Back in 2006, Oxford University’s Professor Julian Savulescu published a frontal attack on the notion of conscientious objection in medicine in the BMJ, a popular medical journal. At the time it seemed odd rather than dangerous, the dream of an ideologue rather than sober policy.
He contended that “A doctors’ conscience has little place in the delivery of modern medical care… If people are not prepared to offer legally permitted, efficient, and beneficial care to a patient because it conflicts with their values, they should not be doctors.” Furthermore, he said, conscience interferes with the delivery of good medical care. “The door to ‘value-driven medicine’ is a door to a Pandora’s box of idiosyncratic, bigoted, discriminatory medicine. Public servants must act in the public interest, not their own.”
These propositions seemed extreme, even brutal. If implemented, they would be denounced as an abuse of a fundamental human right to freedom of conscience.
“Nothing is stronger than an idea whose time has come,” according to Victor Hugo. Well, it seems that Professor Savulescu’s idea may have come for Canadian doctors. Because last week a court there endorsed his utilitarian arguments lock, stock and barrel.
The Ontario Court of Appeal unanimously upheld a lower court ruling that physicians can be forced to facilitate procedures they find morally objectionable, including euthanasia and assisted suicide, by connecting patients with willing providers (“effective referral”).
Three judges firmly endorsed a 2018 decision by the Ontario Divisional Court that had been appealed by the Christian Medical and Dental Society of Canada and others. The appellants objected to a compulsory “effective referral” policy imposed by Ontario’s state medical regulator, the College of Physicians and Surgeons of Ontario.
The judges adopted the view of the College that euthanasia, assisted suicide, abortion, contraception, sterilization, sex change surgery, etc. are all acceptable forms of medical treatment or health care. They further noted that abortion, euthanasia and assisted suicide “carry the stigmatizing legacy of several centuries of criminalization grounded in religious and secular morality.”
The College had no sympathy whatsoever for Ontario doctors who object to legal euthanasia. As far as it was concerned, oncologists or cardiologists dissidents from Canada’s “medical assistance in dying” regime can change their specialty or retire from medicine. They have a list of cutting-edge areas for them:
sleep medicine, hair restoration, sport and exercise medicine, hernia repair, skin disorders for general practitioners, obesity medicine, aviation examinations, travel medicine, and practice as a medical officer of health.
Although this effectively excludes pro-life doctors from the practice of their profession and makes it impossible for pro-life students to enter medicine, the court was utterly unsympathetic. A heart transplant surgeon can take up hair transplants, for all it cares. “The appellants have no common law, proprietary or constitutional right to practice medicine,” says the ruling. Echoing Professor Savulescu, it said that “As members of a regulated and publicly funded profession, they are subject to requirements that focus on the public interest, rather than their interests.”
Lawyers for the College described the ruling a “victory for patients in Ontario.”
“The court has recognized the importance of ensuring patients get access to the care they need,” they said. “The court noted the extensive expert and patient evidence establishing the harm that would result to vulnerable patients in the absence of the effective referral requirement, and that the policies represent a compromise; they are not the optimal solution for patients either.”
Conscientious objection, which was once viewed as heroic defiance of an oppressor, has become a dirty word. Stripped of the legalese surrounding the dispute, the court’s ruling implies that doctors are just cogs in a medical machine, soulless robots. Like soldiers, their job is to follow orders, not to assess the morality of those orders. It’s a view of professional responsibility which always ends in tears, as soldiers know all too well.
Bioethics commentator Wesley J. Smith was scathing in an article in the National Review. “Forcing doctors to be complicit in the taking of human life or face potential civil/professional consequences is despotism.” He said that Canadian doctors forced out of their jobs would be welcome across the border in the United States.
The appellants have 60 days to consider and appeal to the Supreme Court. The future of medicine in Canada – and elsewhere — may hang on the outcome.
Michael Cook is editor of MercatorNet