Physicians are not solely responsible for ensuring access to medical assistance in dying

Diane Kelsall

Patients’ rights to access to medical assistance in dying (MAiD) trumps the religious rights of physicians under the Canadian Charter of Rights and Freedoms  –  or so says the Ontario Superior Court of Justice. But ensuring equitable access to health care is a societal responsibility and does not rest solely on the individual physician. Surely there is a way forward that ensures access for patients requesting MAiD without trampling on physician rights enshrined in law.

 


Kelsall D.  Physicians are not solely responsible for ensuring access to medical assistance in dying. CMAJ February 20, 2018 190 (7) E181; DOI: https://doi.org/10.1503/cmaj.180153

Pregnant women in rural B.C. urged to leave town to deliver

40% of women in rural Canada have to drive at least 1 hour away for maternity services

CBC News

Briar Stewart

For pregnant women in Fort Nelson, B.C., part of the prenatal routine includes agreeing not to have their babies in the northern community.

“Due to staffing issues, we are unable to conduct safe obstetric care,” says the memo from the health centre.

An official with Northern Health, which oversees health centres in the region, says while physicians and staff are equipped to respond to  an “unplanned delivery,” women are advised to leave up to a month before their due date because “the safety of both the mother and the baby must come first.”

Fort Nelson, a community of 3,500, is one of dozens of rural communities in Canada where maternity services have been eliminated, in part because of the ongoing struggle to recruit and retain doctors in remote parts of the country.

The lack of intrapartum care means some women have to travel hundreds of kilometres and pay thousands of dollars to have their babies, even though health experts say long-distance delivery can come with greater health risks. . . [Full Text]

Why we must protect the conscience rights of medical professionals

Is it really such a radical idea to think healthcare professionals should not be forced to help in procedures to which they morally object?

Catholic Herald

Prof. Andrew Tettenborn

Just over three years ago, two devout Catholic midwives lost an important claim in the courts. Disciplined for declining to make arrangements for abortions in a Glasgow maternity ward, they sued, saying that the Abortion Act’s conscience clause allowed them to refuse to participate in the procedure. The Supreme Court, combining an impressive capacity for casuistry with a matching unconcern for moral consistency, chose to define “participation” as meaning carrying out the abortion, and nothing more. Organising, managing and aiding other people to do it was quite different; there was no right to refuse to do it.

The point matters a great deal. Many NHS hospitals now put abortion and other controversial procedures out to tender (a matter itself a cause for concern, though not here), and so organisation rather than participation is increasingly what will be demanded from often unwilling staff. . . [Full Text]

Munich university remembers executed students: “Law changes, the conscience doesn’t”

Ludwig Maximilians Universität München

Justice, freedom, human rights, moral consciousness, courage, willingness to accept responsibility – what do these values and virtues cost? . . . On 18 February 1943, Hans and Sophie Scholl were arrested by the Gestapo, after they had scattered copies of their latest leaflet around the Main University Building. Further arrests were made in the days following and, in several separate trials, the leading members of the White Rose were convicted by an inhuman regime and put to death. [Full text]

Belgium’s euthanasia commission under fire after shock letter by whistleblower

BioEdge

Xavier Symon

Evidence of gross negligence is mounting against Belgium’s peak euthanasia regulatory body, the Federal Commission for Euthanasia Control and Evaluation.

Dr. Ludo Van Opdenbosch, a neurologist who was a Commission member for several years, resigned in September 2017. Associated Press recently obtained the letter of resignation that Dr Van Opdenbosch sent to senior politicians, which details his dissatisfaction with the oversight processes of the Commission. “I do not want to be part of a committee that deliberately violates the law,” he wrote.

According to the letter, the Commission failed to refer to authorities a doctor who Van Opdenbosch says euthanised a demented patient without consent. The letter outlines the basic details of the case – the patient, whose identity was not disclosed, was euthanised at the family’s request, and there was no record of any prior request for euthanasia from the patient.

Furthermore, Van Opdenbosch states that when he expressed concerns about other potentially problematic cases, he was immediately “silenced” by other members of the Commission. He suggests that because many of the doctors on the commission are leading euthanasia practitioners, they can protect each other from scrutiny, and act with “impunity”.

“It’s not euthanasia because the patient didn’t ask, so it’s the voluntary taking of a life,” said Dr An Haekens, psychiatric director at the Alexianen Psychiatric Hospital in Tienen, Belgium. “I don’t know another word other than murder to describe this.”

However, the two co-chairs of the commission, Dr Wim Distelmans and Gilles Genicot, have strongly denied that there has been any negligence. “It can obviously occur that some debate emerges among members but our role is to make sure that the law is observed and certainly not to trespass it,” they said. They also denied that Van Opdenbosch had been muzzled.

Associated Press had already revealed details of a rift between the co-chair of the Commission, Dr. Willem Distelmans, and Lieve Thienpont, an advocate of euthanasia for the mentally ill. Distelmans suggested some of Thienpont’s patients might have been killed without meeting all the legal requirements.

More than 360 doctors, academics and others have since signed a petition calling for tighter controls on euthanasia for psychiatric patients.


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World Medical Association urged to change policy against euthanasia, assisted suicide

Canadian & Royal Dutch Medical Association want censure dropped

Sean Murphy*

The President of the World Federation of the Catholic Medical Associations has disclosed that the Canadian Medical Association (CMA) and Royal Dutch Medical Association (RDMA) have asked the World Medical Association to change its policy against euthanasia and physician assisted suicide.

The WMA issued a Declaration on Euthanasia in 19871 and a Resolution on Euthanasia  in 2002;2  they are now identical. The WMA Statement on Physician Assisted Suicide was made in 1992 and reaffirmed in 2005 and 2015:

Physician-assisted suicide, like euthanasia, is unethical and must be condemned by the medical profession. Where the assistance of the physician is intentionally and deliberately directed at enabling an individual to end his or her own life, the physician acts unethically. However the right to decline medical is a basic right of the patient, and the physician does not act unethically even if respecting such a wish results in the death of the patient.3

Writing to the President of the World Medical Association, Dr. John Lee stated that the CMA and RDMA suggested that existing policy be replaced with the following:

8. The WMA does not support euthanasia or physician assisted suicide, but WMA does not condemn physicians who follow their own conscience in deciding whether or not to participate in these activities, within the bounds of the legislation, in those jurisdictions where euthanasia and/or physician assisted dying are legalized.

9. No physician should be forced to participate in euthanasia or assisted suicide against their personal moral beliefs. Equally, no conscientiously objecting physician should be forced to refer a patient directly to another physician. Jurisdictions that legalize euthanasia or physician assisted suicide must provide mechanisms that will ensure access for those patients who meet the appropriate requirements. Physicians, individually or collectively, must not be made responsible for ensuring access.4

Dr. Lee also expressed opposition to a planned revision to the Declaration of Oslo concerning abortion, which, he said, would require objecting physicians to refer for abortions and even to provide them.  However, he commented at greater length on the proposed change to WMA policy on euthanasia and assisted suicide.

Based on the Canadian experience, acceptance of the ethical neutrality of medically-assisted death has resulted in almost immediate challenges for physicians who are unable to refer because of moral, religious, or ethical concerns. It is a serious problem, with physicians put in the impossible position of having to choose between their conscience and being allowed to continue to care for their patients.4

The Canadian roots of the CMA/RDMA proposal

Dr. Lee’s observations about developments in parts of Canada are accurate.  The text of paragraph 8 is very similar to the CMA resolution used by the CMA Board of Directors as the basis for reversing CMA policy against euthanasia and assisted suicide. . . [Full Text]

Euthanasia dispute in Belgium: When do doctors cross a line?

CBC News

Associated Press

A disputed case of euthanasia in Belgium, involving the death of a dementia patient who never formally asked to die, has again raised concerns about weak oversight in a country with some of the world’s most liberal euthanasia laws.

The case is described in a letter provided to The Associated Press, written by a doctor who resigned from Belgium’s euthanasia commission in protest over the group’s actions on this and other cases.

Some experts say the case as documented in the letter amounts to murder; the patient lacked the mental capacity to ask for euthanasia and the request for the bedridden patient to be killed came from family members. The co-chairs of the commission say the doctor mistakenly reported the death as euthanasia. . . [Full Text]

Politicians call on public to oppose Fraser Health making hospices offer euthanasia

Surrey Now Leader

Heather Colplitts

Fraser Health’s decision to have hospices offer medically assisted dying prompted a couple hundred people to gather Saturday to discuss how to fight back.

A Saturday evening meeting about the local health authority allowing medical assistance in dying (MAiD) included a discussion on whether there’s a possible legal case, and what people, hospice societies and volunteers can do if they disagree with the health authority.

All B.C. health authorities have said their various facilities would provide MAiD. Fraser Health funds the hospice residence near Langley Memorial Hospital where terminally ill people are able to receive care. The society has offices and space for its various bereavement programs at 20660 48th Ave. and has a contract with Fraser Health to provide volunteers for the residence. . . [Full Text]

O’Loan submits Bill that would allow medics to refuse to carry out abortions

Baroness Nuala O’Loan has introduced a Parliamentary Bill which, if passed, could allow medical professionals to opt out of providing any abortion services.

Belfast Telegraph

The Conscientious Objection (Medical Activities) Act 2017 would also excuse medics from participating in the withdrawal of life-sustaining treatment.

The Private Member’s Bill would apply to all medical professionals on the registers of the General Medical Council, the Nursing and Midwifery Council, the Health and Care Professions Council and the General Pharmaceutical Council in England and Wales.

The Bill states that employers “must not discriminate against or victimise” an employee who conscientiously objects. It has passed its second reading in the House of Lords and will now proceed to the committee stage. . . [Full Text]

Catholic Medical Association Joins with 25,000 Physicians Fighting Proposed Global Abortion Policy to Strip Conscience Rights Protections

News Release

Catholic Medical Association

PHILADELPHIA, PA – FEBRUARY 12, 2018 – Conscience rights protections for health care providers in the U.S. and abroad are once again under attack. The World Medical Association (WMA) representing 10 million physicians worldwide is poised to approve a policy that would demand doctors refer for abortion, even against their conscience.

Although current federal statutes in the U.S. protect health care provider’s conscience rights and prohibit recipients of certain federal funds from discriminating against health care providers, WMA ethics policies greatly impact future regulations of the medical profession globally.

The WMA was founded in 1947 in response to Nazi atrocities during WW II. The organization promotes itself as “evaluating and codifying ethics in healthcare.” Currently the WMA policy requires doctors ensure continuity of care for patients who choose abortion, but not force doctors refer for the procedure. However, the WMA’s proposed revision threatens the conscience rights of all physicians and health care professionals by proposing the following amendment:

“Individual doctors have a right to conscientious objection to providing abortion, but that right does not entitle them to impede or deny access to lawful abortion services because it delays care for women, putting their health and life at risk. In such cases, the physician must refer the woman to a willing and trained health professional in the same, or another easily accessible health-care facility, in accordance with national law. Where referral is not possible, the physician who objects, must provide safe abortion or perform whatever procedure is necessary to save the woman’s life and to prevent serious injury to her health.”

The proposed changes in policy would also eliminate the provision that “requires the physician to maintain respect for human life.”

“We do not believe abortion is healthcare. The international impact on this global abortion policy is incalculable,” said CMA President Dr. Peter T. Morrow. “We join with the representatives of over 25,000 physicians, nurses, health care providers and patient advocates who provide excellent, scientific, ethical and moral healthcare in accordance with the principles of the Oath of Hippocrates. Collectively we request that the WMA’s revision be rejected, it is subversive of physician freedom of conscience concerning abortion in the short term, and euthanasia and assisted suicide in the long term.”

The American Medical Association (AMA) is an associate member of the WMA and can recommend rejections and or revisions.  The CMA supports conscience rights of all healthcare professionals with regards to abortion as well as physician assisted suicide, and is jointly sending a letter co-written by: American Association of Pro-Life Obstetricians and Gynecologists, American College of Pediatricians, Christian Medical & Dental Associations, National Association of Catholic Nurses-U.S.A. and The National Catholic Bioethics Center to the AMA strongly denouncing the WMA’s proposed change forcing physicians to violate their conscience rights.

The WMA’s proposed changes could become a global policy. The general assembly is scheduled to vote in October.

Contact:

Susanne LaFrankie, MA
Diector of Communications
email: lafrankie@cathmed.org


The Catholic Medical Association is a national, physician-led community of over 2,400 health care professionals. CMA’s mission is to inform, organize, and inspire its members, to uphold the principles of the Catholic faith in the science and practice of medicine.