Ethics Archives - Page 23 of 81 - Protection of Conscience Project Library

Refusal in “Bartleby, the Scrivener”: Narrative ethics and conscientious objection

Alvan A. Ikoku

American Medical Association Journal of Ethics

Extract
Introduction
In 1853 Herman Melville published “Bartleby, the Scrivener,” his now most well-known piece of short fiction, which over a century and a half later we can certainly read as an illuminating dramatization of conscientious objection [1]. There are, of course, important differences between Melville’s approach to refusal and how we have come to discuss it in medical ethics. The story’s setting, for instance, is not clinical; the central exchanges are between the head of a law office and an employee who politely but insistently refuses to carry out his understood duties.

Ikoku AA. Refusal in “Bartleby, the Scrivener”: Narrative ethics and conscientious objection. Virtual Mentor. 2013;15(3):249-256. doi: 10.1001/virtualmentor.2013.15.3.imhl1-1303.

Conscience, values, and justice in Savulescu

Alvan A. Ikoku

Extract
Introduction
Savulescu’s 2006 article in the British Medical Journal takes up perennially unfinished work on the nature and place of conscience, carried out against the background of contested laws shaped by states and their institutions as well as peoples and their professions. His writing on conscientious objection essentially returns to and intervenes in an extended conversation made possible by continued shifts in relations between individual citizens and loci of authority; shifts that characterized the mid-to-late decades of the twentieth century, when debates about war, civil rights, reproduction, and capital punishment made objection a vital mode of participation and engendered fields of practice and scholarship organized around the mission to decentralize decision making.

Ikoku AA. Conscience, values, and justice in Savulescu. Virtual Mentor. 2013;15(3): doi: 10.1001/virtualmentor.2013.15.3.jdsc1-1303.

Autonomy, conscience, and professional obligation

Robert D. Orr

Extract
Health care professionals have a fiduciary relationship with their patients; i.e., because they have greater knowledge and authority than their patients, they have an obligation to be trustworthy and to serve patients’ best interests. This has been taught since the era of Hippocrates and continues in contemporary medicine, as stated, for example, in the American Medical Association’s Principles of Medical Ethics. . .

Orr RD. Autonomy, conscience, and professional obligation. Virtual Mentor. 2013;15(3):244-248. doi: 10.1001/virtualmentor.2013.15.3.msoc1-1303.

Autonomy, Conscience and Professional Obligation

Robert D Orr

Extract
While I earnestly support the right of conscience, I recognize that some individuals who articulate this stance have made invalid claims. . . .At the other end of the spectrum are those who assert that a physician who is unwilling to provide a legitimate service should no longer be licensed to practice medicine. Such a stance implies that the physician is merely a technician who either has no moral boundaries or is prohibited from exercising them.

Orr RD. Autonomy, Conscience and Professional Obligation. Virtual Mentor. Am Med Ass J Ethics 2013;15(3):244-248.

(Book Review) Conscience and Conviction: The Case for Civil Disobedience

Alon Harel

Kimberley Brownlee. Conscience and Conviction: The Case for Civil Disobedience. Oxford University Press, 2012, 260pp. ISBN 9780199592944

Extract
In her thorough, careful and insightful discussion, Kimberley Brownlee explores the nature of conscience and conscientious convictions and draws important conclusions concerning the justifiable protection of acts of civil disobedience. The first part of her book discusses morality while the second part discusses law. In addition to its rigorous analysis, the book contains lively discussions of real-life examples and hypotheticals designed to illustrate and address all possible objections and establish the centrality of the protection of conscientious convictions and conscience in a liberal society.

Harel A. Book Review: Conscience and Conviction: The Case for Civil Disobedience. Notre Dame Philosophical Reviews, 2013-02-29

Interrupción voluntaria del embarazo y objeción de conciencia en Uruguay

Francisco Cóppola

Abstract
Author Translation
In October 2012 Act 18.987 for the Voluntary Interruption of Pregnancy was passed in Uruguay. This law contemplates the right to conscientious objection, although it lacks conceptual clarity and there was no debate during the discussion of the bill. Thus, declarations by both congressmen and professionals reflect there is confusion regarding such objection. Conscientious objection implies an individual (in this case a health professional) refuses to act in a certain way, which action would be legally enforceable, on account of conscientious issues. Therefore, conscientious objection is an authorization, provided certain requirements and limitations are observed, to refrain from observing a law. This article explores the existence of degrees and nuances within conscientious objection, the importance of distinguishing objectors from pseudo-objectors, whether a previous declaration is necessary or not, its regulatory mechanisms and in particular, the extreme event in which it were necessary to “sacrifice” the freedom of conscience.

Keywords:

Cóppola F. Interrupción voluntaria del embarazo y objeción de conciencia en Uruguay. Revista médica del Uruguay. 2013 Mar;29(1):43-46.

An Examination of Conscience

Mark J Kissler

Extract
The need for protection of conscience within medicine is evidence of precisely this kind of moral fragmentation. Bound by a common profession and motivation to heal, we still can be moral strangers. Physicians seek protection when encountering divisive issues, such as abortion or physician-assisted suicide. The problem is not so much that these disagreements are intractable, but that they embody different (often implicit) conceptions of the ends of medicine. There is a rift at the foundation; and so it is necessary to ask again what medicine is for, what the role of healer is.

Kissler MJ. An Examination of Conscience. Am Med Ass J Ethics (Virtual Mentor). 2013 Mar;15(3):185-187.

Conscience as Clinical Judgment: Medical Education and the Virtue of Prudence

Warren Kinghorn

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.

Kinghorn W. Conscience as Clinical Judgment: Medical Education and the Virtue of Prudence. Virtual Mentor. 2013 Mar;15(3) 202-205.

Not Only the Doctor’s Dilemma: The Complexity of Conscience in Medicine

Elizabeth Sepper

Abstract
In recent years, conscience has become a national catch phrase, invoked regularly in health policy discussions. The word “conscience,” however, often stands in for refusal to deliver abortions or contraception or to remove or withhold life support.

In this talk, I argue that conscience is not so one-sided, nor medical decisionmaking so straightforward. First, medical decisions – especially those involving questions of life and death – inspire divergent moral convictions. Second, medical decisions do not simply implicate conscience for the provider. They should be thought of instead as involving, at minimum, three parties: patients, providers, and institutions. This three-sided relationship complicates moral decisionmaking, with each party asserting potentially conflicting claims.

I contend that in responding to conflicts over medical decisions, lawmakers have overlooked their complexity. As a result, existing legislation undermines conscience, risks harm to patients, and destabilizes ethical decisionmaking within medicine itself. The talk concludes with several proposals to improve the law’s approach to morality in medicine.

Sepper E. Not Only the Doctor’s Dilemma: The Complexity of Conscience in Medicine. 4 Faulkner L. Rev. 385, 406 (2013)

Positive claims of conscience and objections to immigration law

Mark R. Wicclair

Extract
If immigration laws do not provide general exemptions for health care services, should they at least provide exemptions for health care professionals who cannot in good conscience comply with the law because they believe they have an ethical obligation to treat patients without regard to their immigration status?

Wicclair MR. Positive claims of conscience and objections to immigration law. Virtual Mentor. 2013;15(3):188-192. doi: 10.1001/virtualmentor.2013.15.3.ecas1-1303.