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?
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.
Misbehaving corporations are in the news again. In the New York Times, Jack Ewing and Graham Bowley provide an interesting look into the ‘corporate culture’ behind Volkswagen’s emissions-cheating scandal. As Ewing and Bowley note, Volkswagen has blamed “a small group of engineers.” But as their reporting suggests, any anatomy of blame in the Volkswagen case should consider a wide range of social influences – for example, Volkswagen’s institutionalized commitment to aggression, and more local factors such as fear of those in positions of power on engineering teams.
But who is really at fault? It is natural to think that some individuals are responsible, at least in part. Are any individuals responsible in whole? Or is it possible that the corporation – Volkswagen itself – bears some of the responsibility? This kind of idea is something a number of philosophers have recently suggested. These philosophers argue that above the level of individual agency, there is such a thing as group agency. Groups (like Volkswagen) can be constituted by individuals (and also by historical and socio-structural features). Groups can intend to act – even when no member of the group has a similar intention – and act intentionally. Two philosophers (Björnsson and Hess forthcoming) have even argued that corporations are full moral agents, capable of expressing emotions like guilt, and open to the same kinds of blaming and praising attitudes we typically direct at individuals.
I’m not sure whether that is right. Corporations may be less like full moral agents, and more like extremely dangerous psychopaths – capable of manipulating their own responses to achieve the ends they truly value (i.e., maintaining profit margins). Or, corporations may be capable of a kind of agency, but one very unlike our own – one that is masked by thinking of them by analogy with human agents. It is unclear whether all the features associated with human agency are appropriately applied to the issue of corporate agency.
Written by Dr Nicholas Shackel
If you were attacked at a work party you would expect the person who attacked you to get sacked. In this case (http://www.telegraph.co.uk/news/uknews/11846084/London-Zoo-love-rivals-in-vicious-fight-over-llama-keeper.html) it seems to be the person attacked who got sacked, apparently because the boss doesn’t understand the right of self defence. Continue reading
1. The fact that you disagree with the author’s conclusion is not a reason for advising against publication. Quite the contrary, in fact. You have been selected as a peer reviewer because of your eminence, which means (let’s face it), your conservatism. Accordingly if you think the conclusion is wrong, it is far more likely to generate interest and debate than if you agree with it.
2. A very long review will simply indicate to the editors that you’ve got too much time on your hands. And if you have, that probably indicates that you’re not publishing enough yourself. Accordingly excessive length indicates that you’re not appropriately qualified. Continue reading
by Anders Sandberg and Ben Levinstein
Over the past week we have been subsumed by the intense, final work phase just before the deadline of a big, complex report. The profanity-density has been high, mostly aimed at Google, Microsoft and Apple. Not all of it was deserved, but it brought home the issue that designing software carries moral implications. Continue reading
Despite all the jokes there are, in fact, a lot of things that lawyers won’t do. Or at least shouldn’t do. In many jurisdictions qualified lawyers are subject to strict ethical codes which are self-policed, usually effectively, and policed too by alert and draconian regulatory bodies.
Is there any point, then, in law firms having their own ethics committees which would decide:
(a) how the firm should deal with ethical questions arising in the course of work?; and/or
(b) whether the firm should accept particular types of work, particular clients or particular cases? Continue reading
At 7pm, as you’re eating your dinner, you get a call from an unknown number. You pick it up, half out of curiosity (perhaps your numbers have finally come up on the premium bonds), half out of worry (was a family member likely to have been driving at this time?), but wholly anticipating the interaction that in fact transpires:
‘Good evening, I was wondering whether I could talk to [Your Name]?’
‘Can I ask who’s calling?’ you deflect.
Enthusiastically: ‘My name’s Charlie and I’m calling from Well Known Phone Company Ltd. I wanted to check whether you had thought about updating your tariff? You’re due an upgrade.’
You have, in fact, been wondering about updating your tariff, but you’re not in the mood to do it now and dinner is getting cold. You think about explaining this to chirpy Charlie, but even the thought of engaging in an exchange about whether and when you might be free to discuss it feels like too much effort.
‘We’d be able to save you about…’
‘Sorry’, you interject with a shade of sincerity, ‘I’m not in the mood for being polite.’
‘Ok, well, I…’
You hang up, feeling a twinge of guilt and tremendous wonderment at how Charlie of Well Known Phone Company Ltd remains so chirpy in the face of such rejection.
Ordinarily, we tend to think there is a presumption towards being polite to other people. By ‘being polite’ I mean acting courteously – considering and acknowledging the needs and feelings of others with whom we interact, even when those interactions are very brief. If someone follows close behind you through a door, you should pause to keep it open rather than letting it shut in their face. If someone asks you the time, you should at least acknowledge their question. If someone lets you into the traffic, you should indicate your thanks. This presumption towards minimally respectful behavior arises partly from social convention and partly from our duty to acknowledge the moral reality of other people.
Given the presumption towards politeness, how polite must you be to Charlie the Salesman? Were you justified in hanging up mid-sentence or did your twinge of guilt inform you that you had behaved unfairly? Or, given a less tolerant day, would you in fact have been justified in expressing anger and contempt to Charlie? Continue reading
In philosophical discussions, we bring up the notion of plausibility a lot. “That’s implausible” is a common form of objection, while the converse “That’s plausible” is a common way of offering a sort of cautious sympathy with an argument or claim. But what exactly do we mean when we claim something is plausible or implausible, and what implications do such claims have? This question was, for me, most recently prompted by a recent pair of blog posts by Justin Weinberg over at Daily Nous on same-sex marriage. In the posts and discussion, Weinberg appears sympathetic to an interesting pedagogical principle: instructors may legitimately exclude, discount or dismiss from discussion positions they take to be implausible.* Further, opposition same-sex marriage is taken to be such an implausible position and thus excludable/discountable/dismissable from classroom debate. Is this a legitimate line of thought? I’m inclined against it, and will try to explain why in this post.** Continue reading
A GP in Guildford has recently revealed that the NHS is to pay GPs £55 each time they diagnose dementia in a patient. Writing on the medical website Pulse, Dr Martin Brunet, called the incentive scheme a “bribe,” put in place so that the government can “hit its target to raise diagnosis rates.”
The ‘Dementia Identification Scheme’ requires GPs to count how many patients with a dementia diagnosis there were on their register at the end of September, and to compare this with the number at the end of March 2015. They will then receive £55 for every extra patient. The full service specifications can be found here.