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]

The Alarming Trend Of Bullying Hospitals And Hospices Into Assisted Suicide

Huffington Post

Reproduced with permission

Dr. Will Johnston

Canadians who are sick and suicidal can now be put to death under various medicalized and government-approved protocols, following court and legislative victories by euthanasia activists. These activists are now turning their considerable talents to a coercive makeover of the palliative hospice movement by demanding that hospices founded on a promise to never deliberately hasten death should provide a death

Before they got their way in the Canadian Supreme Court, the public posture of euthanasia advocates was one of caution, reassurance and limitation of objectives. After their victory, partisans of the medical killing movement have become impatient with individuals or institutions who want no part in suicide and euthanasia. Activists recommend expanding access to include all the people who were strategically excluded from the plan that had been sold to the public: children, people with chronic nonfatal conditions, the physically disabled, the cognitively disabled, psychiatric patients.

Now, even changing the location of a patient requesting suicide — from a euthanasia-free hospital or hospice, to one that does offer it — is being protested as a cruel imposition. In doing so, the death-seeking person is set up as a victim, and the hospital or hospice is portrayed as a victimizer. Never mind that hospital wards routinely transport people in complete comfort to procedures like X-rays or scopes, or to another location to continue care.

The implications of this are dire. Many hospices serve patients who want nothing to do with assisted suicide, and there will be much harm done by forcing it into their midst. Every community in this country has the resources to provide a distinct euthanasia-free space. That distinct space and its staff could be specialized and uncoerced into death-hastening.

The unpleasant alternative was demonstrated by the recent “sneak attack” on Louis Brier Hospital, a Jewish retirement home in Vancouver. This was the work of euthanasia activist Ellen Wiebe, idolized by like-minded columnists for her aggressive death-providing practice. Rather than arrange a simple transfer — perhaps to the home of one of the suicidal father’s daughters — the patient was killed by Dr. Wiebe against the firm policy of a facility with an understandable aversion to euthanasia.

As Louis Brier’s director protested, “We have a lot of Holocaust survivors. To have a doctor sneak in and kill someone without telling anyone. They’re going to feel like they’re at risk when you learn someone was sneaking in and killing someone.”

What Dr. Wiebe was doing by giving the finger to Louis Brier is a form of ethical bullying, masquerading as an altruistic claim that her client should come first and trump other people’s rights about the kind of place they want to live in.

Wanting Dr. Wiebe to kill you is a tragedy, not an emergency. It is a personal preference, sadly now provided by the Canadian health-care system, but without any judicial or parliamentary authorization to force others to accept involuntary proximity to your actions. It is also, increasingly, about people who are not dying, except in Dr. Wiebe’s elastic interpretation, but about those who have lost meaning and hope. What they get from the euthanasia provider amounts to a heartless endorsement of the hopelessness of their situation, cloaked in the language of autonomy.

Rather than look for a win-win compromise over this issue, the board of Fraser Health Authority, a large B.C. hospital system, has imposed euthanasia provision in all its palliative hospices. This edict, totally uncalled for by provincial or federal guidelines, caused the high-profile resignation of Palliative Care Medical Director Dr. Neil Hilliard.

Meanwhile, our governments are, in Dr. Hilliard’s words, “guilty by neglect” of a “palliative care access gap,” and your sick family member who seeks care, not death, may not find it “equitable or timely.”

Forcing hospices to betray their no-kill founding principles will not close that gap, it will just torpedo the 40-year struggle to convince often-fearful patients that palliative hospices are not about hastening death.

Fraser Health and any other misled health bureaucracies across Canada should back down. Don’t bully hospices as though there are no fair alternatives. Don’t bully Catholic hospitals, founded on a reverence for life long before the public purse got involved.

Suicidal women struggle to get second opinion when seeking an abortion

Expert teams are not always available when assessment needed

Irish Independent

Eilish O’Regan

Concerns have emerged at senior HSE levels about the failure to always secure a psychiatrist to give a second opinion in cases where a pregnant woman is seeking an abortion on the grounds she is suicidal.

An internal document said in some cases it has meant the two psychiatrists and obstetrician, who are required under law to make an assessment in such cases, cannot be found.

Abortion is allowed in cases of suicide risk under the Protection of Life During Pregnancy Act of 2013, which came into effect in 2014.

The abortion can only be allowed if the doctors agree she is suicidal. If she is turned down, the woman then can apply for a review before another panel.

However, in an internal report authorised by Dr Philip Crowley, HSE national director for quality improvement, the lack of availability of a “second opinion” psychiatrist at the initial assessment means that in some cases the woman’s application is going straight to review. . . [Full text]

First compensation claim for compulsory sterilisation in Japan

BioEdge

Michael Cook

A Japanese woman in her 60s is planning to sue the government over her forced sterilization under a 1948 law. This will be the first time that state compensation has been sought for sterilisation. The mentally disabled woman in Miyagi Prefecture was a teenager when she was forced to undergo the procedure.

Records of 2,700 people who were sterilized under the Eugenic Protection Law — which was in force until 1996 — have been found in local government archives, a development which could help victims seek state compensation.

Like some Western countries, Japan has a dark eugenic past.

A 1948 Eugenic Protection Law (EPL) was intended to prevent the births of “inferior descendants” and to foster the health of mothers and pregnant women. It provided for both voluntary and involuntary sterilisation. Doctors could apply for permission for sterilisation to a regional board if a patient suffered from a range of conditions which were believe to be hereditary, including schizophrenia, manic-depressive psychosis, epilepsy, abnormal sexual desire, “remarkable criminal inclination,” Huntington’s disease, muscular dystrophy, albinism, achromatopsia, deafness, haemophilia, and so on.

The Ministry of Health issued guidelines in 1953 clarifying what doctors could do: “It is permissible to restrain the patient’s body, to administer an anesthetic, or to deceive the patient, etc.”

According to government statistics, between 1949 to 1994, 16,520 involuntary sterilizations were performed, 11,356 on women, and 5,164 on men. Most were performed on inmates of psychiatric hospitals and institutions for intellectually disabled people.

Compulsory sterilisation lapsed in 1996 with the passage of the Mother’s Body Protection Law. However, the Japanese government has refused to apologize to the victims of the law or offer them compensation.


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Psychiatrists given clear guidelines on abortion law: HSE

Irish Independent

Eilish O’Regan

The HSE says it has issued “clear guidance” to the heads of mental health services “detailing and clarifying the roles and responsibilities of psychiatrists in cases where a pregnant woman is seeking an abortion on grounds of suicide risk.

The Protection of Life During Pregnancy Act allows for abortion where a woman is assessed as suicidal on the opinion of two psychiatrists and an obstetrician.

But an internal HSE document, overseen by Philip Crowley, the HSE national director for quality improvement, warned of the failure to always secure a psychiatrist locally to give the necessary second opinion.

In some cases this stage is having to be bypassed and the woman must go before a review panel to assess her case. . . [Full Text]