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.
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.
For one discussion of this, see Stahl and Emanuel (2017).
See Greenblum and Kasperbaur (2018, 316, footnote 4).
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.
Aulisio, M.P., and K.S. Arora. 2014. Speak no evil? Conscience and the duty to inform, refer or transfer care. Healthcare Ethics Committee Forum 26(3): 257–266.
Buchanan, A. 2009. Is there a medical profession in the house? In Justice and healthcare: Selected essays, 175–202. Oxford: Oxford University Press.
Cook, R.J., and B. Dickens. 2006. The growing abuse of conscientious objection. AMA Journal of Ethics Virtual Mentor 8(5): 337–340.
Greenblum, J., and T.J. Kasperbaur. 2018. Forget evil: Autonomy, the physician–patient relationship, and the duty to refer. Journal of Bioethical Inquiry 15(3): 313–317.
Hayek, F. 1973. Rules and order. Volume 1 of Law, legislation, and liberty. Chicago, IL. University of Chicago Press.
Pilkington, B.C. 2016. Do no evil: Unnoticed assumptions in accounts of conscience protection. Healthcare Ethics Committee Forum 28(1): 1–10.
Rawls, J. 2003. Political liberalism, expanded edition. New York: Columbia University Press.
———. 1999. A theory of justice, revised edition. Cambridge, MA: Belknap Press of Harvard University Press.
Savulescu, J. 2006. Conscientious objection in medicine. BMJ 332(7536): 294–297.
Stahl, R., and E. Emanuel. 2017. Physicians—not conscripts. Conscientious objection in health care. New England Journal of Medicine 376(14): 1380–1385.
Starr, P. 1982. The social transformation of American medicine. New York: Basic Books.
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Pilkington, B.C. Remember Evil: Remaining Assumptions In Autonomy-based Accounts Of Conscience Protection. Bioethical Inquiry 16, 483–488 (2019). https://doi.org/10.1007/s11673-019-09949-7
- Conscientious objection
- Duty to refer
- Practitioner judgement