Protection of Conscience Project
Protection of Conscience Project
www.consciencelaws.org
Service, not Servitude

Service, not Servitude

Medical Ethics

GENERAL

Medicine,  morality and humanity
Sean Murphy |The practice of medicine is an inescapably moral enterprise precisely because physicians are always seeking to do some kind of good and avoid some kind of evil for their patients. However, the moral aspect of practice as it relates to the conduct and moral responsibility of a physician is usually implicit, not explicit. . . .continue reading
The Hippocratic "oath"
(Some further reasonable hypotheses)
Sergio Musitelli, Ilaria Bossi | Although 65 treatises - either preserved or lost, but quoted by ancient authors like Bacchius (3rd century B.C.), Erotian (1st century A.D.) and Galen (c. 129-199 A.D.) - are ascribed to Hippocrates (c. 469-c. 399 B.C.) and consist of nearly 83 books, nonetheless there is no doubt that none of them was written by Hippocrates himself. This being the fact, we cannot help agreeing with Ulrich von Wilamowitz Möllendorf (1848-1931), who maintained that Hippocrates is a name without writings! . . . continue reading
Medicine's Intrinsic Good
Teresa Iglesias | What is good medicine? Who counts as a good doctor? These are very large questions that cannot be fully addressed here. I want to focus on a basic aspect of these two questions and on the ethical idea of "the good.". . . continue reading
Why Medical Ethics?
Daniel Eisenberg | When I lecture to audiences about the Jewish approach to medical ethics, one issue always lurks below the surface: Why medical ethics? And why particularly Jewish medical ethics? Isn't it sufficient to allow the medical field to police itself? Aren't physicians moral people? . . . continue reading
Is Bioethics Ethical?
Wesley J. Smith | The author argues that control over public policy decisions in health care has been ceded to [secular] bioethicists, "an elite group of academics, philosophers, lawyers, and physicians, many of whom are openly hostile to the sanctity of life and the Hippocratic traditions that most people still take for granted." The result is that law and public policy are increasingly shaped by beliefs that are not shared by the people whom they affect. . . continue reading
The Bioethics Mess
Dianne N. Irving | "Bioethics" -- the word sounds like old-fashioned medical ethics applied to new medical technology. It's the application of traditional philosophical or theological principles to the moral dilemmas created by, say, cloning or experimenting with new AIDS drugs, right? Not really. . . continue reading
Which Medical Ethics for the 21st Century?
Dianne N. Irving | . . . Abstracting from all the possible academic ethical theories . . . I will focus narrowly instead on two theories of medical ethics - secular bioethics and Roman Catholic medical ethics, pointing out briefly what they are, comparing their conclusions about what is right or wrong, and indicating where they have already lead us. . . continue reading
'Bioethics' -- What It Really Means for Prolife Nurses
Dianne N. Irving | . . .When you find yourself in a situation where you and your deepest gut instincts are so pitted against some "theory" - any "theory" - then perhaps it is time to stop and to question this "theory"? The specific "theory" in question here is not really "ethics", but, I would suggest -- "bioethics". . . continue reading
Is American Bioethics Lost in the Woods?
Michael Cook | The debate between a libertarian bioethicist and a communitarian bioethicist illustrates why American bioethics is becoming increasingly marginalised and irrelevant to the democratic society that it intends to serve . . . continue reading
Establishment Bioethics
Sean Murphy | Ethical differences between one theory of bioethics and another may be quite as dramatic as doctrinal differences between religions, though, like religions, there are also similarities. Problems for ethical minorities arise when one version of bioethics becomes predominant, and its practitioners attain positions of influence and power in government, academic and professional circles . . . continue reading
Freedom of conscience in health care: "an interesting moral swamp"?
Responding to Caplan AL. Whose rights come first: Doctors or patients?
Sean Murphy | "Whose rights come first?" asks Professor Arthur Caplan in a recent Medscape column. "Doctors’ or patients?" "You can't have physicians, pharmacists, nurses, and social workers saying they are not going to do legally allowed medicine or standard-of-care treatment because it violates their rights," says Professor Caplan. . .continue reading
The Impact of International Bioethics on the Sanctity of Life Ethics and the Ability of Ob Gyn's to Practise According to Conscience
Dianne N. Irving | . . . the key to understanding any philosophical or theological ethical theory is to identify its philosophical or theological "anthropology"-- or definition of "a human being" or "person". . . Bioethics tries to claim that its theory really has no "anthropology", i.e., the "personhood" issue. . . However, almost all bioethics arguments do incorporate a "delayed personhood" claim, whether or not they know or admit it -- . . . continue reading
Suggestions for the Future of Bioethics
Daniel P. Sulmasy | I suggest that bioethics has evolved through three phases: a religious phase in the 1950s and '60s, a philosophical phase in the '70s and '80s, and a political-empirical phase from the '90s to the present. . . Where should bioethics go next? I will make six suggestions. I am sure they will not be uniformly popular, but I'd like to think they might provoke some interesting discussion. . . continue reading
The Costs of Taking Conscience
Michael A Fragoso | . . .There is already a growing physician shortage . . . The shortage will increase without any of the supply reductions that are likely to occur as a result of decertifying practicing obstetricians who refuse to perform abortions and deterring future obstetricians who will choose a different career or specialty rather than violate their consciences. . . continue reading
Observing Bioethics
Renee C. Fox, Judith P. Swazey (Oxford: University Press, 2008)
Sally Satel  |. . . Whether bioethics has achieved its goal is the urgent question at the core of this useful book . . .Through enjoyable interviews with major figures in the field and a rich trove of personal observations, the book perceptively, if densely, chronicles the growth of bioethics as a profession. . .Fox and Swazey portray bioethics as a field in turmoil. . . [Their] own prescription-to expand the bioethics' franchise into global justice and activism-will not help. Bioethics would become politicized, thereby undermining the already shaky credibility of the field. . . . continue reading (The Right (and Wrong) Answers)
World Medical Association
Project commentaries on WMA policy proposals

MEDICAL PRACTICE AND CONSCIENCE

Critical Review of College of Physicians and Surgeons of NS Policy Conscientious Objection

Sean Murphy | The College of Physicians and Surgeons of Nova Scotia (CPSNS) has adopted Professional Standards Regarding Conscientious Objection (Conscientious Objection) that expands existing CPSNS policies. This critique of Conscientious Objection is limited to issues directly or indirectly related to the protection of physician freedom of conscience and can be applied to all CPSNS policies. . . continue reading

Canadian Medical Association and Referral for Morally Contested Procedures
Sean Murphy | The Canadian Medical Association (CMA) has variously expressed support for physician freedom of conscience in codes of ethics, resolutions at successive General Councils and in policies concerning specific procedures. For over fifty years it has insisted that physicians should not be compelled to make referrals for procedures to which they object for reasons of conscience. It appears that the great majority of CMA members support this position, but are unaware of its history. This paper revisits this history at a time when increasingly strident claims have culminated in demands that the state should force objecting physicians to collaborate in euthanasia and assisted suicide by referral. . . continue reading
Proposed revision to WMA International Code of Medical Ethics
European Institute of Bioethics | Comment on the draft International Code of Medical Ethics of the World Medical Association. . . continue reading
Anscombe Bioethics Institute | Submission to the World Medical Association Public Consultation on a draft devised version of the International Code of Medical Ethics. . . continue reading
Protection of Conscience Project| Submission to the World Medical Association Re: WMA International Code of Medical Ethics. . . continue reading
The caricature of the conscientiously objecting physician
Objecting doctors are the bad guys, obstructing care.
How will disciplining conscientious doctors or driving them from the profession improve health care?
Catherine Ferrier |  Canadian doctors who object to directly causing the death of their patients, once the near-totality of the profession, have, since the enactment of laws permitting "medical assistance in dying" suddenly become outliers. . .continue reading
Physician, heal thyself: the potential crisis of conscience in Canadian medicine
What if your faith in doctors having conscience was shaken?
Gabrielle Horne | . . . When illness strikes, [patients] must often put their lives, their confidence and their most vulnerable selves in the hands of doctors they barely know. The expectation of conscience is at the core of the medical pact.  But what if your faith in doctors having conscience was shaken? . .continue reading
Patients' Rights - A World View
The Patients' Rights Act 20 years on – Achievements and Challenges
Dr. Otmar Kloiber  |  . . .  to understand patient rights and the relation of health professionals to them it is important to be clear what patients are. Towards the end of the last century, particularly during the 1990s, the notion came into being that patients are "customers". Now some prefer the word "clients", which sounds much more elaborate and elegant, however it is merely the French word for "customer". It is undeniable that in any relationship where one pays money for a service there is an aspect or an expectation that classifies one party as a "customer" and the other as a "provider" or "vendor". But transferring this paradigm as the description for the patient/physician relationship falls dangerously short of reality. . . continue reading
Six questions about physician-assisted death, from a conscientious objector
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. . .continue reading
The Hidden Professions of Conscientious Objection
Bob Parke | . . . While interpreters and clinical informatics team members may be asked to participate in euthanasia their right to conscientious objection is not recognized as it is for doctors, nurses, pharmacists and other frontline staff. As such, they need to be considered and supported in organizational policies addressing [euthanasia/assisted suicide] . . .continue reading
Personal Beliefs and Professional Duties: Maintaining Your Integrity
Dr. Larry Reynolds | In modern heath care the role of the physician is at risk of being reduced to becoming a mere tool of the patient's will. The doctor's role will be just to provide services that patients demand. Autonomy of the patient trumps all. This view impoverishes our profession, degrades doctors to mere technicians and will accelerate the moral wasting disease presently plaguing Canadian health care. . .continue reading
Are tribunals the solution to disruptive conscientious objectors?
Michael Cook | While some bioethicists believe that conscientious objection has no place in modern medicine, others feel that they could be accommodated by setting up tribunals. Here are three proposed this year in the Journal of Medical Ethics. . .
continue reading
There's no "mushy middle" on euthanasia
Margaret Somerville | Many know the saying "You have to fish or cut bait". Many fewer know the law's equivalent, "You can't approbate and reprobate". But the Canadian Medical Association's recent dealing with their 2007 Policy on Euthanasia and Assisted Suicide makes it seem they are unaware of the warning and wisdom these axioms communicate. . .continue reading
Entrenching a 'duty to do wrong' in medicine
Canadian government funds project to suppress freedom of conscience and religion
Sean Murphy |A 25 year old woman who went to an Ottawa walk-in clinic for a birth control prescription was told that the physician offered only Natural Family Planning and did not prescribe or refer for contraceptives or related services. She was given a letter explaining that his practice reflected his "medical judgment" and "professional ethical concerns and religious values." She obtained her prescription at another clinic about two minutes away and posted the physician's letter on Facebook. The resulting crusade against the physician and two like-minded colleagues spilled into mainstream media and earned a blog posting by Professor Carolyn McLeod on Impact Ethics. . . continue reading
Conscience in the Practice of the Health Professions
The President's Council on Bioethics: 11 September, 2008
Opening Remarks |  Edmund Pellegrino
A.D. Lyerly |  . . . If we want to talk about the conditions that must be met to conscientiously refuse to inform, refer, or provide care, how we balance may be different depending on what morally is at stake. . .
H. Brody |  . . . we're going to have to say in some cases that a professional with such stringent dictates of conscience ought not choose that particular career, that they cannot at the same time promise they're going to serve the interests of the patients if their individual personal integrity requires them to say no . . .
F. Curlin |  . . . with respect to the present controversies, it cannot be that conscientious refusals per se are ethically problematic. What we are after are criteria by which to distinguish those refusals that are consistent with physicians' professional obligations from those that contradict those obligations. To find such criteria, we have to figure out what in fact physicians are obligated to do. . . unless and until consensus is forged regarding the ends of medicine, refusals of controversial practices cannot be shown to violate physicians' professional obligations.
R.P. George |  . . .The [ACOG] report, in other words, in its driving assumptions, reasoning, and conclusions is not morally neutral. Its analysis and recommendations for action do not proceed from a basis of moral neutrality. It represents a partisan position among the family of possible positions debated or adopted by people of reason and goodwill in the medical profession and beyond. Indeed, for me, the partisanship of the report is its most striking feature. . .
Discussion | Robert P. George, Anne Lyerly, Howard Brody, Farr Curlin, Gilbert C. Meilaender, Jean Beth Elshtain, Peter Ausgustine Lawler, Donald W. Landry, Paul McHugh, Jane D. Rowley, Rebecca S. Dresser, Benjamin S. Carson, William B. Hurlbut, Alfonso Gomez-Lobo
Freedom of Conscience and the Needs of the Patient
Sean Murphy | . . . I am going to focus on the terms in the title of this presentation - freedom, conscience, and needs - touching, in one place, upon ethics, and concluding with a reflection upon faith and the notion of moral neutrality. . . I have not attempted an apology for freedom of conscience, so you will not leave here with slogans to brandish, a handy list of pros and cons or practical advice on how to avoid being sued. Instead, I have offered a number of observations and reflections on words that we too often take for granted, and cause us to stumble: needs, ethics, freedom, conscience, and faith. . . continue reading (Presentation)
The Role of Conscience in Medical Decisions
Daniel P. Sulmasy | In this lecture, Dr. Daniel Sulmasy will discuss how medical professionals can strive to preserve their moral integrity while also respecting and serving patients with whom they might have deep moral disagreements. . . see video
Presentation to President's Council on Bioethics
Christian Medical Association | . . . Because the way things are going, some would actually force out of the profession those physicians who have moral objections to procedures such as abortion. And that loss of physicians--especially Obstetricians and Gynecologists who are already leaving because of malpractice insurance costs--would have a severe impact on the delivery of healthcare. . . continue reading
Liberty of conscience is critical for individual doctors
Dr. Lachlan Dunjey | "Liberty of conscience is critical for individual doctors as it lies at the very heart of our integrity," he said. "It is conscience that must compel doctors to refuse to participate in treatments they believe to be un-ethical. It is not enough for doctors to simply be providers of medical services on demand from consumers or third parties, providing all that is legal whether or not it is consistent with their ethical base. To sacrifice conscience and be concerned only with service provision is to destroy the heart and soul of medicine." . . . continue reading
Medicine, Strasbourg, and conscientious objection
European Court of Human Rights decision
Julian Sheather | . . .Conscientious objection is a live issue in medicine. . . Given the prevailing political pluralism-given the co-existence in our culture of different value systems-to what extent should medicine accommodate such objections? Should those whose consciences differ be treated differently? What forms of conscientious objection should be tolerated and on the basis of what criteria? . . .continue reading [Legal Commentary]
Confronting Conscientious Objection
Maggie Little | Conscientious objection. . . is not something lightly invoked. Its legitimate exercise brings with it strong obligations. Objecting providers must disclose their limitations early and often to minimize patient burdens. And they must convey those restrictions with compassion and respect. . . . The very premise of protecting conscientious refusal, after all, is that deeply good and reasonable people disagree on the issue. . . continue reading

SPECIFIC ISSUES

Abortion

Abortion: Where do we draw the line?
Margaret Somerville | The conferral of an honorary degree on Dr. Henry Morgentaler provided a flashpoint for yet another explosion in the long-standing, deeply acrimonious war as to the values that should govern abortion. The two polar positions are well defined, but I want to speak for those, like me, who regard all abortion as raising serious ethical issues, but who would not legally prohibit early abortion . . .continue reading
Abortion, Conscience and Health Care Provider Rights
E. Christian Brugger | In this essay, I will elaborate the ACOG account, juxtapose it to what I call the "classical account" as defended in Western philosophy, and finally answer the question whether healthcare providers have a right to refuse to treat some patients. . .continue reading
A Tough Call: Does conscience protection excuse a health professional from providing after-abortion care?
Cristina Alarcon | Last November a Planned Parenthood nurse in Idaho rang a local pharmacist and asked for methergine -- a drug used to prevent bleeding after childbirth or an abortion. Considering the source of the request it is quite likely to have been the latter, and the pharmacist, who has a conscientious objection to abortion, asked whether that was the case. The caller refused to say, citing federal privacy law, and the pharmacist refused to fill the prescription. The caller then asked for a referral to another pharmacy and the pharmacist hung up on her. . . continue reading

Artificial reproduction

Australian women complain of 'gender disappointment'
Michael Cook |  "Gender disappointment" is not a recognised medical condition. But many women in Australia – where gender selection is illegal -- attribute their depression to it. Speaking to Australia's ABC network, a woman using the pseudonym Kate described it as as "a guilt-ridden, debilitating depression". She has two boys and she desperately wants a daughter.. . . continue reading

Assisted nutrition and hydration

Tube Feeding: Medical Treatment or Basic Care?
Adrian Treloar, Philip Howard | The authors argue that feeding tube placement is a medical procedure and as such requires consideration of the benefits and risks as for any other medical treatment. However, the day-to-day use of feeding tubes, to provide hydration and nutrition, constitutes ordinary care that does not require medical supervision. Withdrawal of tube feeding raises major ethical and legal questions. . .continue reading

Birth control

Clearing Rhetorical Minefields
Sean Murphy | Progress towards understanding the importance of freedom of conscience for health care workers is not infrequently hindered by rhetorical minefields . . .What follows is an attempt to clarify some of the points of dispute and identify key issues. It introduces the term "embryocide" and specifies the meaning of "abortifacient" and "contraceptive" based upon what is common to parties who hold contrary views about abortion and contraception. . .continue reading
Contraception for the Unmarried
Christian Medical Fellowship [United Kingdom] | . . .I came to the conclusion that I could only provide contraception to married couples, and that my contraceptive advice to unmarried couples would be limited to that of advising them not to have intercourse. I would advise them that if they rejected my advice they should go elsewhere and obtain their contraception from another doctor. I was not forcing my opinion on them, because they were perfectly free to reject my advice and obtain their contraception elsewhere. . .continue reading
Over the counter conscience vote
Beth Doherty | Every now and again, stories hit the media about pharmacists who refuse to stock condoms, dispense the contraceptive pill and, more recently, the morning-after pill. Contrary to what we are led to believe, this is not an irregular occurrence, nor is it a particularly surprising stance for a Christian pharmacist. . .continue reading

Body reconfiguration

If sex reassignment surgery is the answer, what is the question?
Michael Cook | Sex reassignment surgery requires the intervention of doctors. But what kind of treatment is it? Is it a therapy for a disease which should be offered only after psychiatric authorization? Or is it a biomedical enhancement which anyone can freely choose?. . . continue reading
Transgender treatment for kids finally under ethical scrutiny
Michael Cook | More and more young people believe they were born in the wrong body. . . .However, there are no long-term studies which support medical interventions for children, which can include “top” and “bottom” surgery for children over 16.   What are the ethics of treating children with untrialled treatment? Surprisingly little has been written about this. . . continue reading

Criteria for determining death

Report Prompts Protocols for Diagnosis of Brain Death
MY Wang P Wallace JP Gruen | After reviewing the 78 brain deaths documented at the hospital in 1999, J. Peter Gruen, MD, and colleagues at the Keck School of Medicine of the University of Southern California in Los Angeles, discovered that the diagnosis was highly variable and concluded that standards for practice and documentation were sorely needed. . .continue reading

Drugs

Idaho Case of Pharmacist Refusal
Wesley J. Smith | . . .based on the reporting of the story, this isn't even a close call. This is not a proper conscience clause (from my criteria) case and in Wesley World, the pharmacist would not be protected. . .continue reading

Eugenics

New Genetics Functions as Eugenics
Margaret Somerville | One effect of intense individualism in the context of reprogenetics is that the accumulation of individual decisions are resulting in an overall outcome that would never be acceptable as public policy. In short, the new genetics is functioning as eugenics, but that fact is not identified. . . continue reading

Euthanasia, assisted suicide

Assisted Suicide and Euthanasia: pharmacists must also have the right to conscientious objection
Bernadette Flood | In jurisdictions where euthanasia and/or assisted suicide is legal, experience shows there are profound implications for pharmacy practice. Little attention in the current euthanasia debate has been paid to the role of Irish pharmacists. . .continue reading
Canadian Medical Association plans for physician assisted suicide, euthanasia
Commentary on draft framework (June/July, 2015)
Sean Murphy | On 6 February, 2015, the Supreme Court of Canada ordered the legalization of physician-assisted suicide and euthanasia in Canada, effective in February, 2016. . . The Canadian Medical Association (CMA) had been preparing for legalization of physician assisted suicide and euthanasia since 2014.  In the months following the ruling, CMA officials and the Board of Directors finalized draft guidelines ("draft framework") on the subject and published them in June.  An internal CMA on-line consulation concerning the draft framework ran from 8 June to 20 July, 2015. . .
continue reading
Assisted Suicide: What Role for Nurses?
Carrie Farella | Initially, when [Oregon's assisted suicide law] was designed, the assumption was that physicians would be the first ones to explore PAS with patients," . . . "but in reality, nurses are usually the ones in the line of fire. Patients often feel nurses understand their wishes for good quality of life and good quality of death, too." . . .continue reading
'Pulling the plug' isn't euthanasia
Margaret Somerville | . . .The ongoing transformation in the methods and ethics of medicine raises profound moral questions for doctors, nurses, pharmacists, and others who believe in the traditional virtues of Hippocratic medicine that proscribe abortion and assisted suicide and compel physicians to "do no harm.". . . Tolerance toward dissenters of what might be called the "new medicine" is quickly eroding. . .continue reading
Institutional freedom of conscience in relation to euthanasia and assisted suicide
Sean Murphy | The subject of this paper is an institution's refusal to provide or facilitate euthanasia/assisted suicide (EAS) for reasons of conscience: the exercise of preservative freedom of conscience. This typically reflects desire to preserve institutional moral integrity by refusing to be complicit in, cooperate in or otherwise support or encourage the killing of patients, and a desire to prevent harm to others. Institutional religious integrity is not addressed. . . continue reading

Execution

Should American doctors participate in executions?
Michael Cook | The American state of Arkansas executed four prisoners in April. They were given a lethal injection with a three-drug cocktail, a procedure which requires some medical skills. Should doctors take part in such executions? . . . In an unusual intervention in the bitter debate, cardiologist Sandeep Jauhar has written an op-ed . . .arguing that the presence of doctors is ethical. . . continue reading

Harm reduction

Give them sterile razors: controversial self-harm strategy
Michael Cook |  Some people who self-harm should be provided with sterile razors, says a mental health expert in the Journal of Medical Ethics. Patrick Sullivan, of the University of Manchester, argues that this approach may be more respectful of patients' autononomy. He suggests that a harm-minimisation strategy for self-harming individuals could include provision of sterile cutting implements, education on how to self-injure more safely to avoid blood poisoning and infection, as well as therapy and alternative coping strategies. . . . continue reading

Research

Complicity after the fact: moral blindness becomes a virtue and necessity
US scientists were "accomplices after the fact" in Japanese doctors' war crimes
Michael Cook | . . .hundreds of Japanese medical personnel . . . experimented on Chinese civilians and prisoners of war  . . .They killed an estimated 3,000 people in the infamous Unit 731 in Harbin, in northeastern China before and during World War II – plus tens of thousands of civilians when they field-tested germ warfare. . . the Americans struck a deal with the doctors. They traded immunity from prosecution for access to scientific information from the ghastly Japanese experiments – many of which are too grim to detail here. . .continue reading
Physician-Assisted Suicide and the Perils of Empirical Ethical Research
Daniel P. Sulmasy | Al Rabadi et al compare statistics on physician-assisted suicide (PAS) available from public databases for the states of Washington and Oregon and find similar profiles and trends, which is unsurprising given the similarity of the laws and demographic characteristics of these states. Among the unanswered questions are what such a study can contribute to medical ethics (about PAS or any other ethical controversy) and what the limits are of such work. . . continue reading

Sedation

Consensus Guidelines on Analgesia and Sedation in Dying Intensive Care Unit Patients
Laura A Hawryluck William RC Harvey Louise Lemieux-Charles Peter A Singer | (Research Paper) Intensivists must provide enough analgesia and sedation to ensure dying patients receive good palliative care. However, if it is perceived that too much is given, they risk prosecution for committing euthanasia. The goal of this study is to develop consensus guidelines on analgesia and sedation in dying intensive care unit patients that help distinguish palliative care from euthanasia. . . continue reading

Surgery

Is it ethical to refuse a patient surgery for body art?
Michael Cook | The "bioartist" Stelarc has an ear surgically implanted on his forearm. Like him, a number of other people have hacked their own bodies with implants and prostheses. With growing interest in transhumanism, more and more people are likely to request enhancements to turn them into cyborgs. . .
continue reading
If sex reassignment surgery is the answer, what is the question?
Michael Cook | Sex reassignment surgery requires the intervention of doctors. But what kind of treatment is it? Is it a therapy for a disease which should be offered only after psychiatric authorization? Or is it a biomedical enhancement which anyone can freely choose?. . . continue reading
Conscientious objection to "patriarchal norms"
Hymen restoration and 'virginity certificates' in Sweden
Michael Cook  |  Informed consent and conscientious objection are easy to fulminate about, but tricky to discuss with consistency. Take, for instance, the delicate topic of requests for hymen restorations and virginity certificates. Worldwide, an estimated 5,000 women were victims of honour killings in 2000. If a young woman from a culture which sanctions honour killing approaches a doctor, what should he or she do? . . . continue reading

Torture and interrogation

Psychologists criticised in CIA torture report
(USA: December, 2014)
Michael Cook | Two psychologists contracted by the CIA to create enhanced interrogation techniques for al-Qaeda detainees have come under fire for violating human rights and medical ethics. Although pseudonyms were used in the 480-page report published this week by the Senate Select Committee on Intelligence, it was clearly referring to Bruce Jessen and James Mitchell, who were paid US$81 million for their work. . . .continue reading
Complicity after the fact: moral blindness becomes a virtue and necessity
Moral blindness becomes a virtue and necessity:
US scientists were "accomplices after the fact" in Japanese doctors' war crimes

(1945)
Michael Cook | . . .hundreds of Japanese medical personnel . . . experimented on Chinese civilians and prisoners of war  . . .They killed an estimated 3,000 people in the infamous Unit 731 in Harbin, in northeastern China before and during World War II – plus tens of thousands of civilians when they field-tested germ warfare. . . the Americans struck a deal with the doctors. They traded immunity from prosecution for access to scientific information from the ghastly Japanese experiments – many of which are too grim to detail here. . .continue reading
Doctors launch online pledge against torture
Michael Cook | Physicians for Human Rights (PHR) has launched an online pledge for health professionals across the United States to reject torture as an absolute wrong which can never be sanctioned. . . continue reading
Torture: sometimes a man's gotta do what a man's gotta do, say bioethicists
Michael Cook | Torture is an issue on which the public might expect bioethicists to be moral absolutists. Never again! Never ever! It was somewhat surprising, then, to read in the New York Times that one of the world's leading animal rights theorists, Oxford's Jeff McMahan, support torture. . .continue reading
Psychologists and Abusive Interrogations: Acting on Conscience
Dr. Mary Pipher | . . . For the past few years, I have been troubled by various media and Department of Defense reports that psychologists have designed protocols and trained and supervised interrogators in the use of sophisticated methods for breaking the human spirit and destroying mental functioning . . . Full Text
American Psychological Association removes infamous "Nuremberg Defense" from ethics code
Stephen Soldz* | . . . like every change in APA's policies on psychologists providing interrogation support, this change is too little too late. APA leadership waited till over a year after the end of the Bush regime and its "enhanced interrogation" torture program before changing this clause which provided protection for psychologists aiding the torturers. . . continue reading

Vaccination

Compulsory Vaccination
Dave Stevens | I spent a lot of time learning about immunization practices while a missionary in Africa. I had an isolation ward full of children with measles complications and a quarter of them died in the hospital. . . It is clear to me that Steve LeBlanc's, the author of this article, comments are less about immunizations and more about right of conscience. . .continue reading
The ethical minefield of COVID-19 vaccination: Informed consent and the obligations of doctors
Margaret Somerville |  The COVID-19 pandemic has raised a multitude of complex ethical issues — and new ones present themselves daily. . . In many COVID-19 related decision-making situations at each of these levels, decision makers face what is called in bioethics a “world of competing sorrows” — that is, decision making in which there is no “no harm” option, but in which, instead, they must choose to whom harm will be allocated. . . What I want to focus on here is a particular micro- level issue: that of a healthcare professional’s obligation to obtain a person’s informed consent to COVID-19 vaccination. . . continue reading
Is mandatory vaccination ethically justifiable? Yes — the flow-on harms are too great.
Margaret Somerville |  What ethical issues do mandatory interventions to limit the spread of the Covid-19 virus raise — in particular, mandatory vaccination? Asked another way, what weight should be given to the arguments of “anti-vaxxers” who oppose mandatory vaccination? I am not addressing here “involuntary vaccination” — namely, rounding up people and vaccinating them against their will, although in highly dangerous infectious disease situations, Public Health authorities can have powers to impose treatment. Rather, I am focussed on what could be described as “non-voluntary vaccination”, the person can avoid vaccination, but only by making a choice they do not want to make. . . . continue reading