Medical conscience for me, but not for thee
Promoting a one-way conscience right favouring the medical intelligentsia
14 May, 2019
Reproduced with permission
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.
First, he endorses "futile care," the bioethics authoritarianism that allows doctors to refuse wanted life-sustaining treatment based on the doctor's values. From, "Can Doctors Refuse to Treat a Patient?"
A consensus exists among legal and bioethics experts that doctors can refuse to provide treatment in certain situations. For example, courts have ruled that doctors may refuse to treat violent or intransigent patients as long as they give proper notice so that those patients can find alternative care. Forcing doctors to treat such patients, courts have said, would violate the 13th Amendment's prohibition on involuntary servitude….
Doctors may also refuse to provide treatment if it conflicts with good medical practice. Physicians in intensive-care units, for example, routinely limit treatment they believe will provide no benefit, especially in cases of terminal illness.
Did you see the sleight of hand there? The doctor may think that living longer provides "no benefit" and limit treatment even though the patient/surrogate/family does. That's not a medical decision, it is a value judgment.
So in a situation of life and death — Jauhar believes the doctors values should trump those of the patient — presumably, even if stated by a competent patient or instructed in an advance directive. But when it comes to elective interventions identified by the Trump rule — such as abortion, assisted suicide, and transgender interventions — Jauhar is all "patient rights!":
Doctors have an obligation to adhere to the norms of their profession. In my view, as long as treatments are safe and approved by medical organizations, doctors should have limited leeway in refusing to provide them. Patients' needs should come first. At the very least, patients whose medical needs violate a doctor's deeply considered beliefs should receive a timely referral to an alternative provider.
So a pediatrician who believes circumcision is child abuse — as some do — should be forced to remove his patient's foreskin because it is approved by the American Academy of Pediatrics (AAP)? No! That is an elective procedure. The parents can find another doctor on their own.
Jauhar's advocacy would also force a doctor who believes it is wrong — and indeed, harmful — to inhibit the normal onset of puberty in a child diagnosed with gender dysphoria, to do it, procure a willing doctor, or face litigation or professional discipline. After all, puberty blockers are now considered a norm for treating transgender pre-adolescents by the AAP.
And what if the vaunted "norms of the profession" should one day approve the amputation of a healthy limb, blinding, or severing the spinal cord (as the case may be) as a "treatment" for "body identity integrity disorder"— in which the "transable" patient
identifies as a disabled person — as is sometimes now advocated in bioethics? Should a doctor be forced to mutilate a patient too?
Or what if organ harvesting as a form of euthanasia became acceptable, as has been pushed in some prominent medical and bioethics journals? Should transplant surgeons then be force to kill by procuring organs?
Jauhar throws down the gauntlet that would force pro-life and traditional Hippocratic Oath believing MDs out of the profession–as it dissuaded talented students from entering the medical professions if they disagree with the current ideological trends in medicine:
And to avoid such conflicts, medical students who foresee problems of conscience should steer clear of certain fields, such as obstetrics-gynecology, when making career choices. Broad conscientious objection of the sort the Trump administration is defending could lead to chaos in health care.
No. The more elective the desired intervention, the greater should be the right of medical conscience. In a society as morally polyglot as ours, such comity is the only chance we have of remaining cohesive.
Let me put it this way: I only want to be treated by a doctor who would never be willing to kill me or assist my suicide. If Jauhar and his authoritarian ideological school of bioethics prevail, one dark day I might be unable to find such a traditional Hippocratic Oath-believing physician because such doctors would be persona non grata in specialties that treat serious conditions. How frightening would that be?
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