Medical myths about Eighth Amendment must be challenged

Campaign of fear and misinformation has been deployed to tarnish reputation of Irish medicine

Irish Times

Eamon McGuinness

The State acknowledges the right to life of the unborn and, with due regard to the equal right to life of the mother, guarantees in its laws to respect, and, as far as practicable, by its laws to defend and vindicate that right.’

Those words were inserted into our Constitution by the Irish people in 1983. As a consultant obstetrician, and later as chairman of the Institute of Obstetricians and Gynaecologists, I served Irish women and their children under the auspices of the Eighth Amendment.

It should be a matter of some national pride that Ireland, in that time, has been one of the safest places on earth to be a pregnant woman, and one of the safest places in the world to be an unborn child.

In recent times, a sustained campaign has been waged by some people, including several of my colleagues in obstetrics and gynaecology, to suggest that the words at the beginning of this article put women’s lives at risk.

If that were true, I myself would be leading the charge to have them expunged from the Constitution. A constitutional restriction on my ability, or the ability of any of my colleagues, to save the life of a pregnant woman would indeed be intolerable. Let me therefore be clear: no such restriction exists.

The Eighth Amendment has one medical effect only: it prevents Irish doctors from deliberately, as an elective matter, causing the death of an unborn child. It awards to the child in the womb the right to have their life protected in Irish hospitals, in Irish GP surgeries, and in Irish operating theatres.

That right does not restrict doctors from acting to save the life of a woman where a serious complication arises. . . . [Full text]

Declaration in Support of Conscientious Objection in Health Care

Introduction

The Declaration and associated texts you find here are my attempt, as a concerned academic, to provide a platform for the public support of freedom of conscience in health care.

Please read all of the material here. If you agree with the Declaration overall – even if you disagree with or are neutral on various details – I encourage you to add your electronic signature as a demonstration of support.

Signatures from health care professionals and academics in related fields are especially welcome, but you are encouraged to sign simply if you share my concerns and agree with the general way I have expressed them. You do not need an institutional affiliation, professional title, or any particular background. The more signatures this Declaration obtains, the more likely it is to come to the attention of policy makers and people who can amplify the message.

The texts ancillary to the Declaration are not part of its contents; they simply explain how I see and interpret the issues raised in the Declaration, and how I would like to see policy develop. By signing the Declaration, you do not indicate support for anything I say in the ancillary texts.

You will be asked only for your name, professional title (if you have one), institutional affiliation (if you have one), email address, and the country in which you reside. I may use your email occasionally to send you information about the Declaration, such as media coverage, but I will not use your email address for any other purpose. You will not be asked be involved in any other activity. The information you provide will be used solely to represent support for freedom of conscience in health care to professionals in the field (both clinical and academic), policy makers, and other interested parties who might be able to help with the promotion of this issue.

Acknowledgement and Disclaimer
I am grateful to the University of Reading for its support in hosting this material. The views and proposals presented here, however, represent my opinions alone. They do not, in any way, necessarily represent the views of the University of Reading or any of its officers, employees, or students.
David S. Oderberg

Sign the Declaration in Support of Conscientious Objection in Health Care

Show your support by signing the declaration.

Quebec euthanasia statistics: 67% increase in euthanasia deaths in second year

Introduction

Since 10 December, 2015, euthanasia has been provided by physicians in Quebec under the terms of An Act Respecting End of Life Care (ARELC).  Health and social services agencies established by the government throughout the province are state agencies responsible for the delivery and coordination of health care in the province administrative regions. These are called Centres intégrés de santé et de services sociaux (CISSS) and Centres intégrés universitaires de santé et de services sociaux [CIUSSS).  Some administrative regions (like Montreal and the Quebec City region) have more than one CISSS or CIUSSS.

These agencies are responsible for the delivery of euthanasia.  For two years beginning 10 December, 2015, they were required to make reports twice yearly to a commission established by the law to monitor the administration of euthanasia (the Commission sur les soins de fin de vie) and publish them on their websites.  These twice-yearly reports will apparently cease to be published after that time.  The Commission draws from these and other reports to make its required summary of activity to the legislature (National Assembly).

The Project has compiled the statistics provided in these reports from10 December, 2015 to 10 December, 2017.  The compilation includes tables and charts, some of which are reproduced below.

Euthanasia Requests in Quebec, 2016-2017
Euthanasia Requests in Quebec, 2016-2017

Note that, in some cases, the number of patients lethally infused is higher than the number of requests because euthanasia was provided in response to a request made in the previous reporting period.  In addition, not all euthanasia deaths are captured in these reports, as some regions with low populations do not publish reports, and euthanasia may be provided by private entities that are not subject to the statutory twice-yearly reporting requirement.

  • The number of euthanasia requests made weekly in the province increased from about 14 in 2016 to about 23 in 2017. In Montérégie the number of requests weekly doubled; they more than tripled in Bas-Saint-Laurent.
  • Euthanasia was provided about 9 times weekly in the province during 2016 and 14 times weekly in 2017.
  • The number of euthanasia deaths increased by about 67% from 454 in 2016 to 757 in 2017.  This is about 1.1% of deaths from all causes, a rate not reached by Belgium for 9 years after legalization.
    • In Outaouais the number of euthanasia deaths almost doubled (11 to 21)
    • In Chaudière-Appalaches the number more than doubled (18 to 40)
    • The number of euthanaia deaths more than tripled in Saguenay-Lac-Staint-Jean (6 to 19)
    • The number of euthanasia deaths quadrupled in Côte-Nord (2 to 8), and more than quadrupled in Abitibi-Témiscamingue (4 to 18).
  • 434 requests for euthanasia were not acted upon in 2017, up from 263 in 2016.  However, the percentage of all requests not acted upon remained constant at 37%.
    • In 11% of the cases the patient died of natural causes before euthanasia was provided, up from 9% in 2016.
    • About 8% of the patients did not qualify for the procedure, down from 11% in 2016.
  • Marked increases in rates of continuous palliative sedation occurred in a couple of regions, notably Laurentides (a 2017 reate almost six times that of 2016) 

See: full statistical summary with downloadable Excel file

You’re a surgeon. A patient wants to look like a lizard. What do you do?

As medical treatments advance, the need to accommodate conscientious objection in healthcare is more pressing

The Guardian
Reproduced with permission

David S. Oderberg*

Imagine that you are a cosmetic surgeon and a patient asks you to make them look like a lizard. Would you have ethical qualms? Or perhaps you are a neurosurgeon approached by someone wanting a brain implant – not to cure a disability but to make them smarter via cognitive enhancement. Would this go against your code of professional ethics? With the rapid advance of medical technology, problems of conscience threaten to become commonplace. Perhaps explicit legal protection for conscientious objection in healthcare is the solution.

There is limited statutory protection for those performing abortion, and there is some shelter for IVF practitioners. Passive euthanasia (withdrawal of life support with intent to hasten death) is also part of the debate over doctors’ conscience rights. That’s about it as far as UK law is concerned – though freedom of conscience is enshrined in numerous conventions and treaties to which we are party. Abortion, artificial reproductive technologies (involving embryo research and storage) and passive euthanasia are the flashpoints of current and historic controversy in medical ethics. The debate over freedom of conscience in healthcare goes to the heart of what it means to be a medical practitioner.

Curing, healing, not harming: these are the guiding principles of the medical and nursing professions. But what if there is reasonable and persistent disagreement over whether a treatment is in the patient’s best interests? What if a practitioner believes that treating their patient in a particular way is not good for them? What if carrying out the treatment would be a violation of the healthcare worker’s ethical and/or religious beliefs? Should they be coerced into acting contrary to their conscience?

Such coercion, whether it involve threats of dismissal, denial of job opportunities or of promotion, or shaming for not being a team player, is a real issue. Yet in what is supposed to be a liberal, pluralistic and tolerant society, compelling people to violate their deeply held ethical beliefs – making them do what they think is wrong – should strike one as objectionable.

Freedom of conscience is not only about performing an act but about assisting with it. There are some people who ask doctors to amputate healthy limbs. If you were a surgeon, my guess is that you would refuse. But what about being asked to help out? Would you hand over the instruments to a willing surgeon? Or supervise a trainee surgeon to make sure they did the amputation correctly? If conscientious objection is to have any substance in law, it must also cover these acts of assistance.

This country has a long and honourable tradition of accommodating conscientious objectors in wartime – those who decline to fight or to assist or facilitate the fighting by, say, making munitions. They can be assigned to other duties that may support the war effort yet are so remote a form of cooperation as not to trouble their consciences. In any war, the objectors are a tiny fraction of the combat-eligible population. Yet when it comes to one’s rights, do numbers matter? Has their existence ever prevented a war from being carried out to the utmost? I fail to see, then, why we are tolerant enough to make adjustments for conscientious objectors in the midst of a national emergency, yet in peacetime would be reluctant to afford similar adjustments to members of one of the most esteemed professions.

Do we think medical practitioners should be no more than state functionaries, dispensing whatever is legal no matter how much it is in conflict with personal conscience and professional integrity – lest they be hounded out of the profession? Some academics think expulsion is not good enough. Or should healthcare workers be valets, providing whatever service their patients demand? Perhaps when practitioners find themselves faced with demands for the sorts of treatment I’ve mentioned – or perhaps gene editing treatments or compulsory sterilisation, society will act. Or maybe by then it will be too little, too late.

David S Oderberg is professor of philosophy at the University of Reading, and author of Declaration in support of conscientious protection in medicine

 

 

Myths and lies about abortion must be debunked

We are all entitled to our own opinions and beliefs – but not our own facts

The Irish Times

David Robert Grimes

Abortion has long been a contentious issue in Ireland, replete with emotive and frequently dubious rhetoric. This was recently exemplified by Save the Eighth billboard campaign featuring an abortion nurse detailing the horrors he had witnessed.

This testimony was somewhat undermined by the revelation it had been fabricated, leading to the unedifying sight of campaign manager John McGuirk rapidly pivoting from legal threats to grudging acceptance, a volte-face hard to distinguish from surrealist performance art. As the referendum looms ever closer, it is inevitable campaigning will become more charged, both online and off. . . . [Full text]

Response: Thomas Ryan, BL

5 April, 2018

Sir, – David Robert Grimes contrasts pro-life and pro-choice campaigners by saying that “pro-choice advocates do not seek to impose their morality upon others” . . .This is an extraordinary statement, particularly in a pompous article which was intended to wag the finger about the need for factual accuracy. . .

Under the draft legislation proposed by the Government, doctors and nurses who are opposed to abortion will also have a legal duty imposed on them to be complicit in abortions by referring women to another doctor who will perform the abortion. . .

Internationally, but particularly in America and Europe, the legalisation of abortion was quickly followed by a concerted campaign by pro-choice groups to strip away the remaining conscience protections enjoyed by doctors. This process is already under way here. . . [Full Text]

 

‘Medical Conscience’ Is Becoming a Partisan Controversy

National Review
Reproduced with permission

Wesley J. Smith

Should doctors and nurses be forced to participate in interventions they find morally abhorrent or unwarranted? As one example, should ethical rules require pediatricians to medically inhibit normal puberty as demanded by parents to “treat” their child’s gender dysphoria — even if they are morally opposed to the concept and/or the supposed treatment?

Some say yes. Thus, influential bioethicist Ezekiel Emanuel argues that medical professionals are obligated to accede to the patient’s right to receive legal interventions if they are generally accepted within the medical community — specifically including abortion. Emanuel stated doctors who are morally or religiously opposed, should do the procedure anyway or procure a doctor they know will accede to the patient’s demands. Either that, or get out of medicine.

Supporters of “medical conscience” argue that forcing doctors to participate in interventions they find morally abhorrent would be involuntary medical servitude. They want to strengthen existing laws that protect doctors, nurses, and pharmacists’ who refuse participation in legal interventions to which they are morally or religiously opposed.

Now, medical conscience looks to become another battlefront in our bitter partisan divide. After the Trump administration announced rules that will place greater emphasis on enforcing federal laws protecting medical conscience, Democratic state attorneys general promised to seek a court order invalidating the new rule. From the New York Law Journal story:

But 19 state attorneys general, led by New York’s Eric Schneiderman, argue that it is the patients who will be discriminated against under the proposed rule. This is particularly true, they argue, in the cases of marginalized patients who already face discrimination in trying to obtain health care, such as lesbian, gay, bisexual and transgender patients and male patients seeking HIV/AIDS preventative medications, according to the comments filed in opposition to the rule.

“If adopted, the proposed rule … will needlessly and carelessly upset the balance that has long been struck in federal and state law to protect the religious freedom of providers, the business needs of employers, and the health care needs of patients,” they state.

The stakes can only increase as moral controversies in health care intensify in coming years. As just two examples, some bioethicists are lobbying to enact laws that would give dementia patients the right to sign an advance directive requiring nursing homes to starve them to death once they reach a specified level of cognitive decline. There are also increasing calls to do away with the dead-donor rule in transplant medicine so that PVS patients can be organ-harvested while still alive

If these acts become legal, should doctor and nurses who practice in these fields be forced to participate? If Emanuel’s opinion prevails, the answer could be yes. If medical professionals are protected by medical conscience legal protections, the answer would be no.

Medical conscience is not just important to personally affected professionals. All of us have a stake. Think about the potential talent drain we could face if we force health-care professionals to violate their moral beliefs. Experienced doctors and nurses might well take Emanuel’s advice and get out of medicine — while talented young people who could add so much to the field may avoid entering health-care professions altogether.

Comity is essential to societal cohesion in our moral polyglot age. Medical conscience allows patients to obtain morally contentious procedures, while permitting dissenting medical professionals to stay true to their own moral and religious beliefs. I hope the Democrats’ lawsuits are thrown out of court.

Medically assisted death allows couple married almost 73 years to die together

The Brickendens are one of the few couples in Canada to receive a doctor-assisted death together, and the first to speak about it publicly

The Globe and Mail

Kelly Grant

When George and Shirley Brickenden tell the story of how they met, it’s like watching a charming little play unfold – one the couple might have workshopped for seven decades.

It was Christmas in Halifax, 1944. He was in the Navy and she was in the Air Force. Mr. Brickenden’s mother had tried to set them up earlier, but the timing didn’t pan out.

Mr. Brickenden, 95, grinned as he explained why.

“I said, ‘I haven’t got time for her for a few days because I’ve got a few dates.'”

Three of the couple’s four children, sitting nearby, groaned and laughed. They had heard this before.

Mrs. Brickenden, 94, interjected. “I was engaged to somebody else!”

“He’s always saying that he had to break his dates and he never mentions that I already had a ring.”

The Brickendens were reminiscing in a recent interview with The Globe and Mail about their first date – a fairy-tale evening that led Mr. Brickenden to propose marriage six days later – knowing that less than a week after the interview, they would be dead. . . [Full Text]