Doctors can object to procedures, not specific patients, under revised religious discrimination bill

RACGP President Dr Harry Nespolon cautiously welcomed the revisions, saying the college will ‘carefully consider’ the revised bill.

News GP

Doug Hendrie

Under the revisions, conscientious objectors could refuse to provide treatments to which they objected on religious grounds, as long as the refusal is a blanket ban.

Speaking at a press conference, Attorney-General Christian Porter said the revised bill means it would be acceptable for a GP to, for example, refuse to ‘engage in hormone therapies’ for transgender patients broadly, but not for an individual patient only.

The revisions are intended to rule out discrimination, Mr Porter said. . . [Full text]

Woman suing two pharmacies after being denied emergency contraception

The US case brings to light concerns around conscientious objection at a time when a federal religious discrimination bill is being debated in Australia

AJP

Sheshtyn Paola

A woman has filed a lawsuit against a Thrifty White Pharmacy and a CVS Pharmacy in Minnesota in the US, alleging the two pharmacies illegally kept her from accessing emergency contraception.

Andrea Anderson, a 39-year-old mother of five, says she asked the pharmacist at her drugstore in Minnesota more than once why he couldn’t fill her prescription for emergency contraception, according to the Star Tribune.

“I then realised what was happening: he was refusing to fill my prescription for emergency contraception because he did not believe in it,” Ms Anderson said on Tuesday. . . [Full text]

Rules for doctors, pharmacists tightened in new religious discrimination bill

Sydney Morning Herald

Judith Ireland

A pharmacist could refuse to dispense contraception and a doctor could refuse to provide fertility treatment under the government’s proposed new religious discrimination laws, provided they declined to provide that particular service to all patients.

Attorney-General Christian Porter said the second draft of the religious discrimination bill, released on Tuesday, would allow doctors, nurses, midwives, pharmacists and psychologists to conscientiously object as long as it was “to a procedure, not a person”. . . [Full text]

Religious Discrimination Bill may deny ‘vulnerable’ rural patients health care, AMA warns

ABC News

Lauren Roberts

The health of “vulnerable” people living in remote communities across Australia could be put at risk if the Commonwealth pushes ahead with its Religious Discrimination Bill 2019, experts say.

Australian Medical Association NT president Dr Rob Parker has written to Federal Attorney-General Christian Porter asking for significant changes to the proposed legislation.

Dr Parker was concerned conservative doctors could deny vulnerable patients health care on moral grounds, leaving them with few other options. . . [Full text]

A complex issue

Australian Journal of Pharmacy (blog)

Chris Brooker

A majority of Australian pharmacists are in favour of pharmacy playing a dispensing role in physician-assisted suicide, providing there is a clear legislative framework 

The first study to specifically examined the perspectives of Australian pharmacists on physician-assisted suicide (PAS), found more than half of the participants in a series of interviews supported the role of pharmacists in the supply of medicines for PAS. . . [Full text]

Could the threat of lawsuits rein in gender dysphoria doctors?

BioEdge

Michael Cook

Critics of transgender treatment for children have been making heavy weather of persuading people that it could be medically dangerous. However, a well-documented feature in The Australian warns that transgender doctors could face class action suits if they continue to ignore research which claims that children are being harmed. . . [Full text]

Voluntary assisted dying and the role of the GP

With assisted dying debates taking place in parliaments around the country, the question now is: What does it mean for GPs?

RACGP: newsGP

Doug Hendrie

Victoria’s voluntary assisted dying legislation came into effect in June.

With other states like Western Australia and Queensland now moving to introduce similar laws, the question now is – what does assisted dying mean in practice for GPs?

To tackle the practicalities of the process, SBS Insight host Jenny Brockie facilitated an expert panel at the RACGP’s GP19 conference in Adelaide. . . . [Full text]

In the Footsteps of Teiresias: Treatment for Gender Dysphoria in Children and the Role of the Courts

Mike O’Connor, Bill Madden

The Family Court of Australia has stepped back from a previously perceived need for involvement in the approval of stage 1 and stage 2 treatments, for children requiring gender transformation. At present those children and their families who are in agreement need not seek authorisation of the Family Court to undertake either Stage 1 (pubarche blockade with gonadotrophin-releasing hormone agonists) or Stage 2 treatment (cross-hormone therapy such as oestrogen for transgender males). Stage 1 treatment to suppress pubarche would nowadays be commenced at Tanner stage 2 which commences as early as 9.96 years in girls and 10.14 years in boys. Suppression of puberty continues until the age of 16 years when cross hormonal treatment commences. This article questions the assertion that suppression of puberty by GnRH analogues either in cases of precocious puberty or gender dysphoria is “safe and reversible” and argues that it warrants ongoing caution, despite the Family Court having broadly accepted that assertion.


O’Connor M, Madden B. In the Footsteps of Teiresias: Treatment for Gender Dysphoria in Children and the Role of the Courts. J Law Med. 2019 Oct;27(1):149-163.

Kalgoorlie GP calls for euthanasia ‘kill clinics’

Kalgoolrie Miner

Jason Mennell

A longstanding Kalgoorlie-Boulder GP says the State Government should introduce “kill clinics” if proposed euthanasia laws receive the parliamentary seal of approval.

Dr Mal Hodsdon believes it would be “immensely unfair” of politicians to put the onus on GPs to sign off on people’s deaths.

Instead, Dr Hodsdon feels the State Government should take full responsibility by establishing what he calls “kill clinics”, providing a one-stop shop for terminally ill patients wanting to end their lives. . . [Full text]

Abortion law in New South Wales a global first

Freedom of conscience conditional upon gestational age

Sean Murphy*

The Abortion Law Reform Act 2019 No. 11 has become law in New South Wales, Australia. It is obviously modelled on Queensland’s Termination of Pregnancy Act 2018.

The law 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 specialist practitioners find sufficient, including current and future “social circumstances” (6(3)b).

A provision for conscientious objection 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 someone else, to make a decision about whether an abortion should be provided for someone else who is over 22 weeks pregnant (Section 6), or to advise about the performance of an abortion on someone else.

The law 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 someone else [(9(1)a(i) and (ii)], to make a decision about whether an abortion should be provided for someone else who is over 22 weeks pregnant [(9(1)a(iii)], or to advise about the performance of an abortion on someone else [(9(1)a(iv)].

When a woman up to 22 weeks pregnant wants an abortion or advice about an abortion [i.e., under 9(1)a(i) or (ii)], an objecting practitioner is required to disclose his objection [9(2)] explain how she can contact a non-objecting practitioner [9(3)a], or transfer the care of the patient to a practitioner willing to provide an abortion, or to an agency (health service provider) where an abortion can be provided [9(3)b]. 

However, if the woman is over 22 weeks pregnant, a practitioner is obliged to disclose objections to abortion but, if not convinced that the abortion should be performed, is not obliged to facilitate the abortion by explaining how she can contact a non-objecting practitioner or by a transfer of care to a willing colleague. That is because  section 9(3) makes no reference to 9(1)a(iii).

Practitioners who object to abortion in principle and those who object in particular cases are often unwilling to facilitate the procedure by referral, arranging 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 with respect to abortions up to 22 weeks gestation.

On this point Queensland’s Termination of Pregnancy Act, while it also suppresses the exercise of freedom of conscience by physicians who object to referral for abortion, at least does so consistently from conception to birth.

It is possible that the wording of this provision has been been muddled in New South Wales either in an attempt to put an end to the idea that only women can become pregnant, or to avoid the possibility that abortion might not be available to a woman who believes that she is a man, or who believes that she is neither a woman nor a man, but who becomes pregnant.

In any case, New South Wales is the first jurisdiction to make the exercise of freedom of conscience in relation to abortion conditional upon the gestational age of an embryo or foetus.  A physician will be free to fully exercise freedom of conscience at 22 weeks plus one day, but not at 22 weeks minus one day.  The inexact calculation of gestational age contributes further to the arbitrariness of this restriction of fundamental human freedom.