Thursday, July 17, 2014

Joyce Arthur: Conscientious objection should be punished

As we know, the College of Physicians and Surgeons of Ontario is reviewing their policy on conscientious objection (CO), and is looking for input from physicians and the public on their website. CPSO are also posting comments from anyone who would like to contribute to the policy.

Interesting comments on both sides of the debate.

And then there's Joyce Arthur's view on the topic. Arthur co-wrote a paper with Christian Fiala called “Dishonourable disobedience”Why refusal to treat in reproductive healthcare is not conscientious objection

See below for some of Arthur's extreme opinions on conscientious objection. An extreme view by an extreme person. No surprise there.

But it's what happened next that was surprising. After Arthur's article was published, her paper was actually criticized by a pro-choice group: the British Pregnancy Advisory Service (bpas).

Jennie Bristow, editor of Reproductive Review, (the educational arm of BPAS) states:
"It is true that campaigns against abortion have often appropriated the language of ‘conscience’ to push across a more political agenda. However, there are good reasons why prochoice advocates have supported the ability of medical professionals to opt out of performing a procedure that goes against their conscience. The idea of forcing a doctor to perform an abortion when he or she thinks that this is murder sits very uncomfortably with the principles at the heart of a liberal society. So too, of course, does the idea of forcing a women to continue with a pregnancy that she does not want. 
In this regard, choice goes both ways; no woman or doctor should be forced to have or perform an abortion, but women and doctors should be free to choose for themselves whether to have or perform an abortion. That is ultimately why having laws that ban or restrict abortion are such a problem...
...compelling doctors to perform abortions against their wishes would, conversely, lead to unpleasant care for women and set a worrying precedent about how much the law can dictate the beliefs and practice of those working in reproductive healthcare. This includes those doctors and nurses who are motivated by their consciences to perform abortions, and care for the women who need them. 
The problem of abortion is one of too much legal regulation and restriction already. It is hard to see how laws designed to compel professionals to act against their conscience can be of benefit to anybody." (emphasis mine)
Arthur's position was also criticized by by Wendy Chavkin, Global Doctors for Choice.
We are all concerned that conscience-based refusal to provide contested components of reproductive health care exacerbates limited access to such care and thus threatens women’s health and rights. Where we differ with Arthur and Fiala is in our analysis of the issues at stake. We believe that there are competing rights here, and that resolution of such tension is primarily a societal, not individual, responsibility. We also differ in our pragmatic assessment of how best to proceed. 
From the human rights perspective, we see the ability to exercise conscience as fundamental to individual integrity. In fact, allegiance to this principle undergirds our collective defense of the individual woman’s right to autonomy in reproductive decision-making. The international and human rights covenants cited all concur that the individual’s right to hold and manifest beliefs and religion are essential, and subject only to limitations necessary to protect the fundamental rights of others. International and national professional associations have similarly defended the individual clinician’s right of conscience while also asserting that it should be circumscribed by the primary duty to the patient, including requirements to disclose, refer, and impart accurate information, and provide care in cases of emergency. 
The obvious tension here is when the rights of individuals collide: the objecting clinician’s right to refuse, another clinician’s conscience-based commitment to providing that care, the woman’s right to follow through on her conscientiously chosen course of action. (emphasis mine)
Then Arthur apparently felt defensive of her radical views in this rebuttal to their criticism:
"We received several critiques, one published in bpas Reproductive Review, another in RH Reality Check by Global Doctors for Choice, and a few informal criticisms relayed on listservs or online comments, and at a recent conference in Lisbon, Portugal, where we presented our ideas. We paraphrase these criticisms below – most of which we feel ignored or misunderstood our position – and follow with our response."
That's got to be a first. Pro-choicers not agreeing with every confused word that comes out of Joyce Arthur's extremist pro-abortion mouth.

No wonder pro-choicers felt compelled to comment on Arthur's views. Even they realize the importance of conscientious objection for doctors.

Below are excerpts from Arthur's and Fiala's original paper. Arthur's extremist nonsensical views pretty much speak for themselves.

(all emphasis are mine)
"Healthcare professionals who exercise CO are using their position of trust and authority to impose their personal beliefs on patients, who are completely dependent on them for essential healthcare. Health systems and institutions that prohibit staff from providing abortion or contraception services are being discriminatory by systematically denying healthcare services to a vulnerable population and disregarding conscience rights for abortion providers." 
"Some argue that abortion is a type of killing (of the foetus or embryo) and therefore CO is just as relevant in medicine as in the military. However, killing a living person in war cannot be equated with stopping the development of a gestational sac or foetus
Abortion and contraception preserve the health and lives of women, while those practicing CO put women's lives at risk and sometimes even sacrifice them (Attie & Goldwater Productions, 2005)."
"Because reproductive healthcare is largely delivered to women, CO in this field has implications for women's human rights and constitutes discrimination. Women are often expected to fulfil a motherhood role, so they frequently face ignorance, disapproval, or even hostility when requesting abortion. In these circumstances, the exercise of CO becomes a paternalistic initiative to compel women to give birth."
"Abortion is a necessary health intervention, as well as highly ethical."
"Termination of unwanted pregnancy is ethical because women do so only if they don’t see any responsible way to care for that potential child."
"Canada already struck down its law entirely in 1988 and never replaced it, proving that criminal abortion laws are unnecessary and counter-productive."
"Anti-choice objections to providing abortions are based on a denial of this evidence and historical experience. The provision of safe, legal abortion is a vital public interest that negates any grounds for CO."
"Doctors who invoke CO to not perform abortions can benefit professionally by spending more of their time delivering more “reputable” or higher status treatments compared to their abortion-providing colleagues. As a result, they can escape stigma and boost their careers, reputations, and salaries."
"When access to abortion care is reduced, restricted, and stigmatized in so many ways, allowing any degree of CO adds further to the already serious abrogation of patients’ rights and medical ethics."
"CO in reproductive healthcare is largely unworkable and inappropriate, and arguably unethical and unprofessional as well."
"The reliance on a doctor to protect one's life and health makes any right to CO in medicine unethicaland downright dangerous in light of the fact that women often resort to unsafe do-it-yourself abortions when they are unable to access medical care. If peoples’ right to life means anything, they must be able to access necessary healthcare, which should supersede the conscience rights of others."
"CO gives a person a pretext not to do their job, even though they were specifically hired to do that job and are being paid for it."
"The principle of public accommodation requires the discounting of individual conscience within a profession. Everyone's conscience is different and cannot be coerced, which is why a free democratic society places a high value on tolerance and equal respect for all citizens. However, if individuals are permitted to exercise their conscience when serving the public, it gives social sanction to the practice of intolerance. CO invites discrimination against people needing the services being refused, and infringes their freedom of conscience."
"The exercise of CO becomes an excuse for the doctor to exert personal power over the patient by imposing their own views."
"Even doctors who exercise CO within the law are arguably unsuited for their position because they are demonstrating an inability to perform their job – that is, they are allowing religious beliefs or some other personal issue to interfere with their job performance to the extent of negating their professional duty to patients."
 "we propose that healthcare providers be prohibited from a blanket right to refuse to perform or refer for abortion or dispense contraception for personal or religious reasons."
"we propose the following specific remedies to reduce and eventually eliminate CO in reproductive healthcare. Everyone aspiring to enter health professions that involve reproductive healthcare should be required to declare that they will not allow their personal beliefs to interfere with their management of patients to the point of discrimination. Medical students entering the Ob/Gyn specialty should be informed about the full scope of the specialty, including treating women with unwanted pregnancies. Students should be rejected if they do not wish to learn and prescribe contraception or perform abortions for CO reasons. All Ob/Gyns should be required to dispense birth control and perform abortions as part of their practice (unless there is a legitimate medical or professional reason not to). General practitioners should be expected to dispense contraception if requested, and perform abortions if they have the skills and capacity, or else refer appropriately. Pharmacists should be compelled to dispense all lawfully prescribed drugs without exceptions. Institutional CO should be completely prohibited for health systems and businesses that serve the general public."
"Monitoring and enforcement measures should be put into place to ensure that prohibitions on CO are followed. After all, CO is a form of resistance to rules or laws, so those who exercise CO must be prepared to accept punishment for their disobedience, just as in any other profession. Doctors should be sanctioned when they violate laws or codes of ethics that prohibit CO. Disciplinary measures could include a review process, an official reprimand and order to correct, and could escalate to loss of medical license, dismissal, or even criminal charges. In addition, any costs involved in the exercise of CO should be borne by the health professional or institution, who must be held liable for any health risks and negative consequences of their refusal. Patients should be legally entitled to sue and to claim compensation for any physical or mental harm, and for additional costs resulting from the refusal to treat."
"Other needed measures include compulsory training in contraception provision and abortion techniques at medical schools, security measures to protect doctors and patients such as clinic buffer zones, full funding of contraception and abortion through government health insurance, public education to reduce abortion stigma, and other initiatives." 
"Healthcare workers’ refusal to participate in reproductive care such as contraception and abortion is not a “conscientious objection;” rather, it is a refusal to treat that should be seen as unprofessional. A just society and an evidence-based medical system should deem it asdishonourable disobedience,” an ethical breach that should be handled in the same way as any other professional negligence or malpractice, or a mental incapacity to perform one's duties."
"By manipulating women into continuing an unwanted pregnancy against their best interests, the exercise of CO undermines women's self-determination and liberty and risks their health and lives. As such, it has no place in a democratic society."

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