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]

Medics should not be forced to do procedures they object to on ethical grounds

The Conversation
Reproduced with permission

David S. Oderberg*

For most people, the term “conscientious objection” evokes images of Quakers and pacifists registering to avoid military service. Many countries have a long and honourable tradition of accommodating such conscientious objectors. It might not be about bombs and bullets, but healthcare professionals often find themselves fighting a conscience battle of their own.

In the UK, Canada, Sweden and other countries, conscientious objectors in healthcare have found themselves discriminated against in various ways – whether through dismissal, lack of promotion, or more subtle forms of coercion. Most cases involve doctors, nurses or midwives refusing to perform abortion or euthanasia (or to assist with either). Yet these happen, through historical accident, to be the flashpoint of current controversy. . . [Full text]

Answering Physicians Top 5 Legal Questions

In 2017, the medical students’ forum hosted by Canadian Physicians for Life included a question and answer session about legal issues. Albertos Polizogopoulos is lead counsel in the constitutional challenge to the College of Physicians and Surgeons of Ontario (CPSO) policy that demands effective referral for all morally contested services, including euthanasia and assisted suicide.  Phil Horgan, a Toronto lawyer, is President of the Catholic Civil Rights League, which jointly intervened in the case with the Faith and Freedom Alliance and Protection of Conscience Project.  Questions have been listed below with the corresponding time segments.  Links have been provided to background material concerning subjects covered in the answers.

1. How can physicians best disclose to their patients their conscientious objections?  (00:00-11:18)

2. What happens when a patient reports a physician to their college for exercising their right to conscientious objection?  (11:18-20:00)

3. How can conscience and religious rights be exercised, practically speaking?  (20:00-23:33)

4. Is there a sense that other provinces are just waiting to see what is going to happen with these current cases going on in Ontario? (23:33-34:35)

5. Can you comment on institutions?  Do they have rights themselves?   (34:45-40:15)

The courts keep inventing new rights, turning our Charter on its head

National Post
Reproduced with permission

John Carpay

If I told you that I wanted to rob a home or store, would you sell me a gun? Presumably not. But what about giving me the name and contact info of another person who is willing to sell me a gun? If you wanted to avoid any participation in my planned robbery, you would refuse to provide a referral.

When it comes to female genital mutilation (the cutting and removal of some or all of a young girl’s external genitalia) the College of Physicians and Surgeons of Ontario (CPSO) recognizes that referring is as bad as providing. The CPSO prohibits this practice, common in many African and Middle Eastern countries. Female genital mutilation causes infection, disease and death in many girls, and life-long health problems for millions of women.

The CPSO policy prohibits physicians from performing, and from referring for, female genital mutilation procedures. Both performing and referring constitute professional misconduct. The reasoning is obvious. If mutilating a girl is wrong, then it’s also wrong to provide a referral for this barbaric procedure.

College of Physicians and Surgeons of Ontario in Toronto, Ont. on Tuesday April 9, 2013.

Sadly, the CPSO abandoned this common-sense approach in the case of Christian Medical and Dental Society vs. CPSO. This court case was about a challenge to the CPSO policy requiring all doctors in Ontario to provide referrals for abortion, assisted suicide, and other medical procedures which some doctors view as harmful to patients and morally wrong. In court the CPSO argued that “a referral is neither an endorsement of the service for which the referral is provided, nor a guarantee that it will be provided.” The CPSO argued that providing a referral is trivial and insignificant, so a doctor would not be violating her conscience when referring a patient for a procedure that the doctor considers harmful. If the CPSO’s courtroom arguments are true, then why prohibit referring for female genital mutilation?

The Ontario Superior Court of Justice ruled that the CPSO policy violates the Charter freedom of religion and conscience, but then justified this violation as necessary to ensure “equitable” access to health-care services.

Abortion and assisted suicide are both legal medical procedures. Plenty of doctors are available to provide the one, the other, or both. Having to ask two, three or more doctors for a particular medical service is inconvenient for patients, to be sure.

But does the Charter provide citizens with a legal right to be free from inconvenience? Beyond a bald declaration, the court provides no explanation as to how or why being inconvenienced is a violation of the Charter. Nor does the court explain why it is necessary to force every single doctor in Ontario to provide referrals for abortion and assisted suicide. In other words, even if many doctors refuse to provide referrals for these services, the public would still have ready access to both.

The purpose of the Charter is to protect citizens from government. For example, the Charter should protect health-care workers (and everyone else) from being pressured or coerced by a government body to do what one believes to be wrong.

Conversely, there is no Charter right to force another human being to provide a service that runs contrary to their conscience. Interactions between citizens should be free from coercion. A patient’s power to compel a doctor to do what the doctor believes to be harmful is as destructive as a doctor’s power to compel a patient to do what the patient believes to be harmful.

The doctors who challenged the CPSO policy were not merely asking the court to be spared an inconvenience. Rather, an Ontario doctor who refuses to violate her conscience risks expulsion from the medical profession.

In upholding the CPSO policy, the court confuses fundamental Charter freedoms with personal interests and desires. The court has dismissed the Charter’s protection from government coercion as less important than a newly invented “right” to compel our fellow citizens (in this case doctors) to do what we want them to do. The court has turned the Charter on its head.

Lawyer John Carpay is president of the Justice Centre for Constitutional Freedoms (Jccf.ca), which intervened in Christian Medical and Dental Society of Canada vs. College of Physicians and Surgeons of Ontario.

 

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]

 

Contraceptive Coverage and the Balance Between Conscience and Access

Ronit Y. Stahl,PhD; Holly Fernandez Lynch, JD, MBE

When the Obama administration included contraception in the essential benefits package to be covered by employer-sponsored health insurance plans under the Affordable Care Act, it sought to preserve access for women while addressing the concerns of employers with religious objections. Although the accommodations and exemptions were not enough for some employers, balance was the ultimate goal. This also was reflected in Zubik v Burwell, the Supreme Court’s most recent decision on the matter; on May 16, 2016, the justices remanded the litigants to the lower court so they could be afforded the opportunity to reach a compromise between religious exercise and seamless contraceptive coverage. No further compromise was forthcoming.

Now the Trump administration has rejected balance as a worthwhile goal.1 Its new contraceptive coverage rules, released on October 6, 2017, prioritize conscientious objection over access.2,3 The rules take effect immediately, and new legal challenges, this time on behalf of patients rather than objecting employers, have already begun.4 The new rules preserve the default requirement that employers must include free access to contraceptives as part of their insurance plans. However, the rules now exempt employers with religious or moral objections to contraceptives, without requiring any alternative approaches to ensure that beneficiaries can obtain contraceptives at no cost.2,3
[Full Text]


Stahl RY, Lynch HF. Contraceptive Coverage and the Balance Between Conscience and Access. JAMA. Published online October 19, 2017. doi:10.1001/jama.2017.17086

Victoria, Australia: Voluntary Assisted Dying Bill 2017

Comment

Sean Murphy*

euthanasia and assisted suicide bill introduced in the Parliament of Victoria, Australia, includes several provisions that pertain to legal protection of freedom of conscience.  Concerning these:

  • Freedom of conscience provisions concern only individual practitioners, not health care facilities.  Freedom of conscience presumably includes acting upon moral or ethical beliefs grounded in religious teaching.
  • Statements of principles that require encouragement and promotion of an individual “preferences and values,” that people should be “supported” in conversations about treatment and care and “shown respect” for their beliefs, etc. can be interpreted to require affirmation of moral or ethical choices.
    • While the principles may have no direct legal effect, they could be cited by professional regulatory authorities against those who refuse to encourage, promote, or affirm the acceptability of euthanasia and assisted suicide.
  • Registered medical practitioner is not defined, but all would be encompassed by the definition of health care practitioner.
  • All health care practitioners are protected by Section 7.
  • Section 7(b) allows for refusal to participate in the request and assessment process and Section 7(c) protects refusal to be present when lethal medication is administered, but Section 7
    • does not include protection for refusal to participate in the administration of lethal medication, by, for example, inserting an IV line in advance, or by other means
    • does not include protection for refusal to participate in dispensing lethal medication
  • “Participate” in Section 7(b) is broad enough to encompass referral.  However, the bill would be improved by providing protection against coerced indirect participation in administering or dispensing lethal medication.
  • The bill does not require falsification of death certificates, but does require the falsification of the cause of death in the registration of deaths.  The bill includes no protection for a registrar who, for reasons of conscience, is unwilling to falsify a registry entry.

Symposium: Conscience, conditions, and access to civil society

SCOTUSblog

Richard Garnett*

It is striking how easy it has become for a person to stumble into the status of a symbol – or, these days, a viral meme. Jack Phillips is, or was until fairly recently, a skilled cake artist with a small business, Masterpiece Cakeshop, in suburban Denver. Today, he is a litigant in the Supreme Court of the United States and regarded by many as embodying the tension – increasingly, the conflict – between religious conscience and equality. . . Can he be required, though – should he be required, is it necessary for him to be required – to say something he thinks is not true, to disavow what he believes or to act expressively in violation of his conscience? . . . [Full text]

The great divide where religious beliefs and the law meet

Faith is accommodated In Australia, but there is piecemeal protection for religious freedom.

The Conversation

Michael Quinlan*

Australia is a multi-faith society. The 2016 Census shows that, while the mix of beliefs has changed over the years, Australia remains a pretty religious place.

In the last census, nearly 70% of Australians self-identified as religious. The number of Australians who have self-identified as Christian in the census has fallen from 88.2% in 1966 to 52.1% in 2016.

The number of Australians identifying as being of another religion has grown from 0.8% to 8.2%, with Islam (2.6%), Buddhism (2.4%) and Hinduism (1.9%) being the largest non-Christian faiths.

The number who self-identified in the category of “no religion” has grown from 0.8% to 30.1%. This category includes having secular beliefs, other spiritual beliefs or having no religion. This makes it hard to be sure what these Australians believe. . . [Full text]

New Zealand Attorney General apparently confused on issue of referral for euthanasia

Sean Murphy*

Chris Finlayson, the Attorney General of New Zealand, has issued a report on a euthanasia bill that has been introduced by Member of Parliament David Seymour, the leader and only sitting member of ACT New Zealand.

This bill includes protection of conscience provisions that were considered by Mr. Finlayson in his report (paragraphs 62-65).  The Attorney General stated that the provisions require an objecting medical practitioner to refer a patient to another physician for euthanasia, and acknowledged that this infringed freedom of conscience guaranteed by New Zealand’s Bill of Rights.  However, he believed this to be consistent with the Bill of Rights:

I consider that the limit is justified for the effective functioning of the regime for assisted dying created by the Bill.  In particular, I consider that the requirement to identify another medical practitioner is necessary to meet the objective of the Bill and is the most minimal impairment of the right possible.(para. 64)

The Attorney General appears to be confused on this point.

In fact, Section 7(2) of the bill requires only that the patient be told that he may contact the “SCENZ Group” (euthanasia coordination/facilitation service) to obtain the name of a euthanasia practitioner or physician willing to assist in the process.  It is up to the patient to initiate contact with the SCENZ Group, and the bill does not require a physician to assist the patient to do so.  This does not amount to referral to a euthanasia practitioner.

The distinction is important because physicians who object to euthanasia for reasons of conscience often refuse to refer patients for the procedure on the grounds that doing so would make them parties to homicide.  This issue is the focus of an important constitutional challenge in Canada, where the College of Physicians and Surgeons of Ontario is attempting to compel unwilling physicians to make effective referrals for euthanasia and assisted suicide.