Dr. Coelho’s ‘crazy’ battle for conscience rights

The Catholic Register

Michael Swan

It’s not surprising patients fall in love with Dr. Ramona Coelho. Not just because she’s a young, pretty doctor who smiles easily, laughs frequently and focuses her attention completely on whoever is talking to her.

Her patients in London, Ont., know that she’s a doctor who is in it for something more than the status, money or security attached to most medical practices.

“I love my work,” Coelho confesses. “I love being a doctor. I love helping people and being with them — trying to find solutions for them.”

Her practice is heavily slanted to marginalized patients. Her waiting room is full of refugees, ex-cons, the poor. Many of her patients are on permanent disability.

All that is at risk as the College of Physicians and Surgeons of Ontario mounts an ever more prickly defense of its “Professional Obligations and Human Rights Policy.” The policy is currently before the courts. It would force Ontario doctors to refer for abortions and for assisted suicide.  . . [Full text]

Referrals for Services Prohibited In Catholic Health Care Facilities

persp-sex-repro-healthAbstract:

  • Context | Catholic hospitals control a growing share of health care in the United States and prohibit many common reproductive services, including ones related to sterilization, contraception, abortion and fertility. Professional ethics guidelines recommend that clinicians who deny patients reproductive services for moral or religious reasons provide a timely referral to prevent patient harm. Referral practices in Catholic hospitals, however, have not been explored.
  • Methods | Twenty-seven obstetrician-gynecologists who were currently working or had worked in Catholic facilities participated in semistructured interviews in 2011–2012. Interviews explored their experiences with and perspectives on referral practices at Catholic hospitals. The sample was religiously and geographically diverse. Referral-related themes were identified in interview transcripts using qualitative analysis.
  •  Results | Obstetrician-gynecologists reported a range of practices and attitudes in regard to referrals for prohibited services. In some Catholic hospitals, physicians reported that administrators and ethicists encouraged or tolerated the provision of referrals. In others, hospital authorities actively discouraged referrals, or physicians kept referrals hidden. Patients in need of referrals for abortion were given less support than those seeking referrals for other prohibited services. Physicians received mixed messages when hospital leaders wished to retain services for financial reasons, rather than have staff refer patients elsewhere. Respondents felt referrals were not always sufficient to meet the needs of low-income patients or those with urgent medical conditions.
  •  Conclusions | Some Catholic hospitals make it difficult for obstetrician-gynecologists to provide referrals for comprehensive reproductive services.

Stulberg DB, Jackson  RA, Freedman LR.  Referrals for Services Prohibited In Catholic Health Care Facilities. Perspect Sex Repro H, 48:111–117. doi:10.1363/48e10216

ACLU loses case to force Catholic hospital to perform abortions

LifeSite News

Ben Johnson

DETROIT, April 11, 2016 (LifeSiteNews) – A Michigan judge has thrown out the ACLU’s lawsuit attempting to force a nationwide chain of Catholic hospitals to perform abortions.

The U.S. District Court for the Eastern District of Michigan, Southern Division dismissed the case, saying the liberal legal organization lacks standing to sue.

The ACLU filed suit against Trinity Health Corporation, which operates 86 health care facilities in 21 states nationwide, last October because Trinity – a Catholic institution – abides by the U.S. Bishops’ Ethical and Religious Directives (ERDs), which bar physicians from taking unborn human life. . . [Full text]

 

When Policy Produces Moral Distress: Reclaiming Conscience

 Hastings Center Report

Nancy Berlinger

Abstract

For too long, bioethics has followed law in reducing “conscience” to “conscientious objection,” in other words, to laws and policies permitting and protecting refusal. In “Reframing Conscientious Care: Providing Abortion Care When Law and Conscience Collide,” Mara Buchbinder and colleagues draw our attention to one dimension of the problem of reducing conscience to refusal to provide certain forms of medical care: what about the conscience problems experienced by the professionals who are attempting to provide safe, effective health care that includes services that others associate with conscientious objection? In seeking to disrupt a specific medical practice – one that is legal, desired by the patient, and conducted in accordance with medical standards – North Carolina House Bill 854, The Women’s Right to Know Act, and laws like it, appear to be designed to produce moral distress in physicians and other professionals involved in the provision of abortions. For abortion providers in North Carolina and other states, conscientious objection to the mandates of laws like HB 854 isn’t a realistic option. So what can bioethics offer to professionals bound by such laws? We can start by reclaiming the idea of “conscience” as something that can say “yes” to providing health care.

Berlinger, N. (2016), When Policy Produces Moral Distress: Reclaiming Conscience. Hastings Center Report, 46: 32–34. doi: 10.1002/hast.547 [Full text]

 

Conscience, Courage, and “Consent”

Hastings Center Report

Mark A. Hall, Nancy M. P. King

Abstract

How should we think about physicians who object to what law in North Carolina and many other states requires them to tell patients seeking legal abortions? A federal appellate court helped to place this situation in perspective when it struck down the part of the Woman’s Right to Know Act, North Carolina’s mandatory informed consent statute for abortions, that required physicians to show such patients real-time ultrasound images of their fetuses and describe the stage of fetal development. In this court’s view, the state’s WRTK Act forces physicians to express a viewpoint that may be contrary to their medical judgment. Moreover, the ultrasound-viewing provision “simultaneously threaten[s] harm to the patient’s psychological health, interfer[es] with the physician’s professional judgment, and compromis[es] the doctor-patient relationship.” The court continued, “Transforming the physician into the mouthpiece of the state undermines the trust that is necessary for facilitating healthy doctor-patient relationships, and through them, successful treatment outcomes.” Based on this reasoning, the court invalidated the ultrasound-viewing portion of the statute, but the other provisions remain in effect, mandating a long list of disclosures; similar laws exist in many other states.

In this essay, we want to consider what the abortion legislation says about the state’s regard for professional judgment. At the same time that these laws threaten patient trust in physicians – a point Mara Buchbinder and colleagues explore in “Reframing Conscience: Providing Abortion Care When Law and Conscience Collide” (in this same issue of the Report) – the laws display a deep-seated distrust by government in the integrity of medical professionals. The WRTK statute bristles with measures that control physicians’ interactions with patients. In addition to the most egregious example of coerced display and discussion of live ultrasound images, which has now been invalidated, this statute and others like it script in great detail what treating physicians must say to patients in specified settings at prescribed times.

Hall, M. A. and King, N. M. P. (2016), Conscience, Courage, and “Consent”. Hastings Center Report, 46: 30–32. doi: 10.1002/hast.546 [Full text]

 

Reframing Conscientious Care: Providing Abortion Care When Law and Conscience Collide

Hastings Center Report 

Mara Buchbinder, Dragana Lassiter, Rebecca Mercier, Amy Bryant, Anne Drapkin Lyerly

Abstract

“It’s almost like putting salt in a wound, for this person who’s already made a very difficult decision,” suggested Meghan Patterson (an alias), a licensed obstetrician-gynecologist whom we interviewed in our qualitative study of the experiences of North Carolina abortion providers practicing under the state’s Woman’s Right to Know Act (House Bill 854; 2011). The act requires that women receive counseling with state-mandated information at least twenty-four hours prior to obtaining an abortion. After the law was passed, Patterson worked with clinic administrators, in consultation with a lawyer, to write a script to be used in the state-mandated counseling procedure. She and her colleagues took particular steps to mitigate the effects of what she described as HB 854’s “forced language” – such as referring to the “father of the child.” While HB 854 stipulated that patients must be informed of the medical risks associated with the particular abortion procedure as well as those of carrying the child to term, Patterson’s script made explicit the magnitude of comparative risks, emphasizing that the risks of carrying a pregnancy to term are substantially greater than the risks of an early-term abortion. She felt that these contextualization strategies helped to facilitate trust and rapport in a clinical care situation that proved relationally and morally challenging.

In this article, we take up and expand on this point by elucidating an empirically grounded approach to ethically justified care when health care providers face legal or institutional policy mandates that raise possible moral conflicts. Our approach builds on recent bioethics discourse addressing conscience in the practice of medicine. While the concept of conscience has broad philosophical underpinnings relating to moral judgment, agency, and discernments of right and wrong, debates in bioethics have tended to engage the concept primarily vis-à-vis rights of conscientious objection or refusal. Here, we suggest a broader frame for thinking about claims of conscience in health care. Our approach draws on the feminist bioethics and the ethics of care literatures to highlight how providers may be motivated by matters of conscience, including relational concerns, in the active provision of certain forms of care. What emerges are two possibilities: not only conscientious refusal to comply with a policy mandate but also conscientious compliance – working conscientiously within a mandate’s confines.

Buchbinder, M., Lassiter, D., Mercier, R., Bryant, A. and Lyerly, A. D. (2016), Reframing Conscientious Care: Providing Abortion Care When Law and Conscience Collide. Hastings Center Report, 46: 22–30. doi: 10.1002/hast.545 [Full text]

 

Nurses Cannot be Good Catholics

BMJ Blogs

John Olusegun Adenitire

It seems that if you are a nurse you cannot be a good Catholic.  Or, better: if you want to work as a nurse then you might have to give up some of your religious beliefs.  A relatively recent decision of the UK Supreme Court, the highest court in the country, seems to suggest so.  In a legal decision that made it into the general press (see here), the Supreme Court decided that two Catholic midwives could not refuse to undertake administrative and supervisory tasks connected to the provision of abortions.

To be sure, no one asked the nurses to directly assist in the provision of abortions.  The Abortion Act 1967 says that “No person shall be under any duty … to participate in any treatment authorised by this Act to which he has a conscientious objection.”  The Nurses argued that this provision of the Act should be understood widely.  Not only should they be allowed to refuse to directly assist in abortion services: they should also be entitled to refuse to undertake managerial and supervisory tasks if those were linked to abortion services.  The nurses’ employer was not impressed; neither was the Supreme Court which ruled that the possibility to conscientiously object only related to a ‘hands-on’ capacity in the provision of abortion services. . . [Full text]

 

UN Special Rapporteur Favours of a Right to Conscientious Objection

News Release 

European Centre for Law and Justice

On the occasion of a conference organized by the ECLJ at UN headquarters in Geneva, Professor Heiner Bielefeldt, the UN Special Rapporteur on Freedom of Religion or Belief, spoke in favor of the right of medical staff to refuse to participate in performing an abortion or euthanasia. He mentioned the case of a midwife who was harshly sentenced in Sweden for having refused to participate in an abortion and was forced into “professional exile.”

He considers that this right, based on freedom of conscience, should extend to the medical staff directly involved in the matter, as long as their objection is well-founded on a strong and deep conviction. . . [Full text]

 

Submission to the College of Physicians and Surgeons of Nova Scotia

Re: Standard of Practice: Physician Assisted Death

Abstract

The Project considers the proposed standard of practice satisfactory with respect to the accommodation of physician freedom of conscience and respect for the moral integrity of physicians. Neither direct nor indirect participation in euthanasia and assisted suicide is required.

The Project offers simple and uncontroversial recommendations to avoid conflicts of conscience associated with failed assisted suicide and euthanasia attempts and urgent situations.

The standard does not adequately address the continuing effects of criminal law. The College has no basis to proceed against physicians who, having the opinion that a patient does not fit one of the criteria specified by Carter, refuse to do anything that would entail complicity in homicide or suicide. College policies and expectations are of no force and effect to the extent that they are inconsistent with criminal prohibitions.

While the standard is satisfactory with respect to freedom of conscience, the fundamental freedoms of physicians in Nova Scotia will remain at risk as long as the College Registrar and others persist in the attitude and intentions demonstrated in his presentation to the Special Joint Committee on Physician Assisted Dying.


Contents

I.    Outline of the submission

II.    Avoiding foreseeable conflicts

II.1    Failed assisted suicide and euthanasia
II.2    Urgent situations
II.3    Project recommendations

III.    SPPAD and criminal law

IV.    Remarks of the Registrar

IV.1    The Registrar before the Special Joint Committee on Physician Assisted Dying
IV.2    The Registrar, the Conscience Research Group, and “effective referral”
IV.3    The Registrar’s intentions
IV.4    The Registrar’s complaint
IV.5    An ethic of servitude, not service

V.    Conclusion

Appendix “A”    Supreme Court of Canada, Carter v. Canada (Attorney General), 2015 SCC 5

A1.    Carter criteria for euthanasia and physician assisted suicide
A2.    Carter and the criminal law
A3.    Carter and freedom of conscience and religion

Appendix “B”    Conscience Research Group

B1.    Attempts to coerce physicians: abortion
B2.    Plans to coerce physicians: assisted suicide and euthanasia
B3.   Plans to coerce physicians: the CRG Model Policy
B4.    CRG convenes meeting with College representatives

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