3 Décembre 2023

Lesbian case refusal risks diagnosis of prejudice


About 30 years ago, gay men who contracted a mysterious disease called AIDS sometimes faced particularly cruel discrimination.

"In those days, you would have found people dying of AIDS in hospital, and you would find nurses effectively telling them this is what you deserve for your lifestyle," says Udo Schuklenk, Ontario research chairman in bioethics at Queen’s University. "Similar prejudices were displayed by doctors."

Only a few nurses and physicians acted this way, he stresses. But the attitude often went hand-in-hand with the health worker’s religious views. Today, most Canadians would find such behaviour unacceptable.

Later, there was the abortion debate. Some doctors, for religious reasons, refused to end a pregnancy even though abortion had been decriminalized. In contrast to the AIDS example, however, society was and is more tolerant of this ethical stance.

But what to make of the case last week of an Egyptian-born Winnipeg doctor who, for religious reasons, told a lesbian couple she was uncomfortable treating them? The couple says she refused to accept them as patients; her lawyer disputes this.

Medical ethics codes and human rights codes are clear: A doctor can’t refuse treatment on the grounds of sexual orientation. So, must doctors ignore their personal beliefs?


On the job, yes, argues Schuklenk. But Dr. Jeff Blackmer, executive director for ethics at the Canadian Medical Association, says it’s not always so easy.

"Society doesn’t ask most other professions to check their morals at the door," he says.

"It’s a difficult balancing act between protecting your right of conscientious objection and your right to moral and religious freedom, versus ensuring the patient has access to proper medical services."

From time to time, doctors have refused treatment based on their ethics. For instance, a Winnipeg doctor said he wouldn’t treat smokers. A Timmins chest surgeon declined to operate on them. A Toronto orthopedic surgeon won’t do a particular type of bone surgery on them.

These cases are different in principle from what the Manitoba couple alleges, say some experts. In the smoking cases, doctors might have felt physician-patient trust no longer existed because the patient wasn’t, for instance, even trying to kick the habit.

Not much further along the continuum are doctors who "screen" first-time patients. Under this practice, those with complicated health issues risk finding themselves without a physician.

In the Winnipeg lesbian example, still another factor is at play: Culture. Doctors trained abroad don’t always learn Canadian values of equality — with patients or colleagues.

As Canada replenishes its diminished doctor supply more and more with international medical graduates, the problems of conflicting cultures might grow, says Blackmer.

The bottom line, says Dr. Bill Pope, registrar and CEO of the College of Physicians and Surgeons of Manitoba, is "We can’t argue with the law.

"For better or worse, society has decreed in legislation … that there are certain areas that are unacceptable discrimination." Sexual orientation is one.

In Schuklenk’s opinion, "There’s no religion stipulating you must not treat lesbians. This really is on the level of primitive, personal prejudice."