Friday, October 17, 2008

The conscientious objector argument in Thailand

A couple of months ago, the 'conscientious objector' argument in medicine made headlines when the US Department of Health and Human Services proposed regulations that aim to protect health professionals who, for reasons of moral or religious conscience, are unwilling to provide certain medical services to patients. As everybody knows, 'certain medical services' is code for abortion, and no topic divides Americans ideologically more effectively than abortion does. 'Pro-choice' advocates argue that the head of Health and Human Services, Mike Leavitt, not so much concerned about 'discrimination' towards health professionals or freedom of conscience. The real concern is on the embryos and fetuses. But between talk about the conscience of the physician and talk about the fetus, something gets left out: namely the woman who is seeking abortion as a (legal) medical service. Proponents of the proposed regulation point out that it does not prohibit women from seeking abortion services; it merely prohibits women requiring the procedure from physicians who have religious or moral objections to it. Among other things, opponents of the regulation say that once you allow for the conscientious objection argument, you will soon have pharmacists refusing to dispense contraception or nurses refusing to recommend the 'morning after' pill. Women's reproductive rights get increasingly hemmed in by the values of social conservatives.

In a paper a couple of years ago, Julian Savulescu wrote a paper about conscientious objectors, in which he looked to make a reductio ad absurdum argument. Imagine, he writes, if a doctor said that he refused to treat patients over the age of 70, because on moral grounds, scarce medical resources could be better invested in the younger population. People would find such an 'act of conscience' appalling. The example suggests that once you allow for the conscientious objector argument, health professionals will be empowered to refuse to treat patients for all sorts of reasons. A weakness of Savulescu's argument, of course, is that it makes use of a thought experiment. There probably is no doctor who actually thinks this way. But there are doctors (nurses, pharmacists) in the world who do think this way about the provision of abortion services.

A better, real-world example of the conscientious objector argument gone awry surfaced last week. Thailand is currently embroiled in serious civil conflict, the culmination of three years of strife between forces for or against ousted Prime Minister Thaksin Shinawatra. The People's Alliance of Democracy (PAD) launched a street campaign in May against the government of Samak Sundaravej that they claim to be a puppet of Thaksin. There have been violent clashes between protesters and the government police, and in solidarity with the protesters, doctors in some hospitals have refused (or threatened to refuse) to treat injured police officers. The police have been using excessive force against protesters, and the physicians are basically claiming that treating injured policemen would be acting against their own moral conscience. Human rights groups have rightly condemned the doctors' action, saying that it is a violation of medical ethics and international humanitarian law, reaffirming that the doctor's primary task is to heal, not to judge.

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