Conscience Rights Matter
justanoldcountrydoctor, 26 February, 2020
Reproduced with permission
Sohail Gandhi*
As my loyal readers (both of them) know, I happen to be a Trekkie. Permit me to digress a bit, and reflect on one of Captain Jean Luc Picard’s best speeches (Nerd Alert: from the Next Generation episode “The Drumhead”):
“With the first link, the chain is formed. The first speech censured, the first thought forbidden, the first freedom denied, chains us all irrevocably.”
Picard goes on to point out that these words served as wisdom and warning that the first time anyone’s freedoms are trodden upon, we are all damaged.
I think of his speech a lot with debate on Conscience Rights for health care workers being played out in the public. In particular, I think of the decision by the divisional court of Ontario, and then the Ontario Court of Appeal to deny physicians conscience rights. The courts claimed they struck a “reasonable balance”. But they also went on to expressly state in their ruling that the “referral requirement does infringe on doctors’ religious freedoms.” Make no mistake about this, rights and freedoms of certain individuals are being violated by this ruling.
In the 1980s, the hot button issue driving the desire for Conscience Rights was Abortion. In 2020, the main issue is Medical Assistance in Dying (MAID). Many physicians’ groups have expressed concern about being forced to make a referral for this service, in violation of their morals and ethics. This concern has been expressed not just by physicians of faith, but by secular groups like the Canadian Society of Palliative Care Physicians.
Let me be clear about this: Neither myself, nor the Ontario Medical Association will support any physician who actively impedes or prevents a patient from accessing any legal medical service (including MAID). Period. Full Stop. This includes statements like “If you want MAID, I will no longer be your doctor.” That’s just not on.
However, for physicians who feel that actively referring a patient for such a service violates their principles, surely there can be a work around. Turns out, that’s exactly the case in Ontario. If a patient wants MAID, they simply have to contact the MAID co-ordination service and the service will ensure the patient gets the appropriate assessments. Surely handing a patient the contact information (which is not a referral) and leaving it up to the patient to contact the service (which is the patient’s right) is sufficient. Physicians’ conscience rights are protected, and no patient is denied access to a service they want.
Some argue that there will be cases where this is insufficient for various reasons. I disagree. In order to access MAID, you have to be mentally competent. If you’re not competent enough to dial a phone number and ask for this service, you’re not going to qualify anyway. Forcing a physician to do a referral (which involves putting your signature indicating you support the request on a form, setting up the appointment, informing the patient of said appointment and more) in violation of their conscience, isn’t going to alter in any way whether the patient is an appropriate candidate for MAID.
For me however, there is a bigger picture that many people may be missing. We live in an era where technological advances are rapidly occurring. These advances are not just related to computers, and possible interfaces with humans – think ports at the back of your skull to download information directly into your brain – and no, that’s not just science fiction, Elon Musk (yikes!) and Facebook (double yikes!!) are exploring this today. However, the more stunning advances, and I believe the ones with the greatest potential for ethical dilemmas, are the ones in genetics.
Look what’s already happening thanks to gene editing by CRISPR. A scientist in China has edited babies genes. Designer babies (hair, eye colour on order, muscle and IQ per your specifications) are so within the realm of possibility that the ethics are already being debated. Rapidly progressing work is being done to identify the genes (it’s not just one gene, but likely a cluster of several) that link to autism,
Asperger’s and, yes even sexual orientation.
To those physicians who are opposed to legal protection for Conscience Rights, let me ask you this. What would you do if a patient asked you for a referral to have only a blue eyed, blonde haired baby?
Becomes a moral quagmire doesn’t it?
Another Star Trek Captain, James T. Kirk, once said (Nerd Alert: The Original Series Episode: “A Private Little War”):
“There came a time when our knowledge grew faster than our wisdom, and we almost destroyed ourselves.”
This is why Conscience Rights protection is so essential in society. With the explosion of knowledge that is going to continue over the next few decades, it is essential that we handle these advances in fair, ethical, and yes, moral manner. In order to do that, we must allow health care workers the same freedoms as everyone else in society on matters of conscience.
The first link in the chain has been formed. It’s time to break that link with legislation that protects everyone’s fundamental freedoms.
Dr. Sohail Gandhi has practised rural family medicine since 1992 and has active privileges at the Collingwood Hospital. Currently President of the Ontario Medical Association. View all posts by justanoldcountrydoctor