David Lao
© Joe Raedle/Getty Images FILE
The End of Smallpox | History Today
1999-03-03 · Drawing accompanying text in Book XII of the 16th-century Florentine Codex (compiled 1540–1585), showing Nahuas of conquest-era central Mexico with smallpox. Anyone asked to define ‘conscientious objector’ would undoubtedly describe someone refusing military service on religious or …
As the campaign for the 2021 federal election continues, one controversial topic looks to be coming right to the forefront — whether health-care professionals are obligated to provide care for service they morally oppose, or at least refer the patient to another doctor.
At issue is what's known as conscientious objection: when health-care practitioners refuse to do or refer patients for a medical procedure that is against their belief such as abortions, medical assistance in dying or even gender-reassignment surgery.
The conversation comes as Conservative Leader Erin O'Toole was pressed on Thursday to clarify a promise in his party's platform, under the section detailing human rights, to "protect the conscience rights of health-care professionals."
Read more: Tories say doctors should be allowed to refuse abortions, assisted death
"The challenges of dealing with COVID-19 have reminded us of the vital importance of health care professionals — the last thing Canada can afford to do is drive any of these professionals out of their profession. We will also encourage faith-based and other community organizations to expand their provision of palliative and long-term care," read the promise.
O'Toole refused to say whether that means he believes doctors and nurses should be able to refuse to refer their patients to a willing practitioner who can offer the medical care being sought.
Instead, the Conservative leader repeated his personal views on abortion rights, saying that he was "pro-choice."
Video: Medical assistance in dying: why some say they are being unfairly denied, despite new law
“We can get the balance right, but let me be perfectly clear: As a pro-choice leader of this party, I will make sure that we defend the rights of women to make the choice for themselves with respect to their own health,” said O’Toole during an event in Ottawa.
The promise to protect conscience rights is one heralded by social conservatives, who believe physicians should not be forced to perform or even provide referrals for care they oppose.
Read more: Medical schools should deny applicants who object to provide abortion, assisted death, bioethicist says
O’Toole says he supports health care professionals if they choose not to perform abortions, assisted dying
The Liberals were quick to attack O'Toole's stance, with the party releasing a video Thursday that showed Conservative candidate and former leadership rival Leslyn Lewis supporting health-care providers' choice not to refer patients for medical services like abortions.
Liberal Leader Justin Trudeau on Thursday criticized O'Toole's position.
“Pro-choice doesn’t mean the freedom of doctors to choose. It means the freedom of women to choose. Leaders have to be unequivocal on that,” said Trudeau during a campaign stop in Victoria on Thursday.
On Wednesday night, Liberal MP Maryam Monsef slammed O'Toole in a series of tweets that described the leader as having "pretended to be pro-choice."
"That's the same position as Andrew Scheer," Monsef wrote.
While the campaign platform does not make specific mention to referrals, the platform O'Toole ran on while seeking the Conservative party leadership did, promising to protect "the conscience rights of all health care professionals whose beliefs, religious or otherwise, prevent them from carrying out or referring patients for services that violate their conscience.”
In a statement to Global News Thursday, the Conservatives pointed to several quotes of Liberal MPs and ministers in which they mentioned support for the conscience rights of professionals during the legislative debates on assisted dying.
Video: How do you balance doctor, patient rights on assisted-death?
"Mr. Speaker, as I have indicated, I will always respect the conscience rights of doctors," said Labour Minister Filomena Tassi in 2016 during a House of Commons debate on medical assistance in dying.
Tassi, who was not a minister at the time, said she was speaking in the context of accessibility to the service.
Another quote included Justice Minister David Lametti during his defence of assisted dying legislation in 2020. In it, Lametti said that that doctors' conscience rights were protected in the bill.
Yet in an interview with The Canadian Press, Lametti said that ensuring physicians did not have to participate in a medical procedure against their conscience was "way different" than supporting a right for them to refuse to provide referrals.
According to him, conscientiously objecting doctors have a "moral obligation" to refer their patients to someone else.
The majority of provincial physicians' colleges — the governing bodies that set in place policies and guidelines for doctors to follow — for the most part allow their health-care professionals to object to a medical procedure.
Where they differ often comes down to the question of how each college views the ethical obligation for members to refer patients to other doctors who can provide the care.
Read more: Fewer Canadian women appear to be travelling to U.S. for abortions during COVID-19
The College of Physicians and Surgeons of Ontario requires doctors to provide an "effective referral" within a "timely manner" to another professional or agency, should they consciously object.
"Physicians must not impede access to care for existing patients, or those seeking to become patients," reads the college's policy.
That position was challenged in court but upheld as a reasonable measure aimed at ensuring access to healthcare for patients by Ontario's Court of Appeal in 2018. The court also sided with the lower divisional court which ruled allowing doctors to refuse referrals would further stigmatize already vulnerable patients.
The appeal court agreed with the determination that objections by practitioners to providing referrals "were designed to preserve their rights, and were not directed — as they should have been — to promoting the objective of equitable access to health care."
Read more: Canada election: Complete list of promises made during the 2021 campaign
Data gathered about the policies of colleges in other provinces by the Abortion Rights Coalition of Canada found the policies in provinces like Saskatchewan, New Brunswick, Prince Edward Island, Alberta and B.C., were more ambiguous.
Those policies describe processes for the patient to obtain more information or to see another doctor who can provide the service, but do not clearly direct doctors to make an "effective referral."
On Friday morning, Quebec's Collège des médecins du Québec clarified its position on the matter in a tweet which, translated, says that: "In Quebec, doctors cannot abandon patients or even ignore their request by invoking conscientious objections, particularly in matters of abortion or medical assistance in dying, without referring them to another colleague," the college said.
"It is an ethical obligation."
Colleges in Newfoundland and Labrador, Nova Scotia and Manitoba all explicitly say that professionals who refuse to provide service are not required to make a referral, citing the Canadian Medical Association's Code of Ethics and Professionalism.
— with files from The Canadian Press and Amanda Connolly
At issue is what's known as conscientious objection: when health-care practitioners refuse to do or refer patients for a medical procedure that is against their belief such as abortions, medical assistance in dying or even gender-reassignment surgery.
The conversation comes as Conservative Leader Erin O'Toole was pressed on Thursday to clarify a promise in his party's platform, under the section detailing human rights, to "protect the conscience rights of health-care professionals."
Read more: Tories say doctors should be allowed to refuse abortions, assisted death
"The challenges of dealing with COVID-19 have reminded us of the vital importance of health care professionals — the last thing Canada can afford to do is drive any of these professionals out of their profession. We will also encourage faith-based and other community organizations to expand their provision of palliative and long-term care," read the promise.
O'Toole refused to say whether that means he believes doctors and nurses should be able to refuse to refer their patients to a willing practitioner who can offer the medical care being sought.
Instead, the Conservative leader repeated his personal views on abortion rights, saying that he was "pro-choice."
Video: Medical assistance in dying: why some say they are being unfairly denied, despite new law
“We can get the balance right, but let me be perfectly clear: As a pro-choice leader of this party, I will make sure that we defend the rights of women to make the choice for themselves with respect to their own health,” said O’Toole during an event in Ottawa.
The promise to protect conscience rights is one heralded by social conservatives, who believe physicians should not be forced to perform or even provide referrals for care they oppose.
Read more: Medical schools should deny applicants who object to provide abortion, assisted death, bioethicist says
O’Toole says he supports health care professionals if they choose not to perform abortions, assisted dying
The Liberals were quick to attack O'Toole's stance, with the party releasing a video Thursday that showed Conservative candidate and former leadership rival Leslyn Lewis supporting health-care providers' choice not to refer patients for medical services like abortions.
Liberal Leader Justin Trudeau on Thursday criticized O'Toole's position.
“Pro-choice doesn’t mean the freedom of doctors to choose. It means the freedom of women to choose. Leaders have to be unequivocal on that,” said Trudeau during a campaign stop in Victoria on Thursday.
On Wednesday night, Liberal MP Maryam Monsef slammed O'Toole in a series of tweets that described the leader as having "pretended to be pro-choice."
"That's the same position as Andrew Scheer," Monsef wrote.
While the campaign platform does not make specific mention to referrals, the platform O'Toole ran on while seeking the Conservative party leadership did, promising to protect "the conscience rights of all health care professionals whose beliefs, religious or otherwise, prevent them from carrying out or referring patients for services that violate their conscience.”
In a statement to Global News Thursday, the Conservatives pointed to several quotes of Liberal MPs and ministers in which they mentioned support for the conscience rights of professionals during the legislative debates on assisted dying.
Video: How do you balance doctor, patient rights on assisted-death?
"Mr. Speaker, as I have indicated, I will always respect the conscience rights of doctors," said Labour Minister Filomena Tassi in 2016 during a House of Commons debate on medical assistance in dying.
Tassi, who was not a minister at the time, said she was speaking in the context of accessibility to the service.
Another quote included Justice Minister David Lametti during his defence of assisted dying legislation in 2020. In it, Lametti said that that doctors' conscience rights were protected in the bill.
Yet in an interview with The Canadian Press, Lametti said that ensuring physicians did not have to participate in a medical procedure against their conscience was "way different" than supporting a right for them to refuse to provide referrals.
According to him, conscientiously objecting doctors have a "moral obligation" to refer their patients to someone else.
The majority of provincial physicians' colleges — the governing bodies that set in place policies and guidelines for doctors to follow — for the most part allow their health-care professionals to object to a medical procedure.
Where they differ often comes down to the question of how each college views the ethical obligation for members to refer patients to other doctors who can provide the care.
Read more: Fewer Canadian women appear to be travelling to U.S. for abortions during COVID-19
The College of Physicians and Surgeons of Ontario requires doctors to provide an "effective referral" within a "timely manner" to another professional or agency, should they consciously object.
"Physicians must not impede access to care for existing patients, or those seeking to become patients," reads the college's policy.
That position was challenged in court but upheld as a reasonable measure aimed at ensuring access to healthcare for patients by Ontario's Court of Appeal in 2018. The court also sided with the lower divisional court which ruled allowing doctors to refuse referrals would further stigmatize already vulnerable patients.
The appeal court agreed with the determination that objections by practitioners to providing referrals "were designed to preserve their rights, and were not directed — as they should have been — to promoting the objective of equitable access to health care."
Read more: Canada election: Complete list of promises made during the 2021 campaign
Data gathered about the policies of colleges in other provinces by the Abortion Rights Coalition of Canada found the policies in provinces like Saskatchewan, New Brunswick, Prince Edward Island, Alberta and B.C., were more ambiguous.
Those policies describe processes for the patient to obtain more information or to see another doctor who can provide the service, but do not clearly direct doctors to make an "effective referral."
On Friday morning, Quebec's Collège des médecins du Québec clarified its position on the matter in a tweet which, translated, says that: "In Quebec, doctors cannot abandon patients or even ignore their request by invoking conscientious objections, particularly in matters of abortion or medical assistance in dying, without referring them to another colleague," the college said.
"It is an ethical obligation."
Colleges in Newfoundland and Labrador, Nova Scotia and Manitoba all explicitly say that professionals who refuse to provide service are not required to make a referral, citing the Canadian Medical Association's Code of Ethics and Professionalism.
— with files from The Canadian Press and Amanda Connolly
Class, Gender, and the Conscientious Objector to Vaccination, 1898–1907
Published online by Cambridge University Press: 10 May 2013
Nadja Durbach
Article
Extract
In 1898, after forty-five years of enforcing mandatory infant smallpox vaccination, the British parliament passed an act to allow parents to “opt out” of the compulsory system. The 1898 Vaccination Act introduced a conscience clause that entitled parents who objected to the practice of vaccination to claim certificates of conscientious objection by applying to a magistrate for an exemption. This provided working- and lower-middle-class anti-vaccinationists a measure of relief from the repeated fines they had suffered for noncompliance with the law, and from the threat of imprisonment. By the end of 1898, over 200,000 certificates of conscientious objection had been issued. Many of these were granted in anti-vaccination strongholds where exemptions outnumbered vaccinations, but conscientious objection to vaccination was by no means limited to these regions. Once an amended conscience clause was passed in 1907, which made conscientious objector status much easier to attain, the national exemption rate grew to 25 percent of all births.
The vaccination conscience clauses were controversial. As most of the applicants who applied for these exemption certificates came from the working classes, and many were women, these acts generated a national debate over the classed and gendered nature of the conscience and the meanings of conscientious objection. The years between 1898 and 1907 thus mark a significant moment in the making of the modern subject and citizen. For, as the debate over conscientious objection to vaccination reveals, who exactly was entitled to make a claim to possess a conscience, with its concomitant rights, was itself a contested issue.
Vaccination Exemptions | History of Vaccines
The British Vaccination Act of 1898 provided a conscience clause to allow exemptions to mandatory smallpox vaccination. This clause gave rise to the term “conscientious objector,” which later came to refer to those opposed to military service. By the end of 1898, magistrates had issued more than 200,000 vaccination exemptions.
Conscientious objector - Wikipedia
Conscientious objectors who were deemed not to have made any useful contribution to the state were formally disfranchised (through a clause inserted in the Representation of the People Act 1918 at the insistence of back-bench MPs) for the five years 1 September 1921 - 31 August 1926, but as it was a last-minute amendment there was no administrative machinery to enforce such disfranchisement, which …
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