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 That’s because access to care should take priority, and
conscientious objectors may make it more difficult for patients to
get treatment they need, Dr. Julian Savulescu of the University of
Oxford in the U.K. and Udo Schuklenk of Queens University in
Ontario, Canada, argue in an article in the journal Bioethics.
They make their case as a growing number of countries worldwide are
grappling with how much autonomy to give patients and doctors to
make decisions about care at the very beginning and end of life,
particularly in an era when new technology and social media keep
pushing the boundaries of long-held personal and religious beliefs.
“Doctors have values, often deeply held values, like everybody else.
However, unlike in most professions, doctors can sometimes be asked
to perform activities that go against some people’s values,”
Savulescu told Reuters Health by email.
“Although there are situations where conscientious objection could
be allowable where there is an ample and readily available choice of
alternative provision including those who do offer the service, it
should not be a legal right for the doctor,” Savulescu added.
In some countries, including Sweden and Finland, doctors are barred
from refusing to provide any medical care that is legal and can be
fired for doing so, the authors note.
Elsewhere, including countries like Australia, Canada, the U.K. and
the U.S, laws have historically allowed for conscientious objection
and doctors often enter the profession with an expectation that they
won’t be forced to provide care that conflicts with their religious
or personal beliefs, the authors point out.
With contraception, they argue, doctors should have no legal right
to refuse it because women don’t have another way to get it.
Moreover, to the extent women want birth control, family planning is
a social good that may help prevent overpopulation.
Their paper is a rebuttal to a defense of conscientious objection by
Christopher Crowley of University College Dublin that appeared in
Bioethics last year. (http://bit.ly/2dSjoiE)
On the point of contraception, Crowley argues in his paper that
general practitioners who might provide birth control as a very
small part of their practice should have the right to refuse this
service in much the same way they might be accommodated if a back
injury prevented them from performing certain job duties.
With contraception, or with abortion or physician-assisted suicide,
a general practitioner who has moral objections to the service can
refer patients to a provider that has no such objection, Crowley
notes. This way, the conscientious objector doesn’t necessarily
limit access to care.
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But in their rebuttal, the authors of the current paper argue that
people who don’t believe doctors should provide contraception
shouldn’t become general practitioners. Instead, they should choose
another medical specialty or pursue a different career.
It’s best for patients and for physicians for people to get care
from clinicians that willingly provide it, said Holly Fernandez
Lynch, a bioethics researcher at Harvard University in Boston who
wasn’t involved in either paper.
“The medical profession has a responsibility to make sure there are
adequate professionals willing to provide various services under its
monopoly – this doesn’t necessarily mean forcing objectors out, but
rather incentivizing willing professionals,” Lynch said by email.
Whenever possible, patients should ask doctors up front about any
services they won’t provide, and physicians should volunteer any
objections to specific types of care, Lynch added.
Sometimes, hospitals have religious prohibitions against providing
services such as abortion that limit what doctors can do, noted
Arthur Caplan, head of bioethics at New York University Langone
Medical Center.
“For example, in seeking admission to a hospice, nursing home or
home care program it is crucial to ask about their values and
practices in managing end of life issues,” Caplan, who wasn’t
involved in either paper, said by email. “At any hospital they have
an ethics committee and be ready to use it in case of a conflict
with a doctor.”
SOURCE: http://bit.ly/2dl8CkQ Bioethics, online September 22, 2016.
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