October-December, 2008
December
The Montana Medical Association will neither file an amicus brief in an
appeal of a decision legalizing assisted suicide in the state, nor will it
ask the American Medical Association to do so. Dr. Kirk L. Stoner, MMA
President, stated that the Association has no policy on the issue and will
become involved only if the state supreme court or MMA members ask the
Association to do so. [AMA
News]
Numerous attacks on the concept of freedom of conscience in health care
have been launched in response to a new federal protection of conscience
regulation. Many of the critics assert that the regulation will
interfere with access to contraception. These assertions may be based on
claims by some objectors and others that the morning-after pill and even
some hormonal contraceptives act as "abortifacients" because it is alleged
that they can prevent implantation, thus causing the death of the early
embryo. Some objectors have confirmed that this is their understanding of
the regulation. [The
Virgina Pilot]
In addition, however, Section 88.4(d) of the regulation protects health
care workers who, for reasons of conscience, refuse to participate in "any
part of a health service program or research activity." Opponents of the
regulation argue that this includes not only contraception, but artificial
reproductive services and medical treatment of patients who identify
themselves as homosexual or transgender. [Examples opposition to the
regulation:
Oklahoma Gazette;
Letter to Des Moines Register;
Eflux Media;
New York Times;
Letter to the Boston Globe;
Rochesterchiro's Blog;
St. Louis Post Dispatch;
Findlaw
Commentary;
Feministing;
Human
Rights Campaign] The Attorney General of Connecticut plans to take
action against the regulation. [LifeNews.com]
36 percent of US physicians surveyed agreed that the government should be
involved in protecting health care workers who decline to participate in
procedures or services for reasons of conscience. 31 percent disagreed; 33
percent had no opinion. Their responses to questions related to
the new HHS regulation were confused. Most believed that physicians
should not refuse requests for artificial reproduction because of patient
marital status or sexual preferences. [Christian
Post]
An inquiry into second trimester and late-term abortions disclosed that
more than 10,500 such procedures had been performed in the country since
1994, and that infants sometimes survived the procedure and were left to
die.[ABC
News] Such circumstances have been noted elsewhere and have generated
significant conflicts of conscience among health care workers. [see
Personal qualms don't count]
Speaking for the U.S. Conference of Catholic Bishops, Deirdre A. McQuade
welcomed publication of a Department of Health and Human Services
regulation to ensure freedom of conscience for health care workers. "The
enforcement of federal laws to protect their freedom of conscience is long
overdue," she said. The Conference urged President Elect Obama "to honor
this much-needed implementation of longstanding laws." McQuade pointed out
that the rule was already under attack, even though it ought to be common
ground that the freedom of conscience of health care workers with respect to
abortion should be respected. [News
Release]
The US Department of Health and Human Services has issued the final
version of a regulation designed to support freedom of conscience in health
care. The
new regulation requires states and other entities receiving money from
the Department to certify that they do not compel objecting health care
workers to participate in abortion or sterilization. It also requires that
they certify that they do not force objectors "to perform or assist in any
part of a health service program or research activity funded by the
government," or discriminate against them for having refused to do so. [Washington
Post]
The Supreme Court of Illinois has overturned a lower court decision and
ruled that two pharmacists can proceed with a civil suit against an
"emergency regulation" issued by the state governor that compels pharmacies
in the state to provide or refer for the "morning after pill."[Supreme
Court ruling][Chicago
Tribune]
Faced with the prospect that the Freedom of
Choice Act may be reintroduced and become law, American Catholic authorities
have begun to discuss what should be done if that comes to pass. At a
meeting of the U.S. Conference of Catholic Bishops, Chicago Auxiliary Bishop
Thomas Paprocki said that it might be necessary "to consider taking the
drastic step of closing our Catholic hospitals entirely." He stated that it
would be insufficient to merely withdraw sponsorship or sell the hospitals
to entities that would provide abortion. On the other hand, Sister Carol
Keehan, president of the Catholic Health Association, does not believe that
Catholic hospitals would have to close, but insisted that there would be no
compromise on the issue of abortion. According the the Catholic Health
Association, the 614 Catholic hospitals in the United States treat over 5
million patients annually. [Baltimore
Examiner]
Judge Dorothy McCarter of Montana has ruled that citizens of the state
who are mentally competent and terminally ill have a constitutional right to
suicide, and that physicians who prescribe medication for this purpose
cannot be prosecuted. The decision will likely be appealed. [New
York Times]
A 29 year old man in Ashton, north west England, has been convicted of
racially aggravated harassment for insulting and offensive comments he
directed at a Muslim pharmacist who refused to dispense the morning after
pill for reasons of conscience. The pharmacy arranged for another store
remain open an extra five minutes, but the man did not go there because he
said there was not enough time. He went to the media at the time and the
story generated considerable public controversy. The pharmacist made a
complaint was made to the police 12 days later. [Tameside
Advertiser] [See
Muslim pharmacist denounced]
The prime minister of Luxembourg has stated his intention to amend the
country's constitution to deprive head of state Grand Duke Henri of his
power to enact laws by signing bills approved by parliament. The move is a
response to intimations from the Grand Duke that he would refuse to sign a
bill legalizing euthanasia. [Reuters]
While the situation involves legal and constitutional issues peculiar to
constitutional monarchies, it illustrates the kind of pressure likely to be
faced by objecting health care workers if euthanasia is legalized without
robust of protection of conscience measures.
Richard J. Evans, Regius Professor of Modern History at the University of
Cambridge, comments that the gruesome 'experiments' on concentration camp
inmates by Nazi doctors were considered by their peers to be "'normal
science,' subject to standard protocols of peer review in conferences and
journals." Josef Mengele, for example, received funding from the Kaiser
Wilhelm Institute in Berlin, and his work was reviewed by Otmar van
Verschuer, whom Evans describes as an "eminent scientist." [The
Telegraph] Evans' comments invite reflection on the relationship
between establishment moral norms and bioethics on the one hand, and
contrary positions taken by health care workers who reject such norms for
reasons of conscience.
November
Senators Hillary Clinton and Patty Murray have introduced a bill to
prevent the Department of Health and Human Services from implementing a
protection of conscience regulation. Planned Parenthood supports the
intiative. [News
Release]
A survey of American physicians released by the Physicians' Foundation
discloses that almost half of the primary care doctors in the United States
might leave medicine within the next three years if presented with
alternative careers. It is reported that only 2% of the current group of
medical students plan to enter primary care. The principal complaints
concerned the problems generated by 'red tape' from insurance companies and
government. Respondents have adopted a number of strategies to cope:
- changing careers
- charging patients a yearly fee and refusing insurance plans
- limiting the kinds of insurance plans they will accept
- limiting the number of Medicare and Medicaid patients they accept,
or refusing to take them at all [CNN]
Pressure applied by those who wish to deny freedom of conscience to
physicians can only make this situation worse.
Three officials from the federal Equal Employment Opportunity Commission
have complained that a protection of conscience regulation proposed by the
U.S. Department of Health and Human Services would undermine 40 years of
civil rights jurisprudence and is potentially confusing and unnecessary. The
critics are the Commission's legal counsel, Reed L. Russell, Stuart J.
Ishimaru and Christine M. Griffin. Other opponents of the rule include the
National Association of Chain Drug Stores, the American Hospital
Association, the American Medical Association, 28 senators, more than 110
representatives and the attorneys general of 13 states. The Ohio Health
Department and the Planned Parenthood Federation claim that the rule might
force facilities providing contraception and abortion to hire employees who
could refuse to do the work. [New
York Times]
Misericordine nuns of Lecco, who have cared for Eluana Englaro for 14
years at a hospice in Italy, have refused to to comply with a court ruling
that assisted nutrition and hydration can be stopped in order to cause her
death. Further, the Italian Secretary for Welfare has stated that no
government-run hospital is obliged to carry out the order. [Lifesite
News]
An Italian appeals court has agreed that food and fluids can be withdrawn
from a woman who has been living in a vegetative state since a car accident
in 1992. The ruling is the result of litigation by her father. [The
Telegraph] Such rulings can cause conflicts of conscience among
health care workers because many people consider causing death by
dehydration and starvation to be euthanasia.
Dr. Derrick Aarons, a family physician and founding president of the
Bioethics Society of the English-speaking Caribbean (BSEC), told a committee
of the Jamaican parliament that abortion should not be "a matter of
legislation by the state." He argued that the decision whether or not to
abort "should be left to moral beliefs and individual conscience." He
characterized laws against abortion as an attempt to "legislate moral values
and make would-be criminals out of persons wishing to aid in the exercising
of reproductive rights and liberty." [Jamaica
Observer]Based on this reasoning, Dr. Aarons should oppose efforts
to compel health care workers to facilitate abortions if they object to the
procedure for reasons of conscience. However, it does not appear that this
issue was addressed in his testimony.
Over a period of 26 years under the communist regime in Yugoslavia, Dr.
Stojan Adasevic performed about 48,000 abortions, as many as 35 abortions a
day. After a dream and an abortion that he found particularly traumatic,
Adasevic advised the hospital that he would no longer perform the procedure.
As a result, his salary was cut in half, his daughter fired from her job,
and his son was prevented from entering university. [Catholic
News Agency]
Providence Health Care, reported to be the operator of the largest
hospital system in eastern Washington state, has declared that it will not
permit assisted suicide, which is to become legal in the state in March,
2009.[Providence
Health Care Statement]
Initiative I-1000, the Washington Death with Dignity Act, was
approved by voters in yesterday's ballot. In March, 2009, the Act
will legalize assisted suicide by patients who have been diagnosed with
terminal illness. The Act includes a
protection of conscience section. The Act prohibits professional
disciplinary action against health care providers who refuse to participate
in assisted suicide procedures, and specifies that only willing health care
providers will participate in providing lethal drugs to an assisted suicide
candidate. It also allows health care entities to refuse to allow the
assisted suicide process to proceed on their premises, and to discipline
employees who, having been notified of the policy, ignore the prohibition.
However, the Act prevents health care entities from taking action
against employees who refer for assisted suicide on their premises. Thus, it
is possible that referral for assisted suicide will occur hospitals operated
by religious denominations or other groups opposed to the procedure.
Referral is not required by the Act. An objector is only required to
forward relevant medical records during a transfer of care.
What may prove more troublesome is the fact that the Act prohibits
civil action against health care providers who participate in assisted
suicide, but does not prohibit civil action against those who refuse to do
so. This suggests that objectors, while protected from professional
disciplinary action, may be sued by patients or their families. Moreover, it
is not clear whether or not the specification that only willing health care
providers will participate in providing lethal drugs will be interpreted to
include anyone other than those who directly hand the medication to the
candidate.
Finally, there is no provision in the Act to prevent
discrimination against applicants for employment, hospital privileges or
professional education who are unwilling to participate in assisted suicide.
The approval of assisted suicide by Washington state voters has generated
a call for legalization of the procedure elsewhere. A retired British
Columbia physician who is a member of the Right to Die Society of Canada has
said that he would support a similar bill in Canada. His suggestion was
opposed by a University of British Columbia instructor who specializes in
palliative care. [CBC
News] The difference of opinion demonstrates the importance of
protection of conscience legislation when controversial procedures are
legalized.
"[H]ow can we ensure that the next generation of physicians commits to
being the moral conscience of society rather than becoming the purveyors of
evil that the Nazi doctors chose to be?" The question was put to a Toronto
audience at Toronto General Hospital by Dr. Yoel Abells, a Toronto family
doctor and a medical ethics columnist. The occasion was Holocaust Memorial
Week. Abells pointed out that physicians joined the Nazi party in
significantly greater numbers than members of other professional groups. [National
Post;
Toronto Star]
October
England's Lord Justice Scott Baker has ruled that assisting someone to go
to Switzerland for the purpose of assisted suicide is contrary to English
law. The proceeding was launched by a west Yorkshire woman, Ms. Debbie
Purdy, who has who has multiple sclerosis. She was contemplating assisted
suicide at a Swiss assisted suicide facility. [BBC">BBC]
The ruling led a British member of parliament to call for a debate about
legalizing assisted suicide, [The
Guardian] while a member of the Scots Parliament plans to introduce
a euthanasia bill in Scotland before Easter. The bill will include
euthanasia as part of a continuum of palliative care, a concept that has
been adopted in Belgium. [Daily
Express] [The
Herald]
Lord Joffe plans to re-introduce an assisted suicide bill in the British
House of Lords. His Assisted Dying for the Terminally Ill Bill was defeated
by the Lords two years ago. [The
Times]
Suicide "is a human right" that ought to be recognized in law. The claim
is made in an article in The Times by Swiss physician Alois Geiger,
who prescribes lethal drugs for assisted suicide candidates at the Dignitas
facility in Zurich. [The
Times] The significance of the claim for health care workers who
object to assisted suicide is best understood within the context of similar
rights claims that are made for abortion and contraception. Those who make
the claims are frequently unwilling to allow freedom of conscience to those
who do not wish to be morally complicit in such procedures. If they make
some allowance for those who do not wish to actually provide the
controversial service, they almost invariably demand referral or some other
indirect participation that objectors often find troubling or unacceptable.
Since suicide can normally be accomplished without any assistance, the claim
that assisted suicide is a human right amounts to an explicit
assertion that at least some people have a moral obligation to help others
kill themselves.
A private facility operated by the British Pregnancy Advisory Service
(BPAS) will open in Scotland to deal with "hundreds" of late-term abortion
requests. The National Health Service (NHS), Britain's public health care
authority, has been unable to meet the demand for late term abortion in
Scotland because many physicians object to providing late term abortion for
social reasons, others have general moral objections to the procedure, and
few physicians are trained to do it. The facility will perform abortions up
to 24 weeks into a pregnancy. [Scotland
on Sunday] In 2003 BPAS chief executive officer stated that Scots
physicians were reluctant to provide abortions after 15 weeks gestation. He
admitted that it might be difficult to find staff for such a facility. [The
Sunday Herald] The story reflects the fact that the procedure
remains morally controversial and continues to generate conflicts of
conscience in health care workers.
The
Abortion Law Reform Act has been given royal assent and come into
effect in the Australian state of Victoria. The Act requires that
physicians who object to abortion for reasons of conscience refer patients
to colleagues who are willing to facilitate the procedure. [Australian
physicians express anger]
Scholars at the University of Oxford suggest that the supply of organs
available for transplant could be increased by removing organs from living
patients who are permanently unconscious. The idea is proposed by Dr. Julian
Savulescu, the Uehiro Chair of Practical Ethics at the University of Oxford,
and neonatologist and Oxford graduate student Dominic Wilkinson. Wilkinson,
in addition, proposes that organ donation could be made mandatory, rejecting
"the current charade" of informed consent for organ donation. Taken
together, the proposals would permit the harvesting of organs from
unconscious living patients over their own objections or those of their
families. [Death
Fiction and Taking Organs from the Living;
The Paradox of Organ Donation Consent]
A pharmacy operating as an entity of Divine Mercy Care, a Catholic health
care organization, has opened in Chantilly, Virginia. DMC Pharmacy will not
dispense, recommend or counsel for contraceptives and will adhere to other
aspects of Catholic teaching. The pharmacy manager has expressed gratitude
for the opportunity to work in an environment that respects his
conscientious convictions. The pharmacy is intended to cater to "a special
niche" of people who have similar views. Unlike some other states that have
made ownership or management of pharmacies impossible for citizens who share
such convictions, Virginia does not require pharmacies to carry or refer for
contraceptives. NARAL Pro-Choice America is recommends that the pharmacy be
boycotted because it "doesn't respect [patient] choices." The operation of
the pharmacy, on the one hand, and the call for a boycott, on the other,
demonstrates an appropriate balance in the exercise of freedom of conscience
by parties with different views. [Catholic
News Agency;
Washington Times]
A bill to legalize abortion has passed the Upper House in parliament in
the Australian state of Victoria. The bill includes a requirement that
physicians who object to abortion refer patients to non-objecting colleagues
in order to facilitate the procedure. Supporters of the bill claim that this
does not amount to mandatory referral for abortion, but this view is
rejected by its opponents. News reports do not make clear what further
legislative action is required, since it appears that there will be further
debate on amendments to the bill. The head of Catholic Health Australia,
which operates 15 hospitals in the state, responded to the passage of the
bill. "We will challenge any new law in order to fulfil our Catholic
principles," he said. "We are greatly disappointed that the parliament did
not hear our request to let staff at our hospitals practise within their own
conscience." He added, "[W]e will stand right behind our doctors and nurses
and back them to the hilt if they are challenged in exercising their ethical
rights. [Herald
Sun;
The Australian]
The President and Executive Director of Alliance Catholic Healthcare has
submitted a
letter supporting the US Department of Health and Human Services
draft protection of conscience measure. Alliance represents over fifty
hospitals and thousands of physicians in California. William J. Cox,said
regulation is "especially important" because of several attempts to "single
out" and "blacklist" Catholic hospitals in the state. [Catholic
News Agency]
A
bill in the parliament of the Australian state of Victoria is generating
strong opposition from health care workers and others. The bill demands that
a physician who objects to abortion for reasons of conscience must,
nonetheless, refer a patient to a colleague who is willing to facilitate the
procedure. Dandenong general practitioner Janet Gross has posted a sign at
her office to advise patients that she does not refer for abortion, and
"will not obey the proposed legislation forcing doctors to refer for
abortion." Other opponents of the bill include in vitro fertilization
pioneer John Leeton, David Clarke, a psychiatrist, and Graeme Calrk,
inventor of the "bionic ear." Their objections extend beyond the issue of
freedom of conscience. [The
Australian]