Category: Procedures & Services

Debate flies at CMA meeting over physician’s role in assisted dying

 Global News

Julia Wong

HALIFAX – Physicians from across the country spent hours at the Canadian Medical Association’s annual general meeting discussing what their role would entail if asked to assist a patient in dying.

Dozens of physicians took the floor to share their thoughts, concerns and worries over what was morally acceptable and what to do if they had a conscientious objection.

The Supreme Court of Canada struck down the ban on assisted dying in February and gave the federal government one year to create a new law. It will technically be legal for a physician to be involved in assisted dying next year.

Dr. Douglas Maynes, a Halifax psychiatrist who has been practicing for 43 years, said he has concerns about those with mental illness. . . (Full text)

 

Doctors’ Group urges Canadian Medical Association to defend conscience rights on assisted death

News Release

Christian Medical and Dental Society of Canada

HALIFAX, Aug. 24, 2015 /CNW/ – Larry Worthen, Executive Director of the Christian Medical and Dental Society of Canada (CMDS), urged the Canadian Medical Association (CMA), today, to support their members’ freedom of conscience when they meet on Tuesday, August 25th, to consider the CMA’s position on assisted death and conscience rights.

Said Larry Worthen, “Many physicians have moral convictions that will not allow them to participate in medical aid in dying. There should be no discrimination against a physician for her refusal to participate in medical aid in dying for moral or conscience reasons. That is why the Christian Medical and Dental Society of Canada urges the Canadian Medical Association to adopt the third option being presented to them by CMA staff: that physicians have a ‘duty to provide complete information on all options and advise on how to access a separate, central information, counselling and referral service.'”

The Canadian Medical Association will be discussing a policy framework called “Principled Based Approach to Assisted Dying in Canada” at their general council meeting in Halifax on August 25th. Section 5.2 of this document deals with physician conscience protection and assisted death. CMA staff will present four options for dealing with conscientious objection, and delegates will be polled on which option should be included in official CMA policy.

All options deal with the situation in which a physician is not able, for reasons of conscience, to participate in physician-assisted death. The four options are:

  1. Duty to refer directly to a non-objecting physician;
  2. Duty to refer to an independent third party;
  3. Duty to provide complete information on all options and advise on how to access a separate, central information, counselling, and referral service; or
  4. Patient self-referral to a separate central information, counseling, and referral service.

Options ‘1’ and ‘2’ require the objecting physician to refer. Many physicians will have moral convictions that assisted death is never in the best interests of the patient, while others may object to assisted death because of the particular circumstances of the patient. A referral is essentially a recommendation for the procedure, and facilitates its delivery. A requirement to refer means that physicians will be forced to act against their consciences.

Option ‘4’ allows the patient to directly access assisted death, but does not necessarily provide an opportunity for counseling by a physician who has a longer term relationship with the patient.

“Option ‘3’ allows the discussion of all options to occur with the patient and the physician who knows them. If, after considering all of the options, the patient still wants assisted death, the patient may access that directly. This option ensures that all reasonable alternatives are considered. It respects the autonomy of the patient to access all legal services while at the same time protecting physicians’ conscience rights,” added Mr. Worthen.

Option ‘3’ is a summary of a proposal submitted to the CMA by three organizations: the Christian Medical and Dental Society, the Canadian Federation of Catholic Physician Societies, and Canadian Physicians for Life. Taken together, they represent more than 3000 Canadian physicians.

CMDS (Christian Medical and Dental Society) represents some 1600 physicians and dentists across Canada.

See the complete CMDS-CFCPS-CPFL- proposal to the CMA 

 

Turning physicians into executioners

National Post

Sean Murphy*

When the Canadian Medical Association (CMA) convenes in Halifax this month for its Annual General Council, delegates will confront what the CMA’s Dr. Jeff Blackmer has called the biggest change in the medical profession in Canada, maybe in centuries: the legalization of physician-assisted suicide and euthanasia ordered by the Supreme Court of Canada.

Last year, when announcing the intention of the CMA to intervene in the Carter case at the Supreme Court, Dr. Blackmer and CMA President Dr. Louis Hugo Francescutti reflected on what was at stake.

One person’s right is another person’s obligation, and sometimes great burden, they wrote. And in this case, a patient’s right to assisted dying becomes the physician’s obligation to take that patient’s life. . . [Full text]

Canadian Medical Association plans for physician assisted suicide, euthanasia

Commentary on draft framework (August, 2015)

Sean Murphy*

Abstract

The Canadian Medical Association (CMA) draft framework, Principles Based Approach to Assisted Dying in Canada presumes that physicians have an obligation to kill patients or help them commit suicide in the circumstances described by the Supreme Court of Canada in Carter v. Canada. It claims that objecting physicians are obliged to support physicians who do so, and to facilitate their work. By presuming these contested obligations as normative, the framework imposes a structure for response and discussion that is prejudicial to objecting physicians.

CMA officials define “participation” in the draft framework to mean only providing a lethal injection or writing a lethal prescription, although this is not stated in the document. Referral is not counted as “participation,” and the draft framework appears to reflect the view that referral is the preferred method for reconciling conflicts between patients seeking euthanasia or assisted suicide and physicians unwilling to be involved with homicide or suicide. This introduces a fundamental structural bias in framing the CMA approach to accommodating freedom of conscience and religion.

The bias in favour of mandatory referral becomes particularly evident in Schedule B, which considers only compulsory referral as a means of reconciling freedom of conscience and access to services. Further, the structural bias is reflected and reinforced by numerous erroneous and substantially misleading statements.

What support might be offered to physicians unwilling to provide or facilitate euthanasia and assisted suicide is conditional upon their referring the patient to a third party, but the formulation in the draft framework is insufficiently clear and has been compromised by revisions to fundamental principles. An acceptable policy will not require objecting physicians to become part of a chain of causation culminating in a morally contested procedure.

Despite the bias apparent in the draft framework, it should be possible to reconcile respect for the fundamental freedoms of physicians and demands for access to morally contested services. This can be done within the framework proposed by the CMA in the manner suggested in this commentary..

Table of Contents

I.    Introduction

II.    Overview

III.    Principles Based Approach to Assisted Dying in Canada

III.1    Highlights of the decision from a physician perspective

III.2    Strategic Questions

III.2.1    Strategic Question 3

III.2.2    Additional strategic questions

IV.    Schedule A: Draft Principles-Based Recommendations

IV.1    Foundational principles

IV.1.1    2.  Equity

IV.1.2    3.  Respect for physician values

IV.1.3    5.  Clarity

IV.1.4    9: Solidarity

IV.2    Recommendations –  1.  Patient qualifications for access to medical aid in dying

IV.2.1    1.2  Informed decision

IV.2.2    1.3  Capacity

IV.3    Recommendations- 2.  Process map for decision-making in medical aid in dying

IV.3.1    Stages 1& 2: Requesting/Before undertaking medical aid in dying

IV.3.2    Stage 3: After undertaking medical aid in dying

IV.4    5.  Moral opposition to medical aid in dying

IV.4.1    5.2  Conscientious objection by a physician

V.    Schedule B: Legislative Criteria Across Jurisdictions

V.1    Q3:  Reconcile refusal and equitable access? (Table of comparisons)

V.2    Netherlands – misleading and biased

V.3    Luxembourg – incomplete and confusing

V.4    Belgium – confusing

V.5    Oregon -erroneous, misleading, confusing and biased

V.6    Washington -erroneous, misleading, confusing and biased

V.7    Vermont – misleading and biased

V.8    Senate Bill 225 – misleading and biased

V.9    Carter trial decision- seriously misleading and biased

V.10    Carter SCC decision – misleading and biased

VI.    Project Summary

VII.    Project Recommendations

Lack of Conscientious Objection Clause for Medical Staff in Sweden

Decision of the European Committee of Social Rights

News Release

European Federation of Catholic Family Associations  (FAFCE)

Contrary to Resolution 1763 adopted by the Parliamentary Assembly of the Council of Europe (PACE) on 10 October 2011, Medical Staff in Sweden have no legal right to conscientious objection in case of ethically sensitive issues which occur particularly at the beginning and the end of life. The European Federation of Catholic Family Associations (FAFCE) which has a participatory status with the Council of Europe submitted a collective complaint against Sweden in 2013 based on the above grounds and the right to health, together with the Swedish organisations Provita and Christian Medical Doctors and Students (KLM). The decision of the European Committee of Social Rights was made public today.

One of the issues addressed in the Collective Complaint against Sweden was freedom of conscience for medical staff. In its response to the Complaint the Swedish Government argued that freedom of conscience should be discussed in the work place and that if the issue can’t be resolved in a satisfactory manner for the employee, it can be brought before Court, based on article 9 of the European Convention on Human Rights which is incorporated into the Swedish law and on the grounds of the anti-discrimination law for the individual. The right to freedom of conscience is enshrined in article 18 of the Universal Declaration of Human Rights and in article 9 of the European Convention on Human Rights.

In its response the Government also notes that contacts have been established with the concerned employers and workers union: none of these could provide examples of situations where freedom of conscience had been problematic. Thus the Government considers that the problem is purely theoretical.

”It is of course very noteworthy that the Government stated that denied freedom of conscience only is a theoretical problem in its response to the European Social Rights Committee. In a recent complaint to the United Nations Swedish by European Centre for Law and Justice, medical staff – four midwifes, three general practioners and two pediatricians – testify of how the negative attitude towards freedom of conscience has limited them and their colleagues in their professional practice”, says Mrs Nordström, CEO or Provita and President of Scandianvian Human Rights Lawyers, and the legal representative of a Swedish midwife, Ellinor Grimmark, in an ongoing courtcase about freedom of conscience in Sweden. Mrs Grimmark lost her job and was refused employment due to her refusal to perform abortions as part of her tasks as a midwife at several Swedish hospitals. – “This is a concrete case that proves that freedom of conscience for medical staff is all but a theoretical problem in Sweden”, says Ruth Nordström.

In its decision the European Committee of Social Rights states that it has previously, in a Collective Complaint against Italy, considered whether freedom of conscience in accordance with article 11 of the European Social Rights Charter affects women’s access to abortion in Italy (International Planned Parenthood Federation vs. Italy (Complaint 87/2012)).

”The Committee establishes that article 11 is not applicable in this case, where the situation is the opposite, i.e. where women’s access to abortion is not affected. Since article 11 is not applicable the Committee does not take a position regarding the issue of discrimination according to article E in the European Social Rights Charter.” says Ruth Nordström.

The Swedish Federation of Medical Doctors (Läkarförbundet) and the Swedish Federation of Medical Staff (Vårdförbundet) together with the Swedish Planned Parenthood Federation (RFSU) recently claimed that ”conscience clauses threaten free abortion”. In other words the official representative bodies of medical staff in Sweden consider access to abortion as superior to freedom of conscience. FAFCE’s President Antoine Renard remarks that “this statement is a stark contrast to the position recently expressed in another Council of Europe Member State, namely France where The National Council of the Order of Medical Doctors publically opposes the suppression of the conscience clause related to abortion and “recalls that it is a fundamental provision foreseen by the medical deontological statute-book and by the public health law.”

Furthermore, the Committee considers that it cannot be proven that the number of abortions in Sweden is considerably high or that these abortions are a result of insufficient access to preventive measures.

FAFCE’s Secretary General Maria Hildingsson underlines that ”Sweden has among the highest abortion rates in Europe, year after year, statistics show this trend very clearly.” She considers that “it is regrettable that the European Committee of Social Rights does not take a clear stance in favour of stronger legal protection regarding the ethical issues addressed in the Complaint.”

Regarding sex selective abortions in Sweden, another issue reported in the Complaint and the treatment of infants surviving late term abortions the Committee states in its decision ”that FAFCE’s complaints relate to an issue which is very sensitive for many of the State Parties to the Charter, i.e. the question of when human life begins, which depends on the wide diversity of values and traditions in the different states.”. The Committee pursues by saying that “States Parties enjoy a wide margin of appreciation in deciding when life begins and it is therefore for each State Party to determine, within this margin of appreciation, the extent to which a foetus has a right to health.”

“The issue of infants surviving late term abortion has caught considerable attention across Europe during the recent months, namely in connection with a petition signed by over 200 000 citizens which will be debated in the Legal Affairs and Human Rights Committee of the PACE next week” underlines FAFCE’s President Antoine Renard.

“It is astonishing that the Committee argues that Member States should decide when life begins. It is an undisputed biological fact that life begins at conception. What the committee is likely to mean is when the unborn life should be protected and granted human dignity. This wording can hardly be due to ignorance, but rather it is a rhetorical approach that’s both tendentious and cynically” says Tomas Seidal, Vice President of KLM.

”The issue of abortion has been, is and will remain controversial for us who work in medical care, since it is a unique intervention with the consequence of putting an end to a human life. We also consider that the issue becomes particularly complicated when the unborn child is the object of medical care in other circumstances, and as such a patient with the right to life and health care. If it collides with a strongly established conviction and belief against extinguishing a life at its beginning, there must be room for conscientious freedom” says Tomas Seidal.

Contact:

Maria Hildingsson, Secretary General, European Federation of Catholic Family Associations  (FAFCE)
+32 4 70 20 39 18
m.hildingsson@fafce.org

Ruth Nordström, President, Provita 
+46 70 725 1917
ruth.nordstrom@provitasweden.org

Tomas Seidal, Vice-President, Christian Medical Doctors and Students (KLM)
ht.seidal@gmail.com

Founded in 1997 the European Federation of Catholic Family Associations (FAFCE) holds a participatory status with the Council of Europe, is a member of the EU Fundamental Rights Agency Platform, and represents family associations from 15 European countries.