Extract I will argue that we should prefer narrow conscience clauses because they (1) respect patients’ right to informed consent and (2) reduce risks to vulnerable populations. I will then propose and defend an example of what a narrow conscience clause might look like. The clause I propose allows: (1) any person (2) directly involved in providing (3) nonemergency medical treatment or service (4) to refuse to provide the treatment or service in question, so long as the person (5) objects on moral or religious grounds and (6) cooperates in the transfer or referral of the patient to a willing provider. Before I turn to these arguments, a brief overview of the genesis and evolution of conscience clauses in medicine is in order.
Responding to: Charo RA. The Celestial Fire of Conscience – Refusing to Deliver Medical Care N Eng J Med 352:24, June 16, 2005
Extract It is especially noteworthy that, in an essay about the exercise of freedom of conscience by health care workers, Professor R. Alta Charo has virtually nothing to say about freedom or conscience (The Celestial Fire of Conscience- Refusing to Deliver Medical Care. N Eng J Med 352:24, June 16, 2005). “Conscience clauses,” yes: conscientious objection, to be sure: and she mentions acts of conscience and the right of conscience. But nothing about freedom, and, on the subject of conscience itself, the most she can muster is, “Conscience is a tricky business.”
Abstract The authors suggestion that patients should be able to access morally controversial services without compromising health care workers’ freedom of conscience is most welcome, as is their acknowledgment that “other options exist” when pharmacists decline to fill prescriptions.
However, the conflicting interests of patients and health care providers may be accommodated but cannot be balanced because they concern fundamentally different goods. Neither the concept of autonomy nor an appeal to the “needs” of the patient help to resolve conflicts in these situations, while fiduciary obligations cannot necessarily be invoked because they are not governed by fixed rules, and there can be no obligation to participate in wrongdoing.
The fact that post-coital interceptives can cause the death of an early embryo is at the heart of the controversy over the drugs. The authors’ advocacy of mandatory referral follows from their belief this is not wrong. Those with different beliefs do not share their conclusions. Conscientious objection does not prevent patients from obtaining post-coital interceptives from other sources. As the exercise of freedom of speech does not force others to agree with the speaker, the exercise of freedom of conscience does not force others to agree with an objector. Concerns about access to legal services or products can be addressed by dialogue, prudent planning, and the exercise of tolerance, imagination and political will. A proportionate investment in freedom of conscience for health care workers is surely not an unreasonable expectation.
Abstract The fact that certain vaccines are grown in cell strains derived decades ago from an aborted fetus is a concern for some. To understand such concerns, a standardized search identified internet sites discussing vaccines and abortion. Ethical concerns raised include autonomy, conscience, coherence, and immoral material complicity. Two strategies to analyse moral complicity show that vaccination is ethical: the abortions were past events separated in time, agency, and purpose from vaccine production. Rubella disease during pregnancy results in many miscarriages and malformations. Altruism, the burden of rubella disease, and protection by herd immunity argue for widespread vaccination although autonomous decisions and personal conscience should be respected.
Abstract What are moral values and where do they come from? David Hume argued that moral values were the product of a range of passions,inherent to human nature, that aim at the common good of society. Recent developments in game theory, evolutionary biology, animal behaviour, psychology and neuroscience suggest that Hume was right to suppose that humans have such passions. This dissertation reviews these developments, and considers their implications for moral philosophy. I first explain what Darwinian adaptations are, and how they generate behaviour. I then explain that, contrary to the Hobbesian caricature of life in the state of nature, evolutionary theory leads us to expect that organisms will be social, cooperative and even altruistic under certain circumstances. I introduce four main types of cooperation – kin altruism,coordination to mutual advantage, reciprocity and conflict resolution –and provide examples of ‘adaptations for cooperation’ from nonhuman species. I then review the evidence for equivalent adaptations for cooperation in humans. Next, I show how this Humean-Darwinian account of the moral sentiments can be used to make sense of traditional positions in meta-ethics; how it provides a rich deductive framework in which to locate and make sense of a wide variety of apparently contradictory positions in traditional normative ethics; and how it clearly demarcates the problems of applied ethics. I defend this version of ethical naturalism against the charge that it commits ‘the naturalistic fallacy’. I conclude that evolutionary theory provides the best account yet of the origins and status of moral values, and that moral philosophy should be thought of as a branch of natural history.
Abstract Over and above fairness, the concept of justice presupposes that in any community no one member’s wellbeing or life plan is inexorably dependent on the consumption or exploitation of other members. Renunciation of such use of others constitutes moral sociability, without which moral considerability is useless and possibly meaningless. To know if a creature is morally sociable, we must know it in its community; we must know its ecological profile, its species. Justice can be blind to species no more than to circumstance. Speciesism, the recognition of rights on the basis of group membership rather than solely on the basis of moral considerations at the level of the individual creature, embodies this assertion but is often described as a variant of Nazi racism. I consider this description and find it unwarranted, most obviously because Nazi racism extolled the stronger and the abuser and condemned the weaker and the abused, be they species or individuals, humans or animals. To the contrary, I present an argument for speciesism as a precondition to justice.
Extract . . . We are chided for publishing flawed research and told that we should be ashamed of publishing the “opinions” of self-evidently biased researchers. We are accused of doing a disservice to women, medicine and the Journal, of failing to conduct proper peer review, and of not adequately scrutinizing the credentials of the authors.
The abortion debate is so highly charged that a state of respectful listening on either side is almost impossible to achieve. This debate is conducted publicly in religious, ideological and political terms: forms of discourse in which detachment is rare. But we do seem to have the idea in medicine that science offers us a more dispassionate means of analysis. To consider abortion as a health issue, indeed as a medical “procedure,” is to remove it from metaphysical and moral argument and to place it in a pragmatic realm where one deals in terms such as safety, equity of access, outcomes and risk–benefit ratios, and where the prevailing ethical discourse, when it is evoked, uses secular words like autonomy and patient choice. . .
(Conscience and freedom of conscience: An analysis of conflicts of conscience in Swedish society and of the concepts of conscience)
Mats Alden
Thesis
Abstract This thesis has several aims which are related in various ways. The first task is to study conflicts of conscience in Swedish society. In this type of conflict, the terms conscience and freedom of conscience are central terms. Thus it is vital that they are understood and related to when analyzing the conflicts themselves. The second task is therefore to study and come to grips with the term conscience, suggest a definition, and then apply the various ways of understanding conscience to the conflicts of conscience in order to answer the question of whether or not an individual should follow his or her conscience. The third task is to study the term freedom of conscience and provide a definition. In addition, a typology is provided and applied to the conflicts of conscience studied in order to answer the question of whether or not there is ample freedom to follow one’s conscience. Finally, I take a stand for one of the types in the typology. The first task is undertaken in Chapter 2, the second task comprises Chapter 3 and the third task, Chapter 4.
Abstract From a liberationist, feminist, and Catholic point of view, this article attempts to understand the decision of abortion. . . . The paper offers solutions to end the ugliness of the abortion debate by suggesting that we would be able to progress further on the issue of abortion if we looked for the good in the opposing viewpoint. The article continues with a discussion of Catholics For a Free Choice’s position on abortion, and notes firstly that there is no firm position within the Catholic Church on when the fetus becomes a person; secondly that the principle of probablism in Roman Catholicism holds that where the church cannot speak definitively on a matter of fact (in this case, on the personhood of the fetus), the consciences of individual Catholics must be primary and respected, and thirdly that the absolute prohibition on abortion by the church is not infallible. In conclusion, only the woman herself can make the abortion decision.
Extract The efforts of Christian colleagues to articulate a clear framework of specific Christian moral values to assess clinical treatments are a necessary contribution to the debates about justice and resource allocation in health care. Such efforts not only make clear the way in which all such judgement is located, understood and interpreted from a particular social venue and from a particular ethical stance; finding one’s moral location is the first task of critical theory and concomitant practice. The clinical epistemology required in medical resource allocation is framed by cultural and theological stance just as surely as any knowledge, and Christians must be fully responsible for making overt the often covert assumptions that undergird such work. I have been asked to respond to the Consensus Statement by Catholics as a Jewish ethicist.
