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.

2013 here we come

I'm off to a good start into 2013, at least on the work-related fronts. Russell Blackford and I submitted in the dying days of 2012 the final copy of our up-coming 50 Great Myths about Atheism to Wiley-Blackwell, our publisher. I have also been working diligently with Helga Kuhse and Peter Singer on the 3rd edition of Bioethics - An Anthology, which should also be out some time this year. It's going to be an 800+ pages doorstopper. The question is what to do with the remainder of my sabbatical, roughly another 9 months worth of no teaching and administrative responsibilities at the university. I need to get going on a book project on Global Health Ethics, but there's also a tempting new introductory bioethics textbook to produce that's heavily oriented toward the inclusion and utilisation of on-line networking tools. Difficult call, but a decision has to be made. I have also written a piece that's forthcoming during the next few days in the Journal of medical ethics. Using the debate on infanticide I show how bioethics journal editors come under ever-increasing scrutiny by political campaigners and other pressure groups to publish whatever it is that these campaigners and organizations deem 'right', and that we cease and desist from publishing content they disapprove of. These are worrying developments. Keep your eyes open for the article. I understand that it will be an Open Access document, but if it isn't, ask me for the pdf and I shall post it your way. With Ricardo Smalling I have co-authored a paper that also coming out in the next few days, this one in the Journal of Medical Humanities. We are looking there at the impact religiously motivated anti-gay sentiments have on the professional (or not so professional) conduct of some health care professionals. Not terribly original is our suggestion that tighter regulations are required to protect queer patients from such health care personnel's unprofessional conduct. But it had to be said. We are also taking head-on the silly idea that conscience based objections to homosexuality should be a valid reason to treat queer patients different to other patients. Right now I am revising the entry on 'Utilitarianism' for the 4th edition of the Encyclopedia of Bioethics. I had written pretty much what I thought ought to be said and passed it by a number of colleagues. I received plenty  of very constructive feed-back in the middle of the holiday season (who says academics are lazy!). During the rest of this week I will revise what I got, and then submit to the editors of the encyclopedia.

2013 will see in Canada a number of exciting landmark cases being decided by the Supreme Court (well, by virtue of them coming to the Supreme Court they got to be landmark cases, of course). Among them a case where the family of a patient in persistent vegetative state wants the taxpayers to fork out 2,000 C$ per day for futile medical care vs doctors who think they'd have the last word on cessation of treatment. I am not in favour of either party here, so I am curious what the Court will make of it all. Then, of course, presumably by the middle of the year, the Court should issue a finding on the constitutionality of the criminal code prohibition of any form of assisted dying in the country. I suspect that a lot will hang on whether the judges on the Court can be persuaded by one side or the other that there is or isn't a slippery slope from decriminalizing assisted dying in some form or shape to the killing of people who do not wish to see their lives terminated.  I have seen no proof for the existence of such a slippery-slope, but who knows what the judges on the Court will make of the arguments and evidence presented to it. If you were to ask me for a prediction, I would guess that the Court will find that the absolute prohibition of assisted dying in all cases simply is too broad, and that it will open the door for decriminalization in a restricted number of clearly defined cases. But then, your guess is as good as mine.

2013 promises to be an exciting year for us bioethics and health policy wonks.