For millenia the vocation of medicine has attracted men and women of compassion and selfless devotion to healing the sick. The work of physicians is a service to life and health of patients we encounter. This service requires expertise, competence, commitment, and professional ethics. It is not merely a technical service, but an act of dedication and love of neighbour. Sadly, there has been an erosion of these virtues in our time, all in the name of patient autonomy.
Autonomy is not all bad: medical decisions should be based on the informed consent of autonomous patients. Autonomy is a generic good proper to all humans as humans, as beings worthy of respect and capable of reason, choice, and judgment.
However, these days it seems that autonomy trumps all other considerations, such as beneficence and justice.
When autonomy becomes unbridled, the doctor-patient relationship is damaged. The doctor’s expertise is ignored. The doctor’s conscience is also ignored. There is a loss of trust between patient and physician. This trust is a precious quality unique in our society, a shared intention to seek healing for the patient. The doctor is a moral agent as well as the patient, and cannot be expected to cooperate in what the physician regards as wrong. Yet whenever the doctor’s autonomy is challenged—whether this be in law courts or dictates of the College of Physicians—the patient’s autonomy wins.
A good example is euthanasia. Many doctors abhor this practice, but when they express their views, they risk law suits or license challenges. Patients may be euthanized even in hospices, which is a contradiction in terms, because hospice care is not euthanasia.
There are other threats to the integrity of the doctor-patient relationship. One of these threats is virtual medicine. There is economic coercion for doctors to examine patients by technology rather than in person. When clinical judgment—the formulation of a diagnosis and treatment plan—is done remotely, it is inevitably inferior to a real encounter between doctor and patient. Clinical judgment is the activity that best distinguishes the doctor’s vocation from any other enterprise. When this is diluted, all of medicine suffers.
Another contentious issue is abortion. Moral relativists expect doctors to refer for this procedure, even when the doctor is personally opposed to the practice. Referral makes doctors complicit, and thus as wrong as doing the procedure itself. Refusal to refer threatens their license to practice medicine. We are approaching a sinister time when there is no freedom of conscience.
Another threat to physician integrity is the loss of medical manpower. There are not enough doctors to meet the needs of patients. It is exceedingly difficult to find a family doctor, and specialist referrals are slow. The Catholic Physicians’ Guild has an aging executive with no one to take over the reins. Who will take up the fight for conscience protection? Who can we trust to provide medical care that is moral, fearlessly at the service of life?
Dr. Howard Bright is a retired physician and a past president of the Catholic Physicians’ Guild of Vancouver and the Canadian Federation of Catholic Physicians’ Societies. He is a clinical associate professor in UBC’s Department of Family practice.
The B.C. Catholic is publishing stories about local health care providers, organizations, and emerging issues in anticipation of National Catholic Health Care Week Oct. 3-9. In Archbishop J. Michael Miller’s words, many medical professionals are at a crossroads. Join us in appreciating the complex world they navigate today.