October-December, 2010
The European institute of Bioethics [http://www.ieb-eib.org/fr/index.php]
reports that three members of the Belgian House of Representatives (Myriam
Vanlerberghe, Renaat Landuyt and Maya Detiège) have tabled legislation that
will increase the availability of euthanasia by making it available to
people suffering from dementia and to minors. The bill is also said to
attack freedom of conscience by requiring objecting physicians to facilitate
the procedure. [BELN
Blog]
Representative Fortenberry has introduced a bill called the
Respect for Rights of Conscience Act of 2010. It is an amendment to
the Patient Protection and Affordable Care Act to "ensure that
health care stakeholders retain the right to provide, purchase, or enroll in
health coverage that is consistent with their religious beliefs and moral
convictions, without fear of being penalized or discriminated against under
PPACA" and "that no requirement in PPACA creates new pressures to exclude
those exercising such conscientious objection from health plans or other
programs under PPACA."
The European Court of Human Rights decision in the case of
A, B, and C vs Ireland is generating concern, anger, jubilation and
controversy in Ireland. The Court dismissed the complaints of A and B. In
the case of C, it ruled that existing Irish law, which prohibits abortion
except when necessary to save a mother's life, is consistent with European
human rights law. C was unable to find a physician in Ireland who would
certify that her pregnancy put her life at risk. The Court ruled that
Ireland must establish a process through which a woman can obtain such an
opinion. [Irish
Times-01] [Irish
Times-02] [Catholic
World Report] [Belfast
Telegraph] [Huffington
Post] It is not clear whether or not such a process could give rise to
conflicts of conscience in health care, though such difficulties might arise
in the event of disagreement about the prognosis.
[Steven Ertelt, LifeNews.com]
A national organization of Christian doctors is strongly concerned about
the Obama administration's effort to rescind conscience protections the Bush
administration put in place for medical professionals.
The regulations provide additional protections and support for those
doctors and nurses who don't want to be involved in abortions and may face
pressure from medical institutions receiving federal funds.
As LifeNews.com
recently reported, documents the Obama administration filed in November
and December have Obama administration attorneys admitting the
administration wants to finalize
a rescission of the
conscience rules but has been delayed because of other business - likely due
to the HHS working on implementing the provisions of the ObamaCare law.
That greatly concerns Jonathan Imbody, the Vice President for Government
Relations at the Christian Medical Association. . . [read
more]
In 2000 the Constitutional Court of Costa Rica confirmed that in
vitro fertilization is illegal in the country. In 2008, after having
exhausted appeals in Costa Rica courts, a number of couples asked the
Inter-American Commission on Human Rights to intervene. The Commission,
based in Washington, is part of the Organization of American States. It has
now warned Costa Rica that it must lift the ban on IVF, claiming that the
prohibition violates the American Convention on Human Rights, the United
Nations Convention on the Elimination of All Forms of Discrimination Against
Women and the Cairo Program of Action of the United Nations International
Conference on Population and Development.[CNS]
If the claims are accepted, it will likely have an adverse impact on those
who are opposed to the procedure for reasons of conscience, since a refusal
to provide it or assist with it would be considered a violation of human
rights.
In a 5-1 vote, the Pharmacy Board in Washington State has reversed a
decision made in July to revise a contentious regulation. The July decision
was made two weeks before a trial was to begin in a civil suit brought
against the state by objecting pharmacists. The trial was postponed pending
the outcome of the proposed rule change. [Associated
Press] [See
Washington Pharmacy Board to begin hearings on freedom of conscience]
In November and December, the Obama administration filed documents in
federal court stating that the revocation of an
HHS Regulation protecting freedom of conscience regulation has been
delayed, but hopes to have the process finished by the beginning of March,
2011.[LifeNews.com]
Justice Alan MacKenzie of the High Court in Wellington, New Zealand, has
ruled that guidelines proposed by the New Zealand Medical Council imposed
obligations that went beyond those imposed by law. All that is required of a
physician who objects to abortion is to decline to begin the process and
inform his patient that she may obtain the procedure from another
practitioner. The proposed guidelines would have imposed a requirement for
referral, and were challenged by a group of physicians. [News
release] [New
Zealand Herald]
Bhopal Commissioner Manoj Shrivastava has ordered that physicians at
Sultania Hospitals be formally warned that they are falling behind in
sterilizations and will be expected to set and meet targets to achieve the
state's family planning goals. The notices are to be sent to physicians who
have performed fewer than 20 sterilizations. [The
Pioneer] The order illustrates the threat to freedom of conscience in
health care that can arise when the state assumes control of medical
practice, and demonstrates the importance of robust protection of conscience
legislation in such jurisdictions.
The
End of Life Assistance (Scotland) Bill has been defeated in the Scots
parliament. The bill lacked protection of conscience provisions for health
care workers who did not want to be involved with assisted suicide.
A group of doctors, ethicists and parents of disabled children asked to
study the ethics of stunting the growth of disabled children has been unable
to reach a consensus on the issue. A majority of the participants agreed
that the procedure should only be considered in extreme situations, but it
appears that there has been no attempt to fabricate a consensus on the basis
of the majority opinion. [Seattle
Post Intelligencer] It is unfortunate that many are unwilling to admit
that there is no moral consensus with respect to other controversial
procedures.
The American College of Obstetrics and Gynecology has reaffirmed a
2007
statement by its ethics committee that attacks freedom of conscience for
physicians who are opposed to abortion.
A US federal court has rejected a suit filed by Catherina Cenzon-DeCarlo,
a nurse who alleges that she was forced to participate in a late term
abortion at Mount Sinai Hospital in New York City despite her stated and
well-known objections to the procedure. The court ruled that federal
protection of conscience laws do not permit individuals whose rights and
freedoms are violated to take legal action against those responsible. [Have
US conscience clause protections been eviscerated?]
Jeanne Monahan, director of Family Research Council's Center for Human
Dignity, has expressed concern that proposed changes in health care in the
United States would "undermine the conscience rights of many in the health
care profession" and insisted that "the conscience rights of health
insurers, providers and participants who object to contraceptives" be
respected. [News
release]
Writing in the Catholic University of America Tower, Bob Shine
advocates for what he calls "selective freedom of conscience" in the
American military, by which he means the freedom to selectively refuse to
participate in actions that are contrary to one's conscientious convictions.
Traditionally, conscientious objection to military service has been accepted
when the objection is either to military service in general or to the
requirement to kill. Shine argues that it should be possible for soldiers
who do not object to combat in principle to refuse to participate in
military actions that they deem to be immoral. [Article:
Freedom of Conscience] Leaders of a coalition that styles itself the
Truth Commission on Conscience in War
have now asked the U.S. Congress to expand the definition of conscientious
objection [NY
Times Blog] The argument is analogous to that made by health care
workers who do not believe that they are obliged to disregard their moral
convictions when they join a profession: that they should not be obliged to
perform morally contentious procedures to which they object, even if the
procedures are accepted by the profession as a whole.
Of 10,000 physicians surveyed by Medscape, 46% stated that they would
perform an abortion in some circumstances "even if it were against [their]
beliefs." [WebMD]
The response was to one of "21 tough ethical questions" posed in the survey.
A four day conference is being held in Accra, Ghana, by activist and
others who want to expand abortion services in Africa. A number assert that
access to abortion is a "human right," which would have serious
repercussions for health care workers and others who object to the
procedure.[Ghana
News][No
Place for Abortion in African Traditional Life]
By a 3-2 vote the Washington State Pharmacy Board has decided to have its
staff do the groundwork necessary to remove restrictions on the exercise of
freedom of conscience by pharmacists. [Seattle
Times].
The New Brunswick Human Rights Commission has confirmed that it has been
investigating a complaint that the province's abortion policy is too
restrictive. The complainant(s) in the case have not been identified.
Provincial policy requires two doctors to approve each abortion as
"medically necessary." Among the complaints from activists is an allegation
that too many physicians in the province are unwilling to do so. It is not
clear from the to what extent freedom of conscience is implicated, since
physicians who have no moral or religious objection to abortion might judge
the procedure to be medically unnecessary in a given case. The Chairman of
the Commission has stated that a formal board of inquiry may be appointed
and that the inquiry may be held in secret. [National
Post] See also
Responding to a report concerning assisted suicide in Oregon, Baroness
Finlay of Llandaff, professor of palliative medicine at Cardiff University,
said, "Most doctors want nothing to do with assisted dying." Were assisted
suicide legalized in the United Kingdom, she said, one result would be
"doctor shopping" by patients looking for someone willing to approve the
procedure. [Christian
Institute] Her comments indicate the strong probability of conflicts of
conscience arising in the medical profession should euthanasia or assisted
suicide be legalized.
A
letter to the New York Times from a representative of The Truth
Commission on Conscience in War refers to the phenomenon of "moral injury"
that has been observed among soldiers. It is said to be caused by
"witnessing, perpetrating or failing to prevent acts that transgress deeply
held moral beliefs," and is reported to have long-term emotional,
psychological, behavioral consequences. [See
Clin Psychol Rev. 2009 Dec;29(8):695-706. Epub 2009 Jul 29: Moral injury
and moral repair in war veterans: a preliminary model and intervention
strategy] The observations are relevant to recognizing the harms that would
flow from suppression of freedom of conscience in health care.
The Philippines Senate Committee on Health and Demography hearings on
Senate Bill 2378 opened on 18 October. [ABS-CBN
news] The bill is one of two before the Philippines Congress that are
highly controversial and that threaten freedom of conscience of employers
and in health care in the country. [See
Philippines "RH Bills": the shape of things to come?]
News reports from the Philippines indicate that the reproductive health
bills being considered by Congress are generating significant controversy
among government officials, NGO's, Catholic Church representatives and
legislators. The tone of the debate seems often rancorous. [US
News Las Vegas] Since the bills suppress or undermine freedom of
conscience among employers, health care workers and denominational
institutions, the current controversy indicates that passage of either bill
in their present forms would cause conflicts of conscience in health care.
[See
Philippines "RH Bills": the shape of things to come?]
Ann Furedi the chief executive of the
British Pregnancy Advisory Service, has told New Zealanders that
abortion is required as a part of family planning programmes because
contraception is not always effective. She noted that abortion rates do not
drop when more effective means of contraception are available because women
are no longer willing to tolerate the consequences of contraceptive
failure.[TVNZ]
Furedi's comments indicate that pressure to provide abortion is likely to
increase even where contraception is readily available, thus increasing
potential for conflicts of conscience among health care workers who do not
wish to be involved with the procedure.
The Chief Minister of the Indian state of Tamil Nadu, M Karunanidhi,
"appealed to doctors and paramedical staff to render their services to
humanity with conscience and not merely as a means of duty." He was speaking
at the 125th anniversary of the Kasturba Gandhi Hospital for Women and
Children at Chepauk. [News
Today]
Caceres Archbishop Leonardo Legaspi of the Philippines has issued a
pastoral letter to explain the opposition of the Catholic Church to the
reproductive health bills (RH bills) now before the Philippines Congress. It
is reported that the Church also plans to use Facebook, Twitter and other
social networking sites to oppose the bills. [Manila
Times] The bills suppress freedom of conscience of employers and
denominational health care facilities and make conscientious objection by
individuals impossible or ridiculous. [See
Philippines "RH Bills": the shape of things to come?]
The President of the Philippines has met representatives of the Catholic
Bishops' Conference of the Philippines to clarify their respective positions
on the reproductive health bill now before Congress. The meeting was
described as "pleasant," and further meetings are to follow. [Manila
Times] [See
Philippines bishops suggest possibility of civil disobedience] A
retiring Cardinal promised last week that he would break the law if it were
passed and was willing to go to jail. He was referring to
Section 23 in HB96, which will make it a crime to "maliciously engage in
disinformation" about the act. [See
Philippines "RH Bills": the shape of things to come?]
A group of medical professionals in the United Kingdom who support
assisted suicide (which they describe as "assisted dying") has formed
Health Care
Professionals for Change to lobby for changes in the law. The group also
wants to "change medical culture" and "change medical practice." The group
has not announced a policy concerning freedom of conscience for colleagues
who do not agree with them.
The Loyola School of Theology and the John J. Carroll Institute on Church
and Social Issues in the Philippines have issued a paper with talking points
to assist discussion of reproductive health bills now before the Philippines
Congress. The paper notes that the bills suppress freedom of conscience of
employers and acknowledges some of the shortcomings with the provisions that
purport to accommodate freedom of conscience [Talking
Points for Reproductive Health Bill], though it does not appear that the
latter point has been adequately covered. [See
Philippines "RH Bills": the shape of things to come?]
A report that would have seen increased repression of conscientious
objection in Europe has been rejected by the Parliamentary Assembly of the
Council of Europe. Irish senator Ronan Mullen and Luca Volonte of Italy, led
the assembly in passing amendments that converted the report to an
affirmation of the legitimacy of conscientious objection. The result was the
the author of the report and her supporters were forced to vote against it.
[SPUC]
Nonetheless, the motion in its new form passed as
Resolution 1763.
The Protection of Conscience Project has sent a
submission to each of the 47 national delegations at the Parliamentary
Assembly for the Council of Europe. The submission is a response to
recommendations made to the Assembly that would deny freedom of conscience
to denominational health care facilities and, in large part, to medical
practitioners. [See
Council of Europe to consider suppression of freedom of conscience]. A
meeting held in the afternoon by those opposed to the measure was attended
by half a dozen Members of the Assembly, and about 70 NGO representatives.
An American researcher has discovered that government and medical
authorities in the United States and Guatemala cooperated in a series of
unethical experiments performed in Guatemala between 1946 and 1948. Those
involved included John C. Cutler, a physician involved in the Tuskegee
study. Among other things, Cutler deliberately infected patients at a mental
hospital with syphilis or gonorrhea. He and Public Health Service physician
R. C. Arnold were aware that the methods were at least ethically
questionable and were concerned to keep the study secret. President Obama
and two cabinet secretaries have apologized for what was done. [Reverby]
News reports note that the study methodology reflected predominant attitudes
of researchers at the time. "In Massachusetts, institutionalized children
were fed oatmeal laced with radiation as part of nutrition experiments. In
New York, elderly patients were injected with cancer cells."
Boston Globe] The story demonstrates the risk entailed in assigning an
absolute value to "the ethics of the profession" in a particular period, a
practice often associated with attempts to suppress freedom of conscience
among dissenting professionals.
Is there a case for the valid restriction of freedom of conscience in
health care? On the eve of an important debate in the Parliamentary Assembly
of Europe, freedom of
conscience in health care will be discussed at a hearing in Strasbourg on 6
October, 2010. Dr. Andrew Fergusson, former Chairman, Professional Conduct
Committees, UK General Medical Council will speak to freedom of conscience
as a fundamental duty. Mr. Javier Borrego, a former judge of the European
Court of Human Rights, will consider it as a fundamental right. The
conference will take place at 1:00 pm in Room 3 at the Council of Europe.
In an interview with the news agency for the Catholic Bishops' Conference
of the Philippines (CBCP), CBCP Secretary General Msgr. Juanito Figura
said that it is possible that the Church will recommend civil disobedience
if a bill now before the Philippines congress becomes law. Several provision
in
HB96- The Reproductive Health and Population and Development Act/a> would
likely cause conflicts of conscience among health care workers. [CBCP
News] The wording of the bill makes the exercise of freedom of
conscience impossible or ridiculous, and exposes those who claim the
exemption to prosecution for human rights violations. It is not clear
whether the bill has been deliberately constructed as an obstacle to
conscientious objection, or has simply been badly drafted.