A Christian Physician: Combining Conscience, Philanthropia, and Calling

Gregory W. Rutecki, Michael J. Sleasman

Christian Bioethics

Abstract: When physicians today appeal to “conscience,” it has been alleged such exercises pejoratively reflect “conscience without consequence” as contemporary practitioners are said to be insulated from the consequences of such decisions. It has also been implied these physicians avoid traditional professional responsibilities—including providing charity care and making house or night calls. The assertions demand clarification. Fundamentally, what traits constitute an integrated professionalism specific to Christian physicians? Historical evidence verifies sanctity-of-life affirmations by Christian physicians throughout Church history. However, surveying Christian medical practices in the initial centuries of the Common Era, and more recently in the United States, supports integration of conscience with philanthropy and a rigorous definition of a medical vocation. These suggest there may be deterioration in a holistic commitment to medicine in the United States. Reclaiming an integrated professional paradigm—wherein conscience, philanthropia, and vocation are combined—is essential to an authentic contemporary witness.

Sleasman MJ, Rutecki GW.  A Christian Physician: Combining Conscience, Philanthropia, and Calling. Christ Bioeth (2016) 22 (3): 340-362

Implications of Christian Truth Claims for Bioethics

J. Clint Parker

Christian Bioethics

Abstract: Christian bioethics starts with different metaphysical, epistemological, and teleological assumptions. It starts with God as Creator and Sustainer of the universe who as the second person of the Godhead became incarnate as our Redeemer and Lord. Morality reflects God’s nature and is known through reason and intuition guided by revelation. The end of a Christian bioethics is to discover the way our God intends for us to live and to discover the type of person He intends for us to be in order to live a holy and sanctified life. Christian bioethicists will seek integration among their core beliefs and between their beliefs and actions, and they will bear witness to their beliefs in a world that is not yet redeemed. Each contribution in this issue represents an example of these types of Christian integration. Each bears witness to the fact that a Christian bioethics is different.

Parker C.  Implications of Christian Truth Claims for Bioethics. Christ Bioeth (2016) 22 (3): 265-275 doi:10.1093/cb/cbw013

Why Are Religious Reasons Dismissed? Euthanasia, Basic Goods, and Gratuitous Evil

Stephen Napier

Christian Bioethics

Abstract:  Many proponents of euthanasia eschew appeals to religious premises as good reasons for thinking that human life has intrinsic worth. The reasons offered are that religious reasons do not meet some theory-neutral epistemic standard. My first argument is to show that pro-euthanasia arguments fail to meet those same standards. In order to avoid this incoherence, the rejection of religious reasons is a function of thinking that such reasons are simply false. Arguing against religious belief has typically fallen to the evidential argument from evil. My second argument is to show that the argument from evil must hold to a basic goods account of human life. Such an account is contrary to the view of human life held by most euthanasia proponents. So, euthanasia proponents who reject religious belief on the basis of an argument from evil must hold to a contradictory view of human worth. One cannot both be a euthanasia proponent and reject arguments against euthanasia (that are based in part on religious premises). I explore ways to resolve this tension, but none save pro-euthanasia arguments.

Napier S.  Why Are Religious Reasons Dismissed? Euthanasia, Basic Goods, and Gratuitous Evil. Christ Bioeth (2016) 22 (3): 276-300 doi:10.1093/cb/cbw012

Medical Assistance in Dying in Canada: An Ethical Analysis of Conscientious and Religious Objections

Dylan Dahlgren, Fred Koning, John Sloan, Timothy Christie

Bioethique Online

Abstract

Background: The Supreme Court of Canada (SCC) has ruled that the federal government is required to remove the provisions of the Criminal Code of Canada that prohibit medical assistance in dying (MAID). The SCC has stipulated that individual physicians will not be required to provide MAID should they have a religious or conscientious objection. Therefore, the pending legislative response will have to balance the rights of the patients with the rights of physicians, other health care professionals, and objecting institutions.

Objective: The objective of this paper is to critically assess, within the Canadian context, the moral probity of individual or institutional objections to MAID that are for either religious or conscientious reasons.

Methods: Deontological ethics and the Doctrine of Double Effect.

Results: The religious or conscientious objector has conflicting duties, i.e., a duty to respect the “right to life” (section 7 of the Charter) and a duty to respect the tenets of his or her religious or conscientious beliefs (protected by section 2 of the Charter).

Conclusion: The discussion of religious or conscientious objections to MAID has not explicitly considered the competing duties of the conscientious objector. It has focussed on the fact that a conscientious objection exists and has ignored the normative question of whether the duty to respect one’s conscience or religion supersedes the duty to respect the patient’s right to life.

Christie T, Sloan J, Dahlgren D, Konging F.  Medical Assistance in Dying in Canada: An Ethical Analysis of Conscientious and Religious Objections.  BioéthiqueOnLine, 2016, 5/14

Referrals for Services Prohibited In Catholic Health Care Facilities

Debra B. Stulberg, Rebecca A. Jackson, Lori R. Freedman

Perspectives on Sexual and Reproductive Health

Abstract | Context: Catholic hospitals control a growing share of health care in the United States and prohibit many common reproductive services, including ones related to sterilization, contraception, abortion and fertility. Professional ethics guidelines recommend that clinicians who deny patients reproductive services for moral or religious reasons provide a timely referral to prevent patient harm. Referral practices in Catholic hospitals, however, have not been explored.

Methods: Twenty-seven obstetrician-gynecologists who were currently working or had worked in Catholic facilities participated in semistructured interviews in 2011–2012. Interviews explored their experiences with and perspectives on referral practices at Catholic hospitals. The sample was religiously and geographically diverse. Referral-related themes were identified in interview transcripts using qualitative analysis.

 Results: Obstetrician-gynecologists reported a range of practices and attitudes in regard to referrals for prohibited services. In some Catholic hospitals, physicians reported that administrators and ethicists encouraged or tolerated the provision of referrals. In others, hospital authorities actively discouraged referrals, or physicians kept referrals hidden. Patients in need of referrals for abortion were given less support than those seeking referrals for other prohibited services. Physicians received mixed messages when hospital leaders wished to retain services for financial reasons, rather than have staff refer patients elsewhere. Respondents felt referrals were not always sufficient to meet the needs of low-income patients or those with urgent medical conditions.

 Conclusions: Some Catholic hospitals make it difficult for obstetrician-gynecologists to provide referrals for comprehensive reproductive services.

Stulberg DB, Jackson  RA, Freedman LR.  Referrals for Services Prohibited In Catholic Health Care Facilities. Perspect Sex Repro H, 48:111–117. doi:10.1363/48e10216

The Limits of Conscientious and Religious Objection to Physician-Assisted Dying after the Supreme Court’s Decision in Carter v. Canada

Amir Attaran

The Limits of Conscientious and Religious Objection to Physician-Assisted Dying after the Supreme Court’s Decision in Carter v. Canada

In February 2015, the Supreme Court of Canada unanimously ruled in Carter v. Canada (Attorney General) that the Canadian Charter of Rights
and Freedoms (the “Charter”) protects the right of every competent, consenting adult suffering from a grievous and irremediable medical condition to
choose death, assisted by a physician.1 The Court’s decision to quash the sections of the Criminal Code that criminalize physician-assisted dying is in
abeyance until June 2016.2

Trouble is, not many physicians seem willing to assist. In a survey of its members, the Canadian Medical Association found that, at best, only 29 per
cent would consider a patient’s request for medical aid in dying, while a staggering 63 per cent would refuse outright (and even more say they would refuse
if the patient were not terminally ill).3 Further, among that majority of doctors who would refuse, most also believe that the system should require
them to do nothing to help patients die—not even refer the patient to a more willing doctor.4 No doubt there are fissures within the profession — family doctors appear to be more willing to assist dying, and Christian doctors less willing — but overall, it is clear that a majority of Canadian doctors
polled refuse to participate in physician assisted dying.5

. . . This article argues that whether doctors do or do not have the right to refuse to treat patients on conscientious or religious grounds is neither a difficult nor a novel legal issue. Patients and doctors have clashed on this issue before, and when they have, tribunals and courts have overwhelmingly sided
with the patients over the doctors. . .

. . .Equality law therefore greatly limits, but does not wholly abolish, the ability of doctors to opt out of giving medical services. For example, while
a doctor clearly would be justified to opt out of physician-assisted dying if he or she lacks the clinical skills to administer it safely—equality law does
not override the standard of care and fiduciary duty owed to the patient—it is extremely doubtful that a suitably skilled doctor could opt out just because of his or her conscientious or religious objection to assisting death, and that is because doing so would discriminate against the patient.


Attaran A. The Limits of Conscientious and Religious Objectionto Physician-Assisted Dying after the Supreme Court’s Decision in Carter v. Canada. Health Law Can. 2016 Feb;36(3):86-98.

Book Review: Moral Conscience Through the Ages: Fifth Century BCE to the Present

THE (Times Higher Education)
Reproduced with permission

Tom Palaima

Moral Conscience Through the Ages

Richard Sorabji, Oxford University Press, 240pp, £20.00
ISBN 9780199685547. Published 30 October 2014

Always let your conscience be your guide,” sings Jiminy Cricket, conscience personified as a kindly bowler-hatted cricket, to Pinocchio in Walt Disney’s 1940 film classic about a wooden puppet being transformed into a real-life boy. It is one of the few significant social pronouncements about the role of conscience in making us human not found in Richard Sorabji’s compact history of the ideas that important thinkers and doers, beginning with Euripides and Plato and ending with Martin Luther, Thomas Hobbes, Henry David Thoreau, Leo Tolstoy, Friedrich Nietzsche, Sigmund Freud and Mahatma Gandhi, have had about how a conscience works, where it comes from, and what good it is, if any – Nietzsche had no use for conscience, believing that modern men “inherit thousands of years of the vivisection of conscience”.

Sorabji’s close reading of subtle arguments spanning 25 centuries, as he transliterates key Greek and Latin terms and does his best to define their particular meanings in different periods, enables us to see how later figures took up or rejected earlier ideas. Gandhi, for example, came to believe unshakeably in his “still small voice within” – no Jiminy Cricket for him – as “the true voice of God”, as it steeled his commitment to non-violent social actions. Gandhi’s voice of God, we learn, sounded a lot like Tolstoy in his 1894 treatise The Kingdom of God is Within You and Socrates in Plato’s Apology, set in 399BC.

The Greek word for conscience first appears in passages in the work of late 5th-century playwrights where characters wrestle with what we would call moral choices, or defects in Sorabji’s view. The Greek compound verbal formation expresses the notion of a shared knowing (sun: “with” and oida: “know”, literally “I saw and I still see”), Latin con-sciens. The precise meaning of conscience is further complicated by the abstract nouns used for it that are derived from other verbal roots, eg, sunesis and the Latinised sunderesis. The notion of with-ness is the common element.

The key question is: shared with whom? In Sorabji’s view – surprisingly given the role that conscience plays in our interactions with others – we share our thoughts about moral behaviour and moral choices with ourselves. Conscience splits us into two people. From this come expressions like “I could not live with myself” and feelings of having a voice within or a cricket or guardian angel advising from without, as in Freud’s superego or Socrates’ daimōn.

Sorabji also argues that the original concept of conscience, ie, “sharing knowledge with oneself of a defect”, was a largely secular idea. Stoics and Christians turned conscience into a religious concept associated with the law or will of gods or God. Michel de Montaigne, Hobbes and John Locke began a resecularisation process that continued through Thoreau’s civil disobedience and then on to conscientious objection to armed service during the First World War.

But what does a largely secular idea in ancient Greek look like in context? Sorabji gives few original source passages at any length. Conscience appears as a daimōn in Plato’s Apology and arguably also in Euripides’ Orestes, where grief is called a terrible goddess in a kind of chiasmus. So how the Greeks viewed daimones becomes relevant to whether conscience ab origine is secular or religious or something in between. And Hesiod’s thoughts two centuries earlier in Works and Days about daimones as immortal and beneficent guardians of justice should be relevant, too.


Tom Palaima is professor of Classics, University of Texas at Austin.

When Religious Freedom Clashes with Access to Care

I. Glenn Cohen, Holly Fernandez Lynch, Gregory D. Curfman

NEJM

At the tail end of this year’s Supreme Court term, religious freedom came into sharp conflict with the government’s interest in providing affordable access to health care. In a consolidated opinion in Burwell v. Hobby Lobby Stores and Conestoga Wood Specialties Corp. v. Burwell (collectively known as Hobby Lobby) delivered on June 30, the Court sided with religious freedom, highlighting the limitations of our employment-based health insurance system.

Hobby Lobby centered on the contraceptives-coverage mandate, which derived from the Affordable Care Act (ACA) mandate that many employers offer insurance coverage of certain “essential” health benefits, including coverage of “preventive” services without patient copayments or deductibles. The ACA authorized the Department of Health and Human Services (HHS) to define the scope of those preventive services, a task it delegated to the Institute of Medicine, whose list included all 20 contraceptive agents approved by the Food and Drug Administration. HHS articulated various justifications for the resulting mandate, including the fact that many Americans have difficulty affording contraceptives despite their widespread use and the goal of avoiding a disproportionate financial burden on women. Under the regulation, churches are exempt from covering contraception for their employees, and nonprofit religious organizations may apply for an “accommodation,” which shifts to their insurance companies (or other third parties) the responsibility for providing free access. However, HHS made no exception for for-profit, secular businesses with religious owners. . .


Cohen IG, Lynch HF, Curfman GD. When Religious Freedom Clashes with Access to Care. N Engl J Med 2014; 371:596-599 August 14, 2014 DOI: 10.1056/NEJMp1407965

Why religion deserves a place in secular medicine

Nigel Biggar

Journal of Medical Ethics

Abstract:

As a science and practice transcending metaphysical and ethical disagreements, ‘secular’ medicine should not exist. ‘Secularity’ should be understood in an Augustinian sense, not a secularist one: not as a space that is universally rational because it is religion-free, but as a forum for the negotiation of rival reasonings. Religion deserves a place here, because it is not simply or uniquely irrational. However, in assuming his rightful place, the religious believer commits himself to eschewing sheer appeals to religious authorities, and to adopting reasonable means of persuasion. This can come quite naturally. For example, Christianity (theo)logically obliges liberal manners in negotiating ethical controversies in medicine. It also offers reasoned views of human being and ethics that bear upon medicine and are not universally held – for example, a humanist view of human dignity, the bounding of individual autonomy by social obligation, and a special concern for the weak.


Biggar N. Why religion deserves a place in secular medicine. J Med Ethics, 41: 229-233

In Defense of Religious Bioethics

Judah Goldberg, Alan Jotkowitz

The American Journal of Bioethics

In the first year of a celebrated graduate program in bioethics, one of us wrote a short essay about physician-assisted suicide that claimed that murder is not only a breach of rights, but also a “grave affront to all human existence as well as to He who grants life.”  Well, that last part earned me a predictable scribble on the margins of my returned paper, something to the effect of, “What if someone does not believe in a Giver of life?”


Goldberg J, Jotkowitz A. In Defense of Religious Bioethics. American Journal of Bioethics, December, Vol. 12, No. 12, 2012