April-June, 2010
Writing in The Times, prominent British journalist Antonia
Senior recognizes the existence of her daughter began at fertilization and
acknowledges that abortion is the killing of another human being. However,
she justifies the killing an evil that is necessary to ensure women's
prospects and careers are not restricted by pregnancy:"If you are willing to
die for a cause, you must be prepared to kill for it, too." [The
Times]. She does not discuss the issue of freedom of conscience for
health care workers, so it is not clear whether or not she believes that
they should be forced to facilitate such killing.
Idaho's
Freedom of Conscience for Health Care Professionals Act, which
comes into effect 1 July, is being opposed by the Idaho branch of the
American Association of Retired People (AARP). The Association is concerned
that the provision that prevents health care workers from being compelled to
provide end of life treatment or care that is contrary to their
conscientious convictions will result in patients being forced to continue
with unwanted medical interventions [Boise
Weekly].
Courts in numerous jurisdictions have ruled that assisted nutrition and
hydration is "treatment", not medical care, and that patients or proxies
acting on their behalf may refuse food and fluids. In consequence, it is
legally possible in these jurisdictions to cause the death of patients who
are not otherwise dying by denying them nutrition and hydration. Health care
workers who consider this to be euthanasia may object to being part of the
process.
In some jurisdictions where euthanasia has been formally legalized, laws
require only that an objecting physician cooperate in the ordinary way in
the transfer of a patient to a willing colleague who has been identified by
the patient or his family [See, for example, the
Belgian Act on Euthanasia]. This relinquishment of responsibility seems
to reduce the problem of complicity for objecting health care workers.
For the second time in as many months, British prosecutors, applying
guidelines developed last year, have declined to lay charges against
individuals who have assisted in the suicides of others. No charges will be
laid against euthanasia activist Michael Irwin, a physician who has been
struck off the medical register, nor against another man who helped a
patient to travel to Switzerland to commit suicide at a Dignitas facility [Daily
Mail]. Last month, prosecutors refused to lay charges against a man
who helped his wife to commit suicide [Daily
Mail]. Repeated incidents of this type are likely to increase
pressure to legalize assisted suicide on the grounds that people should not
have to travel outside the country to obtain the service, and that suicides
that are managed by non-professional people (as in the latter case) are
likely to be botched or are otherwise "undignified."
The federal high court in Germany has ruled that assisted nutrition and
hydration is a form of treatment that can be refused by patients or proxies
acting for them. It overturned the conviction of a lawyer who has advised
his clients that they could disconnect a feeding tube from their 72 year old
mother. The woman's daughter cut the tube. Hospital staff reconnected it,
but the woman died of natural causes a few days later. As in other
countries, the ruling will permit the starvation and dehydration of patients
who are not dying, a situation likely to give rise to conflicts of
conscience among health care workers. The German doctors' union and hospice
representatives have voiced concern about the ruling [Irish
Times]
News reports state that a woman was mistakenly implanted by a Connecticut
fertility clinic with embryos from a different couple, and that she took the
"morning after pill" in order to terminate the pregnancy[Hartford
Courant]. The
Consent Order that sets out the facts of the case states only that the
patient "initiated treatment" to end the pregnancy. The reporter who broke
the story in the Hartford Courant has advised the Project
Administrator that the source of the information about the use of the
morning after pill is an adverse event report filed by the Center for
Advanced Reproductive Services with the state Department of Public Health.
The incident is of interest because of the ongoing controversy about whether
or not the "morning after pill" acts as an abortifacient. Different kinds of
drugs are used as "morning after pills," some of which are universally
acknowledged to be abortifacient; the mechanism of action of others is
disputed.
A euthanasia/assisted suicide activist has proposed that physicians in
Idaho are free to assist in the suicide of their patients, since the law in
the state is silent on the issue. Kathryn L. Tucker, Director of Legal
Affairs for Compassion and Choices, cites legislation in Washington and
Oregon and a Supreme Court ruling in Montana as precedents for assisted
suicide in Idaho. Tucker's claim concerning Idaho law was rebutted in
commentary following the article.[CDA
Press] The adoption of euthanasia or assisted suicide would create
conflicts of conscience among health care workers opposed to the practice.
[see
The Case of the Disappearing Plaintiffs]
While the Nebraska state Board of Health has approved rules that would
force objecting counsellors to refer patients for assistance with homosexual
relationships, Chief Medical Officer Dr. Joann Schaefer is reported to be
continuing to search for a compromise that would address the concerns of
those who do not wish to be complicit in what they consider to be immoral
conduct [Journal
Star].
A
draft resolution to suppress freedom of conscience in Europe will be
considered by the European Parliamentary Assembly between 4 and 8 October.
The resolution proposes that freedom of conscience should be restricted and
regulated by the member states, that it should be denied to institutions and
organizations such as denominational health care facilities, and that
objectors should be forced to facilitate patients by referral.
The General Pharmaceutical Council, which is superseding the Royal
Pharmaceutical Society of Great Britain as the regulator of the profession
of pharmacy in the United Kindgom, has decided to retain standard 3.4 in the
RPhSGB Code of Ethics,
and review its operation over the course of the coming year.
Ensure that if your religious or moral beliefs prevent
you from providing a particular professional service, the relevant persons
or authorities are informed of this and patients are referred to alternative
providers for the service they require.
The requirement for referral would not be acceptable to some
conscientious objectors. Public consultation on draft standards generated a
number of calls for the complete suppression of freedom of conscience among
pharmacists [GphC
Report]
During a Spanish conference for Catholic doctors, Bishop Juan Antonio
Reig Pla of Alcala de Henares commented that Catholic physicians who attempt
to abide by their moral beliefs face "intense rejection" by society and are
increasingly "defenceless" against the demands of a culture that no longer
respects the sanctity of life [CNA]
In a statement to the UN Human Rights Council, Special Rapporteur Anand
Grover claims that access to abortion, contraception and pre-natal testing
is impeded in Poland by "non-state actors" and demands that access to
abortion be assured by developing protocols concerning conscientious
objection. [Statement]
The assertion is clearly intended to press for restrictions on freedom of
conscience in Poland.
The Mexican Supreme Court has forbidden conscientious objection to the
morning after pill, stating that objections are permitted only to abortion,
and that the morning after pill does not function as an abortifacient.
Physicians can be jailed or subjected to other penalties if, for reasons of
conscience, they refuse government orders to dispense the drug.[Lifesite
News] [See also,
Clearing Rhetorical Minefields]
While affirming that its members should decline to perform any form of
female circumcision or mutilation and should actively discourage parents
from seeking it for their daughters, the American Academy of Pediatrics has
suggested that it might be desirable to modify laws against the practices to
permit a "ritual nick" by a physician, if doing so would prevent their
families from sending them back to countries where a full procedure would be
performed [AAP
Policy Statement][New
York Times]. The statement has been strongly criticized by those
opposed to the procedure [Cultural
Rite, Medical Wrong].
Abortion is illegal in Northern Ireland unless a mother's life or mental
well being is in jeopardy. Last year, a judge ordered abortion guidelines
issued by the Northern Ireland Department of Health to be withdrawn because
they were misleading. New guidelines issued by the Department are being
legally challenged by the Society for the Protection of Unborn Children on
the grounds that they are a breach of the court ruling. [BBC]
[Lifesite
News]
The Irish Family Planning Association had denounced the Irish government
for "political cowardice" because it has refused to legalize abortion. The
denunciation followed news that about 4,400 women who had abortions in the
United Kingdom last year had Irish addresses [The
Herald].
Evidence taken by an Irish Parliamentary committee in 2000 indicated
that most Irish obstetrician/gynaecologists would refuse to participate in
abortion were the procedure legalized.
The government of Quebec plans public consultation on the legalization of
euthanasia and assisted suicide [Globe
and Mail]. Although Quebec does not have jurisdiction to change
Canadian criminal law, which is the prerogative of the federal government,
the province could decide to limit prosecutions for such offences as a
matter of public policy.
Representatives of the US Conference of Catholic Bishops have written to
members of Congress, urging them to accept an
Amendment to HR3590 Patient Protection and Affordable Care Act that
includes protection of conscience measures concerning abortion. [News
release and text of letter]
The Nebraska Catholic Conference is attempting to ensure that proposed
new rules for three state licensing boards do not deny freedom of conscience
to counsellors who do not wish to facilitate or encourage homosexual
conduct. The rules would govern the state Board of Psychology, the Mental
Health Practice Board and the Alcohol and Drug Counseling Board.
Representatives of professional associations for psychologists and other
counsellors claim that refusal to refer for counselling is "morally wrong"
and contrary to the position of other professions [Lincoln
Journal Star]. The claims are untenable, as refusal to refer for
controversial medical procedures is a hotly contested subject in other
professions, and inconsistent with the understanding of complicity that is
implicit in the policy of the American Medical Association on physician
participation in executions. [See
The Problem of Complicity and
Referral: A False Compromise]
Bogotá, Colombia, May 12, 2010 / 05:59 pm (CNA).-
Colombian doctor German Arango Rojas has been suspended by the country's
Medical Ethics Tribunal because he refused to perform an abortion on a
disabled girl, despite the demands of her parents. He was also ordered to
pay damages to the parents. Colombia' s Attorney General, has protested that
Dr. Rojas' fundamental rights have been violated.[CNA]
The American Board of Anesthesiologists has adopted the policy of the
American Medical Association and forbidden its members from 'participating'
in executions[ABA
policy], noting that the definition of "participation" is clearly set
out in the AMA policy. [Washington
Post] What is of interest is that "participation" is defined to
include indirect involvement. Among the actions identified by the AMA as
"participation" in executions are the prescription or administration of
tranquillizers or other drugs as part of the procedure, directly or
indirectly monitoring vital signs, rendering technical advice or consulting
with the executioners, and even (except at the request of the condemned, or
in a non-professional capacity) attending or observing an execution. It
would be inconsistent for the medical profession to define "participation"
in this way with respect to execution, but deny that the definition can be
applied in the case of conscientious objection to other controversial
procedures.
A law proposed Mexico City's ruling Democratic Revolution Party would
impose prison sentences of up to four years on physicians who refuse to
advise patients of the availability of abortion and refer them for the
procedure. [Fox
News]
Nassau University Medical Center in East Meadow, New York, has apologized
to nurses who were disciplined for refusing to participate in an abortion.
Hospital President Arthur Gianelli said, "We erred in our personnel actions,
have apologized to several of the nurses and will do so with the others, as
well. They did nothing wrong." [Newsday.com]
Dr Phil Boyle, of Galway, Ireland, operates a fertility clinic in
accordance with Catholic teaching on sexuality and reproductive technology.
He refused treatment to an unmarried couple and was charged for professional
misconduct. He was acquitted by the Medical Council on the grounds that the
couple had not become his patients and he had been given no opportunity to
refer them to another facility. The ruling did not touch the issue of
freedom of conscience. The couple may pursue a case against him before an
Irish human rights tribunal. [Irish
Times]
Eight nurses Nassau University Medical Center in East Meadow, New York,
have been disciplined for refusing to assist with an abortion performed in
non-emergent circumstances on a woman about 15 weeks pregnant. Although the
hospital had agreed when the nurses were hired that they would not be
required to participate in abortions if contrary to their conscientious
convictions, one of the nurses reported that they were often pressure to do
so. [Long
Island Catholic]
New York law prohibits discrimination against health care workers in
such circumstances.
Two Canadian ethicists have proposed that physicians should deny
information about fetal sex until it is too late for a woman to have a sex
selective abortion. They are opposed by those who insist that there must be
no restriction on abortion, and by those who believe that physicians are
ethically obliged to provide the information if it is requested. [National
Post] [National
Post Letters 1] [National
Post Letters 2] The controversy illustrates how the ethical
evaluation of a procedure influences judgements about physician
responsibilities.
An Orlando, Florida urologist has made it known that patients who support
the new American health care legislation should go elsewhere for their
treatment. Dr. Jack Cassell has posted a sign in his office: "If you voted
for Obama, seek urologic care elsewhere. Changes to your health care begin
right now, not in four years." Dr. Cassell states that he will not turn
patients away, "But if they read the sign and turn the other way, so be it."
However, Dr. Cassells does not believe that it would be wrong to provide
treatment, and, in fact, stated that it would be unethical to refuse
patients for political reasons. [Orlando
Sentinel] While this can be understood as a form of freedom of
expression or association, it would be incorrect to characterize it as an
exercise of freedom of conscience. Unfortunately, this is precisely what
some commentators opposed to and supportive of freedom of conscience in
health care have done. [Contrast
Idaho
Mountain Express and
The Bulletin]
President Barack Obama has named the remaining members of the
Presidential Commission for the Study of
Bioethical Issues. [White
House News Release] They include two individuals who have reflected
publicly on freedom of of conscience in health care. Writing in 2005, Anita
L. Allen stated that the medicine counter is no place for ad hoc
moralizing," adding that pharmacists must "withhold their moral judgments at
work." In the same article she stated, "Refusing to dispense ordinary birth
control pills on moral grounds is as harmful as it is unprincipled." [Rx
for trouble: Just give us the medicine, please] Daniel P. Sulmasy
dislikes the soundbite approach that characterizes much of the controversy
on the subject. Of interest is his assertion that objections to the morning
after pill based on a potential embryocidal effect are not supported by
scientific research. However, he recognizes the importance of freedom of
conscience and is generally opposed to legal coercion to suppress
conscientious objection in health care. See
The Role of Conscience in Medical Decisions.
The
Freedom of Conscience Act has been signed by the Governor of
Oklahoma and is now law. The statute is procedure-specific, concerning only
abortion, procedures involving embryos, assisted suicide and euthanasia. It
prohibits discrimination against individuals and institutions which object
to the procedures for reasons of conscience and refuse to participate in
them. "Participation" is defined to include referral and other forms of
indirect involvement.
35 prominent British Christians have signed a document called the
Westminster Declaration
which is being released for public signatures on Easter Sunday. It was
inspired by the
Manhattan Declaration, which, issued in the United States in
November, 2009, has since collected over 400,000 signatures. The
Westminster Declaration responds to concerns that Christians are being
increasingly persecuted for beliefs that run counter to those in the
prevailing culture. It includes the warning that those supporing the
Declaration "will not be intimidated by any cultural or political power into
silence or acquiescence and we will reject measures that seek to overrule
our Christian consciences or to restrict our freedoms to express Christian
beliefs, or to worship and obey God." Dr. Peter Saunders, chief executive
officer of the Christian Medical Fellowship, was one of the initial
signatories. [The
Telegraph]