New Secular Laws on Conscientious Objection, Physician Assisted Suicide, and Euthanasia
Kevin Powell, MD, PhD
Physician assisted suicide (PAS) is specifically proscribed by the Hippocratic Oath, but is increasingly becoming legalized. Nine of 50 states and the District of Columbia now permit it. A few countries, including recently Canada, have legalized voluntary euthanasia, which Canada has labeled Medical Aid in Dying (MAID.) In the past year, there have been new legal developments in the ability of medical staff to conscientiously refuse to participate in this activity. Canada has taken a different path than the United States. One likely reason is that Canada’s culture is more anticlerical and secular than the US.
The US has a strong culture and history of defending religious liberty, so its laws on PAS protect the right to refuse to participate. The 2016 California law is very clear: “a person or entity that elects, for reasons of conscience, morality, or ethics, not to engage in activities authorized pursuant to this part [the End of Life Option Act] is not required to take any action in support of an individual’s decision under this part.” The federal Final Conscience Rule, released in May 2019, also protects conscientious objection by both personnel and organizations.
In contrast, the Ontario Court of Appeals (ONCA) in May 2019 rejected a lawsuit by the Christian Medical and Dental Society of Canada demanding protection. ONCA ruled that Ontario physicians must either provide MAID when requested or make an effective referral, defined as “a referral made in good faith, to a non-objecting, available, and accessible physician, other health-care professional, or agency.”
There are many articles debating whether physicians (and by extension, other medical staff) should be allowed to invoke conscience to refuse to participate PAS or MAID. Some authors reject personal conscience and advocate that “If people are not prepared to offer legally permitted, efficient, and beneficial care to a patient because it conflicts with their values, they should not be doctors.” Savulescu BMJ 2006. Others reject that consumer-driven model of medicine and seek to define the scope and goals of medical care based on traditional sources and contemporary reasoning.
A third approach, most evident in recent US Supreme Court decisions, is to reject a monolithic system and expect that different ideals will coexist in a pluralistic society. This requires reasonable accommodation of refusals to participate and a fair system for adjudicating what is reasonable. By contrasting the US and Canadian rulings, plus some more recent cases in the news, one can assess the challenges ahead for those with strong religious beliefs who see health care as a calling.
The US has a strong culture and history of defending religious liberty, so its laws on PAS protect the right to refuse to participate. The 2016 California law is very clear: “a person or entity that elects, for reasons of conscience, morality, or ethics, not to engage in activities authorized pursuant to this part [the End of Life Option Act] is not required to take any action in support of an individual’s decision under this part.” The federal Final Conscience Rule, released in May 2019, also protects conscientious objection by both personnel and organizations.
In contrast, the Ontario Court of Appeals (ONCA) in May 2019 rejected a lawsuit by the Christian Medical and Dental Society of Canada demanding protection. ONCA ruled that Ontario physicians must either provide MAID when requested or make an effective referral, defined as “a referral made in good faith, to a non-objecting, available, and accessible physician, other health-care professional, or agency.”
There are many articles debating whether physicians (and by extension, other medical staff) should be allowed to invoke conscience to refuse to participate PAS or MAID. Some authors reject personal conscience and advocate that “If people are not prepared to offer legally permitted, efficient, and beneficial care to a patient because it conflicts with their values, they should not be doctors.” Savulescu BMJ 2006. Others reject that consumer-driven model of medicine and seek to define the scope and goals of medical care based on traditional sources and contemporary reasoning.
A third approach, most evident in recent US Supreme Court decisions, is to reject a monolithic system and expect that different ideals will coexist in a pluralistic society. This requires reasonable accommodation of refusals to participate and a fair system for adjudicating what is reasonable. By contrasting the US and Canadian rulings, plus some more recent cases in the news, one can assess the challenges ahead for those with strong religious beliefs who see health care as a calling.