Freedom of conscience in health care: “an interesting moral swamp”?

Responding to Caplan AL. Whose rights come first: Doctors or patients? Medscape, 5 November, 2019

Sean Murphy*

“Whose rights come first?” asks Professor Arthur Caplan in a recent Medscape column. “Doctors’ or patients?”

“You can’t have physicians, pharmacists, nurses, and social workers saying they are not going to do legally allowed medicine or standard-of-care treatment because it violates their rights,” says Professor Caplan. He does suggest that refusal can be allowed if the objector can find a substitute “and it doesn’t disrupt the ER or the organization of healthcare delivery.” . . . Full text

Whose Rights Come First: Doctors’ or Patients’?

Medscape

Arthur L. Caplan

Hi. I’m Art Caplan. I’m at the Division of Medical Ethics at the NYU School of Medicine. Conscientious objection—everybody seems to be talking about it these days. What are the rights of physicians, pharmacists, nurses, or other healthcare workers to say that something may be legal but they refuse to do it?

This issue has come up particularly as more and more health systems are merging. You see Catholic hospitals merging with secular hospitals. Catholic hospitals have a huge presence in the American world of hospitals and nursing homes, probably accounting for 40% of all facilities. When mergers take place, whose values predominate? . . [Full text]

(Project response: Freedom of conscience in healthcare: “an interesting moral swamp?”)

Facilitating an unethical practice is unethical

Psychiatric Times

Madelyn Hisaio-Rei Hicks*

I am an adult psychiatrist who has worked in public sector psychiatry in the US and the UK. In both countries, physicians struggle with the ethics and professional meaning of legalized or proposed physician-assisted suicide (PAS). I was recently asked by an organization to host a CME course titled “Best Practices in the End-of-Life Options Act.” Passed in 2016, the Act legalized the practice of PAS in California.

My response to the invitation

Thank you very much for your invitation to join in providing a CME about “Best Practices in the End-of-Life Options Act.”the very serious and complex ethical and legal issue of PAS.

At one point in my 14 years of examining and writing about PAS and euthanasia, I thought that, even though I found PAS to be unethical, in situations where it became legal, perhaps the best that psychiatrists and other physicians could do would be to provide thorough assessments and treatment options for individuals requesting PAS. . . [Full text]

Is it ethical for deaf parents to choose to have deaf children?

BioEdge

Michael Cook*

. . . There is a growing body of literature to support the right of deaf parents to use pre-implantation genetic diagnosis (PGD) to select for deaf children. Jacqueline Mae Wallis, a philosopher at the University of Bristol (UK), contends in the journal Medicine, Health Care and Philosophy that this is morally permissible. . . [Full text]

Medical conscience for me, but not for thee

Promoting a one-way conscience right favouring the medical intelligentsia

National Review

Wesley J. Smith*

The New York Times has published an opinion column by cardiologist Sandeep Jauhar that decries the Trump administration’s increased enforcement of medical conscience. But he actually promotes a one-way conscience right that favors protecting the predominate ideological views of the medical intelligentsia, while forcing dissenters to sacrifice their own religious and moral beliefs. . . [Full text]

Bioethics Intends to Destroy Catholic Healthcare

National Review
Reproduced with permission

Wesley J. Smith*

I have been following — and criticizing — the bioethics movement for more than twenty years . . . Most bioethicists, it is fair to say, seek to destroy Catholic institutions’ and professionals’ medical conscience rights and force them (and other religious or conscience dissenters) to adhere to the advancing utilitarian bioethical imperative. . .[Full text]

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

Medical Acts and Conscientious Objection: What Can a Physician be Compelled to Do?

Nathan K. Gamble, Michal Pruski

The New Bioethics

Abstract
A key question has been underexplored in the literature on conscientious objection: if a physician is required to perform ‘medical activities,’ what is a medical activity? This paper explores the question by employing a teleological evaluation of medicine and examining the analogy of military conscripts, commonly cited in the conscientious objection debate. It argues that physicians (and other healthcare professionals) can only be expected to perform and support medical acts – acts directed towards their patients’ health. That is, physicians cannot be forced to provide or support services that are not medical in nature, even if such activities support other socially desirable pursuits. This does not necessarily mean that medical professionals cannot or should not provide non-medical services, but only that they are under no obligation to provide them.

Gamble NK, Pruski M.  Medical Acts and Conscientious Objection: What Can a Physician be Compelled to Do? New Bioethics 2019 Sep; 25(3): 262-282. DOI:10.1080/20502877.2019.1649871