Physician, expert in Jewish medical ethics joins Protection of Conscience Project Advisory Board

News Release

For immediate release

Protection of Conscience Project

Professor Shimon Glick, MD,  of the Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel, has joined the Protection of Conscience Project Advisory Board.

Professor Glick was born in Brooklyn in 1932 and received his medical training in the United States, specializing in internal medicine and endocrinology. He immigrated to Israel in 1974 to become a founding member of the Faculty of Health Sciences (FOHS) at Ben Gurion University of the Negev and head of the Internal Medicine Department at Soroka Medical Center. He and his colleagues instituted the practice of “early clinical exposure,” insisting that students meet patients in their first week at medical school, even before beginning traditional academic studies. “The students don’t just treat patients. They talk to them and learn what it’s like to be sick,” he explains. Students also take their medical or Hippocratic oath when they begin their studies, rather than taking the oath when they finish.

Professor Glick became chair of Israel’s first Internal Medicine Division and served as Dean of the FOHS between 1986 and 1990. During his tenure, he played a key role in formulating the admissions process for medical students – a process based not only on achievements but also the candidates’ character. Professor Glick headed the Prywes Center for Medical Education and the Jakobovits Center for Jewish Medical Ethics, two domains that were assigned a central role in the professional education of students in the Faculty. He was also instrumental in the instruction on doctor-patient communications for first year medical students. In addition, Professor Glick has served as ombudsman for Israel’s Ministry of Health. He is widely recognized as an expert in medical ethics, with a particular focus on Jewish medical ethics, and is at the forefront of the efforts to bring a Jewish perspective to bear on the most important issues of modern bioethics.

In 2014, in recognition of his contributions to medical education and practice, Professor Glick received a Lifetime Achievement Award as part of the Nefesh B’Nefesh Bonei Zion Awards. The award recognizes outstanding Anglo Olim – veteran and recent – who encapsulate the spirit of modern-day Zionism by contributing in a significant way towards the State of Israel.

Professor Glick is blessed with 46 grandchildren and (at last count) 77 great grandchildren.  He continues to teach at the Joyce and Irving Goldman Medical School and the Medical School for International Health (MSIH).  [Faculty Profile]

 

Pharmacist freedom of conscience recognized in British Columbia

LifeSite News

Steve Weatherbe

VANCOUVER, British Columbia, March 9, 2017 (LifeSiteNews) – Christian pharmacists in British Columbia can now practice with a clear conscience.

Under the B.C. College of Pharmacy’s new ethics code, they cannot be forced to prescribe for abortions, euthanasia, or artificial contraception.

Cristina Alarcon, a Vancouver-area community pharmacist who was a driving force behind the new code, says it “covers everything.” For the first time, pharmacists can refuse to dispense any prescription that violates their conscience.

 

Project Submission to the College of Physicians and Surgeons of Ontario

 Re: Professional Obligations and Human Rights


Abstract

The focus of this submission about Professional Obligations and Human Rights (POHR) is its demand for “effective referral” – the demand that physicians do what they believe to be wrong – even gravely wrong – even arranging homicide or suicide – and the implied threat that they will be punished if they refuse.

This is a dangerous and extraordinarily authoritarian policy, completely at odds with liberal democratic aspirations and our national traditions. The burden of proof is on the working group to prove beyond doubt that it is justified and that no reasonable alternatives are available. The working group has not done so.

The working group provided no evidence that such a policy is necessary, and there is evidence that it is not. The briefing materials supplied to Council in support of POHR were not only seriously deficient, but erroneous and seriously misleading. “Public sentiment” captured by a random poll does not justify the suppression of fundamental freedoms, and the results of consultation, when carefully considered, suggest that a policy of “effective referral” is highly controversial.

An example of a reasonable alternative is available from the Australian Medical Association – an example not offered to Council members by the working group, which, instead, completely misrepresented AMA policy.

This submission, supported by detailed analysis in the appendices, provides good reason for Council members to doubt that the requirement for effective referral in POHR is necessary or justifiable, or prudent policy. It also provides reason for them to believe that reasonable alternatives can be developed.

Council members unpersuaded by the working group or left in doubt about POHR should give the benefit of doubt to freedom of conscience and refuse to approve the draft policy in its present form. They should direct the working group to collaborate with those opposed to the present draft to produce a broadly acceptable text. If the real goal is to ensure access – not ideologically driven ethical cleansing – there is no reason to demand that physicians do what they believe to be wrong. If the College’s real goal is to ensure access to services – not to punish objecting physicians, or drive them out of family practice, or out of the profession – that goal is best served by connecting patients with physicians willing to help them.

Contents

  1. Introduction
  1. Reasons for doubt

III.    POHR in practice

  1. Giving freedom of conscience the benefit of the doubt
  2. Conclusion

Appendix “A”:  The Review Process

Appendix “B”:  Unreliability of Jurisdictional Review by College Working Group

Appendix “C”:  Consultation on Physicians and the Human Rights Code

Appendix “D”: A Case for Evidence-based Policy Making

Appendix “E”: Legal Criticism

Full text available on line at http://www.consciencelaws.org/publications/submissions/submissions-013-001-cpso.aspx.

Looking back on 15 years: an anniversary

December, 1999 to December, 2014

Sean Murphy*

The Protection of Conscience Project celebrates its 15th anniversary in December, 2014. The formation of the Project was one of the eventual results of a meeting in Vancouver with British Columbian Senator Ray Perrault1 in the spring of 1999.

Senator Perrault wished to continue the work of retiring Liberal Senator, Stanley Haidasz, whose protection of conscience bill was stalled in the upper chamber.2 Among the experiences that spurred Senator Perrault to continue Senator Haidasz’s work was an encounter while going door to door during an election campaign. A nurse, in tears, told him that she had quit work after 15 years because she was required to participate in abortions, and could no longer do so in good conscience.

The meeting was sponsored by the Catholic Physicians Guild of Vancouver. Most participants were physicians or pharmacists. They spoke of their growing concern that they would be penalized or forced out of their professions if they continued to practise in accordance with their religious or moral beliefs. It became clear that these health care professionals had come to recognize the growing threat to their freedom to serve their patients without violating their personal and professional integrity. This was a key factor in the establishment of the Protection of Conscience Project nine months later.

While the meeting in 1999 was called by a Catholic organization, the Protection of Conscience Project is a non-profit, non-denominational initiative that 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 and religion.

The Project is supported by an Advisory Board drawn from different disciplines and religious traditions, a Human Rights Specialist and an Administrator, all of whom serve without remuneration.3 It was conceived as an initiative rather than an organization, association or society; it has no ‘members’ or structures of an incorporated entity. This ensures that the time and energy that would otherwise be needed to maintain corporate structures is spent on more immediately practical work. The name originated in a comment made by Iain Benson, then Senior Research Fellow of Canada’s Centre for Cultural Renewal, now Senior Resident Scholar, Massey College, University of Toronto.4

“We don’t need another organization,” he said. “We need a project.”  [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]

Project Submission to the College of Physicians and Surgeons of Ontario

Protection of Conscience Project

Re: Physicians and the Ontario Human Rights Code

Abstract [Français]

The Ontario Human Rights Commission made a serious error in 2008 when it attempted to suppress freedom of conscience and religion in the medical profession on the grounds that physicians are “providers of secular public services.” In its public perpetuation of this error, the Commission has contributed significantly to anti-religious sentiments and a climate of religious intolerance in Ontario. Both were on display earlier this year when it became front page news and a public scandal that three physicians had told their patients that they would not recommend, facilitate or do what they believed to be immoral, unethical, or harmful.

The physicians had followed the guidelines of the Canadian Medical Association and the College of Physicians and Surgeons of Ontario. Physicians must advise patients about treatments or procedures they are unwilling to recommend or provide for moral or religious reasons, so that patients can seek the services elsewhere. Physicians are not required help patients obtain services or procedures they believe to be wrong.

The arrangement is a compromise that safeguards the legitimate autonomy patients and preserves the integrity of physicians, but it has been continually attacked by activists who want to compel objecting physicians to provide or facilitate abortion and contraception, and, lately, euthanasia. Essentially, the activists assert that physicians have a duty to do what they believe to be wrong because they must not act upon their moral or religious beliefs.

However, it is incoherent to include a duty to do what one believes to be wrong in a code of ethics, the very purpose of which is to encourage physicians to act ethically and avoid wrongdoing. Moreover, one cannot practise medicine without reference to beliefs, whether they reflect a secular ethic or a religious one, and neither a secular ethic nor a religious ethic is morally neutral. Thus, demands that physicians must not act upon their beliefs or must practise medicine in a morally “neutral” fashion are unacceptable because they are impossible.

The demand that physicians must not act upon religious beliefs because medical practice is a secular profession is unacceptable because it is erroneous. The Supreme Court of Canada has acknowledged that a secular society is not faith-free; it includes both religious and non-religious believers, and rational democratic pluralism must make room for them all. The full bench of the Court has warned that to disadvantage or disqualify the exercise of religiously informed conscience in public affairs is an illiberal distortion of liberal principles that offers “only a feeble notion of pluralism.”

If it is legitimate to compel religious believers to do what they believe to be wrong, then it is equally legitimate to compel non-religious believers to do what they think is wrong; everyone would have a duty to do what is believed to be wrong.

Hence, the compromise worked out by the Canadian Medical Association not only safeguards the integrity of physicians and legitimate autonomy of patients, but protects the community against the temptation to give credence to a dangerous idea: that a learned or privileged class, a profession or state institutions can legitimately compel people to participate in what they believe to be wrong – even gravely wrong – even murder – and punish them if they refuse.

Freedom of conscience and freedom of religion are subject to reasonable limitations, but the mantra, “the freedom to hold beliefs is broader than the freedom to act on them”  is inadequate. More refined distinctions are required to address the difficulties that arise in a pluralist democracy. One of them is the distinction between the two ways in which freedom of conscience is exercised: by pursuing good and avoiding evil. There is a significant difference between preventing people from doing the good that they wish to do and forcing them to do the evil that they abhor.

As a general rule, it is fundamentally unjust and offensive to force people to support, facilitate or participate in what they perceive to be wrongful acts; the more serious the wrongdoing, the graver the injustice and offence. It is a policy fundamentally opposed to civic friendship, which grounds and sustains political community and provides the strongest motive for justice. It is inconsistent with the best traditions and aspirations of liberal democracy.  And it is dangerous, since it instills attitudes more suited to totalitarian regimes than to the demands of responsible freedom.

This does not mean that freedom of conscience exercised to preserve personal integrity can never be limited. It does mean, however, that even the strict approach taken to limiting other fundamental rights and freedoms is not sufficiently refined to be safely applied here. Like the use of potentially deadly force, if the restriction of preservative freedom of conscience can be justified at all, it will only be as a last resort and only in the most exceptional circumstances.

When the College of Physicians and Surgeons of Ontario receives complaints from patients who have been unable to obtain services they want, the College should help connect the patients with willing service providers. That would be more helpful than attempting to suppress freedom of conscience and religion in the medical profession. [Full Text]

Impartiality, complicity and perversity

 Sean Murphy*

Impartiality, complicity and perversityBenjamin Veness weighs in on behalf of the Australian Medical Students’ Association (AMSA) to demand that physicians who believe abortion is wrong should be forced to direct patients to a colleague willing to provide it (“Abortion need not be doctor’s dilemma too.” Sydney Morning Herald, 16 November, 2013).

He and medical students who share his views believe that Victoria’s abortion law is the model that ought to apply throughout Australia.  It follows from this that they believe that any Australian physician who refuses to help a patient find someone willing to do a sex selective abortion should be struck from the medical register or otherwise disciplined.

Mr. Veness correctly believes that this would be consistent with Victoria’s abortion law, and he is hardly alone in believing that physicians who refuse to facilitate abortion for reasons of conscience should be disciplined or expelled from the profession.

However, he and the students whom he represents are mistaken in their assumption that a physician who is morally opposed to abortion – whether in principle, or because he has more limited moral objections to practices like sex selective abortion – is not capable of providing information about the procedure and legal options available to a patient.  In fact, many physicians opposed to abortion are quite willing to do so for the very reasons given by Mr. Veness: that the patient may ultimately decide not to go ahead with it.

More remarkable is the fact that the outlook of Mr. Veness and the Australian Medical Students’ Association suggests that only people willing to do what they believe to be gravely wrong ought to become physicians.  Whether or not this is a condition for membership in the AMSA Mr. Veness does not say, but it is not a policy conducive to the ethical practice of medicine.

What is most striking is Mr. Veness’ belief that only physicians willing to facilitate or provide abortions are “impartial,” as if the judgement that an abortion ought to be provided does not involve a moral judgement.  A conviction that abortion is (or can be) a good thing is just as “partial” as the opposite conviction of an objecting physician.  Mr. Veness’ mistaken notion of what it means to be “impartial’ is evidence that he and the AMSA are anything but.

For some physicians, referral is an acceptable strategy for avoiding complicity in what they hold to be wrong or at least morally questionable.  Others find it unacceptable because they believe that referral and other forms of facilitation actively enable wrongdoing and make them parties to it.  Mr. Veness and the AMSA may dispute this, but it is hardly a novel idea.  It is reflected, for example, in Section 45 of the ACT Criminal Code (Complicity and common purpose).1

More relevant, perhaps, is the broad definition of “participation” developed by the American Medical Association in its prohibition of physician participation in capital punishment. This includes “an action which would assist, supervise, or contribute to the ability of another individual to directly cause the death of the condemned,” and even giving advice.2

Lest the connection with capital punishment be thought out of place here, Australian medical students and physicians should take note that the arguments used to compel objecting physicians to provide or facilitate abortion are the same ones used by euthanasia advocates who would  force physicians to lethally inject their patients, or help them find someone who will.  That has been obvious in Belgium from the beginning,3 and it has been equally evident in Canada,4 most recently in Quebec.5

What is gradually becoming clear is that policies and laws devised to ensure the “accessibility” of abortion by suppressing freedom of conscience among health care workers lead ultimately to a perverse conclusion: that one can be forced to do what one believes to be gravely wrong, even if that means killing someone else, or finding someone who is willing to do the killing.  That conclusion is profoundly inconsistent with principles that ought to inform the laws and policies of a liberal democracy.

Notes

1.  Australian Capital Territory, Criminal Code 2002. (Accessed 2013-11-15)

2.  American Medical Association, Policy E-2.06 Capital Punishment (June, 2000) (Accessed 2013-11-15)

3.  Murphy, Sean. Belgium: Mandatory referral for euthanasia.

4.  A panel of the Royal Society of Canada recommended legalization of assisted suicide/euthanasia. The panel stated that, since physicians who are unwilling to provide what it delicately termed “certain reproductive health services” are obliged to refer patients to others who will (a contested assertion), physicians who refuse to provide (legal) euthanasia or assisted suicide for patients “are duty-bound to refer them in a timely fashion to a health care professional who will.” Report of the Royal Society of Canada Expert Panel, End of Life Decision Making.  November, 2011, p. 61-62 (Accessed 2011-12-31).

5.  Hearings were held recently by a committee of the Quebec National Assembly concerning a bill to legalize euthanasia by physicians.  State regulators of the professions of medicine, nursing and pharmacy all stated that their codes of ethics (developed as a result of controversies about abortion and birth control) require objecting professionals to refer or find colleagues willing to provide the service(s) to which they object.  It is clear that they mean to apply the same rule to euthanasia, although it is equally clear that this causes some of them some discomfort.  See, for example, the statement of Charles Bernard on behalf of the College of Physicians of Quebec (Consultations & hearings on Quebec Bill 52: College of Physicians of Quebec. Tuesday 17 September 2013 – Vol. 43 no. 34, T#154

Quebec’s Charter of Values: Preliminaries to the Charter

Implications of state sovereignty over education, religion and
ethics

 Sean Murphy*

 Introduction

It appears from Quebec government policy documents describing its proposed Charter of Values (the precise language of which has yet to be released) that it considers physicians and other health care workers to be state functionaries because they are engaged in the delivery of “public” health care.  As state functionaries, they will be forbidden to wear noticeable religious symbols or clothing, unless local authorities exempt them from this restriction.

However, no exemptions will be allowed to parts of the Charter that will impose secularism and restrict accommodation of religious beliefs.  These are central government policies that are to be enacted through the Charter of Values and related legislation.  This gives rise to an important question.

Will the government of Quebec – sooner or later –  use its Charter of Values to suppress freedom of conscience and religion among health care workers?

An answer to the question is suggested by a review of the Quebec government’s continuing efforts to establish state hegemony in the moral and ethical education of children. . .  Full Text

 

Abortion in “rural” British Columbia

 Researchers include city of 85,000 as part of “rural” B.C.

 Sean Murphy*

Abstract: 

Two recent research papers based on a 2011 survey of physicians providing abortion in British Columbia assert that “rural abortion services are disappearing in Canada.”  However, what the papers contribute to an understanding of the “barriers” to abortion services in rural British Columbia is doubtful, for two reasons.  First: the analytical structure proposed (the urban-rural dichotomy as defined by the authors) is inadequate.  Second: the authors ignore the significance of an important variable: the nature of the facilities or institutions where abortions are performed.  Concerns expressed about “access” to abortion are frequently accompanied by demands that freedom of conscience for health care workers should be suppressed.  Given the weaknesses noted above, the authors would have been hard-pressed to justify such a suggestion.  To their credit, they do not do so.
[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]