Juno News - Why conscience rights in healthcare matter

00:00:00.000 You're tuned in to The Andrew Lawton Show.

00:00:07.580 In medicine, referral means something very specific.

00:00:11.440 And I saw this addressed by Dr. Sean Watley on Twitter.

00:00:15.680 And I wanted to bring him on the show because I want people to realize why this so-called duty to refer,

00:00:20.420 this requirement of providing a referral, is in fact a violation of the conscience rights that need to be upheld by doctors.

00:00:30.140 And for doctors and other health care practitioners.

00:00:33.000 Sean Watley is the health policy fellow at the MacDonald-Laurier Institute and the author of the fantastic book,

00:00:39.120 When Politics Comes Before Patients.

00:00:41.980 Sean, good to talk to you as always. Thanks for coming on today.

00:00:44.760 Thank you, Andrew.

00:00:45.840 So the last few days of the campaign, the conscience rights question has come up.

00:00:51.540 The conservative platform initially said it was going to protect conscience rights for health care practitioners,

00:00:57.600 Cue liberal backlash.

00:00:59.500 You fast forward a couple of days and Aaron O'Toole has walked it back slightly saying,

00:01:04.880 Yes, we won't make anyone do anything except for refer.

00:01:09.040 Now this would to a lot of people seem like a completely reasonable compromise.

00:01:13.700 But I saw some of your tweets on this and I've heard health care practitioners bring this up before.

00:01:18.740 And the idea of merely referring something like an abortion or an assisted death is not as benign as it's made out to be.

00:01:26.980 Explain this.

00:01:27.760 So I'm glad you brought this to the focus of referral.

00:01:31.700 I think a lot of patients assume that referral is just kind of like telling people information.

00:01:38.220 And actually when you look at what patients want, and I've seen polling data on this,

00:01:42.620 hopefully it'll come out over the next little while,

00:01:44.720 that patients are actually very supportive of their doctors talking to them about things.

00:01:49.420 And I think all doctors want to do this.

00:01:51.560 Let's talk about all the options.

00:01:53.160 Here's the pros and cons of this direction, that direction.

00:01:55.580 How does it fit with you?

00:01:56.660 But when you actually start talking about making a referral,

00:02:00.640 so a medical referral is when I refer you for a procedure that I think is going to be good or help you.

00:02:07.460 You need your gallbladder out.

00:02:08.760 Okay, so I think you need your gallbladder out.

00:02:11.140 That's my professional opinion.

00:02:12.260 I'm going to refer you to a specialist whom I trust to do a good job.

00:02:16.340 So someone that I respect.

00:02:17.960 An effective referral flips the whole concept on its head.

00:02:20.740 I am now referring you, sending you for something that I don't think is actually going to help you.

00:02:27.120 I actually think you need antidepressants for six months,

00:02:29.500 or I think you need better palliative care or pain relief or something else.

00:02:33.760 So I don't actually think ending your life is a good thing for you.

00:02:37.100 So now I'm sending you for something that I don't think is good to someone that I'm not sure I agree with their approach to medicine,

00:02:44.760 and nor do I hold them in high respect.

00:02:48.400 So now I'm in intimate connection with this therapeutic chain of events that leads towards something that I fundamentally don't agree with.

00:02:58.260 And to be clear, this isn't about freedom of religion.

00:03:02.280 It's about freedom of conscience.

00:03:04.120 And so the debate has been framed in such a way that it's very hard to win that debate, right?

00:03:09.740 A tiny group of people who want to practice their religion versus all these patients who just want medical care.

00:03:16.020 Well, everybody's going to say, well, yeah, I don't share your religious beliefs.

00:03:20.060 Why should you impose them on me?

00:03:21.940 That has framed the debate incorrectly.

00:03:25.340 And I can unpack that for you if you want, but I'm not sure if that's where you want to go in this interview.

00:03:29.880 Actually, I would like to, but just if I can interject for a moment here,

00:03:33.520 I know when my old family doctor retired, for example, it was his daughter that took over the practice.

00:03:39.180 So you have generation removed between the one doctor and the other.

00:03:42.880 And even in that, there were some slight changes.

00:03:45.060 Now, it's not like all of a sudden, you know, we fundamentally inverted, you know, what medicine looks like in this clinic.

00:03:51.060 But each of them has their own approach to certain things.

00:03:54.120 And I know that from doctor to doctor, that's probably pretty common.

00:03:58.680 So the idea of, in general, trying to take away a doctor's right to do what's best for their patient in their eyes,

00:04:05.420 which is why they got into medicine, seems like a very dangerous precedent.

00:04:09.680 Yeah.

00:04:09.940 So really, you're going where I wanted to go exactly.

00:04:12.440 So you're talking about what function does freedom of conscience?

00:04:16.720 We don't usually use those words, but that's what you're getting at.

00:04:19.760 So the basis of a profession, certainly in medicine, but also in education, in law enforcement, all over the place,

00:04:28.440 you need people to be able to make free and informed decisions on their own in a professional role

00:04:34.600 when they don't have solid evidence either way.

00:04:38.200 So many of the things that we suggest in medicine don't have evidence-based support for them yet.

00:04:44.840 So, for example, your child falls off a tricycle, hits her head on the ground, and I see you in the eMERGE.

00:04:51.020 And you say, you know, my wife sent me in.

00:04:53.400 That's what usually happens right when the dad's in the eMERGE.

00:04:55.520 My wife sent me in, and she said, get a CAT scan of my daughter's head or whatever. 1.00

00:04:59.200 And so we're there discussing, and I'm saying, you know what, there's no literature to support CAT scans

00:05:04.100 for every little child who bumps her head, and I think we should take a different approach.

00:05:09.200 Furthermore, these are the risks of having, you know, doses of radiation on your brain, et cetera.

00:05:13.500 And you say, no, no, no, I really want this.

00:05:15.440 And so it becomes a debate of, and you may even have evidence on your side.

00:05:19.080 You might say, well, actually, you know, modern CT scans are very low-dose radiation,

00:05:23.000 and you might compare them to flying in an airplane.

00:05:25.020 And so we have an actual data-based discussion.

00:05:29.760 But at the end of it, I need to be able to have the freedom to say, you know, based on

00:05:33.460 my experience and based on my concern for your health, not only today, but 60, 70, 80 years

00:05:39.640 from now, I don't think this is the best direction to go.

00:05:43.420 So that's sort of how freedom of conscience fits into the basis of professions.

00:05:49.320 And that's where the debate needs to happen, because we're talking about painkillers and

00:05:54.460 parking stickers and CT scans for kids' heads, and you just go all day long in the clinic.

00:06:00.720 I'm asked to make decisions.

00:06:03.260 So physicians, family docs in Canada are gatekeepers for the health care system.

00:06:08.320 So to be a gatekeeper, yes, you are informed by evidence, but often you're informed by experience.

00:06:14.100 And you say, you know what?

00:06:15.060 I think the likelihood of you needing another MRI for your anterior knee pain is zero.

00:06:21.420 It's not going to tell us anything.

00:06:23.160 And the patient will say, well, prove it.

00:06:24.940 Well, I can't prove it.

00:06:26.520 And so now I'm making a decision for you based on the absence of evidence, but I'm basing

00:06:31.180 it on professional experience.

00:06:32.760 And this is core to freedom of conscience.

00:06:34.820 So that's where the debate needs to happen, at least on the professional side.

00:06:39.960 And I think those are all completely valid examples.

00:06:42.780 But there are also moral aspects to this.

00:06:45.500 And there are also religious aspects to this.

00:06:47.520 You have some doctors that may have an aversion to birth control or abortion or in a more,

00:06:53.460 I think, modern example, we know that this liberal bill on assisted suicide could extend

00:06:58.960 to people with mental illnesses.

00:07:00.580 And I know there are going to be a lot of doctors that have issues with that.

00:07:04.020 How do you navigate that aspect of it?

00:07:06.200 Because, you know, this is, again, an example that may or may not have happened.

00:07:09.420 But if you were to have a Jehovah's Witness doctor who doesn't like blood transfusions, I

00:07:14.240 mean, where is that squaring with the professional side of things that you've just laid out?

00:07:20.120 Yeah.

00:07:20.340 So I'm glad you threw up at the opening in the introducing this segment.

00:07:24.000 You said, oh, here we go.

00:07:25.040 We already have abortion into the election campaign. 1.00

00:07:27.640 So I'll use that as an example first.

00:07:30.320 You know, we always hear this.

00:07:31.500 We say, oh, I know people are going to be blocked from getting abortion if we allow 1.00

00:07:34.700 docs to act based on their freedom of religion or freedom of conscience in this particular

00:07:39.660 case.

00:07:40.040 But that is a red herring.

00:07:43.780 That is just so wrong.

00:07:45.460 We have had decades of direct access to abortion in Ontario.

00:07:50.760 So when you describe the access, you know, the access is outstanding.

00:07:55.800 It is fantastic.

00:07:57.140 You can access abortion more easily than any, almost any other medical procedure in Ontario

00:08:03.020 right now because you don't have to go through any gatekeeping.

00:08:05.600 If you need one, you want one, you just go get one directly.

00:08:09.440 So to say that, oh, no, now, Andrew, your freedom of religion, conscience, thought,

00:08:15.160 whatever is going to prevent me from accessing abortion is simply not true in reality.

00:08:21.080 So now when we expand this to medical aid in dying, voluntary assisted suicide or any

00:08:26.360 other procedure that society has decided that we are going to provide within our medical

00:08:31.520 system to set this up as a straw man to say, oh, look, now you're going to block me from

00:08:36.000 it.

00:08:36.140 If the state has made a promise to provide a particular procedure, then the state needs

00:08:43.060 to make sure it has it can provide that access without forcing docs to be involved with it.

00:08:48.920 We have over 25,000 practicing physicians at well, 24 to 25,000 practicing physicians in

00:08:54.580 Ontario.

00:08:55.440 The Ministry of Health, I was just talking with a civil servant just recently.

00:08:58.800 They said they have less than 700 docs right now in Ontario who have been involved with

00:09:04.080 medical aid in dying.

00:09:05.420 And many of them, once they do it once, they say, you know what, this this is just this

00:09:09.300 is too heavy.

00:09:10.000 I can't the emotional burden of me doing this.

00:09:13.140 I don't want to make this part of my practice.

00:09:15.080 These are people who support it and are actually being involved with it.

00:09:18.300 So we're going to have a major problem of having even enough physicians available and

00:09:24.420 ready and willing to do the procedure.

00:09:26.640 And so to start talking about, you know, compromising freedom of conscience or a physician's

00:09:31.160 ability to say, no, I don't feel comfortable with this is a major issue.

00:09:35.800 And I think we need to have this baked into legislation.

00:09:39.360 We need to be able to protect docs.

00:09:41.400 And I would say the vast majority of physicians and voters would agree in that direction.

00:09:48.300 To go back to this idea of the referral, if someone were to go to their family doctor

00:09:53.240 who has a conscience-based objection to something and the patient says, I want this thing.

00:09:59.000 If the doctor were to say, I don't do that.

00:10:02.220 I have an objection to it, but call this person.

00:10:04.620 That's not a referral, correct?

00:10:06.520 That is not a referral.

00:10:08.260 You could also talk about a total transfers of care.

00:10:12.060 But actually, that concept of total transfers of care is used by the court to say,

00:10:18.300 oh, you just are trying to abandon your patients now.

00:10:20.960 So actually, the people who are against being forced to refer are very, very clear about

00:10:26.620 saying, we're not talking about transferring all care.

00:10:29.240 We don't want to abandon our patients.

00:10:30.700 We want to stay with our patients, you know, as long as they want to be with us.

00:10:34.980 But telling them, you know, there's a number to call or you can reach out.

00:10:39.040 And to be clear, these are healthy people.

00:10:40.980 When you're talking about euthanasia or medical aid in dying, these are healthy people who've

00:10:44.900 already called your clinic and made an appointment and walked into your clinic and will walk out

00:10:48.800 of your clinic.

00:10:49.360 So these are ambulatory healthy people.

00:10:51.100 We're not talking about the in-hospital situation.

00:10:53.860 We can unpack that if you want later.

00:10:55.600 But simply saying, yes, that's how you access.

00:10:59.460 There's a 1-800 number.

00:11:00.660 There's a website or the local urgent care staffed by public health nurses does it or

00:11:06.680 the community care health center, wherever it is, people are generally very OK with saying,

00:11:13.020 yeah, that's how you access it.

00:11:15.280 When the Liberals are coming out and making that comment that Justin Trudeau made last week,

00:11:19.640 you know, freedom of choice doesn't mean the freedom for a doctor to choose.

00:11:22.340 How do you respond to that as a physician?

00:11:25.660 Yeah.

00:11:25.920 So again, he's framing this, framing it as a debate about competing rights and specifically

00:11:32.160 a freedom of religion versus the access to care, which is a total straw man.

00:11:36.840 And so we have to understand what exactly is freedom of conscience and then how does it

00:11:41.400 apply to our system of government and to professions?

00:11:44.380 We've already unpacked how it applies to professions, but I'll read to you from a Supreme Court of Canada

00:11:48.940 case in 1993, right, Rodriguez case.

00:11:51.760 This is Antonio Lammer saying here, quote, an emphasis on individual conscience and individual

00:11:57.440 judgment also lies at the heart of our democratic political condition or tradition, rather.

00:12:04.220 The ability of each citizen to make free and informed decisions is the absolute prerequisite

00:12:11.240 for the legitimacy, acceptability and efficacy of our system of self-government.

00:12:16.140 And then more recently in 2009, Justice Abella, again, Supreme Court of Canada, quoting a European

00:12:21.820 case, said, quote, freedom of thought, conscience and religion.

00:12:26.460 So she clumps them all together this time is one of the foundations of a democratic society.

00:12:32.280 It is one of the most vital elements that go up to make the identity of believers and their

00:12:36.940 conception of life.

00:12:37.740 But it is also a precious asset for atheists, agnostics, skeptics and the unconcerned.

00:12:45.420 The pluralism indissociable from a democratic society, which depends upon it.

00:12:50.640 So this is the Supreme Court of Canada saying this is the prerequisite for democratic society.

00:12:55.840 And so for for Justin Trudeau to be throwing this out on a campaign and saying, oh, yeah,

00:13:00.940 it's his rights against her rights.

00:13:02.380 And that is just so wrong.

00:13:04.540 And he knows it or he should know it.

00:13:07.320 Dr. Sean Watley, author of the book, When Politics Comes Before Patients, also health policy

00:13:12.380 fellow over at the Macdonald-Laurier Institute.

00:13:15.480 Sean, always a pleasure.

00:13:16.400 Thanks for coming on today.

00:13:18.120 Thanks again, Andrew.

00:13:19.460 Dr. Sean Watley, always a pleasure.

00:13:21.780 We've got to end things here.

00:13:23.380 My thanks to you all for tuning into the program today.

00:13:25.980 Canada's most irreverent talk show.

00:13:28.120 You can keep up with all of our election coverage over at TNC.news.

00:13:32.360 We'll be back with another edition of the program in just a couple of days time.

00:13:36.100 Thank you.

00:13:36.540 God bless and good day to you all.

00:13:38.240 Thanks for listening to The Andrew Lawton Show.

00:13:40.340 Support the program by donating to True North at www.tnc.news.

Juno News - August 24, 2021

Why conscience rights in healthcare matter

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