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0 - Page 4 of 4 - Protection of Conscience Project Library
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Conscientious non-objection in intensive care

Dominic Wilkinson

Cambridge Quarterly of Healthcare Ethics
Cambridge Quarterly of Healthcare Ethics

Abstract
Discussions of conscientious objection (CO) in healthcare often concentrate on objections to interventions that relate to reproduction, such as termination of pregnancy or contraception. Nevertheless, questions of conscience can arise in other areas of medicine. For example, the intensive care unit is a locus of ethically complex and contested decisions. Ethical debate about CO usually concentrates on the issue of whether physicians should be permitted to object to particular courses of treatment; whether CO should be accommodated. In this article, I focus on the question of how clinicians ought to act: should they provide or support a course of action that is contrary to their deeply held moral beliefs? I discuss two secular examples of potential CO in intensive care, and propose that clinicians should adopt a norm of conscientious non-objection (CNO). In the face of divergent values and practice, physicians should set aside their personal moral beliefs and not object to treatment that is legally and professionally accepted and provided by their peers. Although there may be reason to permit conscientious objections in healthcare, conscientious non-objection should be encouraged, taught, and supported.


Wilkinson D. Conscientious non-objection in intensive care. Camb. Q. Healthc. Ethics. 2017;26(1):132-142.

How to Allow Conscientious Objection in Medicine While Protecting Patient Rights

Aaron Ancell, Walter Sinnott-Armstrong

Cambridge Quarterly of Healthcare Ethics
Cambridge Quarterly of Healthcare Ethics

Abstract
Paradigmatic cases of conscientious objection in medicine are those in which a physician refuses to provide a medical service or good because doing so would conflict with that physician’s personal moral or religious beliefs. Should such refusals be allowed in medicine? We argue that (1) many conscientious objections to providing certain services must be allowed because they fall within the range of freedom that physicians have to determine which services to offer in their practices; (2) at least some conscientious objections to serving particular groups of patients should be allowed because they are not invidiously discriminatory; and (3) even in cases of invidiously discriminatory conscientious objections, legally prohibiting individual physicians from refusing to serve patients on the basis of such objections is not always the best solution.


Ancell A, Sinnott-Armstrong W. How to Allow Conscientious Objection in Medicine While Protecting Patient Rights. Camb Q Healthc Ethics. 2017 Jan;26(1):120-131.

The cost of conscience: Kant on Conscience and Conscientious Objection

Jeanette Kennett

Cambridge Quarterly of Healthcare Ethics
Cambridge Quarterly of Healthcare Ethics

Abstract
The spread of demands by physicians and allied health professionals for accommodation of their private ethical, usually religiously based, objections to providing care of a particular type, or to a particular class of persons, suggests the need for a re-evaluation of conscientious objection in healthcare and how it should be regulated. I argue on Kantian grounds that respect for conscience and protection of freedom of conscience is consistent with fairly stringent limitations and regulations governing refusal of service in healthcare settings. Respect for conscience does not entail that refusal of service should be cost free to the objector. I suggest that conscientious objection in medicine should be conceptualized and treated analogously to civil disobedience.


Kennett J. The cost of conscience: Kant on Conscience and Conscientious Objection. Cam Quart Healthcare Ethics 2017 Jan;26(1):69-81.

The Legal Ethical Backbone of Conscientious Refusal

Christian Munthe, Morten Ebbe Juul Nielsen

Cambridge Quarterly of Healthcare Ethics
Cambridge Quarterly of Healthcare Ethics

Abstract
This article analyzes the idea of a legal right to conscientious refusal for healthcare professionals from a basic legal ethical standpoint, using refusal to perform tasks related to legal abortion (in cases of voluntary employment) as a case in point. The idea of a legal right to conscientious refusal is distinguished from ideas regarding moral rights or reasons related to conscientious refusal, and none of the latter are found to support the notion of a legal right. Reasons for allowing some sort of room for conscientious refusal for healthcare professionals based on the importance of cultural identity and the fostering of a critical atmosphere might provide some support, if no countervailing factors apply. One such factor is that a legal right to healthcare professionals’ conscientious refusal must comply with basic legal ethical tenets regarding the rule of law and equal treatment, and this requirement is found to create serious problems for those wishing to defend the idea under consideration. We conclude that the notion of a legal right to conscientious refusal for any profession is either fundamentally incompatible with elementary legal ethical requirements, or implausible because it undermines the functioning of a related professional sector (healthcare) or even of society as a whole.


Munthe C, Nielsen MEJ. The Legal Ethical Backbone of Conscientious Refusal. Cambridge Quarterly of Healthcare Ethics. Cambridge Quarterly of Healthcare Ethics. 2017 Jan; 26(1): 59-68. doi:10.1017/S0963180116000645

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

Robert F. Card

Cambridge Quarterly of Healthcare Ethics
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. Cambridge Quarterly of Healthcare Ethics. 2017 Jan; 26(1): 82-96. DOI: https://doi.org/10.1017/S0963180116000669.