Abstract:Religious considerations and language do not typically belong in the professional advice rendered by a doctor to a patient. Among the rationales mounted by Greenblum and Hubbard in support of that conclusion is that religious considerations and language are incompatible with the role of doctors as public officials.1 Much as I agree with their conclusion, I take issue with this particular aspect of their analysis. It seems based on a mischaracterisation of what societal role doctors fulfil, qua doctors. What obliges doctors to communicate by means of content that is expressed in public reason-based language is not that they are public officials. Doctors as doctors are not necessarily public officials. Rather, doctors have such obligations, because they are professionals. Unlike public officials doctors are part of a profession that is to a significant extent self-governing. This holds true for all professions. The …
Responding to religious patients: why physicians have no business doing theology. Jake Greenblum Ryan K Hubbard Journal of Medical Ethics 2019; – Published Online First: 20 Jun 2019. doi: 10.1136/medethics-2019-105452
Abstract: This paper challenges the leading common morality accounts of medical ethics which hold that medical ethics is nothing but the ethics of everyday life applied to today’s high-tech medicine. Using illustrative examples, the paper shows that neither the Beauchamp and Childress four-principle account of medical ethics nor the Gert et al 10-rule version is an adequate and appropriate guide for physicians’ actions. By demonstrating that medical ethics is distinctly different from the ethics of everyday life and cannot be derived from it, the paper argues that medical professionals need a touchstone other than common morality for guiding their professional decisions. That conclusion implies that a new theory of medical ethics is needed to replace common morality as the standard for understanding how medical professionals should behave and what medical professionalism entails. En route to making this argument, the paper addresses fundamental issues that require clarification: what is a profession? how is a profession different from a role? how is medical ethics related to medical professionalism? The paper concludes with a preliminary sketch for a theory of medical ethics.
Rhodes R. Why not common morality? J Med Ethics 2019;0:1–8. Published Online First: 11 September 2019. doi: 10.1136/medethics-2019-105621
Edited by Kevin Vallier and Michael Weber, New York, NY, Oxford University Press, 2018, 328 pp., £61 (hardback), ISBN: 9780190666187
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. It can exist in Hitler’s Germany, Stalin’s Russia or any oppressive regime we care to consider. . .
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. Whereas, in the past, religious exemptions were limited in scope, governing such narrow subjects a pacifist exemptions against compulsory military service and certain small religious exemptions to education, now, large sectors of religious and conscientious objectors seek exemptions from an ever-burgeoning catalogue of state-mandated duties to participate in a wide range of contentious matters from abortion and euthanasia to same-sex marriage. 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. . .
Edited by Susanna Mancini and Michel Rosenfeld. Pp. 493. Cambridge: Cambridge University Press. 2018. £76. ISBN: 978-1107173309>
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. . .
By David Oderberg. Pp. 136. London: The Institute of Economic Affairs. 2018. Paperback, £12.50; free e-book, at https://iea.org.uk/wp-content/uploads/2018/08/Oderberg-Interactive.pdf. ISBN:978-0-255-36761-5.
Abstract: 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. . . [Full text]
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.
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.
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.
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.
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.