Update 2014-07-01

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

Austria

It has been disclosed that researchers at the Hoff Clinic, at the Vienna University Clinic for Psychiatry and Neurology deliberately infected hospitalised orphaned children with malaria in the hope of finding a cure for syphilis.  The incident is being studied by an historical commission. 

Australia

A bill to legalize physician assisted suicide and euthanasia has been proposed to the Australian Senate, though it is not slated for debate and passage. It includes provisions that provide protection for medical practitioners who refuse to provide the services for "any reason."  However, there are a number of problems with the text.  Among them, there is no protection for non-physicians and no protection against discrimination in employment.

Brazil

Dr. Thomas Schirrmacher is the Rector of Martin Bucer Seminary, Executive Director of the International Institute for Religious Freedom, and Ambassador for Human Rights of the World Evangelical Alliance. He delivered a lecture at Brazil's Supreme Court on the subject of religious freedom that was attended by about 400 congressmen, members of the government, government staff, representatives of public authorities, heads of Christian churches, leaders of other religions, and the leadership of the Christian legal association ANAJURE. 

Canada

Some Canadian physicians are concerned that regulatory changes will generate pressure on  doctors to prescribe marijuana. Dr. William Pope, the registrar of the College of Physicians and Surgeons of Manitoba, said, "As far as most of us are concerned, there is really no appropriate prescribing."

The Quebec legislature has passed An Act Respecting End-of-Life Care ("ARELC") is intended to legalize euthanasia by physicians in the province of Quebec.  It replaces the original Bill 52, the subject of a previous commentary by the Project.  ARELC allows Quebec physicians to provide euthanasia under the Medically Assisted Dying (MAD) protocol.  In addition, substitute decision makers can order legally incompetent patients who are not dying to be starved and dehydrated to death.  This practice is completely unrestricted and is not even reportable.

The law will not take effect until December, 2015.  However, the introduction of euthanasia will require the complicity of thousands of health care workers and administrators.   Many are likely to comply, but palliative care physicians, hospices and an undetermined number of other physicians and health care workers are opposed to euthanasia and assisted suicide.

Physicians may refuse to provide euthanasia if the patient is legally ineligible, and for other reasons, including conscientious objection.  ARELC requires physicians who refuse to provide euthanasia for any reason other than non-eligibility to notify a designated administrator, who then becomes responsible for finding a MAD physician.  The idea is to have the institution or health care system completely relieve the physician of responsibility for facilitating the procedure.

The protection of conscience provision in ARELC distinguishes physicians from other health professionals, providing less protection for physicians than for others.  Physicians may refuse only  "to administer" euthanasia - a very specific action -  which seems to suggest that they are expected to participate in other ways.  A serious problem is presented by the Code of Ethics of the Collège des médecins, because it requires that physicians who are unwilling to provide a service for reasons of conscience help the patient obtain the service elsewhere.

Palliative care hospices and a single Quebec hospital may permit euthanasia under the MAD protocol on their premises, but they do not have to do so.  Patients must be advised of their policy before admission.  A prominent hospice spokesman predicted that hospices refusing to provide euthanasia will operate in an increasingly hostile climate.

The Project commentary on the original draft statute has been revised and republished to reflect the law passed by the legislature.

Three physicians and a lawyer have written an article published in the May issue of the Canadian Medical Association Journal. The authors warn that the medical profession must prepare for the legalization of assisted suicide and euthanasia, and must be ready to answer questions like,"Will physicians who are conscientious objectors be obliged to present physician-assisted death as an option to patients and facilitate transfers of patients to other physicians or facilities?"

The College of Physicians and Surgeons of Ontario (CPSO) has announced a public consultation as part of its review of Physicians and the Ontario Human Rights Code. The policy was adopted amidst considerable controversy in 2008 because of an unsuccessful attempt by the College and the Ontario Human Rights Commission to suppress freedom of conscience in the medical profession.

The CPSO review follows a province-wide crusade earlier this year against three Ottawa physicians who provide support for natural family planning but refuse to prescribe or refer for contraception or abortion.  In June, a Calgary doctor who also refuses to prescribe contraceptives was vehemently denounced, a number of people repeating the increasingly frequent refrain that such people should not be allowed to practise medicine.

France

A French court has acquitted a physician charged with lethally injecting seven terminally ill patients. Dr. Nicolas Bonnemaison claimed that he was acting properly as a physician.  Another French court ordered the cessation of assisted nutrition and hydration for Vincent Lambert, who is comatose, but not dying.  The application was brought by his wife, but is being opposed by his parents, who successfully petitioned the European Court of Human Rights to intervene.

Israel

A bill to permit physician-assisted suicide has been approved by the Ministerial Committee on Legislative Affairs, but is being strongly opposed by rabbinical authorities in the country.

Italy

 Bioethicist Francesca Minerva argues that Italy should offer higher salaries to physicians willing to perform abortions and should establish limits on the number of physicians allowed to exercise freedom of conscience in Italian hospitals.

New Zealand

The Green Party of New Zealand has published a position paper that appears to admit that 99% of abortions are not, in fact, necessary to ensure mental or physical health.  The paper incorrectly implies that a physician willing to provide an abortion is "neutral" with respect to the procedure, while a physician unwilling to do so is not.  The party states that it will force objecting physicians to refer for abortions, even though, according to its own paper, no medical grounds exist for "99%" of abortions now taking place in the country.

Poland

The management of a private Polish hospital, the Hospital Pro-Familia in Rzeszów, is now suing anti-abortion activists who are publicly protesting abortions that are being performed at the facility.  It appears that the hospital is attempting to prevent the activists from describing abortion as "killing."  Such a restriction on expression would make it impossible for many  health care workers who object to abortion to explain the basis for their objections.

A Declaration of Faith for Catholic doctors and medical students was published in a letter by Dr. Wanda Półtawska, a friend of Pope John Paul II, and subsequently signed by over 3,000 people.  The Declaration insists that Catholics, including physicians, "have a right to perform their professional activities in accordance with their conscience."  [Deklaracja Wiary website]

A prominent Polish physician is at the centre of a controversy about abortion.  Dr. Bogdan Chazan, director of Holy Family Children's Hospital in Warsaw, refused to authorize an abortion for a woman whose baby had been diagnosed with severe brain damage, and did not refer her elsewhere for the procedure.  The Polish Prime Minister has weighed in, insisting that physicians who refuse to provide abortions for reasons of conscience must refer patients to someone who will do so.

United Kingdom

Those attending an annual conference of the Catholic Medical Association were told that physicians who adhere to the teaching of the Catholic Church should seriously consider emigrating, since there is no room for such a worldview in medical practice in the country.

Britain's National Health Service will provide drugs to suppress puberty to children as young as nine if they believe that they are they wrong sex.  The treatment is intended to make sex change surgery easier should they later opt for it.  This could eventually give rise to conflicts of conscience among physicians or other health care workers who may be expected to participate or facilitate it, though the treatment is now managed by specialists who do not have moral or ethical concerns about it.

Niall Dickson, the head of the General Medical Council (GMC), has admitted that more than 60 doctors signed forms to authorize abortions without knowing anything about the women who were seeking them.  They acted illegally, and Dickson described it as unacceptable, but no disciplinary action or prosecution was recommended.  According to Dickson, no patients were harmed and the practice has ended.  Since the GMC declines to act against physicians who deliberately do what they know to be wrong in order to facilitate abortion, it remains to be seen whether or not it will act against physcians who refuse to do what they believe to be wrong - such as facilitating abortion. 

United States

As a result of a boycott by European manufacturers opposed to capital punishment, a shortage of a lethal drug, Nembutal, is stopping both executions and assisted suicide in the United States.  Meanwhile, a private group, the Death Penalty Committee of The Constitution Project, has recommended that executions be carried out using a single lethal drug, as is the case with legal assisted suicides.  The group also recommended that every exectuion by lethal injection be carried out under the supervision of medical professionals in order to minimize unnecessary pain or suffering.  The second recommendation contradicts the position of the American Medical Association and has been criticized by professors from Harvard University.

The Supreme Court of the United States has ruled 5/4 in favour of Hobby Lobby, a Christian business seeking exemption from the controversial Health and Human Services birth control mandate.  The ruling is likely to affect the outcome of numerous other civil suits brought against the federal government by employers who object to providing employee insurance for contraceptives, embryocides and sterilization for reasons of conscience.  The HHS birth control mandate and surrounding controversy, while not directly affecting health care workers, has become part of the social environment that affects discussion of freedom of conscience in health care.

A court in Virginia has imposed a sentence that includes mandatory vasectomy on a 27 year old male.  The sentence was part of a plea bargain.  It appears to have been suggested because the accused had fathered numerous children out of wedlock. 

A clinic in Toledo, Ohio, has advised parents that, after June 1, 2015, clinic paediatricians will not accept or treat children whose parents refuse to have them vaccinated.  The decision is not related to the moral or religious beliefs of physicians, but reflects their concern that unvaccinated children present a health risk to others attending the clinic.   

2.  News Items

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

Calgary doctor refuses to prescribe birth control due to personal beliefs

The doctors’ declaration of faith

Should doctors have the right to refuse to treat a patient?

Assisted suicide and euthanasia bill proposed in Australian Senate

Doctor on duty ‘will not prescribe the birth control pill,’ reads sign at Calgary walk-in clinic

Euthanasia rulings in Europe stir right-to-die debate

Virginia’s compulsory vasectomy

Right-to-die already weighing on Quebec’s conscience

New Zealand Green Party will force referral for abortion for non-medical reasons

Director of IIRF Speaks at Brazil’s Superior Court of Justice on Freedom of Expression and Conscientious Objection

Polish Prime Minister says doctors must do abortions despite conscience objection

Chief Rabbi Strongly Condemns Assisted Suicide

Lawmakers clash over euthanasia bill

Doctor group declines care to unvaccinated

Medical marijuana and conscience rights

Catholic physicians who want to follow their conscience must ‘emigrate,’ UK expert says

Top employment strategies for discouraging conscientious objection

Doctors who follow church teaching told to emigrate

Should doctors take part in executions?

Embargo on lethal drug stops executions and assisted suicides in US

Professor argues for a profound rethinking of conscience rights

NHS to give sex change drugs to nine-year-olds: Clinic accused of ‘playing God’ with treatment that stops puberty

Doctors reluctant to give young women permanent birth control

Canadian physicians warned to get ready for euthanasia and assisted suicide

Austrian historians studying another informed consent debacle from the 50s

New execution protocol similar to doctor-assisted suicide recommended

Pre-signing abortion forms is illegal, General Medical Council admits

Polish “Family” Hospital Doing Abortions Sues Pro-Life Activists Exposing Them

3.  Recent Postings

CMA doctors hail Supreme Court mandate ruling, decry ongoing targeting of faith community

ACLJ: Supreme Court Issues “Landmark Decision Protecting Religious Freedom and Freedom of Conscience”

Medical Services (Dying with Dignity) Exposure Draft Bill 2014 (Australia)

Polish physicians and medical students declaration of faith and freedom of conscience

Fundamental freedoms: Why the right to conscientious objection must be restored

MaterCare International stands firmly behind Dr. Bogdan Chazan

West Island Palliative Care Residence clarifies care it offers following passage of Quebec's end-of-life legislation

Physicians and the Ontario Human Rights Code

Redefining the Practice of Medicine: Euthanasia in Quebec.  An Act Respecting End-of-Life Care (June, 2014)

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

Downar J, Bailey TM, Kagan J, Librach SL.  Physician-assisted death: time to move beyond Yes or No.  CMAJ 2014 May 13;186(8):567-8. doi: 10.1503/cmaj.140204. Epub 2014 Apr 7.

Minerva F.  Conscientious objection in Italy.  Med Ethics doi:10.1136/medethics-2013-101656

Nordstrand SJ, Nordstrandagnus MA, Nortvedt P,  Magelssen.  Medical students'attitudes towards conscientious objection: a survey  J Med Ethics 2014;40:609-612 doi:10.1136/medethics-2013-101482

Trigg R. Accommodating conscience in medicine.  J Med Ethics doi:10.1136/medethics-2013-101892 Commentary

Truog RD, Cohen IG, Rockoff MA. Physicians, Medical Ethics, and Execution by Lethal Injection.   JAMA. 2014;311(23):2375-2376. doi:10.1001/jama.2014.6425.

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