When conscientious objection runs amok: A physician refusing HIV preventative to a bisexual patient

Abstract

This paper reports of a case where a physician conscientiously objected to prescribing PrEP to a bisexual patient so as not to “enable immoral sexual behavior.” The case represents an instance of conscience creep, a phenomenon whereby clinicians invoke conscientious objection in sometimes objectionable ways that extend beyond the traditional contexts of abortion, sterilization, or physician aid in dying. This essay uses a reasonability view of conscientious objection to argue that the above case represents a discriminatory instance of conscience creep that should not be permitted.

Acts and distance—a commentary on Brummett's ‘when conscientious objection runs amok’

“…On the other hand, the teleological framework acknowledges that clinical training lends itself to other activities, that while not relating to health, might fulfil other desires; we call these socioclinical acts. Broadly, 1 Cardiff and Vale University Health Board, Cardiff, UK examples of these include the provision of abortion services, body modification surgery (e.g. tongue splitting), sports doping.…”

“…Brummett highlights Savulescu's worry that CO can lead to opening a 'Pandora's box of idiosyncratic, bigoted, discriminatory medicine'. 1,12 Yet, the assumption that CO is a primary reasonable phenomenon, though it should not be limitless in scope, seems to be commonly acceptable. 13 Gamble and I developed our account partially in response to Savulescu's criticism of CO. 6 The teleological framework ensures that CO is neither bigoted, discriminatory nor idiosyncratic.…”

“…Abram Brummett presents a case of a bisexual man who attended the Student Health Centre on the campus of Saint Louis University in the summer of 2018. 1 The man wanted a physician to prescribe him PrEP (human immunodeficiency virus, HIV, pre-exposure prophylaxis). The physician refused to do this because it was noted that he was bisexual, and the physician cited that the university had a Catholic 2 commitment.…”

“…Since the basis of the theological framework is that activities have purposes, and do not require a specific religious commitment, it seems to fulfil the defensibility in the public sphere criterion advanced by Eberl and espoused by Brummett (more commentary on Eberl's criterion is given in a latter section). 1,10 As such, Brummett should in principle accept it as a reasonable framework for critiquing his work.…”

“…There are two important consequences of the teleological framework that contrast with what Brummett's presents. Firstly, the COs that Gamble and I would label as licit span further than the ‘traditional’ contexts of ‘abortion, sterilisation or physician aid in dying’, 1 and could justify objections to contraception as well as to cosmetic amputations and circumcision/female genital mutilation. 6 In this sense, the teleological account allows for conscience creep.…”