Good News and Bad News

Presentation to the Catholic Physicians’ Guild of Vancouver

North Vancouver B.C.

Sean Murphy *

Introduction

Thank you for inviting me to speak this evening. I have never been asked to give a three hour presentation to a group of physicians. You will be relieved to know that I have not been asked to do that tonight.

Those of you who saw the BC Catholic headline may have been expecting a “lecture on medical ethics,” but, thanks to Dr. Bright’s introduction, you now know that I am an administrator, not an ethicist, and that my topic is freedom of conscience in health care.

Protection of Conscience Project

The Protection of Conscience Project will be 15 years old this December. Although a meeting sponsored by the Catholic Physicians Guild provided the impetus for its formation, the Project is a non-denominational initiative, not a Catholic enterprise. Thus, if I mention the Catholic Church or Catholic teaching tonight, it will be as an outsider, as it were, though an outsider with inside information.

One more thing: the Project does not take a position on the acceptability of morally contested procedures like abortion, contraception or euthanasia: not even on torture. The focus is exclusively on freedom of conscience.

Context

Supreme Court of Canada, OttawaThe context for my presentation is provided by the passage of the Quebec euthanasia law1 and the pending decision in Carter v. Canada in the Supreme Court.2 Physicians are now confronted by the prospect that laws against euthanasia and physician assisted suicide will be struck down or changed. If that happens, what does the future hold for Catholic physicians and others who share your beliefs?

Will you be forced to participate in suicide or euthanasia?

If you refuse, will you be disadvantaged, discriminated against, disciplined, sued or fired?

Will you be forced out of your specialty or profession, or forced to emigrate if you wish to continue in it?

What about those who come after you? If you avoid all of these difficulties, will they?

In sum, will freedom of conscience and religion for health care workers be protected if assisted suicide and euthanasia are legalized? [Full Text]

Proposed Australian euthanasia bill may return in 2015

Medical Services (Dying with Dignity) Exposure Draft Bill 2014

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.

Supreme Court of the United Kingdom to hear midwives’s case on 11 November

The Greater Glasgow Health Board has appealed to the Supreme Court of the United Kingdom to overturn a ruling that two midwives cannot be compelled to participate in abortions by delegating, supervising and supporting those involved in the procedures.  The case is to be heard 11 November, 2014.

The midwives’ legal costs have been in excess of £250,000 ($396,758 USD) to date.  The appeal is expected to cost them a further £130,000 ($206,314 USD). The Society for the Protection of Unborn Children is assisting with their legal costs and has appealed for donations.

uk-supreme-court-logoSupreme Court of the United Kingdom

Greater Glasgow Health Board (Appellant) v Doogan and another (Respondents) (Scotland)

Case ID: UKSC 2013/0124

Issue

Judicial Review – Abortion – Conscientious objection – Midwives

Does s.4(1) of the Abortion Act 1967, which provides that “no person shall be under any duty… to participate in any treatment authorised by this Act to which he has a conscientious objection”, entitle a Labour Ward Co-ordinator to refuse to delegate to, supervise and/or support midwives providing care to patients undergoing termination procedures?

Facts

From the outset of their employment with the appellant health board, the respondent senior midwives, both Roman Catholics, objected to and were exempted from directly participating in the treatment of patients undergoing terminations. Following a service reorganisation, the numbers of abortions performed at the hospital where they worked increased. They sought confirmation from the appellant that they would not be required to delegate to, supervise or support other midwives providing care to such patients. The appellant declined to give this assurance, rejecting the respondents’ grievance and subsequent appeal. The respondents challenged the latter decision by way of judicial review, contending that it contravened s.4(1) of the Abortion Act 1967. They were unsuccessful at first instance but succeeded on appeal to the Inner House.

Judgment appealed

[2013] CSIH 36

Appellant

Greater Glasgow Health Board

Respondents

  1. Mary Teresa Doogan
  2. Concepta Wood

Interveners

  1. Royal College of Midwives
  2. British Pregnancy Advisory Service

 

 

When is a problem not a problem?

Refusing to dispense drugs to kill patients with psychiatric illness

Levenseinde Kliniek complains about uncooperative Dutch pharmacists

Sean Murphy*

pharmacist01In April, 2014, a complaint was made in the Netherlands that some Dutch pharmacists were refusing to provide euthanasia drugs.  The complaint led members of the Dutch Parliament from the green party, GroenLinks, to ask for a debate with health minister, and members of other Dutch political parties let it be known that they were also concerned.

 According to the news reports, over half the physicians at “the independent euthanasia clinic” had been refused lethal drugs, and 23 percent of 53 pharmacists surveyed reported that they sometimes refused to fill euthanasia prescriptions.  It was argued that pharmacists should not be able to refuse drugs needed to kill patients if two physicians had approved the euthanasia request.  However, while the law in the Netherlands permits physicians to provide euthanasia, it does not mention pharmacists. [Full Text]

Judgementalism and moralising in response to Brittany Maynard suicide

Sean Murphy*

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.  Assisted suicide is legal in Oregon; that is why Maynard moved to the state.  In the weeks leading up to her death she had become a celebrity because of her public advocacy of assisted suicide, augmented by a kind of “countdown” to the date she had chosen to die. [NBC News]

It is not surprising that the announcement that she had killed herself as planned was followed by an outburst of judgementalism and moralising.

Prominent bioethicist Arthur Caplan stated, “did nothing immoral when she took a lethal dose of pills.”  He dismisses the view that “only God should decide when we die” because he finds that inconsistent with the existence of free choice, adding, “To see God as having to work through respirators, kidney dialysis and heart-lung machines to decide when you will die is to trivialize the divine.” [Brittany Maynard’s Death Was an Ethical Choice]

Chuck Currie, a minister of the United Church of Christ in Oregon, also insisted that Maynard had “made a moral choice.”  He described committing suicide under the terms of the Oregon law as taking “medically appropriate steps to make that death as painless and dignified as possible” – an appropriate exercise of “moral agency.”  Like Caplan, his theological views about the nature of God inform his approach to the issue. [Brittany Maynard Made A Moral Choice]

Writing in the New York Post, Andrea Peyser did not explicitly address either moral or theological questions, but implicit in her headline and awestruck praise for Maynard’s suicide was the premise that the young woman had done a “brave” and good thing. [We should applaud terminally ill woman’s choice to die]

In contrast, the head of the Catholic Church’s Pontifical Academy for Life in Rome, Monsignor Ignacio Carrasco de Paula, said that Maynard’s killing herself was a  “reprehensible” act that “in and of itself should be condemned,” though he stressed that he was speaking of the act of suicide itself, not Maynard’s moral culpability. [Daily News]

Those who condemn “judgementalism” and “moralising” ought to be offended by all of these commentators, because all of them –  Caplan, Currie, Peyser and de Paula – have expressed moral or ethical judgements.  To condemn suicide as “reprehensible” is surely to make a moral or ethical judgement, but moral judgement is equally involved in a declaration that suicide is a “moral” or “ethical” choice that should be applauded.

Health care workers who refuse to participate in some procedures for reasons of conscience or religion are often accused of being “judgemental” or of “moralising.”  In fact, as the preceding examples illustrate, their accusers are not infrequently just as “judgemental” and “moralistic.”   Such differences of opinion are not between moral or religious believers and unbelievers, but between people who believe in different moral absolutes.

This was one of the points made by Father Raymond De Souza during an interview about assisted suicide on CBC Radio’s Cross Country Checkup.  Interviewer Rex Murphy asked him if he thought that  “the idea of any absolute . . . even on the most difficult of questions of life and death . . . are no longer sufficient . . . for the modern world.”  Fr. De Souza’s response:

It’s a shift, Rex, I would say from one set of absolutes to the other.  And the absolute would be the absolute goodness of life, in one case, to assertion of personal autonomy, which is becoming an absolute assertion. And in fact in some of the arguments that have gone before the court, while acknowledging potential difficulties and philosophical objections, the right to personal autonomy trumps everything else.  So, in a certain sense, I wouldn’t say we are moving away from absolutes, but shifting from one set of absolutes to the other . . . [34:21- 35:24]