This paper makes two main claims: first, that the need to protect health professionals' moral integrity is what grounds the right to conscientious objection in health care; and second, that for a given claim of conscientious objection to be acceptable to society, a certain set of criteria should be fulfilled. The importance of moral integrity for individuals and society, including its special role in health care, is advocated. Criteria for evaluating the acceptability of claims to conscientious objection are outlined. The (...) precise content of the criteria is dictated by the two main interests that are at stake in the dilemma of conscientious objection: the patient's interests and the health professional's moral integrity. Alternative criteria proposed by other authors are challenged. The bold claim is made that conscientious objection should be recognised by society as acceptable whenever the five main criteria of the proposed set are met. (shrink)

This new edition of Will Kymlicka's best selling critical introduction to contemporary political theory has been fully revised to include many of the most significant developments in Anglo-American political philosophy in the last eleven years, particularly the new debates over issues of democratic citizenship and cultural pluralism. The book now includes two new chapters on citizenship theory and multiculturalism, in addition to updated chapters on utilitarianism, liberal egalitarianism, libertarianism, socialism, communitarianism, and feminism. The many thinkers discussed include G. A. Cohen, (...) Ronald Dworkin, William Galston, Carol Gilligan, R. M. Hare, Chandran Kukathas, Catherine Mackinnon, David Miller, Philippe Van Parijs, Susan Okin, Robert Nozick, John Rawls, John Roemer, Michael Sandel, Charles Taylor, Michael Walzer, and Iris Young. Extended guides to further reading have been added at the end of each chapter, listing the most important books and articles on each school of thought, as well as relevant journals and websites. Covering some of the most advanced contemporary thinking, Will Kymlicka writes in an engaging, accessible, and non-technical way to ensure that the book is suitable for students approaching these difficult concepts for the first time. This second edition promises to build on the original edition's success as a key text in the teaching of modern political theory. (shrink)

In this classic text, Kant sets out to articulate and defend the Categorical Imperative - the fundamental principle that underlies moral reasoning - and to lay the foundation for a comprehensive account of justice and human virtues. This new edition and translation of Kant's work is designed especially for students. An extensive and comprehensive introduction explains the central concepts of Groundwork and looks at Kant's main lines of argument. Detailed notes aim to clarify Kant's thoughts and to correct some common (...) misunderstandings of his doctrines. (shrink)

Immanuel Kant's Groundwork of the Metaphysics of Morals ranks alongside Plato's Republic and Aristotle's Nicomachean Ethics as one of the most profound and influential works in moral philosophy ever written. In Kant's own words its aim is to search for and establish the supreme principle of morality, the categorical imperative. Kant argues that every human being is an end in himself or herself, never to be used as a means by others, and that moral obligation is an expression of the (...) human capacity for autonomy or self-government. This edition presents the acclaimed translation of the text by Mary Gregor, together with an introduction by Christine M. Korsgaard that examines and explains Kant's argument. (shrink)

In this book Taylor brings together some of his best essays, including "Overcoming Epistemology," "The Validity of Transcendental Argument," "Irreducibly Social ...

The literature on conscience in medicine has paid little attention to what is meant by the word ‘conscience.’ This article distinguishes between retrospective and prospective conscience, distinguishes synderesis from conscience, and argues against intuitionist views of conscience. Conscience is defined as having two interrelated parts: (1) a commitment to morality itself; to acting and choosing morally according to the best of one’s ability, and (2) the activity of judging that an act one has done or about which one is deliberating (...) would violate that commitment. Tolerance is defined as mutual respect for conscience. A set of boundary conditions for justifiable respect for conscientious objection in medicine is proposed. (shrink)

Jocelyn Maclure and Charles Taylor provide a clearly reasoned, articulate account of the two main principles of secularism—equal respect, and freedom of conscience—and argue that in our religiously diverse, politically interconnected world, secularism, properly understood, may offer the only path to religious and philosophical freedom.

A number of health care professionals assert a right to be exempt from performing some actions currently designated as part of their standard professional responsibilities. Most advocates claim that they should be excused from these duties simply by averring that they are conscientiously opposed to performing them. They believe that they need not explain or justify their decisions to anyone; nor should they suffer any undesirable consequences of such refusal. Those who claim this right err by blurring or conflating three (...) issues about the nature and role of conscience, and its significance in determining what other people should permit them to do (or not do). Many who criticize those asserting an exemption conflate the same questions and blur the same distinctions, if not expressly, by failing to acknowledge that sometimes a morally serious agent should not do what she might otherwise be expected to do. Neither side seems to acknowledge that in some cases both claims are true: a conscientious professional should not do her professional duty AND others need not permit or excuse her refusal. I identify these conflations and specify conditions in which a professional might reasonably refuse to do what she is required to do. Then I identify conditions in which the public should exempt a professional from some of her responsibilities. I argue that professionals should refuse far less often than most advocates do . . . and that they should be even less frequently exempt for that failure. Finally, there are compelling reasons why we could not implement a consistent moral policy giving advocates what they want, likely not even in qualified form. (shrink)

In a recent Bioethics editorial, Udo Schuklenk argues against allowing Canadian doctors to conscientiously object to any new euthanasia procedures approved by Parliament. In this he follows Julian Savulescu's 2006 BMJ paper which argued for the removal of the conscientious objection clause in the 1967 UK Abortion Act. Both authors advance powerful arguments based on the need for uniformity of service and on analogies with reprehensible kinds of personal exemption. In this article I want to defend the practice of conscientious (...) objection in publicly-funded healthcare systems, at least in the area of abortion and end-of-life care, without entering either of the substantive moral debates about the permissibility of either. My main claim is that Schuklenk and Savulescu have misunderstood the special nature of medicine, and have misunderstood the motivations of the conscientious objectors. However, I acknowledge Schuklenk's point about differential access to lawful services in remote rural areas, and I argue that the health service should expend more to protect conscientious objection while ensuring universal access. (shrink)

All major western countries today contain groups that differ in their religious beliefs, customary practices or ideas about the right way in which to live. How should public policy respond to this diversity? In this important new work, Brian Barry challenges the currently orthodox answer and develops a powerful restatement of an egalitarian liberalism for the twenty-first century. Until recently it was assumed without much question that cultural diversity could best be accommodated by leaving cultural minorities free to associate in (...) pursuit of their distinctive ends within the limits imposed by a common framework of laws. This solution is rejected by an influential school of political theorists, among whom some of the best known are William Galston, Will Kymlicka, Bhikhu Parekh, Charles Taylor and Iris Marion Young. According to them, this 'difference-blind' conception of liberal equality fails to deliver either liberty or equal treatment. In its place, they propose that the state should 'recognize' group identities, by granting groups exemptions from certain laws, publicly 'affirming' their value, and by providing them with special privileges or subsidies. In Culture and Equality, Barry offers an incisive critique of these arguments and suggests that theorists of multiculturism tend to misdiagnose the problems of minority groups. Often, these are not rooted in culture, and multiculturalist policies may actually stand in the way of universalistic measures that would be genuinely beneficial. (shrink)

We describe a number of conscientious objection cases in a liberal Western democracy. These cases strongly suggest that the typical conscientious objector does not object to unreasonable, controversial professional services—involving torture, for instance—but to the provision of professional services that are both uncontroversially legal and that patients are entitled to receive. We analyse the conflict between these patients' access rights and the conscientious objection accommodation demanded by monopoly providers of such healthcare services. It is implausible that professionals who voluntarily join (...) a profession should be endowed with a legal claim not to provide services that are within the scope of the profession's practice and that society expects them to provide. We discuss common counterarguments to this view and reject all of them. (shrink)

Defending Life is arguably the most comprehensive defense of the pro-life position on abortion - morally, legally, and politically - that has ever been published in an academic monograph. It offers a detailed and critical analysis of Roe v. Wade and Planned Parenthood v. Casey as well as arguments by those who defend a Rawlsian case for abortion-choice, such as J. J. Thomson. The author defends the substance view of persons as the view with the most explanatory power. The substance (...) view entails that the unborn is a subject of moral rights from conception. While defending this view, the author responds to the arguments of thinkers such as Boonin, Dworkin, Stretton, Ford and Brody. He also critiques Thomson's famous violinist argument and its revisions by Boonin and McDonagh. Defending Life includes chapters critiquing arguments found in popular politics and the controversy over cloning and stem cell research. (shrink)

Historically associated with military service, conscientious objection has become a significant phenomenon in health care. Mark Wicclair offers a comprehensive ethical analysis of conscientious objection in three representative health care professions: medicine, nursing and pharmacy. He critically examines two extreme positions: the 'incompatibility thesis', that it is contrary to the professional obligations of practitioners to refuse provision of any service within the scope of their professional competence; and 'conscience absolutism', that they should be exempted from performing any action contrary to (...) their conscience. He argues for a compromise approach that accommodates conscience-based refusals within the limits of specified ethical constraints. He also explores conscientious objection by students in each of the three professions, discusses conscience protection legislation and conscience-based refusals by pharmacies and hospitals, and analyzes several cases. His book is a valuable resource for scholars, professionals, trainees, students, and anyone interested in this increasingly important aspect of health care. (shrink)

Conscientious objection in health care is a form of compromise whereby health care practitioners can refuse to take part in safe, legal, and beneficial medical procedures to which they have a moral opposition (for instance abortion). Arguments in defense of conscientious objection in medicine are usually based on the value of respect for the moral integrity of practitioners. I will show that philosophical arguments in defense of conscientious objection based on respect for such moral integrity are extremely weak and, if (...) taken seriously, lead to consequences that we would not (and should not) accept. I then propose that the best philosophical argument that defenders of conscientious objection in medicine can consistently deploy is one that appeals to (some form of) either moral relativism or subjectivism. I suggest that, unless either moral relativism or subjectivism is a valid theory—which is exactly what many defenders of conscientious objection (as well as many others) do not think—the role of moral integrity and conscientious objection in health care should be significantly downplayed and left out of the range of ethically relevant considerations. (shrink)

Richard Sorabji presents a unique discussion of the development of moral conscience over a period of 2500 years, from the playwrights of the fifth century BCE to the present. He addresses key topics including the original meaning and continuing nature of conscience, the ideas of freedom of religion and conscience with climaxes in the early Christian centuries and the seventeenth, the disputes on absolution or 'terrorisation' of conscience, dilemmas of conscience, and moral double-bind, the reliability of conscience if it is (...) shaped by local custom, and modern opposition to the idea of conscience and its role in legislation. (shrink)

In a thought-provoking paper, Schuklenk and Smalling argue that no right to conscientious objection should be granted to medical professionals. First, they hold that it is impossible to assess either the truth of conscience-based claims or the sincerity of the objectors. Second, even a fettered right to conscientious refusal inevitably has adverse effects on the rights of patients. We argue that the main problem with their position is that it is not derived from a broader reflection on the meaning and (...) implications of freedom of conscience and reasonable accommodation. We point out that they collapse two related but distinct questions, that is, the subjective conception of freedom of conscience and the sincerity test. We note that they do not successfully show that the standard norm according to which exemption claims should not impose undue hardship on others is unworkable. We suggest that the main reason why arguments such as no one is forced to be a medical professional are flawed is that public norms should not constrain citizens to choose between two of their basic rights unless it is necessary. In fine, Schuklenk and Smalling, who see conscience claims as arbitrary dislikes, sell freedom of conscience short and forego any attempts at balancing the competing rights involved. We maintain the authors neglect that most of legal reasoning is contextual and that the blanket restriction of healthcare professionals' freedom of conscience is disproportionate. (shrink)

All major western countries today contain groups that differ in their religious beliefs, customary practices or ideas about the right way in which to live. How should public policy respond to this diversity? In this important new work, Brian Barry challenges the currently orthodox answer and develops a powerful restatement of an egalitarian liberalism for the twenty-first century. Until recently it was assumed without much question that cultural diversity could best be accommodated by leaving cultural minorities free to associate in (...) pursuit of their distinctive ends within the limits imposed by a common framework of laws. This solution is rejected by an influential school of political theorists, among whom some of the best known are William Galston, Will Kymlicka, Bhikhu Parekh, Charles Taylor and Iris Marion Young. According to them, this 'difference-blind' conception of liberal equality fails to deliver either liberty or equal treatment. In its place, they propose that the state should 'recognize' group identities, by granting groups exemptions from certain laws, publicly 'affirming' their value, and by providing them with special privileges or subsidies. In Culture and Equality, Barry offers an incisive critique of these arguments and suggests that theorists of multiculturism tend to misdiagnose the problems of minority groups. Often, these are not rooted in culture, and multiculturalist policies may actually stand in the way of universalistic measures that would be genuinely beneficial. (shrink)

:Complicity in an immoral, and even criminal, activity, such as robbery or murder, is itself regarded as involving responsibility for those acts. What should the position be of health professionals who are expected to participate in actions that they believe are morally wrong? Professional responsibilities may clash with private conscience. Even referring a patient to someone else, when what is in question may be assisted suicide, or euthanasia, seems to involve some complicity. This is a live issue in Canada, but (...) similar dilemmas occur elsewhere. Physicians and others should not be coerced into involvement of any kind in what they regard as wrong. Such coercion goes against the very principles of liberal democracy. Conscience matters. Reasonable accommodation should be given to those whose moral judgment may be at variance with prevailing professional norms. Moral questions should still be given weight within medicine, and disagreements respected. Dedication to the promotion of human welfare should be paramount, but it should be recognized that there may be different visions of what such welfare consists of. (shrink)

Against arguments that suggest that Rawls’s notion of reasonability is ‘obscure’ and ‘unclear’ I argue in this essay that the idea of reasonability in the later Rawls can be defended in three ways. First, it can be shown that reasonability is fundamental to the architectonic of the later work. Reasonability, and the subordination of reason to reasonability, is fundamental to the later (post-1980) writings. Second, it can be shown that reasonability is not necessarily a vague term as many have claimed. (...) Third, it can be shown that reasonability is fundamental to what Rawls calls the three major new ideas of Political Liberalism: overlapping consensus; the reconception of the priority of the right over the good; and the idea of public reason. (shrink)

ABSTRACT In a recent (2015) Bioethics editorial, Udo Schuklenk argues against allowing Canadian doctors to conscientiously object to any new euthanasia procedures approved by Parliament. In this he follows Julian Savulescu's 2006 BMJ paper which argued for the removal of the conscientious objection clause in the 1967 UK Abortion Act. Both authors advance powerful arguments based on the need for uniformity of service and on analogies with reprehensible kinds of personal exemption. In this article I want to defend the practice (...) of conscientious objection in publicly‐funded healthcare systems (such as those of Canada and the UK), at least in the area of abortion and end‐of‐life care, without entering either of the substantive moral debates about the permissibility of either. My main claim is that Schuklenk and Savulescu have misunderstood the special nature of medicine, and have misunderstood the motivations of the conscientious objectors. However, I acknowledge Schuklenk's point about differential access to lawful services in remote rural areas, and I argue that the health service should expend more to protect conscientious objection while ensuring universal access. (shrink)

This paper builds upon previous work in which I argue that we should assess a provider's reasons for his or her objection before granting a conscientious exemption. For instance, if the medical professional's reasoned basis involves an empirical mistake, an accommodation is not warranted. This article poses and begins to address several deep questions about the workings of what I call a reason-giving view: What standard should we use to assess reasons? What policy should we adopt in order to evaluate (...) the reasons offered by medical practitioners in support of their objections? I argue for a reasonability standard to perform the essential function of assessing reasons, and I offer considerations in support of a policy establishing conscientious objector status in medicine. (shrink)