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Physician, heal thyself: the potential crisis of conscience in Canadian medicine

What if your faith in doctors having conscience was shaken?

The Globe and Mail
Reproduced with permission

Gabrielle Horne*

“I’m really sorry,” I said, picking the magnifying glass off the floor and checking it wasn’t cracked. “I think it’s okay.”

It was my third day on the witness stand, testifying against doctors from the hospital where I still worked. I couldn’t read the tiny numbers on the document disclosing how much my colleagues were paid, and the hospital lawyer had offered it to me, to end the theatre.

“He’s just softening you up before cross-examination,” my lawyer had said with a wry smile, standing at the podium.

Afterward, I wondered why I’d apologized, in a full courtroom, to this man who had taken a wrecking ball to my life over the previous 10 years. Then it occurred to me: to apologize is a sign of a conscience.

Doctors are expected to have one. Their job is to heal the sick and save lives, and that role evokes an image and expectation of beneficence – doing only good. Doctors invest in that image when they espouse a code of conduct descended from the Hippocratic oath: “I will use treatment to help the sick according to my ability and judgment, but never with a view to injury and wrongdoing.” Patients also invest in that image and expectation. When illness strikes, they must often put their lives, their confidence and their most vulnerable selves in the hands of doctors they barely know. The expectation of conscience is at the core of the medical pact.

But what if your faith in doctors having conscience was shaken? [Full text]

Photo by Matthew Henry from Burst

Medical conscience for me, but not for thee

Promoting a one-way conscience right favouring the medical intelligentsia

National Review

Wesley J. Smith*

The New York Times has published an opinion column by cardiologist Sandeep Jauhar that decries the Trump administration’s increased enforcement of medical conscience. But he actually promotes a one-way conscience right that favors protecting the predominate ideological views of the medical intelligentsia, while forcing dissenters to sacrifice their own religious and moral beliefs. . . [Full text]

Nova Scotia hospital forced to provide euthanasia, assisted suicide

Services to be provided in attached building

Arrangement said to preserve Catholic identity

Sean Murphy*

Hospital

St. Martha’s Regional Hospital in Antigonish, Nova Scotia, will begin providing euthanasia and assisted suicide (EAS). The hospital had refused to provide the services because they were considered to be contrary to the Catholic identity of the hospital. The change of policy appears to have been forced by the threat of a lawsuit by EAS advocates. A campaign to force the hospital to permit EAS services had been ongoing for some time [See 958 days without medical assistance in dying policy, Ban on assisted dying at St. Martha’s hospital should end, says law prof].

St. Martha’s was established by a Catholic religious order, the Sisters of St. Martha. However, in 1996 the order transferred ownership of the hospital to the state. The terms of the transfer were set out in a “Mission Assurance Agreement” that required the state to ensure that “the philosophy, mission and values of St. Martha’s Regional Hospital would remain the same and the hospital would keep its faith-based identity.”1

Notwithstanding the terms of the agreement, from 1996 the hospital was not legally a private or Catholic institution, even though it is popularly known as “Nova Scotia’s only Catholic hospital .”2 EAS advocates argued that state ownership of the hospital made it a state actor obliged to provide euthanasia and assisted suicide.1 Logically, this would also apply to abortion, surgical sterilizations, and other procedures contrary to Catholic teaching.

The Nova Scotia Health Authority states that the change of policy is consistent with “the spirit of the Mission Assurance Agreement,”3 which seems to imply that a way has been found for the hospital to “keep its [Catholic] faith-based identify” while providing euthanasia and assisted suicide.

According to NSHA’s Vice President of Health Services and Chief Nursing Executive Tim Guest, euthanasia and assisted suicide will be provided in the Antigonish Health and Wellness Centre, formerly the Martha Center.4

Built in 1961, the Antigonish Health and Wellness Center is attached to St. Martha’s Regional Hospital. In 2009, still known as the Martha Center, it was described as “primarily a professional building” of 92,000 square feet that had undergone major renovations between 2006 and 2009.5

The Sisters of St. Martha have issued a statement:

The Sisters of St Martha were informed that the Nova Scotia Health Authority continues to uphold our Mission Assurance Agreement, while providing access in Antigonish for individuals who request Medical Assistance in Dying (MAID).

The Nova Scotia Health Authority has assured us that Medical Assistance in Dying (MAID) will not take place in St. Martha’s Regional Hospital. We do not own St. Martha’s Regional Hospital, or the building called the Antigonish Health and Wellness Center. . . 6

It is not clear from the statements if assessments and preliminaries for euthanasia/assisted suicide will occur in the hospital building, with actual administration of lethal medication taking place in the Health and Wellness Center.

1. Downie J, GilbertD. Nova Scotia now a leader in medical assistance in dying [Internet]. The Chronicle Herald. 2019 Sep 19.

2. Willick F. Ban on assisted dying at St. Martha’s hospital should end, says law prof [Internet]. CBC News. 2018 Dec 28.

3. Lord R, Quon A. NSHA quietly changes medically assisted dying policy at Catholic hospital [Internet]. Global News. 2019 Sep 18.

4. 989XFM. Nova Scotia Health Authority allows Medically Assisted Death at St. Martha’s Regional Hospital [Internet]. 2019 Sep 19.

5. Guysborough Antigonish Strait Health Authority. Request for Proposal: Radio Frequency (RF) Wireless Site Survey [Internet]. 2009 Apr 17.

6. Boisvert B. Sisters of St. Martha Media Statement [Internet]. 2019 Sep 19.

Pope Francis on conscientious objection by health care practitioners

La Croix misrepresents papal statement

Sean Murphy*

Pope FrancisAn article in La Croix International, “Pope reminds health workers to put patients first” includes a subtitle, “Conscientious objectors told that human dignity demands exceptions sometimes be made.” (La Croix International, 20 May, 2019)

The subtitle reflects speculation by critics unidentified by the article’s anonymous author(s) that the Pope’s comments were aimed at “pro-lifers who may object to performing an abortion, even though the mother may, for various reasons, risk serious and even life-threatening physical or psychological trauma should she try to conceive.”

La Croix appears to be alone among news agencies in putting this “spin” upon the Pope’s address (Compare reports by Crux, Vatican News, ANSA, and the Catholic Herald, for example).

“[T]o put patients first” accurately conveys one of Pope Francis’ messages to the Italian Catholic Association of Health Care Workers.

“Conscientious objectors told that human dignity demands exceptions sometimes be made” does not.

Nothing in the text of the of the Pope’s address remotely suggests that human dignity sometimes requires health care workers to set aside their conscientious convictions and their objections and do what they believe to be wrong.

Pope Francis said nothing of the kind.  But that is precisely the kind of demand made by activists and even state authorities in a number of countries, even (as in Canada) to the extent of forcing unwilling practitioners to be parties to killing their patients or helping them commit suicide.

The misrepresentation exemplified in the La Croix article supports such attacks on freedom of conscience (and religion) and exacerbates the problems faced by healthcare practitioners attempting to resist them.

What Pope Francis actually had to say warrants attention by anyone who wants to understand the exercise of freedom of conscience by health care practitioners.

He noted that “any medical practice or intervention on the human being must first be carefully assessed if it actually respects human life and dignity (“di ogni pratica medica o intervento sull’essere umano si deve prima valutare con attenzione se rispetti effettivamente la vita e la dignità umana.”) .

When health care practitioners refuse to provide procedures or services, it is typically because they have made that assessment,and consider the interventions contrary to the good of the human person and subversive of the integrity and dignity of human life: in brief, harmful to the patient.

Conscientious objection in such circumstances, the Pope said, does not just reflect the need to preserve one’s personal integrity, but “also represents a sign for the healthcare environment in which we find ourselves, as well as for the patients themselves and their families” ( “ma rappresenta anche un segno per l’ambiente sanitario nel quale ci si trova, oltre che nei confronti dei pazienti stessi e delle loro famiglie. “)

In many situations, this “sign” may well be a sign of contradiction to the dominant ethos, likely to trigger violent emotional reactions and repression by state or professional authorities. Hence, for purely pragmatic reasons, it behooves objecting practitioners to be careful in expressing themselves. Beyond this, Pope Francis offers advice that reflects the actual practice of practitioners who responsibly exercise freedom of conscience:

La scelta dell’obiezione, tuttavia, quando necessaria, va compiuta con rispetto, perché non diventi motivo di disprezzo o di orgoglio ciò che deve essere fatto con umiltà, per non generare in chi vi osserva un uguale disprezzo, che impedirebbe di comprendere le vere motivazioni che ci spingono. È bene invece cercare sempre il dialogo, soprattutto con coloro che hanno posizioni diverse, mettendosi in ascolto del loro punto di vista e cercando di trasmettere il vostro, non come chi sale in cattedra, ma come chi cerca il vero bene delle persone. Farsi compagni di viaggio di chi ci sta accanto, in particolare degli ultimi, dei più dimenticati, degli esclusi: questo è il miglior modo per comprendere a fondo e con verità le diverse situazioni e il bene morale che vi è implicato.

The choice of the objection, however, when necessary, must be made with respect, so that what must be done with humility, so as not to generate an equal contempt, which would prevent the understanding of the true motivations that drive us. Instead, it is good to always seek dialogue, especially with those who have different positions, listening to their point of view and trying to transmit yours, not as someone who goes up in the chair, but as someone who seeks the true good of people. Be the traveling companions of those around us, especially the last, the most forgotten, the excluded: this is the best way to fully understand the different situations and the moral good that is involved.

Source: Libreria Editrice Vaticana, Discorso del Santo Padre Francesco all’ Assocziazone Cattolica Operatori Sanitari (ACOS).  Sala Clementina, Venerdì, 17 maggio 2019.

Photo by Nacho Arteaga on Unsplash

Maine, assisted suicide, and freedom of conscience

Accommodation of objecting physicians convoluted and unsatisfactory

Sean Murphy*

Introduction

Maine’s Death with Dignity Act1 was signed by the state governor on 12 June, 2019,2 to take effect on 18 September.  By the last week in August, physicians in the state were deeply divided and significant institutional health care providers were expected to opt out.3

In reviewing the Act, the Project focus is on sections relevant to the protection of those who refuse to provide or facilitate suicide for reasons of conscience.  These are convoluted and unsatisfactory.  In brief, the Act

  • imposes obligations on physicians that may be unacceptable to those who unwilling to facilitate assisted suicide,
  •  provides insufficient protection for objecting physicians not employed or by or under contract with an objecting institution,
  •  limits the ability of objecting health care facilities to maintain institutional integrity. . . [Full text]

New Jersey assisted suicide law and freedom of conscience

Lack of clarity on referral  is unsatisfactory

Sean Murphy*

Overview

New Jersey’s Medical Aid in Dying for the Terminally Ill Act1 came into effect on 1 August, 2019.2

The Act permits physician assisted suicide for any resident of New Jersey who is 18 years of age or over, who can make and communicate informed health care decisions, who has been diagnosed with a terminal illness and who is likely to die within six months. Physicians assist by providing a prescription for lethal medication.  The patient must make two oral requests for the medication 15 days apart, and a written request.  Two physicians must agree that the patient is decisionally competent and meets the medical criteria.  Additional consultation is required if there is concern about psychological or psychiatric conditions that may impair a patient’s judgement.  . .[Full text]

Assisted-death lawsuit adjourned, government evidence widens eligibility: lawyer

More Canadians eligible for assisted death: lawyer

The Chronicle Journal

Laura Kane

VANCOUVER – The British Columbia Civil Liberties Association and a woman with a degenerative illness have adjourned their lawsuit challenging the federal assisted-dying law after they say government evidence expanded eligibility for the procedure.

The law says that only people who have a “reasonably foreseeable” natural death qualify, but a government expert has filed a report that states some doctors are now interpreting this category to include people who refuse care that would prolong their lives. . . . [Full text]

Court reinstates lawsuit against Catholic hospital for refusing transgender patient’s surgery

Los Angeles Times

Michael Hiltzik

Stating that California’s interest in fighting discrimination against LGBTQ residents outweighs the right to impose religious standards on healthcare, an appeals court has reinstated a lawsuit against the Catholic Dignity Health hospital chain for barring a hysterectomy for a transgender patient.

The lawsuit was brought by Evan Minton, whose hysterectomy was abruptly canceled by Dignity’s Mercy San Juan Medical Center of Carmichael, Calif., in 2016 when hospital officials learned he was transgender. The hospital took the action to comply with the church’s Ethical and Religious Directives for Catholic Health Care Services, which prohibit sterilization procedures except in very narrow circumstances. . . [Full text]

USCCB Poll: Americans Support Conscience Protection for Healthcare Professionals

News Release

US Conference of Catholic Bishops

September 18, 2019

WASHINGTON, D.C. – Two new polls have revealed widespread discrimination against healthcare workers of faith, as well as broad public support for conscience rights laws and protections. The findings were released today by the United States Conference of Catholic Bishops (USCCB) Committees on Pro-Life Activities; Religious Liberty; Domestic and Social Development; and the Subcommittee for the Promotion and Defense of Marriage, as well as the Christian Medical & Dental Associations (CMDA), the largest faith-based association for healthcare professionals.
 
The findings come in the wake of enforcement actions taken by the U.S. Department of Health and Human Services (HHS) against the University of Vermont Medical Center, which is alleged to have coerced a nurse into participating in an abortion against her beliefs.

Archbishop Joseph F. Naumann, of Kansas City in Kansas and Chairman of the Committee on Pro-Life Activities; Bishop Robert J. McManus, of Worcester and Chairman of the Committee for Religious Liberty; Bishop Frank J. Dewane, of Venice, and Chairman of the Committee on Domestic Justice and Human Development, and Bishop James D. Conley, of Lincoln and Chairman of the Subcommittee for Promotion and Defense of Marriage offered the following statement on the findings:

“An overwhelming majority of Americans agree: no healthcare professional should be forced to violate deeply-held beliefs in order to keep a job. The practice of medicine depends on those courageous and generous enough to serve all people—especially the poor and marginalized—with the highest ethical standards. If we exclude people of faith from the medical profession, Americans will suffer, especially those most in need.”

For more information, click here: http://www.usccb.org/about/pro-life-activities/conscience-protection-teleconference.cfm

Media Contact:
Chieko Noguchi
202-541-3200

Christian Medical & Dental Associations reveal national survey findings on healthcare and conscience

News Release

Christian Medical & Dental Associations

Washington, D.C., September 18, 2019 — The Christian Medical & Dental Associations (CMDA ), the nation’s largest faith-based association of health professionals, today released findings of a national survey showing that conscience-protecting laws and regulations help protect patient access to health care while addressing rampant discrimination against faith-based health professionals.

The survey, a nationwide poll of faith-based health professionals, conducted by Heart and Mind Strategies, LLC, found that 91 percent said they would have to “stop practicing medicine altogether than be forced to violate my conscience.” That finding holds significant implications for millions of patients, especially the poor and those in underserved regions who depend upon faith-based health facilities and professionals for their care.

The survey of faith-based health professionals also found that virtually all care for patients “regardless of sexual orientation, gender identification, or family makeup, with sensitivity and compassion, even when I cannot validate their choices.” The finding puts the lie to the charge that somehow conscience protections will result in whole classes of patients being denied care.

“Faith-based health professionals actually seek out and serve marginalized patients to provide compassionate care, ” explained CM D A CEO Emeritus Dr. David Stevens. “All we ask as we serve is that the government not intrude into the physician-patient relationship by dictating that we must do controversial procedures and prescriptions that counter our best medical judgment or religious beliefs .”

CM DA is currently represented by the Becket law firm in two related cases: Franciscan Alliance v. Azar , which addresses an Affordable Care Act transgender mandate, and New York v. HHS, which addresses a new federal conscience protection rule.

Detail on the poll of faith-based professionals can be found at CMDA-Poll and Freedom2Care.org

The RH Act (2012) in brief

Appendix “B” of Philippines RH Act: Rx for controversy

Sean Murphy*

An outline of principal sections of the Responsible Parenthood and Reproductive Health Act of 2012 relevant to freedom of conscience.

SEC. 1. Title
  • [Not reproduced here]
SEC. 2. Declaration of Policy

The State recognizes and guarantees the human rights of all persons,1 including their right to equality and nondiscrimination of these rights, the right to sustainable human development, the right to health which includes reproductive health,2 the right to education and information, and the right to choose and make decisions3 for themselves in accordance with their religious convictions, ethics, cultural beliefs and the demands of responsible parenthood.4 . . . [Full text]