Category: Ethics

Doctors to fight new abortion law

Hawthorn Caller

Mike Billings

A group of doctors opposed to abortion say they will fight any moves in looming reforms to erode their rights to refuse to deal with patients wanting abortions. The issue of referring patients seeking abortions to another doctor has drawn opposition from the group.

Justice Minister Andrew Little says he agrees with a Law Commission proposal for doctors who are “conscientious objectors” to abortion to be made to directly refer a patient on to another doctor who they know will provide the service.

Currently, such doctors only have to advise the patient they can get the service elsewhere without specifying where. . . [Full text]

Abortion and the medical profession

The Irish Times (Letter)
Reproduced with permission

Dr. Noreen O’Carroll

Sir, –

Dr Mark Murphy states that doctors who are opposed to abortion are in no way affected by the new service and their conscientious right to objection is respected.

In fact, doctors who have a conscientious objection are legally compelled to make arrangements for the transfer of care of the pregnant woman concerned to someone who will terminate the pregnancy. For doctors who cherish human life from its origins, that is tantamount to making them accomplices in taking the life of a developing baby.

This is an abuse of conscience and contrary to the practice of medicine in the spirit of the Hippocratic oath which prohibits the direct intentional taking of human life.

Dr Murphy, who you omitted to mention is on the staff of the department of general practice at the Royal College of Surgeons in Ireland, is one of a minority of GPs in Ireland who have signed up to provide abortion services; the vast majority of GPs have not done so – 274 was the figure recently reported by the HSE.

I am not now, nor have I ever been, a member of a pro-life group; although as an ordinary citizen, I have consistently advocated for the life of the developing baby to be legally protected and have voted accordingly.

– Yours, etc, Dr Noreen O’Carroll, (Lecturer in Medical Ethics, RCSI), Blackrock, Co Dublin.

Controversy dogs ‘assisted dying’ poll of UK doctors

BioEdge

Michael Cook

A controversial poll by the Royal College of Physicians, in the UK, is expected to result in a change in its position on “assisted dying”. Polling ends on March 1 and the result will be announced later in the month.

If the email poll fails to reach a supermajority of 60% who oppose a change from the status quo of opposition, the official position of the College will change to neutrality.

On the face of it, the procedure for the poll is bizarre. If 59% of the RCP’s 35,000 members support opposition to “assisted dying”, which in any democratic election would be an overwhelming victory with a margin of 18 percent, they still lose.

In fact, a former chair of the RCP’s ethics committee has threatened legal action. Dr John Saunders described the vote as a “sham poll with a rigged outcome”. In a letter to The Guardian he contended that the RCP would change its position to neutral even if the result were the same as a 2014 poll, when 57.5% of the doctors who voted did not “support a change in the law to permit assisted suicide by the terminally ill”.

Another group of doctors wrote a letter to The Times in which they accused a cabal of hijacking the RCP. “We are worried that this move represents a deliberate attempt by a minority on the RCP council to drop the college’s opposition to assisted suicide even if the majority of the membership vote to maintain it.”

The RCP President, Dr Andrew Goddard, insists that the poll is both fair and necessary. “It is important that the RCP represents fairly the views of its full membership. We will go ahead with the survey as planned.”

He is quite aware of the impact that a change would have upon public opinion. “The RCP is frequently asked for its stance on this high profile issue, which may be cited in legal cases and parliamentary debate, so it is essential that we base this on an up-to-date understanding of our members’ and fellows’ views.”

Although some reports assumed that “assisted dying” means “assisted suicide”, the RCP’s definition seems to encompass euthanasia as well: “The supply by a doctor of a lethal dose of drugs to a patient who is terminally ill, meets certain criteria that will be defined by law, and requests those drugs in order that they might be used by the person concerned to end their life.” In Oregon, where only assisted suicide is legal, “a physician prescribes a lethal dose of medication to a patient, but the patient – not the doctor – administers the medication.”

Controversy dogs ‘assisted dying’ poll of UK doctors

This 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.

Is there a difference between palliative sedation and euthanasia?

BioEdge

Xavier Symons

One common argument in favour of legalising euthanasia is that several accepted medical practices already involve hastening the death of patients. Some ethicists claim, for example, that we are already hastening patients’ deaths in palliative care contexts through the administration of toxic levels of opioids and sedatives to patients. In palliative sedation — a relatively common procedure in end of life scenarios — doctors administer strong doses of drugs such as midazolam to sedate a patient. Ostensibly this is done to relieve refractory symptoms, yet some suggest that doctors are fully aware that the drugs may bring about a quicker death. In light of this, some ethicists argue that we need not be so concerned about hastening death through euthanasia — this is a mere extension of the already existing practices in palliative care.

There are two common rejoinders to this argument. The first is that palliative sedation does not even hasten death — in fact, studies show that it actually may prolong life. Thus, there is no causal link between the administration of analgesics and barbiturates and the death of the patient.

The second is that the practice of palliative sedation is defensible on the basis of double effect reasoning. The doctrine of double effect is quite difficult to summarise in a sentence, but essentially the claim is that doctors do not intend for the patient’s death to be hastened, even though they foresee that this may be the case.

A new article in the Journal of Medical Ethics attempts to critique these two responses. Doctor Thomas David Riisfeldt of the University of New South Wales argues that empirical evidence on palliative sedation does not in fact provide a reliable indication of whether or not palliative sedation hastens death. In a blog post summarising the article, Riisfeldt writes:

“[the claim that pain killers and sedatives do not hasten death] is not watertight at all.  This is mainly owing to the ethical limitations (more so, the ethical impossibility) of conducting high-quality randomised controlled trials to definitively compare survival times in patients receiving or not receiving palliative opioids and sedatives, along with a number of other practical difficulties.  I conclude that adopting a position of agnosticism on the matter is appropriate”.

In the article, Riisfeldt also suggests that the doctrine of double effect is indefensible, and argues that — in the case of palliative sedation — there is no meaningful distinction between the direct effect of the action (pain relief) and the unintended consequence (death).

So, does Riisfeldt’s critique itself hold water? He makes a series of controversial claims regarding the nature of palliative sedation, and whether it violates the sanctity of life principle (he believes that it does). It seems to this author that his essay would be befitting a robust response from someone familiar with the literature on palliative sedation and also the across the ethics of double effect.

Is there a difference between palliative sedation and euthanasia?

This article is published by Xavier Symons 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.