When Religious Belief Conflicts with Professional Obligation

Doctor's alleged refusal to treat lesbians sparks rights complaint
(PATRICK WHITE, The Globe and Mail, January 28, 2009)

WINNIPEG -- Andrea Markowski says she sensed the doctor's unease from the first waiting-room handshake.

She thought she'd been upfront about her background when she asked for a meet and greet with Dr. Karmeila Elias at Winnipeg's Lakewood Medical Centre.

It was pretty simple. She and her same-sex partner Ginette had just arrived from Yellowknife. They were looking for a good family doctor. Dr. Elias was accepting new patients. In a country where finding a GP can take months of agony, the match appeared to be a no-brainer.

But judging by the confused look Ms. Markowski she says she saw on Dr. Elias's face, nobody had mentioned their sexual orientation ahead of time.

"When I introduced myself and introduced Ginette as my partner, it took [the doctor] a little while to put it together. When she did, she looked really uncomfortable."

It was the beginning of an alleged incident that has prompted a human-rights complaint and raised thorny questions about how the Canadian medical system acculturates foreign-trained doctors.

There are an estimated 7,000 international medical graduates, or IMGs, in Canada. Most go through some form of cultural sensitivity training before earning a Canadian licence, but if Ms. Markowski's experience is in any way accurate, the primer falls short.

She says her encounter with Dr. Elias - who trained in Egypt and moved to Canada five years ago - turned for the worse when the trio retreated to an office.

"We started running through my medical history and [the doctor] could not look at me. She was flustered. She couldn't focus. I knew something was up, so I asked her, 'Is our sexual orientation an issue for you in terms of your ability to treat us?'"

Ms. Markowski alleges Dr. Elias soon confirmed her suspicions.

"She said, first thing, that it was against her religion, and second, that she had no experience caring for lesbian or gay patients."

After a terse discussion during which Ms. Markowski says she told the physician she needed "to be educated and get some help because her response was ill-informed," the couple left.

Offended by what they perceived as a blatant example of discrimination, the couple of 18 years say they lodged complaints with the College of Physicians and Surgeons of Manitoba and the Manitoba Human Rights Commission.

Article 7 of the College's Code of Conduct specifies that no patient shall be discriminated against on grounds of sexual orientation or any other Charter right.

After Ms. Markowski sent a copy of the complaint to the clinic, they quickly received an apology.

But that hasn't ended their efforts. "If we don't do something about this, someone else is going to get hurt," Ms. Markowski said. "The standards on this are very clear. Doctors must treat everyone who walks through the door."

Calls to Dr. Elias were referred to a lawyer yesterday, who questioned whether his client actually refused the couple as patients.

"Dr. Elias felt she should disclose to them her personal religious views," said Thor Hansell. "That was for the purpose of allowing them to make a decision of whether or not that might be relevant to them wanting her to become their doctor or not. That was perceived as a refusal to treat. I think that was unfortunate because that was not the intention."

Up until last year, IMGs in Manitoba took just one week of orientation. That was recently increased to four weeks, said Bill Pope, CEO and registrar of the College of Physicians and Surgeons, after it became apparent some foreign-trained physicians needed more cultural training.

"There were big issues that have to be dealt with," he said. "For example, male physicians cannot perform pelvic exams in some parts of the Middle East."

Dr. Pope said IMGs do receive training in the college's code of conduct, but couldn't say whether ethical issues around sexual orientation were ever taught.

"Obviously we'll have to reinforce this a little more in the future," he said.

But, according to one gay-rights organization, the issue spreads far beyond Manitoba's borders.

"We hear about this all too often," said Helen Kennedy, executive director of Egale. "It's disgraceful. Our governments have to be much more proactive about training basic human rights to physicians entering this country. Hopefully, from this some good can come."

To a degree, that change may be under way already.

"I will certainly see what I can do to make sure the college puts this on a higher burner," Dr. Pope said. "This is a serious issue. It's a breach of our code of ethics. We don't ever want to see this happen again."

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Doctor's alleged refusal to treat lesbians sparks rights complaint
(PATRICK WHITE, The Globe and Mail, January 28, 2009)

Ms. Markowski alleges Dr. Elias soon confirmed her suspicions.

"She said, first thing, that it was against her religion, and second, that she had no experience caring for lesbian or gay patients."

Rumors aside, FOCA legislation no threat to Catholic health care
(By Nancy Frazier O'Brien, Catholic News Service, January 27, 2009)

WASHINGTON (CNS) -- Internet rumors to the contrary, no Catholic hospital in the United States is in danger of closing because of the Freedom of Choice Act.

As a matter of fact, the Freedom of Choice Act died with the 110th Congress and, a week after the inauguration of President Barack Obama, has not been reintroduced.

But that hasn't kept misleading e-mails from flying around the Internet, warning of the dire consequences if Obama signs FOCA into law and promoting a "FOCA novena" in the days leading up to Inauguration Day.

The Catholic Health Association "is strongly committed to opposing FOCA and (the board) is unanimous that we would do all we could to oppose it," said Bishop Robert N. Lynch of St. Petersburg, Fla., an elected member of the CHA board of trustees since June 2006.

"But there is no plan to shut down any hospital if it passes," he added in a Jan. 26 telephone interview. "There's no sense of ominous danger threatening health care institutions."

Sister Carol Keehan, a Daughter of Charity who is CHA president and CEO, was equally sure that FOCA poses no threat to Catholic hospitals or to the conscience rights of those who work there.

"I don't believe that FOCA will pass, although we will continue to monitor all proposed regulations for their potential to help people in this country and for any negative assault on the life issues," she said.

As introduced in previous congresses, the legislation "has never contained anything that would force Catholic hospitals or Catholic personnel to do abortions or to participate in them," she added.

But even in a worst-case scenario, if the most dire predictions were to materialize and a federal law were to mandate that all hospitals provide abortion services, "I want to make it very clear that Catholic health care will not close and we will not compromise our principles," Sister Carol told Catholic News Service Jan. 26.

If necessary, Catholic hospitals will take a lesson from "how people have dealt with unjust laws" in American history, "and we would respond in the same way," she said.

"A very timely example" of that is segregation, which was backed up by U.S. laws and Supreme Court decisions that were unjust, Sister Carol said. "It was a very long and very painful journey to deal with that and now we have an African-American president," she added.

Some of the confusion over FOCA might arise from the fact that the U.S. Conference of Catholic Bishops launched a long-scheduled postcard campaign to Congress against the possible legislation just as the false Internet rumors were reaching a peak.

The postcards, which are being made available for Catholics to sign at Masses over several weekends in January and February, ask members of Congress to oppose FOCA "or any similar measure, and retain laws against federal funding and promotion of abortion."

"At this time of serious national challenges, Americans should unite to serve the good of all, born and unborn," the postcards say.

The FOCA novena e-mails, the source of which has not been identified, have a different tone entirely.

Calling the legislation "the next sick chapter in the book of abortion," the e-mails say it will force all hospitals to perform abortions, increase abortions by 100,000 annually and "could result in a future amendment that would force women by law to have abortions in certain situations (rape, Down syndrome babies, etc.) and could even regulate how many children women are allowed to have."

The rumors have spread like wildfire on blogs and Web sites. On the social networking site Facebook, three separate anti-FOCA groups with membership totaling nearly 130,000 (as of early Jan. 27) contain misinformation about what the so-far-nonexistent legislation would do.

Bishop Kevin W. Vann of Fort Worth, Texas, is "brand new as episcopal liaison" to the Catholic Health Association, a position he got in part because of his background as a medical technologist for three years in a Catholic hospital in Springfield, Ill., before he began his seminary studies.

"There is nothing definite yet about what is being introduced" in Congress, he told CNS Jan. 26. "But CHA is really committed to monitoring any proposed legislation and to upholding the sacredness of life in all our institutions."

Bishop Vann said the postcard campaign, run by the U.S. bishops' pro-life office and the National Committee for a Human Life Amendment, is getting a good reception from Catholics in his diocese.

"It's real simple," he said. "It's the voice of everyday folks expressing concern about FOCA in whatever form it comes."

contain misinformation

Bill would let doctors refuse to do abortions
(by Matthew Benson, The Arizona Republic, Feb. 11, 2009)

Arizona pharmacists who cite a moral objection could refuse to fill prescriptions for emergency contraception, according to legislation introduced this week at the state Capitol.

Similarly, the proposal - House Bill 2564 - would allow any hospital worker or health professional to refuse to participate in an abortion or dispense medication to abort a pregnancy.

For advocates of the legislation such as Ron Johnson of the Arizona Catholic Conference, it's a matter of "rights of conscience" for the health-care workers.

But opponents argue that the bill would place women at risk - especially in rural areas where pharmaceutical options are few and with emergency contraceptives that must be administered within 72 hours of unprotected sex.

"Women have far fewer options, especially when you're talking about rural areas," said House Minority Leader David Lujan, D-Phoenix. "As pharmacists, they have a professional duty. It's an issue of women's health and safety."

The prime sponsor of the legislation, state Rep. Nancy Barto, downplayed any hurdles the provision would represent.

"Certainly, people in rural areas are accustomed to traveling long distances for services," said Barto, R-Phoenix. "This isn't going to keep women from receiving these prescriptions."

Barto's legislation combines provisions from a handful of anti-abortion bills vetoed by former Gov. Janet Napolitano in past years. Among them, the proposal would:
• Require that minors seeking an abortion first receive written, notarized consent from a parent or guardian.
• Mandate a 24-hour "reflection period" before any adult woman could undergo the procedure.
• Bar any individual who is not a physician from performing a surgical abortion.

"We believe these are very common-sense, middle-of-the-road ideals that most Arizonans agree with," Johnson said.

Barto's proposal also would require the informed consent of any adult seeking an abortion.

That means the patient would have to be informed of alternatives to abortion, the medical risks associated with both having an abortion and carrying the fetus to term and the probable gestational age and physiological characteristics of their fetus. Also, the woman would have to be told of medical benefits and government assistance available pre- and post-natal.

"You don't need the Legislature to tell doctors how to help women with their medical health," said Pam Grissom, chairwoman of the board for a Tucson-based abortion-rights group known as Arizona List. "I think they're treating women like they don't have a brain of their own."

Barto suggested that, in many cases, women in Arizona inquire about an abortion and undergo the procedure in the same day - often without being told everything they should to make an informed decision.

Does she hope the 24-hour wait will result in a woman having second thoughts about a planned abortion? "Obviously I do," Barto said. "I would love for her to consider the ramifications of that choice."

Abortion opponents in the Legislature frequently found themselves at odds with Napolitano in recent years. The Democrat vetoed at least nine proposals limiting abortion since becoming governor in 2003.

But with Napolitano replaced by Republican Gov. Jan Brewer, Barto expressed hope that this will be the year the abortion restrictions are signed into law.

Brewer spokesman Paul Senseman wouldn't address the specifics of Barto's proposal, except to note that "the governor has a very consistent pro-life track record."

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Bill would let doctors refuse to do abortions
(by Matthew Benson, The Arizona Republic, Feb. 11, 2009)

Arizona pharmacists who cite a moral objection could refuse to fill prescriptions for emergency contraception, according to legislation introduced this week at the state Capitol.

Similarly, the proposal - House Bill 2564 - would allow any hospital worker or health professional to refuse to participate in an abortion or dispense medication to abort a pregnancy.

Obama Administration to Reverse Bush Rule on 'Conscience' Regulation
(By Rob Stein, The Washington Post, February 27, 2009)

The Obama administration has begun the process of rescinding sweeping new federal protections that were granted in December to health-care workers who refuse to provide care that violates their personal, moral or religious beliefs.

The Office of Management and Budget announced this morning that it was reviewing a proposal to lift the controversial "conscience" regulation, the first step toward reversing the policy. Once the OMB has reviewed the proposal it will be published in Federal Register for a 30-day public comment period.

"We are proposing rescinding the Bush rule," said an official with the Health and Human Services Department, which drafted the rule change.

The administration took the step because the regulation was so broadly written that it could provide protections to health-care workers who object not only to abortion but also to a wide range of health-care services, said the HHS official, who asked not to be named because the process had just begun.

"We've been concerned that the way the Bush rule is written it could make it harder for women to get the care they need. It is worded so vaguely that some have argued it could limit family planning counseling and even potentially blood transfusions and end-of-life care," the official said.

After the 30-day comment period, the regulation could be lifted entirely or it could be modified to make the protections more specific, the official said.

"We support a tightly written conscience clause. We recognize and understand that some providers have objections about abortion, and we want to make sure that current law protects them," the official said. "We want to be thoughtful about this."

The new rule empowers the federal government to cut off federal funding for any state or local government, hospital, health plan, clinic or other entity that does not accommodate doctors, nurses, pharmacists or other employees who refuse to participate in care they find objectionable. The Bush administration adopted the rule at the urging of conservative groups, abortion opponents and others in order to safeguard workers from being fired, disciplined or penalized in other ways.

Women's health advocates, family planning proponents, abortion rights activists and others condemned the regulation, saying it would create a major obstacle to providing many health services, including family planning, infertility treatment and end-of-life care, as well as possibly a wide range of scientific research.

The move marks the latest challenge to the Obama administration's attempt to find more of middle ground on issues related to abortion. President Obama has said repeatedly he hopes those on both sides of the issue can work to reduce the number of abortions by preventing unwanted pregnancies and by offering support to women who do get pregnant and want to continue their pregnancies.

That approach has already been tested. Obama angered abortion opponents when he lifted restrictions on federal funding for international family planning groups that promote abortion. The next closely watched decision will be whether Obama lifts federal restrictions on federal funding for human embryonic stem cell research.

Catholic Church slams new code of conduct forcing teachers to promote Islam and gay rights
(By Simon Caldwell, The Daily Mail, March 2, 2009)

The Roman Catholic Church has severely criticised a proposed new code of conduct for teachers which it says will force Christian schools to actively promote Islam and gay rights.

The Bishops’ Conference of England and Wales has warned the General Teaching Council, by the professional regulatory body, that many teachers will quit the profession because they will not be able to accept the revised code of conduct in good conscience.

Their advisers say the code would also seriously undermine the religious character of church schools by imposing on them a hostile form of secular morality.

The legally-binding code would discriminate against Christian teachers in recruitment and in the classroom, they say.

Principle 4 of the code demands that teachers ‘proactively challenge discrimination’ and ‘promote equality and value diversity in all their professional relationships and interactions’ before they can be registered.

It means that campaigners can complain if teachers fail to observe the new demands and that teachers and schools can be punished if a complaint is upheld.

Oona Stannard, head of the Catholic Education Service, an agency of the bishops’ conference, told the GTC in a written submission that ‘there was an understandable fear that the call to “proactively challenge discrimination” could be used to oppose faith schools per se, and the rights that they have in law, for example, to select leaders who are of the faith’.

‘This anxiety extends similarly to the direction to “promote equality”,’ Miss Stannard said.

‘It would be unacceptable to expect anyone to be required to promote something contrary to their own faith beliefs and, indeed, it would not be possible for a person of faith to promote another faith – this is a matter of conscience.’

Miss Stannard added that there were grave concerns in the Church over the question of whether Catholic teachers would in good conscience feel able to register under the new code.

This means they would either quit the profession or would be dissuaded from entering in the first place, heightening the recruitment crisis already afflicting many schools.

The code proposed by the GTC would be binding on all schools, including the 2,300 primary and secondary schools run by the Catholic Church and the 4,660 run by the Church of England.

The GTC is insisting that all teachers will have to sign up to the new code before they can practice.

The code will then be used by the GTC to assess cases of serious misconduct by teachers and trainee teachers.

However, it will also be used by school governing bodies and local authorities in recruitment and disciplining of teachers; universities in assessing candidates for teacher training and by employment tribunals assessing claims of unfair dismissal.

Many Christians already fear that equality and diversity rules are being used against them.

Caroline Petrie, a nurse, was suspended by North Somerset Primary Care Trust, for failing to ‘demonstrate a personal and professional commitment to equality and diversity’ after telling a patients she would pray for her, while marriage registrar Lillian Ladelle, disciplined for refusing to preside over same-sex civil partnerships, lost her case at the Employment Appeal Tribunal after the panel ruled in favour of the Islington Council’s ‘commitment to equality’.

Brighton Council also withdrew funding from Pilgrim Homes, a Christian care home, after staff refused to quiz elderly residents over the sexual orientation in keeping with ‘fair access and diversity’ policies.

The Christian Institute, a non-denominational charity, says that the GTC code means that universities might ask applicants about their willingness to promote gay rights and Islam.

If a teacher was asked at interview if he or she was willing to use materials designed by gay rights groups, the teacher could be rejected for declining because he or she would be in breach of Principle 4.

If a pupil asked an RE teacher if Jesus Christ was the only means to salvation and the teacher replied yes, a non-Christian parent could complain to the GTC over a breach of Principle 4.

Ofsted inspectors would also be able to criticise schools for promoting the Christian vision of marriage, while teachers who say they will pray for troubled pupils could be suspended for failing to ‘value diversity’.

Colin Hart, Christian Institute director, said: ‘Respect for people as people is not the same as respecting or valuing every religious belief or sexual lifestyle.

‘Forcing this on Christian teachers is to force them to go against their conscience,’ he said.

‘Teachers are there to teach not to be diversity officers.’

The GTC consultation on the new code closed last Friday.

Who are the real victims?
(Terry Sanderson, The Guardian, 25 February 2009)

Look out, here comes Hazel Blears, the communities minister, jumping on the Christians-are-being-persecuted bandwagon. Blears says she intends to challenge the prevailing culture of "political correctness" in a speech she will deliver in the next few days.

In support, Blears quotes the story of Caroline Petrie, the nurse briefly suspended for offering to pray for her patients, and repeats the oft-discredited story that some schools ban Christmas decorations. It seems that no matter what evidence there is against these tales, they persist and grow stronger through repetition.

Most of the recent ones have originated from rightwing politico-religious organisations, the Christian Institute (CI) and the Christian Legal Centre (CLC). They have been enthusiastically – even unquestioningly – taken up by the Daily Mail and the Telegraph.

Take the case of the poor school receptionist whose child was "reprimanded" by her teacher because she talked about Jesus. Her pious mother was naturally distraught at the news and felt moved to send out an email to her "trusted church friends" asking them to pray for her heartbroken kiddy.

Somehow that email fell into the hands of the headteacher at the school at which she worked and she was subsequently carpeted for professional misconduct. Poor persecuted Christian!

However, it seems the Christian Institute left out one or two little details, such as that the little girl was actually telling her playmates that if they didn't believe in Jesus they were going to hell. This frightened some of them and so the teacher took the little evangelist aside and asked her not to say it. There was no "reprimand" or punishment, no order that she must never refer to Jesus again.

One of the trusted church circle, to whom the mother had sent her email, was, in fact, the wife of a school governor, who subsequently passed it to the headteacher. The email wasn't just a request to pray, but was also highly uncomplimentary about the school and some of its teachers.

So had this woman used her privileged position as a school employee to denigrate her employer and co-workers in an untruthful fashion? Was the headtacher, in fact, right to accuse her of professional misconduct?

Local parents, who are nearer to the truth of this, showed overwhelming support for the headteacher in this case.

I expect we will not know the full truth of this tale unless it comes to court, but in the meantime, the Christian Institute's version is touted as authentic by those who want to exploit it.

And as the papers repeat these stories, there is inevitably a sidebar listing the other examples of "Christian persecution" that have gone before. Remember that poor lady at British Airways, Nadia Eweida, who was persecuted because she wanted to wear a cross over rather than under her uniform? Except the employment tribunal and they kicked out all her claims.

Then there was Lillian Ladele, the registrar with Islington Council who was threatened with the sack because her "Christian conscience" would not permit her to carry out civil partnerships for same-sex couples – even though this was part of her job. It was presented as an attack on her rights as a Christian.

Once again, when all the facts came out at the employment tribunal, Ladele lost the case. What she was actually demanding was an exemption from the same terms of employment that all the other registrars in Islington have to abide by.

Similarly with the "praying nurse" Caroline Petrie – hers was not a case of discrimination. It was a case of her insisting that the rules (contained in a National Health Service code of practice) shouldn't apply to her in the same was as they did to her colleagues because – well, she's a Christian and therefore special.

Then we have the Coronation Street cross "scandal". The story was widely circulated that in an episode of Coronation Street that featured a church wedding, a cross had been covered up in one scene so that non-Christians would not be offended. The usual uproar ensued.

Nobody seemed to noticed a small letter in the The Times from the producers of Coronation Street making it clear that the cross was covered up only for technical reasons. Why would they bother to film in a church if they were trying to obscure Christianity? This did not stop the Daily Express repeating the story last week.

In nearly all these cases of claimed discrimination against Christians, it turns out that, in fact, it's Christians discriminating against other people.

Neither the evangelical pressure groups or their episcopal supporters seems be able to make a convincing case for "persecution" without leaving out key facts.

But worse than this is that the propaganda is being used to convince employers and their representative groups that there is a real and growing problem of religious discrimination at work. The "rising number of cases of religious discrimination claims being heard in employment tribunals" has caused the Chartered Management Institute to issue guidance to its members to ensure that they do not "directly or indirectly discriminate against staff holding particular beliefs".

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Who are the real victims?
(Terry Sanderson, The Guardian, 25 February 2009)

However, it seems the Christian Institute left out one or two little details, such as that the little girl was actually telling her playmates that if they didn't believe in Jesus they were going to hell. This frightened some of them and so the teacher took the little evangelist aside and asked her not to say it. There was no "reprimand" or punishment, no order that she must never refer to Jesus again.

Fired University of Toledo administrator sues school
(Associated Press, December 9, 2008)

The firing of a college administrator over her criticism of gay rights has sparked a debate about free speech and whether universities have the right to regulate what employees say outside of their jobs.

Crystal Dixon filed a lawsuit Dec. 8 in federal court seeking to be reinstated to her job at the University of Toledo that she lost after writing in a newspaper column that gay rights can’t be compared to civil rights because homosexuality is a choice.

“I take great umbrage at the notion that those choosing the homosexual lifestyle are ‘civil rights victims,” Dixon wrote in an online edition of the Toledo Free Press on April 18. “Here’s why. I cannot wake up tomorrow and not be a black woman.”

Two weeks later, Dixon was fired from her job as the school’s associate vice president for human resources. School officials said her views contradicted with university policies, according to the lawsuit.

Other school administrators were not punished for expressing their opinions, her attorneys say.

“We have asserted from the beginning that Ms. Dixon was in a position of special sensitivity as associate vice president for human resources and this issue is not about freedom of speech, but about her ability to perform that job given her statements,” university spokesman Larry Burns said in a statement.

Dixon did not mention in the column that she worked at the university, but she did defend the school’s benefits plans and how they apply to gay employees.

She also wrote: “There are consequences for each of our choices, including those who violate God’s divine order.”

In response to the column, hundreds of people wrote letters calling her views disturbing while others were outraged Dixon was punished for speaking her mind. Conservative talk show hosts and members of her church rallied around Dixon after she was fired.

“It comes down to whether you’re speaking as an employee of the university or as a private citizen,” said Brian Rooney, a spokesman for Thomas More Law Center in Ann Arbor, Mich., which is representing Dixon. “If you’re speaking as a private citizen, your speech is protected.”

The university would have been within its rights to discipline her if she had stated she was a school administrator, Rooney said.

The nonprofit Christian law firm says its mission includes “defending the traditional family and challenging special rights for homosexuals.”

“Where is the so-called free expression of ideas and tolerance that universities so adamantly defend?” said Richard Thompson, president of the law center.

Named as defendants in the lawsuit are University of Toledo President Lloyd Jacobs and William Logie, vice president for human resources.

Logie told Dixon he had received a steady stream of complaints about her column and that he was considering placing her on leave, according to the lawsuit.

Jacobs responded to the column by writing his own piece in the weekly newspaper, saying that “her comments do not accord with the values of the University of Toledo.”