The commentaries provided on the website are not a substitute for
legal advice provided by a qualified professional. Commentaries
are grouped by national jurisdiction.
Re: General Commentary
Rights and Obstetric Practice: Legal Issues
- Alberto Mazza*
| . . . The scientific advances in the field of health
today make possible a number of practices and treatments
which sometimes place the professionals who have to apply
them in a clear dilemma whereby they question the goodness
of such practices and not just their legality. . . In an
increasingly pluralistic society, there will be more and
more practices that a doctor may object to . . .It would
imply a severe injury to the doctors' rights if they were
left aside for refusing to undertake certain practices for
personal convictions. . .
Australia needs to recognise conscience rights, not just religious rights
- David Van Gend*| . . . I ask the question: how would a Religious Discrimination Bill protect the free speech, and therefore free conscience, of traditional-minded people like me who make a stand on conscientious, not religious, grounds?
- Xavier Symons* | It is no surprise that the Religious Discrimination Bill is being criticised as too strong by aggressive secularists and too weak by people of faith. . .
It is a religious discrimination bill with a narrow focus on a very specific set of issues. . . a patchwork, jury-rigged, rickety scaffolding to placate religious critics without laying a firm foundation.
The great divide where religious beliefs and the
- Michael Quinlan*
| . . . freedom of conscience and belief is not treated with
the importance our history and international law call for
and state and territory laws regularly override religious
freedom. . . Religion is not going away. Our laws can do a better job
of accommodating people of faith. Our history demands no
The conscience rights of health practitioners must be protected
A NSW bill could deter some of the brightest and best from entering health services
- Greg Walsh* |
One of the main concerns about the Bill recently introduced to amend New South Wales laws on abortion is how health practitioners with a conscientious objection to participating in abortion will be regulated. Under the Bill, health practitioners must disclose that they have a conscientious objection if they are asked to perform, assist with, provide advice about, or make a decision concerning whether an abortion should be performed. . .
Abortion bill in New South Wales a global first
Freedom of conscience conditional upon gestational age
New euthanasia/assisted suicide law in Australia
Victoria's Voluntary Assisted Dying
- Sean Murphy*
| On 19 April, 2018, the legislature of the State of
Victoria, Australia, passed the
Voluntary Assisted Dying
Act 2017, which will come into force in
June, 2019. It is currently the most restrictive
euthanasia/assisted suicide (EAS) legislation in the
world, running to 130 pages. In brief, the law
authorizes physician assisted suicide for terminally ill
adults, but permits euthanasia by physicians only when
patients are physically unable to self-administer a
lethal drug. In both cases a permit must be
obtained in advance. The main elements of the law
are set out below, followed by consideration of its
protection of conscience provisions.
Politicians wrestle with doctors'
consciences in Victoria: Conscientious objection needs to be
- Paul Russell*
| As the Victorian Ministerial Advisory Panel
on "assisted dying" makes ready to release its
interim report sometime in April, The
Age newspaper turned its attention to
the matter of conscience whether a doctor may
refuse to take part in any action that would
bring about the premature and deliberate death
of a person. Conscience - or the ability
to draw upon one's own personal belief system in making a
decision about an action - plays out at different levels in
any debate on euthanasia and assisted suicide.
. . .
The Abortion Law Reform Bill 2008
legalized abortion in the
State of Victoria, Australia. It demands that physicians
who object to abortion for reasons of conscience must refer a
woman to a colleague who has no such objections in order to
facilitate the procedure, and requires physicians to perform
abortions if necessary "to preserve the life of the pregnant
woman." A number of individuals and groups spokeout
against the bill and the law, often for a combination of reasons.
Doctors in Conscience Against Abortion Bill
- . . .We believe it to be an attack on the basic human rights of
health professionals which undermines their moral integrity and
professional autonomy. The state should not coerce its health
professionals to participate in the taking of human life. . .
Dr. John Neil
- . . . It is ludicrous that a "registered medical practitioner"
should have to perform an emergency abortion. Firstly it is coercive,
and others will speak about this. Secondly, it is based on a false
premise that an emergency abortion actually is ever necessary. Coercion
to make an "effective referral" is also unnecessary and prejudicial. . .
Mary Lewis, MBBS, FRACGP, DRANZCOG, MICD, B Min
- . . .This Bill misrepresents and undervalues the process and
responsibilities of professional referral. This Bill implies that
referral removes obligation and participation. However, referrals
between medical professionals imply a partnership of care. . . There is
no way that a practitioner can make or receive such a referral in good
conscience if they do not agree with the procedure and care to be
undertaken. . .
Jacinta Le Page (Medical Student)
- . . . Firstly, referring personally to another medical practitioner,
as this Bill states, seems to be clearly participating in abortion. . .
we fear we will be required to research for a colleague who will readily
'help' her have an abortion. Such a personal referral equals
participation in the killing. . .
Joanne Grainger (Registered Nurse, Bioethicist)
- . . . I am not here representing all Victorian nurses - that would
be a presumptuous assertion. However, there are over 80,000 registered
nurses in Victoria - and I speak on behalf of those many nurses who have
a conscientious objection to their participation in an abortion on
religious, cultural, personal or ethical grounds. . .
Full text of speech
Justine Armstrong (Victorian Division One Theatre Nurse)
- If passed, this Bill would force me to directly participate in
abortions as a theatre nurse. This is totally unacceptable to me and my
family. It is immoral. It violates my personal and professional ethical
framework. It is an affront to my faith and it strips me of my
fundamental rights as a human being and as a professional, to object to
an action that contravenes my personal conscience.
The Australian Egyptian Doctors and the Coptic Doctors
- . . .The bill as it stands . . .coerces the health practitioner to
behave or act in a manner which comprises his or her ethics, morals,
culture and religious beliefs. . .(Egyptian Doctors)
George Cardinal Pell
- The rights of freedom of thought, conscience, religion and belief
are fundamental. The ability to exercise conscientious objection is a
keystone of democracy. All of us should have the right to hold a belief
and not be compelled by the state to act contrary to that conviction. It
is the difference between the free society and the one subject to
Full text of news release
- . . .This centrality of conscience in rights discourse hardly is
surprising. Of all the rich and varied freedoms, the freedom to think
and believe is fundamental. Without it people not only have fewer human
rights, they are less human. . .
. . . One of the most objectionable features of this
legislation is that it effectively removes doctors' right to conscientious
objection. It requires doctors-who-won't to refer women to doctors-who-will.
Furthermore, "in an emergency where the abortion is necessary to preserve
the life of the pregnant woman", the doctor must perform it. . .
A question of conscience
- . . . corrupting the medical profession by forcing doctors and nurses to
collude in this is a clear violation of a universally acknowledged human
right to freedom of conscience. Nowhere else in the world does such a
draconian law exist, not in New Zealand, not in the United Kingdom, not in
Canada, not in the United States. . .
Liberty of Conscience in Medicine: A Declaration
- . . . Liberty of conscience is critical for individual doctors as it
lies at the very heart of our integrity and self-identity. It is
conscience that must compel doctors to refuse to participate in
treatments they believe to be un-ethical or that they consider not to be
in the best interests of patients. . .
Full Text of
Conscience Laws and Healthcare Conference
- Dr. Lachlan Dunjey: In this video, Dr Lachlan
Dunjey speaks on the topic: The Coercion of Doctors: What is
happening to modern medicine?
- Francis Sullivan:
In this video, Francis
Sullivan speaks on the topic: Freedom of Conscience and Good Medical
Practice: The Australian Medical Association's position.
- Martin Laverty:
In this video, Martin Laverty
speaks on the topic: The Victorian Abortion Law and the threat to
religious affiliated healthcare.
- Nigel Preston:
In this video, Nigel Preston
speaks on the topic: The Victorian Abortion Law and Conscientious
Healthworkers: Is there a way out or do we need a test case?
Julian McGauran: In this video, Julian
McGauran speaks on the topic: The Coercion of Conscience: A Federal
Why the right to conscientious objection must be restored
- David van Gend*
| I feel a little out of place coming from
Queensland to speak about the wretched situation in Victoria: coming from a
State where it is always sunny, where the people are always nice, and where we
don't have oppressive laws that try to compel the conscience of free citizens. But we are all in this together: an
assault on fundamental freedoms in one State will become a precedent for similar
abuses in other States. . .
The Australian state of Victoria has a world first: a law which forces doctors to refer women for abortion or to do it themselves -- even if they have a conscientious objection.
- Michael Cook* | Set in a huge mosaic in the lobby of Parliament House in Melbourne is a
Biblical proverb, "Where no counsel is, the people fall; but in the
multitude of counsellors there is safety." A good number of healthcare
workers in the state of Victoria must be wondering now whether this is still
true. Last week their Victorian legislators passed the only law in the
Western world which forces doctors and nurses to participate in abortions
against their conscience. . . .
A question of conscience.
Why are pro-choice activists so dismissive of freedom of conscience?
- Michael Cook* | The conscience of a moral relativist makes arbitrary, even capricious, choices. It is just a whim. The traditional view of conscience is quite different. Only a malfunctioning conscience is capricious.
New frontiers in repressing dissent
- Mishka Gora*
| Tasmania may be small, but it will punch far above its weight on the
world stage in shutting down protests against abortion if a new bill is
passed. . . the real aim of the Labor-Green coalition which is running
Tasmania is to criminalize abortion dissent.
Submission to the Tasmanian Government
- Australian Medical Association Tasmania Ltd.
| AMA Tasmania has grave concerns that the draft legislation has the
potential to criminalise members of the profession with conscientious
objection to termination of pregnancy.
Jurisdictional, organizational and regulatory framework for health care delivery in Canada
- Sean Murphy* | Canadian provinces have constitutional jurisdiction in the regulation of health care and health care professions and over labour and civil rights law within the scope of that jurisdiction. . . .
Conscience Rights Matter
- Sohail Gandhi* | . .
To those physicians who are opposed to legal protection for Conscience Rights, let me ask you this. What would you do if a patient asked you for a referral to have only a blue eyed, blonde haired baby?
- David Anderson* | Bill C-418 seeks to amend the Criminal Code to make it an offence to intimidate a medical practitioner, nurse practitioner, pharmacist or any other health care professional for the purpose of compelling them to take part, directly or indirectly, in the provision of physician-assisted suicide. . .
Nurse diagnosed with PTSD after interacion with patient seeking euthanasia
Tribunal rules "her own convictions" caused her injury: Denies claim for compensation
- Administrative Labour Tribunal
| The worker is a nurse in the palliative care unit of the
Notre-Dame Pavilion at the University Hospital of Montreal. In December 2015, a patient for whom she was in charge decided to
avail himself of the new provisions of the Act Concerning End-of-Life
, commonly known as medical assistance
in dying. This was a first: he was the first patient of this hospital to
express his desire to plan his death. The worker was informed that one of her patients had requested
medical intervention to end his life and developed a psychological
reaction following the death of the latter. . .Full Text
Conscience Versus the Spirit of the Age
- Jason Kenney*
| . . . This evening I wish to share with you, distinguished members of the bar
gathered under the patronage of Saint Thomas More, some thoughts about the
importance of conscience in the life of legislators like myself and those
who, like yourselves, are charged with the administration and adjudication
of those laws. I seek to do so because history in general— and the history
of Thomas More in particular —teaches us that the recognition of the rights
of conscience is an essential limitation of State power. Put another way,
where the rights of conscience are violated, the prospect of a State that
unjustly limits liberty becomes all too real throughout history. . .
"Justice" and the Legal Requirement to Accommodate
Conscience and Religious Beliefs of Professionals in Health Care
- Iain T. Benson*
| Frank M. Archer's critical review, though it might seem to
some people to be a legal and ethical view is, with respect,
neither of these things. While it is, in its way, critical,
it does not deal with the legal or ethical principles that
are necessary in order to make an informed decision
regarding law or ethics in relation to the practice of a
profession in general or the question of "emergency
contraceptives" in particular. . .
Eternal Vigilance is the Price
of Conscience Protection:
The Freedom of Conscience in Relation to "Health"
- Iain T. Benson*
| . . .Apparently this
medical student has been threatened with loss of graduation
if, because of his stated religious reasons, he will not
offer abortion as an option to a patient. In terms of the
legal requirement, the issue is whether or not a physician
is required to refer a patient for an abortion. . . .
Court Gives Course In Medical Ethics To The
- Iain T. Benson*
B. Miller* | . . .Can a
doctor or health care facility legally issue a "do not
resuscitate" order if the patient or the patient's guardian
refuses to consent to that order? What are the obligations
of the Public Trustee's office with respect to consenting or
opposing "do not resuscitate orders? . . .
The Courts' Spectacles:
Some Reflections on the Relationship between Law and
Religion in Charter Analysis
- Mr. Justice David M.Brown*
| . . .The main point which I wish to make in this paper is
that when courts engage in this "managing" exercise they do
not operate as philosophically-neutral actors. Instead, the
case law reveals that they perform the "managing" exercise
through philosophical lenses that are not blank, but reflect
philosophical choices which inform their balancing task. .
In Defence of the New Heretics: A Response to Frank Archer
Responding to Archer F.
Emergency Contraceptives and
Canadian Pharmaceutical Journal, May 2000, Vol. 133, No. 4, p.
- Sean Murphy*
| Before taking action that they may later regret, those who would coerce or
discriminate against conscientious objectors, or drive them from the
practice of pharmacy, would do well to revisit Frank Archer's critical
review . . . Although many pharmacists have accepted the review as a
definitive ethical statement, it is insufficient warrant for repression of
freedom of conscience within the profession. . .
for the Journal of Obstetrics and Gynaecology Canada:
Professors Cook and Dickens
Responding to Cook RJ, Dickens BM, "In
Response". J.Obstet Gyanecol Can 2004; 26(2)112; Cook RJ,
Dickens BM, Access to emergency contraception [letter] J.Obstet
Gynaecol Can 2004; 26(8):706.
- Sean Murphy* | .
. . the arguments of Professors Cook and Dickens for
mandatory referral are unsupported and even contradicted by
their own legal and ethical references. Regulatory officials
with the power to enforce the views of Cook and Dickens are
unlikely to discover this in the pages of the Journal,
since, by editorial fiat, the discussion was terminated with
the publication of their 'final word' on the subject. Here,
then, is the postscript to the discussion, supplemented by
developments in the United Kingdom and Belgium that have a
bearing on the issue. . .
on Cecilia Moore's Case
- Sean Murphy* |
The following commentary concerns the case of Cecilia Moore,
a welfare worker who was fired for refusing to authorize
medical coverage for an abortion. . .
Legalizing therapeutic homicide and assisted suicide:
A tour of
Carter v. Canada
- Sean Murphy* |
The trajectory of the trial was determined by the
unchallenged fundamental premise that suicide can be a
rational and moral act, and that the sole purpose of the law
against assisted suicide is to prevent suicides by
vulnerable people in moments of weakness, who might be
tempted to commit suicide that is not rational and moral.
The only issue was whether or not safeguards could be
designed to permit legitimate access to assisted suicide,
while preventing the vulnerable from accessing it in moments
of weakness. . .
Re: Joint intervention in
Carter v. Canada
Supreme Court of Canada, 15 October, 2014
- In June, 2012, a British Columbia Supreme Court
Justice ruled in favour of physician assisted suicide
and euthanasia. The plaintiffs
appealed to the Supreme Court of Canada.
- The Catholic Civil Rights League,
Faith and Freedom Alliance and the
Protection of Conscience Project were jointly granted intervener status
in Carter by the Supreme Court of Canada. The joint
factum voiced concern that legalization of physician assisted
suicide and euthanasia would likely adversely affect physicians and
health care workers who object to the procedures for reasons of
conscience. The factum was supplemented by a ten minute oral
Supreme Court of Canada orders legalization of physician assisted
suicide - AND euthanasia
Physicians unwilling to kill
already face demands that they find someone who will
- Sean Murphy*
| In a 9-0 ruling released on 6 February, 2015, the Supreme Court of Canada
struck down two sections of Canada’s Criminal Code "insofar as they prohibit
physician-assisted death" in circumstances outlined by the Court.
It appears that most or all of the major media outlets understood this to
mean that the Court had legalized physician assisted suicide. . . the ruling
not only permits physician assisted suicide, but
physician administered euthanasia. . .
Decriminalization of assisted suicide and the violation of our
- Albertos Polizogopoulos* | In October, the Supreme Court of Canada heard the Carter
case, where parties are challenging Criminal Code
prohibitions on physician assisted suicide in the
hopes of decriminalizing it. If they're successful,
it will impact more than just physicians. . .
Amir Attaran and the elves
A law professor makes much ado
- Sean Murphy*
| . . . University of Ottawa law professor
Amir Attaran asserts that the "corrosive hostility"
of the Canadian Medical Association to
"physician-assisted dying" is evident in its
"cowardly and stupid" position on the procedure. . . In his telling, ever since the Court ignored the threat and struck down
the law, the CMA has been acting like a "sore loser," trying to persuade
physicians not to participate. . . And he complains that the CMA won't
force physicians unwilling to kill patients or help
them commit suicide to find someone who will. . .
A "uniquely Canadian approach" to freedom of conscience
Provincial-Territorial Experts recommend coercion to ensure delivery of
euthanasia and assisted suicide
Recommendations designed to broaden and maximize impact of Supreme Court
- Sean Murphy*
| The Experts' recommendations are intended to extend and maximize the
impact of the Carter ruling. They will effectively require all institutions,
facilities, associations, organizations and individuals providing either
health care or residential living for elderly, handicapped or disabled
persons to become enablers of euthanasia and assisted suicide. This will
entail suppression or significant restriction of fundamental freedoms. . .
To kill — or not to kill? That is the question.
An answer for a Dying With Dignity clinical advisor
- Sean Murphy*
| . .>the DWD Clinical Advisor was exasperated by the description of euthanasia and assisted suicide as "killing." This, he/she exclaims, is a malicious lie that adds to the world's misery.
Such a cri de cœur calls for a thoughtful discussion of the question it raises.
Does providing euthanasia and assisted suicide entail killing — or does it not?
Jewish physicians' freedom of
conscience and religion and the Carter Case
- Charles Wagner*,
Adam Hummel* | How does the decision in the Supreme Court of Canada (SCC) in Carter
v. Canada (Attorney General)1
("Carter") impact on the religious Jewish doctor? Will this landmark
decision bring into conflict these doctors' freedom of conscience and
religion with their professional obligations? The Carter case sets
aside federal criminal laws as they relate to physician assisted
suicide. It stands for the proposition that individuals who are
suffering unbearably have a constitutional right to a physician-assisted
Conscience, euthanasia and assisted suicide in Manitoba
The Medical Assistance in Dying (Protection for Health Professionals and Others) Act
- Sean Murphy*
| . .The MAiD Act is a procedure-specific law applying only to euthanasia and assisted suicide. It protects all regulated professionals who refuse to provide or "aid in the provision" of the procedures from professional disciplinary proceedings and adverse employment consequences because they have refused. They remain liable for other misconduct in relation to the refusal.
Quebec’s Act Respecting End of Life Care
Reportable and non-reportable euthanasia
- Sean Murphy*
| . .Quebec's euthanasia law, the Act Regarding End of Life Care (ARELC), permits two kinds of euthanasia, distinguished here as reportable and non-reportable euthanasia. . .
- In July, 2006, the Canadian Medical Association Journal
published a guest editorial by Sanda Rodgers of the Faculty of
Law, University of Ottawa, and Jocelyn Downie, of the Health Law
Institute, Dalhousie University, Halifax, Nova Scotia. The
editorial appears to have been an attempt to bully objecting
physicians who refuse to refer patients for abortion by menacing
assertions about legal and ethical obligations. The CMAJ
is a publication of the Canadian Medical Association, which,
however, asserts that its contents do not necessarily represent
the views of the Association.
More Pharmacists Who Don't Understand Ethics: This Time Ontario
- Iain T. Benson*
| . . . For pharmacists and pharmacy technicians the
accommodation of religious belief and conscience guaranteed
by Section 2 of the Canadian Charter of Rights and
Freedoms will be suspended should this principle go
ahead as drafted. This is not the approach taken by doctors
and the Canadian Medical Association would not endorse this
blunt and unfair kind of principle. . .
Letter to Minister of Health (Ontario)
- Protection of Conscience Project | . .
.I understand that the Ontario College of Pharmacists has
made a recommendation to the OHPRAC to the effect that
freedom of conscience ought to be denied to pharmacists and
pharmacy technicians. I am advised by concerned pharmacists
that those who would have objected to this were unaware that
the College was contemplating such a recommendation and were
not consulted about it. . .
Ontario Human Rights Commission attempts to suppress
freedom of conscience
- Sean Murphy*
| The College of Physicians and Surgeons of Ontario is
the regulatory and licensing authority for physicians and surgeons
practising in Ontario, Canada. In February, 2008, the Ontario Human
Rights Commission recommended that the exercise of freedom of conscience by
physicians be restricted. The College then drafted a policy that
demanded that Ontario physicians sacrifice their freedom of conscience to
avoid prosecution by Ontario's human rights apparatus.
Freedom of Conscience and Human Rights
- Michelle Davis*
| A series of Bioethics Matters will look at the Ontario
Human Rights Commission, the Ontario Human Rights Code, and
the Canadian Charter of Rights and Freedoms to explore the
issues of religious discrimination, the right to be free
from discrimination based on creed (religion), and the
freedom of conscience and religion. . .
- Sean Murphy* | .
. . OHRC agents have broad
powers to enter private property without
warrant, and can, without warrant, search
premises, examine, measure, photograph the area and
and seize they think relevant to the investigation.
. . police can be called upon to assist, using force
if need be.
. .All of this for the purpose of
investigating, not unlawful conduct, but mere
"tension or conflict," or conditions that might lead
to either. In contrast, Canadian police have far
less power to investigate criminal offences -
including murder. . .
Ontario court affirms right of state to compel participation in euthanasia
Doctors must refer patients for 'medical assistance in dying'
- Michael Cook* | Back in 2006, Oxford University's Professor Julian Savulescu published a frontal attack on the notion of conscientious objection in medicine in the BMJ, a popular medical journal. At the time it seemed odd rather than dangerous, the dream of an ideologue rather than sober policy. . . .
With Ontario court's ruling on doctors, the revolution continues
There is a growing antipathy among Canadian elites against conscientious individuals who refuse to accept their views
- Barry W. Bussey* | How is it that such a simple decision could be made so complicated? Given the history of accommodating individual conscience in the medical profession and in Canadian law, the case before the Ontario Court of Appeal to accommodate doctors' consciences was a "no-brainer." The law, history, and basic human decency cried out: "Accommodate the physician!" Instead, the highest court in Ontario followed the worrying legal revolution against accommodation and stomped on conscience. . .
Forced Referral and Freedom of Religion vs Freedom of Conscience
Without freedom of conscience our free democracy would not exist
- Shawn Whatley, MD* |
A recent court decision in Ontario missed the mark when it ignored the impact forced referral has on freedom of conscience.
On May 15, the Ontario appeals court ruled that doctors must give patients a referral for euthanasia, abortion, and other contentious issues, regardless of what an individual doctor thinks about them. . .
Physicians in Canada should be moral actors, not robotic bureaucrats
Doctors should not be obliged to write referrals for procedures they find morally objectionable
- Brian Bird* | Earlier this week, Ontario's highest court heard a case that pits access to health care against the moral convictions of doctors. The case essentially tests the extent to which Canadians can follow their own moral compasses while operating in a professional capacity.
In Ontario, doctors can refuse to perform procedures or prescribe drugs that they consider immoral. However, the public body that regulates these doctors – the College of Physicians and Surgeons of Ontario (CPSO) – requires them to refer patients to doctors who are willing and able to provide the requested health care service. . .
Understanding Freedom of Conscience
- Brian Bird*
| A court case dealing with freedom of conscience gives rise
to questions about what freedom of conscience protects and why
we protect it. . . . Balancing physicians' freedom of conscience with patients' access to
medical services is a delicate task. But that balance will certainly not be
struck if, when it comes to freedom of conscience, we do not know what we
are talking about or why it matters.
conscience, and assisted dying:
By requiring that physicians make referrals for assisted
dying, Ontario is forcing them to leave medicine or abandon
their ethical framework.
- Deina Warren,* Derek Ross*
Of all the jurisdictions worldwide that permit some form
of assisted suicide, Ontario stands alone in mandating that
physicians participate in it. . . [C]ompelling physicians to
participate in MAID results in the state deciding
what everyone should believe; and second, it
undermines physicians' moral integrity, a
foundational component of medical ethics and
principled health care. . .
Ontario must amend its assisted dying
legislation to recognize conscience rights
- John Milloy*
| Canadians ask a lot of our physicians – years
of education, long hours, complex cases and
demanding patients (full disclosure – I am
married to a doctor). Since June of last year, we have also been
asking them to help some of their patients take
their own lives. . . Should we not respect the fact that some
doctors and other health-care providers simply
don't want to be involved in assisted dying for
reasons of conscience?
Re: Redefining the
Practice of Medicine
Euthanasia in Quebec
An Act Respecting End of Life Care
- Sean Murphy*
| Part 1: Overview - An Act Respecting End-of-Life Care
is intended to legalize euthanasia by physicians in the province of
Quebec. It replaces the original Bill 52, the subject of a previous
commentary by the Project. The
original text of the Bill 52 did not define medical aid in
dying (MAD), but ARELC now makes it clear that Quebec
physicians may provide euthanasia under the MAD protocol.
- Part 2: ARELC in detail -
An Act Respecting End-of-Life Care ("ARELC")
is intended to legalize euthanasia by physicians in the province of
Quebec. It replaces the original Bill 52, the subject of a previous
commentary by the
Project. ARELC purports to establish a right to euthanasia
for a certain class of patients by including it under the
umbrella of "end-of-life care." . . .
- Part 3: Evolution or Slippery Slope? - Euthanasia laws frequently include guidelines and safeguards intended
to prevent abuse. Eligibility criteria are the most basic guidelines or
safeguards. In considering their stability, it is important to
consider not only the elasticity of existing statutory provisions, but
recommendations for expansion that might ultimately result in changes to
the law. . .
- Part 4: The Problem of Killing -
The original text of Bill 52 did not define "medical aid dying"
(MAD), but it was understood that, whatever the law actually said, it was
to authorize physicians to kill patients who met MAD
guidelines. The Minister of Health admitted that it
qualifed as homicide, while others acknowledged that MAD
meant intentionally causing the death of a person, and that
its purpose was death. . .
- Part 5: An Obligation to Kill - Statistics from jurisdictions where euthanasia and/or
assisted suicide are legal suggest that the majority of
physicians do not participate directly in the procedures.
Statistics in Oregon and Washington state indicate that the
proportion of licensed physicians directly involved in
assisted suicide is extremely small. . .
- 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. . .
- Part 7: Refusing to Kill - It is important identify problems that the
Act poses for those
who object to euthanasia for reasons of conscience, and to consider how objecting health care workers might
avoid or respond to coercion by the government and the state medical and legal establishments . .
- Part 8: Hospitality and Lethal Injection -
Under the Act Respecting End of Life Care (ARELC) palliative
care hospices may permit euthanasia under the MAD protocol on their
premises, but they do not have to do so. Patients must be advised
of their policy before admission. The government included
another section of ARELC to provide the same exemption for La Michel
Sarrazin, a private hospital. The exemptions were provided for
purely pragmatic and political reasons. . .
- Part 9: Codes of Ethics and Killing -
Refusing to participate, even indirectly, in conduct believed to involve
serious ethical violations or wrongdoing is the response expected of
physicians by professional bodies and regulators. It is not clear
that Quebec legislators or professional regulators understand this. .
Quebec Euthanasia Guidelines: Practice guide issued by Quebec health care profession
regulators (August, 2015)
Re: PACE Report:
"The Problem of
Unregulated Use of Conscientious Objection"
PACE Resolution on Restricting Conscientious
Objection Endangers Freedom of Conscience of Medical
- European Centre for Law and Justice*
| . . .The ECLJ must warn the members of PACE that several
recommendations of the resolution are direct and serious
violations of the freedom of conscience of medical
practitioners, as guaranteed by European and International
law. . .
Protection of Conscience Project
Submission to the Parliamentary Assembly of the
Council of Europe
- . . .Considering the Report from this broader
perspective, as we do here, it becomes apparent that its
recommendations are offensive to human freedom and dignity
and repugnant to fundamental principles of liberal
democracy. . .[
Europe's Choice on Conscience Protection
- Matthew Schmitz*
| This Thursday the Council of Europe . . .will vote on a
resolution and series of recommendations on conscience
protection. . . .It would create guidelines that encourage
member states to force doctors to perform abortions in some
circumstances and to make referrals for them in every
circumstance. . . .it is an all-out assault on conscience
and community. . .
Medicine, Strasbourg, and conscientious objection
European Court of Human Rights decision
- Julian Sheather*
| . . .Conscientious objection is a live issue in medicine.
. . Given the
prevailing political pluralism-given the co-existence in our culture of
different value systems-to what extent should medicine accommodate such
objections? Should those whose consciences differ be treated differently?
What forms of conscientious objection should be tolerated and on the basis
of what criteria?
UN Special Rapporteur on Freedom of Religion or Belief
Favours of a Right to Conscientious Objection in the Context of Abortion
- European Centre for Law and Justice | On the occasion of a conference organized by the ECLJ at UN
headquarters in Geneva, Professor Heiner Bielefeldt, the UN
Special Rapporteur on Freedom of Religion or Belief, spoke in
favor of the right of medical staff to refuse to participate in
performing an abortion or euthanasia. He mentioned the case of a
midwife who was harshly sentenced in Sweden for having refused
to participate in an abortion and was forced into "professional
exile." . . .
Protection of Life During Pregnancy Act 2013
Why abortion bill is a prime example of moral weakness
- Fr. Vincent Twomey*
| . . . This legal injunction offends against one very specific, universal moral
perception which, in the academic discipline of ethics, has been articulated
most clearly in the "principle of co-operation". . . one should not knowingly co-operate in what will
cause serious harm to another person that is foreseen and unavoidable.
Health (Regulation of Termination of Pregnancy) Bill 2018
The abortion law is about coercion and manipulation
- Dr. Noreen O'Carroll* |
I was very struck by the phrase “the abuse of conscience” used by Pope Francis in his apology for the abuse perpetrated on minors by members of the clergy and hierarchy; he apologised not only for sexual abuse and the abuse of power but also for the abuse of conscience (Letter to the People of God, August 20, 2018). The Catholic Church is not the only institution that has failed to protect people from the abuse of conscience. The Oireachtas has questions to answer in this regard too.
Philippines "RH Act" of 2012
- Sean Murphy* | . . . the RH Act would have made the exercise of freedom of conscience
impossible or ridiculous, requiring objectors to invite public obliquy by false confessions of prejudice, in exchange for which the Act offers only counterfeit accommodation. Given the problems with the wording of
other sections of the law, it is not clear whether this provision was deliberately constructed as an
obstacle to conscientious objection, or if it was simply
the product of appalling legislative draftsmanship. . .
- Appendix "A" | The Philippines population grew from about 27 million in 1960 to over 100 million in 2018. However, from 1984 the rate of population growth decreased. By 2017 the Philippines' birth rate had fallen about 15% in 17 years, more than the reduction in the global birthrate. The Philippines fertility rate was halved between 1973 and 2013.
- Appendix "B" | The "RH Act" (2012) in brief |
Annotated Text of the Responsible Parenthood and
Reproductive Health Act of 2012
- Supreme Court of the Philippines Decision: 2014
Proposed Rwandan law would legalize abortion, make conscientious
Law Governing Reproductive Health
- Sean Murphy*
| . . . Rwanda's proposed Reproductive Health Bill: text
and commentary. With respect to freedom of conscience, the
oppressive power of the proposed law is manifestly clear. A
particularly draconian feature of the bill is Article 4(14),
which would prohibit any expression of opposition to the
bill or to anything it advocates.
When can a doctor conscientiously object?
- Bernard G. Prusak*
| Over the last decade, the culture wars in the United
States have broken new ground: They have become battles over
the rights of conscience. For example, now that same-sex
marriage is a right, the question before the U.S. Supreme
Court in the case of Masterpiece Cakeshop is whether its
sympathetic, telegenic owner,
Jack Phillips, is within his rights to refuse to make a
wedding cake for a gay couple. Similarly, under the Obama
administration, the court heard arguments more than once
over whether employers who object on religious grounds to
contraceptives or abortion should be exempted from having to
provide employees health insurance that includes such
services. . .
Medics should not be forced to do procedures they object
to on ethical grounds
- David S. Oderberg*
| For most people, the term "conscientious objection" evokes images of Quakers and pacifists registering to avoid military service. Many countries have a long and honourable tradition of accommodating such conscientious objectors. It might not be about bombs and bullets, but healthcare professionals often find themselves fighting a conscience battle of their own.
Abortion law reform and conscientious objection in the
- Jacky Engel*
| Jacky Engel reviews the legal history of abortion in the
United Kingdom from 'Lord Ellenborough's Act' of 1803,
though most of her attention is directed to developments
beginning with the Bourne case of 1939. Ms. Engel's
discussion of the parliamentary debates in 1967 is
reproduced below because of its references to conscientious
Objection to Abortion: Ethics, Polemics and Law
- Charles Foster*
| The pro-abortion lobby has announced the latest phase in
its offensive. Marie Stopes International wants to
force GP surgeries to display lists indicating which doctors
in the practice will refer women for abortion, and the
pressure group Doctors for a Woman's Choice on Abortion
is encouraging patients to report to the GMC doctors
who refuse to play any part in abortion. . .
- Robin Haig*
| The article below, written by one of
ALDU's officers, appeared in ALDU's Newsletter in the
Winter of 1982 and considered the question of
conscientious objection to abortion and how this might
affect the position of doctors.
Conscientious objection and the worrying implications of the Glasgow
- Philippa Taylor*
| The right for health professionals to exercise their
conscientious objection to participating in abortion – or indeed to
choose on occasion to limit the areas in which they work in order
not to be ethically compromised – has been under
assault worldwide for some time now. . . Now the right for health professionals to exercise their
conscientious objection has been put under even more pressure in the
the Supreme Court today rejected an appeal for conscientious
objection for senior midwives who refused to supervise abortions
performed on a labour ward. It has also delivered a controversial
ruling on referrals for abortion.
Re: House of Lords Select Committee
on Assisted Dying for the Terminally Ill Bill
from the First Report
In 2003 Lord Joffe introduced a private member's bill
into Parliament, the Patient (Assisted Dying) Bill, which progressed only to second reading. In March of the
following year he introduced another private member's bill (Assisted
Dying for the Terminally Ill). It received Second
Reading and was referred to a House of Lords committee for
detailed examination. Extracts concerning
conscientious objection and freedom of conscience in witness
testimony and written evidence are noted below.
- All extracts
- PROFESSOR JOHN HARRIS, University of Manchester,
PROFESSOR SHEILA MCLEAN, Glasgow university, DR EVAN
HARRIS, a Member of the House of Commons, MISS DEBORAH
ANNETTS, Chief Executive, Voluntary Euthanasia Society,
and MR TL BARCLAY (Q1-19;
- LORD JOFFE: Explains amendment to remove requirement
for referral by objecting physician. (Q70-79)
- Witnesses: DR MICHAEL WILKS, Chairman, Medical
Ethics Committee, DR VIVIENNE NATHANSON, Director of
Professional Activities, British Medical Association,
PROFESSOR SIR GRAEME CATTO, President, and MS JANE
O'BRIEN, Head of Standards, General Medical Council,
- Witnesses: DR DAVID COLE, BARONESS GREENGROSS, a
Member of the House, PROFESSOR RAYMOND TALLIS, DR GEORG
BOSSHARD, and DR CAROLE DACOMBE, (Q1920-1939)
- Witnesses: MS MICHELE WATES, DR JIM GILBERT,
PROFESSOR JOHN FINNIS and DR FIONA RANDALL (Q2020-2039)
The bill included an exemption for conscientious
objectors (Clause 7) which required an objecting physician
refer a patient to a colleague willing to process a
euthanasia request. This elicited protests during the
examination of witnesses and inwritten evidence and an
adverse judgement from the Joint Committee on Human Rights,
as a result of which Lord Joffe agreed to remove the
provision for mandatory referral.
(from the Bill)
From Chapter 4
(from the report)
From Chapter 7 (from the report)
Re: House of Lords & Commons Joint Committee On Human Rights