The Toronto intensive care physician and researcher has become one of the leading voices opposing efforts to force doctors to make an “effective referral” for assisted suicide.
Goligher maintains that for the sake of medicine and democratic society, doctors must have a right to conscientious objection — not just for abortion but also for assisted killing.
“Freedom of conscience in the practice of medicine has been seriously eroded in recent years,” Goligher warned at the second annual deVeber Institute lecture delivered at the University of Toronto’s Wycliffe College on Oct. 27.
Goligher rejects the argument that any exercise of conscience by Christian doctors is tantamount to imposing religious dogma on the practice of medicine. He also opposes suggestions that matters of conscience are trumped by the notion that medicine is a public good and must be delivered within the framework of a neutral, secular and non-judgmental public service.
“The secular position is most certainly not neutral,” warned Goligher.
Nor are doctors with religious convictions irrational people who bow to the dictates of their religion. Rather, he said, doctors who reject euthanasia are making rational decisions with a clear medical basis.
He begins the discussion with the four goals of medicine as defined by a leading American bioethics institute, the Hastings Centre: prevention of disease and injury and promotion and maintenance of health; relief of pain and suffering caused by maladies; care and cure of those with a malady and care of those who cannot be cured; and avoidance of premature death and the pursuit of a peaceful death.
To those basic goals Goligher adds the idea of a “covenant of care” between patient and doctor.
Goligher concludes that assisted suicide and euthanasia are inconsistent with medical practice and a violation of the bond of trust between doctor and patient.
The idea that patient autonomy should trump the conscientious, medical judgment of the doctor is a gross distortion of basic principles of medical ethics, Goligher said.
“Patient autonomy is becoming absolutized,” he said. “The patient is no more likely than the physician to be right.”
Any decision agreed to by physician and patient requires mutual consent and physician autonomy matters just as much as patient autonomy, he said.
An example is a healthy, bored, pain-free patient who would like the doctor to prescribe medical marijuana on the grounds that he prefers the euphoria experienced while smoking marijuana to a joyless, humdrum existence. The doctor who refuses this patient is making a conscientious decision that the patient is asking for something outside the bounds of medicine.
It’s not that marijuana won’t work, but that what it does isn’t medical treatment.