Honesty in Medicine

-Jennifer Derwey

Would legislation that requires doctors to conceal information or conceal their professional and morally based opinions be in the best interest of the doctor patient relationship? Consider this from Dr. James F. Drane, Professor Emeritus, University of Edinboro Pennsylvania:

Not telling the truth in the doctor-patient relationship requires special attention because patients today, more than ever, experience serious harm if they are lied to. Not only is patient autonomy undermined but patients who are not told the truth about an intervention experience a loss of that all important trust which is required for healing. Honesty matters to patients. They need it because they are ill, vulnerable, and burdened with pressing questions which require truthful answers. 

Read the full paper here: http://www.uchile.cl/portal/investigacion/centro-interdisciplinario-de-estudios-en-bioetica/publicaciones/76983/honesty-in-medicine-should-doctors-tell-the-truth

An opportunity to be heard

-Lester Liao

The recent policy draft of the CPSO that obligates physicians to refer for procedures they disagree with has given us an opportunity to voice or concerns. We cannot live under the illusion anymore that we face no persecution in Canada as Christians. We have to be bold and stand for what we believe and articulate it well. I urge you to make even a small feedback comment on the CPSO site at http://policyconsult.cpso.on.ca/?page_id=5165. Urge others to do this as well. Get in touch with your churches and the elders and get the whole body involved in this issue. Ask them to pray, and ask them to provide feedback. Be earnest and persevere in this.

We cannot go at this alone and we cannot do nothing anymore.

Lord willing this draft will be revised. Below you will find my own letter that I plan to send. I have put it here for your reference in case you find it helpful in articulating your own thoughts or care to pass it on to others.

Dear College of Physicians and Surgeons of Ontario,

I am a third year medical student in Ontario. Thank you for the work that has gone into drafting the latest policy on Professional Obligations and Human Rights. I recognize that this is a difficult task to be able to protect the rights of all. That being said, I would like to raise a few of my concerns. 

Firstly, I think it is important to define what religious beliefs are. Are religious beliefs those that are related to beliefs in a supernatural power or something else? We must clarify this because every single one of us has moral and religious beliefs. We all believe things about the meaning of life, what makes life valuable, and so on. These are not based on science but are metaphysical questions based on a worldview. We all espouse a worldview, whether it is theistic, deistic, agnostic, or atheistic, and all of our answers to these questions are based on these worldviews or religions. To exclude "religious" views based on some sort of worldview tradition would mean we must exclude how every one of us understands these life questions unanswerable by empirical science. This would prevent us from being people with thoughts, hopes, and any beliefs. In this sense we are all religious people. 

Additionally, every physician has a moral code based on a worldview that he/she then practices with. The decision to help a patient's health is in itself morally charged.  Why should a physician help? No scientific experiment obligates you to help someone - it only tells you what will likely happen if you for example give a certain drug. The decision to help is based on a moral belief that it is good to help others. Every physician has moral beliefs that necessarily play a massive part in his/her clinical practice. The current policy draft to exclude certain moral beliefs is problematic for three reasons: it fragments the humanity of the practitioner, it is logically and practically impossible to exclude moral beliefs from practice, and it presupposes that these moral beliefs are wrong without actually demonstrating so. I will tackle these in turn. 

Firstly, when we decide as a profession that we will force physicians to act against their moral beliefs, we are throwing moral integrity to the wind. We ask our physicians not to have moral integrity but to do what they are told, and it is extremely dangerous to force physicians to do something they believe to be wrong. This fragments who we are fundamentally as people with consciences. This means in essence saying we want slaves to perform our will, not free people working. This is a form of coercion and disregards the rights of the physician as an autonomous person him/herself. For the policy must take into account the humanity of both patient and doctor.

Secondly, we cannot ask physicians to be amoral because the decision to help people is itself moral, and the decision to be amoral is also itself a moral choice. In other words, any decision to be moral or amoral is impossible to exclude from practice logically because the decision is itself a moral one. Moral beliefs are also not a category that we can separate because they are at the heart of why we practice medicine and so we cannot exclude them practically. Do we ask a physician to leave their morals out of medicine, including their moral code to help people, be just, respect patients, and do no harm? No. This would be an absurd thing to do. This notion of keeping moral beliefs outside of practice is not coherent and is actually undesirable. This policy is imposing its beliefs on physicians, which goes against its very own moral stance to not promote one’s own religious/moral beliefs.   

This leads to the third point. If we begin to choose what moral beliefs can or cannot be excluded, we are in fact making moral judgments on whether those moral beliefs are correct or incorrect. To say that they must be excluded presupposes that these beliefs are wrong. We do not tell physicians to leave out their beliefs of helping people because they are believed to be right. If we exclude other beliefs, we automatically presuppose they are wrong. This policy as it stands already assumes these physicians are wrong but does not justify this position with reasons, and ironically it makes a moral conclusion it prohibits practitioners from making. Hence we cannot say that a physician is obligated to refer for a procedure he/she is unwilling to perform based on the grounds that his/her beliefs are simply "moral" or "religious."  

In a similar vein, the distinction between personal and clinical beliefs is unclear. Everyone that answers ethical questions in medicine draws from his/her worldview, which means ultimately these answers are personal for everyone. For example, whether you desire or do not desire to perform abortions is based on your moral outlook that it is either good or bad to do them, which is a personal matter based on worldview. Any decision made clinically is a personal matter. 

Once again I must express sincerely that I appreciate the work that has gone into this draft. This is a laborious process and I am grateful for the feedback process. However, I am afraid of the implications of what this means for physicians in Ontario and the province I hope to practice in. Are we moving to a place where we impose our beliefs on physicians to do things? Can we see ourselves in the future as a province stripping physicians of licenses because despite competently caring for thousands of patients they refuse to refer one based on non-malicious intent? And can we even justify these claims when all parties involved have arguments that are morally and religiously driven from worldviews?

Thank you for taking the time to read this and for carefully considering this letter.

Sincerely, 

Lester

What's in FOCUS?

FOCUS is CMDS Canada's publication covering topics that are important to the Christian medical and dental community. It's a great way to connect with colleagues, get the latest views and news on faith and practice, as well as find interesting and thought provoking essays and articles.

If you're not already subscribed, you can find past subscriptions here on our website or email our office to start your new subscription by mail.

Finding Light

-by Lester Liao

What does it mean to be light (Mt 5:14-16)? Undoubtedly there are many facets to this question, but Jesus does make clear that light is something that is seen and noticeable. It illuminates a house as a lamp put on a stand. Naturally as I considered Jesus’ words, I asked myself – am I shining?

There are many ways to be light in the medical setting. We can work well and glorify God (Col 3:23). We can influence our workplace with godly conduct and care for those who are sick. The list continues. But there is one aspect of light that I had previously given little thought before I hit the hospitals. Jesus addresses his disciples in the Sermon on the Mount (Mt 5:1-2). He says that they are the light of the world. In thinking about how to be bright, I overlooked that somewhere in the workplace there could already be light! And certainly several lights together shine brighter than any light alone.

When I began clerkship, I had my radar on. After a brief comment from one of my preceptors about a mission trip, I was prompted to ask. Turns out he is a Christian, and we shared some wonderful conversation afterwards. I gave him a copy of FOCUS and a book on worldviews. Over our continued time together, we also had the chance to sit down with a patient’s Christian mother and discuss the importance of her daughter’s spiritual health in her physical health. This physician encouraged me.

Over the following month and a half I encountered two more Christian physicians, both of whom I learned of by inquiring. Helpful words were exchanged. I also asked one of my preceptors that I learned did not perform abortions if he was Christian. He is not, but that conversation has prompted a yet-to-be-scheduled dinner over which we can talk about religion.

These are simply to point out that paying attention to where light shines is helpful. Often with the busyness I get caught up in the medicine and lose perspective. But I was surprised to learn that there are more brothers and sisters out there than I suspected, and forming relationships with them has been instrumental in helping me remember what I am doing in Christ. Especially in a time when faith is being pushed out of the public square, it is important to encourage one another. We were never intended to walk our lives of faith alone but to stir one another up to love and good works (Hb 10:24-25). And not surprisingly, other Christian physicians are particularly aware of the challenges we face, and the value of generational wisdom transmission cannot be overstated (Ti 2:1-6). Furthermore, as we begin to identify with one another in a public way, we can show how our faith positively impacts our practices and we can stand together when adversity comes (Ecc 4:12).

My hope is that we can find one another so that we can do life well as family. We can encourage each other to live well for Christ. We need one another. May God help us to come together and so be a brighter light in the medical world.

Upcoming Event: Nov. 6, 2014

Dr. John Patrick lectures throughout the world working for the Christian Medical and Dental Society in Canada and the Christian Medical and Dental Association in the United States. He speaks frequently to Christian and secular groups and is able to communicate effectively on moral issues in medicine and culture and the integration of faith and science.

We're pleased to announce this free, online lecture with Dr. Patrick on the topic of Conscience Rights. 

Go to: https://www.anymeeting.com/532-168-512?rslt=6c3fed29-4e5d-440a-8061-eb8e03e842d7

We encourage all CMDS members, students and staff to attend. You can join by computer, wireless device, or phone.

CMDS Canada Presents: Dr. John Patrick on Conscience Rights
Thursday, November 06, 2014
12:00 PM - 1:00 PM Eastern Time

You can choose to hear the audio for this meeting either through your computer speakers or by dialing the following conference call information with your phone:

Dial-in Number: 213-416-1560 | Attendee PIN: 397 2989#

Copy the following URL into your browser to attend:
https://www.anymeeting.com/532-168-512?rslt=6c3fed29-4e5d-440a-8061-eb8e03e842d7

CMDS welcomes our new Associate Staff member in Ottawa!

CMDS Canada is pleased to announce that Ben Jolliffe has accepted the position of Associate staff for CMDS in Ottawa.

Ben is an ordained minister in the Presbyterian Church and is eager to get started in serving the CMDS group at University of Ottawa. He has a background in campus ministry and a distinct interest in helping people integrate their faith and vocation.

If you would like more information about CMDS at the University of Ottawa, please contact Ben Jolliffe at: ben@resurrectionchurch.ca

Welcome to our new Associate Staff!

CMDS Canada is pleased to announce that Jon Dykeman has accepted the position of Associate staff for CMDS at the University of Toronto.

Jon is currently a part-time youth pastor at Christ Church St. James in Etobicoke. This role has included ministering to youth and young adults in the parish aged 12 - 35. He leads weekly devotionals and bible studies, preaches, organizes special events and retreats and provides pastoral care to individuals. He recently completed his last course in his MDiv from Wycliffe College in "Pioneering Ministries" - which  provided an emphasis on mission and evangelization. Jon also holds a BA in religious studies from Memorial University in St. John's. He has had a lot of experience in youth work, dating back to his undergraduate years.

Jon has a great interest in supporting medical and dental students in the integration of their Christian faith and medical training and practice.

Jon will be available for the Sept 9th meeting with students and will be able to attend our three day conference for Associate Staff across the country on October 14-16th in Toronto.

CMDS would ask that student leaders to get in touch with Jon right away to get him involved with the exciting activities you have in mind. Email him here.