A very good opinion piece,written by a physician and bioethicist, Dr. Bob Orr, appeared in the current AM News, which is published by the AMA. From the column:
The right of conscience in medicine generated very little discussion prior to the current generation. In the 1960s and ’70s, individual autonomy expanded and became dominant in Western medicine. Patients rightly confronted paternalistic physicians and demanded greater say in their medical care. Only in this autonomy-focused setting has the physician’s right of conscience become an issue.
The concomitant legalization of abortion, which had been morally and legally forbidden for centuries, brought the issue into sharp focus. Can a physician who still considers abortion to be immoral be forced to participate in or assist the patient in obtaining this procedure? In broader terms, does a physician have the right to refuse to provide or assist in any way in the provision of a particular service based on religious beliefs?
This is an important point: The laws and popular values changed. But does that mean the ethics of medicine have to, as well? I think not. If ethics mean anything, surely they should apply regardless of the state of the law.
Orr continues:
Those who oppose a physician’s right to exercise his or her conscience in decision-making use flawed reasoning in several areas:
- Opponents maintain that patient autonomy is the final arbiter of treatment decisions. There are clearly times when patient autonomy is not the determining factor, such as imposed immunizations, imposed quarantine, imposition of life-saving treatment when a patient has made an irrational refusal of treatment, and prevention of suicide.
- Opponents assert that licensed physicians are obligated to provide any service that is legal. Acceptance of this flawed precept would require a physician to provide or facilitate each patient request for a legally available service, e.g., every Oregon physician would be required to assist a dying patient with a request for physician-assisted suicide.
- Opponents erroneously maintain that negative patient autonomy (the right to refuse a recommended treatment) and positive patient autonomy (the right to demand a treatment) are morally equivalent. It is a well-established tenet of medicine that the patient’s right to refuse is nearly inviolable, but a patient’s right to demand a specific treatment is subject to physician discretion and veto. Were this not so, patients could demand unnecessary surgery as well as prescriptions for antibiotics or narcotics.
- Opponents assume that matters of conscience for the professional are matters of personal opinion rather than matters of divine or ecclesiastical authority. For a physician to acquiesce to a patient request for a lethal prescription is not a personal opinion. It would be a violation of most people’s understanding of the basic tenets of all three monotheistic faith traditions.
It has been assumed for centuries that physicians are moral agents who have the right to refuse to provide requested services that conflict with their religious or moral beliefs. This assumption is being challenged. This ancient right should be defended by all of society.
Exercising conscience is a powerful way to communicate by conduct that because something is legal doesn’t mean it is right. What is so ironic, is that many of the groups who have been so supportive of “speaking truth to power” in other contexts, are the most vociferous in seeking to deny that right to medical professionals.
