Book Review: Opting Out. Conscience and Cooperation in a Pluralistic Society

Morten Magelssen

Book Review: Opting Out. Conscience and Cooperation in a Pluralistic Society

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]


Magelssen M.  Book Review: Opting Out. Conscience and Cooperation in a Pluralistic Society.  New Bioethics 2019 Sep; 25(3): 283-286, DOI:10.1080/20502877.2019.1647038.

How special is medical conscience?

David S. Oderberg

How special is medical conscience?

Abstract

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.


Oderberg DS.  How Special is medical conscience? New Bioethics. 2019 Sep; 25(3): 207-220, DOI:10.1080/20502877.2019.1651078.

Further clarity on cooperation and morality

David S. Oderberg

Journal of Medical Ethics

Abstract:  I explore the increasingly important issue of cooperation in immoral actions, particularly in connection with healthcare. Conscientious objection, especially as pertains to religious freedom in healthcare, has become a pressing issue in the light of the US Supreme Court judgement in Hobby Lobby. Section ‘Moral evaluation using the basic principles of cooperation’ outlines a theory of cooperation inspired by Catholic moral theologians such as those cited by the court. The theory has independent plausibility and is at least worthy of serious consideration—in part because it is an instance of double-effect reasoning, which is also independently plausible despite its association with moral theology. Section ‘Case study: Burwell v. Hobby Lobby’ examines Hobby Lobby in detail. Even if the judgement was correct in that case the reasoning was not, as it involved applying a ‘mere sincerity’ test to the cooperation question. The mere sincerity test leads to absurd consequences, whereas a reasonableness test applied using the theory of cooperation defended here would avoid absurdity. Section ‘A question of remoteness: “accommodations” and opt-outs’ explores the post-Hobby Lobby problem further, examining opt-outs and accommodations: the Little Sisters of the Poor case shows how opt-outs are misunderstood on a mere sincerity test, which the court rightly rejected. Section ‘Application to the medical field: Doogan and Wood’ discusses the UK case of Doogan and Wood, concerning participation in abortion. Again, a judicially recognised ethic of cooperation, if it were part of the fabric of legal reasoning in such cases, would have enabled the conscientious objectors in this and similar situations to have their freedom of conscience and religion respected in a way that it currently is not.

Oderberg DS, Further clarity on cooperation and morality.  J Med Ethics doi:10.1136/medethics-2016-103476