Hippocratic Resistance: Conscientious Medicine and Strategic Ethics

Abstract

Conscientious medicine enjoys a long history, with roots reaching back to the Hippocratic Oath. Conscientious objection (CO) as a particular manifestation of such practice carries broader implications for healthcare and society. While patients have the right to decline treatments, they are free to do so for a variety of reasons, even against medical advice (AMA). Healthcare professionals (HCPs), on the other hand, are viewed differently. When it comes to morally questionable interventions, they may be asked to put aside their own convictions out of a sense of obligation or duty. Critics claim that conscientious objection that delays or limits interventions can cause harm. Supporters of conscientious objection argue that there is a growing list of interventions that raise larger questions about the definition of harm and the very nature of humanity. Not only is objection justified in such cases, but it may also be essential to the honest practice of pluralistic medicine. This essay argues that conscientious objection is a defending characteristic of medical ethics as part of the healing identity, with strong historical roots. In addition to safety and policy, conscientious practice acts as an ethical line of defense that has protective qualities for society. Current literature on this topic speaks to the clinical challenges involved with balancing objection and access. This essay uses historical examples going back to Hippocrates to illustrate how respecting individual conscience is strategic for the collective endeavor of medical ethics.

Keywords: Autonomy, Authority, Nonmaleficence, Conscientious, Conscience, Medical Ethics, Integrity, Hippocrates

Robert Orr’s Legacy of Theologically Rich Clinical Ethics Leadership

Dr. Robert D. Orr was a committed Christian, good friend, and exemplary physician. His medical prowess and wisdom were perhaps most powerfully evidenced in his book Medical Ethics and the Faith Factor: A Handbook for Clergy and Health-Care Professionals. That book was the third project developed for The Center for Bioethics & Human Dignity’s (CBHD’s) second book series with Eerdmans, Critical Issues in Bioethics. His volume brilliantly demonstrates how the work of earlier books in the series produced by Biola’s Scott Rae and Harvard’s Arthur Dyck cash out in the everyday practice of medicine. It is a wonderful discussion of a great array of real-life case studies, filled with the insight that comes from a lifetime of faithful caring for patients in the service of God.

Robert Orr, MD: Educator

I probably first encountered Dr. Bob Orr in Toronto—close to 40 years ago. We were both attending a conference—sponsored by the Christian Medical & Dental Associations (CMDA)—that was intended to be an introduction to faith-based medical ethics and would drum up interest for this relatively unheralded discipline.

In Remembrance of Robert D. Orr MD, CM: Physician, Mentor, Teacher, and Friend

I first met Bob Orr when I was a medical student and he was teaching a class on bioethics. He had recently started the clinical ethics consult service at Loma Linda University Medical Center (LLUMC), and I had had an interest in ethics since my undergrad days. Dr. Orr had reluctantly left his home in beautiful Vermont to come to the desert of Southern California and start an official ethics program at LLUMC. He was a Family Medicine physician by training; thus, he joined the Family Medicine department and served as one of the attendings who would chief in the residency clinic. Bob was a master teacher. His lectures were engaging and thought-provoking, and he knew that telling stories was the best way to help people understand what ethics was all about. For Bob, he believed that ethics meant treating people kindly and fairly. Ethics was not just an academic endeavor for Bob. He saw it as a way to make the world a kinder, gentler place for those who were often overlooked and disadvantaged.