More on Conscience and Civil Disobedience

Over at The Hastings Center’s Bioethics Forum blog, there’s an interesting post from Rosana Triviño addressing the difference between conscientious refusal and civil disobedience, in relation to Spain’s new law limiting care for undocumented immigrants.  This links nicely to some conversation we’ve been having here at Bill of Health as to whether conscientious refusals and actions ought to be thought of similarly and granted similar protections.

One thing I’m puzzling over is the relevance (or not) of institutional support for the conscientious behavior in question.  So in Spain, several medical organizations have encouraged physicians to avoid withdrawing care from undocumented immigrants, and of course in the US and elsewhere, there are many groups that encourage physicians not to perform abortions and other controversial services.  Does institutional involvement make something look more like civil disobedience?  I think the answer is “kind of.”

Ultimately, something is clearly civil disobedience when refusers or actors – 1 or 100 or 1000 – violate the law on the books for conscientious reasons.  But where numbers or institutions can matter is when refusers refuse on grounds of conscience to do something that is legal but not required.  Their refusals are not violating the law, individually or collectively, and there is no technical disobedience.  But when there are enough refusals to do what the law allows, the law may as well say something different.  And particularly when those refusals are coordinated in some way to prevent access to what the law allows, things start to look a lot more like civil disobedience.  So conscientious violation of law seems to be sufficient but not necessary for civil disobedience, which on a broad view could also include efforts to sabotage or impede a law through collective inaction.

What do you think?

Conscientious Actions and Refusals

Great new Perspectives piece by Lisa Harris out in NEJM on the need to recognize that conscience can compel action, not only refusals to provide certain types of care (including abortion).  Elizabeth Sepper makes a similar argument in her forthcoming article in the Virginia Law Review.

First,  let me just say that I couldn’t agree more – it is essential to recognize both sides of the coin.  As I’ve argued elsewhere, both ought to be respected and protected, to a point, but the issues raised by conscientious refusal versus conscientious action are distinct in some important ways.  The primary problem with refusals is that they can burden patients by creating barriers to care, if not managed appropriately.  On the other hand, conscientious action would make care available to patients – and what could be wrong with that?

Read More

Conference Announcement: Institutional Financial Conflicts of Interest in Research Universities

On November 2 at Harvard Law School, the Petrie-Flom Center and the Edmond J. Safra Center for Ethics will be co-sponsoring a day-long symposium organized by Dr. David Korn on institutional financial conflicts of interest in research universities. The speaker line-up is incredible, including Francis Collins, Derek Bok, and Zeke Emanuel, among other experts from academia and government.

For more information, and to register (attendance is free), check out the symposium webpage.  We hope to see you there!

 

Congratulations to Our Greenwall Scholar, Glenn Cohen!

The Greenwall Foundation has selected Bill of Health co-editor, Glenn Cohen, to receive a Faculty Scholar Award in Bioethics for 2012-2015. 

This career development award is intended to enable outstanding junior faculty members to carry out original research that will help resolve important policy and clinical dilemmas at the intersection of ethics and the life sciences.  Congrats, Glenn!

 

Discrimination in the Doctor-Patient Relationship

By Holly Fernandez Lynch

Nir Eyal’s post below has teed up the issue of doctors refusing to accept patients for reasons that seem to be pretty questionable.  The latest example has to do with obesity, but there are plenty of others having to do with vaccination status, sexual orientation, and the like.  Sometimes these refusals can be clearly categorized as conscientious objections (religious or otherwise).  And other times they are  a bit fuzzier, such as when the refusals are rooted in attempts to drive changes in behavior  (e.g., “get vaccinated or you can’t be my patient”) or when they stem from having inadequate staffing or equipment.  But for the patient, all of these refusals can feel discriminatory.   And that raises the obvious question: can doctors legally discriminate against patients?  The answer: it depends.  Sometimes yes, and sometimes no.

First, bear with me while I make the obligatory pitch for my book, Conflicts of Conscience in Health Care, which is now a few years old, but the issues are still very much live.  In that book, I delve deeply into the question of how to balance provider conscience and patient access.  In general, I argue that it is important to protect provider conscience, to a point (or points) – and those points have to do with burden on the patient and avoidance of invidious discrimination.   Read More

Our First Foray into the World of Blogging

The Petrie-Flom Center at Harvard Law School is in an exciting phase of expansion.  One of our new initiatives is this blog, which we hope you’ll visit regularly for insightful commentary on current issues in health law policy, biotechnology, and bioethics.  Petrie-Flom affiliates will be blogging their thoughts here, as will a number of other leading experts from Harvard and beyond – introductions (and lots of them!) can be found below, or on the About Us page.  We’ll also be posting news and announcements from around the world, from upcoming conferences and calls for papers to job openings and funding opportunities.

Our aim is for this site to become your go-to place for all things related to health policy, biotech, and bioethics – from the legal perspective.  If there’s something you’d like to see here (or something you’d like to see done differently), please let us know.  We’re new at this whole blogging thing, so we’ve got a lot to learn.  But we hope you’ll bear with us as we bring together a bunch of great people for some really great (virtual) conversation.  On that note, please join in the conversation yourself – and comment, comment, comment!