Service, not Servitude
To amend the Patient Protection and Affordable Care Act to protect rights of conscience with regard to requirements for coverage of specific items and services, to amend the Public Health Service Act to prohibit certain abortion-related discrimination in governmental activities, and for other purposes. [Full Text]
The Physicians’ Alliance for the Total Refusal of Euthanasia, a Quebec organization, is comprised mainly of physicians whose focus of practice is on dying patients. The group is adamantly opposed to euthanasia. Over 500 physicians have identified themselves as supporting its Total Refusal of Euthanasia Declaration. The Alliance has issued a news release denouncing the Quebec government’s new euthanasia bill.
Dr. Catherine Ferrier of the Montreal General Hospital is concerned that virtually all of her patients in the geriatric clinic would be eligible for euthanasia, and that the spectre of euthanasia would haunt “every interaction” with her patients were it to be legalized. While she is doubtful about whether or not the euthanasia bill can be stopped, she said ” I am certainly never going to kill a patient.” [CJAD]
Dr. Gerald van Gurp, whose opposition to euthanasia is informed by developments in his homeland, the Netherlands, is a palliative care and emergency physician at Montreal’s Hotel Dieu Hospital. He argues that most Quebeckers do not have access to quality palliative care, and that the solution to that problem is to provide access to high-quality palliative care, not euthanasia. [Montreal Gazette]
Dr. van Gurp said that he would not continue to provide home palliative care for terminally ill patients if the euthanasia bill passes. “I’m not going there,” he said.
Speaking for the Alliance, Dr. Marc Beauchamp described the bill as “an enormous revolution in ethics and law.” [CBC News]
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)
RTE News European Blog
It may come as a surprise, but a relatively liberal abortion regime has existed in Italy since 1978. . . . The law provides for abortion up to 12 weeks into the pregnancy, and up to 23 weeks if there are foetal abnormalities. . . But Law 194 is back in the news in Italy, and the reason may resonate with the debate in Ireland.
The law permits medical personnel to refuse to carry out abortions on conscientious grounds.
The numbers who are now doing so have risen so dramatically that groups in favour of the availability of abortion say the phenomenon is forcing Italian women to seek terminations abroad, or even to submit to illegal abortions in Italy. . . .[read on]
