Evil on its Face

In June of this year, a group of ethicists—should I say that I use that term loosely?—issued a “consensus statement” to guide legislation and institutional policy regarding conscientious objection in medicine.  Conscientious objection, they explained, “is the refusal to provide a certain medical service, for example an abortion or medical assistance in dying, because it conflicts with the practitioner’s moral views.”  Their words, not mine.

They went on to aver that the general medical principle that the care of the patient is paramount, taking priority over the practitioner’s “moral or religious views.”  Not that the practitioner must efface his or her self-interest for the sake of the patient’s best interest, pace Dr. Pellegrino, but that moral arguments must take a back seat to “a patient’s desire for a legal, professionally sanctioned medical service.”  So, in other words, if the law and the powers that be determine that something is permitted within the bounds of medical practice, all practitioners must submit to that.  If they object to, for example, participating in euthanasia when the legislature has deemed this permissible, they must state their reasons—including going before a “tribunal,” if necessary—and refer for the service or perform it themselves if no referral is available.  Punishments are in order: “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 fulfill their professional obligations by providing public-benefitting services.”  I’m not sure whether “by providing public-benefitting services” is intended to modify “compensate” here—that is, the punishment should be community service of some unspecified sort—or to modify “obligations”—that is, construing doctor-assisted suicide and abortion as primary public goods and medical duties.

Further, medical students “should not be exempted” from learning how to perform these acts, because they might need to do so “in an emergency situation.”  Well—emergency doctor-assisted suicide?  Emergency abortion?  In the latter case, certainly procedures to protect a woman’s life in situations that do arise, such as heavy bleeding or the presence of an already-dead fetus should be included, but performance of elective abortions, or of late-term abortions?  Rare cases in this last instance may arise, but not to warrant “practice” in elective cases.  And, as anyone who went to medical school knows, “see one, do one, teach one.”  Learning means doing.

Finally, the tenth and last “principle” is “Healthcare practitioners should also be educated to reflect on the influence of cognitive bias in their objections.”  Really, now.  Follow the link above and read not just the statement but the often-salty comments that follow, and ask just whose “consensus” this is, and note one commenter’s point about the last principle, related to “cognitive bias,” that “mutatis mutandis, the same principle might be enforced on philosophers.”

Sometimes, civility is the enemy of truth, so I must say here that this is calling evil good, a naked attempt to ram abortion, doctor-assisted suicide, and, by extension, numerous other objectionable practices down the throats of Hippocratic-thinking physicians.  There is nothing good to say about this “consensus statement.”  It represents no “consensus” at all and should be condemned in the strongest possible terms and resisted steadfastly.

“Hat tip” to Wesley Smith, who flagged it in a blog post, calling it an example of “medical martyrdom,” an attempt to drive people who revere human life and dignity out of the medical professions.  See here and here.  (Note: National Review Online has folded Smith’s blogging into its “Corner” blog, closing down the separate “Human Exceptionalism” blog, which I, for one, will miss.)

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Trevor Stammers
3 years ago

The JME has only this morning put online an article promoting the Swedish solution to the “problem” of healthcare professionals with conscientious objections to legal practices. Their ‘solution’ rests on the fact that under Swedish law, “employers have a right to decide the content and organisation of work (within the realm of what they are legally required to do in other respects).”

This means that “an employee who insists on being relieved of prescribed work tasks have three options: (1) accepting penalties (such as reduced pay), (2) being discharged due to refusal to do one’s duty or (3) resign before any of 1 or 2 occur and seek alternative employment.”

The author concludes that “Nobody is forced to take up any
employment, and everyone is free to resign on whatever ground
they may find. Therefore, no one is prevented from acting on
their moral, religious or personal beliefs, whatever they happen to be”.

That’s all right then; if you have objection to abortion you can just resign or not work in O and G in the first place. Or have I misunderstood this “solution”? I cant imagine all Swedes find this a just solution let alone readers of this blog and comments.

Jon Holmlund
Jon Holmlund
3 years ago

I don’t know but could imagine that a majority of Swedes might agree with the “solution” you describe. Note that the issue is not just whether one can work in Ob/Gyn but whether one could finish medical school–although maybe the JME article didn’t put the fine point on it, I don’t know. (We should start putting “JME” in quotation marks because “ethics” does not belong in the name of the journal–I might suggest another, four-letter, word that starts with “e”?)

A couple more thoughts about the “Swedish solution”–in general, employers can define terms of employment. But for the US, anyway, one quickly runs up against issues of the religious freedom rights of workers. I can imagine that question getting conflated in the courts with the issues around providing services for same-sex weddings. I can also imagine workers’ religious freedoms being defined narrowly (e.g., having religious symbols in one’s own workspace). I guess we’ll have to see. Also, recall that one criticism of the Affordable Care Act in the US is that it created powerful incentives pushing physicians toward an employment model of practice. Net-net, what Trevor cites here is a piece with the “medical martyrdom” concerns Wesley Smith has raised.

Mark McQuain
Mark McQuain
3 years ago

I wonder if the scenario changes if healthcare becomes a legal right (above and beyond employer/employee contracts), as then a “healthcare practioner” would have a legal obligation to provide the service. It seems to me that such a situation erodes (but perhaps does not eliminate) that practioner’s First Amendment protections.