Professionalism Archives - Page 9 of 11 - Protection of Conscience Project Library

There Is No Moral Authority in Medicine: Response to Cowdin and Tuohey

John F Crosby

Abstract
Central to the Cowdin-Tuohey paper is the concept of a moral authority proper to medical practitioners. Much as I agree with the authors in refusing to degrade doctors to the status of mere technicians, I argue that one does not succeed in retrieving the moral dimension of medical practice by investing doctors with moral authority. I show that none of the cases brought forth by Cowdin-Tuohey really amounts to a case of moral authority. Then I try to explain why no such cases can be found. Developing an insight that is common to all the major moral thinkers in the philosophia perennis, I show that doctors are professionally competent with respect only to a part of the human good; morally wise persons are competent with respect to that which makes man good as man. I try to show why it follows that a) professional expertise has no natural tendency to pass over into moral understanding, and that b) doctor and non-doctor alike start from the same point in developing their understanding of medical morality. It follows that the authors fail in their attempt to de-center the moral magisterium of the Church by setting up centers of moral authority outside of the Church.

Crosby JF. There Is No Moral Authority in Medicine: Response to Cowdin and Tuohey. Christ Bioet. 1998 Jan 01;4(1):63-82.

Professional Versus Moral Duty: Accepting Appointments in Unjust Civil Cases

Teresa Stanton Collett

Extract
Conclusion
Tennessee Formal Ethics Opinion 96-F-140 attempts to disconnect morality from the lawyer’s work. The Board’s disregard of the lawyer’s moral and religious objections to accepting the appointment suggests either a hostility to the particular religious beliefs asserted by the inquiring lawyer or a willingness to demand lawyers accept being treated as mere means to clients’ and courts’ ends. Hostility to religious beliefs is deeply troubling when exhibited by those who are charged with providing lawyers’ guidance in discerning their professional obligations, but the second possible interpretation of the opinion is equally chilling. To the extent that the Board’s opinion represents the members’ considered judgment that lawyers are obligated to act as amoral facilitators of any action not proscribed by positive law, the power of the state is dramatically enlarged and the power of the individual and other social institutions dangerously diminished. This result cannot be tolerated under the terms of the First Amendment, nor can it be reconciled with the lawyer’s basic human rights.

Collett TS. Professional Versus Moral Duty: Accepting Appointments in Unjust Civil Cases. Wake Forest Law Review. 1997;32: 635-670.

Freedom of conscience, professional responsibility, and access to abortion

Rebecca S. Dresser

Extract
Access to abortion is becoming increasingly restricted for many women in the United States. Besides the longstanding financial barriers facing low-income women in most states, a newer source of scar city has emerged. The relatively small number of physicians willing to perform the procedure is compromising the ability of women in certain parts of the country to obtain an abortion. Do physicians have a duty to respond to this situation? Do they have a professional responsibility to ensure that abortions are reasonably available to the women who want to terminate their pregnancies? Or, is abortion so morally and socially controversial as to remove any professional obligation to provide reasonable access?

Dresser RS. Freedom of conscience, professional responsibility, and access to abortion. J Law Med Ethics 1994 Fall;22(3):280-5.

A Clash at the Bedside: Patient Autonomy v. A Physician’s Professional Conscience

Judith F Daar

Extract
Conclusion
The plight of Helga Wanglie . . . focused attention on the issue of physician autonomy in the context of patient decision making. That case challenged the court, as well as our society, to consider whether a physician has an obligation to provide medical treatment he or she believes is inappropriate. . .The concept of a physician’s professional conscience will become increasingly relevant as the cost of health care rises to the point where our demands for care greatly outweigh our ability to pay for such care . . . to downplay the role a physician’s professional conscience plays in medical decision making, as both courts and policy makers traditionally have done, does not advance patient autonomy; instead, it causes doctors to be more conservative and withholding in the range of options they offer their patients. If patient autonomy is to have meaning, recognition must also be given to a physician’s moral autonomy. This Article suggests that when patients clash with their physicians over treatment choices, the principle of patient autonomy does not automatically require that the physician be forced to comply.

Daar JF. A Clash at the Bedside: Patient Autonomy v. A Physician’s Professional Conscience. Hastings Law J. 1993 Aug;44(6):1241-1289.

(Correspondence) Abortion debate continues

Linda Spano, Michael Brennan

Canadian Medical Association Journal, CMAJ — Canadian Medical Association Journal

Extract
. . . we all – including Reynolds – operate from a biased set of basic assumptions. Is it really antireligious to suggest that the antiabortion forces are largely motivated by fundamental religious views that represent fixed basic assumptions? We think not. . . . Medical intervention includes helping people achieve their potential according to their own objectives as well as many other “appropriate” activities, such as the therapeutic termination of pregnancy. . . .The abortion debate is not entirely about abortion or religion, nor is it even a debate. . . the argument is about the freedom of choice and the access of all Canadian women to safe, competent medical care and about the refusal of most Canadians to submit to the irrational demands of a vociferous minority. . .

Spano L, Brennan M. (Correspondence) Abortion debate continues. Can Med Assoc J. 1993 Jun 15;148(12):2112-2113.

Female circumcision: When medical ethics confronts cultural values

Eike-Henner Kluge

Extract
Canadian physicians cannot consistently accept the principle of respect for people in the name of medical ethics, and then perform procedures they know to be medically inappropriate, harmful and demeaning only because they do not want to offend a misplaced cultural sensitivity.

Kluge E-H. Female circumcision: When medical ethics confronts cultural values. Can Med Assoc J. 1993 Jan 15;148(2):288-289.

Abortion: the issue the CMA has refused to address is life

David Knickle

Extract
The CMA’s new statement shifts the balance very heavily away from the sanctity of human life and places more emphasis on these pregnancy-related problems. Surely this is contrary to our traditional medical ethic of protecting life and curing disease. . .

The issue for our profession should be this: What is medically acceptable? We must set our standards of ethical practice. Surely we are capable of defining what is therapeutic and what is non- therapeutic in life-and-death situations. The issue here is not whether we are pro-choice or pro-life, or for or against abortion on demand. The issue is simply whether we will hold to our traditional medical ethic of protecting life and treating disease.

Knickle D. Abortion: the issue the CMA has refused to address is life. Can Med Assoc J. 1988 Nov 15;139(10):990.

Professions as the conscience of society

Paul Sieghart

Abstract
Ethics is no less of a science than any other. It has its roots in conflicts of interest between human beings, and in their conflicting urges to behave either selfishly or altruistically. Resolving such conflicts leads to the specification of rules of conduct, often expressed in terms of rights and duties. In the special case of professional ethics, the paramount rule of conduct is altruism in the service of a ‘noble’ cause, and this distinguishes true professions from other trades or occupations. If professional ethics come into conflict with national laws, the professional today can test the legitimacy of such laws by reference to internationally agreed legal standards in the field of human rights, and so help to perform the role of ‘professions as the conscience of society’.

Sieghart P. Professions as the conscience of society. J Med Ethics. 1985 Sep;11(3):117-122.

(Publisher’s Page) Physicians as civil servants

David Woods

Extract
The Canadian Medical Association’s position paper on the Hall report is unequivocal about this: proposed restrictions on the patient’s right to retain the advice and services of a physician of his or her choice would help to transform the MD from an independent provider of health care into, in effect, “a government-retained dependent contractor – a de facto civil servant”.

But Dr. Augustin Roy, president of the Corporation of Physicians and Surgeons of Quebec, sees things quite differently. Just because Hall wants to do away with extra billing, says Roy, doesn’t necessarily mean that if he gets his way doctors will become state employees. “That is only true if you have defined work hours and someone to report to.”

Yet surely the point is that the more the medical profession’s freedoms are removed, the more governments pick them up. As CMA President Dr. Bill Thomas has observed, the control of health care, the number of doctors produced in Canada, the number allowed to immigrate here, and the qualifications and education required to obtain a licence to practise medicine are all controlled by government now. . . The question isn’t whether Canada’s physicians will become de facto civil servants, but how they can withstand government’s constant chipping away at professional freedom, which will eventually give MDs no control over their collective destiny.

Woods D. Physicians as civil servants. Can Med Assoc J. 1980 Nov 22;123(10):959.

Doctors, torture and abuse of the doctor-patient relationship

Earl M Cooperman

Extract
The doctor-patient relationship is threatened. Once this association implied only one thing: the doctor above all must protect the patient. . . .

. . . it is not inconceivable that, as Canada moves towards socialized medicine and state control of all health facilities, we, too, may sacrifice the privacy of the doctor- patient relationship that we all once regarded as sacred.

. . . There is much concern regarding the
involvement of medical personnel in the use of torture for political purposes. . .

. . . When the Dutch medical community refused to cooperate with the Nazi medical organization, 100 Dutch physicians were sent to concentration camps. Other Dutch physicians did not give in; they took care of the widows and orphans of their colleagues. They did not participate in any Nazi activity; they acted unanimously.

. . . Recently physicians in Portugal studied “the scientific effects” of torture; they examined persons before, during and after torture sessions and evaluated their ability to undergo further torture.

. . .We must therefore each ask what is our duty to our state and what to our profession and to our own sense of moral justice. To what extent might we unwittingly become agents of repression? . . . Physicians in Russia condone beatings; if the prisoner dies the physician complies with government policy and eliminates possible repression by signing the death certificate “cirrhosis of the liver.. or “coronary occlusion.”. . .

Cooperman EM. Doctors, torture and abuse of the doctor-patient relationship. Can Med Assoc J. 1977 Apr 09;116(7):707, 709-710.