Health service unable to cope with demand if abortion legalised, medics claim

GP says referendum campaign has led to ‘fundamental divisions’ within profession

The Irish Times

Sorcha Pollak

The State’s health system will be unable to cope with the demand for additional surgical procedures if access to abortion is legalised, a group of anti-abortion doctors, nurses and midwives has said.

The medics told an event hosted by the Save the 8th campaign on Monday that the Government had not carried out a full assessment of the cost and logistics of law changes arising from the potential repeal of the Eighth Amendment after the May 25th referendum.

Ann Flynn, assistant director of nursing at St Vincent’s hospital, Dublin, said Minister for Health Simon Harris was “asking us to introduce an abortion regime that cannot be introduced” into the health system he leads. . . [Full Text]

‘Intentionally ending the life of an innocent baby does not treat any illness’

Nurses say proposed abortion legislation could mean nurses giving up jobs on conscience grounds

The Irish Times

Patsy McGarry

Proposed abortion legislation could force nurses and midwives out of a job, it has been claimed.

Campaigners for a No vote in the referendum on the Eight Amendment say the conscience clause promised by the Government in legislation if the measure passes is inadequate.

“We are concerned about freedom of conscience and have seen how Scottish midwives lost their case in the UK not to be involved in abortions,” said Mary Kelly Fitzgibbon, of Nurses for Life, a nurse, midwife and a lecturer. . . [Full Text]

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.

Abortion: INMO calls for conscientious objection safeguards

Nurses union has had no discussions to date with HSE about the implications of repeal

The Irish times

Barry Roche

The Irish Nurses and Midwives Organisation expects the same conscientious objection protections that exist for nurses under the Protection of Life in Pregnancy Act to be afforded to nurses and midwives in any forthcoming legislation in the event of the Eighth Amendment being repealed.

INMO director of social policy and regulation Edward Matthews said that nurses and midwives are afforded the same protections as medical practitioners when it comes to conscientious objection to carrying out a termination of pregnancy. . . [Full Text]

Isle of Man abortion reform bill passed by House of Keys

BBC News

Plans to change the Isle of Man’s abortion laws have been approved by the House of Keys by a margin of 22-2.

The Abortion Reform Bill would allow women to have terminations within the first 14 weeks of their pregnancy, with other restrictions also being eased.

Under existing Manx law, abortions can only be carried out if a pregnancy is the result of rape or because of mental health concerns.

Members of the Legislative Council will now consider the bill. . . [Full text]

    • Note: the Abortion Reform Bill as passed by the Keys includes a simple  protection of conscience provision covering all “relevant” professionals (registered medical practitioners, nurses, or midwives) and pharmacists.  It requires objecting practitioners to provide information, but not  referral.

Conscientious objection to participation in abortion by midwives and nurses: a systematic review of reasons

Valerie Fleming Lucy Frith, Ans Luyben, Beate Ramsayer

Abstract

Background

Freedom of conscience is a core element of human rights respected by most European countries. It allows abortion through the inclusion of a conscience clause, which permits opting out of providing such services. However, the grounds for invoking conscientious objection lack clarity. Our aim in this paper is to take a step in this direction by carrying out a systematic review of reasons by midwives and nurses for declining, on conscience grounds, to participate in abortion.

Method

We conducted a systematic review of ethical arguments asking, “What reasons have been reported in the argument based literature for or against conscientious objection to abortion provision by nurses or midwives?” We particularly wanted to identify any discussion of the responsibilities of midwives and nurses in this area. Search terms were conscientious objection and abortion or termination and nurse or midwife or midwives or physicians or doctors or medics within the dates 2000–2016 on: HEIN legal, Medline, CINAHL, Psychinfo, Academic Search Complete, Web of Science including publications in English, German and Dutch. Final articles were subjected to a rigorous analysis, coding and classifying each line into reason mentions, narrow and broad reasons for or against conscientious objection.

Results

Of an initial 1085 articles, 10 were included. We identified 23 broad reasons, containing 116narrow reasons and 269 reason mentions. Eighty one (81) narrow reasons argued in favour of and 35 against conscientious objection. Using predetermined categories of moral, practical, religious or legal reasons, “moral reasons” contained the largest number of narrow reasons (n =  58). The reasons and their associated mentions in this category outnumber those in the sum of the other three categories.

Conclusions

We identified no absolute argument either for or against conscientious objection by midwives or nurses. An invisibility of midwives and nurses exists in the whole debate concerning conscientious objection reflecting a gap between literature and practice, as it is they whom WHO recommend as providers of this service. While the arguments in the literature emphasize the need for provision of conscientious objection, a balanced debate is necessary in this field, which includes all relevant health professionals.


Fleming V, Frith L, Luyben A, Ramsayer B. Conscientious objection to participation in abortion by midwives and nurses: a systematic review of reasons. BMC Medical Ethics. 2018;19:31. doi:10.1186/s12910-018-0268-3.

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]

Referendum on the Eighth Amendment

Amnesty International demands compulsory referral for abortion

Irish Times (Letter to the Editor)

Colm O’Gorman (Executive DIrector, Amnesty International Ireland

Sir, – Dr Andrew O’Regan (April 14th) has firm views on when health practitioners should be allow to refuse participate in abortion procedures if the referendum is passed. However, the limits he considers a trespass on practitioners’ rights are in fact how conscience-based refusal should be regulated in order to safeguard the patient’s rights too.

There is an important difference between conscientiously objecting to something – we all have a human right to thought, conscience and religion – and being allowed to act on that objection in a way that negatively impacts on others. . .

. . . So, yes, a health professional exercising conscience-based refusal should still have a duty to make a timely referral to another who will provide the service. . . . [Full text]

Physician warns of threat to freedom of conscience in Ireland

The Irish Times

Andrew O’Regan

Sir, – I have a number of concerns relating to conscientious objection and abortion.

The recently published heads of Bill define termination of pregnancy as “a medical procedure which is intended to end the life of the foetus”.

If the referendum is passed, this is the procedure that will be available on demand for any reason up to 12 weeks and after 12 weeks on vague health grounds.

First, it is of great worry to Irish practitioners that doctors, nurses and midwives cannot avoid participation in abortion in an increasing number of jurisdictions, including Sweden, Iceland, Finland and Bulgaria.

Second, in the UK supreme court, two midwives lost their battle to be treated as “conscientious objectors”, and to be excused from participating in abortions.

The midwives were told that while they could refuse to carry out the procedures themselves, they were obliged to delegate these duties to other staff and to supervise the staff during the abortions.

Many doctors and nurses consider that if their conscience prevents them from intentionally ending the life of the foetus, they should not be required to supervise and organise this same act.

The legislation proposed if the Eighth Amendment is repealed will oblige GPs and other healthcare professionals who conscientiously object to transfer care to another doctor and to inform the patient in writing that they may seek review of the objecting doctor’s decision.

Third, in 2013 a resolution to restrict the right of doctors and nurses to conscientious objection was narrowly defeated in the European Parliament. Some Irish MEPs voted for this. In the recent Dáil debates some politicians argued against a doctor’s right to avoid participation in abortion.

We have seen how one political party expelled a number of members for voting with their consciences in 2013 and how another party suspended one of the youngest female TDs in Dáil Éireann for exercising her conscience in a vote last month.

Fourth, some academic campaigners have been arguing for the removal of conscientious objection across Europe, claiming that it can be used as a “subtle method for limiting access to abortion”.

Finally, under Minister for Health Simon Harris’s plans for abortion, GPs and others will not be entitled to conscientiously object to participating in the intentional destruction (not delivery) of the foetus where there is a risk to the life or health of the patient in an emergency.

No evidence has been produced to show that intentional destruction of the foetus is necessary to avoid risks to the life or health of a pregnant patient.

I would urge GPs and our colleagues from other disciplines who are also in the front line of patient care to inform themselves fully of the implications for the practice of medicine should this referendum be passed. – Is mise,

Dr ANDREW O’REGAN,

(General Practitioner and Senior Lecturer),
Killarney,
Co Kerry.

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]