When the Prescription is a Lynching

It comes as a surprise to see a group of philosophers demanding that doctors be forced to “provide public-benefitting services”. Philosophers? Telling doctors to do something useful?

The context of this extraordinary piece of advice is a ‘Consensus statement on conscientious objection in healthcare’, issued by a group of fifteen philosophers and bioethicists. It builds on a long campaign by one of them, Julian Savulescu, to ban from the public health system doctors and nurses who conscientiously object to performing certain procedures, such as abortion and euthanasia (reported in the August 25 edition of the Sydney Morning Herald beneath the headline ‘Bioethicist calls for a ban on doctors’ conscientious objection’).

The essence of the document’s reasoning is contained in its opening paragraph:

“Healthcare practitioners’ primary obligations are towards their patients, not towards their own personal conscience. When the patient’s wellbeing (or best interest, or health) is at stake, healthcare practitioners’ professional obligations should normally take priority over their personal moral or religious views.”

That states the issue in exactly the wrong way. The opposition “patient’s interest” versus “personal conscience” is a false one, because the conscientious objectors take a different view of what is in the patient’s best interest, and they have reasons for doing so. Like any doctors, they are motivated by a desire to help patients. They believe that the procedures they refuse to perform are destructive of the patients’ interests, sometime destructive of the patients themselves. So they refuse to perform those operations. To contrast their concern for patients with “personal moral or religious views” is to wilfully misunderstand their motivations.

In the present environment, as codified in documents such as the Australian Nursing and Midwifery’s policy on conscientious objection, health professionals who object do not have an easy time but their position, in theory, is protected from retribution. The “consensus document” criticises the present “cost-free environment” and proposes the imposition of sanctions. That is where the demand that objecting doctors should compensate society by “providing public-benefitting services” comes in. They should also face tribunals to “test the sincerity, strength and the reasonability of healthcare practitioners’ moral objections”. Hiring authorities should be able to favour non-objecting doctors.

It is true that objectors should give some substantial reason for their refusal to perform procedures. “I don’t like it” or “It’s against my religion” won’t cut it. But everyone knows who the objectors mostly are – they are Catholics and other Christians who rely on a developed natural law philosophy of the intrinsic and irreducible worth of persons. It’s a debatable philosophy, but mere “personal belief” it isn’t. The reasons for it are public and long defended, and the tribunals that Savulescu demands to enforce conformity can consult the reasons instead of interrogating the recalcitrant doctors one by one.

The talk of tribunals and sanctions for “failure to fulfil professional obligations” prompted some excitable commenters on the blog post of the “Consensus Document” to reach for Nazi analogies. That is unhelpful, and in any case there are more contemporary analogies available that give an insight into why conscientious objection by doctors has its merits. Certain societies regard is as a professional obligation on doctors to perform genital mutilations; other societies, to remove usable organs from condemned “criminals”. Certain doctors object that those “obligations” conflict with the point of being a doctor, which is to benefit patients. Those doctors are given a hard time. It should not be allowed to happen here.

It would be easy to dismiss the group claiming a “consensus” as a crackpot fringe. Indeed, two of the signatories are Alberto Giubilini and Francesca Minerva, who created a stir in 2012 with their article defending “after-birth abortion”, whileSavulescu himself has advanced such “daring” theses as that it is morally obligatory to clone embryos for spare parts. Those ideas have not gained traction and are not likely to. But two of the other signatories are Jeanette Kennett, president of the Australasian Association of Philosophy, and Justin Oakley, for many years director of Monash University’s Centre for Human Bioethics. Savulescu is editor of the Journal of Medical Ethics. This is serious.

The “consensus document” ends with one last condescending piece of advice: “Healthcare practitioners should also be educated to reflect on the influence of cognitive bias in their objections.” (I am rational, you exhibit cognitive bias.) If the authors had engaged in some of that reflection themselves, they would not have so misrepresented the doctors they propose to bully.

James Franklin set up the Australian Database of Indigenous Violence