Conscientious Objection in Health Care

Letter

Stahl and Emanuel (April 6 issue)1 rightly differentiate between conscripts and physicians. Nonetheless, they state, “the profession . . . uses reflective equilibrium to self-correct. This dynamic process establishes professional obligations . . . regardless of . . . personal beliefs.”1 This point fails to recognize that conscientious objectors are engaging in the dynamic process from within the profession to counter problematic professional obligations and to correct mistakes. . . [Full text]

Liao L,Goligher E.  Conscientious Objection in Health Care, N Engl J Med 2017; 377:96-98 July 6, 2017 DOI: 10.1056/NEJMc1706233

Pro-life medics being forced to choose between career or conscience

Christian Institute

Pro-life medics in the US are ‘under attack’, an academic has warned.

Author and bioethicist, Wesley J. Smith, said medics who are morally opposed to abortion and assisted suicide may soon be forced to choose between “their careers and their convictions”.

He made the comments in an article for First Things, an influential journal of religion and public life.

‘Morally opposed’

In support of his case, he highlighted work published in the New England Journal of Medicine which described abortion as “a standard obstetrical practice” and “not medically controversial”.

Smith said: “The authors take an absolutist position, claiming that personal morality has no place in medical practice.”

He went on to highlight several examples where doctors are being forced to refer patients for abortion and assisted suicide “even if they are morally opposed”. . . . [Full text]

 

Further clarity on cooperation and morality

Abstract:  I explore the increasingly important issue of cooperation in immoral actions, particularly in connection with healthcare. Conscientious objection, especially as pertains to religious freedom in healthcare, has become a pressing issue in the light of the US Supreme Court judgement in Hobby Lobby. Section ‘Moral evaluation using the basic principles of cooperation’ outlines a theory of cooperation inspired by Catholic moral theologians such as those cited by the court. The theory has independent plausibility and is at least worthy of serious consideration—in part because it is an instance of double-effect reasoning, which is also independently plausible despite its association with moral theology. Section ‘Case study: Burwell v. Hobby Lobby’ examines Hobby Lobby in detail. Even if the judgement was correct in that case the reasoning was not, as it involved applying a ‘mere sincerity’ test to the cooperation question. The mere sincerity test leads to absurd consequences, whereas a reasonableness test applied using the theory of cooperation defended here would avoid absurdity. Section ‘A question of remoteness: “accommodations” and opt-outs’ explores the post-Hobby Lobby problem further, examining opt-outs and accommodations: the Little Sisters of the Poor case shows how opt-outs are misunderstood on a mere sincerity test, which the court rightly rejected. Section ‘Application to the medical field: Doogan and Wood’ discusses the UK case of Doogan and Wood, concerning participation in abortion. Again, a judicially recognised ethic of cooperation, if it were part of the fabric of legal reasoning in such cases, would have enabled the conscientious objectors in this and similar situations to have their freedom of conscience and religion respected in a way that it currently is not.

Oderberg DS, Further clarity on cooperation and morality.  J Med Ethics doi:10.1136/medethics-2016-103476

Implications of Christian Truth Claims for Bioethics

Abstract: Christian bioethics starts with different metaphysical, epistemological, and teleological assumptions. It starts with God as Creator and Sustainer of the universe who as the second person of the Godhead became incarnate as our Redeemer and Lord. Morality reflects God’s nature and is known through reason and intuition guided by revelation. The end of a Christian bioethics is to discover the way our God intends for us to live and to discover the type of person He intends for us to be in order to live a holy and sanctified life. Christian bioethicists will seek integration among their core beliefs and between their beliefs and actions, and they will bear witness to their beliefs in a world that is not yet redeemed. Each contribution in this issue represents an example of these types of Christian integration. Each bears witness to the fact that a Christian bioethics is different.

Parker C.  Implications of Christian Truth Claims for Bioethics. Christ Bioeth (2016) 22 (3): 265-275 doi:10.1093/cb/cbw013

 

Why Are Religious Reasons Dismissed? Euthanasia, Basic Goods, and Gratuitous Evil.

Abstract:  Many proponents of euthanasia eschew appeals to religious premises as good reasons for thinking that human life has intrinsic worth. The reasons offered are that religious reasons do not meet some theory-neutral epistemic standard. My first argument is to show that pro-euthanasia arguments fail to meet those same standards. In order to avoid this incoherence, the rejection of religious reasons is a function of thinking that such reasons are simply false. Arguing against religious belief has typically fallen to the evidential argument from evil. My second argument is to show that the argument from evil must hold to a basic goods account of human life. Such an account is contrary to the view of human life held by most euthanasia proponents. So, euthanasia proponents who reject religious belief on the basis of an argument from evil must hold to a contradictory view of human worth. One cannot both be a euthanasia proponent and reject arguments against euthanasia (that are based in part on religious premises). I explore ways to resolve this tension, but none save pro-euthanasia arguments.

Napier S.  Why Are Religious Reasons Dismissed? Euthanasia, Basic Goods, and Gratuitous Evil. Christ Bioeth (2016) 22 (3): 276-300 doi:10.1093/cb/cbw012

   

Medical Assistance in Dying in Canada: An Ethical Analysis of Conscientious and Religious Objections

Abstract

Background: The Supreme Court of Canada (SCC) has ruled that the federal government is required to remove the provisions of the Criminal Code of Canada that prohibit medical assistance in dying (MAID). The SCC has stipulated that individual physicians will not be required to provide MAID should they have a religious or conscientious objection. Therefore, the pending legislative response will have to balance the rights of the patients with the rights of physicians, other health care professionals, and objecting institutions.

Objective: The objective of this paper is to critically assess, within the Canadian context, the moral probity of individual or institutional objections to MAID that are for either religious or conscientious reasons.

Methods: Deontological ethics and the Doctrine of Double Effect.

Results: The religious or conscientious objector has conflicting duties, i.e., a duty to respect the “right to life” (section 7 of the Charter) and a duty to respect the tenets of his or her religious or conscientious beliefs (protected by section 2 of the Charter).

Conclusion: The discussion of religious or conscientious objections to MAID has not explicitly considered the competing duties of the conscientious objector. It has focussed on the fact that a conscientious objection exists and has ignored the normative question of whether the duty to respect one’s conscience or religion supersedes the duty to respect the patient’s right to life.

Christie T, Sloan J, Dahlgren D, Konging F.  Medical Assistance in Dying in Canada: An Ethical Analysis of Conscientious and Religious Objections.  BioéthiqueOnLine, 2016, 5/14

Six questions about physician-assisted death, from a conscientious objector

National Post

Ewan C. Goligher

Canadian policy makers have recently proposed to require all doctors to provide an effective referral for physician-assisted death (PAD) upon the patient’s request. Forcing doctors to knowingly send their patient to another doctor willing to cause the patient’s death will seriously compromise the moral integrity of conscientiously objecting doctors and risks undermining the quality of patient care. To understand the position of conscientiously objecting doctors, consider the following questions.

1. Should doctors provide physician-assisted death merely because it is legal?

2. Must all doctors accept the assumptions underpinning the claim that physician-assisted death is good medical care?

3. If physician-assisted death remained illegal, would doctors be legally liable for making an effective referral?

4. Does the Charter right of Freedom of Conscience apply to doctors?

5. How does respect for conscientious objection affect patient care?

6. Will respect for conscientious objection obstruct access to physician-assisted death?

(For the author’s answers, see the full text)

The Health Care Professional as Person: The Place of Conscience

Canadian Catholic Bioethics Centre

Bioethics Matters

Bridget Campion*

Recently I was asked to present “the Catholic position” on physician-assisted death as part of a panel discussion held at a downtown Toronto hospital. The purpose of the event was not to debate the issue but to educate participants about various points of view. I ran into some difficulty when I was discussing the Catholic Church’s interest in protecting the consciences of health care staff. One panelist immediately redirected our attention to the needs of the patient seeking physician-assisted death and the conversation left the health care professionals behind. In this short article, I would like to bring the focus back to the doctors, nurses, social workers, chaplains, therapists, in short, to the health care staff involved in patient care and who may have objections to performing or assisting in physician-assisted death.. . .  Full Text

Cardinal Thomas Collins: Don’t force physicians to act against their conscience

As Canada develops its assisted dying legislation, we should be careful to protect health care workers’ right to follow their conscience

Toronto Star

“Contemplating Suicide? We Can Help!” There was a time when such an advertisement pointed to a crisis line, where someone was standing by to counsel you and offer hope in a situation of intolerable pain.

We are in a very different time, now. In a few short months, assisted suicide, its grim reality hidden behind blandly deceptive terms like “medical assistance in dying,” will be declared an acceptable option in our country, enshrined in law. As the federal government prepares legislation to implement the Supreme Court’s decision, it is crucial to consider the effects of this fundamental change in our laws.

Death comes to us all – sometimes suddenly, and sometimes slowly. Although patients benefit from medication that controls pain, they are fully justified in refusing burdensome and disproportionate treatment that serves only to prolong the inevitable process of dying. But dying is simply not the same as being killed. We are grateful for physicians and nurses and others who offer medical assistance to patients who are dying, but it is never justified for them to kill a patient. . .[Full text]