15 bioethicists and philosophers last week signed a “consensus” statement on medical professionals raising conscience objections to procedures such as abortion. The statement was published by Oxford University and raised the following 10 points:
- 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.
- In the event of a conflict between practitioners’ conscience and a patient’s desire for a legal, professionally sanctioned medical service, healthcare practitioners should always ensure that patients receive timely medical care. When they have a conscientious objection, they ought to refer their patients to another practitioner who is willing to perform the treatment. In emergency situations, when referral is not possible, or when it poses too great a burden on patients or on the healthcare system, health practitioners should perform the treatment themselves.
- Healthcare practitioners who wish to conscientiously object to providing medical treatment should be required to explain the rationale for their decision.
- The status quo regarding conscientious objection in healthcare in the UK and several other modern Western countries is indefensible. Healthcare practitioners can conscientiously refuse access to legally available, societally accepted, medically indicated and safe services requested by patients in practice for any reason. This is in part due to the cost-free environment in which practitioner choice of service occurs, and in which the practitioner bears no substantive burden of proof. The burden of proof to demonstrate the reasonability and the sincerity of the objection should be on the healthcare practitioners.
- Accordingly, in such countries, the reasons healthcare practitioners offer for their conscientious objection could be assessed by tribunals, which could test the sincerity, strength and the reasonability of healthcare practitioners’ moral objections to certain medical services.
- Policy makers should ensure that in any geographical region there is a sufficient number of non-conscientious objectors for patients to obtain the medical services they need in a timely manner even if some healthcare practitioners conscientiously object to providing that service. This implies that regional authorities, in order to be able to provide medical services in a timely manner, should be allowed to make hiring decisions on the basis of whether possible employees are willing to perform medical procedures to which other healthcare practitioners have a conscientious objection.
- Healthcare practitioners who are exempted from performing certain medical procedures on conscientious grounds should be required to compensate society and the health system for their failure to fulfil (sic) their professional obligations by providing public-benefitting services.
- Medical students should not be exempted from learning how to perform basic medical procedures they consider to be morally wrong. Even if they become conscientious objectors, they will still be required to perform the procedure to which they object in emergency situations or when referral is not possible or poses too great a burden on patients or on the healthcare system.
- Healthcare practitioners should be educated to use a framework of decision-making incorporating legal, ethical and professional arguments to identify the basis of their objection.
- Healthcare practitioners should also be educated to reflect on the influence of cognitive bias in their objections.
Donna Harrison, M.D., the executive director of the American Association of Pro-Life Obstetricians and Gynecologists, responded with the following statement.
Who do you want to care for you and your family: a physician with moral integrity or a physician without moral integrity? Most patients want a physician who shares their moral values and most U.S. women think killing unborn children is wrong. That fact won’t change even though 12 Oxford philosophers would like to force doctors to kill patients.
Elective abortion is not medical care. Killing human beings to solve social problems is not medical care. As stated in the International Dublin Declaration on Maternal Health, and our AAPLOG mission statement, killing our unborn patients has no place in the practice of the healing arts. Elective abortion increases a woman’s risk of preterm birth, suicide, depression and breast cancer.
85% of obstetricians do not perform elective abortions. It is not from lack of skill. Since we are reproductive health care professionals who practice according to the Hippocratic oath, we don’t kill unborn patients because we went into medicine to care for both the pregnant mother and her unborn child. We don’t want to be forced to use our professional skills to participate in killing one of our patients.
Compelling medical professionals and students to perform abortions won’t increase access for women’s healthcare. It will force medical professionals with moral integrity out of the field. Women won’t have more access to abortionists. They’ll have reduced access to health care professionals to meet their health needs and deliver their babies.
The medical profession must recognize conscientious objections to killing patients, as this desire to do no harm is fundamental to patient safety.
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