Ethics Archives - Page 31 of 87 - Protection of Conscience Project Library

What We Can’t Not Know

Revised and Expanded Edition

J. Budziszewski. What We Can’t Not Know. San Francisco: Ignatius Press, 2011, 315 pp. ISBN/UPC: 9781586174811

Publisher’s Description
In this new revised edition of his groundbreaking work, Professor J. Budziszewski questions the modern assumption that moral truths are unknowable. With clear and logical arguments he rehabilitates the natural law tradition and restores confidence in a moral code based upon human nature. What We Can’t Not Know explains the rational foundation of what we all really know to be right and wrong and shows how that foundation has been kicked out from under western society. Having gone through stages of atheism and nihilism in his own search for truth, Budziszewski understands the philosophical and personal roots of moral relativism. With wisdom born of both experience and rigorous intellectual inquiry, he offers a firm foothold to those who are attempting either to understand or to defend the reasonableness of traditional morality.

Conscientious refusals to refer: Findings from a national physician survey

Michael P Combs, Ryan M Antiel, Jon C Tilburt, Paul S Mueller, Farr A Curlin

Abstract
Background: Regarding controversial medical services, many have argued that if physicians cannot in good conscience provide a legal medical intervention for which a patient is a candidate, they should refer the requesting patient to an accommodating provider. This study examines what US physicians think a doctor is obligated to do when the doctor thinks it would be immoral to provide a referral.

Method: The authors conducted a cross-sectional survey of a random sample of 2000 US physicians from all specialties. The primary criterion variable was agreement that physicians have a professional obligation to refer patients for all legal medical services for which the patients are candidates, even if the physician believes that such a referral is immoral.

Results: Of 1895 eligible physicians, 1032 (55%) responded. 57% of physicians agreed that doctors must refer patients regardless of whether or not the doctor believes the referral itself is immoral. Holding this opinion was independently associated with being more theologically pluralistic, describing oneself as sociopolitically liberal, and indicating that respect for patient autonomy is the most important bioethical principle in one’s practice (multivariable ORs, 1.6-2.4).

Conclusions: Physicians are divided about a professional obligation to refer when the physician believes that referral itself is immoral. These data suggest there is no uncontroversial way to resolve conflicts posed when patients request interventions that their physicians cannot in good conscience provide..

Combs MP, Antiel RM, Tilburt JC, Mueller PS, Curlin FA. Conscientious refusals to refer: Findings from a national physician survey. J Med Ethics. 2011;37(7):397-401. Available from:

A Life Worth Giving? The Threshold for Permissible Withdrawal of Life Support From Disabled Newborn Infants

Dominic Wilkinson

Abstract
When is it permissible to allow a newborn infant to die on the basis of their future quality of life? The prevailing official view is that treatment may be withdrawn only if the burdens in an infant’s future life outweigh the benefits. In this paper I outline and defend an alternative view. On the Threshold View, treatment may be withdrawn from infants if their future well-being is below a threshold that is close to, but above the zero-point of well-being. I present four arguments in favor of the Threshold View, and identify and respond to several counterarguments. I conclude that it is justifiable in some circumstances for parents and doctors to decide to allow an infant to die even though the infant’s life would be worth living. The Threshold View provides a justification for treatment decisions that is more consistent, more robust, and potentially more practical than the standard view.

Wilkinson D. A Life Worth Giving? The Threshold for Permissible Withdrawal of Life Support From Disabled Newborn Infants. Am J Bioeth. 2011 Feb;11(2):20-32.

Conscientious Objection, Emergency Contraception, and Public Policy

Robert F Card

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

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

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.

A Not-So-New Eugenics: Harris and Savulescu on Human Enhancement

Robert Sparrow

Abstract
John Harris and Julian Savulescu, leading figures in the “new” eugenics, argue that parents are morally obligated to use genetic and other technologies to enhance their children. But the argument they give leads to conclusions even more radical than they acknowledge. Ultimately, the world it would lead to is not all that different from that championed by eugenicists one hundred years ago.

Sparrow R. A Not-So-New Eugenics: Harris and Savulescu on Human Enhancement. Hast Cent Rep. 2011 January-February;32-42.

Betrayal of conscience

Jeanine Young-Mason

Extract
. . .It behooves us always to strive to understand and search for the roots of other’s humanity without which we are left with dangerous assumptions and fear. All violence breeds tragic consequences for the victims and for the perpetrators who are betraying the consciences they have been given. In sum, the tragedy is not that the perpetrators have no conscience but that they are by their actions betraying the conscience they have in denying the humanity of others.

Young-Mason J. Betrayal of conscience. Clin Nurse Spec. 2011 January;25(1):49.

Rights, professional obligations, and moral disapproval

Mark R Wicclair

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

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.