More Thoughts on Conscience Clauses as Way to Protect Dissenting Health Care Professionals
I have written before--and no doubt will again--that the death culture brooks no dissent. I haven't gotten my mind totally around why this is yet, but I have developed some theories. I think issues such as assisted suicide are part of a (partially unconscious) but clearly unfolding coup de culture. Part of it too, perhaps, is that culture of death adherents are hypersensitive to the charge of supporting moral wrongdoing, and hence want all of us to be complicit in the system--a big reason in my view why the science community had a conniption over the Bush embryonic stem cell policy. Add in that many believe individuals will not be truly free to control their own lives unless virtually all impediments to abortion--and perhaps one day, assisted suicide, and other policies--are removed, and we can begin to see why refusenik medical professionals might be targeted for excommunication from their careers.
Some see conscience clauses as an answer to protect dissenting health professionals in a society that no longer agrees on fundamental issues of morality. I agree, although I don't think the privilege should be absolute. The issue is just coming to the fore of my thinking and I have begun to reflect on it here at SHS. A few days ago, I posted some thoughts on the matter over at the First Things blog. From my FT blog entry:
How ironic that physicians and others who simply wish to adhere to the precepts of the Hippocratic Oath are declared persona non grata in medicine.Other cultural conflicts beyond issues we generally deal with here at SHS have already become part of the conscience issue; such as the recent California Supreme Court ruling permitting a lesbian couple to sue a doctor who refused to artificially inseminate one of the partners due to a religious objection--even though the refusing doctor found another physician willing to perform the treatment for the patient, who was subsequently impregnated.
Be that as it may, those who believe in protecting medical conscience rights need to begin preparing the intellectual ground to protect dissenting professionals' careers without also opening the door to conscience being used as a club to deny wanted life-sustaining treatments such as feeding tubes by physicians who consider it wrong to maintain patients with a "low quality of life"--a proposal already gaining stream in bioethics known as "medical futility."
To keep from so throwing out the baby with the bathwater, I suggest that we consider at least two crucial distinctions in determining what would be a protected refusal to provide a requested medical intervention; first, between elective and non-elective procedures, and second between treatments and patients. Thus, doctors should be permitted to refuse elective procedures--that is, interventions not immediately necessary to save the patient's life or prevent serious physical harm--if their conscience so dictates, whether it be rhinoplasty, abortion, or assisted suicide. To prevent care refusals from being a mere cover for discriminatory attitudes, the requested procedure should generally be what violates the conscience, not bias against the patient. In this way, for example, an oncologist should not be able to refuse to treat a lung-cancer patient because the patient smoked or was a member of a racial minority.
No doubt there will be nuances within nuances here, so there will be much to consider. But with the rights of conscience likely to be an explosive bioethical controversy in the coming decade, the time to begin planning for the struggle is now.
So there will be much with which to grapple. Not fun, but necessary. At stake--literally--will be whether people of certain religious and moral beliefs will be able to enter and/or remain in the health care field, and whether religiously based hospitals and other institutions will be able to keep their doors open.
Labels: Conscience Clauses. Coup de Culture. Culture of Death. Human Exceptionalism.
posted by Wesley J. Smith @ 10:16 PM
23 Comments
23 Comments:
Dissent is no longer permitted in the health care system. One group of people you may want to think about in this regard are paralyzed people who have been dependent upon a ventilator for many years. When they go to the hospital they are often forced to use an inferior or different ventilator even though they are far more comfortable with their own system. When they object they are deemed "difficult" and perceived to be a "problem". Add in the fact the media deems life on a ventilator as inherently inferior and the social pressure brought to bear on those that lead lives on a ventilator is not easy. Shows like ER actively encourage characters and their loved ones to end their life rather than become vent dependent. This is but one specific example where the culture of death dictates the end of life for a distinct and insular minority group.
Liberalism (in the new-left vein) doesn't brook dissent either. Neither does death itself. Neither do bullies.
All this is just going to keep bioethicists in business and create more of a shield (dodging accountability by fobbing off the issue of ethics onto "the bioethicists") for the medical establishment, while the public becomes more and more confused, and the more confusiong the whole thing is, the more able the medical establishment will be to do as it pleases and get away with it. I find SHS rather too gentle and reasonable in discussing these issues; what has, and those who have, to be stopped is and are not reasonable and won't respond to reason; a more cut-to-the-bone approach is the only thing that can stop it, by the entire society.
Naturally there is pressure, including via TV shows like that, to have fewer people on ventilators; that would "save costs." An awful lot of things have gotten messed up in this society and this world since there was television, haven't they. How did the world manage before that. Like the media in general, makes people passive, accustoms them to all hearing the same thing, opens the way to tyranny. They focus on distinct and insular minority groups, and from there they can fan outward. They're the same with the elderly re ventilators. Since when are hospitals entitled to judge patients? Don't they exist in order to solve problems? But they cause them, and thus they try to direct attention and blame away from themselves onto their victims. They figure people need them -- well, now that they're a business, they need to be reminded that they are working for us, not vice-versa. This whole mess could be stopped if society as a whole became aware of what's going on and had the sense to raise Cain about it.
The lesbian insemination case is noteworthy. Whether or not it is moral, it definitely was elective. The MDs did exactly what abortion advocates and morning after pill advocates say that they want pro-life conscience objecting physicians and pharamacists to do-refer to another MD/health care provider. But that wasn't enough-not for them and not for the court. I think we can expect the same with abortion and abortifactient drugs and etc. Referring won't be enough.
One of the most damnable and self centered aspects of all of this is that it will likely alienate potential and working doctors, pharmacists and other medical personnel. This is serious because a large number of potential candidates are going to do something else with their incredible talents. They won't want to go into medicine to violate their morals and consciences. We have huge shortages of health care providers and there are forecasts of larger shortages. But anti-conscience advocates could care less. They are willing to impose their agenda at the expense of the health care needs of the rest of the nation.
Why is this being made so complicated? Why can't there just be a law that a doctor etc. can't kill or harm anyone under any circumstances, and leave the rest of it to the individual doctor, pharmacist, etc.?
That there even would be discussion about "conscience" indicates the problem -- they don't want anyone to have one. The whole "bioethics" thing is just a way in. Doctors WERE ethical before it got started. It's not about technology, or abortion, or homosexuality, or even ethics, or cost. It's really about second-rate intelligence and character, and about greed, arrogance, and power.
Ianthe: It is getting complicated because many in society want doctors to be able to engage in these activities. Conscience clauses are a rear guard action that seeks merely to prevent doctors from being forced to engage in such activities or be complicit in them. And the usual suspects are not amused.
Well "wantin' ain't gettin'" -- and if the medical profession had character it wouldn't be pulling plugs on people who want to live, and needing "conscience clauses, and forcing those who don't want to do certain things to do them or not worth there. The conscience clause should not be necessary; what's necessary is getting rid of those who have abandoned ethics (and turned it over to "bioethics") and who try to force their colleagues do what they consider unethical. In fact the conscience clause doesn't do any good if the usual suspects are giving those whom they are supposed to protect a hard time.
WHO wants doctors to be able to engage in these activities? The same idiots who = the many in society who think they "want" a "living will" when the ones who really "want" those documents are those who want to be able to get rid of the elderly and the disables. It's the same as the syndrome of pharmaceutical ads brainwashing people into not questioning the "Ask your doctor" pitch. Since when is it not the doctor's job to know what the patient should take? I go to a doctor and have to tell him or her what to prescribe me, s/he's no longer a doctor, s/hes a credentialed pharmaceutical company sales clerk. Sure, sometimes, even often, a patient is a step ahead of the doctor and knows what will work for him/her, but that's not on all fours with the pharmaceutical companies' agenda, which is to sell product, and they have pressured doctors and flooded the market to the point where the boundaries of the doctor's role and integrity have been violated. "Medical consumerism" is very good in some ways, but it's run amok. This overall societal phenomenon plays right into the hands of the usual suspects, who use "conscience clauses" as a ruse, a promise they never intended to fulfill.
I know, doctors themselves who wished not to have to violate their own ethical boundaries asked for "conscience clauses," or at least think that they did. But that was because their backs already were against the wall thanks to the "usual suspects," who not only are not amused, but also know that it doesn't matter whether they are amused at all, because they've got the game rigged. The conscience clause is a strong enough weapon, as they well know. Those whom they are supposed to protect have to take other actions in order to prevail.
I meant, the conscience clause is NOT a strong enough weapon, because it doesn't matter whether those from whom it is supposed to protect doctors who sign them are amused or not; the very need for the conscience clause means that they've already won, and doctors with ethics need to take additional routes, e.g. litigation, stopping in at the D.A.'s office, working through state agencies, publicity, picket lines, etc. The public still thinks, to a certain extent at least, that doctors know what they are doing, and doctors reaching into the public consciousness by addressing the public publicly and directly might be very effective.
Wesley,
It is a little off topic, but do you think that the Arizona bar associations consideration of an anti-discrimination against orientation in their oath could be a part of this push to remove conscience protections from ever more people in ever more professions? It seems that there is a real push to make religion a "private matter" to the extent that no one whose judgment is informed by religious or moral traditions is allowed in the public square. I recall there was a case in the last year where the EU refused to seat their government (I am not sure the term) because Italy had sent a Roman Catholic and the head of the EU made the argument that no person who is sincerely Catholic could also be unbiased and non-discriminating. Of course that begs the question: isn't all judgment discriminating in that it must decide which path, etc. is better?
Jessie: This is not the kind of informed opinion that I like to give. But here goes: Yes and no. I think there is a proper desire to prevent discrimination on one hand, that is in some cases mutating into a form of thought policing and coersion that is intended to stifle religious freedom that comes into conflict with the emerging cultural paradigm on the other. I also think that there is a desire among some to destroy robust faith, or at least its power in the public sphere.
I also think that for some, it will never be enough.
I received this note from a reader of SHS who disagrees generally with my perspectives, but supports conscience clauses. I reproduce it in full with his kind permission.
"Dear Mr Smith,
I read your post on conscience clauses. I'm also sympathetic to conscientious objectors, but my argument is very different than yours. (I think you would chastise me as a member of the death culture.) My thoughts are published here: http://smujournal.ca/view.php?aid=39581
All the best,
Mark Mercer"
Don't start me on Catholicism and sincerity. I've long felt sorry for sincere Catholics who have been forced from birth to deal with the antics of the Catholic Church. What I want to know is, what is the religion of the head of the EU? How readily does the EU expect to find an representative from Italy who isn't Catholic?
And how is it any of the EU's business what religion anyone is, anyway? Would they dare pull this stunt re a Muslim? What kind of a "Union" is it, anyway?
If we don't destroy them, they are going to destroy us.
I don't mean anyone in particular, I mean whoever, without restriction, threatens our civilization and what it's based on. Of course it's not "nice" to talk this way. Of course fighting for survival isn't "nice." Too bad, so sad. All the trouble started with "nice," and the ones pushing it as a paramount value and using it as a mask are the danger.
I don't mean anyone in particular, I mean whoever, without restriction, threatens our civilization and what it's based on. Of course it's not "nice" to talk this way. Of course fighting for survival isn't "nice." Too bad, so sad. All the trouble started with "nice," and the ones pushing it as a paramount value and using it as a mask are the danger.
Mr. Mercer seems to be arguing in favor of the tyranny of the majority. In fact, those wishing to pursue a truly liberal social policy should be vigorous defenders of conscientious objections because it protects the minority and its right to disagree in concrete terms. Just a thought.
I think that just as science is overrun with animal experimentation, human intellectualism has become overrun with too much spinning things out in the same manner, and with the same ultimate result, as Cato the Younger, bound and determined, ended his own life. How many disciplines that deal with the ethics and philsophies of other disciplines do we need to have? I agree with Jessie, and this seems to me to be yet another example of what starts out claiming to be one thing ending up in the opposite direction. Which is exactly on all fours with the utilitarianism/futile care school referring matters to "bioethics."
We Catholic feel sorry for you, too, Lanthe, having to put up with the antics of anti-Catholic society, one that embraces the humiliation dolled out onto hapless victims in the name of "Reality TV" and who glorify violence in such epic films as "Faces Of Death IV." And let's not forget the violence pornographers who demanded the right to show the beheading of an American by Muslim extremists on their webstites in the name of free speech. You have inherited a very sad state of affiars, and I pity you.
Wesley -
Here's my theory, and you can buy it for a dollar or throw it in the cat litter box.
1) Hitler showed up and started massacring a large group of human beings for no better reason than he hated his mom for being one.
2) People were horrified by the death camps, and realize that they were accomplices in their hatred of the Jews because they labled the Jews "Christ killers" and talked about how they burned in hell. (I've read the sermons, I'm going with what I know)
3) Around the same time as all this, most of the men were out fighting, so the women had to start taking over the men's jobs. Top that off, women who took those jobs were middle class. Middle class women once upon a time were important economic parts of their households (the "house work" they did was actually work that made the home function and got their produce/dairy/whatever sold properly, so it wasn't just keeping house, they were actually *working.* It wasn't until the industrial age that women had the weird "leisure time" they ended up with and were suddenly bereft of their jobs inside the house).
4) Men came back from war, and women were expected to give up their jobs and go back to the homestead. While that would have been okay back in the day when women were economic producers, we were resentful of losing out on meaningful work and going back to being cooks and house cleaners. We wanted meaningful work again.
5) Combine our desire for meaningful work with the general human horror at realizing a group of people were almost wiped out because of blind hatred, and our societ went out of its way to try to rectify the problem.
6) People that used to be downtrodden liked the fact that the formerly powerful were feeling guilty, and some people started to take advantage of it. People who wanted all humans to be totally equal, both male and female. People who wanted nobody to feel like anybody was superior, because that wasn't right.
10) It got out of control when the desire to knock the king off his horse went haywire, and people wanted everyone to be as lowly as worms because they wanted there to be no chance of someone coming along and saying, "We are the master race!" Only they went overboard.
That's my theory. As I said, you can take it or leave it. It's just a theory. But personally, I figure that's what happened - that people don't want human exceptionalism because they're afraid that "some humans will be more exceptional than others."
The Catholic Church and most of Judeo/Christian/Humanist teaching all say that all humans are equally valuable, no matter gender, color, or culture, but someone is always going to be so ethnocentristic as to think he's suprior. That's what happened with these people - they think they're superior in their desire to be *not* superior. If that makes sense.
Lanthe -
Damn. I'm sorry, I had a rough weekend and was feeling somewhat stressed out when I read your comment, and I came off as a smark aleck.
While I do pity American culture for having a passion for violence and a disregard for human exceptionalism, I shouldn't have mouthed off to you. We may have religious disagreements, but I had no call in being uncivil. I'm sorry.
T.E -- I didn't think you were uncivil. Don't worry about it. I just don't understand how it is that non-Catholics have inherited and have to put up with those things and Catholics don't. Nor is Catholocism the only religion that objects to them. Nor is everyone who objects to them even traditionally religious at all. What I meant by Catholics having to put up with the antics of the Catholic Church is several: Being born into a religion that never gives one a chance to think outside it, what I notices of its effects on the secular and seminary students I taught at a Catholic college, young boys who have been victimized by priests they were raised to believe they could trust, devout Catholics who are dismayed and anguished by the approval of the Vatican for removal from life support, etc. All these things I have seen as an outsider, even as someone who was born into the Orthodox Christian religion, and caused me to shake my head over the dichotomy between, on the one hand, the theology of the Roman Catholic Church, with some of which I agree, and the benefits it offers to a certain extent, and, on the other, the damage it does to many of its own followers, and I note a certain hypocricy in it. That is what I meant. Not to argue religion per se, but to make an observation relevant to one aspect of what, in society, makes it more difficult to win the battle on behalf of life.
Lanthe -
Wow. Thanks for being so understading - I've had a stomach bug and felt royally miserable all week, and I'm glad you did't get annoyed with me.
It's intersting. My mother is Jewish, and the better majority of my friends are Wiccan. I've got a best friend who is a homosexual male who believes in God but not in any religion, and several freinds who are Taoists, and four of my co-workers are Hindu... and my former confessor (my Catholic Priest) was a Hindu before he decided to join the Catholic Church. One thing that I was taught all my life was that if you don't understand the beliefs of others, you can't understand your own beliefs, so comparing religions was never an issue for me or any of my friends.
But anyway, that's just because I was a little surprised about what you said about being raised in the Church. According to the gents I work with, Hinduism also frowns on abortion (even though gender-specific abortion is all the rage in India these days) and euthanasia. So, you're right, Catholicism isn't the only one that frowns on devaluing humans.
I hope Wesley puts up with this question because now you've got me curious - I've never seen anybody go up in arms over the fact that the Vaticant doesn't disapprove of people not receiving unnecessary extraordinary care. Food and water are to be provided until no longer usable (eventually the body shuts down and the person can't eat or drink just because that's what dying does to the body), but keeping a person who is essentially dead on life support doesn't really jive with any of us, and I've never seen anybody complain about it before. Huh. Ah well.
Anyway, I appreciate talking with you. You're always fun to read even if I'm not in a position to reply all the time.
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