Loss of right to conscience costing NHS new midwives it needs

Catholic Universe-The Catholic Times

Nick Benson

Pro-life groups have claimed that the recent drop in applications to midwifery courses could be rectified by enshrining conscientious objection.

Recent figures show that there has been a 35 per cent drop in the number of applicants to midwifery courses since 2013. The Royal College of Midwives (RCM), which analysed the latest Ucas data for England, said the biggest reduction was in those aged 21 or over.

In 2013, more than 12,000 people aged over 21 applied for a midwifery course in England, but by 2017 that figure had dropped to just 6,700 – a decrease of 45 per cent. . . [Full text]

Opposing Medical Conscience with a Soft Touch

National Review
Reproduced with permission

Wesley J. Smith

When the Department of Health and Human Services announced its intention to create a new office to emphasize the protection of medical conscience, the screaming from the usual suspects was so loud one would have thought Roe v. Wade had been overturned.

Now, The New England Journal of Medicine has published an abstruse opinion piece by one Lisa Harris, a professor concerned with “issues along the reproductive justice continuum,” whatever that means.

I bring this up because medical conscience is a burning issue for pro-life medical professionals and those who believe in Hippocratic medicine. The issue is whether doctors, nurses, pharmacists, and others can be forced to participate in requested interventions with which they have a strong religious or moral objection — such as abortion, assisted suicide, and suppressing normal puberty in children with gender dysphoria.

But reading Harris, you would think it was just about “partisans” not understanding the gray areas and nuances of contentious social issues. From, “Divisions Old and New–Conscience and Religious Freedom at HHS”:

I feel an angry argument building in response to HHS’s one-sided framing. But I resist it. Because my challenge these days is to avoid further entrenching polarized positions and to reject the divisiveness that poisons contemporary life. Is it possible, once again, to hold in tension seemingly opposite ideas about abortion? Can we understand abortion as both something that “stops a beating heart” and a fundamental right, rather than insisting it’s only one or the other?

But the conscience issue isn’t about whether we can all just get along and understand people have differences of opinion. It isn’t about “holding in tension seemingly opposite ideas.” It is about protecting doctors from being forced to take a human life or engage in another act in the clinical setting that is violative of their faith or moral beliefs.

Harris just doesn’t get it — or doesn’t want to:

Abortion and parenthood are not mutually exclusive; loving children and ending pregnancies are compatible in patients’ lived experience.

So is loving abortion work and questioning it: abortion providers might express an enormous sense of pride, purpose, and fulfillment in their work, and also say they felt weak-kneed the first time they saw a second-trimester abortion. Some feel sad that in different circumstances, many women would continue their pregnancies, in particular if poverty and economic strain were not issues. There is sometimes a point at which, when pressed, ardently pro-choice caregivers become uncomfortable with abortion. For some, it is a matter of pregnancy duration; for others, the circumstances of an abortion, such as sex selection.

Conversely, some caregivers whose religious beliefs lead them to strongly oppose abortion nevertheless offer assistance. Some religious nurses give medications and offer comfort, compassion, and care during an abortion because they see these tasks as shared purposes of nursing and religion. Sometimes doing so requires “sitting with discomfort in real time” and holding “the tension of two contradictory positions simultaneously.”

To which I respond, bully for them, but so what?

Harris should read Ezekiel Emanuel’s article in the NEJM from not too long ago advocating that doctors who refuse to participate in a legal procedures requested by the patient should be kicked out of medicine. No balancing of “tensions” and “sitting with discomfort in real time” for him!

And there is nothing in Harris’s piece to make me think she isn’t just as opposed to medical-conscience rights as Emanuel. She just says it indirectly, in a passive-aggressive manner, and with a softer touch.

I believe the real reason the medical establishment, the secular Left, and bioethicists like Emanuel and (I believe) Harris oppose strong legal conscience protections is precisely due to the powerful moral message sent when a respected doctor or nurse says to a patient: “No. I can’t do this thing you request. It is wrong.”

There is an old saying in pro-abortion advocacy: “If you don’t believe in abortion, don’t have one.”

To which I add a medical-conscience corollary: If you want an abortion, don’t force a doctor to give you one.

Sometimes comity requires living with unambiguity too.

Obstetricians and Gynaecologists to hold meeting on abortion

Doctors to discuss proposed abortion legislation but opposing views likely to surface

The Irish Times

Marie O’Halloran

The Institute of Obstetricians and Gynaecologists will hold an extraordinary general meeting on Friday to discuss the Government’s proposed abortion legislation.

Divergence of views on abortion proposals is expected to arise but chairman of the institute Dr Peter Boylan rejected a claim made by retired obstetrician Dr Eamon McGuinness that there was “possibly a little dispute” on the executive about the decision to support repeal of the Eighth Amendment.

Dr Boylan said 19 of the executive’s approximately 25 members attended the executive meeting at which the decision was made to support repeal of the Eighth Amendment.

“Everybody voted in favour of the institute being in favour of repeal. There was one abstention but nobody voted against it,” he said.

When can a doctor conscientiously object?

America

Bernard G. Prusak*

Over the last decade, the culture wars in the United States have broken new ground: They have become battles over the rights of conscience. For example, now that same-sex marriage is a right, the question before the U.S. Supreme Court in the case of Masterpiece Cakeshop is whether its sympathetic, telegenic owner, Jack Phillips, is within his rights to refuse to make a wedding cake for a gay couple. Similarly, under the Obama administration, the court heard arguments more than once over whether employers who object on religious grounds to contraceptives or abortion should be exempted from having to provide employees health insurance that includes such services.

By contrast, debates over conscientious objection in medicine have not had the same notoriety, though they have broken out repeatedly among health care professionals and medical ethicists since the turn of the century, when there was a flare-up over pharmacists’ refusing to fill prescriptions for emergency contraceptives.

A bill currently before the House of Lords has brought conscientious objection in medicine into widespread public discussion in the United Kingdom, if not yet on the other side of the Atlantic. . . [Full text]

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]

Medical myths about Eighth Amendment must be challenged

Campaign of fear and misinformation has been deployed to tarnish reputation of Irish medicine

Irish Times

Eamon McGuinness

The State acknowledges the right to life of the unborn and, with due regard to the equal right to life of the mother, guarantees in its laws to respect, and, as far as practicable, by its laws to defend and vindicate that right.’

Those words were inserted into our Constitution by the Irish people in 1983. As a consultant obstetrician, and later as chairman of the Institute of Obstetricians and Gynaecologists, I served Irish women and their children under the auspices of the Eighth Amendment.

It should be a matter of some national pride that Ireland, in that time, has been one of the safest places on earth to be a pregnant woman, and one of the safest places in the world to be an unborn child.

In recent times, a sustained campaign has been waged by some people, including several of my colleagues in obstetrics and gynaecology, to suggest that the words at the beginning of this article put women’s lives at risk.

If that were true, I myself would be leading the charge to have them expunged from the Constitution. A constitutional restriction on my ability, or the ability of any of my colleagues, to save the life of a pregnant woman would indeed be intolerable. Let me therefore be clear: no such restriction exists.

The Eighth Amendment has one medical effect only: it prevents Irish doctors from deliberately, as an elective matter, causing the death of an unborn child. It awards to the child in the womb the right to have their life protected in Irish hospitals, in Irish GP surgeries, and in Irish operating theatres.

That right does not restrict doctors from acting to save the life of a woman where a serious complication arises. . . . [Full text]

Declaration in Support of Conscientious Objection in Health Care

Introduction

The Declaration and associated texts you find here are my attempt, as a concerned academic, to provide a platform for the public support of freedom of conscience in health care.

Please read all of the material here. If you agree with the Declaration overall – even if you disagree with or are neutral on various details – I encourage you to add your electronic signature as a demonstration of support.

Signatures from health care professionals and academics in related fields are especially welcome, but you are encouraged to sign simply if you share my concerns and agree with the general way I have expressed them. You do not need an institutional affiliation, professional title, or any particular background. The more signatures this Declaration obtains, the more likely it is to come to the attention of policy makers and people who can amplify the message.

The texts ancillary to the Declaration are not part of its contents; they simply explain how I see and interpret the issues raised in the Declaration, and how I would like to see policy develop. By signing the Declaration, you do not indicate support for anything I say in the ancillary texts.

You will be asked only for your name, professional title (if you have one), institutional affiliation (if you have one), email address, and the country in which you reside. I may use your email occasionally to send you information about the Declaration, such as media coverage, but I will not use your email address for any other purpose. You will not be asked be involved in any other activity. The information you provide will be used solely to represent support for freedom of conscience in health care to professionals in the field (both clinical and academic), policy makers, and other interested parties who might be able to help with the promotion of this issue.

Acknowledgement and Disclaimer
I am grateful to the University of Reading for its support in hosting this material. The views and proposals presented here, however, represent my opinions alone. They do not, in any way, necessarily represent the views of the University of Reading or any of its officers, employees, or students.
David S. Oderberg

Sign the Declaration in Support of Conscientious Objection in Health Care

Show your support by signing the declaration.

Quebec euthanasia statistics: 67% increase in euthanasia deaths in second year

Introduction

Since 10 December, 2015, euthanasia has been provided by physicians in Quebec under the terms of An Act Respecting End of Life Care (ARELC).  Health and social services agencies established by the government throughout the province are state agencies responsible for the delivery and coordination of health care in the province administrative regions. These are called Centres intégrés de santé et de services sociaux (CISSS) and Centres intégrés universitaires de santé et de services sociaux [CIUSSS).  Some administrative regions (like Montreal and the Quebec City region) have more than one CISSS or CIUSSS.

These agencies are responsible for the delivery of euthanasia.  For two years beginning 10 December, 2015, they were required to make reports twice yearly to a commission established by the law to monitor the administration of euthanasia (the Commission sur les soins de fin de vie) and publish them on their websites.  These twice-yearly reports will apparently cease to be published after that time.  The Commission draws from these and other reports to make its required summary of activity to the legislature (National Assembly).

The Project has compiled the statistics provided in these reports from10 December, 2015 to 10 December, 2017.  The compilation includes tables and charts, some of which are reproduced below.

Euthanasia Requests in Quebec, 2016-2017

Euthanasia Requests in Quebec, 2016-2017

Note that, in some cases, the number of patients lethally infused is higher than the number of requests because euthanasia was provided in response to a request made in the previous reporting period.  In addition, not all euthanasia deaths are captured in these reports, as some regions with low populations do not publish reports, and euthanasia may be provided by private entities that are not subject to the statutory twice-yearly reporting requirement.

  • The number of euthanasia requests made weekly in the province increased from about 14 in 2016 to about 23 in 2017. In Montérégie the number of requests weekly doubled; they more than tripled in Bas-Saint-Laurent.
  • Euthanasia was provided about 9 times weekly in the province during 2016 and 14 times weekly in 2017.
  • The number of euthanasia deaths increased by about 67% from 454 in 2016 to 757 in 2017.  This is about 1.1% of deaths from all causes, a rate not reached by Belgium for 9 years after legalization.
    • In Outaouais the number of euthanasia deaths almost doubled (11 to 21)
    • In Chaudière-Appalaches the number more than doubled (18 to 40)
    • The number of euthanaia deaths more than tripled in Saguenay-Lac-Staint-Jean (6 to 19)
    • The number of euthanasia deaths quadrupled in Côte-Nord (2 to 8), and more than quadrupled in Abitibi-Témiscamingue (4 to 18).
  • 434 requests for euthanasia were not acted upon in 2017, up from 263 in 2016.  However, the percentage of all requests not acted upon remained constant at 37%.
    • In 11% of the cases the patient died of natural causes before euthanasia was provided, up from 9% in 2016.
    • About 8% of the patients did not qualify for the procedure, down from 11% in 2016.
  • Marked increases in rates of continuous palliative sedation occurred in a couple of regions, notably Laurentides (a 2017 reate almost six times that of 2016) 

See: full statistical summary with downloadable Excel file

You’re a surgeon. A patient wants to look like a lizard. What do you do?

As medical treatments advance, the need to accommodate conscientious objection in healthcare is more pressing

The Guardian
Reproduced with permission

David S. Oderberg*

Imagine that you are a cosmetic surgeon and a patient asks you to make them look like a lizard. Would you have ethical qualms? Or perhaps you are a neurosurgeon approached by someone wanting a brain implant – not to cure a disability but to make them smarter via cognitive enhancement. Would this go against your code of professional ethics? With the rapid advance of medical technology, problems of conscience threaten to become commonplace. Perhaps explicit legal protection for conscientious objection in healthcare is the solution.

There is limited statutory protection for those performing abortion, and there is some shelter for IVF practitioners. Passive euthanasia (withdrawal of life support with intent to hasten death) is also part of the debate over doctors’ conscience rights. That’s about it as far as UK law is concerned – though freedom of conscience is enshrined in numerous conventions and treaties to which we are party. Abortion, artificial reproductive technologies (involving embryo research and storage) and passive euthanasia are the flashpoints of current and historic controversy in medical ethics. The debate over freedom of conscience in healthcare goes to the heart of what it means to be a medical practitioner.

Curing, healing, not harming: these are the guiding principles of the medical and nursing professions. But what if there is reasonable and persistent disagreement over whether a treatment is in the patient’s best interests? What if a practitioner believes that treating their patient in a particular way is not good for them? What if carrying out the treatment would be a violation of the healthcare worker’s ethical and/or religious beliefs? Should they be coerced into acting contrary to their conscience?

Such coercion, whether it involve threats of dismissal, denial of job opportunities or of promotion, or shaming for not being a team player, is a real issue. Yet in what is supposed to be a liberal, pluralistic and tolerant society, compelling people to violate their deeply held ethical beliefs – making them do what they think is wrong – should strike one as objectionable.

Freedom of conscience is not only about performing an act but about assisting with it. There are some people who ask doctors to amputate healthy limbs. If you were a surgeon, my guess is that you would refuse. But what about being asked to help out? Would you hand over the instruments to a willing surgeon? Or supervise a trainee surgeon to make sure they did the amputation correctly? If conscientious objection is to have any substance in law, it must also cover these acts of assistance.

This country has a long and honourable tradition of accommodating conscientious objectors in wartime – those who decline to fight or to assist or facilitate the fighting by, say, making munitions. They can be assigned to other duties that may support the war effort yet are so remote a form of cooperation as not to trouble their consciences. In any war, the objectors are a tiny fraction of the combat-eligible population. Yet when it comes to one’s rights, do numbers matter? Has their existence ever prevented a war from being carried out to the utmost? I fail to see, then, why we are tolerant enough to make adjustments for conscientious objectors in the midst of a national emergency, yet in peacetime would be reluctant to afford similar adjustments to members of one of the most esteemed professions.

Do we think medical practitioners should be no more than state functionaries, dispensing whatever is legal no matter how much it is in conflict with personal conscience and professional integrity – lest they be hounded out of the profession? Some academics think expulsion is not good enough. Or should healthcare workers be valets, providing whatever service their patients demand? Perhaps when practitioners find themselves faced with demands for the sorts of treatment I’ve mentioned – or perhaps gene editing treatments or compulsory sterilisation, society will act. Or maybe by then it will be too little, too late.

David S Oderberg is professor of philosophy at the University of Reading, and author of Declaration in support of conscientious protection in medicine