HHS rules prevent providers from being forced to do things that violate moral convictions

The Hill

Reproduced with permission

Diana Ruzicka*

In the April 4, 2018 article, HHS rule lowers the bar for care and discriminates against certain people, nursing leaders, Pamela F. Cipriano and Karen Cox, wrote that the U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR) Proposed Rule: Protecting Statutory Conscience Rights in Health Care; Delegations of Authority expands the ability to discriminate, denies patients health care and should be rescinded. These accusations are unfounded and the rule should be supported.

What the rule does is “more effectively and comprehensively enforce Federal health care conscience and associated anti-discrimination laws.” It is not an effort to allow discrimination but an effort to prevent it by enforcing laws already on the books and gives the OCR the authority to oversee such efforts. This is something that nursing should encourage because it supports the Code of Ethics for Nurses (code).

The code reminds us that, “The nurse owes the same duties to self as to others, including the responsibility to promote health and safety, preserve wholeness of character and integrity, maintain competence and continue personal and professional growth.”

It is precisely because nurses are professionals who hold themselves to these standards that patients have come to see nurses as persons worthy of their trust, persons in whose hands they are willing to place their lives. Being granted by the public this weighty and solemn responsibility is humbling and must never be taken lightly. Thus the nurse’s duty to practice in accord with one’s conscience, to be a person of wholeness of character and integrity, is recognized by the.

It is odd that, despite supporting a nurse’s duty to conscience and the right to refuse to participate in an action to which the nurse objects on the grounds of conscience, Cipriano and Cox insist that the nurse, must assure that others make the care available to the patient. This suggests a failure to recognize that referring the patient to someone who will do the objectionable act in place of the nurse can make the nurse complicit.

The culpability of complicity is well recognized in law and ethics, as an accomplice is liable to the same extent as the person who does the deed. Thus, to make a referral and be complicit in an act to which the nurse conscientiously objects, also violates conscience. We doubt nursing leaders actually support this, as the consequences would be chilling.

When persons are made to violate their conscience, to set it aside, to silence it, moral integrity is eroded and moral disengagement progressively sets in. To move from caring for our fellow human beings to acting on them in ways that our conscience tells us we should not, requires powerful cognitive manipulation and restructuring to free ourselves of the guilt associated with this violation of our deeply held moral or religious beliefs.

Moral disengagement has frightening negative consequences, namely a pernicious dehumanization of persons, including oneself and of society as a whole. Rather than a nurse being someone of moral courage, ethical competence and human rights sensitivity, as our code directs, a nurse would have to be someone who is willing to surrender their conscience to expediency, powerful others, or whatever happens to be permitted by law at the time and place.

No longer would patients find that nurses are persons they can trust. It is precisely because nurses practice in accordance with their conscience that the public continues to grant them high scores on honesty and ethics.

None of this is to say that nurses may abandon patients. By promptly seeking a transfer of assignment that does not involve the objectionable act or by transferring the patient elsewhere without making a referral, the nurse continues to uphold the code by “promoting, advocating for and protecting the rights, health and safety of the patient [and, at the same time,] preserving wholeness of character and integrity.”

Clearly, refusal to care for a patient based on an individual attribute is unjust discrimination and has no place in nursing or health care. But that is not what the rule does. It protects the right to object to being forced to participate in an act that violates a person’s deeply held moral convictions or religious beliefs and from discrimination as a result of one’s refusal to participate in such an act.

To call for rescinding the rule, whose purpose is to protect this fundamental human right, would be short-sighted and could make unjust discrimination more likely and harm not only nursing but also the patients we serve.

 

Discrimination isn’t always wrong

America

John J. Conley

Is discrimination always wrong?

To listen to the current national debate on the topic, it would appear to be so. Virtually all international human-rights covenants categorically reject discrimination on the basis of race, religion and gender. Even contemporary professional philosophers tend to treat discrimination as an unalloyed evil. The University of Chicago’s Brian Leiter has led a very public philosophical campaign to eliminate religious exemptions to anti-discrimination laws and to declare unethical religious practices that appear to be discriminatory, especially in the area of gender and sexual orientation.

But our crusade against discrimination seems to rest on a fundamental confusion. There is a difference between discriminating against someone because of the group to which he or she belongs and discriminating against someone on the basis of his or her actions. . . . [Full text]

Thousands step up in support of doctors’ conscience fight

The Catholic Register

Michael Swan

An Ontario campaign to pressure politicians over the protection of health care conscience rights is “democracy in action,” said an organizer.

The Coalition of HealthCARE has so far collected 19,000 names and e-mail addresses in its “Call for Conscience Campaign.” That does not include results from the Archdiocese of Toronto.

The non-partisan campaign was launched to oppose and raise awareness about regulations that force doctors to refer for assisted suicide and euthanasia against their moral convictions.

By the end of March, people who have signed up during the campaign should receive instructions about how to e-mail all the candidates in their ridings in the run-up to Ontario’s June 7 provincial election. . . [Full text]

Church calls for Scottish Bill to back medics’ conscience rights

Scottish Catholic Observer

Amanda Connelly

The Catholic Church in Scotland has called for a bill that gives medical professionals the right to conscientiously object to medical procedures such as abortion.

The comments come after Baroness O’Loan’s new Conscientious Objection (Medical Activities) Bill for England and Wales, which looks to ensure conscience rights for medical professionals, had a second hearing in the House of Lords on Friday January 26.

“While the bill only applies to England and Wales, its progress should be of interest to people in Scotland, where hopefully a similar bill could be presented to the Scottish Parliament,” director of the Catholic Parliamentary Office Anthony Horan said. . . . [Full text]

 

Divisional Court Accepts Religious and Conscientious Infringement on Ontario Doctors

News Release

Catholic Civil Rights League

TORONTO, ON January 31, 2018 – The Catholic Civil Rights League (CCRL) is gravely disappointed in the ruling released today by the Ontario Divisional Court in the case CMDS et al v. CPSO.

The application was brought by several religious physicians and groups to challenge the mandate of the College of Physicians and Surgeons of Ontario (CPSO), that requires doctors who object to certain procedures on religious or conscientious grounds, such as assisted suicide, to provide nevertheless, an “effective referral” to another physician or caregiver who would perform the service.

The court upheld the policy that requires life affirming physicians to act against their religion and conscience.

It is an alarming development which places Ontario doctors at the risk of professional complaints for refusing to make such referrals.

While finding that the CPSO policies were in breach of the constitutional right to freedom of religion (the court declined to make a ruling on freedom of conscience given its assessment), it found that the policy choice of the CPSO engaged a “reasonable limit” on the exercise of such freedoms.  Speaking on behalf of the three-member panel, Mr. Justice Wilton-Siegel asserted that the CPSO limit on such rights, while not trivial, did not create a substantial infringement, even if it meant forcing a physician to violate one’s conscience, to accommodate his or her practice choices, even to the extent of stepping aside from certain practice areas.

The CCRL has maintained that the CPSO’s insistence on obligating Ontario physicians to perform an “effective referral” for objectionable procedures does nothing to honour the Charter right of freedom of conscience and religion. Rather it is a breach of a physician’s rights and a serious incursion into the professional standing of a physician.

A proper balancing of the rights of physicians with the concept of patient autonomy must not result in the trumping of the rights of physicians in their medical practices.  Such rights extend not only to refusing to perform assisted suicide and euthanasia, but the right not to be obliged to refer to other practitioners who may be willing to provide such services. This clearly constitutes participation in wrong.

According to a recent statement from the John Paul II Academy for Human Life and the Family:

“Seeking to impose on a doctor the duty to perform abortions or euthanasia (or, alternatively, to leave the medical profession or a given hospital), or to impose on him the duty to refer a woman to an abortionist, is gravely sinful and a direct violation of his inalienable human dignity and freedom of conscience.”

“The same also applies to the case where a prolife physician is claimed to be obliged to refer a patient (who requests physician-assisted suicide or euthanasia) to a colleague who would perform such acts.  Not only is the prolife physician not obliged to refer a patient to a colleague who would perform intrinsically wrong acts, he is also absolutely morally forbidden to do so,” they continue.

Speaking to the fallacy of the imposition of personal autonomy on others, “One can hardly imagine a worse perversion of moral truth and natural right than the idea that a person has a right to demand that other persons commit the crime to murder him. Nobody has any right whatsoever to demand from society to assist him to commit a crime against himself, or to oblige others to commit the crime of murdering him.”

“Quite the contrary, the others and the State, in virtue of their true moral autonomy, a moral autonomy subjected to the truth, have the absolute moral duty to reject such a request.”

The CCRL asserted in our legal argument, and relying upon previous authorities, that in a free and democratic society, the state should respect choices made by individuals and, to the greatest extent possible, will avoid subordinating these choices to any one conception of the good life.

Demanding that someone participate in perceived wrongdoing demands the submission of intellect, will and conscience, reducing the person to the status of a thing, to a tool to be used by others, to servitude that cannot be reconciled with principles of equality. It is an assault on human dignity that deprives physicians of their essential humanity.

The court missed an opportunity to require the CPSO to create a policy that would recognize that doctors have different views of what proper accompaniment of vulnerable patients entails.  Many patients not only share the views of the appellants, but also desire to be served by physicians who hold such views. Such doctors care deeply about their patients, and do not wish to be engaged in “referring” patients to their unnatural deaths.

The court instead accepted the arguments of the CPSO and has given its approval to a policy that serves to infringe upon the rights of such physicians.  Such an infringement is by no means insubstantial.

An appeal is required.


About the CCRL

The Catholic Civil Rights League (CCRL)) assists in creating conditions within which Catholic teachings can be better understood, cooperates with other organizations in defending civil rights in Canada, and opposes defamation and discrimination against Catholics on the basis of their beliefs. The CCRL was founded in 1985 as an independent lay organization with a large nationwide membership base. The CCRL is a Canadian non-profit organization entirely supported by the generosity of its members.

For further information: Christian Domenic Elia, PhD CCRL Executive Director 416-466-8244 @CCRLtweets

Medically assisted dying: What happens when religious and individual rights conflict?

Lawyer Allison Fenske explains how Canadian law works, and how the courts strive to balance competing rights

CBC News

A Winnipeg man’s struggle to be assessed for a medically assisted death while he lives at a faith-based hospital has some questioning how we balance personal and religious rights in Canada.

“I want to die and nobody should come in the way of my deciding how to go about it,” Cheppudira Gopalkrishna, 88, said on Saturday.

However, because Gopalkrishna lives at a faith-based hospital that objects to medical assistance in dying, he has struggled to be assessed by Manitoba’s MAID team under provincial guidelines regulating such deaths. . . [Full text]

 

Winnipeg man receives assisted-death assessment after concerns faith-based hospital caused delay

‘I want to die and nobody should come in the way of my deciding how to go about it.’

CBC News

An 88-year-old Winnipeg man has received his required assessment for medically assisted death after he says it was delayed by the faith-based hospital where he now lives.

On Friday, Cheppudira Gopalkrishna was able to do an assessment with the province’s Medical Assistance in Dying (MAID) services.

“I want to die and nobody should come in the way of my deciding how to go about it,” Gopalkrishna said on Saturday evening.

The former teacher has been at the Misericordia Health Centre for several months after his health declined significantly. He has a form of Lou Gehrig’s disease, also known as ALS, and has lost almost all of his mobility.

Gopalkrishna started looking into the possibility of a medically assisted death in May but the hospital and the Winnipeg Regional Health Authority’s timelines differ about what happened next. . . [Full text]

 

Canada’s assisted suicide law spurs a ‘campaign for conscience’

Inquirer.net

Isabella Buenaobra

WINNIPEG, Manitoba — A significant health care-related federal legislation was enacted by the Canadian Parliament on June 17, 2016: The Euthanasia/Assisted Suicide law creates a regulatory framework for medical assistance in dying in Canada.

With the legislation, Canada has joined The Netherlands, Belgium, Sweden and Luxembourg. which have enacted rules on doctor-assisted suicide. . .

Bill 34

In response to the passage of the (MAiD) Act, the Coalition for HealthCare and Conscience, a Canadian Christian-based organization, was organized to support the “Call for Conscience” Campaign. The campaign supports Bill 34—the Medical Assistance in Dying (Protection for Health Professionals & Others) Act, currently being considered by the Legislative Assembly of Manitoba. . . [Full text]

 

Waiting to die: Winnipeg man says faith-based hospital delayed access to assisted death

Timeline of events provided to CBC suggests Misericordia Health Centre delayed transfer of medical records

CBC News

Holly Caruk, Bruce Hoye

An 88-year-old Winnipeg man wants to end his life after being confined to a bed for several months with no chance of recovering and says the faith-based hospital where he now lives is delaying that request.

Cheppudira Gopalkrishna says the Misericordia Health Centre did not help him with his initial request to access the province’s Medical Assistance in Dying (MAID) services, and has since delayed the process further by taking too long to transfer his medical records and delaying an in-person assessment by the MAID team.

“I wouldn’t say [my request was ignored, but it wasn’t placed in the highest priority,” he said from his hospital bed.

The former school teacher has been at the Misericordia for several months, after his health declined significantly over the last year and a half. Gopalkrishna says he’s been told by doctors he has a form of Lou Gehrig’s disease, also known as ALS, and has lost almost all of his mobility.

Misericordia describes itself on its website as being affiliated with the Roman Catholic Archdiocese of Winnipeg. . . .[Full text]

 

Health minister says delayed access to medical assistance in dying ‘should not happen’

Cheppudira Gopalkrishna, 88, says Misericordia hasn’t helped him seek out medically-assisted death

CBC News

Manitoba’s Health Minister says he doesn’t know all the details of a terminally ill Winnipeg man’s search for medical assistance in dying, but he’s troubled by his first impression of the case.

Cheppudira Gopalkrishna, 88, told CBC News he has no chance of recovering from the illness that has confined him to bed for months, and the Misericordia Health Centre hasn’t helped him access the province’s medical assistance in dying (MAID) services.

However, the faith-based hospital — which is part of the Winnipeg Regional Health Authority — and the health authority’s MAID team offer differing accounts of what transpired and the timeline of Gopalkrishna’s request. . . . [Full text]