By: Martyn Wendell Jones
For 25 centuries, the Hippocratic oath guided the ethical practice of medicine. Significantly, Dr. Maria Wolfs said, the text of the oath opens with an expression of accountability to a higher power and includes statements of respect for the absolute sanctity of life. The St. Michael’s Hospital endocrinologist and University of Toronto assistant professor reflected on the oath’s “complete separation” between killing and curing before posing a question to her audience relevant to today’s shifting landscape in bioethics: “who is protecting the physicians?”
Dr. Wolfs spoke on implications for physicians of legal “Medical Aid in Dying” and euthanasia as part of an evening panel on professional codes of ethics and conscience. The panel concluded a daylong conference on conscience rights for healthcare professionals in Canada that took place on Tuesday, May 16 in the Coop in Brennan Hall. Hosted by the Canadian Catholic Bioethics Institute in the University of St. Michael’s College, the conference brought together theologians, lawyers, nurses and physicians to address issues pertaining to conscience and conscientious objection in the context of Canadian provincial healthcare laws and policies, specifically those related to MAiD.
CCBI Executive Director Dr. Moira McQueen opened the conference with a presentation on the meaning and role of conscience in public life as well as a number of relevant protections and threats to conscience in Canadian provincial health law. In Ontario, physicians who refuse to provide euthanasia or participate in MAiD are required by the College of Physicians and Surgeons of Ontario to provide an “effective referral” to another physician who will provide the procedure. An effective referral is a referral that must be made in “a timely manner” that allows for “timely access of care.”
Bishop Ronald Fabbro of London examined this requirement using the principle of cooperation in evil. If a person offers assistance of some kind to a primary agent who is performing an immoral action, that person may be said to be involved in the immoral action through cooperation. Bishop Fabbro identified two kinds of cooperation: formal, in which the person offering assistance approves of the immoral action, and material, in which the person offering assistance does not necessarily approve. Material cooperation exists on a spectrum of proximate to remote, with material cooperation sometimes being allowable in cases where there are multiple goods at play.
In Bishop Fabbro’s view, the CPSO requirement that doctors make an effective referral for services they are unwilling to perform implicates them in the act. However, there are a variety of acts that can sometimes be allowed for morally acceptable reasons even though they might make euthanasia more accessible to a patient who desires it. (An example of this would be a transfer of care to an organization that accepts the practice).
In addition to Dr. McQueen, Bishop Fabbro, and Dr. Wolfs, speakers included lawyer Albertos Polizogopoulos and nursing PhD candidate Christina Lamb. Though an emerging tendency in North American bioethics literature is to argue against respecting conscience rights of physicians unwilling to implicate themselves in euthanasia, there remains disagreement on the matter around the world. Dr. McQueen quoted an opinion of the Dutch Medical Society, which accepts euthanasia but which stated that dissenting physicians ought never to be obligated to grant a request for euthanasia because the practice is “anything but [an] ordinary medical [procedure.]”
Martyn Wendell Jones is a writer in the Office of Communications at the University of St. Michael’s College.