Monday, June 17, 2019

Attacks on Conscience Rights are also an American concern.

By Mark Hodges (EPC researcher)

The Canadian Parliament is debating whether doctors may follow their vow and conviction to “do no harm,” or if government can force them to violate their most sacred and deeply held belief against euthanasia (lethal injection).

On the crucial conscience rights issue, the United States is only a step behind Canada, and may be closing in fast.

Saskatchewan MP David Anderson sponsored the Conscience Rights protection bill (C-418) that will determine whether conscientious objecting physicians will leave their profession, or forced to be complicit with killing.

Over the past decade, a debate has arisen over “competing rights,” namely, the fundamental right of physicians and other citizens to practice with integrity and conscience, versus a new “right” of patients to be euthanized upon request, regardless of their doctor’s convictions.

Assisted suicide advocates in both Canada and the U.S. say doctors’ rights must be overridden or compromised in favor of the "right to die". In 2016, the Canadian Medical Association voted against physicians’ conscience rights by a margin of 71 percent.

Conscience supporters say assisted suicide is not healthcare, and it is a doctor’s right to refuse to kill his/her patients, or refuse to prescribe lethal medication, and refuse to refer or be complicit with the act.

After Canada’s Supreme Court decriminalized euthanasia in 2015, the College of Physicians and Surgeons of Ontario promoted what they called a “compromise” which did not require doctors to lethally inject patients but it required doctors who objected to refer their patients to a death doctor.

This stripping of individual conscience rights is spreading to the United States. Proposed assisted suicide bills in Massachusetts, Minnesota, New Mexico, and Wisconsin included clauses to force objecting physicians to refer for suicide.

Belgium is following Ontario by pressuring all physicians regardless of conviction to refer for death by euthanasia.

Last year, the Ontario Court of Appeal upheld the College’s coercion, admitting that physicians’ rights were indeed “infringed” by the policy, but the infringement is reasonable in a democratic society. In an unprecedented ruling against Charter rights, the court institutionalized a “limit” on fundamental freedoms in the name of “ensuring access” to death “care.” 

Alex Schadenberg
The Euthanasia Prevention Coalition criticized the decision as no “compromise” at all. Alex Schadenberg stated that facilitating suicide makes one complicit in the act. He said:
“If it’s wrong to do the act, then it’s also wrong to send a patient to somebody else who will do the act,”
Ethicist Dr. Edmund Pelligrino explained that referring is participation. He reasoned.
“Formal cooperation is absolutely and always, forbidden. ...This is the case when the physician shares the evil intent, partakes directly and freely, or in any way facilitates an intrinsically evil act like…assisted suicide.”
Pro-assisted suicide politicians and doctors in the U.S. have begun to accuse physicians who refuse to practice assisted suicide of “abandoning patients.” Ironically, even ethicists in professional journal articles have called refusal to refer for death “a toxic form of patient abandonment.”

Alex Schadenberg disagree's, in life-or-death terms.
“People ask for euthanasia because they have lost hope. They may be in depression or experiencing distress, darkened by their reality, and feel that life has lost its purpose or value. In the past, doctors took this request to die as a cry for help, and they tried to find out what their patient needs to weather his or her overwhelming difficulty. The conscientious physician isn’t abandoning his or her patient, they’re caring for that person.”
Conscience advocates add that this is as much an issue of patients’ rights as it is of physicians’ rights.
“Physician conscience rights are important for physicians, but they are more important for protecting patients,”
Schadenberg pointed out, saying that conscience rights are central to protecting patients when they are most vulnerable. 
“I want a physician who will protect my life when I’m going through my deepest darkest times. When I’m going through that physical, psychological, emotional, or existential distress and I’m so darkened that I can’t see beyond my own difficulty, I need a physician who will say ‘no’ to me and will care for me, not kill me.”
Schadenberg concludes that denying conscience rights to physicians actually denies patients their right to live.

Conscience rights are not just for the religious; there are clear secular reasons to object to assisted suicide. First of all, suicide devalues human life.

The American College of Physicians stated in 2001.
“Both society in general and the medical profession in particular have important duties to safeguard the value of human life,” 
“This duty applies especially to the most vulnerable members of society.”
A second conviction against assisted suicide is that, with modern medicine and advances in palliative care, pain can be managed.

The Canadian Society of Palliative Care Physicians issued a statement against assisted euthanasia that emphasized palliative care’s mission is 
“to help patients live as fully as possible until their natural death. Palliative care strives to reduce suffering, not to intentionally end life... The Canadian public must be able to continue to trust that the principles of palliative care remain focused on effective symptom management and psychological, social, and spiritual interventions to help people live as well as they can until their natural death.”
Janice Strukoff of the Delta hospice spoke out against a 2018 edict by the Fraser Health Authority in British Columbia ordering healthcare facilities --including hospices-- to participate in Medical Aid in Dying (euthanasia). 
“Hospice palliative care is not about hastening death, and we object to the bullying currently taking place in B.C.”
Dr Neil Hilliard
The medical director of Fraser Health Palliative Care, Dr Neil Hilliard, resigned over the edict. He stated

“Providing euthanasia or physician-assisted suicide is not in accordance with palliative care, (which) ‘affirms life and regards dying as a normal process,’”
A third argument against assisted suicide is that physician-complicit killing destroys the doctor-patient trust to heal and do no harm.
“Legalizing euthanasia or physician-assisted suicide would have a profound and detrimental effect on the doctor–patient relationship,” 
The British Medical Association stated just sixteen years ago (2003). 
“It would be unacceptable to put vulnerable people in the position of feeling they had to consider precipitating the end of their lives.”
A fourth argument comes from the experience of states and countries where assisted suicide and euthanasia are legal. History proves that once euthanasia is accepted, limitations on candidates diminish and authorized applications expand.

Examples of the limits on euthanasia eroding are happening now. Since legalizing assisted suicide, the Oregon Health Authority changed the definition of “terminal illness” from its universally-understood meaning of “incurable and irreversible fatal disease” to include treatable medical conditions if a patient refuses to take his or her medicine.

Another example of expansion is the several assisted suicide bills debated in the Oregon legislature. One redefines “self-administer” so that the suicidal patient can legally be killed (commit “suicide”) by someone else. Another bill lengthens the necessary prognosis of six months to live. Another enables a pro-suicide doctor to wave the 15 day waiting period. Another widens “terminal” to include any medical condition that ultimately could “substantially contribute to a patient’s death.”

Some euthanasia activists go so far as to elevate the “right to die” to a “duty to die” for patients whose care “costs” too much for their families or for society at large.

In a speech to the Health Lawyers Association, then-Colorado Governor Richard Lamm stated in 1984 that the terminal elderly have “a duty to die and get out of the way,” because giving them health care would turn the U.S. into a “second-rate economic nation.” Time, the Washington Post, and the New York Times reported his remarks favorably.

It must be noted that this callous, purely economic reasoning is precisely the attitude that led pre-Nazi Germany to “dispose” of human “life devoid of value.” 

Dr. Leo Alexander, a Boston psychologist and the American psychiatric representative to the Nuremberg trials, explained that the foundations of genocide lie in euthanasia. Dr. Alexander wrote in the New England Journal of Medicine in 1949:
“The beginnings were at first merely a subtle shift of emphasis in the basic attitudes of physicians in the 1920s. It started with the acceptance of the attitude, basic in the euthanasia movement, that there is such a thing as a life not worthy to be lived,”

“This attitude in its early stages concerned itself merely with the severely and chronically sick, (then)...the socially unproductive, the ideologically unwanted, the racially unwanted, and finally all non-Germans. But it is important to realize the infinitely small wedged-in lever from which the entire mindset received its impetus was the attitude toward the non-rehabilitable sick.”
Summarizing reasons to oppose euthanasia, a 2012 statement from the Ethics, Professionalism and Human Rights Committee of the American College of Physicians read
“Making physician-assisted suicide legal raised serious ethical, clinical and social concerns and that the practice might undermine patient trust; distract from reform in end-of-life care; and be used in vulnerable patients, including those who are poor, are disabled, or are unable to speak for themselves or minority groups who have experienced discrimination.”
These reasons show that physicians’ right to refuse to prescribe death is not necessarily based on faith, but grounded in foundational understandings about humanity and healthcare.

David Anderson MP
Physicians leaving medicine is just what is happening in Canada. MP David Anderson testified

“I have spoken to doctors who feel overt pressure to leave family medicine because of their conscientious beliefs,”

“I have heard of palliative care doctors in Ontario who have stopped practicing altogether. Nurses who feel increasingly bullied are choosing to shift their focus or retire early. I have had personal conversations with people who work in old folks’ homes who explain they do not want to participate in this but are increasingly feeling pressured to do so.”
The effect of Canada’s euthanasia law is to force euthanasia objectors out of their chosen practice, or out of healthcare altogether. In May of this year, the Court of Appeal for Ontario brazenly exposed that effect as intended, actually advising conscientious medical workers to find a job where assisting suicide would not be required.

Anderson lashed out against the court’s insulting advice, calling it 
“incredibly demeaning to those men and women who have gone through years of training.”
“They are being punished for holding that level of dignity, respect and honor for their patients.”
Anderson continued:
“We have such a shortage of physicians and medical services,” 
“Particularly in rural areas, there is an increasing lack of physicians in an increasingly challenged medical system... The answer does not have to be to do it, find someone else to do it or get out of medicine.”
Fortunately, a flickering spark of common sense has been ignited in various places, and we must fan that into a flame.

The U.S. State Department report on international freedoms singled out a growing trend of prospective healthcare professionals whose potential is destroyed by a lack of conscience rights. 
“Medical and nursing students...expressed their reluctance to enter the health care field as a whole, and particularly specialties...where their objections to…euthanasia might not be respected.”
The Trump administration has officially noted Canada’s trashing of doctors’ conscience rights. Last year, U.S. Secretary of State Mike Pompeo released a report pointing out that Canada’s “regulations requiring doctors to refer patients seeking assisted death...constituted facilitation and violated constitutional guarantees of freedom of conscience and religion.”

Earlier this year, the Trump Department of Health and Human Services (HHS) reversed Obama rules and mandated conscience protections 
“for physicians, pharmacists, nurses, teachers, students, and faith-based charities,” exempting them from “having to provide, participate in, pay for, provide coverage of, or refer for, services such as...assisted suicide.”
HHS regulations now protect healthcare entities that object to 
“assisted suicide, euthanasia, or mercy killing” from “being required to perform, participate in, pay for, provide coverage for, counsel or refer for...euthanasia.”
Freedom of conscience “is the bedrock of American life,” President Donald Trump proclaimed.

The new HHS rules specifically include as unlawful discrimination:
“being steered away from a career in obstetrics, family medicine, or geriatric medicine, when one has a religious or moral objection to...physician-assisted suicide or euthanasia.”
Roger Severino, director of HHS’s Office for Civil Rights, elaborated
“This rule ensures that healthcare entities and professionals won’t be bullied out of the healthcare field because they decline to participate in actions that violate their conscience, including the taking of human life.”
Besides the current U.S. administration, there are other glimmers of hope. Last year the Norwegian Supreme Court handed down a landmark conscience rights ruling supporting a Polish physician who was fired for following her conscience not to kill.

In Canada, the province of Manitoba passed conscience rights legislation in 2017 allowing doctors to opt out of killing. MP David Anderson told Parliament.
“The example of the province of Manitoba...shows there does not need to be compulsion in the medical system when it comes to this issue,” 
“Why would one try to force people into doing what they believe to be wrong?”
David Anderson’s bill (C-418) has enabled debate in the Canadian Parliament. He told Parliament Bill C-418 would:
“provides the teeth” that the current law lacks. “make it an offence to intimidate” a healthcare worker “to take part, directly or indirectly, in the provision of physician-assisted suicide.” It would also stop hospitals and employers from firing healthcare workers who opt out of assisting in a patient’s suicide.
It is said, “Where the battle rages, loyalty is proved.” The fight for conscience rights is immediate and intense, and the outcome is in question not only for Canada, but the U.S. and the rest of the civilized world.


gordon friesen said...

Excellent summary Mark !

Unknown said...

Doctors have a right to refuse to assist a patient suicide. it is never a person's right to assist in killing anyone. (by Lois E. Hodges