Submission to the Canadian Medical Association
Re: 2018 Revision of the CMA Code of Ethics
2 April, 2018
VIII. Postscript: torture
VIII.1 The 2018 revision incorporates and
revises 2004 paragraph 9:
9. Refuse to
participate in or support practices that violate basic human rights.
B2. . . .
Respect and promote the inherent dignity and equal worth of all
persons and refuse to participate in or support practices that
violate basic human rights; never participate in or facilitate
torture. [Emphasis added]
VIII.2 The addition of the reference to torture
is instructive because it implies that moral responsibility attaches
not only to direct participation in an act, but also to indirect
forms of facilitation. This is precisely the reason why physicians
who object to a procedure for reasons of conscience may be unwilling
to provide an effective referral for it.
VIII.3 Nonetheless, the reference is out of
keeping with the general approach that has been characteristic of
CMA Codes of Ethics since 1970, and superfluous because
torture is a criminal offence in Canada and prohibited by
international law. The CMA has been on record as opposing torture
since 1979,1 and there is no
evidence that Canadian physicians are participating or likely to
participate in torture.
VIII.4 Moreover, it is odd to insist that
physicians must not participate in or facilitate torture, while
remaining silent about capital punishment. The current state of
criminal law precludes physician participation in both, so if the
Code of Ethics is to speak to one, one would expect it to
speak to the other.
VIII.5 Thus, proscribing physician involvement
in torture while remaining silent about capital punishment could be
construed as an indication of neutrality concerning physician
participation in executions. This, in turn, could be linked to
euthanasia, given the similarity of the procedures and drugs used
for euthanasia and execution by lethal injection.2
On the other hand, for this very reason, adding a reference to
capital punishment to the Code of Ethics could be as
problematic as remaining silent about it.
VIII.6 Finally, the legal ban on euthanasia and
assisted suicide was described by counsel for the claimants in the
Carter case as "tantamount to torture."3
The same argument was made in the Supreme Court of Appeal South
Africa in 2016.4 It requires
little imagination to see that an otherwise inexplicable reference
to torture in the Code of Ethics could be turned against
physicians who refuse to participate in euthanasia or assisted
suicide, just as a reference to capital punishment could be turned
against physicians who provide the services.
VIII.7 In sum, the added reference to torture in
the Code of Ethics is unnecessary. It is not responsive to
present or reasonably foreseeable circumstances in Canada, and is
likely to generate troublesome distractions. It seems prudent to
1. Canadian Medical Association.
Policy resolution BD80-03-99:
Treatment of prisoners [Internet]. 1979 Dec 8; Reviewed 2017 Mar 4
[cited 2018 Mar 30].
2. Standard euthanasia guidelines
direct the use of a drug (thiopental, propofol, phenobarbital) to
induce an artificial coma, followed by the administration of a
neuromuscular blocker (rocuronium, altracurium, cisatracurium) to
cause respiratory arrest and death by anoxia. In Quebec, this is
preceded by the administration of a drug (midazolam) to induce
anxiolysis ( minimal sedation that reduces anxiety). [See Royal
Dutch Medical Association, Royal Dutch Pharmacists Association.
Guidelines for the Practice of Euthanasia and Physician-Assisted
Suicide. 2012; at 13–13; Collège des médecins du Québec. Medical Aid
in Dying: 11/2015 Practice Guidelines. 2015; at 42–48.] Executions
by lethal injection (in practice, infusion) parallel euthanasia
procedures in using a drug (thiopental, pentobarbital, midazolam,
propofol) to induce an artificial coma, followed by a neuromuscular
blocker (rocuronium, pancuronium, vercuronium) to cause respiratory
arrest, but a third drug (potassium chloride) is then used to cause
cardiac arrest. [See Glossip et al v Gross et al, 576 US __ (2015),
135 S Ct 2736 (2015) at p 3–8. See also Krol D.
The Drugs Used in Execution by Lethal Injection. Forbes
[Internet] 2014 May 1 [cited 2018 Mar 13].
3. Keller J.
Euthanasia Ban Like Torture, BC Appeal Court Hears. Huffington Post
[Internet]. 2013 Mar 20 [cited 2018-03-10].
4. Pilane P.
Denying the right to day may be state-sanctioned torture, legal
body says. Bhekisisa [Internet]. 2016 Nov 3 [cited
2018 Mar 10].