The intersection of freedom of conscience and assisted dying -

The intersection of freedom of conscience and assisted dying

One MP’s views on balancing the needs of patients and doctors who have personal issues providing assisted dying

Michele Constantini/Getty Images

Michele Constantini/Getty Images

Garnett Genuis, the Conservative MP for Sherwood Park—Fort Saskatchewan in Alberta, has served on the Physician-Assisted Dying Committee.

Parliament will imminently be dealing again with the issue of physician-assisted suicide / euthanasia. If government legislation follows the direction given in the report of the Liberal-dominated joint committee, we are in for (among other things) a significant change in the way Canadian law treats freedom of conscience.

The court was clear in Carter that nothing in their decision would require anyone to be involved in euthanasia or assisted suicide if they did not wish to be. In this respect, I think the court got it right. Freedom of conscience is protected by the Charter itself. Euthanasia and assisted suicide were considered murder until just this year; it’s understandable that many healthcare providers remain uncomfortable with it.

One might normally expect that every person in a particular field would be willing to fulfill the core functions of that field. A nuclear physicist who does not belief in nuclear energy might do well to choose a different career, rather than invoking ‘conscience’ to avoid participation. But, taking life is not a core function of medicine. Most people involved in healthcare are there because they want to help people improve their health status. Those who have signed up for this career hoping to preserve and protect life should be accommodated as much as possible – especially since the rules of the game are changing mid-stream.

Some confusion often arises with respect to the issue of “referral” in healthcare. The Parliamentary joint committee studying this issue argued that doctors should not be forced to perform euthanasia, but that they should be required to ‘refer’ for it. This is akin to being a country that does not perform capital punishment or torture, but extradites people to countries where they will face capital punishment or torture. It doesn’t take much of a background in moral philosophy to understand that formally passing someone off to receive treatment elsewhere that you don’t want to provide yourself is not exactly a way to keep your hands clean. Notably, Article 3 of the UN Convention against Torture says explicitly – “No State Party shall expel, return or extradite a person to another state where there are substantial grounds for believing that he would be in danger of being subjected to torture.” Extradition and referral are clear forms of moral complicity.

It is important to underline that medical referral is not simply providing information or facilitating an orderly transfer of records. These things should happen in every case. But referral is a formal transfer of care from one clinician to another. The referring clinician isn’t just showing the patient where to go; she is effectively doing the transfer work herself. Understandably, therefore, clinicians are almost never expected to provide referrals for things that they would regard as scientifically or ethically inadvisable.

Quebec’s euthanasia law presents what some have called an “elegant” solution – the requirement that clinicians refer patients to a third party, who then refers the patient to a provider. Notably, though, this really amounts to creating a distinction without a difference. To extend the extradition analogy, this is like sending someone to a country where they will face torture, but doing so by way of a facilitating third country.

For those seeking to provide access without infringing conscience, there is a very straight-forward solution available. Health authorities could compile lists of willing providers, and patients could be made aware of the law and of their ability to access willing providers. This need not be cumbersome for anyone, but would also ensure that we are not chasing good clinicians out of the profession or the country because they don’t want to be involved in something which they find objectionable. Those who are serious about autonomy should be looking for solutions which respect the autonomy of both patients and clinicians.


The intersection of freedom of conscience and assisted dying

  1. You remind us that “Freedom of conscience is protected by the Charter itself.” But we also have the concept of separation of church and state and similar issues have been dealt with/solved/accomodated before. When 2 rights butt heads something has to give. Many assume that those who object to physician assisted suicide are doing so on religous grounds. It is much broader than that…it is on moral grounds.
    So we have 2 rights here. One is the individual’s right of choice over his body and the other is some members of society who object on moral grounds. Both claim charter rights.
    But the individual’s right requires physician assistance….and therein lies the problem.
    Nobody seems to want the responsibility but the issue needs to be aired.
    Is it moral to allow someone to suffer? They kill horses don’t they?

  2. The comparison with torture does not work. No one asks you to please refer them to someone who will torture them. In this case, the client believes in assisted dying. You say to them ‘I do not believe in this, but, since you do, I will recommend someone who shares your belief.’ The provider who refuses assisted dying is the torturer here, and obviously believes in it. We can torture by omission as well as commission, too. Religious belief in preserving life till the painful end is often motivated not by wishing to reduce suffering but by believing God must want you to suffer, and if you don’t, you won’t make it to Heaven and who wants to miss out on that?

    • Thank you to Murphyx for pointing this out! This is among the most spurious analogies I have ever come across. Do better MP Genuis.

  3. It would be wise to skip the referral process as it necessitates an unnecessary and tedious extra visit to a physician who may be of no use whatsoever to the person in need of the assisted suicide service. It would be much better if the college of physicians and surgeons in each province had a list of physicians willing to provide the service in each locale so families could easily access it on their website and call directly for an appointment via a self-referral. The last thing a patient who is suffering needs is extra bureaucracy.