July-September, 2010
On 7 October, 2010, the Parliamentary Assembly of the Council of Europe
(PACE) will consider a
report from the Social Health and Family Affairs Committee that proposes
to deny freedom of conscience to denominational health care facilities and,
in large part, to medical practitioners. If the report is accepted,
regulations will force objectors
- to prove that their intention is based upon morality, ethics or
religion;
- to prove that they are honest and sincere;
- to notify employers and others of their intentions;
- to be formally registered, at least by employers;
Specifically, if asked to do something to which they object, they may
refuse to do it, but they must ensure that it is done by someone else. If
this is not possible, they must do it themselves. The report also recommends
oversight and monitoring of the exercise of freedom of conscience, and
effective complaint mechanisms to ensure that objectors comply with the
rules. The European Centre for Law and
Justice has issued a
critique of the report. It is also opposed by
Christian Action
Research and Education (CARE), which has also submitted a
brief on
the report. [ECLJ
news release]
According to a
Hasting Center Report, despite legalization of assisted suicide in
Oregon, hospices in the state refuse to provide lethal drugs for assisted
suicide by their patients, and most have only marginal involvement in
patient decision making about the procedure. (Courtney S. Campbell and
Jessica C. Cox, "Hospice and Physician-Assisted Death: Collaboration,
Compliance, and Complicity," Hastings Center Report 40, no. 5
(2010): 26-35.) The reluctance of hospices to participate in assisted
suicide suggests the importance of the
protection of conscience measures included in the state's assisted
suicide law.
Speaking at a conference in Dublin organized by the Iona Institute, Prof.
Roger Trigg of Kellogg College, Oxford, insisted that freedom of conscience
and religion are not opposed to human rights, of which religious freedom was
one of the most basic. He argued for reasonable accommodation of freedom of
conscience.[Irish
Times] Professor Trigg is an
Advisor to the Protection of Conscience Project, though he was not
representing the Project at the conference.
The euthanasia bill before the Western Australia parliament has been
defeated 24-11. [AAP]
The Voluntary Euthanasia Bill 2010 (Bill 108), which is to be
debated in the Parliament of Western Australia, includes a provision that
states: "No person may be compelled to do or omit to do any thing required
or permitted under this Act if that act or omission is contrary to that
person's conscience or beliefs," and makes it clear that medical
practitioners are not obligated to assess euthanasia requests or to refer
patients to more willing colleagues. However, the bill does not appear to
offer the same protection to conscientious objectors that is offered to
those willing to assist in the procedure. [Sydney
Morning Herald] [See
relevant sections of the bill]
The Washington State Pharmacy Board is considering a change in its rules
to allow pharmacists who object to providing a service for reasons of
conscience to refer patients elsewhere. The plan is being hotly contested by
opponents of freedom of conscience for pharmacists. The Board suppressed
freedom of conscience by issuing rules in that became the subject of a civil
suit filed by objecting pharmacists. The suit has been stayed pending the
outcome of the Board's reconsideration of the rules. [Seattle
Weekly]
[To make public
Comment] [Directions
to hearings]
Previous Project news items:
-
Washington State governor limits freedom of conscience (August,
2006)
-
Washington pharmacists' freedom of conscience in question;(April,
2007)
-
Pharmacists suing Washington State (26 July, 2007)
-
Washington pharmacy harassed by activists (8 September, 2007)
-
Washington pharmacists seek injunction (2 October, 2007)
-
Preliminary injunction issued against state (8 November, 2007)
-
Candidates in Washington State differ on freedom of conscience (16
November, 2007)
-
Washington court decision protects pharmacists (15 February, 2008)
-
Washington State pharmacists must dispense lethal drugs(27
September, 2009)
-
Washington court rules against freedom of conscience(9 July, 2009)
The Scots parliamentary committee taking evidence concerning a proposed
assisted suicide bill was told by the representative of Highland Hospice
that her organization opposed the bill, and that if assisted suicide were
legalized it would generate "ethical and legal dilemmas" for healthcare
professionals. [The
Scotsman] The British Medical Association - Scotland is also strongly
opposed to the bill. [BMA
Scotland] The evidence highlights the fact that the bill lacks a
protection of conscience provision. [See
Scots assisted suicide bill lacks protection]
Speaking to the members of the Bureau of the Parliamentary Assembly of
the Council of Europe, Pope Benedict XVI emphasized the importance
establishing an adequate foundation for human rights in order to establish
their universal validity.
. . . it is imperative to develop the universal
validity of these rights as well as their inviolability, inalienability and
indivisibility.
On different occasions I have pointed out the risks
associated with relativism in the area of values, rights and duties. If
these were to lack an objective rational foundation, common to all peoples,
and were based exclusively on particular cultures, legislative decisions or
court judgments, how could they offer a solid and long-lasting ground for
supranational institutions such as the Council of Europe, and for your own
task within that prestigious institution? How could a fruitful dialogue
among cultures take place without common values, rights and stable,
universal principles understood in the same way by all Members States of the
Council of Europe? These values, rights and duties are rooted in the natural
dignity of each person, something which is accessible to human reasoning.
The Christian faith does not impede, but favors this search, and is an
invitation to seek a supernatural basis for this dignity. [Full
text]
The Pope's comments reflect concerns similar to those of Professor
Abdulaziz Sachedina, an Islamic scholar and
Project Advisor. [See
The Clash of Universalisms- Religious and Secular in Human Rights]
The
End of Life Assistance (Scotland) Bill, which is to be debated in the
Scots Parliament in the first week of September, lacks any provision to
safeguard the freedom of conscience of those who do not wish to be involved
with assisted suicide. [Firm
Magazine]
Hospitals in Saudi Arabia have been approached by a Saudi to find out if
they would perform surgery to damage a man's spinal cord. The man was
convicted of attacking another man with a cleaver and paralyzing him. The
family of the victim was dissatisfied with the original sentence and have
asked for retributive punishment under Islamic law. At least two of the
hospitals approached by the judge refused to provide the surgery. Amnesty
International has become involved. The group has had reports of people
having teeth pulled out or being sentenced to blindness on the basis of the
principle, "an eye for an eye." [Associated
Press;
Washington Times] However, Saudi authorities have explained that the
hospitals were contacted only for the purpose of helping to convince the
family to accept the monetary compensation ordered by the court. [Reuters]
The Becket Fund for Religious Liberty, an American public interest law
firm, has threatened to sue the Department of Health and Human Services
(HHS) if it tries to force religiously affiliated hospitals to perform
abortions. The threat was delivered in a letter to the Department in
response to a complaint made against Catholic hospitals by the American
Civil Liberties Union. [News
release]
HRA Pharma has announed that the US Federal Drug Administration has
approved a new drug, "Ella" (ulipristal acetate) for sale in the United
states. It has been sold in Europe since 2009 as "ellaOne." The company
news release states that the drug is a prescription-only medication that
is effective up to five days after intercourse. It describes the drug as a
"progesterone agonist/antagonist that potently inhibits follicular rupture
when taken just before ovulation is to occur." However, the company's
summary
of product characteristics states that "[t]he primary mechanism of
action is thought to be inhibition or delay of ovulation, but alterations to
the endometrium may also contribute to the efficacy of the medicinal
product." This suggests that the drug is a potential embryocide, which would
be of concern to some health care workers. [See
Clearing Rhetorical Minefields]
As a result of a budget bill passed in 2009, four of five Catholic
dioceses in Wisconsin, USA, began paying for coverage of contraception for
employees on 1 August. The law requires that any insurance plan offering
coverage for prescription drugs offer coverage for contraceptives; it
exempts self-insured employers. The Diocese of Green Bay has adopted a
self-insurance plan to avoid the demand, and one of the currently compliant
dioceses is considering alternatives. It has been suggested that Catholic
employees hired on condition that they abide by Church teaching could lose
their jobs if they obtain contraceptives through the insurance plan.
However, state privacy laws prevent disclosure of such information, and it
does not appear that Church authorities intend to pursue such a policy
except in cases of overt and public defiance. [Kansas
City Star] [Wisconsin
State Journal]
The government of Quebec has agreed to fund in vitro
fertilization and the demand for the service has overwhelmed existing
resources. There are not enough gynecologists in the province to follow
normal pregnancies, neonatal units are full very few pediatricians are
taking new patients. [Montreal
Gazette] Reports do not discuss the possibility that public funding
will increase demands that health care workers be forced to participate in
the procedure even if they object to it for reasons of conscience.
Speaking at the annual meeting of American Academy of Fertility Care
Professionals in Omaha, Nebraska, Sister Renee Mirkes offered advice about
responding to current threats to freedom of conscience. She discussed the
formation and exercise of conscience, and she urged attendees to follow all
reasonable American Congress of Obstetricians and Gynecologists policies on
conscientious objection, including notification of patients of restrictions
on their practices. Sister Mirkes also encouraged them to engage in
political strategies to protect freedom of conscience in health care. [The
Criterion]
A column in the New York Times suggests that the drug Misoprostol,
originally intended to treat stomach ulcers, can be used effectively as an
abortifacient in developing countries because it is cheap and easy to
distribute. While its efficacy is in the order of 80 to 85% and it can cause
birth defects, proponents of the drug do not consider these issues
significant. It is not clear whether or not they recognize any upper
gestational limit to the use of the drug. [New
York Times] The column does not refer to the problems caused when
the drug is not fully effective and a woman with an incomplete abortion
arrives at hospital expecting it to be completed by health care workers.
[See
note on South African survey]
Only 13.4% of physicians who responded to a
survey in the Delta
state of Nigeria would be willing to provide abortions if the law
restricting the procedure were liberalized. At present, abortion may be
performed only to save the mother's life. 166 surveys were distributed in
the study conducted by researchers at Delta State University, Abraka,
Nigeria; 134 surveys were returned. 91% of the respondents currently do not
perform abortions. The paper concludes with the comment that there is an
urgent need to increase use of contraceptives in Nigeria and a need for
"induced abortion" - by which the authors apparently mean liberalization of
the law. Liberalization would clearly generate serious conflicts of
conscience among health care professionals unless accompanied by robust
protection of conscience laws. [See also
South Africa study;
No Place for Abortion in African Traditional Life]
The British Medical Association has issued
guidelines for physicians faced with patient requests for assisted
suicide. The procedure remains a criminal offence in the United Kingdom, but
Crown Counsel guidelines have been issued that preclude prosecution in
certain circumstances. The BMA advises physicians to "avoid all actions that
might be interpreted as assisting, facilitating or encouraging a suicide
attempt," such as
The guidelines demonstrate that the BMA acknowledges that such conduct
may make physicians complicit in an assisted suicide. This is the same
position taken by conscientious objectors to other controversial procedures.
Dr. Jeffrey Steinberg provides IVF sex selection through clinics operated
in New York and Los Angeles in order to circumvent the law against the
procedure in Scotland. He foresees expanded use of pre-implantation genetic
diagnosis to avoid genetically inherited diseases and choose desired
characteristics. [Daily
Record] The report does not disclose what is done with surplus or
defective embryos; in some jurisdictions they may be destroyed or used for
research. The normalization of such procedures and ensuing demand may create
problems for health care workers where they are legal.
The American organization
Christus Medicus Foundation has reported on its work related to freedom
of conscience in health care in the United States. The Foundation has
- reconvened the Health Right of Conscience Working Group (HCRCWG)
- worked with Americans United for Life and the US Conference of
Catholic Bishops to organize the Washington Summit on Religious Liberty
and Individual Right of Conscience, as a result of which it was agreed
- that all present would actively support the formation of a
National Policy Coalition for the active promotion of Religious
Liberty and the Right of Individual Conscience;
- Secured support among state public policy advocacy leaders in
Kansas, Texas and Missouri for federal and state legislation to secure
freedom of conscience in health care
- Obtained approval from the Catholic Medical Association (CMA) to
coordinate a conference for CMA physicians and administrators that want
to become more active in advancing conscience protection and other
initiatives.
The Northern Ireland Department of Health, Social Services and Public
Safety (DHSSPS) has published guidelines on abortion for public consultation
that will end on 22 October, 2010. Previous guidelines were withdrawn as a
result of court rulings against the Department; the guidelines were
misleading with respect to counselling and conscientious objection. The new
guidelines require objecting physicians to provide abortions if the life of
the woman is in danger and action must be taken immediately to save her
life. They also require objectors to refer for abortion, and note that a
physician who fails to provide an abortion may be liable to criminal charges
if the patient dies as a result. [DHSSPS
news release] [DHSSPS
Consultation Page] [DHSSPS
Cover Letter] [Proposed
Guidelines]
A number of Catholic commentators have taken issue with statements by
Father Bryan Hehir of the Archdiocese of Boston during a
panel discussion at
Boston College on 13 April, 2010, on the subject of freedom of conscience in
health care. Father Hehir is Cabinet Secretary of Social Services for the
Archdiocese of Boston and an aide to Cardinal Sean P. O'Malley, O.F.M. Cap.
The comments illustrate the kind of problem that can arise when clear
distinctions are not made between consideration of practical issues involved
in accommodating freedom of conscience in health care and consideration of
the morality of contentious procedures.[Bryan
Hehir Exposed]
A 62 year old man living in west Cherokee County, Georgia, USA, who has
been diagnosed with amyotrophic lateral sclerosis (Lou Gehrig's Disease),
has volunteered to donate his organs immediately, though the surgery would
cause his death. He would like to see the law changed to permit organ
donation under these circumstances, which would amount to euthanasia or
assisted suicide for the purpose of organ donation. [Cherokee
Tribune] Such procedures have been seriously recommended by some
ethicists, notably Julian Savulescu, who is also opposed to freedom of
conscience in health care: "If people are not prepared to offer legally
permitted, efficient, and beneficial care to a patient because it conflicts
with their values, they should not be doctors." [Savulescu,
Organ Donation Euthanasia;
Conscientious Objection in Medicine]
Christian leaders in Australia have published the
Canberra Declaration, modelled on the
Manhattan and
Westminster Declarations. The Canberra Declaration asserts the
importance of freedom of conscience and freedom of speech, warning the the
suppression of such freedoms marks the beginning of totalitarianism. It
includes a statement that signatories "will not comply with any directive
that compels us to participate in or facilitate abortion, embryo-destructive
research, assisted suicide, euthanasia, or any other act that involves the
intentional taking of innocent human life."[Assist
News]
Repeating the theme of an
article published in June, Kathryn L. Tucker, Director of Legal Affairs
for Compassion and Choices, addressed the Idaho Medical Association to
persuade its members that they are free to assist in patient suicides. It
appears that the presentation generated a strong rebuttal but no noticeable
support. [National
Catholic Register] Legalization of assisted suicide or euthanasia would
likely have an adverse impact on conscientious objectors to the procedures.
Dr. John Pollock, a former general practitioner in New Zealand, has been
diagnosed with terminal cancer and has begun to be more vocal in his support
of euthanasia. He had previously left the New Zealand Medical Association
(NZMA) because of its position against euthanasia, which, he said, was
contrary to his own views and those of other physicians. The chairman of the
NZMA states that euthanasia would remain unethical even if it were
legalized. [Otago
Daily Times] The statement indicates the likelihood of conflicts of
conscience among health care workers should the law be changed and the
medical profession face demands for the delivery of "legal services."
A 56 year old man in the United Kingdom is seeking a ruling from a
superior court that would protect his wife from prosecution should she kill
him at his request. Tom Nicklinson suffers from "locked in" syndrome and
does not wish to live. However, he is unable to take any action necessary to
commit suicide, so it would be necessary for his wife to kill him herself.
This would expose her to prosecution for murder, which Nicklinson wants to
prevent through his court application. A similar case launched by Debbie
Purdy, who suffers from Multiple Sclerosis, forced the Director of Public
Prosecutions to issue guidelines for the prosecution of assisted suicide
which effectively legalize it in some cases, but the guidelines do not apply
to the law on murder. [BBC]
[The
Telegraph] The guidelines do not require the participation of
health care workers, but likely create an expectation of their involvement.
The Archbishop of Burgos, Francisco Gil Hellín, has denounced the law
legalizing abortion in Spain as contrary to right reason and is thus
invalid. [Statement]
This is clearly a challenge to the position of the government, since the
Minister of Justice said last year that there would be no allowance for
conscientious objection to abortion. [Spanish
Justice minister says "no room for conscientious objection to abortion"]
With two weeks to go before the start of a trial in a civil suit brought
by objecting pharmacists, the State of Washington has decided to develop new
rules to accommodate freedom of conscience for pharmacists. The plaintiffs
have agreed to postpone the trial to give the state time to propose new
regulations. [Beckett
Fund News Release]
The American Civil Liberties Union has written to the U.S. Centers for
Medicare and Medicaid Services to complain that religiously affiliated
hospitals (specifically identifying Catholic hospitals) are failing to
provide "emergency reproductive health care" to women: specifically,
abortions. The ACLU claims that this is illegal and has asked the Department
to investigate and enforce the law. This amounts to a demand that Catholic
hospitals be forced to provide abortions in at least some circumstances. [ACLU
News Release;
ACLU
letter] The letter appears to have been triggered by the excommunication
of a Catholic nun who approved an abortion that was subsequently performed
at St. Joseph's Hospital in Phoenix, Arizona. [USA
Today]