Conscientious Objectors: Canaries in the Ethical Mineshaft
Lay Witness,
July/August 2001
Reproduced with permission
. . . life and death issues
facing the health care worker go far beyond abortion
and physician assisted suicide, with conscientious
objectors being the canaries in the ethical
mineshaft. When they can no longer survive the moral
environment in the workplace, others will soon find
themselves in the same position.
Many professionals encounter varying levels of
pressure to comply with proposed actions or deeds
that are in conflict with their sincerely held code
of ethics. This pressure to violate one's conscience
is routine in health care. To alleviate this form of
abuse, "protection of conscience laws" would ensure
that health care workers could opt out - without
fear of reprisal or other discriminatory coercion -
of participation in medical procedures or referrals
that offend their moral or religious convictions.
Such procedures may include: abortion, artificial
birth control, sterilization, artificial
reproduction, use of abortificacients, genetic
terminations, human embryo and human fetal research,
human experimentation, human cloning, purely
experimental high-risk research with the mentally
ill, euthanasia and physician assisted suicide.
Freedom of conscience is an inalienable human
right owed to everyone. Protection of
conscience laws resist the development of a two-tier
system of civil rights within health care
professions, one tier being those who prescribe to a
universal, unchangeable ethic, and the other tier
being those who live by a relativistic, changing
"majority opinion" ethic. As a consequence, such
laws also reflect the ethics you prefer your
health care worker to follow.
Obviously, there are members of society in need
of health care workers who share the same views on
ethics and morality as the conscientious objector.
Should health care workers who do not subscribe to
the ethical dogmas decreed by a handful of
self-described ethicists in health care be treated
as second-class citizens? Unfortunately, as
medicine's philosophy is swinging from allegiance to
the individual patient toward duty to the larger
community, those who do not agree with these ethics
are being forced out of the health care profession
for thinking differently.
Working Out a Solution
Some object to conscience laws on the basis that
they would allow health care workers to impose moral
viewpoints on the patient. That is not true.
Instead, conscience laws will ensure that the morals
of the patient, professional associations and
society cannot be imposed on the health care worker.
Professional ethics should not contradict ethics in
general and professional duty should not crush
personal duty. Accommodating the interests of both
parties is possible without suppressing the freedom
of conscience of others, if we have the
political will.
The interests of the patient and the health care
worker are different -the former wants to obtain a
product or service that they have no conscientious
objection to, while the latter seeks to abide by his
or her conscience, which is why, in the case of
referral, their interests cannot be balanced. The
patient and the physician operate from the concept
of "good" that can be completely different from the
concept of "good" held by the conscientious
objector.
The patient may believe that he is being deprived
of something to which he has a right, but in no
sense is he made to do something that he believes to
be wrong. The claim that the objector is imposing
morality is quite wrong.
"Timely access" is a term that often encourages
medical professionals to confuse the concept of
medical necessity with avoiding patient
inconvenience. Conscience laws would not interfere
with timely access in a properly administered
system; it would simply ensure that suppression of
conscientious objection not be seen as an example of
proper or competent administration. This concept
applies to the profession of pharmacy, where
economic self-interest appears to be a higher
priority than protecting freedom of conscience. The
refusal to cooperate in the distribution of morally
controversial drug products, which make up only a
small percentage of available products, has nothing
to do with abandoning the patient's health care
needs, but in many cases is about losing a patient's
business.
A Matter of Integrity
Imagine you are a student in a school where
cheating is endemic, and you are approached by
Student X for the answers to an upcoming test. If
you decline - for moral reasons - to supply the
answers, should you be forced to direct Student X to
someone willing to provide them? Most people would
maintain that no one should be made to lie or
facilitate cheating, because such things are wrong.
To the extent that you sense or appreciate the
wrongness of an act, you will defend the right to
refuse to assist with it. It is an assertion of
personal integrity, not an effort to impose
limitations upon others.
Now consider something that you believe to be
really wrong. Maybe it's bribery or stealing, or
perhaps even something legal, like pornography. Do
you think that you should be discriminated against
or fired because you refuse to participate in or
facilitate it? Even if other people do it, you still
consider it wrong, and you refuse to be involved.
That is how conscientious objectors in health care
view forced participation.
Forced Participation
In Canada, the province of Manitoba has the only
pharmacy association in the country which protects
its pharmacists from forced participation in
referral. Conversely, the College of Pharmacists of
British Columbia (CPBC) openly - and with impunity,
it seems - defies human rights legislation by
demanding that conscientious objectors dispense or
otherwise help the patient, even if this is contary
to the objector's judgement of conscience. In the
CPBC March/April 2000 College Bulletin, this ethics
committee accused conscientious objectors of
"dissuading patients under the guise of patient
counselling," lying about the existence of services
to patients," and attempting to "promote their own
moral viewpoint." Not surprisingly, the CPBC failed
to provide evidence for their prejudicial
accusations.
In Holland recently, an elderly patient suffering
from cancer had her life terminated without giving
consent. She reluctantly agreed to be admitted to
the hospital after being reassured the staff would
not terminate her life. After she began to improve,
another oncologist needed a bed for a patient and
found this lady "blocking a bed," so he killed her.
Soon after, upon learning of this news, her doctor
was appalled, and created and scene and was
disciplined for unprofessional behaviour. The
"killer" was not disciplined.1How
many health care professionals are to disciplined
for so-called "unprofessional behaviour" when it
comes to protecting and respecting a patient's life?
In Britain, health care professionals attempted
to terminate the life of a severely disabled child.
When the boy's pain medication began to cause
respiratory arrest, the mother requested that the
hospital staff discontinue it. They refused, so the
family disconnected the boy themselves and a fracas
ensued. The three relatives of the child were
convicted of assault after saving his life.2 Imagine the
position of a conscientious objector in this
situation - called upon by an attending physician to
repulse the efforts of the parents as they try to
rescue their child.
A proposed statute concerning decisionally
incapacitated human subjects was recently defeated
in Maryland. A "decisionally incapacitated" patient,
who was legally incompetent to give true informed
consent, could appoint a surrogate or "research
agent." That surrogate or research agent could then
give his or her "substituted judment" that the
patient would have wanted to participate in this
research if that patient were competent.3
Imagine the psychiatric health care worker who does
not want to take part in such procedures.
In Iraq, doctors have been forced against their
conscience by their governments to be involved in
non-medical procedures. For example, they were
required by law to amputate the ears and brand the
foreheads of deserters. Doctors were told that if
they refused they would suffer the same fate. One
doctor was executed and many were imprisoned for
their refusal to exercise medicine punitively.4
Will
conscientious objectors in other countries be
condemned as "counter-revolutionaries"? What about
those patients who want to be cared for by people
whose attitudes are condemned by the establishment
as "counter-revolutionary"?
Already, pharmacists in Alberta (Canada),
California, Florida, Washington, and Indiana have
been reprimanded or fired for their conscientious
objections, as have other health care workers such
as nurses, doctors, social workers and hospital
aides. Although some health care professionals have
successfully won lawsuits against their employers,
they have endured psychological and financial stress
in the process.
Clearly, life and death issues facing the health
care worker go far beyond abortion and physician
assisted suicide, with conscientious objectors being
the canaries in the ethical mineshaft. When they can
no longer survive the moral environment in the
workplace, others will soon find themselves in the
same position.
Notes
1. Christian Medical Dental
Society, Canadian newsletter
2. McGovern, C., The Report
Magazine (July 24, 2000), 48. See
www.spuc.org.uk
3. Irving, D., "Biomedical
research with 'decisionally incapacitated' human
subjects: legalization of a defunct normative
bioethics theory," Journal of Health Care Law &
Policy, University of Maryland (June 30, 1998)
4. Mirzeaei, S. and Knoll, P.,
Letters in the Canadian Medical Association Journal
(2000), 163(5):498-99