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]

Nova Scotia hospital forced to provide euthanasia, assisted suicide

State health authority says arrangement preserves 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.

Notes

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.

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]

Philippines population control and management policies

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

Sean Murphy*

Establishment of POPCOM

In 1967, President Ferdinand Marcos joined other world leaders in adding his signature to a Declaration on Population that had been made the previous year by representatives of 12 countries (often incorrectly cited in Philippines government documents as “the UN Declaration on Population”).1 Two years later, Executive Order 171 established the Commission on Population (POPCOM), and in 1970 Executive Order 233 empowered POPCOM to direct a national population programme.2

The Population Act

The Population Act [RA 6365] passed in 1971 made family planning part of a strategy for national development. Subsequent Presidential Decrees required increased participation of public and private sectors, private organizations and individuals in the population programme.3

Under President Corazon Aquino (1986 to 1992) the family planning element of the programme was transferred to the Department of Health, where it became part of a five year health plan for improvements in health, nutrition and family planning. According to the Philippines National Statistics Office, the strong influence of the Catholic Church undermined political and financial support for family planning, so that the focus of the health policy was on maternal and child health, not on fertility reduction.4

The Population Management Program

The Ramos administration launched the Philippine Population Management Program (PPMP) in 1993. This was modified in 1999, incorporating “responsible parenthood” as a central theme.3 During the Philippines 12th Congress (2001-2004) policymakers and politicians began to focus on “reproductive health.”5

Responsible Parenthood and Family Planning Program

In 2006 the President ordered the Department of Health, POPCOM and local governments to direct and implement the Responsible Parenthood and Family Planning Program.

The Responsible Parenthood and Natural Family Planning Program’s primary policy objective is to promote natural family planning, birth spacing (three years birth spacing) and breastfeeding which are good for the health of the mother, child, family, and community. While LGUs can promote artificial family planning because of local autonomy, the national government advocates natural family planning.3

Population policy effectiveness and outcomes

The population of the Philippines grew steadily from about 27million in 1960 to over 100 million in 2018. Starting from similar populations in 1960, Thailand, Myanmar and South Korea now have much lower populations (Figure 1) . . . [Full text]

Philippines RH Act: Rx for Controversy

Diatribe by Philippines’ President turns back the clock

Sean Murphy*

Abstract

Turning back the clock

In June, 2019, Philippines President Rodrigo Duterte blamed the Catholic Church for obstructing government plans to reduce the country’s birth rate and  population.  “They think that spewing out human beings by the millions is a gift from God,” he claimed, adding that health care workers should resign if they are unwilling to follow government policy on population control for reasons of conscience.

Duterte’s authoritarian diatribe clashes with a ruling of the Supreme Court of the Philippines and turns the clock back to times of harsh and extreme rhetoric when the current law (commonly called the RH Act) was being developed.  The RH Act was the product of over fourteen years of public controversy and political wrangling. It was of concern when it was enacted because it threatened some conscientious objectors with imprisonment and fines. 

In January, 2013, the Project reviewed the Act in detail.  Project criticisms about the law’s suppression of freedom of conscience were validated in April, 2014, when the Supreme Court of the Philippines struck down sections of the law as unconstitutional.

Given the long history of attempts at legislative coercion in the Philippines and President Duterte’s obvious hostility to freedom of conscience and religion in health care, the Project’s 2013 review of the RH Act is here updated and republished.

Assuming that the Philippines government’s concern about population growth in the country is justified, it does not follow that it is best addressed by the kind of state bullying exemplified by President Duterte’s ill-tempered and ill-considered eruption.  Aside from the government’s enormous practical advantage in its control of health care facilities, it has at its disposal all of the legitimate means available to democratic states to accomplish its policy goals.  Not the least of these is persuasive rational argument, an approach fully consistent with the best traditions of liberal democracy, and far less dangerous than state suppression of fundamental freedoms of conscience and religion.

TABLE OF CONTENTS

Turning back the clock

A history of coercive legislative measures

Background

The “RH Act” of 2012: General comments

The “RH Act” of 2012: Specific provisions

Freedom of conscience and religion

The Supreme Court weighs in

The way forward

Appendix “A”:  Philippines population control and management policies

Appendix “B”: The “RH Act” (2012)  in brief

Project Comments