Category: Legal Commentary

Indiana assisted suicide bill fails to protect objecting practitioners

Assisted suicide evolves from “assistance” to  “medical care”

Affirmation has serious consequences for objecting  Indiana physicians

Sean Murphy*

On 7 January, 2020, Representative Matt Pierce introduced HB1020: End of life options in the Indiana General Assembly. HB1020 is the fourth assisted suicide bill introduced by Pierce since 2017; three previous bills died in committee without hearings. Parts of HB1020 relevant to protection of conscience are reproduced on the Project website.

Overview

The bill permits physician assisted suicide for Indiana residents 18 years of age and older who have been diagnosed with a terminal illness likely to cause death within six months. [Full text]

New Hampshire assisted suicide bill introduced

Protection of conscience provision biased against objectors

Sean Murphy*

New Hampshire House Bill 1659 would legalize assisted suicide. Parts of the bill relevant to protection of conscience are reproduced on the Project website.

The bill permits physician assisted suicide for New Hampshire residents 18 years of age and older who have been diagnosed with a terminal illness likely to cause death within six months. Candidates who are capable of making and  communicating health care decisions must apply in writing for a lethal prescription (137-M:3); the application must be witnessed by two independent witnesses (137-M:4).  The candidate must apply personally; substitute medical decision makers cannot apply on behalf of a patient (137-M:3.III).

The bill imposes a number of obligations on physicians primarily responsible for treating a patient’s terminal illness (137-M:5) and upon physicians consulted by them about the illness (137-M:6).  These would be unacceptable to physicians who refuse to participate in assisted suicide for reasons of conscience.

Section 137-M:14 (Immunities) is the provision that is intended to protect objecting health care providers, which includes individuals and health care facilities.  The protection offered is biased in favour of those willing to participate in assisted suicide and insufficient to protect those unwilling to do so.  Specifically:

  • 139-M:14.I limits protection against civil, criminal and professional liability to persons willing to participate in assisted suicide; no protection is provided for those who refuse. It also prevents objecting institutional health care providers from taking action against employees who participate in assisted suicide on their premises.
  • 139-M:14.II protects both participants and non-participants equally, but also prevents objecting institutional health care providers from taking action against individuals who ignore prohibitions against assisted suicide on their premises.
  • 139-M14.III protects those providing assisted suicide drugs against negligence complaints, but does not similarly protect those who refuse to provide assisted suicide drugs.
  • 139-M14.IV declares that no health care provider is under a duty to participate in assisted suicide.  However, the provision is ambiguous because it is inconsistent with the lack of protection noted in 139-M4.I and III. 

Alberta’s conscience rights bill

Western Standard
Reproduced with permission

John Carpay

Alberta’s conscience rights bill

Bill 207 enshrines “freedom of conscience and religion” – protected by the Canadian Charter of Rights and Freedoms– for Alberta’s health care providers. For many years, Premier Jason Kenney has consistently and publicly supported protecting freedom of conscience, so nobody should be surprised if he supports this Private Member’s Bill.

Bill 207 will not limit patient access to abortion. Firstly, abortion does not require a referral, as any abortion clinic will tell you when you call and ask. Secondly, even if abortion did require a referral, if one physician refuses to provide such referral then the patient would simply go to another doctor. Inconvenient? Yes, absolutely. In a free country, the right to honour one’s conscience trumps someone else’s interest in not being inconvenienced.

Forcing someone to do something that they believe to be wrong is serious business. It is also a hallmark of totalitarian states. But in free and democratic societies, the government will bend over backwards to avoid coercing citizens to participate in what they see as evil. This is why the Charter describes freedom of conscience and religion as “fundamental,” and mentions it ahead of the freedoms of expression, association and peaceful assembly.

When a democracy is at war, the pacifists who oppose killing another human being will not be required by government to serve on the front lines and shoot at foreign troops. A democracy can continue with its war efforts without requiring every citizen to be willing to kill enemy soldiers.

Just because pork is legal and popular does not mean that all butchers should be forced, by law, to sell it. Some Muslim and Orthodox Jewish butchers will refuse to handle or sell pork, and no doubt this refusal will inconvenience some customers. The disappointed customers will need to go elsewhere, upon learning that the store they travelled to does not carry what they want.

The BC Human Rights Tribunal recently issued a pro-freedom ruling that female estheticians could refuse to wax the male genitalia of Jessica (Jonathan) Yaniv, for religious and other reasons. Yaniv will be inconvenienced by having to locate a waxologist who is willing and able to provide a Brazilian bikini wax for male genitals. But not forcing women to handle male genitalia is more important than sparing someone the inconvenience of going elsewhere.

Put simply: in a free society, you do not have the right to require other people to do things that they do not wish to do. In a free country, nobody has a legal right to be free from the inconvenience of needing to look elsewhere for a product or service. This respect for freedom is consistent with – or is supposed to be consistent with – the philosophy of the United Conservative Party.

Bill 207 protects doctors from being required to assist their patients in committing suicide, as one example of a medical service that some doctors see as wrong. Many non-religious doctors believe on conscientious grounds that suicide is not a valid or legitimate medical treatment.

Providing a referral is active participation. This is why the Colleges of Physicians and Surgeons of Ontario prohibits doctors from performing female genital mutilation (FGM) and also prohibits doctors from referring for this medical service. If it’s wrong to remove portions of a young girl’s genitals, then it’s also wrong to refer her to another doctor who will provide that same service.  As in Ontario, Alberta’s College states that “no physician should perform such procedures, irrespective of cultural norms in other societies, and no physician should be complicit in allowing such procedures to go ahead.” To refer for FGM is to be complicit in FGM. Requiring doctors to refer for a service they believe to be wrong is to violate the conscience of doctors.

And yet the Alberta College of Physicians and Surgeons requires doctors to refer for assisted suicide. Bill 207 addresses this problem by protecting the fundamental Charter freedoms of doctors and other health care providers. A vote for Bill 2017 is a vote for freedom.

Could the threat of lawsuits rein in gender dysphoria doctors?

BioEdge

Michael Cook

Critics of transgender treatment for children have been making heavy weather of persuading people that it could be medically dangerous. However, a well-documented feature in The Australian warns that transgender doctors could face class action suits if they continue to ignore research which claims that children are being harmed. . . [Full text]

Abortion law in New South Wales a global first

Freedom of conscience conditional upon gestational age

Sean Murphy*

The Abortion Law Reform Act 2019 No. 11 has become law in New South Wales, Australia. It is obviously modelled on Queensland’s Termination of Pregnancy Act 2018.

The law permits abortion up to 22 weeks gestation for any reason; no medical indications are required (Section 5).  Abortion after 22 weeks gestation may be performed for any reason that two specialist practitioners find sufficient, including current and future “social circumstances” (6(3)b).

A provision for conscientious objection requires disclosure of objections to abortion by a practitioner when asked by someone (not necessarily a patient) to perform or assist in the performance of an abortion on someone else, to make a decision about whether an abortion should be provided for someone else who is over 22 weeks pregnant (Section 6), or to advise about the performance of an abortion on someone else.

The law requires disclosure of objections to abortion by a practitioner when asked by someone (not necessarily a patient) to perform or assist in the performance of an abortion on someone else [(9(1)a(i) and (ii)], to make a decision about whether an abortion should be provided for someone else who is over 22 weeks pregnant [(9(1)a(iii)], or to advise about the performance of an abortion on someone else [(9(1)a(iv)].

When a woman up to 22 weeks pregnant wants an abortion or advice about an abortion [i.e., under 9(1)a(i) or (ii)], an objecting practitioner is required to disclose his objection [9(2)] explain how she can contact a non-objecting practitioner [9(3)a], or transfer the care of the patient to a practitioner willing to provide an abortion, or to an agency (health service provider) where an abortion can be provided [9(3)b]. 

However, if the woman is over 22 weeks pregnant, a practitioner is obliged to disclose objections to abortion but, if not convinced that the abortion should be performed, is not obliged to facilitate the abortion by explaining how she can contact a non-objecting practitioner or by a transfer of care to a willing colleague. That is because  section 9(3) makes no reference to 9(1)a(iii).

Practitioners who object to abortion in principle and those who object in particular cases are often unwilling to facilitate the procedure by referral, arranging transfers of care or other means because they believe that this makes them parties to or complicit in an immoral act.  Thus, the provision for conscientious objection in the bill actually suppresses the exercise of freedom of conscience by these practitioners with respect to abortions up to 22 weeks gestation.

On this point Queensland’s Termination of Pregnancy Act, while it also suppresses the exercise of freedom of conscience by physicians who object to referral for abortion, at least does so consistently from conception to birth.

It is possible that the wording of this provision has been been muddled in New South Wales either in an attempt to put an end to the idea that only women can become pregnant, or to avoid the possibility that abortion might not be available to a woman who believes that she is a man, or who believes that she is neither a woman nor a man, but who becomes pregnant.

In any case, New South Wales is the first jurisdiction to make the exercise of freedom of conscience in relation to abortion conditional upon the gestational age of an embryo or foetus.  A physician will be free to fully exercise freedom of conscience at 22 weeks plus one day, but not at 22 weeks minus one day.  The inexact calculation of gestational age contributes further to the arbitrariness of this restriction of fundamental human freedom.