Hostname: page-component-cd9895bd7-lnqnp Total loading time: 0 Render date: 2024-12-22T23:38:54.087Z Has data issue: false hasContentIssue false
  • English
  • Français

My Conscience May Be My Guide, but You May Not Need to Honor It

Published online by Cambridge University Press:  05 April 2016

HUGH LAFOLLETTE
Get access Rights & Permissions [Opens in a new window]

Abstract:

A number of healthcare 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. 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. Finally, there are compelling reasons why we could not implement a consistent policy giving advocates what they want, likely not even in qualified form.

Keywords

consciencerights of conscienceprofessional responsibilitiesvulnerabilityrespect
Type
Special Section: Conscientious Objection in Healthcare: Problems and Perspectives
Information
Cambridge Quarterly of Healthcare Ethics , Volume 26 , Issue 1 , January 2017 , pp. 44 - 58
Copyright
Copyright © Cambridge University Press 2016 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Notes

1. 42 U.S.C. §300a-7.

2. Existing protection of conscience laws. The Protection of Conscience Project; British Columbia, Canada; 2015; available at http://www.consciencelaws.org/law.aspx (last accessed 12 July 2015).

3. Grinberg E, Hassan C. Muslim flight attendant says she was suspended for refusing to serve alcohol. CNN 2015 (updated 6 Sept); available at http://www.cnn.com/2015/09/05/travel/muslim-flight-attendant-feat/ (last accessed 8 Sept 2015).

4. Lawrence, RE, Curlin, FA. Clash of definitions: Controversies about conscience in medicine. The American Journal of Bioethics 2007 Dec 17;7(12):10–14.CrossRefGoogle Scholar

5. Raz, J. Authority, law and morality. The Monist 1985;68(3):295–324.CrossRefGoogle Scholar

6. Nagel, T. The View from Nowhere. New York: Oxford University Press; 1986.Google Scholar

7. Lipton, RJ. Nazi Doctors: Medical Killing and the Psychology of Genocide. New York: Perseus; 2000.Google Scholar

8. Jones, JH. Bad Blood: The Tuskegee Syphilis Experiment. Revised and expanded ed. New York: Free Press; 1993.Google Scholar

9. 50 SE 2nd 735 (I949) and at I99 US 306, 3I8 (I905).

10. Quill, T. Death and dignity: A case of individualized decision making. New England Journal of Medicine 1991;324:691–4.CrossRefGoogle ScholarPubMed

11. Kelly, EI. Publicity. In: LaFollette, H, ed. International Encyclopedia of Ethics. Malden, MA: Blackwell; 2013.Google Scholar

12. Hayek, FA. The Road to Serfdom: Text and Documents: The Definitive Edition. Chicago: The University of Chicago Press 2014.Google Scholar

13. Kahneman, D. Thinking, Fast and Slow. New York: Macmillan; 2011.Google Scholar

14. Burton, RA. On Being Certain: Believing You Are Right Even When You’re Not. New York: St. Martin’s; 2009.Google Scholar

15. Loving v. Virginia, 388 U.S. 1 (1967).

16. Doris, JM. Talking to Our Selves: Reflection, Ignorance, and Agency. Oxford: Oxford University Press; 2015.CrossRefGoogle ScholarPubMed

17. Dunning, D. Self-Insight: Roadblocks and Detours on the Path to Knowing Thyself. New York: Psychology Press; 2005.CrossRefGoogle Scholar

18. Pronin, E. The introspection illusion. Advances in Experimental Social Psychology 2009;41:1–67.CrossRefGoogle Scholar

19. Pronin, E, Kugler, MB. Valuing thoughts, ignoring behavior: The introspection illusion as a source of the bias blind spot. Journal of Experimental Social Psychology 2007;43(4):565–78.CrossRefGoogle Scholar

20. Mill, JS. On Liberty. Indianapolis, IN: Hackett; 1985/1885: 17.Google Scholar

21. Wicclair, MR. Conscientious Objection in Health Care: An Ethical Analysis. Cambridge: Cambridge University Press; 2011.CrossRefGoogle Scholar

22. See note 21, Wicclair 2011.

23. Pharmacist’s model conscience clause. Pharmacists for Life; 1988; available at http://www.pfli.org/main.php?pfli=modelpharmacistcc (last accessed 2 Nov 2005).

24. Why a conscience clause is a must . . . NOW! Pharmacists for Life; 2005; available at http://www.pfli.org/main.php?pfli=conscienceclausefaq (last accessed 2 Nov 2005). Also see note 23, Pharmacist’s model conscience clause 1988.

25. Brock, DW. Conscientious refusal by physicians and pharmacists: Who is obligated to do what, and why? Theoretical Medicine and Bioethics 2008;29(3):187–200.CrossRefGoogle Scholar Also see note 21, Wicclair 2011.

26. See note 21, Wicclair 2011.

27. Curlin, FA, Lawrence, RE, Chin, MH, Lantos, JD. Religion, conscience, and controversial clinical practices. New England Journal of Medicine 2007;356(6):593–600.CrossRefGoogle ScholarPubMed

28. Murphy S. Referral: A false compromise. The Protection of Conscience Project [serial on the Internet]; 2010; available at http://www.consciencelaws.org/ethics/ethics012.aspx. Also see note 24, Why a conscience clause is a must . . . NOW! 2005, and note 27, Curlin et al. 2007.

29. Combs, MP, Antiel, RM, Tilburt, JC, Mueller, PS, Curlin, FA. Conscientious refusals to refer: Findings from a national physician survey. Journal of Medical Ethics 2011 July 1;37(7):397–401.CrossRefGoogle Scholar Also see note 27, Curlin et al. 2007, and note 28, Murphy 2010.

30. Meyers, C, Woods, RD. Conscientious objection? Yes, but make sure it is genuine. American Journal of Bioethics 2007;7(6):19–20.CrossRefGoogle ScholarPubMed