Freedom of conscience in health care: “an interesting moral swamp”?

Responding to Caplan AL. Whose rights come first: Doctors or patients? Medscape, 5 November, 2019

Sean Murphy*

“Whose rights come first?” asks Professor Arthur Caplan in a recent Medscape column. “Doctors’ or patients?”

“You can’t have physicians, pharmacists, nurses, and social workers saying they are not going to do legally allowed medicine or standard-of-care treatment because it violates their rights,” says Professor Caplan. He does suggest that refusal can be allowed if the objector can find a substitute “and it doesn’t disrupt the ER or the organization of healthcare delivery.” . . . 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.

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]

Quebec court hands down ‘robust rejection’ of assisted dying criteria. Here’s what to know

Global News

Maham Abedi

Medically-assisted dying became a discussion point on the second day of the 2019 federal election trail, as leaders reacted to a ruling by the Quebec Superior Court that part of the country’s law is “unconstitutional.”

On Wednesday, a Quebec judge ruled that both the province’s and country’s laws on assisted dying were too restrictive and therefore discriminated against some who sought the procedure. . . [Full text]

Quebec judge invalidates parts of provincial, federal laws for medical aid in dying

Globlal News

Canadian Press

A Quebec Superior Court judge has invalidated sections of both the federal and Quebec laws on medically assisted dying, ruling Wednesday they were too restrictive and therefore unconstitutional.

Justice Christine Baudouin found in favour of two Quebecers struck by incurable degenerative diseases who’d argued they were denied a medically assisted death under laws that are discriminatory. . . [Full text]

Advocates raising money for Saskatoon assisted death facility

Similar to hospice care, The Cider House would provide a homelike space for patients to access the procedure.

Saskatoon Star Phoenix

Amanda Short

A group of health care workers in Saskatoon have started a fundraiser for a dedicated in-patient facility to provide Medical Assistance in Death (MAiD).

Similar to hospice care, The Cider House would provide a homelike space for patients to access the procedure, staffed by either a doctor or nurse practitioner and a team of end-of-life doulas. . . [Full text]

The Role of Nurses When Patients Decide to End Their Lives

Some hospitals and hospices have policies that forbid nurses to be part of the process or even to discuss end-of-life options.

New York Times

Emilie Le Beau Lucchesi

When Ben Wald, 75, was dying of cancer in 2012, he wanted to use Oregon’s Death with Dignity Act to receive a prescription for a lethal medication that would end his life. His hospice nurse, Linda, was part of the discussion and provided both information and support, said his wife, Pam Wald, of Kings Valley, Ore.

His colon cancer had spread to his lungs, and his weight dropped from 180 to 118 pounds. He struggled to speak or eat.

When he was ready to end his life, the couple wanted Linda with them, but the hospice organization she worked for did not allow it, Mrs. Wald said. The organization allowed other hospice workers, such as social workers and massage therapists, to be present, but not the doctors or nurses it employed. . . [Full text]

Doctor Fired after Suing Catholic Hospital over Assisted Suicide

National Review

Wesley J. Smith

Colorado doctor Barbara Morris wants to assist her patient’s suicide. She works at Centura Health, a Catholic/Seventh Day Adventist-owned hospital that prohibits its employees from participating in assisted suicide, legal in Colorado.

Morris sued to be allowed to participate in her patient’s suicide by doctor — which would not happen in the hospital. The hospital responded by firing Morris for violating the terms of her contract by seeking to engage in acts in the context of her employment that violate the hospital’s religiously based moral beliefs.

Morris contends she can’t be prohibited from assisting her patient’s suicide because the Colorado law only allows health care facilities to opt-out if the suicide will occur on-site. The hospital is seeking shelter in the Trump administration’s medical conscience protection policies.

Expect more of these kinds of disputes as many U.S. hospitals are Catholic or otherwise religiously affiliated with churches that reject abortion and assisted suicide doctrinally. From the Kaiser Health News story:

More doctors and patients in the country are providing and receiving health care subject to religious restrictions. About 1 in 6 acute care beds nationally is in a hospital that is Catholic-owned or -affiliated, said Lois Uttley, a program director for the consumer advocacy group Community Catalyst. In Colorado, one-third of the state’s hospitals operate under Catholic guidelines.

The ACLU has already sued several Catholic hospitals over the last few years seeking to force them to violate Church doctrine on issues ranging from sterilization, to abortion, to sex-change surgeries.

Medical conscience disputes are going to become far more common as health care becomes immersed in our accelerating cultural conflicts and vexing questions of federalism. Bottom line: The ultimate goal of those who seek to force medical professionals and institutions to violate their religious beliefs, I believe, is to drive pro-lifers and Hippocratic Oath-adherents out of medicine.