Bioethics is entirely subjective when it comes to coercing doctors.
Many big shots in the bioethics community continue to argue against “medical conscience,” insisting that doctors should be forced to perform all requested legal medical procedures — even if it involves the taking of human life — that can produce the result the patient wants.
In the latest anti-conscience broadside, published in the professional journal Bioethics, two internationally known bioethicists, Julian Savulescu and Udo Schuklenk, take an almost absolutist position:
Our argument is that patients have a right to receive health care when four necessary conditions are satisfied (citations omitted):
1. The treatment is legal in that jurisdiction.
2.Providing the treatment is consistent with constraints of distributive justice.
3. The treatment is in the patient’s interests.
4. The patient autonomously desires the treatment.
The doctors define “patient’s interests” as a “benefit recognisable within accepted professional standards of benefit and harm.” Note carefully that these are often ideological, as opposed to medical, positions.
For example, the New England Journal of Medicine has repeatedly published articles arguing that gender dysphoric children should receive transition interventions such as puberty blockers, often not mentioning the many contrary opinions that have been published. All major medical journals are also pro-abortion without meaningful limitations. And most support assisted suicide. Following Saveulescu and Schuklenk’s prescription would require doctors to perform all of these–and more.
What about doctors’ personal religious or moral objections based on, say, their explicit faith precepts or the Hippocratic Oath? Go fish!
Our argument is that the doctor’s values should not matter at the bedside. Putting limits on the risks of say, infection in a pandemic, to which a doctor could be exposed is different to saying they can do what they want, or even put their moral convictions ahead of their professional obligations, and the patient’s well-being interests.
The authors admit that these are subjective questions, and argue that the interventions that must be provided can differ from culture to culture:
In practice, we must decide what constitutes patient interests. To address this value question, a procedural tool like Collective Equilibrium in Practice (CREP) [which measures public attitudes] may be necessary. CREP attempts to bring ethical theories, principles and concepts into maximum coherence with a given public’s values. This means different societies may endorse different conceptions of interests. It is in this sense that our proposal is ‘value neutral.’
In other words, a patient’s best interests might include assisted suicide in one society, but not in another.
But that approach punishes religious and Hippocratic doctors who hold heterodox beliefs in Western societies. Moreover, such coercion could drive experienced doctors out of the profession, while also dissuading potentially excellent future doctors from attending medical school at all.
Savulescu and Schuklenk sniff that Sweden and Finland disallow medical conscience and have plenty of doctors. Perhaps. But we don’t have enough doctors in the USA, nor does Schuklenk’s country, Canada. (In this regard, the authors reluctantly concede that doctor shortages could potentially allow doctors to refuse wanted interventions. But that exception would depend on circumstances and still leaves a doctor’s individual moral conscience in the lurch.)
What about doctors who became licensed before the objected-to procedures became legal? Shouldn’t they be allowed to opt out? Nope, including administering lethal jabs:
We doubt such grandfathering is necessary, even in the MAiD context. On the foreseeability criterion we note that as more jurisdictions legalised assisted dying through the 2000s and 2010s, the direction of travel was increasingly predictable…This significantly reduces the number of practitioners who would be eligible in the real world for conscientious objection accommodation…
Entry into a healthcare profession entails acceptance not just of its current norms but of the dynamic character of the profession; that second-order expectation is itself foreseeable and known. To invoke norm change, or the psychological discomfort of working within changed norms, as the basis for an exemption claim misunderstands what professional commitment entails.
Reading their support for coercion of dissenting doctors, I wondered whether Savulescu and Schuklenk would similarly force pediatricians to circumcise babies if the doctor considers it to be child abuse. After all, this minor surgery is controversial but common in the USA, is deemed an issue of parental choice by the American Academy of Pediatrics (which is generally as woke as it gets), and is certainly judged by Jewish parents to be in their son’s best interests as culturally or religiously necessary.
Yet, while Savulescu has written that the procedure should be discouraged, from what I can tell, nowhere does he claim that doctors should be forced to perform it.
Schuklenk has gone even farther, arguing on his blog that infant circumcision for nonmedical reasons shouldn’t be allowed:
In the case of children the child’s –medically understood – welfare should take precedence over parents’ religious convictions. That is how most societies rightly address this problem with respect to Jehovah’s Witnesses’ prohibition of blood transfusions and that is how we should handle it with regard to genital mutilations of the various kinds that are popular among particular religions.
Wait a minute! Infant circumcision is culturally accepted throughout much of the world, to the point that about a third of males in the world have been circumcised, most of these while infants. Based on what these authors wrote about the determinants of performing wanted interventions, doctors should be forced to circumcise infants wherever it is culturally acceptable — which includes the United States, where the circumcision rate is above 71 percent.
See how all this works? Bioethics is entirely subjective. It appears that opposing medical conscience really comes down to whether the bioethicists in question who support coercing doctors to violate their consciences approve or disapprove of the procedure being requested.