Protection of Conscience at the Ontario Court of Appeal

Protection of Conscience Project

News Release

On 21/21 January the Protection of Conscience Project jointly intervened at the Court of Appeal of Ontario to support freedom of conscience against an oppressive policy of Ontario’s state medical regulator, the College of Physicians and Surgeons of Ontario (CPSO). CPSO policies demand that physicians who object to morally contested procedures – including euthanasia and assisted suicide – must help patients find a colleague willing to provide the contested services.

The Court was hearing the appeal of the Christian Medical and Dental Society of Canada, the Canadian Federation of Catholic Physicians’ Societies, Canadian Physicians for Life and five individual physicians against an Ontario Divisional Court decision . The Divisional Court had ruled in favour of the CPSO, ruling, in effect, that physicians unwilling to do what they believed to be wrong by providing “effective referrals” were free to move to medical specialties where they would not face conflicts of conscience.

Expert evidence from the appellants indicated that it is extremely difficult for physicians to retrain, and that only 2.5 per cent of all physician positions in Canada would be “safe” for objecting physicians: pathology, hair loss, obesity medicine, sleep disorders and research were among the few available specialities.

The appellants’ submissions were supported by the intervention of the Ontario Medical Association, representing more than 41,000 practising and retired physicians, medical students and residents.

Joining the Project as “Conscience Interveners” were the Catholic Civil Rights League and Faith and Freedom Alliance. The joint submission noted the difference between perfective freedom of conscience (doing what one believes to be good) and preservative freedom of conscience (refusing to do what one believes to be wrong), a distinction hitherto ignored in judicial analysis.

Acknowledging that freedom of conscience can be limited to safeguard the common good, the Conscience Interveners argued that it does not follow that limits on perfective and preservative freedom of conscience can be justified on the same grounds or to the same extent.

The joint intervention drew the Court’s attention to the opinion of Supreme Court Justice Bertha Wilson in R v. Morgentaler, the only extended discussion of freedom of conscience in Canadian jurisprudence. Justice Wilson’s reasoning drew upon the key principle that humans are not a means to an end, and we should never be exploited by someone as a tool to serve someone else’s good – a principle championed by people like Martin Luther King Jr.

This principle – identified as the principle against servitude – was proposed as a principle of fundamental justice, a novel and constitutionally significant assertion. Alternatively, the Conscience Interveners argued that the principle against servitude is so foundational to human rights and freedoms it is difficult to imagine how violating it might be justified.

Forcing someone to participate in perceived wrongdoing demands the submission of intellect, will, and conscience, and violates the principle against servitude by reducing that person to the status of a tool to be used by others. This manner of servitude cannot be reconciled with principles of equality. It is an assault on human dignity that deprives physicians of their essential humanity.

Factum of the Conscience Interveners

The Evangelical Fellowship of Canada, B’nai Brith, and the Justice Centre for Constitutional Freedoms intervened in support of the physician appellants. Dying With Dignity Canada and the Canadian Civil Liberties Association intervened against them.

The Court reserved its decision.

Related: CCRL news release

Contact: Sean Murphy, Administrator, Protection of Conscience Project Email: protection@consciencelaws.org

Nurses and Midwives for Life Ireland Letter to Irish Health Minister

Dear Mr. Harris,

We are dedicated, hardworking nurses and midwives who care for patients from conception to natural death. We have a conscientious commitment to life which accords with the values inherent in Our Code of Professional Conduct and Ethics. We respect and defend the dignity of every stage of human life and we have a responsibility to make every valid or reasonable effort to protect the life and health of pregnant women and their unborn babies.

We are extremely concerned that the Health (Regulation of Termination of Pregnancy) Bill 2018, in particular, Part 3 Section 24 (3)*, will seriously impact on our ability to practise. In 2018 two Scottish midwives Mary Doogan and Connie Wood were forced to quit their jobs when they refused to oversee abortions. For the first time this legislation, which differs from the 2013 Act, will permit the intentional ending of the life of the unborn child up to birth. For us as nurses and midwives participation in termination of pregnancy defined in relation to a pregnant woman, as a medical procedure which is intended to end the life of a foetus, is morally objectionable and conflicts with our conscientious commitment to life.

Participation includes any supervision, delegation, planning or supporting of staff involved in termination of pregnancy. We do not want to be discriminated against by our employers or victimised as employees if we exercise our right to freedom of conscience.

We are in the midst of an unprecedented crisis in the Health Service and as yet there has been no effort made by you as Minister for Health to consult the nursing or midwifery professions on the clinical implications of this bill.

We are calling on you as Minister for Health:

(a) to consult our professions in relation to this legislation and

(b) to support the amendments that have been tabled to protect our right to freedom of conscience so we will not be forced out of our professions.

Yours sincerely,

Margaret McGovern RGN Vice Chair,
Catherina O’Sullivan RPN Secretary,
Fiona McHugh, Clinical Paediatric Nurse Specialist
PRO and Nurses and Midwives for Life Ireland

*Section 24 (3) A person who has a conscientious objection referred to in subsection (1) shall, as soon as may be, make such arrangements for the transfer of care of the pregnant woman concerned as may be necessary to enable the woman to avail of the termination of pregnancy concerned.

New Zealand College of GPs does not endorse euthanasia: opposes coerced referral

College of GPs does not endorse euthanasia or physician-assisted suicide: response to call for submissions on End of Life Choice Bill

News Release

For immediate release

Royal New Zealand College of General Practitioners

The Royal New Zealand College of General Practitioners has submitted its response to the Justice Committee of Parliament today (6 March 2018). The submission is clear that the College does not endorse euthanasia or physician-assisted suicide, which it considers a matter for individual members’ consciences, within the law.

The submission makes 17 recommendations to the Justice Committee, in light of the state of palliative care in New Zealand, the effect legislation may have on vulnerable people, and the effect euthanasia and physician-assisted suicide has on the doctor-patient relationship. The submission also goes into detail to recommend changes to specific challenges the Bill, as drafted, poses. That includes criteria for assisted dying, conscientious objection, and the role of the medical practitioner.

Dr Tim Malloy, President of the Royal New Zealand College of General Practitioners, said:

“Whether for or against euthanasia, the College’s members are motivated by compassion – this is a key tenet of the profession. We believe that each general practitioner in New Zealand will have their own ethical view on whether euthanasia or physician-assisted suicide is right.

“However, whether or not this Bill goes ahead, there are significant challenges that must be addressed. Fundamentally, New Zealanders need accessible, good quality palliative care. The Government should strengthen these services, so we can all experience a dignified, comfortable death.

“The College has made several recommendations to the Justice Committee for its consideration on the Bill itself. The Bill, currently, has poorly defined criteria for assisted dying. Diagnosis is difficult, we sometimes get a diagnosis wrong. And knowing if a patient is able to make a rational decision, during their end of life care, can be incredibly difficult.

“Parliament should consider our 17 recommendations carefully, given the strong apprehension from general practitioners about legalising euthanasia and physician-assisted suicide.”


Background

General practice is a medical speciality, and general practitioners (GPs) treat patients of all ages, from neonates to elderly, across the course of their lives. GPs make up 40 percent of the medical workforce.

The Royal New Zealand College of General Practitioners is the professional body for GPs, and is the largest medical college in the country. The College’s mission is improving the health of all New Zealanders.

The College’s submission to the Justice Committee can be read on its website. The College has also submitted a compilation of members’ submissions.

The recommendations are:

1. The Government improves and strengthens palliative care services for all New Zealanders.

2. The Government provides more financial support for families caring for a family member at the end of their life.

3. The Government invests in ensuring Māori have access to culturally appropriate palliative care.

4. The Government implements a public information campaign to ensure New Zealanders understand what euthanasia and physician-assisted suicide are, who would be eligible for it, and the wider implications of any legalisation before the Bill progresses further through Parliament. This would be of particular importance if the Government holds a referendum on this issue.

5. The Government invests more money in mental health services.

The following recommendations apply if the law is changed:

6. The Bill specifically prevents people with mental health conditions from qualifying for euthanasia or physician-assisted suicide.

7. The Select Committee carefully considers the scope of medical practitioners and minimum practice experience of the practitioners who would offer euthanasia or physician-assisted suicide services.

8. The Bill requires that medical practitioners receive appropriate training and support to enable them to provide quality advice and care to patients and their families.

9. The minimum age of eligibility for euthanasia be set at 25 years.

10. The Bill’s eligibility criteria are reconsidered to tighten the definition of who is eligible for euthanasia and for physician-assisted suicide.

11. The Bill’s introduction be amended to remove the requirement for medical practitioners who do not wish to participate in euthanasia to refer patients to the SCENZ Group.

12. Patients seeking euthanasia or physician-assisted suicide be obliged to self-refer to the SCENZ register in the first instance to consult with a registered medical professional who is trained and willing to provide physician-assisted suicide and euthanasia services.

13. Clause 8 be amended to recognise the difficulties of making accurate prognoses and to clarify whether medical practitioners’ advice to patients is limited to medical impacts.

14. The Select Committee considers how to deal with situations where a patient with reduced decision-making capacity wishes to forgo the Advanced Care Plan made when they were mentally competent.

15. Clause 15 be amended to make it explicitly clear if the Bill refers to euthanasia or physician-assisted suicide, and if both, when the legislation applies to either option.

16. The Select Committee considers the complexities of euthanasia and/or physician-assisted suicide if something goes wrong.

17. Clause 19 be amended to ensure the privacy and confidentiality of the medical professionals who elect to perform euthanasia or provide physician-assisted suicide.

Professor David Oderberg joins Protection of Conscience Project Advisory Board

News Release   

For immediate release

Protection of Conscience Project

The Protection of Conscience Project welcomes David S. Oderberg, Professor of Philosophy at the University of Reading, UK to the Project Advisory Board. Professor Oderberg joined the university after completing his doctorate at Oxford in the early 1990s. He is the author of many articles in metaphysics, ethics, philosophy of religion, philosophy of science, and other areas. He is also the author of several books including Moral Theory and Applied Ethics (Blackwell, 2000) as well as co-editor of collections in ethics such as Human Values: New Essays on Ethics and Natural Law (Palgrave, 2004) and Human Lives: New Essays on Non-Consequentialist Bioethics (Palgrave, 1997).

Prof. Oderberg has been working on freedom of conscience in health care over the last few years, with a recent article in the Journal of Medical Ethics on co-operation, and a forthcoming policy monograph to be published by the Institute of Economic Affairs. He is Editor of Ratio, an international journal of analytic philosophy, and Senior Fellow of the Higher Education Academy. In 2013 he delivered the Hourani Lectures in Ethics at SUNY Buffalo, and has a book forthcoming based on those lectures, to be called The Metaphysics of Good and Evil. [Faculty Profile] [Website]

Contact:
Sean Murphy, Administrator
Protection of Conscience Project
protection@consciencelaws.org


The Protection of Conscience Project is a non-profit, non-denominational initiative that advocates for freedom of conscience in health care. The Project does not take a position on the morality or acceptability of morally contested procedures. Since 1999, the Project has been supporting health care workers who want to provide the best care  for their patients without violating their own personal and professional integrity. 

 

 

Protection of Conscience Project welcomes new advisor from Scotland

News Release
For immediate release

Protection of Conscience Project

The Protection of Conscience Project welcomes Dr. Mary Neal, PhD, LLB Honours, LLM to the Project Advisory Board. Dr. Neal is Senior Lecturer in Law, University of Strathclyde, Glasgow.  She researches, writes, and teaches in the fields of Healthcare Law and Bioethics, focusing on beginning and end-of-life issues.  In 2014-15, she was Adviser to the Scottish Parliamentary Committee scrutinising the Assisted Suicide (Scotland) Bill, and she is a current member [2018] of the British Medical Association’s Medical Ethics Committee. She has published a wide range of academic articles and blogs on a range of topics including, most recently, conscientious objection by healthcare professionals; the nature of ‘proper medical treatment’; the role of the emotions in end-of-life decision-making; and the conceptual structure and content of human dignity.

Dr. Neal was a co-editor of and contributor to the recent volume Ethical Judgments: Re-writing Medical Law (Hart, 2017). Her works-in-progress include articles and book chapters on conscientious objection; the idea of ‘vulnerability’ in healthcare; physician-assisted suicide; and the role of dignity in human rights discourse. Among other research activities, Dr. Neal is currently leading two funded projects relevant to the issue of conscientious objection in healthcare. One is a British Academy/Leverhulme-funded project exploring conflicts between personal values and professional expectations in pharmacy practice. The other is a multi-disciplinary network of academics and healthcare professionals (the ‘Accommodating Conscience Research Network’, or ‘ACoRN’), funded by the Royal Society of Edinburgh, and beginning with a series of roundtables exploring various aspects of conscientious objection in healthcare. Dr Neal is also a spokesperson for the Free Conscience campaign supporting the Conscientious Objection (Medical Activities) Bill currently before the UK Parliament.[Faculty Profile]

Contact:
Sean Murphy, Administrator
Protection of Conscience Project
protection@consciencelaws.org


The Protection of Conscience Project is a non-profit, non-denominational initiative that advocates for freedom of conscience in health care. The Project does not take a position on the morality or acceptability of morally contested procedures. Since 1999, the Project has been supporting health care workers who want to provide the best care  for their patients without violating their own personal and professional integrity.