July-September, 2008
September
In an interview in Canada's
Medical Post (questions 6 and 9), Dr. Bonnie Cham, Chair of the
CMA Ethics Committee, noted that the CMA had considered freedom of
conscience in health care, "including the impact of offering and not
offering abortion services." She reaffirmed the organization's support for
"the identifiable minority" of physicians who do not agree with abortion,
and observed that there is still "a minority who would not refer" for
abortion. [See
CMA Policy on Induced Abortion]
The proposed American Dept. of Health and Human Services
protection of conscience regulation has been attacked by 13 state
attorneys general, who claim that it "completely obliterates the rights of
patients to legal and medically necessary health care services in favor of a
single-minded focus on protecting a health care provider's right to claim a
personal moral or religious belief." [Jurist]
The Catholic Archbishop of Melbourne, Australia, responding to a bill
that will legalize abortion in the state of Victoria. The bill passed the
Legislative Assembly on 11 September and may become law by mid-October. In a
pastoral letter, Archbishop Denis J. Hart described the bill as "an
unprecedented attack on the freedom to hold and exercise fundamental
religious beliefs" that "makes a mockery of the Victorian Charter of Human
Rights and the Equal Opportunity Act." He stated that the bill "is clearly
intended to require Catholic hospitals to permit the referral of women for
abortions," and suggested that it would not be possible for Catholic
hospitals to continue to operate.
In an interview with the Church of Scotland's magazine Life and Work,
Baroness Warnock, described by The Telegraph as "Britain's leading moral
philosopher," stated that people suffering from dementia should consider
euthanasia so as to avoid wasting public health care resources and their
families' lives. She said that she hoped that, one day, people would be
licensed to 'put down' others who were unable to care for themselves. [The
Telegraph] Legalization of euthanasia, particularly on the terms
suggested by Warnock, would likely cause conflicts of conscience among
medical professionals.
While blatantly provocative assertions have been deleted,the
policy approved by the College of Physicians and Surgeons of Ontario
continues to assert that physicians may "in some circumstances" be obliged
to help patients make arrangements for morally controversial procedures. It
continues to link this expectation to the possibility of prosecution for
professional misconduct. The revised draft does make clear that the
principal threat to fundamental freedoms comes from the Ontario Human Rights
Commission, not the College. [Catholic
Register]
Canadian ethicist Margaret Somerville, founding Director of McGill
University's Centre for Medicine, Ethics and Law, has criticized the attempt
by the Ontario Human Right Commission and College of Physicians and Surgeons
to suppress freedom of conscience in the medical profession. She notes that
there is a difference between refusing to provide a morally contentious
service for reasons of conscience and refusing ethically neutral services
for discriminatory reasons, warning that everyone should be concerned "by
such totalitarianism." [Somerville]
Catholic pharmacist Mike Koelzer of Kay Pharmacy in Grand Rapids,
Michigan has notified his customers that the store will no longer be selling
contraceptives of any kind. He reached his decision after a long period of
reflection on the teaching of his Church against contraception. He was,
additionally, troubled by the potentially abortifacient or embryocidal
effects of some birth hormonal birth control. He attempted to continue
dispensing such drugs for non-contracepive purposes, but "found the process
of questioning clients upon purchase to be too strenuous on both his staff
and on his clientele." [Catholic
Exchange] [Koelzer Blog]
Draft documents released on the eve of an important meeting of the
College of Physicians and Surgeons of Ontario indicate that revisions to the
controversial policy to be considered at the meeting were finalized the day
before public consultation ended. The Protection of Conscience Project has
called for the vote to be delayed so that stakeholders and College Council
members can be given time to review the proposed changes. [News
release]
The Ontario Medical Association, representing about 24,000 of the
province's physicians, has denounced attempts by the Ontario Human Rights
Commission and the College of Physicians and Surgeons to suppress freedom of
conscience in the practice of medicine. The OMA urged the College to
"abandon" the policy and stated that the OMA holds "that it should never be
professional misconduct for an Ontarian physician to act in accordance with
his or her religious or moral beliefs." The statement concluded: "It is the
OMA's position that physicians maintain a right to exercise their own moral
judgment and freedom of choice in making decisions regarding medical care
and that the CPSO not insert itself into the interpretation of human rights
statutes." [Note: the statement was posted on the OMA
website but has since been removed.]
In a letter to
the College of Physicians and Surgeons of Ontario, the Catholic
Archbishop of Toronto notes that guidelines proposed by the College are
confusing, threatening, and, in places, "an indirect way of violating the
conscience of the physician, and the physician's right to freedom of
religion." He adds, "To force a physician to facilitate or perform an action
that goes against his or her conscience or religious beliefs is unjust to
the physician, and likely contrary to law."
The Catholic Civil Rights League has warned the College of Physicians and
Surgeons of Ontario that parts of its draft policy on freedom of conscience
"raise significant concerns for freedom of religion and conscience." In
a letter to the College, League Executive Director Joanne McGarry
reminded the College that "Canada has an established custom of accommodating
sincerely held religious and conscientious convictions as much as possible,"
and said that it was unreasonable to expect physicians to act against their
conscientious convictions .
The Christian Legal Fellowship has advised the College of Physicians and
Surgeons of Ontario that its proposed policy on freedom of conscience
"unreasonably interferes" with fundamental freedoms, "lacks an adequate
justification," and has "no basis in law." The Fellowship is asking the
College to reject the proposal. [CLF
letter].
Rabbi Reuven Bulka and Catholic Archbishop Terrence Prendergast, both of
Ottawa, Ontario, have issued a joint statement challenging the attempt by
the Ontario Human Rights Commission and the College of Physicians and
Surgeons of Ontario to suppress freedom of conscience among physicians in
the province. They said that they are "deeply disturbed" by the proposal.
"Many doctors." they wrote, "have expressed a reasonable fear that . . .they
might be disciplined, and even lose their licenses, for obeying their
conscience. They would no longer be free to refuse to perform or refer for
certain medical acts that are contrary to their firmly held beliefs." [LifeSite
News]
Planned Parenthood claims that "Conscientious objection clauses, when
overly or improperly invoked, deny access to services and violate providers'
duty of care to patients,' and demands that objectors be forced to refer
patients and that freedom of conscience be denied to institutions. [Access
to Safe Abortion: A Tool for Assessing Legal and Other Obstacles]
The Protection of Conscience Project has made a
submission to the College of Physicians and Surgeons of Ontario
concerning draft guidelines that will have the effect of suppressing freedom
of conscience among physicians in the province. The submission observes that
the Ontario Human Rights Commission demonstrates "an alarming enthusiasm" in
it efforts to "restrict and suppress the exercise of fundamental freedoms of
conscience and religion." The Project comments that "[i]t is doubtful that
the College can contribute to an improvement in the practice of medicine or
enhance the enjoyment of fundamental rights and freedoms in Ontario by
accepting a new and troublesome role as a surrogate for the OHRC." It
concludes that the College should advise the HRC that if it wishes to
suppress the fundamental freedoms of physicians, it will have to proceed
without the assistance of the College.
Documents obtained by freedom of information request indicate that the
U.S. Army is continuing to use physicians in military interrogations, and
encouraging their involvement on the grounds that they may keep "detainees"
from being injured.[Science
Daily] Conflicts of conscience are foreseeable if there is an
expectation that physicians -especially military physicians - should be
involved in interrogations.
The
Medical Treatment (Physician Assisted Dying) Bill 2008 has been defeated
in the upper house in the Parliament of Victoria, Australia. The bill
included protection of conscience provisions for physicians and health care
facilities, but not for nurses, pharmacists and other health care workers.
In a
submission to the College of Physicians and Surgeons of Ontario, the
Catholic Organization for Life and Family asked the College to guarantee
that it "will not discriminate against physicians who oppose procedures such
as abortion, contraception (including the birth control pill and the
morning-after pill) and the use of certain assisted reproductive
technologies" "uphold the rights of physicians to exercise their
conscientious objection to such medical acts" and "not require doctors to
refer patients, or potential patients, to other doctors for such medical
acts."
Richard Doerflinger, assistant director of the Secretariat of Pro-Life
Activities of the U.S. Conference of Catholic Bishops, attributes the
erosion of religious freedom in the United States (First Amendment rights)
to the 1990 US Supreme Court decision, Employment Division v. Smith,
in which the court ruled that laws of general application can suppress
freedom of religion if not motivated by anti-religious bigotry. Doerflinger
supports the proposed Department of Health and Services protection of
conscience regulation. It is also supported by Catholic Medical Association
executive director John Brehany, who notes that the CMA has had complaints
from medical residents about pressure to prescribe contraceptives and
perform abortions. [National
Catholic Register]
Writing in L'Osservatore Romano, Professor Lucetta Scaraffia,
vice-president of the Italian Association for Science and Life and a member
of the Italian National Committee on Bio-Ethics, suggests that it is time to
revisit the concept of "brain death" that has been widely adopted since a
report from Harvard Medical School in 1968. Professor Scaraffia argues that
the practice of mechanically maintaining the bodily functions of "brain
dead" donors in order to preserve organs for transplant brings into question
whether or not the donors are, in fact, dead. [The
Times] Similar concerns have recently been voiced in the New
England Journal of Medicine [See
Brain death said
doubtful in some organ donation]. Differences of opinion about the
definition of 'death' and about a diagnosis of death could lead to conflicts
of conscience among health care workers involved with organ transplants.
August
The Ontario Human Rights Commission has instructed the College of
Physicians and Surgeons are to "'check their personal views at the door' in
providing medical care." The Project Administrator described the OHRC
directive as "an iron fist in a velvet glove." [Project
news release]
In a submission to the College of Physicians and Surgeons of Ontario, the
Canadian Centre for Bioethical Reform states "it is essential you protect
Ontario doctors' consciences. To strip a physician of his right to refuse
involvement with immoral practices is to demand that physicians act without
integrity-and that is hardly providing patients the best care." [CCBR
submission] In a
letter to the College, Alberta lawyer John W. Veldkamp commented, "Our
medical profession is in a very sorry state when the College is advocating
that physicians be more concerned about offending the Ontario Human
Rights Code that the health of the patient."
A
draft regulation to ensure freedom of conscience for health care workers
has been released by the U.S. Department of Health and Human Services for
public consultation that will last 30 days. [Washington
Post]
20 August, 2010
The College of Physicians and Surgeons of Ontario has extended the time
for public comment on a proposed policy to suppress freedom of conscience
for physicians in the province. The comment period was to end on 15 August,
but protests that erupted when the plan became public convinced the College
to extend the period to 12 September. [LifeSite
News]
In the case of North Coast Women's Care Medical Group v. Superior
Court of San Diego County (Benitez) the California Supreme Court has
ruled that physicians can be compelled to provide artificial reproductive
services to single persons and those identifying themselves as homosexual,
even if the physician believes that it would be immoral to do so. The ruling
was directed against Christian doctors who, while declining to provide the
procedure themselves, referred the woman to a specialist and paid the
associated fees. [AUL;
Pacific Justice Institute]
The Catholic Civil Rights League (Canada) has written to the College of
Physicians and Surgeons of Ontario expressing concern for the maintenance of
freedom of conscience for physicians, and asking for an extension on the
time for public consultation on a policy intended to suppress it. [CCRL
news release]
In a letter to Canada's National Post responding to criticism,
Dr. Preston Zuliani, president of the College of Physicians and Surgeons of
Ontario, said that the College "does not expect physicians to provide
medical services that are against their moral or religious beliefs." [Letter
published 22 August, 2008] He added, however, that it is expected that
objecting physicians will "provide information about accessing care." If, by
this, it is meant that an objecting physician must facilitate what he
considers to be wrongdoing, many in the profession will find the demand
unacceptable.
Canadian Physicians for Life have made an interim submission to the
College of Physicians and Surgeons of Ontario. "Authoritarian and coercive
edicts like these draft policy documents," it states, "suggest a fear of
freedom that is unbecoming of a regulatory institution in a democratic
country. They also raise serious questions about the CPSO's understanding
of, and competence to deal with, issues of freedom, pluralism, accommodation
and tolerance." [CPFL
interim submission]
Canadian Physicians for Life has written to the College of Physicians and
Surgeons of Ontario asking that all stakeholders be given a further 90 days
to respond to a proposed policy that would suppress freedom of conscience in
the medical profession.[CPFL
news release] Dr. Timothy Lau, an Ottawa physician and assistant
professor at the faculty of medicine, University of Ottawa, warned the
College
in a letter that the proposed policy "will endanger the principled,
conscientious, and responsible care of our patients, not just now but in the
years to come.
Canada's National Post reported on the policy being considered
by the College of Physicians and Surgeons of Ontario. [Charles Lewis,
"Religion out of medicine, a new message for Ontario doctors." National
Post, 15 August, 2010]
The Protection of Conscience Project has issued a news release warning
Ontario physicians that the College of Physicians and Surgeons of Ontario is
proposing to enact a policy to suppress freedom of conscience in the medical
profession. The College, the regulatory authority for the practice of
medicine, drafted the policy to conform to demands from the Ontario Human
Rights Commission. The draft was released without public notice near the end
of June with a deadline for public response by 15 August. It was discovered
by accident by an Ontario physician, who contacted the Project. The Project
has also written to the College asking that time for public comment be
extended by 90 days. [Project
news release]
Wriitng in the New England Journal of Medicine, Robert D. Truog, M.D.,
and Franklin G. Miller, Ph.D argue that current transplant practices should
be changed so that there is no longer a need to declare someone dead before
harvesting organs. Instead, they propose that informed consent be the
ethical criterion to justify removal of organs from patients who are alive
but who are expected to die if life support is removed. They note that in
many cases the organ donor does not actually meet the criteria for "brain
death," and that vital organs are thus often removed from living patients. [NEJM]
The discussion highlights to potential for conflicts of conscience among
health care workers involved in organ transplants.
An Indian court has ruled that a woman cannot have an abortion because of
a diagnosis of fetal malformation. The Medical Termination of Pregnancy Act
permits abortion after 20 weeks' gestation only if there is grave danger to
a woman's life. Abortion advocates now want the law changed, while those
against abortion are satisfied with the ruling. [Cybercast
News] Comments from various interested parties demonstrate the
likelihood of conflicts of conscience arising among health care workers
asked to provide such procedures.
July
Opposition is mounting in some circles to the
draft protection of conscience regulation that was leaked from the
Department of Health and Human Services in the United States. Claims are
being made that the regulation "could inhibit research in areas including
stem cells, infertility and even such unrelated fields as cancer." Freedom
of conscience advocates insist that a protection of conscience regulation is
needed. [Washington
Post]
A challenge to legal restriction on abortion in Ireland will be heard by
the European Court of Human Rights. It was begun by three Irish women and is
supported by Irish Family Planning Association case. [Irish
Times]Evidence
taken by an Irish parliamentary committee in 2000 indicated that, at that
time, most Irish obstetrician/gynaecologists would refuse to provide
abortions. While this may have changed since that time, it would be
reasonable to expect that a change in the law would cause conflicts of
conscience in health care professions.
25 Italian physicians have written a letter to the country's attorney
general to protest a court ruling that 37 year old Eluana Englaro can by
starved and dehydrated to death. Englaro is apparently in a "persistent
vegetative state" but is not brain dead or dying. [Zenit]
The letter indicates the probability of conflicts of conscience arising
among health care workers in such circumstances.
The United Nations is pressing Ireland over its restrictive abortion law.
The UN's human rights committee expressed concern and noted that what it
calls progress was slow. [Irish
Times, 25 July] Patrick Buckley of European Life Network, Dublin,
writes: "This is yet another example of an 'out of control' UN committee
operating beyond its mandate and instructing nations to adhere to its own
agenda rather than the covenant it is supposed to be monitoring. There is no
reference to abortion anywhere in the [International Covenant on Civil and
Political Rights] or any other
legally binding international treaty. This is the type of action [which]
brings the UN and its agencies into disrepute." [ELN
blog, 25 July]
Despite opposition from the four main churches and political parties in
Northern Ireland, MP Diane Abbott has proposed an amendment to a government
bill which would make the British abortion law apply to Northern Ireland. [The
Guardian] [Daily
Mail] [BBC]
[In view of strong Northern Irish opposition to the proposal, a change in
the law would likely generate significant conflicts of conscience in the
medical professions.
Cardinal Justin Rigali, chairman of the United States Conference of
Catholic Bishops' Committee on Pro-Life Activities, today wrote to all
members of Congress defending "efforts to reaffirm and implement laws on
conscience protection." [News
release]
A
draft regulation being circulated in the US Department of Health and
Human Services that has been obtained by the New York Times is
reported to provide extensive protection to health care workers who might
face discrimination because of religious or moral objections to abortion and
contraception. The most controversial section of the regulation appears to
be a definition of "abortion" that includes "any of the various procedures -
including the prescription, dispensing and administration of any drug or the
performance of any procedure or any other action - that results in the
termination of the life of a human being in utero between conception
and natural birth, whether before or after implantation." Spokesmen for the
Department refused to comment on the draft. The Christian Medical
Association and Concerned Women for America have issued news releases
supporting the proposal. [New
York Times] [The
Bulletin] [CMA
News Release] [CWA
News Release] [HHS
Secretary BLOG on Freedom of Conscience]
50.6 % of delegates at the Annual General Meeting of the British Medical
Association voted against aresolution
that included a provision that objecting physicians should be forced to
refer for abortions. Much of the opposition to the motion centred on its
requirement that objecting physicians be required to disclose their position
on abortion in pamphlets and other notices. A number of opponents were
concerned that this would indirectly lead to the identification of
physicians who do provide abortions, while others believed that there were
better ways to advise patients of their views. Dr Evan Harris, a Liberal
Democratic MP as well as a BMA members, clearly indicated his desire to
restrict freedom of conscience for health care workers. He was prepared to
accept the existing legal recognition of freedom of conscience in the case
of abortion and artificial reproduction, but argued "we should go no
further." [Scotsman]
Just days before the meeting, the proposal was attacked by Cormac Cardinal
Murphy-O'Connor and Baroness Cumberlege, a Catholic peer and former Junior
Health Minister [Catholic
Herald].
The National Executive Council of the Portuguese Order of Physicians has
given in to government demands that it remove prohibition of abortion from
its Code of Ethics. It is reported that the revised Code will state only
that it is impossible to put an end to a life once it has begun, without
defining the point at which life begins. That will leave determination of
the question to each physician, so that the Code will accommodate both
physicians who object to abortion and those who do not. The President of the
Order of Physicians, Pedro Nunes, supports the revision. He had previously
resisted the pressure and threats from the government to approve abortion. A
vote on the revision is to be held in September.[LifeSite
News]
The Milan Court of Appeal has approved an earlier judgement that food and
fluids can be withdrawn from a 36 year old Italian woman, Eluana Englaro,
who has been in an irreversible coma for 16 years. The woman's father has
been seeking such a judgement since 1999. Since the woman is not dying,
withdrawal of food and fluids will cause her death. Catholic authorities and
others have denounced the decision as formal approval of euthanasia. [Times
Online] In an increasing number of jurisdictions, assisted
nutrition and hydration are legally considered to be forms of medical
treatment that can be refused by a patient or (more frequently) by others
acting on their behalf. This can lead to conflicts of conscience among
health care workers who do not approve of causing death by dehyrdation and
starvation, as well as conflicts between families and health care
authorities (SeeElderly woman in
UK avoids death;
Doctors refuse shifts at hospital to avoid care for elderly patient).
Britain's General Medical Council has cleared a West Cornwall general
practitioner following an investigation of a complaint of misconduct. Dr.
Tammie Downes, a Christian who refuses to refer patients for abortion or
sign approvals for the procedure, was the subject of complaint after she
publicly stated that she discussed all options with patients seeking
abortion and encouraged them to consider the alternatives [SeeObjecting
physician investigated for alleged breach of ethics]. [The
Telegraph]
A
motionto be considered at the Annual General Meeting of the British
Medical Association purports to support conscientious objection that is now
recognized in British
statutes concerning abortion and artificial reproduction, but only on
condition that physicians who object to abortion for reasons of conscience
must facilitate the procedure by referring patients to more willing
colleagues. Representatives from the Catholic Medical Association and the
Islamic Medical Association in Britain have expressed strong opposition to
the motion, which has been brought forward by the Oxford Division, of which
abortion supporter Dr Evan Harris is a member. He is a Liberal Democratic
Member of Parliament who favours abortion [Catholic
Herald]. He and opposes freedom of conscience for health care workers
[SeeObjecting
physician investigated for alleged breach of ethics].
An 88 year old woman is at home after her daughter prevented doctors at
Birmingham's Selly Oak Hospital from removing nutrition and hydration, which
would have caused her death. The woman had been treated for two months for
dementia and C.difficile when doctors informed her daughter that they were
going to withdraw food and fluids. The daughter said that she had to "fight
very, very hard" to stop them. She obtained a second opinion favourable to
her mother, and the hospital agreed to continue treatment. [BBC
News] The situation has become increasingly common and had resulted in
conflicts between medial personnel and families (see
Doctors refuse shifts at hospital to avoid care for elderly patient),
but it also illustrates the potential for conflicst of conscience among
health care workers.