Indiana assisted suicide bill fails to protect objecting practitioners

Assisted suicide evolves from “assistance” to  “medical care”

Affirmation has serious consequences for objecting  Indiana physicians

Sean Murphy*

On 7 January, 2020, Representative Matt Pierce introduced HB1020: End of life options in the Indiana General Assembly. HB1020 is the fourth assisted suicide bill introduced by Pierce since 2017; three previous bills died in committee without hearings. Parts of HB1020 relevant to protection of conscience are reproduced on the Project website.

Overview

The bill permits physician assisted suicide for Indiana residents 18 years of age and older who have been diagnosed with a terminal illness likely to cause death within six months. [Full text]

New Hampshire assisted suicide bill introduced

Protection of conscience provision biased against objectors

Sean Murphy*

New Hampshire House Bill 1659 would legalize assisted suicide. Parts of the bill relevant to protection of conscience are reproduced on the Project website.

The bill permits physician assisted suicide for New Hampshire residents 18 years of age and older who have been diagnosed with a terminal illness likely to cause death within six months. Candidates who are capable of making and  communicating health care decisions must apply in writing for a lethal prescription (137-M:3); the application must be witnessed by two independent witnesses (137-M:4).  The candidate must apply personally; substitute medical decision makers cannot apply on behalf of a patient (137-M:3.III).

The bill imposes a number of obligations on physicians primarily responsible for treating a patient’s terminal illness (137-M:5) and upon physicians consulted by them about the illness (137-M:6).  These would be unacceptable to physicians who refuse to participate in assisted suicide for reasons of conscience.

Section 137-M:14 (Immunities) is the provision that is intended to protect objecting health care providers, which includes individuals and health care facilities.  The protection offered is biased in favour of those willing to participate in assisted suicide and insufficient to protect those unwilling to do so.  Specifically:

  • 139-M:14.I limits protection against civil, criminal and professional liability to persons willing to participate in assisted suicide; no protection is provided for those who refuse. It also prevents objecting institutional health care providers from taking action against employees who participate in assisted suicide on their premises.
  • 139-M:14.II protects both participants and non-participants equally, but also prevents objecting institutional health care providers from taking action against individuals who ignore prohibitions against assisted suicide on their premises.
  • 139-M14.III protects those providing assisted suicide drugs against negligence complaints, but does not similarly protect those who refuse to provide assisted suicide drugs.
  • 139-M14.IV declares that no health care provider is under a duty to participate in assisted suicide.  However, the provision is ambiguous because it is inconsistent with the lack of protection noted in 139-M4.I and III. 

Alberta’s conscience rights bill

Western Standard
Reproduced with permission

John Carpay

Bill 207 enshrines “freedom of conscience and religion” – protected by the Canadian Charter of Rights and Freedoms– for Alberta’s health care providers. For many years, Premier Jason Kenney has consistently and publicly supported protecting freedom of conscience, so nobody should be surprised if he supports this Private Member’s Bill.

Bill 207 will not limit patient access to abortion. Firstly, abortion does not require a referral, as any abortion clinic will tell you when you call and ask. Secondly, even if abortion did require a referral, if one physician refuses to provide such referral then the patient would simply go to another doctor. Inconvenient? Yes, absolutely. In a free country, the right to honour one’s conscience trumps someone else’s interest in not being inconvenienced.

Forcing someone to do something that they believe to be wrong is serious business. It is also a hallmark of totalitarian states. But in free and democratic societies, the government will bend over backwards to avoid coercing citizens to participate in what they see as evil. This is why the Charter describes freedom of conscience and religion as “fundamental,” and mentions it ahead of the freedoms of expression, association and peaceful assembly.

When a democracy is at war, the pacifists who oppose killing another human being will not be required by government to serve on the front lines and shoot at foreign troops. A democracy can continue with its war efforts without requiring every citizen to be willing to kill enemy soldiers.

Just because pork is legal and popular does not mean that all butchers should be forced, by law, to sell it. Some Muslim and Orthodox Jewish butchers will refuse to handle or sell pork, and no doubt this refusal will inconvenience some customers. The disappointed customers will need to go elsewhere, upon learning that the store they travelled to does not carry what they want.

The BC Human Rights Tribunal recently issued a pro-freedom ruling that female estheticians could refuse to wax the male genitalia of Jessica (Jonathan) Yaniv, for religious and other reasons. Yaniv will be inconvenienced by having to locate a waxologist who is willing and able to provide a Brazilian bikini wax for male genitals. But not forcing women to handle male genitalia is more important than sparing someone the inconvenience of going elsewhere.

Put simply: in a free society, you do not have the right to require other people to do things that they do not wish to do. In a free country, nobody has a legal right to be free from the inconvenience of needing to look elsewhere for a product or service. This respect for freedom is consistent with – or is supposed to be consistent with – the philosophy of the United Conservative Party.

Bill 207 protects doctors from being required to assist their patients in committing suicide, as one example of a medical service that some doctors see as wrong. Many non-religious doctors believe on conscientious grounds that suicide is not a valid or legitimate medical treatment.

Providing a referral is active participation. This is why the Colleges of Physicians and Surgeons of Ontario prohibits doctors from performing female genital mutilation (FGM) and also prohibits doctors from referring for this medical service. If it’s wrong to remove portions of a young girl’s genitals, then it’s also wrong to refer her to another doctor who will provide that same service.  As in Ontario, Alberta’s College states that “no physician should perform such procedures, irrespective of cultural norms in other societies, and no physician should be complicit in allowing such procedures to go ahead.” To refer for FGM is to be complicit in FGM. Requiring doctors to refer for a service they believe to be wrong is to violate the conscience of doctors.

And yet the Alberta College of Physicians and Surgeons requires doctors to refer for assisted suicide. Bill 207 addresses this problem by protecting the fundamental Charter freedoms of doctors and other health care providers. A vote for Bill 2017 is a vote for freedom.

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]

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.

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.

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]

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]