January-March, 2007
March
Beginning in April, the controversial Mental Capacity Act comes into
partial effect in the United Kingdom. The Act provides for "living wills"
that can direct health care workers to stop nutrition and hydration to
patients, thus causing their deaths. Should the health care workers refuse
to withdraw nutrition and hydration, they can be charged criminally for
assault. Some doctors have stated that they will go to jail rather than
perform what they consider to be euthanasia. [Daily
Mail, 30 March, 2007]
The California Assembly Judiciary Committee has passed
Assembly Bill 374, an assisted suicide bill with some protection of
conscience clauses.
In an effort to pressure pharmacies to provide the morning-after pill and,
apparently, to encourage activism against pharmacists who object to
dispensing the drug, Planned Parenthood has begun a 'Pill Patrol' in the
United States. The organization urges activists to call pharmacies and ask a
series of questions to determine the immediate availability of the drug, and
whether or not there are conscientious objectors on staff. [Cybercast
News] [SaveRoe]
A bill that would have imposed a two hat would have banned families from
having more than two children has been defeated in the Philippines. The bill
would have included up to six months' imprisonment for couples who broke the
family planning law. [See
Philippines population control bill threatens conscientious objectors with
imprisonment;
Philippines Government launches attack on freedom of conscience]
A mother has secured a restraining order to prevent the disconnection of a
respirator from her 16 month old child, who was born blind and deaf. The
infant has been diagnosed with Leigh's Disease, an incurable disorder that
affects the central nervous system and often leads to respiratory, kidney
and heart failure. The life expectancy of a patient is a few years, though
some have lived into adolescence. Hospital authorities decided that the
"aggressive care" being provided was "medically inappropriate" because it
was causing "suffering [and] harm . . . and [was] without clinical benefit."
The hospital told the mother that care would be continued for ten days to
allow her to find another institution willing to accept the child. The court
order she obtained means that care will continue until at least 10 April.
Current Texas law permits physicians to withdraw treatment or care that they
judge to be "futile," without the consent of the patient. Since the hospital
is Catholic, the case can be contrasted to that of Italian Peirgiorgio
Welby, who was denied a Catholic funeral because he had his life-sustaining
respirator disconnected. [Italian
case illustrates potential for conflict]
Health care workers and others are expressing concern about a return to
the practice of organ donation after only cardiac death (cessation of
heartbeat), which was the norm before criteria for "brain death" became
established as the prerequisite for organ harvesting. "Donations after
cardiac death" (DCD) in the US more than doubled between 2003 and 2006. One
current standard requires that the heart has stopped for five minutes before
organs are removed, but the standard is not universal. In some places
doctors wait three minutes, or two, and surgeons at Denver's Children's
Hospital wait only 75 seconds before harvesting organs. A Washington Post
article illustrates the potential for conflicts of conscience in this field
[Washington
Post] [See also
Nurses alarmed by transplant procedure]
In 2004 Bill Whatcott, a nurse opposed to abortion, was fined $15,000.00 and
suspended for 45 days by a Saskatchewan Licensed Practical Nurses
Association Discipline Tribunal. The tribunal judged him guilty of
"professional misconduct" because he picketed a Planned Parenthood office in
Regina, Saskatchewan. He was suspended indefinitely when he refused to pay
the fine, even though appeals of the decision were in progress. In a
surprise move, the Canadian Civil Liberties Association has applied as an
intervenor in the appeals in support of the nurse. The CCLA explicitly
repudiates Whatcott's views on abortion, but is concerned about the
implications of the conviction for freedom of expression. [CCRL]
A French doctor convicted for having used a lethal injection to kill a
patient suffering from terminal cancer was given one year probation and will
continue to practise medicine. Meanwhile, candidates for all three leading
political parties vying for power in the April election have indicated
support for euthanasia, and more than 2,000 French medical professionals
have signed a petition advocating that the procedure be legalized. [CNN]
A conference on the theme "Christian conscience in support of the right to
life" was sponsored by the Pontifical Academy for Life in Vatican city on 23
and 24 February, 2007. It was attended by over 400 scholars and Academy
members. Adocument,
published as a result of the conference (now available only in Italian),
called upon health care professionals, politicians, and judges to support
the sanctity of life through the exercise of "brave conscientious
objection." It also asked the UN to include recognition of a right to
conscientious objection in the Declaration of Human Rights. [EWTN]
A bill before a Connecticut legislative committee would require Catholic
hospitals to dispense the morning-after pill to rape complainants in all
circumstances, despite concern that the drug could act as an embryocide by
preventing implantation. Current
protocol permits the four Catholic hospitals to dispense the drug if
tests show that ovulation has not occurred or that there is a reasonable
doubt that it has occurred, since, in those circumstances, there is no risk
that the drug will cause the death of an early embryo. [The
Advocate, 13 March, 2007] [Statement
of the Connecticut Catholic Conference]
The Portuguese parliament has modified the country's abortion law, which had
permitted the procedure up to 12 weeks gestation, but only in cases of rape,
or to preserve the health of the mother. The new law permits abortion for
any reason during the first 10 weeks of pregnancy. [CWN]
The Portuguese constitution includes a "Law
of Religious Freedom" that concerns freedom of conscience and
conscientious objection, but the country has no protection of conscience
laws specific to the practice of medicine.
The American Academy of Hospice and Palliative Medicine has officially
adopted a position of "studied neutrality" on the question of whether or not
physician assisted suicide should be legal [AAHPM
Statement]. The organization also changed its terminology, referring,
instead, to "physician assisted death", asserting that "suicide" was too
"emotionally charged." A neutral position taken by the British Medical
Association in 2005 was reversed in 2006. During the debate that led to the
legalization of euthanasia in Belgium in 2002, the Flemish Palliative Care
Association also adopted what might be considered a neutral stance on the
grounds that it was a "pluralist" organization [See Broeckaert, B. Janssens,
R.
"Palliative Care and Euthanasia: Belgian and Dutch Perspectives."
p.20-21 Ethical Perspectives 9/2-3 (June - September - 2002)]. The
Flemish association later ceased to distinguish between palliative care and
euthanasia [Dealing
with Euthanasia and Other Forms of Medically Assisted Death]. Since most
health care workers who are involved in palliative care have traditionally
been opposed to euthanasia, the blurring of distinctions between euthanasia
and palliative care, or even the abolition of such distinctions, would be of
significant concern if euthanasia or assisted suicide were legalized. [See
Belgium: Mandatory Referral for Euthanasia]
A Californian judge has refused to dismiss the suit brought by the state
against the
Hyde-Weldon Amendment, a federal law that denies funding to states that
deny health care professionals or institutions freedom of conscience. (See
California position reveals extent of coercion to suppress conscientious
objection)
The Italian College of Physicians has refused to take disciplinary
action against the anaesthetist who disconnected the respirator of
Peirgiorgio Welby in December, 2006. Dr. Stefano Ojetti resigned from his
position as adviser to the College in protest, calling the incident a "sad
and dark page in the history of our medicine." The Vatican newspaper,
L'Osservatore Romano, called Ojetti's conduct "exemplary." There have been
significant differences of opinion about whether or not the disconnection of
mechanical ventilation amounted to euthanasia. [See
Italian case illustrates potential for conflict]
CURA, the Catholic Church's pregnancy advice service, has been threatened by
the government's Crisis Pregnancy Agency with termination of funding if it
does not distribute a pamphlet that includes contact information about
groups that refer patients to foreign abortion facilities. CURA, which had
originally agreed to distribute the pamphlets, withdrew its agreement after
four Donegal CURA counsellors made public the fact that they were required
to distribute the material. The four counsellors were suspended for
"breaching confidentiality." [RTE
News]
The Vermont House Human Services Committee voted 7-4 in favor of a bill that
would allow patients diagnosed with.terminal illness and a prognosis of six
months or less to live to request a prescription for assisted suicide. [Burlington
Free Press]
February
Authorities at the Sierra Vista Regional Medical Center in San Francisco,
California, alerted by nurses who were concerned about procedures followed
in the case of a potential organ donor, began an investigation into the
conduct of Dr. Hootan Roozrokh. The conduct of a second physician, Dr.
Arturo Martinez, is also under review. The concern is that a transplant
surgeon attempted to hasten the death of a man on life support in order to
harvest his organs. It is reported that nurses were ordered to give the
patient "more candy" (ie, drugs), apparently because the patient was not
dying, or not dying quickly enough. The allegations illustrate how conflicts
of conscience can arise in such situations. [LA
Times]
The
California Assembly Bill 374 (California Compassionate Choices Act
includes a number of protection of conscience measurues, but Lawyer Wesley
J. Smith, an author and lawyer has warned that a new California bill may
force Catholic nursing homes to allow assisted suicide on their premises or
shut down.
A judge has ordered New York City to pay for sex change surgery for a 21
year old man on the grounds that the city is obliged to pay for all
necessary care for children in its care. The case began when the plaintiff
was a ward of the city. [United
Press] The claim of legal entitlement to morally controversial surgery
can raise the same problems for conscientious objectors in health care that
are raised by claims of legal entitlement to other morally controversial
procedures or services.
Senate
Bill 187 was approved by the Health and Human Services after an
amendment to remove
a protection of conscience provision failed, but the bill's sponsor then
withdrew the bill rather than let it go forward. He saw "no sense in even
having this bill" if it did not suppress freedom of conscience among health
care workers. [Argus Leader, 24 February, 2007]
The Rwandan Minister of Finance and Economic Planning has announced plans to
introduce contraceptive advice at hospitals and health centres and free
contraception to women, in addition to contraceptive/sex education in
schools. A law is reported to be in preparation to offer incentives to limit
families to three children; the current average is 6.1 children per family.
The Minister is concerned that an annual population increase of 3% is
straining the country's resources.[Medical News Today, 20 February, 2007]
Increased marketing of contraceptives through the health care system may
raise some moral or ethical concerns among health care workers. There is
much more likelihood of conflicts arising if abortion is expected as a
"backup" to failed contraception, as it is in the developed world. [No
Place for Abortion in African Traditional Life - Some Reflections (2002)]
A 13-year girl has been committed to the psychiatric unit of a Turin
hospital because she contemplating suicide after being forced to have an
abortion. An Italian judge ordered her to have an abortion because her
parents demanded it, and Italian law does not permit a minor to have a
choice in the matter. [Malta
Star] Though there is no evidence that medical staff experienced
conflicts of conscience in this case, it illustrates the fact that
controversial court orders can place health care providers in a difficult
position.
A bill to encourage the prescription of the morning-after pill for rape
complainants has passed in Colorado.
Bill 07-060 includes a
protection of conscience provision for individual practitioners and a
provision that does not require hospitals to dispense the drug if the
patient is pregnant or is not at risk for pregnancy. Pharmacies that do not
carry the drug are required to post a sign to that effect. A joint statement
by Catholic bishops in Colorado asserted that the law was sufficiently
flexible to allow Catholics to work within the parameters of the law in good
conscience, though they had argued for a conscience clause covering
institutions. [CNS]
Marc Litvine, an agent for the European Union, has threatened the country
with the termination of economic aid from Europe if the current law that
forbids abortion is not changed. He described Nicaragua's approach to
abortion as "backward." [CNA,
7 February, 2007] Dr. Rafael Cabrera, president of the Nicaraguan
Association for Life, has complained about "harassment" by international
organizations and officials who want the country to decriminalize abortion.
He stated that Litvine's comments reflected "absolute ignorance and
disrespect for the will of the Nicaraguan people." [CNA,
16 February, 2007] The dispute reflects the fact that the imposition of
European and international views would generate conflicts of conscience
among some Nicaraguan health care workers.
A 30 year old woman suffering from Eisenmenger's syndrome requested that her
doctors sharply increase her dosage of morphine, putting her into 'terminal
sedation', and then withdraw nutrition and hydration in accordance with the
terms of her 'lving will'. The doctors refused, on the grounds that the
procedure amounted to euthanasia. She has now gone to court to compel the
physicians to do as she asks. [The
Independent]
Oklahoma Senator Andrew Rice has introduced two bills designed to suppress
freedom of conscience in health care.
SB 105
(CARE Act) will compel all health care facilities that treat rape
complainants to provide "the complete regimen of emergency contraception
immediately at the hospital or other health care facility to each rape
victim who requests it." Hospitals that fail to comply would be subject to
$5000.00 fines every 30 days, and to revocation of licenses to operate.
'Emergency contraception' includes the morning after pill, a potential
embryocide which some health care workers decline to dispense for reasons of
conscience.
SB555
would compel all pharmacies to dispense contraceptives, regardless of the
moral or religious convictions of pharmacists.
While it has been widely reported that a survey has shown that 1/3 of
Australian doctors would perform euthanasia on suffering newborns for whom
treatment was deemed futile, a closer look at the survey itself is in order.
To begin with, the results concern both Australian and New Zealand
physicians. The study received responses from 78 physicians, though it
appears that responses from only 73 were considered. Of these, 15 (about 20%
)considered "hastening death" unacceptable, while 35 (47%) would "hasten
death" using "analgesia-sedation" and 23 (33%)would "hasten death" by
withdrawing treatment. Two key points have to be considered. First: most
conscientious objectors do not consider withdrawal of burdensome treatment
to be euthanasia, on condition that 'treatment' is defined to include
nutrition and hydration. Second: most objectors would likely use
double-effect reasoning to administer a sedative for the purpose of pain
relief, with the knowledge that it might also shorten life. Third: most
objectors would not characterize a decision to withdraw burdensome treatment
a decision made for the purpose of hastening death. If the study was clear
about relating the action to a deliberate intention to hasten death, the two
striking results are that 47% would be willing to perform euthanasia by
injection/infusion, and 67% believe that deliberately hastening death is
morally acceptable. The results are indicative of a tendency towards
acceptance of euthanasia, with an objecting minority of between 20% and 33%
(depending upon the understanding of respondents concerning withdrawal of
treatment, and the definition of treatment). [Barr,
Peter, "Relationship of neonatologists' end-of-life decisions to their
personal fear of death." Archives of Disease in Childhood - Fetal and
Neonatal Edition 2007;92:F104-F107.]
The New England Journal of Medicine has published the results of a study
undertaken in 2003 that canvassed 1144 physicians in the United States.
Participants were asked if physicians are ethically permitted to disclose
their own objections to morally controversial procedures, if they are
obliged to disclose "all options" (including the controversial practices) to
patients, and if objecting physicians must refer patients for the
procedures. The three procedures chosen as exemplars for the survey were
terminal sedation, abortion following failed contraception, and prescribing
birth control to adolescents without parental approval. 63% agreed that
physicians may describe their objections to patients, 86% believed that a
physician must present "all options," and 71% believed that objecting
physicians are obliged to refer patients to willing colleagues. Not
surprisingly, those who objected to the procedures in question were less
likely to agree to referral. The authors of the study suggested that the
conflict "might be understood in the context of perennial debates about
medical paternalism and patent autonomy," completely overlooking the issue
of personal integrity.[NEJM]
A 2003 survey in China indicated that almost 65% of the respondents agreed
that euthanasia should be legalized. A family with a child suffering from
cerebral palsy in Sichuan province in southwest China is reported to have
asked for euthanasia. There appears to be some uncertainty about the state
of the law in the country, though, in practice, the procedure is not
considered lawful. [China
Daily]
Dr. John Lockley of Bedfordshire has expressed concern that the proposed
Sexual Orientation Regulations in the United Kingdom will cause conflicts of
conscience for physicians who, like him, do not support homosexual adoption.
He is concerned that a physician who declines to provide a "positive
reference" when approached by someone involved in a homosexual lifestyle
will be disciplined and perhaps struck off the medical register. Dr. Lockley
wants a protection of conscience clause included in the regulations. [The
Telegraph]
A new vaccine against human papilloma virus, a common sexually transmitted
infection that can lead to cervical cancer, will be administered to all
11-12 year old girls in Texas. HPV is incurable and easily communicated by
skin-to-skin contact. The executive order mandating the vaccinations permits
opting out of the programme by parents who object to the vaccination of
their daughters for reasons of conscience or religion. It is not clear to
what extent such objections might arise from objections to vaccination
against disease, from objections to the perception of state intrusion into
private life, or from concerns about the safety of the vaccine. It has been
suggested that objectors believe that the vaccine will encourage sexual
promiscuity. It is unlikely that this is a unanimous opinion, since the
vaccine would protect not only rape victims, but women who have not had sex
before marriage from a disease carried by a spouse who had previously been
sexually active. [Daily
Princetonian]
At a session of the French Parliament on 6 February, Mrs Hermange, a
senator, asked the Minister of Health and Solidarity a question about the "necessity
to guarantee medical staff the right to exercise their conscience clause in
the event of an abortion", by virtue of article L. 2212-8 of the French
public health code which stipulates that "a doctor is never required to
carry out an abortion" and that "no midwife, nurse, or medical
assistant whatsoever is required to participate in an abortion". She
stressed that the practice is "ambiguous" sometimes and creates
situations where "exercising the conscience clause becomes a factor for
discrimination, both for recruitment and promotion".She expressed
concern that the conscience clause could be a factor for discrimination : "For
efficiency or practical reasons, certain medical establishments consider an
abortion a medical procedure like any other and therefore prefer to hire
applicants who explicitly state they do not wish to exercise this right.
Several examples of this kind were reported to me recently…"Mrs Hermange
notes that "it appears particularly difficult for
gynaecologists-obstetricians and midwives to carry out their job while
'respecting their convictions'". "One could wonder, Minister, whether
this situation is not one of the reasons for the shortage of doctors
specialised in this field." [Reported sources of this report Le Monde
01/03/07 & Zenit.org 27/02/07. Sources unconfirmed]
The highest court in Switzerland has ruled that assisted suicide should
be available to mentally ill people. The judges stated that this would not
apply in the case of a death wish resulting from a "curable, psychiatric
disorder." An expectation that health care workers will provide assisted
suicide to the mentally ill further increases the likelihood of conflicts of
conscience in the professions. [International
Herald Tribune, 2 February, 2007]
January
The Douglas hospice in Oxford, UK, run by an Anglican nun, assisted a
disable patient who was seeking a prostitute. Sister Frances, foundress of
Douglas House, stated, "It is not our job to make moral decisions for our
guests." This is the argument put forward by those who, arguing for respect
for patient autonomy, would compel objectors to facilitate morally
controversially procedures or services in health care. [The
Telegraph]
A non-governmental organization has applied to the Supreme Court to legalize
euthanasia of terminally ill patients as a human right. [Hindu
News] If the procedure is declared to be a human right, it is doubtful
that any conscientious objection to it would be permitted.
A proposed bill in the Hawaiian Senate would legalize assisted suicide and
voluntary euthanasia for terminally ill, competent patients. An objecting
physician need not participate in the procedure, but must transfer the care
of the patient to another physician upon the request of the patient. Some
protection is offered to health care facilities that have policies against
assisted suicide and voluntary euthanasia..Hawaiian
Senate Bill 1995
Referring to a 12 year old boy who has begun a course of treatment in
preparation for a sex change operation, Dr. Bernd Meyenburg, the head
of Frankfurt university's clinic for children with identity disorders,
commented "it would have been a crime to let Kim grow up as a man". An
alternative translation may be "it would have been very wrong." In either
case, the comment implies that there is a moral obligation to provide sex
change operations to patients diagnosed to have the "wrong body." [The
Telegraph,
"Unhappy as a Boy";"Sex-change
Child"]. The advocacy and acceptance of such views may adversely affect
health care professionals who reject the reasoning that leads to sex change
surgery. [First
Things]
Lawyers for the government of California have asserted that the state
could lose as much as $37 billion in US Government funding because it
discriminates against doctors or hospitals that refuse to perform or refer
for abortions for reasons of conscience. They argue that the federal law
that they are contesting. The
Hyde-Weldon Amendment denies federal funds to states that practise this
discrimination. California wants the Amendment interpreted to mean that the
state can continue to force doctors and hospitals to perform or refer for
abortions "when a woman's life or health is at risk." [California
Daily Catholic] The practical problem with this suggestion from the
perspective of many objectors is that, for the purpose of abortion, "health"
is defined so broadly as to permit abortion on demand, nullifying protection
of conscience measures limited in this way. It is possible that the
Hyde-Weldon amendment will be struck down by Congress, which is now
controlled by the Democratic Party. [CMA
News Release]
During a meeting of the Committee for the Elimination of Discrimination
Against Women (CEDAW), Cuban delegate Magalys Arocha Dominquez,
questioning Polish representatives about access to abortion in that country,
want to know '[h]ow many doctors had been suspended or fired because they
refused to perform abortions?" The question appears to reflect an
expectation that that should be the norm.
The response from the Polish delegation was that doctors could refuse to
perform abortions for reasons of conscience, except "for women whose health
was seriously imperilled by the pregnancy." If all doctors in a hospital
refuse to perform abortions, the hospital "is required to have a contract
with another healthcare facility willing to perform the procedure." [WOM/1591]
HB 2572 would authorize the provision of lethal prescriptions to
terminally ill patients with less than six months to live. Patients would be
required to administer the drug themselves, unless handicapped. The
procedure would involve participation of two physicians, pharmacist and
(possibly) a psychiatrist or psychologist. In the case of a handicapped
patient unable to self-administer the drug, the patient or physician can
delegate someone else to do so. This person need not be a health care
worker. Those who participate in the procedure are protected from
disciplinary action by professional bodies. The bill includes a
protection of conscience section that allows a health care provider to
excuse himself from fulfilling requests to prescribe drugs for suicide, but
mandates that he "promptly transfer the responsibility" to another health
care provider willing to assist in the requested suicide.
Canadian Physicians for Life
has been advised by Alberta Health and Wellness that the Alberta Government
will make Pediacel available in publicly funded immunization programs after
March 2007. Until now, Pentacel has been the only combined infant vaccine
(diphtheria, tetanus, pertussis, polio and Haemophilus B) available to
Canadian parents. Pentacel is partly derived from a cell line created from
aborted fetal tissue; Pediacel (same diseases) is not.
Catholic hospitals in Australia that adhere to the Catholic Health
Australia's Code of Ethical Standards are refusing to dispense the
morning-after pill to rape complainants or refer them to centres that do.
Karen Willis, from the NSW Rape Crisis Centre, has claims that the hospitals
should be forced to provide the drug, despite concern that it may act as an
embryocide. [The Age.com, 11 January, 2007]
In 2004 a six year old girl underwent surgery at a Seattle hospital to
prevent her from maturing and growing to adult size. Her parents had her
uterus and breast buds removed and had her growth stopped by using large
doses of hormones. The parents' decision was based upon concern that if she
continued to grow and mature it would become increasingly difficult to
manage her care. Opponents of the treatment expressed the view that the
surgery was meant for the benefit of the caregivers, not the girl herself.
The ethical controversy illustrates the likelihood of conflicts of
conscience among health care workers called to participate in such
treatment. [Parents' Blog]
[Article]
In 2004, nurse Toni Lemly was removed from a full time position after she
refused to administer the 'morning-after pill' at the family planning clinic
at St. Tammany parish Hospital in Covington, Louisianna. Lawyers with the
Alliance Defense Fund filed suit on her behalf in June 2005 for violation of
freedom of conscience by refusing reasonable accommodation for the exercise
of her moral and religious beliefs. Louisiana's 22nd Judicial District Court
has now ruled that the case may proceed to trial. [Judgement]
[Petition] [News
Release]
The Assisted Reproduction unit of Quir'n Hospital in Donostia-San Sebastian
has culled embryos to ensure the birth of a girl. There was concern that boy
would have a 50% chance of developing Retinosis Pigmentaria (RP), a
degenerative eye disease.