Doctors with moral objections to assisted dying should be able to opt out, committee hears

Assisted dying law could be coupled with improved palliative care, committee hears

CBC News

Peter Zimonjic

Doctors who morally object to physician-assisted dying should not be obligated to refer patients to a doctor who will provide the service, a joint Commons-Senate committee studying the issue heard Wednesday.

Dr. Cindy Forbes, president of the Canadian Medical Association told the panel that doctors shouldn’t have to refer a patient, but they must “advise the patient on all of their options … including physician assisted dying, and make sure the patient has the information they need to access that service” . . . [Full text]

College of Physicians and Surgeons of Ontario decided results of consultation before it started

College decided that physicians must refer for euthanasia/assisted suicide at least a month before consultation began

News Release

Protection of Conscience Project

The College of Physicians and Surgeons of Ontario (CPSO) decided by the first week of November, 2015, that it will force Ontario physicians who refuse to kill patients or help them commit suicide to find someone willing to do so.  The decision was made a month before the College began a public consultation purporting to solicit input on that and other questions related to euthanasia and assisted suicide.

The decision was revealed in the Report of the Federal External Panel consultations on euthanasia and assisted suicide, released today.

When College representatives appeared before the Panel in Toronto between 2 and 6 November, they told the Panel  “that physicians who object to physician-assisted dying requests have a positive obligation to make an effective referral.”

An effective referral, as described by the Ontario College, is a referral made in good faith to a non-objecting available and accessible physician, other health care professional, or agency. The College noted that the medical community has an obligation to ensure access and that conscientious objection should not create barriers.” (p. 100)

“The Protection of Conscience Project submission was made on 10 January, said Sean Murphy, Project Administrator.

“Two days later, the Canadian Medical Association made an excellent submission rejecting the proposal of  ‘effective referral’,” he added.

“Many people responded in good faith to the College’s invitation to participate in the consultation,” said Murphy.  “But it seems that public consultations about College policy are an expensive and time-consuming charade.”

Last year, College officials wrote the final version of the CPSO policy demanding “effective referral” for morally contested procedures a month before the consultation closed. About 90% of 9,000 submissions on the subject were received after the final version had been written.

Canadian Medical Association Submission to the College of Physicians and Surgeons of Ontario

Consultation on CPSO Interim Guidance on Physician-Assisted Death

Project Introduction

The following submission sets out the position of the Canadian Medical Association (CMA) on referral, within the context of the provision of euthanasia and assisted suicide.  The submission concerns a proposed policy by the state regulator of medicine in the province of Ontario, the College of Physicians and Surgeons (CPSO).  The College proposed that its policy of “effective referral” for morally contested services be applied to euthanasia and assisted suicide.

Among the excellent points made by the Association:

It is in fact in a patient’s best interests and in the public interest for physicians to act as moral agents, and not as technicians or service providers devoid of moral judgement. . . . medical regulators ought to be articulating obligations that encourage moral agency, instead of imposing a duty that is essentially punitive to those for whom it is intended and renders an impoverished understanding of conscience.

Full text of the CMA submission

 

Submission to the College of Physicians and Surgeons of Ontario

 

Re: Interim Guidance on Physician Assisted Death

 Abstract

Virtually all of what is proposed in Interim Guidance on Physician-Assisted Death (IGPAD) is satisfactory, requiring only clarifications to avoid misunderstanding and appropriate warnings concerning the continuing effects of criminal law.

The College has no basis to proceed against physicians who refuse to do anything that would entail complicity in homicide or suicide, including “effective referral,” because they believe that a patient does not fit the criteria specified by Carter. College policies and expectations are of no force and effect to the extent that they are inconsistent with criminal prohibitions.

Proposals about respect for patients, access to services, and providing information are acceptable, subject to some clarifications and limitations with respect to offering the option of suicide. Simple and uncontroversial recommendations are offered to avoid problems associated with failed assisted suicide and euthanasia attempts, and in urgent situations.

However, the requirement for “effective referral “is completely unacceptable. It is ludicrous to assert that the reasoning that underpins the law on criminal complicity and culpability, civil liability and the College policy that prohibits referral for Female Genital Cutting can be dismissed as legally irrelevant to the exercise and protection of fundamental freedoms of conscience and religion.

The College cannot justify a demand for “effective referral” on the grounds that it cannot be understood to involve morally significant complicity in killing patients or helping them to commit suicide, nor can it be justified as a reasonable limitation on fundamental freedom.
The only apparent basis for the College’s demand for effective referral is that it has decided what the Supreme Court of Canada did not decide: that euthanasia and assisted suicide in circumstances defined by Carter are morally/ethically acceptable. College officials seem to consider the College justified in using force – the force of law – to compel dissenting physicians to conform to their moral/ethical views.

This is not a reasonable limitation of freedom but a reprehensible attack on them. It is a paradigmatic example of the authoritarian suppression of freedom of conscience and religion and a serious violation of human dignity. Examples of alternative acceptable policies demonstrate that access to assisted suicide and euthanasia can be ensured without suppressing freedom of conscience and religion.


Contents

I.    Outline of the submission

II.    Avoiding foreseeable conflicts

II.1    Failed assisted suicide and euthanasia II.2    Urgent situations
II.3    Project recommendations

III.    IGPAD and criminal law

IV.    IGPAD on respect, access, notification and providing information

IV.1    Treat patients respectfully; do not impede access
IV.2    Notification of objections
IV.3    Providing information

V.    Freedom of conscience

V.1    IGPAD and “effective referral”
V.2    “Effective referral” and criminal law
V.3    Legal vs. ethical/moral evaluation of euthanasia, assisted suicide
V.4    The College position: “error has no rights”

VI.    Project response

VI.1    Previous submissions
VI.2    Making freedom easy – or impossible
VII.    Alternative acceptable policies

VIII.    Conclusion

Appendix “A”    Supreme Court of Canada, Carter v. Canada (Attorney General), 2015 SCC 5

A1.    Carter criteria for euthanasia and physician assisted suicide
A2.    Carter and the criminal law
A3.    Carter and freedom of conscience and religion

Appendix “B”    Carter in theTrial Court, Part VII: A Judicial Soliloquy on Ethics

B1.    A note of caution
B2.    The questions addressed in Part VII
B3.    Plaintiffs’ claim shapes and limits the analysis
B4.    Ethics: which one?
B5.    Medical ethics
B5.1    Ethics and the willingness of physicians
B5.2    Ethics and the positions of medical associations
B5.3    Ethics and the opinions of ethicists
B5.4    Ethics and current end-of-life practices
B6.    Ethics of society
B6.2    Ethics and public opinion
B6.3    Ethics and public committees
B6.4    Ethics and prosecution policies
B7.    Summary of the ethical debate
B8.    Conclusions about the ethical debate
B8.2    Would Canadian physicians provide the services?
B8.3    Current medical practice with respect to end-of-life care?
B8.4   Does the law attempt to uphold a conception of morality?
B9.    Carter Part VII: in brief
B9.1    Unanswered questions
B9.2    Meaningless findings
B9.3    Inconclusiveness
B9.4    Neglected evidence
B9.5    Deficient review of end-of-life decision-making
B10.    On appeal to the Supreme Court of Canada

Appendix “C”    Physician Exercise of Freedom of Conscience and Religion

C1.    Introduction
C2.    Providing information to patients
C3.    Exercising freedom of conscience or religion
C4.    Reminder: treatments in emergencies

Sweden has it all – except freedom of conscience

A court has ruled that abortion rights leave no room for a midwife to be exempted.

Mercatornet

Carolyn Moynihan*

Because of its welfare state and gender equity policies Sweden has become a beacon of progressiveness in everything that affects women. But there is one kind of woman the Scandinavian state seems to have no time for: a health professional who objects to abortion.

Two years ago Ellinor Grimmark completed a midwifery internship at Hoglandssjukhuset women’s clinic in southern Sweden, but because she told the management that she had a conscientious objection to performing abortions, she was denied further employment there.

A voicemail message from the head of the maternity ward informed her that she was “no longer welcome to work with them”, and she was challenged about “whether a person with such views actually can become a midwife.” Her student funding was also cancelled.

Mrs Grimmark was subsequently turned down for employment at another clinic, where she was told that a “person who refuses to perform abortions does not belong at a women’s clinic”.

Finally she was offered a job at the Varnamo Hospital women’s clinic. But by then she had filed a civil rights complaint against the Hoglandssjukhuset clinic with the local Equality Ombudsman, and when the media got wind of it Varnamo withdrew its offer.

These days Mrs Grimmark practices her profession in Norway, where her conscience rights are respected, but her case is by no means closed.

The Ombudsman’s ruling held that she was not being discriminated against for her pro-life views but for not being available to fulfil the job description, thus threatening the “availability of abortion care” and the “protection of health” of patients requiring an abortion in Sweden.

Represented by the organisation Scandinavian Human Rights Lawyers, she then took her case against the county where the Hoglandssjukhuset clinic is located to the Jonkoping District Court, at the same time seeking compensation for damages and discrimination – a total of 140,000 Swedish kronas (around $20,000 USD).

Last week that court acknowledged that Mrs Grimmark’s rights had been infringed, but it still ruled against her, saying that maternity centres have the right to define job descriptions and a “duty to ensure that women have effective access to abortion.” The court also ruled that she is liable to pay for the other party’s legal costs, which will amount to more than USD $109,000.

The US-based Alliance Defending Freedom, which filed an amicus brief on behalf of Mrs Grimmark, regards this order as calculated to scare others who might follow her example. Her wages as a midwife are unlikely to measure up to such punishing costs. Her husband has launched an appeal for funds on Facebook.

Strong grounds for appeal

There are, however, solid grounds for an appeal, as her senior counsel, Ruth Nordstrom, has indicated. She said it was disappointing that the lower court had “decided not to examine the right of freedom of conscience according to international law and the European Convention on human rights, at all.”

The fact is that freedom of conscience is a fundamental human right protected by the 1950 European Convention on Human Rights and Fundamental Freedoms (ECHR), signed by Sweden in 1993. Article 9 (2) states:

“Freedom to manifest one’s religion or beliefs shall be subject only to such limitations as are prescribed by law and, in a democratic society, are necessary with regard to the general public safety or the protection of public order, health or morals or for the protection of other rights and freedoms.”

Is Sweden’s democracy and public health so fragile that it cannot stand the odd health worker being exempted from the grisly business of killing unborn babies?

It’s true that the country seems to have a pressing need for abortion – one in every two women who get pregnant during their lifetime has a termination. This gives Sweden the highest rate in Scandinavia and one of the highest rates in the world – especially among teenagers, who are schooled in birth control rather than abstinence.

Perhaps it is Sweden’s famously liberal sexual culture that makes it so defensive of abortion rights. Writing in National Review in May, Jacob Rudolfsson of the Swedish Evangelical Alliance noted:

* The Swedish Association of Health Professionals has offered no support for Ellinor Grimmark, since it is committed to abortion.

* “Only one hospital has offered her ‘assistance’, and it was for a counsellor to help her ‘overcome her aversion to abortion’ …”

* One local health administrator has declared that he “would gladly stand in the front with a baseball bat to prevent” conscientious objectors working in his hospital.

* Mona Sahlin, the national coordinator against violent extremism, has declared that “one who refuses to participate in abortions is an extreme religious practitioner,” one who is simply “on a different level from the Islamic State”.

Did you get that? A pro-life Swede is just a few notches down from jihadi terrorists, on the same scale.

And yet, says Rudolfsson, when the current Abortion Act was drafted in 1974, assurances were given that medical workers would, for ethical or religious reasons, be able to opt out of participating in abortions. “Forty years later, the consensus has changed.”

‘Consensus’ may carry the day, but whose consensus?

But this freedom-stifling “consensus” actually puts Sweden out of step with a 2010 resolution of the Parliamentary Assembly of the Council of Europe that states:

“No person, hospital or institution shall be coerced, held liable or discriminated against in any manner because of a refusal to perform, accommodate, assist or submit to an abortion, the performance of a human miscarriage, or euthanasia or any act which would cause the death of a human fetus or embryo, for any reason.”

Clear enough, surely, but Sweden has wriggled around resolution 1763 by arguing that it is “soft law” and that it interferes with its own laws guaranteeing abortion within certain limits. At the same time it argues that a midwife’s participation in abortion is required by the (older) ECHR provision that “the interests and rights of individuals seeking legal medical services are respected, protected and fulfilled.”

Legal battles have also been waged in Scotland, Poland, Croatia and Norway, but according to ADF, even last week’s Swedish court acknowledged that the majority of European states allow for rights of conscience for doctors and nurses.

And according to Swedish legal scholar Reinhold Fahlbeck, the stronger the European consensus, the less wriggle room there is for Sweden — or other holdout states.

That consensus just got stronger with a ruling from Poland’s highest court, the Constitutional Tribunal, last month recognising the rights of all medical staff to not perform abortions, based on their conscience. It further ruled that neither would they be required to refer women seeking abortions to physicians who would perform them.

ADF notes that the Polish ruling “significantly raises the stakes in Ellinor’s case, as a victory could define conscience rights for all European medical workers.”

It would also allow some fresh air to blow through the stifling conformity of Sweden’s sexual culture which depends so heavily – and thoughtlessly, it seems – on extinguishing human life. Even for women’s equality, this is too high a price.


Sweden has it all - except freedom of conscienceThis article is published by Carolyn Moynihan and MercatorNet.com under a Creative Commons licence. You may republish it or translate it free of charge with attribution for non-commercial purposes following these guidelines. If you teach at a university we ask that your department make a donation. Commercial media must contact Mercatornet for permission and fees. Some articles on this site are published under different terms.