Thursday, January 21, 2010

A thought on the "Conscience Clause"

After reading this post by Alberta Altruist, I scrapped my work on "The Perils of Online Voting" (which was a whole mess of chaos, best saved for another time), and decided to tackle one of the subjects I am most passionate about: reproductive health. Only because I had no desire to clog up the comments section with my never-ending diatribe on the issue.

This need to discuss what is essentially a dead dog in Canada arises out of the New Wild Rose Alliance party's policy that, if elected, they would: “Implement legislation protecting the ‘conscience rights’ of health care professionals”

Basically, this means that if a doctor finds the procedure you are hoping to get (I'm assuming this only applies to elective procedures) to be irreconcilable with their personal morals, they are not obligated to provide the patient with that medical service. This is all a lot of flourish to essentially give doctors the out on providing abortions or prescriptions for birth control. I mean, what are the chances that my GP is going to find my tonsillectomy morally repugnant? Pr-e-tt-y slim. These clauses always clamp down on JUST reproductive health. 

I am going to step away from the issue of abortion that I brought up originally for 2 reasons:

1. Abortion provision is basically a specialized procedure anyway, and is only provided in hospitals (6 of 100) and reproductive health clinics. You don't go to your GP for a D&C.

2. Abortion can be a divisive issue, and other non policy-related arguments tend to derail the conversation.

So lets talk about contraception and sterilization. Conscience clauses would give my doctor the right to refuse me birth control if they believed that my pre-marital sexual activity was against their beliefs (slattern! It's for your own good!) Or, if they thought any form of birth control is contrary to God's plan for my body. These thoughts make me prickle on their very own (what's with your sense of entitlement? jeez), but even so, I live in Edmonton and I have a car. I can find another doctor who is not so insane antiquated and bigoted - no offense.

I don't make a whole tonne of money, but I do have a certain amount of privilege in that I live in a large urban center and have a personal mode of transportation. Switching doctors = not really a problem. However, I personally just spent nearly a year trying to find a GP who takes new patients, and is knowledgeable about my needs. A year. I live downtown, and this doctor's office is west of Collingwood (on the west side of the Anthony Henday, for those out-of-towners). Finding a physician in this city is not easy. Were I a working-poor, mother of 3 who takes the bus everywhere, finding another doctor would be approaching impossible. 

"But Chelsa!" you say, "There are walk-in clinics scattered all across this great land!" And to you I say, I know. I've sat in them. For 3-4 hours (I also say to you, don't start sentences with conjunctions). 3-4 hours for someone working minimum wage to support a family is a lifetime. And maybe a power bill or groceries.

Additionally, most physicians will NOT give out birth control to someone who has not had their annual fun time, known as the "Pap Smear". Getting a pap at the walk-in: not really ideal. 

So even in the city, conscience clauses would have ramifications. Rural areas? Multiply that. Like, a lot.

Add to that, that free markets do not always function as theory suggests, especially in rural/remote areas. While I think it's patently optimistic to hope that the doctor or pharmacist that refuses to write or fill contraception scripts would eventually be run out of business by another, more savvy opportunist, that's not the way it works in reality. In reality, a small town may have one clinic and one pharmacy that serves a fairly large municipal district. In this case, a clinic or pharmacy cannot realistically be "protested", because these services are all but mandatory and the closest alternative is an hour away. No matter how mad one is about lack of access to contraception, there's not really a way for them to be a good consumer and "vote with their dollar" elsewhere.

You can see the fallout in cases such as the tubal ligation ban in Humbodlt, Saskatchewan. In this case, getting to an urban center that would perform the procedure means a 230km round-trip plus accommodations. For some women, that's a mountain. Or perhaps the woman who was denied birth control in the US (let's not fool ourselves... the WRA is taking this policy straight from the pages of our conservative neighbours to the south), because her physician felt it would cause emotional trauma due to multiple partners. Which, will inevitably be the result of contraceptive use. Can you hear my eyes rolling from where you're sitting?

I don't need to mince words, here: These situations WILL happen, and lack of access to contraception leads to increases in abortion rates... which are publicly funded, fyi.

To sum it all up, conscience clauses undermine equitable access to healthcare in this province, and frankly, we're having enough trouble with that as it is. If people would stop thinking about reproductive health as just a "women's issue" and consider it a community issue (which it is. 'nother post, 'nother time), maybe we would be less likely to throw this aspect of healthcare under the bus for some empty accolades and the "moral high ground".

Do I think doctors should be obligated to provide services they are morally offended by? I refer you to the parable of the vegetarian server working at a steak house. Or more realistically, the story of the Justice of the Peace who was fired (only a few months ago!) after refusing to marry an interracial couple - you know, for the potential kids' sake.

Do your job and keep your morality away from my uterus.

*"insane" removed for its ableist connotations.


  1. Chels,
    Good post. Here is a comment from my blog that may also be used here.
    As far as "conscience rights" for health professionals goes, this actually carries both sides of the sword. Supposing that a government made a rule that said it was illegal to perform abortions at all. Consider a doctor facing one of the infamous "hard cases," perhaps one where both mother and child would die. Consider further, that in the doctor's judgement the child would not survive in any case. The ethical doctor will, of course, carry out the abortion -- and be charged by the government. While this measure does, indeed, protect doctors who do not want to be forced to perform abortions, it addresses a larger issue.

  2. Danielle Smith has stated that a WAP govt would delist abortion as an insured procedure. To me this is a bigger issue than the conscience clause, since it is effectively prohibition. Of course I'm totally oppossed to conscience clauses in the public sphere as wel.

  3. AA, the issue I take with that argument, is that it's a big giant hypothetical. Recent polls suggest that less than 15% of Canadians are actually opposed all forms of abortion. This being the case, I do not see that in the near future we would have to worry about a nation-wide ban on abortion and the ramifications that would follow. Canadians wouldn't be behind it.

    With that in mind, these conscience clause consequences are a matter of "when"... not "if". Especially since the WAP is gaining popularity in the polls.

    I can see the value in conscience clauses... like allowing ob/gyn's who are opposed to genital mutilation (or circumcision, depending on who you ask), could refuse the procedure. But they're hardly ever used like that. 99% of the time CCs are about controlling what women do with their reproductive systems. Sad, but true.

  4. Great post. Thanks for this thoughtful demonstration of why "conscience clauses" are nothing more than legislated morality. Unconscionable if you ask me. It's important that people take the time to understand the implications of far-right policy rather than just getting swept up in the fun of a new Party.

  5. Even IF there were a nation-wide ban on abortion... the "conscience clause" wouldn't allow doctors to break that ban because they felt it was the right thing to do under the circumstances...

    Put another way, this is framed as being about "giving doctors the same rights we all have" - which I don't follow. They have the right to refuse service at present - just like I have the right to tell my boss to go fly a kite. There will be repurcussions - but I have the right to do it. There's no law that says doctors HAVE to perform whatever procedure or perscribe whatever medication is requested by a patient - so why is it necessary to make it a law that they DON'T have to do it? It's already the reality of the situation...

    This reminds me of Bill 44. There was no law that said your children HAD to learn about "the gay", but someone found it necessary to write a law making sure that we all understood that your kids DIDN'T have to learn about "the gay", and you could pull your kids out of class when sexuality was being discussed.

    Which was already happening.

    And just made the politicians responsible look like goofs.

    Sigh... and THIS is the business I want to get into?

  6. More than the topic at hand... I like the way you write. Convention to the wind! Start sentences with numbers... conjunctions... put hyphens between letters.

    I like it... 'cause you made it work.

    Berry nice!

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  8. This "clause" doesn't give WRA a good first start. It's an unnecessary law that would in the end be more of a waste of money which WRA is against. (I wanted to write a few days ago but I was running out of time)