Protection of Conscience Project
Protection of Conscience Project
Service, not Servitude

Service, not Servitude
1.  Developments by Region/Country
Visit the Project News/Blog for details.

An anti-vaccination group that appears to be motivated by concerns about purported vaccine side effects and/or alleged lack of effectiveness is reported to be encouraging its adherents to create a fake church in order to use a religious-based exemption to avoid vaccinating their children.  This kind of fraudulent ploy can bring the legitimate and sincere exercise of freedom of conscience into disrepute. 


A serial rapist and murderer was to be killed under the country's euthanasia law to end his mental anguish arising from 26 years of imprisonment with no prospect of release.  However, the plan was cancelled as a result of further medical advice, and he has been transferred to a new psychiatric treatment.

Flag CanadaCanada

In a 9-0 ruling the Supreme Court of Canada has authorized both physician assisted suicide and physician administered euthanasia in the case of competent adults  who have clearly consented to being killed, and who have a grievous irremediable medical condition "including an illness, disease or disability" that causes "enduring suffering that is intolerable to the individual." 

However, acknowledging the joint intervention in which the Project participated and other submissions, the Court stated: "In our view, nothing in the declaration of invalidity which we propose to issue would compel physicians to provide assistance in dying," adding that "a physician's decision to participate in assisted dying is a matter of conscience and, in some cases, of religious belief."  While they acknowledged that "the Charter rights of patients and physicians will need to be reconciled," the judges offered no guidance as to how this should be done.

The ruling has increased concern about ongoing efforts by medical regulators to suppress freedom of conscience among physicians.  There strong opposition to a draft policy of the College of Physicians and Surgeons of Ontario. Professional Obligations and Human Rights (POHR) that will force objecting physicians to  facilitate abortion, euthanasia, assisted suicide and other morally contested procedures by referral.  An overwhelming majority of written comments during the first consultation supported freedom of conscience for physicians, but only about 2% advocated a policy of mandatory referral. On-line Survey responses indicated that a mandatory referral policy is controversial.  The great majority of respondents in the current consultation, including the submission of the Ontario Medical Association, are opposed to the demand for mandatory referral.

Nonetheless, College officials seem determined to enact POHR.  Briefing materials supplied to Council in support of POHR were not only seriously deficient, but erroneous and seriously misleading.  Officials have even attempted to manipulate the consultation process by intervening in a Discussion Forum about POHR, apparently to discredit critics and defend the policy.

The College of Physicians and Surgeons of Saskatchewan is proposing a draft policy demanding that physicians who object to "legally permissible and publicly-funded health services" must direct patients to colleagues who will provide them.  This will now include not only abortion, but euthanasia and assisted suicide. If another physician is unavailable, the College demands that they provide "legally permissible and publicly-funded" services,  even if doing so "conflicts with physicians' deeply held and considered moral or religious beliefs." The policy is virtually a word-for-word copy of the Model Conscientious Objection Policy proposed by euthanasia and abortion activists – without attribution.

Flag ColombiaColombia

The Colombian Constitutional Court has given the Ministry of Health 30 days to implement a number of protocols pertaining to euthanasia, setting guidelines for all health care providers.  The order is intended to force the government to implement a 1997 Constitutional Court ruling that legalized the practice. 

Flag KenyaKenya

It is reported that Kenyan doctors, nurses and other health practitioners are secretly performing female genital mutilation at the request of families: up to 18 percent of the estimated total number.   The practice is being exposed and strongly opposed by churches, rights groups and other activists.  The reports demonstrate that procedures do not become morally or ethically acceptable simply because they are performed by health care workers.  It is also possible that the medicalization of the practice places health care workers who object to it in a difficult position, especially if they are junior to those providing the service.

FLag UKUnited Kingdom

Britain's Supreme Court ruled against two Catholic midwives who fought their employer's orders to supervise the provision of abortion.  The women now face a legal bill estimated to be as much as £300,000.

As a result of continuing efforts to legalize assisted suicide in Scotland and England, the Royal Pharmaceutical Society has developed a policy that deals with the subject.  It proposes a protection of conscience provision that operates by having pharmacists "opt in" to provide lethal prescriptions rather than "opt out," and it does not require objecting pharmacists to refer patients to willing colleagues.

Flag USAUnited States

The American Medical Association has made a submission to the public consultation on physician freedom of conscience being conducted by the College of Physicians and Surgeons of Ontario (CPSO).  The AMA letter provides important details about a policy on physician freedom of conscience adopted by the AMA House of Delegates in November, 2014, but not due to be formally published until June of this year.  A key element is the decision that physicians should not be forced to refer patients for procedures to which they object for reasons of conscience.

The American Civil Liberties Union (ACLU) is suing a Washington state public hospital district, claiming that it is failing to provide medical and surgical abortions.  In fact, the hospital district provides both, but refers patients to other facilities for abortion when they cannot be provided because of conscientious objection by staff.  It thus appears that the ACLU is not content with forcing facilities to refer for abortion, but intends to force them to provide the procedure despite conscientious objection by physicians and health care workers.  

A paediatrician in Michigan made headlines when she refused to accept a child as a patient, apparently because the child's mother is in a lesbian relationship with another woman who also wishes to be considered the child's parent.  The physician's refusal does not appear to involve the elements of conscientious objection to treatment: a moral or religious conviction that it would be wrong to treat the child or to accept the child as a patient.  In a letter sent to the women following their meeting, reproduced in a news report, the physician said, "I felt that I would not be able to develop the personal patient doctor relationship that I normally do with my patients." She apologized for having caused any hurt or angry feelings, and emphasized that they were always welcome in the clinic and could see other physicians there.

2.  News Items

You can search news items by date, country and topic in the Project News/Blog. 

Belgian court grants killer rapist the right to be put to death after he argues he cannot overcome his violent sexual impulses

Belgian serial rapist will not be euthanized: minister

All Saskatchewan doctors must refer for abortions: draft policy

Saskatoon doctor worried about Supreme Court assisted suicide ruling

Anti-vaccination group 'encouraging parents to join fake church' for religious loophole

A modest proposal for respecting physicians' freedom of conscience

Why I support some religious exemptions (though I myself am not religious)

Euthanasia clinic criticised for helping woman with severe tinnitus to die

Euthanasia is so accepted that doctors must now justify prolonging a life

Dying Dutch: Euthanasia Spreads Across Europe

Inside Canada's secret world of medical error: 'There is a lot of lying, there's a lot of cover-up

African church leaders worry about the 'medicalization' of female genital mutilation

Colombia to Finalize Euthanasia Law in March

The Carter v. Canada Conundrum: Next Steps for Implementing Physician Aid-in-Dying in Canada

American Civil Liberties Union: referral for abortion not good enough

Pediatrician won't treat baby with 2 moms

An attack on the conscience rights of physicians

Silencing the Voices of the Faithful in Health Care

Protect doctors' right to choose

Doctors with conscience speak out

If Supreme Court decriminalizes physician-assisted suicide, doctors may be obligated to help with euthanasia

Canada Court Strikes Down Ban on Aiding Patient Suicide

Doctor-assisted suicide a therapeutic service, says Canadian Medical Association

Helping suffering patients die may be doctor's most humane option, Canadian Medical Association says

How far should a doctor go? MDs say they 'need clarity' on Supreme Court's assisted suicide ruling

'This is moral genocide': Canadian doctors blast plans to force them into helping patients procure abortion

Saskatchewan doctors could face discipline over assisted suicide

Groups make effort to protect physicians' conscience rights

Midwives left with £300,000 legal bill after abortion conscience fight

Euthanasia cases leap 73% at cautioned clinic

York Region health care professionals offer mixed views on doctor-assisted suicide

Archbishop of Toronto: trust in physician regulators is misplaced

Ontario policy forcing doctors to have role in abortion will have 'devastating' consequences: bishops' group

Why conscience (or lack of it) is in the news

Keep the state out of the killing rooms of the nation

Why a 'conscience clause' is essential in assisted suicide legislation

Physician-assisted suicide is a non-issue for most MDs

Let it be known that freedom of conscience still matters

3.  Recent Postings

CBC interviewer fails to ask tough questions

Decriminalization of assisted suicide and the violation of our rights

Moral Reflections on Vaccines Prepared from Cells Derived from Aborted Human Foetuses

Supreme Court of Canada orders legalization of physician assisted suicide – AND euthanasia

Torture: sometimes a man's gotta do what a man's gotta do, say bioethicists

Re: College of Physicians and Surgeons of Saskatachewan

Saskatchewan physicians to be forced to participate in killing their patients

Saskatchewan physicians to be forced to do what they believe to be wrong

What is plagiarism? Saskatchewan College of Physicians provides "teachable moment" for students, teachers

Re: College of Physicians and Surgeons of Ontario

Resuts of the first CPSO consultation on Physicians and the Human Rights Code (Ending 5 August, 2014)

College of Physicians, please stand up for religious minorities

Access – or ethical cleansing?

Ethical Cleansing in Ontario

A watchdog in need of a leash: Ontario College of Physicians manipulates consultation process

American Medical Association provides details of new freedom of conscience policy

No legal "duty to refer" for euthanasia or assisted suicide anywhere in the world

4.  Action Items

 None noted. 

5.  Conferences/Papers

The Project will post notices of conferences that are explore and support the principle freedom of conscience, including the legitimate role of moral or religious conviction in shaping law and public policy in pluralist states or societies.

Call for papers:

Thomas Aquinas' Theory of Conscience and Contemporary Debates on Conscientious Objection: Deadline: 15 June, 2015 (Diametros: An Online Journal of Philosophy)

6.  Publications of Interest

Behrens KG.  Why physicians ought not to perform virginity tests.  J Med Ethics doi:10.1136/medethics-2014-102344

Biggar, N. (2015). Why religion deserves a place in secular medicine. Journal of Medical Ethics, 41: 229-233

Bolt EE, Snijdewind MC, Willems DL, van der Heide A, Onwuteak-Philipsen BD.  Can physicians conceive of performing euthanasia in case of psychiatric disease, dementia or being tired of living? J Med Ethics doi:10.1136/medethics-2014-102150

Cheon J, Coyle N, L. Wiegand DL, Welsh S. Ethical Issues Experienced by Hospice and Palliative Nurses. Journal of Hospice and Palliative Nursing. 2015;17(1):7-13.

Nieminen P, Lappalainen S, Ristimäki P, Myllykangas M, Mustonen A-M. Opinions on conscientious objection to induced abortion among Finnish medical and nursing students and professionals.  BMC Medical Ethics 2015, 16:17  doi:10.1186/s12910-015-0012-1

Rich BA.  Your morality, my mortality: conscientious objection and the standard of care.  Camb Q Healthc Ethics. 2015 Apr;24(2):214-30. doi: 10.1017/S0963180114000528

7.  Video

Saskatoon groups concerned over assisted suicide ruling (Global News)

Webcast on Ontario Physicians' Conscience Rights (Catholic Civil Rights League, the Toronto Catholic Doctors' Guild, and Canadian Catholic Bioethics Institute)

Freedom to Care: The Threat to Conscience Rights in Medicine (Christian Medical and Dental Society)

Website and petition launched to protect physician freedom of conscience in Canada

8.  Audio

 None noted.