Philosophy Archives - Page 4 of 13 - Protection of Conscience Project Library

The Challenges of Conscientious Objection in Health care

Hasan Shanawani

Abstract
Conscientious objection (CO) is the refusal to perform a legal role or responsibility because of personal beliefs. In health care, conscientious objection involves practitioners not providing certain treatments to their patients, based on reasons of morality or “conscience.” The development of conscientious objection among providers is complex and challenging. While there may exist good reasons to accommodate COs of clinical providers, the exercise of rights and beliefs of the provider has an impact on a patient’s health and/ or their access to care. For this reason, it is incumbent on the provider with a CO to minimize or eliminate the impact of their CO both on the delivery of care to the patients they serve and on the medical system in which they serve patients. The increasing exercise of CO, and its impact on large segments of the population, is made more complex by the provision of government-funded health care benefits by private entities. The result is a blurring of the lines between the public, civic space, where all people and corporate entities are expected to have similar rights and responsibilities, and the private space, where personal beliefs and restrictions are expected to be more tolerated. This paper considers the following questions: (1) What are the allowances or limits of the exercise a CO against the rights of a patient to receive care within accept practice? (2) In a society where there exist “private,” personal rights and responsibilities, as well as “civil” or public/shared rights and responsibilities, what defines the boundaries of the public, civil, and private space? (3) As providers and patients face the exercise of CO, what roles, responsibilities, and rights do organizations and institutions have in this interaction?

Shanawani H. The Challenges of Conscientious Objection in Health care. J Religion Health. 2016 Feb 29;55(2):384-393.

Conscientious objection in healthcare: why tribunals might be the answer

Steve Clarke

Abstract
An analogy is sometimes drawn between the proper treatment of conscientious objectors in healthcare and in military contexts. In this paper, I consider an aspect of this analogy that has not, to my knowledge, been considered in debates about conscientious objection in healthcare. In the USA and elsewhere, tribunals have been tasked with the responsibility of recommending particular forms of alternative service for conscientious objectors. Military conscripts who have a conscientious objection to active military service, and whose objections are deemed acceptable, are required either to serve the military in a non-combat role, or assigned some form of community service that does not contribute to the effectiveness of the military. I argue that consideration of the role that military tribunals have played in determining the appropriate form of alternative service for conscripts who are conscientious objectors can help us to understand how conscientious objectors in healthcare ought to be treated. Additionally, I show that it helps us to address the vexed issue of whether or not conscientious objectors who refuse to provide a service requested by a patient should be required to refer that patient to another healthcare professional.

Clarke S. Conscientious objection in healthcare: why tribunals might be the answer. J Med Ethics Feb 25. 2016;1-4.

In defence of medical tribunals and the reasonability standard for conscientious objection in medicine

Robert F Card

Extract
Cowley has recently objected to the idea of using a medical tribunal to make determinations regarding conscientious objections and has criticised using reasonability as a standard for any such tribunal. . . . I argue that Cowley’s discussion sells the idea of medical tribunals short and illustrates serious misunderstandings regarding how the reasonability standard should be deployed in practice.

Card RF. In defence of medical tribunals and the reasonability standard for conscientious objection in medicine. J Med Ethics 2016 Feb;42(2):73-5. doi: 10.1136/medethics-2015-103037

Striking a Balance Between Faith and Freedom: Military Conscientious Objection as a Model for Pharmacist Refusal

Maria Teresa Weidner

Lexis Nexis Summary
Pharmacists who have subscribed to this movement assert that they have a “right” to refuse to fill valid patient prescriptions whenever doing so might violate their own religious or moral beliefs. … The governments of Arkansas, Florida, and South Dakota sought to both endorse and shield from liability instances of religiously motivated pharmacist refusal to dispense family planning products. … Such expectations, as demonstrated in the policy positions set forth by organizations like the American Pharmacists Association (APhA) and Pharmacists for Life, harm the profession by undermining its credibility while underscoring the need to preserve the regulating power of liability as a tool to protect patient interests. … These factors, compounded with the profession’s own struggle for professional legitimacy and insistence on recognition of the practitioners’ “clinical role” in the provision of medication to patients indicate that a defense against alleged malpractice based on a free exercise theory would not succeed both based on the secular nature of the profession and as a matter of existing free exercise jurisprudence. … South Dakota’s legislature has already demonstrated as much by including a provision in its pharmacist refusal clause permitting pharmacists to refuse to dispense palliative drugs that might be used to hasten death, clearly a measure that can affect women and men alike

Weidner MT. Striking a Balance Between Faith and Freedom: Military Conscientious Objection as a Model for Pharmacist Refusal. J Gender, Race & Just. 2008 Jan;11(2):369-408

The Cost of Conscience: Kant on Conscience and Conscientious Objection

Jeanette Kennett

Abstract
The spread of demands by physicians and allied health professionals for accommodation of their private ethical, usually religiously based, objections to providing care of a particular type, or to a particular class of persons, suggests the need for a re-evaluation of conscientious objection in healthcare and how it should be regulated. I argue on Kantian grounds that respect for conscience and protection of freedom of conscience is consistent with fairly stringent limitations and regulations governing refusal of service in healthcare settings. Respect for conscience does not entail that refusal of service should be cost free to the objector. I suggest that conscientious objection in medicine should be conceptualized and treated analogously to civil disobedience.

Kennett J. The Cost of Conscience: Kant on Conscience and Conscientious Objection. Cambridge Quarterly of Healthcare Ethics. 2017 Jan; 26(1): 69 – 81
DOI: https://doi.org/10.1017/S0963180116000657

The right to die and the medical cartel

M Cholbi

Abstract
Advocates of a right to die increasingly assert that the right in question is a positive right (a right to assistance in dying) and that the right in question is held against physicians or the medical community. Physician organizations often reply that these claims to a positive right to die should be rejected on the grounds that medicine’s aims or “internal” norms preclude physicians from killing patients or assisting their patients in killing themselves. The aim of this article is to rebut this reply. Rather than casting doubt on whether assisted dying is consistent with medicine’s “internal” norms, I draw attention to the socioeconomic contexts in which contemporary medicine is practiced. Specifically, contemporary medicine typically functions as a public cartel, one implication of which is that physicians enjoy a monopoly on the most desirable life-ending technologies (fast acting lethal sedatives, etc). While there may be defensible public health reasons for medicine functioning as a cartel and having this monopoly on desirable life-ending technologies, Rawlsian contract-based reasoning illustrates that the status of medicine as a cartel cannot be reconciled with its denying the public access to supervised use of desirable life-ending technologies. The ability to die in ways that reflect one’s conception of the good is arguably a primary social good, a good that individuals have reasons to want, whatever else they may want. Individuals behind Rawls’ veil of ignorance, unaware of their health status, values, etc, will thus reason that they may well have a reasonable desire for the life-ending technologies the medical cartel currently monopolizes. They thus have reasons to endorse a positive right to physician assistance in dying. On the assumption that access to desirable life-ending technologies will be controlled by the medical community, a just society does not permit that community to deny patients access to these technologies by an appeal to medicine’s putative “internal” aims or norms. The most natural response to my Rawlsian argument is to suggest that it only shows that individuals have a positive right against the medical community to access life-ending technologies but not a right to access such technologies from individual physicians. Individual physicians could still refuse to provide such technologies as a matter of moral conscience. Such claims of conscience should be rejected, however. A first difficulty with this proposal is that it is in principle possible for a sufficiently large number of individuals within a profession to invoke claims of conscience so as to materially hinder individuals from exercising their positive right to die, as appears to be the case in several jurisdictions with respect to abortion and other reproductive health treatments. Second, unlike conscientious objectors to military service, physicians who conscientiously object to providing assistance in dying would not be subject to fundamental deprivations of rights if they refused to provide assistance. Physicians who deny patients access to these technologies use their monopoly position in the service of a kind of moral paternalism, hoarding a public resource with which they have been entrusted so as to promote their own conception of the good over that of their patients.

Cholbi M. The right to die and the medical cartel. Ethics Med Pub Health. 2015 Nov 19;1(4):486-493.

Multi-fetal Pregnancy Reduction in Assisted Reproductive Technologies: A License to Kill?

Siddharth Khanijou

Extract
Conclusion
The objective of this Article is not to make a case that multifetal pregnancy reduction should be banned. . . . The procreational autonomy bestowed by the Constitution cannot be extended to permit the unbridled, willful creation and destruction of fetuses. Autonomy does not grant society a license to absolute freedom from intervention in all matters regarding our reproductive capacity. . . .

Assisted reproductive technologies, like other medical technologies, do not exist in a vacuum. The potential economic and social harms that may result from irresponsible practice extend beyond the ART participants. . . . In an era where government silence equals acquiescence and where unregulated technology threatens to devalue humanity, political stalemate is not a valid excuse. Proactive federal oversight is central to cure the problems created over the past twenty- five years by the lack of regulation over ART.

Khanijou S. Multi-fetal Pregnancy Reduction in Assisted Reproductive Technologies: A License to Kill? DePaul J Health Care Law. 2005 Oct;8(2):403-430.

Conscientious Objection and Medical Tribunals

Alberto Giubilini

Extract
Professionals have a prima facie obligation to do what their profession requires. This is an uncontroversial principle. Equally uncontroversial is that our conscience is essential to our moral integrity. On any account of conscience (whether religious, philosophical or psychological), conscience encompasses core and self-identifying moral beliefs. Therefore, there is also a prima facie duty to respect conscience. The issue of conscientious objection in healthcare is the issue of whether and how to strike a balance between these two prima facie duties when they conflict with each other, for example, when doctors have a conscientious objection to abortion.

Giubilini A. Conscientious Objection and Medical Tribunals. J Med Ethics. 2016;42(2):78-79.

Contraceptive Comstockery: Reasoning from Immorality to Illness in the Twenty-First Century

Priscilla J Smith

Abstract
This Article examines the use by anti-contraception advocates of the claims that “contraception harms women” and “contraception is abortion,” claims made most prominently in litigation challenging Obamacare’s contraceptive coverage requirement. See Burwell v. Hobby Lobby, 134 S. Ct. 2751 (2014). The Article uncovers the nineteenth-century roots of these arguments and the strategic reasoning behind their current revival, to reveal that these claims are part of a broad attack on contraception grounded in opposition to non-procreative sex. In Part II, the Article reviews nineteenth-century reasoning about contraceptives, and then in Part III, discusses the modern revival of this Comstock era mode of reasoning about contraception which connected immorality and illness. Today, however, considerable social acceptance of sex for pleasure (at least for some people in some circumstances) means that straightforward arguments against contraception based on its immorality do not resonate as successfully as they once did. Social conservatives have publicly acknowledged as much, expressing an anxiety about the position of religion as “belief” rather than “truth,” and about a rise in what they call “sexualityism.” As a result, modern opponents of contraception have intentionally attempted to mask outmoded and unpopular moral opposition to non-procreative sex by using scientific discourse, citing the best science “we can currently lay our hands on,” for support. The problem for anti-contraception advocates, as revealed in Parts IV and V, is that the appeal to science is a purely rhetorical move, and their claims are contradicted by the latest scientific evidence. The Article establishes the safety and benefits of hormonal contraceptives to women’s and children’s health. The Article also shows that the claim that five hormonal contraceptives are abortifacients is false. Four out of five do not interfere with implantation of a fertilized egg and so cannot be said to terminate a “pregnancy,” even as redefined by opponents as occurring upon fertilization. Opposition to these hormonal contraceptives is thus not truly based on the view that destruction of a fertilized egg is immoral and should be considered an abortion. Rather, the opposition goes much deeper, stemming from a general objection to all forms of contraception and the ability of women to have sex without accepting the possibility of pregnancy and motherhood. The Article concludes in Part VI with evidence of the benefits of increased access to the most effective forms of contraception. Anti-contraception advocates are deploying woman-protective health arguments to limit access to contraception using a strategy similar to that adopted to oppose abortion. Anti-contraception advocates have melded these arguments to contemporary anxieties about heterosexual women’s ability to survive on equal footing with men in today’s sexual and marital “marketplace” in order to stymie efforts to expand contraceptive access and to further restrict access where possible.

Smith PJ. Contraceptive Comstockery: Reasoning from Immorality to Illness in the Twenty-First Century. Conn Law Rev. 2015 May;47(4).

(Editorial) Conscientious Objection in Medicine: Private Ideological Convictions must not Supercede Public Service Obligations

Udo Schuklenk

Extract
The very idea that we ought to countenance conscientious objection in any profession is objectionable. Nobody forces anyone to become a professional. It is a voluntary choice. A conscientious objector in medicine is not dissimilar to a taxi driver who joins a taxi company that runs a fleet of mostly combustion engine cars and who objects on grounds of conscience to drive those cars due to environmental concerns.

Schuklenk U. (Editorial) Conscientious Objection in Medicine: Private Ideological Convictions must not Supercede Public Service Obligations. Bioethics. 2015 May 09;29(5):ii-iii.