The literature on conscientious objection in medicine presents two key problems that remain unresolved: Which conscientious objections in medicine are justified, if it is not feasible for individual medical practitioners to conclusively demonstrate the genuineness or reasonableness of their objections? How does one respect both medical practitioners’ claims of conscience and patients’ interests, without leaving practitioners complicit in perceived or actual wrongdoing? My aim in this paper is to offer a new framework for conscientious objections in (...) medicine, which, by bringing medical professionals’ conscientious objection into the public realm, solves the justification and complicity problems. In particular, I will argue that: an “Uber Conscientious Objection in Medicine Committee” —which includes representatives from the medical community and from other professions, as well as from various religions and from the patient population—should assess various well-known conscientious objections in medicine in terms of public reason and decide which conscientious objections should be permitted, without hearing out individual conscientious objectors; medical practitioners should advertise their conscientious objections, ahead of time, in an online database that would be easily accessible to the public, without being required, in most cases, to refer patients to non-objecting practitioners. (shrink)

A dogma accepted in many ethical, religious, and legal frameworks is that the reasons behind conscientious objection (CO) in healthcare cannot be evaluated or judged by any institution because conscience is individual and autonomous. This paper shows that this background view is mistaken: the requirement to reveal and explain the reasons for conscientious objection in healthcare is ethically justified and legally desirable. Referring to real healthcare cases and legal regulations, this paper argues that these reasons should (...) be evaluated either ex ante or ex post and defends novel conceptual claims that have not been analyzed in the debates on CO. First, a moral threshold requirement: CO is only justified if the reasons behind a refusal are of a moral nature and meet a certain threshold of moral importance. Second, this paper considers the rarely discussed conceptual similarities between CO in healthcare and the legal regulations concerning military refusals that place the burden of proof on conscientious objectors. This paper concludes that conscientious objection in healthcare can be accommodated only in some cases of destroying or killing human organisms. (shrink)

Patients in Quebec can legally obtain medical assistance in dying (MAID) if they are able to give informed consent, have a serious and incurable illness, are at the end of their lives and are in a situation of unbearable suffering. Since the Supreme Court of Canada’s 2015 Carter decision, access to MAID, under certain conditions, has become a constitutional right. Quebec physicians are now likely to receive requests for MAID from their patients. The Quebec and Canadian laws recognize a physician’s (...) right to conscientious objection, but this right is contested both in the medical ethics literature and in the public sphere. This paper presents the results of a qualitative study conducted with twenty Quebec physicians who did not integrate MAID into their medical practice, either because they were opposed to or deeply ambivalent about MAID. The interviews aimed to explore the reasons – religious and secular – for opposition to or ambivalence towards MAID. The secular reasons given by participants were grouped into four main categories: 1) the ends of medicine and professional identity, 2) the philosophy of palliative medicine and resource allocation in palliative care, 3) benevolent paternalism, the “good death”, and the interests of future selves, 4) the risk of a slippery slope and the protection of vulnerable people. (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)

This is part of a symposium on conscientious objection and religious freedom inspired by the US Catholic Church's claim that being forced to pay for health insurance that covers abortions (the effect of 'Obamacare')is the equivalent of forcing pacifists to fight. This article takes issue with this claim, and shows that while it would be unjust on democratic principles to force pacifists to fight, given their willingness to serve their country in other ways, there is no democratic (...) class='Hi'>objection to forcing those who believe abortion to be murder to pay for health insurance coverage that includes abortion. (shrink)

In a recent article in this journal, Abram Brummett argues that new and future assisted reproductive technologies will provide challenging ethical questions relating to lesbian, gay, bisexual and transgender (LGBT) persons. Brummett notes that it is likely that some clinicians may wish to conscientiously object to offering assisted reproductive technologies to LGBT couples on moral or religious grounds, and argues that such appeals to conscience should be constrained. We argue that Brummett's case is unsuccessful because he: does not adequately interact (...) with his opponents’ views; equivocates on the meaning of ‘natural’; fails to show that the practice he opposes is eugenic in any non‐trivial sense; and fails to justify and explicate the relevance of the naturalism he proposes. We do not argue that conscience protections should exist for those objecting to providing LGBT people with artificial reproductive technologies, but only show that Brummett's arguments are insufficient to prove that they should not. (shrink)

Religion is often singled out for special legal treatment in Western societies - which raises an important question: what, if anything, is special about religious conscience beliefs that warrants such special legal treatment? In this paper, I will offer an answer to this specialness question by investigating the relationship between religious conscientious objections and their insulation from relevant evidence. I will begin my analysis by looking at Brian Leiter’s arguments that religious beliefs are insulated from evidence and not worthy (...) of special legal treatment as a result. I will argue that he fails to show that religious conscience beliefs are both in principle responsive to empirical evidence and in practice typically more insulated from this evidence than secular conscience beliefs. If I am right about this, then Leiter fails to answer the “central puzzle” of his recent book and fails to sufficiently distinguish the religious conscience from the secular conscience. Second, I will look at whether or not it is plausible to understand the religious conscience as insulated from other forms of evidence. Following the research of social-psychologist Jonathan Haidt, I will argue that, typically, both forms of conscience seem to be similarly insulated from moral argumentation. I will also show that, while it seems as though the religious conscience usually draws from a larger set of moral values when compared to the secular conscience, this should make no legal difference overall. To conclude, I will explain that the arguments in this paper can be understood as evidence in support of an egalitarian response to religion’s specialness. (shrink)

In her paper, “The cost of conscience: Kant on conscience and conscientious objection,” Jeanette Kennett argues that a Kantian view of conscientious objection in medicine would bar physicians from refusing to perform certain practices based on conscience. I offer a response in the following manner: First, I reconstruct her main argument; second, I present a more accurate picture of Kant’s view of conscience. I conclude that, given a Kantian framework, a physician should be allowed to refuse (...) to perform practices that break the moral law and, thus, refuse practices that violate her conscience. (shrink)

According to the common view, conscientious objection is grounded in autonomy or in ‘freedom of conscience’ and is tolerated out of respect for the objector's autonomy. Emphasising freedom of conscience or autonomy as a central concept within the issue of conscientious objection implies that the conscientious objector should have an independent choice among alternative beliefs, positions or values. In this paper it is argued that: (a) it is not true that the typical conscientious objector (...) has such a choice when they decide to act upon their conscience and (b) it is not true that the typical conscientious objector exercises autonomy when developing or acquiring their conscience. Therefore, with regard to tolerating conscientious objection, we should apply the concept of autonomy with caution, as tolerating conscientious objection does not reflect respect for the conscientious objector’s right to choose but rather acknowledges their lack of real ability to choose their conscience and to refrain from acting upon their conscience. This has both normative and analytical implications for the treatment of conscientious objectors. (shrink)

The debate regarding the role of conscientious objection in healthcare has been protracted, with increasing demands for curbs on conscientious objection. There is a growing body of evidence that indicates that in some cases, high rates of conscientious objection can affect access to legal medical services such as abortion—a major concern of critics of conscientious objection. Moreover, few solutions have been put forward that aim to satisfy both this concern and that of (...) defenders of conscientious objection—being expected to participate in the provision of services that compromise their moral integrity. Here we attempt to bring some resolution to the debate by proposing a pragmatic, long-term solution offering what we believe to be an acceptable compromise—a quota system for medical trainees in specialties where a conscientious objection can be exercised, and is known to cause conflict. We envisage two main objectives of the quota system we propose. First, as a means to introduce conscientious objection into countries where this is not presently permitted. Second, to minimise or eliminate the effects of high rates of conscientious objection in countries such as Italy, where access to legal abortion provision can be negatively affected. (shrink)

Bioethics, Volume 36, Issue 1, Page 63-70, January 2022.

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 the agent’s society has endorsed different norms. In particular, I argue that when a medical professional is reasoning from the standpoint of an impartial spectator, his or her claims of conscience are true, or at least approximate moral truth to the greatest degree possible for creatures like us, and should thus be respected. In addition to providing a justification for conscientious objection in medicine by appealing to the potential truth of the objection, the account advances the debate regarding the integrity and toleration justifications for conscientious objection, since the standard of the impartial spectator specifies the boundaries of legitimate appeals to moral integrity and toleration. The impartial spectator also provides a standpoint of shared deliberation and public reasons, from which a conscientious objector can make their case in terms that other people who adopt this standpoint can and should accept, thus offering a standard fitting to liberal democracies. (shrink)

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 a dubitable claim to be medically beneficial, is rarely clinically indicated, and that conscientious objections should be accepted in these circumstances. We also show that reliance on personal beliefs is difficult to avoid if any form of objection is to be permitted, even if it is based on criteria such as the principles and values of the profession or the scope of professional practice. (shrink)

This study argues for the historical existence of Jesus of Nazareth as a radical Jewish pacifist who angered both the orthodox religious establishment and those who advocated violent insurrection against the Romans. The author asserts that Jesus' views were based on belief in a non-retributive, omnibenevolent God, challenging not only the Mosaic Law but assumptions about eternal punishment and the divine sanction of the state and its retributive institutions of war and punishment. The volume also interprets Paul as being the (...) first Christian revisionist. As a result, orthodox Christianity, through the influence of Paul (and thus Augustine, Aquinas, Luther, and Calvin), has mistakenly promoted the "just war" and "divinely ordained state" doctrines in the name of a thinker whose conclusions were in the opposite direction. (shrink)

Bioethics, Volume 36, Issue 1, Page 54-62, January 2022.

Emergency contraception — also known as the morning after pill — is marketed and sold, under various brand names, in over one hundred countries around the world. In some countries, customers can purchase the drug without a prescription. In others, a prescription must be presented to a licensed pharmacist. In virtually all of these countries, pharmacists are the last link in the chain of delivery. This article examines and ultimately rejects several standard moves in the bioethics literature on the right (...) of pharmacists conscientiously to refuse to dispense emergency contraception. Its central thesis is that the standard ‘moderate’ solution to this problem is mistaken. Thus, when all publicly relevant interests are given their due, it is not acceptable to allow refusals in the big city, where pharmacies are plentiful, but forbid them in rural settings, where pharmacies are scarce. Rather, there should be strong public policy requiring that all pharmacists dispense emergency contraception to customers who request it, regardless of pharmacists' moral or religious objections. (shrink)

A model policy for conscientious objection in medicine.

The controversy around the accommodation of conscientious objections in medicine persists, especially for such contentious services as abortions. COs are typically considered in their negativ...

Currently, the preferred accommodation for conscientious objection to abortion in medicine is to allow the objector to refuse to accede to the patient’s request so long as the objector refers the patient to a physician who performs abortions. The referral part of this arrangement is controversial, however. Pro-life advocates claim that referrals make objectors complicit in the performance of acts that they, the objectors, find morally offensive. McLeod argues that the referral requirement is justifiable, although not in the (...) way that people usually assume. (shrink)

In this paper, we argue that providers who conscientiously refuse to provide legal and professionally accepted medical care are not always morally required to refer their patients to willing providers. Indeed, we will argue that refusing to refer is morally admirable in certain instances. In making the case, we show that belief in a sweeping moral duty to refer depends on an implicit assumption that the procedures sanctioned by legal and professional norms are ethically permissible. Focusing on examples of female (...) genital cutting, clitoridectomy and ‘normalizing’ surgery for children with intersex traits, we argue that this assumption is untenable and that providers are not morally required to refer when refusing to perform genuinely unethical procedures. The fact that acceptance of our thesis would force us to face the challenge of distinguishing between ethical and unethical medical practices is a virtue. This is the central task of medical ethics, and we must confront it rather than evade it. There are no data in this work. (shrink)

Some philosophers have argued for what I call the reason-giving requirement for conscientious refusal in reproductive healthcare. According to this requirement, healthcare practitioners who conscientiously object to administering standard forms of treatment must have arguments to back up their conscience, arguments that are purely public in character. I argue that such a requirement, though attractive in some ways, faces an overlooked epistemic problem: it is either too easy or too difficult to satisfy in standard cases. I close by briefly (...) considering whether a version of the reason-giving requirement can be salvaged despite this important difficulty. (shrink)

Lawrence Nelson (2018) criticizes conscientious objection (CO) to abortion statutes as far as they permit health care providers to escape criminal liability for what would otherwise be the legally wrongful taking of a pregnant woman’s life by refusing treatment (i.e. abortion). His key argument refers to the U.S. Supreme Court judgment (Roe v. Wade 1973) that does not treat the unborn as constitutional persons under the Fourteenth Amendment. Therefore, Nelson claims that within the U.S. legal system any vital (...) interests of pregnant women must always take precedence over fetuses’ interests. While agreeing with the main thesis of the article, we believe that the author’s argument neither vindicates his claim, nor explains why those who believe that fetuses are equally protectable human beings do not have the right to refuse to perform an abortion in lifethreatening emergency circumstances (AE). Therefore, the main aim of our commentary is to outline, by referring to our earlier works on conscientious objection in health care (Z_ uradzki 2016) and cultural exemptions (Ciszewski 2016), a better and universalizable argumentative path that would lead to the same conclusion. (shrink)

In this article, I address what kinds of claims are of the right kind to ground conscientious refusals. Specifically, I investigate what conceptions of moral responsibility and moral wrongness can be permissibly presumed by conscientious objectors. I argue that we must permit HCPs to come to their own subjective conclusions about what they take to be morally wrong and what they take themselves to be morally responsible for. However, these subjective assessments of wrongness and responsibility must be constrained (...) in several important ways: they cannot involve empirical falsehoods, objectionably discriminatory attitudes, or unreasonable normative beliefs. I argue that the sources of these constraints are the basic epistemic, relational, and normative competencies needed to function as a minimally decent health-care professional. Finally, I consider practical implications for my framework, and argue that it shows us that the objection raised by the plaintiffs in Zubik v. Burwell is of the wrong sort. (shrink)

While there is a prolific debate surrounding the issue of conscientious objection of individuals towards performing certain clinical acts, this debate ignores the fact that there are other reasons why clinicians might wish to object providing specific services. This paper briefly discusses the idea that healthcare workers might object to providing specific services because they are against their professional judgement, they want to maintain a specific reputation, or they have pragmatic reasons. Reputation here is not simply understood as (...) being in good standing with a professional body. Rather, reputation is treated in the sense that a craftsman might wish to be known for providing a specific type, quality, and style of service. Professionalism is understood as acting according to the philosophical and scientific principles that are the basis of healthcare (such as acting for the benefit of the patient’s health and following well- evidenced treatment pathways). (shrink)

This essay offers a revisionist defense of classical utilitarianism from an infamous objection to it, which is derived from American science fiction writer, Ursula Le Guin’s, short story, “The Ones Who Walk Away from Omelas.” To that effect, the reply takes inspiration from Le Guin and John Stuart Mill in appealing to the natural law theoretical concept of conscience. I argue that a conscientious utilitarian ethic can escape Le Guin’s objection more satisfactorily than other popular utilitarian ethics. (...) Along the way, this essay discusses at length conscience and its place in moral epistemology, both as it occurs in the natural law tradition and in Mill. The natural law account of conscience is defended and Mill’s account is critiqued. Consequently, this paper also provides an interesting synthesis of utilitarianism with natural law ethics. (shrink)

Conscientious Sociology is an introductory but essential step towards the recognition of paradigmatic contestations and shifts in the post-1970s Social Sciences. It develops an ideal typology of three major paradigms, i.e. the Foundationalist, the Relativist and the Critical-Conscientious Paradigms by discussing and comparing their principles in four Meta-Theoretical domains: Ontology, Epistemology, Methodology, and Axiology. Hosseini, in his book, shows how the Conscientious paradigm deals with well known dilemmas which are not effectively resolved by two other paradigms; dilemmas (...) like how to create an objective account of reality whereas the subjectivities of actors and investigators are accommodated or what relationship must be set up between quantitative and qualitative methods. The book also further discusses the principles that Conscientious sociologist are expected to consider when engaging in empirical research. It finally, provides its readers with a unique perspective adopted from a radical Iranian social thinker, Ali Shariati whose ideas are portrayed as an insightful exemplar for Iranian critical sociologists. The book also contributes to the growing debates around the nature and future of critical sociology in the West by adding a Southern perspective. (shrink)

I defend the feasibility of a medical conscience in the following sense: a medical professional can object to the prevailing medical norms because they are incorrect as medical norms. In other words, I provide an account of conscientious objection that makes use of the idea that the conscience can issue true normative claims, but the claims in question are claims about medical norms rather than about general moral norms. I further argue that in order for this line of (...) reasoning to succeed, there needs to be an internal morality of medicine that determines what medical professionals ought to do qua medical professionals. I utilize a constructivist approach to the internal morality of medicine and argue that medical professionals can conscientiously object to providing treatment X, if providing treatment X is not in accordance with norms that would have been constructed, in light of the end of medicine, by the appropriate agents under the appropriate conditions. (shrink)

I will argue that physicians have an ethical obligation to justify their conscientious objection and the most reliable interpretation of the Polish legal framework claims that conscientious objection is permissible only when the justification shows the genuineness of the judgment of conscience that is not based on false beliefs and arises from a moral norm that has a high rank. I will demonstrate that the dogma accepted in the Polish doctrine that the reasons that lie behind (...) conscientious objection in medicine cannot be evaluated or controlled by anyone is based either on a mistaken interpretation of the Constitution or on the unreliable concept of conscience. I will refer to the legal regulations concerning military refusals that require from objectors to reveal and justify their views. Finally, I will demonstrate why conscientious objection under uncertainty does not deserve acceptance, because it is based on a specific version of the precautionary principle. (shrink)

The double subjectivity of conscience and the need to test conscientious objections -/- Abstract In spite of the collapse of the traditional objective concept of conscience and the subsequent subjectivation of conscience, conscientious objections are still often considered as a valid ground for exemption from legal and professional obligations. Conscientious objections are seen as more serious than ordinary moral objections. It is not evident why this is so. I argue, with Niklas Luhmann, that the function of conscience (...) is to protect the moral core of a person’s identity. Overruling conscientious objections threatens this core. Claims of conscience are usually founded on the right of freedom of conscience. This right is not absolute. I discuss the view of Richard Arneson who rejects the right of freedom of conscience and defends the right against conscience. I agree with Arneson that, at the one hand, conscientious objectors may constitute a threat to the social and legal order when their objections are not recognised and, at the other hand, too easy giving in to conscientious objections may also threaten the viability of social and legal order. That is why it is needed to determine when conscientious objections cannot be taken at face value, but should be subjected to a series of tests. The aim of these tests is to contain the number of objectors. I discuss 6 criteria for determining whether conscientious objections ground an exemption to legal and professional obligations. At the end of the article I discuss the conscientious objections of medical doctors. (shrink)

To date, both the United States federal government and twenty-one individual states have passed Religious Freedom Restoration Acts that aim to protect religious persons from having their sincere beliefs substantially burdened by governmental interests. RFRAs accomplish this by offering a three-pronged exemption test for religious objectors that is satisfied only when (1) an objector has a sincere belief that is being substantially burdened; (2) the government has a very good reason (e.g., health or safety) to interfere; and (3) there is (...) a reasonable alternative to serve the compelling interest. Legal balancing tests like those found in RFRA are content neutral insofar as they sideline the belief-content of conscientious objections as irrelevant when determining the permissibility of granting legal accommodations. However, some theorists worry that this legal picture may be backward: perhaps balancing tests should be content non-neutral given the usual features of conscientious objections. For example, Yossi Nehushtan contends that, contrary to their typical codification, religious conscience beliefs seem undeserving of special legal accommodations because they possess uniquely strong empirical and theoretical ties to intolerance. Thus, the illiberally intolerant content of these conscientious objections might actually give the state a reason to refuse to grant legal exemptions. In this paper, I offer a cursory defense of content neutrality with respect to balancing tests like those found in RFRA. To begin, I outline Nehushtan’s argument for content non-neutrality. The cornerstone of his argument is that illiberal intolerance is intolerable such that conscientious objections that are based upon illiberally intolerant values provide the state with strong, normally prevailing reason not to grant an exemption. I argue that, even when the illiberally intolerant content of one’s conscience constitutes a weighty and relevant factor in determining the permissibility of granting a legal exemption, there remain significant problems. It is difficult, for example, to determine which views are illiberally intolerant and difficult to say whether illiberally intolerant views can effectively serve as the principled demarcating line in balancing tests. To conclude, I offer several cursory arguments in favor of adopting content-neutral approaches without necessarily making a comprehensive case. By drawing on the work of Amy Sepinwall, Nadia Sawicki, and Nathan Chapman, I show that content-neutral approaches can help to safeguard robust protections for conscience by permitting atypical exercises of conscience, protect minority thoughts and practices from being coercively supplanted by majoritarian understandings of morality, appropriately maintain the skepticism and humility that we owe each other as compatriots in a pluralistic society, and allow the kind of justifiable civil disobedience that has an important place in political history among other things. (shrink)

In contemporary positive law there are legal institutions, such as conscientious objection in the context of military service or “conscience clauses” in medical law, which for the sake of respect for judgments of conscience aim at restricting legal obligations. Such restrictions are postulated to protect human freedom in general. On the basis of Thomas Aquinas’ philosophy, it shall be argued that human dignity, understood as the existential perfection of a human being based on special unity, provides a foundation (...) for imposing limitations on the scope of legal obligations in general. Human freedom plays a crucial role in understanding dignity as perfection based on the special individuality of a personal being, which in turn is based on the free choice to pursue a unique way of life. Therefore, Aquinas’ argumentation is, at its core, liberal – the perfection rather than the imperfection of a human being underlies the requirement to limit legal obligations. Dignity understood as the special unity of a person also provides the basis for limiting obligations in the case of conscientious objection; however, in that case, such limitations aim at safeguarding internal integrity rather than the individualisation of a given way of life. _This project was financed with funds from the National Science Centre allocated on the basis of the decision number DEC-2013/09/B/HS5/04232._. (shrink)

Contra Michael Walzer and Jeff McMahan, neither classical just war theory nor the contemporary rules of war require or support any notion of combatant moral equality. Nations rightly accept prohibitions against punishing enemy combatants without recognizing any legal or moral right of aggressors to kill. The notion of combatant moral equality has real import only in our interpersonal -- and intrapersonal -- attitudes, since the notion effectively preempts any ground for conscientious objection. Walzer is criticized for over-emphasizing our (...) collective responses to war conduct and slighting our personal, extra-political responses. (shrink)

Society typically shows conscientious objectors more deference than civil disobedients, on the grounds that they appear more conscientious and less strategically minded than the latter. Kimberley Brownlee challenges this standard picture in Conscience and Conviction: The Case for Civil Disobedience, where she claims that civil disobedience is more conscientious than conscientious objection, in virtue of its communicativeness. Brownlee conceives of conscientious conviction as necessarily communicative, and distinguishes it from ‘conscience’—the set of practical moral skills (...) involved in adequately responding to complex situations. This review article argues that Brownlee’s account of conviction is too narrow, as it excludes many core beliefs which we would want to classify as convictions although they violate one or more of the criteria of communicativeness, while her account of conscience is incomplete, because it ignores some of the persistent obstacles for the development of conscience produced by structural injustice. The article identifies these obstacles and offers some strategies for protecting against them, namely, vigilance, self-scrutiny, empathy and collaborative ambivalence. (shrink)

The “principle of double effect” is a vital tool for moral decision making and is applicable to all areas of medical practice, including (for example) end-of-life care, transplant medicine, and cases of conscientious objection. Both our ultimate and our more immediate intentions are relevant in making and evaluating choices— though side effects must be kept proportionate and can be morally conclusive when linked with some intentions. Intentions help to form the character of doctors, and of human beings generally. (...) While hypocrisy is certainly possible in regard to this form (and other forms) of moral reasoning, double effect reasoning, sincerely practised, remains indispensable in identifying moral problems and solutions. (shrink)

*Runner-up for the 2021 Royal Institute for Philosophy Essay Prize*: What should we think about ‘acts of conscience’, viz., cases where our personal judgments and public authority come into conflict such that principled resistance to the latter seems necessary? Philosophers mainly debate two issues: the Accommodation Question, i.e., ‘When, if ever, should public authority accommodate claims of conscience?’ and the Justification Question, i.e., ‘When, if ever, are we justified in engaging in acts of conscience – and why?’. By contrast, a (...) third important topic – the Conduct Question, i.e., ‘How should we act, morally speaking, when engaging in acts of conscience?’ – has been mostly neglected. This paper aims to offer concrete guidance for persons wishing to engage in acts of conscience in morally virtuous ways. I argue that such agents are subject to two basic prima facie duties: duties to oneself related to demands of integrity and duties to others related to demands of civility. I explain both duties in detail, arguing with regard to, that in light of what I call ‘the paradox of conscience’, we need to rethink our views about both ‘conscience’ and ‘integrity’; and with regard to, that, building upon Rawls’ ‘duty of civility’, we should embrace at least seven general principles for undertaking acts of conscience in a morally conscientious manner. (shrink)

Some bioethicists argue that conscientious objectors in health care should have to justify themselves, just as objectors in the military do. They should have to provide reasons that explain why they should be exempt from offering the services that they find offensive. There are two versions of this view in the literature, each giving different standards of justification. We show these views are each either too permissive (i.e. would result in problematic exemptions based on conscience) or too restrictive (i.e. (...) would produce problematic denials of exemption). We then develop a middle ground position that we believe better combines respect for the conscience of healthcare professionals with concern for the duties that they owe to patients. Our claim, in short, is that insofar as objectors should have to justify themselves, they should have to do it according to the standard that we defend rather than according to the standards that others have developed. (shrink)

In 2019, several US states passed “heartbeat” bills. Should such bills go into effect, they would outlaw abortion once an embryonic heartbeat can be detected, thereby severely limiting an individual’s access to abortion. Many states allow health care professionals to refuse to provide an abortion for reasons of conscience. Yet heartbeat bills do not include a positive conscience clause that would allow health care professionals to provide an abortion for reasons of conscience. I argue that this asymmetry is unjustified. The (...) same criteria that justify protecting conscientious refusals to provide abortion also justify protecting positive conscientious appeals regarding abortion. Thus, if the law provides legal exemptions for health care professionals who, as a matter of conscience, refuse to provide abortions where it is legal, it should also provide exemptions for health care professionals who, as a matter of conscience, feel obligated to provide abortions where it is illegal. (shrink)

„Skoro powszechnie przyjmuje się, że sumienie jest suwerenne, to nie wiadomo, po co lekarz miałby uzasadniać pisemnie swój światopogląd” – napisała Naczelna Izba Lekarska w skardze do Trybunału Konstytucyjnego. Trybunał tę część skargi oddalił w wyroku z 7 października 2015 r., ale stwierdził, że „Celem prowadzenia dokumentacji medycznej nie jest (…) utrwalanie na piśmie poglądów filozoficzno-prawnych lekarza”. Uznał też, że uzasadnienie „powinno mieć charakter medyczny, a nie służyć wyjaśnieniu światopoglądu lekarza, czy też wskazaniu zasady moralnej leżącej u podstaw jego zachowania”. (...) Podobną interpretację akceptuje wielu polskich prawników, twierdząc, że skoro sumienie czy światopogląd lekarza są „indywidualne”, „autonomiczne”, „suwerenne”, to merytoryczne powody odmowy wykonania świadczenia medycznego nie mogą podlegać jakiejkolwiek ocenie i kontroli. (shrink)

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)

A review of Holly Fernandez Lynch's book Conflicts of Conscience in Medicine (MIT Press, 2008).

This chapter reviews fundamental ethical controversy surrounding the ongoing effort to revise the Uniform Determination of Death Act in the United States. Instead of focusing on the process of the revision itself, the chapter explores the underlying ethical debate over brain death that has been ongoing for many decades and finally culminated in this revision. Three issues are focused: the requirement for consent and personal exemptions before applying brain death for the diagnosis of death; redefining the areas of the brain (...) that have ceased to function in the definition of brain death; and codifying the American Academy of Neurology as the authority to issue the standards of the diagnosis of brain death. The chapter concludes that allowing the personal choice of death determination gives a pragmatic compromise to the disputed definition and practice of diagnosing brain death. So long as all risks and imperfections of the diagnosis are accepted through the consenting process, there is nothing ethically objectionable to continuing the current practice of diagnosing brain death as a successful tool to facilitate heart-beating organ donation without violating the dead-donor rule. By contrast, precluding personal choice and imposing legal restrictions to consent and exemptions would further erode public trust. (shrink)

Is there is a moral obligation to militarily intervene in another state to stop a genocide from happening (if this can be done with proportionate force)? My answer is that under exceptional circumstances a state or even a non-state actor might have a duty to stop a genocide (for example if these actors have promised to do so), but under most circumstances there is no such obligation. To wit, “humanity,” states, collectives, and individuals do not have an obligation to make (...) such promises in the first place or to create institutions that would impose a legal obligation of intervention upon them. Nor do states or persons or humanity “collectively” have – originally, without specifically creating such duties by contracts or promises – any pro tanto or special duties to save strangers at considerable cost to themselves or their own citizens (including their soldiers). That is, these costs do not merely override a duty to intervene, but rather there is no such duty to begin with – as shown by the fact that in such cases of non-intervention agents would not owe those they let die any compensation: if I do not save someone’s life because saving him would have cost me my arm or would have come with a high risk of losing my own life or would have forced me to kill innocent bystanders, I do not owe this person compensation. Thus the point of this chapter is that there is no “natural” or “general” or “original” duty to militarily intervene (or to create a legal obligation) to stop a genocide. I will consider and refute a number of arguments to the contrary, for example by Lango, Tan, and Pattison. (shrink)

There are numerous ways in which “the particular”—particular individuals, particular ideologies, values, beliefs, and perspectives—are sometimes overlooked, ignored, or even driven out of the healthcare profession. In many such cases, this is bad for patients, practitioners, and the profession. Hence, we should seek to find a place for the particular in health care. Specific topics that I examine in this essay include distribution of health care based on the particular needs of patients, the importance of protecting physicians’ right to (...) class='Hi'>conscientious objection, the value in tolerating a plurality of moral and medical perspectives within the field, and more. Ultimately, as the imagery in the essay’s title suggests, I argue that if one cares about the “well-being” of the medical profession, then one should seek to avoid destroying the many diverse and particular entities that constitute it. (shrink)

This article contributes to the debate concerning the identification of politically relevant cases of corruption in a democracy by sketching the basic traits of an original liberal theory of institutional corruption. We define this form of corruption as a deviation with respect to the role entrusted to people occupying certain institutional positions, which are crucial for the implementation of public rules, for private gain. In order to illustrate the damages that corrupt behaviour makes to liberal democratic institutions, we discuss the (...) case of health care professionals’ abuse of their right to conscientious objection to abortion services. We show that the conscience clause can be instrumentally abused to sabotage democratically established public rules and thus exert undue private influence on their implementation. In this sense, from a liberal democratic perspective, institutional corruption is problematic because it is disruptive of such fundamental liberal ideals as the impartiality of public institutions and citizens’ political equality. (shrink)

This paper analyses the arguments for and against what we have called automatic organ procurement model in relation to the organs of the deceased. For this purpose, this work provides empirical evidence to assess the potential impact of this model on donation rates and on public opinion. Specifically, we examine first the reasons supporting this model, with special reference to utilitarian and justice arguments. On the other hand, we analyse both the approaches based on the violation of pre mortem and (...) post mortem interests opposing this theoretical model and the rejection the model would generate in the population. Finally, we point out the aspects that, in our opinion, should be exhaustively regulated if this model were implemented. In particular, we refer to the legal status of the human body, the treatments for end-of-life patients, the incentives for health professionals and the recognition of the right to conscientious objection. (shrink)

Euthanasia and the duty to die have both been thoroughly discussed in the field of bioethics as morally justifiable practices within medical healthcare contexts. The existence of a narrow connection between both could also be established, for people having a duty to die should be allowed to actively hasten their death by the active means offered by euthanasia. Choosing the right time to end one’s own life is a decisive factor to retain autonomy at the end of our lives. However, (...) there is no definitive consensus on why physicians should be the ones performing the medical procedure to end a person’s life. The moral problems arising from such assertion are not to be taken lightly, for medical tradition has long regarded the duty not to kill, not to actively end a patient’s life, as the core moral obligation that gives meaning to the medical profession. Our concern is to question the moral justifiability of the arguments offered by physicians not to actively help patients die. (shrink)

In the United States, all military personnel swear to obey “the orders of the President of the United States and the orders of the officers appointed over me.” Military personnel must obey orders promptly in order to facilitate effective military functioning. Yet, obedience to orders has been associated with the commission of war crimes. Military personnel of all ranks have committed torture, rape, genocide, and murder under orders. “I was just following orders” (respondaet superior) is no longer accepted as a (...) complete defense to a charge of war crimes. In the words of the Nuremberg court: “The obedience of a soldier is not the obedience of an automaton. A soldier is a reasoning agent”. This means that military personnel cannot evade responsibility for their actions under orders. But when and under what conditions should military personnel disobey orders? If obedience is sometimes morally wrong, how can obedience be a military virtue? In this chapter I argue that the only plausible conception of military obedience as a virtue is reflective obedience: obedience governed and constrained by the ends of the military profession serving a legitimate state and by the laws of armed conflict. Section 1 explains the concept of obedience and outlines the idea of virtuous obedience. Section 2 explores when the military has legitimate authority to compel obedience. Section 3 concludes by exploring the limits on obedience that derive from the military’s status as a profession and the legitimacy of the military’s authority to issue orders. (shrink)

A prominent way of justifying civil disobedience is to postulate a pro tanto duty to obey the law and to argue that the considerations that ground this duty sometimes justify forms of civil disobedience. However, this view entails that certain kinds of uncivil disobedience are also justified. Thus, either a) civil disobedience is never justified or b) uncivil disobedience is sometimes justified. Since a) is implausible, we should accept b). I respond to the objection that this ignores the fact (...) that civil disobedience enjoys a special normative status on account of instantiating certain special features: nonviolence, publicity, the acceptance of legal consequences, and conscientiousness. I then show that my view is superior to two rivals: the view that we should expand the notion of civility and that civil disobedience, expansively construed, is uniquely appropriate; and the view that uncivil disobedience is justifiable in but only in unfavorable conditions. (shrink)

According to a recent account of epistemic authority proposed by Linda Zagzebski (2012), it is rational for laypersons to believe on authority when they conscientiously judge that the authority is more likely to form true beliefs and avoid false ones than they are in some domain. Christoph Jäger (2016) has recently raised several objections to her view. By contrast, I argue that both theories fail to adequately capture what epistemic authority is, and I offer an alternative account grounded in the (...) abilities that different kinds of authorities are required to possess. (shrink)