By Nancy Valko
The December 2017 issue of the Canadian medical journal Le Specialiste contains a fascinating but disturbing English-language article “First Results from a Unique Study” on pages 36-40.
2015 was the year when the MAID (medical aid in dying, aka doctor-prescribed suicide and even lethal injections in Quebec) Act took effect. The article is about physicians and MAID in the city of Laval in Quebec, Canada that has a population of about 435,000.
The study made news when it reported that after 18 months, conscientious objections from physicians against providing MAID were far more frequent than anticipated. Prior to the law, 48% of doctors said they would participate, 30% with conditions and only 28% said they would never participate.
Afterwards, 77% of the physicians getting MAID requests refused to actively participate, all of them using the conscientious objection clause, even though the study claimed the majority (72%) were in favor of MAID with only 13% of the doctors neutral or ambivalent.
The most common reason given for refusal was “too much of an emotional burden to bear, followed by a perception of lack of clinical expertise, and a fear of being stigmatized by peers or by people in general for participating.”
Other reasons included not adding to an “already heavy clinical burden”, MAID being “a very time-consuming process” and “medical legal concerns”.
The seemingly obvious takeaway from these surprising refusals is that participating in the killing of patients is much harder in reality than approving gauzy claims of just relieving suffering.
Criticism of “Conscientious Objection”
However, the authors did another study “to explore what ‘conscientious objection’ meant to these (refusing) physicians.” Although less than half of the refusing doctors participated in this second study, the authors conclude that legal “conscientious objection” is mostly being used for “reasons other than moral or religious grounds”. They contend that reasons like “high emotional burden, a perception of incompetence to perform the procedure and time constraints” do not meet the classic definition of conscientious objection on moral or religious grounds. They also worry that with the currently low physician participation in MAID, there is a “risk of a looming crisis in access to timely MAID services”.
The authors cite arguments by those who oppose conscientious objection that the authors consider “just as valid” as arguments in favor of conscientious objection:
- “Consequences for patients” leading to denial of access or delay in treatment.
- “Costs for healthcare systems: while the possibility of referring the patient to a colleague exists, this can generate additional costs and prove to be less efficient.” (Note that Canada has a government-controlled health care system.)
- “A heavy burden on the shoulders of a reduced number of physicians who accept to perform” certain acts.
- ”The importance of professionalism” which means “caring for patients, no matter the type of care required”.
These two studies have important implications regarding conscience rights for all health care providers, even those outside the MAID policies in Quebec.
Just last April, the very influential Dr. Ezekiel Emanuel co-wrote in the New England Journal of Medicine article “Physicians, Not Conscripts-Conscientious Objection in Health Care” that:
“Health care professionals who conscientiously object to professionally contested interventions may avoid participating in them directly, but, as with military conscientious objectors, who are required to perform alternative service, they cannot completely absent themselves from providing these services. Conscientious objection still requires conveying accurate information and providing timely referrals to ensure patients receive care.”
“Health care professionals who are unwilling to accept these limits have two choices: select an area of medicine, such as radiology, that will not put them in situations that conflict with their personal morality or, if there is no such area, leave the profession. “ (All emphasis added)
It is ironic how deliberate death decisions defended on the basis of “choice” can easily become “no choice” for those health care professionals dedicated to really caring for patients instead of killing them.
And all of us-whether we are patients or health care professionals-must understand that legalizing physician-assisted suicide inevitably leads to further erosion of medical ethics and thus crucial protections for ourselves, our loved ones and society.