Philosophy Archives - Protection of Conscience Project Library

The religious character of secular arguments supporting euthanasia and what it implies for conscientious practice in medicine

John Tambakis, Lauris Kaldijian, Ewan Goligher

Abstract
Contemporary bioethics generally stipulates that public moral deliberation must avoid allowing religious beliefs to influence or justify health policy and law. Secular premises and arguments are assumed to maintain the neutral, common ground required for moral deliberation in the public square of a pluralistic society. However, a careful examination of non-theistic arguments used to justify euthanasia (regarding contested notions of human dignity, individual autonomy, and death as annihilation) reveals a dependence on metaethical and metaphysical beliefs that are not universally accepted in a pluralistic society. Such beliefs function in non-theistic arguments in the same way that foundational beliefs justify moral convictions in religious frameworks of belief. This parallel is apparent when religious belief is defined broadly (a la John Reeder) as ‘the search for the good in light of the limits and possibilities of the real.’ Seen through this interpretive lens, frameworks comprising Secular foundational commitments function, in ethically relevant respects, like the guiding beliefs found in the comprehensive frameworks of traditional religions. When conscientious practice in healthcare is reconsidered in light of this foundational similarity between the religious and the secular, it is clear that those who object to the foundational beliefs underpinning Secular arguments for euthanasia should not be required to provide, participate in, or refer patients for euthanasia (or other ethically controversial practices similarly dependent on contested frameworks of belief) in pluralistic societies that prize moral freedom as a primary human good.

Tambakis J, Kaldijian L, & Goligher EC. The religious character of secular arguments supporting euthanasia and what it implies for conscientious practice in medicine. Theor Med Bioeth (2022).

Our Inner Guide: Protecting Freedom of Conscience

Cardus

Conscience, though inherently individual, is vital to the common good. Using current case studies from Canada that engage freedom of conscience, this paper offers concrete recommendations as to how this human right can be robustly protected at home and abroad.

Our Inner Guide: Protecting Freedom of Conscience

Executive Summary
Freedom of conscience appears in the Canadian Charter of Rights and Freedoms, the Universal Declaration of Human Rights, and many other bills of rights. Yet, despite its universality, this human right is, by and large, universally neglected by courts, legislatures, and policy-makers.

Today, more so than before, reliance on freedom of conscience implicates the interests and rights of other citizens. Owing to modern phenomena such as globalization, many of us live in deeply diverse, multicultural, and plural societies. These current characteristics of many Western societies inevitably increase the prospect of sharp disagreements between citizens on what is good, right, and true—as well as the need to resolve these disagreements. This paper takes up the challenge of grappling with the clash of interests and rights in these cases.

This paper unpacks what freedom of conscience protects, why it is worth protecting, and when it may—and may not—be limited. For the sake of individual flourishing, peaceful coexistence, and liberal democracy itself, we say that freedom of conscience merits robust protection.

We aim to raise awareness of the importance of freedom of conscience in a liberal democracy and alert Canadians to the pressing need for this human right to be afforded due respect. Using current case studies from Canada that engage freedom of conscience, we offer concrete recommendations as to how this human right can be robustly protected at home and abroad.

History teaches that conscience can instigate fundamental social change, for the better. Conscience not only safeguards core convictions—it also promotes moral growth, for individuals and societies alike. Conscience, though inherently individual, is vital to the common good. To realize societies that are just and equitable, it is safe to say that freedom of conscience is indispensable. It is our intention that this paper will contribute to an essential public discussion on freedom of conscience and how we can better shape our laws, and ourselves, in accordance with this neglected freedom.

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How should a liberal democracy react to conscientious objection claims?

Panel 1: Concepts of Conscience

Royal Irish Academy Symposium

Chair: Professor Bert Gordijn, Dublin City University

Panellists:

Professor Kimberley Brownlee, The University of British Columbia
Dr Katherine Furman, University of Liverpool

Discussion of concepts of conscience, freedom of conscience, conscientious objection, civil disobedience, individual and corporate conscience

Royal Irish Academy: How should a liberal democracy react to conscientious objection claims?

A New Theory of Conscientious Objection in Medicine: Justification and Reasonability

Robert F Card

Robert F. Card. A New Theory of Conscientious Objection in Medicine: Justification and Reasonability. New York & London: Routledge, 2020, 268 pp. ‎ ISBN-10:0367430819

Publisher Summary
This book argues that a conscientiously objecting medical professional should receive an exemption only if the grounds of an objector’s refusal are reasonable. It defends a detailed, contextual account of public reasonability suited for healthcare, which builds from the overarching concept of Rawlsian public reason.

The author analyzes the main competing positions and maintains that these other views fail precisely due to their systematic inattention to the grounding reasons behind a conscientious objection; he argues that any such view is plausible to the extent that it mimics the ‘reason-giving requirement’ for conscience objections defended in this work. Only reasonable objections can defeat the prior professional obligation to assign primacy to patient well-being, therefore one who refuses a patient’s request for a legally available, medically indicated, and safe service must be able to explain the grounds of their objection in terms understandable to other citizens within the public institutional structure of medicine. The book further offers a novel policy proposal to deploy the Reasonability View: establishing conscientious objector status in medicine. It concludes that the Reasonability View is a viable and attractive position in this debate.

A New Theory of Conscientious Objection in Medicine: Justification and Reasonability will be of interest to researchers and advanced students working in bioethics, medical ethics, and philosophy of medicine, as well as thinkers interested in the intersections between law, medical humanities, and philosophy.

(Editor’s Introduction) Examining deeper questions posed by disputes about conscience in medicine

Farr A Curlin, Kevin Powell

Extract
As a whole, this collection of essays raises to the surface some of the key questions that underlie ongoing disputes about health-care practitioners refusing patients’ requests—namely, what is the conscience, and what is medicine? We hope that by foregrounding these questions and offering contrasting responses to them, this collection serves to bring greater clarity to ongoing disputes about what we might reasonably expect of physicians when patients request interventions that physicians do not believe they should provide.

Curlin FA, Powell K. Examining deeper questions posed by disputes about conscience in medicine. Perspect Biol Med. 2019;62(3):379-382.

Conscience and the way of medicine

Farr A Curlin, Christopher O Tollefsen

Abstract
Disputes about conscientious refusals reflect, at root, two rival accounts of what medicine is for and what physicians reasonably profess. On what we call the “provider of services model,” a practitioner of medicine is professionally obligated to provide interventions that patients request so long as the interventions are legal, feasible, and are consistent with well-being as the patient perceives it. On what we call the “Way of Medicine,” by contrast, a practitioner of medicine is professionally obligated to seek the patient’s health, objectively construed, and to refuse requests for interventions that contradict that profession. These two accounts coexist amicably so long as what patients want is for their practitioners to use their best judgment to pursue the patient’s health. But conscientious refusals expose the fact that the two accounts are ultimately irreconcilable. As such, the medical profession faces a choice: either suppress conscientious refusals, and so reify the provider of services model and demoralize medicine, or recover the Way of Medicine, and so allow physicians to refuse requests for any intervention that is not unequivocally required by the physician’s profession to preserve and restore the patient’s health.

Curlin FA, Tollefsen CO. Conscience and the way of medicine. Perspect Biol Med. 2019;62(3):560-575.

Conscience, moral reasoning, and skepticism

Larry R Churchill

Abstract
There is much to admire in Lauris Kaldjian’s explication of conscience and its uses for medical practitioners. Yet his claim that conscience is the final and best assessment of moral judgments is flawed, because it diminishes the influence of moral reasoning that balances and often corrects conscience. Skepticism about conscientious judgments is an important feature of ethics. Kaldjian’s close linkage of conscience with moral integrity blunts the necessary recognition that one’s conscience can be mistaken. His defense of physician refusals to refer patients gives insufficient weight to the idea that patients’ actions in seeking services may also reflect conscientious judgments. Analyses of cases near the end of this essay present no problems with respecting physicians’ conscientious refusals to provide services themselves, but they also mostly leave moral room for physicians to make referrals. Examination of these cases suggests other ways to resolve moral conflicts than recourse to one’s conscience.

Churchill LR. Conscience, moral reasoning, and skepticism. Perspect Biol Med. 2019 Summer;62(3):519-526.

Legislating the Right-to-Die with Dignity in a Confucian Society-Taiwan’s Patient Right to Autonomy Act

Chih-Hsiung Chen

Hastings International and Comparative Law Review

Abstract
In Confucian societies, people tend to avoid the discussion on death matters, let alone making advance directives to reject life-sustaining treatments at the end of life. Taiwan might be a pioneer in legislating the right-to-die with dignity among Confucian countries. As early as 2000, the Hospice Palliative Care Act was declared in Taiwan, which give terminally-ill patients the options to forgo life-sustaining treatments. Furthermore, in 2016, Taiwan passed the Patient Right to Autonomy Act to enhance patients’ choice at the end of life and expanded the coverage to certain types of non-terminally ill patients. On the other hand, end-of-life issues in Japan are regulated mainly through courts’ judgments and medical societies’ guidelines. Korea passed a law to legalize passive euthanasia, which became effective in 2018, but only contains limits to terminally-ill patients.

This paper is divided into three sections. First, this paper analyzes the sociocultural emphasis on family unity in East Asia and attitudes toward death in East Asian cultures, and then the methods adopted in Japan and South Korea of solving related disputes through the judiciary or legislation are explained. Second, the paper describes the legislative background of the aforementioned two laws in Taiwan, including futile medical care, the denial of citizen autonomy with respect to serious injury and death by criminal law theory, the unwillingness of the judiciary to intervene, and disputes encountered at medical sites. Subsequently, we explain the primary content of these two laws, including patients’ rights to self-determination, the judgment procedures of medical institutions, and the operation of advance directives. Finally, this paper analyzes inadequacies in the Patient Right to Autonomy Act, including a lack of penalties, insufficiencies in medical institutions’ scope of duty of disclosure, and the lack of a settlement mechanism for individuals who have not yet established advance directives.

Chen C-H, Kao H-H, Tseng W-T, Tai Y-A. Legislating the Right-to-Die with Dignity in a Confucian Society-Taiwan’s Patient Right to Autonomy Act. Hastings Int Comp Law Rev. 2019;42(2):485-508. Available from:

The Truth Behind Conscientious Objection in Medicine

Nir Ben-Moshe

Abstract
Answers to the questions of what justifies conscientious objection in medicine in general and which specific objections should be respected have proven to be elusive. In this paper, I develop a new framework for conscientious objection in medicine that is based on the idea that conscience can express true moral claims. I draw on one of the historical roots, found in Adam Smith’s impartial spectator account, of the idea that an agent’s conscience can determine the correct moral norms, even if the agent’s society has endorsed different norms. In particular, I argue that when a medical professional is reasoning from the standpoint of an impartial spectator, his or her claims of conscience are true, or at least approximate moral truth to the greatest degree possible for creatures like us, and should thus be respected. In addition to providing a justification for conscientious objection in medicine by appealing to the potential truth of the objection, the account advances the debate regarding the integrity and toleration justifications for conscientious objection, since the standard of the impartial spectator specifies the boundaries of legitimate appeals to moral integrity and toleration. The impartial spectator also provides a standpoint of shared deliberation and public reasons, from which a conscientious objector can make their case in terms that other people who adopt this standpoint can and should accept, thus offering a standard fitting to liberal democracies.

Ben-Moshe N. The Truth Behind Conscientious Objection in Medicine. J Med Ethics. 2019;45(6):404-410.

Public reason in justifications of conscientious objection in health care

Doug McConnell, Robert F Card

Abstract
Current mainstream approaches to conscientious objection either uphold the standards of public health care by preventing objections or protect the consciences of health‐care professionals by accommodating objections. Public justification approaches are a compromise position that accommodate conscientious objections only when objectors can publicly justify the grounds of their objections. Public justification approaches require objectors and assessors to speak a common normative language and to this end it has been suggested that objectors should be required to cast their objection in terms of public reason. We provide critical support for such a public reason condition and argue that it would be neither too demanding nor too permissive. We also respond to objections that it unfairly favours secular over religious objectors and that public reasons cannot be held with the kind of sincerity thought to characterize conscientious objections.

McConnell D, Card RF. Public reason in justifications of conscientious objection in health care. Bioethics 2019 Jun;33(5):625-632. doi: 10.1111/bioe.12573