Peter Baklinski

Physician conscience rights still officially protected in Canada, but increasingly threatened

Peter Baklinski
Peter Baklinski

POWELL RIVER, British Columbia, August 28, 2012 (LifeSiteNews.com) – After the Canadian Medical Association (CMA) voted two weeks ago to support the wording of the country’s Criminal Code which states that a baby becomes a “human being” only after being born, LifeSiteNews decided to track down where the CMA stands with regard to conscious rights for doctors who believe that babies are human before being born and want nothing to do with abortion.

CMA’s current 1988 policy for “induced abortion” in relation to doctors states that a physician “whose moral or religious beliefs prevent him or her from recommending or performing an abortion should inform the patient of this so that she may consult another physician.”

The CMA policy moreover clarifies that “no discrimination should be directed against doctors who do not perform or assist at induced abortions. Respect for the right of personal decision in this area must be stressed, particularly for doctors training in obstetrics and gynecology, and anesthesia.”

While the written policy sounds like it does protect pro-life physicians, LifeSiteNews contacted Sean Murphy, administrator for the Protection of Conscience Project (PCP), to find out more about how the policy is applied in practice, and about freedom of conscience for physicians in general in Canada.

LSN: Even the CMA, which holds rigorous views on abortion, still believes in conscience rights, but not completely. In 2007, Jeff Blackmer, executive director of the Office of Ethics for the CMA, wrote a piece titled “Clarification of the CMA’s position concerning induced abortion” wherein he states that a doctor “should not interfere in any way with this patient’s right to obtain the abortion. At the patient’s request, you [the doctor] should also indicate alternative sources where she might obtain a referral.”

PCP: This statement was published because of a controversy that erupted over a 2006 guest editorial in the CMA Journal by Professor Jocelyn Downie of Dalhousie University and Sanda Rogers of the University of Ottawa. They claimed that physicians were obliged to refer for abortion. Responses from the CPC and others are here.

Dr. Blackmer’s statement is not considered an assertion that physicians are obliged to refer for abortion. It would be sufficient for a physician to indicate that if the patient wished to pursue the matter she could contact other physicians or the College of Physicians and surgeons, or consult a telephone book. In my experience, physicians who object to referral for reasons of conscience (not all do) do not normally object to providing this kind of information.

In June, 1977, the CMA revised its Code of Ethics to include a clause that imposed an obligation to refer for morally contested procedures (abortion was not specifically named). The clause was removed the following year because of opposition from CMA members. David Williams, then CMA director of ethics, told me in 2000 that the policy was dropped because there was no ethical consensus to support it. Nothing has changed in this respect.

The issue of referral has appropriately been described as an intractable problem by Holly Fernandez-Lynch in Conflicts of Conscience in Health Care: An Institutional Compromise. See the PCP review here. It was highly controversial for the CMA in 1977, and it still is. Indeed, given Carter v Canada, [a case that recently legalized euthanasia and assisted suicide in Canada but was appealed by the government of Canada] it may become even more controversial. (see below)

LSN: How do you see the state of conscience rights for doctors in Canada?

PCP: ‘Rights’ language is problematic for a number of reasons, not the least of which is the use of rights language to justify ethical aggression and ethical cleansing of professions. The issue is better expressed in terms of fundamental human freedom.

The situation is precarious because much depends upon the attitude of the legal and human rights establishment, which both appear to be developing attitudes that are increasingly hostile to the exercise of freedom of conscience when the exercise expresses what might be termed politically incorrect views.

The underlying problem is disagreement about the nature of human rights. The foundational problem is disagreement about the nature of the human person.

Physicians are in a better position to defend their fundamental freedoms than most other health care workers because of their professional dominance and relative independence. A physician who has completed the educational and regulatory requirements for practice can, if need be, begin to practise independently. A qualified nurse, on the other hand, must find an employer in order to work, and remains dependent on an employer in order to continue to work and advance in the profession. Pharmacists are similarly disadvantaged.

LSN: Do you see an erosion happening with regard to conscience rights for doctors in Canada?

PCP: This is difficult to assess because factors that can contribute to erosion may operate out of the public eye: in law schools, in committees of Colleges of Physicians or associations, in seminars or meetings of ‘rights’ groups, and in government bureaucracies.

For example:

• Prof. Sanda Rogers was reported to have told a class at the University of Ottawa on 28 October, 2004, that a physician is required by law to refer patients for abortion, even if the physician objects to the procedure for reasons of conscience. The Dean of the Faculty of Medicine denied that the statement was made. However, the CMA Journal editorial she co-authored with Jocelyn Downie in 2006 appears to reflect the position attributed to her two years earlier. We do not know how often this kind of statement is made in post-secondary classrooms across the country.

• In 2008, the Ontario College of Physicians and Surgeons very nearly adopted a policy to prohibit physicians in the province from acting on their moral, ethical or religious beliefs. This was the result of pressure from the Ontario Human Rights Commission.

Most physicians in the province were unaware that this was happening until the day before the deadline for comment on the policy. The PCP issued a news release and alerted its contacts after being called by a physician who discovered the draft policy by accident.

The resulting uproar forced the College to backpedal somewhat. However, its revised draft was completed before the deadline for public consultation had expired, and the College refused to release the revised draft until the eve of the Council meeting that was to consider it, effectively precluding further critical comment on the document that the Council was to consider. Despite calls from the Ontario Medical Association and the PCP to postpone the vote, the policy was adopted. The most blatantly provocative sections were removed, but the amended policy is less than satisfactory.

• Another important consideration is the potential effect of Carter v. Canada, the BC Supreme Court judgement that proposes to legalize physician assisted suicide and therapeutic homicide (the term used by a CMA Journal editorial). The Royal Society of Canada “expert panel” on euthanasia and assisted suicide recommended that objecting physicians be forced to refer for the procedures. Three of the authors of that report were witnesses for the plaintiffs in Carter v. Canada, and a fourth, Joceyln Downie, instructed the plaintiffs’ expert witnesses. 

As noted above, Downie has long been a proponent of compulsory referral for abortion. The PCP does not take a position on the morality or desirability of assisted suicide or therapeutic homicide, but is concerned that legalization of the procedures would threaten freedom of conscience for health care workers. A response to the judgement from the CPC dealing with this issue is in preparation.

LSN: Do we need laws that affirm conscience rights? If so, what should those laws look like?

PCP: Yes, we need laws that affirm conscience rights. Laws can be general or procedure-specific. There are advantages and disadvantages to both approaches. See the Model Statute on the PCP website and examples of other proposed or existing legislation.

LSN: What can a doctor do to keep his job who has made the decision to be no part of a process that ends the life of a child in the womb?

PCP: It is a serious mistake to confine concerns about freedom of conscience to abortion.

• In the case of a morally contested procedure or service, an objecting physician should first ensure that he has a solid understanding of the essential facts concerning it, based on sound science and the latest reliable research.

• Academic discipline requires an ability to distinguish between what lies within the province of science and what lies elsewhere. “Personhood,” for example, can have distinctive philosophical or legal meanings, but it is not a scientific concept at all. Whether or not something “ought” to be done is a subject for philosophy, religion, or ethics - not science. Keeping clear about this is essential for good communication with patients and colleagues.

• Obtain copies of the policies of regulatory and licensing authorities and study them. Do not ignore the policies of specialist associations that may have considerable influence in setting ‘standards of care.’

• Some objectors encounter problems primarily because of the way they communicate with patients, colleagues or others. If it is necessary to explain your position, it must be done so in a way that refers to your own moral responsibility, not that of the patient or colleague. Avoid expressions that impute wrongdoing to others or that might come across as “preaching”.

• Conscientious objection is likely to make colleagues who do not share your views uncomfortable because it implies that what they are doing is wrong. It is unwise to increase their discomfort by making statements that will be perceived as questioning their moral judgement, as they are then likely to become hostile. Take note of their discomfort - “You seem troubled/ disturbed/surprised” and invite dialogue - “Have I offended you?”

• In addition to discomfort, you may encounter a belligerent challenge, contempt or condescension. If you are taken by surprise or become flustered, no harm is done by admitting the fact and suggesting that time should be made for an uninterrupted chat.

• Don’t rush into what might prove to be a contentious discussion simply to counter an offensive or ill-timed remark. Everyone will benefit if even a few minutes is taken to reflect and relax.

• Resist the urge to explain or defend yourself. Instead, ask your interlocutor to explain his concerns. Listen carefully, and ask questions, not to challenge his views, but to clarify the issues and identify any unexamined presuppositions that are governing his approach to them.

• There is no point exasperating a colleague by attempting to argue from incorrect assumptions about what he knows or believes. Let him tell you. Identify points of agreement and points of contention, and work together from there.

• The notion of working together with your critic is important. The goal is authentic and respectful communication, even if it involves serious argument and fundamental disagreements.

• If you are uncertain about how to reply to facts or an argument presented by your critic, you should simply admit it and promise to continue the discussion after you have had time to think further about it or research the problem. Offer your critic the same courtesy, unasked for, if need be. There is no need to resolve everything at once. In fact, it may prove difficult to resolve even preliminary matters in the first encounter.

• Long before a crisis looms you should seek the fellowship of students and professionals from other religious traditions (or none) who have a common interest in securing freedom of conscience in health care. You may be surprised to find that someone from a completely different faith and culture is more supportive of your views than a co-religionist who lives down the street.

Dr. Will Johnston, president of Canadian Physicians for Life recently told LifeSiteNews that Canadian doctors who want a “serious alternative” to the conversation provided by the CMA “can find it in Canadian Physicians for Life.”

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Newsbusters Staff

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Disney ABC embraces X-rated anti-Christian bigot Dan Savage in new prime time show

Newsbusters Staff
By

March 30, 2015 (NewsBusters.org) -- Media Research Center (MRC) and Family Research Council (FRC) are launching a joint national campaign to educate the public about a Disney ABC sitcom pilot based on the life of bigoted activist Dan Savage. MRC and FRC contacted Ben Sherwood, president of Disney/ABC Television Group, more than two weeks ago urging him to put a stop to this atrocity but received no response. [Read the full letter]

A perusal of Dan Savage’s work reveals a career built on advocating violence — even murder — and spewing hatred against people of faith. Savage has spared no one with whom he disagrees from his vitriolic hate speech. Despite his extremism, vulgarity, and unabashed encouragement of dangerous sexual practices, Disney ABC is moving forward with this show, disgustingly titled “Family of the Year.”

Media Research Center President Brent Bozell reacts:

“Disney ABC’s decision to effectively advance Dan Savage’s calls for violence against conservatives and his extremist attacks against people of faith, particularly evangelicals and Catholics, is appalling and outrageous. If hate speech were a crime, this man would be charged with a felony. Disney ABC giving Dan Savage a platform for his anti-religious bigotry is mind-boggling and their silence is deafening.

“By creating a pilot based on the life of this hatemonger and bringing him on as a producer, Disney ABC is sending a signal that they endorse Dan Savage’s wish that a man be murdered. He has stated, ‘Carl Romanelli should be dragged behind a pickup truck until there’s nothing left but the rope.’ ABC knows this. We told them explicitly.

“If the production of ‘Family of the Year’ is allowed to continue, not just Christians but all people of goodwill can only surmise that the company Walt Disney created is endorsing violence.”

Family Research Council President Tony Perkins reacts:

“Does ABC really want to produce a pilot show based on a vile bully like Dan Savage?  Do Dan Savage’s over-the top-obscenity, intimidation of teenagers and even violent rhetoric reflect the values of Disney?  Partnering with Dan Savage and endorsing his x-rated message will be abandoning the wholesome values that have attracted millions of families to Walt Disney.”

Dan Savage has made numerous comments about conservatives, evangelicals, and Catholics that offend basic standards of decency. They include:

  • Proclaiming that he sometimes thinks about “f****ing the shit out of” Senator Rick Santorum

  • Calling for Christians at a high school conference to “ignore the bull**** in the Bible”

  • Saying that “the only thing that stands between my d*** and Brad Pitt’s mouth is a piece of paper” when expressing his feelings on Pope Benedict’s opposition to gay marriage

  • Promoting marital infidelity

  • Saying “Carl Romanelli should be dragged behind a pickup truck until there’s nothing left but the rope.”

  • Telling Bill Maher that he wished Republicans “were all f***ing dead”

  • Telling Dr. Ben Carson to “suck my d***. Name the time and place and I’ll bring my d*** and a camera crew and you can s*** me off and win the argument.”

Reprinted with permission from Newsbusters

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Jacqueline Harvey

Ending the end-of-life impasse: Texas is poised to ban doctor-imposed death by starvation

Jacqueline Harvey
By Jacqueline Harvey

AUSTIN, Texas, March 30, 2015 (TexasInsider.org)  After five consecutive sessions of bitter battles over end-of-life bills, the Texas Legislature is finally poised to pass the first reform to the Texas Advance Directives Act (TADA) in 12 years. An issue that created uncanny adversaries out of natural allies, and equally odd bedfellows, has finally found common ground in H.B. 3074 by State Rep. Drew Springer.  

H.B. 3074 simply prohibits doctor-imposed euthanasia by starvation and dehydration.

Since H.B. 3074 includes only those provisions and language that all major organizations are on record as having deemed acceptable in previous legislative sessions, there is finally hope of ending the end-of-life impasse in the Texas Capitol.

Many would be surprised to learn that Texas law allows physicians to forcibly remove a feeding tube against the will of the patient and their family. In fact, there is a greater legal penalty for failing to feed or water an animal than for a hospital to deny a human being food and water through a tube.

This is because there is no penalty whatsoever for a healthcare provider who wishes to deny artificially-administered nutrition and hydration (AANH). According to Texas Health and Safety Code, “every living dumb creature” is legally entitled access to suitable food and water.

Denying an animal food and water, like in this January case in San Antonio, is punishable by civil fines up to $10,000 and criminal penalties up to two years in jail per offense. Yet Texas law allows health care providers to forcibly deny food and water from human beings – what they would not be able to legally do to their housecat. And healthcare providers are immune from civil and criminal penalties for denial of food and water to human beings as long as they follow the current statutory process which is sorely lacking in safeguards.

Therefore, while it is surprising that Texas has the only state law that explicitly mentions food and water delivered artificially for the purpose of completely permitting its forced denial (the other six states mention AANH explicitly for the opposite purpose, to limit or prohibit its refusal), it is not at all surprising that the issue of protecting a patient’s right to food and water is perhaps the one point of consensus across all major stakeholders.

H.B. 3074 is the first TADA reform bill to include only this provision that is agreed upon across all major players in previous legislative sessions.

There are irreconcilable ideological differences between two major right-to-life organizations that should supposedly be like-minded: Texas Alliance for Life and Texas Right to Life. Each faction (along with their respective allies) have previously sponsored broad and ambitious bills to either preserve but reform the current law (Texas Alliance for Life’s position) or overturn it altogether as Texas Right to Life aims to do.

Prior to H.B. 3074, bills filed by major advocacy organizations have often included AANH, but also a host of other provisions that were so contentious and unacceptable to other organizations that each bill ultimately died, and this mutually-agreed-upon and vital reform always died along with it.

2011 & 2013 Legislative Sessions present prime example

This 2011 media report shows the clear consensus on need for legislation to simply address the need to protect patients’ rights to food and water:

“Hughes [bill sponsor for Texas Right to Life] has widespread support for one of his bill’s goals: making food and water a necessary part of treatment and not something that can be discontinued, unless providing it would harm the patient.”

Nonetheless, in 2013, both organizations and their allies filed complicated, contentious opposing bills, both of which would have protected a patient’s right to food and water but each bill also included provisions the rival group saw as contrary to their goals. Both bills were ultimately defeated and neither group was able to achieve protections for patients at risk of forced starvation and dehydration – a mutual goal that could have been met through a third, narrow bill like H.B. 3074.

H.B. 3074 finally focuses on what unites the organizations involved rather than what divides them, since these differences have resulted in a 12 year standoff with no progress whatsoever.

H.B. 3074 is progress that is pre-negotiated and pre-approved.

It is not a fertile springboard for negotiations on an area of mutual agreement. Rather it is the culmination of years of previous negotiations on bills that all came too late, either due to the complexnature of rival bills, the controversy involved, or even both.

On the contrary, H.B. 3074 is not just simply an area of agreement; moreover, it is has already been negotiated. It should not be stymied by disagreements on language, since Texas Alliance for Life and Texas Right to Life (along with their allies) were able to agree on language in 2007 with C.S.S.B. 439. C.S.S.B. 439 reads that, unlike the status quo that places no legal conditions on when food and water may be withdrawn, it would be permitted for those in a terminal condition if,

“reasonable medical evidence indicates the provision of artificial nutrition and hydration may hasten the patient’s death or seriously exacerbate other major medical problems and the risk of serious medical pain or discomfort that cannot be alleviated based on reasonable medical judgment outweighs the benefit of continued artificial nutrition and hydration.”

This language is strikingly similar to H.B. 3074 which states, “except that artificially administered nutrition and hydration must be provided unless, based on reasonable medical judgment, providingartificially administered nutrition and hydration would:

  1. Hasten the patient’s death;
  2. Seriously exacerbate other major medical problems not outweighed by the benefit of the provision of the treatment;
  3. Result in substantial irremediable physical pain, suffering, or discomfort not outweighed by the benefit of the provision of the treatment;
  4. Be medically ineffective; or
  5. Be contrary to the patient’s clearly stated desire not to receive artificially administered nutrition or hydration.”

With minimal exceptions (the explicit mention of the word terminal, the issue of medical effectiveness and the patient’s right to refuse), the language is virtually identical, and in 2007 Texas Right to Life affirmed this language as clarifying that “ANH can only be withdrawn if the risk of providing ANH is greater than the benefit of continuing it.”

Texas Right to Life would support the language in H.B. 3074 that already has Texas Alliance for Life’s endorsement. Any reconciliation on the minor differences in language would therefore be minimal and could be made by either side, but ultimately, both sides and their allies would gain a huge victory – the first victory in 12 years on this vital issue.

It seems that the Texas Advance Directive Act, even among its sympathizers, has something for everyone to oppose.

The passage of H.B. 3074 and the legal restoration of rights to feeding tubes for Texas patients will not begin to satisfy critics of the Texas Advance Directives Act who desire much greater changes to the law and will assuredly continue to pursue them. H.B. 3074 in no way marks the end for healthcare reform, but perhaps a shift from the belief that anything short of sweeping changes is an endorsement of the status quo.

Rather, we can look at H.B. 3074 as breaking a barrier and indicating larger changes are possible.

And if nothing else, by passing H.B. 3074 introduced by State Rep. Drew Springer, we afford human beings in Texas the same legal access to food and water that we give to our horses. What is cruel to do to an animal remains legal to do to humans in Texas if organizations continue to insist on the whole of their agenda rather than agreeing to smaller bills like H.B. 3074.

The question is, can twelve years of bad blood and bickering be set aside for even this most noble of causes?

Reprinted from TexasInsider.org with the author's permission. 

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By John-Henry Westen

I can’t believe how quickly our annual Spring campaign has flown by. Now,with only 3 days remaining, we still have $96,000 left to raise to meet our absolute minimum goal.

That’s why I must challenge you to stop everything, right now, and make a donation of whatever amount you can afford to support the pro-life and pro-family investigative reporting of LifeSite!

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I want to thank the many readers who helped bring us within striking distance of our minimum goal with their donations over the weekend. 

But though we have made great strides in the past few days, we still need many more donations if we are going to have any hope of making it all the way by April 1st.

In these final, anxious days of our quarterly campaigns, I am always tempted to give in to fear, imagining what will happen if we don’t reach our goal.

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