Do physicians have conscience rights, or must they provide every service?
“I have often wondered at the smugness with which people assert their right to enslave me, to control my work, to force my will, to violate my conscience, to stifle my mind — yet what is it they expect to depend on, when they lie on an operating table under my hands? Their moral code has taught them to believe that it is safe to rely on the virtue of their victims. … Let them discover in their operating rooms and hospital wards that is it not safe to place their lives in the hands of a man whose life they have throttled. It is not safe, if he is the sort of man who resents it — and still less safe if he is the sort who doesn’t."—from the fictional Dr. Hendricks in "Atlas Shrugged” by Ayn Rand
In a paper entitled “Doctors Have no Right to Refuse Medical Assistance in Dying, Abortion or Contraception,” Canadian and British bioethicists Jualian Savulescu and Udo Schuklenk argue that doctors should in fact be “throttled” to the whims of the state. Moreover, they blame a reticence to do so on the influence of organized religion whose values are “imposed” on people. They eschew the idea of conscientious objection protections that were “written into constitutional arrangements in times gone by when the influence of churches was significantly more powerful than it is today.” Instead they prefer the wisdom of “enlightened, progressive secular countries” that have “resolutely prioritised patient access to care over the protection of doctors’ idiosyncratic moral convictions.”
The idiosyncratic moral convictions to which they object? A doctor’s ability to make the distinction between life-giving and life-taking actions.
And what if doctors insist on following their consciences? “Doctors must put patients’ interests ahead of their own integrity,” the authors counter. “They must ensure that legal, beneficial, desired services are provided, if not by them, then by others. If this leads to feelings of guilty remorse or them dropping out of the profession, so be it.”
To further bolster their argument against conscientious objection, they bring a multicultural take on religion to the mix, noting its supporters “confine their analysis to a discussion of Christian conscience.” They cite the religion of Islam, “whose conscientious objectors include those who will not treat the opposite sex at all, and can barely conceive of secular consciences that might influence medical treatment.”
Apparently our pair of bioethicists have their own particular set of blinders with regard to secular consciences, a term that might be more aptly described as “cultural norms.” In several cultures, especially those in the Middle East and Africa, doctors perform female circumcision, a practice most Westerners label female genital mutilation (FGM). Again, if one ascribes to the multicultural proposition that all cultures are equally viable — and that conscientious objection has no place in the medical profession — the practice of cutting of a young woman’s clitoris to diminish her sexual desire and preserve her sexual honor prior to marriage, would not only be viewed as neither right nor wrong, but a procedure doctors would be required to perform.
Should doctors who refuse to do so also “drop out of the profession?”
Patients Rights Council consultant Wesley J. Smith notes the critical distinction between where the medical profession is now and where Savulescu and Schuklenk would like to take it. “Please understand that the bioethicists advocate elevating life-taking practices (where legal) such as euthanasia from what I call ‘mere legality,’ meaning it can be done if a doctor is willing, into a positive right — meaning the doctor must do it,” he writes. “Hence, since the patient has a right to be made dead, society and the medical profession has the duty to coerce all doctors into participating in a medical culture of death.”
And not just doctors. Savulescu and Schuklenk also believe “there is no reason why only doctors could competently provide, for example, contraception, abortion or assisted dying services.”
Larry Worthen of the Christian Medical and Dental Society of Canada get to the heart of the matter. “The only governments in the history of humanity that have stripped away the conscience rights in this way are totalitarian governments,” he explains. “Are we going to get to the point where there’s an ethics test at the beginning of medical school, and if you have too much in the way of ethics, you’re going to be screened out?”
In something best described as overwhelmingly ironic, Savulescu and Schuklenk declare that those who believe in conscientious objection are themselves guilty of ethical relativism. “Ethical relativism is the view that the truth of ethical statements — such as abortion is wrong — is dependent on, or relative to, the culture, group or individual making the statement,” they write. “Ethics is relative to groups, cultures or times.” Thus they further assert if “one accepted ethical relativism, the holocaust was, from the Nazi’s perspective, right. It is just that today we have a different set of values from the Nazis.”
They attempt to wriggle of the hook by claiming there is a “paradox” in the equation. “We do want doctors to act on their conscience when the stakes are high, and their conscience is right: when they are asked to be complicit in or participate in an evil,” they assert. “Nor do we want what might loosely be called ‘unconscientious objection.’ That is, doctors mistakenly failing to provide beneficial care on the basis of false moral beliefs. This is the paradox of conscientious objection.”
Their “solution” to this paradox reveals their totalitarian impulses: the modern-day state should not only be the sole arbiter of good and evil — but their ultimate enforcer.
Furthermore, our duo presumes to know what “most people” think, stating that those “who believe contraception, abortion and euthanasia are wrong don’t believe they are evil in the same way as, for example torture or genocide are evil.”
Really? There are millions of Americans who believe the more than 58 million abortions performed since the U.S. Supreme Court legalized it 43 years ago epitomizes genocide.
Ultimately, the argument proposed by Savulescu and Schuklenk is based on two over-arching premises. First, it is clear these two do not believe all men are “endowed by their Creator with certain unalienable Rights.” In their world, the state is the highest power, and whatever it decides is “ethical” is not only good, but completely enforceable.
Just as speciously, they assert health care is a “right.” It is not. It is a privilege made possible by the dedication and hard work of those who would provide it. Yet for many years progressives and their followers have long insisted otherwise, without bothering to explain how a such a right is implemented without the consent of its administrators.
As in “Atlas Shrugged,” Savulescu and Schuklenk would implement it at the proverbial point of a gun. And while it might be possible to rely on the virtue of their current victims, one is left to wonder how many young people contemplating a career in medicine will go forward if becoming a doctor amounts to nothing more than being an ethically neutered agent of the state — and all its bureaucratic capriciousness.