{"id":3013,"date":"2016-04-22T09:36:23","date_gmt":"2016-04-22T08:36:23","guid":{"rendered":"https:\/\/blogs.bmj.com\/medical-ethics\/?p=3013"},"modified":"2016-04-25T19:42:26","modified_gmt":"2016-04-25T18:42:26","slug":"no-to-conscientious-objection-accommodation-in-health-care","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/medical-ethics\/2016\/04\/22\/no-to-conscientious-objection-accommodation-in-health-care\/","title":{"rendered":"No to Conscientious Objection Accommodation in Health Care"},"content":{"rendered":"<p><em><strong>Guest post by Udo Schuklenk<\/strong><\/em><\/p>\n<p>Canada is currently in the midst of a national debate about the scope of assisted dying regulations and policies. \u00a0It\u2019s a result of a 2015 Supreme Court ruling that declared parts of the country\u2019s Criminal Code null and void that criminalises assisted dying. \u00a0As you would expect, there is a lot of forth and back happening between proponents of a permissive regime (<em>\u00e0 la<\/em> Belgium\/ Netherlands), and those who would like a restrictive regime. \u00a0Another issue is being debated as well as litigated in the courts, the seemingly intractable question of conscientious objection accommodation.<\/p>\n<p>In preparation for incoming provincial policies on assisted dying, the provinces\u2019 statutory medical bodies, such as for instance the <span style=\"color: #0000ff\"><a style=\"color: #0000ff\" href=\"http:\/\/www.cpso.on.ca\/CPSO\/media\/documents\/Policies\/Policy-Items\/Human-Rights.pdf?ext=.pdf\" target=\"_blank\">College of Physicians and Surgeons of Ontario<\/a><\/span>, have stipulated that while doctors are not obliged to provide directly assistance in dying to eligible patients, they must transfer patents on to a colleague who they know will provide that service. \u00a0A similar stance has been taken <span style=\"color: #0000ff\"><a style=\"color: #0000ff\" href=\"http:\/\/www.health.gov.on.ca\/en\/news\/bulletin\/2015\/docs\/eagreport_20151214_en.pdf\" target=\"_blank\">in the recommendations<\/a><\/span> issued by an expert advisory group appointed by the country\u2019s provinces and territories, who are ultimately responsible for health care. \u00a0The same holds true for <span style=\"color: #0000ff\"><a style=\"color: #0000ff\" href=\"https:\/\/www.documentcloud.org\/documents\/2721231-Report-of-the-Special-Joint-Committee-on.html\" target=\"_blank\">a report<\/a><\/span> issued by a special joint parliamentary committee of the country\u2019s national parliament. \u00a0Unsurprisingly, religious doctors\u2019 groups, but not only religious doctors\u2019 groups, are all fired up about this and have taken, for instance, the Ontario College <span style=\"color: #0000ff\"><a style=\"color: #0000ff\" href=\"http:\/\/eol.law.dal.ca\/wp-content\/uploads\/2015\/06\/2015_03_20_Notice_of_Application-3.pdf\" target=\"_blank\">to court<\/a><\/span> to stop this policy from being implemented. \u00a0Their argument is that conscientious objectors among its members must not be forced to provide even this level of assistance if their conscience dictates otherwise.<\/p>\n<p>It is likely that the compromise reached will entail an obligation on health care professionals to transfer patients on to a willing health care professional. \u00a0That will not satisfy the objectors, because if you really hold the view that assisting a competent patient who meets the criteria stipulated by the Supreme Court is tantamount to murder, this compromise would simply translate into you passing on your patient to someone who you know would \u2018murder\u2019 that patient. \u00a0It is also not satisfactory from the patient\u2019s perspective, because they could \u2013 depending on where they live \u2013 be forced to travel great distances in order to meet the obliging health care professional. \u00a0That could well prevent some patients from access to an assisted death.<\/p>\n<p>The question arises why we should accommodate conscientiously objecting health care professionals in the first place. \u00a0It is somewhat taken as a given in much of the medical ethics literature that conscientious objectors are deserving of some kind of accommodation. \u00a0Arguments often focus on what makes a conscientious objection deserving of accommodation, and on what reasonable limits should be imposed on conscientious objectors, as opposed to the question of whether conscientious objectors deserve accommodation at all.<\/p>\n<p><span style=\"color: #0000ff\"><a style=\"color: #0000ff\" href=\"http:\/\/jme.bmj.com\/content\/early\/2016\/04\/22\/medethics-2016-103560.full.pdf\" target=\"_blank\">In our paper<\/a><\/span> we develop a more radical argument for the view that health care professionals have no moral claim to conscientious objection accommodation in liberal democracies. \u00a0We put forward a number of arguments to support that conclusion. \u00a0For starters, it is impossible to evaluate the truth of the authoritative documents that motivate particular consciences. \u00a0The courts in many jurisdictions that have had to deal with conscience related cases have conceded that much. \u00a0It turns out that we also actually cannot test whether someone\u2019s conscience claims are actually true, in the sense that that person actually has those convictions. \u00a0It might just be a convenient cop-out, and yet we readily accommodate objectors at great inconvenience to patients and significant cost to health care systems.<\/p>\n<p>Why should we accommodate privately held convictions that objecting professionals would like to prioritise over their professional obligations to patients? \u00a0 That demand seems unprofessional in its own right. \u00a0The promise to serve the public good and the individual patient first goes right out of the window, there and then. \u00a0These professionals joined their profession voluntarily and they knew that the scope of professional practice and their obligations to patients wouldn\u2019t be defined by them personally, and also that changes to scope would invariably occur over time. \u00a0The content of conscientious objections is by necessity arbitrary and encompasses any number of practical refusals to provide services. \u00a0No health care system should permit its monopoly service providers that sort of freedom when it comes to the delivery of the very same services that they voluntarily contracted to deliver. \u00a0Permitting such conscience accommodations ultimately subverts the very reasons for why society has professions in the first place.<\/p>\n<p>&nbsp;<\/p>\n<p>Udo Schuklenk tweets @schuklenk<\/p>\n<p><em>Read the full paper <span style=\"color: #0000ff\"><a style=\"color: #0000ff\" href=\"http:\/\/jme.bmj.com\/content\/early\/2016\/04\/22\/medethics-2016-103560.full.pdf\" target=\"_blank\">here<\/a><\/span>.<\/em><!--TrendMD v2.4.8--><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Guest post by Udo Schuklenk Canada is currently in the midst of a national debate about the scope of assisted dying regulations and policies. \u00a0It\u2019s a result of a 2015 Supreme Court ruling that declared parts of the country\u2019s Criminal Code null and void that criminalises assisted dying. \u00a0As you would expect, there is a [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/medical-ethics\/2016\/04\/22\/no-to-conscientious-objection-accommodation-in-health-care\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[968,2153,2146,511,443,2148,591,475,2745,1],"tags":[],"class_list":["post-3013","post","type-post","status-publish","format-standard","hentry","category-clinical-ethics","category-guest-post","category-in-the-courts","category-in-the-news","category-jme","category-law","category-life-and-death","category-politics","category-professionalism","category-uncategorized"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.6 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>No to Conscientious Objection Accommodation in Health Care - Journal of Medical Ethics blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" 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