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Protection of Conscience Project

Service, not Servitude
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October-December, 2008


29 December, 2008
Montana Medical Association won't contest assisted suicide ruling

The Montana Medical Association will neither file an amicus brief in an appeal of a decision legalizing assisted suicide in the state, nor will it ask the American Medical Association to do so. Dr. Kirk L. Stoner, MMA President, stated that the Association has no policy on the issue and will become involved only if the state supreme court or MMA members ask the Association to do so. [AMA News]

Furor in US over new protection of conscience rule

Numerous attacks on the concept of freedom of conscience in health care have been launched in response to a new federal protection of conscience regulation. Many of the critics assert that the regulation will interfere with access to contraception. These assertions may be based on claims by some objectors and others that the morning-after pill and even some hormonal contraceptives act as "abortifacients" because it is alleged that they can prevent implantation, thus causing the death of the early embryo. Some objectors have confirmed that this is their understanding of the regulation. [The Virgina Pilot]

In addition, however, Section 88.4(d) of the regulation protects health care workers who, for reasons of conscience, refuse to participate in "any part of a health service program or research activity." Opponents of the regulation argue that this includes not only contraception, but artificial reproductive services and medical treatment of patients who identify themselves as homosexual or transgender. [Examples opposition to the regulation: Oklahoma Gazette; Letter to Des Moines Register; Eflux Media; New York Times; Letter to the Boston Globe; Rochesterchiro's Blog; St. Louis Post Dispatch; Findlaw Commentary; Feministing; Human Rights Campaign] The Attorney General of Connecticut plans to take action against the regulation. []

Survey discloses divisions among US physicians on freedom of conscience

36 percent of US physicians surveyed agreed that the government should be involved in protecting health care workers who decline to participate in procedures or services for reasons of conscience. 31 percent disagreed; 33 percent had no opinion. Their responses to questions related to the new HHS regulation were confused. Most believed that physicians should not refuse requests for artificial reproduction because of patient marital status or sexual preferences. [Christian Post]

22 December, 2008
Late term abortions in Australia

An inquiry into second trimester and late-term abortions disclosed that more than 10,500 such procedures had been performed in the country since 1994, and that infants sometimes survived the procedure and were left to die.[ABC News] Such circumstances have been noted elsewhere and have generated significant conflicts of conscience among health care workers. [see Personal qualms don't count]

19 December, 2008
US Catholic Bishops support new protection of conscience rule

Speaking for the U.S. Conference of Catholic Bishops, Deirdre A. McQuade welcomed publication of a Department of Health and Human Services regulation to ensure freedom of conscience for health care workers. "The enforcement of federal laws to protect their freedom of conscience is long overdue," she said. The Conference urged President Elect Obama "to honor this much-needed implementation of longstanding laws." McQuade pointed out that the rule was already under attack, even though it ought to be common ground that the freedom of conscience of health care workers with respect to abortion should be respected. [News Release]

18 December, 2008
US issues federal protection of conscience regulation

The US Department of Health and Human Services has issued the final version of a regulation designed to support freedom of conscience in health care. The new regulation requires states and other entities receiving money from the Department to certify that they do not compel objecting health care workers to participate in abortion or sterilization. It also requires that they certify that they do not force objectors "to perform or assist in any part of a health service program or research activity funded by the government," or discriminate against them for having refused to do so. [Washington Post]

Illinois Supreme Court rules in favour of pharmacists' case

The Supreme Court of Illinois has overturned a lower court decision and ruled that two pharmacists can proceed with a civil suit against an "emergency regulation" issued by the state governor that compels pharmacies in the state to provide or refer for the "morning after pill."[Supreme Court ruling][Chicago Tribune]

8 December, 2008
Freedom of Choice Act provokes discussion of hospital closures

Faced with the prospect that the Freedom of Choice Act may be reintroduced and become law, American Catholic authorities have begun to discuss what should be done if that comes to pass. At a meeting of the U.S. Conference of Catholic Bishops, Chicago Auxiliary Bishop Thomas Paprocki said that it might be necessary "to consider taking the drastic step of closing our Catholic hospitals entirely." He stated that it would be insufficient to merely withdraw sponsorship or sell the hospitals to entities that would provide abortion. On the other hand, Sister Carol Keehan, president of the Catholic Health Association, does not believe that Catholic hospitals would have to close, but insisted that there would be no compromise on the issue of abortion. According the the Catholic Health Association, the 614 Catholic hospitals in the United States treat over 5 million patients annually. [Baltimore Examiner]

7 December, 2008
Montana judge asserts "right" to suicide

Judge Dorothy McCarter of Montana has ruled that citizens of the state who are mentally competent and terminally ill have a constitutional right to suicide, and that physicians who prescribe medication for this purpose cannot be prosecuted. The decision will likely be appealed. [New York Times]

4 December, 2008
Man convicted for berating Muslim pharmacist

A 29 year old man in Ashton, north west England, has been convicted of racially aggravated harassment for insulting and offensive comments he directed at a Muslim pharmacist who refused to dispense the morning after pill for reasons of conscience. The pharmacy arranged for another store remain open an extra five minutes, but the man did not go there because he said there was not enough time. He went to the media at the time and the story generated considerable public controversy. The pharmacist made a complaint was made to the police 12 days later. [Tameside Advertiser] [See Muslim pharmacist denounced]

2 December, 2008
Grand Duke of Luxembourg to be stripped of powers for opposing euthanasia

The prime minister of Luxembourg has stated his intention to amend the country's constitution to deprive head of state Grand Duke Henri of his power to enact laws by signing bills approved by parliament. The move is a response to intimations from the Grand Duke that he would refuse to sign a bill legalizing euthanasia. [Reuters] While the situation involves legal and constitutional issues peculiar to constitutional monarchies, it illustrates the kind of pressure likely to be faced by objecting health care workers if euthanasia is legalized without robust of protection of conscience measures.

Professor recalls 'normality' of Nazi research

Richard J. Evans, Regius Professor of Modern History at the University of Cambridge, comments that the gruesome 'experiments' on concentration camp inmates by Nazi doctors were considered by their peers to be "'normal science,' subject to standard protocols of peer review in conferences and journals." Josef Mengele, for example, received funding from the Kaiser Wilhelm Institute in Berlin, and his work was reviewed by Otmar van Verschuer, whom Evans describes as an "eminent scientist." [The Telegraph] Evans' comments invite reflection on the relationship between establishment moral norms and bioethics on the one hand, and contrary positions taken by health care workers who reject such norms for reasons of conscience.


20 November, 2008
Senators introduce bill to stop freedom of conscience regulation

Senators Hillary Clinton and Patty Murray have introduced a bill to prevent the Department of Health and Human Services from implementing a protection of conscience regulation. Planned Parenthood supports the intiative. [News Release]

18 November, 2009
Survey forecasts increasing physician shortage in U.S.

A survey of American physicians released by the Physicians' Foundation discloses that almost half of the primary care doctors in the United States might leave medicine within the next three years if presented with alternative careers. It is reported that only 2% of the current group of medical students plan to enter primary care. The principal complaints concerned the problems generated by 'red tape' from insurance companies and government. Respondents have adopted a number of strategies to cope:

  • changing careers
  • charging patients a yearly fee and refusing insurance plans
  • limiting the kinds of insurance plans they will accept
  • limiting the number of Medicare and Medicaid patients they accept, or refusing to take them at all [CNN]

Pressure applied by those who wish to deny freedom of conscience to physicians can only make this situation worse.

17 November, 2008
Opposition to US freedom of conscience regulation

Three officials from the federal Equal Employment Opportunity Commission have complained that a protection of conscience regulation proposed by the U.S. Department of Health and Human Services would undermine 40 years of civil rights jurisprudence and is potentially confusing and unnecessary. The critics are the Commission's legal counsel, Reed L. Russell, Stuart J. Ishimaru and Christine M. Griffin. Other opponents of the rule include the National Association of Chain Drug Stores, the American Hospital Association, the American Medical Association, 28 senators, more than 110 representatives and the attorneys general of 13 states. The Ohio Health Department and the Planned Parenthood Federation claim that the rule might force facilities providing contraception and abortion to hire employees who could refuse to do the work. [New York Times]

17 November, 2008
Hospice nuns refuse order to withdraw food and fluids

Misericordine nuns of Lecco, who have cared for Eluana Englaro for 14 years at a hospice in Italy, have refused to to comply with a court ruling that assisted nutrition and hydration can be stopped in order to cause her death. Further, the Italian Secretary for Welfare has stated that no government-run hospital is obliged to carry out the order. [Lifesite News]

13 November, 2008
Italian court approves starvation and dehydration of patient

An Italian appeals court has agreed that food and fluids can be withdrawn from a woman who has been living in a vegetative state since a car accident in 1992. The ruling is the result of litigation by her father. [The Telegraph] Such rulings can cause conflicts of conscience among health care workers because many people consider causing death by dehydration and starvation to be euthanasia.

12 November, 2008
Jamaican bioethicist urges respect for "individual moral conscience"

Dr. Derrick Aarons, a family physician and founding president of the Bioethics Society of the English-speaking Caribbean (BSEC), told a committee of the Jamaican parliament that abortion should not be "a matter of legislation by the state." He argued that the decision whether or not to abort "should be left to moral beliefs and individual conscience." He characterized laws against abortion as an attempt to "legislate moral values and make would-be criminals out of persons wishing to aid in the exercising of reproductive rights and liberty." [Jamaica Observer]Based on this reasoning, Dr. Aarons should oppose efforts to compel health care workers to facilitate abortions if they object to the procedure for reasons of conscience. However, it does not appear that this issue was addressed in his testimony.

12 November, 2008
Serbian physician persecuted for refusing abortions

Over a period of 26 years under the communist regime in Yugoslavia, Dr. Stojan Adasevic performed about 48,000 abortions, as many as 35 abortions a day. After a dream and an abortion that he found particularly traumatic, Adasevic advised the hospital that he would no longer perform the procedure. As a result, his salary was cut in half, his daughter fired from her job, and his son was prevented from entering university. [Catholic News Agency]

7 November, 2008
Catholic health care system in Washington state refuses participation in assisted suicide

Providence Health Care, reported to be the operator of the largest hospital system in eastern Washington state, has declared that it will not permit assisted suicide, which is to become legal in the state in March, 2009.[Providence Health Care Statement]

5 November, 2008
Washington assisted suicide measure includes protection of conscience provision

Initiative I-1000, the Washington Death with Dignity Act, was approved by voters in yesterday's ballot. In March, 2009, the Act will legalize assisted suicide by patients who have been diagnosed with terminal illness. The Act includes a protection of conscience section. The Act prohibits professional disciplinary action against health care providers who refuse to participate in assisted suicide procedures, and specifies that only willing health care providers will participate in providing lethal drugs to an assisted suicide candidate. It also allows health care entities to refuse to allow the assisted suicide process to proceed on their premises, and to discipline employees who, having been notified of the policy, ignore the prohibition. However, the Act prevents health care entities from taking action against employees who refer for assisted suicide on their premises. Thus, it is possible that referral for assisted suicide will occur hospitals operated by religious denominations or other groups opposed to the procedure. Referral is not required by the Act. An objector is only required to forward relevant medical records during a transfer of care.

What may prove more troublesome is the fact that the Act prohibits civil action against health care providers who participate in assisted suicide, but does not prohibit civil action against those who refuse to do so. This suggests that objectors, while protected from professional disciplinary action, may be sued by patients or their families. Moreover, it is not clear whether or not the specification that only willing health care providers will participate in providing lethal drugs will be interpreted to include anyone other than those who directly hand the medication to the candidate.

Finally, there is no provision in the Act to prevent discrimination against applicants for employment, hospital privileges or professional education who are unwilling to participate in assisted suicide.

Success of Washington State assisted suicide bill invites imitation

The approval of assisted suicide by Washington state voters has generated a call for legalization of the procedure elsewhere. A retired British Columbia physician who is a member of the Right to Die Society of Canada has said that he would support a similar bill in Canada. His suggestion was opposed by a University of British Columbia instructor who specializes in palliative care. [CBC News] The difference of opinion demonstrates the importance of protection of conscience legislation when controversial procedures are legalized.

5 November, 2008
Holocaust memorial week, physicians and conscience

"[H]ow can we ensure that the next generation of physicians commits to being the moral conscience of society rather than becoming the purveyors of evil that the Nazi doctors chose to be?" The question was put to a Toronto audience at Toronto General Hospital by Dr. Yoel Abells, a Toronto family doctor and a medical ethics columnist. The occasion was Holocaust Memorial Week. Abells pointed out that physicians joined the Nazi party in significantly greater numbers than members of other professional groups. [National Post; Toronto Star]


31 October, 2008
Euthanasia and assisted suicide bills planned in United Kingdom

England's Lord Justice Scott Baker has ruled that assisting someone to go to Switzerland for the purpose of assisted suicide is contrary to English law. The proceeding was launched by a west Yorkshire woman, Ms. Debbie Purdy, who has who has multiple sclerosis. She was contemplating assisted suicide at a Swiss assisted suicide facility. [BBC">BBC] The ruling led a British member of parliament to call for a debate about legalizing assisted suicide, [The Guardian] while a member of the Scots Parliament plans to introduce a euthanasia bill in Scotland before Easter. The bill will include euthanasia as part of a continuum of palliative care, a concept that has been adopted in Belgium. [Daily Express] [The Herald] Lord Joffe plans to re-introduce an assisted suicide bill in the British House of Lords. His Assisted Dying for the Terminally Ill Bill was defeated by the Lords two years ago. [The Times]

27 October, 2008
Swiss physician claims suicide a human right

Suicide "is a human right" that ought to be recognized in law. The claim is made in an article in The Times by Swiss physician Alois Geiger, who prescribes lethal drugs for assisted suicide candidates at the Dignitas facility in Zurich. [The Times] The significance of the claim for health care workers who object to assisted suicide is best understood within the context of similar rights claims that are made for abortion and contraception. Those who make the claims are frequently unwilling to allow freedom of conscience to those who do not wish to be morally complicit in such procedures. If they make some allowance for those who do not wish to actually provide the controversial service, they almost invariably demand referral or some other indirect participation that objectors often find troubling or unacceptable. Since suicide can normally be accomplished without any assistance, the claim that assisted suicide is a human right amounts to an explicit assertion that at least some people have a moral obligation to help others kill themselves.

26 October, 2008
Physician reluctance leads to private late term abortion facility in Scotland

A private facility operated by the British Pregnancy Advisory Service (BPAS) will open in Scotland to deal with "hundreds" of late-term abortion requests. The National Health Service (NHS), Britain's public health care authority, has been unable to meet the demand for late term abortion in Scotland because many physicians object to providing late term abortion for social reasons, others have general moral objections to the procedure, and few physicians are trained to do it. The facility will perform abortions up to 24 weeks into a pregnancy. [Scotland on Sunday] In 2003 BPAS chief executive officer stated that Scots physicians were reluctant to provide abortions after 15 weeks gestation. He admitted that it might be difficult to find staff for such a facility. [The Sunday Herald] The story reflects the fact that the procedure remains morally controversial and continues to generate conflicts of conscience in health care workers.

22 October, 2008
Repressive bill becomes law in Australian state of Victoria

The Abortion Law Reform Act has been given royal assent and come into effect in the Australian state of Victoria. The Act requires that physicians who object to abortion for reasons of conscience refer patients to colleagues who are willing to facilitate the procedure. [Australian physicians express anger]

24 October, 2008
Mandatory organ donation from living donors

Scholars at the University of Oxford suggest that the supply of organs available for transplant could be increased by removing organs from living patients who are permanently unconscious. The idea is proposed by Dr. Julian Savulescu, the Uehiro Chair of Practical Ethics at the University of Oxford, and neonatologist and Oxford graduate student Dominic Wilkinson. Wilkinson, in addition, proposes that organ donation could be made mandatory, rejecting "the current charade" of informed consent for organ donation. Taken together, the proposals would permit the harvesting of organs from unconscious living patients over their own objections or those of their families. [Death Fiction and Taking Organs from the Living; The Paradox of Organ Donation Consent]

21 October, 2008
Exercise of freedom of conscience provokes call for boycott

A pharmacy operating as an entity of Divine Mercy Care, a Catholic health care organization, has opened in Chantilly, Virginia. DMC Pharmacy will not dispense, recommend or counsel for contraceptives and will adhere to other aspects of Catholic teaching. The pharmacy manager has expressed gratitude for the opportunity to work in an environment that respects his conscientious convictions. The pharmacy is intended to cater to "a special niche" of people who have similar views. Unlike some other states that have made ownership or management of pharmacies impossible for citizens who share such convictions, Virginia does not require pharmacies to carry or refer for contraceptives. NARAL Pro-Choice America is recommends that the pharmacy be boycotted because it "doesn't respect [patient] choices." The operation of the pharmacy, on the one hand, and the call for a boycott, on the other, demonstrates an appropriate balance in the exercise of freedom of conscience by parties with different views. [Catholic News Agency; Washington Times]

11 October, 2008
Repressive bill passes Australian state parliament

A bill to legalize abortion has passed the Upper House in parliament in the Australian state of Victoria. The bill includes a requirement that physicians who object to abortion refer patients to non-objecting colleagues in order to facilitate the procedure. Supporters of the bill claim that this does not amount to mandatory referral for abortion, but this view is rejected by its opponents. News reports do not make clear what further legislative action is required, since it appears that there will be further debate on amendments to the bill. The head of Catholic Health Australia, which operates 15 hospitals in the state, responded to the passage of the bill. "We will challenge any new law in order to fulfil our Catholic principles," he said. "We are greatly disappointed that the parliament did not hear our request to let staff at our hospitals practise within their own conscience." He added, "[W]e will stand right behind our doctors and nurses and back them to the hilt if they are challenged in exercising their ethical rights. [Herald Sun; The Australian]

1 October, 2008
Catholic health care organization supports draft HHS Regulation

The President and Executive Director of Alliance Catholic Healthcare has submitted a letter supporting the US Department of Health and Human Services draft protection of conscience measure. Alliance represents over fifty hospitals and thousands of physicians in California. William J. Cox,said regulation is "especially important" because of several attempts to "single out" and "blacklist" Catholic hospitals in the state. [Catholic News Agency]

Australian physicians express anger, defiance in face of repressive bill

A bill in the parliament of the Australian state of Victoria is generating strong opposition from health care workers and others. The bill demands that a physician who objects to abortion for reasons of conscience must, nonetheless, refer a patient to a colleague who is willing to facilitate the procedure. Dandenong general practitioner Janet Gross has posted a sign at her office to advise patients that she does not refer for abortion, and "will not obey the proposed legislation forcing doctors to refer for abortion." Other opponents of the bill include in vitro fertilization pioneer John Leeton, David Clarke, a psychiatrist, and Graeme Calrk, inventor of the "bionic ear." Their objections extend beyond the issue of freedom of conscience. [The Australian]