Category: Ethical Commentary

The Health Care Professional as Person: The Place of Conscience

Canadian Catholic Bioethics Centre

Bioethics Matters

Bridget Campion*

Recently I was asked to present “the Catholic position” on physician-assisted death as part of a panel discussion held at a downtown Toronto hospital. The purpose of the event was not to debate the issue but to educate participants about various points of view. I ran into some difficulty when I was discussing the Catholic Church’s interest in protecting the consciences of health care staff. One panelist immediately redirected our attention to the needs of the patient seeking physician-assisted death and the conversation left the health care professionals behind. In this short article, I would like to bring the focus back to the doctors, nurses, social workers, chaplains, therapists, in short, to the health care staff involved in patient care and who may have objections to performing or assisting in physician-assisted death.. . .  Full Text

Bioethics and natural law: an interview with John Keown

BioEdge

Xavier Symons John Keown*

Bioethics discourse is often divided into two broad categories: utilitarian perspectives and so-called deontological or Kantian approaches to ethics. An alternative viewpoint that receives far less attention is a natural law perspective on ethics and medicine. The natural law approach emphasizes interests or ends common to all members of humanity, and offers a teleological account of morality and human flourishing.

Professor John Keown of Georgetown University’s Kennedy Institute for Ethics recently co-authored a book on natural law with the late Georgetown Professor Alfonso Gómez-Lobo. The book is entitled Bioethics and the Human Goods: An Introduction to Natural Law Bioethics. The Deputy Editor of BioEdge, Xavier Symons, interviewed Professor Keown about his latest work.
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Canadian ethicists prepare for the worst

Bioedge

 Michael Cook

Conscientious objection seems like the paradigmatic ethical choice between right and wrong. An ethicist, of all people, ought to have this option, just as mathematicians count or sopranos sing.

Not so fast, write two healthcare ethicists at the Centre for Applied Ethics at McGill University Health Centre, in Montreal, in the blog Impact Ethics. Now that the Canadian Supreme Court has declared that euthanasia is a human right, it is time to focus on who is entitled to conscientious objection to participating in euthanasia. And perhaps ethicists are not.

We found ourselves asking the following questions: Should a clinical ethicist have the right to conscientious objection in cases of medical aid in dying? Can the role of the clinical ethicist to provide ethics analysis in matters of moral ambiguity be reconciled with a right to opt-out on the basis of personal convictions?

The nub of the question is this: when an ethicist is asked for advice, is she involved as a human being or is she merely a database of ethical choices? The ethicists write:

On the other hand, there is a growing consensus that clinical ethics expertise is grounded in the competence of the clinical ethicist to facilitate a robust process aimed at ensuring fair and transparent healthcare decisions. The clinical ethicist is expected to adopt a stance of neutrality which allows her to facilitate discussion of competing values without allowing her own beliefs to influence the discussion.

On this view, it is not the “rightness” or “wrongness” of the final outcome by which the clinical ethicist is professionally judged, but rather her skill in guiding various stakeholders through a reasonable process; a clinical ethicist’s personal convictions should not impact on her ability to facilitate this process. In this sense, perhaps the right to conscientious objection is antithetical to the provision of clinical ethics consultation, as it seems to call into question the profession’s ability to remain neutral on morally contentious issues.

There is an urgent need, the authors write, to articulate the rights and duties of healthcare ethicists, as in the wake of Carter v Canada, the euthanasia case, the boundaries will be tested.

It would be interesting indeed if Canadian ethicists who oppose euthanasia are told to pack their bags and look elsewhere for jobs. What do unemployed ethicists do? Work in Starbucks? Become an Uber driver? There are some great ideas at the website of the Unemployed Philsophers Guild — making coffee mugs, finger puppets, and scented soap.

cclicense-some-rightsThis article is published under a Creative Commons licence. You may republish it or translate it free of charge with attribution  to Michael Cook and BioEdge  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.

 

The nuts and bolts of CIA torture

BioEdge

Michael Cook

Can doctors participate in torture if there is a reasonable expectation of mitigating the harm done? It could be a seductive hope for a military doctor who is under pressure to cooperate.

However, in a book review in the Journal of Medical Ethics, Henry Shue, of Oxford University, explains that the latest CIA techniques of torture make even minimal participation ethically impossible, no matter how low the bar is set.

Contemporary torture is not so much physical as mental. Its goal is to make the person “psychological putty” in the hands of his interrogators.

The goal of the CIA paradigm as used in Guantanamo is to produce at least temporary regression to an infantile state in which the torture victim will become completely compliant (and therefore supposedly tell the torturers what they want to know). Infantile regression is produced by unhinging the structure of the self of the torture victim and alienating him from his own values through methods like sexual humiliation, religious contempt, sleep deprivation and temperature extremes.

An essential element in this is ensuring that no stable human relationship of any kind should develop between the victim and his captors.

… such total control is maintained over the victim that it is difficult for me to imagine how even if a well disposed doctor could manage to have meaningful conferences with a victim, or by some other method somehow discern what she took his genuine interests to be (as a physician attending an unconscious patient might), that the authorities at a torture site like Guantanamo would ever permit a doctor to take action that served the interests of the victim in a manner that was contrary to the demands of its relentless regression regimen.

A doctor needs to establish some bond with a patient and to understand his history in order to help him. But in this regimen, it would be impossible to know anything meaningful about the victim’s real state of mind. So it is quite unlikely that a doctor’s complicity with the torturers will ever succeed in lessening the pain of the victim.

cclicense-some-rightsThis 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 us for permission and fees. Some articles on this site are published under different terms.