The deficiencies and dangers of ‘radical individualism’

Book Review: What it means to be human: The case for the body in Public Bioethics

BioEdge

Margaret Somerville*

The deficiencies and dangers of ‘radical individualism’

O. Carter Snead, What it means to be human: The case for the body in Public Bioethics, Harvard University Press, 2020, pp.321

Anyone concerned about the current values conflicts in our societies should read this book. Although it focuses on conflicts in public bioethics, the insights of the author, O. Carter Snead, have application to a much broader range of values conflicts in what are sometimes called the “culture wars”.

Snead starts with a history of American Public Bioethics. He then asks, “What does it means to be human” and addresses two competing responses – “expressive individualism” and “embodiment” – and articulates the anthropology (the study of human beings and societies) that informs each of these views. He argues the former is inadequate on at least two fronts. First, it “forgets the body” and sees the person as only a mind, a self-actualizing will. Second, it does not contemplate or accommodate human relationships and the reality that we are social beings.

Snead then takes an innovative approach to legal scholarship. He proceeds to an in-depth analysis of six judgments handed down by the Supreme Court of the United States in relation to abortion. He undertakes this analysis in order to determine the law’s view, as manifested in these cases, of what it means to be human, that is, the anthropology that undergirds and informs the judgments he considers. . . continue reading

How should a liberal democracy react to conscientious objection claims

Panel 4: Reacting to Conscience Claims in the Public Square

Royal Irish Academy Symposium

Chair:

  • Mr Bryan Dobson, RTÉ

Panellists:

  • Dr John Adentire, Queen Mary University of London
  • Professor Fiona de Londras, University of Birmingham
  • Senator Michael McDowell, Houses of the Oireachtas

How legislators and governments in liberal democracies should react to claims of conscience.


Royal Irish Academy: How should a liberal democracy react to conscientious objection claims

How should a liberal democracy react to conscientious objection claims?

Panel 2: Conscience in Legal Perspective: Challenges and Controversies 

Royal Irish Academy

Chair:

Professor David Smith, RCSI University of Medicine and Health Sciences

Panellists:

  • Advocate General Gerard Hogan, Court of Justice of the European Union
  • Professor Ronan McCrea, University College London
  • Dr. Regina McQuillan, St Francis Hospice

Conscientious objections in healthcare, services, resistance to authoritarian regimes: effects on third parties: meaning of ‘complicity’ .


Royal Irish Academy: How should a liberal democracy react to conscientious objection claims?

Twin pregnancy, fetal reduction and the ‘all or nothing problem’

Joona Räsänen

Journal of Medical Ethics

Abstract

Fetal reduction is the practice of reducing the number of fetuses in a multiple pregnancy, such as quadruplets, to a twin or singleton pregnancy. Use of assisted reproductive technologies increases the likelihood of multiple pregnancies, and many fetal reductions are done after in vitro fertilisation and embryo transfer, either because of social or health-related reasons. In this paper, I apply Joe Horton’s all or nothing problem to the ethics of fetal reduction in the case of a twin pregnancy. I argue that in the case of a twin pregnancy, there are two intuitively plausible claims: (1) abortion is morally permissible, and (2) it is morally wrong to abort just one of the fetuses. But since we should choose morally permissible acts rather than impermissible ones, the two claims lead to another highly implausible claim: the woman ought to abort both fetuses rather than only one. Yet, this does not seem right. A plausible moral theory cannot advocate such a pro-death view. Or can it? I suggest ways to solve this problem and draw implications for each solution.


Räsänen J. Twin pregnancy, fetal reduction and the ‘all or nothing problem’. J Med Ethics. 2020 Dec 21:medethics-2020-106938. doi: 10.1136/medethics-2020-106938. Epub ahead of print. PMID: 33443129.

The Independence of Judicial Conscience

Barry W. Bussey

The Independence of Judicial Conscience

. . . Competence and character are no longer the sole criteria for evaluating a judicial nominee; candidates face a climate which demands they have the “correct” moral opinions on fundamental human rights issues. Those
issues include abortion, marriage, and the euphemistically-termed Medical Assistance in Dying (MAiD). . . to disregard the judicial conscience is to compromise the dignity of the judge, the worth of her convictions, the fullness of her humanity. Even more, it undermines the very essence of what distinguishes a democratic society characterized by diversity, inclusion, and freedom.


Bussey BW. The Independence of Judicial Conscience. J Christian Legal Thought. 2019; 9(2): 34-37.

Selective Conscientious Objection in Healthcare

Christopher Cowley

Selective Conscientious Objection in Healthcare

Abstract

Most discussions of conscientious objection in healthcare assume that the objection is universal: a doctor objects to all abortions. I want to investigate selective objections, where a doctor objects to one abortion but not to another, depending on the circumstances. I consider not only objections to abortion, but also objections to the withdrawal of life-saving treatment at the request of a competent patient, which is almost always selective. I explore how the objector might articulate the selective objection, and what impact it might have on the patient, within the conceptual space of relevant statutes and professional guidelines.


Cowley C.  Selective Conscientious Objection in Healthcare. New Bioethics 2019 Sep; 25(3): 236-247, DOI:10.1080/20502877.2019.1649861.

Questionable benefits and unavoidable personal beliefs: defending conscientious objection for abortion

Bruce Philip Blackshaw, Daniel Rodger

Journal of Medical Ethics

 Abstract

Conscientious objection in healthcare has come under heavy criticism on two grounds recently, particularly regarding abortion provision. First, critics claim conscientious objection involves a refusal to provide a legal and beneficial procedure requested by a patient, denying them access to healthcare. Second, they argue the exercise of conscientious objection is based on unverifiable personal beliefs. These characteristics, it is claimed, disqualify conscientious objection in healthcare. Here, we defend conscientious objection in the context of abortion provision. We show that abortion has a dubitable claim to be medically beneficial, is rarely clinically indicated, and that conscientious objections should be accepted in these circumstances. We also show that reliance on personal beliefs is difficult to avoid if any form of objection is to be permitted, even if it is based on criteria such as the principles and values of the profession or the scope of professional practice.


Blackshaw BP, Rodger D. Questionable benefits and unavoidable personal beliefs: defending conscientious objection for abortion. J Medical Ethics 2019 Aug 31. pii: medethics-2019-105566. doi: 10.1136/medethics-2019-105566. [Epub ahead of print]

Medical Referral for Abortion and Freedom of Conscience in Australian Law

Joanne Howe, Suzanne Le Mire

Journal of Law and Religion

Abstract

This article examines legislative changes related to abortion regulation in Australia that create obligations of medical referral on practitioners who have a conscientious objection to abortion. Despite a significant Australian history of accepting secularized conscience claims, particularly in the field of military conscription, the limitation of conscience claims about abortion can be traced to a failure to appreciate the significant secular arguments that can be made to support such claims. We draw on arguments of plurality and pragmatism as capable of providing a firm foundation for legislative protections of freedom of conscience in the case of medical referral for abortion. These justifications are not dependent on religious grounds, and therefore they have the potential to be relevant and persuasive in a secular society such as Australia. Acceptance of a pluralistic argument in favor of freedom of conscience is a powerful commitment to the creation of a society that values human autonomy and a diversity of opinion. It sits comfortably with the democratic values that are enshrined in the Australian political system and institutions. It avoids the potential damage to the individual that may be wrought when conscience is overridden by state compulsion.


Howe J, Le Mire S.  Medical Referral for Abortion and Freedom of Conscience in Australian Law. J Law and Religion. 2019 Apr;34(1):85-112 DOI: https://doi.org/10.1017/jlr.2019.14 Published online by Cambridge University Press: 01 July 2019

Conscientious objection to abortion, the law and its implementation in Victoria, Australia: perspectives of abortion service providers

Louise Anne Keogh, Lynn Gillam, Marie Bismark, Kathleen McNamee, Amy Webster, Christine Bayly, Danielle Newton

BMC Medical Ethics

Abstract| Background: In Victoria, Australia, the law regulating abortion was reformed in 2008, and a clause (‘Section 8’) was introduced requiring doctors with a conscientious objection to abortion to refer women to another provider. This study reports the views of abortion experts on the operation of Section 8 of the Abortion Law Reform Act in Victoria.

Methods: Nineteen semi-structured qualitative interviews were conducted with purposively selected Victorian abortion experts in 2015. Interviews explored the impact of abortion law reform on service provision, including the understanding and implementation of Section 8. Interviews were transcribed verbatim and analysed thematically.

Results: The majority of participants described Section 8 as a mechanism to protect women’s right to abortion, rather than a mechanism to protect doctors’ rights. All agreed that most doctors would not let moral or religious beliefs impact on their patients, and yet all could detail negative experiences related to Section 8. The negative experiences arose because doctors had: directly contravened the law by not referring; attempted to make women feel guilty; attempted to delay women’s access; or claimed an objection for reasons other than conscience. Use or misuse of conscientious objection by Government telephone staff, pharmacists, institutions, and political groups was also reported.

Conclusion: Some doctors are not complying with Section 8, with adverse effects on access to care for some women. Further research is needed to inform strategies for improving compliance with the law in order to facilitate timely access to abortion services.


Keogh LA, Gillam L, Bismark M, McNamee K, Webster A, Bayly C, Newton D. Conscientious objection to abortion, the law and its implementation in Victoria, Australia: perspectives of abortion service providers. BMC Medical Ethics201920:11.

From women’s ‘irresponsibility’ to foetal ‘patienthood’: Obstetricians-gynaecologists’ perspectives on abortion and its stigmatisation in Italy and Cataluña

Silvia De Zordo

Global Public Health

Abstract

This article explores obstetricians-gynaecologists’ experiences and attitudes towards abortion, based on two mixed-methods studies respectively undertaken in Italy in 2011–2012, and in Spain (Cataluña) in 2013–2015. Short questionnaires and in-depth interviews were conducted with 54 obstetricians-gynaecologists at 4 hospitals providing abortion care in Rome and Milan, and with 23 obstetricians-gynaecologists at 2 hospitals and one clinic providing abortion care in Barcelona. A medical/moral classification of abortions, from those considered ‘more acceptable’, both medically and morally – for severe foetal malformations – to the ‘least acceptable’ ones – repeated ‘voluntary abortions’, emerged in the discourse of most obstetricians-gynaecologists working in public hospitals, regardless of their religiosity. I argue that this is the result of the increasing medicalisation of contraception as well as of reproduction, which has reinforced the stigmatisation of ‘voluntary abortion’ (in case of unintended pregnancy) in a context of declining fertility rates. This contributes to explain why obstetricians-gynaecologists working in Catalan hospitals, which provide terminations only for medical reasons, unlike Italian hospitals, do not experience abortion stigma and do not object to abortion care as much as their Italian colleagues do.


De Zordo S. From women’s ‘irresponsibility’ to foetal ‘patienthood’: Obstetricians-gynaecologists’ perspectives on abortion and its stigmatisation in Italy and Cataluña. Global Public Health 2018 Jun; 13(6): 711-123. doi: 10.1080/17441692.2017.1293707. Epub 2017 Mar 5.