Conscientious Objection: First, Do No Harm

medical symbolThe College of Physicians and Surgeons of Ontario has recently drafted a policy on the “Professional Obligations and Human Rights”, which will change the way physicians approach treatments for their patients, especially in light of moral or religious objections.  The College has requested input on this document from the general public, so I advise all readers to do read over the four-page document and offer their feedback.


One particularly troubling phrase in the draft runs as follows:  “Where physicians are unwilling to provide certain elements of care due to their moral or religious beliefs, an effective referral to another health care provider must be provided to the patient.  An effective referral means a referral made in good faith, to a non-objecting, available and accessible physician or other health-care provider”.


Ponder that sentence for a moment.  At first, it seems as though the College is allowing conscientious objectors to morally or religiously objectionable practices (like abortion, euthanasia, sterilization and so on) a way out.  Why, if you cannot do the procedure, just refer to another physician who will, and, lo and behold, problem solved.


This reasoning ignores the fundamental distinction between what is termed formal and material cooperation in a moral act.  We may contribute to an act in a purely material way.  If a gun shop owner sells someone a gun in good faith, and that gun is used in a murder, the owner has contributed in some way ‘materially’ to the murder, but in no way formally.  That is, unless he could know that the buyer would likely commit the murder.


Take another case:  Suppose a member of a Mafiosi family objects to killing; he has adopted a kind of pacifist stance based on ‘moral and religious’ objection.  However, the family asks that if a legitimate request comes in for a ‘hit’, he refer the person to another member of the family, say his second-cousin, who has no such objections, and will oblige.  In this case, the pacifist doing the referring is both materially and formally involved.


The ‘allowance’ or ‘freedom’ given to the conscience makes the physician like the Mafiosi rather than the gunshop propreitor.


The distinction lies in the degree of the involvement of one’s will, or what we might term voluntariness.  We say an act is imputable to an agent, or ‘culpable’, either 1)  when he does the act, or 2)  helps in performing the act, or 3)  does not put up reasonable obstacles to the act.  In this last case, we must ask, could and should he have done something to prevent the act to which he morally objects?


This is indeed a complex issue, offering no easy solutions, but some cases are relatively clear-cut.  A physician who does not want to perform an abortion, or assist in a patient’s suicide, must, according to the draft policy, refer ‘in good faith’ to another who will do so.  That is, his formal cooperation is compelled, making him to some degree morally culpable for the act.  He knows full well that he is helping in the performance of the act, under some degree of coercion to be sure, and he is not (and by law cannot) put up any obstacles to the act, either by his own words or his actions.  The natural law obliges us always and everywhere to avoid committing moral evil, especially grave moral evil.  The excuse of the Nazis that they were ‘only following orders’ and ‘they didn’t actually commit any murders’ was, really, did not excuse them entirely.  In fact, such a shifting of blame could, in one sense, make one more morally culpable.


This, to put it mildly, is in no way granting a moral escape clause for an objecting physician, but rather a sop thrown out to convince a casual reader that the College is in fact permitting such ‘freedom of conscience’.  In the end, it would force physicians to violate their conscience.


If this policy is passed, we will soon only have medical students and, then, physicians who have no moral objection to killing their patients, including the unborn, the elderly, the disabled.


Please do write and object to the College, before such a brave new world comes to pass, one in which freedom is lessened, not strengthened, one in which physicians trained to heal are, instead, licensed to kill.


February 14, 2015


Saints Cyril and Methodius