31 December, 2014
Covering the period from 1 November to 31 December, 2014
1. By Region/Country
Visit the Project News/Blog for details.
The Protection of Conscience Project celebrates its 15th anniversary in
December, 2014. The formation of the Project was one of the eventual results of
a meeting in Vancouver with British Columbian Senator Ray Perrault
in the spring of 1999. Most participants were physicians or pharmacists.
They spoke of their growing concern that they would be penalized or forced
out of their professions if they continued to practise in accordance with
their religious or moral beliefs. This was a key factor in the establishment
of the Project nine months later.
The six member Legal and Constitutional Affairs Committee of the
Australian Senate has issued a
report recommending that Greens senator Richard di Natale reflect and
consult further with experts concerning
his euthanasia and assisted suicide bill. The Committee also
recommended that, if a revised bill is formally introduced, senators should
be allowed a "conscience vote" on it. The bill has
some provisions that provide some protection for objecting physicians,
but they are problematic in some respects.
of the College of Physicians and Surgeons of Ontario
demands that physicians must provide services to prevent imminent "harm,
suffering and/or deterioration," even if doing so is contrary to their moral
beliefs. In less urgent circumstances, the draft policy demands that
objecting physicians refer patients to colleagues who will provide the
morally contested service. As written, the policy will apply to euthanasia
and assisted suicide should the Supreme Court of Canada legalize the
procedures. Those who refuse to comply may face disciplinary action.
College officials have said publicly that physicians unwilling to provide or
refer for contraception or abortion should leave family practice. A
public consultation on the draft policy is open until 20 February, 2015.
The Canadian Medical Association says it is preparing for the Supreme Court
of Canada decision in Carter v. Canada, which may (or may not) legalize
physician assisted suicide and euthanasia. Some concerns are being
expressed that the preparation seems to favour legalization of the procedures.
New Brunswick’s Minister of Health and the President of the province’s
Medical Society both claim that physicians who refuse to provide abortion for
reasons of conscience have an obligation to refer patients to colleagues who
will. These assertions contradict the positions of the Canadian Medical
Association and the College of Physicians and Surgeons of New Brunswick. and
fail to take consider how such a policy would play out
should assisted suicide and euthanasia be legalized. The Project has written to
Complaints have been made that, of 27 licensed public hospitals in Croatia, five
have stopped providing abortions because staff physicians are unwilling to
perform them for reasons of conscience: Zagreb’s "Sveti duh" hospital, the
general hospitals in Nasice, Vinkovci and Virovitica, and the general
hospital in Knin. Abortion activists insist that public hospitals should not employ
physicians who object to abortion. There have been unsubstantiated
accusations that some doctors in Zabok and Zagreb who claim a "conscientious
objection" to performing abortions in public hospitals actually do provide
them in illegally in private practice.
Subsequently, the hospitals in Nasice, Virovitica and Vinkovci hired external
gynecologists to provide abortions, some gynecologists at the Knin
General Hospital have rescinded their conscientious objections, and Zagreb’s "Sveti duh" hospital has signed a contract with
the "Sestre milosrdnice" hospital to perform abortions on request.
Professor Theo Boer, a former member of one of the Netherlands' regional
euthanasia control committees, has expressed concern that the Dutch
euthanasia law has gone too far. Dr. Boer reviewed about 4,000 cases
of euthanasia during his nine year term with the committee. He
continues to agree with voluntary euthanasia when provided only for
terminally ill patients who experience "unbearable suffering," but now
thinks that this term is too subjective to be safely applied. He is
also concerned about the activities of the Levenseinde Kliniek, a euthanasia
facility opened to serve patients whose physicians would not provide
Those running Levenseinde Kliniek believe that everyone over 70 years old
should be allowed to have euthanasia if they are tired of living. The
facility has been reprimanded by Dutch euthanasia authorities because of its
handling of two cases. Doctors at the clinic have complained that some
Dutch pharmacists refuse to provide euthanasia drugs.
It does not appear that publication of Professor Boer's concerns has
generated any widespread public concern in the Netherlands, and the
Levenseinde Kliniek has rejected his criticisms. This suggests that
Dutch health care workers who refuse to be involved in euthanasia or
assisted suicide may find themselves increasingly isolated and vulnerable to
discrimination and coercion.
The Supreme Court of the Philippines has issued a decision concerning the
controversial Responsible Parenthood and Reproductive Health Act of 2012
( RH Law). The ruling confirms the Protection of Conscience
criticism of the
parts of the law that adversely affected freedom of conscience
among health care workers. Those sections have been struck down by the
The Supreme Court of the Philippines consists of 15 judges. With
respect to the issue of freedom of conscience among health care workers and
- 11 judges held that the mandatory referral provision in the law was
an unconstitutional violation of freedom of conscience;
- 10 of the 11 also ruled that forcing an objecting health care
worker to provide "complete and correct information" about contraception
was a violation of freedom of conscience
- The eleventh judge held that this was not, but added that the
provision could not be used to suppress the freedom of objecting
health care workers to express professional or other opinions
Sections of the
majority and individual opinions supportive of freedom of conscience are
reproduced on the Project website.
Women have successfully sued the National Health Service for hundreds of thousands of pounds
because they have given birth to healthy babies after failed abortions or
sterilizations. Claims were paid out to compensate for pain giving
birth and discomfort during pregnancy.
Britain's Supreme Court ruled against two Catholic midwives whose
employer required them to supervise the provision of abortions. The
trial court ruled against them, but they were successful on appeal, and the
employer then appealed to the Supreme Court. The Supreme Court ruling
narrowly interpreted the
protection of conscience clause in the Abortion Act 1967 to allow
exemptions only from the direct performance of abortions. Moreover,
the court gratuitously asserted that physicians unwilling to perform
abortions are obliged to refer patients to colleagues who will do so.
It now appears that the midwives may have to leave the profession.
The ruling comes as the House of Lords approved Lord Falconer's physician
assisted suicide bill after adopting amendments to ensure that judges have
the final say in approving applications for the procedure. The measure
apparently satisfied a number of critics of the bill who wanted to see
sufficient safeguards in place. Like the Abortion Act, Lord
Falconer's bill includes a
protection of conscience provision that allows objecting physicians to
refuse to "participate" in assisted suicide. The Supreme Court ruling
indicates that, if the bill ultimately passes, objecting physicians will be
compelled to facilitate assisted suicide.
Two thirds of British general practictioners are said to be refusing
to comply with a National Health Service policy that they must offer to
prescribe statins to anyone with a one in 10 chance of developing heart
disease within ten years (i.e., most men over 60 and most women over 65
- 40% of the public). The demand is backed by the power of the NHS
to cut fees for physicians who fail to meet the targets set. While
the policy has been defended by some cardiologists, those opposed to it
protest that a practice that may benefit those who have heart disease
has not been shown to benefit those without it. There are also
disputes about the side effects of the drugs. Objecting physicians
are not being portrayed as "conscientious objectors," apparently because
their opposition is not seen to involve a moral or ethical judgement.
This view is erroneous.
Two psychologists contracted by the CIA to create enhanced interrogation
techniques for al-Qaeda detainees have been criticized by the Senate Select
Committee on Intelligence for violating human rights and medical ethics.
A U.S. Navy nurse who faces discharge from the military for refusing to
force-feed prisoners at Guantánamo Bay is being supported by the
American Nurses Association(ANA) and Physicians for Human Rights (PHR).
The ANA has written Secretary of Defense Chuck Hagel, insisting that the nurse should not be punished for making an
independent ethical decision. PHR
wants an end to the disciplinary proceedings against the nurse.
On 1 November, Brittany Maynard, a 29 year old woman with terminal brain
cancer, committed suicide in Oregon State with the assistance of a physician
(and, presumably, a pharmacist), who provided the lethal medication she
consumed. In the weeks leading up to her death she had publicly advocated
for legalization of assisted suicide. The story seems to be fuelling a
dramatic increase in support for the procedure.
The American Center for Law & Justice (ACLJ) successfully assisted a
pharmacist in Virginia who was the subject of a formal complaint
because she her refused to fill prescriptions for oral contraceptives.
Several Walgreens customers in Florida have complained that
Walgreens' pharmacies are refusing to fill valid prescriptions for
pain-controlling drugs. The refusals are the result of a company policy
aimed at reducing narcotics abuse, not ethical concerns about the drugs
themselves or the mechanism of action. It appears to be a consequence of
having been fined $80 million for filling fraudulent prescriptions in Florida.
2. News Items
You can search news items by date, country and topic in the
Physicians in Croatia refusing to provide abortion
Top nursing group backs Navy nurse who wouldn't force-feed at
Euthanasia in the Netherlands is getting out of hand: ethicist
who screened over 4,000 euthanasia cases
Proposed Australian euthanasia bill may return in 2015
Should midwives opposed to abortion have the right to refuse any
involvement in cases?
Fury after mothers get thousands in compensation – for healthy
babies they tried to have aborted
Supreme Court of the United Kingdom to hear midwives's case on
Lords back assisted dying providing judge gives final ruling
Lessons Learned: May a Healthcare Professional Say No To
Doctors refusing to prescribe statins
Conscientious objection to abortion: Catholic midwives lose in
Canadian Medical Association says it's getting ready for
legalized euthanasia, but critics say it is pushing it
Canadian doctors preparing for 'all eventualities' in case top
court strikes down ban on assisted suicide
Doctors who oppose abortion should leave family medicine:
Ontario College of Physicians
Catholic midwives' abortion ruling overturned by supreme court
Catholics doctors who reject abortion told to get out of family
Catholic midwives must supervise abortions, Supreme Court
Midwives 'forced to leave profession because they refuse to
partake in abortions'
Supreme Court rules against Glasgow midwives
'Frightening': Life and family leaders react to Ontario College
of Physicians' draft policy
Freedom of Conscience Protected in Virginia
Ontario physicians college draft policy would trample conscience
Assistant minister says issue of access to abortion resolved
Customers claim Walgreens refuses to fill legitimate
With assisted suicide, what begins in compassion seems to end in
3. Recent Postings
Good News and Bad News
Navy Nurse Should Not be Punished for Declining to Force-Feed
American Nurses' Association supports conscientious objection by
U.S. Navy nurse
When is a problem not a problem?
Judgementalism and moralising in response to Brittany Maynard
Supreme Court of the Philippines majority opinion on the RH Law
Clarifying Our Terms for 2015
Ontario physicians to be forced to do what they believe to be
wrong: Draft policy demands that objectors provide or refer.
Policy would apply to euthanasia, if legalized.
New Brunswick health minister unaware of abortion-euthanasia
Looking back on 15 years: an anniversary
Proposed policy of Ontario College of Physicians "appalling"
Ontario College of Physicians' new policy violates basic tenets
Psychologists criticised in CIA torture report
The Globe and Mail: bullying from a bully pulpit
Project letter to the New Brunswick Minister of Health
4. Action Items
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