Should a doctor be allowed to refuse to provide a treatment or procedure when it conflicts with the doctor's religious or moral beliefs?
Mainstream media opinion is very clear: Hell, no. The days of doctors playing God are over. Here's how Martin Regg Cohn put it in the Toronto Star: "If an MD wants to judge people, he should study law, not medicine. If a physician wants to impose religious barriers rather than provide contraceptive barriers, he should study divinity, not doctoring."
People have been especially incensed by the case of a young Ottawa woman who visited a walk-in clinic to get her birth control prescription renewed. The doctor on duty refused, because he didn't believe in contraception. This is clearly ridiculous. It ought to be self-evident that doctors who won't prescribe birth control should not work at walk-in clinics.
Yet the overwhelming focus on contraception in this debate misses the broader issue. The big issue is not that some physicians are trying to force their religious beliefs on the rest of us. The issue is whether trying to remove conscience from the practise of medicine – as if it were a gall bladder – is either possible or desirable.
A policy that "forces doctors to provide treatments and procedures that they find morally objectionable would have far-reaching and negative consequences for many physicians, regardless of whether they are religious or not, conservative or liberal, pro-life or pro-choice," writes one doctor on the Ontario College of Physicians and Surgeons website.
Here are a few issues – beyond the obvious ones – that are ethically and morally problematic for many physicians. Should male infants be circumcised? Even the Canadian Pediatric Society says it's an unnecessary procedure that exposes babies to unnecessary pain and risk. But many parents demand it for cultural as well as religious reasons. What about home births? Many expectant parents would rather give birth at home with their doctor present. But many doctors believe home births are unnecessarily risky. What about prescribing testosterone for sex-change patients? What about medical marijuana? It, too, is legal, but most doctors would rather not prescribe it.
The Ontario College of Physicians and Surgeons is in the midst of reassessing its policies governing the moral and religious accommodation of doctors. Its website has drawn thousands of comments from both doctors and the public.
Many of these go far deeper than the easy moralizing of the pundits. "I frequently 'withhold or refuse' treatment in my family practice: e.g. I don't prescribe antibiotics for a cold virus, I don't prescribe narcotics to unknown patients at a walk-in clinic, I don't request unnecessary investigations," another doctor writes. "In other words, I attempt to practise medicine with integrity according to current knowledge; I offer what is going to [be] best for the patient's well-being."
But in the age of "patient-centred" medicine, even these faintly patriarchal views may not cut it any more. Today's doctors are increasingly regarded as technicians, offering grocery-store medicine to demanding consumers who increasingly regard them as employees of the state (which, in fact, is increasingly what they are). Needless to say, not all doctors are happy with this devolution. They are rightly concerned that if they refuse to provide the full range of medically approved and publicly funded services – services that in some cases are not medically necessary, but merely medically permissible – they will be found guilty of discrimination.
Surely, in this wonderfully diverse country with its diverse cultures and beliefs, we can tolerate a little diversity among physicians. That is why I agree with the statement issued to the CPSO by three religious leaders in late July. "No Canadian citizen, including any physician, should ever be disciplined or risk losing their professional standing for conducting their work in conformity with their most deeply held ethical or religious convictions," wrote Catholic Archbishop Terrence Prendergast, Rabbi Reuven Bulka and Imam Samy Metwally. Citing Quebec's legalization of euthanasia, they wrote, "we have arrived at the worst possible time in Canadian history to turn doctors into mere mechanics whose duty is to blindly do the bidding of their clients."
I am not religious. I believe in birth control and choice. But the slow extirpation of religious values from all spheres of public life – including medicine – is not entirely good. Some of the religious hospitals, including those run by the Catholics and the Salvation Army, offered a quality of care and an ethic of service that are simply unimaginable today. They didn't do abortions, but so what? Other places did.
Trying to turn doctors into moral eunuchs won't make society better off. As the first doctor quoted in this piece wrote, "A system where the consciences of doctors have no place in shaping how they practise is one that does not serve the interests of patients."