A “medical misadventure” in Ireland

Deaths of Savita & Prasa Halappanavar

Galway, Ireland: 21-28 October, 2012

Sean Murphy*

Savita Halappanavar was a 31 year old woman who was 17 weeks pregnant when she presented at the University Hospital, Galway, on 21 October, 2012, with a miscarriage.  She spontaneously delivered a stillborn daughter, Prasa, on the afternoon of 24 October, and died from sepsis early on 28 October.  The circumstances of her death generated a hurricane of controversy in Ireland and around the world about Irish abortion law.  A coroner’s inquest held in Galway in April, 2013 resulted in the classification of Savita’s death as a “medical misadventure.”

What follows is a chronological account of Savita’s care and treatment from 21 to 28 October, drawn from newspaper reports of the evidence taken at the inquest.  [Read more . . .]

Related:

 

Uruguay’s Voluntary Termination of Pregnancy Act

 Protection of conscience provisions may be defined out of existence

Sean Murphy*

In the fall of 2012 the Uruguayan legislature passed the Voluntary Termination of Pregnancy Act, which legalized abortion in the country under certain circumstances.  By January, 2013, Reuters was reporting that the law was meeting “fierce opposition” among Uruguayan gynaecologists, with up to a third of them refusing to provide the procedure for reasons of conscience;1 in some locations, almost none will do so. . . Full Text

Planned Parenthood and “Anti-Choice” Rhetoric

Sean Murphy*

A response to Mario Toneguzzi, “Planned Parenthood Targets ‘Anti-choice’ Docs”, Calgary Herald (19 August, 2004)

Planned Parenthood and "Anti-Choice" Rhetoric

In 1999, citing allegations by un-named “individuals,” a Councillor of the Alberta College of Physicians and Surgeons claimed that some physicians who were not “supportive” of women seeking abortions were “rude and bullying to patients.”(1) Canadian Physicians for Life rebuked the Councillor for relying upon “polemical hearsay” and demanded that the College substantiate the allegation.(2) No evidence was forthcoming.

Three years later the Assistant Registrar of the College indicated that complaints about physician ‘moralizing’ were largely hearsay “from groups who provide birth control and family planning counselling to women” – not a bad definition of Planned Parenthood.(3)First-hand accounts from individual patients were a “distinct minority” of the total.(4)

Planned Parenthood Alberta is now recycling the accusation that physicians who object to abortion may “scare” patients with “misinformation” or “impose their moral beliefs.”(5) One of the problems with this kind of generalized smear is that it may be unfairly applied to conscientious objectors to abortion who follow the guidelines of the Canadian Medical Association (CMA) and the College of Physicians and Surgeons of Alberta (CPSA).

The CMA advises physicians to “inform a patient when their personal morality would influence the recommendation or practice of any medical procedure that the patient needs or wants,” and to advise patients of their objections to abortion so that they can consult another physician.(6) The CPSA does not require physicians to advise every pregnant woman that she can have an abortion or put her child up for adoption,(7) but does expect them to provide information to patients seeking abortion so that they can “make informed decisions on all available options for their pregnancies, including termination.”(8)

In following these guidelines an objecting physician must, at all times, be respectful of the patient’s dignity, and must not be threatening, overbearing or abuse his authority by preaching or moralizing in order to influence his patient’s decision. On the other hand, objecting physicians can hardly be expected to present morally controversial procedures as morally uncontroversial, or in such a way as to indicate that they approve of them or are indifferent to them (i.e., to adopt a ‘neutral’ position). Moreover, the information they reasonably believe necessary to permit the patient to make a truly “informed decision” may be more comprehensive or in other respects different from what Planned Parenthood is accustomed to provide its clients.

A third party who was not present during this kind of exchange, especially an interest group like Planned Parenthood, might well stigmatize the discussion as ‘moralizing’ and providing ‘misinformation’. Partisan polemics of this sort do not provide a basis for sound policy making.

Planned Parenthood Alberta suggests that patients who are unsure of their doctor’s position on abortion should contact the organization because it is compiling a list of what it calls “anti-choice doctors”. Asking the doctor directly seems a simpler and more reliable way for patients to resolve such doubts. If it is desirable to help patients find physicians who share their outlook on moral issues, it would be preferable for doctors to identify themselves, perhaps through the College of Physicians and Surgeons or professional associations.

In the meantime, if Planned Parenthood persists in its plan to identify “anti-choice doctors”, it should include in its list the names of physicians who believe that their colleagues should not be forced to provide or facilitate morally controversial procedures.

Notes

1. Kretzul E. Ethical Responsibilities in Dealing with Women Requesting Abortion Services. The Messenger. 1999 Sep; 73: 6.

2. Canadian Physicians for Life. News Release: Alberta College of Physicians and Surgeons challenged to think about conscience rights [Internet]. Powell River: Protection of Conscience Project; 1999 Oct 11.

3. Theman TW. Freedom of Conscience and the Needs of the Patient. Presentation to the Obstetrics and Gynecology Conference “New Developments-New Boundaries”; 2001 Nov 9-12; Banff, Alberta.

4. Theman, Trevor W. (Assistant Registrar, College of Physicians and Surgeons of Alberta). Letter to: Sean Murphy (Administrator, Protection of Conscience Project). 2002 Jan 2. 1 leaf. Located at: Protection of Conscience Project.

5. Be Aware of Anti-Choice Doctors and Radiologists [Internet]. Edmonton: Planned Parenthood Alberta; 2004 [cited 2004 Aug 28].

6. Canadian Medical Association. Induced Abortion [Internet]. CMAJ. 1988 Dec 15 [cited 2020 Sep 16]; 139:12 1176a–1176b. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1268491/pdf/cmaj00181-0059.pdf.

7. Theman, Trevor W. (Assistant Registrar, College of Physicians and Surgeons of Alberta). Letter to: Sean Murphy (Administrator, Protection of Conscience Project). 2002 Mar 27. 1 Leaf. Located at: Protection of Conscience Project.

8. College of Physicians and Surgeons of Alberta. Termination of Pregnancy. 2000 Jun.

Ontario College of Physicians and Surgeons accommodates Christian physician

 Sean Murphy*

The Ontario College of Physicians and Surgeons has accepted a suggestion from Dr. Stephen Dawson that has resolved complaints lodged against him. Dr. Dawson, a Christian physician who practises in Barrie, Ontario, was charged for professional misconduct because he refused to prescribe birth control pills to four unmarried women.

Dr. Dawson now posts a policy statement in his waiting room that includes a statement that he will not prescribe birth control pills to unmarried women nor Viagra to unmarried men, nor will he arrange for abortions. He will not offer further information about his religious convictions except in response to queries from patients. [Full text]

 

Who is “imposing morality” in Barrie?

Winnipeg, Manitoba
5 April, 2002

Sean Murphy,  Administrator
Protection of Conscience Project

The Canadian Broadcasting Corporation (CBC) is Canada’s publicly funded state radio and television broadcaster. The following was sent to the CBC in Winnipeg, Manitoba, asking whether or not it would be accepted for broadcast in the same region where Dr. Goldman’s editorial was aired. The CBC did not  reply.

In an editorial broadcast on CBC Radio on 7 March, 2002, Dr. Brian Goldman criticized Dr. Frederick Ross of Winnipeg, Manitoba, and Dr. Stephen Dawson of Barrie, Ontario. Dr. Ross had told his patients to stop smoking or find another doctor, while Dr. Dawson had refused to prescribe birth control pills or Viagra to single patients.

It does not seem that Winnipeg’s Dr. Ross believes that treating smokers is wrong, nor that it would be wrong to refer a smoker to another physician. His public statements do not preclude the possibility that he would treat smokers on an ad hoc basis (while standing in for an absent partner, for example).

In contrast, Dr. Dawson refuses to help single patients obtain birth control pills and Viagra under any circumstances, because he believes that by doing so he would be a party to immoral activity (i.e.,extramarital sex). Dr. Goldman was more sympathetic to this position, but criticized Dawson because he would not refer patients to other physicians who would prescribe the drugs.

Dr. Goldman recognized that his colleagues were acting for different reasons, but in drawing his conclusions he failed to maintain this distinction or recognize its significance. It is one thing to refuse to do something because it is inconvenient, difficult, frustrating, or pointless; it is quite another to refuse to do something because it is wrong. Grasping this distinction is the key to understanding the difference between the case of Dr. Ross, which does not seem to involve conscientious objection, and that of Dr. Dawson, which plainly does.

What some characterize as Dr. Dawson’s inflexibility actually illustrates the normal human reaction to a request to do something wrong. For example, a fifty year-old man who wanted to have sex with a fourteen year- old girl might be refused the use a friend’s apartment for that purpose. Nor would it be surprising if the unco-operative  friend also refused to refer the lecher to a more ‘flexible’ apartment owner.

We see the same principle at work in criminal law. It is an offence not only to commit a crime directly, but to counsel, aid or abet a crime committed by someone else. Again: many people who engage in ‘ethical investment’ do so because they do not want to be implicated, even indirectly, in business practices to which they object for reasons of conscience, even if the practices aren’t illegal.

Now, no one is suggesting that consensual extramarital sex between adults is morally equivalent to criminal activity. But when Dr. Dawson refused to provide birth control for single patients, he reacted exactly as an ‘ethical investor’ might react if asked to purchase shares in a company that exploits child labour. He reacted exactly as an honest man would act were he asked to help someone lie or cheat. In other words, he  acted as if extramarital sex really is wrong, and that its wrongness is not merely a matter of opinion or taste. That, in truth, is what has upset many of his critics; he has disturbed their repose in their  comfortable pews.

Of course, one may criticize a physician for causing needless distress to a patient by offering a poorly articulated or inappropriate explanation of his moral position. But that was not Dr. Goldman’s concern. Instead, he complained that Dr. Dawson had acted upon his own beliefs.

In fact, Dr. Goldman does exactly the same thing. He believes that he does nothing wrong by providing single patients with contraceptives and Viagra, and he acts upon that belief by writing prescriptions. Why should Dr. Goldman be allowed to act upon his beliefs by writing prescriptions, while Dr. Dawson is forbidden to act upon his by refusing  to do so? Is it because “the true north strong and free” is afraid of religious believers?

A physician who refuses, for reasons of conscience, to do something he believes to be wrong – falsifying a diagnosis, amputating a healthy limb, or prescribing contraceptives – does not force a patient to conform to his moral code. He is not “imposing morality.” To see what  “imposing morality” really means, watch this month when the Ontario College of Physicians and Surgeons tries to force Barrie’s Dr. Stephen Dawson to give up his Christian convictions, on pain of professional excommunication.