CONSCIENTIOUS OBJECTION IN THE HEALING PROFESSIONS: A READER’S GUIDE TO THE ETHICAL AND SOCIAL ISSUES Physician Assistants Jere Odell, Rahul Abhyankar, Amber Malcolm, Avril Rua (April 19, 2014) Physicians and their assistants do not perform the same roles; it is unfortunate, therefore, that (at this time) the literature on conscientious objection in the health professions seldom addresses the issues that are unique to assistants. In fact, much of the literature written for physician assistants merely repeats the analyses that are typically applied to physicians. Physicians are in a unique position “as they have been granted monopolistic rights over most medical care.” 1,p 603 According to Card, they have less room for conscientious objection as they have a greater moral responsibility. While assistants may be equally obligated to seek the welfare and interests of patients, they are seldom held as directly responsible for it. At the same time, if they have less authority to make decisions, they may also encounter more moral distress than do physicians. For example, a physician assistant (PA) may be have objections to the performance of abortions or prescribing emergency contraception, or to providing reproductive technologies to couples in same sex relationships. Further still, their religious beliefs may also limit indirect participation in the objectionable procedure, for instance a PA may wish to refuse to clean instruments that will be or have been used for abortion. The PA, however, may have fewer opportunities to refer patients and patient care to other, willing, providers. Law and policy, however, not only recognize but often guarantee both physicians and PAs rights to conscientious objection. Without distinguishing too much between the roles of the two positions, Gianola addresses the ethical quandary, “Can the religious conviction of a physician (or physician assistant) be a legitimate basis to refuse to provide a therapy for a patient?” 2, p52 For a more direct discussion relevant to PAs, see The Guidelines for Ethical Conduct of the Physician Assistant Profession by the American Academy of Physician Assistants. Even these guidelines, however, do little to address the unique position of PAs in patient care, but rather, they prohibit physician assistants from discriminating against any patients. 3 Does this mean that the PA’s autonomy is trumped by both the authority of the physician and the autonomy of the patient? According to Pellegrino, who does not discussion the issues for PAs, physicians possess expert knowledge that they should always be free to exercise. Their autonomy should always be considered. However, “the physician has no standing as an expert in human values and has no Jere Odell, Rahul Abhyankar, Amber Malcolm, Avril Rua. Physician assistants. Conscientious objection in the healing professions a readers’ guide to the ethical and social issues. April 19, 2014. (Complete guide available from: http://hdl.handle.net/1805/3844.) Copyright 2014, the authors. This work is licensed under a Creative Commons Attribution-NonCommercial- ShareAlike 4.0 International License. brought to you by CORE View metadata, citation and similar papers at core.ac.uk provided by IUPUIScholarWorks