Gastmans-WMA EoL Presentation Vatican-Nov2017

1
Conscientious objections
in end-of-life care
Chris Gastmans
KU Leuven, Belgium
Introduction
n Belgian euthanasia act came into force in 2002
n Interesting case to study relationships between
culture, religion, and end-of-life care
n Flanders: cultural transformation from dominant
Christian culture into post-traditional Christian,
pluralist culture, characterized by ideological
diversity
n Appropriateness of conscientious objections
remains controversial
n How can personal ethical convictions and beliefs of
individual caregivers (conscientious objections) be
respected?
Argument-based
literature review:
methodology
n Focused questions:
– What are the primary positions
addressing conscientious objections in
end-of-life care?
– Upon what arguments are these
positions based?
Argument-based
literature review:
methodology
n Search methods:
– Pubmed, Embase, Cinahl, Web of
Science, Philosopher’s Index
– Argument-based literature
– Excluded: empirical studies, editorials,
comments, case studies, ethics codes,
position papers
Argument-based
literature review:
methodology
n Nonconventional compatibilists
n Conventional compatibilists
n Conventional incompatibilists
Conscientious objections:
3 categories
n Non-conventional compatibilists
– Socio-cultural conventions do not serve as a
valid basis to override CO
– Right to personal objection is compatible
with professional obligations
– No dichotomy between personal moral
obligation and professional obligation
– Moral person is viewed holistically
– When individual is compelled to act against
his conscience, his personal identity is
violated, resulting in moral distress
2
Conscientious objections:
3 categories
– Obligation to provide continuum of
care until transfer to another caregiver
– Obligation to disclose objections to
involved parties
– Religious sourced, e.g. Edmund
Pellegrino
Conscientious objections:
3 categories
n Conventional compatibilists
– Conscientious objections are compatible
with professional obligations so long as
conventional standards of society permit
such objection
– Willingness to disclose their positions
– Willingness to cooperate in referral
– Patient may not be burdened (counseling)
– Social contract theory and individual
autonomy, e.g. Dan Brock
– Care relation as contract between 2
participants to respect their beliefs, …
Conscientious objections:
3 categories
n Conventional incompatibilists
– Conscientious objection is personal
preference and is incompatible with
caregiver’s professional obligation to render
legally accepted services according to
societal conventions
– Patient autonomy should be of greater
importance than physician autonomy
– Society expects that physician will not
choose treatments by referring to their own
personal preferences.
Conscientious objections:
3 categories
– Temporary toleration until
conscientious objections are made
illegal
– Secular progressive, e.g. Julian
Savulescu
Discussion
n Unsolvable clash?: conscience is part
of identity of whole person versus
conscience is personally acquired
social construct
Discussion
n Agreement:
– Patient should be adequately informed
about conscientious objection;
– Disclosure at the beginning of care
relationship;
– Cooperation in transfer.
3
Discussion
n Argument contra:
– Negative impact on patient’s
autonomy
n Argument pro:
– Making CO illegal would de-motivate
some people to become a physician
– How providing good care when you
should act against your conscience?
References
n Wernow J., Gastmans C. (2010) A Review and taxonomy of
argument-based ethics literature regarding conscientious
objections to end-of-life procedures. Christian Bioethics 16,
274-295.
n Lemiengre J. et al. (2009) Content analysis of euthanasia
policies of nursing homes in Flanders (Belgium). Medicine,
Health Care and Philosophy 12, 313-322.
n Gastmans C. et al. (2006) Pluralism and ethical dialogue in
Christian healthcare institutions. The view of Caritas Catholica
Flanders. Christian Bioethics 12,265-280.