Robert F Card Archives - Protection of Conscience Project Library

A New Theory of Conscientious Objection in Medicine: Justification and Reasonability

Robert F Card

Robert F. Card. A New Theory of Conscientious Objection in Medicine: Justification and Reasonability. New York & London: Routledge, 2020, 268 pp. ‎ ISBN-10:0367430819

Publisher Summary
This book argues that a conscientiously objecting medical professional should receive an exemption only if the grounds of an objector’s refusal are reasonable. It defends a detailed, contextual account of public reasonability suited for healthcare, which builds from the overarching concept of Rawlsian public reason.

The author analyzes the main competing positions and maintains that these other views fail precisely due to their systematic inattention to the grounding reasons behind a conscientious objection; he argues that any such view is plausible to the extent that it mimics the ‘reason-giving requirement’ for conscience objections defended in this work. Only reasonable objections can defeat the prior professional obligation to assign primacy to patient well-being, therefore one who refuses a patient’s request for a legally available, medically indicated, and safe service must be able to explain the grounds of their objection in terms understandable to other citizens within the public institutional structure of medicine. The book further offers a novel policy proposal to deploy the Reasonability View: establishing conscientious objector status in medicine. It concludes that the Reasonability View is a viable and attractive position in this debate.

A New Theory of Conscientious Objection in Medicine: Justification and Reasonability will be of interest to researchers and advanced students working in bioethics, medical ethics, and philosophy of medicine, as well as thinkers interested in the intersections between law, medical humanities, and philosophy.

Public reason in justifications of conscientious objection in health care

Doug McConnell, Robert F Card

Abstract
Current mainstream approaches to conscientious objection either uphold the standards of public health care by preventing objections or protect the consciences of health‐care professionals by accommodating objections. Public justification approaches are a compromise position that accommodate conscientious objections only when objectors can publicly justify the grounds of their objections. Public justification approaches require objectors and assessors to speak a common normative language and to this end it has been suggested that objectors should be required to cast their objection in terms of public reason. We provide critical support for such a public reason condition and argue that it would be neither too demanding nor too permissive. We also respond to objections that it unfairly favours secular over religious objectors and that public reasons cannot be held with the kind of sincerity thought to characterize conscientious objections.

McConnell D, Card RF. Public reason in justifications of conscientious objection in health care. Bioethics 2019 Jun;33(5):625-632. doi: 10.1111/bioe.12573

The Market View on conscientious objection: Overvalued

Robert F Card

Abstract
Ancell and Sinnott-Armstrong argue that medical providers possess wide freedoms to determine the scope of their practice, and therefore, prohibiting almost any conscientious objections is a bad idea. They maintain that we could create an acceptable system on the whole which even grants accommodations to discriminatory refusals by healthcare professionals. Their argument is premised upon applying a free market mechanism to conscientious objections in medicine, yet I argue their Market View possesses a number of absurd and troubling implications. Furthermore, I demonstrate that the fundamental logic of their main argument is flawed. Thinkers who wish to address the issues raised in this debate in general or by discriminatory conscience objections in particular should avoid the Market View and instead envisage theories that assess the reasons underlying conscientious refusals in medicine.

Card RF. The Market View on conscientious objection: Overvalued. J Med Ethics 2019 Mar;45(3):168-172. doi: 10.1136/medethics-2018-105173

Reasons, reasonability and establishing conscientious objector status in medicine

Robert F Card

Abstract
This paper builds upon previous work in which I argue that we should assess a provider’s reasons for his or her objection before granting a conscientious exemption. For instance, if the medical professional’s reasoned basis involves an empirical mistake, an accommodation is not warranted. This article poses and begins to address several deep questions about the workings of what I call a reason-giving view: What standard should we use to assess reasons? What policy should we adopt in order to evaluate the reasons offered by medical practitioners in support of their objections? I argue for a reasonability standard to perform the essential function of assessing reasons, and I offer considerations in support of a policy establishing conscientious objector status in medicine.

Card RF. Reasons, reasonability and establishing conscientious objector status in medicine. J Med Ethics 2017 Apr;43(4):222-225. doi: 10.1136/medethics-2016-103792

The Inevitability of Assessing Reasons in Debates about Conscientious Objection in Medicine

Robert F Card

Cambridge Quarterly of Healthcare Ethics

Abstract
This article first critically reviews the major philosophical positions in the literature on conscientious objection and finds that they possess significant flaws. A substantial number of these problems stem from the fact that these views fail to assess the reasons offered by medical professionals in support of their objections. This observation is used to motivate the reasonability view , one part of which states: A practitioner who lodges a conscientious refusal must publicly state his or her objection as well as the reasoned basis for the objection and have these subjected to critical evaluation before a conscientious exemption can be granted (the reason-giving requirement). It is then argued that when defenders of the other philosophical views attempt to avoid granting an accommodation to spurious objections based on discrimination, empirically mistaken beliefs, or other unjustified biases, they are implicitly committed to the reason-giving requirement. This article concludes that based on these considerations, a reason-giving position such as the reasonability view possesses a decisive advantage in this debate.

Card RF. The Inevitability of Assessing Reasons in Debates about Conscientious Objection in Medicine. Camb Q Healthc Ethics 2017 Jan;26(1):82-96. doi: 10.1017/S0963180116000669

The Inevitability of Assessing Reasons in Debates about Conscientious Objection in Medicine

Robert F. Card

Abstract
This article first critically reviews the major philosophical positions in the literature on conscientious objection and finds that they possess significant flaws. A substantial number of these problems stem from the fact that these views fail to assess the reasons offered by medical professionals in support of their objections. This observation is used to motivate the reasonability view, one part of which states: A practitioner who lodges a conscientious refusal must publicly state his or her objection as well as the reasoned basis for the objection and have these subjected to critical evaluation before a conscientious exemption can be granted (the reason-giving requirement). It is then argued that when defenders of the other philosophical views attempt to avoid granting an accommodation to spurious objections based on discrimination, empirically mistaken beliefs, or other unjustified biases, they are implicitly committed to the reason-giving requirement. This article concludes that based on these considerations, a reason-giving position such as the reasonability view possesses a decisive advantage in this debate.

Card RF. The Inevitability of Assessing Reasons in Debates about Conscientious Objection in Medicine. Cambridge Quarterly of Healthcare Ethics. 2017 Jan; 26(1): 82-96. DOI: https://doi.org/10.1017/S0963180116000669.

Reasons, reasonability and establishing conscientious objector status in medicine

Robert F. Card

Card RF. Reasons, reasonability and establishing conscientious objector status in medicine. J Med Ethics doi:10.1136/medethics-2016-103792

In defence of medical tribunals and the reasonability standard for conscientious objection in medicine

Robert F Card

Extract
Cowley has recently objected to the idea of using a medical tribunal to make determinations regarding conscientious objections and has criticised using reasonability as a standard for any such tribunal. . . . I argue that Cowley’s discussion sells the idea of medical tribunals short and illustrates serious misunderstandings regarding how the reasonability standard should be deployed in practice.

Card RF. In defence of medical tribunals and the reasonability standard for conscientious objection in medicine. J Med Ethics 2016 Feb;42(2):73-5. doi: 10.1136/medethics-2015-103037

Emergency Contraception, Institutional Conscience, and Pharmacy Practice

Robert F CarD, Carl G Williams

Abstract
“Emergency contraception” case law from the state of Washington is reviewed and analyzed. Important legal, social policy, and professional ethical questions are considered with focus on professional and institutional conscientious objection to participating in this therapy.

Card RF, Williams CG. Emergency Contraception, Institutional Conscience, and Pharmacy Practice. J Pharm Pract 2014 Apr;27(2):174-7. doi: 10.1177/0897190013515710

Conscientious objection by Muslim students startling

Michelle McLean

Extract
I read Robert Card’s recent paper entitled ‘Is there no alternative? Conscientious objection by medical students’ with great interest.1 That Muslim students in America are able to conscientiously object (and this was entertained) to the cross-gender consultation is somewhat startling. I have just left the Middle East, where I worked as a medical educator for five-and-a-half years (2006–2011), and, to the best of my knowledge, even in the conservative, gender-segregated traditional Muslim culture of the United Arab Emirates, not once did a male or female student refuse to examine a patient of the opposite sex.

Mclean M. Conscientious objection by Muslim students startling. J Med Ethics November 2013 Vol. 39 No. 11