A letter from CMAJ's editorial board to the CMA

CMAJ's recent commentary on editorials1 raises some important questions about the nature and scope of editorial freedom in writing opinion editorials in journals such as CMAJ. I suspect many Canadian physicians would agree with some of the fundamental points the authors make. CMAJ should not become the political mouthpiece of the CMA. There should be no political censorship in a peer-reviewed academic journal. Provocative questions that enrich debate are a necessary and valuable contribution. CMAJ enjoys an international reputation for excellence not only for the quality of its scientific articles but also for its articles dealing with the social, humanitarian, ethical, legal and political aspects of health care. Ultimately, the concept of editorial freedom must be respected and protected.

The question, however, is not about the value or importance of the concept of editorial freedom but rather with its application in a given case. What are the corresponding editorial duties, obligations and responsibilities that bestow credibility and privilege on the notion of editorial freedom? As the eminent philosopher and medical ethicist Steven Toulmin argued in his seminal work, The Abuse of Casuistry, the application of ethics to real-life situations behooves us to resist the “tyranny of absolutes.”2 Editorial freedom is not an unqualified absolute that can be uncoupled from these other important considerations.

What criteria should we invoke to evaluate the judicious application of editorial privilege? Editors must be free to write challenging and provocative opinions that are well founded, unbiased, balanced, respectful and considerate of potential consequences. I would also argue, however, that editors should not be beyond scrutiny and should be held accountable for any abuses of privilege. Thus, if editorial opinions were to be misrepresented as facts, if they were self-serving in promoting a personal political agenda, if due process was manipulated to impede a balanced perspective through a timely response or if the reasonably anticipated consequences of inflammatory statements were harmful to innocent people, then I would argue that such an editor would have betrayed the trust that was invested in him or her and should be held accountable.

Editors of journals such as CMAJ are privileged with significant power to influence change. This power can be applied judiciously or it can be abused. I believe editors should not use the notion of editorial freedom as a shield to make them immune from scrutiny and accountability.

Who should judge this and how should it be judged? The process and criteria should be clear and transparent. Perhaps in the specific case of the editorial dealing with Quebec's Bill 114, some of these considerations could apply. It may prove helpful to see how Canadian physicians, and particularly the editors themselves, would respond to such a challenge.

Postscript: I wish to point out that although I am the Chair of the CMA's Commitee on Ethics, I have not discussed this issue with any of the committee members. The views expressed are my own.