Questionable benefits and unavoidable personal beliefs: defending conscientious objection for abortion

 Bruce Philip Blackshaw, Daniel Rodger

 Abstract

Journal of Medical Ethics

Conscientious objection in healthcare has come under heavy criticism on two grounds recently, particularly regarding abortion provision. First, critics claim conscientious objection involves a refusal to provide a legal and beneficial procedure requested by a patient, denying them access to healthcare. Second, they argue the exercise of conscientious objection is based on unverifiable personal beliefs. These characteristics, it is claimed, disqualify conscientious objection in healthcare. Here, we defend conscientious objection in the context of abortion provision. We show that abortion has a dubitable claim to be medically beneficial, is rarely clinically indicated, and that conscientious objections should be accepted in these circumstances. We also show that reliance on personal beliefs is difficult to avoid if any form of objection is to be permitted, even if it is based on criteria such as the principles and values of the profession or the scope of professional practice.


Blackshaw BP, Rodger D. Questionable benefits and unavoidable personal beliefs: defending conscientious objection for abortion. J Medical Ethics 2019 Aug 31. pii: medethics-2019-105566. doi: 10.1136/medethics-2019-105566. [Epub ahead of print]

Firing Doctor, Christian Hospital Sets Off National Challenge To Aid-In-Dying Laws

Kaiser Health News

JoNel  Aleccia

DENVER — A Christian-run health system in Colorado has fired a veteran doctor who went to court to fight for the right of her patient to use the state’s medical aid-in-dying law, citing religious doctrine that describes “assisted suicide” as “intrinsically evil.”

Centura Health Corp. this week abruptly terminated Dr. Barbara Morris, 65, a geriatrician with 40 years of experience, who had planned to help her patient, Cornelius “Neil” Mahoney, 64, end his life at his home. Mahoney, who has terminal cancer, is eligible to use the state’s law, overwhelmingly approved by Colorado voters in 2016.

The growing number of state aid-in-dying provisions are increasingly coming into conflict with the precepts of faith-based hospitals, which oppose the practice on religious grounds. . . [Full text]

Doctors issued with new ethical guidelines on providing abortion

Medical Council guide sets out obligations for doctors with conscientious objections

The Irish Times

30 August, 2019

Martin Wall

The Medical Council has issued revised ethical guidance for doctors following the introduction of abortion legislation earlier this year.

A new version of its ethics document provides updated guidance for doctors who have conscientious objections to particular forms of treatment, procedures or care, not just in relation to abortion.

The amended guide to professional conduct and ethics for doctors says termination of pregnancy is legally permissible within the provisions of legislation introduced in 2018. . . [Full text]

Doctors fear state law may veto their objections

The Australian

30 August, 2019

Rosie Lewis

Religious doctors in Victoria and Queensland may still be compelled to refer a patient for an abortion under the Morrison government’s proposed religious ­discrimination bill if they conscientiously object to the procedure, triggering concerns among some legal experts.

The exposure draft bill, released yesterday by Attorney-General Christian Porter, is designed to ensure health practitioners do not have to participate in an abortion or euthanasia, or prescribe contraception to a patient, if they are opposed on religious grounds. . . [Full text]

After Months In A Dish, Lab-Grown Minibrains Start Making ‘Brain Waves’

National Public Radio

Jon Hamilton

By the time a fetus is 6 months old, it is producing electrical signals recognizable as brain waves.

And clusters of lab-grown human brain cells known as organoids seem to follow a similar schedule, researchers reported Thursday in the journal Cell Stem Cell.

“After these organoids are in that six-to-nine-months range, that’s when [the electrical patterns] start to look a lot like what you’d see with a preterm infant,” says Alysson Muotri, director of the stem cell program at the University of California, San Diego. . . [Full text]

OCR Issues Notice of Violation to the University of Vermont Medical Center After It Unlawfully Forced a Nurse to Assist in Abortion

News Release
For immediate release

US Department of Health and Human Services

Contact: HHS Press Office
202-690-6343
media@hhs.gov

The U.S. Department of Health and Human Services (HHS), Office for Civil Rights (OCR) is announcing that, after a thorough investigation and prolonged attempts to resolve the matter, OCR has issued a Notice of Violation letter finding that the University of Vermont Medical Center (UVMMC) violated the Church Amendments (42 U.S.C. 300a-7) by forcing a nurse to assist in an elective abortion procedure over the nurse’s conscience-based objections. OCR also found that UVMMC has discriminatory policies that assign or require employees to assist abortion procedures even after they have recorded their religious or moral objections to assisting in the performance of such abortions. OCR’s Notice of Violation letter asks UVMMC to conform its policies to the Church Amendments and take other corrective action, or face potential action by the HHS component from which UVMMC has received federal funding.

On May 9, 2018, a nurse at UVMMC filed a conscience and religious discrimination complaint with OCR against UVMMC, a medical center in Burlington, Vermont that receives HHS funds, contending that the nurse was forced to assist an abortion in violation of the nurse’s conscience rights. As part of its investigation, OCR contacted UVMMC repeatedly in a good faith effort to seek cooperation from UVMMC, but the hospital refused to conform its policies to federal conscience laws, provide all the documents requested by OCR, or produce witnesses for OCR interviews. Nevertheless, OCR interviewed multiple witnesses and gathered evidence concerning the allegations.

As a result of its investigation, OCR has specifically determined that:

  • UVMMC forced the nurse complainant to assist in an abortion against the nurse’s religious or moral objection. The nurse had expressed an objection for many years and was included in a list of objectors, but UVMMC knowingly assigned the nurse to an abortion procedure. The nurse was not told the procedure was an abortion until the nurse walked into the room, when the doctor—knowing the nurse objected to assisting in abortions—told the nurse, “Don’t hate me.” The nurse again objected, and other staff were present who could have taken the nurse’s place, but the nurse was required to assist with the abortion anyway. If the nurse had not done so, the nurse reasonably feared UVMMC would fire or report the nurse to licensing authorities.
  • OCR spoke with several other UVMMC health care personnel who, since at least the spring of 2017, have been intentionally, unnecessarily, and knowingly scheduled by UVMMC to assist with elective abortions against their religious or moral objections. Such personnel were often not told in advance that the procedures they were being assigned to assist with were abortions. Health care personnel who are coerced in that way suffer moral injury, are subjected to a crisis of conscience, and frequently experience significant emotional distress, even if they succeed in declining to assist in the procedure after the assignment is made.
  • UVMMC maintains a staffing policy that facially violates the Church Amendments because the policy admits to circumstances where UVMMC can and will force staff—on pain of adverse action or discipline—to participate in abortions against their moral or religious objections. The policy also violates UVMMC’s agreement, as a condition of receiving HHS funds, to comply with federal law, including the Church Amendments and HHS’s grants regulations.
  • Consequently, UVMMC is violating 42 U.S.C. § 300a-7(c)(1) of the Church Amendments by discriminating against health-care personnel who have religious or moral objections to abortion, and subjecting them to different terms or conditions of employment than other health-care personnel.

In the Notice of Violation, OCR asks that UVMMC notify OCR within thirty days whether UVMMC intends to work collaboratively with OCR to change its policies so it no longer requires health care personnel to participate in abortion against their religious or moral objections, and to take immediate steps to remedy the effect of its past discriminatory conduct. Otherwise, OCR indicates that it will forward the Notice to the Health Resources and Services Administration (HRSA), a component of HHS that provides grant funds to UVMMC, for consideration and possible additional procedures concerning UVMMC’s receipt of federal funds.  Since October 1998, UVMMC has received—and continues to receive—grants from HRSA.  For the most recently completed three-year project period, which ended April 30, 2018, UVMMC reported that it cumulatively expended $1.6 million of federal financial assistance.

Roger Severino, Director of OCR said, “Forcing medical staff to assist in the taking of human life inflicts a moral injury on them that is not only unnecessary and wrong, it violates longstanding federal law. Our investigation has uncovered serious discrimination by UVMMC against nurses and staff who cannot, in good conscience, assist in elective abortions.”  Severino concluded, “We stand ready to assist UVMMC in changing its policies and procedures to respect conscience rights and remedy the effects of its discrimination.” 

OCR is charged with helping ensure entities come into compliance with federal laws protecting conscience and prohibiting coercion in health care, including the Church Amendments.

ACLJ Vindicates Rights of Vermont Nurse Who Was Unlawfully Forced to Participate in Abortion – HHS Threatens to Pull Medical Center Funding

American Center for Law and Justice

Reproduced with permission

Jay Sekulow*

The ACLJ applauds today’s announcement by the Office of Civil Rights (OCR) of the U.S. Department of Health and Human Services (HHS) regarding a Complaint we filed on behalf of a Vermont nurse who was forced into participating in an abortion procedure against her deeply held religious beliefs.

In our Complaint, we alleged that our client, an operating room nurse at the University of Vermont Medical Center (UVMMC) in Burlington, was coerced into assisting in an abortion in 2017 even though her name was on a list of nurses who, for religious or moral reasons, were conscientiously opposed to such participation and even though other non-objecting nurses were available who could easily have taken her place.

In the more than two decades of work that ACLJ has done to defend the rights of conscience of pro-life health care workers, this is by far the most outrageous case we’ve ever seen. Our client’s most fundamental beliefs about the sanctity of life were simply brushed aside.

Worse, her superiors deliberately misled her into thinking she was assisting in a procedure following a miscarriage. But once trapped inside the OR she discovered that it was, in fact, an elective abortion and that this had been known all along by her superiors who then callously refused to relieve her. To say that she was emotionally traumatized by this event is putting it mildly.

At least four other nurses at UVMMC have confirmed that they too have been subjected to similar violations of their conscience rights. We forwarded them to OCR as part of our Complaint. And after conducting its own thorough investigation of the matter, OCR has substantiated their allegations.

In its announcement, HHS finds that UVMMC has committed violations of the federal Church Amendment – the so-called “conscience clause” – named for the late liberal Idaho Democratic Senator Frank Church. The law was enacted in 1973 as a response to the Supreme Court’s legalization of abortion in Roe v. Wade. In general, it prohibits entities that receive federal funding from discriminating against employees who refuse to perform or assist in the performance of abortions because of their moral or religious beliefs.

But, because the Church Amendment has always lacked a mechanism for enforcement by private citizens, its enforcement has depended on action taken by HHS itself. In the decades since 1973, however, such enforcement has, for all intents and purposes, been nonexistent. With today’s announcement, HHS’s Office of Civil Rights has, at long last, put teeth in a law that has lain largely dormant since its enactment.

HHS has given UVMMC 30 days to come up with a policy that will ensure that the things that happened to our client, and others like her, will not happen again. If they fail to cooperate, they lose their federal funding.

This action by HHS is an enormous step forward toward the full protection of conscience rights of all those in the health care field who recognize the sanctity of all human life. The repercussions of today’s action will be felt in every hospital and health care system in the country.

No longer should pro-life health care professionals have to fear that their values – the values of protecting, not, destroying, life – make them somehow unfit or unsuitable for the healing profession. No nurses, doctors, or other health workers should ever be deliberately trapped in a room and forced to participate in something that their employer knows those workers consider abhorrent at the core of their being.

For over two decades the American Center for Law and Justice (ACLJ) has been at the forefront of advancing and defending the right of free speech and conscientious objection when it comes to the sanctity of human life. In addition to our work with legislators and public policy makers in Washington and around the country, we have also represented dozens of individuals – women and men on the front lines of the pro-life cause – who have found themselves discriminated against because of their pro-life stands. Doctors, nurses, pharmacists, and other health care workers – we’ve gone to court for them before judges and juries from Maine to Hawaii and most points in between.

The ACLJ very much welcomes HHS’s vigorous enforcement of federal conscience rights in this case. No health care worker should be forced to abandon their career because they refuse to abandon their pro-life convictions. If you are a healthcare worker and have experienced a similar situation, please contact us at ACLJ.org/HELP.

Over 1,300 nursing and midwifery posts in Irish hospitals are being left vacant

One in six midwifery posts are being left vacant.

thejournal.ie

Rónán Duffy

THERE ARE OVER 1,300 vacant nursing and midwifery posts in Irish hospitals due to the HSE’s effective recruitment freeze, the INMO has said today.

Phil Ní Sheaghdha of the Irish Nurses and Midwives Organisation has said the figures demonstrate that the government is “refusing to fill frontline healthcare posts” and that patient care is being compromise as a result. . . [Full text]

Conscientious objection: how much discretionary power should physicians have?

BioEdge

Xavier Symons

There has been significant debate about conscientious objection in healthcare in recent years. Some scholars have argued that conscience protections in law and professional codes of conduct may lead to negligence in medical care and may put patient wellbeing at risk. For example, Oxford bioethicist Julian Savulescu has argued that conscience protections open a “Pandora’s box of idiosyncratic, bigoted, discriminatory medicine”, and that “public servants must act in the public interest, not their own”. 

But should physicians have the right to exercise professional discretion with patients? 

Some scholars, such as Daniel Sulmasy, argue that physician discretion is an essential part of good medical practice, and that restrictions on conscientious objection would have a negative impact on medical care. In a 2017 article in the Cambridge Quarterly of Healthcare Ethics, Sulmasy argued that physicians should have the right to exercise their judgement about which treatments they will provide, provided that they are not practicing medicine in a manner that is discriminatory or harmful to patients. He wrote that “professional judgments are both technical and moral in all cases”  and that it is important to “respect and protect a wide discretionary space for physicians regarding ethically controversial interventions”. According to Sulmasy, 

“Conscientious refraining from actions when such restraint does not risk illness, injury, or death, would not seem to rise to the level of being sufficient grounds for compelling conscience”.

This argument, however, has been criticised. Doug McConnell, an ethicist at the University of Oxford, argues in the journal Bioethics (and in Oxford’s Practical Ethics blog) that too much physician discretion can lead to people being denied basic forms of medical care. While Sulmasy agrees that physicians should not practice discriminatory medicine, his framework still allows for objecting doctors to refuse patients treatment for “commonly accepted ailments, such as rashes, headaches, mild depression and anxiety”. 

McConnell also argues that Sulmasy’s framework undermines the fiduciary relationship that clinicians should have with their patients. Sulmasy appears to give equal weight to the interests of doctors and the interests of patients. Thus, a doctor can refuse a patient a treatment if the treatment conflicts with their ethical or religious convictions. But McConnell argues that this is incompatible with a fiduciary relationship: 

“within fiduciary relationships, the party with the fiduciary duty should place greater weight on the others’ interests and, so be prepared to go against his conscience”. 

Physicians, in other words, should be prepared to put patient interests ahead of their own moral or religious convictions. 

Yet McConnell may have misunderstood Sulmasy’s account of the fiduciary relationship between clinicians and patients. Sulmasy is a student of Edmund Pellegrino — a medical ethicist who wrote at length about the notion of “the patient’s good”, and argued that this should be at the centre of a doctor’s professional concerns. It is hard to believe that Sulmasy would downplay a physician’s duties to their patients. 

Perhaps the real distinction between McConnell and Sulmasy is not their concern for the good of the patient, but rather the way in which they conceptualise the patient’s good. For Sulmasy, the patient’s good is determined by a set of moral and technical considerations, whereas for McConnell, the patient’s good is more a matter of their individual preferences and interests.

This article is published by Xavier Symons and BioEdge under a Creative Commons licence. You may republish it or translate it free of charge with attribution for non-commercial purposes following these guidelines. If you teach at a university we ask that your department make a donation to BioEdge. Commercial media must contact BioEdge for permission and fees.

Courts hear conscience arguments of pro-life health-care staffers

Even Supreme Court agreed doctors have ‘the right to refrain from abortion’

WND

WND staff

A “conscience rights” rule implemented by the Trump administration that exempts physicians from providing “treatments” that violate religious faith such as abortion has been challenged by lawsuits in New York and California.

CNBC reported the city of San Francisco sued after alleging people could be deprived of health care treatments such as “assisted suicide” because of someone else’s beliefs. . . [Full Text]