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)

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)

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)

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)

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)

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)

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)

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)

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 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)

Goodman draws together, in this memoir, his explorations of meaning and coincidence, and his lived experiences of chance, and his professional experiences teaching, writing, and consulting about risk. The book opens by describing the author's life-changing encounter with a Zen Buddhist monk in 1977, over a cup of tea. Returning to his beginnings, Goodman recounts his coming-of-age, from participating the 1960’s U.S. protests and Vietnam-War resistance, to finally settling down in Canada. He describes his role in a supporting, silent vigil (...) around Willard Straight Hall at Cornell University, the night after it had been occupied by protestors, and his later application for Conscientious Objector status, following the U.S. draft lottery in 1969. He reflects on the challenges and changes on his road taken, in his career and personal relationships, and in spiritual searches, to share some insights about the seamless nature of chance, and about seeing a Both/And perspective in life that encourages openness to possibilities. -/- . (shrink)

Ernesto Genoni (1885-1975) pioneered biodynamic agriculture in Australia. In 1928 he was the first of (ultimately) twelve Australians to join Rudolf Steiner’s Experimental Circle of Anthroposophical Farmers and Gardeners (ECAFG) which was based at the Goetheanum, Dornach, Switzerland. Ernesto trained as an artist for five years at Milan’s prestigious Brera Academy. He visited his brothers in Australia, broad-acre immigrant farmers in Western Australia, in 1912 and 1914 and during these visits he worked on their, and other’s, farms. In 1916 he (...) enlisted in the Australian Imperial Force (AIF) and served as a stretcher bearer on the battlefields of the Somme, France, before being conscripted into the Italian Army and serving jail-time in Italy as a draft resister and conscientious objector. Ernesto joined the Anthroposophical Society in Milan in 1919. He first met Rudolf Steiner in 1920 at the Goetheanum, the Anthroposophy headquarters in Switzerland. Ernesto left the Goetheanum in 1924 when Steiner retired from public life. He migrated to Australia in 1926 with aspirations for establishing a career as an artist in Australia. Instead, having arrived in Australia, he was again drawn into farm management and agricultural work. Ernesto was a champion for biodynamic agriculture, Anthroposophy, and the Austrian New Age philosopher, Rudolf Steiner - causes to which he devoted the rest of his life. In 1928 he initiated the first Anthroposophy meetings in Melbourne. In 1930 Ernesto made a grand tour of biodynamic enterprises in Europe and met the leading biodynamics advocates and practitioners of the day in Germany, Switzerland and England, including Ehrenfried Pfeiffer, Erika Riese, Ernst Stegemann, and Carl Mirbt. In 1935 Ernesto and his partner, Ileen Macpherson, who was also an anthroposophist and a member of the ECAFG, began their biodynamic farm called Demeter Biological Farm in Dandenong, Victoria. Ernesto was a founder of the Anthroposophical Society Victoria Michael Group in 1932, and he became its leader in 1962. (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)

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)

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)

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)

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 objection to (...) forcing those who believe abortion to be murder to pay for health insurance coverage that includes abortion. (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)

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 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)

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 this paper I uncover and critically analyze a methodological assumption in the literature on conscientious refusals in health care. The assumption is what I call the “Priority of Conscience Principle,” which says the following: to determine the moral status of any act of conscientious refusal, it is first necessary to determine the nature and value of conscience. I argue that it is not always necessary to discuss conscience in the debate on conscientious refusals, and that discussing (...) conscience is even problematic, since it can lead authors to beg the question. (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.

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 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)

A model policy for conscientious objection in medicine.

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)

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)

The aim of this paper is to offer a critical assessment of Buridan's proposed solution to the bridge-keeper paradox. First, I will outline his proposed solution to the paradox, and, second, carefully analyse each issue mentioned in the proposed solution. Finally, I will attempt to conclude that Burden has implicitly accepted a three-valued logic that does not allow him to conclude that Plato ought not do anything.

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)

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...

Abstract: Purpose - This study aimed to analyze the relationship between the determinants of organizational justice and their relationship to conscientious behavior from the point of view of officers working in the Palestinian police in Gaza Strip. Methodology - The study relied on the descriptive and analytical approach, using the questionnaire, targeting a stratified random sample of (400) officers, who hold the rank of captain and above, from the study population of 1550 officers. The study tool was distributed among (...) the sample members in all departments and governorates. Police in Gaza Strip. (353) questionnaires were retrieved, with a recovery rate of (88.3%). Findings - The existence of a positive correlation between the determinants of organizational justice and the behavior of conscience, and the existence of organizational justice in general in a medium degree and the order of its determinants is as follows: fairness of dealings and to a large degree, followed by fairness of procedures and a medium degree, and finally distribution fairness was to a small degree, while the behavior of conscience awareness came to a large extent. Significance - The existence of statistically significant differences between the respondents' averages of responding to the searched relationship due to the variables (type of administration, age group, job title, military rank, years of service). Recommendations - Work to take into account the fairness of distribution by providing adequate and fair salaries, granting bonuses for the additional efforts exerted, and budgeting in the distribution of duties and job burdens, as well as recommending attention to the interests of employees when making decisions and involving them in formulating them, explaining their justifications, and creating an organizational climate dominated by a sense of justice. (shrink)

Moral objections have been levied against the market system for as long as it has existed, but there has been relatively little systematic theorizing about what the requirements of a successful objection are. There are at least two strategies for constructing such a requirement. One strategy is to endorse one of the many moral or political theories on offer. But given persistent contestation over the right moral theory, any requirement produced by this strategy will likely be controversial. A second strategy (...) circumvents this problem, and has been pursued in recent work by Jaeggi (2016), Brennan & Jaworski (2022), and Robson (2023a; 2023b). These authors propose requirements which do not depend on any particular moral or political theory. In this paper, I evaluate these proposed requirements, rejecting most on the grounds that they are either too restrictive or unsystematic. (shrink)

Philosophical Issues, Volume 31, Issue 1, Page 85-103, October 2021.

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)

This paper addresses the likely impact on women of being denied emergency contraception (EC) by pharmacists who conscientiously refuse to provide it. A common view—defended by Elizabeth Fenton and Loren Lomasky, among others—is that these refusals inconvenience rather than harm women so long as the women can easily get EC somewhere else nearby. I argue from a feminist perspective that the refusals harm women even when they can easily get EC somewhere else nearby.

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)

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 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)

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)

*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)

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)

Conceptual engineering projects are sometimes criticized for ‘changing the subject’. In this paper, I first discuss three strategies that have been proposed to address the change of subject objection. I notice that these strategies fail in similar ways: they all deploy a ‘loose’ notion of subject matter, while the objector can always reply deploying a ‘strict’ notion. Based on this, I then argue that at least current formulations of the change of subject objection (together with the response strategies just mentioned), (...) create an overall defective dialectic, whereby no progress can be made on either side. After considering how such defective dialectic could be (at least partly) fixed, it is concluded that current formulations of the change of subject objection may be dismissed on dialectical grounds, even though some practical lessons may still be retained from the objection. (shrink)