No Duty to Refer

The issues of abortion referral and conscientious objection are of keen concern to pro-life physicians and increasingly at issue in the practice of family medicine.

According to Dr. Will Johnston, President of Canadian Physicians for Life (CPL), "Suggestions by regulating bodies that morally troublesome issues need only be referred to a colleague are oblivious to the principled objections of pro-life physicians. Independent medical professionals have no duty to refer anyone to anyone when the referral would violate the conscience and the medical good judgment of the professional.

This elementary conscience protection impartially shields doctors who possess any convictions on any topic at all. Increasingly exotic reproductive technologies may eventually offend even the most laissez-faire physicians. There may come a day where no physician feels free from coercion to violate his or her conscience."

A column in the Alberta College of Physicians and Surgeons September 1999 newsletter prompted media speculation that doctors were obliged to refer women for abortion. CPL Vice-President, Dr. Rob Pankratz, responded, "The comment by Alberta College Councillor Dr. Eugene Kretzul that we need to put our patients needs before our own overlooks the obvious problem that some physicians see the fetus as their patient as well, equally deserving of respect. Doctors do have to respect the patients' values and decisions, but a professional has to profess an ethic and a pro-life physician places the value of an extremely young developing human being ahead of all things less valuable than life, including the college ethics and personal desires of the mother."

Toronto Neurologist Dr. Paul Ranalli adds, "Having respect for your patients' values and decisions, while a worthy notion, is not the same as always agreeing with them. Leadership and good judgment used to be admired in a physician. 'The customer is always right' may be a winning ethic for a fast-food franchise, but it is ill-suited to be the guiding principle of the province's medical regulatory body."

Dr. Larry Reynolds, Professor of Family Medicine at the University of Western Ontario, has often experienced the tension of counseling a woman requesting an abortion. He explains that as he believes abortion to be harmful to both mother and baby, he cannot participate in any way, including referring the woman to another physician who performs abortions. "Some have argued that this means that we are imposing our beliefs on vulnerable women. Of course, this is not the case. We are maintaining our own moral conscience in refusing to become a mere instrument of someone else's moral decisions. If we do anything less than this, we allow ourselves to become mere objects. That same argument also promotes the idea that women are helpless victims dependent on physicians to rescue them. Women are strong independent moral beings and deserve to be treated as such, as do physicians."

Fully inform patients

In a letter to each provincial college, Canadian Physicians for Life requested clarification on the issue of referral. With some variation in tone and policy, the principal response was, as expressed by Ontario registrar, Dr. John M. Bonn,

There is no requirement under any statute or regulatory policy for an Ontario physician to refer a patient for an abortion. As with any medical intervention, a physician is expected to provide a patient seeking information about abortion with sufficient advice so as to be able to make an informed decision about her options. This expectation would be met with the direct provision of medical advice or with the referral to another physician, counsellor or agency which would provide the advice.

Calgary family physician Dr. Joseph Askin notes, "Most if not all of the Colleges stated in their replies that physicians must fully inform their patients of all legal options. Dr. Ohlhauser, the Alberta Registrar, said that fully informing a patient means giving her enough information to refuse treatment. I would suggest, then, that physicians should have at their fingertips up to date data regarding abortion procedures and complications (eg. growing evidence of serious breast cancer risk). Some pro-life physicians have apparently refused to discuss the abortion option with their patients. I think this is a serious mistake; giving information is not the same as participation and just may cause a patient to reconsider her position."

Dr. Ranalli agrees. "A pro-life physician should, by all means, declare her personal views to a pregnant patient considering an abortion, in order to place her subsequent discussion in context. (After all, we are all a complex mix of personal and educative experience, although I wonder how many ardent abortion advocates declare their own personal influences to patients). The doctor then has every right, indeed, a responsibility, to outline in detail the potential mental and physical risks of abortion - and there are plenty - just as she would before prescribing a drug or weighing the merits of surgery. The doctor should also review the development of the fetus at that point in pregnancy."

In a public statement, physician members of the Calgary Christian Medical Society noted the historical precedent,

. should physicians be compelled to compromise the very principles that have undergirded western medicine throughout its history? For two thousand five hundred years the conduct of physicians has been guided by the Hippocratic Oath, which states, in part: " ...I will neither prescribe nor administer a lethal dose of medicine to any patient even if asked nor counsel any such thing nor perform an act or omission with direct intent deliberately to end a human life. I will maintain the utmost respect for every human life from fertilization to natural death and reject abortion that deliberately takes a unique human life ." Would the public expect those of us who respect the Oath to ignore our consciences and sacrifice our professional integrity? Why can't we love both the woman and the fetus she is carrying? We encourage Calgarians to ask their doctors if they practice according to Hippocratic principles.

No Freedom of Choice

While existing human rights legislation and various medical bodies do, in principle, protect conscientious objectors, it is evident that this is not adequate. Protection of conscience legislation is needed to prevent discrimination against pro-life health care students and practitioners.

Dr. Margot Bourassa described her situation while a resident in UBC Obstetrics training program, "I have chosen not to perform or promote abortions. Unfortunately, this particular choice is not acceptable to the 'pro-choice' lobby in our medical school. I am frequently challenged to defend my beliefs, and I am closely scrutinized lest I communicate my 'bias' to patients. Residents who approve of abortion are accepted without question, and there seems little concern that pro-abortion bias will seep into their contact with patients. Likewise, little concern is shown for my discomfort at the widespread destruction of so much young human life."

Bourassa continues: "Meanwhile, the UBC Obstetrics program is receiving proposals from the pro-abortion movement that abortion training be mandatory for all residents. At present, that training is freely available but it seems that not everyone is eager to take it, to say the least. In one scenario, you could be forced to reveal your conscience on abortion before being accepted for Obstetrics training, while they could pass you over for someone else. If these people have their way, some day a woman will have no choice but to be the patient of a pro-abortion physician."

The Protection of Conscience Project

Sean Murphy of Powell River, BC, has for many years researched and raised the issue of the need for protection of conscience legislation. In 1999 he launched The Protection of Conscience Project with input from an international Advisory Board. The Project is a non-denominational, non-profit initiative that seeks laws to protect the freedom of conscience of health care workers and others, who have come under increasing pressure to participate in morally controversial procedures. Such procedures may include abortion, artificial contraception, sterilization, artificial reproduction, euthanasia, physician assisted suicide, human experimentation, etc.

An adequate Protection of Conscience Law should protect conscientious objectors from coercive hiring or employment practices, discrimination, and other forms of punishment or pressure. It should also include protection from civil liability. Several countries and states do have such legislation; Canada does not.

The Project web page provides comprehensive information on all aspects of conscientious objection and has been used by legislators and others advocating for protection of conscience. During its first year, submissions on freedom of conscience were made to the All-Party Oireachtais Committee on the Constitution (Ireland), the British Columbia Civil Liberties Association, and the National Association of Pharmacy Regulatory Authorities (Canada). Efforts have been made to support conscientious objectors by facilitating communication and by referrals and correspondence. For more information visit the Project web site at www.consciencelaws.org

The moral convictions of conscientious objectors are shared by many in religious, philosophical and moral traditions that have existed for centuries. Protection of Conscience Laws, their accommodation and enforcement will provide Freedom of Choice -- for everyone.