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Fortunately UK psychologists don't use the APA Code of Ethics
- Natty Triskel (15 May 2009)
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Psychologists opposed to APA's policy
- Richard Solomon, PhD (15 May 2009)
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Inappropriate cover headline
- John L Derry (16 May 2009)
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Psychologists for Social Responsibility Responds
- Roy J. Eidelson (18 May 2009)
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British Psychological Society Declaration against torture
- Jonathan P Calder (18 May 2009)
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Re:Turf fights over torture
- Pamela Kaden (18 May 2009)
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One psychologist's view of the APA position on torture
- Lorri A Greene (19 May 2009)
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Doing what 's right isn't the problem. It's knowing what's right.
- BM Hegde (20 May 2009)
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One Person's Mights is another Person's Wrong
- susanne stevens mccabe (21 May 2009)
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Poor portrayal of important issues
- Susanne Iqbal, Philip Skogstad, Consultant Clinical & Forensic Psychologist, Fulbourn Hospital, Cambridge, CB21 5EF (23 May 2009)
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rules of conscience editorial
- zev w. wanderer (1 June 2009)
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Formal rule of conscience for MPs
- David M Shaw (6 June 2009)
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doctors are not above the law
- John Lunstroth (16 June 2009)
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Ranking of the rules of conscience
- Tjaard U Hoogenraad (30 June 2009)
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Natty Triskel, Consultant Clinical Psychologist North Bristol NHS Trust
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I'm pleased to let you know that both the British Psychological Society, which currently regulates applied psychologists in the UK, and the Health Professions Council, which will do so after July 2009, have robust codes of ethics which preclude harming the recipients of services. Competing interests: None declared |
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Richard Solomon, PhD, Consultant Child Abuse and Mediation Listening Santa Barbara, Ca. 93101
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Thank you for your editorial about the American Psychological Association's unfortunate and unethical policy on allowing psychologists to participate in "enhanced interrogations" of detainees in the last few years. Please realize that many of us in the field here in the USA have been very distressed by this practice. So much so that we have resigned our membership in APA. In addition, I have always encouraged colleagues to do likewise. Gradually, the truth has come out about how the executives of APA allowed these decisions to be made in secret. I hope that these individuals, and those who participated in such interrogations, will at the very least be excluded from membership in APA and put on probation if not have their licenses to practice revoked. Psychologists also are supposed to adhere to the maxim of "do no harm" to clients/patients. Those who fail to live up to that principle should be censured. Richard Solomon, PhD Licensed Psychologist Competing interests: None declared |
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John L Derry, Coach and professional adviser Oxford Postgraduate Medical & Dental Education Deanery, Oxford OX3 7XP
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I was shocked when I saw the front cover of the journal in which this editorial is published, with its garish colour, dramatic picture, and bold headline: "Interrogating Detainees: Why psychologists participate and doctors don't". When I read what it was about I became angry. The headline actually refers to differing ethical guidance issued by the American Medical and American Psychological Associations. It is misleading and potentially offensive to conflate the term "psychologists" with the American Psychological Association, and similarly "doctors" with the American Medical Association. This front cover is more worthy of the excesses of UK tabloid newspaper journalism and does nothing to add gravitas and meaning to an important ethical debate. If I were a psychologist I might well be offended by the suggestion that I would participate in the kind of abusive interrogative practices indicated by the cover picture. Please can this high-impact medical scientific journal adopt a more responsible approach to advertising its contents and abandon over- simplistic, over-exaggerated journalistic excess? Competing interests: None declared |
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Roy J. Eidelson, President-Elect, Psychologists for Social Responsibility 19004
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Along with other human rights organizations, Psychologists for Social Responsibility (PsySR) has condemned the prominent participation of psychologists in planning and carrying out the systematic abuse of U.S. detainees and has called for an independent commission to examine the role of psychologists and the American Psychological Association (APA) in this abuse. PsySR has also posed six key questions for the APA to answer: 1. Did the APA’s 2005 Presidential Task Force on Psychological Ethics and National Security (PENS) provide an independent evaluation--without outside interference--of the ethics of psychologists’ participation in these interrogations? 2. Has the APA responded appropriately and adequately to official ethics complaints registered against APA members regarding their involvement in abusive interrogations? 3. Was the APA’s sponsorship of post-9/11 invitation-only workshops with security agencies such as the CIA consistent with its “do no harm” core principles? 4. Why did the APA adopt unrealistic assumptions about the impact and autonomy of psychologists present in detainee settings in spite of well- known psychological research to the contrary? 5. Have financial and career considerations--such as the funding of psychological research and practice by the defense-intelligence establishment--influenced APA actions and policies in regard to psychologists’ participation in abusive interrogations? 6. What was the basis for the APA’s revision of Standard 1.02 of its Ethics Code in 2002 to the effect that psychologists may ignore the code where it conflicts with the regulations of an undefined “governing authority” --and why was this standard not modified after APA Council identified its potential to allow for torture? Given the evidence received from diverse sources, PsySR believes that an independent national investigation is an absolute necessity in ensuring that members of the American psychological community do not find themselves repeating their involvement in such widespread human rights abuses ever again. Competing interests: None declared |
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Jonathan P Calder, Communications Officer British Psychological Society, St Andrews House, 48 Princess Road East, Leicester LE1 7DR
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Although your article concerns the actions of American psychologists, we thought it important to make clear the position of the British Psychological Society on this subject. At the Society’s Annual Conference in Manchester in March 2005 we issued our ‘Declaration by The British Psychological Society concerning torture and other cruel, inhuman or degrading treatment or punishment’. The Declaration states that the Society ‘condemns torture wherever it occurs, and supports the United Nations Declaration and Convention Against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment. We further condemn the misuse of psychological knowledge and techniques in the design and enactment of torture’. Speaking of the responsibilities of individual psychologists, the Declaration says: “Psychologists shall not countenance, condone or participate in the practice of torture or other forms of cruel, inhuman or degrading procedures, whatever the offence the victim of such procedures is suspected, accused or guilty, and whatever the victim’s beliefs or motives, and in all situations, including armed conflict and civil strife.’ The full Declaration was published in The Psychologist, the Society’s monthly magazine, in April 2005 (vol. 18, no. 4. p.190). Competing interests: None declared |
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Pamela Kaden, clinical psychologist Chicago, IL
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Your editorial is unfortunate in that there are so many erroneous assertions, it becomes an example of mere turf-fighting. Godlee would like the audience to believe that physicians retain greater morality than psychologists. This is evident in her contrasting psychologists with "doctors" despite the fact that both psychologists and physicians are doctors. Yet, Godlee ends her editorial by citing problems with FDA drug approvals. We know that the FDA has put profit above patients. We know that these decisions follow the recommendation of a panel of physicians--or as she says, "doctors." When one counts the number of people harmed by the inappropriate regulations of medications and medical devises and the silence of physicians on that matter, one wonders about the superior moral grounding of physicians. One's wonderment is perpetuated by recent censorship issues plaguing medical journals, economic conflicts of interest, participation in fulfilling death penalties, and a knowledge bank built upon the prejudice and ignorance that begot such infamous medical studies as the Tuskegee experiments. Godlee clearly has not familiarized herself with the documentation published regarding military psychologists. None claimed that they were "only" obeying orders. Evidence shows that decisions evolved out of painstaking policy debate and self-examination with regard to who is the patient, what is the greater good, and what is the responsibility of the individual participants. And, while I do not agree with decisions, made, to misrepresent how decisions were made, relying upon cheap and sensational analogies to WW2 instead of stating the facts is nothing more than an cheap and dishonest shot in service of the author's ego. Would that true moral superiority came so easily as journal profits garnered through sensationalism. Re: "One ethicist I spoke to was reminded of how German doctors..." Why does Godlee hide the name of the ethicist? Is the name secondary to the inflamatory analogy? In fact, I am reasonably certain of who made that statement, that statement having been trodden out so many times that it has lost all sensationalist value. That person is not an ethicist. That person is an academic and any pretense to being an ethicist is self- annointment. Still, one wonders why the name is not given, and what that means about the author's objectivity. I so wish that Godlee had taken a serious look at this issue, based her opinion on the information at hand, and stated it in a restrained manner. That would give it credence and power and would open the discussion to debate about how to deal with the problems revealed. As written, Godlee seems more concerned with selling subscriptions and comforting herself with distortions that the professional degree in medicine confers a moral superiority that in and of itself is rather "germanic." Competing interests: None declared |
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Lorri A Greene, Psychologist Private practice in San Diego, CA 92117
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I have been a psychologist for over 20 years. I feel honored and humbled each and every day, as people share their life stories with me. These stories are often painful, full of anquish, guilt, sorrow and, hopefully some joy. They trust me to listen, care, and offer hope. I can think of no other profession with such a profound impact on another persons psychological life. Soon after I began hearing stories about the American Psychological Association's comlicity in the torture of detainees at Guantanamo, Camp 7 and other CIA "black sites" I told myself, "This cannot be true. No one in my chosen profession would ever do that." How naive I was. I know now that some members of the APA were not only lending a "helping hand", but were responsible for creating ways in which to do it. I still have a hard time believing it, but I do. Too much evidence has surfaced. The California Psychological Associaton began censoring my listserve posts when I expresssed my outrage or offered evidence of what some in our profession were doing. And, when one of my posts actually got through, some defended the policy of the American Psychological Association. Fortunately, I found Psychologists for Social Responsibility and another group of over 1000 psychologists who were withholding their APA dues over this issue. Even after all of the media attention, the Association is still slow to tell it's membership this is not OK. At this time, I feel ashamed of my affiliation with the American Psychological Association. I used to be proud when someone asked about my profession. Now, I am not so proud. When people ask me why the American Psychological Association doesn't say NO MORE involvement in these horrifc acts I have no answer. Competing interests: None declared |
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BM Hegde, Editor in Chief, Journal of the Sciecne of Healing Outcomes. Mangalore-575 004, India.
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Dear Fiona Godlee,
The title of your editorial is the best that I have seen in medical, nay science, journals in a very long, long time. (1) I am happy that medical science, at least some one there, is thinking of conscience! Do we, doctors, have our conscience at all? If only we audit many of the common interventions that we indulge in and rave about, not excluding many of the drugs that we prescribe, using our conscience, we will have stopped those long ago. (2) Most of what doctors do in daily practice is not based on any one of our “scientific studies.” Most of it is based on what the company representative presents to doctors! How big are the “doctors’ hospitality budgets of many medical device manufacturers? That apart, what applies to controlled conditions of our research can never be extrapolated into real life situations-the latter are much more complicated. (3) Doctors are brainwashed so much that even statistical “scientific” articles are published showing that only drug therapy brings down blood pressure even in mild to moderate hypertension while a plethora of data and experience shows that the majority of mild to moderate hypertensives become normotensives on change of mode of living! Interestingly the same article has a caveat which notes that in real life change of mode of living might lower blood pressure. If that is the case what is the need to a study to show that only drugs lower blood pressure? George J Fodor of the University of Ottawa Heart Institute in his article in the Journal of hypertension sums up the results of a comparatively very small sample of people observed thus: “Whether we like it or not the only thing which we can definitely offer which works is DRUG treatment. I don’t like it and most people don’t like it but, it is the simple TRUTH.” This small study is trying to refute all our experience and the results of larger studies like the Australasian study and the large MRC study with 80,000 patient years of experience of mild to moderate hypertension where simple tender loving care and repeated clinic visits with change in mode of living lowered moderate hypertension to normal in40% of patients! (4) However, the study that is being flaunted to doctors is the Ottawa study! Where is our conscience? (5) Doctors advise patients about all kinds of diets-good, bad and the ugly. I have not been able to find a good foundation, based on hard science, for all those advices. The first Diet-Heart study has always been inconclusive and did not find any connection between heart disease and diet! The whole world of cholesterol advice starts with the infamous Ansel Keys (1953) “seven country study” where he showed a linear relation between fat (cholesterol) intake and death due to atherosclerotic diseases starting with a low in Japan and highest in the USA. (6, 7) While Keys had access to data from 22 countries, why did he choose to ignore the majority of countries (conscience) and selectively pick just the seven (or six) to get a positive correlation? Jerome Kaissirer, former editor of NEJM feels that our complicity with big business (without our conscience pricking us) might endanger the health of the population. (8) Kauffman feels that the bias in recent papers on diets and drugs in peer reviewed journals could be dangerous (9) Briel and colleagues have shown how early treatment with statins did not alter short term clinical outcomes in acute coronary syndromes. (10) Anthony Colpo goes one step further to show that all that we are told about cholesterol is wrong! (11)I agree with Richard Smith who thinks that there are problems with the medical journals. (12) The latest fad is the CRO in the third world countries where the notion of “informed consent” is just eyewash. Many a time illiterate poor patients are lured with a sheet with all the details about the informed consent and are told that they get free treatment and hospitalization if they consented and signed the form. Most do so not knowing what they are in for. Where is our conscience in all these? In addition, the results, when ready, are to be handed over to the drug companies who “look” at them before publication. CROs are a big business these days. (13) Let us not forget that the “tragedy of science is the slaying of a beautiful hypothesis by an ugly fact”, as suggested by Thomas Huxley (1825-1895). Karl Popper was not far off the mark when he said that “growth of knowledge depends entirely on disagreement.” Yours ever, bmhegde References: 1) Godlee F. Rules of conscience. Editor’s choice. BMJ 2009;338:b1972 2) Abramson J. Overdo$ed America. 2005. Harper Collins. 3) Feinstein AR and Horwitz RI. Problems in the “evidence” of evidence based medicine. Am J Med 1998; 105: 361-362. 4) Beavers DG and McGregor G. Hypertension in practice. 1999. Page 138. ISBN 18531 75919. 5) Fodor GJ, S Natalie H. McInnis, Eftyhia Helis, et. al. Life style changes and blood pressure control: community based cross sectional survey. The Journal of Clinical Hypertension 2009; 11: 31-35. 6) Yerushalmy J and Hilleboe HE. Fat in the diet and mortality from heart disease. New York State Journal of medicine 1957; 57: 2343-2354) 7) Keys A. Coronary heart disease in seven countries. Circulation 1970; 41 (suppl1): 1-211) Also read. Kassirer J. Complicity with big business can endanger your health. Am J Phys surg 2005; 10: 25-26. 8) Kaiserrer. J. Managed care and the mortality of the market place. www.utmb.edu/healthpolicy/kassirer.htm - 1 9) Kauffman JM. Bias in recent papers on diets and drugs in peer reviewed journals. Am J Phys surg. 2004; 9: 11-14. 10) Briel M, Schwartz GG, Thomson PL et. al. Effect of early treatment with statins on short-term clinical outcomes in acute coronary syndromes. JAMA 2006; 295: 2046-2056. 11) Colpo A. The great cholesterol Con: why everything you have been told about cholesterol, diet, and heart diseases is wrong? www.lulu.com 2006 ISBN 978-1-4116-9475. 12) Smith R. The trouble with medical journals. 2006. Royal Society of Medicine Press, London UK. 13) Angell M. Truth about drug companies. 2006. Random House Publications. |
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susanne stevens mccabe, retired cf5 6su
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The question of what consitutes ethical behaviour is never settled. It is a case of conflict however politely fought out or reasonably stated which relies partly on the power differential between parties with different views. For example, the ethical stance of the Catholic Church in Ireland trumps that of many Irish Drs and, certainly the ethical decisions of the women who come to UK for termination of pregnancies - carried out by UK doctors practising on the mainland. At the other end of the scale those wishing to end their lives needs must go to Switzerland, where Swiss Doctors can assist their death - an impossible option in UK. All professional groups who have carried out unspeakable violations against others in weaker positions, have had excuses designed to legitimise their abuse. They have not only been psychologists. Wherever a group with vested interests, including the wider medical professions, operate from a position of lack of transparency, of being able to potentially use sections of the population as a means towards and end which has not included their agreement, or their participation in drawing up and constantly revising rules of behaviour, it becomes a shifting power game which the title of Ethics does not completely obfiscate. Competing interests: None declared |
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Susanne Iqbal, Chartered Clinical Psychologist George MacKenzie House, Fulbourn Hospital, Cambridge, CB21 5EF, Philip Skogstad, Consultant Clinical & Forensic Psychologist, Fulbourn Hospital, Cambridge, CB21 5EF
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Dear Editor, It was disturbing and concerning to see the headline ‘Interrogating Detainees Why psychologists participate and doctors don’t’ on the cover of the BMJ (16th May 2009). At best, it is an example of poor communication (violating Grice’s maxims of good communication: avoid obscurity of expression, make your contribution one that is true, and be sufficient informative). At worst, it has a feel of tabloid journalism, designed to get readers’ interests at the cost of accuracy. It is incorrect and misleading to state in a British journal that “psychologists” participate in the interrogation of detainees, when only a comparatively small number of American psychologists (e.g. military psychologists) have been prepared to participate in interrogation. Psychologists who are members of the British Psychological Society adhere to a strict code of ethics and conduct, which is in line with the guidelines issued by the United Nations. Furthermore, in the editorial (BMJ 2009; 338:b1972), the editor’s portrayal of doctors’ and psychologists’ (at least in the US) morality and ethics seems overly simplistic and biased in its presentation, designed more to grab attention than communicate clearly about important issues. The editorial takes no account at all of the strong debate within the US psychology profession and in other countries such as the UK about issues such as interrogation. With regard to the Pope and Gutheil’s article itself (BMJ 2009; 338:b1653): Whilst it is commendable that the authors examine ethics policies, the implicit assumption that it is ‘age of the profession’ that could compromise ethical attitudes is untenable. History is full of examples where doctors’ (e.g. psychiatrists) practice and ethics have been compromised by the social and political context (e.g. the former USSR). Competing interests: None declared |
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zev w. wanderer, professor, clinical psychologist nahal amram 4, eilat, israel, 88000
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in this editorial (may 14 issue), psychologists were compared quite unfavorably with medical doctors on the issue of ethics because of our role as consultants on the interrogation of terrorists. after comparing psychologists with Nazi doctors, the article explains that psychologists' ethics do not contain "the doctor's obligation to heal" and "to do nothing to harm." first let me remind the reader that medical doctors are not the only doctors. in fact, in the u.s., as well as in some other countries, one is not licensed to practice psychology unless one has earned a doctor's degree. secondly, not all psychologists are clinical, or "healing" psychologists. professional psychology has many applications, as attested by the plethora of divisions within our associations, including military psychology. thirdly, psychological consultation on interrogations is offered as an alternative to torture (which does not require an academic degree!), but rather psychological methods of persuasion, mental sleight-of-hand, and emotional positive and negative incentives. but finally, isn't it medical doctors who have sworn the oath to heal and to do no harm that stand by executions and then examine prisoners to make sure the kill was effective wherever the death penalty prevails? is it not medical doctors who amputate hands and legs of offenders in Muslim countries? No psychologists at those posts! perhaps it would be more in place to ask those medical doctors "where are your rules of conscience?" Competing interests: None declared |
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David M Shaw, Lecturer in Ethics University of Glasgow, G2 3JZ
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Your editorial echoes MPs' claims that they were only "following the rules". It is infuriating to even see this repeated, given that one of the rules in question actually mandates conscientious behaviour. The MP's Green Book states that "Members must ensure that claims do not give rise to, or give the appearance of giving rise to, an improper personal financial benefit to themselves or anyone else."
Thus any MP who even appears to have have benefited has broken the rules - even if they obeyed the financial rules governing claims. This in turn means that most of the MPs who claim to have acted "in accordance with the relevant rules" are either ignorant or lying. When even formalised rules of conscience are ignored, it seems safe to assume that ethics are entirely absent.
Competing interests: None declared |
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John Lunstroth, Law professor University of Houston Law Center
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What concerns me about this editorial is it holds as axiomatic that doctors, medical scientists, ethics committees and other health workers are above the law. That is not the case. Godlee says: “…the Helsinki Declaration … contain[s] the crucial statement that a doctor’s or investigator’s conscience and duty of care must transcend national laws.” The foregoing is a perhaps understandable, but nonetheless profound, misunderstanding of the Declaration of Helsinki, art. 10: Physicians should consider the ethical, legal and regulatory norms and standards for research involving human subjects in their own countries as well as applicable international norms and standards. No national or international ethical, legal or regulatory requirement should reduce or eliminate any of the protections for research subjects set forth in this Declaration. All the DH says is that if a national or international law is more expansive than the DH, the physician should follow the more restrictive DH rules. That is, the DH is designed to fit within national and international law, and art. 10 cannot be interpreted to give warrant to a physician to either expand or violate the law. This is not a proscription or a prescription as it does not contain “shall” or its cognates, but an aspirational statement. The law intentionally leaves some decisions to the discretion of those subject to the laws. Laws, or statutory regimes, are usually not intended to cover all situations, but to define areas in which the regulated have no discretion, while leaving other decisions to the discretion of those covered by the law. To utilize an architectural metaphor, the laws establish the fence around an area, or the walls and other structural components of a building. The persons/acts covered by the law are given discretion within the structure defined by the statute. The idea “that law, in relation to health care ethics, is often a minimum standard and provides no protection for morally problematic behaviour,” (Goodyear) does not convey the nuance of the architectural metaphor. Legal regimes create a moral space within which moral agents indeed have agency, but the agency does not extend to doing things outside the fence or walls. In that moral space what we are calling ethics are the positive and unwritten values, norms and custom that guide behavior. One can violate an ethical norm without violating the law; but the reasons that apply within the delimited ethical space do not apply to going outside the walls or fence, i.e., to breaking the law. We are at one level discussing a hierarchy of norms problem. Physicians, scientists and other health workers generally do not have social or legal roles that have much to do with the walls or fence. Of course, Che was a physician; and Doctors Without Borders works in highly complex legal/moral situations all the time, but we are not talking now about the central case, the regulation of physicians and scientists in orderly societies, ones in which there is rule of law. A deeper problem with the interpretation is that it suggests the ethical norms found in a code of ethics passed by an NGO should trump the law. Laws are fundamental social norms that embody a system of justice, whether international or constitutional. Granted, international norms display a complex relationship between law and morality that is subdued by a constitution. That does not change the fact that what we call law is a set of norms whose source is a legitimate political body. NGOs, whether the AMA or the WMA, simply do not qualify as political bodies with the authority to pass laws. Note that the DH admonishes physicians, not other health- workers. Since this particular aspiration is somewhat attenuated from the Hippocratic Duties, it is not clear why it should apply to non-physician health workers. Furthermore, it is really not clear why this admonition should apply to scientist/researchers, whether physician or not. After all, there is no reason scientists should be subject either to the Hippocratic Duties, or ethical norms that bear some relationship to them, as they do not enter into the intimacy of the doctor/patient relationship. The idea of the physician is ambiguous in today’s pluralistic environment. A physician is a legal entity, less a moral entity. If the physician is considered as a moral entity, then the idea would apply to all persons with extensive training in treating sick people, including doctors of homeopathy, traditional Chinese medicine, ayurveda, some nurses, and so on. The point is that in this complex normative environment, there can be no doubts that physicians, and all other health workers, must obey the law. With regard to torture, even though the domestic laws of the US are weak, there is no doubt it is a crime under international law. Health workers who get involved in torture are in a chain of command. That chain of command supersedes the Hippocratic bonds of the doctor/patient relationship, if for some reason they were said to exist. Health workers who are involved with torture are state agents, not individual physicians or moral agents. The laws governing health workers and torture are in dire need of clarification. There is a body of moral thought often gathered under the rubric of “civil disobedience” that is relevant. I think that is probably what Godlee was aiming at. It has little to do with professional ethics codes, and everything to do with the law and individual conscience aligning itself against a widely perceived civil injustice. It is a species of the right to revolt, or the right of revolution, one of the fundamental human rights. As such it gains legitimacy from belief in the injustice by a significant proportion of the polity. It is not about a 1-on-1 relationship, such as found in the doctor/patient relationship. In sum, the idea physicians, health workers, or life scientists have the innate capacity to determine which laws are just and which unjust, have a warrant to break the law willy-nilly, or are above the law ethically, are ideas that need to be clearly identified and soundly rejected. In a democracy the proper form of exercise of political choice is through the vote or through lobbying. Lobbying tends to have terribly inequitable outcomes, but it is allowed in our constitutional system. At the international level there is basically no-way for an individual to participate in governance, but there are legitimate methods of instituting international laws, and the law against torture by anyone at any time is as clear a criminal norm as exists. It does not exclude doctors, scientists or any other class of living thing. One reason there is a desperate need for laws governing health workers and torture is because the chain of command issues are confused by the self-authenticating statements of physicians that they categorically cannot do anything illegal in their professional capacity. If doctors and scientists were to fully recognize the law, they would not get involved in torture, nor use sophistry to justify their participation in the intentional infliction of severe human suffering. The solution is not to give physicians and scientists a warrant to treat the law the same way all tyrants and evil regimes do, as something they can define at will. A different version of this response first appeared on the IRB Forum, a listserve managed by The Center for Bioethics and Department of Medical Ethics University of Pennsylvania School of Medicine. http://www.irbforum.org/. John Lunstroth, LLM, MPH University of Houston Law Center lunstroth@gmail.com Competing interests: None declared |
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Tjaard U Hoogenraad, retired neurologist UMC Utrecht Doorn, 3941VD 20, The Netherlands
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Ranking of the rules of conscience At first blink (1) I felt a bit uneasy with the title of the editorial “rules of conscience”. For me conscience is a strict private affair and ruling conscience seems a sort of contradictio in terminis: isn’t conscience intensively related to religion and isn’t ruling of religion in contradiction with the freedom of religion. Liberty of conscience is a great accustomed right and in my opinion this should stay so: therefore, at first blink, for me, no ruling but freedom of conscience. At a later look I saw that BMJ-editor Fiona Godlee wants to make it clear in her editorial that doctors do better to follow their conscience than to obey to rules and national laws. She seems to have the opinion that “rules of conscience” make part of the rules of the Helsinki Declaration on Ethical Principles for Medical Research that contains the crucial statement that a doctor’s conscience must transcend national laws. She also reminds us that the World Medical Association (WMA) has formulated a code that tells that it is a doctor’s duty to accept their ethical rules. It looks like the WMA is trying to rule the conscience of doctor’s globally and that the WMA thinks that doctors should do better to obey the WMA rules of conscience than to obey their own conscience. Analysing a bit more the meaning of the expression “rules of conscience” in health care I found that there are those who adhere the ruling of doctor’s conscience and those who object to it. In the U.S., the Catholic Medical Association supports the regulation of conscience and in late 2008 the Bush administration announced a “conscience protection rule”. The Obama administration seems to object to such protective ruling of conscience and is moving to overturn this controversial abortion related policy that allows health care workers to decline to participate in any service that violates their conscience. Although I feel uneasy by being ruled in my conscience I respect fully the important endeavours of those who try to regulate the ethical principles of behaviour of doctors. For myself there is a sort of ethical ladder of ranking in obeying of rules: national laws, Hippocratic guidelines, Helsinki declaration, WMA ethical rules, ethical protocol guidelines, personal evidence based patient centered problem solving. Therefore, on second thoughts I stick to my first blink and continue to feel very uneasy if my private conscience would be ruled by someone else. I am responsible for what I do and I realize that I have to accept full personal accountability for my actions. Ref.: 1. Richard G FiddianGreen: Tjaard Hoogenraad’s blink. Re:Re: Rapid Response 11 May 2009 Competing interests: None declared |
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