What’s behind the demolition of conscience rights in Canada?

Mercatornet

Margaret Somerville*

I’ve been puzzling about why Canadian “progressive” values advocates, particularly those passionately in favour of the legalization of euthanasia and physician-assisted suicide (“physician-assisted death” (PAD)), are so adamant in trying to force healthcare professionals and institutions who have conscience or religious objections to these procedures to become complicit in them.

Complicity would occur if objecting individual physicians were forced to provide “effective referrals” or objecting institutions were forced to allow PAD in their facilities. An “effective referral” is defined by the Ontario College of Physicians and Surgeons as “a referral made in good faith, to a non-objecting, available, and accessible physician or other health-care provider.”

In general, progressive values advocates claim to give priority to rights to individual autonomy, choice, control over what happens to oneself, and tolerance for those who believe differently. Yet in relation to respect for the freedom of conscience and, where relevant, religious belief, of physicians or institutions who oppose PAD, none of these principles seem to be applied. Why? [Full text]

ACLU loses case to force Catholic hospital to perform abortions

LifeSite News

Ben Johnson

DETROIT, April 11, 2016 (LifeSiteNews) – A Michigan judge has thrown out the ACLU’s lawsuit attempting to force a nationwide chain of Catholic hospitals to perform abortions.

The U.S. District Court for the Eastern District of Michigan, Southern Division dismissed the case, saying the liberal legal organization lacks standing to sue.

The ACLU filed suit against Trinity Health Corporation, which operates 86 health care facilities in 21 states nationwide, last October because Trinity – a Catholic institution – abides by the U.S. Bishops’ Ethical and Religious Directives (ERDs), which bar physicians from taking unborn human life. . . [Full text]

 

The intersection of freedom of conscience and assisted dying

One MP’s views on balancing the needs of patients and doctors who have personal issues providing assisted dying

Macleans

Garnett Genuis

Garnett Genuis, the Conservative MP for Sherwood Park—Fort Saskatchewan in Alberta, has served on the Physician-Assisted Dying Committee.

Parliament will imminently be dealing again with the issue of physician-assisted suicide / euthanasia. If government legislation follows the direction given in the report of the Liberal-dominated joint committee, we are in for (among other things) a significant change in the way Canadian law treats freedom of conscience.

The court was clear in Carter that nothing in their decision would require anyone to be involved in euthanasia or assisted suicide if they did not wish to be. In this respect, I think the court got it right. Freedom of conscience is protected by the Charter itself. Euthanasia and assisted suicide were considered murder until just this year; it’s understandable that many healthcare providers remain uncomfortable with it. . . [Full text]

 

Here’s What Actually Happens When You Fight for Conscience Rights

A family places its trust in God as it battles Washington state for the right to run their pharmacy and grocery store in line with Catholic teachings.

National Catholic Register

Loredana Vuoto

OLYMPIA, Wash. — Every morning, Greg Stormans contemplates a Bible verse perched in a tiny frame above his bathroom sink, which his daughter handwrote: “This is the day which the Lord has made; let us rejoice and be glad in it” (Psalm 118:24).

This verse sets the tone for his entire day and life.

“When I first heard this verse, even at a young age, it had an impact on me. It really changed my life and how I view it,” Stormans, one of the owners of Ralph’s Thriftway in Olympiatold CNA.

“Every day when I get up, I remember that the Lord has made it and that I should be happy and grateful. You have to share this and be happy, knowing that God has given you a purpose in life.”

Stormans and his family, who have been operating the small grocery story and pharmacy for the past four generations, had no idea they would be at the center of a firestorm in 2007, when the Washington Pharmacy Commission began to require pharmacies to dispense the potentially abortion-inducing drugs Plan B and ella, and make conscience-based referrals illegal.

Devout Catholics, the Stormans decided that they could not sell abortion-related drugs, because it was against their deepest convictions to sell drugs that “promote death.” . . . [Full text]

 

Everybody’s a winner when euthanasia combines with organ donation, say doctors

BioEdge

Michael Cook

Several Dutch and Belgian doctors have proposed legal reforms to increase the popularity of combining euthanasia and organ donation in the Netherlands and Belgium.

Writing in the Journal of Medical Ethics, they report valuable unpublished information about the prevalence of the procedure. So far, it has been performed only about 40 times in the two countries. However, there is “a persisting discrepancy between the number of organ donors and the number of patients on the waiting lists for transplantation” – which euthanasia patients could help to balance.

The authors stress that euthanasia is not a cure-all for the organ shortage. Most euthanasia patients suffer from cancer, which is a contraindication for organ transplantation. However, 25 to 30% of them do not, so there is obviously a real possibility of expanding the supply.

Furthermore, the authors say, public perception of this formerly abhorrent practice is increasingly positive:

. . . transplant coordinators in Belgium and the Netherlands notice a contemporary trend towards an increasing willingness and motivation to undergo euthanasia and to subsequently donate organs as well, supported by the increasing number of publications in popular media on this topic.

Ethically, the procedure is basically uncontroversial as long as the patient is not pressured to donate, they contend.

In the context of organ donation after euthanasia, the right of self-determination is a paramount ethical and legal aspect. It is the patient’s wish and right to die in a dignified way, and likewise his wish to donate his organs is expressed. Organ donation after euthanasia enables those who do not wish to remain alive to prolong the lives of those who do, and also—compared with ‘classical’ donation after circulatory death—allows many more people to fulfil their wish to donate organs after death.

However, there are some legal hitches in both countries. In the Netherlands, unlike Belgium, euthanasia is regarded as an “unnatural death” which has to be reported to the public prosecutor. This could delay donations. If the law were changed to allow the cause of death to be reported as the underlying condition, the procedure would be more expeditious. And “In Belgium, the current policy of determination of death by three independent physicians could be abandoned, facilitating a more lean procedure with only one physician.”

Public perceptions need to be managed as well. At the moment, it is necessary to maintain a strict separation between the request for euthanasia and the need for the organ. Partly this is needed to ensure that the donor is not being pressured. But the public also needs to have confidence that physicians will give objective advice.

Finally, there is the tradition of the dead donor rule “that donation should not cause or hasten death”. The authors imply that this could be scrapped for euthanasia volunteers:

Since a patient undergoing euthanasia has chosen to die, it is worth arguing that the no-touch time (depending on the protocol) could be skipped, limiting the warm ischaemia time and contributing to the quality of the transplanted organs. It is even possible to extend this argument to a ‘heart-beating organ donation euthanasia’ where a patient is sedated, after which his organs are being removed, causing death.

The article’s proposals were not received with great enthusiasm in the UK where there is a simmering debate on assisted dying. Tory MP Fiona Bruce told the Daily Mail: “The paper confirms the worst fears expressed by Parliament when the House of Commons conclusively voted to stop the legalisation of assisted suicide in this country. The possibility of euthanasia achieved through live organ donation, such as by removing a patient’s beating heart, as posited in this paper is shocking and chilling.”

And Lord Carlile of Berriew, a Liberal Democrat peer who is a leading lawyer, said: “I have extreme concerns about the ghoulish nature of the combined euthanasia and organ donation systems in the Netherlands and Belgium. Both can result in unbearable and irresistible pressure on an individual to die, and on a doctor to encourage death.”


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Cardinal Dolan and Archbishop Lori to Congress: Support the Conscience Protection Act

News Release

US Conference of Catholic Bishops

WASHINGTON—Cardinal Timothy M. Dolan and – as chairmen of the U.S. Conference of Catholic Bishops’ Committee on Pro-Life Activities and Ad Hoc Committee for Religious Liberty, respectively – wrote to the U.S. House of Representatives, March 31, urging support for the Conscience Protection Act of 2016 (HR 4828).

The Conscience Protection Act, they wrote, is “essential legislation protecting the fundamental rights of health care providers…to ensure that those providing much-needed health care and health coverage can continue to do so without being forced by government to help destroy innocent unborn children.”

HR 4828 has a “modest scope,” they noted. “While existing federal laws already protect conscientious objection to abortion in theory, this protection has not proved effective in practice… The Conscience Protection Act will address the deficiencies that block effective enforcement of existing laws, most notably by establishing a private right of action allowing victims of discrimination to defend their own rights in court.”

Cardinal Dolan and Archbishop Lori recalled the Hippocratic oath’s rejection of abortion in the profession of medicine, indicating that the Act will benefit not only Catholic medical professionals but “the great majority of ob/gyns [who] remain unwilling to perform abortions.”

Finally, they explained that conscience protection facilitates access to life-affirming health care: “When government…mandates involvement in abortion as a condition for being allowed to provide life-affirming health care services, it not only undermines the widely acknowledged civil rights of health care providers but also limits access to good health care for American women and men.”

The full text of their letter is posted at:
www.usccb.org/issues-and-action/religious-liberty/conscience-protection/upload/Conscience-Protection-Act-Dolan-Lori-Ltr-to-Congress-03-31-16.pdf

For more on the bishops’ promotion of conscience rights, including a recent video about a nurse who was coerced to take part in a late-term abortion, visit:
www.usccb.org/issues-and-action/religious-liberty/conscience-protection.

MEDIA CONTACT
Don Clemmer
O: 202-541-3206

A war interrogator racked by conscience

 Kael Weston

Eric Fair was a civilian interrogator for the U.S. military for several months in Iraq in 2004 and ever since has felt haunted by his inexcusable behavior.

In his important memoir, “Consequence,” Fair confronts his demons. He recognizes the “things that can’t be undone” and writes about them with painful clarity: “This is the first detainee I lay hands on. I grab him by his clothing and drag him out of his chair . . . I shove him into the wall . . . it feels good.” He describes a joint interrogation of an Iraqi boy. The goal: to wrest a confession out of him. “I scare him. I shout,” he writes. “I throw a chair. It ricochets off the wall. I call the MP [military policeman] inside and he handcuffs the boy to the iron loop in the floor. . . . He suffers. He cries.” . .  . [Full text]

When Policy Produces Moral Distress: Reclaiming Conscience

 Hastings Center Report

Nancy Berlinger

Abstract

For too long, bioethics has followed law in reducing “conscience” to “conscientious objection,” in other words, to laws and policies permitting and protecting refusal. In “Reframing Conscientious Care: Providing Abortion Care When Law and Conscience Collide,” Mara Buchbinder and colleagues draw our attention to one dimension of the problem of reducing conscience to refusal to provide certain forms of medical care: what about the conscience problems experienced by the professionals who are attempting to provide safe, effective health care that includes services that others associate with conscientious objection? In seeking to disrupt a specific medical practice – one that is legal, desired by the patient, and conducted in accordance with medical standards – North Carolina House Bill 854, The Women’s Right to Know Act, and laws like it, appear to be designed to produce moral distress in physicians and other professionals involved in the provision of abortions. For abortion providers in North Carolina and other states, conscientious objection to the mandates of laws like HB 854 isn’t a realistic option. So what can bioethics offer to professionals bound by such laws? We can start by reclaiming the idea of “conscience” as something that can say “yes” to providing health care.

Berlinger, N. (2016), When Policy Produces Moral Distress: Reclaiming Conscience. Hastings Center Report, 46: 32–34. doi: 10.1002/hast.547 [Full text]

 

Conscience, Courage, and “Consent”

Hastings Center Report

Mark A. Hall, Nancy M. P. King

Abstract

How should we think about physicians who object to what law in North Carolina and many other states requires them to tell patients seeking legal abortions? A federal appellate court helped to place this situation in perspective when it struck down the part of the Woman’s Right to Know Act, North Carolina’s mandatory informed consent statute for abortions, that required physicians to show such patients real-time ultrasound images of their fetuses and describe the stage of fetal development. In this court’s view, the state’s WRTK Act forces physicians to express a viewpoint that may be contrary to their medical judgment. Moreover, the ultrasound-viewing provision “simultaneously threaten[s] harm to the patient’s psychological health, interfer[es] with the physician’s professional judgment, and compromis[es] the doctor-patient relationship.” The court continued, “Transforming the physician into the mouthpiece of the state undermines the trust that is necessary for facilitating healthy doctor-patient relationships, and through them, successful treatment outcomes.” Based on this reasoning, the court invalidated the ultrasound-viewing portion of the statute, but the other provisions remain in effect, mandating a long list of disclosures; similar laws exist in many other states.

In this essay, we want to consider what the abortion legislation says about the state’s regard for professional judgment. At the same time that these laws threaten patient trust in physicians – a point Mara Buchbinder and colleagues explore in “Reframing Conscience: Providing Abortion Care When Law and Conscience Collide” (in this same issue of the Report) – the laws display a deep-seated distrust by government in the integrity of medical professionals. The WRTK statute bristles with measures that control physicians’ interactions with patients. In addition to the most egregious example of coerced display and discussion of live ultrasound images, which has now been invalidated, this statute and others like it script in great detail what treating physicians must say to patients in specified settings at prescribed times.

Hall, M. A. and King, N. M. P. (2016), Conscience, Courage, and “Consent”. Hastings Center Report, 46: 30–32. doi: 10.1002/hast.546 [Full text]

 

Reframing Conscientious Care: Providing Abortion Care When Law and Conscience Collide

Hastings Center Report 

Mara Buchbinder, Dragana Lassiter, Rebecca Mercier, Amy Bryant, Anne Drapkin Lyerly

Abstract

“It’s almost like putting salt in a wound, for this person who’s already made a very difficult decision,” suggested Meghan Patterson (an alias), a licensed obstetrician-gynecologist whom we interviewed in our qualitative study of the experiences of North Carolina abortion providers practicing under the state’s Woman’s Right to Know Act (House Bill 854; 2011). The act requires that women receive counseling with state-mandated information at least twenty-four hours prior to obtaining an abortion. After the law was passed, Patterson worked with clinic administrators, in consultation with a lawyer, to write a script to be used in the state-mandated counseling procedure. She and her colleagues took particular steps to mitigate the effects of what she described as HB 854’s “forced language” – such as referring to the “father of the child.” While HB 854 stipulated that patients must be informed of the medical risks associated with the particular abortion procedure as well as those of carrying the child to term, Patterson’s script made explicit the magnitude of comparative risks, emphasizing that the risks of carrying a pregnancy to term are substantially greater than the risks of an early-term abortion. She felt that these contextualization strategies helped to facilitate trust and rapport in a clinical care situation that proved relationally and morally challenging.

In this article, we take up and expand on this point by elucidating an empirically grounded approach to ethically justified care when health care providers face legal or institutional policy mandates that raise possible moral conflicts. Our approach builds on recent bioethics discourse addressing conscience in the practice of medicine. While the concept of conscience has broad philosophical underpinnings relating to moral judgment, agency, and discernments of right and wrong, debates in bioethics have tended to engage the concept primarily vis-à-vis rights of conscientious objection or refusal. Here, we suggest a broader frame for thinking about claims of conscience in health care. Our approach draws on the feminist bioethics and the ethics of care literatures to highlight how providers may be motivated by matters of conscience, including relational concerns, in the active provision of certain forms of care. What emerges are two possibilities: not only conscientious refusal to comply with a policy mandate but also conscientious compliance – working conscientiously within a mandate’s confines.

Buchbinder, M., Lassiter, D., Mercier, R., Bryant, A. and Lyerly, A. D. (2016), Reframing Conscientious Care: Providing Abortion Care When Law and Conscience Collide. Hastings Center Report, 46: 22–30. doi: 10.1002/hast.545 [Full text]