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, (...) I endeavor, firstly, to clarify the meaning of some of these terms: conscience, conscientious action, professional judgment, conscientious objection, conscience clauses, civil disobedience, and tolerance. I argue that use of the term conscientious objection to describe these refusals by health care professionals is mistaken and confusing. Secondly, relying on a proper understanding of the moral and technical character of medical judgment, the optimal deference that the state and markets ought to have toward professions, and general principles of Lockean tolerance for a diversity of practices and persons in a flourishing, pluralistic, democratic society, I offer a defense of tolerance with respect to the deeply held convictions of physicians and other health care professionals who hold minority views on contested but legal medical practices. (shrink)

This book is a major work in the history of ethics, and provides the first study of early modern British philosophy in several decades. Professor Darwall discerns two distinct traditions feeding into the moral philosophy of the seventeenth and eighteenth centuries. On the one hand, there is the empirical, naturalist tradition, comprising Hobbes, Locke, Cumberland, Hutcheson, and Hume, which argues that obligation is the practical force that empirical discoveries acquire in the process of deliberation. On the other hand, there is (...) a group including Cudworth, Shaftesbury, Butler, and in some moments Locke, which views obligation as inconceivable without autonomy and which seeks to develop a theory of the will as self-determining. (shrink)

Ever since humankind raised its head toward the heavens in search of universal understanding and spiritual fulfilment, wars, pogroms, persecution, prejudice, and contempt have been the means of resolving the many and varied disagreements that have arisen over matters religious. In his Letter Concerning Toleration, Locke offers a compelling plea for freedom of conscience and religious expression. He outlines the limits of social and political incursion into the realm of personal belief or non-belief, discusses the dangers of mixing church and (...) state, and strikes hard at those who would use the power of the state to fulfil religious or political goals. Rational persuasion is always to be encouraged in the hope that wayward souls may find a moral direction in life, but the use of force in such matters is unwarranted and unacceptable. Locke also addresses the question of denominational infighting and relations among the major religions. Talk of heresy and schism should be set aside in favour of understanding and co-operation to achieve mutually desirable social ends. (shrink)

John Locke's subtle and influential defense of religious toleration as argued in his seminal _Letter Concerning Toleration_ appears in this edition as introduced by one of our most distinguished political theorists and historians of political thought.

v. 1. Essays on ethics by the Earl of Shaftesbury, Frances Hutcheson ; Samuel Butler ; Adam Smith ; Jeremy Bentham - v. 2. Essays by Samuel Clarke ; John Balguy ; Richard Price ; John Brown ; John Clarke ; Ralph Cudworth ; John Gay ; Thomas Hobbes ; Henry Home Kames ; John Locke ; John Mandeville ; William Paley ; William Wollaston.

At the center of medical morality is the healing relationship. It is defined by three phenomena: the fact of illness, the act of profession, and the act of medicine. The first puts the patient in a vulnerable and dependent position; it results in an unequal relationship. The second implies a promise to help. The third involves those actions that will lead to a medically competent healing decision. But it must also be good for the patient in the fullest possible sense. (...) The physician cannot fully heal without giving the patient an understanding of alternatives such that he or she can freely arrive—together with the physician—at a decision in keeping with his or her personal morality and values. In today's pluralistic society, universal agreement on moral issues between physicians and patients is no longer possible. Nevertheless, a reconstruction of professional ethics based on a new appreciation of what makes for a true healing relationship between patient and physician is both possible and necessary. (shrink)

This paper challenges the leading common morality accounts of medical ethics which hold that medical ethics is nothing but the ethics of everyday life applied to today’s high-tech medicine. Using illustrative examples, the paper shows that neither the Beauchamp and Childress four-principle account of medical ethics nor the Gertet al10-rule version is an adequate and appropriate guide for physicians’ actions. By demonstrating that medical ethics is distinctly different from the ethics of everyday life and cannot be derived from it, the (...) paper argues that medical professionals need a touchstone other than common morality for guiding their professional decisions. That conclusion implies that a new theory of medical ethics is needed to replace common morality as the standard for understanding how medical professionals should behave and what medical professionalism entails. En route to making this argument, the paper addresses fundamental issues that require clarification: what is a profession? how is a profession different from a role? how is medical ethics related to medical professionalism? The paper concludes with a preliminary sketch for a theory of medical ethics. (shrink)

First published in 2000. Routledge is an imprint of Taylor & Francis, an informa company.

The aim of this article is to show that there are two distinct ethical theories in the writings of Bishop Butler. This is something that his critics do not seem to have realized. One or two of them have seen that the Dissertation on Virtue contains ideas which do not harmonize very well with those of the Rolls Sermons , but no one has made a detailed study of the differences. It has been usual to dismiss them with the remark (...) that Butler is an inconsistent writer and we should not worry too much over details. (shrink)

We find our way in the world partly by means of the discriminatory power of our emotions. The gut sense that something is repugnant or unsavory—the sort of feeling that many now have about various forms of biotechnology—sometimes turns out to be rooted in articulable and legitimate objections, which with time can be spelled out, weighed, and either endorsed or dismissed. But we ought not dismiss the emotional response at the outset as “mere feeling.”.

Abstract:Arguments against physicians’ claims of a right to refuse to provide tests or treatments to patients based on conscientious objection often depend on two premises that are rarely made explicit. The first is that the protection of religious liberty (broadly construed) should be limited to freedom of worship, assembly, and belief. The second is that because professions are licensed by the state, any citizen who practices a licensed profession is required to provide all the goods and services determined by the (...) profession to fall within the scope of practice of that professional specialty and permitted by the state, regardless of any personal religious, philosophical, or moral objection. In this article, I argue that these premises ought to be rejected, and therefore the arguments that depend on them ought also to be rejected. The first premise is incompatible with Locke’s conception of tolerance, which recognizes that fundamental, self-identifying beliefs affect public as well as private acts and deserve a broad measure of tolerance. The second premise unduly (and unrealistically) narrows the discretionary space of professional practice to an extent that undermines the contributions professions ought to be permitted to make to the common good. Tolerance for conscientious objection in the public sphere of professional practice should not be unlimited, however, and the article proposes several commonsense, Lockean limits to tolerance for physician claims of conscientious objection. (shrink)

Catholic doctrine’s strict prohibition on abortion can lead clinicians or institutions to conscientiously refuse to provide abortion, although a legal duty to provide abortion would apply to anyone who refused. Conscientious refusals by clinicians to end a pregnancy can constitute murder or reckless homicide under American law if a woman dies as a result of such a refusal. Such refusals are not immunized from criminal liability by the constitutional right to the free exercise of religion or by statutes that confer (...) immunity from criminal homicide prosecution. Core principles of the rule of law require the state to protect the lives of all persons equally and to place the life and health of persons above any the interests of providers have in moral integrity or in respecting the moral status of prenatal humans. In some states criminal liability related to conscientious objection also applies to corporate hospital officials. (shrink)