Dame Elizabeth Butler Sloss has ruled that a woman paralysed from the neck
down has the mental capacity to refuse treatment, in the form of artificial
ventilation, even if it will result in her death. She awarded a nominal
judgement of Â£100 for 'trespass' by the physicians who refused to turn off
the ventilator because they believed that to do so would violate their
obligation to protect life. It has not been reported how the problem of
conscientious objection by attending health care workers was dealt with, or
if, in fact, the problem was even recognized. It has been suggested that the
woman might be transferred to another hospital, which may make it possible
for her to find health care workers who have no objection to giving effect
to her decision.
The Abortion Non-Discrimination Act (S. 2008) has been introduced in the
United States Senate by Senator Gregg. It amends 42 USC 238n, which protects
health care entities from abortion-related discrimination, to clarify that
'health care entity' includes the broad range of health care providers. The
bill also amends existing law by prohibiting discrimination based on an
entity's refusal to pay for or provide coverage for abortion.
The Compassionate Care for Female Sexual Assault Survivors Act is a
bill designed by the "Pro-choice" Caucus of the American congress to force
hospitals to supply the potentially abortifacient 'morning-after pill' to
sexual assault complainants, even if the hospital is run by a religious
group opposed to abortion. One of the bill's co-sponsors, Representative
Diana DeGette (Democrat), boasted that the 'pro-choice' caucus was going to
put the run on those who disagree with them, adding that the bill is only a
first step in what appears to be an aggressive agenda to suppress freedom of
conscience in health care.
The Institute for Health Freedom
reports that the revised Model Emergency Health Powers Act, drafted by the
American Center for Disease Control and academics, would expand state and
local government powers. The Act could be used to force individuals to be
medically examined, vaccinated, treated; those who refuse could be
quarantined. Health care workers could be forced to administer treatments or
drugs to which they have conscientious objections. The revised Model State
Emergency Health Powers Act (dated December 21, 2001) can be accessed at
Numerous American states are reported to be considering the proposal or
other like it.
An ABC News/Beliefnet poll suggests that roughly 48 percent of Americans
oppose legalizing assisted suicide, while 40 percent support it. Religious
belief appears to be a key factor in the responses, with Christians
predominant among those who oppose it and non-Christians or non-religionists
making up most of those in support. The division illustrates the problem
inherent in legalizing morally controversial procedures without providing
robust protection of conscience provisions in the law.
The Tesco supermarket chain is dispensing the free morning-after pills to
women under 20 in a pilot project two towns in western England. This kind of
action may relieve pressure in the short term on conscientious objectors in
pharmacy, whatever the pharmacological consequences. Long term consequences
for conscientious objectors cannot be predicted with confidence.
Mrs. Dianne Pretty, who lost a bid for legalization of assisted suicide
before the British House of Lords, has taken her case to the European Court
of Human Rights in Strasbourg. Media coverage has not indicated that any
interest is being taken in the problem that legalization would pose for
health care workers who have moral objections to assisting in suicide.
The Springfield Education Association, Massachusetts Teachers Association
and National Education Association are being sued by a Catholic teacher. He
claims that he should not be forced to support groups that advocate abortion
or condom distribution. The merits of the case are unclear, because he is
not a union member, and pays an "agency fee" rather than ordinary dues.
Agency fees are reduced payments made by those who don't support political
activity by their unions. It appears that the agency fees are intended to
cover the costs associated with collective bargaining, from which the payee
HB 1802, House Draft 1 has been passed by the lower house of the Hawaiian
legislature. It would force all hospitals and primary-care clinics to
provide the potentially abortifacient 'morning-after pills' to sexual
assault complainants. (Honolulu
The Union of Orthodox Jewish Congregations of America and the Rabbinical
Council of America have issued a joint statement that supports human cloning
"for therapeutic purposes" while rejecting human cloning "for reproductive
In New South Wales, Australia, three "profoundly disabled" individuals are
suing doctors for "wrongful life". The mother of one of the plaintiffs was
not diagnosed with rubella when she was pregnant. The second plaintiff, a 17
month old with a clotting disorder, was conceived through in-vitro
fertilization, while the third, a disabled two year-old, was born after what
was apparently a failed vasectomy. It is argued that diagnosis of rubella
would have resulted in an abortion in the first case, eugenic screening
would have prevented the birth of the second, and the third would not have
been conceived at all but for medical negligence.
A new Massachusetts law requires that health plans offered to employees must
include coverage for contraceptive devices. Support for the bill by
legislators was overwhelming.
The British Medical Journal (BMJ 2002;324:561) reports that a case
has been brought by over 100 women against Schering Healthcare, Wyeth , and
Organon Laboratories. The suit alleges that the women suffered side effects
from third generation birth control pills and, in seven cases, died. Side
effects included deep vein thrombosis, pulmonary embolism, strokes,
and cerebral vein thrombosis. If the case generates significant public
interest, it may have the effect of reducing pressure on physicians who have
moral objections to prescribing contraceptives.
Supported by Hawaii Governor Ben Cayetano, an enabling amendment to the
state constitution and a bill legalizing assisted suicide have been approved
in the lower house of the Hawiian legislature. The bills may be stalled in
the state Senate.
in the New England Journal of Medicine indicates that stem cells can be
obtained from circulating blood.
By a margin of about 1%, the proposed amendment to Irish abortion law has
been defeated. Voter turnout was low. City dwellers voted overwhelmingly
against the amendment, which received much more support in the countryside.
The pro-life vote was split because the proposed amendment would have made
the human embryo a legal non-entity prior to implantation, even though it
would ostensibly have disallowed the performance of abortions when the
mother threatens suicide. The consequences of the referendum will not become
clear for some time.
A London fertility treatment centre has been licensed by Britain's Human
Fertilisation and Embryology Authority to eugenically screen in vitro
embryos. The phrase used by a centres representative was "weeding out
problem embryos". [The Times]
The Argentine Supreme Court has ruled that, since human life begins at
conception, the 'morning-after-pill' is to be considered an abortifacient
because it may prevent implantation of the early embryo. The same conclusion
Philippine government to ban the 'morning-after-pill'.
Despite the fact that the Canadian parliament has yet to debate the
government's proposed Assisted Human Reproduction Act, the Canadian
Institutes of Health Research (CIHR) has approved funding for destructive
stem cell research on human embryos.
CIHR guidelines will be applied by a Stem Cell Oversight Committee in
approving applications to use embryos obtained from fertility clinics with
the consent of their parents.
The Health Care Providers' Rights of Conscience Act (HB 2711) will go to
a floor vote in the Kansas House of Representatives on 14 March, 2002. If
passed, it will move to the Senate. Freedom of conscience advocates in
Kansas are seeking the active support of all health care professionals in
their state to ensure that the bill moves forward. They request those
interested to send their contact information to
KansMary@aol.com so that they can be
kept abreast of developments, and to encourage friends and co-workers to do
the same. An explanation of the bill is offered at
Explanation of HB2711. A
statement in support of the bill from the United States Conference of
Catholic Bishops is also available.
The Virginia Senate has rejected
House Bill 563, which would have provided protection for pharmacists and
others who object to dispensing abortifacient drugs. Drugstore
representatives spoke against the bill. A most remarkable statement was made
by a Senator Warren E. Barry, speaking against freedom of conscience for
health care workers: "It seems to me when someone enters the practice of
medicine or pharmacy . . . they have an obligation. I didn't want to kill
people when I went into the Marine Corps, but I knew it would be my job."
Pre-implantation genetic diagnosis, a process in which embryos conceived
in vitro are screened to detect genetic defects or other
characteristics, has been used at the Reproductive Genetics Institute in
Chicago to enable a woman to select a baby that will not develop early
Alzheimer's. Dr. Jeff Nisker, a professor of obstetrics and gynecology at
the University of Western Ontario's medical school, told CBC Radio that the
technique was originally developed to identify genetic defects in embryos in
order to avoid late term abortions, not to develop "designer children".
The British Human Fertilisation and Embryology Authority has been granted
permission to issue licences for human cloning. The United Kingdom has
limited protection of conscience legislation concerning abortion, but not
governing the new reproductive technologies
Opening a seminar on 'reproductive health', the Indian Minister for Health
and Family Welfare said that the government is considering implementation of
a "two child policy". This would have consequences for all Indian citizens,
but could particularly impact health care workers who have moral or
religious objections to abortion, contraception, sterilization, or coercion
of parents by the state.
The January issue of the Journal of the American Osteopathic Association
reports that a survey of over 1,000 osteopaths shows most opposed to
assisted suicide, but a significant number (37-42%) whose answers suggest a
willingness to participate in the procedure. The survey is available at
Apparently anticipating the legalization of euthanasia in Belgium this year,
the Belgian Free University plans to teach medical student how to kill their
patients correctly. News reports do not indicate if this will be an elective
or a mandatory course.
Following approval for the artificial conception and selection of an embryo
suitable as a bone marrow donor for a boy suffering from a fatal illness, it
is reported that six more couples are seeking the same procedure.
The December, 2001 bulletin of the College of Physicians and Surgeons of New
Brunswick asks if "a greater onus" should laid upon physicians who have
conscientious objections to a procedure to facilitate its provision to
patients. "Council would like comment from physicians on whether the above
guideline should be further clarified. For example, if a physician has a
moral objection to a particular treatment approach, should there be a
greater obligation to expedite access to another physician? Should a direct,
and immediate, referral be mandated?" This part of the bulletin made
headlines in February, and a retired Catholic bishop responded with a
letter in defence of the objectors. See the
Project letter to the Telegraph Journal on the subject.
Dr. Stephen Dawson of Barrie, Ontario, has been charged with professional
misconduct as a result of complaints filed by four unmarried women. Dr.
Dawson, a Christian, had refused to prescribe birth control pills for them.
He also refuses to prescribe Viagra for single men, and would refuse to
offer abortions or prescribe the potentially abortifacient
'morning-after-pill'. A University of Toronto professor characterized people
like Dr. Dawson as "scum". See the story from
The Barrie Examiner, and letters to the editor from the Project to
The Barrie Examiner and the
National Post. Comments from the Christian Medical and Dental Society
and the Catholic Civil Rights League (Canada) appear in a
Lifesite News story. Journalist Michael Coren comments in Real Audio at
Senate Bill 109, providing protection for freedom of conscience of
pharmacists, has passed the Kentucky Senate by a vote of 36-2.
The Health Care Providers' Rights of Conscience Act is being hotly
debated in Kansas. [Topeka Eagle, 21 February, 2002]
The New Hampshire General Court defeated
House Bill 1209, which would have provided the state with its first
protection of conscience statute.
testimony before an Irish parliamentary committee to the effect that
most obstetricians and gynaecologists in Ireland would be conscientious
objectors were abortion to be legalized, the Irish Institute of
Obstetricians and Gynaecologists has said that the legalization of abortion
for the purpose of saving a mother's life would legalize an accepted
practice. It is reported that 30 hospitals would be designated to provide
abortions if the bill now the subject of a referendum is passed.
Meanwhile, a split has developed among those those opposed to abortion.
The Protection of Human Life in Pregnancy Bill 2001 does not protect the
early embryo, so that the potentially abortifacient 'morning-after-pill' and
various forms of embryo experimentation would be legal if the bill passes.
Some pro-lifers are against the bill for this reason; others believe that
the bill can be supported. It is not clear what effect the split will have
on the outcome of the referendum in March.
Perhaps to coincide with a Planned Parenthood media campaign for the
'morning-after-pill', the BC Medical Journal featured an IUD-weilding Aryan
warrior on the cover of its January/February issue, in which Dr. Roey
Malleson, medical director of Planned Parenthood in British Columbia,
suggested that physicians who fail to offer the drug may be 'negligent'. See
news release about the article.
"Therapeutic cloning" should be replaced with the less controversial
term "nuclear transplantation", according to an article in
Human embryos have been used to test experimental artificial wombs at
Cornell University's Centre for Reproductive Medicine and Infertility. The
Centre will eventually allow embryos to live for up to 14 days in the
artificial wombs before killing them.
House Bill 563 has been passed by the lower house in Virginia, USA, and
will be introduced in the state Senate.
A widow in the United Kingdom has become pregnant for a second time using
the sperm of her dead husband, whose name cannot be used on the birth
certificate. Those who may not now be concerned about freedom of conscience
should consider how such precedents may affect the concept of 'standard of
care', and its implications for what might eventually be required of them.
2001 saw 21 reported cases of assisted suicide in Oregon, USA, where the
procedure is legal. The report is at
The Christian Medical Association has criticized a
version of the Hippocratic Oath prepared by the American Board of
Internal Medicine. See
House Bill 930, pending in Maryland, would require all hospitals to dispense
the potentially abortifacient 'morning-after-pill' to rape complainants, or
provide them with information about the drug. While there is a potential for
the bill to adversely impact freedom of conscience in some denominational
institutions, it may be possible to comply with the provisions of the law by
providing additional information that clearly sets out the moral objections
of the institution to the drug, so as to disassociate the institution from
The statement "The Embryo As Patient", signed by 200 doctors and surgeons at
a conference held at Rome's University of La Sapienza, asserts that embryos
have the same rights as other patients. The statement illustrates a views on
the subject held by people within the medical and research community that is
often not reflected by professional associations, regulatory authorities and
others who can bring considerable pressure to bear on those who think
Pope John Paul II has called upon all societies to "guarantee to every human
the right to life from conception to natural death." He specifically
included the human embryo as an individual whose fundamental right to life
should be recognized in law. [Zenit]
Consistent with this, the German parliament's recent vote to authorise
imports of embryonic stem cells has been condemned by the president of the
German Catholic episcopal conference and the president of the Council of
German Evangelical Churches. Finally, Bishop Abelardo Alvarado, secretary
general of the Mexican Catholic bishops' conference, has criticized and
rejected a recent ruling from the Mexican Supreme Court liberalizing the
abortion law. [The News Mexico]. There is clearly a potential for conflict
between health care workers who wish to adhere to these expressions of
religious belief, and interest groups or states that would suppress
conscientious objection in order to facilitate morally controversial
procedures or services.
The Guardian reports that the Society for the Protection of the Unborn
Child in the United Kingdom are seeking a judicial review of the sale of the
'morning-after-pill' in pharmacies. The Society will argue that pregnancy
begins with fertilisation of the egg, and that the sale of the
'morning-after'pill' violates an 1861 law against supplying products
intended to procure a miscarriage. What is of interest is the reaction of
the Family Planning Association, the Royal Pharmaceutical Society and the
Department of Health to the possibility that the court might accept the
arguments of the SPUC.
Toni Belfield of the Family Planning Association stated, "This would
affect all except barrier methods and natural family planning
sterilisation." The admission implicity concedes the point that is at the
root of conscientious objections to dispensing the morning-after-pill and
some contraceptives: that these drugs have a potentially abortifacient
mechanism, in that they can cause the destruction of an early embryo.
Massachusetts politicians refused to exempt denominational hospitals and
colleges from a bill that forces private insurers to pay for contraceptives
and potentially abortifacient devices. Unless resisted by civil disobedience
or overturned by a court challenge, the law will effectively suppress the
practice of religious belief by denominations that consider abortion or
contraception to be morally objectionable. [Boston
The lower house in the New York legislature has passed a bill that will
force all employers to provide insurance coverage for contraceptives,
without exemptions for religious denominations that hold contraception to be
morally objectionable. The New York Senate, seeking a compromise that would
protect religious freedom, blocked passage of a similar bill last year.
The Assembly also passed a bill to force hospitals to provide potentially
abortifacient drugs to patients reporting that they had been raped, as well
as information about abortion. It may be possible for institutions wishing
to distance themselves from abortion to comply with the requirement to
provide information, by supplementing what is required by statute with more
specific information about the nature of the procedure and an explanation of
why they object to participation in it. The requirement to supply
potentially abortifacient drugs will clearly be more problematic. [New
Nine Canadian Supreme Court justices have ruled unanimously against Pam and
Murray Krangle of Maple Ridge, British Columbia. The Krangles wanted their
doctor to continue to cover costs for special care needs for their 10 year
old son, who has Down Syndrome, after the boy reaches the age of majority.
Their doctor had been found liable because he did not encourage eugenic
screening so that the mother could choose to abort her son. The court ruled
that once the child has reached the age of majority, responsibility for care
shifts from the doctor to the state. It did not disturb the original finding
of liability for 'wrongful birth'. [Text
of ruling] [Previous
news item on 'wrongful birth']
The American Civil Liberties Union has launched an attack on the freedom of
religious denominations to provide health care in accordance with their
religious convictions. The ACLU wants to force Roman Catholic hospitals to
provide abortions and contraceptive procedures, and has decided that
threatening to put them out of operation by cutting off funds is the most
effective way to do this. [Detroit
Conscientious objectors among pharmacists may now refer to a report in a
peer reviewed journal, which "describes evidence that the drugs may
sometimes fail to prevent ovulation and rely instead on an
after-fertilization effect, causing abortion of the newly formed embryonic
life." The authors argue that failure to provide this information to a
patient is a violation of the principle of informed consent. See
"Postfertilization Effect of Hormonal Emergency Contraception," by Chris
Kahlenborn, MD, Joseph B. Stanford, MD, MSPH, and Walter L. Larimore, MD,
will appear in the March 2002 issue of The Annals of Pharmacotherapy,
and is now available online at
www.theannals.com. The Annals of Pharmacotherapy is the leading
peer-reviewed, international journal for physicians, pharmacists and other
The Israeli Health Minister has received proposals from a committee of 58
doctors, scientists, social workers, nurses, philosophers, lawyers, judges,
and rabbis on
treatment of the terminally ill. They are reported to have achieved
unanimous agreement on 95% of the proposals, and their work has been
described as "a model for public discussion of divisive issues."
Media reports describe the proposals as rejecting "active
euthanasia", which implies that they accept "passive euthanasia", though
the latter term is not used. On closer examination, what appears to be
proposed is recognition of the right to refuse treatment that would only
postpone natural death, formalized by 'living wills' and procedural
safeguards. These are backed by a legal requirement to provide painkilling
drugs, and the encouragement to develop and practise palliative medicine as
a specialty. Most important, while starving or dehydrating patients in order
to kill them has been legalized elsewhere, the proposals forbid withdrawal
of food and fluids. [Jerusalem
Doctors for Choice has been formed in Ireland for the purpose of making
abortion a normal part of Irish medical practice. It is headed by Drs.
Peadar O'Grady and Mary Favier.
Testimony before an Irish Parliamentary committee in 2000 indicated that
the majority of obstetrician-gynaecologists in Ireland would refuse to
participate in abortion for reasons of conscience.
Following three cases in which French courts ruled that doctors could be
sued because they did not diagnose birth defects during pre-natal eugenic
screening, the French parliament has passed a bill that states: "nobody can
claim to have been harmed simply by being born." The latest court ruling led
to a strike by specialists, who refused to perform eugenic screening while
not protected from liability for a missed diagnosis. The new law will allow
parents to sue for damages only if a missed diagnosis is the result of a
blatant error. It is not clear if refusal to provide eugenic screening for
reasons of conscience will be considered a 'blatant error'. [News
item on 'wrongful birth']
London Times reports that Dutch euthanasia organizations have received
dozens of enquiries from elsewhere in Europe, particularly Britain and
Germany, following the formal legalization of euthanasia in the Netherlands.
At present, one must reside in the Netherlands for some time before being
eligible for euthanasia. As in the case of abortion, the fact that people
have to go abroad to access a procedure not legally available in their own
countries will probably be cited as an argument in favour of legalization.
To the extent that this increases the demand for euthanasia or assisted
suicide, this may eventually have significant implications for conscientious
objectors in countries where euthanasia is not legal.
Given developments in the Netherlands over the last couple of decades, it
is doubtful that the extended residence requirement will be strictly
enforced in the long term. Euthanasia does not require expensive health care
resources, and money will be spent in the country on food, accommodation,
etc. by short-term visitors seeking euthanasia. This may be seen to be a net
benefit that can be applied to the health care system, and may bring
additional pressure to bear on conscientious objectors in the Netherlands.
By decree of the French government, all girls under 18 may not get the
morning-after pill without cost, prescription or parental authorization in
French pharmacies. The report does not indicate whether or not provision of
the pills has been made mandatory for pharmacists.
Voice reports that one of Mayor Michael Bloomberg's campaign documents,
Bloomberg's Blueprint for Public Health, includes a plan to require training
in abortions in city public hospitals run by the Health and Hospitals
Corporation. The plan would affect about 100 OB-GYN residents in the city's
11 public hospitals, but a
New York Civil Rights law prevents conscientious objectors from being
forced to participate. It is not clear, however, that conscientious
objectors will be protected against discriminatory hiring practices.
Dutch doctor Wilfred van Ooijen, convicted of murdering an 87 year old
patient last year, is appealing his conviction. The woman he killed was
terminally ill and in a coma, and had not requested euthanasia. Although it
convicted the doctor, the court did not sentence him, apparently because it
approved of his actions. A group of doctors in the Netherlands has
established a fund to pay the legal costs of Dr. van Ooijen's appeal,
apparently in the belief that killing the patient was consistent with sound
medical ethics. The circumstances suggest that health care workers who
object to euthanasia may find it increasingly difficult to work in the
The 26 year old mother of a healthy two year old girl is suing two doctors
at different clinics in Montreal because they failed to diagnose her
pregnancy, despite five trips to the clinics that included two gynecological
exams. She gave birth in a toilet stall in January, 1999. She claims that
she did not realize she was pregnant because she had always had irregular
menstrual cycles and had gained no weight. Had she been told she was
pregnant, she would have had an abortion. The case is unusual in that the
child does not suffer from any handicaps, and failure to provide eugenic
testing is not in issue. If the allegations are made out, it is possible
that damages could be based on emotional trauma rather than the fact that
the child is alive. It is not clear that the case will have an impact on the
issue of conscientious objection.
A circular from the Bureau of Food and Drugs of the Philippines, and
approved by Health Secretary Manuel Dayrit, M.D., has ordered the recall of
the 'morning-after pill' Levonorgestrel and forbidden its importation to the
country. The Bureau found that the drug, taken within three days after
intercourse, inhibits the implantation of the early embryo (technically the
blastocyst) in the uterus. The country's 1987 Constitution expressly
protects life from the moment of conception.
Abortions in Tasmania were stopped after a fifth-year medical student, Armin
Tadj, reported to police that he had seen doctors falsifying documents so
that women who did not want to give birth could have abortions. Doctors and
nurses, fearing prosecution, stopped performing abortions while Parliament
was recalled to pass a new abortion law, which includes a
protection of conscience provision. What is of particular interest is
the fact that forgery must have been a fairly widespread practice, since it
was stated in parliamentary debate that half the pregnancies in Tasmania
were being ended by abortion before the change in the law. This is an
example of the tremendous force that peer pressure can exert within a
medical community. It is unlikely that such a community will welcome those
who, like Armin Tadj, object to corrupt practices.
The Society of Obstetricians and Gynaecologists and the Ontario Medical
Association (Canada) are recommending that doctors provide advance
prescriptions for the morning-after pill. Dr. Ted Boadway, executive
director of the Ontario Medical Association, is quoted as saying that many
doctors are taking the advice on the grounds that regulators are "ignoring
patient needs". It is possible that advance prescriptions will encourage
women to make advance arrangements for obtaining the drug, thus relieving
some of the pressure being applied to pharmacists who object to dispensing
the 'morning-after-pill' because it is potentially abortifacient.
Dr. Boadway appears to be a consistent advocate of doctors 'going their
own way'. He supported a 1994 motion from the ethics committee of the
Canadian Medical Association that euthanasia no longer be proscribed as
unethical, arguing that euthanasia was already "fairly widespread" and that
doctors practising it would continue to do so. This kind of policy approach
may have a significant impact on health care workers who take a different
The Chinese government formally legalized its one-child population
control policy that is reported to have been in effect for 21 years. City
dwellers will be allowed only one child; two children will be allowed (if
the first one is a girl) in rural areas. Even without formal legal
authority, the one-child policy led to
forced abortions and
related problems for health care workers.
The law to legalize euthanasia by lethal injection took effect on 1 January.
There are reports that the Dutch Health Minister has advocated assisted
suicide for non-terminal patients.