Abstract The deaths last September of a British Columbia physician and his wife have raised troubling questions about euthanasia and Alzheimer’s disease. Police described the deaths of Dr. Tom Powell and his wife Dr. Lorraine Miles, a retired dentist, as a murder-suicide. Friends of the couple wonder if more lenient laws concerning euthanasia and assisted suicide might have saved Miles’ life.
Extract Proposals to legalize assisted suicide challenge hospice’s identity and integrity. In the wake of Measure 16, Oregon hospice programs must develop practical policies to balance traditional commitments not to hasten death and not to abandon patients with dying patients’ legal right to request lethal prescriptions. . . . . .
Regardless of the path an individual hospice may follow,-it cannot avoid the uncharted and unknown territory of a law that legalizes a lethal prescription and a scheduled death for some terminally ill patients. Whether a hospice forges a path through the middle of this territory through full participation, skirts along its borders by forms of indirect participation, or creates a detour through abstention and nonparticipation, the nature and mission of hospice in Oregon will be irreversibly altered.
Extract The wave of abortion-on-demand legislation sweeping the world has reached our shores. The first blows to the concept of the sanctity of human life are being dealt at a time when health care in South Africa is undergoing tremendous upheaval. This concept may be irreparably damaged if the present Abortion and Sterilisation Act of 1975 is changed. . . Health professionals should be guided in their decisions and proposals by health values and by scientific evidence. Unfortunately these are not the only prerequisites, since moral and religious considerations are always subconscious realities. Enormous moral and ethical pressures already confront those making decisions about the provision of medical and health care in developing countries. . . The ‘unwanted’ child . . .is therefore victimised, not because of his or her own shortcomings but because society attempts to solve its socio-economic and broader health problems through the sacrifice of its children. . . To avoid abortions, fertility regulation (family planning)should be aggressively propagated in South Africa with specific emphasis on female education and counselling regarding contraceptive information, services and supplies and sterilisation. Contraception saves the lives of thousands of women around the world owing to avoidance of unwanted pregnancies.
Extract The reader is left with no escape from the conclusion that doctors through overwhelming pressure, cowardice, lack of peer support, lack of self-criticism or awareness and even personal conviction and relish have betrayed the principles of their profession, often in the recent past and often not far from home. . . Ultimately the question that remains tantalizingly unanswered is when is punishment not cruel, inhuman or degrading? Paradoxically, through condemning so eloquently the identified abuses of medicine, that which is not condemned seems to be given a degree of immunity for which an extension of the report’s own arguments appears to provide no justification.
Extract Conclusion The plight of Helga Wanglie . . . focused attention on the issue of physician autonomy in the context of patient decision making. That case challenged the court, as well as our society, to consider whether a physician has an obligation to provide medical treatment he or she believes is inappropriate. . .The concept of a physician’s professional conscience will become increasingly relevant as the cost of health care rises to the point where our demands for care greatly outweigh our ability to pay for such care . . . to downplay the role a physician’s professional conscience plays in medical decision making, as both courts and policy makers traditionally have done, does not advance patient autonomy; instead, it causes doctors to be more conservative and withholding in the range of options they offer their patients. If patient autonomy is to have meaning, recognition must also be given to a physician’s moral autonomy. This Article suggests that when patients clash with their physicians over treatment choices, the principle of patient autonomy does not automatically require that the physician be forced to comply.
Abstract The legal right to assert a conscientious objection is reviewed, using as an example the dispensing of abortifacient drugs by pharmacists. The three areas of law that most significantly concern the right to assert a conscientious refusal are employment law, conscience clauses, and religious discrimination law. Each of these is reviewed, with descriptions of recent cases. It is concluded that employment law protects refusals that are consistent with public policy, but does not permit an employee’s personal policy to determine how a business will be run; that conscience clauses appear to provide protection for pharmacists who object to dispensing abortifacients, but that the precise meanings of critical words and phrases in some clauses need to be defined; and that even though laws of religious discrimination require that employers accommodate religious beliefs, they may not protect a pharmacist who objects to dispensing abortifacients if the accommodation becomes unreasonably burdensome.
Extract The implications of legalizing euthanasia for the medical profession and the potential for abuses are very troubling. Before public policy or legislation is formulated, the ethical issues inherent in the practice of euthanasia must be critically examined. . . It is the author’s assertion that the legalization of assisted suicide and/or physician-aid-in-dying is not the proper course of action at this time. There are too many other options available to doctors, nurses, hospitals and other health care institutions which must be exercised to their fullest extent before any form of active euthanasia is legalized.
Extract Canadian physicians cannot consistently accept the principle of respect for people in the name of medical ethics, and then perform procedures they know to be medically inappropriate, harmful and demeaning only because they do not want to offend a misplaced cultural sensitivity.
Extract Conclusion When President Bush successfully thwarted passage of the Emergency Chinese Immigration Relief Act of 1989 and implemented his own order insisting upon “careful consideration” of victims who plead for political asylum because of coercive population control measures in their homelands, he unwittingly illustrated the need for a change in the statutory language. The Executive Order unwisely forces the issue of coercive population control policies into statutory language designed to protect victims of discrimination. Such manipulations would not be necessary if the Refugee Act of 1980 were amended to encompass the Handbook’s interpretation of the U.N. Protocol.
The interpretative guidelines to the U.N. Protocol, and derivatively to the Convention, call for a “conscientious objector” exception to military service. The grant of refugee status to individuals who prove “valid reasons of conscience,” even reasons distinct from religious claims, recognizes that fitting an individual within the protections of the refugee definition requires a judgment on the means other nations use to implement their policy ends, not just the ends themselves. Rather than relying solely on the five narrow grounds for granting asylum that were developed in response to the atrocities of World War II, the U.N. Protocol, as interpreted by the Handbook, also advocates protection for the individual persecuted by virtue of mandatory participation in a military service with which he morally disagrees. Because the debate regarding coercive population control considers the legitimacy of means employed in achieving governmental policy objectives, the logic of the conscientious objector exception also applies to claims such as that of Chang.
Extract The case is of interest to doctors, but not because it deals with midwifery and its legality in Canada – the Supreme Court decision is silent on that point. At issue was the status of the human fetus: Is a full-term human fetus that is partially born a person in the eyes of the criminal law? The court decided it is not. . . . The Supreme Court has decided this case on very narrow legal grounds and it has carefully avoided coming to grips with the issue of whether a fetus is a person in the eyes of the law. This is not surprising. On several occasions, such as cases involving Morgentaler5 and Daigle,6 the Supreme Court has made clear that the status of the fetus should not be resolved in court – the court is not prepared to do Parliament’s work.
