Ontario Human Rights Commission to the College of Physicians and Surgeons of Ontario Regarding the draft policy, "Physicians and the Ontario Human Rights Code.” 15 August, 2008. Accessed 2008-08-31

22.    This presumption obviously underlies standard bioethics texts. See, for example, Beauchamp TL, Childress JF, Principles of Biomedical Ethics (7th ed) New York: Oxford University Press, 2013

23.    Marmor A. Law in the Age of Pluralism. New York: Oxford University Press, 2007, p. 218

24.    Mackay B. Sign in office ends clash between MD's beliefs, patients' requests. CMAJ January 7, 2003 vol. 168 no. 1. Accessed 2014-02-16

25.    Report, Social Health and Family Affairs Committee, Women’s access to lawful medical care: the problem of unregulated use of conscientious objection. Doc. 12347 (20 July, 2010) Explanatory memorandum by Mrs. McCafferty, Part 1, paragraph 2, note 5 (Joanna Mishtal). Accessed 2010-10-04.

26.    Cannold L. “The questionable ethics of unregulated conscientious refusal.”  ABC Religion and Ethics, 25 March, 2011.”  Accessed 2013-08-11

Human Rights Council, Twentieth session, Agenda items 2 and 3: Annual Report of the Office of the United Nations High Commissioner for Human Rights- Technical guidance on the application of a human rights based approach to the implementation of policies and programmes to reduce preventable maternal morbidity and mortality (2 July, 20012) para. 61, 30. Accessed 2013-08-11

O'Rourke A, De Crespigny L, and Pyman A. “Abortion and Conscientious Objection: The New Battleground” (July 10, 2012). Monash Law Review (2012) Vol 38(3): 87-119.  Accessed 2013-08-18

Finer L., Fine JB., “Abortion Law Around the World: Progress and Pushback.”  American Journal of Public Health, Apr 2013, Vol. 103 Issue 4, p. 585. Accessed 2013-08-18

Human Rights Council, 23nd Session - June 3, 2013.  Agenda Item 3: Presentation of Reports by the Special Rapporteur on Violence against Women. Oral Statement: Center for Reproductive Rights.”  Accessed 20-13-08-11

27.    Gardner J. Complicity and Causality, 1 Crim. Law & Phil. 127, 129 (2007). Cited in Haque, A.A. “Torture, Terror, and the Inversion of Moral Principle.” New Criminal Law Review, Vol. 10, No. 4, pp. 613-657, 2007; Workshop: Criminal Law, Terrorism, and the State of Emergency, May 2007. Accessed 2014-02-19

28.    Haque, A.A. “Torture, Terror, and the Inversion of Moral Principle.” New Criminal Law Review, Vol. 10, No. 4, pp. 613-657, 2007; Workshop: Criminal Law, Terrorism, and the State of Emergency, May 2007. Accessed 2014-02-19