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Euthanasia is not medical treatment

J Donald Boudreau, Margaret A. Somerville

Abstract
Introduction or background
The public assumes that if euthanasia and assisted suicide were to be legalized they would be carried out by physicians.
Sources of data
In furthering critical analysis, we supplement the discourse in the ethics and palliative care literature with that from medical education and evolving jurisprudence.
Areas of agreement
Both proponents and opponents agree that the values of respect for human life and for individuals’ autonomy are relevant to the debate.
Areas of controversy
Advocates of euthanasia and assisted suicide give priority to the right to personal autonomy and avoid discussions of harmful impacts of these practices on medicine, law and society. Opponents give priority to respect for life and identify such harmful effects. These both require euthanasia to remain legally prohibited.
Growing points
Proposals are emerging that if society legalizes euthanasia it should not be mandated to physicians.
Areas timely for developing research
The impact of characterizing euthanasia as ‘medical treatment’ on physicians’ professional identity and on the institutions of medicine and law should be examined in jurisdictions where assisted suicide and euthanasia have been de-criminalized.

Boudreau JD, Somerville MA. Euthanasia is not medical treatment. Br Med Bull. 2013;106(1):45-66.

Institutional conscience and access to services: can we have both?

Cameron Flynn, Robin Fretwell Wilson

American Medical Association Journal of Ethics

Extract
It appears, at times, that health care and religion do not mix. Consider the sterilization and contraception coverage mandate under the Patient Protection and Affordable Care Act. The mandate requires nearly all employers and health insurers to cover as “essential health care services” certain sterilization procedures and contraceptives, including emergency contraceptives. Members of the Catholic, evangelical Christian, Mennonite, and Muslim faith communities say that the mandate places them “in the untenable position of having to choose between violating the law and violating their consciences.”

Flynn C, Wilson RF. Institutional conscience and access to services: can we have both? Virtual Mentor. 2013;15(3):226-235. doi: 10.1001/virtualmentor.2013.15.3.pfor1-1303.

Refusal in “Bartleby, the Scrivener”: Narrative ethics and conscientious objection

Alvan A. Ikoku

Extract
Introduction
In 1853 Herman Melville published “Bartleby, the Scrivener,” his now most well-known piece of short fiction, which over a century and a half later we can certainly read as an illuminating dramatization of conscientious objection [1]. There are, of course, important differences between Melville’s approach to refusal and how we have come to discuss it in medical ethics. The story’s setting, for instance, is not clinical; the central exchanges are between the head of a law office and an employee who politely but insistently refuses to carry out his understood duties.

Ikoku AA. Refusal in “Bartleby, the Scrivener”: Narrative ethics and conscientious objection. Virtual Mentor. 2013;15(3):249-256. doi: 10.1001/virtualmentor.2013.15.3.imhl1-1303.

Conscience, values, and justice in Savulescu

Alvan A. Ikoku

Extract
Introduction
Savulescu’s 2006 article in the British Medical Journal takes up perennially unfinished work on the nature and place of conscience, carried out against the background of contested laws shaped by states and their institutions as well as peoples and their professions. His writing on conscientious objection essentially returns to and intervenes in an extended conversation made possible by continued shifts in relations between individual citizens and loci of authority; shifts that characterized the mid-to-late decades of the twentieth century, when debates about war, civil rights, reproduction, and capital punishment made objection a vital mode of participation and engendered fields of practice and scholarship organized around the mission to decentralize decision making.

Ikoku AA. Conscience, values, and justice in Savulescu. Virtual Mentor. 2013;15(3): doi: 10.1001/virtualmentor.2013.15.3.jdsc1-1303.

Autonomy, conscience, and professional obligation

Robert D. Orr

Extract
Health care professionals have a fiduciary relationship with their patients; i.e., because they have greater knowledge and authority than their patients, they have an obligation to be trustworthy and to serve patients’ best interests. This has been taught since the era of Hippocrates and continues in contemporary medicine, as stated, for example, in the American Medical Association’s Principles of Medical Ethics. . .

Orr RD. Autonomy, conscience, and professional obligation. Virtual Mentor. 2013;15(3):244-248. doi: 10.1001/virtualmentor.2013.15.3.msoc1-1303.

Autonomy, Conscience and Professional Obligation

Robert D Orr

Extract
While I earnestly support the right of conscience, I recognize that some individuals who articulate this stance have made invalid claims. . . .At the other end of the spectrum are those who assert that a physician who is unwilling to provide a legitimate service should no longer be licensed to practice medicine. Such a stance implies that the physician is merely a technician who either has no moral boundaries or is prohibited from exercising them.

Orr RD. Autonomy, Conscience and Professional Obligation. Virtual Mentor. Am Med Ass J Ethics 2013;15(3):244-248.

(Book Review) Conscience and Conviction: The Case for Civil Disobedience

Alon Harel

Kimberley Brownlee. Conscience and Conviction: The Case for Civil Disobedience. Oxford University Press, 2012, 260pp. ISBN 9780199592944

Extract
In her thorough, careful and insightful discussion, Kimberley Brownlee explores the nature of conscience and conscientious convictions and draws important conclusions concerning the justifiable protection of acts of civil disobedience. The first part of her book discusses morality while the second part discusses law. In addition to its rigorous analysis, the book contains lively discussions of real-life examples and hypotheticals designed to illustrate and address all possible objections and establish the centrality of the protection of conscientious convictions and conscience in a liberal society.

Harel A. Book Review: Conscience and Conviction: The Case for Civil Disobedience. Notre Dame Philosophical Reviews, 2013-02-29

Protecting positive claims of conscience for employees of religious institutions threatens religious liberty

Christopher O. Tollefsen

Extract
An important good for doctors, nurses, and other health care professionals could be described as that of “professional freedom.” This is the good of being able to bring one’s professional medical knowledge and one’s commitments to the norms and values of the medical profession to bear on one’s professional judgments and actions. This is, after all, one of the important aspects of being in a profession: professionals are not merely technicians performing the same routine tasks over and over, nor are they functionaries, blindly carrying out orders from above with little or no discretion on their part. . .

Tollefson C. Protecting positive claims of conscience for employees of religious institutions threatens religious liberty. Virtual Mentor. 2013;15(3):236-239. doi: 10.1001/virtualmentor.2013.15.3.pfor2-1303.

Interrupción voluntaria del embarazo y objeción de conciencia en Uruguay

Francisco Cóppola

Abstract
Author Translation
In October 2012 Act 18.987 for the Voluntary Interruption of Pregnancy was passed in Uruguay. This law contemplates the right to conscientious objection, although it lacks conceptual clarity and there was no debate during the discussion of the bill. Thus, declarations by both congressmen and professionals reflect there is confusion regarding such objection. Conscientious objection implies an individual (in this case a health professional) refuses to act in a certain way, which action would be legally enforceable, on account of conscientious issues. Therefore, conscientious objection is an authorization, provided certain requirements and limitations are observed, to refrain from observing a law. This article explores the existence of degrees and nuances within conscientious objection, the importance of distinguishing objectors from pseudo-objectors, whether a previous declaration is necessary or not, its regulatory mechanisms and in particular, the extreme event in which it were necessary to “sacrifice” the freedom of conscience.

Keywords:

Cóppola F. Interrupción voluntaria del embarazo y objeción de conciencia en Uruguay. Revista médica del Uruguay. 2013 Mar;29(1):43-46.

An Examination of Conscience

Mark J Kissler

Extract
The need for protection of conscience within medicine is evidence of precisely this kind of moral fragmentation. Bound by a common profession and motivation to heal, we still can be moral strangers. Physicians seek protection when encountering divisive issues, such as abortion or physician-assisted suicide. The problem is not so much that these disagreements are intractable, but that they embody different (often implicit) conceptions of the ends of medicine. There is a rift at the foundation; and so it is necessary to ask again what medicine is for, what the role of healer is.

Kissler MJ. An Examination of Conscience. Am Med Ass J Ethics (Virtual Mentor). 2013 Mar;15(3):185-187.