By Region/Country
Australia
A physician in Melbourne, Australia, has openly defied the State of Victoria law that requires physicians who object to abortion to refer patients to colleagues who will provide the service. Dr. Mark Hobart refused to refer a couple who wanted to abort a girl because they wanted a boy. [Newstalk]
Canada
The government of Quebec has introduced a bill to legalize euthanasia in the province, despite the continuing criminal prohibition of the procedure. An Act respecting end-of-life care (Bill 52) is intended to permit physicians, in defined circumstances, to kill their patients as part of the redefined practice of medicine (“medical aid in dying”; MAD). However, the procedure cannot become part of medical practice in Quebec unless the medical profession itself (broadly speaking) formally accepts it and delivers it through the structures and powers established for the delivery of health care. If Bill 52 passes, health care providers and others who want no part of euthanasia will find their working environments increasingly controlled by a MAD matrix functioning within this system. Moreover, having formally approved of euthanasia, the medical establishment will be at particular pains to defend and enforce the decision. In the end, freedom of conscience for Quebec health care workers who object to euthanasia may come to mean nothing more than the freedom to find another job, or the freedom to leave the province. [See Redefining the practice of medicine: Winks and nods and euthanasia in Quebec]
European Union
The Observatory on Intolerance and Discrimination against Christians released a report describing 41 examples of national laws with adverse effects on Christians in more than 15 European Countries. Additionally, 169 cases of intolerance against Christians in the EU – area in 2012 are portrayed. The Holy See has denounced European discrimination against and intolerance of Christians.
Ireland
The Protection of Life During Pregnancy Act 2013 will permit abortions when there is a “real and substantial risk” to the life of a woman by reason of physical illness or suicidal ideation. The Act includes a protection of conscience provision that is limited to medical practitioners, midwives and nurses. A provision that denied freedom of conscience to institutions has been dropped. However, no conscientious objection will be allowed in emergencies when the mother’s life is in immediate danger.
It is far from certain how much difficulty the mandatory referral requirement will cause, since the Act envisions abortion only in circumstances involving a substantial risk to the mother’s life. This is very rare, and in such circumstances there is much less likelihood of conscientious objection, so the provision may not prove to be troublesome in practice.
On the other hand, government comments accompanying the earlier “heads of bill” noted that medical practitioners do not need to be of the opinion that the risk to the woman’s life “is inevitable or immediate.” The more broadly this interpretation is construed, the more likely it is that conflicts of conscience will occur, and the greater will be the surrounding controversy. Irish physicians speaking to an early draft of the legislation expressed differences of opinion about grounds for abortion.
Italy
Large numbers of Italian obstetricians are reported to be refusing to provide abortion for reasons of conscience – up to 80% of practitioners in some areas. Critics are demanding that steps be taken to ensure “access to abortion,” which may generate pressure to suppress freedom of conscience. [RTE; Morning Ireland]
Netherlands
Only 400 of 20,000 Flemish physicians are trained to provide euthanasia. It appears that most physicians do not want to be directly involved with it. In consequence, the 400 are called upon frequently to provide the required second opinion and sometimes the lethal injection. Confirming the reluctance of physicians to participate in the procedure, Dr. Sarah Van Laer complains that “there are too few doctors ready to perform euthanasia” and that this is a”badly underestimated problem.” [Bioedge]
Philippines
In order to simplify and expedite the hearing scheduled for 9 July to review the controversial Reproductive Health law, the Supreme Court of the Philippines has proposed that the petitioners for and against the bill concentrate on three constitutional themes during their oral submissions:
- proscription of involuntary servitude
- equal protection clause (right to life, freedom of religion, natural law)
- freedom of speech (academic freedom)
The suggestion by the court to include the proscription of involuntary servitude as one of the constitutional themes could be interpreted two ways and could include arguments of two kinds. The first is a claim that compelling someone to do something contrary to his conscientious convictions is a form of involuntary servitude. The second is a claim that a pregnancy that results from difficulty accessing contraception and/or abortion is a form of involuntary servitude. In either case, the reference to the constitutional proscription of involuntary servitude is of particular interest because of a similar proscription in the 13th Amendment to the Constitution of the United States.
United Kingdom
The Family Planning Association has encouraged women to leave a medical practice in south London after anonymous complaints were reported in the media that some physicians in the clinic are unwilling to prescribe the morning-after pill for reasons of conscience. [The Independent]
The National Health Service of Greater Glasgow and Clyde, regional provider of state health care, will attempt to overturn an appeal court ruling favourable to freedom of conscience for health care workers by appealing to Britain’s Supreme Court. Two midwives who, for reasons of conscience, refused to participate in the supervision and support of staff providing abortions successfully appealed a lower court ruling against them. The judgement of the appeal court was given in April. [Irish Post]
A bill introduced in the House of Lords by Lord Falconer proposes to legalize assisted suicide. It includes a protection of conscience provision to protect those who do not wish to participate in the procedure. Participation is the central issue in the midwives case noted above.
United States
The Department of Health and Human Services has confirmed a regulation that will require businesses with over 50 employees to provide health insurance for birth control and surgical sterilization, even if they object to doing so for reasons of conscience. The regulations includes exemptions for objecting “religious employers” (largely limited to houses of worship) and objecting religious non-profit organizations. Nonetheless, the continued demand that objecting business owners be forced to comply and the nature of the exemptions remain unacceptable to many religious organizations. Catholic and Baptist leaders have collaborated in writing a letter of protest to Congress. American Catholic bishops have been adamant that the HHS regulation is unacceptable. There are now 61 civil suits filed against the regulation, with over 200 plaintiffs. [Becket Fund, HHS Information Central]. The Archdiocese of New York is among the plaintiffs in the lawsuits. However, the Archdiocese has, for years, been indirectly paying for health insurance for employees of the Catholic Health Care System that includes coverage for contraception and abortion. [New York Times]
A North Carolina bill that proposes to modify laws pertaining to abortion health insurance coverage includes a protection of conscience provision for health care workers and health care institutions. In Vermont, a new assisted suicide law allows for protection of conscience for health care workers and somewhat more limited protection for health care facilities.
Recent Postings
Personal Opinions and Ideology, Not “Science”. From Conscience and its Enemies: Confronting the Dogmas of Liberal Secularism, by Robert P. George
A “medical misadventure” in Ireland: Deaths of Savita & Prasa Halappanavar. University Hospital, Galway, Ireland (21-28 October, 2012)
Draft Irish Abortion Law: Protection of Conscience- Testimony before the Joint Committee on Health and Children Houses of the Oireachtas (Tithe an Oireachtais) Dublin, Ireland 17-21 May, 2013
What Role does Conscience play in Medical Ethics? Presentation to the Association of Catholic Doctors, Dublin, 27 September, 2008.
Redefining the practice of medicine: Winks and nods and euthanasia in Quebec. Commentary on Bill 52: An Act respecting end-of-life care (June, 2013)
U.S. Senate, Bill S1204 (2013) Health Care Conscience Rights Act
North Carolina, USA: House Bill 730 (2013) Insurance & Health Care Conscience Protection
Vermont, USA: Protection of conscience provision in assisted suicide statute
United Kingdom: Assisted Dying Bill (HL Bill 24) (protection of conscience provision)
Publications of Interest
O’Rourke A, De Crespigny L, Pyman A. Abortion and Conscientious Objection: The New Battleground. Abstract: This paper examines the vexed issue of conscientious objection and abortion. . .We argue that the unregulated use of conscientious objection impedes women’s rights to access safe lawful medical procedures. As such, we contend that a physician’s withdrawal from patient care on the basis of conscience must be limited to certain circumstances. . .the ‘obligation to refer’ in ALRA is consistent with international practice and laws in other jurisdictions. . .
Observatory on Intolerance and Discrimination Against Christians in Europe: Legal Restrictions Affecting Christians / Report 2012
Murphy S, Genuis SJ, “Freedom of Conscience in Health Care: Distinctions and Limits.” Journal of Bioethical Enquiry, June, 2013
Fernandez-Lynch H, “Discrimination at the doctor’s office.” N Engl J Med 2013; 368:1668-1670 May 2, 2013DOI: 10.1056/NEJMp1211375