Tuesday, February 5, 2013

Talk on Conscience Rights of Doctors

Last night, I attended a panel discussion at Just Us Cafe on Spring Garden Road. It was put on by the CIHR (Canadian Institute of Health Research). Every few months they host talks open to the public and they are located in various cafes and restaurants around Halifax. Tea, coffee and snacks are served and the public is welcome to ask questions after the speakers have given their talks. 

Here is the blurb for last night's talk:

Crisis of Conscience: Conscientious Refusal by Healthcare Providers and Access to Care

Conscientious objection in healthcare is often discussed in the context of abortion, but that is only the tip of a much larger iceberg of contexts in which healthcare providers have conscientiously refused to provide services. For example, practitioners have also refused care to patients who engage in ‘unhealthy’ activities (e.g., smoking, body modification, accessing experimental care overseas) or who do not follow their advice. All of this creates difficulties for patients seeking access to services. Can we create policies that allow practitioners freedom, while maintaining a functional healthcare system that is accessible to all Canadians? When can conscience be limited by concerns about access to care?

The speakers were Dr. Mary McNally, a dentist and also a bio-ethics prof at Dalhousie University, Dr. Robyn MacQuarrie, a OBGYN from Amherst NS and PhD candidate in bio-ethics at Dalhousie University, and Jocelyn Downie, law professor at Dalhousie University.

I was thinking that much of the talk would be over my head and certainly I often found myself assailed by jargon, much of which I thought was unnecessary, but that is how law goes. I came away with a few thoughts about this panel discussion.

Jocelyn Downie made the point that "conscience" is not defined in the law, and it seems to be there for the protection of those who do not ascribe to a religious ethic. Medical professionals who say that they cannot perform certain procedures can point to the moral code of their religion as their directive. But people who are non-religious don't have that, so therefore the idea of "conscience" is written into our Charter of Rights and Freedoms for their sake. Jocelyn said that this was the doing of PM Pierre Trudeau who insisted that it be maintained in the wording. She quoted the autobiography of Jean Chretien as her source for that, so I am not at all convinced of the veracity of the claim.

Dr. MacQuarrie, whom I found the most convincing and most interesting of the speakers, began her section by stating that conscience is a person's moral sense of right and wrong and how that applies to one's behaviour.

She then delineated the CMA code of ethics which is:
1. disclose any conflicts of interest in a case and resolve them in the best interests of the patient
2. do not discriminate against any patient on any grounds, i.e. ethnicity, religion, age, gender, gender orientation, etc.
3. treat all persons with respect, even when you do not feel they have earned it
4. provide appropriate care for the patient even when care may no longer benefit them

She pointed out that often doctors will say that they have a crisis of conscience in a particular case, when in actual fact, they are having a problem with something else. She gave the example of a doctor who chooses not to order a lung X-ray for a patient who smokes and refuses to quit.  Some doctors have difficulty treating obese patients who will do nothing to lose weight. Some have conflicts with patients who refuse to be vaccinated or to have their children vaccinated. MacQuarrie said that these are not conscience issues, but rather another issue that is often labeled as a crisis of conscience in order to give the doctor an excuse for his/her behaviour.

Jocelyn Downie cited the fact that the American College of Physicians and Surgeons has a lengthy policy on abortion and conscience rights for doctors. Here in Canada, the Canadian College of Physicians and Surgeons has nothing, silence.

Towards the end of the evening, the three panelists concurred that doctors must put the patient's right to care first in the end. So in the case of a patient wishing to have an abortion, a doctor can say that he/she will not perform an abortion, but all three seemed to agree that the doctor must provide the patient with the information so that she can obtain that abortion elsewhere.

This struck me as a manipulation of words that, in effect, denies a doctor the right to refuse to participate in an abortion. It seems to me that having to refer someone for an abortion is being complicit in an abortion, and I do not see how a doctor's conscience rights are protected by such a statement.

Another statement that struck me as problematic was that all three concurred that they would defend their colleagues' right to refuse to do something if it went against their conscience. However, I have been told that students who apply for medical school and who disclose any pro-life activity in their application will most likely be turned down. So if a pro-life student cannot even make into medical school, who will there be to defend? the problem simply will not come up.

This seemed to me to reinforce the notion that medical school, and law school, favour applicants who are liberal in their thinking. There is no need to be tolerant if you won't admit of any differences.

If I had felt surer of my facts on this, I would have asked them that question. But I felt that the people attending would have been quite hostile should I voice my opinion.

Another area in which I wished I had more information in order to pose a question was the old problem of demographics. The issue of cost effectiveness was raised several times, and we are all aware that physicians are making decisions on the basis of where will the tax dollars be spent best. But the fact that our birth rate has declined to 1.6 per woman here in NS really should be addressed. Because if there are fewer and fewer tax-payers entering the workforce, who will be paying for the medical system that we assume will be there? More people are aging and requiring greater care, while there are fewer workers to pay the taxes that will provide the health care system.

Nobody ever wants to talk about that question, but surely it is rather crucial. We have to raise the taxes somewhere; either the existing population will pay more and more taxes to maintain the system, or the system will have to be greatly reduced in order to be sustained.

The woman sitting beside me, whom I did know from church actually, raised the question that, if doctors can require prospective patients to fill out a questionnaire which they can then use to decide if they will take on that patient, shouldn't patients be allowed to do the same? She also recounted how, when she was  a student nurse, she refused to participate in any abortion-related care on the gynecology ward. She said that she would simply call in sick if she was required to do so, but she did manage to trade with other student nurses to steer clear of the abortion clinic. I doubt that a nurse would be allowed to do that today.

I am sure there were more things discussed that could be written about, but those were the ones that stuck with me. Perhaps the next session will find me better equipped to ask a few questions, the ones that no one seems to want to.

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