In the closing hearings into the controversial Reproductive Health Law, judges of the Philippines Supreme Court questioned a provision in the law that makes it a crime to provide “incorrect information” about contraceptives. When Senior State Solicitor Florin Hilbay explained that the Philippines Food and Drug Administration will determine what is “correct,” a judge pointed out that this would mean that no dissent from that would be allowed. Another judge raised the possibility of the imprisonment of physicians who disagree with the FDA about the safety of a drug.
Hilbay also claimed that objecting physicians have a “professional obligation” to facilitate the provision of the services to which they object by referral, asserting that refusal to refer makes a patient a “victim.” He insisted on this even though he admitted that referral might not be “right.” The court gave lawyers for both sides 60 days to submit memoranda concerning their arguments. [Manila Standard] [Philippine Daily Inquirer] [Inquirer.net]
J. Donald Boudreau, MD
Physicians who refuse to be co-opted into assisting patients accelerate their death are not, as Dr. Dave Lambert seems to imply, medical dinosaurs. And by rejecting his option, we are most certainly not trying to save or prolong lives “at all costs,” that is, we are not vitalists. One can simultaneously reject both vitalism and euthanasia. . . [Full text]
The European Journal of Contraception and Reproductive Health Care, 2013; 18: 231–233
Anna Heino, Mika Gissler, Dan Apter, Christian Fiala
The issue of conscientious objection (CO) arises in healthcare when doctors and nurses refuse to have any involvement in the provision of treatment of certain patients due to their religious or moral beliefs. Most commonly CO is invoked when it comes to induced abortion. Of the EU member states where induced abortion is legal, invoking CO is granted by law in 21 countries. The same applies to the non-EU countries Norway and Switzerland. CO is not legally granted in the EU member states Sweden, Finland, Bulgaria and the Czech Republic. The Icelandic legislation provides no right to CO either. European examples prove that the recommendation that CO should not prevent women from accessing services fails in a number of cases. CO puts women in an unequal position depending on their place of residence, socio-economic status and income. CO should not be presented as a question that relates only to health professionals and their rights. CO mainly concerns women as it has very real consequences for their reproductive health and rights. European countries should assess the laws governing CO and its effects on women ’ s rights. CO should not be used as a subtle method for limiting the legal right to healthcare. [Full Text]
An analysis of the death of Savita Halappanavar in Ireland and similar cases
Reproductive Health Matters 2013;21(41):9–17
Issues arising from the death of Savita Halappanavar in Ireland in October 2012 include the question of whether it is unethical to refuse to terminate a non-viable pregnancy when the woman’s life may be at risk. In Catholic maternity services, this decision intersects with health professionals’ interpretation of Catholic health policy on treatment of miscarriage as well as the law on abortion. This paper explores how these issues came together around Savita’s death and the consequences for pregnant women and maternity services worldwide. It discusses cases not only in Ireland but also the Americas. Many of the events presented are recent, and most of the sources are media and individual reports. However, there is a very worrying common thread across countries and continents. If further research unearths more cases like Savita’s, any Catholic health professionals and/or hospitals refusing to terminate a pregnancy as emergency obstetric care should be stripped of their right to provide maternity services. In some countries these are the main or only existing maternity services. Even so, governments should refuse to fund these services, and either replace them with non-religious services or require that non-religious staff are available at all times specifically to take charge of such cases to prevent unnecessary deaths. At issue is whether a woman’s life comes first or not at all.
Claim that practitioner codes require referral disproved by Australian Medical Association
According to a report in The Examiner, a representative of the Australian Health Practitioner Regulation Association told a Tasmanian legislative committee that physicians who object to a procedure for reasons of conscience are obliged by professional codes of ethics to refer patients to another physician. Lisa McIntosh was addressing the Committee concerning a proposed Reproductive Health Bill.
Her assertion is contradicted by a submission by the Australian Medical Association Tasmania, which protested the section of the bill that would force objecting physicians to facilitate morally contested procedures by referral. The AMA Tasmania submission included quotes from the AMA Code of Ethics and a document from the Medical Board of Australia Good Medical Practice to demonstrate that the draft legislation information paper falsely claimed that there was a duty to refer.
The Committee also heard from Catholic Archbishop Adrian Doyle, whose concerns about the proposed bill included the mandatory referral provision.
Time Magazine reports upon a statement signed by 100 American professors of obstetrics and gynaecology under the headline, “Doctors Urge More Hospitals to Perform Abortions.” The statement expresses frustration that abortion policies and laws envisioned by 100 predecessors who signed a 1972 letter have not materialized. Notably, the statement reiterates the demand of the original letter that objecting physicians should be compelled to refer for abortion, something many objectors find unacceptable, and insists that all hospitals that admit women should be forced to admit women for abortions – and, presumably, provide them. This would be unacceptable to denominational institutions that object to the procedure.
The Time article notes that only 14% of American obstetrician-gynaecologists perform abortion, and hospitals provide only 4% of abortions done annually. The rest are provided in free-standing clinics. The signatories stress the need for hospitals to respond to the demand for second trimester abortions, which are even more controversial than the much more numerous first trimester procedures. It does not appear that the signatories recognize that requiring hospitals to provide second trimester abortions would likely generate more dramatic conflicts of conscience for health care workers who might be pressured to participate.
Peter Finney Jr.
NEW ORLEANS (CNS) — Fine print contained in the Affordable Care Act has weakened conscience protections for physicians who oppose abortion, sterilization or other medical practices on religious or moral grounds, a doctor and ethicist told the American Academy of Fertility Care Professionals.
Dr. John Brehany, executive director and ethicist of the Catholic Medical Association, said with the passage of the new health care law, commonly called Obamacare, “the federal government is posing real threats to faithful health care professionals.”
“While Obamacare itself does have a couple of conscience-protection provisions built in, the fact is, if you look at the big picture, which are the old federal laws and what was achieved from 1973 to 2004, we are now missing some important protections, and we are now vague on how these old laws will carry forward into the future,” Brehany said Aug. 10 during told the academy’s annual gathering in New Orleans. . . . [Full text]
During the 146th Annual General Meeting of the Canadian Medical Association in Calgary, Alberta, discussion of motions concerning euthanasia and assisted suicide demonstrated how contentious the issues are for physicians. The delegates could not even agree upon what terminology should be used for the procedures, referring the question to the CMA board of directors. [Vancouver Sun; CMAJ] However, delegates “easily” passed a motion put forward by one of the delegates to support physician freedom of conscience:
The Canadian Medical Association supports the right of any physician to exercise conscientious objection when faced with a request for medical aid in dying. (DM 5-22)
In late 2010, the Parliamentary Assembly of the Council of Europe (PACE) was presented with a report from its Social, Health and Family Affairs Committee expressing deep concern about the problem of “unregulated conscientious objection” in Europe. The Committee proposed to solve this problem by having states adopt “comprehensive and clear regulations” to address it.
The Council ultimately adopted a resolution that almost completely contradicted the premises of the report, but in 2011 the theme was resurrected by Dr. Leslie Cannold, an Australian ethicist. Dr. Cannold warned that, “[a]t best, unregulated conscientious objection is an accident waiting to happen,” and, at worst, “a sword wielded by the pious against the vulnerable with catastrophic results.” It was, she wrote, “a pressing problem from which we can no longer, in good conscience, look away.” . . .[Full text]
Physician recommends expansion of abortion services beyond designated facilities
Quoting an unnamed official of the Irish Department of Health, the Irish Independent has reported that the Irish government intends to force Catholic hospitals to provide abortions under the new Irish abortion law. The official is quoted as saying that the new law provides for conscientious objection for individuals, but the exemption ” does not apply to a hospital.”
The Irish Independent also reports that Dr. Kevin Walsh, a cardiologist at Mater Hospital, Dublin, has said that more hospitals should be designated to provide abortions, as he believes that the obstetric hospitals do not have the resources to manage women who are “pregnant and critically ill with heart disease.” Abortions in such circumstances would be better provided in acute care hospitals, he said, “on an urgent planned basis rather than immediate emergency basis.”