Conscience clauses, the refusal to treat, and civil disobedience-practicing medicine as a Christian in a hostile secular moral space

Mark J Cherry

Christian Bioethics
Christian Bioethics

Extract
Jürgen Habermas’s recent observations regarding the increasing gulf between traditional religions and contemporary secularism is correct (2002, 2008). The dominant bioethical and political ideologies of the contemporary Western world have come to be not merely secular but often passionately atheistic. Throughout Western Europe and North America, for example, there is a growing movement to undermine the salience of religious discourse, to undue its influence in the public forum, and to erase religion from the public space. Attempts to frame all of medicine within a completely secular morality, relegating religious belief and practice to the realm of private personal choice, have become ever more prominent. Here, one need only consider the current clash between the US Roman Catholic bishops and President Obama’s administration over whether Catholic employers, such as Catholic hospital systems, ought to be legally required to provide insurance coverage for artificial contraception, including abortifacients, in their employer sponsored health care plan.1 In law and public policy, there has been a profound rupture from Traditional Christianity, which secular proponents aggressively seek to place in the distant past, as if Christianity had been an unfortunate, perhaps immoral, accident of history. Habermas’s acknowledgment of the vast divide between traditional religions that approach the world and moral analysis with knowledge of a God Who commands, and secular worldviews that begin all epistemic and normative analysis with the prior assumption that God does not exist, elucidates the fundamental debates of contemporary bioethics.


Cherry MJ. Conscience clauses, the refusal to treat, and civil disobedience-practicing medicine as a Christian in a hostile secular moral space. Christ Bioet. 2012 Apr 01;18(1):1-14.

Discovery and revelation: The consciences of Christians, public policy, and bioethics debate

Grattan T Brown

Christian Bioethics
Christian Bioethics

Abstract
Health care begins as an act of conscience, which urges a response to the sick and holds caregivers accountable to moral standards that public authorities ultimately do not define. Conscience nonetheless expresses itself as a type of dialogue within oneself that is influenced by dialogue with others, especially with society in the form of civil law and professional standards. A well-formed conscience for health care relates the foundations of morality to health care practices and contributes sound moral judgment about them to the common good. Some current health care policies and medical education presume a distorted view of conscience as personal sentiment. These policies circumvent serious discussion and possible resolution of society’s most vexing bioethics controversies.


Brown GT. Discovery and revelation: The consciences of Christians, public policy, and bioethics debate. Christ Bioet. 2012;18(1):41-58.

Obstetrician-gynecologists’ beliefs about when pregnancy begins

Grace S Chung, Ryan E Lawrence, Kenneth A Rasinski, John D Yoon, Farr A Curlin

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

Abstract
Objective: The purpose of this study was to assess obstetrician- gynecologists’ regarding their beliefs about when pregnancy begins and to measure characteristics that are associated with believing that pregnancy begins at implantation rather than at conception.

Study Design: We mailed a questionnaire to a stratified, random sample of 1800 practicing obstetrician-gynecologists in the United States. The outcome of interest was obstetrician-gynecologists’ views of when pregnancy begins. Response options were (1) at conception, (2) at implantation of the embryo, and (3) not sure. Primary predictors were religious affiliation, the importance of religion, and a moral objection to abortion.

Results: The response rate was 66% (1154/1760 physicians). One-half of US obstetrician-gynecologists (57%) believe pregnancy begins at conception. Fewer (28%) believe it begins at implantation, and 16% are not sure. In multivariable analysis, the consideration that religion is the most important thing in one’s life (odds ratio, 0.5; 95% confidence interval, 0.20.9) and an objection to abortion (odds ratio, 0.4; 95% confidence interval, 0.20.9) were associated independently and inversely with believing that pregnancy begins at implantation.

Conclusion: Obstetrician-gynecologists’ beliefs about when pregnancy begins appear to be shaped significantly by whether they object to abortion and by the importance of religion in their lives.


Chung GS, Lawrence RE, Rasinski KA, Yoon JD, Curlin FA. Obstetrician-gynecologists’ beliefs about when pregnancy begins. Am J Obstet Gynecol. 2012;206(2):132.e1-132.e7.

Conscientious objection in medical students: A questionnaire survey

Sophie LM Strickland

Journal of Medical Ethics
Journal of Medical Ethics

Abstract
Objective: To explore attitudes towards conscientious objections among medical students in the UK.

Methods: Medical students at St George’s University of London, Cardiff University, King’s College London and Leeds University were emailed a link to an anonymous online questionnaire, hosted by an online survey company. The questionnaire contained nine questions. A total of 733 medical students responded.

Results: Nearly half of the students in this survey stated that they believed in the right of doctors to conscientiously object to any procedure. Demand for the right to conscientiously object is greater in Muslim medical students when compared with other groups of religious medical students.

Discussion: Abortion continues to be a contentious issue among medical students and this may contribute to the looming crisis in abortion services over the coming years. This project sheds some light on how future doctors view some of their ethical rights and obligations. Using empirical evidence, it reveals that conscientious objection is an issue in the UK medical student body today. These data could help anticipate problems that may arise when these medical students qualify and practise medicine in the community.

Conclusion: Clearer guidance is needed for medical students about the issue of conscientious objection at medical school.


Strickland SL. Conscientious objection in medical students: A questionnaire survey. J Med Ethics. 2012;38(1):22-25.

Conscientious Objection

Giles Cattermole

Conscientious Objection

Extract
Beware of arguments that appear to accept that CO is just about our ‘personal values’; it isn’t. Beware of relying on our fallen consciences rather than on God’s Word. Beware of resorting to the safety of guidelines and laws which may be changed. By God’s grace, we have the right to CO made explicit in our professional guidance, given concrete examples in the law, supported by a European assembly. We can argue from history or personal example in favour of it. But in the end, we need to be prepared to stand for Christ, and the experience of those before us suggests that this will be costly.


Cattermole G. Conscientious Objection. Nucleus. 2011 Summer; 24-27.

Just how much do medicine and morals mix: catholic hospitals and the potential effects of the Freedom of Choice Act

Carolyn Wendel

Notre Dame Journal of Law, Ethics & Public Policy
Notre Dame Journal of Law, Ethics & Public Policy

Extract
Conclusion

It is undeniable that Catholic hospitals play a pivotal role in the administration of health care in America. The requirement that they follow both federal law and canon law can, however, create conflicting obligations. If FOCA were to pass, Catholic hospitals would be required under federal law to provide abortions and other reproductive services in direct conflict with Catholic teachings. At the same time, because the Catholic Church would view FOCA as an unjust law operating against human good and divine good, Catholic hospitals would also have a moral obligation under church teachings to disobey the provisions of FOCA.

Unable to sell because of their inability to cooperate in an evil act, Catholic hospitals would likely engage in civil disobedi ence. And yet, such tactics would only work for so long. Suits would be brought and courts would almost certainly uphold FOCA as a valid and neutral law that is generally applicable. Despite what many would like to believe, FOCA poses a very real and imminent threat to the existence of Catholic hospitals. And the effect least talked about and yet most important is not what effect such closing would have on the Church itself, but what effect it would have on the 92 million patients that Catholic hospitals treat annually. The effects of FOCA passing and Catholic hospitals closing would be much more than a victory for the pro- choice advocates; it would be a loss to every person who has ever received treatment at a Catholic hospital and to all those who would be denied such services in the future. Perhaps we should take a cue from the medical profession itself and remember above all else: first, do no harm


Wendel C. Just how much do medicine and morals mix: catholic hospitals and the potential effects of the Freedom of Choice Act. Notre Dame J Law Ethics Pub Pol. 2011;25(2):663-688.

(White Paper) Emergency Contraceptives & Catholic Healthcare: A New Look at the Science and the Moral Question

Thomas V Berg, Marie T Hilliard, Mark F Stegman

Emergency Contraceptives & Catholic Healthcare, Westchester Institute
Emergency Contraceptives & Catholic Healthcare, Westchester Institute

Conclusion
Concern that provision of emergency contraceptives might occasion the chemical abortion of nascent human life is not only legitimate, but also a genuine expression of the solidarity and stewardship we owe to the most vulnerable members of our society. Catholic moral theologians currently disagree on how that legitimate concern should bear on the formulation of EC protocols in Catholic hospitals. We maintain that, in addition to a pregnancy test, victims of sexual assault should be administered an ovulation test which detects the presence of an LH surge. We sincerely hope that the present study will contribute to the continued substantive discussion of this issue among Catholic moralists. We further trust that it will serve to foster a more cautious approach within the Catholic healthcare establishment to unreasonable incursions by the state that strike at our principled institutional autonomy and identity, and at the very exercise of conscience in Catholic healthcare


Berg TV, Hilliard MT, Stegman MF. (Working Paper) Emergency Contraceptives & Catholic Healthcare: A New Look at the Science and the Moral Question. 2011;2(1)

Conscientious commitment to women’s health

Bernard M Dickens, Rebecca J Cook

International Journal of Gynecology & Obstetrics
International Journal of Gynecology & Obstetrics

Abstract
Conscientious commitment, the reverse of conscientious objection, inspires healthcare providers to overcome barriers to delivery of reproductive services to protect and advance women’s health. History shows social reformers experiencing religious condemnation and imprisonment for promoting means of birth control, until access became popularly accepted. Voluntary sterilization generally followed this pattern to acceptance, but overcoming resistance to voluntary abortion calls for courage and remains challenging. The challenge is aggravated by religious doctrines that view treatment of ectopic pregnancy, spontaneous abortion, and emergency contraception not by reference to women’s healthcare needs, but through the lens of abortion. However, modern legal systems increasingly reject this myopic approach. Providers’ conscientious commitment is to deliver treatments directed to women’s healthcare needs, giving priority to patient care over adherence to conservative religious doctrines or religious self-interest. The development of in vitro fertilization to address childlessness further illustrates the inspiration of conscientious commitment over conservative objections.


Dickens BM, Cook RJ. Conscientious commitment to women’s health. Int J Gyn Ob. 2011;113(2):163-166.

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).