WUOM FM: All Things Considered
Physicians in Ontario are facing a dilemma: What can you do when asked to perform an action that is legal, but violates your moral code or religious beliefs?
In 2015, the Supreme Court of Canada struck down the federal law that prohibited medically-assisted suicide.
In response to that decision, Parliament passed legislation that cleared the way for doctor-assisted suicide.
In Ontario, the service is now covered by the Ontario Health Insurance Plan, and any drugs required to help a patient die will be available at no cost.
Dr. Brad Burke is a physician in Windsor who says assisted dying goes against his conscience. He’s making plans for the day when a patient asks him for help in dying.
He joined us today. Listen to our conversation with him . . . [Full audio interview]
Re. “Catholic hospitals put religious principles ahead of patient rights,” Paula Simons, Sept. 28
As Canada implements legislation related to medical assistance in dying, members of the Catholic Health Alliance of Canada have worked together to respond to requests with integrity — ensuring that we abide by the law and continue our 400-year mission of service in keeping with our ethics and values.
Catholic health care is a vital part of the Canadian health system. Each year, more than 68,000 team members employed by 124 Catholic providers across the country serve millions of Canadians from all backgrounds and faiths with respect, honouring the beliefs and diverse cultural needs and spiritual needs of those we serve.
All Canadians have conscience and religious freedom respected under the Charter. Catholic health care has a long-standing moral tradition that neither prolongs life nor hastens death. Catholic health care’s conscientious objection to medical assistance in dying is a moral commitment to uphold the inherent value of each person while observing the law. It does not constitute a refusal to care for patients or undermine the values and rights of those in our care. . . [Full text]
Abstract: Decisions about allocation of limited healthcare resources are frequently controversial. These decisions are usually based on careful analysis of medical, scientific and health economic evidence. Yet, decisions are also necessarily based on value judgements. There may be differing views among health professionals about how to allocate resources or how to evaluate existing evidence. In specific cases, professionals may have strong personal views (contrary to professional or societal norms) that treatment should or should not be provided. Could these disagreements rise to the level of a conscientious objection? If so, should conscientious objections to existing allocation decisions be accommodated? In the first part of this paper, I assess whether resource allocation could be a matter of conscience. I analyse conceptual and normative models of conscientious objection and argue that rationing could be a matter for conscience. I distinguish between negative and positive forms: conscientious non-treatment and conscientious treatment. In the second part of the paper, I identify distinctive challenges for conscientious objections to resource allocation. Such objections are almost always inappropriate.
Wilkinson D. Rationing conscience. J Med Ethics doi:10.1136/medethics-2016-103795
This spring, a patient told Dr. Ramona Coelho she was thinking about physician-assisted death.
Coelho gently probed to find out what was at the heart of the woman’s fear, anxiety and depression. The patient felt her life was diminished and no longer meaningful. Coelho says she steered the patient away from assisted death to finding ways to make every day seem worthwhile.
“My patients’ death wishes go away when their issues are dealt with,” says Coelho, who has practised medicine since 2007 and did palliative-care work in Montreal before moving to London, Ont., in 2012. She believes time, careful listening, affection and respect are key to a good relationship with patients. . . [Full text]
CMDA – The Point
What do healthcare professionals and health institutions need to know about and how can they defend themselves from the Obama administration’s newly enacted transgender mandate?
What happened when?
The transgender mandate, promulgated by the U.S. Department of Health and Human Services (HHS) under the assumed authority of the Affordable Care Act (Obamacare), went into effect July 18, 2016. A new website explains what the mandate requires, why it violates the law and what conscientious objectors can do to protect their rights.
Whom does the rule target?
HHS recently mandated that healthcare professionals must perform gender transition procedures on any child referred by a mental health professional, even if the physician believes the treatment or hormone therapy could harm the child.
Healthcare professionals who follow the Hippocratic Oath to act in the best interest of their patient instead of this new mandate can face severe consequences, including losing their jobs. The transgender mandate also requires virtually all private insurance companies and many employers to cover gender transition procedures or face stiff penalties and legal action. . . [Full text]
Abstract: I explore the increasingly important issue of cooperation in immoral actions, particularly in connection with healthcare. Conscientious objection, especially as pertains to religious freedom in healthcare, has become a pressing issue in the light of the US Supreme Court judgement in Hobby Lobby. Section ‘Moral evaluation using the basic principles of cooperation’ outlines a theory of cooperation inspired by Catholic moral theologians such as those cited by the court. The theory has independent plausibility and is at least worthy of serious consideration—in part because it is an instance of double-effect reasoning, which is also independently plausible despite its association with moral theology. Section ‘Case study: Burwell v. Hobby Lobby’ examines Hobby Lobby in detail. Even if the judgement was correct in that case the reasoning was not, as it involved applying a ‘mere sincerity’ test to the cooperation question. The mere sincerity test leads to absurd consequences, whereas a reasonableness test applied using the theory of cooperation defended here would avoid absurdity. Section ‘A question of remoteness: “accommodations” and opt-outs’ explores the post-Hobby Lobby problem further, examining opt-outs and accommodations: the Little Sisters of the Poor case shows how opt-outs are misunderstood on a mere sincerity test, which the court rightly rejected. Section ‘Application to the medical field: Doogan and Wood’ discusses the UK case of Doogan and Wood, concerning participation in abortion. Again, a judicially recognised ethic of cooperation, if it were part of the fabric of legal reasoning in such cases, would have enabled the conscientious objectors in this and similar situations to have their freedom of conscience and religion respected in a way that it currently is not.
Oderberg DS, Further clarity on cooperation and morality. J Med Ethics doi:10.1136/medethics-2016-103476
While some bioethicists believe that conscientious objection has no place in modern medicine, others feel that they could be accommodated by setting up tribunals. Here are three proposed this year in the Journal of Medical Ethics.
In times of conscription, military tribunals assess whether a pleas of conscientious objection in legitimate or not. Why not follow this model for healthcare workers, asks Steve Clarke. . .
Robert Card . . . argues in the JME that doctors need to give “public reasons” for conscientious objection. . .This leads him to propose review boards staffed by medical professionals, bioethicists and lawyers.
. . .Jonathan A. Hughes . . . proposed the establishment of Conscientious Objection Tribunals . . . No conscientious objection would be allowed without a licence. . .