Adjudicating rights or analyzing interests: ethicists’ role in the debate over conscience in clinical practice

Armand H Matheny Antommaria

Theoretical Medicine and Bioethics
Theoretical Medicine and Bioethics

Abstract
The analysis of a dispute can focus on either interests, rights, or power. Commentators often frame the conflict over conscience in clinical practice as a dispute between a patient’s right to legally available medical treatment and a clinician’s right to refuse to provide interventions the clinician finds morally objectionable. Multiple sources of unresolvable moral disagreement make resolution in these terms unlikely. One should instead focus on the parties’ interests and the different ways in which the health care delivery system can accommodate them. In the specific case of pharmacists refusing to dispense emergency contraception, alternative systems such as advanced prescription, pharmacist provision, and over-the-counter sales may better reconcile the client’s interest in preventing unintended pregnancy and the pharmacist’s interest in not contravening his or her conscience. Within such an analysis, the ethicist’s role becomes identifying and clarifying the parties’ morally relevant interests.


Antommaria AHM. Adjudicating rights or analyzing interests: ethicists’ role in the debate over conscience in clinical practice. Theor Med Bioeth. 2008;29(3):201-212.

“Who Should Survive?: One of the Choices on Our Conscience”: Mental Retardation and the History of Contemporary Bioethics

Armand H Matheny Antommaria

Kennedy Institute of Ethics Journal
Kennedy Institute of Ethics Journal

Abstract
The film “Who Should Survive?: One of the Choices on Our Conscience” contains a dramatization of the death of an infant with Down syndrome as the result of the parents’ decision not to have a congenital intestinal obstruction surgically corrected. The dramatization was based on two similar cases at The Johns Hopkins Hospital and was financed by the Joseph P. Kennedy, Jr., Foundation. When “Who Should Survive?” was exhibited in 1971, the public reaction was generally critical of the parents’ decision and the physicians’ inaction. Although technological developments in medicine were a necessary condition for the production of this film and its unanticipated reception, they were not a sufficient condition. The proximate cause was a changed understanding of the capabilities of individuals with Down syndrome. Part of the impetus for this change was data showing the adverse effects of institutionalization on normal children.


Antommaria AHM. “Who Should Survive?: One of the Choices on Our Conscience”: Mental Retardation and the History of Contemporary Bioethics. Kennedy Inst Ethics J. 2006;16(3):205-224.