Protection of Conscience Project Library
Service, not Servitude
Extract
For most Canadians, the arguments that began on Oct. 14, 2014, at the Supreme Court in Ottawa are about medical aid in dying. But what is really at stake in Carter et al v Attorney General of Canada et al is Canadian law itself, the meaning of its guarantees, promises and injunctions.
Koch T. The law and physician-assisted dying. Can Med Assoc J. 2014 Nov 18;186(17):1336.
Abstract
This article examines, from a human rights perspective, the experience of women, and the practices of health care providers regarding abortion in Chile. Most abortions, as high as 100,000 a year, are obtained surreptitiously and clandestinely, and income and connections play a key role. The illegality of abortion correlates strongly with vulnerability, feelings of guilt and loneliness, fear of prosecution, physical and psychological harm, and social ostracism. Moreover, the absolute legal ban on abortion has a chilling effect on health care providers and endangers women’s lives and health. Although misoprostol use has significantly helped to prevent greater harm and enhance women’s agency, a ban on sales created a black market. Against this backdrop, feminists have taken action in aid of women. For instance, a feminist collective opened a telephone hotline, Linea Aborto Libre (Free Abortion Line), which has been crucial in informing women of the correct and safe use of misoprostol. Chile is at a crossroads. For the first time in 24 years, abortion law reform seems plausible, at least when the woman’s life or health is at risk and in cases of rape and fetal anomalies incompatible with life. The political scenario is unfolding as we write. Congressional approval does not mean automatic enactment of a new law; a constitutional challenge is highly likely and will have to be overcome.
Casas L, Vivaldi L. Abortion in Chile: The practice under a restrictive regime. Reprod Health Matters. 2014 Nov;22(44):70-81.
From the chapter introduction
The purpose of this chapter is to consider two types of dissent that are generally described as conscientious, namely, civil disobedience and conscientious objection, both of which raise pressing normative questions not only about the proper parameters of dissenters’ rights and duties within a reasonably good society, but also about both the scope of legitimate toleration of assertions of conscientiousness and the appropriate legal and political responses to conscientious disobedience. In what follows, I begin by outlining the conceptual territory of civil disobedience and conscientious objection. I then offer a qualified endorsement of the moral justifiability of these two practices before examining both the scope and legitimacy of their status as moral rights and their grounds for legal defensibility. Among other things, I challenge the dominant liberal position that, in relation to both moral rights and legal defenses, a more compelling case can be made on behalf of private conscientious objection than on behalf of civil disobedience.
Brownlee K. Conscientious Objection and Civil Disobedience. In: Marmor A editors. The Routledge Companion to the Philosophy of Law. 2012;527-539.
THE (Times Higher Education)
Reproduced with permission
Richard Sorabji. Moral Conscience Through the Ages: Fifth Century BCE to the Present. Oxford: Oxford University Press, 2014, 240 pp. ISBN 9780199685547
Always let your conscience be your guide,” sings Jiminy Cricket, conscience personified as a kindly bowler-hatted cricket, to Pinocchio in Walt Disney’s 1940 film classic about a wooden puppet being transformed into a real-life boy. It is one of the few significant social pronouncements about the role of conscience in making us human not found in Richard Sorabji’s compact history of the ideas that important thinkers and doers, beginning with Euripides and Plato and ending with Martin Luther, Thomas Hobbes, Henry David Thoreau, Leo Tolstoy, Friedrich Nietzsche, Sigmund Freud and Mahatma Gandhi, have had about how a conscience works, where it comes from, and what good it is, if any – Nietzsche had no use for conscience, believing that modern men “inherit thousands of years of the vivisection of conscience”.
Sorabji’s close reading of subtle arguments spanning 25 centuries, as he transliterates key Greek and Latin terms and does his best to define their particular meanings in different periods, enables us to see how later figures took up or rejected earlier ideas. Gandhi, for example, came to believe unshakeably in his “still small voice within” – no Jiminy Cricket for him – as “the true voice of God”, as it steeled his commitment to non-violent social actions. Gandhi’s voice of God, we learn, sounded a lot like Tolstoy in his 1894 treatise The Kingdom of God is Within You and Socrates in Plato’s Apology, set in 399BC.
The Greek word for conscience first appears in passages in the work of late 5th-century playwrights where characters wrestle with what we would call moral choices, or defects in Sorabji’s view. The Greek compound verbal formation expresses the notion of a shared knowing (sun: “with” and oida: “know”, literally “I saw and I still see”), Latin con-sciens. The precise meaning of conscience is further complicated by the abstract nouns used for it that are derived from other verbal roots, eg, sunesis and the Latinised sunderesis. The notion of with-ness is the common element.
The key question is: shared with whom? In Sorabji’s view – surprisingly given the role that conscience plays in our interactions with others – we share our thoughts about moral behaviour and moral choices with ourselves. Conscience splits us into two people. From this come expressions like “I could not live with myself” and feelings of having a voice within or a cricket or guardian angel advising from without, as in Freud’s superego or Socrates’ daimōn.
Sorabji also argues that the original concept of conscience, ie, “sharing knowledge with oneself of a defect”, was a largely secular idea. Stoics and Christians turned conscience into a religious concept associated with the law or will of gods or God. Michel de Montaigne, Hobbes and John Locke began a resecularisation process that continued through Thoreau’s civil disobedience and then on to conscientious objection to armed service during the First World War.
But what does a largely secular idea in ancient Greek look like in context? Sorabji gives few original source passages at any length. Conscience appears as a daimōn in Plato’s Apology and arguably also in Euripides’ Orestes, where grief is called a terrible goddess in a kind of chiasmus. So how the Greeks viewed daimones becomes relevant to whether conscience ab origine is secular or religious or something in between. And Hesiod’s thoughts two centuries earlier in Works and Days about daimones as immortal and beneficent guardians of justice should be relevant, too.
Tom Palaima is professor of Classics, University of Texas at Austin.
Abstract
Conscientious Objection or conscientious refusal (CO) in access to reproductive health care is at the center of current legal debates worldwide. In countries such as the US and the UK, constitutional dilemmas surrounding CO in the context of reproductive health services reveal inadequate policy frameworks for balancing CO rights with women’s rights to access contraception and abortion. The Colombian Constitutional Court’s holistic jurisprudence regarding CO standards has applied international human rights norms so as to not only protect women’s reproductive rights as fundamental rights, but to also introduce clear limits for the exercise of CO in health care settings. This paper reviews Latin American lines of regulation in Argentina, Uruguay, and Mexico City to argue that the Colombian Court’s jurisprudence offers a strong guidance for future comprehensive policy approaches that aim to effectively balance tensions between CO and women’s reproductive rights..
Cabal L, Olaya MA, Robledo VM. Striking a Balance: Conscientious Objection and Reproductive Health Care from the Colombian Perspective. Health Human Rights J. 2014;16(2):73-83.
Abstract
It is argued that the primary aim of institutional management is to protect the moral integrity of health professionals without significantly compromising other important values and interests. Institutional policies are recommended as a means to promote fair, consistent, and transparent management of conscience-based refusals. It is further recommended that those policies include the following four requirements: (1) Conscience-based refusals will be accommodated only if a requested accommodation will not impede a patient’s/surrogate’s timely access to information, counseling, and referral. (2) Conscience-based refusals will be accommodated only if a requested accommodation will not impede a patient’s timely access to health care services offered within the institution. (3) Conscience-based refusals will be accommodated only if the accommodation will not impose excessive burdens on colleagues, supervisors, department heads, other administrators, or the institution. (4) Whenever feasible, health professionals should provide advance notification to department heads or supervisors. Formal review may not be required in all cases, but when it is appropriate, several recommendations are offered about standards and the review process. A key recommendation is that when reviewing an objector’s reasons, contrary to what some have proposed, it is not appropriate to adopt an adversarial approach modelled on military review boards’ assessments of requests for conscientious objector status. According to the approach recommended, the primary function of reviews of objectors’ reasons is to engage them in a process of reflecting on the nature and depth of their objections, with the objective of facilitating moral clarity on the part of objectors rather than enabling department heads, supervisors, or ethics committees to determine whether conscientious objections are sufficiently genuine.
Wicclair MR. Managing conscientious objection in health care institutions. HEC Forum. 2014;26(3):267-283.
Abstract
Objective To examine medical students’ views on conscientious objection and controversial medical procedures.
Methods: Questionnaire study among Norwegian 5th and 6th year medical students.
Results: Five hundred and thirty-one of 893 students (59%) responded. Respondents object to a range of procedures not limited to abortion (up to 19%)—notably euthanasia (62%), ritual circumcision for boys (52%), assisted reproduction for same-sex couples (9.7%) and ultrasound in the setting of prenatal diagnosis (5.0%). A small minority (4.9%) would object to referrals for abortion. In the case of abortion, up to 55% would tolerate conscientious refusals, whereas 42% would not. Higher proportions would tolerate refusals for euthanasia (89%) or ritual circumcision for boys (72%).
Discussion: A majority of Norwegian medical students would object to participation in euthanasia or ritual circumcision for boys. However, in most settings, many medical students think doctors should not be able to refuse participation on grounds of conscience. A minority would accept conscientious refusals for procedures they themselves do not object to personally. Most students would not accept conscientious refusals for referrals.
Conclusions: Conscientious objection remains a live issue in the context of several medical procedures not limited to abortion. Although most would want a right to object to participation in euthanasia, tolerance towards conscientious objectors in general was moderate or low.
Nordstrand SJ, Nordstrand MA, Nortvedt P, Magelssen M. Medical students’ attitudes towards conscientious objection: a survey. J Med Ethics 2014;40:609-612 doi:10.1136/medethics-2013-101482
Abstract
Property-based models of the ownership of body parts are common. They are inadequate. They fail to deal satisfactorily with many important problems, and even when they do work, they rely on ideas that have to be derived from deeper, usually unacknowledged principles. This article proposes that the parent principle is always human dignity, and that one will get more satisfactory answers if one interrogates the older, wiser parent instead of the younger, callow offspring. But human dignity has a credibility problem. It is often seen as hopelessly amorphous or incurably theological. These accusations are often just. But a more thorough exegesis exculpates dignity and gives it its proper place at the fountainhead of bioethics. Dignity is objective human thriving. Thriving considerations can and should be applied to dead people as well as live ones. To use dignity properly, the unit of bioethical analysis needs to be the whole transaction rather than (for instance) the doctor-patient relationship. The dignity interests of all the stakeholders are assessed in a sort of utilitarianism. Its use in relation to body part ownership is demonstrated. Article 8(1) of the European Convention of Human Rights endorses and mandates this approach.
Foster C. Dignity and the Ownership and Use of Body Parts. Camb Q Healthc Ethics / Volume 23 / Issue 04 / October 2014, pp 417-430
Extract
Our incremental, fragmented, and incomplete health insurance system means that different Americans have different access to health care on the basis of their income, employment status, age, and sex. The decision in Hobby Lobby unravels only one more thread, perhaps, but it tugs on a quilt that is already inequitable and uneven. A central goal of the ACA was to repair some of this incremental fragmentation by universalizing certain basic health care entitlements. In ruling in favor of idiosyncratic religious claims over such universality, the Court has once again expressed its disagreement with this foundational health-policy goal.
Annas GJ, Ruger TW, Ruger JP. Money, Sex, and Religion-The Supreme Court’s ACA Sequel. N Engl J Med. 2014;371(9):862-865.
Extract
Religious groups, doctor’s organizations, ethicists and abortion rights advocates are raising concerns around the review of an Ontario policy that outlines, among other things, physicians’ right to object to patients’ requests for services on moral grounds.
The College of Physicians and Surgeons of Ontario’s Physicians and Ontario Human Rights Code is up for its five-year review, with both public and expert opinion being sought. . .
Glauser W. Controversy over doctors’ right to say “no”: The most controversial issues relate to abortion referrals or prescribing birth control. CMAJ September 16, 2014 186:E483-E484; published ahead of print August 18, 2014