Robert F Card Archives - Page 2 of 3 - Protection of Conscience Project Library

Is there no alternative? Conscientious objection by medical students

Robert F. Card

Abstract
Recent survey data gathered from British medical students reveal widespread acceptance of conscientious objection in medicine, despite the existence of strict policies in the UK that discourage conscientious refusals by students to aspects of their medical training. This disconnect demonstrates a pressing need to thoughtfully examine policies that allow conscience objections by medical students; as it so happens, the USA is one country that has examples of such policies. After presenting some background on promulgated US conscience protections and reflecting on their significance for conscience objections by medical students, this paper observes that the dominant approach (following the American Medical Association’s conscience clause) is to allow exempted students to instead be evaluated on the basis of alternative curricular activities to learn the associated underlying content. This paper then introduces and discusses an example in which male Muslim students who believe it is wrong to touch members of the opposite sex object to performing physical examinations on female subjects in their medical training. This sort of case, it is argued, causes difficulty for a conscience clause that resolves the dilemma by granting reasonable exemptions in the form of participation in alternative curricular activities: there are cases where one must perform the ‘objectionable’ activity itself in order to learn the necessary content and underlying principles.

Card RF. Is there no alternative? Conscientious objection by medical students. Med Ethics doi:10.1136/medethics-2011-100190

Conscientious Objection, Emergency Contraception, and Public Policy

Robert F Card

Abstract
Defenders of medical professionals’ rights to conscientious objection (CO) regarding emergency contraception (EC) draw an analogy to CO in the military. Such professionals object to EC since it has the possibility of harming zygotic life, yet if we accept this analogy and utilize jurisprudence to frame the associated public policy, those who refuse to dispense EC would not have their objection honored. Legal precedent holds that one must consistently object to all forms of the relevant activity. In the case at hand, then, I argue that these professionals must also oppose morally innocuous practices that may prevent pregnancy after fertilization. These results reveal that such objectors cannot offer a plausible and consistent objection to harming zygotic life. Additionally, there are good reasons to reject the analogy itself. In either case, these findings call into question the case supporting refusals of EC based on scruples.

Card RF. Conscientious Objection, Emergency Contraception, and Public Policy. J Med Phil. 2011;36(1):53-68.

Federal provider conscience regulation: Unconscionable

Robert F Card

Abstract
This paper argues that the provider conscience regulation recently put into place in the USA is misguided. The rule is too broad in the scope of protection it affords, and its conception of what constitutes assistance in the performance of an objectionable procedure reveals that it is unworkable in practice. Furthermore, the regulation wrongly treats refusal of other reproductive services as on a par with conscientious objection to participation in abortion. Finally, the rule allows providers to refuse even to discuss “objectionable” options with patients and serves to protect discriminatory refusals of medical care. For all of these reasons, this regulation is unwise.

Card RF. Federal provider conscience regulation: Unconscionable. J Med Ethics. 2009;35(8):471-472.

Response to Commentators on “Conscientious Objection and Emergency Contraception”: Sex, Drugs and the Rocky Role of Levonorgestrel

Robert F Card

Extract
I thank the thoughtful commentators on my essay. Their contributions have deepened my grasp of the relevant issues. Unfortunately I cannot discuss each selection in turn, but will instead focus on several commentaries that purport to offer the most serious objections to my argument. . . I was inspired to write this article in order to examine some possible moral justifications for conscientious objection with respect to EC, given that objecting providers seemed to be under no obligation to even state their reasons for refusal. To the extent that this paper spurs further elaboration and evaluation of these reasons, I will consider it a success. (Responds to Farr Curlin, Carson Strong).

Card RF. Response to Commentators on “Conscientious Objection and Emergency Contraception”: Sex, Drugs and the Rocky Role of Levonorgestrel. Am J Bioeth. 2007;7(10):W4-W6.

Reasons and Healthcare Professionals’ Claims of Conscience (Conscientious Objection and Emergency Contraception)

Mark R Wicclair

Extract
Robert Card (2007) argues against even a limited conscience based right to refuse to dispense emergency contraception (EC) on the grounds that there are no “reasonable or justified” reasons to support such claims of conscience. This line of argument raises an important question: To what extent is it appropriate to assess reasons in relation to healthcare professionals’ claims of conscience?

Wicclair MR. Reasons and Healthcare Professionals’ Claims of Conscience (Conscientious Objection and Emergency Contraception). Am J Bioeth. 2007;7(6):21-22.

Conscientious Objection the Morning After (Conscientious Objection and Emergency Contraception)

Carson Strong

Extract
In summary, Card supports his view with weak arguments, makes an erroneous assumption about the state of scientific inquiry, and misrepresents the argument of his opponents. When these various errors are brought to light, it becomes clear that Card has not successfully defended his extreme view. . . . Everyone accepts that conscientious refusal conflicts with the patient’s interests. The question is whether this particular type of failure to meet the patient’s interests can ever be ethically justifiable. Simply pointing out that there is a conflict does not constitute an argument. If a limited right to conscientious refusal is consistent with being a professional, then professional organizations that acknowledge such a right are not acting contrary to the purposes and roles of such organizations. What is needed to support de Melo-Martin’s position is an argument that conscientious refusals never, or at least hardly ever, override a patient’s interests, and de Melo-Martin does not provide this.

Strong C. Conscientious Objection the Morning After (Conscientious Objection and Emergency Contraception). Am J Bioethcs. 2007;7(6):32-34.

Caution: Conscience is the Limb on Which Medical Ethics Sits (Conscientious Objection and Emergency Contraception)

Farr A Curlin

Extract
Card (2007) does not merely claim that practitioners are obligated to provide EC; he argues that they are obligated to do so even if they have a conscientious objection. This last clause may seem harmless on the surface, but a closer look reveals that it effectively saws off the limb on which the first clause and all medical ethics sit. . . . A genuine conscientious objection, even if misinformed, is an expression of a commitment to acting morally, and . . . judgments of conscience need not be informed by explicitly religious ideas. Moreover, all ethical arguments are appeals to conscience. As such, acting conscientiously is the most fundamental of all moral obligations.

Curlin FA. Caution: Conscience is the Limb on Which Medical Ethics Sits (Conscientious Objection and Emergency Contraception). Am J Bioeth. 2007;7(6):30-31.

Pharmacists and the Social Contract (Conscientious Objection and Emergency Contraception)

Kenneth A Richman

Extract
. . .pharmacists in the news who claim that emergency contraception causes abortion are acting impermissibly by basing their conscientious objection on false claims. . . My main point here, however, is drawn from a familiar concept of political philosophy — the idea of a social contract. . . Pharmacists benefit from a monopoly on the right to dispense prescription medications. This monopoly, like those offered to public utilities, comes with responsibilities that go beyond the usual duties of professionalism. Pharmacists have a duty to conform to the system which has invested in them and in which they have a vested interest. . .Card (2007) argues that the prima facie right to conscientious objection is defeated by the facts of this particular case. Applying the argument of the Crito to the role of pharmacists in the United States leads us to conclude that this prima facie right is defeated for the pharmacist in the professional role in all cases. What remains are the right to work for change and the right to opt out of the professional role entirely.

Richman KA. Pharmacists and the Social Contract. Am J Bioethics 2007 Jun 01, 7:6,15-16,DOI: 10.1080/15265160701347247

Gatekeeping and Personal Values: Misuses of Professional Roles (Conscientious Objection and Emergency Contraception)

D Micah Hester, Toby Schonfeld, Jean Amoura

Extract
. . .pharmacists and physicians who deny EC to women misuse their role as gatekeepers. This is because EC is safer than many over-the-counter (OTC) medications; therefore, its distribution does not require providers to exercise a particular skill or apply special knowledge. As a result,healthcare providers may appropriately act as advisors to women seeking EC, but may not use their role as gatekeepers as away of imposing their values on the women in their care. . . physicians and pharmacists who bar women from access to EC do so without professional cause. They misuse their role as gatekeeper, imposing personal values where professional ones should prevail.

Hester DM, Schonfeld T, Amoura J. Gatekeeping and Personal Values: Misuses of Professional Roles (Conscientious Objection and Emergency Contraception). Am J Med Ethics. 2007 Jun;7(6):27-8. doi: 10.1080/15265160701347361

Conscientious Objection? Yes, but make sure it’s genuine. (Conscientious Objection and Emergency Contraception)

Christopher Meyers, Robert D Woods

Extract
In our earlier essay (Meyers and Woods 1996, 118–119), and in alignment with Card’s (2007) analogy, we recommended a system similar to that used for exemption from military service, one that incorporates a review board for evaluating claims of genuine conscientious objection. Because different groups have different means for communicating that a belief is profoundly held, the review board should be structured to represent a diversity of racial, ethnic and religious beliefs and academic training. Furthermore, to reduce the potential power asymmetry between the review board and petitioners, it should also include a range of disciplines—medicine, nursing, mental health, social services, chaplaincy—and representatives from the community.

Meyers C, Woods RD. Conscientious Objection? Yes, but make sure it’s genuine. (Conscientious Objection and Emergency Contraception). Am J Bioeth. 2007;7(6):. Available from: