Canada's medical totalitarians

The working group Dr Gabel chairs wants the College to approve this policy. If it does, ethical cleansing of Ontario's medical profession will begin this year, ridding it of practitioners unwilling to do what they believe to be wrong.  Dr Gabel claims that this is required by professional practice and human rights legislation.

It is not clear that the Ontario Medical Association (OMA) will agree.  After all, it requires some effort to maintain that physicians are ethically or morally obligated to do what they believe to be unethical or immoral.  Moreover, last August, the OMA's General and Family Practice Section warned Dr Gabel's working group that the quality of medical care would suffer if only students willing to sacrifice their personal integrity were accepted in medical school.  Moreover, "What about remote areas of practice?" the Section asked.  "Will more prescriptive policies drive physicians to feel that they will have no choice but to practice in more urban settings?"

In other words, is it really better that a pregnant woman in Gravel Roads Only should have no local obstetrical care rather than the help of a rural physician unwilling to recommend or refer for abortion?

The concern expressed by the OMA is understandable, but actually beside the point.  In truth, concern about access to services is not really what is behind the drive for ethical cleansing.  That was made abundantly clear in Ottawa last year, after it was learned that an Ottawa physician was refusing to prescribe or refer for contraceptives.  The story hit the front page of the Ottawa Citizen.

The Citizen did not report the mere facts: that a young woman had to drive around the block to get The Pill.  That might have been dismissed as a first world problem.  No: the Citizen had more ominous news.  It had discovered, lurking in the nation's capital, not just one, but three physicians who would not prescribe or refer for contraceptives or abortion.  There was pandemonium.  An activist group began preaching a crusade against the dissenters, a vitriolic feeding frenzy erupted on Facebook, vehement denunciations appeared elsewhere and the story became the subject of a province-wide CBC broadcast.

One of the Facebookers helpfully suggested that the objecting physicians should move elsewhere, "maybe Dubai," where they could be among their "own kind," while others raged that they had "no business practicing family medicine"  and "[did] not deserve to practice in Canada.  PERIOD."

Physicians will be expected to prescribe, abort or refer, to lethally inject or refer, or get out of medicine — or get out of the country.

To find such comments on Facebook is not surprising.  But it is surprising — and regrettable — that the comments offered by Dr Gabel reflect the same attitude.

Now, there are about 4,000 physicians practising in the Ottawa area, and contraceptives and abortion referrals are so widely available in the city that the Medical Officer of Health says that it is cause for celebration*.  Thus, the wildly disproportionate reaction to news that 0.08% of Ottawa area physicians do not prescribe or refer for contraceptives cannot be explained as a rational response to a problem of supply and demand.

The crusade against the three physicians, now expanded by Dr Gabel and his working group to a crusade for the ethical cleansing of the entire medical profession, is not driven by merely practical concerns about access to services.  It is driven by an a markedly intolerant ideology masquerading as enlightened objectivity.

That is why the OMA's concern that objecting physicians might be restricted to practising in urban centres is understandable, but misplaced.  Ontario physicians must come to grips with the fact that, once ethical cleansing gets underway, dissenting physicians will have no refuge in big cities, even if it takes the crusaders longer to find them there.

Nor, if assisted suicide and euthanasia are legalized, will there be refuge for physicians who don't want to participate in killing patients.  The College's draft policy on end of life care "requires physicians to sensitively respond to a patients wishes or requests to hasten death" and insists that physicians who "limit their practice on the basis of moral and/or religious grounds" must comply with College policy on human rights.  If the law is changed, and Dr Gabel and his working group get their way, this policy will require physicians who refuse to kill patients to help them find someone who will.

Physicians will be expected to prescribe, abort or refer, to lethally inject or refer, or get out of medicine — or get out of the country.