Medical schools should deny applicants who object to provide abortion, assisted death: bioethicist

Global News

Rachel Browne

A bioethicist is calling for medical schools to eliminate applicants who would oppose providing medical services over objections to them based on their personal beliefs.

The call from Udo Schuklenk, a Queen’s University professor and the Ontario Research Chair in Bioethics, comes as the Alberta government grappled with a controversial bill that would have allowed health-care providers to refuse to provide medical care if they object to it on religious or moral grounds. . . [Full text]

David Mackereth: Christian doctor loses trans beliefs case

BBC News

A doctor who refused to use transgender pronouns as people’s chosen sex as it went against his Christian faith has lost his tribunal.

Disability assessor Dr David Mackereth, from Dudley, West Midlands, claimed the Department for Work and Pensions (DWP) breached his right to freedom of thought, conscience and religion.

But a panel ruled his biblical view of what it is to be male and female was “incompatible with human dignity.” . . . [Full text]

OCR Issues Notice of Violation to the University of Vermont Medical Center After It Unlawfully Forced a Nurse to Assist in Abortion

News Release
For immediate release

US Department of Health and Human Services

Contact: HHS Press Office
202-690-6343
media@hhs.gov

The U.S. Department of Health and Human Services (HHS), Office for Civil Rights (OCR) is announcing that, after a thorough investigation and prolonged attempts to resolve the matter, OCR has issued a Notice of Violation letter finding that the University of Vermont Medical Center (UVMMC) violated the Church Amendments (42 U.S.C. 300a-7) by forcing a nurse to assist in an elective abortion procedure over the nurse’s conscience-based objections. OCR also found that UVMMC has discriminatory policies that assign or require employees to assist abortion procedures even after they have recorded their religious or moral objections to assisting in the performance of such abortions. OCR’s Notice of Violation letter asks UVMMC to conform its policies to the Church Amendments and take other corrective action, or face potential action by the HHS component from which UVMMC has received federal funding.

On May 9, 2018, a nurse at UVMMC filed a conscience and religious discrimination complaint with OCR against UVMMC, a medical center in Burlington, Vermont that receives HHS funds, contending that the nurse was forced to assist an abortion in violation of the nurse’s conscience rights. As part of its investigation, OCR contacted UVMMC repeatedly in a good faith effort to seek cooperation from UVMMC, but the hospital refused to conform its policies to federal conscience laws, provide all the documents requested by OCR, or produce witnesses for OCR interviews. Nevertheless, OCR interviewed multiple witnesses and gathered evidence concerning the allegations.

As a result of its investigation, OCR has specifically determined that:

  • UVMMC forced the nurse complainant to assist in an abortion against the nurse’s religious or moral objection. The nurse had expressed an objection for many years and was included in a list of objectors, but UVMMC knowingly assigned the nurse to an abortion procedure. The nurse was not told the procedure was an abortion until the nurse walked into the room, when the doctor—knowing the nurse objected to assisting in abortions—told the nurse, “Don’t hate me.” The nurse again objected, and other staff were present who could have taken the nurse’s place, but the nurse was required to assist with the abortion anyway. If the nurse had not done so, the nurse reasonably feared UVMMC would fire or report the nurse to licensing authorities.
  • OCR spoke with several other UVMMC health care personnel who, since at least the spring of 2017, have been intentionally, unnecessarily, and knowingly scheduled by UVMMC to assist with elective abortions against their religious or moral objections. Such personnel were often not told in advance that the procedures they were being assigned to assist with were abortions. Health care personnel who are coerced in that way suffer moral injury, are subjected to a crisis of conscience, and frequently experience significant emotional distress, even if they succeed in declining to assist in the procedure after the assignment is made.
  • UVMMC maintains a staffing policy that facially violates the Church Amendments because the policy admits to circumstances where UVMMC can and will force staff—on pain of adverse action or discipline—to participate in abortions against their moral or religious objections. The policy also violates UVMMC’s agreement, as a condition of receiving HHS funds, to comply with federal law, including the Church Amendments and HHS’s grants regulations.
  • Consequently, UVMMC is violating 42 U.S.C. § 300a-7(c)(1) of the Church Amendments by discriminating against health-care personnel who have religious or moral objections to abortion, and subjecting them to different terms or conditions of employment than other health-care personnel.

In the Notice of Violation, OCR asks that UVMMC notify OCR within thirty days whether UVMMC intends to work collaboratively with OCR to change its policies so it no longer requires health care personnel to participate in abortion against their religious or moral objections, and to take immediate steps to remedy the effect of its past discriminatory conduct. Otherwise, OCR indicates that it will forward the Notice to the Health Resources and Services Administration (HRSA), a component of HHS that provides grant funds to UVMMC, for consideration and possible additional procedures concerning UVMMC’s receipt of federal funds.  Since October 1998, UVMMC has received—and continues to receive—grants from HRSA.  For the most recently completed three-year project period, which ended April 30, 2018, UVMMC reported that it cumulatively expended $1.6 million of federal financial assistance.

Roger Severino, Director of OCR said, “Forcing medical staff to assist in the taking of human life inflicts a moral injury on them that is not only unnecessary and wrong, it violates longstanding federal law. Our investigation has uncovered serious discrimination by UVMMC against nurses and staff who cannot, in good conscience, assist in elective abortions.”  Severino concluded, “We stand ready to assist UVMMC in changing its policies and procedures to respect conscience rights and remedy the effects of its discrimination.” 

OCR is charged with helping ensure entities come into compliance with federal laws protecting conscience and prohibiting coercion in health care, including the Church Amendments.

ACLJ Vindicates Rights of Vermont Nurse Who Was Unlawfully Forced to Participate in Abortion – HHS Threatens to Pull Medical Center Funding

American Center for Law and Justice

Reproduced with permission

Jay Sekulow*

The ACLJ applauds today’s announcement by the Office of Civil Rights (OCR) of the U.S. Department of Health and Human Services (HHS) regarding a Complaint we filed on behalf of a Vermont nurse who was forced into participating in an abortion procedure against her deeply held religious beliefs.

In our Complaint, we alleged that our client, an operating room nurse at the University of Vermont Medical Center (UVMMC) in Burlington, was coerced into assisting in an abortion in 2017 even though her name was on a list of nurses who, for religious or moral reasons, were conscientiously opposed to such participation and even though other non-objecting nurses were available who could easily have taken her place.

In the more than two decades of work that ACLJ has done to defend the rights of conscience of pro-life health care workers, this is by far the most outrageous case we’ve ever seen. Our client’s most fundamental beliefs about the sanctity of life were simply brushed aside.

Worse, her superiors deliberately misled her into thinking she was assisting in a procedure following a miscarriage. But once trapped inside the OR she discovered that it was, in fact, an elective abortion and that this had been known all along by her superiors who then callously refused to relieve her. To say that she was emotionally traumatized by this event is putting it mildly.

At least four other nurses at UVMMC have confirmed that they too have been subjected to similar violations of their conscience rights. We forwarded them to OCR as part of our Complaint. And after conducting its own thorough investigation of the matter, OCR has substantiated their allegations.

In its announcement, HHS finds that UVMMC has committed violations of the federal Church Amendment – the so-called “conscience clause” – named for the late liberal Idaho Democratic Senator Frank Church. The law was enacted in 1973 as a response to the Supreme Court’s legalization of abortion in Roe v. Wade. In general, it prohibits entities that receive federal funding from discriminating against employees who refuse to perform or assist in the performance of abortions because of their moral or religious beliefs.

But, because the Church Amendment has always lacked a mechanism for enforcement by private citizens, its enforcement has depended on action taken by HHS itself. In the decades since 1973, however, such enforcement has, for all intents and purposes, been nonexistent. With today’s announcement, HHS’s Office of Civil Rights has, at long last, put teeth in a law that has lain largely dormant since its enactment.

HHS has given UVMMC 30 days to come up with a policy that will ensure that the things that happened to our client, and others like her, will not happen again. If they fail to cooperate, they lose their federal funding.

This action by HHS is an enormous step forward toward the full protection of conscience rights of all those in the health care field who recognize the sanctity of all human life. The repercussions of today’s action will be felt in every hospital and health care system in the country.

No longer should pro-life health care professionals have to fear that their values – the values of protecting, not, destroying, life – make them somehow unfit or unsuitable for the healing profession. No nurses, doctors, or other health workers should ever be deliberately trapped in a room and forced to participate in something that their employer knows those workers consider abhorrent at the core of their being.

For over two decades the American Center for Law and Justice (ACLJ) has been at the forefront of advancing and defending the right of free speech and conscientious objection when it comes to the sanctity of human life. In addition to our work with legislators and public policy makers in Washington and around the country, we have also represented dozens of individuals – women and men on the front lines of the pro-life cause – who have found themselves discriminated against because of their pro-life stands. Doctors, nurses, pharmacists, and other health care workers – we’ve gone to court for them before judges and juries from Maine to Hawaii and most points in between.

The ACLJ very much welcomes HHS’s vigorous enforcement of federal conscience rights in this case. No health care worker should be forced to abandon their career because they refuse to abandon their pro-life convictions. If you are a healthcare worker and have experienced a similar situation, please contact us at ACLJ.org/HELP.

Statement on the Denial of Conscientious Objection from the “Effective Referral” Mandate

News Release

Catholic Civil Rights League

Toronto, ON May 15, 2019 – The Catholic Civil Rights League (CCRL) is disappointed with the decision released today of the Ontario Court of Appeal, in CMDS et al v. CPSO.

In its ruling, the unanimous three member panel of the Court of Appeal, comprised of Chief Justice George Strathy, and Appellate Justices Sarah Pepall and J. Michal Fairburn upheld a previous decision from Ontario’s Divisional Court, from January 31, 2018. That ruling denied conscientious exemption from the “effective referral” mandate of the College of Physicians and Surgeons of Ontario (CPSO) for doctors who morally objected to participating in objectionable procedures such as assisted suicide, gender re-assignment surgeries, or abortion.

By way of background, individual Catholic and Christian doctors and several organizations had challenged the CPSO, which over the course of the past four years changed its professional guidelines on professional conduct, forcing Ontario doctors who objected to morally objectionable procedures to provide an “effective referral” to a willing doctor for such services. Previously, doctors were relieved from any such obligation.

Ontario is the only provincial or territorial jurisdiction which has made demands to this extent with its doctors. Other jurisdictions have elected to recognize such conscientious objections, or have provided a means to allow other transfers of a patient’s file, without infringing such rights.

In 2018, the Ontario Divisional Court had ruled in favour of the CPSO, despite finding that the religious freedom of doctors had been infringed. The Applicants appealed.

At the appeal, the CCRL, the Faith and Freedom Alliance (FFA) and the Protection of Conscience Project (PCP), had argued in a joint submission as an intervener that such “effective referrals” made objecting doctors complicit in the provision of the objectionable procedures, such as abortion, or assisted suicide. We argued that the referral requirement imposed the values of the state upon individuals, forcing them to violate their own consciences, without adequate justification.

Our intervention wished to expand the arguments into the area of conscience protection, in addition to religious freedoms asserted by the appellants under s. 2a of the Charter, but those submissions were not pursued by the Court of Appeal.

The Court of Appeal accepted that there was an infringement on the s. 2a rights of the appellants, but that the infringement was justified as a reasonable limit on those rights (para. 187).

The Court of Appeal decision clarified that “non-compliance with the [CPSO] Policies is not an act of misconduct” under the College’s professional misconduct regulations (para. 16), but could be used as evidence of falling below a professional standard if a misconduct allegation were brought (para. 17).

The Court accepted that referrals could be made in a variety of ways, or even by a staff member as a triage engagement (paras. 24-27).

The decision also referred to the availability of other practice arrangements endorsed by the CPSO, to allow doctors to “avoid” the demand for an effective referral, such as working in a hospital setting, or a group practice, if others were prepared to engage in the objectionable treatment, or make the requested referral (paras. 176-187).

The acceptance of such arrangements in the Court’s decision presented a dichotomy. In recognizing the infringement of s. 2a rights, several proposed workarounds were accepted, such as working in a hospital context, or in a group practice where others would be willing to make the referral, or having employees make the referral. Other jurisdictions have avoided the original effective referral demand, or have allowed for conscientious objections outright, which a majority of Ontario doctors supported.

The Court was not persuaded that a demand to change practice or specialty areas constituted a sufficient intrusion into a doctor’s existing practice. That may be a challenge for the typical cancer specialist, or cardiologist, who may be confronted more often with a demand for medical assistance in dying, especially in the absence of available palliative care options. While not underestimating the individual sacrifices that may be required (paras. 186, 187), the court’s answer suggested that it was perhaps time to change one’s specialty, or submit.

The CCRL continues to support Christian or other doctors who have raised serious concerns over the “effective referral” mandate of the CPSO, and look forward to continuing discussions on how best to serve their interests.

Click here to view the written factum of the CCRL, FFA, and PCP, submitted in November 2018, which made reference to important principles of law and philosophy, quoting Martin Luther King Jr., Jacques Maritain, and others.

We submitted that moral rights are central to one’s sense of human dignity, and that it was unacceptable to marginalize objecting physicians as religious extremists. The Ontario Medical Association (OMA) likewise opposed the “effective referral” regime, as representatives of Ontario doctors.

Ontario doctors should be persuaded that it may be time to re-visit these demands with a future Council of the CPSO, for which hopefully conscientious physicians will seek to pursue.

Sometimes change is needed to be undertaken by the governed to secure justice.

The caricature of the conscientiously objecting physician

Objecting doctors are the bad guys, obstructing care.

How will disciplining conscientious doctors or driving them from the profession improve health care?

Physicians’ Alliance Against Euthanasia

Catherine Ferrier

Weary physicianCanadian doctors who object to directly causing the death of their patients, once the near-totality of the profession, have since the enactment of laws permitting “medical assistance in dying” suddenly become outliers. Polling data is unclear, polls are often biased, and there is no doubt that the euthanasia lobby had the ear of media, opinion leaders and politicians long before we knew what they were up to. Be that as it may, we are now told that euthanasia/MAiD is an accepted ‘medical treatment’ that must be provided to those who request it. Many provincial medical colleges, though not requiring doctors to euthanize patients themselves, do expect, to different degrees, that we facilitate their being euthanized by someone else. . . [Full text]

Bolivian doctor to be prosecuted for refusing to perform an abortion

LifeSite News

Jeanne Smits

LA PAZ, Bolivia, March 25, 2019 (LifeSiteNews) — A Bolivian doctor has been suspended by that country’s National Health Fund (Caja Nacional de Salud) for having refused to perform an abortion on a woman pregnant with an anencephalic child. “N.M.,” as he is known, will also be prosecuted before an administrative court, together with the former director of the Jaime Mendoza Workers’ Hospital in Sucre, where the refusal took place.

Abortion is illegal in Bolivia except in cases of rape, incest, danger to the mother’s health, or a lethal malformation of the unborn child.

It was this last case that was invoked by a woman from Cochabamba in February of last year after medical examinations revealed that her baby had a serious congenital malformation. She was five months pregnant. . . [Full text]

Queensland demands practitioners facilitate abortion by referral

Sean Murphy*

The Termination of Pregnancy Act 2018 came into effect in Queensland, Australia, today.

The bill permits abortion up to 22 weeks gestation for any reason; no medical indications are required (Section 5).  Abortion after 22 weeks gestation may be performed for any reason that two practitioners find acceptable (Section6(1)a), including current and future “social circumstances” (6(2)b).

The bill requires disclosure of objections to abortion by a practitioner when asked by someone (not necessarily a patient) to perform or assist in the performance of an abortion on a woman, to make a decision about whether an abortion should be provided for a woman who is over 22 weeks pregnant (Section 6), or to advise about the performance of an abortion on a woman.

When a woman wants an abortion or advice about an abortion for herself, an objecting practitioner is required to refer or transfer the  care of the woman to someone or an agency willing to provide it (Section 3). 

Practitioners who object to abortion in principle and those who object in particular cases are often unwilling to facilitate the procedure by referral, transfers of care or other means because they believe that this makes them parties to or complicit in an immoral act.  Thus, the provision for conscientious objection in the bill actually suppresses the exercise of freedom of conscience by these practitioners.

Thousands step up in support of doctors’ conscience fight

The Catholic Register

Michael Swan

An Ontario campaign to pressure politicians over the protection of health care conscience rights is “democracy in action,” said an organizer.

The Coalition of HealthCARE has so far collected 19,000 names and e-mail addresses in its “Call for Conscience Campaign.” That does not include results from the Archdiocese of Toronto.

The non-partisan campaign was launched to oppose and raise awareness about regulations that force doctors to refer for assisted suicide and euthanasia against their moral convictions.

By the end of March, people who have signed up during the campaign should receive instructions about how to e-mail all the candidates in their ridings in the run-up to Ontario’s June 7 provincial election. . . [Full text]

The courts keep inventing new rights, turning our Charter on its head

National Post
Reproduced with permission

John Carpay

If I told you that I wanted to rob a home or store, would you sell me a gun? Presumably not. But what about giving me the name and contact info of another person who is willing to sell me a gun? If you wanted to avoid any participation in my planned robbery, you would refuse to provide a referral.

When it comes to female genital mutilation (the cutting and removal of some or all of a young girl’s external genitalia) the College of Physicians and Surgeons of Ontario (CPSO) recognizes that referring is as bad as providing. The CPSO prohibits this practice, common in many African and Middle Eastern countries. Female genital mutilation causes infection, disease and death in many girls, and life-long health problems for millions of women.

The CPSO policy prohibits physicians from performing, and from referring for, female genital mutilation procedures. Both performing and referring constitute professional misconduct. The reasoning is obvious. If mutilating a girl is wrong, then it’s also wrong to provide a referral for this barbaric procedure.

College of Physicians and Surgeons of Ontario in Toronto, Ont. on Tuesday April 9, 2013.

Sadly, the CPSO abandoned this common-sense approach in the case of Christian Medical and Dental Society vs. CPSO. This court case was about a challenge to the CPSO policy requiring all doctors in Ontario to provide referrals for abortion, assisted suicide, and other medical procedures which some doctors view as harmful to patients and morally wrong. In court the CPSO argued that “a referral is neither an endorsement of the service for which the referral is provided, nor a guarantee that it will be provided.” The CPSO argued that providing a referral is trivial and insignificant, so a doctor would not be violating her conscience when referring a patient for a procedure that the doctor considers harmful. If the CPSO’s courtroom arguments are true, then why prohibit referring for female genital mutilation?

The Ontario Superior Court of Justice ruled that the CPSO policy violates the Charter freedom of religion and conscience, but then justified this violation as necessary to ensure “equitable” access to health-care services.

Abortion and assisted suicide are both legal medical procedures. Plenty of doctors are available to provide the one, the other, or both. Having to ask two, three or more doctors for a particular medical service is inconvenient for patients, to be sure.

But does the Charter provide citizens with a legal right to be free from inconvenience? Beyond a bald declaration, the court provides no explanation as to how or why being inconvenienced is a violation of the Charter. Nor does the court explain why it is necessary to force every single doctor in Ontario to provide referrals for abortion and assisted suicide. In other words, even if many doctors refuse to provide referrals for these services, the public would still have ready access to both.

The purpose of the Charter is to protect citizens from government. For example, the Charter should protect health-care workers (and everyone else) from being pressured or coerced by a government body to do what one believes to be wrong.

Conversely, there is no Charter right to force another human being to provide a service that runs contrary to their conscience. Interactions between citizens should be free from coercion. A patient’s power to compel a doctor to do what the doctor believes to be harmful is as destructive as a doctor’s power to compel a patient to do what the patient believes to be harmful.

The doctors who challenged the CPSO policy were not merely asking the court to be spared an inconvenience. Rather, an Ontario doctor who refuses to violate her conscience risks expulsion from the medical profession.

In upholding the CPSO policy, the court confuses fundamental Charter freedoms with personal interests and desires. The court has dismissed the Charter’s protection from government coercion as less important than a newly invented “right” to compel our fellow citizens (in this case doctors) to do what we want them to do. The court has turned the Charter on its head.

Lawyer John Carpay is president of the Justice Centre for Constitutional Freedoms (Jccf.ca), which intervened in Christian Medical and Dental Society of Canada vs. College of Physicians and Surgeons of Ontario.