The timeframe did not allow for submission of the draft to the decision makers of the College des midecins du Quebec and its translation. The following comments are therefore presented in French and represent the views of the authors.
Thank you for the invitation to comment on this article. Conscientious objection is certainly a current topic of significant importance. The debates raging in Quebec on a potential secular charter and ongoing discussions of end-of-life care, not to mention recurrent federal debates on abortion, attest to this. The College des midecins du Quebec (CMQ) is directly affected by this article, since the proposal of a conscientious objection policy is specifically addressed to medical regulatory bodies in each of the provinces and territories of Canada.
The fact that the CMQ is already at the heart of this policy, however, creates a bias that should be admitted from the outset. Our perception of the current situation and the necessity of a better policy is certainly not the same as that of the authors of the article, and a lengthy discussion would be required to cover these divergent points of view properly.
We will limit ourselves here to a few comments that may provide further food for thought.
We would first like to correct certain statements that seem to us to be more or less fair, as to the immense confusion almost everywhere in Canada concerning conscientious objection as well as those responsible for the policy for physicians. We feel that they reveal an insufficient knowledge of several particularities in Quebec.
The geopolitical reality in Canada being what it is, jurisdictional disputes are all too common. However, the professional regulation of physicians is clearly a matter of provincial jurisdiction in Quebec. All physicians must be members of the CMQ to practice in the province, and it has complete jurisdiction over their professional practice, unlike other organizations such as the Federation des medecins omnipraticiens (FMOQ), the Federation des midecins specialistes (FMSQ) or the Federation des midecins residents (FMRQ), which are unions, or the Association medicale du Quebec (AMQ), which is a subsidiary of the Canadian Medical Association (CMA). To fulfil its duties, the CMQ does not issue "policy statements" as is done in the other provinces. Instead its work is based on the Code of Ethics of Physicians. Contrary to most codes of ethics, which consist of major moral principles, including that of the CMA, this code consists of some one hundred provisions dealing with violations punishable by sanctions and it has the force of law. Quebec society is in fact equipped with a veritable professional system conferring on the various orders the mission to ensure that the population is protected by quality control of the practices of its members and the authority to impose disciplinary sanctions as required.
The Code thus sets out the obligations that physicians have collectively decided to impose upon themselves regardless of their personal positions, in order to be able to assume collectively the social function assigned to them, namely oversight of the health of individuals and of the general population. The provisions are carefully chosen, worded and updated so as to eliminate any loopholes insofar as possible. The obligation to maintain and work within one's competence as well as to practise according to scientific principles is covered by specific provisions. The same is true of the obligations not to end a therapeutic relationship except on serious grounds, not to refuse to examine or treat a patient on discriminatory grounds, to provide follow-up, to maintain one's professional independence despite conflicts of interest, and so on.
Conscientious objection is the subject of a specific provision in section 24 of the Code of Ethics of Physicians, which reads as follows:
A physician must, where his personal convictions prevent him from
prescribing or providing professional services that may be
appropriate, acquaint his patient with such convictions; he must
also advise him of the possible consequences of not receiving
such professional services. …