Right of Conscience - Christian Medical Dental …：良知的基督教医疗和牙科….ppt

* * Critique of: ACOG Committee Opinion # 385, November 2007 The Limits of Conscientious Refusal in Reproductive Medicine A. This detailed opinion on the right of conscience contains several flawed assumptions: 1. Patient autonomy is the final arbiter of treatment decisions ? For several hundred years, physician beneficence was believed by all to be the final arbiter of treatment decisions. This was meant to reflect the generally accepted belief that whatever the physician felt was in the patient’s best interest was what should be done. ? In western medicine, this imbalance began to change in the 1960’s and 1970’s such that patient autonomy, i.e., the right to self-determination, was appropriately accorded much greater weight. ? Currently, patient autonomy is felt to outweigh the physician’s concept of patient beneficence in most instances. But patient autonomy is not absolute. There are times when the physician’s exercise of beneficent care is supported and even lauded, e.g., o treatment and prevention of suicide o imposition of life-saving treatment when a patient has made an irrational refusal o imposed isolation of a contagious patient who endangers society o imposed immunizations. ? This flawed assumption is exemplified when ACOG states “[a]lthough respect for conscience is important, conscientious refusals should be limited if…[4 broad criteria offered].” The criteria offered are overly broad and biased. (see critique below) While equally, physician autonomy is not absolute, this tipping of the balance so strongly in favor of the patient based on assertions is ethically troubling. 2. Negative patient autonomy (the right to refuse) and positive patient autonomy (the right to demand) are morally equivalent ? Negative patient autonomy is nearly inviolable; it is rarely justified to impose unwanted treatment (see above for examples). ? However, positive patient autonomy carries much less moral weight. Patient demands are routinely denied by conscientio