Assisted dying: Doctors’ group adopts neutral position

BBC News

Hospital doctors have dropped their 13-year opposition to the concept of helping terminally ill patients die.

Following a poll of its members, the Royal College of Physicians has now adopted a neutral stance on the issue of assisted dying.

Some groups have spoken out against the change, saying a respected medical body’s reputation has been damaged. Others called the decision “absurd”. . . [Full text]

Womb transplants could be a “vital medical service” for transgender women

BioEdge

Michael Cook

A well-known British cosmetic surgeon says that transgender women (ie, natal males) should be entitled to womb transplants when the technique becomes safe and feasible. Children have already been born after womb transplants from live and deceased donors.

Dr. Christopher Inglefield, founder of the London Transgender Clinic and a specialist in “gender confirmation surgery”, told the Mirror (UK) that it would be possible to perform the procedure on a transgender woman. . . [Full text]

Consent not a defence, court tells body modification artist

BioEdge

Michael Cook

Dr. Evil, a British body modification artist, has been found guilty of three counts of grievous bodily harm for tongue-splitting and nipple removal despite the fact that his clients consented to the procedures.

The argument put forward in court by Dr Evil, aka Brendan McCarthy, was strongly supported in the community. A petition with 13,400 signatures argued “for the right to express ourselves in whatever modified manner we wish in a safe environment”.

Judge Amjad Nawaz ruled that the kind of radical procedures in which Dr Evil specialised were not analogous to tattoos and piercings. . .[Full text]

Controversy dogs ‘assisted dying’ poll of UK doctors

BioEdge

Michael Cook

A controversial poll by the Royal College of Physicians, in the UK, is expected to result in a change in its position on “assisted dying”. Polling ends on March 1 and the result will be announced later in the month.

If the email poll fails to reach a supermajority of 60% who oppose a change from the status quo of opposition, the official position of the College will change to neutrality.

On the face of it, the procedure for the poll is bizarre. If 59% of the RCP’s 35,000 members support opposition to “assisted dying”, which in any democratic election would be an overwhelming victory with a margin of 18 percent, they still lose.

In fact, a former chair of the RCP’s ethics committee has threatened legal action. Dr John Saunders described the vote as a “sham poll with a rigged outcome”. In a letter to The Guardian he contended that the RCP would change its position to neutral even if the result were the same as a 2014 poll, when 57.5% of the doctors who voted did not “support a change in the law to permit assisted suicide by the terminally ill”.

Another group of doctors wrote a letter to The Times in which they accused a cabal of hijacking the RCP. “We are worried that this move represents a deliberate attempt by a minority on the RCP council to drop the college’s opposition to assisted suicide even if the majority of the membership vote to maintain it.”

The RCP President, Dr Andrew Goddard, insists that the poll is both fair and necessary. “It is important that the RCP represents fairly the views of its full membership. We will go ahead with the survey as planned.”

He is quite aware of the impact that a change would have upon public opinion. “The RCP is frequently asked for its stance on this high profile issue, which may be cited in legal cases and parliamentary debate, so it is essential that we base this on an up-to-date understanding of our members’ and fellows’ views.”

Although some reports assumed that “assisted dying” means “assisted suicide”, the RCP’s definition seems to encompass euthanasia as well: “The supply by a doctor of a lethal dose of drugs to a patient who is terminally ill, meets certain criteria that will be defined by law, and requests those drugs in order that they might be used by the person concerned to end their life.” In Oregon, where only assisted suicide is legal, “a physician prescribes a lethal dose of medication to a patient, but the patient – not the doctor – administers the medication.”


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Assisted dying: 1,500 doctors back campaign against ‘tacit support’ plan

Express

David Maddox

MORE than 1,000 doctors have signed a letter opposing alleged attempts by the Royal College of Physicians to become “neutral” on assisted dying.

The college is locked in a row with members over its position.

Although a poll in 2014 found 58 percent did not support it, the college says unless it has a 60 per cent majority for or against, it will adopt a neutral view. It is conducting a new poll but with a three-way question, which opponents say makes the majority harder to obtain. . .[Full text]

Loss of right to conscience costing NHS new midwives it needs

Catholic Universe-The Catholic Times

Nick Benson

Pro-life groups have claimed that the recent drop in applications to midwifery courses could be rectified by enshrining conscientious objection.

Recent figures show that there has been a 35 per cent drop in the number of applicants to midwifery courses since 2013. The Royal College of Midwives (RCM), which analysed the latest Ucas data for England, said the biggest reduction was in those aged 21 or over.

In 2013, more than 12,000 people aged over 21 applied for a midwifery course in England, but by 2017 that figure had dropped to just 6,700 – a decrease of 45 per cent. . . [Full text]

When can a doctor conscientiously object?

America

Bernard G. Prusak*

Over the last decade, the culture wars in the United States have broken new ground: They have become battles over the rights of conscience. For example, now that same-sex marriage is a right, the question before the U.S. Supreme Court in the case of Masterpiece Cakeshop is whether its sympathetic, telegenic owner, Jack Phillips, is within his rights to refuse to make a wedding cake for a gay couple. Similarly, under the Obama administration, the court heard arguments more than once over whether employers who object on religious grounds to contraceptives or abortion should be exempted from having to provide employees health insurance that includes such services.

By contrast, debates over conscientious objection in medicine have not had the same notoriety, though they have broken out repeatedly among health care professionals and medical ethicists since the turn of the century, when there was a flare-up over pharmacists’ refusing to fill prescriptions for emergency contraceptives.

A bill currently before the House of Lords has brought conscientious objection in medicine into widespread public discussion in the United Kingdom, if not yet on the other side of the Atlantic. . . [Full text]

You’re a surgeon. A patient wants to look like a lizard. What do you do?

As medical treatments advance, the need to accommodate conscientious objection in healthcare is more pressing

The Guardian
Reproduced with permission

David S. Oderberg*

Imagine that you are a cosmetic surgeon and a patient asks you to make them look like a lizard. Would you have ethical qualms? Or perhaps you are a neurosurgeon approached by someone wanting a brain implant – not to cure a disability but to make them smarter via cognitive enhancement. Would this go against your code of professional ethics? With the rapid advance of medical technology, problems of conscience threaten to become commonplace. Perhaps explicit legal protection for conscientious objection in healthcare is the solution.

There is limited statutory protection for those performing abortion, and there is some shelter for IVF practitioners. Passive euthanasia (withdrawal of life support with intent to hasten death) is also part of the debate over doctors’ conscience rights. That’s about it as far as UK law is concerned – though freedom of conscience is enshrined in numerous conventions and treaties to which we are party. Abortion, artificial reproductive technologies (involving embryo research and storage) and passive euthanasia are the flashpoints of current and historic controversy in medical ethics. The debate over freedom of conscience in healthcare goes to the heart of what it means to be a medical practitioner.

Curing, healing, not harming: these are the guiding principles of the medical and nursing professions. But what if there is reasonable and persistent disagreement over whether a treatment is in the patient’s best interests? What if a practitioner believes that treating their patient in a particular way is not good for them? What if carrying out the treatment would be a violation of the healthcare worker’s ethical and/or religious beliefs? Should they be coerced into acting contrary to their conscience?

Such coercion, whether it involve threats of dismissal, denial of job opportunities or of promotion, or shaming for not being a team player, is a real issue. Yet in what is supposed to be a liberal, pluralistic and tolerant society, compelling people to violate their deeply held ethical beliefs – making them do what they think is wrong – should strike one as objectionable.

Freedom of conscience is not only about performing an act but about assisting with it. There are some people who ask doctors to amputate healthy limbs. If you were a surgeon, my guess is that you would refuse. But what about being asked to help out? Would you hand over the instruments to a willing surgeon? Or supervise a trainee surgeon to make sure they did the amputation correctly? If conscientious objection is to have any substance in law, it must also cover these acts of assistance.

This country has a long and honourable tradition of accommodating conscientious objectors in wartime – those who decline to fight or to assist or facilitate the fighting by, say, making munitions. They can be assigned to other duties that may support the war effort yet are so remote a form of cooperation as not to trouble their consciences. In any war, the objectors are a tiny fraction of the combat-eligible population. Yet when it comes to one’s rights, do numbers matter? Has their existence ever prevented a war from being carried out to the utmost? I fail to see, then, why we are tolerant enough to make adjustments for conscientious objectors in the midst of a national emergency, yet in peacetime would be reluctant to afford similar adjustments to members of one of the most esteemed professions.

Do we think medical practitioners should be no more than state functionaries, dispensing whatever is legal no matter how much it is in conflict with personal conscience and professional integrity – lest they be hounded out of the profession? Some academics think expulsion is not good enough. Or should healthcare workers be valets, providing whatever service their patients demand? Perhaps when practitioners find themselves faced with demands for the sorts of treatment I’ve mentioned – or perhaps gene editing treatments or compulsory sterilisation, society will act. Or maybe by then it will be too little, too late.

David S Oderberg is professor of philosophy at the University of Reading, and author of Declaration in support of conscientious protection in medicine

 

 

Protection in the Bill for health staff with conscientious objection

Isle of Man Today

Health staff who have a conscientious objection to abortion will receive protection when the law is reformed.

Members approved an amendment, tabled by Chris Robertshaw (Douglas East), to set out the protection available to staff.

The final version of the amendment was the result of consultation between Mr Robertshaw and Dr Alex Allinson.

The bill already stipulated health workers could not be forced to take part in abortion treatment if they had a genuine conscientious objection. . . [Full text]

 

Protecting conscience: Why this House of Lords bill is aimed at defending healthcare professionals

Christian Today

Laurence Wilkinson

With the Brexit legislation receiving the lion’s share of attention in Parliament, there has been little to no coverage on the progression of any other bill in recent months. This is usually the time of year where activity on private members’ bills (which have only a small chance of passing into law) winds down. However, with the current Parliamentary Session being extended to two years to deal with the magnitude of the Brexit legislation, we are in extraordinary times.

There is one such private member’s bill before the House of Lords which has seen a surprising ramp-up in activity over the last few months. The bill is sponsored by Baroness O’Loan – a widely respected legal mind from Northern Ireland who was the first Police Ombudsman – and will have its committee stage today, Friday. It is focused on the relatively niche area of protection of conscience for healthcare professionals. . . [Full text]