CONSENSUS STATEMENT ON CONSCIENTIOUS OBJECTION IN HEALTHCARE

On the 7th, 8th, and 9th of June 2016 a group of philosophers and bioethicists gathered at the Brocher Foundation in Geneva, Switzerland, to participate in a workshop on healthcare practitioners’ conscience and conscientious objection in healthcare. Conscientious objection is the refusal by a healthcare practitioner to provide a certain medical service, for example an abortion or medical assistance in dying, because it conflicts with the practitioner’s moral views. Aim of the workshop was to discuss the ethical and legal aspects of conscientious objection in healthcare, in view of proposing some guidelines for the regulation of conscientious objection in healthcare in the future.

At the end of the workshop, the participants formulated a consensus statement of 10 points, which are here proposed as ethical guidelines that should inform, at the level of legislations and institutional policies, the way conscientious objections in healthcare is regulated. The 10 points are the following:

  1. Healthcare practitioners’ primary obligations are towards their patients, not towards their own personal conscience. When the patient’s wellbeing (or best interest, or health) is at stake, healthcare practitioners’ professional obligations should normally take priority over their personal moral or religious views.
  2. In the event of a conflict between practitioners’ conscience and a patient’s desire for a legal, professionally sanctioned medical service, healthcare practitioners should always ensure that patients receive timely medical care. When they have a conscientious objection, they ought to refer their patients to another practitioner who is willing to perform the treatment. In emergency situations, when referral is not possible, or when it poses too great a burden on patients or on the healthcare system, health practitioners should perform the treatment themselves.
  3. Healthcare practitioners who wish to conscientiously object to providing medical treatment should be required to explain the rationale for their decision.
  4. The status quo regarding conscientious objection in healthcare in the UK and several other modern Western countries is indefensible. Healthcare practitioners can conscientiously refuse access to legally available, societally accepted, medically indicated and safe services requested by patients in practice for any reason. This is in part due to the cost-free environment in which practitioner choice of service occurs, and in which the practitioner bears no substantive burden of proof. The burden of proof to demonstrate the reasonability and the sincerity of the objection should be on the healthcare practitioners.
  5. Accordingly, in such countries, the reasons healthcare practitioners offer for their conscientious objection could be assessed by tribunals, which could test the sincerity, strength and the reasonability of healthcare practitioners’ moral objections to certain medical services.
  6. Policy makers should ensure that in any geographical region there is a sufficient number of non-conscientious objectors for patients to obtain the medical services they need in a timely manner even if some healthcare practitioners conscientiously object to providing that service. This implies that regional authorities, in order to be able to provide medical services in a timely manner, should be allowed to make hiring decisions on the basis of whether possible employees are willing to perform medical procedures to which other healthcare practitioners have a conscientious objection.
  7. Healthcare practitioners who are exempted from performing certain medical procedures on conscientious grounds should be required to compensate society and the health system for their failure to fulfil their professional obligations by providing public-benefitting services.
  8. Medical students should not be exempted from learning how to perform basic medical procedures they consider to be morally wrong. Even if they become conscientious objectors, they will still be required to perform the procedure to which they object in emergency situations or when referral is not possible or poses too great a burden on patients or on the healthcare system.
  9. Healthcare practitioners should be educated to use a framework of decision-making incorporating legal, ethical and professional arguments to identify the basis of their objection.
  10. Healthcare practitioners should also be educated to reflect on the influence of cognitive bias in their objections.

SIGNATORIES
Angela Ballantyne (Otago University), Robert Card (State University of New York, Oswego and University of Rochester Medical Center), Steve Clarke (Charles Sturt University), Katrien Devolder (University of Oxford), Thomas Douglas (University of Oxford), Alberto Giubilini (University of Oxford), Jeanette Kennett (Macquarie University), Sharyn Milnes (Deakin University), Francesca Minerva (University of Ghent), Maurizio Mori (University of Turin), Christian Munthe (University of Gothenburg), Justin Oakley (Monash University), Ingmar Persson (University of Gothenburg), Julian Savulescu (University of Oxford), Dominic Wilkinson (University of Oxford).

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41 Responses to CONSENSUS STATEMENT ON CONSCIENTIOUS OBJECTION IN HEALTHCARE

  • Calum Miller says:

    Could I clarify? When you say the status quo is indefensible (and, indeed, when you make all these claims), do you have in mind more apparently comprehensive statements on conscientious objection, such as this from the GMC:

    8. You may choose to opt out of providing a particular procedure because of your personal beliefs and values, as long as this does not result in direct or indirect discrimination against, or harassment of, individual patients or groups of patients. This means you must not refuse to treat a particular patient or group of patients because of your personal beliefs or views about them.* And you must not refuse to treat the health consequences of lifestyle choices to which you object because of your beliefs.†

    …or even things like abortion, euthanasia, too? It seems to me that the GMC passage is probably wrong, but it doesn’t seem like most of what is said here could reasonably be defended in the context of things like abortion and euthanasia where there remains considerable disagreement among physicians, at least in the UK (and perhaps even more so in other countries). I’m a bit puzzled. Thanks.

  • Mikael (justiceandhedonism.wordpress.com) says:

    It would be good to now a bit more what “providing public-benefitting services” in point 7 means.

    • Calum Miller says:

      I agree with this point. It seems as though in most cases of conscientious objection that is already the case – that is, conscientious objectors already taken on different hospital work while allowing their colleagues with no objection to perform the disputed procedure. I don’t know of any conscientious objector who would think this is unreasonable, but I’m not sure whether the authors had something else in mind.

  • Dr John CARMODY says:

    There seem to be so many logical and ethical holed in the assertions of this document that (to me) is is simply astonishing that a group of professional philosophers could write it — let alone “endorse” it.
    Item 1. What are the grounds for saying that a patient’s “best interest” should take precedence over a doctor’s moral compass? This argument sounds very like something that might have been said in National Socialist Germany (and I thought that the Nuremberg Trials had dealt with it). Furthermore, the use of the term “medical” (here and elsewhere) seems rather loose.
    Item 4 seems pompous and omniscient. A little more humility in the wording — and better recognition of the complexity of the issues — would have been welcome.
    Item 5 seems, again, redolent of Germany between 1933-12945; or a mediaeval Inquisition. when did “tribunals” become moral arbiters? Judges of professional “competence” perhaps; hardly of moral principles.
    Item 8 is appalling. When did a group of philosophers assume the right to force sanctions on account of moral principles of others?
    Item 10: “Mutatis mutandis” the same principles might be enforced on philosophers.

    • sarah says:

      “What are the grounds for saying that a patient’s “best interest” should take precedence over a doctor’s moral compass? This argument sounds very like something that might have been said in National Socialist Germany (and I thought that the Nuremberg Trials had dealt with it).”

      You are *very* confused about the Nazis if you think that their problem was anything to do with over prioritising the patient’s best interest

  • Dr John CARMODY says:

    To the anonymous Sarah, whoever she might be.

    I am NOT AT ALL confused by the Nazi eras: your comment is exceedingly presumptuous. The point is that “laws” were created and enforced at the whim of the regime; doctors and others had to comply or refuse at great personal and professional cost. The fact that those laws encouraged others to go against any reasonable moral compass, in another direction, is not germane to my point. That point (see Item 2) pertains to the dangerously loose phrase, “legal, professionally sanctioned medical service”. What — in this context — does “legal” mean? Or “professionally sanctioned”? How are these things legitimately achieved?

    • sarah says:

      So you did not say, contrary to the most direct reading of the text that you wrote, that the argument that a “patient’s “best interest” should take precedence over a doctor’s moral compass” is redolent of the Nazis. You actually said that having a dictatorship where laws are made undemocratically, and enforced harshly and according to the “whims” of those in power is like Nazis.

      Well, that is true. But no-one is arguing in favour of that.

      • Dane says:

        You’re making the false assumption that only dictatorships produce abhorrent laws. Perhaps an example without references to Nazi Germany would better highlight the profound problems with these points.

        It was not that long ago in modern Western democracies that mental illness was treated by inducing comas and infecting patients with malaria. If the bioethicists who created these points had their way, doctors during that time period would be compelled by law to treat patients accordingly, because it would be considered by society to be in the best interest of the patient.

        The forced sterilization of homosexuals also comes immediately to mind.

        This is what the above poster is getting at when he asks “What — in this context — does “legal” mean? Or “professionally sanctioned”? How are these things legitimately achieved?”

        I hope this makes you think more carefully about how these points are so dangerously and thoughtlessly worded.

        • Keith Tayler says:

          It is difficult to know where to begin with these ten points. They certainly reflect the status quo and would protect the established power structures within healthcare and medical professions. Not sure that this is deliberate or is the result of lack of experience and knowledge of the signatories.

          Taking up Dane’s points: I worked with people who were forced against their better judgement to administer ECT without a muscle relaxant. (The Bolam test is a living testament of how the medical and legal professions can conspire to harm patients and/or protect their professional interests.) I objected to the use ECT with relaxants for certain patients because it was being used as a form of punishment. This and other “conscientious” objections I had to supposedly ‘legal, professionally sanctioned medical service’ forced me to resign three times from the NHS and its service providers.

          I agree there may be problems with medics refusing to provide some treatments, but these points do little to resolve these and would create a more oppressive environment for staff at all levels which would be detrimental to patient care and wellbeing. I half agree with Dane and ‘hope this makes you think more carefully about how these points are so dangerously and thoughtlessly worded.’ The other half of me would like you to stop thinking about this and instead carefully address the evidence and then perhaps have a think.

  • Paul Treanor says:

    This declaration is symptomatic of an increasing polarisation in most western societies, which is not confined to party politics. We can see it as part of a backlash against the recent tactic of conservative campaigners, to appeal to individual moral objections in the face of tougher anti-discrimination laws. If, for instance, a new law prohibits discrimination against gays in the provision of any service, then service providers (a company, a shop, a bar, a hotel) will say that their religious belief prevent them from doing so. In turn, minorites are increasingly likely to demand that all such bjections are overruled. That’s what this declaration is all about.

    It ought to be clear, that this is taking us nowhere. The cycle of action and reaction, with each side quoting real or alleged ethical principles, will only lead to further controversy and polarisation. None of the parties here offer any resolution of this issue. The Brocher Foundation group simply states their own proposed regulations, and makes no attempt to consider the position of those who disagree.

    I could go on about this, and the underlying historical trend to breakdown of the liberal-democratic consensus in western societies. But instead I will get to the point, and say what needs to happen. We are going to have to accept a rigorous segregation, or re-segregation, of health care systems – along religious and ethical lines. Public health systems, for which the British National Health Service is exemplary, are obsolete. The unity of the medical profession is also obsolete. There is no logical reason why there should not be Christian hospitals for Christian patients, with Christian-trained doctors who don’t know how to perform an abortion. Muslims could go to an Islamic hospital for treatment in accordance with their beliefs, which would not include abortions either. Secularists could go to a secularist hospital for an abortion. There are many more options, but it is not necessary to list them all.

    Now inevitably some people will compare this to Nazi Germany, and its separate Jewish health care. In fact other countries had Jewish hospitals as well, part of a long European tradition of ‘faith-based’ health care. The Netherlands had the closest thing to an entirely separate Jewish health care system. Segregation and separation can not be dismissed out of hand, and it seems the only way that the state can respond to increasingly polarised populations. More and more people are unwilling to make any concession, to the views and aspirations of others: the recent controversies about Islamic clothing are a prime example. Each side typically insists that the other side concedes all its demands, concedes its maximum demands, which are themselves ratcheted up all the time. No solution or compromise is possible in such circumstances.

  • David Albert Jones says:

    I think that looking at the Nazi experience is unlikely to help develop consensus as the example is so extreme that people are likely to differ about whether it is analogous. I am not denying that this is analogous, only suggesting that it is not a fruitful example about which to argue.

    However, I think the ‘consensus’ document is framed as though ‘we’ knew in advance that the ethical judgement of the doctor (his or her conscience) was in error and the ethical judgement of the employer/ hospital management /professional body (who determine the professional obligations) was never in error. This is a touching belief in the establishment.

    I imagine this is because people who drew up this statement had in mind the issue of abortion (or assisted suicide) and regarded abortion (or assisted suicide) as beneficial, or potentially beneficial and not as unjust to others. If a different example were chosen, for example, elective infant circumcision, homosexual ‘reparative’ therapy (before this had been disavowed by the professional body), homeopathy (currently legal and available on the NHS), the provision of drugs of great expense and of marginal benefit (on which NICE guidance was not legally binding), the provision of extremely risky surgery to a patient with unrealistic expectations, the provision of ritalin to an adolescent without diagnosis of ADHD (but who was sitting exams), the provision of slimming aids to someone who is within their normal BMI etc etc then people might take a different view.

    Clearly, prior to the time that ‘reparative’ therapy was disavowed by the profession an individual clinician who regarded it as harmful would seek to persuade the professional body of this (or for some ‘treatments’ perhaps change the law). But in the meantime, would it be the case that a clinician had a duty to “refer their patients to another practitioner who is willing to perform the treatment”? Would all those who signed this statement be happy to find and refer a patient to a doctor who provided interventions that they regarded as unethical (but not yet illegal and not yet disavowed by the profession)? Is it enough that the treatment is legal and desired by the patient and that some other clinicians think it would be beneficial?

    Surely an essential point here is that judgements of conscience are judgements about the patient’s wellbeing (or best interest, or health) and/or are about duties towards persons other than the patient (who might be adversely affected by the decision). The conscientious doctor is the doctor who seeks to fulfill his or her primary obligation toward their patient (qualified by obligations towards others) according to his or her judgement. This will occasionally mean refusing some treatment desired by the patient, on the basis of reasonable professional and ethical judgement. Perhaps most often the profession will already have good guidance, but should a professional abnegate his or her own critical judgement in cases where the professional guidance is mistaken or inadequate?

    It seems most curious for ‘ethical’ guidelines to discourage independent ethical thought on the part of practitioners. Perhaps it is thought that ethical questions could be outsourced to lawyers or professional ethicists and and the clinician should confine him or herself to following the orders of the hospital management (guided of course by the hospital’s lawyers). I would not have confidence that this would be in the best interest of patients. Much better a doctor who thought for him or herself, even if they did not always agree to give me the intervention I desired.

    • Paul Treanor says:

      Although we certainly cannot trust hospital managers, lawyers, or ethicists, we can’t trust doctors either. When they were allowed to’ think for themselves’, doctors castrated homosexuals and sterilised women from ethnic minorities, in both cases believing it to be in the best interest of the patient, their family, and the community. Some programmes were jointly initiated with the state, usually disguised as ‘public health’ measures, but none were implemented without the support and participation of doctors.

      There is no easy answer here, because we, the non-medical public, cannot simply do without medical treatment. What is certainly necessary is that every patient is informed fully, not only about what a treatment does, but also about who takes decisions on that treatment. That includes the motivation of the doctor, the hospital, and its managers and lawyers. That in turn raises another issue, which David Albert Jones evades: the possible malevolence of doctors and other medical personnel.

  • James Franklin says:

    You have laugh (clause 7) at philosophers demanding that doctors be forced to provide “public-benefitting services”.

  • Michel Accad says:

    First, the panelists seem to set -up a false dichotomy. If a healthcare professional objects to providing a given treatment to a patient for reasons of conscience, that is because the he or she believes that the treatment will ultimately be harmful to the patient. Asking professionals to contravene their conscience is to ask them to malpractice.

    Secondly, if the consensus panelists fear that conscientious objectors can interfere with the ability of patients to obtain necessary care, they should recognize that that is an injustice of the legal framework of the healthcare system. One should not combat one injustice with another.

    The demotion of personal conscience is a rather illiberal move, in my opinion.

    • Davide says:

      “he or she believes that the treatment will ultimately be harmful to the patient”
      this only makes sense for doctors that believe 1)that the woman would be punished/suffer in the afterlife for having had an abortion or 2)that there will be negative medical/psychological consequences to the abortion.

      1 doesn’t apply to people who oppose abortion, but don’t actually believe aborting will harm the woman. In fact many seem to frame it as an egotistical choice, harming the fetus for the woman’s benefit

      As for 2…then why frame it as a moral issue at all?

      • Michel Accad says:

        Davide,

        In your case 1, those who oppose abortion surely consider the fetus to be a patient as well, so the argument holds even if they don’t believe there will be negative consequences on the mother. In your case 2, it is a moral issue if the woman does not believe she will suffer negative consequences. In that case, it is pitting patient autonomy against the professional’s belief in non-maleficience.

  • Tully Borland says:

    My question is a simple one: why should we trust the opinions of this group of philosophers? The document does not outline any detailed arguments, it simply lists recommendations and (implicitly) asks us to take their word for it–that is, the word of the consensus of fifteen philosophers.

    But we shouldn’t take their word for it without either knowing a lot more about each of them or their arguments. Here is why:

    1. Whatever expertise philosophers have is over matters wherein there is (a) rational disagreement, (b) no consensus among philosophers, or (c) both. This follows from the nature of philosophy.
    2. This being the case, if (e.g.) fifteen philosophers agree about some proposition p, there will be c.fifteen who disagree about p (or at least there will either be rational disagreement, no consensus, or both about p).
    3. If 2 is the case, no one should take any fifteen philosophers’ testimonies (without additional knowledge) as justification about something of which they claim to be experts. For that matter, one has reason for doubt about the testimony, since the philosophers have delusions of grandeur, (implicitly) asking the public to take their word for something about which there is rational disagreement, no consensus, or both.
    4. …therefore, etc., this document is rubbish as a matter of public evidence for shaping public policy. At best it is simply a political document.

    But don’t take my word for it.

    • James Franklin says:

      Well, we know more about some of them. Two of the signatories created a stir in 2012 for their “bold” paper ‘After-birth abortion: why should the baby live?’

  • Michele Shoun says:

    Tribunals? Regional authorities? Re-education? Mao couldn’t have written it better.

  • Paul Raymont says:

    These guidelines would at least bring the medical profession into line with other healthcare professions. E.g., the guidelines are similar to those that apply to nurses (at least in Ontario). It’s strange that physicians have been granted more leeway with respect to conscience than nurses have. (Though it might, of course, turn out to be better to grant nurses as much freedom here as physicians currently have.)

  • Brian Tenney, MD says:

    We must either choose between recognizing an objective moral code (for which there is ample philosophic support) or a world without such a code. Contentious objectors are vital to either framework.

    Those recognizing the objective moral code must accept with humility our limited ability to perceive this code, and our even more limited ability to accommodate this moral code in law. The contentious objector serves as a witness to the places our laws have fallen short of the objective code (eg: William Wilberfore, MLK).

    Those who deny an objective morality, muddle the debate by using terms like “moral” or “ethical.” They should recognize that their preferences to be allowed to live, have an abortion, or post what they like on a blog falls into the “personal moral or religious views,” and is better termed a “preference”. Those preferences are subject to the whims of those who are stronger in either brute force or voting coalition. For their own protection in times when like minded authorities are not present, developing a societal preference for tolerance of dissenting views is expedient.

    In either framework there is also room for rational disagreement. Neither framework allows discriminating one’s right to live based on size, physical development, age, cognitive or physical ability, location, or a one’s mode of dependence on others– in anyone who is born anyway. It is a rational– not a moral or religious judgement– that this logic should extend to all humans born or not. Many other issues that fall under the broad language of this consensus statement have similar rational grounds for disagreement on their acceptability or prudence.

  • Paul Treanor says:

    I mentioned the issue of malevolent doctors in an earlier comment. Although the Brocher Foundation declaration evades that issue, it is very relevant for any real-world policy, on ethical conflicts in health care. As David Albert Jones points out, implementing the proposed ten-point guidelines would tend to shift decision-making to hospital management and their legal advisors, and to health-care ethicists. That won’t make the issues disappear.

    I suggested that the appropriate policy response is, in fact, state-promoted segregation in health care. That is a logical consequence of differences in values, which are so evident in issues such as abortion and euthanasia. But what does it have to do with malevolent doctors?

    I believe that in western liberal societies a small but significant number of patients are deliberately killed and injured each year, for ‘political’ reasons. My reason to believe that is simply the intensity of hatred in western societies, coupled with the ability to kill and injure without trace, which is inherent in the medical system, especially in hospitals. The Brocher Foundation declaration, like so much discussion of medical issues, attributes essentially noble motives to doctors. That is unrealistic, since we know that negative attitudes to specific groups are prevalent in the general population. Any reasonable policy on health care, ought to take account of at least the possibility of malevolence, among health-care professionals.

    Segregation of health care allows the patient to make reasonable assumptions about the motivation of the doctors and nurses. It is not only a response to possible conscientious objections, such as those on abortions, but also a safeguard against malevolent health-care staff, especially in hospitals.

    Some may wonder what this all about, so let me give an example based on British issues. Suppose there is a surgeon, who is a member of the Conservative Party, an admirer of Margaret Thatcher, a firm believer in the value of hard work, and an opponent of the welfare state. The surgeon must operate on a man, who has never worked a day in his life, and lives on benefits since he left school early. The man comes from a family where no-one works: they all live in social housing, his mother lives on child benefits for her ten children, and when they leave school they all live on benefits too. The surgeon hates and despises such people, who he sees as parasites and scroungers.

    It is therefore a reasonable assumption, that the Conservative surgeon will try to kill the claimant patient. If he can’t kill the patient, he will try to harm him – damage a vital organ, or infect him with a debilitating disease. Of course there also restraining factors: colleagues are watching, and if the surgeon gets caught, then his career is finished, and he will go to jail. Nevertheless, a surgeon has far more opportunity to kill or injure a person surreptitiously. People die in hospitals all the time, or they develop complications – it’s routine, and the police don’t investigate.

    Purely on the basis of ‘sufficient motivation’ and ‘sufficient means’, we must assume that doctors and nurses often kill and injure patients. A lot of people hate others, and often it’s mutual. Xenophobes hate immigrants, homophobes hate gays, and gays also hate homophobes, Thatcherites hate Trotskyites, libertarians hate Stalinists, millions of people in Europe deeply hate Muslims. The allegedly homogenous western liberal-democratic societies are full of hate, and hate breeds violence and death. In polarised societies, we can no longer rely on fictions such as the social contract, the rule of law, and the state monopoly of force.

    Segregation of health care is a pragmatic response to differences in values and ideologies, polarisation, the prevalence of hatred, and the resulting threat to the patient. If the Thatcherite surgeon works in the “Margaret Thatcher Conservative Hospital”, patients will know what sort of doctors and nurses work there. Leftists will avoid it, of course, and claimants would probably avoid it too. If there is a Secular Feminist Women’s Hospital, women will know that they won’t be bullied there, if they need an abortion. Muslim patients can feel safe at the Al-Quds Islamic Hospital, where they won’t be treated by doctors who hate them. Jewish patients, on the other hand, will avoid the Al-Quds Islamic Hospital, and go to a Jewish hospital instead. Christians will go to a Christian hospital, where they will by treated by Christian doctors and nurses. The hospital will perform no abortions, and in turn the Christian doctors and nurses will never have to confront an ethical dilemma, over performing an abortion.

    Segregation protects the patient from the doctor, and can in principle eliminate conflict of values within health care. The Brocher Foundation declaration is written with an implicit assumption of a single unified health-care system, with unified management, and unified norms. Historically, that was not the case in Europe, because health care was often organised along religious lines. And even if health care has since evolved into quasi-national systems, with a tendency to ethical uniformity, that does not mean that they ought to stay that way.

    • David Albert Jones says:

      Dear Paul,

      Clearly doctors can be in error and this is why there is medical law and regulators such as the GMC. If someone suffers as a result of a doctor’s malpractice, whether through negligence or ignorance, the doctor can be subject to civil and in some cases even criminal penalties. He or she could also be struck off the register.

      I do not wish to imply that the doctor should not be accountable, clearly he or she should be, only that there should also be scope for doctors to object to participation in unethical procedures. I think that conscientious objection needs to be defensible, based on a reasonable body of practice, and it is not a right to implement interventions (such as “castrated homosexuals and sterilised women from ethnic minorities”) but is a right to refuse interventions that the clinician believes harmful. It is analogous to the right of the patient to refuse treatment, without having an absolute right to demand a particular treatment. there is more to say on this and a balance to be found but the proposed ‘consensus’ statement is utterly unbalanced and would benefit neither patients nor doctors.

      David

  • John Howland, M.D says:

    This draconian Consensus Statement are an affront to religious liberty and would effectively prevent most if not all physicians with devout religious faith from practicing their profession. What devout Muslim, Christian, or Buddhist physician could abide by these rules? The very nature of religious faith is that we believe in a supreme being or power whose precepts are the ultimate authority in our lives.

  • Andrew Lamb says:

    Death is not health. Killing is not care. If you want to perform abortions and assisted suicides, stop presuming to call yourselves ‘healthcare’ professionals.

  • Tas Walker says:

    This statement is just the personal opinion of those who wrote it. They are trying to pass off their opinion as ‘objective’ morality. Jut because something is legal does not mean it is right. All the people who were put in the gas chambers in Hitler’s Germany were executed legally. This statement is an affront to human dignity.

    • James Franklin says:

      No need to drag Hitler into it. Plenty of contemporary parallels in societies where the consensus is that doctors have a duty to e.g. conduct genital mutilation or extract organs from condemned “criminals”.

  • Donna J. Harrison M.D. says:

    The authors of this statement ignore the decades of research which have demonstrated that abortion harms women. over 150 studies in the peer reviewed medical literature have found that women who have induced abortions have an increased risk of premature delivery in future pregnancies, and a greatly increased risk of extremely early deliveries (22-26 weeks gestation). These are the babies who spend months in the intensive care unit, and the incidence of these extremely early deliveries has been steadily increasing since abortion legalization. Abortion also increases a woman’s risk of suicide, substance abuse and hospitalizable major depression. And aborting fetuses prior to carrying a child to term arrest the breast in a state of immature tissue maturation, and increases her risk of premenopausal breast cancer. These three major harms to women have been documented for decades. It is time to look at the evidence base which shows substantial harms to women from this elective procedure, and of course also kills the obstetricians’ second patient.
    Donna Harrison, M.D. Executive Director, American Association of Pro-Life Obstetricians and Gynecologists

    • Alfonso says:

      Bioethicists and activists liberals even suggest that patients suffering from BIID (body-integrity identity disorder), a sick compulsion to become an amputee , should be treated by having healthy limbs removed, just as transgenders today receive surgical sexual mutilation.
      The ongoing transformation in the methods and ethics of medicine raises profound moral questions for oath that proscribe abortion and assisted suicide and compel physicians to do no poisoned people. There has always been jobs that, despite being legal, shameful and wrong were clearly viewed by society. It was the case of the executioners or slave traders. Were necessary and legal in slave societies or the death penalty, but they knew that their work was “exemplary” and that they were not welcome in their societies. They were a marginal caste. In our time, abortion doctors are in a similar situation. How to sell a society that abortion is a standard medical treatment if there are legions of doctors, social workers, nurses, anesthesiologists and gynecologists who refuse to do? Abortionists you afraid of the objection and of being further cornered in their social ghetto, which gives money but little prestige. Naturally, conscientious objection is a sacred right, the Supreme Court recognized in 1943 that Jehovah’s Witnesses could not be compelled to pledge the flag or perform military service. Idem with abortion. Dr. Henry Morgentaler, who in addition to defending the right to object adds: “In addition, a doctor who does not believe what he does is more likely than not do a good job.” (P. J. Ginés. Wesley J. Smith notes that “the term designates consumerist medicine interventions using traditional methods and tools of medicine (surgery, medicine, technology) not to treat real diseases, but to satisfy personal desires of patients, consolidate their lifestyles or help them achieve their goals unrelated to health. “

    • Nathan says:

      Given that no citations have been provided one can do little more than state the opposite. None of what you say is true. Findings such have these have repeatedly been shown to result from flawed methodologies and/ or simple false positives.

  • Alfonso says:

    Bioethicists and activists liberals even suggest that patients suffering from BIID (body-integrity identity disorder), a sick compulsion to become an amputee , should be treated by having healthy limbs removed, just as transgenders today receive surgical sexual mutilation.
    The ongoing transformation in the methods and ethics of medicine raises profound moral questions for oath that proscribe abortion and assisted suicide and compel physicians to do no poisoned people. There has always been jobs that, despite being legal, shameful and wrong were clearly viewed by society. It was the case of the executioners or slave traders. Were necessary and legal in slave societies or the death penalty, but they knew that their work was “exemplary” and that they were not welcome in their societies. They were a marginal caste. In our time, abortion doctors are in a similar situation. How to sell a society that abortion is a standard medical treatment if there are legions of doctors, social workers, nurses, anesthesiologists and gynecologists who refuse to do? Abortionists you afraid of the objection and of being further cornered in their social ghetto, which gives money but little prestige. Naturally, conscientious objection is a sacred right, the Supreme Court recognized in 1943 that Jehovah’s Witnesses could not be compelled to pledge the flag or perform military service. Idem with abortion. Dr. Henry Morgentaler, who in addition to defending the right to object adds: “In addition, a doctor who does not believe what he does is more likely than not do a good job.” (P. J. Ginés. Wesley J. Smith notes that “the term designates consumerist medicine interventions using traditional methods and tools of medicine (surgery, medicine, technology) not to treat real diseases, but to satisfy personal desires of patients, consolidate their lifestyles or help them achieve their goals unrelated to health. “

  • Agneta Sutton says:

    Asking people to act against their conscience is to ask them to give up their personal integrity. However, it is reasonable to require doctors to refer patients to other doctors when the patient asks for treatment/procedure that the individual doctors disapproves of. This is provided the treatment is legal. But the doctor should also explain to the patient why he/she disapproves of the requested treatment/procedure. This is because the patient might not have taken fully on board all the reasons (moral/philosophical/medical/social…) for and against the treatment. In the case of abortion and euthanasia this could sway the mind of the patients.

    • David Albert Jones says:

      Dear Agenta,

      It is reasonable to tell patients that they have a right to seek another doctor and seek a second opinion, as in the case of professional disagreement. It is not reasonable to ask a doctor to find another doctor who has a particular view. If a GP thinks homeopathy is dangerous rubbish, he should inform patients seeking homeopathy that he will not provide this but that they have a right to seek out a doctor who supports homeopathy, but the GP has no ethical (or legal) duty to find such a practitioner on behalf of the patient. No doctor has a duty to promote bad practice.

      There is a crucial difference between a duty to inform patients of their rights and if necessary help find another physician and the alleged duty to find a particular physician who would provide a particular intervention.

      David

  • Chris says:

    Say it is legal and accepted by the profession to kill newborns. In that context, this statement forces medical professionals to kill newborns, refer people to other doctors to kill newborns, learn how to kill newborns in medical school, etc. Same with forced sterilization. Perhaps that sounds outlandish to you, but it’s not outlandish if you believe all humans should be treated equally regarding basic human rights and you believe that’s true for literally all humans, including the human prior to birth. For those who believe in equality, there’s no moral difference between killing a newborn or killing that same human just months earlier in the womb. Just as no legal system should punish doctors for refusing to kill newborns, so no legal system should punish doctors for refusing to kill those same humans just months earlier.

  • Carol Hicks says:

    I agree with Agneta Sutton’s statement. Please remember that our healthcare practitioners are not robots. It is so wrong to ask them to give up their personal integrity. If you do, then you may well end up treating them due to stress and even breakdown. I cannot believe that highly educated and trained personnel in this field have come up with, and put their name to, such a statement.

  • James Franklin says:

    My article objecting to the ‘Consensus document’ appears in Quadrant Online under the headline ‘When the Prescription is a Lynching’. Links can’t be posted here but it is easily found on Quadrant Online.

    • James Franklin says:

      Chapter 1 of the Book of Exodus says “Then the king of Egypt said to the Hebrew midwives, one of whom was named Shiphrah and the other Puah, ‘When you serve as midwife to the Hebrew women and see them on the birthstool, if it is a son, you shall kill him, but if it is a daughter, she shall live.’ But the midwives feared God and did not do as the king of Egypt commanded them, but let the male children live.” So old-fashioned.

      • Michele Shoun says:

        Very apt because the decider was the government (a forceful 3rd party). But it also applies when the one with the deciding power is the patient. If Hebrew mothers had said, “Kill my child because he has no future in this society,” it would have been appropriate for the midwives to resist.

  • David Richmond MD says:

    You have to stand back a little to get the full picture here. The argument runs like this. Autonomy is a central constitutional value. It grounds a prima facie moral right to request assistance in dying according to one’s views about when life is no longer worth living. But autonomy is not absolute and it may well be that certain countervailing considerations exist that prevent giving legal expression to the prima facie moral right. For example, if it could be shown that decriminalization of euthanasia prevented the State from protecting its most vulnerable citizens, thus interfering with the important constitutional right to protection of the citizenry, then the State should avoid giving legal expression to a right to legal euthanasia. Or, if the doctors and nurses refused to implement a euthanasia program on the grounds of conscience (as happened in the Netherlands during WWII and for which many were imprisoned but subsequently held in high regard by their colleagues elsewhere ) legal expression would be blocked. So, how to counter these inconveniences? In respect of protection of the citizens there is an enormous amount of research performed by Dutch and Belgian investigators showing that great numbers of people in those countries are dispatched without having made any explicit request for it. They don’t see it as an ethical problem but rather as one of logistics. The philosophers who are desperate to overturn existing codes of medical ethics are shown versions of the evidence by Belgian and Dutch authorities who are desperate for the rest of the world to embrace their code and thus agree that there are no grounds for concern should euthanasia be decriminalized. A sort of “see no evil, hear no evil” approach. That is what actually happened in the cases of the Expert Panel on End of Life Decision Making of the of the Royal Society of Canada and the Select Committee on Dying with Dignity of the Quebec National Assembly. Their assurances significantly influenced the opinion of the judges in Fleming v. Canada and Carter v. Canada.
    In the case of resistance by the health professions, there is no alternative but to force them by whatever means necessary to accept that the State alone has the right to determine what is or is not moral. Spelled out clearly is the corollary that those who oppose such a putsch should leave, or be expelled from the practice of clinical medicine. Do I hear faintly in the distance the cry from the tumbrils: “O Bioethics, what crimes are committed in your name”?

  • David Richmond MD says:

    My apologies: in my previous comment I listed Fleming v Canada as a case impacted by the reports of the Expert Panel and the Select Committee. It is incorrectly cited and should be deleted leaving only Carter v. Canada. Fleming was an Irish case.

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