July-September, 2009
The Christian Medical Association has expressed support for a
protection of conscience provision in a bill proposed in the US Congress
by Representative Tom Price. The protection offered is limited to abortion.[CMA
News Release]
A committee of the US Senate has rejected an amendment to a health care
reform bill which was intended to prevent discrimination against health care
workers and institutions unwilling to provide abortion. [AUL]
During the campaign to legalize assisted suicide in the state of
Washington, activists led health care workers to believe that they would not
be forced to participate in the procedure. However, a law passed to force
objecting pharmacists in to dispense contraceptives will now be used to
force them to dispense lethal drugs for assisted suicide. [American
Thinker]
As a result of the decision of the House of Lords in the case of Debbie
Purdy, the British Director of Public Prosecutions has published an interim
policy that will guide Crown Counsel in deciding whether or not to lay a
charge of assisted suicide. The public is invited to respond to the policy
by 16 December, 2009. After taking public response into account, the
Director will issue a final policy in the spring of 2010. The policy
acknowledges that it would be contrary to public policy to prosecute
assisted suicide in certain cases, even though the act would continue to be
a criminal offence. [News
release] Since assisting suicide would remain at least technically
illegal, the policy cannot be used to impose an obligation on health care
workers to assist, nor does it prevent objectors from speaking against the
procedure.
The Catholic Medical Association has issued a letter criticizing the
approach being taken in proposed American health reform bills as "flawed in
principle and ineffective." The organization urges "uncompromising
commitment to defend the sanctity of life and the conscience rights of all
providers as essential parts of health-care reform." [CMA
letter]
Although the Society of Obstetricians and Gynaecologists of Canada
supports natural childbirth and opposes Caesarean sections not warranted by
medical necessity, 42% of Canadian obstetricians surveyed in a University of
British Columbia study believe that women should be able to choose to have
C-sections even when they are not medically indicated, even though 58% of
the same survey group disagreed that a C-section was safer for the baby.
Support for patient autonomy and unwillingness to spend the time necessary
to explain the benefits and risks of the procedure were offered as
explanations for the finding. [National
Post]
While abortion is illegal in Northern Ireland except to save the life of
a mother, guidelines for provision of the procedure in other circumstances
were issued in 2007 by the Dept. of Health, Social Services and Public
Safety. They were rejected by a Committee of the Northern Ireland Assembly
because of the conflict with the law. However, guidelines were again issued
in March, 2009 and are now the subject of a legal challenge from pro-life
groups. The new guidelines state that courts have interpreted "the life of
the mother" to include "adverse effects on her physical or mental health,"
and propose that abortion will be legally justified in Northern Ireland if
these adverse effects are "serious" and "permanent or long term." [Guidelines]
The problem likely to arise within health care professions is that the
evaluation of these effects is subjective, thus inviting disagreement,
conflict and pressure on objecting professionals to participate. Relevant to
this issue is that fact that, in other jurisdictions, purported restrictions
based upon evaluation of maternal "health" have proved impossible to
maintain.
The President of the Christian Medical Association, representing a
coaliton of 50 groups, has sent a letter and petition with 10,000 signatures
from medical professionals and individuals asserting that they want the law
to protect freedom of conscience in health care. [Letter]
Five Quebec doctors who say that they are supported by 100 colleagues
have written an open letter rejecting plans by the Quebec College of
Physicians to support euthanasia. The College regulates the medical
profession in the province and can discipline physicians who refuse to abide
by its policies. It has announced that it will release a policy in November
advocating a change in the law. [CanWest]
[Abridged
Translation]
Pope Benedict XVI, addressing the World Congress of the International
Federation of Catholic Pharmacists in Poland, said that pharmacists must
heed their conscientious convictions and not let market forces and
legislation cause them to sell products that undermine human life.[Genthique]
Current legislative developments in health care reform in the United
States are in a state of flux, with concern being expressed that bills being
considered in Congress fail to provide adequate protection for freedom of
conscience among health care workers. [LifeNews]
The complexity of the bills and the legislative process lead to uncertainty
about the final form that the bills may take. It does seem apparent that
protection of freedom of conscience for health care workers is not a high
priority for many members of Congress.
The National Organization of Women, which describes itself as a group of
feminist activists, is demanding that American health care reform should
abolish existing US protection of conscience laws. NOW "categorically
rejects" the President's promise to a joint session of Congress that he
would maintain such laws.[NOW
news release]
A group that claims to represent 30 million constituents has expressed
opposition to the Obama administration's proposed health care reforms. In a
news release, FreedomFederation.org
stated, "We support conscience laws protecting hospitals and healthcare
providers from coerced participation in abortion," and said that it would
hold Congress accountable to President Obama's promise that protection of
conscience laws would remain in place. [News
release]
Speaking at length to a joint session of Congress on the subject of
health care reform, President Barack Obama stated that "federal conscience
laws will remain in place." [White
House: Remarks]
Britain's General Medical Council heard evidence that a physician ordered
a nurse to administer a potentially lethal overdose of insulin to an 85 year
old woman who said that she wanted to die. The nurse refused, stating that
it would be unethical to do so, and left the room. The physician expressed
"disappointment and surprise" that the nurse refuse to do what she was told.
The case illustrates the kind of situation likely to confront conscientious
objectors where assisted suicide or euthanasia are legal. [Telegraph]
Applying a form of social contract theory popular among many ethicists,
bioethicist Jacob Appel suggests that the state of Montana should guarantee
a 'right' to physician assisted suicide by making the willlingness to write
a lethal prescription a requirement for a license to practise medicine.
Appel points out that lawyers are sometimes ordered to provide services for
unpopular clients, and that, by analogy, physicians might be ordered to
assist patients who want to commit suicide. He concedes, however, that this
should be a last resort. He suggests several alternatives that the state
should try first. [Huffington
Post]
Commenting on essential elements of health care reform, Bishop of Fargo,
North Dakota Samuel J. Aquila has stated, "The right to follow one's
conscience, as informed by God, must be guaranteed." [CNA]
The Montana Supreme Court will begin hearing arguments in an appeal of a
lower court decision that declared physician assisted suicide to be a right
guaranteed in the state's constitution. [See
The Case of the Disappearing Plaintiffs]
Tony Delamothe, deputy editor of the British Medical Journal, has
expressed support for legalization of assisted suicide and called for a
secret ballot of members of the British Medical Association on the subject.
Delamothe notes public support for the changes and argues that the procedure
is justified by the principle of autonomy.[BMJ]
Illinois Judge John W. Belz has issued a preliminary injunction that will
permit two pharmacy owners to refuse to dispense the morning after pill
pending a trial of their suit against the state. In 2004 the governor of the
state issued a regulation ordering pharmacies to dispense the drug even if
pharmacy owners objected to it for reasons of conscience.[ACLJ
news release]
The Wisconsin Catholic Conference has issued a
statement protesting the passage of a provision in the state budget that
requires Catholic agencies that provide health insurance to pay for coverage
of contraception. The bishops voice strong objection to the legislature's
"blatant insensitivity to our moral values and legal rights."
Responding to statements from the Spanish Minister of Justice, Dr.
Esteban Rodriguez of Right to Life (Derecho a Vivir) in Spain said that
objecting physicians would go to jail rather than perform abortions. He
criticized the "totalitarian intentions" of the government.[CNA]
An internet survey of 562 Canadian obstetrician/gynaecologists which
resulted in 170 returns found that about 60% of the respondents do not
perform abortions. About half of these are motivated by "personal beliefs."
[Medical
Post]
Mount Sinai Hospital in New York has filed a brief that claims that nurse
who was forced to assist in a late term abortion has no right of action
under federal law, despite
U.S. federal laws against such discrimination. A brief filed by the
Alliance Defence Fund contests the claim. [ADF
News Release] [Nurse
forced to assist in late term abortion] The issue is significant because
President Obama plans to revoke a regulation enacted by the previous
administration to give practical effect to federal laws in precisely such
cases. [Obama
administration announces plans to revoke protection of conscience regulation]
The ethics committee of the Wisconsin Medical Society has rejected a
motion that the Society adopt a neutral position on assisted suicide, and
reaffirmed its opposition to the procedure. [Second
Hand Smoke;
WMS statement] The statement is a clear indication that legalization of
the procedure would engender conflicts within the medical profession.
Christian Rossiter of Perth, Australia, has secured a judgement from an
Australian court that he can order his nursing home caregivers to stop
providing food and fluids through a gastric tube. Rossiter, a quadriplegic,
wants to die, although he said that he might be persuaded not to give the
order. [ABC]
On 13 August, Spanish Minister of Justice, Francisco Caamano said that
"there is no room for conscientious objection to abortion" in the country.
Collegial Medical Organization President Dr. Juan Jose Rodriguez Sendin has
rejected the Minister's assertion, stating that doctors will exercise their
freedom to refuse to perform abortions whether the government likes it or
not. The Minister's statement also brough a rebuke from the Association for
the Defense of Conscientious Objection. [CNA]
Responding to the news of a
suit filed by a nurse who was forced to participate in an abortion, ANA
programs officer Mary Jean Schumann said that nurses have an obligation to
ensure that their moral beliefs do not create a "barrier to care." She added
"Typically, you would say 'you need to find a different place to work if it
is that hard for you.'" Schumann did note that ethical conflicts could not
be completely avoided and that it was also possible to work around them.
Schumann was quoted by John Commins in an editorial in Health Leaders Media.
Commins asserted that institutions should ensure that "everybody is working
off the same set of ethical principles on abortion," a patent impossibility
unless those who object to abortion are denied employment.[Health
Leaders Media]
Angelo Cardinal Bagnasco, president of the Italian Catholic Bishops'
Conference, is encouraging physicians who have moral objections to abortion
to refuse to prescribe the abortifacient drug Mifepristone (RU486). About
70% of Italian physicians are believed to object to abortion for reasons of
conscience. [CNA]
Douglas P. Olsen, RN, PhD, a nurse ethicist at the U.S. Department of
Veteran's Affairs' National Center for Ethics in Health Care, stated that
conscientious objection by a health care worker implies that "society has
made a moral error," and that resort to it should be rare "and for very
serious problems." [Nurse.com]
The US House of Representatives Energy and Commerce Committee was offered
an
amendment from Representative Lois Capps to America's Affordable Health
Choices Act, one of the health care reform bills being considered in the
United States. The amendment includes a provision that prohibits
discrimination against individuals and institutions that refuse to "provide,
pay for, provide coverage of, or refer for abortions." The provision is
important because other parts of the Capps amendment call for public funding
for abortion. A similar amendment from Representatives Bart Stupak and Joe
Pitts was also adopted. It prohibits discrimination against any physician,
medical professional, hospital, health care facility or insurance plan that
"does not provide, pay for, provide coverage of, or refer for abortions." [ERLC]
In what will be their last decision sitting in the British House of
Lords, the Law Lords have ordered the Director of Public Prosecutions to
publicly set out the conditions under which someone who assists another to
commit suicide abroad will be charged. The appeal was brought by Debbie
Purdy following lower court decisions. Purdy wanted assurance that her
husband would not be charged if he accompanied her to Switzerland, where she
apparently plans to commit suicide. [Guardian][BBC]
The Catholic Medical Association has issued a statement rejecting the
health care reform bills currently before the US Senate and House of
Representatives, and expressing concern that the rush to reform jeopardizes
real progress. The CMA expressed special concern about the need to protect
freedom of conscience for health care workers, and about the financing and
provision of abortion. The Association offers other criticisms of the bills,
and ultimately concludes that it would be best "to scrap them and start
again." [CMA
Statement]
Justin Cardinal Rigali, representing the US Conference of Catholic
Bishops, has written to members of Congress to reiterate concerns about
America's Affordable Health Choices Act (HR3200), the health care reform
bill being considered. Among them, he draws attention to the need to ensure
protection of conscience. "Several federal laws have long protected the
conscience rights of health care providers," he wrote. "President Obama
recently stated that he accepts these current laws and will do nothing to
weaken them. Congress should make the same pledge, by ensuring that this
legislation will maintain protection for conscience rights." [USCCB
letter] [See
President
Obama promises "robust" conscience protection]
78 year old Michael Irwin was struck off the medical register in the
United Kingdom for unprofessional conduct related to the planned suicide of
a friend, who died of natural causes. He is now inviting police to charge
him for having helped Raymond Cutkelvin to go to Switzerland to commit
suicide.[Guardian]
It appears that Irwin is attempting to cause a change the law through civil
disobedience.
The federal secretary of the Australian Medical Association has
criticized a law passed last year in the state of Victoria that demands that
physicians who object to abortion refer patients to a non-objecting
colleague. "This runs counter to the principles of
autonomy and civil liberty that characterise the position promoted by
proponents of the Act," he said. [The
Age]
The British Royal College of Nurses has decided that it will neither
support nor oppose legalization of assisted suicide. At the same time, it
proposes to develop "detailed guidance" on the subject. It does not explain
what kind of guidance it will be able to provide if it takes no position
about it. The decision was based upon returns from 1,200 members. 49%
supported legalization; 40% were opposed [RCN
news release]. The Telegraph reports that the Royal College of
Psychiatrists, the Royal College of Anaesthetists and the Royal College of
Physicians of Edinburgh have also adopted neutral positions,[Telegraph]
while the British Medical Association is opposed.[Medical
News Today] The policy change has been rejected by the group Christian
Nurses and Midwives [Guardian].
Dr. Peter Saunders of the Christian Medical Fellowship noted that less than
half of the RCN's 390,000 members were surveyed, and that the actual returns
amounted to less than a third of 1% of the membership.[Christian
Institute]
Nurse Catherina Cenzon-DeCarlo has commenced legal action against Mount
Sinai Hospital in New York City because she was forced to assist in the
abortion of a 22-week-old infant in utero despite religious
objections that were known to the hospital. [ADF
News Release][ADF
Fact sheet][New
York Post]
What appears to be a steady if not increasing campaign in favour of
legalization of assisted suicide and euthanasia is reflected in a series of
reports and columns in British papers. If the media attention reflects
public attitudes, it is likely that those attitudes will eventually collide
with those of medical professionals opposed to the procedures. [Dignitas
suicide, father-in-law: Telegraph, 19 July, 2009] [Dignitas
suicide, wife: Telegraph, 19 July, 2009] [Hitchens-
Mail, 19 July, 2009] [Dignitas
suicide, Sir Edward & Joan Downes, Daily Express, 19 July, 2009] [Dignitas
suicide, couples: The Guardian, 14 July, 2009][Senior
Welsh official favours assisted suicide: Wales on Line, 20 July, 2009]
Continued protection for freedom of conscience in health care is among
the requirements for health care reform stressed by the US Conference of
Catholic Bishops in a letter to members of the US Congress. "For decades,
Congress has respected the right of health care providers to decline
involvement in abortion or abortion referrals, without exception, and
has respected moral and religious objections in other contexts as well,"
wrote Bishop William F. Murphy on behalf of the Conference. "Health care
reform cannot be a vehicle for abandoning this consensus which respects
freedom of conscience and honors our best American traditions." [USCCB
Letter]
The College of Physicians in the province of Quebec intends to issue a
statement supporting euthanasia. According to press reports, the statement
is being prepared for release in November. [UPI]
The College is the regulatory authority for physicians practising in the
province. Of special concern is the fact the the Quebec College, alone among
regulatory authorities in Canada, requires objecting physicians to refer
patients for controversial procedures. Thus, it is probable that any Quebec
physician who refused to facilitate euthanasia would be liable to discipline
by the College.
The Wisconsin state budget (2009 Act 28), which became law at the end of
June, includes a provision that forces pharmacies to stock and dispense
contraceptives. [LifeSite
News] Individual pharmacists are not required to dispense the products,
but the law would appear to preclude the ownership of pharmacies by people
who object to contraception for reasons of conscience.
An amendment (#205) proposed by Senator Edward Kennedy to a bill being
considered in the US Senate is opposed by the Christian Medical Association.
The amendment is apparently intended to offer some protection for
conscientious objectors to abortion, but it mentions only the actual
performance of an abortion, not referral or other forms of facilitation of
the procedure, and it fails to define the term "emergency." The CMA believes
that Senator Kennedy's amendment fails to provide adequate protection for
objecting health care workers.
News reports indicate that freedom of conscience was one of the topics
discussed privately when President Barack Obama paid a visit to Pope
Benedict XVI in Rome.[Zenit]
The 9th U.S. Circuit Court of Appeals has struck down an injunction that
protected state of Washington pharmacists who refused to dispense the
morning after pill for reasons of conscience.[Ruling][Commonweal]
Health and Human Services Secretary Kathleen Sebelius told the Catholic
News Service that President Barack Obama opposes the
HHS Regulation that requires certification of compliance with U.S.
federal protection of conscience laws, but supports laws that prevent
doctors or pharmacists from being forced to perform the procedure or supply
abortifacient drugs. Sebelius said that the President believed that the
regulation jeopardized "critical health services for women."
Sebelius did not volunteer comments about the President's position on
referral or other forms of participation, nor about protection for health
care institutions. She also did not explain why the President could support
statutes like Illinois'
Health Care Right of Conscience Act and
Abortion Performance Refusal Act, but not the HHS regulation,
which is far less comprehensive. [CNS]
[See
President Obama promises "robust" conscience protection]
Scepticism about the President's intentions remains in some quarters. [Bowman]
An
amendment proposed by Lord Falconer to the Coroners and Justice Bill
being considered by the British House of Lords has been defeated. The
amendment would have made it legal to assist a person to leave the country
to commit suicide.
Joxel Garcia, an obstetrician gynaecologist, is a former assistant
secretary for health. He helped write the
HHS Regulation the Obama administration plans to revoke. Garcia said
that the regulation is needed because few objecting health workers are aware
of laws protecting them from discrimination. For example, in the late
1980's, when he applied for medical residency, he was told not to apply to
some programs if he wouldn't do abortions.
"I didn't know at that time that those facilities that were receiving
federal funds were not supposed to discriminate against me because I did not
perform terminations of pregnancy or abortions." [NPR]
In an
interview with Catholic journalists, President Barack Obama stated, "I'm
a believer in conscience clauses. I was a supporter of a robust conscience
clause in Illinois for Catholic hospitals and health care providers."
With respect to his administration's plans to revoke an existing Dept. of
Health and Human Services regulation, he said, "I can assure all of your
readers that . . . there will be a robust conscience clause in place. . . it
certainly will not be weaker than what existed before [the
HHS Regulation]."
Illinois'
Health Care Right of Conscience Act is probably the most
comprehensive protection of conscience law in the United States, and the
state's
Abortion Performance Refusal Act, if less comprehensive,
protects hospitals and individuals who refuse to "recommend, perform, or
assist in the performance of an abortion."
Taken together, the President's reference to the Illinois statutes and
promise of "robust" protection at least as strong as the Bush
administration's HHS regulation is remarkable. It would seem to guarantee
that President Obama will ensure genuine freedom of conscience for health
care workers.
However, the HHS Regulation that his administration is determined to
revoke is actually far less comprehensive than the Illinois statutes he
states that he supported. Thus, while his support for "robust" protection of
conscience laws is heartening, it remains unclear exactly what this means to
him. [Washington
Post]
Delegates at the annual conference of the British Medical Association
have rejected motions favouring assisted suicide. One motion proposed that
people accompanying a patient during assisted suicide would not be
prosecuted. The other proposed that assisted suicide be available to
competent terminally ill patients. [Medical
News Today]There is strong and continuing pressure to legalize assisted
suicide or euthanasia in the United Kingdom. The BMA decision indicates that
legalization would generate conflicts of conscience within the medical
profession.