World Medical Association to consider policy changes on abortion, euthanasia, assisted suicide

Debate planned for ethics conference in October in Iceland

Sean Murphy*

Following a meeting of the WMA Council in Riga, Latvia, the WMA issued a statement noting that a revised version of the WMA abortion policy would be presented for approval at the WMA annual General Assembly in Reykjavik, Iceland.

In addition, the WMA has announced that there will be a further “open debate” on changing the Association’s policy against physician participation in euthasnasia and assisted suicide.  The debate will occur during a WMA conference on medical ethics taking place at the same time and place.  Formal presentations on euthanasia and assisted suicide will be given on 4 October, 2018, but informal discussions among delegates are likely to be important.  The debate appears to be a consequence of lobbying by the Canadian and Royal Dutch Medical Associations to convince the WMA to drop its condemnation of the practices

It is not clear whether or not WMA members appreciate the relationship between abortion policy and euthanasia policy.  Compulsory referral for abortion is essentially a dress rehearsal for compulsory referral for euthanasia and assisted suicide, something clearly demonstrated in Canada.  Accusations of “patient abandonment” formerly aimed at those refusing to refer for abortion1 are now, in addition, being levelled at those who refuse to refer patients to someone willing to kill them or help them commit suicide.2

In 2011, a Royal Society of Canada panel of experts chaired by Udo Schuklenk  recommended legalization of assisted suicide and euthanasia.3  The experts insisted that health care professionals unwilling to provide euthanasia help patients commit suicide must refer them to someone willing to do so.4 This was justified, they said, because it was agreed that objectors are obliged to refer for “reproductive health services.”5  It really was not agreed: the Canadian Medical Association had, in fact, rejected this claim five years earlier6 after it was made by Jocelyn Downie,7 one of Schuklenk’s colleagues on the Royal Society Panel.

By 2015 Schuklenk was arguing that objecting physicians should not be accommodated at all. Among his arguments was that referring for abortion or euthanasia is not a compromise because it involves moral complicity in the act, “barely reduced” by the act of referral.8  This implied that physicians should be forced to provide abortion and euthanasia, notwithstanding religious or conscientious convictions to the contrary, a position Schuklenk explicitly adopted over the next two years.9, 10

At the same time, Ottawa law professor Amir Attaran was insisting that physicians should be forced to kill eligible patients themselves.11 He claimed that this was required by human rights law,12 describing effective referral as an unacceptable form of illicit discrimination.13

In considering changes to euthanasia, assisted suicide and abortion policies in October, WMA delegates will have to take great care to consider not only the most obvious ethical issues of life and death, but less obvious yet important issues like the distinction between acceptable cooperation and unacceptable collaboration, which play out in disputes about mandatory referral for abortion and euthanasia.


Notes
1.  “According to the prevailing norm of beneficence therefore, as well as those of trust, patient autonomy, and not abandoning patients, physicians should refer patients for abortions.”  McLeod C. Referral in the Wake of Conscientious Objection to Abortion. Hypatia, Vol. 23, No. 4 (October-December, 2008) at p. 36 (Accessed 2018-08-022).

2.  Cook M. Canadian court tells doctors they must refer for euthanasia. Mercatornet, 2 February, 2018

3. Schuklenk U, van Delden JJM, Downie J, McLean S, Upshur R, Weinstock D. Report of the Royal Society of Canada Expert Panel on End-of-Life Decision Making (November, 2011)[“Royal Society“] p. 96 (Accessed 2014-02-23).

4.  Royal Society, p. 69, 101.

5.  Royal Society, p. 62.

6.  Blackmer J. Clarification of the CMA’s position on induced abortion. CMAJ April 24, 2007 vol. 176 no. 9 doi: 10.1503/cmaj.1070035 (Accessed 2017-12-12).

7.  Rodgers S. Downie J. Abortion: Ensuring Access. CMAJ July 4, 2006 vol. 175 no. 1 doi: 10.1503/cmaj.060548 (Accessed 2017-12-12).

8.  Schuklenk, U. Conscientious objection in medicine: private ideological convictions must not supercede public service obligations (2015) 29:5 Bioethics ii, DOI: 10.1111/bioe.12167

9.  Schuklenk U, Smalling R. Why medical professionals have no claim to conscientious objection accommodation in liberal democracies (2016) 43:4 J Med Ethics 234, DOI: http://dx.doi.org/10.1136/medethics-2016-103560.

10. Savulescu J, Schuklenk U. Doctors have no right to refuse medical assistance in dying, abortion or contraception (2017) 31:3 Bioethics 162, DOI: 10.1111/bioe.12288

11.  Though conceding that a lethal drug might be administered in the physician’s presence by a delegate, and that referral might be necessitated by technical incompetence. Attaran A. The Limits of Conscientious and Religious Objection to Physician-Assisted Dying after the Supreme Court’s Decision in Carter v Canada (2016 ) 36:3 Health L Can 86 [“Attaran“], p. 87-88, 96.

12.  “[W]hen a doctor refuses to assist a patient who is disabled by a ‘grievous and irremediable medical condition’, just because the patient wants death rather than something else, that arguably discriminates against the disabled patient.” Attaran, p. 89.

13.  Attaran, p. 91–93.

UN agencies denounce Mexico for proposed law allowing doctors to opt out of abortion, euthanasia

LifeSite News

Matthew Cullinan Hoffman

April 24, 2018 (LifeSiteNews.com) – Three United Nations agencies are denouncing Mexico’s Senate for passing legislation that will protect the right of medical professionals to abstain from practices for which they have a conscientious objection.

Although the legislation covers any case of conscientious objection by a doctor or nurse, it is regarded as most applicable to medical professionals who do not wish to cooperate with anti-life procedures such as abortion, euthanasia, and sterilization.

The three agencies, the United Nations Entity for Gender Equality and the Empowerment of Women (UN Women), the United Nations Population Fund (UNFPA), and the Office in Mexico of the High Commissioner of the United Nations for Human Rights (OHCHR), together denounced the legislation for not requiring conscientious objectors to give referrals to doctors who are willing to carry out the medical practice at issue. . . [Full Text]

UN Bureaucrats Push Full Steam Ahead for Abortion, Slam Breaks on Euthanasia

Experts a seek to limit freedom of conscience for  medical professionals

Center for Family and Human Rights

Stefanno Gennarini

NEW YORK, April 13 (C-Fam) “Sexual and reproductive health and rights are integral to the dignity of women and girls,” said Deputy High Commissioner for Human Rights Kate Gilmore at a gathering of UN experts and bureaucrats in Geneva last month.

Gilmore invited some thirty international experts of two UN human rights treaty monitoring committees to “confront” the UN General Assembly and “defy” UN member states which have repeatedly refused to recognize an international right to abortion.

“This is not a time for optimism. This is not a time for hope. This is a time for courage,” Gilmore said. Egging on the experts, she said that the limitations that member states had placed on their power and resources were a “pernicious intentional effort to counter your authority, to minimize the reach of your responsibilities, and dilute the authority with which you speak.” . . .[Full Text]

Declaration in Support of Conscientious Objection in Health Care

Introduction

The Declaration and associated texts you find here are my attempt, as a concerned academic, to provide a platform for the public support of freedom of conscience in health care.

Please read all of the material here. If you agree with the Declaration overall – even if you disagree with or are neutral on various details – I encourage you to add your electronic signature as a demonstration of support.

Signatures from health care professionals and academics in related fields are especially welcome, but you are encouraged to sign simply if you share my concerns and agree with the general way I have expressed them. You do not need an institutional affiliation, professional title, or any particular background. The more signatures this Declaration obtains, the more likely it is to come to the attention of policy makers and people who can amplify the message.

The texts ancillary to the Declaration are not part of its contents; they simply explain how I see and interpret the issues raised in the Declaration, and how I would like to see policy develop. By signing the Declaration, you do not indicate support for anything I say in the ancillary texts.

You will be asked only for your name, professional title (if you have one), institutional affiliation (if you have one), email address, and the country in which you reside. I may use your email occasionally to send you information about the Declaration, such as media coverage, but I will not use your email address for any other purpose. You will not be asked be involved in any other activity. The information you provide will be used solely to represent support for freedom of conscience in health care to professionals in the field (both clinical and academic), policy makers, and other interested parties who might be able to help with the promotion of this issue.

Acknowledgement and Disclaimer
I am grateful to the University of Reading for its support in hosting this material. The views and proposals presented here, however, represent my opinions alone. They do not, in any way, necessarily represent the views of the University of Reading or any of its officers, employees, or students.
David S. Oderberg

Sign the Declaration in Support of Conscientious Objection in Health Care

Show your support by signing the declaration.

The “Medical Conscience” Civil Rights Movement

First Things

Wesley J. Smith*

Until recently, healthcare was not culturally controversial. Medicine was seen as primarily concerned with extending lives, curing diseases, healing injuries, palliating symptoms, birthing babies, and promoting wellness – and hence, as a sphere in which people of all political and social beliefs were generally able to get along.

That consensus has been shattered. Doctors today may be asked to provide legal but morally contentious medical interventions such as sex selection abortion, assisted suicide, preimplantation genetic diagnosis of IVF embryos, even medications that inhibit the onset of puberty for minors diagnosed with gender dysphoria. As a consequence, medical practice has become embroiled in political and cultural conflict. . .
Full Text

Professor David Oderberg joins Protection of Conscience Project Advisory Board

News Release   

For immediate release

Protection of Conscience Project

The Protection of Conscience Project welcomes David S. Oderberg, Professor of Philosophy at the University of Reading, UK to the Project Advisory Board. Professor Oderberg joined the university after completing his doctorate at Oxford in the early 1990s. He is the author of many articles in metaphysics, ethics, philosophy of religion, philosophy of science, and other areas. He is also the author of several books including Moral Theory and Applied Ethics (Blackwell, 2000) as well as co-editor of collections in ethics such as Human Values: New Essays on Ethics and Natural Law (Palgrave, 2004) and Human Lives: New Essays on Non-Consequentialist Bioethics (Palgrave, 1997).

Prof. Oderberg has been working on freedom of conscience in health care over the last few years, with a recent article in the Journal of Medical Ethics on co-operation, and a forthcoming policy monograph to be published by the Institute of Economic Affairs. He is Editor of Ratio, an international journal of analytic philosophy, and Senior Fellow of the Higher Education Academy. In 2013 he delivered the Hourani Lectures in Ethics at SUNY Buffalo, and has a book forthcoming based on those lectures, to be called The Metaphysics of Good and Evil. [Faculty Profile] [Website]

Contact:
Sean Murphy, Administrator
Protection of Conscience Project
protection@consciencelaws.org


The Protection of Conscience Project is a non-profit, non-denominational initiative that advocates for freedom of conscience in health care. The Project does not take a position on the morality or acceptability of morally contested procedures. Since 1999, the Project has been supporting health care workers who want to provide the best care  for their patients without violating their own personal and professional integrity. 

 

 

Protection of Conscience Project welcomes new advisor from Scotland

News Release
For immediate release

Protection of Conscience Project

The Protection of Conscience Project welcomes Dr. Mary Neal, PhD, LLB Honours, LLM to the Project Advisory Board. Dr. Neal is Senior Lecturer in Law, University of Strathclyde, Glasgow.  She researches, writes, and teaches in the fields of Healthcare Law and Bioethics, focusing on beginning and end-of-life issues.  In 2014-15, she was Adviser to the Scottish Parliamentary Committee scrutinising the Assisted Suicide (Scotland) Bill, and she is a current member [2018] of the British Medical Association’s Medical Ethics Committee. She has published a wide range of academic articles and blogs on a range of topics including, most recently, conscientious objection by healthcare professionals; the nature of ‘proper medical treatment’; the role of the emotions in end-of-life decision-making; and the conceptual structure and content of human dignity.

Dr. Neal was a co-editor of and contributor to the recent volume Ethical Judgments: Re-writing Medical Law (Hart, 2017). Her works-in-progress include articles and book chapters on conscientious objection; the idea of ‘vulnerability’ in healthcare; physician-assisted suicide; and the role of dignity in human rights discourse. Among other research activities, Dr. Neal is currently leading two funded projects relevant to the issue of conscientious objection in healthcare. One is a British Academy/Leverhulme-funded project exploring conflicts between personal values and professional expectations in pharmacy practice. The other is a multi-disciplinary network of academics and healthcare professionals (the ‘Accommodating Conscience Research Network’, or ‘ACoRN’), funded by the Royal Society of Edinburgh, and beginning with a series of roundtables exploring various aspects of conscientious objection in healthcare. Dr Neal is also a spokesperson for the Free Conscience campaign supporting the Conscientious Objection (Medical Activities) Bill currently before the UK Parliament.[Faculty Profile]

Contact:
Sean Murphy, Administrator
Protection of Conscience Project
protection@consciencelaws.org


The Protection of Conscience Project is a non-profit, non-denominational initiative that advocates for freedom of conscience in health care. The Project does not take a position on the morality or acceptability of morally contested procedures. Since 1999, the Project has been supporting health care workers who want to provide the best care  for their patients without violating their own personal and professional integrity. 

International constitutional and human rights lawyer joins Protection of Conscience Project Advisory Board

News release 

For immediate release

Protection of Conscience Project

The Protection of Conscience Project welcomes Dr. Iain Benson, Professor of Law, University of Notre Dame Australia, Sydney and Extraordinary Professor of Law, University of the Free State, Bloemfontein South Africa to the Project Advisory Board.

Born in Edinburgh, Scotland, the father of seven children, Professor Benson is an academic, lecturer and practising lawyer specialising in pluralism and human rights.  His particular focus is on freedoms of association, conscience and religion, the nature of pluralism, multi-culturalism and relationships between law, religion and culture. He has been involved in many of the leading cases on rights of association, conscience and religion in Canada and abroad for two decades.  As a barrister he has appeared before all levels of court and his work has been cited by the Supreme Court of Canada and the Constitutional Court of South Africa.

He was one of the drafters of the South African Charter of Religious Rights and Freedoms (signed by all major religions in that country in September 2010) and remains closely involved in advancing the Charter in that country and similar projects elsewhere.

Author of over 40 academic articles and book chapters, he is co-editor with Barry W. Bussey, of Religion Liberty and the Jurisdictional Limits of Law (Toronto: Lexis Nexis, 2017) and authored Living Together with Disagreement: Pluralism, the Secular and the Fair Treatment of Beliefs by Law (Ballan Australia: Connor Court, 2012). His scholarly work is referred to in many books and articles.

He teaches Legal Philosophy, Legal History, Public International Law, Human Rights and Contemporary Legal Issues. He works in English and French, dividing his time between Australia (where he now lives) and France, South Africa and Canada (in the latter two of which he has appointments).[Faculty profile]

Contact:
Sean Murphy, Administrator
Protection of Conscience Project
protection@consciencelaws.org


The Protection of Conscience Project is a non-profit, non-denominational initiative that advocates for freedom of conscience in health care. The Project does not take a position on the morality or acceptability of morally contested procedures. Since 1999, the Project has been supporting health care workers who want to provide the best care  for their patients without violating their own personal and professional integrity. 

World medical body pushes back on conscience fight

The Catholic Register

Michael Swan

The international society of Catholic doctors is using Canada as an example of what can go wrong when doctors are forced to refer for abortion.

The World Federation of Catholic Medical Associations is drawing on Canada’s experience to counter proposals before the World Medical Association to adopt forced referrals and signal ethical acceptance for euthanasia. . . [Full Text]

World Medical Association urged to change policy against euthanasia, assisted suicide

Canadian & Royal Dutch Medical Association want censure dropped

Sean Murphy*

The President of the World Federation of the Catholic Medical Associations has disclosed that the Canadian Medical Association (CMA) and Royal Dutch Medical Association (RDMA) have asked the World Medical Association to change its policy against euthanasia and physician assisted suicide.

The WMA issued a Declaration on Euthanasia in 19871 and a Resolution on Euthanasia  in 2002;2  they are now identical. The WMA Statement on Physician Assisted Suicide was made in 1992 and reaffirmed in 2005 and 2015:

Physician-assisted suicide, like euthanasia, is unethical and must be condemned by the medical profession. Where the assistance of the physician is intentionally and deliberately directed at enabling an individual to end his or her own life, the physician acts unethically. However the right to decline medical is a basic right of the patient, and the physician does not act unethically even if respecting such a wish results in the death of the patient.3

Writing to the President of the World Medical Association, Dr. John Lee stated that the CMA and RDMA suggested that existing policy be replaced with the following:

8. The WMA does not support euthanasia or physician assisted suicide, but WMA does not condemn physicians who follow their own conscience in deciding whether or not to participate in these activities, within the bounds of the legislation, in those jurisdictions where euthanasia and/or physician assisted dying are legalized.

9. No physician should be forced to participate in euthanasia or assisted suicide against their personal moral beliefs. Equally, no conscientiously objecting physician should be forced to refer a patient directly to another physician. Jurisdictions that legalize euthanasia or physician assisted suicide must provide mechanisms that will ensure access for those patients who meet the appropriate requirements. Physicians, individually or collectively, must not be made responsible for ensuring access.4

Dr. Lee also expressed opposition to a planned revision to the Declaration of Oslo concerning abortion, which, he said, would require objecting physicians to refer for abortions and even to provide them.  However, he commented at greater length on the proposed change to WMA policy on euthanasia and assisted suicide.

Based on the Canadian experience, acceptance of the ethical neutrality of medically-assisted death has resulted in almost immediate challenges for physicians who are unable to refer because of moral, religious, or ethical concerns. It is a serious problem, with physicians put in the impossible position of having to choose between their conscience and being allowed to continue to care for their patients.4

The Canadian roots of the CMA/RDMA proposal

Dr. Lee’s observations about developments in parts of Canada are accurate.  The text of paragraph 8 is very similar to the CMA resolution used by the CMA Board of Directors as the basis for reversing CMA policy against euthanasia and assisted suicide. . . [Full Text]