July-September, 2011
An anonymous physician writing on a
French language blog asserts that doctors in France are increasinlgy
unwilling to perform abortions, and tolerate rather than accept the
practice. Most apparently refuse to be involved for reasons of conscience. [Lifesite
News]
Citing serious challenges to religious liberty by the American
government, the President of the US Conference of Catholic Bishops has
announced the formation of an Ad Hoc Committee on Religious Liberty.
Archbishop Timothy M. Dolan of New York stated that the move "is one element
of what I expect to be a new moment in the history of our Conference. Never
before have we faced this kind of challenge to our ability to engage in the
public square as people of faith and as a service provider. If we do not act
now, the consequence will be grave." [Letter]
28 September, 2011
With the deadline approaching for the end of public comment on a new US
federal regulation that would force employers to pay for health insurance
for services to which they object for reasons of conscience, a
representative of the US Conference of Catholic Bishops notes that over
32,000 comments were filed with the Department of Health and Human Services
using the link provided on an insert to church bulletins. The proposed
regulation would force Catholic institutions to pay not only for
contraceptives, but for abortifacients. [M.
Winters]
The President of Notre Dame University has reminded the Secretary of the
Department of Health and Human Services that President Obama promised to
support "a sensible conscience clause." Rev. John Jenkins points out that a
"sensible conscience clause" is lacking in the proposed regulation that
would force Catholic institutions to pay for insurance for contraception and
potentially embryocidal or abortificaient services. Like others protesting
the regulation, he asserts that the definition of "religious employer" is
too narrow. [Jenkins'
letter]
Seven Regina physicians have written to the College of Physicians and
Surgeons of Saskatchewan, the regulatory authority for the province's
physicians, to complain about a Guideline for Unplanned Pregnancy adopted
earlier this year. While
the letter questions the need for guidelines at all, it also appears to
suggest that objecting physicians should be forced to refer patients for
abortions if they are unwilling to perform or recommend the procedure
themselves. The Project review of the Guideline found it less than clear
[See
Clarifying the Clarification]
The UN Committee Against Torture has issued a report that demands that
Ireland legalize abortion, suggesting that this is required by the
Convention Against Torture and Other Cruel, Inhuman or Degrading Treatment
or Punishment. [CAT
Report]. The claim is a fabrication. (See
Conscientious Objection as a Crime Against Humanity)
The Catholic Health Association has filed comments supporting freedom of
conscience for health care workers and institutions and protesting plans by
the federal Department of Health and Human Services to revoke a regulation
passed by the previous administration. "Our religious and moral convictions
are the source of both the work we do," wrote the CHA, "and the limits on
what we will do." The Association argues that the proposed definition of
"religious employer" is too narrow, that the proposed regulation conflicts
with state and federal protection of conscience laws, and that it would put
Catholic hospitals in the position of having to pay for employee insurance
coverage for procedures that they refuse to perform for reasons of
conscience. [Full
text]
Responding to proposals to legalize euthanasia in Portugal, Miguel
Oliveira da Silva, president of Portugal's National Ethics Council for Life
Sciences, states that 80 to 90 percent of Portuguese physicians would refuse
to provide the procedure. [Lifesite
News]
Regis University, a Jesuit institution in Colorado, is considering its
legal options as a result of a new Colorado statute that demands that
insurance plans provide contraceptives and potentially embryocidal or
abortifacient drugs or devices. The law was passed without an exemption for
religious institutions or employers despite opposition from the Colorado
Catholic Conference of Bishops. The University does not plan to provide or
refer for contraceptives. [CNA]
Catholic Archbishop Edwin F. O'Brien, Washington Cardinal Donald Wuerl
and Wilmington Bishop W. Francis Malooly have written to US Dept. of Health
and Human Secretary Kathleen Sebelius to protest the proposed regulation
that would force employers to provide insurance for FDA-approved
contraceptive methods, sterilization procedures and related educational
services. They describe the proposal as "a radically new and unprecedented
attack on religious freedom." [The
Catholic Review]
A report by Special Rapporteur Anand Grover to the 18th Session of the UN
Human Rights Council (Thematic
study on the realization of the right to health of
older persons) drew a warning from a representative of the Holy See,
which noted that Grover introduced the topic of euthanasia and assisted
suicide within the context of a discussion of "a holistic approach to
health" that addresses "the process of dying." (Paragraph 59). Grover
explicitly stated that the report did not consider "issues of patient
autonomy in respect of deciding to end life," but the Holy See made a point
of rejecting the notion that there is a "right" to deliberately end life [Statement
from the Holy See]. It did not, however, reject the idea that there is a
"right to health," which is the fundamental assumption underlying the
report.
The right to health will not provide a magic solution
to these multifaceted challenges, but it will allow shifting the discourse
on older persons from a needs-based approach to a rights-based one, and
enable greater articulation of the rights of older persons. Health is a
fundamental human right, indispensable for the exercise of many other
rights. (Paragraph 11)
What is of interest here is that Grover explicitly frames his comments on
end of life issues and the desire to "die with dignity" within "a human
rights perspective." He has previously argued "rights to sexual and
reproductive health" are being impeded by individuals exercising
conscientious objection to abortion and contracepetion. [Statement]
It is reasonable to believe that he and other will apply the same reasoning
to suppress conscientious objection among health care workers to euthanasia
and assisted sucide on the grounds a "right to health" includes a "right" to
these procedures.
58 trade unions representing 6 1/2 million workers in the United Kingdom
have unanimously voted to support a "conscience clause" to protect
journalists who refuse to participate in unethical activities. [Journalism.com]
This would seem to suggest that, in principle, the
Trade Union Congress
should support similar protection for health care workers.
The Philippines Congress has resumed consideration of a controversial
Reproductive Health Bill bill that presents a threat to freedom of
conscience among health care workers. The head of the country's Catholic
Bishops' Cosnference said earlier this week that the Church's oppostion to
the bill is "non-negotiable." [UCA
News] The Church has organized rallies against the bill, while its
supporters have staged marches in favour of it. Hundreds marched in the
Iloilo provincial capital wearing purple clothes as part of a "National Day
of the Purple Ribbon for Reproductive Health." Some surveys suggest that
over 70% of Filipinos support the legislation. [Philippines
Daily Inquirer]
80 year old Dr. Michael Irwin of England, who was struck from the medical
register for attempting to assist someone to commit suicide, publicly
acknowledges that he frequently provides advice to people who want to go to
Switzerland to commit suicide. [The
Telegraph] Irwin is among the activists who continue to press for
legalization of the procedure in the United Kingdom, though it is unlikely
that most people asissting in suicide will be prosecuted (Administrative
legalization of assisted suicide in United Kingdom).
A Quebec woman suffering from amyotrophic lateral sclerosis (ALS) is
planning a challenge to Canada's law against assisted suicide. Her lawyer
plans to launch the civil suit in the Quebec Superior Court. [Canada.com]
Another case has already been initiated in British Columbia, supported by
the BC Civil Liberties Association. It specifically seeks legalization of
physician assisted suicide.
Daniel Kuebler, Ph.D, a professor of biology at Franciscan University of
Steubenville, Ohio, has published a column in the National Catholic Register
that claims that medical schools in the United States discriminate against
medical school applicants who have conscientious objections to abortion.
While he admits that this has not been demonstrated by any "systematic
study," he cites anecdotal evidence complied over a thirty year period that,
he says, proves "that many schools are using abortion-related questions to
screen out pro-life candidates." [NCR]
The Dutch Physicians Association (KNMG) has published a policy on
physician invovlement in euthanasia and assisted suicide that acknowledges
that there is no right to the procedures in law, that the procedures are not
part of the standard care offered by physicians, and that the views of
physicians who object to the procedures must be respected. However, the
policy also demands that objecting physicians promptly refer patients for
euthanasia or assisted suicide. It admits that there is no legal duty to do
so, but claims that there is "a moral and professional duty" to refer. [The
Role of the Physician in the Voluntary Termination of Life]
Wrting on behalf of the US Conference of Catholic Bishops, Daniel
Cardinal DiNardo has urged the US Congress to support two bills that would
support freedom of conscience currently denied under the Patient Protection
and Affordable Care Act (see
HR1179 Respect for Rights of Conscience Act of 2011, and
S1467 - Respect for Rights of Conscience Act of 2011). In his
letter, the Cardinal also expressed concern about the Obama
administration's plan to force all employers to pay for insurance coverage
for contraception and other services that are contrary to Catholic teaching.
He said that the attempt "to corral religion exclusively into the
sanctuaries of houses of worship betrays a complete ignorance of the role of
religion in American life, and of Congress's long tradition of far more
helpful laws on religious freedom." [News
release]
Since 2009, Crown prosectuors in the United Kingdom, following
administrative guidelines approved in 2010, have not prosecuted anyone for
assisted suicide, though 44 cases have been referred to them by police.
While assisted suicide is a criminal offence, the guidelines permit
prosecution only in circumstances in which someone is pressured to commit
suicide or the person assisting profits from their death. In essence, police
and Crown counsel are acting as regulators of the practice. The advantage to
this arrangement for objecting health care workers is that they cannot be
pressured to assist in what remains (technically) a criminal offence. [The
Telegraph] How long this will remain the case is uncertain, since a
similar arrangement, based on a statute rather than administrative
guideline, permits euthanasia and assisted suicide in Holland, and the Dutch
Physicians' Association now claims that objecting physicians have a moral
and professional obligation to refer for the procedures. [The
Role of the Physician in the Voluntary Termination of Life]
Speaking in Rome, Irish senator Ronan Mullen stated, "The challenge in a
pluralist society is to accommodate people's freedom on conscience while at
the same time acknowledging that what is lawful is going to go on in that
society." Mullen led the opposition to a proposal in the European Union that
would have suppressed freedom of conscience for health care workers in
Europe. [Rome
Reports]
Dr. Esteban Rodriguez Martin, a Spanish gynecologist, began a court case
in 2008 to defend his freedom to refuse to be complicit in abortions. He has
limited his practice to working with women in their third trimesters in
order to avoid having to provide prenatal diagnoses that are usually used to
facilitate eugenic abortions. He acknowledges that, if he loses the case, he
may have to quit the practice of medicine. [CNA]
An Englishman who has been paralyzed for six years after suffering a
stroke is planning a legal challenge to allow for euthanasia "in only the
most special of circumstances." [BBC
News]
The US Conference of Catholic Bishops has submitted a
comment on the interim
regulation promulgated by the US Department of Health and Human Services
that will force employers to provide health insurance coverage for
contraceptives. The submission states that the regulation is unprecedented,
violates several federal laws as well as the US Constitution. The
regulation, says the submission, would impose "burdens on conscience . .
.almost entirely on observant Catholics." It would force objectors "to
subsidize-and thereby endorse-conduct that they teach or otherwise state is
wrong."
A survey of 1800 US obstetrician/gynaecologists found that 97% had
encountered patients seeking abortion, but only 14% were willing to provide
the procedure. ("Abortion
Provision Among Practicing Obstetrician-Gynecologists." Stulberg, Debra
B. MD, MAPP; Dude, Annie M. MD, PhD; Dahlquist, Irma BS; Curlin, Farr A. MD.
Obstetrics & Gynecology: September 2011 - Volume 118 - Issue 3 - p
609-614doi: 10.1097/AOG.0b013e31822ad973). Given the constant demands that
medical professionals provide abortions, the study underlines the importance
of protection of conscience legislation.
President Benigno Aquino III has announced that the consolidated
reproductive health bill will be included among 13 priority legislative
measures that will be sent to Congress. He is seeking 10 amendments to the
bill, including accommodation of conscientious objectors. [Manila
Standard] The provisions in the
current bill concerning freedom of conscience are unsatisfactory.
The Telegraph reported earlier this month that a new guideline for
pharmacists circulated by the General Pharmaceutical Council (Britain's
pharmacy regulator) told pharmacists "For the first time . . . that their
right to conscientious objection on religious grounds is secondary to the
contractual demands of employers, such as the NHS." A Catholic pharmacist
quoted in the report was concerned that some pharmacists would become
unemployable, and a spokesman for the Thomas More Legal Centre warned that
the guideline went too far in requiring an objector to facilitate access to
a controversial service by referral. [Telegraph]
The Council has since issued a news release stating that no new guidelines
have been issued, though an existing guideline had been re-published and
circulated.[News
release] The existing Code of Ethics (3.4) imposes an obligation on
objectors to "refer patients and the public to other providers," which some
would find unacceptable.
Two nurses in the United Kingdom objected, for reasons of conscience, to
working in a weekly medical abortion clinic in their hospital, where the
abortifacient drug mifepristone was provided to patients. Hospital
administration told them that they had no choice but to participate. The
Thomas More Legal Centre
wrote to the hospital, pointing out that the nurses had an absolute right to
refuse to participate under the
protection of conscience provision in the Abortion Act. The
Center aslo warned the hospital that the Equality Act prohibited any
discrimination against or harassment of the nurses based on their belief in
the sanctity of life. The hospital first attempted to require the nurses to
work in the clinic, without administering the drugs, but this was rejected
as involving unacceptable complicity in the act of abortion. Ultimately, the
hospital conceded the point and the nurses were assigned to other duties. [SPUC]
The Central Regional Minster of Ghana, Madam Ama Benyiwa-Doe, has told
nurses that they are obliged not only to deliver family planning information
to patients, but to "ensure that they accept them and practice them." [GNA]
Her comments suggest that state pressure to conform to "family planning"
practice is being applied not only to nurses, but to patients.
The
regulation promulgated by the US Department of Health and Human Services
that employers will be required by law to provide health insurance coverage
for contraceptives has been welcomed by a number of commentators and
interest groups. The Washington Post
called it a "wise decision," and an editorial in a South Carolina
newspaper
said it makes "perfect sense." The Center for Reproductive Rights
described it as "a tremendous victory for women," and it has been
applauded by Planned Parenthood.
However, the move has been denounced by freedom of conscience advocates,
especially observant Catholics who are to be forced to subsidize and
facilitate what they consider to be gravely immoral conduct. It appears to
have caught some of them by surprise.
"They defied the bishops to support President Barack Obama's health care
overhaul,"
wrote the Associated Press. "Now Catholic hospitals are dismayed the law
may force them to cover birth control free of charge to their employees."
The Association
said that it is "very concerned about the inadequacy of the conscience
protections" in the rules.
A spokesman for the US Conference of Catholic Bishops
noted that the protection of conscience provision is so narrowly written
that it will not apply to most Catholic institutions. He asked if it was the
government's intention to force the withdrawal of the Church from the
provision of health care and social services. Similar criticisms were
offered by a number of other commentators, including Michael Sean Winters.
Writing in the National Catholic Reporter, he
described the conscience provisions as "totally inadequate."
The Catholic League for Relgious and Civil Rights
called the situation "even more pernicious than it looks." It pointed
out that the current administration is moving to deny funds to religious
groups that preferentially hire from within their own denominations to
administer their social programmes and institutions, yet the regulation
limits protection for freedom of conscience to religious entities set up
precisely in that way. "If they are too religious, Catholic social service
agencies risk losing federal funds, but if Catholic hospitals are not
sufficiently religious, they cannot be exempt from carrying health insurance
policies that transgress their religious tenets."
The organs of a 17 year old woman who died after being struck by a car in
Israel have been donated to four recipients. In addition, her family
obtained a court order to harvest and freeze her eggs. For the moment, the
hospital will not fertilize the ova without a court order. This is the first
such incident in Israel. [Haaretz]
The case illustrates the potential for conflicts of conscience among health
care workers, both with respect to the harvesting of the eggs and their
later fertilization and implantation.
An ABC news report [North
Carolina's History of Eugenics] has described the treatment of men,
womena nd children who were sterilized during the 45 year span of a state
sterilization programme operated on eugenic principles.
"Eugenics in the U.S. is something that's still not
nationally known. People associate it with Nazis; they don't realize that
the U.S. did it too," says Rebecca Kluchin, an assistant professor of
History at California State University, Sacramento who specializes in the
U.S. eugenics programs.
The story graphically illustrates that "the ethics of the profession" of
medicine sometimes leave much to be desired, thus underlining the importance
of preserving freedom of consience for health care workers.
The Supreme Court of British Columbia has agreed to expedite the hearing
of a challenge to Canada's law against assisted suicide and euthanasia. The
case will now begin on 15 November, 2011. The move is in response to a
request from one of the plaintiff's, Gloria Taylor, who suffers from
amyotrophic lateral sclerosis, or Lou Gehrig's disease. Taylor joined an
action begun by three other plaintiffs and the BC Civil Liberties
Association. The goal is to legalize physician-assisted suicide and
physician-provided euthanasia. [Globe
and Mail]
US Senator Roy Blunt has introduced
Senate Bill 1467, the "Respect for Rights of Conscience Act of 2011."
The bill is identical to a
House of Representatives bill of the same name. Co-sponsors are Senators
Marco Rubio and Kelly Ayotte.
The US Department of Health and Human Services has issued an
interim regulation that will enact the recommendation of the Institute
of Medicine that contraception and sterilization must be offered in health
insurance plans provided by employers, without charge to employees. The
public will have 60 days to respond to the draft before it is finalized.[HHS
news release]
The Catholic diocese of Pagadian and Human Life International organized a
rally against the proposed
Reproductive Health Bill. About 8000 people attended the event in the
city's public plaza. [CBCP
News] The rally demonstrates the controversial nature of the bill and
the likelihood of conflicts of conscience among health care workers if it
passes in its present form.
Bill No. 88, an amendment to the criminal law in South Australia, will,
if passed, make it possible for physicians to provide assisted suicide and
euthanasia. In comparison to other euthanasia and assisted suicide bills it
is unusual, since it does not propose to legalize either procedure per
se. Instead, it provides a series of defences for physicians who are
charged for providing euthanasia or assisted suicide. Since the standard of
proof in a criminal trial is proof beyond reasonable doubt, the defences
would probably lower the likelihood of prosecution as well as conviction.
From the perspective of freedom of conscience, this would not adversely
affect physicians who object to the procedures, which would technically
remain criminal offences. Further: the absence of any kind of approval
process that would implicate the medical profession or the state would make
it very unlikely that pressure would be brought to bear on objectors by
colleagues or the state. Long term consequences are more difficult to
predict, since a similar arrangement with respect to abortion following the
Bourne case in England eventually proved to be an early step in the
legalization of the procedure. Once abortion was legalized in Britain,
conscientious objectors to abortion began to experience discrimination and
coercion. [See
Question of Conscience]
A nurse supervisor responsible for the care of a minimally conscious
woman whose relatives want to stop assisted nutrition and hydration has
filed a statement with the Court of Protection in the United Kingdom. The
nurse reports that the woman "responds to music and conversation and tries
to communicate," and expresses concern that the family does not understand
the practical effects of withdrawing food and fluids. The case is the first
application in Britain to withdraw food and fluids from a patient who is
minimally conscious rather than in a "persistent vegetative state." [Independent]
The nurse's statement indicates the potential for conflicts of conscience
among health care workers in such situations.
Identical bills have been introduced in the US House of Representatives (HR2659)
and US Senate (S1415)
that have been described as attacks on freedom of conscience for
pharmacists. The bills' recommended "congressional findings" include the
clearly erroneous statement that access to contraception "is a protected
fundamental right in the United States"; it is not. The "findings" also
exclude reference to the potential embryocidal or abortifacient effects of
some products that are marketed as contraceptives. However, the bills would
not apply to any pharmacy that does not stock contraceptives, so they would
have no effect on pharmacies operated by those who object to that line of
product. The obligations to facilitate access to such products is imposed
only on those who normally provide them. Finally, the obligation to
facilitate access lies with the pharmacy, not with individual pharmacists,
so the accommodation of objecting pharmacists would still be possible.
The Catholic Medical Association and the United States Conference of
Catholic Bishops, among others, have spoken out against the recommendations
that employers should be made to provide health insurance converage for
contraception and sterilization. In addition to arguments against
contraception per se, they protest that it is offensive to
principles of freedom of conscience and religion to compel individuals and
denominational institutions to facilitate conduct that they believe to be
wrong.[CMA
news release] [DiNardo
news release] [USCCB
news release] [USCCB
spokesman] [National
Catholic Reporter]
A gathering of about 4,000 Catholic students was held at the University
of Santo Tomas (UST) in Manila to celebrate the anniversary of the
encyclical Humanae Vitae and to oppose the controversial
Reproductive Health bill currently being considered by the Philippines
Congress. [GMA
News] If the bill becomes law in its current form, it is likely to
adversely affect health care workers who object to contraception or
potentially embryocidal drugs or devices for reasons of conscience.
An American organization, the Institute of Medicine, has issued a report
(Clinical
Preventive Services for Women: Closing the Gaps) that recommends
that "the full range of Food and Drug Administration approved contraceptive
methods, sterilization procedures, and patient education and counselling for
women with reproductive capacity" be provided by insurance plans by
employers without charge to their employees. The basis for the
recommendation is the American health care reform bill, the Patient
Protection and Affordable Care Act of 2010, which requires that "preventive"
medical services be provided without charge to patients. The recommendation
will be controversial among those who have moral objections to sterilization
and contraception, and among those who are concerned that some products
marketed as contraceptives may have embryodical or abortifacient effects,
causing the death of an embryo before or after implantation. [Fox
News]
A survey of 733 students in four medical schools in the United Kindgom
(Cardiff University, King's college London, Leeds University and St George's
University of London) has disclosed that almost half believe that physicians
should be allowed to refuse to perform procedures to which they object for
moral, cultural or religious reasons. For some respondents, this included
treating someone who is drunk or high on drugs. A significant number of the
students would not perform abortions after 24 weeks, nor because of failed
contraception. This elicited the concern from various quarters about what is
perceived as a growing unwillingness of physicians to provide
abortions.[Sophie L.M. Strickland,
Conscientious objection in medical students: a questionnaire survey. J
Med Ethics doi:10.1136/jme.2011.042770] [The
Guardian] [The
Telegraph] The study warrants attention, because to extend grounds for
objection to non-moral reasons (culture) and to what could be distaste or
difficulty (drug or alcohol intoxicated patients) is not justifiable.
Ultimately, such attitudes are likely to undermine public support for
freedom of conscience for health care workers.
The National Association for the Defense of the Right to Conscientious
Objection (La Asociación Nacional Para La
Defensa Del Derecho de Objeción de Consciencia) in Spain is protesting
what it describes as the secretive manner in which the country's Collegial
Medical Organization adopted changes to its code of ethics. According to the
Association, the changes, which may adversely affect conscientious objectors
to abortion, were not to be discussed until September.[CNA]
Britain's Equality and Human Rights Commission is supporting four
Christians who have brought religious discrimination cases to the European
Court of Human Rights. According tothe Commission, judges in the United
Kingdom have failed to interpret the law broadly enough when dealing with
Christian victims of religious discrimination. The Commission is urging a
policy of accommodation of relgious belief. Meanwhile, the Church of England
General Synod has been told that some employers consider any manifestation
of religious belief offensive, and that Christians find work environments
increasingly difficult. [Christian
Today]
The Christian Medical Association (CMA) has sent a petition with over
61,000 signatures to President Barack Obama in support of freedom of
conscience in health care. In the accompanying letter,
Dr. David Stevens, CEO of the Association, noted that the Obama
administration had "gutted" a federal protection of conscience regulation,
but, nonetheless, asked the President to "consider the voices and values of
these many Americans and (a) restore a strong conscience-protecting
regulation and (b) support and sign into law strong conscience-protecting
legislation." [CMA
news release]
As a result of a court case, the Department of Health has released
statistics on eugenic abortion for England and Wales covering a nine
year period, from 2002 to 2010, disclosing the reasons for the procedure.
The figures disclosed that an average of 1,942 eugenic abortions were
performed each year (about five per day); an average of 132 were performed
each year after 24 weeks gestation (between two and three per week). [BBC
News] Specific moral controversies are generated by eugenic abortion and
late term abortion and may give rise to conflicts of conscience among health
care workers.