0 - Page 2 of 4 - Protection of Conscience Project Library

Moral Disengagement-Mechanisms Propelling the Euthanasia/PAS Movement

Fabian Stahle

Abstract
The international movement that promotes the legalisation of euthanasia/physician-assisted suicide (PAS) is propelled by highly potent psychological mechanisms to overcome the resistance to its agenda. It is all about cognitive restructuring to justify inhumane actions. These are always in use when normal, well-socialised persons are coerced into accepting and participating in the killing of fellow human beings. Various scientific studies, pioneered by Albert Bandura, have shown that participators are able to endure their deeds by activating these powerful mechanisms of moral disengagement. However, those who make use of such mechanisms pay a high price. These mechanisms have a personality-changing power that dehumanizes the perpetrators. For the society that has allowed itself to be manipulated by such mechanisms for the purpose of systematizing “death on demand”, there are also serious consequences. These consequences can be described in terms of dehumanization and brutalization of that society as a whole.

Stahle F. Moral Disengagement-Mechanisms Propelling the Euthanasia/PAS Movement. J Ethics Ment Health. 2017;10 (1-15)

The Conscience of the Pharmacist

John J Conley

Proceedings of the Sixteenth University Faculty for Life Conference — Proceedings of the University Faculty for Life

Abstract
Recent legal efforts to force pharmacists to distribute potentially abortifacient drugs constitute a violation of conscience. This campaign of coercion violates religious freedom, professional deontology, and the right to refuse even material cooperation in acts of grave evil.

Conley JJ. The Conscience of the Pharmacist. In: Koterski JW editors. Proceedings of the UFL Life and Learning Conference XVII. 2007;431-437.

The history of autonomy in medicine from antiquity to principlism

Toni C Saad

Abstract
Respect for Autonomy (RFA) has been a mainstay of medical ethics since its enshrinement as one of the four principles of biomedical ethics by Beauchamp and Childress’ in the late 1970s. This paper traces the development of this modern concept from Antiquity to the present day, paying attention to its Enlightenment origins in Kant and Rousseau. The rapid C20th developments of bioethics and RFA are then considered in the context of the post-war period and American socio-political thought. The validity and utility of the RFA are discussed in light of this philosophical-historical account. It is concluded that it is not necessary to embrace an ethic of autonomy in order to guard patients from coercion or paternalism, and that, on the contrary, the dominance of autonomy threatens to undermine those very things which have helped doctors come to view and respect their patients as persons.

Saad TC. The history of autonomy in medicine from antiquity to principlism. Med Health Care Phil. 2018;21(1):125-137.

Medical Assistance in Dying — Implementing a Hospital-Based Program in Canada

Madeline Li, Sarah Watt, Marnie Escaf, Michael Gardam, Ann Heesters, Gerald O’Leary, and Gary Rodin

New England Journal of Medicine, NEJM — New England Journal of Medicine

Extract
After Canada legalized medical assistance in dying (MAiD), the University Health Network in Toronto implemented a hospital-based MAiD program. UHN offers a framework for assessing patients for and providing MAiD while respecting the rights of patients and staff.

Li M, Watt S, Escaf M, Gardam M, Heesters A, O’Leary G, M.B., Rodin G. Medical Assistance in Dying — Implementing a Hospital-Based Program in Canada. N Engl J Med 2017; 376:2082-2088 May 25, 2017 DOI: 10.1056/NEJMms1700606

Mistakes and missed opportunities regarding cosmetic surgery and conscientious objection

Toni C Saad

Abstract
In her paper Cosmetic surgery and conscientious objection’, Minerva rightly identifies cosmetic surgery as an interesting test case for the question of conscientious objection in medicine. Her treatment of this important subject, however, seems problematic. It is argued that Minerva’s suggestion that a doctor has a prima facie duty to satisfy patient preferences even against his better clinical judgment, which we call Patient Preference Absolutism, must be regarded with scepticism. This is because (1) it overlooks an important distinction regarding autonomy’s meaning and place in clinical practice, and (2) it makes obsolete the important concepts of expert clinical judgment and beneficence. Finally, we discuss two ideas which emerge from consideration of cosmetic surgery in relation to conscientious objection. These are the possible analogy between clinical judgment and conscientious objection, and the possible role the goals of medicine can play in defining the scope of conscientious objection.

Saad TC. Mistakes and missed opportunities regarding cosmetic surgery and conscientious objection. J Med Ethics. 2018;44(9):649-650.

Professional and conscience-based refusals: the case of the psychiatrist’s harmful prescription

Morten Magelssen

Abstract
By way of a case story, two common presuppositions in the academic debate on conscientious objection in healthcare are challenged. First, the debate typically presupposes a sharp division between conscience-based refusals based on personal core moral beliefs and refusals based on professional (eg, medical) reasons. Only the former might involve the moral gravity to warrant accommodation. The case story challenges this division, and it is argued that just as much might sometimes be at stake morally in refusals based on professional reasons. The objector’s moral integrity might be equally threatened in objections based on professional reasons as in objections based on personal beliefs. Second, the literature on conscientious objection typically presupposes that conflicts of conscience pertain to well-circumscribed and typical situations which can be identified as controversial without attention to individualising features of the concrete situation. However, the case shows that conflicts of conscience can sometimes be more particular, born from concrete features of the actual situation, and difficult, if not impossible, to predict before they arise. Guidelines should be updated to address such ‘situation-based’ conscientious refusals explicitly.

Magelssen M. Professional and conscience-based refusals: the case of the psychiatrist’s harmful prescription. Journal of Medical Ethics Published Online First: 24 April 2017. doi: 10.1136/medethics-2017-104162

Reasons, reasonability and establishing conscientious objector status in medicine

Robert F Card

Abstract
This paper builds upon previous work in which I argue that we should assess a provider’s reasons for his or her objection before granting a conscientious exemption. For instance, if the medical professional’s reasoned basis involves an empirical mistake, an accommodation is not warranted. This article poses and begins to address several deep questions about the workings of what I call a reason-giving view: What standard should we use to assess reasons? What policy should we adopt in order to evaluate the reasons offered by medical practitioners in support of their objections? I argue for a reasonability standard to perform the essential function of assessing reasons, and I offer considerations in support of a policy establishing conscientious objector status in medicine.

Card RF. Reasons, reasonability and establishing conscientious objector status in medicine. J Med Ethics 2017 Apr;43(4):222-225. doi: 10.1136/medethics-2016-103792

Physicians, Not Conscripts — Conscientious Objection in Health Care

Ronit Y. Stahl, Ezekiel J. Emanuel

Journal Summary
Conscientious objection laws give health care professionals the legal right to refuse, on the basis of personal beliefs, to perform certain procedures or care for particular patients. The authors argue that professional societies should declare conscientious objection unethical.

Stahl RY, Emanuel EJ. Physicians, Not Conscripts – Conscientious Objection in Health Care. N Engl J Med 2017; 376:1380-1385 April 6, 2017 DOI: 10.1056/NEJMsb1612472

Abortion decriminalisation and statutory rights of conscience

Mary Neal

Extract
On 13 March 2017, the House of Commons voted by 172 to 142 in favour of a second reading for the Reproductive Health (Access to Terminations) Bill. The bill, introduced by Diana Johnson MP, would decriminalise abortion until the end of the 24th week of pregnancy, meaning that abortion could be performed until the end of the 24th week of pregnancy without the need to satisfy any statutory grounds, or to obtain two doctors’ authorisation. Many campaigners see this bill as a first step toward the longer-term goal of fully decriminalising abortion. [1]

The prospect of decriminalisation raises a number of interesting and important issues, including an issue which has been neglected in the debates over decriminalisation so far, namely what any change in the law might mean for the right of health professionals to withdraw from participation in abortion on grounds of conscience, under section 4 of the Abortion Act 1967. . . .

Neal M. Abortion decriminalisation and statutory rights of conscience. the bmjopinion [Internet]. 2017 Mar 24.

Aid-in-dying laws and the physician’s duty to inform

Mara Buchbinder

Abstract
On 19 July 2016, three medical organisations filed a federal lawsuit against representatives from several Vermont agencies over the Patient Choice and Control at End of Life Act. The law is similar to aid-in-dying (AID) laws in four other US states, but the lawsuit hinges on a distinctive aspect of Vermont’s law pertaining to patients’ rights to information. The lawsuit raises questions about whether, and under what circumstances, there is an ethical obligation to inform terminally ill patients about AID as an end-of-life option. Much of the literature on clinical communication about AID addresses how physicians should respond to patient requests for assisted dying, but neglects the question of how physicians should approach patients who may not know enough about AID to request it. In this article, I examine the possibility of an affirmative duty to inform terminally ill patients about AID in light of ethical concerns about professional responsibilities to patients and the maintenance of the patient–provider relationship. I suggest that we should not take for granted that communication about AID ought to be patient-initiated, and that there may be circumstances in which physicians have good reasons to introduce the topic themselves. By identifying ethical considerations that ought to inform such discussions, I aim to set an agenda for future bioethical research that adopts a broader perspective on clinical communication about AID.

Buchbinder M. Aid-in-dying laws and the physician’s duty to inform. J Med Ethics. 2016;43(10):1-4.