Tuesday, May 26, 2009

Abortion and execution

Commenter Alphonsus asks, "Given that capital punishment is legal, would it be possible for the government to force a given doctor to perform an execution if no other doctor was willing?"

This question is confused on a number of points. Superficially, the law is at best an imperfect mirror of ethics (and at worst and usually simply a codification of class oppression). It's physically possible for the government to force most anyone to do most anything; the question is: is it ethical to do so?

More deeply, though, in discussing abortion specifically, we're asking about the best interests of the patient. There are two general ethical questions relating to abortion. First: is the fetus a patient whose best interests a physician is ethically obligated to act? It's notable that Bob Hunt does not address this particular question in his opinion. He asks instead: if a physician (or other medical professional) believes that some treatment is indeed in the best interest of the patient, but the treatment violates the physician's own personal moral beliefs, is the physician is entitled to deny that treatment? He answers in the affirmative.

(Another question is: to what degree does a woman forfeit any of her ethical rights by getting pregnant? It's entirely contemptible to answer this question in any way except, "Not at all.")

A condemned prisoner is in an objective sense a sapient human being. Regardless of legal, social and ethical considerations, it's objectively true that a prisoner has interests, and it is never in his interest to be executed (assuming he does not wish to commit suicide). Therefore a physician cannot act in the prisoner's best interests by participating in an execution, and therefore the physician should not be compelled to do so. Indeed, medical ethics — if constructed in terms of the patient's best interests — would forbid participation in an execution. In Mr. Hunt's own terminology, a physician would indeed become a "tool of the state", acting in the state's interests instead of the patient's.

Thus Alphonsus asks a substantively different ethical question: answering one (on any basis) does not in any way suggest any particular answer to the other.

12 comments:

  1. Impeccable argument.

    I hope this argument can help people to examine their positions on capital punishment. It had that effect for me.

    Well done.

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  2. "It's physically possible for the government to force most anyone to do most anything; the question is: is it ethical to do so?"

    Did you honestly think I was asking about the physical possibility of the Government coercing doctors? I though it was obvious from the context that I was inquiring about legal and/or ethical possibility.

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  3. Kindly untwist your knickers, Alphonsus. I try not to make assumptions about what people mean, and I call that particular confusion superficial. Since I actually do address your substantive point, you have little cause for complaint.

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  4. "Since I actually do address your substantive point, you have little cause for complaint."

    For clarification, are you against capital punishment in general, or only against doctors participating in capital punishment?

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  5. Alphonsus: I personally oppose capital punishment, but even if I were to support it, I couldn't see how a physician could ethically participate.

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  6. "Alphonsus: I personally oppose capital punishment, but even if I were to support it, I couldn't see how a physician could ethically participate."

    Hypothetically, then, who would be able to participate in executions/prevent them from being cruel and painful?

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  7. If one is going to actually kill someone against their will, ensuring that their death is not "cruel or painful" seems a trivial concern. What's wrong with a bullet to the back of the head?

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  8. "If one is going to actually kill someone against their will, ensuring that their death is not "cruel or painful" seems a trivial concern. What's wrong with a bullet to the back of the head?"

    Well, cruel and unusual punishment is banned so, if capital punishment is deemed OK, it seems it would have to be performed in a way that is neither cruel nor unusual.

    Even suicide attempts can be sloppy/failed, so a bullet to the back of the head is not a sure thing.

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  9. Well, cruel and unusual punishment is banned so, if capital punishment is deemed OK, it seems it would have to be performed in a way that is neither cruel nor unusual.Indeed. It seems better and simpler to just get rid of capital punishment rather than compromise medical ethics to carry it out.

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  10. Mr. Hamelin,

    I'm afraid you've misrepresented my position. I never said that, if a physician believes that some treatment is in the best interest of the patient, but the treatment violates the physician's own personal moral beliefs, that the physician is entitled to deny treatment.

    You defined the matter in terms of the patient's best interest "in the patient's own terms," not the physician's. That's a big wrench to throw into the equation. I'm stuck on trying to think of an example of a situation where the physician would genuinely regard a treatment in the patient's best interest but have moral objections to the treatment. Obviously, a physician would judge a treatment as contrary to his or her conscience because he or she believes that it would not be in the patient's best interest, even if that means disagreeing with the patient on what is in the patient's best interest.

    An example: last December, Judge Dorothy McCarter, in Baxter v. Montana, decided that the ban on physician-assisted suicide (PAS) in Montana is contratry to that state's constitution. Mr. Baxter had suid for the right to receive assistance from a physician to kill himself. (It's being appealed to the state supreme court, but as of now PAS is legal in Montana). Compassion and Choices (formerly the Hemlock Society) is outraged, however, that no physician in the state has come forward and agreed to participate. Mr. Baxter, the patient, clearly believes that it is in his best interest to die by suicide and requests that physician to assist. Doctors in Montana have so far refused to do so, not because they believe it's in Mr. Baxter's best interest, though contrary to their moral beliefs. Rather, it is contrary to their moral beliefs precisely because they disagree that it is in Mr. Baxter's best interest, even though Mr. Baxter thinks it is. Your construct insists that the physician's judgment on what is or is not in the best interest of Mr. Baxter is irrelevant. Since Mr. Baxter feels it's in his best interest, the physician should comply.

    So, is it your position that the state of Montana is ethically and legally in a position to require that a physician step forward and assist Mr. Baxter in killing himself or face prosecution, or the loss of his or her license, or a fine, or some other punishment?

    Bob Hunt, RN

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  11. Mr. Hunt:

    I have sincerely represented your position as best I understand it. If anything, I may have misunderstood your position.

    Now that you have explicitly clarified your position, I stand corrected and will address your position as stated.

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  12. Bob Hunt, RN5/27/09, 4:54 AM

    Mr. Hamelin,

    I see that my statement could be read as suggesting insincerity on your part. I hadn't intended it that way, and I apologize for the misunderstanding.

    I look forward to your response.

    ReplyDelete

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