Category: Ethics

‘Medical Conscience’ Is Becoming a Partisan Controversy

National Review
Reproduced with permission

Wesley J. Smith

Should doctors and nurses be forced to participate in interventions they find morally abhorrent or unwarranted? As one example, should ethical rules require pediatricians to medically inhibit normal puberty as demanded by parents to “treat” their child’s gender dysphoria — even if they are morally opposed to the concept and/or the supposed treatment?

Some say yes. Thus, influential bioethicist Ezekiel Emanuel argues that medical professionals are obligated to accede to the patient’s right to receive legal interventions if they are generally accepted within the medical community — specifically including abortion. Emanuel stated doctors who are morally or religiously opposed, should do the procedure anyway or procure a doctor they know will accede to the patient’s demands. Either that, or get out of medicine.

Supporters of “medical conscience” argue that forcing doctors to participate in interventions they find morally abhorrent would be involuntary medical servitude. They want to strengthen existing laws that protect doctors, nurses, and pharmacists’ who refuse participation in legal interventions to which they are morally or religiously opposed.

Now, medical conscience looks to become another battlefront in our bitter partisan divide. After the Trump administration announced rules that will place greater emphasis on enforcing federal laws protecting medical conscience, Democratic state attorneys general promised to seek a court order invalidating the new rule. From the New York Law Journal story:

But 19 state attorneys general, led by New York’s Eric Schneiderman, argue that it is the patients who will be discriminated against under the proposed rule. This is particularly true, they argue, in the cases of marginalized patients who already face discrimination in trying to obtain health care, such as lesbian, gay, bisexual and transgender patients and male patients seeking HIV/AIDS preventative medications, according to the comments filed in opposition to the rule.

“If adopted, the proposed rule … will needlessly and carelessly upset the balance that has long been struck in federal and state law to protect the religious freedom of providers, the business needs of employers, and the health care needs of patients,” they state.

The stakes can only increase as moral controversies in health care intensify in coming years. As just two examples, some bioethicists are lobbying to enact laws that would give dementia patients the right to sign an advance directive requiring nursing homes to starve them to death once they reach a specified level of cognitive decline. There are also increasing calls to do away with the dead-donor rule in transplant medicine so that PVS patients can be organ-harvested while still alive

If these acts become legal, should doctor and nurses who practice in these fields be forced to participate? If Emanuel’s opinion prevails, the answer could be yes. If medical professionals are protected by medical conscience legal protections, the answer would be no.

Medical conscience is not just important to personally affected professionals. All of us have a stake. Think about the potential talent drain we could face if we force health-care professionals to violate their moral beliefs. Experienced doctors and nurses might well take Emanuel’s advice and get out of medicine — while talented young people who could add so much to the field may avoid entering health-care professions altogether.

Comity is essential to societal cohesion in our moral polyglot age. Medical conscience allows patients to obtain morally contentious procedures, while permitting dissenting medical professionals to stay true to their own moral and religious beliefs. I hope the Democrats’ lawsuits are thrown out of court.

The “Medical Conscience” Civil Rights Movement

First Things

Wesley J. Smith*

Until recently, healthcare was not culturally controversial. Medicine was seen as primarily concerned with extending lives, curing diseases, healing injuries, palliating symptoms, birthing babies, and promoting wellness – and hence, as a sphere in which people of all political and social beliefs were generally able to get along.

That consensus has been shattered. Doctors today may be asked to provide legal but morally contentious medical interventions such as sex selection abortion, assisted suicide, preimplantation genetic diagnosis of IVF embryos, even medications that inhibit the onset of puberty for minors diagnosed with gender dysphoria. As a consequence, medical practice has become embroiled in political and cultural conflict. . .
Full Text

Two-thirds of GPs will refuse to provide abortion pills

Doctors voted in closed forum to rule themselves out of service

Irish Independent

Eilish O’Regan

A majority of GPs say they will not provide abortion pills to women in the first 12 weeks of pregnancy if it becomes law, according to a survey of family doctors.

Nearly seven in 10 of the 497 GPs who voted in a closed doctors’ forum said they would not be involved in medical abortions.

Around 15.7pc said they would provide the service and 16.1pc were “unsure”.

The doctors are among 3,700 GPs who are registered with GPBuddy.ie, the online medical directory designed by GPs for Irish healthcare professionals.

They responded to a series of questions on the confidential forum.

Although the survey has its limitations, it indicates that, if rolled out nationwide, it would mean a substantial number of GPs would opt out of the abortion service.

However, they would be obliged to refer a woman seeking an abortion to a doctor who provides the procedure. . . [Full Text]

Euthanasia performed on Canadian prisoner

BioEdge

Michael Cook

A request by a Belgian prisoner for euthanasia made international headlines not too long ago, even though he was not permitted to take advantage of the legislation.

But in a measure of how enthusiastically Canada has embraced euthanasia, one prisoner has already been killed under its Medical Aid in Dying (MAID) law, and three others have been approved. According to a report in CBC News, the death took place in a hospital outside of the prison, under the supervision of two correctional officers.

Correctional Service Canada (CSC) told CBC News that it had, to date, received eight requests for MAID.

CSC is now permitted to organise MAID in a community hospital — but it can also take place in a penitentiary regional hospital or treatment centre in exceptional circumstances and at the request of the inmate.

Correctional Investigator Ivan Zinger criticised the possibility of inmates being euthanised in a prison in a letter to the CSC head:

“Practically and perceptually, I simply can not imagine a scenario where it would be considered acceptable to allow an external provider to carry out a MAID procedure in a federal penitentiary,”

Zinger said that MAID should occur only outside prisons. A prohibition on MAID within prisons would protect the integrity of the system now and in the future, when eligibility for assisted death could expand to prisoners suffering from acute psychiatric illnesses – and in prisons there are a number of these.

Euthanasia performed on Canadian prisonerThis 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 to BioEdge. Commercial media must contact BioEdge for permission and fees. Some articles on this site are published under different terms.

World Medical Association urged to change policy against euthanasia, assisted suicide

Canadian & Royal Dutch Medical Association want censure dropped

Sean Murphy*

The President of the World Federation of the Catholic Medical Associations has disclosed that the Canadian Medical Association (CMA) and Royal Dutch Medical Association (RDMA) have asked the World Medical Association to change its policy against euthanasia and physician assisted suicide.

The WMA issued a Declaration on Euthanasia in 19871 and a Resolution on Euthanasia  in 2002;2  they are now identical. The WMA Statement on Physician Assisted Suicide was made in 1992 and reaffirmed in 2005 and 2015:

Physician-assisted suicide, like euthanasia, is unethical and must be condemned by the medical profession. Where the assistance of the physician is intentionally and deliberately directed at enabling an individual to end his or her own life, the physician acts unethically. However the right to decline medical is a basic right of the patient, and the physician does not act unethically even if respecting such a wish results in the death of the patient.3

Writing to the President of the World Medical Association, Dr. John Lee stated that the CMA and RDMA suggested that existing policy be replaced with the following:

8. The WMA does not support euthanasia or physician assisted suicide, but WMA does not condemn physicians who follow their own conscience in deciding whether or not to participate in these activities, within the bounds of the legislation, in those jurisdictions where euthanasia and/or physician assisted dying are legalized.

9. No physician should be forced to participate in euthanasia or assisted suicide against their personal moral beliefs. Equally, no conscientiously objecting physician should be forced to refer a patient directly to another physician. Jurisdictions that legalize euthanasia or physician assisted suicide must provide mechanisms that will ensure access for those patients who meet the appropriate requirements. Physicians, individually or collectively, must not be made responsible for ensuring access.4

Dr. Lee also expressed opposition to a planned revision to the Declaration of Oslo concerning abortion, which, he said, would require objecting physicians to refer for abortions and even to provide them.  However, he commented at greater length on the proposed change to WMA policy on euthanasia and assisted suicide.

Based on the Canadian experience, acceptance of the ethical neutrality of medically-assisted death has resulted in almost immediate challenges for physicians who are unable to refer because of moral, religious, or ethical concerns. It is a serious problem, with physicians put in the impossible position of having to choose between their conscience and being allowed to continue to care for their patients.4

The Canadian roots of the CMA/RDMA proposal

Dr. Lee’s observations about developments in parts of Canada are accurate.  The text of paragraph 8 is very similar to the CMA resolution used by the CMA Board of Directors as the basis for reversing CMA policy against euthanasia and assisted suicide. . . [Full Text]