A bioethicist is calling for medical schools to eliminate applicants who would oppose providing medical services over objections to them based on their personal beliefs.
The call from Udo Schuklenk, a Queen’s University professor and the Ontario Research Chair in Bioethics, comes as the Alberta government grappled with a controversial bill that would have allowed health-care providers to refuse to provide medical care if they object to it on religious or moral grounds.
Earlier this month, backbench MLA Dan Williams with Alberta’s United Conservative Party put forward a proposed law that would have allowed health-care providers in the province to refuse to provide certain procedures, such as assisted death, abortion and prescribing contraception, if those procedures countered their own religious or personal beliefs.
Yet an Alberta legislative committee voted down the bill, meaning that it will not move forward for debate in the house.
The province’s NDP Opposition critic for women and LGBTQ issues Janis Irwin told reporters that while she’s pleased the bill has been halted, she is disheartened because “we really shouldn’t have been having this conversation in 2019.”
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For Schuklenk, a possible solution to prevent such debates from cropping up at all would be to screen out would-be doctors who say they would object to providing health care on conscience grounds before they even get to medical school.
This could be done through a survey or asking medical school applicants outright if they foresee themselves objecting to providing certain types of health care.
“The problems that we are having now that lead to the kinds of legislation they are considering now in Alberta is caused by these sorts of doctors who prioritize their private beliefs, ultimately, over patient well-being,” Schuklenk told Global News.
“Medical schools, pharmacy schools should go out of their way to basically eliminate applicants who they know already will not provide these services.”
He also blames medical schools, in part, for the current disagreements over conscientious rights.
“Medical schools that don’t look at this issue are failing the public that, ultimately, is paying their bills.”
The Alberta “conscience rights” bill would also have done away with the requirement for doctors to refer patients to other health-care providers who would be willing to provide the services in question. This runs counter to a ruling by Ontario’s top court in May that upheld the rule that doctors in the province must refer patients to other doctors willing to provide any medical services they refuse to offer.
The Alberta legislation, which purports to uphold the autonomy of health-care providers, has prompted widespread criticism that it would create new barriers for basic health care for women and LGBTQ2 people, as well as those looking for medical assistance in dying, which became legal in 2016.
Williams, the bill’s sponsor, has denied his legislation would hinder access to medical services.
Schuklenk pointed to countries such as Sweden, where there is no legal right to conscientious refusal for workers in any profession, including in health care. This is also the case in Finland and Iceland.
Sweden holds that because no one is forced to enter into a profession and may resign at any time, no one can be prevented from acting on their own moral or religious beliefs.
This is also how Schuklenk sees things when it comes to medical professionals.
“They fought tooth and nail to get into medical school, pharmacy schools and so on to join these professions. And these professions have a deal with us as a society that they provide these highly specialized services,” he said.
Other experts on medical care disagree that such a screening process for prospective medical students would be necessary or effective in dealing with questions around moral autonomy and ethical concerns among health providers.
A spokesperson for the Canadian Medical Association, which represents more than 75,000 medical doctors, told Global News in an email that the group supports mechanisms that “balance two equally legitimate considerations: patients have access to all forms of legal treatment in Canada while simultaneously allowing physicians to adhere to their personal values and beliefs.”
Ivy Bourgeault, the Canadian Institutes of Health research chair at the University of Ottawa, said that this one-off type of assessment is not sufficient in dealing with the way that the ethics among health professionals, as with broader society, change over time.
“There needs to be a system of refresh and assessment about that not just at medical schools — it should not be the only point of intervention,” Bourgeault said, adding that the views and beliefs of anyone, including medical professionals, may shift over time and cannot just be measured at the outset of medical school.
“There’s a broader conversation about all the different points of intervention to recognize that ethics really do change, our perspectives on what is ethical or not ethical,” she said.
“Some things are hard and fast and some things, we do have changing trends. And then how does the profession of medicine, how does the practice of health care more broadly reflect those changing mores of society?”
Bourgeault said dozens of medical schools in Canada and the U.S. already use a personality test component as part of their application processes but that there isn’t enough available data yet to evaluate how effective they are. Even so, such a mechanism alone wouldn’t be sufficient to grappling with the worldviews of medical professionals and how that impacts their roles.
As someone who comes from Alberta and has family there, the debate unfolding in the province is personal for Bourgeault.
“There’s a concern from a broader women’s health advocate perspective in terms of limiting services that some people deem to be unethical, immoral,” she said.
“But the general medical profession as represented by the colleges … that would be what I would focus on as the main guidelines that should be how the professions are governed and regulated.”
Earlier this week, Williams, the Alberta bill’s sponsor, said he had drawn up a number of amendments to the bill amid the backlash.
“Making sure we can protect freedom of conscience for these objectors and, yes, also making sure that we have access to services and the colleges continue on,” he said at a meeting of a legislative committee.