Conscientious Objection, Emergency Contraception, and Public Policy

Robert F Card

The Journal of Medicine and Philosophy
The Journal of Medicine and Philosophy

Abstract
Defenders of medical professionals’ rights to conscientious objection (CO) regarding emergency contraception (EC) draw an analogy to CO in the military. Such professionals object to EC since it has the possibility of harming zygotic life, yet if we accept this analogy and utilize jurisprudence to frame the associated public policy, those who refuse to dispense EC would not have their objection honored. Legal precedent holds that one must consistently object to all forms of the relevant activity. In the case at hand, then, I argue that these professionals must also oppose morally innocuous practices that may prevent pregnancy after fertilization. These results reveal that such objectors cannot offer a plausible and consistent objection to harming zygotic life. Additionally, there are good reasons to reject the analogy itself. In either case, these findings call into question the case supporting refusals of EC based on scruples.


Card RF. Conscientious Objection, Emergency Contraception, and Public Policy. J Med Phil. 2011;36(1):53-68.

Dishonest deed, clear conscience: When cheating leads to moral disengagement and motivated forgetting

Lisa L Shu, Francesca Gino, Max H Bazerman

Personality and Social Psychology Bulletin
Personality and Social Psychology Bulletin

Abstract
People routinely engage in dishonest acts without feeling guilty about their behavior. When and why does this occur? Across four studies, people justified their dishonest deeds through moral disengagement and exhibited motivated forgetting of information that might otherwise limit their dishonesty. Using hypothetical scenarios (Studies 1 and 2) and real tasks involving the opportunity to cheat (Studies 3 and 4), the authors find that one’s own dishonest behavior increased moral disengagement and motivated forgetting of moral rules. Such changes did not occur in the case of honest behavior or consideration of the dishonest behavior of others. In addition, increasing moral saliency by having participants read or sign an honor code significantly reduced unethical behavior and prevented subsequent moral disengagement. Although dishonest behavior motivated moral leniency and led to forgetting of moral rules, honest behavior motivated moral stringency and diligent recollection of moral rules.


Shu LL, Gino F, Bazerman MH. Dishonest deed, clear conscience: When cheating leads to moral disengagement and motivated forgetting. Pers Soc Psychol B. 2011 Feb 9;37(3):330-349.

Obstetrician-gynecologists’ views on contraception and natural family planning: a national survey

RE Lawrence, Kenneth A Rasinski, John D Yoon, Farr A Curlin

American Journal of Obstetrics & Gynecology
American Journal of Obstetrics & Gynecology

Abstract
Objective

To characterize beliefs about contraception among obstetrician-gynecologists (Ob/Gyns).

Study design
National mailed survey of 1800 U.S. Ob/Gyns. Criterion variables were whether physicians have a moral or ethical objection to – and whether they would offer – six common contraceptive methods. Covariates included physician demographic and religious characteristics.

Results
1154 of 1760 eligible Ob/Gyns responded (66%). Some Ob/Gyns object to intrauterine devices (4.4% object, 3.6% would not offer), progesterone implants and/or injections (1.7% object, 2.1% would not offer), tubal ligations (1.5% object, 1.5% would not offer), oral contraceptive pills (1.3% object, 1.1% would not offer), condoms (1.3% object, 1.8% would not offer), and the diaphragm or cervical cap with spermicide (1.3% object, 3.3% would not offer). Religious physicians were more likely to object (OR 7.4) and to refuse to provide a contraceptive (OR 1.9).

Conclusion
Controversies about contraception are ongoing, but among Ob/Gyns objections and refusals to provide contraceptives are infrequent.


Lawrence RE, Rasinski KA, Yoon JD, Curlin FA. Obstetrician-gynecologists’ views on contraception and natural family planning: a national survey. Am J Obstet Gynecol. 2011;204(2):124e1-124e7.

Rights, professional obligations, and moral disapproval

Mark R Wicclair

Cambridge Quarterly of Healthcare Ethics
Cambridge Quarterly of Healthcare Ethics

Extract
The claim that providing post-transplant care to Mr. C would compromise a physician’s moral integrity might have a consequentialist basis or it might rest on a conception of moral complicity. From a consequentialist perspective, it might be thought that refusing to provide post-transplant care would act as a disincentive for patients like Mr. C to go to China for organ transplants. That is, it might be thought that refusing to provide follow-up care will promote a reduction in unethical transplant practices, and transplant physicians might believe that they have an ethical obligation to do what they can to effectuate such a reduction. Alternatively, a physician might believe that to avoid moral complicity in an unethical practice, she must refrain from any direct or indirect participation in that practice, which includes providing post-transplant care.


Wicclair MR. Rights, professional obligations, and moral disapproval. Camb Q. Healthc Ethics. 2011;20(1):144-147.

Conscientious refusals by hospitals and emergency contraception

Mark R Wicclair

Cambridge Quarterly of Healthcare Ethics
Cambridge Quarterly of Healthcare Ethics

Journal’s Extract
Hospitals sometimes refuse to provide goods and services or honor patients’ decisions to forgo life-sustaining treatment for reasons that appear to resemble appeals to conscience. For example, based on the Ethical and Religious Directives for Catholic Health Care Services (ERD), Catholic hospitals have refused to forgo medically provided nutrition and hydration (MPNH), and Catholic hospitals have refused to provide emergency contraception (EC) and perform abortions or sterilization procedures. I consider whether it is justified to refuse to offer EC to victims of sexual assault who present at the emergency department (ED). A preliminary question, however, is whether a hospital’s refusal to provide services can be conceptualized as conscience based.


Wicclair MR. Conscientious refusals by hospitals and emergency contraception. Camb Q Healthc Ethics. 2011;20(1):130-138.

Professional Right of Conscience

Margaret W Beal, Joyce Cappiello

Journal of Midwifery & Women's Health
Journal of Midwifery & Women’s Health

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.


Beal MW, Cappiello J. Professional Right of Conscience. J. Midwifery Womens Health. 2008;53(5):406-412.

Was It Science, Not Religion?

Maimon Schwarzschild

San Diego Law Review
San Diego Law Review

Abstract
Does freedom of conscience, and perhaps freedom of thought generally, have religious roots? Ronald Beiner’s Three Versions of the Politics of Conscience: Hobbes, Spinoza, Locke traces the idea of conscience as a factor in Western political thought to ideas that crystallized in the seventeenth century. Beiner examines three leading seventeenth century thinkers – Hobbes, Spinoza, and Locke – to explore whether conscience, or rather the idea of freedom of conscience, was specially a religious imperative for these thinkers: whether their religious commitments or their respect for religious integrity underlay and motivated their ideas about freedom of conscience.


Schwarzschild M. Was It Science, Not Religion? 47 San Diego L. Rev. 1125 (2010).

Three Versions of the Politics of Conscience: Hobbes, Spinoza, Locke

Ronald Beiner

San Diego Law Review
San Diego Law Review

Abstract
The organizers of this symposium have posed the question: is the idea of conscience fundamentally rooted in religious commitments? This question inevitably draws us back to the seventeenth century, for that is when the discourse of conscience ultimately originated. And when we consult the most important sources from that epoch, we get, I believe a clear answer to the question, although it may not be the answer that the organizers of the symposium anticipated when they conceived the theme of this gathering.


Beiner R. Three Versions of the Politics of Conscience: Hobbes, Spinoza, Locke. 47 San Diego L. Rev. 1107 (2010).

The First Amendment’s Religion Clauses: “Freedom of Conscience” Versus Institutional Accommodation

Michael J. White

San Diego Law Review
San Diego Law Review

Abstract:
The phrase “freedom of conscience” is, of course, not to be found in the United States Constitution: the First Amendment says only that “Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof.” However, it seems probable that one, then-contemporary Protestant conception of freedom of conscience was presupposed in these two clauses. Evidence for this conjecture can be found not only in the debate and proposals concerning the Bill of Rights of the United States Constitution but also in the frequently more expansive language of early state constitutions.


White MJ. The First Amendment’s Religion Clauses: “Freedom of Conscience” Versus Institutional Accommodation. 47 San Diego L. Rev. 1075 (2010).

Theses on Secularism

Nomi M. Stolzenberg

San Diego Law Review
San Diego Law Review

Abstract
Notwithstanding the notorious difficulty of defining religion and the consequent effort on the part of jurists and academics to avoid embracing any particular definition, one model of religion has dominated modern discourse: religion as conscience. Because of the dominance of this model, alternative views – which either subordinate the conscience to other supposedly more fundamental features of religion or dispense with the psychological apparatus of conscience altogether – have been largely submerged in modern political and legal discourse. Yet they will not remain suppressed. As a number of the conference papers have attest, alternatives and challenges to the dominant model have been surfacing with increasing regularity and insistence, particularly in the last decade, in part because the logic of the model seems to have exhausted or deconstructed itself, or driven itself into a corner, but also because theoretical rivals to the conception of religion as conscience have always existed, have never disappeared, and have never stopped pressing their claims.


Stolzenberg NM. Theses on Secularism. 47 San Diego L. Rev. 1041 (2010).