T Nation

Conscience Rule


#1

I am taking a bioethics class, and I am required to ask a question to people regarding the new Conscience Rule. Would you all say that the main ethical question is whether organizations and individuals should be required to participate in, pay for, provide coverage for, or refer for services that directly contradict their deeply held religious and moral beliefs or would you say that the main issue is whether patient's rights, health, and well being should be placed directly behind the rights of ideologically-driven physicians and anyone else directly or indirectly involved in their health care.

The next question is one that I am required to answer for paper I am writing and need a little help on. I understand how kantian ethics and virtue ethics would analyze this issue but, I do not really know what a Utalitarian perspective would be.


#2

I would say that it depends on the type of health care system you have. If it is a free market system and there are any number of doctors available to choose from - then the hospitals, clinics and doctors should be allowed to choose what type of services they offer. This does not harm the individual seeking medical aid.

On the other hand if you have a nationalized health care system - the hospitals, clinics and doctors are the sole option for the individual and they all work at the behest of the controlling authority and so must provide any and all services required by the individuals assigned to their care.

In a larger sense though - this goes back to a much more basic question. Do people have a fundamental right to have access to doctors? I say they do not. Access to doctors is a privilege regardless of the health care delivery system that is or is not available.

anyway - my 2 cents


#3

It isn't as though another doc can't come in and do any procedure your personal doctor won't due...

So if you're asking me whether I think we should put a gun to the head of physicians and tell them they MUST preform certain procedures, I'll answer with a hearty fuck that.


#4

I think doctors should be required to follow civilly established guidelines, with certain exceptions where the patient's life and health are not at risk.

For example, a doctor shouldn't be required to perform an abortion if her religious beliefs prevent her from doing so. However, if a doctor is a Jehovah's Witness, and is the only doctor present, and a patient's life depends on getting a blood transfusion, the doctor should be required to provide this service.


#5

uh, has anything like that ever happened? They wouldn't get through med school.


#6

I think you should just figure out what your profs opinion is and write that down -- forget using reason to answer this.


#7


#8

Well the new rule expands on a 30 yr old one that states that those against abortions are not obligated to perform them. The new rule however gives healthcare professionals including the pharmacy cashier, and receptionist the right to refuse to provide information, service or advice to patients on subjects such as family planning, blood transfusions, contraception and even vaccine counseling.

I have to come at this as a medical ethicist so, I must be objective. The thing is that depending on ones position would the main ethical issue not be different?


#9

Well the new rule expands on a 30 yr old one that states that those against abortions are not obligated to perform them. The new rule however gives healthcare professionals including the pharmacy cashier, and receptionist the right to refuse to provide information, service or advice to patients on subjects such as family planning, blood transfusions, contraception and even vaccine counseling.

I have to come at this as a medical ethicist so, I must be objective. The thing is that depending on ones position would the main ethical issue not be different?


#10

What is so hard about the utilitarian perspective?

If the utility for some outweighs the net loss of others, i.e. the net utility is positive, you force them to do it.

There is of course no way of knowing whether the net utility is positive and even if it was it would still be impossible to know that ex ante and if you open the door for that kind of reasoning in a democratic system it opens the door for a tyranny of the majority.


#11

The question is whether you want to follow a deontological or a consequential ethic and whether you think that an authority can make that decision for someone else and force them to act that way.


#12

Thats just it I understand what it means "Greatest amount of good for the greatest number of beings" but how can one apply it to this question without being objective? Using a Kantian perpective your own belief does not really matter you may disagree but the perspective is set.


#13

I have no idea what you just wrote.

First I think the "objective" in the second sentence should have meant "subjective" to which I would, "exactly, you can´t, but utilitarianism allows you to pretend that you are objective"-

What perspective is set by a Kantian perspective, besides a Kantian of course?

Do you have a Kantian perspective as a regulator or as a doctor?

PS- Sooner or later they will confront you with a form of utilitarianism where they measure utility in the form of money. That is highly seductive and completely wrong, see Rothbards critique of neo cardinalism.


#14

Yes, you are right my mistake. Another mistake on my part, I had been reading an article on patient autonomy regarding Kants philosophy so, it would seem he sided with the patient but, in looking over this issue I completely ignored the autonomy and rights of the doctor. It seems like one can't be objective on the issue.

The report is that of a medical ethicist writing to a pharmicist struggling with writting certain prescriptions. How can I as a medical ethicist write a report for the pharmacist, in which I objectively and dispassionately analyze the situation without forcing my beliefs onto her? The only thing I can think of is writing a report arguing both sides views but, that would lead us back to where we started.


#15

I am fine with doctors deciding not to render services that they disagree with, but I do think that they should be required to tell a patient what all options for treatment are. By keeping a patient in the dark about possible treatment options, the doctor is in effect making a decision for the patient. I'm not okay with that.


#16

I reread your posts and I think what it comes down to is this:

Should a patient have the right to be treated no matter what or can a doctor refuse?

Or is it:

What decision does a doctor make and how would his stance be justifiable using different standards?