When can a doctor conscientiously object?

America

Bernard G. Prusak

Over the last decade, the culture wars in the United States have broken new ground: They have become battles over the rights of conscience. For example, now that same-sex marriage is a right, the question before the U.S. Supreme Court in the case of Masterpiece Cakeshop is whether its sympathetic, telegenic owner, Jack Phillips, is within his rights to refuse to make a wedding cake for a gay couple. Similarly, under the Obama administration, the court heard arguments more than once over whether employers who object on religious grounds to contraceptives or abortion should be exempted from having to provide employees health insurance that includes such services.

By contrast, debates over conscientious objection in medicine have not had the same notoriety, though they have broken out repeatedly among health care professionals and medical ethicists since the turn of the century, when there was a flare-up over pharmacists’ refusing to fill prescriptions for emergency contraceptives. . . [Full text]

Hawaii legalizes assisted suicide: Refusing to refer for suicide may incur legal liability

Sean Murphy*

Assisted suicide will become legal in Hawaii on 1 January, 2019, as a result of the passage of the Our Care, Our Choice Act. Introduced in the state House of Representatives only in January, it passed both the House and Senate and was approved by Governor David Ige on 5 April. Beginning next year, physicians will be able to write prescriptions for lethal medications for Hawaiian residents who are capable of informed consent, who are at least 18 years old, and who have been diagnosed with a terminal, incurable disease expected to result in death within six months.1

And beginning next year, Hawaiian physicians who refuse to facilitate assisted suicide by referring patients to a willing colleague may face discipline — including expulsion from the medical profession — or other legal liabilities. Hawaii could become one of only two jurisdictions in the world where willingness to refer patients for suicide is a condition for practising medicine.2 . . . [Full text]

‘Medical Conscience’ Is Becoming a Partisan Controversy

National Review
Reproduced with permission

Wesley J. Smith

Should doctors and nurses be forced to participate in interventions they find morally abhorrent or unwarranted? As one example, should ethical rules require pediatricians to medically inhibit normal puberty as demanded by parents to “treat” their child’s gender dysphoria — even if they are morally opposed to the concept and/or the supposed treatment?

Some say yes. Thus, influential bioethicist Ezekiel Emanuel argues that medical professionals are obligated to accede to the patient’s right to receive legal interventions if they are generally accepted within the medical community — specifically including abortion. Emanuel stated doctors who are morally or religiously opposed, should do the procedure anyway or procure a doctor they know will accede to the patient’s demands. Either that, or get out of medicine.

Supporters of “medical conscience” argue that forcing doctors to participate in interventions they find morally abhorrent would be involuntary medical servitude. They want to strengthen existing laws that protect doctors, nurses, and pharmacists’ who refuse participation in legal interventions to which they are morally or religiously opposed.

Now, medical conscience looks to become another battlefront in our bitter partisan divide. After the Trump administration announced rules that will place greater emphasis on enforcing federal laws protecting medical conscience, Democratic state attorneys general promised to seek a court order invalidating the new rule. From the New York Law Journal story:

But 19 state attorneys general, led by New York’s Eric Schneiderman, argue that it is the patients who will be discriminated against under the proposed rule. This is particularly true, they argue, in the cases of marginalized patients who already face discrimination in trying to obtain health care, such as lesbian, gay, bisexual and transgender patients and male patients seeking HIV/AIDS preventative medications, according to the comments filed in opposition to the rule.

“If adopted, the proposed rule … will needlessly and carelessly upset the balance that has long been struck in federal and state law to protect the religious freedom of providers, the business needs of employers, and the health care needs of patients,” they state.

The stakes can only increase as moral controversies in health care intensify in coming years. As just two examples, some bioethicists are lobbying to enact laws that would give dementia patients the right to sign an advance directive requiring nursing homes to starve them to death once they reach a specified level of cognitive decline. There are also increasing calls to do away with the dead-donor rule in transplant medicine so that PVS patients can be organ-harvested while still alive

If these acts become legal, should doctor and nurses who practice in these fields be forced to participate? If Emanuel’s opinion prevails, the answer could be yes. If medical professionals are protected by medical conscience legal protections, the answer would be no.

Medical conscience is not just important to personally affected professionals. All of us have a stake. Think about the potential talent drain we could face if we force health-care professionals to violate their moral beliefs. Experienced doctors and nurses might well take Emanuel’s advice and get out of medicine — while talented young people who could add so much to the field may avoid entering health-care professions altogether.

Comity is essential to societal cohesion in our moral polyglot age. Medical conscience allows patients to obtain morally contentious procedures, while permitting dissenting medical professionals to stay true to their own moral and religious beliefs. I hope the Democrats’ lawsuits are thrown out of court.

Divisions, New and Old — Conscience and Religious Freedom at HHS

Lisa H. Harris

In January, the U.S. Department of Health and Human Services (HHS) announced the creation of its Conscience and Religious Freedom Division, explaining that it will allow HHS’s Office of Civil Rights to “more vigorously and effectively enforce existing laws protecting the rights of conscience and religious freedom” and will ensure that “no one is coerced into participating in activities that would violate their consciences, such as abortion, sterilization or assisted suicide.”1 Responses were as expected: religious conservatives hailed the new division as a needed intervention; public health and clinical leaders and advocates decried it, worrying about its impact on access to care and harm to patients. . .


Harris LH.  Divisions, New and Old — Conscience and Religious Freedom at HHS.  N Engl J Med 2018; 378:1369-1371. DOI: 10.1056/NEJMp1801154

Assisted-Suicide Pushers Want Forced MD Participation

National Review
Reproduced with permission

Wesley J. Smith*

Assisted-suicide advocates pretend they want assisted suicide limited to the terminally ill.

They pretend that they favor strict guidelines.

And they pretend they would never want doctors forced to participate in intentionally ending the life of a patient. Indeed, the laws they have passed all contain conscience protections.

Except, sometimes they show their true hands. For example, when the Canadian Supreme Court imposed a broad right to lethal-injection euthanasia — certainly not limited to the dying — Compassion and Choices (formerly the Hemlock Society) issued a laudatory press release — later scrubbed because it told the truth about the movement’s true goals.

And now, Compassion and Choices — again, which has included conscience protections in laws it sponsored as a necessary predicate to passage — has come out strongly against a proposed Trump-administration office in HHS to protect medical professionals from forced participation in procedures against their consciences and/or religious beliefs. From an email sent to its supporters (my emphasis):

The new division marks one of the greatest threats we’re facing to the future of the end-of-life choice movement and patient-centered care.

Under the HHS proposed rules, providers who object to various procedures could impose their own religious beliefs on their patients by withholding vital information about treatment options from them — including options such as voluntarily stopping eating and drinking, palliative sedation or medical aid in dying. And your federal tax dollars will be used to protect physicians who make the unconscionable decision to willfully hold back information from a patient and abandon them when they are at their most vulnerable.

This is unacceptable and needs to be stopped.

Note the warning that conscience protections threaten “the future” of the assisted-suicide movement. It is abundantly clear that these suicide advocates believe forcing doctors to participate in suicide is essential to implementing their lethal agenda.

C & C already tried to impose such a duty on doctors in Vermont in support of a regulation that sought to force doctors to share information on assisted suicide with patients. That violated the assisted-suicide law’s conscience protections. Dissenting doctors sued and forced the bureaucrats to retreat. C & C tried to intervene legally to (unsuccessfully) thwart that settlement.

So, this is the truth: If C & C prevails in legalizing assisted suicide (and eventually, euthanasia) across the country, pressure will soon begin to force dissenting MDs, nurses, and pharmacists to either get on the death train or get out of medicine.

For those with eyes to see, let them see.

 

Accessed 2018-03-28

 

Catholic Medical Association Joins with 25,000 Physicians Fighting Proposed Global Abortion Policy to Strip Conscience Rights Protections

News Release

Catholic Medical Association

PHILADELPHIA, PA – FEBRUARY 12, 2018 – Conscience rights protections for health care providers in the U.S. and abroad are once again under attack. The World Medical Association (WMA) representing 10 million physicians worldwide is poised to approve a policy that would demand doctors refer for abortion, even against their conscience.

Although current federal statutes in the U.S. protect health care provider’s conscience rights and prohibit recipients of certain federal funds from discriminating against health care providers, WMA ethics policies greatly impact future regulations of the medical profession globally.

The WMA was founded in 1947 in response to Nazi atrocities during WW II. The organization promotes itself as “evaluating and codifying ethics in healthcare.” Currently the WMA policy requires doctors ensure continuity of care for patients who choose abortion, but not force doctors refer for the procedure. However, the WMA’s proposed revision threatens the conscience rights of all physicians and health care professionals by proposing the following amendment:

“Individual doctors have a right to conscientious objection to providing abortion, but that right does not entitle them to impede or deny access to lawful abortion services because it delays care for women, putting their health and life at risk. In such cases, the physician must refer the woman to a willing and trained health professional in the same, or another easily accessible health-care facility, in accordance with national law. Where referral is not possible, the physician who objects, must provide safe abortion or perform whatever procedure is necessary to save the woman’s life and to prevent serious injury to her health.”

The proposed changes in policy would also eliminate the provision that “requires the physician to maintain respect for human life.”

“We do not believe abortion is healthcare. The international impact on this global abortion policy is incalculable,” said CMA President Dr. Peter T. Morrow. “We join with the representatives of over 25,000 physicians, nurses, health care providers and patient advocates who provide excellent, scientific, ethical and moral healthcare in accordance with the principles of the Oath of Hippocrates. Collectively we request that the WMA’s revision be rejected, it is subversive of physician freedom of conscience concerning abortion in the short term, and euthanasia and assisted suicide in the long term.”

The American Medical Association (AMA) is an associate member of the WMA and can recommend rejections and or revisions.  The CMA supports conscience rights of all healthcare professionals with regards to abortion as well as physician assisted suicide, and is jointly sending a letter co-written by: American Association of Pro-Life Obstetricians and Gynecologists, American College of Pediatricians, Christian Medical & Dental Associations, National Association of Catholic Nurses-U.S.A. and The National Catholic Bioethics Center to the AMA strongly denouncing the WMA’s proposed change forcing physicians to violate their conscience rights.

The WMA’s proposed changes could become a global policy. The general assembly is scheduled to vote in October.

Contact:

Susanne LaFrankie, MA
Diector of Communications
email: lafrankie@cathmed.org


The Catholic Medical Association is a national, physician-led community of over 2,400 health care professionals. CMA’s mission is to inform, organize, and inspire its members, to uphold the principles of the Catholic faith in the science and practice of medicine.

Court Holds Health Care Conscience Act Trumps County’s Immunity Claim

News Release

For immediate release

Mauck & Baker LLC

ROCKFORD, Ill.—On Monday, Chief Judge Eugene Doherty rejected Winnebago County’s primary defense that the Tort Immunity Act shielded it from liability for claims that Rockford nurse Sandra (Mendoza) Rojas brought against it after she was forced out of her job for refusing to participate in abortion-related services. Rojas’ right to refuse to participate in such services is protected under the Illinois Health Care Right of Conscience Act and Illinois Religious Freedom Restoration Act. A devout Catholic, Rojas worked for the Health Department for 18 years providing pediatric care, immunizations, and screenings.

In 2015, the county’s new Public Health Administrator, Dr. Sandra Martell, merged the pediatric clinic with women’s health services and mandated that all nurses be trained to provide abortion referrals and participate in the provision of abortifacients like Plan B. When Rojas, who Dr. Martell considered to be a “good nurse,” informed the administration of her conscientious objections to participating in any way in the provision of abortions, Dr. Martell gave Rojas two weeks to either quit or accept a demotion to a temporary job as a food inspector. Rojas refused the demotion and lost her job at the clinic.

The suit seeks damages under the Illinois Health Care Right of Conscience Act which prohibits public officials from discriminating against a person in any manner because of their conscientious refusal to participate in any way in the provision of abortions. The Act provides for treble damages and the recovery of attorneys’ fees and costs. “Nursing is more than just a job, it is a noble calling to protect life and do no harm. There is something terribly wrong when you are forced out of your job on account of your commitment to protect life,” said nurse Rojas.

Rojas’ attorney, Noel Sterett, from the law firm Mauck & Baker in Chicago, said, “The Conscience Act was written to ensure that both public and private health care professionals would be protected from government efforts to force them out on account of their conscientious objections.” Denise Harle, Alliance Defending Freedom legal counsel said, “Pro-life nurses shouldn’t be forced to perform or assist in abortion procedures. An individual’s conscience and commitment to the Hippocratic Oath to ‘do no harm’ is often what draws health care workers into the medical field.”

View Complaint

View Order

Contact:
Mauck & Baker Attorney
Noel W. Sterett, Esq.
312-726-6454

The War on the Hippocratic Oath

First Things

Wesley J. Smith

The screaming was so loud, you would have thought that the Trump administration had overturned Roe v. Wade. It hadn’t, of course. But it had directed needed attention at the existing legal protection that allows doctors and nurses to refuse to participate in abortions without fear of firing or other job sanctions. This protection is sometimes called “medical conscience rights.”

The occasion for the uproar? The Department of Health and Human Services announced its intention to create a new office of Conscience and Religious Freedom Division in the HHS Office for Civil Rights (OCR) to enforce medical conscience. It is worth noting that this proposed action will not change the law. . . [Full text]

 

Doctors Condemn Massachusetts Suicide Bill

Bill would force every doctor to participate in prescribing lethal medication

The Washington Free Beacon

Bill McMorris

Doctors in Massachusetts are speaking out against a proposal to approve physician-assisted suicide, arguing that its End of Life Options Act could force all doctors to participate in doling out lethal medication and pressure patients into suicide.

On Tuesday, Dr. Tom Sullivan, former president of the Massachusetts Medical Society, led more than 20 physicians into the statehouse to urge lawmakers to oppose a bill that would grant immunity to doctors who help terminal patients kill themselves. . .  the Massachusetts Medical Society (MMS) overturned its long-standing condemnation of the practice and voted to remain neutral on the legislation.  Sullivan and several other former MMS presidents spoke out against the neutral stance during debate. While they were unsuccessful in swaying the vote, they were able to insert language into the society’s stance, including conscience protections for any doctor who objected to the practice. The current bill includes no such protections . . . [Full text]

HHS Announces New Conscience and Religious Freedom Division

News Release

For immediate release

U.S. Department of Health and Human Services

Today, the U.S. Department of Health and Human Services (HHS) is pleased to announce the formation of a new Conscience and Religious Freedom Division in the HHS Office for Civil Rights (OCR).  The announcement will take place at an event at HHS headquarters from 10:30 a.m. to noon.  It will be livestreamed here. Speakers will include Acting Secretary Eric D. Hargan, House Majority Leader Kevin McCarthy, Representative Vicky Hartzler, Senator James Lankford, OCR Director Roger Severino, and special guests.

The Conscience and Religious Freedom Division has been established to restore federal enforcement of our nation’s laws that protect the fundamental and unalienable rights of conscience and religious freedom.  OCR is the law enforcement agency within HHS that enforces federal laws protecting civil rights and conscience in health and human services, and the security and privacy of people’s health information.  The creation of the new division will provide HHS with the focus it needs to more vigorously and effectively enforce existing laws protecting the rights of conscience and religious freedom, the first freedom protected in the Bill of Rights.

OCR already has enforcement authority over federal conscience protection statutes, such as the Church, Coats-Snowe, and Weldon Amendments; Section 1553 of the Affordable Care Act (on assisted suicide); and certain federal nondiscrimination laws that prohibit discrimination on the basis of religion in a variety of HHS programs.

OCR Director Severino said, “Laws protecting religious freedom and conscience rights are just empty words on paper if they aren’t enforced. No one should be forced to choose between helping sick people and living by one’s deepest moral or religious convictions, and the new division will help guarantee that victims of unlawful discrimination find justice. For too long, governments big and small have treated conscience claims with hostility instead of protection, but change is coming and it begins here and now.”

Acting HHS Secretary Hargan said, “President Trump promised the American people that his administration would vigorously uphold the rights of conscience and religious freedom.  That promise is being kept today. The Founding Fathers knew that a nation that respects conscience rights is more diverse and more free, and OCR’s new division will help make that vision a reality.”

Contact: Office for Civil Rights
202-774-3009

arina.grossu@hhs.gov

To learn more about the new Conscience and Religious Freedom Division, visit us at www.hhs.gov/conscience.

To file a complaint with OCR based on a violation of civil rights, conscience or religious freedom, or health information privacy, visit us at https://www.hhs.gov/ocr/complaints.