Some corrections and clarifications

Project letter to the Calgary Herald

Sean Murphy*

While I am pleased to see that Laura Wershler is willing to accommodate freedom of conscience among health care workers, I must correct some misleading statements included in her article (“The morning after: Pro-life agenda misrepresents the emergency contraceptive pill, or ECP”,Calgary Herald, 13 February, 2004).

In the first place, http://www.consciencelaws.org is the URL of the Protection of Conscience Project, not “Repression of Conscience”. Contrary to Ms. Wershler’s assertion, this is a non-denominational human rights project, not a not a pro-life initiative. Pro-lifers are interested in the Project and sometimes link to our website, but the Project does not take a position on the morality of controversial procedures. It is enough to recognize the controversy, and advocate the accommodation of conscientious objectors. At least one pro-life pharmacist does not use the Project pamphlet about the morning-after pill precisely because the pamphlet does not argue against its use.

Second, Ms. Wershler’s article incorrectly attributes to the Project the use of the terms “abortion drug” and “emergency contraceptive (ECP)”. The Project does not use either term, except when quoting other sources. They are confusing, and complicate articulation of freedom of conscience issues.

“Abortion drug” is an appropriate description of mifepristone (RU486), which is designed specifically to cause the abortion of an embryo that has implanted in the uterus. The morning-after pill has not been designed for that purpose, and does not act in that way.

“Emergency contraception” is a fabulously successful marketing term. However, 94% of the women who take the morning-after pill do not require it to prevent childbirth. This statistic, provided by the drug’s advocates,[1] belies the notion of ’emergency’ that is often used to browbeat conscientious objectors. As to “contraceptive”, Ms.Wershler herself acknowledges that these drugs have three mechanisms of action, one of which may prevent implantation of the early embryo, thus causing its death. This is considered by many conscientious objectors to be the moral equivalent of abortion, a term acknowledged as appropriate by some authorities,[2] though the usage is not uncontested. The Project refers to these drugs generically as the ‘morning-after pill’ because this term is widely understood. We describe the morning-after pill as “potentially abortifacient”, in the sense that it may cause the death of the early embryo, but does not necessarily do so.

A final note to prevent further confusion: the meaning of “abortifacient” in a medical or scientific context is not the same as its meaning in a moral context. In a medical context, a drug that prevents fertilization (acts contraceptively) 95 to 99 times out of a hundred would be called a contraceptive rather than a abortifacient. But in a moral context, when the outcome may be death, a drug may be treated as an abortifacient if there is even a 1% chance of it killing the embryo by preventing implantation. A number of disputes that arise about the morning-after pill are a regrettable consequence of failing to recognize these distinctions.

Notes

1. Apply a calculator to the following statement: “In 16 months of ECP services, pharmacists provided almost 12,000 ECP prescriptions, which is estimated to have prevented about 700 unintended pregnancies.” Cooper, Janet, Brenda Osmond and Melanie Rantucci, “Emergency Contraceptive Pills- Questions and Answers”. Canadian Pharmaceutical Journal, June 2000, Vol. 133, No. 5, at p. 28.

2. Keith L. Moore and T.V.N. Persaud, The Developing Human: Clinically Oriented Embryology (6th ed.) (Philadelphia: W.B. Saunders Company, 1998), p. 532. Quoted in Irving, Diane N., A “One-Act Drama:The Early Human Embryo:’Scientific’ Myths and Scientific Facts:Implications for Ethics and Public Policy, Medicine and Human Dignity.” International Bioethics Conference, ‘Conceiving the Embryo’, Centre Culturel, Woluwe-St. Pierre, Brussels, Belgium: October 20, 2002 (9:30 A.M.)(Revised 23 October, 2002) Note 23.

Project Letter to the Telegraph Journal

New Brunswick, Canada
12 November, 2002

Sean Murphy, Administrator
Protection of Conscience Project

Doctors at the hospital in Moncton have decided to perform only abortions they believe necessary for maternal health, so that scarce health care resources can be dedicated to reducing waiting lists for surgery. Dr. Henry Morgentaler calls this “disgusting”. He also accuses his colleagues of unethical conduct because they appear to be imposing their religious or moral views on patients. (Morgentaler calls decision to halt abortions ‘disgusting’ 9 November, 2002)

It is remarkable that Dr. Morgentaler should be disgusted by physicians who perform abortions for ‘health’ reasons, but not abortions for which there is no medical justification. When he decided to break the law against abortion, it was because he decided to follow something he called his “medical conscience”.1 His Moncton colleagues, while they will break no law, are doing the same thing. Baseless diatribes about ‘imposing moral beliefs’ are unfair and do nothing to improve health care in New Brunswick.

Dr. Morgentaler has also misrepresented the Code of Ethics of the Canadian Medical Association by implying that it obliges doctors to provide abortions. It does not, nor does it require physicians to referfor abortions or other morally controversial procedures.

Finally, Dr. Morgentaler clearly applies his own moral views in his own medical practice. Upon what basis would he deny his colleagues the same freedom?


Notes: 1.  Pelrine, Eleanor Wright, Morgentaler: The Doctor Who Couldn’t Turn Away. Canada: Gage Publishing, 1975, p. 29

Project Letter to the Barrie Examiner

Barrie, Ontario, Canada
22 February, 2002

Sean Murphy, Administrator
Protection of Conscience Project

Continuing attempts to suppress the freedom of conscience of health care workers like Dr. Stephen Dawson (“Doctor’s Faith Under Scrutiny,” The Barrie Examiner February 21, 2002) give the lie to the claim, oft repeated by Canadian politicians, that protection of conscience legislation is unnecessary. Perhaps their complacent attitude reflects the influence of rigid party discipline that only rarely permits them  the ‘privilege’ of voting according to conscience.

Professor J.R. Brown of the University of Toronto appears to covet the role of party whip, ready to lash or to exile recalcitrant ‘scum’ like Dr. Dawson for daring to let their beliefs affect their public behaviour.

Yet Professor Brown’s private beliefs affected his public behaviour when he asserted that people like Dr. Dawson should “find another job.” Will Professor Brown take his own advice? Or will he continue to speak, act and live in accordance with his own beliefs, even as he denies the same freedom to others who think differently – those whom he characterizes as ‘scum’?

Thoughtful readers will recognize that their relationships and their political and social activities are almost always governed, not by an analysis of empirical evidence, but by deeply held convictions about human dignity and equality, about good and evil, and other equally fundamental concepts. Some of these beliefs may be religious, others not, but all are beliefs. There is no reason, apart from anti-religious bigotry, to allow only atheists and agnostics the freedom to act on their beliefs in public life.

Project letter to the Edmonton Sun

Edmonton, Alberta, Canada
25 April, 2000

Sean Murphy, Administrator
Protection of Conscience Project

Mindelle Jacobs cites Arthur Schafer, director of the Centre for Professional and Applied Ethics at the University of Manitoba, to the effect that conscientious objectors should be driven out of the medical profession if they are unwilling to provide “perfectly legal services” to patients who want the services but can’t go elsewhere to get them. According to Jacobs, Alberta Pharmaceutical Association registrar Greg Eberhart has similar views (Pharmacists want right of refusal, Edmonton Sun, 16 April, 2000).

Well, perhaps they wouldn’t drive them out of the profession. Perhaps they’d just drive them out of the province, or out of the country. Freedom of conscience, if you insist, but not in my back yard.

Now, Jacobs is surely convinced of the truth of the moral vision she shares with Schafer and Eberhart, and of its fundamental importance. After all, she wants to impose that morality by denying conscientious objectors employment, or firing them, or forcing them to go elsewhere to make a living. One wouldn’t do such things unless the morality to be imposed was at least superior to the morality being suppressed, and unless one was also convinced of the necessity of forcing it upon others.

Unfortunately, Jacobs does not explain why her morality is superior to that of pharmacists like Maria Bizecki and Concerned Pharmacists for Conscience. Instead, she indulges in a bit of speculative scare-mongering. If “Bizecki and her pals”have their way, she wonders, “Where will it stop?”

One might also ask where it will stop if conscientious objection is suppressed. A recent bulletin from the College of Pharmacists of British Columbia (Vol. 25, No. 2. Ethics in Practice: Moral Conflicts in Pharmacy Practice) suggests the answer. Driven by the primary ‘ethical criteria’ of legality and consumer demand, the CPBC would require pharmacists to dispense drugs not only for abortion, but for euthanasia, assisted suicide and execution by lethal injection. Canada Safeway, apparently taking its ethical direction from such missives, entered the millennium by asserting that it has the right to ensure employees with religious scruples “promptly serve its customers” and not direct them to competitors for euthanasia drugs and abortion pills (Pharmacy Policies and Procedures, Section IV, Pharmacy Operations, Chapter 4, 1/1/2000, Page No. 16).

Alberta M.L.A. Julius Yankowsky has put forward a bill seeking limited legal protection of conscience for health care workers. The bill does not take any position on the morality or desirability of abortion, assisted suicide, euthanasia or other controversial medical procedures. It simply recognizes that such procedures are morally controversial. It permits discussion and reasoned argument, but not discrimination or coercion.

Sadly, the reaction of Mindelle Jacobs, Arthur Schafer and Greg Eberhart to Mr. Yankowsky’s modest proposal demonstrates the need for such legislation.