Canada passed a law in June 2016 to make legal and to offer protection to the providers of medically assisted dying. Let’s just pretend for a moment that “Medically Assisted Dying” isn’t one of the lamest, most watered-down name for the practice of euthanasia. Predictably, there were a number of objectors to this bill, many from faith-based communities and I want to start this out by saying I am not going to get into any debates about what any religion or faith has to say about suicide or murder. This is not a debate about the tenets of your faith.
The College of Physicians and Surgeons in Ontario have indicated that physicians in that province who can not or will not provide this service to terminally ill patients are required to give their patients a referral to a council of physicians or to specific physicians who do provide the service. This sort of requirement is necessary because what’s happening here is a clash of freedoms/rights: Canadians are free to worship and honour their religious traditions, and adult Canadians are free to request physicians assist them in dying provided: they are capable of making that decision; their condition is “serious and incurable”; they are in an advanced state of decline of ability; their physical or psychological suffering is intolerable; and their death is “reasonably forseeable”. While there are debates going on about how hand-wavey some of those terms may be, they are focused primarily on the patient, as they should be. However, there are other debates going on in different regions of the country about the physicians’ rights.
Does a physician have the right to refuse a particular service if it violates their ethics and morality? Is euthanasia a violation of the Hippocratic Oath?
Euthanasia is absolutely not a violation of the Hippocratic Oath (that physicians must do no harm, and put the patient’s welfare first). If the job of a physician is to heal the patient, and the patient cannot be healed, then surely the next best thing a physician can do is to alleviate the patient’s suffering. The only person who can tell you when they are no longer suffering is the patient. Not physicians, not nurses, not priests or rabbis or imams or shamans or astrologers, and certainly not God(s). If the only way to end a patient’s suffering is to hasten their inevitably natural death, how is that harmful? Remember, we’re leaving aside the argument about what may or may not happen after death – all I’m discussing here is what we can directly observe. If you, as a physician, know that you can do something to *end* a patient’s suffering – not just lessen it, but actually end it – that’s harm reduction. That’s helping the patient.
Does a physician have the right to refuse a particular service by using ‘conscientious objector’ arguments?
Well, not REALLY. Not if we frame the question like that because conscientious objection is reserved pretty much for military involvement. But let’s broaden the terminology and talk about whether it’s okay to refuse to do part of your job because of your religious beliefs.
Religion is personal. Faith is personal. Your faith and expression of your religious beliefs is something you must only apply to yourself. To do otherwise is to violate other peoples’ rights. However there are religion-based values (and not all ethical objections are based on religious grounds of course) and values that dictate we should not cause harm to others. In fact, this is pretty much a universal tenet of all major world religions and of ethics and morality in general. Don’t cause harm. That’s legit a SUPER SIMPLE instruction. But what it talks about is how your actions necessarily affect others unless you choose to withdraw from society (and it can be argued that that decision also affects others because we don’t exist in a vacuum). This is getting pretty high-level philosophical I guess, but what I’m getting at is that sometimes your own moral/ethical value system may prevent you from doing something (or not doing something) that will directly affect someone else. So yeah, if you object to ending a patient’s life, EVEN THOUGH it will alleviate their suffering, EVEN THOUGH it will reduce harm, that’s fine.
However, what’s NOT okay is preventing that patient’s access to the service in any way. If you choose not to provide your patient with information pamphlets or referrals to physicians who WILL provide the services they need, you’re causing harm.
We could get into all kinds of debate about what “participation” means when it comes to end of life care. Does providing that referral mean you’re complicit in ending a human life? Absolutely not. That human life is already in the process of ending, whether you help it along or not. Refusing to provide that referral means you’re causing harm.
There’s an important discussion piece here about religious institutions, too. Specifically, faith-based hospitals, hospices, and care facilities. It’ll come as no surprise that I’m a firm believer that any institution that receives public money must follow public policy. There shouldn’t even BE any faith-based hospitals and healthcare facilities in a publicly funded system because that sets the stage for “two-tiered health care”. However, removing those institutions from the playing field would end up hurting a lot of people, and I see the good it does to have them in operation, subsidised in part by their respective faith-based communities. Faith-based communities are welcome to donate whatever they want to hospitals and health care facilities, with the understanding that those facilities will offer all the services that are legal, all the time, without strings. Just like publicly accredited and funded schools must follow the approved curriculum in all areas (including not teaching creationism as “science”, teaching biology and reproductive sciences according to curriculae), publicly licensed and funded health care facilities must provide the services their patients require/request. It’s fine to have doctors and nurses and care professionals refuse to provide those services as long as there are health professionals on staff who will, who can, and who won’t face professional repercussion from doing so.
The Manitoba government is attempting to pass a law that will, at least in part, offer protection to health care professionals – physicians specifically – who choose not to provide euthanasia for their patients. The protection is supposedly job-related – that is to say, that health care professionals who refuse to provide all services will not face discrimination at work or the possibility of losing their jobs if they refuse to provide services to which they have moral or ethical objections. This law already exists nationally, and in most places it exists regionally as well; you’re not allowed to discipline or release and employee because of their religious beliefs. Why the Manitoba government feels the need to pass ANOTHER law about this is a little mysterious, unless what they’re trying to do is make an end-run around federal legislation. Are they trying to offer some kind of legal protections for faith-based institutions to refuse to provide euthanasia services for patients?
It’s one thing to refuse to provide a service to which you have deeply held moral and/or ethical objections. It’s another thing entirely to refuse to “participate in” a patient’s health care. It’s unethical and immoral to refuse to help a patient who is requesting help; a patient who needs help.