John Rawls Archives - Protection of Conscience Project Library

A New Theory of Conscientious Objection in Medicine: Justification and Reasonability

Robert F Card

Robert F. Card. A New Theory of Conscientious Objection in Medicine: Justification and Reasonability. New York & London: Routledge, 2020, 268 pp. ‎ ISBN-10:0367430819

Publisher Summary
This book argues that a conscientiously objecting medical professional should receive an exemption only if the grounds of an objector’s refusal are reasonable. It defends a detailed, contextual account of public reasonability suited for healthcare, which builds from the overarching concept of Rawlsian public reason.

The author analyzes the main competing positions and maintains that these other views fail precisely due to their systematic inattention to the grounding reasons behind a conscientious objection; he argues that any such view is plausible to the extent that it mimics the ‘reason-giving requirement’ for conscience objections defended in this work. Only reasonable objections can defeat the prior professional obligation to assign primacy to patient well-being, therefore one who refuses a patient’s request for a legally available, medically indicated, and safe service must be able to explain the grounds of their objection in terms understandable to other citizens within the public institutional structure of medicine. The book further offers a novel policy proposal to deploy the Reasonability View: establishing conscientious objector status in medicine. It concludes that the Reasonability View is a viable and attractive position in this debate.

A New Theory of Conscientious Objection in Medicine: Justification and Reasonability will be of interest to researchers and advanced students working in bioethics, medical ethics, and philosophy of medicine, as well as thinkers interested in the intersections between law, medical humanities, and philosophy.

Rawls, Reasonableness, and Conscientious Objection in Health Care

Xavier Symons

Abstract
Much ink has been spilled in recent years over the controversial topic of conscientious objection in health care. In particular, commentators have proposed various ways with which we might distinguish legitimate conscience claims from those that are poorly reasoned or based on prejudice. The aim of this chapter is to argue in favor of the “reasonableness” approach to conscientious objection, viz., the view that we should develop an account of “reasonableness” and “reasonable disagreement” and use this as a way of distinguishing licit and illicit conscience claims. The author discusses Rawls’ account of “reasonableness” and “reasonable disagreement,” and consider how this might guide us in regulating conscientious objection in health care. The author analyzes the “public reason” account offered in Card (2007, 2014), and argue that we should modify Card’s account to include a consensus among regulators about what counts as “basic medical care.” The author suggests that Medical Conscientious Objection Review boards should consider whether conscience-based refusals are based on defensible ethical foundations.

Symons X. Rawls, Reasonableness, and Conscientious Objection in Health Care. In: Grant B, Drew J, Christensen H, editors. Applied Ethics in the Fractured State (Research in Ethical Issues in Organizations, Vol. 20). Bingley, UK: Emerald Publishing Limited; 2018. p. 45-54. https://doi.org/10.1108/S1529-209620180000020004

On the Philosophical Foundations of Medical Ethics: Aristotle, Kant, JS Mill and Rawls

Raphael Cohen-Almagor

Abstract
This article aims to trace back some of the theoretical foundations of medical ethics that stem from the philosophies of Aristotle, Immanuel Kant, John Stuart Mill and John Rawls. The four philosophers had in mind rational and autonomous human beings who are able to decide their destiny, who pave for themselves the path for their own happiness. It is argued that their philosophies have influenced the field of medical ethics as they crafted some very important principles of the field. I discuss the concept of autonomy according to Kant and JS Mill, Kant’s concepts of dignity, benevolence and beneficence, Mill’s Harm Principle (nonmaleficence), the concept of justice according to Aristotle, Mill and Rawls, and Aristotle’s concept of responsibility..

Cohen-Almagor R. On the Philosophical Foundations of Medical Ethics: Aristotle, Kant, JS Mill and Rawls. Ethics Med Pub Health. 2017;3(4):436-444.

The right to die and the medical cartel

M Cholbi

Abstract
Advocates of a right to die increasingly assert that the right in question is a positive right (a right to assistance in dying) and that the right in question is held against physicians or the medical community. Physician organizations often reply that these claims to a positive right to die should be rejected on the grounds that medicine’s aims or “internal” norms preclude physicians from killing patients or assisting their patients in killing themselves. The aim of this article is to rebut this reply. Rather than casting doubt on whether assisted dying is consistent with medicine’s “internal” norms, I draw attention to the socioeconomic contexts in which contemporary medicine is practiced. Specifically, contemporary medicine typically functions as a public cartel, one implication of which is that physicians enjoy a monopoly on the most desirable life-ending technologies (fast acting lethal sedatives, etc). While there may be defensible public health reasons for medicine functioning as a cartel and having this monopoly on desirable life-ending technologies, Rawlsian contract-based reasoning illustrates that the status of medicine as a cartel cannot be reconciled with its denying the public access to supervised use of desirable life-ending technologies. The ability to die in ways that reflect one’s conception of the good is arguably a primary social good, a good that individuals have reasons to want, whatever else they may want. Individuals behind Rawls’ veil of ignorance, unaware of their health status, values, etc, will thus reason that they may well have a reasonable desire for the life-ending technologies the medical cartel currently monopolizes. They thus have reasons to endorse a positive right to physician assistance in dying. On the assumption that access to desirable life-ending technologies will be controlled by the medical community, a just society does not permit that community to deny patients access to these technologies by an appeal to medicine’s putative “internal” aims or norms. The most natural response to my Rawlsian argument is to suggest that it only shows that individuals have a positive right against the medical community to access life-ending technologies but not a right to access such technologies from individual physicians. Individual physicians could still refuse to provide such technologies as a matter of moral conscience. Such claims of conscience should be rejected, however. A first difficulty with this proposal is that it is in principle possible for a sufficiently large number of individuals within a profession to invoke claims of conscience so as to materially hinder individuals from exercising their positive right to die, as appears to be the case in several jurisdictions with respect to abortion and other reproductive health treatments. Second, unlike conscientious objectors to military service, physicians who conscientiously object to providing assistance in dying would not be subject to fundamental deprivations of rights if they refused to provide assistance. Physicians who deny patients access to these technologies use their monopoly position in the service of a kind of moral paternalism, hoarding a public resource with which they have been entrusted so as to promote their own conception of the good over that of their patients.

Cholbi M. The right to die and the medical cartel. Ethics Med Pub Health. 2015 Nov 19;1(4):486-493.

Rawls and religious paternalism

David M Shaw, Jacob Busch

Abstract
MacDougall has argued that Rawls’s liberal social theory suggests that parents who hold certain religious convictions can legitimately refuse blood transfusion on their children’s behalf. This paper argues that this is wrong for at least five reasons. First, MacDougall neglects the possibility that true freedom of conscience entails the right to choose one’s own religion rather than have it dictated by one’s parents. Second, he conveniently ignores the fact that children in such situations are much more likely to die than to survive without blood. Third, he relies on an ambiguous understanding of what is “rational” and treats children as mere extensions of their parents. Fourth, he neglects the fact that those in the original position would seek to protect themselves from persecution and enslavement and thus would not allow groups of children to be killed because of their parents’ beliefs. Finally, Rawls makes it clear that we should choose for children as we would choose for ourselves in the original position, with no particular conception of the good (such as that held by Jehovah’s Witnesses).

Shaw DM, Busch J. Rawls and religious paternalism. J Med Phil 2012 Aug;37(4):373-386.