Ethics Archives - Page 4 of 87 - Protection of Conscience Project Library

In the Footsteps of Teiresias: Treatment for Gender Dysphoria in Children and the Role of the Courts

Mike O’Connor, Bill Madden

The Family Court of Australia has stepped back from a previously perceived need for involvement in the approval of stage 1 and stage 2 treatments, for children requiring gender transformation. At present those children and their families who are in agreement need not seek authorisation of the Family Court to undertake either Stage 1 (pubarche blockade with gonadotrophin-releasing hormone agonists) or Stage 2 treatment (cross-hormone therapy such as oestrogen for transgender males). Stage 1 treatment to suppress pubarche would nowadays be commenced at Tanner stage 2 which commences as early as 9.96 years in girls and 10.14 years in boys. Suppression of puberty continues until the age of 16 years when cross hormonal treatment commences. This article questions the assertion that suppression of puberty by GnRH analogues either in cases of precocious puberty or gender dysphoria is “safe and reversible” and argues that it warrants ongoing caution, despite the Family Court having broadly accepted that assertion.

O’Connor M, Madden B. In the Footsteps of Teiresias: Treatment for Gender Dysphoria in Children and the Role of the Courts. J Law Med. 2019 Oct;27(1):149-163.

Is it ever morally permissible to select for deafness in one’s child?

Jacqueline Mae Wallis

Abstract
As reproductive genetic technologies advance, families have more options to choose what sort of child they want to have. Using preimplantation genetic diagnosis (PGD), for example, allows parents to evaluate several existing embryos before selecting which to implant via in vitro fertilization (IVF). One of the traits PGD can identify is genetic deafness, and hearing embryos are now preferentially selected around the globe using this method. Importantly, some Deaf families desire a deaf child, and PGD–IVF is also an option for them. Selection for genetic deafness, however, encounters widespread disapproval in the hearing community, including mainstream philosophy and bioethics. In this paper I apply Elizabeth Barnes’ value-neutral model of disability as mere-difference to the case of selecting for deafness. I draw on evidence from Deaf Studies and Disability Studies to build an understanding of deafness, the Deaf community, and the circumstances relevant to reproductive choices that may obtain for some Deaf families. Selection for deafness, with deafness understood as mere-difference and valued for its cultural identity, need not necessitate impermissible moral harms. I thus advocate that it is sometimes morally permissible to select for deafness in one’s child.

Wallis, J.M. Is it ever morally permissible to select for deafness in one’s child?. Med Health Care and Philos 23, 3–15 (2020). https://doi.org/10.1007/s11019-019-09922-6

Professionalism eliminates religion as a proper tool for doctors rendering advice to patients

Udo Schuklenk

Abstract:Religious considerations and language do not typically belong in the professional advice rendered by a doctor to a patient. Among the rationales mounted by Greenblum and Hubbard in support of that conclusion is that religious considerations and language are incompatible with the role of doctors as public officials.1 Much as I agree with their conclusion, I take issue with this particular aspect of their analysis. It seems based on a mischaracterisation of what societal role doctors fulfil, qua doctors. What obliges doctors to communicate by means of content that is expressed in public reason-based language is not that they are public officials. Doctors as doctors are not necessarily public officials. Rather, doctors have such obligations, because they are professionals. Unlike public officials doctors are part of a profession that is to a significant extent self-governing. This holds true for all professions. The …

Responding to religious patients: why physicians have no business doing theology. Jake Greenblum Ryan K Hubbard Journal of Medical Ethics 2019; – Published Online First: 20 Jun 2019. doi: 10.1136/medethics-2019-105452

Schuklenk U. Professionalism eliminates religion as a proper tool for doctors rendering advice to patients. J Medical Ethics. 2019 Sep 12. pii: medethics-2019-105703. doi: 10.1136/medethics-2019-105703. [Epub ahead of print]

Why not common morality?

Rosamond Rhodes

Abstract
This paper challenges the leading common morality accounts of medical ethics which hold that medical ethics is nothing but the ethics of everyday life applied to today’s high-tech medicine. Using illustrative examples, the paper shows that neither the Beauchamp and Childress four-principle account of medical ethics nor the Gert et al 10-rule version is an adequate and appropriate guide for physicians’ actions. By demonstrating that medical ethics is distinctly different from the ethics of everyday life and cannot be derived from it, the paper argues that medical professionals need a touchstone other than common morality for guiding their professional decisions. That conclusion implies that a new theory of medical ethics is needed to replace common morality as the standard for understanding how medical professionals should behave and what medical professionalism entails. En route to making this argument, the paper addresses fundamental issues that require clarification: what is a profession? how is a profession different from a role? how is medical ethics related to medical professionalism? The paper concludes with a preliminary sketch for a theory of medical ethics.

Rhodes R. Why not common morality? J Med Ethics 2019;0:1–8. Published Online First: 11 September 2019. doi: 10.1136/medethics-2019-105621

(Book Review) Opting Out: Conscience and Cooperation in a Pluralistic Society

Morten Magelssen

David Oderberg. Opting Out: Conscience and Cooperation in a Pluralistic Society. London: The Institute of Economic Affairs, 2018, pp. 136. ISBN:978-0-255-36761-5.

Extract
In this brief monograph, the philosopher David Oderberg argues that freedom of conscience and religion, as fundamental rights in a liberal democracy, need increased protection in legislation and from the courts. Conscientious objection – in which a professional refuses to perform specific tasks for moral or religious reasons – is especially relevant in healthcare. Oderberg draws most of his examples from this field (e.g. abortion, contraception, treatment-limiting decisions and euthanasia), but also discusses cases from other sectors, such as the bakers and florists who refused to sell goods in connection with gay weddings. . .

Magelssen M. Book Review: Opting Out. Conscience and Cooperation in a Pluralistic Society. New Bioethics 2019 Sep; 25(3): 283-286, DOI:10.1080/20502877.2019.1647038.

Medical Acts and Conscientious Objection: What Can a Physician be Compelled to Do?

Nathan K. Gamble, Michal Pruski

Abstract
A key question has been underexplored in the literature on conscientious objection: if a physician is required to perform ‘medical activities,’ what is a medical activity? This paper explores the question by employing a teleological evaluation of medicine and examining the analogy of military conscripts, commonly cited in the conscientious objection debate. It argues that physicians (and other healthcare professionals) can only be expected to perform and support medical acts – acts directed towards their patients’ health. That is, physicians cannot be forced to provide or support services that are not medical in nature, even if such activities support other socially desirable pursuits. This does not necessarily mean that medical professionals cannot or should not provide non-medical services, but only that they are under no obligation to provide them.

Gamble NK, Pruski M. Medical Acts and Conscientious Objection: What Can a Physician be Compelled to Do? New Bioethics 2019 Sep; 25(3): 262-282. DOI:10.1080/20502877.2019.1649871

Conscientious Objection and Clinical Judgement: The Right to Refuse to Harm

Toni C. Saad

Abstract
This paper argues that healthcare aims at the good of health, that this pursuit of the good necessitates conscience, and that conscience is required in every practical judgement, including clinical judgment. Conscientious objection in healthcare is usually restricted to a handful of controversial ends (e.g. abortion, euthanasia, contraception), yet the necessity of conscience in all clinical judgements implies the possibility of conscientious objection to means. The distinction between conscientious objection to means and ends is explored and its implications considered. Based on this, it is suggested that conscientious objection, whether to means or ends, occurs when a proposed course of action comes into irreconcilable conflict with the moral principle ‘do no harm’. It is, therefore, concluded that conscientious objection in healthcare can be conceived as a requirement of the moral imperative to do no harm, the right to refuse to harm in regard to health.

Saad TC. Conscientious Objection and Clinical Judgement: The Right to Refuse to Harm. New Bioethics. 2019 Sep; 25(3): 248-261 DOI:10.1080/20502877.2019.1649863

Is conscientious objection incompatible with healthcare professionalism?

Mary Neal, Sara Fovargue

Abstract
Is conscientious objection (CO) necessarily incompatible with the role and duties of a healthcare professional? An influential minority of writers on the subject think that it is. Here, we outline the positive case for accommodating CO and examine one particular type of incompatibility claim, namely that CO is fundamentally incompatible with proper healthcare professionalism because the attitude of the conscientious objector exists in opposition to the disposition (attitudes and underlying character) that we should expect from a ‘good’ healthcare professional. We ask first whether this claim is true in principle: what is the disposition of a ‘good’ healthcare professional, and how does CO align with or contradict it? Then, we consider practical compatibility, acknowledging the need to identify appropriate limits on the exercise of CO and considering what those limits might be. We conclude that CO is not fundamentally incompatible – either in principle or in practice – with good healthcare professionalism.

Neal M, Fovargue S. Is conscientious objection incompatible with healthcare professionalism? New Bioethics 2019 Sep; 25(3): 221-235, DOI:10.1080/20502877.2019.1651935.

How special is medical conscience?

David S. Oderberg

Abstract
The vigorous legal and ethical debates over conscientious objection have taken place largely within the domain of health care. Is this because conscience in medicine is of a special kind, or are there other reasons why it tends to dominate these debates? Beginning with an analysis of the analogy between medical conscience and conscientious objection in wartime, I go on to examine various possible grounds for distinguishing between medicine and other professional contexts (taking law and accountancy as examples). The conclusion is that no principled difference exists between the military and medical cases, nor between the health professions and other professions. Nevertheless, there are practical reasons why medical conscience has distinctive importance, mainly concerning the rapid advance of medical technology. Medical conscience will, for these reasons, continue to drive the debate over conscientious objection, even though legal protection should in principle extend to all professions.

Oderberg DS. How Special is medical conscience? New Bioethics. 2019 Sep; 25(3): 207-220, DOI:10.1080/20502877.2019.1651078.

Guest editorial re: conscience in health care

Special edition of The New Bioethics

Mary Neal, Sara Fovargue & Stephen W. Smith

Extract
It is probably fair to say that academic interest in the role of conscience in healthcare (and specifically, in the phenomenon of conscientious objection (CO)) has never been more intense, as evidenced by the volume of articles (and indeed, special issues) devoted to the topic in recent years. The three of us have contributed to this burgeoning literature, writing separately and together.

This special issue of The New Bioethics marks the mid-point of a project devised and co-managed by us and funded by the Royal Society of Edinburgh’s Research Networks scheme: the Accommodating Conscience Research Network (ACoRN). Our aim in developing this multidisciplinary network (including academics from arange of disciplines, practitioners, and representatives of professional bodies) is to carve out intellectual space within which to begin exploring conscience/CO inhealthcare from a broadly supportive perspective. Our sense, as participants in academic debates about conscience, is that although the literature contains many rich insights and fascinating discussions, some of the most interesting questions about conscience are being overshadowed by the loudest and most polarized disagreement over whether there is any legitimate role for CO in healthcare at all. This is despite the fact that it seems to us that most contributors adopt positions that are hospitableto the accommodation of CO, at least to some extent and in some circumstances. . . [Full text]

Neal M, Fovargue S, Smith SW. Guest editorial. The New Bioethics. 2019 Sep;25(3): 203-206, DOI:10.1080/20502877.2019.1659485.