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The legislation proposed if the Eighth Amendment is repealed will oblige GPs and other healthcare professionals who conscientiously object to transfer care to another doctor and to inform the patient in writing that they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.

No legal “duty to refer” for euthanasia or assisted suicide anywhere in the world

 

Maurice Vellacott, MP
Saskatoon-Wanuskewin

For Immediate Release

OTTAWA – In anticipation of the possible striking down of Canada’s laws against euthanasia and assisted suicide (pending the Supreme Court’s decision in the Carter case), and given the College of Physicians and Surgeons of Ontario’s (CPSO’s) draft policy “Professional Obligations and Human Rights” [i] which, if passed, would require Ontario physicians to make referrals for controversial medical procedures regardless of their conscientious/religious convictions, Member of Parliament Maurice Vellacott today issued the following statement:

I am deeply concerned about the assault on the fundamental freedoms of Ontario’s doctors should CPSO’s policy forcing doctors to make referrals for morally objectionable “treatments” pass. If the Supreme Court of Canada strikes down Canada’s current laws on euthanasia or assisted suicide, then CPSO’s policy would mean Ontario’s physicians would have a “duty to refer” patients for treatments intended to kill the patient.

From the research I have conducted, with the help of the Library of Parliament, I have learned there is not a single jurisdiction in the world that forces doctors to violate their consciences through mandatory referrals for these life-ending “treatments.” (See attached list of laws in jurisdictions which have legalized euthanasia or assisted suicide.)

We all recognize it is criminally wrong to aid or abet the commission of a criminal act.[ii] In the same way, it would be morally wrong for a doctor to aid or abet (i.e. through referral) the commission of what that doctor deems to be an immoral act – in this case, intentionally killing, or assisting in the killing of, their patient. Following one’s conscience in the provision of euthanasia or assisted suicide, then, entails making a conscientious decision not only about performing euthanasia or assisted suicide, but also about making referrals for them.

The Canadian Medical Association has long been a defender of a physician’s freedom to abstain from being involved in morally objectionable procedures. Last August, the CMA clearly expressed its support for physicians’ freedom of conscience in the provision of euthanasia and assisted suicide should those acts ever be legalized.[iii]

In spite of no jurisdiction in the world imposing on physicians a legal duty to refer for euthanasia or assisted suicide, and in spite of the support for freedom of conscience by the national medical organization representing Canada’s physicians, we have the regulatory body in Ontario poised to punish physicians who act upon their moral guidance system that tells them that killing their patients is wrong.

Over the years, there have been repeated attempts by activists and special interest groups to impose their version of morality on all health care workers (almost succeeding in 2008 to convince CPSO to impose mandatory referral, until a loud public outcry from right across the country compelled CPSO to reverse course.) Such was the threatening climate that compelled me to introduce several private members bills, in successive Parliaments, that would protect health care workers who had conscientious objections to being involved in practices that deliberately take human life.

If the Supreme Court strikes down our laws against assisted suicide/euthanasia, then it will be up to Parliament to come up with a new law. It is clear from CPSO’s actions that we can’t leave it to the regulatory bodies to protect freedom of conscience. Any new law to regulate these life-ending medical procedures will need to include explicit protection for those health care workers who won’t take part in any action that aids or abets the killing of their patients.

– 30 –

For further information and comment, call (613) 992-1966 or (613) 297-2249; email: maurice.vellacott.a1@parl.gc.ca


Notes

[i] http://policyconsult.cpso.on.ca/wp-content/uploads/2014/12/Draft-Professional-Obligations-and-Human-Rights.pdf

[ii]http://laws-lois.justice.gc.ca/eng/acts/C-46/FullText.html

  1. (1) Every one is a party to an offence who
  • (a) actually commits it;
  • (b) does or omits to do anything for the purpose of aiding any person to commit it; or
  • (c) abets any person in committing it.

[iii] “Medical Association vows to protect conscience rights,” by Michael Swain, The Catholic Register, August 27, 2014, http://www.catholicregister.org/item/18703-medical-association-vows-to-protect-conscience-rights;  and Resolution adopted by General Council at 2014 AGM: “The Canadian Medical Association (CMA) supports the right of all physicians, within the bounds of existing legislation, to follow their conscience when deciding whether to provide medical aid in dying as defined in CMA’s policy on euthanasia and assisted suicide.” (https://www.cma.ca/Assets/assets-library/document/en/GC/Final-Resolutions-GC-2014-Confirmed-Nov-2014.pdf )

Conscientious objection to abortion: Catholic midwives lose in Supreme Court

UK Human Rights Blog

The Supreme Court recently handed down its judgment in an interesting and potentially controversial case concerning the interpretation of the conscientious objection clause in the Abortion Act 1967. Overturning the Inner House of the Court of Session’s ruling, the Court held that two Catholic midwives could be required by their employer to delegate to, supervise and support other staff who were involved in carrying out abortion procedures, as part of their roles as Labour Ward Co-ordinators at the Southern General Hospital in Glasgow.

We set out the background to the case and explained the earlier rulings and their ramifications on this blog here and here. The key question the Supreme Court had to grapple with the meaning of the words “to participate in any treatment authorised by this Act to which he has a conscientious objection” in section 4 of the 1967 Act.

The disappearing Article 9 argument

Somewhat frustratingly (at least from the perspective of the writers of a human rights blog!) an argument based around Article 9 of the European Convention – the right to freedom of thought, conscience and religion – was not really dealt with by the Supreme Court, despite having been trailed in the earlier court proceedings. Lady Hale JSC, who wrote the judgment with which the other Supreme Court Justices agreed, described the point as a “distraction” . . . [Full text]

 

Canadian doctors preparing for ‘all eventualities’ in case top court strikes down ban on assisted suicide

National Post

Sharon Kirkey

The nation’s largest doctors’ group is quietly preparing for possible changes in federal laws governing physician-assisted death, as support among its own members for medical aid in dying grows.

The Canadian Medical Association has consulted medical associations in jurisdictions around the world where euthanasia or assisted suicide is legal to devise possible protocols for Canada if the federal law is changed.

The powerful doctors’ lobby says it would be naïve not to prepare for “all eventualities” as the country awaits a Supreme Court of Canada ruling over whether the federal prohibition outlawing assisted suicide is unconstitutional.

“I think we’re looking at the possibility that the court will refer this back to the lawmakers,” said Dr. Jeff Blackmer, the CMA’s director of ethics.

The Supreme Court could strike down Canada’s ban on assisted suicide and give Parliament one year to craft new legislation, as it did with prostitution.

“They could suggest some framework from the bench that we might want to be in a position to comment on fairly quickly. Or there could be a long period for reflection and committee hearings that we would want to be prepared for,” Blackmer said. “We’re preparing for all eventualities, and that [a lifting of the ban] is absolutely one of them.”

If there is a change in law, Blackmer said doctors opposed to physician-assisted death “will be looking to us for protection of their conscience and their right not to participate.” . . . [Full text]

 

Proposed policy of Ontario College of Physicians “appalling”

Medscape

Reproduced with permission of the author

Dr. Terence McQuiston, M.D.

Dr. Gabel is not alone in this opinion, but I find it nevertheless appalling. Ever since Hippocrates medical ethics were determined by our profession independently of government legislation (including human rights tribunals). We Canadians stood in judgement at Nuremberg over the German physicians of the Nazi period.

Their defense was that they had done nothing outside of the law (true). However, we took the view that ethics transcend and should inform legislation, not the other way around, and therefore we could hold them to account for their deeds.

Such transcendence of ethics is only possible by the exercise of conscience by all physicians. Granted there may be differences arising from this exercise, but we should do our best to accommodate these differences.

That’s why we permit conscientious objection in wartime. Individual conscience is too precious a part of our social fabric to be casually overridden. The policy defended by Dr. Gabel in effect puts conscience on ice. If euthanasia becomes legal, I for one still won’t do it.


This comment responds to the Medscape article “Doctors opposing draft abortion policy may need to rethink whether family practice is right for them, says CPSO official: Direct referrals a sticking point in Ontario’s human rights policy (17 December, 2014)  Dr. Marc Gabel was quoted to the effect that physicians unwilling to provide or facilitate abortion and contraception should not practice family medicine. Administrator

 

 

Catholic midwives’ abortion ruling overturned by supreme court

 Judges rule against Mary Doogan and Concepta Wood, who brought case objecting to any involvement in abortions

The Guardian

Libby Brooks

The UK’s supreme court has ruled that two Catholic midwives do not have the right to refuse to help other nurses with abortion procedures or planning.

Upholding an appeal by Greater Glasgow health board, the court found that Mary Doogan, 58, and Concepta Wood, 52, who worked as labour ward co-ordinators at the southern general hospital in Glasgow, did not have a legal right to object to helping with abortions in any way.

As conscientious objectors, the senior midwives have had no direct role in pregnancy terminations, but they argued that they should also be entitled to refuse to delegate, supervise and support staff involved in the procedures or providing care to patients during the process.

Reproductive rights campaigners were concerned that a decision by the court of session in Edinburgh in favour of the women’s case last year could have wide-ranging implications for the way the NHS dealt with other health staff who opposed abortions on religious grounds. . . [Full text]

 

Catholic midwives must supervise abortions, Supreme Court decides

Catholic midwives Mary Doogan and Connie Wood lose case against being made to supervise other staff carrying out abortions

The Telegraph

Patrick Sawer

Two Catholic midwives who refused to take part in any abortion procedures have lost their legal battle to be treated as ‘conscientious objectors’.

The UK’s highest court overturned a previous ruling made in favour of the two midwives, after a Scottish health authority urged it to overturn last year’s decision of the Court of Session, in Edinburgh, in the case of Mary Doogan and Connie Wood.

The ruling is likely to mean that Ms Doogan and Ms Wood will now have to supervise abortions carried out by other staff, as part of their terms of employment, although they will still be free to refuse to carry out the terminations themselves.

The case centres on the scope of the right to conscientious objection under the Abortion Act 1967, which provides that “no person shall be under any duty … to participate in any treatment authorised by this Act to which he has a conscientious objection”. . . [Full text]

 

Midwives ‘forced to leave profession because they refuse to partake in abortions’

The UK’s highest court ruled on the matter this morning.

The Journal.ie

TWO MIDWIVES WHO do not want to partake in any abortion services in the UK have been told they must still delegate, supervise and support other staff.

The ruling was made by the UK’s highest court today, overruling a previous judgement that found in favour of the nurses.

Concepta Wood and Mary Doogan are both conscientious objectors and have been labelled in the British media as “Catholic midwives” since they began their legal challenge seven years ago. . . [Full text]

Supreme Court rules against Glasgow midwives

Midwives, Archbishop of Glasgow and SPUC react to decision announced this morning that fails to protect their right to conscientiously object to supervising abortion

Scottish Catholic Observer

Ian Dunn

The Supreme Court has ruled two Glasgow Catholic midwives cannot conscientiously object to supervising abortions performed on labour wards.

Mary Doogan and Connie Wood, the midwives in the case, commented on the ruling, releaed this morning to say the they were ‘saddened and extremely disappointed with the verdict’ and suggested it will have a substantial ‘detrimental effect’  on ‘staff of conscience throughout the UK.’

“Despite it having been recognised that the number of abortions on the labour ward at our hospital is in fact a tiny percentage of the workload, which in turn could allow the accommodation of conscientious objection with minimal effort, this judgment, with its constraints and narrow interpretation, has resulted in the provision of a conscience clause which now in practice is meaningless for senior midwives on a labour ward,” they said. . . [Full Text]

 

Good News and Bad News

Presentation to the Catholic Physicians’ Guild of Vancouver

North Vancouver B.C.

Sean Murphy *

Introduction

Thank you for inviting me to speak this evening. I have never been asked to give a three hour presentation to a group of physicians. You will be relieved to know that I have not been asked to do that tonight.

Those of you who saw the BC Catholic headline may have been expecting a “lecture on medical ethics,” but, thanks to Dr. Bright’s introduction, you now know that I am an administrator, not an ethicist, and that my topic is freedom of conscience in health care.

Protection of Conscience Project

The Protection of Conscience Project will be 15 years old this December. Although a meeting sponsored by the Catholic Physicians Guild provided the impetus for its formation, the Project is a non-denominational initiative, not a Catholic enterprise. Thus, if I mention the Catholic Church or Catholic teaching tonight, it will be as an outsider, as it were, though an outsider with inside information.

One more thing: the Project does not take a position on the acceptability of morally contested procedures like abortion, contraception or euthanasia: not even on torture. The focus is exclusively on freedom of conscience.

Context

Supreme Court of Canada, OttawaThe context for my presentation is provided by the passage of the Quebec euthanasia law1 and the pending decision in Carter v. Canada in the Supreme Court.2 Physicians are now confronted by the prospect that laws against euthanasia and physician assisted suicide will be struck down or changed. If that happens, what does the future hold for Catholic physicians and others who share your beliefs?

Will you be forced to participate in suicide or euthanasia?

If you refuse, will you be disadvantaged, discriminated against, disciplined, sued or fired?

Will you be forced out of your specialty or profession, or forced to emigrate if you wish to continue in it?

What about those who come after you? If you avoid all of these difficulties, will they?

In sum, will freedom of conscience and religion for health care workers be protected if assisted suicide and euthanasia are legalized? [Full Text]