Arthur L. Caplan
Hi. I’m Art Caplan. I’m at the Division of Medical Ethics at the NYU School of Medicine. Conscientious objection—everybody seems to be talking about it these days. What are the rights of physicians, pharmacists, nurses, or other healthcare workers to say that something may be legal but they refuse to do it?
This issue has come up particularly as more and more health systems are merging. You see Catholic hospitals merging with secular hospitals. Catholic hospitals have a huge presence in the American world of hospitals and nursing homes, probably accounting for 40% of all facilities. When mergers take place, whose values predominate? . . [Full text]
(Project response: Freedom of conscience in healthcare: “an interesting moral swamp?”)
A Clash of Organizational and Individual Conscience
The 2016 Colorado End-of-Life Options Act includes a provision unique among states with such laws, specifically privileging individual health care professionals, including physicians and pharmacists, to choose whether to write and fill prescriptions for life-ending medications, such as high-dose secobarbital or various combinations of morphine, diazepam, beta-blockers, and digoxin, without regard to the position their employer has taken on the law. This provision virtually guaranteed the Colorado law would eventually be challenged, which happened in August 2019.1 The current legal case directly pits the conscience rights of individual health care professionals against those of religiously affiliated corporations. Because 5 of the top 10 US hospital systems by net revenue are now religiously affiliated,2 and these systems often restrict medical care in a variety of ways,3 how the case is resolved could have far-reaching implications for US health care, extending well beyond the relatively rare use of aid-in-dying medications at the end of life.
Wynia M. Colorado End-of-Life Options Act: A Clash of Organizational and Individual Conscience. JAMA. 2019;322(20):1953-1954. doi:10.1001/jama.2019.16438
Centura Health, a Catholic health care network in Colorado, fired a doctor who attempted to help a terminally ill man end his life. According to KDVR, the lawsuit filed against Centura will be going back to state court where questions about freedom of religion could be raised.
Dr. Barbara Morris wanted to prescribe life-ending drugs to Neil Mahoney, a 64-year-old with incurable cancer. Centura’s policies against assisted suicide allegedly violated state law. KCNC reports that after asking a state court to declare that she could not be sanctioned for attempting to help her patient end his life, Dr. Morris was dismissed from her position. . . . [Full text]
7 The Denver Channel
The Associated Press
DENVER (AP) — After watching his mother die slowly when he stopped her medication, Neil Mahoney knew he wanted the option of ending his own life peacefully when a doctor told him in July that he had months to live after being diagnosed with cancer.
A physician was willing to help him do that under Colorado’s medically assisted suicide law, but she was fired by Centura Health, a Christian-affiliated health system, for violating its guidelines on the issue. . . [Full text]
Three major health systems have announced they will not participate
The Denver Post
Up to 30 Colorado hospitals are opting out of the state’s new medical aid-in-dying law, either fully or in part, but whether that means the doctors they employ are banned from writing life-ending prescriptions is a controversy that could wind up in court.
At this point, terminally ill Coloradans who want to end their lives under the law will need to find out whether their physicians are allowed to participate.
Three major health systems with 30 hospitals among them — Centura Health and SCL Health System, both religiously affiliated, and HealthOne — have announced they will not participate in the law. What that means for doctors, though, varies by system. . . [Full text]
The American Center for Law and Justice (ACLJ) has filed a lawsuit against the regulation on behalf of two Ohio companies [Lifenews]. A U.S. District Judge has dismissed suits filed by the Archdiocese of Washington and four other Catholic nonprofit groups on the grounds that the suits are premature [Bloomberg] Lawsuits filed by Colorado Christian University and Notre Dame University in Indiana have also been dismissed [The Coloradoan; First Things]. The Catholic diocese of Nashville, Tennessee and seven other groups in the state are appealing a lower court ruling against them[The Tennessean]. In Illinois, a temporary injunction has been granted against state legislation that is similar to the HHS regulation because the state’s Religious Freedom Restoration Act and Health Care Right of Conscience Act [Georgia Bulletin]. However, the U.S. federal government is appealing a decision to grant a temporary injunction against the HHS regulation to Tyndale House Publishers Inc. of Illinois [Bloomberg].A temporary injunction against the HHS regulation has been granted to a Missouri company, Sharpe Holdings Inc., the third such injunction granted in the state [St. Louis Beacon]. Virginia Attorney General Ken Cuccinelli attracted criticism because of his remarks to the effect that the nature of the HHS regulation will only become apparent if people go to jail for refusing to obey it [Reason.com]
For a map and up-to-date overview of lawsuits filed against the U.S. Department of Health and Human Services, see the Becket Fund’s HHS Information Central.