A right to be unconscious

Julian Savulescu, Janet Radcliffe-Richards

[Referring to Sinmyee et al] This seems to us to be an important, landmark paper. This is because the issues it addresses are important in their own right: how to ensure death without suffering in jurisdictions where assisted dying (including assisted suicide or euthanasia) is allowed, and also, because the technicalities are the same, in cases of capital punishment by lethal injection. Moreover, the paper shows the potential for the use of anaesthesia in contexts beyond surgery. Anaesthesia in its ordinary uses is intended to facilitate surgery designed to restore a patient to improved health and functioning. In assisted dying, however, there is no question of restoring health. The proposition is to use anaesthesia primarily to prevent suffering in a patient who is about to die and, in this sense, places anaesthesia on a new footing as a primary medical intervention, serving a purpose in its own right.


Savulescu J, Radcliffe-Richards J.  A right to be unconscious. Anaesthesia. 2019 May; 74(5): 557-559

Canadian court tells doctors they must refer for euthanasia

Will they be hounded out of their profession?

Mercatornet

Michael Cook

For years bioethicists of a utilitarian cast have argued that conscientious objection has no place in medicine. Now Canadian courts are beginning to put their stamp of approval on the extinction of doctors’ right to refuse to kill their patients.

The Superior Court of Justice Division Court of Ontario ruled this week that if doctors are unwilling to perform legal actions, they should find another job.

A group of five doctors and three professional organizations were contesting a policy issued by Ontario’s medical regulator, the College of Physicians and Surgeons of Ontario (CPSO), arguing it infringed their right to freedom of religion and conscience under Canada’s Charter of Rights and Freedoms.

However, Justice Herman J. Wilton-Siegel wrote on behalf of a three-member panel:

“the applicants do not have a common law right or a property right to practise medicine, much less a constitutionally protected right.

“Those who enjoy the benefits of a licence to practise a regulated profession must expect to be subject to regulatory requirements that focus on the public interest, rather than the interests of the professionals themselves.”

At issue is the policy of “effective referral”. A doctor who objects to participating in euthanasia cannot be forced to do it. But he is expected to pass the patient to another doctor who will. The CPSO argues that effective referral is necessary “to protect the public, prevent harm to patients and facilitate access to care for patients in our multicultural, multifaith society, by guiding all physicians on how to uphold their professional and ethical obligations of non-abandonment and of patient-centred care within the context of Ontario’s public health-care system.”

Without the policy of effective referral, equitable access would be “compromised or sacrificed, in a variety of circumstances, more often than not involving vulnerable members of our society at the time of requesting services,” Justice Herman Wilton-Siegel wrote. People in remote communities might request euthanasia. If their doctor refused, they might suffer needlessly and taxpayers would have to foot the bill to subsidise the refusnik’s conscience.

It is remarkable how closely Justice Wilton-Siegel’s text hews to the arguments of bioethicists who have been chipping away at the right to conscientious objection for years.

In 2005 American legal scholar Alta Charo described conscientious objection as “an unfettered  right to personal autonomy while holding monopolistic control over a public good … an abuse of the public trust—all  the worse if it is not in fact a personal act of conscience but, rather, an attempt at cultural conquest’.

In 2006 Oxford’s Julian Savulescu argued in the BMJ that “when conscientious objection compromises the quality, efficiency, or equitable delivery of a service, it should not be tolerated”.

More recently, Canadian bioethicist Udo Schuklenk and a colleague contended in the BMJ that

“If at any given time a doctor is unable to continue practicing due to their—ultimately arbitrary—conscience views, nothing would stop them from leaving the profession and taking up a different vocation. This happens across industries and professions very frequently. Professionals can be expected to take responsibility for the voluntary choices they make.”

Responding to the ruling, Larry Worthen, executive director of the Christian Medical and Dental Society of Canada, said: “We heard from our members and other doctors with conscientious objections over and over again that they felt referral made them complicit and that they wouldn’t be able to live with themselves or stay in the profession if effective referral is still required.”

The case is sure to be appealed, but if the doctors championing conscientious objection fail, the consequences will be dire.

Throughout Canada, doctors would be required to refer for euthanasia. If they refuse, they will be hounded out of their profession, or, at best, shunted into specialties where the question will not arise, like pathology or dermatology.

This ruling shows how quickly tolerance vanishes after euthanasia has been legalised. In the Carter decision which legalised it, Canada’s Supreme Court explicitly stated that legalizing euthanasia did not entail a duty on the part of physicians to provide it. Now, however, 18 months and more than a thousand death after legalisation, conscientious objection is at risk.

It also shows how vulnerable religious-based arguments can be. The plaintiffs contended that referring patients violated their right to religious freedom. While this is true, is this the main ground for conscientious objection? As several doctors pointed out in the Canadian Medical Association Journal last year, “Insofar as all refusals of therapy are ultimately justified by the ethical belief that the goal of therapy is to provide benefit and avoid harm, all treatment refusals are matters of conscience.”


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Canadian nurse forced out for refusing to participate in euthanasia

Lifesite News

Pete Baklinski

PALMER RAPIDS, Ontario, June 14, 2017 (LifeSiteNews) — A Canadian nurse no longer has her job helping the sick and the elderly after she was told that she must either assist patients who wanted to kill themselves using the country’s new euthanasia law, or resign.

Mary Jean Martin, a Registered Nurse who worked in middle-management as a Homecare Coordinator in Ontario, said she became a nurse in the late 1980s to help the “vulnerable and the struggling,” not to be a link in a chain that would ultimately lead to a patient’s death.

“Can you imagine being a nurse and being told that you have to help kill someone? That’s so against the philosophy of nursing and it’s so against the heart of the healthcare person,” she told LifeSiteNews in an exclusive interview. . . [Full text]

 

Conscience and Conscientious Objection in Health Care

An ARC Discovery Project, running from 2015 to 2017

Summary of project

Conscientious objection is a central topic in bioethics and is becoming more ever important. This is hardly surprising if we consider the liberal trend in developments of policies about abortion and other bioethical issues worldwide. In recent decades the right to abortion has been granted by many countries, and increasingly many conservative and/or religious doctors are being asked to perform an activity that clashes with their deepest moral and/or religious values.

Debates about conscientious objection are set to become more intense given the increase in medical options which are becoming available or may well be available soon (e.g. embryonic stem cell therapies, genetic selection, human bio-enhancement, sex modification), and given the increasingly multicultural and multi-faith character of Australian society. Not only will doctors conscientiously object to abortion, and to practices commonly acknowledged as morally controversial, but some of them may also object to a wide range of new and even established practices that conflict with their personal values for example, Muslim doctors refusing to examine patients of the opposite sex.

Defining conscientious objection and identifying reliable markers for it, as well as setting the boundaries of legitimate conscientious objection through clear and justifiable principles, are difficult but pressing tasks.

This project advances bioethical debate by producing a philosophically and psychologically informed analysis of conscience, and by applying this to discussions about the legitimate limits to conscientious objection in health care.

 Personnel

Chief Investigator Dr Steve Clarke, Charles Sturt University

Chief Investigator Prof. Jeanette Kennett, Macquarie University

Partner Investigator Prof. Julian Savulescu, University of Oxford

[Full text]

Doctors needed. Leave your conscience at home

 National Post

Marni Soupcoff

In a new paper, two prominent bioethicists suggest that all doctors should be required to see to it personally that any medical procedure — including abortions and assisted suicides — be performed for patients who request and qualify for them.

This should be the case, the authors argue, despite any personal moral or religious qualms the doctors may have about the operations or prescriptions in question. Sadly for devout Catholics, evangelical Protestants or others with deep religious or moral convictions, the prospect of medical school itself would be completely off the table if co-authors Udo Schuklenk and Julian Savulescu had their way; they argue that medical students should be screened for over-active consciences when it comes to things like contraception, abortion and euthanasia. Apparently those for whom these issues are anything but no-brainers shouldn’t be considered acceptable physician material at all. . . [Full text]