Extract What would be the implications for medical ethics, however, if “conscience” were not some sort of external moral faculty that trafficked in “values” (rather than “facts”) but, rather, were a quite ordinary part of human decision making, inseparable from the living of everyday life and from the routine, day-to-day practice of medicine? Such a conception of conscience would render it more mundane and unremarkable but would, on the other hand, raise awareness of its quiet but important presence within the daily lives of physicians and medical practitioners. As it turns out, this more integrated conception of conscience was common in premodern moral philosophy. In this brief essay, I will outline the account of conscience given by the premodern philosopher and theologian Thomas Aquinas (~1225-1274), whose work was important in extending the thought of Aristotle into the medieval era, and will briefly suggest how Aquinas’ thirteenth-century conception of conscience might apply to modern bioethics and to the modern education of physicians.
Extract The moral problem related to defining a space for personal values in medical care is that they may conflict with professional values, legitimising discrimination. Then it would be nearly impossible to criticise doctors and institutions that refuse abortion, do not examine patients of the opposite sex on religious grounds, and refuse to operate on HIV-positive patients or to treat people with different political affiliations. It would be hard to call that kind of environment a “healthy diversity”.
Abstract Conscientious objection by doctors, as is commonly practised, is discriminatory medicine. Only a fully justified and publicly accepted set of objective values results in ethical medicine as a proper public service with agreed and justified moral and legal standards to which doctors should be held.
Extract Respect for doctors’ right to conscientiously object is the ultimate safeguard against abuses of power, error and exploitation in medicine. It is the key safeguard of the doctor–patient relationship.
Abstract In recent years there have been numerous media reports of professionals attempting to expand the right of conscience and deny health care services requested by consumers. While the media has focused the most attention on pharmacists’ right to refuse access to contraception, this trend is an expansion of the right originally established to protect professionals from being required to perform abortions or to provide direct assistance with abortions. State legislatures have addressed this issue, in some cases by overtly protecting consumers’ rights and in other cases by broadening professional right of conscience. In this article, the literature on provider right of conscience is reviewed, and approaches advised by professional organizations are discussed.
Extract What duties accompany conscientious objection? To sum up what follows: The obligations to the patient remain unchanged, but for the denial of the contested request.
Specifically, what do these obligations entail? First, following from the very meaning of professing—and to develop a point previously mooted—full disclosure imposes the obligation to promulgate to the relevant parties one’s conscientious objection. This includes one’s prospective and current patients, colleagues, employers, and relevant institutions, for example hospitals and insurance companies. . . .
Second, conscientious objector status obliges the relevant professional to explain her reasons for her objection to those patients who request further information. . . . the patient is due the offer of an explanation. This does not, however, amount to the professional’s having a right to pontificate concerning the relevant matter. Rather, the interested patient ought to receive some answer to the question as to why the professional objects. Certainly, not all patients will be interested to know why. Those who are not interested ought not to be treated as captive audiences; those who do want to know ought to receive a considerate and considered answer. . .
Third, conscientious objector status bears exclusively on the patient’s contested request; it does not relate to the other care the physician, nurse, or pharmacist provides for the patient. If a relationship exists with the patient . . . the physician, nurse, or pharmacist must provide care to which she does not object. . .
Fourth, conscientious objector status requires the continued maintenance of confidentiality, particularly with respect to the fact that the professional objects to something the patient requests. . . .the professional must strenuously and scrupulously protect the patient’s privacy specifically concerning the patient’s request and the practitioner’s conscientious objection.
Finally, as earlier noted, while conscientious objection does not require referral to a third party who will abide by the patient’s request, it does require transfer of relevant documents, returning a prescription, and, more generally, acts which, while they may result in the act to which one objects, do not require one to aim at that act.
Paula N Kagan, Marlaine C Smith, W Richard Cowling, Peggy L Chinn
Nursing Philosophy
Abstract The purpose of this paper is to present the theoretical and philosophical assumptions of the Nursing Manifesto, written by three activist scholars whose objective was to promote emancipatory nursing research, practice , and education within the dialogue and praxis of social justice. Inspired by discussions with a number of nurse philosophers at the 2008 Knowledge Conference in Boston, two of the original Manifesto authors and two colleagues discussed the need to explicate emancipatory knowing as it emerged from the Manifesto. Our analysis yielded an epistemological framework based on liberation principles to advance praxis in the discipline of nursing. This paper adds to what is already known on this topic, as there is not an explicit contribution to the literature of this specific Manifesto, its significance, and utility for the discipline. While each of us have written on emancipatory knowing and social justice in a variety of works, it is in this article that we identify, as a unit of knowledge production and as a direction towards praxis, a set of critical values that arose from the emancipatory conscienceness and intention seen in the framework of the Nursing Manifesto.
Abstract We provide comprehensive, practical guidance for physicians on when to offer, recommend, perform, and refer patients for induced abortion and feticide. We precisely define terminology and articulate an ethical framework based on respecting the autonomy of the pregnant woman, the fetus as a patient, and the individual conscience of the physician. We elucidate autonomy-based and beneficence-based obligations and distinguish professional conscience from individual conscience. The obstetrician’s role should be based primarily on professional conscience, which is shaped by autonomy-based and beneficence-based obligations of the obstetrician to the pregnant and fetal patients, with important but limited constraints originating in individual conscience.
Extract Closing Arguments • Professionalism is in vogue today, as evidenced by the proliferation of discussion in the academic literature and in policy and guidance issued by various medical organizations.
• There is general agreement in the literature that, essentially, to be a medical professional is to profess competence in medicine and to use it primarily for the benefit of patients and communities.
• Although there has been no formal study of whether FPs agree on what professionalism is, there is reason to suppose that they agree on the general concept as it is generally elaborated in the literature and on the moral norms associated with the professional ideal.
• Family physicians might disagree about particular applications of the moral norms that make up the professional ideal, but such disagreement is perfectly compatible with the idea of professional judgment and is indeed a part of it.
Extract The challenge is thus to accommodate conscience- based treatment refusals without jeopardizing the foundations of pluralistic medical professionalism. I believe that medical professionals functioning in pluralistic healthcare settings may be excused from providing certain information or services if they apologize to those in need of this aid, and if those in need of aid can be assured equitable access to the information or services in question. Note carefully, I am proposing conditions for excusing professionals who fail to maintain moral neutrality; I am not defending a right to conscience-based denials of healthcare, or ‘civil rights’ protections for refusers. . .Refusals to refer to other professionals or to transfer prescriptions are inexcusable.
