Extract Conscience and conscientious objection or moral justification are social activities not just Individualistic, “do-it-yourself” moralities. This requires education, training and intentional moral development and active input and encouragement. It is not just a matter of our moral biases but of awareness of the different applications of such principles and perspectives to particular situations and cases and of how to respond to moral critique and alternative conscientious grounds and beliefs.
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.
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 Card (2007) does not merely claim that practitioners are obligated to provide EC; he argues that they are obligated to do so even if they have a conscientious objection. This last clause may seem harmless on the surface, but a closer look reveals that it effectively saws off the limb on which the first clause and all medical ethics sit. . . . A genuine conscientious objection, even if misinformed, is an expression of a commitment to acting morally, and . . . judgments of conscience need not be informed by explicitly religious ideas. Moreover, all ethical arguments are appeals to conscience. As such, acting conscientiously is the most fundamental of all moral obligations.
Extract . . .pharmacists in the news who claim that emergency contraception causes abortion are acting impermissibly by basing their conscientious objection on false claims. . . My main point here, however, is drawn from a familiar concept of political philosophy — the idea of a social contract. . . Pharmacists benefit from a monopoly on the right to dispense prescription medications. This monopoly, like those offered to public utilities, comes with responsibilities that go beyond the usual duties of professionalism. Pharmacists have a duty to conform to the system which has invested in them and in which they have a vested interest. . .Card (2007) argues that the prima facie right to conscientious objection is defeated by the facts of this particular case. Applying the argument of the Crito to the role of pharmacists in the United States leads us to conclude that this prima facie right is defeated for the pharmacist in the professional role in all cases. What remains are the right to work for change and the right to opt out of the professional role entirely.
Farr A Curlin, Ryan E Lawrence, Marshall H Chin, John D Lantos
New England Journal of Medicine
Abstract Background There is a heated debate about whether health professionals may refuse to provide treatments to which they object on moral grounds. It is important to understand how physicians think about their ethical rights and obligations when such conflicts emerge in clinical practice.
Methods We conducted a cross-sectional survey of a stratified, random sample of 2000 practicing U.S. physicians from all specialties by mail. The primary criterion variables were physicians’ judgments about their ethical rights and obligations when patients request a legal medical procedure to which the physician objects for religious or moral reasons. These procedures included administering terminal sedation in dying patients, providing abortion for failed contraception, and prescribing birth control to adolescents without parental approval.
Results A total of 1144 of 1820 physicians (63%) responded to our survey. On the basis of our results, we estimate that most physicians believe that it is ethically permissible for doctors to explain their moral objections to patients (63%). Most also believe that physicians are obligated to present all options (86%) and to refer the patient to another clinician who does not object to the requested procedure (71%). Physicians who were male, those who were religious, and those who had personal objections to morally controversial clinical practices were less likely to report that doctors must disclose information about or refer patients for medical procedures to which the physician objected on moral grounds (multivariate odds ratios, 0.3 to 0.5).
Conclusions Many physicians do not consider themselves obligated to disclose information about or refer patients for legal but morally controversial medical procedures. Patients who want information about and access to such procedures may need to inquire proactively to determine whether their physicians would accommodate such requests.
Abstract Debate about physician-assisted suicide has typically focused on the values of autonomy and patient well-being. This is understandable, even reasonable, given the importance of these values in bioethics. However, these are not the only moral values there are. The purpose of this paper is to examine physician-assisted suicide on the basis of the values of equality and justice. In particular, I will evaluate two arguments that invoke equality, one in favour of physician-assisted suicide, one against it, and I will eventually argue that a convincing equality-based argument in support of physician-assisted suicide is available. I will conclude by showing how an equality-based perspective transforms some secondary features of debate about this issue.
Extract Religious initiatives to propose, legislate, and enforce laws that protect denial of care or assistance to patients, (almost invariably women in need), and bar their right of access to lawful health services, are abuses of conscientious objection clauses that aggravate public divisiveness and bring unjustified criticism toward more mainstream religious beliefs. Physicians who abuse the right to conscientious objection and fail to refer patients to nonobjecting colleagues are not fulfilling their profession’s covenant with society.
Extract There are other flaws with Bill C-407, but this is not the place to present them in detail. However, there is one serious flaw that is appropriately considered in this forum, and that is the fact that the Bill is a partial measure at best. It deals only with assisted suicide, not euthanasia. It would not help those who, although competent, could not perform the final act themselves because they are disabled. . . .As well, the Bill ignores those who have never been competent and never will be. Their rights would still be less than those of other persons: they would be condemned to suffer when a competent person would not. An appropriately crafted suicide and euthanasia Bill would change that situation.
Kluge E-H. Assisted Suicide & Euthanasia: a Proposal for Restructuring the Criminal Code of Canada. Humanist Perspectives Online Supplement. 2005;38(4):1-5
