Conscience, Dignity and Good Medical Practice.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

An article by a group of Canadian physicians on conscience rights was published in the December 2020 issue of the World Medical Journal. The article titled: The Declaration of Geneva: Conscience, Dignity and Good Medical Practice starts on page 41 of the World Medical Journal and emphasizes the importance of conscience rights in the practice of medicine. I have limited my article to a few key points:

Conscience rights enable peaceful and productive relationships within a pluralistic society. The article states:

Agreement on foundational principles does not eliminate disagreements, since people hold differing reasonable comprehensive world views leading to different ethical theories, like deontology, consequentialism, principlism and virtue ethics. Recognition of rational moral pluralism enables people to live peacefully and productively with these differences, and this is best ensured by robust protection of freedom of thought, of conscience and of religion, all recognized in Article 18 of the UDHR (Universal Declaration of Human Rights).

Under the section - preservative freedom of conscience - the article recognizes how conscience rights protect physicians and patients. It states:

Refusing to act wrongfully is foundational for the individual and society, contributes substantially to social stability and is the necessary but not sufficient condition for perfective freedom of conscience. It is essential for ethical medical practice because it protects personal and professional integrity and can be the ultimate safeguard for patients.

Forcing a physician to go against their conscience treats them like a government "agent" and causes them to leave their field of medicine. The article states:

For example, a palliative care physician, succumbing to fear of professional discipline, referred a patient for euthanasia. She described the experience as “destructive to my very core.” Haunted for months by the memory, she doubted she could continue in palliative care.  

There is a further point. When the state forces physicians to do what they believe to be wrong it demands the submission of intellect, will, and conscience to serve ends they find morally abhorrent. They are treated as cogs in the state machine,

The article asserts that conscience rights require a moral freedom that enables the goal of treating the other the same as one would treat oneself. The article states:

Thus, to practise “with conscience” is to treat the other as oneself: to impartially care for patients to the best of one’s ability, applying “scientific methods allied with the spirit of charity and service”: to provide for their bodily needs, relieve suffering, prolong human life and prevent disease: to defend fundamental human rights and respect patients’ human dignity and “moral freedom”. Further, recognition of a patient as another self-obliges physicians to prevent and resist harm to patients, and makes deliberately harming them an especially egregious offence.

This group of physicians also had an article published in the September 2020 issue of the World Medical Journal titled: Practising medicine with conscience and dignity (Link).

Sean Murphy,
Administrator Protection of Conscience Project
British Columbia Canada

Dr. Ramona Coelho,
MDCM, CCFP

Dr. Philippe D. Violette, MSc.
MDCM, FRCSC
Assistant Professor Depts. of Surgery and Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.

Ewan C Goligher MD PhD
Assistant Professor
Interdepartmental Division of Critical Care Medicine, University of Toronto

Timothy Lau, MD, FRCPC
Distinguished Teacher, Associate Professor, Faculty of Medicine,
Department of Psychiatry, Geriatrics, Royal Ottawa Hospital.

Sheila Rutledge Harding,
MD, MA, FRCPC Hematology
Saskatchewan Health Authority
Professor, University of Saskatchewan Saskatoon, Saskatchewan, Canada