The World Medical Association (WMA) has voted to protect conscientious objection for medical personnel concerning assisted suicide and euthanasia by excluding a provision that would mandate “effective referral” in its International Code of Medical Ethics. The WMA’s policies currently state, “No physician should be forced to participate in euthanasia or assisted suicide, nor should any physician be obliged to make referral decisions to this end.”
Principled conscientious objection for healthcare workers has been facing threats around the world, as some bioethicists have come out against doctors’ ability to refuse to participate in euthanasia or abortion for ethical reasons. In medicine, an “effective referral” has been defined as “taking positive action to ensure the patient is connected to a non-objecting, available, and accessible physician, other health-care professional, or agency” — a controversial practice when combined with issues like abortion and euthanasia. It requires physicians to make a referral to another provider who will commit these acts and thus leads the original physician to feel complicit with assisted suicide or abortion. Doctors have a strong tradition of respecting each other’s “conscientious objections.”
The final unanimous vote of the revised code of ethics by physician leaders from almost 60 national medical associations came after a years-long process that involved several regional conferences and multiple public discussions. American doctor Daniel P. Sulmasy made a passionate and persuasive appeal to remove the introduced provision at a July 2022 WMA meeting in Jakarta, Indonesia. Dr. Sulmasy emphasized in a 2019 Journal of American Medical Association (JAMA) article that “safeguards” built into the laws are now considered “barriers” by some, that slippery slopes toward abuse exist, and that there are too many unknown factors with the risks being too high. He has also emphasized that “the medical literature is, in general, favorably disposed toward the empirical and the new” and therefore creates a bias in favor of assisted suicide and euthanasia.
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The penultimate debate was held in Washington, D.C. this past August, where even more physicians objected to forced complicity, and the provision was successfully removed. The final approval of the code was held at WMA’s annual General Assembly meeting in Berlin, Germany in October 2022.
In addition, an open letter from the UK’s Anscombe Bioethics Centre signed by over 100 doctors and medical ethicists stated, “We the undersigned hold that to fulfil their professional duties to patients, to uphold the integrity of the medical profession, and to avoid harm to society as a whole, physicians must commit themselves to acting ethically in the practice of medicine and must always refrain from actions that they judge to be unethical. The duty of a physician to practise with conscience includes the duty not to act contrary to conscience.”
The outcome of this ethics vote may be seen as a rebuke to Canada’s system of assisted suicide and euthanasia, known as Medical Aid in Dying (MAiD). Under most circumstances, doctors in Canada are required to make an “effective referral” for euthanasia and assisted suicide. It has been an extremely contentious policy.