Project Administrator, Author at Protection of Conscience Project Library

Referral vs Transfer of Care:Ethical Options When Values Differ

Cynthia Jones-Nosacek

Abstract
Conscientious objection (CO) in medicine is where a healthcare professional (HCP) firmly opposes, with an expression of reasoned disapproval, a legally available procedure or treatment that is proscribed by one’s conscience. While there remains controversy regarding whether conscientious objection should be a part of medicine, even among those who support CO state that if the HCP does not provide the requested service such as abortion, physician assisted suicide, etc., there is an obligation on the part of the objecting HCP to refer to someone who will provide it. However, referral makes the referring HCP complicit in the act the referrer believes to be immoral since the referrer has a duty to know that the HCP who will accept the patient is not only able to do the procedure but is competent in its performance as well. The referrer thus facilitates the process. Since one has a moral obligation to limit complicity with immoral actions when it cannot be avoided, the alternative is to allow the patient to transfer care to another when the patient has made the autonomous decision to reject the advice of the HCP.

Jones-Nosacek C. Referral vs Transfer of Care:Ethical Options When Values Differ. The Linacre Quarterly 2022 89(1):36-46.

Our Inner Guide: Protecting Freedom of Conscience

Cardus

Conscience, though inherently individual, is vital to the common good. Using current case studies from Canada that engage freedom of conscience, this paper offers concrete recommendations as to how this human right can be robustly protected at home and abroad.

Our Inner Guide: Protecting Freedom of Conscience

Executive Summary
Freedom of conscience appears in the Canadian Charter of Rights and Freedoms, the Universal Declaration of Human Rights, and many other bills of rights. Yet, despite its universality, this human right is, by and large, universally neglected by courts, legislatures, and policy-makers.

Today, more so than before, reliance on freedom of conscience implicates the interests and rights of other citizens. Owing to modern phenomena such as globalization, many of us live in deeply diverse, multicultural, and plural societies. These current characteristics of many Western societies inevitably increase the prospect of sharp disagreements between citizens on what is good, right, and true—as well as the need to resolve these disagreements. This paper takes up the challenge of grappling with the clash of interests and rights in these cases.

This paper unpacks what freedom of conscience protects, why it is worth protecting, and when it may—and may not—be limited. For the sake of individual flourishing, peaceful coexistence, and liberal democracy itself, we say that freedom of conscience merits robust protection.

We aim to raise awareness of the importance of freedom of conscience in a liberal democracy and alert Canadians to the pressing need for this human right to be afforded due respect. Using current case studies from Canada that engage freedom of conscience, we offer concrete recommendations as to how this human right can be robustly protected at home and abroad.

History teaches that conscience can instigate fundamental social change, for the better. Conscience not only safeguards core convictions—it also promotes moral growth, for individuals and societies alike. Conscience, though inherently individual, is vital to the common good. To realize societies that are just and equitable, it is safe to say that freedom of conscience is indispensable. It is our intention that this paper will contribute to an essential public discussion on freedom of conscience and how we can better shape our laws, and ourselves, in accordance with this neglected freedom.

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(Editorial) Assisted dying: a question of when, not if

Richard Hurley, Tessa Richards, Fiona Godlee

British Medical Journal, BMJ — British Medical Journal

Extract
Doctors’ views on assisted dying are split, and most doctors’ organisations take no position on the issue; a few—including the BMA—oppose legalisation. Their stance matters: lawmakers and judges regularly seek, and listen to, their views. The BMJ has called for the professions’ representatives to take a position of neutrality—neither in support nor opposition—on the grounds that doctors should not obstruct a decision that is for society and parliament to make.

Engaged neutrality is far from an abdication of responsibility. It honours the diversity in professionals’ opinion. We believe that it also enables organisations to facilitate and fully engage with much needed societal conversations about death and what it means to die well.

Neutral organisations can be closely involved in drafting laws and guidelines, which would be impossible if they opposed their existence. They can lobby for the interests of doctors who do not wish to participate, as well as of doctors who do. . .

Hurley R, Richards T, Godlee F. (Editorial) Assisted dying: a question of when, not if. Br. Med. J. 2021;374(2128)

Organ donation after euthanasia starting at home in a patient with multiple system atrophy

Najat Tajaâte, Nathalie van Dijk, Elien Pragt, David Shaw,A. Kempener‑Deguelle, Wim de Jongh, Jan Bollen,Walther van Mook

Abstract

Background: A patient who fulfils the due diligence requirements for euthanasia, and is medically suitable, is able to donate his organs after euthanasia in Belgium, the Netherlands and Canada. Since 2012, more than 70 patients have undergone this combined procedure in the Netherlands. Even though all patients who undergo euthanasia are suf‑ fering hopelessly and unbearably, some of these patients are nevertheless willing to help others in need of an organ.

Organ donation after euthanasia is a so‑called donation after circulatory death (DCD), Maastricht category III procedure, which takes place following cardiac arrest, comparable to donation after withdrawal of life sustaining therapy in critically ill patients. To minimize the period of organ ischemia, the patient is transported to the operating room immediately after the legally mandated no‑touch period of 5 min following circulatory arrest. This means that the organ donation procedure following euthanasia must take place in the hospital, which appears to be insurmountable to many patients who are willing to donate, since they already spent a lot of time in the hospital.

Case presentation: This article describes the procedure of organ donation after euthanasia starting at home (ODAEH) following anesthesia in a former health care professional suffering from multiple system atrophy. This case is unique for at least two reasons. He spent his last conscious hours surrounded by his family at home, after which he underwent general anaesthesia and was intubated, before being transported to the hospital for euthanasia and organ donation. In addition, the patient explicitly requested the euthanasia to be performed in the preparation room, next to the operating room, in order to limit the period of organ ischemia due to transport time from the intensive care unit to the operating room. The medical, legal and ethical considerations related to this illustrative case are subsequently discussed.

Conclusions: Organ donation after euthanasia is a pure act of altruism. This combined procedure can also be performed after the patient has been anesthetized at home and during transportation to the hospital.

Tajaâte N, van Dijk N, Pragt E, Shaw D, Kempener‑Deguelle A, de Jongh W et al. Organ donation after euthanasia starting at home in a patient with multiple system atrophy. BMC Medical Ethics. 2021;22(120).

(Correspondence) MAID, social determinants and the slippery slope

Tom Koch

Rapid Response: extract
Jocelyn Downie and Udo Schuklenk conclude, first, that the Canadian experience denies the existence of a ‘slippery slope’ expanding medical termination from a limited to a broader medical constituency. Second, they argue a failure to provide social constituents of health and support is a significant factor in the increased requests for ‘medical aide in dying.’ (1) It is hard to credit their conclusions on either point. . . .

. . . As a Canadian long engaged in this debate–legal and social–as well as in the care of those with chronic conditions I thus find their arguments incomplete and their conclusions inaccurate. . .

Koch T. (Rapid Response) MAID, social determinants and the slippery slope. J Med Ethics. 2021 Aug 04;47(10).

How torturers are made: Evidence from Saddam Hussein’s Iraq

Christopher J Einolf

Abstract

Because of the difficulties in researching torturers, little is known about how they are recruited, trained, and authorized, and how they morally justify their actions. This study examines oral history testimonies from 14 former torturers in Saddam Hussein’s Iraq. Torturers volunteered for jobs in the security services, and attributed their choice of career to psychologically traumatic childhoods. Torturers were trained to think of their victims as subhuman and dangerous, and to cultivate mercilessness as a type of strength. They carried out torture under direct orders, and two were tortured themselves when they failed to obey. They justified their actions morally by diffusing responsibility, blaming victims, and using just-cause thinking. Overall, the findings show that there is no single path to becoming a torturer, as there is great variation even among torturers from a single country. Much more research is needed to fully understand how torturers think and work.

Einolf CJ. How torturers are made: Evidence from Saddam Hussein’s Iraq. Journal of Human Rights. 2021;20(4):381-395.

End-of-Life Options Act Fails to Protect Conscience Rights

Andrew S. Kubick

Extract
The New Mexico Senate passed the Elizabeth Whitefield End-of-Life Options Act on March 15 by a vote of twentyfour to seventeen. That vote followed a February vote of thirty-nine to twenty-seven in the lower chamber. Now with the stroke of Governor Michelle Lujan Grisham’s pen, New Mexico has become the ninth state in the United States to enact a physician assisted suicide law. (The practice also is legal in Washington, DC.) The End-of-Life Options Act is incompatible with the moral teachings of Catholicism (along with several other religions). A provider who embraces the Catholic faith will be faced with the following ultimatum: You can either write a prescription for a lethal dose of a sedative or refer the patient to a physician who will then write it, or you can suffer the professional consequences of conscientiously objecting to both of those options. It is clear upon review of the End-of-Life Options Act that it fails to fully protect the conscience rights of providers. . .

Kubick AS. End-of-Life Options Act Fails to Protect Conscience Rights. Ethics & Medics 2021 Jun; 46(6): 1-2.

(Book Review) What it means to be human: The case for the body in Public Bioethics

The deficiencies and dangers of ‘radical individualism’

Margaret Somerville

O. Carter Snead. What it means to be human: The case for the body in Public Bioethics. Cambridge, Mass: Harvard University Press, 2020, pp 321. ISBN-10: 0674987721.

Extract
Anyone concerned about the current values conflicts in our societies should read this book. Although it focuses on conflicts in public bioethics, the insights of the author, O. Carter Snead, have application to a much broader range of values conflicts in what are sometimes called the “culture wars”.

Snead starts with a history of American Public Bioethics. He then asks, “What does it means to be human” and addresses two competing responses – “expressive individualism” and “embodiment” – and articulates the anthropology (the study of human beings and societies) that informs each of these views. He argues the former is inadequate on at least two fronts. First, it “forgets the body” and sees the person as only a mind, a self-actualizing will. Second, it does not contemplate or accommodate human relationships and the reality that we are social beings.

Snead then takes an innovative approach to legal scholarship. He proceeds to an in-depth analysis of six judgments handed down by the Supreme Court of the United States in relation to abortion. He undertakes this analysis in order to determine the law’s view, as manifested in these cases, of what it means to be human, that is, the anthropology that undergirds and informs the judgments he considers. . . continue reading

Equality of Autonomy? Physician Aid in Dying and Supported Decision-Making

Megan S Wright

Extract
Abstract
. . . This Article is the first to address whether terminally ill persons with cognitive impairments should be able to access PAID [Physician Aid In Dying] through supported decision-making. If provided with decision-making support, terminally ill persons with cognitive impairments may be able to elect PAID intentionally, voluntarily, and with understanding; that is, despite their impairments, such persons may be capable of autonomous end-of-life decision-making. This Article thus argues that the principle of equality demands that the law not exclude terminally ill supported persons with decisional impairments from PAID. This Article also argues that supported decision-making is a superior means for terminally ill persons with decisional impairments to access this end-of-life option compared to advance directives, which have numerous and well-documented problems. . .

Wright MS. Equality of Autonomy? Physician Aid in Dying and Supported Decision-Making. Arizona Law Review. 2021;63(157):158-197.

How should a liberal democracy react to conscientious objection claims

Panel 4: Reacting to Conscience Claims in the Public Square

Royal Irish Academy Symposium

Chair:

Mr Bryan Dobson, RTÉ

Panellists:

Dr John Adentire, Queen Mary University of London
Professor Fiona de Londras, University of Birmingham
Senator Michael McDowell, Houses of the Oireachtas

How legislators and governments in liberal democracies should react to claims of conscience.

Royal Irish Academy: How should a liberal democracy react to conscientious objection claims