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  1. Three Arguments Against Institutional Conscientious Objection, and Why They Are (Metaphysically) Unconvincing.Xavier Symons & Reginald Mary Chua - 2024 - Journal of Medicine and Philosophy 49 (3):298-312.
    The past decade has seen a burgeoning of scholarly interest in conscientious objection in healthcare. While the literature to date has focused primarily on individual healthcare practitioners who object to participation in morally controversial procedures, in this article we consider a different albeit related issue, namely, whether publicly funded healthcare institutions should be required to provide morally controversial services such as abortions, emergency contraception, voluntary sterilizations, and voluntary euthanasia. Substantive debates about institutional responsibility have remained largely at the level of (...)
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  • Assessing Public Reason Approaches to Conscientious Objection in Healthcare.Doug McConnell - forthcoming - Cambridge Quarterly of Healthcare Ethics:1-11.
    Sometimes healthcare professionals conscientiously refuse to treat patients despite the patient requesting legal, medically indicated treatments within the professionals’ remit. Recently, there has been a proliferation of views using the concept of public reason to specify which conscientious refusals of treatment should be accommodated. Four such views are critically assessed, namely, those of Robert Card, Massimo Reichlin, David Scott, and Doug McConnell. This paper argues that McConnell’s view has advantages over the other approaches because it combines the requirement that healthcare (...)
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  • Preventing conscientious objection in medicine from running amok: a defense of reasonable accommodation.Mark R. Wicclair - 2019 - Theoretical Medicine and Bioethics 40 (6):539-564.
    A US Department of Health and Human Services Final Rule, Protecting Statutory Conscience Rights in Health Care, and a proposed bill in the British House of Lords, the Conscientious Objection Bill, may well warrant a concern that—to borrow a phrase Daniel Callahan applied to self-determination—conscientious objection in health care has “run amok.” Insofar as there are no significant constraints or limitations on accommodation, both rules endorse an approach that is aptly designated “conscience absolutism.” There are two common strategies to counter (...)
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  • Conscience Clauses and Ideological Bias.Mark Wicclair - 2021 - American Journal of Bioethics 21 (8):65-67.
    Conscience clauses typically protect health care providers who cannot in good conscience provide a legal, professionally accepted, and clinically appropriate medical service (negative appeals to co...
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  • Why Conscience Matters: A Theory of Conscience and Its Relevance to Conscientious Objection in Medicine.Xavier Symons - 2023 - Res Publica 29 (1):1-21.
    Conscience is an idea that has significant currency in liberal democratic societies. Yet contemporary moral philosophical scholarship on conscience is surprisingly sparse. This paper seeks to offer a rigorous philosophical account of the role of conscience in moral life with a view to informing debates about the ethics of conscientious objection in medicine. I argue that conscience is concerned with a commitment to moral integrity and that restrictions on freedom of conscience prevent agents from living a moral life. In section (...)
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  • Conscientious Objection in Health Care: Why the Professional Duty Argument is Unconvincing.Xavier Symons - 2022 - Journal of Medicine and Philosophy 47 (4):549-557.
    The past decade has seen a burgeoning of scholarly interest in conscientious objection in health care. Specifically, several commentators have discussed the implications that conscientious objection has for the delivery of timely, efficient, and nondiscriminatory medical care. In this paper, I discuss the main argument put forward by the most prominent critics of conscientious objection—what I call the Professional Duty Argument or PDA. According to proponents of PDA, doctors should place patients’ well-being and rights at the center of their professional (...)
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  • Conscience, tolerance, and pluralism in health care.Daniel P. Sulmasy - 2019 - Theoretical Medicine and Bioethics 40 (6):507-521.
    Increasingly, physicians are being asked to provide technical services that many believe are morally wrong or inconsistent with their beliefs about the meaning and purposes of medicine. This controversy has sparked persistent debate over whether practitioners should be permitted to decline participation in a variety of legal practices, most notably physician-assisted suicide and abortion. These debates have become heavily politicized, and some of the key words and phrases are being used without a clear understanding of their meaning. In this essay, (...)
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  • Religious Accommodation in Bioethics and the Practice of Medicine.William R. Smith & Robert Audi - 2021 - Journal of Medicine and Philosophy 46 (2):188-218.
    Debates about the ethics of health care and medical research in contemporary pluralistic democracies often arise partly from competing religious and secular values. Such disagreements raise challenges of balancing claims of religious liberty with claims to equal treatment in health care. This paper proposes several mid-level principles to help in framing sound policies for resolving such disputes. We develop and illustrate these principles, exploring their application to conscientious objection by religious providers and religious institutions, accommodation of religious priorities in biomedical (...)
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  • Conscience, conscientious objections, and medicine.Rosamond Rhodes - 2019 - Theoretical Medicine and Bioethics 40 (6):487-506.
    To inform the ongoing discussion of whether claims of conscientious objection allow medical professionals to refuse to perform tasks that would otherwise be their duty, this paper begins with a review of the philosophical literature that describes conscience as either a moral sense or the dictate of reason. Even though authors have starkly different views on what conscience is, advocates of both approaches agree that conscience should be obeyed and that keeping promises is a conscience-given moral imperative. The paper then (...)
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  • The Importance of Clear and Careful Thinking in Clinical Ethics.J. Clint Parker - 2021 - Journal of Medicine and Philosophy 46 (1):1-16.
    Clear and careful thinking is an indispensable aid in the pursuit of answers to the difficult ethical question faced by clinicians, patients, and families. In this issue of The Journal of Medicine and Philosophy devoted to issues in clinical ethics, the authors engage in this enterprise by reflecting on morally good medical decision making, conscientious objection, presumed consent in organ donation, the permissibility of surrogate decision making, and the failure of legislative limits on the scope of euthanasia in Belgium.
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  • Religion, Authenticity, and Clinical Ethics Consultation.J. Clint Parker - 2019 - HEC Forum 31 (2):103-117.
    A clinical ethics consultant may, at times, be called upon to make independent substantive moral judgments and then offer justifications for those judgments. A CEC does not act unprofessionally by utilizing background beliefs that are religious in nature to justify those judgments. It is important, however, for a CEC to make such judgments authentically and, when asked, to offer up one’s reasons for why one believes the judgment is true in a transparent fashion.
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  • Conscientious objection in healthcare: How much discretionary space best supports good medicine?Doug McConnell - 2018 - Bioethics 33 (1):154-161.
    Daniel Sulmasy has recently argued that good medicine depends on physicians having a wide discretionary space in which they can act on their consciences. The only constraints Sulmasy believes we should place on physicians’ discretionary space are those defined by a form of tolerance he derives from Locke whereby people can publicly act in accordance with their personal religious and moral beliefs as long as their actions are not destructive to society. Sulmasy also claims that those who would reject physicians’ (...)
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  • Conscientious Objection in Health Care: Pinning down the Reasonability View.Doug McConnell - 2021 - Journal of Medicine and Philosophy 46 (1):37-57.
    Robert Card’s “Reasonability View” is a significant contribution to the debate over the place of conscientious objection in health care. In his view, conscientious objections can only be accommodated if the grounds for the objection meet a reasonability standard. I identify inconsistencies in Card’s description of the reasonability standard and argue that each version he specifies is unsatisfactory. The criteria for reasonability that Card sets out most frequently have no clear underpinning principle and are too permissive of immoral objections. Card (...)
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  • Internal morality of medicine and physician autonomy.Stephen McAndrew - 2019 - Journal of Medical Ethics 45 (3):198-203.
    Robert Veatch and others have questioned whether there are internal moral rules of medicine. This paper examines the legal regulatory model for governing professions as the autonomous exercise of professional skills and asks whether there is a theoretical basis for this model. Taking John Rawls’s distinction between the justification of a practice and justification of the rules internal to the practice, this paper argues that the autonomous exercise of professional skills is justified so long as it benefits society. In opposition (...)
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  • Conscientious Objection or an Internal Morality of Medicine?David Hershenov - 2021 - Christian Bioethics 27 (1):104-121.
    Doctors, nurses, and pharmacists who refuse on grounds of conscience to participate in certain legal, expected, and standard practices have been accused of unprofessionally introducing their personal views into medicine. My first response is that they often are not engaging in conscientious objection because that involves invoking convictions external to those of the medical community. I contend that medicine, properly construed, is pathocentric, and so refusing to induce a pathology via abortion, contraception, euthanasia, etc., is actually being loyal to the (...)
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  • Tensions Between Ethics and the Law: Examination of a Legal Case by Two Midwives Invoking a Conscientious Objection to Abortion in Scotland.Valerie Fleming, Lucy Frith & Beate Ramsayer - 2019 - HEC Forum 33 (3):1-25.
    This paper examines a legal case arising from a workplace grievance that progressed to being heard at the UK’s Supreme Court. The case of Doogan and Wood versus Greater Glasgow and Clyde Health Board concerned two senior midwives in Scotland, both practicing Roman Catholics, who exercised their perceived rights in accordance with section 4 of the Abortion Act not to participate in the treatment of women undergoing abortions. The key question raised by this case was: “Is Greater Glasgow and Clyde (...)
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  • Tensions Between Ethics and the Law: Examination of a Legal Case by Two Midwives Invoking a Conscientious Objection to Abortion in Scotland.Valerie Fleming, Lucy Frith & Beate Ramsayer - 2019 - HEC Forum 33 (3):189-213.
    This paper examines a legal case arising from a workplace grievance that progressed to being heard at the UK’s Supreme Court. The case of Doogan and Wood versus Greater Glasgow and Clyde Health Board concerned two senior midwives in Scotland, both practicing Roman Catholics, who exercised their perceived rights in accordance with section 4 of the Abortion Act not to participate in the treatment of women undergoing abortions. The key question raised by this case was: “Is Greater Glasgow and Clyde (...)
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  • Selecting Treatment Options and Choosing Between them: Delineating Patient and Professional Autonomy in Shared Decision-Making.Emma Cave - 2020 - Health Care Analysis 28 (1):4-24.
    Professional control in the selection of treatment options for patients is changing. In light of social and legal developments emphasising patient choice and autonomy, and restricting medical paternalism and judicial deference, this article examines how far patients and families can demand NHS treatment in England and Wales. It considers situations where the patient is an adult with capacity, an adult lacking capacity and a child. In all three cases, there is judicial support for professional autonomy, but there are also inconsistencies (...)
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  • Conscientious objection and person-centered care.Stephen Buetow & Natalie Gauld - 2018 - Theoretical Medicine and Bioethics 39 (2):143-155.
    Person-centered care offers a promising way to manage clinicians’ conscientious objection to providing services they consider morally wrong. Health care centered on persons, rather than patients, recognizes clinicians and patients on the same stratum. The moral interests of clinicians, as persons, thus warrant as much consideration as those of other persons, including patients. Interconnected moral interests of clinicians, patients, and society construct the clinician as a socially embedded and integrated self, transcending the simplistic duality of private conscience versus public role (...)
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  • Questionable benefits and unavoidable personal beliefs: defending conscientious objection for abortion.Bruce Philip Blackshaw & Daniel Rodger - 2020 - Journal of Medical Ethics 3 (46):178-182.
    Conscientious objection in healthcare has come under heavy criticism on two grounds recently, particularly regarding abortion provision. First, critics claim conscientious objection involves a refusal to provide a legal and beneficial procedure requested by a patient, denying them access to healthcare. Second, they argue the exercise of conscientious objection is based on unverifiable personal beliefs. These characteristics, it is claimed, disqualify conscientious objection in healthcare. Here, we defend conscientious objection in the context of abortion provision. We show that abortion has (...)
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  • The truth behind conscientious objection in medicine.Nir Ben-Moshe - 2019 - Journal of Medical Ethics 45 (6):404-410.
    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 (...)
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