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Protection of Conscience Project

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October-December, 2006


30 December, 2006
67 year old gives birth

A 67 year old Spanish woman who had fertility treatment in Latin America gave birth to twins in Barcelona. [BBC News]

22 December, 2006
Italian case illustrates potential for conflict

The potential for conflicts of conscience in end of life care is illustrated in the case of Peirgiorgio Welby. Welby suffered from muscular dystrophy and, from 1997, had relied upon mechanical ventilation to breathe. In April, 2006 he lost the ability to use a computer mouse, which had facilitated communication, and he made a public request that his respirator be disconnected so that he could die. A judge ruled that he could order the respirator to be disconnected, but that Italian law would then require doctors to resuscitate him. Eventually, an anaesthetist, apparently violating instructions from others, disconnected Welby' s respirator at his request. No attempt was made to resuscitate him, and death was pronounced about forty minutes later.

Catholic teaching does not require the use of extraordinary or excessively burdensome measures to prolong life, noting, however, that while treatment may be considered burdensome, life must not. Thus, the disconnection of a mechanical ventilation would not necessarily constitute euthanasia. However, it appears that Welby's public advocacy of euthanasia and repeated references to ending his life caused some Church officials to treat his death as a form of euthanasia, and Welby was denied a Catholic funeral because he had "repeatedly and publicly affirmed his desire to end his own life." [BBC News, 22 December, 2006] The decision remains controversial among Catholics.

15 December, 2006
New UN convention contradicts medical and legal practice

The UN Convention on the Rights of Persons with Disabilities, just adopted by the General Assembly, includes a provision (Article 25f) that forbids "discriminatory denial of health care or health services or food and fluids on the basis of disability." This is being interpreted by a number of organizations to prohibit the practice of withdrawing nourishment (artificial nutrition and hydration) from persons in persistent vegetative state, which has common in countries like Britain and the United States. The Convention also refers to "sexual and reproductive health", the first time the phrase has been accepted in an international treaty. Abortion advocates typically use the phrase to include abortion, and, for this reason, the Holy See will not sign the convention.

12 December, 2006
British government approves chimeras, artificial reproduction for homosexuals

Despite public opposition, a "command paper" from the British government indicates that laws and regulations will be changed so that a child's need for a father will no longer be considered relevant to applications for artificial reproductive techniques. This will facilitate the insemination of single women and lesbians who do not want a relationship with a man. Sex-selection for non-medical reasons will continue to be banned, but the selection of tissue-matched embryos to supply tissue for a sibling suffering a life-threatening illness will be permitted. The production of chimeras (embryos combining human and animal cells) will be allowed, but the reproductive techniques that would produce embryos from genetic material from a woman alone will be forbidden. Other changes will affect sperm donors, children conceived by IVF, and surrogacy. The health minister asserts that the aim of the revisions "is to pursue the common good through a system broadly acceptable to society." [The Telegraph] Since a number of the provisions are morally controversial, it remains to be seen what effect they will have on health care workers who do not share the minister's understanding of the common good.

BBC alleges killing of newborns for stem cells

The BBC reports that it has obtained video footage of the post-mortem examination of 30 deceased newborns in the city of Kharkiv, Ukraine. The video shows that organs, including brains, have been stripped, and the dismemberment of some bodies. According to a senior British forensic pathologist, dismemberment is not standard post-mortem practice. The BBC speculates that the video may be evidence of harvesting stem cells from bone marrow.[BBC]

7 December, 2006
Court approves starvation, dehydration

A woman who lapsed into a coma following a massive brain haemorrhage in 1993 and has been in a persistent vegetative state since will be deprived of nutrition and hydration as a result of a court ruling. The National Health Services Trust has been given permission to withdraw all life sustaining 'treatment', which, in British law, includes food and fluids. [The Guardian] The case illustrates the problem faced by conscientious objectors to euthanasia, since the woman was not dying and the sole purpose for withdrawing nourishment is to cause her death.

5 December, 2006
Canadian Physicians for Life asks for choice in vaccines
Canadian Physicians for Life has pointed out that some vaccines (like the infant vaccine PENTACEL, used against diphtheria, tetanus, pertussis, polio and Haemophilus B) are derived from tissue from aborted foetuses, while others (like PEDICEL) do not. "This presents a serious moral dilemma to those who might view the use of such abortion-related vaccines as a form of cooperation with an immoral act," the organization says. While both vaccines are approved in Canada, only PENTACEL is marketed in the country and publicly funded in childhood vaccination programs. CPFL has asked federal and provincial governments to provide a choice between the two vaccines and "ensure the supply of vaccines from non-objectionable sources."[CPFL News Release] [Vaccines developed from aborted foetal cells]


30 November, 2006
Appeal of oppressive ruling in New York

Catholic Charities of the Dioceses of Albany and Ogdensburg, Servants of Relief for Incurable Cancer, Our Lady of Consolation Geriatric Care Center, the Carmelite Sisters for the Aged and Infirm, Bishop Ludden High School, Delta Development of Western New York, the Temple Baptist Church and the First Bible Baptist Church are appealing a ruling by the New York Court of Appeals. The Court upheld a state law requiring all employers, without exception, to include contraceptive coverage in drug benefit plans for employees. It is being suggested that, if the ruling is not overturned, prescription drug benefit plans may be cancelled completely by objecting institutions.

28 November, 2006
British law 'arcane': nurses should dispense abortifacients

The British Pregnancy Advisory Service wants the law in the United Kingdom changed so that two doctors no longer have to approve an abortion, and wants nurses to dispense abortifacient drugs to women during the first nine weeks of pregnancy. The chief executive of the service acknowledged that 40% of abortions are a consequence of contraceptive failure, including the failure of the birth control pill, and that abortion is considered a "backup" for failed contraception. [The Guardian] A change in the law that resulted in an increase in demand for abortion or dispensing of abortifacient drugs by nurses would likely have an adverse impact on conscientious objectors.

20 November, 2006
Lord Chancellor of England threatens objectors with prosecution

Lord Falconer, Lord Chancellor of England, has issued guidelines for the application of the Mental Capacity Act that state that a health care worker who refuses to abide by the terms of a "living will" may be charged criminally or liable to civil penalties. Criminal prosecution could result in imprisonment. Concern among conscientious objectors arises from the legal definition of "treatment" to include artificial nutrition and hydration. Since patients can legally refuse treatment, patients (or proxies) can refuse nutrition and hydration in order to cause death. The guidelines are reported to recognize conscientious objection, but require an objecting physician to transfer a patient to a colleague willing to carry out the instructions. A conflict could still arise if the transfer had to be initiated by the objecting physician rather than by the patient or proxy. [Evening Standard]

16 November, 2006
Nuffield Council comments on conscientious objection

Despite the suggestion of the Royal College of of Obstetricians and Gynaecology, a report published by the Nuffield Council on Biothecs "unreserverdly" rejected euthanasia for newborns "even when that life is 'intolerable.'" [2.37, Critical Care Decisions in Fetal and Neo-natal Medicine: Ethical Issues].

The Council recommended that babies born at 24 to 25 weeks gestation should not receive disproportionately burdensome treatment, noting that most babies born at less that 25 weeks gestation will die. At 23 weeks it held that it is very difficult to predict the outcome of intervention, stating that physicians are not legally obliged to initiate or continue what they consider to be futile care at this state. The Council recommended that intensive care should be provided to babies in the 22nd week of gestation only in exceptional cases, when parents insist upon it and physicians agree that it is in the baby's best interest. The Council viewed attempts to resuscitate babies below 22 weeks gestation as experimental, and insisted that it not be attempted outside an approved research programme following the normal protocols.

The report also referred to the issue of conscientious objection:

Paragraph 4.34 If a doctor or other health professional has a conscientious objection to termination of pregnancy, they have the right under the Abortion Act 1967 to refuse to participate in such procedures. [Although not in a situation when the termination is needed to save the life of or prevent severe permanent injury to the pregnant woman.] and refer the patient to another doctor.[citing Mason JK and Laurie GT (2005) Mason and McCall Smith's Law and Medical Ethics, 7th Edition (Oxford: Oxford University Press).] This right of conscientious objection to participating in terminations is supported by the BMA. [citing British Medical Association (1999) The Law and Ethics of Abortion] However, research suggests that, while midwives involved in feticide felt that the right to object was genuinely available, consultants typically saw this right as theoretical. [citing Graham R, Rankin J, Haimes E and Robson S (2006) Providing feticide: An exploration of health professional perspectives J Obstet Gynaecol 26 (Supp. 1): S14 -16.]

Paragraph 8.41 It is unrealistic to envisage legislation in the UK which did not offer doctors a right to refuse to practise euthanasia on grounds of conscience. When analogous rights of conscientious objection are granted in other legislation, it is clear that the objector is required to refer his or her patient to another clinician. The difficulty of moving a baby already gravely ill may either render any 'right' to euthanasia impracticable, or render the right to conscientious objection meaningless. [, citing General Medical Council (2001) Withholding and Withdrawing Life-prolonging Treatments: Good practice in decision-making, paragraph 28.]

The Council's view regarding an obligation to refer is not uncontested [See Conscientious objection and referral; Joint Committee on Human Rights].

Attack on protection of conscience law fails

A federal appeals court upheld the dismissal of a lawsuit brought by the National Family Planning and Reproductive Health Association against the "Weldon Amendment." The Weldon Amendment is a clause in federal law that prohibits the federal government from providing certain kinds of federal aid to states that discriminate against medical professionals who decline to participate in abortions. [ADF News Release]

13 November, 2006
Morning-after pill legalized by Chilean court; abortion bill introduced

The Fifth Circuit Court of Appeals in Chile has upheld a lower court decision that allows the morning-after pill to be dispensed to minors without parental consent, and a bill has been introduced to legalize abortion during the first 12 weeks of pregnancy. The developments suggest the likelihood of conflicts of conscience among some health care workers in the country.

8 November, 2006
UK researchers seek permission to produce chimeric embryos

Two different research teams in Britain have applied for permission to fuse human cells with animal eggs. One team wants to produce chimeric embryos that will be about 99.9% human and 0.1% animal in order to obtain stem cells from the embryos for research. The embryos would be destroyed after 14 days. The other wants to inject human skin cells into cow eggs to study how adult cells can be "reprogrammed" into primitive cells. The research is controversial, but a precedent for it is said to be the accepted practice of using human sperm to fertilize a hamster egg to test the quality of the sperm. The resulting embryo is destroyed at the two cell stage. [The Telegraph]

5 November, 2006
Sex selection favoured by UK researcher
Professor Lord Robert Winston, who introduced pre-implantation genetic diagnosis (PGD) of embryos conceived in vitro, now believes that it is acceptable to use the technique to select embryos for sex. He had previously held that it should be used only to identify embryos having a serious genetic disorder. Current regulations permit sex selection only in the case of conditions inherited only by one sex. Britain's Human Fertilisation and Embryology Authority (HFEA) cites surveys showing public opposition to sex selection running at about 80%. [Sunday Herald]
UK medical authorities recommend euthanasia for disabled newborns

The Royal College of Obstetricians and Gynaecology has recommended that euthanasia be seriously considered for severely disabled infants, arguing that "a very disabled child can mean a disabled family." The recommendation was made to the Nuffield Council on Bioethics during its inquiry into the ethical issues raised by the policy of prolonging life in newborn babies. The College qualifies the recommendation as a call for debate rather than legalization. [Sunday Times] Adoption of the practice would be of concern to physicians opposed to it for moral or ethical reasons.


31 October, 2006
Thai Buddhists and Catholics against abortion

The Catholi Cardinal Archbishop of Bangkok and an assistant monk at the Buddhist Suan Kaew Temple both spoke out against abortion in response to a conference organized by Thammasat University's Faculty of Social Administration on legalization of abortion. The conference asserted that abortion was "not a moral issue." [Asia News] The outright denial of a legitimate moral perspective on the issue and the possibility that a change in the law could adversely impact those who have a different view give reason for concern about freedom of conscience in the country.

30 October, 2006
Late term abortions cause controversy

Danish women travel to Spain to undergo abortions up to week 32, or eight months into a pregnancy. The legal limit for abortions in Denmark is 12 weeks (with the possibility of later abortions upon application): in Spain, 24 weeks. German, British and Spanish women also use the private facility for abortions that would not be legal in their own countries. The disclosure, made in a television documentary, caused shock among doctors and politicians, indicating that conflicts of conscience can arise even among health care workers generally supportive of a controversial procedure. [Sapa-dpa]

26 October, 2006
European Union continues support for coercive policies

Ms. Kathy Sinnott, a Member of the European Parliament from Ireland, noted that the European Parliament had rejected amendments to a budget provision that would have stopped funding of programmes that include coercive abortion, involuntary sterilization and infanticide. [Ms Sinnott's office, 26 October, 2005]

23 October, 2006
More Israeli doctors suspected in illegal experiments
Further to the arrest of four Israeli physicians (Israeli physicians arrested for illegal experiments), a police Chief Superintendent has told the Knesset Labour and Welfare Committee that eight more are under investigation. [Haaretz]
22 October, 2006
Early premature babies should be denied birth certificates

According to a news report in Britain's Sunday Times, the Royal College of Obstetricians and Gynaecologists is expected to recommend that birth certificates be denied to babies born at less than 22 weeks gestation. This would currently affect about 300 babies each year, including about 50 born alive during or after failed abortions. The Society would prefer that they be classified as "pre-viable" and that their live-births not be officially recognized. [Sunday Times]

20 October, 2006
Catholic hospitals in Australia will refuse therapies from embryonic stem cells

Most Rev Anthony Fisher OP, an auxiliary Catholic bishop in Sydney, Australia, states that Catholic hospitals in the country will refuse to co-operate in treatment involving the use of products from embryonic stem cell research. The statement illustrates how conflicts of conscience can arise as a result of artificial reproductive technology, even though they may not occur among the researchers directly involved. [LifeSite, 20 October, 2006 ]

New York Court suppresses freedom of conscience

By a 6-to-0 decision, the New York Court of Appeals dismissed an appeal against rulings by the State Supreme Court and the Appellate Division, that upheld a statute requiring the Roman Catholic Church and other religious organizations to cover the cost of contraception for employees. Eight Catholic and two Baptist organizations had sought to broaden a "religious employer" exemption to include religious schools, hospitals and social service organizations. The New York State Catholic Conference is considering an appeal. [New York Times] [Ruling]

19 October, 2006
Probation appears to be standard sentence for euthanasia in Quebec
A man who attempted to asphyxiate his wife was placed on probation for three years by Quebec judge. The judge asserted that Andre Bergeron acted "out of love," and his lawyer has suggested that the judges remarks and sentence signal the need to change the law. A Quebec woman convicted of assisting in her son's suicide received the same sentence earlier this year. [Western Catholic Reporter] It is unlikely that future sentences in the province will depart significantly from this standard. Acceptance by the legal profession of the notion that euthanasia and assisted suicide are acts of love and compassion will likely make it difficult for conscientious objectors to avoid involvement with the procedures should they be legalized.
18 October, 2006
Royal Pharmaceutical Society demands referral or assistance
While acknowledging that freedom of conscience of pharmacists ought to be respected, the Head of Professional Ethics of the Royal Pharmaceutical Society asserts that an objecting pharmacist or other staff member "must advise the patient of an alternative source for the service requested." [Daily Telegraph] To require the objecting pharmacist to facilitate the provision of the drug would be problematic for a number of objecting practitioners. [See Referral: False Compromise]
16 October, 2006
Possibility of dialogue in British Columbia
A resolution prepared for the Annual General Meeting of the College of Pharmacists of British Columbia one 25 November, 2006, appears to have opened an avenue for dialogue on the subject of freedom of conscience for pharmacists. The resolution asked that the College propose a more appropriate forum than the Annual General Meeting for the discussion of important ethical issues. The governing College Council has now suggested that a representative of conscientious objectors in the profession meet with the College's Ethics Committee over the next few months to discuss the issue.

The proposed resolution followed repeated rejection of policy proposals intended to ensure respect for freedom of conscience and religion for pharmacists. The College of Pharmacists of British Columbia has been particularly hostile to the concept. In 2000, its ethics committee issued a bulletin that impugned the integrity of conscientious objectors, making accusations the College had no evidence to support. [See Project Report 2001-01].

13 October, 2006
Conscientious objection by Muslim pharmacist sparks protest

A 37 year old woman complained to the media that she had been refused the 'morning after pill' at a Lloyds Pharmacy in Green Arbour Road, Thurcroft. She suggested that he should find a different line of work. A local Director of Public Health agreed that a pharmacist could refuse to provide a drug for reasons of conscience, but was obliged to tell the patient where to obtain it. Lloyds is supporting the exercise of freedom of conscience by the pharmacist [This Is London]. The circumstances related in the news article suggest that some improvements could be made in communicating with patients in these circumstances.

10 October, 2006
Organ donation procedure raises ethical questions

Dr. Christopher James Doig of the University of Calgary, Alberta, has voiced opposition to organ transplants based upon the criteria of donor cardiac arrest rather than donor brain death. The former criteria (DCD), used in the first organ transplants, were replaced in North America by brain death criteria (DBD), but in June of this year the Ottawa Hospitla announced that it was returning to the earlier practice. Dr. Doig asserts that returning to the earlier criteria " is a major change in end-of-life practice and poses significant ethical problems for end-of-life decision-making in intensive care units (ICUs). His concern is that the treatment of severely brain-injured patients will be compromised because of pressure to harvest their organs. Of particular interest is his reference to research showing a wide variation in practice in Canadian intensive care units in the withdrawal of life-sustaining treatment. He believes that "the possibility of conflicted decision-makingin a controlled DCD program is more than a theoretical possibility." [CMAJ] Dr. Doig's concerns and the differences in practice noted indicate the potential for conflicts of conscience among health care providers. A letter responding to his comments emphasized the importance of adopting DCD in order to save lives, but acknowledged the need to develop "consistent end of life protocols" across the country. [CMAJ letters] This would not necessarily resolve conflicts of conscience, especially if the protocols reflect only the views of a predominant secular ethical establishment.

Israeli physicians arrested for illegal experiments

Four senior doctors at Kaplan Hospital in Rehovot and the Hartzfeld Geriatric Hospital in Gedera have been arrested during an investigation of hundreds of illegal and unethical experiments on elderly patients over several years. Allegations include causing "wrongful death through negligence, abuse of helpless victims, aggravated assault, fraud, violation of a statutory obligation and interference in an investigation." Some of the illegal experiments were reported in professional journals and formed the basis of the reputations of some of those accused as geriatrics experts, and some of the experiments had not medical or scientific value. There are indications that responsibility for the experiments extends beyond the physicians arrested.[Haaretz] The story demonstrates the need for health care workers to develop conscientious convictions independent of an established ethos in a profession or institution, so that they will be better able to recognize and respond appropriately to unethical practices. It also illustrates the potential for conflicts of conscience among health care workers practising in an ethically compromised institution or profession.

8 October, 2006
IVF treatments for single women increase in UK

Acting on what appears to be a belief that children do not need fathers, the number of single women obtaining IVF has doubled in the past five years, while IVF treatment for lesbian couples has increased fourfold. [Sunday Telegraph]

6 October, 2006
Military physician wins conscientious objector status

Mary Hanna, who describes herself as a "devout Coptic Orthodox Christian," agreed to serve four years in the US military on active service and four years in the reserves so that the US Army would pay for her medical education. The 30 year old anaesthesologist joined the army in 1997, at which time she had no religious objections to military service. However, she said, she experienced a growth of religious interest after the death of her father in 2003 and submitted an application for conscientious objector status after being ordered to report for active duty in August, 2006. The application was approved by her superiors but denied by the Conscientious Objector Review Board. A federal judge has now ruled in her favour. Her lawyer states that she is willing to repay the army the $184,000.00 invested in her education.

Euthanasia rejected by Catalonian physicians

Responding to the latest report of Catalonia's Consultative Bioethics Committee on euthanasia, an association of Christian doctors released a statement that said: "We doctors do not want to be executioners." [Zenit]

5 October, 2006
Chimeric embryos to be created in UK

British scientists are seeking approval to create embryos by fusing human cells with animal eggs in controversial research which will boost stem cell science and tackle some of the most debilitating and untreatable neurological diseases.

Three British research teams plan to submit applications to the Human Fertilisation and Embryololgy Authority seeking permission to replace nuclei in rabbit and cow eggs with human cells. The result is expected to be embryos that have a full set of human genes with animal genes contained in mitochondria: chimeras that are 99.9% human and 0.1% animal. [The Guardian]

3 October, 2006
Experimentation on pvs patients proposed
Several articles in the Journal of Medical Ethics discuss the use of pvs patients as experimental subjects. Some authors assert that they would be especially useful in studies of the long-term effects of animal organs transplants.
  • R Sparrow
    Right of the living dead? Consent to experimental surgery in the event of cortical death. J. Med. Ethics, Oct 2006; 32: 601 - 605.
  • S Curry
    Living patients in a permanent vegetative state as legitimate research subjects. J. Med. Ethics, Oct 2006; 32: 606 - 607.
  • H Draper
    Research and patients in a permanent vegetative state.
    J. Med. Ethics, Oct 2006; 32: 607
  • J Thompson
    Relatives of the living dead. J. Med. Ethics, Oct 2006; 32: 607 - 608.
  • N Levy, A Ravelingien, J Braeckman, F Mortier, E Mortier, and I Kerremans
    Respecting rights ... to death. J. Med. Ethics, Oct 2006; 32: 608 - 611.
2 October, 2006
South African nurse goes to Labour Appeals Court

A South African nurse who alleges that she was forced to resign because she refused to participate in abortion [See "South African nurse denied position"] has been given leave to proceed against the Health Department in the Labour Appeals Court. The Health Department claims that conscientious objectors are forced to participate in abortion only in an 'emergency situation.'