Question 66: May a physician refer patients who desire morally excluded services?
- Case Summary
An obstetrician-gynecologist who practices Catholicism has a moral dilemma, due to making a commitment to conduct his medical practices according to the teaching of the Catholic Church. The physician is indecisive about whether it’s ethically acceptable to refer their patients who ask for an abortion, sterilization or contraception to doctors who most certainly will help them to satisfy their will
In this case we read a story from a person who works as a gynecologist and is a faithful Catholic. Their concern is a moral dilemma. The questionnaire cannot decide whether it is fine for them, as for a Catholic, as a religious person, the questioner finds those actions immoral and does not want to be sinful of taking part in them. They want to practice medicine in a strict agreement with the Church’s order. Therefore, they ask Grisez to resolve their problem.
As Grisez puts it, referring a patient to another specialist who most certainly will provide them with services Church calls immoral is a problematic thing to do. It weakens physician’s position and makes them vulnerable to be suspected in lack of principles which they base their practice on: “Since physicians making referrals ordinarily intend that the patient receive the service for which he or she is referred, a patient so referred and others hearing about it would reasonably think: “This physician does not wish to dirty his/her own hands with things like abortion but does not mind having others do them.” (Grisez, 2004). As a Christian, Grisez, of course, believe in God and absolute morality. Therefore, the possibility of performing something like prescribing contraception, sterilization or abortion is not taken into consideration at all (although, Grisez justifies abortion in certain cases, when they are necessary to save parent’s life: “On this assumption, the proposal adopted is, not to kill the unborn baby, but to have him or her removed from the womb, with death as a foreseen and accepted side effect. An abortion carrying out such a choice would not be an intentional killing.”(Grisez, 1997). They are wrong and taking part in them is also wrong. Consequently, Grisez suggests the questionnaire to warn their patients about their beliefs at the beginning of cooperation and to act accordingly, giving the patient the possibility to decide whether they want to receive treatment from a Catholic gynecologist right away. He also writes that gynecologist have to do their best to save the child anyway and they ought to try to convince the patient not to get the immoral procedures but warn them about difficulties of their condition anyway: “You may advise the patient not to neglect her problem and/or warn her against some inappropriate action, for example: “You must not let this go, so you should see someone else as soon as possible” or “Don’t march off to the neighborhood abortion clinic, for they will simply do an abortion, while ignoring other aspects of your problem.”
According to Philippa Foot’s philosophy, there must be some objective grounds to the moral principles. Although she explains morality as a system of hypothetical, not categorical, imperatives (Foot, 1972), she claims that moral judgments need a reason for them. Foot argues that morality should be rational despite one’s personal feelings about it. If one can’t provide their morality with rational and objective argumentation, they are being immoral and what she calls “defective”. “One shouldn’t think that morality must pass the test of rationality, but rather that rationality must pass the test of morality” (Foot, 2003) says Foot, which means she stands for a system of a practical rationality that would go through facings of morality: “One shouldn’t think that morality must pass the test of rationality, but rather that rationality must pass the test of morality”(Foot, 2003). She is strictly anti-relativistic and argues that person can be defective despite what their interests are, which means that they are responsible for the harm caused by their actions even though they may not personally believe that they ca are using any harm. “Nevertheless, he is defective. For he is failing to recognize and act on something that is a reason.” The reason must arise from natural goodness: “ I argue that thinking in terms of natural goodness, as I define it, provides this unity. Both the taking of means to ends in an efficient way and the recognition of relevant reasons are things needed in human life, and a defect in either of these is a defect in practical rationality”(Foot, 2003). I would suggest that Philippa Foot would disagree with Grisez in his answer. She would say that physician’s role is to save the patient and they don’t have to address their personal beliefs to do so. They should do what is better for the patient and what is the most rational choice in a given situation. They should do the good thing, and the good thing is not what makes them happy, Foot would say, but what is beneficial to a patient.
Even though Grisez has nearly convincing suggestion for the questionnaire to merely warn their patients about their faith and practice, which seems plausible, I would agree on this with Foot. Medicine is a field where specialists are very often faced with difficult moral decisions. Therefore, they sometimes may need to decide very quickly what to do. In the given case there is no warranty that the physician would not lose their clear judgment underestimate the severity of the patient’s condition in order to adhere to their morals. And their refusal to work with a patient may postpone the receiving the necessary help. Overall, if one knows that their practice can happen to contradict their creeds, they should not start it at all.
1
Regarding the case, Grisez would disagree with Philippa Foot. For instance, Grisez advice a doctor not to refer a patient to medics, knowing well enough that him or her is going to get a treatment that does not abide with their principles. Instead, the doctor should ensure that wherever a patient goes, he or she receives medication that corresponds with their moral standing. (Grisez, 1997). On the other hand, and in a similar situation, Philippa Foot would take a different stand. She claims that due to philosophical contrasts, the doctor should do according to the will of the patient regardless of morality. Philippa Foot brushes aside morality as only a reaction and with no foundational basis at all. This means that if the tables turned, and the patient became the doctor, he would apply different moral rules due to the change in context. There are no specific morals standards applicable to all the people at once. Foot tries emphasizing that morality is just a feeling that differs from one society to the next or from one person to another. Whether it is right or wrong to engage in something entirely depends on the commitment of a particular individual to that feeling or line of thought. Therefore, a doctor does not go against the teaching of their values or moral obligation when they meet a patient who does not subscribe to their system of thought or values. Morality should not exhibit any form of subjection. The moment it does; it becomes bias (Grisez, 1997).
2
Foot takes a flexible point of view. She gives alternatives and sentiments that simplify the work of a doctor. The field of medicine relies heavily on genuine work (Foot, 2003). Facts do not undermine morality and other values but give a precise solution to the predicament. For example, in a state of affairs where a patient requires sterilization, the work of a doctor is to look at all the aspects that can make the procedure successful for the patient. Rather than deny her the chance based on morality. Lack of a hardline in her opinion gives everyone a chance and responsibility to bear the burden of his or her choices. A doctor has one call, and that is to ensure medication of his or her patient.
Foot makes a vital point. The type of perspective one takes in every situation makes the difference. A doctor can ask a patient the reason behind their choices. Some of the underlying causes may give a chance to correct the patient or get to see their situation from their perspective and empathize with them. Morality presents a one-sided part of the case and does not show the side of the patient who might have a valid reason for undergoing a particular procedure. Any moral choice should coincide with evidence to support and cement the moral judgment and give it the credit it deserves to shape opinion and stand legitimacy. One should not just say an act is wrong. They should provide enough evidence to show that it is indeed wrong. In this manner, all points of view intermarry and agree on the way forward as opposed to following a person's beliefs and code of conduct. The underlying point of Philippa Foot gives a different angle that at the same time retains values and ethical god will cater to the needs of humanity (Foot, 2003).
References
Foot, P. (1972). Morality as a System of Hypothetical Imperatives. The Philosophical Review, 81(3), 305–316.
Foot, P. (2003). The Grammar of Goodness. Harvard Review of Philosophy, 11, 32–44.
Grisez, Germain Gabriel. (1997). The way of the Lord Jesus (1st ed.).
Grisez, R. H. F. P. of C. E. G. J. (2004). Difficult Moral Q
References
Foot, P. (1972). Morality as a System of Hypothetical Imperatives. The Philosophical Review, 81(3), 305–316.
Foot, P. (2003). The Grammar of Goodness. Harvard Review of Philosophy, 11, 32–44.
Grisez, Germain Gabriel. (1997). The way of the Lord Jesus (1st ed.).
Grisez, R. H. F. P. of C. E. G. J. (2004). Difficult Moral Questions (1st ed.).
Browning, H. & Van Velsor, E. (2000). Why seek assessment, challenge, and support? In Three
Keys to Development: Defining & Meeting Your Leadership Challenges (7-9).
Buckingham, M. (2007). Build strong habits: Put your strengths to work. Leadership Excellence,
Vol. 24.
Conger, J.A. & Fulmer, R.M. (2003). Developing your leadership pipeline. Harvard Business
Review, 76-84.
Ibarra, H. (2002). How to stay stuck in the wrong career. Harvard Business Review, 40-47.
It is very true that we are born with different configurations and are not the same in terms ability, strengths, and weakness among other attributes. It is in this light that I agree with Buckingham (2007) that we see ourselves as different from others and continue to work on our strengths and thereby building on strong habits. To preserve on our strengths path, one has to build the right habits, so that the individual maintain control, continuously striving toward actions that strengthen a person, always watching for those that let us lose our focus (Buckingham, 2007).
In order to maintain our focus in building strong habits, Buckingham (2007) maintains that each day we list three strong statements and three weaknesses in our own words and make a commitment on how to deal with them, spending about 15 minutes of our time completing a robust week plan where one’s takes a hard look at what they have done in real terms to work on their strengths. Another action plan is having a discussion with one’s supervisor concerning how they are managing their strengths for possible feedback and this should happen once every quarter (Buckingham, 2007). I must admit that that these action steps are solid in trying to build strong and vibrant habits, but there has to be a strong commitment on one’s part to really deal with their own pathway to building good habits.
Developing your leadership pipeline – Jay A. Conger and Robert M. Fulmer
Leadership is a key to the success of every business and so, good organizations have to invest in those who they consider have the abilities to lead others. In this sense, very elaborate strategy should be devoted to mentoring, developing people to become good leaders for their respective institutions. Conger and Fulmer (2003) intimate five core principles that should be followed when engaging in succession planning. Firstly, there must be flexibility where the system leans toward developmental activities and not an unyielding list of high-potential personnel and the openings they might fill in succession planning.
The second rule is that planners should not forget about middle level management where they group of leaders could be. Generally, succession planning has become the exclusivity of very few executives of an organization whereas succession planning generally should trickle down to mid-level management since they form part of the long-term strategy of the health of the institution (Conger & Fulmer, 2003). Breaking up the two functions- senior executives and mid-level management into a single system enables organizations to take a long term view of the process of organizing middle managers, even those below the director grade, to aspire to be general managers (Conger & Fulmer, 2003). Thirdly, there should be transparency in the process since it is for the betterment of the organization. This point drives home very clear because in all the organizations that I have worked, the process has been shrouded in total secrecy and no one really had a hint except a few lucky who are powerfully connected to the upper echelons of the executives.
The measurement of succession planning process on a regular basis is the fourth rule. Many a time, Human Resources personnel identify key people to groom and there is no formalized plan to bring them up, and as a result, there is no way of regularly measuring progress or checking in to see whether people have feedback. Executives usually wait until there is crisis before they even remember that they should be working on a plan. The last rule of thumb postulated by Conger and Fulmer (2003) is that succession planning should be flexible. My manager always maintains that complicated plans take long to materialize and sometimes waste everyone’s time; but an easy-going and flexible plan usually gets people’s attention and moves fast. According to Conger and Fulmer (2003), classical succession planning is fairly rigid; people do not progress on and off the list lithely. This should not be so because it must help people to succeed.
How to stay stuck in the wrong career – Hermina Ibarra
Getting stuck in a certain job type can be very unsettling depending on what one is looking for in a career or depending on one’s educational level or commercial acumen. It is based on this that doing something one enjoys becomes necessary since there are passion and commitment involved. Scholars have found out that humans fear change and are not likely to change quickly, and so they stay in a career regardless of what type of job they are doing (Ibarra, 2002). The conventional wisdom has been to know what we as humans want to do and letting those acquired knowledge guide our activities but Ibarra, (2002) thinks otherwise – doing what we want to do should come first and knowing what we want to do comes next.
Ibarra, (2002) suggests that it is critical for us humans to really know ourselves and what we want before contemplating a career change. Knowing oneself comes out of a deeper reflection or self-introspection or standard questionnaire. This is one of the hardest exercises to complete since it is not very easy to do that self-analysis. After the self-introspection or self-analysis, there are abound to be questions and some things that may not be clear and Ibarra, (2002) suggests to seek advisers who you can share ideas with in the course of changing careers.
These advisers should be people you hold in high esteem and those you can trust to give you solid opinions to make you better, and not worse. One should not rely on people they are comfortable with since they will tell them things they want to hear, rather those who can give honest and objective feedback.
Career changes can be a daunting exercise and could make or break one’s life if not carefully vetted, and that is why we will need to think big during these times of change. In thinking big, Ibarra, (2002) suggests that we should do this in a more careful and gradual manner so as not to defeat the purpose since big things could crumple on the individual making the change. Our identity should at some point come to play in the process. We need to think about the future of the organization we are seeking to join and most importantly, our impact or future plans with the move that we want to make.
Why seek assessment, challenge, and support? Three Keys to Development: Defining & Meeting Your Leadership Challenges Henry Browning & Ellen Van Velsor
Leadership development has to be all about building capacity and has to be over a period of time making it imperative to seek support while taking series of assessments to evaluate one. For a lot of individuals, the capability for leadership must be unceasingly established over a lifetime of experience (Browning & Van Velsor, 2000). Even though individuals who have or expect to have leadership duties normally attend leadership development programs to attain the needed talents and perspectives, most leadership development occurs outside the normal classroom on job assignments, through connections with others, or from services to the community or other experiences outside of work arena (Browning & Van Velsor, 2000).
I recently attended a program at the Center of Creative Leadership and can confidently say that it really helps students learn a lot about themselves through the 360 degree feedback assessment. Benchmarks for executives are a statistically dependable, effective, and comprehensive 360-degree feedback instrument. Also, in offering feedback to assist identifying strengths and development needs, it ensures what its name proposes by providing the students with a benchmark of how they are doing when compared to a meaningful norm group (Browning & Van Velsor, 2000). Benchmarks for the students/executives are focused on the Center for Creative Leadership's (CCL) studies of how effective executives develop.
