Is mandatory vaccination ethically justifiable?

Yes — the flow-on harms are too great.

MercatorNet

Margaret Somerville

Is mandatory vaccination ethically justifiable?

What ethical issues do mandatory interventions to limit the spread of the Covid-19 virus raise — in particular, mandatory vaccination? Asked another way, what weight should be given to the arguments of “anti-vaxxers” who oppose mandatory vaccination?

I am not addressing here “involuntary vaccination” — namely, rounding up people and vaccinating them against their will, although in highly dangerous infectious disease situations, Public Health authorities can have powers to impose treatment. Rather, I am focussed on what could be described as “non-voluntary vaccination”, the person can avoid vaccination, but only by making a choice they do not want to make. . . continue reading

The ethical minefield of COVID-19 vaccination: Informed consent and the obligations of doctors

Australian Broadcasting Corporation

Margaret Somerville

The ethical minefield of COVID-19 vaccination: Informed consent and the obligations of doctors

The COVID-19 pandemic has raised a multitude of complex ethical issues — and new ones present themselves daily. These issues, including those related to vaccination, arise at four levels: micro or individual (for example, when a doctor vaccinates a patient); meso or institutional (regarding, for instance, a hospital’s or aged care residence’s policy on vaccinating staff); macro or societal ( a government’s decisions or public health regulations governing distribution of vaccines and access to vaccination); and mega or global (such as a nation’s obligations to provide vaccines to those in developing countries, which are without vaccines).

In many COVID-19 related decision-making situations at each of these levels, decision makers face what is called in bioethics a “world of competing sorrows” — that is, decision making in which there is no “no harm” option, but in which, instead, they must choose to whom harm will be allocated. The ethical difficulties are exacerbated when the harms and benefits do not accrue to the same people or, at least, not in equal measure. A striking example of such a situation at the macro or societal level would be the use of “lockdowns”, when the choice is between protecting public health and inflicting serious economic harm.

What I want to focus on here is a particular micro- level issue: that of a healthcare professional’s obligation to obtain a person’s informed consent to COVID-19 vaccination.

Failure to obtain an informed consent to, or an informed refusal of, medical treatment — which includes vaccination — is medical negligence (medical malpractice). Informed consent to or refusal of medical treatment has three requirements: competence, information, and voluntariness. There is a wealth of research on what is needed to establish each element, but here is a brief summary. . . Continue reading

Dr. Robert’s regrets: Towards death à la carte?

Sean Murphy*

The state medical regulator in the province of Quebec, the Collège des Médecins du Québec, published an reflection in 2009 that effectively encouraged the legalization of euthanasia. During hearings into Quebec’s Bill 52, which eventually became the province’s euthanasia law (the Act Respecting End of Life Care), Dr. Charles Bernard , Dr. Yves Robert and Dr. Michelle Marchand appeared on behalf of the Collège.  They were effusive in their support for the proposed law, describing it as “a very important milestone,” the product of “outstanding work,” and “responsive to the vision we initially proposed.”

One of the points Dr. Bernard  emphasized was that euthanasia should be “an option of last resort for  exceptionally difficult situations at the end of life. . . in the final stages of a serious and incurable disease that is inflicting refractory suffering.”  Dr. Robert himself added that euthanasia should only be considered in what was truly the “last slice of life in the final phase of the life.”  Only then, he said, might it be considered an option “from a medical point of view.”

Consistent with these views, the original text of the Bill was amended to include a provision that a patient had to be “at the end of life,” even though the legislators could not agree on what this meant.  It is not certain that the term is being interpreted consistently throughout the province, though returns from reporting agencies sometimes report refusal to provide euthanasia because a patient is “not at the end of life.”  About 8% of refusals in the first half of 2017 were attributed to patient ineligibility, which includes this criterion, among others.

In any event, Dr. Robert has published a commentary indicating alarm at increasing pressure to provide euthanasia in circumstances and for reasons apparently not envisaged by Collège des Médecins du Québec when it published its 2009 reflection and expressed its support for the new legislation.  Of particular interest, he suggests that, if current trends to broaden criteria for euthanasia continue and are affirmed, it may be appropriate for the medical profession to be replaced by some kind of non-medical (but presumably technically competent) euthanasia service.

During the legislative hearings into Bill 52, Professor Margaret Somerville suggested that lawyers could be trained for this purpose.  Her suggestion was ignored at the time, but Dr. Robert’s comments suggest that he and other euthanasia supporters may now be more open to Dr. Somerville’s proposal.  Having a corps of voluntary euthanasia service providers would relieve the pressure now being experienced by physicians and health care workers who object to euthanasia for reasons of conscience.

  • Dr. Robert’s regrets [Full English translation of Vers la mort à la carte? provided by the Physicians’ Alliance against Euthanasia]

What’s behind the demolition of conscience rights in Canada?

Mercatornet

Margaret Somerville*

I’ve been puzzling about why Canadian “progressive” values advocates, particularly those passionately in favour of the legalization of euthanasia and physician-assisted suicide (“physician-assisted death” (PAD)), are so adamant in trying to force healthcare professionals and institutions who have conscience or religious objections to these procedures to become complicit in them.

Complicity would occur if objecting individual physicians were forced to provide “effective referrals” or objecting institutions were forced to allow PAD in their facilities. An “effective referral” is defined by the Ontario College of Physicians and Surgeons as “a referral made in good faith, to a non-objecting, available, and accessible physician or other health-care provider.”

In general, progressive values advocates claim to give priority to rights to individual autonomy, choice, control over what happens to oneself, and tolerance for those who believe differently. Yet in relation to respect for the freedom of conscience and, where relevant, religious belief, of physicians or institutions who oppose PAD, none of these principles seem to be applied. Why? [Full text]

A modest proposal for respecting physicians’ freedom of conscience

National Post

Margaret Somerville

The Ontario College of Physicians and Surgeons is consulting on whether patients’ right of access to certain procedures, such as abortion, should trump the rights of those physicians who refuse, for reasons of conscience, to provide them. Dr. Marc Gabel, a College official, chairs the working group looking at this issue, which is drafting a new policy on “Professional Obligations and Human Rights.”

Dr. Gabel has been reported as saying that “physicians unwilling to provide or facilitate abortion for reasons of conscience should not be family physicians” and it seems wants the College to approve that stance. Sean Murphy, of the Protection of Conscience Project, argues that “if it does, ethical cleansing of Ontario’s medical profession will begin this year, ridding it of practitioners unwilling to do what they believe to be wrong.”

Freedom of conscience, like the other fundamental freedoms enshrined in the Canadian Charter of Rights and Freedoms, is a fundamental pillar of democracy. So how could breaching this right be, as Dr Gabel claims, “required by professional practice and human rights legislation”? . . . [Full text]