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12/01/2016

Bioethics Under Attack: Analysis Is Seen As Threat

by Craig Klugman, Ph.D.

A September article in Bioethics by Julian Savulescu and Udo Schuklenk has lit a fire under the Christian media. According to such news sources as The Stream (a conservative Christian website) and author William Briggs (you have to read his bio) “Bioethicists Want to Purge Christian Doctors.” This reaction to the Bioethics article is further evidence that we see what we want in writing rather than what is actually written.

In their article, “Doctors Have No Right to Refuse Medical Assistance in Dying, Abortion or Contraception,” Savulescu and Schuklenk offer a refutation of an article by Christopher Cowley’s, “A Defence of Conscientious Objection in Medicine: A Reply to Schuklenk and Savulescu.” Yes, the article that has offended the Christian press is a reply to a reply to a 2015 editorial written by Schuklenk and a 2006 analysis by Savulescu.

First, it’s important to note that editorials and analyses are not facts but are statements of the opinions and findings of the author. Second, the earliest lesson of ethics and humanities is to always go to the source. Savulescu’s 2006 BMJ Kantian analysis argues that if there is a true duty of a physician than a doctor must do it because if the action was morally wrong, then it would not be a duty. Thus, he concludes that conscious objection should not be part of medicine. If a person is not willing to “offer legally permitted, efficient, and beneficial care to a patient because it conflicts with their values, they should not be doctors.” Basically, Savulescu argues that professional duties outweigh personal values and if a person cannot perform such duties, then he or she should not be in medicine.

In Schuklenk’s 2015 Bioethics editorial, he writes in regards to Canada’s Supreme Court decision stating that practitioner-assisted suicide is a constitutional right. Schuklenk argues that conscientious objections are problematic because from one perspective if a provider has strong beliefs against an action, the requirement to transfer a patient to another provider who will provide treatment is implicit engagement in an immoral act and thus in itself is immoral. From the patient perspective, having a provider who objects to a procedure could mean not receiving the procedure if located in a rural area (or other place with few doctors), or might require a patient to call dozens of doctors to find one who can give him/her a legal, safe, and desired treatment. Thus, he concludes that conscientious objection for those who do not want to participate in assistant suicide should not be permitted. In Canada, assisted suicide is part of the job and if one has a problem with it, then that person should not be a doctor.

Cowley’s 2015 article in Bioethics debates both of the previous articles, stating both Savulescu and Schuklenk “have misunderstood the special nature of medicine, and have misunderstood the motivations of the conscientious objectors.” In other words, he argues that for the most part (but not in all parts) they are wrong.

In response to Cowley, Savulescu and Schuklenk jointly published a 2016 article in Bioethics, where they argue that Cowley’s belief that they misunderstand is incorrect. “We argue that there should be better protections for patients from doctor’s personal values and there should be more severe restrictions on the right to conscientious objection particularly in relation to assisted dying. “ They state that three conditions are possible. 1) Eliminate conscientious objection, 2. Choose people to practice medicine and to practice specific specialties who have no objection to all of the legal, safe, and efficacious actions that such a professional must understand, or 3. Give people outside of medicine the power to perform these actions over which medicine currently has a monopoly. It is this latest article with which the Christian press has an issue and has declared that Savulescu and Schuklenk are against Christian doctors. Of course, this is a statement that they never said nor insinuated.

Essentially, these exchange of papers has been over whether professional duties override personal values or vice-versa. And the Christian Press turned that into a rage against bioethicists who are against “Christian doctors.” “Values” do not equal Christianity. “Conscientious objection” does not always mean being a conservative (remember when the term meant one was avoiding the draft and was labeled a bleeding heart liberal?). This is a case of an author inserting content and meaning into an academic debate that was never there. This is a case of sensationalizing ideas and spinning them to support one’s perspective and agenda—in this case fodder for bioethics being against religion (specifically Christianity). And of course, such conclusion is based on a single response to a response article, rather than someone who read through all of the articles in this exchange and took the time to examine what this debate is about. It’s more fun and raises more money (and draws more readers) if you simply type in all caps and distort what others are saying.

Savulescu and Schuklenk hold that professional obligation overrides personal belief while Briggs beliefs that personal values always outweigh professional obligations, a position held by many in the religious right. For example. under Pence, Indiana passed a religious liberty bill that allows one to discriminate against anyone whose actions, beliefs or status challenge religious beliefs. There is no right or wrong here, it is a difference of worldview.

In a recent blog, Art Caplan held that Trump may not be a friend of bioethics and we may face some tough times ahead as the things valued by most in bioethics—science, social justice, proven facts—are not part of the values currently in vogue: “Bioethics is in for some self-assessment and tough hand to hand combat.” Caplan states that under Trump there will be a rise in power of the religious right that may send us back to the culture wars of the 1980s. This prediction may come true far sooner than we ever thought and bioethics, alongside much of the academy, may be in a difficult time. As painful as it may be, we also have to reach out and read fringe media sources outside of the mainstream and outside of our comfort zone. Instead of running from these trolls, we need to continue to educate, to speak, and to question. And as Caplan says, we must do so humbly.

 

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