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Moral diversity in healthcare

Should religious or moral beliefs influence a doctor's decision?

Canada Flag diversity 

Illustration by Robert Wilcockson

There has been quite an uproar in Canada recently over the case of a young woman who visited a walk-in clinic to get her birth control prescription renewed and was refused by the physician on duty on the grounds that he didn't believe in contraception because it conflicted with his religious and/or moral beliefs.

An op-ed piece in Canada's national newspaper attempted to frame this issue not as an attempt by a clinician to force his religious beliefs upon a patient but, rather, as a larger debate on whether it is indeed possible or desirable to remove 'conscience' from the practice of medicine. Commentary on this case has ranged from 'this clinician's actions are totally absurd' to 'medicine without a conscience does not serve the best interests of patients'. The list of treatments upon which a clinician can impose his or her moral view is long: contraception, abortion, blood transfusion, organ retrieval and donation - to name a few.

Canadian public opinion has largely been split on this issue and it is abundantly clear that there is no 'right' or 'wrong'. It is difficult to compartmentalise one's strongly held beliefs and 'check them at the door' simply by virtue of throwing on some scrubs or putting on a lab coat and stethoscope. Yet the notion of 'welfare healthcare' where we believe that an individual is, for the most part, the best judge of his or her own welfare (with the exception perhaps of the mentally ill) is also a critical piece of this debate.

Diversity among physicians has a place in any society, but where does it end

If there is a contraindication to the treatment or a patient safety issue of some sort, there really is no argument: the clinical judgment of the doctor along with best practice guidelines and current standard of care would dictate the actions and there would be very little uproar. In this case, however, the doctor did not cite the long-term deleterious effects of prolonged oral contraceptive use as his rationale for denying the renewal. He just simply refused on moral ground.

In fact another simmering issue in this Canadian case is that this was a prescription renewal and not an initial visit with patient counselling, a better and complete understanding of the patient's lifestyle and behaviour or any sort of clinical workup. Another peer and colleague of this clinician had already determined that oral contraceptives were both safe and appropriate to prescribe for this patient (ie they fit the construct of his moral beliefs and clinical judgment).

The typical knee-jerk reaction in situations like this is to suggest overtly that 'healthcare is different' and that 'medicine is special', so we can't compare this to normal, everyday situations. We've conditioned ourselves to believe that when we're talking about healthcare there are no rules and that everything is an exception. Really? So, for the sake of argument, if your Jewish airline pilot refused to fly through Arab airspace on moral ground, would this be acceptable? Would we suggest that it is not necessarily possible or desirable to remove conscience from the airline industry or that a system without conscience is not in the best interests of consumers? If a waitress refused to serve you beef on the moral ground that she is Hindu and does not believe in the slaughter of cows for human consumption, what would we say?

This op-ed piece goes on to suggest that 'in this wonderfully diverse country [Canada] with its diverse cultures and beliefs, we can tolerate a little diversity among physicians'. But that has nothing to do with the situation and Canada might as well be a proxy for any number of countries which have the same richly diverse cultural fabric.

Diversity among physicians certainly has a place in any society but the question is where does the diversity start and where does it end? Is refusing to provide someone with a medication by virtue of one's moral beliefs diversity? Some would argue it is not. Who interprets what constitutes diversity anyway? Policy folks? Law makers? Politicians? Clinicians? This is a slippery slope.

The College of Physicians and Surgeons issued a statement endorsed by a Catholic Archbishop, Rabbi and Imam and it reads as follows: “No Canadian citizen, including any physician, should ever be disciplined or risk losing their professional standing for conducting their work in the conformity with their most deeply held ethical or religious convictions.” The only problem with this statement is that they forgot the last line: “Unless it conflicts with and impinges upon the most deeply held ethical, moral of religious convictions of their patients.”

Article by
Rohit Khanna

Rohit is the managing director of Catalytic Health, a healthcare communications, advertising & strategy agency. He can be reached at:

25th September 2014

From: Marketing, Healthcare



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