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Issues In Depth
Ethical Commentaries
GENERAL

ETHICAL ISSUES AND RELIGIOUS BELIEVERS

GENERAL

Background

Cristina Alarcon

I would like to address today what I see as a great flaw in our current code of ethics – the failure to provide for the accommodation of conscience and religion. Before I develop this however, I would like to touch on the international recognition of the dignity of the individual because such dignity is for all people whether, in our context, patients seeking medical services broadly construed, or those who provide them whether medical services personnel or pharmacists. . .

Iain T. Benson

A popular summary of an article published in the University of British Columbia Law Review (Iain T.Benson,   "Notes Towards a (Re) Definition of the "Secular" [2000] 33 U.B.C. Law Rev. 519 - 549, Special Issue: "Religion, Morality, and Law.").  Mr. Benson draws attention to the erroneous notion that "secular" means "faith-free".   He argues that this error is transmitted through the culture and imposed by the courts, thus allowing the "implicit faith" of atheists and agnostics to dominate and displace all others.  "Why," he asks, "should the opinions of those who don't know or refuse to articulate what they believe dominate those who can say what they believe in and why they think it matters?"

When professional codes of conduct allude to 'personal values', and workplace controversies about issues of conscience are characterized as 'conflicts of values", it is past time to ask what meaning is conveyed by such terms.  The author holds that values language "obscures moral discourse rather than furthers it."  His short article serves as a suitable introduction to the subject.

J. Budziszewski, Ph.D

Professor Budziszewski tackles the problem of conflicts of conscience that arise in teaching "those sensitive subjects where the conscientious convictions of different students, or of students and teachers, are likely to come into conflict."

The author discusses the false dichotomy of 'religious' and 'secular', directing attention to the fact that everyone, religious or not, abides by some "practice of ultimate concern that orders all other concerns, unconditioned loyalty that trumps all other loyalties."   Understanding this concept is critical if one hopes to respond to the absolutist claims of those who would banish from public life all but what they call 'secular' ethics.

Sue Careless

Globally, religion is gaining clout, and the way we order our lives together politically is once again being forced to take into account the spiritual. So argued many of the speakers at a "Pluralism, Religion, and Public Policy" conference held Oct. 9-11 at McGill University. Citizens, they said, should not have to check their deepest beliefs at the vestibule before entering the public square.

Christian Medical Association

. . . Because the way things are going, some would actually force out of the profession those physicians who have moral objections to procedures such as abortion. And that loss of physicians--especially Obstetricians and Gynecologists who are already leaving because of malpractice insurance costs--would have a severe impact on the delivery of healthcare. 

Michael Cook

The debate between a libertarian bioethicist and a communitarian bioethicist illustrates why American bioethics is becoming increasingly marginalised and irrelevant to the democratic society that it intends to serve . . .

Teresa Iglesias, D.Phil

What is good medicine? Who counts as a good doctor? These are very large questions that cannot be fully addressed here. I want to focus on a basic aspect of these two questions and on the ethical idea of “the good.”

One of the most fundamental questions that is increasingly facing bioethicists and society alike is the question, "What does it mean to be human?" "In what consists the act of being human?" "Is my humanity a 'bodily' humanity?" In every area of philosophical concern we are always thrown back to these basic questions.

Dianne N. Irving, M.A., Ph.D. 

What will be the basis for 21st century decisions about euthanasia, physician-assisted suicide, test-tube babies, cloning and stem cell research, etc.?  "Perhaps it is time," writes Dr. Irvine, " to stop and seriously reconsider which medical ethics should be used as the basis of these choices - while we still can!"

The author examines two different theories of medical ethics, "pointing out briefly what they are, comparing their conclusions about what is right or wrong, and indicating where they have already lead us. . ."

The author points out that knowing correct scientific information is preliminary to moral decision making by the patient, the physician and a multitude of others.  She argues that any scientific error in the beginning  precludes one from making morally correct decisions in the end.  The author writes from a Catholic perspective, but her approach to the subject may be adopted without difficulty by non-Catholics.  The paper was written for a mixed audience of 'average citizens' and specialists in academic disciplines.  The text is accessible to the non-specialist, while the extensive end notes  meet the exacting requirements of academic discussion.

"Bioethics" -- the word sounds like old-fashioned medical ethics applied to new medical technology. It's the application of traditional philosophical or theological principles to the moral dilemmas created by, say, cloning or experimenting with new AIDS drugs, right? Not really.

. . . the key to understanding any philosophical or theological ethical theory is to identify its philosophical or theological "anthropology"-- or definition of "a human being" or "person". Different anthropologies lead to different ethical theories. Some anthropologies match reality; others don't. Bioethics tries to claim that its theory really has no "anthropology", i.e., the "personhood" issue. Bioethics is "just" about "ethics". However, almost all bioethics arguments do incorporate a "delayed personhood" claim, whether or not they know or admit it --

The aim of this paper is to debunk these current myths concerning the relativism of what a human being or a human person is, and to at least raise the question at the end of how these "myths" came about even at the level of scientific and philosophical professional "expertise".  What I will argue is that we can and do have an objective and empirically-based definition of a human being and a human person, and that, other than conceptually, one cannot really split a human being from a human person.

Sean Murphy

Ethical differences between one theory of bioethics and another may be quite as dramatic as doctrinal differences between religions, though, like religions, there are also similarities.  Problems for ethical minorities arise when one version of bioethics becomes predominant, and its practitioners attain positions of influence and power in government, academic and professional circles.

Progress towards understanding the importance of freedom of conscience for health care workers is not infrequently hindered by rhetorical minefields . . .What follows is an attempt to clarify some of the points of dispute and identify key issues. It introduces the term “embryocide” and specifies the meaning of “abortifacient” and “contraceptive” based upon what is common to parties who hold contrary views about abortion and contraception. . .

Judging from the title of her article, Professor Julie D. Cantor believes that “selfless professionalism” in medicine is being destroyed by health care workers who will not do what they believe to be wrong. (Cantor, Julie D., Conscientious Professionalism Gone Awry - Restoring Selfless Professionalism in Medicine.” N Eng J Med 360;15, 9 April, 2009) . . .

It appears that most people are willing to grant that a health care worker who has serious moral objections to a procedure should not be compelled to perform it or assist directly with it. However, many people find it more difficult to understand why some health care workers object to even indirect forms of involvement: why they might refuse to help patients obtain a morally controversial service or procedure by referring them to a more willing colleague.

Before taking action that they may later regret, those who would coerce or discriminate against conscientious objectors, or drive them from the practice of pharmacy, would do well to revisit Frank Archer=s critical review, AEmergency Contraceptives and Professional Ethics@ (Canadian Pharmaceutical Journal, May 2000, Vol. 133, No. 4, p. 22-26 ). Although many pharmacists have accepted the review as a definitive ethical statement, it is insufficient warrant for repression of freedom of conscience within the profession.

. . .As the subtitle of the book indicates, [the author] is seeking a compromise that will provide "maximal liberty for all parties." She believes that freedom of conscience for physicians and the provision of legal medical services are both important social goals, and that they are not incompatible. . . . quoting the Protection of Conscience Project, she affirms that all legitimate concerns can be met by "dialogue, prudent planning, and the exercise of tolerance, imagination and political will." . . .

Eamon O'Dwyer LL.B, F.R.C.P.I., F.R.C.O.G.

. . . Natural Law is rooted in history. To understand it fully and to appreciate its significance, it is necessary to trace its development from its origin in ancient Greek philosophy. . .

Sally Satel

. . . Whether bioethics has achieved its goal is the urgent question at the core of this useful book, co-authored by Renée C. Fox, a highly distinguished sociologist, and Judith P. Swazey, a respected historian of medicine. Between them, Fox and Swazey have spent many decades as participant observers in the house of medicine. . . .

Margaret Somerville

Euthanasia advocates argue respect for human dignity requires that euthanasia be legalized and opponents of euthanasia argue exactly the opposite, that respect for human dignity requires it remain prohibited. In short, the concept of human dignity and what is required to respect it is at the centre of the euthanasia debate, but there is no consensus on what we mean by human dignity, its proper use, or its basis. . . .

Wesley J. Smith

The author argues that control over public policy decisions in health care has been ceded to [secular] bioethicists, "an elite group of academics, philosophers, lawyers, and physicians, many of whom are openly hostile to the sanctity of life and the Hippocratic traditions that most people still take for granted."  The result is that law and public policy are increasingly shaped by beliefs that are not shared by the people whom they affect.  Smith's  powerful critique closes with a call for greater media vigilance, public awareness and even "a counter-bioethics movement" to vigorously engage and contain the spread of an ideology he believes is "directing us down immoral and dangerous paths."

Ethics of Freedom

George Weigel

. . . Isaiah Berlin thus deserves considerable credit for identifying the perversion of liberty that was at the root of the totalitarian project, and for defending a concept of liberty–as–noninterference that, in setting legal limits to coercive state power, has deep resonances in the American political tradition. And yet, forty–four years after “Two Concepts of Liberty,” one has to ask whether Berlin’s analysis of the problem of freedom is truly adequate. . . .

Ethical Issues in Current Practice

Cristina Alarcon

Should pharmacists have the right to act according to their consciences, or are they prescription-filling robots? . . . A Canadian pharmacist and bioethicist, Cristina Alarcon, explains what is at stake in her profession.

Iain T. Benson

Responding to: R. Alta Charo, J.D., The Celestial Fire of Conscience — Refusing to Deliver Medical Care N Eng J Med 352:2471-2473; 24, June 16, 2005

Maria Bizecki, B.S.P.,

The author, who has direct experience in her subject, discusses the pressures faced by people whose moral convictions expose them to discrimination and coercion in the workplace in order to explain the need for protection of conscience laws.

A. Cyrenian

How a Catholic pharmacist followed his convictions and stopped dispensing contraception.

Dionysius Dialogues
Christian Medical Fellowship (United Kingdom)

Dionysius: Well, for a start, we can't refuse to diagnose and treat them just because they are sinners. We wouldn't see anybody. Where could we draw the line? Nitpickerus: It's not that which worries me. It's when they want us to help them do something which we regard as unethical  Dionysius: Let's have a real example. Nitpickerus: OK. A man wants you to write a doctor's certificate so he can be compensated for the time he's taken off work but you have good reason to believe he's been malingering. Do you write the certificate?


Beth Doherty

Every now and again, stories hit the media about pharmacists who refuse to stock condoms, dispense the contraceptive pill and, more recently, the morning-after pill. Contrary to what we are led to believe, this is not an irregular occurrence, nor is it a particularly surprising stance for a Christian pharmacist.

Carrie Farella, RN, MA,

Initially, when [Oregon's assisted suicide law] was designed, the assumption was that physicians would be the first ones to explore PAS with patients,” says Pam Matthews, RN, BSN, administrator for Evergreen Hospice, Albany, OR, “but in reality, nurses are usually the ones in the line of fire. Patients often feel nurses understand their wishes for good quality of life and good quality of death, too.

Laura A Hawryluck,  William RC Harvey,  Louise Lemieux-Charles  and Peter A Singer

(Research Paper) Intensivists must provide enough analgesia and sedation to ensure dying patients receive good palliative care. However, if it is perceived that too much is given, they risk prosecution for committing euthanasia. The goal of this study is to develop consensus guidelines on analgesia and sedation in dying intensive care unit patients that help distinguish palliative care from euthanasia.

Dianne N. Irving, M.A., Ph.D.

. . .When you find yourself in a situation where you and your deepest gut instincts are so pitted against some “theory” – any “theory” – then perhaps it is time to stop and to question this “theory”? The specific “theory” in question here is not really “ethics”, but, I would suggest -- “bioethics”.

John Mallon

What are the limits of conscience? Can there be any limits on conscience? Professor R. Alta Charo, who teaches law and bioethics at the University of Wisconsin Law and Medical Schools in Madison, thinks there should be, and that the law should require health care professionals to violate their consciences in certain cases . . .

Susan Martinuk

The author introduces the new course for health care workers in the 21st century - "Sticky Issues 101" - by considering conflicts of conscience in pharmacy.  Susan Martinuk, a former Ph.D student in reproductive technology, is a Vancouver-based columnist and speaker on biomedical and ethical issues.

Abortion on demand may soon take on a whole new meaning in Alberta. The Alberta College of Physicians and Surgeons has rewritten its guidelines covering the standard of care that doctors must provide. . .

Sean Murphy

Responding to: Cantor J, Baum K. The Limits of Conscientious Objection - May Pharmacists Refuse to Fill Prescriptions for Emergency Contraception? N Eng J Med 351;19, November 4, 2004

Responding to: Charo, RA. The Celestial Fire of Conscience- Refusing to Deliver Medical Care. N Eng J Med 352:24, June 16, 2005

The notion that referral is an acceptable compromise may presume that moral culpability attaches only to direct participation in X, and not to facilitating the provision of X by someone else. This presumption contradicts important religious and moral traditions that hold that we may be morally responsible for the actions of someone else.

Paper delivered 11 November, 2001 at Obstetrics and Gynaecology conference New Developments - New Boundaries, Banff, Alberta, Canada.

. . . The audience finds British Captain Jack (Lucky Jack) Aubrey and the crew of his man o’war on the north coast of Brazil, hunting the French privateer Acheron. The film follows the hunt down the east coast of South America, around Cape Horn and into the Pacific. . .

Nucleus
Christian Medical Fellowship (United Kingdom)

. . .I came to the conclusion that I could only provide contraception to married couples, and that my contraceptive advice to unmarried couples would be limited to that of advising them not to have intercourse. I would advise them that if they rejected my advice they should go elsewhere and obtain their contraception from another doctor. I was not forcing my opinion on them, because they were perfectly free to reject my advice and obtain their contraception elsewhere.

Dr. Mary Pipher

. . . For the past few years, I have been troubled by various media and Department of Defense reports that psychologists have designed protocols and trained and supervised interrogators in the use of sophisticated methods for breaking the human spirit and destroying mental functioning . . .

Peter Saunders

This edition of Triple Helix highlights three possible changes in British Law that could lead to Christians receiving criminal convictions . . .

Wesley J. Smith

Margaret Somerville

The conferral of an honorary degree on Dr. Henry Morgentaler provided a flashpoint for yet another explosion in the long-standing, deeply acrimonious war as to the values that should govern abortion. The two polar positions are well defined, but I want to speak for those, like me, who regard all abortion as raising serious ethical issues, but who would not legally prohibit early abortion . . .

The author argues that "[o]ne effect of intense individualism in the context of reprogenetics is that the accumulation of individual decisions are resulting in an overall outcome that would never be acceptable as public policy. In short, the new genetics is functioning as eugenics, but that fact is not identified."

Dr. Larry Reynolds

In modern heath care the role of the physician is at risk of being reduced to becoming a mere tool of the patient’s will. The doctor’s role will be just to provide services that patients demand. Autonomy of the patient trumps all. This view impoverishes our profession, degrades doctors to mere technicians and will accelerate the moral wasting disease presently plaguing Canadian health care. . .

Gene Rudd MD

The governor of Illinois has told pharmacists to check their conscience at the door. They are not to allow their personal convictions to alter their professional activities. Specifically, pharmacies are to fill all legal prescriptions, even if doing so is contrary to deeply held moral or religious beliefs of the pharmacists. . .

Dave Stevens, MD

"I spent a lot of time learning about immunization practices while a missionary in Africa. I had an isolation ward full of children with measles complications and a quarter of them died in the hospital. . . It is clear to me that Steve LeBlanc's, the author of this article, comments are less about immunizations and more about right of conscience. . .

Adrian Treloar, Philip Howard

The authors argue that feeding tube placement is a medical procedure and as such requires consideration of the benefits and risks as for any other medical treatment. However, the day-to-day use of feeding tubes, to provide hydration and nutrition, constitutes ordinary care that does not require medical supervision. Withdrawal of tube feeding raises major ethical and legal questions.

Wang MY,  Wallace P,  Gruen JP.  

After reviewing the 78 brain deaths documented at the hospital in 1999, J. Peter Gruen, MD, and colleagues at the Keck School of Medicine of the University of Southern California in Los Angeles, discovered that the diagnosis was highly variable and concluded that standards for practice and documentation were sorely needed.

Resisting Ethical Aggression

Re: "Abortion: Ensuring Access"

In July,2006, the Canadian Medical Association Journal published a guest editorial by Sanda Rodgers of the Faculty of Law, University of Ottawa, and Jocelyn Downie, of the Health Law Institute, Dalhousie University, Halifax, Nova Scotia.  The editorial appears to have been an attempt to bully objecting physicians who refuse to refer patients for abortion by menacing assertions about legal and ethical obligations.  The CMAJ is a publication of the Canadian Medical Association, which, however, asserts that its contents do not necessarily represent the views of the Association.

Re: Physicians and the Ontario Human Rights Code

Re:   American College of Obstetricians and Gynecologists continues attacks on freedom of conscience

Re:  Letter to President Barack Obama from Christian Medical Association and Freedom2Care Coalition