American Medical Association provides details of new freedom of conscience policy

AMA submission to Ontario College of Physicians an improvement on quality of briefing by College working group

Sean Murphy*

The American Medical Association has made a submission to the public consultation on physician freedom of conscience being conducted by the College of Physicians and Surgeons of Ontario (CPSO).  The AMA letter provides important details about a policy on physician freedom of conscience adopted by the AMA House of Delegates in November, 2014, but not due to be formally published until June of this year.

The current consultation on a controversial draft policy, Professional Obligations and Human Rights (POHR), was approved by College Council in December, 2014.  Briefing materials provided to Council members by the College working group at that time included the American Medical Association as one of the organizations selected for international comparison of policies.

However, the single sentence offered by the working group as representative of AMA policy was taken from an on-line source of short essays about medical ethics, not an authoritative source of information about AMA policy. In fact, the article was about conscientious objection among pharmacists, not about the policies of the American Medical Association concerning freedom of conscience in health care.

The letter from the AMA is a substantial improvement upon what the Protection of Conscience Project submission characterizes as the “deficient and superficial” briefing materials concerning the United States supplied to College Council in December.

. . .In the Council’s view, an account of the nature and scope of a physician’s duty to inform or to refer when a patient seeks treatment that is in tension with the physician’s deeply held personal beliefs must address in a nuanced way the question of moral complicity. The Council concurs that physicians must provide information a patient needs to make a well-considered decision about care, including informing the patient about options the physician sincerely believes are morally objectionable. However, the Council sought to clarify that requirement, holding that before initiating a patient-physician relationship the physician should “make clear any specific interventions or services the physician cannot in good conscience provide because they are contrary to the physician’s deeply held personal beliefs, focusing on interventions or services that a patient might otherwise reasonably expect the practice to offer.”

The Council also reached a somewhat different conclusion than the College with respect to a duty to refer.

The College’s draft policy provides that, when a physician is “unwilling to provide certain elements of care on moral or religious grounds,” the physician must provide “an effective referral” to “a nonobjecting, available, and accessible physician or other health care provider.”

This seems to us to overstate a duty to refer, risk making the physician morally complicit in violation of deeply held personal beliefs, and falls short of according appropriate respect to the physician as a moral agent. On our view, a somewhat less stringent formulation of a duty to refer better serves the goals of non-abandonment, continuity of care, and respect for physicians’ moral agency. The council concluded that:

In general, physicians should refer a patient to another physician or institution to provide treatment the physician declines to offer. When a deeply held, well-considered personal belief leads a physician also to decline to refer, the physician should offer impartial guidance to patients about how to inform themselves regarding access to desired services.

On the Council’s analysis, the degree or depth of moral complicity is defined in part by ones “‘moral distance’ from the wrongdoer or the act, including the degree to which one shares the wrongful intent.”

Other factors also influence complicity, including “the severity of the immoral act, whether one was  under duress in participating in the immoral act, the likelihood that one’s conduct will induce others to act immorally, and the extent to which one’s participation is needed to facilitate the wrongdoing.” . . .

Pediatrician won’t treat baby with 2 moms

 USA Today

Tresa Baldas, Detroit Free Press

DETROIT  –  Sitting in the pediatrician’s office with their 6-day-old daughter, the two moms couldn’t wait to meet the doctor they had picked out months before.

The Roseville, Mich., pediatrician  –  one of many they had interviewed  –  seemed the perfect fit: She took a holistic approach to treating children. She used natural oils and probiotics. And she knew they were lesbians.

But as Jami and Krista Contreras sat in the exam room, waiting to be seen for their newborn’s first checkup, another pediatrician entered the room and delivered a major blow: The doctor they were hoping for had a change of heart. After “much prayer,” she decided that she couldn’t treat their baby because they are lesbians. [Full text]


Redefining the Practice of Medicine- Euthanasia in Quebec, Part 6: Participation in Killing


It appears that, even where euthanasia or assisted suicide is legal, the majority of physicians do not actually provide the services.  However, by establishing a purported legal “right” to euthanasia, ARELC generates a demand that physicians kill their patients, despite the high probability that a majority of physicians will not do so.

Often for purely pragmatic reasons, euthanasia supporters do not usually insist that an unwilling physician should be compelled to personally kill a patient.  Thus, the difficulty created by the law can be addressed by administrative measures that connect patients looking for euthanasia with the minority of physicians willing to provide it.  Nonetheless, physicians who object to euthanasia for reasons of conscience will likely be expected to facilitate access to the procedure by helping the patient find a colleague willing to provide it.

However, objecting physicians not only refuse to kill patients, but also often refuse to do anything that they believe makes them morally responsible for the killing.  This includes actions that indirectly support or facilitate it.  Hence, it is likely that most of the attacks on freedom of conscience resulting from ARELC will be preciptated, not by a refusal to kill directly, but by this kind of refusal to participate indirectly in killing.

The Criminal Code demonstrates that a physician who refuses to facilitate the killing of a patient because he does not want to be a culpable participant in killing is acting well within well-established moral and legal norms reflected in our criminal law.  Further, the polices of professional medical organizations that forbid physician participation in capital punishment, torture, and female genital cutting indicate that it is not unreasonable for objecting physicians to refuse to facilitate euthanasia even indirectly.

On the contrary: refusing to participate, even indirectly, in conduct believed to involve serious ethical violations or wrongdoing is not aberrant behaviour.  It is the response expected of physicians by professional bodies and regulators in order to avoid physician complicity in such procedures. [Full Text]

El problema de la objeción de conciencia no regulada

Cuando la conciencia molesta a la ley

Sean Murphy*

A finales de 2010, en la Asamblea Parlamentaria del Consejo de Europa (PACE) se presentó un informe de su Comisión de Asuntos Sociales, Salud y Familia en el que expresaba su profunda preocupación por el problema de la “objeción de conciencia no regulada” en Europa. El Comité propuso que los Estados adoptaran “una regulación integral y clara” para hacer frente a este problema. . .[aceprensa]

The problem of unregulated conscientious objection

  Sean Murphy*

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]


The Obama Administration’s Attack on Roe v. Wade and Doe v. Bolton

Alliance Defence Fund
January 24th, 2012
Reproduced with permission

Casey Mattox

Thirty-nine years ago the United States Supreme Court recognized that medical professionals, let alone others, have a right not to assist in abortions in violation of their conscience. What’s that? Yes, I do have the date right. I’m talking about Roe v. Wade and Doe v. Bolton. While those cases held, wrongly, that women and their doctors have a fundamental constitutional right to kill an unborn child, they also recognized as important predicates to those decisions the right NOT to participate in abortion in violation of one’s conscience. Friday’s announcement that the Obama Administration would force employers – including nonprofit religious employers – to pay for their employees’ contraception and abortifacients is just the latest example of how the abortion industry and its friends in the Obama Administration are attacking these well established rights of conscience in ways even the authors of Roe and Doe did not envision.

Even at the time of Roe, some were concerned that legalized abortion would lead to compelled participation in abortion, a concern that was not misplaced as ACLU attorneys were working in Montana to force Catholic hospitals to perform sterilizations. The Supreme Court acknowledged but dismissed that concern, holding only that “the attending physician, in consultation with his patient, is free to determine, … the patient’s pregnancy should be terminated.” The Court cited favorably the resolution of the AMA House of Delegates stating:

RESOLVED, That no physician or other professional personnel shall be compelled to perform any act which violates his good medical judgment. Neither physician, hospital, nor hospital personnel shall be required to perform any act violative of personally held moral principles. In these circumstances, good medical practice requires only that the physician or other professional personnel withdraw from the case so long as the withdrawal is consistent with good medical practice.

Similarly, in Doe v. Bolton while the Supreme Court struck down some parts of a Georgia abortion law, it left standing a provision that allowed any medical professional or hospital to decline to participate in abortions, saying that this provision was an “appropriate protection to the individual and to the denominational hospital.” Thus, in the seminal abortion decisions that President Obama and the abortion industry celebrate this weekend, the same Court acknowledged the right NOT to assist in abortions in violation of conscience.

To be absolutely sure however, the U.S. Congress passed the Church Amendments, turning back ACLU efforts to treat Catholic hospitals receiving Medicare funds as public hospitals and force them to perform sterilizations (and ultimately abortions), and prohibiting recipients of certain federal funds from requiring medical professionals or any person to participate in abortions, sterilizations, or other procedures in violation of conscience. This was so uncontroversial it passed with only a single vote against in either house – a vote total unthinkable even for a bill to honor mom and apple pie today. In fact, noted right wing extremist Senator Ted Kennedy spoke in favor of the law on the floor of the Senate, saying that it protected the constitutional right not to participate in abortion and he supported the “full protection to the religious freedom of physicians and others.” In 1973, as the opinions reflect, there was no doubt that whatever right the penumbral emanations of the constitution gave to women and doctors to participate in abortions, it certainly protected the right not to participate in abortions or other medical procedures that violated one’s conscience.

It is in the face of this history that the Obama Administration announced on Friday that it will, with only a 1 year reprieve, fine virtually every faith-based ministry in the country that does not pay for contraception and abortifacients (Plan B, Ella, IUD, etc. included). This decision is certainly an affront to religious liberty –perhaps the greatest in our nation’s history. But it is also completely unsupported, indeed rejected by the very cases that the Obama Administration would use to support its cause. Roe and Doe, as bad as those decisions are, reject the Administration’s claim that a woman’s “right” to contraception and abortifacients justify the federal government compelling Christ-centered ministries to violate their conscience by buying these for them. When you hear abortion industry supporters rely upon those decisions to justify this assault on conscience, don’t believe it. Even Roe itself is conservative compared to the radical anti-life advocacy of the present Administration.

ADF is a legal alliance of Christian attorneys and like-minded organizations defending the right of people to freely live out their faith. Launched in 1994, ADF employs a unique combination of strategy, training, funding, and litigation to protect and preserve religious liberty, the sanctity of life, marriage, and the family.