Moving Forward with a Clear Conscience: A Model Conscientious Objection Policy for Canadian Colleges of Physicians and Surgeons

Article excerpt

Introduction

In 2008, one of us (JD) together with the former Dean of Law at the University of Ottawa (Sanda Rodgers), wrote a guest editorial for the Canadian Medical Association Journal on the topic of access to abortion in Canada. In the editorial, we argued, among other things, that "health care professionals who withhold a diagnosis, fail to provide appropriate referrals, delay access, misdirect women or provide punitive treatment are committing malpractice and risk lawsuits and disciplinary proceedings." (1) In response to a series of letters to the editor written about our editorial, we wrote that, under the Canadian Medical Association (CMA) Code of Ethics (Update 2004) (2) and the CMA Induced Abortion policy (1988), "all physicians are under an obligation to refer"--that is, to make referrals for abortion--and "[the policy] does not allow a right of conscientious objection in relation to referrals." (3) The Executive Director of the CMA Office of Ethics (Jeff Blackmer) then weighed in, asserting we were mistaken with respect to physicians' duty to refer. (4)

Several months later, the Co-Chairs of the Parliamentary Pro-Life Caucus wrote to our law deans and "ask[ed] that you take the necessary steps to ensure that your Faculty members--who have tremendous power to influence the minds of our future lawyers and doctors--not allow their own personal biases to impair their ability to accurately represent the law." (5)The extreme reaction to the suggestion that physicians have a duty to refer when patients request abortion services planted the seed for the development of a model policy on conscientious objections for Canadian Colleges of Physicians and Surgeons.

Inspired in part by the above sequence of events, Carolyn McLeod brought together a team of academics from philosophy and law to reflect on the moral and legal dimensions of conscientious refusals in healthcare. (6) The meetings of this team provided rich soil within which to germinate the seed for a model policy. In this paper, we recount the stages that were involved in developing this policy and then present the policy itself in the hopes of encouraging its adoption by Colleges of Physicians and Surgeons across the country.

The Process

We first critically evaluated and contributed to the philosophical and bioethical literature on conscience and conscientious refusals. Among the issues we examined were the moral nature and value of conscience, the moral demands on professionals, the potential benefit and harm of conscientious objections by health care professionals, and ethically plausible responses by professional bodies to these objections. Papers written for this part of the process are listed online on the website for our research team. (7)

We then embarked on a thorough review and analysis of existing policies of professional regulatory bodies for four different healthcare professions--medicine, nursing, pharmacy and dentistry--at national as well as provincial/territorial levels. The policy review results are available online, (8) and the full analysis of the policies is published elsewhere.(9) In sum, our policy review

  ... uncovered confusion about, and differences among,
  the conscience-related policies of the various professions
  and jurisdictions. Potential implications of the confusion
  and variability include: regional disparities in patients'
  healthcare options and outcomes; increased care costs,
  some being borne by patients as they access alternative
  providers and others borne by Canada's health care system;
  interprofessional friction, particularly as interprofessional
  collaborative care alters traditional hierarchies and
  professional roles; and broadly, both patient and provider
  uncertainty regarding the services to be expected in a
  conflict. The policy environment with respect to conscientious
  objection across Canada is, to some extent, one of 'feast or
  famine': a confusing array of national and provincial policies
  applying in some regions, with significant policy gaps in
  others. …