Tag: referral

Philippines government demands referral by objecting physicians even if not “right”

In the closing hearings into the controversial Reproductive Health Law, judges of the Philippines Supreme Court questioned a provision in the law that makes it a crime to provide “incorrect information” about contraceptives.  When Senior State Solicitor Florin Hilbay explained that the Philippines Food and Drug Administration will determine what is “correct,” a judge pointed out that this would mean that no dissent from that would be allowed.  Another judge raised the possibility  of the imprisonment of physicians who disagree with the FDA about the safety of a drug.

Hilbay also claimed that objecting physicians have a “professional obligation” to facilitate the provision of the services to which they object by referral, asserting that refusal to refer makes a patient a “victim.” He insisted on this even though he admitted that referral might not be “right.” The court gave lawyers for both sides 60 days to submit memoranda concerning their arguments. [Manila Standard] [Philippine Daily Inquirer] [Inquirer.net]

Australian regulator misrepresents physician obligations

Claim that practitioner codes require referral disproved by Australian Medical Association

Sean Murphy*

According to a report in The Examiner, a representative of the Australian Health Practitioner Regulation Association told a Tasmanian legislative committee that physicians who object to a procedure for reasons of conscience are obliged by professional codes of ethics to refer patients to another physician.  Lisa McIntosh was addressing the Committee concerning a proposed Reproductive Health Bill.

Her assertion is contradicted by a submission by the Australian Medical Association Tasmania, which protested the section of the bill that would force objecting physicians to facilitate morally contested procedures by referral.  The AMA Tasmania submission included quotes from the AMA Code of Ethics and a document from the Medical Board of Australia Good Medical Practice to demonstrate that the draft legislation information paper falsely claimed that there was a duty to refer.

The Committee also heard from Catholic Archbishop Adrian Doyle, whose concerns about the proposed bill included the mandatory referral provision.

 

New Zealand abortion activists complain about physician freedom of conscience

Dr. Joseph Lee, a physician in Blenheim, New Zealand, has been criticized by abortion activists because he refused to prescribe contraceptives for a 23 year old patient.  Dr. Lee practises at the Wairau Community Clinic.  A pamphlet in the reception area advises patients that some of the clinic’s physicians will not prescribe contraceptives, and staff attempt to direct patients accordingly.  The clinic leader may consider installing a sign to minimize further conflicts.

Dr. Lee identifies himself as a Catholic, but is reported to have said that he would be willing to prescribe the birth control pill to a woman who was spacing children or had had at least four children.  That is not consistent with the teaching of the Catholic Church on the subject, and it is an unusual position among health care workers who object to providing contraception.

The Abortion Law Reform Association NZ (ALRANZ) wants the General Medical Council to force objecting physicians to refer patients or otherwise assist them to obtain morally contested services.  The president of ALRANZ, Dr. Morgan Healey, claims that a High Court decision in 2010 has made the question of referral legally ambiguous. [New Zealand Herald]

However, Justice Alan MacKenzie of the High Court in Wellington, New Zealand,unambiguously ruled that New Zealand’s Contraception, Sterilisation and Abortion Act protected objecting physicians, and that the General Medical Council could not force them to refer abortion.  All that is required of a physician who objects to abortion is to decline to begin the process and inform his patient that she may obtain the procedure from another practitioner.  The protection of conscience provision states that objecting health care workers are not obliged “To fit or assist in the fitting, or supply or administer or assist in the supply or administering, of any contraceptive, or to offer or give any advice relating to contraception.”  The ruling was the result of litigation by the New Zealand Health Professionals Alliance, which, earlier this year established a website to support freedom of conscience for health care workers.

 

Personal Opinions and Ideology, Not “Science”

From Conscience and its Enemies: Confronting the Dogmas of Liberal Secularism

Robert P. George*

On September 11, 2008, the President’s Council on Bioethics heard testimony by Anne Lyerly, MD, chair of ACOG ‘s Committee on Ethics. Dr. Lyerly appeared in connection with the council’s review of her committee ‘s opinion (No. 385) entitled “Limits of Conscientious Refusal in Reproductive Medicine.” That opinion proposes that physicians in the field of women’s health be required as a matter of ethical duty to refer patients for abortions and sometimes even to perform abortions themselves .

I found the ACOG Ethics Committee ‘s opinion shocking and,  indeed, frightening. One problem was its lack of regard – bordering on contempt , really – for the sincere claims of conscience of Catholic, Evangelical Protestant , Orthodox Jewish , and other pro-life physicians and health-care workers. . .[Full text]

New Irish abortion law demands referral by objectors

Protection of Life During Pregnancy Act 2013

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. In the former case, two medical practitioners must certify the risk.  In the case of threats to commit suicide, three medical practitioners, including two psychiatrists, must certify the risk.  In all cases, they must also certify that the risk can only be averted by abortion.  In emergencies, when there is an immediate risk of the mother’s death and the abortion is necessary to save her life, a medical practitioner may provide an abortion without prior certification.

Protection  of Conscience Provision

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.

One third of Irish psychiatrists signed a letter to the government asserting that abortion is not a treatment for suicidal ideation, so it is not clear how the part of the Act dealing with threats of suicide will function in practice.

The Act demands that medical practitioners who do not want to participate in the procedure must arrange “for the transfer of care of the pregnant woman concerned as may be necessary to enable the woman to avail of the medical procedure concerned.”  Many conscientious objectors are unwilling to refer patients for morally contested procedures because they believe that by doing so they become morally complicit in wrongdoing.

However, 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.

While the proposed bill is the product of the controversy generated by the death of Savita Halippanavar in Galway in October of last year, it does not appear to propose anything that would have made a difference to the outcome of that case.  Her death was caused by a particularly virulent infection that is not normally found in maternity settings.  An emergency induction of the kind contemplated the proposed Act was legal at that time and had been decided upon when she spontaneously delivered a stillborn daughter.  (See A “medical misadventure” in Ireland: Deaths of Savita and Prasa Halappanavar)