October-December, 2009
December
The Supreme Court of Montana has ruled that there is no constitutional
right to assisted suicide in the state, reversing a decision by a lower
court. [See
The Case of the Disappearing Plaintiffs: Robert Baxter et al vs.
State of Montana (Montana, USA, 2008-2009).] This will prevent
physicians and other health care workers from being compelled to facilitate
suicide based on human rights claims. However, the court also ruled that
assisted suicide was not illegal in Montana, nor against public policy. As a
result, health care workers may come under pressure to become involved. [First
Things]
The US Senate has passed the Patient Protection and Affordable Health
Care Act. The final law will have to reconcile the bill with other
health care reform bills in Congress.
A media blog from the US Conference of Catholic Bishops insists that
health care reform must include protection of freedom of conscience for
institutions and individuals. "Forcing someone to violate his or her
conscience is an act of violence no civilized society should tolerate,"
Sister Mary Ann Walsh notes, adding that resistance to writing such
protections into law "makes one pause." She asks, "Do government leaders
fear we'll be overrun by citizens with consciences?" Sr. Walsh concludes
that protection of conscience measures must "be written into the health care
reform bill." [USCCB
Media Blog] Other statements from the Conference indicate that the
bishops find protection of conscience provisions unsatisfactory [PR
Newswire].
Senator Harry Reid has introduced an amendment to the Patient Protection
and Affordable Health Care Act, the health care reform bill now before the
US Senate. The
provision concerning protection of conscience for health care providers
has not been changed. It is limited to abortion. Another part of the bill
prohibits discrimination against those who refuse to participate in assisted
suicide or euthanasia, but the
provision excludes protection of health care providers who object to
euthanasia by starvation and dehydration.
Israel has passed a law that will require that priority for organ
donation be given to those who have themselves agreed to be organ donors. [The
Independent] Wales is considering a law that would presume consent for
organ donation in the absence of explicit instructions to the contrary or
objections of the immediate family. [BBC]
Both moves are intended to increase the rate of organ donation. The former
has generated criticism because it is said that the law indicates that some
people are more deserving of organs than others. Concern in the latter case
is associated with fear that people will be denied treatment in order to
harvest their organs, or that the organs will be harvested before the
patients are dead. The latter seems more likely to generate conflicts of
conscience among health care workers than the former.
Dr. David Stevens, Chief Executive Officer of the Christian Medical
Association in the United States, has resigned from the American Medical
Association. Dr. Stevens protested meetings held behind closed doors by
Washington legislators and AMA representatives, asserting that the AMA
brokered a deal with politicians to secure higher Medicare payments in
exchange for support for health care reform. He also stated that the AMA has
worked to overturn a federal protection of conscience regulation, in
violation of its own ethical position on freedom of conscience within the
profession. [Catholic
Online]
U.S Senator Sam Brownback introduced an amendment to a health care reform
bill before the US Senate to provide strong conscience protection for
individuals and institutional health care providers including: health plans,
health insurance issuers, purchasers and plan sponsors. [Amendment]
[News
Release]
President Barack Obama has appointed Dr. Amy Gutman the Chair of the
Presidential Commission for the Study of Bioethical Issues, and Dr. James W.
Wagner as Vice-Chair. Gutman is president of the University of Pennsylvania
and Wagner is president of Emory University. [Almanac]
Diane France, editor-at-large of Canada's National Post, has proposed
that all countries adopt a mandatory one-child policy, like that of China,
on the grounds that overpopulation will eventually cause worldwide
disaster.[Financial
Post] Implementation of the proposal would require draconian laws and
would certainly involve widespread suppression of freedom of conscience and
religion.
Senator Tom Coburn has filed a protection of conscience
amendment to a
US health reform bill now before the Senate.
Over 200,000 people are reported to have signed the Manhattan
Declaration, published on 20 November by prominent Christian leaders. The
declaration affirms an intention to resist demands subordinate conscientious
convictions to demands of social policy or law. [CBN
News]
Lord Justice Girvan of Belfast's High Court has ruled that guidelines on
abortion issued by Northern Ireland Department of Health, Social Services
and Public Safety must be re-written. Girvan accepted arguments that health
care workers could not be expected to offer non-directive counselling to
women about abortion, which is normally a criminal offence in Northern
Ireland. He also agreed that the guidelines were wrong in their expectation
of referral or facilitation by objecting physicians.[SPUC
news release][Irish
Times]
President Barack Obama today signed an executive order creating a new
presidential bioethics commission. The commission will have 13 members
appointed by the President. At least one and as many as three of them may be
members of the executive branch of government.[Executive
Order] The new commission replaces the body created under the previous
administration and abolished earlier this year. [See
President Obama dismisses council on bioethics]
The US Conference of Catholic Bishops has advised the US Senate that its
health care reform bill [HR3590(A.S.)]
does not meet "moral criteria" necessary to secure their support, further
specifying that the moral criteria do not refer to "marginal issues or
special interest concerns." With particular reference to freedom of
conscience, they state that the bill "seriously weakens" existing
protections for objectors while offering unbalanced protection favouring
abortion facilities and promoters, while neglecting "critically important"
problems.
To take just one example, the bill fails to ensure that even religious
institutions would retain the freedom to offer their own employees
health insurance coverage that conforms to the institution's teaching.
On these various issues the new Senate bill is an enormous
disappointment, creating new and completely unacceptable federal policy
that endangers human life and rights of conscience.
[USCCB
letter][HR3590(A.S.)
Protection of conscience provisions]
The Center for Reproductive Rights (CRR), a US based activist group that
has been active outside the United States in trying to suppress freedom of
conscience in health care [see
Colombian court
attacks freedom of conscience], has issued a
fact sheet supporting the Senate health care reform bill [HR3590(A.S.)].
The CRR claims that the Senate bill "provides more comprehensive protection
for conscience rights" than
HR3962, the Affordable Health Care for America Act, which passed the US
House of Representatives and is to be considered by the Senate.
A resolution
that is to be brought before the Council of Europe seeks affirmation that
abortion and other controversial medical procedures are "human rights," and
proposes to restrict freedom of conscience of medical professionals. [ECLJ
News Release]
Christian religious leaders in the United States have issued the
Manhattan Declaration, putting government at all levels on notice that
they intend to resist attacks on freedom of religion and freedom of
conscience, by civil disobedience, if need be. The declaration affirms that
they will refuse to comply with "any edict that purports to compel our
institutions to participate in abortions, embryo-destructive research,
assisted suicide and euthanasia, or any other anti-life act," and that they
will not "bend to any rule" that would force them to deny their own moral
views. The document is signed by over 150 Christian religious leaders from
different denominations, though not all from the United States. [NY
Times] [Manhattan
Declaration Website]
A
euthanasia bill has been defeated in the Parliament of South Australia.
[ABC
news] The bill included some
protection of conscience provisions.
The American Constitution requires all revenue bills to begin in the
House of Representatives. The US Senate has taken HR3590, a bill unrelated
to health care that began in the House, and plans to use its power of
amendment to replace the entire text of the original bill with the
text of a health care reform bill over 2,000 pages long. The bill
includes
protection of conscience provisions, limited to abortion. It states that
qualified health plans may not be required to provide coverage for abortion,
and that neither individual health care providers or institutions may be
discriminated against for refusing "to provide, pay for, provide coverage
of, or refer for abortions." The bill also states that it is not to be
construed to affect federal protection of conscience or anti-discrimination
laws.
A committee of the New Hampshire state legislature has voted down a bill
that would have legalized assisted suicide. [Seacoast
Online]
Francis Cardinal George, President of the US Conference of Catholic
Bishops, has issued a
statement offering support for the Affordable Health Care for America
Act that has just passed the US House of Representatives. He states that the
continued support of the bishops is conditional upon the provision that
prohibits funding of abortion, and said, "We will continue to insist that
health care reform legislation must protect conscience rights."
The US House of Representatives has passed
HR3962, the Affordable Health Care for America Act, after it was amended
to prohibit federal funding of abortion.[Stupak
Amendment] The bill includes
protection of conscience provisions, but only with respect to abortion.
News reports focus almost exclusively on the controversy over the abortion
funding provision.
Prof. Margaret Somerville of McGill University, in an article that argues
against euthanasia, notes that legalization of the procedure would likely
make it necessary to train medical students how to administer lethal
injections. She also noted that it is important to consider the significant
difference in attitudes toward euthanasia within the medical profession and
in the public at large. [Ottawa
Citizen] The failure to take such differences into account when
legalizing abortion has caused conflict in some countries. [South
African Survey]
Dr. David Stevens, CEO of the Christian Medical Association, states that
the health care reform bills now before the US congress fail to protect
freedom of conscience for health care workers, and, if passed in their
current form, may drive many religious believers out of health care. [OneNewsNow]
Citing provision of abortion and lack of protection for freedom of
conscience among health care workers, three Catholic bishops writing on
behalf of the US Conference of Catholic Bishops have told American
Congressmen that the bills now before them are unacceptable. [Zenit]
A
bill that would have legalized assisted suicide and euthanasia has been
defeated in the Tasmanian Parliament, but the bill's sponsor has promised to
bring it back again and again until it passes. [ABC
News] The bill included some
protection of conscience provisions.
An elderly husband and wife have committed suicide in Newbury, Berkshire,
England. They were not in poor health but decided to kill themselves before
their health deteriorated. They wrote a letter to the BBC to complain that
the law against assisted suicide denied them "a basic human right."
The Quebec College of Physicians, the regulatory authority for the
province, has published a position paper callling for the legalization of
euthanasia in cases of "imminent and inevitable death." A College official
stated that "death can be an appropriate type of care in certain
circumstances." [National
Post] With respect to conscientious objection by physicians, the
document is ambiguous. On the one hand it states that doctors must be
assured that 'they will not be obliged to practise euthanasia." On the other
hand, it quotes that part of the College's Code of Ethics that imposes a
duty to ensure that a patient dies with dignity and with "appropriate
support and relief." This could easily be interpreted to require
participation in euthanasia or assisted suicide in some way, should the
procedures be legalized. Moreover, the College foresees only conditional
freedom to refuse, without clarifying the nature of the conditions.[College
Statement]
The Colombian Constitutional Court has rejected as suspension of its
ruling that all hospitals must provide abortion and insists that its ruling
be obeyed.[Columbia
Reports]
Acting at the direction of the First Section of the Colombian High Court,
the State Council of Columbia has suspended a ruling by the Columbian
Constitutional Court that would have forced all hospitals, secular and
religious, to provide abortions.[Colombia
Reports]
The Colombian Constitutional Court has ruled that medical professionals
may refuse to provide abortions for reasons of conscience, but only if they
provide written reasons for their refusal and refer the patient for the
procedure. Moreover, the ruling prohibits health care institutions from
refusing abortion and demands that all health care institutions
-denominational or secular - ensure that medical staff are available to
provide abortions. Individuals or institutions that fail to comply with the
ruling are to be punished. The Center for Reproductive Rights is celebrating
the ruling as a "tremendous victory." [CRR
news release]
A judge of the Ontario Superior Court of Justice has ruled that
physicians have a duty of care to infants in utero. The ruling was
made in a case brought against the Guelph Hospital and physicians, alleging
that negligence in monitoring led to handicaps caused by oxygen deprivation.
The ruling has significant implications for physicians who refuse to provide
services or procedures on the grounds that they may harm the unborn child.[Legate
news release]
An article published in the New England Journal of Medicine claims that
advanced dementia is "a leading cause of death in the United States." Since
it was acknowledged that actual causes of death were infections like
pneumonia or eating problems, it appears that the goal of the paper is to
justify, if not encourage, the withdrawal of food and fluids from patients
suffering from advanced dementia but who are not dying.[NEJM,
Reuters] This would likely lead to conflicts of conscience for health
care workers opposed to euthanasia by dehydrations and starvation.
A man wrongly diagnosed with cancer was denied food and fluids for two
weeks and died of pneumonia at Marie Curie hospice in Liverpool. The hospice
has refused to admit liability but has paid £18,000
compensation to his widow, who accepted the settlement only because she
would otherwise have lost her legal aid. The treating physician was Dr.
Alison Coackley, a palliative care specialist who apparently espouses
"futile care theory." [Mail]
The case illustrates the potential for conflicts of conscience among health
care workers where such theories are applied.
A nurse who was struck from the register after exposing severe neglect of
patients at the Royal Sussex Hospital in Brighton, England, has been
reinstated. She was disciplined for breaching patient confidentiality as a
result of a complaint from the National Health Services Trust, the
organization responsible for what one critic called "the subhuman
conditions" in which patients were kept. The High Court ordered her
reinstatement, substituting a one year caution for the original penalty. The
case illustrates the kind of adverse circumstances that may complicate
conscientious objection in health care.[The
Independent]
A pharmacist in Griffith, New South Wales, has stopped selling
contraceptives, including condoms, in accordance with his religious
convictions. Trevor Dal Broi is a Catholic. The government has acknowledged
that pharmacists are not obliged to sell contraceptives. The Pharmacists
Guild has pointed out that the town of 16,000 has other pharmacies, and that
condoms can be purchased anywhere. Another unidentified Catholic pharmacist
in the town who does provide contraceptives did not directly comment on the
matter, but implied that the Catholic Church would be wrong to oppose the
sale of contraceptives. The report notes "outrage" expressed by others in
the community.[Sydney
Morning Herald][Over
the counter conscience vote]
An 80 year old East Sussex woman with pneumonia survived her stay at the
Conquest Hospital in Hastings, East Sussex, as a result of determined
intervention by her daughter. Physicians acting under the "Liverppool Care
Pathway" and the Mental Capacity Act denied the woman food and fluids and
stopped antibiotic treatment. Her daughter reported that she had to "fight
hospital staff for weeks" to prevent her mother from being starved and
dehydrated to death. [Telegraph]
It is not difficult to imagine such cases generating conflicts of conscience
among health care workers.
The US Conference of Catholic Bishops has warned US Senators that the
Conference will oppose a major health care reform bill proposed by Senator
Baucus unless it is amended. Among the unacceptable features of the current
bill the bishops identified a failure to ensure protection of conscience
measures for health care workers.[USCCB
letter]
A young woman with a history of mental illness and self-injury and who is
reported to have been depressed was allowed to die by physicians after she
took poison to kill herself. They did not treat her because she gave them a
letter signed in the presence of a lawyer stating that she did not want to
be treated. Critics are blaming the Mental Capacity Act for for her death. [Telegraph]
However, previous to the passage of the Act, the common law had forbidden
physicians to treat patients without their consent unless the patient was
deemed incompetent. A more accurate reading of the circumstances indicates
that the physicians judged that her desire to kill herself was a rational
response to her depressive condition rather than evidence of incompetence
arising from it.
A woman who identifies herself as lesbian who was refused artificial
insemination by Christian doctors at North Coast Women's Care Medical Group
in Oceanside, California, has accepted an out-of-court settlement for an
undisclosed amount of money. The case began eight years ago. [Christian
Post] Many physicians are concerned that cases like this will lead to
suppression of freedom of conscience in health care and drive religious
believers out of the profession of medicine. [OneNewsNow]