Medicine, morality and humanity

Sean Murphy*

Medicine is a moral enterprise.

Medicine, morality and humanityThe practice of medicine is an inescapably moral enterprise precisely because physicians are always seeking to do some kind of good and avoid some kind of evil for their patients. However, the moral aspect of practice as it relates to the conduct and moral responsibility of a physician is usually implicit, not explicit. It is normally eclipsed by the needs of the patient and exigencies of practice. But it is never absent; every decision concerning treatment is a moral decision, whether or not the physician specifically adverts to that fact.

This point is frequently overlooked when a physician, for reasons of conscience, declines to participate in or provide a service or procedure that is routinely provided by his colleagues. They may be disturbed because they assume that, in making a moral decision about treatment, he has done something unusual, even improper. Seeing nothing wrong with the procedure, they see no moral judgement involved in providing it. In their view, the objector has brought morality into a situation where it doesn’t belong, and, worse, it is his morality. . .  [Full Text]


Christian Medical Association Physicians Gain Support from Congress and States in Court Fight Against Discriminatory Firing

States and Members of Congress file brief supporting conscience rule protections

News Release

For immediate release

Christian Medical and Dental Associations (USA)

Washington, DC—May 26, 2020 – Christian Medical Association physicians (CMA*, www.cmda.org) received support from states, Members of Congress, minority groups, medical affiliate organizations, and legal experts who recently filed legal briefs in a case regarding a federal conscience protection rule for health professionals.

In New York v. HHS, CMA and Dr. Regina Frost are defending against attempts by states that want to discriminate against doctors and nurses who refuse to violate their consciences and medical judgment by performing procedures such as abortions or physician-assisted suicide. This case is now in the U.S. Court of Appeals for the Second Circuit.

CMA CEO Dr. Mike Chupp noted, “As a general surgeon who did patient care for over 30 years, my professional judgment has been based upon available medical evidence, training and experience, and a deep sense of obligation to care for my patients in a way that best benefits their health. The conscientious practice of medicine depends upon the integration of these factors by a healthcare professional. The informed conscience of every healthcare professional serves as an inner compass for the best kind of patient care. The HHS conscience rule affirms that our CMA members must be protected from violating their deeply held beliefs as they seek to serve all patients with excellence and compassion.”

CMA Senior Vice President for Bioethics and Public Policy and Obstetrician-Gynecologist, Dr. Jeffrey Barrows noted, “As an Ob-Gyn physician, I have delivered many babies of mothers and fathers who specifically sought a life-affirming physician for their care. The conscience rule not only upholds and enforces decades of federal law passed on a bipartisan basis; it also helps ensure that patients will have a choice of life-affirming physicians who match their values.

“All health care professionals must have the freedom to practice medicine without being forced to violate their conscience. The updated conscience rule released by HHS in 2019 ensures this freedom, establishing conscience protections for all health care professionals, regardless of faith background.”

Evidence indicates that conscience protections help ensure patient access to healthcare at a time of physician shortages nationally. National polling commissioned by CMA and conducted in 2019 by an independent polling firm found that while faith-based health professional respondents overwhelmingly said that they care for all patients regardless of agreement with patients’ choices, none of ten said that being required to violate their consciences would force them to leave the practice of medicine.

For more information on the court case and access to the amicus briefs, see https://www.becketlaw.org/case/new-york-v-hhs/.

For legal perspectives and attorney interviews, contact Ryan Colby: media@becketlaw.org, 202-349-7219.


*The Christian Medical Association serves approximately 19,000 members and, along with the Christian Dental Association, forms the Christian Medical & Dental Associations.

Broad support to protect doctors, nurses from discriminatory firing

Medical groups, minorities, legal experts line up against New York’s attempt to block healthcare anti-discrimination law

News Release

For immediate release

Becket Law

WASHINGTON – A diverse group of states, Members of Congress, minority groups, medical affiliate organizations, and legal experts recently filed half-a-dozen briefs supporting the U.S. Department of Health and Human Service’s (HHS) Conscience Rule, which provides federal conscience protections for medical professionals. In New York v. HHS, the Becket Fund for Religious Liberty is defending Dr. Regina Frost and the Christian Medical & Dental Associations (CMDA) from attempts by states to discriminate against doctors and nurses who refuse to violate their consciences and medical judgment by performing procedures such as abortions or physician-assisted suicide.  This case is now in the U.S. Court of Appeals for the Second Circuit.

Highlights from the friend-of-the-court filings in New York v. HHS:

  • A congressional brief filed by dozens of Members of Congress explained why the new rule’s provisions flowed directly from unchallenged—and bipartisan—statutory protections for medical conscience that have been on the books for decades.
  • Former Senator Coats and former Representative Weldon (the named sponsors of two key statutory conscience protections for healthcare providers) filed their own brief in support, explaining why conscience protections are important for health care providers and how the government’s new regulation supports key bipartisan statutory protections that have long been on the books.
  • The Jewish Coalition for Religious Liberty and the Coalition for Jewish Values also highlighted the disproportionate impact that New York’s lawsuit would have on medical professionals of minority faiths.
  • The Center for Constitutional Jurisprudence explained why this new rule helps the government better enforce existing federal conscience protections.
  • A coalition of medical professional organizations—including the American College Of Pediatricians, the Catholic Medical Association, and the National Catholic Bioethics Center—filed a brief highlighting ongoing threats to medical professionals of faith and explaining why this rule will help ensure medical providers cannot be coerced by employers to either violate their conscience or lose their job.

“Healthcare is one area where protecting conscience is particularly vital,” said Ohio Attorney General Dave Yost, in a brief on behalf of sixteen states. “That is why Congress has routinely enacted laws to ensure that these professionals can provide care without violating their beliefs.”

Polling from last year shows that religious healthcare professionals are committed to serving all patients, but face increasing pressures to engage in procedures such as abortions that violate their faith, which could force over ninety percent of religious doctors out of the medical field.  The U.S. Department of Health and Human Services (HHS) issued a Conscience Rule last year to better enforce bipartisan laws that, for decades, have promised to allow religious doctors, nurses and healthcare professionals to serve patients without facing employment discrimination directed against their consciences. The Rule simply clarifies and enforces existing federal statutes designed to ensure religious health professionals won’t be forced out of the practice of medicine by entities that voluntarily choose to accept federal tax money. But, led by the State of New York, several states and abortion providers are suing to keep the federal funds while preventing the government from enforcing the conscience protections that they agreed to when they accepted the funds.

“It is encouraging to see this broad coalition stand up in support of conscience rights,” said Dr. Regina Frost. “I hope the Court will recognize that the Rule simply enforces common-sense, bipartisan protections that protect both medical professionals from unjust discrimination and patients from losing their doctors.”

Dr. Frost is an OB-GYN and one of nearly 19,000 medical professionals in CMDA serving the sick and vulnerable in the United States and abroad. CMDA members serve the homeless, prisoners living with HIV, and victims of opioid addiction, sex trafficking, and gang violence. Overseas, CMDA members serve in war zones, refugee clinics, and remote areas without quality healthcare. New York’s lawsuit needlessly threatens the health and well-being of at-risk, underserved populations across the globe.

Dr. Frost and CMDA are also represented by Allyson Ho and Daniel Nowicki of Gibson, Dunn & Crutcher LLP.

For more information or to arrange an interview with a Becket attorney, contact Ryan Colby at media@becketlaw.org or 202-349-7219.Interviews can be arranged in English, Chinese, French, German, Portuguese, Russian, or Spanish.


Additional Information

Case Page: New York v. HHS

Link: Friend-of-the-Court Briefs in New York v. HHS

Legal Doc: Order in New York v. HHS 11/06/2019

Link: Media Kit

“We are being bullied to participate in medical assistance dying”

Alert from a growing number of Canadian physicians

News Release

Physicians’ Alliance Against Euthanasia

Montréal, March 9, 2020 – The Physicians’ Alliance against Euthanasia has received reports that unwilling physicians are being pressured and bullied to participate in Medical Assistance in Dying (MAiD): euphemism for euthanasia and assisted suicide.  Fearing reprisals, physicians have asked that no information that could identify them be disclosed.

The pressure has been intense for many physicians, especially amongst palliative specialists, some leaving even before this latest development. Descriptions were made of toxic practice environments and fear of discipline by medical regulators.

“The anxiety, fear, and sadness surrounding my work bled into my family life, and I ultimately felt that I could not manage practicing palliative care at this stage of my life.”  (Former palliative care physician, March 2020)

In different locations across Canada over the last months to weeks there has been a change in certain hospital MAiD policies. The change seems intended to provoke crisis or confrontation: to force objecting physicians to facilitate MAiD, or to have to refuse — and face contrived allegations of “obstructing access.” 

Reports consistently focus on the MAiD providers refusing to accept full responsibility for the death of the patient and forcing other physicians to share responsibility for the death. If the physician asks to withdraw from care and allow the MAiD provider to take over as before, the MAiD provider resists assuming the natural pattern of care.

The reports we are hearing from distressed physicians describe deliberate disruption of arrangements that were previously working satisfactorily and that had permitted patients to have access to MAiD while still allowing for conscience objectors to not be involved in facilitating the patient’s death. This bullying and betrayal of collegial relationships can poison practice environments and compromise patient care. Such behavior should not be tolerated by health care administrators in Canada.

Canadian physicians having similar stories of bullying are encouraged to contact the by email: info@collectifmedecins.org.

Contact: Charmine Francis,Coordinator
438-938-9410
info@collectifmedecins.org

Resources:

Canadian Medical Protective Association: Most Responsible Physician: A key link in the coordination of care.

Lauren Vogel. Culture of bullying in medicine starts at the top.
Canadian Medical Association Journal (December, 2018

Camille Bains. Systemic change needed to address suicide among physicians in Canada, doctors say. CBC News/Canadian Press (May, 2019)

Gabrielle Horne. Physician, heal thyself: the potential crisis of conscience in Canadian medicine. What if your faith in doctors having conscience was shaken? Globe and Mail (May, 2019)

BC Hospice challenges closure over government’s proeuthanasia policy

Government refuses compromise

Easier and cheaper to kill than to care

News Release

Delta Hospice Society

Vancouver — Delta Hospice officials were shocked and outraged this week by the Fraser Health Authority’s blatant move to cut off all discussions and close the facility because it wants the hospice to provide MAiD (Medical Assistance in Dying) at every facility. The Irene Thomas Hospice is dedicated to allowing patients access to expert symptom management for physical, emotional and spiritual distress. It provides comfort, meaning dignity and hope as one dies a natural death.

Angelina Ireland, President of the Delta Hospice, said the Fraser Health Authority and the British Columbia Minister of Health abruptly cancelled the Hospice’s contract on Tuesday without even acknowledging or responding to the hospice’s offer to a reduced level of government financing of the facility by $750,000 per year in order to meet the 50% funding level for exemption from providing MAiD.

“The actions of the Ministry reveal that the issue of MAiD vs. palliative care is an agenda-driven policy rather than one that ensures access to skilled and compassionate palliative care for eligible patients in distress, and their families,” she said. “And it’s all about dollars. It is easier and cheaper for the government to provide euthanasia rather than continue with palliative care. Basically, they are saying that no palliative care facility in BC has a right to exist unless it also provides euthanasia.”

Faced with the government’s decision and refusal to consider other options such as decreased provincial funding, Ms. Ireland said the hospice will look at all of its legal and other options to continue to exist and serve patients and families in their final days, as they have always done.

The decision is particularly baffling, she said, since access to MAiD for those who request it is available at many locations in the lower mainland, including Delta Hospital right next door to the hospice. That, in her mind, reinforces the view that this is not about patients or families, but rather about a social policy agenda.

BC Hospice challenges closure over government’s proeuthanasia  policy

“MAiD is a separate public health care stream, distinct and apart from palliative care. If the government wants to open MAiD facilities that’s their option, but they must not be allowed to download it onto the backs of private palliative care facilities.”

“Palliative care physicians and nurses believe in the philosophy of specialty palliative care and practice as defined by the World Health Organization (WHO), which maintains that palliative care provides relief from pain and other distressing symptoms and which affirms life and regards death as a normal process. At no point does WHO include euthanasia as an aspect of palliative care!”

Forced closure of the facility ignores the fact that this is a privately owned hospice built on land leased from the government, employs more than fifty people and has contributed significantly to BC’s public health care system.

“This is an invasion of the historic medical discipline of palliative care. The Canadian model is respected around the world. The government and the health authority are running roughshod over that principle and reputation.”

Ms. Ireland expressed hope that “even at this late date” Fraser Health Authority and the BC Ministry of Health will come to the table and discuss the issues, including the financial offer. “Our deepest concern is with those patients and families who have entrusted their final days to us. We want to make sure those days are filled with comfort and peace. That is still our goal.”

The Ministry and the Authority have both publicly stated they plan to take control of the premises currently occupied by the Hospice. The Delta Hospice Society built the Irene Thomas Hospice without taxpayer funds, at the cost of approximately $9,000,000. The Society has operated the Irene Thomas Hospice for 10 years, providing more than 700,000 hours of volunteer labour and $30 million to the public health care system. For the government to step in and seize this private property is “a scandalous appropriation of private assets,” said Ireland.

On Saturday April 4, a Rally for Delta Hospice will be held in front of the
Legislative Buildings at noon. Speakers include Dr. Margaret Cottle (palliative care physician) and Dr. Will Johnston (family physician and obstetrician) along with MP Tamara Jansen and Alex Schadenberg of the Euthanasia Prevention Coalition.

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For further information, contact:
Angelina Ireland. President Delta Hospice
irelandangelina@gmail.com