neutrality Archives - Protection of Conscience Project Library

Physician-Assisted Suicide: Why Neutrality by Organized Medicine Is Neither Neutral Nor Appropriate

Daniel P. Sulmasy, Ilora Finlay, Faith Fitzgerald, Kathleen Foley, Richard Payne, Mark Siegler

Abstract
It has been proposed that medical organizations adopt neutrality with respect to physician-assisted suicide (PAS), given that the practice is legal in some jurisdictions and that membership is divided. We review developments in end-of-life care and the role of medical organizations with respect to the legalization of PAS since the 1990s. We argue that moving from opposition to neutrality is not ethically neutral, but a substantive shift from prohibited to optional. We argue that medical organizations already oppose many practices that are legal in many jurisdictions, and that unanimity among membership has not been required for any other clinical or ethical policy positions. Moreover, on an issue so central to the meaning of medical professionalism, it seems important for organized medicine to take a stand. We subsequently review the arguments in favor of PAS (arguments from autonomy and mercy, and against the distinction between killing and allowing to die (K/ATD)) and the arguments against legalization (the limits of autonomy, effects on the patient-physician relationship, the meaning of healing, the validity of the K/ATD distinction, the social nature of suicide, the availability of alternatives, the propensity for incremental extension, and the meaning of control). We conclude that organized medicine should continue its opposition to PAS.

Sulmasy DP, Finlay I, Fitzgerald F, Foley K, Payne R, Siegler M. Physician-Assisted Suicide: Why Neutrality by Organized Medicine Is Neither Neutral Nor Appropriate. J Gen Intern Med. 2018 Aug;33(8):1394-1399. doi: 10.1007/s11606-018-4424-8. Epub 2018 May 2.

Public cartels, private conscience

Michael Cholbi

Abstract
Many contributors to debates about professional conscience assume a basic, pre-professional right of conscientious refusal and proceed to address how to ‘balance’ this right against other goods. Here I argue that opponents of a right of conscientious refusal concede too much in assuming such a right, overlooking that the professions in which conscientious refusal is invoked nearly always operate as public cartels, enjoying various economic benefits, including protection from competition, made possible by governments exercising powers of coercion, regulation, and taxation. To acknowledge a right of conscientious refusal is to license professionals to disrespect the profession’s clients, in opposition to liberal ideals of neutrality, and to engage in moral paternalism toward them; to permit them to violate duties of reciprocity they incur by virtue of being members of public cartels; and to compel those clients to provide material support for conceptions of the good they themselves reject. However, so long as (a) a public cartel discharges its obligations to distribute the socially important goods they have are uniquely authorized to provide without undue burden to its clientele, and (b) conscientious refusal has the assent of other members of a profession, individual professionals’ claims of conscience can be accommodated.

Cholbi M. Public cartels, private conscience. Polit Phil Econ. 2018 May 30;17(4):356-377.

(Editorial) Conscience and the Unconscionable

Robert Baker

Extract
The challenge is thus to accommodate conscience- based treatment refusals without jeopardizing the foundations of pluralistic medical professionalism. I believe that medical professionals functioning in pluralistic healthcare settings may be excused from providing certain information or services if they apologize to those in need of this aid, and if those in need of aid can be assured equitable access to the information or services in question. Note carefully, I am proposing conditions for excusing professionals who fail to maintain moral neutrality; I am not defending a right to conscience-based denials of healthcare, or ‘civil rights’ protections for refusers. . .Refusals to refer to other professionals or to transfer prescriptions are inexcusable.

Baker R. (Editorial) Conscience and the Unconscionable. Bioethics. 2009;23(5):350-352.

(Correspondence) Therapeutic Abortion

Liam H Wright

British Medical Journal, BMJ — British Medical Journal

Extract
Dr. D. G. Withers (16 April, p. 978) questions the right of a gynaecologist to ” refuse to do the work he is employed to do on the grounds of moral prejudice.” I would question Dr. Withers’s knowledge of the current medical status of termination of pregnancy. I would question, too, his use of the words ” moral prejudice.” As it is axiomatic that in medical discussions on this subject a Catholic is held incapable of an objective and unbiased view, my personal opinions will carry no weight with Dr. Withers. He should know, however, that there is no indication for termination of pregnancy about which there is universal agreement among gynaecologists (or other doctors). For each and every suggested indication there is a substantial body of competent informed non-Catholic medical opinion which opposes termination. These doctors, too, may be accused of (or praised for) moral prejudice.

Wright LH. (Correspondence) Therapeutic Abortion. Br Med J. 1966 Jul 23;5507):240.