Physicians can justifiably euthanize certain severely impaired neonates

Udo Schuklenk

Journal of Thoracic and Cardiovascular Surgery
Journal of Thoracic and Cardiovascular Surgery

Extract
Once we have concluded that death is what is in the best interest of an infant, it is unreasonable not to bring about this death as painlessly and as much controlled in terms of timing by the parents as is feasible.


Schuklenk U. Physicians can justifiably euthanize certain severely impaired neonates. J Thorac Cardiovasc Surg. 2015 Feb;149(2):535-537.

Political Justification through Democratic Participation: The Case for Conscientious Objection

Emanuela Ceva

Social Theory and Practice
Social Theory and Practice

Abstract
On a proceduralist account of democracy, collective decisions derive their justification-at least in part-from the qualities of the process through which they have been made. To fulfill its justificatory function, this process should ensure that citizens have an equal right to political participation as a respectful response to their equal status as agents capable of self-legislation. How should democratic participation be understood if it is to offer such a procedural justification for democratic decisions? I suggest that, in order to overcome the structural procedural disadvantages affecting the actual, effective opportunities that citizens who hold nonmainstream views have to exercise their right to political participation, the enhancement of such opportunities requires securing space for contestation. Against this background, I vindicate the (currently underestimated) role of conscientious objection as a form of political participation.


Ceva E. Political Justification through Democratic Participation: The Case for Conscientious Objection. Social Theory and Practice. 2015 Jan;41(1):26-50

Conscientious Objection and Civil Disobedience

Kimberley Brownlee

Conscientious Objection and Civil Disobedience

From the chapter introduction

The purpose of this chapter is to consider two types of dissent that are generally described as conscientious, namely, civil disobedience and conscientious objection, both of which raise pressing normative questions not only about the proper parameters of dissenters’ rights and duties within a reasonably good society, but also about both the scope of legitimate toleration of assertions of conscientiousness and the appropriate legal and political responses to conscientious disobedience. In what follows, I begin by outlining the conceptual territory of civil disobedience and conscientious objection. I then offer a qualified endorsement of the moral justifiability of these two practices before examining both the scope and legitimacy of their status as moral rights and their grounds for legal defensibility. Among other things, I challenge the dominant liberal position that, in relation to both moral rights and legal defenses, a more compelling case can be made on behalf of private conscientious objection than on behalf of civil disobedience.


Brownlee K. Conscientious Objection and Civil Disobedience. In: Marmor A editors. The Routledge Companion to the Philosophy of Law. 2012;527-539.

(Book Review) Moral Conscience Through the Ages: Fifth Century BCE to the Present

THE (Times Higher Education)
Reproduced with permission

Tom Palaima

Moral Conscience Through the Ages

Richard Sorabji. Moral Conscience Through the Ages: Fifth Century BCE to the Present. Oxford: Oxford University Press, 2014, 240 pp. ISBN 9780199685547

Always let your conscience be your guide,” sings Jiminy Cricket, conscience personified as a kindly bowler-hatted cricket, to Pinocchio in Walt Disney’s 1940 film classic about a wooden puppet being transformed into a real-life boy. It is one of the few significant social pronouncements about the role of conscience in making us human not found in Richard Sorabji’s compact history of the ideas that important thinkers and doers, beginning with Euripides and Plato and ending with Martin Luther, Thomas Hobbes, Henry David Thoreau, Leo Tolstoy, Friedrich Nietzsche, Sigmund Freud and Mahatma Gandhi, have had about how a conscience works, where it comes from, and what good it is, if any – Nietzsche had no use for conscience, believing that modern men “inherit thousands of years of the vivisection of conscience”.

Sorabji’s close reading of subtle arguments spanning 25 centuries, as he transliterates key Greek and Latin terms and does his best to define their particular meanings in different periods, enables us to see how later figures took up or rejected earlier ideas. Gandhi, for example, came to believe unshakeably in his “still small voice within” – no Jiminy Cricket for him – as “the true voice of God”, as it steeled his commitment to non-violent social actions. Gandhi’s voice of God, we learn, sounded a lot like Tolstoy in his 1894 treatise The Kingdom of God is Within You and Socrates in Plato’s Apology, set in 399BC.

The Greek word for conscience first appears in passages in the work of late 5th-century playwrights where characters wrestle with what we would call moral choices, or defects in Sorabji’s view. The Greek compound verbal formation expresses the notion of a shared knowing (sun: “with” and oida: “know”, literally “I saw and I still see”), Latin con-sciens. The precise meaning of conscience is further complicated by the abstract nouns used for it that are derived from other verbal roots, eg, sunesis and the Latinised sunderesis. The notion of with-ness is the common element.

The key question is: shared with whom? In Sorabji’s view – surprisingly given the role that conscience plays in our interactions with others – we share our thoughts about moral behaviour and moral choices with ourselves. Conscience splits us into two people. From this come expressions like “I could not live with myself” and feelings of having a voice within or a cricket or guardian angel advising from without, as in Freud’s superego or Socrates’ daimōn.

Sorabji also argues that the original concept of conscience, ie, “sharing knowledge with oneself of a defect”, was a largely secular idea. Stoics and Christians turned conscience into a religious concept associated with the law or will of gods or God. Michel de Montaigne, Hobbes and John Locke began a resecularisation process that continued through Thoreau’s civil disobedience and then on to conscientious objection to armed service during the First World War.

But what does a largely secular idea in ancient Greek look like in context? Sorabji gives few original source passages at any length. Conscience appears as a daimōn in Plato’s Apology and arguably also in Euripides’ Orestes, where grief is called a terrible goddess in a kind of chiasmus. So how the Greeks viewed daimones becomes relevant to whether conscience ab origine is secular or religious or something in between. And Hesiod’s thoughts two centuries earlier in Works and Days about daimones as immortal and beneficent guardians of justice should be relevant, too.


Tom Palaima is professor of Classics, University of Texas at Austin.

Reasonability and Conscientious Objection in Medicine: A Reply to Marsh and an Elaboration of the Reason-Giving Requirement

Robert F. Card

Bioethics
Bioethics

Abstract
In this paper I defend the Reasonability View: the position that medical professionals seeking a conscientious exemption must state reasons in support of their objection and allow those reasons to be subject to evaluation. Recently, this view has been criticized by Jason Marsh as proposing a standard that is either too difficult to meet or too easy to satisfy. First, I defend the Reasonability View from this proposed dilemma. Then, I develop this view by presenting and explaining some of the central criteria it uses to assess whether a conscientious objection is proper grounds for extending an exemption to a medical practitioner.


Card RF. Reasonability and Conscientious Objection in Medicine: A Reply to Marsh and an Elaboration of the Reason-Giving Requirement. Bioethics 2014 Jul; 28(6):320-6. doi: 10.1111/bioe.12022.

The Paradox of Conscientious Objection and the Anemic Concept of ‘Conscience’: Downplaying the Role of Moral Integrity in Health Care

Alberto Giubilini

Kennedy Institute of Ethics Journal
Kennedy Institute of Ethics Journal

Abstract
Conscientious objection in health care is a form of compromise whereby health care practitioners can refuse to take part in safe, legal, and beneficial medical procedures to which they have a moral opposition (for instance abortion). Arguments in defense of conscientious objection in medicine are usually based on the value of respect for the moral integrity of practitioners. I will show that philosophical arguments in defense of conscientious objection based on respect for such moral integrity are extremely weak and, if taken seriously, lead to consequences that we would not (and should not) accept. I then propose that the best philosophical argument that defenders of conscientious objection in medicine can consistently deploy is one that appeals to (some form of) either moral relativism or subjectivism. I suggest that, unless either moral relativism or subjectivism is a valid theory-which is exactly what many defenders of conscientious objection (as well as many others) do not think-the role of moral integrity and conscientious objection in health care should be significantly downplayed and left out of the range of ethically relevant considerations.


Giubilini A. The Paradox of Conscientious Objection and the Anemic Concept of ‘Conscience’: Downplaying the Role of Moral Integrity in Health Care. Kennedy Inst Ethics J. 2014 Jun 15;24(2):159-185.

Practicing Medicine and Ethics: Integrating Wisdom, Conscience and Goals of Care

Lauris Christopher Kaldjian

Practicing Medicine and Ethics: Integrating Wisdom, Conscience and Goals of Care

Lauris Christoper Kaldjian. Practicing Medicine and Ethics: Integrating Wisdom, Conscience and Goals of Care. New York: Cambridge University Press, 2014, 296 pp. ISBN 10- 1107012163

Publisher’s Description
To practice medicine and ethics, physicians need wisdom and integrity to integrate scientific knowledge, patient preferences, their own moral commitments, and society’s expectations. This work of integration requires a physician to pursue certain goals of care, determine moral priorities, and understand that conscience or integrity require harmony among a person’s beliefs, values, reasoning, actions, and identity. But the moral and religious pluralism of contemporary society makes this integration challenging and uncertain. How physicians treat patients will depend on the particular beliefs and values they and other health professionals bring to each instance of shared decision making. This book offers a framework for practical wisdom in medicine that addresses the need for integrity in the life of each health professional. In doing so, it acknowledges the challenge of moral pluralism and the need for moral dialogue and humility as professionals fulfil their obligations to patients, themselves, and society.

(Thesis) Conflictos de conciencia: la objeción en el ejercicio de las profesiones sanitarias

Rosana Triviño Caballero

Theses
Thesis

Abstract
[ES] La proliferación de los conflictos por motivos de conciencia en el contexto sanitario ha conducido con frecuencia a un tratamiento inadecuado de los mismos. En el caso de los profesionales sanitarios, es posible observar un uso inapropiado de conceptos como el de objeción de conciencia, banalizándolo o sacralizándolo, sin considerar el alcance que la negativa a prestar un tratamiento pueda tener para el resto de personas implicadas; en el caso de los usuarios, es frecuente que sus convicciones tengan un reconocimiento limitado a la hora de tomar decisiones que atañen a su bienestar. A partir de estas premisas, se pretende analizar las tensiones entre intereses, derechos y deberes de las partes implicadas, así como las relaciones de poder que se establecen entre quienes ostentan el conocimiento experto y quienes se encuentran en situación de mayor vulnerabilidad. Este análisis persigue identificar los problemas en los distintos niveles discursivos ¿de intereses, de derechos y deberes y de relaciones de poder- para establecer posteriormente una serie de límites que condicionen el ejercicio de la libertad de conciencia tanto para los profesionales como para los usuarios. Con ello se aspira a ofrecer un marco ético-normativo que pudiera servir como referencia para la resolución de conflictos, basado en una noción de conciencia menos individualista y más relacional-feminista.


[Translation] The proliferation of conflicts for reasons of conscience in the health context has frequently led to their inadequate treatment. In the case of health professionals, it is possible to observe an inappropriate use of concepts such as conscientious objection, trivializing or sacralizing it, without considering the scope that the refusal to provide treatment may have for the rest of the people involved; In the case of users, it is common for their convictions to have limited recognition when making decisions that concern their well-being. Based on these premises, it is intended to analyze the tensions between interests, rights and duties of the parties involved, as well as the power relations that are established between those who hold expert knowledge and those who are in a situation of greater vulnerability. This analysis seeks to identify the problems at the different discursive levels – interests, rights and duties and power relations – to subsequently establish a series of limits that condition the exercise of freedom of conscience for both professionals and users. With this, it aspires to offer an ethical-regulatory framework that could serve as a reference for conflict resolution, based on a less individualist and more relational-feminist notion of conscience.


Caballero RT. (Thesis) Conflictos de conciencia: la objeción en el ejercicio de las profesiones sanitarias. University of Salamanca. 2014.

Conscientious objection to harmful animal use within veterinary and other biomedical education

Andrew Knight

Animals
Animals

Abstract
Laboratory classes in which animals are seriously harmed or killed, or which use cadavers or body parts from ethically debatable sources, are controversial within veterinary and other biomedical curricula. Along with the development of more humane teaching methods, this has increasingly led to objections to participation in harmful animal use. Such cases raise a host of issues of importance to universities, including those pertaining to curricular design and course accreditation, and compliance with applicable animal welfare and antidiscrimination legislation. Accordingly, after detailed investigation, some universities have implemented formal policies to guide faculty responses to such cases, and to ensure that decisions are consistent and defensible from legal and other policy perspectives. However, many other institutions have not yet done so, instead dealing with such cases on an ad hoc basis as they arise. Among other undesirable outcomes this can lead to insufficient student and faculty preparation, suboptimal and inconsistent responses, and greater likelihood of legal challenge. Accordingly, this paper provides pertinent information about the evolution of conscientious objection policies within Australian veterinary schools, and about the jurisprudential bases for conscientious objection within Australia and the USA. It concludes with recommendations for the development and implementation of policy within this arena.


Knight A. Conscientious objection to harmful animal use within veterinary and other biomedical education. Animals. 2014 Jan 21;4(1):16-34.

Dignity, death, and dilemmas: A study of Washington hospices and physician-assisted death

Courtney S Campbell, Margaret A Black

Journal of Paint and Symptom Management
Journal of Paint and Symptom Management

Abstract
The legalization of physician-assisted death in states such as Washington and Oregon has presented defining ethical issues for hospice programs because up to 90% of terminally ill patients who use the state-regulated procedure to end their lives are enrolled in hospice care. The authors recently partnered with the Washington State Hospice and Palliative Care Organization to examine the policies developed by individual hospice programs on program and staff participation in the Washington Death with Dignity Act. This article sets a national and local context for the discussion of hospice involvement in physician-assisted death, summarizes the content of hospice policies in Washington State, and presents an analysis of these findings. The study reveals meaningful differences among hospice programs about the integrity and identity of hospice and hospice care, leading to different policies, values, understandings of the medical procedure, and caregiving practices. In particular, the authors found differences 1) in the language used by hospices to refer to the Washington statute that reflect differences among national organizations, 2) the values that hospice programs draw on to support their policies, 3) dilemmas created by requests by patients for hospice staff to be present at a patient’s death, and 4) five primary levels of noninvolvement and participation by hospice programs in requests from patients for physician-assisted death. This analysis concludes with a framework of questions for developing a comprehensive hospice policy on involvement in physician-assisted death and to assist national, state, local, and personal reflection.


Campbell CS, Black MA. Dignity, death, and dilemmas: A study of Washington hospices and physician-assisted death. J Pain Symptom Manage. 2014 Jan;47(1):137-153.