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.

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.

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]

A Philosophical Defense of Conscientious Objection to Abortion

Medical Bag

Medical Bag Contributing Writer

In an article published in the Journal of Medical Ethics, Bruce Philip Blackshaw of the department of philosophy at the University of Birmingham, United Kingdom, and Daniel Rodger from the School of Health and Social Care, London South Bank University, United Kingdom, defended conscientious objection to abortion provision, claiming that the usual arguments critics make for disqualifying conscientious objection in healthcare do not apply in cases of abortion. . . [Full text]

New Northern Ireland abortion law ‘may give health staff no choice’

Midwife voices fear for conscientious objectors if NI legislation changes

Belfast Telegraph

Allan Preston

Health workers in Northern Ireland could be left “exposed” by changes to abortion law, a lecturer in midwifery has claimed.

Debbie Duncan spent over 30 years working as a midwife in Scotland and England and now lectures at the school of nursing and midwifery at Queen’s University Belfast.

She was never obliged to take part in abortions during her career as the law allowed her to conscientiously object.

Ms Duncan said she fears “too much change with no regulation” means the same protections may not apply here. . . [Full text]

Two counties still without any GPs offering abortion as just 13pc sign up to the service

Irish Independent

Cormac McQuin

Just 13pc of GPs have signed up to provide abortion services and there are still two counties where there are no family doctors offering terminations.

The latest figures show that there are now 337 GPs around the country who have signed the contract to provide the service. . . [Full text]

Conscientious objection obstacle to safe terminations: Qld Government

Concerns have been raised that increasing numbers of doctors with objections to abortion may threaten a woman’s ability to seek a termination

NewsGP

The head of the State Government’s healthcare improvement agency, Clinical Excellence Queensland, recently wrote to the RACGP calling for better management of conscientious objection to termination of pregnancy.

But the RACGP [Royal Australian College of General Practitioners] maintained its view that conscientious objection is necessary. . . [Full text]

Korean doctors categorize 12 cases to refuse treatment

Korean Biomedical Review

Song Soo-youn

The local medical community’s voice is growing for doctors’ rights to refuse to treat a patient, but patients are against the idea. However, the U.S. and Europe have already recognized such rights.

Based on examples in other countries, Korean physicians should also be allowed to refuse treatment in particular situations such as a forced surgery to terminate a fetus, a report said.

The Korean Medical Association (KMA)’s Medical Policy Research Institute released the report, “Status and Challenges of Treatment Refusal,” on Thursday. The institute analyzed examples in other countries and offered 12 situations where doctors can refuse to deliver treatment services. . . [Full text]

Protection of conscience an issue in backbench revolt on Australian abortion bill

Demand for compulsory referral by objecting physicians among provisions deemed unacceptable

Sean Murphy*

Two Liberal Members of Parliament in New South Wales, Australia, have threatened to break with their party cross the floor to sit in opposition if the government does not make changes to a bill decriminalizing abortion (the Reproductive Health Care Reform Bill 2019). Should they do so, the government will lose its parliamentary majority.

Among the amendments Tanya Davies and Kevin Conolly are seeking is removal of a requirement that objecting physicians provide patients with contact information for non-objecting colleagues.

If the bill passes unamended, a physician will be free to fully exercise freedom of conscience at 22 weeks plus one day (when there is no requirement to provide contact information), but not at 22 weeks minus one day (when the bill requires contact information to be supplied.)  The inexact calculation of gestational age contributes further to the arbitrariness of this restriction of fundamental human freedom. (See Abortion bill in New South Wales a global first)

Questionable benefits and unavoidable personal beliefs: defending conscientious objection for abortion

 Bruce Philip Blackshaw, Daniel Rodger

 Abstract

Journal of Medical Ethics

Conscientious objection in healthcare has come under heavy criticism on two grounds recently, particularly regarding abortion provision. First, critics claim conscientious objection involves a refusal to provide a legal and beneficial procedure requested by a patient, denying them access to healthcare. Second, they argue the exercise of conscientious objection is based on unverifiable personal beliefs. These characteristics, it is claimed, disqualify conscientious objection in healthcare. Here, we defend conscientious objection in the context of abortion provision. We show that abortion has a dubitable claim to be medically beneficial, is rarely clinically indicated, and that conscientious objections should be accepted in these circumstances. We also show that reliance on personal beliefs is difficult to avoid if any form of objection is to be permitted, even if it is based on criteria such as the principles and values of the profession or the scope of professional practice.


Blackshaw BP, Rodger D. Questionable benefits and unavoidable personal beliefs: defending conscientious objection for abortion. J Medical Ethics 2019 Aug 31. pii: medethics-2019-105566. doi: 10.1136/medethics-2019-105566. [Epub ahead of print]