Conscience claims, metaphysics, and avoiding an LGBT eugenic

Abram Brummet

Abstract

Novel assisted reproductive technologies (ART) are poised to present our society with strange new ethical questions, such as whether lesbian, gay, bisexual, and transgender (LGBT) couples should be allowed to produce children biologically related to both parents, or whether trans-women who want to experience childbirth should be allowed to receive uterine transplants. Clinicians opposed to offering such technologies to LGBT couples on moral grounds are likely to seek legal shelter through the conscience clauses enshrined in U.S. law. This paper begins by briefly discussing some novel ART on the horizon and noting that it is unclear whether current conscience clauses will permit fertility clinics to deny such services to LGBT individuals. A compromise approach to conscience is any view that sees the value of respecting conscience claims within limits. I describe and critique the constraints proposed in the recent work of Wicclair, NeJaime and Siegel as ultimately begging the question. My purpose is to strengthen their arguments by suggesting that in the controversial situations that elicit claims of conscience, bioethicists should engage with the metaphysical claims in play. I argue that conscience claims against LGBT individuals ought to be constrained because the underlying metaphysic—that God has decreed the LGBT lifestyle to be sinful—is highly implausible from the perspective of a naturalized metaphysic, which ought to be the lens through which we evaluate conscience claims.


Brummett A. Conscience claims, metaphysics, and avoiding an LGBT eugenic. Bioethics. 2018;00:1–9.

Tongue splitting, bodily harm, and human dignity

BioEdge

Xavier Symons

Contemporary cosmetic surgery has become a tool for realising bizarre personal fantasies. Sometimes it also leads to significant bodily harm. “Tongue-splitting” is an operation whereby a person’s tongue is split from the tip to as far back as the underside base. The operation has become a common alteration for body-modification enthusiasts, who say it heightens their sense of taste and touch.

Some jurisdictions, however, have enacted a ban on the procedure. The operation can be painful, and can temporarily impede one’s capacity for speech.

In a recent post on the blog Practical Ethics, UK lawyer Charles Foster considers the legality and ethics of the procedure.

Foster discusses the case of R v BM, where a Wolverhampton tattooist was found guilty of inflicting grievous bodily harm on a patient after splitting their tongue. Even though the customer consented, the court found that consent was not a defence against having inflicted grievous bodily harm.

Foster argues that the ruling represents a defence of basic human dignity, which transcends the ambit of personal autonomy:

[The ruling] is a salutary reminder that there are limits to the law’s protection of personal autonomy. Factors other than autonomy are in play in the criminal law. I have argued elsewhere that the primary factor (and the foundational factor in the criminal law – in which all other factors, including autonomy, are rooted) is human dignity.

Indeed, Foster argues that in harming another, one does violence to one’s own human dignity:

One might say that X causing injury to Y is doubly culpable because in doing so X outrages not only Y’s dignity but also his own (X’s) dignity…dignity is ‘Janus-faced’.


This article is published by Xavier Symons and BioEdge under a Creative Commons licence. You may republish it or translate it free of charge with attribution for non-commercial purposes following these guidelines. If you teach at a university we ask that your department make a donation to BioEdge. Commercial media must contact BioEdge for permission and fees.

Loss of right to conscience costing NHS new midwives it needs

Catholic Universe-The Catholic Times

Nick Benson

Pro-life groups have claimed that the recent drop in applications to midwifery courses could be rectified by enshrining conscientious objection.

Recent figures show that there has been a 35 per cent drop in the number of applicants to midwifery courses since 2013. The Royal College of Midwives (RCM), which analysed the latest Ucas data for England, said the biggest reduction was in those aged 21 or over.

In 2013, more than 12,000 people aged over 21 applied for a midwifery course in England, but by 2017 that figure had dropped to just 6,700 – a decrease of 45 per cent. . . [Full text]

Hawaii legalizes assisted suicide: Refusing to refer for suicide may incur legal liability

Sean Murphy*

Assisted suicide will become legal in Hawaii on 1 January, 2019, as a result of the passage of the Our Care, Our Choice Act. Introduced in the state House of Representatives only in January, it passed both the House and Senate and was approved by Governor David Ige on 5 April. Beginning next year, physicians will be able to write prescriptions for lethal medications for Hawaiian residents who are capable of informed consent, who are at least 18 years old, and who have been diagnosed with a terminal, incurable disease expected to result in death within six months.1

And beginning next year, Hawaiian physicians who refuse to facilitate assisted suicide by referring patients to a willing colleague may face discipline — including expulsion from the medical profession — or other legal liabilities. Hawaii could become one of only two jurisdictions in the world where willingness to refer patients for suicide is a condition for practising medicine.2 . . . [Full text]

Quebec euthanasia statistics: 67% increase in euthanasia deaths in second year

Introduction

Since 10 December, 2015, euthanasia has been provided by physicians in Quebec under the terms of An Act Respecting End of Life Care (ARELC).  Health and social services agencies established by the government throughout the province are state agencies responsible for the delivery and coordination of health care in the province administrative regions. These are called Centres intégrés de santé et de services sociaux (CISSS) and Centres intégrés universitaires de santé et de services sociaux [CIUSSS).  Some administrative regions (like Montreal and the Quebec City region) have more than one CISSS or CIUSSS.

These agencies are responsible for the delivery of euthanasia.  For two years beginning 10 December, 2015, they were required to make reports twice yearly to a commission established by the law to monitor the administration of euthanasia (the Commission sur les soins de fin de vie) and publish them on their websites.  These twice-yearly reports will apparently cease to be published after that time.  The Commission draws from these and other reports to make its required summary of activity to the legislature (National Assembly).

The Project has compiled the statistics provided in these reports from10 December, 2015 to 10 December, 2017.  The compilation includes tables and charts, some of which are reproduced below.

Euthanasia Requests in Quebec, 2016-2017

Euthanasia Requests in Quebec, 2016-2017

Note that, in some cases, the number of patients lethally infused is higher than the number of requests because euthanasia was provided in response to a request made in the previous reporting period.  In addition, not all euthanasia deaths are captured in these reports, as some regions with low populations do not publish reports, and euthanasia may be provided by private entities that are not subject to the statutory twice-yearly reporting requirement.

  • The number of euthanasia requests made weekly in the province increased from about 14 in 2016 to about 23 in 2017. In Montérégie the number of requests weekly doubled; they more than tripled in Bas-Saint-Laurent.
  • Euthanasia was provided about 9 times weekly in the province during 2016 and 14 times weekly in 2017.
  • The number of euthanasia deaths increased by about 67% from 454 in 2016 to 757 in 2017.  This is about 1.1% of deaths from all causes, a rate not reached by Belgium for 9 years after legalization.
    • In Outaouais the number of euthanasia deaths almost doubled (11 to 21)
    • In Chaudière-Appalaches the number more than doubled (18 to 40)
    • The number of euthanaia deaths more than tripled in Saguenay-Lac-Staint-Jean (6 to 19)
    • The number of euthanasia deaths quadrupled in Côte-Nord (2 to 8), and more than quadrupled in Abitibi-Témiscamingue (4 to 18).
  • 434 requests for euthanasia were not acted upon in 2017, up from 263 in 2016.  However, the percentage of all requests not acted upon remained constant at 37%.
    • In 11% of the cases the patient died of natural causes before euthanasia was provided, up from 9% in 2016.
    • About 8% of the patients did not qualify for the procedure, down from 11% in 2016.
  • Marked increases in rates of continuous palliative sedation occurred in a couple of regions, notably Laurentides (a 2017 reate almost six times that of 2016) 

See: full statistical summary with downloadable Excel file

You’re a surgeon. A patient wants to look like a lizard. What do you do?

As medical treatments advance, the need to accommodate conscientious objection in healthcare is more pressing

The Guardian
Reproduced with permission

David S. Oderberg*

Imagine that you are a cosmetic surgeon and a patient asks you to make them look like a lizard. Would you have ethical qualms? Or perhaps you are a neurosurgeon approached by someone wanting a brain implant – not to cure a disability but to make them smarter via cognitive enhancement. Would this go against your code of professional ethics? With the rapid advance of medical technology, problems of conscience threaten to become commonplace. Perhaps explicit legal protection for conscientious objection in healthcare is the solution.

There is limited statutory protection for those performing abortion, and there is some shelter for IVF practitioners. Passive euthanasia (withdrawal of life support with intent to hasten death) is also part of the debate over doctors’ conscience rights. That’s about it as far as UK law is concerned – though freedom of conscience is enshrined in numerous conventions and treaties to which we are party. Abortion, artificial reproductive technologies (involving embryo research and storage) and passive euthanasia are the flashpoints of current and historic controversy in medical ethics. The debate over freedom of conscience in healthcare goes to the heart of what it means to be a medical practitioner.

Curing, healing, not harming: these are the guiding principles of the medical and nursing professions. But what if there is reasonable and persistent disagreement over whether a treatment is in the patient’s best interests? What if a practitioner believes that treating their patient in a particular way is not good for them? What if carrying out the treatment would be a violation of the healthcare worker’s ethical and/or religious beliefs? Should they be coerced into acting contrary to their conscience?

Such coercion, whether it involve threats of dismissal, denial of job opportunities or of promotion, or shaming for not being a team player, is a real issue. Yet in what is supposed to be a liberal, pluralistic and tolerant society, compelling people to violate their deeply held ethical beliefs – making them do what they think is wrong – should strike one as objectionable.

Freedom of conscience is not only about performing an act but about assisting with it. There are some people who ask doctors to amputate healthy limbs. If you were a surgeon, my guess is that you would refuse. But what about being asked to help out? Would you hand over the instruments to a willing surgeon? Or supervise a trainee surgeon to make sure they did the amputation correctly? If conscientious objection is to have any substance in law, it must also cover these acts of assistance.

This country has a long and honourable tradition of accommodating conscientious objectors in wartime – those who decline to fight or to assist or facilitate the fighting by, say, making munitions. They can be assigned to other duties that may support the war effort yet are so remote a form of cooperation as not to trouble their consciences. In any war, the objectors are a tiny fraction of the combat-eligible population. Yet when it comes to one’s rights, do numbers matter? Has their existence ever prevented a war from being carried out to the utmost? I fail to see, then, why we are tolerant enough to make adjustments for conscientious objectors in the midst of a national emergency, yet in peacetime would be reluctant to afford similar adjustments to members of one of the most esteemed professions.

Do we think medical practitioners should be no more than state functionaries, dispensing whatever is legal no matter how much it is in conflict with personal conscience and professional integrity – lest they be hounded out of the profession? Some academics think expulsion is not good enough. Or should healthcare workers be valets, providing whatever service their patients demand? Perhaps when practitioners find themselves faced with demands for the sorts of treatment I’ve mentioned – or perhaps gene editing treatments or compulsory sterilisation, society will act. Or maybe by then it will be too little, too late.

David S Oderberg is professor of philosophy at the University of Reading, and author of Declaration in support of conscientious protection in medicine

 

 

Divisions, New and Old — Conscience and Religious Freedom at HHS

Lisa H. Harris

In January, the U.S. Department of Health and Human Services (HHS) announced the creation of its Conscience and Religious Freedom Division, explaining that it will allow HHS’s Office of Civil Rights to “more vigorously and effectively enforce existing laws protecting the rights of conscience and religious freedom” and will ensure that “no one is coerced into participating in activities that would violate their consciences, such as abortion, sterilization or assisted suicide.”1 Responses were as expected: religious conservatives hailed the new division as a needed intervention; public health and clinical leaders and advocates decried it, worrying about its impact on access to care and harm to patients. . .


Harris LH.  Divisions, New and Old — Conscience and Religious Freedom at HHS.  N Engl J Med 2018; 378:1369-1371. DOI: 10.1056/NEJMp1801154

Protection in the Bill for health staff with conscientious objection

Isle of Man Today

Health staff who have a conscientious objection to abortion will receive protection when the law is reformed.

Members approved an amendment, tabled by Chris Robertshaw (Douglas East), to set out the protection available to staff.

The final version of the amendment was the result of consultation between Mr Robertshaw and Dr Alex Allinson.

The bill already stipulated health workers could not be forced to take part in abortion treatment if they had a genuine conscientious objection. . . [Full text]

 

Mexican Senate approves medical conscientious objection bill

Catholic News Agency

Mexico City, Mexico, Mar 26, 2018 / 06:14 pm (ACI Prensa).- The Mexican Senate has approved a measure protecting the conscientious objections of medical personnel who hold moral or ethical objections to certain treatments.

The decree, approved March 22, states that “professionals, technicians, aides, social service providers that are part of the National Healthcare System shall be able to invoke the right of conscientious objection and excuse themselves from participating and/or cooperating in all those programs, activities, practices, treatments, methods or research that contravenes their freedom of conscience based on their values or ethical principles.” . . . [Full text]