Conscientious refusal / objection in health care: new article draft online, and an upcoming symposium

A while back, I made a post with a number of critical remarks on the idea of a legal right of health care professionals to so-called conscientious refusal/objection. That is the idea that such professionals should enjoy a guaranteed exemption from the standard labour law rule, that employee's are obliged to carry out legal instructions of their employer, in cases when they object to the practice they are instructed to carry out, or its legal status. I made the post mainly to get some opinions of particular relevance to current health care policy off my chest, but as it turned out, these ideas have attracted attention within the international community of more systematic research undertaken in this area.

First, the post lead to an invitation to contribute to a coming special issue of the journal Cambridge Quarterly of Health Care Ethics, guest edited by Alberto Giubilini and Julian Savulescu, on the very subject of the ethics of conscientious objection/refusal in health care.

Second, I was invited to contribute to a symposium on the same topic at the Brocher Foundation in Geneva in  June this year, organised once again by Julian, now in collaboration with Sharyn Milnes. My contribution to the symposium is entitled "All or nothing: The legal, ethical and jurisprudential basis of legal rights to conscientious objection of voluntarily employed professionals", and the contribution to the special issue also focus on the combination of ethical and legal reasons in this area.

The work on this article has been undertaken in collaboration with my Danish colleague Morten Ebbe Juul Nielsen, who made contact almost immediately when the blog post was online to suggest that we collaborate, as he had been thinking along the lines of some of the central points of the post already, and had started to scan the relevant literature in more detail. Said and done, the first result of our efforts, the submitted draft manuscript to the mentioned special issue, entitled "The Legal Ethical Backbone of Conscientious Refusal",  can now be viewed online here and here. As this submitted manuscript is undergoing review and will almost certainly be subject to revision, me and Morten are happy to receive any sort of constructive comments.

New article published: The counseling, self-care, adherence approach to person-centered care and shared decision making: Moral psychology, executive autonomy, and ethics in multi-dimensional care decisions

A few days ago, an article by myself and three colleagues from philosophy, psychological safety research and pediatrics that's been accepted for a long time finally came online at the journal Health Communication's website. The article explores how standard accounts of how models for increased interaction and collaboration between patients and health care professionals – often termed patient or person centred care, and shared decision-making – fit badly to a broad group of patients; namely those whose care are mostly self-administered, who suffer vulnerable decision capacities and who exhibit a weakening adherence to decided care plans. In the article we illustrate the point with a study of adolescent diabetes care, based on video-taped consultation meetings between patients and health care professionals, and develop a general argument based on broadly recognised research in decision-making and moral psychology to revise the standard approach to person centredness and shared decision-making for this group of patients, focusing less on making shared rational autonomous decisions in health care meetings, and more on emotionally empowering patients and help them to develop virtues necessary to take responsibility for the self-care they agree on in collaboration with health professionals. Here is the abstract:

This article argues that standard models of person-centred care (PCC) and shared decision making (SDM) rely on simplistic, often unrealistic assumptions of patient capacities that entail that PCC/SDM might have detrimental effects in many applications. We suggest a complementary PCC/SDM approach to ensure that patients are able to execute rational decisions taken jointly with care professionals when performing self-care. Illustrated by concrete examples from a study of adolescent diabetes care, we suggest a combination of moral and psychological considerations to support the claim that standard PCC/SDM threatens to systematically undermine its own goals. This threat is due to a tension between the ethical requirements of SDM in ideal circumstances and more long-term needs actualized by the context of self-care handled by patients with limited capacities for taking responsibility and adhere to their own rational decisions. To improve this situation, we suggest a counseling, self-care, adherence approach to PCC/SDM, where more attention is given to how treatment goals are internalized by patients, how patients perceive choice situations, and what emotional feedback patients are given. This focus may involve less of a concentration on autonomous and rational clinical decision making otherwise stressed in standard PCC/SDM advocacy.

The article itself can be found here. For those who lack access to university libraries or subscriptions, a so-called postprint of the article – i.e. the author's finally submitted manuscript after peer review, but before editorial and type setting changes, pagination and so on – can be found here. Or you can contact me, to request a pdf of the published version.

The Paris, COP 21, Climate Change Policy Deal

The news's just flowing out of Paris that a global deal on climate change policy has been struck. The draft agreement (as it is called), can be found here. As so many agreements at this level it is virtually unreadable for a lay person, and the first 19 pages are only about the background, earlier deals and formal stuff about adoption, how to sign up, etc.

The real stuff – the actual deal – starts in the so-called Annex, on page 20, and on page 21, in article 2, we find the nitty-gritty:

Article 2

1. This Agreement, in enhancing the implementation of the Convention, including its objective, aims to strengthen the global response to the threat of climate change, in the context of sustainable development and efforts to eradicate poverty, including by: 

(a) Holding the increase in the global average temperature to well below 2 °C above pre-industrial levels and to pursue efforts to limit the temperature increase to 1.5 °C above pre-industrial levels, recognizing that this would significantly reduce the risks and impacts of climate change;

(b) Increasing the ability to adapt to the adverse impacts of climate change and foster climate resilience and low greenhouse gas emissions development, in a manner that does not threaten food production;

(c) Making finance flows consistent with a pathway towards low greenhouse gas emissions and climate-resilient development. 

2. This Agreement will be implemented to reflect equity and the principle of common but differentiated responsibilities and respective capabilities, in the light of different national circumstances.

The rest is detail. Not unimportant, as it stresses, e.g., the strong responsibility of rich countries to present the main bankrolling regarding mitigation, adaption, compensation,  technology transfer, etc. But article 2 is what sets the level of political ambition: the point of all the rest. The fact that the agreement has now clearly stood against all attempts to abandon the 2°C target for a higher one, has now been not only been scrapped, but reversed to aim for a lower level is very good news for anyone who has inspected the dire global consequences in all areas of life and society of already a 2°C rise of the global temperature.