Protection of Conscience Project News

Navigating Vaccine Ethics

Reproduced with permission

Jonathon Imbody

CMDA Senior Vice President for Bioethics and Public Policy Dr. Jeff Barrows and I recently wrote a piece for The Public Discourse, “Is Receiving the Pfizer-BioNTech COVID-19 Vaccine Ethical?” that suggested principles to consider as we navigate ethical issues related to COVID-19 vaccines. I’ve included brief highlights below; more from the original article and also new observations will be published in an upcoming edition of CMDA Today (previously known as Today’s Christian Doctor).

CMDA has approved an ethics statement that can help guide individuals’ analyses of immunizations and the potential for moral complicity with evil:

“Using technology developed from tissue of an intentionally aborted fetus, but without continuing the cell line from that fetus, may be morally acceptable.
“Continued use of a cell line developed from an intentionally aborted fetus poses moral questions and must be decided as a matter of conscience, weighing the clear moral obligation to protect the health of our families and society against the risk of complicity with evil.
“Using a vaccine that requires the continued destruction of human life is morally unacceptable.”

Deciding which COVID-19 vaccine poses the least ethical concerns hinges in part on the implication of abortion in (a) the initial design of the vaccine, (b) the confirmatory testing of the vaccine and (c) the ongoing production of the vaccine. Vaccines that continue to use the abortion-derived cell line in ongoing production pose the most obvious ethical barrier to use by pro-life individuals. This category includes vaccines by AstraZeneca–University of Oxford and by Janssen–Johnson & Johnson. In fact, these vaccines employ abortion-related cell lines in all three stages—design, confirmation and production.

While still ethically concerning, the fact that this remote and limited interaction with abortion does not involve the continuing use of an aborted fetal cell line makes it less ethically problematic compared to its competitors that use these cell lines for ongoing vaccine production.

Unlike the aforementioned COVID-19 vaccine candidates that rely on abortion-derived cells for their ongoing production, the Pfizer-BioNTech vaccine used the HEK-293 cell line from a 1972 abortion only to confirm that messenger RNA was properly coding for the spike protein of the SARS-CoV-2 virus. While still ethically disconcerting, the fact that this remote and limited interaction with abortion does not involve the continuing use of an aborted fetal cell line makes it less ethically problematic compared to its competitors than use these cell lines for ongoing vaccine production.

A consideration of the harm to others that can come without vaccination goes to the heart of Christian ethics in a way that virtually every believer understands: Vaccinating yourself and those who depend on you is an important component of following the command to love thy neighbor.

We recognize that each individual must weigh ethical considerations before making a vaccine decision. When we examine the Pfizer-BioNTech vaccine in light of ethical principles of (a) loving our neighbor by protecting them through our own vaccination, (b) the distance in time from an abortion connection and (c) the fact that the vaccine does not continue to use cell lines derived from an abortion, we find these factors considerable in mitigating the ethical concerns and opening the door to receiving the vaccine in good conscience.

Is Reducing Down Syndrome Births a Form of Eugenics?

We are still choosing who lives and who dies based on genes.

Psychology Today

Richard Gunderman

A recently released study finds that Europe has reduced the number of babies born with Down syndrome by 54%. In 2016, the same researchers found that the U.S. rate of Down syndrome births had declined by 33%. Some friends and colleagues have asked me whether such reductions, which entail prenatal diagnosis and elective pregnancy termination, mean that we are still practicing some form of eugenics.

Down syndrome is a genetic disorder usually associated with an extra copy of chromosome 21 – hence its other name, trisomy 21. Children with Down syndrome generally exhibit growth delays, reduced intelligence, and a shortened life span of around 60 years. The risk of having a baby with Down syndrome increases with parental age. When prenatal testing reveals the diagnosis, some parents, including apparently many in Europe and the US, elect to terminate the pregnancy. . . [Full text]

On Sex and Gender, The New England Journal of Medicine Has Abandoned Its Scientific Mission

Quillette

Colin Wright*

Two years ago, “Titania McGrath,” whose satirical Twitter account regularly skewers the ideological excesses of social-justice culture, suggested that “we should remove biological sex from birth certificates altogether to prevent any more mistakes.” The joke (obvious to those who follow the culture wars closely, but perhaps obscure to those who don’t) was directed at gender activists who insist that male and female designations “assigned at birth” are misleading (and even dangerous), since they may misrepresent a person’s true “gender identity”—that internally felt soul-like quality that supposedly transcends such superficial physical indicia as gonads and genitalia.

But the line between satire and sincerity has become blurry on this issue. Last Thursday, the New England Journal of Medicine (NEJM), widely considered to be the world’s most prestigious medical journal, published an article entitled Failed Assignments—Rethinking Sex Designations on Birth Certificates, arguing that (in the words of the abstract) “sex designations on birth certificates offer no clinical utility, and they can be harmful for intersex and transgender people.” The resemblance to Titania McGrath’s 2018-era Twitter feed is uncanny. Two of the authors are doctors. The third, Jessica A. Clarke, is a law school professor who seeks to remake our legal system so as to “recognize nonbinary gender identities or eliminate unnecessary legal sex classifications.” . . . Full Text

As criteria for medical assistance in dying shifts, calls for more alternatives, support for people who are suffering

Vancouver Sun

Kristen Holliday

The last time Ray Chwartkowski saw his sister, Cheryl Lowen, was two days before she died in December, 2019.

On that day, he was shocked to learn that her death was scheduled, as she had been approved for medical assistance in dying, often referred to as MAID.

“She never had a diagnosis for any terminal illness,” he said. “I consider her death a total tragedy.”

Chwartkowski, a digital content creator who lives in Vancouver, hasn’t seen Lowen’s official MAID application or assessment paperwork, but he believes his sister should not have been eligible for medical assistance to end her life.

He said Lowen, who was 50 when she died, had a difficult childhood and struggled with physical and mental health problems throughout her life. In mid-2019, she was diagnosed with median arcuate ligament syndrome, a chronic illness that causes severe abdominal pain.

Chwartkowski said he has compassion for her pain but is certain she didn’t meet MAID’s criteria of a reasonably foreseeable death. He also questions her ability to make a well-informed decision after receiving the difficult diagnosis.

“From what I understood, she was refusing to eat, she was refusing immediate medical attention,” said Chwartkowski, adding that she also refused surgery to treat her condition. . . .

. . . Chwartkowski said, to his knowledge, Lowen applied for MAID twice and was denied the first time. . . . continue reading

Lack of support vs. option to die

The London Free Press

Reproduced with permission

Leonie Herx, Ramona Coelho, Sohail Gandhi

As the COVID-19 pandemic dominates the political agenda and strains the country’s health-care systems, the federal Liberals are intent on passing Bill C-7, which proposes to expand medical assistance in dying (MAiD) to those who are not dying.

Proponents say the bill allows choice and dignity for those with chronic illness and disability. However, the bill fails to provide them with the dignity and humanity that comes with good care and access to supports.

We are doctors who witness the struggles that confront our patients and their loved ones every day. Those living on the margins and with disabilities face significant barriers to care though systemic discrimination (ableism) that can make it harder to live a healthy, fulfilling life in community.

As doctors we should be instilling hope, supporting resilience and using our expertise to find creative solutions to address health and well-being. Instead, we would be required to suggest assisted suicide as an option if this bill becomes law.

Spring Hawes, a woman who has had a spinal cord injury for 15 years, said: “As disabled people, we are conditioned to view ourselves as burdensome. We are taught to apologize for our existence, and to be grateful for the tolerance of those around us. We are often shown that our lives are worth less than non-disabled lives. Our lives and our survival depend on our agreeableness.”

A choice to die isn’t a free choice when life depends on good behaviours and compliance to societal norms. Sadly, the medical community can be complicit in this messaging.

Gabrielle Peters, a brilliant writer who has struggled with poverty since her disability, has shared that a health-care professional sat at her bedside and urged her to consider death. This was just after Peters’ partner announced he was leaving her because she was too much of a burden and she no longer fit into the life he wanted.

Doctors can pressure someone to die as in Peters’ situation but also more subtly can confirm a patient’s fears that her life is not worth living and MAiD would indeed be a good medical choice.

Day after day, we participate in a health-care system and a social support system that does not come close to meeting the basic needs of our most vulnerable patients. However, our role as physicians should always be to first advocate that our patients access all reasonable supports for meaningful life with no suffering.

But alas, Canada does not seem to prioritize health care and supports for all, and soon, that lack of support will be pitted against an option to access death in 90 days.

Patients entrust doctors to make ethical decisions every day regarding their care and to make recommendations that are always aimed at promoting health and healing. The core role of medicine is to be restorative, not destructive. Advocating for our patients’ health and well-being is solemn oath we took.

As physicians we help our patients do many things in the context of a trusting, shared decision-making process. Doctors encourage healthy habits. We refuse to prescribe antibiotics when patients have a viral infection, or opioids on demand. We pull a driver’s licence when we have concerns for patient safety and the public good. We refuse to write mask exemptions without good reason. We serve both patient and the common good.

All of this requires courage to not betray the trust society and the patient have bestowed on our profession. Society’s belief in the inherent virtue and ethics of the profession has been the necessary basis of the physician-patient trust. Would you trust your doctor if you thought they didn’t care about your safety and well-being?

While we recognize patients have the right to ask for MAiD, physicians must not be forced to suggest or forced to facilitate this, especially when reasonable options for living with dignity exist. We must continue to offer our patients what is good and practise medicine with integrity.

As Thomas Fung, physician lead for Siksika Nation, a southern Alberta First Nation, said: “Assisted death should be an option of last resort, and not the path of least resistance for the vulnerable and disadvantaged. Conscience protection is needed in this bill, as no one should be forced to participate in the intentional death of another person against their goodwill.”

One of the most important foundations of our Canadian identity is that we are a caring, compassionate country. We are proud of our universal health-care mandate, and we place a high premium on being inclusive and tolerant while working hard toward the accommodation and integration of marginalized and vulnerable members of our community. And yet, if Bill C-7 is allowed to stand without amendments, we will be in serious danger of losing this fundamental element of our Canadian identity.

Ramona Coelho is a family physician in London. Sohail Gandhi is immediate past-president of the Ontario Medical Association. Leonie Herx is division chair and associate professor of palliative medicine at Queen’s University and past-president of the Canadian Society of Palliative Care Physicians. An earlier version of this article appeared in the London Free Press.