Your morality, my mortality: conscientious objection and the standard of care

Camb Q Healthc Ethics. 2015 Apr;24(2):214-30. doi: 10.1017/S0963180114000528.

Ben A. Rich

Abstract

Recently the scope of protections afforded those healthcare professionals and institutions that refuse to provide certain interventions on the grounds of conscience have expanded, in some instances insulating providers (institutional and individual) from any liability or sanction for harms that patients experience as a result. With the exponential increase in the penetration of Catholic-affiliated healthcare across the country, physicians and nurses who are not practicing Catholics are nevertheless required to execute documents pledging to conform their patient care to the Ethical and Religious Directives for Health Care Services as a condition of employment or medical staff privileges. In some instances, doing so may result in patient morbidity or mortality or violate professional standards for respecting advance directives or surrogate decisionmaking. This article challenges the ethical propriety of such institutional mandates and argues that legal protections for conscientious refusal must provide redress for patients who are harmed by care that falls below the prevailing clinical standards. [Full text]

 

Conscience and Community: Understanding the Freedom of Religion

Responding to Protections and Applications of the First Amendment Today

Georgetown University,
Berkley Center for Religion, Peace and World Affairs
Cornerstone
Reproduced with permission

Richard Garnett*

“Religion,” said Justice William Douglas in his Wisconsin v. Yoder (1972) opinion, is “an individual experience.” The opinion was a partial dissent, and this statement is partially correct. But, it does not tell the entire story.  Many “religious experiences” are those of monks, mystics, and prophets – and of salesmen, coaches, teachers, and cops. But, many are also of peoples and tribes and congregations. As Justice Douglas’s colleague, Justice William Brennan, insisted in Corporation of the Presiding Bishop v. Amos (1987), “[f]or many individuals, religious activity derives meaning in large measure from participation in a larger religious community. Such a community represents an ongoing tradition of shared beliefs, an organic entity not reducible to a mere aggregation of individuals.” [Full Text]

Alabama House Bill 491 (2015)

Health Care Rights of Conscience Act

A BILL TO BE ENTITLED AN ACT

Relating to health care, to allow health care providers to decline to perform any health care service that violates their conscience and provide remedies for persons who exercise that right and suffer consequences as a result. [Full text]

Tunnel vision at the College of Physicians

National Post

Sean Murphy

The College of Physicians and Surgeons of Ontario has adopted a policy requiring physicians who have moral or ethical objections to a procedure to make an “effective referral” of patients to a colleague who will provide it, or to an agency that will arrange for it. In 2008, amidst great controversy, the Australian state of Victoria passed an abortion law with a similar provision.

After the law passed, a Melbourne physician, morally opposed to abortion, publicly announced that he had refused to provide an abortion referral for a patient. This effectively challenged the government and medical regulator to prosecute or discipline him. They did not. The law notwithstanding, no one dared prosecute him for refusing to help a woman 19 weeks pregnant obtain an abortion because she and her husband wanted a boy, not a girl.

They obtained the abortion without the assistance of the objecting physician, and they could have done the same in Ontario. College Council member Dr. Wayne Spotswood, himself an abortion provider, told Council that everyone 15 or 16 years old knows that anyone refused an abortion by one doctor “can walk down the street” to obtain the procedure elsewhere.

So why did the College working group that drafted the demand for “effective referral” urge College Council to adopt a policy that so clearly has the potential to make the College look ridiculous? . . .[Full text]

Canadian medical schools readying doctors to talk to patients about assisted suicide

National Post

Sharon Kirkey

Canada’s medical schools are preparing for what was once unimaginable — teaching medical students and residents how to help patients take their own lives.

As the nation moves toward legalized physician-assisted death, Canada’s 17 faculties of medicine have begun to consider how they will introduce assisted dying into the curriculum for the next generations of doctors.

It is a profound change for medical educators, who have long taught future doctors that it is immoral to end a life intentionally.

“If legislation passes, and if it becomes a standard of practice in Canada for a small subset of patients who desire assisted death, and where all the conditions are met, would we want a cadre of doctors that are trained in the emotional, communicative and technical aspects of making those decisions, and assisting patients,” said Dr. Richard Reznick, dean of the faculty of health sciences at Queen’s University in Kingston. “We would.” . . . [Full text]

Canadian doctor rallies colleagues against ‘tyrannical’ attack on conscience and sound medicine

LifeSite News

Steve Weatherbe

Dr. Martin Owen, a Calgary family doctor, has taken on the task of rousing his fellow practitioners to the danger posed to their integrity by policies being pushed by professional regulators in several provinces.

“My conscience is on the line,” Owen said in a chain e-letter. “If I lived in Ontario, I’d probably move my 7 children to another province so I could avoid the tyranny over my professional medical judgment and my conscience.”

Appalled by the Ontario College of Physicians and Surgeons’ new requirement for all doctors, regardless of moral objections, to do or refer abortions,  Owen has launched a website, freedomofconscience.ca, with Ezra Levant just before the latter’s Sun News Network folded, and sent chain e-letters to colleagues asking them to vote in a “poorly worded” CBC poll about the issue. And as with a chain letter, he has asked his recipients to pass his message on to 10 colleagues.

“The time has come when doctors now need to fight for the right not to perform abortions, prescribe birth control, or refer patients for controversial procedures,” the email stated. . . [Full text]

 

Saskatchewan policy forcing doctors to violate conscience fails to win enough support: final decision delayed

LifeSiteNews

Steve Weatherbe

A move to force Christian doctors in Saskatchewan to do abortions, assist at suicides, or refer patients to other willing doctors failed to win sufficient support at a meeting of the College of Physicians and Surgeons’ ruling council Thursday.

Faced with 4,400 hostile letters, many instigated by the Catholic Diocese of Saskatoon, the council decided to continue discussion at an emergency meeting on Saturday, and likely to put off a final vote until June, after a full public consultation.

“They weren’t all on the same page at all,” said Colette Stang, the head of Saskatchewan Pro-Life Association. “So it was a bit of a relief. I was pleased the decision wasn’t made.”. . . [Full text]

Court challenge raises issue of “reasonable apprehension of bias”

Sean Murphy*

The College of Physicians and Surgeons of Ontario is facing a court challenge by the Christian Medical and Dental Society and the Canadian Federation of Catholic Physicians’ Societies.  They have filed an application in the Ontario Superior Court of Justice asking for an injunction against enforcement of the College’s controversial new policy, Professional Obligations and Human Rights.  According to the application the College acknowledged that it had received 15,977 submissions during the second consultation concerning the policy, which ended on 20 February, 2015.  The great majority of submissions opposed the policy.

While the consultation ended on 20 February, a working group wrote the final version of the policy by 11 February, at least nine days before the consultation closed.  This is one of the factors that gives rise to concern about what the CMDS application calls either “actual bias” or “a reasonable apprehension of bias” on the part of the working group.

On this point, the statistics provided by the College are of interest.

submissionsAccording to the briefing note supplied to the College Council, by 11 February, 2015 the College had received 3,105 submissions.  This means that 12,872 submissions were received from 12 to 20 February inclusive.  In other words, over 80% of the submissions in the second consultation were received after the final version of the policy was written.

Moreover, allowing sufficient time to receive feedback is only the beginning.  Having received them, one would expect that a working group seriously interested in feedback would allow sufficient time to review and analyse the submissions.

During the 64 days of consultation ending 11 February, the College received an average of almost 50 submissions per day.  There were 43 working days during that period.  Assuming someone spent eight full hours every working day reading the submissions, it would have taken one person about seven minutes to review each one.

analysisHowever, during the nine days of consultation ending 20 February, the College received an average of 60 submissions every hour.  With 16 working days available from 12 February to 5 March inclusive, the day before the Council meeting, one person reading eight hours a day would have had no more than 36 seconds to review each submission.

Presumably this will be one of the issues to which the attention of the court will be directed if the case goes to trial.

Christian doctors’ group says new college policy infringes on freedom of conscience

Christian Medical and Dental Society seeks protection from a College of Physicians rule requiring doctors to refer patients seeking abortions and, once it’s legal, euthanasia.

Toronto Star

Lauren Pelly

With physician-assisted suicide on the horizon, the Christian Medical and Dental Society of Canada is asking the Ontario Superior Court to declare that a new regulatory policy infringes upon doctors’ freedom of conscience.

The society, which represents close to 1,700 members, filed documents in court on Friday regarding the CPSO’s Professional Obligations and Human Rights policy that was announced on March 6. The policy means doctors who refuse to refer patients for services on religious and moral grounds, including abortions, could face discipline from their regulating body. . . [Full Text]

 

Opinions on conscientious objection to induced abortion among Finnish medical and nursing students and professionals

BMC Medical Ethics 2015, 16:17  doi:10.1186/s12910-015-0012-1

Petteri Nieminen, Saara Lappalainen, Pauliina Ristimäki, Markku Myllykangas, Anne-Mari Mustonen

Abstract: Conscientious objection (CO) to participating in induced abortion is not present in the Finnish health care system or legislation unlike in many other European countries.

Methods: We conducted a questionnaire survey with the 1st- and the last-year medical and nursing students and professionals (548 respondents; response rate 66-100%) including several aspects of the abortion process and their relation to CO in 2013.

Results: The male medical respondents chose later time points of pregnancy than the nursing respondents when considering when the embryo/fetus ‘becomes a person’. Of all respondents, 3.5-14.1% expressed a personal wish to CO.

The medical professionals supported the right to CO more often (34.2%) than the nursing professionals (21.4%), while ≥62.4% could work with someone expressing CO. Yet ≥57.9% of the respondents anticipated social problems at work communities caused by CO.

Most respondents considered self-reported religious/ethical conviction to be adequate for CO but, at the same time, 30.1-50.7% considered that no conviction would be sufficient. The respondents most commonly included the medical doctor conducting surgical or medical abortion to be eligible to CO.

The nursing respondents considered that vacuum suction would be a better justification for CO than medical abortion. The indications most commonly included to potential CO were second-trimester abortions and social reasons.

Among the medical respondents, the men were more willing to grant CO also in case of a life-threatening emergency of the pregnant woman.

Conclusions: While the respondents mostly seemed to consider the continuation of adequate services important if CO is introduced, the viewpoint was often focused on the staff and surgical abortion procedure instead of the patients. The issue proved to be complex, which should be taken into consideration for legislation.

[Full text]