The brave new world of contemporary bioethics

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A few months ago, I tweeted that today’s ethicists sometimes serve the function that sophists used to fulfill in Ancient Greece: to provide moral cover for the powerful.  A “consensus statement” issued last week by a committee of philosophers and bioethicists  brings some pertinence to my comment.

These international scholars–all from prestigious Western institutions–had met in June in Geneva, Switzerland to take up the question of conscientious objection in healthcare.  Here are the first five points of their ten-point statement, published on the Practical Ethics blog of the University of Oxford philosophy department:

  1. Healthcare practitioners’ primary obligations are towards their patients, not towards their own personal conscience. When the patient’s well-being (or best interest, or health) is at stake, healthcare practitioners’ professional obligations should normally take priority over their personal moral or religious views.
  2. 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.
  3. Healthcare practitioners who wish to conscientiously object to providing medical treatment should be required to explain the rationale for their decision.
  4. 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[sic] 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[sic] and the sincerity of the objection should be on the healthcare practitioners.
  5. 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[sic] of healthcare practitioners’ moral objections to certain medical services.

The remaining 5 points add additional demands on how to deal with rogue objectors, including the provision that  medical students “should not be exempted from learning how to perform basic medical procedures they consider to be morally wrong.”

Whether the ethicists on the panel have any knowledge or understanding of history and of the use of the medical profession for  is unclear.  In the comment section following the statement, David Albert Jones remarked that “it seems most curious for ‘ethical’ guidelines to discourage independent ethical thought on the part of practitioners.”  Most curious indeed…

If the proscription against following one’s conscience sounds like a tough pill to swallow, physicians and healthcare professionals should not be too despondent.  Practical Ethics provides a very practical remedy against any qualms we may have about providing medical care that we morally object to:  One of their most popular online articles is a blog post entitled—I kid you not—”7 Reasons Not To Feel Bad About Yourself When You Have Acted Immorally

Of all the signatories to the statement, only one holds a medical degree and none of them are healthcare professionals.  As far as I can tell, that is fairly typical for the field of bioethics, which is dominated by non-clinical personnel.  Of course, a lack of first-hand clinical experience does not disqualify one from holding worthy ethical opinions, but I suspect that clinicians may be more likely to have a sense that the concept of “legally, professionally sanctioned medical services” does not necessarily correspond to an objective good.

Besides, one would also hope that well-trained philosophers would also have some sense that modern philosophy provides very little support for an objective concept of health on the basis of which one might claim to trump the right of the healthcare worker to conscientious objection.  On the contrary, the dogmatic pronouncements of the statement make it seem like the notion of “patient benefit” is like a verifiable, mathematical proposition.

The ethicists seem so oblivious to the intrinsic violence of their demands that it is not too surprising they should elsewhere justify other forms of overt violence.  Two of the signatories–Francesca Minerva and Alberto Giubilini–drew headlines a few years ago for writing a paper in which they made the case for “after-birth abortion,” or elective infanticide.  To their credit, the logic they applied to the argument is hard to dismiss: if an unborn fetus has no moral status, why should a newborn baby have moral claim just for being outside the womb?

Perhaps that’s where we should seek an explanation—if we want to be charitable and look for one—for the bizarre and chilling new ethics.  It doesn’t stem from a failure to reason properly, but from proper reasoning under false metaphysical assumptions.  If the metaphysical worldview of the new ethicists is one of atoms twirling in the void (and we can suspect it is, since that is the default perspective in most academic philosophical circles), then it may be unsurprising that the notion of violence should be so elusive to them.  There is no account of violent motion in a Newtonian world (as there is in the classical philosophy of nature), just like there is no distinction between things, save accidentally: the child and the salamander are simply different arrangements of the same underlying matter.

Given the truncated paradigms under which many of today’s ethicists operate, asking them to differentiate genuine medical care from that practiced according to majority opinion or under the mandates of the powerful may be too much to expect.

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6 thoughts on “The brave new world of contemporary bioethics

  1. Excellent article depicting the usual oppression and diminishment of individual integrity and conscience when the collectivist ethos carries the day! We’ve seen where that takes us from innumerable frightening examples in the historical record of collectivist movements. We should fight every manifestation of this in the government’s interactions with physicians and medical care, or we will rue the days we failed to do that.

  2. I think this is all well and good for the physician who runs a self-employed cash business. But for those who accept third party payments and/or work for others, isn’t this issue covered by the idea that one should take the job expectations into account when deciding on a career?

    I don’t see it as a freedom of speech issue if one decides to become a Catholic priest and is disciplined for joining a pro-abortion rally. Becoming a priest was a choice, and the Church’s objection to its priests publicly supporting abortion was readily anticipated. No one is forced to or has an absolute right to become a priest. Likewise, I probably shouldn’t become a cop if my beliefs about social justice make me profoundly uncomfortable with moving homeless people’s encampments off privately held land. It doesn’t take a lot of foresight to recognize that as a police officer, one is likely to be asked to do that. Otherwise, taken to its logical extreme, the police captain is left walking into the squad room whenever a case comes up asking “Hey, can I get some volunteers who would be comfortable doing X?”.

    • Not sure the cash business aspect is that relevant. As of yet, most physicians (and hospitals) still operate under fee-for-service, even in countries with national healthcare systems. Shouldn’t physicians be allowed to pass on business they find objectionable? Of course, one can invoke a theory of “public accommodation” to force anything on anyone. I certainly find that objectionable, regardless of what the particular issue might be. It’s a fundamental threat to civil liberties.

      As far as employed physicians are concerned, your point may be more valid, but only if the employment contract stipulates from the get-go what the job expectations are. These contracts would be tailored individually and employers would presumably have recourse to penalize physicians under existing contract law.

      I also don’t think the main issue is necessarily a theist/atheist struggle, although that clearly is in the background. I’m sure atheists have consciences too and, on principle, would object to have it be subject to the whims of the political structure. Also, there are anti-abortion atheists (http://www.prolifehumanists.org/secular-case-against-abortion/) Again, a principle of civil liberties.

  3. Very nice reflection on the implications of such a disregard for physician conscience, which is to say, a disregard for medical professionalism itself. I agree wholeheartedly when you identify metaphysical ignorance at the root of this. We should not be surprised at these conclusions when we recognize that Modern Medicine has forgotten or has chosen to willfully ignore its traditional goal: the restoration of natural, organic function in the human being. Instead, we have chosen as our new purpose the fulfillment of human will, whatever that may require. A conscience-based refusal to perform a procedure is a denial of the sovereignty of the human will and thus cannot be tolerated…