As more nations and states legalize medical assistance in dying (herein “MAID”), more cases are being reported of coercive and abusive pressures being used to force doctors who object to performing, assisting or making referrals for physician-assisted suicide to engage in complicit behavior.
In 2016 it was reported that euthanasia or assisted suicide was legal in only eight nations (Belgium, Canada, Colombia, Germany, Japan, Luxembourg, Netherlands, and Switzerland) and in only six American states (California, Colorado, Montana, Oregon, Vermont, and Washington – plus also in the District of Columbia). That amounts to less than four percent of the sovereign nations in the world, and just twelve percent of American states.
Thus, the total number of jurisdictions that allow MAID is actually very small. The acceptance of MAID globally and in the U.S. has been rather under-whelming – especially since efforts to legalize such practices have been urged for many decades.
The miniscule portion of jurisdictions that have legalized MAID is all the more striking when contrasted with the decades of relentless efforts to legalize such practices. Yet the profound moral dilemmas that MAID creates are of great significance.
Yet the experience of nations where MAID is legal is very troubling. Some advocates of MAID cannot abide having any doctors who will not perform or support such killings, so they pressure those who disagree with them to comply and conform. They seem to view the mere existence of differing views in their medical community to be a threat that must be eliminated.
Because of such dynamics, there really is no “middle ground” on the issue of legalizing MAID. Either a health care provider supports the “progressive” policy of MAID, or he/she is viewed and treated as a real or potential threat – to be marginalized, opposed, and excluded from professional influence.
Sadly, such “progressive” hostility to conscientious objection harms communities and the individual and family members of communities. It deprives them of a safety-net that keeps the medical system and the medical establishment honest.
“Free conscientious objection to MAID” [Medical Assistance in Dying], wrote Assistant Professor Christine Cserti-Gazdewich, “reveals flaws and coaxes improvements. This constructive dialogue is … the vitality of a system striving for excellence.” Without such protections as for rights of conscience she predicted “quantitative and qualitative corrosion of our health care workforce.”
Such checks and balances are especially important now, as medical decisions and medical professionals are playing an increasing – and increasingly important – role in the lives of more and more citizens. Loss of the protection of conscientious objection marginalizes and endangers the significant (if small) community of medical professionals who have and try to live by the values of their religious faiths.
For example, Sean Murphy of Canada reports that: “Attacks on physician freedom of conscience in the Canadian province of Ontario have become acute since the legalization of euthanasia and physician assisted suicide in 2016. Doctors have been threatened with discipline or dismissal if they refuse to comply.”
For some persons of faith, the act of referring a patient to a professional who will aid them to commit suicide or voluntary self-euthanasia is an act of complicity in a severe moral evil. While others may not agree with those moral principles, all of us can and should respect those who hold those views and should protect their right to try to live by them.
MAID is a relative recent phenomenon in North America. In 2015, the Supreme Court of Canada ruled unanimously in Carter v. Canada that the Canadian Charter of Rights and Freedoms required the government to allow MAID for “a competent adult person who (1) clearly consents to the termination of life; and (2) has a grievous and irremediable medical condition (including an illness, disease or disability) that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition.”
In June 2016 Canada enacted a law (Bill C-14, the Medicial Assistance in Dying Act) that allowed MAID for adults suffering from terminal physical illnesses whose natural death is “reasonable foreseeable.” Ironically, the most vigorous opposition to the Canadian MAID legislation was not from conservatives opposed to legalizing assisted suicide or euthanasia but from liberals who wanted MAID to be available to minors and to persons suffering from non-physical illnesses and to persons whose death was not imminent.
Canada has had less than a year’s experience with MAID. Yet, already some Canadian doctors have left the profession to avoid being forced to refer persons for euthanasia.
Coalition for HealthCARE and Conscience has been formed to support physicians who oppose being forced to perform or refer patients to doctors who perform medical assistance in dying (assisted suicide). Likewise, Canadian Physicians for Life is another organization of medical professionals to oppose mandatory MAID.
Such organizations are not just commendable but essential. If the experience of medical abuses in Nazi Germany showed nothing else, they showed that institutional pressures to facilitate killing the unwanted and the vulnerable eventually corrupt professional organizations that were formed to protect the weak and to provide healing services to the ill and injured. So the creation of institutions willing to blow the whistle about such abuses is critical to protect rights of conscience.
The failure of the Canadian government to create serious institutional checks and protections and the lack of agencies and officials clearly charged to protect and given adequate resources to prevent and punish abuses are revealing. Merely mouthing platitudes about respect for rights of conscience without real institutional means and without systemic commitment to do so virtually guarantees neglect of the rights of the minority who oppose killing within the profession and nation.
Lynn D. Wardle is the Bruce C. Hafen Professor of Law at Brigham Young University. He is author or editor of numerous books and law review articles mostly about family, biomedical ethics and conflict of laws policy issues. His publications present only his personal (not institutional) views.