[DRAFT] Conscience Rights in Healthcare

[Auralia]

Conscience Rights in Healthcare
Category: Human Rights | Strength: Significant

Recognizing that certain healthcare practitioners and facilities object to some forms of health care that they sincerely believe to be unethical, harmful, or otherwise contrary to good medical practice,

Believing that it benefits nobody to drive skilled doctors and nurses from the medical profession by coercing them to act contrary to their well-formed medical judgement,

Seeking to provide adequate protection for the conscience rights of healthcare practitioners and facilities in member states,

The General Assembly,

1. Defines, for the purposes of this resolution, the following terms:
   
   1. "health care practitioner" as any individual who is employed or contracted to provide or assist in the provision of health care, such a physician, nurse, or pharmacist, and
   2. "health care facility" as any business, non-profit institution, or other organization established for the purpose of providing health care, such as a hospital or pharmacy;
2. Prohibits member states from:
   
   1. requiring any health care practitioner, or private health care facility, to provide or assist in the provision of specific forms of health care in cases where:
      
      1. the practitioner or facility would otherwise have a duty to provide or assist in the provision of such care pursuant to government regulation, an employment agreement, or a contract, and
      2. the practitioner or facility sincerely objects to the provision of such care as unethical, harmful, or otherwise contrary to good medical practice,
   2. punishing or otherwise discriminating against a practitioner or facility for refusing to provide or assist in the provision of such care in such circumstances;
3. Exempts from the protections of this resolution health care practitioners and facilities who:
   
   1. fail to provide reasonable notice of their objections to appropriate parties, as required by law, in advance of refusing to carry out their duties,
   2. object to providing emergency care in cases where death is both probable and imminent if it is not provided, or
   3. object to performing the majority of the duties for which they are employed or contracted;
4. Reminds member states that the provisions of this resolution are without prejudice to any duty to provide or make available certain forms of health care under World Assembly law, but that member states may not contravene the provisions of this resolution in order to fulfill such duty.

[Alsace and Lorraine United]

You have the support of Alsace and Lorraine United! A very well written draft ambassador. Your time here has served you well!

[United Massachusetts]

ii. the practitioner or facility sincerely objects to the provision of such care as unethical, harmful, or otherwise contrary to good medical practice,

What if a health care worker is opposed to providing treatment on questionable grounds (ie. support for eugenics), or views the provision of health care to, for instance, racial minorities to be harmful (to the society as a whole)? Would such objections fall outside the domain of "good medical practice" (I presume, but must check)--is "good medical practice" a broad enough term?

Reminds member states that the provisions of this resolution are without prejudice to any duty to provide or make available certain forms of health care under World Assembly law, but that member states may not contravene the provisions of this resolution in order to fulfill such duty.

Note taken. Note appreciated.

[Kenmoria]

"This is a proposal we can support,"

[Separatist Peoples]

"I would limit this to medical practitioners, and not entire facilities. Organizations do not have a conscience, and this requirement should extend only as far as those entities with consciences. Further, there are policy issues that abound with extending it to organizations. The only hospital in a rural area should not be able to deny patients treatment when there are doctors on staff willing to offer that treatment. Otherwise, I find this quite reasonable. It strikes a very fair balance between personal objections and patient needs."

[United Massachusetts]

"I would limit this to medical practitioners, and not entire facilities. Organizations do not have a conscience, and this requirement should extend only as far as those entities with consciences. Further, there are policy issues that abound with extending it to organizations. The only hospital in a rural area should not be able to deny patients treatment when there are doctors on staff willing to offer that treatment. Otherwise, I find this quite reasonable. It strikes a very fair balance between personal objections and patient needs."

"I dissent. Catholic medical institutions should not be compelled to provide abortion services."

[Imperium Anglorum]

Regarding the above from UM. No. And I think I’ve the votes to enforce it.

[United Massachusetts]

Regarding the above from UM. No. And I think I’ve the votes to enforce it.

"How tolerant of you. Please be assured that you will be placed in our weekly prayer bulletin, and that our prayer shawl group will sew a special patch for the spiritual conversion of Imperium Anglorum."

[Imperium Anglorum]

Elsie Mortimer Wellesley: To what were you responding? However that is, our government may be replaced in the next few months. There’s clamouring in the Parliament for elections. And the premier is unclear on whether we will be returned.

You’ll be happy that the polls show a fundamentalist party winning, advocating the elimination of all religious forms other than Anglicanism, some drivel about being a threat to the polity and the state. Absolute rubbish.

[United Massachusetts]

Elsie Mortimer Wellesley: To what were you responding? However that is, our government may be replaced in the next few months. There’s clamouring in the Parliament for elections. And the premier is unclear on whether we will be returned.

You’ll be happy that the polls show a fundamentalist party winning, advocating the elimination of all religious forms other than Anglicanism, some drivel about being a threat to the polity and the state. Absolute rubbish.

"Rebels," grumbles the Cardinal. "Divorce-hungry nationalist rebels."

[Separatist Peoples]

"I would limit this to medical practitioners, and not entire facilities. Organizations do not have a conscience, and this requirement should extend only as far as those entities with consciences. Further, there are policy issues that abound with extending it to organizations. The only hospital in a rural area should not be able to deny patients treatment when there are doctors on staff willing to offer that treatment. Otherwise, I find this quite reasonable. It strikes a very fair balance between personal objections and patient needs."

"I dissent. Catholic medical institutions should not be compelled to provide abortion services."

"Glad to see you're willing to deny people lawful medical care under WA law, despite having doctors and staff willing to provide it. I'm sure that the busilding's conscience will be much assuaged." Bell rolls his eyes. "Bloody cultists."

[Desmosthenes and Burke]

"I dissent. Catholic medical institutions should not be compelled to provide abortion services."

"Glad to see you're willing to deny people lawful medical care under WA law, despite having doctors and staff willing to provide it. I'm sure that the busilding's conscience will be much assuaged." Bell rolls his eyes. "Bloody cultists."

One could sidestep this entirely if we recognized that Catholic Institutions ought not be required to hire so-called doctors who are willing to perform on-demand abortion in the first place. Of course, I suspect Mssrs. Bell and Wellesley find that objectionable as well. Tolerance is not known to be amongst their virtues, after all.

[Christian Democrats]

We support this proposal but would like to see another exemption added:

Exempts from the protections of this resolution health care practitioners and facilities who:

• object to providing emergency medical treatment in cases where, due to some physical injury or disease, death is both probable and imminent if treatment is not provided.

[Separatist Peoples]

"Glad to see you're willing to deny people lawful medical care under WA law, despite having doctors and staff willing to provide it. I'm sure that the busilding's conscience will be much assuaged." Bell rolls his eyes. "Bloody cultists."

One could sidestep this entirely if we recognized that Catholic Institutions ought not be required to hire so-called doctors who are willing to perform on-demand abortion in the first place. Of course, I suspect Mssrs. Bell and Wellesley find that objectionable as well. Tolerance is not known to be amongst their virtues, after all.

"Tolerance of a bad thing is not beneficial. I've yet to see evidence that religion is anything but bad.

"Such a hiring practice would likely violate CoCR as it is applied. Such moral objections tend to fall along protected classifications."

[Desmosthenes and Burke]

One could sidestep this entirely if we recognized that Catholic Institutions ought not be required to hire so-called doctors who are willing to perform on-demand abortion in the first place. Of course, I suspect Mssrs. Bell and Wellesley find that objectionable as well. Tolerance is not known to be amongst their virtues, after all.

"Tolerance of a bad thing is not beneficial. I've yet to see evidence that religion is anything but bad.

"Such a hiring practice would likely violate CoCR as it is applied. Such moral objections tend to fall along protected classifications."

We would consider a religious body hiring only members of its religion for ministerial positions (and we believe the Roman Catholic cult considers the medical staff of its hospitals to be ministerial positions bound by the ethical guidelines of the relevant Bishops' Conference) as being a compelling practical purpose. Certainly we would expect the Priests of Hera to hire only women who are followers of the Cultus Romanorum to administer its rights.

[Auralia]

I have removed clause 3(c) as I believe it is redundant in light of 2(a)(ii).

What if a health care worker is opposed to providing treatment on questionable grounds (ie. support for eugenics), or views the provision of health care to, for instance, racial minorities to be harmful (to the society as a whole)? Would such objections fall outside the domain of "good medical practice" (I presume, but must check)--is "good medical practice" a broad enough term?

If a health care professional sincerely believes that health care is unethical, harmful, or otherwise contrary to good medical practice, they are protected by this resolution in refusing to provide such care.

"I would limit this to medical practitioners, and not entire facilities. Organizations do not have a conscience, and this requirement should extend only as far as those entities with consciences.

Organizations are owned and operated by individuals with consciences, and their consciences continue to bind them in such contexts.

Further, there are policy issues that abound with extending it to organizations. The only hospital in a rural area should not be able to deny patients treatment when there are doctors on staff willing to offer that treatment.

The same argument can be made with respect to individuals: what if there is only one doctor in a rural area? The solution is the same in both cases: hire more doctors and establish more facilities willing to provide such care. I suppose the state could also expropriate facilities where necessary.

We support this proposal but would like to see another exemption added:

Exempts from the protections of this resolution health care practitioners and facilities who:

• object to providing emergency medical treatment in cases where, due to some physical injury or disease, death is both probable and imminent if treatment is not provided.

Done.

"Such a hiring practice would likely violate CoCR as it is applied. Such moral objections tend to fall along protected classifications."

If a hospital would be compelled to provide access to abortion by hiring individuals who are willing to perform abortions, that seems like a compelling practical purpose to refuse to employ such individuals.

Martin Russell
Chief Ambassador, Auralian Mission to the World Assembly

[Sierra Lyricalia]

"The Christian Democratic delegation addressed the biggest flaw in this draft, and we applaud the change. However, I have to concur with Ambassador Bell that permitting an organization which is a public accommodation (such as a hospital) to deny its practitioners the right to perform procedures to which the institution somehow objects is unacceptable. It is within neither the spirit nor the letter of GAR 35 to allow a medical institution the ability to base hiring decisions on individual beliefs about the propriety of treatment of consenting adult patients. Decisions regarding treatment are the exclusive province of a patient and his doctor, and institutional objections do not enter the picture outside of criminal or civil liability concerns."

Leo takes a sip.of water after this lengthy statement.

"In short we deny the power of institutions, whether seen as faceless monoliths or as the collective choices of individuals, to dictate their employees' beliefs and actions to that extent."

OOC: I don't see how enabling a nominally (e.g.) Catholic hospital, treating the general population, to dictate that every practitioner it employs must believe every last tenet of the catechism, constitutes a compelling practical purpose. Certainly I would have found it unbelievably unpleasant to have been denied entry to see my then-girlfriend who was passing a kidney stone at 3 a.m. simply because we were still several years away from marriage. There may be purpose there, it may even be compelling in some lights, but practical it ain't.

[Christian Democrats]

OOC: I don't see how enabling a nominally (e.g.) Catholic hospital, treating the general population, to dictate that every practitioner it employs must believe every last tenet of the catechism, constitutes a compelling practical purpose. Certainly I would have found it unbelievably unpleasant to have been denied entry to see my then-girlfriend who was passing a kidney stone at 3 a.m. simply because we were still several years away from marriage. There may be purpose there, it may even be compelling in some lights, but practical it ain't.

OOC: The Catholic Church doesn't prohibit dating, and visiting a patient isn't a medical procedure.

[Separatist Peoples]

Organizations are owned and operated by individuals with consciences, and their consciences continue to bind them in such contexts.

"And those individuals need not perform abortions."

The same argument can be made with respect to individuals: what if there is only one doctor in a rural area? The solution is the same in both cases: hire more doctors and establish more facilities willing to provide such care. I suppose the state could also expropriate facilities where necessary.

"Individual practitioners are more numerous than facilities. It's less likely that there is only one doctor in a region than only one hospital. As a matter of policy, making the distinction is reasonable. That is, regrettably, a deal-breaker for my delegation."

If a hospital would be compelled to provide access to abortion by hiring individuals who are willing to perform abortions, that seems like a compelling practical purpose to refuse to employ such individuals.

"I struggle to see a compelling practical purpose in circumventing a law that permits abortion when abortion is more or less carte blanche legal per WA law."

[Sierra Lyricalia]

OOC: The Catholic Church doesn't prohibit dating, and visiting a patient isn't a medical procedure.

OOC: I stand corrected then (though I think the classical term is "living in sin"). I worried a bit at the time, it being the middle of the night and me not knowing what the hell was happening.

Anyway, personal anecdote aside, the principle stands.

[The Unfounded]

"We tentatively support this resolution, however we would suggest an addendum the spirit of which is thus: Alternative Practitioners must be available and equally accessible to those that pose conscientious objection to such controversial procedures."

"Or would that already be accounted for in previous legislation? The overlap rules are sometimes blurry on the issue."

[Kowani]

Agreeing with The Unfounded above. If you’re going to allow them to not perform treatment based on subjective ethics, then mandating for the addition of specialists who can do the job should be done as well. However, the institution/individual debate is a good point: what if the only institution in the area refuses to hire someone because they have no problem completing certain procedures? Do we force them to hire? So many states have Affirmative Action laws put into place, but this opens up a new can of worms; ideological rulings.

[United Massachusetts]

"In short we deny the power of institutions, whether seen as faceless monoliths or as the collective choices of individuals, to dictate their employees' beliefs and actions to that extent."

"You are correct in the former conclusion, Ambassador, but not in the latter. A private medical institution has every right to determine what care it is to provide or condone in its premises. If it makes known to prospective employees well in advance what services in will not provide, then the employee has fundamentally consented to such terms by signing up to work in that institution. A private institution cannot discriminate in hiring practices by belief, but the employees have the right to choose for which institution to work. Freedom of Contract is the fundamental right at play here--denying the right of private organisations to choose which services to provide is an egregious violation of said freedom."

"We tentatively support this resolution, however we would suggest an addendum the spirit of which is thus: Alternative Practitioners must be available and equally accessible to those that pose conscientious objection to such controversial procedures."

"Or would that already be accounted for in previous legislation? The overlap rules are sometimes blurry on the issue."

"Does equally accessible refer to cost access? Who would provide said access? Based on what you said, it sounds like the burden would fall on the private institution to make the practitioner equally accessible (ie. travel costs). It sounds like your text would make Catholic hospitals pay to transport people to abortion clinics when they are further away. In a rural region, where said Catholic hospital is perhaps the only medical institution nearby, these transport costs are very real."

[The Unfounded]

"In short we deny the power of institutions, whether seen as faceless monoliths or as the collective choices of individuals, to dictate their employees' beliefs and actions to that extent."

"You are correct in the former conclusion, Ambassador, but not in the latter. A private medical institution has every right to determine what care it is to provide or condone in its premises. If it makes known to prospective employees well in advance what services in will not provide, then the employee has fundamentally consented to such terms by signing up to work in that institution. A private institution cannot discriminate in hiring practices by belief, but the employees have the right to choose for which institution to work. Freedom of Contract is the fundamental right at play here--denying the right of private organisations to choose which services to provide is an egregious violation of said freedom."

"We tentatively support this resolution, however we would suggest an addendum the spirit of which is thus: Alternative Practitioners must be available and equally accessible to those that pose conscientious objection to such controversial procedures."

"Or would that already be accounted for in previous legislation? The overlap rules are sometimes blurry on the issue."

"Does equally accessible refer to cost access? Who would provide said access? Based on what you said, it sounds like the burden would fall on the private institution to make the practitioner equally accessible (ie. travel costs). It sounds like your text would make Catholic hospitals pay to transport people to abortion clinics when they are further away. In a rural region, where said Catholic hospital is perhaps the only medical institution nearby, these transport costs are very real."

“If this is a very real issue to you, and to the writer of this legislation, then we formally withdraw our support for this legislation and would pose a legality challenge in that it violates the section of GAR 286 that prohibits implementation of impediments to accessibility for such procedures. Your doctors are fully welcome to their conscientious objections, but if there is not an equally accessible alternative available, then professional obligation outweighs personal.”

[Auralia]

It is within neither the spirit nor the letter of GAR 35 to allow a medical institution the ability to base hiring decisions on individual beliefs about the propriety of treatment of consenting adult patients.

This has nothing to do with individual beliefs of practitioners, but whether they are permitted to force the hospital to permit the use of hospital resources in order to act upon those beliefs.

Decisions regarding treatment are the exclusive province of a patient and his doctor, and institutional objections do not enter the picture outside of criminal or civil liability concerns."

I completely disagree. Institutions are established for certain purposes, and employees of an institution can reasonably be expected to act in a manner consistent with those purposes. This is no less true for hospitals and other medical institutions. Your proposed approach would bar most religious organizations from owning or operating hospitals.

If a physician wants to provide access to abortions, he has that right under World Assembly law. But the physician has no right to force a Catholic hospital to allow the physician to perform abortions on the premises of the hospital or to use hospital resources in doing so.

I don't see how enabling a nominally (e.g.) Catholic hospital, treating the general population, to dictate that every practitioner it employs must believe every last tenet of the catechism, constitutes a compelling practical purpose.

((OOC: As I said, there is a distinction between requiring medical practitioners to be Catholics and requiring them to refrain from using hospital resources to engage in acts which the hospital deems contrary to the moral law. The former is not reasonable, but the latter certainly is.))

Certainly I would have found it unbelievably unpleasant to have been denied entry to see my then-girlfriend who was passing a kidney stone at 3 a.m. simply because we were still several years away from marriage. There may be purpose there, it may even be compelling in some lights, but practical it ain't.

((OOC: What do visitation rights have to do with permitting abortions, sterilizations, or other such procedures in Catholic hospitals?))

"And those individuals need not perform abortions."

They shouldn't be compelled to provide the space or medical equipment used to perform them, either.

"Individual practitioners are more numerous than facilities. It's less likely that there is only one doctor in a region than only one hospital. As a matter of policy, making the distinction is reasonable. That is, regrettably, a deal-breaker for my delegation."

If the state wishes to ensure access to abortions in a particular region, they can do so by establishing their own clinic.

"I struggle to see a compelling practical purpose in circumventing a law that permits abortion when abortion is more or less carte blanche legal per WA law."

I struggle to see how not forcing individuals or institutions to participate in abortion is "circumventing" the legality of abortion. Just because abortion is legal does not mean there is a personal obligation to perform it or otherwise participate in it.

"We tentatively support this resolution, however we would suggest an addendum the spirit of which is thus: Alternative Practitioners must be available and equally accessible to those that pose conscientious objection to such controversial procedures."

The final clause of this proposal makes clear that this proposal does not affect any World Assembly mandate that a particular medical procedure be made available. The implication is that member states must take appropriate steps to find practitioners who do not object to the performance of such procedures and establish public institutions where such procedures can be performed.

Martin Russell
Chief Ambassador, Auralian Mission to the World Assembly-