Conscientious Objection by Physicians

Posted by on Mar 9, 2015 in Letters to the Editor
Dear Editor:
          Please publish this as a letter to the editor or an opinion piece.
           Despite the furor and debate regarding a doctor’s freedom to not practice against his conscience it seems nothing is really resolved. As a well experienced clinician and academic I would like to comment by way of a description of a quite possible situation:
Patient (P) cheerily, “Good morning doctor. Its a nice day isn’t it.”
Family doctor, (Dr.D)sensing something isn’t quite right. “Who are you”
P. smiling sweetly. “I’m your new patient and I need an abortion”
Dr.D. “I don’t do abortions.”
P. “Then you must refer me to someone who can”
Dr.D. “ I can’t do that.”
P. blows a shrill whistle and his office suddenly fills with reporters as she shouts in triumph.”We got you, you stupid religious freak”
Dr.D making himself heard above the din with a voice he developed in the army. “Yes, I feel well set up and stung but don’t forget wasps that sting soon die”
     A few days later a registered letter arrives informing this well loved physician that his license has been suspended pending further investigation by the College of Physicians and Surgeons.
    After tense preliminaries in the College board room the President (Dr.P2) speaks very sternly. “Dr. D. you have heard the charge. It appears that you have wilfully disobeyed the new directive from your college indicating you cannot object to providing or referring for legally permissible and publically funded medical services even if they conflict with your deeply held and considered moral and religious beliefs. It has been reported by reliable witnesses that on March 13 you refused to perform an abortion for patient P. you weren’t trained to do abortions.  You then refused to refer her to someone who could. Please explain to this council your position in this case.
Dr.D. Scratching his head and looking awkwardly at his large feet. “Well Dr. P2 you are quite correct. I have never been trained to do abortions and should never attempt to do so. Am I correct?
P2 “Of course”
Dr. D. “I did not have a chance to exam this new patient to determine her need for an abortion. By College rules this is required before a referral. Am I correct?
P2 Yes, but she has a right to……”
Dr.D. I agree with you sir, she has a right to good medical care. That is what I intended to do before I was so rudely interrupted. She seemed healthy to me so to avoid bilking our medical plan I needed to establish the fact she required expert treatment. Was I right?
Dr.P2 “Yes, but you are avoiding the point. Would you have referred her for an abortion even if she was apparently healthy?”
Dr.D.  “If I had referred a totally healthy patient for expensive treatment I would have contravened the College and the Medical plan’s mandate. You would have suspended my license to practice, Yes?
Dr. P2 Getting pushed into a logical corner  “No I mean Yes. It all depends”.
Dr.D. “Yes it depends on if the patient needs treatment and if it is good medicine, does it not?”
Dr. P2 Losing his cool. “Damn it, did you object to referring this patient for an abortion because of your moral or religious beliefs.
Dr. D. “No sir, I did not refuse to refer her on the grounds of my beliefs. In fact I believe no doctor should refuse any required procedure on the grounds of conscience”.
Utter, stunned silence in which it was easy to hear a hidden cell phone drop.
Dr. P2  Flustered, sensing he is walking with eyes wide open but blinded into some kind of trap. “What are you saying? Speak up young man, we don’t have all day for this?
Dr. D. “I said no doctor should practice according to his conscience but by all the rules of evidence based medicine. That being the case I saw no need for this unnecessary procedure which has no scientifically established benefit and a growing mound of evidence showing short and long term harms. If I referred her for unnecessary surgery I could have also been named in a suit for damages done by the abortionist. If I had used a curette to invade her body without medical justification, I could be charged with criminal assault. Isn’t that true Dr. P2?”
Dr. P2  “Get out of here. Get out of here now. We’ll get you yet”
Dr. D. “And just to show you I am serious about this; if you can find a case that medically requires an abortion and if you can provide evidence of benefit to the patient and if you can show there are no serious side effects, I’ll do the abortion myself”.
         No physician should practice according the dictates of  his conscience any more that an airline pilot fly his passengers or a mechanic fix brakes according to the dictates of his conscience. The simple rule has been and should continue to be, only practice what is good medicine.
         There is no evidence of benefit and considerable data on harm from almost every abortion. As a physician who practices according to evidence based medicine, I cannot, I will not practice bad medicine. You cannot make me, so help me God.
         Suddenly there is wild cheering and Dr. D is hoisted to the shoulders of colleagues who had quietly infiltrated the college. From an awkward up-side-down position, Dr. D is heard to be roaring, “And don’t forget Dr.P2 that the onus of proof in medicine always rests on anyone who provides or supports an unproven remedy”
        And now the whole place is filled with enthusiastic noise, this time by an unnumbered group of women and their families shouting,  “Good practice, good practice, we want good practice, all the time, every time”.
              Philip G. Ney MD FRCP(C)  250 642 4483. Victoria BC