Answers to the questions of what justifies conscientious objection in medicine in general and which specific objections should be respected have proven to be elusive. In this paper, I develop a new framework for conscientious objection in medicine that is based on the idea that conscience can express true moral claims. I draw on one of the historical roots, found in Adam Smith’s impartial spectator account, of the idea that an agent’s conscience can determine the correct moral norms, even if (...) the agent’s society has endorsed different norms. In particular, I argue that when a medical professional is reasoning from the standpoint of an impartial spectator, his or her claims of conscience are true, or at least approximate moral truth to the greatest degree possible for creatures like us, and should thus be respected. In addition to providing a justification for conscientious objection in medicine by appealing to the potential truth of the objection, the account advances the debate regarding the integrity and toleration justifications for conscientious objection, since the standard of the impartial spectator specifies the boundaries of legitimate appeals to moral integrity and toleration. The impartial spectator also provides a standpoint of shared deliberation and public reasons, from which a conscientious objector can make their case in terms that other people who adopt this standpoint can and should accept, thus offering a standard fitting to liberal democracies. (shrink)

This paper comes out of a panel honoring the work of Anne Donchin (1940-2014), which took place at the 2016 Congress of the International Network on Feminist Approaches to Bioethics (FAB) in Edinburgh. My general aim is to highlight the contributions Anne made to feminist bioethics, and to feminist reproductive ethics in particular. My more specific aim, however, is to have a kind of conversation with Anne, through her work, about whether reproductive justice could demand insurance coverage for in vitro (...) fertilization. I quote liberally from Anne’s work for this purpose, but also to shower the reader with her words, reminding those of us who knew her well what a wonderful colleague she was. (shrink)

Though abortion is legal in Canada, policies currently in place at various levels of the health care system, and the individual actions of medical professionals, can inhibit access to abortion. This paper examines the various extra-legal barriers to abortion access that exist in Canada, and argues that these barriers are unjust because there are no good reasons for the restrictions on autonomy that they present. The paper then outlines the various policy measures that could be taken to improve access.

In Kimberly Brownlee’s book, Conscience and Conviction, she argues that Thomas More’s paradigmatic ‘personal objection’ successfully meets the 4 conditions of her ‘Communicative Principle’. In this article I want to challenge Brownlee’s ‘universality’ condition and the ‘dialogical’ condition by focusing on a counter-example of a British GP conscientiously objecting to authorizing an abortion. I argue that such an objection can be morally admirable, even though the GP is not politically active, even though she is not open-minded to the possibility that (...) she might be wrong, and even if she refuses to condemn her non-objecting colleagues. I suggest that this particular counter-example can tell us more general things about the nature of ethical disagreement and ethical incomprehension. (shrink)

Some contributions to the current literature on conscience objection in healthcare posit the notion that the requirement to refer patients to a non-objecting provider is a morally questionable undertaking in need of explanation. The issue is that providing a referral renders those who conscientiously object to being involved in a particular intervention complicit in its provision. This essay seeks to engage with such claims and argues that referrals can be construed in terms of what Harman calls morally permissible moral mistakes. (...) I go on to suggest that one might frame the (in)actions of those who exercise the right of non-participation generated by the claim to conscientiously object in similar terms; they can also be considered morally permissible moral mistakes. Finally, and given that the arguments already advanced involve simultaneously looking at the same issue from competing ethical perspectives, I offer some brief remarks that support viewing conscientious objection as an ethicopolitical device. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Proof and Persuasion in the Philosophical Debate about AbortionChris KaposyPhilosophers involved in debating the abortion issue often assume that the arguments they provide can offer decisive resolution.1 Arguments on the prolife side of the debate, for example, usually imply that it is rationally mandatory to view the fetus as having a right to life, or full moral standing.2 Such an account assumes that philosophical argument can compel the reader (...) to see the fetus in a certain way and that dissent risks irrationality.I wish to question this image of the use of philosophical argument in the abortion debate. I focus on the question of fetal moral standing, which is one of the subproblems in the debate. I am especially concerned with prolife arguments for fetal moral standing, since the prolife side must argue for a position that is compulsory. The prochoice side, in contrast, typically holds that people are entitled to believe what they want about the fetus’s moral standing.My position is that philosophical arguments should be understood as tools for persuasion in the abortion debate rather than as a method for discovering decisive proofs about the morality of abortion. I argue that because any one position on the moral standing of fetuses cannot be established decisively, law and policy should favour the prochoice position. In support of these conclusions, I present two common argumentative strategies used to suggest that the prolife view of the fetus is rationally [End Page 139] mandatory, and I illustrate why arguments involving these strategies do not compel us to view the fetus as having full moral standing.Framing the IssueIn order to show that abortion is wrong (in cases in which it is considered wrong), one must first establish that fetuses have full moral standing.3 It is a serious moral wrong to take the life of someone with full moral standing—this is part of what it means to have this status. The possessor of full moral standing is entitled to have his or her life protected. If abortion is wrong, then the fetus must have full moral standing, because without such standing, killing a fetus could be justified by the pregnant woman’s strong interest in ending an unwanted pregnancy. Those arguing against the moral permissibility of abortion must show that it is mandatory (in some way) to view the fetus as having full moral standing. There are a range of positions one could take with regard to the fetus’s status, from viewing the fetus as an incipient organism with no moral standing to seeing the fetus as gaining moral standing as the pregnancy progresses. But if it is mandatory to view the fetus as having full moral standing, all other positions must then be mistaken, incorrect, or somehow unjustified.This paper analyzes why philosophers opposed to abortion think it is mandatory to attribute full moral standing to fetuses. There are two popular argumentative strategies offering different accounts of the source of this obligation. The first strategy suggests that fetal full moral standing derives from morally relevant facts about the fetus. According to this line of argument, we are rationally obligated to view the fetus as having full moral standing because we cannot deny (without courting irrationality) that there are properties, characteristics, or attributes of the fetus that entitle it to this status.The second strategy is to claim that the fetus has full moral standing because this position is most consistent with our intuitions in cases unrelated to abortion. Philosophers taking this approach are fond of analogies comparing fetuses to comatose adults or to people at the end of life, for example. This strategy of appealing to your interlocutor’s sense of consistency I call the “shared-value” strategy.The two strategies map very well onto the distinction some have made between argumentum ad rem and argumentum ad hominem. The philosopher of rhetoric Henry Johnstone Jr. draws this distinction in very clear terms, and others in the history of philosophy make note of the difference [End Page 140] between these two types of arguments as well.4 The appeal to the facts (or argumentum ad rem) seeks to establish the truth of its... (shrink)

An analogy is sometimes drawn between the proper treatment of conscientious objectors in healthcare and in military contexts. In this paper, I consider an aspect of this analogy that has not, to my knowledge, been considered in debates about conscientious objection in healthcare. In the USA and elsewhere, tribunals have been tasked with the responsibility of recommending particular forms of alternative service for conscientious objectors. Military conscripts who have a conscientious objection to active military service, and whose objections are deemed (...) acceptable, are required either to serve the military in a non-combat role, or assigned some form of community service that does not contribute to the effectiveness of the military. I argue that consideration of the role that military tribunals have played in determining the appropriate form of alternative service for conscripts who are conscientious objectors can help us to understand how conscientious objectors in healthcare ought to be treated. Additionally, I show that it helps us to address the vexed issue of whether or not conscientious objectors who refuse to provide a service requested by a patient should be required to refer that patient to another healthcare professional. (shrink)