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Extract This Comment, based on a review of other exemptions, concludes that enacting legislation to accommodate civil servants while still providing equal service to all members of the public would be both the most effective method of accommodation and the method most likely to be enacted by legislatures. The current methods of accommodation provide little protection for conscientious objectors because legislatures enact them infrequently and courts interpret them narrowly.
Abstract The value of conscience in healthcare ethics is widely debated. While some sources present it as an unquestionably positive attribute, others question both the veracity of its decisions and the effect of conscientious objection on patient access to health care. This paper argues that the right to object conscientiously should be broadened, subject to certain provisos, as there are many benefits to healthcare practice in the development of the consciences of practitioners. While effects such as the preservation of moral integrity are widely considered to benefit practitioners, this paper draws on the work of Hannah Arendt to offer several original arguments in defence of conscience that may more directly benefit patients, namely that a pang of conscience may be useful in rapidly unfolding situations in which there is no time to reflect satisfactorily upon activities and that, given the hierarchical nature of healthcare institutions, a right to defy authority on the basis of conscience may benefit junior staff who lack the institutional power to challenge the orders of superiors.
Abstract Article 9 of the European Convention on Human Rights provides protection for freedom of thought, conscience and religion. From one perspective, it may be said that Article 9 guarantees a right to conscientious objection in health care, whereas from another perspective, a Strasbourg case, such as Pichon and Sajous v France, effectively means that Article 9 provides little or no protection in that context. In this article it is argued that the matter is more complex than either of these two positions would suggest. Moreover, given the nature of the subject matter, national authorities should be afforded a significant margin of appreciation in the way that they protect and regulate conscientious objection. By way of illustration, there is a discussion of the ways in which Article 9 might affect conscientious objection in health care under English law. The final part of the article considers the conceptual limitations of Article 9 in thinking about conscientious objection in health care; in particular, the claim that the extent to which Article 9 of the Convention provides protection for a conscientious objection in the health care context is a different question from whether conscientious objection by doctors and other health care practitioners is justified in principle.
Abstract Conscientious objection by doctors, as is commonly practised, is discriminatory medicine. Only a fully justified and publicly accepted set of objective values results in ethical medicine as a proper public service with agreed and justified moral and legal standards to which doctors should be held.
Joyce Cappiello, Margaret W Beal, Kim Gallogly-Hudson
Journal of Obstetric, Gynecologic & Neonatal Nursing
Abstract Using a case study that incorporates patient, nurse practitioner, and student perspectives, we address ethical principles of respect for autonomy, beneficence, and fairness; professionals’ right of conscience; and a social justice model for the discussion of prevention and management of unintended pregnancy. Through an ongoing process of self-reflection and values clarification, nurses can prepare for the challenge of applying ethical principles to the reproductive health care of women.
Grace S Chung, Ryan E Lawrence, Kenneth A Rasinski, John D Yoon, Farr A Curlin
American Journal of Obstetrics & Gynecology
Abstract Objective: The purpose of this study was to assess obstetrician- gynecologists’ regarding their beliefs about when pregnancy begins and to measure characteristics that are associated with believing that pregnancy begins at implantation rather than at conception.
Study Design: We mailed a questionnaire to a stratified, random sample of 1800 practicing obstetrician-gynecologists in the United States. The outcome of interest was obstetrician-gynecologists’ views of when pregnancy begins. Response options were (1) at conception, (2) at implantation of the embryo, and (3) not sure. Primary predictors were religious affiliation, the importance of religion, and a moral objection to abortion.
Results: The response rate was 66% (1154/1760 physicians). One-half of US obstetrician-gynecologists (57%) believe pregnancy begins at conception. Fewer (28%) believe it begins at implantation, and 16% are not sure. In multivariable analysis, the consideration that religion is the most important thing in one’s life (odds ratio, 0.5; 95% confidence interval, 0.20.9) and an objection to abortion (odds ratio, 0.4; 95% confidence interval, 0.20.9) were associated independently and inversely with believing that pregnancy begins at implantation.
Conclusion: Obstetrician-gynecologists’ beliefs about when pregnancy begins appear to be shaped significantly by whether they object to abortion and by the importance of religion in their lives.
Extract Respect for doctors’ right to conscientiously object is the ultimate safeguard against abuses of power, error and exploitation in medicine. It is the key safeguard of the doctor–patient relationship.
Lisa H Harris, Alexandra Cooper, Kenneth A Rasinski, Farr A Curlin, Anne Drapkin Lyerly
Obstetrics & Gynecology
Abstract Objective: To describe obstetrician-gynecologists’ (ob-gyns’) views and willingness to help women seeking abortion in a variety of clinical scenarios.
Methods: We conducted a mailed survey of 1,800 U.S. ob-gyns. We presented seven scenarios in which patients sought abortions. For each, respondents indicated if they morally objected to abortion and if they would help patients obtain an abortion. We analyzed predictors of objection and assistance.
Results: The response rate was 66%. Objection to abortion ranged from 16% (cardiopulmonary disease) to 82% (sex selection); willingness to assist ranged from 64% (sex selection) to 93% (cardiopulmonary disease). Excluding sex selection, objection was less likely among ob-gyns who were female (odds ratio [OR] 0.5, 95% confidence interval [CI] 0.4-0.8), urban (OR 0.3, 95% CI 0.1-0.7), or Jewish (OR 0.3, 95% CI 0.1-0.7) compared with male, rural, or religiously unaffiliated ob-gyns. Objection was more likely among ob-gyns from the South (OR 1.9, 95% CI 1.2-3.0) or Midwest (OR 1.9, 95% CI 1.2-3.1), and among Catholic, Evangelical Protestant, or Muslim ob-gyns, or those for whom religion was most important, compared with reference. Among ob-gyns who objected to abortion in a given case, approximately two-thirds would help patients obtain an abortion. Excluding sex selection, assistance despite objection was more likely among female (OR 1.8, 95% CI 1.1-2.9) and United States-born ob-gyns (OR 2.2, 95% CI 1.1-4.7) and less likely among southern ob-gyns (OR 0.3, 95% CI 0.2-0.6) or those for whom religion was most important (OR 0.3, 95% CI 0.1-0.7).
Conclusion: Most ob-gyns help patients obtain an abortion even when they morally object to abortion in that case. Willingness to assist varies by clinical context and physician characteristics.
Abstract This paper reports on a national study that explored the complexity surrounding ethical conflicts related to conscientious objection in social work. Specific focus was on the extent to which practitioners have a right to remove themselves from professional services and situations that conflict with a religious or moral worldview.
Abstract In much contemporary constitutional thought the exercise of state power unbounded by or contrary to the law is nothing other than the failure of justice in the constitutional order. Yet it has not always been so. For a substantial period of common- law legal history the exercise of judgment despite the law was viewed as essential to seeing that justice was done. This article argues that attention to the imaginative architecture of our criminal justice system discloses the continued presence of the concept of the positive conscience-based exception as a dimension of modern constitutionalism. This article looks at jury nullification, the royal prerogative of mercy, and prosecutorial discretion as abiding expressions of the idea that law and reason alone are insufficient to give full expression to our sense of state justice. The persistence of these sites for conscience-based decisions unbounded by the law ought to trouble prevailing theories of modern constitutionalism based on the preeminence of a reason- driven proportionality in which all decisions must be contained and regulated by the reason of law. Without denying the dangers of the exception, this article suggests that the conscientious decision made against or in spite of the law remains an important component of the way in which we imagine criminal justice.
