Extract Lawrence and Curlin (2007) correctly note that not all disputants agree about what conscience is. However, I doubt that their distinction is as important as they think. I believe that understanding the distinctions just discussed is far more likely to lead to a satisfactory conclusion. If advocates of conscientious objection for medical professionals attended to these distinctions, they would see that what they want cannot be justified, at least not in the unqualified form most of them advocate.
Extract The first way to avoid the problems that conscience raises is. . . that physicians and others be required to tell patients what areas of practice would be against their conscience. A second way is not to license physicians, pharmacists or others who will refuse to involve themselves in certain areas of medicine because of conscience. Because the practice of medicine (and pharmacy, etc.) is a social role and society already exercises some control over who may legally perform these roles, adding requirements is not such a radical idea.
Extract At what point is an individual accountable for involvement in an action that he or she believes to be immoral? This subquestion is, I believe, important to both the religious and the non-religious individual in dealing with matters of personal or professional conscience. . . Lawrence and Curlin (2007) have stated it is important to have a basic understanding of what an individual means when he or she invokes this right of conscience. I believe it is equally important for those individuals, and for the public at large, to understand that there is a spectrum of belief about one’s moral complicity. Thus two people of faith may arrive at different conclusions about when it is appropriate to invoke this right. Such variation is fundamental to the concept of an individual’s conscience.
Extract I think most would agree that to progress the debate over the role of conscience in medicine we must continue the conversation about the means and ends of medicine as suggested by Lawrence and Curlin (2007, 10). This must be done because the tensions that exist between negotiating one’s personal integrity and one’s professional integrity will never go away. These tensions are not exclusive to the profession of medicine, but are enhanced by potential conflicts between physician integrity and patient autonomy. The objective of the conversation should neither be to eliminate these tensions nor to narrowly compartmentalize them as having religious or secular origins. Rather, the objective of the conversation should be to first encourage each physician to engage in moral reflection upon what they believe is right or wrong and the source that informs these values. Only then will physicians be able to appropriately negotiate the tensions that exist between the moral duties of personal and professional integrity and engage in meaningful dialogue rather than disagreement with their peers and their patients.
Abstract What role should the physician’s conscience play in the practice of medicine? Much controversy has surrounded the question, yet little attention has been paid to the possibility that disputants are operating with contrasting definitions of the conscience. To illustrate this divergence, we contrast definitions stemming from Abrahamic religions and those stemming from secular moral tradition. Clear differences emerge regarding what the term conscience conveys, how the conscience should be informed, and what the consequences are for violating one’s conscience. Importantly, these basic disagreements underlie current controversies regarding the role of the clinician’s conscience in the practice of medicine. Consequently participants in ongoing debates would do well to specify their definitions of the conscience and the reasons for and implications of those definitions. This specification would allow participants to advance a more philosophically and theologically robust conversation about the means and ends of medicine.
Extract Asserting that we should encourage dialogue is one thing; showing that such dialogue is possible is another. My commentary has in no way argued against having beliefs that result from religious conscience; rather, I have argued only that religious conscience, regardless of the religion from which it develops, has no place in medical decision-making.
Abstract Conclusion “[H]uman law does not prohibit everything that is forbidden by the natural law. Perhaps this aphorism from Saint Thomas Aquinas says it best. In fact, the very reality of conscientious objection concedes as much given that, with the rare exception of a worker being asked to commit a crime, it always involves an objection to an otherwise legal act. Of course, it is likely no coincidence that those who support or oppose laws conferring a right to object to a particular act seem to also oppose or support, respectively, the act in general. Perhaps, as in the case of the abortion based laws, this is simply the result of political compromise. However, such reflexive logic can grow suspect when it extends in a more general manner, whether that be in providing a global right to refuse in the private workplace or, to the contrary, in barring any refusals at all. As noted from the start, this article provides no panacea. Rather, it simply suggests that the trend of open-ended conscience protection that is presently sweeping the nation in the health care arena insufficiently considers the interests of affected employers in at-will authority. The trend is inconsistent with treatments of conscience in law and culture generally, and ignores the fundamental prejudice and public policy bases that otherwise operate in the limited exceptions to the at-will rule that have been developed to this point. Finally, by removing the issue from the deliberative process between employers and their employees, the trend threatens to balkanize both sides in a manner that is good neither for them nor the communities they serve. Conscience is an important and vigorous principle in our common life. For it to remain so on the job, it must act like any other value in an otherwise free and fair system-submit itself to the marketplace of both work and ideas.
Extract Conclusion In conclusion, states may provide pharmacists and pharmacies with rights of conscience without infringing upon the constitutional rights of patients. Pharmacists’ beliefs should be respected and accommodated, especially when there are ways to do so without depriving patients of validly prescribed medications. Specific conscience clause legislation is the best method for protecting pharmacists’ consciences, and such legislation also provides the most clarity and certainty when well- drafted. Conscience clause legislation should address who is covered, whether a religious objection is required, the medications involved, the scope of the protection, any requirements for compliance, and whether a private cause of action is created. Such legislation provides adequate protection to pharmacists and clarifies the rights of both pharmacists and patients. If such legislation operates in tandem with policies such as pharmacist prescribing, doctor dispensing, and doctor referrals to pharmacies known to handle the prescription, which have shown promise in some states, then patients should have adequate access to medications without forcing pharmacists to compromise their beliefs.
Extract This discussion leaves us with a very practical question: what do I do if my informed conscience says not to participate in, say, an abortion or some other intervention, while the patient, law, and hospital policy allow it? The only answer I have is the answer common to other human encounters — speak truthfully, quickly and transparently. But do not abandon conscience, which, though certainly fallible, is far better than the alternative of having a person with immense power such as a physician acting without it. Conscience is the imperfect means by which we tether medicine and morality.
LL Wynn, Joanna N Erdman, Angel M Foster, James Trussell
Studies in Family Planning
Abstract This article compares the ethical pivot points in debates over nonprescription access to emergency contraceptive pills in Canada and the United States. These include women’s right to be informed about the contraceptive method and its mechanism of action, pharmacists’ conscientious objection concerning the dispensing of emergency contraceptive pills, and rights and equality of access to the method, especially for poor women and minorities. In both countries, arguments in support of expanding access to the pills were shaped by two competing orientations toward health and sexuality. The first, “harm reduction,” promotes emergency contraception as attenuating the public health risks entailed in sex. The second orientation regards access to pills as a question of women’s right to engage in nonprocreative sex and to choose from among all reproductive health-care options. The authors contend that arguments for expanding access to emergency contraceptive pills that frame issues in terms of health and science are insufficient bases for drug regulation; ultimately, women’s health is also a matter of women’s rights.
