Update on American HHS controversy

The Department of Health and Human Services has confirmed a regulation that will require businesses with over 50 employees to provide health insurance for birth control and surgical sterilization, even if they object to doing so for reasons of conscience.  The regulations includes exemptions for objecting “religious employers” (largely limited to houses of worship) and objecting religious non-profit organizations.  However, the continued demand that objecting business owners be forced to comply and the nature of the exemptions remain unacceptable to many religious organizations.  Speaking for the Becket Fund for Religious Liberty, Eric Rassbach, Deputy General Counsel, said:  

When it comes to religious liberty, the Department of Health and Human Services is acting like a kid who doesn’t want to eat his lima beans. Our Constitution and laws require them to protect religious exercise, but they really don’t want to, so they are trying every trick in the book to avoid doing so. But we will keep suing until the courts make HHS comply with its obligations. [Becket Fund News Release]

The U.S. House of Representatives Energy and Committee has issued a report accusing the Obama administration and Department of Health and Human Services of “unprecedented abuse” of religious liberty.

There are now 61 civil suits filed against the regulation, with over 200 plaintiffs. [Becket Fund, HHS Information Central].  In one of them, a unanimous decision by the10th Circuit Court of Appeals in Denver has directed a lower court allow a civil suit brought by Hobby Lobby, a chain of arts and crafts stores.  The owners of the company object to being forced to provide embryocidal forms of birth control.  They are seeking an injunction against the enforcement of the regulation [The Tennessean].  A Largo, Florida, company with the same objections has been granted a preliminary injunction [Tampa Tribune], as has Geneva College, a Christian college in Pennsylvania [NCR].

American Catholic bishops have been adamant that the HHS regulation is unacceptable, once again declaring a “Fortnight for Freedom” from 21 June to 4 July to encourage opposition to it and support for freedom of religion.  Timothy Cardinal Dolan, Archbishop of New York, has been one of the leading opponents of the law.  The Archdiocese of New York is among the plaintiffs in the lawsuits against the regulation.  However, the Archdiocese of New York has, for years, been indirectly paying for health insurance for employees of the Catholic Health Care System that includes coverage for contraception and abortion.  The arrangement was approved by Cardinal Dolan’s predecessor, Archbishop John O’Connor, who died in 2000.  A spokesman for the Archdiocese stated that the coverage is provided “under protest.”  [New York Times]

Health care providers’ attitudes towards termination of pregnancy: A qualitative study in Western Nigeria.

Open Journal of Obstetrics and Gynecology, 2013, 3, 400-410 OJOG doi:10.4236/ojog.2013.34074 . Published Online June 2013

Mustafa Adelaja Lamina

Abstract:

Background: Despite restrictive abortion law in Nigeria, women still seek abortion services. Restrictive policies on abortion make it difficult for safe and legal abortion to be obtained. Hence, abortion is provided on clandestine basis in some private health facilities, and where the cost of such service is prohibitory, women resort to unsafe methods, including visiting quacks and self medication, resulting in severe complications including death. In Nigeria, little is known about the personal and professional attitudes of individuals who are currently providing abortion services. Exploring the factors which determine health care providers’ involvement in or disengagement from abortion services may facilitate improvement in the planning and provision of future services.

Methods: Data were collected using qualitative research methods. Thirty-six in-depth interviews and one focus group discussion were conducted between January 2010 and July 2010 with health care providers who were involved in a range of abortion services provision in the Western Nigeria. Data were analysed using a thematic analysis approach.

Results: Complex patterns of service delivery were prevalent throughout many of the health care facilities. Fragmented levels of service provision operated in order to accommodate health care providers’ willingness to be involved in different aspects of abortion provision. Closely linked with this was the urgent need expressed by many providers for liberalization of abortion laws in Nigeria in order to create a supportive environment for both clients and providers. Almost all providers were concerned about the numerous difficulties women faced in seeking an abortion and their general quality of care. An overriding concern was poor pre and post abortion counselling including contraceptive counselling and provision.

Conclusion: This is the first known qualitative study undertaken in Nigeria exploring providers’ attitudes towards abortion and it adds to the body of information addressing the barriers to safe abortion services. In order to provide an enabling environment and sustain a pool of abortion service providers, a drastic change in Nigerian abortion laws is mandatory, after which policies that both attract prospective abortion service providers and retain existing ones can be developed. [Full Text]

Personal Opinions and Ideology, Not “Science”

From Conscience and its Enemies: Confronting the Dogmas of Liberal Secularism

Robert P. George*

On September 11, 2008, the President’s Council on Bioethics heard testimony by Anne Lyerly, MD, chair of ACOG ‘s Committee on Ethics. Dr. Lyerly appeared in connection with the council’s review of her committee ‘s opinion (No. 385) entitled “Limits of Conscientious Refusal in Reproductive Medicine.” That opinion proposes that physicians in the field of women’s health be required as a matter of ethical duty to refer patients for abortions and sometimes even to perform abortions themselves .

I found the ACOG Ethics Committee ‘s opinion shocking and,  indeed, frightening. One problem was its lack of regard – bordering on contempt , really – for the sincere claims of conscience of Catholic, Evangelical Protestant , Orthodox Jewish , and other pro-life physicians and health-care workers. . .[Full text]

What role does Conscience play in Medical Ethics?

  • D. Vincent Twomey, SVD* | . . . conscience is assumed to be a purely subjective thing, a personal preference . . .that is fundamentally irrational. . . The sincerity of those who hold a subjective view of conscience is not in doubt. But is it enough? More importantly, what is wrong about that all-pervasive contemporary understanding of conscience? For the rest of this paper, I will concentrate on such a misunderstanding in the hope of clarifying what conscience in fact is. . . Full Text

Most Flemish physicians avoid euthanasia

Only 400 of 20,000 Flemish physicians are trained to provide euthanasia.  It appears that most physicians do not want to be directly involved with it.  In consequence, the 400 are called upon frequently to provide the required second opinion and sometimes the lethal injection.  There have been complaints that they are not paid for the second opinion. [Bioedge]  Confirming the reluctance of physicians to participate in the procedure, Dr. Sarah Van Laer complains that “there are too few doctors ready to perform euthanasia” and that this is a “badly underestimated problem.” [Bioedge]

Letter to General Medical Council (UK) re: conscientious objection to abortion

 Peter Saunders

When two Glasgow midwives won the right to opt out of supervising abortions last April I suggested that the General Medical Council (GMC) needed to revise its professional guidance on the matter which now seemed to be at odds with the law.

At the time Niall Dickson (pictured), the GMC’s chief executive, actually told the Guardian that the GMC would need to consider the implications of the judges’ decision on its guidance. He is quoted as saying:

We will study the outcome of this ruling, which has just come out, to see if there are any implications for our guidance. We already have clear guidance which says that doctors should be open with employers and colleagues so they can practise in accordance with their beliefs without compromising patient care.

As I have heard nothing further from the GMC about the matter, and almost two months have passed, I have today written to Mr Dickson to ask what is happening. [Full text]

 

Redefining the practice of medicine – Part 3

Winks and nods and euthanasia in Quebec

Re:  Bill 52: An Act respecting end-of-life care (June, 2013)

Sean Murphy*

Part 3: Working in the MAD matrix

Abstract

“Medical aid in dying” in Bill 52 (An Act respecting end-of-life care) will be transformed into euthanasia using the structures and powers established by other Quebec statutes governing the delivery of health care. These laws have established a multi-layered and overlapping bureaucracy. If Bill 52 passes, health care providers and others who want no part of euthanasia will find their working environments increasingly controlled by a MAD matrix functioning within this system.

The Minister for Social Services and Youth Protection may issue “policy directions” about euthanasia. Health care in every region in Quebec is delivered under the direction of a regional health and social service agency. In addition, local health and social services networks have been established. These will be expected to provide or facilitate euthanasia.

Almost all local community service centres, hospital centres or residential and long-term care centres will be required to offer euthanasia, as will rehabilitation centres, which serve developmentally disabled patients. Palliative care hospices and hospitals are not required to do so. Physicians associated with private health care facilities must not provide euthanasia unless authorized by a local health authority.

Policies, standards, codes of ethics, protocols, guidelines, directives, etc. can be used to normalize euthanasia, and disciplinary and complaints procedures can be used to force participation in it. Local complaints commissioners, the Health and Social Services Ombudsman and syndics (investigators) for professional orders could create considerable difficulty for objecting physicians.

Under Quebec’s Professional Code, the Physicians’ Alliance for Total Refusal of Euthanasia, the Euthanasia Prevention Coalition and other groups that oppose euthanasia might face substantial fines if they persist in encouraging or advising physicians not to participate in the procedure.

Physicians may refuse to provide euthanasia if the patient is legally ineligible, and for other reasons, including conscientious objection. Section 30 of the bill should be amended to avoid unnecessary conflict with objecting physicians. Section 44, the provision specific to conscientious objection, is inadequate. Further, patients may lodge complaints against physicians who refuse to provide or facilitate euthanasia with institutions and the regulatory authority, regardless of the reasons for refusal.

Despite the promise of immunity, some Quebec physicians may be unwilling to provide euthanasia while the criminal law stands, even if they do not object to the procedure. Similar reluctance might arise in regional health agencies, councils of physicians or other entities responsible for issuing MAD guidelines. Some might deliberately and obstinately interpret “medical aid in dying” to exclude killing patients, on the ground that the Act does not explicitly require or permit euthanasia, and the criminal law precludes such an interpretation.

Finally, objecting physicians might be able to appeal to the Public Protector, who is empowered to intervene “whenever he has reasonable cause to believe that a person or group of persons has suffered or may very likely suffer prejudice as the result of an act or omission of a public body.” [Full commentary]

Redefining the practice of medicine – Part 2

Winks and nods and euthanasia in Quebec

Re:  Bill 52: An Act respecting end-of-life care (June, 2013)

Sean Murphy*

Part 1: Bill 52 in detail

Abstract

An Act respecting end-of-life care (Bill 52) purports to establish a right to euthanasia for a certain class of patients by including it under the umbrella of “end-of-life care.” Those seeking euthanasia may not be near the end of their lives and may not be terminally ill, but they are apparently classed as “end-of-life patients” because they have chosen to end their lives.

Section 25 introduces a term not used by the medical profession, “terminal palliative sedation” (TPS). By this the Quebec government means an irreversible procedure intended to kill the patient slowly. Any patient is eligible for TPS, and a proxy can consent to it on behalf of an incompetent patient.

Section 26 permits patients to be killed quickly by “medical aid in dying”(MAD) if they are competent adult Quebec residents suffering from an incurable serious illness, in an advanced state of irreversible decline and suffering from constant and unbearable physical or psychological pain. The patient need not be terminally ill and is free to refuse effective palliative treatments.

A qualifying patient must personally make a written request for MAD “in a free and informed manner.” It must be signed in the presence of professional, who must also sign the request. The attending physician must confirm the eligibility of the patient and the free and informed nature of the request. He must verify the persistence of suffering and a continuing desire for euthanasia, speak to other members of the health care team and see that the patient is able to discuss the decision with others. However, the physician cannot advise family members unless the patient so wishes. Thus a physician may kill a patient without the knowledge of the family. Finally, the attending physician must obtain a written opinion of an independent physician confirming eligibility for euthanasia.

Only physicians may provide euthanasia (MAD), and, having done so, must “take care” of a patient until he dies. Physicians who provide TPS or MAD must report the fact to institutional authorities. They must report all euthanasia cases to the Commission on End-of-Life Care.

The Act appears to assume that the regulators will establish “clinical standards” for euthanasia but does not assign them a central role, making institutional authorities primarily responsible for it.

Canadian criminal law is not affected by the Act. It continues to apply to the killing of patients by physicians, but also to any act or omission done for that purpose, including the making and distribution of MAD guidelines and protocols.

First degree murder is defined as murder that is “planned and deliberate.” A physician who does what the Act requires will have provided excellent evidence that the killing was intentional, planned and deliberate. Conforming to the Act respecting end-of-life care would seem to increase the likelihood that a physician – and anyone counselling, aiding, abetting his act – could be charged and convicted for first degree murder, for which the punishment is life imprisonment without parole for 25 years. [Full commentary]

Redefining the practice of medicine – Part 1

Winks and nods and euthanasia in Quebec

Re:  Bill 52: An Act respecting end-of-life care (June, 2013)

Sean Murphy*

Part 1: Overview

Abstract

An Act respecting end-of-life care (Bill 52) is intended to permit physicians, in defined circumstances, to kill their patients as part of the redefined practice of medicine. However, the procedure cannot become part of medical practice in Quebec unless the medical profession itself (broadly speaking) formally accepts it as a form of health care.

The strategy of the Quebec government includes three key elements:

a) A statute that authorizes and allows the regulation of “medical aid in dying” (MAD) but does not define the term, so as to avoid conflict with the criminal law and constitutional challenges to the law;

b) Compliant medical regulators, professionals and health care authorities who are expected to define MAD to include euthanasia, thus establishing it as a legitimate aspect of health care;

c) Refusal to prosecute physicians who kill patients in accordance with MAD guidelines, thus circumventing the criminal prohibition of euthanasia.

While the federal government could, in theory, appoint and pay lawyers to act as prosecutors to enforce the criminal law, this would be especially contentious in Quebec and would involve political and practical problems. If Bill 52 passes, it seems unlikely that Quebec physicians who provide euthanasia under MAD guidelines will be prosecuted. The province formerly refused to enforce Canada’s criminal law on abortion for over twenty years, so a policy of refusing to prosecute physicians providing euthanasia could have similar staying power.

Though Bill 52 does not actually require or authorize the killing of patients, from a practical perspective, the text of the statute is a “mere technicality.” Nonetheless, it is not a mere technicality that the medical establishment and not the statute will have directed that patients can be killed in order to relieve their symptoms.

On the contrary: it is profoundly significant. Having formally approved of euthanasia, the medical establishment (meaning all of those who collaborate in drawing up MAD guidelines and protocols) will be at particular pains to defend and enforce the decision. In the end, freedom of conscience for Quebec health care workers who object to euthanasia may come to mean nothing more than the freedom to find another job, or the freedom to leave the province.  [Full commentary]

The attack on Western religions by Western law

Re-framing pluralism, liberalism and diversity

International Journal for Religious Freedom, Volume 6, Issue 1/2, 2013

Iain T. Benson*

Abstract

This paper discusses how law is increasingly being used to attack religious associations under the guise of “equality” advancement and “non-discrimination” restrictions. I explore two important insights: first that the concept of “transformation” has been distorted, to shelter approaches to law that fail to respect properly associational diversity. When misused, “transformation” seeks to change the moral viewpoints or religious beliefs of religious associations by force of law. Second, the paper discusses the expansion of law so that it becomes a threat to associations. The “goods of religion” and the “limits of law” need to be more widely recognized and understood both by religious communities and by those involved in law, politics and the media. These insights demonstrate how “equality activists” employ a rhetoric of “equality” to produce inequality, “diversity” to produce homogeneity and “non-discrimination” to discriminate against religious communities and religious beliefs. Several solutions for identifying these errors and resisting them are outlined in brief.[Full Text]