Some medical services have long generated deep moral controversy within the medical profession as well as in broader society and have led to conscientious refusals by some physicians to provide those services to their patients. More recently, pharmacists in a number of states have refused on grounds of conscience to fill legal prescriptions for their customers. This paper assesses these controversies. First, I offer a brief account of the basis and limits of the claim to be free to act on (...) one’s conscience. Second, I sketch an account of the basis of the medical and pharmacy professions’ responsibilities and the process by which they are specified and change over time. Third, I then set out and defend what I call the “conventional compromise” as a reasonable accommodation to conflicts between these professions’ responsibilities and the moral integrity of their individual members. Finally, I take up and reject the complicity objection to the conventional compromise. Put together, this provides my answer to the question posed in the title of my paper: “Conscientious refusal by physicians and pharmacists: who is obligated to do what, and why?”. (shrink)

This chapter contains sections titled: The Nature of Women's Disadvantage and Oppression The Source of Women's Disadvantage and Oppression Achieving Gender Justice.

Freedom of conscience is a core element of human rights respected by most European countries. It allows abortion through the inclusion of a conscience clause, which permits opting out of providing such services. However, the grounds for invoking conscientious objection lack clarity. Our aim in this paper is to take a step in this direction by carrying out a systematic review of reasons by midwives and nurses for declining, on conscience grounds, to participate in abortion. We conducted a systematic review (...) of ethical arguments asking, “What reasons have been reported in the argument based literature for or against conscientious objection to abortion provision by nurses or midwives?” We particularly wanted to identify any discussion of the responsibilities of midwives and nurses in this area. Search terms were conscientious objection and abortion or termination and nurse or midwife or midwives or physicians or doctors or medics within the dates 2000–2016 on: HEIN legal, Medline, CINAHL, Psychinfo, Academic Search Complete, Web of Science including publications in English, German and Dutch. Final articles were subjected to a rigorous analysis, coding and classifying each line into reason mentions, narrow and broad reasons for or against conscientious objection. Of an initial 1085 articles, 10 were included. We identified 23 broad reasons, containing 116narrow reasons and 269 reason mentions. Eighty one narrow reasons argued in favour of and 35 against conscientious objection. Using predetermined categories of moral, practical, religious or legal reasons, “moral reasons” contained the largest number of narrow reasons. The reasons and their associated mentions in this category outnumber those in the sum of the other three categories. We identified no absolute argument either for or against conscientious objection by midwives or nurses. An invisibility of midwives and nurses exists in the whole debate concerning conscientious objection reflecting a gap between literature and practice, as it is they whom WHO recommend as providers of this service. While the arguments in the literature emphasize the need for provision of conscientious objection, a balanced debate is necessary in this field, which includes all relevant health professionals. (shrink)

Hermeneutic research in nursing: developing a Gadamerian‐based research method This paper takes the stance that although there are many different approaches to phenomenological and hermeneutic research, some of these have become blurred due to multiple interpretations of translated materials. Working from original texts by the German philosophers, this paper reconsiders the relevance of phenomenology and hermeneutics to nursing research. We trace the development of Gadamer's philosophy in order to propose a research method based in this tradition. Five steps have been (...) identified as a guide for nurse researchers. These are deciding upon a question, identification of preunderstandings, gaining understanding through dialogue with participants, gaining understanding through dialogue with text and establishing trustworthiness. (shrink)

Until recently, Northern Ireland was infamous for having one of the most restrictive legal frameworks for abortion in Europe. This meant that few were performed in the country, and those who wished to terminate a pregnancy were forced to travel to other parts of the UK or further afield. In 2019 a continuing political stalemate in Northern Ireland has indirectly resulted in the relevant legislation recently being repealed by the UK government. For a short time, this meant that the legal (...) position in Northern Ireland regarding abortion became one of the most permissive in Europe. This short paper sets out the current position and, in the light of the political and legislative roadmap set out by the Northern Ireland Office, identifies and briefly discusses some potential problems that might arise. Most notable are the points raised with regard to conscientious objection. Specifically, the potential for developments in Northern Ireland to further calls for healthcare professional’s ability to rely upon conscientious objection to be removed. (shrink)

Many professional associations have policies explaining when it is or is not acceptable for health-care professionals to refuse to participate in the administration of certain interventions on grounds of conscience. In both Canada and the United States, nursing associations tend to have much more detailed, permissive policies than medical associations. There are reasons to think that this distinction is not justifiable, and I argue that some specific North American medical associations should endorse policies regarding conscientious refusals that are modeled on (...) those endorsed by nursing associations and the United Kingdom’s General Medical Council. (shrink)

A recent focus of the debate on conscientious objection in healthcare is the question of whether practitioners should have to justify their refusal to perform certain functions. A recent article by Cowley addresses a practical aspect of this controversy, namely the question of whether doctors claiming conscientious objector status in relation to abortion should be required, like their counterparts claiming exemption from military conscription, to defend their claim before a tribunal. Cowley argues against the use of tribunals in the medical (...) case, on the grounds that there are likely to be fewer unjustified claims to conscientious objection in this context than in the military, and that in any case tribunals will not be an effective way of distinguishing genuine and false cases. I reject these arguments and propose a different conception of the role of a medical conscientious objection tribunal. (shrink)

Conscientious objection in the health care field—that is, refusal on the part of a medical professional to perform or cooperate in a procedure when it violates his or her conscience—is a growing concern for international legislators and a source of contentious debates among ethicists and the general public. Recognizing a general right to conscientious objection based on individual liberty, and thus a subjective right, could have negative consequences. Conscientious objection in health care settings should be fully protected, however, when the (...) objection is based on principles that are fundamental to the medical profession and the legal system. Examples from Italy and other nations show how protections there safeguard conscientious objection when a health professional objects to taking a human life. National Catholic Bioethics Quarterly 12.4 (Winter 2012): 611–620. (shrink)

Although some healthcare professionals have the legal right to conscientiously object to authorise or perform certain lawful medical services, they have an associated duty to provide the patient with enough information to seek out another professional willing to authorise or provide the service (the ‘duty to refer’). Does the duty to refer morally undermine the professional's conscientious objection (CO)? I narrow my discussion to the National Health Service in Britain, and the case of a general practitioner (GP) being asked by (...) a pregnant woman to authorise an abortion. I will be careful not to enter the debate about whether abortion should be legalised, or the debate about whether CO should be permitted—I will take both as given. I defend the objecting GP's duty to refer against those I call the ‘conscience absolutists’, who would claim that if a state is serious enough in permitting the GP's objection in the first place (as is the UK), then it has to recognise the right to withhold any information about abortion. (shrink)