July-September, 2005
September
Guidelines developed by the Groningen University Medical Center for
killing terminally ill infants who are in great pain and have no likelihood
of recovery will be discussed in Parliament, but there will be no vote
before they are put into effect. Under the guidelines, two doctors and the
parents must agree to the procedure. Opposition to the change voiced from
different quarters indicates the potential for conflicts of conscience
arising among health care workers involved in such cases. (CBC)
The National Family Planning and Reproductive Health Association failed to
convince a federal court to overturn the Hyde-Weldon Amendment, which helps
to prevent discrimination against health care workers who refuse to perform
or refer for abortion. The NFPRHA argued, in effect, that protecting their
freedom of conscience was unconstitutional. The suit was opposed by the
Christian Legal Society and Alliance Defense Fund, representing the
Christian Medical Association and the American Association of Pro-Life
Obstetricians and Gynecologists. (WorldNetDaily.com
)
The Australian state of Tasmania will pay for prostitutes for disabled
clients unable to afford their fees, while a disabled Danish man can expect
the government to pay for the services of a prostitute twice a month. In
either case, the arrangements illustrate the potential for conflicts of
conscience arising among social workers who may not want to facilitate such
sexual liaisons. Danish guidelines suggest that caregivers may have to help
clients communicate their sexual wishes to the prostitutes. In principle,
there appears to be no reason not to expect health care workers to find
prostitutes for patients.
Dignitas, a Swiss organization that has helped over 450 people commit
suicide since 1998, has opened an office in Hanover, Germany. Legalization
of the procedure would likely have a significant impact on health care
workers who object to it for reasons of conscience.
Assembly Bill 207 (The Conscience Protection Act) passed the Wisconsin
Senate by a 21-12 vote and goes to the governor for signature. Governor
Doyle has repeatedly vetoed freedom of conscience legislation.
Sangamon County Judge John Belz declined to issue a temporary
restraining order against a rule imposed by the state governor that requires
pharmacies to dispense the morning after pill. Lawyer for the state Attorney
General argued successfully that the complainants, who are pharmacy owners
who object to the rule for reasons of conscience, do not have legal standing
to apply for an order because they have not yet been sued or prosecuted.
The Conscience Protection Act (AB
207) will be debated in the Wisconsin Senate on 27 September, 2005. It would
protect medical professionals, medical students, medical facilities and
medical schools from being forced to participate in abortion, assisted
suicide, euthanasia, the deliberate destruction of human embryos for
research purposes or any other purpose, and the use of the body parts of
aborted babies. The bill does not prohibit any of the activities from taking
place but simply protects those in the health care community who do not wish
to engage in activities that deliberately destroy human life.
University of California at Irvine researchers have injected stem cells from
the brains of aborted infants in experiments into mice that have spinal cord
injuries. The mice regained some mobility. Use of tissue from abortions is
morally controversial. It could give rise to conflicts of conscience among
researchers. If a product or treatment depending on such tissue is
developed, it would continue to be morally controversial and would likely
generate conflicts of conscience among other health care workers. Already,
StemCells Inc. of Palo Alto, California, is seeking permission to inject
foetal cells into infants with Batten disease, which destroys the central
nervous system. [Washington
Post]
An amendment to the Canadian Criminal Code to permit assisted suicide, Bill
C-407, will be debated on 31 October during second reading in the House of
Commons. The bill could be defeated at that stage or be sent to committee.
The bill includes no protection for conscientious objectors.
The Senate and House of Representatives in Massachusetts have overridden
a veto by the state governor in order to enact legislation that will force
hospitals to provide the morning-pill to rape complainants.
The argument that an 'emergency' order by the Governor of Illinois is
acceptable because it directs pharmacies, not pharmacists, to dispense the
morning after pill , is now being contested by four pharmacists who own or
co-own five pharmacies in the state. The suit alleges that the governor's
order violates the Illinois
Health Care Right of Conscience Act by suppressing the freedom of
conscience of pharmacy owners.
The Wisconsin Senate Health, Children, Families, Aging & Long Term Care
Committee was scheduled to hold a hearing today on
Assembly Bill 207, authored by Rep. Jean Hundertmark (R-Clintonville)
and Sen. Carol Roessler (R-Oshkosh). The bill has already passed the state
Assembly. [News
release]
Only about a quarter of applications for re-approval of health care items
like feeding tubes, nutritional formula and ventilators have been approved
since a new law took effect on 1 September in Missouri. The law made such
items "optional equipment," despite the fact that they are essential for
some patients. Concern is being expressed by representatives of disability
rights groups that the changes, made for economic reasons, will result in
the death of people dependent upon such equipment. [Agape
Press] [St.
Louis Post Dispatch] The law may also cause conflicts of conscience for
health care workers.
In March, 2005, the Ontario College of Pharmacists submitted recommendations
regarding a "Code of Ethics for Pharmacists and Pharmacy Technicians" to the
Ontario Health Professions Regulatory Advisory Council (HPRAC). "Principle
4" of the submission states: "The pharmacist and pharmacy technician
respects the autonomy, individuality and dignity of each patient and
provides care with respect for human rights and without discrimination. No
patient shall be deprived of pharmaceutical services because of the personal
convictions or religious beliefs of a pharmacist or pharmacy technician."
Despite the fact that a well-known controversy surrounds freedom of
conscience in health care, especially with respect to pharmacists, the
College did not, in drafting its recommendation, confer with or invite
submissions from those likely to be adversely affected by the implementation
of such a principle. The submission appears to have been drafted secretly
and made without any announcement. News of the submission came through Iain
Benson of the Centre for Cultural Renewal, who sharply attacked the
College's recommendation as inconsistent with the approach taken by the
Canadian Medical Association and contrary to the Canadian Charter of Rights
and Freedoms. [See
"A narrow and frankly totalitarian view of professional practice"]
A forum sponsored by Canadian Physicians for Life will be held in Montreal
from 17 to 19 November, 2005. Students will be encouraged to learn to
articulate their views in a manner that is likely to be more readily
understood and accepted by colleagues. This is of particular importance for
those who object to some medical procedures or services for reasons of
conscience.
The University of Liverpool, England, is the site for an international
conference on euthanasia that begins on 13 September. Topics will include
the withdrawal or withholding of medical treatment, voluntary euthanasia and
assisted suicide. Medical and legal experts from German, Belgian, Dutch and
UK universities will be taking part [BBCNews].
The Christian Medical Association has accused the 'pro-choice' ACOG of
hypocrisy for attempting to deny freedom of choice to physicians who object
to abortion. In a
letter to US Senators, ACOG President, Dr. Michael T. Mennuti, insisted
that physicians unwilling to perform abortions for reasons of conscience
should be forced to refer patients for the procedure. [CMA
news release]
Mifepristone (RU-486) has been banned in Australia since 1996, but the Royal
Australian and New Zealand College of Obstetricians and Gynaecologists
argues for its legalization in a policy document to be released later in
2005. The use of the drug can cause problems for conscientious objectors,
even if they are not required to provide it themselves. [See
Mifepristone (RU486) urged without regard for consequences for conscientious
objectors]
The Californian Senate has passed a
bill that allows pharmacists to decline to dispense drugs for reasons of
conscience, but which compels the pharmacy manager or owner to ensure that
the patient has "timely access" to the drug. An 'emergency' order from the
governor of Illinois issued early this year was drafted in a similar manner
and has given rise to lawsuits by affected pharmacists.
The Daily Mail (United Kingdom) has published an
interview with a New Orleans doctor who admitted that, after the
devastation caused by hurricane Katrian, he had given lethal injections of
morphine to patients who would otherwise "have been dead within hours, if
not days." Local government officials and a hospital orderly corroborated
the story. An emergency worker was quoted as saying that the patients "were
given a lot of morphine and lain down in a dark place to die." The failure
to respond promptly to the needs of patients left helpless after the
hurricane clearly contributed to the decision to kill the patients, but the
procedure remains morally controversial even in the extraordinary
circumstances prevailing after the catastrophic flood that overwhelmed the
city. It is unlikely that any issues arose in New Orleans concerning
conscientious objection, but the fact that euthanasia was practised is
likely to be used as an argument for its legalization. This may have
long-term consequences for objectors.
Foetal spleen and liver cells and fragments of foetal spine are among the
products advertised for sale on the website
http://www.celltransplantation.iatp.org.ua/specialist.htm. The
'products' are produced by the Institute for Problems of Cryobiology and
Cryomedicine of the National Academy of Sciences of Ukraine, in Kharkov from
legal abortions. An
article in The Times On-Line reports that babies born before 27 weeks
gestation are considered 'abortions' and not registered. Those that do not
survive may be harvested by medical authorities for their body parts.
Ukraine is in the process of changing the definition of 'birth,' which may
address this problem. Similar controversies have arisen elsewhere [
Wholesale enterprise supplies researchers (Canada & U.S.A.) (1999)]
The Human Fertilisation and Embryology Authority in the United Kingdom has
approved a plan by researchers at the University of Newcastle to make
embryos with genetic materials combined from a man and two women. [BBC News]
The project illustrates the continuing development of morally controversial
procedures and the need for comprehensive protection of conscience
legislation drafted with such developments in mind.
This is Bristol reports that 100 members of the House of Lords
support the campaign of a terminally ill woman to legalize euthanasia. Her
supporters include Lord Joffe, the author of a bill that would legalize the
procedure. 29 year old Kelly Taylor abandoned an attempt to starve herself
to death because it caused too much suffering.
In a ruling that illustrates the moral controversy surrounding the
morning-after pill, a court in Lima has prohibited the distribution of the
drug in the country until it has been determined not to have an
abortifacient mechanism of action.
August
Results of an internet opinion pole by the Daily Telegraph suggest that 58%
of Britons favoured an upper limit of 20 weeks or less for abortion. In
contrast, 87% favoured euthanasia and 67% supported assisted suicide. The
numbers suggest that conflicts of conscience are more likely with respect to
abortion than euthanasia or assisted suicide, but that the pressure on
objectors to the latter procedures would probably be more pronounced were
they to be legalized.
Sister Wilhelmien Charles has begun an action in the Johannesburg High Court
against the Kopanong Hospital in Vereenging for having barred her from
working in an operating room because she objected to assisting with
abortion. She is seeking R50,000. in damages and reinstatement. [South
African nurse denied position]
In Arizona, a Maricopa County Superior Court judge has ruled that a county
sheriff's office must transport female inmates for elective abortion without
first obtaining a court order to do so. The Sheriff had refused to do so
primarily because of security and liability concerns. No issue was raised
with respect to conscientious objection by sheriff's officers. [Arizona
Daily Star]
Several pharmacists in Illinois have stated that they will not comply
with the state governor's order that requires pharmacies to dispense or
refer for the morning-after pill if they carry contraceptives. The governor
argues that the rule applies to pharmacies, not pharmacists, so it is
unclear how the rule will be applied. In theory, it would adversely impact
objectors who own their own pharmacies, but only one of the pharmacists
refusing the order has an interest in the business in which he works.
Skin from an aborted baby has been used as a graft to treat burn victims by
physicians at the University Hospital of Lausanne in Switzerland. The use of
tissue from aborted infants has the potential to cause conflicts of
conscience among health care workers and patients.
The Illinois state legislature's Joint Committee on Administrative Rules
approved a rule by Governor Blagojevich that pharmacists must dispense
contraceptives "without delay," regardless of conscientious objection to the
drugs. All but two members of the bipartisan committee voted in favour of
the rule.
A spokesman for St John and St Elizabeth Hospital, a private Catholic
institution in the United Kingdom that is apparently well-known because the
babies of numerous celebrities have been born there, has stated that
patients are being referred for abortions by physicians at the hospital when
they are deemed "medically necessary." She described this as a "compromise"
between Catholic teaching and the hospital's philosophy. However, Dr. Helen
Watt of the Linacre Centre for Healthcare Ethics, also located at the
hospital, states that the practice of referral for abortion should not be
permitted in a Catholic facility. The situation became public as a result of
a decision by the hospital to lease space to National Health Service
physicians, who are reported to be obliged by contract to refer for
abortions and prescribe abortifacient drugs. Cormac Cardinal Murphy-O'Connor
is reported to be heading an inquiry into the problem.
Kathy Kushnir, an executive officer of Planned Parenthood of Rhode Island,
has described the exercise of freedom of conscience by a pharmacist as
"criminal." On a Friday night, a pharmacist at a drive-in window of a CVS
Pharmacy in Providence, Rhode Island, refused to fill a prescription for the
potentially abortifacient morning-after pill for reasons of conscience. The
pharmacist advised the patient that she could return later or drive to
another 24 hour pharmacy to have the prescription filled. The patient
returned the next day and obtained the drug. CVS is supporting the
pharmacist, but Planned Parenthood claims that every prescription presented
by a woman must be filled "period, end of story." Presumably Planned
Parenthood would make the same demand (without respect to the sex of the
patient) for the filling of prescriptions for euthanasia and assisted
suicide. The aggressive policies of the organization illustrate the ongoing
threat to freedom of conscience for health care workers.
The Confraternity of Catholic Clergy has issued a statement that describes
the provision of nutrition and hydration as ordinary medical care that must
always be provided, adding that "to withhold or withdraw them while still
effective is completely immoral." The group also condemned destructive human
embryo research. The statement illustrates the potential for conflicts of
conscience arising among health care workers and researchers.
The Irish Family Planning Association (IFPA) is assisting the case of three
anonymous Irish women who have lodged a complaint against the Irish
constitution with the European Court of Human Rights. The IFPA is also
launching a campaign to legalize abortion in Ireland. Over 6,000 women are
reported to have gone from Ireland to England for abortion in 2004.
Legalization of abortion would likely lead to serious conflicts of
conscience for many health care professionals, most of whom appear to be
opposed to the procedure. [See
Conscientious Objection in Ireland (May, 2000)]
Half of the 3,614 doctors surveyed in a study of general practitioners in
the Netherlands had received at least one request for euthanasia in the
previous year. The government reported 1,886 cases of euthanasia in the
year, out of more than 2,600 requests. The figures suggest that legalized
euthanasia affects a substantial number of physicians. About 60% of the
physicians approached responded to the survey.
A case pending in the 4th District Court of Appeals in San Diego,
California, will be of considerable importance to religious believers in the
state. Dr. Christine Brody, Dr. Douglas Fenton and their medical practice
are being sued by a lesbian whom they refused to inseminate for reasons of
conscience. The plaintiff and defendants describe these reasons differently.
The former claims that they had religious objections to her homosexual
lifestyle/conduct, while the latter assert that they had religious
objections to inseminating the unmarried. Lawyers for the plaintiff want the
court to deny a jury the right to decide whether or not the physicians "were
acting out of sincere religious belief or simply discriminating against
gays" on the grounds that to do so would permit discrimination "under the
guise of religious freedom." Jennifer Pizer of the Lambda Legal Defense and
Education Fund, said that religious believers in the public square must
follow the "neutral" rules that society has adopted - as if the legalization
of homosexual conduct, relationships, or artificial insemination were
morally "neutral." [On this point see
There Are No Secular Unbelievers ;
The Illusion of Moral Neutrality - Part IV;
Establishment Bioethics]
On 11 July, 2005, Mexican President Vicente Fox ordered public hospitals or
clinics to make the morning after pill available free. The policy was
condemned by the country's Catholic bishops, and a government minister has
called for the policy to be rescinded. The controversy illustrates the
probability of conflicts of conscience among health care workers called upon
to distribute the drug.
A 50 year old woman in Australia died 10 days after a feeding tube was
removed. She had been severely brain-injured after an attempt on her life by
her husband's lover about six months earlier. Removal or denial of assisted
nutrition or hydration from patients who are not dying remains a morally
controversial procedure, though it is legally allowed in many jurisdictions.
In 1997 a court ruling in Columbia decriminalized assisted suicide, but the
practice remains unregulated. Carlos Gaviria, now a senator, who wrote the
majority court decision, is now calling for a debate on regulating
euthanasia.
An English appeal court has reversed a lower court ruling that would
have prevented doctors from stopping assisted nutrition and hydration when
patients are unable to communicate their wishes. The case may go to the
House of Lords.
Luke Vander Bleek, R.Ph., owner of several pharmacies serving rural
areas in Illinois, appeared before the House Small Business Committee to
testify that an 'emergency' order by Illinois Governor Rod Blagojevich
"creates an environment in Illinois whereby a person holding deep moral
convictions concerning the unborn cannot own and operate a licensed
pharmacy." The hearing was arranged by Committee Chairman Rep. Don Manzullo
(R-Illinois) as a result of the Governor's order that Illinois pharmacies
must fill orders for the morning-after pill. One witness said that she was
"humiliated and discriminated against" by a pharmacist who refused a
prescription. She admitted that she obtained the drug at another store that
was 20 minutes away. [Hearing
transcripts]
The Catholic Pontifical Academy for Life has produced a document,
approved by the Congregation for the Doctrine of the Faith, that reflects on
the use of vaccines originating in tissue obtained from abortion.(Moral
Reflections on Vaccines Prepared from Cells Derived from Aborted Human
Foetuses). The document summarizes the nature of formal and material
cooperation and the moral culpability of those who produce and use such
vaccines, so it is of particular importance for Catholics and those who
apply similar moral reasoning to arrive at judgements of conscience.
Claiming that refusal to refer for abortion violates the guidelines of
Britain's General Medical Council, Marie Stopes International and a group
called Abortion Rights are urging women to complain to the GMC if a
physician who will not provide an abortion refuses to give them the name of
an abortionist. The attack on freedom of conscience will be resisted by
objecting physicians, according to Dr. Peter Saunders of the Christian
Medical Fellowship [The Times, 17 July]
Dr Beverley Malone, the general secretary of the Royal College of
Nursing, stated that the organization wants to increase access to abortion
in the early stages of pregnancy "and allow nurses greater involvement in
providing services." She made no reference to the issue of freedom of
conscience for nurses, which the College supports. (See
Policy of the Royal College of Nursing of the United Kingdom)
A vote by the Church of England Synod that went overwhelmingly
against a legalization of euthanasia contrasts with the recent decision of
the British Medical Association to cease opposition to euthanasia and
assisted suicide. It provides further evidence that significant conflicts of
conscience will arise if the law is changed. The vote was directed at Lord
Joffe's Assisted Dying for the Terminally Ill Bill.
Michigan Governor Jennifer Granholm is reported to be considering a
policy that would force employers who provide health insurance to include
coverage for contraception. Such a possibility concerns the Michigan
Catholic Conference, since it would force Catholic employers to choose
between withholding a benefit from employees and providing what the Catholic
Church holds to be a morally objectionable drug.
Mifepristone and misoprostol, abortion drugs, have been added to the World
Health Organisation's list of essential medicines. Hans Hogerzeil, director
of medicines policy and standards, stated that the drugs will be especially
valuable in developing countries. The use of the drug can pose significant
problems for conscientious objectors. (See
Mifepristone (RU486) urged without regard for consequences for conscientious
objectors)
A blood test kit sold for $275.00 (US) is reported to be 99% accurate in
determining the sex of an infant in utuero. Ethicists like Dr.
Michael Grodin of the Boston University School of Public Health, who are not
concerned about abortion to dispose of infants with genetic or medical
disorders, are concerned that the kits will facilitate sex-selective
abortions. The concern illustrates the fact that conscientious objections
can occur among people who do not ordinarily object to a procedure. [New
Fetal Gender Test Raises Ethical Questions]
As a result of a trial of mifespristone (RU486) involving 50 women at
the Royal Infirmary in Aberdeen, some doctors are pressing for approval for
the use of the drug at home. Widespread use of the drug in South Africa has
caused problems for conscientious objectors at emergency departments in
state hospitals, since the women are often given the drug and told to go to
the hospital to have the abortion completed if there are any complications
(See
Mifepristone (RU486) urged without regard for consequences for conscientious
objectors)