Tag: David S. Oderberg

When can a doctor conscientiously object?

America

Bernard G. Prusak*

Over the last decade, the culture wars in the United States have broken new ground: They have become battles over the rights of conscience. For example, now that same-sex marriage is a right, the question before the U.S. Supreme Court in the case of Masterpiece Cakeshop is whether its sympathetic, telegenic owner, Jack Phillips, is within his rights to refuse to make a wedding cake for a gay couple. Similarly, under the Obama administration, the court heard arguments more than once over whether employers who object on religious grounds to contraceptives or abortion should be exempted from having to provide employees health insurance that includes such services.

By contrast, debates over conscientious objection in medicine have not had the same notoriety, though they have broken out repeatedly among health care professionals and medical ethicists since the turn of the century, when there was a flare-up over pharmacists’ refusing to fill prescriptions for emergency contraceptives.

A bill currently before the House of Lords has brought conscientious objection in medicine into widespread public discussion in the United Kingdom, if not yet on the other side of the Atlantic. . . [Full text]

Declaration in Support of Conscientious Objection in Health Care

Introduction

The Declaration and associated texts you find here are my attempt, as a concerned academic, to provide a platform for the public support of freedom of conscience in health care.

Please read all of the material here. If you agree with the Declaration overall – even if you disagree with or are neutral on various details – I encourage you to add your electronic signature as a demonstration of support.

Signatures from health care professionals and academics in related fields are especially welcome, but you are encouraged to sign simply if you share my concerns and agree with the general way I have expressed them. You do not need an institutional affiliation, professional title, or any particular background. The more signatures this Declaration obtains, the more likely it is to come to the attention of policy makers and people who can amplify the message.

The texts ancillary to the Declaration are not part of its contents; they simply explain how I see and interpret the issues raised in the Declaration, and how I would like to see policy develop. By signing the Declaration, you do not indicate support for anything I say in the ancillary texts.

You will be asked only for your name, professional title (if you have one), institutional affiliation (if you have one), email address, and the country in which you reside. I may use your email occasionally to send you information about the Declaration, such as media coverage, but I will not use your email address for any other purpose. You will not be asked be involved in any other activity. The information you provide will be used solely to represent support for freedom of conscience in health care to professionals in the field (both clinical and academic), policy makers, and other interested parties who might be able to help with the promotion of this issue.

Acknowledgement and Disclaimer
I am grateful to the University of Reading for its support in hosting this material. The views and proposals presented here, however, represent my opinions alone. They do not, in any way, necessarily represent the views of the University of Reading or any of its officers, employees, or students.
David S. Oderberg

Sign the Declaration in Support of Conscientious Objection in Health Care

Show your support by signing the declaration.

You’re a surgeon. A patient wants to look like a lizard. What do you do?

As medical treatments advance, the need to accommodate conscientious objection in healthcare is more pressing

The Guardian
Reproduced with permission

David S. Oderberg*

Imagine that you are a cosmetic surgeon and a patient asks you to make them look like a lizard. Would you have ethical qualms? Or perhaps you are a neurosurgeon approached by someone wanting a brain implant – not to cure a disability but to make them smarter via cognitive enhancement. Would this go against your code of professional ethics? With the rapid advance of medical technology, problems of conscience threaten to become commonplace. Perhaps explicit legal protection for conscientious objection in healthcare is the solution.

There is limited statutory protection for those performing abortion, and there is some shelter for IVF practitioners. Passive euthanasia (withdrawal of life support with intent to hasten death) is also part of the debate over doctors’ conscience rights. That’s about it as far as UK law is concerned – though freedom of conscience is enshrined in numerous conventions and treaties to which we are party. Abortion, artificial reproductive technologies (involving embryo research and storage) and passive euthanasia are the flashpoints of current and historic controversy in medical ethics. The debate over freedom of conscience in healthcare goes to the heart of what it means to be a medical practitioner.

Curing, healing, not harming: these are the guiding principles of the medical and nursing professions. But what if there is reasonable and persistent disagreement over whether a treatment is in the patient’s best interests? What if a practitioner believes that treating their patient in a particular way is not good for them? What if carrying out the treatment would be a violation of the healthcare worker’s ethical and/or religious beliefs? Should they be coerced into acting contrary to their conscience?

Such coercion, whether it involve threats of dismissal, denial of job opportunities or of promotion, or shaming for not being a team player, is a real issue. Yet in what is supposed to be a liberal, pluralistic and tolerant society, compelling people to violate their deeply held ethical beliefs – making them do what they think is wrong – should strike one as objectionable.

Freedom of conscience is not only about performing an act but about assisting with it. There are some people who ask doctors to amputate healthy limbs. If you were a surgeon, my guess is that you would refuse. But what about being asked to help out? Would you hand over the instruments to a willing surgeon? Or supervise a trainee surgeon to make sure they did the amputation correctly? If conscientious objection is to have any substance in law, it must also cover these acts of assistance.

This country has a long and honourable tradition of accommodating conscientious objectors in wartime – those who decline to fight or to assist or facilitate the fighting by, say, making munitions. They can be assigned to other duties that may support the war effort yet are so remote a form of cooperation as not to trouble their consciences. In any war, the objectors are a tiny fraction of the combat-eligible population. Yet when it comes to one’s rights, do numbers matter? Has their existence ever prevented a war from being carried out to the utmost? I fail to see, then, why we are tolerant enough to make adjustments for conscientious objectors in the midst of a national emergency, yet in peacetime would be reluctant to afford similar adjustments to members of one of the most esteemed professions.

Do we think medical practitioners should be no more than state functionaries, dispensing whatever is legal no matter how much it is in conflict with personal conscience and professional integrity – lest they be hounded out of the profession? Some academics think expulsion is not good enough. Or should healthcare workers be valets, providing whatever service their patients demand? Perhaps when practitioners find themselves faced with demands for the sorts of treatment I’ve mentioned – or perhaps gene editing treatments or compulsory sterilisation, society will act. Or maybe by then it will be too little, too late.

David S Oderberg is professor of philosophy at the University of Reading, and author of Declaration in support of conscientious protection in medicine

 

 

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

Medics should not be forced to do procedures they object to on ethical grounds

The Conversation
Reproduced with permission

David S. Oderberg*

For most people, the term “conscientious objection” evokes images of Quakers and pacifists registering to avoid military service. Many countries have a long and honourable tradition of accommodating such conscientious objectors. It might not be about bombs and bullets, but healthcare professionals often find themselves fighting a conscience battle of their own.

In the UK, Canada, Sweden and other countries, conscientious objectors in healthcare have found themselves discriminated against in various ways – whether through dismissal, lack of promotion, or more subtle forms of coercion. Most cases involve doctors, nurses or midwives refusing to perform abortion or euthanasia (or to assist with either). Yet these happen, through historical accident, to be the flashpoint of current controversy. . . [Full text]