Assisted death a balance of rights and convictions

Does the right to treatment exist if no one is willing to provide it? That’s what’s at stake in the argument brewing over conscientious objection and medically assisted death.

Canadians now have the right to a physician-assisted death. Thanks to Bill C-14, adults suffering a grievous and irremediable condition and facing foreseeable death can choose a dignified end. But not all physicians are comfortable taking an active role hastening the inevitable. For some it violates their understanding of the Hippocratic Oath to do no harm. Some even consider it a mortal sin.

Bill C-14 explicitly upholds physicians’ freedom of conscience and religion. No doctor can be compelled to help a patient die. But two prominent bioethicists think that should change.

Last week in the journal Bioethics, Julian Savulescu of Oxford and Udo Schuklenk of Queen’s asserted doctors should not have the right to refuse medical assistance in dying based on dictates of their conscience; nor, by extension, contraception or abortion. In essence, they argue, it’s unprofessional to put personal morals ahead of patients’ well-being.

Practising medicine comes with an evolving job description, the authors contend. If doctors cannot overcome their reservations to provide legal medical procedures, they should choose a different career.

The suggestion met a wall of scorn. People aren’t buying the idea doctors are better at their job when they check their ethics at the door. As long as they provide a timely referral to an accessible, non-objecting physician, most feel there’s nothing to gain in forcing doctors to actively participate in treatment they believe to be morally wrong.

But let’s be clear: The viability of ethical objections hinges on effective referrals. The health-care system can’t function if every doctor, nurse and pharmacist can pull a Kim Davis and withhold services to which patients are legally entitled. It’s what separates conscientious objectors — who acknowledge patients’ rights but can’t in good conscience participate — from mere moralizers, who would impose their own values to restrict other people’s choices.

The referral question is not so simple when non-objecting doctors and pharmacists turn out to be in short supply. What if no pharmacist in a wide geographic area will dispense the morning-after pill, an emergency contraceptive that must be taken within 72 hours? There could be devastating consequences for people in remote communities, including rape victims.

Myfegymiso — the “abortion pill” — is poised to raise similar dilemmas. When it becomes available this fall, it will help address serious gaps in reproductive care — but only if doctors provide it. Already, women’s reproductive rights in some regions exist more in theory than fact; across P.E.I., not one hospital or clinic provides therapeutic abortions.

If someone has a right under the law then there is a corresponding obligation to provide that service. If education is a right, the state must in fact build schools and hire teachers and fund bussing to the remotest rural areas to ensure every child can exercise that right.

Likewise, if qualifying patients have the right to a medically assisted death — which the Supreme Court has left in no doubt — then the government has an obligation to make it possible. And not travel-to-Switzerland possible. Realistically accessible.

The proposal to filter conscientious objectors out of medical school is wrong-headed. In the same way communities lure family physicians to practise in far-flung regions, we may need to build incentives to attract non-objecting practitioners to underserviced areas.

Medicine is constantly changing. Our health-care delivery must evolve to maintain a balance between personal convictions and legal rights.