Growing Intolerance Threatens Rights of Conscience of Health Care Workers

Lynn Wardle*

Around the world, policies and actions of many governments and governmental agencies are threatening rights of conscience of health care providers and employees.  These challenges and dangers seem to be increasing.

Recent times have seen numerous high-profile incidents in which nurses, doctors, hospital staff, government employees, and other health care workers are being pressured, required and forced to provide morally-controversial elective procedures (such as non-therapeutic abortions) despite their expressed moral objections to participating in such services. [Full text]


Legal and ethical aspects of organ donation after euthanasia in Belgium and the Netherlands

Med Ethics doi:10.1136/medethics-2015-102898

Jan Bollen


Organ donation after euthanasia has been performed more than 40 times in Belgium and the Netherlands together. Preliminary results of procedures that have been performed until now demonstrate that this leads to good medical results in the recipient of the organs. Several legal aspects could be changed to further facilitate the combination of organ donation and euthanasia. On the ethical side, several controversies remain, giving rise to an ongoing, but necessary and useful debate. Further experiences will clarify whether both procedures should be strictly separated and whether the dead donor rule should be strictly applied. Opinions still differ on whether the patient’s physician should address the possibility of organ donation after euthanasia, which laws should be adapted and which preparatory acts should be performed. These and other procedural issues potentially conflict with the patient’s request for organ donation or the circumstances in which euthanasia (without subsequent organ donation) traditionally occurs. [Full text]

The CCRL strongly opposes the College of Nurses of Ontario’s Physician-Assisted Death: Interim Guidance for Nursing in Ontario

News Release

Catholic Civil Rights League

TORONTO, ON March 24, 2016 – The Catholic Civil Rights League (CCRL) sent the following letter to the College of Nurses of Ontario (CNO) in opposition to Physician-Assisted Death: Interim Guidance for Nursing in Ontario on grounds that its main recommendation seriously violates a nurse’s freedom of conscience and religion.

College of Nurses of Ontario
101 Davenport Rd. Toronto,
ON M5R 3P1

March 24, 2016

RE: College of Nurses of Ontario’s Physician-Assisted Death: Interim Guidance for Nursing in Ontario

The Catholic Civil Rights League (CCRL) strongly opposes the College of Nurses of Ontario’s Physician-Assisted Death: Interim Guidance for Nursing in Ontario on grounds that its main recommendation seriously violates a nurse’s freedom of conscience and religion. Page 3 of the document states:

…some nurses may have conscientious objections to participating in physician-assisted death. Both the Special Joint Committee on Physician-Assisted Dying of the Parliament of Canada and the Provincial-Territorial Expert Advisory Group on Physician-Assisted Dying have recommended that health care professionals who have conscientious objections should refer or transfer a client to another health care provider. If no other caregiver can be arranged, you must provide the immediate care required.

We are hopeful that your suggestion of “immediate care” is in the noble tradition of the nursing profession to preserve life, and to provide medical assistance to save lives.  However, our fear is that your proposed guideline is suggestive that a nurse will be obliged in such circumstances to engage in the new Orwellian concept of “medical aid in dying”, a prospect for which polling suggests a majority of your membership vigorously disagrees.

If the final statement and the directive “you must provide the immediate care required” is intended to mean “medical aid in dying”, then your College has asserted the most jarringly outrageous example of forcing a health care professional to violate his or her conscience that has been proposed by any regulatory body in Canada. It even outweighs the aforementioned recommendations of the Special Joint Committee on Physician-Assisted Dying of the Parliament of Canada and the Provincial-Territorial Expert Advisory Group on Physician-Assisted Dying.

Whereas the CCRL submits that euthanasia and assisted suicide in itself is morally and ethically wrong, compelling another person to be involved in this morally and ethically depraved act is no less wrong.  As interveners in Carter,the CCRL focussed on the impact to health care in general and to the conscience rights of health care workers specifically.  We strongly advocated for a robust understanding and protection of the Charter right of freedom of conscience and religion.

The right to avoid moral complicity in assisted suicide and euthanasia is an essential part of one’s religious and conscientious freedom.

The CCRL appeals to the College of Nurses of Ontario (CNO) to strike from the interim guidance document the necessity to “provide the immediate care required” if “no other caregiver can be arranged.” This compulsion is morally unacceptable.

It is also unacceptable that nurses are treated so poorly, by their own governing college, no less. Instead of limiting nurses’ rights and violating their constitutional right to freedom of conscience and religion, the CNO ought to instead advocate for nurses who conscientiously object to euthanasia and assisted suicide.

As with any regulatory entity, the CNO has no business second-guessing the validity of sincerely held religious beliefs, exercised in the course of one’s professional judgment.

Christian Domenic Elia, PhD
Executive Director
Catholic Civil Rights League (CCRL)

Philip Horgan
Catholic Civil Rights League (CCRL)

About the CCRL

Catholic Civil Rights League (CCRL) ( assists in creating conditions within which Catholic teachings can be better understood, cooperates with other organizations in defending civil rights in Canada, and opposes defamation and discrimination against Catholics on the basis of their beliefs. The CCRL was founded in 1985 as an independent lay organization with a large nationwide membership base. The CCRL is a Canadian non-profit organization entirely supported by the generosity of its members.

For further information:

Christian Domenic Elia, PhD
CCRL Executive Director
416-466-8244 @CCRLtweets

Nurses Cannot be Good Catholics

BMJ Blogs

John Olusegun Adenitire

It seems that if you are a nurse you cannot be a good Catholic.  Or, better: if you want to work as a nurse then you might have to give up some of your religious beliefs.  A relatively recent decision of the UK Supreme Court, the highest court in the country, seems to suggest so.  In a legal decision that made it into the general press (see here), the Supreme Court decided that two Catholic midwives could not refuse to undertake administrative and supervisory tasks connected to the provision of abortions.

To be sure, no one asked the nurses to directly assist in the provision of abortions.  The Abortion Act 1967 says that “No person shall be under any duty … to participate in any treatment authorised by this Act to which he has a conscientious objection.”  The Nurses argued that this provision of the Act should be understood widely.  Not only should they be allowed to refuse to directly assist in abortion services: they should also be entitled to refuse to undertake managerial and supervisory tasks if those were linked to abortion services.  The nurses’ employer was not impressed; neither was the Supreme Court which ruled that the possibility to conscientiously object only related to a ‘hands-on’ capacity in the provision of abortion services. . . [Full text]


Fleming Introduces Bill To Protect Pro-Life Health Care Providers

News Release

Congressman John Fleming

WASHINGTON, D.C. –Congressman John Fleming, M.D. released the following statement after introducing H.R. 4828, the Conscience Protection Act, which affords doctors, nurses, hospitals, and all health care providers the ability to choose not to provide abortions as part of their health care practice.

“As a family practice physician for over 30 years, I know for a fact that doctors and nurses are dedicated medical professionals uniquely qualified to assess the health and wellness needs of their patients. There is no room in the clinic for government discrimination, for Big Brother to force a health care provider to participate, in any way, in an abortion. My legislation offers common sense conscience protections for the front line of the medical profession. From clinician to hospital, from an HMO to insurance coverage, and from a student health plan to a physician in training, H.R. 4828 protects against forced participation in abortions and provides recourse for victims facing discrimination.”

Rep. Hartzler (R-MO), an original co-sponsor of  H.R. 4828 added, “Forcing a health care provider, church, private employer, or charity to violate their conscience is simply wrong. Caring professionals such as nurses and doctors should not be forced to perform abortions; nor should states, like California, force individuals to buy or provide insurance policies that pay for abortions. Our bill reinforces conscience protections already provided and offers a legal right of action to those who have been harmed by discriminatory or unlawful mandates. I am proud to co-sponsor this measure to stand up for those courageously standing by their convictions, to protect life, and to preserve the religious freedoms afforded to all of us.”

Background: There is an urgent need to pass the Conscience Protection Act. Longstanding, bipartisan, annual federal appropriations language, known as the Hyde/Weldon amendment, offers limited protections against discrimination for health care providers which do not provide, pay for, provide coverage of, or refer for abortions. Despite the Hyde/Weldon amendment, nurses have been forced to participate in gruesome dismemberment abortions and/or instructed that performing an abortion is mandatory for training or employment purposes. Additionally, beginning in August 2014 the California Department for Managed Health Care (DMHC) issued a directive requiring that all insurance plans under the State’s authority immediately cover abortions. This means that California churches, religious charities, employers and individuals are forced to purchase abortion coverage via their health plans. In a second brazen move, the Golden State is now requiring that pregnancy care centers post signs instructing clients where they can obtain an abortion. Despite the fact that California’s actions violate the Hyde/Weldon pro-life policy, the current Administration has failed to resolve the matter. The Conscience Protection Act would protect pro-life health care providers from forced complicity in an abortion and would also provide a private right of action, enabling victims of governmental discrimination to seek redress in court.

Contact: Sarah Althouse (202-225-2777)

Junior doctors to ‘escalate’ strike action by refusing to offer emergency care in full walkout

 Evening Standard

Tom Marshall

Junior doctors are to “escalate” their industrial action by refusing to provide emergency care during a strike next month, the British Medical Association has said.

The second of two bouts of industrial action planned next month will see a full walkout from junior doctors, the BMA announced.

In previous days of industrial action, junior doctors have still provided emergency cover.

The BMA said the move “follows the continued refusal by the Government to step back from its decision to impose a new contract on junior doctors from August this year and resolve the dispute by re-entering talks”. . . [Full text]


Canadian Association of Physician Assistants wants objecting physicians forced to refer for euthanasia, assisted suicide

Sean Murphy*

A policy statement by the Canadian Association of Physician Assistants asserts that physician assistants “should play a supportive role” in euthanasia and assisted suicide and states that physician assistants should be allowed to personally provide the procedures under the direction of a physician.

PAs as well as other health professions can play an active role in helping to facilitate PAD and supporting physicians throughout the process.


The statement purports to respect objecting physician assistance “freedom of choice” (the term used is not “freedom of conscience”) , stating that those “who have a conscientious objection based on moral and/or religious beliefs should not be required to assist in this process.”  However, it adds that the Association “supports the requirement for an effective referral process” – which would require physicians unwilling to kill patients or help them commit suicide to find someone willing to do so.

Polish baby left screaming for an hour before dying after botched abortion: reports

LifeSite News

Natalia Dueholm

March 21, 2016 (LifeSiteNews) – Physicians at Holy Family Hospital in Warsaw, Poland, left a child to die after a botched abortion earlier this month, according to local media.

As Republika Television reports, the baby was born March 7, 2016 at the 24th week of gestational age and cried and screamed for an hour before dying. According to witnesses, the baby’s cry is impossible to forget. Nonetheless, medical personnel did not try to help the child in any way.

Hospital spokesperson Dorota Jasłowska-Niemyska explained that a patient at the end of the 23rd week of pregnancy came to the hospital, and her medical tests suggested that the baby had Down syndrome. The hospital claims that everything that happened thereafter was according to the law and medical procedures. The dignity of the patient and the dignity of the fetus were respected, she continued.

When asked by a reporter of Salve TV about the dignity of a child that had been born alive, Jasłowska-Niemyska said: “Those are details which I can’t talk about. It is confidential, and I am not allowed to comment on the details of this procedure.” . . . [Full Text]


Hospitals should be able to opt out of doctor-assisted death, expert says

Ottawa Citizen

Elizabeth Payne

Neither doctors nor the institutions where they work should be forced to offer physician-assisted suicide, an expert on end-of-life decision making said Monday.

Judith Wahl, of Toronto’s Advocacy Centre for the Elderly, said Ontario should be able to create a system in which physician assisted death is accessible for those who qualify and want it, without forcing institutions and physicians to act against their beliefs.

“The provincial government can authorize those exemptions. I think people should be able to opt out and facilities should be able to opt out. I think we have to look at the system as a whole.”

With months to go until there is a law on physician assisted dying, the issue is already controversial. Catholic hospitals and health institutions across Ontario  –  including Bruyere Continuing Care in Ottawa  –  say they will not offer physician assisted death once it becomes law later this year. Bruyere is Ottawa’s only hospital with an acute palliative care ward. . . [Full text]


The unsettled status of conscientious objection in the UK


Michael Cook

What are the rights of doctors who have a conscientious objection to certain procedures in the United Kingdom? The slightly confusing status quo is the subject of an article in the Journal of Medical Ethics by a Cambridge University academic, John Adenitire.

Dr Adenitire sketches a gradation of hostility towards conscientious objection.

1. At the very top there are Julian Savulescu and others who have argued that conscientious objection is “a door to a Pandora’s box of idiosyncratic, bigoted, discriminatory medicine” and has little place in modern medical practice. This is not a widely shared view.

2. Then there is the British Medical Association (BMA), the profession’s “trade union”, which defends conscientious objection only in three specific scenarios. It “should ordinarily be limited to those procedures where statute recognises their right (abortion and fertility treatment) and to withdrawing life-prolonging treatment from patients who lack capacity, where other doctors are in a position to take over the care.”

3. And then there is the General Medical Council (GMC), the profession’s regulator in the UK, which allows conscientious objection, albeit with a number of caveats. According to its 2013 policy statement, Personal beliefs and medical practice: “You may choose to opt out of providing a particular procedure because of your personal beliefs and values, as long as this does not result in direct or indirect discrimination against, or harassment of, individual patients or groups of patients. This means you must not refuse to treat a particular patient or group of patients because of your personal beliefs or views about them.‡ And you must not refuse to treat the health consequences of lifestyle choices to which you object because of your beliefs.”

4. Most accommodating of all is a ruling of the European Court of Human Rights (ECtHR) in the British case of Eweida in 2013. It applied Article 9 of the European Convention on Human Rights to several cases of discrimination in the UK. Article 9 guarantees “the right to freedom of thought, conscience and religion”, “subject only to such limitations as are prescribed by law and are necessary in a democratic society in the interests of public safety, for the protection of public order, health or morals, or for the protection of the rights and freedoms of others”.

It is Dr Adenitire’s contention that the Eweida ruling “effectively provides that medical professionals have the right to conscientiously object to providing certain healthcare services well beyond the scope endorsed by the BMA”.

This implies that “Given the unsettled nature of the law on the topic, [National Health Service] employers will have to proceed very cautiously as it will not always be clear whether denying a request will be considered lawful by a court. This entails that NHS bodies may be at risk of expensive legal challenges by medical professionals whose requests have been denied.”

Dr Adenitire therefore believes that the BMA’s policy should be changed to align more closely to the Eweida ruling.

However, the law is still unsettled and Dr Adenitire is not necessarily hostile to proposals for legalised assisted dying which are currently being debated in the UK. In an unpublished paper he goes on to argue that in certain circumstances doctors already have a “conscience-based right to provide assistance in dying”.

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