Protection of Conscience Project Library
Service, not Servitude
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Savulescu’s account of conscientious objection in medicine is a bold statement that requires all obstetricians to perform abortions, regardless of any moral convictions that they may have to the contrary. Unfortunately, he violates the standards of argument based ethics.
Chervenak FA, McCullough LB. (Correspondence) Conscientious Objection in Medicine: Author did not meet standards of argument based ethics. Br Med J. 2006 Feb 18;332(7538):425.
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Since visiting Auschwitz, I have grappled with the question of how I would have behaved as a doctor in Nazi Germany or Stalinist Russia. I hope I would have had the moral courage to refuse to participate in the various perversions of medicine that these regimes demanded — for example, respectively, eugenic “research” and psychiatric “treatment” of dissidents. . . . My chances of behaving honourably would have been
greatest if I had felt part of an independent medical profession with allegiance to something higher and more enduring than the regime of the day. They would have been least if Savulescu’s opinions had prevailed . . .After 30 years of reading the BMJ, Sava-
lescu’s article was the first one to make me feel physically sick.
Smith VP. (Correspondence) Conscientious objection in medicine: Doctors’ freedom of conscience. Br Med J. 2006 Feb 18;332(425)
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We question Savulescu’s statement that a specialist valuing her own life more than her duty to her patients during a bird flu epidemic would be demonstrating values “incompatible with being a doctor.” . . . recklessly to treat a highly contagious individual without taking adequate precautions would be imprudent and irresponsible. Equity and fairness requires a professional to judiciously balance the needs of one patient with the needs of others, including those of his or her own family.
Murray E, de_Zulueta P. Conscientious objection in medicine: the ethics of responding to bird flu. Br Med J. 2006;332(7538):425.
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I was intrigued by her argument that an “autonomous” medical decision can sometimes involve simple deference to medical authority, but I’m still unclear what she means when she says that such decisions can be construed as conscientiously autonomous if derived from a patient’s “self trust.” This seems precisely the paradox at the heart of debates over the existence of free will, or in Kukla’s rubric, autonomous choice: is there a “space” outside of social life constituting individual desires where choices derive from what one “really” wants?
Browner C. (Correspondence) Conscientious Autonomy: What Patients Do vs. What Is Done to Them. Hastings Cent Rep. 2005; September-October:4-5.
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With regard to Dr. Lee’s comment that the proposed Wisconsin legislation does not eliminate a health care provider’s duty to provide a referral after refusing to perform a service, I would note that Assembly Bill 207 . . . specifically permits health care providers’ refusals to “participate in” services they find personally objectionable, with “participate in” specifically defined . . . as “to perform; practice; engage in; assist in; recommend; counsel in favor of; make referrals for; prescribe, dispense or administer drugs”.
Charo RA. (Correspondence) The Celestial Fire of Conscience: Prof. Charo Replies. N Engl J Med. 2005 Sep 22;353(12):1302.
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Real medical care and services always respect human
life. No one should be forced to collaborate in abortion (even when it is achieved through the prevention of implantation), lethal research on embryos, euthanasia, or assisted suicide.
Castro O, Lombardo FA, Gordeuk VR. (Correspondence) The Celestial Fire of Conscience. N Engl J Med. 2005 Sep 22;353(12):1301.
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To bring out what I see as the most plausible interpretation of Kukla’s article, I recast her main point as follows (though I am not optimistic that she would accept this restatement): The received view in bioethics is commonly interpreted so that autonomy occurs exclusively through discrete informed consents to medical procedures. However, this vision of autonomy is too narrow. Autonomy is also expressed through stable, enduring, and committed acceptance of medical practices. Kukla rightly points out that this account must be rounded by a rich understanding of medical practices together with a model of the virtue of conscientiousness in upholding the practices, principles, regimes, and values adopted.
Beauchamp TL. (Correspondence) Conscientious Autonomy: What Patients Do vs. What Is Done to Them. Hastings Cent. Rep.. 2005;September-October):5-6.
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L.L. deVeber and Ian Gentles imply that termination of pregnancy causes psychological problems. However, pre-existing differences between women who seek abortion and those who carry pregnancies to term are considerable and may account for differences in psychological status after abortion or delivery. A relevant comparison would assess psychological distress experienced by women seeking and obtaining an abortion and those seeking but denied pregnancy termination. . . The research cited by deVeber and Gentles, however, fails to meet this standard. . . . There is no causal evidence that abortion alone elevates the risk of psychiatric admission. Observational evidence of such an association may be readily interpreted as resulting from confounding pre-existing factors.
Singh SS, Fisher WA. (Corrrespondence) Psychological aftermath of abortion (Two of the authors respond). Can Med Assoc J. 2005 Aug 30;173(5):467.
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I cannot understand how Dr. Ursus can claim to have a “middle-of-the- road” position on abortion . . . however, by performing these procedures or referring patients for them, he’s chosen against his smaller, defenceless patients. He is on that side of the road.
Stephens DS. (Correspondence) Not a middle-of-the-road position. Can Med Assoc J. 2005 Feb 1;172(3):312.
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The Hippocratic Oath states: “I will use treatment to help the sick according to my ability and judgment, but never with a view to injury and wrongdoing.” It is our responsibility to make these words a reality.
Sofair AN, Lurie PG. (Correspondence) Military medicine and human rights. The Lancet. 2004 Nov 20;364(1851.