When can a doctor conscientiously object?

America

Bernard G. Prusak

Over the last decade, the culture wars in the United States have broken new ground: They have become battles over the rights of conscience. For example, now that same-sex marriage is a right, the question before the U.S. Supreme Court in the case of Masterpiece Cakeshop is whether its sympathetic, telegenic owner, Jack Phillips, is within his rights to refuse to make a wedding cake for a gay couple. Similarly, under the Obama administration, the court heard arguments more than once over whether employers who object on religious grounds to contraceptives or abortion should be exempted from having to provide employees health insurance that includes such services.

By contrast, debates over conscientious objection in medicine have not had the same notoriety, though they have broken out repeatedly among health care professionals and medical ethicists since the turn of the century, when there was a flare-up over pharmacists’ refusing to fill prescriptions for emergency contraceptives. . . [Full text]

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

 

 

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]

 

Protecting conscience: Why this House of Lords bill is aimed at defending healthcare professionals

Christian Today

Laurence Wilkinson

With the Brexit legislation receiving the lion’s share of attention in Parliament, there has been little to no coverage on the progression of any other bill in recent months. This is usually the time of year where activity on private members’ bills (which have only a small chance of passing into law) winds down. However, with the current Parliamentary Session being extended to two years to deal with the magnitude of the Brexit legislation, we are in extraordinary times.

There is one such private member’s bill before the House of Lords which has seen a surprising ramp-up in activity over the last few months. The bill is sponsored by Baroness O’Loan – a widely respected legal mind from Northern Ireland who was the first Police Ombudsman – and will have its committee stage today, Friday. It is focused on the relatively niche area of protection of conscience for healthcare professionals. . . [Full text]

 

Medics should not be forced to do procedures they object to on ethical grounds

The Conversation
Reproduced with permission

David S. Oderberg*

For most people, the term “conscientious objection” evokes images of Quakers and pacifists registering to avoid military service. Many countries have a long and honourable tradition of accommodating such conscientious objectors. It might not be about bombs and bullets, but healthcare professionals often find themselves fighting a conscience battle of their own.

In the UK, Canada, Sweden and other countries, conscientious objectors in healthcare have found themselves discriminated against in various ways – whether through dismissal, lack of promotion, or more subtle forms of coercion. Most cases involve doctors, nurses or midwives refusing to perform abortion or euthanasia (or to assist with either). Yet these happen, through historical accident, to be the flashpoint of current controversy. . . [Full text]

Bill to give medical staff right to refuse role in abortions condemned

The Guardian

Tim Wyatt

Pro-choice groups have condemned an attempt to create new laws that would allow doctors and nurses to refuse to take part in abortions on moral grounds.

A private bill going through the House of Lords that would expand rights of conscientious objection for healthcare professionals has been dismissed as unnecessary by abortion providers and campaigners.

Those in favour of the bill, sponsored by the Northern Irish crossbench peer Nuala O’Loan, insisted their aim was not to restrict abortion but to uphold freedom of belief and religion they claim is under threat in hospitals since a contentious supreme court ruling in 2014. . . [Full text]

 

Why conscientious objection in the medical profession must be protected

The House Magazine

Fiona Bruce, MP

Accommodation of conscientious objection is a long-respected matter of liberty and equality in this country. This respect should be as relevant today as ever, writes Fiona Bruce

The Conscientious Objection (Medical Activities) Bill is scheduled for Committee Stage in the House of Lords this Friday, and I have been watching its progress with interest. The Bill’s sponsor is Baroness Nuala O’Loan – a widely respected legal mind in the Lords who served as first Police Ombudsman in Northern Ireland, and is a former Chair of the Equality and Human Rights Commission’s Human Rights Inquiry. Among those who spoke in favour of the Bill at Second Reading were the former Conservative Lord Chancellor, Lord Mackay of Clashfern, and senior Conservative Peers Lord Elton, Baroness Eaton and the renowned surgeon, Lord McColl of Dulwich. . . [Full text]

 

NI peer’s bill could excuse medical staff from taking part in abortions

Belfast Newsletter

A Northern Ireland-based peer is championing a bill which aims to protect the freedom of conscience for medical professionals.

The Conscientious Objection (Medical Activities) Bill is designed to grant protection to healthcare workers – including doctors, midwives, nurses, and pharmacists – who object on grounds of conscience to being asked to participate in end-of-life treatment.

In practice, this could see medics opting out of any involvement in abortion services.

Professionals could be excused from taking part in the withdrawal of life-sustaining treatment, and could also refuse to participate in any aspect of IVF treatment. . . [Full text]

 

Church calls for Scottish Bill to back medics’ conscience rights

Scottish Catholic Observer

Amanda Connelly

The Catholic Church in Scotland has called for a bill that gives medical professionals the right to conscientiously object to medical procedures such as abortion.

The comments come after Baroness O’Loan’s new Conscientious Objection (Medical Activities) Bill for England and Wales, which looks to ensure conscience rights for medical professionals, had a second hearing in the House of Lords on Friday January 26.

“While the bill only applies to England and Wales, its progress should be of interest to people in Scotland, where hopefully a similar bill could be presented to the Scottish Parliament,” director of the Catholic Parliamentary Office Anthony Horan said. . . . [Full text]

 

British conscience protection bill: second reading set for 26 January, 2018

The Conscientious Objection (Medical Activities) Bill [HL] 2017-19, introduced by Baroness Nuala O’Loan, will be debated during second reading in the British House of Lords on 26 January, 2018.  The proposal is a procedure-specific bill limited to activities associated with abortion, artificial reproduction and withdrawing life sustaining treatment.