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This is one of those times I’m glad I’m not a family doctor.
Or, more specifically, a family doctor (any medical doctor, really) who objects to certain procedures based on my conscience.
Because if I was, and if I was working in Ontario, I’d find myself choosing between my career, and all I’ve worked for, and my deepest beliefs.
It’s a stark choice many doctors in Ontario must now make. This choice follows a recent decision by the Court of Appeal for Ontario that denies doctors the right to act according to their conscience.
In the past, a doctor who believed abortion, euthanasia and other services were unconscionable acts could refuse to perform the services. They could also refuse to refer the patient to a doctor who offers these services.
The ruling doesn’t require doctors to perform acts that they consider objectionable. But they must now provide a referral to a doctor known to offer these services. Doctors who don’t provide referrals can face professional sanction.
For many doctors, even a referral implicates them in activities they view as immoral. It violates their conscience.
So goodbye conscience. Or goodbye career.
The doctors who say their rights have been violated are correct. The court admitted so, noting that the ruling curtails a citizen’s right to “freedom of conscience and religion,” the first of four “fundamental freedoms” outlined in the Charter of Rights and Freedoms.
The court chose to curtail these clearly stated freedoms so patients may have “equal and equitable access” to public health care.
It’s important to mention that the procedures under dispute are all elective. Essentially, the court is saying that patients should be able to receive whatever health care they want, whenever they want it, much like they can order whatever they want off the lunch menu.
This isn’t “equal and equitable access” to health care. This is health care that’s equal, equitable and a la carte.
This reasoning undermines the spirit of public health care and strengthens the case for privatized medicine in Canada.
It does so by bringing a retail attitude into the hospital. True, no money exchanges hands, but the slogan of every retail carnival barker sounds loud and clear: The customer is always right.
Or if you prefer Roy Orbison: “Anything you want, you got it.”
The vision of health care on display in this ruling puts individual wants at its centre. This is the definition of privatization.
If this is our preferred vision of health care in Canada, then let’s admit that we want a private system and act accordingly. Open the health-care market to competition and allow doctors to charge for services. Customers can shop for doctors who will prescribe birth control, provide abortions and euthanize them. The market will meet the demand while allowing a minority of doctors to act according to their conscience. And maybe go out of business.
Who will pay for these services?
The government. Unless we want to go fully private and allow customers and insurance plans to pay for whatever medical procedures a customer hopes to procure.
Perhaps I’ve read too much into this ruling. Maybe the door to two-tiered medicine is still firmly locked, chained and bolted.
Regardless, there’s no confusion in the court’s ruling. In it we have a clear case of the state legislating the conscience of Canadian citizens – in this case, the doctors of Ontario.
Many doctors must now consider what their careers look like in a world of attenuated conscience and freedom.
Those of us who don’t practise medicine can tell ourselves that we don’t need to worry. The government isn’t forcing us to make a choice between our careers and what we believe is unconscionable.
And many of us won’t care. Like consumers in line at the local drive-through, we’ll insist on getting what we want. Health care a la carte, served up the way I want it.
Robert Price lectures at the University of Toronto Mississauga. Opinions expressed are his own.
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