Blog by-the-Sea

Pending Case about Doctors' Religious Freedom

A case called North Coast Women's Medical Group v. Benitez, now pending before the California Supreme Court, raises a question concerning a medical doctor's right to refuse to perform a medical procedure in violation of their religious beliefs under the First Amendment's freedom of religion.  The California Catholic Daily has an article about "amicus" (friend of the courts) briefs filed in support of the doctors.  The California Courts website provides a list of the briefs filed.

The Court of Appeal previously held that the doctor's could offer evidence that they refused to perform an intrauterine insemination (IUI) on an unmarried patient because their religious beliefs prohibited such a procedure for any married woman.  [You can download the Court of Appeal decision here:  Court of Appeal.PDF]  The patient contends that the doctors refused to perform the procedure because she told them she was a lesbian.  At the time when the doctors refused to perform the procedure, discrimination for sexual orientation was illegal by state statute, and discrimination for marital status was legal.

The issue before the Supreme Court is summarized as follows on the California Courts' website: "Does a physician have a constitutional right to refuse on religious grounds to perform a medical procedure for a patient because of the patient's sexual orientation, or do the provisions of the Unruh Act . . . preclude such discrimination in the provision of services notwithstanding the physician's religious beliefs?"

The Supreme Court has not yet scheduled argument in the case.

More U.K. Doctors Refusing to Perform Abortions

The U.K.'s Royal College of Obstetricians and Gynæcologists ("RCOG") issued a statement yesterday in response to an article published the same day in the Independent titled "Abortion Crisis as Doctors Refuse to Perform Surgery."  The article spoke of an "exodus" of doctors, who in increasing numbers are refusing to perform the procedure.  The reluctance of doctors and nurses to perform abortions has grown in recent years, such that it has become difficult to obtain an abortion through the public health care facilities.  At the same time, the demand for abortions has doubled since the 1970's, to a record high at the present time. The Independent thus stated:

"As a result, after decades of campaigning, anti-abortion organisations may be on the point of achieving their objective by default. Repeated efforts to tighten the law have failed and public opinion remains firmly in support, but the growing number of doctors refusing to do the work means there may soon not be enough prepared to carry out terminations to meet demand."

The RCOG's statement in response to the article affirmed that medical trainees increasingly opt out of training in abortion.  The statement also affirmed a doctor's right to refuse to perform such procedures, but also stated:

"The RCOG recognises that it is an important right for any doctor to object to performing abortion. The future of the sexual healthcare services requires careful workforce planning in order for abortion services to be available to the women who need it most."

How does one do "workforce planning in order for abortion services to be available to the women who need it most"?  Any plan to screen out medical school applicants who object to abortion on moral grounds would clearly violate First Amendment religious freedom in the United States, although that might be viewed differently in the U.K.  Women "who need it most" presumably means women who would have difficulty affording the expense of a private abortion clinic.  Would "workforce planning" mean restricting job opportunities in the public health-care system to doctors and nurses who have no moral objection to performing abortions?  In the U.S., discrimination in hiring based on a doctor's religious beliefs would also violate constitutional protections.

Nonetheless, a recent survey of U.S. doctors showing that 52% of American doctors oppose abortion for failed contraception (discussed in an earlier post) prompted a New York Times article speaking of doctors as failing their patients.  As discussed in the NEJM article that reported the survey results, students drawn to medical school often have strong religious views.

A Zenit article about the situation in the U.K. quotes Julia Millington of the U.K.'s ProLife Alliance, who said of young doctors, "Those choosing to go into medicine presumably do so because they want to cure sickness and disease, not end the lives of innocent human beings." 

The possibility of choosing medical students or hiring doctors for public health facilities based on their willingness to perform abortions raises the prospect of passing over the most qualified medical school applicants and those most likely to be motivated by charitable interest in helping others.  Long term, this would almost surely work contrary to the best interest of the same low income population intended whose interests would appear to be served.

The Right to Conscientious Objection

Today, the Pope spoke with the bishops of Europe in addressing a Congress on "50 Years After the Treaty of Rome: Values and Perspectives for the Europe of Tomorrow."  Tomorrow is the 50th anniversary of that treaty, which .  He spoke of progress over the past 50 years in Europe reconciling its "two lungs," East and West, and expressed concerns that by the demographics, Europe risks writing itself out of history by a process of unification that ignores the identity of the peoples of the continent.

Translations of his address are available from the Vatican, Zenit, Sandro Magister, and from Teresa Benedetta at Papa Ratzinger Forum.  I will add links to other translations as they become available.  Here is an excerpt from Teresa Benedetta's translation:

"In the present historical moment and in the face of the many challenges that characterize our time, the European Union - in order to be a valid guarantor of rights and an effective promoter of universal values - cannot but recognize clearly the existence of a stable and permanent human nature, which is the source of common rights for every person, including those who would deny those rights. In this context, the right to conscientious objection must be safeguarded every time fundamental human rights are violated."

52% of American Doctors Oppose Abortion

A January 13, 2007 editorial in the New York Times is titled "Doctors Who Fail Their Patients."  One might think it would be about American medical doctors with drug addiction problems, doctors who commit insurance fraud, or doctors who treat their patients as billing accounts more than as people.

But that is not what the editorial is about.

Instead, the editorial is a complaint about the doctors who do act on conscience.   The editorial states its complaint as follows:

"Now a new survey . . . by researchers at the University of Chicago, was published last week in The New England Journal of Medicine. The researchers mailed questionnaires to some 2,000 doctors asking whether they had religious or moral objections to three controversial practices. Of the 1,144 who responded, only 17 percent objected to “terminal sedation” to render dying patients unconscious, but 42 percent objected to prescribing birth control for adolescents without parental approval, and 52 percent opposed abortion for failed contraception.

"The encouraging news is that substantial majorities thought that doctors who objected to a practice nevertheless had an obligation to present all options and refer patients to someone who did not object. But that left 8 percent who felt no obligation to present all options and an alarming 18 percent who felt no obligation to refer patients to other doctors. Tens of millions of Americans probably have such doctors and are unaware of their attitudes."

Well, do atheist doctors ever refer Christian, Jewish or Muslim patients to doctors who do object to the procedures that many people of faith do not want?  Do they refer patients of faith to doctors who share the patient's opposition to birth control, for example, or do they, instead, give them a polite (or annoyed) look and a bill?  Whenever I have stated my religious preference in a medical office or hospital, I have never once had a health care office respond that the doctor I was about to see did not share my religion's views on an issue and that they could refer me to someone who did.

The medical journal article mentioned in the editorial is Religious, Conscience and Controversial Clinical Practices, authored by Farr A. Curline, M.D., et al, in the February 8, 2007 issue of the New England Journal of Medicine.  The article actually points out that medical doctors, under the laws of most states, are legally protected in their ability to act on their conscience in refusing to provide such controversial procedures as abortion.  Some of those protections now face challenges from people who do not want doctors to be free to act on conscience in modern medical care.  Of course, those people's concern is that they, as patients, want to have a doctor who will act in accordance with the patient's values.  So do I, and in my case that means I want to have a doctor who has a conscience and will act on it, not a doctor who feels as if he has to deliver a soul-less form of medical care with the exception of that pretense of holistic medicine that throws in a dose of touchy-feeliness with any bad news.
 
But aren't there more important aspects to the information shown in the journal article in question?

For one thing, how do the Portuguese pro-abortion advocates get away with telling the Portuguese people that if they want to be modern, they must legalize abortion for any reason up to 10 weeks of pregnancy when the New England Journal of Medicine shows that 52% of modern U.S. doctors oppose abortion for failed contraception?  Are 52% of American doctors all that backward?

Isn't it more likely the case that if 52% of the people most highly educated in life and death medical issues consider this procedure to be immoral, that society should take take notice, at least to the point of considering that view as a respectable educated opinion on a topic informed by medical expertise?

And do a majority of American doctors hold a somewhat pro-life view because people of faith are more likely to become doctors?  If so, then isn't that too worthy of comment?  If children who grow up in families of faith that hold pro-life views (including many Christian, Jewish and Muslim families), are more likely to become doctors, that presents a powerful message about the stability and motivation of such families.

Of the doctors shown in the survey, 36% were categorized as having  high "intrinsic religiosity".  46% of the surveyed doctors attend religious services twice a month or more, while only 10% never do so.  The breakdown of religious groups was 38% Protestant, 22% Catholic,16% Jewish, 14% other, and 10% none.  In comparison, about 20% of Americans reported that they had no religion, or that they were unwilling to answer a question about what their religion was, in the latest U.S. Census.

Of great importance, the journal article reports that most physicians support a balance  involving both full disclosure and open dialogue with their patients about options, in a manner that respects both the doctor's own values and those of the patient:

"This balance resembles the interactive models proposed by Emanuel and Emanuel, Quill and Brody,  Siegler, and Thomasma.  These ethicists have all recommended models for the doctor–patient relationship that retain the moral agency of both the physician and the patient by encouraging them to engage in a dialogue and negotiate mutually acceptable accommodations that do not require either of the parties to violate their own convictions. . . . [These models] allow physicians to explain the reasons for their objections to the requested procedures."

In addition, the study found that the differences among doctors about whether to refer patients to other doctors who are willing to provide a controversial treatment that they themselves are not willing to provide reflects the disagreement on that same issue within the field of bioethics.

The New York Times editorial, saying that such physicians "fail their patients", does not accurately reflect the journal article in question.  Other issues raised by that article merited more attention, including as the disagreement among physicians of what they can ethically do when handling controversial contemporary issues, and its affirmation that 52% of physicians are pro-life in the case of abortion for contraceptive failure.

Vote on "Religion Law" Friday in Moldova

Please pray about a vote scheduled for this Friday in Moldova's Parliament that would diminish religious freedom in that country.  The Law on Religious Cults ("Religion Law"), if it passes, will curtail the ability of religious minorities in that country to invite people to religious and evangelistic activities.

Christian Newswire reports that the Expert Committee on Legislation and Implementation of the Institute on Religion and Public Policy in Washington, D.C., has expressed concern that the draft Religion Law violates fundamental rights.  One article of the draft Law requires religious denominations that have ecclesiastical courts to submit their courts' regulations for approval by the State.  Another article allows the Government to ask a court to suspend and liquidate a denomination's activities or component parts that the Government says contravene the Religion Law, and suspension or liquidation could even result from minor offenses.   

The law will prohibit "abusive proselytism", which the law defines as "the action of changing the religious beliefs of a person or a group of persons through means of violence, abuse of authority, blackmail, threats, constraints, religious hatred, disinformation, psychological manipulation or subliminal techniques."  A missionary in Eastern Europe has asked for prayer about this vote, which potentially could prevent Christian organizations from inviting people to evangelistic activities.  There are concerns that terms like "disinformation", "psychological manipulation" and "subliminal techniques" are vague. Those descriptions could possibly be applied to such things as Protestant evangelistic sermons and  to people inviting friends to Christian sports activities.

Moldova is a former republic of the Soviet Union, situated by Ukraine and Romania.  Its Parliament's largest political party is a Communist party with an interest in the European Union.  Moldova is one of the poorest nations in Eastern Europe.  By far, most believing Moldovans are Russian Orthodox. More than 20,000 Catholics and 1,000 Baptists also live in Moldova.  Also, 1.5% of the population is Jewish.

Update Feb. 10: No one seems to know anything yet about Friday's debate in Moldova's parliament.  The discussion was behind closed doors, unlike debates in the U.S. and U.K. governments.  I looked for any news reports and found none.  They may not yet have actually voted.  Please continue to pray.  When something official is announced, I will update it here.

Inter-Faith Support on Contemporary Issues of the Family

New expressions of inter-faith agreement have recently addressed shared concerns about family and religious freedom.  The Diocese of Lyon website today posted a common agreement among Catholic, Anglican, Lutheran, Jewish and Muslim clergy on marriage.  Here is an English translation (by me):

Today, the question arises whether the law can authorize the marriage of two people of the same sex.  That is not a matter of a simple social debate, but of a major choice, without precedent in the history of humanity.  It is not a gift to be given to future generations.

There is already enough suffering caused by the fragility of family ties, not to speak of diseases that touch those close to us, and losses.  This fragility is for many in the difficulty that adults encounter in helping young people to build their lives.  How will they be able to acquire a solid formation, to face their future with confidence, to honour the obligations of a profession, and to build their own families in balance, if the institution of marriage is relativized?  It is paramount not to disturb this cornerstone of humanity.

Such an essential institution cannot be subjected to the fluctuations of currents of thought.  It is placed well beyond religious differences or ideological cleavages.  In an hour when so many teachers note the increasing difficulty for young people from broken families in following their scholarship correctly, can we really consider such an upheaval, the consequences of which could be devastation?  Experience shows what it is costing us today to have let nature be ransacked.  Let us not go on now to destroy humanity, which is the heart of all creation!

There is a lie to the claim that it does not matter whether or not a child grows up with a father and a mother.  Humanity’s foundational stories are built on the difference and the complementarity of man and woman.  The faithful see its attestation in the creation accounts that the Word of God transmits to them: "In the beginning, God created man and woman".  They are called to unite in marriage to give life and to make it grow.  Such is the original pedestal on which our personal lives, our families and our societies are founded.  Let us not forget that it is fragile!

Lyon, February 6, 2007

Cardinal Philippe BARBARIN, Archbishop of Lyon

Mr. Azzedine GACI, President of the Rhone-Alps Regional Council of the Muslim Faith

Father Athanase ISKOS, Priest of the Greek Orthodox Church

Mr. Kamel KABTANE, Rector of the Mosque of Lyon

Rev. Chris MARTIN, Minister of the Anglican Church

Pastor Jean-Frédéric PATRZYNSKI, of the Lutheran Church

Mr. Richard WERTENSCHLAG, Grand Rabbi of Lyon and of the Rhone-Alps Region

Pastor John WILSON, of the Evangelical Baptist Church

Msgr. Norvan ZAKARIAN, Bishop of the Armenian Apostolic Church

In similar mutual support, U.K. Muslim groups last week voiced support for the Catholic Church's request for the Catholic Adoption Agency to have an exemption from a new law that prohibits discrimination against gay couples in adoption services.  The new law will go into effect in April, and the Church will have 20 months before the law is scheduled to fully impact Catholic and other religious adoption agencies.  In the meantime, those adoption agencies will be required to refer any homosexual couple to an agency that provides adoption services to gay couples on an equal basis with heterosexual couples.

The U.K.'s Federation of Synagogues has also called on Jewish leaders to stand with Catholics and Anglicans on this issue, according to a U.K. Jewish website. 

Cardinal Cormac Murphy-O'Connor wrote a letter on January 22 asking for the exemption, followed by a January 31 article in the Telegraph about the issue.

Ruth Gledhill at the Times Online quoted Tom Wright, the Anglican Bishop of Durham, as follows, giving outspoken support to the call for religious freedom to be respected in connection with the new law:

"This completely fails to take into account the views and beliefs of all those involved. The idea that New Labour - which has got every second thing wrong and is backtracking on extended drinking hours, is in a mess over this cash-for-peerages business, cannot keep all its prisons under control - the idea that New Labour can come up with a new morality which it forces on the Catholic Church after 2,000 years - I am sorry - this is amazing arrogance on the part of the Government.

"Legislation for a nouveau morality is deeply unwise. That is not how morality works. At a time when the Government is foundering with so many of its policies - and I haven't even mentioned Iraq - the thought that this Government has the moral credibility to be able tell the Roman Catholic Church how to order one area of its episcopal teaching is frankly laughable. When you think about it like that, it is quite extraordinary. I suppose the hope is that in 18 months time there will be a different Prime Minister who might take a different view, and this will kick it into the long grass until then."

Rowan Williams, the Archbishop of Canterbury, said this last week about the issue's implications for religious freedom in the U.K.:

"I’ll wait to see I think what the period of negotiation that lies ahead will bring, to see whether the concerns of the Catholic Church has raised are going to be addressed. But what we’d most want to do is to disentangle two things. There’s a particular issue on which the Catholic church has taken a stand, as other Christians have; and there’s a general issue about the rights of the state and the rights of conscience especially in voluntary bodies. Now that second question is one that, I think, is by no means restricted to this issue. And I think it’s not going to go away, so I would like to see some more serious debate now about that particular question – what are the limits, if there are limits, to the State’s power to control and determine the actions of voluntary bodies within it, in pursuit of what are quite proper goals of non-discrimination. So I hope there’ll be a debate about that."

Cardinal Cormac Murphy-O'Connor's Article on Adoption Laws

The Archdiocese of Westminster has posted a copy of Cardinal Cormac Murphy-O'Connor's January 31 article in The Daily Telegraph, titled "Regulation Must Not Trump Conscience."  He wrote the article in response to the U.K.'s "Equality Act," which is expected to prohibit adoption agencies from refusing to place babies for adoption with homosexual couples. 

As that Act presently stands, it will not exempt Catholic adoption agencies from those requirements.  The new law allows a two year period to find a solution to the implications for religious adoption agencies, including Catholic agencies, that may not continue to function under the Act as presently anticipated.   Regulations on the details of the Act's implications have not yet been finalized. 

Here is an excerpt from the Cardinal's article:

"This debate will not go away. The detailed regulations, soon to be put forward, will be debated in Parliament. We look to those debates to address these fundamental points. How, as a society, do we understand and best provide parental care to meet the needs of children seeking adoption? How desirable are the complementary roles of father and mother? How can our society create the flexibility that is needed to promote mutually respectful co-operation between public authorities and the religiously motivated agencies, so they can work in public service with integrity and good conscience?

"The answers to these questions are essential as we seek to form a shared vision of what constitutes the common good."

On January 23, the Archbishops of Canterbury and York, Church of England, sent a letter to Prime Minnister Tony Blair supporting the Catholic Church's position on this issue.  The issue also affects other religious groups within the U.K., as it would constitute a precedent for the government to regulate the faith and practice of religions within its boarders, including those that do not constitute a "State Church" and issues of conscience and morality.

Science and Higher Values

Yesterday, the Pope addressed participants in the plenary assembly of the Pontifical Academy of Science.  An article with quotations is available from Asia News.  A transcript is available from the Vatican and Zenit.  Speaking in English, he considered the theme of faith and science.  Here is an excerpt:

"Science, however, while giving generously, gives only what it is meant to give. Man cannot place in science and technology so radical and unconditional a trust as to believe that scientific and technological progress can explain everything and completely fulfill all his existential and spiritual needs. Science cannot replace philosophy and revelation by giving an exhaustive answer to man's most radical questions: questions about the meaning of living and dying, about ultimate values, and about the nature of progress itself. For this reason, the Second Vatican Council, after acknowledging the benefits gained by scientific advances, pointed out that the "scientific methods of investigation can be unjustifiably taken as the supreme norm for arriving at truth", and added that "there is a danger that man, trusting too much in the discoveries of today, may think that he is sufficient unto himself and no longer seek the higher values" (ibid., 57)."

Rowan Williams in China

Rowan Williams, Archbishop of Canterbury and head of the Anglican Communion, completed a two-week visit to China yesterday.  The itinerary was posted on the Archbishop of Canterbury website.  Several of his addresses and sermons while in China are also posted there, including a sermon at Mu En Church Shanghai, Remarks at a Reception of Scholars in Nanjing, Speech on "What Is a University?", and a Sermon Preached at Chaoyang Church Beijing. 

P.I.M.E. Asia News has an article about hi's sermon in Beijing on Sunday, October 22.  That article has an excellent summary of major points of that sermon, including this:

“Christians must develop an inner freedom,” Archbishop Williams said, “a freedom that allows them to see the truth about themselves and their society.” He explained that only through inner freedom, gained through prayer and reflection, would Christians know what the country's real needs were. "It is very important there are people in this country with that kind of freedom, people who are able to say the question is not only about economic prosperity, [but] about human dignity," he added."

He spoke from the Sunday readings about Jesus becoming a servant, and several principles about the manner in which God becomes a servant.  Here are some excerpts from the sermon, dealing with Christianity in China becoming distinctively Chinese, the form of Christian freedom, and the importance of prayer and reflection:

"The church here has worked hard to make itself understood as part of China, its culture, its history, its hopes. It is no longer true, if it ever was true, that to be a Christian is to stop being really Chinese.  And so we are encouraged to see a church that is trying to find its own way forward honestly – find a language that really belongs in this place.  It is no kind of imposed Christianity, whether conservative or Liberal, that will answer the questions of China. It is the Gospel itself in its glory, taking root here.  So there is the first principle - service begins with identification.

"Here is the second principle; if that is true, the Christians must develop an inner freedom – a freedom that allows them to see the truth about themselves and the truth about the society they live in.  In prayer and reflection, inner freedom grows and when there is such inner freedom the Christian will be able to see what the real questions and the real needs are. . . .

"And here is the third principle – Jesus calls others into his world of service. Although he is God on earth, yet he calls human beings to join him in his work of transforming love.  And so it is that the church draws others into the words of the good news, as the church lets itself be drawn into cooperation with others."

The speech on 'What Is a University?" includes an interesting historical summary from Williams, the academic, who once taught history and theology including the Church Fathers and the 16th century Spanish mystics:

"Naturally, as the order of the old Roman Empire collapsed, in the fifth and sixth centuries after Christ, the ideals of this kind of education largely disappeared – at least in the terms that would have been recognised by earlier generations.  Some of it indeed survived in the eastern Mediterranean world, where the Greek-speaking Empire continued for some centuries to need educated public servants.  But in Western Europe, the only people left with any of the skills to run society in an age of huge political instability were the priests of the Christian Church.  Aspects and portions of the old system were used in the schools that grew up around the great monasteries and cathedrals of the West to train priests and other clergy. Now they were the ones who had to know how to read texts, to construct arguments and to speak convincingly – both so that they could teach in the churches and so that they could manage the business of the new kingdoms that were developing.

"As early as the late fourth century, the greatest Christian thinker of the period, Augustine of Hippo in Africa, had argued that Christians needed to learn how to read their Bible with the same sort of skill and attention and literary sophistication that others brought to the classics. So the interpretation of the Bible became, in a sense, the crown and climax of the process of ‘higher education’.  You would learn what a pagan Roman might have learned about logic and music and mathematics, about good and bad arguments and about the nature of proportion and harmony in different contexts; but then you would move on not only to philosophy but to theology, in which you were shown how to trace the connections and harmonies in the text of the Bible so as to defend the consistency and rationality of doctrines taught by the Church.  Not everyone would go on to that level, but the whole system was constructed on the assumption that theology would give you the key to how it all hung together.  The word ‘university’ dates from the Middle Ages; and it originally meant a universal course of studies recognised throughout the Christian world, so that anyone emerging from the courses of a ‘university’ institution was regarded as competent to teach in any other similar institution

"Just as the fall of the Roman Empire destroyed the old pattern, so the upheavals in the Christian Church in the sixteenth century and the great political changes that came with the newly centralised states of Europe gradually changed the universities of the Christian Middle Ages beyond recognition.  Although they still retained the character of training grounds for the clergy and for at least some of the legal professions, there was first of all a widening of the scope of the university to include once more the young men of ‘good family’ who were likely to play a significant role in public life; and then, especially on the continent of Europe, many new universities were established, often by local rulers, initially to train public officials, bureaucrats, in a common culture, though there was an increasing interest in pure research. While continental Europe developed along these lines, however, English universities experienced remarkably little structural change; they preserved a narrow focus on mathematics and the Greek and Roman classics until the latter part of the nineteenth century. But their role in shaping the ethos of a governing class was no less important. And of course as the political and social atmosphere of western societies altered with the greater public role of women, it was inevitable that for the first time women should be included (initially with great reluctance) in the processes of higher education)."