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March 21, 2016

Physicians have a right to refuse to participate in assisted suicide, but they should have no right to refuse to refer a patient who wants assistance in dying to another physician who will help that patient. That was one central conclusion in the report of the parliamentary committee on physician-assisted dying issued last month.

In short, a physician should have a right to be true to his or her conscience on matters of life and death, but has a responsibility to help every patient who wants to exercise his or her supposed right to receive help in dying.

From the committee's point of view, this is reasonable. The physician exercising their right of conscience does not intend to cause the patient's death nor does he or she cause that death, even indirectly. Insisting that the physician refer the patient does not make the doctor an agent of death and even allows them to keep their intentions pure. Who could object to such a fine compromise?

The dissenting physician foresees that another doctor will assist the patient's death, but does not share in the intention to bring about that death. Indeed, he or she would rather that the death not be hastened. Their desire is quite the opposite of that of the patient and the assisting physician.

Still, the physician of conscience should not make the referral and is morally culpable if he or she does. Thus, they should have the right to refrain from making a referral or being in any way complicit in the process that leads to the patient's assisted suicide.

Moral responsibility involves more than the intended consequences of one's actions. We can also be morally responsible for the effects of our actions and omissions, even if we do not intend those consequences.

  • First, the referral does involve a direct complicity in a morally wrong act; the assisted suicide may not take place if one counsels the patient against it and refuses to make the referral.
  • As well, the referral will have secondary consequences that go beyond the death of this one patient. First, it will contribute to a social climate of acceptance of assisted suicide. People will be more likely to see assisted suicide as morally permissible if people whom they respect cooperate with it.
  • Second, making one referral will make it more likely that the referring physician will make other referrals and will thus become an ongoing participant in the evil of assisted suicide.
  • Third, making referrals will be seen by one's family, co-workers, the family of the patient and others as an example for their own choices.
  • Fourth, one's complicity in such acts and contribution to the social climate of acceptance will make a further contribution to decisions for assisted suicide by people with whom one has not even had any personal contact.
  • Fifth, one's complicity will push society further along the slippery slope that leads to involuntary euthanasia where the health-care system deliberately kills patients without their informed consent. (See story on Page 6.)
  • Sixth, performing referrals will have bad effects on oneself. Injustice - not only assisted suicide, but other forms of exploitation - will seem less repugnant because of one's own cooperation in it. One will be less inclined to form bonds of solidarity with the afflicted, but will, however, establish deeper bonds and interdependence with those who do perform assisted suicides.
  • Seventh, one's complicity through doing referrals will undermine one's credibility if one does decide to speak against assisted suicide.

Evil is not only found in specific actions, but is a web in which one becomes entangled through complicity with others who do wrong. When a physician makes their first referral for an assisted suicide, they likely will not foresee that they are becoming entangled in a web of evil. Yet, they have already set foot in the web, and it will only be a matter of time before their whole being becomes thoroughly enmeshed.

Preserving the physician's right to refuse to make referrals for assisted suicide is a matter of utmost importance, not only for the physicians themselves, but for the future of a society which is increasingly becoming what St. John Paul II called a culture of death.