Politicians wrestle with doctors'
consciences in Victoria
Conscientious objection needs to be
protected
MercatorNet
20 April, 2017
Reproduced with permission
Paul Russell*
As the Victorian Ministerial Advisory Panel
on "assisted dying" makes ready to release its
interim report sometime in April, The
Age newspaper turned its attention to
the matter of conscience whether a doctor may
refuse to take part in any action that would
bring about the premature and deliberate death
of a person.
Conscience - or the ability to draw upon
one's own personal belief system in making a
decision about an action - plays out at
different levels in any debate on euthanasia and
assisted suicide.
Trumpetted firstly on the announcement of any
debate is the ability afforded to every member
of parliament to vote on any bill according to
their values and beliefs. This may take the form
of a religious or ethical opposition to doctors
killing their patients or assisting them to
their suicide or it may simply be that a member
of parliament objects to a particular form of a
bill; recognising that the ideal of patient
safety and the protection of people from
possible abuse can never be practically
achieved.
Secondly, we are assured that euthanasia
and/or assisted suicide will be "voluntary": an
action freely chosen by a competent individual
without coercion and in full knowledge of all
the relevant information. It will involve a
decision of conscience or, at the very least,
what is commonly known as a matter of informed
consent. There are sound reasons to doubt that
this would ever be an iron-clad reality.
The recent case reported from Holland
of a elderly woman who cried 'No!' to her
imminent death by euthanasia but was
nevertheless injected with a lethal substance
after her doctor instructed her family to hold
her down while the deed was done, rightly casts
a huge shadow over voluntariness.
Thirdly, and the focus of the recent article
by Farrah Tomazin in The Age, we have
the matter of conscience in respect to doctors
and their rights of conscience. Tomazin opens
her article with empty assurances:
"Doctors will have the right to refuse to
help terminally ill patients who wish to die
provided they don't obstruct people from
seeking support elsewhere, under assisted
dying laws to be drafted by the Andrews
government."
But is that really the whole story? Tomazin
lets the cat out of the bag:
"In a high-level report to be considered
by cabinet, an expert panel is set to
recommend allowing doctors to hold a
'conscientious objection' to
physician-assisted death – similar to the
provisions that allow them to refuse
abortions in Victoria."
The provisions mentioned in the Victorian
abortion laws are such that a doctor who holds a
conscientious objection must refer the person to
another doctor who does not hold to such
objections. In the case of euthanasia and
assisted suicide this would mean that a doctor
who did not want to be complicit in the death of
his or her patient would necessarily be required
to be complicit in any case by the act of making
a referral.
Would it be an "obstruction" if a doctor
actively attempted to dissuade a person away
from assisted suicide or euthanasia - even if
only for a short time - for the sake of trying a
different approach to their illness or their
pain management? The article is silent on this
as I expect will be the report. Yet precisely
that kind of ethical and moral disuassion saved
the life of Janette
Hall in Oregon who has survived her
prognosis by 14 years after taking the sound
advice of her doctor.
Could it not also be the case that even a
doctor who held no such conscientious objection
might not fall foul of "obstruction" by way of
wise advice to the effect that maybe waiting for
a little while - for a myriad of good reasons -
might not be a better course of action?
And what about other medical staff and
services? The pro-euthanasia Australian Nursing
and Midwifery Federation supported the inclusion
of the possibility of nurses actively killing
patients in the South Australian debate last
year in a similar fashion to the provisions in
the Canadian law. They, too, see the solution of
conscience as simply a matter of referral.
Faith-based hospital services will likely
receive some form of exemption based on a
requirement to ensure that a ban on euthanasia
or assisted suicide in their premises is made
widely known to prospective patients. Such a
provision was successfully challenged in the Belgian
courts a few years ago exposing the reality
that any exemptions will be subject to possible
later change.
What then about public services such as
hospice care where the prevailing view that
killing patients should not sit along side
palliative care informs their decision not to
participate? Public funding brings its own
problems as McGill
University Hospital's palliative care
service found out shortly after the Quebec
euthanasia law was passed. He who pays the piper
calls the tune!
At best, this fudging on conscience displays
a very poor understanding of Ethics 101
dismisses the ability of doctors to exercise
their autonomy while making sacrosanct the
ability of a patient to exercise theirs.
Australian Medical Association President, Dr
Michael Gannon shot a warning across the bows of
such faux conscience provisions in a recent
tweet:
"Any bill that compels Doctors to act
against their conscience and 2,500 years of
ethics should and will fail."
The provincial
government of Ontario is currently
considering its legislative response to the
Ottawa government's law on assisted suicide
which talks about a doctor with a conscientious
objection needing to make an "effective
referral". Their Bill 84 is silent on any
further definition of "effective referral" yet
the policy document of the College
of Physicians and Surgeons of Ontario puts
it this way:
"Where a physician declines to provide
medical assistance in dying for reasons of
conscience or religion, the physician must
not abandon the patient. An effective
referral must be provided. An effective
referral means a referral made in good
faith, to a non-objecting, available, and
accessible physician, nurse practitioner or
agency. The referral must be made in a
timely manner to allow the patient to access
medical assistance in dying. Patients must
not be exposed to adverse clinical outcomes
due to delayed referrals."
This paints any delay or even refusal to
co-operate by a doctor as an "abandonment" of
the patient to possibly "adverse clinical
outcomes" when the opposite may well be the
reality. Ultimately this may boil down to a
situation where a doctor may have to justify why
he or she did not want to see their patient made
dead - precisely the reverse of the standards
supposedly applied in these laws.
Time will tell as to whether such a
recommendation survives scrutiny by Premier
Andrews and whether it might eventually appear
as part of a bill later this year. Opponents of
euthanasia and assisted suicide have always
maintained that such laws undermine the medical
profession and relationships between doctors and
their patients. It is not difficult to imagine
that doctors who hold ethical objections to
killing patients or helping them commit suicide
will, under such a regime, find negotiating with
their patients all the more difficult with a
Sword of Damocles above their heads.
Paul Russell is director of HOPE:
preventing euthanasia & assisted suicide,
which is based in Australia. This article
from
his blog was edited and republished by
Mercatornet with permission.
Copyright © Paul Russell . Published by MercatorNet. You may download and print extracts from this article for your own personal and non-commercial use only. Contact
MercatorNet if you wish to discuss republication.