Auch unter Befürwortern der Zulässigkeit einer Suizidassistenz durch Ärzte unter bestimmten Bedingungen besteht weitgehendes Einverständnis darüber, dass kein Arzt zu einer Suizidassistenz rechtlich oder berufsrechtlich verpflichtet sein sollte. Auch das Bundesverfassungsgericht hat in seinem Urteil vom Februar 2020 Suizidwilligen unter bestimmten Bedingungen nicht mehr als ein ungerichtetes in rem-Recht auf Suizidhilfe zugesprochen, das keinen Anspruch gegen einen einzelnen Arzt begründet. Mit dem letzten Satz seines Urteils hat es vielmehr die Freiheit jedes einzelnen Arztes – wie auch jedes anderen potenziellen Helfers (...) –, Nein zu sagen, nachdrücklich bekräftigt. Auf dem Hintergrund einer empirischen Untersuchung der Gründe, die in der Schweiz für die Ablehnung entsprechender Patientenanfragen gegeben werden, untersucht und gewichtet der Beitrag die Gründe, die für diese Freiheit sprechen, unter ethischen Gesichtspunkten und verteidigt ein bedingtes Recht auf Ablehnung gegen dessen jüngste Kritiker. In Fällen, in denen die Bedingungen erfüllt sind, durch die das Bundesverwaltungsgericht in seinem Urteil vom März 2017 „extreme Notlagen“ definiert hat, sollte jedoch zumindest eine moralische Pflicht anerkannt werden, den Patienten an einen Arzt zu verweisen, der zu einer Unterstützung bereit ist. (shrink)

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The vigorous legal and ethical debates over conscientious objection have taken place largely within the domain of health care. Is this because conscience in medicine is of a special kind, or are th...

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Many contributors to debates about professional conscience assume a basic, pre-professional right of conscientious refusal and proceed to address how to ‘balance’ this right against other goods. Here I argue that opponents of a right of conscientious refusal concede too much in assuming such a right, overlooking that the professions in which conscientious refusal is invoked nearly always operate as public cartels, enjoying various economic benefits, including protection from competition, made possible by governments exercising powers of coercion, regulation, and taxation. (...) To acknowledge a right of conscientious refusal is to license professionals to disrespect the profession’s clients, in opposition to liberal ideals of neutrality, and to engage in moral paternalism toward them; to permit them to violate duties of reciprocity they incur by virtue of being members of public cartels; and to compel those clients to provide material support for conceptions of the good they themselves reject. However, so long... (shrink)

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RESUMEN La falta de equidad y justicia en la distribución de alta tecnología no excluye la salud pública en casos donde la disponibilidad es inferior a la demanda. Dentro de la estomatología, la implantología en Cuba dispone de recursos limitados y la valoración multidisciplinaria para rehabilitar mediante implantes dentales al adulto mayor depende de factores objetivos y subjetivos. En el presente artículo, en la medida que se identifican los factores que determinan en la exclusión de adultos mayores para rehabilitarse mediante (...) implantes dentales; se pretende como objetivo exponer consideraciones clínicas y éticas a considerar para una justa y eficaz selección. Se concluyó que los factores subjetivos influyen en los bajos índices de ingresos de adultos mayores para rehabilitarse, y que la consulta multidisciplinaria debe impartir equidad y justicia en la selección considerando la calidad de vida como un factor primordial para alcanzar un envejecimiento saludable. ABSTRACT The lack of justness and justice in the distribution of high technology don't exclude the public health in cases where the readiness is inferior to the demand. Inside of dentistry, the implantology has in our country limited resources, and the multidisciplinary assesment to rehabilitate by means of dental implant to senior adult it depends on objective and subjective factors. In this article, in the measure that the factors which determine an bigger exclusion of senior adult are identified to become rehabilitated by means of dental implant; it is sought as objective to expose clinical and ethical considerations to consider for a fair and effective selection. Was concluded that in spite of having an established systematical diagnoses, subjective factors influence in the low index of senior adult to become rehabilitated, and that the multidisciplinary consultation should impart justness and justice in the selection considering the quality of life like a primordial factor to reach a healthy aging. (shrink)

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Most democratic states tolerate, to various extents, conscientious objection. The same states tend not to tolerate acts of civil disobedience and what they perceive as selective conscientious objection. In this paper it is claimed that the dichotomy between civil disobedience and conscientious objection is often misguided; that the existence of a “civic conscience” makes it impossible to differentiate between conscientious objection and civil disobedience; and that there is no such thing as “selective” conscientious objection—or that classifying an objection as “selective” (...) has no significant moral or practical implications. These claims are supported by a preliminary, more general argument according to which conscientious objection is and should be tolerated because the objector lacks the ability to choose his conscience and to decide whether to act upon it. The lack-of-choice argument, it is claimed, applies equally to all types of conscientious objection, including those that are mistakenly called “selective” objection. It also applies to one type of civil disobedience. As a result, if a state is willing to tolerate non-selective conscientious objection, it may and at times must also tolerate selective conscientious objection and civil disobedience and to a similar degree. (shrink)

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Spain’s Roma community has its own cultural and moral values. These values influence the way in which end-of-life decision-making is confronted. The objective of this study was to explore the perspective of Roma women on end-of-life decision-making. It was a qualitative study involving thirty-three Roma women belonging to groups for training and social development in two municipalities. We brought together five focus groups between February and December 2012. Six mediators each recruited five to six participants. We considered age and care (...) role to be the variables that can have the most influence on opinion regarding end-of-life decision-making. We considered the discussion saturated when the ideas expressed were repeated. Data analysis was carried out according to five steps: describing, organizing, connecting, corroborating/legitimating, and representing the account. The main ideas gleaned from the data were as follows: the important role of the family in end-of-life care, especially the role of women; the large influence of community opinion over personal or family decisions, typical of closed societies; the different preferences women had for themselves compared to that for others regarding desired end-of-life care; unawareness or rejection of advance directives. Roma women wish for their healthcare preferences to be taken into account, but “not in writing.” The study concluded that the success of end-of-life healthcare in Roma families and of their involvement in the making of healthcare decisions depends upon considering and respecting their idiosyncrasy. (shrink)

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Debate rages over whether Canadian provincial and territorial governments should allow healthcare institutions to conscientiously object to providing medical assistance in dying (MAiD). This issue is likely to end up in court soon through challenges from patients, clinicians, or advocacy groups such as Dying With Dignity Canada. When it does, one key question for the courts will be whether allowing institutional conscientious objection (ICO) to MAiD respects (i.e., shows due regard for) the consciences of the objecting healthcare institutions, understood as (...) unitary entities. This question has been thoroughly explored elsewhere in the academic literature. However, another key question has been underexplored. Specifically, precedent set by the Supreme Court of Canada’s decision in Loyola High School v. Quebec (Attorney General) suggests that the courts will consider whether allowing ICO to MAiD respects the consciences of the personnel within objecting healthcare institutions. My answer to this question is no, by which I mean that allowing ICO to MAiD shows undue disregard for some consciences and undue regard for others. To justify this answer, I analyze the arguments that hold that allowing ICO in healthcare respects the consciences of the personnel within objecting healthcare institutions. My conclusion is that none of these personnel-based arguments succeed in the case of ICO to MAiD. Some fail because they are wrong about the nature of conscience and complicity. Others fail because they contradict the arguments’ proponents’ positions on conscientious objection by individual healthcare providers. Still others fail because they are internally inconsistent. (shrink)

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