Update 2013-03-01

1.  By Region/Country
Visit the Project News/Blog for details.

Belgium

45 year old identical twin brothers were killed by lethal injection at Brussels University hospital, in Jette, Belgium, by physicians acting under the country's euthanasia law. The twins, who were deaf, had learned that they were going blind, and decided to be killed rather than never see each other again. The Belgian government has prpoosed an amendment to further expand grounds for euthanasia. [Daily Mail]  This demonstrate the likelihood of conflicts of conscience among health care workers in jurisidictions that permit euthanasia in such circumstances.

Canada

Although euthansia and assisted suicide are criminal offences in Canada, and criminal law is under the jurisdiction of the federal government, the government of Quebec has announced that it will legalize assisted suicide and euthanasia provided by health care workers. [National Post] The commission that recommended this step also recommended that objecting physicians be forced to facilitate the procedures by referral. Prominent Quebec physicians have formed The Physicians' Alliance for Total Refusal of Euthanasia. The Alliance is directly challenging the medical regulatory authority.

European Union

On January 15, 2013, the European Court of Human Rights issued judgments on four cases of dealing with religious freedom.  The Court ruled against a nurse who wished to wear a cross at work to manifest religious belief because the employer's prohibition was related to what could be construed as legitimate health and safety concerns in a hospital environment.  However, the ruling did not touch the issue of conscientious objection.  The nurse was prevented from doing something she wished to do, but not forced to do something she believed to be wrong.  In two other cases, however, the Court ruled that employers can force people to do what they believe to be wrong, if the perceived wrongdoing is lawful and supported by the dominant moral ethos. One case was brought by a Christian counsellor, who was fired for refusing to provide sexual advice to homosexual couples.  The second arose from a complaint by a civil registrar unwilling to conduct marriage ceremonies for homosexual couples.  [Commentary by Project Advisor Prof. Roger Trigg]

International

Dr. Babatunde Osotimehin, Executive Director of the United Nations Population Fund, has published and editorial that extols the passage of the Philippines Reproductive Health Act. He argues that "family planning is a long established human right" and makes a claim for "reproductive rights," and asserts that it is necessary to "tear down . . . barriers that prevent [people] from accessing information and services."  Freedom of conscience among health care workers is seen by activists like Dr. Osotimehin as one of the "barriers" to be torn down.

Ireland

A three judge panel of the Irish High Court has rejected a suit by a woman suffering from multiple sclerosis to strike down the absolute ban on assisted suicide.  The decision is likely to be appealed. [Irish Times; Appeal Likely]

A paper published in the Journal of Medical Ethics argues that pharmacist regulators must compel all pharmacists to dispense the morning after pill to all suitable patients who request it, or that objecting pharmacists must refuse to supply the morning after pill and refuse to refer the patient to an alternative supplier.  The paper formally argues that providing the drug directly and referring for it are morally equivalent actions, and that it is ethically incoherent for an objecting pharmacist to refer for the drug.  However, the paper adopts a tendentious position with respect to the purported rights of patients and corresponding obligations of pharmacists, so that the outcome of a disciplinary hearing based on their paper would be suppression of freedom of conscience among pharmacists.

Japan

A new study explored the relationship between professional quality of life and emotion work and the major stress factors related to abortion care in Japanese obstetric and gynecological nurses and midwives.  These findings indicated that providing abortion services is a highly distressing experience for nurses and midwives.

Philippines

The new reproductive health law in the Philippines makes the exercise of freedom of conscience iimpossible or ridiculous, and exposes those who claim the exemption to prosecution for human rights violations.  It is not clear whether this part of the bill has been deliberately constructed as an obstacle to conscientious objection, or if it is simply the product of appalling legislative draftsmanship.

United Kingdom

A panel of three judges in Edinburgh is hearing arguments in an appeal by two midwives who were ordered to supervise provision of abortion in the National Health Service Greater Glasgow and Clyde region. A lower court ruled that the protection of conscience provision in the 1967 Abortion Act did not apply to them. [BBC] The case turns upon the definition of "participation," which is not set out in the Act.

The Life Issues Institute reports that ads are being run on Facebook in the United Kingdom that offer women assistance in finding nearby abortion facilities, including late-term abortion specialists. The ads demonstrate that there is no need to force objecting health care workers to facilitate abortion by referral or by providing abortionist contact information, as access to abortion can be easily facilitated by popular social media and websites.

United States

Lawsuits against a federal regulation continue to be filed and are at various stages of litigation and appeal.  The contested regulation requires employers of 50 or more people to provide health insurance coverage for contraceptives, embryocides and surgical sterilization, even if the employers object to the services for reasons of concience.  As a result of the lawsuits and widespread protests, the Obama administration has proposed amendments to the regulation, which have been rejected as unsatisfactory by its opponents (New York Times). Judges are split on the issue (Los Angeles Times).  For a map and up-to-date overview of lawsuits filed against the U.S. Department of Health and Human Services, see the Becket Fund's HHS Information Central. 

As a result of an investigation following a lawsuit filed by the Alliance Defending Freedom, Mt. Sinai Hospital in New York has agreed to abide by federal conscience protection laws, train employees about the hospital's obligation to those laws and how to properly keep records of those who are objecting or not objecting to participating in abortions, and update a Human Resource policy to state that the hospital will not engage in any form of employment discrimination based on an employee's refusal to participate in an abortion. [ADF News Release]

Writing on behalf of the US Conference of Catholic Bishops Ad Hoc Committee on Religious Liberty, Archbishop William E. Lori has asked Congress to pass measures in an appropriations bill. One "clarifies current nondiscrimination laws to improve protection of individuals and institutions that decline involvement in abortion, allowing the victims of discrimination to vindicate their rights in court." The other merges the Hyde/Weldon amendment with a 1996 law that prevents people from being forced to participate in abortion training.

Writing in the New England Journal of Medicine, two euthanasia advocates have characterized refusal of physicans to provide euthanasia as patient abandonment, a violation of medical ethics. The assertion appears in their response to a suggestion that euthanasia could be provided by a state agency rather than physicians.

Uruguay

In the fall of 2012 the Uruguayan legislature passed the Voluntary Termination of Pregnancy Act, which legalized abortion in the country under certain circumstances. By January, 2013, Reuters was reporting that the law was meeting "fierce opposition" among Uruguayan gynaecologists, with up to a third of them refusing to provide the procedure for reasons of conscience; in some locations, almost none will do so.  While there are protection of conscience provisions in the law, the law also provides that objecting workers can be compelled to be involved in providing abortion when there is a "serious risk" to the health of the mother.  This can be so broadly construed as to completely eliminate the possibility of conscientious objection to abortion.[Project commentary]

2.  News Items

You can search news items by date, country and topic in the Project News/Blog. 

3.  Recent Postings

Confronting Conscientious Objection

U.S. Federal Govt- Proposed Rule: Coverage of Certain Preventive Services Under the Affordable Care Act (Proposal for revision of "preventive services" mandate)

Physcians' Alliance for Total Refusal of Euthanasia

U.S. House of Representatives Bill HR _ (2012): Appropriations for the Departments of Labor, Health and Human Services, and Education, and related agencies (2013)

Obama freedom to worship assaults First Amendment

Medicine, Strasbourg, and conscientious objection:European Court of Human Rights decision

Uruguay's Voluntary Termination of Pregnancy Act: Protection of conscience provisions may be defined out of existence

Uruguay's abortion law: Protection of conscience provisions

Conscientious Abortions? We Don't Need New Laws Protecting Abortionists

Philippines RH Act: Rx for controversy.  The Responsible Parenthood and Reproductive Health Act of 2012: New law threatens some objectors with fines and imprisonment

The "RH Act" (2012) in brief: The Responsible Parenthood and Reproductive Health Act of 2012 

4.  Action Items

None noted.

5.  Conferences/Papers

The Project will post notices of conferences that are explore and support the principle freedom of conscience, including the legitimate role of moral or religious conviction in shaping law and public policy in pluralist states or societies.

6.  Publications of Interest

Letter re: Redefining Physicians' Role in Assisted Dying.

Angell M., Lowenstein E.  N Engl J Med 2013; 368:485-486 January 31, 2013 DOI: 10.1056/NEJMc1209798

• Writing in the New England Journal of Medicine, two euthanasia advocates have characterized refusal of physicans to provide euthanasia as patient abandonment, a violation of medical ethics. The assertion appears in their response to a suggestion that euthanasia could be provided by a state agency rather than physicians.

Professional QOL of Japanese nurses/midwives providing abortion/childbirth care

Mizuno M, Kinefuchi E, Kimura R, Nurs Ethics January 17, 2013 0969733012463723

• This study explored the relationship between professional quality of life and emotion work and the major stress factors related to abortion care in Japanese obstetric and gynecological nurses and midwives. . . . Multiple regression analysis revealed that of all the evaluated variables, the Japanese version of the Frankfurt Emotional Work Scale score for negative emotions display was the most significant positive predictor of compassion fatigue and burnout. The stress factors "thinking that the aborted fetus deserved to live" and "difficulty in controlling emotions during abortion care" were associated with compassion fatigue. These findings indicate that providing abortion services is a highly distressing experience for nurses and midwives. [Full Text]

The fox and the grapes: an Anglo-Irish perspective on conscientious objection to the supply of emergency hormonal contraception without prescription

Cathal T Gallagher, Alice Holton, Lisa J McDonald, Paul J Gallagher
J Med Ethics doi:10.1136/medethics-2012-100975

Abstract:  . . . Either the regulators must compel all pharmacists to dispense emergency contraception to all suitable patients who request it, or a pharmacist must refuse either to supply EHC or to refer the patient to an alternative supplier and challenge any subsequent sanctions imposed by their regulator.[Full Text]

7.  Video

 s

8.  Audio

 s