Category: Legal Commentary

Conscientious Objection: A Quick(ish) Answer

Journal of Medical Ethics

Mary Neal

The Conscientious Objection (Medical Activities) [HL] Bill, introduced by the crossbench peer Baroness O’Loan, received its second reading in the House of Lords on Friday 26th January and successfully proceeded to the committee stage.  In a post on this blog the following day, Iain posed a very reasonable question about clause 1(1)(a) of the Bill.  That clause would allow health professionals to refuse to be involved in “the withdrawal of life-sustaining treatment”, and Iain asks how this can be compatible with existing civil and criminal law, under which it is unlawful to fail to withdraw treatment (including life-sustaining treatment) from a competent patient who no longer consents to it, or from a patient who lacks capacity if treatment is no longer in her best interests.

Before responding, I should declare an interest: I’m a spokesperson for the Free Conscience campaign, which supports the Bill.  I endorse the Bill’s premise that healthcare professionals should, in key areas of practice, benefit from statutory conscience rights that are both meaningful and effective. . . [Full Text]

Medically assisted dying: What happens when religious and individual rights conflict?

Lawyer Allison Fenske explains how Canadian law works, and how the courts strive to balance competing rights

CBC News

A Winnipeg man’s struggle to be assessed for a medically assisted death while he lives at a faith-based hospital has some questioning how we balance personal and religious rights in Canada.

“I want to die and nobody should come in the way of my deciding how to go about it,” Cheppudira Gopalkrishna, 88, said on Saturday.

However, because Gopalkrishna lives at a faith-based hospital that objects to medical assistance in dying, he has struggled to be assessed by Manitoba’s MAID team under provincial guidelines regulating such deaths. . . [Full text]

 

Contraceptive Coverage and the Balance Between Conscience and Access

Ronit Y. Stahl,PhD; Holly Fernandez Lynch, JD, MBE

When the Obama administration included contraception in the essential benefits package to be covered by employer-sponsored health insurance plans under the Affordable Care Act, it sought to preserve access for women while addressing the concerns of employers with religious objections. Although the accommodations and exemptions were not enough for some employers, balance was the ultimate goal. This also was reflected in Zubik v Burwell, the Supreme Court’s most recent decision on the matter; on May 16, 2016, the justices remanded the litigants to the lower court so they could be afforded the opportunity to reach a compromise between religious exercise and seamless contraceptive coverage. No further compromise was forthcoming.

Now the Trump administration has rejected balance as a worthwhile goal.1 Its new contraceptive coverage rules, released on October 6, 2017, prioritize conscientious objection over access.2,3 The rules take effect immediately, and new legal challenges, this time on behalf of patients rather than objecting employers, have already begun.4 The new rules preserve the default requirement that employers must include free access to contraceptives as part of their insurance plans. However, the rules now exempt employers with religious or moral objections to contraceptives, without requiring any alternative approaches to ensure that beneficiaries can obtain contraceptives at no cost.2,3
[Full Text]

Stahl RY, Lynch HF. Contraceptive Coverage and the Balance Between Conscience and Access. JAMA. Published online October 19, 2017. doi:10.1001/jama.2017.17086

Victoria, Australia: Voluntary Assisted Dying Bill 2017

Comment

Sean Murphy*

A  euthanasia and assisted suicide bill introduced in the Parliament of Victoria, Australia, includes several provisions that pertain to legal protection of freedom of conscience.  Concerning these:

  • Freedom of conscience provisions concern only individual practitioners, not health care facilities.  Freedom of conscience presumably includes acting upon moral or ethical beliefs grounded in religious teaching.
  • Statements of principles that require encouragement and promotion of an individual “preferences and values,” that people should be “supported” in conversations about treatment and care and “shown respect” for their beliefs, etc. can be interpreted to require affirmation of moral or ethical choices.
    • While the principles may have no direct legal effect, they could be cited by professional regulatory authorities against those who refuse to encourage, promote, or affirm the acceptability of euthanasia and assisted suicide.
  • Registered medical practitioner is not defined, but all would be encompassed by the definition of health care practitioner.
  • All health care practitioners are protected by Section 7.
  • Section 7(b) allows for refusal to participate in the request and assessment process and Section 7(c) protects refusal to be present when lethal medication is administered, but Section 7
    • does not include protection for refusal to participate in the administration of lethal medication, by, for example, inserting an IV line in advance, or by other means
    • does not include protection for refusal to participate in dispensing lethal medication
  • “Participate” in Section 7(b) is broad enough to encompass referral.  However, the bill would be improved by providing protection against coerced indirect participation in administering or dispensing lethal medication.
  • The bill does not require falsification of death certificates, but does require the falsification of the cause of death in the registration of deaths.  The bill includes no protection for a registrar who, for reasons of conscience, is unwilling to falsify a registry entry.

Symposium: Conscience, conditions, and access to civil society

SCOTUSblog

Richard Garnett*

It is striking how easy it has become for a person to stumble into the status of a symbol – or, these days, a viral meme. Jack Phillips is, or was until fairly recently, a skilled cake artist with a small business, Masterpiece Cakeshop, in suburban Denver. Today, he is a litigant in the Supreme Court of the United States and regarded by many as embodying the tension – increasingly, the conflict – between religious conscience and equality. . . Can he be required, though – should he be required, is it necessary for him to be required – to say something he thinks is not true, to disavow what he believes or to act expressively in violation of his conscience? . . . [Full text]