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]

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

Coalition’s religious discrimination bill goes far, but not far enough

The Sydney Morning Herald

Reproduced with permission

Xavier Symons*

It is no surprise that the Religious Discrimination Bill is being criticised as too strong by aggressive secularists and too weak by people of faith. Federal Attorney-General Christian Porter describes the bill as a “shield against discrimination”, not a sword.

The fundamental point is that this is not a religious freedom bill. It is a religious discrimination bill with a narrow focus on a very specific set of issues.

It characterises religious belief as a “protected attribute” of individuals akin to age, sex or sexual orientation. This is unlikely to satisfy many religious stakeholders who believe that religion is a positive good, not just for individuals (like sexual orientation), but also for communities. . . [Full text]

Drafting error in abortion bill

Eternity

John Sandeman

The “Reproductive Health Care Reform Bill 2019 – which decriminalises abortion in NSW – has a drafting error in it, according to Freedom For Faith‘s Michael Kellahan.

The drafting error makes the “conscientious objection” provision in the bill much less effective, despite being designed to protect medical practitioners who do not wish to be involved in abortion.

The effect is that the protection is not operative where the pregnant woman herself asks for a termination of the pregnancy. . . [Full text]

WA’s take on assisted dying has many similarities with the Victorian law – and some important differences

The  Conversation

Ben White, Katrine  Del Villar, Lindy  Wilmott, Rebecca Meehan

Western Australia may soon become the second Australian state to permit voluntary assisted dying, with the release on Tuesday of its Voluntary Assisted Dying Bill 2019.

As in Victoria, whose law is now just under two months old, the bill was the product of reviews by a parliamentary committee and ministerial expert panel. It’s expected to be debated in the Western Australian parliament in three weeks.

So how does what’s being proposed compare to the law in Victoria? . . . [Full text]

Abortion bill in New South Wales a global first

Freedom of conscience conditional upon gestational age

Sean Murphy*

The Legislative Assembly in New South Wales, Australia, has passed a bill decriminalizing abortion. It is obviously modelled on Queensland’s Termination of Pregnancy Act 2018.

The Reproductive Health Care Reform Bill 2019 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 practitioners find acceptable (Section6(1)a), 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.

When a woman up to 22 weeks pregnant wants an abortion or advice about an abortion, an objecting practitioner is required to explain how she can contact a non-objecting practitioner, 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. 

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 (Section 9(3)).

Practitioners who object to abortion in principle and those who object in particular cases are often unwilling to facilitate the procedure by referral, 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 may become 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.  If the bill passes, 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.

Euthanasia bill falls short on freedom of conscience

Objecting students unprotected, refusal may incur civil, criminal liability

Sean Murphy*

Western Australia’s Voluntary Assisted Dying Bill 2019 includes provisions intended to protect all registered health practitioners who refuse to participate for reasons of conscience. By virtue of the Health Practitioner Regulation National Law (Western Australia) this includes nurses, midwives, pharmacists, radiologists, psychologists and other professions.

However, the bill explicitly excludes students, probably to ensure that only non-student practitioners are permitted to accept and process requests, assess patients and provide euthanasia or assisted suicide (EAS).  Unfortunately, the effect of this exclusion is that nothing in the bill prevents students from being required to participate in all aspects of EAS delivery under the direction of a fully qualified registered health practitioner, or making such practical training a requirement for professional qualification.  This would be inconsistent with one of the guiding principles in the bill (Section 4(1)j), so it may be an oversight that will be corrected during the legislative process.

Fully qualified registered health practitioners may refuse to participate in the request and assessment process, prescription, supply or administration of lethal drugs, and to be present when the drugs are administered (Section 9(1)).  The bill further states that, by identifying these actions, it does not intend “to limit the circumstances in which a registered health practitioner may refuse” to do them (Section 9(2)).  This would seem to extend protection to include refusal to do do things not specified in the section, but obviously related to providing euthanasia or assisted suicide, like setting an intravenous line for administration of lethal drugs.  That interpretation is consistent with the definition of voluntary assisted dying, whichincludes “steps reasonably related to such administration.”  Clearly, this would include any of the actions explicitly required by the law, such as assessments, notifications, acting as a witness, dispensing lethal drugs, filing reports, etc., as well as setting intravenous lines and other technical preparations for providing EAS.

Sections 112 and 113 provide protection from civil and criminal liability and disciplinary proceedings for those involved in processing and fulfilling EAS requests if they act in accordance with the law. Section 113(4) extends this protection to omissions in accordance with the bill, but not to the refusals it permits.  Since “omission” does not mean “refusal”, this may reflect either an oversight in drafting or a deliberate decision to expose objecting practitioners to liability.

What could prove to be most contentious is the requirement in Section 19(5)b that an objecting physician give a patient “information approved by the CEO” of a public service department, perhaps a health department.  Whether this will be acceptable to objecting practitioners will depend entirely on the substance of the “approved” information.  It is unlikely to be problematic if it consists of general information about how to contact other physicians or health authorities.  On the other hand, resistance is likely if the “approved” information portrays euthanasia and assisted suicide as morally acceptable services or directs patients to EAS providers.  Objecting practitioners may refuse to comply if the law effectively compels them to express support for moral views they reject, or forces them to facilitate what they consider to be immoral or unethical acts by directing patients to EAS providers.