Mary Neal, Sara Fovargue
The issue of conscientious refusal by health care practitioners continues to attract attention from academics, and was the subject of a recent UK Supreme Court decision. Activism aimed at changing abortion law and the decision to devolve governance of abortion law to the Scottish Parliament both raise the prospect of altered provision for conscience in domestic law. In this article, building on earlier work, we argue that conscience is fundamentally connected to moral integrity and essential to the proper functioning of moral agency. We examine recent attempts to undermine the view of conscience as a matter of integrity and argue that these have been unsuccessful. With our view of conscience as a prerequisite for moral integrity and agency established and defended, we then take issue with the ‘incompatibility thesis’ (the claim that protection for conscience is incompatible with the professional obligations of health care practitioners). We reject each of the alternative premises on which the incompatibility thesis might rest, and challenge the assumption of a public/private divide which is entailed by all versions of the thesis. Finally, we raise concerns about the apparent blindness of the thesis to issues of power and privilege, and conclude that conscience merits robust protection.
Neal M, Fovargue S. Conscience and Agent-Integrity: A Defence of Conscience-Based Exemptions in the Health Care Context. Med Law Rev. 2016 Nov 1;24(4):544-570. doi: 10.1093/medlaw/fww023
Faith-based hospitals reject euthanasia
Winnipeg Free Press
At least six faith-based health-care facilities in Manitoba — including two Winnipeg hospitals — will not be providing medically assisted deaths to their patients or long-term care residences.
Officials from St. Boniface Hospital told the Free Press Monday patients seeking medical assistance in dying will have to go to another facility to have the service offered.
Other medical care facilities under the Catholic Health Corp. of Manitoba umbrella, including St. Joseph’s residence in northwest Winnipeg, Ste. Rose General Hospital near Dauphin, and Winnipegosis and District Health Centre will also follow suit, explained the corporation’s CEO, Daniel Lussier. . . [Full text]
Abstract: It may be the case that the most challenging moral problem of the twenty-first century will be the relationship between the individual moral agent and the practices and institutions in which the moral agent is embedded. In this paper, we continue the efforts that one of us, Joan Liaschenko, first called for in 1993, that of using feminist ethics as a lens for viewing the relationship between individual nurses as moral agents and the highly complex institutions in which they do the work of nursing. Feminist ethics, with its emphasis on the inextricable relationship between ethics and politics, provides a useful lens to understand the work of nurses in context. Using Margaret Urban Walker’s and Hilde Lindemann’s concepts of identity, relationships, values, and moral agency, we argue that health care institutions can be moral communities and profoundly affect the work and identity and, therefore, the moral agency of all who work within those structures, including nurses. Nurses are not only shaped by these organizations but also have the power to shape them. Because moral agency is intimately connected to one’s identity, moral identity work is essential for nurses to exercise their moral agency and to foster moral community in health care organizations. We first provide a brief history of nursing’s morally problematic relationship with institutions and examine the impact institutional master narratives and corporatism exert today on nurses’ moral identities and agency. We close by emphasizing the significance of ongoing dialogue in creating and sustaining moral communities, repairing moral identities, and strengthening moral agency.
Liaschenko J, Peter E. Fostering Nurses’ Moral Agency and Moral Identity: The Importance of Moral Community. The Hastings Center Report, Volume 46, Issue S1, September/October 2016, Pages S18–S21.
An ARC Discovery Project, running from 2015 to 2017
Summary of project
Conscientious objection is a central topic in bioethics and is becoming more ever important. This is hardly surprising if we consider the liberal trend in developments of policies about abortion and other bioethical issues worldwide. In recent decades the right to abortion has been granted by many countries, and increasingly many conservative and/or religious doctors are being asked to perform an activity that clashes with their deepest moral and/or religious values.
Debates about conscientious objection are set to become more intense given the increase in medical options which are becoming available or may well be available soon (e.g. embryonic stem cell therapies, genetic selection, human bio-enhancement, sex modification), and given the increasingly multicultural and multi-faith character of Australian society. Not only will doctors conscientiously object to abortion, and to practices commonly acknowledged as morally controversial, but some of them may also object to a wide range of new and even established practices that conflict with their personal values for example, Muslim doctors refusing to examine patients of the opposite sex.
Defining conscientious objection and identifying reliable markers for it, as well as setting the boundaries of legitimate conscientious objection through clear and justifiable principles, are difficult but pressing tasks.
This project advances bioethical debate by producing a philosophically and psychologically informed analysis of conscience, and by applying this to discussions about the legitimate limits to conscientious objection in health care.
Chief Investigator Dr Steve Clarke, Charles Sturt University
Chief Investigator Prof. Jeanette Kennett, Macquarie University
Partner Investigator Prof. Julian Savulescu, University of Oxford
Waterloo Region Record
Physicians are supposed to save lives, not hasten death.
So it’s not surprising that some doctors are having problems seeing how they fit into Canada’s new law that legalizes physician-assisted suicide for some patients.
It turns out that conscientious objectors like Sandra Brickell, a physician who works in Kitchener hospitals, are not protected.
“When somebody wants to end their life, it goes against what we’ve been trained to do,” she said at a meeting Friday with several other doctors, Kitchener-Conestoga MP Harold Albrecht and Kitchener-Conestoga MPP Michael Harris. . . [Full Text]
St. Boniface General Hospital and Concordia Hospital conscientiously object to legal practice
Two faith-based hospitals in Winnipeg say they will not be providing doctor-assisted deaths to their patients.
Both Concordia Hospital (Anabaptist-Mennonite) and St. Boniface Hospital (Catholic) say they will not offer the legal service to patients.
In June, the federal government amended the criminal code with Bill C-14 to allow doctors and nurse practitioners to help patients with “grievous and irremediable” illnesses to die. Manitoba introduced its own policy to implement medical assistance in dying, commonly called MAID, that same month. . . [Full text]
Abstract: The aim of this article is to present an account of an important element of medical ethics and law which is widely cited but is often confused. This element is most frequently referred to as ‘the principle of the sanctity of life’, and it is often assumed that this language has a religious provenance. However, the phrase is neither rooted in the traditions it purports to represent nor is it used consistently in contemporary discourse. Understood as the name of an established ‘principle’ the ‘sanctity of life’ is virtually an invention of the late twentieth century. The language came to prominence as the label of a position that was being rejected: it is the name of a caricature. Hence there is no locus classicus for a definition of the terms and different authors freely apply the phrase to divergent and contradictory positions. Appeal to this ‘principle’ thus serves only to perpetuate confusion. This language is best jettisoned in favour of clearer and more traditional ethical concepts.
Jones DA, An Unholy Mess: Why ‘The Sanctity of Life Principle’ Should Be Jettisoned. The New Biothics, Vol. 22, 2016, Issue 3.
Dr. Prijo Sidipratomo told BBC news that Indonesian doctors cannot be involved with chemical castration of convicted sex offenders “because we have to uphold medical ethics,” and must not “do anything harmful to any human being.”
His comments follow the passage of a new law in Indonesia authorizing chemical castration for paedophiles.
Interviewed by the BBC, Indonesian President Joko Widodo said, “That’s fine if the doctors don’t want to do it. We can use other doctors. We could use military doctors. . . . There are lots of people who want to do it. That’s not a problem. . . It’s up to the doctors in Indonesia. But if the court hands out that punishment, we will carry it out. Military doctors or government doctors can do it.”
The BBC report does not indicate whether or not the Indonesian medical profession accepts the distinction apparently made by the President between the ethical responsibilities of physicians employed by the state and those in private practice. It appears that the President believes that the first allegiance of physicians who are employed by the state is to the law and state policy rather than to medical ethics or conscientious convictions. This is not dissimilar to arguments being made in Canada to the effect that physicians, as agents of the state health care system, must at least collaborate in killing patients or helping them commit suicide; some academics claim that they must actually do the killing themselves if they wish to continue in practice.
Douglas Farrow, Will Johnston
In 1639 three nuns got off the boat from France and began to build Hotel Dieu in Montreal, the first hospital in Canada. Over time, some 275 hospitals were built across our country by self-sacrificing Catholics who faithfully served the sick and dying out of love and compassion, without regard to their patients’ faith or lack of faith. Succeeding generations of Canadians have been grateful for the spiritual and physical care they have received at such places.
St. Paul’s Hospital in Vancouver is one of those Catholic hospitals. In keeping with its faith-based principles, it respects the Catholic sense of human dignity — meaning, among other things, that it does not perform abortions or participate in assisted suicide or euthanasia.
Ellen Wiebe, a physician who is also an abortion and euthanasia activist, together with a lawyer, Richard Owens, recently criticized St. Paul’s because it would not euthanize one of its dying patients, Ian Shearer. . . [Full text]