{"id":9331,"date":"2019-08-25T20:18:22","date_gmt":"2019-08-26T03:18:22","guid":{"rendered":"https:\/\/news.consciencelaws.org\/?p=9331"},"modified":"2020-08-02T15:50:58","modified_gmt":"2020-08-02T22:50:58","slug":"conscientious-objection-how-much-discretionary-power-should-physicians-have","status":"publish","type":"post","link":"https:\/\/news.consciencelaws.org\/?p=9331","title":{"rendered":"Conscientious objection: how much discretionary power should physicians have?"},"content":{"rendered":"\n<p><strong><em>BioEdge<\/em><\/strong><\/p>\n\n\n\n<h4 class=\"wp-block-heading\">Xavier Symons<\/h4>\n\n\n\n<p>\n        There has been significant debate about conscientious objection in healthcare in recent years. Some scholars have argued that conscience protections in law and professional codes of conduct may lead to negligence in medical care and may put patient wellbeing at risk. For example, Oxford bioethicist&nbsp;<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC1360408\/\">Julian Savulescu has argued<\/a> that conscience protections open a \u201cPandora&#8217;s box of idiosyncratic, bigoted, discriminatory medicine\u201d, and that \u201cpublic servants must act in the public interest, not their own\u201d.&nbsp;<\/p>\n\n\n\n<p>\n        But should physicians have the right to exercise professional discretion with patients?&nbsp;<\/p>\n\n\n\n<p>\n       Some scholars, such as Daniel Sulmasy, argue that physician discretion is an essential part of good medical practice, and that restrictions on conscientious objection would have a negative impact on medical care. In a 2017 article in the <a href=\"https:\/\/www.cambridge.org\/core\/journals\/cambridge-quarterly-of-healthcare-ethics\/article\/tolerance-professional-judgment-and-the-discretionary-space-of-the-physician\/D05C15C8CCDA74858598231C3ADEE809\">Cambridge Quarterly of Healthcare Ethics<\/a>, Sulmasy argued that physicians should have the right to exercise their judgement about which treatments they will provide, provided that they are not practicing medicine in a manner that is discriminatory or harmful to patients. He wrote that \u201cprofessional judgments are both technical and moral in all cases\u201d&nbsp; and that it is important to \u201crespect and protect a wide discretionary space for physicians regarding ethically \n        controversial interventions\u201d. According to Sulmasy,&nbsp;<\/p>\n\n\n\n<blockquote class=\"wp-block-quote is-layout-flow wp-block-quote-is-layout-flow\"><p>         \u201cConscientious refraining from actions when such restraint does not risk illness, injury, or death, would not seem to rise to the level of being sufficient grounds for compelling conscience\u201d.<\/p><\/blockquote>\n\n\n\n<p>\n        This argument, however, has been criticised. <a href=\"http:\/\/www.bioethics.net\/2019\/08\/conscientious-objection-professional-discretionary-space-and-good-medicine\/\">Doug McConnell<\/a>, an ethicist at the University of Oxford, argues in the journal <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/30014476\">Bioethics<\/a> (and in Oxford&#8217;s <a href=\"http:\/\/blog.practicalethics.ox.ac.uk\/2019\/08\/conscientious-objection-professional-discretionary-space-and-good-medicine\/\">Practical Ethics blog<\/a>) that too much physician discretion can lead to people being denied basic forms of medical care. While Sulmasy agrees that physicians should not practice discriminatory medicine, his framework still allows for objecting doctors to refuse patients treatment for \u201ccommonly accepted ailments, such as rashes, headaches, mild depression and anxiety\u201d.&nbsp;<\/p>\n\n\n\n<p>\n        McConnell also argues that Sulmasy\u2019s framework undermines the fiduciary relationship that clinicians should have with their patients. Sulmasy appears to give equal weight to the interests of doctors and the interests of patients. Thus, a doctor can refuse a patient a treatment if the treatment conflicts with their ethical or religious convictions. But McConnell argues that this is incompatible with a fiduciary relationship:&nbsp;<\/p>\n\n\n\n<blockquote class=\"wp-block-quote is-layout-flow wp-block-quote-is-layout-flow\"><p>         \u201cwithin fiduciary relationships, the party with the fiduciary duty should place greater weight on the others\u2019 interests and, so be prepared to go against his conscience\u201d.&nbsp;<\/p><\/blockquote>\n\n\n\n<p>\n        Physicians, in other words, should be prepared to put patient interests ahead of their own moral or religious convictions.&nbsp;<\/p>\n\n\n\n<p>\n        Yet McConnell may have misunderstood Sulmasy\u2019s account of the fiduciary relationship between clinicians and patients. Sulmasy is a student of Edmund Pellegrino &#8212; a medical ethicist who wrote at length about the notion of <a href=\"https:\/\/philpapers.org\/rec\/PELFTP\">\u201cthe patient\u2019s good\u201d<\/a>, and argued that this should be at the centre of a doctor\u2019s professional concerns. It is hard to believe that Sulmasy would downplay a physician\u2019s duties to their patients.&nbsp;<\/p>\n\n\n\n<p>           Perhaps the real distinction between McConnell and Sulmasy is not their  concern for the good of the patient, but rather the way in which they  conceptualise the patient\u2019s good.  For Sulmasy, the patient\u2019s good is determined by a set of moral and technical considerations, whereas for McConnell, the patient\u2019s good is more a matter of their individual preferences and interests. <\/p>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"alignleft size-large\"><img decoding=\"async\" src=\"https:\/\/news.consciencelaws.org\/wp-content\/uploads\/cclicense-some-rights.jpg\" alt=\"Conscientious objection: how much discretionary power should physicians have?\" class=\"wp-image-10155\"\/><\/figure><\/div>\n\n\n\n<p>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 <a href=\"https:\/\/www.bioedge.org\/index.php\/bioethics\/copyright_and_syndication\">these guidelines<\/a>. If you teach at a university we ask that your department make a donation to BioEdge. Commercial media must <a href=\"mailto:michael@bioedge.org\">contact BioEdge<\/a> for permission and fees.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>BioEdge Xavier Symons There has been significant debate about conscientious objection in healthcare in recent years. Some scholars have argued that conscience protections in law and professional codes of conduct may lead to negligence in medical care and may put patient wellbeing at risk. For example, Oxford bioethicist&nbsp;Julian Savulescu has argued that conscience protections open &hellip; <a href=\"https:\/\/news.consciencelaws.org\/?p=9331\" class=\"more-link\">Continue reading<span class=\"screen-reader-text\"> &#8220;Conscientious objection: how much discretionary power should physicians have?&#8221;<\/span><\/a><\/p>\n","protected":false},"author":5432,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[508],"tags":[129,3690],"post_folder":[],"class_list":["post-9331","post","type-post","status-publish","format-standard","hentry","category-ethical-commentary","tag-daniel-p-sulmasy","tag-doug-mcconnell"],"yoast_head":"\r\n<title>Conscientious objection: how much discretionary power should physicians have? - Protection of Conscience Project News<\/title>\r\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\r\n<link rel=\"canonical\" href=\"https:\/\/news.consciencelaws.org\/?p=9331\" \/>\r\n<meta property=\"og:locale\" content=\"en_US\" \/>\r\n<meta property=\"og:type\" content=\"article\" \/>\r\n<meta property=\"og:title\" content=\"Conscientious objection: how much discretionary power should physicians have? - Protection of Conscience Project News\" \/>\r\n<meta property=\"og:description\" content=\"BioEdge Xavier Symons There has been significant debate about conscientious objection in healthcare in recent years. 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