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Toni Saad, final year student at Cardiff University, was the recipient of a 2018 IME Elective Bursary. Read his report below ...

Conscientious Objection in Healthcare

April 2018, Anscombe Bioethics Centre, Oxford, UK

For two weeks of my medical elective, after completing six weeks in Neurology, I was the Anscombe Bioethics Centre's Visiting Research Fellow, working on the current controversy of conscientious objection in healthcare. My time consisted of preparing a paper for a half-day symposium on the subject and planning a joint seminar between the Uehiro Centre and the Anscombe Centre.

The seminar took place at the Oxford Martin School and consisted of a discussion of the Consensus Statement on Conscientious Objection (published on the University of Oxford's Practical Ethics blog) and Prof. David Oderberg's Declaration on Conscientious Objection. The merits of these were debated and their implications explored. The overriding goal was for parties to gain a better understanding of the core disagreement(s) about conscientious objection. One of the attendees drafted a dozen points upon which disagreement was agreed, and these were summarised at the end. After the event, the discussion was continued by email. We are hoping to draft some of the work which has come out of the seminar for submission for publication. The value of this exercise was to locate precisely the points of disagreement which underly the respective positions on conscientious objection in healthcare, as well as points upon which parties agreed.

The second major event was the half-day symposium on conscientious objection in law and medicine at which I presented a paper. Dr Mary Neal spoke about some of the legal aspects of conscientious objection in healthcare, while my talk considered the ethical and medical aspects. I argued that some common arguments raised against conscientious objection do no withstand logical scrutiny: arguments about the requirements of autonomy fail to recognise the real difference between positive and negative autonomy; arguments about the duty of a healthcare professionals typically do not consider the goals of medicine or the nature of clinical judgement; and arguments about the inappropottaeness of values in clinical decision-making ignore the ineluctably moral character of healthcare and the inevitability of making clinical decision on the basis of conscience. The second part of the paper explored the question of why hostility to conscientious objection has come about in recent times. I argued that the hostility is not towards conscience per se, although that is often how arguments are presented, but it is to do with concerns over controversial issues relating to sex and reproduction. If these issues were different, I speculated that there would not be such a hostile literature towards conscientious objection. After delivering the paper, I heard Dr Andrew Papanikitas' response to it, and took questions from the attendees. This last part was most challenging, as I was forced to answer questions which I had not previously considered. However, the event was undoubtedly useful for my own learning.

My time in Oxford highlighted the need to continually refine my thinking about conscientious objection in healthcare. Interacting face-to-face with those who take a view opposed to my own showed me that I had misunderstood some of the concerns of those opposed to conscientious objection and failed to answer these adequately. Moreover, I realised that previous work I had done in defence of conscientious objection needed revision in light of very helpful conversations with Prof. David Albert Jones. I had previously argued in a paper in Clinical Ethics that conscientious objection should only be permitted with respect to procedures which do not conform to the goal of medicine defined as healing. In this category I included abortion, contraception, euthanasia and ritual circumcision etc. What I realised is, if medicine really is a moral endeavour which requires conscience to make any clinical decision, then it does not make sense to shut down from the outset conscientious objection to things which are not part of a pre-agreed list of controversial procedures. It is too narrow to talk about conscientious objection only in terms of ends, and not also in terms of means. These two can be distinguished, and doing so shows that, even when there is no conflict about the morality of ends, there can be conflict over means. Hence, thought a cardiologist may not be opposed to treating heart disease with a given drug in principle, he may refuse to do so in practice if he deems it would be ineffective or disproportionally harmful. This is a decision of conscience as much as typical examples, though it is about means rather than ends. This is an area which remains uncharted in the debate over conscientious objection. I now believe the discussion needs to move beyond its focus on lists of controversial procedures and view healthcare holistically as a moral endeavour: conscience is not only for the dilemma and controversy, but for every act where one aims to do good.

I am very grateful to the IME for its generous grant for this medical elective, and would like to thank them for making it possible. I would also like to thank Prof. David Jones of the Anscombe Bioethics Centre for the honour of making me the centre's Visiting Research Fellow and guiding my work in preparation for my elective. I look forward to studying further this surprisingly complex subject.

Toni Saad holds an MA in medical ethics and is the book reviews editor for The New Bioethics.



Call for Abstracts PGBC 2018 - Bioethics in the Public Square

Deadline for abstracts: 1 May 2018 - see link below for details

The conference will take place on 23-24 July 2018 at King's College London, Strand & Waterloo Campus

Attendance is free-of-charge, however a £50 refundable deposit will be charged upon booking.

A limited number of bursaries are available - deadline 1 May 2018

Click here for all the details

 

Click here to register and for bursary application



Medical Students! The IME Student Council are recruiting...

Click here for details. Join us!

Deadline for applications: 3 June 2018



Below is a report from Lydia Daniels, third year medical student at Imperial College London, who was given an IME grant to attend our Spring Conference: Rights, Access & Entitlement to Healthcare on 9 March 2018

 

daniels finalI was given the opportunity to attend the 12th Annual IME Spring (Education) Conference entitled Rights, Access, and Entitlement to Healthcare, held in Manchester on the 9th March, thanks to support from the IME conference grant. I arrived eager to uncover lesser-known truths about inequalities within our NHS. There is no doubt that I came away from the conference with a heightened awareness of access disparities between UK communities and the existence of stigma and prejudice within our healthcare system, alongside both the ethical tensions and the opportunities that this creates.

One of the most striking sessions of the day was delivered by Anna Miller on the topic of healthcare provision for migrants, refugees and trafficked people, with reference to her policy and advocacy work with Doctors of the World. We focused on the many barriers facing undocumented migrants who need to access healthcare, and the complex of loops undocumented migrants must jump through before they can receive NHS services. Hospitals do not follow this process as closely as it is described within the law, yet a true enforcement would create a huge resource burden. Measuring this beside the comparatively small proportion of NHS money that is spent on undocumented migrants, some would argue the charging process is somewhat futile especially as this group are unable to secure legal, well paid employment.

The current guidelines from NHS England make it clear that no lack of ID or immigration status disclosure should prevent a person from full registration with a GP practice, however when Doctors of the World have made attempts to register migrants on their behalf, only 2 in 5 applicants were successful - the others were rejected on the aforementioned grounds. These statistics were appalling revelations, and show a discrepancy between guidelines and reality.

We were also made aware of migrants' reluctance to access healthcare due to fear that they will be detained and forced to leave the country. Anna described a 2017 agreement (the Memorandum of Understanding) that allows NHS digital to pass information to the Home Office for immigration law enforcement purposes. We were caused to ponder upon the ethical unease this creates, including the obvious impact on trust in the doctor-patient relationship. A reluctance towards full disclosure means clinicians are neither able to safeguard effectively nor pursue a full holistic approach. Migrants are some of the most vulnerable people living in our country, and it is next to impossible for them to freely access healthcare. Therefore, we must ask: what message does this send about the values of our NHS, and does this come into moral conflict with its founding principles?

Fascinating insights into incorporating homeless people into healthcare were delivered by Dr Shaun Jackson, a GP at Urban Village Medical Practice in Manchester and innovator of "needs-led" homeless healthcare clinics. Shaun began his talk by giving us some hard-hitting statistics. Homeless people have a significantly lower average life expectancy than the general population, and many die from treatable conditions – this group, with some of the greatest health needs, often falls outside the NHS's field of vision. Shaun's clinics consist of fully integrated, multidisciplinary services, including mental health support, tissue viability, and drug assessment and treatment, tied together under the concept of 'inclusion health'.

Conference attendees were encouraged to reach out to this group, with Shaun's assurance that homeless people are, in his experience, greatly concerned for their health. Therefore, they are often surprisingly capable of engaging with health interventions. This translates into a clear opportunity for health professionals to expand their services to reach out to those in great need, to more faithfully implement the principle of universal provision: proportional healthcare access for marginalised people. Ingrained attitudes towards people experiencing homelessness were emphasised as a constraining factor, and it was suggested that a lack of exposure within training could hold responsibility for this.

This report is merely a glimpse into the insights that were shared on this day. I, like many others, left the conference better informed, and inspired to join the fight to better serve the health needs of those on the fringes of society.

Lydia Daniels, 3rd Year Medical Student, Imperial College London



Briefing Note: Nuffield Council on Bioethics: Ethical challenges in bioscience and health policy for the UK Parliament

 

This briefing document sets out four key ethical challenges in bioscience and health policy for the UK Parliament and suggests how these challenges can be addressed.

Four challenges, explored in greater detail in this document, include:

 

  1. Build and maintain trust in medical research and the life sciences

  2. Ensure research and innovation address the needs of society

  3. Promote responsible health policy and research

  4. Promote international leadership in bioethics

 

These challenges draw on current and previous projects including their work on genome editing, cosmetic procedures, non-invasive prenatal testing, biological and health data, the culture of scientific research, children and clinical research, donor conception, emerging biotechnologies, mitochondrial DNA disorders, solidarity, naturalness, organ donation, biofuels, personalised healthcare, dementia, public health and forensic bioinformation.

 

The briefing document, along with short summaries of the Council’s recent reports, policy briefing papers and responses to policy consultations are available here.

 

 

 

 

 



NEW BOOK: D. Jones, C. Gastmans, C. MacKellar (Eds.) Euthanasia and Assisted Suicide: Lessons from Belgium. Cambridge University Press. 2017

 

 

 

Euthanasia in Belgium – one of the only five countries where euthanasia is practiced legally – is the subject of a large body of empirical research. However, until the present volume no study has sought to draw this research together into a coherent narrative and present it to an English-speaking readership. The book includes fourteen contributions from academics and clinicians in Belgium and six from international academics. Looking at the implications of legalized euthanasia and assisted suicide from an international and interdisciplinary perspective, this panel of experts has written an in-depth analysis of the ethical aspects of this complex area, appealing to law, philosophy and medical disciplines. The discussion forms a foundation for informed debate about assisted dying and provides a useful guide to similar choices faced by other jurisdictions.

 

 

 

Click here for more information

 



PET Report: Basic Understanding of Genome Editing

 

The Progress Educational Trust has just published their report entitled Basic Understanding of Genome Editing. The report summarises the findings of a project they carried out with their fellow charity Genetic Alliance UK, funded by the Wellcome Trust. The project explored what patients and laypeople think and know about genome editing and its implications, and developed recommendations for how best to discuss genome editing in public.

Click here

 



ICCEC 2018

The abstract submission process has now closed. Thank you to everyone who submitted - you will be notified of the outcome by end March 2018.

Meanwhile, please find below details of ICCEC 2018 bursaries.

The organisers of ICCEC 2018 are delighted to be able to provide a number of bursaries to attend the conference for delegates from both the UK and overseas.

The Institute of Medical Ethics (IME) are extending their Conference Grant Scheme to cover UK based undergraduate medical students and UK based postgraduate students studying for their MA, MPhil or PhD in medical ethics or bioethics (and includes F1 & 2 doctors). 

 

Important Dates

Important dates

Closing of abstract submissions

Friday 15th December 2017

Notification of acceptance

Friday 23rd February 2018

Confirmation of acceptance

Friday 9th March 2018

Launch of early bird registration rate

Friday 5th January 2018

Deadline for bursary applications

Wednesday 28th February 2018

Deadline for early bird registration rate

Friday 20th April 2018

Deadline for standard registration rate

Friday 15th June 2018



IME Elective Bursaries: Transitional round of bursaries to be awarded for 2018

DEADLINE EXTENDED!

Closing date extended to: 00.59 pm Sunday 22 October 2017

Students to be informed of outcome by: Tuesday 5 December 2017

This is for elective bursaries to be awarded for 2018.

The latest application form and guidelines for this round are available on the awards page of the website, along with an additional document entitled Research methods in medical ethics - IME guidance for Elective Bursary Projects which we would encourage applicants to read. Please use only these documents for this round.

(Please note: If you are already in receipt of an IME bursary, this notice does not apply to you.)