Tag: referral

When can a doctor conscientiously object?

America

Bernard G. Prusak*

Over the last decade, the culture wars in the United States have broken new ground: They have become battles over the rights of conscience. For example, now that same-sex marriage is a right, the question before the U.S. Supreme Court in the case of Masterpiece Cakeshop is whether its sympathetic, telegenic owner, Jack Phillips, is within his rights to refuse to make a wedding cake for a gay couple. Similarly, under the Obama administration, the court heard arguments more than once over whether employers who object on religious grounds to contraceptives or abortion should be exempted from having to provide employees health insurance that includes such services.

By contrast, debates over conscientious objection in medicine have not had the same notoriety, though they have broken out repeatedly among health care professionals and medical ethicists since the turn of the century, when there was a flare-up over pharmacists’ refusing to fill prescriptions for emergency contraceptives.

A bill currently before the House of Lords has brought conscientious objection in medicine into widespread public discussion in the United Kingdom, if not yet on the other side of the Atlantic. . . [Full text]

Hawaii legalizes assisted suicide: Refusing to refer for suicide may incur legal liability

Sean Murphy*

Assisted suicide will become legal in Hawaii on 1 January, 2019, as a result of the passage of the Our Care, Our Choice Act. Introduced in the state House of Representatives only in January, it passed both the House and Senate and was approved by Governor David Ige on 5 April. Beginning next year, physicians will be able to write prescriptions for lethal medications for Hawaiian residents who are capable of informed consent, who are at least 18 years old, and who have been diagnosed with a terminal, incurable disease expected to result in death within six months.1

And beginning next year, Hawaiian physicians who refuse to facilitate assisted suicide by referring patients to a willing colleague may face discipline — including expulsion from the medical profession — or other legal liabilities. Hawaii could become one of only two jurisdictions in the world where willingness to refer patients for suicide is a condition for practising medicine.2 . . . [Full text]

The Eighth Amendment and right to conscientious objection

The Irish Times
(Letters to the editor)

Fiona de Londras

Sir, – Thomas Ryan (April 5th) claims that “Once the so-called “right to choose” is placed on legal footing, it is quickly transformed into the right to force people to pay for abortions and force medical professionals to perform them”.  . . .

The right to conscientious objection has been enjoyed by Irish medics, healthcare professionals, and pharmacists for many years. . . but doctors and pharmacists have always had the right to refuse to prescribe or dispense contraception and emergency contraception.

. . . The general scheme of the proposed post-repeal law explicitly protects individuals’ right to conscientiously abstain from direct provision of abortion care.

Mr Ryan appears to object to the continuing obligation to refer a patient to another health care professional . . . Any other approach would privilege the right of a medic in a way that abandons and does harm to the pregnant person. No system could realistically countenance so unbalanced an approach, and it is difficult to understand how one’s conscience could demand it. . . .[Full text]

Mexico enacts provision protecting freedom of conscience for physicians, nurses

Sean Murphy*

Mexico has added a provision to its General Law on Health recognizing freedom of conscience of all physicians and nurses in relation to all services, except in emergencies and life-threatening situations.  In doing so, those responsible took note of existing provisions in The Bioethics Code for Health Personnel and The Code of Conduct for Health Personnel.  The latter includes a particularly striking passage:

32.  It should be emphasized that doctors are  professionals of science and conscience, and cannot be reduced to mere instruments of the patient’s will, since, like the patient, they  are free and responsible persons with a unique collection of values that regulate their lives.

There is no requirement for referral, which many objecting health care workers would find unacceptable because of concern that referral would make them complicit in what they believe to be wrongful conduct.  The new provision is specific to freedom of conscience and does not address issues of access and availability of non-objecting personnel, which will presumably be managed administrative measures or other legal means.

Two-thirds of GPs will refuse to provide abortion pills

Doctors voted in closed forum to rule themselves out of service

Irish Independent

Eilish O’Regan

A majority of GPs say they will not provide abortion pills to women in the first 12 weeks of pregnancy if it becomes law, according to a survey of family doctors.

Nearly seven in 10 of the 497 GPs who voted in a closed doctors’ forum said they would not be involved in medical abortions.

Around 15.7pc said they would provide the service and 16.1pc were “unsure”.

The doctors are among 3,700 GPs who are registered with GPBuddy.ie, the online medical directory designed by GPs for Irish healthcare professionals.

They responded to a series of questions on the confidential forum.

Although the survey has its limitations, it indicates that, if rolled out nationwide, it would mean a substantial number of GPs would opt out of the abortion service.

However, they would be obliged to refer a woman seeking an abortion to a doctor who provides the procedure. . . [Full Text]