Project Administrator, Author at Protection of Conscience Project Library

Professional and conscience-based refusals: the case of the psychiatrist’s harmful prescription

Morten Magelssen

Abstract
By way of a case story, two common presuppositions in the academic debate on conscientious objection in healthcare are challenged. First, the debate typically presupposes a sharp division between conscience-based refusals based on personal core moral beliefs and refusals based on professional (eg, medical) reasons. Only the former might involve the moral gravity to warrant accommodation. The case story challenges this division, and it is argued that just as much might sometimes be at stake morally in refusals based on professional reasons. The objector’s moral integrity might be equally threatened in objections based on professional reasons as in objections based on personal beliefs. Second, the literature on conscientious objection typically presupposes that conflicts of conscience pertain to well-circumscribed and typical situations which can be identified as controversial without attention to individualising features of the concrete situation. However, the case shows that conflicts of conscience can sometimes be more particular, born from concrete features of the actual situation, and difficult, if not impossible, to predict before they arise. Guidelines should be updated to address such ‘situation-based’ conscientious refusals explicitly.

Magelssen M. Professional and conscience-based refusals: the case of the psychiatrist’s harmful prescription. Journal of Medical Ethics Published Online First: 24 April 2017. doi: 10.1136/medethics-2017-104162

Reasons, reasonability and establishing conscientious objector status in medicine

Robert F Card

Abstract
This paper builds upon previous work in which I argue that we should assess a provider’s reasons for his or her objection before granting a conscientious exemption. For instance, if the medical professional’s reasoned basis involves an empirical mistake, an accommodation is not warranted. This article poses and begins to address several deep questions about the workings of what I call a reason-giving view: What standard should we use to assess reasons? What policy should we adopt in order to evaluate the reasons offered by medical practitioners in support of their objections? I argue for a reasonability standard to perform the essential function of assessing reasons, and I offer considerations in support of a policy establishing conscientious objector status in medicine.

Card RF. Reasons, reasonability and establishing conscientious objector status in medicine. J Med Ethics 2017 Apr;43(4):222-225. doi: 10.1136/medethics-2016-103792

Physicians, Not Conscripts — Conscientious Objection in Health Care

Ronit Y. Stahl, Ezekiel J. Emanuel

New England Journal of Medicine, NEJM — New England Journal of Medicine

Journal Summary
Conscientious objection laws give health care professionals the legal right to refuse, on the basis of personal beliefs, to perform certain procedures or care for particular patients. The authors argue that professional societies should declare conscientious objection unethical.

Stahl RY, Emanuel EJ. Physicians, Not Conscripts – Conscientious Objection in Health Care. N Engl J Med 2017; 376:1380-1385 April 6, 2017 DOI: 10.1056/NEJMsb1612472

Abortion decriminalisation and statutory rights of conscience

Mary Neal

Extract
On 13 March 2017, the House of Commons voted by 172 to 142 in favour of a second reading for the Reproductive Health (Access to Terminations) Bill. The bill, introduced by Diana Johnson MP, would decriminalise abortion until the end of the 24th week of pregnancy, meaning that abortion could be performed until the end of the 24th week of pregnancy without the need to satisfy any statutory grounds, or to obtain two doctors’ authorisation. Many campaigners see this bill as a first step toward the longer-term goal of fully decriminalising abortion. [1]

The prospect of decriminalisation raises a number of interesting and important issues, including an issue which has been neglected in the debates over decriminalisation so far, namely what any change in the law might mean for the right of health professionals to withdraw from participation in abortion on grounds of conscience, under section 4 of the Abortion Act 1967. . . .

Neal M. Abortion decriminalisation and statutory rights of conscience. the bmjopinion [Internet]. 2017 Mar 24.

Aid-in-dying laws and the physician’s duty to inform

Mara Buchbinder

Abstract
On 19 July 2016, three medical organisations filed a federal lawsuit against representatives from several Vermont agencies over the Patient Choice and Control at End of Life Act. The law is similar to aid-in-dying (AID) laws in four other US states, but the lawsuit hinges on a distinctive aspect of Vermont’s law pertaining to patients’ rights to information. The lawsuit raises questions about whether, and under what circumstances, there is an ethical obligation to inform terminally ill patients about AID as an end-of-life option. Much of the literature on clinical communication about AID addresses how physicians should respond to patient requests for assisted dying, but neglects the question of how physicians should approach patients who may not know enough about AID to request it. In this article, I examine the possibility of an affirmative duty to inform terminally ill patients about AID in light of ethical concerns about professional responsibilities to patients and the maintenance of the patient–provider relationship. I suggest that we should not take for granted that communication about AID ought to be patient-initiated, and that there may be circumstances in which physicians have good reasons to introduce the topic themselves. By identifying ethical considerations that ought to inform such discussions, I aim to set an agenda for future bioethical research that adopts a broader perspective on clinical communication about AID.

Buchbinder M. Aid-in-dying laws and the physician’s duty to inform. J Med Ethics. 2016;43(10):1-4.

Conscientious objection to vaccination

Steve Clarke, Alberto Giubilini, Mary Jean Walker

Abstract
Vaccine refusal occurs for a variety of reasons. In this article we examine vaccine refusals that are made on conscientious grounds that is, for religious, moral, or philosophical reasons. We focus on two questions: first, whether people should be entitled to conscientiously object to vaccination against contagious diseases (either for themselves or for their children) second, if so, to what constraints or requirements should conscientious objection (CO) to vaccination be subject. To address these questions, we consider an analogy between CO to vaccination and CO to military service. We argue that conscientious objectors to vaccination should make an appropriate contribution to society in lieu of being vaccinated. The contribution to be made will depend on the severity of the relevant disease(s), its morbidity, and also the likelihood that vaccine refusal will lead to harm. In particular, the contribution required will depend on whether the rate of CO in a given population threatens herd immunity to the disease in question: for severe or highly contagious diseases, if the population rate of CO becomes high enough to threaten herd immunity, the requirements for CO could become so onerous that CO, though in principle permissible, would be de facto impermissible.

Clarke S, Giubilini A, Walker MJ. Conscientious objection to vaccination. Bioethics. 2017 Mar;31(3):155-161.

The corporately produced conscience: Emergency contraception and the politics of workplace accommodations

Isaac Weiner

Journal of the American Academy of Religion

Abstract
This article uses a chance encounter with a supermarket checkout clerk as an occasion for reframing contemporary debates about workplace accommodations and the religious politics of contraception. Scholarship on workplace religion has tended to assume a rigid distinction between the religious spaces in which conscience is formed and the secular spaces to which claims of conscience are brought. In contrast, I argue that we might productively redescribe employee claims of conscience as corporately produced, rather than emanating from the realm of the private or personal. I reimagine the workplace as an important site of ethical subject formation, as a space in and through which moral claims are constituted, rather than to which they are brought, and I explore how accommodations can produce the very differences they are meant to protect. In this way, my discussion reveals how legal mandates and corporate policies join together to produce new moral subjects.

Weiner I. The corporately produced conscience: Emergency contraception and the politics of workplace accommodations. J Am Acad Religion. 2017 Mar;85(1):31-63.

Cosmetic surgery and conscientious objection

Francesca Minerva

Abstract
In this paper, I analyse the issue of conscientious objection in relation to cosmetic surgery. I consider cases of doctors who might refuse to perform a cosmetic treatment because: (1) the treatment aims at achieving a goal which is not in the traditional scope of cosmetic surgery; (2) the motivation of the patient to undergo the surgery is considered trivial; (3) the patient wants to use the surgery to promote moral or political values that conflict with the doctor’s ones; (4) the patient requires an intervention that would benefit himself/herself, but could damage society at large.

Minerva F. Cosmetic surgery and conscientious objection. Journal of Medical Ethics. Published Online First: 02 March 2017. doi:10.1136/medethics-2016-103804

Conscientious objection in healthcare and the duty to refer

Christopher Cowley

Abstract
Although some healthcare professionals have the legal right to conscientiously object to authorise or perform certain lawful medical services, they have an associated duty to provide the patient with enough information to seek out another professional willing to authorise or provide the service (the ‘duty to refer’). Does the duty to refer morally undermine the professional’s conscientious objection (CO)? I narrow my discussion to the National Health Service in Britain, and the case of a general practitioner (GP) being asked by a pregnant woman to authorise an abortion. I will be careful not to enter the debate about whether abortion should be legalised, or the debate about whether CO should be permitted—I will take both as given. I defend the objecting GP’s duty to refer against those I call the ‘conscience absolutists’, who would claim that if a state is serious enough in permitting the GP’s objection in the first place (as is the UK), then it has to recognise the right to withhold any information about abortion.

Cowley C. Conscientious objection in healthcare and the duty to refer. J Med Ethics 2017;43:207-212.

Conscientious Objection and Medical Assistance in Dying (MAID) in Canada: Difficult Questions – Insufficient Answers

PG Brindley, JP Kerrie

Canadian Journal of General Internal Medicine

Abstract
“Conscientious objection” typically implies refusal to participate in an action based on strongly held ethical beliefs. It is historically associated with refusing to fight on the grounds of personal conscience or religion.2 Like other military allusions such as collateral damage or life in the trenches, its usage has spread into wider societal use. Conscientious objection is now used in regards to opposing euthanasia in Canada. Euthanasia, in turn, is now referred to by the less emotive term, Medical Assistance in Dying (MAID). Most medical practitioners and hospitals that object do so in part because of their disagreement or discomfort with the act of killing. As such, the analogy is not wholly unjustified. What is less clear is how this construct, and this terminology, will ultimately affect patients, practitioners, administrators and politicians.

Brindley PG, Kerrie JP. Conscientious Objection and Medical Assistance in Dying (MAID) in Canada: Difficult Questions – Insufficient Answers. Canadian Journal of General Internal Medicine. 2016;11(4):7-10.