Protection of Conscience Project Library
Service, not Servitude
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Real medical care and services always respect human
life. No one should be forced to collaborate in abortion (even when it is achieved through the prevention of implantation), lethal research on embryos, euthanasia, or assisted suicide.
Castro O, Lombardo FA, Gordeuk VR. (Correspondence) The Celestial Fire of Conscience. N Engl J Med. 2005 Sep 22;353(12):1301.
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. . . In medical and legal opinion, Terri Schiavo’s cognizance of her self and her life ended in 1990, when she suffered a cardiac arrhythmia and massive cerebral cortical encephalopathy that left her in a persistent vegetative state. Her facial expressions, along with a seemingly “normal” sleep–wake cycle, constituted but one dimension of the cruelty of this condition. . .
. . .More than one commentator has viewed the “right- to-life” fight to prolong Schiavo’s pitiable existence as an anti-abortion campaign “by other means.” . . .
. . . there seems little doubt that, in North America, ideology and religion have begun to seriously distort the type of consensus-building that is the proper business of democratic politics . . .
Where do physicians find themselves in such debates? Medicine is a secular and scientific profession that, for all that, must still contend with the sacred matters of birth, life and death. In practice, physicians must set aside their own beliefs in deference to the moral autonomy of each patient — or else transfer that patient’s care to someone who can meet this secular ethic. . .
. . .The emotionalism and rancour that swirled around the Schiavo case underscores a wider societal duty borne by the medical and scientific community. This is to remain alert to political and legislative tendencies that impose imprecise moral generalizations on the majority, at the expense of reason, scientific understanding and, not infrequently, compassion.
CMAJ. (Editorial) The sacred and the secular: the life and death of Terri Schiavo. Can. Med. Assoc. J.. 2005 Apr 26;172(9):1151.
Abstract
In this essay I shall describe and analyse the current debate on physician assisted suicide in contemporary German Protestant church and theology. It will be shown that the Protestant (mainly Lutheran) Church in Germany together with her Roman Catholic sister church has a specific and influential position in the public discussion: The two churches counting the majority of the population in Germany among their members tend to ‘‘organize” a social and political consensus on end-of-life questions. This cooperation is until now very successful: Speaking with one voice on end-of-life questions, the two churches function as the guardians of a moral consensus which is appreciated even by many non-believers. . .I shall argue that it will be necessary to go beyond this actual controversy to the works of Gerhard Ebeling and Karl Barth for a clear and instructive account of conscience and a theological analysis of the concepts of life and suicide. On the basis of their considerations, a conscience-related approach to physician assisted suicide is developed.
Bartmann P. Physician-Assisted Suicide and Euthanasia: German Protestantism, Conscience, and the Limits of Purely Ethical Reflection. Christ Bioet. 2003;9(3):203-225.
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This case concerns the justification of moral constraints that a physician group decides to apply to itself in the provision of patient services. Family physicians confront this issue with regard to reproductive medical services and state laws such as those in Oregon regarding physician-assisted suicide. Whether such constraints are ethically justified depends on the distinction between professional medical ethics and individual conscience.
Chervenak FA, McCullough L. A Group Practice Disagrees About Offering Contraception. Am Fam Physician. 2002 Mar 15;65(6):1230-1233.
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In the first part of this article the input of palliative care organisations in the Dutch euthanasia debate is described and explained by situating it in its broader context. First opinions on euthanasia of a variety of palliative care organisations are described. Secondly the Dutch debate on palliative care and euthanasia is analysed and evaluated. In a second part of this article a brief introduction to Belgian palliative care is given. This introduction is followed by an overview of the way organised palliative care has been active in the Belgian euthanasia debate. Attention too is given to the Belgian discussion on palliative sedation, sedation being presented by some as the palliative alternative to euthanasia but seen by others as nothing but euthanasia in disguise
Broeckaert B, Janssens R. Palliative Care and Euthanasia: Belgian and Dutch Perspectives. Ethical Perspectives 9(2-3); 2002 Feb 01, 156-175
Abstract
Op 20 maart 2001 werd het euthanasiewetsvoorstel van de meerderheidspartijen, samen met een wetsvoorstel over palliatieve zorg, goedgekeurd door de Verenigde Commissies voor Justitie en Sociale Aangelegenheden. Op initiatief van de Senaatsvoorzitter werd het euthanasiewetsvoorstel intussen doorgestuurd naar de Raad Van State, voor een spoedadvies. In zijn advies (2 juli 2001) stelt de Raad Van State uitdrukkelijk dat het euthanasiewetsvoorstel niet in strijd is met artikel 2 van het Europees Verdrag over de Rechten van de Mens (EVRM) en artikel 6 van het Internationaal Verdrag inzake Burgerlijke en Politieke Rechten (IVBPR), artikels die handelen over het door de wet beschermde recht op leven. Wat betreft het euthanasievoorstel beperkt de Raad van State zich tot detailkritiek.
In de bespreking van het wetsvoorstel over palliatieve zorg is de toon heel anders: hier toont de Raad Van State zich bijzonder kritisch. Vragen worden onder meer gesteld bij de vaagheid van de term palliatieve zorg, bij gecontroleerde sedatie en bij de federale bevoegdheid wat betreft de palliatieve zorg. Na het zomerreces is het nu (van 23 tot 25 oktober 2001) aan de plenaire vergadering van de Senaat om zich over het euthanasiewetsvoorstel uit te spreken.
Met de onderstaande tekst (26 september 2001) wil de Federatie Palliatieve Zorg Vlaanderen haar voorstel om in de euthanasieprocedure een palliatieve filter in te bouwen nogmaals onder de aandacht van de Senatoren brengen.
[Translation] On March 20, 2001, the euthanasia bill proposed by the majority parties, along with a bill on palliative care, was approved by the United Committees on Justice and Social Affairs. At the initiative of the Senate President, the euthanasia bill has now been forwarded to the Council of State for urgent advice. In its advice (July 2, 2001), the Council of State expressly states that the euthanasia bill does not conflict with Article 2 of the European Convention on Human Rights (ECHR) and Article 6 of the International Covenant on Civil and Political Rights ( ICCPR), articles dealing with the right to life protected by law. With regard to the euthanasia proposal, the Council of State restricts itself to detailed criticism.
In the discussion of the bill on palliative care, the tone is very different: the Council of State is particularly critical here. Questions are asked about the vagueness of the term palliative care, about controlled sedation and about the federal competence with regard to palliative care. After the summer recess, it is now (from 23 to 25 October 2001) up to the plenary session of the Senate to pronounce on the euthanasia bill.
With the text below (September 26, 2001), the Federation Palliative Care Flanders wants to bring its proposal to include a palliative filter in the euthanasia procedure once again to the attention of the Senators.
Broeckaert B. Federatie Palliatieve Zorg Vlaanderen Pleit Voor Een Palliatieve Filter in de Euhanasie Procedure (Flanders Palliative Care Federation Advocates A Palliative Filter in the Euthanasia Procedure). Ethische perspectieven. 2001;11(3):171-176.
The purpose of this paper is to address how analysts and commentators approach the relationship between abortion law and law governing medically assisted death, discussion of which is here limited to assisted suicide and voluntary active euthanasia. The issue of involuntary euthanasia or “mercy killing” of non-consenting persons is beyond the present discussion. This paper is further limited to English language literature, and to legal experience and commentary primarily from the United States of America, Britain and Canada, although reactions to developments in the Netherlands are included. Attention will be directed initially to legal and related analysts and commentators who oppose legalization both of abortion and of medically assisted death, and who resist application of the reasoning that supported decriminalization of abortion to medically assisted death. They represent the socalled Pro-Life protagonists in the debate. Language is often employed instrumentally in the conduct of the disagreement, but the practice adopted here is to refer to protagonists by the titles they give themselves.
Second, attention will be given to adherents to the so-called pro-choice position, who favor both liberalized abortion laws and tolerance of medical means by which individuals may end their own lives when they find survival excessively painful, burdensome, or undignified. Consideration is then given to those who oppose liberal abortion laws, perhaps because of fetal vulnerability, but who consider that non-vulnerable, competent persons, such as terminal patients in unrelievable distress, should be legally entitled to assistance in dying. The reverse is then addressed, concerning those who favor women’s choice on abortion, but oppose medically assisted death because, for instance, it may be exploitive of disabled patients or violative of ethical duties that health care professionals owe patients. In conclusion, it will be proposed that reconciliation of opposing views may be approached through promotion of choice, both to continue unplanned pregnancy and burdensome life, through availability of options that individuals may be encouraged and supported, but not coerced, to adopt.
Dickens BM. The Continuing Conflict between Sanctity of Life and Quality of Life: From Abortion to Medically Assisted Death. Annals NY Acad Sciences 2000 Sep;913:88-104
Abstract
Background and Methods
The characteristics and frequency of clinical problems with the performance of euthanasia and physician-assisted suicide are uncertain. We analyzed data from two studies of euthanasia and physician-assisted suicide in the Netherlands (one conducted in 1990 and 1991 and the other in 1995 and 1996), with a total of 649 cases. We categorized clinical problems as technical problems, such as difficulty inserting an intravenous line; complications, such as myoclonus or vomiting; or problems with completion, such as a longer-than-expected interval between the administration of medications and death.
Results
In 114 cases, the physician’s intention was to provide assistance with suicide, and in 535, the intention was to perform euthanasia. Problems of any type were more frequent in cases of assisted suicide than in cases of euthanasia. Complications occurred in 7 percent of cases of assisted suicide, and problems with completion (a longer-than-expected time to death, failure to induce coma, or induction of coma followed by awakening of the patient) occurred in 16 percent of the cases; complications and problems with completion occurred in 3 percent and 6 percent of cases of euthanasia, respectively. The physician decided to administer a lethal medication in 21 of the cases of assisted suicide (18 percent), which thus became cases of euthanasia. The reasons for this decision included problems with completion (in 12 cases) and the inability of the patient to take all the medications (in 5).
Conclusions
There may be clinical problems with the performance of euthanasia and physician-assisted suicide. In the Netherlands, physicians who intend to provide assistance with suicide sometimes end up administering a lethal medication themselves because of the patient’s inability to take the medication or because of problems with the completion of physician-assisted suicide.
Groenewoud JH, van der Heide A, Onwuteaka-Philipsen BD, Willems DL, van der Maas PJ, van der Wal G. Clinical Problems with the Performance of Euthanasia and Physician-Assisted Suicide in the Netherlands. N Engl J Med 2000; 342:551-556 February 24, 2000 DOI:10.1056/NEJM200002243420805
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Ask your pharmacist: It’s the ubiquitous slogan of the past decade, underscoring the campaigns of most national and provincial pharmacy organizations as they promote the value of pharmacy services. But what if the question is about RU-486, the abortion drug, or Preven, the morning-after-pill? What if the question is from a physician seeking information on terminal sedation or assisted suicide?
Such questions push, and often breach, an ethical boundary for some pharmacists, who find their desire to help the patient in conflict with their moral convictions. And the ethical quagmire is likely to get deeper as advocacy groups press the federal government to allow physician-assisted suicide and various health organizations promote greater access to emergency postcoital contraception.
If these practices compromise your moral convictions, could you be fired by your employer for refusing to fill a prescription? More specifically, is there a point at which your personal beliefs supersede your obligation to the patient? That’s the difficult question posed by an Alberta-based group called Concerned Pharmacists for Conscience, which has suggested a conscience clause to protect pharmacists in such situations.
Thatcher C. Conscience clause: moral compromise. Can Pharm J. 1999;132(7):10-11
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. . . In unanimous rulings last month, [United States] Chief Justice Rehnquist, writing for the court, held that there is no fundamental right to assistance in committing suicide1 and that, legally, distinguishing between refusing life saving medical treatment and requesting assistance in suicide “comports with fundamental legal principles of causation and intent.”
. . . Attempts to decriminalise assisted suicide in Britain have so far fallen well short of legislation.. . . Pressure groups in favour of voluntary euthanasia seem to accept that it will be difficult to achieve euthanasia legislation in one step but consider that assisted suicide represents a more attainable goal. From an opinion survey of Scottish doctors, the medical profession seems less resistant to assisting suicide than to practising euthanasia. . .
. . . it remains to be seen whether societal acceptance of physician assisted suicide will increase and how it will affect both social support for vulnerable and dying citizens and trust between patients and their doctors.
Churchill LR, King NMP. (Editorial) Physician assisted suicide, euthanasia, or withdrawal of treatment: Distinguishing between them clarifies moral, legal, and practical positions. Br Med J. 1997 Jul 19;315(7101):137-138.