Showing posts with label conscientious objection. Show all posts
Showing posts with label conscientious objection. Show all posts

Thursday, April 12, 2018

Back to blogging - stuff is happening :)

I have been pretty quiet on the blogging frontiers during the last few months. I have been juggling various manuscripts, including a book manuscript, as well as teaching, so basically I was too tired to blog much (well, too tired to blog at all).

Anyhow, so here's an update:

Issue CoverRuth Chadwick and I managed to send a first rough draft of our textbook to Wiley to have it externally reviewed. It will need quite a bit more work, but we hope to get this done during the summer months.

I have a lengthy review article on the ethics of Conscientious Objection accommodation in the British Medical Journal. You can find it here. 

The title is: Conscientious objection in medicine: accommodation versus professionalism and the public good.


IssuesI also, jointly with Justine Dembo and Jonathan Reggler have an Open Access paper in the Canadian Journal of Psychiatry on medical aid in dying and depression. You can find it here.

The title is: 'For their own good': A Response to Popular Arguments Against Permitting Medical Aid in Dying (MAID) where Mental Illness Is the Sole Underlying Condition.


There is also a completed book chapter to report in a Palgrave MacMillan handbook on, I think, political philosophy. I did that jointly with an undergraduate student at Queen's, Benjamin Zolf.

And there are various Editorial type papers, including (in German) this one on the use of ethical deliberation in the decision-making on public health policy.

Friday, March 10, 2017

Conscientious objection, ethical problems in clinical research in public health emergencies, problems with ethics guidelines and other stuff

I know I know, I have not posted much since September last year. It's been an unusually busy time, professionally, so I must beg for your understanding that this blog has taken a backseat to other projects. I mostly want to alert you here to content I have published or that I have forthcoming. as well as the odd project that's going forward.

Let's start then with a heads-up on publications! I have done a lot of work on the issue of conscientious objection, mostly because I feared (I was right) it would be one of the tools in the armament of those determined to subvert the Canadian Supreme Court decision that decriminalised assisted dying. We have since discovered that buildings (hospitals) think they have conscience rights, even conscience rights that weigh heavier than the conscience rights of the doctors and other health care professionals working in them. Naturally, I am referring to Canada's legions of Catholic hospitals. Then there are health care professionals who think that saying 'I object on grounds of conscience' to the delivery of professional services that they are monopoly providers of, should kinda trigger all-out societal accommodation efforts, patients rights to service delivery be damned. I think both the hospitals as well as those doctors got it badly wrong, and I published a few papers designed to show why that is so.

Here's a paper in the Journal of Clinical Ethics, another one in the Journal of medical ethics, one in Bioethics [Open Access], a reply to various critics in the Journal of medical ethics and an Editorial in Bioethics, all on the conscientious objection issue.

I have also written a few other Editorials, on the ethics of access to unregistered medical interventions during infectious disease outbreaks, on baby boomers and assisted dying, and on the seemingly vacuous rhetoric of 'dignity' and 'vulnerability' that is liberally deployed in UNESCO's bioethics documents.

There are a few other papers in the production pipeline, one on treatment resistant depression and assisted dying is currently under review, and a piece on catastrophically ill patients right to access unregistered medical interventions, forthcoming in the Journal of Law, Medicine and Ethics.

I am currently busy organising an international workshop to be held at this lovely location in mid August, on recent revisions of the World Medical Associations Declaration of Helsinki and the Council for International Organisations of Medical Sciences research ethics guidelines. My own take on the CIOMS document was published in the Indian Journal of Medical Ethics.

Last week, in London, I spent a day with Ruth Chadwick, the other Editor of Bioethics, and our Editors at Wiley, to discuss how we will develop the journal to make it even more successful. Stay tuned for developments on that frontier. Oh, Ruth and I are also close to completing a new bioethics textbook that we are writing jointly. It's years late, which is probably inevitable when you have your plate full with research, teaching and other stuff, but we're close to completion of that project!

I also delivered on the teaching frontiers, creating a new first-year bioethics course for Queen's undergraduates. I have not taught undergraduates for oodles of years, so that was quite an experience. The teaching evaluations suggest that folks enjoyed it. But then, I would say that, wouldn't I?

Last but not least, in the end of March Ruth and I will be off to China to participate in a bioethics conference.

And that's a wrap.

Tuesday, August 16, 2016

Conscientious objection accommodation in medicine - a new look

I published in 2015 an Editorial in Bioethics where I took the stance that we have no good ethical reasons to accommodate conscientious objectors in medicine in liberal democracies. That Editorial led to a bit of a splash among religious activists who liberally make use of conscientious objection accommodation afforded to them in order to avoid providing professional services to patients. There has also been a more considered reply by Christopher Cowley that was published in Bioethics. Julian Savulescu, the Editor of the Journal of medical ethics was another target of Cowley's reply. Julian and I have finally got around to writing a reply to Cowley. It's forthcoming in Bioethics (as an Editor of the journal, I was, of course, not involved in the decision-making process on that manuscript). Look out for it, it's gone into production. The title of our paper: Doctors have no right to refuse medical assistance in dying, abortion or contraception.

The American Medical Association's Council on Ethical and Judicial Affairs produced a new opinion on conscientious objection. The Journal of Clinical Ethics organised a symposium with replies to that document. My paper titled Conscientious objection accommodation in medicine: Private ideological convictions must not trump professional obligations is scheduled for publication in that journal this fall. Check it out.

Last but not least, Ricardo Smalling and I had a lengthier review piece in the Journal of medical ethics on conscientious objection. Check it out here. You won't be surprised by its title, I suspect: Why medical professionals have no moral claim to conscientious objection accommodation in liberal democracies. The journal apparently received a couple of responses and so we're currently busy drafting a response to those.

The Journal of medical ethics as well as the Cambridge Quarterly of Health Care Ethics are currently in the process of putting out special issues dedicated to the conscientious objection problem. Look out for that forthcoming content.

Why is there this sudden flurry of publications and special journal issues on this subject matter? I think it has mostly to do with the fact that conscientious objectors make reliable service delivery ever more difficult with their accommodation demands. Court challenges are under way in Canada where Christian doctors demand to be accommodated in the country's coming medical aid in dying regime. They even refuse to transfer assistance-seeking eligible patients to colleagues who would provide the medical services that these patients would be entitled to receive. It cannot surprise, seeing such unprofessional conduct, that bioethicists the world all over have become interested in this issue again.

Let the arguments begin.

Thursday, February 11, 2016

Hiatus - Apologies

I have been unusually slow in terms of up-dating this blog. It's not for lack of content to write about. The CMA is embarrassing itself currently on the issue of conscientious objection and assisted dying, behaving like a true trade union would, without much concern for patient access to such services that its members will likely be monopoly providers of. The reason why I have not been able to actually blog about this is that I am swamped with publication deadlines. Editorials for both Bioethics and Developing World Bioethics had to be written, I was also briefly a Visiting Professor at St George's this January where I managed to catch up with colleagues like Cheryl Cox and Matthew Wynia, and I had to travel to Belgium as part of consultancy work I did for MSF/Doctors without Borders in 2015. - I have been travelling way too much. I also gave talks during events organised in November by the FDA/CDC and NIH in Bethesda as well as one organised a week or two later by the German National Ethics Council and the country's national science academy in Berlin. Then there were various paper deadlines, one of which I met, the other is one that I am working frantically toward meeting.  One of these papers is on conscientious objection, and I have finally managed to submit it for consideration to guest editors of a bioethics journal, then there is a response I need to write to someone who responded to an Editorial I had in Bioethics (ya, a reply to a reply, very academic), as well as another article I need to produce on the issue of catastrophically ill patients' moral entitlement to access unregistered medical interventions. I have written about this before, but this paper will add new arguments to what I have said in the past on this topic. Yes well, then there are departmental obligations. I must produce our departmental newsletter, and I'm looking forward to doing just that. I'm also busy preparing for a bunch of lectures that I'm giving in various countries during the next few months.

The long and short of it is that I didn't have time to blog as frequently as I would have liked to. I'll try to do better.

Thursday, March 26, 2015

Conscientious objection in medicine: Private ideological convictions must not supersede public service obligations


Canada’s Supreme Court decided that Canadians’ constitutional rights are violated by the criminalisation of assisted dying. Canada’s politicians are currently scrambling to come up with an assisted dying regime within the 12 month period that the Supreme Court gave them to fix the problem.

Since then the Canadian Medical Association, the country’s doctors’ lobby organisation, has insisted not only that doctors must not be forced to provide assisted dying, but also that doctors must not be required to transfer patients asking for assisted dying on to a colleague who they know will oblige these patients.(1) 

In many countries, including Canada, conscientious objection clauses protect – mostly - health care professionals from being forced to act against their individual ideological convictions. I suspect it isn’t unfair to note that these protections in the real world are nothing other than protections for Christian doctors who are unwilling to deliver services they would be obliged to deliver to patients who are legally entitled to receive these services, were it not for their religiously motivated objections.(2) Secular health care professionals could arguably avail themselves of conscience clauses, but in a liberal democracy, what reasonable conscience based cause could they have to refuse the provision of health care services to patients? Conscience clauses today are by and large a concession of special rights to Christian health care professionals, at least in secular Western democracies.

An uneasy compromise is often struck that stipulates that conscientious objectors must not be forced to deliver the health care services that they object to, but that they must ensure that patients will be transferred to a health care professional willing to provide the requested service. Typically they are prohibited from engaging in activities aimed at persuading the patient to see the errors of their ways. Typically they must also transfer the patient in an expeditious manner to their more obliging colleague.

Looked at from a conscientious objector’s perspective, this compromise is anything but a compromise. If I object to abortion because I believe that abortion is akin to murder, as Christian objectors happen to believe, surely my moral responsibility is barely smaller if I knowingly pass a pregnant woman looking for an abortion on to a colleague who will commit the act rather than if I do it myself. Christians are not typically known to see these issues through a consequentialist analytical lense, but even from their perspective, moral responsibility is barely reduced by the compromise. I sympathise with their objections to the compromise, because it is not a compromise. A compromise under the circumstances arguably is not feasible to begin with.  

Patients are entitled to receive uniform service delivery from health care professionals. They ought not to be subjected to today’s conscientious objection lottery. The Canadian Medical Association proposes that Canada ought to establish a website where patients can ascertain where the nearest non-objecting doctor is located.(3) One difficulty with this proposition is that in many rural areas there might be only one doctor and the next – more obliging - health care professional might actually be a flight away. Nothing would stop us from taking this proposal to its absurd logical conclusion: why not establish comprehensive websites where patients can find out whether their doctor objects on grounds of conscience to treating sexually active gay patients, or perhaps whether their conscience prohibits them from treating patients of a particular objectionable ethnicity. Consequentialists might well decide not to treat Ebola Virus Disease patients because of the risk involved, call it their consequentialist conscience. Health care service delivery would soon become a random event, entirely based on the vagaries of conscientious objections. Incidentally, Canadian doctors’ legal conscience protections do not actually cover these kinds of objections, because really these protections are designed to protect Christian doctors’ convictions, despite feeble attempts at giving them a lick of neutrality paint. The odd thing about conscientious objections is that there is no way to find out whether they are genuine or just a matter of convenience. Even if they were genuinely held beliefs, why should that constitute a sound reason for refusing service delivery?

The very idea that we ought to countenance conscientious objection in any profession is objectionable.(4) Nobody forces anyone to become a professional. It is a voluntary choice. A conscientious objector in medicine is not dissimilar to a taxi driver who joins a taxi company that runs a fleet of mostly combustion engine cars and who objects on grounds of conscience to drive those cars due to environmental concerns. Why did she become a taxi driver in the first place? Perhaps she should have opened a bicycle taxi company instead. I recall well, during an extended teaching stint in a dental school, that in every intake there were a fair number of dental students mentioning that they settled on going to dental school rather than medical school because of their objections to abortion. That seems a much more reasonable decision than to join a medical school and cause throughout one’s working life problems for patients seeking medical care for health issues that they are legally entitled to receive medical care for and that one objects to for one reason or another. Societies ought not to prioritise individual ideological commitments of some health care professionals over patients’ rights to receive professional care in a timely and hassle free fashion. Dying patients living in rural areas should not be subjected to an access-to-assisted-dying-lottery caused by conscientious objectors. Doctors are first and foremost providers of health care services. Society has every right to determine what kinds of services they ought to deliver.

That a doctors’ lobby organisation such as the Canadian Medical Association should aim to prioritise its members’ interests over patient access to care is not terribly surprising, albeit disappointing. Canadian legislators would do well to ignore its plea on this occasion.

 

UDO SCHUKLENK

 

 

 

 

 



[1] Sharon K. 2015. Unacceptable to force doctors to participate in assisted dying against their conscience: CMA. National Post March 05. http://news.nationalpost.com/2015/03/05/unacceptable-to-force-doctors-to-participate-in-assisted-dying-against-their-conscience-cma-head/ [Accessed March 26, 2015.]
[2] Leiter B. 2013. Why Tolerate Religion? Princeton, NJ: Princeton University Press.
[3] Kirkey S. Op.cit.
[4] Savulescu J. 2006. Conscientious objection in medicine. bmj 332: 294

Saturday, April 19, 2014

Compulsory child vaccination and the conscientious objection business

Ontario’s health minister Deb Matthews announced this week that she is adding three further diseases to the list of illnesses against which children in the province must be vaccinated. It’s mandatory. Her move has been widely lauded by public health experts and medical ethicists. We have seen in recent months outbreaks of preventable illnesses in communities with unusually low vaccination rates. You might recall the most recent outbreak of measles in BC’s Fraser Valley where more than 200 children came down with the measles. The situation seems directly linked to a community objecting to vaccines on religious grounds. Don’t think of measles as a harmless kind of infection. More than 100.000 children die each year worldwide of this entirely preventable disease.

Why on earth would parents not wish to protect their children against a serious infectious but preventable disease? Well, some parents likely will simply forget, or think that it’s not that important. After all, if we have herd immunity you can with reasonable confidence become a non-vaccinated free-rider on your responsibly vaccinated fellow citizens. However, if lots of us choose to become such free-riders the risk of a disease outbreak increases quite dramatically. It’s simple maths really. In any case, it is probably fair to say that not getting your children vaccinated simply because you were too lazy or too selfish, aren’t terribly good ethical justifications for your omission to get your kids vaccinated.

Another possibility is that you belong to those misguided parents out there who have decided, typically based on conspiracy websites that I won’t even be mentioning here, that vaccines do all kinds of evil things and really you mean to protect your child from these evils. No doubt you’ll mention autism as an example of the evils caused by vaccines. Well, let me just tell you that the only peer reviewed research output supporting these claims has since been withdrawn by the journal that published it initially. The researcher who wrote the piece was found guilty of misconduct by a statutory medical council. Shown to be a fraudster he was barred from ever practicing medicine again in Britain. He still remains the posterboy of current-day anti-vaccine activists. What better hero than a medical researcher ‘censored’ by the ‘establishment’. In light of this, to my mind, it makes perfect sense for governments to protect children from parents prone to listening to conspiracy theorists. This is so because if you choose to run with the views of one convicted fraudster against the rest of the biomedical and public health research establishment you haven’t quite done your due diligence. It is that simple.

Let’s assume you’re neither too lazy to have your kids vaccinated nor prone to buying into, however ludicrous, conspiracy theories. What’s left? Funny enough, there is a reason left to you that our health minister (no doubt based on good legal advice) thinks is an acceptable reason. Deb Matthews notes that it could be acceptable for you to object on grounds of conscience, or, as she describes it: religious or philosophical reasons. Fair enough, you need to make your case and apply for an exemption. But, what kind of religious reason could that be? That your god kind of had it in for your kids and that if they catch the measles (and pass them on), it’s ‘God’s will’? Or is the idea that because your imaginary friend in the sky is defined as ‘perfect’ by you, and that that perfect being would not create us as anything other than perfect. So, why bother with vaccines then? Is that it?

I’m flabbergasted about the tolerance we show toward folks objecting – against all the available evidence – to the compulsory vaccination of their children on religious grounds. They are not only risking their children’s health, they are also risking other people’s children’s health. There are always kids who suffer from a weakened immune system or who suffer from illnesses (such as cancer) that do not permit us to vaccinate them. They are put at grave risk by conscientiously objecting anti-vaccine parents.

What’s bothersome here is that, as a society, we ultimately prioritize the value of the parents’ religious convictions over their children’s well-being. I cannot see how that could possibly be ethically defended. Are we really saying that people’s clearly mistaken views about the universe matter more than the well-being of their children – and, indeed, that of other children? That’s what Minister Matthews’ religious and philosophical exemption clause ultimately boils down to. It is one thing to permit legally competent adults to make such choices for themselves, provided they are the only ones seriously affected by the consequences of their actions. Adult Jehovah’s Witnesses come to mind. If they wish to refuse life-preserving blood transfusions and bet on their imaginary friend in the sky, we should respect their choices, however, if they wish to place that bet for their vulnerable children, then surely society needs to step in and protect those children. The same holds true for children whose health is gambled with by their anti-vaccine parents. We should not tolerate religious cop-outs anymore than we tolerate parental convictions based on nonsensical conspiracy theories. Irresponsible parental conduct that is putting their children’s well-being at risk does not deserve societal accommodation.


Udo Schuklenk teaches bioethics at Queen’s University, he tweets @schuklenk.

Thursday, April 29, 2010

Britain does away with conscientious objection nonsense

A victory for sanity in Britain. A Christian counsellor (photo to the left), employed by the state, lost a court case that's essentially focused on conscientious objection. The guidance counsellor refused to provide services to gay couples, on religious reasons. The Guardian reports 'Lord Justice Laws said legislation to protect views held purely on religious grounds could not be justified. He said it was an irrational idea "but it is also divisive, capricious and arbitrary". Laws is correct here. The truth of religious belief cannot be established, there's competing and importantly conflicting religious beliefs about. Surely the question of whether someone receives professional services without a great deal of fuzz must not depend on whatever private beliefs a professional services provider holds.

Says Laws, "We do not live in a society where all the people share uniform religious beliefs. The precepts of any one religion – any belief system – cannot, by force of their religious origins, sound any louder in the general law than the precepts of any other. If they did, those out in the cold would be less than citizens and our constitution would be on the way to a theocracy, which is of necessity autocratic....The law of a theocracy is dictated without option to the people, not made by their judges and governments. The individual conscience is free to accept such dictated law, but the state, if its people are to be free, has the burdensome duty of thinking for itself."

Church people like the evangelical former archbishop of Canterbury, Lord Carey suggested that rulings such as these could lead to 'public unrest' because special rules and special dispensation ain't provided to him and his fellow religious believers. Says Carey, "The comparison of a Christian, in effect, with a 'bigot' (ie, a person with an irrational dislike to homosexuals) begs further questions. It is further evidence of a disparaging attitude to the Christian faith and its values." Makes you wonder how else you'd described someone who irrationally discriminates against fellow citizens. 'Bigot' seems an appropriate description, adding 'God' as justification does precious little to change that situation.

Carey also claims, “It is, of course, but a short step from the dismissal of a sincere Christian from employment to a religious bar to any employment by Christians." This is utter nonsense, of course, a good teaching case for showing how unsubstantiated slippery slope claims are used for rhetorical gain. There is no short step of any kind here. All the court is saying is that Christians got to do their jobs like like everyone else, muslim or atheist, communist or liberal. If they don't feel like doing particular jobs they'd try to find other jobs. It's really a bit like a communist saying that she has conscientious objections to working for Deutsche Bank. We'd think that's funny, too, and suggest that perhaps she's in the wrong job.

The crux of it is, of course, that if you offer public services (particularly so if you're in the pay of taxpayers) you can't choose who you offer these services to, based on arbitrary criteria such as skin color, sex or sexual orientation. Nobody forced you to enter a profession that would require you to provide services to people whom your religious ideology tells you to discriminate again. Do something else, like for instance working in a church - if there is one not subsidized one way or another by the state - and enjoy the intellectual incest that goes with interacting with people like yourself. You certainly are not entitled to have your prejudiced life sponsored by tax monies.

Saturday, February 27, 2010

The things that are

Update: March 02, 2010. I have received further information on the issue discussed in the middle part of this blog, from Catholics for a Free Choice in the USA.

Here's an excerpt from a report they published in 1998: '
The US bishops' Ethical and Religious Directives for Catholic Health Care Services, which strongly prohibit abortion in Catholic hospitals, also say that "operation, treatment, and medications that have as their direct purpose the cure of a proportionately serious pathological condition of a pregnant woman are permitted when they cannot be safely postponed until the unborn child is viable, even if they will result in the death of the unborn child."

"It may seem that this directive permits all life-saving abortions, but that is not the case. The language closely mirrors Catholic teaching on abortion, which forbids direct abortions in all circumstances, even to save the life of the mother. The word "direct" is critical. Indirect abortions are allowed - but there are only a few cases where this applies. In a case where a woman's life was threatened by pregnancy, abortion is directly intended and therefore not permitted.

"The full meaning of the directive played out in 1998 when a pregnant woman on Medicaid in need of an emergency abortion was denied services at a merged hospital in Manchester, N.H. The 35-year-old patient, who had miscarried in the last year, rushed to Elliot Hospital when her water broke at 14 weeks. When she arrived her physician determined she needed an emergency abortion in order to prevent a life threatening uterine infection and other complications. However, because Elliott had merged with Catholic Medical Center in 1994, abortions were banned in 1997 from Elliot at the insistence of its Catholic partner.'

This week I had a look at how our collection of atheist thought, 50 Voices of Disbelief, is doing on amazon. I was delighted to see that it has received a reasonable 4.5 rating (out of 5) on amazon.com and some 11 or so reviews. Check out the comments some of the readers left behind,
here. I thought the most critical review (aka 3*** out of 5) is still quite complimentary. Glad the volume is holding up nicely in terms of sales!

In other news: I have been attacked as 'puerile' by an anti-choice organization in Canada for suggesting in said volume that there are Catholic hospitals where pregnant women are sacrificed for the sake of rescuing the fetus in case there is a conflict between the two. I have not, of course, suggested that this is a standard operating procedure in every single Catholic hospital (if it were, we surely would have heard about it). The anti-choice writer wheeled out that lovely Catholic concept of the Doctrine of the Double Effect (DDE) to explain why I am puerily (I made that word up) off the mark. This Doctrine, in turn, depends on your buying into another distinction, namely that of intention-foresight.

Here's what this argument is all about: The DDE holds essentially that we should distinguish between the intended outcome of actions and outcomes that we are able to predict (or foresee) but that we do not intend. The DDE, historically, goes back to an argument advanced by St Thomas Aquinas. He used the example of permissible homicide in self-defense. Aquinas imagined a situation where someone’s intention is to fend off an attacker. However, while he succeeds in fending off the attacker the attacker dies as a result of the defender’s actions. The attacker’s death was unintentional here, and, according to Aquinas is permissible ‘because self-preservation is a legitimate aim and a person who is unjustly attacked has a greater duty to preserve his own life than he has to preserve the life of the attacker.’ The morally important claim here is that the person who is attacked permits the death of the attacker to occur but does not intend for it to happen. The implicit understanding is that the death of the attacker is something that is undesirable and if possible ought to be avoided. One assumption here is that our victim (ie the attacked person) is acting from good motives. The argument from the DDE relies on us accepting a further concept, namely that of the Intention-Foresight Distinction (IFD). This distinction upholds the view that there is a moral difference between intending a patient’s death and foreseeing that it might or will happen, but not intending it. So, in the case of the conflict that I started of with, the doctor who rescues the pregnant woman and foresees but doesn't intend the death of the fetus could be in the clear, according to this Doctrine. The idea, that there is more to the evaluation of a person’s actions than the consequences that that person’s actions produced, is based on a modus of moral theorizing that is best described as deontological. Consequentialists will maintain that both the DDE as well as the IFD are irrelevant consideration in our evaluation of the morality of actions. However, for many health care professionals, as well as in law, the IFD matters a great deal. In homicide investigations, for instance, the determination of the intention of the assailant will make a significant difference in terms of making a deciding on whether she will be prosecuted under a murder or manslaughter charge. I doubt that this is ethically defensible, but there you go. To my mind outcomes are the only thing that matters.

While it is possible to draw this distinction (it is perfectly possible to say that I foresee that A is going to happen as a result of my intending to achieve B, but that I do not intend for A to occur), I cannot see why I should be any less responsible for the foreseen consequences of my actions. What makes A an acceptable cost to incur is surely the greater benefit derived from achieving B, as opposed to anything to do with my intentions.

In any case, the other question is whether or not there is evidence that Catholic hospitals sacrifice the lives of pregnant women in order to rescue fetuses. The answer to this is unequivocally 'yes'. In Catholic Nicaragua, for instance this position is even government policy (law in this case). As I write this, a cancer stricken pregnant woman is not given access to life preserving chemotherapy in that country, because this would risk the fetus' well-being. Just check out recent amnesty international reports on this matter. There have also been bona fide reports of health care professionals working in Catholic hospitals in the USA transporting pregnant women on to secular hospitals, so they could have access to life-preserving (life of the pregnant woman that is) abortions.

While I understand where the anti-choice position is coming from on this issue, I am surprised that anyone from that political corner would deny that these sorts of things are happening in the Catholicism controlled parts of our little universe. These sorts of policy positions do not come cost neutral no matter how hard they might intend (pun intended) for them to be.

There is more in the anti-choice site's article, in particular a rant on the conscientious objection issue. It is noticeable that the defense advanced there is essentially a legal response to an ethical/political argument I made. I did not argue that conscientious objection is illegal currently, I lamented that it is not. Oh well...

Hey, on to one last thing. I worked yesterday busily with the audio/video folks at Queen's University on a virtual presentation (I just couldn't be persuaded it's worth flying/traveling for more than 30 hours in economy class to do a 30 min presentation). The topic was a bit dicy as I am not really an expert in chronic disease issues, but it's been great fun doing this. Check the video out here. I am looking forward to discussing this with the conference participants in about a fortnight!


Saturday, January 16, 2010

Maia Caron interviews Udo Schuklenk

Grin, here's a nice interview by Maia Caron with myself. Enjoy (or not, as the case might be). In case you are interested or can be bothered, here and here are discussions of the views expressed in the interview. I have not corrected the few mistakes that can be found in the original text below. You might want to note that I am not author of the volumes mentioned, but usually a co-editor. In case you want to know what it is that I have written or edited during the last 10 years or so, go here.

Interview with Udo Schuklenk

Posted By Maia Caron on January 14, 2010

I’m hosting an interview series with prominent atheist and skeptic authors called Conversations with Freethinking Authors.

Today, I’m talking to Udo Schuklenk, co-editor with Russell Blackford of 50 Voices of Disbelief, Why We Are Atheists. Udo is also author of The Power of Pills: Social, Ethical and Legal Issues in Drug Development and The Bioethics Reader.

MAIA: Welcome Udo, and I appreciate you taking the time to talk about your and Russell Blackford’s book. I very much enjoyed reading these essays. Not only was it an opportunity to hear favorite atheist authors air recent thoughts on their personal realizations on what it means to be an atheist, but it also introduced me to other areligious authors and their books. It’s a compelling read and a powerful argument for atheism. Thank you for compiling so many excellent essays.

In the introduction to 50 Voices of Disbelief, you and Russell Blackford write that, “Religious dogmas and organizations are legitimate targets for fearless criticism and satire” and “There must not be special treatment for religious ideas of any kind.” I couldn’t agree more. You also mention the importance of Voices of Reason being heard at this point in our history. Why now more than ever?

UDO: I think there are several good but also quite varied reasons for this. One reason is that the religious backlash against humanist thinking is becoming ever more virulent. The UN Human Rights Council has decided to encourage the organisation’s member states to introduce blasphemy laws. I have argued in THE ECONOMIST magazine, ‘freedom of speech “must include the right to ‘defame’ religions” (“The meaning of freedom”, April 4th). The UN Human Rights Council, which adopted a resolution decrying religious defamation as an affront to human dignity, is controlled mostly by countries that are among the most prolific violators of civil rights, including the right to speak one’s mind.

The blasphemy document itself is remarkable in its scope and deliberate vagueness. Notorious civil-rights violators like Iran and Saudi Arabia will now be able to claim with some confidence that the UN is on their side when they clamp down on liberal-minded or secular Muslims. Western countries will also be happy to note that the council thinks the human right to free speech is not violated when they enforce their own, less draconian, blasphemy laws. The UN has firmly established itself as a body that is not even prepared to defend the basic principles enshrined in its Universal Declaration of Human Rights.' This then is the first answer to your question: Religious institutions and the states they control move ever more viciously against freedom of speech to protect themselves from legitimate criticism. We must not allow this to stand. Religious beliefs, ultimately, can only survive if our right to question and criticize them can be efficiently curtailed. If I am right, and we are at some kind of strategic inflection point as far as the influence of organized religions in the Western world is concerned, their fight to maintain their special rights and status will become ever more vicious. Hence, it is important right now for us to speak out and not leave that to very few atheist cheer leaders.

I also happen to think that it is important to demonstrate to the wider public that atheists can think for themselves and that our views about many issues are very diverse. We don’t do ourselves any favors at all by leaving people with the impression that our capacity to think independently is reducible to Dawkins, Harris and Hitchens. We are not a hierarchical religious outfit after all. Our book, the 50 Voices of Disbelief demonstrates just that beautifully.

MAIA: I couldn’t agree more that atheists and anyone who cares about freedom of speech and human rights must act rather than remain silent. In your introduction, you reference contributing essayists, saying: “… some are even wary of the words atheism and atheist words that can carry unwanted connotations in many social contexts.” This is a theme also picked up in Michael Shermer’s essay in the book. He wrote, “Words matter and labels carry baggage,” going on to say that people associate atheism with “… communism, socialism, or extreme liberalism,” and that “… we can try redefining the word in a more positive direction.” There’s an ongoing debate among atheists/skeptics/agnostics/freethinkers/rationalists as to what an unbeliever should be called. Do you think the word “atheist” is a viable term? Or should a new name be coined that would more accurately represent the areligious?

UDO: That’s a very good question. I hold it with Karl Popper on labels really. It’s unimportant to me what label we use as long as it is clearly defined (and packs a punch in the public arena). To me it matters not at all what label it is, but it would be nice to have not too many competing such labels about as they only distract from the main messages and are indicative of sectarian scheming and territory marking. You might recall in Monty Python’s Life of Brian, there is this scene where our would-be liberationists sit in an arena introducing themselves to each other. They all follow pretty much closely aligned (albeit not exactly aligned) agendas and have nearly all the same name bar some small difference in labeling. They go on arguing forever about their small differences and miss the bigger picture as a result of that. I think we would be well advised to go about this more professionally by surveying which label the wider public would be most comfortable with, take that label and move on from there. A good example of how successful this is is the self-labeling of anti-choice campaigners in the context of reproductive rights. They call themselves ‘pro-life’ which clearly sounds much better than ‘we-don’t-care-about women’, or ‘we decide for pregnant women’ or ‘anti-choice’, which is what they really are. Marketing in this context clearly matters, unless we think that our agenda is entirely theoretical and inconsequential.

MAIA: I’ll have to watch Life of Brian again for that scene you descsribe. Good analogy for what goes on in the many-labelled freethinking/atheist community. In your introduction you also write, “It is high time we took charge of, and responsibility for, our own destinies without God, or God’s priestly interpreters, coming between us and our decision-making.” It’s a theme that Ophelia Benson picks up in her essay when she writes: “I refuse to consider a God ‘good’ that expects us to ignore our own best judgment and reasoning faculties.” Do you see more people taking responsibility for their own destinies? And what is the danger when they do not?

UDO: The fact that the number of people clearly affiliated with mainstream religions has been decreasing in the West for more than a decade by now indicates that more and more people have begun thinking for themselves. I suspect, ironically, this is even true for many religious people who confronted the atheist challenge, and on reflection decided to remain with their God. Reflecting on these issues is a good thing. We can only truly live our own lives if we make a considered choice as to the values (and basis of those values) that guide our lives. If we don’t, if we follow religious (or other authority) blindly, we live an other-directed life, and in that sense we don’t actually live our own lives. The ongoing public exchanges between non-religious people and people believing in some kind of higher being actually serve that purpose.

MAIA: “Other-directed life” is an excellent way of putting it. I couldn’t agree more that ”otherness” is a foundational problem, and many individuals don’t realize how thoroughly they are plugged into “they” and “we.” In 50 Voices of Disbelief, a common recurring theme among the atheist contributors (yourself included) is an early questioning of the status quo of the religion you were brought up believing. Why do you think some people believe willingly, accepting without question their entire lives, and others question early, and reject the façade of belief?

UDO: You are asking an empirical as opposed to a philosophical or ethical question. I’m not trained to address this question as a professional. I can think of only one good reason for why someone might decide (unconsciously, if there is such a thing as an unconscious decision), and that is that there is quite a lot of comfort one can take from believing in a higher being. This comfort might be mistaken if there is no such being, as we atheists happen to think, but surely one got to acknowledge that confidence in an afterlife will make it easier for many religious people to cope with miserable lives. This is especially true for miserable lives that seem to have no end. I have always thought, call it arrogant, that those who are stronger willed or stronger minded are more likely to question this comfort and its pseudo-answers than people who are psychologically weaker. Surely there is comfort in knowing that a good, all-knowing entity is watching over you. It’s delusional, no doubt, but believing this must give you a warm and fuzzy feeling, and possibly the strength to deal with life’s adversity.

MAIA: In your own contribution to the book, an essay titled Human Self-Determination, Biomedical Progress, and God, you raise what I think is a very important issue, writing, “Political correctness today seems to demand that progressive intellectuals pretend that the barbarism that pervades many Islamic countries is not happening.” Political Correctness has become pervasive. Do you think that in general, atheists should be more aggressive in criticizing Islam?and exposing harmful religious ideologies?

UDO: Oh, absolutely. As writers like Henryk Broder have rightly pointed out, what we see across the Western world is the political left and political liberals continuing their arguments with Christians, but not with the arguably much greater threat to secular multi-cultural societies, that is conservative Islam. The UN Human Rights Council has already decided to deliberately muddy the waters by claiming that Islamophobia is a form of racism. How offensive is that to anyone who has ever been attacked or otherwise discriminated against because of their ethnicity? People choose these religious ideologies, you don’t choose the color of your skin. – As an aside, if these people argue that they have not even consciously made the choice to be Muslim (or Christian, or Scientologist or Aquarian for that matter), there is even less reason to take their religious convictions seriously, because they’re not meaningfully their own. – I think the conflation of such issues is deliberate.

There is also this continuing stuff about how peace loving Islam and its adherents are, yet most acts of religiously motivated violence we have seen across the world during the last decade or two were motivated by the ideology of Islam. We have all seen time and again on TV how adherents to this ideology have burned effigies of leaders of Western countries where cartoonists ridicule their God. What makes them think that their strongly held beliefs, baseless as they clearly are, deserve special respect? What makes them think that there is some divine right of Muslims not to be offended by people who disagree with their beliefs? I am offended all the time by their views on a lot of normative issues. Do I go out and burn effigies of Islamic countries’ leaders or prominent religious figures? No. Do I bomb Iran’s airline? No. There is no special moral entitlement of Muslim or other religious folks not to be offended by someone who disagrees with the ideology they hold dear to their heart. Protecting religious ideologies from the same acerbic wit that other ideologies (communism, capitalism, liberalism etc etc) have to endure is mistaken. This is what the rough and tumble of liberal democracies is all about. It is important for us as atheists to protect these freedoms against the onslaught of religious (and other) ideologies.

MAIA: I agree with you whole-heartedly on that. In your essay, you also bring up a very important point about the special rights that health care professionals have under “conscientious objection,” that if they “strongly hold personal religious beliefs that are in conflict with what would normally be required of them as a health care professional, they can “legitimately object to providing such professional services on grounds of personal conscience.” This practice is reprehensible and as you write, “It is arguable that, if individuals abuse that privilege by discriminating against particular patients because of their personal convictions, they violate basic standards of professional conduct.” This sort of thing goes on, and yet atheism is considered the unethical force. As you say, “religious consciences are reaching arbitrary conclusions about what is right and what is wrong.” Do you see the need for atheists to organize a more united front and demand that this kind of unfair practice be controlled by government legislation?

UDO: I have written on this issue on my blog and various articles during the last few years. I do believe we should do away with the right to conscientious objection in medicine altogether. Here are my reasons for this: Usually in the context of the abortion controversy, religiously motivated health care professionals claim the moral (and often legal) right to conscientious objection to the provision of certain health care services. The basic idea is that if, say, Christian doctors and nurses object for religious (conscience) reasons to abortion they should not be forced to provide such services. On the face of it this seems uncontroversial. I think both accepting such conscience based refusals to provide health care services as well as assuming that such decisions are uncontroversial is mistaken. Let me explain why.

First things first: health care professionals such as doctors and nurses are first and foremost called upon by us as members of society as professionals and not as members of the Communist Party, the Klu Klux Clan, the local chess club, or a particular church. They provide a public service. In return for this we as society grant them a monopoly on the provision of such services (eg doctors have a monopoly on the provision of many health delivery services, including the prescription of drugs). We as society also invest substantial amounts of public funds into their training.

In many countries abortion is legal to some extent or other. In other words, societies have decided that it is ethically acceptable for women to make such choices (usually within certain well-defined limits). In societies providing public health care, women are entitled to receive abortion services through health care professionals that are publicly funded. These professionals are seen by pregnant women for the purpose of having an abortion. They are sought out as professionals and not at all as private individuals with their own private views on the morality or otherwise of abortion. I think it is preposterous to suggest that such professionals could kind of opt-out of the provision of some services because they feel strongly about such services. Religious provisions are more or less arbitrary. Some make sense, others don’t, and among religions there is little consensus on what is and isn’t ethical. To permit the delivery of health care to be controlled by what amounts essentially to a lottery is unacceptable.

Patients treated by a public sector doctor belonging to Jehova’s Witnesses wouldn’t get blood transfusions, those falling into the hands of an adherent to the Scientology Church won’t receive antidepressants, the list is endless. It’s easily imaginable that a racist doctor belonging to a suitably racist church could refuse to provide life-preserving services to patients from ethnicities other than her own. The conscientious objection to abortion crowd might not like to hear this, but there is no in-principle difference between their objection and that of the medic belonging to the Aryan Nation Church of Jesus Christ Christian. They will, of course, claim that they have ‘better’ reasons and that the competing church (ie the smallish racist outfit) is either not a ‘real’ church or that the racists are ‘wrong’ etc. The thing is, strictly speaking, none of this can be shown to be true, because, as it happens all monotheistic religions depend on untestable claims about the existence of ‘God’.

A reliable delivery of health services (and this includes equitable access) depends on guaranteeing timely access based on health need. Conscientious objections are a serious threat to precisely that. If you are a pregnant woman living in a rural area with a limited number of predominantly conservative Christian or Muslim doctors you might well not be able to execute your legal right to have an abortion at a certain point in time, if respect for conscientious objections was considered to be of greater importance than your access to services.

This argument is very powerful indeed, when you consider the dearth of health care professionals serving the public sector in developing countries. So, the sooner we get rid of the right to conscientious objection, the better for us, the public. And to be clear, if health care professionals feel strongly enough about this matter, they should be invited to leave the profession and do something else with their lives. We cannot reasonably permit a pick-and-choose type interpretation of professionalism to become the norm. As someone who has taught for many years in medical schools, I can testify to quite a number of people who have chosen dentistry over medicine, for instance, because they did not wish to ever have to face the moral conflicts that come into play in the abortion controversy or end-of-life decision-making. In all honesty, these professionals deserve our respect for what I think is a grown-up understanding of what it means to be a professional. I think a strong case can be made for atheists targeting this serious problem policy wise.

MAIA: In Michael Tooley’s essay, he writes, “Most people in the world accept the religious beliefs of their parents with relatively minor changes, and never think critically about those beliefs.” He asks an important question: “Can anything be done to enable ordinary people to step back from their religious beliefs and to consider whether those beliefs are really true?” This question is echoed by many other atheist contributors, among them: Julian Baggini: “Why do intelligent people continue to believe?” Susan Blackmore: “God and the paranormal …. inspire deeply held beliefs and have spawned highly evolved memeplexes that are very infectious and difficult to root out once they are installed in the human mind,” Dale McGowan: “How do we go on, century after century, skating on the thin ice of a system so self-evidently false and self-contradictory?” and Ophelia Benson: “A lot of people think they know things about God which seem to be contradicted by everything we see around us. It’s odd that the discrepancies don’t interfere with the knowledge.” Because the theme of questioning is prevalent in my own book, I’d like to hear what you think can be done to turn the penchant of humans to believe rather than question. Is it possible?

UDO: Another empirical question. I suspect as atheists we probably need to offer an alternative to the needs ‘God’ satisfies (well, doesn’t satisfy in reality, but psychologically – you know, the afterlife, redemption for wrong-doing, some good all powerful big guy watching over you, that kinda stuff). We need to show that a life without ‘God’ can be meaningful and satisfying. I think humanist groups presiding over non-religious weddings and funerals have made a good and quite successful start in many countries on this front. Beyond that, it’s up to each of us individually to provoke believers into explaining themselves and their beliefs. After all, as Dawkins (yes, Dawkins) said once, ‘There is more to vicars than giving tea parties, there are evil consequences.’ US evangelicals were by and large behind attempts to introduce the death penalty for certain homosexual sex acts in Uganda.

I think it might well be worth re-focusing humanist efforts, like the religious organizations have done for many many decades, on developing countries, supporting free speech and liberal causes and their supporters there more pro-actively. The fights humanists have on their hands in places like Nigeria, India and other such countries is arguably of much greater significance than the skirmishing we engage in with Christians in the developed world.

MAIA: Thanks for joining me today, Udo. I appreciate the time you’ve taken to address these topics. If you’d like to know more about Udo Schuklenk, please visit his website. And if you haven’t read 50 Voices of Disbelief, I highly recommend it. Let’s raise our disbelieving voices and be heard.


Friday, November 06, 2009

Stand up, stand up, against Jesus

Civility has its uses, but we should not be afraid of satire and mockery as weapons against religious power

The question: Is there an atheist schism?

Religious teachings promise us much — eternal life, spiritual salvation, moral direction, and a deeper understanding of reality. It all sounds good, but these teachings are also onerous in their demands. If they can't deliver on what they promise, it would be well to clear that up. Put bluntly, are the teachings of any religion actually true or not? Do they have any rational support? It's hard to see what questions could be more important. Surely the claims of religion — of all religions — merit scrutiny from every angle, whether historical, philosophical, scientific, or any other.

Contrary to many expectations in the 1970s, or even the 1990s, religion has not faded away, even in the Western democracies, and we still see intense activism from religious lobbies. Even now, one religion or another opposes abortion rights, most contraceptive technologies, and therapeutic cloning research. Various churches and sects condemn many harmless, pleasurable sexual activities that adults can reasonably enjoy. As a result, these are frowned upon, if not prohibited outright, in many parts of the world, indeed people lose their lives because of them. Most religious organisations reject dying patients' requests to end their lives as they see fit. Even in relatively secular countries, such as the UK, Canada, and Australia, governments pander blatantly to Christian moral concerns as the protection of religiously motivated refusals to provide medical professional services demonstrates.

In a different world, the merits, or otherwise, of religious teachings might be discussed more dispassionately. In that world, some of us who criticise religion itself might be content to argue that the church (and the mosque, and all the other religious architecture that sprouts across the landscape) should be kept separate from the state. Unfortunately, however, we don't live in that world.

When religion claims authority in the political sphere, it is unsurprising — and totally justifiable — that atheists and skeptics question the source of this authority. If religious organisations or their leaders claim to speak on behalf of a god, it is fair to ask whether the god concerned really makes the claims that are communicated on its behalf. Does this god even exist? Where is the evidence? And even if this being does exist, why, exactly, should its wishes be translated into law?

In many situations, it is better to be civil, as Paul Kurtz has pointed out, but satire and mockery have traditionally had a legitimate place whenever absurd ideas are joined to power and privilege. Enlightenment thinkers such as Voltaire often used mockery to show the absurdity of ideological stances — including religious ones — that were considered sacrosanct. Mockery is one way of saying that a view does not deserve to be taken seriously. Religious views are fair game if one can also show, on a more serious level, why the view in question does indeed not deserve serious respect.

Perhaps some rationalist or humanist organisations, such as Kurtz's venerable Center for Inquiry, do have good reason to maintain a scholarly and dignified brand image. But there is also room for the younger, brasher atheists whom Kurtz inaccurately brands as "fundamentalists", and, in any event, there is a world of difference between appropriate civility and keeping quiet.
In the US, unfortunately, some atheists appear to have concluded that even civil and thoughtful criticism of supposedly "moderate" religion (i.e., almost anything that does not dispute evolutionary theory) should be discouraged.

These "accommodationist" atheists tend to be focused on science advocacy, particularly the teaching of evolution in public schools. In seeking public support for their positions, they think it prudent to take the various American demographics as they are. Since they want to sell evolutionary science to very large numbers of pious Americans, the last thing they want is to see it linked with atheism.

Once you think in that way, from a kind of marketing perspective, it can take over your approach to what you think you ought to say. Sincerity goes out the window, and everything must be "framed" to please the audience. We doubt that this strategy can work.

Religion cannot be eradicated — that is not a realistic goal — but the many problems with religious dogma can and should be highlighted. As atheists, we should state clearly that no religion has any rational warrant, and that many churches and sects promote cruelty, ignorance, and civil rights abuses.

There are harmful consequences to real people in the real world if the views of churches and sects are enshrined in law or given undue social deference - the acceptance even in liberal secular societies of conscientious objection as a legitimate reason for health care professionals and even civil servants to refuse to provide professional services to certain citizens is a case in point. For these reasons it is important that we should speak out and publicly contest the special authority that is accorded, all too often, to pontiffs, imams, priests, and presbyters. Religious leaders are not our moral leaders, much as they clamour to be, and however much the politicians flatter them. These spiritual emperors have no clothes, and we shouldn't flinch from saying so.

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