Ethics Archives - Page 6 of 81 - Protection of Conscience Project Library

Legislating the Right-to-Die with Dignity in a Confucian Society-Taiwan’s Patient Right to Autonomy Act

Chih-Hsiung Chen

Hastings International and Comparative Law Review

Abstract
In Confucian societies, people tend to avoid the discussion on death matters, let alone making advance directives to reject life-sustaining treatments at the end of life. Taiwan might be a pioneer in legislating the right-to-die with dignity among Confucian countries. As early as 2000, the Hospice Palliative Care Act was declared in Taiwan, which give terminally-ill patients the options to forgo life-sustaining treatments. Furthermore, in 2016, Taiwan passed the Patient Right to Autonomy Act to enhance patients’ choice at the end of life and expanded the coverage to certain types of non-terminally ill patients. On the other hand, end-of-life issues in Japan are regulated mainly through courts’ judgments and medical societies’ guidelines. Korea passed a law to legalize passive euthanasia, which became effective in 2018, but only contains limits to terminally-ill patients.

This paper is divided into three sections. First, this paper analyzes the sociocultural emphasis on family unity in East Asia and attitudes toward death in East Asian cultures, and then the methods adopted in Japan and South Korea of solving related disputes through the judiciary or legislation are explained. Second, the paper describes the legislative background of the aforementioned two laws in Taiwan, including futile medical care, the denial of citizen autonomy with respect to serious injury and death by criminal law theory, the unwillingness of the judiciary to intervene, and disputes encountered at medical sites. Subsequently, we explain the primary content of these two laws, including patients’ rights to self-determination, the judgment procedures of medical institutions, and the operation of advance directives. Finally, this paper analyzes inadequacies in the Patient Right to Autonomy Act, including a lack of penalties, insufficiencies in medical institutions’ scope of duty of disclosure, and the lack of a settlement mechanism for individuals who have not yet established advance directives.

Chen C-H, Kao H-H, Tseng W-T, Tai Y-A. Legislating the Right-to-Die with Dignity in a Confucian Society-Taiwan’s Patient Right to Autonomy Act. Hastings Int Comp Law Rev. 2019;42(2):485-508. Available from:

The Truth Behind Conscientious Objection in Medicine

Nir Ben-Moshe

Abstract
Answers to the questions of what justifies conscientious objection in medicine in general and which specific objections should be respected have proven to be elusive. In this paper, I develop a new framework for conscientious objection in medicine that is based on the idea that conscience can express true moral claims. I draw on one of the historical roots, found in Adam Smith’s impartial spectator account, of the idea that an agent’s conscience can determine the correct moral norms, even if the agent’s society has endorsed different norms. In particular, I argue that when a medical professional is reasoning from the standpoint of an impartial spectator, his or her claims of conscience are true, or at least approximate moral truth to the greatest degree possible for creatures like us, and should thus be respected. In addition to providing a justification for conscientious objection in medicine by appealing to the potential truth of the objection, the account advances the debate regarding the integrity and toleration justifications for conscientious objection, since the standard of the impartial spectator specifies the boundaries of legitimate appeals to moral integrity and toleration. The impartial spectator also provides a standpoint of shared deliberation and public reasons, from which a conscientious objector can make their case in terms that other people who adopt this standpoint can and should accept, thus offering a standard fitting to liberal democracies.

Ben-Moshe N. The Truth Behind Conscientious Objection in Medicine. J Med Ethics. 2019;45(6):404-410.

Might there be a medical conscience

Nir Ben-Moshe

Abstract
I defend the feasibility of a medical conscience in the following sense: a medical professional can object to the prevailing medical norms because they are incorrect as medical norms. In other words, I provide an account of conscientious objection that makes use of the idea that the conscience can issue true normative claims, but the claims in question are claims about medical norms rather than about general moral norms. I further argue that in order for this line of reasoning to succeed, there needs to be an internal morality of medicine that determines what medical professionals ought to do qua medical professionals. I utilize a constructivist approach to the internal morality of medicine and argue that medical professionals can conscientiously object to providing treatment X, if providing treatment X is not in accordance with norms that would have been constructed, in light of the end of medicine, by the appropriate agents under the appropriate conditions.

Ben‐Moshe, N. Might there be a medical conscience? Bioethics. 2019; 33: 835– 841. https://doi.org/10.1111/bioe.12611

Responding to religious patients: why physicians have no business doing theology

Jake Greenblum, Ryan K. Hubbard

Abstract: A survey of the recent literature suggests that physicians should engage religious patients on religious grounds when the patient cites religious considerations for a medical decision. We offer two arguments that physicians ought to avoid engaging patients in this manner. The first is the Public Reason Argument. We explain why physicians are relevantly akin to public officials. This suggests that it is not the physician’s proper role to engage in religious deliberation. This is because the public character of a physician’s role binds him/her to public reason, which precludes the use of religious considerations. The second argument is the Fiduciary Argument. We show that the patient-physician relationship is a fiduciary relationship, which suggests that the patient has the clinical expectation that physicians limit themselves to medical considerations. Since engaging in religious deliberations lies outside this set of considerations, such engagement undermines trust and therefore damages the patient-physician relationship.

Greenblum J, Ryan K ubbard RK. Responding to religious patients: why physicians have no business doing theology. J Med Ethics 2019;45:705-710. Published Online First: 20 Jun 2019. doi: 10.1136/medethics-2019-105452

Public reason in justifications of conscientious objection in health care

Doug McConnell, Robert F Card

Abstract
Current mainstream approaches to conscientious objection either uphold the standards of public health care by preventing objections or protect the consciences of health‐care professionals by accommodating objections. Public justification approaches are a compromise position that accommodate conscientious objections only when objectors can publicly justify the grounds of their objections. Public justification approaches require objectors and assessors to speak a common normative language and to this end it has been suggested that objectors should be required to cast their objection in terms of public reason. We provide critical support for such a public reason condition and argue that it would be neither too demanding nor too permissive. We also respond to objections that it unfairly favours secular over religious objectors and that public reasons cannot be held with the kind of sincerity thought to characterize conscientious objections.

McConnell D, Card RF. Public reason in justifications of conscientious objection in health care. Bioethics 2019 Jun;33(5):625-632. doi: 10.1111/bioe.12573

Integrity and conscience in medical ethics: A Ciceronian perspective

Jed W Atkins

Abstract
In his work on medical ethics, Lauris Kaldjian identifies conscience with integrity. However, there are competing notions of integrity that may guide the conscience. This paper addresses debates over conscientious refusals by considering Cicero’s account of integrity, a conception previously not discussed in the context of this debate. Cicero offers a framework for understanding integrity and conscience for the physician that is an alternative to Alasdair MacIntyre’s notion of the completely unified life, an idea appropriated by Kaldjian in his argument that there can be no clean distinction between personal, private, practical reasoning and moral decision-making. Cicero’s account rejects the modern-individualist idea of the autonomous self living a wholly compartmentalized life. It agrees with Kaldjian’s stress on flexible decision- making, the internal morality of medicine, the importance of virtues, and the need to accommodate pluralism. However, Ciceronian integrity is better suited than the MacIntyreian account to our present liberal order. It offers a place for the “moral hero” while recognizing that the vast majority of moral agents will be “progressors” who lack the consistency of the moral hero’s fully integrated life. The inclusion of both types of individuals in the medical field may offset the potentially harmful tendencies to which each is prone.

Atkins JW. Integrity and conscience in medical ethics: A Ciceronian perspective. Perspect Biol Med. 2019;62(3):470-488.

Eugenics between Darwin’s Εra and the Holocaust

Dimitra Chousou, Daniela Theodoridou, George Boutlas, Anna Batistatou, Christos Yapijakis, Maria Syrrou

Abstract
Heredity and reproduction have always been matters of concern. Eugenics is a story that began well before the Holocaust, but the Holocaust completely changed the way eugenics was perceived at that time. What began with Galton (1883) as a scientific movement aimed at the improvement of the human race based on the theories and principles of heredity and statistics became by the beginning of the 20th century an international movement that sought to engineer human supremacy. Eugenic ideas, however, trace back to ancient Greek aristocratic ideas exemplified in Plato’s Republic, which played an important role in shaping modern eugenic social practices and government policies. Both positive (encouragement of the propagation of the fit, namely without hereditary afflictions, i.e. socially acceptable) and negative (institutionalization, sterilization, euthanasia) eugenics focused on the encouragement of healthy and discouragement of unhealthy reproduction. All these practices were often based on existing prejudices about race and disability. In this article, we will focus on the rise of eugenics, starting with the publication of Origin of Species to the Holocaust. This examination will be multidisciplinary, utilizing genetics, legal history and bioethical aspects. Through this examination, we will discuss how provisional understandings of genetics influenced eugenics-based legislation. We will also discuss the rise of biopolitics, the change of medical ethos and stance towards negative eugenics policies, and the possible power of bioethical principles to prevent such phenomena.

Chousou D, Theodoridou D, Boutlas G, Batistatou A, Yapijakis C, Syrrou M. Eugenics between Darwin’s Εra and the Holocaust. Conatus J Philosophy; 2019 4(2); 171-204. DOI: https://dx.doi.org/10.12681/cjp.21061.

Deceased organ and tissue donation after medical assistance in dying and other conscious and competent donors: guidance for policy

James Downar, Sam D. Shemie, Clay Gillrie, Marie-Chantal Fortin, Amber Appleby, Daniel Z. Buchman, Christen Shoesmith, Aviva Goldberg, Vanessa Gruben, Jehan Lalani, Dirk Ysebaert, Lindsay Wilson and Michael D. Sharpe

Canadian Medical Association Journal, CMAJ — Canadian Medical Association Journal

Extract
Key Points

First-person consent for organ donation after medical assistance in dying (MAiD) or withdrawal of life-sustaining measures (WLSM) should be an option in jurisdictions that allow MAiD or WLSM and donation after circulatory determination of death.
The most important ethical concern — that the decision for MAiD or WLSM is being driven by a desire to donate organs — should be managed by ensuring that any discussion about organ donation takes place only after the decision for MAiD or WLSM is made.
If indications for MAiD change, this guidance for policies and the practice of organ donation after MAiD should be reviewed to ensure that the changes have not created new ethical or practical concerns. . .

Downar J, Shemie SD, Gillrie C, Fortin M-C, Amber Appleby A, Buchman DZ, Shoesmith C, Goldberg A, Gruben V, Lalani J, Ysebaert D, Wilson L, Sharpe MD. Deceased organ and tissue donation after medical assistance in dying and other conscious and competent donors: guidance for policy. CMAJ. 2019 Jun 3;191(22):E604-E613. doi: 10.1503/cmaj.181648.

U.S. Public Health Service STD Experiments in Guatemala (1946–1948) and Their Aftermath

Kayte Spector-Bagdady, Paul A. Lombardo

Abstract
The U.S. Public Health Service’s sexually transmitted disease (STD) experiments in Guatemala are an important case study not only in human subjects research transgressions but also in the response to serious lapses in research ethics. This case study describes how individuals in the STD experiments were tested, exposed to STDs, and exploited as the source of biological specimens—all without informed consent and often with active deceit. It also explores and evaluates governmental and professional responses that followed the public revelation of these experiments, including by academic institutions, professional organizations, and the U.S. federal government, pushing us to reconsider both how we prevent such lapses in the future and how we respond when they are first revealed.

SpectorBagdady K, Lombardo PA. U.S. Public Health Service STD Experiments in Guatemala (1946–1948) and Their Aftermath. Ethics & Human Research. 2019 Apr; 41(2): 29-34.

The Market View on conscientious objection: Overvalued

Robert F Card

Abstract
Ancell and Sinnott-Armstrong argue that medical providers possess wide freedoms to determine the scope of their practice, and therefore, prohibiting almost any conscientious objections is a bad idea. They maintain that we could create an acceptable system on the whole which even grants accommodations to discriminatory refusals by healthcare professionals. Their argument is premised upon applying a free market mechanism to conscientious objections in medicine, yet I argue their Market View possesses a number of absurd and troubling implications. Furthermore, I demonstrate that the fundamental logic of their main argument is flawed. Thinkers who wish to address the issues raised in this debate in general or by discriminatory conscience objections in particular should avoid the Market View and instead envisage theories that assess the reasons underlying conscientious refusals in medicine.

Card RF. The Market View on conscientious objection: Overvalued. J Med Ethics 2019 Mar;45(3):168-172. doi: 10.1136/medethics-2018-105173