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.
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.
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.
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.
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.
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.
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.
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.
Extract Asserting that we should encourage dialogue is one thing; showing that such dialogue is possible is another. My commentary has in no way argued against having beliefs that result from religious conscience; rather, I have argued only that religious conscience, regardless of the religion from which it develops, has no place in medical decision-making.
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.
