Freedom and conscientious objection in the health professions
Gonzalo Herranz, department de Humanities Biomedical, University of Navarra
lecture at high school of Pharmacists
Pamplona, May 15, 2006
I.
Permanent interest of the topic
The selective unpopularity of the health odc
II.
Relationship between freedom, conscience and odc
What happened to Savulescu's article ?
a. The denial of the odc is a denial of freedom.
b. Risk of identifying what is legal with what is fair
c. Distortion of the doctor-patient relationship.
Greetings and thanks
A complex topic , an irregular polyhedron, with many facets: ethical, legal, political, philosophical, religious, social. Susceptible to be charged with electricity, to provoke controversy: of incomprehension and rejection; or of abuse and manipulation. A topic of which one never stops talking or writing.
In considering the content and the degree scroll of this intervention of mine today, I decided to construct it with an introduction that serves to highlight the ethical nature of conscientious objection (CO), its demands and its costs, its dignity and moral beauty and its risks, and then to try to approach, from a new angle for me, provoked by the recent publication of a article by Julian Savulescu, the problem of the special relationship between freedom and CO.
This seemed to me to be an acceptable way of approaching our subject, which relieves me of the task of giving this talk an encyclopedic article cut. Moreover, I assume that those present here, active members of this information society of ours, are familiar with the basic concepts and the real problems of pharmaceutical odc. It is enough to go to Google and ask, in different languages, for health odc, to be submerged by a torrential cascade of academic programs of study , press news, current comments, regulations, reviews, associationist propaganda of one sign or another: a gigantic accumulation of information that reveals the vitality of odc in the health professions.
I.
In my opinion, probably the most significant achievement of modern ethics in the health professions has been to elevate patients, physicians, nurses and pharmacists to the equal status of conscious, free and responsible moral agents. To act in a truly human way is to do things freely and conscientiously, that is, with knowledge and maturity, with skill and deliberation: on purpose and from agreement with certain rationally founded and deeply felt principles.
In general, patients and healthcare professionals, including public healthcare managers, usually agree on agreement on what should be done to protect and restore health. And, in general, we all maintain peaceful, friendly relations.
It also happens that, because of the prevailing pluralism of today's society, we disagree with each other on many issues, most of them minor. This minor disagreement subject does not necessarily lead to insoluble conflicts: on the contrary, it adds salt to life. These disagreements usually concern questions of preference or convenience, which are by their very nature negotiable: they fall within legitimate professional discretion, legitimate freedom of choice. And they always make it possible to reach a decision that, although less than optimal for all, can be accepted by all. No one therefore has to renounce intangible ethical convictions or betray well-founded scientific reasons.
But at other times we disagree on some more important issues. Then things take a different turn, especially if authority-subordination relationships come into play.
In fact and from time to time, someone may refuse to execute an order or a requirement of another; or may not follow, or deviate from, a conduct admitted or imposed by the law, because he feels towards those commands or behaviors a deep, invincible ethical repugnance, because to submit to what is required would mean to betray his own conscience, to violate with serious damage his dignity staff, to cross out his identity as a moral being.
The rejection, for moral, personal or religious reasons, of what is ordered by authority or the law is a common feature of various attitudes of social dissidence, such as, for example, conscientious objection, civil disobedience, or evasive insubordination.
What characterizes the odc is its peaceful and non-violent character; its ethical, and also religious-moral, rather than political, foundation. Its intention is to protect one's own moral life; and, tangentially but not necessarily, to bear ethical witness against conduct which, although permitted by law or custom, the objector considers unacceptable. The human tonality of the genuine odc is peaceful. The objector seeks to be a good citizen who wishes to live in society with others, exercising his freedom and preserving his moral convictions. By refraining from actions that could seriously harm his own ethical self, the only thing that matters to him is to save his conscience and his soul. odc is based on charity. She is neither arrogant nor rude, she is neither irritating nor proud: she bears everything with patience. He respects others, he does not hurt them, but he defends with serene firmness his right to be respected in a few and precise moral values, fundamental for him.
It is very important to retain in the mind and show in action these specific features of odc. The objector does not try to overturn legislation, nor does he seek to subvert with violence the prevailing political, legal or social status , as the civil disobedience activist does with his public demonstrations, or the insubordinate or rebel with his spectacular protest actions. The objector simply tries to exempt himself from certain actions, without, as a consequence, having to renounce his civic rights or suffer unjust marginalization.
There are not many actions to which health professionals oppose odc and which, to a greater or lesser extent, have been recognized as legitimate by legislation, professional regulation or simple everyday life. They include induced abortion; contraception, especially post-coital contraception and voluntary sterilization; assisted reproduction, destructive research of embryos; euthanasia and medical financial aid suicide; forced feeding of prisoners on hunger strike, cooperation with the police in torture or in the forced collection of information.
Permanent interest of the topic
The odc of healthcare professionals is the subject of a permanent discussion , both within the professions and in political bodies and among the general public. It is still far from being a peacefully held custom or a recognized and specified right.
Objectors have suffered and will continue to suffer more or less insistent harassment by some social activist groups and a large and influential sector of the health bureaucracy.
Public opinion is divided on the issue of CODE. Some believe that, once certain actions, such as abortion or sterilization, have been decriminalized, it is unjust for doctors to refuse them to those who request them, especially since they are among the health services offered, and even subsidized, by the public health services: doctors, nurses and pharmacists are, according to this view, mere technicians whose moral values must be passively subjected to legal dynamism. Others maintain that, in an advanced society made up of free and responsible men and caring for the rights and freedoms of its citizens, no one can be legitimately forced to perform an action that is seriously repugnant to his or her moral conscience.
In the never-ending and lively discussion on health odc, modern permissive laws and the ethical tradition of the profession, liberated behaviors and deep-rooted moral convictions, the functional efficiency of the health management and the ethical fidelity of those who sincerely respect the life and dignity of all people collide with each other.
Not only is there discussion: seriously unjust and discriminatory resolutions are taken against objectors. Intolerance of objection occurs in nations that consider themselves very liberal and advanced in the promotion of civil rights. A few examples will suffice. In Sweden, the right of doctors, nurses, pharmacists and students to conscientiously object to abortion is still pending legal recognition: there, objectors form a professional underclass with fewer rights and opportunities. In the United Kingdom, excluding Northern Ireland where abortion has not been decriminalized, serious abuses have been denounced: some of them have been studied by the committee Social Services of the House of Commons. It has been found that, contrary to the provisions of article 4 of the 1967 Abortion Act, serious impediments had been placed there to the professional degree program of objectors, especially nurses and young doctors, and access to Medical Schools has been prevented to candidates reluctant to abortion. In the United States, the American Medical association and the Joint Commission of accreditation of Hospitals, faced with the shortage of physicians willing to perform abortions, prepared rules to impose the learning and internship of abortion as an inexcusable requirement in the training of future specialists in Obstetrics and Gynecology. Fortunately, the initiative met with very strong resistance and was soon abandoned.
In Spain, there has also been talk on some occasions of limiting the OCD of health professionals. Years ago, the Socialist government announced its decision to send to Parliament a project bill on the Voluntary Interruption of Pregnancy, the text of which contained a vague threat to doctors specializing in Obstetrics and Gynecology who, for reasons of conscience, abstain from abortion internship . This legal project raised an energetic civil service examination both from the board Directive of the Spanish Society of Gynecology and Obstetrics, as well as from the Collegiate Medical Organization. The former demanded changes in the text of the project and requested that odc be regulated by means of an organic law, as proposed by the Constitutional Court. The latter reiterated its deontological promise to firmly and uncompromisingly defend the ODC of physicians. But we are still without a specific law on professional dentistry.
We are also witnessing a psycho-social evolution that tends to surround objectors with antipathy and unpopularity.
The selective unpopularity of the health odc
The objector does not always provoke reactions of civil tolerance, of human appreciation, of ethical admiration. On the contrary, he faces serious legal and professional difficulties. He encounters incomprehension in very important and influential social areas: among politicians, administrators, jurists. And also from a considerable part of the public. And, worst of all, from some of his colleagues. Walley's story1.
The B of the case is that this antipathy is selectively directed at the odc based on respect for human life and the dignity of the body and the person. It is common to brand the objector with the stigma of fundamentalist. In the most favorable circumstances, they are considered to be abnormally scrupulous, or insensitive, anti-modern and installed in a cultural status already outdated. Sometimes the accusation of pharisaism, and even of hypocrisy, of double standards, of objecting in the public context and not doing so in the private one, is not lacking.
It is worth bearing in mind that not only ethical and political factors are at work in the exercise of the odc: there are some components of moral and social psychology that cannot be left out, because they give an emotional tone to our debates and sometimes override the purely ethical speech . It is very difficult to be a socially appreciated objector.
We cannot forget that the objector is a strong moral reproach for those who do not share his deep ethical convictions. The non-objector may feel insulted and offended by the moral lesson that comes from the objector's conduct. The reaction of many to the objector is not one of simple annoyance, such as that provoked by a transport strike that spoils an important business or professional opportunity. In such a case, the Username may, in the midst of the displeasure, feel some sympathy, albeit distant, to those who aspire to improve an unfair salary or degraded conditions of work.
Never, the customer who goes in search of a certain product in a store reacts as if he were morally assaulted by the shopkeeper's reply that he does not have that product, because, for example, he has decided, in response to his political convictions, to boycott Belgian products as long as Brussels continues to allow the sale of arms to third world countries. The customer, if he wants that product, goes to another store until he finds it: he knows that the satisfaction of his specific desire has a cost. And he also knows that sometimes he will have to resort to a substitute because the product of his choice is no longer marketed in that region: no store carries it. Our man will regret it, he will miss the good old days, but he will not be indignant or cry out for revenge: he does not think of going to report the case to the Department of Commerce.
But what happens when the pharmacist refuses to dispense a counter-prescription drug? The refusal, however attentive and respectful it may be, can be interpreted as a moral slap in the face, provoking, depending on the person, reactions ranging from mute rupture of relations, angry protest, to vociferous condemnation or indignant denunciation. This does not simply translate the frustration of not receiving a service to which one is supposed to be entitled: the tone and content of the protest is a rejection of the moral ideas of the other that are interpreted as an unacceptable, humiliating moral censure.
In particular, within health care centers, the odc can be an occasion for serious conflicts in interprofessional relations. There is no shortage of hospitals in which a stable and frictionless status has been established. However, in many others, the relationship between health care managers who are ideologically in favor of abortion and objecting doctors and nurses is very complex.
Managers aspire to the efficiency of their management and the desire to please their superiors. Fascinated by efficiency and the need for accreditation, they will never be able to view with sympathy anyone who breaks the regular rhythm of the uniform and programmed work . All the more so since hospital or health area managers have been invested, in order to reduce the economic and human cost of medical care, with extensive organizational powers to keep the healthcare machine running at a maximum level of performance. This makes it necessary to consider any exception or exemption as an inconvenience that disturbs the desired homogeneous response.
The relationship between consumers and suppliers is also very complex in today's society. The associative movement of users and consumers has brought evident improvements in the quality and uniformity of the industrial products that are acquired, the food that is consumed, the services that are contracted, the attention that is received. In order to lure us into certain lifestyles and to create needs of urgent satisfaction, advertising constantly flatters us as presumed consumers and turns us, with its promises, into people who are not satisfied with little. It is not easy for today's consumers to give up the immediate satisfaction of their aspirations, or to be content with less than they have promised themselves.
The rejection of the odc is accentuated as the so-called civil ethics takes root in society, the idea that rules and regulations (the laws of parliaments, the sentences of jurisprudence, the decisions of ministries, the orders of directors) is both the cause and expression of public morality, of civil ethics, which speaks on behalf of all, that we all, as good citizens, are charged with the duty to comply with it. It is affirmed that one becomes part of the community in which one lives to the extent that one abides by the rules of the game, and submits to the legal order in which we all have to live peacefully, and which politicians have agreed upon for all. The ethical peace of society is achieved through consensus in which the principles of minimum legal intervention and the imposition of a minimum common ethical denominator and the reduction of strong moral convictions to the private sphere coincide.
Nor does it seem that the objector will find generous support in the legal doctrine. For some years now, there has been increasing reflection by law professors and magistrates to undermine the status of fundamental right that the OCD received from the Constitutional Court in 1985 and which allows it to be exercised independently of its regulation, in order to transfer the OCD to the sphere of autonomous, non-fundamental constitutional rights, which need specific regulation. In such a case, the objector's right would be subject to regulation by ordinary law, which would include both the "due guarantees" due to the objector, and those that the community would apply to defend its own demands before those who oppose objecting behavior. In a 1995 proposal on "An Alternative to the Legal Treatment of OCD," the group of programs of study of Criminal Policy, came to some certainly intimidating conclusions for objectors: they stated that our Constitution does not enshrine "an individualism incompatible with the social and democratic rule of law", and that, consequently, "the physician is obliged, despite his or her objection, to perform the abortion when there are no other professionals willing to perform the termination of pregnancy" and that "the manager of the establishment or the staff health care provider may be held legally responsible for the consequences that their refusal to perform the intervention may have on the life, health and liberty of the pregnant woman". In anticipation of the possible decriminalization of euthanasia, they propose that odc cannot oppose the legal euthanasia requested by the patient, and that the physician must be held responsible for his obstructive actions if he impedes the right of the patient who has requested financial aid to die.
In conclusion, there is no shortage of reasons to be concerned. But there are reasons for hope. That is what I intend to show in this second part of my talk, which sets out to make some suggestions about the relationship between freedom, conscience and odc.
II.
Relationship between freedom, conscience and odc
On the human existential level, conscience and freedom are the hallmarks of our dignity. With a profound experience staff, John Paul II affirmed: "Conscience and freedom: these are the essential elements of fully human action". And he added, as if hinting at the topic of the odc: "The world has many ways of weakening the will and obscuring the conscience. Therefore, we must defend them from all violence". This is what we read in the Tenth Station of the Way of the Cross at the Colosseum in 2000.
On the cultural level, conscience and freedom constitute an iconic dyad, which has inspired much heroism: the clamorous of the martyrs and the silent and anonymous of those who have accepted marginalization, negative discrimination, depreciation or censorship out of loyalty to their freedom, to their convictions.
On the political and social levels, the close connection between conscience and freedom implies the aspiration to plenary session of the Executive Council civil recognition of the human rights of all, including minorities; of the right to exist in authenticity and coherence; of seeking intelligent ways for all to live together in respect for diversity. Invocations to pluralism and globalization remain empty gestures if they are not accompanied by the willingness of all to pay the social cost of ideological diversity.
But it seems that, instead of living freely in a diverse and varied world, things are moving towards standardizing our souls in an obligatory gray ready-to-wear.
But many of us don't want to. It reveals
For that I need to refer to a article, graduate "Conscientious objection and medicine", which, early last February, was published in the BMJ by Julian Savulescu, professor of ethics internship at Oxford University.
The article raised an immense stir. It is a provocative tone article , intended to hurt sensibilities, to raise protests: a trigger that released a lot of latent energy. Curiously, it has found very little support. Within days, dozens of letters from readers appeared in the Rapid Responses section of the BMJ. Massively critical of Savulescu's article . Only 3 out of 57 showed him some support. Another 3 adopted a cautious position average.
Savulescu's article put his finger on the sore point of this relationship between freedom and odc, which is what interests us now. I will summarize his main assertions, using, as far as possible, textual references. I will then try, in vain, to summarize and order the essentials of the answers, which is neither little nor monotonous.
The core topic in which Savulescu writes is already defined in the first lines. He begins with a quotation, incomplete and out of context, taken from the tragedy of Shakespeare's King Richard III, which states that "conscience is a word that cowards use when they seek to frighten the strong". And, without further ado, the author adds: "Conscience, of course, can be an excuse for vice and an alibi for not fulfilling one's duties. When a duty is a true duty, the odc is wrong and immoral. And if it is a grave duty, the odc should be illegal. The conscience of the physician has very little to do in modern medical internship ."
Savulescu imagines, with much fantasy and little mercy, some motives and circumstances for objection, with the visible purpose of describing objecting physicians as paternalistic, tyrannical, capricious, unfair, inefficient, selfish, comfortable, and bad citizens, who flout the law, frustrate the legitimate wishes of patients, impose their particular values on them, and unfairly distribute finite resources. The objecting physician is a species to become extinct: students must be told, before being admitted to medical schools, that, above their particular values, are professional commitments: that they must be willing to comply with the provisions of the law, and, if they are not, to go home, for they should not become physicians. The medical profession has, according to Savulescu, a public obligation to ensure that all patients receive the full spectrum of services that the law does not prohibit, as these are services to which they are entitled. He adds that doctors who, for reasons of conscience, place limits in any way on the care of their patients, should be punished by depriving them of the licence to practice the profession, since medicine must be governed exclusively by the values that the law dictates to public medicine.
Reinterpreting in core topic extremely radical the ideas of Harris, Engelhardt and Rhodes, he concludes that there are two separate worlds, that of public life and that of private life, each with its own values, each with its own conscience. One or the other values may participate in theoretical discussions about what the health service of a given society might be like. But private values cannot decide the care that each individual physician offers to his or her patients. An open door to a "medicine driven by personal values" would be an open door to a Pandora's box of idiosyncratic, fundamentalist, discriminatory medicine.
The slogan "Leave your convictions at home. Here, dedicate yourself to carrying out the orders given to you by those elected by the people" is presented, in Savulescu's opinion, as a moral paradigm for today's physician, as a simple and safe precept for survival in a world that has opted for minimal legal ethics, with its aura of legality, civility, and peaceful coexistence.
At summary: Savulescu's article is based on a one-sided, strongly autonomist interpretation of the principles of biomedical ethics. He concludes that there are autonomies and autonomies, that is, that some autonomies are more autonomous than others. In the capitalist system of American bioethics, the prevailing autonomy is the autonomy of the Health Maintaining Organizations, of the private insurance companies (not that of the patient); and what is valid in European social democracies with national health services is the autonomy of the bureaucracy that manages them (not that of the Username, nor that of its servant, the physician).
It seems that, in both cases, the same thing happens: he who pays, calls the shots. It is his responsibility. With good reason, it is your obligation to do so, after a reasonable discussion, in terms of economic programming, in terms of the management of services.
Savulescu's article is over the top. Many readers reproached the BMJ editors for publishing such a hurtful piece of writing without the slightest commentary: not a grade from presentation, not a publishing house, not a article commissioned from anyone who dissented or tried to put Savulescu's claims in perspective.
The article is a caricature, highlighting some features of the thinking of a few doctors, nurses and pharmacists; of more numerous managers of the organization and the Economics of health care; of a considerable proportion of bioethicists and philosophers and, obviously, of a minority, noisy and radical section of the general society.
But it raises a real problem: that there are widely disparate ideas about the role that conscience and freedom play in health care, which merit scrutiny.
What happened to Savulescu's article ?
It is not possible to summarize here the flood of ideas provoked by Savulescu's article . I will highlight only those that seem to me to be the most salient, for their freshness, their rationality, or for their testimonial value. I do so because these quick answers bring a message of spontaneity, of popular clamor, coming from ordinary doctors, nurses and pharmacists. Taken together, they come to represent a spontaneous referendum, massively favorable to the odc. I distribute them, loosely, grouped according to the topics to which they allude.
a. The denial of the odc is a denial of freedom.
Healthcare professionals, doctors, nurses, pharmacists, are themselves part of the pluralistic culture that values freedom and tolerance. It is to be expected, therefore, that they share among the different and legitimate ways of understanding life, ethics and society. Where does it come from that they are the only ones who are obliged to follow a single way of thinking?
If it may be true that a coward, or a pretender, may abuse the odc to save himself the performance of a duty, it is equally true that, in order to nip such abuses in the bud, legislators cannot fall into the abuse of putting everyone on a firm footing and not admitting criticism or reasonable exceptions to their infallible directives.
Multiculturalism and freedom do not consist in the search for uniformity, but in the tolerance of diverse opinions. Savulescu seeks to deprive toilets of their freedoms and autonomy, as if they were not citizens with human rights.
Limiting freedom of conscience, and its necessary consequence the freedom to conscientiously object, reveals a profound misunderstanding of what objection is, of its role in society, of the ethical motivations of objectors.
Savulescu's article has the aura of totalitarian thinking. It reflects the freezing conviction, contrary to that of the free healthcare practitioners of yesterday and today, that the system is always more important than the individual, whether patient or physician. Freedom of choice is not a luxury reserved only for the individual who governs, but also belongs to patients and physicians. Freedom is an essential part of the human condition. Conscience and morality are also part of what is human, of the prerogative of being human.
If serious individual freedoms are at stake, the organizations that promote and defend them must support the Tyrians and Trojans, and their lawyers must appear in court to defend any party that has been the victim of a real or insinuated violation of their freedoms.
b. Risk of identifying what is legal with what is fair
A moment of reflection sample that what is legal is not the same as what is ethical and just. Legislators can turn an action that was criminal yesterday into an obligation that is legal today. That this is so reveals the emptiness of the ethics of status that today informs much opportunistic legislation. If what is being legislated is subject controversial and deals with important issues, both physicians and patients should be free to choose what is most in accordance with their ethical convictions.
Very few people, with a critical sense and an awakened mind, accept that what is legal always constitutes a "true" duty. No one, not even legislators, believes that this equation is valid. Neither believers nor atheists accept that, in fact, the law incorporates only just and timely mandates. The immense value of odc is that it facilitates the democratic questioning of the rule of law: along with non-compliance, it is one of the mechanisms by which civil society protects itself against unjust and misguided laws.
How can a physician follow laws that change overnight? I remember that, until June 30, 1970, abortion was illegal in New York City. A week later, our hospital received visit from some investigators: they were coming to see why we had not reached our allotted quota of abortions that week.
What will one have to do in countries where torture is legal, where doctors are required, as good citizens, to contribute with their art to the execution of capital punishment or corporal punishment (amputations, sterilizations) decreed by judges? Do doctors then have to leave their conscience at home, to act against it in prison or at the public place ?
If the values of the objectors cannot play any role in their professional practice, why should the values preached by Savulescu play a role in the professional practice of those who follow his ideas? The physician, blind servant of the law he proposes, is as much or more paternalistic, tyrannical, capricious and discriminatory than the most radical objector one can imagine.
Savulescu's logic leads to a dead end. If the internship of assisted suicide were authorized by law, all doctors would automatically be obliged to help patients kill themselves. And all pharmacists would be obliged to dispense the euthanasia kit to customers who presented themselves with the corresponding prescription. There would be no escape for the physician.
agreement That only physicians who were in agreement with the laws passed by the parliaments could be admitted to the professional practice. Extrapolating this idea, and imagining the strange laws and the repeals of laws that, because of political swings and the obsessions of certain parliamentarians, may enter into force or be annulled, the medical profession would be heading for a tragic destiny: to be composed of individuals without conscience, by automatons capable of applying successively contradictory laws.
In a culture that equates fair and legal, the line between legal and illegal ends up blurring. Savulescu shoots herself in the foot when she asserts that terminating a pregnancy before the 13th week should be the sole decision of a woman who does not want to give up her degree program for reasons that suit her. But such an abortion is not authorized by law, which has decriminalized abortion in very specific circumstances.
Savulescu states that the primary purpose of a health service is to protect the health of its users, whom the physician must serve without discrimination. But how does that become a reality for the fetus that is the Username of a termination of pregnancy? An obstetrician who evaluates the care of his patients more than his degree program professional prospects, reputation, or popularity may freely conclude, but at great cost to his degree program, that the best care he can render to his fetal patient is to preserve her life, not destroy it. Forcing such an obstetrician to go against his values is immoral and dangerous.
It is an opinion brimming with prejudice that "moral values cannot be allowed to corrupt the provision of a health service established by law". The Nazis would have supported such an assertion.
There are many associations of medical students and agnostic physicians who maintain that euthanasia and abortion represent the destruction of innocent lives, which is not the purpose of medicine.
c. Distortion of the doctor-patient relationship.
The physician has no right (by virtue of his autonomy) to impose a treatment on his patient. On the other hand, the exercise of his autonomy, which allows the patient to refuse treatment, does not authorize him to order the physician to do something positive and specific to him. The patient cannot demand a treatment that is contrary to good clinical judgment or to the conscientious opinion of his physician. Anything beyond that point ceases to be a just human relationship and becomes autocracy.
The basic problem from the ethical point of view seems to lie in a clash of autonomies. When two people's rights to self-determination conflict, then neither should be assigned the right of precedence over the other. The problem lies in finding a way to strike a fair and ethical balance between them. In order to exercise autonomy, each must be able to consider the problem with deliberation, with freedom.
Savulescu states that physicians cannot make moral judgments when treating their patients. The fact is that not only do they make them, but patients go to the doctor in the hope that he will help them make them. This has always been the case and will continue to be the case.
A large part of the crisis affecting obstetrics today, which translates into a lack of physicians willing to perform abortions, is due precisely to the fact that many physicians shy away from specialization program because they do not want to be implicated in the internship of abortions.
For many objecting physicians and pharmacists, it is humiliating to rule legally compel them to inform their patients or clients the data of non-objecting colleagues who may provide the services they refuse for ethical reasons. They may judge such conduct as cooperating with the evil to which they object. They should not be forced to do so. Legislators, out of respect for the conscience of citizens, should bear the responsibility of establishing information systems easily accessible to the public with the data of physicians and pharmacies can be made position of such situations.
That Savulescu's idea that objecting physicians should post a sign in their offices saying "I have no objection to performing euthanasia or abortion" should be reciprocated by non-objecting physicians posting a sign at work .
The few letters in favor of Savulescu contain some of the clichés of the anti-OdC literature: the Nietzschean idea of the objector as a moral slave, as an egomaniac who puts the welfare of his conscience before the suffering of others, the irresponsible lack of solidarity, the lack of civil citizenship. Secularist clichés. They are blind to the inconveniences of the objector's life. Accusations of perverse, opportunistic or political use of the odc. Or for the claim of the odc to protect unjustifiably what is mere comfort, sensibility or emotionalism.
WTO Declaration on the WTO (May 31, 1997).
The CCD, in view of the discussions on odc, prepared this Declaration, in view of the report of the CEDM doctrine and the absence of a concrete legal rules and regulations . It was published to assist the social and legislative discussion .
Its essential points are these: It declares the ethical dignity of odc, when it is supported by serious, sincere and constant reasons, and deals with serious and fundamental issues. The OCD is to be limited to those actions that provoke an insurmountable and sincere moral repugnance to perform actions that seriously degrade one's own moral identity. It responds to a universal deontological tradition, and to a maturing of social ethics in tolerance, acceptance of ideological freedom and recognition of the fundamental rights of persons.
Although it may create tense situations and incomprehension, the odc refers to the refusal of certain actions: it has nothing to do with the refusal of persons. The objecting physician, while refraining from performing the objected act, is nevertheless obliged, especially in case of emergency, to provide any other medical care, antecedent or subsequent, to the person undergoing the objected intervention. The Declaration strongly condemns the intolerable conduct of a physician who conscientiously objects in the institution where he/she works as a salaried employee, and performs the objected action when he/she works on his/her own account. The Commission therefore suggests the creation of a voluntary and confidential register of members who object. It advocates non-discrimination of objecting physicians and recalls that the Associations have undertaken to defend them when they suffer unjustly because of their rightful objecting conduct. It affirms that the odc can never be an opportunity to obtain employment advantages and that it must be linked to the performance of tasks that compensate for those that have been omitted because of the objection.
[1] English gynecologist who had to emigrate to Canada in order to be able to practice because his position staff against abortion closed the doors to being hired in the English health service.