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Remember Evil: Remaining Assumptions In Autonomy-based Accounts Of Conscience Protection


Discussions of the proper role of conscience and practitioner judgement within medicine have increased of late, and with good reason. The cost of allowing practitioners the space to exercise their best judgement and act according to their conscience is significant. Misuse of such protections carve out societal space in which abuse, discrimination, abandonment of patients, and simple malpractice might occur. These concerns are offered amid a backdrop of increased societal polarization and are about a profession (or set of professions) which has historically fought for such privileged space. There is a great deal that has been and might yet be said about these topics, but in this paper I aim to address one recent thread of this discussion: justification of conscience protection rooted in autonomy. In particular, I respond to an argument from Greenblum and Kasperbaur (2018) and clarify a critique I offered (2016) of an autonomy-based conscience protection argument which Greenblum and Kasperbaur seek to improve and defend. To this end, I briefly recap the central contention of that argument, briefly describe Greenblum and Kasperbaur’s analysis of autonomy and of my critique, and correct what appears to be a mistake in interpretation of both my work and of autonomy-based defenses of conscience protection in general.

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    There I described this as requiring an impoverished view of the moral life.

  2. 2.

    Elsewhere, I describe this as the consistency approach, given that Aulisio and Arora seek a degree of consistency in treatment of the patient and the practitioner.

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    For one discussion of this, see Stahl and Emanuel (2017).

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    See Greenblum and Kasperbaur (2018, 316, footnote 4).

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    They note, following Cook and Dickens (2006), that a practitioner could change her beliefs. Though this phrasing suggesting a fairly unsophisticated account of moral conversion, even if this is granted, mechanisms could be put in place to allow for changes in disclosure and general referrals that might alleviate concerns here.


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Correspondence to Bryan C. Pilkington.

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Pilkington, B.C. Remember Evil: Remaining Assumptions In Autonomy-based Accounts Of Conscience Protection. Bioethical Inquiry 16, 483–488 (2019).

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  • Conscientious objection
  • Autonomy
  • Duty to refer
  • Practitioner judgement