{"id":3148,"date":"2017-03-24T07:06:04","date_gmt":"2017-03-24T06:06:04","guid":{"rendered":"https:\/\/blogs.bmj.com\/medical-ethics\/?p=3148"},"modified":"2017-03-25T04:06:53","modified_gmt":"2017-03-25T03:06:53","slug":"conscientious-objection-accommodation-in-healthcare-clashing-perspectives","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/medical-ethics\/2017\/03\/24\/conscientious-objection-accommodation-in-healthcare-clashing-perspectives\/","title":{"rendered":"Conscientious Objection Accommodation in Healthcare – Clashing Perspectives"},"content":{"rendered":"

by Brian D. Earp<\/a>\u00a0\/\u00a0(@briandavidearp<\/a>)<\/p>\n

On behalf of the\u00a0Journal of Medical Ethics,<\/em> I would like to draw your attention to the current issue, now available online<\/a>, which is almost entirely dedicated to the vexing question\u00a0of conscientious objection in healthcare<\/strong>. When, if ever, should a healthcare provider’s personal conviction about the wrongness of some intervention (be it abortion, euthanasia, or whatever)\u00a0be accommodated?<\/p>\n

In a paper<\/a> that has already attracted much attention, Ricardo Smalling and Udo Schuklenk argue that medical professionals have\u00a0no moral claim to conscientious objection accommodation\u00a0in liberal democracies.<\/p>\n

In part, they base their argument on their judgment that “the typical conscientious objector does not object to unreasonable<\/strong>, controversial professional services\u2014involving torture, for instance\u2014but to the provision of professional services that are both uncontroversially legal and that patients are entitled to receive” (emphasis added).<\/span><\/p>\n

It seems clear that\u00a0a lot hinges\u00a0on what is meant by “unreasonable” there–and on who should get to decide\u00a0what falls under that label. One answer to this question\u00a0might be,\u00a0“society should get to decide, through the enactment of laws, which ideally express the view of the\u00a0majority of people as to what is reasonable or unreasonable in medical and other contexts.”<\/p>\n

“Therefore,” this answer continues, “if a doctor thinks that some legally allowed service X is immoral, then she should rally\u00a0her fellow citizens to lobby their representatives to change the relevant law; but she should not be excused from providing the\u00a0service, if by law the patient is entitled to receive it.”<\/p>\n

“And if she really doesn’t want to do X,” the answer concludes, “she can always leave the profession and take up some other line of work.”<\/p>\n

This is a rough summary of what Smalling and Schuklenk do in fact say. I’d be curious to hear what people think. My hunch is that a person’s\u00a0attitude toward the\u00a0answer (i.e., whether they see it as good and convincing or not) will depend in large part on what they substitute for “X” in their minds when thinking about conscientious objection.<\/p>\n

The example that is almost always at the foreground of this debate is\u00a0“abortion,” and\u00a0the conscientious objector is usually\u00a0imagined–at least by those who argue against her accommodation–to be a deeply religious person who thinks that abortion is wrong, if not the equivalent of murder. If religious people’s beliefs\u00a0were routinely accommodated in such a context, the argument goes, many women would not have access to an important aspect of their healthcare (as it\u00a0is usually framed) to which they have a right. Therefore, conscientious objection should not be accommodated.<\/p>\n

But what if you substitute something else for X, and imagine a different kind of objector? In their contribution<\/a>,\u00a0Shimon Glick and Alan Jotkowitz reveal to the reader that, despite being religiously observant themselves, they<\/span>\u00a0“recognise and respect the consciences of atheists as well.” They go on to ask, “How would the authors react to physicians who refuse to perform genital mutilations such as circumcision, either male or female, which may be part of the services offered by the health agencies of liberal democracies?”<\/span><\/p>\n

Smalling and Schuklenk respond<\/a>\u00a0by pointing out some conditions they had laid down in their original piece: “the patients must be volunteers; the patient must be entitled to access the services; and the objection must be on private moral or religious grounds.”<\/span><\/p>\n

So, they go on to state, “Our argument is not addressing situations where eligible patients are not requesting a particular medical service. This renders the authors’ reference to issues such as involuntary euthanasia or female genital mutilation a moot point.<\/span>\u00a0Further, the patients must be legally entitled to receive such services.”<\/span><\/p>\n

I found this response a bit weird. First, Smalling and Schuklenk dodge on the issue of male circumcision (or “male genital mutilation<\/a>” in the words of Glick and Jotkowitz), and go straight to “female genital mutilation”\u00a0which is much more\u00a0widely\u00a0condemned. They then lump such “mutilation” in with\u00a0“involuntary euthanasia” as something that clearly fails\u00a0to meet their criterion\u00a0that “the patients must be volunteers.”<\/p>\n

Here is what I found confusing.\u00a0First, it seems that Smalling and Schuklenk simply assume that\u00a0“female genital mutilation” is always performed\u00a0on\u00a0a person who hasn’t volunteered. But the World Health Organization does not\u00a0distinguish between minor girls and mature\u00a0women<\/a> in its definition of “FGM,” thereby\u00a0creating a rather\u00a0tricky situation for so-called female genital cosmetic surgeries<\/a>, such as labiaplasty performed on consenting adults.<\/p>\n

I wonder what Smalling and Schuklenk would say about that case — is it OK to object to cutting the healthy genitals of an adult female “patient”\u00a0on conscience grounds, because you regard such cutting\u00a0as a form of mutilation (or as something that reinforces unjust\u00a0social norms, etc.)? If so, should\u00a0your objection be accommodated?<\/p>\n

And what about male circumcision<\/a>?\u00a0In Western countries, this is primarily done to healthy boys\u00a0for cultural or religious reasons: Should we say\u00a0the “patient” has not “volunteered”?\u00a0If we should say that, then perhaps doctors do have a moral claim to\u00a0conscientious objection\u00a0accommodation if they refuse to perform circumcisions–or any controversial procedure–on a minor. But then,\u00a0why would Smalling and Schuklenk skip over that example? It seemed key to the rhetorical question\u00a0raised\u00a0by\u00a0Glick and Jotkowitz.<\/p>\n

Who knows. It’s a fascinating debate. As you will see from the collection of papers below, there are a lot of “sides” to this\u00a0debate worth exploring. Check out the following sample of articles in this month’s issue of the\u00a0Journal of Medical Ethics<\/em>.<\/p>\n\n\n\n
\n\n\n\n
\n

Conscientious objection in healthcare: new directions<\/b><\/b><\/a><\/span><\/p>\n

Steve Clarke<\/span><\/p>\n

Further clarity on cooperation and morality<\/b><\/b><\/a><\/span><\/p>\n

David S Oderberg<\/span><\/p>\n

Mere sincerity<\/b><\/b><\/a><\/span><\/p>\n

Edward Collins Vacek<\/span><\/p>\n

A reasonable objection? Commentary on \u2018Further clarity on cooperation and morality\u2019<\/b><\/b><\/a><\/span><\/p>\n

Trevor G Stammers<\/span><\/p>\n

Response to commentaries: \u2018Further clarity on cooperation and morality\u2019<\/b><\/b><\/a><\/span><\/p>\n

David S Oderberg<\/span><\/p>\n

Conscientious objection in healthcare and the duty to refer<\/b><\/b><\/a><\/span><\/p>\n

Christopher Cowley<\/span><\/p>\n

Conscientious objection in healthcare: why tribunals might be the answer<\/b><\/b><\/a><\/span><\/p>\n

Jonathan A Hughes<\/span><\/p>\n

Conscientious objection in healthcare, referral and the military analogy<\/b><\/a><\/span><\/p>\n

Steve Clarke<\/span><\/p>\n

Reasons, reasonability and establishing conscientious objector status in medicine<\/b><\/b><\/a><\/span><\/p>\n

Robert F Card<\/span><\/p>\n

Rationing conscience<\/b><\/a><\/span><\/p>\n

Dominic Wilkinson<\/span><\/p>\n

Cosmetic surgery and conscientious objection<\/b><\/b><\/a><\/span><\/p>\n

Francesca Minerva<\/span><\/p>\n

Why medical professionals have no moral claim to conscientious objection accommodation in liberal democracies<\/b><\/b><\/a><\/span><\/p>\n

Udo Schuklenk, Ricardo Smalling<\/span><\/p>\n

Selling conscience short: a response to Schuklenk and Smalling on conscientious objections by medical professionals<\/b><\/b><\/a><\/span><\/p>\n

Jocelyn Maclure, Isabelle Dumont<\/span><\/p>\n

Two conceptions of conscience and the problem of conscientious objection<\/b><\/b><\/a><\/span><\/p>\n

Xavier Symons<\/span><\/p>\n

Response to: \u2018Why medical professionals have no moral claim to conscientious objection accommodation in liberal democracies\u2019 by Schuklenk and Smalling<\/b><\/b><\/a><\/span><\/p>\n

Shimon M Glick, Alan Jotkowitz<\/span><\/p>\n

Response to: \u2018Why medical professionals have no moral claim to conscientious objection accommodation in liberal democracies\u2019 by Schuklenk and Smalling<\/b><\/b><\/a><\/span><\/p>\n

Richard John Lyus<\/span><\/p>\n

Against the accommodation of subjective healthcare provider beliefs in medicine: counteracting supporters of conscientious objector accommodation arguments<\/b><\/b><\/a><\/span><\/p>\n

Ricardo Smalling, Udo Schuklenk<\/span><\/p>\n

Conscientious refusal in healthcare: the Swedish solution<\/b><\/b><\/a><\/span><\/p>\n

Christian Munthe<\/span><\/p>\n

The BMA’s guidance on conscientious objection may be contrary to human rights law<\/b><\/b><\/a><\/span><\/p>\n

John Olusegun Adenitire<\/span><\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

<\/p>\n","protected":false},"excerpt":{"rendered":"

by Brian D. Earp\u00a0\/\u00a0(@briandavidearp) On behalf of the\u00a0Journal of Medical Ethics, I would like to draw your attention to the current issue, now available online, which is almost entirely dedicated to the vexing question\u00a0of conscientious objection in healthcare. When, if ever, should a healthcare provider’s personal conviction about the wrongness of some intervention (be it […]<\/p>\n

Read More…<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1240,7933,443],"tags":[7994,2611,7993,7995,291,7964,7925],"class_list":["post-3148","post","type-post","status-publish","format-standard","hentry","category-blogosphere","category-brian-earps-posts","category-jme","tag-children","tag-circumcision","tag-conscientious-objection","tag-cosmetic-surgery","tag-euthanasia","tag-female-genital-mutilation","tag-journal-of-medical-ethics"],"yoast_head":"\nConscientious Objection Accommodation in Healthcare - Clashing Perspectives - 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\" href=\"https:\/\/blogs.bmj.com\/medical-ethics\/2017\/03\/24\/conscientious-objection-accommodation-in-healthcare-clashing-perspectives\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Conscientious Objection Accommodation in Healthcare - Clashing Perspectives - Journal of Medical Ethics blog\" \/>\n<meta property=\"og:description\" content=\"by Brian D. Earp\u00a0\/\u00a0(@briandavidearp) On behalf of the\u00a0Journal of Medical Ethics, I would like to draw your attention to the current issue, now available online, which is almost entirely dedicated to the vexing question\u00a0of conscientious objection in healthcare. 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Earp\u00a0\/\u00a0(@briandavidearp) On behalf of the\u00a0Journal of Medical Ethics, I would like to draw your attention to the current issue, now available online, which is almost entirely dedicated to the vexing question\u00a0of conscientious objection in healthcare. When, if ever, should a healthcare provider’s personal conviction about the wrongness of some intervention (be it [...]Read More...","og_url":"https:\/\/blogs.bmj.com\/medical-ethics\/2017\/03\/24\/conscientious-objection-accommodation-in-healthcare-clashing-perspectives\/","og_site_name":"Journal of Medical Ethics blog","article_published_time":"2017-03-24T06:06:04+00:00","article_modified_time":"2017-03-25T03:06:53+00:00","author":"BMJ","twitter_card":"summary_large_image","twitter_misc":{"Written by":"BMJ","Est. reading time":"6 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"Article","@id":"https:\/\/blogs.bmj.com\/medical-ethics\/2017\/03\/24\/conscientious-objection-accommodation-in-healthcare-clashing-perspectives\/#article","isPartOf":{"@id":"https:\/\/blogs.bmj.com\/medical-ethics\/2017\/03\/24\/conscientious-objection-accommodation-in-healthcare-clashing-perspectives\/"},"author":{"name":"BMJ","@id":"https:\/\/blogs.bmj.com\/medical-ethics\/#\/schema\/person\/ba3da426ed20e8f1d933ca367d8216fe"},"headline":"Conscientious Objection Accommodation in Healthcare – Clashing Perspectives","datePublished":"2017-03-24T06:06:04+00:00","dateModified":"2017-03-25T03:06:53+00:00","mainEntityOfPage":{"@id":"https:\/\/blogs.bmj.com\/medical-ethics\/2017\/03\/24\/conscientious-objection-accommodation-in-healthcare-clashing-perspectives\/"},"wordCount":1190,"commentCount":0,"publisher":{"@id":"https:\/\/blogs.bmj.com\/medical-ethics\/#organization"},"keywords":["children","circumcision","conscientious objection","cosmetic surgery","Euthanasia","female genital mutilation","Journal of Medical Ethics"],"articleSection":["Blogosphere","Brian Earp's Posts","JME"],"inLanguage":"en-US","potentialAction":[{"@type":"CommentAction","name":"Comment","target":["https:\/\/blogs.bmj.com\/medical-ethics\/2017\/03\/24\/conscientious-objection-accommodation-in-healthcare-clashing-perspectives\/#respond"]}]},{"@type":"WebPage","@id":"https:\/\/blogs.bmj.com\/medical-ethics\/2017\/03\/24\/conscientious-objection-accommodation-in-healthcare-clashing-perspectives\/","url":"https:\/\/blogs.bmj.com\/medical-ethics\/2017\/03\/24\/conscientious-objection-accommodation-in-healthcare-clashing-perspectives\/","name":"Conscientious Objection Accommodation in Healthcare - 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