The global euthanasia agenda would be supported by the change proposed by WMA in the International Code of Medical Ethics. Is it a programed step to undermine the strong opposition of physicians to euthanasia? 

On February 21 this year, we published an article reporting a change in the German medical code, which involved removing the sentence “A doctor may not provide any assistance for suicide” from their charter (read the full article HERE). Based on an internet poll, the German Doctors’ Federation changed a key phrase of their ethical code that, in turn, modified its hard stance against euthanasia and assisted suicide in the country that has most suffered eugenic euthanasia. Now, our Observatory is concerned with a proposed change to the World Medical Association’s Ethical code, after it published a page entitled PUBLIC CONSULTATION ON A DRAFT REVISED VERSION OF THE INTERNATIONAL CODE OF MEDICAL ETHICS on its website inviting doctors and those concerned about ethical medicine to give views on a new draft of the Code.

The International Code of Medical Ethics is a list that outlines the duties of a physician, and is effectively a summary of the Declaration of Geneva made by the World Medical Association (WMA), restating the ancient doctor’s oath in 1948 as a reaction against the participation of doctors in crimes against humanity. The last revision was in 2017.

In this respect, we refer to a Briefing Paper published by The Anscombe Bioethics Centre, which presents conscientious objection as a key issue in medical ethics. The paper reports that:

“For the first time this draft Code introduces the idea of ‘conscientious objection’:

Paragraph 27 reads:

‘Physicians have an ethical obligation to minimize disruption to patient care. Conscientious objection must only be considered if the individual patient is not discriminated against or disadvantaged, the patient’s health is not endangered, and undelayed continuity of care is ensured through effective and timely referral to another qualified physician.*

* This paragraph will be debated in greater detail at the WMA’s dedicated conference on the subject of conscientious objection in 2021 or 2022. However, comments on this paragraph are also welcome at this time.’”

“Deeply problematic as a statement of the rights of conscience in medicine” says Anscombe Centre

The draft proposes a conscientious objection in medicine new concept

It continues, “Unfortunately, this is deeply problematic as a statement of the rights of conscience in medicine [our emphasis].

  • In the first place, it utterly fails to establish the duty of doctors to object to practices and procedures that are unconscionable because harmful, discriminatory, unjust or unethical. The right to conscientious objection is based on the duty to be conscientious which is fundamental to medical ethics.
  • In the second place, “conscientious objection” is presented as conflicting with “patient care”. This overlooks the fact that there can be no adequate patient care without conscientious healthcare professionals. To assume that disruption or inconvenience caused by conscientious objection undermines patient care begs the question. If the practice or procedure is ethically objectionable then hastening the delivery of the procedure does not enhance patient care; it harms it [our emphasis].

The paper develops these two statements with clear examples. “Even leaving aside whether the doctor is correct in thinking that the procedure is incompatible with good patient care, the fact that the doctor believes the procedure is unethical is a reason not to require the doctor to facilitate it.” It continues with examples to make it easier to understand the potential specific effects of this proposed statement in medical practice “[…] A doctor might, for example, conscientiously object to infant male circumcision, to conversion therapy (in jurisdictions where this is legal), to skin whitening or to disabling surgery such as elective amputation. It would be contrary to that individual doctor’s judgment of good patient care to arrange an “effective and timely referral” to a practitioner who would provide the service. Again, if a doctor objects in conscience to
participation in torture or capital punishment or to force-feeding of a prisoner who is on hunger strike, it would be unprincipled for them to find someone with fewer scruples to do the deed for them. To require a conscientious objector to facilitate delivery of the procedure to which they object is a direct attack on person’s conscience and moral integrity, and thus serious harm to them.”

Anscombe’s briefing paper ends its comment on this key issue with this strong affirmation: “It would be much better to say nothing about conscientious objection than to undermine it by imposing a requirement for “effective and timely referral” [our emphasis].

Our statement on the proposed change in the WMA Code of Medical Ethics

Our Observatory agrees with this clear statement in the defense of conscientious objection in medicine, which is more necessary than ever given the current ethical challenges that have arisen in several areas of this discipline. The briefing continues with another critical issue: the worldwide effects of this proposed change in the International Code of Medical Ethics in relation to end-of-life issues.

The proposed change would leave physicians, conscientious objectors of euthanasia, without support worldwide

The Anscombe briefing paper addresses assisted suicide and euthanasia in the possible new scenario proposed by the WMA draft.

The WMA’s “Declaration on euthanasia and physician-assisted suicide” currently published on its website contains a strong statement against these practices, and indeed it has supported the conscientious objection of physicians in countries where these laws have been approved:

“The WMA policy is directly relevant to the situation of physicians in jurisdictions where euthanasia or assisted suicide are legal. The policy provides a basis to challenge the legal and medical authorities in Canada in their efforts to impose on all physicians a requirement to refer for ‘medical assistance in dying’. It also provides an argument against those in California who are seeking to strip away the conscience protections at the End of Life Option Act.”

The draft revision of the Code contradicts the agreed WMA policy and exposes doctors in countries with euthanasia or assisted suicide to increased pressure to facilitate these practices.”

In Anscombe’s opinion, the draft revision discussed in this article is incompatible with the WMA’s aforementioned declaration. “The draft revision of the International Code of Medical Ethics not only fails to make explicit reference to the right to object in conscience to participate in euthanasia and assisted suicide. By imposing a requirement for “effective and timely referral” the draft revision is incompatible with WMA policy which states that there must be no obligation “to make referral decisions to this end” [our emphasis]. The draft revision of the Code contradicts the agreed WMA policy and exposes doctors in countries with euthanasia or assisted suicide to increased pressure to facilitate these practices.”

As a final reflection, the Anscombe paper says that “Those who have written the draft should be informed that it is incompatible with the current WMA policy on euthanasia and assisted suicide. The revision of the Code must not require physicians to refer patients for unconscionable procedures. The present draft revision would coerce physicians to act against their consciences or would drive conscientious professionals out of healthcare. This in turn would harm patients, who need to be cared for by those who take their ethical responsibilities seriously.

It is better not to include an item on conscientious objection than to impose a requirement that undermines the rights of conscience.”

Our Observatory agrees with the Anscombe Centre statement, which defends the right of doctors to conscientious objection as an inalienable principle of the medical profession in a scenario where medical authorities in countries where euthanasia and assisted suicide are approved can impose a requirement on all physicians to refer patients for so-called medical assistance in dying. We should also add other important topics in medical practice where ethical principles are seriously involved, such as abortion, criteria for death, etc.



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