Trampling on health care providers’ consciences

(RNS) History teaches us to protect a health care provider's right to refuse to participate in controversial medical practices.

Sick man in bed surrounded by physician, priest and attendants. Woodcut attributed to Albrecht Dürer in 1509.  Image courtesy of Wellcome Library, London, via Creative Commons

(RNS) Western culture wants to welcome and protect different perspectives. But that commitment to pluralism is butting up against another cherished value — the commitment to respect an individual’s conscience — on an increasingly challenging front in the culture wars: controversial medical practices.

This is happening in many different countries, but in the United States we are seeing lawsuits attempting to protect physicians from being forced to counsel patients on assisted suicide and Catholic hospitals from being forced to perform abortions.

Bioethicists have been thinking for many decades about how to balance a commitment to pluralism with a commitment to justice when it comes to these kinds of controversial medical practices.

The most recent example of this came when the Brocher Foundation gathered an impressive international group of bioethicists in Geneva to put out a consensus statement on “contentious objection in health care.” Here is the opening paragraph to the statement, just released this week on Oxford’s Practical Ethics website:

“Healthcare practitioners’ primary obligations are towards their patients, not towards their own personal conscience. When the patient’s wellbeing (or best interest, or health) is at stake, healthcare practitioners’ professional obligations should normally take priority over their personal moral or religious views.”

These claims provoke a number of questions. Here are just a few:

Who counts as a patient? Of what does a patient’s “wellbeing” consist? Rights being respected? Which rights? What happens when they conflict? How should one patient’s well-being be measured against the well-being of many others?

Let’s do some historical thought experiments to drive home the weight of these questions:

A. Imagine you are a Christian physician in late first-century, pagan Rome when a patient comes to you with his just-born child who, because she is a girl, he wants you to kill by giving her hemlock.

B. Imagine you are a Catholic physician living in Nazi Germany working in the psych ward of a Catholic hospital when a patient who initially asked you to admit his mentally ill daughter now asks you to kill her so she is no longer a drain on the Reich’s resources.

You cannot participate in either act, of course, without violating a fundamental part of who you are. But signatories of the Geneva statement would insist you either assist the patient in killing his child or refer your patient “to another practitioner who is willing” to help kill his child.

Furthermore, the signatories insist that if it is too burdensome for your patient to travel to the nearest physician willing to perform the medical service, you must perform it yourself.

We are told, after all, that “a patient’s desire for a legal, professionally sanctioned medical service” trumps “personal moral or religious views.”

These historical examples shed light on two “legal, professionally sanctioned medical services” in many contemporary Western cultures: abortion and physician-assisted killing. Signatories of the Geneva statement believe health care providers must be willing to participate in the kinds of killings that many consider morally similar to A and B above. The signatories even claim that providers should be forced to perform such killings as part of their training in medical school and that they may be discriminated against in employment because of their refusal to perform such killings in the future.

Another historical thought experiment challenges the signatories from a different perspective:

C. Imagine you are a pro-LGBT psychiatrist practicing in the 1950s United States. Suppose you are approached by a father with a daughter, 12, who identifies as a lesbian. Further suppose that this patient requests you to perform “restorative therapy” on his daughter in an attempt to, in his words, “turn her back into a heterosexual.”

Such therapy was, at the time, a “professionally sanctioned” medical service. The signatories would be forced to conclude that this physician should either provide the therapy himself or refer the father and daughter to a physician who would do the therapy. And in an “emergency” situation — perhaps where the family cannot reasonably travel to the closest psychiatrist willing to provide the therapy — the physician should be forced to provide it himself.

These historical thought experiments remind us that the moral confidence the signatories have in a medical practice simply because it is legal and currently accepted by medical professionals is completely unwarranted.

We’ve gotten things dramatically wrong when it comes to our medical practices in the past, and there is absolutely no reason to believe we aren’t getting them dramatically wrong today. One of many reasons to err on the side of protecting the consciences of health care providers is that we must provide them the freedom to resist the practices our broader culture has not yet recognized as unacceptable.

(Charles C. Camosy is associate professor of theological and social ethics at Fordham University in New York City. His most recent book is “Beyond the Abortion Wars: A Way Forward for a New Generation.”)

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