Protection of Conscience Project
Protection of Conscience Project
www.consciencelaws.org
Service, not Servitude

Service, not Servitude

Submission to Department of Health and Human Services (USA)
Re: Draft Regulation: Ensuring that Department of Health and Human Services Funds Do Not Support Coercive or Discriminatory Policies or Practices In Violation of Federal Law.


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1. Department of Health and Human Services, 45 CFR Part 88, RIN 0991-AB48, Ensuring that Department of Health and Human Services Funds Do Not Support Coercive or Discriminatory Policies or Practices In Violation of Federal Law. Agency: Office of the Secretary. Action: Proposed Rule, p. 10-11.  Accessed 2008-09-24

2.   American College of Obstetrics and Gynecology, Committee on Ethics Opinion No. 385, The Limits of Conscientious Refusal in Reproductive Medicine  Accessed 2008-09-24

3.  Submission of the Ontario Human Rights Commission to the College of Physicians and Surgeons of Ontario Regarding the draft policy, "Physicians and the Ontario Human Rights Code." 15 August, 2008. Accessed 3008-08-31

4.   "In an emergency in which referral is not possible or might negatively affect a patient's physical or mental health, providers have an obligation to provide medically indicated and requested care regardless of the provider's personal moral objections." American College of Obstetrics and Gynecology, Committee on Ethics Opinion No. 385, The Limits of Conscientious Refusal in Reproductive Medicine, p. 5, recommendation 5.  Accessed 2008-09-24. In assessing the scope of this claim, it is necessary to note that the statement fails to define key terms: "emergency," "health," "medically indicated," and "care." The statement is also notably broad in its unqualified reference to anything that "might negatively affect" the health of the patient.

5.  Dr. James Robert Brown, a professor of science and religion at the University of Toronto, said he agrees with prosecuting a doctor with that sort of conflict. "Suppose someone (doctor) said, 'I'm uncomfortable with (treating) a minority,' I'd say, 'So long scum'," said Brown.

Brown believes performing abortions and offering other forms of contraception are necessary and if Dawson won't perform them, then, Brown added, 'Fine - just resign from medicine and find another job."

"Religious beliefs are highly emotional - as is any belief that is effecting your behaviour in society. You have no right letting your private beliefs effect your public behaviour." Canning, Cheryl, "Doctor's faith under scrutiny:Barrie physician won't offer the pill, could lose his licence." The Barrie Examiner, February 21, 2002.

6.   Asoka ascended his father's throne in 269 BC. Time-Life Books, TimeFrame 400 BC - AD 200: Empires Ascendant, p. 107-109

7.  Joyner, James, "Desmond Doss, Pacifist Medal of Honor Recipient, Dies at 87." Outside the Beltway, 24 March, 2006; Carlfeldt, Tim, "Medal of Honor recipient Desmond Doss, 87, dies." Rome News-Tribune, 23 March, 2006. Accessed 2008-09-22

8.  Center of Military History, United States Army, Medal of Honor Recipients, WWII, A-F  Accessed 2008-09-22

9.  Center of Military History, United States Army, Medal of Honor Recipients, WWII, A-F  Accessed 2008-09-22

10.  "Realizing the dangerous situation, Scrimger organized the evacuation of the wounded to the rear, but one of his patients, Captain H. F. McDonald, had a serious head wound. Any movement before he was stabilized would likely kill him. Scrimger chose to stay behind. The shells fell around them and then began to land on the farm. The slight, 5-foot-7-inch doctor, who weighed only 148 pounds, shielded McDonald's prone body while he worked over him. During the bombardment, the building was demolished and set on fire, but both Scrimger and McDonald survived the whirling shrapnel and exploding ammunition. Blinded by the smoke and heat of the fire, Scrimger pulled the larger, unconscious infantry officer onto his back and staggered out of the building. German infantry were advancing on the farm and the only escape was to cross the moat to the rear. Lurching to safety with McDonald on his back, Scrimger passed through the barrage, moving from shell hole to shell hole for cover. Hiding in a nearby ditch throughout the rest of the day, they avoided the enemy infantry. Captain McDonald later testified that each time the shells exploded around them, "Captain Scrimger curled himself round my wounded head and shoulder to protect me from the heavy shell fire, at obvious peril to his life. He stayed with me all that time and by good luck was not hit."
Canadian War Museum, Backgrounder: Francis Scrimger, V.C.  Accessed 2008-09-05

11.  Kingsmill, Suzanne, Francis Scrimger: Beyond the Call of Duty. Hannah Institute for the History of Medicine, Dundurn Press Ltd., 1991, p. 25. See also "The greatest devotion to duty": Dr. Francis Scrimger and his Victoria Cross. McCulloch, I. CMAJ. 1994 February 1; 150(3): 414-416.  Accessed 2008-09-04)

12.   Benson, Iain T., "There are No Secular 'Unbelievers.'" Centrepoints 7, Vol. 4, No. 1, Spring 2000, P. 3.

13.  Swenson, Scott, "HHS Sec. Leavitt Blogs Again, Avoids Contraception Again, Still Ignores Ab-Only." Reality Check, 12 August, 2008.  Accessed 2008-09-24

14.  Melling, Louise, "Proposed Bush Regulation Jeopardizes Women's Health." Feministing Community, 26 August, 2008. Accessed 2008-09-21

15.  American College of Obstetrics and Gynecology, Committee on Ethics Opinion No. 385, The Limits of Conscientious Refusal in Reproductive Medicine , p.3.  Accessed 2008-09-24

16.   Charo, R. Alta, The Celestial Fire of Conscience- Refusing to Deliver Medical Care. N Eng J Med 352:24, June 16, 2005  Accessed 2008-09-13

17.  Lewis, C.S., "Bulverism: The Foundation of Twentieth Century Thought" (1941). In Hooper, Walter (Ed.) C.S. Lewis- First and Second Things. Willliam Collins & Sons: Glasgow, 1985, p.16

18.  Lewis, C.S., "Bulverism: The Foundation of Twentieth Century Thought" (1941). In Hooper, Walter (Ed) C.S. Lewis- First and Second Things. Collins: Glasgow, 1985, p.17

19.  For example: "The moral position of an individual pharmacist, if it differs from the ethics of the profession, cannot take precedence over that of the profession as a whole." College of Pharmacists of British Columbia Bulletin, Ethics in Practice: Moral Conflicts in Pharmacy Practice. March/April 2000, Vol. 25, No. 2, P. 5. For further information about the bulletin and related issues, see Project Report 2001-01, College of Pharmacists of British Columbia: Conduct of the Ethics Advisory Committee, 26 March, 2001.

20.  One critic outlines the extent of the penetration of bioethics principlism, as defined in the American Belmont Report: "Many colleges and universities already require a course in bioethics in order to graduate, and most medical and nursing schools have incorporated it in their curricula. Bioethics is even being taught now in the high schools. And what is being taught as bioethics are the Belmont principles, or renditions of one or more of these principles as defined in Belmont terms. Nods may be given to 'alternative' propositions here and there, but in the end it is the language of principlism which sets the standards." Irving, Dianne N., What is "Bioethics"? (Quid est "Bioethics"?). Tenth Annual Conference: Life and Learning X (in press)University Faculty For Life, Georgetown University, Washington, V.C.  Accessed 2008-09-11

21.  American College of Obstetrics and Gynecology, Committee on Ethics Opinion No. 385, The Limits of Conscientious Refusal in Reproductive Medicine , p.3.  Accessed 2008-09-24

22.  "Medical professionalism includes both the relationship between a physician and a patient and a social contract between physicians and society." Canadian Medical Association, Policy: medical professionalism.  (Update 2005) p. 1 (Accessed 2008-09-06)

"Professionalism is also the moral understanding among medical practitioners that gives reality to the social contract between medicine and society. This contract in return grants the medical profession a monopoly over the use of its knowledge base, the right to considerable autonomy in practice and the privilege of self-regulation." Canadian Stakeholders Coalition on Medical Professionalism, quoted in Canadian Medical Association: Medical Professionalism (Accessed 2008-09-06)

"Professionalism is the basis of medicine's contract with society." "Medical Professionalism in the New Millennium: A Physician Charter." Annals of Internal Medicine, 5 February 2002 | Volume 136 Issue 3 | Pages 243-246  (Accessed 2008-09-06)

"In Canada and the United States the social basis of the extraordinary grant of occupational authority and independence to professionalized occupations such as medicine and law has been a social contract between the profession and the public. Professionalism is the moral understanding among professionals that gives concrete reality to this social contract." Sullivan, William M., Medicine under threat: professionalism and professional identity. CMAJ, March 7, 2000; 162 (5)  (Accessed 2008-09-06) Similarly, Cruess, Sylvia R. and Cruess, Richard L., Professionalism: a contract between medicine and society. CMAJ 7 March 2000; 162 (5). Accessed 2008-09-06

23.  "We also exchanged, or rather subsumed, social contract and morality into a single term, moral contract. It seemed to us that the idea of a moral dimension to medicine was important. It indicated something right and good in relation to the behaviours and actions of a doctor. The ultimate expression of those behaviours and actions is perhaps best summed up in the idea of a contract between the public and the profession - a moral contract. A social contract, while a correct description of the mutual agreement that exists between the public and profession, seemed too neutral a term. We wanted to emphasise an ethical edge to that mutual agreement."  Doctors in Society: Medical Professionalism in a Changing World. Royal College of Physicians Report of a Working Party (December, 2005), para. 2.15.   Accessed 2008-09-06

24.  Latimer, Elizabeth J., Accidental patient. A doctor takes a different view. Can Fam Physician. 2002 August; 48: 1295-1296. Accessed 2008-09-06. James T.C, The Patient-Physician Relationship: Covenant or Contract? Mayo Clin Proc. 1996;71:917-918. Accessed 2008-09-07

25.  Honderich, Ted (Ed.) The Oxford Companion to Philosophy (2nd Ed.) Oxford: Oxford University Press, 2005. p. 174

26.  Machinists v Street, 367 U.S. 740 (1961)  Accessed 2008-09-23. The case concerned the use of union dues to support political causes opposed by individual union members. However, it is arguably worse to require a citizen "to surrender any matters of conscience, belief, or expression" as a condition of membership in a profession.

27.   Laidlaw, Stuart, "College of physicians debates doctors' rights to refuse treatments." Toronto Star, 18 September, 2008. Accessed 2008-09-21

28.  American College of Obstetrics and Gynecology, Committee on Ethics Opinion No. 385, The Limits of Conscientious Refusal in Reproductive Medicine , p.2-3.  Accessed 2008-09-24

29. Cromwell, Oliver, "Declaration of the Lord Lieutenant of Ireland." (January, 1649) Carlyle, Thomas, Oliver Cromwell's Letters and Speeches, with elucidations. Boston: Estes and Lauriat, 1886, Vol. I, Part 5, p. 18.

30.  Cromwell, Oliver, "Declaration of the Lord Lieutenant of Ireland." (January, 1649) Carlyle, Thomas, Oliver Cromwell's Letters and Speeches, with elucidations. Boston: Estes and Lauriat, 1886, Vol. I, Part 5, p. 18.

31.  Trinity Western University v. British Columbia College of Teachers (2001) 1 SCR 772

32.  Lee, Jenny, "Official slams 'sex selection' blood test: Gender of fetus can be seen five weeks into pregnancy." Vancouver Sun, 13 August, 2005.  (Accessed 2005-10-10)

33.   Ramsay, Sarah, "Controversy over UK surgeon who amputated healthy limbs." The Lancet, Volume 355, Number 9202, 05 February 2000. Dr. Smith waived his fee and the patients paid for the surgery.  (Accessed 2001-10-04)

34.  Gawande, Atul, When law and ethics collide - Why physicians participate in executions. N Engl J Med 354;12 23 March, 2006, 1221-1229.  Accessed 2008-09-08

35.  American Medical Association Policy E-2.06: Capital Punishment (June, 1998)  (Accessed 2008-09-06)

36. Gawande, Atul, When law and ethics collide - Why physicians participate in executions. N Engl J Med 354;12 23 March, 2006, 1221-1229. Accessed 2008-09-08

37.  Curfman, Gregory D., Morrissey, Stephen, and Drazen, Jeffrey M., Physicians and Execution. N Engl J Med 358;4 () Accessed 2008-09-08

38.  American College of Obstetrics and Gynecology, Committee on Ethics Opinion No. 385, The Limits of Conscientious Refusal in Reproductive Medicine.  Accessed 2008-09-24

39.  Alter, Jonathon, "Time to Think About Torture." Newsweek, 5 November, 2001, p. 45.

40.  Maher's Story. Accessed 2008-09-08

41. Commission of Inquiry into the Actions of Canadian Officials in Relation to Maher Arar, Report of the Events Relating to Maher Arar: Analysis and Recommendations. (hereinafter, "Arar Inquiry: Analysis and Recommendations") p. 9. Accessed 2008-09-08

42.  Arar Inquiry: Analysis and Recommendations, p. 35-36. Accessed 2008-09-08

43 Deputy Prime Minister Issues Terms of Reference for the Public Inquiry into the Maher Arar Affair. Accessed 2008-09-08

44.  Re: briefing note for RCMP Commissioner Zaccardelli: "Assistant Commissioner Proulx states [in the note] that the RCMP can be considered complicit in Mr. El Maati's detention in Syria. However, Mr. Proulx testified that it was the media and public who would consider the RCMP's actions to be complicit. He did not personally believe that the RCMP was complicit, nor was he referring to complicity in the criminal sense." Commission of Inquiry into the Actions of Canadian Officials in Relation to Maher Arar, Report of the Events Relating to Maher Arar: Factual Background, Vol. 1, (hereinafter "Arar Inquiry: Vol. I") p. 64.  Accessed 2008-09-08.

45.  "The Ambassador did not consider that seeking the fruits of the Syrian interrogation made Canada complicit in obtaining information that might have been the product of torture. He reasoned that he did not ask the Syrians to continue interrogating Mr. Arar so that Canada could obtain information. Furthermore, the Ambassador did not have any evidence that Mr. Arar was being tortured or held incommunicado. Arar Inquiry: Vol. I, p. 271.  Accessed 2008-09-08.

46.  "Superintendent Killam was aware that Secretary Powell had given Minister Graham the clear impression that the RCMP was complicit in Mr. Arar's deportation. However, Superintendent Killam testified that, even without making further inquiries in response to the media reports, he was able to exclude the possibility that the allegation of complicity might be true, because the allegation was inconsistent with the RCMP position."Arar Inquiry: Vol. I, p. 299. Accessed 2008-09-08.

47.  "Mr. Solomon prepared a draft memorandum for the Minister . . .which dealt with the upcoming CSIS trip to Syria and stated . . . "there are concerns as to whether a visit to Arar by Canadian intelligence officials may make Canada appear complicit in his detention and possible poor treatment by Syrian authorities." Arar Inquiry: Vol. I, p. 309. Accessed 2008-09-08.

 "Mr. Livermore testified that the original statement about the reliability of the confession and the possible complicity by Canada if CSIS was to meet with Mr. Arar was "very much on the speculative side" and "it was anticipating something that we later ironed out with CSIS, namely that they would not seek access to Mr. Arar." Arar Inquiry: Vol. I, p. 310.  Accessed 2008-09-08

48.   ". . . the intervenors suggest that the circumstances under which these individuals ended up in Syrian detention raise troubling questions about whether Canadian officials were complicit in their detention. The evidence of what happened to them could possibly show a pattern of misconduct by Canadian officials." 770 Commission of Inquiry into the Actions of Canadian Officials in Relation to Maher Arar, Report of the Events Relating to Maher Arar: Factual Background, Vol. II, p. 770. Accessed 2008-09-08

49.   "Canadian officials did not participate or acquiesce in the American decisions to detain Mr. Arar and remove him to Syria. I have thoroughly reviewed all of the evidence relating to events both before and during Mr. Arar's detention in New York, and there is no evidence that any Canadian authorities - the RCMP, CSIS or others - were complicit in those decisions."  Arar Inquiry: Analysis and Recommendations, p. 29. Accessed 2008-09-08

"Although decisions to interact must be made on a case-by-case basis, they should be made in a way that is politically accountable, and interactions should be strictly controlled to guard against Canadian complicity in human rights abuses or a perception that Canada condones such abuses." Arar Inquiry: Analysis and Recommendations, p. 35.  Accessed 2008-09-08

"If it is determined that there is a credible risk that the Canadian interactions would render Canada complicit in torture or create the perception that Canada condones the use of torture, then a decision should be made that no interaction is to take place." Arar Inquiry: Analysis and Recommendations, p. 199. Accessed 2008-09-08

"Even if one were to accept that Canadian officials were somehow complicit in those arrests, that would not change my conclusion, based on the evidence at the Inquiry, that Canadian officials
did not participate or acquiesce in the American decision to send Mr. Arar to Syria from the United States." Arar Inquiry: Analysis and Recommendations, p. 271.  Accessed 2008-09-08

"Information should never be provided to a foreign country where there is a credible risk that it will cause or contribute to the use of torture. Policies should include specific directions aimed at eliminating any possible Canadian complicity in torture, avoiding the risk of other human rights abuses and ensuring accountability." Arar Inquiry: Analysis and Recommendations,p. 345. Accessed 2008-09-08

"Clearly, the prohibition against torture in the Convention against Torture is absolute. Canada should not inflict torture, nor should it be complicit in the infliction of torture by others." Arar Inquiry: Analysis and Recommendations, p. 346.  Accessed 2008-09-08

50.  Smith, Graeme, "From Canadian custody into cruel hands." Globe and Mail, 23 April, 2007. Accessed 2008-09-07

51.  Editorial, "The truth Canada did not wish to see." Globe and Mail, 2 April, 2007. Accessed 2008-09-08

52.  "We will have to repent in this generation, not merely for the hateful words and actions of the bad people, but for the appalling silence of the good people."King, Martin Luther, Letter from Birmingham Jail, 16 April, 1963. Accessed 2005-08-02

"Non-cooperation with evil is as much a duty as is cooperation with good."Gandhi, Mahatma, Statement before Mr. C. N. Broomfield, I. C. S., District and Sessions Judge. Ahmedabad, 18 March, 1922.  Accessed 2005-08-02

53.  Editorial, "How complicit are doctors in the abuse of detainees?" The Lancet, Vol 364, August 21, 2004, p. 725-729

54.   Miles, Steven H., "Abu Ghraib: its legacy for military medicine." The Lancet, Vol 364, August 21, 2004, p. 725-729; Lifton, Robert Jay, Doctors and Torture. N Engl J Med 351;5

55.  American Medical Association Policy E-2.06: Capital Punishment  (Accessed 2008-09-08)

56.  American Medical Association Policy E.2.067: Torture. Accessed 2008-09-08

57.  Canadian Medical Association Policy resolution BD80-03-99 - Treatment of prisoners. Status: Approved, 1979-Dec-08. Last Reviewed, 2004-Feb-28: Still relevant.

58. See American College of Obstetrics and Gynecology, Committee on Ethics Opinion No. 385, The Limits of Conscientious Refusal in Reproductive Medicine , p.5, recommendation 4.  Accessed 2008-09-24

59. Elahi, Maryam and Kushner, Adam "Doctors With 'Dirty Hands.'" Physicians for Human Rights Library. Accessed 2008-09-09. Originally published in the Washington Post, 8 June, 2003

60.  Hartle, Anthony E., "Atrocities in war: dirty hands and noncombatants - International Justice, War Crimes, and Terrorism: The U.S. Record." Social Research, Winter, 2002. Accessed 2008-09-08

61.   A practical observation is that ethical advice "falls squarely into the most contested domain of social and public policy. Rawlsians and feminists; casuists and communitarians: all have their divergent visions of what individuals should find life worth living for, or be willing to live with. And these visions will not always coincide with the wishes of the patient, much less the consensus of society." Shalit, Ruth, "When we Were Philosopher Kings." The New Republic, April 28, 1997.   Smith, Wesley J., "Is Bioethics Ethical?" The Weekly Standard, 28 May, 2000.

62.   Richard G. Frey, "The ethics of the search for benefits: Animal experimentation in medicine," in Raanan Gillon (ed.), Principles of Health Care Ethics (New York: John Wiley & Sons, 1994), pp. 1067-1075; cited in Irving, Dianne N., "Scientific and Philosophical Expertise: An Evaluation of the Arguments on 'Personhood'". Linacre Quarterly, February 1993, 60:1:18-46 [Updated and extensively revised, September 20, 1996]

63.  Bleich, Dr. J. David, "Euthanasia", in Judaism and Healing: Halakhic Perspectives (1st Ed.), Ktav Publishing House, 1981, p. 139. Essay reprinted in A Matter of Choice: Responsibility to Live, Right to Die - Five Discussion Papers from the Jewish Perspective on Euthanasia. 13 April, 1994, Lubavitch Centre, Vancouver, B.C. (Ethics and Torah forum series)

American Medical Association Policy E.2.067: Torture. (http://www0.ama-assn.org/apps/pf_new/pf_online?f_n=browse&doc=policyfiles/HnE/E-2.067.HTM&&s_t=&st_p=&nth=1&prev_pol=policyfiles/HnE/E-1.02.HTM&nxt_pol=policyfiles/HnE/E-2.01.HTM&) Accessed 2008-09-08

64.  Maritain, Jacques (John J. Fitzgerald, trans.) The Person and the Common Good. Notre Dame, Indiana: University of Notre Dame Press, 2002, p. 36, 43, 46

65.   King, Martin Luther, Sermon: The Three Dimensions of a Complete Life. New Covenant Baptist Church, Chicago, Illinois, 9 April 1967. Accessed 2005-08-02

66.  King, Martin Luther, Sermon: Rediscovering Lost Values. 2nd Baptist Church, Detroit 28 February, 1954. Accessed 2005-08-02

67. Charo, R. Alta, The Celestial Fire of Conscience- Refusing to Deliver Medical Care. N Eng J Med 352:24, June 16, 2005. Accessed 2008-09-13

68.   Lewis, C.S., "Learning in War Time." In The Weight of Glory and Other Addresses. Grand Rapids, Mich.: William B. Eerdmans, 1975, p. 47

69.  Maritain, Jacques (John J. Fitzgerald, trans.) The Person and the Common Good. Notre Dame, Indiana: University of Notre Dame Press, 2002, p. 59; Maritain, Jacques (Doris C. Anson, trans.) The Rights of Man and Natural Law. New York: Gordian Press, 1971, p. 3, 9

70.  Maritain, Jacques (Doris C. Anson, trans.) The Rights of Man and Natural Law. New York: Gordian Press, 1971, p. 3-4

71.  Somerville, Margaret, Death Talk: The Case Against Euthanasia and Assisted Suicide. Montreal & Kingston: McGill-Queens University Press, 2001, p. 191-192.

72.  Maritain, Jacques (Doris C. Anson, trans.) The Rights of Man and Natural Law. New York: Gordian Press, 1971, p. 3

73.  Maritain, Jacques (Doris C. Anson, trans.) The Rights of Man and Natural Law. New York: Gordian Press, 1971, p. 18

74.  Maritain, Jacques (John J. Fitzgerald, trans.) The Person and the Common Good. Notre Dame, Indiana: University of Notre Dame Press, 2002, p. 71; Maritain, Jacques (Doris C. Anson, trans.) The Rights of Man and Natural Law. New York: Gordian Press, 1971, p. 14

75.  Maritain, Jacques (John J. Fitzgerald, trans.) The Person and the Common Good. Notre Dame, Indiana: University of Notre Dame Press, 2002, p. 73; Maritain, Jacques (Doris C. Anson, trans.) The Rights of Man and Natural Law. New York: Gordian Press, 1971, p. 15-17, 76

76.  Maritain, Jacques (Doris C. Anson, trans.) The Rights of Man and Natural Law. New York: Gordian Press, 1971, p. 11

77.  Maritain, Jacques (John J. Fitzgerald, trans.) The Person and the Common Good. Notre Dame, Indiana: University of Notre Dame Press, 2002, p. 58

78.  Maritain, Jacques (Doris C. Anson, trans.) The Rights of Man and Natural Law. New York: Gordian Press, 1971, p. 65

79.  Maritain, Jacques (Doris C. Anson, trans.) The Rights of Man and Natural Law. New York: Gordian Press, 1971, p. 45

80.  Joad, C.E.M., Guide to the Philosophy of Morals and Politics. London: Gollancz Ltd., (1938), p. 803. Quoted in R. v. Morgentaler (1988)1 S.C.R 30 at p. 178. Accessed 2008-09-10

81.  Joad, C.E.M., Guide to the Philosophy of Morals and Politics. London: Gollancz Ltd., (1938), p. 805. Cited in R. v. Morgentaler  (1988)1 S.C.R 30 at p. 178. Accessed 2008-09-10. See Maritain, Jacques, Man and the State. Chicago: University of Chicago Press, 1951, p. 13

82.  Lewis, C.S., "The Humanitarian Theory of Punishment." In Hooper, Walter (Ed.) C.S. Lewis: First and Second Things. Glasgow: William Collins & Sons, 1985, p. 101

83.  King, Martin Luther, Letter from Birmingham Jail, 16 April, 1963. Accessed 2005-08-02

84.  Wojtyla, Karol, Love and Responsibility. San Francisco: Ignatius Press, 1993, p. 27

85.  Kant, Immanuel, Fundamental Principles of the Metaphysic of Morals. Accessed 2008-09-10. Quoted in The Internet Encyclopedia of Philosophy, "Immanuel Kant (1724-1804) Metaphysics" . Accessed 2008-09-10

86.   R. v. Morgentaler  (1988)1 S.C.R 30 (Supreme Court of Canada) Accessed 2008-09-10.

87 R. v. Morgentaler  (1988)1 S.C.R 30 (Supreme Court of Canada) Accessed 2008-09-10.

88 R. v. Morgentaler  (1988)1 S.C.R 30 (Supreme Court of Canada) Accessed 2008-09-10.

89 R. v. Morgentaler  (1988)1 S.C.R 30 (Supreme Court of Canada) Accessed 2008-09-10.

90.  Nussbaum, Martha C., Liberty of Conscience" In defence of America's Tradition of Religious Equality. New York: Basic Books, 2008, p. 80

91.  Solzhenitsyn, Alexander, "As Breathing and Consciousness Return." In From Under the Rubble. Bantam Books (USA & Canada) 1976, p. 23

92.  American College of Obstetrics and Gynecology, Committee on Ethics Opinion No. 385, The Limits of Conscientious Refusal in Reproductive Medicine. p.2. Accessed 2008-09-24

93.  Murphy, Sean, Belgium: mandatory referral for euthanasia

94.  United States Constitution, 13th Amendment . Accessed 2008-09-24

95.  Maritain, Jacques (Doris C. Anson, trans.) The Rights of Man and Natural Law. New York: Gordian Press, 1971, p. 106, 112

96.  As enumerated: "(1) educate the public and health care providers on the obligations imposed, and protections afforded, by federal law; (2) work with State and local governments and other recipients of funds from the Department to ensure compliance with the nondiscrimination requirements embodied in the Church Amendments, PHS Act ยง 245, and the Weldon Amendment; (3) when such compliance efforts prove unsuccessful, enforce these nondiscrimination laws through the various Department mechanisms, to ensure that Department funds do not support morally coercive or discriminatory practices or policies in violation of federal law; and (4) otherwise take an active role in promoting open communication within the healthcare industry, and between providers and patients, fostering a more inclusive, tolerant environment in the health care industry than may currently exist." Department of Health and Human Services, 45 CFR Part 88, RIN 0991-AB48, Ensuring that Department of Health and Human Services Funds Do Not Support Coercive or Discriminatory Policies or Practices In Violation of Federal Law. Agency: Office of the Secretary. Action: Proposed Rule, p. 10-11.  Accessed 2008-09-24

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