Home : Archive : Bimonthly Updates : 1 November, 2012
Covering the period from 1 September to 31 October, 2012
The UN Human Rights Commision has issued a document that purports to base the restriction or suppression of freedom of conscience among health care workers on human rights claims. It calls for changing laws and policies that allow conscientious objection "to hinder women's access to a full range of services." The resolution was endorsed by New Zealand, Burkina Faso, and Colombia and enumerates access to abortion among "sexual and reproductive health rights." 20 of the 47 council members opposed the text. [CFAM]
According to a law that went into effect on 1 September, Spanish physicians may not provide health care for undocumented migrants except in cases of emergency, pregnancy, or delivery. The Spanish Society of Family and Community Medicine (SEMFyC), supported by the Spanish Medical Colleges is advising physicians to become "conscientious objectors" to the law. [Hastings Center Bioethics Forum] The Society calls this "conscientious objection," but it can be understood in two ways: as conscientious objection to the law, and as an exercise of freedom of conscience in providing rather than in refusing to provide a service.
The main news from the United States is the continuing controversy over the Obama Administration's plan to force employers to provide insurance coverage for birth control and sterilization even if they object to the services for reasons of conscience. The Becket Fund reports that more than 100 plaintiffs have now joined lawsuits against the federal government [Becket Fund HHS Page].
While the contested regulation does not bear directly or immediately upon freedom of conscience for health care workers, it does raise significant issues about the nature and extent of freedom of conscience and religion in a liberal democracy. Moreover, the public discourse associated with the controversy shapes social and professional environments, and this has implications for conscientious objectors. This is reflected in Resolution 507 (Physician Conscience Protection Rights) passed by the American Academy of Family Physicians (AAFP) to support freedom of conscience for physicians. [MedPage Today] It is also reflected in a warning to physicians attending a Catholic Medical Association conference that they are practising medicine in an increasingly toxic culture, and that even physicians who do not follow Church teaching may be forced to do things that they believe to be wrong. [NCR]
Two pharmacists have won an appeal against a 2005 executive order issued by the Governor of Illinois that required all pharmacies to fill prescriptions for the morning after pill. The appeals court upheld a lower court injunction based on the Illinois Health Care Right of Conscience Act.
The American Nurses' Association has prepared a draft policy document opposing nurse participation in euthanasia and assisted suicide. Some of those opposed to the procedures remain concerned that the draft statement equates the provision of food and fluids with medical treatment. In any case, the document demonstrates that legalization of assisted suicide and euthanasia is likely to cause conflicts of conscience among some health care workers.
A new version of the controversial Reproductive Health bill is being circulated among Filipino lawmakers. The substitute bill, proposed by the sponsor of the original bill, is reported to include a number of changes responsive to concerns of the bill's opponents. Some of the proposed changes deals with sections of the bill that could have an adverse impact on health care workers opposed to some birth control methods for reasons of conscience. The bill's author is now prepared to remove the provision that threatens objectors with prosecution if they speak out, and to exempt denominational hospitals from a requirement to provide services that contravene their religious ethos. [Inquirer]
192 professors of the Jesuit Ateneo de Manila University from its Loyola Schools, School of Medicine and Public Health, Law School and School of Government have publicly expressed support for the bill. Their declaration fails to refer to provisions that are problematic from the perspective of freedom of conscience. In describing the bill as an affirmation of human rights, it adopts the position of activists who are using human right claims to force objecting health care workers to participate in or facilitate contraception and abortion. [Declaration] [The Philippines RH bill of 2011: the shape of things to come?]
A 19 year old girl who was seriously injured in a car crash in October, 2011, narrowly escaped having vital organs removed for transplant following what appears to have been a misdiagnosis by attending physicians. [Medical Daily] The case is a good illustration of one of the practical reasons for respecting freedom of conscience among health care workers who may have ethical reservations about procedures in some circumstances.
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Conscientious actors vs. conscientious objectors
Writing in the New England Journal of Medicine, Dr. Lisa Harris, who specializes in late term abortions, argues that protection of conscience laws are unbalanced because they support conscientious objectors but not physicians who, for reasons of conscience, provide morally contested procedures like abortion or assisted suicide. [Harris LH, Recognizing Conscience in Abortion Provision N Engl J Med 2012; 367:981-983]
Similarly, Elizabeth Sepper of Washington University in St. Louis asserts that protection of conscience laws and policies are neglecting those who provide morally contentious services despite opposition from employers or other authorities. The forthcoming issue of the Virginia Law Review will include a paper by Sepper, "Taking Conscience Seriously," that makes this argument. Citing Catholic hospitals and contraception, she argues that individual health care workers at denominational hospitals may be denied freedom of conscience by their employers. [ScienceDaily]
The publications appear to signal a new development in discourse about freedom of conscience.
The Protection of Conscience Project makes a principled distinction between conscientious objectors and conscientious actors, identifying the former as being in particular need of protection. (See Notes toward an understanding of freedom of conscience.)
Muslim medical students
Card, Robert F, Is there no alternative? Conscientious objection by medical students. J Med Ethics 602-604 doi:10.1136/medethics-2011-100190
Card discusses issues raised by Muslim medical students who, citing religious prohibitions, are unwilling to perform physical examinations of patients of the opposite sex, or to learn about alcohol or sexually related diseases. It is noteworthy that the anecdotes he cites originate in a Times newspaper article from 2007, which makes clear (as he does not) that Muslim authorities and medical practitioners in the United Kingdom did not support the position of the students. Similarly, Professor Abdulaziz Sachedina (author of Islamic Biomedical Ethics) and Dr. Shahid Athar, Muslim advisors to the Project, discount the notion that Islamic law prevents Muslim physicians from examining or treating members of the opposite sex. While Card does make some interesting observations, and his article warrants a more extended response, it is regrettable that he did not consider the possiblity that what he calls the "deeper and more troubling" objection by Muslim students might be addressed effectively from within the Islamic tradition.