(USA: 2008)
- Freedom2Care.org | Brief examples that demonstrate the often subtle, sometimes flagrant and increasingly pervasive discrimination faced by pro-life, faith-based and conscience-driven individuals in the healthcare professions. Full Text
Category: Ethics
Ethical misconduct by abuse of conscientious objection laws
Med Law. 2006 Sep;25(3):513-22. PubMed PMID: 17078524
Abstract:
This paper addresses laws and practices urged by conservative religious organizations that invoke conscientious objection in order to deny patients access to lawful procedures. Many are reproductive health services, such as contraception, sterilization and abortion, on which women’s health depends. Religious institutions that historically served a mission to provide healthcare are now perverting this commitment in order to deny care. Physicians who followed their calling honourably in a spirit of self-sacrifice are being urged to sacrifice patients’ interests to promote their own, compromising their professional ethics by conflict of interest. The shield tolerant societies allowed to protect religious conscience is abused by religiously-influenced agencies that beat it into a sword to compel patients, particularly women, to comply with religious values they do not share. This is unethical unless accompanied by objectors’ duty of referral to non-objecting practitioners, and governmental responsibility to ensure supply of and patients’ access to such practitioners. [Full Text]
Bedrock values?
Project letter to The Canadian Pharmaceutical Journal
Sean Murphy*
Polly Thompson asserts that religious tolerance is “a bedrock value of our democracy, and it goes both ways,” but then claims that “the onus is on the health professional to respect the religious beliefs of the patient, not the other way around,” a most peculiar form of tolerant reciprocity. The balance of the editorial demonstrates a troubling ignorance of the legal requirements to accommodate conscientious objectors[1] and de facto contempt of the “bedrock value” she purports to respect in theory. (The Public Trust and Access to Medication, Canadian Pharmaceutical Journal, October, 2004, Vol. 137, No. 8).
Patients and pharmacists have equal claims to freedom of conscience and expression, but one looks in vain in the editorial for a thoughtful analysis of how to deal fairly with conflicts of conscience in health care. A principled approach to conscientious objection would, among other things, distinguish between life-threatening injuries or conditions, and non-emergent situations. To equate the provision of blood transfusions for accident victims with dispensing contraceptives or post-coital interceptives suggests a disappointing editorial interest in polemics, not principle.
Thompson is mistaken when she claims that some pharmacists raise religious objections to her access to medication. Their concerns are not with her access, but with their own moral culpability should they facilitate harmful conduct or other wrongdoing by someone else.
The fact that a drug is legal does not determine this issue. By way of comparison, mouthwash is a legal product commonly sold in pharmacies. It can also be an intoxicant when consumed as a beverage. A conscientious pharmacist might well refuse to sell mouthwash to an alcoholic known to consume it for that purpose, whether or not the product could be accessed elsewhere.
Similarly, the practice of law is a self-regulated profession, and, like pharmacists, lawyers are expected to serve the interests of their clients. But a client cannot force a lawyer to facilitate what the lawyer considers to be a wrongful act – even if the act is legal.
Ms. Thompson’s fierce determination to adhere to her own moral views is not surprising, but she has failed to demonstrate that her morality is so superior that it should be imposed upon those who disagree with her. Indeed, she did not even attempt such a demonstration before calling for the elimination of “troubling holes” and “wiggle room” that make grudging allowance for freedom of conscience in pharmacy. Her message to those unwilling to go along with her is uncompromising; get out of the profession. Given this totalitarian mindset, Ms. Thompson’s complaint that ‘fundamentalist extremists’ dictate policy in the United States invites the waggish response that in Canada they write editorials for professional journals.
Pharmacy regulatory authorities can, with some imagination and good will, find ways to ensure “timely access to legal medication” without suppressing of freedom of conscience in the profession. The Canadian Pharmaceutical Journal can contribute to this kind of fruitful accommodation. But the profession and the public are not well served by the kind of incoherence, intolerance, polemics and ignorance of human rights jurisprudence displayed in its October editorial.
Sean Murphy, Administrator
Protection of Conscience Project
Notes
1. Benson I. “Autonomy”, “Justice” and the Legal Requirement to Accommodate the Conscience and Religious Beliefs of Professionals in Health Care [Internet]. Powell River (BC): Protection of Conscience Project; 2001 Mar. The Canadian Pharmaceutical Journal declined to publish the essay, which was a response to an article by Frank Archer that had appeared in an earlier number of the Journal. See also Murphy S. In Defence of the New Heretics: A Response to Frank Archer [Internet]. Powell River (BC): Protection of Conscience Project; 2000 Jul – also declined by the CPJ.
Planned Parenthood and “Anti-Choice” Rhetoric
News Release
Protection of Conscience Project
Planned Parenthood Alberta is recycling the accusation that physicians who object to abortion may “scare” patients with “misinformation” or “impose their moral beliefs.” This smear may be unfairly applied to conscientious objectors who follow the guidelines of the Canadian Medical Association (CMA) and the College of Physicians and Surgeons of Alberta (CPSA).
The CMA advises physicians to inform a patient when their personal morality would influence their recommendations or practice, and to advise patients of their objections to abortion. The CPSA expects physicians to provide information to patients seeking abortion so that they can “make informed decisions on all available options for their pregnancies, including termination.”
On the other hand, objecting physicians can hardly be expected to present morally controversial procedures as morally uncontroversial, or in such a way as to indicate that they approve of them or are indifferent to them. Moreover, the information they reasonably believe necessary to permit the patient to make a truly “informed decision” may be more comprehensive or in other respects different from what Planned Parenthood is accustomed to provide its clients.
An interest group like Planned Parenthood might well stigmatize such discussion as ‘moralizing’ and providing ‘misinformation’. Partisan polemics of this sort do not provide a basis for sound policy making.
Planned Parenthood Alberta is compiling a list of what it calls “anti-choice doctors.” If it is desirable to help patients find physicians who share their outlook on moral issues, it would be preferable for doctors to identify themselves, perhaps through the College of Physicians and Surgeons or professional associations.
But if Planned Parenthood persists in its plan to identify “anti-choice doctors”, it should include in its list the names of physicians who believe that their colleagues should be forced to provide or facilitate morally controversial procedures.
Related: Planned Parenthood and “Anti-Choice Rhetoric” (commentary)
Planned Parenthood and “Anti-Choice” Rhetoric
Sean Murphy*
A response to Mario Toneguzzi, “Planned Parenthood Targets ‘Anti-choice’ Docs”, Calgary Herald (19 August, 2004)
In 1999, citing allegations by un-named “individuals,” a Councillor of the Alberta College of Physicians and Surgeons claimed that some physicians who were not “supportive” of women seeking abortions were “rude and bullying to patients.”(1) Canadian Physicians for Life rebuked the Councillor for relying upon “polemical hearsay” and demanded that the College substantiate the allegation.(2) No evidence was forthcoming.
Three years later the Assistant Registrar of the College indicated that complaints about physician ‘moralizing’ were largely hearsay “from groups who provide birth control and family planning counselling to women” – not a bad definition of Planned Parenthood.(3)First-hand accounts from individual patients were a “distinct minority” of the total.(4)
Planned Parenthood Alberta is now recycling the accusation that physicians who object to abortion may “scare” patients with “misinformation” or “impose their moral beliefs.”(5) One of the problems with this kind of generalized smear is that it may be unfairly applied to conscientious objectors to abortion who follow the guidelines of the Canadian Medical Association (CMA) and the College of Physicians and Surgeons of Alberta (CPSA).
The CMA advises physicians to “inform a patient when their personal morality would influence the recommendation or practice of any medical procedure that the patient needs or wants,” and to advise patients of their objections to abortion so that they can consult another physician.(6) The CPSA does not require physicians to advise every pregnant woman that she can have an abortion or put her child up for adoption,(7) but does expect them to provide information to patients seeking abortion so that they can “make informed decisions on all available options for their pregnancies, including termination.”(8)
In following these guidelines an objecting physician must, at all times, be respectful of the patient’s dignity, and must not be threatening, overbearing or abuse his authority by preaching or moralizing in order to influence his patient’s decision. On the other hand, objecting physicians can hardly be expected to present morally controversial procedures as morally uncontroversial, or in such a way as to indicate that they approve of them or are indifferent to them (i.e., to adopt a ‘neutral’ position). Moreover, the information they reasonably believe necessary to permit the patient to make a truly “informed decision” may be more comprehensive or in other respects different from what Planned Parenthood is accustomed to provide its clients.
A third party who was not present during this kind of exchange, especially an interest group like Planned Parenthood, might well stigmatize the discussion as ‘moralizing’ and providing ‘misinformation’. Partisan polemics of this sort do not provide a basis for sound policy making.
Planned Parenthood Alberta suggests that patients who are unsure of their doctor’s position on abortion should contact the organization because it is compiling a list of what it calls “anti-choice doctors”. Asking the doctor directly seems a simpler and more reliable way for patients to resolve such doubts. If it is desirable to help patients find physicians who share their outlook on moral issues, it would be preferable for doctors to identify themselves, perhaps through the College of Physicians and Surgeons or professional associations.
In the meantime, if Planned Parenthood persists in its plan to identify “anti-choice doctors”, it should include in its list the names of physicians who believe that their colleagues should not be forced to provide or facilitate morally controversial procedures.
Notes
1. Kretzul E. Ethical Responsibilities in Dealing with Women Requesting Abortion Services. The Messenger. 1999 Sep; 73: 6.
2. Canadian Physicians for Life. News Release: Alberta College of Physicians and Surgeons challenged to think about conscience rights [Internet]. Powell River: Protection of Conscience Project; 1999 Oct 11.
3. Theman TW. Freedom of Conscience and the Needs of the Patient. Presentation to the Obstetrics and Gynecology Conference “New Developments-New Boundaries”; 2001 Nov 9-12; Banff, Alberta.
4. Theman, Trevor W. (Assistant Registrar, College of Physicians and Surgeons of Alberta). Letter to: Sean Murphy (Administrator, Protection of Conscience Project). 2002 Jan 2. 1 leaf. Located at: Protection of Conscience Project.
5. Be Aware of Anti-Choice Doctors and Radiologists [Internet]. Edmonton: Planned Parenthood Alberta; 2004 [cited 2004 Aug 28].
6. Canadian Medical Association. Induced Abortion [Internet]. CMAJ. 1988 Dec 15 [cited 2020 Sep 16]; 139:12 1176a–1176b. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1268491/pdf/cmaj00181-0059.pdf.
7. Theman, Trevor W. (Assistant Registrar, College of Physicians and Surgeons of Alberta). Letter to: Sean Murphy (Administrator, Protection of Conscience Project). 2002 Mar 27. 1 Leaf. Located at: Protection of Conscience Project.
8. College of Physicians and Surgeons of Alberta. Termination of Pregnancy. 2000 Jun.