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Appeal to sound medicine, not conscience rights: expert

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Defenders of life called to polish arguments for the right to life
By Deborah Gyapong
Photo caption: Dr. Farr Curlin gives Augustine College's annual Weston Lecture Mar. 16. The palliative care physician and co-director of Duke University's Theology, Medicine and Culture Initiative has been called as an expert witness in the challenge by five Ontario doctors of the College of Ontario Physicians and Surgeons Policy that forces effective referral on morally objectionable practices. (Deborah Gyapong / CCN)
A U.S. physician and theologian is warning appeals to conscience rights may no longer be effective because they appear to pit physicians against their patients.
Instead, defenders of conscience rights must polish their rhetorical arguments in defence of good professional judgment and sound medicine, said Dr. Farr Curlin March 16. He was giving the annual Weston lecture sponsored by Augustine College.
A palliative care physician and co-director of the Theology, Medicine and Culture Initiative at Duke University in Raleigh, NC, Curlin has been called as an expert witness in the case of five Ontario doctors who are challenging the College of Physicians and Surgeons of Ontario’s policy that would force physicians to make effective referrals on abortion, euthanasia, and other procedures they may find morally objectionable.
“The policy is outrageous and unprecedented,” Curlin said. “It’s also incoherent.”
Canada now has the most liberal euthanasia and assisted suicide policy in the world, he said.
But Curlin raised concerns about the “docility” and fear with which physicians are reacting to the policy, considering an estimated 10,000 Ontario physicians oppose it. “How many have publicly made it clear ‘I will not follow this policy,’?” he asked.
“Don’t wait until your colleagues agree with you before you act according to your best judgment,” he said. “Act peaceably and resolutely and be prepared to give an answer” about the importance of professional judgment rather than the doctor’s rights, he said.
Arguments defending conscience rights could run into trouble because any remaining public respect for them persists as a “residue” of earlier presumptions about the “intelligibility of nature” and cultural foundations of Judeo-Christian thought that have been “eroded for generations,” he said. Just as society has recently seen sudden reversals on the definition of marriage and on transgender issues, the same could happen with defence of conscience rights.
“When a tipping point is reached, society pivots quickly,” he warned.
One cultural loss is Aristotle’s teleological understanding of purposes or ends for human beings and various actions, he said. For example, the end of economics is wealth; the end of medicine is health.
If the end of the medical art is health, physicians are not to engage in practices that injure health, he said. Each section of the Hippocratic oath corresponds to a temptation a physician might experience, he said, since their expertise can be used to end patients’ lives as well as heal them.
In addition to “widespread skepticism about human beings having a given end or purpose,” there is “no longer a consensus (that) medicine is for the patient’s health,” Curlin said.
This “progressive deconstruction” of the end of medicine means doctors are increasingly seen as “health care providers” not physicians who promote the health of patients, he said.
Individual conscience is “seen as arbitrary and personal,” and any doctor who judges what is ethical or good for a patient is “unjustly imposing their personal beliefs on the patient.”
Understanding the cultural shift can help guide the arguments that can be made against it. “We would do well to use language people can hear,” he said. “Rhetoric really matters.”
He urged physicians to promote the health of patients and solidarity with the weak and the vulnerable and to refuse to “use skills to do them harm.”

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