Why conscientious objection merits respect

In his important commentary on respecting conscientious objection to the provision of physician-assisted death (PAD), Dr. Fletcher cites the long-standing tradition of tolerance within the Canadian medical community.1 We wish to point out several more reasons for respecting conscientious objection to PAD.

First, there is no duty in Canadian law or medical ethics for physicians to provide access to PAD. In the Carter decision, the Supreme Court of Canada explicitly stated that legalizing PAD did not entail a duty on the part of physicians to provide PAD.

Second, physicians frequently decline to offer treatments because they deem them nonbeneficial or harmful.2 Insofar as all refusals of therapy are ultimately justified by the ethical belief that the goal of therapy is to provide benefit and avoid harm, all treatment refusals are matters of conscience.

Third, the ethical justification of PAD remains debatable because it relies on uncertain metaphysical assumptions about the benefit of death3^–5 and contravenes widely held basic moral intuitions about the inestimable intrinsic value of humans.6 Because it remains distinctly possible that PAD is unethical, objecting physicians should not be forced to facilitate access to PAD for their patients.

Fourth, physicians are ethically complicit when they deliberately refer a patient for a specific intervention.7 For example, it is clearly objectionable to provide a referral for female genital mutilation. Analogously, if one finds PAD similarly unethical, providing a referral for PAD is highly objectionable and undermines one’s moral integrity.

Fifth, respect for conscientious objection upholds the moral integrity of physicians,8^,9 the foundation for society’s confidence in the profession. Disregarding conscientious objection prioritizes moral conformity over moral integrity, undermining the trustworthiness of the profession. Prioritizing moral integrity by respecting conscientious objection can foster quality medical care and enhance patient safety.10