September-December, 2003
December
Debate about legalizing euthanasia and assisted suicide continues in
Britain. The Evening Gazette quotes member of parliament Dr. Marjorie
Mowlam, a former cabinet minister, as recommending that Britain should "look
at voluntary euthanasia." Baroness Warnock has written in support of Lord
Joffe's bill that would legalize such procedures. Dr Michael Irwin, chairman
of the Voluntary Euthanasia Society, resigned after being arrested for
conspiracy in connection with the death of a euthanasia campaigner on the
Isle of Man. The doctor attended the patient with a large number of sleeping
pills, but says that the man died without taking them. The problem that
legalization would pose for conscientious objectors within the medical
profession does not appear to be attracting attention.
Meanwhile a 43 year old Lancaster man is going to court to ensure that he
is protected from doctors who might stop his nutrition and hydration. Leslie
Burke suffers from a degenerative brain disease, and worries that General
Medical Council (GMC) rules will be used to justify stopping his food and
fluids at a later stage in his illness. He argues that the current GMC rules
do not require physicians to obtain court approval before doing so.
The Abortion Supervisory Committee in New Zealand has reported that many
health care professionals in the country do not wish to perform abortion.
This was apparently revealed in a report from the Committee in December,
2002. The Committee's latest report, published this month, states that this
has made it necessary to fly abortionists into the country. This
demonstrates that accommodation of conscientious objectors is possible, if
there is sufficient imagination and political will.
Bills are now before both houses of congress in the United States that would
prohibit governmental discrimination against health care providers who
decline to be involved in abortion. The Abortion Non-Discrimination Act
(ANDA) is bill
HR3664 in the House of Representatives and
SB1397 in the Senate. [Fact
sheets]
In a development that appears to underline the need for protection of
conscience legislation, the Scientific Organization for Flemish General
Practitioners has issued a statement to the effect that it will work with
groups like "Life's End Information Forum" to assist Belgian doctors whose
patients are demanding euthanasia under Belgian law. The legalization of
euthanasia in Belgium, the group says, "demands a change in attitude from
many doctors." 203 patients have been killed by euthanasia since September,
2003, when euthanasia was legalized. [Expatica]
Citing internal memos from the Center for Reproductive Rights, the Catholic
Family & Human Rights Institute reports that the Center's long-term plan is
to establish state-financed abortion on demand, as well as other "sexual
rights", as human rights that will be enforced by international tribunals.
The organization, proceeding by what it describes as "stealth", will attempt
to have existing international agreements interpreted in this fashion, and
also plans to develop "soft norms" in the form of customary rules that
acknowledge such 'rights' as "reproductive autonomy" - for children as well
as adults. (See
Secret Memos Reveal Worldwide Pro-Abortion Legal Strategy) It appears
that an example of a "soft norm" is the policy of the College of Pharmacists
of British Columbia against freedom of conscience for pharmacists. (See
Project Report 2001-01).
Dr John Harris, professor of bio-ethics at Manchester University, has told
the British Medical Association that living donors should be able to sell
their organs. The suggestion was challenged by Dr Jacqueline Laing, senior
lecturer in the department of law at London Metropolitan University, and
contradicts a ruling by Britain's General Medical Council ( See
British doctor suspended six months for encouraging organ trade). To put
the suggestion into practice would clearly create conflicts of conscience
for many health care workers.
"Undercover" Sunday Times reporters who purported to be parents of large
families approached fourteen Catholic priests to ask for advice about using
artificial contraception. Eight of the fourteen priests contradicted
Catholic teaching by advising them that they could do so. The Times exercise
clearly illustrates the problem faced by health care workers whose religious
objections to certain procedures or drugs are undercut by demands from
co-religionists supported by their own religious authorities. [Times]
A South African nurse will be able to apply for work if she succeeds in
re-registering as a nurse. She was was struck off the nurses' register and
banned from practice for12 months because she she was found to have shouted
at women having abortions, leaving them to deliver their own dead babies and
clean up the results. She states that at the time of the incidents she was
suffering from claims that severe work stress that resulted in nightmares
and emotional agony. Reports have not indicated whether or not the nurse was
compelled to participate in procedures to which she objected for reasons of
conscience. (See
South African nurse convicted)
Bishop Joe Duffy, head of the Catholic hierarchy's Committee on European
Affairs, commenting upon embryo research proposals being considered in
Europe, added remarks to the effect that performance of abortions by third
world Catholic hospitals should not be a condition for funding from the
European Union.
November
The Supreme Court of California will hear arguments against a state law
that requires employee prescription drug plans to include contraceptive
coverage, even if the employer is a religious entity that objects to
contraception for moral reasons. Such laws also exist in Arizona,
Connecticut, Delaware, Iowa, Georgia, Hawaii, Maine, Maryland,
Massachusetts, Missouri, Nevada, New Hampshire, New Mexico, New York, North
Carolina, Rhode Island, Texas, Vermont and Washington. The issue is
significant for hospitals and charities that adhere to the teaching of the
Catholic Church, which proscribes contraception as sinful. The law is
supported by the American Civil Liberties Union. [Las
Vegas Sun]
The Annual General Meeting of the BC College of Pharmacists meeting in
Burnaby, British Columbia, again rejected a motion in support of freedom of
conscience. The motion was defeated 33-9. (Address
to College Council and Pharmacists, AGM, College of Pharmacists of B.C.).
For background on the situation in British Columbia, see
"Autonomy", "Justice"and the Legal Requirement to Accommodate;
In Defence of the New Heretics;
Project Report 2001-01
A poll conducted by Nursing Times magazine is being cited by euthanasia
advocates as evidence favouring legalization of euthanasia and assisted
suicide. Two thirds of the 2,700 respondents said that they wanted
"voluntary euthanasia" legalized. 40% reported that they had administered
pain relief to patients, knowing that the drugs could hasten death. However,
the term "voluntary euthanasia" was defined to include withdrawal of life
support, which does not always constitute
euthanasia. Similarly, the possibility that life may be shortened by the
use of pain-killing drugs does not preclude their use when the intention is
not to kill the patient but to relieve suffering. The failure to make these
distinctions makes it difficult to assess of the results of the survey. It
is clear that one third of the nurses surveyed opposed euthanasia, a
position supported by the Royal College of Nursing and the British Medical
Association. (British
Medical Association rejects assisted suicide). This indicates that
legalization of the procedure would generate significant ethical conflicts
among health care workers.[BBC]
It appears that the government's controversial draft Mental
Incapacity Bill will not be introduced during this parliamentary session.
However, the House of Lords Liaison Committee has recommended that a
committee study "assisted dying", a euphemism for assisted suicide. The news
was welcomed by Lord Joffe, who believes that the public is becoming more
open to assisted suicide as a result of the case of Diane Pretty. (
Push for euthanasia continues in United Kingdom ;BBC
reports "British woman denied right to die")
Conflicts of conscience among health care workers can be expected in St.
Lucia. The procedure was legalized a week after a parliamentary debate on
the subject was cancelled due to protests that included a petition signed by
9.000 of the 160,000 island residents. The new law will allow abortion in
cases of rape, incest and to protect the "health" of the mother.
The Federal Health Ministry of Belgium reports that 203 people were killed
by euthanasia by September, 2003, a year after the procedure was legalized.[Expatica]
A Swiss assisted suicide clinic run by Dignitas is being
investigated in connection with the deaths of a Frenchman and British
couple. The Frenchman had Alzheimers, which brings into question the
possibility of informed consent, while the British citizens were not
terminally ill. A double suicide of French twins suffering from
schizophrenia is also under investigation.
In France, a doctor and nurse are suspects in the death of a
terminally ill cancer patient who was killed by lethal injection.
The news items seem to indicate continuing interest in the
legalization of assisted suicide and euthanasia, and the cases under
investigation are likely to be cited as reasons for doing so.
Olubunmi Cardinal Okogie of Lagos has criticized a proposal made by a judge
in the country that the National Assembly should consider legalizing
euthanasia. Legalization of the procedure would have serious implications
for conscientious objectors among health care workers.
Catholic, Protestant and Muslim leaders in Kenya have condemned work by
three scientists who are trying to develop low-cost in vitro
fertilization techniques. The denunciation illustrates the potential for
conflicts of conscience for Kenyan health care workers whose views are
represented by the religious spokesmen.
The Society for the Protection of Unborn Children is urging Britons to
contact their members of parliament to prevent the introduction of the
government's draft Mental Incapacity Bill into parliament. On the other hand
several organizations, including the Alzheimers Society, Down's Syndrome
Association and Mental Health Foundation are supporting the bill. Critics of
the bill charge that it will allow euthanasia by withdrawal of nourishment
and fluids from incapacitated patients, which would place objecting health
care workers in a difficult position. [See
Unprecedented number of letters received by parliamentary committee]
A chemist (pharmacist) in Bridgnorth, England, may face discipline because
she refused to dispense the morning-after pill for religious reasons.
Despite the fact the the woman demanding the pill was able to obtain it from
another pharmacy on the same street, she has filed a complaint for the
purpose of suppressing freedom of professionals to practice according to
their religious beliefs. [Shropshire
Star]. Meanwhile, a similar attack on freedom of conscience for
pharmacists is underway in Wisconsin, USA. Pharmacist Neil Noeson refused to
dispense birth control to a woman at a K Mart Pharmacy in Wisconsin in the
summer of 2002, and now faces a disciplinary trial in Madison, Wis. on 18
December, 2003; the Wisconsin Pharmacy Board is attempting to revoke his
licence. (Police
Used to Intimidate Objecting Pharmacist.
Patrick Kneen, a euthanasia/assisted suicide advocate who helped convince
the Isle of Man parliament to consider legalizing assisted suicide, is
reported to have died a month ago of prostate cancer. However his widow has
now been arrested in connection with his death, apparently as a result of a
letter she sent to a local newspaper. Continuing pressure for legalization
of assisted suicide and euthanasia is a source of concern for health care
workers who do not want to be compelled to participate in such procedures.
In a non-binding opinion, the Attorney General of Wisconsin has asserted
that health insurance plans that cover prescription drugs must also include
coverage for contraception. Democrats in the legislature have been
attempting to force such coverage even upon those who would object to such
coverage for reasons of conscience.
After three years of uncertainty, Maria Bizecki, a Christian pharmacist in
Calgary, Alberta has finally received confirmation that the Alberta College
of Pharmacists will accept the agreement she has negotiated with her
employer that will allow her to refuse to dispense drugs which she declines
to dispense for reasons of conscience. She was suspended by her employer for
over a year and incurred substantial legal bills. (See
Alberta Pharmacist Vindicated for Pro-Life Stand)
October
The Wisconsin Senate Judiciary, Corrections and Privacy Committee has heard
testimony urging legislators to support a statutory ban on "wrongful birth"
and "wrongful life" lawsuits. Such suits are brought by parents who sue
doctors should a child be born with a disability, and have a considerable
impact on physicians who are morally opposed to eugenic practices.
A bill that has been criticized for failing to prohibit cloning human
embryos for research and for supporting in vitro fertilization has
passed the Canadian House of Commons and will proceed to the Senate. It is
not certain that the Senate will be able to pass the bill before the end of
the parliamentary session. The Project criticized the bill for failing to
include any provision for protection of conscience. [See
Protection of Conscience Project Submission on the proposed Assisted Human
Reproduction Act (Canada)]
The National Right to Life Committee in the United States, responding to the
Terri Schiavo case, has drafted a model state law to protect people in
similar circumstances. The director of medical ethics for the organization
asserted that the Schiavo case is an example of a common practice in
American nursing homes and hospitals, which implies that conflicts of
conscience among health care workers on this issue may be widespread.
Dr Jafer Qureshi, a leading Muslim doctor, told a London conference that
Muslims and medical students are being discriminated against because of
their pro-life views. He said that some cases may be taken to the Commission
for Racial Equality.
Three doctors, including Nobel prize nominee William Hammesfahr, insist that
Judge George Greer was mistaken in ordering the removal of Terri Schiavo's
feeding tube. Hammesfahr is a neurologist and a national expert on
persistent vegetative states. Their opinions contrast sharply with those of
Mrs. Schiavo's former physician, illustrating the potential for ethical
conflicts among team members providing treatment or care for such patients.
Terri Schiavo was removed from Woodside Hospice because staff were unwilling
to obey the governor's order to reinsert her feeding tube. Her own doctor
resigned from the case, apparently unwilling to do so, and two doctors who
came to the hospice for that purpose were refused entry. Mrs. Schiavo was
taken to another hospital, where fear of being sued by her husband's lawyers
delayed re-instatement of feeding by hospital staff. They eventually began
intravenous nourishment and rehydration, and she was later returned to the
Woodside Hospice. A guardian with limited legal responsibilities has been
appointed for her by a court, but her husband, who has been trying to have
her nourishment cut off, continues to be legally responsible for her care.
These incidents illustrate not only different approaches to conscientious
judgement, but the impact of institutional policy and law on ethical
decision making.
Britain's National Institute for Clinical Excellence has recommended
universal screening of infants in utero for Downs syndrome, with a
view to aborting those identified.
The Vermont chapter of End-of-Life Choices (formerly the Hemlock Society)
has established an 'advisory committee' on assisted suicide that includes a
retired federal judge, two former state governors and a former lieutenant
governor. The organization has asked for donations to support lobbying for a
bill now before the state legislature. The Vermont Medical Society will
survey its members by mail before deciding its position on physician
assisted suicide.
On 20 October, 2003, the Florida House of Representatives, called into
emergency session, passed "Terri's Law," which orders a halt to all deaths
being caused by dehydration and starvation in Florida. Acting under the
authority of new legislation, Florida Governor Jeb Bush ordered the
reinsertion of Terri Schiavo's feeding tube.
Despite having assurance from Canadian doctors and nurses who volunteered to
provide care, Canadian Immigration Minister Dennis Coderre refused to grant
Terri Schiavo asylum in Canada. She is reported to have reacted with joy
when Monsignor Thaddeus Malinowski arrived, turning in her chair to greet
him. Malinowski is a Catholic priest who has visited Schiavo weekly for over
three years. However, during the sacrament of anointing (known to
non-Cathoics as the 'last rites') he was forbidden to give her a quarter of
a wafer of Holy Communion ( a full wafer is about the size of a quarter),
even soaked in water. He was told police would use force to prevent him from
doing so. Schiavo's husband has already ordered her cremation immediately
following her death, despite her family's request for an autopsy to examine
injuries that had been sustained after her paralysis. These incidents
highlight some of the practical issues that can generate conflicts of
conscience for health care workers involved.
Terri Schiavo's feeding tube was removed in accordance with an order from
Circuit Court Judge George Greer of Florida. A demonstration/vigil is in
progress outside the hospice where Schiavo is expected to die. The Canadian
Immigration Minister has been approached by Human Life Matters, an advocacy
group for disabled persons, and asked to grant Schiavo temporary asylum in
Canada. The request is largely symbolic, because Schiavo's legal guardian,
her husband, is the one who has obtained the court order to have her feeding
tube withdrawn.
Schiavo's
family, which has been trying to prevent her from being starved and
dehydrated to death, has released a videotape made in August, 2001. The tape
demonstrates that she is not in a "persistent vegetative state". Lawyers for
her husband, who obtained the order for removal of the tube, had threatened
to prevent the family from seeing her without their supervision if they
released the tape. They have now made good the threat.
The case is generating widespread interest in the ethics of causing death
by withdrawal of food and fluids from patients who are not dying. Schreeuw
om Leven, President of the Dutch group Cry for Life, noted the similarity of
the Schiavo case to that of Mrs. Ineke Stinissen, a comatose patient. Mrs.
Stinissen's died of starvation in 1990 after her husband obtained a ruling
from a Dutch court that permitted the withdrawal of food and fluids. He
described the Stinissen case as one that paved the way for legalization of
euthanasia in Holland.
France's President Jacques Chirac has told the general conference of United
Nations Educational, Scientific and Cultural Organization (UNESCO) that the
world needs an international convention on bioethics that has the force of
international law. He suggested that the UN should begin by making a
declaration of basic bioethics principles. UNESCO's Director-General,
Koichiro Matsuura, believes that finding universal agreement on such
principles would be problematic. This point is illustrated by the fact that
Chirac's focus is on scientific research, even as the French justice
minister is encouraging discussion about legalizing euthanasia. [See
Is Bioethics Ethical?;
Which Medical Ethics for the 21st Century?;
Establishment Bioethics;
The Bioethics Mess]
The French parliament has created a commission to study legalization of
assisted suicide, and the French minister of justice is promoting a debate
on euthanasia on his ministry's website. In contrast, the Italian Minister
of Health, speaking at a medical conference in Milan, has rejected the
legalization of euthanasia and proposals to halt forced-feeding.
Life Choices (formerly the Hemlock Society), and the Alliance for Ethical
Healthcare conducted polls that have yielded completely contradictory
results on the issue of legalizing assisted suicide in Vermont. Surveys of
doctors in two hospitals showed them to be 58% and 74% opposed to the
practice. The state governor does not support a bill, now in the
legislature, that would legalize assisted suicide.
An injunction was issued by the English High Court to compel a hospital to
provide food and fluids to a 91 year old woman who had been admitted after
having suffered a stroke. The family claimed that the woman was being left
to die by the hospital. The woman died a few days later. The case is being
cited by Dr. Jacqueline Laing as evidence that the government's draft Mental
Incapacity Bill would increase the vulnerability of incapacitated patients
and prevent family members from intervening to secure care and treatment.
Meanwhile, a federal judge in Florida refused to allow patient Terri
Schiavo to learn to eat and drink before the court-ordered removal of her
feeding tube. 10 organizations concerned with the rights of disabled persons
plan to intervene in the case, but the judge's ruling on the issue of
letting her learn to eat and drink cannot be appealed.
Dr Daniel Brison of St Mary's hospital, Manchester, wants the law changed so
that eggs obtained for in vitro fertilization, but not used, can be used to
make human embryos for research purposes. He described opposition to the
practice as an "ethical barrier" that has to be 'got over' in order to
address a 'shortage' of human embryos available for research. It appears
that his suggestion would involve abolishing the requirement for donor
consent. Continually 'pushing the ethical envelope' may increase the
likelihood of conscientious objections arising among health care workers.
The position of the Vermont Medical Society on assisted suicide remains
unclear. The Society is to meet on 17-18 October and will likely consider
the proposed assisted suicide bill. The Governor of Vermont has indicated
that he would veto the bill if it passes.
Dr Frederic Chaussoy, who states that he switched off the life support
machine of a comatose patient, has claimed that euthanasia is likely a daily
occurrence, concealed by a "tradition of hypocrisy" that encourages doctors
to lie about it. The claim that euthanasia is a frequent occurrence is
commonly made by euthanasia advocates, but is often supported by reference
to practices that are not considered euthanasia, like the withdrawal of
burdensome treatment.
The Korea Times reports that financial pressures and traditions cause many
families to take terminally ill patients from hospitals to die at home. The
practice is being described by the medical profession as 'passive
euthanasia', though it is by no means clear from the report that ordinary
treatment or care is being withdrawn. The failure to distinguish between
euthanasia and legitimate refusal or withdrawal of burdensome or
extraordinary treatment can have the effect of making euthanasia appear to
be a normal or acceptable practice, increasing pressure for its
legalization, with ensuing complications for conscientious objectors.
Vermont legislators are now studying three bills in committees. One bans
physician-assisted suicide, one legalizes it, and one would establish a
commission to provide advice on palliative care and pain management. It is
reported that a position of 'neutrality' on physician-assisted suicide is
being considered by the Vermont Medical Society. This is a good illustration
of the false concept of moral neutrality that is often used to justify
suppression of conscientious objection. Faced with two choices - supporting
or rejecting assisted suicide or euthanasia - to declare neutrality would be
an assertion by the Society that there is no moral difference between
killing or not killing the patient; killing the patient would, therefore, be
a morally permissible option.