Project Letter to the BC Medical Journal

British Columbia, Canada
16 February, 2002

Sean Murphy, Administrator
Protection of Conscience Project

The cover of your  January/February 2002 edition highlighting Dr. Roey M. Malleson’s article on ‘emergency contraception’ was unexpected: a brawny, half-naked, Aryan warrior, eyes glinting murderously from under his horned helmet, wielding a copper IUD, crouched to spring and slaughter.

I would like permission to  post the cover on the Project website, and would appreciate it if you would send me seven copies of the issue. The cover is a splendid  illustration of the usual basis for conscientious objection to  potentially abortifacient devices and drugs, and the article provides  an excellent example of moral obfuscation masquerading as science.

Dr. Malleson clearly  believes, as a matter of faith (for it cannot be science), that it is not immoral to destroy an early human embryo by preventing implantation. However, the article fails to explain why this belief should be forced upon those who do not share it. The Journal of the Society of Obstetricians and Gynaecologists, cited to support Dr. Malleson’s threatening accusation of negligence, is not widely acknowledged to be an infallible authority on faith and morals, nor is Dr. Malleson.

Finally, astute readers will recognize that the law is more complex than suggested by the article. Freedom of conscience is recognized as a fundamental freedom that must be accommodated. It is imprudent and unhelpful to publicly incite civil actions against colleagues in order to secure their submission to the moral outlook so aptly expressed by your cover.

Letter to the Telegraph Journal

New Brunswick, Canada
14 February, 2002

J. Edward Troy,
Bishop Emeritus of  Saint John Rothesay

[Comments in the December, 2001, Bulletin of the College of Physicians and Surgeons  came to media attention in February, 2002, generating pressure on conscientious objectors in New Brunswick.  Catholic Bishop J.  Edward Troy responded to the news reports in this letter, reproduced with permission of the author.  – Administrator-]

The headline on the front page, “MDs’ morals restricting birth control access” (Telegraph-Journal, Feb. 9) was eye-catching. Upon reading the piece, I learned the reporter was culling from the Bulletin of the College of Physicians and Surgeons of New Brunswick (CPSNB) in which it was recorded that at its meeting of Nov. 23, 2001, its council discussed the implications of the right of physicians not to participate in a treatment or process to which they morally object.

In other words, the Code of Ethics of the College quite properly permits physicians to practice their profession in accordance with their conscience. The discussion, as recorded in the bulletin, is repeated  almost in its entirety in the Telegraph-Journal. It was particularly noted that some patients are not referred for an abortion or do not receive advice on contraception from their doctors. This is followed by  comments (not contained in the bulletin) from one physician in Saint John who doesn’t have the same moral qualms, and by some remarks from  the administrator of the Morgentaler abortion facility in Fredericton.

There is an underlying indignation present in the article more suitable to an opinion piece than to a news report. The writer goes back to Nov. 23 for this information which is given headline treatment on Feb. 9,  breathlessly zeroing in on the roughly eight per cent of the text in the college bulletin that considers the case of patients whose doctors refuse to counsel abortion or contraception because of their moral  principles.

Nothing about the other important matters the council deliberated upon  and which were reported in the pages of the same bulletin. Nothing about  the patient who died from a heart attack after being refused treatment for heart disease. Nothing about the instances where allegations of  malpractice were lodged against doctors for a variety of reasons that  resulted in loss of life or serious illness. Nothing about the extremely difficult choices physicians are faced with every day and the honest  efforts the vast majority of them make to serve their patients with  integrity and skill, but also with fallibility and occasional failure.

No, the focus, in a somewhat negative and disapproving fashion, on the  good news that physicians are acting conscientiously in their professional lives. Indeed I was impressed and heartened by all that I read in the bulletin precisely because it revealed the conscientious  manner in which the council of the CPSNB monitors and guides its members.

I doubt very much the CPSNB would wish to change its code of ethics so as to require physicians to disregard their consciences, especially today when there are factions promoting euthanasia and  physician-assisted suicide. While the code of ethics of the CPSNB does  not allow the doctor to impose his moral views on the patient, it would be equally objectionable to insist that the patient be authorized to  impose his or her moral outlook on the doctor. One hears of patients demanding a prescription for this or that drug; should the physician be  obliged to comply? There is reference in the newspaper piece to the  “morning after pill” that is not really a contraceptive but rather an abortifacient.

Pro-life doctors do not perform or cause abortions nor do they  co-operate with others in procuring an abortion. They rightly consider that abortion is the taking of a human life at an early stage in its  development.

In today’s social and cultural climate, the opposition to contraception is not easily understood, let alone accepted. This is not surprising  since the whole idea of any binding moral principles in the area of  sexuality is widely rejected. According to the lax standards prevalent in our culture, no sexual behaviour is morally wrong – fornication, promiscuity, adultery, masturbation, homosexuality, bestiality, etc.

With the exception of child sexual abuse, the guiding rationale seems to be a light-hearted “different folks, different strokes!”

If a person adheres to this sexual libertinism, he or she is not likely to be persuaded by any amount of argumentation that artificial methods  of contraception are wrong, nor will he or she be able or willing to  grasp the distinction between them and natural family planning. He or she will not see that the warm embrace of contraception has led logically and historically to the widespread acceptance of abortion.

While the views of the administrator of the Morgentaler facility were  completely predictable, she really demonstrates a lot of nerve in lecturing physicians about ethics. “I think it’s very irresponsible of doctors not to be meeting patients’ needs, regardless of their personal opinion or religious beliefs,” she is quoted as saying.  Now this judgment comes from someone who is managing a business devoted  to the destruction of babies in the womb!

Talk about the moral high ground! Also, please observe the mentality  revealed in this declaration. If the abortionists were in charge, they would require people to act against their conscience. These are the same  folks that are always whining about pro-life people who, they say, wish to impose their morality on them. However, it’s apparently all right for  the pro-abortion people to impose their morality on the rest of us.

She is also reported complaining that “many” women who had  been refused birth control pills by doctors were using other methods such as condoms and became pregnant. Was that a slip of the tongue?  Doesn’t she belong to the school that keeps insisting that condoms  should be made available to teens and others so that they won’t become  pregnant or contract AIDS? What about all that propaganda about  “safe sex?” It appears that she knows, as everyone should,  that condoms do fail with the result that the woman becomes pregnant or  the unaffected partner gets AIDS.

I salute physicians – no doubt the vast majority of practitioners – who refuse to ignore conscience and moral principle in the exercise of their  calling. I honour physicians who do not derive their notions of what is  right and wrong from popular magazines or from the superficial opinions of “celebrities” or from Hollywood script writers or from harangues by those who operate abortuaries.

Doctors have access to a long and solid tradition of medical ethics.  It’s encouraging to see that so many continue to draw on that wisdom in the practice of their profession and aren’t easily swayed by the fog of  moral indifference which covers so much of the world today.

Project letter to the editor, The Province

There is a whiff of arrogance, as well as intolerance, in the BC College of Pharmacists threat to discipline conscientious objectors (Pharmacists’ college warns renegades about not dispensing morning-after pill, The Province, 23 November, 2000).

While the moral convictions of conscientious objectors are trivialized by describing them as ‘personal’ or ‘private’, many of those convictions are, in fact, shared by millions in religious, philosophical and moral traditions that have existed for millennia. If such convictions are ‘private’, those of the College are not less so, even if dressed up as ‘the ethics of the profession’. Yet the College refuses to explain – or cannot explain – why its newly-minted code of ethics (1997) is morally superior to the moral or ethical systems that it threatens to suppress.

Moreover, it is unclear why the College demands blind faith in the dogmatic judgement of its Ethics Advisory Committee. Among other things, the College has no policy governing qualifications, selection and appointment of ethics committee members, nor does it appear that any of the current committee members have formal qualifications in ethics or related fields.

Finally, the College has not demonstrated that, with respect to a dissenting minority, it is necessary to pursue a policy of institutional aggression rather than accommodation.

Sean Murphy, Administrator
Protection of Conscience Project

 

Letter to the editor, Pharmacy Practice

Rosalyn Wosnick invites her readers to equate conscientious objection among pharmacists to the bigotry of a ‘deep south’ restauranteur, who argued that he had a right to deny service to blacks. (Editorial, Pharmacy Practice, July 2000) The analogy is misplaced, misrepresents the position of conscientious objectors, and is likely to engender prejudicial attitudes among their colleagues.

It would have been more accurate to compare pharmacists who have moral objections to dispensing a drug with a coffee shop owner who refuses to sell Brand X coffee to anyone, because it has been produced by child labour. The object, in both cases, is to avoid complicity in what the parties judge to be evil, regardless of the legalities involved.

However, Ms. Wosnick suggests that if a product is legal, and she wants it, other people should be made to give it to her, even if doing so would be contrary to their moral convictions. The product she is concerned about is Preven. Let’s consider a different product.

Ammunition, like Preven, is a legal product. Moreover, one has a legal right to defend one’s own home, even to the point of using deadly force, if need be. Suppose that a householder wants ammunition for defence against burglars, but a gun store clerk with moral objections to this type of crime prevention refuses to sell him ammunition. Applying Ms. Wosnick’s reasoning, the customer complains that the clerk is denying him his “right” to obtain a legal product. He demands that the clerk sell him the ammunition, or refer him to a more willing colleague, threatening to have him fired if he does not do so.

To say shotgun slugs are “legal”, however, means only that the customer is free to obtain and use them for legal purposes. It implies nothing about how gun store clerks should exercise their own freedom, even if licensed gun stores have a monopoly on the sale of ammunition as part of the state gun control system. Freedom to buy shotgun slugs – or drugs – does not mean that one is legally obliged to sell them, or to help others buy them.

If Ms. Wosnick asserts, instead, that there is a moral obligation to dispense a drug, and that this moral obligation is absolutely binding, she must identify the source of this morality. Moreover, since she would not dare to suppress the moral or ethical beliefs of others unless she was convinced that they were inferior to her own, she must explain why her moral views are superior to those that she seeks to suppress. Finally, in view of human rights jurisprudence that generally requires accommodation of belief rather than its suppression, she must explain why accommodation of those who disagree with her is impossible or undesirable.

Sean Murphy, Administrator
Protection of Conscience Project

Project letter to the editor, Pharmacy Practice

NAPRA, the Canadian Pharmacy Association and New Brunswick, Newfoundland, Prince Edward Island, Yukon and Alberta colleges or associations of pharmacy have stonewalled efforts from outside the profession to discuss freedom of conscience in pharmacy. Gordon Stueck’s invitation to serious, open dialogue on the subject is welcome (“Here we go again…” Pharmacy Practice, May 2000). One hopes it will encourage a change of attitude among those governing the profession. This is particularly important if, as Mr. Stueck states, a significant number of pharmacists object to dispensing Preven for reasons of conscience.

Mr. Stueck suggests that the proper context for such discussion is “the role of the pharmacist in today’s society”, and puts forward an argument against freedom of conscience based on economic self-interest. His primary concern is that the monopoly that pharmacists now enjoy in dispensing prescription drugs will be endangered if too many pharmacists refuse to dispense certain drugs for moral or religious reasons. What this amounts to is an assertion that economic self-interest is a greater good that should be protected at the expense of lesser goods – like freedom of conscience and religion.

Is economic self-interest a greater good than freedom of conscience and religion? Perhaps, in Mr. Stueck’s view, it is, but his view has not been dominant in the histories of liberal democracies, and it is not reflected in the Charter of Rights. The Charter guarantees freedom of conscience and religion- not economic self-interest.

Mr. Strueck’s assertion notwithstanding, public policy in Canada is rarely, in practice, determined by everyone in society, but by those in power. The rejection of the Charlottetown Accord in the nationwide referendum was a singular exception to the general rule. The results of other referenda have been ignored when they have conflicted with the views of public policy makers.

Whatever ‘public policy’ might be with respect to this drug or that, suppression of freedom of conscience and religion is not acknowledged by any authority to be a matter of public policy in Canada.

It should not become the policy of a professional association.

Sean Murphy, Administrator
Protection of Conscience Project

Project letter to the editor, The Standard

A number of health care professionals have moral or ethical objections to dispensing the ‘morning after pill’, so a recent article in The Standard (“Morning-after pill poses moral dilemma for some Mds”, 29 June 2000) is of interest beyond the community served by your paper. I would like to make two points.

First: though the drug in question was described as a ‘contraceptive’ that ‘prevents pregnancy’, many who are familiar with the action of the drug consider it an abortifacient, not a contraceptive, and object to dispensing it for that reason. Moreover, people attempting to understand the issues involved need to be aware that the words ‘abortion’, ‘pregnancy’, ‘conception’ and ‘contraception’ are often assigned completely different meanings by parties in the dispute about Preven.

Second: the good news in the story is almost too obvious for many to see. The woman obtained the drug that she wanted, and the physician was not forced to involve himself in something that he considered to be morally abhorrent. Arrangements at the hospital accommodated both her request for the drug, and his request not to have someone else’s morality imposed upon him.

This is the kind of common-sense accommodation that ought to be more widely practised.

Sean Murphy, Administrator
Protection of Conscience Project

Project letter to the editor, The Winnipeg Sun

As submitted

I am pleased to see that the Winnipeg Sun supports the principle that people should not have to dispense products that they find morally offensive. Your editorial (Pharmacological farce, 6 June, 2000) makes clear that conscientious objectors who refuse to sell cigarettes can count on your support, even though cigarettes are legal in Canada.

What remains unclear are the reasons why you insist on a two-tiered system of civil rights with respect to freedom of conscience: full rights for people who agree with you, like those who would refuse to sell cigarettes, and none for those who do not agree with you, like Concerned Pharmacists for Conscience.

However, the fact that you support the principle with respect to like-minded individuals suggests that a more tolerant and liberal attitude toward others may eventually prevail.

Contrary to the dismissive comment in your editorial, concerns that pharmacists may be forced to dispense drugs for assisted suicide and euthanasia are not misplaced. The College of Pharmacists of BC has put its members on notice about such possibilities. Legalization of assisted suicide, as well as execution by lethal injection, have led some pharmacists’ associations in the United States to adopt policies to protect conscientious objectors.

An attempt to force moral beliefs upon the populace? While that may be a fitting description of the Sun’s editorial, it is not the position of conscientious objectors. They simply do not wish to have the private morality of drug companies and newspaper editors forced upon them.

Sean Murphy, Administrator
Protection of Conscience Project


As Published

Objection sustained

I am pleased The Winnipeg Sun supports the principle that people should not have to dispense products they find morally offensive. Pharmacological Farce, June 6, makes clear that conscientious objectors who refuse to sell cigarettes can count on your support.

Why do you insist on full rights for people who agree with you, like those who won’t sell cigarettes, and none for those who do not agree with you, such as Concerned Pharmacists for Conscience.

The B.C. College of Pharmacists has warned members about the possibility of being forced to dispense drugs for assisted suicide and euthanasia. Legalizing assisted suicide and execution by lethal injection led U.S. pharmacist associations to protect conscientious objectors.

Conscientious objectors aren’t trying to force moral beliefs upon others. They simply do not wish to have the private morality of drug companies and newspaper editors forced upon them.

Letter to the editor, Globe and Mail

Reproduced with permission

Re: April 27, 2000: Don’t let drugstores become pulpits

An “inability to distinguish between emergency contraception and the abortion pill”, and “irresponsible and blatantly uninformed” actually describes Planned Parenthood, not educated pharmacists. Planned Parenthood eagerly wants women to ingest dangerous hormones, which in the case of the morning after pill, fails at least 25% of the time. Planned Parenthood, not pharmacists, makes the choice for women by withholding facts and “spreading misinformation” in the name of sexual freedom.

Let every woman exercise her right to make an informed decision: the scientific literature is clear and abundant that the morning after pill (post-coital interception) acts primarily to prevent implantation, not ovulation. Therefore, to call it a contraceptive is false and misleading. To argue that pregnancy is not already established is a minority viewpoint ignoring virtually all embryology, biology and genetics texts.

Dr. Albert Yuzpe invented the morning after pill, yet does not mention ovulation prevention in his Contemporary Obstetrics and Gynecology article in 1994. He does mention, however, structural changes in the endometrium might “represent a hostile or non-receptive site for implantation”.

Futhermore, Jennifer Kessell, spokewoman for the company making Preven, confirmed that “more often it would prevent implantation” (The Report, Dec 6, 1999).

Pharmacists are objecting to participate, not attempting to block patient access to products. Doctors cannot be forced to perform procedures that violate their consciences, why should pharmacists? By pushing their morality on health care workers, the public violates a pharmacist’s autonomy, integrity, and basic human rights in a country that protects its minorities

Maria Bizecki
Concerned Pharmacists for Conscience

 

 

Project letter to the editor, Globe and Mail

(Not published)

Joy Thompson and Hazelle Palmer betray a fundamental misunderstanding of conscientious objection in their criticism of Concerned Pharmacists for Conscience (Don’t let drug stores become pulpits, Globe & Mail, 26 April 2000).

Pharmacists who have moral objections to dispensing the morning after pill usually assert that a new, unique and living human being begins to exist – and pregnancy begins – with the union of sperm and egg. This union they call conception or fertilization. These are hardly novel propositions in an era when fertilization is accomplished routinely in petri dishes, the resulting early embryos kept alive and matured pending implantation – or civil litigation.

The morning after pill prevents the union of sperm and egg only if it is taken in time to suppress ovulation. In other cases, it brings about the death of the early embryo by preventing implantation in the womb. This is the crux of the moral problem faced by pharmacists who hold that it is gravely wrong to deliberately cause the death of the developing human being at any point after conception.

Planned Parenthood and The Society of Obstetricians and Gynaecologists of Canada think that the morning after pill is a good thing. They call it ‘emergency contraception’, they claim that it does not cause abortions, and they ridicule those who disagree. “Out of step with medical community”, “professionally irresponsible, or blatantly uninformed”, and “inventing a controversy” are the accusations hurled from the Planned Parenthood pulpit at conscientious objectors.

The controversy being invented here arises from a difference in terminology. Thompson and Palmer et al define conception – and the beginning of pregnancy – as implantation of the early embryo in the womb, not as the union of sperm and egg. Thus, in their view, ‘contraception’ includes not only drugs or devices that prevent conception (fertilization), but anything that prevents implantation of the early embryo. That is why they describe the morning after pill as a ‘contraceptive’, regardless of its mechanism, and insist that it does not interfere with pregnancy. In their lexicon, the existence of the early embryo following fertilization does not count as pregnancy unless implantation occurs, and the destruction of the embryo prior to implantation is not abortion. The public can hardly be expected to make sense of the present dispute unless these points are clarified.

Out of step with medical community? The Canadian Medical Association advises physicians who have moral objections to abortion to explain this to their patients, and insists that there be no discrimination against physicians who refuse to perform or assist with abortions. Dr. John Williams, the CMA’s Director of Ethics, recently confirmed that doctors are not obliged to refer patients for abortions. “Respect for the right of personal decision in this area must be stressed,” states CMA policy. Is the respect given to doctors to be denied pharmacists and other health care professionals because powerful interests are able to shout them down?

Contrary to Thompson and Palmer’s assertions, conscientious objectors are not trying to prevent the introduction of abortifacient or contraceptive drugs, nor are they attempting to block access to them. These are impossible objectives for such a vulnerable minority with limited means. Instead, they simply ask that they not be hounded out of their professions because they will not do what they believe to be gravely wrong. Does The Best Country in the World have room for such people?

Sean Murphy, Administrator
Protection of Conscience Project

Project letter to the Edmonton Sun

Edmonton, Alberta, Canada
25 April, 2000

Sean Murphy, Administrator
Protection of Conscience Project

Mindelle Jacobs cites Arthur Schafer, director of the Centre for Professional and Applied Ethics at the University of Manitoba, to the effect that conscientious objectors should be driven out of the medical profession if they are unwilling to provide “perfectly legal services” to patients who want the services but can’t go elsewhere to get them. According to Jacobs, Alberta Pharmaceutical Association registrar Greg Eberhart has similar views (Pharmacists want right of refusal, Edmonton Sun, 16 April, 2000).

Well, perhaps they wouldn’t drive them out of the profession. Perhaps they’d just drive them out of the province, or out of the country. Freedom of conscience, if you insist, but not in my back yard.

Now, Jacobs is surely convinced of the truth of the moral vision she shares with Schafer and Eberhart, and of its fundamental importance. After all, she wants to impose that morality by denying conscientious objectors employment, or firing them, or forcing them to go elsewhere to make a living. One wouldn’t do such things unless the morality to be imposed was at least superior to the morality being suppressed, and unless one was also convinced of the necessity of forcing it upon others.

Unfortunately, Jacobs does not explain why her morality is superior to that of pharmacists like Maria Bizecki and Concerned Pharmacists for Conscience. Instead, she indulges in a bit of speculative scare-mongering. If “Bizecki and her pals”have their way, she wonders, “Where will it stop?”

One might also ask where it will stop if conscientious objection is suppressed. A recent bulletin from the College of Pharmacists of British Columbia (Vol. 25, No. 2. Ethics in Practice: Moral Conflicts in Pharmacy Practice) suggests the answer. Driven by the primary ‘ethical criteria’ of legality and consumer demand, the CPBC would require pharmacists to dispense drugs not only for abortion, but for euthanasia, assisted suicide and execution by lethal injection. Canada Safeway, apparently taking its ethical direction from such missives, entered the millennium by asserting that it has the right to ensure employees with religious scruples “promptly serve its customers” and not direct them to competitors for euthanasia drugs and abortion pills (Pharmacy Policies and Procedures, Section IV, Pharmacy Operations, Chapter 4, 1/1/2000, Page No. 16).

Alberta M.L.A. Julius Yankowsky has put forward a bill seeking limited legal protection of conscience for health care workers. The bill does not take any position on the morality or desirability of abortion, assisted suicide, euthanasia or other controversial medical procedures. It simply recognizes that such procedures are morally controversial. It permits discussion and reasoned argument, but not discrimination or coercion.

Sadly, the reaction of Mindelle Jacobs, Arthur Schafer and Greg Eberhart to Mr. Yankowsky’s modest proposal demonstrates the need for such legislation.