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Getting conscience right and wrong

Wed, 2017-05-24 13:08

Can a doctor refuse to participate in something he finds unconscionable? Is this an important liberty to be safeguarded, or an unwarranted privilege which interferes with patient care? Must we leave our conscience at the door of our professional life?

These some of the questions currently being discussed in the medical ethics literature.

It should concern all those who care about liberty and integrity that the debate is skewed heavily in favour of those who wish to see the end of conscientious objection. One representative of this side is Francesca Minerva, a scholar based in Belgium. She has previously advocated the inducement of Italian doctors with financial rewards to practice abortion, and co-authored the infamous paper on ‘after-birth abortion’.

Minerva’s most recent paper in the Journal of Medical Ethics caught my attention.

In it she argues that cosmetic surgeons are not at liberty to decline to perform any procedure, even if it goes against their better judgment—and even if it is ‘ugly-fying’. Essentially, patient preferences have priority over clinical judgment: the patient’s right to request treatment is near absolute, while the doctor’s right to refuse is practically non-existent. The Journal of Medical Ethics published my response to Minerva’s arguments, which I briefly outline below.

Firstly, even passing familiarity with medicine indicates that Minerva’s proposal is unrealistic. Patients do not have an absolute right of request, even if they are willing to pay (and I don’t believe that any doctor would endorse such a right). Doctors, as the gatekeepers of healthcare, shoulder the responsibility of deciding who needs or does not need a scan, test or procedure. These things are not ordinary consumables. They are often risky, and require expertise to co-ordinate and decide upon. Doctors are not mere mediators of medicine, but active agents. It is impossible to get around this.

Secondly, Minerva’s conception of autonomy is mistaken. Patients have a right to say no to treatment, but not an absolute right to request whatever they wish. For example, a patient with a brain tumour can decline a biopsy offered to him. This sort of negative autonomy is fundamental. But absolute positive autonomy is in the realm of fantasy. If a man with a gouty toe requests the amputation of his foot, his surgeon is under no obligation to comply because amputation is unnecessarily harmful. Moreover, to fulfil his request with this knowledge would be to invite severe criticism of one’s integrity.

Thirdly, absolute positive autonomy makes the idea of benevolence redundant. If a doctor’s basic duty is to maximise patient preferences, he no longer need think about what it means to do good to his neighbour. Minerva’s underlying assumption, it seems, is that human happiness is found in preference satisfaction; it is nothing more than a feeling. Is it beneficent to perform invasive surgery unnecessarily just because it is requested? To give a positive answer, one requires a severely limited account of human flourishing.

Fourthly, it has been the strategy of those who oppose conscientious objection to frame it as a purely moral or religious matter. But doctors make ‘moral’ judgments every day when they decide on a patient’s care plan, on what is a good course of action. And if a doctor objects to a certain treatment based on his clinical judgement, is he to be harangued for interfering patient access to care? It’s doubtful. A patient might be entitled in law to a particular treatment, but a doctor’s considered, professional opinion can lead to its being withheld. Expertise informs opinion regarding what is right. This is not far from ‘usual’ conscientious objection, but is normally called clinical judgment. Could it be that the two are somehow related?

Fifthly, the goals of medicine deserve consideration. If medicine is anything which improves our subjective sense of wellbeing, as the WHO would put it, then there really is no scope for refusing anything at all, since all refusal would be a desertion of duty. But a reasonable definition of the goals of medicine which distinguishes between restoring health and enhancing lifestyle permits the possibility of saying ‘no’ to what is beyond the scope of medicine (and therefore not one’s professional duty). Interventions which do not restore health include elective abortion, euthanasia, prescribing contraception, sterilisation, cosmetic surgery and ritual circumcision. Pregnancy, frailty, fertility, genitalia and plainness are not diseases in need of ‘treatment’. Hence, a doctor should have the liberty to say no to participating in them.

Much more could and has been said about conscientious objection. There is ample cause for concern; the momentum is not on the side of conscience.

Christians should seriously consider the matter, as must all right-minded people who care about liberty and personal integrity, and make a reasoned defence of it in the public square. There may come a time when we are forced to participate in evil, or forced to face the consequences of not doing so. Thankfully, such is not yet the case, but we must prepare for the increasingly likely eventuality.

 

Toni Saad is a medical student at Cardiff University

Categories: Discussion

If we trust women, we should listen to them

Tue, 2017-05-23 13:03

Contrary to impressions given in the media, by professional bodies such as the Royal college of Obstetricians and Gynaecologists (RCOG) and by most Parliamentarians, an overwhelming majority of Britons actually want to make it harder for women to get abortions, a new poll reveals.

It is particularly striking how much support there is amongst women for lowering the time limit for abortion, which currently stands at 24 weeks. Of the 70% of women who want the limit lowered nearly six in ten are in favour of a limit of 16 weeks or fewer and 41% actually want it 12 weeks or less.

2,000 people were recently interviewed by Comres, finding that:

  • 70% of women would like the current time limit for abortion to be lowered
  • 59% of women would like the abortion time limit lowered to 16 weeks or lower
  • Only 1% want the abortion time limit raised to birth
  • 93% of women want independent abortion counselling introduced
  • 79% of general population want a five-day consideration period before abortion
  • 84% of women want improved pregnancy support for women in crisis
  • 70% of parents want introduction of parental consent for girls 15 and under to get abortions
  • 56% support freedom of conscience for doctors

These new statistics speak for themselves, so I want to highlight just two messages.

First is to show how these findings are almost entirely at odds with the stance taken by most public broadcasters, pundits and parliamentarians.

To illustrate, over the past couple of years there has been a concerted effort by pro-abortion groups to campaign for the ‘decriminalisation’ of abortion, which would effectively scrap the 24-week limit altogether, allowing abortion to birth (note that only 1% of those polled actually back this idea!). This pro-abortion campaign uses the slogan ‘we trust women’ which seems particularly ironic in view of what 70% of women really want. The campaign recently culminated in a Bill in Parliament which passed by 172 to 142 and would have decriminalised abortion had it progressed further, illustrating how many Parliamentarians are also out of touch with what women really want.

Moreover the media has provided plenty of backing for the campaign (see here too).  Last week Tim Farron did a complete about-turn on earlier statements that he was opposed to abortion. A Liberal Democrat source told PoliticsHome last week that Farron: ‘…spoke to experts, looked at the evidence and changed his mind.’ The irony is that he was clearly speaking to the wrong ‘experts’. Perhaps if he’d seen these poll results earlier he’d have realised that his earlier position was actually more in line with what women want, rather than what his ‘experts’ told him last week.

Second point to highlight is the difference in findings between men and women.  Contrary to what most people generally assume, women want more restrictions on abortion than men.

I’ve noted above that 70% of women want the time limit for abortion lowered to 20 weeks or less.  Yet amongst men, 49% want the limit at 20 weeks or less.

The gender difference seems to be counterintuitive but it does fit with previous findings and the fact that it is consistent should prompt us to ask questions about why this is the case.

I looked at this intriguing difference a few years ago, concluding that it may simply be that women are more sensitive to the fact that pregnancy involves carrying a living baby and therefore is very different to tooth extraction. And that perhaps women are more supportive than men of doctors being involved in the decision, and of time limits being tightened, because it is a way of sharing the decision-making burden, and a way of taking the decision out of their hands completely. Maybe men are more supportive of unrestrictive abortion because it absolves them of their responsibilities?

Whether or not my analysis is correct, counterintuitive as it seems, that fact that more women want more restrictions to abortion than men requires explanation. It has been repeated enough to not be ignored.

And whatever the reason, this all suggests that if ‘we trust women’ we should be bringing in more restrictions on abortion not fewer.

Little of this will come as a surprise to those who do listen to women who have experienced abortion. As counsellors around the country know, having an abortion is a life changing event and can frequently lead to psycho-social,and occasionally physical, harm for women. It seems that most women understand that that too, listening to them.

 

May 21st 2017 it was reported that:

ComRes interviewed 2,008 British adults online between 12th and 14th May 2017. Data was weighted to be representative of all GB adults. ComRes is a member of the British Polling Council and abides by its rules.

 

Categories: Discussion

Brilliant Resources to help Christians engage with the General Election on 8 June

Thu, 2017-05-18 15:28

On 8 June the UK goes to the polls for the general election. Whoever assumes power will have a profound influence in shaping public policy in matters which affect us, our families, churches, patients and colleagues.

Some claim that politics and religion should not mix – ‘We don’t do God’, famously said spin doctor Alistair Campbell. But God is intimately involved in politics. He is sovereign over the rise and fall of nations. He establishes governing authorities, and holds them ultimately accountable. As Christians, we should both pray for our political leaders and be subject to them.

But God has also given us a part to play in who actually exercises civil authority. Each of us, before God and in good conscience, must make our own decisions about voting; but we have a duty before God to ensure that we exercise our votes wisely, thoughtfully and in an informed way.

For some, the key question will be about who they would prefer as prime minister for the next five years. For others it will be a matter of which specific issues they care about most and how the various parties and candidates stand on these.

Christians will want to be informed on the big headline issues of leadership, ‘Brexit’, the economy, health, education, welfare and immigration.

But we must also consider issues that are often forgotten in the mainstream press like marriage and family, sexuality, abortion, euthanasia and freedom of conscience.

Here are twelve questions – apart from health, education, crime and the economy – that Christian doctors might ask their candidates.

  1. Euthanasia – How will you ensure that euthanasia is not legalised in this country?
  1. Abortion – What will you do to stem the tide of abortions?
  1. Embryo-destructive research – Will you seek to repeal existing laws and prevent further liberalisation? 
  1. Sexual health – What is your policy to arrest the spread of STIs?
  1. Poverty and Health – How will you ensure justice in healthcare for the developing world?
  1. Freedom of worship – How will you ensure that Christians are able to practise, share and defend their faith without being prosecuted? 
  1. Marriage and family – What will you do to affirm, protect and support the traditional family?
  1. Addiction – How will you act to reduce alcohol, nicotine, drug and gambling addiction?
    Present policy is aimed more at harm reduction than at restricting access (through price control) and effecting behaviour change.
  1. Obesity and Inactivity – What will you do to encourage the general population to adopt a healthy diet and get regular exercise?
  1. Marginalised groups – How will you ensure that vulnerable groups like the elderly, the mentally ill, ethnic minorities and asylum seekers receive an adequate basic level of healthcare and are not marginalised in healthcare allocation?
  1. NHS – How are you going to fund the health service better?
  1. Care – What are your plans to address the crisis in care provision and its lack of integration with the health service?

Whether we choose to vote for, or against, a particular party or candidate, or on a specific issue, there are lots of resources to help us reach our decision.

Several Christian campaigning groups have produced helpful resources which shed light on why and how our faith can inform our choice in the election, as well as how it can affect life and family issues:

  • Evangelical Alliance: ‘What Kind of Society?’ explores the core Christian themes: ‘love’, ‘freedom’, ‘justice’ and ‘truth’, and how they affect what we should be asking and looking for in our candidates.
  • CARE: engaGE 2017 gives a great overview of how the general election works, why Christians should vote and how to get involved. It focuses on family, marriage and life issues.
  • Where do they Stand? is a helpful independent resource to find out where your local candidates stand on life issues, such as abortion, euthanasia and embryo research.
  • Care Not Killing provides important information on how to think about end of life issues when considering which candidate to vote for and how to encourage candidates to think about and express these issues too.
  • Christian Institute has a comprehensive list of resources. These include a briefing, which goes through the policies of each party, question cards, and how each MP voted on important ethical issues.
  • Christian Concern has a brilliant ‘Election 2017’ website ‘the Power of the Cross’ which focuses on marriage, freedom and life issues:  A Christian Vision, a Christian Voice, A Christian Vote.

These resources explain how important it is to vote and give helpful overviews on crucial issues. Of course, these are not just things to engage with at election time.

MPs are our representatives with the power to preserve or change our existing laws and country’s direction.

Let’s make use of all this valuable information in making an informed vote that really counts this June. But let’s also pray for the future of our country, and our health service.

For a brief rundown on why Christians should vote in the election, visit here.

Categories: Discussion

Exposing the dark side of egg ‘donation’: the headlines this week should be just the start

Fri, 2017-05-05 15:48

At last! The media has finally picked up on the ethical and exploitative mess that is egg ‘donation’.

I have blogged on this, included it in submissions, asked questions in conferences and, most recently, raised it when giving oral evidence to a Parliamentary Select Committee in April. The aim being to expose the industry around egg ‘donation’ and egg freezing that exploits women’s health and purses.

Now, thanks to the Daily Mail’s front page undercover investigation, the Humn Fertilisation and Embryology Authority (HFEA) has said they are investigating several fertility clinics accused of exploiting couples desperate to have children. Health Secretary, Jeremy Hunt says the allegations are serious and worrying.

 The major allegation against the fertility clinics visited by undercover journalists was that women were being convinced to donate their healthy eggs in return for free IVF, at clinics in London, Hertfordshire and County Durham.

But this is not just a story for journalists.

I personally know a woman who was persuaded a few years ago to ‘donate’ half of her eggs for someone else’s fertility treatment, in order to have reduced cost IVF for herself and partner. Years later, she is still highly traumatised having been unsuccessful in her own IVF treatment but knowing that her ‘donated’ eggs resulted in a successful birth for another woman.

Somewhere, she knows, she has a daughter, who she will never know.

This is real life. This is the dark side behind the industry.  This woman has never had any practical or emotional help or support from the fertility clinic. She is on her own, literally (with no child), living in the aftermath of an industry that does not seem to care for the women it is exploiting.

Of course it could be argued that the other woman, who had a child from one of the donated eggs, has benefitted. But has she? Has her husband/partner? What effect will it have on the child who will never know his/her biological mother?  Anecdotally, we know anonymous gamete donation can cause a lifetime of harm. The lessons to be learnt from adopted children are that they frequently feel a deep sense of loss if they don’t know about their genetic parents, despite having loving social parents. Plus their medical histories are being denied them. This website reveals some of the life long heartache of people who have been donor conceived.

To clarify, adoption is a biblical, positive and mutually beneficial act, providing a child for a childless couple and a loving home for a child in need. It is making the best of a difficult situation, whereas the fertility industry deliberately and intentionally creates difficult situations, and loss, for financial gain.

Unfortunately, I have to rely mainly on anecdotal evidence of harm because the HFEA, Government and regulatory bodies all fail to follow up women who have donated eggs, or women who have received donated eggs, or children who are born of donated gametes. It is an industry left to its own devices. We and others have called time and again for proper follow up.

But our concerns with egg donation go further than the Daily Mail investigation.

We urgently need more exposure of:

  1. The unethical marketing of egg freezing to women. The success rate of egg freezing to live birth is just 0.95 per cent! And yet egg freezing costs £3,000 for three years.
  2. The health risks of egg donation (here too). There is no follow up of women’s health after egg donation yet we know it can cause major, long-term, health issues, as well as psychological harm (as my story above illustrates).
  3. The exploitation involved. Only disadvantaged, economically needy, infertile, vulnerable and – deliberately targeted – students donate eggs, rarely wealthy women. Why? Because it is risky, painful, invasive and emotionally damaging, so only those needing an incentive will consider doing it, ie for cash (£750 per cycle of donation) or free IVF.
  4. The research industry. Women’s eggs are needed for embryo research (including for gene editing, creating three parent babies, hybrids etc), so how do scientists get hold of the hundreds of eggs needed for research? By enticing women with cash or cut price IVF. (See this advert here). Such incentives are essential because there are no health benefits for women donors – and it is ethically dubious research.

Does the health and well being of women count for nothing? Where are the feminists standing up for them? Where are the regulators? The lack of tracking, research and data is shocking. Egg donors need to know that long-term research simply is not there.

This is an industry built on the eggsploitation of women and it needs exposing.

Categories: Discussion