Critical Review of College of Physicians and Surgeons of NS Policy Conscientious Objection

17 June, 2024

Sean Murphy*

Full Text

Abstract

The College of Physicians and Surgeons of Nova Scotia (CPSNS) has adopted Professional Standards Regarding Conscientious Objection (Conscientious Objection) that expands existing CPSNS policies. This critique of Conscientious Objection is limited to issues directly or indirectly related to the protection of physician freedom of conscience and can be applied to all CPSNS policies.

Judgements of conscience (including conscientious objection) are integral to medical practice, not the exception, a point more accurately reflected by the policy preamble than by the title. However, physicians may be unable or unwilling to provide a treatment for reasons unrelated to ethical/moral judgement. They should notify patients when unwilling to provide a service for any reason.

There is no plausible moral/ethical reason to refuse to provide information necessary to enable informed medical decision-making. Physicians unwilling to provide such information for any reason should promptly connect the patient with a physician, health care practitioner or agency willing to do so.

Physicians cannot be expected to characterize what they believe to be an unethical/immoral procedure or treatment as normal, acceptable or relevant, especially when they consider it to be unethical/immoral because it is actually or potentially harmful. What counts as relevant medical treatment depends upon a philosophy of medicine, several of which are current nationally and internationally, none of which hold the trump card in Nova Scotia.

It is unacceptable to compel unwilling physicians to become parties to killing their patients or to other procedures they believe to be gravely wrong and/or contrary to good medical practice. The Canadian Medical Association (CMA) has repeatedly gone on record against mandatory effective referral, and the College of Physicians and Surgeons of Alberta does not support it, contrary to what Conscientious Objection seems to imply by referencing these authorities.

The hostility of the CPSNS to physician freedom of conscience may reflect the College Registrar’s longstanding promotion of mandatory effective referral for abortion, euthanasia and assisted suicide. Nova Scotians will not be well-served by morally partisan CPSNS standards likely to cause physicians to emigrate, retire, restrict their practices or leave family medicine or palliative care.

The Project includes effective referral among alternative options informed by two key distinctions: cooperation vs. collaboration, and providing a service vs. providing information about a service. The willingness of objecting physicians to cooperate (but not to collaborate) and to provide and even refer for information (but not to provide or refer for a contested service) make it possible to accommodate patient requests and the diversity manifested in physician responses to ethical/moral conflicts.

Objecting physicians unwilling to directly enable a procedure by initiating transfers of care are generally willing to cooperate in transfers of care initiated by a patient or others by forwarding heath records upon request. They are also usually willing to continue to provide treatment and care unrelated to the contested procedures that patients seek from other practitioners. However, some physicians may be unable or unwilling to continue a physician-patient relationship for reasons unrelated to ethical/moral judgement. In all cases, physicians must continue to provide unrelated care until a colleague has assumed responsibility for the patient, or until after a patient has had reasonable notice that the relationship will be ended.

The Project has not encountered physicians who would refuse to fulfil their ethical obligation to provide medical treatment in emergencies, as that obligation has been traditionally understood and expressed. However, providing euthanasia/assisted suicide is recognized as a potential emergency by mainstream actors in Canada’s public healthcare system, including Nova Scotia. To avoid misunderstanding, the Project recommends that Conscientious Objection be made more specific about what triggers the universally recognized ethical obligation of physicians to provide treatment in emergencies. If the CPSNS intends to depart from or revise this obligation, it should begin a transparent public consultation, not introduce it by means of a morally partisan interpretation of its policies and standards.

Introduction

Critical Review of College of Physicians and Surgeons of NS Policy Conscientious Objection

Abstract

TABLE OF CONTENTS

Introduction

I. Title, preamble and definitions

II. Standards 1 & 2 (Providing information)

III. Standard 3 (Promotion of practitioner beliefs)

IV. Standard 4 (Effective referral)

V. Standard 5 (Providing patient records)

VI. Standard 6 (Providing continuing care)

VII. Standard 7 (Medical emergencies)

Appendix “A”: Conscience in medical practice

Appendix “B”: CPSA and referral for morally contested services (1991–2020)

Appendix “C”: Summary of Recommended Revisions