The Energy & Commerce Committee of the American congress will
tentatively hold a hearing on
the Abortion Non-Discrimination Act on July 9th, 2002. The bill's supporters
are seeking witnesses who can provide oral or written testimony about the
need for additional legal protection of conscientious objectors.
Scientists at the University of Minnesota Stem Cell Institute have
established that adult stem cells (multipotent adult progenitor cells-MAPCs)
in mice and rats can be transformed into specialized cells in the body.
Commentators observed that the finding could increase opposition to using
human embryos in stem cell research. The good news for those concerned about
freedom of conscience in health care is that the research should also
diminish pressure to participate in morally objectionable research or
Parents whose son was born without hands or lower arms and with deformed
legs sued their obstetrician for failing to detect the defects during
prenatal eugenic screening. They were seeking compensation for his care, and
damages for depression suffered by the boy's mother, who said that she would
have aborted him had she known about the deformities. The German Federal
Court has now ruled that the doctor must pay the parents 275,800 euros and a
further 10,225 euros to the mother. German doctors are protesting the
ruling. A French court made a similar ruling earlier this year. (See
continues to feel effects of wrongful birth ruling.) Wrongful birth and
wrongful life lawsuits have a particularly adverse impact on health care
workers who do not want to be associated with eugenic practices for reasons
Critics of artificial reproductive technologies greeted reports of the
birth of the millionth baby conceived in vitro with the observation
that millions of embryos have been destroyed in the process. The increasing
use of the technologies brings pressure to bear on those who do not want to
be involved with them. For example, pharmacists may be asked to dispense
drugs used during the process, and physicians may be expected to co-operate
by referring for artificial interventions or participating in surrogacy
In 2000, the South African Minister of Health complained that abortion "is
still not a service that we can confidentially offer to all women." She
claimed that one of the main reasons was "the prevailing attitude among some
health professionals." In 2002 she again complained that women seeking
abortions were hampered by the fact that few health workers were willing to
participate. Now, a television documentary, videotaped using concealed
cameras at a large rural hospital near Groblersdal in Mpumalanga, appears to
be generating further criticism of conscientious objectors.
In fact, the government of the day was warned repeatedly that its
proposed Termination of Pregnancy Act would prove unworkable in practice
because of the large numbers of health care workers opposed to abortion and
lack of resources available to implement it. The advice was ignored, and it
now seems that the warnings were well-founded. See the
letters from Dr. Harvey Ward of Cape Town, and the text of a
survey he conducted in the Western Cape in 1997. Other relevant
background information is found in the article
No Place for Abortion in African Traditional Life - Some Reflections .
Widespread problems for conscientious objectors have been avoided by a
decision to make the potentially abortifacient 'morning after pill' an
optional rather than mandatory product carried in American military
pharmacies. It will be important to ensure that objectors are accommodated
in pharmacies that elect to carry the drug.
A North of England woman is suing Britain's National Health Service (NHS)
for failing to warn her about the possibility of post-abortion stress that
resulted in a serious breakdown three years later when she gave birth to a
child. If the case is successful, it may have the secondary effect of
alleviating pressure on health care workers who do not want to participate
in abortions.[BBC News online, 12 June]
Justice Timothy Studdert of the Supreme Court of New South Wales has ruled
that 'wrongful life' is a concept that has no basis in Australian law. He
rejected claims by three disabled children, who were suing their physicians.
His ruling was based on the assertion that such claims were contrary to
public policy. To accept them would erode respect for human life and for the
handicapped in society. Alternatively, he ruled, it was impossible to
compare existence with non-existence. Finally, to recognize wrongful life
claims would likely have other adverse social impacts, such as encouraging
the handicapped to sue their mothers for having continued with their
Age] Like 'wrongful birth' suits, 'wrongful life' claims are a legal
method used to force objecting health care workers to participate in eugenic
So many Thai women are using the 'morning after pill' at the rate of
more than 10 pills a month (more than twice the maximum recommended dosage)
that it is being suggested that the pill be called the 'emergency pill'
instead. The idea is to more clearly convey the importance of not using the
drug routinely. [Bankok
Post] However, the use of the word 'emergency' in this context is
problematic from the perspective of conscientious objectors. 'Emergency
contraception' is the preferred marketing term used in North America, and it
is used to try to force objectors to prescribe or dispense the drug on the
grounds that the possibility of a pregnancy is a medical 'emergency'.
Wayne Berry, the Labor Party speaker of the Australian Capital Territory
(ACT) legislative assembly, has proposed a bill to make abortion legal at
all times during pregnancy, for any reason. If the bill becomes law it will
likely have a significant impact on health care workers who do not want to
be involved with abortion.
The Religious Coalition for Reproductive Choice was founded in 1973. It
includes representatives from the Episcopal Church, Presbyterian Church
(U.S.A.), United Church of Christ, United Methodist Church, Unitarian
Universalist Association, Reform and Conservative Judaism, and other faith
traditions. A conference planned for June in Washington, D.C., will
introduce Muslim and Buddhist theological perspectives. Daniel Maguire,
identified as a 'Catholic theologian', will be the keynote speaker. The
group illustrates the tensions that can exist between conscientious
objectors and opponents, who may be members of the same religious
Andrea and Thomas Klercke of Maryland chose to abort their child because of
a diagnosis of anencephaly, a rare condition in which the brain fails to
develop. They are demanding that their health insurance company pay for the
abortion. The company refused to pay because it ruled that the abortion was
elective rather than therapeutic. [Frederick News-Post]
H.R. 4691 has been referred to the House Committee on Energy and Commerce.
Markup is expected soon. It is important that all members of this House
committee be contacted immediately. This
bill reaffirms a basic principle: no health care provider should be forced
to perform or participate in abortions. See
Kathleen Klamut considered the Ohio Education Association to promote
abortion through its political positions. In 1999, while working in
Louisville, she negotiated an agreement through the Equal Opportunity
Commission to send her union dues to a charity. The president of the union
local at Ravenna City Schools refuses to accept the agreement. Klamut has
filed another complaint with the Equal Opportunity Commission. Fortunately,
a lawyer for the Ohio Education Association believes that she will be
accommodated, as the union routinely accedes to requests from conscientious
objectors to divert fees.[Cleveland Plain Dealer]
In May, 2002, Leger Marketing conducted a telephone survey of Canadians
concerning Catholic doctrine about abortion and contraception, among other
things. 72% of Canadians and 74% of Catholics polled agreed with the
statement that the doctrines were "dated and out of sync with the times."
The poll appears to indicate the probability of conflict between Catholic
health care workers who adhere to Church doctrine and others who do not.
However, the validity of this conclusion depends upon the exact wording of
the question(s) used in the survey.
40% of the electorate voted to make abortion more readily available. 72% of
those casting ballots supported the measure. The referendum had been forced
by an anti-abortion coalition seeking to tighten the existing law, which was
rarely enforced. Abortions were, in fact, performed regularly, though not in
all parts of the country. Government statistics suggest 12,000 to 13,000
abortions were performed each year. The new law permits abortion prior to 12
weeks gestation if a physician believes that the mother will face "distress"
if a child is born. Abortions after 12 weeks will be permitted if the
physician believes that the mother will face "profound distress" or a threat
to her "physical integrity." [Associated Press, Reuters] Since abortions
were already being performed, it is unclear how much impact the new law will
have on conscientious objectors. Elsewhere, the fact that abortion has been
legalized is frequently used as a reason for suppressing freedom of
conscience among health care workers.
A trend to fewer infant deaths in Canada has been attributed to a 578
percent increase in the number of abortions performed on women 20 to 21
weeks pregnant, probably as a result of eugenic screening for birth defects.
Late term abortions, sometimes called 'genetic terminations', can be
particularly traumatic for health care workers who may be pressured to
) ( See
Foothills Hospital Now Forces Nurses To Participate In Genetic Terminations)
A Wisconsin appeals has dismissed a suit by parents of a boy who was born at
less than 24 weeks gestation. They had claimed that they were not informed
about the possibility that he would be disabled, and were thus denied the
opportunity to withdraw or withhold treatment. The court ruled that parents
have a right to withhold treatment only in in the case of an infant in a
"persistent vegetative state". (The Washington Times)
New York City Mayor Michael Bloomberg's (R) plan to force all OB/GYN
residents at public hospitals to undergo abortion
training is limited by New York state's protection of conscience
legislation, which prohibits discrimination against health care workers
who refuse to participate in abortion. The number of OB/GYN residents who
now refuse to participate is estimated at 15%. However, the law does not
protect applicants for employment, for medical school or for hospital
privileges or positions. While objectors who currently hold positions are
protected by the 'opt out' provision in the law, those who object to
abortion may find themselves excluded from practice by discriminatory hiring
story) (Washington Times)
Dr. Philip Nitschke, an Australian physician who wants euthanasia legalized,
is reported to be preparing to assist in the suicide of a terminally ill
Melbourne woman. She is one of several people the doctor intends to 'assist'
in coming weeks. A previous patient, who was said to have been diagnosed
with terminal cancer, killed herself with an overdose of barbiturates in the
presence of 21 family members. An autopsy later disclosed that she had an
inoperable twisted bowel, not cancer. Dr. Nitschke subsequently admitted
that he had been present when the deceased had been told that she did not
have cancer. Dr. Nitschke's activism, covered by the media, keeps up
pressure for legalization of euthanasia, something that would have a serious
impact on health care workers who have moral objections to it. (Herald Sun)(The
A U.S. District Court jury found that Riverside County violated the
constitutional rights of former nurse Michelle Diaz by firing her after she
refused to dispense the morning after pill. The jury found that the
Riverside Neighborhood Health Center violated her First Amendment rights of
free speech, her rights of freedom of religion, and failed to reasonably
accommodate her religious beliefs. It awarded damages totaling more than
$47,000 - including $19,000 in damages for back pay, and more than $28,000
in damages for emotional distress. Diaz was fired in June, 1999. (News
Bill S185, that would force insurers to provide contraceptive coverage, has
been stalled in New Jersey. Freedom of conscience advocates are seeking
further support to see that it does not proceed.
A study published in the current issue of the
England Journal of Medicine suggests that an unacceptably high
percentage of Dutch patients with amyotrophic lateral sclerosis (ALS - Lou
Gehrig's Disease) died by euthanasia or assisted suicide.
Amendments to the 1964 Civil Rights Act have been proposed in bill
S2572 in the United States Senate. The amendments include a definition
of the term 'undue hardship' (used with reference to an employer's duty to
accommodate religious belief to the point of 'undue hardship'). The proposed
definition will prevent courts from limiting religious freedom by minimizing
what constitutes 'undue hardship'.
that the European Parliament will vote in June on a document that would
make legalization of abortion a requirement for membership in the European
union. Abortion is illegal in almost all cases in Ireland, a full member of
the EU, and in Poland and Malta, which are seeking membership.
A poll conducted in Denmark indicates that euthanasia is supported by 68% of
the Danish electorate. The results, published in the Jyllands-Posten
newspaper, show only twenty percent of the 999 people surveyed were opposed
to euthanasia. 93% favoured it to relieve the suffering of terminally ill
patients, while 82% approved of it in the case of incurable illness. Shock
expressed by Denmark's Health Minister Lars Loekke Rasmussen indicates that
those surveyed also indicated support for ending the lives of the aged,
mentally ill and handicapped. Danish Medical Association president Jesper
Poulsen described euthanasia as "incompatible with the role of
practitioners" (Agence France-Presse; May 21, 2002). The comments from Dr.
Poulsen offer hope that the position of health care workers who are morally
opposed to euthanasia will not be neglected in subsequent discussion.
A 28 year old woman from China's northern Henan Province has received an
ovary from an aborted fetus in a transplant operation at the No.2 Hospital
of Zhengzhou University. The transplant was performed to treat premature
senility of her ovaries, which had led to insomnia, mood swings and
coarsened skin. (Xinhua
News Agency) Increasing resort to this type of procedure may adversely
impact health care workers who object to the use of tissue or organs
obtained from abortion.
Within three months, a law permitting euthanasia will be in force in
Belgium. The law will allow doctors to kill terminally ill, conscious
patients who are suffering "constant and unbearable physical or
psychological pain" from an accident or incurable illness and have freely
asked to be killed. Doctors must ensure that patients are aware that
treatment for pain is available. The new law will likely bring pressure to
bear on health care workers who have moral objections to euthanasia. (Agence
France Presse English, 16 May, 2002) Marc Moens, vice-chairman of the
Belgian medical chamber (ABSYM) told
Reuters Health that Belgian doctors oppose the new Belgian euthanasia
law because it allows the killing of patients who are not terminally ill. A
survey conducted in 2001 by the Artsen medical journal found that 75% of
doctors opposed the law, and 80% stated that they would be unwilling to
carry out patients' requests for euthanasia. Meanwhile, Zenit reports that
the new Netherlands government favours a revision of euthanasia law. The
Christian Democrats, who opposed legalization of euthanasia, won a majority
in the Dutch general election. [Zenit, 17 May, 2002]
High insurance rates for malpractice are forcing doctors to abandon
obstetrics or limit their practices. The rates have been rising because of
the increasing frequency of suits and increasing amounts of awards. About
30% of the suits are brought for the birth of a "neurologically impaired
infant", something that can affect physicians who have moral objections to
using eugenic screening to identify targets for abortion. The soaring rates
and probability of being sued have led most Las Vegas obstetricians to
refuse to accept newly pregnant women as patients. It is reported that most
Mississippi cities with less than a population of 20,000 no longer have
doctors who deliver babies, apparently because the state is notorious for
high damage awards and a law that allows suits to be filed in jurisdictions
with reputations for high damage awards, regardless where in the state the
case originates. Florida, Nevada, New Jersey, New York, Pennsylvania, Texas,
Washington, and West Virginia have also been identified as states in which
obstetricians are limiting or abandoning their practices.(Fox
A new bill to provide necessary protection for freedom of conscience with
respect to abortion has been introduced in the US House of Representatives.
Freedom of conscience advocates in New Jersey encourage citizens in the
state to contact their elected representatives about bill A1693, which may
be amended to force religious believers to provide prescription medications
that they find morally objectionable.
Parents with a Down Syndrome child are arguing that the Utah Supreme Court
should throw out a 1983 state law that bans 'wrongful birth' lawsuits. Their
lawyer asserts that they were deprived of the opportunity to consider
abortion because the pre-natal tests failed to disclose the genetic markers
for the condition. He suggests that failure to provide information for the
purpose of eugenic screening is "medical malpractice". The hospital responds
that it provided all of the information in its possession and points out
that the tests are not perfect.
A parliamentary hearing organized by the Reproductive Rights Alliance, a
pro-abortion lobby group, took place on 7 and 8 May in South Africa.
Pro-life groups were not invited to participate, and a silent protest was
held at the end of the second day to protest the managed exclusion of their
viewpoint. Protestors held posters of a newborn baby and a fetus with the
captions: "They can't speak. neither can we" and "They can't speak. Now we
are not allowed to speak for them". The Chairman of the Health Committee
accused them of breaking the rules of parliament and called police to eject
tore-up one of the placards and manhandled an elderly pro-lifer.
Only 38% (88 of 290) abortion sites in South Africa are operating, and
the hearings heard that this is due to lack of resources and doctors and
health care workers who refuse to participate in abortion for reasons of
conscience. At one point it was suggested that conscientious objection be
criminalized. No objectors were present to defend their position, nor were
submissions invited from them. (
Action South Africa)
The problems discussed in the hearing were predicted by a South African
doctor before the passage of the Termination of Pregnancy Act. Writing to
the Constitutional Assembly and National Assembly in 1996, Dr. Harvey Ward
of Cape Town (now Lac La Biche, Alberta, Canada), warned that failure to
consider both resources and the willingness of doctors to participate in
abortion might see "our facilities overwhelmed, our personnel dispirited and
divided, and our existing services in disarray." (Letters)
In 1997, Dr. Ward conducted a survey of Western Cape physicians, the results
of which supported his earlier warnings to the government.
The Hawaiian Senate pulled a bill legalizing physician assisted suicide out
of committee to force a vote on it, but the bill was defeated 14-3 when
three senators switched sides. [Catholic News Service, 6 May]
In a unanimous judgement, seven judges of the European Court have ruled that
Diane Pretty, a terminally ill British woman, cannot claim a "right to die"
under the European Convention on Human Rights. (Previous
Richard Lynn, emeritus professor of psychology at the University of Ulster,
asserts that eugenics is being practised in the form of pre-implantation
genetic diagnosis, and that there is nothing wrong with the notion that the
"genetic quality of the population" can be improved by eugenic practices.
Prenatal eugenic screening already presents problems for conscientious
Arizona Governor Jane Hull has signed a bill to force insurance companies
offering prescription drugs to supply female birth control. The only
exemptions allowed are for religious institutions whose employees and
clients share the same beliefs. The exemptions do not protect denominational
health care organizations, such as hospitals run by the Catholic Church that
serve the general public. Hull's attitude was exemplified by an
anti-Catholic jibe. Referring to the current scandal about clerical sexual
misconduct, she asserted that the Catholic Church should clean its own house
rather than concerning itself with "the subjugation of women."
The California state assembly has passed a bill that would require
hospitals to provide the potentially abortifacient 'morning-after pill' to
sexual assault complainants. Washington, New York and Illinois have enacted
A three judge panel of the Supreme Court of Canada has refused leave to
appeal from James Wakeford, who was requesting legal assisted suicide.
House Bill 2487, which would legalize assisted suicide for terminally ill,
competent adults, has been stopped in a Hawaiian senate committee after
having passed the lower House.
A Christian physician in Barrie, Ontario, who faces a disciplinary hearing
for refusing to prescribe contraceptives to unmarried patients has stopped
taking new patients and has scaled back his practice. Dr. Stephen Dawson was
to have faced a tribunal in April, but an additional complaint has forced
postponement of the hearing until September. Originally scheduled for 4
days, it is now believed that the hearing will take 10 days. (See
Father Frank Pavone, co-founder of Priests for Life, has suggested that
"non-medical service personnel who may be called upon to help an abortion
facility" such as plumbers or electricians, are entitled to refuse to
provide services for reasons of conscience. While this is certainly true,
Fr. Pavone clearly makes the suggestion as a tactic that is intended to make
it more difficult to operate abortion facilities. This approach may cause
difficulties for health care workers seeking protection, because it lends
credence to the claims that 'conscience clauses' are nothing more than a
clever attempt to limit access to abortion.
In what has been incorrectly called a 'wrongful birth' suit, a woman
suffering from lupus is suing her doctor for failing to diagnose her
pregnancy in time for her to have an abortion. She appears to have argued
that she would have had an abortion had the pregnancy been diagnosed
earlier. She was in the second trimester of pregnancy when she stopped
taking some of her medication for lupus, as a result of which, it is
alleged, she suffered eventual kidney failure and required a kidney
transplant. The appeals court explicitly ruled out the possibility of suing
for costs associated with the raising of the child, which is the usual
characteristic of a 'wrongful birth' suit.
Concerns have been raised over consultation by the British government with
the Voluntary Euthanasia Society in developing guidelines for withdrawing of
assisted nutrition and hydration from adults who are not dying. Withdrawal
of nutrition and hydration has been widely adopted under the rubric of
'refusal of treatment', and is considered by many conscientious objectors to
be a form of euthanasia.
Doctors are suggesting that governments should pay living donors who offer
kidneys for transplantation. The kidneys would become part of a pool that
could be screened and offered to recipients. The proposed scheme would
continue to prohibit the purchase of organs by individuals. It is being
suggested as a way of dealing with black market trade in human organs.
The New York state Senate and Assembly each passed similar 'women's health
bills' earlier in 2002. The Assembly bill would have forced all employers to
provide contraceptive coverage in health plans, while the Senate bill
included an exemption for religious institutions that object to
contraception. The two chambers have now agreed to a bill that incorporates
the Senate's exemption clause, which does not apply to church-run
institutions like schools or hospitals.
Despite new legislation providing some protection against civil suits for
doctors who fail to diagnose birth defects, soaring malpractice insurance
rates and the filing of 'copycat' lawsuits are causing French doctors to
consider giving up the practice of prenatal eugenic screening. Low fees for
service are contributing to the pressure. (USA
New York public hospitals are continuing plans to train all obstetrics and
gynecology residents in abortion. Conscientious objectors will not be
required to participate, but it is not clear that they will be protected
against discrimination in other respects. New York's 11 public hospitals
provide 6,500 of the 100,000 abortions performed annually in the city.
The parents of a severely disabled 11 year old girl are suing Women's
Hospital in Houston, Texas. The child was 4 months premature at birth. The
parents had insisted that no heroic measures be undertaken, but the
attending physicians concluded that they were legally obliged to intervene.
An ultrasound indicated a birth weight of about 1.4 pounds, and hospital
policy required lifesaving efforts for any infant over 1.1 pounds. Aside
from this critical point, there is a dispute about whether or not the
treatment caused the continuing disabilities. A $60 million dollar award to
the parents was overturned on a first appeal. The case does not directly
impact freedom of conscience in health care, but does illustrate the kind of
complicated situations within which that freedom must be exercised.
Cell Factors, a company in the United Kingdom, is reported to have used
fetal brain cells obtained from abortions to develop a self-replicating line
of brain cells. These are to be sold for pharmaceutical and neuroscience
research, making it more likely that employees of research facilities may be
faced with conflicts of conscience.
California Gov. Gray Davis has ordered all HMOs to provide coverage for the
potentially abortifacient 'morning-after pill'. He is quoted by Reuters as
having said, "A women's right to choose must never be held up by red tape."
The law permitting euthanasia has come into force in Holland. Patients who
are said to be facing unbearable and interminable suffering are permitted to
request euthanasia. Doctors who adhere to the prescribed procedural
safeguards will not be prosecuted for killing them. Pressure for broadening
of the law is already being exerted, with the Netherlands Voluntary
Euthanasia Society suggesting that the elderly should be prescribed a
suicide pill that they can take when they feel the time is right.
Legalization of euthanasia presents a significant problem for medical
professionals who object to euthanasia for reasons of conscience.
Washington Post 11 page cover story describes the efforts of a deaf
lesbian couple who sought a sperm donor with a history of deafness in his
family to increase the chances that a child conceived would be born deaf.
Their efforts have resulted in a deaf five year old daughter and an infant
son who has extremely limited hearing. The story is a reminder to
professionals working in the field of reproductive technology that they
should not dismiss the possibility that they will one day be faced with a
demand that conflicts with their conscientious convictions.