Conscience Rights are HUMAN Rights

Last year, I wrote a blog about Conscience Rights.  The motivation for the blog was the concerning move by the Ontario courts to “infringe on doctors’ religious freedoms.

I know, I know, the case dealt with whether physicians (and other health care providers) had the ability to refuse to provide a referral for situations where they conscientiously objected. Currently, the hot topic for this scenario is Medical Assistance in Dying (MAiD). And yes, the headlines simply said the request for an appeal of a lower court decision on granting physicians conscience rights was denied. I also know there was a lot of talk about the right of the patient to determine their own health care (which is of course must be respected).

But in the text of the initial ruling, the courts clearly and unequivocally admitted that they were infringing on doctors’ rights.

I made a Star Trek reference in my last blog on this issue. Hence, one would be appropriate here. It would seem the Ontario Courts were using the logic first uttered by Mr. Spock in Star Trek 2 – The Wrath of Khan:

“Logic clearly dictates that the needs of the many outweigh the needs of the few.”

But is that really the case here? Will patients be unable to access legal health care services, simply because physicians are able to keep their fundamental human rights? The short answer is no.

In Ontario, for a service such as MAiD, all a patient really has to do is call the MAiD co-ordination service, and they are guaranteed an assessment. A physician who gets a request for this service simply has to give a patient the 1-800 number to call. Heck, patients can even look the number up online and call themselves without asking their own physician.

In short, the service is readily available to those who want it. The needs of the many are not, in any way, shape or form compromised by Conscience Rights legislation. The Ontario Courts have therefore willingly infringed on the rights of a minority, on the basis of a false premise.

Let me also mention the reaction to my last blog on this issue. I had mentioned that in the near future, we would be facing many ethical dilemmas as a society. Not the least of these include new genetic treatments and therapies. Most physicians were supportive of my blog but some expressed concern that brining up genetic advancements was too extreme. One commentator even used the analogy that seemingly all twitter arguments degrade to – “…can’t compare asking for MAID to asking to revisit the Nazi eugenics movement

And yet.

Look what’s happening in the world.

In China, a group of scientists have inserted human brain DNA into monkeys. They state the reason for this is to study conditions like Autism. Jeez, have these people never seen Planet of the Apes????

As Elon Musk dreams of colonizing Mars, scientists are now actively looking at “tweaking” the DNA of people who wish to colonize Mars as a way to protect them from harmful radiation and microgravity. There is even thought being given to merging our DNA with tardigrades (weird microscopic creatures that can seemingly survive anything).

This s all in addition to work that is being done by companies like Neuralink (another Elon Musk organization) to develop brain implants.

Indeed, as Davis Masci pointed out last September:

“But thanks to recent scientific developments in areas such as biotechnology, information technology and nanotechnology, humanity may be on the cusp of an enhancement revolution. In the next two or three decades, people may have the option to change themselves and their children in ways that, up to now, have existed largely in the minds of science fiction writers and creators of comic book superheroes”

These aren’t some weird tabloid, National Enquirer type stories. There are real scientists actively doing this kind of work. The point being that protecting Conscience Rights is not just about MAiD, it’s about ensuring that on a go forward basis, peoples fundamental freedoms are not impugned in what promises to be the most ethically challenging time for science in human history. It’s about ensuring that people do not have to work on or accept for themselves, things that they find morally objectionable.

As a free society, we have always recognized certain inalienable human rights. It’s not just the right to free speech, assembly or vote. The Canadian Charter of Rights and Freedoms specifically mentions freedom of conscience and religion (see section 2). This was due in large part to a recognition that a diverse society is a stronger society and in order to protect that diversity, we must protect fundamental freedoms.

That’s where the judges erred last year. By infringing on the rights of a few, stating that by doing so they were protecting the right of many (which as I’ve shown above, isn’t even the case), the judges have damaged our society as whole, and made it easier to take away more rights from more people. They failed to realize that you cannot make a society stronger, or more free, by taking away the rights of a minority. You only increase the possibility of taking away more rights in the future.

As a society, we must be ever watchful for these infringements on our freedoms. To use another Star Trek quote, this time from Captain Jean-Luc Picard (nerd alert – TNG episode “The Drumhead”):

Vigilance. That is the price we continually have to pay.

Does Bill C-7 Make Assisted Death the Path of Least Resistance?

The following blog was co-written with me by Dr. Leonie Herx, Division Chair and Associate Professor of Medicine at Queen’s University and Past- President of the Canadian Society of Palliative Care Physicians and Dr. Ramona Coelho, a family physician who provides care to a large number of marginalized patients. A version of this opinion piece initially ran in the London Free Press on Saturday December 5, 2020.

As the COVID-19 pandemic dominates the political agenda and strains the country’s health-care systems, the federal Liberals are intent on passing Bill C-7, which proposes to expand medical assistance in dying (MAiD) to those who are not dying. Proponents of the bill state that it allows choice and dignity for those with chronic illness.  However, the bill fails to provide them with the dignity and humanity of requiring them to have good care or access to supports.

As physicians, we witness the struggles that confront our patients and their loved ones every day. Those living on the margins and with disabilities face significant barriers to care though systemic discrimination (ableism) that can make it harder to live a healthy, fulfilling life in community. As doctors we should be instilling hope, supporting resilience and using our expertise to find creative solutions to address health and wellbeing. Instead, we now will be required to suggest assisted suicide as an option.

Spring Hawes, a lady who has a spinal cord injury for 15 years publicly stated, 

“As disabled people, we are conditioned to view ourselves as burdensome. We are taught to apologize for our existence, and to be grateful for the tolerance of those around us. We are often shown that our lives are worth less than nondisabled lives. Our lives and our survival depend on our agreeableness.” 

A choice to die isn’t a free choice when life depends on good behaviours and compliance to societal norms. Sadly, the medical community can be complicit in this messaging.

Gabrielle Peters, a brilliant writer, who has struggled with poverty since her disability, has shared that a healthcare professional sat at her bedside and urged her to consider death. This was just after Gabrielle’s partner announced he was leaving her because she was too much of a burden and she no longer fit into the life he wanted. 

Doctors can pressure someone to die as in Gabrielle’s situation but also more subtly can confirm a patient’s fears that her life is not worth living and MAiD would indeed be a good medical choice.

Day after day, we participate in a healthcare system and a social support system that does not come close to meeting the basic needs of our most vulnerable patients. However, our role as physicians should always be to first advocate that our patients access all reasonable supports for a meaningful life with no suffering.  But alas, Canada does not seem to prioritize health care and supports for all, and soon, that lack of support will be pitted against an option to access death in 90 days.

Patients entrust doctors to make ethical decisions every day regarding their care and to make recommendations that are always aimed at promoting health and healing. The core role of medicine is to be restorative, not destructive. Advocating for our patient’s health and wellbeing, is a solemn oath we took.

As physicians we help our patients do many things in the context of a trusting, shared, decision making process. Doctors encourage healthy habits.  We refuse to prescribe antibiotics when patients have a viral infection, or opioids on demand. We pull a driver’s license when we have concerns for patient safety and the public good. We refuse to write mask exemptions without good reason. We serve both patient and the common good.

All of this requires courage to not betray the trust society and the patient has bestowed on our profession. Society’s belief in the inherent virtue and ethics of the profession has been the necessary basis of the physician-patient trust.  Would you trust your doctor if you thought they didn’t care about your safety and well-being?

While we recognize patients have the right to ask for MAiD, physicians must not be forced to suggest or forced to facilitate this, when reasonable options for living with dignity exist. We must continue to offer our patients what is good and practice medicine with integrity.

As Dr. Thomas Fung, Physician Lead for Siksika Nation stated, 

“Assisted death should be an option of last resort, and not the path of least resistance for the vulnerable and disadvantaged. Conscience protection is needed in this bill, as no one should be forced to participate in the intentional death of another person against their good will.”

One of the most important foundations of our Canadian identity is that we are a caring, compassionate country. We are proud of our universal healthcare mandate, and we place a high premium on being inclusive and tolerant while working hard toward the accommodation and integration of marginalized and vulnerable members of our community. And yet, if Bill C7 is allowed to stand without amendments, we will be in serious danger of losing this fundamental element of our Canadian identity.