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(Book Review) Religious Exemptions

Jacqueline Lang

Kevin Vallier and Michael Weber (eds). Religious Exemptions. New York, NY: Oxford University Press, 2018, 328 pp. ISBN: 9780190666187

Extract
An exemption from legal requirements is a right to be excluded from specific law that, to all intents and purposes, have general application. A religious exemption broadly, is an exemption on religious or conscientious grounds. Of course, an exemption can function in any positive legal framework and at any time. . . .

Religious Exemptions, edited by Kevin Vallier and Michael Weber, contains fourteen chapters by authors analysing the concept of a religious exemption in the context of recent accretions in contemporary American positive law. The text explores a variety of issues, including vaccine refusal, commercial accommodations, exemption from equality of the sexes, same-sex marriage and trial proceedings. . . .In modem times, the laws newly introduced incur significant harm to whole sections of the community. A Muslim or Christian objector to same-sex marriage, for example, might never find employment in his field because he is automatically classified as guilty of hate and unlawful discrimination. . .

Lang J. Book Review: Religious exemptions. New Bioethics 2019 Sep; 25(3): 290-292, DOI:10.1080/20502877.2019.1649867

(Book Review) The Conscience Wars: Rethinking the Balance between Religion, Identity, and Equality

Christopher Cowley

Susanna Mancini and Michel Rosenfeld (eds). The Conscience Wars: Rethinking the Balance between Religion, Identity, and Equality. Cambridge: Cambridge University Press, 2018, pp. 493. ISBN: 978-1107173309

Extract
This volume is based on a conference held at the Cardozo School of Law in ew York in 2015, and brings together American and European law academics to discuss the distinctive ways in which conscience claims have ‘spread’ in the public discourse over the last two or three decades. Conscientious objection used to be an individual matter for e.g. draftees and doctors, aimed at recusing oneself from complicity with evil, in contrast to civil disobedience, which was a larger collective movement aimed at changing public opinion and the law. These days, however, conscience seems to be in the news much more, mostly associated with organized religious conservative agendas – hence the title’s reference to a ‘war’ playing out in parallel to the efforts in and around a country’s legislature. Perhaps the most famous recent case of mobilized public conscience was that of the US Supreme Court case of Burwell u Hobby Lobby (2014), in which the owners of a company successfully challenged the legal requirement (under the 2010 Affordable Care Act) that the company fund contraception for its female employees. The owners’ objection was religious, and was framed in terms of their right to religious expression. . .

Cowley C. Book Review: The Conscience Wars; Rethinking the Balance between Religion, Identity, and Equality. New Bioethics. 2019 Sep; 25(3): 286-289, DOI:10.1080/20502877.2019.1647039

(Book Review) Opting Out: Conscience and Cooperation in a Pluralistic Society

Morten Magelssen

David Oderberg. Opting Out: Conscience and Cooperation in a Pluralistic Society. London: The Institute of Economic Affairs, 2018, pp. 136. ISBN:978-0-255-36761-5.

Extract
In this brief monograph, the philosopher David Oderberg argues that freedom of conscience and religion, as fundamental rights in a liberal democracy, need increased protection in legislation and from the courts. Conscientious objection – in which a professional refuses to perform specific tasks for moral or religious reasons – is especially relevant in healthcare. Oderberg draws most of his examples from this field (e.g. abortion, contraception, treatment-limiting decisions and euthanasia), but also discusses cases from other sectors, such as the bakers and florists who refused to sell goods in connection with gay weddings. . .

Magelssen M. Book Review: Opting Out. Conscience and Cooperation in a Pluralistic Society. New Bioethics 2019 Sep; 25(3): 283-286, DOI:10.1080/20502877.2019.1647038.

Medical Acts and Conscientious Objection: What Can a Physician be Compelled to Do?

Nathan K. Gamble, Michal Pruski

Abstract
A key question has been underexplored in the literature on conscientious objection: if a physician is required to perform ‘medical activities,’ what is a medical activity? This paper explores the question by employing a teleological evaluation of medicine and examining the analogy of military conscripts, commonly cited in the conscientious objection debate. It argues that physicians (and other healthcare professionals) can only be expected to perform and support medical acts – acts directed towards their patients’ health. That is, physicians cannot be forced to provide or support services that are not medical in nature, even if such activities support other socially desirable pursuits. This does not necessarily mean that medical professionals cannot or should not provide non-medical services, but only that they are under no obligation to provide them.

Gamble NK, Pruski M. Medical Acts and Conscientious Objection: What Can a Physician be Compelled to Do? New Bioethics 2019 Sep; 25(3): 262-282. DOI:10.1080/20502877.2019.1649871

Conscientious Objection and Clinical Judgement: The Right to Refuse to Harm

Toni C. Saad

Abstract
This paper argues that healthcare aims at the good of health, that this pursuit of the good necessitates conscience, and that conscience is required in every practical judgement, including clinical judgment. Conscientious objection in healthcare is usually restricted to a handful of controversial ends (e.g. abortion, euthanasia, contraception), yet the necessity of conscience in all clinical judgements implies the possibility of conscientious objection to means. The distinction between conscientious objection to means and ends is explored and its implications considered. Based on this, it is suggested that conscientious objection, whether to means or ends, occurs when a proposed course of action comes into irreconcilable conflict with the moral principle ‘do no harm’. It is, therefore, concluded that conscientious objection in healthcare can be conceived as a requirement of the moral imperative to do no harm, the right to refuse to harm in regard to health.

Saad TC. Conscientious Objection and Clinical Judgement: The Right to Refuse to Harm. New Bioethics. 2019 Sep; 25(3): 248-261 DOI:10.1080/20502877.2019.1649863

Selective Conscientious Objection in Healthcare

Christopher Cowley

Abstract
Most discussions of conscientious objection in healthcare assume that the objection is universal: a doctor objects to all abortions. I want to investigate selective objections, where a doctor objects to one abortion but not to another, depending on the circumstances. I consider not only objections to abortion, but also objections to the withdrawal of life-saving treatment at the request of a competent patient, which is almost always selective. I explore how the objector might articulate the selective objection, and what impact it might have on the patient, within the conceptual space of relevant statutes and professional guidelines.

Cowley C. Selective Conscientious Objection in Healthcare. New Bioethics 2019 Sep; 25(3): 236-247, DOI:10.1080/20502877.2019.1649861.

Is conscientious objection incompatible with healthcare professionalism?

Mary Neal, Sara Fovargue

Abstract
Is conscientious objection (CO) necessarily incompatible with the role and duties of a healthcare professional? An influential minority of writers on the subject think that it is. Here, we outline the positive case for accommodating CO and examine one particular type of incompatibility claim, namely that CO is fundamentally incompatible with proper healthcare professionalism because the attitude of the conscientious objector exists in opposition to the disposition (attitudes and underlying character) that we should expect from a ‘good’ healthcare professional. We ask first whether this claim is true in principle: what is the disposition of a ‘good’ healthcare professional, and how does CO align with or contradict it? Then, we consider practical compatibility, acknowledging the need to identify appropriate limits on the exercise of CO and considering what those limits might be. We conclude that CO is not fundamentally incompatible – either in principle or in practice – with good healthcare professionalism.

Neal M, Fovargue S. Is conscientious objection incompatible with healthcare professionalism? New Bioethics 2019 Sep; 25(3): 221-235, DOI:10.1080/20502877.2019.1651935.

How special is medical conscience?

David S. Oderberg

Abstract
The vigorous legal and ethical debates over conscientious objection have taken place largely within the domain of health care. Is this because conscience in medicine is of a special kind, or are there other reasons why it tends to dominate these debates? Beginning with an analysis of the analogy between medical conscience and conscientious objection in wartime, I go on to examine various possible grounds for distinguishing between medicine and other professional contexts (taking law and accountancy as examples). The conclusion is that no principled difference exists between the military and medical cases, nor between the health professions and other professions. Nevertheless, there are practical reasons why medical conscience has distinctive importance, mainly concerning the rapid advance of medical technology. Medical conscience will, for these reasons, continue to drive the debate over conscientious objection, even though legal protection should in principle extend to all professions.

Oderberg DS. How Special is medical conscience? New Bioethics. 2019 Sep; 25(3): 207-220, DOI:10.1080/20502877.2019.1651078.

Guest editorial re: conscience in health care

Special edition of The New Bioethics

Mary Neal, Sara Fovargue & Stephen W. Smith

Extract
It is probably fair to say that academic interest in the role of conscience in healthcare (and specifically, in the phenomenon of conscientious objection (CO)) has never been more intense, as evidenced by the volume of articles (and indeed, special issues) devoted to the topic in recent years. The three of us have contributed to this burgeoning literature, writing separately and together.

This special issue of The New Bioethics marks the mid-point of a project devised and co-managed by us and funded by the Royal Society of Edinburgh’s Research Networks scheme: the Accommodating Conscience Research Network (ACoRN). Our aim in developing this multidisciplinary network (including academics from arange of disciplines, practitioners, and representatives of professional bodies) is to carve out intellectual space within which to begin exploring conscience/CO inhealthcare from a broadly supportive perspective. Our sense, as participants in academic debates about conscience, is that although the literature contains many rich insights and fascinating discussions, some of the most interesting questions about conscience are being overshadowed by the loudest and most polarized disagreement over whether there is any legitimate role for CO in healthcare at all. This is despite the fact that it seems to us that most contributors adopt positions that are hospitableto the accommodation of CO, at least to some extent and in some circumstances. . . [Full text]

Neal M, Fovargue S, Smith SW. Guest editorial. The New Bioethics. 2019 Sep;25(3): 203-206, DOI:10.1080/20502877.2019.1659485.

Questionable benefits and unavoidable personal beliefs: defending conscientious objection for abortion

Bruce Philip Blackshaw, Daniel Rodger

Abstract
Conscientious objection in healthcare has come under heavy criticism on two grounds recently, particularly regarding abortion provision. First, critics claim conscientious objection involves a refusal to provide a legal and beneficial procedure requested by a patient, denying them access to healthcare. Second, they argue the exercise of conscientious objection is based on unverifiable personal beliefs. These characteristics, it is claimed, disqualify conscientious objection in healthcare. Here, we defend conscientious objection in the context of abortion provision. We show that abortion has a dubitable claim to be medically beneficial, is rarely clinically indicated, and that conscientious objections should be accepted in these circumstances. We also show that reliance on personal beliefs is difficult to avoid if any form of objection is to be permitted, even if it is based on criteria such as the principles and values of the profession or the scope of professional practice.

Blackshaw BP, Rodger D. Questionable benefits and unavoidable personal beliefs: defending conscientious objection for abortion. J Medical Ethics 2019 Aug 31. pii: medethics-2019-105566. doi: 10.1136/medethics-2019-105566. [Epub ahead of print]