Farr A Curlin Archives - Page 3 of 4 - Protection of Conscience Project Library

Religion, conscience and clinical decisions

John D Lantos, Farr A Curlin

Extract
However, as long as medicine is practiced in a pluralistic democracy where some people find moral guidance in religions and others do not, situations will arise in which two paediatricians, both acting deliberately and conscientiously, will choose different responses to a given clinical decision. The policy challenge becomes one of specifying the situations for which conscience claims ought to be tolerated. . . For situations in which disagreement is consistent with good medical practice, practitioners must be free to follow the dictates of conscience. The risks of disallowing conscientious practice to the profession are greater than that of allowing grounded and well-articulated zones of moral pluralism.

Lantos JD, Curlin FA. Religion, conscience and clinical decisions. Acta Paediatrica. 2008;97(3):265-266.

The Moral Significance of Claims of Conscience in Healthcare (Conscience in Medicine)

Mark R Wicclair

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.

Wicclair MR. The Moral Significance of Claims of Conscience in Healthcare (Conscience in Medicine). Am J Bioeth. 2007;7(1):30-31.

The Tao of Conscience: Conflict and Resolution (Conscience in Medicine)

Linda MacDonald Glenn, Jeanann Boyce

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.

Glenn LM, Boyce J. The Tao of Conscience: Conflict and Resolution (Conscience in Medicine). Am J Bioeth. 2007;7(12):33.

The physician’s conscience (Conscience in Medicine)

Hugh LaFollette

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.

LaFollette H. The physician’s conscience (Conscience in Medicine). Am J Bioeth. 2007;7(12):15-17.

The Role of Moral Complicity in Issues of Conscience (Conscience in Medicine)

Robert D Orr

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.

Orr RD. The Role of Moral Complicity in Issues of Conscience (Conscience in Medicine). Am J Bioeth. 2007;7(12).

Clash of definitions: Controversies about conscience in medicine (Conscience in Medicine)

Ryan E Lawrence, Farr A Curlin

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.

Lawrence RE, Curlin FA. Clash of definitions: Controversies about conscience in medicine (Conscience in Medicine). Am J Bioeth. 2007;7(12):10-14.

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.

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.

(Correspondence) Religion, Conscience and Controversial Clinical Practices

Nada L Stotland

New England Journal of Medicine, NEJM — New England Journal of Medicine

Extract
It is unrealistic and unfair to expect patients to anticipate all conditions that may befall them, identify which ones might be problematic for their physicians, and agree either to reach a compromise or to seek care elsewhere.

Stotland NL. (Correspondence) Religion, Conscience and Controversial Clinical Practices. N Engl J Med.. 2007;356(18):1889-1890.

(Correspondence) Religion, Conscience and Controversial Clinical Practices (Authors respond)

Farr A Curlin, Ryan E Lawrence, John D Lantos

Extract
Those who act conscientiously do not “disavow responsibility” and “substitute their personal values for the fundamental rights of their patients.” Rather, they are engaging in the struggle to know and do the right thing and to understand and fulfill their moral obligations in a particular situation. This task cannot be externalized or delegated. Indeed, acting conscientiously is the heart of the ethical life, and to the extent that physicians give it up, they are no longer acting as moral agents.

Curlin FA, Lawrence RE, Lantos JD. (Correspondence) Religion, Conscience and Controversial Clinical Practices (Authors respond). N. Engl. J. Med.. 2007;356(18):1891-1892.