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Protection of Conscience Project

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July-September, 2008


25 September, 2008
Canadian Medical Association position on physician freedom of conscience

In an interview in Canada's Medical Post (questions 6 and 9), Dr. Bonnie Cham, Chair of the CMA Ethics Committee, noted that the CMA had considered freedom of conscience in health care, "including the impact of offering and not offering abortion services." She reaffirmed the organization's support for "the identifiable minority" of physicians who do not agree with abortion, and observed that there is still "a minority who would not refer" for abortion. [See CMA Policy on Induced Abortion]

19 September, 2008
13 U.S. state attorneys general attack draft protection of conscience regulation

The proposed American Dept. of Health and Human Services protection of conscience regulation has been attacked by 13 state attorneys general, who claim that it "completely obliterates the rights of patients to legal and medically necessary health care services in favor of a single-minded focus on protecting a health care provider's right to claim a personal moral or religious belief." [Jurist]

22 September, 2008
Catholic Archbishop warns that abortion law threatens Catholic hospitals

The Catholic Archbishop of Melbourne, Australia, responding to a bill that will legalize abortion in the state of Victoria. The bill passed the Legislative Assembly on 11 September and may become law by mid-October. In a pastoral letter, Archbishop Denis J. Hart described the bill as "an unprecedented attack on the freedom to hold and exercise fundamental religious beliefs" that "makes a mockery of the Victorian Charter of Human Rights and the Equal Opportunity Act." He stated that the bill "is clearly intended to require Catholic hospitals to permit the referral of women for abortions," and suggested that it would not be possible for Catholic hospitals to continue to operate.

19 September, 2008
UK ethicist argues that dementia patients have a "duty to die"

In an interview with the Church of Scotland's magazine Life and Work, Baroness Warnock, described by The Telegraph as "Britain's leading moral philosopher," stated that people suffering from dementia should consider euthanasia so as to avoid wasting public health care resources and their families' lives. She said that she hoped that, one day, people would be licensed to 'put down' others who were unable to care for themselves. [The Telegraph] Legalization of euthanasia, particularly on the terms suggested by Warnock, would likely cause conflicts of conscience among medical professionals.

College of Physicians and Surgeons of Ontario approves amended policy

While blatantly provocative assertions have been deleted,the policy approved by the College of Physicians and Surgeons of Ontario continues to assert that physicians may "in some circumstances" be obliged to help patients make arrangements for morally controversial procedures. It continues to link this expectation to the possibility of prosecution for professional misconduct. The revised draft does make clear that the principal threat to fundamental freedoms comes from the Ontario Human Rights Commission, not the College. [Catholic Register]

17 September, 2008
Canadian ethicist: suppression of physician freedom of conscience 'totalitarian'

Canadian ethicist Margaret Somerville, founding Director of McGill University's Centre for Medicine, Ethics and Law, has criticized the attempt by the Ontario Human Right Commission and College of Physicians and Surgeons to suppress freedom of conscience in the medical profession. She notes that there is a difference between refusing to provide a morally contentious service for reasons of conscience and refusing ethically neutral services for discriminatory reasons, warning that everyone should be concerned "by such totalitarianism." [Somerville]

Michigan pharmacist ends sale of contraceptives

Catholic pharmacist Mike Koelzer of Kay Pharmacy in Grand Rapids, Michigan has notified his customers that the store will no longer be selling contraceptives of any kind. He reached his decision after a long period of reflection on the teaching of his Church against contraception. He was, additionally, troubled by the potentially abortifacient or embryocidal effects of some birth hormonal birth control. He attempted to continue dispensing such drugs for non-contracepive purposes, but "found the process of questioning clients upon purchase to be too strenuous on both his staff and on his clientele." [Catholic Exchange] [Koelzer Blog]

Protection of Conscience Project calls for delay in College vote

Draft documents released on the eve of an important meeting of the College of Physicians and Surgeons of Ontario indicate that revisions to the controversial policy to be considered at the meeting were finalized the day before public consultation ended. The Protection of Conscience Project has called for the vote to be delayed so that stakeholders and College Council members can be given time to review the proposed changes. [News release]

12 September, 2008
Medical Association opposes Human Rights Commission, College

The Ontario Medical Association, representing about 24,000 of the province's physicians, has denounced attempts by the Ontario Human Rights Commission and the College of Physicians and Surgeons to suppress freedom of conscience in the practice of medicine. The OMA urged the College to "abandon" the policy and stated that the OMA holds "that it should never be professional misconduct for an Ontarian physician to act in accordance with his or her religious or moral beliefs." The statement concluded: "It is the OMA's position that physicians maintain a right to exercise their own moral judgment and freedom of choice in making decisions regarding medical care and that the CPSO not insert itself into the interpretation of human rights statutes." [Note: the statement was posted on the OMA website but has since been removed.]

Catholic Archbishop of Toronto criticizes proposed College of Physicians guidelines

In a letter to the College of Physicians and Surgeons of Ontario, the Catholic Archbishop of Toronto notes that guidelines proposed by the College are confusing, threatening, and, in places, "an indirect way of violating the conscience of the physician, and the physician's right to freedom of religion." He adds, "To force a physician to facilitate or perform an action that goes against his or her conscience or religious beliefs is unjust to the physician, and likely contrary to law."

Catholic Civil Rights League warns College of Physicians

The Catholic Civil Rights League has warned the College of Physicians and Surgeons of Ontario that parts of its draft policy on freedom of conscience "raise significant concerns for freedom of religion and conscience." In a letter to the College, League Executive Director Joanne McGarry reminded the College that "Canada has an established custom of accommodating sincerely held religious and conscientious convictions as much as possible," and said that it was unreasonable to expect physicians to act against their conscientious convictions .

Christian Legal Fellowship decries College of Physicians draft policy

The Christian Legal Fellowship has advised the College of Physicians and Surgeons of Ontario that its proposed policy on freedom of conscience "unreasonably interferes" with fundamental freedoms, "lacks an adequate justification," and has "no basis in law." The Fellowship is asking the College to reject the proposal. [CLF letter].

Religious leaders oppose Human Rights Commission, College of Physicians

Rabbi Reuven Bulka and Catholic Archbishop Terrence Prendergast, both of Ottawa, Ontario, have issued a joint statement challenging the attempt by the Ontario Human Rights Commission and the College of Physicians and Surgeons of Ontario to suppress freedom of conscience among physicians in the province. They said that they are "deeply disturbed" by the proposal. "Many doctors." they wrote, "have expressed a reasonable fear that . . .they might be disciplined, and even lose their licenses, for obeying their conscience. They would no longer be free to refuse to perform or refer for certain medical acts that are contrary to their firmly held beliefs." [LifeSite News]

11 September, 2008
Planned Parenthood policy to restrict or suppress freedom of conscience

Planned Parenthood claims that "Conscientious objection clauses, when overly or improperly invoked, deny access to services and violate providers' duty of care to patients,' and demands that objectors be forced to refer patients and that freedom of conscience be denied to institutions. [Access to Safe Abortion: A Tool for Assessing Legal and Other Obstacles]

Protection of Conscience Project submission to Ontario regulatory authority

The Protection of Conscience Project has made a submission to the College of Physicians and Surgeons of Ontario concerning draft guidelines that will have the effect of suppressing freedom of conscience among physicians in the province. The submission observes that the Ontario Human Rights Commission demonstrates "an alarming enthusiasm" in it efforts to "restrict and suppress the exercise of fundamental freedoms of conscience and religion." The Project comments that "[i]t is doubtful that the College can contribute to an improvement in the practice of medicine or enhance the enjoyment of fundamental rights and freedoms in Ontario by accepting a new and troublesome role as a surrogate for the OHRC." It concludes that the College should advise the HRC that if it wishes to suppress the fundamental freedoms of physicians, it will have to proceed without the assistance of the College.

Physician involvement in military interrogations

Documents obtained by freedom of information request indicate that the U.S. Army is continuing to use physicians in military interrogations, and encouraging their involvement on the grounds that they may keep "detainees" from being injured.[Science Daily] Conflicts of conscience are foreseeable if there is an expectation that physicians -especially military physicians - should be involved in interrogations.

Assisted suicide bill defeated in Australia

The Medical Treatment (Physician Assisted Dying) Bill 2008 has been defeated in the upper house in the Parliament of Victoria, Australia. The bill included protection of conscience provisions for physicians and health care facilities, but not for nurses, pharmacists and other health care workers.

10 September, 2008
Catholic Organization for Life and Family defends freedom of conscience

In a submission to the College of Physicians and Surgeons of Ontario, the Catholic Organization for Life and Family asked the College to guarantee that it "will not discriminate against physicians who oppose procedures such as abortion, contraception (including the birth control pill and the morning-after pill) and the use of certain assisted reproductive technologies" "uphold the rights of physicians to exercise their conscientious objection to such medical acts" and "not require doctors to refer patients, or potential patients, to other doctors for such medical acts."

7 September, 2008
Proposed American protection of conscience regulation in the news

Richard Doerflinger, assistant director of the Secretariat of Pro-Life Activities of the U.S. Conference of Catholic Bishops, attributes the erosion of religious freedom in the United States (First Amendment rights) to the 1990 US Supreme Court decision, Employment Division v. Smith, in which the court ruled that laws of general application can suppress freedom of religion if not motivated by anti-religious bigotry. Doerflinger supports the proposed Department of Health and Services protection of conscience regulation. It is also supported by Catholic Medical Association executive director John Brehany, who notes that the CMA has had complaints from medical residents about pressure to prescribe contraceptives and perform abortions. [National Catholic Register]

3 September, 2008
Validity of "brain death" questioned

Writing in L'Osservatore Romano, Professor Lucetta Scaraffia, vice-president of the Italian Association for Science and Life and a member of the Italian National Committee on Bio-Ethics, suggests that it is time to revisit the concept of "brain death" that has been widely adopted since a report from Harvard Medical School in 1968. Professor Scaraffia argues that the practice of mechanically maintaining the bodily functions of "brain dead" donors in order to preserve organs for transplant brings into question whether or not the donors are, in fact, dead. [The Times] Similar concerns have recently been voiced in the New England Journal of Medicine [See Brain death said doubtful in some organ donation]. Differences of opinion about the definition of 'death' and about a diagnosis of death could lead to conflicts of conscience among health care workers involved with organ transplants.


31 August, 2010
Ontario Human Rights Commission demands suppression of physician freedom of conscience

The Ontario Human Rights Commission has instructed the College of Physicians and Surgeons are to "'check their personal views at the door' in providing medical care." The Project Administrator described the OHRC directive as "an iron fist in a velvet glove." [Project news release]

22 August, 2010
Canadian Centre for Bioethical Reform and others support freedom of conscience

In a submission to the College of Physicians and Surgeons of Ontario, the Canadian Centre for Bioethical Reform states "it is essential you protect Ontario doctors' consciences. To strip a physician of his right to refuse involvement with immoral practices is to demand that physicians act without integrity-and that is hardly providing patients the best care." [CCBR submission] In a letter to the College, Alberta lawyer John W. Veldkamp commented, "Our medical profession is in a very sorry state when the College is advocating that physicians be more concerned about offending the Ontario Human Rights Code that the health of the patient."

US Department of Health and Human Services releases draft policy

A draft regulation to ensure freedom of conscience for health care workers has been released by the U.S. Department of Health and Human Services for public consultation that will last 30 days. [Washington Post]

20 August, 2010
Reaction forces extension of comment to 12 September

The College of Physicians and Surgeons of Ontario has extended the time for public comment on a proposed policy to suppress freedom of conscience for physicians in the province. The comment period was to end on 15 August, but protests that erupted when the plan became public convinced the College to extend the period to 12 September. [LifeSite News]

19 August, 2008
California Supreme Court rules against freedom of conscience

In the case of North Coast Women's Care Medical Group v. Superior Court of San Diego County (Benitez) the California Supreme Court has ruled that physicians can be compelled to provide artificial reproductive services to single persons and those identifying themselves as homosexual, even if the physician believes that it would be immoral to do so. The ruling was directed against Christian doctors who, while declining to provide the procedure themselves, referred the woman to a specialist and paid the associated fees. [AUL; Pacific Justice Institute]

18 August, 2010
Catholic Civil Rights League seeks extension on consultation

The Catholic Civil Rights League (Canada) has written to the College of Physicians and Surgeons of Ontario expressing concern for the maintenance of freedom of conscience for physicians, and asking for an extension on the time for public consultation on a policy intended to suppress it. [CCRL news release]

College of Physicians president denies physicians to be coerced

In a letter to Canada's National Post responding to criticism, Dr. Preston Zuliani, president of the College of Physicians and Surgeons of Ontario, said that the College "does not expect physicians to provide medical services that are against their moral or religious beliefs." [Letter published 22 August, 2008] He added, however, that it is expected that objecting physicians will "provide information about accessing care." If, by this, it is meant that an objecting physician must facilitate what he considers to be wrongdoing, many in the profession will find the demand unacceptable.

Physicians group makes interim submission to defend freedom of conscience

Canadian Physicians for Life have made an interim submission to the College of Physicians and Surgeons of Ontario. "Authoritarian and coercive edicts like these draft policy documents," it states, "suggest a fear of freedom that is unbecoming of a regulatory institution in a democratic country. They also raise serious questions about the CPSO's understanding of, and competence to deal with, issues of freedom, pluralism, accommodation and tolerance." [CPFL interim submission]

15 August, 2010
Physicians group asks for extension on policy consultation

Canadian Physicians for Life has written to the College of Physicians and Surgeons of Ontario asking that all stakeholders be given a further 90 days to respond to a proposed policy that would suppress freedom of conscience in the medical profession.[CPFL news release] Dr. Timothy Lau, an Ottawa physician and assistant professor at the faculty of medicine, University of Ottawa, warned the College in a letter that the proposed policy "will endanger the principled, conscientious, and responsible care of our patients, not just now but in the years to come.

News breaks of plan to suppress physician freedom of conscience

Canada's National Post reported on the policy being considered by the College of Physicians and Surgeons of Ontario. [Charles Lewis, "Religion out of medicine, a new message for Ontario doctors." National Post, 15 August, 2010]

14 August, 2010
Project issues warning about plan to suppress freedom of conscience

The Protection of Conscience Project has issued a news release warning Ontario physicians that the College of Physicians and Surgeons of Ontario is proposing to enact a policy to suppress freedom of conscience in the medical profession. The College, the regulatory authority for the practice of medicine, drafted the policy to conform to demands from the Ontario Human Rights Commission. The draft was released without public notice near the end of June with a deadline for public response by 15 August. It was discovered by accident by an Ontario physician, who contacted the Project. The Project has also written to the College asking that time for public comment be extended by 90 days. [Project news release]

Brain death said doubtful in some organ donation

Wriitng in the New England Journal of Medicine, Robert D. Truog, M.D., and Franklin G. Miller, Ph.D argue that current transplant practices should be changed so that there is no longer a need to declare someone dead before harvesting organs. Instead, they propose that informed consent be the ethical criterion to justify removal of organs from patients who are alive but who are expected to die if life support is removed. They note that in many cases the organ donor does not actually meet the criteria for "brain death," and that vital organs are thus often removed from living patients. [NEJM] The discussion highlights to potential for conflicts of conscience among health care workers involved in organ transplants.

8 August, 2010
Controversy in India demonstrates lack of consensus on abortion

An Indian court has ruled that a woman cannot have an abortion because of a diagnosis of fetal malformation. The Medical Termination of Pregnancy Act permits abortion after 20 weeks' gestation only if there is grave danger to a woman's life. Abortion advocates now want the law changed, while those against abortion are satisfied with the ruling. [Cybercast News] Comments from various interested parties demonstrate the likelihood of conflicts of conscience arising among health care workers asked to provide such procedures.


31 July, 2008
Draft US rule generates controversy over definition of abortion

Opposition is mounting in some circles to the draft protection of conscience regulation that was leaked from the Department of Health and Human Services in the United States. Claims are being made that the regulation "could inhibit research in areas including stem cells, infertility and even such unrelated fields as cancer." Freedom of conscience advocates insist that a protection of conscience regulation is needed. [Washington Post]

28 July, 2008
European Court of Human Rights to hear case against Irish abortion law

A challenge to legal restriction on abortion in Ireland will be heard by the European Court of Human Rights. It was begun by three Irish women and is supported by Irish Family Planning Association case. [Irish Times]Evidence taken by an Irish parliamentary committee in 2000 indicated that, at that time, most Irish obstetrician/gynaecologists would refuse to provide abortions. While this may have changed since that time, it would be reasonable to expect that a change in the law would cause conflicts of conscience in health care professions.

Italian doctors protest attempts to deny woman food, fluids

25 Italian physicians have written a letter to the country's attorney general to protest a court ruling that 37 year old Eluana Englaro can by starved and dehydrated to death. Englaro is apparently in a "persistent vegetative state" but is not brain dead or dying. [Zenit] The letter indicates the probability of conflicts of conscience arising among health care workers in such circumstances.

25 July, 2008
UN Committee pressures Ireland on abortion

The United Nations is pressing Ireland over its restrictive abortion law. The UN's human rights committee expressed concern and noted that what it calls progress was slow. [Irish Times, 25 July] Patrick Buckley of European Life Network, Dublin, writes: "This is yet another example of an 'out of control' UN committee operating beyond its mandate and instructing nations to adhere to its own agenda rather than the covenant it is supposed to be monitoring. There is no reference to abortion anywhere in the [International Covenant on Civil and Political Rights] or any other
legally binding international treaty. This is the type of action [which] brings the UN and its agencies into disrepute." [ELN blog, 25 July]

23 July, 2008
British abortion law pressed on Northern Ireland

Despite opposition from the four main churches and political parties in Northern Ireland, MP Diane Abbott has proposed an amendment to a government bill which would make the British abortion law apply to Northern Ireland. [The Guardian] [Daily Mail] [BBC] [In view of strong Northern Irish opposition to the proposal, a change in the law would likely generate significant conflicts of conscience in the medical professions.

18 July, 2008
American cardinal writes in support of protection of conscience regulations

Cardinal Justin Rigali, chairman of the United States Conference of Catholic Bishops' Committee on Pro-Life Activities, today wrote to all members of Congress defending "efforts to reaffirm and implement laws on conscience protection." [News release]

15 July, 2008
US administration circulates draft protection of conscience regulation

A draft regulation being circulated in the US Department of Health and Human Services that has been obtained by the New York Times is reported to provide extensive protection to health care workers who might face discrimination because of religious or moral objections to abortion and contraception. The most controversial section of the regulation appears to be a definition of "abortion" that includes "any of the various procedures - including the prescription, dispensing and administration of any drug or the performance of any procedure or any other action - that results in the termination of the life of a human being in utero between conception and natural birth, whether before or after implantation." Spokesmen for the Department refused to comment on the draft. The Christian Medical Association and Concerned Women for America have issued news releases supporting the proposal. [New York Times] [The Bulletin] [CMA News Release] [CWA News Release] [HHS Secretary BLOG on Freedom of Conscience]

11 July, 2008
BMA narrowly rejects attack on freedom of conscience

50.6 % of delegates at the Annual General Meeting of the British Medical Association voted against aresolution that included a provision that objecting physicians should be forced to refer for abortions. Much of the opposition to the motion centred on its requirement that objecting physicians be required to disclose their position on abortion in pamphlets and other notices. A number of opponents were concerned that this would indirectly lead to the identification of physicians who do provide abortions, while others believed that there were better ways to advise patients of their views. Dr Evan Harris, a Liberal Democratic MP as well as a BMA members, clearly indicated his desire to restrict freedom of conscience for health care workers. He was prepared to accept the existing legal recognition of freedom of conscience in the case of abortion and artificial reproduction, but argued "we should go no further." [Scotsman] Just days before the meeting, the proposal was attacked by Cormac Cardinal Murphy-O'Connor and Baroness Cumberlege, a Catholic peer and former Junior Health Minister [Catholic Herald].

Portuguese physicians being forced to change code of ethics

The National Executive Council of the Portuguese Order of Physicians has given in to government demands that it remove prohibition of abortion from its Code of Ethics. It is reported that the revised Code will state only that it is impossible to put an end to a life once it has begun, without defining the point at which life begins. That will leave determination of the question to each physician, so that the Code will accommodate both physicians who object to abortion and those who do not. The President of the Order of Physicians, Pedro Nunes, supports the revision. He had previously resisted the pressure and threats from the government to approve abortion. A vote on the revision is to be held in September.[LifeSite News]

9 July, 2008
Death approved for Italian woman

The Milan Court of Appeal has approved an earlier judgement that food and fluids can be withdrawn from a 36 year old Italian woman, Eluana Englaro, who has been in an irreversible coma for 16 years. The woman's father has been seeking such a judgement since 1999. Since the woman is not dying, withdrawal of food and fluids will cause her death. Catholic authorities and others have denounced the decision as formal approval of euthanasia. [Times Online] In an increasing number of jurisdictions, assisted nutrition and hydration are legally considered to be forms of medical treatment that can be refused by a patient or (more frequently) by others acting on their behalf. This can lead to conflicts of conscience among health care workers who do not approve of causing death by dehyrdation and starvation, as well as conflicts between families and health care authorities (SeeElderly woman in UK avoids death; Doctors refuse shifts at hospital to avoid care for elderly patient).

7 July, 2008
Objecting physician cleared of misconduct allegation

Britain's General Medical Council has cleared a West Cornwall general practitioner following an investigation of a complaint of misconduct. Dr. Tammie Downes, a Christian who refuses to refer patients for abortion or sign approvals for the procedure, was the subject of complaint after she publicly stated that she discussed all options with patients seeking abortion and encouraged them to consider the alternatives [SeeObjecting physician investigated for alleged breach of ethics]. [The Telegraph]

4 July, 2008
Freedom of conscience threatened by motion for British Medical Association

A motionto be considered at the Annual General Meeting of the British Medical Association purports to support conscientious objection that is now recognized in British statutes concerning abortion and artificial reproduction, but only on condition that physicians who object to abortion for reasons of conscience must facilitate the procedure by referring patients to more willing colleagues. Representatives from the Catholic Medical Association and the Islamic Medical Association in Britain have expressed strong opposition to the motion, which has been brought forward by the Oxford Division, of which abortion supporter Dr Evan Harris is a member. He is a Liberal Democratic Member of Parliament who favours abortion [Catholic Herald]. He and opposes freedom of conscience for health care workers [SeeObjecting physician investigated for alleged breach of ethics].

2 July, 2008
Elderly woman in UK avoids death

An 88 year old woman is at home after her daughter prevented doctors at Birmingham's Selly Oak Hospital from removing nutrition and hydration, which would have caused her death. The woman had been treated for two months for dementia and C.difficile when doctors informed her daughter that they were going to withdraw food and fluids. The daughter said that she had to "fight very, very hard" to stop them. She obtained a second opinion favourable to her mother, and the hospital agreed to continue treatment. [BBC News] The situation has become increasingly common and had resulted in conflicts between medial personnel and families (see Doctors refuse shifts at hospital to avoid care for elderly patient), but it also illustrates the potential for conflicst of conscience among health care workers.