State Representative Gordon Denlinger has suspended work on a bill to amend the state constitution to ensure freedom of conscience for citizens who refuse to provide services for reasons of conscience or religion. He explained that he encountered difficulty in drafting the amendment so as to avoid providing a legal pretext for unjust discrimination. [insurancenewsnet.com]
Hymen restoration and ‘virginity certificates’ in Sweden
Informed consent and conscientious objection are easy to fulminate about, but tricky to discuss with consistency. Take, for instance, the delicate topic of requests for hymen restorations and virginity certificates. Worldwide, an estimated 5,000 women were victims of honour killings in 2000. If a young woman from a culture which sanctions honour killing approaches a doctor, what should he or she do?
Refusal is not a popular or even, in some jurisdictions, a legal option for doctors who are asked to refer for an abortion or to prescribe contraception. But a request which reinforces “patriarchal norms” is different.
J Med Ethics doi:10.1136/medethics-2013-101675
N.Juth, N, Lynöe
Many countries, Sweden among them, lack professional guidelines and established procedures for responding to young females requesting virginity certificates or hymen restoration due to honour-related threats. The purpose of the present survey study was to further examine the attitudes of the Swedish healthcare professionals concerned towards young females requesting virginity certificates or hymen restorations. The study indicates that a small majority of Swedish general practitioners and gynaecologists would accommodate these patients, at least given certain circumstances. But a large minority of physicians would under no circumstances help the young females, regardless of speciality, years of practice within medicine, gender, or experience of the phenomenon. Their responses are similar to other areas where it has been claimed that society should adopt a zero tolerance policy against certain phenomena, for instance drug policy, where it has also been argued that society should never act in ways that express support for the practice in question. However, this argument is questionable. A more pragmatic approach would also allow for follow-ups and evaluation of virginity certificates and hymen restorations, as is demonstrated by the Dutch policy. Hence, there are some obvious advantages to this pragmatic approach compared to the restrictive one espoused by a large minority of Swedish physicians and Swedish policy-makers in this area.
Cambridge Quarterly of Healthcare Ethics / Volume 23 / Issue 02 / April 2014, pp 220-230
Brody H, Leonard SE, Nie J-B, Weindling P.
In 1945–46, representatives of the U.S. government made similar discoveries in both Germany and Japan, unearthing evidence of unethical experiments on human beings that could be viewed as war crimes. The outcomes in the two defeated nations, however, were strikingly different. In Germany, the United States, influenced by the Canadian physician John Thompson, played a key role in bringing Nazi physicians to trial and publicizing their misdeeds. In Japan, the United States played an equally key role in concealing information about the biological warfare experiments and in securing immunity from prosecution for the perpetrators. The greater force of appeals to national security and wartime exigency help to explain these different outcomes.
J Med Ethics doi:10.1136/medethics-2013-101731
This paper aims to demonstrate how public disclosure can be used to balance physicians’ conscientious objections with their professional obligations to patients – specifically respect for patient autonomy and informed consent. It is argued here that physicians should be permitted to exercise conscientious objections, but that they have a professional obligation to provide advance notification to patients about those objections. It is further argued here that public disclosure is an appropriate and ethically justifiable limit to the principle of advance notification. The argument for publicly disclosing physicians’ conscientious objections is made in this paper by discussing three practical benefits of public disclosure in medicine, and then addressing how publicly disclosing physicians’ conscientious objections is not an undue invasion of privacy. Three additional concerns with public disclosure of physicians’ conscientious objections are briefly addressed – potential harassment of physicians, workplace discrimination, and mischaracterising physicians’ professional aptitude – concluding that each of these concerns requires further deliberation in the realm of business ethics.
Little Sisters of the Poor have filed appeal in Denver, Colorado against the HHS Mandate. Catholic Notre Dame University in Indiana has been denied injunctive relief, apparently because it had already agreed to comply with the mandate. The Becket Fund reports 95 lawsuits filed against the federal government regulation, with over 300 plaintiffs: 47 by for-profit corporations, 46 by non-profit corporations, and two class action lawsuits. Of the rulings so far, 33 injunctions have been granted to for-profit corporations (six denied) and 19 have been granted to non-profit corporations (one denied).
Crusade against NFP-only physicians
“Religious beliefs should remain where they belong – in the private domain.”
A 25 year old woman could not obtain a prescription for contraceptives at a clinic because the physician did not prescribe them for reasons of “medical judgment as well as professional ethical concerns and religious values.” She obtained the prescription at a clinic two minutes away. A crusade was started against the physician and two colleagues with the same views. Crusaders argued that in a ‘secular’ state health care system, physicians should be forbidden to act on their moral or religious beliefs.
Physicians who refuse to prescribe contraceptives face a difficult challenge, since aggressive contraceptive promotion has left most people unaware of alternatives. Further, the social progress of women is widely attributed to contraceptives, so that failure to provide them risks an adverse reaction. Nonetheless, based on a respectful understanding of female fertility cycles and other factors, plausible reasons can be given to justify refusal to prescribe contraceptives and recommendation of Natural Family Planning.
The Supreme Court of Canada has acknowledged that secularists are believers, no less persons with religious beliefs. There is no legal warrant for the idea that a secular state must be purged of the expression of religious belief. The claim that a secular state or health care system is “faith-free” is radically false. Both religious belief and secularism can result in narrow dogmatism and intolerance, as demonstrated by the crusade against the physicians.
Since the practice of medicine is an inescapably moral enterprise, every decision concerning treatment is a moral decision. Since the practice of morality is a human enterprise, the secular public square is populated by people with many moral viewpoints. To discriminate against religious belief is a distortion of liberal principles. Moreover, if religious believers can be forced to do what they believe to be wrong, so can non-religious believers. This would establish a destructive and dangerous ‘duty to do what is wrong.’
It is essential to maintain the integrity of physicians and well-being of patients. After abortion was legalized, a difficult compromise emerged that safeguards both, while protecting the community against a purported ‘duty to do what is wrong.’ Nonetheless, some people are trying to entrench that duty in medical practice, moving from a purported duty to provide or facilitate abortion to a duty to kill or facilitate the killing of patients by euthanasia. It is unacceptable to compel people to commit or even to facilitate what they see as murder, and punish or penalize them if they refuse. It is equally unacceptable to insist that physicians must not act upon beliefs, because it is impossible; one cannot act morally without reference to beliefs. Such policies are inconsistent with the central place occupied by individual conscience and judgment in a liberal democracy.
Freedom of conscience can be adequately accommodated in a society characterized by a plurality of moral and political viewpoints if appropriate distinctions are made. The first of these is the distinction between the exercise of perfective freedom of conscience: pursuing an apparent good – and preservative freedom of conscience: refusing to participate in wrongdoing. The state can sometimes legitimately limit perfective freedom of conscience by preventing people from doing what they believe to be good, but it does not follow that it is equally free to suppress preservative freedom of conscience by forcing them to do what they believe to be wrong.
To force people to do something they believe to be wrong is always an assault on their personal dignity and essential humanity, and it always has negative implications for society. It is a policy fundamentally opposed to civic friendship, which grounds and sustains political community and provides the strongest motive for justice. It is inconsistent with the best traditions and aspirations of liberal democracy, since it instills attitudes more suited to totalitarian regimes than to the demands of responsible freedom. Even the strict approach taken to limiting other fundamental rights and freedoms is not sufficiently refined to be safely applied to limit freedom of conscience in its preservative form. Like the use of potentially deadly force, if the restriction of preservative freedom of conscience can be justified at all, it will only be as a last resort and only in the most exceptional circumstances.
That a young woman had to drive around the block to fill a birth control prescription does not meet this standard.
Canada’s Liberal Party, meeting at a policy convention in Montreal, Quebec, has overwhelmingly adopted a policy resolution favouring the legalization of euthanasia and assisted suicide. However, the policy is not binding on the party leader, Justin Trudeau, so it is not certain that it will be included in his official platform in the next Canadian federal election. The policy resolution calls for a change in the law after public consultation. [National Post]
Moral blindness becomes a virtue and necessity
US scientists were “accomplices after the fact” in Japanese doctors’ war crimes
All of contemporary bioethics springs from the Nuremberg Doctors Trial in 1947. Seven Nazi doctors and officials were hanged and nine received severe prison sentences for performing experiments on an estimated 25,000 prisoners in concentration camps without their consent. Only about 1,200 died but many were maimed and psychologically scarred.
So what did the US do to the hundreds of Japanese medical personnel who experimented on Chinese civilians and prisoners of war of many nationalities, including Chinese, Koreans, Russians, Australians, and Americans? They killed an estimated 3,000 people in the infamous Unit 731 in Harbin, in northeastern China before and during World War II – plus tens of thousands of civilians when they field-tested germ warfare. Many of the doctors were academics from Japan’s leading medical schools.
The government of Quebec was unable to convince the opposition Liberal Party to complete debate on Bill 52, legislation to legalize euthanasia, in order to bring it to a vote before the Quebec National Assembly adjourned for two weeks. The government has tabled a budget, which takes precedence over other bills. It is believed that the government will call an election when the Assembly returns, which means that the euthanasia bill will not pass. It could be resurrected by a government formed after the election. [CBC News]