Tag: referral

Submission to the World Medical Association

Public Consultation on a draft devised version of the International Code of Medical Ethics

The Anscombe Bioethics Centre

The Anscombe Bioethics Centre

The Anscombe Bioethics Centre is the oldest national bioethics centre in the United Kingdom, established in 1977 by the Roman Catholic Archbishops of England and Wales. It was originally known as The Linacre Centre for Healthcare Ethics and was situated in London before moving to Oxford. The Centre engages with the moral questions arising in clinical practice and biomedical research. It brings to bear on those questions principles of natural law, virtue ethics, and the teaching of the Catholic Church, and seeks to develop the implications of that teaching for emerging fields of practice. The Centre engages in scholarly dialogue with academics and practitioners of other traditions. It contributes to public policy debates as well as to debates and consultations within the Church.

A key issue: conscientious objection

For the first time this draft Code introduces the idea of “conscientious objection”:

Paragraph 27 reads:

Physicians have an ethical obligation to minimise disruption to patient care. Conscientious objection must only be considered if the individual patient is not discriminated against or disadvantaged, the patient’s health is not endangered, and undelayed continuity of care is ensured through effective and timely referral to another qualified physician.*

* This paragraph will be debated in greater detail at the WMA’s dedicated conference on the subject of conscientious objection in 2021 or 2022. However, comments on this paragraph are also welcome at this time.

Unfortunately, this is deeply problematic as a statement of the rights of conscience in medicine. In the first place it utterly fails to establish the duty of doctors to object to practices and procedures that are unconscionable because harmful, discriminatory, unjust or unethical. The right to conscientious objection is based on the duty to be conscientious which is fundamental to medical ethics. . . continue reading

Conscience Project critiques Ontario Physicians College euthanasia/assisted suicide policy

Referral, urgent situations, death certificates, criminal law

News Release

For immediate release

Protection of Conscience Project

Conscience Project critiques Ontario Physicians College euthanasia/assisted suicide policy

Powell River, BC. (28 April, 2021) The 2019 decision of the Ontario Court of Appeal supporting the College of Physicians and Surgeons of Ontario was not the last word on the subject of physician freedom of conscience.

That message was delivered to the College by the Protection of Conscience Project in a submission responding to the College’s request for public feedback on its policy, Medical Assistance in Dying (MAiD). The submission focuses primarily on the College demand that physicians unwilling to provide euthanasia or assisted suicide (EAS) for reasons of conscience provide an “effective referral”: that is, connect the patient directly with someone willing to provide a lethal injection or assist with suicide.

The submission on MAiD addresses three points unique to euthanasia and assisted suicide.

Conflicts in urgent situations: If a patient is approved for EAS at some future date, a sudden deterioration of the patient’s condition may cause the patient to ask for immediate relief by EAS. In the absence of an EAS practitioner, other practitioners may be willing to alleviate the patient’s distress by palliative interventions, but not to provide EAS. The Project suggests how this conflict can be avoided.

Falsifying death certificates: Falsification of death certificates is contrary to accepted international standards and can be considered deceptive, unethical or professionally ill-advised. The Project suggests how EAS practitioners unwilling to falsify death certificates can be accommodated by the College and Office of the Chief Coroner even if current government policy does not change.

Criminal law limits on College policy: The Project’s position is that the College cannot proceed against practitioners who, having the opinion that a patient is not eligible for EAS, refuse to do anything that would entail criminal responsibility for homicide/assisted suicide, including “effective referral.” Further, to advise or attempt to coerce them to present EAS as treatment options or to participate by effective referral would seem to be a criminal offence. Finally, since counselling suicide remains a criminal offence, it appears that practitioners cannot be compelled to present assisted suicide or MaiD as treatment options unless a patient has expressed an interest in the services.

The College’s clarification that it does not require objecting practitioners to personally kill their patients is welcome. However, the Project’s position is that this ought to be the norm in a democratic society, not a “concession”or an element in the “accommodation” of freedom of conscience.

While the submission includes specific policy recommendations within the existing MAiD policy framework, it recommends that the College adopt a single protection of conscience policy in line with “the basic theory” of the Canadian Charter of Rights affirmed by the Supreme Court of Canada and consistent with rational moral pluralism. Such a generally applicable policy is included in the simultaneous Project submission to the College on Professional Obligations and Human Rights.

Public consultations on Professional Obligations and Human Rights [Consultation Page] and Medical Assistance in Dying [Consultation Page] are open until 14 May, 2021.

Contact: Sean Murphy,
Administrator, Protection of Conscience Project
protection@consciencelaws.org

Ontario College of Physicians policy challenged

Forcing physicians out of Covid fight not in public interest

News Release

For immediate release

Protection of Conscience Project

Ontario College of Physicians policy challenged

Powell River, B.C. (28 April, 2021) The 2019 decision of the Ontario Court of Appeal supporting the College of Physicians and Surgeons of Ontario was not the last word on the subject of physician freedom of conscience.

That message was delivered to the College by the Protection of Conscience Project in a submission responding to the College’s request for public feedback on its policy, Professional Obligations and Human Rights (POHR).

The submission includes a cautionary note about the potential implications of human rights law for practitioners providing euthanasia and assisted suicide. However, the primary focus is on the College demand that physicians unwilling to provide a service or procedure for reasons of conscience provide an “effective referral”: that is, connect the patient directly with someone willing to do what they consider immoral/unethical.

Practitioners who object to providing a service typically provide information and work cooperatively with patients and others in relation to patient access to services. While willing to respectfully cooperate, they are unwilling to collaborate by doing something that makes them a party to what they consider wrongful and/or harmful. The distinctions between providing information vs. providing a service and between cooperation vs. collaboration enable an approach that accommodates both patients and practitioners, argues the Project.

However, the College is clearly confused about such critical distinctions. Citing College policy and reasoning, the submission states, “the College’s assertion that effective referral for euthanasia/assisted suicide does not ‘signal’ endorsement or support for the procedures [Advice:MAiD] is either disingenuous or the product of badly muddled wishful thinking.”

“The College does not even correctly apply its own definition of effective referral in its companion policy document,” observes Sean Murphy, Administrator of the Project.

According to the College, physicians unwilling to comply with its effective referral policy should restrict their practices to specialties like hair restoration.[1] This would force all objecting physicians out of general practice.

“To put it in a currently relevant perspective,” says Murphy, “the College would have them terminate all Covid 19 pandemic activities and take up podiatry or aviation medicine. This is hardly consistent with ensuring access to health care or protecting the public interest.”

The Project recommends that the College adopt a single protection of conscience policy in line with “the basic theory” of the Canadian Charter of Rights affirmed by the Supreme Court of Canada and consistent with rational moral pluralism. The submission includes a such general policy, drawing on policy documents from the Canadian Medical Association, Canadian Nurses’ Association, Catholic Health Association of Canada and the Canadian Medical Protective Association.

The Protection of Conscience Project has also made a submission about College’s policy on euthanasia and assisted suicide, Medical Assistance in Dying. Public consultations on Professional Obligations and Human Rights [Consultation Page] and Medical Assistance in Dying [Consultation Page] are open until 14 May, 2021.

Notes

  1. Christian Medical and Dental Society of Canada v. College of Physicians and Surgeons of Ontario, 2019 ONCA 393 (CanLII) at para 184.

Contact: Sean Murphy,
Administrator, Protection of Conscience Project
protection@consciencelaws.org

Dying with Dignity Bill represents a failure of compassion

Mandatory referral “unacceptable”

News Release

Irish Catholic Bishops’ Conference

The following statement has been agreed by the Spring General Meeting of the Irish Catholic Bishops’ Conference which took place this week. 

Statement

In January 2021, the Council for Life of the Catholic Bishops’ Conference made a submission to the Oireachtas Committee on Health, regarding the Dying with Dignity Bill. Alongside the protection of human life, our concern is to offer our pastoral support to people living with terminal illness and to their families. We are very aware that, sadly, all across Ireland, many families are engaged day by day in accompanying loved ones through terminal illness.

The Bill currently before the Oireachtas wrongly proposes the deliberate ending of life as a way of conferring dignity on people with terminal illness. The opposite is the case. Human dignity belongs to every person by virtue of his or her human nature. Terminal illness does not take away that dignity. Indeed, in our experience, the inherent dignity of the person often shines through under those difficult circumstances. Under existing law and current best practice, people with terminal illness are supported by family members, by doctors and nurses and palliative care teams, in living life to the full until death comes naturally. We take this opportunity to thank the many healthcare professionals who so generously devote their lives to the care of people with terminal illness.

What this Bill proposes may be appropriately described as “Assisted Suicide”, because it involves one person taking his or her own life, with the active participation of another. We believe that every life has an inherent value, which should be endorsed by society. This Bill, if passed, would be a sad reflection of the unwillingness of society to accompany people with terminal illness. It would reflect a failure of compassion.

The Dying with Dignity Bill presents the deliberate ending of life as an expression of personal autonomy, but what is proposed in this Bill has implications for society as a whole. Once it is accepted in principle, that one person may participate actively in ending the life of another, there is no longer any logical basis for refusing this same option to any person who feels that life is no longer worth living. We are aware that, in countries where it is legally permitted for healthcare professionals to be directly involved in the taking of human life, it has very quickly been extended to include people who are not terminally ill (the elderly, people with intellectual disability, young adults on the autistic spectrum and even minors who, in other circumstances, would not be considered capable of giving legal consent).

The Bill anticipates that doctors and nurses, whose vocation and purpose is to serve life, will now be prepared to involve themselves in ending life. This would represent a radical transformation of the meaning of healthcare. While the Bill does, theoretically, provide for conscientious objection, it still requires healthcare professionals to refer their patients to other medical practitioners who will carry out their wishes. This means that, one way or another, healthcare professionals are required to involve themselves in something which they believe to be contrary to morality and to medical best practice. This, in our view is unacceptable.

As we mark the anniversary of the arrival of Covid-19 in Ireland, and consider the enormous efforts that have been made across every sector of society to protect the life and health of people who are most vulnerable, this Bill is in clear contradiction with the shared commitment of our society. It is at odds with the common good, which it is the function of the state to promote. This Bill is fundamentally flawed. It cannot be repaired or improved and we call on Catholics to ask their elected representatives to reject it entirely.

ENDS         

For media contact: Catholic Communications Office Maynooth: Martin Long +353 (0) 86 172 7678 and Brenda Drumm +353 (0) 87 310 4444.

Health professionals conscience objection to abortion at risk, court told

Wellington Higher Courts Reporter

A health professionals’ group has gone to court over the right to having a conscientious objection to providing abortion services, without adversely affecting employment.

At the High Court in Wellington on Monday the New Zealand Health Professionals Alliance asked Justice Rebecca Ellis​ to make a declaration that the abortion law was inconsistent with the Bill of Rights Act.

Lawyer Ian Bassett​ said a change to the law on March 24, 2020, raised the concern that the new law contained a “coercive” element. . . [Full text]