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I am writing to respond to Dr. Eric Brown's letter "RE: Doctors don't need to refer for MAiD". It is true, as Dr. Brown states, that "The religious rights of all Canadians are protected, but the right to a particular occupation is not". The intended implication, it seems, is that any conscientious objectors should simply leave the practice of medicine. This is a common argument leveled against conscientious objectors. However, there are several problems with this argument, and I would like to highlight two.
Firstly, it is worth keeping at the forefront of our minds that, as Dr. Kelsall pointed out in her article, any kind of participation in MAiD would have been judged as culpable homicide until 2015. If Dr. Brown's argument is taken to its logical conclusion, what would it mean for the many doctors who entered practice before that time with both a legal and a personal moral responsibility not to intentionally end the lives of their patients? It's certainly not the case that they "knew what they were getting into", and therefore have no excuse for refusing to perform a service that's "part of the job". Instead, it seems as though this line of reasoning would force many competent, compassionate, and well-intentioned physicians out of a profession that they entered in good faith. This is a loss for both patients and the medical profession.
Secondly, I would like to point out that Dr. Brown's line of reasoning will result in depriving patients of access to many physicians with a crucial quality: integrity. It is not for nothing that the new CMA Code of Ethics, which is currently under consultation, states that integrity is one of the "Virtues Exemplified By The Ethical Physician". I am not suggesting that MAiD practitioners lack integrity, but it is important to consider the implications of Dr. Brown's argument. If Dr. Brown's line of reasoning were taken to its logical conclusion, the only physicians who would be allowed to practice medicine would be those who toed the party line when it came to ethical issues, even if they felt personally uncomfortable; in other words, physicians without integrity. This is a loss for patients. Moreover, it is not too difficult to think of times where there was a broad acceptance in the medical community of practices which we now find objectionable. One can call to mind the Tuskegee Syphilis Study, or involuntary sterilizations during the eugenics movement in the early 20th century. Note that I do not intend to compare these events with the provision of MAiD, but only to point out the following: if we only allow physicians who disregard their personal convictions and toe the party line, how will we ever make ethical progress as a profession? The loss of physicians with integrity will, again, harm both patients and the medical profession.
Given these flaws, and given that Ontario is one of, if not the the only jurisdiction in the world which mandates that physicians make such a direct referral, one has to ask: is this really necessary? As Dr. Kelsall states, surely there is a better way forward!