Abstract Conscientious objection in health care is a form of compromise whereby health care practitioners can refuse to take part in safe, legal, and beneficial medical procedures to which they have a moral opposition (for instance abortion). Arguments in defense of conscientious objection in medicine are usually based on the value of respect for the moral integrity of practitioners. I will show that philosophical arguments in defense of conscientious objection based on respect for such moral integrity are extremely weak and, if taken seriously, lead to consequences that we would not (and should not) accept. I then propose that the best philosophical argument that defenders of conscientious objection in medicine can consistently deploy is one that appeals to (some form of) either moral relativism or subjectivism. I suggest that, unless either moral relativism or subjectivism is a valid theory-which is exactly what many defenders of conscientious objection (as well as many others) do not think-the role of moral integrity and conscientious objection in health care should be significantly downplayed and left out of the range of ethically relevant considerations.
Abstract The issue of conscientious objection to agreed public policy is a vexed one. The clearest example is that of conscientious objection to military service. A free and democratic society has to respect the consciences of those who believe that killing in battle is absolutely wrong. Many disagree with the moral stance being taken, but it has been seen as the mark of a mature and civilised society to respect the conscience of pacifists. The freedom to be able to live by what one thinks most important has been seen as a constituent element in the freedoms that others have fought to preserve.
Respect for the conscience of those medical professionals who feel unable to participate in abortion appears to be in the same category (as would be respect for those who refused to participate in assisted suicide or euthanasia). Issues about the value of human life are at stake. Matters are undoubtedly complicated in the case of abortion by arguments over the supposed ‘humanity’ or ‘personhood’ of a fetus. Even so, some sincerely regard abortion as murder. Mutual respect is easy between people who agree. The problem in a democratic society arises when there is significant disagreement, but it is …
Abstract The law regulating abortion in Italy gives healthcare practitioners the option to make a conscientious objection to activities that are specific and necessary to an abortive intervention. Conscientious objectors among Italian gynaecologists amount to about 70%. This means that only a few doctors are available to perform abortions, and therefore access to abortion is subject to constraints. In 2012 the International Planned Parenthood Federation European Network (IPPF EN) lodged a complaint against Italy to the European Committee of Social Rights, claiming that the inadequate protection of the right to access abortion implies a violation of the right to health. In this paper I will discuss the Italian situation with respect to conscientious objection to abortion and I will suggest possible solutions to the problem.
Abstract Although 65 treatises – either preserved or lost, but quoted by ancient authors like Bacchius (3rd century B.C.), Erotian (1st century A.D.) and Galen (c. 129-199 A.D.) – are ascribed to Hippocrates (c. 469-c. 399 B.C.) and consist of nearly 83 books, nonetheless there is no doubt that none of them was written by Hippocrates himself. This being the fact, we cannot help agreeing with Ulrich von Wilamowitz Möllendorf (1848-1931), who maintained that Hippocrates is a name without writings!
Indeed the most of the treatises of the “Corpus hippocraticum” are not the collection of Hippocrates’ works, but were likely the “library” of the Medical School of Kos. The fact that it contains some treatises that represent the theories of the Medical school of Cnidos (most probably founded by a certain Euryphon, almost contemporary with Hippocrates), with which it seems that Hippocrates entered into a relentless debate, is an absolute evidence.
Moreover, we must confess that, although Celsus (1st century B.C.-1st century A.D.) (De medicina, I, Prooemium) writes that “Hippocrates of Kos…separated this branch of learning (i.e. Medicine) from the study of philosophy”, we have nothing to learn from the hippocratic treatises under the scientific point of view.
However, whatever its origin, the “Oath” is a real landmark in the ethics of medicine and we can say – with Thuchydides (460/455-400 B.C.) (Histories, I, 22, 4) – that it is “an achievement for eternity”.
Suffice it to remember that every graduand in Medicine is generally still bound to take an oath that is a more or less modified and more or less updated text of the “Hippocratic oath” and that even the modern concept of bioethics has its very roots in the Hippocratic medical ethics.
“The art is long; life is short; opportunity fleeting; experiment treacherous; judgment difficult: The physician must be ready, not only to do his duty himself, but also to secure the co-operation of the patient, of the attendants and of externals, ” says the first “Aphorism” and the latest author of “Precepts” (chapter VI) writes: “where there is love of man, there is also love of the art”, and the “art” par excellence is medicine! These precepts go surely back to Hippocrates’s moral teaching.
Nonetheless, the preserved text of the marvellous “Oath” raises many problems. Namely:
1) which is the date of it”?
2) Is it mutilated or interpolated?
3) Who took the oath, i.e. all the practitioners or only those belonging to a guild?
4) What binding force had it beyond its moral sanction”?
5) Last but not least: was it a reality or merely a “counsel of perfection”?
In this article we have gathered and discussed all the available and most important sources, but do not presume to have solved all these problems and confine ourselves to proposing some reasonable hypotheses and letting the readers evaluate the positive and negative points of our proposals.
Abstract As a science and practice transcending metaphysical and ethical disagreements, ‘secular’ medicine should not exist. ‘Secularity’ should be understood in an Augustinian sense, not a secularist one: not as a space that is universally rational because it is religion-free, but as a forum for the negotiation of rival reasonings. Religion deserves a place here, because it is not simply or uniquely irrational. However, in assuming his rightful place, the religious believer commits himself to eschewing sheer appeals to religious authorities, and to adopting reasonable means of persuasion. This can come quite naturally. For example, Christianity (theo)logically obliges liberal manners in negotiating ethical controversies in medicine. It also offers reasoned views of human being and ethics that bear upon medicine and are not universally held – for example, a humanist view of human dignity, the bounding of individual autonomy by social obligation, and a special concern for the weak.
Abstract “Emergency contraception” case law from the state of Washington is reviewed and analyzed. Important legal, social policy, and professional ethical questions are considered with focus on professional and institutional conscientious objection to participating in this therapy.
Abstract There is surprising confusion surrounding the concept of biological totipotency, both within the scientific community and in society at large. Increasingly, ethical objections to scientific research have both practical and political implications. Ethical controversy surrounding an area of research can have a chilling effect on investors and industry, which in turn slows the development of novel medical therapies. In this context, clarifying precisely what is meant by “totipotency” and how it is experimentally determined will both avoid unnecessary controversy and potentially reduce inappropriate barriers to research. Here, the concept of totipotency is discussed, and the confusions surrounding this term in the scientific and nonscientific literature are considered. A new term, “plenipotent,” is proposed to resolve this confusion. The requirement for specific, oocyte-derived cytoplasm as a component of totipotency is outlined. Finally, the implications of twinning for our understanding of totipotency are discussed.
Highlights
Inaccurate use of the term “totipotent” by scientists creates unnecessary ethical controversy.
Public concern over producing embryos by reprogramming reflects confusion over totipotency.
Twinning by blastocyst splitting does not provide scientific evidence for totipotency.
Abstract Many countries, Sweden among them, lack professional guidelines and established procedures for responding to young females requesting virginity certificates or hymen restoration due to honour-related threats. The purpose of the present survey study was to further examine the attitudes of the Swedish healthcare professionals concerned towards young females requesting virginity certificates or hymen restorations. The study indicates that a small majority of Swedish general practitioners and gynaecologists would accommodate these patients, at least given certain circumstances. But a large minority of physicians would under no circumstances help the young females, regardless of speciality, years of practice within medicine, gender, or experience of the phenomenon. Their responses are similar to other areas where it has been claimed that society should adopt a zero tolerance policy against certain phenomena, for instance drug policy, where it has also been argued that society should never act in ways that express support for the practice in question. However, this argument is questionable. A more pragmatic approach would also allow for follow-ups and evaluation of virginity certificates and hymen restorations, as is demonstrated by the Dutch policy. Hence, there are some obvious advantages to this pragmatic approach compared to the restrictive one espoused by a large minority of Swedish physicians and Swedish policy-makers in this area.
Howard Brody, Sarah E. Leonard, Jing-Bao Nie, Paul Weindling
Cambridge Quarterly of Healthcare Ethics
Abstract In 1945–46, representatives of the U.S. government made similar discoveries in both Germany and Japan, unearthing evidence of unethical experiments on human beings that could be viewed as war crimes. The outcomes in the two defeated nations, however, were strikingly different. In Germany, the United States, influenced by the Canadian physician John Thompson, played a key role in bringing Nazi physicians to trial and publicizing their misdeeds. In Japan, the United States played an equally key role in concealing information about the biological warfare experiments and in securing immunity from prosecution for the perpetrators. The greater force of appeals to national security and wartime exigency help to explain these different outcomes.
Abstract This paper aims to demonstrate how public disclosure can be used to balance physicians’ conscientious objections with their professional obligations to patients – specifically respect for patient autonomy and informed consent. It is argued here that physicians should be permitted to exercise conscientious objections, but that they have a professional obligation to provide advance notification to patients about those objections. It is further argued here that public disclosure is an appropriate and ethically justifiable limit to the principle of advance notification. The argument for publicly disclosing physicians’ conscientious objections is made in this paper by discussing three practical benefits of public disclosure in medicine, and then addressing how publicly disclosing physicians’ conscientious objections is not an undue invasion of privacy. Three additional concerns with public disclosure of physicians’ conscientious objections are briefly addressed – potential harassment of physicians, workplace discrimination, and mischaracterising physicians’ professional aptitude – concluding that each of these concerns requires further deliberation in the realm of business ethics.
