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Protection of Conscience Project

Service, not Servitude
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April-June, 2010


30 June, 2010
Prominent UK journalist justifies killing to support of women's aspirations

Writing in The Times, prominent British journalist Antonia Senior recognizes the existence of her daughter began at fertilization and acknowledges that abortion is the killing of another human being. However, she justifies the killing an evil that is necessary to ensure women's prospects and careers are not restricted by pregnancy:"If you are willing to die for a cause, you must be prepared to kill for it, too." [The Times]. She does not discuss the issue of freedom of conscience for health care workers, so it is not clear whether or not she believes that they should be forced to facilitate such killing.

Protection of conscience law in Idaho causes debate

Idaho's Freedom of Conscience for Health Care Professionals Act, which comes into effect 1 July, is being opposed by the Idaho branch of the American Association of Retired People (AARP). The Association is concerned that the provision that prevents health care workers from being compelled to provide end of life treatment or care that is contrary to their conscientious convictions will result in patients being forced to continue with unwanted medical interventions [Boise Weekly].

Courts in numerous jurisdictions have ruled that assisted nutrition and hydration is "treatment", not medical care, and that patients or proxies acting on their behalf may refuse food and fluids. In consequence, it is legally possible in these jurisdictions to cause the death of patients who are not otherwise dying by denying them nutrition and hydration. Health care workers who consider this to be euthanasia may object to being part of the process.

In some jurisdictions where euthanasia has been formally legalized, laws require only that an objecting physician cooperate in the ordinary way in the transfer of a patient to a willing colleague who has been identified by the patient or his family [See, for example, the Belgian Act on Euthanasia]. This relinquishment of responsibility seems to reduce the problem of complicity for objecting health care workers.

26 June, 2010
Non-prosecution for assisted suicide in the United Kingdom

For the second time in as many months, British prosecutors, applying guidelines developed last year, have declined to lay charges against individuals who have assisted in the suicides of others. No charges will be laid against euthanasia activist Michael Irwin, a physician who has been struck off the medical register, nor against another man who helped a patient to travel to Switzerland to commit suicide at a Dignitas facility [Daily Mail]. Last month, prosecutors refused to lay charges against a man who helped his wife to commit suicide [Daily Mail]. Repeated incidents of this type are likely to increase pressure to legalize assisted suicide on the grounds that people should not have to travel outside the country to obtain the service, and that suicides that are managed by non-professional people (as in the latter case) are likely to be botched or are otherwise "undignified."

German court rules that patients can be starved/dehydrated

The federal high court in Germany has ruled that assisted nutrition and hydration is a form of treatment that can be refused by patients or proxies acting for them. It overturned the conviction of a lawyer who has advised his clients that they could disconnect a feeding tube from their 72 year old mother. The woman's daughter cut the tube. Hospital staff reconnected it, but the woman died of natural causes a few days later. As in other countries, the ruling will permit the starvation and dehydration of patients who are not dying, a situation likely to give rise to conflicts of conscience among health care workers. The German doctors' union and hospice representatives have voiced concern about the ruling [Irish Times]

25 June, 2010
Use of morning after pill to kill embryos reported

News reports state that a woman was mistakenly implanted by a Connecticut fertility clinic with embryos from a different couple, and that she took the "morning after pill" in order to terminate the pregnancy[Hartford Courant]. The Consent Order that sets out the facts of the case states only that the patient "initiated treatment" to end the pregnancy. The reporter who broke the story in the Hartford Courant has advised the Project Administrator that the source of the information about the use of the morning after pill is an adverse event report filed by the Center for Advanced Reproductive Services with the state Department of Public Health. The incident is of interest because of the ongoing controversy about whether or not the "morning after pill" acts as an abortifacient. Different kinds of drugs are used as "morning after pills," some of which are universally acknowledged to be abortifacient; the mechanism of action of others is disputed.

Activist proposes assisted suicide in Idaho

A euthanasia/assisted suicide activist has proposed that physicians in Idaho are free to assist in the suicide of their patients, since the law in the state is silent on the issue. Kathryn L. Tucker, Director of Legal Affairs for Compassion and Choices, cites legislation in Washington and Oregon and a Supreme Court ruling in Montana as precedents for assisted suicide in Idaho. Tucker's claim concerning Idaho law was rebutted in commentary following the article.[CDA Press] The adoption of euthanasia or assisted suicide would create conflicts of conscience among health care workers opposed to the practice. [see The Case of the Disappearing Plaintiffs]

22 June, 2010
Compromise being sought in Nebraska

While the Nebraska state Board of Health has approved rules that would force objecting counsellors to refer patients for assistance with homosexual relationships, Chief Medical Officer Dr. Joann Schaefer is reported to be continuing to search for a compromise that would address the concerns of those who do not wish to be complicit in what they consider to be immoral conduct [Journal Star].

21 June, 2010
Plan to restrict freedom of conscience in Europe

A draft resolution to suppress freedom of conscience in Europe will be considered by the European Parliamentary Assembly between 4 and 8 October. The resolution proposes that freedom of conscience should be restricted and regulated by the member states, that it should be denied to institutions and organizations such as denominational health care facilities, and that objectors should be forced to facilitate patients by referral.

16 June, 2010
Conscience protection for pharmacists in the UK

The General Pharmaceutical Council, which is superseding the Royal Pharmaceutical Society of Great Britain as the regulator of the profession of pharmacy in the United Kindgom, has decided to retain standard 3.4 in the RPhSGB Code of Ethics, and review its operation over the course of the coming year.

Ensure that if your religious or moral beliefs prevent you from providing a particular professional service, the relevant persons or authorities are informed of this and patients are referred to alternative providers for the service they require.

The requirement for referral would not be acceptable to some conscientious objectors. Public consultation on draft standards generated a number of calls for the complete suppression of freedom of conscience among pharmacists [GphC Report]

14 June, 2010
Physicians face "intense rejection" for adherence to moral beliefs

During a Spanish conference for Catholic doctors, Bishop Juan Antonio Reig Pla of Alcala de Henares commented that Catholic physicians who attempt to abide by their moral beliefs face "intense rejection" by society and are increasingly "defenceless" against the demands of a culture that no longer respects the sanctity of life [CNA]

3 June, 2010
European official worried by freedom of conscience in Poland

In a statement to the UN Human Rights Council, Special Rapporteur Anand Grover claims that access to abortion, contraception and pre-natal testing is impeded in Poland by "non-state actors" and demands that access to abortion be assured by developing protocols concerning conscientious objection. [Statement] The assertion is clearly intended to press for restrictions on freedom of conscience in Poland.


31 May, 2010
Mexican Supreme Court threatens objectors with jail

The Mexican Supreme Court has forbidden conscientious objection to the morning after pill, stating that objections are permitted only to abortion, and that the morning after pill does not function as an abortifacient. Physicians can be jailed or subjected to other penalties if, for reasons of conscience, they refuse government orders to dispense the drug.[Lifesite News] [See also, Clearing Rhetorical Minefields]

27 May, 2010
Harm reduction suggested as grounds for ritual genital surgery on girls

While affirming that its members should decline to perform any form of female circumcision or mutilation and should actively discourage parents from seeking it for their daughters, the American Academy of Pediatrics has suggested that it might be desirable to modify laws against the practices to permit a "ritual nick" by a physician, if doing so would prevent their families from sending them back to countries where a full procedure would be performed [AAP Policy Statement][New York Times]. The statement has been strongly criticized by those opposed to the procedure [Cultural Rite, Medical Wrong].

Abortion guidelines in Northern Ireland challenged

Abortion is illegal in Northern Ireland unless a mother's life or mental well being is in jeopardy. Last year, a judge ordered abortion guidelines issued by the Northern Ireland Department of Health to be withdrawn because they were misleading. New guidelines issued by the Department are being legally challenged by the Society for the Protection of Unborn Children on the grounds that they are a breach of the court ruling. [BBC] [Lifesite News]

26 May, 2010
Activists demand Ireland legalize abortion

The Irish Family Planning Association had denounced the Irish government for "political cowardice" because it has refused to legalize abortion. The denunciation followed news that about 4,400 women who had abortions in the United Kingdom last year had Irish addresses [The Herald]. Evidence taken by an Irish Parliamentary committee in 2000 indicated that most Irish obstetrician/gynaecologists would refuse to participate in abortion were the procedure legalized.

25 May, 2010
Quebec considers legalization of euthanasia/assisted suicide

The government of Quebec plans public consultation on the legalization of euthanasia and assisted suicide [Globe and Mail]. Although Quebec does not have jurisdiction to change Canadian criminal law, which is the prerogative of the federal government, the province could decide to limit prosecutions for such offences as a matter of public policy.

20 May, 2010
US Catholic bishops urge support for bill to remedy lack of conscience protection

Representatives of the US Conference of Catholic Bishops have written to members of Congress, urging them to accept an Amendment to HR3590 Patient Protection and Affordable Care Act that includes protection of conscience measures concerning abortion. [News release and text of letter]

15 May, 2010
Attempts to deny freedom of conscience to Nebraska counsellors

The Nebraska Catholic Conference is attempting to ensure that proposed new rules for three state licensing boards do not deny freedom of conscience to counsellors who do not wish to facilitate or encourage homosexual conduct. The rules would govern the state Board of Psychology, the Mental Health Practice Board and the Alcohol and Drug Counseling Board. Representatives of professional associations for psychologists and other counsellors claim that refusal to refer for counselling is "morally wrong" and contrary to the position of other professions [Lincoln Journal Star]. The claims are untenable, as refusal to refer for controversial medical procedures is a hotly contested subject in other professions, and inconsistent with the understanding of complicity that is implicit in the policy of the American Medical Association on physician participation in executions. [See The Problem of Complicity and Referral: A False Compromise]

12 May, 2010
Colombian doctor punished for refusing to perform abortion

.- Colombian doctor German Arango Rojas has been suspended by the country's Medical Ethics Tribunal because he refused to perform an abortion on a disabled girl, despite the demands of her parents. He was also ordered to pay damages to the parents. Colombia' s Attorney General, has protested that Dr. Rojas' fundamental rights have been violated.[CNA]

2 May, 2010
American Board of Anesthesiologists forbids "participation" in executions

The American Board of Anesthesiologists has adopted the policy of the American Medical Association and forbidden its members from 'participating' in executions[ABA policy], noting that the definition of "participation" is clearly set out in the AMA policy. [Washington Post] What is of interest is that "participation" is defined to include indirect involvement. Among the actions identified by the AMA as "participation" in executions are the prescription or administration of tranquillizers or other drugs as part of the procedure, directly or indirectly monitoring vital signs, rendering technical advice or consulting with the executioners, and even (except at the request of the condemned, or in a non-professional capacity) attending or observing an execution. It would be inconsistent for the medical profession to define "participation" in this way with respect to execution, but deny that the definition can be applied in the case of conscientious objection to other controversial procedures.


29 April, 2010
Proposed law in Mexico City threatens objecting physicians with jail

A law proposed Mexico City's ruling Democratic Revolution Party would impose prison sentences of up to four years on physicians who refuse to advise patients of the availability of abortion and refer them for the procedure. [Fox News]

27 April, 2010
Hospital apologizes to nurses disciplined for refusal to assist at abortion

Nassau University Medical Center in East Meadow, New York, has apologized to nurses who were disciplined for refusing to participate in an abortion. Hospital President Arthur Gianelli said, "We erred in our personnel actions, have apologized to several of the nurses and will do so with the others, as well. They did nothing wrong." []

15 April, 2010
Irish physician prosecuted for refusing fertility treatment

Dr Phil Boyle, of Galway, Ireland, operates a fertility clinic in accordance with Catholic teaching on sexuality and reproductive technology. He refused treatment to an unmarried couple and was charged for professional misconduct. He was acquitted by the Medical Council on the grounds that the couple had not become his patients and he had been given no opportunity to refer them to another facility. The ruling did not touch the issue of freedom of conscience. The couple may pursue a case against him before an Irish human rights tribunal. [Irish Times]

14 April, 2010
Nurses disciplined for refusing to assist in abortion

Eight nurses Nassau University Medical Center in East Meadow, New York, have been disciplined for refusing to assist with an abortion performed in non-emergent circumstances on a woman about 15 weeks pregnant. Although the hospital had agreed when the nurses were hired that they would not be required to participate in abortions if contrary to their conscientious convictions, one of the nurses reported that they were often pressure to do so. [Long Island Catholic] New York law prohibits discrimination against health care workers in such circumstances.

11 April, 2010
Sex selective abortion controversy in Canada

Two Canadian ethicists have proposed that physicians should deny information about fetal sex until it is too late for a woman to have a sex selective abortion. They are opposed by those who insist that there must be no restriction on abortion, and by those who believe that physicians are ethically obliged to provide the information if it is requested. [National Post] [National Post Letters 1] [National Post Letters 2] The controversy illustrates how the ethical evaluation of a procedure influences judgements about physician responsibilities.

9 April, 2010
Political protest incorrectly identified as freedom of conscience issue

An Orlando, Florida urologist has made it known that patients who support the new American health care legislation should go elsewhere for their treatment. Dr. Jack Cassell has posted a sign in his office: "If you voted for Obama, seek urologic care elsewhere. Changes to your health care begin right now, not in four years." Dr. Cassell states that he will not turn patients away, "But if they read the sign and turn the other way, so be it." However, Dr. Cassells does not believe that it would be wrong to provide treatment, and, in fact, stated that it would be unethical to refuse patients for political reasons. [Orlando Sentinel] While this can be understood as a form of freedom of expression or association, it would be incorrect to characterize it as an exercise of freedom of conscience. Unfortunately, this is precisely what some commentators opposed to and supportive of freedom of conscience in health care have done. [Contrast Idaho Mountain Express and The Bulletin]

7 April, 2010
New presidential bioethics commission appointees

President Barack Obama has named the remaining members of the Presidential Commission for the Study of Bioethical Issues. [White House News Release] They include two individuals who have reflected publicly on freedom of of conscience in health care. Writing in 2005, Anita L. Allen stated that the medicine counter is no place for ad hoc moralizing," adding that pharmacists must "withhold their moral judgments at work." In the same article she stated, "Refusing to dispense ordinary birth control pills on moral grounds is as harmful as it is unprincipled." [Rx for trouble: Just give us the medicine, please] Daniel P. Sulmasy dislikes the soundbite approach that characterizes much of the controversy on the subject. Of interest is his assertion that objections to the morning after pill based on a potential embryocidal effect are not supported by scientific research. However, he recognizes the importance of freedom of conscience and is generally opposed to legal coercion to suppress conscientious objection in health care. See The Role of Conscience in Medical Decisions.

5 April, 2010
Oklahoma governor signs Freedom of Conscience Act

The Freedom of Conscience Act has been signed by the Governor of Oklahoma and is now law. The statute is procedure-specific, concerning only abortion, procedures involving embryos, assisted suicide and euthanasia. It prohibits discrimination against individuals and institutions which object to the procedures for reasons of conscience and refuse to participate in them. "Participation" is defined to include referral and other forms of indirect involvement.

4 April, 2010
British Christians issue declaration asserting freedom of conscience and religion

35 prominent British Christians have signed a document called the Westminster Declaration which is being released for public signatures on Easter Sunday. It was inspired by the Manhattan Declaration, which, issued in the United States in November, 2009, has since collected over 400,000 signatures. The Westminster Declaration responds to concerns that Christians are being increasingly persecuted for beliefs that run counter to those in the prevailing culture. It includes the warning that those supporing the Declaration "will not be intimidated by any cultural or political power into silence or acquiescence and we will reject measures that seek to overrule our Christian consciences or to restrict our freedoms to express Christian beliefs, or to worship and obey God." Dr. Peter Saunders, chief executive officer of the Christian Medical Fellowship, was one of the initial signatories. [The Telegraph]