0 - Protection of Conscience Project Library

The Proper Place of Values in the Delivery of Medicine (Conscience in Medicine)

Julian Savulescu

Extract
Physicians who fail to act in their patient’s interests breach the fundamental duty of care of a physician. It is negligent to deny a person who would benefit a blood transfusion, a vaccination, an abortion, intensive care or sedation at the end of their life. Physicians should not play God. If they morally disagree with some medical treatment, they can give their reasons to their patients and they can take that debate to the level of law and professional bodies. But in a liberal society they should not inflict their judgments on their patients. Physicians can disagree, but they should not dictate.

Savulescu J. The Proper Place of Values in the Delivery of Medicine (Conscience in Medicine). Am J Bioeth. 2007 Dec 19;21-22.

Always Let Your Conscience Be Your Guide (Conscience in Medicine)

E David Cook

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.

Cook ED. Always Let Your Conscience Be Your Guide (Conscience in Medicine). Am J Bioeth. 2007 Dec 19;7(12):17-19.

The Moral Significance of Claims of Conscience in Healthcare (Conscience in Medicine)

Mark R Wicclair

Extract
Contrary to what Lawrence and Curlin (2007) suggest, it is not primarily disagreement about the nature of “the conscience” that underlies the controversy about whether and when health professionals should be allowed to refuse to provide services that violate their ethical beliefs. Rather, the primary source of disagreement is over the professional obligations of physicians, pharmacists and other healthcare providers and how to resolve conflicts between those obligations and healthcare professionals’ interest in maintaining their moral integrity.

Wicclair MR. The Moral Significance of Claims of Conscience in Healthcare (Conscience in Medicine). Am J Bioeth. 2007;7(1):30-31.

The Tao of Conscience: Conflict and Resolution (Conscience in Medicine)

Linda MacDonald Glenn, Jeanann Boyce

Extract
The strength of the nondualistic-approach is that it will contribute to “meaningful dialogue about the role of the conscience” which depends on “shared definitions of the relevant terms” (Lawrence and Curlin 2007, 10). This approach of “shared definitions” can also be termed commensurability— when two people who hold incommensurable values can create common ground when one or both changes their values, empathize or agree to disagree and work towards a common goal (Glenn 2003). . . The alternative to seeking commensurability is the enforcement of a law, which is a solution that does not always resolve the underlying issues. The legal system devotes many resources to the resolving of problems, but the result is often “winner-take-all”—without regard to the long-term consequences and impact on the relationship of the parties.

Glenn LM, Boyce J. The Tao of Conscience: Conflict and Resolution (Conscience in Medicine). Am J Bioeth. 2007;7(12):33.

Defining Conscience and Acting Conscientiously (Conscience in Medicine)

Claudia I Emerson, Abdallah S Daar

Abstract
In a perfect world, acting conscientiously would always be compatible with acting in conformity with the conscience. But ours is not a perfect world; in the context of healthcare, acting conscientiously may require acting against the conscience. For the conscience is sometimes unreliable and cannot serve as a guiding principle where public health is at stake. Defining the conscience does not change that, nor does it offer a justification for conscientious objection. To deliver responsible healthcare, physicians must act conscientiously.

Emerson CI, Daar AS. Defining Conscience and Acting Conscientiously (Conscience in Medicine). Am J Bioeth. 2007;7(12):19-21.

The physician’s conscience (Conscience in Medicine)

Hugh LaFollette

Extract
Lawrence and Curlin (2007) correctly note that not all disputants agree about what conscience is. However, I doubt that their distinction is as important as they think. I believe that understanding the distinctions just discussed is far more likely to lead to a satisfactory conclusion. If advocates of conscientious objection for medical professionals attended to these distinctions, they would see that what they want cannot be justified, at least not in the unqualified form most of them advocate.

LaFollette H. The physician’s conscience (Conscience in Medicine). Am J Bioeth. 2007;7(12):15-17.

Some Reflections on Conscience (Conscience in Medicine)

Rosalind Ekman Ladd

Extract
The first way to avoid the problems that conscience raises is. . . that physicians and others be required to tell patients what areas of practice would be against their conscience. A second way is not to license physicians, pharmacists or others who will refuse to involve themselves in certain areas of medicine because of conscience. Because the practice of medicine (and pharmacy, etc.) is a social role and society already exercises some control over who may legally perform these roles, adding requirements is not such a radical idea.

Ladd RE. Some Reflections on Conscience (Conscience in Medicine). Am J Bioeth. 2007;7(12):32-33.

The Role of Moral Complicity in Issues of Conscience (Conscience in Medicine)

Robert D Orr

Extract
At what point is an individual accountable for involvement in an action that he or she believes to be immoral? This subquestion is, I believe, important to both the religious and the non-religious individual in dealing with matters of personal or professional conscience. . . Lawrence and Curlin (2007) have stated it is important to have a basic understanding of what an individual means when he or she invokes this right of conscience. I believe it is equally important for those individuals, and for the public at large, to understand that there is a spectrum of belief about one’s moral complicity. Thus two people of faith may arrive at different conclusions about when it is appropriate to invoke this right. Such variation is fundamental to the concept of an individual’s conscience.

Orr RD. The Role of Moral Complicity in Issues of Conscience (Conscience in Medicine). Am J Bioeth. 2007;7(12).

Negotiating the Tension Between Two Integrities: A Richer Perspective on Conscience (Conscience in Medicine)

Susan S Night

Extract
I think most would agree that to progress the debate over the role of conscience in medicine we must continue the conversation about the means and ends of medicine as suggested by Lawrence and Curlin (2007, 10). This must be done because the tensions that exist between negotiating one’s personal integrity and one’s professional integrity will never go away. These tensions are not exclusive to the profession of medicine, but are enhanced by potential conflicts between physician integrity and patient autonomy. The objective of the conversation should neither be to eliminate these tensions nor to narrowly compartmentalize them as having religious or secular origins. Rather, the objective of the conversation should be to first encourage each physician to engage in moral reflection upon what they believe is right or wrong and the source that informs these values. Only then will physicians be able to appropriately negotiate the tensions that exist between the moral duties of personal and professional integrity and engage in meaningful dialogue rather than disagreement with their peers and their patients.

Night SS. Negotiating the Tension Between Two Integrities: A Richer Perspective on Conscience (Conscience in Medicine). Am J Bioeth. 2007;7(12):24-26.

Clash of definitions: Controversies about conscience in medicine (Conscience in Medicine)

Ryan E Lawrence, Farr A Curlin

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.

Lawrence RE, Curlin FA. Clash of definitions: Controversies about conscience in medicine (Conscience in Medicine). Am J Bioeth. 2007;7(12):10-14.