: Managed care organizations can produce conflicts of obligation and conflicts of interest that may lead to problems of conscience for health care professionals. This paper provides a basis for understanding the notions of conscience and conscientious objection and offers a framework for clinicians to stake out positions grounded in personal conscience as a way for them to respond to unacceptable pressures from managers to limit services.

Three pictures of integrity have gained philosophical currency. On the integrated self picture, integrity involves the integration of "parts" of oneself into a whole. On the identity picture, integrity means fidelity to projects and principles constitutive of one's core identity. On the clean hands picture, integrity means maintaining the purity of one's agency, especially in dirty hands situations. I sketch each picture and suggest two general criticisms. First, integrity is reduced to something else with which it is not equivalent--to the (...) conditions of unified agency, to the conditions for continuing as the same self, and to the conditions for having reason to refuse cooperating with evil. Second, integrity is understood as a personal, but not also a social virtue; this limits the analysis of what integrity is and why it is a virtue. In the last section, I suggest a way of understanding integrity as the social virtue of standing before others for what, in one's best judgment, is worth persons' doing. (shrink)

: This paper examines the obligations of pharmacy licensees and pharmacists in the context of conscience-based objections to filling lawful prescriptions for certain types of medications—e.g., standard and emergency contraceptives. Claims of conscience are analyzed as means to preserve or maintain an individual's moral integrity. It is argued that pharmacy licensees have an obligation to dispense prescription medications that satisfy the health needs of the populations they serve, and this obligation can override claims of conscience. Although efforts should be made (...) to respect the moral integrity of pharmacists and accommodate their claims of conscience, it is argued that the health needs of patients and the professional obligations of pharmacists limit the extent to which pharmacists may refuse to assist patients who have lawful prescriptions for medically indicated drugs. (shrink)