A Philosophical Defense of Conscientious Objection to Abortion

Medical Bag

Medical Bag Contributing Writer

In an article published in the Journal of Medical Ethics, Bruce Philip Blackshaw of the department of philosophy at the University of Birmingham, United Kingdom, and Daniel Rodger from the School of Health and Social Care, London South Bank University, United Kingdom, defended conscientious objection to abortion provision, claiming that the usual arguments critics make for disqualifying conscientious objection in healthcare do not apply in cases of abortion. . . [Full text]

Professionalism eliminates religion as a proper tool for doctors rendering advice to patients

Udo Schuklenk

Abstract

Journal of Medical Ethics

Religious considerations and language do not typically belong in the professional advice rendered by a doctor to a patient. Among the rationales mounted by Greenblum and Hubbard in support of that conclusion is that religious considerations and language are incompatible with the role of doctors as public officials.1 Much as I agree with their conclusion, I take issue with this particular aspect of their analysis. It seems based on a mischaracterisation of what societal role doctors fulfil, qua doctors. What obliges doctors to communicate by means of content that is expressed in public reason-based language is not that they are public officials. Doctors as doctors are not necessarily public officials. Rather, doctors have such obligations, because they are professionals. Unlike public officials doctors are part of a profession that is to a significant extent self-governing. This holds true for all professions. The …

Responding to religious patients: why physicians have no business doing theology. Jake Greenblum Ryan K Hubbard Journal of Medical Ethics 2019; – Published Online First: 20 Jun 2019. doi: 10.1136/medethics-2019-105452


Schuklenk U. Professionalism eliminates religion as a proper tool for doctors rendering advice to patients. J Medical Ethics. 2019 Sep 12. pii: medethics-2019-105703. doi: 10.1136/medethics-2019-105703. [Epub ahead of print]

Why not common morality?

Rosamond Rhodes

Abstract

Journal of Medical Ethics

This paper challenges the leading common morality accounts of medical ethics which hold that medical ethics is nothing but the ethics of everyday life applied to today’s high-tech medicine. Using illustrative examples, the paper shows that neither the Beauchamp and Childress four-principle account of medical ethics nor the Gert et al 10-rule version is an adequate and appropriate guide for physicians’ actions. By demonstrating that medical ethics is distinctly different from the ethics of everyday life and cannot be derived from it, the paper argues that medical professionals need a touchstone other than common morality for guiding their professional decisions. That conclusion implies that a new theory of medical ethics is needed to replace common morality as the standard for understanding how medical professionals should behave and what medical professionalism entails. En route to making this argument, the paper addresses fundamental issues that require clarification: what is a profession? how is a profession different from a role? how is medical ethics related to medical professionalism? The paper concludes with a preliminary sketch for a theory of medical ethics.


Rhodes R. Why not common morality? J Med Ethics 2019;0:1–8. Published Online First: 11 September 2019. doi: 10.1136/medethics-2019-105621

The Role of Nurses When Patients Decide to End Their Lives

Some hospitals and hospices have policies that forbid nurses to be part of the process or even to discuss end-of-life options.

New York Times

Emilie Le Beau Lucchesi

When Ben Wald, 75, was dying of cancer in 2012, he wanted to use Oregon’s Death with Dignity Act to receive a prescription for a lethal medication that would end his life. His hospice nurse, Linda, was part of the discussion and provided both information and support, said his wife, Pam Wald, of Kings Valley, Ore.

His colon cancer had spread to his lungs, and his weight dropped from 180 to 118 pounds. He struggled to speak or eat.

When he was ready to end his life, the couple wanted Linda with them, but the hospice organization she worked for did not allow it, Mrs. Wald said. The organization allowed other hospice workers, such as social workers and massage therapists, to be present, but not the doctors or nurses it employed. . . [Full text]

Korean doctors categorize 12 cases to refuse treatment

Korean Biomedical Review

Song Soo-youn

The local medical community’s voice is growing for doctors’ rights to refuse to treat a patient, but patients are against the idea. However, the U.S. and Europe have already recognized such rights.

Based on examples in other countries, Korean physicians should also be allowed to refuse treatment in particular situations such as a forced surgery to terminate a fetus, a report said.

The Korean Medical Association (KMA)’s Medical Policy Research Institute released the report, “Status and Challenges of Treatment Refusal,” on Thursday. The institute analyzed examples in other countries and offered 12 situations where doctors can refuse to deliver treatment services. . . [Full text]

Questionable benefits and unavoidable personal beliefs: defending conscientious objection for abortion

 Bruce Philip Blackshaw, Daniel Rodger

 Abstract

Journal of Medical Ethics

Conscientious objection in healthcare has come under heavy criticism on two grounds recently, particularly regarding abortion provision. First, critics claim conscientious objection involves a refusal to provide a legal and beneficial procedure requested by a patient, denying them access to healthcare. Second, they argue the exercise of conscientious objection is based on unverifiable personal beliefs. These characteristics, it is claimed, disqualify conscientious objection in healthcare. Here, we defend conscientious objection in the context of abortion provision. We show that abortion has a dubitable claim to be medically beneficial, is rarely clinically indicated, and that conscientious objections should be accepted in these circumstances. We also show that reliance on personal beliefs is difficult to avoid if any form of objection is to be permitted, even if it is based on criteria such as the principles and values of the profession or the scope of professional practice.


Blackshaw BP, Rodger D. Questionable benefits and unavoidable personal beliefs: defending conscientious objection for abortion. J Medical Ethics 2019 Aug 31. pii: medethics-2019-105566. doi: 10.1136/medethics-2019-105566. [Epub ahead of print]

Doctors issued with new ethical guidelines on providing abortion

Medical Council guide sets out obligations for doctors with conscientious objections

The Irish Times

30 August, 2019

Martin Wall

The Medical Council has issued revised ethical guidance for doctors following the introduction of abortion legislation earlier this year.

A new version of its ethics document provides updated guidance for doctors who have conscientious objections to particular forms of treatment, procedures or care, not just in relation to abortion.

The amended guide to professional conduct and ethics for doctors says termination of pregnancy is legally permissible within the provisions of legislation introduced in 2018. . . [Full text]

OCR Issues Notice of Violation to the University of Vermont Medical Center After It Unlawfully Forced a Nurse to Assist in Abortion

News Release
For immediate release

US Department of Health and Human Services

Contact: HHS Press Office
202-690-6343
media@hhs.gov

The U.S. Department of Health and Human Services (HHS), Office for Civil Rights (OCR) is announcing that, after a thorough investigation and prolonged attempts to resolve the matter, OCR has issued a Notice of Violation letter finding that the University of Vermont Medical Center (UVMMC) violated the Church Amendments (42 U.S.C. 300a-7) by forcing a nurse to assist in an elective abortion procedure over the nurse’s conscience-based objections. OCR also found that UVMMC has discriminatory policies that assign or require employees to assist abortion procedures even after they have recorded their religious or moral objections to assisting in the performance of such abortions. OCR’s Notice of Violation letter asks UVMMC to conform its policies to the Church Amendments and take other corrective action, or face potential action by the HHS component from which UVMMC has received federal funding.

On May 9, 2018, a nurse at UVMMC filed a conscience and religious discrimination complaint with OCR against UVMMC, a medical center in Burlington, Vermont that receives HHS funds, contending that the nurse was forced to assist an abortion in violation of the nurse’s conscience rights. As part of its investigation, OCR contacted UVMMC repeatedly in a good faith effort to seek cooperation from UVMMC, but the hospital refused to conform its policies to federal conscience laws, provide all the documents requested by OCR, or produce witnesses for OCR interviews. Nevertheless, OCR interviewed multiple witnesses and gathered evidence concerning the allegations.

As a result of its investigation, OCR has specifically determined that:

  • UVMMC forced the nurse complainant to assist in an abortion against the nurse’s religious or moral objection. The nurse had expressed an objection for many years and was included in a list of objectors, but UVMMC knowingly assigned the nurse to an abortion procedure. The nurse was not told the procedure was an abortion until the nurse walked into the room, when the doctor—knowing the nurse objected to assisting in abortions—told the nurse, “Don’t hate me.” The nurse again objected, and other staff were present who could have taken the nurse’s place, but the nurse was required to assist with the abortion anyway. If the nurse had not done so, the nurse reasonably feared UVMMC would fire or report the nurse to licensing authorities.
  • OCR spoke with several other UVMMC health care personnel who, since at least the spring of 2017, have been intentionally, unnecessarily, and knowingly scheduled by UVMMC to assist with elective abortions against their religious or moral objections. Such personnel were often not told in advance that the procedures they were being assigned to assist with were abortions. Health care personnel who are coerced in that way suffer moral injury, are subjected to a crisis of conscience, and frequently experience significant emotional distress, even if they succeed in declining to assist in the procedure after the assignment is made.
  • UVMMC maintains a staffing policy that facially violates the Church Amendments because the policy admits to circumstances where UVMMC can and will force staff—on pain of adverse action or discipline—to participate in abortions against their moral or religious objections. The policy also violates UVMMC’s agreement, as a condition of receiving HHS funds, to comply with federal law, including the Church Amendments and HHS’s grants regulations.
  • Consequently, UVMMC is violating 42 U.S.C. § 300a-7(c)(1) of the Church Amendments by discriminating against health-care personnel who have religious or moral objections to abortion, and subjecting them to different terms or conditions of employment than other health-care personnel.

In the Notice of Violation, OCR asks that UVMMC notify OCR within thirty days whether UVMMC intends to work collaboratively with OCR to change its policies so it no longer requires health care personnel to participate in abortion against their religious or moral objections, and to take immediate steps to remedy the effect of its past discriminatory conduct. Otherwise, OCR indicates that it will forward the Notice to the Health Resources and Services Administration (HRSA), a component of HHS that provides grant funds to UVMMC, for consideration and possible additional procedures concerning UVMMC’s receipt of federal funds.  Since October 1998, UVMMC has received—and continues to receive—grants from HRSA.  For the most recently completed three-year project period, which ended April 30, 2018, UVMMC reported that it cumulatively expended $1.6 million of federal financial assistance.

Roger Severino, Director of OCR said, “Forcing medical staff to assist in the taking of human life inflicts a moral injury on them that is not only unnecessary and wrong, it violates longstanding federal law. Our investigation has uncovered serious discrimination by UVMMC against nurses and staff who cannot, in good conscience, assist in elective abortions.”  Severino concluded, “We stand ready to assist UVMMC in changing its policies and procedures to respect conscience rights and remedy the effects of its discrimination.” 

OCR is charged with helping ensure entities come into compliance with federal laws protecting conscience and prohibiting coercion in health care, including the Church Amendments.

Conscientious objection: how much discretionary power should physicians have?

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 Julian Savulescu has argued that conscience protections open a “Pandora’s box of idiosyncratic, bigoted, discriminatory medicine”, and that “public servants must act in the public interest, not their own”. 

But should physicians have the right to exercise professional discretion with patients? 

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 Cambridge Quarterly of Healthcare Ethics, 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 “professional judgments are both technical and moral in all cases”  and that it is important to “respect and protect a wide discretionary space for physicians regarding ethically controversial interventions”. According to Sulmasy, 

“Conscientious 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”.

This argument, however, has been criticised. Doug McConnell, an ethicist at the University of Oxford, argues in the journal Bioethics (and in Oxford’s Practical Ethics blog) 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 “commonly accepted ailments, such as rashes, headaches, mild depression and anxiety”. 

McConnell also argues that Sulmasy’s 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: 

“within fiduciary relationships, the party with the fiduciary duty should place greater weight on the others’ interests and, so be prepared to go against his conscience”. 

Physicians, in other words, should be prepared to put patient interests ahead of their own moral or religious convictions. 

Yet McConnell may have misunderstood Sulmasy’s account of the fiduciary relationship between clinicians and patients. Sulmasy is a student of Edmund Pellegrino — a medical ethicist who wrote at length about the notion of “the patient’s good”, and argued that this should be at the centre of a doctor’s professional concerns. It is hard to believe that Sulmasy would downplay a physician’s duties to their patients. 

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’s good. For Sulmasy, the patient’s good is determined by a set of moral and technical considerations, whereas for McConnell, the patient’s good is more a matter of their individual preferences and interests.

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 these guidelines. If you teach at a university we ask that your department make a donation to BioEdge. Commercial media must contact BioEdge for permission and fees.

Bergenfield Doctor’s Lawsuit Halts NJ Physician-Assisted Suicide Act

Jewish Link

Bracha Schwartz

Rabbi Yosef P. Glassman, MD, of Bergenfield, has won a lawsuit to temporarily stop the New Jersey Medical Aid in Dying for the Terminally Ill Act that had been scheduled to take effect on August 16. The law would allow physicians, under certain conditions, to prescribe drugs to terminally ill patients for the sole purpose of ending their lives. But the battle has just begun.

In an email interview, Rabbi Dr. Glassman explained why he initiated the lawsuit. “I was motivated to act by the chilling prospect of being a part of the suicide process, which strongly conflicted with both my professional and religious values. I was fortunate enough to engage in meaningful discussions with several concerned Jewish community members on the topic, and I decided to take a firm position, being involved in the field of geriatrics. Some people who may oppose my action may say that I want dying patients to suffer, chas v’shalom. Quite the opposite—we as physicians have ample tools to alleviate the suffering for the living, even for the terminally ill, without the need to license suicide.” . . . [Full text]