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Conscience or Contempt of Court?
Court orders sterilization of woman
Province of Quebec, Canada (1999)

Related Links
Service or Servitude:
 Reflections on
 Freedom of Conscience
for Health Care Workers

Freedom of Conscience
and the Needs
of the Patient

Establishment Bioethics

Referral:
 A False Compromise

by Sean Murphy
Administrator, Protection of Conscience Project

In July, 1999, Quebec Superior Court Judge Paul Vezina ordered that Cassandre Lavoie have a second trimester abortion and tubal ligation.  Lavoie, who was mentally ill, had been a ward of the province of Quebec for five years.   Evidence received by the court was that she was not capable of requesting or consenting to the procedures.

While there were no physiological grounds for the abortion,  it was the opinion of the hosptial psychiatrist that giving up the child for adoption would impose a psychological burden on the woman.  No evidence was heard about the possible emotional or psychological impact of forced abortion and sterilization.  Neither the  lawyer appointed to represent Lavoie nor her caregivers challenged the application, which was supported by the public trustee.

If lobbying for legalization of euthanasia and assisted suicide is eventually successful, courts that now order abortion and sterilization of incompetent patients will almost certainly issue orders that they be killed (See Chief Justice favours assisted suicide, willing to order assistance).  Given the conduct of the lawyer, caregivers and public trustee in Lavoie's case, one is entitled to doubt that applications for such orders will be meaningfully contested.

Criticizing the judgement, Canada's National Post asked, "When did abortion become the official choice of first resort?"  (Whose Choice?  National Post (Canada) Editorial,  Monday, August 30, 1999)

The more relevant question from the perspective of health care institutions and workers is, "If I refuse to perform  a court ordered procedure for reasons of conscience, will I be charged for contempt of court?"

Morning-after pill poses moral dilemma for some MDs:
Doctors don't have to prescribe contraceptive pill but they have to offer patients an alternative 
The Standard (St. Catharines - Niagara)  29 June, 2000
(Reproduced with permission)

Related Links
Project Letter to the Editor
by Allison Lawlor

When a young woman arrived in a panic at the St. Catharines General's emergency department last month looking for a drug, commonly known as a morning-after pill, she didn't expect to be told the doctor on duty wouldn't give it to her. 

The woman, who did not want to be identified for reasons of privacy, was told by a nurse the doctor was morally opposed to the pill, which prevents pregnancy after sex, and would not prescribe it. 

The recent incident raises several questions about the controversial issue of doctors refusing to administer a drug based on personal beliefs. 

The issue set off a debate when the drug Preven, known as the morning-after pill, was approved by Health Canada late last year. It is now sold in some pharmacies. 

``As far as a physician is concerned they can decide to give treatment or withhold depending on his moral feeling,'' said Dr. Ashok Sharma, chief of staff at the St. Catharines site of the Niagara Health System. 

As long as doctors are upfront with their patients, give them sufficient information or alternatives and fall within the province's Regulated Health Professions Act, they have the right to limit their medical practice, said Jill Hefley, spokeswoman for the College of Physicians and Surgeons of Ontario. 

``It is up to physicians to define the parameter of their practice,'' said Hefley.

Of the 10 doctors who rotate shifts in St. Catharines General hospital's emergency room, only one will not prescribe the emergency contraceptive pill on moral grounds, said Sharma. The hospital would not release the name of the physician and said the doctor did not wish to talk publicly
about his beliefs. 

If a doctor is morally opposed to a medical treatment, it is his or her obligation to provide the patient with alternatives, said Sharma. 

In a non-emergency situation where contraception was not used during sex or it failed, a doctor at St. Catharines General can recommend a woman go to a walk-in clinic, a birth control centre or another hospital emergency room. 

In a case of sexual assault, the circumstances change, said the chief of staff. 

``There is a standing order that they (doctors) have to give the pill in any emergency,'' he said. 

The Sexual Assault Treatment Centre, which serves the region, is located at the hospital.  

Women who fear an unwanted pregnancy have 72 hours after intercourse to take the drug.  

``It is not uncommon for people to come to get the morning-after pill,'' said Maria Vuono, program manager of the hospital's critical care unit. 

The emergency room gets a handful of non-emergency requests each month for the treatment, she said. 

``ER is not the right place for contraceptive care,'' said Sharma. ``We are too busy.''  

The emergency room can't provide sufficient counselling or follow-up care. Family doctors or walk-in clinics provide more appropriate care, said Sharma. 

In the recent case of the St. Catharines woman, she was told by the nurse on duty she had the option of either waiting until another doctor came on duty or go to the St. Catharines birth-control centre or a walk-in clinic to get the pill. She went to a centre. 

Niagara Region runs three birth-control centres. If a woman goes to a centre looking for the morning-after pill, she can't get it without a doctor. 

``Emergency contraception is always prescribed by a physician,'' said Alan Spencer, program manager of sexual health with the Region's public health department. ``People can access it through the clinic.'' 

The clinics in Welland and Niagara Falls are only open during the afternoon. The St. Catharines clinic is open all day but doctors are not on-duty at the three clinics at all times. If a physician is not available, the woman will be referred to a family doctor or walk-in clinic, said Spencer. 

A person would only be denied the emergency contraceptive on a medical and not a moral basis, he said. 

``We believe in non-judgmental health treatment,'' said Spencer. ``We want people to be healthy.'' 

At Hotel Dieu Hospital, the decision to prescribe the drug is left to the emergency room physician, said Rick Mauro, the hospital's spokesman. 

The Catholic hospital would prefer to refer a woman to the city's other hospital because it is better equipped to deal with such cases, said Mauro. 

However, administering the drug is still a decision each doctor must make, said Mauro.  

City Council Refuses Conscience Clause
Washington, D.C., U.S.A. (2000)

Introduction This story has a happy ending.  However, it illustrates the kind of adverse political environment that can have a significant impact on freedom of conscience.

 

  WASHINGTON, D.C., JUL 12 (ZENIT.org).- In a controversial 13-0 vote, the Washington, D.C., city council decided that all insurance policies in the district that cover prescription drugs must cover contraceptives as well. A last-minute attempt to insert a conscience clause was voted down, and all that remains for the exaction of this ordinance is the mayor's approval.

The bill, which won preliminary approval last month, would mandate that all health insurance plans covering prescription drugs also pay for prescribed contraceptives, including birth control pills, shots and implants. When first introduced, the measure contained a conscience clause that would have exempted Catholic employers, since contraception is against Church teaching. Under pressure from Planned Parenthood, however, this clause was dropped.

In the last-minute negotiations to pass the bill, its sponsors tried to insert a conscience clause that would have applied only to purely religious institutions, but still applying to hospitals, universities, and other institutions. "It seems to me unseemly for the city government to tell the Church which of its institutions can follow Catholic teachings and which cannot,"said Auxiliary Bishop William E. Lori. In any case, even this minor exemption failed in the voting.

As a result, if Mayor Anthony Williams signs the measure into law, the Archdiocese of Washington and the National Council of Catholic Bishops would be in the position of being forced by the government to violate Church teaching.

Last Sunday, all the parishes in the archdiocese read a letter from Cardinal James Hickey and Bishop Lori explaining the case. "This flawed bill would seriously infringe on religious freedom by forcing organizations with religious convictions to violate those convictions at the direction of the government," said the letter. Afterwards, according to one city official, the city council experienced the most vigorous public response since the snow-removal problems last winter.

Several states have similar provisions, but have always provided a conscience clause. Bishop Lori says that the diocese has not decided on its reaction, given that the mayor has not yet signed the bill.

Richard Doerflinger, a pro-life activist with the National Conference of Catholic Bishops, said a stalemate on the issue could mean the end of coverage for the District's many Catholic Church employees. "We can't violate our consciences," he told the Washington Post, counting himself among those who might lose coverage. "I don't know how I'm going to pay for it."
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Support for conscience in the House of Representatives
On 17 July, 2000, it was reported that the chairman of the House Appropriations Subcommittee on the District of Columbia had added a clause to the District of Columbia spending bill that would have stopped the imposition of the measure.  Rep. Ernest Istook (R-Okla.) wanted to see a 'conscience clause' included to exempt employers who object to contraceptive coverage because of religious beliefs.

Mayor vetoes bill, councillor voices second thoughts
Mr. Istook's efforts were superseded when Washington, D.C. Mayor Anthony Williams refused to sign the D.C. City Council bill.  His decision was announced on 1 August, 2000.    The mayor is reported to have stated that he  would not sign a bill that lacked an exemption for employers who oppose birth control or abortion on religious or moral grounds.

Harold Brazil, the councillor who proposed the 'conscience clause' that was defeated during the debate that preceded passsage of the bill, appears to have regretted his decision to support the bill without the exemption.  In a Washington Post article that must have been written prior to the mayor's decision, but which did not appear until afterward, he stated that he could not let the issue rest.  He urged his fellow councillors to "reenact it with a conscience clause and by doing so re-establish its respect for and commitment to religious liberty." (Washington Post, The Contraceptives Act Saturday, August 5, 2000; Page A18 )

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