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Abortion and Conscience Protections
Published in Christopher Kaczor, The Ethics of Abortion, 2023
Much is at stake in the debate about conscience, as the true story makes clear. What is conscience? Although some understand conscience as a feeling or instinct, what I mean by conscience, or the act of conscience, is the agent's best-reasoned judgment about whether or not to perform an action, reasoning which should be informed by careful consideration of moral truth and relevant circumstances. An action does not become morally right simply because it is done in accordance with conscience. Considered objectively as an action, to torture and murder an innocent person is always wrong. If someone's conscience compels him or her to torture and murder another person, it is difficult to avoid the conclusion that such an agent has voluntarily suppressed knowledge that they can and ought to know. Such voluntary culpable ignorance does not excuse an action that is morally wrong. Such a voluntarily ignorant agent is therefore guilty both of not properly informing his conscience and of harming and killing a person, the negative consequence that follows directly from his lack of due care in finding out what is truly just. Agents always have moral obligations to obey their consciences, and agents always also have a moral obligation to properly inform their consciences.
The inescapability of conscience in primary healthcare
Published in Andrew Papanikitas, John Spicer, Handbook of Primary Care Ethics, 2017
The source of conflict based on conscience lies in the values and beliefs that are held by the clinician, the profession, the state and the patient or patient’s representative. This represents somewhat more complex power struggle than the one between medical profession, civil society and the state.29 Arguments have been made that doctors (but by extension, any clinicians) with a conscientious objection to something the state has agreed to provide should be made to submit to behavioural therapy30 or removed from practice.1 This is problematic, because conscience represents a way in which unethical practices, some of which are based on unsound beliefs, may be identified and resisted. Better understanding is needed however of conscience, what it is, and the benefits and burdens that it carries. The features of conscience that are epistemological (related to belief itself) rather than moral require greater public understanding. That understanding should not be focused on one type of case such as abortion, if the case is not to eclipse the broader understanding that is possible. There is much scope for conscience to be a part of reflection in education, and there is no reason why conscience should be inextricably linked with a theistic religion. Indeed, unless the beliefs and values (whatever their source) of clinician, patient, profession and state are somehow always in perfect alignment, conscience and conscientious objection are inescapable features of clinical practice.
Implementing person-centred health care
Published in Stephen Buetow, Person-centred Health Care, 2016
For people to learn, for example, how to value moral equality and develop the virtue of justice, they can draw on experience of having suffered in some way, such as from personal experience of inequality. Such experience indicates moral sensitivity that can elicit strong emotions, especially those consistently and firmly validated in the social milieu. These emotions can motivate persons to feel, reason and act in ways that validate their feelings and intuitions.45,46 The more powerfully that people experience inequality as intuitively incompatible with a good life – as something repulsive that educates and pricks their conscience and especially their sense of vulnerability – the less likely they are to turn away from inequality. If the felt threat of inequality is strong enough, they will be moved not only to value equality strongly but also to practise deliberately their learnt skills to achieve it. Reinforcement of this value over time can lead them to cultivate the virtue of justice – to become fair persons who resist inequality within the constraints of their capabilities. A catalyst for change here is a developed conscience that wills persons to do what they deeply sense is morally right. Conscience is not infallible but, from an obligation to form one’s conscience correctly,47 person-centred health care requires exceptional circumstances before compelling people to act against their conscience.48
Do Clinicians Have a Duty to Participate in Pragmatic Clinical Trials?
Published in The American Journal of Bioethics, 2023
Andrew Garland, Stephanie Morain, Jeremy Sugarman
Refusals to participate might also arise from individual objections to the research. These objections can take several forms. The most morally fraught is conscientious objection, which as a matter of ongoing debate deserves special attention. To some, conscientious objection is incompatible with professional duties (Giubilini 2014; Hughes 2018; Savulescu 2006; Savulescu and Schuklenk 2018). When the medical profession has judged that an intervention is a valid component of appropriate care, then a clinician who refuses to provide that care is failing a professional duty. Qualms of conscience—the argument goes—are not good enough to excuse this failure. Being a member of the profession permits exercise of professional judgment, but conscientious objections illegitimately imply private constraints on medical care. To be clear, this distinction depends on whether assertions of conscience are moral claims, rather than professional judgments couched in moralized terms. As noted above, clinicians typically think they are morally obliged to provide high-quality care, so knowingly providing bad care is morally bad. Yet there is a difference between making a professional judgment about the quality of care and having a moral objection to the care itself. For example, physicians who refuse to perform abortions typically do not argue that abortions are contra-indicated, but that they are morally wrong.
Medical Disobedience and the Conscientious Provision of Prohibited Care
Published in The American Journal of Bioethics, 2021
Conscience often refers to an individual’s beliefs about right and wrong that are central to her identity and character: who she is and what she stands for, when it comes down to it. Having moral integrity means living according to these core convictions. Conscience looms large in ethically fraught professions like health care. Before the U.S. Supreme Court legalized abortion nationwide in 1973, some doctors who’d seen self-induced or back-alley abortions kill patients said their conscientious commitment to the equal dignity of women or to compassionate care for the desperate and vulnerable compelled them to provide unlawful procedures at risk of losing their license or going to jail (Joffe 1995). But medical conscience has been tied to religious conservativism ever since the backlash against Roe v. Wade. That’s when many states passed laws insulating practitioners who refuse to perform abortions on the ground that it would contravene their faith in the sanctity of life.
Conscience Clauses and Ideological Bias
Published in The American Journal of Bioethics, 2021
Conscience clauses typically protect health care providers who cannot in good conscience provide a legal, professionally accepted, and clinically appropriate medical service (negative appeals to conscience) but offer no protection to health care providers who cannot in good conscience comply with a legal or institutional rule or policy that prohibits them from providing a medical service (positive appeals to conscience). This difference in the treatment of negative and positive appeals to conscience evidences an asymmetry in conscience clauses. Kyle Fritz offers one example of this asymmetry (Fritz 2021): Whereas conscience clauses typically protect providers who cannot in good conscience perform abortions, laws that prohibit abortions after a heartbeat is detectable (heartbeat statutes) do not exempt providers who cannot in good conscience comply because compliance would prevent them from fulfilling their perceived moral and professional obligations to their patients.1