The Tale of the Ethical Neonatologist – And Why There Shouldn’t Be a Legal Right of Conscientious Objection
Doctors have values. These are sometimes described as their conscience. Those values can conflict with what has evolved to be medical practice. Where that practice is consistent with principles, concept and norms of medical ethics, their values should not compromise patient care. The place for doctors to express their values and seek to revise the practice of medicine is at the level of policy and law, not at the bedside. Because conscientious objection can compromise patient care, there should be no legal right to conscientious objection to medical practice that is consistent with medical ethics. Personal values (“conscience”) can be accommodated by employers under standard labour law as occurs in Sweden and Finland, or candidates selected for medical specialties who have values consistent with ethical medicine, or new professions developed to provide those services.
Doctors may have very defensible values. But just because their values are reasonable does not imply they should be accommodated by medicine. Consider the Conscientious Neonatologist.
The Conscientious Neonatologist
Peter is a thoughtful, reflective specialist caring for premature babies in intensive care. He is a vegetarian for 20 years. He became deeply concerned about the welfare of animals during his university years. He believes in “animal liberation”. Neither he nor his family consume meat or use animal products for clothing.
In his job, he must prescribe “surfactant” – a substance to help the lungs of premature babies function better. The standard, and most effective form is derived from the lungs of pigs. However there is a new artificial form. He considers this a more “ethical” product and considers using it in his medical practice. However, it is not currently used in the newborn intensive care unit because it is more expensive than standard treatment, and there is not clear evidence about its effectiveness.
Peter conscientiously objects to the use of animals in medicine and medical research. How should his personal values influence his professional practice?
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:
Abortion remains a crime in Queensland and NSW in Australia. Queensland Parliament has just decided against decriminalising abortion. However, laws are obsolete and unclear, dating back over 100 years. Around 100,000 abortions are performed around Australia every year. In practice, early abortion is available on demand.
Abortion should be decriminalised. Early abortion should be freely and easily available on request. Late abortion should be freely and easily available at least for those who have a valid justification: significant fetal abnormality, threat to woman’s health or serious social reason, for example child pregnancy or rape. Family planning, including safe, free and open abortion services, is an essential part of a civilized society.
Failure to regulate abortion properly results in women being denied safe, effective abortion services, affecting their mental health and social welfare, as well as those of their family and society. It is stigmatising to women and health professionals to allow abortion to occur, while retaining it as a criminal offence. It is also moral hypocrisy.
Associate Professor and Consultant Neonatologist Dominic Wilkinson (Oxford Uehiro Centre for Practical Ethics) argues that medical doctors should not always listen to their own conscience and that often they should do what the patient requests, even when this conflicts with their own values.
Written by: Rajiv Shah, PhD Candidate, Faculty of Law, University of Cambridge
Donald Trump suggested that women who have abortions should face punishment. For that he was criticised by both the pro-choice side and the pro-life side. The latter claimed that their view is that women should not face punishment for having abortions but that only providers should. This raises the interesting question of whether the pro-life position is coherent. It would seem that it is not. If the foetus has the right to life then having an abortion is like murder and so those who abort should be treated as such. This post argues that the pro-lifer can coherently reject this implication whilst still holding that the foetus has the right to life. Since it considers the responses a pro-lifer could make this post will assume for the sake of argument that the foetus does have a right to life. Continue reading
In Roald Dahl’s short story, William and Mary, William dies of cancer. But a novel procedure allows his brain, with one eye attached, to be kept functioning in a clear plastic vat. His wife convinces William’s neurosurgeon to allow her to take William (or rather his brain and eye) home with her.
When home, Mary places William in a prominent place in the sitting room from where he can survey all her actions. He had been a domineering and controlling husband. He forbade her to have a TV and to smoke. Now, Mary purchases a TV and takes up smoking, blowing smoke in the direction of William. She will punish him for his abuse and his brain may stay alive, utterly powerless, for up to 200 years.
This story was science fiction. But yesterday, the first step to creating the brain in a vat was reported in the US. Back in July 2013, scientists reported the first organ grown from stem cells: a liver. A kidney, heart and other organs have followed. The potential of these technologies to eventually provide replacement organs is also an opportunity to sweep away complex ethical issues: most obviously in avoiding the need for organ donation, but also in enhancing the ability to test drugs on lab grown organs before testing in humans- reducing the risk of harm to research participants, hopefully some day to a negligible amount.
Now, just 2 years later, the first brain has been grown in a laboratory. The organoid has been grown for 12 weeks, the equivalent of a 5 week old foetus.
Lead researcher Professor Rene Anand, from Ohio State University in the US,
“It not only looks like the developing brain, its diverse cell types express nearly all genes like a brain.”
Many share an intuition that self-consciousness is highly morally significant. Some hold that self-consciousness significantly enhances an entity’s moral status. Others hold self-consciousness underwrites the attribution of so-called personhood (or full moral status) to self-conscious entities. On such views, self-consciousness is highly morally significant: the fact that an entity is self-conscious generates strong moral reasons to treat that entity in certain ways (reasons that, for example, make killing such entities a very serious matter).
Why believe that? Continue reading
For a long time, Ann Furedi (chief executive of bpas) has been advocating women’s right to choose regarding their pregnancies. She is quite radical with regard to this pro-choice principle. For example, she questioned the 24-week limit of abortion, saying that every limit is arbitrary, and women have good reasons when they request an abortion after the 24-week limit. She defends gender selection. She argues that abortion is justified when the continuation of the pregnancy is likely to cause injury to the mental or physical health of the woman and having a child with an undesired gender could cause such suffering. According to her, you are either pro-choice or you are not. You can’t reject women’s right to choose when you don’t like her choice and still be pro-choice. There is no middle ground. What is at stake is the principle of moral autonomy with respect to reproductive decisions. If we set limits to this principle, then we violate the principle all-together. We should trust women to make their own decisions, as only they best know their own circumstances.
Left to make their own moral judgements, some women will inevitably make decisions that we would not; perhaps even those we think are ‘wrong’. And we must live with that: tolerance is the price we pay for our freedom of conscience in a world where women can exercise their human capacity through their moral expression. We either support women’s moral agency or we do not. (…) We can make the judgement that their choice is wrong – but we must tolerate their right to decide. There is no middle ground to straddle.
The latest issue of the Journal of Medical Ethics is out, and in it, Professor Nigel Biggar—an Oxford theologian—argues that “religion” should have a place in secular medicine (click here for a link to the article).
Some people will feel a shiver go down their spines—and not only the non-religious. After all, different religions require different things, and sometimes they come to opposite conclusions. So whose religion, exactly, does Professor Biggar have in mind, and what kind of “place” is he trying to make a case for?
1. Many think that the wrongness of killing has at least partly to do with the harm and/or badness of death. I assume that is right.
2. Many think that the harm and/or badness of death has primarily to do with the deprivation of a future. In particular, many think that the future contains valuable experiences and states of affairs, and that death robs an entity of experiencing or otherwise attaining these valuable things. Although there are different ways of making explicit how a future is valuable, I assume that the general idea is right.
3. The value in the future is prima facie problematic for those who find abortion permissible. Fetuses seem to have valuable futures. If so, then at the very least there is a (potentially defeasible) moral reason against killing a fetus (cf. Marquis 1989). Continue reading