The Harms of the Cleansing of Conscience Objection on the Practice of Medicine
Total Page：16
File Type：pdf, Size：1020Kb
The Harms of the Cleansing of Conscience Objection on the Practice of Medicine Thesis Presented in Partial Fulfillment of the Requirements for the Degree Master of Arts in the Graduate School of The Ohio State University By Cynthia Jones-Nosacek, MD Graduate Program in Bioethics The Ohio State University 2020 Thesis Committee: Ashley Fernandes, Advisor Ryan Nash Courtney Thiele Copyright by Cynthia Jones-Nosacek 2020 Abstract Secular bioethicists such as Ronit Stahl and Ezekiel Emmanuel (among others) look at controversial issues such as abortion and reproductive health and have declared that consensus has been reached. Those who disagree are told that if they cannot sacrifice their consciences, they should sacrifice their careers. They assert that people who agree to enter the field of medicine are bound by the decisions of various medical societies, even ones they do not belong to. It is those societies alone who will determine what it means to be a physician. But what happens if conscience is removed from the moral equation and ceded to a medical society? While there are limits to conscientious objection where there is imminent risk of injury or death, the cleansing from the practice of medicine of persons who have moral objections would harm not only physicians and the medical profession, but most importantly, harm patients. First, the impact of the removal of conscience will be decidedly negative. Physicians will know that they cannot be trusted based on their own moral values, that even their own medical societies don’t trust them. They can be forced to act against their conscience without any evidence than what they were doing is causing anything more than subjective patient disagreement or inconvenience. Stahl and Emmanuel’s argument would claim that health care professionals are to do whatever the bureaucracy of medicine tells them to do as long, as it satisfies the demands of the patients. Physicians must submit to the paternalism of external agents. Second, the limitations on conscience in medicine. While the legal protections are beyond the scope of this paper, there needs to be an ethical evaluation of the conditions for limitations. I i will defend Daniel Sulmasy’s view that treatment should be provided in an emergency as defined as imminent risk of actual illness or injury and, if there are objections to what is provided by the objector, it should be evidence based, not anecdotal. Furthermore, the information should be accurate. The physician should not lie nor withhold medically necessary information. However, I will suggest that there may be controversy over what is medically “accurate” and what level of evidence is necessary, especially since “politically correct” treatments such as for gender dysphoria are acceptable at the lowest level of “expert.” The reasons for conscientious objection should also be nondiscriminatory. Care should not be denied based on race, creed or sexual orientation. Finally, alternatives to what the patient is demanding should be offered. Third, the demand to remove conscience from medicine is based on a fundamental change in its ethos. Medicine will no longer be considered a calling but a job where an external bureaucracy determines what is proper or not. Lastly, removing persons who morally object to using their medical knowledge to treat conditions which are not a disease will cause serious harm not only to physicians, but also the medical profession and, most importantly, patients. It will not only prevent the reflective equilibrium which Stahl and Emmanuel so value, but actually cause harm by preventing to correct the mistakes that they admit that medical societies have made in the past. ii Dedication This thesis is dedicated to my patients who taught me well. iii Acknowledgements Ashley Fernandes who talked me into this program My professors who taught me about the realm of bioethics and made me think My husband Gary, daughter Theresa, son-in-law Tim, and grandchildren Argentina and Xavier who put up with my studying iv Vita Education: 1974-1977 B.S. cum laude Carroll College Waukesha, WI 1977-1980 M.D. Loyola University/Stritch School of Medicine Maywood, IL 2018-present graduate master’s degree student bioethics Ohio State University Postgraduate Training: 1980-1983 Family Practice Resurrection Hospital Chicago, IL Specialty Certification: 1983 American Academy of Family Practice Recertified 1990, 1996, 2003, 2014 Fellow of the American Academy of Family Medicine Administrative Appointments Department Head, Family Practice St. Mary’s Medical Clinic 6/88-5/94 Academic Appointments: Associate Professor of Clinical Medicine, Family Practice Medical College of Wisconsin 1990-92 Preceptor Nurse Practitioner Students University of Wisconsin-Milwaukee 1998-2019 v University of St. Louis 2003 Marquette University 2003-2010 Concordia University 2007-2010 Marian University 2012-2013 Columbia/St. Mary’s Family Medicine Teaching Service 10/06-2/07 Research Projects Marquette Model of Natural Family Planning 2001 REACH (registry for enhancement of asthma control and health) 2002 Hospital Committees NICU, St. Mary’s Hospital 3/1992-2/1994, 3/1996-2/1998 Physician Advocate Columbia/St. Mary’s 9/2005-6/2007 (100,000 lives initiative, SBAR) vi Publications Jones-Nosacek C. (2014) End of Life Care Should Not Necessarily Be Minimal and Swift, Ch 2. Death and Dying Scherer L, ed., Greenhaven Press (reprinted from "Giving Up Is Hard to Do," Milwaukee-Journal Sentinel, 2/28/2013) Jones-Nosacek C. (2015). Treating Patients as Customers--Whom Does it Help?. WMJ : official publication of the State Medical Society of Wisconsin, 114(6), 229. Jones-Nosacek C. (2016) Colloquy: Opportunistic Salpingectomy: Benefits Do Not Outweigh Risks. National Catholic Bioethics Quarterly, 16(2):193-195 https://doi.org/10.5840/ncbq201616216 Jones-Nosacek C. (2018) The Hippocratic Oath and Why It Should Still Matter. The Natural Family, 32(1-2):47-70 Jones-Nosacek, C. (2020). Fertility Technology Research and the Use of Human Beings as Property. The Linacre Quarterly. https://doi.org/10.1177/0024363920947263 Jones-Nosacek, C. (2020). Stay-at-Home Orders and the Common Good. The Linacre Quarterly. https://doi.org/10.1177/0024363920951659 Field of Study Major Field: Bioethics vii Table of Contents Abstract ...............................................................................................................i Dedication ........................................................................................................ iii Acknowledgements ..........................................................................................iv Vita .................................................................................................................... v Publications .....................................................................................................vii List of Tables ..................................................................................................... x List of Figures ...................................................................................................xi Introduction…………………………………………………………..….…….1 Ch. 1 A Review of Secularist Accounts of Conscientious Objection.……..….4 Ch. 2 Defining Terms: A Critical Issue……………………………………...12 Ch. 3 History of the Term Conscientious Objection and Protection of Conscience…………………………………………………………………...16 Ch. 4 Conscience…………………………………………………………….20 Ch. 5 Limits of Conscience in Medicine…………………………………….28 Ch. 6 Referrals vs Transferring Care………………………………………..33 Ch. 7 The Telos and Ethos of Medicine…………………………………….35 Ch. 8 Medical Decisions and Values………………………………….…….44 Ch. 9 Harms…………………………………………………………………49 Conclusion…………………………………………………………………..60 viii Bibliography………………………………………………………………...67 ix List of Tables Table 1 Summary of key articles in the literature against conscientious objection………8 Table 2 Opposition to CO……………………………………………………………….11 Table 3 Limits of Conscience……………………………………………………………32 Table 4 Ethos of Medicine as Commodity vs Vocation…………………………………42 Table 5 Harms……………………………………………………………………………59 x List of Figures Figure 1 Hull Article………………….……………………………………………………….2 xi Introduction The literature on conscientious objection (CO) is increasingly vast. Since Savulescu first published in 2006, there has been a steady drumbeat against CO. After decades of accommodation, CO at its worst is as Christina Fiala and Joyce Arthur point out, “dishonorable disobedience” to the dictates of the profession (Fiala and Arthur, 2014). It is an unprofessional refusal to provide a democratically determined medical service (Savulescu, 2017). It is harmful to patients (Fiala and Arthur, 2017). Those who object to what these authors support should practice in a way that limits those harms if not leave the medical profession altogether. In 2016, the ACLU published “Healthcare Denied.” In it, it supposedly debunks “myths” that Catholic hospitals give adequate care in emergencies and decries that no tubal ligations or abortions are done there (ACLU, 2016). Under the Affordable Care Act, the Obama administration interpreted section 1557 to include termination of pregnancy and that one must treat patients according to their gender identification (Smeaton, 2020). In the fall of 2019, a transgendered person won a suit against a Catholic Hospital in California for denying “full and equal access” by refusing to perform a hysterectomy (Meyer, 2019). In the New England Journal of Medicine, the merger of Catholic Hospitals with secular one was called a “growing