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.

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

Lisa H. Harris

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.

HHS leaders’ comments to date suggest that they are uninterested in discrimination against health care providers whose consciences compel them to provide care, and uninterested in injuries to patients caused by care refusals. This framing makes conscience yet another issue dividing Americans, largely along partisan lines.


Harris LH.  Divisions, New and Old — Conscience and Religious Freedom at HHS. N Eng J Med 2018 Apr 12;378(15):1369-1371. doi: 10.1056/NEJMp1801154. Epub 2018 Mar 14

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

Should lesbian couples have access to mitochondrial replacement therapy?

BioEdge

Michael Cook

“Three parent babies!!!!” was a shock-horror headline across the world when the UK was debating mitochondrial replacement therapy a couple of years ago. This is a technique to avoid passing on mitochondrial diseases from mother to child. There are different methods, but they involve combining the nuclear DNA of the mother’s egg with healthy mitochondrial DNA from another woman and fertilisation with sperm.

The government’s fertility regulator, the HFEA, explained that this was meant to “to avoid passing on serious genetic diseases to future generations”. Under existing legislation, MRT can only be used for this purpose.

Much of the opposition to the technique in a very heated debate was the unconventional matter of a child sharing two mothers, or at least, sharing the genes of two women. Many found this profoundly unnatural.

However, there is a group of women who might welcome this – lesbian couples. For them, it could be a way of creating a child with a shared genetic heritage.

Or so argue Giulia Cavaliere and César Palacios-González, of , King’s College London, in the Journal of Medical Ethics. Their reasoning is quite interesting. (It is spelled out a bit more simply in a blog post.)

First of all, against the headlines about “cures” for desperately ill children, they insist (as did many opponents of MTR) that no MRTs can be considered therapeutic as they do not cure children/embryos affected by mtDNA diseases, but they are rather a means to create children that are not affected by mtDNA diseases.

Second, they ask, if “cures” are not the reason for the existing legislation, what is? Their answer might have escaped the MPs who votes for it, but it fits:

the rationale to offer MRTs is to allow women at risk of transmitting mtDNA disease to have healthy children that are genetically related to them. The rationale, in other words, is to expand these women’s reproductive freedom …

Third, if reproductive freedom (and not the health of a child) is the most fundamental reason, then all women deserve to take advantage of MTR, not just the mothers of sick children. Lesbian couples are equally needy and deserving.

Providing access to MRTs to women at risk of transmitting a mtDNA disease and not to lesbian couples is in our view contrary to one of the tenets of morality, which demands to treat like cases alike. Denying access to MRTs to lesbian couples is morally unjustifiable in as much as it curtails the enjoyment of certain freedoms to a certain group without good reason, whilst allowing others to enjoy the very same freedoms.

Some bioethicists would call this the slippery slope in action. Others would respond that it is merely extending the inherent logic of the legislation. In any case, it certainly is an unexpected interpretation of the legislation.

This article is published by Michael Cook 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. Commercial media must contact BioEdge for permission and fees. Some articles on this site are published under different terms.

Accessed 2018-03-28

 

Is there any difference between euthanasia and palliated starvation?

BioEdge

Xavier Symons

While euthanasia and assisted suicide are currently illegal in most countries, the practice of voluntarily stopping eating and drinking (VSED) is seen by some as an ethically and legally permissible alternative. VSED refers to seriously-ill patients refusing to eat and drink for a sustained period of time with the intention of bringing about their own death.

Yet a new paper published in BMC Medicine argues that VSED is ethically indistinguishable from assisted suicide, and should be subject to the same legal regulations as more salient cases of assistance in dying.

The paper, lead-authored by Ralf J. Jox of the Institute for Ethics, History and Theory of Medicine at the University of Munich, argues that “supporting patients who embark on VSED amounts to assistance in suicide, at least in some instances, depending on the kind of support and its relation to the patient’s intention”.

While VSED does not involve an invasive or aggressive act like many other means of suicide, the authors write that “VSED should [nevertheless] be considered as a form of suicide, as there is both an intention to bring about death and an omission that directly causes this effect”. Doctors who assist patients in VSED — by encouraging them, or promising pain-relief if VSED is undertaken — are potentially instrumental in the deaths of the patients, as the suicide would not occur without them, and they share the patient’s intention of inducing death.

The authors of the paper conclude that the same legal prescriptions or regulations that apply to physician assisted suicide should also apply to VSED.

“[We] maintain… that future ethical discussions on assisted suicide require consideration of medically supported VSED, and vice versa…Thus, the widely held position by palliative care societies, professional bodies of physicians, legal scholars, and ethicists to disapprove of assisted suicide but approve of and even promote medically supported VSED appears inconsistent”.


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.

 

Accessed 2017-08-11

 

The status of the human embryo in various religions

William Neaves

Abstract

Research into human development involves the use of human embryos and their derivative cells and tissues. How religions view the human embryo depends on beliefs about ensoulment and the inception of personhood, and science can neither prove nor refute the teaching of those religions that consider the zygote to be a human person with an immortal soul. This Spotlight article discusses some of the dominant themes that have emerged with regard to how different religions view the human embryo, with a focus on the Christian faith as well as Buddhist, Hindu, Jewish and Islamic perspectives.


Neaves W. The status of the human embryo in various religions. Development 2017 144: 2541-2543; doi: 10.1242/dev.151886

Dignitarian medical ethics

Linda Barclay

Abstract

Philosophers and bioethicists are typically sceptical about invocations of dignity in ethical debates. Many believe that dignity is essentially devoid of meaning: either a mere rhetorical gesture used in the absence of good argument or a faddish term for existing values like autonomy and respect. On the other hand, the patient experience of dignity is a substantial area of research in healthcare fields like nursing and palliative care. In this paper, it is argued that philosophers have much to learn from the concrete patient experiences described in healthcare literature. Dignity is conferred on people when they are treated as having equal status, something the sick and frail are often denied in healthcare settings. The importance of equal status as a unique value has been forcefully argued and widely recognised in political philosophy in the last 15 years. This paper brings medical ethics up to date with philosophical discussion about the value of equal status by developing an equal status conception of dignity.


Barclay L. Dignitarian medical ethics. Journal of Medical Ethics Published Online First: 13 October 2017. doi: 10.1136/medethics-2017-104467

Navigating the new era of assisted suicide and execution drugs

Sean Riley

I. Introduction

Lethal medication provisions are in a precarious state. Over the past decade, pharmaceutical companies have attempted to stamp out the use of their drugs in executions, creating several economic and regulatory hurdles for access to these medications. As a result, patients seeking physician-assisted suicide (PAS) as well as death penalty states aiming to execute their capital offenders have been forced to turn to unregulated and dangerous alternatives for these drugs. This note attempts to unpack the quality, safety, and access issues emerging from these recent changes and to explore the implications for the future of these practices.

In order to fully grasp the exact mechanisms at work, this note will first offer a brief pharmacological description of the lethal medications and detail many technical aspects of their use. The next section provides a historical account of the past decade, illustrating the emergent quality, safety, and access issues. This note then evaluates the competing notions of ‘botched’ executions and ‘complications’ in PAS while analysing the standards set forward to measure safety and efficacy for each. Finally, this note closes by exploring the future of each practice in light of our discussion.


Riley S. Navigating the new era of assisted suicide and execution drugs. Journal of Law and the Biosciences. Volume 4, Issue 2, 1 August 2017, Pages 424–434, https://doi.org/10.1093/jlb/lsx028

There is no defence for ‘Conscientious objection’ in reproductive health care

Abstract

A widespread assumption has taken hold in the field of medicine that we must allow health care professionals the right to refuse treatment under the guise of ‘conscientious objection’ (CO), in particular for women seeking abortions. At the same time, it is widely recognized that the refusal to treat creates harm and barriers for patients receiving reproductive health care. In response, many recommendations have been put forward as solutions to limit those harms. Further, some researchers make a distinction between true CO and ‘obstructionist CO’, based on the motivations or actions of various objectors. This paper argues that ‘CO’ in reproductive health care should not be considered a right, but an unethical refusal to treat. Supporters of CO have no real defence of their stance, other than the mistaken assumption that CO in reproductive health care is the same as CO in the military, when the two have nothing in common (for example, objecting doctors are rarely disciplined, while the patient pays the price). Refusals to treat are based on non-verifiable personal beliefs, usually religious beliefs, but introducing religion into medicine undermines best practices that depend on scientific evidence and medical ethics. CO therefore represents an abandonment of professional obligations to patients. Countries should strive to reduce the number of objectors in reproductive health care as much as possible until CO can feasibly be prohibited. Several Scandinavian countries already have a successful ban on CO.

Fiala C, Arthur JH. Eur J Obstet Gynecol Reprod Biol. 2017 Jul 23. pii: S0301-2115(17)30357-3. doi: 10.1016/j.ejogrb.2017.07.023. [Epub ahead of print]

 

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