John J. Conley
Is discrimination always wrong?
To listen to the current national debate on the topic, it would appear to be so. Virtually all international human-rights covenants categorically reject discrimination on the basis of race, religion and gender. Even contemporary professional philosophers tend to treat discrimination as an unalloyed evil. The University of Chicago’s Brian Leiter has led a very public philosophical campaign to eliminate religious exemptions to anti-discrimination laws and to declare unethical religious practices that appear to be discriminatory, especially in the area of gender and sexual orientation.
But our crusade against discrimination seems to rest on a fundamental confusion. There is a difference between discriminating against someone because of the group to which he or she belongs and discriminating against someone on the basis of his or her actions. . . . [Full text]
Aaron Ancell, Walter Sinnott-Armstrong
Paradigmatic cases of conscientious objection in medicine are those in which a physician refuses to provide a medical service or good because doing so would conflict with that physician’s personal moral or religious beliefs. Should such refusals be allowed in medicine? We argue that (1) many conscientious objections to providing certain services must be allowed because they fall within the range of freedom that physicians have to determine which services to offer in their practices; (2) at least some conscientious objections to serving particular groups of patients should be allowed because they are not invidiously discriminatory; and (3) even in cases of invidiously discriminatory conscientious objections, legally prohibiting individual physicians from refusing to serve patients on the basis of such objections is not always the best solution.
Ancell A, Sinnott-Armstrong W. How to Allow Conscientious Objection in Medicine While Protecting Patient Rights. Camb Q Healthc Ethics. 2017 Jan;26(1):120-131.
Canadian Family Physician
Stephen J. Genuis
Discussion on physician autonomy at the 2014 and 2015 Canadian Medical Association (CMA) annual meetings highlighted an emerging issue of enormous importance: the contentious matter of freedom of conscience (FOC) within clinical practice. In 2014, a motion was passed by delegates to CMA’s General Council,and affirmed by the Board of Directors, supporting the right of all physicians, within the bounds of existing legislation, to follow their conscience with regard to providing medical aid in dying. The overwhelming sentiment among those in attendance was that physicians should retain the right to choose when it comes to matters of conscience related to end-of-life intervention. Support for doctors refusing to engage in care that clashes with their beliefs was reaffirmed in 2015. However, a registrar from a provincial college of physicians and surgeons is reported to have a differing perspective, stating “Patient rights trump our rights. Patient needs trump our needs.1
So, do the personal wishes of doctors hold much sway in Canadian society, where physicians are increasingly perceived as publicly funded service providers? Should the colleges of physicians and surgeons have the power to remove competent physicians who refuse to violate their own conscience?
And what about FOC in a range of other thorny medical situations unrelated to physician-assisted dying?
Genuis SJ. Emerging assault on freedom of conscience. Canadian Family Physician April 2016 vol. 62 no. 4 293-296 [Full text]
Mary Anne Waldron offers three solutions for legal quagmires
The B.C. Catholic
An argument in favour of changing how citizens approach freedom of conscience and religion was presented May 2. Mary Anne Waldron, a professor of law at the University of Victoria, spoke to an audience of 80 in Holy Name of Jesus Parish Hall in Vancouver.
Her lecture was the first event co-hosted by the Catholic Physicians’ Guild of the Archdiocese of Vancouver and the St. Thomas More Catholic Lawyers Guild.
She asked the crowd to ponder why “we protect conscientious and religious freedom, when it is so often inconvenient, may seem unfair, and often offends others.”
The law professor declared perhaps many would prefer a world “in which our (specific) view prevailed” on major legal problems: abortion, euthanasia, and sexual moral codes.
Freedom of conscience and religion rights, she asserted, should allow the participation of all citizens in debates on social policies and norms, “protecting the minority against tyranny by the majority.” [Full Text]
New England Journal of Medicine
Holly Fernandez Lynch
Doctors dedicate themselves to helping others. But how selective can they be in deciding whom to help? Recent years have seen some highly publicized examples of doctors who reject patients not because of time constraints or limited expertise but on far more questionable grounds, including the patient’s sexual orientation, parents’ unwillingness to vaccinate (in surveys, as many as 30% of pediatricians say they have asked families to leave their practice for this reason), and most recently, the patient’s weight. [Read more . . .]
Before Wisconsin Senate Committee on Health, Children, Families, Aging and Long-Term Care
Beth LaChance, R.N.
. . . I . . . experienced an onslaught of disciplinary reprimands, retaliation, criticism and
ostracism. . . I was no longer assigned to train or mentor new nurses despite my credentials and qualifications. . . .I was denied career advancement to clinical nurse three status, as the research project which qualified me for advancement, was resigned to another nurse without my prior knowledge or consent. I was grilled as a “second class nurse” or “nobody”. . .[Full text]
T. Everett Julyan, MBChB BSc *
INTRODUCTION The practice of discriminating between applicants for posts within obstetrics and gynaecology on the basis of their beliefs about the status of the embryo is becoming increasingly common. This affects not only the individual discriminated against, but also medicine and society as a whole. When this discrimination is faced because of a desire to please the God of the Bible it is more accurately described as persecution (Matthew 5:10-12).
EFFECTS ON THE INDIVIDUAL The effects of this persecution on the individual may be vocational, social, financial, emotional or spiritual. These include influencing ultimate choice of career, rejection by colleagues, unemployment in extreme cases, disappointment, disillusionment and temptation towards compromise. The only positives may be the maintenance of personal integrity and promise of heavenly reward.
EFFECTS ON MEDICINE & SOCIETY Excluding all those who refuse to end a human life simply because its existence happens to be inconvenient to another does medicine a disservice. It is antithetical to historical medicine which calls for self-sacrifice on the part of the doctor in order to preserve the patient according to an established ethical code. It seems that contemporary medicine only wants doctors who follow the status quo by changing their ethical framework to suit the wishes of their patients. The logical outcome of this kind of thinking is that autonomy may be considered to be of greater value than human life in a variety of clinical situations. But medical practice will become unethical if doctors are expected to give treatment which they consider to be inappropriate, such as killing an unborn child. The practice of medicine is in danger of becoming a commodity marketed with the expedient business ethic of supply on demand, where the value of human life can fluctuate as a relative integer. Denying employment to those who seek to preserve life instead of destroying it is a logical step of pragmatism in a culture where abortion is on demand. But medicine should not be a business designed to supply every demand indiscriminately when the demand may not be in the patient’s best interests. If medicine evolves by defining good practice simply as what the patient wants then society will ultimately become a victim of its own unethical requests (cf. Romans 1:28-32).
CONCLUSION Discrimination against those who refuse to include ending human life as part of their job description is becoming increasingly common. However, this serves neither doctors nor patients and is a symptom of a relativistic view of medical ethics. Its detrimental effects are far-reaching, affecting individuals, the medical profession and society in general. Those who see the dangers in this trend have a duty to protect society, the future of medicine, their colleagues and themselves from wrongly redefining beneficence and non-maleficence. [Full text]